Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Funding: Bill & Melinda Gates Foundation

ENGAGE Global Scenarios

This data set includes global climate change mitigation scenarios as summarized by Riahi et al., 2021. The scenarios are developed as part of the ENGAGE project and were assessed in terms of the their investment implications (Bertram et al., 2021), their land-use dynamics (Hasegawa et al., 2021) as we all as with respect to their costs and benefits (Drouret et al., 2021). The scenarios include a current national policies scenario and an NDC scenario that depict relevant near-term GHG emission tends and targets. In the long-term, two types of CO2 emission budgets are implemented, so called “net-zero budgets” and “end-of-century” budgets. The “net-zero-budget” scenarios assume climate policies that limit the remaining cumulative CO2 emissions until net zero CO2 emissions are reached. These scenarios limit the temperature overshoot and do not rely on global net-negative CO2 emissions to keep warming below the intended temperature limit. In contrast, the “end-of-century budget” scenarios assume long-term climate policies that limit cumulative CO2 emissions over the full course of the 21st century. Depending on the availability of carbon dioxide removal options, these scenarios may comprise high temperature overshoot and global net negative CO2 emissions in the second half of the century. The near-term dimension of current national policies until 2020 or NDCs until 2030 is then combined with reaching the net-zero and full-century CO2 emissions budgets. To cover a relevant range of temperature outcomes (which in addition to the budgets themselves also determined by mitigation of non-CO2 GHG and aerosol emissions), the budgets are varied between 200 and 3000 GtCO2 in steps of 50 – 500 GtCO2. The data is available for download at the ENGAGE Scenario Explorer. The license permits use of the scenario ensemble for scientific research and science communication, but restricts redistribution of substantial parts of the data. Please refer to the FAQ and legal code for more information

Criopreservação de ovócitos de bovinos imaturos desnudados ou não, utilizando o etilenoglicol pelo método da vitrificação Cryopreservation of bovines immature oocytes desnudes or not, by the ethylene glycol vitrification method

Objetivou-se avaliar os efeitos da vitrificação em ovócitos de bovinos após o cultivo in vitro, utilizando o etilenoglicol como crioprotetor. Ovócitos obtidos de ovários de vacas abatidas em matadouro foram distribuídos aleatoriamente em três tratamentos. Tratamento 0 (testemunha): ovócitos não-desnudados e não-congelados. Tratamento 1: vitrificação de ovócitos imaturos não desnudados, desidratados previamente por cinco minutos em três soluções contendo 20, 20 e 40% de etilenoglicol, acrescidas de 0,3 mol L-1 de trehalose e 20% de PVP, em meio de Talp Hepes. Tratamento 2: vitrificação de ovócitos imaturos desnudados, conforme o Tratamento 1. Após o descongelamento (imersão em banho-maria a 30ºC por 20 segundos), os ovócitos foram reidratados gradativamente, mantendo-os por 6 minutos em cada uma das soluções a seguir, sucessivamente: meio Talp Hepes com 20% de etilenoglicol + 0,3 mol L-1 de trehalose + 10% de PVP e meio Talp Hepes sem etilenoglicol, trehalose e PVP, onde foram lavados três vezes. Posteriormente, os ovócitos foram cultivados a 38,5ºC, com 95% de umidade e atmosfera de 5% de CO2 por 24 horas. Após o cultivo, os ovócitos foram fecundados e os embriões cultivados in vitro por sete dias. Foi encontrada uma taxa de maturação nuclear de 81 (68/84), 19 (7/36) e 0% (0/31), nos Tratamentos 0, 1 e 2, respectivamente. As taxas de clivagem e de desenvolvimento embrionário foram de 56,4 (102/181) e 54,9% (56/102), 1,7 (1/60) e 0,0% (1/60), 0,0 (0/71) e 0,0% (0/71), nos Tratamentos 0, 1 e 2, respectivamente. Esses resultados indicam que o procedimento de vitrificação, segundo os protocolos utilizados, não é indicado para a criopreservação de ovócitos de bovinos.<br>The objective was to evaluate the effects of vitrification of immature bovine oocytes after in vitro culture, by the use of cryoprotectors ethylene glycol. Oocytes from cows ovaries from slaughters houses were randomly alocated into three treatments. Treatment 0 (control): frozen-thawed undesnude oocytes; treatment 1, immature vitrificated undesnude oocytes dehydrated for 5 minutes in each of the following solutions of 20, 20 and 40% of ethylene glycol, respectively, associated to 0.3 Mol l-1 of trehalose and 20% of PVP, in media Talp Hepes, and, treatment 2, the same as treatment 1, but desnudes oocytes. After frozen-thawed of the oocytes (imersion in water bath at 30ºC for 20 seconds), the oocytes were gradually rehydrated, in the following sequence of solutions: media Talp Hepes with 20% of ethylene glycol + 0.3 Mol l-1 of trehalose + 10% of PVP and media Talp Hepes without ethylene glycol, trehalose and PVP, were washed three times. Ultimately, the oocytes were cultured at 38.5ºC, with 95% umidity and atmosphere of 5% of CO2 for 24 hours. After culture, the oocytes were fertilized and the embryos cultured in vitro for seven days. The nuclear maturation were 81 (68/84), 19 (7/36) and 0% (0/31), for treatments 0, 1 and 2, respectively. The cleavage and development rates were: 56.4(102/181) and 54,9% (56/102), 1,7. (1/60) and 0,0% (1/60), 0,0 (0/71) and 0,0% (0/71), for the treatments 1, 2 e 3, respectively. These results show that the vitrification procedures, by the used protocols, are not indicated for bovine oocytes cryopreservation