{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T06:31:06Z","timestamp":1776753066920,"version":"3.51.2"},"reference-count":52,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T00:00:00Z","timestamp":1608076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T00:00:00Z","timestamp":1608076800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Bill"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>We monitored the burden of cancer in Italy and its trends over the last three decades, providing estimates of cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs), for cancer overall and 30 cancer sites using data from the Global Burden of Disease study 2017. An overview of mortality trends between 1990 and 2017 was also provided. In 2017, there were 254,336 new cancer cases in men and 214,994 in women, corresponding to an age-standardized incidence rate (ASIR) of 438 and 330\/100,000, respectively. Between 1990 and 2017, incident cancer cases, and, to a lesser extent, ASIRs significantly increased overall and for almost all cancer sites, but ASIRs significantly declined for lung and other tobacco-related neoplasms. In 2017, there were 101,659 cancer deaths in men (age-standardized death rate, ASDR, 158.5\/100,000) and 78,918 in women (ASDR 93.9\/100,000). Cancer deaths significantly increased between 1990 and 2017 (+\u200918%), but ASDR significantly decreased (\u2212\u200928%). Deaths significantly increased for many cancer sites, but decreased for stomach, esophageal, laryngeal, Hodgkin lymphoma, and testicular cancer. ASDRs significantly decreased for most neoplasms, with the main exceptions of cancer of the pancreas and uterus, and multiple myeloma. In 2017, cancer caused 3,204,000 DALYs. Between 1990 and 2017, DALYs and age-standardized DALY rates significantly declined (-3.4% and -33%, respectively). Age-standardized mortality rates in Italy showed favorable patterns over the last few decades. However, the absolute number of cancer cases and, to a lower extent, of cancer deaths increased likely due to the progressive ageing of the population, this calling for a continuous effort in cancer prevention, early diagnosis, and treatment.<\/jats:p>","DOI":"10.1038\/s41598-020-79176-3","type":"journal-article","created":{"date-parts":[[2020,12,16]],"date-time":"2020-12-16T11:06:18Z","timestamp":1608116778000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["National burden of cancer in Italy, 1990\u20132017: a systematic analysis for the global burden of disease study 2017"],"prefix":"10.1038","volume":"10","author":[{"given":"Cristina","family":"Bosetti","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenio","family":"Traini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tahiya","family":"Alam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine A.","family":"Allen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Carreras","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly","family":"Compton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Fitzmaurice","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa M.","family":"Force","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvano","family":"Gallus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Gorini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James D.","family":"Harvey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M.","family":"Kocarnik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"La Vecchia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandra","family":"Lugo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohsen","family":"Naghavi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa","family":"Pennini","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristiano","family":"Piccinelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luca","family":"Ronfani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rixing","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Monasta","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,12,16]]},"reference":[{"key":"79176_CR1","doi-asserted-by":"publisher","first-page":"1749","DOI":"10.1001\/jamaoncol.2019.2996","volume":"5","author":"GBD Cancer Collaboration","year":"2019","unstructured":"GBD Cancer Collaboration. 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 2017: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol 5, 1749\u20131768 (2019).","journal-title":"JAMA Oncol"},{"key":"79176_CR2","doi-asserted-by":"publisher","first-page":"1736","DOI":"10.1016\/S0140-6736(18)32203-7","volume":"392","author":"GBD Causes of Death Collaborators","year":"2018","unstructured":"GBD Causes of Death Collaborators. Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980\u20132017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392, 1736\u20131788 (2018).","journal-title":"Lancet"},{"key":"79176_CR3","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1056\/NEJMp1600894","volume":"374","author":"DR Lowy","year":"2016","unstructured":"Lowy, D. R. & Collins, F. S. Aiming high-changing the trajectory for cancer. N. Engl. J. Med. 374, 1901\u20131904 (2016).","journal-title":"N. Engl. J. Med."},{"key":"79176_CR4","doi-asserted-by":"publisher","first-page":"549","DOI":"10.1016\/S0140-6736(13)62224-2","volume":"383","author":"P Vineis","year":"2014","unstructured":"Vineis, P. & Wild, C. P. Global cancer patterns: causes and prevention. Lancet 383, 549\u2013557 (2014).","journal-title":"Lancet"},{"key":"79176_CR5","unstructured":"Istituto Statistico Nazionale (ISTAT). I.Stat. Available at: http:\/\/dati.istat.it\/ (last accessed June 2019)."},{"key":"79176_CR6","doi-asserted-by":"publisher","first-page":"1941","DOI":"10.1002\/ijc.31937","volume":"144","author":"J Ferlay","year":"2019","unstructured":"Ferlay, J. et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int. J. Cancer 144, 1941\u20131953 (2019).","journal-title":"Int. J. Cancer"},{"key":"79176_CR7","doi-asserted-by":"publisher","first-page":"2657","DOI":"10.1093\/annonc\/mdt301","volume":"24","author":"C Bosetti","year":"2013","unstructured":"Bosetti, C. et al. Cancer mortality in Europe, 2005\u20132009, and an overview of trends since 1980. Ann. Oncol. 24, 2657\u20132671 (2013).","journal-title":"Ann. Oncol."},{"key":"79176_CR8","doi-asserted-by":"publisher","first-page":"664","DOI":"10.5301\/tj.5000352","volume":"101","author":"T Rosso","year":"2015","unstructured":"Rosso, T., Bertuccio, P., La Vecchia, C., Negri, E. & Malvezzi, M. Cancer mortality trend analysis in Italy, 1980\u20132010, and predictions for 2015. Tumori 101, 664\u2013675 (2015).","journal-title":"Tumori"},{"key":"79176_CR9","unstructured":"OECD. Italy: Country Health Profile 2017 \u2013 State of Health in the EU. European Observatory on Health Systems and Policies, 2017. (OECD Publishing, 2017)."},{"key":"79176_CR10","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1097\/CEJ.0b013e32836562f1","volume":"23","author":"C La Vecchia","year":"2014","unstructured":"La Vecchia, C. et al. Trends in alcohol consumption in Europe and their impact on major alcohol-related cancers. Eur J Cancer Prev 23, 319\u2013322 (2014).","journal-title":"Eur J Cancer Prev"},{"key":"79176_CR11","doi-asserted-by":"publisher","first-page":"1885","DOI":"10.1016\/S0140-6736(17)30819-X","volume":"389","author":"GBD 2015 Tobacco Collaborators","year":"2017","unstructured":"GBD 2015 Tobacco Collaborators. Smoking prevalence and attributable disease burden in 195 countries and territories, 1990\u20132015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 389, 1885\u20131906 (2017).","journal-title":"Lancet"},{"key":"79176_CR12","doi-asserted-by":"publisher","first-page":"353","DOI":"10.5301\/tj.5000644","volume":"103","author":"A Lugo","year":"2017","unstructured":"Lugo, A. et al. Smoking in Italy in 2015\u20132016: prevalence, trends, roll-your-own cigarettes, and attitudes towards incoming regulations. Tumori 103, 353\u2013359 (2017).","journal-title":"Tumori"},{"key":"79176_CR13","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1038\/bjc.2014.579","volume":"112","author":"V Bagnardi","year":"2015","unstructured":"Bagnardi, V. et al. Alcohol consumption and site-specific cancer risk: a comprehensive dose-response meta-analysis. Br. J. Cancer 112, 580\u2013593 (2015).","journal-title":"Br. J. Cancer"},{"key":"79176_CR14","doi-asserted-by":"publisher","first-page":"2029","DOI":"10.1053\/j.gastro.2010.01.057","volume":"138","author":"AT Chan","year":"2010","unstructured":"Chan, A. T. & Giovannucci, E. L. Primary prevention of colorectal cancer. Gastroenterology 138, 2029\u20132043 (2010).","journal-title":"Gastroenterology"},{"key":"79176_CR15","unstructured":"World Cancer Research Fund\/American Institute for Cancer Research. Diet, Nutrition, Physical Activity and Cancer: a Global Perspective. Continuous Update Project Expert Report 2018. Available at: www.dietandcancerreport.org (2018)."},{"key":"79176_CR16","doi-asserted-by":"publisher","first-page":"1625","DOI":"10.1056\/NEJMoa021423","volume":"348","author":"EE Calle","year":"2003","unstructured":"Calle, E. E., Rodriguez, C., Walker-Thurmond, K. & Thun, M. J. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N. Engl. J. Med. 348, 1625\u20131638 (2003).","journal-title":"N. Engl. J. Med."},{"key":"79176_CR17","doi-asserted-by":"publisher","first-page":"1928","DOI":"10.1016\/j.ejca.2011.03.003","volume":"47","author":"Q Ben","year":"2011","unstructured":"Ben, Q. et al. Diabetes mellitus and risk of pancreatic cancer: a meta-analysis of cohort studies. Eur. J. Cancer 47, 1928\u20131937 (2011).","journal-title":"Eur. J. Cancer"},{"key":"79176_CR18","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1007\/s00394-014-0746-4","volume":"54","author":"S Gallus","year":"2015","unstructured":"Gallus, S. et al. Overweight and obesity in 16 European countries. Eur. J. Nutr. 54, 679\u2013689 (2015).","journal-title":"Eur. J. Nutr."},{"key":"79176_CR19","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1007\/s00394-012-0372-y","volume":"52","author":"S Gallus","year":"2013","unstructured":"Gallus, S. et al. Overweight and obesity prevalence and determinants in Italy: an update to 2010. Eur. J. Nutr. 52, 677\u2013685 (2013).","journal-title":"Eur. J. Nutr."},{"key":"79176_CR20","doi-asserted-by":"publisher","first-page":"g3174","DOI":"10.1136\/bmj.g3174","volume":"348","author":"AC Ford","year":"2014","unstructured":"Ford, A. C., Forman, D., Hunt, R. H., Yuan, Y. & Moayyedi, P. Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ 348, g3174 (2014).","journal-title":"BMJ"},{"key":"79176_CR21","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1111\/apt.13474","volume":"43","author":"SE Roberts","year":"2016","unstructured":"Roberts, S. E. et al. Review article: the prevalence of Helicobacter pylori and the incidence of gastric cancer across Europe. Aliment Pharmacol. Ther. 43, 334\u2013345 (2016).","journal-title":"Aliment Pharmacol. Ther."},{"key":"79176_CR22","doi-asserted-by":"publisher","first-page":"e609","DOI":"10.1016\/S2214-109X(16)30143-7","volume":"4","author":"M Plummer","year":"2016","unstructured":"Plummer, M. et al. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob. Health 4, e609-616 (2016).","journal-title":"Lancet Glob. Health"},{"key":"79176_CR23","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1016\/j.jhep.2018.05.011","volume":"69","author":"L Pimpin","year":"2018","unstructured":"Pimpin, L. et al. Burden of liver disease in Europe: epidemiology and analysis of risk factors to identify prevention policies. J. Hepatol. 69, 718\u2013735 (2018).","journal-title":"J. Hepatol."},{"key":"79176_CR24","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.ypmed.2016.11.020","volume":"98","author":"P Giorgi Rossi","year":"2017","unstructured":"Giorgi Rossi, P. et al. Cervical cancer screening in women vaccinated against human papillomavirus infection: recommendations from a consensus conference. Prev. Med. 98, 21\u201330 (2017).","journal-title":"Prev. Med."},{"key":"79176_CR25","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.eururo.2016.06.010","volume":"71","author":"S Antoni","year":"2017","unstructured":"Antoni, S. et al. Bladder cancer incidence and mortality: a global overview and recent trends. Eur. Urol. 71, 96\u2013108 (2017).","journal-title":"Eur. Urol."},{"key":"79176_CR26","first-page":"1","volume":"4","author":"P Boffetta","year":"2018","unstructured":"Boffetta, P., Malvezzi, M., Pira, E., Negri, E. & La Vecchia, C. International analysis of age-specific mortality rates from mesothelioma on the basis of the international classification of diseases, 10th revision. J. Glob. Oncol. 4, 1\u201315 (2018).","journal-title":"J. Glob. Oncol."},{"key":"79176_CR27","unstructured":"ISPRA. Analisi dei trend dei principali inquinanti atmosferici in Italia, 2008\u20132017. Rapporti 302\/2018. Availlable at: http:\/\/www.isprambiente.gov.it\/it\/pubblicazioni\/rapporti\/analisi-dei-trend-dei-principali-inquinanti-atmosferici-in-italia-2008-2013-2017 (2019)."},{"key":"79176_CR28","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/S0140-6736(04)16674-9","volume":"364","author":"J Peto","year":"2004","unstructured":"Peto, J., Gilham, C., Fletcher, O. & Matthews, F. E. The cervical cancer epidemic that screening has prevented in the UK. Lancet 364, 249\u2013256 (2004).","journal-title":"Lancet"},{"key":"79176_CR29","doi-asserted-by":"publisher","first-page":"S11","DOI":"10.1016\/j.ygyno.2010.01.025","volume":"117","author":"J Cuzick","year":"2010","unstructured":"Cuzick, J. Long-term cervical cancer prevention strategies across the globe. Gynecol. Oncol. 117, S11-14 (2010).","journal-title":"Gynecol. Oncol."},{"key":"79176_CR30","unstructured":"Osservatorio Nazionale Screening. Rapporto 2018. Availlable at: https:\/\/www.osservatorionazionalescreening.it\/content\/rapporto-2018 (2018)."},{"key":"79176_CR31","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/j.gie.2012.02.040","volume":"76","author":"CN Manser","year":"2012","unstructured":"Manser, C. N. et al. Colonoscopy screening markedly reduces the occurrence of colon carcinomas and carcinoma-related death: a closed cohort study. Gastrointest. Endosc. 76, 110\u2013117 (2012).","journal-title":"Gastrointest. Endosc."},{"key":"79176_CR32","doi-asserted-by":"publisher","first-page":"2576","DOI":"10.1001\/jama.2016.3332","volume":"315","author":"JS Lin","year":"2016","unstructured":"Lin, J. S. et al. Screening for colorectal cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA 315, 2576\u20132594 (2016).","journal-title":"JAMA"},{"key":"79176_CR33","doi-asserted-by":"publisher","first-page":"1784","DOI":"10.1056\/NEJMoa050518","volume":"353","author":"DA Berry","year":"2005","unstructured":"Berry, D. A. et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N. Engl. J. Med. 353, 1784\u20131792 (2005).","journal-title":"N. Engl. J. Med."},{"key":"79176_CR34","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1258\/jms.2011.011134","volume":"18","author":"V Beral","year":"2011","unstructured":"Beral, V. et al. The number of women who would need to be screened regularly by mammography to prevent one death from breast cancer. J. Med. Screen 18, 210\u2013212 (2011).","journal-title":"J. Med. Screen"},{"key":"79176_CR35","doi-asserted-by":"publisher","first-page":"3040","DOI":"10.1016\/j.ejca.2010.09.013","volume":"46","author":"F Bray","year":"2010","unstructured":"Bray, F., Lortet-Tieulent, J., Ferlay, J., Forman, D. & Auvinen, A. Prostate cancer incidence and mortality trends in 37 European countries: an overview. Eur. J. Cancer 46, 3040\u20133052 (2010).","journal-title":"Eur. J. Cancer"},{"key":"79176_CR36","doi-asserted-by":"publisher","first-page":"5955","DOI":"10.1002\/cncr.27594","volume":"118","author":"R Etzioni","year":"2012","unstructured":"Etzioni, R. et al. The prostate cancer conundrum revisited: treatment changes and prostate cancer mortality declines. Cancer 118, 5955\u20135963 (2012).","journal-title":"Cancer"},{"key":"79176_CR37","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1097\/GCO.0000000000000343","volume":"29","author":"SB Giordano","year":"2017","unstructured":"Giordano, S. B. & Gradishar, W. Breast cancer: updates and advances in 2016. Curr. Opin. Obstet. Gynecol. 29, 12\u201317 (2017).","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"79176_CR38","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1097\/00001622-200205000-00002","volume":"14","author":"BA Hellerstedt","year":"2002","unstructured":"Hellerstedt, B. A. & Pienta, K. J. Testicular cancer. Curr. Opin. Oncol. 14, 260\u2013264 (2002).","journal-title":"Curr. Opin. Oncol."},{"key":"79176_CR39","doi-asserted-by":"publisher","first-page":"1432","DOI":"10.1002\/cncr.31931","volume":"125","author":"S Sharma","year":"2019","unstructured":"Sharma, S. & Rai, K. R. Chronic lymphocytic leukemia (CLL) treatment: So many choices, such great options. Cancer 125, 1432\u20131440 (2019).","journal-title":"Cancer"},{"key":"79176_CR40","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.leukres.2018.10.008","volume":"74","author":"RV Raj","year":"2018","unstructured":"Raj, R. V., Abedin, S. M. & Atallah, E. Incorporating newer agents in the treatment of acute myeloid leukemia. Leuk. Res. 74, 113\u2013120 (2018).","journal-title":"Leuk. Res."},{"key":"79176_CR41","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.ypmed.2014.11.015","volume":"70","author":"S Gallus","year":"2015","unstructured":"Gallus, S., Bosetti, C., Chatenoud, L. & La Vecchia, C. Long live the Italians!. Prev. Med. 70, 76\u201377 (2015).","journal-title":"Prev. Med."},{"key":"79176_CR42","unstructured":"GBD 2017 Italy Collaborators. Italy\u2019s health performance, 1990\u20132017: Findings 1 from the Global Burden of Disease Study 2017. Lancet Public Health (2019)."},{"key":"79176_CR43","unstructured":"World Health Organization. World Health Report 2010: Health systems financing - the path to universal coverage. (WHO, 2010)."},{"key":"79176_CR44","unstructured":"Lu, W. & Del Giudice, V. Italy's struggling economy has world's healthiest people. Bloomberg 2017. Available at: https:\/\/www.bloomberg.com\/news\/articles\/2017-03-20\/italy-s-struggling-economy-has-world-s-healthiest-people (Last accessed July 18, 2019)."},{"key":"79176_CR45","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1001\/jamaoncol.2016.5688","volume":"3","author":"GBD Cancer Collaboration","year":"2017","unstructured":"GBD Cancer Collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the Global Burden of Disease Study. JAMA Oncol. 3, 524\u2013548 (2017).","journal-title":"JAMA Oncol."},{"key":"79176_CR46","unstructured":"AIRTUM. Copertura dei Registri Tumori in Italia. Available at: https:\/\/www.registri-tumori.it\/cms\/notizie\/copertura-dei-registri-tumori-italia. Last accessed: July 15, 2019."},{"key":"79176_CR47","doi-asserted-by":"publisher","first-page":"E359","DOI":"10.1002\/ijc.29210","volume":"136","author":"J Ferlay","year":"2015","unstructured":"Ferlay, J. et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int. J. Cancer 136, E359-386 (2015).","journal-title":"Int. J. Cancer"},{"key":"79176_CR48","unstructured":"OECD. Health expenditure and financing: Health expenditure indicators. OECD Health Statistics (database). Availlable at: http:\/\/www.oecd.org\/els\/health-systems\/health-data.htm (Last accessed July 18, 2019)."},{"key":"79176_CR49","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","volume":"392","author":"GBD Disease Injury Incidence Prevalence Collaborators","year":"2018","unstructured":"GBD Disease Injury Incidence Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392, 1789\u20131858 (2018).","journal-title":"Lancet"},{"key":"79176_CR50","doi-asserted-by":"crossref","unstructured":"DALYs, G. & Collaborators, H. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392, 1859\u20131922 (2018).","DOI":"10.1016\/S0140-6736(18)32335-3"},{"key":"79176_CR51","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1478-7954-10-1","volume":"10","author":"KJ Foreman","year":"2012","unstructured":"Foreman, K. J., Lozano, R., Lopez, A. D. & Murray, C. J. Modeling causes of death: an integrated approach using CODEm. Popul. Health Metr. 10, 1 (2012).","journal-title":"Popul. Health Metr."},{"key":"79176_CR52","unstructured":"GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 392, 1923\u20131994 (2018)."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-79176-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-79176-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-79176-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,7]],"date-time":"2022-12-07T00:41:55Z","timestamp":1670373715000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-020-79176-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,12,16]]},"references-count":52,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["79176"],"URL":"https:\/\/doi.org\/10.1038\/s41598-020-79176-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,16]]},"assertion":[{"value":"11 March 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 November 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"22099"}}