Browsing by Author "Richard Gyan Aboagye"

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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
Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019
(Elsevier Ltd, 2022) Hmwe Hmwe Kyu; Avina Vongpradith; Sarah Brooke Sirota; Amanda Novotney; Christopher E Troeger; Matthew C Doxey; Rose G Bender; Jorge R Ledesma; Molly H Biehl; Samuel B Albertson; Joseph Jon Frostad; Katrin Burkart; Fiona B Bennitt; Jeff T Zhao; William M Gardner; Hailey Hagins; Dana Bryazka; Regina-Mae Villanueva Dominguez; Semagn Mekonnen Abate; Michael Abdelmasseh; Amir Abdoli; Gholamreza Abdoli; Aidin Abedi; Vida Abedi; Tadesse M Abegaz; Hassan Abidi; Richard Gyan Aboagye; Hassan Abolhassani; Yonas Derso Abtew; Hiwa Abubaker Ali; Eman Abu-Gharbieh; Ahmed Abu-Zaid; Kidist Adamu; Isaac Yeboah Addo; Oyelola A Adegboye; Mohammad Adnan; Qorinah Estiningtyas Sakilah Adnani; Muhammad Sohail Afzal; Saira Afzal; Bright Opoku Ahinkorah; Aqeel Ahmad; Araz Ramazan Ahmad; Sajjad Ahmad; Ali Ahmadi; Sepideh Ahmadi; Haroon Ahmed; Jivan Qasim Ahmed; Tarik Ahmed Rashid; Mostafa Akbarzadeh-Khiavi; Hanadi Al Hamad; Luciana Albano; Mamoon A Aldeyab; Bezatu Mengistie Alemu; Kefyalew Addis Alene; Abdelazeem M Algammal; Fadwa Alhalaiqa Naji Alhalaiqa; Robert Kaba Alhassan; Beriwan Abdulqadir Ali; Liaqat Ali; Musa Mohammed Ali; Syed Shujait Ali; Yousef Alimohamadi; Vahid Alipour; Adel Al-Jumaily; Syed Mohamed Aljunid; Sami Almustanyir; Rajaa M Al-Raddadi; Rami H Hani Al-Rifai; Saif Aldeen S AlRyalat; Nelson Alvis-Guzman; Nelson J Alvis-Zakzuk; Edward Kwabena Ameyaw; Javad Javad Aminian Dehkordi; John H Amuasi; Dickson A Amugsi; Etsay Woldu Anbesu; Adnan Ansar; Anayochukwu Edward Anyasodor; Jalal Arabloo; Demelash Areda; Ayele Mamo Argaw; Zeleke Gebru Argaw; Judie Arulappan; Raphael Taiwo Aruleba; Mulusew A Asemahagn; Seyyed Shamsadin Athari; Daniel Atlaw; Engi F Attia; Sameh Attia; Avinash Aujayeb; Tewachew Awoke; Tegegn Mulatu Ayana; Martin Amogre Ayanore; Sina Azadnajafabad; Mohammadreza Azangou-Khyavy; Samad Azari; Amirhossein Azari Jafari; Muhammad Badar; Ashish D Badiye; Nayereh Baghcheghi; Sara Bagherieh; Atif Amin Baig; MacIej Banach; Indrajit Banerjee; Mainak Bardhan; Francesco Barone-Adesi; Hiba Jawdat Barqawi; Amadou Barrow; Azadeh Bashiri; Quique Bassat; Abdul-Monim Mohammad Batiha; Abate Bekele Belachew; Melaku Ashagrie Belete; Uzma Iqbal Belgaumi; Akshaya Srikanth Bhagavathula; Nikha Bhardwaj; Pankaj Bhardwaj; Parth Bhatt; Vijayalakshmi S Bhojaraja; Zulfiqar A Bhutta; Soumitra S Bhuyan; Ali Bijani; Saeid Bitaraf; Belay Boda Abule Bodicha; Nikolay Ivanovich Briko; Danilo Buonsenso; Muhammad Hammad Butt; Jiao Cai; Paulo Camargos; Luis Alberto Cámera; Promit Ananyo Chakraborty; Muluken Genetu Chanie; Jaykaran Charan; Vijay Kumar Chattu; Patrick R Ching; Sungchul Choi; Yuen Yu Chong; Sonali Gajanan Choudhari; Enayet Karim Chowdhury; Devasahayam J Christopher; Dinh-Toi Chu; Natalie L Cobb; Aaron J Cohen; Natália Cruz-Martins; Omid Dadras; Fentaw Teshome Dagnaw; Xiaochen Dai; Lalit Dandona; Rakhi Dandona; An Thi Minh Dao; Sisay Abebe Debela; Biniyam Demisse; Fitsum Wolde Demisse; Solomon Demissie; Diriba Dereje; Hardik Dineshbhai Desai; Abebaw Alemayehu Desta; Belay Desye; Sameer Dhingra; Nancy Diao; Daniel Diaz; Lankamo Ena Digesa; Linh Phuong Doan; Milad Dodangeh; Deepa Dongarwar; Fariba Dorostkar; Wendel Mombaque Dos Santos; Haneil Larson Dsouza; Eleonora Dubljanin; Oyewole Christopher Durojaiye; Hisham Atan Edinur; Elham Ehsani-Chimeh; Ebrahim Eini; Michael Ekholuenetale; Temitope Cyrus Ekundayo; Eman D El Desouky; Iman El Sayed; Maysaa El Sayed Zaki; Muhammed Elhadi; Ahmed Mahmoud Rabie Elkhapery; Amir Emami; Luchuo Engelbert Bain; Ryenchindorj Erkhembayar; Farshid Etaee; Mohamad Ezati Asar; Adeniyi Francis Fagbamigbe; Shahab Falahi; Aida Fallahzadeh; Anwar Faraj; Emerito Jose A Faraon; Ali Fatehizadeh; Pietro Ferrara; Allegra Allegra Ferrari; Getahun Fetensa; Florian Fischer; Joanne Flavel; Masoud Foroutan; Peter Andras Gaal; Abhay Motiramji Gaidhane; Santosh Gaihre; Nasrin Galehdar; Alberto L Garcia-Basteiro; Tushar Garg; Mesfin Damtew Gebrehiwot; Mathewos Alemu Gebremichael; Yibeltal Yismaw Gela; Belete Negese Belete Gemeda; Bradford D Gessner; Melaku Getachew; Asmare Getie; Seyyed-Hadi Ghamari; Mohammad Ghasemi Nour; Ahmad Ghashghaee; Ali Gholamrezanezhad; Abdolmajid Gholizadeh; Rakesh Ghosh; Sherief Ghozy; Pouya Goleij; Mohamad Golitaleb; Giuseppe Gorini; Alessandra C Goulart; Girma Garedew Goyomsa; Habtamu Alganeh Guadie; Zewdie Gudisa; Rashid Abdi Guled; Sapna Gupta; Veer Bala Gupta; Vivek Kumar Gupta; Alemu Guta; Parham Habibzadeh; Arvin Haj-Mirzaian; Rabih Halwani; Samer Hamidi; Md Abdul Hannan; Mehdi Harorani; Ahmed I Hasaballah; Hamidreza Hasani; Abbas M Hassan; Shokoufeh Hassani; Hossein Hassanian-Moghaddam; Hadi Hassankhani; Khezar Hayat; Behzad Heibati; Mohammad Heidari; Demisu Zenbaba Heyi; Kamal Hezam; Ramesh Holla; Sung Hwi Hong; Nobuyuki Horita; Mohammad-Salar Hosseini; Mehdi Hosseinzadeh; Mihaela Hostiuc; Mowafa Househ; Soodabeh Hoveidamanesh; Junjie Huang; Nawfal R Hussein; Ivo Iavicoli; Segun Emmanuel Ibitoye; Kevin S Ikuta; Olayinka Stephen Ilesanmi; Irena M Ilic; Milena D Ilic; Mustapha Immurana; Nahlah Elkudssiah Ismail; Masao Iwagami; Jalil Jaafari; Elham Jamshidi; Sung-In Jang; Amirreza Javadi Mamaghani; Tahereh Javaheri; Fatemeh Javanmardi; Javad Javidnia; Sathish Kumar Jayapal; Umesh Jayarajah; Shubha Jayaram; Alelign Tasew Jema; Wonjeong Jeong; Jost B Jonas; Nitin Joseph; Farahnaz Joukar; Jacek Jerzy Jozwiak; V. 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Background: The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods: In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings: Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation: The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. 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
Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
(Elsevier B.V., 2025) Simon I. Hay; Kanyin Liane Ong; Damian Francesco Santomauro; A. Bhoomadevi; Mohammad Amin Aalipour; Hasan Abualruz; Hazim S. Ababneh; Ukachukwu Okoroafor Abaraogu; Biruk Beletew Abate; Cristiana Abbafati; Nasir Abbas; Mitra Abbasifard; Mohsen Abbasi-Kangevari; Samar Abd ElHafeez; Ashraf N. Abdalla; Mohammed Altigani Abdalla; Emad M. Abdallah; Barkhad Aden Abdeeq; Nadin M. Abdel Razeq; Ahmed Abdelrahman Abdelgalil; Reda S. Abdel-Hameed; Michael Abdelmasseh; Mahmoud Hassan Abdelnabi; Wael M. Abdel-Rahman; Sherief M. Abd-Elsalam; Sepideh Abdi; Mohammad Abdollahi; Meriem Abdoun; Arman Abdous; Jeza Muhamad Abdul Aziz; Deldar Morad Abdulah; Rizwan Suliankatchi Abdulkader; Adam Ibrahim Abdullahi; Auwal S. Abdullahi; Toufik Abdul-Rahman; Kulmira Abdykerimova; Habtamu Abebe Getahun; Aidin Abedi; Armita Abedi; Asrat Agalu Abejew; Roberto Ariel Abeldaño Zuñiga; E. S. Abhilash; Shehab Uddin Al Abid; Syed Hani Abidi; Alemwork Abie; Olugbenga Olusola Abiodun; Olumide A. Abiodun; Richard Gyan Aboagye; Shady M. Abohashem; Hassan Abolhassani; Ulric Sena Abonie; Nagah M. Abourashed; Mohamed Riad Abouzid; Dmitry Abramov; Lucas Guimarães Abreu; Dariush Abtahi; Rana K. Abu Farha; Fuad Hamdi Abuadas; Aminu Kende Abubakar; Bilyaminu Abubakar; Eman F. Abu-Gharbieh; Sawsan Hammad Abuhammad; Ahmad Yousef Abuhelwa; Hana J. Abukhadijah; Niveen M.E. Abu-Rmeileh; Salahdein Aburuz; Dina Hamdi Abushanab; Raghu Ram Achar; Anirudh B. Acharya; Apurba Acharya; Ilana N. Ackerman; Juan Manuel Acuna; Ousman Adal; Lisa Christine Adams; Lawan H. Adamu; Mesafint Molla Adane; Zenaw Debasu Addisu; Isaac Yeboah Addo; Oluwafemi Atanda Adeagbo; Tajudeen Adesanmi Adebisi; Isaac Akinkunmi Adedeji; David Adedia; Kamoru A. Adedokun; Rufus A. Adedoyin; Oluwatobi E. Adegbile; Oyelola Abdulwasiu Adegboye; Nurudeen A. Adegoke; Olumide Thomas Adeleke; Isaac A. Adesina; Miracle Ayomikun Adesina; Habeeb Omoponle Adewuyi; Temitayo Esther Adeyeoluwa; Olorunsola I. Adeyomoye; Kishor Adhikari; Ripon Kumar Adhikary; Usha Sachidananda Adiga; Mohd Adnan; Qorinah Estiningtyas Sakilah Adnani; Prince Owusu Adoma; Leticia Akua Adzigbli
Background For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. Methods The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010–23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Findings Total numbers of global DALYs grew 6·1% (95% UI 4·0–8·1), from 2·64 billion (2·46–2·86) in 2010 to 2·80 billion (2·57–3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0–14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31–1·61) global DALYs in 2010, increasing to 1·80 billion (1·63–2·03) in 2023, alongside a concurrent 4·1% (1·9–6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176–209] DALYs), stroke (157 million [141–172]), and diabetes (90·2 million [75·2–107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0–107·5]), depressive disorders (26·3% [11·6–42·9]), and diabetes (14·9% [7·5–25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837–917) in 2010 to 681 million (642–736) in 2023, and a 25·8% (22·6–28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7–61·0) for diarrhoeal diseases, 42·9% (38·0–48·0) for HIV/AIDS, and 42·2% (23·6–56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6–22·0) and 24·8% (7·4–36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7–19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18–1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation—with high SBP accounting for 8·4% (6·9–10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories—behavioural, metabolic, and environmental and occupational—risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8–37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0–11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023—eg, declining by 54·4% (38·7–65·3) for unsafe sanitation, 50·5% (33·3–63·1) for unsafe water source, and 45·2% (25·6–72·0) for no access to handwashing facility, and by 44·9% (37·3–53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [–2·7 to 15·6]; non-significant). Interpretation Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors—eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG—including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic—the complex interaction of multiple health risks, social determinants, and systemic challenges—will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Funding Gates Foundation and Bloomberg Philanthropies. © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
(Elsevier B.V., 2024) Austin E. Schumacher; Hmwe Hmwe Kyu; Amirali Aali; Cristiana Abbafati; Jaffar Abbas; Rouzbeh Abbasgholizadeh; Madineh Akram Abbasi; Mohammadreza Abbasian; Samar Abd ElHafeez; Michael Abdelmasseh; Sherief Abd-Elsalam; Ahmed Abdelwahab; Mohammad Abdollahi; Meriem Abdoun; Auwal Abdullahi; Ame Mehadi Abdurehman; Mesfin Abebe; Aidin Abedi; Armita Abedi; Tadesse M. Abegaz; Roberto Ariel Abeldaño Zuñiga; E.S. Abhilash; Olugbenga Olusola Abiodun; Richard Gyan Aboagye; Hassan Abolhassani; Mohamed Abouzid; Lucas Guimarães Abreu; Woldu Aberhe Abrha; Michael R.M. Abrigo; Dariush Abtahi; Samir Abu Rumeileh; Niveen M.E. Abu-Rmeileh; Salahdein Aburuz; Ahmed Abu-Zaid; Juan Manuel Acuna; Tim Adair; Isaac Yeboah Addo; Oladimeji M. Adebayo; Oyelola A. Adegboye; Victor Adekanmbi; Bashir Aden; Abiola Victor Adepoju; Charles Oluwaseun Adetunji; Temitayo Esther Adeyeoluwa; Olorunsola Israel Adeyomoye; Rishan Adha; Amin Adibi; Wirawan Adikusuma; Qorinah Estiningtyas Sakilah Adnani; Saryia Adra; Abel Afework; Aanuoluwapo Adeyimika Afolabi; Ali Afraz; Shadi Afyouni; Saira Afzal; Pradyumna Agasthi; Shahin Aghamiri; Antonella Agodi; Williams Agyemang-Duah; Bright Opoku Ahinkorah; Aqeel Ahmad; Danish Ahmad; Firdos Ahmad; Muayyad M. Ahmad; Tauseef Ahmad; Keivan Ahmadi; Amir Mahmoud Ahmadzade; Mohadese Ahmadzade; Ayman Ahmed; Haroon Ahmed; Luai A. Ahmed; Muktar Beshir Ahmed; Syed Anees Ahmed; Marjan Ajami; Budi Aji; Olufemi Ajumobi; Gizachew Taddesse Akalu; Essona Matatom Akara; Karolina Akinosoglou; Sreelatha Akkala; Samuel Akyirem; Hanadi Al Hamad; Syed Mahfuz Al Hasan; Ammar Al Homsi; Mohammad Al Qadire; Moein Ala; Timothy Olukunle Aladelusi; Tareq Mohammed Ali Al-Ahdal; Samer O. Alalalmeh; Ziyad Al-Aly; Khurshid Alam; Manjurul Alam; Zufishan Alam; Rasmieh Mustafa Al-Amer; Fahad Mashhour Alanezi; Turki M. Alanzi; Mohammed Albashtawy; Mohammad T. AlBataineh; Robert W. Aldridge; Sharifullah Alemi; Ayman Al-Eyadhy; Adel Ali Saeed Al-Gheethi; Khalid F. Alhabib; Fadwa Alhalaiqa Naji Alhalaiqa; Mohammed Khaled Al-Hanawi; Abid Ali; Akhtar Ali; Beriwan Abdulqadir Ali; Hassam Ali; Mohammed Usman Ali; Rafat Ali; Syed Shujait Shujait Ali; Zahid Ali; Shohreh Alian Samakkhah; Gianfranco Alicandro; Sheikh Mohammad Alif; Mohammad Aligol; Rasoul Alimi; Ahmednur Adem Aliyi; Adel Al-Jumaily; Syed Mohamed Aljunid; Wael Almahmeed; Sabah Al-Marwani; Sadeq Ali Ali Al-Maweri; Joseph Uy Almazan; Hesham M. Al-Mekhlafi; Omar Almidani; Mahmoud A. Alomari; Nivaldo Alonso; Jaber S. Alqahtani; Ahmed Yaseen Alqutaibi; Salman Khalifah Al-Sabah; Awais Altaf; Jaffar A. Al-Tawfiq; Khalid A. Altirkawi; Farrukh Jawad Alvi; Hassan Alwafi; Yaser Mohammed Al-Worafi; Hany Aly; Karem H. Alzoubi; Azmeraw T. Amare; Edward Kwabena Ameyaw; Abebe Feyissa Amhare; Tarek Tawfik Amin; Alireza Amindarolzarbi; Javad Aminian Dehkordi; Sohrab Amiri; Hubert Amu; Dickson A. Amugsi; Jimoh Amzat; Robert Ancuceanu; Deanna Anderlini; Pedro Prata Andrade; Catalina Liliana Andrei; Tudorel Andrei; Dhanalakshmi Angappan; Abhishek Anil; Afifa Anjum; Catherine M. Antony; Ernoiz Antriyandarti; Iyadunni Adesola Anuoluwa; Sumadi Lukman Anwar; Anayochukwu Edward Anyasodor; Seth Christopher Yaw Appiah; Muhammad Aqeel; Jalal Arabloo; Razman Arabzadeh Bahri; Morteza Arab-Zozani; Mosab Arafat; Ana Margarida Araújo; Aleksandr Y. Aravkin; Abdulfatai Aremu; Hany Ariffin; Timur Aripov; Benedetta Armocida; Mahwish Arooj; Anton A. Artamonov; Kurnia Dwi Artanti; Judie Arulappan; Idowu Thomas Aruleba; Raphael Taiwo Aruleba; Ashokan Arumugam; Malke Asaad; Saeed Asgary; Mubarek Yesse Ashemo; Muhammad Ashraf; Marvellous O. Asika; Seyyed Shamsadin Athari; Maha Moh'd Wahbi Atout; Alok Atreya; Sameh Attia; Avinash Aujayeb; Abolfazl Avan; Adedapo Wasiu Awotidebe; Beatriz Paulina Ayala Quintanilla; Martin Amogre Ayanore; Getnet Melaku Ayele; Jose L. Ayuso-Mateos; Seyed Mohammad Ayyoubzadeh; Sina Azadnajafabad; Gulrez Shah Azhar; Shahkaar Aziz; Ahmed Y. Azzam; Mina Babashahi; Abraham Samuel Babu; Muhammad Badar; Alaa Badawi; Ashish D. Badiye; Soroush Baghdadi; Nasser Bagheri; Sara Bagherieh; Sulaiman Bah; Saeed Bahadorikhalili; Jianjun Bai; Ruhai Bai; Jennifer L. Baker; Shankar M. Bakkannavar; Abdulaziz T. Bako; Senthilkumar Balakrishnan; Saliu A. Balogun; Ovidiu Constantin Baltatu; Kiran Bam; Maciej Banach; Soham Bandyopadhyay; Biswajit Banik; Palash Chandra Banik; Hansi Bansal; Shirin Barati; Martina Barchitta; Mainak Bardhan; Suzanne Lyn Barker-Collo; Francesco Barone-Adesi; Hiba Jawdat Barqawi; Ronald D. Barr; Lope H. Barrero; Zarrin Basharat; Asma'u I.J. Bashir; Hameed Akande Bashiru; Pritish Baskaran; Buddha Basnyat; Quique Bassat; João Diogo Basso; Saurav Basu; Kavita Batra; Ravi Batra; Bernhard T. Baune; Mohsen Bayati; Nebiyou Simegnew Bayileyegn; Thomas Beaney; Neeraj Bedi; Tahmina Begum; Emad Behboudi; Amir Hossein Behnoush; Maryam Beiranvand; Diana Fernanda Bejarano Ramirez; Uzma Iqbal Belgaumi; Michelle L. Bell; Aminu K. Bello; Muhammad Bashir Bello; Olorunjuwon Omolaja Bello; Luis Belo; Apostolos Beloukas; Salaheddine Bendak; Derrick A. Bennett; Isabela M. Bensenor; Habib Benzian; Zombor Berezvai; Adam E. Berman; Amiel Nazer C. Bermudez; Paulo J.G. Bettencourt; Habtamu B. Beyene; Kebede A. Beyene; Devidas S. Bhagat; Akshaya Srikanth Bhagavathula; Neeraj Bhala; Ashish Bhalla; Dinesh Bhandari; Nikha Bhardwaj; Pankaj Bhardwaj; Prarthna V. Bhardwaj; Ashish Bhargava; Sonu Bhaskar; Vivek Bhat; Gurjit Kaur Bhatti; Jasvinder Singh Bhatti; Manpreet S. Bhatti; Rajbir Bhatti; Zulfiqar A. Bhutta; Boris Bikbov; Nada Binmadi; Bagas Suryo Bintoro; Antonio Biondi; Catherine Bisignano; Francesca Bisulli; Atanu Biswas; Raaj Kishore Biswas; Saeid Bitaraf; Tone Bjørge; Archie Bleyer; Mary Sefa Boampong; Virginia Bodolica; Aadam Olalekan Bodunrin; Obasanjo Afolabi Bolarinwa; Milad Bonakdar Hashemi; Aime Bonny; Kaustubh Bora; Berrak Bora Basara; Safiya Bala Borodo; Rohan Borschmann; Alejandro Botero Carvajal; Souad Bouaoud; Sofiane Boudalia; Edward J. Boyko; Nicola Luigi Bragazzi; Dejana Braithwaite; Hermann Brenner; Gabrielle Britton; Annie J. Browne; Andre R. Brunoni; Norma B. Bulamu; Lemma N. Bulto; Danilo Buonsenso; Katrin Burkart; Richard A. Burns; Sharath Burugina Nagaraja; Reinhard Busse; Yasser Bustanji; Zahid A. Butt; Florentino Luciano Caetano Dos Santos; Tianji Cai; Daniela Calina; Luis Alberto Cámera; Luciana Aparecida Campos; Ismael R. Campos-Nonato; Chao Cao; Carlos Alberto Cardenas; Rosario Cárdenas; Sinclair Carr; Giulia Carreras; Juan J. Carrero; Andrea Carugno; Felix Carvalho; Márcia Carvalho; Joao Mauricio Castaldelli-Maia; Carlos A. Castañeda-Orjuela; Giulio Castelpietra; Ferrán Catalá-López; Alberico L. Catapano; Maria Sofia Cattaruzza; Arthur Caye; Christopher R. Cederroth; Francieli Cembranel; Muthia Cenderadewi; Kelly M. Cercy; Ester Cerin; Muge Cevik; Pamela R. Chacón-Uscamaita; Yaacoub Chahine; Chiranjib Chakraborty; Jeffrey Shi Kai Chan; Chin-Kuo Chang; Periklis Charalampous; Jaykaran Charan; Vijay Kumar Chattu; Victoria Chatzimavridou-Grigoriadou; Malizgani Paul Chavula; Huzaifa Ahmad Cheema; An-Tian Chen; Haowei Chen; Lingxiao Chen; Meng Xuan Chen; Simiao Chen; Nicolas Cherbuin; Derek S. Chew; Gerald Chi; Jesus Lorenzo Chirinos-Caceres; Abdulaal Chitheer; So Mi Jemma Cho; William C.S. Cho; Bryan Chong; Hitesh Chopra; Rahul Choudhary; Rajiv Chowdhury; Dinh-Toi Chu; Isaac Sunday Chukwu; Eric Chung; Eunice Chung; Sheng-Chia Chung; Karly I. Cini; Cain C.T. Clark; Kaleb Coberly; Alyssa Columbus; Haley Comfort; Joao Conde; Sara Conti; Paolo Angelo Cortesi; Vera Marisa Costa; Ewerton Cousin; Richard G. Cowden; Michael H. Criqui; Natália Cruz-Martins; Garland T. Culbreth; Patricia Cullen; Matthew Cunningham; Daniel da Silva E Silva; Sriharsha Dadana; Omid Dadras; Zhaoli Dai; Koustuv Dalal; Lachlan L. Dalli; Giovanni Damiani; Emanuele D'Amico; Sara Daneshvar; Aso Mohammad Darwesh; Jai K. Das; Saswati Das; Nihar Ranjan Dash; Mohsen Dashti; Claudio Alberto Dávila-Cervantes; Nicole Davis Weaver; Kairat Davletov; Diego De Leo; Aklilu Tamire Debele; Louisa Degenhardt; Reza Dehbandi; Lee Deitesfeld; Ivan Delgado-Enciso; Laura Delgado-Ortiz; Daniel Demant; Berecha Hundessa Demessa; Andreas K. Demetriades; Xinlei Deng; Edgar Denova-Gutiérrez; Kebede Deribe; Nikolaos Dervenis; Don C. Des Jarlais; Hardik Dineshbhai Desai; Rupak Desai; Keshab Deuba; Vinoth Gnana Chellaiyan Devanbu; Sourav Dey; Arkadeep Dhali; Kuldeep Dhama; Mandira Lamichhane Dhimal; Meghnath Dhimal; Sameer Dhingra; Diana Dias Da Silva; Daniel Diaz; Adriana Dima; Delaney D. Ding; M. Ashworth Dirac; Abhinav Dixit; Shilpi Gupta Dixit; Thanh Chi Do; Thao Huynh Phuong Do; Camila Bruneli Do Prado; Masoud Dodangeh; Klara Georgieva Dokova; Christiane Dolecek; E Ray Dorsey; Wendel Mombaque dos Santos; Rajkumar Doshi; Leila Doshmangir; Abdel Douiri; Robert Kokou Dowou; Tim Robert Driscoll; Haneil Larson Dsouza; John Dube; Samuel C. Dumith; Susanna J. Dunachie; Bruce B. Duncan; Andre Rodrigues Duraes; Senbagam Duraisamy; Oyewole Christopher Durojaiye; Sulagna Dutta; Paulina Agnieszka Dzianach; Arkadiusz Marian Dziedzic; Oluwakemi Ebenezer; Ejemai Eboreime; Alireza Ebrahimi; Chidiebere Peter Echieh; Abdelaziz Ed-Dra; Hisham Atan Edinur; David Edvardsson; Kristina Edvardsson; Defi Efendi; Ferry Efendi; Shayan Eghdami; Terje Andreas Eikemo; Ebrahim Eini; Michael Ekholuenetale; Emmanuel Ekpor; Temitope Cyrus Ekundayo; Rabie Adel El Arab; Doaa Abdel Wahab El Morsi; Maysaa El Sayed Zaki; Maha El Tantawi; Iffat Elbarazi; Noha Mousaad Elemam; Frank J. Elgar; Islam Y. Elgendy; Ghada Metwally Tawfik ElGohary; Hala Rashad Elhabashy; Muhammed Elhadi; Omar Abdelsadek Abdou Elmeligy; Mohammed Elshaer; Ibrahim Elsohaby; Amir Emami Zeydi; Mehdi Emamverdi; Theophilus I. Emeto; Luchuo Engelbert Bain; Ryenchindorj Erkhembayar; Tesfahun C. 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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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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. Amugsi; Ganiyu Adeniyi Amusa; Robert Ancuceanu; Deanna Anderlini; David B. Anderson; Pedro Prata Andrade; Catalina Liliana Andrei; Tudorel Andrei; Colin Angus; Abhishek Anil; Sneha Anil; Amir Anoushiravani; Hossein Ansari; Ansariadi Ansariadi; Alireza Ansari-Moghaddam; Catherine M. Antony; Ernoiz Antriyandarti; Davood Anvari; Saeid Anvari; Saleha Anwar; Sumadi Lukman Anwar; Razique Anwer; Anayochukwu Edward Anyasodor; Muhammad Aqeel; Juan Pablo Arab; Jalal Arabloo; Mosab Arafat; Aleksandr Y. Aravkin; Demelash Areda; Abdulfatai Aremu; Olatunde Aremu; Hany Ariffin; Mesay Arkew; Benedetta Armocida; Michael Benjamin Arndt; Johan Arnlov; Mahwish Arooj; Anton A. 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. Ferrari; Nuno Ferreira; Getahun Fetensa; Bikila Regassa Feyisa; Irina Filip; Florian Fischer; Joanne Flavel; David Flood; Bobirca Teodor Florin; Nataliya A. Foigt; Morenike Oluwatoyin Folayan; Artem Alekseevich Fomenkov; Behzad Foroutan; Masoud Foroutan; Ingeborg Forthun; Daniela Fortuna; Matteo Foschi; Kayode Raphael Fowobaje; Kate Louise Francis; Richard Charles Franklin; Alberto Freitas; Joseph Friedman; Sara D. Friedman; Takeshi Fukumoto; John E. Fuller; Blima Fux; Peter Andras Gaal; Muktar A. Gadanya; Abhay Motiramji Gaidhane; Santosh Gaihre; Emmanuela Gakidou; Yaseen Galali; Natalie C. Galles; Silvano Gallus; Mandukhai Ganbat; Aravind P. Gandhi; Balasankar Ganesan; Mohammad Arfat Ganiyani; Ma Garcia-Gordillo; William M. Gardner; Jalaj Garg; Naval Garg; Rupesh K. Gautam; Semiu Olatunde Gbadamosi; Tilaye Gebru Gebi; Miglas W. Gebregergis; Mesfin Gebrehiwot; Teferi Gebru Gebremeskel; Simona Roxana Georgescu; Tamirat Getachew; Peter W. Gething; Molla Getie; Keyghobad Ghadiri; Sulmaz Ghahramani; Khalid Yaser Ghailan; Mohammad-Reza Ghasemi; Ghazal Ghasempour Dabaghi; Afsaneh Ghasemzadeh; Ahmad Ghashghaee; Fariba Ghassemi; Ramy Mohamed Ghazy; Ajnish Ghimire; Sama Ghoba; Maryam Gholamalizadeh; Asadollah Gholamian; Ali Gholamrezanezhad; Nasim Gholizadeh; Mahsa Ghorbani; Pooyan Ghorbani Vajargah; Aloke Gopal Ghoshal; Paramjit Singh Gill; Tiffany K. Gill; Richard F. Gillum; Themba G. Ginindza; Alem Girmay; James C. Glasbey; Elena V. Gnedovskaya; Laszlo Gobolos; Myron Anthony Godinho; Amit Goel; Ali Golchin; Mohamad Goldust; Mahaveer Golechha; Pouya Goleij; Nelson G. M. Gomes; Philimon N. Gona; Sameer Vali Gopalani; Giuseppe Gorini; Houman Goudarzi; Alessandra C. Goulart; Barbara Niegia Garcia Goulart; Anmol Goyal; Ayman Grada; Simon Matthew Graham; Michal Grivna; Giuseppe Grosso; Shi-Yang Guan; Giovanni Guarducci; Mohammed Ibrahim Mohialdeen Gubari; Mesay Dechasa Gudeta; Avirup Guha; Stefano Guicciardi; Rafael Alves Guimaraes; Snigdha Gulati; Damitha Asanga Gunawardane; Sasidhar Gunturu; Cui Guo; Anish Kumar Gupta; Bhawna Gupta; Manoj Kumar Gupta; Mohak Gupta; Rajat Das Gupta; Rajeev Gupta; Sapna Gupta; Veer Bala Gupta; Vijai Kumar Gupta; Vivek Kumar Gupta; Lami Gurmessa; Reyna Alma Gutierrez; Farrokh Habibzadeh; Parham Habibzadeh; Rasool Haddadi; Mostafa Hadei; Najah R. Hadi; Nils Haep; Nima Hafezi-Nejad; Demewoz Haile; Alemayehu Hailu; Arvin Haj-Mirzaian; Esam S. Halboub; Brian J. Hall; Sebastian Haller; Rabih Halwani; Randah R. Hamadeh; Sajid Hameed; Samer Hamidi; Erin B. Hamilton; Chieh Han; Qiuxia Han; Asif Hanif; Nasrin Hanifi; Graeme J. Hankey; Fahad Hanna; Md Abdul Hannan; Md Nuruzzaman Haque; Harapan Harapan; Arief Hargono; Josep Maria Haro; Ahmed I. Hasaballah; Ikramul Hasan; M. Tasdik Hasan; Hamidreza Hasani; Mohammad Hasanian; Abdiwahab Hashi; Md Saquib Hasnain; Ikrama Hassan; Soheil Hassanipour; Hadi Hassankhani; Johannes Haubold; Rasmus J. Havmoeller; Simon I. Hay; Jiawei He; Jeffrey J. Hebert; Omar E. Hegazi; Golnaz Heidari; Mohammad Heidari; Mahsa Heidari-Foroozan; Bartosz Helfer; Delia Hendrie; Brenda Yuliana Herrera-Serna; Claudiu Herteliu; Hamed Hesami; Kamal Hezam; Catherine L. Hill; Yuta Hiraike; Ramesh Holla; Nobuyuki Horita; Md Mahbub Hossain; Sahadat Hossain; Mohammad-Salar Hosseini; Hassan Hosseinzadeh; Mehdi Hosseinzadeh; Ahmad Hosseinzadeh Adli; Mihaela Hostiuc; Sorin Hostiuc; Mohamed Hsairi; Vivian Chiarong Hsieh; Rebecca L. Hsu; Chengxi Hu; Junjie Huang; Michael Hultstrom; Ayesha Humayun; Tsegaye Gebreyes Hundie; Javid Hussain; M. Azhar Hussain; Nawfal R. Hussein; Foziya Mohammed Hussien; Hong-Han Huynh; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Khalid S. Ibrahim; Pulwasha Maria Iftikhar; Desta Ijo; Adalia I. Ikiroma; Kevin S. Ikuta; Paul Chukwudi Ikwegbue; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Mohammad Tarique Imam; Mustapha Immurana; Sumant Inamdar; Endang Indriasih; Muhammad Iqhrammullah; Arnaud Iradukunda; Kenneth Chukwuemeka Iregbu; Md Rabiul Islam; Sheikh Mohammed Shariful Islam; Farhad Islami; Faisal Ismail; Nahlah Elkudssiah Ismail; Hiroyasu Iso; Gaetano Isola; Masao Iwagami; Chidozie C. D. Iwu; Ihoghosa Osamuyi Iyamu; Mahalaxmi Iyer; J. Linda Merin; Jalil Jaafari; Louis Jacob; Kathryn H. Jacobsen; Farhad Jadidi-Niaragh; Morteza Jafarinia; Abdollah Jafarzadeh; Khushleen Jaggi; Kasra Jahankhani; Nader Jahanmehr; Haitham Jahrami; Nityanand Jain; Ammar Abdulrahman Jairoun; Abhishek Jaiswal; Elham Jamshidi; Mark M. Janko; Abubakar Ibrahim Jatau; Sabzali Javadov; Tahereh Javaheri; Sathish Kumar Jayapal; Shubha Jayaram; Rime Jebai; Sun Ha Jee; Jayakumar Jeganathan; Anil K. Jha; Ravi Prakash Jha; Heng Jiang; Yingzhao Jin; Olatunji Johnson; Mohammad Jokar; Jost B. Jonas; Tamas Joo; Abel Joseph; Nitin Joseph; Charity Ehimwenma Joshua; Grace Joshy; Jacek Jerzy Jozwiak; Mikk Jurisson; K. Vaishali; Billingsley Kaambwa; Ali Kabir; Zubair Kabir; Vidya Kadashetti; Dler Hussein Kadir; Rizwan Kalani; Laleh R. Kalankesh; Leila R. Kalankesh; Feroze Kaliyadan; Sanjay Kalra; Vineet Kumar Kamal; Sivesh Kathir Kamarajah; Rajesh Kamath; Zahra Kamiab; Naser Kamyari; Thanigaivelan Kanagasabai; Tanuj Kanchan; Himal Kandel; Arun R. Kanmanthareddy; Edmund Wedam Kanmiki; Kehinde Kazeem Kanmodi; S. Suthanthira Kannan; Sushil Kumar Kansal; Rami S. Kantar; Neeti Kapoor; Mehrdad Karajizadeh; Shama D. Karanth; Reema A. Karasneh; Ibraheem M. Karaye; Andre Karch; Asima Karim; Salah Eddin Karimi; Arman Karimi Behnagh; Faizan Zaffar Kashoo; Qalandar Hussein Abdulkarim Kasnazani; Hengameh Kasraei; Nicholas J. Kassebaum; Molly B. Kassel; Joonas H. Kauppila; Navjot Kaur; Norito Kawakami; Gbenga A. Kayode; Foad Kazemi; Sina Kazemian; Tahseen Haider Kazmi; Getu Mosisa Kebebew; Adera Debella Kebede; Fassikaw Kebede; Tibebeselassie S. Keflie; Peter Njenga Keiyoro; Cathleen Keller; Jaimon Terence Kelly; John H. Kempen; Jessica A. Kerr; Emmanuelle Kesse-Guyot; Himanshu Khajuria; Amirmohammad Khalaji; Nauman Khalid; Anees Ahmed Khalil; Alireza Khalilian; Faham Khamesipour; Ajmal Khan; Asaduzzaman Khan; Gulfaraz Khan; Ikramullah Khan; Imteyaz A. Khan; M. Nuruzzaman Khan; Mohammad Jobair Khan; Moien Ab Khan; Zeeshan Ali Khan; Mahammed Ziauddin Khan Suheb; Shaghayegh Khanmohammadi
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 mortality associated with 33 bacterial pathogens in 2019: a systematic analysis for the Global Burden of Disease Study 2019
(Elsevier B.V., 2022) Kevin S Ikuta; Lucien R Swetschinski; Gisela Robles Aguilar; Fablina Sharara; Tomislav Mestrovic; Authia P Gray; Nicole Davis Weaver; Eve E Wool; Chieh Han; Anna Gershberg Hayoon; Amirali Aali; Semagn Mekonnen Abate; Mohsen Abbasi-Kangevari; Zeinab Abbasi-Kangevari; Sherief Abd-Elsalam; Getachew Abebe; Aidin Abedi; Amir Parsa Abhari; Hassan Abidi; Richard Gyan Aboagye; Abdorrahim Absalan; Hiwa Abubaker Ali; Juan Manuel Acuna; Tigist Demssew Adane; Isaac Yeboah Addo; Oyelola A Adegboye; Mohammad Adnan; Qorinah Estiningtyas Sakilah Adnani; Muhammad Sohail Afzal; Saira Afzal; Zahra Babaei Aghdam; Bright Opoku Ahinkorah; Aqeel Ahmad; Araz Ramazan Ahmad; Rizwan Ahmad; Sajjad Ahmad; Sohail Ahmad; Sepideh Ahmadi; Ali Ahmed; Haroon Ahmed; Jivan Qasim Ahmed; Tarik Ahmed Rashid; Marjan Ajami; Budi Aji; Mostafa Akbarzadeh-Khiavi; Chisom Joyqueenet Akunna; Hanadi Al Hamad; Fares Alahdab; Ziyad Al-Aly; Mamoon A Aldeyab; Alicia V Aleman; Fadwa Alhalaiqa Naji Alhalaiqa; Robert Kaba Alhassan; Beriwan Abdulqadir Ali; Liaqat Ali; Syed Shujait Ali; Yousef Alimohamadi; Vahid Alipour; Atiyeh Alizadeh; Syed Mohamed Aljunid; Kasim Allel; Sami Almustanyir; Edward Kwabena Ameyaw; Arianna Maever L Amit; Nivedita Anandavelane; Robert Ancuceanu; Catalina Liliana Andrei; Tudorel Andrei; Dewi Anggraini; Adnan Ansar; Anayochukwu Edward Anyasodor; Jalal Arabloo; Aleksandr Y Aravkin; Demelash Areda; Timur Aripov; Anton A Artamonov; Judie Arulappan; Raphael Taiwo Aruleba; Muhammad Asaduzzaman; Tahira Ashraf; Seyyed Shamsadin Athari; Daniel Atlaw; Sameh Attia; Marcel Ausloos; Tewachew Awoke; Beatriz Paulina Ayala Quintanilla; Tegegn Mulatu Ayana; Sina Azadnajafabad; Amirhossein Azari Jafari; B. Darshan; Muhammad Badar; Ashish D Badiye; Nayereh Baghcheghi; Sara Bagherieh; Atif Amin Baig; Indrajit Banerjee; Aleksandra Barac; Mainak Bardhan; Francesco Barone-Adesi; Hiba Jawdat Barqawi; Amadou Barrow; Pritish Baskaran; Saurav Basu; Abdul-Monim Mohammad Batiha; Neeraj Bedi; Melaku Ashagrie Belete; Uzma Iqbal Belgaumi; Rose G Bender; Bharti Bhandari; Dinesh Bhandari; Pankaj Bhardwaj; Sonu Bhaskar; Krittika Bhattacharyya; Suraj Bhattarai; Saeid Bitaraf; Danilo Buonsenso; Zahid A Butt; Florentino Luciano Caetano Dos Santos; Jiao Cai; Daniela Calina; Paulo Camargos; Luis Alberto Cámera; Rosario Cárdenas; Muge Cevik; Joshua Chadwick; Jaykaran Charan; Akhilanand Chaurasia; Patrick R Ching; Sonali Gajanan Choudhari; Enayet Karim Chowdhury; Fazle Rabbi Chowdhury; Dinh-Toi Chu; Isaac Sunday Chukwu; Omid Dadras; Fentaw Teshome Dagnaw; Xiaochen Dai; Saswati Das; Anna Dastiridou; Sisay Abebe Debela; Fitsum Wolde Demisse; Solomon Demissie; Diriba Dereje; Msganaw Derese; Hardik Dineshbhai Desai; Fikadu Nugusu Dessalegn; Samuel Abebe A Dessalegni; Belay Desye; Kartik Dhaduk; Meghnath Dhimal; Sameer Dhingra; Nancy Diao; Daniel Diaz; Shirin Djalalinia; Milad Dodangeh; Deepa Dongarwar; Bezabih Terefe Dora; Fariba Dorostkar; Haneil Larson Dsouza; Eleonora Dubljanin; Susanna J Dunachie; Oyewole Christopher Durojaiye; Hisham Atan Edinur; Habtamu Bekele Ejigu; Michael Ekholuenetale; Temitope Cyrus Ekundayo; Hassan El-Abid; Muhammed Elhadi; Mohamed A Elmonem; Amir Emami; Luchuo Engelbert Bain; Daniel Berhanie Enyew; Ryenchindorj Erkhembayar; Babak Eshrati; Farshid Etaee; Adeniyi Francis Fagbamigbe; Shahab Falahi; Aida Fallahzadeh; Emerito Jose A Faraon; Ali Fatehizadeh; Ginenus Fekadu; João C Fernandes; Allegra Ferrari; Getahun Fetensa; Irina Filip; Florian Fischer; Masoud Foroutan; Peter Andras Gaal; Muktar A Gadanya; Abhay Motiramji Gaidhane; Balasankar Ganesan; Mesfin Gebrehiwot; Reza Ghanbari; Mohammad Ghasemi Nour; Ahmad Ghashghaee; Ali Gholamrezanezhad; Abdolmajid Gholizadeh; Mahaveer Golechha; Pouya Goleij; Davide Golinelli; Amador Goodridge; Damitha Asanga Gunawardane; Yuming Guo; Rajat Das Gupta; Sapna Gupta; Veer Bala Gupta; Vivek Kumar Gupta; Alemu Guta; Parham Habibzadeh; Atlas Haddadi Avval; Rabih Halwani; Asif Hanif; Md Abdul Hannan; Harapan Harapan; Shoaib Hassan; Hadi Hassankhani; Khezar Hayat; Behzad Heibati; Golnaz Heidari; Mohammad Heidari; Reza Heidari-Soureshjani; Claudiu Herteliu; Demisu Zenbaba Heyi; Kamal Hezam; Praveen Hoogar; Nobuyuki Horita; Md Mahbub Hossain; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Soodabeh Hoveidamanesh; Junjie Huang; Salman Hussain; Nawfal R Hussein; Segun Emmanuel Ibitoye; Olayinka Stephen Ilesanmi; Irena M Ilic; Milena D Ilic; Mohammad Tarique Imam; Mustapha Immurana; Leeberk Raja Inbaraj; Arnaud Iradukunda; Nahlah Elkudssiah Ismail; Chidozie C D Iwu; Chinwe Juliana Iwu; Merin J. Linda; Mihajlo Jakovljevic; Elham Jamshidi; Tahereh Javaheri; Fatemeh Javanmardi; Javad Javidnia; Sathish Kumar Jayapal; Umesh Jayarajah; Rime Jebai; Ravi Prakash Jha; Tamas Joo; Nitin Joseph; Farahnaz Joukar; Jacek Jerzy Jozwiak; Salah Eddine Oussama Kacimi; Vidya Kadashetti; Laleh R Kalankesh; Rohollah Kalhor; Vineet Kumar Kamal; Himal Kandel; Neeti Kapoor; Samad Karkhah; Bekalu Getnet Kassa; Nicholas J Kassebaum; Patrick D.M.C. Katoto; Mohammad Keykhaei; Himanshu Khajuria; Abbas Khan; Imteyaz A. Khan; Maseer Khan; Md Nuruzzaman Khan; Moien A.B. Khan; Moawiah Mohammad Khatatbeh; Mona M Khater; Hamid Reza Khayat Kashani; Jagdish Khubchandani; Hanna Kim; Min Seo Kim; Ruth W Kimokoti; Niranjan Kissoon; Sonali Kochhar; Farzad Kompani; Soewarta Kosen; Parvaiz A Koul; Sindhura Lakshmi Koulmane Laxminarayana; Fiorella Krapp Lopez; Kewal Krishan; Vijay Krishnamoorthy; Vishnutheertha Kulkarni; Naveen Kumar; Om P Kurmi; Ambily Kuttikkattu; Hmwe Hmwe Kyu; Dharmesh Kumar Lal; Judit Lám; Iván Landires; Savita Lasrado; Sang-Woong Lee; Jacopo Lenzi; Sonia Lewycka; Shanshan Li; Stephen S Lim; Wei Liu; Rakesh Lodha; Michael J Loftus; Ayush Lohiya; Lászl Lorenzovici; Mojgan Lotfi; Ata Mahmoodpoor; Mansour Adam Mahmoud; Razzagh Mahmoudi; Azeem Majeed; Jamal Majidpoor; Alaa Makki; Galana Ayana Mamo; Yosef Manla; Miquel Martorell; Clara N Matei; Barney Mcmanigal; Entezar Mehrabi Nasab; Ravi Mehrotra; Addisu Melese; Oliver Mendoza-Cano; Ritesh G Menezes; Alexios-Fotios A Mentis; Georgia Micha; Irmina Maria Michalek; Ana Carolina Micheletti Gomide Nogueira Des; Neda Milevska Kostova; Shabir Ahmad Mir; Mojgan Mirghafourvand; Seyyedmohammadsadeq Mirmoeeni; Erkin M Mirrakhimov; Mohammad Mirza-Aghazadeh-attari; Abay Sisay Misganaw; Awoke Misganaw; Sanjeev Misra; Esmaeil Mohammadi; Mokhtar Mohammadi; Abdollah Mohammadian-Hafshejani; Shafiu Mohammed; Syam Mohan; Mohammad Mohseni; Ali H Mokdad; Sara Momtazmanesh; Lorenzo Monasta; Catrin E Moore; Maryam Moradi; Mostafa Moradi Sarabi; Shane Douglas Morrison; Majid Motaghinejad; Haleh Mousavi Isfahani; Amin Mousavi Khaneghah; Seyed Ali Mousavi-Aghdas; Sumaira Mubarik; Francesk Mulita; Getaneh Baye B Mulu; Sandra B Munro; Saravanan Muthupandian; Tapas Sadasivan Nair; Atta Abbas Naqvi; Himanshi Narang; Zuhair S Natto; Muhammad Naveed; Biswa Prakash Nayak; Shumaila Naz; Ionut Negoi; Seyed Aria Nejadghaderi; Sandhya Neupane Kandel; Che Henry Ngwa; Robina Khan Niazi; Antonio Tolentino Nogueira Des; Nafise Noroozi; Hasti Nouraei; Ali Nowroozi; Virginia Nuñez-Samudio; Jerry John Nutor; Chimezie Igwegbe Nzoputam; Ogochukwu Janet Nzoputam; Bogdan Oancea; Rahman Md Obaidur; Vivek Anand Ojha; Akinkunmi Paul Okekunle; Osaretin Christabel Okonji; Andrew T Olagunju; Bolajoko Olubukunola Olusanya; Ahmed Omar Bali; Emad Omer; Nikita Otstavnov; Bilcha Oumer; Jagadish Rao Padubidri; Keyvan Pakshir; Tamás Palicz; Adrian Pana; Shahina Pardhan; Jose L Paredes; Utsav Parekh; Eun-Cheol Park; Seoyeon Park; Ashish Pathak; Rajan Paudel; Uttam Paudel; Shrikant Pawar; Hamidreza Pazoki Toroudi; Minjin Peng; Umberto Pensato; Veincent Christian Filipino Pepito; Marcos Pereira; Mario F P Peres; Norberto Perico; Ionela-Roxana Petcu; Zahra Zahid Piracha; Indrashis Podder; Nayanum Pokhrel; Ramesh Poluru; Maarten J Postma; Naeimeh Pourtaheri; Akila Prashant; Ibrahim Qattea; Mohammad Rabiee; Navid Rabiee; Amir Radfar; Saber Raeghi; Sima Rafiei; Pankaja Raghav Raghav; Leila Rahbarnia; Vafa Rahimi-Movaghar; Mosiur Rahman; Muhammad Aziz Rahman; Amir Masoud Rahmani; Vahid Rahmanian; Pradhum Ram; Muhammad Modassar Ali Nawaz Ranjha; Sowmya J Rao; Mohammad-Mahdi Rashidi; Azad Rasul; Zubair Ahmed Ratan; Salman Rawaf; Reza Rawassizadeh; Mohammad Sadegh Razeghinia; Elrashdy Moustafa Mohamed Redwan; Misganu Teshoma Regasa; Giuseppe Remuzzi; Melese Abate Reta; Nazila Rezaei; Aziz Rezapour; Abanoub Riad; Rezaul Karim Ripon; Kristina E Rudd; Basema Saddik; Saeid Sadeghian; Umar Saeed; Mohsen Safaei; Azam Safary; Sher Zaman Safi; Maryam Sahebazzamani; Amirhossein Sahebkar; Harihar Sahoo; Saina Salahi; Sarvenaz Salahi; Hedayat Salari; Sana Salehi; Hossein Samadi Kafil; Abdallah M Samy; Nima Sanadgol; Senthilkumar Sankararaman; Francesco Sanmarchi; Brijesh Sathian; Monika Sawhney; Ganesh Kumar Saya; Subramanian Senthilkumaran; Allen Seylani; Pritik A Shah; Masood Ali Shaikh; Elaheh Shaker; Murad Ziyaudinovich Shakhmardanov; Mequannent Melaku Sharew; Athena Sharifi-Razavi; Purva Sharma; Rahim Ali Sheikhi; Ali Sheikhy; Pavanchand H Shetty; Mika Shigematsu; Jae Il Shin; Hesamaddin Shirzad-Aski; K.M. Shivakumar; Parnian Shobeiri; Seyed Afshin Shorofi; Sunil Shrestha; Migbar Mekonnen Sibhat; Negussie Boti Sidemo; Mustafa Kamal Sikder; Luís Manuel Lopes Rodrigues Silva; Jasvinder A Singh; Paramdeep Singh; Surjit Singh; Md Shahjahan Siraj; Samarjeet Singh Siwal; Valentin Yurievich Skryabin; Anna Aleksandrovna Skryabina; Bogdan Socea; Damtew Damtew Solomon; Yimeng Song; Chandrashekhar T Sreeramareddy; Muhammad Suleman; Rizwan Suliankatchi Abdulkader; Saima Sultana; Miklós Szócska; Seyed-Amir Tabatabaeizadeh; Mohammad Tabish; Majid Taheri; Elahe Taki; Ker-Kan Tan; Sarmila Tandukar; Nathan Y Tat; Vivian Y Tat; Belay Negash Tefera; Yibekal Manaye Tefera; Gebremaryam Temesgen; Mohamad-Hani Temsah; Samar Tharwat; Arulmani Thiyagarajan; Imad I Tleyjeh; Christopher E Troeger; Krishna Kishore Umapathi; Era Upadhyay; Sahel Valadan Tahbaz; Pascual R Valdez; Jef Van Den Eynde; H Rogier Van Doorn; Siavash Vaziri; Georgios-Ioannis Verras; Harimadhav Viswanathan; Bay Vo; Abdul Waris; Gizachew Tadesse Wassie; Nuwan Darshana Wickramasinghe; Sajad Yaghoubi; Gahin Abdulraheem Tayib Yahya Yahya; Seyed Hossein Yahyazadeh Jabbari; Arzu Yigit; Vahit Yigit; Dong Keon Yon; Naohiro Yonemoto; Mazyar Zahir; Burhan Abdullah Zaman; Sojib Bin Zaman; Moein Zangiabadian; Iman Zare; Mikhail Sergeevich Zastrozhin; Zhi-Jiang Zhang; Peng Zheng; Chenwen Zhong; Mohammad Zoladl; Alimuddin Zumla; Simon I Hay; Christiane Dolecek; Benn Sartorius; Christopher J L Murray; Mohsen Naghavi
Background: Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. Methods: We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. Findings: From an estimated 13·7 million (95% UI 10·9–17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7–10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2–18·1) of all global deaths and 56·2% (52·1–60·1) of all sepsis-related deaths in 2019. Five leading pathogens—Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa—were responsible for 54·9% (52·9–56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185–285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4–71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. Interpretation: The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. Funding: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021
(Elsevier Ltd, 2024) Jorge R. Ledesma; Jianing Ma; Meixin Zhang; Ann V. L. Basting; Huong Thi Chu; Avina Vongpradith; Amanda Novotney; Kate E. LeGrand; Yvonne Yiru Xu; Xiaochen Dai; Sneha Ingle Nicholson; Lauryn K. Stafford; Austin Carter; Jennifer M. Ross; Hedayat Abbastabar; Meriem Abdoun; Deldar Morad Abdulah; Richard Gyan Aboagye; Hassan Abolhassani; Woldu Aberhe Abrha; Hiwa Abubaker Ali; Eman Abu-Gharbieh; Salahdein Aburuz; Isaac Yeboah Addo; Abiola Victor Adepoju; Kishor Adhikari; Qorinah Estiningtyas Sakilah Adnani; Saryia Adra; Abel Afework; Shahin Aghamiri; Williams Agyemang-Duah; Bright Opoku Ahinkorah; Danish Ahmad; Sajjad Ahmad; Amir Mahmoud Ahmadzade; Haroon Ahmed; Mohammed Ahmed; Ayman Ahmed; Karolina Akinosoglou; Tareq Mohammed Ali Al-Ahdal; Nazmul Alam; Mohammed Albashtawy; Mohammad T. AlBataineh; Adel Ali Saeed Al-Gheethi; Abid Ali; Endale Alemayehu Ali; Liaqat Ali; Zahid Ali; Syed Shujait Shujait Ali; Kasim Allel; Awais Altaf; Jaffar A. Al-Tawfiq; Nelson Alvis-Guzman; Nelson J. Alvis-Zakzuk; Reza Amani; Ganiyu Adeniyi Amusa; Jimoh Amzat; Jason R. Andrews; Abhishek Anil; Razique Anwer; Aleksandr Y. Aravkin; Damelash Areda; Anton A. Artamonov; Raphael Taiwo Aruleba; Mulusew A. Asemahagn; Sachin R. Atre; Avinash Aujayeb; Davood Azadi; Sina Azadnajafabad; Ahmed Y. Azzam; Muhammad Badar; Ashish D. Badiye; Sara Bagherieh; Saeed Bahadorikhalili; Atif Amin Baig; Maciej Banach; Biswajit Banik; Mainak Bardhan; Hiba Jawdat Barqawi; Zarrin Basharat; Pritish Baskaran; Saurav Basu; Maryam Beiranvand; Melaku Ashagrie Belete; Makda Abate Belew; Uzma Iqbal Belgaumi; Apostolos Beloukas; Paulo J. G. Bettencourt; Akshaya Srikanth Bhagavathula; Nikha Bhardwaj; Pankaj Bhardwaj; Ashish Bhargava; Vivek Bhat; Jasvinder Singh Bhatti; Gurjit Kaur Bhatti; Boris Bikbov; Veera R. Bitra; Vesna Bjegovic-Mikanovic; Danilo Buonsenso; Katrin Burkart; Yasser Bustanji; Zahid A. Butt; Paulo Camargos; Yu Cao; Sinclair Carr; Felix Carvalho; Luca Cegolon; Muthia Cenderadewi; Muge Cevik; Yaacoub Chahine; Vijay Kumar Chattu; Patrick R. Ching; Hitesh Chopra; Eunice Chung; Mareli M. Claassens; Kaleb Coberly; Natália Cruz-Martins; Bashir Dabo; Sriharsha Dadana; Omid Dadras; Isaac Darban; Jiregna Darega Gela; Aso Mohammad Darwesh; Mahmood Dashti; Berecha Hundessa Demessa; Biniyam Demisse; Solomon Demissie; Awoke Masrie Asrat Derese; Kebede Deribe; Hardik Dineshbhai Desai; Vinoth Gnana Chellaiyan Devanbu; Arkadeep Dhali; Kuldeep Dhama; Sameer Dhingra; Thao Huynh Phuong Do; Deepa Dongarwar; Haneil Larson Dsouza; John Dube; Arkadiusz Marian Dziedzic; Abdelaziz Ed-Dra; Ferry Efendi; Diyan Ermawan Effendi; Aziz Eftekharimehrabad; Nopryan Ekadinata; Temitope Cyrus Ekundayo; Muhammed Elhadi; Legesse Tesfaye Elilo; Theophilus I. Emeto; Luchuo Engelbert Bain; Adeniyi Francis Fagbamigbe; Ayesha Fahim; Alireza Feizkhah; Getahun Fetensa; Florian Fischer; Abduzhappar Gaipov; Aravind P. Gandhi; Rupesh K. Gautam; Miglas W. Gebregergis; Mesfin Gebrehiwot; Kahsu Gebrekirstos Gebrekidan; Kazem Ghaffari; Fariba Ghassemi; Ramy Mohamed Ghazy; Amador Goodridge; Anmol Goyal; Shi-Yang Guan; Mesay Dechasa Gudeta; Rashid Abdi Guled; Novianti Br Gultom; Veer Bala Gupta; Vivek Kumar Gupta; Sapna Gupta; Hailey Hagins; Semira Goitom Hailu; Wase Benti Hailu; Samer Hamidi; Asif Hanif; Harapan Harapan; Rumina Syeda Hasan; Shoaib Hassan; Johannes Haubold; Kamal Hezam; Sung Hwi Hong; Nobuyuki Horita; Md Belal Hossain; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Hong-Han Huynh; Segun Emmanuel Ibitoye; Kevin S. Ikuta; Irena M. Ilic; Milena D. Ilic; Md Rabiul Islam; Nahlah Elkudssiah Ismail; Faisal Ismail; Abdollah Jafarzadeh; Mihajlo Jakovljevic; Mahsa Jalili; Manthan Dilipkumar Janodia; Nabi Jomehzadeh; Jost B. Jonas; Nitin Joseph; Charity Ehimwenma Joshua; Zubair Kabir; Bhushan Dattatray Kamble; Tanuj Kanchan; Himal Kandel; Kehinde Kazeem Kanmodi; Rami S. Kantar; Ibraheem M. Karaye; Arman Karimi Behnagh; Gebrehiwot G. Kassa; Rimple Jeet Kaur; Navjot Kaur; Himanshu Khajuria; Faham Khamesipour; Yusra H. Khan; M. Nuruzzaman Khan; Mahammed Ziauddin Khan Suheb; Khaled Khatab; Fatemeh Khatami; Min Seo Kim; Soewarta Kosen; Parvaiz A. Koul; Sindhura Lakshmi Koulmane Laxminarayana; Kewal Krishan; Burcu Kucuk Bicer; Md Abdul Kuddus; Mukhtar Kulimbet; Nithin Kumar; Dharmesh Kumar Lal; Iván Landires; Kamaluddin Latief; Trang Diep Thanh Le; Thao Thi Thu Le; Caterina Ledda; Munjae Lee; Seung Won Lee; Temesgen L. Lerango; Stephen S. Lim; Chaojie Liu; Xuefeng Liu; Platon D. Lopukhov; Hong Luo; Hengliang Lv; Preetam Bhalchandra Mahajan; Amir Ali Mahboobipour; Azeem Majeed; Elaheh Malakan Rad; Kashish Malhotra; Muhammad Sajeel Ahmed Malik; Lesibana Anthony Malinga; Tauqeer Hussain Mallhi; Aseer Manilal; Bernardo Alfonso Martinez-Guerra; Francisco Rogerlândio Martins-Melo; Roy Rillera Marzo; Hossein Masoumi-Asl; Vasundhara Mathur; Richard James Maude; Ravi Mehrotra; Ziad A. Memish; Walter Mendoza; Ritesh G. Menezes; Muayad Aghali Merza; Tomislav Mestrovic; Laurette Mhlanga; Sanjeev Misra; Arup Kumar Misra; Prasanna Mithra; Babak Moazen; Hussen Mohammed; Ali H. Mokdad; Lorenzo Monasta; Catrin E. Moore; Parsa Mousavi; Francesk Mulita; Fungai Musaigwa; Raman Muthusamy; Ahamarshan Jayaraman Nagarajan; Pirouz Naghavi; Ganesh R. Naik; Gurudatta Naik; Sanjeev Nair; Tapas Sadasivan Nair; Zuhair S. Natto; Biswa Prakash Nayak; Hadush Negash; Dang H. Nguyen; Van Thanh Nguyen; Robina Khan Niazi; Chukwudi A. Nnaji; Lawrence Achilles Nnyanzi; Efaq Ali Noman; Shuhei Nomura; Bogdan Oancea; Kehinde O. Obamiro; Ismail A. Odetokun; Daniel Bogale Odo Odo; Oluwakemi Ololade Odukoya; In-Hwan Oh; Chukwuma O. Okereke; Osaretin Christabel Okonji; Eyal Oren; Edgar Ortiz-Brizuela; Uchechukwu Levi Osuagwu; Amel Ouyahia; P.A. Mahesh Padukudru; Pragyan Paramita Parija; Romil R. Parikh; Seoyeon Park; Ashwaghosha Parthasarathi; Shankargouda Patil; Shrikant Pawar; Minjin Peng; Veincent Christian Filipino Pepito; Prince Peprah; João Perdigão; Norberto Perico; Hoang Tran Pham; Maarten J. Postma; Attur Ravindra Attur Prabhu; Manya Prasad; Akila Prashant; Elton Junio Sady Prates; Fakher Rahim; Mosiur Rahman; Muhammad Aziz Rahman; Masoud Rahmati; Sathish Rajaa; Shakthi Kumaran Ramasamy; Indu Ramachandra Rao; Sowmya J. Rao; Deepthi Rapaka; Ahmed Mustafa Rashid; Zubair Ahmed Ratan; Nakul Ravikumar; Salman Rawaf; Murali Mohan Rama Krishna Reddy; Elrashdy Moustafa Mohamed Redwan; Giuseppe Remuzzi; Luis Felipe Reyes; Nazila Rezaei; Mohsen Rezaeian; Omid Rezahosseini; Mónica Rodrigues; Priyanka Roy; Guilherme de Andrade Ruela; Siamak Sabour; Basema Saddik; Umar Saeed; Sher Zaman Safi; Narjes Saheb Sharif-Askari; Fatemeh Saheb Sharif-Askari; Amirhossein Sahebkar; Biniyam Sahiledengle; Soumya Swaroop Sahoo; Nasir Salam; Afeez Abolarinwa Salami; Samreen Saleem; Mohamed A. Saleh; Hossein Samadi Kafil; Sara Samadzadeh; Yoseph Leonardo Samodra; Rama Krishna Sanjeev; Aswini Saravanan; Susan M. Sawyer; Siddharthan Selvaraj; Sabyasachi Senapati; Subramanian Senthilkumaran; Pritik A. Shah; Samiah Shahid; Masood Ali Shaikh; Sunder Sham; Mohammad Ali Shamshirgaran; Mohd Shanawaz; Medha Sharath; Samendra P. Sherchan; Ranjitha S. Shetty; Hesamaddin Shirzad-Aski; Aminu Shittu; Emmanuel Edwar Siddig; João Pedro Silva; Surjit Singh; Paramdeep Singh; Harpreet Singh; Jasvinder A. Singh; Md Shahjahan Siraj; Siswanto Siswanto; Ranjan Solanki; Yonatan Solomon; Joan B. Soriano; Chandrashekhar T. Sreeramareddy; Vijay Kumar Srivastava; Paschalis Steiropoulos; Chandan Kumar Swain; Takahiro Tabuchi; Mircea Tampa; Jacques J. L. Lukenze Tamuzi; Nathan Y. Tat; Razieh Tavakoli Oliaee; Gebrehiwot Teklay; Edosa Geta Tesfaye; Belay Tessema; Pugazhenthan Thangaraju; Rekha Thapar; Chern Choong Chern Thum; Jansje Henny Vera Ticoalu; Imad M. Tleyjeh; Ruoyan Tobe-Gai; Temesgen Mohammed Toma; Khai Hoan Tram; Aniefiok John Udoakang; Tungki Pratama Umar; Chukwuma David Umeokonkwo; Seyed Mohammad Vahabi; Asokan Govindaraj Vaithinathan; Job F. M. van Boven; Shoban Babu Varthya; Ziyue Wang; Muktar S. A. Warsame; Ronny Westerman; Tewodros Eshete Wonde; Sajad Yaghoubi; Siyan Yi; Vahit Yigit; Dong Keon Yon; Naohiro Yonemoto; Chuanhua Yu; Fathiah Zakham; Moein Zangiabadian; Francis Zeukeng; Haijun Zhang; Yang Zhao; Peng Zheng; Magdalena Zielinska; Joshua A. Salomon; Robert C. Reiner; Mohsen Naghavi; Theo Vos; Simon I. Hay; Christopher J. L. Murray; Hmwe Hmwe Kyu
Background: Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. Methods: We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990–2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. Findings: We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5–14 years, 6·29% (5·05 to 7·70) in those aged 15–49 years, 5·72% (4·02 to 7·39) in those aged 50–69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5–14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15–49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50–69 years, and a 3·29% (–5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (–713 to 2180) fewer deaths. Interpretation: Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. 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 allergic disorders and their risk factors in 204 countries and territories, from 1990 to 2019: A systematic analysis for the Global Burden of Disease Study 2019
(John Wiley and Sons Inc, 2023) Youn Ho Shin; Jimin Hwang; Rosie Kwon; Seung Won Lee; Min Seo Kim; Jae Il Shin; Dong Keon Yon; Yohannes Habtegiorgis Abate; Mohsen Abbasi-Kangevari; Zeinab Abbasi-Kangevari; Michael Abdelmasseh; Deldar Morad Abdulah; Richard Gyan Aboagye; Hassan Abolhassani; Elissa M. Abrams; Yonas Derso Abtew; Eman Abu-Gharbieh; Denberu Eshetie Adane Adane; Tigist Demssew Adane; Isaac Yeboah Addo; Rishan Adha; Amin Adibi; Qorinah Estiningtyas Sakilah Adnani; Anurag Agrawal; Sohail Ahmad; Ali Ahmadi; Ali Ahmed; Ayman Ahmed; Sayer Al-Azzam; Fadwa Alhalaiqa Naji Alhalaiqa; Sheikh Mohammad Alif; Vahid Alipour; Zaid Altaany; Khalid A. Altirkawi; Nelson Alvis-Guzman; Hany Aly; Adnan Ansar; Judie Arulappan; Mohammad Asghari-Jafarabadi; Tahira Ashraf; Seyyed Shamsadin Athari; Daniel Atlaw; Avinash Aujayeb; Sina Azadnajafabad; Mahsa Babaei; Hassan Babamohamadi; Alaa Badawi; Nayereh Baghcheghi; Sara Bagherieh; Khuloud Bajbouj; Maciej Banach; Mainak Bardhan; Francesco Barone-Adesi; Amadou Barrow; Azadeh Bashiri; Nebiyou Simegnew Bayileyegn; Isabela M. Bensenor; Alemshet Yirga Berhie; Kebede A. Beyene; Akshaya Srikanth Bhagavathula; Pankaj Bhardwaj; Ajay Nagesh Bhat; Vijayalakshmi S. Bhojaraja; Ali Bijani; Andras Bikov; Jiao Cai; Paulo Camargos; Josip Car; Sinclair Carr; Andrea Carugno; Promit Ananyo Chakraborty; Jeffrey Shi Kai Chan; Periklis Charalampous; Mohammadreza Chashmyazdan; Vijay Kumar Chattu; Mohiuddin Ahsanul Kabir Chowdhury; Dinh-Toi Chu; Barbara Corso; Natália Cruz-Martins; Omid Dadras; Xiaochen Dai; Giovanni Damiani; Lalit Dandona; Rakhi Dandona; Dessalegn Demeke; Biniyam Demisse; Daniel Diaz; Mengistie Diress; Deepa Dongarwar; Michael Ekholuenetale; Temitope Cyrus Ekundayo; Muhammed Elhadi; Omar Abdelsadek Abdou Elmeligy; Habtamu Esubalew; Farshid Etaee; Azin Etemadimanesh; Adeniyi Francis Fagbamigbe; Ildar Ravisovich Fakhradiyev; Ali Fatehizadeh; Syeda Anum Fatima Fatima; Xiaoqi Feng; Mohammad Fereidouni; Nuno Ferreira; Getahun Fetensa; Florian Fischer; Masoud Foroutan; Takeshi Fukumoto; Abduzhappar Gaipov; Yibeltal Yismaw Gela; Abera Getachew Obsa; Fataneh Ghadirian; Seyyed-Hadi Ghamari; Sherief Ghozy; Richard F. Gillum; Abraham Tamirat Gizaw; Admasu Belay AB Gizaw; Mohamad Goldust; Mahaveer Golechha; Pouya Goleij; Sapna Gupta; Vivek Kumar Gupta; Arvin Haj-Mirzaian; Rabih Halwani; Samer Hamidi; Md Abdul Hannan; Ahmed I. Hasaballah; Hamidreza Hasani; Abdiwahab Hashi; Mohammed Bheser Hassen; Behzad Heibati; Golnaz Heidari; Mohammad Heidari; Mahsa Heidari-Foroozan; Ramesh Holla; Nobuyuki Horita; Md Shakhaoat Hossain; Salman Hussain; Bing-Fang Hwang; Irena M. Ilic; Milena D. Ilic; Rana Irilouzadian; Nahlah Elkudssiah Ismail; Zhanat Bakhitovna I. Z. B. Ispayeva; Chidozie C. D. Iwu; Linda Merin J; Maziar Jajarmi; Elham Jamshidi; Manthan Dilipkumar Janodia; Shubha Jayaram; Rime Jebai; Jost B. Jonas; Nitin Joseph; Billingsley Kaambwa; Zubair Kabir; Feroze Kaliyadan; Himal Kandel; Rami S. Kantar; Ibraheem M. Karaye; Hanie Karimi; Harkiran Kaur; Leila Keikavoosi-Arani; Mohammad Keykhaei; Yousef Saleh Khader; Himanshu Khajuria; Imteyaz A. Khan; Maseer Khan; Moien A. B. Khan; Saval Khanal; Moawiah Mohammad Khatatbeh; Jagdish Khubchandani; Biruk Getahun Kibret; Adnan Kisa; Sezer Kisa; Pavel Kolkhir; Farzad Kompani; Hamid Reza Koohestani; Oleksii Korzh; Parvaiz A. Koul; Ai Koyanagi; Kewal Krishan; Claudia E. Kuehni; G. Anil Kumar; Om P. Kurmi; L. V. Simhachalam Kutikuppala; Ambily Kuttikkattu; Judit Lám; Bagher Larijani; Kamaluddin Latief; Paolo Lauriola; Thao Thi Thu Le; Yo Han Lee; Jacopo Lenzi; Ming-Chieh Li; Shanshan Li; Virendra S. Ligade; Stephen S. Lim; Gang Liu; Wei Liu; Xuefeng Liu; Chun-Han Lo; Graciliana Lopes; Soundarya Mahalingam; Sandeep B. Maharaj; Mansour Adam Mahmoud; Azeem Majeed; Mohammad-Reza Malekpour; Ahmad Azam Malik; Tauqeer Hussain Mallhi; Deborah Carvalho Malta; Abdullah A. Mamun; Seyedeh Zahra Masoumi; Andrea Maugeri; John Robert Carabeo Medina; Ritesh G. Menezes; George A. Mensah; Alexios-Fotios A. Mentis; Tomislav Mestrovic; Irmina Maria Michalek; Le Huu Nhat Minh; Erkin M. Mirrakhimov; Awoke Misganaw; Manish Mishra; Shafiu Mohammed; Ali H. Mokdad; Sara Momtazmanesh; Lorenzo Monasta; Md Moniruzzaman; Temesgen Mulugeta; Daniel Munblit; Efrén Murillo-Zamora; Ghulam Mustafa; Tapas Sadasivan Nair; Vinay Nangia; Sreenivas Narasimha Swamy; Hasan Nassereldine; Zuhair S. Natto; Biswa Prakash Nayak; Javad Nazari; Tze Pin Ng; Dang H. Nguyen; Van Thanh Nguyen; Robina Khan Niazi; Hasti Nouraei; Ogochukwu Janet Nzoputam; Bogdan Oancea; Rahman Md Obaidur; Hassan Okati-Aliabad; Osaretin Christabel Okonji; Patrick Godwin Okwute; Andrew T. Olagunju; Isaac Iyinoluwa Olufadewa; Hans Orru; P.A. Mahesh; Jagadish Rao Padubidri; Anamika Pandey; Shahina Pardhan; Eun-Kee Park; Jay Patel; Shankargouda Patil; Venkata Suresh Patthipati; Uttam Paudel; Marcos Pereira; Renato B. Pereira; Ionela-Roxana Petcu; Indrashis Podder; Vivek Podder; Arash Pour Mohammad; Ibrahim Qattea; Navid Rabiee; Mehran Rahimi; Mosiur Rahman; Muhammad Aziz Rahman; Amir Masoud Rahmani; Shayan Rahmani; Vahid Rahmanian; Prashant Rajput; Pradhum Ram; Premkumar Ramasubramani; Indu Ramachandra Rao; Ahmed Mustafa Rashid; Zubair Ahmed Ratan; Nakul Ravikumar; Salman Rawaf; Lal Rawal; Elrashdy Moustafa Mohamed Redwan; Aavishkar Raj Regmi; Nazila Rezaei; Negar Rezaei; Nima Rezaei; Saeid Rezaei; Mohsen Rezaeian; Jefferson Antonio Buendia Rodriguez; Leonardo Roever; Esperanza Romero-Rodríguez; Luca Ronfani; Aly M. A. Saad; Basema Saddik; Umar Saeed; Dominic Sagoe; Fatemeh Saheb Sharif-Askari; Amirhossein Sahebkar; Harihar Sahoo; Mirza Rizwan Sajid; Joseph W. Sakshaug; Saina Salahi; Sana Salehi; Abdallah M. Samy; Milena M. Santric-Milicevic; Made Ary Sarasmita; Maryam Sarkhosh; Ganesh Kumar Saya; Subramanian Senthilkumaran; Humaira Shah; Masood Ali Shaikh; Mohd Shanawaz; Aziz Sheikh; Shashank Shekhar; Mika Shigematsu; Parnian Shobeiri; Seyed Afshin Shorofi; Migbar Mekonnen Sibhat; Colin R. Simpson; Jasvinder A. Singh; Paramdeep Singh; Surjit Singh; Virendra Singh; Md Shahjahan Siraj; Anna Aleksandrovna Skryabina; Yonatan Solomon; Suhang Song; Sergey Soshnikov; Ireneous N. Soyiri; Paschalis Steiropoulos; Mindy D. Szeto; Iman M. Talaat; Jacques J. L. Lukenze Tamuzi; Ker-Kan Tan; Nathan Y. Tat; Mohamad-Hani Temsah; Dufera Rikitu Terefa; Riki Tesler; Pugazhenthan Thangaraju; Jansje Henny Vera Ticoalu; Tala Tillawi; Mai Thi Ngoc Tran; Biruk Shalmeno Tusa; Irfan Ullah; Saif Ullah; Sana Ullah; Era Upadhyay; Seyed Mohammad Vahabi; Job F. M. van Boven; Tommi Juhani Vasankari; Georgios-Ioannis Verras; Rafael José Vieira; Francesco S. Violante; Theo Vos; Ronny Westerman; Nuwan Darshana Wickramasinghe; Hywel C. Williams; Dereje Y. Yada; Yazachew Yismaw; Naohiro Yonemoto; Chuanhua Yu; Ismaeel Yunusa; Mazyar Zahir; Heather J. Zar; Iman Zare; Mikhail Sergeevich Zastrozhin; Mohammad A. Zeineddine; Getachew Assefa Zenebe; Zhi-Jiang Zhang; Hanqing Zhao; Mohammad Zoladl
Background: Asthma and atopic dermatitis (AD) are chronic allergic conditions, along with allergic rhinitis and food allergy and cause high morbidity and mortality both in children and adults. This study aims to evaluate the global, regional, national, and temporal trends of the burden of asthma and AD from 1990 to 2019 and analyze their associations with geographic, demographic, social, and clinical factors. Methods: Using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2019, we assessed the age-standardized prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of both asthma and AD from 1990 to 2019, stratified by geographic region, age, sex, and socio-demographic index (SDI). DALYs were calculated as the sum of years lived with disability and years of life lost to premature mortality. Additionally, the disease burden of asthma attributable to high body mass index, occupational asthmagens, and smoking was described. Results: In 2019, there were a total of 262 million [95% uncertainty interval (UI): 224–309 million] cases of asthma and 171 million [95% UI: 165–178 million] total cases of AD globally; age-standardized prevalence rates were 3416 [95% UI: 2899–4066] and 2277 [95% UI: 2192–2369] per 100,000 population for asthma and AD, respectively, a 24.1% [95% UI: −27.2 to −20.8] decrease for asthma and a 4.3% [95% UI: 3.8–4.8] decrease for AD compared to baseline in 1990. Both asthma and AD had similar trends according to age, with age-specific prevalence rates peaking at age 5–9 years and rising again in adulthood. The prevalence and incidence of asthma and AD were both higher for individuals with higher SDI; however, mortality and DALYs rates of individuals with asthma had a reverse trend, with higher mortality and DALYs rates in those in the lower SDI quintiles. Of the three risk factors, high body mass index contributed to the highest DALYs and deaths due to asthma, accounting for a total of 3.65 million [95% UI: 2.14–5.60 million] asthma DALYs and 75,377 [95% UI: 40,615–122,841] asthma deaths. Conclusions: Asthma and AD continue to cause significant morbidity worldwide, having increased in total prevalence and incidence cases worldwide, but having decreased in age-standardized prevalence rates from 1990 to 2019. Although both are more frequent at younger ages and more prevalent in high-SDI countries, each condition has distinct temporal and regional characteristics. Understanding the temporospatial trends in the disease burden of asthma and AD could guide future policies and interventions to better manage these diseases worldwide and achieve equity in prevention, diagnosis, and treatment. © 2023 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.
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; 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Tesfahun Mekene Meto; Hadush Negash Meles; Walter Mendoza; Ritesh G Menezes; George A Mensah; Sultan Ayoub Meo; Atte Meretoja; Tuomo J Meretoja; Tomislav Mestrovic; Chamila Dinushi Kukulege Mettananda; Tomasz Miazgowski; Irmina Maria Michalek; Ana Carolina Micheletti Gomide Nogueira de Sá; Giuseppe Minervini; Le Huu Nhat Minh; G.K. Mini; Mojgan Mirghafourvand; Andreea Mirica; Erkin M Mirrakhimov; Mohammad Mirza-Aghazadeh-Attari; Manish Mishra; Sanjeev Misra; Prasanna Mithra; Ahmed Ismail Mohamed; Jama Mohamed; Nouh Saad Mohamed; Ameen Mosa Mohammad; Esmaeil Mohammadi; Saeed Mohammadi; Soheil Mohammadi; Abdollah Mohammadian-Hafshejani; Ibrahim Mohammadzadeh; Hussen Mohammed; Mustapha Mohammed; Salahuddin Mohammed; Shafiu Mohammed; Ali H Mokdad; Hossein Molavi Vardanjani; Mariam Molokhia; Shaher Momani; Lorenzo Monasta; Mohammad Ali Moni; Fateme Montazeri; AmirAli Moodi Ghalibaf; Mahmood Moosazadeh; Maryam Moradi; Yousef Moradi; Paula Moraga; Lidia Morawska; Rafael Silveira Moreira; Shane Douglas Morrison; Reza Mosaddeghi Heris; Elias Mossialos; Parsa Mousavi; Ahmed Msherghi; Sumaira Mubarik; Lorenzo Muccioli; Admir Mulita; Malaisamy Muniyandi; Kavita Munjal; Efren Murillo-Zamora; Sathish Muthu; Woojae Myung; Amin Nabavi; Ashraf Fawzy Nabhan; Ayoub Nafei; Ahamarshan Jayaraman Nagarajan; Pirouz Naghavi; Ganesh R Naik; Gurudatta Naik; Mukhammad David Naimzada; Sanjeev Nair; Tapas Sadasivan Nair; Soroush Najdaghi; Hastyar Hama Rashid Najmuldeen; Noureddin Nakhostin Ansari; Vinay Nangia; Sreenivas Narasimha Swamy; Shumaila Nargus; Delaram Narimani Davani; Bruno Ramos Nascimento; Gustavo G Nascimento; Ali Nasrollahizadeh; Amir Nasrollahizadeh; Zuhair S Natto; Javaid Nauman; Samidi Nirasha Kumari Navaratna; Biswa Prakash Nayak; Vinod C Nayak; Athare Nazri-Panjaki; Rawlance Ndejjo; Ionut Negoi; Ruxandra Irina Negoi; Seyed Aria Nejadghaderi; Chakib Nejjari; Mohammad Hadi Nematollahi; Samata Nepal; Charles Richard James Newton; Dang H Nguyen; Duc Hoang Nguyen; Hau Thi Hien Nguyen; Hien Quang Nguyen; Nhien Ngoc Y Nguyen; Phat Tuan Nguyen; Van Thanh Nguyen; Robina Khan Niazi; Yeshambel T Nigatu; Nasrin Nikravangolsefid; Dina Nur Anggraini Ningrum; Chukwudi A Nnaji; Lawrence Achilles Nnyanzi; Shuhei Nomura; Syed Toukir Ahmed Noor; Bo Norrving; Nawsherwan Nawsherwan; Jean Jacques Noubiap; Chisom Adaobi Nri-Ezedi; George Ntaios; Mpiko Ntsekhe; Fred Nugen; Mario Cesare Nurchis; Dieta Nurrika; Chimezie Igwegbe Nzoputam; Ogochukwu Janet Nzoputam; Bogdan Oancea; Kehinde O Obamiro; Ismail A Odetokun; Martin James O'Donnell; James Odhiambo Oguta; In-Hwan Oh; Tolulope R Ojo-Akosile; Hassan Okati-Aliabad; Sylvester Reuben Okeke; Akinkunmi Paul Okekunle; Lawrence Okidi; Osaretin Christabel Okonji; Morteza Oladnabi; Andrew T Olagunju; Muideen Tunbosun Olaiya; Oladotun Victor Olalusi; Tosin Abiola Olasehinde; Omotola O Olasupo; Matthew Idowu Olatubi; Arão Belitardo Oliveira; Gláucia Maria Moraes Oliveira; Abdulhakeem Abayomi Olorukooba; Isaac Iyinoluwa Olufadewa; Yinka Doris Doris Oluwafemi; Gideon Olamilekan Oluwatunase; Hany A Omar; Ahmed Omar Bali; Adrienne E O'Neil; Sok King Ong; Obinna E Onwujekwe; Abdulahi Opejin Opejin; Michal Ordak; Raffaele Ornello; Doris V Ortega-Altamirano; Alberto Ortiz; Esteban Ortiz-Prado; Wael M S Osman; Uchechukwu Levi Osuagwu; Stanislav S Otstavnov; Mayowa O Owolabi; Ifeoluwa Temitayo Oyeyemi; Ahmad Ozair; Mahesh Padukudru P A; Kevin Pacheco-Barrios; Alicia Padron-Monedero; Jagadish Rao Padubidri; Tamás Palicz; Raul Felipe Palma-Alvarez; Feng Pan; Songhomitra Panda-Jonas; Deepshikha Pande Katare; Anamika Pandey; Ashok Pandey; Seithikurippu R Pandi-Perumal; Leonidas D Panos; Ioannis Pantazopoulos; Paraskevi Papadopoulou; Shahina Pardhan; Pragyan Paramita Parija
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
Global, regional, and national prevalence and mortality burden of sickle cell disease, 2000–2021: a systematic analysis from the Global Burden of Disease Study 2021
(Elsevier Ltd, 2023) Azalea M. Thomson; Theresa A. McHugh; Assaf P. Oron; Corey Teply; Nikhil Lonberg; Victor M. Vilchis Tella; Lauren B. Wilner; Kia Fuller; Hailey Hagins; Richard Gyan Aboagye; Melka Biratu Aboye; Eman Abu-Gharbieh; Ahmed Abu-Zaid; Isaac Yeboah Addo; Bright Opoku Ahinkorah; Aqeel Ahmad; Saif Aldeen S. AlRyalat; Hubert Amu; Aleksandr Y. Aravkin; Judie Arulappan; Maha Moh'd Wahbi Atout; Ashish D. Badiye; Sara Bagherieh; MacIej Banach; Morteza Banakar; Mainak Bardhan; Amadou Barrow; Deriba Abera Bedane; Isabela M. Bensenor; Akshaya Srikanth Bhagavathula; Pankaj Bhardwaj; Prarthna V. Bhardwaj; Ajay Nagesh Bhat; Zulfiqar A. Bhutta; Mariah Malak Bilalaga; Jessica Devin Bishai; Saeid Bitaraf; Archith Boloor; Muhammad Hammad Butt; Vijay Kumar Chattu; Dinh-Toi Chu; Omid Dadras; Xiaochen Dai; Bardia Danaei; Anh Kim Dang; Fitsum Wolde Demisse; Meghnath Dhimal; Daniel Diaz; Shirin Djalalinia; Deepa Dongarwar; Muhammed Elhadi; Mohamed A. Elmonem; Christopher Imokhuede Esezobor; Farshid Etaee; Oghenowede Eyawo; Adeniyi Francis Fagbamigbe; Ali Fatehizadeh; Lisa M. Force; William M. Gardner; Kazem Ghaffari; Paramjit Singh Gill; Mahaveer Golechha; Pouya Goleij; Vivek Kumar Gupta; Hamidreza Hasani; Treska S. Hassan; Mohammed Bheser Hassen; Segun Emmanuel Ibitoye; Adalia I. Ikiroma; Chidozie C.D. Iwu; Peter Bai James; Shubha Jayaram; Rime Jebai; Ravi Prakash Jha; Nitin Joseph; Farnaz Kalantar; Himal Kandel; Ibraheem M. Karaye; Woldeteklehaymanot Dagne Kassahun; Imteyaz A. Khan; Shaghayegh Khanmohammadi; Adnan Kisa; Farzad Kompani; Kewal Krishan; Iván Landires; Stephen S. Lim; Preetam Bhalchandra Mahajan; Soleiman Mahjoub; Azeem Majeed; Bishnu P. Marasini; Haftu Asmerom Meresa; Tomislav Mestrovic; Sonica Minhas; Awoke Misganaw; Ali H. Mokdad; Lorenzo Monasta; Ghulam Mustafa; Tapas Sadasivan Nair; Sreenivas Narasimha Swamy; Hasan Nassereldine; Zuhair S. Natto; Muhammad Naveed; Biswa Prakash Nayak; Jean Jacques Noubiap; Taylor Noyes; Chisom Adaobi Nri-Ezedi; Vincent Ebuka Nwatah; Chimezie Igwegbe Nzoputam; Ogochukwu Janet Nzoputam; Osaretin Christabel Okonji; Adeyinka Omoniyi Onikan; Mayowa O. Owolabi; Jay Patel; Siddhartha Pati; Shrikant Pawar; Ionela-Roxana Petcu; Frédéric B. Piel; Ibrahim Qattea; Mehran Rahimi; Mosiur Rahman; Salman Rawaf; Elrashdy Moustafa Mohamed Redwan; Nazila Rezaei; Basema Saddik; Umar Saeed; Fatemeh Saheb Sharif-Askari; Abdallah M. Samy; Austin E. Schumacher; Elaheh Shaker; Adithi Shetty; Migbar Mekonnen Sibhat; Jasvinder A. Singh; Muhammad Suleman; Dev Ram Sunuwar; Mindy D. Szeto; Jacques J.L. Lukenze Tamuzi; Nathan Y. Tat; Birhan Tsegaw Taye; Mohamad-Hani Temsah; Muhammad Umair; Sahel Valadan Tahbaz; Cong Wang; Nuwan Darshana Wickramasinghe; Arzu Yigit; Vahit Yigit; Ismaeel Yunusa; Burhan Abdullah Zaman; Moein Zangiabadian; Peng Zheng; Simon I. Hay; Mohsen Naghavi; Christopher J.L. Murray; Nicholas J. Kassebaum
Background: Previous global analyses, with known underdiagnosis and single cause per death attribution systems, provide only a small insight into the suspected high population health effect of sickle cell disease. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study delivers a comprehensive global assessment of prevalence of sickle cell disease and mortality burden by age and sex for 204 countries and territories from 2000 to 2021. Methods: We estimated cause-specific sickle cell disease mortality using standardised GBD approaches, in which each death is assigned to a single underlying cause, to estimate mortality rates from the International Classification of Diseases (ICD)-coded vital registration, surveillance, and verbal autopsy data. In parallel, our goal was to estimate a more accurate account of sickle cell disease health burden using four types of epidemiological data on sickle cell disease: birth incidence, age-specific prevalence, with-condition mortality (total deaths), and excess mortality (excess deaths). Systematic reviews, supplemented with ICD-coded hospital discharge and insurance claims data, informed this modelling approach. We employed DisMod-MR 2.1 to triangulate between these measures—borrowing strength from predictive covariates and across age, time, and geography—and generated internally consistent estimates of incidence, prevalence, and mortality for three distinct genotypes of sickle cell disease: homozygous sickle cell disease and severe sickle cell β-thalassaemia, sickle-haemoglobin C disease, and mild sickle cell β-thalassaemia. Summing the three models yielded final estimates of incidence at birth, prevalence by age and sex, and total sickle cell disease mortality, the latter of which was compared directly against cause-specific mortality estimates to evaluate differences in mortality burden assessment and implications for the Sustainable Development Goals (SDGs). Findings: Between 2000 and 2021, national incidence rates of sickle cell disease were relatively stable, but total births of babies with sickle cell disease increased globally by 13·7% (95% uncertainty interval 11·1–16·5), to 515 000 (425 000–614 000), primarily due to population growth in the Caribbean and western and central sub-Saharan Africa. The number of people living with sickle cell disease globally increased by 41·4% (38·3–44·9), from 5·46 million (4·62–6·45) in 2000 to 7·74 million (6·51–9·2) in 2021. We estimated 34 400 (25 000–45 200) cause-specific all-age deaths globally in 2021, but total sickle cell disease mortality burden was nearly 11-times higher at 376 000 (303 000–467 000). In children younger than 5 years, there were 81 100 (58 800–108 000) deaths, ranking total sickle cell disease mortality as 12th (compared to 40th for cause-specific sickle cell disease mortality) across all causes estimated by the GBD in 2021. Interpretation: Our findings show a strikingly high contribution of sickle cell disease to all-cause mortality that is not apparent when each death is assigned to only a single cause. Sickle cell disease mortality burden is highest in children, especially in countries with the greatest under-5 mortality rates. Without comprehensive strategies to address morbidity and mortality associated with sickle cell disease, attainment of SDG 3.1, 3.2, and 3.4 is uncertain. Widespread data gaps and correspondingly high uncertainty in the estimates highlight the urgent need for routine and sustained surveillance efforts, further research to assess the contribution of conditions associated with sickle cell disease, and widespread deployment of evidence-based prevention and treatment for those with sickle cell disease. Funding: Bill & Melinda Gates Foundation. © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019
(Elsevier B.V., 2022) Khanh Bao Tran; Justin J. Lang; Kelly Compton; Rixing Xu; Alistair R. Acheson; Hannah Jacqueline Henrikson; Jonathan M. Kocarnik; Louise Penberthy; Amirali Aali; Qamar Abbas; Behzad Abbasi; Mohsen Abbasi-Kangevari; Zeinab Abbasi-Kangevari; Hedayat Abbastabar; Michael Abdelmasseh; Sherief Abd-Elsalam; Ahmed Abdelwahab Abdelwahab; Gholamreza Abdoli; Hanan Abdulkadir Abdulkadir; Aidin Abedi; Kedir Hussein Abegaz; Hassan Abidi; Richard Gyan Aboagye; Hassan Abolhassani; Abdorrahim Absalan; Yonas Derso Abtew; Hiwa Abubaker Ali; Eman Abu-Gharbieh; Basavaprabhu Achappa; Juan Manuel Acuna; Daniel Addison; Isaac Yeboah Addo; Oyelola A. Adegboye; Miracle Ayomikun Adesina; Mohammad Adnan; Qorinah Estiningtyas Sakilah Adnani; Shailesh M. Advani; Sumia Afrin; Muhammad Sohail Afzal; Manik Aggarwal; Bright Opoku Ahinkorah; Araz Ramazan Ahmad; Rizwan Ahmad; Sajjad Ahmad; Sohail Ahmad; Sepideh Ahmadi; Haroon Ahmed; Luai A. Ahmed; Muktar Beshir Ahmed; Tarik Ahmed Rashid; Wajeeha Aiman; Marjan Ajami; Gizachew Taddesse Akalu; Mostafa Akbarzadeh-Khiavi; Addis Aklilu; Maxwell Akonde; Chisom Joyqueenet Akunna; Hanadi Al Hamad; Fares Alahdab; Fahad Mashhour Alanezi; Turki M. Alanzi; Saleh Ali Alessy; Abdelazeem M. Algammal; Mohammed Khaled Al-Hanawi; Robert Kaba Alhassan; Beriwan Abdulqadir Ali; Liaqat Ali; Syed Shujait Ali; Yousef Alimohamadi; Vahid Alipour; Syed Mohamed Aljunid; Motasem Alkhayyat; Sadeq Ali Ali Al-Maweri; Sami Almustanyir; Nivaldo Alonso; Shehabaldin Alqalyoobi; Rajaa M. Al-Raddadi; Rami H. Hani Al-Rifai; Salman Khalifah Al-Sabah; Ala’a B. Al-Tammemi; Haya Altawalah; Nelson Alvis-Guzman; Firehiwot Amare; Edward Kwabena Ameyaw; Javad Javad Aminian Dehkordi; Mohammad Hosein Amirzade-Iranaq; Hubert Amu; Ganiyu Adeniyi Amusa; Robert Ancuceanu; Jason A. Anderson; Yaregal Animut Animut; Amir Anoushiravani; Ali Arash Anoushirvani; Alireza Ansari-Moghaddam; Mustafa Geleto Ansha; Benny Antony; Maxwell Hubert Antwi; Sumadi Lukman Anwar; Razique Anwer; Anayochukwu Edward Anyasodor; Jalal Arabloo; Morteza Arab-Zozani; Olatunde Aremu; Ayele Mamo Argaw; Hany Ariffin; Timur Aripov; Muhammad Arshad; Al Artaman; Judie Arulappan; Raphael Taiwo Aruleba; Armin Aryannejad; Malke Asaad; Mulusew A. Asemahagn; Zatollah Asemi; Mohammad Asghari-Jafarabadi; Tahira Ashraf; Reza Assadi; Mohammad Athar; Seyyed Shamsadin Athari; Maha Moh’d Wahbi Atout; Sameh Attia; Avinash Aujayeb; Marcel Ausloos; Leticia Avila-Burgos; Atalel Fentahun Awedew; Mamaru Ayenew Awoke; Tewachew Awoke; Beatriz Paulina Ayala Quintanilla; Tegegn Mulatu Ayana; Solomon Shitu Ayen; Davood Azadi; Sina Azadnajafabad; Saber Azami-Aghdash; Melkalem Mamuye Azanaw; Mohammadreza Azangou-Khyavy; Amirhossein Azari Jafari; Hosein Azizi; Ahmed Y.Y. Azzam; Amirhesam Babajani; Muhammad Badar; Ashish D. Badiye; Nayereh Baghcheghi; Nader Bagheri; Sara Bagherieh; Saeed Bahadory; Atif Amin Baig; Jennifer L. Baker; Ahad Bakhtiari; Ravleen Kaur Bakshi; Maciej Banach; Indrajit Banerjee; Mainak Bardhan; Francesco Barone-Adesi; Fabio Barra; Amadou Barrow; Nasir Z. Bashir; Azadeh Bashiri; Saurav Basu; Abdul-Monim Mohammad Batiha; Aeysha Begum; Alehegn Bekele Bekele; Alemayehu Sayih Belay; Melaku Ashagrie Belete; Uzma Iqbal Belgaumi; Arielle Wilder Bell; Luis Belo; Habib Benzian; Alemshet Yirga Berhie; Amiel Nazer C. Bermudez; Eduardo Bernabe; Akshaya Srikanth Bhagavathula; Neeraj Bhala; Bharti Bhandari Bhandari; Nikha Bhardwaj; Pankaj Bhardwaj; Krittika Bhattacharyya; Vijayalakshmi S. Bhojaraja; Soumitra S. Bhuyan; Sadia Bibi; Awraris Hailu Bilchut; Bagas Suryo Bintoro; Antonio Biondi; Mesfin Geremaw Birega Birega; Habitu Eshetu Birhan; Tone Bjørge; Oleg Blyuss; Belay Boda Abule Bodicha; Srinivasa Rao Bolla; Archith Boloor; Cristina Bosetti; Dejana Braithwaite; Michael Brauer; Hermann Brenner; Andrey Nikolaevich Briko; Nikolay Ivanovich Briko; Christina Maree Buchanan; Norma B. Bulamu; Maria Teresa Bustamante-Teixeira; Muhammad Hammad Butt; Nadeem Shafique Butt; Zahid A. Butt; Florentino Luciano Caetano Dos Santos; Luis Alberto Cámera; Chao Cao; Yin Cao; Giulia Carreras; Márcia Carvalho; Francieli Cembranel; Ester Cerin; Promit Ananyo Chakraborty; Periklis Charalampous; Vijay Kumar Chattu; Odgerel Chimed-Ochir; Jesus Lorenzo Chirinos-Caceres; Daniel Youngwhan Cho; William C.S. Cho; Devasahayam J. Christopher; Dinh-Toi Chu; Isaac Sunday Chukwu; Aaron J. Cohen; Joao Conde; Sandra Cortés; Vera Marisa Costa; Natália Cruz-Martins; Garland T. Culbreth; Omid Dadras; Fentaw Teshome Dagnaw; Saad M.A. Dahlawi; Xiaochen Dai; Lalit Dandona; Rakhi Dandona; Parnaz Daneshpajouhnejad; Anna Danielewicz; An Thi Minh Dao; Reza Darvishi Cheshmeh Soltani; Aso Mohammad Darwesh; Saswati Das; Dragos Virgil Davitoiu; Elham Davtalab Esmaeili; Fernando Pio De La Hoz; Sisay Abebe Debela; Azizallah Dehghan; Biniyam Demisse; Fitsum Wolde Demisse; Edgar Denova-Gutiérrez; Afshin Derakhshani; Meseret Derbew Molla; Diriba Dereje; Kalkidan Solomon Deribe; Rupak Desai; Markos Desalegn Desalegn; Fikadu Nugusu Dessalegn; Samuel Abebe A. Dessalegni; Gashaw Dessie; Abebaw Alemayehu Desta; Syed Masudur Rahman Dewan; Samath Dhamminda Dharmaratne; Meghnath Dhimal; Mostafa Dianatinasab; Nancy Diao; Daniel Diaz; Lankamo Ena Digesa; Shilpi Gupta Dixit; Saeid Doaei; Linh Phuong Doan; Paul Narh Doku; Deepa Dongarwar; Wendel Mombaque dos Santos; Tim Robert Driscoll; Haneil Larson Dsouza; Oyewole Christopher Durojaiye; Sareh Edalati; Fatemeh Eghbalian; Elham Ehsani-Chimeh; Ebrahim Eini; Michael Ekholuenetale; Temitope Cyrus Ekundayo; Donatus U. Ekwueme; Maha El Tantawi; Mostafa Ahmed Elbahnasawy; Iffat Elbarazi; Hesham Elghazaly; Muhammed Elhadi; Waseem El-Huneidi; Mohammad Hassan Emamian; Luchuo Engelbert Bain; Daniel Berhanie Enyew; Ryenchindorj Erkhembayar; Tegegne Eshetu; Babak Eshrati; Sharareh Eskandarieh; Juan Espinosa-Montero; Farshid Etaee; Azin Etemadimanesh; Tahir Eyayu; Ifeanyi Jude Ezeonwumelu; Sayeh Ezzikouri; Adeniyi Francis Fagbamigbe; Saman Fahimi; Ildar Ravisovich Fakhradiyev; Emerito Jose A. 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Hassan; Soheil Hassanipour; Khezar Hayat; Golnaz Heidari; Mohammad Heidari; Zahra Heidarymeybodi; Brenda Yuliana Herrera-Serna; Claudiu Herteliu; Kamal Hezam; Yuta Hiraike; Mbuzeleni Mbuzeleni Hlongwa; Ramesh Holla; Marianne Holm; Nobuyuki Horita; Mohammad Hoseini; Md. Mahbub Hossain; Mohammad Bellal Hossain Hossain; Mohammad-Salar Hosseini; Ali Hosseinzadeh; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mowafa Househ; Junjie Huang; Fernando N. Hugo; Ayesha Humayun; Salman Hussain; Nawfal R. Hussein; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Pulwasha Maria Iftikhar; Kevin S. Ikuta; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Mustapha Immurana; Kaire Innos; Pooya Iranpour; Lalu Muhammad Irham; Md Shariful Islam; Rakibul M. Islam; Farhad Islami; Nahlah Elkudssiah Ismail; Gaetano Isola; Masao Iwagami; Linda Merin J; Abhishek Jaiswal; Mihajlo Jakovljevic; Mahsa Jalili; Shahram Jalilian; Elham Jamshidi; Sung-In Jang; Chinmay T. Jani; Tahereh Javaheri; Umesh Umesh Jayarajah; Shubha Jayaram; Seyed Behzad Jazayeri; Rime Jebai; Bedru Jemal; Wonjeong Jeong; Ravi Prakash Jha; Har Ashish Jindal; Yetunde O. John-Akinola; Jost B. Jonas; Tamas Joo; Nitin Joseph; Farahnaz Joukar; Jacek Jerzy Jozwiak; Mikk Jürisson; Ali Kabir; Salah Eddine Oussama Kacimi; Vidya Kadashetti; Farima Kahe; Pradnya Vishal Kakodkar; Laleh R. Kalankesh; Leila R. Kalankesh; Rohollah Kalhor; Vineet Kumar Kamal; Farin Kamangar; Ashwin Kamath; Tanuj Kanchan; Eswar Kandaswamy; Himal Kandel; HyeJung Kang; Girum Gebremeskel Kanno; Neeti Kapoor; Sitanshu Sekhar Kar; Shama D. Karanth; Ibraheem M. Karaye; André Karch; Amirali Karimi; Bekalu Getnet Kassa; Patrick D.M.C. Katoto; Joonas H. Kauppila; Harkiran Kaur; Abinet Gebremickael Kebede; Leila Keikavoosi-Arani; Gemechu Gemechu Kejela; Phillip M. Kemp Bohan; Maryam Keramati; Mohammad Keykhaei; Himanshu Khajuria; Abbas Khan; Abdul Aziz Khan Khan; Ejaz Ahmad Khan; Gulfaraz Khan; Md. 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Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license