Browsing by Author "Mesafint Molla Adane"

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Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
(Elsevier B.V., 2025) Simon I. Hay; Kanyin Liane Ong; Damian Francesco Santomauro; A. Bhoomadevi; Mohammad Amin Aalipour; Hasan Abualruz; Hazim S. Ababneh; Ukachukwu Okoroafor Abaraogu; Biruk Beletew Abate; Cristiana Abbafati; Nasir Abbas; Mitra Abbasifard; Mohsen Abbasi-Kangevari; Samar Abd ElHafeez; Ashraf N. Abdalla; Mohammed Altigani Abdalla; Emad M. Abdallah; Barkhad Aden Abdeeq; Nadin M. Abdel Razeq; Ahmed Abdelrahman Abdelgalil; Reda S. Abdel-Hameed; Michael Abdelmasseh; Mahmoud Hassan Abdelnabi; Wael M. Abdel-Rahman; Sherief M. Abd-Elsalam; Sepideh Abdi; Mohammad Abdollahi; Meriem Abdoun; Arman Abdous; Jeza Muhamad Abdul Aziz; Deldar Morad Abdulah; Rizwan Suliankatchi Abdulkader; Adam Ibrahim Abdullahi; Auwal S. Abdullahi; Toufik Abdul-Rahman; Kulmira Abdykerimova; Habtamu Abebe Getahun; Aidin Abedi; Armita Abedi; Asrat Agalu Abejew; Roberto Ariel Abeldaño Zuñiga; E. S. Abhilash; Shehab Uddin Al Abid; Syed Hani Abidi; Alemwork Abie; Olugbenga Olusola Abiodun; Olumide A. Abiodun; Richard Gyan Aboagye; Shady M. Abohashem; Hassan Abolhassani; Ulric Sena Abonie; Nagah M. Abourashed; Mohamed Riad Abouzid; Dmitry Abramov; Lucas Guimarães Abreu; Dariush Abtahi; Rana K. Abu Farha; Fuad Hamdi Abuadas; Aminu Kende Abubakar; Bilyaminu Abubakar; Eman F. Abu-Gharbieh; Sawsan Hammad Abuhammad; Ahmad Yousef Abuhelwa; Hana J. Abukhadijah; Niveen M.E. Abu-Rmeileh; Salahdein Aburuz; Dina Hamdi Abushanab; Raghu Ram Achar; Anirudh B. Acharya; Apurba Acharya; Ilana N. Ackerman; Juan Manuel Acuna; Ousman Adal; Lisa Christine Adams; Lawan H. Adamu; Mesafint Molla Adane; Zenaw Debasu Addisu; Isaac Yeboah Addo; Oluwafemi Atanda Adeagbo; Tajudeen Adesanmi Adebisi; Isaac Akinkunmi Adedeji; David Adedia; Kamoru A. Adedokun; Rufus A. Adedoyin; Oluwatobi E. Adegbile; Oyelola Abdulwasiu Adegboye; Nurudeen A. Adegoke; Olumide Thomas Adeleke; Isaac A. Adesina; Miracle Ayomikun Adesina; Habeeb Omoponle Adewuyi; Temitayo Esther Adeyeoluwa; Olorunsola I. Adeyomoye; Kishor Adhikari; Ripon Kumar Adhikary; Usha Sachidananda Adiga; Mohd Adnan; Qorinah Estiningtyas Sakilah Adnani; Prince Owusu Adoma; Leticia Akua Adzigbli
Background For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. Methods The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010–23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Findings Total numbers of global DALYs grew 6·1% (95% UI 4·0–8·1), from 2·64 billion (2·46–2·86) in 2010 to 2·80 billion (2·57–3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0–14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31–1·61) global DALYs in 2010, increasing to 1·80 billion (1·63–2·03) in 2023, alongside a concurrent 4·1% (1·9–6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176–209] DALYs), stroke (157 million [141–172]), and diabetes (90·2 million [75·2–107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0–107·5]), depressive disorders (26·3% [11·6–42·9]), and diabetes (14·9% [7·5–25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837–917) in 2010 to 681 million (642–736) in 2023, and a 25·8% (22·6–28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7–61·0) for diarrhoeal diseases, 42·9% (38·0–48·0) for HIV/AIDS, and 42·2% (23·6–56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6–22·0) and 24·8% (7·4–36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7–19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18–1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation—with high SBP accounting for 8·4% (6·9–10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories—behavioural, metabolic, and environmental and occupational—risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8–37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0–11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023—eg, declining by 54·4% (38·7–65·3) for unsafe sanitation, 50·5% (33·3–63·1) for unsafe water source, and 45·2% (25·6–72·0) for no access to handwashing facility, and by 44·9% (37·3–53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [–2·7 to 15·6]; non-significant). Interpretation Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors—eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG—including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic—the complex interaction of multiple health risks, social determinants, and systemic challenges—will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Funding Gates Foundation and Bloomberg Philanthropies. © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Global 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. Kubeisy; Burcu Kucuk Bicer; Md Abdul Kuddus; Mohammed Kuddus; Ilari Kuitunen; Mukhtar Kulimbet; Harish Kumar; Satyajit Kundu; Kunle Rotimi Kunle; Om P. Kurmi; Asep Kusnali; Dian Kusuma; Evans F. Kyei; Ilias Kyriopoulos; Carlo La Vecchia; Ben Lacey; Muhammad Awwal Ladan; Lucie Laflamme; Chandrakant Lahariya; Daphne Teck Ching Lai; Dharmesh Kumar Lal; Ratilal Lalloo; Judit Lám; Demetris Lamnisos; Ivan Landires; Francesco Lanfranchi; Berthold Langguth; Ariane Laplante-Lévesque; Heidi Jane Larson; Anders O. Larsson; Savita Lasrado; Kamaluddin Latief; Kaveh Latifinaibin; Long Khanh Dao Le; Nhi Huu Hanh Le; Trang Diep Thanh Le; Caterina Ledda; Munjae Lee; Paul H. Lee; Seung Won Lee; Yo Han Lee; Gebretsadik Kiros Lema; Elvynna Leong; Temesgen L. Lerango; An Li; Ming-Chieh Li; Shanshan Li; Wei Li; Xiaopan Li; Virendra S. Ligade; Stephen S. Lim; Ro-Ting Lin; Paulina A. Lindstedt; Stefan Listl; Gang Liu; Jue Liu; Xiaofeng Liu; Xuefeng Liu; Yuewei Liu; Erand Llanaj; Ruben López-Bueno; Platon D. 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. McPhail; Rahul Mehra; Kamran Mehrabani-Zeinabad; Entezar Mehrabi Nasab; Tesfahun Mekene Meto; Max Alberto Mendez Mendez-Lopez; Walter Mendoza; Ritesh G. Menezes; George A. Mensah; Alexios-Fotios A. Mentis; Sultan Ayoub Meo; Mohsen Merati; Atte Meretoja; Tuomo J. Meretoja; Abera M. Mersha; Tomislav Mestrovic; Pouya Metanat; Kukulege Chamila Dinushi Mettananda; Sachith Mettananda; Adquate Mhlanga; Laurette Mhlanga; Tianyue Mi; Tomasz Miazgowski; Georgia Micha; Irmina Maria Michalek; Ted R. Miller; Le Huu Nhat Minh; Mojgan Mirghafourvand; Erkin M. Mirrakhimov; Mizan Kiros Mirutse; Moonis Mirza; Roya Mirzaei; Ashim Mishra; Sanjeev Misra; Philip B. Mitchell; Chaitanya Mittal; Babak Moazen; Abdalla Z. Mohamed; Ahmed Ismail Mohamed; Jama Mohamed; Mouhand F.H. Mohamed; Nouh Saad Mohamed; Sakineh Mohammad-Alizadeh-Charandabi; Soheil Mohammadi; Abdollah Mohammadian-Hafshejani; Mustapha Mohammed; Salahuddin Mohammed; Shafiu Mohammed; Ali H. Mokdad; Peyman Mokhtarzadehazar; Hossein Molavi Vardanjani; Sabrina Molinaro; Lorenzo Monasta; Mohammad Ali Moni; Maryam Moradi; Yousef Moradi; Paula Moraga; Rafael Silveira Moreira; Negar Morovatdar; Shane Douglas Morrison; Jakub Morze; Abbas Mosapour; Elias Mossialos; Rohith Motappa; Parsa Mousavi; Amin Mousavi Khaneghah; Christine Mpundu-Kaambwa; Sumaira Mubarik; Lorenzo Muccioli; Francesk Mulita; Kavita Munjal; Efren Murillo-Zamora; Jonah Musa; Fungai Musaigwa; Ana-Maria Musina; Sathish Muthu; Saravanan Muthupandian; Muhammad Muzaffar; Woojae Myung; Ahamarshan Jayaraman Nagarajan; Gabriele Nagel; Pirouz Naghavi; Ganesh R. Naik; Gurudatta Naik; Mukhammad David Naimzada; Firzan Nainu; Vinay Nangia; Sreenivas Narasimha Swamy; Bruno Ramos Nascimento; Gustavo G. Nascimento; Abdallah Y. Naser; Mohammad Javad Nasiri; Zuhair S. Natto; Javaid Nauman; Muhammad Naveed; Biswa Prakash Nayak; Vinod C. 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 burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
(Elsevier Ltd, 2022) Brittney S. Sheena; Lindsey Hiebert; Hannah Han; Helen Ippolito; Mohsen Abbasi-Kangevari; Zeinab Abbasi-Kangevari; Hedayat Abbastabar; Amir Abdoli; Hiwa Abubaker Ali; Mesafint Molla Adane; Oyelola A. Adegboye; Qorinah Estiningtyas Sakilah Adnani; Shailesh M. Advani; Muhammad Sohail Afzal; Saira Afzal; Mohamad Aghaie Meybodi; Bahman Ahadinezhad; Bright Opoku Ahinkorah; Sajjad Ahmad; Tauseef Ahmad; Sepideh Ahmadi; Haroon Ahmed; Muktar Beshir Ahmed; Tarik Ahmed Rashid; Gizachew Taddesse Akalu; Addis Aklilu; Tayyaba Akram; Hanadi Al Hamad; Fares Alahdab; Adugnaw Zeleke Alem; Dejene Tsegaye Alem; Fadwa Alhalaiqa Naji Alhalaiqa; Robert Kaba Alhassan; Liaqat Ali; Muhammad Ashar Ali; Yousef Alimohamadi; Vahid Alipour; Motasem Alkhayyat; Sami Almustanyir; Rajaa M. Al-Raddadi; Haya Altawalah; Saeed Amini; Hubert Amu; Robert Ancuceanu; Catalina Liliana Andrei; Tudorel Andrei; Amir Anoushiravani; Adnan Ansar; Anayochukwu Edward Anyasodor; Jalal Arabloo; Morteza Arab-Zozani; Ayele Mamo Argaw; Zeleke Gebru Argaw; Muhammad Arshad; Anton A. Artamonov; Tahira Ashraf; Daniel Atlaw; Floriane Ausloos; Marcel Ausloos; Sina Azadnajafabad; Mohammadreza Azangou-Khyavy; Amirhossein Azari Jafari; Ghasem Azarian; Sayna Bagheri; Saeed Bahadory; Atif Amin Baig; Maciej Banach; Nastaran Barati; Amadou Barrow; Abdul-Monim Mohammad Batiha; Diana Fernanda Bejarano Ramirez; Uzma Iqbal Belgaumi; Alemshet Yirga Berhie; Devidas S. Bhagat; Nikha Bhardwaj; Pankaj Bhardwaj; Krittika Bhattacharyya; Vijayalakshmi S. Bhojaraja; Ali Bijani; Antonio Biondi; Belay Boda Abule Bodicha; Hunduma Amensisa Bojia; Archith Boloor; Cristina Bosetti; Dejana Braithwaite; Nikolay Ivanovich Briko; Zahid A. Butt; Luis Alberto Cámera; Raja Chandra Chakinala; Promit Ananyo Chakraborty; Jaykaran Charan; Shu Chen; Jee-Young Jasmine Choi; Sonali Gajanan Choudhari; Fazle Rabbi Chowdhury; Dinh-Toi Chu; Sheng-Chia Chung; Paolo Angelo Cortesi; Benjamin C. Cowie; Garland T. Culbreth; Omid Dadras; Xiaochen Dai; Lalit Dandona; Rakhi Dandona; Fernando Pio De La Hoz; Sisay Abebe Debela; Mohammed Gebre Dedefo; Feleke Mekonnen Demeke; Takele Gezahegn G. Demie; Getu Debalkie Demissie; Meseret Derbew Molla; Abebaw Alemayehu Desta; Deepak Dhamnetiya; Mandira Lamichhane Dhimal; Meghnath Dhimal; Mojtaba Didehdar; Linh Phuong Doan; Fariba Dorostkar; Thomas M. Drake; Fatemeh Eghbalian; Michael Ekholuenetale; Iman El Sayed; Maysaa El Sayed Zaki; Muhammed Elhadi; Mohamed A. Elmonem; Aisha Elsharkawy; Shymaa Enany; Daniel Berhanie Enyew; Ryenchindorj Erkhembayar; Sharareh Eskandarieh; Firooz Esmaeilzadeh; Sayeh Ezzikouri; Hossein Farrokhpour; Getahun Fetensa; Florian Fischer; Masoud Foroutan; Mohamed M. Gad; Abhay Motiramji Gaidhane; Shilpa Gaidhane; Natalie C. Galles; Silvano Gallus; Teferi Gebru Gebremeskel; Eyob Alemayehu Gebreyohannes; Keyghobad Ghadiri; Kazem Ghaffari; Mansour Ghafourifard; Seyyed-Hadi Ghamari; Ahmad Ghashghaee; Ali Gholami; Abdolmajid Gholizadeh; Aima Gilani; Amit Goel; Mahaveer Golechha; Pouya Goleij; Davide Golinelli; Giuseppe Gorini; Yitayal Ayalew Goshu; Max G. Griswold; Mohammed Ibrahim Mohialdeen Gubari; Bhawna Gupta; Sapna Gupta; Veer Bala Gupta; Vivek Kumar Gupta; Rasool Haddadi; Rabih Halwani; Saeed S. Hamid; Samer Hamidi; Asif Hanif; Shafiul Haque; Harapan Harapan; Arief Hargono; Sanam Hariri; Ahmed I. Hasaballah; S.M. Mahmudul Hasan; Soheil Hassanipour; Hadi Hassankhani; Simon I. Hay; Khezar Hayat; Golnaz Heidari; Claudiu Herteliu; Demisu Zenbaba Heyi; Kamal Hezam; Ramesh Holla; Mohammad-Salar Hosseini; Mostafa Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Mowafa Househ; Junjie Huang; Nawfal R. Hussein; Ivo Iavicoli; Segun Emmanuel Ibitoye; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Lalu Muhammad Irham; Jessica Y. Islam; Nahlah Elkudssiah Ismail; Kathryn H. Jacobsen; Farhad Jadidi-Niaragh; Amirreza Javadi Mamaghani; Shubha Jayaram; Ranil Jayawardena; Rime Jebai; Ravi Prakash Jha; Nitin Joseph; Farahnaz Joukar; Billingsley Kaambwa; Ali Kabir; Zubair Kabir; Rohollah Kalhor; Himal Kandel; Tesfaye K. Tesfaye Kanko; Rami S. Kantar; Ibraheem M. Karaye; Bekalu Getnet Kassa; Phillip M. Kemp Bohan; Mohammad Keykhaei; Yousef Saleh Khader; Himanshu Khajuria; Gulfaraz Khan; Imteyaz A. Khan; Junaid Khan; Moien A.B. Khan; Javad Khanali; Amir M. Khater; Mahalaqua Nazli Khatib; Mahmoud Khodadost; Abdullah T. Khoja; Omid Khosravizadeh; Jagdish Khubchandani; Gyu Ri Kim; Hanna Kim; Min Seo Kim; Yun Jin Kim; Jonathan M. Kocarnik; Ali-Asghar Kolahi; Rajasekaran Koteeswaran; G. Anil Kumar; Carlo La Vecchia; Dharmesh Kumar Lal; Iván Landires; Savita Lasrado; Jeffrey V. 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Murray; Mohsen Naghavi; Mukhammad David Naimzada; Sreenivas Narasimha Swamy; Zuhair S. Natto; Biswa Prakash Nayak; Javad Nazari; Ionut Negoi; Serban Mircea Negru; Seyed Aria Nejadghaderi; Sandhya Neupane Kandel; Huong Lan Thi Nguyen; Che Henry Ngwa; Robina Khan Niazi; Chukwudi A. Nnaji; Jean Jacques Noubiap; Ali Nowroozi; Virginia Nuñez-Samudio; Bogdan Oancea; Chimedsuren Ochir; Oluwakemi Ololade Odukoya; In-Hwan Oh; Andrew T. Olagunju; Babayemi Oluwaseun Olakunde; Ahmed Omar Bali; Emad Omer; Stanislav S. Otstavnov; Bilcha Oumer; Jagadish Rao Padubidri; Adrian Pana; Anamika Pandey; Eun-Cheol Park; Fatemeh Pashazadeh Kan; Urvish K. Patel; Uttam Paudel; Ionela-Roxana Petcu; Zahra Zahid Piracha; Richard Charles G. Pollok; Maarten J. Postma; Akram Pourshams; Hossein Poustchi; Mohammad Rabiee; Navid Rabiee; Alireza Rafiei; Sima Rafiei; Pavan Manibettu Raghuram; Mosiur Rahman; Amir Masoud Rahmani; Setyaningrum Rahmawaty; Aashish Rajesh; Priyanga Ranasinghe; Chythra R. Rao; Sowmya J. Rao; Mahsa Rashidi; Mohammad-Mahdi Rashidi; David Laith Rawaf; Salman Rawaf; Reza Rawassizadeh; Negar Rezaei; Aziz Rezapour; Sahba Rezazadeh-Khadem; Jefferson Antonio Buendia Rodriguez; Godfrey M. Rwegerera; Siamak Sabour; Basema Saddik; Mohammad Reza Saeb; Umar Saeed; Amirhossein Sahebkar; K.M. Saif-Ur-Rahman; Sarvenaz Salahi; Hamideh Salimzadeh; Chethan Sampath; Abdallah M. Samy; Juan Sanabria; Francesco Sanmarchi; Milena M. Santric-Milicevic; Arash Sarveazad; Brijesh Sathian; Monika Sawhney; Abdul-Aziz Seidu; Sadaf G. Sepanlou; Allen Seylani; Saeed Shahabi; Masood Ali Shaikh; Elaheh Shaker; Murad Ziyaudinovich Shakhmardanov; Mohammed Shannawaz; Suchitra M. Shenoy; Jeevan K. Shetty; Pavanchand H. Shetty; Kenji Shibuya; Jae Il Shin; Parnian Shobeiri; Migbar Mekonnen Sibhat; Achintya Dinesh Singh; Jasvinder A. Singh; Surjit Singh; Valentin Yurievich Skryabin; Anna Aleksandrovna Skryabina; Amir Ali Sohrabpour; Suhang Song; Seidamir Pasha Tabaeian; Eyayou Girma Tadesse; Majid Taheri; Mircea Tampa; Ker-Kan Tan; Ahmad Tavakoli; Abdelghani Tbakhi; Belay Negash Tefera; Arash Tehrani-Banihashemi; Habtamu Molla Tesfaw; Rekha Thapar; Aravind Thavamani; Seyed Abolfazl Tohidast; Daniel Nigusse Tollosa; Maria Elena Tosti; Marcos Roberto Tovani-Palone; Eugenio Traini; Mai Thi Ngoc Tran; Indang Trihandini; Biruk Shalmeno Tusa; Irfan Ullah; Marco Vacante; Sahel Valadan Tahbaz; Pascual R. Valdez; Shoban Babu Varthya; Bay Vo; Yasir Waheed; Adisu Birhanu Weldesenbet; Melat Woldemariam; Suowen Xu; Seyed Hossein Yahyazadeh Jabbari; Mehdi Yaseri; Yigizie Yeshaw; Vahit Yiǧit; Birhanu Wubale Yirdaw; Naohiro Yonemoto; Chuanhua Yu; Ismaeel Yunusa; Mazyar Zahir; Leila Zaki; Mohammad Zamani; Maryam Zamanian; Mikhail Sergeevich Zastrozhin; Theo Vos; John W. Ward; M. Ashworth Dirac
Background: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets. Methods: The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B. Findings: In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [–5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [–5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000. Interpretation: The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global, regional, and national burden of household air pollution, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
(Elsevier B.V., 2025) Fiona B. Bennitt; Sarah S. Wozniak; Kate Causey; Sandra Spearman; Chukwuma O. Okereke; Vanessa Garcia; Nadim Hashmeh; Charlie Ashbaugh; Atef Abdelkader; Meriem Abdoun; Muhammed Jemal Abdurebi; Armita Abedi; Roberto Ariel Abeldaño Zuñiga; Richard Gyan Aboagye; Bilyaminu Abubakar; Ahmed Abu-Zaid; Mesafint Molla Adane; Oyelola Abdulwasiu Adegboye; Victor Tunde Adekanmbi; Abiola Victor Adepoju; Temitayo Esther Adeyeoluwa; Olorunsola I. Adeyomoye; Rishan Adha; Muhammad Sohail Afzal; Saira Afzal; Feleke Doyore Agide; Aqeel Ahmad; Danish Ahmad; Muayyad M. Ahmad; Sajjad U. Ahmad; A. A. Ahmadi; Sepideh Ahmadi; Anisuddin Ahmed; Ayman Ahmed; Haroon Ahmed; Marjan Ajami; Rufus Olusola Akinyemi; Salah T. Al Awaidy; Hanadi Al Hamad; Muaaz Mutaz Alajlani; Mulubirhan Assefa Alemayohu; Adel Ali Saeed Al-Gheethi; Abid Ali; Waad K. Ali; Sheikh Mohammad Alif; Sami Almustanyir; Nelson Rafael Alvis-Guzman; Nelson J. Alvis-Zakzuk; Hany Z. Aly; Hubert Amu; Ganiyu Adeniyi Amusa; Tadele Fentabil Anagaw; Boluwatife Stephen Anuoluwa; Iyadunni A. Anuoluwa; Saeid Anvari; Ekenedilichukwu Emmanuel Anyabolo; Geminn Louis Carace Apostol; Aleksandr Y. Aravkin; Demelash Areda; Brhane Berhe Aregawi; Olatunde Aremu; Akeza Awealom Asgedom; Mubarek Yesse Ashemo; Tahira Ashraf; Seyyed Shamsadin Athari; Sina Azadnajafabad; Ahmed Y. Azzam; Giridhara Rathnaiah Rathnaiah Babu; Saeed Bahramian; Kiran Bam; Maciej P. Banach; Biswajit Banik; Mehmet Firat Baran; Francesco Barone-Adesi; Sandra Barteit; Hameed Akande Bashiru; Pritish Baskaran; Mohammad Mahdi Bastan; Sanjay Basu; Saurav Basu; Sefealem Assefa Belay; Melesse B.Y. Belayneh; Apostolos I. Beloukas; Derrick A. Bennett; Devidas S. Bhagat; Dinesh Mani Bhandari; Pankaj Bhardwaj; Sonu M.M. Bhaskar; Ajay Nagesh Bhat; Priyadarshini Bhattacharjee; Gurjit Kaur Bhatti; Manpreet Singh Bhatti; Cem Bilgin; Mary Sefa Boampong; Sri Harsha Boppana; Samuel Adolf Bosoka; Boudalia Sofiane; Fan Cao; Rama Mohan Chandika; Gashaw Sisay Chanie
Background: Despite a substantial reduction in the use of solid fuels for cooking worldwide, exposure to household air pollution (HAP) remains a leading global risk factor, contributing considerably to the burden of disease. We present a comprehensive analysis of spatial patterns and temporal trends in exposure and attributable disease from 1990 to 2021, featuring substantial methodological updates compared with previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study, including improved exposure estimations accounting for specific fuel types. Methods: We estimated HAP exposure and trends and attributable burden for cataract, chronic obstructive pulmonary disease, ischaemic heart disease, lower respiratory infections, tracheal cancer, bronchus cancer, lung cancer, stroke, type 2 diabetes, and causes mediated via adverse reproductive outcomes for 204 countries and territories from 1990 to 2021. We first estimated the mean fuel type-specific concentrations (in μg/m3) of fine particulate matter (PM2·5) pollution to which individuals using solid fuels for cooking were exposed, categorised by fuel type, location, year, age, and sex. Using a systematic review of the epidemiological literature and a newly developed meta-regression tool (meta-regression: Bayesian, regularised, trimmed), we derived disease-specific, non-parametric exposure–response curves to estimate relative risk as a function of PM2·5 concentration. We combined our exposure estimates and relative risks to estimate population attributable fractions and attributable burden for each cause by sex, age, location, and year. Findings: In 2021, 2·67 billion (95% uncertainty interval [UI] 2·63–2·71) people, 33·8% (95% UI 33·2–34·3) of the global population, were exposed to HAP from all sources at a mean concentration of 84·2 μg/m3. Although these figures show a notable reduction in the percentage of the global population exposed in 1990 (56·7%, 56·4–57·1), in absolute terms, there has been only a decline of 0·35 billion (10%) from the 3·02 billion people exposed to HAP in 1990. In 2021, 111 million (95% UI 75·1–164) global disability-adjusted life-years (DALYs) were attributable to HAP, accounting for 3·9% (95% UI 2·6–5·7) of all DALYs. The rate of global, HAP-attributable DALYs in 2021 was 1500·3 (95% UI 1028·4–2195·6) age-standardised DALYs per 100 000 population, a decline of 63·8% since 1990, when HAP-attributable DALYs comprised 4147·7 (3101·4–5104·6) age-standardised DALYs per 100 000 population. HAP-attributable burden remained highest in sub-Saharan Africa and south Asia, with 4044·1 (3103·4–5219·7) and 3213·5 (2165·4–4409·4) age-standardised DALYs per 100 000 population, respectively. The rate of HAP-attributable DALYs was higher for males (1530·5, 1023·4–2263·6) than for females (1318·5, 866·1–1977·2). Approximately one-third of the HAP-attributable burden (518·1, 410·1–641·7) was mediated via short gestation and low birthweight. Decomposition of trends and drivers behind changes in the HAP-attributable burden highlighted that declines in exposures were counteracted by population growth in most regions of the world, especially sub-Saharan Africa. Interpretation: Although the burden attributable to HAP has decreased considerably, HAP remains a substantial risk factor, especially in sub-Saharan Africa and south Asia. Our comprehensive estimates of HAP exposure and attributable burden offer a robust and reliable resource for health policy makers and practitioners to precisely target and tailor health interventions. Given the persistent and substantial impact of HAP in many regions and countries, it is imperative to accelerate efforts to transition under-resourced communities to cleaner household energy sources. Such initiatives are crucial for mitigating health risks and promoting sustainable development, ultimately improving the quality of life and health outcomes for millions of people. Funding: Bill & Melinda Gates Foundation. © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license
Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
(Elsevier Ltd, 2024) Valery L Feigin; Melsew Dagne Abate; Yohannes Habtegiorgis Abate; Samar Abd ElHafeez; Foad Abd-Allah; Ahmed Abdelalim; Atef Abdelkader; Michael Abdelmasseh; Sherief Abd-Elsalam; Parsa Abdi; Arash Abdollahi; Meriem Abdoun; Rami Abd-Rabu; Deldar Morad Abdulah; Auwal Abdullahi; Mesfin Abebe; Roberto Ariel Abeldaño Zuñiga; E.S. Abhilash; Olugbenga Olusola Abiodun; Olumide Abiodun; Rahim Abo Kasem; Richard Gyan Aboagye; Mohamed Abouzid; Lucas Guimarães Abreu; Woldu Aberhe Abrha; Dariush Abtahi; Samir Abu Rumeileh; Ahmed Abualhasan; Hasan Abualruz; Eman Abu-Gharbieh; Hana J Abukhadijah; Niveen ME Abu-Rmeileh; Salahdein Aburuz; Ahmed Abu-Zaid; Juan Manuel Acuna; Denberu Eshetie Adane; Mesafint Molla Adane; Isaac Yeboah Addo; Rufus Adesoji Adedoyin; Oyelola A Adegboye; Victor Adekanmbi; Kishor Adhikari; Qorinah Estiningtyas Sakilah Adnani; Saryia Adra; Leticia Akua Adzigbli; Abdelrahman Yousry Afify; Aanuoluwapo Adeyimika Afolabi; Fatemeh Afrashteh; Muhammad Sohail Afzal; Saira Afzal; Shahin Aghamiri; Williams Agyemang-Duah; Bright Opoku Ahinkorah; Aqeel Ahmad; Muayyad M Ahmad; Sajjad Ahmad; Shahzaib Ahmad; Tauseef Ahmad; Amir Mahmoud Ahmadzade; Ali Ahmed; Ayman Ahmed; Haroon Ahmed; Syed Anees Ahmed; Marjan Ajami; Budi Aji; Essona Matatom Akara; Rufus Olusola Akinyemi; Mohammed Ahmed Akkaif; Ashley E Akrami; Salah Al Awaidy; Hanadi Al Hamad; Syed Mahfuz Al Hasan; Mohammad Al Qadire; Omar Al Ta'ani; Yazan Al-Ajlouni; Samer O Alalalmeh; Tariq A Alalwan; Ziyad Al-Aly; Rasmieh Mustafa Al-amer; Wafa A Aldhaleei; Mohammed S Aldossary; Seyedeh Yasaman Alemohammad; Bassam Al-Fatly; Adel Ali Saeed Al-Gheethi; Fadwa Naji Alhalaiqa; Maryam Alharrasi; Abid Ali; Mohammed Usman Ali; Rafat Ali; Syed Shujait Ali; Waad Ali; Akram Al-Ibraheem; Sheikh Mohammad Alif; Syed Mohamed Aljunid; Wael Almahmeed; Sabah Al-Marwani; Mahmoud A Alomari; Jordi Alonso; Jaber S Alqahtani; Rajaa M Mohammad Al-Raddadi; Ahmad Alrawashdeh; Mohammed A Alsabri; Najim Z Alshahrani; Zaid Altaany; Awais Altaf; Alaa B Al-Tammemi; Diala Altwalbeh; Nelson Alvis-Guzman; Hassan Alwafi; Mohammad Al-Wardat; Yaser Mohammed Al-Worafi; Hany Aly; Safwat Aly; Mohammad Sharif Ibrahim Alyahya; Karem H Alzoubi; Walid Adnan Al-Zyoud; Reza Amani; Prince M Amegbor; Tewodros Getnet Amera; Tarek Tawfik Amin; Alireza Amindarolzarbi; Sohrab Amiri; Hubert Amu; Dickson A Amugsi; Ganiyu Adeniyi Amusa; Robert Ancuceanu; Deanna Anderlini; Dhanalakshmi Angappan; Abhishek Anil; Mohammed Tahir Tahir Ansari; Alireza Ansari-Moghaddam; Rockson Ansong; Saeid Anvari; Saleha Anwar; Sumadi Lukman Anwar; Ekenedilichukwu Emmanuel Anyabolo; Anayochukwu Edward Anyasodor; Geminn Louis Carace Apostol; Francis Appiah; Muhammad Aqeel; Jalal Arabloo; Razman Arabzadeh Bahri; Mosab Arafat; Aleksandr Y Aravkin; Ali Ardekani; Demelash Areda; Brhane Berhe Aregawi; Getnet Mesfin Aregu; Olatunde Aremu; Hidayat Arifin; Johan Ärnlöv; Anton A Artamonov; Judie Arulappan; Umesh Raj Aryal; Zahra Aryan; Akram M Asbeutah; Mulusew A Asemahagn; Mulu Tiruneh Asemu; Mohammad Asghari-Jafarabadi; Mubarek Yesse Ashemo; Tahira Ashraf; Armin Aslani; Haftu Asmerom Asmerom; Thomas Astell-Burt; Seyyed Shamsadin Athari; Prince Atorkey; Maha Moh'd Wahbi Atout; Alok Atreya; Avinash Aujayeb; Marcel Ausloos; Abolfazl Avan; Hamzeh Awad; Adedapo Wasiu Awotidebe; Lemessa Assefa A Ayana; Setognal Birara Aychiluhm; Amdehiwot A Aynalem; Zewdu Bishaw Aynalem; Sina Azadnajafabad; Hiva Azami; Shahkaar Aziz; Ahmed Y Azzam; Abraham Samuel Babu; Giridhara Rathnaiah Babu; Muhammad Badar; Ashish D Badiye; Pegah Bahrami Taghanaki; Saeed Bahramian; Ruhai Bai; Atif Amin Baig; Shankar M Bakkannavar; Abdulaziz T Bako; Ovidiu Constantin Baltatu; Kiran Bam; Maciej Banach; Morteza Banakar; Soham Bandyopadhyay; Palash Chandra Banik; Kannu Bansal; Yanping Bao; Miguel A Barboza; Mainak Bardhan; Noel C Barengo; Suzanne Lyn Barker-Collo; Till Winfried Bärnighausen; Hiba Jawdat Barqawi; Amadou Barrow; Lingkan Barua; Azadeh Bashiri; Hameed Akande Bashiru; Afisu Basiru; Mohammad-Mahdi Bastan; Sanjay Basu; Saurav Basu; Kavita Batra; Ahmet Begde; Babak Behnam; Amir Hossein Behnoush; Melesse B Y Belayneh; Michael Belingheri; Umar Muhammad Bello; Derrick A Bennett; Isabela M Bensenor; Fentaw Tadese Berhe; Amiel Nazer C Bermudez; Habtamu B B Beyene; Kebede A Beyene; Devidas S Bhagat; Akshaya Srikanth Bhagavathula; Neeraj Bhala; Ashish Bhalla; Nikha Bhardwaj; Pankaj Bhardwaj; Sonu Bhaskar; Ajay Nagesh Bhat; Vivek Bhat; Gurjit Kaur Bhatti; Jasvinder Singh Singh Bhatti; Mohiuddin Ahmed Bhuiyan; Subarna Bhusal; Boris Bikbov; Cem Bilgin; Antonio Biondi; Keralem Anteneh Bishaw; Atanu Biswas; Bijit Biswas; Trupti Bodhare; Eyob Ketema Bogale; Archith Boloor; Milad Bonakdar Hashemi; Aime Bonny; Berrak Bora Basara; Hamed Borhany; Samuel Adolf Bosoka; Souad Bouaoud; Abdelhakim Bouyahya; Edward J Boyko; Marija M Bozic; Dejana Braithwaite; Susanne Breitner; Hermann Brenner; Gabrielle Britton; Andre R Brunoni; Dana Bryazka; Raffaele Bugiardini; Lemma N Bulto; Katrin Burkart; Yasser Bustanji; Zahid A Butt; Florentino Luciano Caetano dos Santos; Luis Alberto Cámera; Luciana Aparecida Campos; Ismael R Campos-Nonato; Fan Cao; Angelo Capodici; Rosario Cárdenas; Sinclair Carr; Giulia Carreras; Andre F Carvalho; Felix Carvalho; Joao Mauricio Castaldelli-Maia; Carlos A Castañeda-Orjuela; Giulio Castelpietra; Alberico L Catapano; Maria Sofia Cattaruzza; Luca Cegolon; Francieli Cembranel; Edina Cenko; Ester Cerin; Joshua Chadwick; Chiranjib Chakraborty; Sandip Chakraborty; Jeffrey Shi Kai Chan; Rama Mohan Chandika; Eeshwar K Chandrasekar; Gashaw Sisay Chanie; Vijay Kumar Chattu; Anis Ahmad Chaudhary; Akhilanand Chaurasia; Haowei Chen; Mingling Chen; Simiao Chen; Gerald Chi; Fatemeh Chichagi; Ritesh Chimoriya; Patrick R Ching; Abdulaal Chitheer; So Mi Jemma Cho; Dong-Woo Choi; Bryan Chong; Chean Lin Chong; Hitesh Chopra; Sonali Gajanan Choudhari; Rahul Choudhary; Dinh-Toi Chu; Isaac Sunday Chukwu; Sheng-Chia Chung; Zinhle Cindi; Iolanda Cioffi; Rebecca M Cogen; Alyssa Columbus; Simona Costanzo; Rosa A S Couto; Michael H Criqui; Natalia Cruz-Martins; Silvia Magali Cuadra-Hernández; Alanna Gomes da Silva; Sriharsha Dadana; Omid Dadras; Xiaochen Dai; Koustuv Dalal; Lachlan L Dalli; Giovanni Damiani; Emanuele D'Amico; Lalit Dandona; Rakhi Dandona; Amira Hamed Darwish; Saswati Das; Mohsen Dashti; Mohadese Dashtkoohi; Mohammad Dashtkoohi; Maedeh Dastmardi; Kairat Davletov; Vanessa De la Cruz-Góngora; Sean DeAngelo; Aklilu Tamire Debele; Shayom Debopadhaya; Ivan Delgado-Enciso; Berecha Hundessa Demessa; Andreas K Demetriades; Edgar Denova-Gutiérrez; Emina Dervišević; Hardik Dineshbhai Desai; Aragaw Tesfaw Desale; Fikreab Desta; Vinoth Gnana Chellaiyan Devanbu; Devananda Devegowda; Syed Masudur Rahman Dewan; Amol S Dhane; Meghnath Dhimal; Vishal R Dhulipala; Michael J Diaz; Mengistie Diress; Milad Dodangeh; Phidelia Theresa Doegah; Sushil Dohare; Mohamed Fahmy Doheim; Klara Georgieva Dokova; Deepa Dongarwar; Mario D'Oria; Ojas Prakashbhai Doshi; Rajkumar Prakashbhai Doshi; Abdel Douiri; Robert Kokou Dowou; Ashel Chelsea Dsouza; Haneil Larson Dsouza; Viola Savy Dsouza; Bruce B Duncan; Andre Rodrigues Duraes; Arkadiusz Marian Dziedzic; Michael Ekholuenetale; Ibrahim Farahat El Bayoumy; Maysaa El Sayed Zaki; Iffat Elbarazi; Faris El-Dahiyat; Islam Y Elgendy; Muhammed Elhadi; Waseem El-Huneidi; Mohamed A Elmonem; Adel B Elmoselhi; Chadi Eltaha; Theophilus I Emeto; Christopher Imokhuede Esezobor; Negin Esfandiari; Zahra Esmaeili; Francesco Esposito; Mohammad Etoom; Natalia Fabin; Ibtihal Fadhil; Adeniyi Francis Fagbamigbe; Omotayo Francis Fagbule; Shahriar Faghani; Ayesha Fahim; Ildar Ravisovich Fakhradiyev; Luca Falzone; Mohammad Fareed; Jawad Fares; Carla Sofia e Sá Farinha; MoezAlIslam Ezzat Mahmoud Faris; Pawan Sirwan Faris; Mohsen Farjoud Kouhanjani; Andre Faro; Hossein Farrokhpour; Abidemi Omolara Fasanmi; Nelsensius Klau Fauk; Patrick Fazeli; Timur Fazylov; Alireza Feizkhah; Ginenus Fekadu; Xiaoqi Feng; Seyed-Mohammad Fereshtehnejad; Pietro Ferrara; Nuno Ferreira; Getahun Fetensa; Bikila Regassa Feyisa; Florian Fischer; Luisa S Flor; Kristen Marie Foley; Ana Catarina Fonseca; Roham Foroumadi; Behzad Foroutan; Daniela Fortuna; Matteo Foschi; Richard Charles Franklin; Ni Kadek Yuni Fridayani; Sridevi G; Peter Andras Gaal; Abhay Motiramji Gaidhane; Abduzhappar Gaipov; Yaseen Galali; Silvano Gallus; Aravind P Gandhi; Balasankar Ganesan; Danijela Gasevic; Prem Gautam; Rupesh K Gautam; Miglas Welay Gebregergis; Mesfin Gebrehiwot; Kebre Gebrekirstos Gebrekidan; Lemma Getacher; Genanew K Getahun; Molla Getie; Delaram J Ghadimi; Fataneh Ghadirian; Amir Ghaffari Jolfayi; Mansour Ghafourifard; Mohammad-Reza Ghasemi; Afsaneh Ghasemzadeh; Ramy Mohamed Ghazy; Ehsan Gholami; Zainab Gholami; Sherief Ghozy; Stefano Giannoni Luza; Jaleed Ahmed Gilani; Tiffany K Gill; Richard F Gillum; Ebisa Zerihun Gindaba; Elena V Gnedovskaya; Amit Goel; Mohamad Goldust; Mahaveer Golechha; Pouya Goleij; Davide Golinelli; Philimon N Gona; Giuseppe Gorini; Alessandra C Goulart; Barbara Niegia Garcia Goulart; Mahdi Gouravani; Michal Grivna; Giuseppe Grosso; Ashna Grover; Shi-Yang Guan; Giovanni Guarducci; Avirup Guha; Stefano Guicciardi; Snigdha Gulati; Damitha Asanga Gunawardane; Cui Guo; Zhifeng Guo; Anish Kumar Gupta; Bhawna Gupta; Mohak Gupta; Rahul Gupta; Rajat Das Gupta; Rajeev Gupta; Sapna Gupta; Farrokh Habibzadeh; Najah R Hadi; Mohammad Haghani Dogahe; Hamed Haghi-Aminjan; Dariush Haghmorad; Arvin Haj-Mirzaian; Aram Halimi; Nadia M Hamdy; Samer Hamidi; Erin B Hamilton; Asif Hanif; Nasrin Hanifi; Graeme J Hankey; Md Abdul Hannan; Zaim Anan Haq; Arief Hargono; Netanja I Harlianto; Josep Maria Haro; Eka Mishbahatul Marah Has; Ahmed I Hasaballah; Ikramul Hasan; Md Saquib Hasnain; Ikrama Hassan; Mahgol Sadat Hassan Zadeh Tabatabaei; Johannes Haubold; Rasmus J Havmoeller; Simon I Hay; Youssef Hbid; Jeffrey J Hebert; Omar E Hegazi; Mohammad Heidari; Mehdi Hemmati; Demisu Zenbaba Heyi; Kamal Hezam; Yuta Hiraike; Nguyen Quoc Hoan; Ramesh Holla; Nobuyuki Horita; Md Mahbub Hossain; Hassan Hosseinzadeh; Mehdi Hosseinzadeh; Ahmad Hosseinzadeh Adli; Mihaela Hostiuc; Sorin Hostiuc; Ben Hu; Chengxi Hu; Junjie Huang; Ayesha Humayun; Salman Hussain; Le Duc Huy; Hong-Han Huynh; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Nayu Ikeda; Adalia Ikiroma; Olayinka Stephen Ilesanmi; Irena M Ilic; Milena D Ilic; Mohammad Tarique Imam; Mustapha Immurana; Leeberk Raja Inbaraj; Muhammad Iqhrammullah; Arnaud Iradukunda; Lalu Muhammad Irham; Md Rabiul Islam; Faisal Ismail; Nahlah Elkudssiah Ismail; Hiroyasu Iso; Gaetano Isola; Ramaiah Itumalla; Masao Iwagami; Chidozie Declan CD Iwu; Vinothini J; Jalil Jaafari; Louis Jacob; Abdollah Jafarzadeh; Haitham Jahrami; Akhil Jain; Nityanand Jain; Ammar Abdulrahman Jairoun; Abhishek Jaiswal; Mihajlo Jakovljevic; Reza Jalilzadeh Yengejeh; Balamurugan Janakiraman; Abubakar Ibrahim Jatau; Sathish Kumar Jayapal; Shubha Jayaram; Sun Ha Jee; Jayakumar Jeganathan; Mihretu Jegnie; Alelign Tasew Jema; Bijay Mukesh Jeswani; Angeline Jeyakumar; Anil K Jha; Ravi Prakash Jha; Zixiang Ji; Heng Jiang; Shuai Jin; Yingzhao Jin; Mohammad Jokar; Jost B Jonas; Tamas Joo; Jobinse Jose; Nitin Joseph; Charity Ehimwenma Joshua; Farahnaz Joukar; Jacek Jerzy Jozwiak; Mikk Jürisson; Ali Kabir; Md Awal Kabir; Zubair Kabir; Vidya Kadashetti; Rizwan Kalani; Sanjay Kalra; Vineet Kumar Kamal; Arun Kamireddy; Haidong Kan; Mona Kanaan; Himal Kandel; Kehinde Kazeem Kanmodi; 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Background: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. Methods: We estimated incidence, prevalence, death, and disability-adjusted life-year (DALY) counts and age-standardised rates per 100 000 people per year for overall stroke, ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage, for 204 countries and territories from 1990 to 2021. We also calculated burden of stroke attributable to 23 risk factors and six risk clusters (air pollution, tobacco smoking, behavioural, dietary, environmental, and metabolic risks) at the global and regional levels (21 GBD regions and Socio-demographic Index [SDI] quintiles), using the standard GBD methodology. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In 2021, stroke was the third most common GBD level 3 cause of death (7·3 million [95% UI 6·6–7·8] deaths; 10·7% [9·8–11·3] of all deaths) after ischaemic heart disease and COVID-19, and the fourth most common cause of DALYs (160·5 million [147·8–171·6] DALYs; 5·6% [5·0–6·1] of all DALYs). In 2021, there were 93·8 million (89·0–99·3) prevalent and 11·9 million (10·7–13·2) incident strokes. We found disparities in stroke burden and risk factors by GBD region, country or territory, and SDI, as well as a stagnation in the reduction of incidence from 2015 onwards, and even some increases in the stroke incidence, death, prevalence, and DALY rates in southeast Asia, east Asia, and Oceania, countries with lower SDI, and people younger than 70 years. Globally, ischaemic stroke constituted 65·3% (62·4–67·7), intracerebral haemorrhage constituted 28·8% (28·3–28·8), and subarachnoid haemorrhage constituted 5·8% (5·7–6·0) of incident strokes. There were substantial increases in DALYs attributable to high BMI (88·2% [53·4–117·7]), high ambient temperature (72·4% [51·1 to 179·5]), high fasting plasma glucose (32·1% [26·7–38·1]), diet high in sugar-sweetened beverages (23·4% [12·7–35·7]), low physical activity (11·3% [1·8–34·9]), high systolic blood pressure (6·7% [2·5–11·6]), lead exposure (6·5% [4·5–11·2]), and diet low in omega-6 polyunsaturated fatty acids (5·3% [0·5–10·5]). Interpretation: Stroke burden has increased from 1990 to 2021, and the contribution of several risk factors has also increased. Effective, accessible, and affordable measures to improve stroke surveillance, prevention (with the emphasis on blood pressure, lifestyle, and environmental factors), acute care, and rehabilitation need to be urgently implemented across all countries to reduce stroke burden. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global, regional, and national burden of upper respiratory infections and otitis media, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021
(Elsevier Ltd, 2025) Sarah Brooke Sirota; Regina Mae Villanueva Dominguez; Rose Grace Bender; Avina Vongpradith; Samuel B. Albertson; Amanda Novotney; Katrin G. Burkart; Austin R. Carter; Erin Chung; Xiaochen Dai; Luisa Sório Flor; Stephen S. Lim; Tomislav Meštrović; Ali H.I. Mokdad; Vincent Mougin; Maja Pasovic; David M. Pigott; Quinn Rafferty; Austin E. Schumacher; Aleksandr Y. Aravkin; Nicholas J. Kassebaum; Mohsen Naghavi; Theo Vos; Simon I. Hay; Christopher J.L. Murray; Hmwe Hmwe Kyu; Benn K.D. Sartorius; Sonali Kochhar; Vijay Krishnamoorthy; Hafsa Zia; Matthew C. Doxey; Mohamad Goldust; Xiaofeng Liu; Shrikant Pawar; Parsa Abdi; Meriem Abdoun; Ayele Mamo Abebe; Birhan Tsegaw Taye; Kedir Hussein Abegaz; Mesud Mohammed; Richard Gyan Aboagye; Leticia Akua Adzigbli; Robert Kaba Alhassan; Hubert Amu; V. N. Orish; Hassan Abolhassani; Nazila Rezaei; Mohammad Mahdi Bastan; Parsa Mousavi; Mohammad Mahdi Rashidi; Nima A. Rezaei; Amir Hossein Behnoush; Amirmohammad Khalaji; Mohsen Merati; Fatemeh Chichagi; Omid Dadras; Mohadese Dashtkoohi; Mostafa Hadei; Elaheh Malakan Rad; Mohammad Sadeq Najafi; Vafa Rahimi-Movaghar; Seyedahmad Ahmad Seyedalinaghi; Mahan Shafie; Amin Sharifan; Seyed Mohammad Vahabi; Lucas Guimarães Abreu; Elton Junio Sady Prates; Hasan Abualruz; Eman F. Abu-Gharbieh; Yasser Khalil Bustanji; Malik Sallam; Hiba Jawdat Barqawi; Nihar Ranjan Dash; Rabih Halwani; Mahmoud M. Ramadan; Narjes Saheb Sharif-Askari; Iman M. Talaat; Karem Hasan Alzoubi; Basema Ahmad Saddik; Mohamed A. Saleh; Fatemeh Saheb Sharif-Askari; Sameh S.M. Soliman; Salahdein Mohammed Aburuz; Rami H. Al-Rifai; Gulfaraz Khan; Mesafint Molla Adane; Eyob Ketema Bogale; Isaac Yeboah Addo; Victor Tunde Adekanmbi; Weichen Lee; Qorinah Estiningtyas Sakilah Adnani; Maarten Jacobus Postma; Muhammad Sohail Afzal; Saira Afzal; Bright Opoku Ahinkorah; Gang Liu; Nghia Minh Tran; Sajjad U. Ahmad; Ayman Ahmed; Emmanuel Edwar Siddig
Background: Upper respiratory infections (URIs) are the leading cause of acute disease incidence worldwide and contribute to a substantial health-care burden. Although acute otitis media is a common complication of URIs, the combined global burden of URIs and otitis media has not been studied comprehensively. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to explore the fatal and non-fatal burden of the two diseases across all age groups, including a granular analysis of children younger than 5 years, in 204 countries and territories from 1990 to 2021. Methods: Mortality due to URIs and otitis media was estimated with use of vital registration and sample-based vital registration data, which are used as inputs to the Cause of Death Ensemble model to separately model URIs and otitis media mortality by age and sex. Morbidity was modelled with a Bayesian meta-regression tool using data from published studies identified via systematic reviews, population-based survey data, and cause-specific URI and otitis media mortality estimates. Additionally, we assessed and compared the burden of otitis media as it relates to URIs and examined the collective burden and contributing risk factors of both diseases. Findings: The global number of new episodes of URIs was 12·8 billion (95% uncertainty interval 11·4 to 14·5) for all ages across males and females in 2021. The global all-age incidence rate of URIs decreased by 10·1% (-12·0 to -8·1) from 1990 to 2019. From 2019 to 2021, the global all-age incidence rate fell by 0·5% (-0·8 to -0·1). Globally, the incidence rate of URIs was 162 484·8 per 100 000 population (144 834·0 to 183 289·4) in 2021, a decrease of 10·5% (-12·4 to -8·4) from 1990, when the incidence rate was 181 552·5 per 100 000 population (160 827·4 to 206 214·7). The highest incidence rates of URIs were seen in children younger than 2 years in 2021, and the largest number of episodes was in children aged 5-9 years. The number of new episodes of otitis media globally for all ages was 391 million (292 to 525) in 2021. The global incidence rate of otitis media was 4958·9 per 100 000 (3705·4 to 6658·6) in 2021, a decrease of 16·3% (-18·1 to -14·0) from 1990, when the incidence rate was 5925·5 per 100 000 (4371·8 to 8097·9). The incidence rate of otitis media in 2021 was highest in children younger than 2 years, and the largest number of episodes was in children aged 2-4 years. The mortality rate of URIs in 2021 was 0·2 per 100 000 (0·1 to 0·5), a decrease of 64·2% (-84·6 to -43·4) from 1990, when the mortality rate was 0·7 per 100 000 (0·2 to 1·1). In both 1990 and 2021, the mortality rate of otitis media was less than 0·1 per 100 000. Together, the combined burden accounted for by URIs and otitis media in 2021 was 6·86 million (4·24 to 10·4) years lived with disability and 8·16 million (4·99 to 12·0) disability-adjusted life-years (DALYs) for all ages across males and females. Globally, the all-age DALY rate of URIs and otitis media combined in 2021 was 103 per 100 000 (63 to 152). Infants aged 1-5 months had the highest combined DALY rate in 2021 (647 per 100 000 [189 to 1412]), followed by early neonates (aged 0-6 days; 582 per 100 000 [176 to 1297]) and late neonates (aged 7-24 days; 482 per 100 000 [161 to 1052]). Interpretation: The findings of this study highlight the widespread burden posed by URIs and otitis media across all age groups and both sexes. There is a continued need for surveillance, prevention, and management to better understand and reduce the burden associated with URIs and otitis media, and research is needed to assess their impacts on individuals, communities, economies, and health-care systems worldwide. Funding: Bill & Melinda Gates Foundation. © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license