Browsing by Author "Juan Manuel Acuna"

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Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
(Elsevier B.V., 2025) Simon I. Hay; Kanyin Liane Ong; Damian Francesco Santomauro; A. Bhoomadevi; Mohammad Amin Aalipour; Hasan Abualruz; Hazim S. Ababneh; Ukachukwu Okoroafor Abaraogu; Biruk Beletew Abate; Cristiana Abbafati; Nasir Abbas; Mitra Abbasifard; Mohsen Abbasi-Kangevari; Samar Abd ElHafeez; Ashraf N. Abdalla; Mohammed Altigani Abdalla; Emad M. Abdallah; Barkhad Aden Abdeeq; Nadin M. Abdel Razeq; Ahmed Abdelrahman Abdelgalil; Reda S. Abdel-Hameed; Michael Abdelmasseh; Mahmoud Hassan Abdelnabi; Wael M. Abdel-Rahman; Sherief M. Abd-Elsalam; Sepideh Abdi; Mohammad Abdollahi; Meriem Abdoun; Arman Abdous; Jeza Muhamad Abdul Aziz; Deldar Morad Abdulah; Rizwan Suliankatchi Abdulkader; Adam Ibrahim Abdullahi; Auwal S. Abdullahi; Toufik Abdul-Rahman; Kulmira Abdykerimova; Habtamu Abebe Getahun; Aidin Abedi; Armita Abedi; Asrat Agalu Abejew; Roberto Ariel Abeldaño Zuñiga; E. S. Abhilash; Shehab Uddin Al Abid; Syed Hani Abidi; Alemwork Abie; Olugbenga Olusola Abiodun; Olumide A. Abiodun; Richard Gyan Aboagye; Shady M. Abohashem; Hassan Abolhassani; Ulric Sena Abonie; Nagah M. Abourashed; Mohamed Riad Abouzid; Dmitry Abramov; Lucas Guimarães Abreu; Dariush Abtahi; Rana K. Abu Farha; Fuad Hamdi Abuadas; Aminu Kende Abubakar; Bilyaminu Abubakar; Eman F. Abu-Gharbieh; Sawsan Hammad Abuhammad; Ahmad Yousef Abuhelwa; Hana J. Abukhadijah; Niveen M.E. Abu-Rmeileh; Salahdein Aburuz; Dina Hamdi Abushanab; Raghu Ram Achar; Anirudh B. Acharya; Apurba Acharya; Ilana N. Ackerman; Juan Manuel Acuna; Ousman Adal; Lisa Christine Adams; Lawan H. Adamu; Mesafint Molla Adane; Zenaw Debasu Addisu; Isaac Yeboah Addo; Oluwafemi Atanda Adeagbo; Tajudeen Adesanmi Adebisi; Isaac Akinkunmi Adedeji; David Adedia; Kamoru A. Adedokun; Rufus A. Adedoyin; Oluwatobi E. Adegbile; Oyelola Abdulwasiu Adegboye; Nurudeen A. Adegoke; Olumide Thomas Adeleke; Isaac A. Adesina; Miracle Ayomikun Adesina; Habeeb Omoponle Adewuyi; Temitayo Esther Adeyeoluwa; Olorunsola I. Adeyomoye; Kishor Adhikari; Ripon Kumar Adhikary; Usha Sachidananda Adiga; Mohd Adnan; Qorinah Estiningtyas Sakilah Adnani; Prince Owusu Adoma; Leticia Akua Adzigbli
Background For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. Methods The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010–23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Findings Total numbers of global DALYs grew 6·1% (95% UI 4·0–8·1), from 2·64 billion (2·46–2·86) in 2010 to 2·80 billion (2·57–3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0–14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31–1·61) global DALYs in 2010, increasing to 1·80 billion (1·63–2·03) in 2023, alongside a concurrent 4·1% (1·9–6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176–209] DALYs), stroke (157 million [141–172]), and diabetes (90·2 million [75·2–107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0–107·5]), depressive disorders (26·3% [11·6–42·9]), and diabetes (14·9% [7·5–25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837–917) in 2010 to 681 million (642–736) in 2023, and a 25·8% (22·6–28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7–61·0) for diarrhoeal diseases, 42·9% (38·0–48·0) for HIV/AIDS, and 42·2% (23·6–56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6–22·0) and 24·8% (7·4–36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7–19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18–1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation—with high SBP accounting for 8·4% (6·9–10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories—behavioural, metabolic, and environmental and occupational—risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8–37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0–11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023—eg, declining by 54·4% (38·7–65·3) for unsafe sanitation, 50·5% (33·3–63·1) for unsafe water source, and 45·2% (25·6–72·0) for no access to handwashing facility, and by 44·9% (37·3–53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [–2·7 to 15·6]; non-significant). Interpretation Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors—eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG—including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic—the complex interaction of multiple health risks, social determinants, and systemic challenges—will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Funding Gates Foundation and Bloomberg Philanthropies. © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
(Elsevier B.V., 2024) Austin E. Schumacher; Hmwe Hmwe Kyu; Amirali Aali; Cristiana Abbafati; Jaffar Abbas; Rouzbeh Abbasgholizadeh; Madineh Akram Abbasi; Mohammadreza Abbasian; Samar Abd ElHafeez; Michael Abdelmasseh; Sherief Abd-Elsalam; Ahmed Abdelwahab; Mohammad Abdollahi; Meriem Abdoun; Auwal Abdullahi; Ame Mehadi Abdurehman; Mesfin Abebe; Aidin Abedi; Armita Abedi; Tadesse M. Abegaz; Roberto Ariel Abeldaño Zuñiga; E.S. Abhilash; Olugbenga Olusola Abiodun; Richard Gyan Aboagye; Hassan Abolhassani; Mohamed Abouzid; Lucas Guimarães Abreu; Woldu Aberhe Abrha; Michael R.M. Abrigo; Dariush Abtahi; Samir Abu Rumeileh; Niveen M.E. Abu-Rmeileh; Salahdein Aburuz; Ahmed Abu-Zaid; Juan Manuel Acuna; Tim Adair; Isaac Yeboah Addo; Oladimeji M. Adebayo; Oyelola A. Adegboye; Victor Adekanmbi; Bashir Aden; Abiola Victor Adepoju; Charles Oluwaseun Adetunji; Temitayo Esther Adeyeoluwa; Olorunsola Israel Adeyomoye; Rishan Adha; Amin Adibi; Wirawan Adikusuma; Qorinah Estiningtyas Sakilah Adnani; Saryia Adra; Abel Afework; Aanuoluwapo Adeyimika Afolabi; Ali Afraz; Shadi Afyouni; Saira Afzal; Pradyumna Agasthi; Shahin Aghamiri; Antonella Agodi; Williams Agyemang-Duah; Bright Opoku Ahinkorah; Aqeel Ahmad; Danish Ahmad; Firdos Ahmad; Muayyad M. Ahmad; Tauseef Ahmad; Keivan Ahmadi; Amir Mahmoud Ahmadzade; Mohadese Ahmadzade; Ayman Ahmed; Haroon Ahmed; Luai A. Ahmed; Muktar Beshir Ahmed; Syed Anees Ahmed; Marjan Ajami; Budi Aji; Olufemi Ajumobi; Gizachew Taddesse Akalu; Essona Matatom Akara; Karolina Akinosoglou; Sreelatha Akkala; Samuel Akyirem; Hanadi Al Hamad; Syed Mahfuz Al Hasan; Ammar Al Homsi; Mohammad Al Qadire; Moein Ala; Timothy Olukunle Aladelusi; Tareq Mohammed Ali Al-Ahdal; Samer O. Alalalmeh; Ziyad Al-Aly; Khurshid Alam; Manjurul Alam; Zufishan Alam; Rasmieh Mustafa Al-Amer; Fahad Mashhour Alanezi; Turki M. Alanzi; Mohammed Albashtawy; Mohammad T. AlBataineh; Robert W. Aldridge; Sharifullah Alemi; Ayman Al-Eyadhy; Adel Ali Saeed Al-Gheethi; Khalid F. Alhabib; Fadwa Alhalaiqa Naji Alhalaiqa; Mohammed Khaled Al-Hanawi; Abid Ali; Akhtar Ali; Beriwan Abdulqadir Ali; Hassam Ali; Mohammed Usman Ali; Rafat Ali; Syed Shujait Shujait Ali; Zahid Ali; Shohreh Alian Samakkhah; Gianfranco Alicandro; Sheikh Mohammad Alif; Mohammad Aligol; Rasoul Alimi; Ahmednur Adem Aliyi; Adel Al-Jumaily; Syed Mohamed Aljunid; Wael Almahmeed; Sabah Al-Marwani; Sadeq Ali Ali Al-Maweri; Joseph Uy Almazan; Hesham M. Al-Mekhlafi; Omar Almidani; Mahmoud A. Alomari; Nivaldo Alonso; Jaber S. Alqahtani; Ahmed Yaseen Alqutaibi; Salman Khalifah Al-Sabah; Awais Altaf; Jaffar A. Al-Tawfiq; Khalid A. Altirkawi; Farrukh Jawad Alvi; Hassan Alwafi; Yaser Mohammed Al-Worafi; Hany Aly; Karem H. Alzoubi; Azmeraw T. Amare; Edward Kwabena Ameyaw; Abebe Feyissa Amhare; Tarek Tawfik Amin; Alireza Amindarolzarbi; Javad Aminian Dehkordi; Sohrab Amiri; Hubert Amu; Dickson A. Amugsi; Jimoh Amzat; Robert Ancuceanu; Deanna Anderlini; Pedro Prata Andrade; Catalina Liliana Andrei; Tudorel Andrei; Dhanalakshmi Angappan; Abhishek Anil; Afifa Anjum; Catherine M. Antony; Ernoiz Antriyandarti; Iyadunni Adesola Anuoluwa; Sumadi Lukman Anwar; Anayochukwu Edward Anyasodor; Seth Christopher Yaw Appiah; Muhammad Aqeel; Jalal Arabloo; Razman Arabzadeh Bahri; Morteza Arab-Zozani; Mosab Arafat; Ana Margarida Araújo; Aleksandr Y. Aravkin; Abdulfatai Aremu; Hany Ariffin; Timur Aripov; Benedetta Armocida; Mahwish Arooj; Anton A. Artamonov; Kurnia Dwi Artanti; Judie Arulappan; Idowu Thomas Aruleba; Raphael Taiwo Aruleba; Ashokan Arumugam; Malke Asaad; Saeed Asgary; Mubarek Yesse Ashemo; Muhammad Ashraf; Marvellous O. Asika; Seyyed Shamsadin Athari; Maha Moh'd Wahbi Atout; Alok Atreya; Sameh Attia; Avinash Aujayeb; Abolfazl Avan; Adedapo Wasiu Awotidebe; Beatriz Paulina Ayala Quintanilla; Martin Amogre Ayanore; Getnet Melaku Ayele; Jose L. Ayuso-Mateos; Seyed Mohammad Ayyoubzadeh; Sina Azadnajafabad; Gulrez Shah Azhar; Shahkaar Aziz; Ahmed Y. Azzam; Mina Babashahi; Abraham Samuel Babu; Muhammad Badar; Alaa Badawi; Ashish D. Badiye; Soroush Baghdadi; Nasser Bagheri; Sara Bagherieh; Sulaiman Bah; Saeed Bahadorikhalili; Jianjun Bai; Ruhai Bai; Jennifer L. Baker; Shankar M. Bakkannavar; Abdulaziz T. Bako; Senthilkumar Balakrishnan; Saliu A. Balogun; Ovidiu Constantin Baltatu; Kiran Bam; Maciej Banach; Soham Bandyopadhyay; Biswajit Banik; Palash Chandra Banik; Hansi Bansal; Shirin Barati; Martina Barchitta; Mainak Bardhan; Suzanne Lyn Barker-Collo; Francesco Barone-Adesi; Hiba Jawdat Barqawi; Ronald D. Barr; Lope H. Barrero; Zarrin Basharat; Asma'u I.J. Bashir; Hameed Akande Bashiru; Pritish Baskaran; Buddha Basnyat; Quique Bassat; João Diogo Basso; Saurav Basu; Kavita Batra; Ravi Batra; Bernhard T. Baune; Mohsen Bayati; Nebiyou Simegnew Bayileyegn; Thomas Beaney; Neeraj Bedi; Tahmina Begum; Emad Behboudi; Amir Hossein Behnoush; Maryam Beiranvand; Diana Fernanda Bejarano Ramirez; Uzma Iqbal Belgaumi; Michelle L. Bell; Aminu K. Bello; Muhammad Bashir Bello; Olorunjuwon Omolaja Bello; Luis Belo; Apostolos Beloukas; Salaheddine Bendak; Derrick A. Bennett; Isabela M. Bensenor; Habib Benzian; Zombor Berezvai; Adam E. Berman; Amiel Nazer C. Bermudez; Paulo J.G. Bettencourt; Habtamu B. Beyene; Kebede A. Beyene; Devidas S. Bhagat; Akshaya Srikanth Bhagavathula; Neeraj Bhala; Ashish Bhalla; Dinesh Bhandari; Nikha Bhardwaj; Pankaj Bhardwaj; Prarthna V. Bhardwaj; Ashish Bhargava; Sonu Bhaskar; Vivek Bhat; Gurjit Kaur Bhatti; Jasvinder Singh Bhatti; Manpreet S. Bhatti; Rajbir Bhatti; Zulfiqar A. Bhutta; Boris Bikbov; Nada Binmadi; Bagas Suryo Bintoro; Antonio Biondi; Catherine Bisignano; Francesca Bisulli; Atanu Biswas; Raaj Kishore Biswas; Saeid Bitaraf; Tone Bjørge; Archie Bleyer; Mary Sefa Boampong; Virginia Bodolica; Aadam Olalekan Bodunrin; Obasanjo Afolabi Bolarinwa; Milad Bonakdar Hashemi; Aime Bonny; Kaustubh Bora; Berrak Bora Basara; Safiya Bala Borodo; Rohan Borschmann; Alejandro Botero Carvajal; Souad Bouaoud; Sofiane Boudalia; Edward J. Boyko; Nicola Luigi Bragazzi; Dejana Braithwaite; Hermann Brenner; Gabrielle Britton; Annie J. Browne; Andre R. Brunoni; Norma B. Bulamu; Lemma N. Bulto; Danilo Buonsenso; Katrin Burkart; Richard A. Burns; Sharath Burugina Nagaraja; Reinhard Busse; Yasser Bustanji; Zahid A. Butt; Florentino Luciano Caetano Dos Santos; Tianji Cai; Daniela Calina; Luis Alberto Cámera; Luciana Aparecida Campos; Ismael R. Campos-Nonato; Chao Cao; Carlos Alberto Cardenas; Rosario Cárdenas; Sinclair Carr; Giulia Carreras; Juan J. Carrero; Andrea Carugno; Felix Carvalho; Márcia Carvalho; Joao Mauricio Castaldelli-Maia; Carlos A. Castañeda-Orjuela; Giulio Castelpietra; Ferrán Catalá-López; Alberico L. Catapano; Maria Sofia Cattaruzza; Arthur Caye; Christopher R. Cederroth; Francieli Cembranel; Muthia Cenderadewi; Kelly M. Cercy; Ester Cerin; Muge Cevik; Pamela R. Chacón-Uscamaita; Yaacoub Chahine; Chiranjib Chakraborty; Jeffrey Shi Kai Chan; Chin-Kuo Chang; Periklis Charalampous; Jaykaran Charan; Vijay Kumar Chattu; Victoria Chatzimavridou-Grigoriadou; Malizgani Paul Chavula; Huzaifa Ahmad Cheema; An-Tian Chen; Haowei Chen; Lingxiao Chen; Meng Xuan Chen; Simiao Chen; Nicolas Cherbuin; Derek S. Chew; Gerald Chi; Jesus Lorenzo Chirinos-Caceres; Abdulaal Chitheer; So Mi Jemma Cho; William C.S. Cho; Bryan Chong; Hitesh Chopra; Rahul Choudhary; Rajiv Chowdhury; Dinh-Toi Chu; Isaac Sunday Chukwu; Eric Chung; Eunice Chung; Sheng-Chia Chung; Karly I. Cini; Cain C.T. Clark; Kaleb Coberly; Alyssa Columbus; Haley Comfort; Joao Conde; Sara Conti; Paolo Angelo Cortesi; Vera Marisa Costa; Ewerton Cousin; Richard G. Cowden; Michael H. Criqui; Natália Cruz-Martins; Garland T. Culbreth; Patricia Cullen; Matthew Cunningham; Daniel da Silva E Silva; Sriharsha Dadana; Omid Dadras; Zhaoli Dai; Koustuv Dalal; Lachlan L. Dalli; Giovanni Damiani; Emanuele D'Amico; Sara Daneshvar; Aso Mohammad Darwesh; Jai K. Das; Saswati Das; Nihar Ranjan Dash; Mohsen Dashti; Claudio Alberto Dávila-Cervantes; Nicole Davis Weaver; Kairat Davletov; Diego De Leo; Aklilu Tamire Debele; Louisa Degenhardt; Reza Dehbandi; Lee Deitesfeld; Ivan Delgado-Enciso; Laura Delgado-Ortiz; Daniel Demant; Berecha Hundessa Demessa; Andreas K. Demetriades; Xinlei Deng; Edgar Denova-Gutiérrez; Kebede Deribe; Nikolaos Dervenis; Don C. Des Jarlais; Hardik Dineshbhai Desai; Rupak Desai; Keshab Deuba; Vinoth Gnana Chellaiyan Devanbu; Sourav Dey; Arkadeep Dhali; Kuldeep Dhama; Mandira Lamichhane Dhimal; Meghnath Dhimal; Sameer Dhingra; Diana Dias Da Silva; Daniel Diaz; Adriana Dima; Delaney D. Ding; M. Ashworth Dirac; Abhinav Dixit; Shilpi Gupta Dixit; Thanh Chi Do; Thao Huynh Phuong Do; Camila Bruneli Do Prado; Masoud Dodangeh; Klara Georgieva Dokova; Christiane Dolecek; E Ray Dorsey; Wendel Mombaque dos Santos; Rajkumar Doshi; Leila Doshmangir; Abdel Douiri; Robert Kokou Dowou; Tim Robert Driscoll; Haneil Larson Dsouza; John Dube; Samuel C. Dumith; Susanna J. Dunachie; Bruce B. Duncan; Andre Rodrigues Duraes; Senbagam Duraisamy; Oyewole Christopher Durojaiye; Sulagna Dutta; Paulina Agnieszka Dzianach; Arkadiusz Marian Dziedzic; Oluwakemi Ebenezer; Ejemai Eboreime; Alireza Ebrahimi; Chidiebere Peter Echieh; Abdelaziz Ed-Dra; Hisham Atan Edinur; David Edvardsson; Kristina Edvardsson; Defi Efendi; Ferry Efendi; Shayan Eghdami; Terje Andreas Eikemo; Ebrahim Eini; Michael Ekholuenetale; Emmanuel Ekpor; Temitope Cyrus Ekundayo; Rabie Adel El Arab; Doaa Abdel Wahab El Morsi; Maysaa El Sayed Zaki; Maha El Tantawi; Iffat Elbarazi; Noha Mousaad Elemam; Frank J. Elgar; Islam Y. Elgendy; Ghada Metwally Tawfik ElGohary; Hala Rashad Elhabashy; Muhammed Elhadi; Omar Abdelsadek Abdou Elmeligy; Mohammed Elshaer; Ibrahim Elsohaby; Amir Emami Zeydi; Mehdi Emamverdi; Theophilus I. Emeto; Luchuo Engelbert Bain; Ryenchindorj Erkhembayar; Tesfahun C. Eshetie; Sharareh Eskandarieh; Juan Espinosa-Montero; Kara Estep; Farshid Etaee; Ugochukwu Anthony Eze; Natalia Fabin; Adewale Oluwaseun Fadaka; Adeniyi Francis Fagbamigbe; Saman Fahimi; Luca Falzone; Carla Sofia E Sá Farinha; MoezAlIslam Ezzat Mahmoud Faris; Mohsen Farjoud Kouhanjani; Andre Faro; Hossein Farrokhpour; Ali Fatehizadeh; Hamed Fattahi; Nelsensius Klau Fauk; Pooria Fazeli; Valery L. Feigin; Ginenus Fekadu; Seyed-Mohammad Fereshtehnejad; Abdullah Hamid Feroze; Daniela Ferrante; Pietro Ferrara; Nuno Ferreira; Getahun Fetensa; Irina Filip; Florian Fischer; Joanne Flavel; Abraham D. Flaxman; Luisa S. Flor; Bobirca Teodor Florin; Morenike Oluwatoyin Folayan; Kristen Marie Foley; Artem Alekseevich Fomenkov; Lisa M. Force; Carla Fornari; Behzad Foroutan; Matteo Foschi; Kate Louise Francis; Richard Charles Franklin; Alberto Freitas; Joseph Friedman; Sara D. Friedman; Takeshi Fukumoto; John E. Fuller; Peter Andras Gaal; Muktar A. Gadanya; Santosh Gaihre; Abduzhappar Gaipov; Emmanuela Gakidou; Yaseen Galali; Nasrin Galehdar; Silvano Gallus; Quan Gan; Aravind P. Gandhi; Balasankar Ganesan; Jalaj Garg; Shuo-Yan Gau; Prem Gautam; Rupesh K. Gautam; Federica Gazzelloni; Miglas W. Gebregergis; Mesfin Gebrehiwot; Tesfay Brhane Gebremariam; Urge Gerema; Motuma Erena Getachew; Tamirat Getachew; Peter W. Gething; Mansour Ghafourifard; Sulmaz Ghahramani; Khalid Yaser Ghailan; Alireza Ghajar; Mohammad Javad Ghanbarnia; MohammadReza Ghasemi; Afsaneh Ghasemzadeh; Fariba Ghassemi; Ramy Mohamed Ghazy; Sailaja Ghimire; Asadollah Gholamian; Ali Gholamrezanezhad; Pooyan Ghorbani Vajargah; Ghozali Ghozali; Sherief Ghozy; Arun Digambarrao Ghuge; Alessandro Gialluisi; Ruth Margaret Gibson; Artyom Urievich Gil; Paramjit Singh Gill; Tiffany K. Gill; Richard F. Gillum; Themba G. Ginindza; Alem Girmay; James C. Glasbey; Elena V. Gnedovskaya; Laszlo Göbölös; Amit Goel; Mohamad Goldust; Mahaveer Golechha; Pouya Goleij; Arefeh Golestanfar; Davide Golinelli; Philimon N. Gona; Houman Goudarzi; Amir Hossein Goudarzian; Anmol Goyal; Scott Greenhalgh; Michal Grivna; Giovanni Guarducci; Mohammed Ibrahim Mohialdeen Gubari; Mesay Dechasa Gudeta; Avirup Guha; Stefano Guicciardi; Damitha Asanga Gunawardane; Sasidhar Gunturu; Cui Guo; Anish Kumar Gupta; Bhawna Gupta; Indarchand Ratanlal Gupta; Rajat Das Gupta; Sapna Gupta; Veer Bala Gupta; Vijai Kumar Gupta; Vivek Kumar Gupta; Reyna Alma Gutiérrez; Farrokh Habibzadeh; Parham Habibzadeh; Vladimir Hachinski; Mohammad Haddadi; Rasool Haddadi; Nils Haep; Adel Hajj Ali; Esam S. Halboub; Sobia Ahsan Halim; Brian J. Hall; Sebastian Haller; Rabih Halwani; Randah R. Hamadeh; Kanaan Hamagharib Abdullah; Samer Hamidi; Mohammad Hamiduzzaman; Ahmad Hammoud; Nasrin Hanifi; Graeme J. Hankey; Md Abdul Hannan; Md Nuruzzaman Haque; Harapan Harapan; Josep Maria Haro; Ahmed I. Hasaballah; Faizul Hasan; Ikramul Hasan; M Tasdik Hasan; Hamidreza Hasani; Mohammad Hasanian; Ali Hasanpour-Dehkordi; Abbas M. Hassan; Amr Hassan; Hossein Hassanian-Moghaddam; Soheil Hassanipour; Johannes Haubold; Rasmus J. Havmoeller; Simon I. Hay; Youssef Hbid; Jeffrey J. Hebert; Omar E. Hegazi; Golnaz Heidari; Mohammad Heidari; Mahsa Heidari-Foroozan; Reza Heidari-Soureshjani; Bartosz Helfer; Claudiu Herteliu; Hamed Hesami; Dineshani Hettiarachchi; Demisu Zenbaba Heyi; Kamal Hezam; Yuta Hiraike; Howard J. Hoffman; Ramesh Holla; Nobuyuki Horita; Md Belal Hossain; Md Mahbub Hossain; Sahadat Hossain; Mohammad-Salar Hosseini; Hassan Hosseinzadeh; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mohamed Hsairi; Vivian Chia-Rong Hsieh; Chengxi Hu; Junjie Huang; Md Nazmul Huda; Fernando N. Hugo; Michael Hultström; Javid Hussain; Salman Hussain; Nawfal R. Hussein; Le Duc Huy; Hong-Han Huynh; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Oluwatope Olaniyi Idowu; Desta Ijo; Kevin S. 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Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019
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Khan; Moawiah Mohammad Khatatbeh; Mona M Khater; Hamid Reza Khayat Kashani; Jagdish Khubchandani; Hanna Kim; Min Seo Kim; Ruth W Kimokoti; Niranjan Kissoon; Sonali Kochhar; Farzad Kompani; Soewarta Kosen; Parvaiz A Koul; Sindhura Lakshmi Koulmane Laxminarayana; Fiorella Krapp Lopez; Kewal Krishan; Vijay Krishnamoorthy; Vishnutheertha Kulkarni; Naveen Kumar; Om P Kurmi; Ambily Kuttikkattu; Hmwe Hmwe Kyu; Dharmesh Kumar Lal; Judit Lám; Iván Landires; Savita Lasrado; Sang-Woong Lee; Jacopo Lenzi; Sonia Lewycka; Shanshan Li; Stephen S Lim; Wei Liu; Rakesh Lodha; Michael J Loftus; Ayush Lohiya; Lászl Lorenzovici; Mojgan Lotfi; Ata Mahmoodpoor; Mansour Adam Mahmoud; Razzagh Mahmoudi; Azeem Majeed; Jamal Majidpoor; Alaa Makki; Galana Ayana Mamo; Yosef Manla; Miquel Martorell; Clara N Matei; Barney Mcmanigal; Entezar Mehrabi Nasab; Ravi Mehrotra; Addisu Melese; Oliver Mendoza-Cano; Ritesh G Menezes; Alexios-Fotios A Mentis; Georgia Micha; Irmina Maria Michalek; Ana Carolina Micheletti Gomide Nogueira Des; Neda Milevska Kostova; Shabir Ahmad Mir; Mojgan Mirghafourvand; Seyyedmohammadsadeq Mirmoeeni; Erkin M Mirrakhimov; Mohammad Mirza-Aghazadeh-attari; Abay Sisay Misganaw; Awoke Misganaw; Sanjeev Misra; Esmaeil Mohammadi; Mokhtar Mohammadi; Abdollah Mohammadian-Hafshejani; Shafiu Mohammed; Syam Mohan; Mohammad Mohseni; Ali H Mokdad; Sara Momtazmanesh; Lorenzo Monasta; Catrin E Moore; Maryam Moradi; Mostafa Moradi Sarabi; Shane Douglas Morrison; Majid Motaghinejad; Haleh Mousavi Isfahani; Amin Mousavi Khaneghah; Seyed Ali Mousavi-Aghdas; Sumaira Mubarik; Francesk Mulita; Getaneh Baye B Mulu; Sandra B Munro; Saravanan Muthupandian; Tapas Sadasivan Nair; Atta Abbas Naqvi; Himanshi Narang; Zuhair S Natto; Muhammad Naveed; Biswa Prakash Nayak; Shumaila Naz; Ionut Negoi; Seyed Aria Nejadghaderi; Sandhya Neupane Kandel; Che Henry Ngwa; Robina Khan Niazi; Antonio Tolentino Nogueira Des; Nafise Noroozi; Hasti Nouraei; Ali Nowroozi; Virginia Nuñez-Samudio; Jerry John Nutor; Chimezie Igwegbe Nzoputam; Ogochukwu Janet Nzoputam; Bogdan Oancea; Rahman Md Obaidur; Vivek Anand Ojha; Akinkunmi Paul Okekunle; Osaretin Christabel Okonji; Andrew T Olagunju; Bolajoko Olubukunola Olusanya; Ahmed Omar Bali; Emad Omer; Nikita Otstavnov; Bilcha Oumer; Jagadish Rao Padubidri; Keyvan Pakshir; Tamás Palicz; Adrian Pana; Shahina Pardhan; Jose L Paredes; Utsav Parekh; Eun-Cheol Park; Seoyeon Park; Ashish Pathak; Rajan Paudel; Uttam Paudel; Shrikant Pawar; Hamidreza Pazoki Toroudi; Minjin Peng; Umberto Pensato; Veincent Christian Filipino Pepito; Marcos Pereira; Mario F P Peres; Norberto Perico; Ionela-Roxana Petcu; Zahra Zahid Piracha; Indrashis Podder; Nayanum Pokhrel; Ramesh Poluru; Maarten J Postma; Naeimeh Pourtaheri; Akila Prashant; Ibrahim Qattea; Mohammad Rabiee; Navid Rabiee; Amir Radfar; Saber Raeghi; Sima Rafiei; Pankaja Raghav Raghav; Leila Rahbarnia; Vafa Rahimi-Movaghar; Mosiur Rahman; Muhammad Aziz Rahman; Amir Masoud Rahmani; Vahid Rahmanian; Pradhum Ram; Muhammad Modassar Ali Nawaz Ranjha; Sowmya J Rao; Mohammad-Mahdi Rashidi; Azad Rasul; Zubair Ahmed Ratan; Salman Rawaf; Reza Rawassizadeh; Mohammad Sadegh Razeghinia; Elrashdy Moustafa Mohamed Redwan; Misganu Teshoma Regasa; Giuseppe Remuzzi; Melese Abate Reta; Nazila Rezaei; Aziz Rezapour; Abanoub Riad; Rezaul Karim Ripon; Kristina E Rudd; Basema Saddik; Saeid Sadeghian; Umar Saeed; Mohsen Safaei; Azam Safary; Sher Zaman Safi; Maryam Sahebazzamani; Amirhossein Sahebkar; Harihar Sahoo; Saina Salahi; Sarvenaz Salahi; Hedayat Salari; Sana Salehi; Hossein Samadi Kafil; Abdallah M Samy; Nima Sanadgol; Senthilkumar Sankararaman; Francesco Sanmarchi; Brijesh Sathian; Monika Sawhney; Ganesh Kumar Saya; Subramanian Senthilkumaran; Allen Seylani; Pritik A Shah; Masood Ali Shaikh; Elaheh Shaker; Murad Ziyaudinovich Shakhmardanov; Mequannent Melaku Sharew; Athena Sharifi-Razavi; Purva Sharma; Rahim Ali Sheikhi; Ali Sheikhy; Pavanchand H Shetty; Mika Shigematsu; Jae Il Shin; Hesamaddin Shirzad-Aski; K.M. Shivakumar; Parnian Shobeiri; Seyed Afshin Shorofi; Sunil Shrestha; Migbar Mekonnen Sibhat; Negussie Boti Sidemo; Mustafa Kamal Sikder; Luís Manuel Lopes Rodrigues Silva; Jasvinder A Singh; Paramdeep Singh; Surjit Singh; Md Shahjahan Siraj; Samarjeet Singh Siwal; Valentin Yurievich Skryabin; Anna Aleksandrovna Skryabina; Bogdan Socea; Damtew Damtew Solomon; Yimeng Song; Chandrashekhar T Sreeramareddy; Muhammad Suleman; Rizwan Suliankatchi Abdulkader; Saima Sultana; Miklós Szócska; Seyed-Amir Tabatabaeizadeh; Mohammad Tabish; Majid Taheri; Elahe Taki; Ker-Kan Tan; Sarmila Tandukar; Nathan Y Tat; Vivian Y Tat; Belay Negash Tefera; Yibekal Manaye Tefera; Gebremaryam Temesgen; Mohamad-Hani Temsah; Samar Tharwat; Arulmani Thiyagarajan; Imad I Tleyjeh; Christopher E Troeger; Krishna Kishore Umapathi; Era Upadhyay; Sahel Valadan Tahbaz; Pascual R Valdez; Jef Van Den Eynde; H Rogier Van Doorn; Siavash Vaziri; Georgios-Ioannis Verras; Harimadhav Viswanathan; Bay Vo; Abdul Waris; Gizachew Tadesse Wassie; Nuwan Darshana Wickramasinghe; Sajad Yaghoubi; Gahin Abdulraheem Tayib Yahya Yahya; Seyed Hossein Yahyazadeh Jabbari; Arzu Yigit; Vahit Yigit; Dong Keon Yon; Naohiro Yonemoto; Mazyar Zahir; Burhan Abdullah Zaman; Sojib Bin Zaman; Moein Zangiabadian; Iman Zare; Mikhail Sergeevich Zastrozhin; Zhi-Jiang Zhang; Peng Zheng; Chenwen Zhong; Mohammad Zoladl; Alimuddin Zumla; Simon I Hay; Christiane Dolecek; Benn Sartorius; Christopher J L Murray; Mohsen Naghavi
Background: Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods: We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. Findings: From an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2–18·1) of all global deaths and 56·2% (52·1–60·1) of all sepsis-related deaths in 2019. Five leading pathogens—Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa—were responsible for 54·9% (52·9–56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185–285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4–71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation: The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. Funding: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
(Elsevier Ltd, 2022) Rajesh Sharma; Mohsen Abbasi-Kangevari; Rami Abd-Rabu; Hassan Abidi; Eman Abu-Gharbieh; Juan Manuel Acuna; Sangeet Adhikari; Shailesh M. Advani; Muhammad Sohail Afzal; Mohamad Aghaie Meybodi; Bright Opoku Ahinkorah; Sajjad Ahmad; Ali Ahmadi; Sepideh Ahmadi; Haroon Ahmed; Luai A. Ahmed; Muktar Beshir Ahmed; Hanadi Al Hamad; Fares Alahdab; Fahad Mashhour Alanezi; Turki M. Alanzi; Fadwa Alhalaiqa Naji Alhalaiqa; Yousef Alimohamadi; Vahid Alipour; Syed Mohamed Aljunid; Motasem Alkhayyat; Sami Almustanyir; Rajaa M. Al-Raddadi; Saba Alvand; Nelson Alvis-Guzman; Saeed Amini; Robert Ancuceanu; Amir Anoushiravani; Ali Arash Anoushirvani; Alireza Ansari-Moghaddam; Jalal Arabloo; Armin Aryannejad; Mohammad Asghari Jafarabadi; Seyyed Shamsadin Athari; Floriane Ausloos; Marcel Ausloos; Atalel Fentahun Awedew; Mamaru Ayenew Awoke; Tegegn Mulatu Ayana; Sina Azadnajafabad; Hiva Azami; Mohammadreza Azangou-Khyavy; Amirhossein Azari Jafari; Ashish D. Badiye; Sara Bagherieh; Saeed Bahadory; Atif Amin Baig; Jennifer L. Baker; Maciej Banach; Amadou Barrow; Alemshet Yirga Berhie; Sima Besharat; Devidas S. Bhagat; Akshaya Srikanth Bhagavathula; Neeraj Bhala; Krittika Bhattacharyya; Vijayalakshmi S. Bhojaraja; Sadia Bibi; Ali Bijani; Antonio Biondi; Tone Bjørge; Belay Boda Abule Bodicha; Dejana Braithwaite; Hermann Brenner; Daniela Calina; Chao Cao; Yin Cao; Giulia Carreras; Felix Carvalho; Ester Cerin; Raja Chandra Chakinala; William C.S. Cho; Dinh-Toi Chu; Joao Conde; Vera Marisa Costa; Natália Cruz-Martins; Omid Dadras; Xiaochen Dai; Lalit Dandona; Rakhi Dandona; Anna Danielewicz; Feleke Mekonnen Demeke; Getu Debalkie Demissie; Rupak Desai; Deepak Dhamnetiya; Mostafa Dianatinasab; Daniel Diaz; Mojtaba Didehdar; Saeid Doaei; Linh Phuong Doan; Milad Dodangeh; Fatemeh Eghbalian; Debela Debela Ejeta; Michael Ekholuenetale; Temitope Cyrus Ekundayo; Iman El Sayed; Muhammed Elhadi; Daniel Berhanie Enyew; Tahir Eyayu; Rana Ezzeddini; Ildar Ravisovich Fakhradiyev; Umar Farooque; Hossein Farrokhpour; Farshad Farzadfar; Ali Fatehizadeh; Hamed Fattahi; Nima Fattahi; Masood Fereidoonnezhad; Eduarda Fernandes; Getahun Fetensa; Irina Filip; Florian Fischer; Masoud Foroutan; Peter Andras Gaal; Mohamed M. Gad; Silvano Gallus; Tushar Garg; Tamiru Getachew; Seyyed-Hadi Ghamari; Ahmad Ghashghaee; Nermin Ghith; Maryam Gholamalizadeh; Jamshid Gholizadeh Navashenaq; Abraham Tamirat Gizaw; James C. Glasbey; Mahaveer Golechha; Pouya Goleij; Kebebe Bekele Gonfa; Giuseppe Gorini; Avirup Guha; Sapna Gupta; Veer Bala Gupta; Vivek Kumar Gupta; Rasool Haddadi; Nima Hafezi-Nejad; Arvin Haj-Mirzaian; Rabih Halwani; Shafiul Haque; Sanam Hariri; Ahmed I. Hasaballah; Soheil Hassanipour; Simon I. Hay; Claudiu Herteliu; Ramesh Holla; Mohammad-Salar Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Mowafa Househ; Junjie Huang; Ayesha Humayun; Ivo Iavicoli; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Farhad Islami; Masao Iwagami; Mohammad Ali Jahani; Mihajlo Jakovljevic; Tahereh Javaheri; Ranil Jayawardena; Rime Jebai; Ravi Prakash Jha; Tamas Joo; Nitin Joseph; Farahnaz Joukar; Jacek Jerzy Jozwiak; Ali Kabir; Rohollah Kalhor; Ashwin Kamath; Neeti Kapoor; Ibraheem M. Karaye; Amirali Karimi; Joonas H. Kauppila; Asma Kazemi; Mohammad Keykhaei; Yousef Saleh Khader; Himanshu Khajuria; Rovshan Khalilov; Javad Khanali; Maryam Khayamzadeh; Mahmoud Khodadost; Hanna Kim; Min Seo Kim; Adnan Kisa; Sezer Kisa; Ali-Asghar Kolahi; Hamid Reza Koohestani; Jacek A. Kopec; Rajasekaran Koteeswaran; Ai Koyanagi; Yuvaraj Krishnamoorthy; G. Anil Kumar; Manoj Kumar; Vivek Kumar; Carlo La Vecchia; Faris Hasan Lami; Iván Landires; Caterina Ledda; Sang-Woong Lee; Wei-Chen Lee; Yeong Yeh Lee; Elvynna Leong; Bingyu Li; Stephen S. Lim; Stany W. Lobo; Joana A. Loureiro; Raimundas Lunevicius; Farzan Madadizadeh; Ata Mahmoodpoor; Azeem Majeed; Mohammad-Reza Malekpour; Reza Malekzadeh; Ahmad Azam Malik; Fariborz Mansour-Ghanaei; Lorenzo Giovanni Mantovani; Miquel Martorell; Sahar Masoudi; Prashant Mathur; Jitendra Kumar Meena; Entezar Mehrabi Nasab; Walter Mendoza; Alexios-Fotios A. Mentis; Tomislav Mestrovic; Junmei Miao Jonasson; Bartosz Miazgowski; Tomasz Miazgowski; Gelana Fekadu Worku Mijena; Seyyedmohammadsadeq Mirmoeeni; Mohammad Mirza-Aghazadeh-Attari; Hamed Mirzaei; Sanjeev Misra; Karzan Abdulmuhsin Mohammad; Esmaeil Mohammadi; Saeed Mohammadi; Seyyede Momeneh Mohammadi; Abdollah Mohammadian-Hafshejani; Shafiu Mohammed; Teroj Abdulrahman Mohammed; Nagabhishek Moka; Ali H. Mokdad; Zeinab Mokhtari; Mariam Molokhia; Sara Momtazmanesh; Lorenzo Monasta; Ghobad Moradi; Rahmatollah Moradzadeh; Paula Moraga; Joana Morgado-Da-Costa; Sumaira Mubarik; Francesk Mulita; Mohsen Naghavi; Mukhammad David Naimzada; Hae Sung Nam; Zuhair S. Natto; Biswa Prakash Nayak; Javad Nazari; Ehsan Nazemalhosseini-Mojarad; Ionut Negoi; Cuong Tat Nguyen; Son Hoang Nguyen; Nurulamin M. Noor; Maryam Noori; Seyyed Mohammad Ali Noori; Virginia Nuñez-Samudio; Chimezie Igwegbe Nzoputam; Bogdan Oancea; Oluwakemi Ololade Odukoya; Ayodipupo Sikiru Oguntade; Hassan Okati-Aliabad; Andrew T. Olagunju; Tinuke O. Olagunju; Sokking Ong; Samuel M. Ostroff; Alicia Padron-Monedero; Reza Pakzad; Adrian Pana; Anamika Pandey; Fatemeh Pashazadeh Kan; Urvish K. Patel; Uttam Paudel; Renato B. Pereira; Navaraj Perumalsamy; Richard G. Pestell; Zahra Zahid Piracha; Richard Charles G. Pollok; Akram Pourshams; Naeimeh Pourtaheri; Akila Prashant; Mohammad Rabiee; Navid Rabiee; Amir Radfar; Sima Rafiei; Mosiur Rahman; Amir Masoud Rahmani; Vahid Rahmanian; Nazanin Rajai; Aashish Rajesh; Vajiheh Ramezani-Doroh; Kiana Ramezanzadeh; Kamal Ranabhat; Sina Rashedi; Amirfarzan Rashidi; Mahsa Rashidi; Mohammad-Mahdi Rashidi; Mandana Rastegar; David Laith Rawaf; Salman Rawaf; Reza Rawassizadeh; Mohammad Sadegh Razeghinia; Andre M.N. Renzaho; Negar Rezaei; Nima Rezaei; Saeid Rezaei; Mohsen Rezaeian; Sahba Rezazadeh-Khadem; Gholamreza Roshandel; Maha Mohamed Saber-Ayad; Bahar Saberzadeh-Ardestani; Basema Saddik; Hossein Sadeghi; Umar Saeed; Maryam Sahebazzamani; Amirhossein Sahebkar; Amir Salek Farrokhi; Amir Salimi; Hamideh Salimzadeh; Pouria Samadi; Mehrnoosh Samaei; Abdallah M. Samy; Juan Sanabria; Milena M. Santric-Milicevic; Muhammad Arif Nadeem Saqib; Arash Sarveazad; Brijesh Sathian; Maheswar Satpathy; Ione Jayce Ceola Schneider; Mario Šekerija; Sadaf G. Sepanlou; Allen Seylani; Feng Sha; Sayed Mohammad Shafiee; Zahra Shaghaghi; Saeed Shahabi; Elaheh Shaker; Maedeh Sharifian; Javad Sharifi-Rad; Sara Sheikhbahaei; Jeevan K. Shetty; Reza Shirkoohi; Parnian Shobeiri; Sudeep K. Siddappa Malleshappa; Diego Augusto Santos Silva; Guilherme Silva Julian; Achintya Dinesh Singh; Jasvinder A. Singh; Md Shahjahan Siraj; Gholam Reza Sivandzadeh; Valentin Yurievich Skryabin; Anna Aleksandrovna Skryabina; Bogdan Socea; Marco Solmi; Mohammad Sadegh Soltani-Zangbar; Suhang Song; Viktória Szerencsés; Miklós Szócska; Rafael Tabarés-Seisdedos; Elnaz Tabibian; Majid Taheri; Yasaman Taheri Abkenar; Amir Taherkhani; Iman M. Talaat; Ker-Kan Tan; Abdelghani Tbakhi; Bekele Tesfaye; Amir Tiyuri; Daniel Nigusse Tollosa; Mathilde Touvier; Bach Xuan Tran; Biruk Shalmeno Tusa; Irfan Ullah; Saif Ullah; Marco Vacante; Sahel Valadan Tahbaz; Massimiliano Veroux; Bay Vo; Theo Vos; Cong Wang; Ronny Westerman; Melat Woldemariam; Seyed Hossein Yahyazadeh Jabbari; Lin Yang; Fereshteh Yazdanpanah; Chuanhua Yu; Deniz Yuce; Ismaeel Yunusa; Vesna Zadnik; Mazyar Zahir; Iman Zare; Zhi-Jiang Zhang; Mohammad Zoladi
Background: Colorectal cancer is the third leading cause of cancer deaths worldwide. Given the recent increasing trends in colorectal cancer incidence globally, up-to-date information on the colorectal cancer burden could guide screening, early detection, and treatment strategies, and help effectively allocate resources. We examined the temporal patterns of the global, regional, and national burden of colorectal cancer and its risk factors in 204 countries and territories across the past three decades. Methods: Estimates of incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer were generated as a part of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 by age, sex, and geographical location for the period 1990–2019. Mortality estimates were produced using the cause of death ensemble model. We also calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. Findings: Globally, between 1990 and 2019, colorectal cancer incident cases more than doubled, from 842 098 (95% uncertainty interval [UI] 810 408–868 574) to 2·17 million (2·00–2·34), and deaths increased from 518 126 (493 682–537 877) to 1·09 million (1·02–1·15). The global age-standardised incidence rate increased from 22·2 (95% UI 21·3–23·0) per 100 000 to 26·7 (24·6–28·9) per 100 000, whereas the age-standardised mortality rate decreased from 14·3 (13·5–14·9) per 100 000 to 13·7 (12·6–14·5) per 100 000 and the age-standardised DALY rate decreased from 308·5 (294·7–320·7) per 100 000 to 295·5 (275·2–313·0) per 100 000 from 1990 through 2019. Taiwan (province of China; 62·0 [48·9–80·0] per 100 000), Monaco (60·7 [48·5–73·6] per 100 000), and Andorra (56·6 [42·8–71·9] per 100 000) had the highest age-standardised incidence rates, while Greenland (31·4 [26·0–37·1] per 100 000), Brunei (30·3 [26·6–34·1] per 100 000), and Hungary (28·6 [23·6–34·0] per 100 000) had the highest age-standardised mortality rates. From 1990 through 2019, a substantial rise in incidence rates was observed in younger adults (age <50 years), particularly in high Socio-demographic Index (SDI) countries. Globally, a diet low in milk (15·6%), smoking (13·3%), a diet low in calcium (12·9%), and alcohol use (9·9%) were the main contributors to colorectal cancer DALYs in 2019. Interpretation: The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
(Elsevier Ltd, 2024) Valery L Feigin; Melsew Dagne Abate; Yohannes Habtegiorgis Abate; Samar Abd ElHafeez; Foad Abd-Allah; Ahmed Abdelalim; Atef Abdelkader; Michael Abdelmasseh; Sherief Abd-Elsalam; Parsa Abdi; Arash Abdollahi; Meriem Abdoun; Rami Abd-Rabu; Deldar Morad Abdulah; Auwal Abdullahi; Mesfin Abebe; Roberto Ariel Abeldaño Zuñiga; E.S. Abhilash; Olugbenga Olusola Abiodun; Olumide Abiodun; Rahim Abo Kasem; Richard Gyan Aboagye; Mohamed Abouzid; Lucas Guimarães Abreu; Woldu Aberhe Abrha; Dariush Abtahi; Samir Abu Rumeileh; Ahmed Abualhasan; Hasan Abualruz; Eman Abu-Gharbieh; Hana J Abukhadijah; Niveen ME Abu-Rmeileh; Salahdein Aburuz; Ahmed Abu-Zaid; Juan Manuel Acuna; Denberu Eshetie Adane; Mesafint Molla Adane; Isaac Yeboah Addo; Rufus Adesoji Adedoyin; Oyelola A Adegboye; Victor Adekanmbi; Kishor Adhikari; Qorinah Estiningtyas Sakilah Adnani; Saryia Adra; Leticia Akua Adzigbli; Abdelrahman Yousry Afify; Aanuoluwapo Adeyimika Afolabi; Fatemeh Afrashteh; Muhammad Sohail Afzal; Saira Afzal; Shahin Aghamiri; Williams Agyemang-Duah; Bright Opoku Ahinkorah; Aqeel Ahmad; Muayyad M Ahmad; Sajjad Ahmad; Shahzaib Ahmad; Tauseef Ahmad; Amir Mahmoud Ahmadzade; Ali Ahmed; Ayman Ahmed; Haroon Ahmed; Syed Anees Ahmed; Marjan Ajami; Budi Aji; Essona Matatom Akara; Rufus Olusola Akinyemi; Mohammed Ahmed Akkaif; Ashley E Akrami; Salah Al Awaidy; Hanadi Al Hamad; Syed Mahfuz Al Hasan; Mohammad Al Qadire; Omar Al Ta'ani; Yazan Al-Ajlouni; Samer O Alalalmeh; Tariq A Alalwan; Ziyad Al-Aly; Rasmieh Mustafa Al-amer; Wafa A Aldhaleei; Mohammed S Aldossary; Seyedeh Yasaman Alemohammad; Bassam Al-Fatly; Adel Ali Saeed Al-Gheethi; Fadwa Naji Alhalaiqa; Maryam Alharrasi; Abid Ali; Mohammed Usman Ali; Rafat Ali; Syed Shujait Ali; Waad Ali; Akram Al-Ibraheem; Sheikh Mohammad Alif; Syed Mohamed Aljunid; Wael Almahmeed; Sabah Al-Marwani; Mahmoud A Alomari; Jordi Alonso; Jaber S Alqahtani; Rajaa M Mohammad Al-Raddadi; Ahmad Alrawashdeh; Mohammed A Alsabri; Najim Z Alshahrani; Zaid Altaany; Awais Altaf; Alaa B Al-Tammemi; Diala Altwalbeh; Nelson Alvis-Guzman; Hassan Alwafi; Mohammad Al-Wardat; Yaser Mohammed Al-Worafi; Hany Aly; Safwat Aly; Mohammad Sharif Ibrahim Alyahya; Karem H Alzoubi; Walid Adnan Al-Zyoud; Reza Amani; Prince M Amegbor; Tewodros Getnet Amera; Tarek Tawfik Amin; Alireza Amindarolzarbi; Sohrab Amiri; Hubert Amu; Dickson A Amugsi; Ganiyu Adeniyi Amusa; Robert Ancuceanu; Deanna Anderlini; Dhanalakshmi Angappan; Abhishek Anil; Mohammed Tahir Tahir Ansari; Alireza Ansari-Moghaddam; Rockson Ansong; Saeid Anvari; Saleha Anwar; Sumadi Lukman Anwar; Ekenedilichukwu Emmanuel Anyabolo; Anayochukwu Edward Anyasodor; Geminn Louis Carace Apostol; Francis Appiah; Muhammad Aqeel; Jalal Arabloo; Razman Arabzadeh Bahri; Mosab Arafat; Aleksandr Y Aravkin; Ali Ardekani; Demelash Areda; Brhane Berhe Aregawi; Getnet Mesfin Aregu; Olatunde Aremu; Hidayat Arifin; Johan Ärnlöv; Anton A Artamonov; Judie Arulappan; Umesh Raj Aryal; Zahra Aryan; Akram M Asbeutah; Mulusew A Asemahagn; Mulu Tiruneh Asemu; Mohammad Asghari-Jafarabadi; Mubarek Yesse Ashemo; Tahira Ashraf; Armin Aslani; Haftu Asmerom Asmerom; Thomas Astell-Burt; Seyyed Shamsadin Athari; Prince Atorkey; Maha Moh'd Wahbi Atout; Alok Atreya; Avinash Aujayeb; Marcel Ausloos; Abolfazl Avan; Hamzeh Awad; Adedapo Wasiu Awotidebe; Lemessa Assefa A Ayana; Setognal Birara Aychiluhm; Amdehiwot A Aynalem; 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Muhammad Iqhrammullah; Arnaud Iradukunda; Lalu Muhammad Irham; Md Rabiul Islam; Faisal Ismail; Nahlah Elkudssiah Ismail; Hiroyasu Iso; Gaetano Isola; Ramaiah Itumalla; Masao Iwagami; Chidozie Declan CD Iwu; Vinothini J; Jalil Jaafari; Louis Jacob; Abdollah Jafarzadeh; Haitham Jahrami; Akhil Jain; Nityanand Jain; Ammar Abdulrahman Jairoun; Abhishek Jaiswal; Mihajlo Jakovljevic; Reza Jalilzadeh Yengejeh; Balamurugan Janakiraman; Abubakar Ibrahim Jatau; Sathish Kumar Jayapal; Shubha Jayaram; Sun Ha Jee; Jayakumar Jeganathan; Mihretu Jegnie; Alelign Tasew Jema; Bijay Mukesh Jeswani; Angeline Jeyakumar; Anil K Jha; Ravi Prakash Jha; Zixiang Ji; Heng Jiang; Shuai Jin; Yingzhao Jin; Mohammad Jokar; Jost B Jonas; Tamas Joo; Jobinse Jose; Nitin Joseph; Charity Ehimwenma Joshua; Farahnaz Joukar; Jacek Jerzy Jozwiak; Mikk Jürisson; Ali Kabir; Md Awal Kabir; Zubair Kabir; Vidya Kadashetti; Rizwan Kalani; Sanjay Kalra; Vineet Kumar Kamal; Arun Kamireddy; Haidong Kan; Mona Kanaan; Himal Kandel; Kehinde Kazeem Kanmodi; 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Miikka Korja; Vladimir Andreevich Korshunov; Oleksii Korzh; Soewarta Kosen; Karel Kostev; Nikhil Kothari; Ashwin Laxmikant Kotnis; Sindhura Lakshmi Koulmane Laxminarayana; Kewal Krishan; Varun Krishna; Vijay Krishnamoorthy; Bindu Krishnan; Jera Kruja; Barthelemy Kuate Defo; Burcu Kucuk Bicer; Md Abdul Kuddus; Mohammed Kuddus; Nuworza Kugbey; Mukhtar Kulimbet; Vishnutheertha Kulkarni; Akshay Kumar; Ashish Kumar; Dewesh Kumar; G Anil Kumar; Nithin Kumar; Rakesh Kumar; Senthil Kumaran D; Amartya Kundu; Satyajit Kundu; Setor K Kunutsor; Om P Kurmi; Dian Kusuma; L V Simhachalam Kutikuppala; Ambily Kuttikkattu; Ville Kytö; Carlo La Vecchia; Ben Lacey; Chandrakant Lahariya; Dharmesh Kumar Lal; Tea Lallukka; Judit Lám; Iván Landires; Anders O Larsson; Savita Lasrado; Kaveh Latifinaibin; Paolo Lauriola; Pablo M Lavados; Basira Kankia Lawal; Long Khanh Dao Le; Nhi Huu Hanh Le; Thao Thi Thu Le; Trang Diep Thanh Le; Paul H Lee; Seung Won Lee; Wei-Chen Lee; Yo Han Lee; Ming-Chieh Li; Wei Li; Xiaopan Li; 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Background: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. Methods: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6–7·8] deaths; 10·7% [9·8–11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8–171·6] DALYs; 5·6% [5·0–6·1] of all DALYs). In 2021, there were 93·8 million (89·0–99·3) prevalent and 11·9 million (10·7–13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4–67·7), intracerebral haemorrhage constituted 28·8% (28·3–28·8), and subarachnoid haemorrhage constituted 5·8% (5·7–6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4–117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7–38·1]), diet high in sugar-sweetened beverages (23·4% [12·7–35·7]), low physical activity (11·3% [1·8–34·9]), high systolic blood pressure (6·7% [2·5–11·6]), lead exposure (6·5% [4·5–11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5–10·5]). Interpretation: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020
(Elsevier B.V., 2022) Dana Bryazka; Marissa B. Reitsma; Max G. Griswold; Kalkidan Hassen Abate; Cristiana Abbafati; Mohsen Abbasi-Kangevari; Zeinab Abbasi-Kangevari; Amir Abdoli; Mohammad Abdollahi; Abu Yousuf Md. Abdullah; E.S. Abhilash; Eman Abu-Gharbieh; Juan Manuel Acuna; Giovanni Addolorato; Oladimeji M. Adebayo; Victor Adekanmbi; Kishor Adhikari; Sangeet Adhikari; Qorinah Estiningtyas Sakilah Adnani; Saira Afzal; Wubetu Yimam Agegnehu; Manik Aggarwal; Bright Opoku Ahinkorah; Araz Ramazan Ahmad; Sajjad Ahmad; Tauseef Ahmad; Ali Ahmadi; Sepideh Ahmadi; Haroon Ahmed; Tarik Ahmed Rashid; Chisom Joyqueenet Akunna; Hanadi Al Hamad; Md.Zakiul Alam; Dejene Tsegaye Alem; Kefyalew Addis Alene; Yousef Alimohamadi; Atiyeh Alizadeh; Kasim Allel; Jordi Alonso; Saba Alvand; Nelson Alvis-Guzman; Firehiwot Amare; Edward Kwabena Ameyaw; Sohrab Amiri; Robert Ancuceanu; Jason A. Anderson; Catalina Liliana Andrei; Tudorel Andrei; Jalal Arabloo; Muhammad Arshad; Anton A. Artamonov; Zahra Aryan; Malke Asaad; Mulusew A. Asemahagn; Thomas Astell-Burt; Seyyed Shamsadin Athari; Desta Debalkie Atnafu; Prince Atorkey; Alok Atreya; Floriane Ausloos; Marcel Ausloos; Getinet Ayano; Martin Amogre Ayanore; Olatunde O. Ayinde; Jose L. Ayuso-Mateos; Sina Azadnajafabad; Melkalem Mamuye Azanaw; Mohammadreza Azangou-Khyavy; Amirhossein Azari Jafari; Ahmed Y. Azzam; Ashish D. Badiye; Nasser Bagheri; Sara Bagherieh; Mohan Bairwa; Shankar M. Bakkannavar; Ravleen Kaur Bakshi; Awraris Hailu Balchut Bilchut; T.W. Bärnighausen; Fabio Barra; Amadou Barrow; Pritish Baskaran; Luis Belo; Derrick A. Bennett; Isabela M. Bensenor; Akshaya Srikanth Bhagavathula; Neeraj Bhala; Ashish Bhalla; Nikha Bhardwaj; Pankaj Bhardwaj; Sonu Bhaskar; Krittika Bhattacharyya; Vijayalakshmi S. Bhojaraja; Bagas Suryo Bintoro; Elena A. Elena Blokhina; Belay Boda Abule Bodicha; Archith Boloor; Cristina Bosetti; Dejana Braithwaite; Hermann Brenner; Nikolay Ivanovich Briko; Andre R. Brunoni; Zahid A. Butt; Chao Cao; Yin Cao; Rosario Cárdenas; Andre F. Carvalho; Márcia Carvalho; Joao Mauricio Castaldelli-Maia; Giulio Castelpietra; Luis F.S. Castro-De-Araujo; Maria Sofia Cattaruzza; Promit Ananyo Chakraborty; Jaykaran Charan; Vijay Kumar Chattu; Akhilanand Chaurasia; Nicolas Cherbuin; Dinh-Toi Chu; Nandita Chudal; Sheng-Chia Chung; Chuchu Churko; Liliana G. Ciobanu; Massimo Cirillo; Rafael M. Claro; Simona Costanzo; Richard G. Cowden; Michael H. Criqui; Natália Cruz-Martins; Garland T. Culbreth; Berihun Assefa Dachew; Omid Dadras; Xiaochen Dai; Giovanni Damiani; Lalit Dandona; Rakhi Dandona; Beniam Darge Daniel; Anna Danielewicz; Jiregna Darega Gela; Kairat Davletov; Jacyra Azevedo Paiva de Araujo; Antonio Reis De Sá; Sisay Abebe Debela; Azizallah Dehghan; Andreas K. Demetriades; Meseret Derbew Molla; Rupak Desai; Abebaw Alemayehu Desta; Diana Dias da Silva; Daniel Diaz; Lankamo Ena Digesa; Mengistie Diress; Milad Dodangeh; Deepa Dongarwar; Fariba Dorostkar; Haneil Larson Dsouza; Bereket Duko; Bruce B. Duncan; Kristina Edvardsson; Michael Ekholuenetale; Frank J. Elgar; Muhammed Elhadi; Mohamed A. Elmonem; Aman Yesuf Endries; Sharareh Eskandarieh; Azin Etemadimanesh; Adeniyi Francis Fagbamigbe; Ildar Ravisovich Fakhradiyev; Fatemeh Farahmand; Carla Sofia E. Sá Farinha; Andre Faro; Farshad Farzadfar; Ali Fatehizadeh; Nelsensius Klau Fauk; Valery L. Feigin; Rachel Feldman; Xiaoqi Feng; Zinabu Fentaw; Simone Ferrero; Lorenzo Ferro Desideri; Irina Filip; Florian Fischer; Joel Msafiri Francis; Richard Charles Franklin; Peter Andras Gaal; Mohamed M. Gad; Silvano Gallus; Fabio Galvano; Balasankar Ganesan; Tushar Garg; Mesfin Gebrehiwot Damtew Gebrehiwot; Teferi Gebru Gebremeskel; Mathewos Alemu Gebremichael; Tadele Regasa Gemechu; Lemma Getacher; Motuma Erena Getachew; Abera Getachew Obsa; Asmare Getie; Amir Ghaderi; Mansour Ghafourifard; Alireza Ghajar; Seyyed-Hadi Ghamari; Lilian A. Ghandour; Mohammad Ghasemi Nour; Ahmad Ghashghaee; Sherief Ghozy; Franklin N. Glozah; Ekaterina Vladimirovna Glushkova; Justyna Godos; Amit Goel; Salime Goharinezhad; Mahaveer Golechha; Pouya Goleij; Mohamad Golitaleb; Felix Greaves; Michal Grivna; Giuseppe Grosso; Temesgen Worku Gudayu; Bhawna Gupta; Rajeev Gupta; Sapna Gupta; Veer Bala Gupta; Vivek Kumar Gupta; Nima Hafezi-Nejad; Arvin Haj-Mirzaian; Brian J. Hall; Rabih Halwani; Tiilahun Beyene Handiso; Graeme J. Hankey; Sanam Hariri; Josep Maria Haro; Ahmed I. Hasaballah; Hossein Hassanian-Moghaddam; Simon I. 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Nuruzzaman; Chimezie Igwegbe Nzoputam; Kehinde O. Obamiro; Felix Akpojene Ogbo; Ayodipupo Sikiru Oguntade; Hassan Okati-Aliabad; Babayemi Oluwaseun Olakunde; Gláucia Maria Moraes Oliveira; Ahmed Omar Bali; Emad Omer; Doris V. Ortega-Altamirano; Adrian Otoiu; Stanislav S. Otstavnov; Bilcha Oumer; P.A. Mahesh; Alicia Padron-Monedero; Raffaele Palladino; Adrian Pana; Songhomitra Panda-Jonas; Anamika Pandey; Ashok Pandey; Shahina Pardhan; Tarang Parekh; Eun-Kee Park; Charles D.H. Parry; Fatemeh Pashazadeh Kan; Jay Patel; Siddhartha Pati; George C. Patton; Uttam Paudel; Shrikant Pawar; Amy E. Peden; Ionela-Roxana Petcu; Michael R. Phillips; Marina Pinheiro; Evgenii Plotnikov; Pranil Man Singh Pradhan; Akila Prashant; Jianchao Quan; Amir Radfar; Alireza Rafiei; Pankaja Raghav Raghav; Vafa Rahimi-Movaghar; Azizur Rahman; Md.Mosfequr Rahman; Mosiur Rahman; Amir Masoud Rahmani; Shayan Rahmani; Chhabi Lal Ranabhat; Priyanga Ranasinghe; Chythra R. 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Background: The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods: For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings: The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation: There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019
(Elsevier Ltd, 2022) Elysia M. Alvarez; Lisa M. Force; Rixing Xu; Kelly Compton; Dan Lu; Hannah Jacqueline Henrikson; Jonathan M. Kocarnik; James D. Harvey; Alyssa Pennini; Frances E. Dean; Weijia Fu; Martina T. Vargas; Theresa H. M. Keegan; Hany Ariffin; Ronald D. Barr; Yana Arturovna Erdomaeva; D. Sanjeeva Gunasekera; Yetunde O. John-Akinola; Tyler G. Ketterl; Tezer Kutluk; Marcio Henrique Malogolowkin; Prashant Mathur; Venkatraman Radhakrishnan; Lynn Ann Gloeckler Ries; Carlos Rodriguez-Galindo; Garik Barisovich Sagoyan; Iyad Sultan; Behzad Abbasi; Mohsen Abbasi-Kangevari; Zeinab Abbasi-Kangevari; Hedayat Abbastabar; Michael Abdelmasseh; Sherief Abd-Elsalam; Amir Abdoli; Haimanot Abebe; Aidin Abedi; Hassan Abidi; Hassan Abolhassani; Hiwa Abubaker Ali; Eman Abu-Gharbieh; Basavaprabhu Achappa; Juan Manuel Acuna; Isaac Akinkunmi Adedeji; Oyelola A. Adegboye; Qorinah Estiningtyas Sakilah Adnani; Shailesh M. Advani; Muhammad Sohail Afzal; Mohamad Aghaie Meybodi; Bahman Ahadinezhad; Bright Opoku Ahinkorah; Sajjad Ahmad; Sepideh Ahmadi; Muktar Beshir Ahmed; Tarik Ahmed Rashid; Yusra Ahmed Salih; Wajeeha Aiman; Gizachew Taddesse Akalu; Hanadi Al Hamad; Fares Alahdab; Abdulhadi A. AlAmodi; Fahad Mashhour Alanezi; Turki M. Alanzi; Adugnaw Zeleke Alem; Dejene Tsegaye Alem; Yosef Alemayehu; Fadwa Naji Alhalaiqa; Robert Kaba Alhassan; Saqib Ali; Gianfranco Alicandro; Vahid Alipour; Syed Mohamed Aljunid; Motasem Alkhayyat; Sunitha Alluri; Nihad A. Almasri; Sadeq Ali Al-Maweri; Sami Almustanyir; Rajaa M. Al-Raddadi; Nelson Alvis-Guzman; Edward Kwabena Ameyaw; Saeed Amini; Hubert Amu; Robert Ancuceanu; Catalina Liliana Andrei; Tudorel Andrei; Fereshteh Ansari; Alireza Ansari-Moghaddam; Davood Anvari; Anayochukwu Edward Anyasodor; Jalal Arabloo; Morteza Arab-Zozani; Ayele Mamo Argaw; Muhammad Arshad; Judie Arulappan; Armin Aryannejad; Zatollah Asemi; Mohammad Asghari Jafarabadi; Mohammad Reza Atashzar; Prince Atorkey; Alok Atreya; Sameh Attia; Avinash Aujayeb; Marcel Ausloos; Leticia Avila-Burgos; Atalel Fentahun Awedew; Beatriz Paulina Ayala Quintanilla; Alemu Degu Ayele; Solomon Shitu Ayen; Mohammed A. Azab; Sina Azadnajafabad; Hiva Azami; Mohammadreza Azangou-Khyavy; Amirhossein Azari Jafari; Ghasem Azarian; Ahmed Y. Azzam; Saeed Bahadory; Jianjun Bai; Atif Amin Baig; Jennifer L. 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Chavan; Odgerel Chimed-Ochir; Jee-Young Jasmine Choi; Devasahayam J. Christopher; Dinh-Toi Chu; Michael T. Chung; Joao Conde; Vera Marisa Costa; Omar B. Da; Omid Dadras; Saad M. A. Dahlawi; Xiaochen Dai; Giovanni Damiani; Emanuele D'Amico; Lalit Dandona; Rakhi Dandona; Parnaz Daneshpajouhnejad; Amira Hamed Darwish; Ahmad Daryani; Fernando Pio De La Hoz; Sisay Abebe Debela; Takele Gezahegn G. Demie; Getu Debalkie Demissie; Zeleke Geto Demissie; Edgar Denova-Gutiérrez; Meseret Derbew Molla; Rupak Desai; Abebaw Alemayehu Desta; Deepak Dhamnetiya; Samath Dhamminda Dharmaratne; Mandira Lamichhane Dhimal; Meghnath Dhimal; Mostafa Dianatinasab; Mojtaba Didehdar; Mengistie Diress; Shirin Djalalinia; Huyen Phuc Do; Saeid Doaei; Fariba Dorostkar; Wendel Mombaque Dos Santos; Thomas M. Drake; Michael Ekholuenetale; Iman El Sayed; Maysaa El Sayed Zaki; Maha El Tantawi; Hassan El-Abid; Mostafa Ahmed Elbahnasawy; Iffat Elbarazi; Hala Rashad Elhabashy; Muhammed Elhadi; Shaimaa I. El-Jaafary; Daniel Berhanie Enyew; Ryenchindorj Erkhembayar; Babak Eshrati; Sharareh Eskandarieh; Mohammed Faisaluddin; Jawad Fares; Umar Farooque; Abidemi Omolara Fasanmi; Wafa Fatima; José Miguel P. Ferreira De Oliveira; Simone Ferrero; Lorenzo Ferro Desideri; Getahun Fetensa; Irina Filip; Florian Fischer; James L. Fisher; Masoud Foroutan; Takeshi Fukumoto; Peter Andras Gaal; Mohamed M. Gad; Piyada Gaewkhiew; Silvano Gallus; Tushar Garg; Teferi Gebru Gebremeskel; Belete Negese Belete Gemeda; Tamiru Getachew; Mansour Ghafourifard; Seyyed-Hadi Ghamari; Ahmad Ghashghaee; Fariba Ghassemi; Nermin Ghith; Ali Gholami; Jamshid Gholizadeh Navashenaq; Syed Amir Gilani; Themba G. Ginindza; Abraham Tamirat Gizaw; James C. 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Hole; Ramesh Holla; Nobuyuki Horita; Md Mahbub Hossain; Mohammad Bellal Hossain; Mohammad-Salar Hosseini; Mostafa Hosseini; Ali Hosseinzadeh; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mowafa Househ; Mohamed Hsairi; Junjie Huang; Nawfal R. Hussein; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Kaire Innos; Lalu Muhammad Irham; Rakibul M. Islam; Sheikh Mohammed Shariful Islam; Nahlah Elkudssiah Ismail; Gaetano Isola; Masao Iwagami; Louis Jacob; Farhad Jadidi-Niaragh; Vardhmaan Jain; Mihajlo Jakovljevic; Roksana Janghorban; Amirreza Javadi Mamaghani; Shubha Jayaram; Ranil Jayawardena; Seyed Behzad Jazayeri; Rime Jebai; Ravi Prakash Jha; Tamas Joo; Nitin Joseph; Farahnaz Joukar; Mikk Jürisson; Billingsley Kaambwa; Ali Kabir; Leila R. Kalankesh; Feroze Kaliyadan; Zul Kamal; Ashwin Kamath; Himal Kandel; Sitanshu Sekhar Kar; Ibraheem M. Karaye; Amirali Karimi; Bekalu Getnet Kassa; Joonas H. Kauppila; Phillip M. Kemp Bohan; Andre Pascal Kengne; Amene Abebe Kerbo; Mohammad Keykhaei; Yousef Saleh Khader; Himanshu Khajuria; Nastaran Khalili; Neda Khalili; Ejaz Ahmad Khan; Gulfaraz Khan; Maseer Khan; Md Nuruzzaman Khan; Moien A. B. Khan; Javad Khanali; Maryam Khayamzadeh; Omid Khosravizadeh; Jagdish Khubchandani; Roba Khundkar; Min Seo Kim; Yun Jin Kim; Adnan Kisa; Sezer Kisa; Katarzyna Kissimova-Skarbek; Ali-Asghar Kolahi; Jacek A. Kopec; Rajasekaran Koteeswaran; Sindhura Lakshmi Koulmane Laxminarayana; Ai Koyanagi; Nuworza Kugbey; G. Anil Kumar; Nithin Kumar; Alexander Kwarteng; Carlo La Vecchia; Qing Lan; Iván Landires; Savita Lasrado; Paolo Lauriola; Caterina Ledda; Sang-Woong Lee; Wei-Chen Lee; Yeong Yeh Lee; Yo Han Lee; James Leigh; Elvynna Leong; Bingyu Li; Jiarui Li; Ming-Chieh Li; Stephen S. Lim; Xuefeng Liu; Stany W. Lobo; Joana A. Loureiro; Alessandra Lugo; Raimundas Lunevicius; Hassan Magdy Abd El Razek; Muhammed Magdy Abd El Razek; Morteza Mahmoudi; Azeem Majeed; Alaa Makki; Shilpa Male; Mohammad-Reza Malekpour; Reza Malekzadeh; Ahmad Azam Malik; Mohammed A. Mamun; Navid Manafi; Fariborz Mansour-Ghanaei; Borhan Mansouri; Mohammad Ali Mansournia; Santi Martini; Seyedeh Zahra Masoumi; Clara N. Matei; Manu Raj Mathur; Colm McAlinden; Ravi Mehrotra; Walter Mendoza; Ritesh G. Menezes; Alexios-Fotios A. Mentis; Tuomo J. Meretoja; Amanual Getnet Mersha; Mohamed Kamal Mesregah; Tomislav Mestrovic; Junmei Miao Jonasson; Bartosz Miazgowski; Irmina Maria Michalek; Ted R. Miller; Alemu Basazin Mingude; Seyyedmohammadsadeq Mirmoeeni; Hamed Mirzaei; Sanjeev Misra; Prasanna Mithra; Karzan Abdulmuhsin Mohammad; Mokhtar Mohammadi; Seyyede Momeneh Mohammadi; Abdollah Mohammadian-Hafshejani; Reza Mohammadpourhodki; Arif Mohammed; Shafiu Mohammed; Teroj Abdulrahman Mohammed; Nagabhishek Moka; Ali H. Mokdad; Mariam Molokhia; Sara Momtazmanesh; Lorenzo Monasta; Mohammad Ali Moni; Ghobad Moradi; Yousef Moradi; Maliheh Moradzadeh; Rahmatollah Moradzadeh; Paula Moraga; Shane Douglas Morrison; Ebrahim Mostafavi; Amin Mousavi Khaneghah; Christine Mpundu-Kaambwa; Sumaira Mubarik; Lillian Mwanri; Ashraf F. Nabhan; Shankar Prasad Nagaraju; Chie Nagata; Mohsen Naghavi; Mukhammad David Naimzada; Luigi Naldi; Vinay Nangia; Atta Abbas Naqvi; Sreenivas Narasimha Swamy; Aparna Ichalangod Narayana; Biswa Prakash Nayak; Vinod C. Nayak; Javad Nazari; Sabina Onyinye Nduaguba; Ionut Negoi; Serban Mircea Negru; Seyed Aria Nejadghaderi; Samata Nepal; Sandhya Neupane Kandel; Haruna Asura Nggada; Cuong Tat Nguyen; Chukwudi A. Nnaji; Hamed Nosrati; Hasti Nouraei; Ali Nowroozi; Virginia Nuñez-Samudio; Vincent Ebuka Nwatah; Chimezie Igwegbe Nzoputam; Bogdan Oancea; Oluwakemi Ololade Odukoya; Ayodipupo Sikiru Oguntade; In-Hwan Oh; Andrew T. Olagunju; Tinuke O. 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Background: In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15–39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods: Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15–39 years to define adolescents and young adults. Findings: There were 1·19 million (95% UI 1·11–1·28) incident cancer cases and 396 000 (370 000–425 000) deaths due to cancer among people aged 15–39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5–65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8–57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9–15·6] per 100 000 person-years) and middle SDI (13·6 [12·6–14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9–25·2) DALYs to the global burden of disease, of which 2·7% (1·9–3·6) came from YLDs and 97·3% (96·4–98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation: Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Funding: Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019
(Elsevier B.V., 2022) Khanh Bao Tran; Justin J. Lang; Kelly Compton; Rixing Xu; Alistair R. Acheson; Hannah Jacqueline Henrikson; Jonathan M. Kocarnik; Louise Penberthy; Amirali Aali; Qamar Abbas; Behzad Abbasi; Mohsen Abbasi-Kangevari; Zeinab Abbasi-Kangevari; Hedayat Abbastabar; Michael Abdelmasseh; Sherief Abd-Elsalam; Ahmed Abdelwahab Abdelwahab; Gholamreza Abdoli; Hanan Abdulkadir Abdulkadir; Aidin Abedi; Kedir Hussein Abegaz; Hassan Abidi; Richard Gyan Aboagye; Hassan Abolhassani; Abdorrahim Absalan; Yonas Derso Abtew; Hiwa Abubaker Ali; Eman Abu-Gharbieh; Basavaprabhu Achappa; Juan Manuel Acuna; Daniel Addison; Isaac Yeboah Addo; Oyelola A. Adegboye; Miracle Ayomikun Adesina; Mohammad Adnan; Qorinah Estiningtyas Sakilah Adnani; Shailesh M. Advani; Sumia Afrin; Muhammad Sohail Afzal; Manik Aggarwal; Bright Opoku Ahinkorah; Araz Ramazan Ahmad; Rizwan Ahmad; Sajjad Ahmad; Sohail Ahmad; Sepideh Ahmadi; Haroon Ahmed; Luai A. Ahmed; Muktar Beshir Ahmed; Tarik Ahmed Rashid; Wajeeha Aiman; Marjan Ajami; Gizachew Taddesse Akalu; Mostafa Akbarzadeh-Khiavi; Addis Aklilu; Maxwell Akonde; Chisom Joyqueenet Akunna; Hanadi Al Hamad; Fares Alahdab; Fahad Mashhour Alanezi; Turki M. Alanzi; Saleh Ali Alessy; Abdelazeem M. Algammal; Mohammed Khaled Al-Hanawi; Robert Kaba Alhassan; Beriwan Abdulqadir Ali; Liaqat Ali; Syed Shujait Ali; Yousef Alimohamadi; Vahid Alipour; Syed Mohamed Aljunid; Motasem Alkhayyat; Sadeq Ali Ali Al-Maweri; Sami Almustanyir; Nivaldo Alonso; Shehabaldin Alqalyoobi; Rajaa M. Al-Raddadi; Rami H. Hani Al-Rifai; Salman Khalifah Al-Sabah; Ala’a B. Al-Tammemi; Haya Altawalah; Nelson Alvis-Guzman; Firehiwot Amare; Edward Kwabena Ameyaw; Javad Javad Aminian Dehkordi; Mohammad Hosein Amirzade-Iranaq; Hubert Amu; Ganiyu Adeniyi Amusa; Robert Ancuceanu; Jason A. Anderson; Yaregal Animut Animut; Amir Anoushiravani; Ali Arash Anoushirvani; Alireza Ansari-Moghaddam; Mustafa Geleto Ansha; Benny Antony; Maxwell Hubert Antwi; Sumadi Lukman Anwar; Razique Anwer; Anayochukwu Edward Anyasodor; Jalal Arabloo; Morteza Arab-Zozani; Olatunde Aremu; Ayele Mamo Argaw; Hany Ariffin; Timur Aripov; Muhammad Arshad; Al Artaman; Judie Arulappan; Raphael Taiwo Aruleba; Armin Aryannejad; Malke Asaad; Mulusew A. Asemahagn; Zatollah Asemi; Mohammad Asghari-Jafarabadi; Tahira Ashraf; Reza Assadi; Mohammad Athar; Seyyed Shamsadin Athari; Maha Moh’d Wahbi Atout; Sameh Attia; Avinash Aujayeb; Marcel Ausloos; Leticia Avila-Burgos; Atalel Fentahun Awedew; Mamaru Ayenew Awoke; Tewachew Awoke; Beatriz Paulina Ayala Quintanilla; Tegegn Mulatu Ayana; Solomon Shitu Ayen; Davood Azadi; Sina Azadnajafabad; Saber Azami-Aghdash; Melkalem Mamuye Azanaw; Mohammadreza Azangou-Khyavy; Amirhossein Azari Jafari; Hosein Azizi; Ahmed Y.Y. 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Bhuyan; Sadia Bibi; Awraris Hailu Bilchut; Bagas Suryo Bintoro; Antonio Biondi; Mesfin Geremaw Birega Birega; Habitu Eshetu Birhan; Tone Bjørge; Oleg Blyuss; Belay Boda Abule Bodicha; Srinivasa Rao Bolla; Archith Boloor; Cristina Bosetti; Dejana Braithwaite; Michael Brauer; Hermann Brenner; Andrey Nikolaevich Briko; Nikolay Ivanovich Briko; Christina Maree Buchanan; Norma B. Bulamu; Maria Teresa Bustamante-Teixeira; Muhammad Hammad Butt; Nadeem Shafique Butt; Zahid A. Butt; Florentino Luciano Caetano Dos Santos; Luis Alberto Cámera; Chao Cao; Yin Cao; Giulia Carreras; Márcia Carvalho; Francieli Cembranel; Ester Cerin; Promit Ananyo Chakraborty; Periklis Charalampous; Vijay Kumar Chattu; Odgerel Chimed-Ochir; Jesus Lorenzo Chirinos-Caceres; Daniel Youngwhan Cho; William C.S. Cho; Devasahayam J. Christopher; Dinh-Toi Chu; Isaac Sunday Chukwu; Aaron J. Cohen; Joao Conde; Sandra Cortés; Vera Marisa Costa; Natália Cruz-Martins; Garland T. Culbreth; Omid Dadras; Fentaw Teshome Dagnaw; Saad M.A. Dahlawi; Xiaochen Dai; Lalit Dandona; Rakhi Dandona; Parnaz Daneshpajouhnejad; Anna Danielewicz; An Thi Minh Dao; Reza Darvishi Cheshmeh Soltani; Aso Mohammad Darwesh; Saswati Das; Dragos Virgil Davitoiu; Elham Davtalab Esmaeili; Fernando Pio De La Hoz; Sisay Abebe Debela; Azizallah Dehghan; Biniyam Demisse; Fitsum Wolde Demisse; Edgar Denova-Gutiérrez; Afshin Derakhshani; Meseret Derbew Molla; Diriba Dereje; Kalkidan Solomon Deribe; Rupak Desai; Markos Desalegn Desalegn; Fikadu Nugusu Dessalegn; Samuel Abebe A. Dessalegni; Gashaw Dessie; Abebaw Alemayehu Desta; Syed Masudur Rahman Dewan; Samath Dhamminda Dharmaratne; Meghnath Dhimal; Mostafa Dianatinasab; Nancy Diao; Daniel Diaz; Lankamo Ena Digesa; Shilpi Gupta Dixit; Saeid Doaei; Linh Phuong Doan; Paul Narh Doku; Deepa Dongarwar; Wendel Mombaque dos Santos; Tim Robert Driscoll; Haneil Larson Dsouza; Oyewole Christopher Durojaiye; Sareh Edalati; Fatemeh Eghbalian; Elham Ehsani-Chimeh; Ebrahim Eini; Michael Ekholuenetale; Temitope Cyrus Ekundayo; Donatus U. Ekwueme; Maha El Tantawi; Mostafa Ahmed Elbahnasawy; Iffat Elbarazi; Hesham Elghazaly; Muhammed Elhadi; Waseem El-Huneidi; Mohammad Hassan Emamian; Luchuo Engelbert Bain; Daniel Berhanie Enyew; Ryenchindorj Erkhembayar; Tegegne Eshetu; Babak Eshrati; Sharareh Eskandarieh; Juan Espinosa-Montero; Farshid Etaee; Azin Etemadimanesh; Tahir Eyayu; Ifeanyi Jude Ezeonwumelu; Sayeh Ezzikouri; Adeniyi Francis Fagbamigbe; Saman Fahimi; Ildar Ravisovich Fakhradiyev; Emerito Jose A. Faraon; Jawad Fares; Abbas Farmany; Umar Farooque; Hossein Farrokhpour; Abidemi Omolara Fasanmi; Ali Fatehizadeh; Wafa Fatima; Hamed Fattahi; Ginenus Fekadu; Berhanu Elfu Feleke; Allegra Allegra Ferrari; Simone Ferrero; Lorenzo Ferro Desideri; Irina Filip; Florian Fischer; Roham Foroumadi; Masoud Foroutan; Takeshi Fukumoto; Peter Andras Gaal; Mohamed M. Gad; Muktar A. Gadanya; Abduzhappar Gaipov; Nasrin Galehdar; Silvano Gallus; Tushar Garg; Mariana Gaspar Fonseca; Yosef Haile Gebremariam; Teferi Gebru Gebremeskel; Mathewos Alemu Gebremichael; Yohannes Fikadu Geda; Yibeltal Yismaw Gela; Belete Negese Belete Gemeda; Melaku Getachew; Motuma Erena Getachew; Kazem Ghaffari; Mansour Ghafourifard; Seyyed-Hadi Ghamari; Mohammad Ghasemi Nour; Fariba Ghassemi; Ajnish Ghimire; Nermin Ghith; Maryam Gholamalizadeh; Jamshid Gholizadeh Navashenaq; Sherief Ghozy; Syed Amir Gilani; Paramjit Singh Gill; Themba G. Ginindza; Abraham Tamirat T. Gizaw; James C. Glasbey; Justyna Godos; Amit Goel; Mahaveer Golechha; Pouya Goleij; Davide Golinelli; Mohamad Golitaleb; Giuseppe Gorini; Bárbara Niegia Garcia Goulart; Giuseppe Grosso; Habtamu Alganeh Guadie; Mohammed Ibrahim Mohialdeen Gubari; Temesgen Worku Gudayu; Maximiliano Ribeiro Guerra; Damitha Asanga Gunawardane; Bhawna Gupta; Sapna Gupta; Veer Bala Gupta; Vivek Kumar Gupta; Mekdes Kondale Gurara; Alemu Guta; Parham Habibzadeh; Atlas Haddadi Avval; Nima Hafezi-Nejad; Adel Hajj Ali; Arvin Haj-Mirzaian; Esam S. Halboub; Aram Halimi; Rabih Halwani; Randah R. Hamadeh; Sajid Hameed; Samer Hamidi; Asif Hanif; Sanam Hariri; Netanja I. Harlianto; Josep Maria Haro; Risky Kusuma Hartono; Ahmed I. Hasaballah; S.M. Mahmudul Hasan; Hamidreza Hasani; Seyedeh Melika Hashemi; Abbas M. Hassan; Soheil Hassanipour; Khezar Hayat; Golnaz Heidari; Mohammad Heidari; Zahra Heidarymeybodi; Brenda Yuliana Herrera-Serna; Claudiu Herteliu; Kamal Hezam; Yuta Hiraike; Mbuzeleni Mbuzeleni Hlongwa; Ramesh Holla; Marianne Holm; Nobuyuki Horita; Mohammad Hoseini; Md. Mahbub Hossain; Mohammad Bellal Hossain Hossain; Mohammad-Salar Hosseini; Ali Hosseinzadeh; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mowafa Househ; Junjie Huang; Fernando N. Hugo; Ayesha Humayun; Salman Hussain; Nawfal R. Hussein; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Pulwasha Maria Iftikhar; Kevin S. Ikuta; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Mustapha Immurana; Kaire Innos; Pooya Iranpour; Lalu Muhammad Irham; Md Shariful Islam; Rakibul M. Islam; Farhad Islami; Nahlah Elkudssiah Ismail; Gaetano Isola; Masao Iwagami; Linda Merin J; Abhishek Jaiswal; Mihajlo Jakovljevic; Mahsa Jalili; Shahram Jalilian; Elham Jamshidi; Sung-In Jang; Chinmay T. Jani; Tahereh Javaheri; Umesh Umesh Jayarajah; Shubha Jayaram; Seyed Behzad Jazayeri; Rime Jebai; Bedru Jemal; Wonjeong Jeong; Ravi Prakash Jha; Har Ashish Jindal; Yetunde O. John-Akinola; Jost B. Jonas; Tamas Joo; Nitin Joseph; Farahnaz Joukar; Jacek Jerzy Jozwiak; Mikk Jürisson; Ali Kabir; Salah Eddine Oussama Kacimi; Vidya Kadashetti; Farima Kahe; Pradnya Vishal Kakodkar; Laleh R. Kalankesh; Leila R. Kalankesh; Rohollah Kalhor; Vineet Kumar Kamal; Farin Kamangar; Ashwin Kamath; Tanuj Kanchan; Eswar Kandaswamy; Himal Kandel; HyeJung Kang; Girum Gebremeskel Kanno; Neeti Kapoor; Sitanshu Sekhar Kar; Shama D. Karanth; Ibraheem M. Karaye; André Karch; Amirali Karimi; Bekalu Getnet Kassa; Patrick D.M.C. Katoto; Joonas H. Kauppila; Harkiran Kaur; Abinet Gebremickael Kebede; Leila Keikavoosi-Arani; Gemechu Gemechu Kejela; Phillip M. Kemp Bohan; Maryam Keramati; Mohammad Keykhaei; Himanshu Khajuria; Abbas Khan; Abdul Aziz Khan Khan; Ejaz Ahmad Khan; Gulfaraz Khan; Md. Nuruzzaman Khan; Moien A.B. Khan; Javad Khanali; Khaled Khatab; Moawiah Mohammad Khatatbeh; Mahalaqua Nazli Khatib; Maryam Khayamzadeh; Hamid Reza Khayat Kashani; Mohammad Amin Khazeei Tabari; Mehdi Khezeli; Mahmoud Khodadost; Min Seo Kim; Yun Jin Kim; Adnan Kisa; Sezer Kisa; Miloslav Klugar; Jitka Klugarová; Ali-Asghar Kolahi; Pavel Kolkhir; Farzad Kompani; Parvaiz A. Koul; Sindhura Lakshmi Koulmane Laxminarayana; Ai Koyanagi; Kewal Krishan; Yuvaraj Krishnamoorthy; Burcu Kucuk Bicer; Nuworza Kugbey; Mukhtar Kulimbet; Akshay Kumar; G. Anil Kumar; Narinder Kumar; Om P. Kurmi; Ambily Kuttikkattu; Carlo La Vecchia; Arista Lahiri; Dharmesh Kumar Lal; Judit Lám; Qing Lan; Iván Landires; Bagher Larijani; Savita Lasrado; Jerrald Lau; Paolo Lauriola; Caterina Ledda; Sang-Woong Lee; Shaun Wen Huey Lee; Wei-Chen Lee; Yeong Yeh Lee; Yo Han Lee; Samson Mideksa Legesse; James Leigh; Elvynna Leong; Ming-Chieh Li; Stephen S. Lim; Gang Liu; Jue Liu; Chun-Han Lo; Ayush Lohiya; Platon D. Lopukhov; László Lorenzovici; Mojgan Lotfi; Joana A. Loureiro; Raimundas Lunevicius; Farzan Madadizadeh; Ahmad R. Mafi; Sameh Magdeldin; Soleiman Mahjoub; Ata Mahmoodpoor; Morteza Mahmoudi; Marzieh Mahmoudimanesh; Rashidul Alam Mahumud; Azeem Majeed; Jamal Majidpoor; Alaa Makki; Konstantinos Christos Makris; Elaheh Malakan Rad; Mohammad-Reza Malekpour; Reza Malekzadeh; Ahmad Azam Malik; Tauqeer Hussain Mallhi; Sneha Deepak Mallya; Mohammed A. Mamun; Ana Laura Manda; Fariborz Mansour-Ghanaei; Borhan Mansouri; Mohammad Ali Mansournia; Lorenzo Giovanni Mantovani; Santi Martini; Miquel Martorell; Sahar Masoudi; Seyedeh Zahra Masoumi; Clara N. Matei; Elezebeth Mathews; Manu Raj Mathur; Vasundhara Mathur; Martin McKee; Jitendra Kumar Meena; Khalid Mehmood; Entezar Mehrabi Nasab; Ravi Mehrotra; Addisu Melese; Walter Mendoza; Ritesh G. Menezes; SIsay Derso Mengesha; Laverne G. Mensah; Alexios-Fotios A. Mentis; Andry Yasmid Mera Mera-Mamián; Tuomo J. 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Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license