Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Study the Growth Attributes of Cotton as Influenced by Various Levels of Nitrogen under Rainfed Condition

The field investigation was carried out at Department of Agronomy farm, Dr. Panjabrao Deshmukh Krishi Vidyapeeth, Akola during 2019-20. The experiment was laid out in randomized block design with three replications and seven different nitrogen levels treatment with an objective to study the growth and yield of cotton as influenced by various levels of nitrogen under rainfed condition. Treatments consisted of different nutrient management practices including FYM and nitrogen doses viz., Absolute Control (N1), FYM @ 5 t ha-1 (N2), N2 + 30 kg N ha-1 (N3), N2 + 60 kg N ha-1 (N4), N2 + 90 kg N ha-1 (N5), N2 +120 kg N ha-1 (N6) and N2 + 150 kg N ha-1 (N7). Cotton crop was sawn on 29th June 2019 while it was harvested in four pickings. The result revealed that a significant differences in plant height, leaf area, number of sympodial branches and dry matter accumulation and until harvest. Growth attributes viz., plant height and numbers of sympodial branches were maximum in treatment of FYM @ 5 t ha-1+150 kg N ha-1. However, leaf area and dry matter accumulation were maximum with treatment of FYM @ 5 t ha-1+120 kg N ha-1

Performance of Different Radish (Raphanus sativus L.) Varieties in Black Soils of Vidharbha-Maharashtra

The present study was carried out at ‘Chilli and Vegetable Research Unit’, Dr. Panjabrao Deshmukh Krishi Vidyapeeth, Akola, Maharashtra, India during winter season of 2013-14 to investigate growth, yield and qualitative parameters of various radish varieties. The experiment was laid out in Randomized Block Design (R.B.D.) with seven treatments and three replications. Seven varieties of radish, used for the study as treatments were viz., V1- Pusa Desi, V2-PusaChetki, V3- Pusa Reshmi, V4- Pusa Himani,V5- Japanese White, V6- Arka Nishant and V7- IHR-1-1. The plant height was supreme (28.29 cm) in Arka Nishant, maximum chlorophyll content of leaves (3.10 mg g-1) recorded in Arka Nishant. The variety Arka Nishant required minimum (43 days) number of days, in weight of total fresh weight of plant (190.06 g to 226.60 g) were observed. It was maximum in variety Arka Nishant, whereas, minimum in variety Pusa Desi. The variations in fresh weight of root (122.76 g to 161.74 g) were observed. The maximum root to shoot ratio (1.37) was observed in variety Arka Nishant. The values of root diameter were maximum (3.69 cm) in variety Arka Nishant. The maximum root yield plot-1 (32.34 kg plot-1) and hectare-1 (53.91 t ha-1) was produced in variety Arka Nishant. The maximum moisture content of root (97.75%) was recorded in Arka Nishant variety. The ascorbic acid content was maximum (18.36 mg 100 g-1), TSS (4.00 0B) was recorded in the variety Arka Nishant

Performance of Different Radish (Raphanus sativus L.) Varieties in Black Soils of Vidharbha-Maharashtra

The present study was carried out at ‘Chilli and Vegetable Research Unit’, Dr. Panjabrao Deshmukh Krishi Vidyapeeth, Akola, Maharashtra, India during winter season of 2013-14 to investigate growth, yield and qualitative parameters of various radish varieties. The experiment was laid out in Randomized Block Design (R.B.D.) with seven treatments and three replications. Seven varieties of radish, used for the study as treatments were viz., V1- Pusa Desi, V2-PusaChetki, V3- Pusa Reshmi, V4- Pusa Himani,V5- Japanese White, V6- Arka Nishant and V7- IHR-1-1. The plant height was supreme (28.29 cm) in Arka Nishant, maximum chlorophyll content of leaves (3.10 mg g-1) recorded in Arka Nishant. The variety Arka Nishant required minimum (43 days) number of days, in weight of total fresh weight of plant (190.06 g to 226.60 g) were observed. It was maximum in variety Arka Nishant, whereas, minimum in variety Pusa Desi. The variations in fresh weight of root (122.76 g to 161.74 g) were observed. The maximum root to shoot ratio (1.37) was observed in variety Arka Nishant. The values of root diameter were maximum (3.69 cm) in variety Arka Nishant. The maximum root yield plot-1 (32.34 kg plot-1) and hectare-1 (53.91 t ha-1) was produced in variety Arka Nishant. The maximum moisture content of root (97.75%) was recorded in Arka Nishant variety. The ascorbic acid content was maximum (18.36 mg 100 g-1), TSS (4.00 0B) was recorded in the variety Arka Nishant

Feasibility of Multispectral Observations for Detecting Nitrogen Stress and Yield Potential in Cotton (Gossypium hirsutum L.) through Remote Sensing

The present investigation was conducted during kharif 2019-20 at Department of Agronomy farm, Dr. Panjabrao Deshmukh Krishi Vidyapeeth, Akola. The experiment was laid out in randomized block design with seven treatments and three replications. Treatments consisted of different nutrient management practices including FYM and nitrogen doses viz., Absolute Control (N1), FYM @ 5 t ha-1 (N2), N2 + 30 kg N ha-1 (N3), N2 + 60 kg N ha-1 (N4), N2 + 90 kg N ha-1 (N5), N2 +120 kg N (N6) and N2 + 150 kg N ha-1 (N7). Cotton crop was sown on 29th June 2019 and was harvested in four pickings. Among various spectral bands, significantly higher positive and negative correlation coefficient values (at 0.05 % level of significance) for plant chlorophyll content were noted with the simple ratio of NIR/G (r2=0.829) and G/NIR(r2=-0.826), respectively, being most efficient in detecting the nitrogen stress in cotton crop. Yield potential of cotton was established (at 0.05 % level of significance) with negative and positive (both) correlation coefficient of simple ratio of R/NIR (r2=-0.815 and r2=-0.869) and NIR/R (r2=0.811and r2=0.865) respectively at 180 DAS

Assessment of Micronutrient Content and Strategies for Improvement of Micronutrient Status in the Soils of Bhandara Tehsil, Maharashtra, India

The study was undertaken to determine the available micro-nutrient status of the Bhandara tehsil of Maharashtra with the help of GPS-based one hundred-and-five soil samples during the period of 2021-2022 from paddy growing fields. Samples were analyzed at the Soil Science and Agricultural Chemistry Section, College of Agriculture, Nagpur. The results revealed that soils were clay loam to sandy clay loam in texture. The study area was slightly acidic to slightly alkaline and non-saline in reaction. The mean values of 0.42 mg kg-1, 5.44 mg kg-1, 6.39 mg kg-1, 0.98 mg kg-1, and 0.90 mg kg-1 for Zn, Fe, Mn, Cu and B respectively, were recorded. The soil nutrient index values showed that available Zn was low; available Fe was moderate; available Mn and B were moderately high; and available Cu was high. The farmers of the study area mostly adopt improper nutrient management practices which might have resulted in poor fertility status in the area.  Taking these things into consideration, a data-driven Decision Support System (DSS) on micronutrient management in soil has been given. To address this problem, farmers of Bhandara tehsil may use micronutrient fertilizers or implement soil management practices that promote the uptake and availability of micronutrients to plants

Global, regional, and national burden of meningitis and its aetiologies, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we aimed to assess incident cases and deaths due to acute infectious meningitis by aetiology and age from 1990 to 2019, for 204 countries and territories. Methods We modelled meningitis mortality using vital registration, verbal autopsy, sample-based vital registration, and mortality surveillance data. Meningitis morbidity was modelled with a Bayesian compartmental model, using data from the published literature identified by a systematic review, as well as surveillance data, inpatient hospital admissions, health insurance claims, and cause-specific meningitis mortality estimates. For aetiology estimation, data from multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature studies were analysed by use of a network analysis model to estimate the proportion of meningitis deaths and cases attributable to the following aetiologies: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococcus, Escherichia coli, Klebsiella pneumoniae, Listeria monocytogenes, Staphylococcus aureus, viruses, and a residual other pathogen category. Findings In 2019, there were an estimated 236 000 deaths (95% uncertainty interval [UI] 204 000-277 000) and 2.51 million (2.11-2.99) incident cases due to meningitis globally. The burden was greatest in children younger than 5 years, with 112 000 deaths (87 400-145 000) and 1.28 million incident cases (0.947-1.71) in 2019. Age-standardised mortality rates decreased from 7.5 (6.6-8.4) per 100 000 population in 1990 to 3.3 (2.8-3.9) per 100 000 population in 2019. The highest proportion of total all-age meningitis deaths in 2019 was attributable to S pneumoniae (18.1% [17.1-19.2]), followed by N meningitidis (13.6% [12.7-14.4]) and K pneumoniae (12.2% [10.2-14.3]). Between 1990 and 2019, H influenzae showed the largest reduction in the number of deaths among children younger than 5 years (76.5% [69.5-81.8]), followed by N meningitidis (72.3% [64.4-78.5]) and viruses (58.2% [47.1-67.3]). Interpretation Substantial progress has been made in reducing meningitis mortality over the past three decades. However, more meningitis-related deaths might be prevented by quickly scaling up immunisation and expanding access to health services. Further reduction in the global meningitis burden should be possible through low-cost multivalent vaccines, increased access to accurate and rapid diagnostic assays, enhanced surveillance, and early treatmen

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

Summary 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 23 109 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 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) 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 (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). 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 (–70·7% [–77·2 to –61·8]). 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] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) 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