Measuring progress and projecting attainment on the basis of past trends of the health-related Sustainable Development Goals in 188 countries: an analysis from the Global Burden of Disease Study 2016

The UN’s Sustainable Development Goals (SDGs) are grounded in the global ambition of “leaving no one behind”. Understanding today’s gains and gaps for the health-related SDGs is essential for decision makers as they aim to improve the health of populations. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), we measured 37 of the 50 health-related SDG indicators over the period 1990–2016 for 188 countries, and then on the basis of these past trends, we projected indicators to 2030

Erratum: Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Interpretation: By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49\ub74% (95% uncertainty interval [UI] 46\ub74–52\ub70). The TFR decreased from 4\ub77 livebirths (4\ub75–4\ub79) to 2\ub74 livebirths (2\ub72–2\ub75), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83\ub78 million people per year since 1985. The global population increased by 197\ub72% (193\ub73–200\ub78) since 1950, from 2\ub76 billion (2\ub75–2\ub76) to 7\ub76 billion (7\ub74–7\ub79) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2\ub70%; this rate then remained nearly constant until 1970 and then decreased to 1\ub71% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2\ub75% in 1963 to 0\ub77% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2\ub77%. The global average age increased from 26\ub76 years in 1950 to 32\ub71 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59\ub79% to 65\ub73%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1\ub70 livebirths (95% UI 0\ub79–1\ub72) in Cyprus to a high of 7\ub71 livebirths (6\ub78–7\ub74) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0\ub708 livebirths (0\ub707–0\ub709) in South Korea to 2\ub74 livebirths (2\ub72–2\ub76) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0\ub73 livebirths (0\ub73–0\ub74) in Puerto Rico to a high of 3\ub71 livebirths (3\ub70–3\ub72) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2\ub70% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress. Funding: Bill & Melinda Gates Foundation

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

NANCY: Next-generation All-sky Near-infrared Community surveY

International audienceThe Nancy Grace Roman Space Telescope is capable of delivering an unprecedented all-sky, high-spatial resolution, multi-epoch infrared map to the astronomical community. This opportunity arises in the midst of numerous ground- and space-based surveys that will provide extensive spectroscopy and imaging together covering the entire sky (such as Rubin/LSST, Euclid, UNIONS, SPHEREx, DESI, SDSS-V, GALAH, 4MOST, WEAVE, MOONS, PFS, UVEX, NEO Surveyor, etc.). Roman can uniquely provide uniform high-spatial-resolution (~0.1 arcsec) imaging over the entire sky, vastly expanding the science reach and precision of all of these near-term and future surveys. This imaging will not only enhance other surveys, but also facilitate completely new science. By imaging the full sky over two epochs, Roman can measure the proper motions for stars across the entire Milky Way, probing 100 times fainter than Gaia out to the very edge of the Galaxy. Here, we propose NANCY: a completely public, all-sky survey that will create a high-value legacy dataset benefiting innumerable ongoing and forthcoming studies of the universe. NANCY is a pure expression of Roman's potential: it images the entire sky, at high spatial resolution, in a broad infrared bandpass that collects as many photons as possible. The majority of all ongoing astronomical surveys would benefit from incorporating observations of NANCY into their analyses, whether these surveys focus on nearby stars, the Milky Way, near-field cosmology, or the broader universe

NANCY: Next-generation All-sky Near-infrared Community surveY

International audienceThe Nancy Grace Roman Space Telescope is capable of delivering an unprecedented all-sky, high-spatial resolution, multi-epoch infrared map to the astronomical community. This opportunity arises in the midst of numerous ground- and space-based surveys that will provide extensive spectroscopy and imaging together covering the entire sky (such as Rubin/LSST, Euclid, UNIONS, SPHEREx, DESI, SDSS-V, GALAH, 4MOST, WEAVE, MOONS, PFS, UVEX, NEO Surveyor, etc.). Roman can uniquely provide uniform high-spatial-resolution (~0.1 arcsec) imaging over the entire sky, vastly expanding the science reach and precision of all of these near-term and future surveys. This imaging will not only enhance other surveys, but also facilitate completely new science. By imaging the full sky over two epochs, Roman can measure the proper motions for stars across the entire Milky Way, probing 100 times fainter than Gaia out to the very edge of the Galaxy. Here, we propose NANCY: a completely public, all-sky survey that will create a high-value legacy dataset benefiting innumerable ongoing and forthcoming studies of the universe. NANCY is a pure expression of Roman's potential: it images the entire sky, at high spatial resolution, in a broad infrared bandpass that collects as many photons as possible. The majority of all ongoing astronomical surveys would benefit from incorporating observations of NANCY into their analyses, whether these surveys focus on nearby stars, the Milky Way, near-field cosmology, or the broader universe

NANCY: Next-generation All-sky Near-infrared Community surveY

International audienceThe Nancy Grace Roman Space Telescope is capable of delivering an unprecedented all-sky, high-spatial resolution, multi-epoch infrared map to the astronomical community. This opportunity arises in the midst of numerous ground- and space-based surveys that will provide extensive spectroscopy and imaging together covering the entire sky (such as Rubin/LSST, Euclid, UNIONS, SPHEREx, DESI, SDSS-V, GALAH, 4MOST, WEAVE, MOONS, PFS, UVEX, NEO Surveyor, etc.). Roman can uniquely provide uniform high-spatial-resolution (~0.1 arcsec) imaging over the entire sky, vastly expanding the science reach and precision of all of these near-term and future surveys. This imaging will not only enhance other surveys, but also facilitate completely new science. By imaging the full sky over two epochs, Roman can measure the proper motions for stars across the entire Milky Way, probing 100 times fainter than Gaia out to the very edge of the Galaxy. Here, we propose NANCY: a completely public, all-sky survey that will create a high-value legacy dataset benefiting innumerable ongoing and forthcoming studies of the universe. NANCY is a pure expression of Roman's potential: it images the entire sky, at high spatial resolution, in a broad infrared bandpass that collects as many photons as possible. The majority of all ongoing astronomical surveys would benefit from incorporating observations of NANCY into their analyses, whether these surveys focus on nearby stars, the Milky Way, near-field cosmology, or the broader universe

NANCY: Next-generation All-sky Near-infrared Community surveY

International audienceThe Nancy Grace Roman Space Telescope is capable of delivering an unprecedented all-sky, high-spatial resolution, multi-epoch infrared map to the astronomical community. This opportunity arises in the midst of numerous ground- and space-based surveys that will provide extensive spectroscopy and imaging together covering the entire sky (such as Rubin/LSST, Euclid, UNIONS, SPHEREx, DESI, SDSS-V, GALAH, 4MOST, WEAVE, MOONS, PFS, UVEX, NEO Surveyor, etc.). Roman can uniquely provide uniform high-spatial-resolution (~0.1 arcsec) imaging over the entire sky, vastly expanding the science reach and precision of all of these near-term and future surveys. This imaging will not only enhance other surveys, but also facilitate completely new science. By imaging the full sky over two epochs, Roman can measure the proper motions for stars across the entire Milky Way, probing 100 times fainter than Gaia out to the very edge of the Galaxy. Here, we propose NANCY: a completely public, all-sky survey that will create a high-value legacy dataset benefiting innumerable ongoing and forthcoming studies of the universe. NANCY is a pure expression of Roman's potential: it images the entire sky, at high spatial resolution, in a broad infrared bandpass that collects as many photons as possible. The majority of all ongoing astronomical surveys would benefit from incorporating observations of NANCY into their analyses, whether these surveys focus on nearby stars, the Milky Way, near-field cosmology, or the broader universe

NANCY: Next-generation All-sky Near-infrared Community surveY

International audienceThe Nancy Grace Roman Space Telescope is capable of delivering an unprecedented all-sky, high-spatial resolution, multi-epoch infrared map to the astronomical community. This opportunity arises in the midst of numerous ground- and space-based surveys that will provide extensive spectroscopy and imaging together covering the entire sky (such as Rubin/LSST, Euclid, UNIONS, SPHEREx, DESI, SDSS-V, GALAH, 4MOST, WEAVE, MOONS, PFS, UVEX, NEO Surveyor, etc.). Roman can uniquely provide uniform high-spatial-resolution (~0.1 arcsec) imaging over the entire sky, vastly expanding the science reach and precision of all of these near-term and future surveys. This imaging will not only enhance other surveys, but also facilitate completely new science. By imaging the full sky over two epochs, Roman can measure the proper motions for stars across the entire Milky Way, probing 100 times fainter than Gaia out to the very edge of the Galaxy. Here, we propose NANCY: a completely public, all-sky survey that will create a high-value legacy dataset benefiting innumerable ongoing and forthcoming studies of the universe. NANCY is a pure expression of Roman's potential: it images the entire sky, at high spatial resolution, in a broad infrared bandpass that collects as many photons as possible. The majority of all ongoing astronomical surveys would benefit from incorporating observations of NANCY into their analyses, whether these surveys focus on nearby stars, the Milky Way, near-field cosmology, or the broader universe