Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
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18 May 2024Elsevier B.V.
The Lancet
2024#403Issue 104402162 - 2203 pp.
Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimates distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation.
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Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
Division of Cardiology, University of Washington, Seattle, WA, United States
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
Department of Applied Mathematics, University of Washington, Seattle, WA, United States
Department of Global Health, University of Washington, Seattle, WA, United States
Division of Pediatric Hematology-Oncology, University of Washington, Seattle, WA, United States
Department of Neurology, University of Washington, Seattle, WA, United States
Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
Division of Plastic and Reconstructive Surgery, University of Washington, Seattle, WA, United States
Henry M Jackson School of International Studies, University of Washington, Seattle, WA, United States
Department of Pharmacy, University of Washington, Seattle, WA, United States
Department of Medicine, University of Washington, Seattle, WA, United States
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
Department of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
School of Nursing, University of British Columbia, Vancouver, BC, Canada
Department of Nutrition and Dietetics, Jimma University, Jimma, Ethiopia
Department of Epidemiology, Jimma University, Jimma, Ethiopia
Department of Public Health, Jimma University, Jimma, Ethiopia
Department of Surgery, Jimma University, Jimma, Ethiopia
Institute of Health Science, Jimma University, Jimma, Ethiopia
Department of Psychiatry, Jimma University, Jimma, Ethiopia
Department of Clinical Governance and Quality Improvement, Aleta Wondo Hospital, Aleta Wondo, Ethiopia
Department of Juridical and Economic Studies, La Sapienza University, Rome, Italy
Department of Public Health and Infectious Diseases, La Sapienza University, Rome, Italy
Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
Infectious and Tropical Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
Department of Health Policy and Management, Tabriz University of Medical Sciences, Tabriz, Iran
School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
Department of Immunology, Tabriz University of Medical Sciences, Tabriz, Iran
Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
Neurosciences Research Center (NSRC), Tabriz University of Medical Sciences, Tabriz, Iran
Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Department of Orthopedic Surgery, Harvard University, Boston, MA, United States
Department of Pediatrics, Harvard University, Boston, MA, United States
TH Chan School of Public Health, Harvard University, Boston, MA, United States
Center for Primary Care, Harvard University, Boston, MA, United States
Department of Global Health and Social Medicine, Harvard University, Boston, MA, United States
Harvard Business School, Harvard University, Boston, MA, United States
Department of Epidemiology, Harvard University, Boston, MA, United States
Division of Cardiovascular Medicine, Harvard University, Boston, MA, United States
Harvard Medical School, Harvard University, Boston, MA, United States
Department of Neurological Surgery, Harvard University, Boston, MA, United States
Department of Ophthalmology, Harvard University, Boston, MA, United States
Department of Global Health and Population, Harvard University, Boston, MA, United States
Department of Health Policy and Oral Epidemiology, Harvard University, Boston, MA, United States
Department of Physical Medicine and Rehabilitation, Harvard University, Boston, MA, United States
Beth Israel Deaconess Medical Center, Harvard University, Boston, MA, United States
Division of General Internal Medicine, Harvard University, Boston, MA, United States
Department of Orthopaedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Biotechnology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Urology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Internal Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Occupational Health and Safety Engineering, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Psychiatric Nursing and Management Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Center for Comprehensive Genetic Services, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Food Technology Research, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Immunology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Health Policy and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Neurosurgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Student Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Epidemiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Internal Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Clinical Research Development Unit, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Department of Epidemiology and Biostatistics, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
The Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran
Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Department of Scientific Research, Tehran University of Medical Sciences, Tehran, Iran
Iranian Research Center for HIV/AIDS, Tehran University of Medical Sciences, Tehran, Iran
Department of Ophthalmology, Tehran University of Medical Sciences, Tehran, Iran
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, Tehran, Iran
Childrens Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Orthopedic Department, Tehran University of Medical Sciences, Tehran, Iran
Department of Cardiology, Tehran University of Medical Sciences, Tehran, Iran
Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Department of Physiotherapy, Tehran University of Medical Sciences, Tehran, Iran
Research Center for War-affected People, Tehran University of Medical Sciences, Tehran, Iran
Department of Pharmacology, Tehran University of Medical Sciences, Tehran, Iran
Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
Pharmaceutical Sciences Research Center (PSRC), Tehran University of Medical Sciences, Tehran, Iran
Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
Department of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Department of Pharmaceutical Care, Tehran University of Medical Sciences, Tehran, Iran
Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
Tehran University of Medical Sciences, Tehran, Iran
Department of Epidemiology, Alexandria University, Alexandria, Egypt
Pediatric Dentistry and Dental Public Health Department, Alexandria University, Alexandria, Egypt
Department of Tropical Health and Parasitology, Alexandria University, Alexandria, Egypt
Department of Pathology, Alexandria University, Alexandria, Egypt
Department of Tropical Medicine and Infectious Diseases, Tanta University, Tanta, Egypt
Department of Medicine, Memorial University, St Johns, NL, Canada
Department of Medicine, University of Setif Algeria, Sétif, Algeria
Community and Maternity Nursing Unit, University of Duhok, Duhok, Iraq
Department of Physiotherapy, Bayero University Kano, Kano, Nigeria
Department of Nursing Science, Bayero University Kano, Kano, Nigeria
Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
Department of Midwifery, Dilla University, Dilla, Ethiopia
Department of Psychiatry, Dilla University, Dilla, Ethiopia
Department of Public Health, Dilla University, Dilla, Ethiopia
Department of Neurosurgery, University of Southern California, Los Angeles, CA, United States
Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
Department of Radiology, University of Southern California, Los Angeles, CA, United States
Mark and Mary Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
Department of Emergency Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
Department of Immunology, Zanjan University of Medical Sciences, Zanjan, Iran
Department of Critical Care and Emergency Nursing, Zanjan University of Medical Sciences, Zanjan, Iran
Department of Clinical Pharmacy, University of Gondar, Gondar, Ethiopia
Department of Pharmacology, University of Gondar, Gondar, Ethiopia
College of Pharmacy and Pharmaceutical Sciences, Florida Agricultural and Mechanical University, Tallahassee, FL, United States
Postgraduate Department, University of Sierra Sur, Miahuatlan de Porfirio Diaz, Mexico
National Research Council of Mexico, Mexico City, Mexico
Department of Community Medicine, Babcock University, Ilishan-Remo, Nigeria
School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
Department of Family and Community Health, University of Health and Allied Sciences, Ho, Ghana
Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ho, Ghana
Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
Department of Population and Behavioural Sciences, University of Health and Allied Sciences, Ho, Ghana
Department of Health Policy Planning and Management, University of Health and Allied Sciences, Ho, Ghana
Department of Microbiology and Immunology, University of Health and Allied Sciences, Ho, Ghana
Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
Department of Physical Pharmacy and Pharmacokinetics, Poznan University of Medical Sciences, Poznan, Poland
Department of Public Health, Madda Walabu University, Addis Ababa, Ethiopia
Department of Nutrition and Dietetics, Jimma University, Addis Ababa, Ethiopia
Department of Pediatric Dentistry, Federal University of Minas Gerais, Belo Horizonte, Brazil
Department of Internal Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
Department of Maternal-Child Nursing and Public Health, Federal University of Minas Gerais, Belo Horizonte, Brazil
Department of Clinical Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
Clinical Hospital, Federal University of Minas Gerais, Belo Horizonte, Brazil
Centre of Telehealth, Federal University of Minas Gerais, Belo Horizonte, Brazil
Vaccination Research Observatory, Federal University of Minas Gerais, Belo Horizonte, Brazil
Department of Nursing, Al Zaytoonah University of Jordan, Amman, Jordan
Department of Pharmacology and Toxicology, Usmanu Danfodiyo University, Sokoto, Sokoto, Nigeria
Department of Veterinary Microbiology, Usmanu Danfodiyo University, Sokoto, Sokoto, Nigeria
Department of Veterinary Public Health and Preventive Medicine, Usmanu Danfodiyo University, Sokoto, Sokoto, Nigeria
Clinical Science Department, Nigerian Institute of Medical Research, Lagos, Nigeria
Nigerian Institute of Medical Research, Lagos, Nigeria
Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
Department of Physiotherapy, University of Sharjah, Sharjah, United Arab Emirates
Department of Basic Biomedical Sciences, University of Sharjah, Sharjah, United Arab Emirates
Sharjah Institute for Medical Research, University of Sharjah, Sharjah, United Arab Emirates
Department of Clinical Nutrition and Dietetics, University of Sharjah, Sharjah, United Arab Emirates
Department of Basic Medical Sciences, University of Sharjah, Sharjah, United Arab Emirates
Department of Clinical Science, University of Sharjah, Sharjah, United Arab Emirates
Sharjah Institute of Medical Sciences, University of Sharjah, Sharjah, United Arab Emirates
College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
Research Institute of Medical & Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
Department of Medicinal Chemistry, University of Sharjah, Sharjah, United Arab Emirates
University of Sharjah, Sharjah, United Arab Emirates
Research Department, Hamad Medical Corporation, Doha, Qatar
Department of Nursing Education & Research, Hamad Medical Corporation, Doha, Qatar
Department of Geriatric and Long Term Care, Hamad Medical Corporation, Doha, Qatar
Department of Therapeutics, United Arab Emirates University, Al Ain, United Arab Emirates
Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
Family Medicine Department, United Arab Emirates University, Al Ain, United Arab Emirates
Department of Computer Science and Software Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
College of Pharmacy, University of Jordan, Amman, Jordan
Department of Surgery, Alfaisal University, Riyadh, Saudi Arabia
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
College of Graduate Health Sciences, University of Tennessee, Memphis, TN, United States
College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
Department of Epidemiology and Biostatistics, Bahir Dar University, Bahir Dar, Ethiopia
Department of Health Promotion and Behavioural Science, Bahir Dar University, Bahir Dar, Ethiopia
Department of Nursing, Bahir Dar University, Bahir Dar, Ethiopia
Department of Health Promotion and Behavioral Science, Bahir Dar University, Bahir Dar, Ethiopia
Department of Pharmacy, Bahir Dar University, Bahir Dar, Ethiopia
Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
St George and Sutherland Clinical School, University of New South Wales, Sydney, NSW, Australia
School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
Transport and Road Safety (TARS) Research Centre, University of New South Wales, Sydney, NSW, Australia
School of Population Health, University of New South Wales, Sydney, NSW, Australia
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia
School of Medicine, University of New South Wales, Sydney, NSW, Australia
School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
Centre for Primary Health Care and Equity (CPHCE), University of New South Wales, Sydney, NSW, Australia
School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia
School of Risk and Actuarial Studies, University of New South Wales, Sydney, NSW, Australia
The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
Quality and Systems Performance Unit, Cancer Institute NSW, Sydney, NSW, Australia
Internal Medicine and Alcohol Related Disease Unit, Fondazione Policlinico Universitario A Gemelli IRCCS (Agostino Gemelli University Polyclinic IRCCS), Rome, Italy
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A Gemelli IRCCS (Agostino Gemelli University Polyclinic IRCCS), Rome, Italy
Department of Medical and Surgical Sciences, Università Cattolica di Roma (Catholic University of Rome), Rome, Italy
Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States
College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
Department of Biology, Khalifa University, Abu Dhabi, United Arab Emirates
Khalifa University, Abu Dhabi, United Arab Emirates
Institute of Public Health, Walden University, Al Ain, United Arab Emirates
Department of Biochemistry, Osun State University, Osogbo, Nigeria
Department of Biosciences and Biotechnology, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Environmental and Occupational Health, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Microbiology, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Biological Sciences, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Chemistry, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
Department of Periodontology and Community Dentistry, University of Ibadan, Ibadan, Nigeria
Department of Health Promotion and Education, University of Ibadan, Ibadan, Nigeria
College of Medicine, University of Ibadan, Ibadan, Nigeria
Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
Department of Medicine, University of Ibadan, Ibadan, Nigeria
Department of Business Administration, Muhammadiyah University of Mataram, Mataram, Indonesia
Faculty of Medicine, Universitas Padjadjaran (Padjadjaran University), Bandung, Indonesia
Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran (Padjadjaran University), Bandung, Indonesia
Department of Radiology, Johns Hopkins University, Baltimore, MD, United States
School of Medicine, Johns Hopkins University, Baltimore, MD, United States
Johns Hopkins University, Baltimore, MD, United States
Department of Biostatistics, Johns Hopkins University, Baltimore, MD, United States
School of Nursing, Johns Hopkins University, Baltimore, MD, United States
Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, United States
Department of Medicine, Johns Hopkins University, Baltimore, MD, United States
Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD, United States
Department of International Health, Johns Hopkins University, Baltimore, MD, United States
Department of Life Sciences, University of Management and Technology, Lahore, Pakistan
Department of Community Medicine, King Edward Memorial Hospital, Lahore, Pakistan
Department of Public Health, Public Health Institute, Lahore, Pakistan
Department of Community Medicine, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
Department of Parasitology, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
International Vaccine Institute, Seoul, South Korea
Department of Global and Public Health, McGill University, Montreal, QC, Canada
School of Population and Global Health, McGill University, Montreal, QC, Canada
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
Trivedi School of Biosciences, Ashoka University, Sonipat, India
Section of General Internal Medicine, Baylor College of Medicine, Houston, TX, United States
Department of Geography and Planning, Queens University, Kingston, ON, Canada
Department of Biomedical and Molecular Sciences, Queens University, Kingston, ON, Canada
School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
School of Nursing and Midwifery, University of Technology Sydney, Sydney, NSW, Australia
School of Life Sciences, University of Technology Sydney, Sydney, NSW, Australia
Department of Medical Biochemistry, Shaqra University, Shaqra, Saudi Arabia
Department of Pediatrics, Shaqra University, Shaqra, Saudi Arabia
Department of Pharmacology, Shaqra University, Shaqra, Saudi Arabia
School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
Research School of Population Health, Australian National University, Canberra, ACT, Australia
Public Health Foundation of India, Gandhinagar, India
Department of Medical Oncology, Miami Cancer Institute, Miami, FL, United States
Department of Medicine, Miami Cancer Institute, Miami, FL, United States
Department of Community Medicine and Preventive Health, King Edward Medical University Lahore, Lahore, Pakistan
Department of Epidemiology and Health Statistics, Southeast University, Nanjing, China
Department of Pharmacy Practice, Riphah Institute of Pharmaceutical Sciences, Islamabad, Pakistan
Division of Infectious Diseases and Global Public Health (IDGPH), University of California San Diego, San Diego, CA, United States
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
Department of Womens and Childrens Health, Uppsala University, Uppsala, Sweden
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
Department of Medical Sciences, Uppsala University, Uppsala, Sweden
Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
Unit of Basic Medical Sciences, University of Khartoum, Khartoum, Sudan
Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
Australian Center for Precision Health, University of South Australia, Adelaide, SA, Australia
Department of Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
Department of Biochemistry, Jamia Hamdard, Delhi, India
Brody School of Medicine, East Carolina University, Greenville, NC, United States
Department of Computer Science, East Carolina University, Greenville, NC, United States
Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, United States
Department of Physiology, East Carolina University, Greenville, NC, United States
Department of Food and Nutrition Policy and Planning Research, National Nutrition and Food Technology Research Institute, Tehran, Iran
Department of Food Science and Nutrition, National Nutrition and Food Technology Research Institute, Tehran, Iran
Department of Microbiology, Immunology and Parasitology, St Pauls Hospital Millennium Medical College, Addis Ababa, Ethiopia
Department of Microbial, Cellular, and Molecular Biology, Addis Ababa University, Addis Ababa, Ethiopia
Department of Medical Laboratory Science, Addis Ababa University, Addis Ababa, Ethiopia
Moyen Mono Health District, Ministry of Health, Tohoun, Togo
Toxicology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Orthodontics, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Education Development Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Internal Medicine, University of Patras, Patras, Greece
Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, Patras, Greece
Department of Population Health Sciences, Duke University, Durham, NC, United States
Duke Global Health Institute, Duke University, Durham, NC, United States
Department of Anesthesiology, Duke University, Durham, NC, United States
Department of Cardiology, Fudan University, Shanghai, China
Department of Management, Policy, and Community Health, University of Texas, Houston, TX, United States
Health Science Center, University of Texas, Houston, TX, United States
Department of Communicable Diseases, Ministry of Health, Muscat, Oman
Middle East, Eurasia, and Africa Influenza Stakeholders Network, Muscat, Oman
Division of Public Health Sciences, Washington University School of Medicine, St Louis, MO, United States
McWilliams School of Biomedical Informatics, UTHealth, Houston, TX, United States
Department of Biomedical Informatics, Biostatistics, and Epidemiology, University of Missouri, Columbia, MO, United States
Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
Center for Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
Department of Biology, University of Bahrain, Zallaq, Bahrain
College of Health and Sport Sciences, University of Bahrain, Zallaq, Bahrain
John T Milliken Department of Internal Medicine, Washington University in St Louis, St Louis, MO, United States
Department of Surgery, Washington University in St Louis, St Louis, MO, United States
Department of Energy, Environmental, and Chemical Engineering, Washington University in St Louis, St Louis, MO, United States
Brown School, Washington University in St Louis, St Louis, MO, United States
Clinical Epidemiology Center, US Department of Veterans Affairs (VA), St Louis, MO, United States
Murdoch Business School, Murdoch University, Perth, WA, Australia
Department of Public Health, Asian University for Women, Chittagong, Bangladesh
Asian University for Women, McGill University, Chittagong, Bangladesh
Department of Health Information Management and Technology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Division of Forensic Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
Department of Medicine, Royal Jordanian Medical Services, Amman, Jordan
Faculty of Medicine, Yarmouk University, Irbid, Jordan
Department of Basic Sciences, Yarmouk University, Irbid, Jordan
Department of Basic Medical Sciences, Yarmouk University, Irbid, Jordan
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, United States
Institute of Health Informatics, University College London, London, United Kingdom
Department of Health Informatics, University College London, London, United Kingdom
Department of Behavioural Science and Health, University College London, London, United Kingdom
Department of Population Health Sciences, University College London, London, United Kingdom
Department of Infection, University College London, London, United Kingdom
Department of Epidemiology, M
Institute for Health Metrics and Evaluation
Division of Cardiology
Department of Health Metrics Sciences
Department of Applied Mathematics
Department of Global Health
Division of Pediatric Hematology-Oncology
Department of Neurology
Department of Anesthesiology & Pain Medicine
Division of Plastic and Reconstructive Surgery
Henry M Jackson School of International Studies
Department of Pharmacy
Department of Medicine
School of Population and Public Health
Department of Pharmaceutical Sciences
School of Nursing
Department of Nutrition and Dietetics
Department of Epidemiology
Department of Public Health
Department of Surgery
Institute of Health Science
Department of Psychiatry
Department of Clinical Governance and Quality Improvement
Department of Juridical and Economic Studies
Department of Public Health and Infectious Diseases
Doheny Eye Institute
David Geffen School of Medicine
Infectious and Tropical Research Center
Research Center of Psychiatry and Behavioral Sciences
Department of Radiology
Department of Health Policy and Management
School of Nursing and Midwifery
Department of Immunology
Faculty of Nursing and Midwifery
Neurosciences Research Center (NSRC)
Student Research Committee
Drug Applied Research Center
Department of Orthopedic Surgery
Department of Pediatrics
TH Chan School of Public Health
Center for Primary Care
Department of Global Health and Social Medicine
Harvard Business School
Department of Epidemiology
Division of Cardiovascular Medicine
Harvard Medical School
Department of Neurological Surgery
Department of Ophthalmology
Department of Global Health and Population
Department of Health Policy and Oral Epidemiology
Department of Physical Medicine and Rehabilitation
Beth Israel Deaconess Medical Center
Division of General Internal Medicine
Department of Orthopaedic Surgery
Department of Biotechnology
National Nutrition and Food Technology Research Institute
Research Institute of Dental Sciences
Urology Department
Internal Medicine Department
Department of Occupational Health and Safety Engineering
Psychiatric Nursing and Management Department
Faculty of Medicine
Department of Medical Genetics
Center for Comprehensive Genetic Services
Food Technology Research
Research Institute for Endocrine Sciences
Department of Immunology
Department of Health Policy and Management
Safety Promotion and Injury Prevention Research Center
Department of Neurosurgery
Ophthalmic Research Center
Social Determinants of Health Research Center
School of Medicine
Student Research Committee
Department of Epidemiology
Department of Health
Department of Anesthesiology
Emergency Department
Department of Medical Education
Department of Internal Medicine
Clinical Research Development Unit
Department of Epidemiology and Biostatistics
Non-communicable Diseases Research Center
The Institute of Pharmaceutical Sciences (TIPS)
School of Pharmacy
Research Center for Immunodeficiencies
Universal Scientific Education and Research Network (USERN)
Digestive Diseases Research Institute
Urology Research Center
Department of Epidemiology and Biostatistics
School of Medicine
Department of Scientific Research
Iranian Research Center for HIV/AIDS
Department of Ophthalmology
Sina Trauma and Surgery Research Center
Center for Research and Training in Skin Diseases and Leprosy
Childrens Medical Center
Endocrinology and Metabolism Research Institute
Orthopedic Department
Department of Cardiology
Tehran Heart Center
Faculty of Nursing and Midwifery
Faculty of Medicine
Department of Physiotherapy
Research Center for War-affected People
Department of Pharmacology
Department of Neurosurgery
Pharmaceutical Sciences Research Center (PSRC)
Department of Neurology
Department of Medicine
Department of Pharmaceutical Care
Research Center for Rational Use of Drugs
Tehran University of Medical Sciences
Department of Epidemiology
Pediatric Dentistry and Dental Public Health Department
Department of Tropical Health and Parasitology
Department of Pathology
Department of Tropical Medicine and Infectious Diseases
Department of Medicine
Department of Medicine
Community and Maternity Nursing Unit
Department of Physiotherapy
Department of Nursing Science
Department of Rehabilitation Sciences
Department of Midwifery
Department of Psychiatry
Department of Public Health
Department of Neurosurgery
Keck School of Medicine
Department of Radiology
Mark and Mary Stevens Neuroimaging and Informatics Institute
Department of Emergency Medicine
Department of Immunology
Department of Critical Care and Emergency Nursing
Department of Clinical Pharmacy
Department of Pharmacology
College of Pharmacy and Pharmaceutical Sciences
Postgraduate Department
National Research Council of Mexico
Department of Community Medicine
School of Public Health
Department of Family and Community Health
Department of Epidemiology and Biostatistics
Institute of Health Research
Department of Population and Behavioural Sciences
Department of Health Policy Planning and Management
Department of Microbiology and Immunology
Department of Medical Biochemistry and Biophysics
Department of Neurobiology
Department of Medical Epidemiology and Biostatistics
Department of Physiology and Pharmacology
Department of Molecular Medicine and Surgery
Department of Global Public Health
Department of Physical Pharmacy and Pharmacokinetics
Department of Public Health
Department of Nutrition and Dietetics
Department of Pediatric Dentistry
Department of Internal Medicine
School of Nursing
Department of Maternal-Child Nursing and Public Health
Department of Clinical Medicine
Clinical Hospital
Centre of Telehealth
Vaccination Research Observatory
Department of Nursing
Department of Pharmacology and Toxicology
Department of Veterinary Microbiology
Department of Veterinary Public Health and Preventive Medicine
Clinical Science Department
Nigerian Institute of Medical Research
Clinical Sciences Department
College of Medicine
Department of Pharmacy Practice and Pharmacotherapeutics
Department of Physiotherapy
Department of Basic Biomedical Sciences
Sharjah Institute for Medical Research
Department of Clinical Nutrition and Dietetics
Department of Basic Medical Sciences
Department of Clinical Science
Sharjah Institute of Medical Sciences
College of Pharmacy
Research Institute of Medical & Health Sciences
Department of Medicinal Chemistry
University of Sharjah
Research Department
Department of Nursing Education & Research
Department of Geriatric and Long Term Care
Department of Therapeutics
Institute of Public Health
College of Medicine and Health Sciences
Family Medicine Department
Department of Computer Science and Software Engineering
College of Pharmacy
Department of Surgery
College of Medicine
College of Graduate Health Sciences
College of Medicine and Health Sciences
Department of Epidemiology and Biostatistics
Department of Health Promotion and Behavioural Science
Department of Nursing
Department of Health Promotion and Behavioral Science
Department of Pharmacy
Centre for Social Research in Health
St George and Sutherland Clinical School
School of Public Health and Community Medicine
Transport and Road Safety (TARS) Research Centre
School of Population Health
National Drug and Alcohol Research Centre
School of Clinical Medicine
School of Medicine
School of Psychiatry
Centre for Primary Health Care and Equity (CPHCE)
School of Optometry and Vision Science
School of Risk and Actuarial Studies
The George Institute for Global Health
Quality and Systems Performance Unit
Internal Medicine and Alcohol Related Disease Unit
Department of Woman and Child Health and Public Health
Department of Medical and Surgical Sciences
Department of Medical Rehabilitation
Department of Child Dental Health
Department of Obstetrics and Gynecology
College of Medicine and Health Sciences
Department of Biology
Khalifa University
Institute of Public Health
Department of Biochemistry
Department of Biosciences and Biotechnology
Department of Environmental and Occupational Health
Department of Microbiology
Department of Biological Sciences
Department of Chemistry
Department of Veterinary Medicine
Department of Community Medicine
Department of Epidemiology and Medical Statistics
Department of Periodontology and Community Dentistry
Department of Health Promotion and Education
College of Medicine
Faculty of Public Health
Department of Medicine
Department of Business Administration
Faculty of Medicine
Center of Excellence in Higher Education for Pharmaceutical Care Innovation
Department of Radiology
School of Medicine
Johns Hopkins University
Department of Biostatistics
School of Nursing
Department of Neurosurgery
Department of Medicine
Department of Health Policy and Management
Department of International Health
Department of Life Sciences
Department of Community Medicine
Department of Public Health
Department of Community Medicine
Department of Parasitology
International Vaccine Institute
Department of Global and Public Health
School of Population and Global Health
Department of Epidemiology
Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia
Department of Biomedical and Biotechnological Sciences
Department of General Surgery and Medical-Surgical Specialties
Department of Clinical and Experimental Medicine
Trivedi School of Biosciences
Section of General Internal Medicine
Department of Geography and Planning
Department of Biomedical and Molecular Sciences
School of Public Health
School of Nursing and Midwifery
School of Life Sciences
Department of Medical Biochemistry
Department of Pediatrics
Department of Pharmacology
School of Medicine and Psychology
National Centre for Epidemiology and Population Health
Research School of Population Health
Public Health Foundation of India
Department of Medical Oncology
Department of Medicine
Department of Community Medicine and Preventive Health
Department of Epidemiology and Health Statistics
Department of Pharmacy Practice
Division of Infectious Diseases and Global Public Health (IDGPH)
Maternal and Child Health Division
Department of Womens and Childrens Health
Department of Surgical Sciences
Department of Medical Cell Biology
Department of Medical Sciences
Institute of Endemic Diseases
Unit of Basic Medical Sciences
Swiss Tropical and Public Health Institute
Australian Center for Precision Health
Department of Allied Health and Human Performance
Department of Biochemistry
Brody School of Medicine
Department of Computer Science
Department of Cardiovascular Sciences
Department of Physiology
Department of Food and Nutrition Policy and Planning Research
Department of Food Science and Nutrition
Department of Microbiology
Department of Microbial
Department of Medical Laboratory Science
Moyen Mono Health District
Toxicology Research Center
Department of Orthodontics
Environmental Technologies Research Center
Department of Public Health
Education Development Center
Department of Internal Medicine
Department of Internal Medicine and Infectious Diseases
Department of Population Health Sciences
Duke Global Health Institute
Department of Anesthesiology
Department of Cardiology
Department of Management
Health Science Center
Department of Communicable Diseases
Middle East
Division of Public Health Sciences
McWilliams School of Biomedical Informatics
Department of Biomedical Informatics
Heidelberg Institute of Global Health (HIGH)
Department of Clinical Sciences
Center for Medical and Bio-Allied Health Sciences Research
Department of Biology
College of Health and Sport Sciences
John T Milliken Department of Internal Medicine
Department of Surgery
Department of Energy
Brown School
Clinical Epidemiology Center
Murdoch Business School
Department of Public Health
Asian University for Women
Department of Health Information Management and Technology
Division of Forensic Medicine
Imam Abdulrahman Bin Faisal University
Department of Medicine
Faculty of Medicine
Department of Basic Sciences
Department of Basic Medical Sciences
Division of Gastroenterology and Hepatology
Institute of Health Informatics
Department of Health Informatics
Department of Behavioural Science and Health
Department of Population Health Sciences
Department of Infection
Department of Epidemiology
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