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

<span style="font-size:14.0pt;line-height: 115%;font-family:"Times New Roman";mso-fareast-font-family:"Times New Roman"; color:black;mso-ansi-language:EN-IN;mso-fareast-language:EN-IN;mso-bidi-language: HI" lang="EN-IN">Bacterial and protozoan (Ciliate) diseases of <span style="font-size:14.0pt;line-height:115%;font-family:"Times New Roman"; mso-fareast-font-family:HiddenHorzOCR;color:black;mso-ansi-language:EN-IN; mso-fareast-language:EN-IN;mso-bidi-language:HI" lang="EN-IN">praw <i><span style="font-size:14.0pt;line-height:115%;font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";color:black;mso-ansi-language:EN-IN; mso-fareast-language:EN-IN;mso-bidi-language:HI" lang="EN-IN">Penaeus indicus </span></i><span style="font-size:14.0pt;line-height:115%;font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman";color:black;mso-ansi-language:EN-IN; mso-fareast-language:EN-IN;mso-bidi-language:HI" lang="EN-IN">(Decapoda: Crustacea)</span></span></span>

285-296A survey was carried out on the prevalence of bacteria and ciliate protozoan of Penaeus indicus obtained from Ennore estuary, Chennai (Madras), India from November 1989 to July 1992. The study revealed the occurrence of Vibrio parahaemolyticus, V.vulnificus, V. harveyi; V. anguillarum, V. damsela, Pseudomonas sp., P. aeruginosa and a filamentous bacterium Leucothrix sp. This study also revealed the occurrence of three different peritrichous ciliates viz .. Zoothamnium sp., Epistylis sp. and Vorticella sp. and a loricate ciliate Lagenophrys sp. Zoothamnium  sp ., Epistylis sp. and Vorticella sp. were recorded on the body surface, gills, appendages and pleopods. Trophonts of Zoothamnium sp. occurred as branched colonies with contractile stalk with myoneme. Epistylis sp. also consisted of branched colonies but was lacking myoneme. In contrast the Vorticella sp. occurred as individual trophonts with a contractile stalk. Scanning electron microscopy of Epistylis sp. revealed the surface topography, convoluted ridges over the trophont surface and stalk. Both Pseudomonas spp. and Vibrio spp. caused darkening of cuticle, loss of appendage setae and their hairs in the pleopods and uropods, blister in the gills and accumulation of hemocytes at the infected sites. Minimum inhibitory concentration of acriflavin, ampicillin, furazolidone, kanamycin and prefuran required to control the growth of Vibrio spp. and Pseudomonas spp. were found to be higher than the recommended limits. Intramuscular inoculation of bacterial cells of Vibrio spp. and Pseudomonanas spp. into P. indicus caused mortalities from 30% to 80% but drug treatment with neomycin sulphate (20 μg ml-1 of culture tank)/ streptomycin (10 <span style="font-size:14.0pt; line-height:115%;font-family:" times="" new="" roman";mso-fareast-font-family:hiddenhorzocr;="" color:black;mso-ansi-language:en-in;mso-fareast-language:en-in;mso-bidi-language:="" hi"="" lang="EN-IN">μg <span style="font-size:14.0pt;line-height:115%; font-family:" times="" new="" roman";mso-fareast-font-family:"times="" roman";="" color:black;mso-ansi-language:en-in;mso-fareast-language:en-in;mso-bidi-language:="" hi"="" lang="EN-IN">ml-1 of culture tank) reduced the mortality (0% - 30%). Drug therapy of P. indicus infected with peritrichous ciliates revealed that formalin and a flavonoid flavone effectively killed the ciliates whereas methylene blue was ineffective. The present study revealed that the populations of the prawn P. indicus suffer from bacterial and epibiont protozoan diseases reflecting the quality of the environment which is polluted with industrial effluents and sewage discharge.</span

Assessment of transboundary aquifer resources in Asia: Status and progress towards sustainable groundwater management

Study region: Asia. Study focus: Internationally shared aquifers (Transboundary aquifers; TBAs) are recognised as an important water resource in Asia. Despite their importance, studies on the assessment of TBA resources have received less attention in comparison to transboundary rivers. A lack of expertise, experience, and institutional support has restricted the cooperative and sustainable management of the shared aquifer resources. This study attempts to provide a comprehensive overview of the status of transboundary groundwater resources in Asia, including the TBA inventories, socio-economic implications, and future perspectives. Specifically, the study focuses on the progress of the assessment of TBAs in Asia as a result of the Internationally Shared Aquifer Resources Management Initiative (ISRAM). New hydrological insights for the region: In Asia, TBAs have played a major role in providing freshwater resources and sustaining socio-economic development. Since 2000, many regional cooperative initiatives have achieved considerable progress in developing TBA inventories of Asia, but the level of understanding of the shared aquifer systems remains limited, particularly for the developing countries. Legal and institutional frameworks for regional TBA cooperation are vital, and many countries in Asia have come to recognise the need to cooperate with their neighbours in dealing with TBA governance. Sustainable and equitable management of TBA in Asia requires an increasing effort from different sectors and countries in order to reach mutual acceptance of effective cooperation. Keywords: Transboundary aquifers (TBAs), Groundwater, Asia region, ISAR

Climate Change Vulnerability Mapping for the Greater Mekong Sub-region

Climate change poses a serious threat to the environment, socio-economic development, and livelihoods, especially those in developing countries, where severe natural disasters are common. Adaptation strategies and mitigation responses for the world’s most vulnerable people are needed, including in the Greater Mekong Sub-region (defined here as Cambodia, Lao PDR, Myanmar, Thailand, and Vietnam, and excluding Yunnan Province, China). Within this context, this study aims to identify the most vulnerable areas to climate change and climate-induced water problems in the Mekong countries. The study used the framework of the Intergovernmental Panel on Climate Change (IPCC) in 2001, by looking at the exposure, sensitivity, and adaptive capacity of an area to adapt or recover from the effects of hazardous climate events. The results showed that Mekong countries would be affected more severely by major natural disasters, including tropical cyclones, floods, and droughts. Among the Mekong countries, we found that Thailand had a high adaptive capacity to climate change, whereas the western coastline of Myanmar and the Cambodian Mekong lowland region were the most vulnerable areas

Special issue: Environmental, Health and Social legacies of mining activities in Sub-Saharan Africa

Over > 40 years of implementation of the International Geoscience Programme (IGCP), a partnership and flagship programme between UNESCO and the International Union of Geological Sciences (IUGS), UNESCO realized that the involvement of Africa both in terms of projects devoted to the continent and leadership, was marginal. Between 2011 and 2013, UNESCO collaborated with the Swedish International Development Cooperation Agency (Sida) to support capacity-building activities aiming to increase the participation of Africa in IGCP. From this exercise, two projects (UNESCO/Sida IGCP-594 and IGCP-606) emerged as a research networking platform between scientists from Africa and Europe on the environmental and health challenges of mining activities in Africa. At the end of their implementation, the two projects jointly prepared and published a Special Issue on “Impacts of mining and mineral processing on the environment and human health in Africa” in the Journal of Geochemical Exploration in 2014 edited by Kříbek et al. (2014). However, it was obvious that the challenges facing African countries as a result of mining activities go well beyond simple IGCP projects, and need extensive mobilisation in terms of human re- sources, laboratory facilities and fund raising. The success of two major IGCP projects (IGCP-594 and IGCP-606) encouraged UNESCO to enter into a new Programme Cooperation Agreement with Sida for the period 2014–2018 to support an expanded project entitled “Mapping and Assessing the Environmental and Health Impacts of Abandoned Mines in Sub- Saharan African Countries”. The project aimed to reduce the adverse effects of mining activities on the ecosystem and health of adjacent communities while, at the same time, promote a peaceful mining atmosphere among industry, authorities and local communities. An important advancement in the mining sector is the legal ob- ligation for mining companies to rehabilitate former operational mine sites and ensure that they are restored to a safe environmental state after the mine is closed. While this concept is well rooted in mining legislation in many developed countries, this is not always the case in developing countries, especially in Sub-Saharan Africa. Apart from poor environmental governance as highlighted in the Africa Mining Vision, many African countries lack a precise inventory and assessment of abandoned and derelict mines. It is therefore important to make an assessment of the true extent of the detrimental effects of metal and metalloid pollutants and their impact on human and animal health, as well as on ecosystems. This is a pre-requisite for appropriate legislation development and enforcement. This new project intended to provide crucial scientific knowledge that will contribute to understanding of the factors that control cycling of pollutants from abandoned mines in soils, water and vegetation and the impact on the food chain. Development of appropriated technologies to mitigate environmental risk associated with mining activities was also at the heart of the project. Furthermore, influencing policies, training, education and awareness focusing on communities involved or living around mine sites were important aspects of the project. We anticipate that the results of the project will be used to improve the environmental norms in individual countries in Sub-Saharan Africa and the efficiency of governments in addressing the challenges related to the adverse effects of abandoned mines. The new project builds on a strong network of > 100 scientists working on 29 sites in 17 African countries, with focus on field assessment of pollution (soil, water, crops, health of human and animals), rehabilitation of degraded ecosystems, and policy issues for the attention of communities and governments. For the monitoring of the project, UNESCO put in place a scientific board composed of international experts in this field, some of whom have served as Co-Guest Editors of this Special Issue. An important meeting took place in April 2018 in Nairobi, Kenya, where all project leaders met with the members of the scientific board to evaluate the progress of the project. A key resolution by participants of this meeting was the preparation of another Special Issue to avail the new research contributions to the scientific community

Biofuel and Biochemical Analysis of Amphora coffeaeformis RR03, a Novel Marine Diatom, Cultivated in an Open Raceway Pond

(1) Background: To increase the biochemical productivity and to reduce the production cost of microalgal biodiesel, this study aimed to investigate the effects of CO2 on biomass, fatty acids, carbon-hydrogen, and biochemical accumulation of the marine diatom, Amphora coffeaeformis RR03 (A. coffeaeformis) RR03. (2) Methods: Fatty acid composition of the dry biomass of A. coffeaeformis RR03 was analysed using Gas chromatography-mass spectrometry (GC-MS). (3) Results: The results showed that A. coffeaeformis RR03 contained high biomass productivity and biochemical composition in different cultivation conditions. A. coffeaeformis RR03 showed maximum growth of 5.2 &times; 106/mL on 21st day cultivation under CO2 supply. The bio-crude oil production from A. coffeaeformis RR03 was 36.19 megajoule (MJ). GC-MS analysis found that the dry biomass of A. coffeaeformis RR03 contained maximum of 47.72% fatty acids of 16-octadecanoic acid methyl ester (10:12) and 19.58% pentadecanoic acid, 13-methyl-, and methyl ester (9.24). (4) Conclusion: The results of this study may suggest that a novel diatom of A. coffeaeformis RR03 could be a suitable candidate for biocrude production in order to meet the future demand of energy