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

Produção e composição químico-bromatológica do capim-furachão (Panicum repens L.) sob adubação e diferentes idades de corte Production and chemical composition of furachão grass (Panicum repens L.) under fertilization and different cutting ages

O objetivo deste trabalho foi avaliar a produção de matéria seca (MS) e a composição químico-bromatológica do capim-furachão (Panicum repens L.) em diferentes idades de corte (15, 30, 45, 60 e 75 dias), na presença e ausência de adubação. Para as análises de produção e composição química, utilizou-se delineamento em blocos casualizados, em um fatorial 5 x 2 (cinco idades de corte e dois níveis de adubação), com três repetições. A adubação proporcionou aumento na produção e redução nos teores de MS. Os teores de proteína bruta (PB) foram reduzidos com o avanço da idade da gramínea. Aos 60 dias, encontraram-se produções de 541,87 kg/ha de PB e 5343,92 kg/ha de MS e teores médios de FDN e FDA de 69,70 e 34,25% na MS, respectivamente. As idades de corte influíram nos teores de FDN e FDA, mas a adubação não influenciou os teores de FDN. Os teores de Ca não diferiram na presença ou ausência de adubação, com média de 0,13% na MS, e aumentaram com a idade de corte. Os teores de P diminuíram com o avanço da idade da gramínea, sendo o maior valor 0,22% na MS, na condição sem adubo.<br>The objective of this work was to evaluate the dry matter (DM) yield and chemical composition of furachão grass (Panicum repens L.) at different cutting ages (15, 30, 45, 60 and 75 days), with and without fertilization. For the yield analysis and chemical aanalysis composition, a completely randomized block design in a 5 x 2 factorial arrangement (cutting ages and fertilization levels), with three replicates, was used. Fertilization increased DM produced and reduction in the DM contents. The crude protein (CP) contents decreased as the cutting ages increased. At 60 days, productions of 541,87 kg/ha CP and 5343.92 kg/ha DM and average neutral detergent fiber (NDF) and acid detergent fiber (ADF) contents of 69.7 and basis 34.25% in DM respectively were observed. The cutting ages affected the NDF and ADF average contents, but fertilization did not affect NDF contents. At 60 days of age the mean NDF and ADF contents were 69,70% e 34,25% on DM basis, respectively. The Ca contents were not affected by fertilization, with mean value of 0.13% in DM basis, and increased with the cutting age. The P contents reduced as the cutting ages of grass increased and the highest mean value was 0.22% on DM basis, in the without fertilization condition

Water consumption when exposed to sun and shade for native goats in the semiarid of the State of Paraiba, Brazil Consumo de água quando exposta ao sol e à sombra por caprinos nativos no Semiárido Paraibano

This work aimed to evaluate the preference and water consumption of native goats in the semiarid of Brazil. The water was freely supplied, in individual buckets, one exposed to the sun and the other in the shade. The experiment was realized using 18 animals of Moxotó, Graúna and Azul breeds, with average weight of 16,6 ± 2,4 kg, kept in confinement in individual stalls equipped with feeders and drinkers, during the period from January to February of 2009. The water temperature was measured by sensors (thermocouples type T - copper/constantan), which were coupled to a system of data acquisition. It was observed that the average water temperature exposed to the sun was 29.02 ºC, and 23.85 ºC in the shade. For all breeds there was a preference for the water exposed to the sun, corresponding to an average consumption of 64.71% of the total. Among the breeds, the greatest preference for water exposed to the sun was the Azul (71.18%), followed by the Moxotó (65.95%) and the Graúna (57.00%). The animals consumed more water during the day, and the average water consumption was 1.15 grams day-1, corresponding to 6.9 % of body weight of the animals.<br>O trabalho teve o objetivo de avaliar a preferência e o consumo de água por caprinos nativos no semiárido brasileiro, fornecida à vontade, em baldes individuais, sendo um exposto ao sol e outro à sombra. O experimento foi realizado, utilizado-se de 18 animais das raça Moxotó, Graúna e Azul, com peso vivo médio de 16,6 ± 2,4 kg, mantidos em confinamento, em baias individuais, providas de comedouro e bebedouro, durante o período de janeiro a março de 2009. A temperatura da água foi medida através de sensores (termopares tipo T - cobre/constantan), que estavam acoplados a um sistema de aquisição de dados. Observou-se que a temperatura média da água exposta ao sol foi de 29,02 ºC, e à sombra, de 23,85 ºC. Para todas as raças, houve preferência pela água exposta ao sol, correspondendo a um consumo médio de 64,71% do total. Entre as raças, a maior preferência pela água exposta ao sol foi da Azul (71,18%), seguida da Moxotó (65,95%) e Graúna (57,00%). Os animais consumiram mais água no período diurno, sendo o consumo médio de 1.150 gramas dia-1, correspondendo a 6,9% do peso vivo dos animais

Efeito do fósforo e do potássio sobre o desenvolvimento e a nodulação de três leguminosas anuais de estação fria Effect of phosphorus and potassium on development and nodulation of three cool season annual legumes

Este experimento foi conduzido em casa de vegetação da Embrapa Clima Temperado, Pelotas, RS, com o objetivo de avaliar os efeitos de diferentes doses de fósforo e potássio na produção de matéria seca da parte aérea e das raízes, comprimento da parte aérea e sistema radicular, escore e eficiência da nodulação de três leguminosas forrageiras anuais de estação fria. Os tratamentos consistiram de cinco doses de P (0,0; 1,08; 2,15; 3,23 e 4,30 mg/dm³ de P2O5) e K (0,0; 0,43; 0,85; 1,28 e 1,70 mg/dm³ de K2O), correspondendo a 0,0 (controle) 1, 2, 3 e 4 vezes a recomendação da análise de solo, em vasos, com 8 kg de solo tipo Planossolo, unidade de mapeamento Pelotas. As leguminosas utilizadas foram: Trifolium resupinatum L. cv. Kyambro (trevo-persa), Trifolium subterraneum L. cv. Woogenellup e Lotus subbiflorus Lag. cv. El Rincón. O delineamento experimental foi o completamente ao acaso, em arranjo fatorial 3 x 5 x 5, com três repetições. O trabalho foi conduzido no período de maio a outubro de 2000, sendo os dados colhidos ao final do período experimental, aproximadamente 170 dias após a semeadura. A maioria das características estudadas não foi influenciada pela aplicação de potássio, e sim pela aplicação de fósforo. Para as variáveis relacionadas com produção (MS parte aérea e raízes), o trevo-persa foi a espécie mais produtiva. Para a nodulação, o trevo-subterrâneo e o Lotus El Rincón apresentaram maior eficiência e quantidade de nódulos.<br>This experiment was established in greenhouse at Embrapa Clima Temperado, Pelotas, RS, with the objective to evaluate the effects of different doses of phosphorus and potassium on dry matter production of aerial biomass and roots, length of above ground parts and roots and efficiency and score of nodulation of three cool season annual forage legumes. The treatments were five doses of P (0,0; 1,08; 2,15; 3,23 e 4,30 mg de P2O5/dm³) and K (00,0; 0,43; 0,85; 1,28 e 1,70 mg de K2O/dm³) representing to 0,0 (control ) and 1, 2, 3 and 4 times the soil analysis recommendation, in pots, filled up with 8 kg de soil type Planossolo, mapping unit Pelotas. The legumes used were: Trifolium resupinatum L. cv. Kyambro (persian clover), Trifolium subterraneum L. cv. Woogenellup and Lotus subbiflorus Lag. cv. El Rincón. The experimental design consisted of a 5x5x3 factorial treatment arrangement, in a completely randomized design, with three replications. The experiment was carried out from May to October 2000, and the data were collected at the end of the experimental period, approximately 170 days after sowing. The majority of variables were not affected by K, but by P fertilization. For the variables related with production, persian clover was the most productive species. For nodulation, subterranean clover and Lotus El Rincón showed higher nodule numbers and efficiency

Políticas públicas no meio rural: visibilidade e participação social como perspectivas de cidadania solidária e saúde Public policies in rural areas: visibility and social participation as perspectives of supportive citizenship and health

O artigo visa estimular o debate sobre o papel que o Estado vem assumindo na construção de uma cidadania mais solidária e na promoção da saúde. Propõe pensar essas relações por meio da Teoria da Dádiva e de categorias analíticas como participação e visibilidade. Parte-se do pressuposto de que, ao circularem bens materiais e imateriais nas políticas públicas, dá-se visibilidade e reconhecimento às necessidades dos usuários, possibilitando abertura para participação e alargamento das parcerias e solidariedades entre Estado-sociedade e sociedade-sociedade. Isso, por sua vez, contribuiria para a concretização de direitos, a potencialização de programas e a materialização da saúde, pensada de uma forma mais ampla. As reflexões aqui apresentadas partem de estudos realizados com abordagem qualitativa, tendo como lócus uma comunidade rural do Rio Grande do Sul. Os dados foram produzidos por meio de entrevistas, observações participantes e grupos focais; na apreciação das informações adotou-se a análise temática. Foi possível apreender que, por um lado, as políticas, ao propiciarem a visibilidade e a participação, permitem o exercício da cidadania, vínculos mais solidários e o enfrentamento do cotidiano na busca das necessidades sociais e em saúde; por outro, elas também podem, ao atuar na contramão da cidadania, contribuir com o imobilismo e clientelismo, (re)produzindo desigualdades. Por fim, muito se tem avançado em termos de políticas públicas; porém, para alcançarmos uma cidadania mais solidária e a saúde, parece ser necessário, por parte do Estado, superar práticas pouco democráticas e, pelo lado da sociedade, um civismo tutelado e conformista.<br>This paper aims to stimulate the debate on the role the State takes in the development of a more supportive citizenship and health promotion. It proposes to analyze those relationships through the Theory of Donation and analytical categories such as participation and visibility. It is believed that the use of material and immaterial goods in public policies gives visibility and recognition to the users' needs, enabling the participation and the enlargement of partnerships and solidarity between State-society and society-society. This, in turn, would contribute in achieving rights, empowering health programs and materializing health conceived in a broader way. The reflections here presented come from studies of qualitative approach, which have as locus a rural community of Rio Grande do Sul state, Brazil. Data were produced through interviews, participating observations and focus groups; in the assessment of information it was adopted a thematic analysis. It was possible to see that, on one hand, when policies favor visibility and participation they allow the exercise of citizenship, the development of solidarity ties, and coping in the search of health and social needs. On the other, when they are against citizenship they can also favor immobility and clientelism, (re)producing inequalities. Finally, there has been much progress in terms of public policies, but to achieve a more supportive citizenship, the State must overcome its undemocratic practices, and society must overcome its tutored and conformist public spirit