Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Heat transfer due to impinging double free circular jets

The heat transfer and fluid flow between a horizontal heated plate and impinging circular double jets were studied experimentally. The parameters investigated are the Reynolds number of each jet and jet-to-jet spacing. Experiments are carried out covering a range for Reynolds number from 7100 to 30,800 for each jet, the dimensionless jet-to-jet spacing from 22.73 to 90.1. During experimental phases, the right jet Reynolds number was higher than the left jet Reynolds number. The isothermal contours were plotted for different cases as well as the distribution of water film thickness over the heated plate. The results indicated that increasing the Reynolds number of one jet than the other increases both local and average Nusselt numbers. In addition, increasing the jet-to-jet spacing at the same Reynolds number increases the average Nusselt number

Impact of addition oxy-hydrogen gas (HHO) on vehicle engines performance and emissions

The electrolysis process of water produces oxy-hydrogen (HHO) gas that can be used as an energy source to solve the shortage problem of fossil fuel and reduces the exhaust emissions of greenhouse gases from vehicles engines. In this study, HHO dry cell generator was designed, fabricated and tested experimentally to investigate its performance. The hybrid internal combustion engines using HHO gas is considered one of the most important studied applications. The vehicle engines performance and gas emissions are investigated for two different engines; 150CC with carburetor and 1300CC with Electronic Control Unit (ECU). The results recorded the consumption of the fuel is reduced by 14.8% for 150CC engine and 16.3% for 1300CC engine. HHO gas reduced the emission gases by 33% and 24.5% reduction in CO and 27.4% and 21% reduction in HC for 150CC and 1300CC engines respectively. HHO gas can be efficient used as a secondary fuel for vehicle engines

Double diffusive mixed convection study in a vertical annulus at different aspect ratio and Richardson number

The present study has been considered in heat, mass transfer and the reversal flow occurrence inside the annulus of concentric vertical cylinders numerically. Both the thermal buoyancy and the buoyancy due to different concentrations are of equal magnitude and direction. The forced flow direction effect is investigated. The problem is considered a laminar flow and steady state. The influencing parameters are identified for the problem are Richardson number, Lewis number, and length to gap ratio and Radius ratio. The dimensionless gap is kept constant at unity. The Richardson number is varied from 0.1 to 10, dimensionless length from 5 to 25, the dimensionless radius ratio from 1.5 to 11 and the lewis number from 0.1 to 10. The dimensionless temperature and concentration distributions are illustrated at various range of parameters. In addition, the average values concerning Nusselt as well as Sherwood numbers are correlated. The reverse flow is examined at both aiding and opposing flows. The reverse flow existence is affected by the Richardson number and the length to gap ratio. The value concerning thermal Grashof number is stable at 104. Keywords: Double diffusion, Reverse flow, Vertical cylinder, Annulus ga

The influence of thermal properties of delafossite nanofluid CuAlO2 on the turbulent natural convection inside a cavity

In the present work, an enhancement for the free turbulent convection in a rectangular cavity is examined by using a novel Delafossite Nanofluid. Delafossite CuAlO2 nanoparticles prepared using Al2O3 as dominant at four different weight concentrations of the doping copper 0, 1, 3 and 5% using an easily scalable co- precipitation chemical approach. Al2O3 nanofluid was prepared at three volume concentration 1, 3 and 5%, while the Delafossite CuAl2O3 at 5%. The microstructure of as prepared delafossite CuAlO2 nanoparticles were dedicated by different common methods showed a mean particle size of 28 nm. Thermal properties of water-based nanofluid increased with increasing of a Cu loading level in CuAl2O3. The nanofluid viscosity increases with the augmentation of the nanoparticles and also with increasing the copper content in the delafossite structure. An experimental setup was designed to investigate the influence of the CuAlO2 delafossite nanofluid on both heat transfer and flow structure. A cavity was fabricated with two opposite copper plates. One plate was considered as a heat source subjected to constant heat flux while the other with lower temperature and the rest of sides are considered insulated. The Rayleigh number varied from 7.3 × 107 to 2.21 × 108. The effect of Rayleigh number, volume fraction and the type of nanoparticle were examined experimentally and numerically. The maximum augmentation in the average Nusselt number reaches 51% at Ra = 2.21 × 108 for ϕ = 5% for CuAlO2 for Cu = 5%wt comparing to Al2O3. Keywords: Turbulent, Natural convection, Delafossite nanoflui