Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Regional dimensions of disparities in crop productivity in Uttar Pradesh

In the present study, the data on yield rates of rice and wheat crops are analysed at tehsil level in Uttar Pradesh for alI 244 tehsils where crop cutting experiments on randomly selected fields were conducted on both rice and wheat crops. One of the objectives of the study is to find out whether the 8th Five Year Plan has made significant impact in increasing the yield rates of rice and wheat over the 7th Five Year Plan. The level of agricultural development with respect to rice and wheat productivity is estimated for all the tehsils of Uttar Pradesh. The technique of analysis of variance is used to test whether the efforts made in the 8th Five Year Plan had made any impact in increasing the yield levels of rice and wheat over the achievements of the 7th Five Year Plan. The variation between tehsils and between years within Plan periods are also tested. It would be quite interesting and useful to examine and rank the level of agricultural development in various tehsils. For this purpose, the composite indices of agricultural development as exhibited by the yield rates of rice and wheat from the period 1985-86 to 1994-95 have been obtained by the procedures described by Narain et at. [1], [2]. Tehsils are ranked on the basis of composite indices of agricultural development. Wide disparities have been observed between different tehsils in the level of rice and wheat productivity. The yield levels of rice and wheat crops are positively associated. Western region and Plain portion of the hilly region of the State are found to be better developed as compared to other regions of the State with respect to productivity levels of rice and wheat crops. For bringing about uniform regional growth and development of agriculture in the State, future strategies of agricultural development in low developed tehsils/districts/regions have been suggested

Dimensions of regional disparities in socio-economic development of Madhya Pradesh

The level of development of various districts of Madhya Pradesh was estimated with the help of composite index based on optimum combination of socio-economic indicators. All the forty five districts of the State have been inlcluded in the study. The data for the year 1994-95 on forty seven socio-economic indicators have been used. The level of development was separately estimated for agricultural, industrial, infrastructural and socia.economic fields. Out of forty seven indicators included in the study, twenty three indicators are directly connected with agricultural development, six indicators depict the progress of development in industrial sector and the rest eighteen indicators present the level of development in infrastructural service sector. For bringing about uniform regional development, model districts have been identified and potential targets for various indicators have estimated for low developed districts. These districts require improvement various dimensions in most of the indicators for enhancing the level of over all socio-economic development

Estimation of socio-economic development in hilly states

The level of development of hilly states of the country has been estimated with the help of composite index based on optimum combination of socio-economic indicators. The states of Arunachal Pradesh, Assam, Himachal Pradesh, Jammu &amp; Kashmir, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim, Tripura and Uttaranchal has been included in the study. The data for the year 2000-2001 on seventeen socio-economic indicators have been used. Out of seventeen indicators included in the study, five indicators are directly concerned with agricultural development and the rest twelve indicators describe the level of development in infrastructural service sector. The level of development has been separately estimated for agricultural, infrastructural and overall socio-economic fields. In case of overall socio-economic development, the State of Mizoram has been ranked first and the State of Arunachal Pradesh is ranked last. Positive significant association is found between the developments in infrastructural facilities and overall socio-economic fields. Literacy rate is also influencing the level of development in the positive direction. For bringing about uniform regional development, potential targets for various indicators have been estimated for low developed states

Statistical evaluation of social development at district level

Special programmes of socio-economic development have been launched in the country for improving the quality of life of people. The level of socio-economic development was estimated for different districts in the States of Andhra Pradesh, Assam, Jammu &amp; Kashmir, Karnataka, Kerala, Madhya Pradesh (including Chhattisgarh), Maharashtra, Orissa, Tamil Nadu and Uttar Pradesh (including Uttaranchal) from the period 1991 to 2005. The status of development in agriculture sector and infrastructural facilities was evaluated for different districts. The evaluation of industrial development was also undertaken in some of the states. About 282 districts belonging to these states were convered in the study. The status of development had been worked out on the basis of a number of developmental indicators. The level of development was estimated with the help of composite index based on optimum combination of all the developmental indicators. The districts falling in different stages of development such as high level developed, middle level developed and low level developed have been identified for all the states covered in the study. Association among the levels of development in agricultural sector and overall socio-economic sector had been worked out. For enhancing the level of development of low developed districts, model districts had been identified and potential targets of important developmental indicators had been estimated

Dimensions of socio-economic development in Jammu &amp; Kashmir

The level ofdevelopmentofdifferent districts of Jammu &amp; Kashmir was obtained with the help of composite index based on optimum combination of twenty nine developmental indicators. The district-wise data on these indicators for the year 2001-02 were used for obtaining the level of development ofall the fourteen districts ofthe State. The level ofdevelopment was estimated separately for agricultural sector, infrastructural facilities and overall socio-economic sector. The district of Kathua was ranked first and the district ofKargil was ranked last in the socio-economic development. Wide disparities were observed in the level of development between different districts of the State. Infrastructural facilities and literacy status ofthe people were found to be positively associated with the socio-economic development. For bringing out uniform regional development, potential targets of various developmental indicators have been estimated in respect of low developed districts. These districts require improvement of various dimensions in some of the indicators for enhancing the level of development

Regional disparities in socio-economic development in Tamil Nadu

The level of development of different districts of Tamil Nadu was obtained with the help of composite index based on optimum combination of forty two socio-economic indicators. The district-wise data in respect of forty two indicators were used for twenty two districts of the State. The data on most of the indicators were for the year 1994-95. The level of development was obtained separately for agricultural, infrastructural service and socio- economic sectors. The district of Chengalpattu MGR was ranked first and the district of Pasumpon Muthuramalinga Thevar was ranked last in the level of socio-economic development in the State. Wide disparities were obtained in the level of development among different districts. Northern and north-eastern districts were found to be better developed. The socio-economic development was positively associated with the growth and progress of agricultural development and infrastructural facilities. The level of education, provision of health services, banking facilities, transport and communication systems did not significantly influence the agricultural development in the State. For bringing out uniform regional development, potential targets have been estimated for low developed districts. These districts require improvements of various dimensions in some of the indicators for enhancing the \evel of overall socio-economic development. Some of the districts require unified balanced integration of curative, preventive and promotional health services

Traditional Preparations and Methanol Extracts of Medicinal Plants from Papua New Guinea Exhibit Similar Cytochrome P450 Inhibition

The hypothesis underlying this current work is that fresh juice expressed from Papua New Guinea (PNG) medicinal plants (succus) will inhibit human Cytochrome P450s (CYPs). The CYP inhibitory activity identified in fresh material was compared with inhibition in methanol extracts of dried material. Succus is the most common method of traditional medicine (TM) preparation for consumption in PNG. There is increasing concern that TMs might antagonize or complicate drug therapy. We have previously shown that methanol extracts of commonly consumed PNG medicinal plants are able to induce and/or inhibit human CYPs in vitro. In this current work plant succus was prepared from fresh plant leaves. Inhibition of three major CYPs was determined using human liver microsomes and enzyme-selective model substrates. Of 15 species tested, succus from 6/15 was found to inhibit CYP1A2, 7/15 inhibited CYP3A4, and 4/15 inhibited CYP2D6. Chi-squared tests determined differences in inhibitory activity between succus and methanol preparations. Over 80% agreement was found. Thus, fresh juice from PNG medicinal plants does exhibit the potential to complicate drug therapy in at risk populations. Further, the general reproducibility of these findings suggests that methanol extraction of dried material is a reasonable surrogate preparation method for fresh plant samples