Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Burden of non-communicable diseases among adolescents aged 10–24 years in the EU, 1990–2019: a systematic analysis of the Global Burden of Diseases Study 2019

Background Disability and mortality burden of non-communicable diseases (NCDs) have risen worldwide; however, the NCD burden among adolescents remains poorly described in the EU. Methods Estimates were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Causes of NCDs were analysed at three different levels of the GBD 2019 hierarchy, for which mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were extracted. Estimates, with the 95% uncertainty intervals (UI), were retrieved for EU Member States from 1990 to 2019, three age subgroups (10–14 years, 15–19 years, and 20–24 years), and by sex. Spearman's correlation was conducted between DALY rates for NCDs and the Socio-demographic Index (SDI) of each EU Member State. Findings In 2019, NCDs accounted for 86·4% (95% uncertainty interval 83·5–88·8) of all YLDs and 38·8% (37·4–39·8) of total deaths in adolescents aged 10–24 years. For NCDs in this age group, neoplasms were the leading causes of both mortality (4·01 [95% uncertainty interval 3·62–4·25] per 100 000 population) and YLLs (281·78 [254·25–298·92] per 100 000 population), whereas mental disorders were the leading cause for YLDs (2039·36 [1432·56–2773·47] per 100 000 population) and DALYs (2040·59 [1433·96–2774·62] per 100 000 population) in all EU Member States, and in all studied age groups. In 2019, among adolescents aged 10–24 years, males had a higher mortality rate per 100 000 population due to NCDs than females (11·66 [11·04–12·28] vs 7·89 [7·53–8·23]), whereas females presented a higher DALY rate per 100 000 population due to NCDs (8003·25 [5812·78–10 701·59] vs 6083·91 [4576·63–7857·92]). From 1990 to 2019, mortality rate due to NCDs in adolescents aged 10–24 years substantially decreased (–40·41% [–43·00 to –37·61), and also the YLL rate considerably decreased (–40·56% [–43·16 to –37·74]), except for mental disorders (which increased by 32·18% [1·67 to 66·49]), whereas the YLD rate increased slightly (1·44% [0·09 to 2·79]). Positive correlations were observed between DALY rates and SDIs for substance use disorders (rs=0·58, p=0·0012) and skin and subcutaneous diseases (rs=0·45, p=0·017), whereas negative correlations were found between DALY rates and SDIs for cardiovascular diseases (rs=–0·46, p=0·015), neoplasms (rs=–0·57, p=0·0015), and sense organ diseases (rs=–0·61, p=0·0005)

THE CONTRIBUTION OF THE CONTRAST SENSITIVITY TESTING IN THE EVALUATION OF EARLYCHRONIC SIMPLE GLAUCOMA AND OCULAR HYPERTENSION.

THE PRESENT STUDY DEALS WITH THE PROBLEM OF THE CONTRIBUTION OF THE CONTRAST SENSITIVITY (CS) TESTING IN THE EVALUATION OF EARLY OPEN ANGLE GLAUCOMA (EARLY CHRONIC SIMPLE GLAUCOMA-EASG) AND OCULAR HYPERTENSION. THE CS OF 248 PATIENTS(208 WITH OCULAR HYPERTENSION: GROUP A & 40 WITH EASG: GROUP C) AND 175 NORMAL CONTROLS WAS TESTED. AMONG THE 208 PATIENTS OF GROUP A 65 (GROUP B) PRESENTED CS LOSS. MEASURES OF CS AT FREQUENCIES OF 1.5,3,6,9,12,20 & 40 C/D WERE TAKEN. MEASURES OF THE VISUAL FIELD WERE TAKEN WITH THE H-CP (HUMPHREY- COMPUTERIZED PERIMETER - PROGRAMME CENTRAL 30-2 STATPAC ANALYSIS). THE ANALYSIS OF THE RESULTS OF GROUP B SHOWED THAT CS LOSS WAS PRESENT AT ALL SPATIAL FREQUENCIES BUT IT WAS FOCALIZED PARTICULARLY AT 3,6 AND 9 C/D. 39 PATIENTS OF GROUP CPRESENTED CS LOSS. THERE IS A HIGH CORRELATION BETWEEN CS LOSS AND MD (MEANDEVIATION) (R =0.67, P<0.000001) BUT LOW CORRELATION BETWEEN CS LOSS AND PSD (PATTERN STANDARD DEVIATION) (R=0.25, 0.01<P<0.05). CONCLUSIONS: CS CONSTITUTE A METHOD SUPERIOR THAN THE CP IN THE DETECTION OF EARLY GLAUTOMATOUS DAMAGE. THE CS LOSS OBSERVED IN PATIENTS WITH OCULAR HYPERTENSION CONSTITUTE A SIGN OF EARLY GLAUTOMATOUS DAMAGE (EAD). CS LOSS CONSTITUTES A CONSTANT FOUND IN CASES OF EARLY OPEN ANGLE GLAUCOMA. CS LOSS IN CASES OF EAD IS PRESENT AT ALL SPATIAL FREQUENCIES PARTICULARLY AT MEDIUM RANGE (3-9 C/D). THE MEASURE OF CS IS USEFUL FOR THE DIAGNOSIS OF EARLY GLAUCOMA. ALTHOUGH THIS IS NOT THE MOST APPROPRIATE METHOD FOR FOLLOWING GLAUCOMATOUS PATIENTS. IN THIS CASE THE CPIS EFFECTIVE.ΕΞΕΤΑΣΤΗΚΕ Η CONTRAST SENSITIVITY (CS) 248 ΑΣΘΕΝΩΝ (208 ΜΕ ΑΠΛΗ ΥΠΕΡΤΟΝΙΑ: ΟΜΑΔΑ Α ΚΑΙ 40 ΜΕ ΑΡΧΟΜΕΝΟ ΧΡΟΝΙΟ ΑΠΛΟ ΓΛΑΥΚΩΜΑ: ΟΜΑΔΑ Γ) ΚΑΙ 175 ΦΥΣΙΟΛΟΓΙΚΩΝ ΜΑΡΤΥΡΩΝ. ΑΠΟ ΤΟΥΣ 208 ΑΣΘΕΝΕΙΣ ΤΗΣ ΟΜΑΔΑΣ Α ΟΙ 65 (31.25% ΟΜ. Β) ΠΑΡΟΥΣΙΑΣΑΝ ΕΚΠΤΩΣΗ ΤΗΣ CS. OI ΜΕΤΡΗΣΕΙΣ ΤΗΣ CS ΕΓΙΝΑΝ ΣΕ ΧΩΡΙΚΕΣ ΣΥΧΝΟΤΗΤΕΣ 1.5,3,6,9,12,20 ΚΑΙ 40 C/D. Η ΕΚΠΤΩΣΗ ΤΗΣ CS ΑΦΟΡΟΥΣΕ ΟΛΕΣ ΤΙΣ ΧΩΡΙΚΕΣ ΣΥΧΝΟΤΗΤΕΣ ΑΛΛΑ ΕΝΤΟΠΙΖΟΤΑΝ ΚΥΡΙΩΣ ΣΤΙΣ 3,6 & 9 C/D. ΑΠΟ ΤΟΥΣ 40 ΑΣΘΕΝΕΙΣ ΤΗΣ ΟΜΑΔΑΣ Γ ΟΙ 39 ΠΑΡΟΥΣΙΑΣΑΝ ΕΚΠΤΩΣΗ ΤΗΣ CS. Ο ΕΛΕΓΧΟΣ ΟΠΤΙΚΟΥ ΠΕΔΙΟΥ ΕΓΙΝΕ ΜΕ ΑΥΤΟΜΑΤΟ ΠΕΡΙΜΕΤΡΟ HUMPHREY. ΕΞΕΤΑΣΤΗΚΕ Η ΣΥΣΧΕΤΙΣΗ ΤΗΣ ΕΚΤΩΣΗΣ CS ΜΕ ΤΗΝ ΜΕΑΝ DEFECT (MD) ΚΑΙ Η ΣΥΣΧΕΤΙΣΗ ΕΚΠΤΩΣΗΣ CS ΜΕ ΤΗΝ PATTERN STANDARD DEVIATION (PSD). ΧΡΗΣΙΜΟΠΟΙΗΘΗΚΑΝ ΤΑ ΑΠΟΤΕΛΕΣΜΑΤΑ ΤΩΝ ΑΣΘΕΝΩΝ ΤΗΣ ΟΜΑΔΑΣ Γ ΚΑΙ ΒΡΕΘΗΚΕ ΙΣΧΥΡΗ ΣΥΣΧΕΤΙΣΗ CS KAI MD ΚΑΙ ΑΣΘΕΝΗΣ ΣΥΣΧΕΤΙΣΗ CS KAI PSD. ΣΥΜΠΕΡΑΣΜΑΤΑ: ΥΠΕΡΤΕΡΕΙ Η CS ΕΝΑΝΤΙ ΤΗΣ ΑΥΤΟΜΑΤΗΣ ΠΕΡΙΜΕΤΡΙΑΣ ΟΤΑΝ ΔΙΕΡΕΥΝΑΤΑΙ Η ΑΡΧΟΜΕΝΗ ΓΛΑΥΚΩΜΑΤΙΚΗ ΒΛΑΒΗ (ΑΓΒ). Η ΕΚΤΩΣΗ ΤΗΣ CS ΣΕ ΑΣΘΕΝΕΙΣ ΜΕ ΑΥ ΑΠΟΤΕΛΕΙ ΕΝΔΕΙΞΗ ΑΓΒ. Η ΕΚΠΤΩΣΗ ΤΗΣ CS ΑΠΟΤΕΛΕΙ ΣΤΑΘΕΡΟ ΕΥΡΗΜΑ ΣΤΟ ΑΡΧΟΜΕΝΟ ΓΛΑΥΚΩΜΑ ΑΝΟΙΧΤΗΣ ΓΩΝΙΑΣ. Η ΕΚΠΤΩΣΗ ΤΗΣ CS ΣΕ ΠΕΡΙΠΤΩΣΕΙΣ ΑΓΒ ΠΑΡΑΤΗΡΕΙΤΑΙ ΣΕ ΟΛΕΣ ΤIΣ ΧΩΡΙΚΕΣ ΣΥΧΝΟΤΗΤΕΣ ΑΛΛΑ ΕΝΤΟΠΙΖΕΤΑΙ ΚΥΡΙΩΣ ΣΤΙΣ ΜΕΣΑΙΕΣ ΧΩΡΙΚΕΣ ΣΥΧΝΟΤΗΤΕΣ (3-9 C/D). O ΕΛΕΓΧΟΣ ΤΗΣ CS ΑΠΟΤΕΛΕΙ ΧΡΗΣΙΜΗ ΔΙΑΓΝΩΣΤΙΚΗ ΜΕΘΟΔΟ ΣΤΟ ΑΡΧΟΜΕΝΟ ΓΛΑΥΚΩΜΑ. ΔΕΝ ΕΙΝΑΙ ΟΜΩΣ Η ΠΛΕΟΝ ΚΑΤΑΛΛΗΛΗ ΓΙΑ ΤΗ ΜΕΤΕΠΕΙΤΑ ΠΑΡΑΚΟΛΟΥΘΗΣΗ ΓΛΑΥΚΩΜΑΤΙΚΩΝ ΑΣΘΕΝΩΝ ΟΠΟΥ Η ΑΥΤΟΜΑΤΗ ΠΕΡΙΜΕΤΡΙΑ ΑΠΟΔΕΙΚΝΥΕΤΑΙ ΠΙΟ ΑΠΟΤΕΛΕΣΜΑΤΙΚΗ

Development and Validation of the Life for Low Vision Questionnaire (LIFE4LVQ) Using Rasch Analysis: A Questionnaire Evaluating Ability and Independence

Low vision (LV) has a substantial impact on an individual’s daily functionality and patient-reported outcome measures (PROMs) are increasingly incorporated into the evaluation of this problem. The objective of this study was to describe the design of the new “Life for Low Vision Questionnaire (LIFE4LVQ)”, as a measure of daily functionality in LV and to explore its psychometric properties. A total of 294 participants completed the LIFE4LVQ and the data were subjected to Rasch analysis to determine the psychometric properties of the questionnaire, including response category ordering, item fit statistics, principal component analysis, precision, differential item functioning, and targeting. Test–retest reliability was evaluated with an interval of three weeks and intraclass correlation coefficients (ICC) were used. The correlation between the questionnaire score and Best Corrected Visual Acuity (BCVA) was examined using Spearman’s correlation coefficient. Rasch analysis revealed that for most items the infit and outfit mean square fit values were close to 1, both for the whole scale and its subscales (ability and independence). The separation index for person measures was 5.18 with a reliability of 0.96, indicating good discriminant ability and adequate model fit. Five response categories were found for all items. The ICC was 0.96 (p < 0.001; 95% CI, 0.93–0.98), suggesting excellent repeatability of the measure. Poorer BCVA was significantly associated with worse scores (rho = 0.559, p < 0.001), indicating excellent convergent validity. The functional, 40-item LIFE4LVQ proved to be a reliable and valid tool that effectively measures the impact of LV on ability and independence