The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

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 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

Sindrome abdominal agudo en una potranca. Estudio de caso

"El objetivo del presente estudio de caso clínico es exponer y valorar lo relacionado al síndrome abdominal agudo, en base a un caso que se presentó para diagnóstico en el CIESA. Se evalúo el cadáver de un equino hembra de 3 meses de edad, que tuvo el an

Erysipelothrix rhusiopathiae en sistema nervioso de un ovino. reporte clíinico patológico

El objetivo del presente estudio es valorar la importancia e implicación patológica de Erysipelothrix rhusiopathiae en el sistema nervioso de un ovino remitido para diagnóstico; debido a que no es una condición común, y que puede afectar a otras especies animales e incluso al humano. Se remitió el cadáver de un ovino suffolk, con antecedentes de sialorrea, anorexia, secreción nasal serosa y postración. Al estudio anatomopatológico se identificaron larvas de Oestrus ovis en senos frontales con abundante exudado purulento, reblandecimiento óseo del área adyacente al encéfalo, senos nasales con congestión severa y edematosos; en el cerebro congestión leptomeningea y edema. Histológicamente en cerebro se observó infiltración de neutrofílos y necrosis licuefactiva focal, infiltración linfocitaria y de neutrófilos en leptomeninges y en el espacio linfático perivascular. Al diagnóstico integral del caso se determinó una leptomeningoencefalitis supurativa severa y necrótica, con aislamiento de Erisipelothrix rhusiopathiae a partir de encéfalo, de ahí que sea importante poner atención en futuros casos para determinar la posible implicación de Erisipelothrix rhusiopathiae

Estudio de caso de sindrome neurologico asociado a astrocitoma

El astrocitoma es una neoplasia primaria del sistema nervioso central que se puede presentar en los animales; de las especies domésticas se ha observado con mayor frecuencia en los perros, de éstos, la edad y la raza son factores que influyen en su presentación, en estudios anteriores han descrito que el astrocitoma es una neoplasia que se presenta con mayor frecuencia en perros de características braquicefalicas, además que su malignidad depende de la localización y del carácter invasivo que presenta. Se presenta el estudio de caso de un paciente canino Labrador, macho de 6 años de edad, con un cuadro clínico neurológico de origen compresivo y obstructivo, derivado de una neoplasia intracraneala. Se documentó el caso a través del método clínico, basado en la historia clínica y la evolución del caso, imagenología e histopatología. Lo observado a través de las placas, correspondieron a una masa tumoral en la región ventral correspondiente al diencéfalo cuya localización se refiere adyacente a la estructura hipotalámica con efecto obstructivo y compresivo compatible con un astrocitoma; al estudio anatomopatológico se observo un tumor localizado adyacente al hipotálamo del cerebro; histológicamente el tumor se identifico como un astrocitoma gemistocítico

Miasis cavitaria y procesos patológicos alternos en un ovino

Se remitió el cadáver de ovino macho (semental), suffolk, con antecedentes de sialorrea, anorexia, secreción nasal serosa por nariz y postración. En el cerebro se observo congestión leptomeningea y edema, y en la parte adyacente de tejido óseo - en el área de senos frontales abundante exudado purulento (verde pistache) de olor fétido, reblandecimiento de hueso, senos nasales blandos con congestión severa (y color blanquecino-edematoso) y con el mismo exudado purulento. Al estudio anatomopatológico se determino una miasis cavitaria con afección de tejido nervioso. Histológicamente en: cornetes nasales infiltración leve de neutrófilos en las células epiteliales y congestión severa; en cerebro infiltración linfocitaria y de neutrófilos en leptomeninges y en el espacio linfático perivascular, infiltración neutrofílica y necrosis licuefactiva focal. A partir de encéfalo se aisló: Staphylococcus epidermidis. Oestrus ovis por si mismo puede llegar a invadir meninges y cerebro, además por acción traumática, irritativa y bacterifera ocasionar alteraciones alternas en otros tejidos

Bordetella bronchiseptica como un riesgo importante de salud publica. Estudio clínico patológico en conejos

"B. bronchiseptica es reconocida como un patógeno primario inicial del tracto respiratorio en animales domésticos, puede provocar tos de las perreras (perro), respiración ruidosa (en conejos) y rinitis atrófica (en el cerdo). Conel objeto de enfatizar l

Implicaciones del uso de clorhidrato de clenbuterol en la producción pecuaria

El objetivo del presente trabajo es resaltar la importancia y el riesgo que tiene en salud pública el consumir productos contaminados con clorhidrato de clenbuterol (CCL). En los sistemas de producción animal actuales se hace uso una gran cantidad de sustancias que son adicionadas o incluidas dentro de la alimentación de diferentes especies productivas con el interés de mejorar los parámetros productivos reproductivos, descuidando el aspecto de inocuidad. El CCL es un aditivo sintético perteneciente a una clase de medicamentos análogos fisiológicamente a la adrenalina. Químicamente se describe como polvo blanco, anhidro, muy soluble en agua y altamente estable a temperatura ambiente. En el humano se utiliza como un medicamento broncodilatador para el tratamiento del asma y en físico culturismo es utilizado por el efecto anabólico que provoca. Es un compuesto utilizado en forma clandestina en animales de ceba destinados para el consumo humano, sin respetar el periodo de retiro antes del sacrificio. El efecto de la administración oral en el ganado, cerdos, ovinos y aves modifica e incrementa el crecimiento por aumento de la masa muscular y disminución de la acumulación de grasa; puede provocar un depósito en diferentes órganos, principalmente en hígado; esta acumulación puede provocar intoxicación en las personas que consuman dicho tejido, los signos clínicos reportados, son: taquicardia, temblor y dolor muscular, mareos, cefalea, incremento en la presión sanguínea, enfermedades tiroideas, alergias, y provocar la muerte por falla cardiaca. Por las repercusiones y problemas en salud pública que produce el CCL se deben mantener programas de vigilancia epidemiológica para el control y erradicación del uso de esta sustancia en la producción animal