Age-standardized YLL, YLD, and DALY rates (95% UI) and country ranks (from best to worst) for Poland and other Central European countries, for both sexes combined, males, and females, in 1990 and 2017.

Age-standardized YLL, YLD, and DALY rates (95% UI) and country ranks (from best to worst) for Poland and other Central European countries, for both sexes combined, males, and females, in 1990 and 2017.</p

Changes in disease burden in Poland between 1990–2017 in comparison with other Central European countries: A systematic analysis for the Global Burden of Disease Study 2017 - Fig 3

Leading Level 4 causes of YLLs (a), YLDs (b), and DALYs (c) in Central European countries, with the ratio of observed to expected (OER) age-standardized rates by location: (a) YLLs, (b) YLDs, (c) DALYs. Colors represent OER ranges: 0–0.54 = blue, 0.55–0.69 = green, 0.70–0.84 = light green, 0.85–0.99 = yellow green, 1.0 = white, 1.01–1.24 = dark yellow, 1.25–1.66 = orange, 1.67–2.91 = dark orange, 2.92+ = red.</p

Observed-to-expected ratios for age-standardized YLL, YLD, and DALY rates for both sexes from all causes in Central European countries in 2017.

Observed-to-expected ratios for age-standardized YLL, YLD, and DALY rates for both sexes from all causes in Central European countries in 2017.</p

Ranking of Central European countries according to all-cause DALY rates for both sexes combined in 1990 and 2017, by age categories.

Ranking of Central European countries according to all-cause DALY rates for both sexes combined in 1990 and 2017, by age categories.</p

Changes in disease burden in Poland between 1990–2017 in comparison with other Central European countries: A systematic analysis for the Global Burden of Disease Study 2017 - Fig 1

Age-standardized rates in 2017 (left) and relative (%) change from 1990 to 2017 (right) for YLLs, YLDs, and DALYs for males, females, and both sexes combined for Poland, Eastern Europe, Central Europe, and Western Europe.</p

Top 25 Level 3 causes of YLLs, YLDs, and DALYs in Poland in 2017 for both sexes combined, males, and females, and changes in ranks, counts, all-age rates, and age-standardized rates between 1990 and 2017.

Top 25 Level 3 causes of YLLs, YLDs, and DALYs in Poland in 2017 for both sexes combined, males, and females, and changes in ranks, counts, all-age rates, and age-standardized rates between 1990 and 2017.</p

Ranking of CE countries according to age-standardized DALY rates, for both sexes combined, in 1990 and 2017.

Ranking of CE countries according to age-standardized DALY rates, for both sexes combined, in 1990 and 2017.</p

All-age rates, percentage contribution, and relative (%) change for Level 1 causes of YLLs, YLDs, and DALYs for Poland and Central Europe, both sexes combined, in 1990 and 2017.

All-age rates, percentage contribution, and relative (%) change for Level 1 causes of YLLs, YLDs, and DALYs for Poland and Central Europe, both sexes combined, in 1990 and 2017.</p

Mapping disparities in education across low- and middle-income countries

Educational attainment is an important social determinant of maternal, newborn, and child health1–3. As a tool for promoting gender equity, it has gained increasing traction in popular media, international aid strategies, and global agenda-setting4–6. The global health agenda is increasingly focused on evidence of precision public health, which illustrates the subnational distribution of disease and illness7,8; however, an agenda focused on future equity must integrate comparable evidence on the distribution of social determinants of health9–11. Here we expand on the available precision SDG evidence by estimating the subnational distribution of educational attainment, including the proportions of individuals who have completed key levels of schooling, across all low- and middle-income countries from 2000 to 2017. Previous analyses have focused on geographical disparities in average attainment across Africa or for specific countries, but—to our knowledge—no analysis has examined the subnational proportions of individuals who completed specific levels of education across all low- and middle-income countries12–14. By geolocating subnational data for more than 184 million person-years across 528 data sources, we precisely identify inequalities across geography as well as within populations

Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

BackgroundRegularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels.MethodsWe applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level.FindingsIn 2019, there were 12·2 million (95% UI 11·0-13·6) incident cases of stroke, 101 million (93·2-111) prevalent cases of stroke, 143 million (133-153) DALYs due to stroke, and 6·55 million (6·00-7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8-12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1-6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0-73·0), prevalent strokes increased by 85·0% (83·0-88·0), deaths from stroke increased by 43·0% (31·0-55·0), and DALYs due to stroke increased by 32·0% (22·0-42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0-18·0), mortality decreased by 36·0% (31·0-42·0), prevalence decreased by 6·0% (5·0-7·0), and DALYs decreased by 36·0% (31·0-42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0-24·0) and incidence rates increased by 15·0% (12·0-18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5-3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5-3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57-8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97-3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01-1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7-90·8] DALYs or 55·5% [48·2-62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3-48·6] DALYs or 24·3% [15·7-33·2]), high fasting plasma glucose (28·9 million [19·8-41·5] DALYs or 20·2% [13·8-29·1]), ambient particulate matter pollution (28·7 million [23·4-33·4] DALYs or 20·1% [16·6-23·0]), and smoking (25·3 million [22·6-28·2] DALYs or 17·6% [16·4-19·0]).InterpretationThe annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries.FundingBill & Melinda Gates Foundation