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

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

A non-volatile chalcogenide switchable hyperbolic metamaterial

Phase change materials have enabled the realization of dynamic nanophotonic devices with various functionalities. Reconfigurable hyperbolic metamaterials integrated with such elements have been demonstrated in the past but the volatile nature of their optical properties is a limitation, particularly for applications that require the device to be preserved in a specified state. Here, a proof-of-concept demonstration of a non-volatile, switchable hyperbolic metamaterial based on a chalcogenide glass is reported. By using the Ge2Sb2Te5 alloy as one of the components of a multilayered nanocomposite structure and exploiting its phase change property, a hyperbolic metamaterial in which the type-I hyperbolic dispersion (ε⊥ 0) and negative refraction can be switched from the near-infrared to the visible region is demonstrated. This opens up new opportunities for reconfigurable device applications, such as imaging, optical data storage, and sensing.MOE (Min. of Education, S’pore)Accepted versio

Topological insulator metamaterials

Confinement of electromagnetic fields at the subwavelength scale via metamaterial paradigms is an established method to engineer light-matter interaction in most common material systems, from insulators to semiconductors and from metals to superconductors. In recent years, this approach has been extended to the realm of topological materials, providing a new avenue to access nontrivial features of their electronic band structure. In this review, we survey various topological material classes from a photonics standpoint, including crystal growth and lithographic structuring methods. We discuss how exotic electronic features such as spin-selective Dirac plasmon polaritons in topological insulators or hyperbolic plasmon polaritons in Weyl semimetals may give rise to unconventional magneto-optic, nonlinear, and circular photogalvanic effects in metamaterials across the visible to infrared spectrum. Finally, we dwell on how these effects may be dynamically controlled by applying external perturbations in the form of electric and magnetic fields or ultrafast optical pulses. Through these examples and future perspectives, we argue that topological insulator, semimetal and superconductor metamaterials are unique systems to bridge the missing links between nanophotonic, electronic, and spintronic technologies.Ministry of Education (MOE)National Research Foundation (NRF)This research was supported by the Singapore Ministry of Education (Program MOE2016-T3-1-006), and the Quantum Engineering Programmes of the Singapore National Research Foundation (QEP-P1 and NRF2021-QEP2-01-P01)

Bidirectional reconfiguration and thermal tuning of microcantilever metamaterial device operating from 77 K to 400 K

We experimentally report the bidirectional reconfiguration of an out-of-plane deformable microcantilever based metamaterial for advanced and dynamic manipulation of terahertz waves. The microcantilever is made of a bimaterial stack with a large difference in the coefficient of thermal expansion of the constituent materials. This allows for the continuous deformation of microcantilevers in upward or downward direction in response to positive or negative temperature gradient, respectively. The fundamental resonance frequency of the fabricated microcantilever metamaterial is measured at 0.4 THz at room temperature of 293 K. With decreasing temperature, the resonance frequency continuously blue shifts by 30 GHz at 77 K. On the other hand, with increasing temperature, the resonance frequency gradually red shifts by 80 GHz and saturates at 0.32 THz for 400 K. Furthermore, as the temperature is increased above room temperature, which results in the downward actuation of the microcantilever, a significant resonance line-narrowing with an enhanced quality factor is observed due to tight field confinement in the metamaterial structure. The thermal control of the microcantilever possesses numerous inherent advantages such as enhanced tunable range (∼37.5% in this work compared to previously reported microcantilever metamaterials), continuous tunability, and repeatable operations. The microcantilever metamaterial also shows high robustness to operate at cryogenic conditions and hence opens up the possibility of using meta-devices in harsh environments such as space, polar, and deep sea applications.NRF (Natl Research Foundation, S’pore)Published versio

Perovskite metamaterials and metasurfaces

The development of new materials for clean and efficient energy generation and storage is an important area of research that needs to be urgently addressed in modern science due to concerns about global warming, dwindling fossil fuel reserves, and the need for energy security. Perovskite solar cells using methylammonium lead iodide, introduced by Professor Miyasaka et al. in 2009 in the field of solar cells, was selected as one of the most significant scientific breakthroughs of the year by the journals Science and Nature in 2013. I entered this exciting field as a computational chemist in 2012 with Dr. Giacomo Giorgi, one of the editors of this book, and over the past decade, I have been fascinated by the depth of OIHPs as materials, with their chemical diversity, structural diversity, and unique physical properties. It has been a fascinating and exciting field of research. “Halide Perovskites for Photonics” presents the latest experimental and theoretical methodologies for photonic applications of halide perovskites, discusses prospects for future applications, and gives the reader a timely overview of this exciting field. Topics discussed include the following: Chapter 1, Review and future perspectives on photonic applications focusing on the relationship between the nanostructure of halide perovskites and their luminescence properties; Chapter 2, Physicochemical properties of nanostructured halide perovskites and the state of the art in synthesis methods; Chapter 3, Effect of electron doping on electrical properties, such as carrier concentration, conductivity, band structure, and carrier dynamics in perovskite solar cells; Chapter 4, Role of carbon allotropes charge transport layers in improving the performance of perovskite solar cells; Chapter 5, Effect of electron doping on the performance and electrical properties of perovskite solar cells; Chapter 6, Theoretical modeling of photoexcitation dynamics, such as non-radiative relaxation of charge carriers, charge separation, and recombination at interfaces in metal halide perovskites; Chapter 7, Modeling of spontaneous emission and its amplification mechanism in polycrystalline and nanocrystalline films of lead halide perovskites; Chapter 8, Photophysics of defects in solution-processed halide perovskites and their impact on solar cell performance; Chapter 9, Optical properties of two-dimensional layered perovskites and their application to photonic devices; Chapter 10, Recent advances in perovskite nanophotonics and their paradigm with plasmonic and dielectric metamaterials; and Chapter 11, Orbital-free density functional theory and data-driven approaches to plasmonic effects for photonic applications of halide perovskites. I am confident that this book will be an attractive introduction for those who are new to this exciting field and a valuable reference for experienced researchers who are already working on specific materials development and theoretical modeling