Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Japanese Students in America : Have They Made the Adjustment?

この研究論文は,アメリカにいる日本人留学生が,どのように新しい環境に適応し,どのような問題を抱え,困難に直面したときに,誰に相談をしているのかを,調査したものである。 毎年,何千人もの学生が留学をしている中,留学生が留学を成功するかしないか,その要因を調査することは,教育者と保護者にとって大変興味深いことである。 この調査の対象学生は,カリフォルニア州とワシントン州のコミュニティ・カレッジに留学をしている120名の留学生である

A METRIC-BASED APPROACH FOR MEASURING THE CONCEPTUAL INTEGRITY OF SOFTWARE ARCHITECTURES

ABSTRAC

Effect of gold electrode annealing on gas sensing properties of nano-and microstructures of macroporous silicon

This paper presents porous silicon (PS) with nano-and microstructures as carbon dioxide sensing layers. The p-type Si substrate is subjected to PS etching. The PS morphology has been characterized by scanning electron microscope. According to the parameters of electrochemical process, PS layers were found to have a different structure. By using dimethylformamide (DMF) in electrolyte, regular, honeycomb-like and macroporous structures were formed. PS side of the substrate is then coated with a thin layer of gold and annealed at 500°C. These devices, which operate at room temperature, are more sensitive to the applied voltages in CO2 gas. The effect of annealing of gold electrode on current-voltage and response-voltage characteristics of PS has been studied. Our results show that the conductivity and response of PS sensors improve much more when its surface is modified with annealing of gold electrode and also nanostructured PS has greater response than the others

An Experimental and Numerical Thermal Flow Analysis in a Solar Air Collector with Different Delta Wing Height Ratios

This study conducts both numerical and empirical assessments of thermal transfer and f luid f low characteristics in a Solar Air Collector (SAC) using a Delta Wing Vortex Generator (DWVG), and the effects of different height ratios (Rh = 0.6, 0.8, 1, 1.2 and 1.4) in delta wing vortex generators, which were not considered in the earlier studies, are investigated. Energy and exergy analyses are performed to gain maximum efficiency. The Reynolds number based on the outlet velocity and hydraulic diameter falls between 4400 and 22000, corresponding to the volume f low rate of 5.21–26.07 m3/h. It is observed that the delta wing vortex generators with a higher height ratio yield maximum heat transfer enhancement and overall enhancement ratio. The empirical and numerical findings demonstrate that the exergy and thermal efficiencies decline in a specific range. The Nusselt number, pressure drop, energy, and exergy efficiencies enhance with rising Reynolds number, although the friction coefficient diminishes. The maximum heat transfer enhancement is 57%. According to the evaluation of exergy efficiency, the greatest efficiency of 31.2% is obtained at Rh = 1.4 and Reynolds number 22000.</p