Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 2145-2191 |
| Journal | Lancet (London, England) |
| Volume | 386 |
| Issue number | 10009 |
| DOIs | |
| Publication status | Published - 28 Nov 2015 |
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In: Lancet (London, England), Vol. 386, No. 10009, 28.11.2015, p. 2145-2191.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition
AU - Murray, Christopher
AU - Barber, Ryan
AU - Foreman, Kyle
AU - Abbasoglu Ozgoren, Ayse
AU - Abd-Allah, Foad
AU - Abera, Semaw
AU - Aboyans, Victor
AU - Abraham, Jerry
AU - Abubakar, Ibrahim
AU - Abu-Raddad, Laith
AU - Abu-Rmeileh, Niveen
AU - Achoki, Tom
AU - Ackerman, Ilana
AU - Ademi, Zanfina
AU - Adou, Arsène
AU - Adsuar, José
AU - Afshin, Ashkan
AU - Agardh, Emilie
AU - Alam, Sayed Saidul
AU - Alasfoor, Deena
AU - Albittar, Mohammed
AU - Alegretti, Miguel
AU - Alemu, Zewdie
AU - Alfonso-Cristancho, Rafael
AU - Alhabib, Samia
AU - Ali, Raghib
AU - Alla, François
AU - Allebeck, Peter
AU - Almazroa, Mohammad
AU - Alsharif, Ubai
AU - Alvarez, Elena
AU - Alvis-Guzman, Nelson
AU - Amare, Azmeraw
AU - Ameh, Emmanuel
AU - Amini, Heresh
AU - Ammar, Walid
AU - Anderson, H. Ross
AU - Anderson, Benjamin
AU - Antonio, Carl Abelardo
AU - Anwari, Palwasha
AU - Arnlöv, Johan
AU - Arsenijevic, Valentina
AU - Artaman, Al
AU - Asghar, Rana
AU - Assadi, Reza
AU - Atkins, Lydia
AU - Avila, Marco
AU - Awuah, Baffour
AU - Bachman, Victoria
AU - Badawi, Alaa
AU - Bahit, Maria
AU - Balakrishnan, Kalpana
AU - Banerjee, Amitava
AU - Barker-Collo, Suzanne
AU - Barquera, Simon
AU - Barregard, Lars
AU - Barrero, Lope
AU - Basu, Arindam
AU - Basu, Sanjay
AU - Basulaiman, Mohammed
AU - Beardsley, Justin
AU - Bedi, Neeraj
AU - Beghi, Ettore
AU - Bekele, Tolesa
AU - Bell, Michelle
AU - Benjet, Corina
AU - Bennett, Derrick
AU - Bensenor, Isabela
AU - Benzian, Habib
AU - Bernabé, Eduardo
AU - Bertozzi-Villa, Amelia
AU - Beyene, Tariku
AU - Bhala, Neeraj
AU - Bhalla, Ashish
AU - Bhutta, Zulfiqar
AU - Bienhoff, Kelly
AU - Bikbov, Boris
AU - Biryukov, Stanley
AU - Blore, Jed
AU - Blosser, Christopher
AU - Blyth, Fiona
AU - Bohensky, Megan
AU - Bolliger, Ian
AU - Bora Başara, Berrak
AU - Bornstein, Natan
AU - Bose, Dipan
AU - Boufous, Soufiane
AU - Bourne, Rupert
AU - Boyers, Lindsay
AU - Brainin, Michael
AU - Brayne, Carol
AU - Brazinova, Alexandra
AU - Breitborde, Nicholas
AU - Brenner, Hermann
AU - Briggs, Adam
AU - Brooks, Peter
AU - Brown, Jonathan
AU - Brugha, Traolach
AU - Buchbinder, Rachelle
AU - Buckle, Geoffrey
AU - Budke, Christine
AU - Bulchis, Anne
AU - Bulloch, Andrew
AU - Campos-Nonato, Ismael
AU - Carabin, Hélène
AU - Carapetis, Jonathan
AU - Cárdenas, Rosario
AU - Carpenter, David
AU - Caso, Valeria
AU - Castañeda-Orjuela, Carlos
AU - Castro, Ruben
AU - Catalá-López, Ferrán
AU - Cavalleri, Fiorella
AU - Çavlin, Alanur
AU - Chadha, Vineet
AU - Chang, Jung-Chen
AU - Charlson, Fiona
AU - Chen, Honglei
AU - Chen, Wanqing
AU - Chiang, Peggy
AU - Chimed-Ochir, Odgerel
AU - Chowdhury, Rajiv
AU - Christensen, Hanne
AU - Christophi, Costas
AU - Cirillo, Massimo
AU - Coates, Matthew
AU - Coffeng, Luc
AU - Coggeshall, Megan
AU - Colistro, Valentina
AU - Colquhoun, Samantha
AU - Cooke, Graham
AU - Cooper, Cyrus
AU - Cooper, Leslie
AU - Coppola, Luis
AU - Cortinovis, Monica
AU - Criqui, Michael
AU - Crump, John
AU - Cuevas-Nasu, Lucia
AU - Danawi, Hadi
AU - Dandona, Lalit
AU - Dandona, Rakhi
AU - Dansereau, Emily
AU - Dargan, Paul
AU - Davey, Gail
AU - Davis, Adrian
AU - Davitoiu, Dragos
AU - Dayama, Anand
AU - De Leo, Diego
AU - Degenhardt, Louisa
AU - Del Pozo-Cruz, Borja
AU - Dellavalle, Robert
AU - Deribe, Kebede
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AU - Des Jarlais, Don
AU - Dessalegn, Muluken
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AU - Dherani, Mukesh
AU - Diaz-Torné, Cesar
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AU - Ding, Eric
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AU - Driscoll, Tim
AU - Duan, Leilei
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AU - Ebel, Beth
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AU - Feigin, Valery
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AU - Fereshtehnejad, Seyed-Mohammad
AU - Fernandes, Jefferson
AU - Ferrari, Alize
AU - Fitzmaurice, Christina
AU - Flaxman, Abraham
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AU - Foigt, Nataliya
AU - Forouzanfar, Mohammad
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AU - Hammami, Mouhanad
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AU - Hankey, Graeme
AU - Hansen, Gillian
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AU - Harb, Hilda
AU - Haro, Josep Maria
AU - Havmoeller, Rasmus
AU - Hay, Simon
AU - Hay, Roderick
AU - Heredia-Pi, Ileana
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AU - Hosgood, H. Dean
AU - Hossain, Mazeda
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AU - Hoy, Damian
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AU - Huang, John
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AU - Jee, Sun Ha
AU - Jeemon, Panniyammakal
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AU - Jha, Vivekanand
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AU - Jonas, Jost
AU - Juel, Knud
AU - Kan, Haidong
AU - Karch, André
AU - Karema, Corine
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AU - Karthikeyan, Ganesan
AU - Kassebaum, Nicholas
AU - Kaul, Anil
AU - Kawakami, Norito
AU - Kazanjan, Konstantin
AU - Kemp, Andrew
AU - Kengne, Andre
AU - Keren, Andre
AU - Khader, Yousef
AU - Khalifa, Shams Eldin Ali
AU - Khan, Ejaz
AU - Khan, Gulfaraz
AU - Khang, Young-Ho
AU - Kieling, Christian
AU - Kim, Daniel
AU - Kim, Sungroul
AU - Kim, Yunjin
AU - Kinfu, Yohannes
AU - Kinge, Jonas
AU - Kivipelto, Miia
AU - Knibbs, Luke
AU - Knudsen, Ann Kristin
AU - Kokubo, Yoshihiro
AU - Kosen, Soewarta
AU - Krishnaswami, Sanjay
AU - Kuate Defo, Barthelemy
AU - Kucuk Bicer, Burcu
AU - Kuipers, Ernst
AU - Kulkarni, Chanda
AU - Kulkarni, Veena
AU - Kumar, G. Anil
AU - Kyu, Hmwe
AU - Lai, Taavi
AU - Lalloo, Ratilal
AU - Lallukka, Tea
AU - Lam, Hilton
AU - Lan, Qing
AU - Lansingh, Van
AU - Larsson, Anders
AU - Lawrynowicz, Alicia
AU - Leasher, Janet
AU - Leigh, James
AU - Leung, Ricky
AU - Levitz, Carly
AU - Li, Bin
AU - Li, Yichong
AU - Li, Yongmei
AU - Lim, Stephen
AU - Lind, Maggie
AU - Lipshultz, Steven
AU - Liu, Shiwei
AU - Liu, Yang
AU - Lloyd, Belinda
AU - Lofgren, Katherine
AU - Logroscino, Giancarlo
AU - Looker, Katharine
AU - Lortet-Tieulent, Joannie
AU - Lotufo, Paulo
AU - Lozano, Rafael
AU - Lucas, Robyn
AU - Lunevicius, Raimundas
AU - Lyons, Ronan
AU - Ma, Stefan
AU - MacIntyre, Michael
AU - Mackay, Mark
AU - Majdan, Marek
AU - Malekzadeh, Reza
AU - Marcenes, Wagner
AU - Margolis, David
AU - Margono, Christopher
AU - Marzan, Melvin
AU - Masci, Joseph
AU - Mashal, Mohammad
AU - Matzopoulos, Richard
AU - Mayosi, Bongani
AU - Mazorodze, Tasara
AU - Mcgill, Neil
AU - Mcgrath, John
AU - McKee, Martin
AU - McLain, Abigail
AU - Meaney, Peter
AU - Medina, Catalina
AU - Mehndiratta, Man Mohan
AU - Mekonnen, Wubegzier
AU - Melaku, Yohannes
AU - Meltzer, Michele
AU - Memish, Ziad
AU - Mensah, George
AU - Meretoja, Atte
AU - Mhimbira, Francis
AU - Micha, Renata
AU - Miller, Ted
AU - Mills, Edward
AU - Mitchell, Philip
AU - Mock, Charles
AU - Mohamed Ibrahim, Norlinah
AU - Mohammad, Karzan
AU - Mokdad, Ali
AU - Mola, Glen
AU - Monasta, Lorenzo
AU - Montañez Hernandez, Julio
AU - Montico, Marcella
AU - Montine, Thomas
AU - Mooney, Meghan
AU - Moore, Ami
AU - Moradi-Lakeh, Maziar
AU - Moran, Andrew
AU - Mori, Rintaro
AU - Moschandreas, Joanna
AU - Moturi, Wilkister
AU - Moyer, Madeline
AU - Mozaffarian, Dariush
AU - Msemburi, William
AU - Mueller, Ulrich
AU - Mukaigawara, Mitsuru
AU - Mullany, Erin
AU - Murdoch, Michele
AU - Murray, Joseph
AU - Murthy, Kinnari
AU - Naghavi, Mohsen
AU - Naheed, Aliya
AU - Naidoo, Kovin
AU - Naldi, Luigi
AU - Nand, Devina
AU - Nangia, Vinay
AU - Narayan, Venkat
AU - Nejjari, Chakib
AU - Neupane, Sudan
AU - Newton, Charles
AU - Ng, Marie
AU - Ngalesoni, Frida
AU - Nguyen, Grant
AU - Nisar, Muhammad
AU - Nolte, Sandra
AU - Norheim, Ole
AU - Norman, Rosana
AU - Norrving, Bo
AU - Nyakarahuka, Luke
AU - Oh, In-Hwan
AU - Ohkubo, Takayoshi
AU - Ohno, Summer
AU - Olusanya, Bolajoko
AU - Opio, John Nelson
AU - Ortblad, Katrina
AU - Ortiz, Alberto
AU - Pain, Amanda
AU - Pandian, Jeyaraj
AU - Panelo, Carlo Irwin
AU - Papachristou, Christina
AU - Park, Eun-Kee
AU - Park, Jae-Hyun
AU - Patten, Scott
AU - Patton, George
AU - Paul, Vinod
AU - Pavlin, Boris
AU - Pearce, Neil
AU - Pereira, David
AU - Perez-Padilla, Rogelio
AU - Perez-Ruiz, Fernando
AU - Perico, Norberto
AU - Pervaiz, Aslam
AU - Pesudovs, Konrad
AU - Peterson, Carrie
AU - Petzold, Max
AU - Phillips, Michael
AU - Phillips, Bryan
AU - Phillips, David
AU - Piel, Frédéric
AU - Plass, Dietrich
AU - Poenaru, Dan
AU - Polinder, Suzanne
AU - Pope, Daniel
AU - Popova, Svetlana
AU - Poulton, Richie
AU - Pourmalek, Farshad
AU - Prabhakaran, Dorairaj
AU - Prasad, Noela
AU - Pullan, Rachel
AU - Qato, Dima
AU - Quistberg, D. Alex
AU - Rafay, Anwar
AU - Rahimi, Kazem
AU - Rahman, Sajjad Ur
AU - Raju, Murugesan
AU - Rana, Saleem
AU - Razavi, Homie
AU - Reddy, K. Srinath
AU - Refaat, Amany
AU - Remuzzi, Giuseppe
AU - Resnikoff, Serge
AU - Ribeiro, Antonio
AU - Richardson, Lee
AU - Richardus, Jan Hendrik
AU - Roberts, D. Allen
AU - Rojas-Rueda, David
AU - Ronfani, Luca
AU - Roth, Gregory
AU - Rothenbacher, Dietrich
AU - Rothstein, David
AU - Rowley, Jane
AU - Roy, Nobhojit
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AU - Saeedi, Mohammad
AU - Saha, Sukanta
AU - Sahraian, Mohammad Ali
AU - Sampson, Uchechukwu
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AU - Sandar, Logan
AU - Santos, Itamar
AU - Satpathy, Maheswar
AU - Sawhney, Monika
AU - Scarborough, Peter
AU - Schneider, Ione
AU - Schöttker, Ben
AU - Schumacher, Austin
AU - Schwebel, David
AU - Scott, James
AU - Seedat, Soraya
AU - Sepanlou, Sadaf
AU - Serina, Peter
AU - Servan-Mori, Edson
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AU - She, Jun
AU - Sheikhbahaei, Sara
AU - Shi, Peilin
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AU - Shiue, Ivy
AU - Shrime, Mark
AU - Sigfusdottir, Inga
AU - Silberberg, Donald
AU - Simard, Edgar
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AU - Singh, Abhishek
AU - Singh, Jasvinder
AU - Singh, Lavanya
AU - Skirbekk, Vegard
AU - Slepak, Erica Leigh
AU - Sliwa, Karen
AU - Soneji, Samir
AU - Søreide, Kjetil
AU - Soshnikov, Sergey
AU - Sposato, Luciano
AU - Sreeramareddy, Chandrashekhar
AU - Stanaway, Jeffrey
AU - Stathopoulou, Vasiliki
AU - Stein, Dan
AU - Stein, Murray
AU - Steiner, Caitlyn
AU - Steiner, Timothy
AU - Stevens, Antony
AU - Stewart, Andrea
AU - Stovner, Lars
AU - Stroumpoulis, Konstantinos
AU - Sunguya, Bruno
AU - Swaminathan, Soumya
AU - Swaroop, Mamta
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AU - Te Ao, Braden
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AU - Tenkorang, Eric
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AU - Thrift, Amanda
AU - Thurston, George
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AU - Toyoshima, Hideaki
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AU - Truelsen, Thomas
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AU - Tuzcu, Emin Murat
AU - Uchendu, Uche
AU - Ukwaja, Kingsley
AU - Undurraga, Eduardo
AU - Uzun, Selen
AU - van Brakel, Wim
AU - van de Vijver, Steven
AU - van Gool, Coen
AU - van Os, Jim
AU - Vasankari, Tommi
AU - Venketasubramanian, Narayanaswamy
AU - Violante, Francesco
AU - Vlassov, Vasiliy
AU - Vollset, Stein Emil
AU - Wagner, Gregory
AU - Wagner, Joseph
AU - Waller, Stephen
AU - Wang, Xiaoxian
AU - Wang, Haidong
AU - Wang, JianLi
AU - Wang, Linhong
AU - Warouw, Tati
AU - Weichenthal, Scott
AU - Weiderpass, Elisabete
AU - Weintraub, Robert
AU - Wang, Wenzhi
AU - Werdecker, Andrea
AU - Westerman, Ronny
AU - Whiteford, Harvey
AU - Wilkinson, James
AU - Williams, Thomas
AU - Wolfe, Charles
AU - Wolock, Timothy
AU - Woolf, Anthony
AU - Wulf Hanson, Sarah
AU - Wurtz, Brittany
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AU - Yan, Lijing
AU - Yano, Yuichiro
AU - Ye, Pengpeng
AU - Yentür, Gökalp
AU - Yip, Paul
AU - Yonemoto, Naohiro
AU - Yoon, Seok-Jun
AU - Younis, Mustafa
AU - Yu, Chuanhua
AU - Zaki, Maysaa
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PY - 2015/11/28
Y1 - 2015/11/28
N2 - BACKGROUND The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING Bill & Melinda Gates Foundation
AB - BACKGROUND The Global Burden of Disease Study 2013 (GBD 2013) aims to bring together all available epidemiological data using a coherent measurement framework, standardised estimation methods, and transparent data sources to enable comparisons of health loss over time and across causes, age-sex groups, and countries. The GBD can be used to generate summary measures such as disability-adjusted life-years (DALYs) and healthy life expectancy (HALE) that make possible comparative assessments of broad epidemiological patterns across countries and time. These summary measures can also be used to quantify the component of variation in epidemiology that is related to sociodemographic development. METHODS We used the published GBD 2013 data for age-specific mortality, years of life lost due to premature mortality (YLLs), and years lived with disability (YLDs) to calculate DALYs and HALE for 1990, 1995, 2000, 2005, 2010, and 2013 for 188 countries. We calculated HALE using the Sullivan method; 95% uncertainty intervals (UIs) represent uncertainty in age-specific death rates and YLDs per person for each country, age, sex, and year. We estimated DALYs for 306 causes for each country as the sum of YLLs and YLDs; 95% UIs represent uncertainty in YLL and YLD rates. We quantified patterns of the epidemiological transition with a composite indicator of sociodemographic status, which we constructed from income per person, average years of schooling after age 15 years, and the total fertility rate and mean age of the population. We applied hierarchical regression to DALY rates by cause across countries to decompose variance related to the sociodemographic status variable, country, and time. FINDINGS Worldwide, from 1990 to 2013, life expectancy at birth rose by 6·2 years (95% UI 5·6-6·6), from 65·3 years (65·0-65·6) in 1990 to 71·5 years (71·0-71·9) in 2013, HALE at birth rose by 5·4 years (4·9-5·8), from 56·9 years (54·5-59·1) to 62·3 years (59·7-64·8), total DALYs fell by 3·6% (0·3-7·4), and age-standardised DALY rates per 100 000 people fell by 26·7% (24·6-29·1). For communicable, maternal, neonatal, and nutritional disorders, global DALY numbers, crude rates, and age-standardised rates have all declined between 1990 and 2013, whereas for non-communicable diseases, global DALYs have been increasing, DALY rates have remained nearly constant, and age-standardised DALY rates declined during the same period. From 2005 to 2013, the number of DALYs increased for most specific non-communicable diseases, including cardiovascular diseases and neoplasms, in addition to dengue, food-borne trematodes, and leishmaniasis; DALYs decreased for nearly all other causes. By 2013, the five leading causes of DALYs were ischaemic heart disease, lower respiratory infections, cerebrovascular disease, low back and neck pain, and road injuries. Sociodemographic status explained more than 50% of the variance between countries and over time for diarrhoea, lower respiratory infections, and other common infectious diseases; maternal disorders; neonatal disorders; nutritional deficiencies; other communicable, maternal, neonatal, and nutritional diseases; musculoskeletal disorders; and other non-communicable diseases. However, sociodemographic status explained less than 10% of the variance in DALY rates for cardiovascular diseases; chronic respiratory diseases; cirrhosis; diabetes, urogenital, blood, and endocrine diseases; unintentional injuries; and self-harm and interpersonal violence. Predictably, increased sociodemographic status was associated with a shift in burden from YLLs to YLDs, driven by declines in YLLs and increases in YLDs from musculoskeletal disorders, neurological disorders, and mental and substance use disorders. In most country-specific estimates, the increase in life expectancy was greater than that in HALE. Leading causes of DALYs are highly variable across countries. INTERPRETATION Global health is improving. Population growth and ageing have driven up numbers of DALYs, but crude rates have remained relatively constant, showing that progress in health does not mean fewer demands on health systems. The notion of an epidemiological transition--in which increasing sociodemographic status brings structured change in disease burden--is useful, but there is tremendous variation in burden of disease that is not associated with sociodemographic status. This further underscores the need for country-specific assessments of DALYs and HALE to appropriately inform health policy decisions and attendant actions. FUNDING Bill & Melinda Gates Foundation
U2 - 10.1016/S0140-6736(15)61340-X
DO - 10.1016/S0140-6736(15)61340-X
M3 - Article
SN - 0140-6736
SN - 1474-547X
VL - 386
SP - 2145
EP - 2191
JO - Lancet (London, England)
JF - Lancet (London, England)
IS - 10009
ER -