Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Photochemical formation of gold nanoparticles in aqueous Triton X-100 and its application for cyanide determination

75-78Pink coloured stable gold sol (λmax: 523 nm) has been prepared photochemi cally in aqueous Triton X-100 (TX-100) medium and used for spectrophotometric determination of cyanide. The colour of the sol decreases on cyanide addition and becomes colourless at the end point. Linear calibration is obtained in the range of 0-26 ppm of cyanide concentration. The relative standard deviation for 8.65 ppm of cyanide is found to be ±2.03%. The method is simple, rapid and applied for real sample analysis

Fluorometric determination of trichloroacetic acid and its application in water sample analysis

253-255<span style="font-size:11.0pt;line-height:115%; font-family:" calibri","sans-serif";mso-ascii-theme-font:minor-latin;mso-fareast-font-family:="" "dejavu="" sans";mso-hansi-theme-font:minor-latin;mso-bidi-font-family:mangal;="" mso-bidi-theme-font:minor-bidi;color:#00000a;mso-ansi-language:en-us;="" mso-fareast-language:en-us;mso-bidi-language:ar-sa"="">A simple and rapid method for the determination of trichloroacetic acid (TCA) at the parts per million (ppm) levels is developed. This is based on the photoreaction of TCA with diphenylamine (DPA) to give a fluorescent product (ʎem: 380 nm. ʎexc: 335 nm). The method has excellent reproducibility. The linear dynamic range for TCA is 20-200 ppm. Effects of reagent concentration, irradiation time and solvent are studied. The method is applicable to water analysis.</span

Fluorimetric determination of bromoform via its photochemical reaction with diphenylamine in aqueous Triton X-100 medium

15-19A new fluorimetric method based on the photochemical reaction of CHBr3 with diphenylamine (DPA) in aqueous Triton X-100 (TX-100) medium is described for the determination of bromoform (CHBr3)' The fluorescence intensity of the product at 480nm (λex: 400 nm) is a direct measure of CHBr3 concentration. The calibration graph is linear in the range of 0-21.8 ppm of CHBr3. The limit of detection (LOD) is 0.1 ppm of CHBr3. The effect of reagent concentration, TX-100 concentration, time of irradiation, interfering substances, and statistical parameters are discussed

Solvent extraction-spectrofluorometric determination of anionic surfactants using acridine orange.

105-108 A simple and rapid extraction-fluorometric method for the determination of anionic surfactant (AS) at the parts-per-billion (ppb) level is developed. Sodium dodecyl sulfate (SDS), an anionic surfactant after the formation of an ion-associate with acridine orange (ACO), a fluorescent cationic dye was extracted in toluene. The fluorescence intensity (λem : 530 nm,λexc: 480 nm) of the complex is a direct measure of the SDS concentration. The calibration graph is linear in the range of 0-1040 ppb of SDS (in toluene). The relative standard deviation is < ± 7%. The method is applicable to river water, pond water and tap water. It is free from interference from sodium chloride upto 0.5M concentration level, and also from many cations and anions upto a large concentration.    

Photochemical reaction of trihalomethanes with diphenylamine in organic media and its analytical application

290-294Photochemical reaction of trihalomethanes (THMs) such as dichlorobromomethane (CHBrCl2), dibromochloromethane (CHBr2Cl), and bromoform (CHBr3) with diphenylamine (DPA) in acetonitrile (CH3CN) leading to a fluorescent product (λem: 480 nm, λex: 400 nm) has been studied for the first time. The fluorescence intensity of the product is a direct measure of THM concentration. The limits of detection (LODs) are in the sub parts per million (ppm) levels and can further be lowered through pre-extraction step. The photochemical reaction of CHBr3 with DPA for its quantification through fluorescence analysis has been utilized. The effect of reagent concentration, irradiation time, solvent and interfering substances are discussed. The statistical parameters are reported. The method can be applied for CHBr3 detection in water samples also

Spectrophotometric determination of anionic surfactants in wastewater using acridine orange

145-148A simple and rapid spectrophotometric method for the determination of sodium dodecyl sulphate (SDS), an anionic surfactant (AS) is developed. SDS forms a yellow coloured complex with acridine orange (ACO), a cationic dye. The complex is extracted in toluene. The absorbance of the complex in toluene layer is measured at maximum wavelength (λmax) of 467 nm. The calibration curve is linear in the range of 0 – 6.0 ppm of SDS concentration. The method is compared with the standard MBAS method in terms of time, ease and accuracy. It is noticed that the present method is much easier and less time consuming. The method requires chemicals, which are less toxic than those required for the standard method. The method is applicable to wastewater analysis

Adsorbent selection for anionic surfactant removal from water

281-284In the present study, an attempt was made to find out a low cost adsorbing material for the removal of anionic surfactant (AS) from water. Sodium dodecyl sulphate (SDS) has been selected as a representative member of AS. Adsorbents such as granular activated charcoal, waste tire rubber granules, wood charcoal, and silica gel were tried. Kinetic profiles of removal of SDS were generated for all materials to assess the equilibrium time. The percentage of SDS removal at 7h equilibrium time was 96% for granular activated charcoal, 96.5% for waste tire rubber granules, 88% for wood charcoal and 92% for silica gel. Equilibrium studies were carried out for all materials to assess the adsorption equilibrium model that they followed. The correlation coefficients were determined by linear regression analysis, and compared. Maximum adsorption capacities (Qmax) for granular activated charcoal, waste tire rubber granules, wood charcoal and silica gel, were found to be 3.750, 4.164, 5.170 and 5.181 mg/g, respectively. The removal efficiency, maximum adsorption capacity and cost were the guiding parameters for the selection of the adsorbent in the present study. Considering all factors waste tire rubber granule was chosen as the best adsorbent for AS removal. The physical or chemical characteristics of the rubber granules were reported

Fine needle aspiration cytology of ovarian tumors with histological correlation

Background: Till today, there has been some hesitation to accept the role of fine needle aspiration cytology (FNAC) in pelvic mass. We have tried to study the role of ultrasonography (USG) and computed tomography (CT) guided FNAC as diagnostic and supportive investigation for ovarian tumors. Aim: To evaluate the current status of image-directed percutaneous aspiration of ovarian neoplasm for the purpose of early detection of malignancy. Materials and Methods: Seventy-four fine needle aspirations of ovarian neoplasms were performed between January 2007 and December 2008 by transabdominal approach under USG and CT guidance and correlated with histopathological findings and tumor markers. Results: A total of 47 (63.5%) cases were assessed as malignant and 21 (28.3%) as benign and 6 (8.1%) as inconclusive. The neoplastic lesions were categorized as per World Health Organization (WHO) classification. Conclusion: With the availability of modern techniques, USG and CT guided FNAC can be an optimum modality for the diagnosis of primary and metastatic ovarian neoplasms and evaluation of recurrent malignant tumors, which has great impact on patient management consequently

INVOLVEMENT OF OXIDATIVE STRESS IN ISCHEMIC HEART DISEASE (IHD) IN PATIENTS ADMITTED IN A TERTIARY CARE HOSPITAL, WEST BENGAL, INDIA

Objectives: The present study is aimed at investigating the involvement of oxidative stress in ischemic heart disease (IHD) of patients in tertiary care hospital in Kolkata. Methods: Serum parameters of myocardial injury, oxidative stress biomarkers and antioxidant enzymes were measured. These data were supported by the data of electrocardiography and echocardiography. Results: The current studies indicate involvement of oxidative stress in Indian IHD patients, and assessing these biomarkers may be useful in diagnosis of patients with ischemic hypertrophic cardiomyopathy. Conclusion: Cardiovascular diseases are becoming one of the leading health problems in India. The majority of cardiovascular diseases and related complications occur due to imbalance of oxidants and pro-oxidants in an individual. Thus, oxidative stress is one of the main factors in ischemic heart disease (IHD). &nbsp