Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

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. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd

Le politiche xenofobe continuano a essere incostituzionali

In tre pronunce del 2018 la Corte costituzionale è tornata a ribadire che l’art. 3 della Costituzione è un baluardo contro scelte politiche che strumentalizzano il requisito del radicamento nel territorio, ai fini dell’accesso a provvidenze sociali, e lo trasformano in una mal celata forma di xenofobia. La Corte riconosce che, in linea di principio, le situazioni di bisogno o di disagio, riferibili direttamente alla persona in quanto tale, costituiscono il presupposto di fruibilità delle provvidenze sociali. Il dettato costituzionale è rafforzato, in maniera significativa, dal diritto antidiscriminatorio UE

Nivelación de Lenguaje - HU546 - 202101

Descripción: Nivelación de Lenguaje es un curso de formación general, de carácter práctico, dirigido a estudiantes de primeros ciclos. Esta asignatura busca desarrollar habilidades de redacción, aterrizadas en un correlato real de escritura determinado: un correo electrónico, una reseña, un párrafo de opinión, etc. Para ello, el curso se orienta a afianzar las habilidades relacionadas con la organización del texto, así como los conocimientos básicos 1sobre la normativa de la lengua española. Lo aprendido en esta asignatura ofrecerá al estudiante las herramientas lingüísticas básicas idóneas para desarrollarse con suficiencia en una redacción cotidiana, en un comentario en sus redes sociales o en un examen de algún curso. Propósito: El curso desarrolla la competencia de Comunicación Escrita, en el nivel 1; es decir, el estudiante es capaz de construir mensajes coherentes y sólidos que se adecúan a la situación y propósito comunicativo. Este desarrollo le permite la generación y construcción de nuevas ideas, lo cual es relevante para su vida académica y profesional. La actual sociedad de la información y el conocimiento, caracterizada por la disrupción, la innovación y la complejidad en las formas de comunicación mediadas por la tecnología, enfrenta al estudiante y al profesional a nuevos retos en las maneras de comunicar aquello que conoce y que construye. En este escenario, la competencia comunicativa escrita adquiere protagonismo como herramienta para transmitir el conocimiento creado. El curso se alinea con esta exigencia, pues contribuye a que el estudiante responda exitosamente a las demandas comunicativas del contexto académico, y a que el egresado pueda desenvolverse idóneamente en el campo profesional y laboral

Comprensión y Producción de Lenguaje I - HU543 - 202102

Descripción: Comprensión y Producción de Lenguaje 1 es un curso de primer ciclo, que busca desarrollar las habilidades vinculadas con la comprensión lectora y la redacción de textos escritos formales y adecuados a una situación comunicativa determinada. Por ello, durante el curso, las actividades posibilitarán que el estudiante reflexione sobre cómo el lenguaje es una herramienta que nos permite entender la realidad (comprensión) y comunicar adecuadamente nuestras ideas sobre ella (producción). Esta reflexión se realizará con énfasis en el uso del lenguaje en las redes sociales, espacio que se ha constituido como un nuevo lugar para la divulgación de asuntos diversos: desde temas de ocio o entretenimiento hasta temas académicos, científicos y políticos. En ese sentido, este curso propone que el alumno asuma el rol de un ciudadano crítico, es decir, aquella persona que no solo consume información, sino que produce contenido a partir de una investigación en fuentes confiables. Considerando lo explicado, nuestros alumnos no solo serán capaces de redactar un texto escrito formal de acuerdo con las necesidades comunicativas del ámbito universitario y de la sociedad actual, sino que podrán transformarlo en un texto multimodal (el cual involucra diferentes medios de comunicación: visual, auditivo, imagen, texto, entre otros) que tenga sentido en las redes sociales, lugar de interacción real con sus lectores. Estos productos comunicativos deberán presentar una organización conveniente, un desarrollo sólido y suficiente (lo que implica una lectura crítica de las fuentes de información), y una escritura acorde con la normativa vigente. Propósito: El curso desarrolla la competencia de comunicación escrita, en el nivel 1; es decir, el estudiante es capaz de construir mensajes coherentes y sólidos que se adecúan a la situación y propósito comunicativo. Este desarrollo le permite la generación y construcción de nuevas ideas, lo cual es relevante para su vida académica y profesional. La actual sociedad de la información y el conocimiento, caracterizada por la disrupción, la innovación y la complejidad en las formas de comunicación mediadas por la tecnología, enfrenta al estudiante y al profesional a nuevos retos en las maneras de comunicar aquello que conoce y que construye. En este escenario, la competencia comunicativa escrita adquiere protagonismo como herramienta para transmitir el conocimiento creado. El curso se alinea con esta exigencia, pues contribuye a que el estudiante responda exitosamente a las demandas comunicativas del contexto académico, y a que el egresado pueda desenvolverse idóneamente en el campo profesional y laboral

Nivelación de lenguaje - HU24 201801

Descripción: Nivelación de Lenguaje es un curso de formación general, de carácter práctico, dirigido a estudiantes de primeros ciclos. Esta asignatura busca desarrollar habilidades de redacción prácticas, aterrizadas en un correlato real de escritura determinado: un correo electrónico, una publicación de Facebook, etc. Para ello, el curso se orienta a afianzar las habilidades relacionadas con la organización del texto, así como los conocimientos básicos sobre la normativa de la lengua española. Lo aprendido en esta asignatura ofrecerá al estudiante las herramientas lingüísticas básicas idóneas para desarrollarse con suficiencia en una redacción cotidiana, en un comentario en sus redes sociales o en un examen de algún curso. Propósito: El curso desarrolla la competencia de Comunicación Escrita, en el nivel 1; es decir, el estudiante es capaz de construir mensajes coherentes y sólidos que se adecúan a la situación y propósito comunicativo. Este desarrollo le permite la generación y construcción de nuevas ideas, lo cual es relevante para su vida académica y profesional. La actual sociedad de la información y el conocimiento, caracterizada por la disrupción, la innovación y la complejidad en las formas de comunicación mediadas por la tecnología, enfrenta al estudiante y al profesional a nuevos retos en las maneras de comunicar aquello que conoce y que construye. En este escenario, la competencia comunicativa escrita adquiere protagonismo como herramienta para transmitir el conocimiento creado. El curso se alinea con esta exigencia, pues contribuye a que el estudiante responda exitosamente a las demandas comunicativas del contexto académico, y a que el egresado pueda desenvolverse idóneamente en el campo profesional y laboral

Comprensión y Producción de Lenguaje I - HU543 - 202101

Descripción: Comprensión y Producción de Lenguaje 1 es un curso de primer ciclo, que busca desarrollar las habilidades vinculadas con la comprensión lectora y la redacción de textos escritos formales y adecuados a una situación comunicativa determinada. Por ello, durante el curso, las actividades posibilitarán que el estudiante reflexione sobre cómo el lenguaje es una herramienta que nos permite entender la realidad (comprensión) y comunicar adecuadamente nuestras ideas sobre ella (producción). Esta reflexión se realizará con énfasis en el uso del lenguaje en las redes sociales, espacio que se ha constituido como un nuevo lugar para la divulgación de asuntos diversos: desde temas de ocio o entretenimiento hasta temas académicos, científicos y políticos. En ese sentido, este curso propone que el alumno asuma el rol de un ciudadano crítico, es decir, aquella persona que no solo consume información, sino que produce contenido a partir de una investigación en fuentes confiables. Considerando lo explicado, nuestros alumnos no solo serán capaces de redactar un texto escrito formal de acuerdo con las necesidades comunicativas del ámbito universitario y de la sociedad actual, sino que podrán transformarlo en un texto multimodal (el cual involucra diferentes medios de comunicación: visual, auditivo, imagen, texto, entre otros) que tenga sentido en las redes sociales, lugar de interacción real con sus lectores. Estos productos comunicativos deberán presentar una organización conveniente, un desarrollo sólido y suficiente (lo que implica una lectura crítica de las fuentes de información), y una escritura acorde con la normativa vigente. 3 Propósito: El curso desarrolla la competencia de comunicación escrita, en el nivel 1; es decir, el estudiante es capaz de construir mensajes coherentes y sólidos que se adecúan a la situación y propósito comunicativo. Este desarrollo le permite la generación y construcción de nuevas ideas, lo cual es relevante para su vida académica y profesional. La actual sociedad de la información y el conocimiento, caracterizada por la disrupción, la innovación y la complejidad en las formas de comunicación mediadas por la tecnología, enfrenta al estudiante y al profesional a nuevos retos en las maneras de comunicar aquello que conoce y que construye. En este escenario, la competencia comunicativa escrita adquiere protagonismo como herramienta para transmitir el conocimiento creado. El curso se alinea con esta exigencia, pues contribuye a que el estudiante responda exitosamente a las demandas comunicativas del contexto académico, y a que el egresado pueda desenvolverse idóneamente en el campo profesional y laboral

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. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe