Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation

Measurement of the Bs0→ μμ effective lifetime with the ATLAS detector

This paper reports the first ATLAS measurement of the B0s → μμ effective lifetime. The measurement is based on the data collected in 2015–2016, amounting to 26.3 fb−1 of 13 TeV LHC proton-proton collisions. The proper decay-time distribution of 58 ± 13 background-subtracted signal candidates is fit with simulated signal templates parameterised as a function of the B0s effective lifetime, with statistical uncertainties extracted through a Neyman construction. The resulting effective measurement of the B0s → μμ lifetime is 0.99+0.42−0.07 (stat.) ± 0.17 (syst.) ps and it is found to be consistent with the Standard Model

Evidence of pair production of longitudinally polarised vector bosons and study of CP properties in ZZ → 4ℓ events with the ATLAS detector at √s = 13 TeV

A study of the polarisation and CP properties in ZZ production is presented. The used data set corresponds to an integrated luminosity of 140 fb−1 of proton-proton collisions at a centre-of-mass energy of 13 TeV recorded by the ATLAS detector at the Large Hadron Collider. The ZZ candidate events are reconstructed using two same-flavour opposite-charge electron or muon pairs. The production of two longitudinally polarised Z bosons is measured with a significance of 4.3 standard deviations, and its cross-section is measured in a fiducial phase space to be 2.45 ± 0.60 fb, consistent with the next-to-leading-order Standard Model prediction. The inclusive differential cross-section as a function of a CP-sensitive angular observable is also measured. The results are used to constrain anomalous CP-odd neutral triple gauge couplings

Search for direct production of electroweakinos in final states with one lepton, jets and missing transverse momentum in pp collisions at √s = 13 TeV with the ATLAS detector

Searches for electroweak production of wino-like chargino pairs, χ˜ + 1 χ˜ − 1 , and of wino-like chargino and next-to-lightest neutralino, χ˜ ± 1 χ˜ 0 2 , are presented. The models explored assume that the charginos decay into a W boson and the lightest neutralino, χ˜ ± 1 → W±χ˜ 0 1 . The next-to-lightest neutralinos are degenerate in mass with the chargino and decay to χ˜ 0 1 and either a Z or a Higgs boson, χ˜ 0 2 → Zχ˜ 0 1 or hχ˜ 0 1 . The searches exploit the presence of a single isolated lepton and missing transverse momentum from the W boson decay products and the lightest neutralinos, and the presence of jets from hadronically decaying Z or W bosons or from the Higgs boson decaying into a pair of b-quarks. The searches use 139 fb−1 of √ s = 13 TeV proton-proton collisions data collected by the ATLAS detector at the Large Hadron Collider between 2015 and 2018. No deviations from the Standard Model expectations are found, and 95% confdence level exclusion limits are set. Chargino masses ranging from 260 to 520 GeV are excluded for a massless χ˜ 0 1 in chargino pair production models. Degenerate chargino and next-to-lightest neutralino masses ranging from 260 to 420 GeV are excluded for a massless χ˜ 0 1 for χ˜ 0 2 → Zχ˜ 0 1 . For decays through an on-shell Higgs boson and for mass-splitting between χ˜ ± 1 /χ˜ 0 2 and χ˜ 0 1 as small as the Higgs boson mass, mass limits are improved by up to 40 GeV in the range of 200–260 GeV and 280–470 GeV compared to previous ATLAS constraints

Measurement of the tt¯ cross section and its ratio to the Z production cross section using pp collisions at √s = 13.6 TeV with the ATLAS detector

The inclusive top-quark-pair production cross section σtt¯ and its ratio to the Z-boson production cross section have been measured in proton–proton collisions at √s = 13.6 TeV, using 29 fb−1 of data collected in 2022 with the ATLAS experiment at the Large Hadron Collider. Using events with an opposite-charge electron-muon pair and b-tagged jets, and assuming Standard Model decays, the top-quark-pair production cross section is measured to be σtt¯=850±3(stat.)±18(syst.)±20(lumi.) pb. The ratio of the tt¯ and the Z-boson production cross sections is also measured, where the Z-boson contribution is determined for inclusive e+e− and μ+μ− events in a fiducial phase space. The relative uncertainty on the ratio is reduced compared to the tt¯ cross section, thanks to the cancellation of several systematic uncertainties. The result for the ratio, Rtt¯/Z=1.145±0.003(stat.)±0.021(syst.)±0.002(lumi.) is consistent with the Standard Model prediction using the PDF4LHC21 PDF set

Search for flavour-changing neutral tqH interactions with H → γγ in pp collisions at √s = 13 TeV using the ATLAS detector

A search for flavour-changing neutral interactions involving the top quark, the Higgs boson and an up-type quark q (q = c, u) is presented. The proton-proton collision data set used, with an integrated luminosity of 139 fb−1, was collected at √s = 13 TeV by the ATLAS experiment at the Large Hadron Collider. Both the decay process t → qH in tt¯ production and the production process pp → tH, with the Higgs boson decaying into two photons, are investigated. No significant excess is observed and upper limits are set on the t → cH and the t → uH branching ratios of 4.3 × 10−4 and 3.8 × 10−4, respectively, at the 95% confidence level, while the expected limits in the absence of signal are 4.7 × 10−4 and 3.9 × 10−4. Combining this search with ATLAS searches in the H → τ+τ− and H → b¯b final states yields observed (expected) upper limits on the t → cH branching ratio of 5.8 × 10−4 (3.0 × 10−4) at the 95% confidence level. The corresponding observed (expected) upper limit on the t → uH branching ratio is 4.0 × 10−4 (2.4 × 10−4)

Measurement of ZZ production cross-sections in the four-lepton final state in pp collisions at √s = 13.6 TeV with the ATLAS experiment

This paper reports cross-section measurements of ZZ production in pp collisions at √s = 13.6TeV at the Large Hadron Collider. The data were collected by the ATLAS detector in 2022, and correspond to an integrated luminosity of 29 fb−1. Events in the ZZ → 4ℓ (ℓ = e, μ) final states are selected and used to measure the inclusive and differential cross-sections in a fiducial region defined close to the analysis selections. The inclusive cross-section is further extrapolated to the total phase space with a requirement of 66 <mZ < 116 GeV for both Z bosons, yielding 16.8 ± 1.1 pb. The results are well described by the Standard Model predictions

Electron and photon energy calibration with the ATLAS detector using LHC Run 2 data

This paper presents the electron and photon energy calibration obtained with the ATLAS detector using 140 fb-1 of LHC proton-proton collision data recorded at √(s) = 13 TeV between 2015 and 2018. Methods for the measurement of electron and photon energies are outlined, along with the current knowledge of the passive material in front of the ATLAS electromagnetic calorimeter. The energy calibration steps are discussed in detail, with emphasis on the improvements introduced in this paper. The absolute energy scale is set using a large sample of Z-boson decays into electron-positron pairs, and its residual dependence on the electron energy is used for the first time to further constrain systematic uncertainties. The achieved calibration uncertainties are typically 0.05% for electrons from resonant Z-boson decays, 0.4% at ET ∼ 10 GeV, and 0.3% at ET ∼ 1 TeV; for photons at ET ∼ 60 GeV, they are 0.2% on average. This is more than twice as precise as the previous calibration. The new energy calibration is validated using J/ψ → ee and radiative Z-boson decays

Performance and calibration of quark/gluon-jet taggers using 140 fb−1 of pp collisions at √s = 13 TeV with the ATLAS detector

The identification of jets originating from quarks and gluons, often referred to as quark/gluon tagging, plays an important role in various analyses performed at the Large Hadron Collider, as Standard Model measurements and searches for new particles decaying to quarks often rely on suppressing a large gluon-induced background. This paper describes the measurement of the efficiencies of quark/gluon taggers developed within the ATLAS Collaboration, using √s = 13 TeV proton–proton collision data with an integrated luminosity of 140 fb-1 collected by the ATLAS experiment. Two taggers with high performances in rejecting jets from gluon over jets from quarks are studied: one tagger is based on requirements on the number of inner-detector tracks associated with the jet, and the other combines several jet substructure observables using a boosted decision tree. A method is established to determine the quark/gluon fraction in data, by using quark/gluon-enriched subsamples defined by the jet pseudorapidity. Differences in tagging efficiency between data and simulation are provided for jets with transverse momentum between 500 GeV and 2 TeV and for multiple tagger working points

Measurement of the Higgs boson mass with H → γγ decays in 140 fb−1 of √s = 13 TeV pp collisions with the ATLAS detector

The mass of the Higgs boson is measured in the H → γγ decay channel, exploiting the high resolution of the invariant mass of photon pairs reconstructed from the decays of Higgs bosons produced in proton–proton collisions at a centre-of-mass energy √s = 13 TeV. The dataset was collected between 2015 and 2018 by the ATLAS detector at the Large Hadron Collider, and corresponds to an integrated luminosity of 140 fb−1. The measured value of the Higgs boson mass is 125.17 ± 0.11 (stat.)±0.09 (syst.) GeV and is based on an improved energy scale calibration for photons, whose impact on the measurement is about four times smaller than in the previous publication. A combination with the corresponding measurement using 7 and 8 TeV pp collision ATLAS data results in a Higgs boson mass measurement of 125.22 ± 0.11 (stat.)±0.09 (syst.) GeV. With an uncertainty of 1.1 per mille, this is currently the most precise measurement of the mass of the Higgs boson from a single decay channel