Avaliação do Programa Nacional de Suplementação de Ferro em crianças de seis a 18 meses atendidas em centros de saúde da rede pública de Florianópolis, Santa Catarina

Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em NutriçãoIntrodução: A anemia por deficiência de ferro é considerada a carência nutricional mais prevalente no mundo, chegando a atingir mais de 50% das crianças nos dois primeiros anos de vida. No Brasil, com o intuito de prevenir essa doença, o Ministério da Saúde implantou em 2005 o Programa Nacional de Suplementação de Ferro (PNSF), que normatiza que toda criança entre seis e 18 meses de idade receba 5 mL de xarope de sulfato ferroso uma vez por semana (equivalente a um frasco de 60 mL do xarope a cada três meses). Objetivo: Avaliar a cobertura do PNSF em relação às crianças de seis a 18 meses de idade que foram atendidas em 35 centros de saúde da rede pública de Florianópolis, Santa Catarina em 2010, assim como o cumprimento da normativa de utilização da suplementação de ferro entre as crianças cadastradas neste programa e estabelecer a sua relação com fatores sócio-demográficos. Metodologia: Estudo transversal, com dados secundários obtidos do sistema de informações em saúde da Secretaria Municipal de Saúde de Florianópolis-SC, o INFOSAUDE. A população do estudo foi constituída por todas as crianças cadastradas no PNSF em 2010. Foram obtidas do INFOSAUDE informações sobre o número de crianças cadastradas no programa, número total de crianças cadastradas no sistema (na mesma faixa etária e período de tempo), datas do recebimento de cada frasco do suplemento, data de nascimento e variáveis sócio-demográficas (sexo, cor da pele e escolaridade materna, área geográfica do centro de saúde e distância do domicílio ao centro de saúde). Os dados correspondentes as variáveis dependentes e independentes deste estudo foram digitados em uma planilha do programa Microsoft Office Excel 2007, os quais foram duplamente checados e posteriormente codificados. Para a análise estatística foi utilizado o software STATA 11.0. Resultados: De um total de 13.197 crianças entre seis e 18 meses que foram atendidas nos centros de saúde da rede pública de Florianópolis em 2010, apenas 834 foram cadastradas no PNSF (cobertura de 6,3%; IC95% 5,9-6,7). Entre as crianças cobertas por esta estratégia, menos da metade (43,5%; IC95% 40,1-47,0) iniciaram a suplementação dentro da idade recomendada (com até seis meses de idade), enquanto que 27,7% (IC95% 24,7-30,9) começaram com mais de nove meses. Em relação a periodicidade no recebimento da suplementação, apenas 7% (IC95% 5,3-8,9) receberam um frasco de sulfato ferroso a cada três meses, e 82,4% (IC95% 79,6-84,9) receberam o suplemento a cada seis meses ou mais. Considerando as duas normativas, somente em 2,3% (IC95% 1,4-3,5) dos casos houve cumprimento da normativa quanto ao início e periodicidade da suplementação. A falta de cumprimento das duas normativas não esteve associada com o sexo das crianças, com a cor da pele e escolaridade materna, área geográfica de residência e nem com a distância do domicílio ao centro de saúde. Conclusão: A baixa cobertura identificada, assim como o baixo percentual de cumprimento da normativa de utilização da suplementação de ferro indicam fragilidades no processo de identificação e acompanhamento do público alvo, independentemente de características sócio-demográficas.Introduction: Iron deficiency anemia is considered the most prevalent nutritional deficiency worldwide, reaching more than 50% of children in the first two years of life. In Brazil, in order to prevent this disease, the Ministry of Health created in 2005 the National Program of Iron Supplementation (PNSF), which defined that all children between six and 18 months of age have to receive 5 mL of syrup of iron sulfate once per week (bottle of 60 mL every three months). Objective: To evaluate the coverage of PNSF among children aged six to 18 month, which were attended at 35 public health centers of Florianópolis, Santa Catarina in 2010, as well as to evaluate the compliance of the supplementation according to the normative of the PNSF (age at the onset six months and periodicity) and to investigate its relationship with socio-demographic factors. Methodology: Cross sectional study using secondary data obtained from the health information system of Municipal Health Department of Florianópolis-SC, INFOSAUDE. The study population consisted of all children registered in PNSF in 2010. All the information were obtained from the INFOSAUDE, including the number of children registered in the program, total number of children registered in the system (with the same age and registered in the same period), dates of each received bottle of the supplement, date of birth and socio-demographic variables (gender, skin color/ethnicity and maternal education, geographic area of the health center, and distance from home to the health center). Information on dependent and independent variables in this study were included in a dataset using the Microsoft Excel 2007 program, which was subsequently coded and double checked. STATA 11.0 was used in statistical analysis. Results: A total of 13197 children aged six to 18 months attended at public health centers of Florianópolis in 2010, and only 834 were registered in PNSF (coverage = 6,3%; CI95% 5,9-6,7). Among the children covered by this strategy, less than a half (43.5%; CI95% 40,1-47,0) began supplementation within the recommended age (at six months of age), while 27.7% (CI95% 24,7-30,9) started with more than nine months. Regarding the frequency of receiving supplementation, only 7% (CI95% 5,3-8,9) received a bottle every three months, and 82.4% (IC95% 79,6-84,9) received the supplement every six months or more. Considering the two normative, in only 2.3% (CI95% 1,4-3,5) of the cases there was compliance with the rules of the onset and frequency of supplementation. Failure to comply these two normative was not associated with the sex of the children, skin color, maternal education, geographic area of residence or with the distance from home to the health center. Conclusion: The low coverage identified, as well as the low percentage of compliance with the normative about the use of iron supplementation, indicate weaknesses in the process of identification and monitoring of the target population, regardless of socio-demographic characteristics

Deficiências no consumo de micronutrientes e sua associação com indicadores de obesidade geral e abdominal em nível populacional: estudo EpiFloripa adultos

Tese (doutorado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, Florianópolis, 2016.A presente tese foi desenvolvida com o objetivo de investigar a associação entre o consumo alimentar inadequado de micronutrientes (cálcio, ferro, zinco, vitaminas A, C, D e E) e indicadores de obesidade geral e abdominal entre adultos residentes em Florianópolis, Santa Catarina, região Sul do Brasil. Para tanto, realizou-se um estudo transversal com dados provenientes da segunda onda do estudo longitudinal, de base populacional, EpiFloripa Adultos (2012), com amostra de 1.222 indivíduos de 22 a 63 anos de idade residentes na área urbana de Florianópolis. O estado nutricional de obesidade foi mensurado considerando-se valores do índice de massa corporal (IMC = 30 kg/m² - obesidade geral) e da circunferência da cintura (CC = 102,0 cm em homens e CC = 88,0 cm em mulheres - obesidade abdominal). Esses indicadores também foram avaliados como variáveis contínuas. Os dados sobre o consumo alimentar, por sua vez, foram obtidos mediante a aplicação de dois recordatórios de 24 horas (um no total da amostra e outro em subamostra de 40% dos entrevistados), sendo o consumo dos micronutrientes estimado conforme as recomendações do Institute of Medicine e do National Research Council. Os resultados encontram-se apresentados na forma de três artigos científicos. No primeiro artigo, foram estimadas as prevalências de inadequação no consumo dos micronutrientes cálcio, ferro, zinco, vitamina A, vitamina C, vitamina D e vitamina E, segundo o sexo e faixas etárias, utilizando as recomendações da Estimated Average Requirement (EAR) como ponto de corte. Para toda a amostra foram observadas prevalências elevadas de consumo inadequado, com variação entre 52 e 100% para as vitaminas A, C, D e E. O consumo de cálcio e de ferro foi mais inadequado entre as mulheres (87,3% e 13,7%, respectivamente) e o de zinco entre os homens (25,1%). No segundo artigo, foi analisada a associação entre o consumo alimentar de micronutrientes e o nível socioeconômico da amostra (renda e escolaridade), por meio da regressão linear múltipla. Prevalências de inadequação no consumo segundo a renda e a escolaridade também foram estimadas de acordo com os pontos de corte da EAR. Verificou-se que a inadequação no consumo da maioria dos micronutrientes diminuiu com o aumento da renda e da escolaridade, mesmo assim, prevalências de inadequação entre 85,5% e 100% foram encontradas para as vitaminas A, D e E. Para o ferro, porém, o consumo inadequado foi associado somente com a escolaridade e somente entre as mulheres (20 a 50 anos). Além disso, a maior parte dos micronutrientes se mostraram associados à renda e à escolaridade de forma independente. Finalmente, no terceiro artigo foi avaliada a associação entre as deficiências no consumo de micronutrientes e os dois indicadores de estado nutricional (IMC e CC), utilizando-se a regressão linear. Prevalências de inadequação no consumo segundo o estado nutricional da amostra também foram estimadas, considerando-se mais uma vez os pontos de corte da EAR. Adultos com obesidade geral e abdominal, quando comparados a adultos sem obesidade, apresentaram prevalências mais altas de consumo inadequado de micronutrientes, de modo geral superiores a 59% para o cálcio, vitamina A, vitamina C e vitamina D. Além disso, verificou-se a existência de associação inversa e estatisticamente significante entre o consumo alimentar insuficiente de cálcio e ferro com valores elevados do IMC e da CC, e o consumo alimentar insuficiente das vitaminas A e D com a CC elevada. Em conclusão, os achados desta investigação permitiram confirmar a existência de associação inversa entre o estado nutricional de obesidade geral e abdominal e o consumo inadequado de micronutrientes, como cálcio, ferro, vitamina A e vitamina D também em uma amostra de adultos brasileiros. Diante disso, mostra-se fundamental não só a adoção de estratégias que permitam aos indivíduos de menor renda o acesso a alimentos de melhor qualidade nutricional, mas sobretudo os achados indicam que investir em educação nutricional pode ser um caminho factível para se alcançar um consumo melhor de micronutrientes na população. Deste modo, espera-se não só a redução das prevalências de inadequação no consumo de micronutrientes, mas também alcançar a prevenção e o controle da obesidade, e de outras doenças crônicas subjacentes a ambas as condições.Abstract : This thesis was designed to investigate the association between inadequate dietary intake of micronutrients (calcium, iron, zinc, vitamins A, C, D and E) and indicators of overall and abdominal obesity among adults living in Florianópolis, Santa Catarina, Southern Brazil. A cross-sectional study has been performed, with data from the second wave of the longitudinal study, population-based EpiFloripa Adults (2012), with sample of 1.222 adults aged of 22 to 63 years old, residents in the urban area of Florianópolis. The nutritional status of obesity has been measured considering values of body mass index (BMI = 30 kg/m²) and waist circumference (WC = 102 cm in men and = 88 cm in women). These indicators has been also evaluated as continuous variables. The data on food consumption has been obtained by the application of two 24-hour records (one on the total sample and another on a subsample of 40% of respondents). The consumption of micronutrients has been estimated according to the recommendations of the Institute of Medicine and the National Research Council. The results are presented in the form of three scientific articles. In the first article, the prevalence of inadequacy in micronutrients consumption have been estimated according to gender and age groups, using the recommendations of the Estimated Average Requirement (EAR) as the cutoff point. For the whole sample, high prevalence of inadequate consumption have been observed, ranging from 52% to 100% for vitamins A, C, D and E. The consumption of calcium and iron has been most inadequate among women (87.3% and 13.7%, respectively), and the consumption of zinc has been more inadequate among men (25.1%). In the second article, we analyzed the association between the micronutrients consumption and the socioeconomic status of the sample (income and education level), using Multiple Linear Regression. Inadequacy prevalence in micronutrients consumption based on income and educational level were also estimated according to the cutoff points of EAR. It has been verified that inadequate consumption of most micronutrients decreases with the increase in income and educational level. Even in these cases, however, inadequacy prevalences between 85% to a 100% has been found in regard to vitamin A, vitamin D and vitamin E. For iron, however, the inadequate consumption has been associated only with the degree of education and merely among women. Furthermore, most of the micronutrients has been associated with income and educational level independently. Finally, the third article we evaluated the association between the deficiencies in micronutrients intake and the indicators of nutritional status (BMI and WC), using Linear Regression. The inadequacy prevalences in micronutrients consumption according to the nutritional status of the sample has been estimated, considering again the cutting points of EAR. Adults with overall and abdominal obesity, compared to non-obese adults, had higher prevalence of inadequate micronutrients consumption, in general over 59% for calcium, vitamin A, vitamin C and vitamin D. In addition, there is an inverse association, statistically significant between the insufficient consumption of calcium and iron and higher values of BMI and WC, and between the consumption of vitamin A and vitamin D with high WC. In conclusion, the findings of this research have made it possible to confirm the existence of an inverse association between the nutritional status of overall and abdominal obesity and the inadequate consumption of micronutrients such as calcium, iron, vitamin A and vitamin D, in a sample of Brazilian adults. Given this finding, it is fundamental not only to adopt of strategies which provide people with a lower income an access to better nutritional quality food, but especially to invest in education as a feasible way to achieve a better micronutrient consumption in the population. Thus, it is expected not only to reduce the prevalence of micronutrient deficiencies, but also to achieve prevention and control regarding obesity and other chronic diseases that underlie both conditions

Efetividade da suplementação de sulfato ferroso na prevenção da anemia em crianças: revisão sistemática da literatura e metanálise

Revisão sistemática e metanálise de estudos que avaliaram a efetividade da suplementação de sulfato ferroso na prevenção da anemia em crianças menores de cinco anos de idade. Foram pesquisadas as bases PubMed, Scopus, SciELO e LILACS e incluídos artigos publicados entre 1980-2011 em espanhol, inglês ou português, utilizando os unitermos: criança, pré-escolar, lactente, anemia, prevenção, suplementação e ferro. Foram selecionados 13 estudos, que mostraram que independentemente da dose e do tempo de suplementação, o esquema diário foi mais consistente na melhoria dos níveis de hemoglobina (efeito combinado 0,56mg/dL, IC95%: 0,31; 0,81, p < 0,001) do que o semanal (efeito combinado 0,28mg/dL, IC95%: -0,22; 0,78, p = 0,273). Não houve efeito da suplementação na redução da prevalência de anemia, mesmo com doses diárias, e a administração conjunta com outros micronutrientes não trouxe benefícios adicionais em comparação com a administração exclusiva do suplemento. A suplementação diária de sulfato ferroso mostrou-se mais efetiva do que doses semanais na melhoria dos níveis de hemoglobina

Relato de experiência de uma ação extensionista do programa de extensão Nutrição e Memória (N&M)

Report the experience under the "Nutrition and Memory Extension Program (N&amp;M)" in 2021, developed by professors and students at Federal University of Santa Catarina (UFSC). In 2021, N&amp;M offered the internal and external community of UFSC two editions of an online course, also entitled Nutrition and Memory, on Nutrition's specificities in cognitive function during aging. 24 participants from different regions of the country participated in these editions of the course, which enabled N&amp;M to spread its scientific knowledge nationwide, and to achieve positive results from 91.7% of the participants who, at the end of the course, reported adopting dietary practices healthy aiming at aging with autonomy and quality of life. For the executing team, the course delivery in online format added improvement of this teaching method, as well as new knowledge of a specific field of Nutrition to the collaborating students.Reporte la experiencia bajo el "Programa de Extensión de Nutrición y Memoria (N&amp;M)" en 2021, desarrollado por profesores y estudiantes de la Universidad Federal de Santa Catarina (UFSC). En 2021, N&amp;M ofreció a la comunidad interna y externa de la UFSC dos ediciones de un curso en línea, también titulado Nutrición y Memoria, sobre las especificidades de la nutrición en la función cognitiva durante el envejecimiento. En estas ediciones del curso participaron veinticuatro participantes de diferentes regiones del país, lo que permitió a N&amp;M difundir su conocimiento científico a nivel nacional, y lograr resultados positivos del 91,7% de los participantes que, al finalizar el curso, informaron adoptar medidas dietéticas prácticas saludables con el objetivo de envejecer con autonomía y calidad de vida. Para el equipo ejecutor, la impartición del curso en formato online supuso una mejora de este método de enseñanza, así como un nuevo conocimiento de un campo específico de la Nutrición a los alumnos colaboradores.Relatar a experiência vivenciada no âmbito do “Programa de Extensão Nutrição e Memória (N&amp;M)” no ano de 2021, desenvolvido por docentes e discentes da Universidade Federal de Santa Catarina (UFSC). No ano de 2021, o N&amp;M ofertou à comunidade interna e externa da UFSC duas edições de um curso online, também intitulado como Nutrição e Memória sobre especificidades da Nutrição na função cognitiva durante o envelhecimento. Participaram dessas edições do Curso 24 participantes de diferentes regiões do país, o que possibilitou ao N&amp;M difundir seus conhecimentos de base científica em abrangência nacional, e alcançar como resultados relatos positivos de 91,7% dos participantes que ao término do curso referiram a adoção de práticas alimentares saudáveis visando um envelhecer com autonomia e qualidade de vida. Para a equipe executora a ministração do curso em formato online agregou aprimoramento desse método de ensino, assim como novos conhecimentos de um campo específico da Nutrição aos discentes colaboradores.

Inadequações na ingestão dietética de micronutrientes por homens e mulheres residentes no Sul do Brasil: Estudo EpiFloripa Adultos 2012

Resumo: O objetivo do estudo foi estimar a ingestão dietética de micronutrientes por adultos em um município do Sul do Brasil segundo sexo e idade, assim como identificar a prevalência de ingestão inadequada de micronutrientes segundo sexo. Trata-se de um estudo transversal, de base populacional, com 1.222 adultos de 22 a 63 anos, residentes em Florianópolis, Santa Catarina, Brasil. Os dados sobre a ingestão alimentar foram obtidos pela aplicação de dois recordatórios de 24 horas (um no total da amostra e outro em subamostra de 40% dos entrevistados), sendo a ingestão de micronutrientes e as prevalências de inadequação na ingestão estimadas conforme recomendações do National Research Council e do Institute of Medicine. Prevalências elevadas de inadequação para toda a amostra foram vistas para as vitaminas A, C, D e E (variação de 52%-100%). A ingestão de cálcio e ferro foi a mais inadequada entre as mulheres (87,3% e 13,7%, respectivamente), e a de zinco entre os homens (25,1%). Adultos de Florianópolis apresentaram prevalências elevadas de inadequação na ingestão de micronutrientes essenciais

Manual do Entrevistador Epifloripa Idoso

Manual do entrevistadorEste manual tem como objetivo orientar as condutas das equipes de campo durante a coleta de dados da 3ª onda da Pesquisa intitulada: “Condições de Vida e Saúde de Idosos Residentes em Florianópolis - EpiFloripa Idoso 2017”. O EpiFloripa é uma pesquisa longitudinal que envolve grande número de participantes, assim entende como necessário o treinamento eficiente dos entrevistadores para padronização da coleta das informações. As orientações dos procedimentos de campo são fundamentais para garantir a qualidade dos dados e a validade do estudo. Assim, foi construído este documento para orientar os entrevistadores em relação às características gerais da pesquisa na qual estão inseridos, bem como para tornar-se material de apoio e esclarecimento em suas atividades de coleta de dados. O texto está organizado em duas partes: na primeira, encontram-se a saudação da coordenação, informações gerais sobre a pesquisa, os membros da equipe, fluxograma das atividades, o material de trabalho, dicas sobre a postura e os procedimentos que devem ser adotadas durante a atuação em campo. Na segunda parte, estão as orientações para o preenchimento de cada bloco do questionário, destacando possíveis peculiaridades de cada questão.A terceira onda do EpiFloripa foi financiada com recursos do Economic and Social Research Council (ESRC) do Reino Unido através do projeto multicêntrico Promoting Independence in Dementia (PRIDE), valor financiado: R$574.698,20 contrato 75/2017 entre UFSC e FAPEU, período: janeiro de 2016 a fevereiro de 2020

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 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 the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

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

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