39 research outputs found

    Hearing loss prevalence and years lived with disability, 1990‚Äď2019: findings from the Global Burden of Disease Study 2019

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    Background Hearing loss affects access to spoken language, which can affect cognition and development, and can negatively affect social wellbeing. We present updated estimates from the Global Burden of Disease (GBD) study on the prevalence of hearing loss in 2019, as well as the condition's associated disability. Methods We did systematic reviews of population-representative surveys on hearing loss prevalence from 1990 to 2019. We fitted nested meta-regression models for severity-specific prevalence, accounting for hearing aid coverage, cause, and the presence of tinnitus. We also forecasted the prevalence of hearing loss until 2050. Findings An estimated 1¬∑57 billion (95% uncertainty interval 1¬∑51‚Äď1¬∑64) people globally had hearing loss in 2019, accounting for one in five people (20¬∑3% [19¬∑5‚Äď21¬∑1]). Of these, 403¬∑3 million (357¬∑3‚Äď449¬∑5) people had hearing loss that was moderate or higher in severity after adjusting for hearing aid use, and 430¬∑4 million (381¬∑7‚Äď479¬∑6) without adjustment. The largest number of people with moderate-to-complete hearing loss resided in the Western Pacific region (127¬∑1 million people [112¬∑3‚Äď142¬∑6]). Of all people with a hearing impairment, 62¬∑1% (60¬∑2‚Äď63¬∑9) were older than 50 years. The Healthcare Access and Quality (HAQ) Index explained 65¬∑8% of the variation in national age-standardised rates of years lived with disability, because countries with a low HAQ Index had higher rates of years lived with disability. By 2050, a projected 2¬∑45 billion (2¬∑35‚Äď2¬∑56) people will have hearing loss, a 56¬∑1% (47¬∑3‚Äď65¬∑2) increase from 2019, despite stable age-standardised prevalence. Interpretation As populations age, the number of people with hearing loss will increase. Interventions such as childhood screening, hearing aids, effective management of otitis media and meningitis, and cochlear implants have the potential to ameliorate this burden. Because the burden of moderate-to-complete hearing loss is concentrated in countries with low health-care quality and access, stronger health-care provision mechanisms are needed to reduce the burden of unaddressed hearing loss in these settings

    Global, regional, and national burden of colorectal cancer and its risk factors, 1990‚Äď2019: a systematic analysis for the Global Burden of Disease Study 2019

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    Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin

    Mapping development and health effects of cooking with solid fuels in low-income and middle-income countries, 2000-18 : a geospatial modelling study

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    Background More than 3 billion people do not have access to clean energy and primarily use solid fuels to cook. Use of solid fuels generates household air pollution, which was associated with more than 2 million deaths in 2019. Although local patterns in cooking vary systematically, subnational trends in use of solid fuels have yet to be comprehensively analysed. We estimated the prevalence of solid-fuel use with high spatial resolution to explore subnational inequalities, assess local progress, and assess the effects on health in low-income and middle-income countries (LMICs) without universal access to clean fuels.Methods We did a geospatial modelling study to map the prevalence of solid-fuel use for cooking at a 5 km x 5 km resolution in 98 LMICs based on 2.1 million household observations of the primary cooking fuel used from 663 population-based household surveys over the years 2000 to 2018. We use observed temporal patterns to forecast household air pollution in 2030 and to assess the probability of attaining the Sustainable Development Goal (SDG) target indicator for clean cooking. We aligned our estimates of household air pollution to geospatial estimates of ambient air pollution to establish the risk transition occurring in LMICs. Finally, we quantified the effect of residual primary solid-fuel use for cooking on child health by doing a counterfactual risk assessment to estimate the proportion of deaths from lower respiratory tract infections in children younger than 5 years that could be associated with household air pollution.Findings Although primary reliance on solid-fuel use for cooking has declined globally, it remains widespread. 593 million people live in districts where the prevalence of solid-fuel use for cooking exceeds 95%. 66% of people in LMICs live in districts that are not on track to meet the SDG target for universal access to clean energy by 2030. Household air pollution continues to be a major contributor to particulate exposure in LMICs, and rising ambient air pollution is undermining potential gains from reductions in the prevalence of solid-fuel use for cooking in many countries. We estimated that, in 2018, 205000 (95% uncertainty interval 147000-257000) children younger than 5 years died from lower respiratory tract infections that could be attributed to household air pollution.Interpretation Efforts to accelerate the adoption of clean cooking fuels need to be substantially increased and recalibrated to account for subnational inequalities, because there are substantial opportunities to improve air quality and avert child mortality associated with household air pollution. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.Peer reviewe

    Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990-2019, for 204 countries and territories: the Global Burden of Diseases Study 2019

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    Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0¬∑03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1¬∑0). Findings: In 2019, there were 36¬∑8 million (95% uncertainty interval [UI] 35¬∑1‚Äď38¬∑9) people living with HIV worldwide. There were 0¬∑84 males (95% UI 0¬∑78‚Äď0¬∑91) per female living with HIV in 2019, 0¬∑99 male infections (0¬∑91‚Äď1¬∑10) for every female infection, and 1¬∑02 male deaths (0¬∑95‚Äď1¬∑10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28¬∑52% decrease in incident cases, 95% UI 19¬∑58‚Äď35¬∑43, and a 39¬∑66% decrease in deaths, 36¬∑49‚Äď42¬∑36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0¬∑05 (95% UI 0¬∑05‚Äď0¬∑06) and the global incidence-to-mortality ratio was 1¬∑94 (1¬∑76‚Äď2¬∑12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH

    Global, regional, and national burden of hepatitis B, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

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    Global, regional, and national burden of stroke and its risk factors, 1990‚Äď2019: a systematic analysis for the Global Burden of Disease Study 2019

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    Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12¬∑2 million (95% UI 11¬∑0‚Äď13¬∑6) incident cases of stroke, 101 million (93¬∑2‚Äď111) prevalent cases of stroke, 143 million (133‚Äď153) DALYs due to stroke, and 6¬∑55 million (6¬∑00‚Äď7¬∑02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11¬∑6% [10¬∑8‚Äď12¬∑2] of total deaths) and the third-leading cause of death and disability combined (5¬∑7% [5¬∑1‚Äď6¬∑2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70¬∑0% (67¬∑0‚Äď73¬∑0), prevalent strokes increased by 85¬∑0% (83¬∑0‚Äď88¬∑0), deaths from stroke increased by 43¬∑0% (31¬∑0‚Äď55¬∑0), and DALYs due to stroke increased by 32¬∑0% (22¬∑0‚Äď42¬∑0). During the same period, age-standardised rates of stroke incidence decreased by 17¬∑0% (15¬∑0‚Äď18¬∑0), mortality decreased by 36¬∑0% (31¬∑0‚Äď42¬∑0), prevalence decreased by 6¬∑0% (5¬∑0‚Äď7¬∑0), and DALYs decreased by 36¬∑0% (31¬∑0‚Äď42¬∑0). However, among people younger than 70 years, prevalence rates increased by 22¬∑0% (21¬∑0‚Äď24¬∑0) and incidence rates increased by 15¬∑0% (12¬∑0‚Äď18¬∑0). In 2019, the age-standardised stroke-related mortality rate was 3¬∑6 (3¬∑5‚Äď3¬∑8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3¬∑7 (3¬∑5‚Äď3¬∑9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62¬∑4% of all incident strokes in 2019 (7¬∑63 million [6¬∑57‚Äď8¬∑96]), while intracerebral haemorrhage constituted 27¬∑9% (3¬∑41 million [2¬∑97‚Äď3¬∑91]) and subarachnoid haemorrhage constituted 9¬∑7% (1¬∑18 million [1¬∑01‚Äď1¬∑39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79¬∑6 million [67¬∑7‚Äď90¬∑8] DALYs or 55¬∑5% [48¬∑2‚Äď62¬∑0] of total stroke DALYs), high body-mass index (34¬∑9 million [22¬∑3‚Äď48¬∑6] DALYs or 24¬∑3% [15¬∑7‚Äď33¬∑2]), high fasting plasma glucose (28¬∑9 million [19¬∑8‚Äď41¬∑5] DALYs or 20¬∑2% [13¬∑8‚Äď29¬∑1]), ambient particulate matter pollution (28¬∑7 million [23¬∑4‚Äď33¬∑4] DALYs or 20¬∑1% [16¬∑6‚Äď23¬∑0]), and smoking (25¬∑3 million [22¬∑6‚Äď28¬∑2] DALYs or 17¬∑6% [16¬∑4‚Äď19¬∑0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.publishedVersio

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

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    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

    Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

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    Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10‚Äď24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10‚Äď14, 15‚Äď19, and 20‚Äď24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31¬∑1 million DALYs (of which 16¬∑2 million [52%] were transport related) among adolescents aged 10‚Äď24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34¬∑4% (from 17¬∑5 to 11¬∑5 per 100 000) for transport injuries, and by 47¬∑7% (from 15¬∑9 to 8¬∑3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80¬∑5% to 42 774 for transport injuries and by 39¬∑4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010‚Äď19, the rate per 100 000 of transport injury DALYs was reduced by 16¬∑7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48¬∑5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0¬∑2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010‚Äď19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low‚Äďmiddle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding: Bill &amp; Melinda Gates Foundation

    The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019