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Global injury morbidity and mortality from 1990 to 2017: results from the Global Burden of Disease Study 2017
  1. Spencer L James 1,
  2. Chris D Castle 1,
  3. Zachary V Dingels 1,
  4. Jack T Fox 1,
  5. Erin B Hamilton 1,
  6. Zichen Liu 1,
  7. Nicholas L S Roberts1,
  8. Dillon O Sylte 1,
  9. Nathaniel J Henry 1,
  10. Kate E LeGrand 1,
  11. Ahmed Abdelalim 2,
  12. Amir Abdoli 3,
  13. Ibrahim Abdollahpour 4,
  14. Rizwan Suliankatchi Abdulkader 5,
  15. Aidin Abedi 6,
  16. Akine Eshete Abosetugn 7,
  17. Abdelrahman I Abushouk 8,
  18. Oladimeji M Adebayo 9,
  19. Marcela Agudelo-Botero 10,
  20. Tauseef Ahmad 11,12,
  21. Rushdia Ahmed 13,14,
  22. Muktar Beshir Ahmed 15,
  23. Miloud Taki Eddine Aichour16,
  24. Fares Alahdab 17,
  25. Genet Melak Alamene 18,
  26. Fahad Mashhour Alanezi 19,
  27. Animut Alebel 20,
  28. Niguse Meles Alema 21,
  29. Suliman A Alghnam 22,
  30. Samar Al-Hajj 23,24,
  31. Beriwan Abdulqadir Ali 25,26,
  32. Saqib Ali 27,
  33. Mahtab Alikhani 28,
  34. Cyrus Alinia 29,
  35. Vahid Alipour 30,31,
  36. Syed Mohamed Aljunid 32,33,
  37. Amir Almasi-Hashiani 34,
  38. Nihad A Almasri 35,
  39. Khalid Altirkawi 36,
  40. Yasser Sami Abdeldayem Amer37,38,
  41. Saeed Amini 39,
  42. Arianna Maever Loreche Amit40,41,
  43. Catalina Liliana Andrei 42,
  44. Alireza Ansari-Moghaddam 43,
  45. Carl Abelardo T Antonio44,45,
  46. Seth Christopher Yaw Appiah46,47,
  47. Jalal Arabloo 30,
  48. Morteza Arab-Zozani 48,
  49. Zohreh Arefi 49,
  50. Olatunde Aremu 50,
  51. Filippo Ariani 51,
  52. Amit Arora 52,53,
  53. Malke Asaad 54,
  54. Babak Asghari 55,
  55. Nefsu Awoke 56,
  56. Beatriz Paulina Ayala Quintanilla57,58,
  57. Getinet Ayano 59,
  58. Martin Amogre Ayanore 60,
  59. Samad Azari 30,
  60. Ghasem Azarian 61,
  61. Alaa Badawi 62,63,
  62. Ashish D Badiye 64,
  63. Eleni Bagli 65,66,
  64. Atif Amin Baig 67,68,
  65. Mohan Bairwa 69,70,
  66. Ahad Bakhtiari 71,
  67. Arun Balachandran 72,73,
  68. Maciej Banach 74,75,
  69. Srikanta K Banerjee 76,
  70. Palash Chandra Banik 77,
  71. Amrit Banstola 78,
  72. Suzanne Lyn Barker-Collo 79,
  73. Till Winfried Bärnighausen 80,81,
  74. Lope H Barrero 82,
  75. Akbar Barzegar 83,
  76. Mohsen Bayati 84,
  77. Bayisa Abdissa Baye 85,
  78. Neeraj Bedi 86,87,
  79. Masoud Behzadifar 88,
  80. Tariku Tesfaye Bekuma 89,
  81. Habte Belete 90,
  82. Corina Benjet 91,
  83. Derrick A Bennett 92,
  84. Isabela M Bensenor 93,
  85. Kidanemaryam Berhe 94,
  86. Pankaj Bhardwaj 95,96,
  87. Anusha Ganapati Bhat 97,
  88. Krittika Bhattacharyya 98,99,
  89. Sadia Bibi 100,
  90. Ali Bijani 101,
  91. Muhammad Shahdaat Bin Sayeed102,103,
  92. Guilherme Borges 91,
  93. Antonio Maria Borzì104,
  94. Soufiane Boufous 105,
  95. Alexandra Brazinova 106,
  96. Nikolay Ivanovich Briko 107,
  97. Shyam S Budhathoki 108,
  98. Josip Car 109,110,
  99. Rosario Cárdenas111,
  100. Félix Carvalho 112,
  101. João Mauricio Castaldelli-Maia 113,
  102. Carlos A Castañeda-Orjuela114,115,
  103. Giulio Castelpietra 116,117,
  104. Ferrán Catalá-López118,119,
  105. Ester Cerin 120,121,
  106. Joht S Chandan 122,
  107. Wagaye Fentahun Chanie 123,
  108. Soosanna Kumary Chattu 124,
  109. Vijay Kumar Chattu 125,
  110. Irini Chatziralli 126,127,
  111. Neha Chaudhary 128,129,
  112. Daniel Youngwhan Cho 130,
  113. Mohiuddin Ahsanul Kabir Chowdhury131,132,
  114. Dinh-Toi Chu 133,
  115. Samantha M Colquhoun 134,
  116. Maria-Magdalena Constantin 135,136,
  117. Vera M Costa 112,
  118. Giovanni Damiani 137,138,
  119. Ahmad Daryani 139,
  120. Claudio Alberto Dávila-Cervantes 140,
  121. Feleke Mekonnen Demeke 141,
  122. Asmamaw Bizuneh Demis 142,143,
  123. Gebre Teklemariam Demoz 144,145,
  124. Desalegn Getnet Demsie 21,
  125. Afshin Derakhshani 146,
  126. Kebede Deribe 147,148,
  127. Rupak Desai 149,
  128. Mostafa Dianati Nasab 150,
  129. Diana Dias da Silva151,
  130. Zahra Sadat Dibaji Forooshani152,
  131. Kerrie E Doyle 153,
  132. Tim Robert Driscoll 154,
  133. Eleonora Dubljanin 155,
  134. Bereket Duko Adema 156,157,
  135. Arielle Wilder Eagan 158,159,
  136. Aziz Eftekhari 160,161,
  137. Elham Ehsani-Chimeh 162,
  138. Maysaa El Sayed Zaki163,
  139. Demelash Abewa Elemineh 164,
  140. Shaimaa I El-Jaafary 2,
  141. Ziad El-Khatib 165,166,
  142. Christian Lycke Ellingsen 167,168,
  143. Mohammad Hassan Emamian 169,
  144. Daniel Adane Endalew 170,
  145. Sharareh Eskandarieh 171,
  146. Pawan Sirwan Faris 172,173,
  147. Andre Faro 174,
  148. Farshad Farzadfar 175,
  149. Yousef Fatahi 176,
  150. Wubalem Fekadu 90,177,
  151. Tomas Y Ferede 178,
  152. Seyed-Mohammad Fereshtehnejad 179,180,
  153. Eduarda Fernandes 181,
  154. Pietro Ferrara 182,
  155. Garumma Tolu Feyissa 183,
  156. Irina Filip 184,185,
  157. Florian Fischer 186,
  158. Morenike Oluwatoyin Folayan 187,
  159. Masoud Foroutan 188,
  160. Joel Msafiri Francis 189,
  161. Richard Charles Franklin 190,191,
  162. Takeshi Fukumoto 192,193,
  163. Biniyam Sahiledengle Geberemariyam 194,
  164. Abadi Kahsu Gebre 195,
  165. Ketema Bizuwork Gebremedhin 196,
  166. Gebreamlak Gebremedhn Gebremeskel 197,198,
  167. Berhe Gebremichael 199,
  168. Getnet Azeze Gedefaw 200,201,
  169. Birhanu Geta 202,
  170. Mansour Ghafourifard 203,
  171. Farhad Ghamari 204,
  172. Ahmad Ghashghaee 205,
  173. Asadollah Gholamian 206,207,
  174. Tiffany K Gill 208,
  175. Alessandra C Goulart 93,209,
  176. Ayman Grada 210,
  177. Michal Grivna 211,
  178. Mohammed Ibrahim Mohialdeen Gubari212,
  179. Rafael Alves Guimarães213,
  180. Yuming Guo 214,215,
  181. Gaurav Gupta 216,
  182. Juanita A Haagsma 217,
  183. Nima Hafezi-Nejad 218,219,
  184. Hassan Haghparast Bidgoli 220,
  185. Brian James Hall 221,
  186. Randah R Hamadeh 222,
  187. Samer Hamidi 223,
  188. Josep Maria Haro 224,225,
  189. Md Mehedi Hasan 226,
  190. Amir Hasanzadeh 227,228,
  191. Soheil Hassanipour 229,
  192. Hadi Hassankhani 230,231,
  193. Hamid Yimam Hassen 232,233,
  194. Rasmus Havmoeller 234,
  195. Khezar Hayat 235,236,
  196. Delia Hendrie 59,
  197. Fatemeh Heydarpour 237,
  198. Martha Híjar238,239,
  199. Hung Chak Ho 240,
  200. Chi Linh Hoang 241,
  201. Michael K Hole 242,
  202. Ramesh Holla 243,
  203. Naznin Hossain 244,245,
  204. Mehdi Hosseinzadeh 246,247,
  205. Sorin Hostiuc 248,249,
  206. Guoqing Hu 250,
  207. Segun Emmanuel Ibitoye 251,
  208. Olayinka Stephen Ilesanmi 252,
  209. Irena Ilic 155,
  210. Milena D Ilic 253,
  211. Leeberk Raja Inbaraj 254,
  212. Endang Indriasih 255,
  213. Seyed Sina Naghibi Irvani256,
  214. Sheikh Mohammed Shariful Islam257,258,
  215. M Mofizul Islam 259,
  216. Rebecca Q Ivers 260,
  217. Kathryn H Jacobsen 261,
  218. Mohammad Ali Jahani 262,
  219. Nader Jahanmehr 263,264,
  220. Mihajlo Jakovljevic 265,
  221. Farzad Jalilian 266,
  222. Sudha Jayaraman 267,
  223. Achala Upendra Jayatilleke 268,269,
  224. Ravi Prakash Jha 270,
  225. Yetunde O John-Akinola 251,
  226. Jost B Jonas 271,272,
  227. Nitin Joseph 273,
  228. Farahnaz Joukar 229,
  229. Jacek Jerzy Jozwiak 274,
  230. Suresh Banayya Jungari 275,
  231. Mikk Jürisson276,
  232. Ali Kabir 277,
  233. Rajendra Kadel 278,
  234. Amaha Kahsay 94,
  235. Leila R Kalankesh279,
  236. Rohollah Kalhor 280,281,
  237. Teshome Abegaz Kamil 282,
  238. Tanuj Kanchan 283,
  239. Neeti Kapoor 64,
  240. Manoochehr Karami 284,
  241. Amir Kasaeian 285,286,
  242. Hagazi Gebremedhin Kassaye 21,
  243. Taras Kavetskyy 287,288,
  244. Hafte Kahsay Kebede 289,
  245. Peter Njenga Keiyoro 290,
  246. Abraham Getachew Kelbore 291,
  247. Bayew Kelkay 292,
  248. Yousef Saleh Khader 293,
  249. Morteza Abdullatif Khafaie 294,
  250. Nauman Khalid 295,
  251. Ibrahim A Khalil 296,
  252. Rovshan Khalilov 297,
  253. Mohammad Khammarnia 298,
  254. Ejaz Ahmad Khan 299,
  255. Maseer Khan 300,
  256. Tripti Khanna 301,302,
  257. Habibolah Khazaie 303,
  258. Fatemeh Khosravi Shadmani 304,
  259. Roba Khundkar 305,
  260. Daniel N Kiirithio 306,
  261. Young-Eun Kim 307,
  262. Daniel Kim 308,
  263. Yun Jin Kim 309,
  264. Adnan Kisa 310,
  265. Sezer Kisa 311,
  266. Hamidreza Komaki 312,313,
  267. Shivakumar K M Kondlahalli314,
  268. Vladimir Andreevich Korshunov 107,
  269. Ai Koyanagi 315,316,
  270. Moritz U G Kraemer317,318,
  271. Kewal Krishan 319,
  272. Burcu Kucuk Bicer 320,321,
  273. Nuworza Kugbey 322,323,
  274. Vivek Kumar 324,
  275. Nithin Kumar 273,
  276. G Anil Kumar 325,
  277. Manasi Kumar 326,327,
  278. Girikumar Kumaresh 328,
  279. Om P Kurmi 327,329,
  280. Oluwatosin Kuti 330,
  281. Carlo La Vecchia 331,
  282. Faris Hasan Lami 332,
  283. Prabhat Lamichhane 333,
  284. Justin J Lang 334,
  285. Van C Lansingh 335,336,
  286. Dennis Odai Laryea 337,
  287. Savita Lasrado 338,
  288. Arman Latifi 339,
  289. Paolo Lauriola 340,
  290. Janet L Leasher 341,
  291. Shaun Wen Huey Lee342,343,
  292. Tsegaye Lolaso Lenjebo 344,
  293. Miriam Levi 51,345,
  294. Shanshan Li 214,
  295. Shai Linn 346,
  296. Xuefeng Liu 347,
  297. Alan D Lopez 1,348,349,
  298. Paulo A Lotufo 350,
  299. Raimundas Lunevicius 351,352,
  300. Ronan A Lyons 353,
  301. Mohammed Madadin 354,
  302. Muhammed Magdy Abd El Razek355,
  303. Narayan Bahadur Mahotra 356,
  304. Marek Majdan 357,
  305. Azeem Majeed 358,
  306. Jeadran N Malagon-Rojas 359,360,
  307. Venkatesh Maled 361,362,
  308. Reza Malekzadeh 363,364,
  309. Deborah Carvalho Malta 365,
  310. Navid Manafi 366,367,
  311. Amir Manafi 368,
  312. Ana-Laura Manda 369,
  313. Narayana Manjunatha 370,
  314. Fariborz Mansour-Ghanaei 229,
  315. Borhan Mansouri 371,
  316. Mohammad Ali Mansournia 372,
  317. Joemer C Maravilla 373,
  318. Lyn M March 374,
  319. Amanda J Mason-Jones 375,
  320. Seyedeh Zahra Masoumi 376,
  321. Benjamin Ballard Massenburg 130,
  322. Pallab K Maulik 377,378,
  323. Gebrekiros Gebremichael Meles 379,
  324. Addisu Melese 141,
  325. Zeleke Aschalew Melketsedik 380,
  326. Peter T N Memiah381,
  327. Walter Mendoza 382,
  328. Ritesh G Menezes 383,
  329. Meresa Berwo Mengesha 384,
  330. Melkamu Merid Mengesha 385,
  331. Tuomo J Meretoja 386,387,
  332. Atte Meretoja 388,389,
  333. Hayimro Edemealem Merie 164,
  334. Tomislav Mestrovic 390,391,
  335. Bartosz Miazgowski 392,
  336. Tomasz Miazgowski 393,
  337. Ted R Miller 59,394,
  338. GK Mini 395,396,
  339. Andreea Mirica 397,398,
  340. Erkin M Mirrakhimov 399,400,
  341. Mehdi Mirzaei-Alavijeh 266,
  342. Prasanna Mithra 273,
  343. Babak Moazen 401,402,
  344. Masoud Moghadaszadeh 403,404,
  345. Efat Mohamadi 405,
  346. Yousef Mohammad 406,
  347. Karzan Abdulmuhsin Mohammad 407,408,
  348. Aso Mohammad Darwesh 409,
  349. Naser Mohammad Gholi Mezerji410,
  350. Abdollah Mohammadian-Hafshejani 411,
  351. Milad Mohammadoo-Khorasani 412,
  352. Reza Mohammadpourhodki 413,
  353. Shafiu Mohammed 80,414,
  354. Jemal Abdu Mohammed 415,
  355. Farnam Mohebi 175,416,
  356. Mariam Molokhia 417,
  357. Lorenzo Monasta 418,
  358. Yoshan Moodley 419,
  359. Mahmood Moosazadeh 420,
  360. Masoud Moradi 421,
  361. Ghobad Moradi 422,423,
  362. Maziar Moradi-Lakeh 424,
  363. Farhad Moradpour 422,
  364. Lidia Morawska 425,
  365. Ilais Moreno Velásquez 426,
  366. Naho Morisaki 427,
  367. Shane Douglas Morrison 130,
  368. Tilahun Belete Mossie 90,
  369. Atalay Goshu Muluneh 428,
  370. Srinivas Murthy 429,
  371. Kamarul Imran Musa 430,
  372. Ghulam Mustafa 431,432,
  373. Ashraf F Nabhan 433,434,
  374. Ahamarshan Jayaraman Nagarajan 435,436,
  375. Gurudatta Naik 437,
  376. Mukhammad David Naimzada 438,439,
  377. Farid Najafi 440,
  378. Vinay Nangia 441,
  379. Bruno Ramos Nascimento 442,
  380. Morteza Naserbakht 424,443,
  381. Vinod Nayak 444,
  382. Duduzile Edith Ndwandwe 445,
  383. Ionut Negoi 446,447,
  384. Josephine W Ngunjiri 448,
  385. Cuong Tat Nguyen 449,
  386. Huong Lan Thi Nguyen449,
  387. Rajan Nikbakhsh 450,451,
  388. Dina Nur Anggraini Ningrum452,453,
  389. Chukwudi A Nnaji 445,454,
  390. Peter S Nyasulu 455,
  391. Felix Akpojene Ogbo 112,
  392. Onome Bright Oghenetega 456,
  393. In-Hwan Oh 457,
  394. Emmanuel Wandera Okunga 458,
  395. Andrew T Olagunju 459,460,
  396. Tinuke O Olagunju 461,
  397. Ahmed Omar Bali 462,
  398. Obinna E Onwujekwe 463,
  399. Kwaku Oppong Asante 464,465,
  400. Heather M Orpana 466,467,
  401. Erika Ota 468,
  402. Nikita Otstavnov 438,469,
  403. Stanislav S Otstavnov 438,470,
  404. Mahesh P A 471,
  405. Jagadish Rao Padubidri 472,
  406. Smita Pakhale 473,
  407. Keyvan Pakshir 474,
  408. Songhomitra Panda-Jonas 475,
  409. Eun-Kee Park 476,
  410. Sangram Kishor Patel 477,478,
  411. Ashish Pathak 165,479,
  412. Sanghamitra Pati 480,
  413. George C Patton 481,482,
  414. Kebreab Paulos 483,
  415. Amy E Peden 191,484,
  416. Veincent Christian Filipino Pepito485,
  417. Jeevan Pereira 486,
  418. Hai Quang Pham 449,
  419. Michael R Phillips 487,488,
  420. Marina Pinheiro 489,
  421. Roman V Polibin 490,
  422. Suzanne Polinder 217,
  423. Hossein Poustchi 363,
  424. Swayam Prakash 491,
  425. Dimas Ria Angga Pribadi492,
  426. Parul Puri 493,
  427. Zahiruddin Quazi Syed 96,
  428. Mohammad Rabiee 494,
  429. Navid Rabiee 495,
  430. Amir Radfar 496,497,
  431. Anwar Rafay 498,
  432. Ata Rafiee 499,
  433. Alireza Rafiei 500,501,
  434. Fakher Rahim 502,503,
  435. Siavash Rahimi 504,
  436. Vafa Rahimi-Movaghar 505,
  437. Muhammad Aziz Rahman 506,507,
  438. Ali Rajabpour-Sanati 508,
  439. Fatemeh Rajati 421,
  440. Ivo Rakovac 509,
  441. Kavitha Ranganathan 510,
  442. Sowmya J Rao 511,
  443. Vahid Rashedi 512,
  444. Prateek Rastogi 513,
  445. Priya Rathi 514,
  446. Salman Rawaf 358,515,
  447. Lal Rawal 516,
  448. Reza Rawassizadeh 517,
  449. Vishnu Renjith 518,
  450. Andre M N Renzaho519,520,
  451. Serge Resnikoff 521,
  452. Aziz Rezapour 522,
  453. Ana Isabel Ribeiro 523,
  454. Jennifer Rickard 524,525,
  455. Carlos Miguel Rios González 526,527,
  456. Luca Ronfani 418,
  457. Gholamreza Roshandel 363,528,
  458. Anas M Saad 529,
  459. Yogesh Damodar Sabde 530,
  460. Siamak Sabour 531,
  461. Basema Saddik 532,
  462. Saeed Safari 533,
  463. Roya Safari-Faramani 534,
  464. Hamid Safarpour 535,
  465. Mahdi Safdarian 505,536,
  466. S Mohammad Sajadi 537,
  467. Payman Salamati 505,
  468. Farkhonde Salehi 538,
  469. Saleh Salehi Zahabi 539,540,
  470. Marwa R Rashad Salem541,
  471. Hosni Salem 542,
  472. Omar Salman 543,544,
  473. Inbal Salz 545,
  474. Abdallah M Samy 546,
  475. Juan Sanabria 547,548,
  476. Lidia Sanchez Riera 549,550,
  477. Milena M Santric Milicevic551,552,
  478. Abdur Razzaque Sarker 553,
  479. Arash Sarveazad 554,
  480. Brijesh Sathian 555,556,
  481. Monika Sawhney 557,
  482. Susan M Sawyer 558,559,
  483. Sonia Saxena 560,
  484. Mehdi Sayyah 561,
  485. David C Schwebel 562,
  486. Soraya Seedat 563,
  487. Subramanian Senthilkumaran 564,
  488. Sadaf G Sepanlou 363,364,
  489. Seyedmojtaba Seyedmousavi 565,
  490. Feng Sha 566,
  491. Faramarz Shaahmadi 567,
  492. Saeed Shahabi 568,
  493. Masood Ali Shaikh 569,
  494. Mehran Shams-Beyranvand 570,
  495. Morteza Shamsizadeh 571,
  496. Mahdi Sharif-Alhoseini 505,
  497. Hamid Sharifi 572,
  498. Aziz Sheikh 573,574,
  499. Mika Shigematsu 575,
  500. Jae Il Shin 576,577,
  501. Rahman Shiri 578,
  502. Soraya Siabani 579,580,
  503. Inga Dora Sigfusdottir 581,582,
  504. Pankaj Kumar Singh 583,
  505. Jasvinder A Singh 584,585,
  506. Dhirendra Narain Sinha 586,587,
  507. Catalin-Gabriel Smarandache 588,589,
  508. Emma U R Smith590,591,
  509. Amin Soheili 592,593,
  510. Bija Soleymani 237,
  511. Ali Reza Soltanian 594,
  512. Joan B Soriano 595,596,
  513. Muluken Bekele Sorrie 597,
  514. Ireneous N Soyiri 598,599,
  515. Dan J Stein 600,601,
  516. Mark A Stokes 602,
  517. Mu'awiyyah Babale Sufiyan 603,
  518. Hafiz Ansar Rasul Suleria604,
  519. Bryan L Sykes 605,
  520. Rafael Tabarés-Seisdedos606,607,
  521. Karen M Tabb 608,
  522. Biruk Wogayehu Taddele 609,
  523. Degena Bahrey Tadesse 197,610,
  524. Animut Tagele Tamiru 611,
  525. Ingan Ukur Tarigan 255,
  526. Yonatal Mesfin Tefera 612,613,
  527. Arash Tehrani-Banihashemi 424,614,
  528. Merhawi Gebremedhin Tekle 199,
  529. Gebretsadkan Hintsa Tekulu 615,
  530. Ayenew Kassie Tesema616,
  531. Berhe Etsay Tesfay 617,
  532. Rekha Thapar 273,
  533. Asres Bedaso Tilahune 618,
  534. Kenean Getaneh Tlaye 142,
  535. Hamid Reza Tohidinik 372,572,
  536. Roman Topor-Madry 619,620,
  537. Bach Xuan Tran 621,
  538. Khanh Bao Tran 622,623,
  539. Jaya Prasad Tripathy 624,
  540. Alexander C Tsai 625,626,
  541. Lorainne Tudor Car 627,
  542. Saif Ullah 628,
  543. Irfan Ullah 629,630,
  544. Maida Umar 631,
  545. Bhaskaran Unnikrishnan 273,
  546. Era Upadhyay 632,
  547. Olalekan A Uthman 633,
  548. Pascual R Valdez 634,635,
  549. Tommi Juhani Vasankari 636,
  550. Narayanaswamy Venketasubramanian 637,638,
  551. Francesco S Violante 639,640,
  552. Vasily Vlassov 641,
  553. Yasir Waheed 642,
  554. Girmay Teklay Weldesamuel 197,
  555. Andrea Werdecker 643,644,
  556. Taweewat Wiangkham 645,
  557. Haileab Fekadu Wolde 428,
  558. Dawit Habte Woldeyes 646,
  559. Dawit Zewdu Wondafrash 647,648,
  560. Temesgen Gebeyehu Wondmeneh 415,
  561. Adam Belay Wondmieneh 196,649,
  562. Ai-Min Wu 650,
  563. Rajaram Yadav 493,
  564. Ali Yadollahpour 651,
  565. Yuichiro Yano 652,
  566. Sanni Yaya 653,
  567. Vahid Yazdi-Feyzabadi 654,655,
  568. Paul Yip 656,657,
  569. Engida Yisma 658,
  570. Naohiro Yonemoto 659,
  571. Seok-Jun Yoon 307,
  572. Yoosik Youm 660,
  573. Mustafa Z Younis 661,662,
  574. Zabihollah Yousefi 663,664,
  575. Yong Yu 665,
  576. Chuanhua Yu 666,667,
  577. Hasan Yusefzadeh 29,
  578. Telma Zahirian Moghadam 30,668,
  579. Zoubida Zaidi 669,
  580. Sojib Bin Zaman 131,670,
  581. Mohammad Zamani 671,
  582. Maryam Zamanian 34,
  583. Hamed Zandian 668,672,
  584. Ahmad Zarei 673,
  585. Fatemeh Zare 674,
  586. Zhi-Jiang Zhang 675,
  587. Yunquan Zhang 676,677,
  588. Sanjay Zodpey 678,
  589. Lalit Dandona 1,325,349,
  590. Rakhi Dandona 1,325,
  591. Louisa Degenhardt 1,679,
  592. Samath Dhamminda Dharmaratne 1,349,680,
  593. Simon I Hay 1,349,
  594. Ali H Mokdad 1,349,
  595. Robert C Reiner Jr1,349,
  596. Benn Sartorius 349,681,
  597. Theo Vos1,349
  1. 1Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
  2. 2Department of Neurology, Cairo University, Cairo, Egypt
  3. 3Department of Parasitology and Mycology, Jahrom University of Medical Sciences, Jahrom, Iran
  4. 4Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
  5. 5Department of Public Health, Ministry of Health, Riyadh, Saudi Arabia
  6. 6Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
  7. 7Department of Public Health, Debre Berhan University, Debre Berhan, Ethiopia
  8. 8Cardiovascular Medicine, Ain Shams University, Abbasia, Egypt
  9. 9Department of Medicine, University College Hospital, Ibadan, Ibadan, Nigeria
  10. 10School of Medicine Center for Politics, Population and Health Research, National Autonomous University of Mexico, Mexico City, Mexico
  11. 11Department of Epidemiology and Health Statistics, Southeast University Nanjing, Nanjing, China
  12. 12Department of Microbiology, Hazara University Mansehra, Mansehra, Pakistan
  13. 13James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  14. 14Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
  15. 15Department of Epidemiology, Jimma University, Jimma, Ethiopia
  16. 16Higher National School of Veterinary Medicine, Algiers, Algeria
  17. 17Evidence Based Practice Center, Mayo Clinic Foundation for Medical Education and Research, Rochester, MN, USA
  18. 18School of Health Sciences, Madda Walabu University, Bale Goba, Ethiopia
  19. 19Department of Computer Sciences, Imam Abdulrehman Bin Faisal University, Dammam, Saudi Arabia
  20. 20Department of Nursing, Debre Markos University, Debre Markos, Ethiopia
  21. 21Department of Pharmacy, Adigrat University, Adigrat, Ethiopia
  22. 22Department of Population Health Research, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
  23. 23Faculty of Health Sciences - Health Management and Policy, American University of Beirut, Beirut, Lebanon
  24. 24British Columbia Injury Research Prevention Unit, British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
  25. 25Medical Technical Institute, Erbil Polytechnic University, Erbil, Iraq
  26. 26Faculty of Pharmacy, Ishik University, Erbil, Iraq
  27. 27Department of Information Systems, College of Economics and Political Science, Sultan Qaboos University, Muscat, Oman
  28. 28School of Health Management and Information Sciences, Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
  29. 29Department of Health Care Management and Economics, Urmia University of Medical Science, Urmia, Iran
  30. 30Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
  31. 31Health Economics Department, Iran University of Medical Sciences, Tehran, Iran
  32. 32Department of Health Policy and Management, Kuwait University, Safat, Kuwait
  33. 33International Centre for Casemix and Clinical Coding, National University of Malaysia, Bandar Tun Razak, Malaysia
  34. 34Department of Epidemiology, Arak University of Medical Sciences, Arak, Iran
  35. 35Physiotherapy Department, The University of Jordan, Amman, Jordan
  36. 36King Saud University, Riyadh, Saudi Arabia
  37. 37Clinical Practice Guidelines Unit, King Saud University, Riyadh, Saudi Arabia
  38. 38Alexandria Center for Evidence-Based Clinical Practice Guidelines, Alexandria University, Alexandria, Egypt
  39. 39Health Services Management Department, Arak University of Medical Sciences, Arak, Iran
  40. 40Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, Philippines
  41. 41Online Programs for Applied Learning, Johns Hopkins University, Baltimore, MD, USA
  42. 42Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  43. 43Department of Epidemiology and Biostatistics, Health Promotion Research Center, Zahedan, Iran
  44. 44Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
  45. 45Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong, China
  46. 46Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  47. 47Center for International Health, Ludwig Maximilians University, Munich, Germany
  48. 48Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
  49. 49Department of Health Promotion and Education, Tehran University of Medical Sciences, Tehran, Iran
  50. 50School of Health Sciences, Birmingham City University, Birmingham, UK
  51. 51Regional Centre for the Analysis of Data on Occupational and Work-related Injuries and Diseases, Local Health Unit Tuscany Centre, Florence, Italy
  52. 52School of Science and Health, Western Sydney University, Sydney, New South Wales, Australia
  53. 53Oral Health Services, Sydney Local Health District, Sydney, New South Wales, Australia
  54. 54Department of Plastic Surgery, University of Texas, Houston, TX, USA
  55. 55Department of Microbiology, Hamedan University of Medical Sciences, Azad Tabriz University, Iran
  56. 56Department of Nursing, Wolaita Sodo University, Wolaita Sodo, Ethiopia
  57. 57The Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia
  58. 58General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru
  59. 59School of Public Health, Curtin University, Perth, WA, Australia
  60. 60Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana
  61. 61Department of Environmental Health Engineering, Hamadan University of Medical Sciences, Hamadan, Iran
  62. 62Public Health Risk Sciences Division, Public Health Agency of Canada, Toronto, Ontario, Canada
  63. 63Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
  64. 64Department of Forensic Science, Government Institute of Forensic Science, Nagpur, India
  65. 65Department of Ophthalmology, University Hospital of Ioannina, Ioannina, Greece
  66. 66Institute of Molecular Biology & Biotechnology, Foundation for Research & Technology, Ioannina, Greece
  67. 67Biochemistry Unit, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
  68. 68School of Health Sciences, Univeristi Sultan Zainal Abidin, Kuala Terengganu, Malaysia
  69. 69Institute of Health Management Research, Indian Institute of Health Management Research University, Jaipur, India
  70. 70Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
  71. 71Health Policy And Management Department, Tehran University of Medical Sciences, Tehran, Iran
  72. 72Department of Demography, University of Groningen, Groningen, Netherlands
  73. 73Population Research Centre, Institute for Social and Economic Change, Bengaluru, India
  74. 74Department of Hypertension, Medical University of Lodz, Lodz, Poland
  75. 75Polish Mothers’ Memorial Hospital Research Institute, Lodz, Poland
  76. 76School of Health Sciences, Walden University, Minneapolis, MN, USA
  77. 77Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
  78. 78Department of Research, Public Health Perspective Nepal, Pokhara-Lekhnath Metropolitan City, Nepal
  79. 79School of Psychology, University of Auckland, Auckland, New Zealand
  80. 80Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
  81. 81T H Chan School of Public Health, Harvard University, Boston, MA, USA
  82. 82Department of Industrial Engineering, Pontifical Javeriana University, Bogota, Colombia
  83. 83Occupational Health Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
  84. 84Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  85. 85Department of Public Health, Ambo University, Ambo, Ethiopia
  86. 86Department of Community Medicine, Gandhi Medical College Bhopal, Bhopal, India
  87. 87Jazan University, Jazan, Saudi Arabia
  88. 88Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
  89. 89Institute of Health Sciences, School of Public Health, Wollega University, Nekemte, Ethiopia
  90. 90Department of Psychiatry, Bahir Dar University, Bahir Dar, Ethiopia
  91. 91Department of Epidemiology and Psychosocial Reseach, Ramón de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
  92. 92Nuffield Department of Population Health, University of Oxford, Oxford, UK
  93. 93Department of Internal Medicine, University of São Paulo, São Paulo, Brazil
  94. 94Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia
  95. 95Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Jodhpur, India
  96. 96Department of Community Medicine, Datta Meghe Institute of Medical Sciences, Wardha, India
  97. 97Department of Internal Medicine, University of Massachusetts Medical School, Springfield, MA, USA
  98. 98Department of Statistical and Computational Genomics, National Institute of Biomedical Genomics, Kalyani, India
  99. 99Department of Statistics, University of Calcutta, Kolkata, India
  100. 100Institute of Soil and Environmental Sciences, University of Agriculture, Faisalabad, Faisalabad, Pakistan
  101. 101Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
  102. 102National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
  103. 103Department of Clinical Pharmacy and Pharmacology, University of Dhaka, Dhaka, Bangladesh
  104. 104Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
  105. 105Transport and Road Safety (TARS) Research Department, University of New South Wales, Sydney, New South Wales, Australia
  106. 106Institute of Epidemiology, Comenius University, Bratislava, Slovakia
  107. 107Department of Epidemiology and Evidence Based Medicine, I M Sechenov First Moscow State Medical University, Moscow, Russia
  108. 108Research Department, Golden Community, Kathmandu, Nepal
  109. 109Centre for Population Health Sciences, Nanyang Technological University, Singapore
  110. 110Global eHealth Unit, Imperial College London, London, UK
  111. 111Department of Population and Health, Metropolitan Autonomous University, Mexico City, Mexico
  112. 112Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
  113. 113Department of Psychiatry, University of São Paulo, São Paulo, Brazil
  114. 114Colombian National Health Observatory, National Institute of Health, Bogota, Colombia
  115. 115Epidemiology and Public Health Evaluation Group, National University of Colombia, Bogota, Colombia
  116. 116Primary Care Services Area, Central Health Directorate, Region Friuli Venezia Giulia, Trieste, Italy
  117. 117Department of Medicine (DAME), University of Udine, Udine, Italy
  118. 118National School of Public Health, Carlos III Health Institute, Madrid, Spain
  119. 119Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
  120. 120Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
  121. 121School of Public Health, University of Hong Kong, Hong Kong, China
  122. 122Institute of Applied Health Research, University of Birmingham, Birmingham, UK
  123. 123Department of Gynecology and Obstetrics, University of Gondar, Gondar, Ethiopia
  124. 124Department of Public Health, Texila American University, Georgetown, Guyana
  125. 125Department of Medicine, University of Toronto, Toronto, Canada
  126. 1262nd Department of Ophthalmology, University of Athens, Haidari, Greece
  127. 127Ophthalmology Private Practice Office, Independent Consultant, Athens, Greece
  128. 128Department of Pediatrics, Harvard University, Boston, MA, USA
  129. 129Department of Neonatology, Beth Israel Deaconess Medical center, Boston, MA, USA
  130. 130Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, USA
  131. 131Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
  132. 132Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
  133. 133Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
  134. 134Research School of Population Health, Australian National University, Action, ACT, Australia
  135. 135Department of Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  136. 1362nd Department of Dermatology, Colentina Clinical Hospital, Bucharest, Romania
  137. 137Department of Dermatology, Case Western Reserve University, Cleveland, OH, USA
  138. 138Department of Dermatology, University of Milan, Milan, Italy
  139. 139Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  140. 140Population and Development, Facultad Latinoamericana de Ciencias Sociales Mexico, Mexico City, Mexico
  141. 141Department of Medical Laboratory Sciences, Bahir Dar University, Bahir Dar, Ethiopia
  142. 142Department of Nursing, Woldia University, Woldia, Ethiopia
  143. 143School of Nursing, Jimma University, Jimma, Ethiopia
  144. 144School of Pharmacy, Aksum University, Aksum, Ethiopia
  145. 145Addis Ababa University, Addis Ababa, Ethiopia
  146. 146Immunology Research Center, Tabriz University of Medical Sciences, , Iran
  147. 147Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
  148. 148School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
  149. 149Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, GA, USA
  150. 150Department of Epidemiology, Shiraz University of Medical Sciences, Shiraz, Iran
  151. 151Faculty of Pharmacy, University of Porto, Porto, Portugal
  152. 152Tehran University of Medical Sciences, Tehran, Iran
  153. 153School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Bundoora, VIC, Australia
  154. 154Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
  155. 155Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  156. 156Public Health Department, Hawassa University, Hawassa, Ethiopia
  157. 157Curtin University, Perth, WA, Australia
  158. 158Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
  159. 159Department of Social Services, Tufts Medical Center, Boston, MA, USA
  160. 160Department of Pharmacology and Toxicology, Maragheh University of Medical Sciences, Maragheh, Iran
  161. 161Department of Pharmacology and Toxicology, Tabriz University of Medical Sciences, Tabriz, Iran
  162. 162National Institute for Health Researches, Tehran University of Medical Sciences, Tehran, Iran
  163. 163Department of Clinical Pathology, Mansoura University, Mansoura, Egypt
  164. 164Department of Statistics, Debre Markos University, Debre Markos, Ethiopia
  165. 165Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  166. 166World Health Programme, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
  167. 167Department of Pathology, Stavanger University Hospital, Stavanger, Norway
  168. 168Norwegian Institute of Public Health, Oslo, Norway
  169. 169Ophthalmic Epidemiology Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
  170. 170Department of Midwifery, Wolkite University, Wolkite, Ethiopia
  171. 171Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
  172. 172Biology Department, Salahaddin University-Erbil, Erbil, Iraq
  173. 173Biology and Biotechnolaniogy"L Spallanzani", University of Pavia, Pavia, Italy
  174. 174Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil
  175. 175Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  176. 176Pharmaceutical Nanotechnology, Tehran University of Medical Sciences, Tehran, Iran
  177. 177Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia
  178. 178Nursing Department, Hawassa University, Hawassa, Ethiopia
  179. 179Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
  180. 180Division of Neurology, University of Ottawa, Ottawa, ON, Canada
  181. 181REQUIMTE/LAQV, University of Porto, Porto, Portugal
  182. 182Research Centre on Public Health (CESP), University of Milan Bicocca, Monza, Italy
  183. 183Department of Health Education & Behavioral Sciences, Jimma University, Jimma, Ethiopia
  184. 184Psychiatry Department, Kaiser Permanente, Fontana, CA, USA
  185. 185School of Health Sciences, A T Still University, Mesa, AZ, USA
  186. 186Department of Population Medicine and Health Services Research, Bielefeld University, Bielefeld, Germany
  187. 187Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
  188. 188Abadan School of Medical Sciences, Abadan University of Medical Sciences, Abadan, Iran
  189. 189Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
  190. 190College of Public Health, Medical and Veterinary Science, James Cook University, Douglas, QLD, Australia
  191. 191Royal Life Saving Society, Sydney, NSW, Australia
  192. 192Department of Dermatology, Kobe University, Kobe, Japan
  193. 193Gene Expression & Regulation Program, The Wistar Institute, Philadelphia, PA, USA
  194. 194Public Health Department, Madda Walabu University, Bale-Robe, Ethiopia
  195. 195School of Pharmacy, Mekelle University, Mekelle, Ethiopia
  196. 196Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
  197. 197Department of Nursing, Aksum University, Aksum, Ethiopia
  198. 198Department of Nursing, Mekelle University, Mekelle, Ethiopia
  199. 199School of Public Health, Haramaya University, Harar, Ethiopia
  200. 200Bahir Dar University, Bahir Dar, Ethiopia
  201. 201Haramaya University, Dire Dawa, Ethiopia
  202. 202Department of Pharmacy, Wollo University, Dessie, Ethiopia
  203. 203Department of Medical Surgery, Tabriz University of Medical Sciences, Tabriz, Iran
  204. 204Occupational Health Department, Arak University of Medical Sciences, Arak, Iran
  205. 205Department of Health Services Management, Iran University of Medical Sciences, Tehran, Iran
  206. 206Science and Research Branch, Islamic Azad University, Tehran, Iran
  207. 207Young Researchers and Elite Club, Rasht Branch, Islamic Azad University, Rasht, Iran
  208. 208Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
  209. 209Center for Clinical and Epidemiological Research, University of São Paulo, Sao Paulo, Brazil
  210. 210Department of Dermatology, Boston University, Boston, MA, USA
  211. 211Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
  212. 212Technical College of Health, Sulaimani Polytechnic University, Sulaimani, Iraq
  213. 213Instituto de Patologia Tropical e Saúde Pública, Federal University of Goias, Goiânia, Brazil
  214. 214School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
  215. 215Department of Epidemiology and Biostatistics, Zhengzhou University, Zhengzhou, China
  216. 216Non-Communicable Diseases (NCD), World Health Organization (WHO), New Delhi, India
  217. 217Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
  218. 218Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
  219. 219School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  220. 220Institute for Global Health, University College London, London, UK
  221. 221Global and Community Mental Health Research Group, University of Macau, Macao, China
  222. 222Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
  223. 223School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai, United Arab Emirates
  224. 224Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
  225. 225Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
  226. 226Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
  227. 227Department of Microbiology, Maragheh University of Medical Sciences, Maragheh, Iran
  228. 228Department of Microbiology, Tehran University of Medical Sciences, Tehran, Iran
  229. 229Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
  230. 230School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
  231. 231Independent Consultant, Tabriz, Iran
  232. 232Department of Public Health, Mizan-Tepi University, Tepi, Ethiopia
  233. 233Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium
  234. 234Department of Clinical Sciences, Karolinska University Hospital, Stockholm, Sweden
  235. 235Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
  236. 236Department of Pharmacy Administration and Clinical Pharmacy, Xian Jiaotong University, Xian, China
  237. 237Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
  238. 238Research Coordination, AC Environments Foundation, Cuernavaca, Mexico
  239. 239CISS, National Institute of Public Health, Cuernavaca, Mexico
  240. 240Department of Urban Planning and Design, University of Hong Kong, Hong Kong, China
  241. 241Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
  242. 242Department of Pediatrics, Dell Medical School, University of Texas Austin, Austin, TX, USA
  243. 243Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
  244. 244Department of Pharmacology and Therapeutics, Dhaka Medical College, Dhaka, Bangladesh
  245. 245Department of Pharmacology, Bangladesh Industrial Gases Limited, Tangail, Bangladesh
  246. 246Department of Computer Engineering, Islamic Azad University, Tehran, Iran
  247. 247Computer Science Department, University of Human Development, Sulaymaniyah, Iraq
  248. 248Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  249. 249Clinical Legal Medicine Department, National Institute of Legal Medicine Mina Minovici, Bucharest, Romania
  250. 250Department of Epidemiology and Health Statistics, Central South University, Changsha, China
  251. 251Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
  252. 252Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
  253. 253Department of Epidemiology, University of Kragujevac, Kragujevac, Serbia
  254. 254Department of Family Medicine, Bangalore Baptist Hospital, Bangalore, India
  255. 255Center for Health Resource and Services Research and Development, National Institute of Health Research & Development, Jakarta, Indonesia
  256. 256Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  257. 257Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
  258. 258Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  259. 259School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC, Australia
  260. 260School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
  261. 261Department of Global and Community Health, George Mason University, Fairfax, VA, USA
  262. 262Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
  263. 263School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  264. 264Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  265. 265Department for Health Care and Public Health, I M Sechenov First Moscow State Medical University, Moscow, Russia
  266. 266Social Development & Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
  267. 267Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
  268. 268Institute of Medicine, University of Colombo, Colombo, Sri Lanka
  269. 269Faculty of Graduate Studies, University of Colombo, Colombo, Sri Lanka
  270. 270Department of Community Medicine, Banaras Hindu University, Varanasi, India
  271. 271Department of Ophthalmology, Heidelberg University, Mannheim, Germany
  272. 272Beijing Ophthalmology & Visual Science Key Laboratory, Beijing Tongren Hospital, Beijing, China
  273. 273Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
  274. 274Department of Family Medicine and Public Health, University of Opole, Opole, Poland
  275. 275School of Health Sciences, Savitribai Phule Pune University, Pune, India
  276. 276Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
  277. 277Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
  278. 278Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
  279. 279Department of Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
  280. 280Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
  281. 281Health Services Management Department, Qazvin University of Medical Sciences, Qazvin, Iran
  282. 282School of Public Health, Department of Health Informatics and Health Innovation, A C S Medical College and Hospital, Mekelle, Ethiopia
  283. 283Department of Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Jodhpur, India
  284. 284Department of Epidemiology, Hamadan University of Medical Sciences, Hamadan, Iran
  285. 285Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  286. 286Pars Advanced and Minimally Invasive Medical Manners Research Center, Iran University of Medical Sciences, Tehran, Iran
  287. 287Department of Applied Physics, The John Paul II Catholic University of Lublin, Lublin Voivodeship, Poland
  288. 288Department of Biology and Chemistry, Drohobych Ivan Franko State Pedagogical University, Drohobych, Ukraine
  289. 289Department of Pharmacy, Jimma University, Jimma, Ethiopia
  290. 290Open, Distance and eLearning Campus, University of Nairobi, Nairobi, Kenya
  291. 291Department of Dermatology, Wolaita Sodo University, Wolaita Sodo, Ethiopia
  292. 292Department of Midwifery, University of Gondar, Gondar, Ethiopia
  293. 293Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
  294. 294Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  295. 295School of Food and Agricultural Sciences, University of Management and Technology, Lahore, Pakistan
  296. 296Department of Global Health, University of Washington, Seattle, WA, USA
  297. 297Department of Physiology, Baku State University, Baku, Azerbaijan
  298. 298Health Care Management, Zahedan University of Medical Sciences, zahedan, Iran
  299. 299Epidemiology and Biostatistics Department, Health Services Academy, Islamabad, Pakistan
  300. 300Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
  301. 301Department of Health Research, Indian Council of Medical Research, New Delhi, India
  302. 302Centre for Ethics, Jawahar Lal Nehru University, New Delhi, India
  303. 303Department of Psychiatry, Kermanshah University of Medical Sciences, Kermanshah, Iran
  304. 304Department of Epidemiology, Kermanshah University of Medical Sciences, Kermanshah, Iran
  305. 305Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
  306. 306Research and Data Solutions, Synotech Consultant, Nairobi, Kenya
  307. 307Department of Preventive Medicine, Korea University, Seoul, South Korea
  308. 308Department of Health Sciences, Northeastern University, Boston, MA, USA
  309. 309School of Medicine, Xiamen University Malaysia, Sepang, Malaysia
  310. 310School of Health Sciences, Kristiania University College, Oslo, Norway
  311. 311Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
  312. 312Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
  313. 313Brain Engineering Research Center, Institute for Research in Fundamental Sciences, Tehran, Iran
  314. 314Department of Public Health Dentistry, Deemed University, karad, India
  315. 315CIBERSAM, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain
  316. 316Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
  317. 317Department of Zoology, University of Oxford, Oxford, UK
  318. 318Harvard Medical School, Harvard University, Boston, MA, USA
  319. 319Department of Anthropology, Panjab University, Chandigarh, India
  320. 320Department of Public Health, Yuksek Ihtisas University, Ankara, Turkey
  321. 321Department of Public Health, Hacettepe University, Ankara, Turkey
  322. 322Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
  323. 323Department of Psychology and Health Promotion, University of KwaZulu-Natal, Durban, South Africa
  324. 324Department of Medicine, Brigham and Women’s Hospital, Harvard University, Boston, MA, USA
  325. 325Public Health Foundation of India, Gurugram, India
  326. 326Department of Psychiatry, University of Nairobi, Nairobi, Kenya
  327. 327Institute of Occupational and Environmental Medicine, University of Birmingham, Birmingham, UK
  328. 328Mechanical and Industrial Engineering, Indian Institute of Technology, Roorkee, Roorkee, India
  329. 329Department of Medicine, McMaster University, Hamilton, ON, Canada
  330. 330Health and Nutrition Section, United Nations Childrens’ Fund (UNICEF), Accra, Ghana
  331. 331Department of Clinical Medicine and Community Health, University of Milan, Milano, Italy
  332. 332Department of Community and Family Medicine, University of Baghdad, Baghdad, Iraq
  333. 333School of Medicine, Deakin University, Geelong, VIC, Australia
  334. 334Health Promotion and Chronic Disease Prevention Branch, Public Health Agency of Canada, Ottawa, ON, Canada
  335. 335HelpMeSee, New York, NY, USA
  336. 336International Relations, Mexican Institute of Ophthalmology, Queretaro, Mexico
  337. 337Disease Control Department, Ghana Health Service, Accra, Ghana
  338. 338Department of Otorhinolaryngology (ENT), Father Muller Medical College, Mangalore, India
  339. 339Department of Public Health, Maragheh University of Medical Sciences, Maragheh, Iran
  340. 340Institute of Clinical Physiology, Italian National Research Council, Pisa, Italy
  341. 341College of Optometry, Nova Southeastern University, Fort Lauderdale, FL, USA
  342. 342School of Pharmacy, Monash University, Bandar Sunway, Malaysia
  343. 343School of Pharmacy, Taylor’s University Lakeside Campus, Subang Jaya, Malaysia
  344. 344School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
  345. 345Department of Health Sciences, University of Florence, Florence, Italy
  346. 346School of Public Health, University of Haifa, Haifa, Israel
  347. 347Department of Systems, Populations and Leadership, University of Michigan, Ann Arbor, MI, USA
  348. 348School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
  349. 349Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
  350. 350Department of Medicine, University of São Paulo, Sao Paulo, Brazil
  351. 351Department of General Surgery, Aintree University Hospital National Health Service (NHS) Foundation Trust, Liverpool, UK
  352. 352Department of Surgery, University of Liverpool, Liverpool, UK
  353. 353Health Data Research UK, Swansea University, Swansea, UK
  354. 354College of Medicine, Pathology Department, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  355. 355Ophthalmology Department, Aswan Faculty of Medicine, Aswan, Egypt
  356. 356Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
  357. 357Department of Public Health, Trnava University, Trnava, Slovakia
  358. 358Department of Primary Care and Public Health, Imperial College London, London, UK
  359. 359Public Health Research Department, National Health Institute Colombia, Bogota, Colombia
  360. 360Faculty of Medicine, El Bosque University, Bogota, Colombia
  361. 361Health Education and Research Department, SDM College of Medical Sciences & Hospital, Dharwad, India
  362. 362Rajiv Gandhi University of Health Sciences, Bangalore, India
  363. 363Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  364. 364Non-communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  365. 365Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
  366. 366Department of Ophthalmology, Iran University of Medical Sciences, Tehran, Iran
  367. 367Ophthalmology Department, University of Manitoba, Winnipeg, MB, Canada
  368. 368Department of Surgery, University of Virginia, Charlottesville, VA, USA
  369. 369Surgery Department, Emergency University Hospital Bucharest, Bucharest, Romania
  370. 370Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
  371. 371Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
  372. 372Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
  373. 373Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
  374. 374Institute of Bone and Joint Research, University of Sydney, St Leonards, NSW, Australia
  375. 375Department of Health Sciences, University of York, York, UK
  376. 376Department of Midwifery-Reproductive Health, Hamadan University of Medical Sciences, Hamadan, Iran
  377. 377Research Department, The George Institute for Global Health, New Delhi, India
  378. 378School of Medicine, University of New South Wales, Sydney, NSW, Australia
  379. 379Department of Public Health, Mekelle University, Mekelle, Ethiopia
  380. 380Department of Nursing, Arba Minch University, Arba Minch, Ethiopia
  381. 381Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland, Baltimore, MD, USA
  382. 382Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru
  383. 383Forensic Medicine Division, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
  384. 384College of Health Science, Department of Midwifery, Adigrat University, Adigrat, Ethiopia
  385. 385Department of Epidemiology and Biostatistics, Haramaya University, Harar, Ethiopia
  386. 386Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
  387. 387University of Helsinki, Helsinki, Finland
  388. 388Neurocenter, Helsinki University Hospital, Helsinki, Finland
  389. 389School of Health Sciences, University of Melbourne, Parkville, VIC, Australia
  390. 390Clinical Microbiology and Parasitology Unit, ZoraProfozic Polyclinic, Zagreb, Croatia
  391. 391University Centre Varazdin, University North, Varazdin, Croatia
  392. 392Center for Innovation in Medical Education, Pomeranian Medical University, Szczecin, Poland
  393. 393Department of Propedeutics of Internal Diseases & Arterial Hypertension, Pomeranian Medical University, Szczecin, Poland
  394. 394Pacific Institute for Research & Evaluation, Calverton, MD, USA
  395. 395Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
  396. 396Global Institute of Public Health (GIPH), Ananthapuri Hospitals and Research Centre, Trivandrum, India
  397. 397Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
  398. 398President’s Office, National Institute of Statistics Romania, Bucharest, Romania
  399. 399Faculty of Internal Medicine, Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan
  400. 400Department of Atherosclerosis and Coronary Heart Disease, National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan
  401. 401Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
  402. 402Institute of Addiction Research (ISFF), Frankfurt University of Applied Sciences, Frankfurt, Germany
  403. 403Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  404. 404Molecular Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
  405. 405Health Equity Research Center, Tehran University of Medical Sciences, Tehran, Iran
  406. 406Internal Medicine Department, King Saud University, Riyadh, Saudi Arabia
  407. 407Research Center, Salahaddin University, Erbil, Iraq
  408. 408Ishik University, Erbil, Iraq
  409. 409Department of Information Technology, University of Human Development, Sulaymaniyah, Iraq
  410. 410Department of Biostatistics, Hamadan University of Medical Sciences, Hamadan, Iran
  411. 411Department of Epidemiology and Biostatistics, Shahrekord University of Medical Sciences, Shahrekord, Iran
  412. 412Department of Clinical Biochemistry, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
  413. 413Department of Nursing, Shahroud University of Medical Sciences, Shahroud, Iran
  414. 414Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
  415. 415Department of Public Health, Samara University, Samara, Ethiopia
  416. 416Iran National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
  417. 417Faculty of Life Sciences and Medicine, King’s College London, London, UK
  418. 418Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
  419. 419Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
  420. 420Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  421. 421Research Center for Environmental Determinants of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
  422. 422Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
  423. 423Department of Epidemiology and Biostatistics, Kurdistan University of Medical Sciences, Sanandaj, Iran
  424. 424Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
  425. 425International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
  426. 426Gorgas Memorial Institute for Health Studies, Panama City, Panama
  427. 427Department of Social Medicine, National Center for Child Health and Development, Setagaya, Japan
  428. 428Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
  429. 429Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
  430. 430School of Medical Sciences, Science University of Malaysia, Kubang Kerian, Malaysia
  431. 431Department of Pediatric Medicine, Nishtar Medical University, Multan, Pakistan
  432. 432Department of Pediatrics & Pediatric Pulmonology, Institute of Mother & Child Care, Multan, Pakistan
  433. 433Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
  434. 434Knowledge Translation and Utilization, Egyptian Center for Evidence Based Medicine, Egypt
  435. 435Research and Analytics, Initiative for Financing Health and Human Development, Chennai, India
  436. 436Research and Analytics, Bioinsilico Technologies, Chennai, India
  437. 437Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
  438. 438Laboratory of Public Health Indicators Analysis and Health Digitalization, Moscow Institute of Physics and Technology, Dolgoprudny, Russia
  439. 439Experimental Surgery and Oncology Laboratory, Kursk State Medical University of the Ministry of Health of the Russian Federation, Kursk, Russia
  440. 440Department of Epidemiology & Biostatistics, Kermanshah University of Medical Sciences, Kermanshah, Iran
  441. 441Suraj Eye Institute, Nagpur, India
  442. 442Hospital of the Federal University of Minas Gerais, Federal University of Minas Gerais, Belo Horizonte, Brazil
  443. 443Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
  444. 444Department of Forensic Medicine and Toxicology, Manipal Academy of Higher Education, Manipal, India
  445. 445Cochrane Unit, South African Medical Research Council, Cape Town, South Africa
  446. 446Department of General Surgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  447. 447Department of General Surgery, Emergency Hospital of Bucharest, Bucharest, Romania
  448. 448Department of Biological Sciences, University of Embu, Embu, Kenya
  449. 449Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
  450. 450Department of Pharmacology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  451. 451Heidelberg University Hospital, Heidelberg, Germany
  452. 452Public Health Department, Universitas Negeri Semarang, Kota Semarang, Indonesia
  453. 453Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan
  454. 454School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
  455. 455Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
  456. 456Reproductive Health Sciences, Department Obstetrics and Gynecology, University of Ibadan, Ibadan, Nigeria
  457. 457Department of Preventive Medicine, Kyung Hee University, Dongdaemun-gu, South Korea
  458. 458Disease Surveillance and Epidemic Response, Ministry of Health, Nairobi, Kenya
  459. 459Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
  460. 460Department of Psychiatry, University of Lagos, Lagos, Nigeria
  461. 461Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
  462. 462Diplomacy and Public Relations Department, University of Human Development, Sulaimaniyah, Iraq
  463. 463Department of Pharmacology and Therapeutics, University of Nigeria Nsukka, Enugu, Nigeria
  464. 464Department of Psychology, University of Ghana, Accra, Ghana
  465. 465Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa
  466. 466Applied Research Division, Public Health Agency of Canada, Ottawa, ON, Canada
  467. 467School of Psychology, University of Ottawa, Ottawa, ON, Canada
  468. 468Department of Global Health Nursing, St Luke’s International University, Chuo-ku, Japan
  469. 469Academic department, Unium Ltd, Moscow, Russia
  470. 470Department of Project Management, National Research University Higher School of Economics, Moscow, Russia
  471. 471Department of Respiratory Medicine, Jagadguru Sri Shivarathreeswara Academy of Health Education and Research, Mysore, India
  472. 472Department of Forensic Medicine, Manipal Academy of Higher Education, Manipal, India
  473. 473Department of Medicine, Ottawa Hospital Research Institute, OttawaON, Canada
  474. 474Parasitology and Mycology, Shiraz University of Medical Sciences, Shiraz, Iran
  475. 475Augenpraxis Jonas, Heidelberg University, Heidelberg, Germany
  476. 476Department of Medical Humanities and Social Medicine, Kosin University, Busan, South Korea
  477. 477Research and Evaluation, Population Council, New Delhi, India
  478. 478Indian Institute of Health Management Research University Delhi, Jaipur, India
  479. 479Department of Pediatircs, RD Gardi Medical College, Ujjain, India
  480. 480Regional Medical Research Centre, Indian Council of Medical Research, Bhubaneswar, India
  481. 481Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
  482. 482Population Health Theme, Murdoch Childrens Research Institute, Melbourne, VIC, Australia
  483. 483Department of Midwifery, Wolaita Sodo University, Wolaita Sodo, Ethiopia
  484. 484School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
  485. 485Center for Research and Innovation, Ateneo De Manila University, Pasig City, Philippines
  486. 486Department of Orthopedics, Yenepoya Medical College, Mangalore, India
  487. 487Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China
  488. 488Department of Psychiatry, Department of Epidemiology, Columbia University, New York City, NY, USA
  489. 489Department of Chemistry, Faculty of Pharmacy, University of Porto, Porto, Portugal
  490. 490Department of Epidemiology and Evidence-Based Medicine, Sechenon University, Moscow, Russia
  491. 491Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  492. 492Health Sciences Department, Muhammadiyah University of Surakarta, Sukoharjo, Indonesia
  493. 493Department of Population Studies, International Institute for Population Sciences, Mumbai, India
  494. 494Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
  495. 495Department of Chemistry, Sharif University of Technology, Tehran, Iran
  496. 496College of Medicine, University of Central Florida, Orlando, FL, USA
  497. 497College of Graduate Health Sciences, A T Still University, Mesa, AZ, USA
  498. 498Department of Epidemiology & Biostatistics, Contech School of Public Health, Lahore, Pakistan
  499. 499Department of Medicine, University of Alberta, EdmontonAB, Canada
  500. 500Department of Immunology, Mazandaran University of Medical Sciences, Sari, Iran
  501. 501Molecular and Cell Biology Research Center, Mazandaran University of Medical Sciences, Sari, Iran
  502. 502Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  503. 503Metabolomics and Genomics Research Center, Tehran University of Medical Sciences, Tehran, Iran
  504. 504Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
  505. 505Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
  506. 506School of Nursing and Healthcare Professions, Federation University Australia, Berwick, VIC, Australia
  507. 507School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
  508. 508Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
  509. 509European Office for the Prevention and Control of Noncommunicable Diseases, World Health Organization (WHO), Moscow, Russia
  510. 510Department of Surgery, University of Michigan, Ann Arbor, MI, USA
  511. 511Department of Oral Pathology, Srinivas Institute of Dental Sciences, Mangalore, India
  512. 512School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Tehran, Iran
  513. 513Forensic Medicine, Manipal Academy of Higher Education, Mangalore, India
  514. 514Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
  515. 515Academic Public Health Department, Public Health England, London, UK
  516. 516School of Health, Medical and Applied Sciences, CQ University, Sydney, NSW, Australia
  517. 517Department of Computer Science, Metropolitan College, Boston University, Boston, USA
  518. 518Neurology Department, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India
  519. 519School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia
  520. 520Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
  521. 521Brien Holden Vision Institute, Sydney, NSW, Australia
  522. 522Organization for the Prevention of Blindness, Paris, France
  523. 523EPIUnit - Public Health Institute University Porto (ISPUP), University of Porto, Porto, Portugal
  524. 524Surgery Department, University of Minnesota, Minneapolis, MN, USA
  525. 525Surgery Department, University Teaching Hospital of Kigali, Kigali, Rwanda
  526. 526Research Directorate, Nihon Gakko University, Fernando de la Mora, Paraguay
  527. 527Research Direction, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay
  528. 528Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
  529. 529Faculty of Medicine, Ain Shams University, Cairo, Egypt
  530. 530National Institute for Research in Environmental Health, Indian Council of Medical Research, Bhopal, India
  531. 531Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  532. 532College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
  533. 533Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  534. 534Faculty of Public Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
  535. 535Department of Health in Disasters and Emergencies, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  536. 536Department of Neuroscience, Iran University of Medical Sciences, Tehran, Iran
  537. 537Nanobiotechnology Center, Soran University, Soran, Iraq
  538. 538Taleghani Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
  539. 539Radiology and Nuclear Medicine Department, Kermanshah University of Medical Sciences, Kermanshah, Iran
  540. 540Research Deputy, Taleghani Hospital, Kermanshah, Iran
  541. 541Public Health and Community Medicine Department, Cairo University, Giza, Egypt
  542. 542Department of Urology, Cairo University, Cairo, Egypt
  543. 543Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
  544. 544Global Health Institute, American University of Beirut, Beirut, Lebanon
  545. 545Health and Disability Intelligence Group, Ministry of Health, Wellington, New Zealand
  546. 546Department of Entomology, Ain Shams University, Cairo, Egypt
  547. 547Department of Surgery, Marshall University, Huntington, WV, USA
  548. 548Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, OH, USA
  549. 549Rheumatology Department, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  550. 550Institute of Bone and Joint Research, University of Sydney, Syndey, NSW, Australia
  551. 551Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
  552. 552Centre-School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia
  553. 553Health Economics, Bangladesh Institute of Development Studies (BIDS), Dhaka, Bangladesh
  554. 554Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
  555. 555Surgery Department, Hamad Medical Corporation, Doha, Qatar
  556. 556Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
  557. 557Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
  558. 558Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
  559. 559Centre for Adolescent Health, Murdoch Childrens Research Institute, Parkville, VIC, Australia
  560. 560School of Public Health, Imperial College London, London, UK
  561. 561Faculty member of Education Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  562. 562Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
  563. 563Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
  564. 564Emergency Department, Manian Medical Centre, Erode, India
  565. 565Microbiology Service, National Institutes of Health, Bethesda, MD, USA
  566. 566Center for Biomedical Information Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
  567. 567Department of Health Promotion and Education, Alborz University of Medical Sciences, Karaj, Iran
  568. 568Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
  569. 569Independent Consultant, Karachi, Pakistan
  570. 570School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
  571. 571Chronic Diseases (Home Care) Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
  572. 572HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
  573. 573Centre for Medical Informatics, University of Edinburgh, Edinburgh, UK
  574. 574Division of General Internal Medicine, Harvard University, Boston, MA, USA
  575. 575National Institute of Infectious Diseases, Tokyo, Japan
  576. 576College of Medicine, Yonsei University, Seodaemun-gu, South Korea
  577. 577Division of Cardiology, Emory University, Atlanta, GA, USA
  578. 578Finnish Institute of Occupational Health, Helsinki, Finland
  579. 579Department of Health Education & Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
  580. 580School of Health, University of Technology Sydney, Sydney, NSW, Australia
  581. 581Department of Psychology, Reykjavik University, Reykjavik, Iceland
  582. 582Department of Health and Behavior Studies, Columbia University, New York, NY, USA
  583. 583Department of Forensic Medicine, Kathmandu University, Dhulikhel, Nepal
  584. 584Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
  585. 585Medicine Service, US Department of Veterans Affairs (VA), Birmingham, AL, USA
  586. 586Department of Epidemiology, School of Preventive Oncology, Patna, India
  587. 587Department of Epidemiology, Healis Sekhsaria Institute for Public Health, Mumbai, India
  588. 5882nd Department of Surgery-SUUB, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
  589. 5892nd Surgery Department, Bucharest Emergency Hospital, Bucharest, Romania
  590. 590Pain Management Research Institute (PMRI), Northern Clinical School, University of Sydney, St Leonards, NSW, Australia
  591. 591Michael J Cousins Pain Management & Research Centre, Northern Sydney Local Health District, St Leonards, NSW, Australia
  592. 592Department of Medical Surgical Nursing, Urmia University of Medical Science, Urmia, Iran
  593. 593Emergency Nursing Department, Semnan University of Medical Sciences, Semnan, Iran
  594. 594Department of Biostatistics, Hamedan University of Medical Sciences, Hamadan, Iran
  595. 595Hospital Universitario de la Princesa, Autonomous University of Madrid, Madrid, Spain
  596. 596Centro de Investigación Biomédica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain
  597. 597Department of Public Health, Arba Minch University, Arba Minch, Ethiopia
  598. 598Hull York Medical School, University of Hull, Hull City, UK
  599. 599Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  600. 600Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
  601. 601South African Medical Research Council, Cape Town, South Africa
  602. 602Department of Psychology, Deakin University, Burwood, VIC, Australia
  603. 603Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
  604. 604Department of Agriculture and Food Systems, University of Melbourne, Melbourne, VIC, Australia
  605. 605Department of Criminology, Law and Society, University of California Irvine, Irvine, CA, USA
  606. 606Department of Medicine, University of Valencia, Valencia, Spain
  607. 607Carlos III Health Institute, Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain
  608. 608School of Social Work, University of Illinois, Urbana, IL, USA
  609. 609Department of Public Health, Arbaminch College of Health Sciences, Arbaminch town sikela, Ethiopia
  610. 610Axum College of Health Science, mekelle, Ethiopia
  611. 611School of Midwifery, University of Gondar, Gondar, Ethiopia
  612. 612School of Public Health, University of Adelaide, Adelaide, SA, Australia
  613. 613Department of Environmental Health, Wollo University, Dessie, Ethiopia
  614. 614Department of Community and Family Medicine, Iran University of Medical Sciences, Tehran, Iran
  615. 615Department of Pharmacognosy, Mekelle University, Mekelle, Ethiopia
  616. 616Institute of Public Health, University of Gondar, Gondar, Ethiopia
  617. 617Department of Public Health, Adigrat University, Adigrat, Ethiopia
  618. 618Psychiatry Department, Hawassa University, Hawassa, Ethiopia
  619. 619Institute of Public Health, Jagiellonian University Medical College, Krakow, Poland
  620. 620The Agency for Health Technology Assessment and Tariff System, Warszawa, Poland
  621. 621Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
  622. 622Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand
  623. 623Clinical Hematology and Toxicology, Military Medical University, Hanoi, Vietnam
  624. 624Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
  625. 625Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
  626. 626Mbarara University of Science and Technology, Mbarara, Uganda
  627. 627Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
  628. 628Institute of Soil and Environmental Sciences, A T Still University, Faisalabad, Pakistan
  629. 629Gomal Center of Biochemistry and Biotechnology, Gomal University, Dera Ismail Khan, Pakistan
  630. 630TB Culture Laboratory, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, Pakistan
  631. 631Research Department, National Institute of Population Studies (NIPS), Islamabad, Pakistan
  632. 632Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur, India
  633. 633Division of Health Sciences, University of Warwick, Coventry, UK
  634. 634Argentine Society of Medicine, Buenos Aires, Argentina
  635. 635Velez Sarsfield Hospital, Buenos Aires, Argentina
  636. 636UKK Institute, Tampere, Finland
  637. 637Raffles Neuroscience Centre, Raffles Hospital, Singapore
  638. 638Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  639. 639Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  640. 640Occupational Health Unit, Sant’Orsola Malpighi Hospital, Bologna, Italy
  641. 641Department of Health Care Administration and Economics, National Research University Higher School of Economics, Moscow, Russia
  642. 642Foundation University Medical College, Foundation University, Islamabad, Pakistan
  643. 643Demographic Change and Ageing Research Area, Federal Institute for Population Research, Wiesbaden, Germany
  644. 644Center of Population and Health, Wiesbaden, Germany
  645. 645Department of Physical Therapy, Naresuan University, Meung District, Thailand
  646. 646Department of Human Anatomy, Histology, Embryology, Bahir Dar University, Bahir Dar, Ethiopia
  647. 647Department of Pharmacology and Toxicology, Mekelle University, Mekelle, Ethiopia
  648. 648Department of Pharmacology, Addis Ababa University, Addis ababa, Ethiopia
  649. 649Department of Nursing, Wollo University, Dessie, Ethiopia
  650. 650Department of Orthopaedics, Wenzhou Medical University, Wenzhou, China
  651. 651Medical Physics Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  652. 652Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
  653. 653School of International Development and Global Studies, University of Ottawa, OttawaON, Canada
  654. 654Health Services Management Research Center, Kerman University of Medical Sciences, Kerman, Iran
  655. 655Department of Health Management, Policy and Economics, Kerman University of Medical Sciences, Kerman, Iran
  656. 656Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China
  657. 657Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China
  658. 658School of Allied Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
  659. 659Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
  660. 660Department of Sociology, Yonsei University, Seoul, South Korea
  661. 661Department of Health Policy & Management, Jackson State University, Jackson, MS, USA
  662. 662School of Medicine, Tsinghua University, Beijing, China
  663. 663Department of Environmental Health, Mazandaran University of Medical Sciences, Sari, Iran
  664. 664Department of Environmental Health, Academy of Medical Science, Sari, Iran
  665. 665School of Public Health and Management, Hubei University of Medicine, Shiyan, China
  666. 666Department of Epidemiology and Biostatistics, Wuhan University, Wuhan, China
  667. 667Global Health Institute, Wuhan University, Wuhan, China
  668. 668Social Determinants of Health Research Center, Ardabil University of Medical Science, Ardabil, Iran
  669. 669Department of Epidemiology, University Hospital of Setif, Setif, Algeria
  670. 670Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
  671. 671Student Research Committee, Babol University of Medical Sciences, Babol, Iran
  672. 672Department of Community Medicine, Ardabil University of Medical Science, Ardabil, Iran
  673. 673Department of Environment Health Engineering, Gonabad University of Medical Sciences, Gonabad, Iran
  674. 674Faculty of Medical Sciences, Department of Health Education, Tarbiat Modares University, Tehran, Iran
  675. 675Department of Preventive Medicine, Wuhan University, Wuhan, China
  676. 676School of Public Health, Wuhan University of Science and Technology, Wuhan, China
  677. 677Hubei Province Key Laboratory of Occupational Hazard Identification and Control, Wuhan University of Science and Technology, Wuhan, China
  678. 678Indian Institute of Public Health, Public Health Foundation of India, Gurugram, India
  679. 679National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
  680. 680Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka
  681. 681Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
  1. Correspondence to Dr Spencer L James, Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA 98121, USA; spencj{at}uw.edu

Abstract

Background Past research in population health trends has shown that injuries form a substantial burden of population health loss. Regular updates to injury burden assessments are critical. We report Global Burden of Disease (GBD) 2017 Study estimates on morbidity and mortality for all injuries.

Methods We reviewed results for injuries from the GBD 2017 study. GBD 2017 measured injury-specific mortality and years of life lost (YLLs) using the Cause of Death Ensemble model. To measure non-fatal injuries, GBD 2017 modelled injury-specific incidence and converted this to prevalence and years lived with disability (YLDs). YLLs and YLDs were summed to calculate disability-adjusted life years (DALYs).

Findings In 1990, there were 4 260 493 (4 085 700 to 4 396 138) injury deaths, which increased to 4 484 722 (4 332 010 to 4 585 554) deaths in 2017, while age-standardised mortality decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In 1990, there were 354 064 302 (95% uncertainty interval: 338 174 876 to 371 610 802) new cases of injury globally, which increased to 520 710 288 (493 430 247 to 547 988 635) new cases in 2017. During this time, age-standardised incidence decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. Between 1990 and 2017, age-standardised DALYs decreased from 4947 (4655 to 5233) per 100 000 to 3267 (3058 to 3505).

Interpretation Injuries are an important cause of health loss globally, though mortality has declined between 1990 and 2017. Future research in injury burden should focus on prevention in high-burden populations, improving data collection and ensuring access to medical care.

  • burden of disease
  • global
  • descriptive epidemiology
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Introduction

Injury burden assessments are a critical component of population health measurement. Across the global landscape of population health research, injuries are unique in that they are almost universally avertable yet can cause death or disability at any age. Even common injuries such as concussion resulting from falls, violence or road injuries may cause longer term sequelae, and injuries such as spinal cord injuries or limb amputations can cause long-term disability.1 As a result, injuries are recognised as being a source of lost health and human capital that could be averted with improved safety and prevention programmes as well as ensuring access to care resources.2 Across geographies, certain injuries such as envenomation may be relevant in specific locations where venomous creatures live, while injuries such as those occurring from adverse medical events are an increasing area of research in higher income areas of the world.3–5 Bolstering such programmes, however, requires detailed measurement of when, where and to whom injuries are occurring, necessitating focused research studies to add insight and context to broader geographical trends. Across all domains of injury prevention research, it is important to measure the causes of injury, such as road injuries, and the resulting disability, such as fractures, burns or traumatic brain injury, that can occur as a result. Such detailed measurement lends perspective for understanding burden and anticipating resources needed to care for and hopefully prevent future injury burden. Detailed measurements and assessments of this nature are critical for empowering policy makers and health system planners to appropriately plan and invest for mitigating future health loss from injuries. Reducing injury burden is an important component in global efforts such as the Sustainable Development Goal 3 to ‘ensure healthy lives and promote well-being for all at all ages’.6

While some research has focused on a certain type of injury or outcome from injury or specific area of the world,7–10 it has become important in an era of more sophisticated population health measurement to measure health loss from injuries comprehensively with detailed fatal and non-fatal estimates for different ages, sexes, across time periods and accounting for multiple different types of morbidity that can occur in an injury. Previously published literature on global injury burden through 2015 has provided comprehensive measurements of health loss due to injuries but still require regular updates to help inform research and policy, as new years of estimates are added and as new injuries and injury outcomes are incorporated.11 Comprehensive research of this nature shows how injury burden varies dynamically by age, sex, year, area of the world and type of injury, and hence, it is important to maintain close monitoring of injury burden every year in all parts of the world. In addition, as new datasets and statistical modelling methods become available, producing regular updates to burden estimation also ensures that results are as accurate as possible.

While the burden of injuries is widely studied and monitored through various methods of research, the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study is the only study framework that routinely provides estimates of morbidity and mortality from an exhaustive list of injuries in all areas of the world across ages and sexes. The most recent update to GBD was published in 2018 and provided morbidity and mortality estimates for 30 mutually exclusive causes of injury for 195 countries from 1990 to 2017.12–17 As part of this regular update, new datasets on cause of death and incidence are incorporated into the study, and additional geographical detail is added to better measure heterogeneity in burden estimates at a subnational level. In addition, updates such as reporting both nature of injury and cause of injury (described in more detail below) are incorporated. In this study, we describe key components in the GBD injury methodology and provide results from key trends in injury burden in terms of incidence, prevalence, years lived with disability (YLDs), cause-specific mortality, years of life lost (YLLs) and disability-adjusted life years (DALYs) by country, age groups, sex, year and injury type.

Methods

The methods and results in this study are the same as are provided in GBD capstone publications, and a detailed description of GBD data and methods used for all processes related to GBD 2017 is provided in associated studies.12–17 Overall, GBD methods are also summarised in online supplementary appendix 1. Below, we summarise the specific methods used for measurement of injuries morbidity and mortality in GBD 2017.

Key components of GBD study design

The GBD study incorporates several key components to allow for internally consistent estimates across all burden measures and metrics. First, population is measured to ensure consistent denominators for all population-level measurement. Second, all-cause mortality is measured using demographic methods. Third, cause-specific mortality for a mutually exclusive, collectively exhaustive hierarchy of diseases and injuries is measured, such that every death has one underlying cause of death and such that estimates for every possible cause of death are included, which requires the use of residual causes like ‘other transport injuries’. This results in the sum of cause-specific mortality equalling total all-cause mortality. Fourth, non-fatal health loss is measured for individuals living with a disease or injury that detracts from their full health status. Fifth, a composite measure of mortality and morbidity is computed. These steps are conducted within an age, sex and location hierarchy constructed such that demographic detail is available but where all estimates are internally consistent with all other estimates. GBD produces estimates for all causes, ages, sexes, years and locations. Risk factors and attributable burden for different are also measured, but those results are not included in this study.

Case definition and cause hierarchy

The GBD case definition for an injury death is a death where the injury was the underlying cause of death. For example, if an individual falls on ice and sustains an epidural haematoma and dies after a seizure, the fall is the underlying cause. If an individual sustains a myocardial infarction and then falls and sustains the same epidural haematoma, then the myocardial infarction is the underlying cause of death. For non-fatal injuries, we define a case as an injury that warranted medical care. For example, if an individual slips and falls but does not sustain any bodily injury, it is not considered an injury. Online supplementary appendix table 1 provides the International Classification of Disease (ICD) codes used to identify causes of injury.

Cause-specific mortality estimation

Cause-specific mortality from injuries is measured using the Cause of Death Ensemble model (CODEm). CODEm is described in more detail elsewhere; a summary of its use for injuries is as follows.18 First, all available data that can be used for cause of death estimation are identified. For injuries, this includes vital registration, verbal autopsy, police records, mortuary data and census data. These data are processed for use in the GBD cause and demographic hierarchy via a series of data processing steps including a process whereby ill-defined causes of death are reassigned to true underlying causes of death, which is described in more detail elsewhere but essentially is the process by which ill-defined causes of death are reclassified to causes of death in the GBD cause hierarchy.19 20 Next, a cause-specific mortality model is developed for each one of the 30 different causes of injury. For example, falls are modelled differently than road injuries, though both use the same CODEm modelling architecture. For each cause of injury, covariates that may be associated with the cause are identified and added as candidate covariates. CODEm runs different combinations of models using different covariates and outcome variables, specifically cause fraction models and cause-specific mortality rate models. Ensembles of models are also conducted to test performance of overall models formed from submodels. Once all models have been run, the top-performing models are selected based on out-of-sample predictive validity, wherein the model makes predictions on data that were not included in developing the model. The top-performing models are then weighted according to performance, and the final estimates form the penultimate estimate for cause-specific mortality from that injury. Those estimates are then adjusted to fit within the all-cause mortality estimate, so that cause-specific deaths sum up to the overall mortality estimate for each population and demographic. YLLs are computed as the cause-specific mortality rate at a given age multiplied by the residual life expectancy at that age, which is based on the observed maximum global life expectancy.

Non-fatal injury estimation

Non-fatal injury estimation is also described in more detail in GBD literature. Key components in this process are as follows. First, data on incidence of non-fatal injury causes (eg, road injuries) is obtained from the GBD collaborator network and other injury research groups and researchers around the world. Data are cleaned and organised according to GBD study guidelines. Next, incidence of each cause of injury is modelled in DisMod-MR 2.1, which is a Bayesian meta-analysis tool used extensively in GBD research. Incidence estimates of injuries requiring medical care for each cause of injury then stream through an analytical pipeline. During this process, injury incidence is split into inpatient and outpatient to account for the different severity that is expected to occur. The coefficient that determines this split is derived from locations where both inpatient and outpatient data are available. After this, we measure the proportion of each cause of injury that leads to one of 47 different natures of injury using clinical data where both cause and nature are coded as well a Dirichlet statistical modelling process. Based on these steps, the incidence of each cause is also split into incidence of each cause-nature, which is the proportion of a given cause’s incidence leading to some specific nature of injury being the most severe injury sustained as estimated by the Dirichlet regression. These estimates are then converted to short-term and long-term injuries based on probability of each injury becoming long term, as determined by long-term follow-up injury surveys.21–27 For short-term injuries, incidence is converted to prevalence based on multiplying incidence by an expected duration of injury as determined by physicians and injury experts involved in the GBD study. For long-term injuries, incidence is converted to prevalence using differential equations that take into account the increased mortality for certain types of injury, for example, traumatic brain injury.1 Disability weights as derived elsewhere in the GBD study are then used to measure disability based on nature of injury.28 These measures are then summed across natures of injury for each cause to calculate YLDs. Each of these steps is conducted for every cause, age, sex, year and location in the GBD study design. Associated literature provides more detail on each of these steps.12–17

DALY measurement

DALYs are calculated by summing YLLs and YLDs for each cause, age, sex, year and location.

Uncertainty measurement

Uncertainty is measured at each step of the analytical process based on the sample size, SE or original uncertainty interval (UI) from each input to the study. Uncertainty is propagated through each step of the analysis by maintaining distributions of 1000 draws on which each analytical step is conducted. Final 95% UIs are determined based on the 25th and 975th values of the ordered values across draws.

Code and results

Steps of the analytical process were conducted in Python version 2.7, Stata V.13.1 or R version 3.3. All steps of the analytical process are available online at ghdx.healthdata.org. This study reports a subset of measures and metrics for every cause of injury. All results and results with additional detail by age, sex, year and location can be downloaded at ghdx.healthdata.org.

Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) statement

This study is adherent with guidelines from the GATHER (described in more detail in online supplementary appendix 2).29

Results

Online supplementary appendix table 2 shows age-standardised incidence, prevalence, YLDs, deaths, YLLs and DALYs in 2017 by country as well as percentage change and UI from 1990 for each metric. Online supplementary appendix table 3 shows all-age numbers (ie, not divided by population) of incidence, prevalence, YLDs, deaths, YLLs and DALYs in 2017 by country as well as percentage change from 1990 and UI for each metric. In some instances, the UI for the per cent change crosses zero, meaning that statistically there was no significant difference. Online supplementary appendix figures 1–6, show the incidence and mortality from transport injuries, unintentional injuries, and interpersonal violence and self-harm by country for 2017 as well as the percentage change for both incidence and mortality between 1990 and 2017. All other results including age-specific and sex-specific results can be viewed and downloaded via freely and publicly available tools at ghdx.healthdata.org.

Global trends in overall injury burden

In terms of fatal outcomes, deaths due to all injuries increased from 4 260 493 (4 085 700 to 4 396 138) in 1990 to 4 484 722 (4 332 010 to 4 585 554) in 2017, while YLLs decreased from 232 104 206 (219 920 058 to 241 973 733) to 195 231 148 (188 807 653 to 199 825 464) and age-standardised mortality rates decreased from 1079 (1073 to 1086) to 738 (730 to 745) per 100 000. In terms of non-fatal outcomes, all-injury incidence (new cases) increased from 354 064 302 (338 174 876 to 371 610 802) in 1990 to 520 710 288 (493 430 247 to 547 988 635) in 2017, and YLDs increased from 37 452 031 (27 805 854 to 49 010 103) to 57 174 469 (42 073 855 to 75 427 036), while age-standardised incidence rates decreased non-significantly from 6824 (6534 to 7147) to 6763 (6412 to 7118) per 100 000. In terms of DALYs, age-standardised DALY rates decreased from 4947 (4655 to 5233) per 100 000 in 1990 to 3267 (3058 to 3505) in 2017.

Figure 1 shows age-standardised DALY rates by country for 2017. While certain countries—specifically, Syria, Central African Republic and Iraq—have much higher DALY rates than most other countries, there still exists considerable heterogeneity across countries that are not among these countries with the highest burden. South Sudan, Somalia and Yemen have much higher injury burden than much of the rest of the world, for example, with age-standardised DALY rates of 7391.51 per 100 000 (6536.44 to 8440.14), 7364.66 per 100 000 (6143.11 to 8960.58) and 7297.88 per 100 000 (6525.7 to 8438.15), respectively. Papua New Guinea also demonstrates high all-injury burden with 6803.33 DALYs per 100 000 (5652.2 to 8040.89) in 2017.

Figure 1

Age-standardised DALY rates by country, 2017. DALYs, disability-adjusted life years.

Figure 2 presents deaths as a stacked graph for overall injury groups and population from 1990 to 2017 with labelled fatal discontinuities, defined as changes in deaths due to sudden, unexpected spikes in mortality that depart from the underlying mortality trend.13 Although population has steadily increased in the 28 years of the study, deaths per year due to injuries have remained relatively consistent over time. Natural disasters, such as earthquakes, have caused pronounced spikes in unintentional injuries deaths, while conflict and genocide have caused spikes in deaths in the interpersonal violence injury category.

Figure 2

Global deaths for level 2 injuries and population from 1990 to 2017 with labelled fatal discontinuities.

All-injury YLDs and YLLs by country in 2017

Figure 3 shows the percentage of total all-age, combined-sex YLDs by country in 2017. This figure shows several geographical patterns that help depict the non-fatal burden of injuries globally in terms of their relative contribution to overall disability. First, the percentage of total disability caused by injuries varies widely by country. Mauritius experiences only 3.04% (2.79% to 3.29%) of non-fatal burden from injuries, while Slovenia experiences 19.11% (17.11% to 21.27%) of non-fatal burden from injuries. In other words, if all disability in these two populations is combined in 2017, there is over sixfold variation in how much of this disability was caused by injuries. These patterns also reflect burden from non-injury conditions, since locations with higher burden from communicable disease may have correspondingly lower proportion due to injuries. As an extension of these geographical trends, this map makes it evident that there are striking regional patterns in non-fatal injury burden. Eastern and Central Europe and Central Asia as well as Australasia have a notably higher percentage of total non-fatal burden from injuries than countries in other regions, while these percentages are relatively lower in most areas of Africa, the Americas and areas of South, East and Southeast Asia. To some extent, this map also reflects the underlying burden from non-injury causes, too, since areas of the world with high non-fatal disability from conditions such as anaemia, communicable diseases and other types of health loss could have correspondingly higher percentages of disability from these conditions instead of injuries. This map also shows examples of positive deviations from global trends; Indonesia, for example, has a relatively low percentage of non-fatal health loss due to injuries compared with many other countries.

Figure 3

Percentage of YLDs in all ages due to injuries in 2017. YLDs, years lived with disability.

Figure 4 similarly shows the percentage of total all-age, combined-sex YLLs by country in 2017. This figure interestingly shows how mortality patterns demonstrate different geographical trends than the non-fatal burden, as depicted in figure 2, though it should be noted that YLLs will also be disproportionately higher in younger populations, all else being equal. In particular, the locations with the highest percentage of YLLs due to injuries are in certain countries in North Africa and the Middle East, including Syria, where 59.51% (56.59% to 62.35%) of YLLs were due to injuries in 2017, and Iraq, where 41.34% of YLLs were due to injuries in 2017. Areas of Latin America including Venezuela, Honduras and Belize also have a relatively high percentage of total YLLs due to injuries. Conversely, certain areas of the world also demonstrate a relatively low percentage of total YLLs due to injuries, specifically, certain countries in Africa such as Nigeria and Madagascar have relatively lower percentages, though this also reflects relatively higher mortality from other non-injury causes in these countries.

Figure 4

Percentage of YLLs in all ages due to injuries in 2017. YLLs, years of life lost.

Cause-specific DALY rates by sex

Figure 5 shows cause-specific DALY rates by sex for 17 injuries in 2017 as well as percentage change from 1990 to 2017 by cause and sex. The black and dark blue bars show causes with greater relative improvement over the time period of this study, while lighter blue, orange and red show injuries that have had lesser improvements, no improvements or increasing burden over time.

Figure 5

Age-standardised DALY rates by sex for injuries in level 3 of the GBD cause hierarchy in 2017 and percentage change from 1990 to 2017. DALY, disability-adjusted life year; GBD, Global Burden of Disease.

In 2017, men experienced higher age-standardised DALY rates than women for all injuries except fire, heat and hot substances. The most marked differences, where DALY rates for men are more than double those of women, can be seen in self-harm, interpersonal violence, road injuries, other transport injuries, exposure to mechanical forces, environmental heat and cold exposure, and executions and police violence. Road injuries (1272 (1209 to 1331) per 100 000), self-harm (577 (525 to 604)) and falls (550 (462 to 653)) were the causes with the highest DALY rates for men in 2017. Women had the highest DALY rates due to the same injuries, but at a lesser magnitude, with rates of 467 (432 to 502) per 100 000 for road injuries, 367 (304 to 442) for falls and 282 (268 to 293) for self-harm.

The causes with the largest decreases in DALY rates for men from 1990 to 2017 were exposure to forces of nature (72.4% (63.8% to 79.1%)), drowning (62.7% (58.8% to 65.4%)) and fire, heat and hot substances (43.6% (26.4% to 49.9%)). For women, exposure to forces of nature (72.8% (63.8% to 79.6%)), drowning (65.8% (58.6% to 69.2%)) and self-harm (50.8% (48.2% to 55.9%)) had the largest decreases in DALY rates. The only increases in DALY rates were seen in executions and police conflict for both women (298.0% (257.1% to 389.0%)) and men (46.4% (31.2% to 173.0%)).

Comparative regional DALY rates in 2017

Figure 6 shows a heatmap of the number of standard deviations (SD) above or below the mean of a row (ie, a Z-score) of age-standardised DALY rates for select injuries by GBD region in 2017. For example, the figure shows that the rate of age-standardised DALYs in Eastern Europe is approximately three SD higher than the across mean age-standardised DALY rates of environmental heat and cold exposure across all regions. Poisonings is also a cause with an age-standardised DALY rate that is approximately three SD higher than in other regions. Positive deviance is seen in high-income Asia Pacific for road injuries, where age-standardised DALYs are one SD lower than the mean across regions. Conversely, Central sub-Saharan Africa has age-standardised DALY rates that are two SD higher than the mean across regions. This figure also demonstrates how certain causes have relatively less variation across regions, for example, most regions do not deviate from the mean age-standardised DALY rates across regions for exposure to forces of nature, with the exception of the Caribbean, which had an age-standardised DALY rate that was approximately four SD above the mean across regions in 2017. Oceania and Eastern Europe stand out as having higher DALY rates for select injuries than other regions, while East Asia, high-income Asia Pacific, high-income North America, Western Europe and Southern Latin America experienced less than average burden of injuries in 2017.

Figure 6

Heatmap showing the Z-score of age-standardised mean DALY rates for select injuries by GBD region in 2017. GBD, Global Burden of Disease.

Discussion

Measuring, understanding and acting on the global burden of injuries should be considered a foundational component of population health research. While this study has reviewed injury burden trends from GBD 2017, it is also evident that these trends are sufficiently different by injury type and geography that it becomes difficult to succinctly generalise the findings in this study. Nevertheless, this study reveals themes and principles germane to the state of global injury burden in 2017 that are relevant to injury burden and prevention research.

First, it should be recognised that despite global population growth with increases in injury cases and deaths, age-standardised death rates from injuries declined from 1990 to 2017. More research into successful improvements for specific injuries in specific countries should be more investigated to help guide efforts towards future improvements. In general terms, the reduction in injury mortality likely represent the combined effects of improvements in healthcare systems, investments in injury prevention programmes and, in certain circumstances, safety improvement such as vehicle safety testing, helmet, seatbelt and drinking and driving laws. While burden trends across all diseases and injuries vary by geography and time, these improvements in injury burden are generally consistent with reporting of communicable and non-communicable disease trends reported in GBD 2017.

Despite improvements in terms of rates, however, it is important to consider the impact of absolute injury burden in younger and adult ages on the social capital and workforce in a country. Second, in reviewing temporal trends in figure 2, it becomes evident that war and conflict and environmental disasters can cause profound increases in deaths over a short period of time. This unfortunate and tragic reality should be made more broadly visible as issues such as war, conflict and climate change continue to threaten the populations of the 21st century. Third, sex differentials in the burden of different injury types are large, with men experiencing significantly higher burden from the four leading causes of injury DALYs in 2017. Preventive research and focused interventions into why this is occurring in road injuries, falls, self-harm, interpersonal violence and drowning is critical. It is also critical to address injuries such as fire, heat and hot substance and sexual violence where females experience greater burden and to better understand the factors that drive sex differences. As a fourth theme, we observed that there are cases of both positive and negative deviance from cross-region trends for each injury, as shown in figure 6, which appear to occur even outside of expected differences by income group. For example, understanding why high-income Asia Pacific and Western Europe are performing better than high-income North America in road injury burden could help improve road injury burden even in this higher income setting.

Beyond these four themes, there are evidently a great deal of nuances and specific outcomes to measure and understand in future injury research. While every cause of health loss in a population is important to measure and understand, injuries are unique in that understanding burden requires investigation of an array of circumstances such as infrastructure, the built environment, rates of interpersonal violence in a population and individual behaviours such as alcohol intoxication or drug use. The findings in this paper also demonstrate how it is critical to measure and understand the spectrum of health loss due to injuries ranging from relatively silent injuries to injuries that profoundly affect functional status. An incident as elemental as a trip and fall can lead to profoundly disabling health consequences such as spinal cord injury, which can have lifelong disability. The disability caused by shorter term injuries, such as an arm fracture, in addition to causing suffering and disability, can cause loss of human capital.30 While this study focused more on the causes of injury as defined in the GBD cause hierarchy, future GBD studies should focus also on depicting the distribution of nature of injury results to better understand how these types of disability affect an individual’s functional status. Such analyses become increasingly meaningful as research emerges on, for example, the increased risk of dementia that traumatic brain injury patients may experience.31 The findings in this paper also demonstrate how measuring injury burden necessitates review of the population factors that affect injury risk. For example, an event as disastrous as an earthquake may have radically different impacts on a population depending on infrastructure and access to care resources. Understanding how populations can protect themselves against future, unanticipated catastrophe could lead to averted death and disability in the future. As was shown in figure 2, catastrophic events both in terms of natural disasters and war and conflict can significantly add to the death and disability experienced by a population in a short period of time.

The geographical trends shown in this paper are also critical to review and understand by the broader global health community. As shown in figure 6, considerable heterogeneity exists across regions for certain causes. While vehicles were driven in nearly every populated area of earth in 2017, this study shows that different regions of the world have markedly different rates of death and disability resulting from road injuries, underscoring the importance of measuring and understanding the effects of specific factors on injury burden.32 It is not necessarily surprising to observe that countries or regions with relatively lower healthcare access and quality, less road safety infrastructure and lower utilisation of vehicles with modern safety standards would have higher rates of road injuries DALYs. The question that extends from this observation, however, is the extent to which burden from this type of injury cause could be avoided were every country to have the safety and prevention factors available in higher income settings. The injury and safety research communities should consider future investigation of counterfactual analyses to better measure and understand the impact that road safety legislation, modernisation of roads and vehicles and improving first response medical care could have on road injury burden, as an example, though parallel examples can be developed for other injury causes as well. This research could help cost-effectiveness analyses and guide investment in safer infrastructure.

These observations converge on a common theme: much of the injury burden may be largely preventable and understanding the success or failure of different prevention efforts should be a prioritised area of health research. Moreover, it is critical for there to be continued engagement across different areas of the world for the purposes of discussing effective and ineffective injury prevention strategies. Dialogue focused on findings across injury prevention efforts via forums such as global safety conferences as well as studies published in research journals should continue to help policy makers and public health planners make strategic investments for preventing future injury burden.33 In addition, more research into the cause of injury and resulting bodily injury and environmental and contextual features where injuries occur such type of road in a road injury or fires in factories versus in residences may provide further insight into preventing future injury burden.

Known limitations of injury burden estimation in the GBD framework have been reported previously in peer-reviewed literature.1 11 13 16 Generally, identified limitations include data sparsity and correspondingly greater uncertainty in certain geographies, limited geographical coverage of data informing long-term disability estimates and cause–nature relationships, and potential reporting biases for injuries such as self-harm and interpersonal violence. These limitations have been discussed in the aforementioned literature, and this overview study was additionally limited in scope due to the extensive size of the GBD cause hierarchy and location hierarchy. Indeed, over 1400 different cause–nature combinations are available for reporting in the GBD cause hierarchy, and future research would benefit from examining results in the detailed cause hierarchy and across the detailed location, age and sex hierarchy. The GBD Study platform and collaborator network provide a constructive collaborative platform on which future assessments can be conducted and published.

Conclusion

Injury burden is complex but foundational in formulating global health loss. We have identified four broad trends in global injury burden that converge on the principle that injuries should be considered largely preventable but that detailed burden estimates through recent years are a critical global resource to inform meaningful policy. It will be important accurate measurement to continue into the future to guide injury prevention policy.

What is already known on the subject

  • Injury burden globally varies across many dimensions but remains as an important component of global health loss. Regular updates in injury burden measurement are critical.

  • Injuries can be largely preventable, but prevention efforts must be guided by up-to-date estimates of injury burden that can be used on an age-specific, sex-specific, year-specific, location-specific and injury-specific basis.

What this study adds

  • This study incorporates updated data and methods that were used in Global Burden of Disease 2017 with updated burden estimates for the year 2017, as well as newly available results in terms of nature of injury.

  • Global age-standardised mortality and disability-adjusted life years decreased between 1990 and 2017. Decreases in age-standardised incidence were not statistically significant.

  • Trends over time vary depending on the specific injury, sex and location.

  • Injury burden in a population can be radically affected by war, civil conflict and natural disasters.

Acknowledgments

Syed Aljunid acknowledges the Department of Health Policy and Management, Faculty of Public Health, Kuwait University and International Centre for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia and for the approval and support to participate in this research project. Alaa Badawi acknowledges support from the Public Health Agency of Canada. Till Bärnighausen acknowledges support from the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. Felix Carvalho acknowledges UID/MULTI/04378/2019 support with funding from FCT/MCTES through national funds. Vera M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. Kebede Deribe acknowledges support from a grant from the Wellcome Trust [grant number 201900] as part of his International Intermediate Fellowship. Tim Driscoll acknowledges the work on occupational risk factors was partially supported by funds from the World Health Organization. Eduarda Fernandes acknowledges UID/QUI/50006/2019 support with funding from FCT/MCTES through national funds. Yuming Guo acknowledges support from Career Development Fellowships of the Australian National Health and Medical Research Council (numbers APP1107107 and APP1163693). Sheikh Mohammed Shariful Islam acknowledges funding by a Fellowship from National Heart Foundation of Australia and Institute for Physical Activity and Nutrition, Deakin University.Mihajlo Jakovljevic acknowledges support by the Ministry of Education Science and Technological Development of the Republic of Serbia through the Grant number OI175014; publication of results was not contingent upon Ministry's censorship or approval. Sudha Jayaraman acknowledges support from: NIH R21: 1R21TW010439-01A1 (PI); Rotary Foundation Global Grant #GG1749568 (PI); NIH P20: 1P20CA210284-01A1 (Co-PI); DOD grant W81XWH-16-2-0040 (Co-I) during the submitted work. Yun Jin Kim acknowledges support from a grant from the Research Management Centre, Xiamen University Malaysia [grant number: XMUMRF/2018-C2/ITCM/0001]. Kewal Krishan acknowledges support by UGC Centre of Advanced Study (CAS II) awarded to the Department of Anthropology, Panjab University, Chandigarh, India. Manasi Kumar acknowledges FIC/NIH funding from grant K43 1K43MH114320-01. Amanda Mason-Jones acknowledges institutional support from the University of York. Walter Mendoza is currently Program Analyst Population and Development at the Peru Country Office of the United Nations Population Fund-UNFPA, which not necessarily endorses this study. Mariam Molokhia acknowledges support from the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. Ilais Moreno Velásquez acknowledges support by the Sistema Nacional de Investigación (SNI, Senacyt, Panama). Mukhammad David Naimzada acknowledges support from Government of the Russian Federation (Agreement No – 075-02-2019-967). Stanislav S. Otstavnov acknowledges the support from the Government of the Russian Federation (Agreement No – 075-02-2019-967). Ashish Pathak acknowledges support from the Indian Council of Medical Research (ICMR), New Delhi, India (Grant number 2013-1253). Michael R Phillips acknowledges support in part by a grant from the National Science Foundation of China (No. 81761128031). Marina Pinheiro acknowledges FCT for funding support through program DL 57/2016-Norma transitória. Abdallah M. Samy acknowledges support from a fellowship from the Egyptian Fulbright Mission Program. Milena Santric Milicevic acknowledges the support from the Ministry of Education, Science and Technological Development, the Republic of Serbia (Contract No. 175087). Seyedmojtaba Seyedmousavi acknowledges support from the Intramural Research Program of the National Institutes of Health, Clinical Center, Department of Laboratory Medicine, Bethesda, MD, USA. Rafael Tabarés-Seisdedos acknowledges support in part by the national grant PI17/00719 from ISCIII-FEDER. Sojib Bin Zaman acknowledges support from an "Australian Government Research Training Program (RTP) Scholarship." Louisa Degenhardt acknowledges support from an Australian National Health and Medical Research Council (NHMRC) Senior Principal Research Fellowship (#1135991) and by a National Institute of Health (NIH) National Institute on Drug Abuse (NIDA) grant (R01DA1104470).

References

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Footnotes

  • Funding Bill and Melinda Gates Foundation OPP1152504.

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  • Competing interests Dr. James reports grants from Sanofi Pasteur, outside the submitted work. Dr. Driscoll reports grants from World Health Organization, during the conduct of the study. Dr. Ivers reports grants from National Health and Medical Research Council of Australia, during the conduct of the study. Dr. Jozwiak reports personal fees from TEVA, personal fees from ALAB, personal fees from BOEHRINGER INGELHEIM, personal fees from SYNEXUS, non-financial support from SERVIER, non-financial support from MICROLIFE, non-financial support from MEDICOVER, outside the submitted work. Dr. Rakovac reports grants from World Health Organization, during the conduct of the study. Dr Shariful Islam is funded by National Heart Foundation of Australia and Institute for Physical Activity and Nutrition, Deakin University. Dr. Sheikh reports grants from Health Data Research UK, outside the submitted work. Dr. Singh reports personal fees from Crealta/Horizon, Medisys, Fidia, UBM LLC, Trio health, Medscape, WebMD, Clinical Care options, Clearview healthcare partners, Putnam associates, Spherix, Practice Point communications, the National Institutes of Health and the American College of Rheumatology, and Speaker’s bureau of Simply Speaking, owns stock options in Amarin pharmaceuticals and Viking pharmaceuticals, serves on the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arm’s length funding from 12 pharmaceutical companies, serves on the FDA Arthritis Advisory Committee, is a member of the Veterans Affairs Rheumatology Field Advisory Committee, and is the editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis, outside the submitted work. Dr. Stein reports personal fees from Lundbeck, personal fees from Sun, outside the submitted work. Dr. Degenhardt reports grants from Indivior, Seqirus, Reckitt Benckiser, outside the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Availability of input data depends on original source. Select data are available in a public, open access repository. Select data are available on reasonable request. Select data may be obtained from a third party and are not publicly available. All results relevant to the study are included in the article or uploaded as supplementary information or are available online.

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