Browsing by Author "Samar Abd ElHafeez"

Now showing 1 - 5 of 5

Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023
(Elsevier B.V., 2025) Simon I. Hay; Kanyin Liane Ong; Damian Francesco Santomauro; A. Bhoomadevi; Mohammad Amin Aalipour; Hasan Abualruz; Hazim S. Ababneh; Ukachukwu Okoroafor Abaraogu; Biruk Beletew Abate; Cristiana Abbafati; Nasir Abbas; Mitra Abbasifard; Mohsen Abbasi-Kangevari; Samar Abd ElHafeez; Ashraf N. Abdalla; Mohammed Altigani Abdalla; Emad M. Abdallah; Barkhad Aden Abdeeq; Nadin M. Abdel Razeq; Ahmed Abdelrahman Abdelgalil; Reda S. Abdel-Hameed; Michael Abdelmasseh; Mahmoud Hassan Abdelnabi; Wael M. Abdel-Rahman; Sherief M. Abd-Elsalam; Sepideh Abdi; Mohammad Abdollahi; Meriem Abdoun; Arman Abdous; Jeza Muhamad Abdul Aziz; Deldar Morad Abdulah; Rizwan Suliankatchi Abdulkader; Adam Ibrahim Abdullahi; Auwal S. Abdullahi; Toufik Abdul-Rahman; Kulmira Abdykerimova; Habtamu Abebe Getahun; Aidin Abedi; Armita Abedi; Asrat Agalu Abejew; Roberto Ariel Abeldaño Zuñiga; E. S. Abhilash; Shehab Uddin Al Abid; Syed Hani Abidi; Alemwork Abie; Olugbenga Olusola Abiodun; Olumide A. Abiodun; Richard Gyan Aboagye; Shady M. Abohashem; Hassan Abolhassani; Ulric Sena Abonie; Nagah M. Abourashed; Mohamed Riad Abouzid; Dmitry Abramov; Lucas Guimarães Abreu; Dariush Abtahi; Rana K. Abu Farha; Fuad Hamdi Abuadas; Aminu Kende Abubakar; Bilyaminu Abubakar; Eman F. Abu-Gharbieh; Sawsan Hammad Abuhammad; Ahmad Yousef Abuhelwa; Hana J. Abukhadijah; Niveen M.E. Abu-Rmeileh; Salahdein Aburuz; Dina Hamdi Abushanab; Raghu Ram Achar; Anirudh B. Acharya; Apurba Acharya; Ilana N. Ackerman; Juan Manuel Acuna; Ousman Adal; Lisa Christine Adams; Lawan H. Adamu; Mesafint Molla Adane; Zenaw Debasu Addisu; Isaac Yeboah Addo; Oluwafemi Atanda Adeagbo; Tajudeen Adesanmi Adebisi; Isaac Akinkunmi Adedeji; David Adedia; Kamoru A. Adedokun; Rufus A. Adedoyin; Oluwatobi E. Adegbile; Oyelola Abdulwasiu Adegboye; Nurudeen A. Adegoke; Olumide Thomas Adeleke; Isaac A. Adesina; Miracle Ayomikun Adesina; Habeeb Omoponle Adewuyi; Temitayo Esther Adeyeoluwa; Olorunsola I. Adeyomoye; Kishor Adhikari; Ripon Kumar Adhikary; Usha Sachidananda Adiga; Mohd Adnan; Qorinah Estiningtyas Sakilah Adnani; Prince Owusu Adoma; Leticia Akua Adzigbli
Background For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. Methods The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010–23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Findings Total numbers of global DALYs grew 6·1% (95% UI 4·0–8·1), from 2·64 billion (2·46–2·86) in 2010 to 2·80 billion (2·57–3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0–14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31–1·61) global DALYs in 2010, increasing to 1·80 billion (1·63–2·03) in 2023, alongside a concurrent 4·1% (1·9–6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176–209] DALYs), stroke (157 million [141–172]), and diabetes (90·2 million [75·2–107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0–107·5]), depressive disorders (26·3% [11·6–42·9]), and diabetes (14·9% [7·5–25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837–917) in 2010 to 681 million (642–736) in 2023, and a 25·8% (22·6–28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7–61·0) for diarrhoeal diseases, 42·9% (38·0–48·0) for HIV/AIDS, and 42·2% (23·6–56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6–22·0) and 24·8% (7·4–36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7–19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18–1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation—with high SBP accounting for 8·4% (6·9–10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories—behavioural, metabolic, and environmental and occupational—risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8–37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0–11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023—eg, declining by 54·4% (38·7–65·3) for unsafe sanitation, 50·5% (33·3–63·1) for unsafe water source, and 45·2% (25·6–72·0) for no access to handwashing facility, and by 44·9% (37·3–53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [–2·7 to 15·6]; non-significant). Interpretation Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors—eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG—including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic—the complex interaction of multiple health risks, social determinants, and systemic challenges—will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Funding Gates Foundation and Bloomberg Philanthropies. © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
(Elsevier B.V., 2024) Austin E. Schumacher; Hmwe Hmwe Kyu; Amirali Aali; Cristiana Abbafati; Jaffar Abbas; Rouzbeh Abbasgholizadeh; Madineh Akram Abbasi; Mohammadreza Abbasian; Samar Abd ElHafeez; Michael Abdelmasseh; Sherief Abd-Elsalam; Ahmed Abdelwahab; Mohammad Abdollahi; Meriem Abdoun; Auwal Abdullahi; Ame Mehadi Abdurehman; Mesfin Abebe; Aidin Abedi; Armita Abedi; Tadesse M. Abegaz; Roberto Ariel Abeldaño Zuñiga; E.S. Abhilash; Olugbenga Olusola Abiodun; Richard Gyan Aboagye; Hassan Abolhassani; Mohamed Abouzid; Lucas Guimarães Abreu; Woldu Aberhe Abrha; Michael R.M. Abrigo; Dariush Abtahi; Samir Abu Rumeileh; Niveen M.E. Abu-Rmeileh; Salahdein Aburuz; Ahmed Abu-Zaid; Juan Manuel Acuna; Tim Adair; Isaac Yeboah Addo; Oladimeji M. Adebayo; Oyelola A. Adegboye; Victor Adekanmbi; Bashir Aden; Abiola Victor Adepoju; Charles Oluwaseun Adetunji; Temitayo Esther Adeyeoluwa; Olorunsola Israel Adeyomoye; Rishan Adha; Amin Adibi; Wirawan Adikusuma; Qorinah Estiningtyas Sakilah Adnani; Saryia Adra; Abel Afework; Aanuoluwapo Adeyimika Afolabi; Ali Afraz; Shadi Afyouni; Saira Afzal; Pradyumna Agasthi; Shahin Aghamiri; Antonella Agodi; Williams Agyemang-Duah; Bright Opoku Ahinkorah; Aqeel Ahmad; Danish Ahmad; Firdos Ahmad; Muayyad M. Ahmad; Tauseef Ahmad; Keivan Ahmadi; Amir Mahmoud Ahmadzade; Mohadese Ahmadzade; Ayman Ahmed; Haroon Ahmed; Luai A. Ahmed; Muktar Beshir Ahmed; Syed Anees Ahmed; Marjan Ajami; Budi Aji; Olufemi Ajumobi; Gizachew Taddesse Akalu; Essona Matatom Akara; Karolina Akinosoglou; Sreelatha Akkala; Samuel Akyirem; Hanadi Al Hamad; Syed Mahfuz Al Hasan; Ammar Al Homsi; Mohammad Al Qadire; Moein Ala; Timothy Olukunle Aladelusi; Tareq Mohammed Ali Al-Ahdal; Samer O. Alalalmeh; Ziyad Al-Aly; Khurshid Alam; Manjurul Alam; Zufishan Alam; Rasmieh Mustafa Al-Amer; Fahad Mashhour Alanezi; Turki M. Alanzi; Mohammed Albashtawy; Mohammad T. AlBataineh; Robert W. Aldridge; Sharifullah Alemi; Ayman Al-Eyadhy; Adel Ali Saeed Al-Gheethi; Khalid F. Alhabib; Fadwa Alhalaiqa Naji Alhalaiqa; Mohammed Khaled Al-Hanawi; Abid Ali; Akhtar Ali; Beriwan Abdulqadir Ali; Hassam Ali; Mohammed Usman Ali; Rafat Ali; Syed Shujait Shujait Ali; Zahid Ali; Shohreh Alian Samakkhah; Gianfranco Alicandro; Sheikh Mohammad Alif; Mohammad Aligol; Rasoul Alimi; Ahmednur Adem Aliyi; Adel Al-Jumaily; Syed Mohamed Aljunid; Wael Almahmeed; Sabah Al-Marwani; Sadeq Ali Ali Al-Maweri; Joseph Uy Almazan; Hesham M. Al-Mekhlafi; Omar Almidani; Mahmoud A. Alomari; Nivaldo Alonso; Jaber S. Alqahtani; Ahmed Yaseen Alqutaibi; Salman Khalifah Al-Sabah; Awais Altaf; Jaffar A. Al-Tawfiq; Khalid A. Altirkawi; Farrukh Jawad Alvi; Hassan Alwafi; Yaser Mohammed Al-Worafi; Hany Aly; Karem H. Alzoubi; Azmeraw T. Amare; Edward Kwabena Ameyaw; Abebe Feyissa Amhare; Tarek Tawfik Amin; Alireza Amindarolzarbi; Javad Aminian Dehkordi; Sohrab Amiri; Hubert Amu; Dickson A. Amugsi; Jimoh Amzat; Robert Ancuceanu; Deanna Anderlini; Pedro Prata Andrade; Catalina Liliana Andrei; Tudorel Andrei; Dhanalakshmi Angappan; Abhishek Anil; Afifa Anjum; Catherine M. Antony; Ernoiz Antriyandarti; Iyadunni Adesola Anuoluwa; Sumadi Lukman Anwar; Anayochukwu Edward Anyasodor; Seth Christopher Yaw Appiah; Muhammad Aqeel; Jalal Arabloo; Razman Arabzadeh Bahri; Morteza Arab-Zozani; Mosab Arafat; Ana Margarida Araújo; Aleksandr Y. Aravkin; Abdulfatai Aremu; Hany Ariffin; Timur Aripov; Benedetta Armocida; Mahwish Arooj; Anton A. Artamonov; Kurnia Dwi Artanti; Judie Arulappan; Idowu Thomas Aruleba; Raphael Taiwo Aruleba; Ashokan Arumugam; Malke Asaad; Saeed Asgary; Mubarek Yesse Ashemo; Muhammad Ashraf; Marvellous O. Asika; Seyyed Shamsadin Athari; Maha Moh'd Wahbi Atout; Alok Atreya; Sameh Attia; Avinash Aujayeb; Abolfazl Avan; Adedapo Wasiu Awotidebe; Beatriz Paulina Ayala Quintanilla; Martin Amogre Ayanore; Getnet Melaku Ayele; Jose L. Ayuso-Mateos; Seyed Mohammad Ayyoubzadeh; Sina Azadnajafabad; Gulrez Shah Azhar; Shahkaar Aziz; Ahmed Y. Azzam; Mina Babashahi; Abraham Samuel Babu; Muhammad Badar; Alaa Badawi; Ashish D. Badiye; Soroush Baghdadi; Nasser Bagheri; Sara Bagherieh; Sulaiman Bah; Saeed Bahadorikhalili; Jianjun Bai; Ruhai Bai; Jennifer L. Baker; Shankar M. Bakkannavar; Abdulaziz T. Bako; Senthilkumar Balakrishnan; Saliu A. Balogun; Ovidiu Constantin Baltatu; Kiran Bam; Maciej Banach; Soham Bandyopadhyay; Biswajit Banik; Palash Chandra Banik; Hansi Bansal; Shirin Barati; Martina Barchitta; Mainak Bardhan; Suzanne Lyn Barker-Collo; Francesco Barone-Adesi; Hiba Jawdat Barqawi; Ronald D. Barr; Lope H. Barrero; Zarrin Basharat; Asma'u I.J. Bashir; Hameed Akande Bashiru; Pritish Baskaran; Buddha Basnyat; Quique Bassat; João Diogo Basso; Saurav Basu; Kavita Batra; Ravi Batra; Bernhard T. Baune; Mohsen Bayati; Nebiyou Simegnew Bayileyegn; Thomas Beaney; Neeraj Bedi; Tahmina Begum; Emad Behboudi; Amir Hossein Behnoush; Maryam Beiranvand; Diana Fernanda Bejarano Ramirez; Uzma Iqbal Belgaumi; Michelle L. Bell; Aminu K. Bello; Muhammad Bashir Bello; Olorunjuwon Omolaja Bello; Luis Belo; Apostolos Beloukas; Salaheddine Bendak; Derrick A. Bennett; Isabela M. Bensenor; Habib Benzian; Zombor Berezvai; Adam E. Berman; Amiel Nazer C. Bermudez; Paulo J.G. Bettencourt; Habtamu B. Beyene; Kebede A. Beyene; Devidas S. Bhagat; Akshaya Srikanth Bhagavathula; Neeraj Bhala; Ashish Bhalla; Dinesh Bhandari; Nikha Bhardwaj; Pankaj Bhardwaj; Prarthna V. Bhardwaj; Ashish Bhargava; Sonu Bhaskar; Vivek Bhat; Gurjit Kaur Bhatti; Jasvinder Singh Bhatti; Manpreet S. Bhatti; Rajbir Bhatti; Zulfiqar A. Bhutta; Boris Bikbov; Nada Binmadi; Bagas Suryo Bintoro; Antonio Biondi; Catherine Bisignano; Francesca Bisulli; Atanu Biswas; Raaj Kishore Biswas; Saeid Bitaraf; Tone Bjørge; Archie Bleyer; Mary Sefa Boampong; Virginia Bodolica; Aadam Olalekan Bodunrin; Obasanjo Afolabi Bolarinwa; Milad Bonakdar Hashemi; Aime Bonny; Kaustubh Bora; Berrak Bora Basara; Safiya Bala Borodo; Rohan Borschmann; Alejandro Botero Carvajal; Souad Bouaoud; Sofiane Boudalia; Edward J. Boyko; Nicola Luigi Bragazzi; Dejana Braithwaite; Hermann Brenner; Gabrielle Britton; Annie J. Browne; Andre R. Brunoni; Norma B. Bulamu; Lemma N. Bulto; Danilo Buonsenso; Katrin Burkart; Richard A. Burns; Sharath Burugina Nagaraja; Reinhard Busse; Yasser Bustanji; Zahid A. Butt; Florentino Luciano Caetano Dos Santos; Tianji Cai; Daniela Calina; Luis Alberto Cámera; Luciana Aparecida Campos; Ismael R. Campos-Nonato; Chao Cao; Carlos Alberto Cardenas; Rosario Cárdenas; Sinclair Carr; Giulia Carreras; Juan J. Carrero; Andrea Carugno; Felix Carvalho; Márcia Carvalho; Joao Mauricio Castaldelli-Maia; Carlos A. Castañeda-Orjuela; Giulio Castelpietra; Ferrán Catalá-López; Alberico L. Catapano; Maria Sofia Cattaruzza; Arthur Caye; Christopher R. Cederroth; Francieli Cembranel; Muthia Cenderadewi; Kelly M. Cercy; Ester Cerin; Muge Cevik; Pamela R. Chacón-Uscamaita; Yaacoub Chahine; Chiranjib Chakraborty; Jeffrey Shi Kai Chan; Chin-Kuo Chang; Periklis Charalampous; Jaykaran Charan; Vijay Kumar Chattu; Victoria Chatzimavridou-Grigoriadou; Malizgani Paul Chavula; Huzaifa Ahmad Cheema; An-Tian Chen; Haowei Chen; Lingxiao Chen; Meng Xuan Chen; Simiao Chen; Nicolas Cherbuin; Derek S. Chew; Gerald Chi; Jesus Lorenzo Chirinos-Caceres; Abdulaal Chitheer; So Mi Jemma Cho; William C.S. Cho; Bryan Chong; Hitesh Chopra; Rahul Choudhary; Rajiv Chowdhury; Dinh-Toi Chu; Isaac Sunday Chukwu; Eric Chung; Eunice Chung; Sheng-Chia Chung; Karly I. Cini; Cain C.T. Clark; Kaleb Coberly; Alyssa Columbus; Haley Comfort; Joao Conde; Sara Conti; Paolo Angelo Cortesi; Vera Marisa Costa; Ewerton Cousin; Richard G. Cowden; Michael H. Criqui; Natália Cruz-Martins; Garland T. Culbreth; Patricia Cullen; Matthew Cunningham; Daniel da Silva E Silva; Sriharsha Dadana; Omid Dadras; Zhaoli Dai; Koustuv Dalal; Lachlan L. Dalli; Giovanni Damiani; Emanuele D'Amico; Sara Daneshvar; Aso Mohammad Darwesh; Jai K. Das; Saswati Das; Nihar Ranjan Dash; Mohsen Dashti; Claudio Alberto Dávila-Cervantes; Nicole Davis Weaver; Kairat Davletov; Diego De Leo; Aklilu Tamire Debele; Louisa Degenhardt; Reza Dehbandi; Lee Deitesfeld; Ivan Delgado-Enciso; Laura Delgado-Ortiz; Daniel Demant; Berecha Hundessa Demessa; Andreas K. Demetriades; Xinlei Deng; Edgar Denova-Gutiérrez; Kebede Deribe; Nikolaos Dervenis; Don C. Des Jarlais; Hardik Dineshbhai Desai; Rupak Desai; Keshab Deuba; Vinoth Gnana Chellaiyan Devanbu; Sourav Dey; Arkadeep Dhali; Kuldeep Dhama; Mandira Lamichhane Dhimal; Meghnath Dhimal; Sameer Dhingra; Diana Dias Da Silva; Daniel Diaz; Adriana Dima; Delaney D. Ding; M. Ashworth Dirac; Abhinav Dixit; Shilpi Gupta Dixit; Thanh Chi Do; Thao Huynh Phuong Do; Camila Bruneli Do Prado; Masoud Dodangeh; Klara Georgieva Dokova; Christiane Dolecek; E Ray Dorsey; Wendel Mombaque dos Santos; Rajkumar Doshi; Leila Doshmangir; Abdel Douiri; Robert Kokou Dowou; Tim Robert Driscoll; Haneil Larson Dsouza; John Dube; Samuel C. Dumith; Susanna J. Dunachie; Bruce B. Duncan; Andre Rodrigues Duraes; Senbagam Duraisamy; Oyewole Christopher Durojaiye; Sulagna Dutta; Paulina Agnieszka Dzianach; Arkadiusz Marian Dziedzic; Oluwakemi Ebenezer; Ejemai Eboreime; Alireza Ebrahimi; Chidiebere Peter Echieh; Abdelaziz Ed-Dra; Hisham Atan Edinur; David Edvardsson; Kristina Edvardsson; Defi Efendi; Ferry Efendi; Shayan Eghdami; Terje Andreas Eikemo; Ebrahim Eini; Michael Ekholuenetale; Emmanuel Ekpor; Temitope Cyrus Ekundayo; Rabie Adel El Arab; Doaa Abdel Wahab El Morsi; Maysaa El Sayed Zaki; Maha El Tantawi; Iffat Elbarazi; Noha Mousaad Elemam; Frank J. Elgar; Islam Y. Elgendy; Ghada Metwally Tawfik ElGohary; Hala Rashad Elhabashy; Muhammed Elhadi; Omar Abdelsadek Abdou Elmeligy; Mohammed Elshaer; Ibrahim Elsohaby; Amir Emami Zeydi; Mehdi Emamverdi; Theophilus I. Emeto; Luchuo Engelbert Bain; Ryenchindorj Erkhembayar; Tesfahun C. Eshetie; Sharareh Eskandarieh; Juan Espinosa-Montero; Kara Estep; Farshid Etaee; Ugochukwu Anthony Eze; Natalia Fabin; Adewale Oluwaseun Fadaka; Adeniyi Francis Fagbamigbe; Saman Fahimi; Luca Falzone; Carla Sofia E Sá Farinha; MoezAlIslam Ezzat Mahmoud Faris; Mohsen Farjoud Kouhanjani; Andre Faro; Hossein Farrokhpour; Ali Fatehizadeh; Hamed Fattahi; Nelsensius Klau Fauk; Pooria Fazeli; Valery L. Feigin; Ginenus Fekadu; Seyed-Mohammad Fereshtehnejad; Abdullah Hamid Feroze; Daniela Ferrante; Pietro Ferrara; Nuno Ferreira; Getahun Fetensa; Irina Filip; Florian Fischer; Joanne Flavel; Abraham D. Flaxman; Luisa S. Flor; Bobirca Teodor Florin; Morenike Oluwatoyin Folayan; Kristen Marie Foley; Artem Alekseevich Fomenkov; Lisa M. Force; Carla Fornari; Behzad Foroutan; Matteo Foschi; Kate Louise Francis; Richard Charles Franklin; Alberto Freitas; Joseph Friedman; Sara D. Friedman; Takeshi Fukumoto; John E. Fuller; Peter Andras Gaal; Muktar A. Gadanya; Santosh Gaihre; Abduzhappar Gaipov; Emmanuela Gakidou; Yaseen Galali; Nasrin Galehdar; Silvano Gallus; Quan Gan; Aravind P. Gandhi; Balasankar Ganesan; Jalaj Garg; Shuo-Yan Gau; Prem Gautam; Rupesh K. Gautam; Federica Gazzelloni; Miglas W. Gebregergis; Mesfin Gebrehiwot; Tesfay Brhane Gebremariam; Urge Gerema; Motuma Erena Getachew; Tamirat Getachew; Peter W. Gething; Mansour Ghafourifard; Sulmaz Ghahramani; Khalid Yaser Ghailan; Alireza Ghajar; Mohammad Javad Ghanbarnia; MohammadReza Ghasemi; Afsaneh Ghasemzadeh; Fariba Ghassemi; Ramy Mohamed Ghazy; Sailaja Ghimire; Asadollah Gholamian; Ali Gholamrezanezhad; Pooyan Ghorbani Vajargah; Ghozali Ghozali; Sherief Ghozy; Arun Digambarrao Ghuge; Alessandro Gialluisi; Ruth Margaret Gibson; Artyom Urievich Gil; Paramjit Singh Gill; Tiffany K. Gill; Richard F. Gillum; Themba G. Ginindza; Alem Girmay; James C. Glasbey; Elena V. Gnedovskaya; Laszlo Göbölös; Amit Goel; Mohamad Goldust; Mahaveer Golechha; Pouya Goleij; Arefeh Golestanfar; Davide Golinelli; Philimon N. Gona; Houman Goudarzi; Amir Hossein Goudarzian; Anmol Goyal; Scott Greenhalgh; Michal Grivna; Giovanni Guarducci; Mohammed Ibrahim Mohialdeen Gubari; Mesay Dechasa Gudeta; Avirup Guha; Stefano Guicciardi; Damitha Asanga Gunawardane; Sasidhar Gunturu; Cui Guo; Anish Kumar Gupta; Bhawna Gupta; Indarchand Ratanlal Gupta; Rajat Das Gupta; Sapna Gupta; Veer Bala Gupta; Vijai Kumar Gupta; Vivek Kumar Gupta; Reyna Alma Gutiérrez; Farrokh Habibzadeh; Parham Habibzadeh; Vladimir Hachinski; Mohammad Haddadi; Rasool Haddadi; Nils Haep; Adel Hajj Ali; Esam S. Halboub; Sobia Ahsan Halim; Brian J. Hall; Sebastian Haller; Rabih Halwani; Randah R. Hamadeh; Kanaan Hamagharib Abdullah; Samer Hamidi; Mohammad Hamiduzzaman; Ahmad Hammoud; Nasrin Hanifi; Graeme J. Hankey; Md Abdul Hannan; Md Nuruzzaman Haque; Harapan Harapan; Josep Maria Haro; Ahmed I. Hasaballah; Faizul Hasan; Ikramul Hasan; M Tasdik Hasan; Hamidreza Hasani; Mohammad Hasanian; Ali Hasanpour-Dehkordi; Abbas M. Hassan; Amr Hassan; Hossein Hassanian-Moghaddam; Soheil Hassanipour; Johannes Haubold; Rasmus J. Havmoeller; Simon I. Hay; Youssef Hbid; Jeffrey J. Hebert; Omar E. Hegazi; Golnaz Heidari; Mohammad Heidari; Mahsa Heidari-Foroozan; Reza Heidari-Soureshjani; Bartosz Helfer; Claudiu Herteliu; Hamed Hesami; Dineshani Hettiarachchi; Demisu Zenbaba Heyi; Kamal Hezam; Yuta Hiraike; Howard J. Hoffman; Ramesh Holla; Nobuyuki Horita; Md Belal Hossain; Md Mahbub Hossain; Sahadat Hossain; Mohammad-Salar Hosseini; Hassan Hosseinzadeh; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mohamed Hsairi; Vivian Chia-Rong Hsieh; Chengxi Hu; Junjie Huang; Md Nazmul Huda; Fernando N. Hugo; Michael Hultström; Javid Hussain; Salman Hussain; Nawfal R. Hussein; Le Duc Huy; Hong-Han Huynh; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Oluwatope Olaniyi Idowu; Desta Ijo; Kevin S. Ikuta; Mehran Ilaghi; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Mustapha Immurana; Leeberk Raja Inbaraj; Arnaud Iradukunda; Farideh Iravanpour; Kenneth Chukwuemeka Iregbu; Md Rabiul Islam; Mohammad Mainul Islam; Sheikh Mohammed Shariful Islam; Farhad Islami; Nahlah Elkudssiah Ismail; Gaetano Isola; Masao Iwagami; Chidozie C.D. Iwu; Chinwe Juliana Iwu-Jaja; Mahalaxmi Iyer; Linda Merin; Jalil Jaafari; Louis Jacob; Kathryn H. Jacobsen; Farhad Jadidi-Niaragh; Morteza Jafarinia; Khushleen Jaggi; Kasra Jahankhani; Nader Jahanmehr; Haitham Jahrami; Akhil Jain; Nityanand Jain; Ammar Abdulrahman Jairoun; Mihajlo Jakovljevic; Reza Jalilzadeh Yengejeh; Elham Jamshidi; Chinmay T. Jani; Mark M. Janko; Abubakar Ibrahim Jatau; Sathish Kumar Jayapal; Shubha Jayaram; Jayakumar Jeganathan; Alelign Tasew Jema; Digisie Mequanint Jemere; Wonjeong Jeong; Anil K. Jha; Ravi Prakash Jha; John S. Ji; Heng Jiang; Yingzhao Jin; Yinzi Jin; Olatunji Johnson; Nabi Jomehzadeh; Darwin Phan Jones; Tamas Joo; Abel Joseph; Nitin Joseph; Charity Ehimwenma Joshua; Jacek Jerzy Jozwiak; Mikk Jürisson; Billingsley Kaambwa; Ali Kabir; Hannaneh Kabir; Zubair Kabir; Vidya Kadashetti; Farima Kahe; Pradnya Vishal Kakodkar; Rizwan Kalani; Leila R. Kalankesh; Feroze Kaliyadan; Sanjay Kalra; Ashwin Kamath; Arun Kamireddy; Thanigaivelan Kanagasabai; Himal Kandel; Edmund Wedam Kanmiki; Kehinde Kazeem Kanmodi; Rami S. Kantar; Neeti Kapoor; Mehrdad Karajizadeh; Behzad Karami Matin; Shama D. Karanth; Ibraheem M. Karaye; Asima Karim; Hanie Karimi; Salah Eddin Karimi; Arman Karimi Behnagh; Samad Karkhah; Ajit K. Karna; Faizan Zaffar Kashoo; Hengameh Kasraei; Nigussie Assefa Kassaw; Nicholas J. Kassebaum; Molly B. Kassel; Adarsh Katamreddy; Srinivasa Vittal Katikireddi; Patrick D.M.C. Katoto; Joonas H. Kauppila; Navjot Kaur; Neda Kaydi; Jeanne Françoise Kayibanda; Gbenga A. Kayode; Foad Kazemi; Sina Kazemian; Sara Kazeminia; Leila Keikavoosi-Arani; Cathleen Keller; John H. Kempen; Jessica A. Kerr; Emmanuelle Kesse-Guyot; Mohammad Keykhaei; Mohamad Mehdi Khadembashiri; Mohammad Amin Khadembashiri; Morteza Abdullatif Khafaie; Himanshu Khajuria; Mohammad Khalafi; Amirmohammad Khalaji; Nauman Khalid; Ibrahim A. Khalil; Faham Khamesipour; Asaduzzaman Khan; Gulfaraz Khan; Ikramullah Khan; Imteyaz A. Khan; Maseer Khan; Moien A.B. Khan; Taimoor Khan; Mahammed Ziauddin Khan Suheb; Shaghayegh Khanmohammadi; Khaled Khatab; Fatemeh Khatami; Armin Khavandegar; Hamid Reza Khayat Kashani; Khalid A. Kheirallah; Feriha Fatima Khidri; Elaheh Khodadoust; Moein Khormali; Mahmood Khosrowjerdi; Jagdish Khubchandani; Helda Khusun; Zemene Demelash Kifle; Grace Kim; Jihee Kim; Ruth W. Kimokoti; Kasey E. Kinzel; Girmay Tsegay Kiross; Adnan Kisa; Sezer Kisa; Juniper Boroka Kiss; Mika Kivimäki; Desmond Klu; Ann Kristin Skrindo Knudsen; Ali-Asghar Kolahi; Farzad Kompani; Gerbrand Koren; Soewarta Kosen; Karel Kostev; Ashwin Laxmikant Kotnis; Parvaiz A. Koul; Sindhura Lakshmi Koulmane Laxminarayana; Ai Koyanagi; Michael A. Kravchenko; Kewal Krishan; Hare Krishna; Vijay Krishnamoorthy; Yuvaraj Krishnamoorthy; Kris J. Krohn; Barthelemy Kuate Defo; Connor M. Kubeisy; Burcu Kucuk Bicer; Md Abdul Kuddus; Mohammed Kuddus; Ilari Kuitunen; Omar Kujan; Mukhtar Kulimbet; Vishnutheertha Kulkarni; Ashish Kumar; Harish Kumar; Nithin Kumar; Rahul Kumar; Shiv Kumar; Madhulata Kumari; Almagul Kurmanova; Om P. Kurmi; Asep Kusnali; Dian Kusuma; Tezer Kutluk; Ambily Kuttikkattu; Evans F. Kyei; Ilias Kyriopoulos; Carlo La Vecchia; Muhammad Awwal Ladan; Lucie Laflamme; Chandrakant Lahariya; Abdelilah Lahmar; Daphne Teck Ching Lai; Tri Laksono; Dharmesh Kumar Lal; Ratilal Lalloo; Tea Lallukka; Judit Lám; Demetris Lamnisos; Tuo Lan; Francesco Lanfranchi; Berthold Langguth; Van Charles Lansingh; Ariane Laplante-Lévesque; Bagher Larijani; Anders O. Larsson; Savita Lasrado; Kamaluddin Latief; Mahrukh Latif; Kaveh Latifinaibin; Paolo Lauriola; Long Khanh Dao Le; Nhi Huu Hanh Le; Thao Thi Thu Le; Trang Diep Thanh Le; Munjae Lee; Paul H. Lee; Sang-Woong Lee; Seung Won Lee; Wei-Chen Lee; Yo Han Lee; Samson Mideksa Legesse; James Leigh; Jacopo Lenzi; Elvynna Leong; Temesgen L. Lerango; Ming-Chieh Li; Wei Li; Xiaopan Li; Yichong Li; Zhihui Li; Massimo Libra; Virendra S. Ligade; Andrew Tiyamike Makhiringa Likaka; Lee-Ling Lim; Ro-Ting Lin; Shuzhi Lin; Vasileios-Arsenios Lioutas; Stefan Listl; Jue Liu; Simin Liu; Xiaofeng Liu; Katherine M. Livingstone; Erand Llanaj; Chun-Han Lo; Arianna Maever Loreche; László Lorenzovici; Mojgan Lotfi; Masoud Lotfizadeh; Rafael Lozano; Jailos Lubinda; Giancarlo Lucchetti; Alessandra Lugo; Raimundas Lunevicius
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 fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
(Elsevier B.V., 2024) Natalia V. Bhattacharjee; Austin E. Schumacher; Amirali Aali; Yohannes Habtegiorgis Abate; Rouzbeh Abbasgholizadeh; Mohammadreza Abbasian; Mohsen Abbasi-Kangevari; Hedayat Abbastabar; Samar Abd ElHafeez; Sherief Abd-Elsalam; Mohammad Abdollahi; Mohammad-Amin Abdollahifar; Meriem Abdoun; Auwal Abdullahi; Mesfin Abebe; Samrawit Shawel Abebe; Olumide Abiodun; Hassan Abolhassani; Meysam Abolmaali; Mohamed Abouzid; Girma Beressa Aboye; Lucas Guimarães Abreu; Woldu Aberhe Abrha; Michael R.M. Abrigo; Dariush Abtahi; Hasan Abualruz; Bilyaminu Abubakar; Eman Abu-Gharbieh; Niveen M.E. Abu-Rmeileh; Tadele Girum Girum Adal; Mesafint Molla Adane; Oluwafemi Atanda Adeagbo Adeagbo; Rufus Adesoji Adedoyin; Victor Adekanmbi; Bashir Aden; Abiola Victor Adepoju; Olatunji O. Adetokunboh; Juliana Bunmi Adetunji; Daniel Adedayo Adeyinka; Olorunsola Israel Adeyomoye; Qorinah Estiningtyas Sakilah Adnani; Saryia Adra; Rotimi Felix Afolabi; Shadi Afyouni; Muhammad Sohail Afzal; Saira Afzal; Shahin Aghamiri; Antonella Agodi; Williams Agyemang-Duah; Bright Opoku Ahinkorah; Austin J. Ahlstrom; Aqeel Ahmad; Danish Ahmad; Firdos Ahmad; Muayyad M. Ahmad; Sajjad Ahmad; Tauseef Ahmad; Ali Ahmed; Ayman Ahmed; Haroon Ahmed; Luai A. Ahmed; Meqdad Saleh Ahmed; Syed Anees Ahmed; Marjan Ajami; Budi Aji; Gizachew Taddesse Akalu; Hossein Akbarialiabad; Rufus Olusola Akinyemi; Mohammed Ahmed Akkaif; Sreelatha Akkala; Hanadi Al Hamad; Syed Mahfuz Al Hasan; Mohammad Al Qadire; Tareq Mohammed Ali AL-Ahdal; Samer O. Alalalmeh; Tariq A. Alalwan; Ziyad Al-Aly; Khurshid Alam; Rasmieh Mustafa Al-Amer; Fahad Mashhour Alanezi; Turki M. Alanzi; Almaza Albakri; Mohammed Albashtawy; Mohammad T. AlBataineh; Hediyeh Alemi; Sharifullah Alemi; Yihun Mulugeta Alemu; Ayman Al-Eyadhy; Adel Ali Saeed Al-Gheethi; Khalid F. Alhabib; Noora Alhajri; Fadwa Alhalaiqa Naji Alhalaiqa; Robert Kaba Alhassan; Abid Ali; Beriwan Abdulqadir Ali; Liaqat Ali; Mohammed Usman Ali; Rafat Ali; Syed Shujait Shujait Ali; Sheikh Mohammad Alif; Mohammad Aligol; Mehran Alijanzadeh; Mohammad A.M. Aljasir; Syed Mohamed Aljunid; Sabah Al-Marwani; Joseph Uy Almazan; Hesham M. Al-Mekhlafi; Omar Almidani; Mahmoud A. Alomari; Basem Al-Omari; Jaber S. Alqahtani; Ahmed Yaseen Alqutaibi; Rajaa M. Al-Raddadi; Salman Khalifah Al-Sabah; Awais Altaf; Jaffar A. Al-Tawfiq; Khalid A. Altirkawi; Deborah Oyine Aluh; Farrukh Jawad Alvi; Nelson Alvis-Guzman; Hassan Alwafi; Yaser Mohammed Al-Worafi; Hany Aly; Safwat Aly; Karem H. Alzoubi; Edward Kwabena Ameyaw; Tarek Tawfik Amin; Alireza Amindarolzarbi; Mostafa Amini-Rarani; Sohrab Amiri; Irene Gyamfuah Ampomah; Dickson A. Amugsi; Ganiyu Adeniyi Amusa; Robert Ancuceanu; Deanna Anderlini; Pedro Prata Andrade; Catalina Liliana Andrei; Tudorel Andrei; Abhishek Anil; Sneha Anil; Adnan Ansar; Alireza Ansari-Moghaddam; Catherine M. Antony; Ernoiz Antriyandarti; Saeid Anvari; Saleha Anwar; Razique Anwer; Anayochukwu Edward Anyasodor; Jalal Arabloo; Razman Arabzadeh Bahri; Elshaimaa A. Arafa; Mosab Arafat; Ana Margarida Araujo; Aleksandr Y. Aravkin; Abdulfatai Aremu; Timur Aripov; Mesay Arkew; Benedetta Armocida; Johan Ärnlöv; Mahwish Arooj; Anton A. Artamonov; Judie Arulappan; Raphael Taiwo Aruleba; Ashokan Arumugam; Mohsen Asadi-Lari; Zatollah Asemi; Saeed Asgary; Mona Asghariahmadabad; Mohammad Asghari-Jafarabadi; Mubarek Yesse Ashemo; Muhammad Ashraf; Tahira Ashraf; Marvellous O. Asika; Seyyed Shamsadin Athari; Maha Moh'd Wahbi Atout; Alok Atreya; Avinash Aujayeb; Marcel Ausloos; Abolfazl Avan; Amlaku Mulat Aweke; Getnet Melaku Ayele; Seyed Mohammad Ayyoubzadeh; Sina Azadnajafabad; Rui M.S. Azevedo; Ahmed Y. Azzam; Muhammad Badar; Ashish D. Badiye; Soroush Baghdadi; Nasser Bagheri; Sara Bagherieh; Najmeh Bahmanziari; Ruhai Bai; Atif Amin Baig; Jennifer L. Baker; Abdulaziz T. Bako; Ravleen Kaur Bakshi; Madhan Balasubramanian; Ovidiu Constantin Baltatu; Kiran Bam; MacIej Banach; Soham Bandyopadhyay; Biswajit Banik; Palash Chandra Banik; Hansi Bansal; Mehmet Firat Baran; Martina Barchitta; Mainak Bardhan; Erfan Bardideh; Suzanne Lyn Barker-Collo; Till Winfried Bärnighausen; Francesco Barone-Adesi; Hiba Jawdat Barqawi; Amadou Barrow; Sandra Barteit; Zarrin Basharat; Asma'u I.J. Bashir; Hameed Akande Bashiru; Afisu Basiru; Joao Diogo Basso; Sanjay Basu; Abdul-Monim Mohammad Batiha; Kavita Batra; Bernhard T. Baune; Mohsen Bayati; Tahmina Begum; Emad Behboudi; Amir Hossein Behnoush; Maryam Beiranvand; Diana Fernanda Bejarano Ramirez; Alehegn Bekele; Sefealem Assefa Belay; Uzma Iqbal Belgaumi; Michelle L. Bell; Olorunjuwon Omolaja Bello; Apostolos Beloukas; Isabela M. Bensenor; Zombor Berezvai; Alemshet Yirga Berhie; Amiel Nazer C. Bermudez; Paulo J.G. Bettencourt; Akshaya Srikanth Bhagavathula; Nikha Bhardwaj; Pankaj Bhardwaj; Prarthna V. Bhardwaj; Sonu Bhaskar; Vivek Bhat; Gurjit Kaur Bhatti; Jasvinder Singh Bhatti; Manpreet S. Bhatti; Rajbir Bhatti; Antonio Biondi; Catherine Bisignano; Atanu Biswas; Raaj Kishore Biswas; Veera R. Bitra; Tone Bjørge; Elye Bliss; Micheal Kofi Boachie; Anca Vasilica Bobirca; Virginia Bodolica; Aadam Olalekan Bodunrin; Eyob Ketema Bogale; Kassawmar Angaw Bogale; Milad Bonakdar Hashemi; Berrak Bora Basara; Souad Bouaoud; Dejana Braithwaite; Michael Brauer; Nicholas J.K. Breitborde; Dana Bryazka; Norma B. Bulamu; Danilo Buonsenso; Katrin Burkart; Richard A. Burns; Yasser Bustanji; Nadeem Shafique Butt; Zahid A. Butt; Florentino Luciano Caetano Dos Santos; Daniela Calina; Ismael R. Campos-Nonato; Fan Cao; Shujin Cao; Angelo Capodici; Giulia Carreras; Andrea Carugno; Carlos A. Castañeda-Orjuela; Giulio Castelpietra; Maria Sofia Cattaruzza; Arthur Caye; Luca Cegolon; Francieli Cembranel; Ester Cerin; Joshua Chadwick; Yaacoub Chahine; Chiranjib Chakraborty; Julian Chalek; Jeffrey Shi Kai Chan; Periklis Charalampous; Vijay Kumar Chattu; Sarika Chaturvedi; Malizgani Paul Chavula; An-Tian Chen; Haowei Chen; Simiao Chen; Gerald Chi; Fatemeh Chichagi; Ju-Huei Chien; Patrick R. Ching; William C.S. Cho; Sungchul Choi; Bryan Chong; Hitesh Chopra; Sonali Gajanan Choudhari; Devasahayam J. Christopher; Dinh-Toi Chu; Isaac Sunday Chukwu; Eric Chung; Sheng-Chia Chung; Zinhle Cindi; Iolanda Cioffi; Raffaela Ciuffreda; Rafael M. Claro; Kaleb Coberly; Alyssa Columbus; Haley Comfort; Joao Conde; Michael H. Criqui; Natalia Cruz-Martins; Silvia Magali Cuadra-Hernández; Sriharsha Dadana; Omid Dadras; Tukur Dahiru; Zhaoli Dai; Bronte Dalton; Giovanni Damiani; Aso Mohammad Darwesh; Jai K. Das; Saswati Das; Mohsen Dashti; Anna Dastiridou; Claudio Alberto Dávila-Cervantes; Kairat Davletov; Aklilu Tamire Debele; Shayom Debopadhaya; Somayeh Delavari; Ivan Delgado-Enciso; Dessalegn Demeke; Berecha Hundessa Demessa; Xinlei Deng; Edgar Denova-Gutiérrez; Kebede Deribe; Nikolaos Dervenis; Hardik Dineshbhai Desai; Rupak Desai; Vinoth Gnana Chellaiyan Devanbu; Arkadeep Dhali; Kuldeep Dhama; Meghnath Dhimal; Vishal R. Dhulipala; Diana Dias Da Silva; Daniel Diaz; Michael J. Diaz; Adriana Dima; Delaney D. Ding; M. Ashworth Dirac; Thanh Chi Do; Thao Huynh Phuong Do; Camila Bruneli Do Prado; Sushil Dohare; Wanyue Dong; Mario D'Oria; Wendel Mombaque Dos Santos; Leila Doshmangir; Robert Kokou Dowou; Ashel Chelsea Dsouza; Haneil Larson Dsouza; Viola Dsouza; John Dube; Joe Duprey; Andre Rodrigues Duraes; Senbagam Duraisamy; Oyewole Christopher Durojaiye; Sulagna Dutta; Laura Dwyer-Lindgren; Paulina Agnieszka Dzianach; Arkadiusz Marian Dziedzic; Alireza Ebrahimi; Hisham Atan Edinur; Kristina Edvardsson; Ferry Efendi; Terje Andreas Eikemo; Michael Ekholuenetale; Maha El Tantawi; Noha Mousaad Elemam; Ghada Metwally Tawfik ElGohary; Muhammed Elhadi; Legesse Tesfaye Elilo; Omar Abdelsadek Abdou Elmeligy; Mohamed A. Elmonem; Mohammed Elshaer; Ibrahim Elsohaby; Amir Emami Zeydi; Luchuo Engelbert Bain; Sharareh Eskandarieh; Francesco Esposito; Kara Estep; Farshid Etaee; Natalia Fabin; Adeniyi Francis Fagbamigbe; Saman Fahimi; Aliasghar Fakhri-Demeshghieh; Luca Falzone; Ali Faramarzi; MoezAlIslam Ezzat Mahmoud Faris; Sam Farmer; Andre Faro; Abidemi Omolara Fasanmi; Ali Fatehizadeh; Nelsensius Klau Fauk; Pooria Fazeli; Valery L. Feigin; Seyed-Mohammad Fereshtehnejad; Abdullah Hamid Feroze; Pietro Ferrara; Nuno Ferreira; Getahun Fetensa; Irina Filip; Florian Fischer; Joanne Flavel; Nataliya A. Foigt; Morenike Oluwatoyin Folayan; Artem Alekseevich Fomenkov; Behzad Foroutan; Matteo Foschi; Kayode Raphael Fowobaje; Kate Louise Francis; Alberto Freitas; Takeshi Fukumoto; John E. Fuller; Blima Fux; Peter Andras Gaal; Muktar A. Gadanya; Abhay Motiramji Gaidhane; Yaseen Galali; Silvano Gallus; Aravind P. Gandhi; Balasankar Ganesan; Mohammad Arfat Ganiyani; M.A. Garcia-Gordillo; Naval Garg; Rupesh K. Gautam; Federica Gazzelloni; Semiu Olatunde Gbadamosi; Miglas W. Gebregergis; Mesfin Gebrehiwot; Tesfay Brhane Gebremariam; Teferi Gebru Gebremeskel; Yohannes Fikadu Geda; Simona Roxana Georgescu; Urge Gerema; Habtamu Geremew; Motuma Erena Getachew; Peter W. Gething; MohammadReza Ghasemi; Ghazal Ghasempour Dabaghi; Afsaneh Ghasemzadeh; Fariba Ghassemi; Ramy Mohamed Ghazy; Sailaja Ghimire; Asadollah Gholamian; Ali Gholamrezanezhad; Mahsa Ghorbani; Aloke Gopal Ghoshal; Arun Digambarrao Ghuge; Artyom Urievich Gil; Tiffany K. Gill; Matteo Giorgi; Alem Girmay; James C. Glasbey; Laszlo Göbölös; Amit Goel; Ali Golchin; Mahaveer Golechha; Pouya Goleij; Sameer Vali Gopalani; Houman Goudarzi; Alessandra C. Goulart; Anmol Goyal; Simon Matthew Graham; Michal Grivna; Shi-Yang Guan; Giovanni Guarducci; Mohammed Ibrahim Mohialdeen Gubari; Mesay Dechasa Gudeta; Stefano Guicciardi; Snigdha Gulati; David Gulisashvili; Damitha Asanga Gunawardane; Cui Guo; Anish Kumar Gupta; Bhawna Gupta; Manoj Kumar Gupta; Mohak Gupta; Sapna Gupta; Veer Bala Gupta; Vijai Kumar Gupta; Vivek Kumar Gupta; Annie Haakenstad; Farrokh Habibzadeh; Najah R. Hadi; Nils Haep; Ramtin Hajibeygi; Sebastian Haller; Rabih Halwani; Randah R. Hamadeh; Nadia M. Hamdy; Sajid Hameed; Samer Hamidi; Qiuxia Han; Alexis J. Handal; Graeme J. Hankey; Md Nuruzzaman Haque; Josep Maria Haro; Ahmed I. Hasaballah; Ikramul Hasan; Mohammad Jahid Hasan; S.M. Mahmudul Hasan; Hamidreza Hasani; Md Saquib Hasnain; Amr Hassan; Ikrama Hassan; Soheil Hassanipour; Hadi Hassankhani; Simon I. Hay; Jeffrey J. Hebert; Omar E. Hegazi; Mohammad Heidari; Bartosz Helfer; Mehdi Hemmati; Brenda Yuliana Herrera-Serna; Claudiu Herteliu; Kamran Hessami; Kamal Hezam; Yuta Hiraike; Nguyen Quoc Hoan; Ramesh Holla; Nobuyuki Horita; Md Mahbub Hossain; Mohammad Bellal Hossain Hossain; Hassan Hosseinzadeh; Mehdi Hosseinzadeh; Mihaela Hostiuc; Sorin Hostiuc; Mohamed Hsairi; Vivian Chia-Rong Hsieh; Chengxi Hu; Junjie Huang; M. Mamun Huda; Ayesha Humayun; Javid Hussain; Nawfal R. Hussein; Hong-Han Huynh; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Pulwasha Maria Iftikhar; Olayinka Stephen Ilesanmi; Irena M. Ilic; Milena D. Ilic; Mustapha Immurana; Leeberk Raja Inbaraj; Afrin Iqbal; Md. Rabiul Islam; Nahlah Elkudssiah Ismail; Hiroyasu Iso; Gaetano Isola; Masao Iwagami; Mahalaxmi Iyer; J. Linda Merin; Jalil Jaafari; Louis Jacob; Farhad Jadidi-Niaragh; Khushleen Jaggi; Kasra Jahankhani; Nader Jahanmehr; Haitham Jahrami; Akhil Jain; Nityanand Jain; Ammar Abdulrahman Jairoun; Mihajlo Jakovljevic; Elham Jamshidi; Sabzali Javadov; Tahereh Javaheri; Sathish Kumar Jayapal; Shubha Jayaram; Sun Ha Jee; Jayakumar Jeganathan; Anil K. Jha; Ravi Prakash Jha; Heng Jiang; Mohammad Jokar; Jost B. Jonas; Tamas Joo; Nitin Joseph; Charity Ehimwenma Joshua; Farahnaz Joukar; Jacek Jerzy Jozwiak; Mikk Jürisson; K. Vaishali; Billingsley Kaambwa; Abdulkareem Kabir; Ali Kabir; Hannaneh Kabir; Zubair Kabir; Rizwan Kalani; Leila R. Kalankesh; Feroze Kaliyadan; Sanjay Kalra; Rajesh Kamath; Sagarika Kamath; Tanuj Kanchan; Edmund Wedam Kanmiki; Kehinde Kazeem Kanmodi; S. Suthanthira Kannan; Sushil Kumar Kansal; Rami S. Kantar; Neeti Kapoor; Mehrdad Karajizadeh; Manoochehr Karami; Ibraheem M. Karaye; Faizan Zaffar Kashoo; Hengameh Kasraei; Nicholas J. Kassebaum; Molly B. Kassel; Joonas H. Kauppila; Foad Kazemi; Sara Kazeminia; John H. Kempen; Evie Shoshannah Kendal; Kamyab Keshtkar; Mohammad Keykhaei; Himanshu Khajuria; Amirmohammad Khalaji; Nauman Khalid; Anees Ahmed Khalil; Alireza Khalilian; Faham Khamesipour; Ajmal Khan; Asaduzzaman Khan; Ikramullah Khan; M. Nuruzzaman Khan; Maseer Khan; Mohammad Jobair Khan; Moien A.B. Khan; Young-Ho Khang; Shaghayegh Khanmohammadi; Khaled Khatab; Armin Khavandegar; Hamid Reza Khayat Kashani; Feriha Fatima Khidri; Moein Khormali; Mohammad Ali Khosravi; Mahmood Khosrowjerdi; Wondwosen Teklesilasie Kidane; Zemene Demelash Kifle; Julie Sojin Kim; Min Seo Kim; Ruth W. Kimokoti; Kasey E. Kinzel; Girmay Tsegay Kiross; Adnan Kisa; Sezer Kisa; Ali-Asghar Kolahi; Farzad Kompani; Gerbrand Koren; Oleksii Korzh; Soewarta Kosen; Sindhura Lakshmi Koulmane Laxminarayana; Kewal Krishan; Varun Krishna; Vijay Krishnamoorthy; Barthelemy Kuate Defo; Connor M. Kubeisy; Burcu Kucuk Bicer; Md Abdul Kuddus; Mohammed Kuddus; Ilari Kuitunen; Mukhtar Kulimbet; Harish Kumar; Satyajit Kundu; Kunle Rotimi Kunle; Om P. Kurmi; Asep Kusnali; Dian Kusuma; Evans F. Kyei; Ilias Kyriopoulos; Carlo La Vecchia; Ben Lacey; Muhammad Awwal Ladan; Lucie Laflamme; Chandrakant Lahariya; Daphne Teck Ching Lai; Dharmesh Kumar Lal; Ratilal Lalloo; Judit Lám; Demetris Lamnisos; Ivan Landires; Francesco Lanfranchi; Berthold Langguth; Ariane Laplante-Lévesque; Heidi Jane Larson; Anders O. Larsson; Savita Lasrado; Kamaluddin Latief; Kaveh Latifinaibin; Long Khanh Dao Le; Nhi Huu Hanh Le; Trang Diep Thanh Le; Caterina Ledda; Munjae Lee; Paul H. Lee; Seung Won Lee; Yo Han Lee; Gebretsadik Kiros Lema; Elvynna Leong; Temesgen L. Lerango; An Li; Ming-Chieh Li; Shanshan Li; Wei Li; Xiaopan Li; Virendra S. Ligade; Stephen S. Lim; Ro-Ting Lin; Paulina A. Lindstedt; Stefan Listl; Gang Liu; Jue Liu; Xiaofeng Liu; Xuefeng Liu; Yuewei Liu; Erand Llanaj; Ruben López-Bueno; Platon D. Lopukhov; Laszlo Lorenzovici; Paulo A. Lotufo; Jailos Lubinda; Giancarlo Lucchetti; Alessandra Lugo; Raimundas Lunevicius; Hengliang Lv; Zheng Feei Ma; Kelsey Lynn Maass; Monika MacHoy; Áurea M. Madureira-Carvalho; Mohammed Magdy Abd El Razek; Azzam A. Maghazachi; Soleiman Mahjoub; Mansour Adam Mahmoud; Azeem Majeed; Jeadran N. Malagón-Rojas; Elaheh Malakan Rad; Kashish Malhotra; Ahmad Azam Malik; Iram Malik; Deborah Carvalho Malta; Abdullah A. Mamun; Yosef Manla; Yasaman Mansoori; Ali Mansour; Borhan Mansouri; Zeinab Mansouri; Mohammad Ali Mansournia; Joemer C. Maravilla; Mirko Marino; Abdoljalal Marjani; Gabriel Martinez; Ramon Martinez-Piedra; Francisco Rogerlandio Martins-Melo; Miquel Martorell; Sharmeen Maryam; Roy Rillera Marzo; Alireza Masoudi; Jishanth Mattumpuram; Richard James Maude; Andrea Maugeri; Erin A. May; Mahsa Mayeli; Maryam Mazaheri; John J. McGrath; Martin McKee; Anna Laura Wensel McKowen; Susan A. McLaughlin; Steven M. McPhail; Rahul Mehra; Kamran Mehrabani-Zeinabad; Entezar Mehrabi Nasab; Tesfahun Mekene Meto; Max Alberto Mendez Mendez-Lopez; Walter Mendoza; Ritesh G. Menezes; George A. Mensah; Alexios-Fotios A. Mentis; Sultan Ayoub Meo; Mohsen Merati; Atte Meretoja; Tuomo J. Meretoja; Abera M. Mersha; Tomislav Mestrovic; Pouya Metanat; Kukulege Chamila Dinushi Mettananda; Sachith Mettananda; Adquate Mhlanga; Laurette Mhlanga; Tianyue Mi; Tomasz Miazgowski; Georgia Micha; Irmina Maria Michalek; Ted R. Miller; Le Huu Nhat Minh; Mojgan Mirghafourvand; Erkin M. Mirrakhimov; Mizan Kiros Mirutse; Moonis Mirza; Roya Mirzaei; Ashim Mishra; Sanjeev Misra; Philip B. Mitchell; Chaitanya Mittal; Babak Moazen; Abdalla Z. Mohamed; Ahmed Ismail Mohamed; Jama Mohamed; Mouhand F.H. Mohamed; Nouh Saad Mohamed; Sakineh Mohammad-Alizadeh-Charandabi; Soheil Mohammadi; Abdollah Mohammadian-Hafshejani; Mustapha Mohammed; Salahuddin Mohammed; Shafiu Mohammed; Ali H. Mokdad; Peyman Mokhtarzadehazar; Hossein Molavi Vardanjani; Sabrina Molinaro; Lorenzo Monasta; Mohammad Ali Moni; Maryam Moradi; Yousef Moradi; Paula Moraga; Rafael Silveira Moreira; Negar Morovatdar; Shane Douglas Morrison; Jakub Morze; Abbas Mosapour; Elias Mossialos; Rohith Motappa; Parsa Mousavi; Amin Mousavi Khaneghah; Christine Mpundu-Kaambwa; Sumaira Mubarik; Lorenzo Muccioli; Francesk Mulita; Kavita Munjal; Efren Murillo-Zamora; Jonah Musa; Fungai Musaigwa; Ana-Maria Musina; Sathish Muthu; Saravanan Muthupandian; Muhammad Muzaffar; Woojae Myung; Ahamarshan Jayaraman Nagarajan; Gabriele Nagel; Pirouz Naghavi; Ganesh R. Naik; Gurudatta Naik; Mukhammad David Naimzada; Firzan Nainu; Vinay Nangia; Sreenivas Narasimha Swamy; Bruno Ramos Nascimento; Gustavo G. Nascimento; Abdallah Y. Naser; Mohammad Javad Nasiri; Zuhair S. Natto; Javaid Nauman; Muhammad Naveed; Biswa Prakash Nayak; Vinod C. Nayak; Rawlance Ndejjo; Sabina Onyinye Nduaguba; Hadush Negash; Chernet Tafere Negesse; Ionut Negoi; Ruxandra Irina Negoi; Seyed Aria Nejadghaderi; Chakib Nejjari; Samata Nepal; Henok Biresaw Netsere; Georges Nguefack-Tsague; Josephine W. Ngunjiri; Dang H. Nguyen; Hau Thi Hien Nguyen; Phuong The Nguyen; QuynhAnh P. Nguyen; Van Thanh Nguyen; Robina Khan Niazi; Yeshambel T. Nigatu; Taxiarchis Konstantinos Nikolouzakis; Ali Nikoobar; Amin Reza Nikpoor; Chukwudi A. Nnaji; Lawrence Achilles Nnyanzi; Efaq Ali Noman; Shuhei Nomura; Mamoona Noreen; Nafise Noroozi; Chisom Adaobi Nri-Ezedi; Mengistu H. Nunemo; Virginia Nuñez-Samudio; Dieta Nurrika; Jerry John Nutor; Bogdan Oancea; Kehinde O. Obamiro; Ismail A. Odetokun; Nkechi Martina Odogwu; Martin James O'Donnell; Oluwakemi Ololade Odukoya; Ayodipupo Sikiru Oguntade; James Odhiambo Oguta; In-Hwan Oh; Sylvester Reuben Okeke; Akinkunmi Paul Okekunle; Osaretin Christabel Okonji; Patrick Godwin Okwute; Andrew T. Olagunju; Omotola O. Olasupo; Matthew Idowu Olatubi; Glaucia Maria Moraes Oliveira; Bolajoko Olubukunola Olusanya; Jacob Olusegun Olusanya; Gideon Olamilekan Oluwatunase; Hany A. Omar; Goran Latif Omer; Obinna E. Onwujekwe; Michal Ordak; Orish Ebere Orisakwe; Verner N. Orish; Doris V. Ortega-Altamirano; Alberto Ortiz; Esteban Ortiz-Prado; Wael M.S. Osman; Uchechukwu Levi Osuagwu; Olayinka Osuolale; Adrian Otoiu; Stanislav S. Otstavnov; Amel Ouyahia; Guoqing Ouyang; Mayowa O. Owolabi; Yaz Ozten; P.A. Mahesh Padukudru; Mohammad Taha Pahlevan Fallahy; Feng Pan; Hai-Feng Pan; Adrian Pana; Paramjot Panda; Songhomitra Panda-Jonas
Background: Accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. Findings: During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Interpretation: Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
(Elsevier Ltd, 2024) Valery L Feigin; Melsew Dagne Abate; Yohannes Habtegiorgis Abate; Samar Abd ElHafeez; Foad Abd-Allah; Ahmed Abdelalim; Atef Abdelkader; Michael Abdelmasseh; Sherief Abd-Elsalam; Parsa Abdi; Arash Abdollahi; Meriem Abdoun; Rami Abd-Rabu; Deldar Morad Abdulah; Auwal Abdullahi; Mesfin Abebe; Roberto Ariel Abeldaño Zuñiga; E.S. Abhilash; Olugbenga Olusola Abiodun; Olumide Abiodun; Rahim Abo Kasem; Richard Gyan Aboagye; Mohamed Abouzid; Lucas Guimarães Abreu; Woldu Aberhe Abrha; Dariush Abtahi; Samir Abu Rumeileh; Ahmed Abualhasan; Hasan Abualruz; Eman Abu-Gharbieh; Hana J Abukhadijah; Niveen ME Abu-Rmeileh; Salahdein Aburuz; Ahmed Abu-Zaid; Juan Manuel Acuna; Denberu Eshetie Adane; Mesafint Molla Adane; Isaac Yeboah Addo; Rufus Adesoji Adedoyin; Oyelola A Adegboye; Victor Adekanmbi; Kishor Adhikari; Qorinah Estiningtyas Sakilah Adnani; Saryia Adra; Leticia Akua Adzigbli; Abdelrahman Yousry Afify; Aanuoluwapo Adeyimika Afolabi; Fatemeh Afrashteh; Muhammad Sohail Afzal; Saira Afzal; Shahin Aghamiri; Williams Agyemang-Duah; Bright Opoku Ahinkorah; Aqeel Ahmad; Muayyad M Ahmad; Sajjad Ahmad; Shahzaib Ahmad; Tauseef Ahmad; Amir Mahmoud Ahmadzade; Ali Ahmed; Ayman Ahmed; Haroon Ahmed; Syed Anees Ahmed; Marjan Ajami; Budi Aji; Essona Matatom Akara; Rufus Olusola Akinyemi; Mohammed Ahmed Akkaif; Ashley E Akrami; Salah Al Awaidy; Hanadi Al Hamad; Syed Mahfuz Al Hasan; Mohammad Al Qadire; Omar Al Ta'ani; Yazan Al-Ajlouni; Samer O Alalalmeh; Tariq A Alalwan; Ziyad Al-Aly; Rasmieh Mustafa Al-amer; Wafa A Aldhaleei; Mohammed S Aldossary; Seyedeh Yasaman Alemohammad; Bassam Al-Fatly; Adel Ali Saeed Al-Gheethi; Fadwa Naji Alhalaiqa; Maryam Alharrasi; Abid Ali; Mohammed Usman Ali; Rafat Ali; Syed Shujait Ali; Waad Ali; Akram Al-Ibraheem; Sheikh Mohammad Alif; Syed Mohamed Aljunid; Wael Almahmeed; Sabah Al-Marwani; Mahmoud A Alomari; Jordi Alonso; Jaber S Alqahtani; Rajaa M Mohammad Al-Raddadi; Ahmad Alrawashdeh; Mohammed A Alsabri; Najim Z Alshahrani; Zaid Altaany; Awais Altaf; Alaa B Al-Tammemi; Diala Altwalbeh; Nelson Alvis-Guzman; Hassan Alwafi; Mohammad Al-Wardat; Yaser Mohammed Al-Worafi; Hany Aly; Safwat Aly; Mohammad Sharif Ibrahim Alyahya; Karem H Alzoubi; Walid Adnan Al-Zyoud; Reza Amani; Prince M Amegbor; Tewodros Getnet Amera; Tarek Tawfik Amin; Alireza Amindarolzarbi; Sohrab Amiri; Hubert Amu; Dickson A Amugsi; Ganiyu Adeniyi Amusa; Robert Ancuceanu; Deanna Anderlini; Dhanalakshmi Angappan; Abhishek Anil; Mohammed Tahir Tahir Ansari; Alireza Ansari-Moghaddam; Rockson Ansong; Saeid Anvari; Saleha Anwar; Sumadi Lukman Anwar; Ekenedilichukwu Emmanuel Anyabolo; Anayochukwu Edward Anyasodor; Geminn Louis Carace Apostol; Francis Appiah; Muhammad Aqeel; Jalal Arabloo; Razman Arabzadeh Bahri; Mosab Arafat; Aleksandr Y Aravkin; Ali Ardekani; Demelash Areda; Brhane Berhe Aregawi; Getnet Mesfin Aregu; Olatunde Aremu; Hidayat Arifin; Johan Ärnlöv; Anton A Artamonov; Judie Arulappan; Umesh Raj Aryal; Zahra Aryan; Akram M Asbeutah; Mulusew A Asemahagn; Mulu Tiruneh Asemu; Mohammad Asghari-Jafarabadi; Mubarek Yesse Ashemo; Tahira Ashraf; Armin Aslani; Haftu Asmerom Asmerom; Thomas Astell-Burt; Seyyed Shamsadin Athari; Prince Atorkey; Maha Moh'd Wahbi Atout; Alok Atreya; Avinash Aujayeb; Marcel Ausloos; Abolfazl Avan; Hamzeh Awad; Adedapo Wasiu Awotidebe; Lemessa Assefa A Ayana; Setognal Birara Aychiluhm; Amdehiwot A Aynalem; Zewdu Bishaw Aynalem; Sina Azadnajafabad; Hiva Azami; Shahkaar Aziz; Ahmed Y Azzam; Abraham Samuel Babu; Giridhara Rathnaiah Babu; Muhammad Badar; Ashish D Badiye; Pegah Bahrami Taghanaki; Saeed Bahramian; Ruhai Bai; Atif Amin Baig; Shankar M Bakkannavar; Abdulaziz T Bako; Ovidiu Constantin Baltatu; Kiran Bam; Maciej Banach; Morteza Banakar; Soham Bandyopadhyay; Palash Chandra Banik; Kannu Bansal; Yanping Bao; Miguel A Barboza; Mainak Bardhan; Noel C Barengo; Suzanne Lyn Barker-Collo; Till Winfried Bärnighausen; Hiba Jawdat Barqawi; Amadou Barrow; Lingkan Barua; Azadeh Bashiri; Hameed Akande Bashiru; Afisu Basiru; Mohammad-Mahdi Bastan; Sanjay Basu; Saurav Basu; Kavita Batra; Ahmet Begde; Babak Behnam; Amir Hossein Behnoush; Melesse B Y Belayneh; Michael Belingheri; Umar Muhammad Bello; Derrick A Bennett; Isabela M Bensenor; Fentaw Tadese Berhe; Amiel Nazer C Bermudez; Habtamu B B Beyene; Kebede A Beyene; Devidas S Bhagat; Akshaya Srikanth Bhagavathula; Neeraj Bhala; Ashish Bhalla; Nikha Bhardwaj; Pankaj Bhardwaj; Sonu Bhaskar; Ajay Nagesh Bhat; Vivek Bhat; Gurjit Kaur Bhatti; Jasvinder Singh Singh Bhatti; Mohiuddin Ahmed Bhuiyan; Subarna Bhusal; Boris Bikbov; Cem Bilgin; Antonio Biondi; Keralem Anteneh Bishaw; Atanu Biswas; Bijit Biswas; Trupti Bodhare; Eyob Ketema Bogale; Archith Boloor; Milad Bonakdar Hashemi; Aime Bonny; Berrak Bora Basara; Hamed Borhany; Samuel Adolf Bosoka; Souad Bouaoud; Abdelhakim Bouyahya; Edward J Boyko; Marija M Bozic; Dejana Braithwaite; Susanne Breitner; Hermann Brenner; Gabrielle Britton; Andre R Brunoni; Dana Bryazka; Raffaele Bugiardini; Lemma N Bulto; Katrin Burkart; Yasser Bustanji; Zahid A Butt; Florentino Luciano Caetano dos Santos; Luis Alberto Cámera; Luciana Aparecida Campos; Ismael R Campos-Nonato; Fan Cao; Angelo Capodici; Rosario Cárdenas; Sinclair Carr; Giulia Carreras; Andre F Carvalho; Felix Carvalho; Joao Mauricio Castaldelli-Maia; Carlos A Castañeda-Orjuela; Giulio Castelpietra; Alberico L Catapano; Maria Sofia Cattaruzza; Luca Cegolon; Francieli Cembranel; Edina Cenko; Ester Cerin; Joshua Chadwick; Chiranjib Chakraborty; Sandip Chakraborty; Jeffrey Shi Kai Chan; Rama Mohan Chandika; Eeshwar K Chandrasekar; Gashaw Sisay Chanie; Vijay Kumar Chattu; Anis Ahmad Chaudhary; Akhilanand Chaurasia; Haowei Chen; Mingling Chen; Simiao Chen; Gerald Chi; Fatemeh Chichagi; Ritesh Chimoriya; Patrick R Ching; Abdulaal Chitheer; So Mi Jemma Cho; Dong-Woo Choi; Bryan Chong; Chean Lin Chong; Hitesh Chopra; Sonali Gajanan Choudhari; Rahul Choudhary; Dinh-Toi Chu; Isaac Sunday Chukwu; Sheng-Chia Chung; Zinhle Cindi; Iolanda Cioffi; Rebecca M Cogen; Alyssa Columbus; Simona Costanzo; Rosa A S Couto; Michael H Criqui; Natalia Cruz-Martins; Silvia Magali Cuadra-Hernández; Alanna Gomes da Silva; Sriharsha Dadana; Omid Dadras; Xiaochen Dai; Koustuv Dalal; Lachlan L Dalli; Giovanni Damiani; Emanuele D'Amico; Lalit Dandona; Rakhi Dandona; Amira Hamed Darwish; Saswati Das; Mohsen Dashti; Mohadese Dashtkoohi; Mohammad Dashtkoohi; Maedeh Dastmardi; Kairat Davletov; Vanessa De la Cruz-Góngora; Sean DeAngelo; Aklilu Tamire Debele; Shayom Debopadhaya; Ivan Delgado-Enciso; Berecha Hundessa Demessa; Andreas K Demetriades; Edgar Denova-Gutiérrez; Emina Dervišević; Hardik Dineshbhai Desai; Aragaw Tesfaw Desale; Fikreab Desta; Vinoth Gnana Chellaiyan Devanbu; Devananda Devegowda; Syed Masudur Rahman Dewan; Amol S Dhane; Meghnath Dhimal; Vishal R Dhulipala; Michael J Diaz; Mengistie Diress; Milad Dodangeh; Phidelia Theresa Doegah; Sushil Dohare; Mohamed Fahmy Doheim; Klara Georgieva Dokova; Deepa Dongarwar; Mario D'Oria; Ojas Prakashbhai Doshi; Rajkumar Prakashbhai Doshi; Abdel Douiri; Robert Kokou Dowou; Ashel Chelsea Dsouza; Haneil Larson Dsouza; Viola Savy Dsouza; Bruce B Duncan; Andre Rodrigues Duraes; Arkadiusz Marian Dziedzic; Michael Ekholuenetale; Ibrahim Farahat El Bayoumy; Maysaa El Sayed Zaki; Iffat Elbarazi; Faris El-Dahiyat; Islam Y Elgendy; Muhammed Elhadi; Waseem El-Huneidi; Mohamed A Elmonem; Adel B Elmoselhi; Chadi Eltaha; Theophilus I Emeto; Christopher Imokhuede Esezobor; Negin Esfandiari; Zahra Esmaeili; Francesco Esposito; Mohammad Etoom; Natalia Fabin; Ibtihal Fadhil; Adeniyi Francis Fagbamigbe; Omotayo Francis Fagbule; Shahriar Faghani; Ayesha Fahim; Ildar Ravisovich Fakhradiyev; Luca Falzone; Mohammad Fareed; Jawad Fares; Carla Sofia e Sá Farinha; MoezAlIslam Ezzat Mahmoud Faris; Pawan Sirwan Faris; Mohsen Farjoud Kouhanjani; Andre Faro; Hossein Farrokhpour; Abidemi Omolara Fasanmi; Nelsensius Klau Fauk; Patrick Fazeli; Timur Fazylov; Alireza Feizkhah; Ginenus Fekadu; Xiaoqi Feng; Seyed-Mohammad Fereshtehnejad; Pietro Ferrara; Nuno Ferreira; Getahun Fetensa; Bikila Regassa Feyisa; Florian Fischer; Luisa S Flor; Kristen Marie Foley; Ana Catarina Fonseca; Roham Foroumadi; Behzad Foroutan; Daniela Fortuna; Matteo Foschi; Richard Charles Franklin; Ni Kadek Yuni Fridayani; Sridevi G; Peter Andras Gaal; Abhay Motiramji Gaidhane; Abduzhappar Gaipov; Yaseen Galali; Silvano Gallus; Aravind P Gandhi; Balasankar Ganesan; Danijela Gasevic; Prem Gautam; Rupesh K Gautam; Miglas Welay Gebregergis; Mesfin Gebrehiwot; Kebre Gebrekirstos Gebrekidan; Lemma Getacher; Genanew K Getahun; Molla Getie; Delaram J Ghadimi; Fataneh Ghadirian; Amir Ghaffari Jolfayi; Mansour Ghafourifard; Mohammad-Reza Ghasemi; Afsaneh Ghasemzadeh; Ramy Mohamed Ghazy; Ehsan Gholami; Zainab Gholami; Sherief Ghozy; Stefano Giannoni Luza; Jaleed Ahmed Gilani; Tiffany K Gill; Richard F Gillum; Ebisa Zerihun Gindaba; Elena V Gnedovskaya; Amit Goel; Mohamad Goldust; Mahaveer Golechha; Pouya Goleij; Davide Golinelli; Philimon N Gona; Giuseppe Gorini; Alessandra C Goulart; Barbara Niegia Garcia Goulart; Mahdi Gouravani; Michal Grivna; Giuseppe Grosso; Ashna Grover; Shi-Yang Guan; Giovanni Guarducci; Avirup Guha; Stefano Guicciardi; Snigdha Gulati; Damitha Asanga Gunawardane; Cui Guo; Zhifeng Guo; Anish Kumar Gupta; Bhawna Gupta; Mohak Gupta; Rahul Gupta; Rajat Das Gupta; Rajeev Gupta; Sapna Gupta; Farrokh Habibzadeh; Najah R Hadi; Mohammad Haghani Dogahe; Hamed Haghi-Aminjan; Dariush Haghmorad; Arvin Haj-Mirzaian; Aram Halimi; Nadia M Hamdy; Samer Hamidi; Erin B Hamilton; Asif Hanif; Nasrin Hanifi; Graeme J Hankey; Md Abdul Hannan; Zaim Anan Haq; Arief Hargono; Netanja I Harlianto; Josep Maria Haro; Eka Mishbahatul Marah Has; Ahmed I Hasaballah; Ikramul Hasan; Md Saquib Hasnain; Ikrama Hassan; Mahgol Sadat Hassan Zadeh Tabatabaei; Johannes Haubold; Rasmus J Havmoeller; Simon I Hay; Youssef Hbid; Jeffrey J Hebert; Omar E Hegazi; Mohammad Heidari; Mehdi Hemmati; Demisu Zenbaba Heyi; Kamal Hezam; Yuta Hiraike; Nguyen Quoc Hoan; Ramesh Holla; Nobuyuki Horita; Md Mahbub Hossain; Hassan Hosseinzadeh; Mehdi Hosseinzadeh; Ahmad Hosseinzadeh Adli; Mihaela Hostiuc; Sorin Hostiuc; Ben Hu; Chengxi Hu; Junjie Huang; Ayesha Humayun; Salman Hussain; Le Duc Huy; Hong-Han Huynh; Bing-Fang Hwang; Segun Emmanuel Ibitoye; Nayu Ikeda; Adalia Ikiroma; Olayinka Stephen Ilesanmi; Irena M Ilic; Milena D Ilic; Mohammad Tarique Imam; Mustapha Immurana; Leeberk Raja Inbaraj; Muhammad Iqhrammullah; Arnaud Iradukunda; Lalu Muhammad Irham; Md Rabiul Islam; Faisal Ismail; Nahlah Elkudssiah Ismail; Hiroyasu Iso; Gaetano Isola; Ramaiah Itumalla; Masao Iwagami; Chidozie Declan CD Iwu; Vinothini J; Jalil Jaafari; Louis Jacob; Abdollah Jafarzadeh; Haitham Jahrami; Akhil Jain; Nityanand Jain; Ammar Abdulrahman Jairoun; Abhishek Jaiswal; Mihajlo Jakovljevic; Reza Jalilzadeh Yengejeh; Balamurugan Janakiraman; Abubakar Ibrahim Jatau; Sathish Kumar Jayapal; Shubha Jayaram; Sun Ha Jee; Jayakumar Jeganathan; Mihretu Jegnie; Alelign Tasew Jema; Bijay Mukesh Jeswani; Angeline Jeyakumar; Anil K Jha; Ravi Prakash Jha; Zixiang Ji; Heng Jiang; Shuai Jin; Yingzhao Jin; Mohammad Jokar; Jost B Jonas; Tamas Joo; Jobinse Jose; Nitin Joseph; Charity Ehimwenma Joshua; Farahnaz Joukar; Jacek Jerzy Jozwiak; Mikk Jürisson; Ali Kabir; Md Awal Kabir; Zubair Kabir; Vidya Kadashetti; Rizwan Kalani; Sanjay Kalra; Vineet Kumar Kamal; Arun Kamireddy; Haidong Kan; Mona Kanaan; Himal Kandel; Kehinde Kazeem Kanmodi; Rami S Kantar; Neeti Kapoor; Paschalis Karakasis; Ibraheem M Karaye; André Karch; Hanie Karimi; Salah Eddin Karimi; Yeganeh Karimi; Arman Karimi Behnagh; Prabin Karki; Hengameh Kasraei; Joonas H Kauppila; Harkiran Kaur; Neda Kaydi; Gbenga A Kayode; Foad Kazemi; Sina Kazemian; Emmanuelle Kesse-Guyot; Yousef Saleh Khader; Morteza Abdullatif Khafaie; Inn Kynn Khaing; Himanshu Khajuria; Amirmohammad Khalaji; Nauman Khalid; Anees Ahmed Khalil; Asaduzzaman Khan; Fayaz Khan; M Nuruzzaman Khan; Maseer Khan; Mohammad Jobair Khan; Moien AB Khan; Yusra H Khan; Shaghayegh Khanmohammadi; Khaled Khatab; Haitham Khatatbeh; Moawiah Mohammad Khatatbeh; Sorour Khateri; Mahalaqua Nazli Khatib; Maryam Khayamzadeh; Hamid Reza Khayat Kashani; Feriha Fatima Khidri; Manoj Khokhar; Atulya Aman Khosla; Majid Khosravi; Jagdish Khubchandani; Saeid Kian; Kwanghyun Kim; Min Seo Kim; Yun Jin Kim; Ruth W Kimokoti; Adnan Kisa; Sezer Kisa; Ali-Asghar Kolahi; Kamrun Nahar Koly; Farzad Kompani; Shivakumar KM Marulasiddaiah Kondlahalli; Miikka Korja; Vladimir Andreevich Korshunov; Oleksii Korzh; Soewarta Kosen; Karel Kostev; Nikhil Kothari; Ashwin Laxmikant Kotnis; Sindhura Lakshmi Koulmane Laxminarayana; Kewal Krishan; Varun Krishna; Vijay Krishnamoorthy; Bindu Krishnan; Jera Kruja; Barthelemy Kuate Defo; Burcu Kucuk Bicer; Md Abdul Kuddus; Mohammed Kuddus; Nuworza Kugbey; Mukhtar Kulimbet; Vishnutheertha Kulkarni; Akshay Kumar; Ashish Kumar; Dewesh Kumar; G Anil Kumar; Nithin Kumar; Rakesh Kumar; Senthil Kumaran D; Amartya Kundu; Satyajit Kundu; Setor K Kunutsor; Om P Kurmi; Dian Kusuma; L V Simhachalam Kutikuppala; Ambily Kuttikkattu; Ville Kytö; Carlo La Vecchia; Ben Lacey; Chandrakant Lahariya; Dharmesh Kumar Lal; Tea Lallukka; Judit Lám; Iván Landires; Anders O Larsson; Savita Lasrado; Kaveh Latifinaibin; Paolo Lauriola; Pablo M Lavados; Basira Kankia Lawal; Long Khanh Dao Le; Nhi Huu Hanh Le; Thao Thi Thu Le; Trang Diep Thanh Le; Paul H Lee; Seung Won Lee; Wei-Chen Lee; Yo Han Lee; Ming-Chieh Li; Wei Li; Xiaopan Li; Yichong Li; Lee-Ling Lim; Stephen S Lim; John C Lin; Daniel Lindholm; Shai Linn; Gang Liu; Runben Liu; Shuke Liu; Xiaofeng Liu; Xuefeng Liu; Erand Llanaj; Chun-Han Lo; Warren David Lo; Valerie Lohner; José Francisco López-Gil; László Lorenzovici; Stefan Lorkowski; Paulo A Lotufo; Giancarlo Lucchetti; Lisha Luo; Jay B Lusk; Zheng Feei Ma; Monika Machoy; Farzan Madadizadeh; Ralph Maddison; Elham Mahmoudi; Golnaz Mahmoudvand; Omar M Makram; Elaheh Malakan Rad; Kashish Malhotra; Ahmad Azam Malik; Iram Malik; Tauqeer Hussain Mallhi; Deborah Carvalho Malta; Abdullah A Mamun; Yosef Manla; Mohammad Hadi Mansouri; Pejman Mansouri; Vahid Mansouri; Mohammad Ali Mansournia; Lorenzo Giovanni Mantovani; Emmanuel Manu; Hamid Reza Marateb; Abdoljalal Marjani; Daniela Martini; Santi Martini; Miquel Martorell; Sharmeen Maryam; Roy Rillera Marzo; Awoke Masrie; Yasith Mathangasinghe; Pallab K Maulik; Mahsa Mayeli; Mohsen Mazidi; Martin McKee; Steven M McPhail; Enkeleint A Mechili; Asim Mehmood; Kamran Mehrabani-Zeinabad; 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