Vigencia y transformación del derecho del trabajo en el siglo

El futuro del derecho del trabajo. El derecho en la sociedad. El trabajo como una mercancía. Justicia y trabajo. La protección del trabajo. Competencia en vez de regulación. Sustento ideológico de la reforma neoliberal. Extinción o adecuación. La modificación legislativa. La autonomía del derecho del trabajo. Presente y futuro. Las normas laborales panameñas. -- El derecho del trabajo es una disciplina jurídica especializada. La explicación del derecho. La función del derecho reflejada en el derecho del trabajo. Resolución de conflictos. Organizar el poder político. Los fines del derecho se expresan en el derecho del trabajo. La justicia. El orden. La paz social. La seguridad o certeza jurídica. Relación entre estructura económica y derecho. Teoría económica del Estado. La plusvalía. Materialismo histórico. Análisis critico del materialismo histórico. Contra el materialismo histórico. De la defensa de la propiedad territorial individual a derecho social. Surgimiento del Derecho. Los antiguos estados orientales. Grecia antigua. Roma. La monarquía. La república. El alto imperio. El bajo imperio. Supervivencia Derecho Romano. El Estado y el derecho feudal. El derecho liberal. Teoría clásica liberal. El derecho en la edad moderna. Declaración de los derechos del Hombre y del Ciudadano. La regulación de la relación de trabajo. El derecho indiano o de las Américas. Las leyes de Indias. El derecho social. La Revolución Industrial. Los efectos sociales de la revolución industrial. Reacción ante la cuestión social. Reacciones conformistas. Reacciones inconformes. El socialismo utópico. Saint Simon. Fourier. Sismondi. Robert Owen. Proudon. Loius Leblanc. El socialismo científico. La doctrina social de la Iglesia Católica. Teoría y concepto de justicia social. Expresiones jurídicas de la justicia social. El concepto de Derecho Social. Normas positivas de Derecho Social. El derecho del trabajo. Concepto de trabajo. Trabajo físico y fisiológico. Concepto filosófico del trabajo. Escuela idealista. Escuela materialista. Noción económica del trabajo. El trabajo en la historia. Comunismo primitivo. El esclavismo. El feudalismo. El capitalismo. Trabajo objeto del derecho. Teoría general del Derecho del Trabajo. Los principios del Derecho del Trabajo. Principio protector. Principio de irrenunciabilidad o indisponibilidad. Principio de continuidad. Principio de primacía de la realidad. Principio de razonabilidad. Principio de la buena fe. Características del Derecho del Trabajo. Autonomía. Normas de Orden Público. Derecho protector de los trabajadores. Derecho reivindicatorio de los trabajadores. Mínimo de garantías sociales. Constante expansión. Naturaleza jurídica del Derecho del Trabajo. Las fuentes del Derecho del Trabajo. Los sujetos del Derecho del Trabajo. Evolución de las normas del trabajo. Del contrato civil al contrato de trabajo. Las primeras leyes proteccionistas. Los convenios colectivos. Constitucionalización de las normas laborales. Intenacionalización. Antecedentes. Surgimiento de la Organización Internacional del Trabajo. Evolución en América Latina. Arrendamiento de servicios. Leyes pro obreras. Doctrina de protección estatal del trabajador. Codificación de las normas laborales. Mayor cobertura garantista. Retrocesos y vaivenes. Los derechos humanos de los trabajadores. La teoría de los Derechos Humanos. La dignidad humana. La tolerancia. Características de los derechos humanos. Racionalidad humana. Homocentrismo. Igualitarismo. Universalidad. Evolución de los derechos humanos. Primera generación. Estado liberal. Segunda generación. Estado benefactor. Tercera generación. Estado constitucional. Expresiones jurídicas de los derechos humanos. Los derechos humanos en las relaciones laborales. Antecedentes teóricos. El papel de la iglesia Católica. Teoría de los derechos humanos laborales. Normas constitucionales. Legislación internacional sobre derechos humanos. Los convenios de la Organización Internacional del Trabajo. -- La reforma laboral. Creación y reforma de la norma laboral. Las premisas del Derecho del Trabajo. El trabajo como producto social. Determinismo histórico acerca del trabajo. El trabajo asalariado. La relación de trabajo. El conflicto laboral. Partes desiguales en el contrato de trabajo. El sistema capitalista. Concepto económico. Concepto sociológico. Los efectos del sistema capitalista. La producción de bienes y servicios. Los efectos psicológicos. Efectos sociológicos. El papel del derecho del trabajo en el sistema. Mercantilismo y derecho. Dos razones del derecho del trabajo. Los roles del derecho del trabajo. Derecho laboral y derecho patrimonial. Contradicción y convivencia. La norma laboral. Norma programática y norma imperativa. Nuevas fuentes normativas. Legitimación de la norma laboral. El papel de la doctrina. El papel de los interactores sociales. Los intereses de las partes. Acción estatal y social. El tripartismo. Factores influyentes en la creación y modificación de la ley laboral. Estabilidad y cambio del derecho. La legitimación del derecho. La transformación del derecho. Factores de carácter subjetivo. Los intereses económicos del inversionista. Los intereses de los trabajadores. Las expectativas o intereses de los consumidores. Las autoridades públicas. El interés de las empresas multinacionales. Factores de carácter objetivo. Las modalidades del desarrollo capitalista. Los ámbitos del trabajo humano. Cambios en la administración y/o ejecución de la producción. Los avances tecnológicos. El desarrollo natural de derecho. La estructura económica nacional y/o regional. Las expresiones ideológicas imperantes. La gestión sindical. Modalidades de la reforma legislativa laboral. Rediseño de la norma laboral. Las normas laborales originales. El Estado de bienestar. La reforma neoliberal. La flexibilidad laboral. Flexibilidad europea. La flexi seguridad. Flexibilidad laboral en América Latina. Medios de flexibilización. La legislación. La jurisprudencia. Desaplicación normativa. Contratación atípica. Formas de regulación alternas. El soft law. Responsabilidad social empresarial. Códigos de conducta. Alcance de la reforma neoliberal. Europa. América Latina. Los contenidos de la reforma. La Ilamada desregulación salvaje. La otra reforma. Los derechos colectivos en la reforma. Los efectos de la reforma flexible y desreguladora. Efectos en la relación de trabajo. Efectos sociales y económicos. Factores presentes en la reforma neoliberal. La reforma post neoliberal. Nuevos actores sociales. Nuevos escenarios. El derecho laboral universal. El núcleo incólume del derecho del trabajo. La disciplina jurídica Derecho del Trabajo. La doctrina. La normativa o autonomía legislativa. La evolución de la norma legislativa. La jurisdicción del trabajo. Origen y evolución. Concepto y funcionalidad. Normas procesales. La reforma procesal laboral. La enseñanza del Derecho del Trabajo. La enseñanza superior. Evolución. La enseñanza del Derecho. La enseñanza del Derecho del Trabajo a nivel superior. -- La experiencia panameña. Desarrollo económico nacional. La llamada vocación económica del istmo. Centro comercial colonial. Estancamiento durante unión a Colombia. Aparición del capitalismo. Geopolítica y comercio interoceánico. Los comerciantes panameños. La construcción del Canal. Periodo posterior a la construcción del Canal. La industrialización y el Estado de Bienestar (1945-1968). Estatización de la economía (1969-1983). Economía neoliberal (1983-2009). La nación panameña. La nación y el Derecho del Trabajo. La formación de la nación panameña. Época precolombina. La identidad nacional durante la conquista. La nación panameña durante la colonia. Independencia de España. La nación durante la unión a Colombia. El siglo XX en la identidad nacional. Interacción con Estados Unidos. Gestión nacional sobre la jurisdicción en el Canal. La oligarquía panameña. Los militares y la identidad nacional. La sociedad neoliberal. Relación de trabajo en Panamá. El esclavismo. La encomienda. La esclavitud de los negros. Fin de la esclavitud. El feudalismo. La mita. Formas pre capitalistas de producción. El capitalismo. El ferrocarril de Panamá. Los enclaves coloniales. United Fruit Company (UFCO). El Canal de Panamá. Capitalismo monopolista de Estado. Periodo de estancamiento. La industrialización. El Estado inversionista. La sociedad globalizada. Evolución de la norma laboral panameña. Factores influyentes en la evolución normativa laboral panameña. Los derechos de Ios trabajadores durante la conquista. Las leyes de Indias como normas protectoras. Normas sobre la esclavitud negra. Normatividad sobre el trabajo. Conversión de las relaciones de trabajo. Regulación del trabajo. Las normas liberales. Liberalismo, monopolio y militarismo. La legislación pro obrera. Las particularidades de la codificación. Liberalismo y garantismo. El derecho del trabajo. El primer Código de Trabajo. Macartismo versus justicia social. Los años 60 del siglo XX. Profundización del garantismo. Normatividad laboral del sector público. Aplicación del derecho del trabajo en el sector público. La lucha por la estabilidad laboral. Otras normas laborales del sector público. Reformas a Ia Iegislación del trabajo. La reforma natural y su entorno. La reforma neoliberal en Panamá. Desregulación salvaje o flexibilidad inflexible. Flexibilización normativa en la administración pública. Otras regulaciones. Desaceleración laboral neoliberal. Los efectos de la flexibilidad laboral. La Iegislación laboral panameña vista por OIT. Vigencia institucional del derecho del trabajo panameño. La doctrina. La normatividad. La jurisdicción. La enseñanza del derecho del trabajo. Conclusiones. Bibliografía

"Unificación de la legislación laboral del sector público y privado"

Nuestro trabajo pretende hacer un recorrido histórico acerca de los servidores públicos desde sus orígenes hasta nuestros días, por lo que iniciamos desarrollando aspectos conceptuales e históricos, necesarios para entender la situación actual de nuestros servidores públicos. En el segundo Capítulo justificamos desde el punto de vista teórico doctrinario, la posibilidad no sólo de la unificación, sino de la sustitución del viejo derecho Administrativo por el derecho del Trabajo en el marco de la regulación de la relación existente entre el Estado y. sus trabajadores o "servidores". Como quiera que formamos parte de un mundo globalizado, en donde las comunicaciones son cada vez menos complejas tanto a nivel nacional como internacional, revisamos en nuestro tercer Capítulo la situación del Derecho Comparado y del Derecho del Trabajo Internacional, incluyendo las modernas concepciones de la Organización Internacional del Trabajo (O.I.T.) El cuarto y último capítulo presenta nuestra propuesta de unificación legislativa laboral, sustentada en la realidad nacional, desarrollando aspectos como el fundamento constitucional; el marco teórico de la legislación laboral sobre derechos individuales, colectivos y la jurisdicción; definiendo el ámbito de aplicación propuesto; la viabilidad económica y el impacto administrativo de la reforma, así como lo relativo al período de transición que necesariamente habrá de darse

Segundo Informe sobre la Situación del Trabajo en Panamá Año 2019

Con la publicación del primer informe acerca de la situación nacional del trabajo, ocurrida en el año 2017, nos comprometimos con los actores sociales del trabajo y con la sociedad panameña, a entregar al menos cada dos años un informe similar por lo que en tal sentido, presentamos este segundo informe, elaborado por expertos investigadores en las materias que trata, bajo la coordinación del Instituto de Estudios del Trabajo (INETRA) de la Universidad Especializada de las Américas (UDELAS). Ratificamos así nuestro compromiso de cumplir con nuestra misión de poner el conocimiento y el esfuerzo académico, al servicio de la sociedad panameña, elaborando por segunda vez, con más interés y disposición que recursos, este informe sobre la Situación del Trabajo en Panamá, con el objetivo que sirva de insumo para los actores sociales del mundo del trabajo, en la ejecución de sus tareas para conectar el crecimiento económico con el desarrollo de nuestro país, a la vez que facilitar información que coadyuve a promover la equidad en la distribución de nuestra riqueza, e iniciar acciones y políticas que nos muevan del triste lugar que ocupamos en la región y el mundo en cuanto a la desigual distribución de nuestra riqueza. Buscamos aportar en un solo documento, los datos cualitativos y cuantitativos disponibles, así como la presentación de las realidades laborales panameñas que nos rodean en la región, y que influyen en muchas de las situaciones descritas en el informe, haciendo énfasis en los temas más trascendentes como el empleo y las inequidades y exclusiones laborales, y su vinculación con el modelo y desarrollo de la economía nacional

Autoimmune Diseases and COVID-19 as Risk Factors for Poor Outcomes: Data on 13,940 Hospitalized Patients from the Spanish Nationwide SEMI-COVID-19 Registry

(1) Objectives: To describe the clinical characteristics and clinical course of hospitalized patients with COVID-19 and autoimmune diseases (ADs) compared to the general population. (2) Methods: We used information available in the nationwide Spanish SEMI-COVID-19 Registry, which retrospectively compiles data from the first admission of adult patients with COVID-19. We selected all patients with ADs included in the registry and compared them to the remaining patients. The primary outcome was all-cause mortality during admission, readmission, and subsequent admissions, and secondary outcomes were a composite outcome including the need for intensive care unit (ICU) admission, invasive and non-invasive mechanical ventilation (MV), or death, as well as in-hospital complications. (3) Results: A total of 13,940 patients diagnosed with COVID-19 were included, of which 362 (2.6%) had an AD. Patients with ADs were older, more likely to be female, and had greater comorbidity. On the multivariate logistic regression analysis, which involved the inverse propensity score weighting method, AD as a whole was not associated with an increased risk of any of the outcome variables. Habitual treatment with corticosteroids (CSs), age, Barthel Index score, and comorbidity were associated with poor outcomes. Biological disease-modifying anti-rheumatic drugs (bDMARDs) were associated with a decrease in mortality in patients with AD. (4) Conclusions: The analysis of the SEMI-COVID-19 Registry shows that ADs do not lead to a different prognosis, measured by mortality, complications, or the composite outcome. Considered individually, it seems that some diseases entail a different prognosis than that of the general population. Immunosuppressive/immunoregulatory treatments (IST) prior to admission had variable effects

Burden of injury along the development spectrum : associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017

Background The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. Methods Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. Results For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. Conclusions The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.Peer reviewe

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

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

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

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. FUNDING: Bill & Melinda Gates Foundation