Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Background: Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. Methods: Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. Findings: In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. Interpretation: Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. Funding: Bill & Melinda Gates Foundation

The use of watershed geomorphic data in flash flood susceptibility zoning: a case study of the Karnaphuli and Sangu river basins of Bangladesh

The occurrence of heavy rainfall in the south-eastern hilly region of Bangladesh makes this area highly susceptible to recurrent flash flooding. As the region is the commercial capital of Bangladesh, these flash floods pose a significant threat to the national economy. Predicting this type of flooding is a complex task which requires a detailed understanding of the river basin characteristics. This study evaluated the susceptibility of the region to flash floods emanating from within the Karnaphuli and Sangu river basins. Twenty-two morphometric parameters were used. The occurrence and impact of flash floods within these basins are mainly associated with the volume of runoff, runoff velocity, and the surface infiltration capacity of the various watersheds. Analysis showed that major parts of the basin were susceptible to flash flooding events of a ‘moderate’-to-‘very high’ level of severity. The degree of susceptibility of ten of the watersheds was rated as ‘high’, and one was ‘very high’. The flash flood susceptibility map drawn from the analysis was used at the sub-district level to identify populated areas at risk. More than 80% of the total area of the 16 sub-districts were determined to have a ‘high’-to-‘very-high’-level flood susceptibility. The analysis noted that around 3.4 million people reside in flash flood-prone areas, therefore indicating the potential for loss of life and property. The study identified significant flash flood potential zones within a region of national importance, and exposure of the population to these events. Detailed analysis and display of flash flood susceptibility data at the sub-district level can enable the relevant organizations to improve watershed management practices and, as a consequence, alleviate future flood risk

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. Funding Bill & Melinda Gates Foundation

Modeling soil salinity using direct and indirect measurement techniques: A comparative analysis

Soil salinization is a major problem for low-elevation countries like Bangladesh and is expected to worsen due to global warming and associated sea level rise. A constant monitoring of salinity affected areas is imperative to prevent land degradation, agricultural and livelihood losses. With this aim, we developed three soil salinity models with direct, indirect and a combination of both of these soil salinity measurement techniques, for south-western Bangladesh. The five salinity indexes (direct) and eleven environmental variables (indirect) were integrated using Principal Component Analysis, and the predictability of the models was evaluated against ground-based soil salinity measurements from soil survey and land cover maps generated during the model development. Delineation based solely on salinity indexes yielded results that contradicted with models developed from indirect variables and combining all the variables. Results suggest that the salinity model developed by combining direct and indirect techniques has the highest prediction capacity and can also be explained in terms of land cover changes. Therefore, an integrated approach yielded better delineation of salt-affected areas, characterized by active hydrological processes and vegetation cover. The findings and maps produced from this study would provide a new contextual planning tool to policymakers, for devising adaptation strategies in affected areas of Bangladesh

The effects of changing land use and flood hazard on poverty in coastal Bangladesh

The construction of polders in the coastal region of Bangladesh has significantly modified the patterns of flooding, as well as leading to significant land use/land cover (hereinafter, LULC) changes. The impact of LULC change and flooding on poverty is complex and poorly understood. This study presents a spatiotemporal appraisal of poverty in relation to LULC change and pluvial flood risk in the south western embanked area of Bangladesh. A combination of logistic regression (LR), cellular automata (CA), and Markov Chain models were utilised to predict future LULC based on historical data. Flood risk assessment was performed at present and for future LULC scenarios. A spatial regression model was developed, incorporating multiple parameters to estimate the wealth index (WI) for present-day and future scenarios. In the study area, agricultural lands reduced from 34 % in 2005 to 8% in 2010, while aquaculture land cover increased from 17 % to 39 % during the same time. The rate of LULC change was relatively low between 2010 and 2019. Based on the recent trend, LULC was predicted for the year 2030. Flood risk was positively correlated with LULC and the expected annual damage (EAD) was estimated at USD903 million in 2005, which is likely to increase to USD2096 million by 2030, considering changes in LULC scenarios. The analysis further showed that the EAD and LULC change were negatively associated with the WI. Despite consistent national GDP growth in Bangladesh in recent years, the rate of increase of WI is likely to be low in the future because flood risk and patterns of LULC change have a negative effect on WI

Youth Quitline: an accessible telephone-based smoking cessation hotline for youth

Poster Presentation - Behaviour: no. D02Conference Theme: From Awareness to Action: Cross-sector Partnerships for Healthy Environment and Healthy Peoplelink_to_OA_fulltex

Characteristics of Chinese smokers participated in a randomized controlled trial of smoking reduction intervention

Conference Theme: Building capapcity of a tobacco-free worl

Spatio-temporal patterns of land use/land cover change in the heterogeneous coastal Region of Bangladesh between 1990 and 2017

Although a detailed analysis of land use and land cover (LULC) change is essential in providing a greater understanding of increased human-environment interactions across the coastal region of Bangladesh, substantial challenges still exist for accurately classifying coastal LULC. This is due to the existence of high-level landscape heterogeneity and unavailability of good quality remotely sensed data. This study, the first of a kind, implemented a unique methodological approach to this challenge. Using freely available Landsat imagery, eXtreme Gradient Boosting (XGBoost)-based informative feature selection and Random Forest classification is used to elucidate spatio-temporal patterns of LULC across coastal areas over a 28-year period (1990–2017). We show that the XGBoost feature selection approach effectively addresses the issue of high landscape heterogeneity and spectral complexities in the image data, successfully augmenting the RF model performance (providing a mean user’s accuracy > 0.82). Multi-temporal LULC maps reveal that Bangladesh’s coastal areas experienced a net increase in agricultural land (5.44%), built-up (4.91%) and river (4.52%) areas over the past 28 years. While vegetation cover experienced a net decrease (8.26%), an increasing vegetation trend was observed in the years since 2000, primarily due to the Bangladesh government’s afforestation initiatives across the southern coastal belts. These findings provide a comprehensive picture of coastal LULC patterns, which will be useful for policy makers and resource managers to incorporate into coastal land use and environmental management practices. This work also provides useful methodological insights for future research to effectively address the spatial and spectral complexities of remotely sensed data used in classifying the LULC of a heterogeneous landscape