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

Risk assessment of industrial hydrocarbon release and transport in the vadose zone as it travels to groundwater table: A case study

In this paper, a modeling tool for risk assessment analysis of the movement of hydrocarbon contaminants in the vadose zone and mass flux of contamination release into the groundwater table was developed. Also, advection-diffusion-reaction equations in combination with a three-phase equilibrium state between trapped air, soil humidity, and solid particles of unsaturated soil matrix were numerically solved to obtain a one dimensional concentration change in respect to depth of soil and total mass loading rate of hydrocarbons into the groundwater table. The developed model calibrations by means of sensitivity analysis and model validation via data from a site contaminated with BTEX were performed. Subsequently, the introduced model was applied on the collected hydrocarbon concentration data from a contaminated region of a gas refinery plant in Booshehr, Iran. Four different scenarios representing the role of different risk management policies and natural bio-degradation effects were defined to predict the future contaminant profile as well as the risk of the mass flux of contaminant components seeping into the groundwater table. The comparison between different scenarios showed that bio-degradation plays an important role in the contaminant attenuation rate; where in the scenarios including bio-degradation, the contaminant flux into the ground water table lasted for 50 years with the maximum release rate of around 20 gr per year while in the scenarios without including bio-degradation, 300 years of contaminant release into groundwater table with the maximum rate of 100 gr per year is obtained. Risk assessment analysis strongly suggests a need for bioremediation enhancement in the contaminated zones to reduce the contaminant influx to groundwater

An Adaptive Time-Step Backward Differentiation Algorithm to Solve Stiff Ordinary Differential Equations: Application to Solve Activated Sludge Models

Abstract A backward differentiation formula (BDF) has been shown to be an effective way to solve a system of ordinary differential equations (ODEs) that have some degree of stiffness. However, sometimes, due to high-frequency variations in the external time series of boundary conditions, a small time-step is required to solve the ODE system throughout the entire simulation period, which can lead to a high computational cost, slower response, and need for more memory resources. One possible strategy to overcome this problem is to dynamically adjust the time-step with respect to the system's stiffness. Therefore, small time-steps can be applied when needed, and larger time-steps can be used when allowable. This paper presents a new algorithm for adjusting the dynamic time-step based on a BDF discretization method. The parameters used to dynamically adjust the size of the time-step can be optimally specified to result in a minimum computation time and reasonable accuracy for a particular case of ODEs. The proposed algorithm was applied to solve the system of ODEs obtained from an activated sludge model (ASM) for biological wastewater treatment processes. The algorithm was tested for various solver parameters, and the optimum set of three adjustable parameters that represented minimum computation time was identified. In addition, the accuracy of the algorithm was evaluated for various sets of solver parameters

Nitrate vulnerability projections from Bayesian inference of multiple groundwater age tracers

Nitrate is a major source of contamination of groundwater in the United States and around the world. We tested the applicability of multiple groundwater age tracers (³H, ³He, ⁴He, ¹⁴C, ¹³C, and ⁸⁵Kr) in projecting future trends of nitrate concentration in 9 long-screened, public drinking water wells in Turlock, California, where nitrate concentrations are increasing toward the regulatory limit. Very low 85Kr concentrations and apparent ³H/³He ages point to a relatively old modern fraction (40–50 years), diluted with pre-modern groundwater, corroborated by the onset and slope of increasing nitrate concentrations. An inverse Gaussian–Dirac model was chosen to represent the age distribution of the sampled groundwater at each well. Model parameters were estimated using a Bayesian inference, resulting in the posterior probability distribution – including the associated uncertainty – of the parameters and projected nitrate concentrations. Three scenarios were considered, including combined historic nitrate and age tracer data, the sole use of nitrate and the sole use of age tracer data. Each scenario was evaluated based on the ability of the model to reproduce the data and the level of reliability of the nitrate projections. The tracer-only scenario closely reproduced tracer concentrations, but not observed trends in the nitrate concentration. Both cases that included nitrate data resulted in good agreement with historical nitrate trends. Use of combined tracers and nitrate data resulted in a narrower range of projections of future nitrate levels. However, use of combined tracer and nitrate resulted in a larger discrepancy between modeled and measured tracers for some of the tracers. Despite nitrate trend slopes between 0.56 and 1.73 mg/L/year in 7 of the 9 wells, the probability that concentrations will increase to levels above the MCL by 2040 are over 95% for only two of the wells, and below 15% in the other wells, due to a leveling off of reconstructed historical nitrate loadings to groundwater since about 1990

A spatial Markov model for the evolution of the joint distribution of groundwater age, arrival time, and velocity in heterogeneous media

European Research Council (ERC), project MHetScale (contract no. 617511)Peer reviewe