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

Immunological Aspects of Dental Implant Rejection

Nowadays, dental implants are a prominent therapeutic approach among dentists for replacing missing teeth. Failure in dental implants is a severe challenge recently. The factors which lead to dental implant failure are known. These factors can be categorized into different groups. In this article, we discussed the immunological aspects of implant failure as one of these groups. Cytokines and immune cells have extensive and various functions in peri-implantitis. The equilibrium between pro and anti-inflammatory cytokines and cells, which involve in this orchestra, has a crucial role in implant prognosis. In conclusion, immune cells, especially macrophages and dendritic cells, almost increased in the patients with implant failure. Also, proinflammatory cytokines were proposed as diagnostic factors according to their higher levels in dental implant rejection

Detection of alteration zones using the Dirichlet process Stick-Breaking model-based clustering algorithm to hyperion data: the case study of Kuh-Panj porphyry copper deposits, Southern Iran

Detection of hydrothermal alteration zones (HAZs) associated with porphyry copper systems using remote sensing imagery is a crucial stage for discovering high potential zone of ore mineralization. Statistical model-based clustering methods have great potential for automatic and accurate detection of hydrothermal alteration minerals using hyperspectral remote sensing imagery. In this research, the Dirichlet Process based on Stick-Breaking (DPSB) model-based clustering algorithm was implemented to hyperion remote sensing imagery to discriminate HAZs associated with the Kuh-Panj porphyry copper deposit, south, Iran. The DPSB clustering algorithm was implemented and subsequently compared with the k-means algorithm, CLARA clustering, hierarchical clustering, Gaussian finite mixture model (GFMM), Gaussian model for high-dimensional (GMHD) and spectral clustering as well as spectral angle mapping (SAM). Results derived from the DPSB model-based clustering algorithm show 88.6% accuracy in distinguishing propylitic, argillic, advanced argillic, propylitic-argillic and phyllic alteration zones. The DPSB algorithm can be broadly implemented to hyperspectral remote sensing imagery for detecting alteration zones associated with porphyry systems

Application of Dirichlet Process and Support Vector Machine Techniques for Mapping Alteration Zones Associated with Porphyry Copper Deposit Using ASTER Remote Sensing Imagery

The application of machine learning (ML) algorithms for processing remote sensing data is momentous, particularly for mapping hydrothermal alteration zones associated with porphyry copper deposits. The unsupervised Dirichlet Process (DP) and the supervised Support Vector Machine (SVM) techniques can be executed for mapping hydrothermal alteration zones associated with porphyry copper deposits. The main objective of this investigation is to practice an algorithm that can accurately model the best training data as input for supervised methods such as SVM. For this purpose, the Zefreh porphyry copper deposit located in the Urumieh-Dokhtar Magmatic Arc (UDMA) of central Iran was selected and used as training data. Initially, using ASTER data, different alteration zones of the Zefreh porphyry copper deposit were detected by Band Ratio, Relative Band Depth (RBD), Linear Spectral Unmixing (LSU), Spectral Feature Fitting (SFF), and Orthogonal Subspace Projection (OSP) techniques. Then, using the DP method, the exact extent of each alteration was determined. Finally, the detected alterations were used as training data to identify similar alteration zones in full scene of ASTER using SVM and Spectral Angle Mapper (SAM) methods. Several high potential zones were identified in the study area. Field surveys and laboratory analysis were used to validate the image processing results. This investigation demonstrates that the application of the SVM algorithm for mapping hydrothermal alteration zones associated with porphyry copper deposits is broadly applicable to ASTER data and can be used for prospectivity mapping in many metallogenic provinces around the world

Application of Dirichlet Process and Support Vector Machine Techniques for Mapping Alteration Zones Associated with Porphyry Copper Deposit Using ASTER Remote Sensing Imagery

The application of machine learning (ML) algorithms for processing remote sensing data is momentous, particularly for mapping hydrothermal alteration zones associated with porphyry copper deposits. The unsupervised Dirichlet Process (DP) and the supervised Support Vector Machine (SVM) techniques can be executed for mapping hydrothermal alteration zones associated with porphyry copper deposits. The main objective of this investigation is to practice an algorithm that can accurately model the best training data as input for supervised methods such as SVM. For this purpose, the Zefreh porphyry copper deposit located in the Urumieh-Dokhtar Magmatic Arc (UDMA) of central Iran was selected and used as training data. Initially, using ASTER data, different alteration zones of the Zefreh porphyry copper deposit were detected by Band Ratio, Relative Band Depth (RBD), Linear Spectral Unmixing (LSU), Spectral Feature Fitting (SFF), and Orthogonal Subspace Projection (OSP) techniques. Then, using the DP method, the exact extent of each alteration was determined. Finally, the detected alterations were used as training data to identify similar alteration zones in full scene of ASTER using SVM and Spectral Angle Mapper (SAM) methods. Several high potential zones were identified in the study area. Field surveys and laboratory analysis were used to validate the image processing results. This investigation demonstrates that the application of the SVM algorithm for mapping hydrothermal alteration zones associated with porphyry copper deposits is broadly applicable to ASTER data and can be used for prospectivity mapping in many metallogenic provinces around the world

Attitudes towards vaccines and intention to vaccinate against COVID-19: a cross-sectional analysis - implications for public health communications in Australia

Objective To examine SARS-CoV-2 vaccine confidence, attitudes and intentions in Australian adults as part of the iCARE Study. Design and setting Cross-sectional online survey conducted when free COVID-19 vaccinations first became available in Australia in February 2021. Participants Total of 1166 Australians from general population aged 18-90 years (mean 52, SD of 19). Main outcome measures Primary outcome: responses to question € If a vaccine for COVID-19 were available today, what is the likelihood that you would get vaccinated?'. Secondary outcome: analyses of putative drivers of uptake, including vaccine confidence, socioeconomic status and sources of trust, derived from multiple survey questions. Results Seventy-eight per cent reported being likely to receive a SARS-CoV-2 vaccine. Higher SARS-CoV-2 vaccine intentions were associated with: increasing age (OR: 2.01 (95% CI 1.77 to 2.77)), being male (1.37 (95% CI 1.08 to 1.72)), residing in least disadvantaged area quintile (2.27 (95% CI 1.53 to 3.37)) and a self-perceived high risk of getting COVID-19 (1.52 (95% CI 1.08 to 2.14)). However, 72% did not believe they were at a high risk of getting COVID-19. Findings regarding vaccines in general were similar except there were no sex differences. For both the SARS-CoV-2 vaccine and vaccines in general, there were no differences in intentions to vaccinate as a function of education level, perceived income level and rurality. Knowing that the vaccine is safe and effective and that getting vaccinated will protect others, trusting the company that made it and vaccination recommended by a doctor were reported to influence a large proportion of the study cohort to uptake the SARS-CoV-2 vaccine. Seventy-eight per cent reported the intent to continue engaging in virus-protecting behaviours (mask wearing, social distancing, etc) postvaccine. Conclusions Most Australians are likely to receive a SARS-CoV-2 vaccine. Key influencing factors identified (eg, knowing vaccine is safe and effective, and doctor's recommendation to get vaccinated) can inform public health messaging to enhance vaccination rates