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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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    Repositioning of the global epicentre of non-optimal cholesterol
    Taddei, Cristina ; Zhou, Bin ; Bixby, Honor ; Carrillo-Larco, Rodrigo M. ; Danaei, Goodarz ; Jackson, Rod T. ; Farzadfar, Farshad ; Sophiea, Marisa K. ; Cesare, Mariachiara Di; Iurilli, Maria Laura Caminia ; Martinez, Andrea Rodriguez ; Asghari, Golaleh ; Dhana, Klodian ; Gulayin, Pablo ; Kakarmath, Sujay ; Santero, Marilina ; Voortman, Trudy ; Riley, Leanne M. ; Cowan, Melanie J. ; Savin, Stefan ; Bennett, James E. ; Stevens, Gretchen A. ; Paciorek, Christopher J. ; Aekplakorn, Wichai ; Cifkova, Renata ; Giampaoli, Simona ; Kengne, Andre Pascal ; Khang, Young Ho ; Kuulasmaa, Kari ; Laxmaiah, Avula ; Margozzini, Paula ; Mathur, Prashant ; Nordestgaard, Børge G. ; Zhao, Dong ; Aadahl, Mette ; Abarca-Gómez, Leandra ; Rahim, Hanan Abdul ; Abu-Rmeileh, Niveen M. ; Acosta-Cazares, Benjamin ; Adams, Robert J. ; Ferrieres, Jean ; Geleijnse, Johanna M. ; He, Yuna ; Jacobs, Jeremy M. ; Kromhout, Daan ; Ma, Guansheng ; Dam, Rob M. van; Wang, Qian ; Wang, Ya Xing ; Wang, Ying Wei - \ 2020
    Nature 582 (2020)7810. - ISSN 0028-0836 - p. 73 - 77.

    High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

    Rising rural body-mass index is the main driver of the global obesity epidemic in adults
    Bixby, Honor ; Bentham, James ; Zhou, Bin ; Cesare, Mariachiara Di; Paciorek, Christopher J. ; Bennett, James E. ; Taddei, Cristina ; Stevens, Gretchen A. ; Rodriguez-Martinez, Andrea ; Carrillo-Larco, Rodrigo M. ; Khang, Young Ho ; Sorić, Maroje ; Gregg, Edward W. ; Miranda, J.J. ; Bhutta, Zulfiqar A. ; Savin, Stefan ; Sophiea, Marisa K. ; Iurilli, Maria L.C. ; Solomon, Bethlehem D. ; Cowan, Melanie J. ; Riley, Leanne M. ; Danaei, Goodarz ; Bovet, Pascal ; Chirita-Emandi, Adela ; Hambleton, Ian R. ; Hayes, Alison J. ; Ikeda, Nayu ; Kengne, Andre P. ; Laxmaiah, Avula ; Li, Yanping ; McGarvey, Stephen T. ; Mostafa, Aya ; Neovius, Martin ; Starc, Gregor ; Zainuddin, Ahmad A. ; Abarca-Gómez, Leandra ; Abdeen, Ziad A. ; Abdrakhmanova, Shynar ; Abdul Ghaffar, Suhaila ; Abdul Hamid, Zargar ; Abubakar Garba, Jamila ; Ferrieres, Jean ; He, Yuna ; Jacobs, Jeremy M. ; Kromhout, Daan ; Ma, Guansheng ; Visser, Marjolein ; Wang, Qian ; Wang, Ya Xing ; Wang, Ying Wei - \ 2019
    Nature 569 (2019)7755. - ISSN 0028-0836 - p. 260 - 264.

    Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities 1,2 . This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity 3–6 . Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

    Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure : A pooled analysis of 1018 population-based measurement studies with 88.6 million participants
    Ezzati, Majid ; Zhou, Bin ; Bentham, James ; Cesare, Mariachiara di; Bixby, Honor ; Danaei, Goodarz ; Hajifathalian, Kaveh ; Taddei, Cristina ; Carrillo-Larco, Rodrigo M. ; Djalalinia, Shirin ; Khatibzadeh, Shahab ; Lugero, Charles ; Peykari, Niloofar ; Zhang, Wan Zhu ; Bennett, James ; Bilano, Ver ; Stevens, Gretchen A. ; Cowan, Melanie J. ; Riley, Leanne M. ; Chen, Zhengming ; Hambleton, Ian R. ; Jackson, Rod T. ; Kengne, Andre Pascal ; Khang, Young Ho ; Laxmaiah, Avula ; Liu, Jing ; Malekzadeh, Reza ; Neuhauser, Hannelore K. ; Sorić, Maroje ; Starc, Gregor ; Sundström, Johan ; Woodward, Mark ; Abarca-Gómez, Leandra ; Abdeen, Ziad A. ; Abu-Rmeileh, Niveen M. ; Acosta-Cazares, Benjamin ; Adams, Robert J. ; Aekplakorn, Wichai ; Afsana, Kaosar ; Aguilar-Salinas, Carlos A. ; Geleijnse, Johanna M. - \ 2018
    International Journal of Epidemiology 47 (2018)3. - ISSN 0300-5771 - p. 872 - 883i.
    Blood pressure - Global health - Hypertension - Non-communicable disease - Population health

    Background: Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods: We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20-29 years to 70-79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probittransformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results: In 2005-16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the highincome Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions: Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

    Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015
    Feigin, V.L. ; Krishnamurthi, R.V. ; Theadom, A.M. ; Abajobir, A.A. ; Mishra, S.R. ; Ahmed, M.B. ; Abate, K.H. ; Mengistie, M.A. ; Wakayo, T. ; Abd-Allah, F. ; Abdulle, A.M. ; Abera, S.F. ; Mohammed, K.E. ; Abyu, G.Y. ; Asgedom, S.W. ; Atey, T.M. ; Betsu, B.D. ; Mezgebe, H.B. ; Tuem, K.B. ; Woldu, M.A. ; Aichour, A.N. ; Aichour, I. ; Aichour, M.T. ; Akinyemi, R.O. ; Alabed, S. ; Al-Raddadi, R. ; Alvis-Guzman, N. ; Amare, A.T. ; Ansari, H. ; Anwari, P. ; Ärnlöv, J. ; Fereshtehnejad, S. ; Weiderpass, E. ; Havmoeller, R. ; Asayesh, H. ; Avila-Burgos, L. ; Avokpaho, E.F.G.A. ; Afrique, L.E.R.A.S. ; Azarpazhooh, M.R. ; Barac, A. ; Barboza, M. ; Barker-Collo, S.L. ; Bärnighausen, T. ; Farvid, M.S. ; Mohammed, S. ; Bedi, N. ; Beghi, E. ; Giussani, G. ; Bennett, D.A. ; Hay, S.I. ; Goulart, A.C. ; Santos, I.S. ; Bensenor, I.M. ; Lotufo, P.A. ; Berhane, A. ; Jeemon, P. ; Bhaumik, S. ; Dandona, L. ; Dandona, R. ; Kumar, G.A. ; Birlik, S.M. ; Biryukov, S. ; Casey, D. ; Foreman, K.J. ; Goldberg, E.M. ; Khalil, I.A. ; Kyu, H.H. ; Manhertz, T. ; Mokdad, A.H. ; Naghavi, M. ; Nguyen, G. ; Nichols, E. ; Smith, M. ; Carabin, H. ; Roth, G.A. ; Stanaway, J.D. ; Vos, T. ; Ellenbogen, R.G. ; Jakovljevic, M.B. ; Tirschwell, D.L. ; Zunt, J.R. ; Boneya, D.J. ; Hambisa, M. ; Bulto, L.N.B. ; Carabin, H. ; Castañeda-Orjuela, C.A. ; Catalá-López, F. ; Tabarés-Seisdedos, R. ; Chen, H. ; Chitheer, A.A. ; Chowdhury, R. ; Christensen, H. ; Deveber, G.A. ; Dharmaratne, S.D. ; Do, H.P. ; Nguyen, C.T. ; Nguyen, Q.L. ; Nguyen, T.H. ; Nong, V.M. ; Sheth, K.N. ; Dorsey, E.R. ; Eskandarieh, S. ; Fischer, F. ; Majeed, A. ; Steiner, T.J. ; Rawaf, S. ; Shakir, R. ; Shoman, H. ; Geleijnse, J.M. ; Gillum, R.F. ; Gona, P.N. ; Gugnani, H.C. ; Gupta, R. ; Hachinski, V. ; Hamadeh, R.R. ; Hankey, G.J. ; Hareri, H.A. ; Heydarpour, P. ; Sahraian, M.A. ; Kasaeian, A. ; Malekzadeh, R. ; Roshandel, G. ; Sepanlou, S.G. ; Hotez, P.J. ; Javanbakht, M. ; Jonas, J.B. ; Kalkonde, Y. ; Kandel, A. ; Karch, A. ; Kastor, A. ; Rahman, M.H.U. ; Keiyoro, P.N. ; Khader, Y.S. ; Khan, E.A. ; Khang, Y. ; Khoja, A.T.A. ; Tran, B.X. ; Khubchandani, J. ; Kim, D. ; Kim, Y.J. ; Kivimaki, M. ; Kokubo, Y. ; Kosen, S. ; Kravchenko, M. ; Piradov, M.A. ; Varakin, Y.Y. ; Defo, B.K. ; Kulkarni, C. ; Kumar, R. ; Larsson, A. ; Lavados, P.M. ; Li, Y. ; Liang, X. ; Liben, M.L. ; Lo, W.D. ; Logroscino, G. ; Loy, C.T. ; Mackay, M.T. ; Meretoja, A. ; Szoeke, C.E.I. ; Abd El Razek, H.M. ; Mantovani, L.G. ; Massano, J. ; Mazidi, M. ; McAlinden, C. ; Mehata, S. ; Mehndiratta, M.M. ; Memish, Z.A. ; Mendoza, W. ; Mensah, G.A. ; Wijeratne, T. ; Miller, T.R. ; Mohamed Ibrahim, N. ; Mohammadi, A. ; Moradi-Lakeh, M. ; Velasquez, I.M. ; Musa, K.I. ; Ngunjiri, J.W. ; Ningrum, D.N.A. ; Norrving, B. ; Stein, D.J. ; Noubiap, J.J.N. ; Ogbo, F.A. ; Renzaho, A.M.N. ; Owolabi, M.O. ; Pandian, J.D. ; Parmar, P.G. ; Pereira, D.M. ; Petzold, M. ; Phillips, M.R. ; Poulton, R.G. ; Pourmalek, F. ; Qorbani, M. ; Rafay, A. ; Rai, R.K. ; Rajsic, S. ; Ranta, A. ; Rezai, M.S. ; Rubagotti, E. ; Sachdev, P. ; Safiri, S. ; Sahathevan, R. ; Samy, A.M. ; Santalucia, P. ; Sartorius, B. ; Satpathy, M. ; Sawhney, M. ; Saylan, M.I. ; Shaikh, M.A. ; Shamsizadeh, M. ; Sheth, K.N. ; Shigematsu, M. ; Silva, D.A.S. ; Sobngwi, E. ; Sposato, L.A. ; Stovner, L.J. ; Suliankatchi Abdulkader, R. ; Tanne, D. ; Thrift, A.G. ; Topor-Madry, R. ; Truelsen, T. ; Ukwaja, K.N. ; Uthman, O.A. ; Yonemoto, N. ; Venketasubramanian, N. ; Vlassov, V.V. ; Wadilo, F. ; Wallin, M.T. ; Westerman, R. ; Wiysonge, C.S. ; Wolfe, C.D. ; Xavier, D. ; Xu, G. ; Yano, Y. ; Yimam, H.H. ; Yonemoto, N. ; Yu, C. ; Zaidi, Z. ; Zaki, M.E. - \ 2017
    The Lancet Neurology 16 (2017)11. - ISSN 1474-4422 - p. 877 - 897.

    Background Comparable data on the global and country-specific burden of neurological disorders and their trends are crucial for health-care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study provides such information but does not routinely aggregate results that are of interest to clinicians specialising in neurological conditions. In this systematic analysis, we quantified the global disease burden due to neurological disorders in 2015 and its relationship with country development level. Methods We estimated global and country-specific prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for various neurological disorders that in the GBD classification have been previously spread across multiple disease groupings. The more inclusive grouping of neurological disorders included stroke, meningitis, encephalitis, tetanus, Alzheimer's disease and other dementias, Parkinson's disease, epilepsy, multiple sclerosis, motor neuron disease, migraine, tension-type headache, medication overuse headache, brain and nervous system cancers, and a residual category of other neurological disorders. We also analysed results based on the Socio-demographic Index (SDI), a compound measure of income per capita, education, and fertility, to identify patterns associated with development and how countries fare against expected outcomes relative to their level of development. Findings Neurological disorders ranked as the leading cause group of DALYs in 2015 (250·7 [95% uncertainty interval (UI) 229·1 to 274·7] million, comprising 10·2% of global DALYs) and the second-leading cause group of deaths (9·4 [9·1 to 9·7] million], comprising 16·8% of global deaths). The most prevalent neurological disorders were tension-type headache (1505·9 [UI 1337·3 to 1681·6 million cases]), migraine (958·8 [872·1 to 1055·6] million), medication overuse headache (58·5 [50·8 to 67·4 million]), and Alzheimer's disease and other dementias (46·0 [40·2 to 52·7 million]). Between 1990 and 2015, the number of deaths from neurological disorders increased by 36·7%, and the number of DALYs by 7·4%. These increases occurred despite decreases in age-standardised rates of death and DALYs of 26·1% and 29·7%, respectively; stroke and communicable neurological disorders were responsible for most of these decreases. Communicable neurological disorders were the largest cause of DALYs in countries with low SDI. Stroke rates were highest at middle levels of SDI and lowest at the highest SDI. Most of the changes in DALY rates of neurological disorders with development were driven by changes in YLLs. Interpretation Neurological disorders are an important cause of disability and death worldwide. Globally, the burden of neurological disorders has increased substantially over the past 25 years because of expanding population numbers and ageing, despite substantial decreases in mortality rates from stroke and communicable neurological disorders. The number of patients who will need care by clinicians with expertise in neurological conditions will continue to grow in coming decades. Policy makers and health-care providers should be aware of these trends to provide adequate services. Funding Bill & Melinda Gates Foundation.

    Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults
    Bentham, James ; Cesare, Mariachiara Di; Bilano, Ver ; Bixby, Honor ; Zhou, Bin ; Stevens, Gretchen A. ; Riley, Leanne M. ; Taddei, Cristina ; Hajifathalian, Kaveh ; Lu, Yuan ; Savin, Stefan ; Cowan, Melanie J. ; Paciorek, Christopher J. ; Chirita-Emandi, Adela ; Hayes, Alison J. ; Katz, Joanne ; Kelishadi, Roya ; Kengne, Andre Pascal ; Khang, Young Ho ; Laxmaiah, Avula ; Li, Yanping ; Ma, Jun ; Miranda, J.J. ; Mostafa, Aya ; Neovius, Martin ; Padez, Cristina ; Rampal, Lekhraj ; Zhu, Aubrianna ; Bennett, James E. ; Danaei, Goodarz ; Bhutta, Zulfiqar A. ; Ezzati, Majid ; Abarca-Gómez, Leandra ; Abdeen, Ziad A. ; Hamid, Zargar Abdul ; Abu-Rmeileh, Niveen M. ; Acosta-Cazares, Benjamin ; Acuin, Cecilia ; Adams, Robert J. ; Aekplakorn, Wichai ; Afsana, Kaosar ; Aguilar-Salinas, Carlos A. ; Ferrieres, Jean ; Jacobs, Jeremy M. ; Kromhout, Daan ; Ma, Guansheng ; Peeters, Petra H. ; Wang, Qian ; Wang, Ya Xing ; Wang, Ying Wei ; Geleijnse, J.M. - \ 2017
    The Lancet 390 (2017)10113. - ISSN 0140-6736 - p. 2627 - 2642.

    Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese. Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults. Funding Wellcome Trust, AstraZeneca Young Health Programme.

    Evolution and patterns of global health financing 1995-2014 : Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries
    Dieleman, Joseph ; Campbell, Madeline ; Chapin, Abigail ; Eldrenkamp, Erika ; Fan, Victoria Y. ; Haakenstad, Annie ; Kates, Jennifer ; Liu, Yingying ; Matyasz, Taylor ; Micah, Angela ; Reynolds, Alex ; Sadat, Nafis ; Schneider, Matthew T. ; Sorensen, Reed ; Evans, Tim ; Evans, David ; Kurowski, Christoph ; Tandon, Ajay ; Abbas, Kaja M. ; Abera, Semaw Ferede ; Ahmad Kiadaliri, Aliasghar ; Ahmed, Kedir Yimam ; Ahmed, Muktar Beshir ; Alam, Khurshid ; Alizadeh-Navaei, Reza ; Alkerwi, A. ; Amini, Erfan ; Ammar, Walid ; Amrock, Stephen Marc ; Antonio, Carl Abelardo T. ; Atey, Tesfay Mehari ; Avila-Burgos, Leticia ; Awasthi, Ashish ; Barac, Aleksandra ; Bernal, Oscar Alberto ; Beyene, Addisu Shunu ; Beyene, Tariku Jibat ; Birungi, Charles ; Bizuayehu, Habtamu Mellie ; Breitborde, Nicholas J.K. ; Cahuana-Hurtado, Lucero ; Castro, Ruben Estanislao ; Catalá-López, Ferran ; Dalal, Koustuv ; Dandona, Lalit ; Dandona, Rakhi ; Jager, Pieter De; Dharmaratne, Samath D. ; Dubey, Manisha ; Sa Farinha, Carla Sofia E. ; Faro, Andre ; Feigl, Andrea B. ; Fischer, Florian ; Fitchett, Joseph Robert Anderson ; Foigt, Nataliya ; Giref, Ababi Zergaw ; Gupta, Rahul ; Hamidi, Samer ; Harb, Hilda L. ; Hay, Simon I. ; Hendrie, Delia ; Horino, Masako ; Jürisson, Mikk ; Jakovljevic, Mihajlo B. ; Javanbakht, Mehdi ; John, Denny ; Jonas, Jost B. ; Karimi, Seyed M. ; Khang, Young Ho ; Khubchandani, Jagdish ; Kim, Yun Jin ; Kinge, Jonas M. ; Krohn, Kristopher J. ; Kumar, G.A. ; Magdy Abd El Razek, Hassan ; Magdy Abd El Razek, Mohammed ; Majeed, Azeem ; Malekzadeh, Reza ; Masiye, Felix ; Meier, Toni ; Meretoja, Atte ; Miller, Ted R. ; Mirrakhimov, Erkin M. ; Mohammed, Shafiu ; Nangia, Vinay ; Olgiati, Stefano ; Osman, Abdalla Sidahmed ; Owolabi, Mayowa O. ; Patel, Tejas ; Paternina Caicedo, Angel J. ; Pereira, David M. ; Perelman, Julian ; Polinder, Suzanne ; Rafay, Anwar ; Rahimi-Movaghar, Vafa ; Rai, Rajesh Kumar ; Ram, Usha ; Ranabhat, Chhabi Lal ; Roba, Hirbo Shore ; Salama, Joseph ; Savic, Miloje ; Sepanlou, Sadaf G. ; Shrime, Mark G. ; Talongwa, Roberto Tchio ; Ao, Braden J. Te; Tediosi, Fabrizio ; Tesema, Azeb Gebresilassie ; Thomson, Alan J. ; Tobe-Gai, Ruoyan ; Topor-Madry, Roman ; Undurraga, Eduardo A. ; Vasankari, Tommi ; Violante, Francesco S. ; Werdecker, Andrea ; Wijeratne, Tissa ; Xu, Gelin ; Yonemoto, Naohiro ; Younis, Mustafa Z. ; Yu, Chuanhua ; Zaidi, Zoubida ; Sayed Zaki, Maysaa El; Murray, Christopher J.L. - \ 2017
    The Lancet 389 (2017)10083. - ISSN 0140-6736 - p. 1981 - 2004.
    Background: An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. Methods: We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Findings: Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3.0%. The largest health spending growth rates were in upper-middle-income (5.9) and lower-middle-income groups (5.0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4.6%, and health spending increased from $51 to $120 per capita. In 2014, 59.2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29.1% and 58.0% of spending was OOP spending and 35.7% and 3.0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1.8%, and reached US$37.6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. Interpretation: Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage.
    Future and potential spending on health 2015-40 : Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries
    Dieleman, Joseph L. ; Campbell, Madeline ; Chapin, Abigail ; Eldrenkamp, Erika ; Fan, Victoria Y. ; Haakenstad, Annie ; Kates, Jennifer ; Li, Zhiyin ; Matyasz, Taylor ; Micah, Angela ; Reynolds, Alex ; Sadat, Nafis ; Schneider, Matthew T. ; Sorensen, Reed ; Abbas, Kaja M. ; Abera, Semaw Ferede ; Ahmad Kiadaliri, Aliasghar ; Ahmed, Muktar Beshir ; Alam, Khurshid ; Alizadeh-Navaei, Reza ; Alkerwi, A. ; Amini, Erfan ; Ammar, Walid ; Antonio, Carl Abelardo T. ; Atey, Tesfay Mehari ; Avila-Burgos, Leticia ; Awasthi, Ashish ; Barac, Aleksandra ; Berheto, Tezera Moshago ; Beyene, Addisu Shunu ; Beyene, Tariku Jibat ; Birungi, Charles ; Bizuayehu, Habtamu Mellie ; Breitborde, Nicholas J.K. ; Cahuana-Hurtado, Lucero ; Castro, Ruben Estanislao ; Catalá-López, Ferran ; Dalal, Koustuv ; Dandona, Lalit ; Dharmaratne, Rakhi Dandona Samath D. ; Dubey, Manisha ; Faro, Andé ; Feigl, Andrea B. ; Fischer, Florian ; Anderson Fitchett, Joseph R. ; Foigt, Nataliya ; Giref, Ababi Zergaw ; Gupta, Rahul ; Hamidi, Samer ; Harb, Hilda L. ; Hay, Simon I. ; Hendrie, Delia ; Horino, Masako ; Jürisson, Mikk ; Jakovljevic, Mihajlo B. ; Javanbakht, Mehdi ; John, Denny ; Jonas, Jost B. ; Karimi, Seyed M. ; Khang, Young Ho ; Khubchandani, Jagdish ; Kim, Yun Jin ; Kinge, Jonas M. ; Krohn, Kristopher J. ; Kumar, G.A. ; Leung, Ricky ; Magdy Abd El Razek, Hassan ; Magdy Abd El Razek, Mohammed ; Majeed, Azeem ; Malekzadeh, Reza ; Malta, Deborah Carvalho ; Meretoja, Atte ; Miller, Ted R. ; Mirrakhimov, Erkin M. ; Mohammed, Shafiu ; Molla, Gedefaw ; Nangia, Vinay ; Olgiati, Stefano ; Owolabi, Mayowa O. ; Patel, Tejas ; Paternina Caicedo, Angel J. ; Pereira, David M. ; Perelman, Julian ; Polinder, Suzanne ; Rafay, Anwar ; Rahimi-Movaghar, Vafa ; Rai, Rajesh Kumar ; Ram, Usha ; Ranabhat, Chhabi Lal ; Roba, Hirbo Shore ; Savic, Miloje ; Sepanlou, Sadaf G. ; Ao, Braden J. Te; Tesema, Azeb Gebresilassie ; Thomson, Alan J. ; Tobe-Gai, Ruoyan ; Topor-Madry, Roman ; Undurraga, Eduardo A. ; Vargas, Veronica ; Vasankari, Tommi ; Violante, Francesco S. ; Wijeratne, Tissa ; Xu, Gelin ; Yonemoto, Naohiro ; Younis, Mustafa Z. ; Yu, Chuanhua ; Zaidi, Zoubida ; Sayed Zaki, Maysaa El; Murray, Christopher J.L. - \ 2017
    The Lancet 389 (2017)10083. - ISSN 0140-6736 - p. 2005 - 2030.
    Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to $24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential.
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