Imperial College London

ProfessorMajidEzzati

Faculty of MedicineSchool of Public Health

Chair in Global Environmental Health
 
 
 
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Contact

 

+44 (0)20 7594 0767majid.ezzati Website

 
 
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Location

 

Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

330 results found

Yakoob MY, Micha R, Khatibzadeh S, Singh GM, Shi P, Ahsan H, Balakrishna N, Brahmam GNV, Chen Y, Afshin A, Fahimi S, Danaei G, Powles JW, Ezzati M, Mozaffarian Det al., 2016, Impact of Dietary and Metabolic Risk Factors on Cardiovascular and Diabetes Mortality in South Asia: Analysis From the 2010 Global Burden of Disease Study, AMERICAN JOURNAL OF PUBLIC HEALTH, Vol: 106, Pages: 2113-2125, ISSN: 0090-0036

Journal article

Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E, Sania A, Fawzi MCS, Ezzati M, Fawzi WWet al., 2016, Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels, PLOS MEDICINE, Vol: 13, ISSN: 1549-1676

Journal article

Howie SR, Schellenberg J, Chimah O, Ideh RC, Ebruke BE, Oluwalana C, Mackenzie G, Jallow M, Njie M, Donkor S, Dionisio KL, Goldberg G, Fornace K, Bottomley C, Hill PC, Grant CC, Corrah T, Prentice AM, Ezzati M, Greenwood BM, Smith PG, Adegbola RA, Mulholland Ket al., 2016, Childhood pneumonia and crowding, bed-sharing and nutrition: a case-control study from The Gambia, International Journal of Tuberculosis and Lung Disease, Vol: 20, Pages: 1405-1415, ISSN: 1815-7920

SETTING: Greater Banjul and Upper River Regions, The Gambia. OBJECTIVE: To investigate tractable social, environmental and nutritional risk factors for childhood pneumonia. DESIGN: A case-control study examining the association of crowding, household air pollution (HAP) and nutritional factors with pneumonia was undertaken in children aged 2-59 months: 458 children with severe pneumonia, defined according to the modified WHO criteria, were compared with 322 children with non-severe pneumonia, and these groups were compared to 801 neighbourhood controls. Controls were matched by age, sex, area and season. RESULTS: Strong evidence was found of an association between bed-sharing with someone with a cough and severe pneumonia (adjusted OR [aOR] 5.1, 95%CI 3.2-8.2, P < 0.001) and non-severe pneumonia (aOR 7.3, 95%CI 4.1-13.1, P < 0.001), with 18% of severe cases estimated to be attributable to this risk factor. Malnutrition and pneumonia had clear evidence of association, which was strongest between severe malnutrition and severe pneumonia (aOR 8.7, 95%CI 4.2-17.8, P < 0.001). No association was found between pneumonia and individual carbon monoxide exposure as a measure of HAP. CONCLUSION: Bed-sharing with someone with a cough is an important risk factor for severe pneumonia, and potentially tractable to intervention, while malnutrition remains an important tractable determinant.

Journal article

Khatibzadeh S, Saheb Kashaf M, Micha R, Fahimi S, Shi P, Elmadfa I, Kalantarian S, Wirojratana P, Ezzati M, Powles J, Mozaffarian D, Global Burden of Diseases Nutrition, Chronic Diseases Expert Group NutriCodeet al., 2016, A global database of food and nutrient consumption., Bull World Health Organ, Vol: 94, Pages: 931-934

Journal article

Allen RT, Hales NM, Baccarelli A, Jerrett M, Ezzati M, Dockery DW, Pope CAet al., 2016, Countervailing effects of income, air pollution, smoking, and obesity on aging and life expectancy: population-based study of U.S. Counties, Environmental Health, Vol: 15, ISSN: 1832-3367

BackgroundIncome, air pollution, obesity, and smoking are primary factors associated with human health and longevity in population-based studies. These four factors may have countervailing impacts on longevity. This analysis investigates longevity trade-offs between air pollution and income, and explores how relative effects of income and air pollution on human longevity are potentially influenced by accounting for smoking and obesity.MethodsCounty-level data from 2,996 U.S. counties were analyzed in a cross-sectional analysis to investigate relationships between longevity and the four factors of interest: air pollution (mean 1999–2008 PM2.5), median income, smoking, and obesity. Two longevity measures were used: life expectancy (LE) and an exceptional aging (EA) index. Linear regression, generalized additive regression models, and bivariate thin-plate smoothing splines were used to estimate the benefits of living in counties with higher incomes or lower PM2.5. Models were estimated with and without controls for smoking, obesity, and other factors.ResultsModels which account for smoking and obesity result in substantially smaller estimates of the effects of income and pollution on longevity. Linear regression models without these two variables estimate that a $1,000 increase in median income (1 μg/m3 decrease in PM2.5) corresponds to a 27.39 (33.68) increase in EA and a 0.14 (0.12) increase in LE, whereas models that control for smoking and obesity estimate only a 12.32 (20.22) increase in EA and a 0.07 (0.05) increase in LE. Nonlinear models and thin-plate smoothing splines also illustrate that, at higher levels of income, the relative benefits of the income-pollution tradeoff changed—the benefit of higher incomes diminished relative to the benefit of lower air pollution exposure.ConclusionsHigher incomes and lower levels of air pollution both correspond with increased human longevity. Adjusting for smoking and obesity reduces estimates of the benefi

Journal article

Bentham J, Di Cesare M, Stevens GA, Zhou B, Bixby H, Cowan M, Fortunato L, Bennett J, Danaei G, Hajifathalian K, Lu Y, Riley LM, Laxmaiah A, Kontis V, Paciorek CJ, Riboli E, Ezzati M, Chan Q, Elliott P, Gunter M, Hihtaniemi IT, Murphy N, Norat T, Riboli E, Vineis P, NCD Risk Factor Collaboration NCD-RisCet al., 2016, A century of trends in adult human height, eLife, Vol: 5, ISSN: 2050-084X

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

Journal article

Engelgau MM, Peprah E, Sampson UK, Mishoe H, Benjamin IJ, Douglas PS, Hochman JS, Ridker PM, Brandes N, Checkley W, El-Saharty S, Ezzati M, Hennis A, Jiang L, Krumholz HM, Lamourelle G, Makani J, Narayan KM, Ohene-Frempong K, Straus SE, Stuckler D, Chambers DA, Belis D, Bennett GC, Boyington JE, Creazzo TL, de Jesus JM, Krishnamurti C, Lowden MR, Punturieri A, Shero ST, Young NS, Zou S, Mensah GAet al., 2016, Perspectives from NHLBI Global Health Think Tank Meeting for Late Stage (T4) Translation Research., Global Heart, ISSN: 2211-8179

Almost three-quarters (74%) of all the noncommunicable disease burden is found within low- and middle-income countries. In September 2014, the National Heart, Lung, and Blood Institute held a Global Health Think Tank meeting to obtain expert advice and recommendations for addressing compelling scientific questions for late stage (T4) research-research that studies implementation strategies for proven effective interventions-to inform and guide the National Heart, Lung, and Blood Institute's global health research and training efforts. Major themes emerged in two broad categories: 1) developing research capacity; and 2) efficiently defining compelling scientific questions within the local context. Compelling scientific questions included how to deliver inexpensive, scalable, and sustainable interventions using alternative health delivery models that leverage existing human capital, technologies and therapeutics, and entrepreneurial strategies. These broad themes provide perspectives that inform an overarching strategy needed to reduce the heart, lung, blood, and sleep disorders disease burden and global health disparities.

Journal article

Fink G, Peet E, Danaei G, Andrews K, McCoy DC, Sudfeld CR, Smith Fawzi MC, Ezzati M, Fawzi WWet al., 2016, Schooling and wage income losses due to early-childhood growth faltering in developing countries: national, regional, and global estimates., American Journal of Clinical Nutrition, Vol: 104, Pages: 104-112, ISSN: 1938-3207

BACKGROUND: The growth of >300 million children <5 y old was mildly, moderately, or severely stunted worldwide in 2010. However, national estimates of the human capital and financial losses due to growth faltering in early childhood are not available. OBJECTIVE: We quantified the economic cost of growth faltering in developing countries. DESIGN: We combined the most recent country-level estimates of linear growth delays from the Nutrition Impact Model Study with estimates of returns to education in developing countries to estimate the impact of early-life growth faltering on educational attainment and future incomes. Primary outcomes were total years of educational attainment lost as well as the net present value of future wage earnings lost per child and birth cohort due to growth faltering in 137 developing countries. Bootstrapped standard errors were computed to account for uncertainty in modeling inputs. RESULTS: Our estimates suggest that early-life growth faltering in developing countries caused a total loss of 69.4 million y of educational attainment (95% CI: 41.7 million, 92.6 million y) per birth cohort. Educational attainment losses were largest in South Asia (27.6 million y; 95% CI: 20.0 million, 35.8 million y) as well as in Eastern (10.3 million y; 95% CI: 7.2 million, 12.9 million y) and Western sub-Saharan Africa (8.8 million y; 95% CI: 6.4 million, 11.5 million y). Globally, growth faltering in developing countries caused a total economic cost of $176.8 billion (95% CI: $100.9 billion, $262.6 billion)/birth cohort at nominal exchange rates, and $616.5 billion (95% CI: $365.3 billion, $898.9 billion) at purchasing power parity-adjusted exchange rates. At the regional level, economic costs were largest in South Asia ($46.6 billion; 95% CI: $33.3 billion, $61.1 billion), followed by Latin America ($44.7 billion; 95% CI: $19.2 billion, $74.6 billion) and sub-Saharan Africa ($34.2 billion; 95% CI: $24.4 billion, $45.3 billion). CONCLUSIONS: Our resu

Journal article

Carter E, Archer-Nicholls S, Ni K, Lai AM, Niu H, Secrest MH, Sauer SM, Schauer JJ, Ezzati M, Wiedinmyer C, Yang X, Baumgartner Jet al., 2016, Seasonal and Diurnal Air Pollution from Residential Cooking and Space Heating in the Eastern Tibetan Plateau., Environmental Science & Technology, Vol: 50, Pages: 8353-8361, ISSN: 1520-5851

Residential combustion of solid fuel is a major source of air pollution. In regions where space heating and cooking occur at the same time and using the same stoves and fuels, evaluating air-pollution patterns for household-energy-use scenarios with and without heating is essential to energy intervention design and estimation of its population health impacts as well as the development of residential emission inventories and air-quality models. We measured continuous and 48 h integrated indoor PM2.5 concentrations over 221 and 203 household-days and outdoor PM2.5 concentrations on a subset of those days (in summer and winter, respectively) in 204 households in the eastern Tibetan Plateau that burned biomass in traditional stoves and open fires. Using continuous indoor PM2.5 concentrations, we estimated mean daily hours of combustion activity, which increased from 5.4 h per day (95% CI: 5.0, 5.8) in summer to 8.9 h per day (95% CI: 8.1, 9.7) in winter, and effective air-exchange rates, which decreased from 18 ± 9 h(-1) in summer to 15 ± 7 h(-1) in winter. Indoor geometric-mean 48 h PM2.5 concentrations were over two times higher in winter (252 μg/m(3); 95% CI: 215, 295) than in summer (101 μg/m(3); 95%: 91, 112), whereas outdoor PM2.5 levels had little seasonal variability.

Journal article

Stevens GA, Alkema L, Black RE, Boerma JT, Collins GS, Ezzati M, Grove JT, Hogan DR, Hogan MC, Horton R, Lawn JE, Marusic A, Mathers CD, Murray CJL, Rudan I, Salomon JA, Simpson PJ, Vos T, Welch Vet al., 2016, Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement, PLOS MEDICINE, Vol: 13, ISSN: 1549-1676

Journal article

Arku RE, Bennett JE, Castro MC, Agyeman-Duah K, Mintah SE, Ware JH, Nyarko P, Spengler JD, Agyei-Mensah S, Ezzati Met al., 2016, Geographical Inequalities and Social and Environmental Risk Factors for Under-Five Mortality in Ghana in 2000 and 2010: Bayesian Spatial Analysis of Census Data, PLOS Medicine, Vol: 13, ISSN: 1549-1277

BackgroundUnder-five mortality is declining in Ghana and many other countries. Very few studies have measured under-five mortality—and its social and environmental risk factors—at fine spatial resolutions, which is relevant for policy purposes. Our aim was to estimate under-five mortality and its social and environmental risk factors at the district level in Ghana.Methods and FindingsWe used 10% random samples of Ghana’s 2000 and 2010 National Population and Housing Censuses. We applied indirect demographic methods and a Bayesian spatial model to the information on total number of children ever born and children surviving to estimate under-five mortality (probability of dying by 5 y of age, 5q0) for each of Ghana’s 110 districts. We also used the census data to estimate the distributions of households or persons in each district in terms of fuel used for cooking, sanitation facility, drinking water source, and parental education. Median district 5q0 declined from 99 deaths per 1,000 live births in 2000 to 70 in 2010. The decline ranged from <5% in some northern districts, where 5q0 had been higher in 2000, to >40% in southern districts, where it had been lower in 2000, exacerbating existing inequalities. Primary education increased in men and women, and more households had access to improved water and sanitation and cleaner cooking fuels. Higher use of liquefied petroleum gas for cooking was associated with lower 5q0 in multivariate analysis.ConclusionsUnder-five mortality has declined in all of Ghana’s districts, but the cross-district inequality in mortality has increased. There is a need for additional data, including on healthcare, and additional environmental and socioeconomic measurements, to understand the reasons for the variations in mortality levels and trends.

Journal article

Lu Y, Ezzati M, Rimm EB, Hajifathalian K, Ueda P, Danaei Get al., 2016, Sick Populations and Sick Subpopulations: Reducing Disparities in Cardiovascular Disease Between Blacks and Whites in the United States., Circulation, ISSN: 0009-7322

BACKGROUND: -Cardiovascular disease (CVD) death rates are much higher in blacks than whites in the United States (US). It is unclear how CVD risk and events are distributed among blacks vs. whites and how interventions reduce racial disparities. METHODS: -We developed risk models for fatal and for fatal-and-nonfatal CVD using 8 cohorts in the US. We used 6,154 adults aged 50-69 years in the National Health and Nutrition Examination Survey 1999-2012 to estimate the distributions of risk and events in blacks and whites. We estimated the total as well as disparity impacts of a range of population-wide, targeted and risk-based interventions on 10-year CVD risks and event rates. RESULTS: -25% (95% confidence interval 22-28) of black men and 12% (10-14) of black women were at ≥ 6.67% risk of fatal CVD (almost equivalent to 20% risk of fatal or nonfatal CVD), compared with 10% (8-12) of white men and 3% (2-4) of white women. These high-risk individuals accounted for 55% (49-59) of CVD deaths among black men and 42% (35-46) in black women, compared with 30% (24-35) in white men and 18% (13-22) in white women. We estimated that an intervention that treated multiple risk factors in high-risk individuals could reduce black-white difference in CVD death rate from 1,659 to 1,244 per 100,000 in men and from 1,320 to 897 in women. Rates of fatal-and-nonfatal CVD were generally similar between black and white men. In women, a larger proportion of women were at ≥ 7.5% risk of CVD (30% versus 19% in whites) and an intervention that targeted multiple risk factors among this group was estimated to reduce black-white differences in CVD rates from 1,688 to 1,197 per 100,000. CONCLUSIONS: -A substantially larger proportion of blacks have a high risk of fatal CVD and bear a large share of CVD deaths. A risk-based intervention that reduces multiple risk factors could substantially reduce overall CVD rates and racial disparities in CVD death rates.

Journal article

Ni K, Carter E, Schauer JJ, Ezzati M, Zhang Y, Niu H, Lai AM, Shan M, Wang Y, Yang X, Baumgartner Jet al., 2016, Seasonal variation in outdoor, indoor, and personal air pollution exposures of women using wood stoves in the Tibetan Plateau: Baseline assessment for an energy intervention study., Environment International, ISSN: 1873-6750

Cooking and heating with coal and biomass is the main source of household air pollution in China and a leading contributor to disease burden. As part of a baseline assessment for a household energy intervention program, we enrolled 205 adult women cooking with biomass fuels in Sichuan, China and measured their 48-h personal exposure to fine particulate matter (PM2.5) and carbon monoxide (CO) in winter and summer. We also measured the indoor 48-h PM2.5 concentrations in their homes and conducted outdoor PM2.5 measurements during 101 (74) days in summer (winter). Indoor concentrations of CO and nitrogen oxides (NO, NO2) were measured over 48-h in a subset of ~80 homes. Women's geometric mean 48-h exposure to PM2.5 was 80μg/m(3) (95% CI: 74, 87) in summer and twice as high in winter (169μg/m(3) (95% CI: 150, 190), with similar seasonal trends for indoor PM2.5 concentrations (winter: 252μg/m(3); 95% CI: 215, 295; summer: 101μg/m(3); 95% CI: 91, 112). We found a moderately strong relationship between indoor PM2.5 and CO (r=0.60, 95% CI: 0.46, 0.72), and a weak correlation between personal PM2.5 and CO (r=0.41, 95% CI: -0.02, 0.71). NO2/NO ratios were higher in summer (range: 0.01 to 0.68) than in winter (range: 0 to 0.11), suggesting outdoor formation of NO2 via reaction of NO with ozone is a more important source of NO2 than biomass combustion indoors. The predictors of women's personal exposure to PM2.5 differed by season. In winter, our results show that primary heating with a low-polluting fuel (i.e., electric stove or wood-charcoal) and more frequent kitchen ventilation could reduce personal PM2.5 exposures. In summer, primary use of a gaseous fuel or electricity for cooking and reducing exposure to outdoor PM2.5 would likely have the greatest impacts on personal PM2.5 exposure.

Journal article

Kwan GF, Mayosi BM, Mocumbi AO, Miranda JJ, Ezzati M, Jain Y, Robles G, Benjamin EJ, Subramanian SV, Bukhman Get al., 2016, Endemic Cardiovascular Diseases of the Poorest Billion, Circulation, Vol: 133, Pages: 2561-2575, ISSN: 0009-7322

Journal article

Tzoulaki I, Elliott P, Kontis V, Ezzati Met al., 2016, Worldwide Exposures to Cardiovascular Risk Factors and Associated Health Effects: Current Knowledge and Data Gaps, Circulation, Vol: 133, Pages: 2314-2333, ISSN: 0009-7322

Information on exposure to, and health effects of, cardiovascular disease (CVD) risk factors is needed to develop effective strategies to prevent CVD events and deaths. Here, we provide an overview of the data and evidence on worldwide exposures to CVD risk factors and the associated health effects. Global comparative risk assessment studies have estimated that hundreds of thousands or millions of CVD deaths are attributable to established CVD risk factors (high blood pressure and serum cholesterol, smoking, and high blood glucose), high body mass index, harmful alcohol use, some dietary and environmental exposures, and physical inactivity. The established risk factors plus body mass index are collectively responsible for ≈9.7 million annual CVD deaths, with high blood pressure accounting for more CVD deaths than any other risk factor. Age-standardized CVD death rates attributable to established risk factors plus high body mass index are lowest in high-income countries, followed by Latin America and the Caribbean; they are highest in the region of central and eastern Europe and central Asia. However, estimates of the health effects of CVD risk factors are highly uncertain because there are insufficient population-based data on exposure to most CVD risk factors and because the magnitudes of their effects on CVDs in observational studies are likely to be biased. We identify directions for research and surveillance to better estimate the effects of CVD risk factors and policy options for reducing CVD burden by modifying preventable risk factors.

Journal article

McCoy DC, Peet ED, Ezzati M, Danaei G, Black MM, Sudfeld CR, Fawzi W, Fink Get al., 2016, Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modeling, PLOS Medicine, Vol: 13, ISSN: 1549-1277

BACKGROUND: The development of cognitive and socioemotional skills early in life influences later health and well-being. Existing estimates of unmet developmental potential in low- and middle-income countries (LMICs) are based on either measures of physical growth or proxy measures such as poverty. In this paper we aim to directly estimate the number of children in LMICs who would be reported by their caregivers to show low cognitive and/or socioemotional development. METHODS AND FINDINGS: The present paper uses Early Childhood Development Index (ECDI) data collected between 2005 and 2015 from 99,222 3- and 4-y-old children living in 35 LMICs as part of the Multiple Indicator Cluster Survey (MICS) and Demographic and Health Surveys (DHS) programs. First, we estimate the prevalence of low cognitive and/or socioemotional ECDI scores within our MICS/DHS sample. Next, we test a series of ordinary least squares regression models predicting low ECDI scores across our MICS/DHS sample countries based on country-level data from the Human Development Index (HDI) and the Nutrition Impact Model Study. We use cross-validation to select the model with the best predictive validity. We then apply this model to all LMICs to generate country-level estimates of the prevalence of low ECDI scores globally, as well as confidence intervals around these estimates. In the pooled MICS and DHS sample, 14.6% of children had low ECDI scores in the cognitive domain, 26.2% had low socioemotional scores, and 36.8% performed poorly in either or both domains. Country-level prevalence of low cognitive and/or socioemotional scores on the ECDI was best represented by a model using the HDI as a predictor. Applying this model to all LMICs, we estimate that 80.8 million children ages 3 and 4 y (95% CI 48.1 million, 113.6 million) in LMICs experienced low cognitive and/or socioemotional development in 2010, with the largest number of affected children in sub-Saharan Africa (29.4.1 million; 43.8% of childre

Journal article

Chai J, Fink G, Kaaya S, Danaei G, Fawzi W, Ezzati M, Lienert J, Fawzi MCSet al., 2016, Association between intimate partner violence and poor child growth: results from 42 demographic and health surveys, Bulletin of the World Health Organization, Vol: 94, Pages: 331-339, ISSN: 1564-0604

Journal article

Majeed F, Hansell A, Saxena S, Millett C, Ward H, Harris M, Hayhoe B, Car J, Easton G, Donnelly CA, Perneczky R, Jarvelin MR, Ezzati M, Rawaf S, Vineis P, Ferguson N, Riboli Eet al., 2016, How would a decision to leave the European Union affect medical research and health in the United Kingdom?, Journal of the Royal Society of Medicine, Vol: 109, Pages: 216-218, ISSN: 1758-1095

Journal article

Foreman KJ, Li G, Best N, Ezzati Met al., 2016, Small area forecasts of cause-specific mortality: application of a Bayesian hierarchical model to US vital registration data, Journal of the Royal Statistical Society: Series C, Vol: 66, Pages: 121-139, ISSN: 0035-9254

Mortality forecasts are typically limited in that they pertain only to national death rates, predict only all-cause mortality or do not capture and utilize the correlation between diseases. We present a novel Bayesian hierarchical model that jointly forecasts cause-specific death rates for geographic subunits. We examine its effectiveness by applying it to US vital statistics data for 1979–2011 and produce forecasts to 2024. Not only does the model generate coherent forecasts for mutually exclusive causes of death, but also it has lower out-of-sample error than alternative commonly used models for forecasting mortality.

Journal article

Foreman KJ, Naghavi M, Ezzati M, 2016, Improving the usefulness of US mortality data: new methods for reclassification of underlying cause of death, Population Health Metrics, Vol: 14, ISSN: 1478-7954

BackgroundMortality data are affected by miscertification of the medical cause of death deaths and changes to cause of death classification systems. We present both mappings of ICD9 and ICD10 to a unified list of causes, and a new statistical model for reducing the impact of misclassification of cause of death.MethodsWe propose a Bayesian mixed-effects multinomial logistic model that can be run on individual record level death certificates to reclassify “garbage-coded” deaths onto causes that are more meaningful for public health purposes. The model uses information on the contributing causes of death and demographic characteristics of each decedent to make informed predictions of the underlying cause of death. We apply our method to death certificate data in the US from 1979 to 2011, creating more directly comparable series of cause-specific mortality for 25 major causes of death.ResultsWe find that many death certificates coded to garbage codes contain other information that provides strong clues about the valid underlying cause of death. In particular, a plausible underlying cause often appears in the contributing causes of death, implying that it may be incorrect ordering of the causal chain and not missed cause assignment that leads to many garbage-coded deaths. We present an example that redistributes 48 % of heart failure deaths to other cardiovascular diseases, 25 % to ischemic heart disease, and 15 % to chronic respiratory diseases.ConclusionsOur methods take advantage of more detailed micro-level data than is typically considered in garbage code redistribution algorithms, making it a useful tool in circumstances in which detailed death certificate data needs to be aggregated for public health purposes. We find that this method gives different redistribution results than commonly used methods that only consider population-level proportions.

Journal article

Singh GM, Micha R, Khatibzadeh S, Lim S, Ezzati M, Mozaffarian Det al., 2016, Response to Letter Regarding Article, "Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010", Circulation, Vol: 133, ISSN: 0009-7322

Journal article

Zhou B, Lu Y, Hajifathalian K, Bentham J, Di Cesare M, Danaei G, Bixby H, Cowan MJ, Ali MK, Taddei C, Lo W-C, Reis-Santos B, Stevens GA, Riley LM, Miranda JJ, Bjerregaard P, Rivera JA, Fouad HM, Ma G, Mbanya JCN, McGarvey ST, Mohan V, Onat A, Ramachandran A, Ben Romdhane H, Paciorek CJ, Bennett JE, Ezzati M, Abdeen ZA, Kadir KA, Abu-Rmeileh NM, Acosta-Cazares B, Adams R, Aekplakorn W, Aguilar-Salinas CA, Agyemang C, Ahmadvand A, Al-Othman AR, Alkerwi A, Amouyel P, Amuzu A, Andersen LB, Anderssen SA, Anjana RM, Aounallah-Skhiri H, Aris T, Arlappa N, Arveiler D, Assah FK, Avdicova M, Azizi F, Balakrishna N, Bandosz P, Barbagallo CM, Barcelo A, Batieha AM, Baur LA, Ben Romdhane H, Benet M, Bernabe-Ortiz A, Bharadwaj S, Bhargava SK, Bi Y, Bjerregaard P, Bjertness E, Bjertness MB, Bjorkelund C, Blokstra A, Bo S, Boehm BO, Boissonnet CP, Bovet P, Brajkovich I, Breckenkamp J, Brenner H, Brewster LM, Brian GR, Bruno G, Bugge A, Cabrera de Leon A, Can G, Candido APC, Capuano V, Carlsson AC, Carvalho MJ, Casanueva FF, Casas J-P, Caserta CA, Castetbon K, Chamukuttan S, Chaturvedi N, Chen C-J, Chen F, Chen S, Cheng C-Y, Chetrit A, Chiou S-T, Cho Y, Chudek J, Cifkova R, Claessens F, Concin H, Cooper C, Cooper R, Costanzo S, Cottel D, Cowell C, Crujeiras AB, D'Arrigo G, Dallongeville J, Dankner R, Dauchet L, de Gaetano G, De Henauw S, Deepa M, Dehghan A, Deschamps V, Dhana K, Di Castelnuovo AF, Djalalinia S, Doua K, Drygas W, Du Y, Dzerve V, Egbagbe EE, Eggertsen R, El Ati J, Elosua R, Erasmus RT, Erem C, Ergor G, Eriksen L, Escobedo-de la Pena J, Fall CH, Farzadfar F, Felix-Redondo FJ, Ferguson TS, Fernandez-Berges D, Ferrari M, Ferreccio C, Feskens EJM, Finn JD, Foeger B, Foo LH, Forslund A-S, Fouad HM, Francis DK, Franco MDC, Franco OH, Frontera G, Furusawa T, Gaciong Z, Garnett SP, Gaspoz J-M, Gasull M, Gates L, Geleijnse JM, Ghasemian A, Ghimire A, Giampaoli S, Gianfagna F, Giovannelli J, Giwercman A, Gonzalez Gross M, Gonzalez Rivas JP, Bonet Gorbea M, Gottrand F, Grafnetteet al., 2016, Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants, Lancet, Vol: 387, Pages: 1513-1530, ISSN: 1474-547X

BackgroundOne of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes.MethodsWe pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.FindingsWe used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalenc

Journal article

Di Cesare M, Bentham J, Stevens GA, Zhou B, Danaei G, Lu Y, Bixby H, Cowan MJ, Riley LM, Hajifathalian K, Fortunato L, Taddei C, Bennett JE, Ikeda N, Khang Y-H, Kyobutungi C, Laxmaiah A, Li Y, Lin H-H, Miranda JJ, Mostafa A, Turley ML, Paciorek CJ, Gunter M, Ezzati M, Abdeen ZA, Hamid ZA, Abu-Rmeileh NM, Acosta-Cazares B, Adams R, Aekplakorn W, Aguilar-Salinas CA, Ahmadvand A, Ahrens W, Ali MM, Alkerwi A, Alvarez-Pedrerol M, Aly E, Amouyel P, Amuzu A, Andersen LB, Anderssen SA, Andrade DS, Anjana RM, Aounallah-Skhiri H, Ariansen I, Aris T, Arlappa N, Arveiler D, Assah FK, Avdicova M, Azizi F, Babu BV, Balakrishna N, Bandosz P, Banegas JR, Barbagallo CM, Barcelo A, Barkat A, Barros MV, Bata I, Batieha AM, Batista RL, Baur LA, Beaglehole R, Ben Romdhane H, Benet M, Bernabe-Ortiz A, Bernotiene G, Bettiol H, Bhagyalaxmi A, Bharadwaj S, Bhargava SK, Bhatti Z, Bhutta ZA, Bi H, Bi Y, Bjerregaard P, Bjertness E, Bjertness MB, Bjorkelund C, Blake M, Blokstra A, Bo S, Bobak M, Boddy LM, Boehm BO, Boeing H, Boissonnet CP, Bongard V, Bovet P, Braeckman L, Bragt MCE, Brajkovich I, Branca F, Breckenkamp J, Brenner H, Brewster LM, Brian GR, Bruno G, Bueno-de-Mesquita HBA, Bugge A, Burns C, Cabrera de Leon A, Cacciottolo J, Cama T, Cameron C, Camolas J, Can G, Candido APC, Capuano V, Cardoso VC, Carvalho MJ, Casanueva FF, Casas J-P, Caserta CA, Castetbon K, Chamukuttan S, Chan AW, Chan Q, Chaturvedi HK, Chaturvedi N, Chen C-J, Chen F, Chen H, Chen S, Chen Z, Cheng C-Y, Chetrit A, Chiolero A, Chiou S-T, Chirita-Emandi A, Cho Y, Christensen K, Chudek J, Cifkova R, Claessens F, Clays E, Concin H, Cooper C, Cooper R, Coppinger TC, Costanzo S, Cottel D, Cowell C, Craig CL, Crujeiras AB, D'Arrigo G, d'Orsi E, Dallongeville J, Damasceno A, Damsgaard CT, Danaei G, Dankner R, Dauchet L, De Backer G, De Bacquer D, de Gaetano G, De Henauw S, De Smedt D, Deepa M, Deev AD, Dehghan A, Delisle H, Delpeuch F, Dhana K, Di Castelnuovo AF, Dias-da-Costa JS, Diaz A, Djalalinia S, Do HTP, Dobson AJ, Doet al., 2016, Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants, Lancet, Vol: 387, Pages: 1377-1396, ISSN: 1474-547X

BackgroundUnderweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries.MethodsWe analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue.FindingsWe used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of un

Journal article

Otto MCDO, Afshin A, Micha R, Khatibzadeh S, Fahimi S, Singh G, Danaei G, Sichieri R, Monteiro CA, Louzada MLC, Ezzati M, Mozaffarian Det al., 2016, The Impact of Dietary and Metabolic Risk Factors on Cardiovascular Diseases and Type 2 Diabetes Mortality in Brazil, PLOS One, Vol: 11, ISSN: 1932-6203

BackgroundTrends in food availability and metabolic risk factors in Brazil suggest a shift toward unhealthy dietary patterns and increased cardiometabolic disease risk, yet little is known about the impact of dietary and metabolic risk factors on cardiometabolic mortality in Brazil.MethodsBased on data from Global Burden of Disease (GBD) Study, we used comparative risk assessment to estimate the burden of 11 dietary and 4 metabolic risk factors on mortality due to cardiovascular diseases and diabetes in Brazil in 2010. Information on national diets and metabolic risks were obtained from the Brazilian Household Budget Survey, the Food and Agriculture Organization database, and large observational studies including Brazilian adults. Relative risks for each risk factor were obtained from meta-analyses of randomized trials or prospective cohort studies; and disease-specific mortality from the GBD 2010 database. We quantified uncertainty using probabilistic simulation analyses, incorporating uncertainty in dietary and metabolic data and relative risks by age and sex. Robustness of findings was evaluated by sensitivity to varying feasible optimal levels of each risk factor.ResultsIn 2010, high systolic blood pressure (SBP) and suboptimal diet were the largest contributors to cardiometabolic deaths in Brazil, responsible for 214,263 deaths (95% uncertainty interval [UI]: 195,073 to 233,936) and 202,949 deaths (95% UI: 194,322 to 211,747), respectively. Among individual dietary factors, low intakes of fruits and whole grains and high intakes of sodium were the largest contributors to cardiometabolic deaths. For premature cardiometabolic deaths (before age 70 years, representing 40% of cardiometabolic deaths), the leading risk factors were suboptimal diet (104,169 deaths; 95% UI: 99,964 to 108,002), high SBP (98,923 deaths; 95%UI: 92,912 to 104,609) and high body-mass index (BMI) (42,643 deaths; 95%UI: 40,161 to 45,111).Conclusionsuboptimal diet, high SBP, and high BMI are m

Journal article

Wylie BJ, Kishashu Y, Matechi E, Zhou Z, Coull B, Abioye AI, Dionisio KL, Mugusi F, Premji Z, Fawzi W, Hauser R, Ezzati Met al., 2016, Maternal exposure to carbon monoxide and fine particulate matter during pregnancy in an urban Tanzanian cohort, INDOOR AIR, Vol: 27, Pages: 136-146, ISSN: 0905-6947

Journal article

Finlay JE, Fink G, McCoy DC, Tavárez LC, Chai J, Danaei G, Ezzati M, Fawzi W, Fawzi MCet al., 2016, Stunting risk of orphans by caregiver and living arrangement in low-income and middle-income countries., Journal of Epidemiology and Community Health, Vol: 70, Pages: 784-790, ISSN: 1470-2738

BACKGROUND: An estimated 151 million children worldwide have lost one or both parents (UNICEF). Although a considerable literature has documented the impact of parental loss on children's emotional development, to date there are mixed findings regarding the potential effect of orphanhood on children's physical growth. The aim of the study is to examine the association between orphanhood (maternal, paternal or both) on childhood stunting status, accounting for living arrangement. METHODS: We combine nationally representative data from 84 Demographic Health Surveys for 49 low-income and middle-income countries (LMICs). Data from 222 690 children aged 0-23 months were included in the analytical sample. We show pooled estimates from multiple analysis models, as well as models examining the role of the surviving parent's residence and household structure. RESULTS: In fully adjusted models, maternal orphans were found to have an increased risk of stunting (RR 1.3, 95% CI 1.2 to 1.4) compared to children with two living parents. The stratified models demonstrated that the greatest risk was observed for maternal orphans whose surviving fathers did not live with the child (RR 1.4, 95% CI 1.3 to 1.6). CONCLUSIONS: Early orphanhood constitutes a major risk for children's physical development in LMICs. However, the results suggest that the adverse effects of a parental loss can be mitigated if appropriate support is provided, indicating the potential benefits of the surviving parents staying with their children. The benefits of targeted social policies aimed at single fathers and grandparents supporting orphans may be significant.

Journal article

Wang Q, Afshin A, Yakoob MY, Singh GM, Rehm CD, Khatibzadeh S, Micha R, Shi P, Mozaffarian D, Global Burden of Diseases Nutrition and Chronic Diseases Expert Group NutriCoDEet al., 2016, Impact of Nonoptimal Intakes of Saturated, Polyunsaturated, and Trans Fat on Global Burdens of Coronary Heart Disease., Journal of the American Heart Association, Vol: 5, ISSN: 2047-9980

BACKGROUND: Saturated fat (SFA), ω-6 (n-6) polyunsaturated fat (PUFA), and trans fat (TFA) influence risk of coronary heart disease (CHD), but attributable CHD mortalities by country, age, sex, and time are unclear. METHODS AND RESULTS: National intakes of SFA, n-6 PUFA, and TFA were estimated using a Bayesian hierarchical model based on country-specific dietary surveys; food availability data; and, for TFA, industry reports on fats/oils and packaged foods. Etiologic effects of dietary fats on CHD mortality were derived from meta-analyses of prospective cohorts and CHD mortality rates from the 2010 Global Burden of Diseases study. Absolute and proportional attributable CHD mortality were computed using a comparative risk assessment framework. In 2010, nonoptimal intakes of n-6 PUFA, SFA, and TFA were estimated to result in 711 800 (95% uncertainty interval [UI] 680 700-745 000), 250 900 (95% UI 236 900-265 800), and 537 200 (95% UI 517 600-557 000) CHD deaths per year worldwide, accounting for 10.3% (95% UI 9.9%-10.6%), 3.6%, (95% UI 3.5%-3.6%) and 7.7% (95% UI 7.6%-7.9%) of global CHD mortality. Tropical oil-consuming countries were estimated to have the highest proportional n-6 PUFA- and SFA-attributable CHD mortality, whereas Egypt, Pakistan, and Canada were estimated to have the highest proportional TFA-attributable CHD mortality. From 1990 to 2010 globally, the estimated proportional CHD mortality decreased by 9% for insufficient n-6 PUFA and by 21% for higher SFA, whereas it increased by 4% for higher TFA, with the latter driven by increases in low- and middle-income countries. CONCLUSIONS: Nonoptimal intakes of n-6 PUFA, TFA, and SFA each contribute to significant estimated CHD mortality, with important heterogeneity across countries that informs nation-specific clinical, public health, and policy priorities.

Journal article

Ezzati M, Bennett JE, Black RE, Bhutta ZA, Fawzi Wet al., 2016, Vitamin A deficiency: policy implications of estimates of trends and mortality in children, Lancet Global Health, Vol: 4, Pages: E22-E22, ISSN: 2214-109X

Journal article

Wang Q, Afshin A, Yakoob MY, Singh GM, Rehm CD, Khatibzadeh S, Micha R, Shi P, Mozaffarian D, Ezzati M, Fahimi S, Wirojratana P, Powles J, Elmadfa I, Rao M, Alpert W, Lim SS, Engell RE, Andrews KG, Abbott PA, Abdollahi M, Abeyá Gilardon EO, Ahsan H, Al Nsour MAA, Al-Hooti SN, Arambepola C, Fernando DN, Barennes H, Barquera S, Baylin A, Becker W, Bjerregaard P, Bourne LT, Capanzana MV, Castetbon K, Chang HY, Chen Y, Cowan MJ, Riley LM, De Henauw S, Ding EL, Duante CA, Duran P, Barbieri HE, Farzadfar F, Hadziomeragic AF, Fisberg RM, Forsyth S, Garriguet D, Gaspoz JM, Gauci D, Calleja N, Ginnela BNV, Guessous I, Gulliford MC, Hadden W, Haerpfer C, Hoffman DJ, Houshiar-Rad A, Huybrechts I, Hwalla NC, Ibrahim HM, Inoue M, Jackson MD, Johansson L, Keinan-Boker L, Kim CI, Koksal E, Lee HJ, Li Y, Lipoeto NI, Ma G, Mangialavori GL, Matsumura Y, McGarvey ST, Fen CM, Monge-Rojas RA, Musaiger AO, Nagalla B, Naska A, Ocke MC, Oltarzewski M, Szponar L, Orfanos P, Ovaskainen ML, Tapanainen H, Pan WH, Panagiotakos DB, Pekcan GA, Petrova S, Piaseu N, Pitsavos C, Posada LG, Sánchez-Romero LM, Selamat RBT, Sharma S, Sibai AM, Sichieri R, Simmala C, Steingrimsdottir Let al., 2016, Correction to: Impact of nonoptimal intakes of saturated, polyunsaturated, and trans fat on global burdens of coronary heart disease. [J Am Heart Assoc. (2016) 5, e002891.] Doi:10.1161/JAHA.115.002891., Journal of the American Heart Association, Vol: 5, Pages: 1-1

© 2016 The Authors. In the article by Wang et al, "Impact of Nonoptimal Intakes of Saturated, Polyunsaturated, and Trans Fat on Global Burdens of Coronary Heart Disease," which published online January 20, 2016, and appeared in the January 2016 issue of the journal (J Am Heart Assoc. 2016;5:e002891 doi:10.1161/ JAHA.115.002891), the full list of the Global Burden of Diseases Nutrition and Chronic Diseases Expert Group (NutriCoDE) group were erroneously listed as authors in the HTML version of the article. The publisher regrets the error. The online version of the article has been updated and is available at http://jaha.ahajournals.org/content/5/1/ e002891.

Journal article

Ruel-Bergeron JC, Stevens GA, Sugimoto JD, Roos FF, Ezzati M, Black RE, Kraemer Ket al., 2015, Global Update and Trends of Hidden Hunger, 1995-2011: The Hidden Hunger Index, PLOS One, Vol: 10, ISSN: 1932-6203

BackgroundDeficiencies in essential vitamins and minerals–also termed hidden hunger–are pervasive and hold negative consequences for the cognitive and physical development of children.MethodsThis analysis evaluates the change in hidden hunger over time in the form of one composite indicator–the Hidden Hunger Index (HHI)–using an unweighted average of prevalence estimates from the Nutrition Impact Model Study for anemia due to iron deficiency, vitamin A deficiency, and stunting (used as a proxy indicator for zinc deficiency). Net changes from 1995–2011 and population weighted regional means for various time periods are measured.FindingsGlobally, hidden hunger improved (-6.7 net change in HHI) from 1995–2011. Africa was the only region to see a deterioration in hidden hunger (+1.9) over the studied time period; East Asia and the Pacific performed exceptionally well (-13.0), while other regions improved only slightly. Improvements in HHI were mostly due to reductions in zinc and vitamin A deficiencies, while anemia due to iron deficiency persisted and even increased.InterpretationThis analysis is critical for informing and tracking the impact of policy and programmatic efforts to reduce micronutrient deficiencies, to advance the global nutrition agenda, and to achieve the Millennium Development Goals (MDGs). However, there remains an unmet need to invest in gathering frequent, nationally representative, high-quality micronutrient data as we renew our efforts to scale up nutrition, and as we enter the post-2015 development agenda.FundingPreparation of this manuscript was funded by Sight and Life. There was no funding involved in the study design, data collection, analysis, or decision to publish.

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