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. Funding: Bill & Melinda Gates Foundation

Not Available

Not AvailableIndia has witnessed a spectacular advancement in agricultural production and productivity during the last four decades. Foodgrains production registered more than five-fold increase, from 50 million tonnes in 1950-51 to 265 million tonnes in 2013-14, and productivity also increased by more than five times, from 522 kg/ha in 1950-51 to 2,100 kg/ha in 2013-14. Since the early eighties, this has enabled the country in achieving and sustaining self-sufficiency in grains production along with the adequate buffer stock to meet contingencies, and more recently for exports. This transformation is attributed to the development and adoption of high-yielding varieties/hybrids of several crops. The pace with which the country has progressed in the crop improvement programme would have not been possible without the simultaneous evolution of institutional system for crop breeding research and seed production. Crop improvement research immediately after independence was augmented in phases through the establishment of commodity-oriented National Institutes, National Research Centres and Project Directorates under the Indian Council of Agricultural Research. At present, there are 17 Crop Research Institutes, 5 Project Directorates, 3 National Network Projects, one National Research Centre, one deemed to be University for improvement of different field crops and one Institute for germplasm conservation. Another major step of the ICAR was to launch crops oriented All- India Coordinated Crop Improvement Projects, starting with maize in 1957; followed by wheat and rice in mid -sixties. Presently, there are 20 All-India Coordinated Crop Improvement Projects, ear-marked to research needs of different crops. In addition, there are 44 State Agricultural Universities (SAUs) and three Central Agricultural Universities (CAUs) contributing towards crop improvement research in the country. A multi-disciplinary approach for varietal improvement and crop production-related problems; collective planning and testing; exchange of germplasm and breeding material; flexibility in operations, cutting-across administrative and other boundaries and linkages with the International Research Centres are some of the characteristics features of the AICCIPs. Conceptually, this testing system facilitates generation of multilocation data within the shorter period of a few years. This unique model of multi-disciplinary approach based on the multilocation testing facilitated rapid generation and identification of appropriate high-yielding varieties and development of improved package of practices for different agro-ecologies. More than 3,000 high-yielding varieties/hybrids of field crops have been developed till 2014; combining desired levels of resistance to biotic/abiotic stresses, adaptation to diverse agronomic variables and cropping systems. Meeting the prescribed quality standards in testing and production have helped in revolutionizing crop production. The international nurseries and trials, being organized worldwide by the CGIAR institutes, are basically modeled on the lines of AICCIPs. In spite of the impressive mileage, the system has given across crops since 1957, there has been an apprehension regarding its continued utility in the present form. There is a considerable scope to bring in changes in view of the new technological advancements, changing production conditions and evolving national and international policies and procedures. A set of uniform guidelines for plant variety testing, identification, release and notification of crop varieties in the country was developed and published in 2002 as “Guidelines for Crop Variety Testing under All- India Coordinated Crop Improvement Projects”. The system of identification and release of varieties as well as for the production of nucleus/breeder Preface seed and for on-farm verification trials are very well developed and standardized in crops like wheat and pearl millet. However, in several other crops, the situation is not the same. In some of the projects, for instance, the entries are subjected to specific zonal testings only without exposing them to other potential zones. Very often plot sizes and number of replications do not commensurate with the minimum requirements to properly assess genotypes for their yielding ability. In some cases, the number of testing locations are also not adequate, while in some crops, sufficient information is not generated even on the key components of yield, reaction to major diseases and insect-pests. In some cases no attempts are made to study responses to agronomic variables and adaptation to abiotic stresses. Details of weather parameters, and even occurrence and severity of stresses are not reported. Appropriate morphological descriptors to establish distinct identity of the test material are also not developed. The existing testing system is considered too rigid for variety identification and release with regard to the criterion of a number of years of testing before a strain becomes eligible for consideration for identification, release and notification. Although the AICCIP system is a proven success, there is unanimity that there is much potential to give more mileage by taking into consideration new developments due to globalization of agriculture and trade. Large-scale adoption of new breeding techniques such as marker -aided selection, requires appropriate consideration in varietal testing procedures. Genetically engineered varieties have become a reality in several crops. Their development and introduction necessitate appropriate testing procedures for ensuring bio-safety. The development of export-oriented agricultural produce, including foodgrains, is likely to increase considerably with globalization of economy and trade. Another important development is increasing role of private sector involvement in crop breeding, seed production and supply. This demands for creation of a reliable and a transparent testing and evaluation system. A Committee was constituted by the Council to critically review the existing guidelines and update these by incorporating the present needs. A series of meetings were held by the Committee and suggestions/ comments from Directors/Project Directors/Coordinators were also sought. The draft was circulated among all concerned, and it was discussed under the Chairmanship of Deputy Director General (Crop Science) to bring out this document to its present form. The Committee acknowledges the support rendered by the Indian Council of Agricultural Research. Dr S. K. Datta, Deputy Director General (Crop Science) consistently facilitated in collection of information and Dr J. S. Chauhan, Assistant Director General (Seeds) also supported in getting appropriate inputs from all the Project Directors/Coordinators, which helped in bringing out this document in its form. All the PD/PCs suggestions for improving this document are also thankfully acknowledged. The Committee is also grateful to the Director, Indian Agricultural Research Institute, New Delhi, for facilitating in logistics and in conducting meetings.Not Availabl

AICRP on Pearlmillet Annual Report 2010-2011

This gives achievements of All India Coordinated Research Project on Pearl Millet during 2010-2011.Not Availabl

Not Available

This gives achievements of All India Coordinated Research Project on Pearl Millet during 2011-12.This gives achievements of All India Coordinated Research Project on Pearl Millet during 2011-12.Not Availabl