Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2•72 (95% uncertainty interval [UI] 2•66–2•79) in 2000 to 2•31 (2•17–2•46) in 2019. Global annual livebirths increased from 134•5 million (131•5–137•8) in 2000 to a peak of 139•6 million (133•0–146•9) in 2016. Global livebirths then declined to 135•3 million (127•2–144•1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2•1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27•1% (95% UI 26•4–27•8) of global livebirths. Global life expectancy at birth increased from 67•2 years (95% UI 66•8–67•6) in 2000 to 73•5 years (72•8–74•3) in 2019. The total number of deaths increased from 50•7 million (49•5–51•9) in 2000 to 56•5 million (53•7–59•2) in 2019. Under-5 deaths declined from 9•6 million (9•1–10•3) in 2000 to 5•0 million (4•3–6•0) in 2019. Global population increased by 25•7%, from 6•2 billion (6•0–6•3) in 2000 to 7•7 billion (7•5–8•0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58•6 years (56•1–60•8) in 2000 to 63•5 years (60•8–66•1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Global burden of 87 risk factors in 204 countries and territories, 1990�2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk�outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk�outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk�outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95 uncertainty interval UI 9·51�12·1) deaths (19·2% 16·9�21·3 of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12�9·31) deaths (15·4% 14·6�16·2 of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253�350) DALYs (11·6% 10·3�13·1 of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0�9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10�24 years, alcohol use for those aged 25�49 years, and high systolic blood pressure for those aged 50�74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Effect Of Increasing Level Of Dietary Urea In Diets For Dairy Cows On Composition And Yield Of Minas Frescal Cheese [efeito De Níveis Crescentes De Uréia Na Dieta De Vacas Leiteiras Sobre A Composição E Rendimento De Fabricação De Queijos Minas Frescal]

The aim of this study was to evaluate the substitution of soybean meal for increasing levels of dietary urea on the composition and yield of Minas cheese. For each cheese making process, 15 kg of milk were collected from nine lactating Holstein cows that were arranged in 3 Latin squares. Three diets with sugar cane as roughage were fed for cows and consisted of: A) control diet formulated to provide 100% of the requirements of crude protein (CP), rumen undegradable protein (RUP) and rumen degradable protein (RDP), using soybean meal; B) urea inclusion at 0.75% of dry matter in substitution for soybean meal crude protein equivalent; C) urea inclusion at 1.5% of dry matter in substitution for soybean meal crude protein equivalent. Energy and protein levels of rations comply with NRC (2001), and were isoenergetic and isonitrogenous. When the data were analyzed by simple polynomial regression, no effect of treatments were observed on pasteurized milk composition and milk nitrogen fractions, as well as for cheese composition (pH, moisture,fat,ash, sodium cloride, crude protein, soluble nitrogen in pH 4,6 and in TCA 12%) and cheese yield. Based on the results of this study, it can be concluded that the addition of urea up to 1.5% in dry matter basis in substitution for soybean meal in the diet of Holstein cows did not alter cheese composition and yield.464273279Emmons, D.B., Dubé, C., Modler, H.W., Transfer of protein from milk to cheese (2003) Journal of Dairy Science, 86 (2), pp. 469-485Oliveira, J.S., (1986) Queijo: Fundamentos tecnológicos, p. 147. , 2 ed. São Paulo: Ícone(2001) Nutrient requirements of dairy cattle, p. 381. , NATIONAL RESEARCH COUNCIL, Washington: National Academy of Science, National Academy Press(1995) Official methods of analysis, p. 1141. , ASSOCIATION OF OFFICIAL ANALYTICAL CHEMISTS, 16. ed. Washington: Arlington(1990) Official methods of analysis, p. 1050. , ASSOCIATION OF OFFICIAL ANALYTICAL CHEMISTS, 11 ed. Washington: ArlingtonRichardson, G.H., (1985) Standard methods for examination of dairy products, p. 412. , Washington: American Public Health AssociationLucey, J., Kelly, J., Cheese yield (1994) Journal of the Society of Dairy Technology, 47 (1), pp. 1-14(1996) SAS user's guide: Statistics, p. 842. , STATISTICAL ANALISYS SYSTEM, North Caroline: SASCarmo, C.A., Santos, F.A.P., Imaizumi, H., Pires, A.V., Scoton, R.A., Substituição do farelo de soja por uréia ou amiréia para vacas em final de lactação (2005) Acta Scientiarum, 27 (2), pp. 277-286Oliveira, A.S., Valadares, R.F.D., Valadares Filho, S.C., Cecon, P.R., Oliveira, G.A., Silva, R.M.N., Costa, M.A.L., Consumo, digestibilidade aparente, produção e composição do leite de vacas alimentadas com quatro níveis de compostos nitrogenados não-protéicos (2001) Revista Brasileira de Zootecnia, 30 (4), pp. 1358-1366Silva, R.M.N., Valadares, R.F.D., Valadares Filho, S.C., Cecon, P.R., Campos, J.M.S., Oliveira, G.A., Oliveira, A.S., Uréia para vacas em lactação. 1. Consumo, digestibilidade, produção e composição do leite (2001) Revista Brasileira de Zootecnia, 30 (5), pp. 1639-1649Reynal, S.M., Broderick, G.A., Effect of dietary level of rumen-degraded protein on production and nitrogen metabolism in lactating dairy cows (2005) Journal of Dairy Science, 88 (11), pp. 4045-4064Bateman, H.G., Spain, J.N., Kerley, M.S., Belyea, R.L., Marshall, R.T., Evaluation of ruminally protected methionine and lysine or blood meal and fish meal as protein sources for lactating Holsteins (1999) Journal of Dairy Science, 82 (10), pp. 2115-2120Coulon, J.B., Hurtaud, C., Remond, B., Verite, R., Factors contributing to variation in the proportion of casein in cows' milk true protein: A review of recent INRA experiments (1998) Journal of Dairy Research, 65 (3), pp. 375-387Cunha, C.R., Spadoti, L.M., Zacarchenco, P.B., Viotto, W.H., Efeito do fator de concentração do retentado na composição e proteólise de queijo Minas Frescal de baixo teor de gordura fabricado por ultrafiltração (2002) Ciência e Tecnologia de Alimentos, 22 (1), pp. 82-8

Chemical composition and digestibility of sugarcane harvested at two periods of the year

The objectives of this study were to evaluate the effect of time of harvest on chemical composition and in vitro digestibility of sugarcane genotypes, to compare chemical composition and in vitro digestibility of the stem and leaf fractions, and to determine possible correlations between chemical composition and in vitro digestibility of the whole plant in sugarcane genotypes. Nine genotypes were harvested in May and September of 2006. In May, only the whole-plant fraction was analyzed, in September the genotypes were separated in stems, leaves or whole-plant for determination of chemical composition, sucrose (POL) and in vitro digestibility. Stems had lower neutral detergent fiber (NDF) and lignin in the DM, and greater in vitro dry matter digestibility (IVDMD) than leaves. However, stems had lower in vitro NDF digestibility (IVNDFD), higher lignin in the NDF and lower crude protein (CP). The NDF and IVNDFD were reduced with advanced maturity, while IVDMD, POL and lignin were increased. IVDMD was negatively correlated with NDF and NDF/POL, however there was no correlation between IVFDND and NDF or NDF/POL. It can be concluded that with the advance in maturity the IVNDFD was reduced and IVDMD was increased, and there was no genetic correlation between accumulation of sugar and in vitro fiber digestibility. Data from this study indicate that it is not expected that selection of genotypes with greater stem IVNDFD would alter the sugar content of the plant

Sólidos totais do leite em amostras de tanque nos estados do Paraná, Santa Catarina e São Paulo Milk total solids in bulk tank samples of Paraná, Santa Catarina and São Paulo States

Objetivou-se, neste trabalho, estudar a variação dos sólidos totais em amostras de leite de tanques de 32.590 rebanhos dos estados do Paraná, Santa Catarina e São Paulo. Foram analisadas 257.540 amostras de leite de tanques coletadas entre janeiro de 1999 e novembro de 2001, no Laboratório Central do Programa de Análise de Rebanhos Leiteiros do Paraná (PARLPR), da Associação Paranaense de Criadores de Bovinos da Raça Holandesa. Utilizando-se o método dos quadrados mínimos, foram estudados os efeitos de rebanho, região, mês e ano de análise, idade da amostra e escore de células somáticas sobre os sólidos totais, em amostras de leite de tanques. As médias ajustadas dos sólidos totais por região variaram de 11,78 a 12,83%; a maior média foi verificada em maio de 2001 e a menor, em janeiro de 2000; os sólidos totais não demonstraram variação até o quinto dia de análise; o efeito de escore de células somáticas foi contraditório, se comparado aos relatados por outros autores. Todos os fatores incluídos no modelo linear foram altamente significativos sobre as características analisadas. O coeficiente de correlação entre sólidos totais e seus componentes foi de 0,875 para gordura, 0,653 para proteína, 0,237 para lactose, e 0,643 para sólidos não-gordurosos. A correlação de sólidos totais com contagem de células somáticas foi 0,012, e com escore de células somáticas, de 0,023.<br>The objective of this research was to study the variation of total solids in bulk tank milk samples in 32,590 herds of Paraná, Santa Catarina and São Paulo states, in Brazil. A total of 257,540 bulk tank samples collected between January 1999 and November 2001 were analyzed at the Central Laboratory of the Programa de Análise dos Rebanhos Leiteiros do Paraná (PARLPR) of the Holstein Association of the state of Paraná. Least Square Means Method procedures were used to study the effects of herd, region, month and year of test, age of the sample and somatic cell score on total solids of bulk tank milk. The adjusted means of total solids by region ranged from 11.78 to 12.83%; the greatest means were in May 2001 and the smallest in January 2000; total solids did not show variation until the fifth day of analysis; the effect of cell score was contradictory, when compared with other authors. All factors included in the linear model had highly significant effect on the trait analyzed. The correlation coefficient between total solids and their components were 0.875 for fat, 0.653 for protein, 0.237 for lactose, and 0.643 for solids not fat. Correlation of total solids with somatic cell count was 0.012, and 0.023 with somatic cell score

Effectiveness of the combination elvitegravir/cobicistat/tenofovir/emtricitabine (EVG/COB/TFV/FTC) plus darunavir among treatment-experienced patients in clinical practice : A multicentre cohort study

Background: The aim of this study was to investigate the effectiveness and tolerability of the combination elvitegravir/cobicistat/tenofovir/emtricitabine plus darunavir (EVG/COB/TFV/FTC + DRV) in treatment-experienced patients from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods: Treatment-experienced patients starting treatment with EVG/COB/TFV/FTC + DRV during the years 2014-2018 and with more than 24 weeks of follow-up were included. TFV could be administered either as tenofovir disoproxil fumarate or tenofovir alafenamide. We evaluated virological response, defined as viral load (VL) < 50 copies/ml and < 200 copies/ml at 24 and 48 weeks after starting this regimen, stratified by baseline VL (< 50 or ≥ 50 copies/ml at the start of the regimen). Results: We included 39 patients (12.8% women). At baseline, 10 (25.6%) patients had VL < 50 copies/ml and 29 (74.4%) had ≥ 50 copies/ml. Among patients with baseline VL < 50 copies/ml, 85.7% and 80.0% had VL < 50 copies/ml at 24 and 48 weeks, respectively, and 100% had VL < 200 copies/ml at 24 and 48 weeks. Among patients with baseline VL ≥ 50 copies/ml, 42.3% and 40.9% had VL < 50 copies/ml and 69.2% and 68.2% had VL < 200 copies/ml at 24 and 48 weeks. During the first 48 weeks, no patients changed their treatment due to toxicity, and 4 patients (all with baseline VL ≥ 50 copies/ml) changed due to virological failure. Conclusions: EVG/COB/TFV/FTC + DRV was well tolerated and effective in treatment-experienced patients with undetectable viral load as a simplification strategy, allowing once-daily, two-pill regimen with three antiretroviral drug classes. Effectiveness was low in patients with detectable viral loads

Predictors for anastomotic leak, postoperative complications, and mortality after right colectomy for cancer: Results from an international snapshot audit

Background: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. Objective: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy. Design: This was a snapshot observational prospective study. Setting: The study was conducted as a multicenter international study. Patients: The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients. Main Outcome Measures: Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method. Results: Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p 65 0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041). Limitations: This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors. Conclusions: Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950�2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10�14 and 50�54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95 uncertainty interval UI 2·66�2·79) in 2000 to 2·31 (2·17�2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5�137·8) in 2000 to a peak of 139·6 million (133·0�146·9) in 2016. Global livebirths then declined to 135·3 million (127·2�144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4�27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8�67·6) in 2000 to 73·5 years (72·8�74·3) in 2019. The total number of deaths increased from 50·7 million (49·5�51·9) in 2000 to 56·5 million (53·7�59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1�10·3) in 2000 to 5·0 million (4·3�6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0�6·3) in 2000 to 7·7 billion (7·5�8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1�60·8) in 2000 to 63·5 years (60·8�66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens