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

Potential for the application of emerging market Z-score in UAE Islamic banks

Purpose – The purpose of this study is primarily to implement the emerging market (EM) Z-score model to predict bankruptcy and to measure the financial performance of major Islamic banks in the UAE. In addition, this study aims to introduce the Z-score model to this industry as a beneficial diagnostic tool for possible causes standing behind the deterioration of financial performance. Design/methodology/approach – The methodology that has been used in this study is based on Z-score model for EMs developed by Altman. The related studies have proved that Z-score has more than 80 percent accuracy and verified it is a robust tool and is useful in assessing the business performance and prediction of potential distress of firms. The approach determined in this study is to examine the financial statements of the UAE Islamic banks by calculating the EM Z-score for the past three years and comparing it with the current year's score as an effort to measure the overall financial performance as well as the likelihood of bankruptcy of the UAE Islamic banks. Findings – The paper finds that UAE Islamic banks should work on improving the ratios that are dragging their scores down to better understand their past performance and realize their current position in the industry; Z-score can be adopted by the UAE Islamic banks as effective evaluation approach toward financing the potential long-term partnership projects including small and medium business enterprises (SMEs); Z-score model can be adapted by Islamic banks as an independent credit risk analysis approach to measure the competencies and financial strengths of potential projects; Islamic banks in the UAE are by and large financially sound and healthy and that Z-score is a beneficial analytical tool that can be adapted by Islamic banks in the UAE to complement other financial analysis techniques to establish Islamic banking industry averages. The study also finds that the ratios used in calculating Z-score can be considered to provide valuable instrumental indicators. Research limitations/implications – Z-score model is a valid model to measure the performance of Islamic banks and the ratios used in calculating Z-score can be considered to provide valuable instrumental indicators. Z-score can be adopted by the UAE Islamic banks to finance long-term partnership projects and SMEs. Limitations including the Islamic banking industry are still considered small size, which might has negative effect on the maximum outcomes of the study. Future studies are needed toward updating the coefficient values connected to each ratios in Z-score model as per the inputs from the Islamic banking industry. Practical implications – Z-score model is a valid model to measure Islamic banks performance and the ratios used in calculating Z-score can be considered to provide valuable instrumental indicators. Z-score can be adopted by the UAE Islamic banks to finance long-term partnership projects and SMEs. Social implications – The model is believed to widen the industry exposure in order to finance more projects and companies which is believed will reflect positively on the society welfare. By adopted Z-score SMEs will be provided with all financings needed specially providing the microfinance for small projects. Originality/value – Introducing Z-score to the Islamic banking industry as crucial credit risk measuring tool.Business ethics banking, Finance, Islam, Risk management, United Arab Emirates

Obesity and Sleep-Related Breathing Disorders in Middle East and UAE

A pandemic of obesity is sweeping all across the globe and the Middle East region also does not remain untouched by this prevailing pandemic. In fact, as per WHO report, Kuwait has the second highest obesity prevalence followed closely by other Middle East (ME) countries, namely, Qatar, Saudi Arabia, and United Arab Emirates (UAE). Apart from direct medical, psychological, and quality of life related adverse effects of obesity, many indirect medical comorbidities, namely, obstructive sleep apnea (OSA), obesity hypoventilation syndrome (OHS), diabetes mellitus (DM), hypertension (HTN), and metabolic syndrome, imposes a significant health burden on the individual and community with consequent morbidity and mortality. The purpose of this review is to shed light on the very high prevalence of obesity, undiagnosed sleep apnea, and other obesity related disorders with discussion of the contributing factors specific to the region including the fair insight into the current status of sleep medicine services in Middle East and UAE despite huge number of patients having undiagnosed sleep disorders. We will also suggest to control this epidemic of obesity and OSA so that the corrective measure could be taken at health ministry level to help people of this region to fight against obesity and related disorders, primarily OSA

Accessibility and Selective Stabilization of the Principal Spin States of Iron by Pyridyl versus Phenolic Ketimines: Modulation of the \u3csup\u3e6\u3c/sup\u3eA1 ↔ \u3csup\u3e2\u3c/sup\u3eT\u3csub\u3e2\u3c/sub\u3e Ground-State Transformation of the [FeN\u3csub\u3e4\u3c/sub\u3eO\u3csub\u3e2\u3c/sub\u3e]+ Chromophore

Several potentially tridentate pyridyl and phenolic Schiff bases (apRen and HhapRen, respectively) were derived from the condensation reactions of 2-acetylpyridine (ap) and 2′-hydroxyacetophenone (Hhap), respectively, with N-R-ethylenediamine (RNHCH2CH2NH2, Ren; R = H, Me or Et) and com-plexed in situ with iron(II) or iron(III), as dictated by the nature of the ligand donor set, to generate the six-coordinate iron compounds [FeII(apRen)2]X2 (R = H, Me; X– = ClO4–, BPh4–, PF6–) and [FeIII(hapRen)2]X (R = Me, Et; X– = ClO4–, BPh4–). Single-crystal X-ray analyses of [FeII(apRen)2](ClO4)2 (R = H, Me) revealed a pseudo-octahedral geometry about the ferrous ion with the FeII–N bond dis-tances (1.896–2.041 Å) pointing to the 1A1 (dπ6) ground state; the existence of this spin state was cor-roborated by magnetic susceptibility measurements and Mössbauer spectroscopy. In contrast, the X-ray structure of the phenolate complex [FeIII(hapMen)2]ClO4, determined at 100 K, demonstrated sta-bilization of the ferric state; the compression of the coordinate bonds at the metal center is in accord with the 2T2 (dπ5) ground state. Magnetic susceptibility measurements along with EPR and Möss-bauer spectroscopic techniques have shown that the iron(III) complexes are spin-crossover (SCO) materials. The spin transition within the [FeIIIN4O2]+ chromophore was modulated with alkyl substit-uents to afford two-step and one-step 6A1 ↔ 2T2 transformations in [FeIII(hapMen)2]ClO4 and [FeIII(hapEen)2]ClO4, respectively. Previously, none of the X-salRen- and Xsal2trien-based ferric spin-crossover compounds exhibited a stepwise transition. The optical spectra of the LS iron(II) and SCO iron(III) complexes display intense dπ → pπ* and pπ → dπ CT visible absorptions, respectively, which account for the spectacular color differences. All the complexes are redox-active; as expected, the one-electron oxidative process in the divalent compounds occurs at higher redox potentials than does the reverse process in the trivalent compounds. The cyclic voltammograms of the latter com-pounds reveal irreversible electrochemical generation of the phenoxyl radical. Finally, the H2salen-type quadridentate ketimine H2hapen complexed with an equivalent amount of iron(III) to afford the μ-oxo-monobridged dinuclear complex [{FeIII(hapen)}2(μ-O)] exhibiting a distorted square- pyramidal geometry at the metal centers and considerable antiferromagnetic coupling of spins (J ≈ −99 cm−1)

Accessibility and selective stabilization of the principal spin states of iron by pyridyl versus phenolic ketimines : modulation of the 6A1↔2T2^6A_1 \leftrightarrow ^2T_2 ground-state transformation of the [FeN4O2]+[FeN_4O_2]^{+} chromophore

Several potentially tridentate pyridyl and phenolic Schi ff bases (apRen and HhapRen, respectively) were derived from the condensation reactions of 2- acetylpyridine (ap) and 2 ′ -hydroxyacetophenone (Hhap), respectively, with N -R-ethylenediamine (RNHCH 2 CH 2 NH 2 , Ren; R = H, Me or Et) and complexed in situ with iron(II) or iron(III), as dictated by the nature of the ligand donor set, to generate the six-coordinate iron compounds [Fe II (apRen) 2 ]X 2 (R = H, Me; X − = ClO 4 − , BPh 4 − ,PF 6 − ) and [Fe III (hapRen) 2 ]X (R = Me, Et; X − = ClO 4 − , BPh 4 − ). Single-crystal X-ray analyses of [Fe II (apRen) 2 ](ClO 4 ) 2 (R = H, Me) revealed a pseudo-octahedral geometry about the ferrous ion with the Fe II − N bond distances (1.896 − 2.041 Å) pointing to the 1 A 1 (d π 6 ) ground state; the existence of this spin state was corroborated by magnetic susceptibility measurements and Mo ssbauer spectroscopy. In contrast, the X-ray structure of the phenolate complex [Fe III (hapMen) 2 ]ClO 4 , determined at 100 K, demonstrated stabilization of the ferric state; the compression of the coordinate bonds at the metal center is in accord with the 2 T 2 (d π 5 ) ground state. Magnetic susceptibility measurements along with EPR and Mo ssbauer spectroscopic techniques have shown that the iron(III) complexes are spin-crossover (SCO) materials. The spin transition within the [Fe III N 4 O 2 ] + chromophore was modulated with alkyl substituents to a ff ord two-step and one-step 6 A 1 ↔ 2 T 2 transformations in [Fe III (hapMen) 2 ]ClO 4 and [Fe III (hapEen) 2 ]ClO 4 , respectively. Previously, none of the X-salRen- and X- sal 2 trien-based ferric spin-crossover compounds exhibited a stepwise transition. The optical spectra of the LS iron(II) and SCO iron(III) complexes display intense d π → p π * and p π → d π CT visible absorptions, respectively, which account for the spectacular color di ff erences. All the complexes are redox-active; as expected, the one-electron oxidative process in the divalent compounds occurs at higher redox potentials than does the reverse process in the trivalent compounds. The cyclic voltammograms of the latter compounds reveal irreversible electrochemical generation of the phenoxyl radical. Finally, the H 2 salen-type quadridentate ketimine H 2 hapen complexed with an equivalent amount of iron(III) to a ff ord the μ -oxo-monobridged dinuclear complex [{Fe III (hapen)} 2 ( μ -O)] exhibiting a distorted square-pyramidal geometry at the metal centers and considerable antiferromagnetic coupling of spins ( J ≈− 99 cm − 1 )

Accessibility and Selective Stabilization of the Principal Spin States of Iron by Pyridyl versus Phenolic Ketimines: Modulation of the ⁶<i>A</i>₁ ↔ ²<i>T</i>₂ Ground-State Transformation of the [FeN₄O₂]⁺ Chromophore

Several potentially tridentate pyridyl and phenolic Schiff bases (apRen and HhapRen, respectively) were derived from the condensation reactions of 2-acetylpyridine (ap) and 2′-hydroxyacetophenone (Hhap), respectively, with <i>N</i>-R-ethylenediamine (RNHCH₂CH₂NH₂, Ren; R = H, Me or Et) and complexed in situ with iron­(II) or iron­(III), as dictated by the nature of the ligand donor set, to generate the six-coordinate iron compounds [Fe^II(apRen)₂]­X₂ (R = H, Me; X^– = ClO₄^–, BPh₄^–, PF₆^–) and [Fe^III(hapRen)₂]­X (R = Me, Et; X^– = ClO₄^–, BPh₄^–). Single-crystal X-ray analyses of [Fe^II(apRen)₂]­(ClO₄)₂ (R = H, Me) revealed a pseudo-octahedral geometry about the ferrous ion with the Fe^II–N bond distances (1.896–2.041 Å) pointing to the ¹<i>A</i>₁ (d_π⁶) ground state; the existence of this spin state was corroborated by magnetic susceptibility measurements and Mössbauer spectroscopy. In contrast, the X-ray structure of the phenolate complex [Fe^III(hapMen)₂]­ClO₄, determined at 100 K, demonstrated stabilization of the ferric state; the compression of the coordinate bonds at the metal center is in accord with the ²<i>T</i>₂ (d_π⁵) ground state. Magnetic susceptibility measurements along with EPR and Mössbauer spectroscopic techniques have shown that the iron­(III) complexes are spin-crossover (SCO) materials. The spin transition within the [Fe^IIIN₄O₂]⁺ chromophore was modulated with alkyl substituents to afford two-step and one-step ⁶<i>A</i>₁ ↔ ²<i>T</i>₂ transformations in [Fe^III(hapMen)₂]­ClO₄ and [Fe^III(hapEen)₂]­ClO₄, respectively. Previously, none of the X-salRen- and X-sal₂trien-based ferric spin-crossover compounds exhibited a stepwise transition. The optical spectra of the LS iron­(II) and SCO iron­(III) complexes display intense d_π → p_π* and p_π → d_π CT visible absorptions, respectively, which account for the spectacular color differences. All the complexes are redox-active; as expected, the one-electron oxidative process in the divalent compounds occurs at higher redox potentials than does the reverse process in the trivalent compounds. The cyclic voltammograms of the latter compounds reveal irreversible electrochemical generation of the phenoxyl radical. Finally, the H₂salen-type quadridentate ketimine H₂hapen complexed with an equivalent amount of iron­(III) to afford the μ-oxo-monobridged dinuclear complex [{Fe^III(hapen)}₂(μ-O)] exhibiting a distorted square-pyramidal geometry at the metal centers and considerable antiferromagnetic coupling of spins (<i>J</i> ≈ −99 cm^–1)

Accessibility and Selective Stabilization of the Principal Spin States of Iron by Pyridyl versus Phenolic Ketimines: Modulation of the ⁶<i>A</i>₁ ↔ ²<i>T</i>₂ Ground-State Transformation of the [FeN₄O₂]⁺ Chromophore

Several potentially tridentate pyridyl and phenolic Schiff bases (apRen and HhapRen, respectively) were derived from the condensation reactions of 2-acetylpyridine (ap) and 2′-hydroxyacetophenone (Hhap), respectively, with <i>N</i>-R-ethylenediamine (RNHCH₂CH₂NH₂, Ren; R = H, Me or Et) and complexed in situ with iron­(II) or iron­(III), as dictated by the nature of the ligand donor set, to generate the six-coordinate iron compounds [Fe^II(apRen)₂]­X₂ (R = H, Me; X^– = ClO₄^–, BPh₄^–, PF₆^–) and [Fe^III(hapRen)₂]­X (R = Me, Et; X^– = ClO₄^–, BPh₄^–). Single-crystal X-ray analyses of [Fe^II(apRen)₂]­(ClO₄)₂ (R = H, Me) revealed a pseudo-octahedral geometry about the ferrous ion with the Fe^II–N bond distances (1.896–2.041 Å) pointing to the ¹<i>A</i>₁ (d_π⁶) ground state; the existence of this spin state was corroborated by magnetic susceptibility measurements and Mössbauer spectroscopy. In contrast, the X-ray structure of the phenolate complex [Fe^III(hapMen)₂]­ClO₄, determined at 100 K, demonstrated stabilization of the ferric state; the compression of the coordinate bonds at the metal center is in accord with the ²<i>T</i>₂ (d_π⁵) ground state. Magnetic susceptibility measurements along with EPR and Mössbauer spectroscopic techniques have shown that the iron­(III) complexes are spin-crossover (SCO) materials. The spin transition within the [Fe^IIIN₄O₂]⁺ chromophore was modulated with alkyl substituents to afford two-step and one-step ⁶<i>A</i>₁ ↔ ²<i>T</i>₂ transformations in [Fe^III(hapMen)₂]­ClO₄ and [Fe^III(hapEen)₂]­ClO₄, respectively. Previously, none of the X-salRen- and X-sal₂trien-based ferric spin-crossover compounds exhibited a stepwise transition. The optical spectra of the LS iron­(II) and SCO iron­(III) complexes display intense d_π → p_π* and p_π → d_π CT visible absorptions, respectively, which account for the spectacular color differences. All the complexes are redox-active; as expected, the one-electron oxidative process in the divalent compounds occurs at higher redox potentials than does the reverse process in the trivalent compounds. The cyclic voltammograms of the latter compounds reveal irreversible electrochemical generation of the phenoxyl radical. Finally, the H₂salen-type quadridentate ketimine H₂hapen complexed with an equivalent amount of iron­(III) to afford the μ-oxo-monobridged dinuclear complex [{Fe^III(hapen)}₂(μ-O)] exhibiting a distorted square-pyramidal geometry at the metal centers and considerable antiferromagnetic coupling of spins (<i>J</i> ≈ −99 cm^–1)