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      Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016 : A Systematic Analysis for the Global Burden of Disease Study

      Global Burden of Disease Cancer Collaboration , MD , 1 , 2 , 3 , PhD 4 , PhD 5 , MPH 2 , PhD 6 , BA 2 , MPH 7 , PhD 8 , MD 9 , 10 , MD 11 , PhD 12 , PhD 13 , MS 14 , PhD 15 , MS 14 , PhD 16 , PhD 17 , PhD 18 , PhD 19 , BA 2 , PhD 20 , MD 21 , MD 22 , PhD 16 , MSc 23 , 24 , PhD 25 , 26 , PhD 27 , 28 , MD 29 , PhD 30 , PhD 31 , 32 , MD 2 , 33 , PhD 2 , 33 , PhD 34 , 35 , PhD 36 , MD 37 , PhD 38 , 39 , PhD 40 , MPhil 41 , MPH 9 , 42 , MS 43 , PhD 44 , 45 , MPH 46 , PhD 47 , MD 21 , PhD 2 , 48 , MS 49 , MPH 50 , PhD 51 , 52 , MD 53 , MPH 54 , DPhil 55 , DrPH 56 , BS 2 , MPH 57 , DM 58 , 59 , DSc 2 , 60 , PhD 61 , MPH 62 , MD 63 , PhD 64 , MD 65 , PhD 66 , PhD 67 , PhD 68 , 69 , MSc 2 , MD 70 , PhD 71 , 72 , MS 14 , ScD 73 , MD 74 , PhD 75 , MD 76 , 77 , MD 78 , 79 , PhD 80 , PhD 81 , PhD 33 2 , DM 82 , MD 83 , PhD 84 , MS 14 , PhD 85 , MD 86   , PhD 87 , 88 , MD 89 , MD 90 , PhD 91 , DSc 83 , MD 92 , PhD 93 , MPH 94 , 95 , MS 96 , PhD 97 , MD 98 , PhD 99 , 100 , MS 14 , PhD 101 , 102   , PhD 103 , 104 , PhD 2 , PhD 105 106 , PhD 107 , MD 108 , MSc 109 , MSc 109 , MPH 110 , MD 111 , 112 , 113 , DNB 114 , PhD 115 , MD 116 , PhD 117 , MD 10 , 118 , PhD 119 , 120 , PhD 81 , PhD 121 , MS 122 , 123 , MD 48 , MD 124 , 125 , 126 , PhD 90 , 127 , PhD 128 , PhD 129 , MD 130 , 131 , PhD 132 , 133 , PhD 134 , 135   , PhD 136 , PhD 90 , BA 2 , MD 137 , PhD 138 , MD 139 , PhD 140 , PhD 141 , 142 , MD 143 , MD 144 , MS 43 , MPH 2 , MBA 145 , PhD 146 , PhD 25 , MPH 96 , 147 , PhD 148 , 149 , MSc 109 , PhD 150 , 151 , MD 152 , MD 153 , DrPH 2 , PhD 154 , 155 , 156 , 157 , DSc 158 , MS 159 , MPH 160 , DrPH 161 , DPhil 2 , PhD 2

      JAMA Oncology

      American Medical Association

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          This systematic analysis evaluates the cancer burden over time at the global and national levels measured in incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years.

          Key Points

          Question

          What is the cancer burden over time at the global and national levels measured in incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs)?

          Findings

          In this systematic analysis, in 2016 there were 17.2 million incident cancer cases, 8.9 million deaths, and 213.2 million DALYs due to cancer worldwide. Between 2006 and 2016, incident cases increased by 28%, with the largest increase occurring in the least developed countries.

          Meaning

          To achieve the Sustainable Development Goals as well as targets set in the World Health Organization Global Action Plan on noncommunicable diseases, cancer control planning and implementation as well as strategic investments are urgently needed.

          Abstract

          Importance

          The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required.

          Objective

          To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus.

          Evidence Review

          Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition.

          Findings

          In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, −1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories.

          Conclusions and Relevance

          Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.

          Related collections

          Most cited references 19

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          Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

          Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100,000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade. Bill & Melinda Gates Foundation. Copyright © 2015 Elsevier Ltd. All rights reserved.
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            Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

            Summary Background As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. Methods We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8–75·9 million [7·2%, 6·0–8·3]), 45·1 million (29·0–62·8 million [5·6%, 4·0–7·2]), 36·3 million (25·3–50·9 million [4·5%, 3·8–5·3]), 34·7 million (23·0–49·6 million [4·3%, 3·5–5·2]), and 34·1 million (23·5–46·0 million [4·2%, 3·2–5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3–3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0–11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer’s disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862–11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018–19 228). Interpretation The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response.
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              Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016

              Summary Background Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. Findings The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2–73·2) of deaths in 2016 with 19·3% (18·5–20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00–8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006–16—age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176–181) increase in deaths in ages 90–94 years and a 210% (208–212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. Interpretation The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems. Funding Bill & Melinda Gates Foundation.
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                Author and article information

                Journal
                JAMA Oncol
                JAMA Oncol
                JAMA Oncol
                JAMA Oncology
                American Medical Association
                2374-2437
                2374-2445
                2 June 2018
                November 2018
                2 June 2018
                : 4
                : 11
                :
                Affiliations
                [1 ]Division of Hematology, Department of Medicine, University of Washington, Seattle
                [2 ]Institute for Health Metrics and Evaluation, University of Washington, Seattle
                [3 ]Fred Hutchinson Cancer Research Center, Seattle, Washington
                [4 ]Department of Epidemiology, University of Alabama at Birmingham
                [5 ]Baghdad College of Medicine, Baghdad, Baghdad, Iraq
                [6 ]Gastrointestinal Cancer Research Center, Mazandaran University of Medical Sciences, Sari, Iran
                [7 ]Charite University Medicine Berlin, Charité Universitätsmedizin, Berlin, Berlin, Germany
                [8 ]ALZAK Foundation–Universidad de la Costa, Universidad de Cartagena, Universidad de Cartagena, Cartagena de Indias, Colombia
                [9 ]Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
                [10 ]Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran
                [11 ]University of Washington, Seattle
                [12 ]Birmingham City, University Department of Public Health and Therapies, Birmingham, England
                [13 ]University of Manitoba, Winnipeg, Manitoba, Canada
                [14 ]Mekelle University, Mekelle, Ethiopia
                [15 ]Mashhad University of Medical Sciences, Mashhad, Iran
                [16 ]National Institute of Public Health, Cuernavaca, Morelos, Mexico
                [17 ]Indian Institute of Public Health, Gandhinagar, Gujarat, India
                [18 ]Faculty of Medicine and Health Sciences, Aden University, Aden, Yemen
                [19 ]Faculty of Medicine, University of Belgrade, Belgrade, Belgrade, Serbia
                [20 ]University of São Paulo, São Paulo, São Paulo, Brazil
                [21 ]St Jude Children’s Research Hospital, Memphis, Tennessee
                [22 ]German Cancer Research Center, Heidelberg, Germany
                [23 ]Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Bogota, DC, Colombia
                [24 ]Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogota, Colombia
                [25 ]Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
                [26 ]Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
                [27 ]Seoul National University Hospital, Seoul, South Korea
                [28 ]Seoul National University Medical Library, Seoul, South Korea
                [29 ]Christian Medical College, Vellore, Tamilnadu, India
                [30 ]The Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, England
                [31 ]Accamargo Cancer Center, Sao Paulo, Sao Paulo, Brazil
                [32 ]International Prevention Research Institute, Ecully, France
                [33 ]Public Health Foundation of India, Gurugram, National Capital Region, India
                [34 ]INEB–Instituto de Engenharia Biomédica, University of Porto, Porto, Portugal
                [35 ]i3S–Instituto de Investigação e Inovação em Saúde, University of Porto, Porto, Portugal
                [36 ]Indian Institute of Public Health, Delhi, India
                [37 ]Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
                [38 ]University of Cape Coast, Cape Coast, Ghana
                [39 ]University of Tampere, Tampere, Finland
                [40 ]Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
                [41 ]International Institute for Population Sciences, Mumbai, Maharashtra, India
                [42 ]Liver and Pancreaticobiliary Diseases Research Center, Digestive Disease Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
                [43 ]Haramaya University, Harar, Ethiopia
                [44 ]Department of Global Health and Social Medicine, Harvard Medical School, Kigali, Rwanda
                [45 ]Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
                [46 ]Arba Minch University, Arba Minch, SNNPR, Ethiopia
                [47 ]School of Public Health, Bielefeld University, Bielefeld, North Rhine-Westphalia, Germany
                [48 ]Imperial College London, London, England
                [49 ]College of Health Sciences, Mekelle University, Mekelle, Ethiopia
                [50 ]Department of Health and Social Affairs, Government of the Federated States of Micronesia, Palikir, Pohnpei, Federated States of Micronesia
                [51 ]University Hospital Policlinico “Vittorio Emanuele,” Catania, Italy
                [52 ]NNEdPro Global Centre for Nutrition and Health, Cambridge, England
                [53 ]West Virginia Bureau for Public Health, Charleston
                [54 ]Aarhus University, Aarhus, Denmark
                [55 ]Arabian Gulf University, Manama, Bahrain
                [56 ]Haan Bin Mohammed Smart University, Dubai, United Arab Emirates
                [57 ]Mizan Tepi University, Mizan Teferi, Ethiopia
                [58 ]International Foundation for Dermatology, London, England
                [59 ]King's College London, London, England
                [60 ]Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, England
                [61 ]Air Pollution Research Center, Iran University of Medical Sciences, Tehran, Iran
                [62 ]Samara University, Samara, Ethiopia
                [63 ]Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Kanagawa, Japan
                [64 ]Albert Einstein College of Medicine, Bronx, New York, USA
                [65 ]National Public Health Institute, Monrovia, Monserrado County, Liberia
                [66 ]National Institute for Health Development, Tallinn, Estonia
                [67 ]Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
                [68 ]Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Central Serbia, Serbia
                [69 ]Center for Health Trends and Forecasts, University of Washington, Seattle
                [70 ]Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
                [71 ]Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran
                [72 ]Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
                [73 ]Department of Community Medicine, Public Health and Family Medicine, Jordan University of Science and Technology, Irbid, Jordan
                [74 ]Health Services Academy, Islamabad, Punjab, Pakistan
                [75 ]Department of Microbiology and Immunology, College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, United Arab Emirates
                [76 ]Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea
                [77 ]Institute of Health Policy and Management, Seoul National University Medical Center, Seoul, South Korea
                [78 ]Baqiyatallah University of Medical Sciences, Tehran, Iran
                [79 ]International Otorhinolaryngology Research Association (IORA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
                [80 ]Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
                [81 ]University of British Columbia, Vancouver, British Columbia, Canada
                [82 ]Post Graduate Institute of Medical Education and Research, Chandigarh, India
                [83 ]University of Milano Bicocca, Monza, MB, Italy
                [84 ]National Cancer Institute, Rockville, Maryland
                [85 ]University of Sydney, Sydney, New South Wales, Australia
                [86 ]University of Haifa, Haifa, Israel
                [87 ]Aintree University Hospital National Health Service Foundation Trust, Liverpool, England
                [88 ]School of Medicine, University of Liverpool, Liverpool, England
                [89 ]Department of Primary Care & Public Health, Imperial College London, London, England
                [90 ]Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
                [91 ]Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
                [92 ]Alaska Native Tribal Health Consortium, Anchorage
                [93 ]Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Martin Luther University Halle-Wittenberg, Saale, Germany
                [94 ]School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
                [95 ]School of Public Health, Mekelle University, Mekelle, Ethiopia
                [96 ]University of Gondar, Gondar, Ethiopia
                [97 ]University of West Florida, Pensacola, Florida
                [98 ]United Nations Population Fund, Lima, Peru
                [99 ]Comprehensive Cancer Center, Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland
                [100 ]University of Helsinki, Helsinki, Finland
                [101 ]Pacific Institute for Research & Evaluation, Calverton, Maryland
                [102 ]School of Public Health, Curtin University, Perth, Western Australia, Australia
                [103 ]Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria
                [104 ]Institute of Public Health, Heidelberg University, Heidelberg, Baden Wuettemberg, Germany
                [105 ]Health Science Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
                [106 ]Lancaster Medical School, Lancaster University, Lancaster, England
                [107 ]Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
                [108 ]Suraj Eye Institute, Nagpur, Maharashtra, India
                [109 ]Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
                [110 ]Centre for Health Research, Western Sydney University, Sydney, New South Wales, Australia
                [111 ]Department of Psychiatry, College of Medicine, University of Lagos, Lagos, Lagos State, Nigeria
                [112 ]Department of Psychiatry, Lagos University Teaching Hospital, Lagos, Nigeria
                [113 ]Discipline of Psychiatry, University of Adelaide, Adelaide, South Australia, Australia
                [114 ]JSS Medical College (PA), JSS University, Mysore, Karnataka, India
                [115 ]Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea
                [116 ]White Plains Hospital, White Plains, New York
                [117 ]REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
                [118 ]Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
                [119 ]University Medical Center Groningen, Groningen, the Netherlands
                [120 ]University of Groningen, Groningen, the Netherlands
                [121 ]Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
                [122 ]Contech International Health Consultants, Lahore, Pakistan
                [123 ]Contech School of Public Health, Lahore, Pakistan
                [124 ]North Hampshire Hospitals, Basingstroke, England
                [125 ]University College London Hospitals, London, England
                [126 ]WHO Collaborating Centre, Imperial College of London, London, England
                [127 ]Golestan Research Center of Gastroenterology and Hepatology, Golestan University of Medical Sciences, Gorgan, Iran
                [128 ]Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran
                [129 ]Tehran University of Medical Sciences, Tehran, Iran
                [130 ]Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
                [131 ]Case Western Reserve University, Cleveland, Ohio
                [132 ]Centre School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, Belgrade, Belgrade, Serbia
                [133 ]Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Belgrade, Serbia
                [134 ]Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
                [135 ]UKZN Gastrointestinal Cancer Research Centre, South African Medical Research Council, Durban, South Africa
                [136 ]Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India
                [137 ]Independent Consultant, Karachi, Pakistan
                [138 ]Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
                [139 ]Department of Pulmonary Medicine, Zhongshan Hospital (She), Fudan University, Shanghai, China
                [140 ]Department of Public Health Sciences, Korea University, Seoul, South Korea
                [141 ]Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, Scotland
                [142 ]Institut für Medizinische Epidemiologie, Biometrie und Informatik, Martin Luther University Halle-Wittenberg, Saale, Germany
                [143 ]Harvard Medical School, Kigali, Rwanda
                [144 ]Ethiopian Medical Association, Addis Ababa, Ethiopia
                [145 ]Ahmadu Bello University, Zaria, Nigeria
                [146 ]Departments of Criminology, Law & Society, Sociology, and Public Health, University of California, Irvine
                [147 ]University of Adelaide, Adelaide, South Australia, Australia
                [148 ]Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
                [149 ]Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
                [150 ]Johns Hopkins University, Baltimore, Maryland
                [151 ]Hanoi Medical University, Hanoi, Vietnam
                [152 ]Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
                [153 ]National Research University Higher School of Economics, Moscow, Russia
                [154 ]Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
                [155 ]Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
                [156 ]Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
                [157 ]Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
                [158 ]Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, England
                [159 ]Woldia University, Woldia, Amhara, Ethiopia
                [160 ]Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan
                [161 ]Jackson State University, Jackson, Mississippi
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                Corresponding Author: Christina Fitzmaurice, MD, MPH, Division of Hematology, Department of Medicine, Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Ste 600, Seattle, WA 98121 ( cf11@ 123456uw.edu ).
                Open Access: CC-BY License JAMA Oncology
                Published Online:10.1001/jamaoncol.2018.2706
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                Article
                coi180055
                10.1001/jamaoncol.2018.2706
                6248091
                29860482
                Copyright 2018 Global Burden of Disease Cancer Collaboration. JAMA Oncology.

                This is an open access article distributed under the terms of the CC-BY License.

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