Imperial College London

DrFelixGreaves

Faculty of MedicineSchool of Public Health

Clinical Senior Lecturer
 
 
 
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Contact

 

felix.greaves08

 
 
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Charing Cross HospitalCharing Cross Campus

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Summary

 

Publications

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126 results found

Karpathakis K, Libow G, Potts HWW, Dixon S, Greaves F, Murray Eet al., 2021, An Evaluation Service for Digital Public Health Interventions: User-Centered Design Approach., J Med Internet Res, Vol: 23

BACKGROUND: Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating DHIs. OBJECTIVE: This study aims to report on the Public Health England (PHE) initiative set out to operationalize an evaluation framework that combines biomedical and digital approaches and demonstrates the impact, cost-effectiveness, and benefit of DHIs on public health. METHODS: We comprised a multidisciplinary project team including service designers, academics, and public health professionals and used user-centered design methods, such as qualitative research, engagement with end users and stakeholders, and iterative learning. The iterative approach enabled the team to sequentially define the problem, understand user needs, identify opportunity areas, develop concepts, test prototypes, and plan service implementation. Stakeholders, senior leaders from PHE, and a working group critiqued the outputs. RESULTS: We identified 26 themes and 82 user needs from semistructured interviews (N=15), expressed as 46 Jobs To Be Done, which were then validated across the journey of evaluation design for a DHI. We identified seven essential concepts for evaluating DHIs: evaluation thinking, evaluation canvas, contract assistant, testing toolkit, development history, data hub, and publish health outcomes. Of these, three concepts were prioritized for further testing and development, and subsequently refined into the proposed PHE Evaluation Service for public health DHIs. Testing with PHE's Couch-to-5K app digital team confirmed the viability, desirability, and feasibility of both the evaluation approach and the Evaluation Service. CONCLUSIONS: An iterative, user-centered design approach enabled PHE to combine the strengths of academi

Journal article

Jombart T, Ghozzi S, Schumacher D, Taylor TJ, Leclerc QJ, Jit M, Flasche S, Greaves F, Ward T, Eggo RM, Nightingale E, Meakin S, Brady OJ, Medley GF, Hohle M, Edmunds WJet al., 2021, Real-time monitoring of COVID-19 dynamics using automated trend fitting and anomaly detection, PHILOSOPHICAL TRANSACTIONS OF THE ROYAL SOCIETY B-BIOLOGICAL SCIENCES, Vol: 376, ISSN: 0962-8436

Journal article

Sounderajah V, Ashrafian H, Golub RM, Shetty S, De Fauw J, Hooft L, Moons K, Collins G, Moher D, Bossuyt PM, Darzi A, Karthikesalingam A, Denniston AK, Mateen BA, Ting D, Treanor D, King D, Greaves F, Godwin J, Pearson-Stuttard J, Harling L, McInnes M, Rifai N, Tomasev N, Normahani P, Whiting P, Aggarwal R, Vollmer S, Markar SR, Panch T, Liu X, STARD-AI Steering Committeeet al., 2021, Developing a reporting guideline for artificial intelligence-centred diagnostic test accuracy studies: the STARD-AI protocol, BMJ Open, Vol: 11, ISSN: 2044-6055

Introduction Standards for Reporting of Diagnostic Accuracy Study (STARD) was developed to improve the completeness and transparency of reporting in studies investigating diagnostic test accuracy. However, its current form, STARD 2015 does not address the issues and challenges raised by artificial intelligence (AI)-centred interventions. As such, we propose an AI-specific version of the STARD checklist (STARD-AI), which focuses on the reporting of AI diagnostic test accuracy studies. This paper describes the methods that will be used to develop STARD-AI.Methods and analysis The development of the STARD-AI checklist can be distilled into six stages. (1) A project organisation phase has been undertaken, during which a Project Team and a Steering Committee were established; (2) An item generation process has been completed following a literature review, a patient and public involvement and engagement exercise and an online scoping survey of international experts; (3) A three-round modified Delphi consensus methodology is underway, which will culminate in a teleconference consensus meeting of experts; (4) Thereafter, the Project Team will draft the initial STARD-AI checklist and the accompanying documents; (5) A piloting phase among expert users will be undertaken to identify items which are either unclear or missing. This process, consisting of surveys and semistructured interviews, will contribute towards the explanation and elaboration document and (6) On finalisation of the manuscripts, the group’s efforts turn towards an organised dissemination and implementation strategy to maximise end-user adoption.Ethics and dissemination Ethical approval has been granted by the Joint Research Compliance Office at Imperial College London (reference number: 19IC5679). A dissemination strategy will be aimed towards five groups of stakeholders: (1) academia, (2) policy, (3) guidelines and regulation, (4) industry and (5) public and non-specific stakeholders. We anticipate th

Journal article

Reitsma MB, Kendrick PJ, Ababneh E, Abbafati C, Abbasi-Kangevari M, Abdoli A, Abedi A, Abhilash ES, Abila DB, Aboyans V, Abu-Rmeileh NME, Adebayo OM, Advani SM, Aghaali M, Ahinkorah BO, Ahmad S, Ahmadi K, Ahmed H, Aji B, Akunna CJ, Al-Aly Z, Alanzi TM, Alhabib KF, Ali L, Alif SM, Alipour V, Aljunid SM, Alla F, Allebeck P, Alvis-Guzman N, Amin TT, Amini S, Amu H, Amul GGH, Ancuceanu R, Anderson JA, Ansari-Moghaddam A, Antonio CAT, Antony B, Anvari D, Arabloo J, Arian ND, Arora M, Asaad M, Ausloos M, Awan AT, Ayano G, Aynalem GL, Azari S, B DB, Badiye AD, Baig AA, Bakhshaei MH, Banach M, Banik PC, Barker-Collo SL, Bärnighausen TW, Barqawi HJ, Basu S, Bayati M, Bazargan-Hejazi S, Behzadifar M, Bekuma TT, Bennett DA, Bensenor IM, Berfield KSS, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bibi S, Bijani A, Bintoro BS, Biondi A, Birara S, Braithwaite D, Brenner H, Brunoni AR, Burkart K, Butt ZA, Caetano dos Santos FL, Cámera LA, Car J, Cárdenas R, Carreras G, Carrero JJ, Castaldelli-Maia JM, Cattaruzza MSS, Chang J-C, Chen S, Chu D-T, Chung S-C, Cirillo M, Costa VM, Couto RAS, Dadras O, Dai X, Damasceno AAM, Damiani G, Dandona L, Dandona R, Daneshpajouhnejad P, Darega Gela J, Davletov K, Derbew Molla M, Dessie GA, Desta AA, Dharmaratne SD, Dianatinasab M, Diaz D, Do HT, Douiri A, Duncan BB, Duraes AR, Eagan AW, Ebrahimi Kalan M, Edvardsson K, Elbarazi I, El Tantawi M, Esmaeilnejad S, Fadhil I, Faraon EJA, Farinha CSES, Farwati M, Farzadfar F, Fazlzadeh M, Feigin VL, Feldman R, Fernandez Prendes C, Ferrara P, Filip I, Filippidis F, Fischer F, Flor LS, Foigt NA, Folayan MO, Foroutan M, Gad MM, Gaidhane AM, Gallus S, Geberemariyam BS, Ghafourifard M, Ghajar A, Ghashghaee A, Giampaoli S, Gill PS, Glozah FN, Gnedovskaya EV, Golechha M, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Greaves F, Guha A, Guo Y, Gupta B, Gupta RD, Gupta R, Gupta T, Gupta V, Hafezi-Nejad N, Haider MR, Hamadeh RR, Hankey GJ, Hargono A, Hartono RK, Hassankhani H, Hay SI, Heidari G, Hertelet al., 2021, Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019, The Lancet, Vol: 397, Pages: 2337-2360, ISSN: 0140-6736

BackgroundEnding the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally.MethodsWe estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available.FindingsGlobally in 2019, 1·14 billion (95% uncertainty interval 1·13–1·16) individuals were current smokers, who consumed 7·41 trillion (7·11–7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5–28·5] reduction) and females (37·7% [35·4–39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98–1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16–8·20) deaths and 200 million (185–214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3–21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers.Int

Journal article

Unsworth H, Dillon B, Collinson L, Powell H, Salmon M, Oladapo T, Ayiku L, Shield G, Holden J, Patel N, Campbell M, Greaves F, Joshi I, Powell J, Tonnel Aet al., 2021, The NICE Evidence Standards Framework for digital health and care technologies - Developing and maintaining an innovative evidence framework with global impact, DIGITAL HEALTH, Vol: 7, ISSN: 2055-2076

Journal article

Naughton F, Brown C, High J, Notley C, Mascolo C, Coleman T, Barton G, Shepstone L, Sutton S, Prevost AT, Crane D, Greaves F, Hope Aet al., 2021, Randomised controlled trial of a just-in-time adaptive intervention (JITAI) smoking cessation smartphone app: the Quit Sense feasibility trial protocol., BMJ Open, Vol: 11

INTRODUCTION: A lapse (any smoking) early in a smoking cessation attempt is strongly associated with reduced success. A substantial proportion of lapses are due to urges to smoke triggered by situational cues. Currently, no available interventions proactively respond to such cues in real time. Quit Sense is a theory-guided just-in-time adaptive intervention smartphone app that uses a learning tool and smartphone sensing to provide in-the-moment tailored support to help smokers manage cue-induced urges to smoke. The primary aim of this randomised controlled trial (RCT) is to assess the feasibility of delivering a definitive online efficacy trial of Quit Sense. METHODS AND ANALYSES: A two-arm parallel-group RCT allocating smokers willing to make a quit attempt, recruited via online adverts, to usual care (referral to the NHS SmokeFree website) or usual care plus Quit Sense. Randomisation will be stratified by smoking rate (<16 vs ≥16 cigarettes/day) and socioeconomic status (low vs high). Recruitment, enrolment, baseline data collection, allocation and intervention delivery will be automated through the study website. Outcomes will be collected at 6 weeks and 6 months follow-up via the study website or telephone, and during app usage. The study aims to recruit 200 smokers to estimate key feasibility outcomes, the preliminary impact of Quit Sense and potential cost-effectiveness, in addition to gaining insights on user views of the app through qualitative interviews. ETHICS AND DISSEMINATION: Ethics approval has been granted by the Wales NHS Research Ethics Committee 7 (19/WA/0361). The findings will be disseminated to the public, the funders, relevant practice and policy representatives and other researchers. TRIAL REGISTRATION NUMBER: ISRCTN12326962.

Journal article

Gold N, Egan M, Londakova K, Mottershaw A, Harper H, Burton R, Henn C, Smolar M, Walmsley M, Arambepola R, Watson R, Bowen S, Greaves Fet al., 2021, Effect of alcohol label designs with different pictorial representations of alcohol content and health warnings on knowledge and understanding of low-risk drinking guidelines: a randomized controlled trial, ADDICTION, Vol: 116, Pages: 1443-1459, ISSN: 0965-2140

Journal article

Greaves F, Boysen M, 2021, NICE's approach to measuring value, BMJ-BRITISH MEDICAL JOURNAL, Vol: 372, ISSN: 1756-1833

Journal article

Garnett C, Oldham M, Angus C, Beard E, Burton R, Field M, Greaves F, Hickman M, Kaner E, Loebenberg G, Michie S, Munafo M, Pizzo E, Brown Jet al., 2020, Evaluating the effectiveness of the smartphone app, Drink Less, compared with the NHS alcohol advice webpage, for the reduction of alcohol consumption among hazardous and harmful adult drinkers in the UK at 6-month follow-up: protocol for a randomised controlled trial, ADDICTION, Vol: 116, Pages: 412-425, ISSN: 0965-2140

Journal article

Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abolhassani H, Aboyans V, Abrams EM, Abreu LG, Abrigo MRM, Abu-Raddad LJ, Abushouk AI, Acebedo A, Ackerman IN, Adabi M, Adamu AA, Adebayo OM, Adekanmbi V, Adelson JD, Adetokunboh OO, Adham D, Afshari M, Afshin A, Agardh EE, Agarwal G, Agesa KM, Aghaali M, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmadpour E, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Al-Aly Z, Alam K, Alam N, Alam S, Alam T, Alanzi TM, Albertson SB, Alcalde-Rabanal JE, Alema NM, Ali M, Ali S, Alicandro G, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Aminorroaya A, Amiri F, Amit AML, Amugsi DA, Amul GGH, Anderlini D, Andrei CL, Andrei T, Anjomshoa M, Ansari F, Ansari I, Ansari-Moghaddam A, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Arabloo J, Arab-Zozani M, Aravkin AY, Ariani F, Ärnlöv J, Aryal KK, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari B, Ashbaugh C, Atnafu DD, Atre SR, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, Babaee E, Badawi A, Bagherzadeh M, Bakhshaei MH, Bakhtiari A, Balakrishnan S, Balalla S, Balassyano S, Banach M, Banik PC, Bannick MS, Bante AB, Baraki AG, Barboza MA, Barker-Collo SL, Barthelemy CM, Barua L, Barzegar A, Basu S, Baune BT, Bayati M, Bazmandegan G, Bedi N, Beghi E, Béjot Y, Bello AK, Bender RG, Bennett DA, Bennitt FB, Bensenor IM, Benziger CP, Berhe K, Bernabe E, Bertolacci GJ, Bhageerathy R, Bhala N, Bhandari D, Bhardwaj P, Bhattacharyya K, Bhutta ZA, Bibi S, Biehl MH, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisanzio D, Bisignano C, Biswas RK, Bohlouli S, Bohluli M, Bolla SRR, Boloor A, Boon-Dooley AS, Borges G, Borzì AM, Bourne R, Brady OJ, Brauer M, Brayne C, Breet al., 2020, Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 396, Pages: 1204-1222, ISSN: 0140-6736

BackgroundIn an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries.MethodsGBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of

Journal article

Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abegaz KH, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abualhasan A, Abu-Raddad LJ, Abushouk AI, Adabi M, Adekanmbi V, Adeoye AM, Adetokunboh OO, Adham D, Advani SM, Agarwal G, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmadieh H, Ahmed MB, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Akunna CJ, Alahdab F, Al-Aly Z, Alam K, Alam S, Alam T, Alanezi FM, Alanzi TM, Alemu BW, Alhabib KF, Ali M, Ali S, Alicandro G, Alinia C, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Al-Mekhlafi HM, Alonso J, Altirkawi KA, Amini-Rarani M, Amiri F, Amugsi DA, Ancuceanu R, Anderlini D, Anderson JA, Andrei CL, Andrei T, Angus C, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonazzo IC, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ariani F, Armoon B, Ärnlöv J, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Assmus M, Atafar Z, Atnafu DD, Atout MMW, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azarian G, Azene ZN, Badawi A, Badiye AD, Bahrami MA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Baldasseroni A, Ball K, Ballew SH, Balzi D, Banach M, Banerjee SK, Bante AB, Baraki AG, Barker-Collo SL, Bärnighausen TW, Barrero LH, Barthelemy CM, Barua L, Basu S, Baune BT, Bayati M, Becker JS, Bedi N, Beghi E, Béjot Y, Bell ML, Bennitt FB, Bensenor IM, Berhe K, Berman AE, Bhagavathula AS, Bhageerathy R, Bhala N, Bhandari D, Bhattacharyya K, Bhutta ZA, Bijani A, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisignano C, Biswas RK, Bitew H, Bohlouli S, Bohluli M, Boon-Dooley AS, Borges G, Borzì AM, Borzouei S, Bosetti C, Boufous S, Braithwaite D, Breitborde NJK, Breitner S, Brenner H, Briant PS, Briko AN, Briko NI, Britton GB, Bryazka D, Bumgarner BR, Burkart K, Burnett RT, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cahill LE, Cámeraet al., 2020, Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019, The Lancet, Vol: 396, Pages: 1223-1249, ISSN: 0140-6736

BackgroundRigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease.MethodsGBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quant

Journal article

Murray CJL, Abbafati C, Abbas KM, Abbasi M, Abbasi-Kangevari M, Abd-Allah F, Abdollahi M, Abedi P, Abedi A, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abu-Gharbieh E, Abu Haimed AK, Abushouk AI, Acebedo A, Ackerman IN, Adabi M, Adamu AA, Adebayo OM, Adelson JD, Adetokunboh OO, Afarideh M, Afshin A, Agarwal G, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmed MB, Aji B, Akinyemiju T, Akombi B, Alahdab F, Alam K, Alanezi FM, Alanzi TM, Albertson SB, Alemu BW, Alemu YM, Alhabib KF, Ali M, Ali S, Alicandro G, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almadi MAH, Almasi-Hashiani A, Al-Mekhlafi HM, Almulhim AM, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Amare B, Amare AT, Amini S, Amit AML, Amugsi DA, Anbesu EW, Ancuceanu R, Anderlini D, Anderson JA, Andrei T, Andrei CL, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonio CAT, Antony CM, Anvari D, Appiah SCY, Arabloo J, Arab-Zozani M, Aravkin AY, Arba AAK, Aripov T, Ärnlöv J, Arowosegbe OO, Asaad M, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Assmus M, Atout MMW, Ausloos M, Ausloos F, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azene ZN, B DB, Babaee E, Badawi A, Badiye AD, Bagherzadeh M, Bairwa M, Bakhtiari A, Bakkannavar SM, Balachandran A, Banach M, Banerjee SK, Banik PC, Baraki AG, Barker-Collo SL, Basaleem H, Basu S, Baune BT, Bayati M, Baye BA, Bedi N, Beghi E, Bell ML, Bensenor IM, Berhe K, Berman AE, Bhagavathula AS, Bhala N, Bhardwaj P, Bhattacharyya K, Bhattarai S, Bhutta ZA, Bijani A, Bikbov B, Biondi A, Bisignano C, Biswas RK, Bjørge T, Bohlouli S, Bohluli M, Bolla SRR, Boloor A, Bose D, Boufous S, Brady OJ, Braithwaite D, Brauer M, Breitborde NJK, Brenner H, Breusov AV, Briant PS, Briggs AM, Britton GB, Brugha T, Burugina Nagaraja S, Busse R, Butt ZA, Caetano dos Santos FL, Cámera LLAA, Campos-Nonato IR, Campuzano Rincon JC, Car J, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castelpietra G, Castro F, Catalá-López F, Causey K, Cederroth CR, Cercy KM Cet al., 2020, Five insights from the global burden of disease study 2019, The Lancet, Vol: 396, Pages: 1135-1159, ISSN: 0140-6736

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a rules-based synthesis of the available evidence on levels and trends in health outcomes, a diverse set of risk factors, and health system responses. GBD 2019 covered 204 countries and territories, as well as first administrative level disaggregations for 22 countries, from 1990 to 2019. Because GBD is highly standardised and comprehensive, spanning both fatal and non-fatal outcomes, and uses a mutually exclusive and collectively exhaustive list of hierarchical disease and injury causes, the study provides a powerful basis for detailed and broad insights on global health trends and emerging challenges. GBD 2019 incorporates data from 281 586 sources and provides more than 3·5 billion estimates of health outcome and health system measures of interest for global, national, and subnational policy dialogue. All GBD estimates are publicly available and adhere to the Guidelines on Accurate and Transparent Health Estimate Reporting. From this vast amount of information, five key insights that are important for health, social, and economic development strategies have been distilled. These insights are subject to the many limitations outlined in each of the component GBD capstone papers.

Journal article

Nguyen V, Aldridge R, Blackburn R, Hayward A, Greaves F, Flowers Jet al., 2020, Does the NHS Diabetes Prevention Programme prevent diabetes? A population-based matched cohort study, Publisher: OXFORD UNIV PRESS, Pages: V437-V437, ISSN: 1101-1262

Conference paper

Ram B, Venkatraman T, Foley K, Honeyford K, Ells L, van Sluijs E, Hargreaves D, Greaves F, Viner R, Saxena Set al., 2020, Impact of school-based physical activity interventions in primary schools: measuring what matters, European Public Health Conference, Publisher: Oxford University Press, Pages: 1-2, ISSN: 1101-1262

BackgroundA growing number of small studies suggest that school-based physical activity initiatives can help children achieve the recommended 60 minutes of physical activity per day. However, the heterogeneity of outcomes and measures used in small studies prevents pooling of results to demonstrate whether short-term health benefits are sustained. Qualitative studies suggest many benefits that are not represented by outcomes in trials to date. The aim of this study was to generate a list of outcomes that have been studied to develop a core outcome set (COS) acceptable to key stakeholders for future studies evaluating school-based physical activity initiatives.MethodsWe searched six databases (MEDLINE, EMBASE, PsycINFO, CINAHL, CENTRAL and Cochrane Database of Systematic Reviews) systematically for reviews of school-based physical activity interventions, and extracted relevant studies to identify the outcomes and measures used in each paper. A long list was generated from the literature and a previous workshop with stakeholders. This study is registered with COMET (#1322), and with PROSPERO (CRD42019146621).Results75/121 cited studies drawn from 53/2409 reviews met our inclusion criteria. We grouped 65 outcomes into 3 domains: (i) physical activity and health (ii) social and emotional health, and (iii) educational attainment. We will conduct two Delphi survey rounds with four stakeholder groups (health professionals, researchers, educators and parents) to rate the importance of each outcome. A core outcome set will be generated from a consensus process.ConclusionsThere is currently a large variation of outcomes and measures studied that precludes evidence synthesis of the impact of school-based physical activity interventions. Consensus methods are needed to focus research on the outcomes that matter the most to key stakeholders and to provide tools for future studies to assess long-term impact.Key messagesVariations in outcomes studied precludes evidence synt

Conference paper

Alturkistani A, Qavi A, Anyanwu PE, Greenfield G, Greaves F, Costelloe Cet al., 2020, Patient portal functionalities and patient outcomes among patients with diabetes: systematic review (Preprint), Publisher: JMIR Publications

Background:Patient portal use could help improve diabetes patients’ care and health outcomes due to the features such as appointment booking, e-messaging, repeat prescription ordering that enable patient-centred care and improved patient self-management of the disease.Objective:To assess health and healthcare quality outcomes associated with the use of tethered (portals that are connected to the electronic healthcare record) patient portals by adult patients (18 years or older) with diabetes.Methods:We searched the databases including Medline, Embase and Scopus and reported the review methodology using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent reviewers screened titles and abstracts, and two reviewers assessed full-texts of relevant studies and performed data extraction and quality assessments of the included studies. We used the Cochrane Collaboration Risk of Bias Tool and the National Heart, Lung and Blood Institute (NIH) Study Quality Assessment Tools to assess the risk of bias of the included studies. Data were summarised through narrative synthesis.Results:Twelve studies were included in this review. Nine studies reported outcomes related to glycaemic control and most of them found statistically significant associations between using a patient portal and glycaemic control. Some studies also found an inverse association or no association between patient portal use and blood pressure, LDL cholesterol or BMI. Studies reported mixed outcomes regarding the use of patient portals and healthcare utilisation measures such as office visits, emergency department visits and hospitalisations. Few studies reported overall improved quality of care for diabetes patients who used patient portals.Conclusions:Studies mostly reported improved health outcomes for diabetes patients who used patient portals. However, the limitations of studying the effects of patient portals exist that do not guarantee whether

Working paper

Alturkistani A, Qavi A, Anyanwu PE, Greenfield G, Greaves F, Costelloe Cet al., 2020, Patient portal functionalities and patient outcomes among diabetes patients: a systematic, Journal of Medical Internet Research, Vol: 22, Pages: 1-9, ISSN: 1438-8871

Background:Patient portal use could help improve diabetes patients’ care and health outcomes due to the functionalities such as appointment booking, e-messaging, repeat prescription ordering that enable patient-centred care and improve the patient’s self-management of the disease.Objective:To summarise the evidence regarding the use of patient portal (portals that are connected to the electronic healthcare record) or patient portal functionality (e.g. appointment booking or e-messages) and their reported associations with health and healthcare quality outcomes among adult diabetes patients.Methods:We searched the databases including Medline, Embase and Scopus and reported the review methodology using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three independent reviewers screened titles and abstracts, and two reviewers assessed full-texts of relevant studies and performed data extraction and quality assessments of the included studies. We used the Cochrane Collaboration Risk of Bias Tool and the National Heart, Lung and Blood Institute (NHLBI) Study Quality Assessment Tools to assess the risk of bias of the included studies. Data was summarised through narrative synthesis.Results:Twelve studies were included in this review. Five studies reported overall patient portal use and its association with diabetes health and healthcare quality outcomes. Six studies reported E-messaging or email use associated outcomes and two studies reported prescription refill associated outcomes. Reported associations included the association between patient portal use and blood pressure, LDL cholesterol or BMI. Few studies reported outcomes regarding the use of patient portals and healthcare utilisation measures such as office visits, emergency department visits and hospitalisations. Limited number of studies reported overall quality of care for diabetes patients who used patient portals.Conclusions:The included studies mostly r

Journal article

Alturkistani A, Greenfield G, Greaves F, Aliabadi S, Jenkins RH, Costelloe Cet al., 2020, Patient portal functionalities and uptake: a systematic review protocol, JMIR Research Protocols, Vol: 9, ISSN: 1929-0748

Background: Patient portals are digital health tools adopted by healthcare organisations. The portals are generally connected to the electronic health record of the healthcare organisation and offer patients functionalities such as access to the medical record, ability to order repeat prescriptions, make appointments or message the healthcare provider. Patient portals may be beneficial for patients and for the healthcare system. Patient portals can widely differ from one context to another due to the differences in the portal functionalities and capabilities and it is anticipated that outcomes associated with the functionalities to differ as well. Current systematic reviews report outcomes associated with patient portal uptake but do not explicitly specify the patient portal functionalities. Objective: The aim of this systematic review is to synthesise the evidence on health and healthcare quality outcomes associated with patient portal use among adult (18 years or older) patients. The review research questions are: What kind of health outcomes do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? and What kind of healthcare quality outcomes including healthcare utilisation outcomes, do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? Methods: The systematic review will be conducted by searching the Medline, Embase, and Scopus databases for relevant literature. The review inclusion criteria will be studies about adult patients (18 years or older), studies only about tethered patient portals and studies with or without a comparator. We will report patient portal-associated health and healthcare quality outcomes based on the patient portal functionalities. All quantitative primary study types will be included. Risk of bias of included studies will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomised

Journal article

Sounderajah V, Ashrafian H, Aggarwal R, De Fauw J, Denniston AK, Greaves F, Karthikesalingam A, King D, Liu X, Markar SR, McInnes MDF, Panch T, Pearson-Stuttard J, Ting DSW, Golub RM, Moher D, Bossuyt PM, Darzi Aet al., 2020, Developing specific reporting guidelines for diagnostic accuracy studies assessing AI interventions: The STARD-AI Steering Group, Nature Medicine, Vol: 26, Pages: 807-808, ISSN: 1078-8956

Journal article

Foley K, Venkatraman T, Ram B, Ells LJ, van Sluijs EMF, Hargreaves DS, Greaves F, Taghavi Azar Sharabiani M, Viner RM, Bottle A, Saxena Set al., 2019, A protocol for developing a core outcomes set for evaluation of school-based physical activity interventions in primary schools, BMJ Open, Vol: 9, Pages: 1-5, ISSN: 2044-6055

Introduction: Primary school-based physical activity interventions, such as The Daily Mile initiative, have the potential to increase children’s physical activity levels over time, which is associated with a variety of health benefits. Comparing interventions or combining results of several studies of a single intervention is challenging because previous studies have examined different outcomes or used different measures that are not feasible or relevant for researchers in school settings. The development and implementation of a core outcome set (COS) for primary school-based physical activity interventions would ensure outcomes important to those involved in implementing and evaluating interventions are standardized.Methods and Analysis: Our aim is to identify a Core Outcomes Set for studies of school based physical activity interventions. We will achieve this by undertaking a four-stage process: (1) identify a list of outcomes assessed in studies through a systematic review of international literature; (2) establish domains from these outcomes to produce questionnaire items; (3) prioritize outcomes through a 2-stage Delphi survey with four key stakeholder groups (researchers, public health professionals, educators and parents) where stakeholders rate the importance of each outcome on a 9-point Likert scale ( consensus that the outcomes should be included in the COS will be determined as 70% or more of all stakeholders scoring the outcome 7 to 9 and 15% or less scoring 1 to 3); (4) achieve consensus on a final Core Outcomes Set in face-to-face meetings with a sample of stakeholders and primary school children. Ethics and Dissemination: We have received ethical approval from Imperial College London (ref: 19IC5428). The results of this study will be disseminated via conference presentations/public health meetings, peer-reviewed publications and through appropriate media channels. Registration details: This study has been prospectively registered with Core Out

Journal article

Forde H, White M, Levy L, Greaves F, Hammond D, Vanderlee L, Sharp S, Adams Jet al., 2019, The Relationship between Self-Reported Exposure to Sugar-Sweetened Beverage Promotions and Intake: Cross-Sectional Analysis of the 2017 International Food Policy Study, NUTRIENTS, Vol: 11

Journal article

Marsden J, White M, Annand F, Burkinshaw P, Carville S, Eastwood B, Kelleher M, Knight J, O'Connor R, Tran A, Willey P, Greaves F, Taylor Set al., 2019, Medicines associated with dependence or withdrawal: a mixed-methods public health review and national database study in England, Lancet Psychiatry, Vol: 6, Pages: 935-950, ISSN: 2215-0366

BACKGROUND: Antidepressants, opioids for non-cancer pain, gabapentinoids (gabapentin and pregabalin), benzodiazepines, and Z-drugs (zopiclone, zaleplon, and zolpidem) are commonly prescribed medicine classes associated with a risk of dependence or withdrawal. We aimed to review the evidence for these harms and estimate the prevalence of dispensed prescriptions, their geographical distribution, and duration of continuous receipt using all patient-linked prescription data in England. METHODS: This was a mixed-methods public health review, comprising a rapid evidence assessment of articles (Jan 1, 2008, to Oct 3, 2018; with searches of MEDLINE, Embase, and PsycINFO, and the Cochrane and King's Fund libraries), an open call-for-evidence on patient experience and service evaluations, and a retrospective, patient-linked analysis of the National Health Service (NHS) Business Services Authority prescription database (April 1, 2015, to March 30, 2018) for all adults aged 18 years and over. Indirectly (sex and age) standardised rates (ISRs) were computed for all 195 NHS Clinical Commissioning Groups in England, containing 7821 general practices for the geographical analysis. We used publicly available mid-year (June 30) data on the resident adult population and investigated deprivation using the English Indices of Multiple Deprivation (IMD) quintiles (quintile 1 least deprived, quintile 5 most deprived), with each patient assigned to the IMD quintile score of their general practitioner's practice for each year. Statistical modelling (adjusted incident rate ratios [IRRs]) of the number of patients who had a prescription dispensed for each medicine class, and the number of patients in receipt of a prescription for at least 12 months, was done by sex, age group, and IMD quintile. FINDINGS: 77 articles on the five medicine classes were identified from the literature search and call-for-evidence. 17 randomised placebo-controlled trials (6729 participants) reported antidepressant-a

Journal article

Forde H, Penney T, White M, Levy L, Greaves F, Adams Jet al., 2019, Understanding changes in soft drinks marketing after introduction of the UK Soft Drinks Industry Levy: developing a theory of change by use of concept mapping and stakeholder interviews, National Conference on Public Health Science Dedicated to New Research in UK Public Health, Publisher: ELSEVIER SCIENCE INC, Pages: 40-40, ISSN: 0140-6736

Conference paper

Burstein R, Henry NJ, Collison ML, Marczak LB, Sligar A, Watson S, Marquez N, Abbasalizad-Farhangi M, Abbasi M, Abd-Allah F, Abdoli A, Abdollahi M, Abdollahpour I, Abdulkader RS, Abrigo MRM, Acharya D, Adebayo OM, Adekanmbi V, Adham D, Afshari M, Aghaali M, Ahmadi K, Ahmadi M, Ahmadpour E, Ahmed R, Akal CG, Akinyemi JO, Alahdab F, Alam N, Alamene GM, Alene KA, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Almalki MJ, Al-Mekhlafi HM, Altirkawi K, Alvis-Guzman N, Amegah AK, Amini S, Amit AML, Anbari Z, Androudi S, Anjomshoa M, Ansari F, Antonio CAT, Arabloo J, Arefi Z, Aremu O, Armoon B, Arora A, Artaman A, Asadi A, Asadi-Aliabadi M, Ashraf-Ganjouei A, Assadi R, Ataeinia B, Atre SR, Quintanilla BPA, Ayanore MA, Azari S, Babaee E, Babazadeh A, Badawi A, Bagheri S, Bagherzadeh M, Baheiraei N, Balouchi A, Barac A, Bassat Q, Baune BT, Bayati M, Bedi N, Beghi E, Behzadifar M, Behzadifar M, Belay YB, Bell B, Bell ML, Berbada DA, Bernstein RS, Bhattacharjee NV, Bhattarai S, Bhutta ZA, Bijani A, Bohlouli S, Breitborde NJK, Britton G, Browne AJ, Nagaraja SB, Busse R, Butt ZA, Car J, Cárdenas R, Castañeda-Orjuela CA, Cerin E, Chanie WF, Chatterjee P, Chu D-T, Cooper C, Costa VM, Dalal K, Dandona L, Dandona R, Daoud F, Daryani A, Das Gupta R, Davis I, Davis Weaver N, Davitoiu DV, De Neve J-W, Demeke FM, Demoz GT, Deribe K, Desai R, Deshpande A, Desyibelew HD, Dey S, Dharmaratne SD, Dhimal M, Diaz D, Doshmangir L, Duraes AR, Dwyer-Lindgren L, Earl L, Ebrahimi R, Ebrahimpour S, Effiong A, Eftekhari A, Ehsani-Chimeh E, El Sayed I, El Sayed Zaki M, El Tantawi M, El-Khatib Z, Emamian MH, Enany S, Eskandarieh S, Eyawo O, Ezalarab M, Faramarzi M, Fareed M, Faridnia R, Faro A, Fazaeli AA, Fazlzadeh M, Fentahun N, Fereshtehnejad S-M, Fernandes JC, Filip I, Fischer F, Foigt NA, Foroutan M, Francis JM, Fukumoto T, Fullman N, Gallus S, Gebre DG, Gebrehiwot TT, Gebremeskel GG, Gessner BD, Geta B, Gething PW, Ghadimi R, Ghadiri K, Ghajarzadeh M, Ghashghaee A, Gill PS, Gill TK, Golding N, Goet al., 2019, Mapping 123 million neonatal, infant and child deaths between 2000 and 2017, Nature, Vol: 574, Pages: 353-358, ISSN: 0028-0836

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Journal article

Panch T, Pearson-Stuttard J, Greaves F, Atun Ret al., 2019, Artificial intelligence: opportunities and risks for public health (vol 1, pg e13, 2019), LANCET DIGITAL HEALTH, Vol: 1, Pages: E113-E113

Journal article

Alturkistani A, Greenfield G, Greaves F, Aliabadi S, Jenkins RH, Costelloe Cet al., 2019, Patient portal functionalities and uptake: systematic review protocol (Preprint), Publisher: JMIR Publications

Background:Patient portals are digital health tools adopted by healthcare organisations. The portals are generally connected to the electronic health record of the healthcare organisation and offer patients functionalities such as access to the medical record, ability to order repeat prescriptions, make appointments or message the healthcare provider. Research shows that there are many potential benefits of using patient portals both for patients and for the healthcare system. Patient portals can widely differ from one context to another due to differences in the portal functionalities and capabilities. Current research reports patient portal uptake but does not explicitly specify the patient portal functionalities.Objective:The aim of the review is to identify the functionalities of electronic patient portals offered globally in primary care and secondary care both and determine its association with patient portal uptake and facilitators and barriers of its use.Methods:Medline, Embase, Scopus, PsycINFO, IEEE Xplore Digital Library, and CINAHL will be searched for relevant literature. The review inclusion criteria will be studies about patients or other portal users such as carers, studies only about tethered patient portals, studies with or without a comparator. We will report patient portal uptake numbers based on the patient portal functionalities. We will also look at facilitators and barriers to using patient portals. All primary study types will be included. Risk of bias of included studies will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomised trials and the National Heart, Lung, and Blood Institute Institute’ quality assessment tools. Data will be synthesised using narrative synthesis and will be reported according to the patient portal functionalities, country and healthcare system model.Results:Searches will be conducted in June 2019, and the review is anticipated to be complete by November 2019.Conclu

Working paper

Panch T, Pearson-Stuttard J, Greaves F, Atun Ret al., 2019, Artificial intelligence: opportunities and risks for public health, The Lancet Digital Health, Vol: 1, Pages: e13-e14, ISSN: 2589-7500

Journal article

Greaves F, Joshi I, Campbell M, Roberts S, Patel N, Powell Jet al., 2018, What is an appropriate level of evidence for a digital health intervention?, Lancet, Vol: 392, Pages: 2665-2667, ISSN: 0140-6736

Journal article

Steel N, Ford JA, Newton JN, Davis ACJ, Vos T, Naghavi M, Glenn S, Hughes A, Dalton AM, Stockton D, Humphreys C, Dallat M, Schmidt J, Flowers J, Fox S, Abubakar I, Aldridge RW, Baker A, Brayne C, Brugha T, Capewell S, Car J, Cooper C, Ezzati M, Fitzpatrick J, Greaves F, Hay R, Hay S, Kee F, Larson HJ, Lyons RA, Majeed A, McKee M, Rawaf S, Rutter H, Saxena S, Sheikh A, Smeeth L, Viner RM, Vollset SE, Williams HC, Wolfe C, Woolf A, Murray CJLet al., 2018, Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016, The Lancet, Vol: 392, Pages: 1647-1661, ISSN: 0140-6736

BackgroundPrevious studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile.MethodsWe extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters.FindingsThe leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791–15 875] in Blackpool to 6888 [6145–7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD.

Journal article

Griswold MG, Fullman N, Hawley C, Rawaf DL, Rawaf S, Murray C, GBD 2016 Alcohol Collaboratorset al., 2018, Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016, The Lancet, Vol: 392, Pages: 1015-1035, ISSN: 0140-6736

BackgroundAlcohol use is a leading risk factor for death and disability, but its overall association with health remains complex given the possible protective effects of moderate alcohol consumption on some conditions. With our comprehensive approach to health accounting within the Global Burden of Diseases, Injuries, and Risk Factors Study 2016, we generated improved estimates of alcohol use and alcohol-attributable deaths and disability-adjusted life-years (DALYs) for 195 locations from 1990 to 2016, for both sexes and for 5-year age groups between the ages of 15 years and 95 years and older.MethodsUsing 694 data sources of individual and population-level alcohol consumption, along with 592 prospective and retrospective studies on the risk of alcohol use, we produced estimates of the prevalence of current drinking, abstention, the distribution of alcohol consumption among current drinkers in standard drinks daily (defined as 10 g of pure ethyl alcohol), and alcohol-attributable deaths and DALYs. We made several methodological improvements compared with previous estimates: first, we adjusted alcohol sales estimates to take into account tourist and unrecorded consumption; second, we did a new meta-analysis of relative risks for 23 health outcomes associated with alcohol use; and third, we developed a new method to quantify the level of alcohol consumption that minimises the overall risk to individual health.FindingsGlobally, alcohol use was the seventh leading risk factor for both deaths and DALYs in 2016, accounting for 2·2% (95% uncertainty interval [UI] 1·5–3·0) of age-standardised female deaths and 6·8% (5·8–8·0) of age-standardised male deaths. Among the population aged 15–49 years, alcohol use was the leading risk factor globally in 2016, with 3·8% (95% UI 3·2–4·3) of female deaths and 12·2% (10·8–13·6) of male deaths attributable to alcohol use. F

Journal article

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