TY - JOUR
T1 - Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years
T2 - an analysis for the Global Burden of Disease Study 2017
AU - Troeger, Christopher E.
AU - Khalil, Ibrahim A.
AU - Blacker, Brigette F.
AU - Biehl, Molly H.
AU - Albertson, Samuel B.
AU - Zimsen, Stephanie R.M.
AU - Rao, Puja C.
AU - Abate, Degu
AU - Admasie, Amha
AU - Ahmadi, Alireza
AU - Ahmed, Mohamed Lemine Cheikh Brahim
AU - Akal, Chalachew Genet
AU - Alahdab, Fares
AU - Alam, Noore
AU - Alene, Kefyalew Addis
AU - Alipour, Vahid
AU - Aljunid, Syed Mohamed
AU - Al-Raddadi, Rajaa M.
AU - Alvis-Guzman, Nelson
AU - Amini, Saeed
AU - Anjomshoa, Mina
AU - Antonio, Carl Abelardo T.
AU - Arabloo, Jalal
AU - Aremu, Olatunde
AU - Atalay, Hagos Tasew
AU - Atique, Suleman
AU - Avokpaho, Euripide F.G.A.
AU - Awad, Samah
AU - Awasthi, Ashish
AU - Badawi, Alaa
AU - Balakrishnan, Kalpana
AU - Banoub, Joseph Adel Mattar
AU - Barac, Aleksandra
AU - Bassat, Quique
AU - Bedi, Neeraj
AU - Bennett, Derrick A.
AU - Bhattacharyya, Krittika
AU - Bhutta, Zulfiqar A.
AU - Bijani, Ali
AU - Bills, Corey B.
AU - Car, Josip
AU - Carvalho, Félix
AU - Castañeda-Orjuela, Carlos A.
AU - Causey, Kate
AU - Christopher, Devasahayam J.
AU - Cohen, Aaron J.
AU - Dandona, Lalit
AU - Dandona, Rakhi
AU - Daryani, Ahmad
AU - Demeke, Feleke Mekonnen
AU - Djalalinia, Shirin
AU - Dubey, Manisha
AU - Dubljanin, Eleonora
AU - Duken, Eyasu Ejeta
AU - El Sayed Zaki, Maysaa
AU - Endries, Aman Yesuf
AU - Fernandes, Eduarda
AU - Fischer, Florian
AU - Frostad, Joseph
AU - Fullman, Nancy
AU - Gardner, William M.
AU - Geta, Birhanu
AU - Ghadiri, Keyghobad
AU - Gorini, Giuseppe
AU - Goulart, Alessandra C.
AU - Guo, Yuming
AU - Hailu, Gessessew Bugssa
AU - Haj-Mirzaian, Arvin
AU - Haj-Mirzaian, Arya
AU - Hamidi, Samer
AU - Hassen, Hamid Yimam
AU - Hoang, Chi Linh
AU - Horita, Nobuyuki
AU - Hostiuc, Mihaela
AU - Hussain, Zakir
AU - Irvani, Seyed Sina Naghibi
AU - James, Spencer L.
AU - Jha, Ravi Prakash
AU - Jonas, Jost B.
AU - Karch, André
AU - Kasaeian, Amir
AU - Kassa, Tesfaye Dessale
AU - Kassebaum, Nicholas J.
AU - Kefale, Adane Teshome
AU - Khader, Yousef Saleh
AU - Khan, Ejaz Ahmad
AU - Khan, Gulfaraz
AU - Khan, Md Nuruzzaman
AU - Khang, Young Ho
AU - Khoja, Abdullah T.
AU - Kimokoti, Ruth W.
AU - Kisa, Adnan
AU - Kisa, Sezer
AU - Kissoon, Niranjan
AU - Knibbs, Luke D.
AU - Kochhar, Sonali
AU - Kosen, Soewarta
AU - Koul, Parvaiz A.
AU - Koyanagi, Ai
AU - Kuate Defo, Barthelemy
AU - Kumar, G. Anil
AU - Lal, Dharmesh Kumar
AU - Leshargie, Cheru Tesema
AU - Lewycka, Sonia
AU - Li, Shanshan
AU - Lodha, Rakesh
AU - Macarayan, Erlyn Rachelle King
AU - Majdan, Marek
AU - Mamun, Abdullah A.
AU - Manguerra, Helena
AU - Mehta, Varshil
AU - Melese, Addisu
AU - Memish, Ziad A.
AU - Mengistu, Desalegn Tadese
AU - Meretoja, Tuomo J.
AU - Mestrovic, Tomislav
AU - Miazgowski, Bartosz
AU - Mirrakhimov, Erkin M.
AU - Moazen, Babak
AU - Mohammad, Karzan Abdulmuhsin
AU - Mohammed, Shafiu
AU - Monasta, Lorenzo
AU - Moore, Catrin E.
AU - Morawska, Lidia
AU - Mosser, Jonathan F.
AU - Mousavi, Seyyed Meysam
AU - Murthy, Srinivas
AU - Mustafa, Ghulam
AU - Nazari, Javad
AU - Nguyen, Cuong Tat
AU - Nguyen, Huong Lan Thi
AU - Nguyen, Long Hoang
AU - Nguyen, Son Hoang
AU - Nielsen, Katie R.
AU - Nisar, Muhammad Imran
AU - Nixon, Molly R.
AU - Ogbo, Felix Akpojene
AU - Okoro, Anselm
AU - Olagunju, Andrew T.
AU - Olagunju, Tinuke O.
AU - Oren, Eyal
AU - Ortiz, Justin R.
AU - P A, Mahesh
AU - Pakhale, Smita
AU - Postma, Maarten J.
AU - Qorbani, Mostafa
AU - Quansah, Reginald
AU - Rafiei, Alireza
AU - Rahim, Fakher
AU - Rahimi-Movaghar, Vafa
AU - Rai, Rajesh Kumar
AU - Reitsma, Marissa Bettay
AU - Rezai, Mohammad Sadegh
AU - Rezapour, Aziz
AU - Rios-Blancas, Maria Jesus
AU - Ronfani, Luca
AU - Rothenbacher, Dietrich
AU - Rubino, Salvatore
AU - Saleem, Zikria
AU - Sambala, Evanson Zondani
AU - Samy, Abdallah M.
AU - Santric Milicevic, Milena M.
AU - Sarmiento-Suárez, Rodrigo
AU - Sartorius, Benn
AU - Savic, Miloje
AU - Sawhney, Monika
AU - Saxena, Sonia
AU - Sbarra, Alyssa
AU - Seyedmousavi, Seyedmojtaba
AU - Shaikh, Masood Ali
AU - Sheikh, Aziz
AU - Shigematsu, Mika
AU - Smith, David L.
AU - Sreeramareddy, Chandrashekhar T.
AU - Stanaway, Jeffrey D.
AU - Sufiyan, Mu'awiyyah Babale
AU - Temsah, Mohamad Hani
AU - Tessema, Belay
AU - Tran, Bach Xuan
AU - Tran, Khanh Bao
AU - Tsadik, Afewerki Gebremeskel
AU - Ullah, Irfan
AU - Updike, Rachel L.
AU - Vasankari, Tommi Juhani
AU - Veisani, Yousef
AU - Wada, Fiseha Wadilo
AU - Waheed, Yasir
AU - Welgan, Katie
AU - Wiens, Kirsten E.
AU - Wiysonge, Charles Shey
AU - Yimer, Ebrahim M.
AU - Yonemoto, Naohiro
AU - Zaidi, Zoubida
AU - Zar, Heather J.
AU - Lim, Stephen S.
AU - Vos, Theo
AU - Mokdad, Ali H.
AU - Murray, Christopher J.L.
AU - Kyu, Hmwe Hmwe
AU - Hay, Simon I.
AU - Reiner, Robert C.
AU - GBD 2017 Lower Respiratory Infections Collaborators
PY - 2020/1
Y1 - 2020/1
N2 - Background: Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. Methods: We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. Findings: In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286–873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5–68·5) and in mortality rate (from 362·7 deaths [330·1–392·0] per 100 000 children to 118·9 deaths [109·8–128·3] per 100 000 children; 67·2% decrease, 63·5–70·1). LRI incidence declined globally (32·4% decrease, 27·2–37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0–24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1–6·3), and reductions in household air pollution (8·4%, 6·8–9·2). Interpretation: Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths. Funding: Bill & Melinda Gates Foundation.
AB - Background: Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. Methods: We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. Findings: In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286–873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5–68·5) and in mortality rate (from 362·7 deaths [330·1–392·0] per 100 000 children to 118·9 deaths [109·8–128·3] per 100 000 children; 67·2% decrease, 63·5–70·1). LRI incidence declined globally (32·4% decrease, 27·2–37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0–24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1–6·3), and reductions in household air pollution (8·4%, 6·8–9·2). Interpretation: Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths. Funding: Bill & Melinda Gates Foundation.
UR - http://www.scopus.com/inward/record.url?scp=85076678739&partnerID=8YFLogxK
U2 - 10.1016/S1473-3099(19)30410-4
DO - 10.1016/S1473-3099(19)30410-4
M3 - Article
C2 - 31678026
AN - SCOPUS:85076678739
VL - 20
SP - 60
EP - 79
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
SN - 1473-3099
IS - 1
ER -