51 research outputs found
Elevated free interleukin-18 associated with severity and mortality in prospective cohort study of 206 hospitalised COVID-19 patients
- Publication venue
- 'Springer Science and Business Media LLC'
- Publication date
- 24/02/2023
- Field of study
Early-life exposure to lead (Pb) alters the expression of microRNA that target proteins associated with Alzheimer’s disease
- Publication venue
- DigitalCommons@URI
- Publication date
- 01/01/2016
- Field of study
There is a growing recognition of the impact of environmental toxins on the epigenetic regulation of gene expression, including the genes that play a critical role in neural development, neural function and neurodegeneration. We have shown previously that exposure to the heavy metal lead (Pb) in early life results in a latent over-expression of AD-related proteins in rodents and primates. The present study provides evidence that early postnatal exposure to Pb also alters the expression of select miRNA. Mice were exposed to 0.2% Pb acetate from Postnatal Day 1 (PND 1, first 24 hours after birth) to PND 20 via their mother’s milk, brain tissue was harvested at PND 20, 180, or 700 and miRNA were isolated and quantified by qPCR. This exposure produced a transient increase (relative to control) in the expression of miR-106b (binds to AβPP mRNA), miR-29b (targets the mRNA for the transcription factor SP1) and two miRNAs (miR- 29b and miR-132) that have the ability to inhibit translation of proteins involved in promoter methylation. The expression of miR-106b decreased over time in the Pb-exposed animals and was significantly less than the levels exhibited by the control animals at PND700. The level of miR-124, which binds to SP1 mRNA, was also reduced (relative to controls) at PND700. In summary, we show that exposure to the heavy metal Pb in early life has a significant impact on the short- and long-term expression of miRNA that target epigenetic mediators and neurotoxic proteins
Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study
- Author
- A Yacoub M.
- A. Adam M.
- A. Nassar M.
- A. Nemer A.
- Aahlin E. K.
- Ab Rahim M. F.
- Abad Gurumeta A.
- Abad-Motos A.
- Abang Jamari D. Z. H.
- Abantanga F.
- Abarca S.
- Abazid E.
- Abbas A.
- Abbas K.
- Abbas M. M.
- Abbasy J.
- Abbosh A.
- Abd B.
- Abd Karim M. F. S.
- Abd Wahab H. H.
- Abdalei A.
- Abdalla Ahmed Elkamel A.
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- Abdelhady Mousa H.
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- Abdellatif E.
- Abdelmaksoud Tawakel N.
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- Abdelsalam I.
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- Publication venue
- 'Elsevier BV'
- Publication date
- 01/01/2022
- Field of study
Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised
Use of anticoagulants and antiplatelet agents in stable outpatients with coronary artery disease and atrial fibrillation. International CLARIFY registry
- Author
- A. L. R. Ng
- Abardia Oliva F. J.
- Abdel Malak S.
- Abdel Wahab H.
- Abdul Kareem B. B.
- Abdul Manap H.
- Abdul Rahim A. A.
- Abdulkader F.
- Abdulla A. H. K.
- AbdulWahab M. Z.
- Abduvalieva V.
- Abele S.
- Aboyans V.
- Abreu P. E.
- Adam-Blanpain M.
- Adamaszek K.
- Adamczyk-Kot D.
- Adamkiewicz-Piejko A.
- Adda M.
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- Aguiar C.
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- Akbar M.
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- Al-Khalidi B.
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- Publication venue
- 'Public Library of Science (PLoS)'
- Publication date
- 01/01/2015
- Field of study
Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.
- Author
- Aawsaj Y.
- Abad Gurumeta A.
- Abad-Motos A.
- Abate E.
- Abatini C.
- Abbadessa F.
- Abbas A. M.
- Abbassi-Ghadi N.
- Abbott D.
- Abbott T.
- Abd Elazeem H. A. S.
- Abdalla M.
- Abdallah M.
- Abdel Al S.
- Abdel Jalil R.
- Abdeldayem H.
- Abdelkader Salama I.
- Abdelkarem M. M.
- Abdelkarim M.
- Abdelmajeed A.
- Abdelrahman A.
- Abdelrahman S.
- Abdelsamed A.
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- Abou Chaar M. K.
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- Abu Za'nouneh F. J.
- Abu-Nayla I.
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- Publication venue
- J Clin Oncol
- Publication date
- 01/01/2020
- Field of study
PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks
Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study
- Author
- Aawsaj Y.
- Abad Gurumeta A.
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- Abate E.
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- Abbadessa F.
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- Abd Elazeem H. A. S.
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- Zani S.
- Zanotti S.
- Zanus G.
- Zapardiel I.
- Zarabini A. G.
- Zatecky J.
- Zegarac M.
- Zelic M.
- Zeller N.
- Zengin A. K.
- Zerbib P.
- Zervas K.
- Zese M.
- Zhang H.
- Zivanovic M.
- Zivkovic M.
- Zizzo M.
- Zografos C.
- Zonta S.
- Zorrilla Ortuzar J.
- Zourntou S.
- Zouzoulas D.
- Zubaidi A.
- Zullo A.
- Publication venue
- 'American Society of Clinical Oncology (ASCO)'
- Publication date
- 01/01/2021
- Field of study
PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks
Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
- Author
- 14 | COVIDSurg COllabOratIVe Tzovaras G. (General University Hospital of Larissa)
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- COVIDSurg COllabOratIVe | 15 Violante T. (IRCCS Azienda Ospedaliero – Universitaria di Bologna
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- Kovacevic B.
- Krarup P.
- Krdzic I. (Zvezdara University Medical Center). Singapore: Lieske B. (National University Hospital). South Africa: Almgla N.
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- Université Mohammed V Rabat). Netherlands: Hompes R.
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- Urbani A. (Azienda Ospedaliero Universitaria San’anna)
- Urbieta A. (Hospital Universitario la Paz)
- Uslu G.
- Utkan N. Z.
- Uyanik M. S. (Samsun Training and Research Hospital)
- Uzunoglu F. G. (University Medical Center Hamburg–Eppendorf). Greece: Antonakis P.
- Vaccarella G. (Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello)
- Valbuena Jabares V. (Marqués de Valdecilla University Hospital)
- Valdes- Hernandez J. (Hospital Universitario Virgen Macarena)
- Valero Soriano M. (Hospital General Reina Sofía)
- Valle Rubio A. (Getafe University Hospital)
- Valverde S. (Hospital Clinic Barcelona)
- Van den Eynde J.
- Van den Eynde R. (Uz Leuven). Bulgaria: Sokolov M. (University Hospital Alexandrovska). Canada: Boutros M.
- Varma M. (University of California
- Vasljević J.
- Vassiliu P. (Attikon University General Hospital)
- Vaz Pereira R.
- Vaz S. (Centro Hospitalar e Universitário de São João)
- Velchuru V.
- Velickovic D. (Clinic for Digestive Surgery
- Velidedeoglu M.
- Venn M. (Royal London Hospital)
- Venskutonis D. (Lithuanian University of Health Sciences Kaunas Clinical Hospital). Madagascar: Rasoaherinomenjanahary F.
- Vera Mansilla C. (Hospital Universitario Principe de Asturias)
- Verberne C. (John Radcliffe Hospital)
- Vergari R. (Ospedali Riuniti di Ancona)
- Vernon L. (Cork University Hospital)
- Vervoort D.
- Vescio G. (University ‘Magna Graecia’ of Catanzaro)
- Vezakis A. (Aretaieion Hospital)
- Videira J. F. (IPO Porto). Réunion: Kassir R.
- Vieira B. (Centro Hospitalar de Trás-Os-Montes e Alto Douro
- Vieira Caroço T. (IPO Coimbra)
- Vieira Paiva Lopes A. C. (Hospital de Torres Vedras – Centro Hospitalar do Oeste)
- Vignali A. (San Raffaele Scientific Institute
- Vigorita V. (Álvaro Cunqueiro Hospital)
- Vijayan D. (Queen Elizabeth Hospital Birmingham)
- Villalabeitia Ateca I. (Hospital Universitario Cruces)
- Vimalachandran D. (Countess of Chester Hospital)
- Viswanath Y. K. S. (James Cook University Hospital)
- Vitali A. (Ospedale San Giovanni di Dio)
- Vitone L. (Royal Blackburn Hospital)
- Vives R. V. (Bellvitge University Hospital)
- Vo U. G. (Fiona Stanley Hospital)
- Von Papen M.
- Vovola F. (Ospedali Riuniti Azienda Ospedaliera Universitaria Foggia)
- Vucic N.
- Vázquez Fernández A. (Hospital Clínico Universitario de Valladolid)
- Wadham B. (The University Hospital of South Manchester)
- Walkes K. (Queen Elizabeth Hospital). Belgium: Flamey N.
- Wani R. (Sher-I-Kashmir Institute of Medical Sciences)
- Waqar S. H. (Pakistan Institute of Medical Sciences). Poland: Major P. (Jagiellonian University Medical College). Portugal: Azevedo C.
- Warren O. (Chelsea and Westminster Hospital)
- Watson L. J. (Sunderland Royal Hospital)
- Watson N. (King’s Mill Hospital)
- Weitz J.
- Welsch T. (Carl-Gustav-Carus University Hospital
- Werner J. (LMU Klinikum Campus Innenstadt)
- Westwood E. (James Paget University NHS Foundation Trust Hospital)
- Whelan M. (Tallaght University Hospital)
- Whitmore H. (Torbay and South Devon NHS Trust)
- Wilkin R. J. W. (South Warwickshire NHS Foundation Trust)
- Wilkins A. (Hull University Teaching Hospitals NHS Trust)
- Williams G. (Royal Gwent Hospital)
- Williams K. (St George’s Hospital)
- Wilson M. (Forth Valley Royal Hospital)
- Wimmer A. (Paracelsus Medical University Salzburg). Barbados: Barker D.
- Wong M.
- Worku D. (Queens Medical Centre)
- Wullschleger M. (Gold Coast University Hospital)
- Xavier R. G.
- Xenaki S.
- Xynos E. (University Hospital of Heraklion Crete and Interclinic Hospital of Crete). Hong Kong: Futaba K.
- Yang W.
- Yassin N. (Royal Wolverhampton NHS Trust)
- Ye G.
- Yesantharao P.
- Yetkin S. G. (Sisli Hamidiye Etfal Training and Research Hospital)
- Yeşilyurt D. (University of Health Sciences Tepecik Training and Research Hospital)
- Yiallourou A. (Nicosia General Hospital). Czechia: Martinek L.
- Yıldırım A.
- Yildiz A. (Yildirim Beyazit University Yenimahalle Training and Research Hospital). Uganda: Lule H.
- Young R. (York Teaching Hospitals NHS Trust)
- Yousof E. A. (Assiut University Hospital)
- Youssef M. (Norfolk and Norwich University Hospital)
- Yurttas C. (University Hospital Tuebingen)
- Yánez C. (Royo Villanova)
- Yüksel E. (Kocaeli University Teaching Hospital)
- Zafar S. N. (University of Wisconsin)
- Zakaria A. D.
- Zakaria Z. (School of Medical Sciences and Hospital
- Zambon M. (Policlinico Umberto I Sapienza University of Rome)
- Zanus G. (Ca’ Foncello Treviso – DISCOG – Università di Padova)
- Zegarac M. (Institute for Oncology and Radiology of Serbia)
- Zelić M. (University Hospital Center Rijeka)
- Zengin A. K. (Istanbul Universty – Cerrahpaşa Medical Faculty)
- Zerbib P. (CHU Lille)
- Zervas K.
- Zese M. (Santa Maria degli Angeli Hospital ULSS 5 – Adria)
- Zhang H. (Concord Repatriation General Hospital)
- Zizzo M. (Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia)
- Zografos C. (Laiko University Hospital)
- Zorrilla Ortúzar J. (Hospital General Universitario Gregorio Marañón)
- Zourntou S. (General Hospital of Larissa ‘Koutlimpaneio and Triantafylleio’)
- Zubaidi A. M. (King Saud University). Serbia: Aleksić L.
- Ângelo M.
- Çelebi F.
- Çolak E.
- Öfner D. (Medical University of Innsbruck)
- Öhlberger L.
- Özçelık M. F.
- Öğücü H.
- Überrück L.
- Ćoza I.
- Publication venue
- 'Wiley'
- Publication date
- 01/01/2020
- Field of study
This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic
Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021
- Author
- Ababneh Hazim S
- Abate Yohannes Habtegiorgis
- Abbafati Cristiana
- Abbasgholizadeh Rouzbeh
- Abbasian Mohammadreza
- Abbastabar Hedayat
- Abd Al Magied Abdallah H A
- Abd ElHafeez Samar
- Abd-Elsalam Sherief
- Abdelkader Atef
- Abdelmasseh Michael
- Abdi Parsa
- Abdollahi Mohammad
- Abdoun Meriem
- Abdullahi Auwal
- Abebe Mesfin
- Abiodun Olumide
- Aboagye Richard Gyan
- Abolhassani Hassan
- Abouzid Mohamed
- Aboye Girma Beressa
- Abreu Lucas Guimarães
- Absalan Abdorrahim
- Abualruz Hasan
- Abubakar Bilyaminu
- Abukhadijah Hana Jihad Jihad
- Addolorato Giovanni
- Adekanmbi Victor
- Adetunji Charles Oluwaseun
- Adetunji Juliana Bunmi
- Adeyeoluwa Temitayo Esther
- Adha Rishan
- Adhikary Ripon Kumar
- Adnani Qorinah Estiningtyas Sakilah
- Adzigbli Leticia Akua
- Afrashteh Fatemeh
- Afzal Muhammad Sohail
- Afzal Saira
- Agbozo Faith
- Agodi Antonella
- Agrawal Anurag
- Agyemang-Duah Williams
- Ahinkorah Bright Opoku
- Ahlstrom Austin J
- Ahmad Aqeel
- Ahmad Firdos
- Ahmad Muayyad M
- Ahmad Sajjad
- Ahmad Shahzaib
- Ahmed Anisuddin
- Ahmed Ayman
- Ahmed Haroon
- Ahmed Safoora
- Ahmed Syed Anees
- Akinosoglou Karolina
- Akkaif Mohammed Ahmed
- Akrami Ashley E
- Akter Ema
- Al Awaidy Salah
- Al Hasan Syed Mahfuz
- Al Mosa Amjad S
- Al Ta'ani Omar
- Al Zaabi Omar Ali Mohammed
- Al-Ajlouni Yazan
- Al-Aly Ziyad
- Al-amer Rasmieh Mustafa
- Al-Gheethi Adel Ali Saeed
- Al-Hanawi Mohammed Khaled
- Al-Ibraheem Akram
- Al-Mekhlafi Hesham M
- Al-Sabah Salman Khalifah
- Al-Tammemi Ala'a B.
- Al-Tawfiq Jaffar A
- Al-Wardat Mohammad Sami
- Al-Worafi Yaser Mohammed
- Al-Zyoud Walid
- Alahdab Fares
- Alajlani Muaaz M
- Alalalmeh Samer O
- Alam Khurshid
- Alam Noore
- Alam Tahiya
- Alam Zufishan
- Alanezi Fahad Mashhour
- Alanzi Turki M
- Albakri Almaza
- Aldhaleei Wafa A
- Aldridge Robert W
- Alemohammad Seyedeh Yasaman
- Alemu Yihun Mulugeta
- Ali Abid
- Ali Amjad
- Ali Iman
- Ali Mohammed Usman
- Ali Rafat
- Ali Syed Shujait Shujait
- Ali Victor Ekoche
- Ali Waad
- Alicandro Gianfranco
- Alif Sheikh Mohammad
- Aljunid Syed Mohamed
- Alla François
- Almazan Joseph Uy
- Alqutaibi Ahmed Yaseen
- Alrawashdeh Ahmad
- Alrousan Sahel Majed
- Alsabri Mohammed A
- Altaany Zaid
- Altirkawi Khalid A
- Aluh Deborah Oyine
- Alvis-Guzman Nelson
- Aly Hany
- Alyahya Mohammad Sharif
- Alzoubi Karem H
- Amani Reza
- Ameyaw Edward Kwabena
- Amin Tarek Tawfik
- Amindarolzarbi Alireza
- Amiri Sohrab
- Amirzade-Iranaq Mohammad Hosein
- Amu Hubert
- Amugsi Dickson A
- Ancuceanu Robert
- Anderlini Deanna
- Anderson David B
- Andrade Pedro Prata
- Andrei Catalina Liliana
- Andrei Tudorel
- Andrews Erick Adrian
- Anil Abhishek
- Anil Sneha
- Anoushiravani Amir
- Antony Catherine M
- Antriyandarti Ernoiz
- Anuoluwa Boluwatife Stephen
- Anvari Saeid
- Anyasodor Anayochukwu Edward
- Appiah Francis
- Aquilano Michele
- Arab Juan Pablo
- Arabloo Jalal
- Arafa Elshaimaa A
- Arafat Mosab
- Aravkin Aleksandr Y
- Ardekani Ali
- Areda Demelash
- Aregawi Brhane Berhe
- Aremu Abdulfatai
- Ariffin Hany
- Arkew Mesay
- Armani Keivan
- Artamonov Anton A
- Arumugam Ashokan
- Asghari-Jafarabadi Mohammad
- Ashbaugh Charlie
- Astell-Burt Thomas
- Athari Seyyed Shamsadin
- Atorkey Prince
- Atout Maha Moh'd Wahbi
- Aujayeb Avinash
- Ausloos Marcel
- Awad Hamzeh
- Awotidebe Adedapo Wasiu
- Ayatollahi Haleh
- Ayuso-Mateos Jose L
- Azadnajafabad Sina
- Azeez Fahad Khan
- Azevedo Rui M S
- Badar Muhammad
- Baghdadi Soroush
- Bagheri Mahboube
- Bagheri Nasser
- Bai Ruhai
- Baker Jennifer L
- Bako Abdulaziz T
- Balakrishnan Senthilkumar
- Balcha Wondu Feyisa
- Baltatu Ovidiu Constantin
- Barchitta Martina
- Bardideh Erfan
- Barker-Collo Suzanne Lyn
- Barqawi Hiba Jawdat
- Barteit Sandra
- Basiru Afisu
- Basso João Diogo
- Bastan Mohammad-Mahdi
- Basu Sanjay
- Bauckneht Matteo
- Baune Bernhard T
- Bayati Mohsen
- Bayileyegn Nebiyou Simegnew
- Bärnighausen Till Winfried
- Behnoush Amir Hossein
- Behzadi Payam
- Beiranvand Maryam
- Bello Olorunjuwon Omolaja
- Belo Luis
- Beloukas Apostolos
- Bemanalizadeh Maryam
- Bensenor Isabela M
- Benzian Habib
- Beran Azizullah
- Berezvai Zombor
- Bernstein Robert S
- Bettencourt Paulo J G
- Beyene Kebede A
- Beyene Melak Gedamu
- Bhagat Devidas S
- Bhagavathula Akshaya Srikanth
- Bhala Neeraj
- Bhandari Dinesh
- Bharadwaj Ravi
- Bhardwaj Nikha
- Bhardwaj Pankaj
- Bhargava Ashish
- Bhaskar Sonu
- Bhat Vivek
- Bhattacharjee Natalia V
- Bhatti Gurjit Kaur
- Bhatti Jasvinder Singh
- Bhatti Manpreet S
- Bhuiyan Mohiuddin Ahmed
- Bisignano Catherine
- Biswas Bijit
- Bjørge Tone
- Bodolica Virginia
- Bodunrin Aadam Olalekan
- Bonakdar Hashemi Milad
- Bora Basara Berrak
- Borhany Hamed
- Bosoka Samuel Adolf
- Botero Carvajal Alejandro
- Bouaoud Souad
- Boufous Soufiane
- Boxe Christopher
- Boyko Edward J
- Brady Oliver J
- Braithwaite Dejana
- Brauer Michael
- Brazo-Sayavera Javier
- Brenner Hermann
- Brown Colin Stewart
- Browne Annie J
- Brugha Traolach
- Bryazka Dana
- Bulamu Norma B
- Buonsenso Danilo
- Burkart Katrin
- Burns Richard A
- Busse Reinhard
- Bustanji Yasser
- Butt Zahid A
- Caetano dos Santos Florentino Luciano
- Calina Daniela
- Campos Luciana Aparecida
- Cao Shujin
- Capodici Angelo
- Carreras Giulia
- Carugno Andrea
- Carvalho Márcia
- Castaldelli-Maia Joao Mauricio
- Castelpietra Giulio
- Cattaruzza Maria Sofia
- Caye Arthur
- Cárdenas Rosario
- Cegolon Luca
- Cembranel Francieli
- Cenko Edina
- Cerin Ester
- Chadban Steven J
- Chadwick Joshua
- Chakraborty Chiranjib
- Chakraborty Sandip
- Chalek Julian
- Chan Jeffrey Shi Kai
- Chandika Rama Mohan
- Chandy Sara
- Charan Jaykaran
- Chaudhary Anis Ahmad
- Chaurasia Akhilanand
- Chen An-Tian
- Chen Haowei
- Chen Meng Xuan
- Chen Simiao
- Cherbuin Nicolas
- Chi Gerald
- Chichagi Fatemeh
- Chimed-Ochir Odgerel
- Chimoriya Ritesh
- Ching Patrick R
- Chirinos-Caceres Jesus Lorenzo
- Chitheer Abdulaal
- Cho Daniel Youngwhan
- Cho William C S
- Choi Dong-Woo
- Chong Bryan
- Chong Chean Lin
- Chopra Hitesh
- Chu Dinh-Toi
- Chung Eric
- Chutiyami Muhammad
- Clayton Justin T
- Cogen Rebecca M
- Cohen Aaron J
- Columbus Alyssa
- Comfort Haley
- Conde Joao
- Connolly Jon T
- Cooper Ezra E K
- Cortese Samuele
- Cruz-Martins Natália
- Çakmak Barsbay Mehtap
- D'Oria Mario
- da Silva Alanna Gomes
- Dadras Omid
- Dai Xiaochen
- Dai Zhaoli
- Dalton Bronte E
- Damiani Giovanni
- Dandona Lalit
- Dandona Rakhi
- Das Jai K
- Das Saswati
- Das Subasish
- Dash Nihar Ranjan
- Davletov Kairat
- De la Hoz Fernando Pio
- De Leo Diego
- Debopadhaya Shayom
- Delgado-Enciso Ivan
- Denova-Gutiérrez Edgar
- Dervenis Nikolaos
- Desai Hardik Dineshbhai
- Devanbu Vinoth Gnana Chellaiyan
- Dewan Syed Masudur Rahman
- Dhama Kuldeep
- Dhane Amol S
- Dhingra Sameer
- Dias da Silva Diana
- Diaz Daniel
- Diaz Luis Antonio
- Diaz Michael J
- Dima Adriana
- Ding Delaney D
- do Prado Camila Bruneli
- Do Thao Huynh Phuong
- Dodangeh Masoud
- Dodangeh Milad
- Doegah Phidelia Theresa
- Dohare Sushil
- Dong Wanyue
- Doshi Rajkumar
- Dowou Robert Kokou
- Dsouza Haneil Larson
- Dsouza Viola
- Dube John
- Dumith Samuel C
- Duncan Bruce B
- Duraes Andre Rodrigues
- Duraisamy Senbagam
- Durojaiye Oyewole Christopher
- Dushpanova Anar
- Dutta Sulagna
- Dzianach Paulina Agnieszka
- Dziedzic Arkadiusz Marian
- Eboreime Ejemai
- Ebrahimi Kalan Mohammad
- Ebrahimi Alireza
- Edinur Hisham Atan
- Efendi Ferry
- Eikemo Terje Andreas
- Eini Ebrahim
- Ekundayo Temitope Cyrus
- El Arab Rabie Adel
- El Sayed Iman
- Elamin Osman
- Elemam Noha Mousaad
- ElGohary Ghada Metwally Tawfik
- Elhadi Muhammed
- Elmeligy Omar Abdelsadek Abdou
- Elmoselhi Adel B
- Elshaer Mohammed
- Elsohaby Ibrahim
- Eltahir Mohd. Elmagzoub
- Emeto Theophilus I
- Eshrati Babak
- Eslami Majid
- Esmaeili Zahra
- Fabin Natalia
- Fagbamigbe Adeniyi Francis
- Fagbule Omotayo Francis
- Falzone Luca
- Fareed Mohammad
- Farinha Carla Sofia e Sá
- Faris MoezAlIslam Ezzat Mahmoud
- Faro Andre
- Fasihi Kiana
- Fatehizadeh Ali
- Fauk Nelsensius Klau
- Fazylov Timur
- Feigin Valery L
- Fekadu Ginenus
- Feng Xiaoqi
- Fereshtehnejad Seyed-Mohammad
- Ferrara Pietro
- Ferreira Nuno
- Firew Belete Sewasew
- Fischer Florian
- Fitriana Ida
- Flavel Joanne
- Flor Luisa S
- Folayan Morenike Oluwatoyin
- Foley Kristen Marie
- Fonzo Marco
- Force Lisa M
- Foschi Matteo
- Freitas Alberto
- Fridayani Ni Kadek Yuni
- Fukutaki Kai Glenn
- Furtado João M
- Fux Blima
- Gaal Peter Andras
- Gadanya Muktar A
- Gallus Silvano
- Ganesan Balasankar
- Ganiyani Mohammad Arfat
- Gautam Rupesh K
- Gebi Tilaye Gebru
- Gebregergis Miglas W
- Gebrehiwot Mesfin
- Getacher Lemma
- Getahun Genanew K A
- Gething Peter W
- Ghadimi Delaram J
- Ghadirian Fataneh
- Ghafarian Sadegh
- Ghailan Khalid Yaser
- Ghasemi MohammadReza
- Ghasempour Dabaghi Ghazal
- Ghazy Ramy Mohamed
- Ghoba Sama
- Gholami Ehsan
- Gholamrezanezhad Ali
- Gholizadeh Nasim
- Ghorbani Vajargah Pooyan
- Ghorbani Mahsa
- Ghotbi Elena
- Gil Artyom Urievich
- Gill Tiffany K
- Girmay Alem
- Glasbey James C
- Glushkova Ekaterina Vladimirovna
- Gnedovskaya Elena V
- Goldust Mohamad
- Goleij Pouya
- Golinelli Davide
- Gopalani Sameer Vali
- Goulart Alessandra C
- Gouravani Mahdi
- Goyal Anmol
- Göbölös Laszlo
- Grivna Michal
- Grosso Giuseppe
- Guarducci Giovanni
- Gubari Mohammed Ibrahim Mohialdeen
- Guicciardi Stefano
- Guimarães Rafael Alves
- Gulati Snigdha
- Gulisashvili David
- Gunawardane Damitha Asanga
- Guo Cui
- Gupta Anish Kumar
- Gupta Rahul
- Gupta Rajeev
- Gupta Renu
- Gupta Sapna
- Gupta Vijai Kumar
- Haakenstad Annie
- Hadi Najah R
- Haep Nils
- Hafiz Abdul
- Haghmorad Dariush
- Haile Demewoz
- Haj-Mirzaian Arvin
- Hajj Ali Adel
- Hajj Ali Ali
- Halboub Esam S
- Haller Sebastian
- Halwani Rabih
- Hamagharib Abdullah Kanaan
- Hamdy Nadia M
- Hamoudi Rifat
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- Haq Zaim Anan
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- Harapan Harapan
- Hargono Arief
- Haro Josep Maria
- Hasaballah Ahmed I
- Hasan S. M. Mahmudul
- Hasanian Mohammad
- Hasnain Md Saquib
- Hassan Amr
- Haubold Johannes
- Hay Simon I
- Hebert Jeffrey J
- Hegazi Omar E
- Heidari Mohammad
- Hemmati Mehdi
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- Herrera-Serna Brenda Yuliana
- Herteliu Claudiu
- Heydari Majid
- Hezam Kamal
- Hidayana Irma
- Hiraike Yuta
- Hoan Nguyen Quoc
- Holla Ramesh
- Hoogar Praveen
- Horita Nobuyuki
- Hossain Md Mahbub
- Hosseinzadeh Hassan
- Hosseinzadeh Mehdi
- Hostiuc Mihaela
- Hostiuc Sorin
- Hu Chengxi
- Huang Junjie
- Hultström Michael
- Hundie Tsegaye Gebreyes
- Hunt Aliza J
- Hushmandi Kiavash
- Hussain Javid
- Hussain M. Azhar
- Hussein Nawfal R
- Huynh Hong-Han
- Hwang Bing-Fang
- Ibitoye Segun Emmanuel
- Iftikhar Pulwasha Maria
- Ikiroma Adalia I
- Ikwegbue Paul Chukwudi
- Ilic Irena M
- Ilic Milena D
- Immurana Mustapha
- Isa Mustafa Alhaji
- Islam Md. Rabiul
- Islam Sheikh Mohammed Shariful
- Ismail Faisal
- Ismail Nahlah Elkudssiah
- Isola Gaetano
- Iwagami Masao
- Iyamu Ihoghosa Osamuyi
- Jacob Louis
- Jacobsen Kathryn H
- Jafarinia Morteza
- Jahankhani Kasra
- Jahanmehr Nader
- Jain Nityanand
- Jairoun Ammar Abdulrahman
- Jakhmola Mani Dr Ruchi
- Jamil Safayet
- Jamora Roland Dominic G
- Jatau Abubakar Ibrahim
- Javadov Sabzali
- Javaheri Tahereh
- Jayaram Shubha
- Jee Sun Ha
- Jeganathan Jayakumar
- Jiang Heng
- Jokar Mohammad
- Jonas Jost B
- Joseph Nitin
- Joshua Charity Ehimwenma
- Jürisson Mikk
- K Vaishali
- Kabir Ali
- Kabir Zubair
- Kadashetti Vidya
- Kalankesh Laleh R
- Kalra Sanjay
- Kamath Ashwin
- Kamath Rajesh
- Kamireddy Arun
- Kanaan Mona
- Kanchan Tanuj
- Kanmiki Edmund Wedam
- Kanmodi Kehinde Kazeem
- Kansal Sushil Kumar
- Karim Asima
- Karkhah Samad
- Kashoo Faizan Zaffar
- Kasraei Hengameh
- Kassel Molly B
- Katikireddi Srinivasa Vittal
- Kauppila Joonas H
- Kaur Harkiran
- Kayode Gbenga A
- Kazemi Foad
- Kazemian Sina
- Kebede Fassikaw
- Kendal Evie Shoshannah
- Kesse-Guyot Emmanuelle
- Khademvatan Shahram
- Khajuria Himanshu
- Khalaji Amirmohammad
- Khalid Asaad
- Khalid Nauman
- Khalilian Alireza
- Khamesipour Faham
- Khan Fayaz
- Khan Mohammad Jobair
- Khan Moien AB
- Khanmohammadi Shaghayegh
- Khatab Khaled
- Khatatbeh Haitham
- Khatatbeh Moawiah Mohammad
- Khatib Mahalaqua Nazli
- Khayat Kashani Hamid Reza
- Kheirallah Khalid A
- Khokhar Manoj
- Khormali Moein
- Khorrami Zahra
- Khosla Atulya Aman
- Khosravi Majid
- Khosrowjerdi Mahmood
- Khubchandani Jagdish
- Kifle Zemene Demelash
- Kim Grace
- Kim Julie Sojin
- Kim Min Seo
- Kim Yun Jin
- Kimokoti Ruth W
- Kisa Adnan
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- Knudsen Ann Kristin Skrindo
- Kochhar Sonali
- Kolahi Ali-Asghar
- Kompani Farzad
- Koren Gerbrand
- Korzh Oleksii
- Krishan Kewal
- Krishna Varun
- Krishnamoorthy Vijay
- Kucuk Bicer Burcu
- Kuddus Md Abdul
- Kuddus Mohammed
- Kuitunen Ilari
- Kujan Omar
- Kulimbet Mukhtar
- Kulkarni Vishnutheertha
- Kumar G Anil
- Kumar Harish
- Kumar Nithin
- Kumar Rakesh
- Kumar Vijay
- Kundu Amartya
- Kusuma Dian
- Kyei-Arthur Frank
- Kytö Ville
- Kyu Hmwe Hmwe
- La Vecchia Carlo
- Lacey Ben
- Ladan Muhammad Awwal
- Laflamme Lucie
- Lahariya Chandrakant
- Lai Daphne Teck Ching
- Lalloo Ratilal
- Lallukka Tea
- Lan Qing
- Lan Tuo
- Landires Iván
- Lanfranchi Francesco
- Langguth Berthold
- Lansingh Van Charles
- Laplante-Lévesque Ariane
- Larijani Bagher
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- Widowati Evi
- Wojewodzic Marcin W
- Woldeyes Dawit Habte
- Wolf Axel Walter
- Wolfe Charles D A
- Wu Chenkai
- Wu Dongze
- Wu Felicia
- Wu Jiayuan
- Wu Zenghong
- Wulf Hanson Sarah
- Xiao Hong
- Xu Suowen
- Yadav Rakesh
- Yamagishi Kazumasa
- Yang Danting
- Yano Yuichiro
- Yarahmadi Amir
- Yazdani Nia Iman
- Ye Pengpeng
- Yesodharan Renjulal
- Yesuf Subah Abderehim
- Yezli Saber
- Yigzaw Zeamanuel Anteneh
- Yiğit Arzu
- Yiğit Vahit
- Yin Dehui
- Yip Paul
- Yonemoto Naohiro
- You Yuyi
- Younis Mustafa Z
- Yu Chuanhua
- Yu Elaine A
- Yu Yong
- Yuan Chun-Wei
- Yusuf Hadiza
- Zafar Uzma
- Zafari Nima
- Zahid Mondal Hasan
- Zakham Fathiah
- Zaki Nazar
- Zerfu Taddese Alemu
- Zhang Haijun
- Zhang Jingya
- Zhang Liqun
- Zhang Yunquan
- Zhang Zhiqiang
- Zhao Xiu-Ju George
- Zhao Yang
- Zhao Zhongyi
- Zhong Chenwen
- Zhou Bolun
- Zhou Juexiao
- Zhou Shangcheng
- Zhu Bin
- Zhumagaliuly Abzal
- Zielińska Magdalena
- Zoghi Ghazal
- Zumla Alimuddin
- Zyoud Sa'ed H
- Zyoud Samer H
- Publication venue
- Publication date
- 01/01/2024
- Field of study
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
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
- Author
- Abate Kalkidan Hassen
- Abate Yohannes Habtegiorgis
- Abbafati Cristiana
- Abbasgholizadeh Rouzbeh
- Abbasi Madineh Akram
- Abbasi-Kangevari Mohsen
- Abbasian Mohammadreza
- Abbasifard Mitra
- Abd ElHafeez Samar
- Abd-Elsalam Sherief
- Abdi Parsa
- Abdollahi Mohammad
- Abdoun Meriem
- Abdulah Deldar Morad
- Abdullahi Auwal
- Abebe Mesfin
- Abedi Aidin
- Abedi Armita
- Abegaz Tadesse M
- Abeldaño Zuñiga Roberto Ariel
- Abiodun Olumide
- Abiso Temesgen Lera
- Aboagye Richard Gyan
- Abolhassani Hassan
- Abouzid Mohamed
- Aboye Girma Beressa
- Abreu Lucas Guimarães
- Abu-Gharbieh Eman
- Abu-Zaid Ahmed
- Abualruz Hasan
- Abubakar Bilyaminu
- Abukhadijah Hana Jihad Jihad
- Aburuz Salahdein
- Adane Mesafint Molla
- Addo Isaac Yeboah
- Addolorato Giovanni
- Adedoyin Rufus Adesoji
- Adekanmbi Victor
- Aden Bashir
- Adetunji Juliana Bunmi
- Adeyeoluwa Temitayo Esther
- Adha Rishan
- Adibi Amin
- Adnani Qorinah Estiningtyas Sakilah
- Adzigbli Leticia Akua
- Afolabi Aanuoluwapo Adeyimika
- Afolabi Rotimi Felix
- Afshin Ashkan
- Afyouni Shadi
- Afzal Muhammad Sohail
- Afzal Saira
- Agampodi Suneth Buddhika
- Agbozo Faith
- Aghamiri Shahin
- Agodi Antonella
- Agrawal Anurag
- Agyemang-Duah Williams
- Ahinkorah Bright Opoku
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- Ahmad Danish
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- Ahmad Noah
- Ahmad Shahzaib
- Ahmad Tauseef
- Ahmed Ali
- Ahmed Anisuddin
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- Akhlaghi Shiva
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- Akinyemiju Tomi
- Akkaif Mohammed Ahmed
- Akkala Sreelatha
- Akombi-Inyang Blessing
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- Zare Iman
- Zarimeidani Fatemeh
- Zastrozhin Mikhail Sergeevich
- Zeng Youjie
- Zhai Chunxia
- Zhang Anthony Lin
- Zhang Haijun
- Zhang Liqun
- Zhang Meixin
- Zhang Yunquan
- Zhang Zhenyu
- Zhang Zhi-Jiang
- Zhao Hanqing
- Zhao Jeff T
- Zhao Xiu-Ju George
- Zhao Yang
- Zhao Yong
- Zheng Peng
- Zhong Chenwen
- Zhou Jingjing
- Zhou Juexiao
- Zhou Shangcheng
- Zhu Bin
- Zhu Lei
- Zhu Zhaohua
- Ziaeian Boback
- Ziafati Makan
- Zielińska Magdalena
- Zimsen Stephanie R M
- Zoghi Ghazal
- Zoller Thomas
- Zumla Alimuddin
- Zyoud Sa'ed H
- Zyoud Samer H
- Publication venue
- Publication date
- 01/01/2024
- Field of study
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
Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
- Author
- Aali Amirali
- Abate Yohannes Habtegiorgis
- Abbafati Cristiana
- Abbastabar Hedayat
- Abd ElHafeez Samar
- Abd-Elsalam Sherief
- Abdelmasseh Michael
- Abdollahi Arash
- Abdullahi Auwal
- Abegaz Kedir Hussein
- Abeldaño Zuñiga Roberto Ariel
- Aboagye Richard Gyan
- Abolhassani Hassan
- Abreu Lucas Guimarães
- Abu-Gharbieh Eman
- Abu-Rmeileh Niveen ME
- Abualruz Hasan
- Ackerman Ilana N
- Addo Isaac Yeboah
- Addolorato Giovanni
- Adebiyi Akindele Olupelumi
- Adepoju Abiola Victor
- Adewuyi Habeeb Omoponle
- Afyouni Shadi
- Afzal Saira
- Afzal Sina
- Agodi Antonella
- Ahmad Aqeel
- Ahmad Danish
- Ahmad Firdos
- Ahmad Shahzaib
- Ahmed Ali
- Ahmed Luai A
- Ahmed Muktar Beshir
- Ajami Marjan
- Akinosoglou Karolina
- Akkaif Mohammed Ahmed
- Al Hasan Syed Mahfuz
- Al-Aly Ziyad
- Al-Gheethi Adel Ali Saeed
- Al-Marwani Sabah
- Al-Omari Basem
- Al-Wardat Mohammad Sami
- Al-Worafi Yaser Mohammed
- Alalalmeh Samer O
- Albashtawy Mohammed
- Aldridge Robert W
- Alemu Meseret Desalegn
- Alemu Yihun Mulugeta
- Alene Kefyalew Addis
- Alharrasi Maryam
- Alhassan Robert Kaba
- Ali Mohammed Usman
- Ali Rafat
- Ali Syed Shujait Shujait
- Alif Sheikh Mohammad
- Aljunid Syed Mohamed
- Almazan Joseph Uy
- Alomari Mahmoud A
- Altaany Zaid
- Alvis-Guzman Nelson
- Alvis-Zakzuk Nelson J
- Alwafi Hassan
- Aly Safwat
- Alzoubi Karem H
- Amare Azmeraw T
- Amegbor Prince M
- Ameyaw Edward Kwabena
- Amin Tarek Tawfik
- Amindarolzarbi Alireza
- Amiri Sohrab
- Amugsi Dickson A
- Ancuceanu Robert
- Anderlini Deanna
- Anderson David B
- Andrade Pedro Prata
- Andrei Catalina Liliana
- Ansari Hossein
- Antony Catherine M
- Anwar Saleha
- Anwar Sumadi Lukman
- Anwer Razique
- Anyanwu Philip Emeka
- Arab Juan Pablo
- Arabloo Jalal
- Arafat Mosab
- Araki Daniel T
- Aravkin Aleksandr Y
- Arkew Mesay
- Armocida Benedetta
- Arndt Michael Benjamin
- Arooj Mahwish
- Artamonov Anton A
- Aruleba Raphael Taiwo
- Arumugam Ashokan
- Ashbaugh Charlie
- Ashemo Mubarek Yesse
- Ashraf Muhammad
- Asika Marvellous O
- Askari Elaheh
- Astell-Burt Thomas
- Athari Seyyed Shamsadin
- Atorkey Prince
- Atout Maha Moh'd Wahbi
- Atreya Alok
- Aujayeb Avinash
- Ausloos Marcel
- Avan Abolfazl
- Awotidebe Adedapo Wasiu
- Awuviry-Newton Kofi
- Ayala Quintanilla Beatriz Paulina
- Ayuso-Mateos Jose L
- Azadnajafabad Sina
- Azevedo Rui M S
- Babu Abraham Samuel
- Badar Muhammad
- Badiye Ashish D
- Baghdadi Soroush
- Bagheri Nasser
- Bah Sulaiman
- Bai Ruhai
- Baker Jennifer L
- Bakkannavar Shankar M
- Bako Abdulaziz T
- Balakrishnan Senthilkumar
- Bam Kiran
- Banik Palash Chandra
- Barchitta Martina
- Bardhan Mainak
- Bardideh Erfan
- Barker-Collo Suzanne Lyn
- Barqawi Hiba Jawdat
- Barrow Amadou
- Barteit Sandra
- Barua Lingkan
- Bashiri Aliabadi Somaye
- Basiru Afisu
- Basu Sanjay
- Basu Saurav
- Bathini Prapthi Persis
- Batra Kavita
- Baune Bernhard T
- Bayileyegn Nebiyou Simegnew
- Behnam Babak
- Behnoush Amir Hossein
- Beiranvand Maryam
- Bejarano Ramirez Diana Fernanda
- Bell Michelle L
- Bello Olorunjuwon Omolaja
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- Bensenor Isabela M
- Berezvai Zombor
- Bernabe Eduardo
- Bernstein Robert S
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- Bhagavathula Akshaya Srikanth
- Bhala Neeraj
- Bhandari Dinesh
- Bhargava Ashish
- Bhaskar Sonu
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- Borhany Hamed
- Boxe Christopher
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- Bragazzi Nicola Luigi
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- Brant Luisa C
- Brauer Michael
- Breitner Susanne
- Brenner Hermann
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- Bulamu Norma B
- Buonsenso Danilo
- Burkart Katrin
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- Bustanji Yasser
- Butt Zahid A
- Byun Justin
- Caetano dos Santos Florentino Luciano
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- Campos-Nonato Ismael R
- Cao Chao
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- Castaldelli-Maia Joao Mauricio
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- Ching Patrick R
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- Das Jai K
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- De Leo Diego
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- Deeba Farah
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- Demetriades Andreas K
- Denova-Gutiérrez Edgar
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- Desai Hardik Dineshbhai
- Desai Rupak
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- Dhama Kuldeep
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- Dirac M Ashworth
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- Do Thao Huynh Phuong
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- Dominguez Regina-Mae Villanueva
- Dong Wanyue
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- Dorsey E Ray
- Doshmangir Leila
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- Driscoll Tim Robert
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- Dumith Samuel C
- Duncan Bruce B
- Duraes Andre Rodrigues
- Duraisamy Senbagam
- Durojaiye Oyewole Christopher
- Dzianach Paulina Agnieszka
- Dziedzic Arkadiusz Marian
- Eboreime Ejemai
- Ebrahimi Alireza
- Edinur Hisham Atan
- Edvardsson David
- Eikemo Terje Andreas
- Eini Ebrahim
- Ekholuenetale Michael
- Ekundayo Temitope Cyrus
- El Sayed Iman
- El Tantawi Maha
- Elbarazi Iffat
- Elemam Noha Mousaad
- ElGohary Ghada Metwally Tawfik
- Elhadi Muhammed
- Elmeligy Omar Abdelsadek Abdou
- ELNahas Gihan
- Elshaer Mohammed
- Elsohaby Ibrahim
- Engelbert Bain Luchuo
- Erkhembayar Ryenchindorj
- Eshrati Babak
- Estep Kara
- Fabin Natalia
- Fagbamigbe Adeniyi Francis
- Falzone Luca
- Fareed Mohammad
- Farinha Carla Sofia e Sá
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- Ghajar Alireza
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- Gulati Snigdha
- Gulisashvili David
- Gunawardane Damitha Asanga
- Guo Cui
- Gupta Anish Kumar
- Gupta Bhawna
- Gupta Ishita
- Gupta Mohak
- Gupta Rajeev
- Gupta Veer Bala
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- Marx Wolfgang
- Maryam Sharmeen
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- Xia Yanjie
- Xiao Hong
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- Xu Yvonne Yiru
- Yadav Lalit
- Yadollahpour Ali
- Yaghoubi Sajad
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- Yang Lin
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- Yao Yao
- Yaribeygi Habib
- Yazdanpanah Mohammad Hosein
- Ye Pengpeng
- Yehualashet Sisay Shewasinad
- Yesuf Subah Abderehim
- Yezli Saber
- Yigzaw Zeamanuel Anteneh
- Yiğit Arzu
- Yiğit Vahit
- Yismaw Yazachew
- Yon Dong Keon
- Yonemoto Naohiro
- Younis Mustafa Z
- Yu Chuanhua
- Yu Yong
- Yusuf Hadiza
- Zahid Mondal Hasan
- Zakham Fathiah
- Zaki Leila
- Zaki Nazar
- Zaman Burhan Abdullah
- Zamora Nelson
- Zand Ramin
- Zandieh Ghazal G Z
- Zar Heather J
- Zarrintan Armin
- Zastrozhin Mikhail Sergeevich
- Zhang Haijun
- Zhang Ning
- Zhang Yunquan
- Zhao Hanqing
- Zhong Chenwen
- Zhong Panliang
- Zhou Juexiao
- Zhu Zhaohua
- Ziafati Makan
- Zielińska Magdalena
- Zimsen Stephanie R M
- Zoladl Mohammad
- Zumla Alimuddin
- Zyoud Samer H
- Publication venue
- Publication date
- 01/01/2024
- Field of study
Background: Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-based interventions that enable public health researchers, policy makers, and other professionals to implement strategies that can mitigate diseases. It can also facilitate more rigorous monitoring of progress towards national and international health targets, such as the Sustainable Development Goals. For three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has filled that need. A global network of collaborators contributed to the production of GBD 2021 by providing, reviewing, and analysing all available data. GBD estimates are updated routinely with additional data and refined analytical methods. GBD 2021 presents, for the first time, estimates of health loss due to the COVID-19 pandemic. Methods: The GBD 2021 disease and injury burden analysis estimated years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries using 100 983 data sources. Data were extracted from vital registration systems, verbal autopsies, censuses, household surveys, disease-specific registries, health service contact data, and other sources. YLDs were calculated by multiplying cause-age-sex-location-year-specific prevalence of sequelae by their respective disability weights, for each disease and injury. YLLs were calculated by multiplying cause-age-sex-location-year-specific deaths by the standard life expectancy at the age that death occurred. DALYs were calculated by summing YLDs and YLLs. HALE estimates were produced using YLDs per capita and age-specific mortality rates by location, age, sex, year, and cause. 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws. Uncertainty was propagated at each step of the estimation process. Counts and age-standardised rates were calculated globally, for seven super-regions, 21 regions, 204 countries and territories (including 21 countries with subnational locations), and 811 subnational locations, from 1990 to 2021. Here we report data for 2010 to 2021 to highlight trends in disease burden over the past decade and through the first 2 years of the COVID-19 pandemic. Findings: Global DALYs increased from 2·63 billion (95% UI 2·44–2·85) in 2010 to 2·88 billion (2·64–3·15) in 2021 for all causes combined. Much of this increase in the number of DALYs was due to population growth and ageing, as indicated by a decrease in global age-standardised all-cause DALY rates of 14·2% (95% UI 10·7–17·3) between 2010 and 2019. Notably, however, this decrease in rates reversed during the first 2 years of the COVID-19 pandemic, with increases in global age-standardised all-cause DALY rates since 2019 of 4·1% (1·8–6·3) in 2020 and 7·2% (4·7–10·0) in 2021. In 2021, COVID-19 was the leading cause of DALYs globally (212·0 million [198·0–234·5] DALYs), followed by ischaemic heart disease (188·3 million [176·7–198·3]), neonatal disorders (186·3 million [162·3–214·9]), and stroke (160·4 million [148·0–171·7]). However, notable health gains were seen among other leading communicable, maternal, neonatal, and nutritional (CMNN) diseases. Globally between 2010 and 2021, the age-standardised DALY rates for HIV/AIDS decreased by 47·8% (43·3–51·7) and for diarrhoeal diseases decreased by 47·0% (39·9–52·9). Non-communicable diseases contributed 1·73 billion (95% UI 1·54–1·94) DALYs in 2021, with a decrease in age-standardised DALY rates since 2010 of 6·4% (95% UI 3·5–9·5). Between 2010 and 2021, among the 25 leading Level 3 causes, age-standardised DALY rates increased most substantially for anxiety disorders (16·7% [14·0–19·8]), depressive disorders (16·4% [11·9–21·3]), and diabetes (14·0% [10·0–17·4]). Age-standardised DALY rates due to injuries decreased globally by 24·0% (20·7–27·2) between 2010 and 2021, although improvements were not uniform across locations, ages, and sexes. Globally, HALE at birth improved slightly, from 61·3 years (58·6–63·6) in 2010 to 62·2 years (59·4–64·7) in 2021. However, despite this overall increase, HALE decreased by 2·2% (1·6–2·9) between 2019 and 2021. Interpretation: Putting the COVID-19 pandemic in the context of a mutually exclusive and collectively exhaustive list of causes of health loss is crucial to understanding its impact and ensuring that health funding and policy address needs at both local and global levels through cost-effective and evidence-based interventions. A global epidemiological transition remains underway. Our findings suggest that prioritising non-communicable disease prevention and treatment policies, as well as strengthening health systems, continues to be crucially important. The progress on reducing the burden of CMNN diseases must not stall; although global trends are improving, the burden of CMNN diseases remains unacceptably high. Evidence-based interventions will help save the lives of young children and mothers and improve the overall health and economic conditions of societies across the world. Governments and multilateral organisations should prioritise pandemic preparedness planning alongside efforts to reduce the burden of diseases and injuries that will strain resources in the coming decades. Funding: Bill & Melinda Gates Foundation
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