Health disparities across the counties of Kenya and implications for policy makers, 1990–2016: a systematic analysis for the Global Burden of Disease.

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Health disparities across the counties of Kenya and implications for policy makers, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 Tom Achoki, PhD, Molly K Miller-Petrie, MSc, Scott D Glenn, MSc, Nikhila Kalra, DPhil, Abaleng Lesego, MIHMEP, Gladwell K Gathecha, MS, Uzma Alam, PhD, Helen W Kiarie, MS, Isabella Wanjiku Maina, MPH, Ifedayo M O Adetifa, PhD, Hellen C Barsosio, MSc, Tizta Tilahun Degfie, PhD, Prof Peter Njenga Keiyoro, PhD, Daniel N Kiirithio, MSc, Yohannes Kinfu, PhD, Damaris K Kinyoki, PhD, James M Kisia, MD, Varsha Sarah Krish, BA, Abraham K Lagat, BS, Meghan D Mooney, BS, Wilkister Nyaora Moturi, PhD, Prof Charles Richard James Newton, MD, Josephine W Ngunjiri, Dr PHD, Molly R Nixon, PhD, David O Soti, MD, Steven Van De Vijver, PhD, Prof Gerald Yonga, MD, Prof Simon I Hay, FMedSci, Prof Christopher J L Murray, DPhil, Prof Mohsen Naghavi, MD The Lancet Global Health Volume 7, Issue 1, Pages e81-e95 (January 2019) DOI: 10.1016/S2214-109X(18)30472-8 Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 1 Annualised percentage change in all-cause mortality rates in Kenya, by sex Each coloured line represents the annualised percentage change in all-cause mortality rate for males and females across all age ranges. Shaded areas indicate 95% uncertainty intervals. Early neonatal=age 0–6 days. Late neonatal=age 7–27 days. Post neonatal=age 28–364 days. The Lancet Global Health 2019 7, e81-e95DOI: (10.1016/S2214-109X(18)30472-8) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 2 Attribution of changes in life expectancy in Kenya and its counties to changes in major groups of causes of death Periods shown are (A) 1990 to 2006, (B) 2006 to 2016, and (C) 1990 to 2016. Life expectancy is shown for both sexes. Life expectancy at the beginning of each period is indicated by a purple bar; life expectancy at the end of each period is indicated by a black bar. Counties are listed in decreasing order of life expectancy at the end of each period. The Lancet Global Health 2019 7, e81-e95DOI: (10.1016/S2214-109X(18)30472-8) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 3 Observed and expected HALE in Kenya and its counties in 1990 and 2016 Observed and expected HALEs are based on SDI for both sexes. Counties are grouped in colours by former provinces. The black line represents 1:1 observed to expected HALE. Points above the line have higher HALE than predicted by SDI; points below the line have lower HALE than predicted by SDI. HALE=healthy average life expectancy. SDI=Socio-demographic Index. The Lancet Global Health 2019 7, e81-e95DOI: (10.1016/S2214-109X(18)30472-8) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 4 Rankings of leading risk factors attributable to age-standardised DALYs in Kenya and its counties GBD level 2 risk factors in (A) 1990 and (B) 2016 are ranked from 1 (leading) to 10 or more (lowest) and are based on attributable age-standardised DALYs in both sexes. DALYs=disability-adjusted life-years. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. The Lancet Global Health 2019 7, e81-e95DOI: (10.1016/S2214-109X(18)30472-8) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 5 Age-standardised rates of DALYs in Kenyan counties in 1990 and 2016 for both sexes DALYs=disability-adjusted life-years. The Lancet Global Health 2019 7, e81-e95DOI: (10.1016/S2214-109X(18)30472-8) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 6 Annualised percentage change in HIV/AIDS-specific mortality rates for males and females Each coloured line represents the annualised percentage change in HIV/AIDS mortality for males and females across all age ranges. Shaded areas indicate 95% uncertainty intervals. Early neonatal and late neonatal are not estimated for HIV/AIDS. Post neonatal=age 28–364 days. The Lancet Global Health 2019 7, e81-e95DOI: (10.1016/S2214-109X(18)30472-8) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions

Figure 7 Age-standardised rates of YLLs and YLDs in Kenya Rates of YLLs and YLDs in 1990 and 2016 attributable to (A) lower respiratory infections and (B) diarrhoea are shown for both sexes by county. LRI=lower respiratory infection. YLD=years lived with disability. YLL=years of life lost. The Lancet Global Health 2019 7, e81-e95DOI: (10.1016/S2214-109X(18)30472-8) Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license Terms and Conditions