Cyrus Cooper

AUG 2015MurrayThe Lancet

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

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.

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Evaluating outcomes of psychological support services in minimum security prisons in England: a quasi-experimental retrospective cohort study using propensity score matching and survival analysis

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Association between maternal vitamin D supplementation during pregnancy and the risk of acute respiratory infections in offspring: a systematic review and meta-analysis

Background Acute respiratory infections (ARIs) are a leading cause of mortality in infants. Vitamin D supports innate antimicrobial effector mechanisms in leucocytes and respiratory epithelium. Maternal vitamin D supplementation during pregnancy has been proposed as a preventive strategy, however, an up-to-date synthesis of available data from randomised controlled trials (RCTs) has not been conducted. Methods We conducted a systematic review and meta-analysis of aggregate data from RCTs of maternal vitamin D supplementation for prevention of ARIs in offspring. Data were analysed using a random-effects model. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, Web of Science and the ClinicalTrials.gov from database inception to 5th August 2025. No language restrictions were imposed. Double-blind RCTs of maternal vitamin D supplementation, with placebo or lower-dose vitamin D control, were eligible if approved by Research Ethics Committee and if ARI incidence in offspring was collected prospectively and pre-specified as an efficacy outcome. Sub-group analyses were done to determine whether effects of maternal vitamin D supplementation on offspring ARI risk varied according to maternal baseline circulating 25-hydroxyvitamin D (25 [OH]D) concentrations (<25 nmol/L, 25–49.9 nmol/L, 50–74.9 nmol/L, or ≥75 nmol/L). The study was registered with PROSPERO, CRD42024527191. Findings Our search identified 405 unique studies, of which 4 RCTs (3678 participants) were eligible and included. For the primary comparison of any maternal vitamin D supplementation vs. placebo, the intervention did not significantly affect overall ARI risk in offspring (incidence rate ratio [IRR] 1.01, 95% CI 0.98–1.03, P=0.66; 4 studies; I 2 14.5%, absolute effects from GRADE assessment: 0.05 higher rate in vitamin D arm; moderate quality finding). Pre-specified subgroup analysis did not reveal evidence of effect modification by maternal baseline vitamin D status: <25 nmol/L group: IRR 1.12, 95% CI 0.98–1.27 (607 participants in 4 studies, I 2 47.8%) vs. 25–49.9 nmol/L group: IRR 1.04, 95% CI 0.96–1.13 (1154 participants in 4 studies, I 2 68.5%) vs. 50–74.9 nmol/L group: IRR 1.00, 95% CI 0.93–1.08 (789 participants in 4 studies, I 2 64.9%) vs. ≥75 nmol/L group: IRR 0.97, 95% CI 0.89–1.06 (505 participants in 4 studies, I 2 47.6%). A funnel plot did not indicate the presence of publication bias or small-study effects (P = 0.71, Egger's test). Interpretation Our analysis of current data does not support routine antenatal vitamin D supplementation for the prevention of ARI in offspring. Key limitations of the study were the administration of a low dose vitamin D standard-of-care in some populations which may have attenuated effects of the intervention, and heterogeneity in ARI case definitions which may have introduced misclassification bias. Targeted supplementation in deficient populations may warrant further investigation.

Agent SPI-WSI: In context learning for computationally spatial pathway inferring on whole slide histopathology images conditioned on bulk RNA sequencing using pathologist in the loop.

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The global, regional, and national burden attributable to low bone mineral density, 1990–2020: an analysis of a modifiable risk factor from the Global Burden of Disease Study 2021

BACKGROUND: Fractures related to osteoporosis and low bone mineral density lead to substantial morbidity, mortality, and cost to individuals and health systems. Here we present the most up-to-date global, regional, and national estimates of the contribution of low bone mineral density to the burden of fractures from falls and additional categories of injuries from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. METHODS: ). The population-attributable fraction for low bone mineral density was calculated by comparing the observed distributions of standardised femoral neck bone mineral density to an age-specific and sex-specific counterfactual distribution, defined as the 99th percentile of five rounds of the National Health and Nutrition Examination Survey in the USA, by 5-year age group and sex. Hospital and emergency department data were used to derive the incidence of fractures for six categories of injury (road injuries, other transport injuries, falls, non-venomous animal contact, exposure to mechanical forces, and physical interpersonal violence) using ICD codes. Deaths due to fractures were estimated as the proportion of in-hospital deaths due to the specified injury causes for which a fracture (nature of injury code) was more severe than the cause of injury code. YLDs and DALYs attributable to low bone mineral density by cause of injury were also determined according to previous GBD methods. FINDINGS: In 2020, 8·32 million (95% UI 5·58-10·84) YLDs, 17·2 million (14·1-20·2) DALYs, and 477 000 (411 000-536 000) deaths were attributable to low bone mineral density globally in individuals aged 40 years and older. Between 1990 and 2020, global YLDs, DALYs, and deaths attributable to low bone mineral density increased by 91·8% (88·5-95·1), 89·8% (81·5-99·0), and 127·1% (108·5-144·5), respectively. Over this period, the age-standardised global rates of YLDs, DALYs, and deaths attributable to low bone mineral density showed modest decreases. In 2020, falls accounted for 76·2% (95% UI 74·2-78·3) of YLDs, 65·2% (62·9-67·6) of DALYs, and 71·0% (67·4-72·8) of deaths attributable to low bone mineral density, and road injuries largely accounted for the remaining amount: 12·4% (11·1-13·6) of YLDs, 24·6% (22·5-27·1) of DALYs, and 23·1% (21·6-26·2) of deaths. As a proportion of all fall-related burden, low bone mineral density accounted for 26·6% (23·2-28·7) of YLDs, 25·6% (22·1-27·4) of DALYs, and 40·6% (35·4-44·0) of deaths in 2020. Of all road injury-related burden, 12·6% (10·8-13·5) of YLDs, 6·3% (5·4-6·9) of DALYs, and 8·9% (7·6-9·6) of deaths were attributable to low bone mineral density. In men, road injuries accounted for the largest proportion of DALYs attributable to low bone mineral density in those aged 40-59 years and the largest proportion of deaths in those aged 40-64 years. In women, road injuries were the leading cause of DALYs attributable to low bone mineral density in those aged 40-44 years and the leading cause of deaths attributable to low bone mineral density in those aged 40-54 years. In older age groups among both men and women, falls were the leading cause of the burden attributable to low bone mineral density. INTERPRETATION: Low bone mineral density is a crucial modifiable risk factor for fractures, which are an important cause of morbidity and mortality particularly in ageing populations. This analysis highlights low bone mineral density as a cause of health loss not just from falls, but also from road injuries.

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AUG 2025CooperEcology Of Freshwater Fish

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