Genotyping of Hepatitis B Virus in HBsAg Positive Individuals Referred to the Health Centers of Shahrekord, Iran

Background & aim: Hepatitis B Virus is one of the most important viral hepatitis which includes eight genotypes based on genetic variations in the gene encoding virus RNA polymerase. Clinical picture, treatment response and prognosis of HBV infection is genotype dependent. Therefore, this study was aimed to determine the HBV genotypes in HBsAg-positive individuals. . Methods: This experimental study was conducted on one hundred and sixteen HBsAgpositiveindividuals referred to the health centers of Shahrekord, Iran, in 2011. Firstly, the viral nucleic acid was extracted from serum samples and subsequently, the samples were subjected to Polymerase Chain Reaction (PCR). Finally, genotyping was carried out on the positive samples, using Real-time PCR with type specific primers and probes. The data were analyzed using the chisquare test. Results: 23 out of 116 (19.8%) of the HBsAg-positive individuals were positive for HBV DNA. 17 out of 23 (73.9%) and 6 out of 23 (26.1%) of the patients were found to be infected with HBV genotypes of D and C, respectively. Conclusion: Same as other regions of Iran, genotype D, , is the dominate genotype of HBV in Shahrekord, Iran. However, genotype C may be one of the other common genotypes in this region

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

A study on heavy metals in green concrete compared to the Swedish Environmental Protection Agency's guidelines.

Examensarbetet som omfattar 22,5 högskolepoäng har utförs som den slutliga delen avhögskoleingenjörsprogrammet i byggteknik, inriktning husbyggnad vid KarlstadsUniversitet.  Hållbarhet är ett viktigt ämne som berör företag av alla slag. Ingen bransch kan undvika attfundera över hur de kan främja hållbarhet. Frågan om hur varje bransch kan göra detta äralltid viktig. Genom regeringens förslag och överenskommelser står det klart attkoldioxidutsläppen ska halveras till 2030. Det är dock inte klart hur koldioxidutsläppen skahalveras.  Grön betong är en typ av miljövänlig betong där en del av cementen ersätts av masugnsslaggeller flygaska som har tagits fram av Cementa och Swecem. De två vanligaste typerna avcement som används i grön betong är Merit och Anläggningscement FA. Merit kommer frånSwecem medan Anläggningscement AF kommer från Cementa. Målet med denna typ avbetong är att minska byggbranschens koldioxidutsläpp. Rapporten syftar till att ge läsarna en överblick över de olika typer av cement som användsvid tillverkning av grön betong och dess miljökonsekvenser. Rapporten bygger på en mängdlitteraturforskning och dialog med experter från Swecem och Cementa för att få en bättreförståelse för fenomenet grön betong. Den tar också hänsyn till hur deras produkt bidrar tillhållbarhet. En labundersökning gjordes för att jämföra halterna av tungmetaller i olika typerav cement, speciellt grön betong kontra konventionell betong. S1 titan detektorn används föratt mäta och samla in data, detektorn använder röntgenfluorescens (XRF) som mätmetod. Studien fann att både produkterna Merit och Anläggningscement AF innehöll lägretungmetaller än Naturvårdsverkets gränsvärde. Grön restbetong kan återvinnas på sammasätt som en vanlig betong till ballast eller vägfyllnadsmaterial. Grön restbetong innehållerendast tungmetaller som finns i själva cementen. Grön rivningsbetong som innehåller avfallsåsom brandskydd, värmeisolering, skumplast, elinstallationer, fogmassor och rör kanpotentiellt innehålla högre halter av tungmetaller och kan leda till potentiell lakning avfarliga ämnen till naturen. The degree project, which includes 22.5 higher education credits, has been carried out as the final part of the higher education engineering program in construction technology, majoring in building construction at Karlstad University. Sustainability is an important topic that affects companies of all kinds. No industry can avoid thinking about how they can promote sustainability. The question of how each industry can do this is always important. Through the government's proposals and agreements, it is clear that carbon dioxide emissions are to be halved by 2030. However, it is not clear how carbon dioxide emissions are to be halved. Green concrete is a type of environmentally friendly concrete where part of the cement is replaced by blast furnace slag or fly ash that has been produced by Cementa and Swecem. The two most common types of cement used in green concrete are Merit and Anläggningscement FA. Merit comes from Swecem, while Construction cement AF comes from Cementa. The goal of this type of concrete is to reduce the construction industry's carbon dioxide emissions. The report aims to give readers an overview of the different types of cement used in the production of green concrete and its environmental consequences. The report is based on a lot of literature research and dialogue with experts from Swecem and Cement to gain a better understanding of the phenomenon of green concrete. It also takes into account how its product contributes to sustainability. A lab study compared the levels of heavy metals in different types of cement, especially green concrete versus conventional concrete. The S1 titanium detector is used to measure and collect data, the detector uses X-ray fluorescence(XRF) as the measurement method. The study found that both the products Merit and Anläggningscement AF contained lower heavy metals than the Environmental Protection Agency's limit value. Residual green concrete can be recycled in the same way as ordinary concrete for aggregate or road-filling material. Residual green concrete only contains heavy metals found in the cement itself. Green demolition concrete that contains waste such as fire protection, thermal insulation, foam plastic, electrical installations, grouts, and pipes can potentially contain higher levels of heavy metals and can lead to the potential leaching of hazardous substances into nature

A study on heavy metals in green concrete compared to the Swedish Environmental Protection Agency's guidelines.

Examensarbetet som omfattar 22,5 högskolepoäng har utförs som den slutliga delen avhögskoleingenjörsprogrammet i byggteknik, inriktning husbyggnad vid KarlstadsUniversitet.  Hållbarhet är ett viktigt ämne som berör företag av alla slag. Ingen bransch kan undvika attfundera över hur de kan främja hållbarhet. Frågan om hur varje bransch kan göra detta äralltid viktig. Genom regeringens förslag och överenskommelser står det klart attkoldioxidutsläppen ska halveras till 2030. Det är dock inte klart hur koldioxidutsläppen skahalveras.  Grön betong är en typ av miljövänlig betong där en del av cementen ersätts av masugnsslaggeller flygaska som har tagits fram av Cementa och Swecem. De två vanligaste typerna avcement som används i grön betong är Merit och Anläggningscement FA. Merit kommer frånSwecem medan Anläggningscement AF kommer från Cementa. Målet med denna typ avbetong är att minska byggbranschens koldioxidutsläpp. Rapporten syftar till att ge läsarna en överblick över de olika typer av cement som användsvid tillverkning av grön betong och dess miljökonsekvenser. Rapporten bygger på en mängdlitteraturforskning och dialog med experter från Swecem och Cementa för att få en bättreförståelse för fenomenet grön betong. Den tar också hänsyn till hur deras produkt bidrar tillhållbarhet. En labundersökning gjordes för att jämföra halterna av tungmetaller i olika typerav cement, speciellt grön betong kontra konventionell betong. S1 titan detektorn används föratt mäta och samla in data, detektorn använder röntgenfluorescens (XRF) som mätmetod. Studien fann att både produkterna Merit och Anläggningscement AF innehöll lägretungmetaller än Naturvårdsverkets gränsvärde. Grön restbetong kan återvinnas på sammasätt som en vanlig betong till ballast eller vägfyllnadsmaterial. Grön restbetong innehållerendast tungmetaller som finns i själva cementen. Grön rivningsbetong som innehåller avfallsåsom brandskydd, värmeisolering, skumplast, elinstallationer, fogmassor och rör kanpotentiellt innehålla högre halter av tungmetaller och kan leda till potentiell lakning avfarliga ämnen till naturen. The degree project, which includes 22.5 higher education credits, has been carried out as the final part of the higher education engineering program in construction technology, majoring in building construction at Karlstad University. Sustainability is an important topic that affects companies of all kinds. No industry can avoid thinking about how they can promote sustainability. The question of how each industry can do this is always important. Through the government's proposals and agreements, it is clear that carbon dioxide emissions are to be halved by 2030. However, it is not clear how carbon dioxide emissions are to be halved. Green concrete is a type of environmentally friendly concrete where part of the cement is replaced by blast furnace slag or fly ash that has been produced by Cementa and Swecem. The two most common types of cement used in green concrete are Merit and Anläggningscement FA. Merit comes from Swecem, while Construction cement AF comes from Cementa. The goal of this type of concrete is to reduce the construction industry's carbon dioxide emissions. The report aims to give readers an overview of the different types of cement used in the production of green concrete and its environmental consequences. The report is based on a lot of literature research and dialogue with experts from Swecem and Cement to gain a better understanding of the phenomenon of green concrete. It also takes into account how its product contributes to sustainability. A lab study compared the levels of heavy metals in different types of cement, especially green concrete versus conventional concrete. The S1 titanium detector is used to measure and collect data, the detector uses X-ray fluorescence(XRF) as the measurement method. The study found that both the products Merit and Anläggningscement AF contained lower heavy metals than the Environmental Protection Agency's limit value. Residual green concrete can be recycled in the same way as ordinary concrete for aggregate or road-filling material. Residual green concrete only contains heavy metals found in the cement itself. Green demolition concrete that contains waste such as fire protection, thermal insulation, foam plastic, electrical installations, grouts, and pipes can potentially contain higher levels of heavy metals and can lead to the potential leaching of hazardous substances into nature

Epidemiology and prevalence of tobacco use in Tehran; a report from the recruitment phase of Tehran cohort study

Tobacco use is a major health concern worldwide, especially in low/middle-income countries. We aimed to assess the prevalence of cigarette smoking, waterpipe, and pipe use in Tehran, Iran. We used data from 8272 participants of the Tehran Cohort Study recruitment phase. Tobacco use was defined as a positive answer to using cigarettes, waterpipes, or pipes. Participants who did not report tobacco use during the interview but had a previous smoking history were categorized as former users. Age- and sex-weighted prevalence rates were calculated based on the national census data, and characteristics of current and former tobacco users were analyzed. Age- and sex-weighted prevalence of current tobacco users, cigarette smokers, waterpipe, and pipe users in Tehran was 19.8%, 14.9%, 6.1%, and 0.5%, respectively. Current tobacco use was higher in younger individuals (35-45 years: 23.4% vs. ≥ 75 years: 10.4%, P < 0.001) and men compared to women (32.9% vs. 7.7% P < 0.001). The prevalence of tobacco use increased with more years of education (> 12 years: 19.3% vs. illiterate: 9.7%, P < 0.001), lower body mass index (< 20 kg/m2: 31.3% vs. ≥ 35 kg/m2: 13.8%, P < 0.001), higher physical activity (high: 23.0% vs. low: 16.4%, P < 0.001), opium (user: 66.6% vs. non-user: 16.5%, P < 0.001), and alcohol use (drinker: 57.5% vs. non-drinker: 15.4%, P < 0.001). Waterpipe users were younger (46.1 vs. 53.2 years) and had a narrower gender gap in prevalence than cigarette smokers (male/female ratio in waterpipe users: 2.39 vs. cigarette smokers: 5.47). Opium (OR = 5.557, P < 0.001) and alcohol consumption (OR = 4.737, P < 0.001) were strongly associated with tobacco use. Hypertension was negatively associated with tobacco use (OR = 0.774, P = 0.005). The concerning prevalence of tobacco use in Tehran and its large gender gap for cigarette and waterpipe use warrant tailored preventive policies

Epidemiology and prevalence of tobacco use in Tehran; a report from the recruitment phase of Tehran cohort study

Abstract Introduction Tobacco use is a major health concern worldwide, especially in low/middle-income countries. We aimed to assess the prevalence of cigarette smoking, waterpipe, and pipe use in Tehran, Iran. Methods We used data from 8272 participants of the Tehran Cohort Study recruitment phase. Tobacco use was defined as a positive answer to using cigarettes, waterpipes, or pipes. Participants who did not report tobacco use during the interview but had a previous smoking history were categorized as former users. Age- and sex-weighted prevalence rates were calculated based on the national census data, and characteristics of current and former tobacco users were analyzed. Results Age- and sex-weighted prevalence of current tobacco users, cigarette smokers, waterpipe, and pipe users in Tehran was 19.8%, 14.9%, 6.1%, and 0.5%, respectively. Current tobacco use was higher in younger individuals (35–45 years: 23.4% vs. ≥ 75 years: 10.4%, P  12 years: 19.3% vs. illiterate: 9.7%, P < 0.001), lower body mass index (< 20 kg/m2: 31.3% vs. ≥ 35 kg/m2: 13.8%, P < 0.001), higher physical activity (high: 23.0% vs. low: 16.4%, P < 0.001), opium (user: 66.6% vs. non-user: 16.5%, P < 0.001), and alcohol use (drinker: 57.5% vs. non-drinker: 15.4%, P < 0.001). Waterpipe users were younger (46.1 vs. 53.2 years) and had a narrower gender gap in prevalence than cigarette smokers (male/female ratio in waterpipe users: 2.39 vs. cigarette smokers: 5.47). Opium (OR = 5.557, P < 0.001) and alcohol consumption (OR = 4.737, P < 0.001) were strongly associated with tobacco use. Hypertension was negatively associated with tobacco use (OR = 0.774, P = 0.005). Conclusion The concerning prevalence of tobacco use in Tehran and its large gender gap for cigarette and waterpipe use warrant tailored preventive policies

Global burden of 87 risk factors in 204 countries and territories, 1990–2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation.Peer reviewe

Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation

Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases