Browsing by Author "Kate Louise Francis"

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Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019
(Elsevier Ltd, 2022) Amy E. Peden; Patricia Cullen; Kate Louise Francis; Holger Moeller; Margaret M. Peden; Pengpeng Ye; Maoyi Tian; Zhiyong Zou; Susan M. Sawyer; Amirali Aali; Zeinab Abbasi-Kangevari; Mohsen Abbasi-Kangevari; Michael Abdelmasseh; Meriem Abdoun; Rami Abd-Rabu; Deldar Morad Abdulah; Ame Mehadi Abdurehman; Getachew Abebe; Ayele Mamo Abebe; Aidin Abedi; Hassan Abidi; Richard Gyan Aboagye; Hiwa Abubaker Ali; Eman Abu Gharbieh; Denberu Eshetie Adane; Tigist Demssew Adane; Isaac Yeboah Addo; Ololade Grace Adewole; Sangeet Adhikari; Mohammad Adnan; Qorinah Estiningtyas Sakilah Adnani; Aanuoluwapo Adeyimika Bachelor Afolabi; Saira Afzal; Muhammad Sohail Afzal; Zahra Babaei Aghdam; Bright Opoku Ahinkorah; Araz Ramazan Ahmad; Tauseef Ahmad; Sajjad Ahmad; Ali Ahmadi; Haroon Ahmed; Muktar Beshir Ahmed; Ali Ahmed; Ayman Ahmed; Jivan Qasim Ahmed; Tarik Ahmed Rashid; Janardhana P. Aithala; Budi Aji; Meisam Akhlaghdoust; Fares Alahdab; Fahad Mashhour Alanezi; Astawus Alemayehu; Hanadi Al Hamad; Syed Shujait Ali; Liaqat Ali; Yousef Alimohamadi; Vahid Alipour; Syed Mohamed Aljunid; Louay Almidani; Sami Almustanyir; Khalid A. Altirkawi; Nelson J. Alvis-Zakzuk; Edward Kwabena Ameyaw; Tarek Tawfik Amin; Mehrdad Amir-Behghadami; Sohrab Amiri; Hoda Amiri; Tadele Fentabil Anagaw; Tudorel Andrei; Catalina Liliana Andrei; Davood Anvari; Sumadi Lukman Anwar; Anayochukwu Edward Anyasodor; Jalal Arabloo; Morteza Arab-Zozani; Asrat Arja; Judie Arulappan; Ashokan Arumugam; Armin Aryannejad; Saeed Asgary; Tahira Ashraf; Seyyed Shamsadin Athari; Alok Atreya; Sameh Attia; Avinash Aujayeb; Atalel Fentahun Awedew; Sina Azadnajafabad; Mohammadreza Azangou-Khyavy; Samad Azari; Amirhossein Azari Jafari; Hosein Azizi; Ahmed Y. Azzam; Ashish D. Badiye; Nayereh Baghcheghi; Sara Bagherieh; Atif Amin Baig; Shankar M. Bakkannavar; Asaminew Birhanu Balta; MacIej Banach; Palash Chandra Banik; Hansi Bansal; Mainak Bardhan; Francesco BaroneAdesi; Amadou Barrow; Azadeh Bashiri; Pritish Baskaran; Saurav Basu; Nebiyou Simegnew Bayileyegn; Abebe Ayalew Bekel; Alehegn Bekele Bekele; Salaheddine Bendak; Isabela M. Bensenor; Alemshet Yirga Berhie; Devidas S. Bhagat; Akshaya Srikanth Bhagavathula; Pankaj Bhardwaj; Nikha Bhardwaj; Sonu Bhaskar; Ajay Nagesh Bhat; Krittika Bhattacharyya; Zulfiqar A. Bhutta; Sadia Bibi; Bagas Suryo Bintoro; Saeid Bitaraf; Belay Boda Abule Bodicha; Archith Boloor; Souad Bouaoud; Julie Brown; Katrin Burkart; Nadeem Shafique Butt; Muhammad Hammad Butt; Luis Alberto CÃ¡mera; Julio Cesar Campuzano Rincon; Chao Cao; Andre F. Carvalho; MÃ¡rcia Carvalho; Promit Ananyo Chakraborty; Eeshwar K. Chandrasekar; Jung-Chen Chang; Periklis Charalampous; Jaykaran Charan; Vijay Kumar Chattu; Bitew Mekonnen Chekole; Abdulaal Chitheer; Daniel Youngwhan Cho; Hitesh Chopra; Devasahayam J. Christopher; Isaac Sunday Chukwu; NatÃ¡lia Cruz-Martins; Omid Dadras; Saad M.A. Dahlawi; Xiaochen Dai; Giovanni Damiani; Gary L. Darmstadt; Reza Darvishi Cheshmeh Soltani; Aso Mohammad Darwesh; Saswati Das; Anna Dastiridou; Sisay Abebe Debela; Amin Dehghan; Getnet Makasha Demeke; Andreas K. Demetriades; Solomon Demissie; Fikadu Nugusu Dessalegn; Abebaw Alemayehu Desta; Mostafa Dianatinasab; Nancy Diao; Diana Dias Da Silva; Daniel Diaz; Lankamo Ena Digesa; Mengistie Diress; Shirin Djalalinia; Linh Phuong Doan; Milad Dodangeh; Paul Narh Doku; Deepa Dongarwar; Haneil Larson Dsouza; Ebrahim Eini; Michael Ekholuenetale; Temitope Cyrus Ekundayo; Ahmed Elabbas Mustafa Elagali; Mostafa Ahmed Elbahnasawy; Hala Rashad Elhabashy; Muhammed Elhadi; Maysaa El Sayed Zaki; Daniel Berhanie Enyew; Ryenchindorj Erkhembayar; Sharareh Eskandarieh; Farshid Etaee; Adeniyi Francis Fagbamigbe; Pawan Sirwan Faris; Abbas Farmany; Andre Faro; Farshad Farzadfar; Ali Fatehizadeh; Seyed Mohammad Fereshtehnejad; Abdullah Hamid Feroze; Getahun Fetensa; Bikila Regassa Feyisa; Irina Filip; Florian Fischer; Behzad Foroutan; Masoud Foroutan; Kayode Raphael Fowobaje; Richard Charles Franklin; Takeshi Fukumoto; Peter Andras Gaal; Muktar A. Gadanya; Yaseen Galali; Nasrin Galehdar; Balasankar Ganesan; Tushar Garg; Mesfin Gebrehiwot Damtew Gebrehiwot; Yosef Haile Gebremariam; Yibeltal Yismaw Gela; Urge Gerema; Mansour Ghafourifard; Seyyed-Hadi Ghamari; Reza Ghanbari; Mohammad Ghasemi Nour; Maryam Gholamalizadeh; Ali Gholami; Ali Gholamrezanezhad; Sherief Ghozy; Syed Amir Gilani; Tiffany K. Gill; Iago GinÃ©-VÃ¡zquez; Zeleke Abate Girma; James C. Glasbey; Franklin N. Glozah; Mahaveer Golechha; Pouya Goleij; Michal Grivna; Habtamu Alganeh Guadie; Damitha Asanga Gunawardane; Yuming Guo; Veer Bala Gupta; Sapna Gupta; Bhawna Gupta; Vivek Kumar Gupta; Arvin Haj-Mirzaian; Rabih Halwani; Randah R. Hamadeh; Sajid Hameed; Lolemo Kelbiso Hanfore; Asif Hanif; Arief Hargono; Netanja I. Harlianto; Mehdi Harorani; Ahmed I. Hasaballah; S.M. Mahmudul Hasan; Amr Hassan; Soheil Hassanipour; Hadi Hassankhani; Rasmus J. Havmoeller; Simon I. Hay; Mohammad Heidari; Delia Hendrie; Demisu Zenbaba Heyi; Yuta Hiraike; Ramesh Holla; Nobuyuki Horita; Sheikh Jamal Hossain; Mohammad Bellal Hossain Hossain; Sedighe Hosseini Shabanan; Mehdi Hosseinzadeh; Sorin Hostiuc; Amir Human Hoveidaei; Alexander Kevin Hsiao; Salman Hussain; Amal Hussein; Segun Emmanuel Ibitoye; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Behzad Imani; Mustapha Immurana; Leeberk Raja Inbaraj; Sheikh Mohammed Shariful Islam; Rakibul M. Islam; Mohammad Mainul Islam; Nahlah Elkudssiah Ismail; J. Linda Merin; Haitham Jahrami; Mihajlo Jakovljevic; Manthan Dilipkumar Janodia; Tahereh Javaheri; Sathish Kumar Jayapal; Umesh Umesh Jayarajah; Sudha Jayaraman; Jayakumar Jeganathan; Bedru Jemal; Ravi Prakash Jha; Jost B. Jonas; Tamas Joo; Nitin Joseph; Jacek Jerzy Jozwiak; Mikk JÃ¼risson; Ali Kabir; Vidya Kadashetti; Dler Hussein Kadir; Laleh R. Kalankesh; Leila R. Kalankesh; Rohollah Kalhor; Vineet Kumar Kamal; Rajesh Kamath; Himal Kandel; Rami S. Kantar; Neeti Kapoor; Hassan Karami; Ibraheem M. Karaye; Samad Karkhah; Patrick D.M.C. Katoto; Joonas H. Kauppila; Gbenga A. Kayode; Leila Keikavoosi-Arani; Cumali Keskin; Yousef Saleh Khader; Himanshu Khajuria; Mohammad Khammarnia; Ejaz Ahmad Khan; Md Nuruzzaman Khan; Maseer Khan; Yusra H. Khan; Imteyaz A. Khan; Abbas Khan; Moien A.B. Khan; Javad Khanali; Moawiah Mohammad Khatatbeh; Hamid Reza Khayat Kashani; Habibolah Khazaie; Jagdish Khubchandani; Zemene Demelash Kifle; Jihee Kim; Yun Jin Kim; Sezer Kisa; Adnan Kisa; Cameron J. Kneib; Farzad Kompani; Hamid Reza Koohestani; Parvaiz A. Koul; Sindhura Lakshmi Koulmane Laxminarayana; Ai Koyanagi; Kewal Krishan; Vijay Krishnamoorthy; Burcu Kucuk Bicer; Nithin Kumar; Naveen Kumar; Narinder Kumar; Manasi Kumar; Om P. Kurmi; Lucie Laflamme; Judit LÃ¡m; IvÃ¡n Landires; Bagher Larijani; Savita Lasrado; Paolo Lauriola; Carlo La Vecchia; Shaun Wen Huey Lee; Yo Han Lee; Sang-Woong Lee; Wei Chen Lee; Samson Mideksa Legesse; Shanshan Li; Stephen S. Lim; LÃ¡szlÃ³ Lorenzovici; Amana Ogeto Luke; Farzan Madadizadeh; Áurea M. Madureira-Carvalho; Muhammed Magdy Abd El Razek; Soleiman Mahjoub; Ata Mahmoodpoor; Razzagh Mahmoudi; Marzieh Mahmoudimanesh; Azeem Majeed; Alaa Makki; Elaheh Malakan Rad; Mohammad-Reza Malekpour; Ahmad Azam Malik; Tauqeer Hussain Mallhi; Deborah Carvalho Malta; Borhan Mansouri; Mohammad Ali Mansournia; Elezebeth Mathews; Sazan Qadir Maulud; Dennis Mazingi; Entezar Mehrabi Nasab; Oliver Mendoza-Cano; Ritesh G. Menezes; Dechasa Adare Mengistu; Alexios-Fotios A. Mentis; Atte Meretoja; Mohamed Kamal Mesregah; Tomislav Mestrovic; Ana Carolina Micheletti Gomide Nogueira de Sá; Ted R. Miller; Seyed Peyman Mirghaderi; Andreea Mirica; Seyyedmohammadsadeq Mirmoeeni; Erkin M. Mirrakhimov; Moonis Mirza; Sanjeev Misra; Prasanna Mithra; Chaitanya Mittal; Madeline E. Moberg; Mokhtar Mohammadi; Soheil Mohammadi; Esmaeil Mohammadi; Reza Mohammadpourhodki; Shafiu Mohammed; Teroj Abdulrahman Mohammed; Mohammad Mohseni; Ali H. Mokdad; Sara Momtazmanesh; Lorenzo Monasta; Mohammad Ali Moni; Rafael Silveira Moreira; Shane Douglas Morrison; Ebrahim Mostafavi; Haleh Mousavi Isfahani; Sumaira Mubarik; Lorenzo Muccioli; Soumyadeep Mukherjee; Francesk Mulita; Ghulam Mustafa; Ahamarshan Jayaraman Nagarajan; Mukhammad David Naimzada; Vinay Nangia; Hasan Nassereldine; Zuhair S. Natto; Biswa Prakash Nayak; Ionut Negoi; Seyed Aria Nejadghaderi; Samata Nepal; Sandhya Neupane Kandel; Nafise Noroozi; Virginia NuÃ±ez-Samudio; Ogochukwu Janet Nzoputam; Chimezie Igwegbe Nzoputam; Chimedsuren Ochir; Julius Nyerere Odhiambo; Oluwakemi Ololade Odukoya; Hassan Okati-Aliabad; Osaretin Christabel Okonji; Andrew T. Olagunju; Ahmed Omar Bali; Emad Omer; Adrian Otoiu; Stanislav S. Otstavnov; Nikita Otstavnov; Bilcha Oumer; Mayowa O. Owolabi; P.A. Mahesh; Alicia Padron-Monedero; Jagadish Rao Padubidri; Mohammad Taha Pahlevan Fallahy; Songhomitra Panda-Jonas; Seithikurippu R. Pandi-Perumal; Shahina Pardhan; Eun-Kee Park; Sangram Kishor Patel; Aslam Ramjan Pathan; Siddhartha Pati; Uttam Paudel; Shrikant Pawar; Paolo Pedersini; Mario F.P. Peres; Ionela-Roxana Petcu; Michael R. Phillips; Julian David Pillay; Zahra Zahid Piracha; Mohsen Poursadeqiyan; Naeimeh Pourtaheri; Ibrahim Qattea; Amir Radfar; Ata Rafiee; Pankaja Raghav Raghav; Fakher Rahim; Muhammad Aziz Rahman; Firman Suryadi Rahman; Mosiur Rahman; Amir Masoud Rahmani; Shayan Rahmani; Sheetal Raj Moolambally; Sheena Ramazanu; Kiana Ramezanzadeh; Juwel Rana; Saleem Muhammad Rana; Chythra R. Rao; Sowmya J. Rao; Vahid Rashedi; Mohammad Mahdi Rashidi; Prateek Rastogi; Azad Rasul; Salman Rawaf; David Laith Rawaf; Lal Rawal; Reza Rawassizadeh; Negar Rezaei; Nazila Rezaei; Mohsen Rezaeian; Aziz Rezapour; Abanoub Riad; Muhammad Riaz; Jennifer Rickard; Jefferson Antonio Buendia Rodriguez; Leonardo Roever; Luca Ronfani; Bedanta Roy; S. Manjula; Aly M.A. Saad; Siamak Sabour; Leila Sabzmakan; Basema Saddik; Malihe Sadeghi; Mohammad Reza Saeb; Umar Saeed; Sahar Saeedi Moghaddam; Sher Zaman Safi; Biniyam Sahiledengle; Harihar Sahoo; Mohammad Ali Sahraian; Morteza Saki; Payman Salamati; Sana Salehi; Marwa Rashad Salem; Abdallah M. Samy; Juan Sanabria; Milena M. Santric-Milicevic; Muhammad Arif Nadeem Saqib; Yaser Sarikhani; Arash Sarveazad; Brijesh Sathian; Maheswar Satpathy; Ganesh Kumar Saya; Ione Jayce Ceola Schneider; David C. Schwebel; Hamed Seddighi; Subramanian Senthilkumaran; Allen Seylani; Hosein Shabaninejad; Melika Shafeghat; Pritik A. Shah; Saeed Shahabi; Ataollah Shahbandi; Fariba Shahraki-Sanavi; Masood Ali Shaikh; Elaheh Shaker; Mehran Shams-Beyranvand; Mohd Shanawaz; Mohammed Shannawaz; Mequannent Melaku Sharew Sharew; Neeraj Sharma; Bereket Beyene Shashamo; Maryam Shayan; Rahim Ali Sheikhi; Jiabin Shen; B. Suresh Kumar Shetty; Pavanchand H. Shetty; Jae Il Shin; Nebiyu Aniley Shitaye; K.M. Shivakumar; Parnian Shobeiri; Seyed Afshin Shorofi; Sunil Shrestha; Soraya Siabani; Negussie Boti Sidemo; Wudneh Simegn; Ehsan Sinaei; Paramdeep Singh; Robert Sinto; Md Shahjahan Siraj; Valentin Yurievich Skryabin; Anna Aleksandrovna Skryabina; David A. Sleet; S.N. Chandan; Bogdan Socea; Marco Solmi; Yonatan Solomon; Yi Song; Raúl A.R.C. Sousa; Ireneous N. Soyiri; Mark A. Stokes; Muhammad Suleman; Rizwan Suliankatchi Abdulkader; Jing Sun; Rafael TabarÃ©s-Seisdedos; Seyyed Mohammad Tabatabaei; Mohammad Tabish; Ensiyeh Taheri; Moslem Taheri Soodejani; Mircea Tampa; KerKan Tan; Ingan Ukur Tarigan; Md Tariqujjaman; Nathan Y. Tat; Vivian Y. Tat; Arash Tavakoli; Belay Negash Tefera; Yibekal Manaye Tefera; Gebremaryam Temesgen; Mohamad-Hani Temsah; Pugazhenthan Thangaraju; Rekha Thapar; Nikhil Kenny Thomas; Jansje Henny Vera Ticoalu; Marius Belmondo Tincho; Amir Tiyuri; Munkhsaikhan Togtmol; Marcos Roberto Tovani-Palone; Mai Thi Ngoc Tran; Sana Ullah; Saif Ullah; Irfan Ullah; Srikanth Umakanthan; Bhaskaran Unnikrishnan; Era Upadhyay; Sahel Valadan Tahbaz; Pascual R. Valdez; Tommi Juhani Vasankari; Siavash Vaziri; Massimiliano Veroux; Dominique Vervoort; Francesco S. Violante; Vasily Vlassov; Linh Gia Vu; Yasir Waheed; Yanzhong Wang; Yuan-Pang Wang; Cong Wang; Taweewat Wiangkham; Nuwan Darshana Wickramasinghe; Abay Tadesse Woday; Ai-Min Wu; Gahin Abdulraheem Tayib Yahya; Seyed Hossein Yahyazadeh Jabbari; Lin Yang; Sanni Yaya; Arzu Yigit; Vahit Yigit; Eshetu Yisihak; Naohiro Yonemoto; Yuyi You; Mustafa Z. Younis; Chuanhua Yu; Ismaeel Yunusa; Hossein Yusefi; Mazyar Zahir; Sojib Bin Zaman; Iman Zare; Kourosh Zarea; Mikhail Sergeevich Zastrozhin; Zhi-Jiang Zhang; Yunquan Zhang; Arash Ziapour; Sanjay Zodpey; Mohammad Zoladl; George C. Patton; Rebecca Q. Ivers
Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. 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 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. 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Ikuta; Mehran Ilaghi; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Mustapha Immurana; Leeberk Raja Inbaraj; Arnaud Iradukunda; Farideh Iravanpour; Kenneth Chukwuemeka Iregbu; Md Rabiul Islam; Mohammad Mainul Islam; Sheikh Mohammed Shariful Islam; Farhad Islami; Nahlah Elkudssiah Ismail; Gaetano Isola; Masao Iwagami; Chidozie C.D. Iwu; Chinwe Juliana Iwu-Jaja; Mahalaxmi Iyer; Linda Merin; Jalil Jaafari; Louis Jacob; Kathryn H. Jacobsen; Farhad Jadidi-Niaragh; Morteza Jafarinia; Khushleen Jaggi; Kasra Jahankhani; Nader Jahanmehr; Haitham Jahrami; Akhil Jain; Nityanand Jain; Ammar Abdulrahman Jairoun; Mihajlo Jakovljevic; Reza Jalilzadeh Yengejeh; Elham Jamshidi; Chinmay T. Jani; Mark M. Janko; Abubakar Ibrahim Jatau; Sathish Kumar Jayapal; Shubha Jayaram; Jayakumar Jeganathan; Alelign Tasew Jema; Digisie Mequanint Jemere; Wonjeong Jeong; Anil K. Jha; Ravi Prakash Jha; John 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 burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
(Elsevier B.V., 2024) Mohsen Naghavi; Kanyin Liane Ong; Amirali Aali; Hazim S. Ababneh; Yohannes Habtegiorgis Abate; Cristiana Abbafati; Rouzbeh Abbasgholizadeh; Mohammadreza Abbasian; Mohsen Abbasi-Kangevari; Hedayat Abbastabar; Samar Abd ElHafeez; Michael Abdelmasseh; Sherief Abd-Elsalam; Ahmed Abdelwahab; Mohammad Abdollahi; Mohammad-Amin Abdollahifar; Meriem Abdoun; Deldar Morad Abdulah; Auwal Abdullahi; Mesfin Abebe; Samrawit Shawel Abebe; Aidin Abedi; Kedir Hussein Abegaz; E.S. Abhilash; Hassan Abidi; Olumide Abiodun; Richard Gyan Aboagye; Hassan Abolhassani; Meysam Abolmaali; Mohamed Abouzid; Girma Beressa Aboye; Lucas Guimaraes Abreu; Woldu Aberhe Abrha; Dariush Abtahi; Samir Abu Rumeileh; Hasan Abualruz; Bilyaminu Abubakar; Eman Abu-Gharbieh; Niveen Me Abu-Rmeileh; Salahdein Aburuz; Ahmed Abu-Zaid; Manfred Mario Kokou Accrombessi; Tadele Girum Adal; Abdu A. Adamu; Isaac Yeboah Addo; Giovanni Addolorato; Akindele Olupelumi Adebiyi; Victor Adekanmbi; Abiola Victor Adepoju; Charles Oluwaseun Adetunji; Juliana Bunmi Adetunji; Temitayo Esther Adeyeoluwa; Daniel Adedayo Adeyinka; Olorunsola Israel Adeyomoye; Biruk Adie Admass; Qorinah Estiningtyas Sakilah Adnani; Saryia Adra; Aanuoluwapo Adeyimika Afolabi; Muhammad Sohail Afzal; Saira Afzal; Suneth Buddhika Agampodi; Pradyumna Agasthi; Manik Aggarwal; Shahin Aghamiri; Feleke Doyore Agide; Antonella Agodi; Anurag Agrawal; Williams Agyemang-Duah; Bright Opoku Ahinkorah; Aqeel Ahmad; Danish Ahmad; Firdos Ahmad; Muayyad M Ahmad; Sajjad Ahmad; Shahzaib Ahmad; Tauseef Ahmad; Keivan Ahmadi; Amir Mahmoud Ahmadzade; Ali Ahmed; Ayman Ahmed; Haroon Ahmed; Luai A. Ahmed; Mehrunnisha Sharif Ahmed; Meqdad Saleh Ahmed; Muktar Beshir Ahmed; Syed Anees Ahmed; Marjan Ajami; Budi Aji; Essona Matatom Akara; Hossein Akbarialiabad; Karolina Akinosoglou; Tomi Akinyemiju; Mohammed Ahmed Akkaif; Samuel Akyirem; Hanadi Al Hamad; Syed Mahfuz Al Hasan; Fares Alahdab; Samer O. Alalalmeh; Tariq A. Alalwan; Ziyad Al-Aly; Khurshid Alam; Manjurul Alam; Noore Alam; Rasmieh Mustafa Al-Amer; Fahad Mashhour Alanezi; Turki M. Alanzi; Sayer Al-Azzam; Almaza Albakri; Mohammed Albashtawy; Mohammad T. AlBataineh; Jacqueline Elizabeth Alcalde-Rabanal; Khalifah A. Aldawsari; Wafa A. Aldhaleei; Robert W. Aldridge; Haileselasie Berhane Alema; Mulubirhan Assefa Alemayohu; Sharifullah Alemi; Yihun Mulugeta Alemu; Adel Ali Saeed Al-Gheethi; Khalid F. Alhabib; Fadwa Alhalaiqa Naji Alhalaiqa; Mohammed Khaled Al-Hanawi; Abid Ali; Amjad Ali; Liaqat Ali; Mohammed Usman Ali; Rafat Ali; Shahid Ali; Syed Shujait Shujait Ali; Gianfranco Alicandro; Sheikh Mohammad Alif; Reyhaneh Alikhani; Yousef Alimohamadi; Ahmednur Adem Aliyi; Mohammad A. M. Aljasir; Syed Mohamed Aljunid; Francois Alla; Peter Allebeck; Sabah Al-Marwani; Sadeq Ali Ali Al-Maweri; Joseph Uy Almazan; Hesham M. Al-Mekhlafi; Louay Almidani; Omar Almidani; Mahmoud A. Alomari; Basem Al-Omari; Jordi Alonso; Jaber S. Alqahtani; Shehabaldin Alqalyoobi; Ahmed Yaseen Alqutaibi; Salman Khalifah Al-Sabah; Zaid Altaany; Awais Altaf; Jaffar A. Al-Tawfiq; Khalid A. Altirkawi; Deborah Oyine Aluh; Nelson Alvis-Guzman; Hassan Alwafi; Yaser Mohammed Al-Worafi; Hany Aly; Safwat Aly; Karem H. Alzoubi; Reza Amani; Azmeraw T. Amare; Prince M. Amegbor; Edward Kwabena Ameyaw; Tarek Tawfik Amin; Alireza Amindarolzarbi; Sohrab Amiri; Mohammad Hosein Amirzade-Iranaq; Hubert Amu; Dickson A. 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Artamonov; Judie Arulappan; Raphael Taiwo Aruleba; Ashokan Arumugam; Malke Asaad; Mohsen Asadi-Lari; Akeza Awealom Asgedom; Mona Asghariahmadabad; Mohammad Asghari-Jafarabadi; Muhammad Ashraf; Armin Aslani; Thomas Astell-Burt; Mohammad Athar; Seyyed Shamsadin Athari; Bantalem Tilaye Tilaye Atinafu; Habtamu Wondmagegn Atlaw; Prince Atorkey; Maha Moh'D Wahbi Atout; Alok Atreya; Avinash Aujayeb; Marcel Ausloos; Abolfazl Avan; Atalel Fentahun Awedew; Amlaku Mulat Aweke; Beatriz Paulina Ayala Quintanilla; Haleh Ayatollahi; Jose L. Ayuso-Mateos; Seyed Mohammad Ayyoubzadeh; Sina Azadnajafabad; Rui M. S. Azevedo; Ahmed Y. Azzam; B.B. Darshan; Abraham Samuel Babu; Muhammad Badar; Ashish D. Badiye; Soroush Baghdadi; Nasser Bagheri; Sara Bagherieh; Sulaiman Bah; Saeed Bahadorikhalili; Najmeh Bahmanziari; Ruhai Bai; Atif Amin Baig; Jennifer L. Baker; Abdulaziz T. Bako; Ravleen Kaur Bakshi; Senthilkumar Balakrishnan; Madhan Balasubramanian; Ovidiu Constantin Baltatu; Kiran Bam; MacIej Banach; Soham Bandyopadhyay; Palash Chandra Banik; Hansi Bansal; Kannu Bansal; Franca Barbic; Martina Barchitta; Mainak Bardhan; Erfan Bardideh; Suzanne Lyn Barker-Collo; Till Winfried Barnighausen; Francesco Barone-Adesi; Hiba Jawdat Barqawi; Lope H. Barrero; Amadou Barrow; Sandra Barteit; Lingkan Barua; Zarrin Basharat; Azadeh Bashiri; Afisu Basiru; Pritish Baskaran; Buddha Basnyat; Quique Bassat; João Diogo Basso; Ann V. L. Basting; Sanjay Basu; Kavita Batra; Bernhard T. Baune; Mohsen Bayati; Nebiyou Simegnew Bayileyegn; Thomas Beaney; Neeraj Bedi; Massimiliano Beghi; Emad Behboudi; Priyamadhaba Behera; Amir Hossein Behnoush; Masoud Behzadifar; Maryam Beiranvand; Diana Fernanda Bejarano Ramirez; Yannick Béjot; Sefealem Assefa Belay; Chalie Mulu Belete; Michelle L. Bell; Muhammad Bashir Bello; Olorunjuwon Omolaja Bello; Luis Belo; Apostolos Beloukas; Rose Grace Bender; Isabela M. Bensenor; Azizullah Beran; Zombor Berezvai; Alemshet Yirga Berhie; Betyna N. Berice; Robert S. Bernstein; Gregory J. Bertolacci; Paulo J. G. Bettencourt; Kebede A. Beyene; Devidas S. Bhagat; Akshaya Srikanth Bhagavathula; Neeraj Bhala; Ashish Bhalla; Dinesh Bhandari; Kayleigh Bhangdia; 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; Jessica Devin Bishai; Catherine Bisignano; Francesca Bisulli; Atanu Biswas; Bijit Biswas; Saeid Bitaraf; Bikes Destaw Bitew; Veera R. Bitra; Tone Bjørge; Micheal Kofi Boachie; Mary Sefa Boampong; Anca Vasilica Bobirca; Virginia Bodolica; Aadam Olalekan Bodunrin; Eyob Ketema Bogale; Kassawmar Angaw Bogale; Somayeh Bohlouli; Obasanjo Afolabi Bolarinwa; Archith Boloor; Milad Bonakdar Hashemi; Aime Bonny; Kaustubh Bora; Berrak Bora Basara; Hamed Borhany; Arturo Borzutzky; Souad Bouaoud; Antoine Boustany; Christopher Boxe; Edward J. Boyko; Oliver J. Brady; Dejana Braithwaite; Luisa C. Brant; Michael Brauer; Alexandra Brazinova; Javier Brazo-Sayavera; Nicholas J. K. Breitborde; Susanne Breitner; Hermann Brenner; Andrey Nikolaevich Briko; Nikolay Ivanovich Briko; Gabrielle Britton; Julie Brown; Traolach Brugha; Norma B. Bulamu; Lemma N. Bulto; Danilo Buonsenso; Richard A. Burns; Reinhard Busse; Yasser Bustanji; Nadeem Shafique Butt; Zahid A. Butt; Florentino Luciano Caetano Dos Santos; Daniela Calina; Luis Alberto Camera; Luciana Aparecida Campos; Ismael R. Campos-Nonato; Chao Cao; Yin Cao; Angelo Capodici; Rosario Cárdenas; Sinclair Carr; Giulia Carreras; Juan J. Carrero; Andrea Carugno; Cristina G. Carvalheiro; Felix Carvalho; Márcia Carvalho; Joao Mauricio Castaldelli-Maia; Carlos A. Castañeda-Orjuela; Giulio Castelpietra; Ferrán Catalá-López; Alberico L. Catapano; Maria Sofia Cattaruzza; Christopher R. Cederroth; Luca Cegolon; Francieli Cembranel; Muthia Cenderadewi; Kelly M. Cercy; Ester Cerin; Muge Cevik; Joshua Chadwick; Yaacoub Chahine; Chiranjib Chakraborty; Promit Ananyo Chakraborty; Jeffrey Shi Kai Chan; Raymond N. C. Chan; Rama Mohan Chandika; Eeshwar K. Chandrasekar; Chin-Kuo Chang; Jung-Chen Chang; Gashaw Sisay Chanie; Periklis Charalampous; Vijay Kumar Chattu; Pankaj Chaturvedi; Victoria Chatzimavridou-Grigoriadou; Akhilanand Chaurasia; Angela W. Chen; An-Tian Chen; Catherine S. Chen; Haowei Chen; Meng Xuan Chen; Simiao Chen; Ching-Yu Cheng; Esther T. W. Cheng; Nicolas Cherbuin; Wondimye Ashenafi Cheru; Ju-Huei Chien; Odgerel Chimed-Ochir; Ritesh Chimoriya; Patrick R. Ching; Jesus Lorenzo Chirinos-Caceres; Abdulaal Chitheer; William C. S. Cho; Bryan Chong; Hitesh Chopra; Sonali Gajanan Choudhari; Rajiv Chowdhury; Devasahayam J. Christopher; Isaac Sunday Chukwu; Eric Chung; Erin Chung; Eunice Chung; Sheng-Chia Chung; Muhammad Chutiyami; Zinhle Cindi; Iolanda Cioffi; Mareli M. Claassens; Rafael M. Claro; Kaleb Coberly; Rebecca M. Cogen; Alyssa Columbus; Haley Comfort; Joao Conde; Samuele Cortese; Paolo Angelo Cortesi; Vera Marisa Costa; Simona Costanzo; Ewerton Cousin; Rosa A. S. Couto; Richard G. Cowden; Kenneth Michael Cramer; Michael H. Criqui; Natalia Cruz-Martins; Silvia Magali Cuadra-Hernandez; Garland T. Culbreth; Patricia Cullen; Matthew Cunningham; Maria Paula Curado; Sriharsha Dadana; Omid Dadras; Siyu Dai; Xiaochen Dai; Zhaoli Dai; Lachlan L. Dalli; Giovanni Damiani; Jiregna Darega Gela; Jai K. Das; Saswati Das; Subasish Das; Ana Maria Dascalu; Nihar Ranjan Dash; Mohsen Dashti; Anna Dastiridou; Gail Davey; Claudio Alberto Davila-Cervantes; Nicole Davis Weaver; Kairat Davletov; Diego De Leo; Katie De Luca; Aklilu Tamire Debele; Shayom Debopadhaya; Louisa Degenhardt; Azizallah Dehghan; Lee Deitesfeld; Cristian Del Bo; Ivan Delgado-Enciso; Berecha Hundessa Demessa; Andreas K. Demetriades; Ke Deng; Xinlei Deng; Edgar Denova-Gutierrez; Niloofar Deravi; Nebiyu Dereje; Nikolaos Dervenis; Emina Dervišević; Don C. Des Jarlais; Hardik Dineshbhai Desai; Rupak Desai; Vinoth Gnana Chellaiyan Devanbu; Syed Masudur Rahman Dewan; Arkadeep Dhali; Kuldeep Dhama; Meghnath Dhimal; Sameer Dhingra; Vishal R. Dhulipala; Diana Dias Da Silva; Daniel Diaz; Michael J. Diaz; Adriana Dima; Delaney D. Ding; Huanghe Ding; Ricardo Jorge Dinis-Oliveira; M. Ashworth Dirac; Shirin Djalalinia; Thao Huynh Phuong Do; Camila Bruneli Do Prado; Saeid Doaei; Masoud Dodangeh; Milad Dodangeh; Sushil Dohare; Klara Georgieva Dokova; Christiane Dolecek; Regina-Mae Villanueva Dominguez; Wanyue Dong; Deepa Dongarwar; Mario D'Oria; Fariba Dorostkar; E. Ray Dorsey; Wendel Mombaque Dos Santos; Rajkumar Doshi; Leila Doshmangir; Robert Kokou Dowou; Tim Robert Driscoll; Haneil Larson Dsouza; Viola Dsouza; Mi Du; John Dube; Bruce B. Duncan; Andre Rodrigues Duraes; Senbagam Duraisamy; Oyewole Christopher Durojaiye; Laura Dwyer-Lindgren; Paulina Agnieszka Dzianach; Arkadiusz Marian Dziedzic; Abdel Rahman E'Mar; Ejemai Eboreime; Alireza Ebrahimi; Chidiebere Peter Echieh; Hisham Atan Edinur; David Edvardsson; Kristina Edvardsson; Defi Efendi; Ferry Efendi; Diyan Ermawan Effendi; Terje Andreas Eikemo; Ebrahim Eini; Michael Ekholuenetale; Temitope Cyrus Ekundayo; Iman El Sayed; Iffat Elbarazi; Teshome Bekele Elema; Noha Mousaad Elemam; Frank J. Elgar; Islam Y. Elgendy; Ghada Metwally Tawfik ElGohary; Hala Rashad Elhabashy; Muhammed Elhadi; Waseem El-Huneidi; Legesse Tesfaye Elilo; Omar Abdelsadek Abdou Elmeligy; Mohamed A. Elmonem; Mohammed Elshaer; Ibrahim Elsohaby; Theophilus I. Emeto; Luchuo Engelbert Bain; Ryenchindorj Erkhembayar; Christopher Imokhuede Esezobor; Babak Eshrati; Sharareh Eskandarieh; Juan Espinosa-Montero; Habtamu Esubalew; Farshid Etaee; Natalia Fabin; Adewale Oluwaseun Fadaka; Adeniyi Francis Fagbamigbe; Ayesha Fahim; Saman Fahimi; Aliasghar Fakhri-Demeshghieh; Luca Falzone; Mohammad Fareed; Carla Sofia E Sa Farinha; Moezalislam Ezzat Mahmoud Faris; Pawan Sirwan Faris; Andre Faro; Abidemi Omolara Fasanmi; Ali Fatehizadeh; Hamed Fattahi; Nelsensius Klau Fauk; Pooria Fazeli; Valery L. Feigin; Alireza Feizkhah; Ginenus Fekadu; Xiaoru Feng; Seyed-Mohammad Fereshtehnejad; Abdullah Hamid Feroze; Daniela Ferrante; Alize J. 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Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. 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 fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
(Elsevier B.V., 2024) Natalia V. Bhattacharjee; Austin E. Schumacher; Amirali Aali; Yohannes Habtegiorgis Abate; Rouzbeh Abbasgholizadeh; Mohammadreza Abbasian; Mohsen Abbasi-Kangevari; Hedayat Abbastabar; Samar Abd ElHafeez; Sherief Abd-Elsalam; Mohammad Abdollahi; Mohammad-Amin Abdollahifar; Meriem Abdoun; Auwal Abdullahi; Mesfin Abebe; Samrawit Shawel Abebe; Olumide Abiodun; Hassan Abolhassani; Meysam Abolmaali; Mohamed Abouzid; Girma Beressa Aboye; Lucas Guimarães Abreu; Woldu Aberhe Abrha; Michael R.M. Abrigo; Dariush Abtahi; Hasan Abualruz; Bilyaminu Abubakar; Eman Abu-Gharbieh; Niveen M.E. Abu-Rmeileh; Tadele Girum Girum Adal; Mesafint Molla Adane; Oluwafemi Atanda Adeagbo Adeagbo; Rufus Adesoji Adedoyin; Victor Adekanmbi; Bashir Aden; Abiola Victor Adepoju; Olatunji O. Adetokunboh; Juliana Bunmi Adetunji; Daniel Adedayo Adeyinka; Olorunsola Israel Adeyomoye; Qorinah Estiningtyas Sakilah Adnani; Saryia Adra; Rotimi Felix Afolabi; Shadi Afyouni; Muhammad Sohail Afzal; Saira Afzal; Shahin Aghamiri; Antonella Agodi; Williams Agyemang-Duah; Bright Opoku Ahinkorah; Austin J. Ahlstrom; Aqeel Ahmad; Danish Ahmad; Firdos Ahmad; Muayyad M. Ahmad; Sajjad Ahmad; Tauseef Ahmad; Ali Ahmed; Ayman Ahmed; Haroon Ahmed; Luai A. Ahmed; Meqdad Saleh Ahmed; Syed Anees Ahmed; Marjan Ajami; Budi Aji; Gizachew Taddesse Akalu; Hossein Akbarialiabad; Rufus Olusola Akinyemi; Mohammed Ahmed Akkaif; Sreelatha Akkala; Hanadi Al Hamad; Syed Mahfuz Al Hasan; Mohammad Al Qadire; Tareq Mohammed Ali AL-Ahdal; Samer O. Alalalmeh; Tariq A. Alalwan; Ziyad Al-Aly; Khurshid Alam; Rasmieh Mustafa Al-Amer; Fahad Mashhour Alanezi; Turki M. Alanzi; Almaza Albakri; Mohammed Albashtawy; Mohammad T. AlBataineh; Hediyeh Alemi; Sharifullah Alemi; Yihun Mulugeta Alemu; Ayman Al-Eyadhy; Adel Ali Saeed Al-Gheethi; Khalid F. Alhabib; Noora Alhajri; Fadwa Alhalaiqa Naji Alhalaiqa; Robert Kaba Alhassan; Abid Ali; Beriwan Abdulqadir Ali; Liaqat Ali; Mohammed Usman Ali; Rafat Ali; Syed Shujait Shujait Ali; Sheikh Mohammad Alif; Mohammad Aligol; Mehran Alijanzadeh; Mohammad A.M. Aljasir; Syed Mohamed Aljunid; Sabah Al-Marwani; Joseph Uy Almazan; Hesham M. Al-Mekhlafi; Omar Almidani; Mahmoud A. Alomari; Basem Al-Omari; Jaber S. Alqahtani; Ahmed Yaseen Alqutaibi; Rajaa M. Al-Raddadi; Salman Khalifah Al-Sabah; Awais Altaf; Jaffar A. Al-Tawfiq; Khalid A. Altirkawi; Deborah Oyine Aluh; Farrukh Jawad Alvi; Nelson Alvis-Guzman; Hassan Alwafi; Yaser Mohammed Al-Worafi; Hany Aly; Safwat Aly; Karem H. Alzoubi; Edward Kwabena Ameyaw; Tarek Tawfik Amin; Alireza Amindarolzarbi; Mostafa Amini-Rarani; Sohrab Amiri; Irene Gyamfuah Ampomah; Dickson A. Amugsi; Ganiyu Adeniyi Amusa; Robert Ancuceanu; Deanna Anderlini; Pedro Prata Andrade; Catalina Liliana Andrei; Tudorel Andrei; Abhishek Anil; Sneha Anil; Adnan Ansar; Alireza Ansari-Moghaddam; Catherine M. Antony; Ernoiz Antriyandarti; Saeid Anvari; Saleha Anwar; Razique Anwer; Anayochukwu Edward Anyasodor; Jalal Arabloo; Razman Arabzadeh Bahri; Elshaimaa A. Arafa; Mosab Arafat; Ana Margarida Araujo; Aleksandr Y. Aravkin; Abdulfatai Aremu; Timur Aripov; Mesay Arkew; Benedetta Armocida; Johan Ärnlöv; Mahwish Arooj; Anton A. Artamonov; Judie Arulappan; Raphael Taiwo Aruleba; Ashokan Arumugam; Mohsen Asadi-Lari; Zatollah Asemi; Saeed Asgary; Mona Asghariahmadabad; Mohammad Asghari-Jafarabadi; Mubarek Yesse Ashemo; Muhammad Ashraf; Tahira Ashraf; Marvellous O. Asika; Seyyed Shamsadin Athari; Maha Moh'd Wahbi Atout; Alok Atreya; Avinash Aujayeb; Marcel Ausloos; Abolfazl Avan; Amlaku Mulat Aweke; Getnet Melaku Ayele; Seyed Mohammad Ayyoubzadeh; Sina Azadnajafabad; Rui M.S. Azevedo; Ahmed Y. Azzam; Muhammad Badar; Ashish D. Badiye; Soroush Baghdadi; Nasser Bagheri; Sara Bagherieh; Najmeh Bahmanziari; Ruhai Bai; Atif Amin Baig; Jennifer L. Baker; Abdulaziz T. Bako; Ravleen Kaur Bakshi; Madhan Balasubramanian; Ovidiu Constantin Baltatu; Kiran Bam; MacIej Banach; Soham Bandyopadhyay; Biswajit Banik; Palash Chandra Banik; Hansi Bansal; Mehmet Firat Baran; Martina Barchitta; Mainak Bardhan; Erfan Bardideh; Suzanne Lyn Barker-Collo; Till Winfried Bärnighausen; Francesco Barone-Adesi; Hiba Jawdat Barqawi; Amadou Barrow; Sandra Barteit; Zarrin Basharat; Asma'u I.J. Bashir; Hameed Akande Bashiru; Afisu Basiru; Joao Diogo Basso; Sanjay Basu; Abdul-Monim Mohammad Batiha; Kavita Batra; Bernhard T. Baune; Mohsen Bayati; Tahmina Begum; Emad Behboudi; Amir Hossein Behnoush; Maryam Beiranvand; Diana Fernanda Bejarano Ramirez; Alehegn Bekele; Sefealem Assefa Belay; Uzma Iqbal Belgaumi; Michelle L. Bell; Olorunjuwon Omolaja Bello; Apostolos Beloukas; Isabela M. Bensenor; Zombor Berezvai; Alemshet Yirga Berhie; Amiel Nazer C. Bermudez; Paulo J.G. Bettencourt; Akshaya Srikanth Bhagavathula; Nikha Bhardwaj; Pankaj Bhardwaj; Prarthna V. Bhardwaj; Sonu Bhaskar; Vivek Bhat; Gurjit Kaur Bhatti; Jasvinder Singh Bhatti; Manpreet S. Bhatti; Rajbir Bhatti; Antonio Biondi; Catherine Bisignano; Atanu Biswas; Raaj Kishore Biswas; Veera R. Bitra; Tone Bjørge; Elye Bliss; Micheal Kofi Boachie; Anca Vasilica Bobirca; Virginia Bodolica; Aadam Olalekan Bodunrin; Eyob Ketema Bogale; Kassawmar Angaw Bogale; Milad Bonakdar Hashemi; Berrak Bora Basara; Souad Bouaoud; Dejana Braithwaite; Michael Brauer; Nicholas J.K. Breitborde; Dana Bryazka; Norma B. Bulamu; Danilo Buonsenso; Katrin Burkart; Richard A. Burns; Yasser Bustanji; Nadeem Shafique Butt; Zahid A. Butt; Florentino Luciano Caetano Dos Santos; Daniela Calina; Ismael R. Campos-Nonato; Fan Cao; Shujin Cao; Angelo Capodici; Giulia Carreras; Andrea Carugno; Carlos A. Castañeda-Orjuela; Giulio Castelpietra; Maria Sofia Cattaruzza; Arthur Caye; Luca Cegolon; Francieli Cembranel; Ester Cerin; Joshua Chadwick; Yaacoub Chahine; Chiranjib Chakraborty; Julian Chalek; Jeffrey Shi Kai Chan; Periklis Charalampous; Vijay Kumar Chattu; Sarika Chaturvedi; Malizgani Paul Chavula; An-Tian Chen; Haowei Chen; Simiao Chen; Gerald Chi; Fatemeh Chichagi; Ju-Huei Chien; Patrick R. Ching; William C.S. Cho; Sungchul Choi; Bryan Chong; Hitesh Chopra; Sonali Gajanan Choudhari; Devasahayam J. Christopher; Dinh-Toi Chu; Isaac Sunday Chukwu; Eric Chung; Sheng-Chia Chung; Zinhle Cindi; Iolanda Cioffi; Raffaela Ciuffreda; Rafael M. Claro; Kaleb Coberly; Alyssa Columbus; Haley Comfort; Joao Conde; Michael H. Criqui; Natalia Cruz-Martins; Silvia Magali Cuadra-Hernández; Sriharsha Dadana; Omid Dadras; Tukur Dahiru; Zhaoli Dai; Bronte Dalton; Giovanni Damiani; Aso Mohammad Darwesh; Jai K. Das; Saswati Das; Mohsen Dashti; Anna Dastiridou; Claudio Alberto Dávila-Cervantes; Kairat Davletov; Aklilu Tamire Debele; Shayom Debopadhaya; Somayeh Delavari; Ivan Delgado-Enciso; Dessalegn Demeke; Berecha Hundessa Demessa; Xinlei Deng; Edgar Denova-Gutiérrez; Kebede Deribe; Nikolaos Dervenis; Hardik Dineshbhai Desai; Rupak Desai; Vinoth Gnana Chellaiyan Devanbu; Arkadeep Dhali; Kuldeep Dhama; Meghnath Dhimal; Vishal R. Dhulipala; Diana Dias Da Silva; Daniel Diaz; Michael J. Diaz; Adriana Dima; Delaney D. Ding; M. Ashworth Dirac; Thanh Chi Do; Thao Huynh Phuong Do; Camila Bruneli Do Prado; Sushil Dohare; Wanyue Dong; Mario D'Oria; Wendel Mombaque Dos Santos; Leila Doshmangir; Robert Kokou Dowou; Ashel Chelsea Dsouza; Haneil Larson Dsouza; Viola Dsouza; John Dube; Joe Duprey; Andre Rodrigues Duraes; Senbagam Duraisamy; Oyewole Christopher Durojaiye; Sulagna Dutta; Laura Dwyer-Lindgren; Paulina Agnieszka Dzianach; Arkadiusz Marian Dziedzic; Alireza Ebrahimi; Hisham Atan Edinur; Kristina Edvardsson; Ferry Efendi; Terje Andreas Eikemo; Michael Ekholuenetale; Maha El Tantawi; Noha Mousaad Elemam; Ghada Metwally Tawfik ElGohary; Muhammed Elhadi; Legesse Tesfaye Elilo; Omar Abdelsadek Abdou Elmeligy; Mohamed A. Elmonem; Mohammed Elshaer; Ibrahim Elsohaby; Amir Emami Zeydi; Luchuo Engelbert Bain; Sharareh Eskandarieh; Francesco Esposito; Kara Estep; Farshid Etaee; Natalia Fabin; Adeniyi Francis Fagbamigbe; Saman Fahimi; Aliasghar Fakhri-Demeshghieh; Luca Falzone; Ali Faramarzi; MoezAlIslam Ezzat Mahmoud Faris; Sam Farmer; Andre Faro; Abidemi Omolara Fasanmi; Ali Fatehizadeh; Nelsensius Klau Fauk; Pooria Fazeli; Valery L. Feigin; Seyed-Mohammad Fereshtehnejad; Abdullah Hamid Feroze; Pietro Ferrara; Nuno Ferreira; Getahun Fetensa; Irina Filip; Florian Fischer; Joanne Flavel; Nataliya A. Foigt; Morenike Oluwatoyin Folayan; Artem Alekseevich Fomenkov; Behzad Foroutan; Matteo Foschi; Kayode Raphael Fowobaje; Kate Louise Francis; Alberto Freitas; Takeshi Fukumoto; John E. Fuller; Blima Fux; Peter Andras Gaal; Muktar A. Gadanya; Abhay Motiramji Gaidhane; Yaseen Galali; Silvano Gallus; Aravind P. Gandhi; Balasankar Ganesan; Mohammad Arfat Ganiyani; M.A. Garcia-Gordillo; Naval Garg; Rupesh K. Gautam; Federica Gazzelloni; Semiu Olatunde Gbadamosi; Miglas W. Gebregergis; Mesfin Gebrehiwot; Tesfay Brhane Gebremariam; Teferi Gebru Gebremeskel; Yohannes Fikadu Geda; Simona Roxana Georgescu; Urge Gerema; Habtamu Geremew; Motuma Erena Getachew; Peter W. Gething; MohammadReza Ghasemi; Ghazal Ghasempour Dabaghi; Afsaneh Ghasemzadeh; Fariba Ghassemi; Ramy Mohamed Ghazy; Sailaja Ghimire; Asadollah Gholamian; Ali Gholamrezanezhad; Mahsa Ghorbani; Aloke Gopal Ghoshal; Arun Digambarrao Ghuge; Artyom Urievich Gil; Tiffany K. Gill; Matteo Giorgi; Alem Girmay; James C. Glasbey; Laszlo Göbölös; Amit Goel; Ali Golchin; Mahaveer Golechha; Pouya Goleij; Sameer Vali Gopalani; Houman Goudarzi; Alessandra C. Goulart; Anmol Goyal; Simon Matthew Graham; Michal Grivna; Shi-Yang Guan; Giovanni Guarducci; Mohammed Ibrahim Mohialdeen Gubari; Mesay Dechasa Gudeta; Stefano Guicciardi; Snigdha Gulati; David Gulisashvili; Damitha Asanga Gunawardane; Cui Guo; Anish Kumar Gupta; Bhawna Gupta; Manoj Kumar Gupta; Mohak Gupta; Sapna Gupta; Veer Bala Gupta; Vijai Kumar Gupta; Vivek Kumar Gupta; Annie Haakenstad; Farrokh Habibzadeh; Najah R. Hadi; Nils Haep; Ramtin Hajibeygi; Sebastian Haller; Rabih Halwani; Randah R. Hamadeh; Nadia M. Hamdy; Sajid Hameed; Samer Hamidi; Qiuxia Han; Alexis J. Handal; Graeme J. Hankey; Md Nuruzzaman Haque; Josep Maria Haro; Ahmed I. Hasaballah; Ikramul Hasan; Mohammad Jahid Hasan; S.M. Mahmudul Hasan; Hamidreza Hasani; Md Saquib Hasnain; Amr Hassan; Ikrama Hassan; Soheil Hassanipour; Hadi Hassankhani; Simon I. Hay; Jeffrey J. Hebert; Omar E. Hegazi; Mohammad Heidari; Bartosz Helfer; Mehdi Hemmati; Brenda Yuliana Herrera-Serna; Claudiu Herteliu; Kamran Hessami; Kamal Hezam; Yuta Hiraike; Nguyen Quoc Hoan; Ramesh Holla; Nobuyuki Horita; Md Mahbub Hossain; Mohammad Bellal Hossain Hossain; Hassan Hosseinzadeh; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mohamed Hsairi; Vivian Chia-Rong Hsieh; Chengxi Hu; Junjie Huang; M. Mamun Huda; Ayesha Humayun; Javid Hussain; Nawfal R. Hussein; Hong-Han Huynh; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Pulwasha Maria Iftikhar; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Mustapha Immurana; Leeberk Raja Inbaraj; Afrin Iqbal; Md. Rabiul Islam; Nahlah Elkudssiah Ismail; Hiroyasu Iso; Gaetano Isola; Masao Iwagami; Mahalaxmi Iyer; J. Linda Merin; Jalil Jaafari; Louis Jacob; Farhad Jadidi-Niaragh; Khushleen Jaggi; Kasra Jahankhani; Nader Jahanmehr; Haitham Jahrami; Akhil Jain; Nityanand Jain; Ammar Abdulrahman Jairoun; Mihajlo Jakovljevic; Elham Jamshidi; Sabzali Javadov; Tahereh Javaheri; Sathish Kumar Jayapal; Shubha Jayaram; Sun Ha Jee; Jayakumar Jeganathan; Anil K. Jha; Ravi Prakash Jha; Heng Jiang; Mohammad Jokar; Jost B. Jonas; Tamas Joo; Nitin Joseph; Charity Ehimwenma Joshua; Farahnaz Joukar; Jacek Jerzy Jozwiak; Mikk Jürisson; K. Vaishali; Billingsley Kaambwa; Abdulkareem Kabir; Ali Kabir; Hannaneh Kabir; Zubair Kabir; Rizwan Kalani; Leila R. Kalankesh; Feroze Kaliyadan; Sanjay Kalra; Rajesh Kamath; Sagarika Kamath; Tanuj Kanchan; Edmund Wedam Kanmiki; Kehinde Kazeem Kanmodi; S. Suthanthira Kannan; Sushil Kumar Kansal; Rami S. Kantar; Neeti Kapoor; Mehrdad Karajizadeh; Manoochehr Karami; Ibraheem M. Karaye; Faizan Zaffar Kashoo; Hengameh Kasraei; Nicholas J. Kassebaum; Molly B. Kassel; Joonas H. Kauppila; Foad Kazemi; Sara Kazeminia; John H. Kempen; Evie Shoshannah Kendal; Kamyab Keshtkar; Mohammad Keykhaei; Himanshu Khajuria; Amirmohammad Khalaji; Nauman Khalid; Anees Ahmed Khalil; Alireza Khalilian; Faham Khamesipour; Ajmal Khan; Asaduzzaman Khan; Ikramullah Khan; M. Nuruzzaman Khan; Maseer Khan; Mohammad Jobair Khan; Moien A.B. Khan; Young-Ho Khang; Shaghayegh Khanmohammadi; Khaled Khatab; Armin Khavandegar; Hamid Reza Khayat Kashani; Feriha Fatima Khidri; Moein Khormali; Mohammad Ali Khosravi; Mahmood Khosrowjerdi; Wondwosen Teklesilasie Kidane; Zemene Demelash Kifle; Julie Sojin Kim; Min Seo Kim; Ruth W. Kimokoti; Kasey E. Kinzel; Girmay Tsegay Kiross; Adnan Kisa; Sezer Kisa; Ali-Asghar Kolahi; Farzad Kompani; Gerbrand Koren; Oleksii Korzh; Soewarta Kosen; Sindhura Lakshmi Koulmane Laxminarayana; Kewal Krishan; Varun Krishna; Vijay Krishnamoorthy; Barthelemy Kuate Defo; Connor M. 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Lopukhov; Laszlo Lorenzovici; Paulo A. Lotufo; Jailos Lubinda; Giancarlo Lucchetti; Alessandra Lugo; Raimundas Lunevicius; Hengliang Lv; Zheng Feei Ma; Kelsey Lynn Maass; Monika MacHoy; Áurea M. Madureira-Carvalho; Mohammed Magdy Abd El Razek; Azzam A. Maghazachi; Soleiman Mahjoub; Mansour Adam Mahmoud; Azeem Majeed; Jeadran N. Malagón-Rojas; Elaheh Malakan Rad; Kashish Malhotra; Ahmad Azam Malik; Iram Malik; Deborah Carvalho Malta; Abdullah A. Mamun; Yosef Manla; Yasaman Mansoori; Ali Mansour; Borhan Mansouri; Zeinab Mansouri; Mohammad Ali Mansournia; Joemer C. Maravilla; Mirko Marino; Abdoljalal Marjani; Gabriel Martinez; Ramon Martinez-Piedra; Francisco Rogerlandio Martins-Melo; Miquel Martorell; Sharmeen Maryam; Roy Rillera Marzo; Alireza Masoudi; Jishanth Mattumpuram; Richard James Maude; Andrea Maugeri; Erin A. May; Mahsa Mayeli; Maryam Mazaheri; John J. McGrath; Martin McKee; Anna Laura Wensel McKowen; Susan A. McLaughlin; Steven M. 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Nayak; Rawlance Ndejjo; Sabina Onyinye Nduaguba; Hadush Negash; Chernet Tafere Negesse; Ionut Negoi; Ruxandra Irina Negoi; Seyed Aria Nejadghaderi; Chakib Nejjari; Samata Nepal; Henok Biresaw Netsere; Georges Nguefack-Tsague; Josephine W. Ngunjiri; Dang H. Nguyen; Hau Thi Hien Nguyen; Phuong The Nguyen; QuynhAnh P. Nguyen; Van Thanh Nguyen; Robina Khan Niazi; Yeshambel T. Nigatu; Taxiarchis Konstantinos Nikolouzakis; Ali Nikoobar; Amin Reza Nikpoor; Chukwudi A. Nnaji; Lawrence Achilles Nnyanzi; Efaq Ali Noman; Shuhei Nomura; Mamoona Noreen; Nafise Noroozi; Chisom Adaobi Nri-Ezedi; Mengistu H. Nunemo; Virginia Nuñez-Samudio; Dieta Nurrika; Jerry John Nutor; Bogdan Oancea; Kehinde O. Obamiro; Ismail A. Odetokun; Nkechi Martina Odogwu; Martin James O'Donnell; Oluwakemi Ololade Odukoya; Ayodipupo Sikiru Oguntade; James Odhiambo Oguta; In-Hwan Oh; Sylvester Reuben Okeke; Akinkunmi Paul Okekunle; Osaretin Christabel Okonji; Patrick Godwin Okwute; Andrew T. Olagunju; Omotola O. Olasupo; Matthew Idowu Olatubi; Glaucia Maria Moraes Oliveira; Bolajoko Olubukunola Olusanya; Jacob Olusegun Olusanya; Gideon Olamilekan Oluwatunase; Hany A. Omar; Goran Latif Omer; Obinna E. Onwujekwe; Michal Ordak; Orish Ebere Orisakwe; Verner N. Orish; Doris V. Ortega-Altamirano; Alberto Ortiz; Esteban Ortiz-Prado; Wael M.S. Osman; Uchechukwu Levi Osuagwu; Olayinka Osuolale; Adrian Otoiu; Stanislav S. Otstavnov; Amel Ouyahia; Guoqing Ouyang; Mayowa O. Owolabi; Yaz Ozten; P.A. Mahesh Padukudru; Mohammad Taha Pahlevan Fallahy; Feng Pan; Hai-Feng Pan; Adrian Pana; Paramjot Panda; Songhomitra Panda-Jonas
Background: Accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. Findings: During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Interpretation: Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. 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, regional, and national mortality among young people aged 10–24 years, 1950–2019: a systematic analysis for the Global Burden of Disease Study 2019
(Elsevier B.V., 2021) Joseph L. Ward; Peter S Azzopardi; Kate Louise Francis; John S Santelli; Vegard Skirbekk; Susan M Sawyer; Nicholas J Kassebaum; Ali H Mokdad; Simon I Hay; Foad Abd-Allah; Amir Abdoli; Mohammad Abdollahi; Aidin Abedi; Hassan Abolhassani; Lucas Guimarães Abreu; Michael R M Abrigo; Eman Abu-Gharbieh; Abdelrahman I Abushouk; Oladimeji M Adebayo; Victor Adekanmbi; Davoud Adham; Shailesh M Advani; Khashayar Afshari; Anurag Agrawal; Tauseef Ahmad; Keivan Ahmadi; Anwar E Ahmed; Budi Aji; Blessing Akombi-Inyang; Fares Alahdab; Ziyad Al-Aly; Khurshid Alam; Fahad Mashhour Alanezi; Turki M Alanzi; Jacqueline Elizabeth Alcalde-Rabanal; Biresaw Wassihun Alemu; Samar Al-Hajj; Robert Kaba Alhassan; Saqib Ali; Gianfranco Alicandro; Mehran Alijanzadeh; Syed Mohamed Aljunid; Amir Almasi-Hashiani; Nihad A Almasri; Hesham M Al-Mekhlafi; Jordi Alonso; Rajaa M Al-Raddadi; Khalid A Altirkawi; Nelson Alvis-Guzman; Azmeraw T Amare; Saeed Amini; Arya Aminorroaya; Arianna Maever L Amit; Dickson A Amugsi; Robert Ancuceanu; Deanna Anderlini; Catalina Liliana Andrei; Sofia Androudi; Fereshteh Ansari; Iman Ansari; Carl Abelardo T Antonio; Davood Anvari; Razique Anwer; Seth Christopher Yaw Appiah; Jalal Arabloo; Morteza Arab-Zozani; Johan Ärnlöv; Malke Asaad; Mehran Asadi-Aliabadi; Ali A Asadi-Pooya; Maha Moh'd Wahbi Atout; Marcel Ausloos; Elvis Korku Avenyo; Leticia Avila-Burgos; Beatriz Paulina Ayala Quintanilla; Getinet Ayano; Yared Asmare Aynalem; Samad Azari; Zelalem Nigussie Azene; Mohammad Hossein Bakhshaei; Shankar M Bakkannavar; MacIej Banach; Palash Chandra Banik; Miguel A Barboza; Suzanne Lyn Barker-Collo; Till Winfried Bärnighausen; Sanjay Basu; Bernhard T Baune; Mohsen Bayati; Neeraj Bedi; Ettore Beghi; Tariku Tesfaye Bekuma; Arielle Wilder Bell; Michelle L Bell; Corina Benjet; Isabela M Bensenor; Abadi Kidanemariam Berhe; Kidanemaryam Berhe; Adam E Berman; Akshaya Srikanth Bhagavathula; Nikha Bhardwaj; Pankaj Bhardwaj; Krittika Bhattacharyya; Suraj Bhattarai; Zulfiqar A Bhutta; Ali Bijani; Boris Bikbov; Antonio Biondi; Tesega Tesega Mengistu Birhanu; Raaj Kishore Biswas; Somayeh Bohlouli; Srinivasa Rao Bolla; Archith Boloor; Rohan Borschmann; Soufiane Boufous; Nicola Luigi Bragazzi; Dejana Braithwaite; Nicholas J K Breitborde; Hermann Brenner; Gabrielle B Britton; Richard A Burns; Sharath Burugina Nagaraja; Zahid A Butt; Florentino Luciano Caetano Dos Santos; Luis Alberto Cámera; Ismael R Campos-Nonato; Julio Cesar Campuzano Rincon; Rosario Cárdenas; Giulia Carreras; Juan J Carrero; Felix Carvalho; Joao Mauricio Castaldelli-Maia; Carlos A Castañeda-Orjuela; Giulio Castelpietra; Ferrán Catalá-López; Ester Cerin; Joht Singh Chandan; Hsing-Yi Chang; Jung-Chen Chang; Jaykaran Charan; Vijay Kumar Chattu; Sarika Chaturvedi; Jee-Young Jasmine Choi; Mohiuddin Ahsanul Kabir Chowdhury; Devasahayam J Christopher; Dinh-Toi Chu; Michael T Chung; Sheng-Chia Chung; Flavia M Cicuttini; Traian Vasile Constantin; Vera Marisa Costa; Saad M A Dahlawi; Haijiang Dai; Xiaochen Dai; Giovanni Damiani; Lalit Dandona; Rakhi Dandona; Parnaz Daneshpajouhnejad; Aso Mohammad Darwesh; Claudio Alberto Dávila-Cervantes; Kairat Davletov; Fernando Pio De La Hoz; Diego De Leo; Nikolaos Dervenis; Rupak Desai; Assefa Desalew; Keshab Deuba; Samath Dhamminda Dharmaratne; Govinda Prasad Dhungana; Mostafa Dianatinasab; Diana Dias Da Silva; Daniel Diaz; Alireza Didarloo; Shirin Djalalinia; Fariba Dorostkar; Chirag P Doshi; Leila Doshmangir; Kerrie E Doyle; Andre Rodrigues Duraes; Mohammad Ebrahimi Kalan; Sanam Ebtehaj; David Edvardsson; Maha El Tantawi; Islam Y Elgendy; Shaimaa I El-Jaafary; Aisha Elsharkawy; Babak Eshrati; Sharareh Eskandarieh; Saman Esmaeilnejad; Firooz Esmaeilzadeh; Sadaf Esteghamati; Andre Faro; Farshad Farzadfar; Nazir Fattahi; Valery L Feigin; Tomas Y Ferede; Seyed-Mohammad Fereshtehnejad; Eduarda Fernandes; Pietro Ferrara; Irina Filip; Florian Fischer; James L Fisher; Nataliya A Foigt; Morenike Oluwatoyin Folayan; Artem Alekseevich Fomenkov; Masoud Foroutan; Takeshi Fukumoto; Mohamed M Gad; Abhay Motiramji Gaidhane; Silvano Gallus; Teshome Gebre; Ketema Bizuwork Gebremedhin; Gebreamlak Gebremedhn Gebremeskel; Leake Gebremeskel; Assefa Ayalew Gebreslassie; Hailay Abrha Gesesew; Keyghobad Ghadiri; Mansour Ghafourifard; Farhad Ghamari; Ahmad Ghashghaee; Syed Amir Gilani; Elena V Gnedovskaya; Myron Anthony Godinho; Mahaveer Golechha; Srinivas Goli; Philimon N Gona; Sameer Vali Gopalani; Giuseppe Gorini; Michal Grivna; Mohammed Ibrahim Mohialdeen Gubari; Harish Chander Gugnani; Rafael Alves Guimarães; Yuming Guo; Rajeev Gupta; Juanita A Haagsma; Nima Hafezi-Nejad; Teklehaimanot Gereziher Haile; Arvin Haj-Mirzaian; Arya Haj-Mirzaian; Brian J Hall; Randah R Hamadeh; Kanaan Hamagharib Abdullah; Samer Hamidi; Demelash Woldeyohannes Handiso; Asif Hanif; Graeme J Hankey; Hamidreza Haririan; Josep Maria Haro; Ahmed I Hasaballah; Abdiwahab Hashi; Amr Hassan; Soheil Hassanipour; Hadi Hassankhani; Khezar Hayat; Reza Heidari-Soureshjani; Claudiu Herteliu; Fatemeh Heydarpour; Hung Chak Ho; Michael K Hole; Ramesh Holla; Praveen Hoogar; Mostafa Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mowafa Househ; Mohamed Hsairi; Tanvir M Huda; Ayesha Humayun; Rabia Hussain; Bing-Fang Hwang; Ivo Iavicoli; Segun Emmanuel Ibitoye; Olayinka Stephen Ilesanmi; Irena M Ilic; Milena D Ilic; Leeberk Raja Inbaraj; Nirun Intarut; Usman Iqbal; Seyed Sina Naghibi Irvani; M Mofizul Islam; Sheikh Mohammed Shariful Islam; Hiroyasu Iso; Rebecca Q Ivers; Mohammad Ali Jahani; Mihajlo Jakovljevic; Amir Jalali; Manthan Dilipkumar Janodia; Tahereh Javaheri; Panniyammakal Jeemon; Ensiyeh Jenabi; Ravi Prakash Jha; Vivekanand Jha; John S Ji; Jost B Jonas; Kelly M Jones; Farahnaz Joukar; Jacek Jerzy Jozwiak; Petur B Juliusson; Mikk Jürisson; Ali Kabir; Zubair Kabir; Leila R Kalankesh; Rohollah Kalhor; Naser Kamyari; Tanuj Kanchan; Andr Karch; Salah Eddin Karimi; Supreet Kaur; Gbenga A Kayode; Peter Njenga Keiyoro; Nauman Khalid; Mohammad Khammarnia; Maseer Khan; Md Nuruzzaman Khan; Khaled Khatab; Mona M Khater; Mahalaqua Nazli Khatib; Maryam Khayamzadeh; Habibolah Khazaie; Abdullah T Khoja; Christian Kieling; Young-Eun Kim; Yun Jin Kim; Ruth W Kimokoti; Adnan Kisa; Sezer Kisa; Mika Kivimäki; Ali Koolivand; Soewarta Kosen; Ai Koyanagi; Kewal Krishan; Nuworza Kugbey; G Anil Kumar; Manasi Kumar; Nithin Kumar; Om P Kurmi; Dian Kusuma; Carlo La Vecchia; Ben Lacey; Dharmesh Kumar Lal; Ratilal Lalloo; Qing Lan; Iván Landires; Van Charles Lansingh; Anders O Larsson; Savita Lasrado; Zohra S Lassi; Paolo Lauriola; Paul H Lee; Shaun Wen Huey Lee; James Leigh; Matilde Leonardi; Janni Leung; Miriam Levi; Sonia Lewycka; Bingyu Li; Ming-Chieh Li; Shanshan Li; Lee-Ling Lim; Stephen S Lim; Xuefeng Liu; Stefan Lorkowski; Paulo A Lotufo; Raimundas Lunevicius; Ralph Maddison; Phetole Walter Mahasha; Mokhtar Mahdavi Mahdavi; Morteza Mahmoudi; Azeem Majeed; Afshin Maleki; Reza Malekzadeh; Deborah Carvalho Malta; Abdullah A Mamun; Borhan Mansouri; Mohammad Ali Mansournia; Gabriel Martinez; Jose Martinez-Raga; Francisco Rogerlândio Martins-Melo; Amanda J Mason-Jones; Seyedeh Zahra Masoumi; Manu Raj Mathur; Pallab K Maulik; John J McGrath; Man Mohan Mehndiratta; Fereshteh Mehri; Peter T N Memiah; Walter Mendoza; Ritesh G Menezes; Endalkachew Worku Mengesha; Atte Meretoja; Tuomo J Meretoja; Tomislav Mestrovic; Bartosz Miazgowski; Tomasz Miazgowski; Irmina Maria Michalek; Ted R Miller; G.K. Mini; Andreea Mirica; Erkin M Mirrakhimov; Hamed Mirzaei; Maryam Mirzaei; Babak Moazen; Dara K Mohammad; Shadieh Mohammadi; Abdollah Mohammadian-Hafshejani; Noushin Mohammadifard; Reza Mohammadpourhodki; Shafiu Mohammed; Lorenzo Monasta; Ghobad Moradi; Maziar Moradi-Lakeh; Rahmatollah Moradzadeh; Paula Moraga; Shane Douglas Morrison; Abbas Mosapour; Amin Mousavi Khaneghah; Ulrich Otto Mueller; Moses K Muriithi; Christopher J L Murray; Saravanan Muthupandian; Mehdi Naderi; Ahamarshan Jayaraman Nagarajan; Mohsen Naghavi; Mukhammad David Naimzada; Vinay Nangia; Vinod C Nayak; Javad Nazari; Rawlance Ndejjo; Ionut Negoi; Ruxandra Irina Negoi; Henok Biresaw Netsere; Georges Nguefack-Tsague; Diep Ngoc Nguyen; Huong Lan Thi Nguyen; Jing Nie; Dina Nur Anggraini Ningrum; Chukwudi A Nnaji; Shuhei Nomura; Jean Jacques Noubiap; Christoph Nowak; Virginia Nuñez-Samudio; Felix Akpojene Ogbo; Onome Bright Oghenetega; In-Hwan Oh; Morteza Oladnabi; Andrew T Olagunju; Bolajoko Olubukunola Olusanya; Jacob Olusegun Olusanya; Ahmed Omar Bali; Muktar Omer Omer; Obinna E Onwujekwe; Alberto Ortiz; Adrian Otoiu; Nikita Otstavnov; Stanislav S Otstavnov; Simon Øverland; Mayowa O Owolabi; Jagadish Rao Padubidri; Keyvan Pakshir; Raffaele Palladino; Adrian Pana; Songhomitra Panda-Jonas; Anamika Pandey; Carlo Irwin Able Panelo; Eun-Kee Park; Scott B Patten; Amy E Peden; Veincent Christian Filipino Pepito; Emmanuel K Peprah; Jeevan Pereira; Konrad Pesudovs; Hai Quang Pham; Michael R Phillips; Michael A Piradov; Meghdad Pirsaheb; Maarten J Postma; Faheem Hyder Pottoo; Hadi Pourjafar; Akram Pourshams; Sergio I Prada; Elisabetta Pupillo; Zahiruddin Quazi Syed; Mohammad Hasan Rabiee; Navid Rabiee; Amir Radfar; Ata Rafiee; Alberto Raggi; Fakher Rahim; Vafa Rahimi-Movaghar; Mohammad Hifz Ur Rahman; Muhammad Aziz Rahman; Kiana Ramezanzadeh; Chhabi Lal Ranabhat; Sowmya J Rao; Vahid Rashedi; Prateek Rastogi; Priya Rathi; David Laith Rawaf; Salman Rawaf; Lal Rawal; Reza Rawassizadeh; Andre M N Renzaho; Negar Rezaei; Nima Rezaei; Mohammad Sadegh Rezai; Seyed Mohammad Riahi; Jennifer Rickard; Leonardo Roever; Luca Ronfani; Gregory A Roth; Enrico Rubagotti; Susan Fred Rumisha; Godfrey M Rwegerera; Siamak Sabour; Perminder S Sachdev; Basema Saddik; Ehsan Sadeghi; Sahar Saeedi Moghaddam; Rajesh Sagar; Amirhossein Sahebkar; Mohammad Ali Sahraian; S Mohammad Sajadi; Marwa Rashad Salem; Hamideh Salimzadeh; Abdallah M Samy; Juan Sanabria; Milena M Santric-Milicevic; Sivan Yegnanarayana Iyer Saraswathy; Nizal Sarrafzadegan; Arash Sarveazad; Thirunavukkarasu Sathish; Davide Sattin; Deepak Saxena; Sonia Saxena; Silvia Schiavolin; David C Schwebel; Falk Schwendicke; Subramanian Senthilkumaran; Sadaf G Sepanlou; Feng Sha; Omid Shafaat; Saeed Shahabi; Amira A Shaheen; Masood Ali Shaikh; Saeed Shakiba; MohammadBagher Shamsi; Mohammed Shannawaz; Kiomars Sharafi; Aziz Sheikh; Sara Sheikhbahaei; B Suresh Kumar Shetty; Peilin Shi; Mika Shigematsu; Jae Il Shin; Rahman Shiri; Kerem Shuval; Soraya Siabani; Inga Dora Sigfusdottir; Rannveig Sigurvinsdottir; Diego Augusto Santos Silva; João Pedro Silva; Biagio Simonetti; Jasvinder A Singh; Virendra Singh; Abiy H Sinke; Valentin Yurievich Skryabin; Helen Slater; Emma U R Smith; Mohammad Reza Sobhiyeh; Eugene Sobngwi; Amin Soheili; Oluwaseyi Dolapo Somefun; Muluken Bekele Sorrie; Ireneous N Soyiri; Chandrashekhar T Sreeramareddy; Dan J Stein; Mark A Stokes; Agus Sudaryanto; Iyad Sultan; Rafael Tabarés-Seisdedos; Takahiro Tabuchi; Santosh Kumar Tadakamadla; Amir Taherkhani; Animut Tagele Tamiru; Md Ismail Tareque; Kavumpurathu Raman Thankappan; Rekha Thapar; Nihal Thomas; Mariya Vladimirovna Titova; Marcello Tonelli; Marcos Roberto Tovani-Palone; Bach Xuan Tran; Ravensara S Travillian; Alexander C Tsai; Aristidis Tsatsakis; Lorainne Tudor Car; Riaz Uddin; Brigid Unim; Bhaskaran Unnikrishnan; Era Upadhyay; Marco Vacante; Sahel Valadan Tahbaz; Pascual R Valdez; Santosh Varughese; Tommi Juhani Vasankari; Narayanaswamy Venketasubramanian; Paul J Villeneuve; Francesco S Violante; Vasily Vlassov; Theo Vos; Giang Thu Vu; Yasir Waheed; Richard G Wamai; Yafeng Wang; Yanzhong Wang; Yuan-Pang Wang; Ronny Westerman; Nuwan Darshana Wickramasinghe; Ai-Min Wu; Chenkai Wu; Seyed Hossein Yahyazadeh Jabbari; Kazumasa Yamagishi; Yuichiro Yano; Sanni Yaya; Vahid Yazdi-Feyzabadi; Yordanos Gizachew Yeshitila; Paul Yip; Naohiro Yonemoto; Seok-Jun Yoon; Mustafa Z Younis; Taraneh Yousefinezhadi; Chuanhua Yu; Yong Yu; Deniz Yuce; Syed Saoud Zaidi; Sojib Bin Zaman; Mohammad Zamani; Maryam Zamanian; Hadi Zarafshan; Ahmad Zarei; Mikhail Sergeevich Zastrozhin; Yunquan Zhang; Zhi-Jiang Zhang; Xiu-Ju George Zhao; Cong Zhu; George C Patton; Russell M Viner
Background: Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017). Findings: In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10–14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15–19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1–4 years (2·4%), and around a third less than in females aged 1–4 years (2·5%). The proportion of global deaths in people aged 0–24 years that occurred in people aged 10–24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%. Interpretation: Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10–24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Funding: Bill & Melinda Gates Foundation. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license