Food Safety and Health from the Perspective of Islam

For downloading the full-text of this article please click here.Background and Objective: The relationship between food and the health of the soul and body is one of the issues mentioned in a monotheistic worldview including Islam. The verse "And We send down of the Qur'an that which is healing and mercy for the believers" confirms the influence of religious teachings in this respect. This study examines the Qur'anic guidelines on food safety and hygiene.Methods: This review study investigates into the health system through library reviews of authentic sources, religious teachings, Quranic verses, authentic statements from the infallibles (Imams and the prophet), important Qur'anic commentaries, statements and books on nutrition on national and international databases. After categorization, the results were analyzed and integrated. The authors declared no conflict of interest.Results: About 250 Qur'anic verses and dozens of statements from the infallibles point to the importance of food and nutrition. The Holy Qur'an mentions the word “food” 48 times, the word “eating” 107 times, and the word “drink” 39 times. In the verses related to food, it has been mentioned six times that food should be Halal, and in various interpretations, the importance of nourishing the body is emphasized. Attitude to food as a sign in knowing God, believing in divine generosity, enjoying divine intent, asserting the rights of those in need, clean eating, having a balanced diet, adhering to halal food, and avoiding forbidden foods are the most important attitudinal and habitual strategies related to food safety. In addition, human dignity is one of the most important outcomes of adhering to Islamic food safety strategies.Conclusion: Since in revelatory doctrines, a healthy diet involves physical, mental, spiritual and social aspects of human life, it is essential that health policy makers consider the Islamic nutritional approach to achieve a true universal health.For downloading the full-text of this article please click here.Please cite this article as: Biglari H, Dargahi A, Vaziri Y, Ivanbagh R, Hami M, Poursadeqiyan M. Food Safety and Health from the Perspective of Islam. Journal of Pizhūhish dar dīn va salāmat. 2020;6(1):131-143.https://doi.org/10.22037/jrrh.v6i1.1914

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

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

ایمنی و بهداشت مواد غذایی از منظر اسلام

خلفية البحث وأهدافه: تعتبر علاقة التغذية بسلامة الروح والجسم من القضايا التي قد اشير اليها في النظرة التوحيدية ودين الإسلام. ففي القرآن الكريم تؤكد آية "وَنُنَزِّلُ مِنَ الْقُرْآَنِ مَا هُوَ شِفَاءٌ وَرَحْمَةٌ لِلْمُؤْمِنِينَ" على تأثير التعاليم الدينية على مفهوم السلامة الغذائية. إن الغرض من هذا البحث، دراسة التعاليم القرآنية في مجال صحة التغدية وسلامتها من منظور الإسلام. منهجية البحث: بغرض البحث في نظام الصحة ومن خلال دراسة مكتبية للمصادر الموثوقة والتعاليم الدينية للمختارات من الآيات القرآنية والأحاديث الصحيحة للأئمة المعصومين عليهم السلام والتفاسير القرآنية المهمة وتفاسير الروايات والأحاديث المتعلقة بسلامة المواد الغذائية في القواعد المعلوماتية الوطنية والدولية، معتمداً على أدوات الجمع والدراسة والفحص والتأمل، والمستوحى من تعاليم علماء الحضارة الإسلامية في إرشادات سلامة الأغذية والصحة. تم الإبلاغ عن النتائج بعد تصنیف المعطيات وتجزئتها وتحليلها و تركيبها. إن مؤلفي البحث لم يشيروا الى اي تضارب في المصالح. الكشوفات: ان مايقارب 250 آية من الآيات القرآنية وعشرات من الاحاديث المروية عن المعصومين تدل على أهمية الطعام والتغدية. لقد جاء في القرآن الكريم 48 مرة كلمة الطعام، 107 مرات كلمة "أكل" و39 مرة كلمة "شراب" وكذلك قد اشير 6 مرات في الآيات المتعلقة بالطعام الى حلية الأطعمة؛ كما انه قد أكدت التفاسير المختلفة الى اهمية التغذية وتأثيرها على الروح. ان التأمل في الطعام كآية من ايات معرفة الله، والإعتقاد بأن الله هو الرزاق وأن نجعل النية الإلهية في إستهلاك الطعام واعطاء حق المحتاجين من الطعام ونظافة الطعام والتنوع في الطعام والإلتزام بتناول الطعام الحلال وتجنب أكل المحرمات وكل هذا يعتبر من أهم الاستراتيجيات السلوكية في سلامة الغذاء من منظور إسلامي. وإضافة الى هذا فإن الكرامة الإنسانية تعتبر من أهم نتائج الإلتزام بإستراتيجيات السلامة الغذائية. الاستنتاج: بما أن التغذية السليمة في الرؤية الإسلامية تشمل جميع جوانب الصحة الجسمية والعقلية والروحية والإجتماعية؛ فمن الضروري لواضعي السياسات في مجال الصحة، ايلاء الإهتمام في النهج التغذوي في الإسلام من أجل تحقيق الصحة الشاملة الحقيقية في المجمتع.   يتم استناد المقالة على الترتيب التالي: Biglari H, Dargahi A, Vaziri Y, Ivanbagh R, Hami M, Poursadeqiyan M. Food Safety and Health from the Perspective of Islam. Journal of Pizhūhish dar dīn va salāmat. 2020;6(1):131-143. https://doi.org/10.22037/jrrh.v6i1.19142Background and Objective: The relationship between food and the health of the soul and body is one of the issues mentioned in a monotheistic worldview including Islam. The verse "And We send down of the Qur'an that which is healing and mercy for the believers" confirms the influence of religious teachings in this respect. This study examines the Qur'anic guidelines on food safety and hygiene. Methods: This review study investigates into the health system through library reviews of authentic sources, religious teachings, Quranic verses, authentic statements from the infallibles (Imams and the prophet), important Qur'anic commentaries, statements and books on nutrition on national and international databases. After categorization, the results were analyzed and integrated. The authors declared no conflict of interest. Results: About 250 Qur'anic verses and dozens of statements from the infallibles point to the importance of food and nutrition. The Holy Qur'an mentions the word “food” 48 times, the word “eating” 107 times, and the word “drink” 39 times. In the verses related to food, it has been mentioned six times that food should be Halal, and in various interpretations, the importance of nourishing the body is emphasized. Attitude to food as a sign in knowing God, believing in divine generosity, enjoying divine intent, asserting the rights of those in need, clean eating, having a balanced diet, adhering to halal food, and avoiding forbidden foods are the most important attitudinal and habitual strategies related to food safety. In addition, human dignity is one of the most important outcomes of adhering to Islamic food safety strategies. Conclusion: Since in revelatory doctrines, a healthy diet involves physical, mental, spiritual and social aspects of human life, it is essential that health policy makers consider the Islamic nutritional approach to achieve a true universal health.   Please cite this article as: Biglari H, Dargahi A, Vaziri Y, Ivanbagh R, Hami M, Poursadeqiyan M. Food Safety and Health from the Perspective of Islam. Journal of Pizhūhish dar dīn va salāmat. 2020;6(1):131-143. https://doi.org/10.22037/jrrh.v6i1.19142سابقه و هدف: ارتباط ‌غذا‌ با‌ سلامت ‌روح‌ و ‌جسم ‌از‌ مسائلی ‌است‌ که ‌در ‌جهان‌بینی ‌توحیدي ‌و ‌مکتب‌ اسلام ‌به‌ آن ‌اشاره ‌شده ‌است. ‌آيۀ ‌«وَنُنَزِّلُ مِنَ الْقُرْآَنِ مَا هُوَ شِفَاءٌ وَرَحْمَةٌ لِلْمُؤْمِنِينَ»‌ مؤید اثر‌گذار‌‌ی آموزه‌‌های ‌دینی در ‌مفهوم‌ ایمنی ‌غذایی ‌است. هدف ‌اين‌ مطالعه بررسي رهنمودهاي‌ قرآني ‌در‌ زمینۀ ‌ایمنی‌ و‌ بهداشت مواد‌ غذایی ‌از ‌منظر ‌اسلام ‌بود. روش کار: ‌این ‌مطالعۀ‌ مروری‌ با‌ هدف ‌تحقيق ‌در‌ نظام ‌‌سلامت ‌از ‌طریق‌ بررسی‌های کتابخانه‌‌ای ‌منابع معتبر‌ و‌ آموزه‌‌های ‌دینی، ‌بر‌گزيده‌‌اي ‌از‌ آيات ‌قرآني‌، احاديث‌ معتبر ‌معصومان‌ (ع)‌، ‌تفاسير ‌قرآني ‌مهم و کتاب‌هايي ‌در‌ شرح ‌احاديث ‌و روایات ‌مرتبط ‌با‌ بهداشت‌ و ‌ایمنی ‌مواد ‌غذایی ‌در‌ پايگاه‌هاي ‌اطلاعاتي ‌ملي‌ و ‌بين‌‌المللي؛ ‌با‌ اتکا‌ بر ‌ابزار ‌گردآوری، مطالعه، ‌تفحص‌ و ‌تعمق و ‌‌با‌ الهام‌‌گيري‌ از‌ آموخته‌هاي ‌حکيمان تمدن ‌اسلامي ‌به‌ رهنمودهاي ‌ایمنی‌ و‌ بهداشت ‌مواد‌ غذایی‌ انجام ‌شد.‌ پس ‌از دسته‌‌بندی، ‌تجزیه‌ و ‌تحلیل و‌ یکپارچه‌سازی ‌نتایج‌ گزارش ‌شد. مؤلفان مقاله هیچ‌گونه تضاد منافعی گزارش نکرده‌اند. یافته‌ها: حدود ‌250 ‌آیۀ‌ قرآنی ‌و ‌ده‌ها ‌روایت ‌از ‌معصومان ‌(ع) ‌بـر ‌اهمیت ‌غـذا‌ و ‌تغذیه‌ دلالت ‌می‌کند. در قرآن‌ کریم‌ ‌۴۸‌ بار ‌واژۀ‌ طعام، ‌۱۰۷ ‌بار ‌واژۀ‌ اکل ‌و ‌۳۹‌ بار‌ ‌واژۀ شراب آورده ‌شده‌ که‌ در‌ آیات‌ مرتبط ‌با طعام، ‌شش بار ‌به حلال ‌بودن‌ غذاها‌ ‌اشاره؛ و‌ در ‌تفاسیر ‌مختلف ‌به اهمیت ‌تغذیۀ جسم ‌در ‌روح‌ ‌تأکید ‌شده است. نگرش ‌به‌ غذا ‌به‌‌عنوان‌ آیه‌ای‌ در شناخت‌ خدا، ‌باورمندی ‌به ‌رازقیت ‌الهی،‌ برخورداری ‌از نیت ‌الهی در ‌مصرف،‌ ادای‌ حقوق نیازمندان ‌به ‌هنگام مصرف،‌ پاکیزگی ‌غذا، تنوع غذایی،‌ التزام ‌به‌ غذای‌ حلال و پرهیز‌ از ‌غذای ‌حرام ‌مهم‌ترین راهبردهای‌ نگرشی‌ و‌ رفتاری ‌ایمنی‌‌ غذایی‌ با‌ نگاه ‌اسلامی ‌است. ‌به‌علاوه، از ‌مهم‌ترین ‌نتایج‌ التزام راهبردهای ایمنی ‌غذایی،‌ کرامت‌ انسان‌ شمرده ‌شده ‌است. نتیجه‌گیری: از‌ آنجا‌ که‌ در‌ آموزه‌‌های ‌وحیانی، ‌تغذیۀ ‌سالم شامل جنبه‌‌های‌ جسمی،‌ روانی، ‌معنوی‌ و‌ اجتماعی است؛ ضروری ‌است‌ ‌سیاست‌‌گذاران ‌عرصۀ‌ سلامت‌ به ‌رویکرد ‌تغذیه‌‌ای اسلام ‌‌توجه کنند ‌تا سلامت ‌همه‌جانبۀ واقعی ‌یا ‌جامع‌‌نگر‌ در‌ جامعه‌ حاصل ‌گردد. استناد مقاله به این صورت است: Biglari H, Dargahi A, Vaziri Y, Ivanbagh R, Hami M, Poursadeqiyan M. Food Safety and Health from the Perspective of Islam. Journal of Pizhūhish dar dīn va salāmat. 2020;6(1):131-143. https://doi.org/10.22037/jrrh.v6i1.1914

Degradation of 2,4-dinitrotoluene in aqueous solution by dielectric barrier discharge plasma combined with Fe–RGO–BiVO4 nanocomposite

Abstract 2,4-Dinitrotoluene (2,4-DNT) as a priority and hazardous pollutant, is widely used in industrial and military activities. In this study the synergistic effect of Fe–RGO–BiVO4 nanocomposite in a non-thermal dielectric barrier discharge plasma reactor (NTP-DBD) for degrading 2,4-DNT was evaluated. Preparation of the Fe–RGO–BiVO4 nanocomposite was done by a stepwise chemical method depositing Fe and reduced graphene oxide (RGO) on BiVO4. Field emission scanning electron microscopy (FESEM), X-ray diffraction analysis (XRD), UV–vis diffuse reflectance spectra (DRS), and energy-dispersive X-ray spectroscopy mapping (EDS-mapping) validated the satisfactory synthesis of Fe–RGO–BiVO4. To find the optimal conditions and to determine the interaction of model parameters, a central composite design (RSM-CCD) had been employed. 2,4 DNT can be completely degraded at: initial 2,4-DNT concentration of 40 mg L−1, Fe–RGO–BiVO4 dosage of 0.75 g L−1, applied voltage of 21kV, reaction time of 30 min and pH equal to 7, while the single plasma process reached a degradation efficiency of 67%. The removal efficiency of chemical oxygen demand (COD) and total organic carbon (TOC) were 90.62% and 88.02% at 30 min contact time, respectively. Results also indicated that average oxidation state (AOS) and carbon oxidation state (COS) were enhanced in the catalytic NTP-DBD process, which demonstrate the effectiveness of proposed process for facilitating biodegradability of 2,4-DNT

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10-24 years during the past three decades. Methods Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10-14, 15-19, and 20-24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings In 2019, 369 061 deaths (of which 214337 [58%] were transport related) and 31.1 million DALYs (of which 16.2 million [52%] were transport related) among adolescents aged 10-24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34.4% (from 17.5 to 11.5 per 100 000) for transport injuries, and by 47.7% (from 15.9 to 8.3 per 100000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80.5% to 42 774 for transport injuries and by 39.4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010-19, the rate per 100 000 of transport injury DALYs was reduced by 16.7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48.5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0.2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010-19. Interpretation As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low-middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury

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

BackgroundRegular, 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.MethodsThe 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.FindingsThe 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.InterpretationLong-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