124 research outputs found
Regional variations and socio-economic disparities in neonatal mortality in Angola: a cross-sectional study using demographic and health surveys.
BackgroundInequalities in neonatal mortality rates (NMRs) in low- and middle-income countries show key disparities at the detriment of disadvantaged population subgroups. There is a lack of scholarly evidence on the extent and reasons for the inequalities in NMRs in Angola.ObjectiveThe aim of this study was to assess the socio-economic, place of residence, region and gender inequalities in the NMRs in Angola.MethodsThe World Health Organization Health Equity Assessment Toolkit software was used to analyse data from the 2015 Angola Demographic and Health Survey. Five equity stratifiers: subnational regions, education, wealth, residence and sex were used to disaggregate NMR inequality. Absolute and relative inequality measures, namely, difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio, were calculated to provide a broader understanding of the inequalities in NMR. Statistical significance was calculated at corresponding 95% uncertainty intervals.FindingsWe found significant wealth-driven [PAR = -14.16, 95% corresponding interval (CI): -15.12, -13.19], education-related (PAF = -22.5%, 95% CI: -25.93, -19.23), urban-rural (PAF = -14.5%, 95% CI: -16.38, -12.74), sex-based (PAR = -5.6%, 95% CI: -6.17, -5.10) and subnational regional (PAF = -82.2%, 95% CI: -90.14, -74.41) disparities in NMRs, with higher burden among deprived population subgroups.ConclusionsHigh NMRs were found among male neonates and those born to mothers with no formal education, poor mothers and those living in rural areas and the Benguela region. Interventions aimed at reducing NMRs, should be designed with specific focus on disadvantaged subpopulations
Socioeconomic and geographic variations in antenatal care coverage in Angola: further analysis of the 2015 demographic and health survey.
BACKGROUND:In African countries, including Angola, antenatal care (ANC) coverage is suboptimal and maternal mortality is still high due to pregnancy and childbirth-related complications. There is evidence of disparities in the uptake of ANC services, however, little is known about both the socio-economic and geographic-based disparity in the use of ANC services in Angola. The aim of this study was to assess the extent of socio-economic, urban-rural and subnational inequality in ANC coverage in Angola. METHODS:We analyzed data from the 2015 Angola Demographic and Health Survey (ADHS) using the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) software. The analysis consisted of disaggregated ANC coverage rates using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population Attributable Risk, Ratio and Population Attributable Fraction). To measure statistical significance, an uncertainty interval (UI) of 95% was constructed around point estimates. RESULTS:The study showed both absolute and relative inequalities in coverage of ANC services in Angola. More specifically, inequality favored women who were rich (Dโ=โ54.2, 95% UI; 49.59, 58.70, PAFโ=โ43.5, 95% UI; 40.12, 46.92), educated (PARโ=โ19.9, 95% UI; 18.14, 21.64, Rโ=โ2.14, 95% UI; 1.96, 2.32), living in regions such as Luanda (Dโ=โ51.7, 95% UI; 43.56, 59.85, Rโ=โ2.64, 95% UI; 2.01, 3.26) and residing in urban dwellings (PAFโ=โ20, 95% UI; 17.70, 22.38, PARโ=โ12.3, 95% UI; 10.88, 13.75). CONCLUSION:The uptake of ANC services were lower among poor, uneducated, and rural residents as well as women from the Cuanza Sul region. Government policy makers must consider vulnerable subpopulations when designing needed interventions to improve ANC coverage in Angola to achieve the 2030 Sustainable Development Goal of reducing global maternal mortality ratio to 70 deaths per 100,000 live births
Demographic and Health Surveys showed widening trends in polio immunisation inequalities in Guinea
AimThis study examined trends in absolute and relative socio-economic, gender and geographical inequalities in the coverage of polio immunisation in Guinea, West Africa, from 1999 to 2016.MethodsData from the 1999, 2005 and 2012 Guinea Demographic and Health Survey and the 2016 Guinea Multiple Indicator Cluster Survey were analysed using the World Health Organization's health equity assessment toolkit. We disaggregated polio immunisation coverage using five equity stratifiers: household economic status, maternal educational level, place of residence, child's gender and region. The four summary measures used were the difference, ratio, population attributable risk and population attributable fraction. A 95% confidence interval (CI) was constructed around point estimates to measure statistical significance.ResultsA total of 4778 1-year-old children were included. Polio immunisation coverage in 1999, 2005, 2012 and 2016 were 43.4%, 50.7%, 51.2% and 38.6%, respectively. Socio-economic and geographical inequalities in polio immunisation favoured children with educated mothers who came from richer families living in urban areas. There were also differences in the eight regions over the 1999-2016ย study period.ConclusionTargeting children from disadvantaged subgroups must be prioritised to ensure equitable immunisation services that help to eradicate polio in Guinea
Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health : all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019
Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival.
Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index.
Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million [95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% [95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier.
Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress
Global, regional, and national burden of stroke and its risk factors, 1990-2019 : a systematic analysis for the Global Burden of Disease Study 2019
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 12ยท2 million (95% UI 11ยท0โ13ยท6) incident cases of stroke, 101 million (93ยท2โ111) prevalent cases of stroke, 143 million (133โ153) DALYs due to stroke, and 6ยท55 million (6ยท00โ7ยท02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11ยท6% [10ยท8โ12ยท2] of total deaths) and the third-leading cause of death and disability combined (5ยท7% [5ยท1โ6ยท2] of total DALYs) in 2019. From 1990 to 2019, the
absolute number of incident strokes increased by 70ยท0% (67ยท0โ73ยท0), prevalent strokes increased by 85ยท0% (83ยท0โ88ยท0), deaths from stroke increased by 43ยท0% (31ยท0โ55ยท0), and DALYs due to stroke increased by 32ยท0% (22ยท0โ42ยท0). During the same period, age-standardised rates of stroke incidence decreased by 17ยท0% (15ยท0โ18ยท0), mortality decreased by 36ยท0% (31ยท0โ42ยท0), prevalence decreased by 6ยท0% (5ยท0โ7ยท0), and DALYs decreased by 36ยท0% (31ยท0โ42ยท0). However, among people younger than 70 years, prevalence rates increased by 22ยท0% (21ยท0โ24ยท0)
and incidence rates increased by 15ยท0% (12ยท0โ18ยท0). In 2019, the age-standardised stroke-related mortality rate was 3ยท6 (3ยท5โ3ยท8) 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 3ยท7 (3ยท5โ3ยท9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62ยท4% of all incident strokes in 2019 (7ยท63 million [6ยท57โ8ยท96]), while intracerebral haemorrhage constituted 27ยท9% (3ยท41 million [2ยท97โ3ยท91]) and subarachnoid haemorrhage constituted 9ยท7% (1ยท18 million [1ยท01โ1ยท39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79ยท6 million [67ยท7โ90ยท8] DALYs or 55ยท5% [48ยท2โ62ยท0] of total stroke DALYs), high bodymass index (34ยท9 million [22ยท3โ48ยท6] DALYs or 24ยท3% [15ยท7โ33ยท2]), high fasting plasma glucose (28ยท9 million [19ยท8โ41ยท5] DALYs or 20ยท2% [13ยท8โ29ยท1]), ambient particulate matter pollution (28ยท7 million [23ยท4โ33ยท4] DALYs or 20ยท1% [16ยท6โ23ยท0]), and smoking (25ยท3 million [22ยท6โ28ยท2] DALYs or 17ยท6% [16ยท4โ19ยท0]). 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
Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990โ2019, for 204 countries and territories : the Global Burden of Diseases Study 2019
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 <0ยท03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1ยท0). Findings: In 2019, there were 36ยท8 million (95% uncertainty interval [UI] 35ยท1โ38ยท9) people living with HIV worldwide. There were 0ยท84 males (95% UI 0ยท78โ0ยท91) per female living with HIV in 2019, 0ยท99 male infections (0ยท91โ1ยท10) for every female infection, and 1ยท02 male deaths (0ยท95โ1ยท10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28ยท52% decrease in incident cases, 95% UI 19ยท58โ35ยท43, and a 39ยท66% decrease in deaths, 36ยท49โ42ยท36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0ยท05 (95% UI 0ยท05โ0ยท06) and the global incidence-to-mortality ratio was 1ยท94 (1ยท76โ2ยท12). 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
Tracking development assistance for health and for COVID-19 : a review of development assistance, government, out-of-pocket, and other private spending on health for 204 countries and territories, 1990โ2050
Background: The rapid spread of COVID-19 renewed the focus on how health systems across the globe are financed, especially during public health emergencies. Development assistance is an important source of health financing in many low-income countries, yet little is known about how much of this funding was disbursed for COVID-19. We aimed to put development assistance for health for COVID-19 in the context of broader trends in global health financing, and to estimate total health spending from 1995 to 2050 and development assistance for COVID-19 in 2020. Methods: We estimated domestic health spending and development assistance for health to generate total health-sector spending estimates for 204 countries and territories. We leveraged data from the WHO Global Health Expenditure Database to produce estimates of domestic health spending. To generate estimates for development assistance for health, we relied on project-level disbursement data from the major international development agencies' online databases and annual financial statements and reports for information on income sources. To adjust our estimates for 2020 to include disbursements related to COVID-19, we extracted project data on commitments and disbursements from a broader set of databases (because not all of the data sources used to estimate the historical series extend to 2020), including the UN Office of Humanitarian Assistance Financial Tracking Service and the International Aid Transparency Initiative. We reported all the historic and future spending estimates in inflation-adjusted 2020 US per capita, purchasing-power parity-adjusted US8รยท8 trillion (95% uncertainty interval [UI] 8รยท7โ8รยท8) or 40รยท4 billion (0รยท5%, 95% UI 0รยท5โ0รยท5) was development assistance for health provided to low-income and middle-income countries, which made up 24รยท6% (UI 24รยท0โ25รยท1) of total spending in low-income countries. We estimate that 13รยท7 billion was targeted toward the COVID-19 health response. 1รยท4 billion was repurposed from existing health projects. 2รยท4 billion (17รยท9%) was for supply chain and logistics. Only 1519 (1448โ1591) per person in 2050, although spending across countries is expected to remain varied. Interpretation: Global health spending is expected to continue to grow, but remain unequally distributed between countries. We estimate that development organisations substantially increased the amount of development assistance for health provided in 2020. Continued efforts are needed to raise sufficient resources to mitigate the pandemic for the most vulnerable, and to help curtail the pandemic for all. Funding: Bill & Melinda Gates Foundation
Measuring routine childhood vaccination coverage in 204 countries and territories, 1980โ2019 : a systematic analysis for the Global Burden of Disease Study 2020, Release 1
Background: Measuring routine childhood vaccination is crucial to inform global vaccine policies and programme implementation, and to track progress towards targets set by the Global Vaccine Action Plan (GVAP) and Immunization Agenda 2030. Robust estimates of routine vaccine coverage are needed to identify past successes and persistent vulnerabilities. Drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, Release 1, we did a systematic analysis of global, regional, and national vaccine coverage trends using a statistical framework, by vaccine and over time. Methods: For this analysis we collated 55 326 country-specific, cohort-specific, year-specific, vaccine-specific, and dose-specific observations of routine childhood vaccination coverage between 1980 and 2019. Using spatiotemporal Gaussian process regression, we produced location-specific and year-specific estimates of 11 routine childhood vaccine coverage indicators for 204 countries and territories from 1980 to 2019, adjusting for biases in country-reported data and reflecting reported stockouts and supply disruptions. We analysed global and regional trends in coverage and numbers of zero-dose children (defined as those who never received a diphtheria-tetanus-pertussis [DTP] vaccine dose), progress towards GVAP targets, and the relationship between vaccine coverage and sociodemographic development. Findings: By 2019, global coverage of third-dose DTP (DTP3; 81ยท6% [95% uncertainty interval 80ยท4โ82ยท7]) more than doubled from levels estimated in 1980 (39ยท9% [37ยท5โ42ยท1]), as did global coverage of the first-dose measles-containing vaccine (MCV1; from 38ยท5% [35ยท4โ41ยท3] in 1980 to 83ยท6% [82ยท3โ84ยท8] in 2019). Third-dose polio vaccine (Pol3) coverage also increased, from 42ยท6% (41ยท4โ44ยท1) in 1980 to 79ยท8% (78ยท4โ81ยท1) in 2019, and global coverage of newer vaccines increased rapidly between 2000 and 2019. The global number of zero-dose children fell by nearly 75% between 1980 and 2019, from 56ยท8 million (52ยท6โ60ยท9) to 14ยท5 million (13ยท4โ15ยท9). However, over the past decade, global vaccine coverage broadly plateaued; 94 countries and territories recorded decreasing DTP3 coverage since 2010. Only 11 countries and territories were estimated to have reached the national GVAP target of at least 90% coverage for all assessed vaccines in 2019. Interpretation: After achieving large gains in childhood vaccine coverage worldwide, in much of the world this progress was stalled or reversed from 2010 to 2019. These findings underscore the importance of revisiting routine immunisation strategies and programmatic approaches, recentring service delivery around equity and underserved populations. Strengthening vaccine data and monitoring systems is crucial to these pursuits, now and through to 2030, to ensure that all children have access to, and can benefit from, lifesaving vaccines
Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019 : results from the Global Burden of Disease Study 2019
BACKGROUND: The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. METHODS: In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466-469, 470.0, 480-482.8, 483.0-483.9, 484.1-484.2, 484.6-484.7, and 487-489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4-B97.6, J09-J15.8, J16-J16.9, J20-J21.9, J91.0, P23.0-P23.4, and U04-U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23โ109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age-sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age-sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. FINDINGS: Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240-275) LRI incident episodes in males and 232 million (217-248) in females. In the same year, LRIs accounted for 1รยท30 million (95% UI 1รยท18-1รยท42) male deaths and 1รยท20 million (1รยท07-1รยท33) female deaths. Age-standardised incidence and mortality rates were 1รยท17 times (95% UI 1รยท16-1รยท18) and 1รยท31 times (95% UI 1รยท23-1รยท41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126รยท0% [95% UI 121รยท4-131รยท1]) and deaths (100รยท0% [83รยท4-115รยท9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (-70รยท7% [-77รยท2 to -61รยท8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53รยท0% [95% UI 37รยท7-61รยท8] in males and 56รยท4% [40รยท7-65รยท1] in females), and more than a quarter of LRI deaths among those aged 5-14 years were attributable to household air pollution (PAF 26รยท0% [95% UI 16รยท6-35รยท5] for males and PAF 25รยท8% [16รยท3-35รยท4] for females). PAFs of male LRI deaths attributed to smoking were 20รยท4% (95% UI 15รยท4-25รยท2) in those aged 15-49 years, 30รยท5% (24รยท1-36รยท9) in those aged 50-69 years, and 21รยท9% (16รยท8-27รยท3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21รยท1% (95% UI 14รยท5-27รยท9) in those aged 15-49 years and 18รยท2% (12รยท5-24รยท5) in those aged 50-69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11รยท7% (95% UI 8รยท2-15รยท8) of LRI deaths. INTERPRETATION: The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities. FUNDING: Bill & Melinda Gates Foundation
Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990โ2019, for 204 countries and territories: the Global Burden of Diseases Study 2019
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 <0ยท03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1ยท0). Findings: In 2019, there were 36ยท8 million (95% uncertainty interval [UI] 35ยท1โ38ยท9) people living with HIV worldwide. There were 0ยท84 males (95% UI 0ยท78โ0ยท91) per female living with HIV in 2019, 0ยท99 male infections (0ยท91โ1ยท10) for every female infection, and 1ยท02 male deaths (0ยท95โ1ยท10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28ยท52% decrease in incident cases, 95% UI 19ยท58โ35ยท43, and a 39ยท66% decrease in deaths, 36ยท49โ42ยท36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0ยท05 (95% UI 0ยท05โ0ยท06) and the global incidence-to-mortality ratio was 1ยท94 (1ยท76โ2ยท12). 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
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