The burden of diseases, injuries, and risk factors by state in the USA, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
Mokdad A.H. Bisignano C. Hsu J.M. Ababneh H.S. Abbasgholizadeh R. Abdelkader A. Abdelmasseh M. Abiodun O.O. Aboagye R.G. Abu-Zaid A. Abukhadijah H.J. Addo I.Y. Adeagbo O.A. Adegboye O.A. Adekanmbi V. Adeyeoluwa T.E. Adzigbli L.A. Afolabi A.A. Agyemang-Duah W. Ahmad S. Ahmad D. Ahmed A. Ahmed S.A. Akkaif M.A. Akrami A.E. Akter E. Al Hasan S.M. Al Ta’ani O. Al-Ajlouni Y. Al-Aly Z. Al-Rifai R.H. Al-Tawfiq J.A. Al-Wardat M. Al-Zyoud W.A. Alam M. Albakri A. Aldhaleei W.A. Aldridge R.W. Ali M.U. Ali A. Ali R. Ali W. Almustanyir S. Alqutaibi A.Y. Alrawashdeh A. Alsabri M.A. Aly H. Amani R. Amegbor P.M. Amindarolzarbi A. Amiri S. Anil A. Appiah F. Arabloo J. Arafa E.A. Arafat M. Aravkin A.Y. Ardekani A. Areda D. Ashina S. Atreya A. Ayalew F.B. Azzam A.Y. Babu G.R. Baghdadi S. Bagherieh S. Bahramian S. Bahreini R. Bako A.T. Bansal K. Bärnighausen T.W. Barrow A. Bastan M.-M. Basu S. Batra R. Batra K. Bayati M. Beiranvand M. Bell M.L. Beloukas A. Bemanalizadeh M. Bennitt F.B. Benzian H. Beran A. 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Jamshidi E. Javaheri T. Jeswani B.M. Jeyakumar A. Johnson E.K. Kanmodi K.K. Kantar R.S. Karanth S.D. Karaye I.M. Kassebaum N.J. Katamreddy A. Kazemi F. Kerr J.A. Khader Y.S. Khamesipour F. Khan M.J. Khan Z.A. Khan F. Khan A. Khatab K. Khatami F. Khatatbeh M.M. Khormali M. Khosla A.A. Khosravi S. Khosravi M. Khubchandani J. Kim G. Kim M.S. Kimokoti R.W. Kisa A. Kochhar S. Koren G. Krishnamoorthy V. Kubeisy C.M. Kuddus Md.A. Kulimbet M. Kulkarni V. Kumar V. Kumar A. Kumar R. Kundu S. Kurmi O.P. Kyei E.F. Lai H. Lan Q. Lansingh V.C. Le T.D.T. Le H.-H. Le N.H.H. Le T.T.T. Leasher J.L. Lee S.W. Lee W.-C. Li W. Libra M. Lim S.S. Lin J. Lin J.C. Lioutas V.-A. Liu X. Liu R.T. Liu X. Liu J. López-Gil J.F. Lopukhov P.D. Lucchetti G. Lunevicius R. Lusk J.B. Mafhoumi A. Malakan Rad E. Manla Y. Mansouri V. Manu E. Marconi A.M. Marino M. Martin R.V. Martinez-Piedra R. Marx W. Marzo R.R. Mathangasinghe Y. Matozinhos F.P. McPhail S.M. Mekene Meto T.M. Meles H.N. Melese E.B. Mensah G.A. Mensah L.G. 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7 December 2024Elsevier B.V.
The Lancet
2024#404Issue 104692314 - 2340 pp.
Background: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides a comprehensive assessment of health and risk factor trends at global, regional, national, and subnational levels. This study aims to examine the burden of diseases, injuries, and risk factors in the USA and highlight the disparities in health outcomes across different states. Methods: GBD 2021 analysed trends in mortality, morbidity, and disability for 371 diseases and injuries and 88 risk factors in the USA between 1990 and 2021. We used several metrics to report sources of health and health loss related to specific diseases, injuries, and risk factors. GBD 2021 methods accounted for differences in data sources and biases. The analysis of levels and trends for causes and risk factors within the same computational framework enabled comparisons across states, years, age groups, and sex. GBD 2021 estimated years lived with disability (YLDs) and disability-adjusted life-years (DALYs; the sum of years of life lost to premature mortality and YLDs) for 371 diseases and injuries, years of life lost (YLLs) and mortality for 288 causes of death, and life expectancy and healthy life expectancy (HALE). We provided estimates for 88 risk factors in relation to 155 health outcomes for 631 risk–outcome pairs and produced risk-specific estimates of summary exposure value, relative health risk, population attributable fraction, and risk-attributable burden measured in DALYs and deaths. Estimates were produced by sex (male and female), age (25 age groups from birth to ≥95 years), and year (annually between 1990 and 2021). 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws (ie, 500 random samples from the estimates distribution). Uncertainty was propagated at each step of the estimation process. Findings: We found disparities in health outcomes and risk factors across US states. Our analysis of GBD 2021 highlighted the relative decline in life expectancy and HALE compared with other countries, as well as the impact of COVID-19 during the first 2 years of the pandemic. We found a decline in the USAs ranking of life expectancy from 1990 to 2021: in 1990, the USA ranked 35th of 204 countries and territories for males and 19th for females, but dropped to 46th for males and 47th for females in 2021. When comparing life expectancy in the best-performing and worst-performing US states against all 203 other countries and territories (excluding the USA as a whole), Hawaii (the best-ranked state in 1990 and 2021) dropped from sixth-highest life expectancy in the world for males and fourth for females in 1990 to 28th for males and 22nd for females in 2021. The worst-ranked state in 2021 ranked 107th for males (Mississippi) and 99th for females (West Virginia). 14 US states lost life expectancy over the study period, with West Virginia experiencing the greatest loss (2·7 years between 1990 and 2021). HALE ranking declines were even greater; in 1990, the USA was ranked 42nd for males and 32nd for females but dropped to 69th for males and 76th for females in 2021. When comparing HALE in the best-performing and worst-performing US states against all 203 other countries and territories, Hawaii ranked 14th highest HALE for males and fifth for females in 1990, dropping to 39th for males and 34th for females in 2021. In 2021, West Virginia—the lowest-ranked state that year—ranked 141st for males and 137th for females. Nationally, age-standardised mortality rates declined between 1990 and 2021 for many leading causes of death, most notably for ischaemic heart disease (56·1% [95% UI 55·1–57·2] decline), lung cancer (41·9% [39·7–44·6]), and breast cancer (40·9% [38·7–43·7]). Over the same period, age-standardised mortality rates increased for other causes, particularly drug use disorders (878·0% [770·1–1015·5]), chronic kidney disease (158·3% [149·6–167·9]), and falls (89·7% [79·8–95·8]). We found substantial variation in mortality rates between states, with Hawaii having the lowest age-standardised mortality rate (433·2 per 100 000 [380·6–493·4]) in 2021 and Mississippi having the highest (867·5 per 100 000 [772·6–975·7]). Hawaii had the lowest age-standardised mortality rates throughout the study period, whereas Washington, DC, experienced the most improvement (a 40·7% decline [33·2–47·3]). Only six countries had age-standardised rates of YLDs higher than the USA in 2021: Afghanistan, Lesotho, Liberia, Mozambique, South Africa, and the Central African Republic, largely because the impact of musculoskeletal disorders, mental disorders, and substance use disorders on age-standardised disability rates in the USA is so large. At the state level, eight US states had higher age-standardised YLD rates than any country in the world: West Virginia, Kentucky, Oklahoma, Pennsylvania, New Mexico, Ohio, Tennessee, and Arizona. Low back pain was the leading cause of YLDs in the USA in 1990 and 2021, although the age-standardised rate declined by 7·9% (1·8–13·0) from 1990. Depressive disorders (56·0% increase [48·2–64·3]) and drug use disorders (287·6% [247·9–329·8]) were the second-leading and third-leading causes of age-standardised YLDs in 2021. For females, mental health disorders had the highest age-standardised YLD rate, with an increase of 59·8% (50·6–68·5) between 1990 and 2021. Hawaii had the lowest age-standardised rates of YLDs for all sexes combined (12 085·3 per 100 000 [9090·8–15 557·1]), whereas West Virginia had the highest (14 832·9 per 100 000 [11 226·9–18 882·5]). At the national level, the leading GBD Level 2 risk factors for death for all sexes combined in 2021 were high systolic blood pressure, high fasting plasma glucose, and tobacco use. From 1990 to 2021, the age-standardised mortality rates attributable to high systolic blood pressure decreased by 47·8% (43·4–52·5) and for tobacco use by 5·1% (48·3%–54·1%), but rates increased for high fasting plasma glucose by 9·3% (0·4–18·7). The burden attributable to risk factors varied by age and sex. For example, for ages 15–49 years, the leading risk factors for death were drug use, high alcohol use, and dietary risks. By comparison, for ages 50–69 years, tobacco was the leading risk factor for death, followed by dietary risks and high BMI. Interpretation: GBD 2021 provides valuable information for policy makers, health-care professionals, and researchers in the USA at the national and state levels to prioritise interventions, allocate resources effectively, and assess the effects of health policies and programmes. By addressing socioeconomic determinants, risk behaviours, environmental influences, and health disparities among minority populations, the USA can work towards improving health outcomes so that people can live longer and healthier lives. Funding: Bill & Melinda Gates Foundation.
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Institute for Health Metrics and Evaluation, 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
School of Medicine, University of Washington, Seattle, WA, United States
Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
Department of Global Health, 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
Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, United States
Department of Epidemiology, University of Washington, Seattle, WA, United States
Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States
Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA, United States
Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
Division of Cardiology, Massachusetts General Hospital, Boston, MA, United States
Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, United States
Massachusetts General Hospital, Boston, MA, United States
Doheny Eye Institute, University of California Los Angeles, Los Angeles, CA, United States
Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, United States
Department of Mathematics and Sciences, Ajman University, Ajman, United Arab Emirates
Department of Clinical Sciences, Ajman University, Ajman, United Arab Emirates
Department of Surgery, Marshall University, Huntington, WV, United States
Department of Internal Medicine, Federal Medical Centre, Abuja, Nigeria
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
Department of Population and Behavioural Sciences, University of Health and Allied Sciences, Ho, Ghana
Department of Biochemistry and Molecular Medicine, Alfaisal University, Riyadh, Saudi Arabia
College of Medicine, University of Tennessee, Memphis, TN, United States
College of Graduate Health Sciences, University of Tennessee, Memphis, TN, United States
Academic Health System, Hamad Medical Corporation, Doha, Qatar
Nursing and Midwifery Research Department (NMRD), Hamad Medical Corporation, Doha, Qatar
Centre for Social Research in Health, 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
Quality and Systems Performance Unit, Cancer Institute NSW, Sydney, NSW, Australia
Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, SC, United States
Department of Public Health, University of KwaZulu-Natal, Durban, South Africa
Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States
The Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, United States
Department of Pharmacology and Therapeutics, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Microbiology, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
Department of Veterinary Public Health and Preventive Medicine, University of Ibadan, Ibadan, Nigeria
Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
Technical Services Directorate, MSI Nigeria Reproductive Choices, Abuja, Nigeria
Department of Geography and Planning, Queens University, Kingston, ON, Canada
Department of Medical Oncology, Miami Cancer Institute, Miami, FL, United States
Department of Medicine, King Edward Medical University Lahore, Lahore, Pakistan
Department of Community Medicine and Preventive Health, King Edward Medical University Lahore, Lahore, Pakistan
School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
Public Health Foundation of India, Gandhinagar, India
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
Brody School of Medicine, East Carolina University, Greenville, NC, United States
Department of Computer Science, East Carolina University, Greenville, NC, United States
Department of Geography, East Carolina University, Greenville, NC, United States
Department of Physiology, East Carolina University, Greenville, NC, United States
Department of Cardiology, Fudan University, Shanghai, China
Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL, United States
Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
Department of Medicine, Northwestern University, Chicago, IL, United States
Northwestern University, Chicago, IL, United States
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
Department of Research and Development, Washington University in St. Louis, St. Louis, MO, United States
Department of Medicine, 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
Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, United States
School of Medicine, New York Medical College, Valhalla, NY, United States
Department of Epidemiology, Columbia University, New York, NY, United States
Departments of Psychiatry and Epidemiology, Columbia University, New York, NY, United States
Department of Neurology, Columbia University, New York, NY, United States
Clinical Epidemiology Center, US Department of Veterans Affairs (VA), St. Louis, MO, United States
Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
Department of Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
Department of Biomedical Engineering, German Jordanian University, Amman, Jordan
Department of Bioengineering, George Mason University, Fairfax, VA, United States
Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, United States
Department of Medicine, Royal Jordanian Medical Services, Amman, Jordan
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, United States
Department of Cardiovascular Medicine, 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 Medical Rehabilitation (Physiotherapy), University of Maiduguri, Maiduguri, Nigeria
Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
School of Nursing, Hong Kong Polytechnic University, Hong Kong
Department of Zoology, Abdul Wali Khan University Mardan, Mardan, Pakistan
Department of Biosciences, Jamia Millia Islamia, New Delhi, India
Department of Geography, Sultan Qaboos University, Muscat, Oman
Ministry of Health, Riyadh, Saudi Arabia
Department of Prosthodontics and Implant Dentistry, Taibah University, Medinah, Saudi Arabia
Department of Prosthodontics and Implant Dentistry, Ibb University, Ibb, Yemen
Department of Emergency Medicine, Sanaa University, Sana’a, Yemen
Pediatric Emergency Medicine Department, St. Christopher’s Hospital for Children, Philadelphia, PA, United States
Department of Pediatrics, Cleveland Clinic, Cleveland, OH, United States
Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
Interdisciplinary Graduate Program in Human Toxicology, University of Iowa, Iowa City, IA, United States
Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Health Human Resources Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
Department of Occupational Health and Safety Engineering, Shiraz University of Medical Sciences, Shiraz, Iran
School of Global Public Health, New York University, New York, NY, United States
Department of Epidemiology and Health Promotion, New York University, New York, NY, United States
Department of Child and Adolescent Psychiatry, New York University, New York, NY, United States
Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD, United States
Department of Anesthesia and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
School of Nursing, Johns Hopkins University, Baltimore, MD, United States
Department of Epidemiology, Johns Hopkins University, Baltimore, MD, United States
Department of Neurosurgery, 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
Johns Hopkins University, Baltimore, MD, United States
Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
Department of Pharmacology and Research, All India Institute of Medical Sciences, Jodhpur, India
All India Institute of Medical Sciences, Bhubaneswar, India
Department of Social Sciences, Berekum College of Education, Berekum, Ghana
School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Department of Health Economics, Iran University of Medical Sciences, Tehran, Iran
Gastrointestinal and Liver Diseases Research Center, Iran University of Medical Sciences, Tehran, Iran
Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran
Department of Ophthalmology, Iran University of Medical Sciences, Tehran, Iran
Department of Pharmacology and Toxicology, Beni-Suef University, Beni-Suef, Egypt
College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
College of Art and Science, Ottawa University, Surprise, AZ, United States
School of Life Sciences, Arizona State University, Tempe, AZ, United States
Department of Anesthesia, Critical Care and Pain Medicine, Harvard University, Boston, MA, United States
T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
Center for Primary Care, Harvard University, Boston, MA, United States
Harvard Business School, Harvard University, Boston, MA, United States
Division of Cardiovascular Medicine, Harvard University, Boston, MA, United States
Department of Neurological Surgery, Harvard University, Boston, MA, United States
Department of Health Policy and Management, Harvard University, Boston, MA, United States
Department of Health Policy and Oral Epidemiology, Harvard University, Boston, MA, United States
Department of Global Health and Social Medicine, Harvard University, Boston, MA, United States
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Department of Forensic Medicine, Lumbini Medical College, Palpa, Nepal
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MA, United States
Montefiore-Einstein Cerebrovascular Research Lab, Albert Einstein College of Medicine, Bronx, NY, United States
Faculty of Medicine, October 6 University, 6th of October City, Egypt
Department of Population Medicine, Qatar University, Doha, Qatar
Division of Orthopaedics, Childrens Hospital of Philadelphia, Philadelphia, PA, United States
School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
Heart Failure Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Clinical Biochemistry, Isfahan University of Medical Sciences, Isfahan, Iran
College of Optometry, Pacific University, Forest Grove, OR, United States
Department of Neurosurgery, Houston Methodist Hospital, Houston, TX, United States
Houston Methodist Hospital, Houston, TX, United States
Department of Medicine, University of Massachusetts Medical School, Worcester, MA, United States
Department of Medicine, Saint Vincent Hospital, Worcester, MA, United States
Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
Department of Public and Environmental Health, University of The Gambia, Banjul, Gambia
Department of Epidemiology, University of Florida, Gainesville, FL, United States
Division of Pulmonary, Critical Care, and Sleep, University of Florida, Gainesville, FL, United States
College of Medicine, University of Florida, Gainesville, FL, United States
UF Health Cancer Center, University of Florida, Gainesville, FL, United States
Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Pediatric Neurology, Tehran University of Medical Sciences, Tehran, Iran
Department of Reproductive Health, Tehran University of Medical Sciences, Tehran, Iran
Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
Orthopedic Department, Tehran University of Medical Sciences, Tehran, Iran
Department of Pediatric Cardiology, Tehran University of Medical Sciences, Tehran, Iran
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
School of Medicine, 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
Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran, Iran
School of Public Health, Imperial College London, London, United Kingdom
Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
School of Public Health, University of Nevada Las Vegas, Las Vegas, NV, United States
Department of Medical Education, University of Nevada Las Vegas, Las Vegas, NV, United States
Department of Social and Behavioral Health, University of Nevada Las Vegas, Las Vegas, NV, United States
IT Department, Coforge, GA, United States
School of the Environment, Yale University, New Haven, CT, United States
Department of Internal Medicine, Yale University, New Haven, CT, United States
Department of Dermatology, Yale University, New Haven, CT, United States
Department of Psychiatry, Yale University, New Haven, CT, United States
Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
Department of Genetics, Yale University, New Haven, CT, United States
Department of Biomedical Sciences, University of West Attica, Athens, Greece
National AIDS Reference Center of Southern Greece, University of West Attica, Athens, Greece
Department of Civil and Environmental Engineering, University of Massachusetts Amherst, Amherst, MA, United States
School of Medicine, Indiana University, Indianapolis, IN, United States
Department of Epidemiology and Biostatistics, University of the Philippines Manila, Manila, Philippines
Department of Epidemiology, Brown University, Providence, RI, United States
Department of Internal Medicine, Brown University, Providence, RI, United States
Hubert Department of Global Health, Emory University, Atlanta, GA, United States
School of Medicine, Emory University, Atlanta, GA, United States
Rollins School of Public Health, Emory University, Atlanta, GA, United States
Department of Global Health, George Washington University, Washington, DC, United States
Metabolomics Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
Hypertension and Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
Department of Microbiology, Addis Ababa University, Addis Ababa, Ethiopia
Department of Pharmaceutical and Administrative Sciences, University of Health Sciences and Pharmacy in St. Louis, St. Louis, MO, United States
School of Pharmacy, University of Aukland, Auckland, New Zealand
Department of Public Health, North Dakota State University, Fargo, ND, United States
Institutes of Applied Health Research and Translational Medicine, Queen Elizabeth Hospital Birmingham, Nottingham, United Kingdom
Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
Department of Internal Medicine, Wayne State University, Detroit, MI, United States
Global Health Neurology Lab, NSW Brain Clot Bank, Sydney, NSW, Australia
Division of Cerebrovascular Medicine and Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
Department of Internal Medicine, St. Johns National Academy of Health Sciences, Bangalore, India
Internal Medicine Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Obstetrics and Gynecology Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Obesity Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Research Center for Social Determinants of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Skull Base Research Center, 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
Emergency Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Disease Surveillance Department, Ghana Health Service, Ho, Ghana
Department of Earth, Environment, and Equity, Howard University, Washington, DC, United States
General Medicine Service, Department of Veterans Affairs, Seattle, WA, United States
Cancer Population Sciences Program, University of Florida Health Cancer Center, Gainesville, FL, United States
School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
School of Nursing, University of British Columbia, Vancouver, BC, Canada
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
Dipartimento di Scienze Biomediche e Neuromotorie, University of Bologna, Bologna, Italy
School of Pharmacy, The University of Jordan, Amman, Jordan
Department of Basic Biomedical Sciences, University of Sharjah, Sharjah, United Arab Emirates
Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
Basic Medical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
Research Institute of Medical & Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, Sharjah, United Arab Emirates
Department of Medicinal Chemistry, University of Sharjah, Sharjah, United Arab Emirates
School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
Al Shifa School of Public Health, Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan
Dana-Farber Cancer Institute, Boston, MA, United States
Department of Management and Healthcare (EMbeDS), SantAnna School of Advanced Studies, Pisa, Italy
Department of Psychiatry, University of São Paulo, São Paulo, Brazil
Department of Nutrition, Federal University of Santa Catarina, Florianópolis, Brazil
Department of Anesthesiology and Perioperative Medicine, University of Rochester, Rochester, NY, United States
School of Medicine, University of Rochester, Rochester, NY, United States
University of Rochester, Rochester, NY, United States
Department of Biology, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
Department of Computer Science, University of Texas at Austin, Austin, TX, United States
Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, United States
Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
University of Michigan, Ann Arbor, United States
Department of Medicine, National University of Singapore, Singapore, Singapore
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
Department of Community Medicine, Jawaharlal Nehru Medical College, Wardha, India
Florida International University, Miami, FL, United States
Department of Epidemiology, University of Bern, Bern, Switzerland
Health Data Research UK, London, United Kingdom
Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
School of Psychology, University of Southampton, Southampton, United Kingdom
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
Department of Diagnostic and Therapeutic Technologies, Cooperativa de Ensino Superior Politécnico e Universitário (Polytechnic and University Higher Education Cooperative), Vila Nova de Famalicão, Portugal
Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy
Cardio-Thoraco- Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
College of Public Health, University of South Florida, Tampa, FL, United States
Department of Medical Engineering, University of South Florida, Tampa, FL, United States
Department of Medical Microbiology and Parasitology, Bayero University, Kano, Nigeria
School of Pharmacy, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
Sydney Medical School, University of Sydney, Sydney, NSW, Australia
IRCCS Istituto Ortopedico Galeazzi, University of Milan, Milan, Italy
Department of Dermatology, Case Western Reserve University, Cleveland, OH, United States
Lerner College of Medicine, Case Western Reserve University, Cleveland, OH, United States
Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, OH, United States
Department of Quantitative Health Science, Case Western Reserve University, Cleveland, OH, United States
Department of Public Health, Haramaya University, Harar, Ethiopia
Department of Information Technology, University of Human Development, Sulaymaniyah, Iraq
Department of Computer Science, University of Human Development, Sulaymaniyah, Iraq
Department of Biochemistry, Ministry of Health and Welfare, New Delhi, India
Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Department of Radiology, Tabriz University of Medical Sciences, Tabriz, Iran
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
Icahn School of Medicine at Mount Sinai, New York, NY, United States
Institute for Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
Icahn School of Medicine at Mount Sinai, New York, NY, United States
Chettinad Hospital & Research Institute, Chettinad Academy of Research and Education, Chennai, India
Department of Pharmacy, United International University, Dhaka, Bangladesh
Pharmacology Division, Center for Life Sciences Research Bangladesh, Dhaka, Bangladesh
Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, India
Faculty of Science, National Autonomous University of Mexico, Mexico City, Mexico
Department of Gastroenterology, Pontifical Catholic University of Chile, Santiago, Chile
Department of Medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Viet Nam
Department of Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Viet Nam
Department of Pathology, Temple University Hospital, Philadelphia, PA, United States
Health Science Center, University of Texas, Houston, TX, United States
Department of Plastic Surgery, University of Texas, Houston, TX, United States
South Plainfield, NJ, United States
Department of Cardiology, St. Josephs University Medical Center, Paterson, NJ, United States
School of Population Health and Environmental Sciences, Kings College London, London, United Kingdom
Office of Institutional Analysis, University of Windsor, Windsor, ON, Canada
Department of Pharmacology, All India Institute of Medical Sciences, Rajkot, India
Department of Conservative Dentistry with Endodontics, Medical University of Silesia, Katowice, Poland
Almoosa College of Health Sciences, Al Ahsa, Saudi Arabia
Department of Public Health and Community Medicine, Texila American University, Tanta, Egypt
School of Public Health, Texila American University, Guyana, Guyana
Faculty of Medicine, University of Tripoli, Tripoli, Libya
Department of Neuropsychiatry, Ain Shams University, Cairo, Egypt
Department of Entomology, Ain Shams University, Cairo, Egypt
Medical Ain Shams Research Institute (MASRI), Ain Shams University, Cairo, Egypt
International Association for Women Mental Health, Potomac, MD, United States
Department of Clinical Pathology, Mansoura University, Mansoura, Egypt
Department of Pediatrics, Texas A&M University, Dallas, TX, United States
Department of Health Management and Policy, Drexel University, Philadelphia, PA, United States
Department of Oral Biology, The University of Lahore, Lahore, Pakistan
Department of Food Hygiene and Quality Control, University of Tehran, Tehran, Iran
Satcher Health Leadership Institute, Morehouse School of Medicine, Atlanta, GA, United States
Laboratory of experimental Medicine, Kazakh National Medical University, Almaty, Kazakhstan
Atchabarov Scientific-Research Institute of Fundamental and Applied Medicine, Kazakh National Medical University, Almaty, Kazakhstan
National Research Institute of Fundamental and Applied Medicine named after B. Atchabarov, Kazakh National Medical University, Almaty, Kazakhstan
National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
Research Center of Neurology, Moscow, Russian Federation
Department of Public Health and Infectious Diseases, City University of Hong Kong, Hong Kong
Department of Pharmacy, Wollega University, Nekemte, Ethiopia
Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
Department of Psychiatry, Kaiser Permanente, Mission Viejo, CA, United States
School of Health Sciences, A.T. Still University, Mesa, AZ, United States
Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
Department of Dermatology, Kobe University, Kobe, Japan
Department of Community Medicine, Bayero University Kano, Kano, Nigeria
Department of Community Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
Department of Neurosurgery, Albany Medical College, Albany, NY, United States
Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, United States
Department of Medicine, University of Pennsylvania, Philadelphia, PA, United States
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA, United States
Institute of Health and Wellbeing, Federation University Australia, Churchill, VIC, Australia
Department of General Medicine, Grant Medical College, Sir J.J. Group of Hospitals, Mumbai, India
School of Public Health, Xuzhou Medical University, Xuzhou, China
Key Lab of Environment and Health, Xuzhou Medical University, Xuzhou, China
Department of Midwifery, Adigrat University, Adigrat, Ethiopia
Department of Medical Laboratory Sciences, Adigrat University, Adigrat, Ethiopia
Department of Environmental Health, Wollo University, Dessie, Ethiopia
Department of Reproductive and Family Health, Axum College of Health Science, Axum, Ethiopia
College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
Department of Radiology, University of Southern California, Los Angeles, CA, United States
Department of Cardiac Surgery, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
Department of Health Systems and Policy Research, Indian Institute of Public Health, Gandhinagar, India
Department of Life Sciences, Health and Healthcare Professions, Link Campus University, Rome, Italy
Health Services Research, Evaluation and Policy Unit, AUSL della Romagna, Ravenna, Italy
Division of Cardiovascular Medicine, Ohio State University, Columbus, OH, United States
Health Directorate, Local Health Authority of
Institute for Health Metrics and Evaluation
Department of Health Metrics Sciences
Department of Applied Mathematics
School of Medicine
Department of Anesthesiology & Pain Medicine
Department of Global Health
Division of Plastic and Reconstructive Surgery
Henry M Jackson School of International Studies
Division of Allergy and Infectious Diseases
Department of Epidemiology
Department of Radiation Oncology
Department of Orthopaedic Surgery
Department of Radiology
Department of Psychiatry
Division of Cardiology
Cardiovascular Research Center
Massachusetts General Hospital
Doheny Eye Institute
Department of Ophthalmology
Department of Mathematics and Sciences
Department of Clinical Sciences
Department of Surgery
Department of Internal Medicine
Department of Family and Community Health
Department of Epidemiology and Biostatistics
Department of Population and Behavioural Sciences
Department of Biochemistry and Molecular Medicine
College of Medicine
College of Graduate Health Sciences
Academic Health System
Nursing and Midwifery Research Department (NMRD)
Centre for Social Research in Health
School of Population Health
National Drug and Alcohol Research Centre
Quality and Systems Performance Unit
Department of Health Promotion
Department of Public Health
Menzies School of Health Research
Department of Obstetrics and Gynecology
The Department of Family Medicine
Department of Pharmacology and Therapeutics
Department of Microbiology
Department of Veterinary Medicine
Department of Veterinary Public Health and Preventive Medicine
Faculty of Public Health
Technical Services Directorate
Department of Geography and Planning
Department of Medical Oncology
Department of Medicine
Department of Community Medicine and Preventive Health
School of Medicine and Psychology
Public Health Foundation of India
Institute of Endemic Diseases
Unit of Basic Medical Sciences
Swiss Tropical and Public Health Institute
Brody School of Medicine
Department of Computer Science
Department of Geography
Department of Physiology
Department of Cardiology
Chicago College of Osteopathic Medicine
Feinberg School of Medicine
Department of Medicine
Northwestern University
Maternal and Child Health Division
Department of Surgery
Department of Research and Development
Department of Medicine
Department of Energy
Department of Internal Medicine
School of Medicine
Department of Epidemiology
Departments of Psychiatry and Epidemiology
Department of Neurology
Clinical Epidemiology Center
Institute of Public Health
Department of Specialty Internal Medicine
Department of Medicine
Department of Rehabilitation Sciences
Department of Allied Medical Sciences
Department of Public Health
Department of Biomedical Engineering
Department of Bioengineering
Department of Nutrition and Food Studies
Department of Medicine
Division of Gastroenterology and Hepatology
Department of Cardiovascular Medicine
Institute of Health Informatics
Department of Health Informatics
Department of Medical Rehabilitation (Physiotherapy)
Department of Rehabilitation Sciences
School of Nursing
Department of Zoology
Department of Biosciences
Department of Geography
Ministry of Health
Department of Prosthodontics and Implant Dentistry
Department of Prosthodontics and Implant Dentistry
Department of Emergency Medicine
Pediatric Emergency Medicine Department
Department of Pediatrics
Lerner Research Institute
Interdisciplinary Graduate Program in Human Toxicology
Health Policy Research Center
Health Human Resources Research Center
Department of Biostatistics
Department of Occupational Health and Safety Engineering
School of Global Public Health
Department of Epidemiology and Health Promotion
Department of Child and Adolescent Psychiatry
Department of Radiology and Radiological Science
Department of Anesthesia and Critical Care Medicine
School of Nursing
Department of Epidemiology
Department of Neurosurgery
Department of Health Policy and Management
Department of International Health
Johns Hopkins University
Quran and Hadith Research Center
Nephrology and Urology Research Center
Department of Pharmacology
Department of Pharmacology and Research
All India Institute of Medical Sciences
Department of Social Sciences
School of Public Health
Health Management and Economics Research Center
School of Medicine
Department of Health Economics
Gastrointestinal and Liver Diseases Research Center
Preventive Medicine and Public Health Research Center
Department of Ophthalmology
Department of Pharmacology and Toxicology
College of Pharmacy
College of Art and Science
School of Life Sciences
Department of Anesthesia
T.H. Chan School of Public Health
Center for Primary Care
Harvard Business School
Division of Cardiovascular Medicine
Department of Neurological Surgery
Department of Health Policy and Management
Department of Health Policy and Oral Epidemiology
Department of Global Health and Social Medicine
Department of Clinical Medicine
Department of Forensic Medicine
Bloomberg School of Public Health
Montefiore-Einstein Cerebrovascular Research Lab
Faculty of Medicine
Department of Population Medicine
Division of Orthopaedics
School of Medicine
Department of Pediatrics
Heart Failure Research Center
Neuroscience Research Center
Department of Clinical Biochemistry
College of Optometry
Department of Neurosurgery
Houston Methodist Hospital
Department of Medicine
Department of Medicine
Heidelberg Institute of Global Health (HIGH)
Department of Public and Environmental Health
Department of Epidemiology
Division of Pulmonary
College of Medicine
UF Health Cancer Center
Non-communicable Diseases Research Center
Department of Pediatric Neurology
Department of Reproductive Health
Urology Research Center
Sina Trauma and Surgery Research Center
Orthopedic Department
Department of Pediatric Cardiology
Digestive Diseases Research Institute
School of Medicine
Department of Neurology
Department of Medicine
Sina Hospital
Research Center for Rational Use of Drugs
School of Public Health
Department of Primary Care and Public Health
School of Public Health
Department of Medical Education
Department of Social and Behavioral Health
IT Department
School of the Environment
Department of Internal Medicine
Department of Dermatology
Department of Psychiatry
Department of Radiology and Biomedical Imaging
Department of Genetics
Department of Biomedical Sciences
National AIDS Reference Center of Southern Greece
Department of Civil and Environmental Engineering
School of Medicine
Department of Epidemiology and Biostatistics
Department of Epidemiology
Department of Internal Medicine
Hubert Department of Global Health
School of Medicine
Rollins School of Public Health
Department of Global Health
Metabolomics Laboratory
Hypertension and Kidney Disease Laboratory
Department of Microbiology
Department of Pharmaceutical and Administrative Sciences
School of Pharmacy
Department of Public Health
Institutes of Applied Health Research and Translational Medicine
Institute of Applied Health Research
Department of Internal Medicine
Global Health Neurology Lab
Division of Cerebrovascular Medicine and Neurology
Department of Internal Medicine
Internal Medicine Department
School of Medicine
Obstetrics and Gynecology Department
Obesity Research Center
Research Center for Social Determinants of Health
Skull Base Research Center
Student Research Committee
Department of Epidemiology
Department of Health
Emergency Department
Disease Surveillance Department
Department of Earth
General Medicine Service
Cancer Population Sciences Program
School of Population and Public Health
School of Nursing
Department of Medical and Surgical Sciences
Department of Biomedical and Neuromotor Sciences
Dipartimento di Scienze Biomediche e Neuromotorie
School of Pharmacy
Department of Basic Biomedical Sciences
Clinical Sciences Department
Basic Medical Sciences Department
Research Institute of Medical & Health Sciences
Department of Pharmacy Practice and Pharmacotherapeutics
Department of Medicinal Chemistry
School of Public Health Sciences
Al Shifa School of Public Health
Dana-Farber Cancer Institute
Department of Management and Healthcare (EMbeDS)
Department of Psychiatry
Department of Nutrition
Department of Anesthesiology and Perioperative Medicine
School of Medicine
University of Rochester
Department of Biology
Fuwai Hospital
Department of Computer Science
Department of Ophthalmology and Visual Sciences
Institute for Social Research
University of Michigan
Department of Medicine
Saw Swee Hock School of Public Health
Department of Community Medicine
Florida International University
Department of Epidemiology
Health Data Research UK
Nova Medical School
School of Psychology
Department of Family Medicine and Public Health
Department of Diagnostic and Therapeutic Technologies
Institute for Research and Innovation in Health (i3S)
Department of Medical
Cardio-Thoraco- Vascular Department
College of Public Health
Department of Medical Engineering
Department of Medical Microbiology and Parasitology
School of Pharmacy
Sydney Medical School
IRCCS Istituto Ortopedico Galeazzi
Department of Dermatology
Lerner College of Medicine
Harrington Heart and Vascular Institute
Department of Quantitative Health Science
Department of Public Health
Department of Information Technology
Department of Computer Science
Department of Biochemistry
Immunology Research Center
Department of Radiology
Department of Psychiatry
Icahn School of Medicine at Mount Sinai
Institute for Critical Care Medicine
Department of Cardiology
Icahn School of Medicine at Mount Sinai
Chettinad Hospital & Research Institute
Department of Pharmacy
Pharmacology Division
Division of Pathology
Faculty of Science
Department of Gastroenterology
Department of Medicine
Department of Medicine
Department of Pathology
Health Science Center
Department of Plastic Surgery
South Plainfield
Department of Cardiology
School of Population Health and Environmental Sciences
Office of Institutional Analysis
Department of Pharmacology
Department of Conservative Dentistry with Endodontics
Almoosa College of Health Sciences
Department of Public Health and Community Medicine
School of Public Health
Faculty of Medicine
Department of Neuropsychiatry
Department of Entomology
Medical Ain Shams Research Institute (MASRI)
International Association for Women Mental Health
Department of Clinical Pathology
Department of Pediatrics
Department of Health Management and Policy
Department of Oral Biology
Department of Food Hygiene and Quality Control
Satcher Health Leadership Institute
Laboratory of experimental Medicine
Atchabarov Scientific-Research Institute of Fundamental and Applied Medicine
National Research Institute of Fundamental and Applied Medicine named after B. Atchabarov
National Institute for Stroke and Applied Neurosciences
Research Center of Neurology
Department of Public Health and Infectious Diseases
Department of Pharmacy
Department of Social Sciences
Department of Psychiatry
School of Health Sciences
Institute of Public Health
Department of Dermatology
Department of Community Medicine
Department of Community Medicine
Department of Neurosurgery
Department of Neurosurgery
Department of Medicine
Department of Biostatistics
Institute of Health and Wellbeing
Department of General Medicine
School of Public Health
Key Lab of Environment and Health
Department of Midwifery
Department of Medical Laboratory Sciences
Department of Environmental Health
Department of Reproductive and Family Health
College of Medicine and Public Health
Department of Radiology
Department of Cardiac Surgery
Department of Health Systems and Policy Research
Department of Life Sciences
Health Services Research
Division of Cardiovascular Medicine
Health Directorate
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