Image security system using hybrid cryptosystem

This work presents and describes a novel method to hide messages in images in a hybrid manner, as steganography is combined with quantum cryptography. Through stimulating and implementing this hybrid approach, the least significant bit (LSB) substitution is employed for hiding secret messages within cover images that consist of three bands (Red, Green and Blue), after which the output is encrypted using quantum one-time pad encryption. The models are illustrated explicitly and tested. In addition, the test analysis uses a steganalysis tool called StegExpose to detect LSB steganography in images. The experimental results proved that the image hiding is reliably secure and undetectable, and hence the proposed new hybrid model provides a sufficient security level as well as we have tested the proposed system using robust state-of- the-art steganalysis techniques and found the low payload threshold maintained in the proposed system produces a high margin of communication security safety. No payload files were detected (0% detections), despite each file containing the entire content of the information as embedded text

Improvement of Erosion -Corrosion Resistance of Tin-Bronze Alloy by Addition of Al and Al2O3 via Powder Technology

سبيكة (قصديرــ برونز) ذات التركيب المسامي تمتلك العديد من التطبيقات الهندسية ولاسيما في انظمة الترشيح، كراسي التحميل ذاتية التزييت، المبادلات الحرارية. لكونها تمتاز بخصائص ميكانيكيه وفيزيائية فريدة حيث تجمع ما بين خفة الوزن والمتانة الجيدة مع القدرة على النفاذية والتوصيل الحراري والكهربائي. في العمل الحالي تم تحضير نماذج من سبيكة (قصديرــ برونز) ذات التركيب الكيمائي (90 wt. % Cu, 10 wt. % Sn) بتقنية ميتالورجيا المساحيق، وتم استخدام دقائق مسحوق (NaCl) عالية النقاوة (99.6 wt. %) كعامل لتوليد المسامات وبنسبة اضافة (35 wt. %) والتي تم ازالتها لاحقا عن طريق اذابتها بالماء عند درجة (100˚C) تبعتها عمليه تنظيف باستعمال جهاز الموجات فوق الصوتية (Ultrasonic cleaner device). تم اضافة كلا من الالمنيوم بنسبة (3 wt. %) واوكسيد الالمنيوم بثلاث نسب مختلفة (3% 5%,7%,) الى السبيكة الاساس ذات التركيب الكيميائي (90% Cu, 10% Sn) لتحضير عينات متراكبة اضافة الى العينة الاساس ودراسة تأثير هذه الاضافات على السلوك الفيزيائي والميكانيكي والتاكلي والتاكل بالتعرية. خلطت المساحيق لمدة (5) ساعات وكبست تحت ضغط (40 MPa) وتم تلبيد العينات عند درجة حرارة (600˚C) ولفترة زمنية (180 min) بعد ان تركت ساعة واحدة عند درجة حرارة (200˚C) في جو مفرغ من الهواء ولغاية (10-4 Torr) ثم تركت العينات لتبرد داخل الفرن الى درجة حرارة الغرفة مع ضمان استمرار تفريغ الهواء. اظهرت النتائج فشل العينة ذات الإضافة (7 wt. % Al2O3, 3 wt. % Al) في عمليه التلبيد في حين نجحت بقية العينات في عمليه التلبيد تحت نفس الظروف. اجريت العديد من الاختبارات وتضمنت: فحص البنيية المجهرية (المجهر الضوئي)، اختبار البنية (المجهر الإلكتروني)، فحص التحليل الكيمائي (EDS)، اختبار حيود الأشعة السينية (اشعة اكس)، المسامية، الكثافة، اختبار الصلادة الميكروية (فيكرز)، فحص التآكل (تافل)، وفحص تآكل بالتعرية. اظهرت نتائج المجهر الالكتروني وجود دقائق ((Al2O3 في ارضية العينات المضاف اليها دقائق اوكسيد الالمنيوم. بينما اظهرت نتائج فحص حيود الأشعة السينية ان العينات المحضرة تتكون من طورين هما ((Cu,Snα الذي يمثل ارضية السبيكة الاساس والطور الثاني (ε-Cu3Sn) كمركب شبه معدني.  كما اظهرت نتائج فحص الكثافة والمسامية انخفاض في قيمة الكثافة بعد اضافة الالمنيوم واوكسيد الالمنيوم ويزداد هذا الانخفاض مع زيادة نسبة اضافة اوكسيد الالمنيوم في حين تزداد المسامية بنسبة قليل مع زيادة هذه الاضافة. من خلال اختبار الصلادة الدقيقة بينت النتائج ان اضافه اوكسيد الالمنيوم والالمنيوم أدت الى زيادة في قيمه الصلادة حيث لوحظ زيادة قيمه الصلادة من ((44.41 HV للسبيكة الاساس الى (HV83.3) عند اضافة 3%Al واوكسيد الالمنيوم (7%).  اما في اختبارات التآكل، فقد اشارت نتائج فحص التآكل الكهروكيميائية (تافل) في محلول ((3.5 wt. %NaCl تحسن كبير في مقاومة التآكل حيث لوحظ انخفاض في قيمة كثافة التيار من (μA/mm21.76112) للسبيكة الخالية من اضافة الالمنيوم واوكسيد الالمنيوم الى 0.00326 μA/mm2)) للسبيكة بعد اضافه الالمنيوم (  (3 wt.% Al واوكسيد الالمنيوم بنسبة (5 wt. %). ومن خلال اختبار التآكل بالتعرية في محلول ((3.5 wt. %NaCl لوحظ ان معدل التاكل بالتعرية بعد اضافة3% الالمنيوم و5% واوكسيد الالمنيوم كان4)  (5.8*10- g/hr. في حين بلغ معدل التاكل بالتعرية للنموذج بدون اضافة الالمنيوم واوكسيد الالمنيوم (11.5*10-4 g/hr)  عند المنطقة المستقرة.The porous (tin-bronze) alloy has many engineering applications, especially in filtration systems, self-lubricating loading chairs and heat exchangers. Because of its unique mechanical and physical properties, it combines light weight, good durability with permeability, thermal and electrical conductivity. In the present study, samples of tin-bronze alloy with chemical composition (90 % Cu, 10 % Sn) have been prepared by using powder metallurgy,(35 wt. %) high purity (99.6 wt. %) NaCl powder was used as a pore-forming agent for the generation of pores, which was subsequently removed by dissolved with water at (100˚C) followed by ultrasonic cleaning (Ultrasonic cleaner device). Aluminum (3%) and alumina (3%,  5%, and 7%) were added to the base alloy to prepare composite samples in addition to the base alloy and study the effect of these additives on physical ,mechanical, corrosion, and erosion -corrosion properties. The powders were mixed for 5 hours and pressed under 40 MPa. Samples were sintered at(200˚C) for one hour and then the temperature was raised to  (600˚C) for period of (180 min)  with heating  rate (10 ˚C/min)  in a vacuum atmosphere (10-4 Torr) Then let it cool inside the furnace to room temperature while ensuring continued air discharge. The results showed that the sample of the addition of (3% Al and 7% Al2O3,) failed in the sintering process while the rest of the samples succeeded in sintering process under the same conditions.  Several tests were carried out including:  microstructure test (light optical microscopy), scanning electron microscopy test (SEM), X-ray diffraction test (XRD), Energy dispersion spectrometer test (EDS), Vickers micro-hardness test ,porosity, density, corrosion behavior  (Tafel), and erosion corrosion test. The results of the SEM showed the presence of particle (Al2O3) in the matrix of the samples containing the addition of alumina particles. While the results of the X-ray diffraction examination showed that the prepared samples consist of two phases α (Cu, Sn) which represents the alloy matrix and the second phase (ε-Cu3Sn) as an intermetallic compound. The results of the density and porosity tests showed a decrease in the density value after the addition of aluminum and alumina. This decreasing increases with the increase of the percentage of the addition of alumina, while the porosity increases slightly with the increase of this addition. Through the test of micro- hardness, the results showed that the addition of alumina and aluminum led to an increase in the hardness value, where it was observed to increase the hardness value from (44.41) Hv of the alloy without addition to (83.30Hv) When the percentage of addition was (3% Al+5% Al2O3). In corrosion tests, the results of the electrochemical corrosion test (Tafel) in the solution (3.5% NaCl) significantly improved the corrosion resistance as the current density value decreased from (1.76112 μA / mm2) for base alloy to (0.00326 μA / mm2) for composite sample of (3%Al) and (5% Al2O3).  While in the erosion- corrosion test in (3.5% NaCl solution), the rate of erosion corrosion in alloy( 90% Cu- 10% Sn) was (11.5*10-4 g/hr) and   the rate of erosion corrosion for alloy with addition of (3%Al+5%Al2O3) was (5.8*10-4 g/hr) at steady state condition.

Knowledge of Patients Undergoing Chemotherapy toward Home Management of Side Effect

Cancer is one of the dangers health problems today, which that lead to death. Most the of patients diagnosed with cancer receive chemotherapy. Chemotherapy result many side effects that will effects on physical, mental, social life, all of which affect patients’ self-care performances. It has been demonstrated that treatment inconveniences is slower with suitable self-care. The main aim of the study is to assess knowledge of patients undergoing chemotherapy toward home management of side effect. A descriptive study design is carried out at Baqubah Teaching Hospital, from 7th October, 2022 to 22th April, 2023. The instruments were constructed by the researcher for the purpose of the study. A purposive random sample comprised of (30) patients undergoing chemotherapy The study instrument is composed of three main parts: Part I. The socio- demographic characteristics of the patients, Part II. Clinical data of the patients, Part III. Knowledge of patients undergoing chemotherapy toward self-care. Validity of the study instrument was determined through a panel of experts and reliability of the instrument was determined through Cronbach's Alpha method. The analysis of the data used was descriptive statistics and statistical inferential, in order to find the differences between the study group. The study findings indicate that there are poor knowledge in the study group in overall III main domains regarding patient’ knowledge toward home management of side effect

Microfluidic fluid flow design with Arduino relay and temperature controller for processor

Considering microfluidic technology, this work has been innovated to consist of monitoring, temperature control and cooling sections. The work consists of peltier a module attached to the heatsink and fan for cooling purposes. The peltier cooling is used to cool down the fluid from the water reservoir tank that will flow into the microfin CPU block. This work consists of one water reservoir tank that uses feedback system, which makes fluid will flow into the microfin (microfluidic) CPU block, and transferred back to the water reservoir tank. The temperature monitoring is monitored using the Intelligent Temperature Controller (XH-W1401) located near the system. The Arduino coding controls the relay for the on/off operation of the whole system and the water pump is for the cooling section. Overall the methodology implemented and the controller system have been successfully designed, functionally operated and tested. It is found that, the system temperature without the cooling effect reaches up to 80°C–100°C while the temperature of the system with the microfluidic microfin CPU block can be reduced to 45°C–50°C degree when the processor becomes too hot

An FPGA implementation and performance analysis between radix-2 and radix-4 of 4096 point FFT

The rapid grown in wireless 4G and 5G technology push to the edge to high input data processing. High input data processing required advance Orthogonal Frequency Division Multiplexing (OFDM). The main block in any OFDM transceiver is the Fast Fourier Transform (FFT). FFT consider the transformation bridge between the time and frequency domains. In this research an implementation and direct analysis between radix-2 and radix-4 FFT algorithms presented. Memory-based architecture adopted for the all algorithms. The entire algorithm designed by Altera Quartus II and synthesis for Altera DE2-70 field programmable gate arrays (FPGA) board, in order to investigate and determine the desired algorithm based on the application used for and the system requirement

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021. METHODS: We estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined. FINDINGS: Globally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer. INTERPRETATION: As the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

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

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. FUNDING: Bill & Melinda Gates Foundation

Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation