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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990â2021: 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 56â604 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 100â000 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 100â000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100â000 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 100â000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100â000 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
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study
Summary
Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally.
Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies
have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of
the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income
countries globally, and identified factors associated with mortality.
Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to
hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis,
exomphalos, anorectal malformation, and Hirschsprungâs disease. Recruitment was of consecutive patients for a
minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical
status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary
intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause,
in-hospital mortality for all conditions combined and each condition individually, stratified by country income status.
We did a complete case analysis.
Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital
diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal
malformation, and 517 with Hirschsprungâs disease) from 264 hospitals (89 in high-income countries, 166 in middleincome
countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male.
Median gestational age at birth was 38 weeks (IQR 36â39) and median bodyweight at presentation was 2·8 kg (2·3â3·3).
Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income
countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups).
Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome
countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries;
pâ€0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients
combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88â4·11],
p<0·0001; middle-income vs high-income countries, 2·11 [1·59â2·79], p<0·0001), sepsis at presentation (1·20
[1·04â1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention
(ASA 4â5 vs ASA 1â2, 1·82 [1·40â2·35], p<0·0001; ASA 3 vs ASA 1â2, 1·58, [1·30â1·92], p<0·0001]), surgical safety
checklist not used (1·39 [1·02â1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed
(ventilation 1·96, [1·41â2·71], p=0·0001; parenteral nutrition 1·35, [1·05â1·74], p=0·018). Administration of
parenteral nutrition (0·61, [0·47â0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65
[0·50â0·86], p=0·0024) or percutaneous central line (0·69 [0·48â1·00], p=0·049) were associated with lower mortality.
Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome,
middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will
be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger
than 5 years by 2030
Molecular identification of heteroatomic and metal species related to hydrometallation and hydroconversion.
La prĂ©sence d'hĂ©tĂ©roatomes et mĂ©taux dans des fractions lourdes de pĂ©trole brut peuvent entraĂźner la dĂ©sactivation des catalyseurs dâhydrotraitement et dâhydrocraquage. Les composĂ©s contenant ces Ă©lĂ©ments sont connus pour ĂȘtre inclus dans des agrĂ©gats macromolĂ©culaires dâasphaltĂšnes, qui sont considĂ©rĂ©es comme les composants les plus problĂ©matiques des produits pĂ©troliers. Ces travaux ont pour objectif dâapporter une meilleure comprĂ©hension de lâenvironnement chimique de ces espĂšces et des phĂ©nomĂšnes dâagrĂ©gation pour optimiser les processus de raffinage. Des techniques de sĂ©paration comme la chromatographie de permĂ©ation de gel ou Gel Permeation Chromatography (GPC), Advanced Polymer chromatographie (APC) et la chromatographie sur couche mince dâhaute performance ou High Performance Thin Layer Chromatography (HPTLC) ont Ă©tĂ© combinĂ©es avec des techniques dâanalyse Ă©lĂ©mentaire comme la spectromĂ©trie de masse Ă plasma Ă couplage inductif ou Inductively Coupled Plasma Mass Spectrometry (ICP-MS) et la spectromĂ©trie de masse molĂ©culaire dâhaute rĂ©solution pour la caractĂ©risation des fractions pĂ©troliĂšres lourdes. Les profils de distribution en taille dâespĂšces qui contiennent du vanadium, du nickel et du soufre, les hĂ©tĂ©roatomes et mĂ©taux les plus abondants dans les produits pĂ©troliers, ont Ă©tĂ© dĂ©terminĂ©s par GPC couplĂ© Ă une dĂ©tection Ă©lĂ©mentaire par ICP MS. Les paramĂštres ayant le plus dâimpact sur la distribution en taille et lâĂ©volution des agrĂ©gats dans les solutions de diffĂ©rentes coupes pĂ©troliĂšres ont Ă©tĂ© optimisĂ©s. Cela nous a permis de faire diffĂ©rentes comparaisons, entre de nombreuses charges et effluents de procĂ©dĂ©s, ainsi que dâautres sĂ©ries dâĂ©chantillons ou de mĂ©langes provenant dâunitĂ©s-pilotes dâhydrotraitement. Les rĂ©sultats obtenus ont pu ĂȘtre mis en regard de caractĂ©ristiques macroscopiques comme la viscositĂ©. Le couplage du nouveau systĂšme APC avec lâICP MS a Ă©tĂ© mis au point avec succĂšs. Cette technique a permis de rĂ©aliser des cartographies dâĂ©chantillons pĂ©troliers plus rapides quâen GPC tout en consommant moins de solvant. Cependant, les diffĂ©rences des chromatogrammes APC obtenus par rapport aux profils GPC suggĂšrent des interactions indĂ©sirables avec la phase stationnaire, qui ont Ă©tĂ© lâobjet dâune Ă©valuation approfondie.Enfin, un dernier type de sĂ©paration a Ă©tĂ© Ă©valuĂ©e. LâHPTLC, qui utilise des plaques Ă usage unique, peut ĂȘtre appliquĂ©e Ă la sĂ©paration de produits lourds par polaritĂ©, et ce sans Ă©tapes de dĂ©asphaltage prĂ©alable, contrairement aux colonnes de chromatographie liquide qui peuvent ĂȘtre dĂ©tĂ©riorĂ©es Ă cause de l'adsorption irrĂ©versible et de la prĂ©cipitation des asphaltĂšnes. DiffĂ©rents types de plaques et Ă©luants ont Ă©tĂ© testĂ©s afin de dĂ©velopper une mĂ©thode simple pour la sĂ©paration des fractions SAR (SaturĂ©s, Aromatiques et RĂ©sines) des Ă©chantillons de distillat sous vide ou Vacuum Gas Oil (VGO). Ce travail avait pour but des migrations en une seule Ă©tape et analyse UV qui pourrait ĂȘtre mis en Ćuvre pour lâanalyse de routine dans les laboratoires de contrĂŽle avec une adsorption irrĂ©versible rĂ©duite. Des rĂ©sultats trĂšs prometteurs ont Ă©tĂ© obtenus avec lâutilisation de plaques de cellulose pour la sĂ©paration des familles de polaritĂ© diffĂ©rentes au sein des agrĂ©gats dâasphaltĂšnes. Des tests sur l'analyse directe des plaques par DĂ©sorption-Ionisation par ĂlectronĂ©bulisation (DESI) MS, l'analyse directe en temps rĂ©el ou Direct Analysis in Real Time (DART) MS et Ablation Laser (LA) ICP MS ont Ă©tĂ© effectuĂ©s.The presence of heteroatoms and metals in heavy fractions of crude oil can cause the deactivation of hydrotreatment and hydrocracking catalysts. Compounds containing these elements are known to be included in macromolecular asphaltene aggregates, which are considered the most problematic components of heavy oil. This thesis aimed for a better understanding of the chemical environment of these species and on the aggregation phenomenon to optimize refining processes. Separation techniques such as Gel Permeation Chromatography (GPC), Advanced Polymer Chromatography (APC) and High Performance Thin Layer Chromatography (HPTLC) were combined with elementary analysis techniques such as Inductively Coupled Plasma Mass Spectrometry (ICP MS) or high-resolution molecular mass spectrometry for the characterization of heavy fractions of crude oil. Here, the size profiles of species that contain vanadium, nickel and sulfur, the most abundant heteroatoms and metals present in petroleum products, were determined by GPC online with elemental detection by ICP MS. The parameters having the most significant impact on size distribution and the evolution over time of aggregates from solutions of different petroleum cuts were optimized. This allowed the comparison between various feeds and effluents and other series of samples and mixtures from pilot units of refining processes by GPC ICP MS. Results obtained could be related to macroscopic characteristics such as viscosity. Hyphenation of the new APC System to ICP MS has been successfully completed. It allowed the mapping of petroleum samples faster than GPC, therefore with less solvent consumption. However, the differences of the APC chromatograms obtained with respect to the GPC profiles suggested significant unwanted interactions of the highly polar compounds of the petroleum samples with the stationary phase, which have been thoroughly studied. Finally, another type of separation was evaluated. HPTLC, of single-use plates, can be applied to the analysis of heavy petroleum products by polarity without prior deasphalting steps while chromatography columns can be deteriorated because of the irreversible adsorption and asphaltene precipitation. To this end, various types of plates and eluents were tested to develop straightforward SAR (Saturates, Aromatics and Resins) separations of Vacuum Gas Oil (VGO) samples. This method, based on single-step migrations with reduced irreversible adsorption and UV monitoring, could be implemented for routine analysis in control laboratories. Very promising results were obtained by the use of cellulose plates for the separation of different families within asphaltene aggregates. Tests on Desorption ElectroSpray Ionization (DESI) MS, Direct Analysis in Real Time (DART) MS and Laser Ablation (LA) ICP MS analyses of the plates have been performed
Molecular Fingerprints and Speciation of Crude Oils and Heavy Fractions Revealed by Molecular and Elemental Mass Spectrometry: Keystone between Petroleomics, Metallopetroleomics, and Petrointeractomics
International audiencePetroleum and its fractions are some of the most complex mixtures found in analytical chemistry. Mass spectrometry currently plays an increasing role in the characterization of these matrices. Since the last review on this topic in 2011, several new approaches have been introduced, and these approaches increasingly use sample fractionation by extraction and/or liquid chromatographic techniques. This review considers molecular mass spectrometry (with special emphasis on the use of ion mobility) and inorganic mass spectrometry. The combination of both techniques paves the way to "petrointeractomic" approaches, which are introduced as a novel, important part of "petroleomic" approaches