作者：
Giugliano, Robert P.;Ruff, Christian T.;Braunwald, Eugene;Murphy, Sabina A.;Wiviott, Stephen D.;Halperin, Jonathan L.;Waldo, Albert L.;Ezekowitz, Michael D.;Weitz, Jeffrey I.;Spinar, Jindrich;Ruzyllo, Witold;Ruda, Mikhail;Koretsune, Yukihiro;Betcher, Joshua;Shi, Minggao;Grip, Laura T.;Patel, Shirali P.;Patel, Indravadan;Hanyok, James J.;Mercuri, Michele
期刊：
The New England journal of medicine,2013年369(22):2093-2104 ISSN：0028-4793
通讯作者：
Giugliano, R. P.
作者机构：
[Wiviott, Stephen D.; Ruff, Christian T.; Braunwald, Eugene; Murphy, Sabina A.; Antman, Elliott M.; Grip, Laura T.; Giugliano, Robert P.] Brigham & Womens Hosp, Boston, MA 02115 USA.;[Wiviott, Stephen D.; Ruff, Christian T.; Braunwald, Eugene; Murphy, Sabina A.; Antman, Elliott M.; Grip, Laura T.; Giugliano, Robert P.] Harvard Univ, Sch Med, Boston, MA USA.;[Halperin, Jonathan L.] Mt Sinai Med Ctr, New York, NY 10029 USA.;[Waldo, Albert L.] Univ Hosp Case Med Ctr, Cleveland, OH USA.;[Ezekowitz, Michael D.] Thomas Jefferson Med Coll, Philadelphia, PA USA.
通讯机构：
[Giugliano, R. P.] Brigham & Womens Hosp, Div Cardiovasc Med, TIMI Study Grp, 350 Longwood Ave,1st Flr, Boston, MA 02115 USA.
作者：
Scirica, Benjamin M.;Bhatt, Deepak L.*;Braunwald, Eugene;Steg, P. Gabriel;Davidson, Jaime;Hirshberg, Boaz;Ohman, Peter;Frederich, Robert;Wiviott, Stephen D.;Hoffman, Elaine B.;Cavender, Matthew A.;Udell, Jacob A.;Desai, Nihar R.;Mosenzon, Ofri;McGuire, Darren K.;Ray, Kausik K.;Leiter, Lawrence A.;Raz, Itamar;Desai, Nihar;Abrahamsen, Timothy
期刊：
The New England journal of medicine,2013年369(14):1317-1326 ISSN：0028-4793
通讯作者：
Bhatt, Deepak L.
作者机构：
[Hoffman, Elaine B.; Cavender, Matthew A.; Wiviott, Stephen D.; Udell, Jacob A.; Braunwald, Eugene; Bhatt, Deepak L.; Desai, Nihar R.; Scirica, Benjamin M.] Brigham & Womens Hosp, TIMI Study Grp, Cardiovasc Div, Boston, MA 02115 USA.;[Bhatt, Deepak L.] VA Boston Healthcare Syst, 1400 VFW Pkwy, Boston, MA 02132 USA.;[Hoffman, Elaine B.; Cavender, Matthew A.; Wiviott, Stephen D.; Udell, Jacob A.; Braunwald, Eugene; Bhatt, Deepak L.; Desai, Nihar R.; Scirica, Benjamin M.] Harvard Univ, Sch Med, Boston, MA USA.;[Bhatt, Deepak L.] VA Boston Healthcare Syst, Boston, MA 02132 USA.;[Steg, P. Gabriel] Univ Paris Diderot, Paris, France.
通讯机构：
[Bhatt, Deepak L.] VA Boston Healthcare Syst, 1400 VFW Pkwy, Boston, MA 02132 USA.
摘要：
BACKGROUND: The cardiovascular safety and efficacy of many current antihyperglycemic agents, including saxagliptin, a dipeptidyl peptidase 4 (DPP-4) inhibitor, are unclear. METHODS: We randomly assigned 16,492 patients with type 2 diabetes who had a history of, or were at risk for, cardiovascular events to receive saxagliptin or placebo and followed them for a median of 2.1 years. Physicians were permitted to adjust other medications, including antihyperglycemic agents. The primary end point was a composite of cardiovascular death, myocardial infarction, or ischemic stroke. RESULTS: A primary end-point event occurred in 613 patients in the saxagliptin group and in 609 patients in the placebo group (7.3% and 7.2%, respectively, according to 2-year Kaplan-Meier estimates; hazard ratio with saxagliptin, 1.00; 95% confidence interval [CI], 0.89 to 1.12; P=0.99 for superiority; P<0.001 for noninferiority); the results were similar in the "on-treatment" analysis (hazard ratio, 1.03; 95% CI, 0.91 to 1.17). The major secondary end point of a composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, coronary revascularization, or heart failure occurred in 1059 patients in the saxagliptin group and in 1034 patients in the placebo group (12.8% and 12.4%, respectively, according to 2-year Kaplan-Meier estimates; hazard ratio, 1.02; 95% CI, 0.94 to 1.11; P=0.66). More patients in the saxagliptin group than in the placebo group were hospitalized for heart failure (3.5% vs. 2.8%; hazard ratio, 1.27; 95% CI, 1.07 to 1.51; P=0.007). Rates of adjudicated cases of acute and chronic pancreatitis were similar in the two groups (acute pancreatitis, 0.3% in the saxagliptin group and 0.2% in the placebo group; chronic pancreatitis, <0.1% and 0.1% in the two groups, respectively). CONCLUSIONS: DPP-4 inhibition with saxagliptin did not increase or decrease the rate of ischemic events, though the rate of hospitalization for heart failure was increased. Although saxagliptin improves glycemic control, other approaches are necessary to reduce cardiovascular risk in patients with diabetes. (Funded by AstraZeneca and Bristol-Myers Squibb; SAVOR-TIMI 53 ClinicalTrials.gov number, NCT01107886.).
作者机构：
[Wang, Haidong; Naghavi, Mohsen; Allen, Christine; Barber, Ryan M.; Carter, Austin; Casey, Daniel C.; Charlson, Fiona J.; Chen, Alan Zian; Coates, Matthew M.; Coggeshall, Megan; Dandona, Lalit; Dicker, Daniel J.; Erskine, Holly E.; Ferrari, Alize J.; Fitzmaurice, Christina; Foreman, Kyle; Forouzanfar, Mohammad H.; Fraser, Maya S.; Goldberg, Ellen M.; Graetz, Nicholas; Huynh, Chantal; Johnson, Catherine; Kassebaum, Nicholas J.; Kulikoff, Xie Rachel; Kutz, Michael; Kyu, Hmwe H.; Larson, Heidi J.; Leung, Janni; Lim, Stephen S.; Lind, Margaret; Lozano, Rafael; Marquez, Neal; Mikesell, Joe; Mokdad, Ali H.; Mooney, Meghan D.; Nguyen, Grant; Nsoesie, Elaine; Pigott, David M.; Pinho, Christine; Roth, Gregory A.; Sandar, Logan; Silpakit, Naris; Sligar, Amber; Sorensen, Reed J. D.; Stanaway, Jeffrey; Steiner, Caitlyn; Teeple, Stephanie; Thomas, Bernadette A.; Troeger, Christopher; VanderZanden, Amelia; Vollset, Stein Emil; Wanga, Valentine; Whiteford, Harvey A.; Wolock, Timothy; Zoeckler, Leo; Achoki, Tom; Afshin, Ashkan; Alexander, Lily T.; Anderson, Gregory M.; Biryukov, Stan; Blore, Jed D.; Brown, Alexandria; Brown, Jonathan; Cercy, Kelly; Chew, Adrienne; Cohen, Aaron J.; Daoud, Farah; Dossou, Edem; Estep, Kara; Flaxman, Abraham; Friedman, Joseph; Frostad, Joseph; Futran, Neal D.; Godwin, William W.; Hancock, Jamie; Kasaeian, Amir; Kemmer, Laura; Khalil, Ibrahim A.; Lindsay, M. Patrice; Liu, Patrick Y.; Masiye, Felix; Mirarefin, Mojde; Misganaw, Awoke; Moradi-Lakeh, Maziar; Morgan, Katherine; Ng, Marie; Quame-Amaglo, Justice; Rao, Puja; Reitsma, Marissa B.; Shackelford, Katya A.; Sur, Patrick; Wagner, Joseph A.; Vos, Theo; Lopez, Alan D.; Murray, Christopher J. L.] Inst Hlth Metr & Evaluat, Seattle, WA USA.;[Ellenbogen, Richard G.] Harborview UW Med, Seattle, WA USA.;[Mock, Charles N.; Quistberg, D. Alex] Harborview Injury Prevent & Res Ctr, Seattle, WA USA.;[Quistberg, D. Alex] Dept Anesthesiol & Pain Med, Seattle, WA USA.;[Anderson, Benjamin; Blosser, Christopher D.; Futran, Neal D.; Heckbert, Susan R.; Jensen, Paul N.; Montine, Thomas J.; Tirschwell, David L.; Watkins, David A.] Univ Washington, Seattle, WA 98195 USA.
通讯机构：
[Murray, Christopher J. L.] 2301 5th Ave,Suite 600, Seattle, WA 98121 USA.
摘要：
Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11.3 years (3.7-17.4), to 62.6 years (56.5-70.2). Total deaths increased by 4.1% (2.6-5.6) from 2005 to 2015, rising to 55.8 million (54.9 million to 56.6 million) in 2015, but age-standardised death rates fell by 17.0% (15.8-18.1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14.1% (12.6-16.0) to 39.8 million (39.2 million to 40.5 million) in 2015, whereas age-standardised rates decreased by 13.1% (11.9-14.3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42.1%, 39.1-44.6), malaria (43.1%, 34.7-51.8), neonatal preterm birth complications (29.8%, 24.8-34.9), and maternal disorders (29.1%, 19.3-37.1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Copyright (C) The Author(s). Published by Elsevier Ltd.
作者机构：
[Wu, Feixiang; Lee, Jung Tae; Yushin, Gleb; Nitta, Naoki] Georgia Inst Technol, Sch Mat Sci & Engn, Atlanta, GA 30332 USA.;[Wu, Feixiang] Cent S Univ, Sch Met & Environm, Changsha 410083, Hunan, Peoples R China.
通讯机构：
[Yushin, Gleb] Georgia Inst Technol, Sch Mat Sci & Engn, Atlanta, GA 30332 USA.
摘要：
This review covers key technological developments and scientific challenges for a broad range of Li-ion battery electrodes. Periodic table and potential/capacity plots are used to compare many families of suitable materials. Performance characteristics, current limitations, and recent breakthroughs in the development of commercial intercalation materials such as lithium cobalt oxide (LCO), lithium nickel cobalt manganese oxide (NCM), lithium nickel cobalt aluminum oxide (NCA), lithium iron phosphate (LFP), lithium titanium oxide (LTO) and others are contrasted with that of conversion materials, such as alloying anodes (Si, Ge, Sn, etc.), chalcogenides (S, Se, Te), and metal halides (F, Cl, Br, I). New polyanion cathode materials are also discussed. The cost, abundance, safety, Li and electron transport, volumetric expansion, material dissolution, and surface reactions for each type of electrode materials are described. Both general and specific strategies to overcome the current challenges are covered and categorized.
作者：
Forouzanfar, Mohammad H.;Alexander, Lily;Anderson, H. Ross;Bachman, Victoria F.;Biryukov, Stan;Brauer, Michael;Burnett, Richard;Casey, Daniel;Coates, Matthew M.;Cohen, Aaron;Delwiche, Kristen;Estep, Kara;Frostad, Joseph J.;Astha, K. C.;Kyu, Hmwe H.;Moradi-Lakeh, Maziar;Ng, Marie;Slepak, Erica Leigh;Thomas, Bernadette A.;Wagner, Joseph
期刊：
The Lancet,2015年386(10010):2287-2323 ISSN：0140-6736
通讯作者：
Murray, Christopher J.
作者机构：
[Naghavi, Mohsen; Lozano, Rafael; McLain, Abigail; Moradi-Lakeh, Maziar; Foreman, Kyle J.; Barber, Ryan M.; Kyu, Hmwe H.; Wagner, Joseph; Dandona, Lalit; Larson, Heidi J.; Vos, Theo; Brauer, Michael; Frostad, Joseph J.; Gakidou, Emmanuela; Delwiche, Kristen; Mokdad, Ali H.; Richardson, Lee; MacIntyre, Michael F.; Fleming, Thomas D.; Atkinson, Charles; Slepak, Erica Leigh; Thomas, Bernadette A.; Robinson, Margaret; Margono, Christopher; Achoki, Tom; Ku, Tiffany; Wurtz, Brittany; Mullany, Erin C.; Hay, Simon I.; Cooperrider, Kimberly; Coates, Matthew M.; Cohen, Aaron; Casey, Daniel; Nguyen, Grant; Bachman, Victoria F.; Murray, Christopher J.; Thomson, Blake; Flaxman, Abraham D.; Estep, Kara; Biryukov, Stan; Lopez, Alan D.; Pain, Amanda W.; Iannarone, Marissa L.; Lim, Stephen S.; Ng, Marie; Stephens, Natalie; Dicker, Daniel; Heuton, Kyle R.; Sandar, Logan; Alexander, Lily; Wan, Xia; Forouzanfar, Mohammad H.] Inst Hlth Metr & Evaluat, 2301 5th Ave,Suite 600, Seattle, WA 98121 USA.;[Ebel, Beth E.] Univ Washington, Harborview Injury Prevent & Res Ctr, Seattle, WA 98195 USA.;[Ellenbogen, Richard G.] Univ Washington, Harborview UW Med, Seattle, WA 98195 USA.;[Wright, Jonathan L.] Univ Washington, Sch Med, Seattle, WA 98195 USA.;[Anderson, Benjamin O.; Jensen, Paul N.; Alfonso-Cristancho, Rafael; Quistberg, D. Alex A.; Zunt, Joseph R.; Vavilala, Monica S.; Riederer, Anne] Univ Washington, Seattle, WA 98195 USA.
通讯机构：
[Murray, Christopher J.] Inst Hlth Metr & Evaluat, 2301 5th Ave,Suite 600, Seattle, WA 98121 USA.
摘要：
BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. FINDINGS: All risks combined account for 57.2% (95% uncertainty interval [UI] 55.8-58.5) of deaths and 41.6% (40.1-43.0) of DALYs. Risks quantified account for 87.9% (86.5-89.3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11.3 million deaths and 241.4 million DALYs, high systolic blood pressure for 10.4 million deaths and 208.1 million DALYs, child and maternal malnutrition for 1.7 million deaths and 176.9 million DALYs, tobacco smoke for 6.1 million deaths and 143.5 million DALYs, air pollution for 5.5 million deaths and 141.5 million DALYs, and high BMI for 4.4 million deaths and 134.0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks. FUNDING: Bill & Melinda Gates Foundation.
作者机构：
[Forouzanfar, Mohammad H.; Afshin, Ashkan; Alexander, Lily T.; Biryukov, Stan; Brauer, Michael; Cercy, Kelly; Charlson, Fiona J.; Cohen, Aaron J.; Dandona, Lalit; Estep, Kara; Ferrari, Alize J.; Frostad, Joseph J.; Fullman, Nancy; Godwin, William W.; Griswold, Max; Kyu, Hmwe H.; Larson, Heidi J.; Lim, Stephen S.; Liu, Patrick Y.; Lopez, Alan D.; Lozano, Rafael; Marczak, Laurie; Mokdad, Ali H.; Moradi-Lakeh, Maziar; Naghavi, Mohsen; Reitsma, Marissa B.; Roth, Gregory A.; Sur, Patrick J.; Vos, Theo; Wagner, Joseph A.; Wang, Haidong; Zhao, Yi; Zhou, Maigeng; Barber, Ryan M.; Blore, Jed D.; Casey, Daniel C.; Coates, Matthew M.; Cooperrider, Kimberly; Cornaby, Leslie; Dicker, Daniel; Erskine, Holly E.; Fleming, Tom; Foreman, Kyle; Gakidou, Emmanuela; Haagsma, Juanita A.; Johnson, Catherine O.; Ku, Tiffany; Leung, Janni; Mirarefin, Mojde; Misganaw, Awoke; Mullany, Erin; Mumford, John Everett; Ng, Marie; Olsen, Helen; Rao, Puja; Reinig, Nikolas; Roman, Yesenia; Sandar, Logan; Santomauro, Damian F.; Slepak, Erica Leigh; Sorensen, Reed J. D.; Thomas, Bernadette A.; Vollset, Stein Emil; Whiteford, Harvey A.; Zipkin, Ben; Murray, Christopher J. L.] Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;[Mock, Charles N.] Univ Washington, Harborview Injury Prevent & Res Ctr, Seattle, WA 98195 USA.;[Anderson, Benjamin O.; Futran, Neal D.] Univ Washington, Seattle, WA 98195 USA.;[Anderson, H. Ross] St Georges Univ London, Populat Hlth Res Inst, London, England.;[Bhutta, Zulficiar A.] Aga Khan Univ, Ctr Excellence Women & Child Hlth, Karachi, Pakistan.
通讯机构：
[Murray, Christopher J. L.] Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.
摘要：
Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57.8% (95% CI 56.6-58.8) of global deaths and 41.2% (39.8-42.8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211.8 million [192.7 million to 231.1 million] global DALYs), smoking (148.6 million [134.2 million to 163.1 million]), high fasting plasma glucose (143.1 million [125.1 million to 163.5 million]), high BMI (120.1 million [83.8 million to 158.4 million]), childhood undernutrition (113.3 million [103.9 million to 123.4 million]), ambient particulate matter (103.1 million [90.8 million to 115.1 million]), high total cholesterol (88.7 million [74.6 million to 105.7 million]), household air pollution (85.6 million [66.7 million to 106.1 million]), alcohol use (85.0 million [77.2 million to 93.0 million]), and diets high in sodium (83.0 million [49.3 million to 127.5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. Copyright (C) The Author(s). Published by Elsevier Ltd.
作者：
Murray, Christopher J. L.*;Barber, Ryan M.;Foreman, Kyle J.;Ozgoren, Ayse Abbasoglu;Abd-Allah, Foad;Abera, Semaw F.;Aboyans, Victor;Abraham, Jerry P.;Abubakar, Ibrahim;Abu-Raddad, Laith J.;Abu-Rmeileh, Niveen M.;Achoki, Tom;Ackerman, Ilana N.;Ademi, Zanfina;Adou, Arsene K.;Adsuar, Jose C.;Afshin, Ashkan;Agardh, Emilie E.;Alam, Sayed Saidul;Alasfoor, Deena
期刊：
The Lancet,2015年386(10009):2145-2191 ISSN：0140-6736
通讯作者：
Murray, Christopher J. L.
作者机构：
[Bulchis, Anne; Duber, Herbert C.; Lind, Maggie; Naghavi, Mohsen; Lozano, Rafael; Levitz, Carly E.; Temesgen, Awoke M.; McLain, Abigail; Moradi-Lakeh, Maziar; Foreman, Kyle J.; Hamavid, Hannah; Roberts, D. Allen; Barber, Ryan M.; Huynh, Chantal; Afshin, Ashkan; Macintyre, Michael F.; Kyu, Hmwe H.; Wagner, Joseph; Shackelford, Katya A.; Phillips, David E.; Dandona, Lalit; Phillips, Bryan K.; Vos, Theo; Templin, Tara; Bertozzi-Villa, Amelia; Mokdad, Ali H.; Richardson, Lee; Blore, Jed D.; Fleming, Thomas D.; Schumacher, Austin E.; Slepak, Erica Leigh; Margono, Christopher; Achoki, Tom; Wurtz, Brittany; Mullany, Erin C.; Hay, Simon I.; Coates, Matthew M.; Roth, Gregory A.; Nguyen, Grant; Hancock, Jamie; Bachman, Victoria F.; Thomson, Blake; Flaxman, Abraham D.; Stanaway, Jeffrey D.; Bolliger, Ian W.; Ortblad, Katrina; Estep, Kara; Serina, Peter T.; Biryukov, Stan; Brown, Jonathan C.; Stewart, Andrea; Wolock, Timothy M.; Moyer, Madeline L.; Pain, Amanda W.; Singh, Lavanya; Iannarone, Marissa L.; Graetz, Nicholas; Lim, Stephen S.; Fitzmaurice, Christina; Dansereau, Emily; Ng, Marie; Murray, Christopher J. L.; Steiner, Caitlyn; Msemburi, William T.; Stevens, Antony; Hansen, Gillian M.; Dicker, Daniel; Heuton, Kyle R.; Ohno, Summer L.; Lofgren, Katherine T.; Wulf, Sarah; Coggeshall, Megan S.; Mooney, Meghan D.; Higashi, Hideki; Sandar, Logan; Gonzalez-Medina, Diego; Haagsma, Juanita; Coffeng, Luc E.; Wan, Xia; Forouzanfar, Mohammad H.; Bienhoff, Kelly; Kassebaum, Nicholas J.; Wang, Haidong] Univ Washington, Inst Hlth Metr & Evaluat, Seattle, WA 98121 USA.;[Ebel, Beth E.] Univ Washington, Harborview Injury Prevent & Res Ctr, Seattle, WA 98195 USA.;[Kassebaum, Nicholas J.] Univ Washington, Seattle Childrens Hosp, Seattle, WA 98195 USA.;[Anderson, Benjamin O.; Blosser, Christopher D.; Mock, Charles N.; Montine, Thomas J.; Quistberg, D. Alex; Jensen, Paul N.; Alfonso-Cristancho, Rafael] Univ Washington, Seattle, WA 98195 USA.;[Fuerst, Thomas] Univ London Imperial Coll Sci Technol & Med, Dept Infect Dis Epidemiol, London, England.
通讯机构：
[Murray, Christopher J. L.] Inst Hlth Metr & Evaluat, 2301 5th Ave,Suite 600, Seattle, WA 98121 USA.
摘要：
BACKGROUND: The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS: We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS: Worldwide, from 1990 to 2013, life expectancy at birth rose by 6.2 years (95% UI 5.6-6.6), from 65.3 years (65.0-65.6) in 1990 to 71.5 years (71.0-71.9) in 2013, HALE at birth rose by 5.4 years (4.9-5.8), from 56.9 years (54.5-59.1) to 62.3 years (59.7-64.8), total DALYs fell by 3.6% (0.3-7.4), and age-standardised DALY rates per 100 000 people fell by 26.7% (24.6-29.1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION: Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING: Bill & Melinda Gates Foundation.
作者：
Bonaca, Marc P.*;Bhatt, Deepak L.;Cohen, Marc;Steg, Philippe Gabriel;Storey, Robert F.;Jensen, Eva C.;Magnani, Giulia;Bansilal, Sameer;Fish, M. Polly;Im, Kyungah;Bengtsson, Olof;Ophuis, Ton Oude;Budaj, Andrzej;Theroux, Pierre;Ruda, Mikhail;Hamm, Christian;Goto, Shinya;Spinar, Jindrich;Nicolau, Jose Carlos;Kiss, Robert G.
期刊：
The New England journal of medicine,2015年372(19):1791-1800 ISSN：0028-4793
通讯作者：
Bonaca, Marc P.
作者机构：
[Wiviott, Stephen D.; Bonaca, Marc P.; Magnani, Giulia; Im, KyungAh; Murphy, Sabina A.; Fish, M. Polly; Sabatine, Marc S.; Braunwald, Eugene; Bhatt, Deepak L.] Brigham & Womens Hosp, Thrombolysis Myocardial Infarct TIMI Study Grp, Cardiovasc Div, Dept Med, Boston, MA 02115 USA.;[Wiviott, Stephen D.; Bonaca, Marc P.; Magnani, Giulia; Im, KyungAh; Murphy, Sabina A.; Fish, M. Polly; Sabatine, Marc S.; Braunwald, Eugene; Bhatt, Deepak L.] Harvard Univ, Sch Med, Boston, MA USA.;[Cohen, Marc] Rutgers New Jersey Med Sch, Newark Beth Israel Med Ctr, Dept Med, Cardiovasc Div, Newark, NJ USA.;[Steg, Philippe Gabriel] Hop Bichat Claude Bernard, AP HP, Dept Hosp Univ Fibrosis,INSERM,U1148, French Alliance Cardiovasc Trials,Inflammat,Remod, F-75877 Paris, France.;[Steg, Philippe Gabriel] Univ Paris Diderot, Sorbonne Paris Cite, Paris, France.
通讯机构：
[Bonaca, Marc P.] Brigham & Womens Hosp, TIMI Study Grp, Cardiovasc Div, 75 Francis St, Boston, MA 02115 USA.
摘要：
BACKGROUND The potential benefit of dual antiplatelet therapy beyond 1 year after a myocardial infarction has not been established. We investigated the efficacy and safety of ticagrelor, a P2Y(12) receptor antagonist with established efficacy after an acute coronary syndrome, in this context. METHODS We randomly assigned, in a double-blind 1: 1: 1 fashion, 21,162 patients who had had a myocardial infarction 1 to 3 years earlier to ticagrelor at a dose of 90 mg twice daily, ticagrelor at a dose of 60 mg twice daily, or placebo. All the patients were to receive low-dose aspirin and were followed for a median of 33 months. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The primary safety end point was Thrombolysis in Myocardial Infarction (TIMI) major bleeding. RESULTS The two ticagrelor doses each reduced, as compared with placebo, the rate of the primary efficacy end point, with Kaplan-Meier rates at 3 years of 7.85% in the group that received 90 mg of ticagrelor twice daily, 7.77% in the group that received 60 mg of ticagrelor twice daily, and 9.04% in the placebo group (hazard ratio for 90 mg of ticagrelor vs. placebo, 0.85; 95% confidence interval [CI], 0.75 to 0.96; P = 0.008; hazard ratio for 60 mg of ticagrelor vs. placebo, 0.84; 95% CI, 0.74 to 0.95; P = 0.004). Rates of TIMI major bleeding were higher with ticagrelor (2.60% with 90 mg and 2.30% with 60 mg) than with placebo (1.06%) (P < 0.001 for each dose vs. placebo); the rates of intracranial hemorrhage or fatal bleeding in the three groups were 0.63%, 0.71%, and 0.60%, respectively. CONCLUSIONS In patients with a myocardial infarction more than 1 year previously, treatment with ticagrelor significantly reduced the risk of cardiovascular death, myocardial infarction, or stroke and increased the risk of major bleeding. (Funded by AstraZeneca; PEGASUS-TIMI 54 ClinicalTrials.gov number, NCT01225562.)
