NIH Disease Funding Levels and Burden of Disease

Gillum, Leslie A.; Gouveia, Christopher J.; Dorsey, E. Ray; Pletcher, Mark J.; Mathers, Colin; McCulloch, Charles E.; Johnston, S. Claiborne

doi:10.1371/journal.pone.0016837

Cited by 194 publications

(213 citation statements)

References 18 publications

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“…However, in the United States, a mismatch between National Institutes of Health funding and burden of disease has persisted despite 1998 Institute of Medicine recommendations to improve funding priorities. 6,7 Many of the diseases in less developed countries have a substantial prevalence in more developed countrieswhere they are well studied, raising the question of whether the best strategy would be to apply evidence derived from trials conducted in more developed nations to populations in less developed countries and vice versa. 18 The determinants of disease as well as the contexts for prevention and treatment are sometimes similar, but other times they can be vastly different in low-and middleincome countries, limiting the adoption of recommendations developed in highincome settings.…”

Section: Discussionmentioning

confidence: 99%

“…Previous work has shown that funding from the National Institutes of Health for all patient populations in the United States is only modestly correlated with the burden of disease. 6,7 However, it is unknown how well existing pediatric clinical trials are aligned with the needs of children, both in high-income countries and globally. Clinical trials have been previously used as a proxy of clinical research activity in comparisons of research and disease burden.…”

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confidence: 99%

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Association Between Pediatric Clinical Trials and Global Burden of Disease

Bourgeois¹,

Olson

Ioannidis

et al. 2014

Pediatrics

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BACKGROUND: The allocation of research resources should favor conditions responsible for the greatest disease burden. This is particularly important in pediatric populations, which have been underrepresented in clinical research. Our aim was to measure the association between the focus of pediatric clinical trials and burden of disease and to identify neglected clinical domains. METHODS: We performed a cross-sectional study of clinical trials by using trial records in ClinicalTrials.gov. All trials started in 2006 or after and studying patient-level interventions in pediatric populations were included. Age-specific measures of disease burden were obtained for 21 separate conditions for high-, middle-, and low-income countries. We measured the correlation between number of pediatric clinical trials and disease burden for each condition. RESULTS: Neuropsychiatric conditions and infectious diseases were the most studied conditions globally in terms of number of trials (874 and 847 trials, respectively), while intentional injuries (5 trials) and maternal conditions (4 trials) were the least studied. Clinical trials were only moderately correlated with global disease burden (r = 0.58, P = .006). Correlations were also moderate within each of the country income levels, but lowest in low-income countries (r = .47, P = .03). Globally, the conditions most understudied relative to disease burden were injuries (–260 trials for unintentional injuries and –160 trials for intentional injuries), nutritional deficiencies (–175 trials), and respiratory infections (–171 trials). CONCLUSIONS: Pediatric clinical trial activity is only moderately associated with pediatric burden of disease, and least associated in low-income countries. The mismatch between clinical trials and disease burden identifies key clinical areas for focus and investment.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Association Between Pediatric Clinical Trials and Global Burden of Disease

Bourgeois¹,

Olson

Ioannidis

et al. 2014

Pediatrics

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“…This skewed resource allocation is particularly pronounced in the orthopaedic literature where increased global musculoskeletal disease and trauma in the developing world have not been met with a concomitant increase in attention or funding [2,17,30]. Research is a way to contribute lasting change in a lowresource setting and is as important as research performed in a high-resource setting.…”

Section: Introductionmentioning

confidence: 99%

What Factors Influence the Production of Orthopaedic Research in East Africa? A Qualitative Analysis of Interviews

Elliott

Sonshine

Akhavan

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Research addressing the burden of musculoskeletal disease in low-and middle-income countries does not reflect the magnitude of the epidemic in these countries as only 9% of the world's biomedical resources are devoted to addressing problems that affect the health of 90% of the world's population. Little is known regarding the barriers to and drivers of orthopaedic surgery research in such resource-poor settings, the knowledge of which would help direct specific interventions for increasing research capacity and help surgeons from high-income countries support the efforts of our colleagues in low-and middle-income countries. Purpose We sought to identify through surveying academic orthopaedic surgeons in East Africa: (1) barriers impeding research, (2) factors that support or drive research, and (3) factors that were identified by some surgeons as barriers and others as drivers (what we term barrier-driver overlap) as they considered the production of clinical research in resource-poor environments. Materials Semistructured interviews were conducted with 21 orthopaedic surgeon faculty members at four academic medical centers in Ethiopia, Kenya, Tanzania, and Uganda. Qualitative content analysis of the interviews was conducted using methods based in grounded theory. Grounded theory begins with qualitative data, such as interview transcripts, and analyzes the data for repeated ideas or concepts which then are coded and grouped into categories which allow for identification of subjects or problems that may not have been apparent previously to the interviewer. Results We identified and quantified 19 barriers to and 21 drivers of orthopaedic surgery research (mentioned n = 1688 and n = 1729, respectively). Resource, research process, and institutional domains were identified to This study was supported by private donations to the Institute for Global Orthopaedics and Traumatology (IGOT, San Francisco, CA, USA). No authors received payment or in-kind benefit for this study, nor are any authors members of a company that provided funding to IGOT. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. categorize the barriers (n = 7, n = 5, n = 7, respectively) and drivers (n = 7, n = 8, n = 6, respectively). Resource barriers (46%) were discussed more often by interview subjects compared with the research process (26%) and institutional barriers (28%). Drivers of research discussed at least once were proportionally similar across the three domains. Some themes such as research ethics boards, technology, and literature access occurred with similar frequency as barriers to and drivers of orthopaedic surgery research. Conclusions The barriers we identified most often among East African academic orthopaedic faculty members focused on resources to accomplish research, followed by institutional barriers, and method or process ba...

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“…Although there is growing interest in the investigation of multidimensional effects of COPD, there has been little research addressing the impact of COPD on disability (30). Disability, or even its descriptors such as ADLs or IADLs, is an infrequent outcome in COPD studies (31), and representative national data have rarely been used to test the impact of COPD on any form of disability (11).…”

Section: Discussionmentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease, Cognitive Impairment, and Development of Disability: The Health and Retirement Study

et al. 2014

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Rationale: The relationship between chronic obstructive pulmonary disease (COPD) and cognitive impairment in leading to disability has not been characterized.Objectives: We aimed to investigate the prevalence and cumulative incidence of disability among adults with and without COPD and the association of COPD and cognitive impairment with disability. Methods:We analyzed 2006-2008 waves of the Health and Retirement Study, a nationally representative longitudinal health survey. COPD was self-reported. Prevalent disability was defined as baseline dependency in one or more activities of daily living (ADLs) and incident disability as one or more additional ADL dependencies. We used a validated performance-based measure of cognition to identify dementia and mild cognitive impairment. Covariates included seven chronic diseases, four geriatric syndromes, and sociodemographics. We used logistic regression to test associations between COPD, cognitive status, and prevalent/incident disability.Measurements and Main Results: Of 17,535 participants at least 53 years of age in wave 2006 (representing 77.7 million Americans), 9.5% reported COPD and 13.5% mild cognitive impairment; 17.5% of those with COPD had mild cognitive impairment. Prevalent disability for COPD was 12.8% (5.2% for no-COPD, P , 0.001). An additional 9.2% with COPD developed incident disability at 2 years (4.0% for no-COPD, P , 0.001). In adjusted models, COPD was associated with baseline (odds ratio, 2.0) and incident disability (odds ratio, 2.1; adjusted for baseline disability). Cognitive impairment had an additive effect to COPD. The COPD-disability association, prevalent/incident, was of similar or greater magnitude than that of other chronic diseases (e.g., stroke, diabetes). The associations were maintained in sensitivity analyses using alternative definitions of disability (dependency in two or more ADLs, dependency in instrumental ADLs), and in analysis excluding respondents with dementia.Conclusions: Both COPD and mild cognitive impairment increase the risk of disability. The risk conferred by COPD is significant and similar or higher than other chronic diseases.

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NIH Disease Funding Levels and Burden of Disease

Cited by 194 publications

References 18 publications

Association Between Pediatric Clinical Trials and Global Burden of Disease

Association Between Pediatric Clinical Trials and Global Burden of Disease

What Factors Influence the Production of Orthopaedic Research in East Africa? A Qualitative Analysis of Interviews

Chronic Obstructive Pulmonary Disease, Cognitive Impairment, and Development of Disability: The Health and Retirement Study

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