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Browsing by Author "Ikuta, Kevin S. (57211541916)"

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    Publication
    Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019 A Systematic Analysis for the Global Burden of Disease Study 2019
    (2022)
    Kocarnik, Jonathan M. (56041211800)
    ;
    Compton, Kelly (57205330541)
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    Dean, Frances E. (57211949247)
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    Fu, Weijia (57218882680)
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    Gaw, Brian L. (57405726000)
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    Harvey, James D. (57196074369)
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    Henrikson, Hannah Jacqueline (57219861283)
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    Lu, Dan (59057346200)
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    Pennini, Alyssa (57210820174)
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    Xu, Rixing (57204186670)
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    Ababneh, Emad (57210792873)
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    Abbasi-Kangevari, Mohsen (57193543882)
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    Abbastabar, Hedayat (57212441848)
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    Abd-Elsalam, Sherief M. (57189845325)
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    Abdoli, Amir (59421084100)
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    Abedi, Aidin (56673854800)
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    Abidi, Hassan (36769387800)
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    Abolhassani, Hassan (58597704600)
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    Adedeji, Isaac Akinkunmi (57208456508)
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    Adnani, Qorinah Estiningtyas Sakilah (57211604149)
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    Advani, Shailesh M. (56841222900)
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    Afzal, Muhammad Sohail (56009310800)
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    Aghaali, Mohammad (38860949800)
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    Ahinkorah, Bright Opoku (57194684030)
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    Ahmad, Sajjad (57218961022)
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    Ahmad, Tauseef (57214283386)
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    Ahmadi, Ali (57193998515)
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    Ahmadi, Sepideh (58189812000)
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    Ahmed Rashid, Tarik (57023479100)
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    Ahmed Salih, Yusra (57226834461)
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    Akalu, Gizachew Taddesse (56905441600)
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    Aklilu, Addis (56450972500)
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    Akram, Tayyaba (57208951047)
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    Akunna, Chisom Joyqueenet (57214884531)
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    Al Hamad, Hanadi (56955516200)
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    Alahdab, Fares (55135922900)
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    Al-Aly, Ziyad (9738161500)
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    Ali, Saqib (7403094290)
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    Alimohamadi, Yousef (56069375900)
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    Alipour, Vahid (56436629300)
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    Aljunid, Syed Mohamed (6504304159)
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    Alkhayyat, Motasem (57191475872)
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    Almasi-Hashiani, Amir (42360952700)
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    Almasri, Nihad A. (35301840000)
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    Al-Maweri, Sadeq Ali Ali (36023535700)
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    Almustanyir, Sami (57217589155)
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    Alonso, Nivaldo (7004026436)
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    Alvis-Guzman, Nelson (57210741239)
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    Amu, Hubert (57190183918)
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    Anbesu, Etsay Woldu (57219860911)
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    Ancuceanu, Robert (35728302200)
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    Ansari, Fereshteh (56478531800)
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    Ansari-Moghaddam, Alireza (57192807651)
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    Antwi, Maxwell Hubert (57224904063)
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    Anvari, Davood (57201259536)
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    Anyasodor, Anayochukwu Edward (57192947419)
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    Aqeel, Muhammad (57192083161)
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    Arabloo, Jalal (57208760927)
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    Arab-Zozani, Morteza (57210284593)
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    Aremu, Olatunde (57214958833)
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    Ariffin, Hany (7004238528)
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    Aripov, Timur (35104283700)
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    Arshad, Muhammad (25722979300)
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    Artaman, Al (57217223811)
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    Arulappan, Judie (57224210161)
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    Asemi, Zatollah (36738697900)
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    Asghari Jafarabadi, Mohammad (57226675591)
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    Ashraf, Tahira (56366752600)
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    Atorkey, Prince (57218950488)
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    Aujayeb, Avinash (6504403791)
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    Ausloos, Marcel (7101798907)
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    Awedew, Atalel Fentahun (57216741537)
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    Ayala Quintanilla, Beatriz Paulina (55598298700)
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    Ayenew, Temesgen (57202544869)
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    Azab, Mohammed A. (57202323253)
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    Azadnajafabad, Sina (57219389837)
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    Azari Jafari, Amirhossein (56084531100)
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    Azarian, Ghasem (57220306214)
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    Azzam, Ahmed Y. (57208274797)
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    Badiye, Ashish D. (56340201200)
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    Bahadory, Saeed (57208205157)
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    Baig, Atif Amin (49460999600)
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    Baker, Jennifer L. (8705509600)
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    Balakrishnan, Senthilkumar (56640778400)
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    Banach, Maciej (22936699500)
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    Bärnighausen, Till Winfried (23011726900)
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    Barone-Adesi, Francesco (8722189200)
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    Barra, Fabio (57201953956)
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    Barrow, Amadou (57217061576)
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    Behzadifar, Masoud (57204671696)
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    Belgaumi, Uzma Iqbal (55639511900)
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    Bezabhe, Woldesellassie M. Mequanint (55932461200)
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    Bezabih, Yihienew Mequanint (57209397638)
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    Bhagat, Devidas S. (57327243700)
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    Bhagavathula, Akshaya Srikanth (56398498300)
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    Bhardwaj, Nikha (57221591832)
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    Bhardwaj, Pankaj (57226841442)
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    Bhaskar, Sonu (57192268582)
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    Bhattacharyya, Krittika (57204647266)
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    Bhojaraja, Vijayalakshmi S. (55989506600)
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    Bibi, Sadia (57524553300)
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    Bijani, Ali (23134684900)
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    Biondi, Antonio (57226837403)
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    Bisignano, Catherine (57211140934)
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    Bjorge, Tone (7004208100)
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    Bleyer, Archie (57192109538)
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    Blyuss, Oleg (56020531500)
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    Bolarinwa, Obasanjo Afolabi (57218336464)
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    Bolla, Srinivasa Rao (23048516100)
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    Braithwaite, Dejana (7006987079)
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    Brar, Amanpreet (57675605800)
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    Brenner, Hermann (7201832825)
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    Bustamante-Teixeira, Maria Teresa (6506392089)
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    Butt, Nadeem Shafique (7003613681)
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    Butt, Zahid A. (57202522739)
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    Caetano dos Santos, Florentino Luciano (56373058500)
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    Cao, Yin (55270204400)
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    Carreras, Giulia (57221176357)
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    Catalá-López, Ferrán (57202553733)
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    Cembranel, Francieli (55867592900)
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    Cerin, Ester (14522064200)
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    Cernigliaro, Achille (12787090100)
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    Chakinala, Raja Chandra (57190575127)
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    Chattu, Soosanna Kumary (57209796729)
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    Chattu, Vijay Kumar (55743746500)
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    Chaturvedi, Pankaj (35547314900)
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    Chimed-Ochir, Odgerel (57217262222)
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    Cho, Daniel Youngwhan (57192666710)
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    Christopher, Devasahayam J. (57209863533)
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    Chu, Dinh-Toi (56239816300)
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    Chung, Michael T. (55551050400)
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    Conde, Joao (56992468300)
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    Cortés, Sanda (55659922800)
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    Cortesi, Paolo Angelo (57200306512)
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    Costa, Vera Marisa (17134373000)
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    Cunha, Amanda Ramos (57214078354)
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    Dadras, Omid (57205721978)
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    Dagnew, Amare Belachew (57194785365)
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    Dahlawi, Saad M.A. (57189234459)
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    Dai, Xiaochen (57221591169)
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    Dandona, Lalit (7007017243)
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    Dandona, Rakhi (57203043697)
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    Darwesh, Aso Mohammad (57199749880)
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    das Neves, José (57208073193)
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    De la Hoz, Fernando Pio (23134262800)
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    Demis, Asmamaw Bizuneh (57207453281)
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    Denova-Gutiérrez, Edgar (25228198700)
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    Dhamnetiya, Deepak (56884613200)
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    Dhimal, Mandira Lamichhane (57201374139)
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    Dhimal, Meghnath (54941157300)
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    Dianatinasab, Mostafa (57281638900)
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    Diaz, Daniel (56644152500)
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    Djalalinia, Shirin (37113718000)
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    Do, Huyen Phuc (57200737094)
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    Doaei, Saeid (56016552900)
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    Dorostkar, Fariba (57214882995)
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    dos Santos Figueiredo, Francisco Winter (57197830836)
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    Driscoll, Tim Robert (7005928308)
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    Ebrahimi, Hedyeh (57195329214)
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    Eftekharzadeh, Sahar (57192113055)
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    El Tantawi, Maha (57214851491)
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    El-Abid, Hassan (59138919700)
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    Elbarazi, Iffat (58509635500)
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    Elhabashy, Hala Rashad (34869491800)
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    Elhadi, Muhammed (57212082248)
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    El-Jaafary, Shaimaa I. (34869528300)
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    Eshrati, Babak (16030619200)
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    Eskandarieh, Sharareh (57211720158)
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    Esmaeilzadeh, Firooz (56450483600)
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    Etemadi, Arash (7004686554)
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    Ezzikouri, Sayeh (16836144700)
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    Faisaluddin, Mohammed (57204007767)
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    Faraon, Emerito Jose A. (57195414019)
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    Fares, Jawad (55606854400)
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    Farzadfar, Farshad (57195049611)
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    Feroze, Abdullah Hamid (47161109900)
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    Ferrero, Simone (57190137236)
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    Ferro Desideri, Lorenzo (57201549628)
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    Filip, Irina (55570061400)
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    Fischer, Florian (55508208800)
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    Fisher, James L. (7404013876)
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    Foroutan, Masoud (58948371300)
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    Fukumoto, Takeshi (26531100300)
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    Gaal, Peter Andras (55966171600)
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    Gad, Mohamed M. (57203749611)
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    Gadanya, Muktar A. (25957587400)
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    Gallus, Silvano (7005387365)
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    Gaspar Fonseca, Mariana (57363275600)
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    Getachew Obsa, Abera (57356847100)
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    Ghafourifard, Mansour (57193420915)
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    Ghashghaee, Ahmad (57194174020)
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    Ghith, Nermin (55249750100)
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    Gholamalizadeh, Maryam (56017715600)
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    Gilani, Syed Amir (37008269900)
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    Ginindza, Themba G. (24468039800)
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    Gizaw, Abraham Tamirat T. (57193237477)
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    Glasbey, James C. (57195948986)
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    Golechha, Mahaveer (36006347600)
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    Goleij, Pouya (57217533849)
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    Gomez, Ricardo Santiago (7402250311)
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    Gopalani, Sameer Vali (57190277891)
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    Gorini, Giuseppe (56509988200)
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    Goudarzi, Houman (55606092000)
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    Grosso, Giuseppe (57196998256)
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    Gubari, Mohammed Ibrahim Mohialdeen (57210795029)
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    Guerra, Maximiliano Ribeiro (56818011600)
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    Guha, Avirup (56201612900)
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    Gunasekera, D. Sanjeeva (6701450084)
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    Gupta, Bhawna (56763353100)
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    Gupta, Veer Bala (57194978364)
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    Gupta, Vivek Kumar (35073936800)
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    Gutiérrez, Reyna Alma (57200298415)
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    Hafezi-Nejad, Nima (57216814261)
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    Haider, Mohammad Rifat (56660365700)
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    Haj-Mirzaian, Arvin (57210768364)
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    Halwani, Rabih (15065354400)
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    Hamadeh, Randah R. (57202769526)
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    Hameed, Sajid (57225330442)
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    Hamidi, Samer (24366336000)
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    Hanif, Asif (55360052800)
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    Haque, Shafiul (35793732800)
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    Harlianto, Netanja I. (57218510727)
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    Haro, Josep Maria (57215877903)
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    Hasaballah, Ahmed I. (56002305300)
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    Hassanipour, Soheil (57191513993)
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    Hay, Roderick J. (56785229200)
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    Hay, Simon I. (7101875313)
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    Hayat, Khezar (57219918947)
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    Heidari, Golnaz (57218883864)
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    Heidari, Mohammad (56494430400)
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    Herrera-Serna, Brenda Yuliana (57204618451)
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    Herteliu, Claudiu (26035943100)
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    Hezam, Kamal (57199187791)
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    Holla, Ramesh (55270371800)
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    Hossain, Md Mahbub (57207311791)
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    Hossain, Mohammad Bellal Hossain (36028425500)
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    Hosseini, Mohammad-Salar (57209828879)
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    Hosseini, Mostafa (57204569481)
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    Hosseinzadeh, Mehdi (57201880569)
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    Hostiuc, Mihaela (51763789200)
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    Hostiuc, Sorin (24829099800)
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    Househ, Mowafa (8667908000)
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    Hsairi, Mohamed (57209033943)
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    Huang, Junjie (57199198962)
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    Hugo, Fernando N. (13403199800)
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    Hussain, Rabia (7103224786)
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    Hussein, Nawfal R. (24766000100)
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    Hwang, Bing-Fang (7201453928)
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    Iavicoli, Ivo (6603685479)
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    Ibitoye, Segun Emmanuel (57212027408)
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    Ida, Fidelia (57218557641)
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    Ikuta, Kevin S. (57211541916)
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    Ilesanmi, Olayinka Stephen (54782692800)
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    Ilic, Irena M. (57210823522)
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    Ilic, Milena D. (7102981394)
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    Irham, Lalu Muhammad (57195464918)
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    Islam, Jessica Y. (26032107000)
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    Islam, Rakibul M. (57205202128)
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    Islam, Sheikh Mohammed Shariful (56400111100)
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    Ismail, Nahlah Elkudssiah (57885381900)
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    Isola, Gaetano (25825125500)
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    Iwagami, Masao (54381883100)
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    Jacob, Louis (56779678900)
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    Jain, Vardhmaan (57208149266)
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    Jakovljevic, Mihajlo B. (14318929700)
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    Javaheri, Tahereh (36102883000)
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    Jayaram, Shubha (57221589240)
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    Jazayeri, Seyed Behzad (55260694800)
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    Jha, Ravi Prakash (58586863400)
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    Jonas, Jost B. (7202492953)
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    Joo, Tamas (57214777013)
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    Joseph, Nitin (35292547200)
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    Joukar, Farahnaz (26024213000)
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    Jürisson, Mikk (55547524800)
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    Kabir, Ali (23050698400)
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    Kahrizi, Danial (15725585500)
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    Kalankesh, Leila R. (12796418600)
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    Kalhor, Rohollah (55670548600)
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    Kaliyadan, Feroze (16836323500)
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    Kalkonde, Yogeshwar (57211874790)
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    Kamath, Ashwin (35724313100)
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    Kameran Al-Salihi, Nawzad (24576701300)
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    Kandel, Himal (57226834655)
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    Kapoor, Neeti (56340726700)
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    Karch, André (55917217700)
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    Kasa, Ayele Semachew (57203538861)
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    Katikireddi, Srinivasa Vittal (6508254091)
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    Kauppila, Joonas H. (37665210400)
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    Kavetskyy, Taras (57220358576)
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    Kebede, Sewnet Adem (57215661049)
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    Keshavarz, Pedram (57209008531)
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    Keykhaei, Mohammad (57208162861)
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    Khader, Yousef Saleh (55654192600)
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    Khalilov, Rovshan (57193308858)
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    Khan, Gulfaraz (6701635515)
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    Khan, Maseer (57215721758)
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    Khan, Md Nuruzzaman (57209404949)
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    Khan, Moien A.B. (57209800900)
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    Khang, Young-Ho (57198904674)
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    Khater, Amir M. (57211138055)
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    Khayamzadeh, Maryam (57212086295)
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    Kim, Gyu Ri (57204396981)
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    Kim, Yun Jin (57211086375)
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    Kisa, Adnan (6603346067)
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    Kisa, Sezer (14030019900)
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    Kissimova-Skarbek, Katarzyna (6508376962)
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    Kopec, Jacek A. (7006284395)
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    Koteeswaran, Rajasekaran (56685819200)
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    Koul, Parvaiz A. (14022262900)
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    Koulmane Laxminarayana, Sindhura Lakshmi (57196152832)
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    Koyanagi, Ai (57197741912)
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    Kucuk Bicer, Burcu (57204528360)
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    Kugbey, Nuworza (57195398167)
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    Kumar, G. Anil (57139550500)
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    Kumar, Narinder (8215803600)
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    Kumar, Nithin (36678889900)
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    Kurmi, Om P. (23389886800)
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    Kutluk, Tezer (20934856000)
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    La Vecchia, Carlo (36063266200)
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    Lami, Faris Hasan (57200737005)
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    Landires, Iván (15063040000)
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    Lauriola, Paolo (7004129174)
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    Lee, Sang-Woong (57193130569)
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    Lee, Shaun Wen Huey (35201185800)
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    Lee, Wei-Chen (57394248700)
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    Lee, Yo Han (57193632340)
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    Leigh, James (7202089604)
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    Leong, Elvynna (56462346200)
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    Li, Jiarui (57205664641)
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    Li, Ming-Chieh (56144176300)
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    Liu, Xuefeng (37050047900)
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    Loureiro, Joana A. (55851941412)
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    Lunevicius, Raimundas (57216165063)
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    Magdy Abd El Razek, Muhammed (57201191366)
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    Majeed, Azeem (7102027801)
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    Makki, Alaa (57224607101)
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    Male, Shilpa (57404584000)
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    Malik, Ahmad Azam (57198682313)
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    Mansournia, Mohammad Ali (34570618600)
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    Martini, Santi (57162600900)
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    Masoumi, Seyedeh Zahra (55769011500)
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    Mathur, Prashant (7201845777)
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    McKee, Martin (7202304775)
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    Mehrotra, Ravi (7203045563)
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    Mendoza, Walter (57216905642)
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    Menezes, Ritesh G. (55517099900)
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    Mengesha, Endalkachew Worku (57216203521)
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    Mesregah, Mohamed Kamal (57204623773)
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    Mestrovic, Tomislav (6507240107)
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    Miao Jonasson, Junmei (35875296300)
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    Miazgowski, Bartosz (56857536900)
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    Miazgowski, Tomasz (6701404689)
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    Michalek, Irmina Maria (56982945900)
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    Miller, Ted R. (7403948600)
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    Mirzaei, Hamed (37034594600)
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    Mirzaei, Hamid Reza (57218466685)
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    Misra, Sanjeev (35501005200)
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    Mithra, Prasanna (36018632500)
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    Moghadaszadeh, Masoud (57200791890)
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    Mohammad, Karzan Abdulmuhsin (57205300378)
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    Mohammad, Yousef (6603403710)
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    Mohammadi, Mokhtar (57188972365)
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    Mohammadi, Seyyede Momeneh (57190491827)
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    Mohammadian-Hafshejani, Abdollah (55602206500)
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    Mohammed, Shafiu (57838689000)
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    Moka, Nagabhishek (35764778400)
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    Mokdad, Ali H. (7004813962)
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    Molokhia, Mariam (7004121920)
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    Monasta, Lorenzo (7801520497)
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    Moni, Mohammad Ali (35119094400)
    ;
    Moosavi, Mohammad Amin (8677868300)
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    Moradi, Yousef (55338348700)
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    Moraga, Paula (46761426800)
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    Morgado-Da-Costa, Joana (57204560697)
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    Morrison, Shane Douglas (45661573100)
    ;
    Mosapour, Abbas (16425956900)
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    Mubarik, Sumaira (57202290474)
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    Mwanri, Lillian (6603154148)
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    Nagarajan, Ahamarshan Jayaraman (57204562074)
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    Force, Lisa M. (57188548035)
    IMPORTANCE The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world. © 2022 American Medical Association. All rights reserved.
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    Publication
    Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019 A Systematic Analysis for the Global Burden of Disease Study 2019
    (2022)
    Kocarnik, Jonathan M. (56041211800)
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    Sur, Daniel (57194064798)
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    Szócska, Miklós (13410278600)
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    Tabarés-Seisdedos, Rafael (6602981102)
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    Tabuchi, Takahiro (55177892400)
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    Tadbiri, Hooman (57138410000)
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    Taherkhani, Amir (57203973738)
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    Takahashi, Ken (55741242600)
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    Talaat, Iman M. (7801465176)
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    Tan, Ker-Kan (16745396700)
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    Tat, Vivian Y. (57221326673)
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    Tedla, Bemnet Amare A. (57211142920)
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    Tefera, Yonas Getaye (56043059700)
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    Tehrani-Banihashemi, Arash (57204006020)
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    Temsah, Mohamad-Hani (56115852000)
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    Tesfay, Fisaha Haile (57203977293)
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    Tessema, Gizachew Assefa (57196316304)
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    Thapar, Rekha (36337431900)
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    Traini, Eugenio (57211137081)
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    Tripathy, Jaya Prasad (55290251600)
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    Ullah, Irfan (56992676600)
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    Ullah, Saif (57219395828)
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    Unnikrishnan, Bhaskaran (12790012100)
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    Upadhyay, Era (6505961711)
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    Vacante, Marco (23037085900)
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    Velazquez, Diana Zuleika (57221604940)
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    Veroux, Massimiliano (7003920425)
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    Violante, Francesco S. (7003555890)
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    Vlassov, Vasily (57211633239)
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    Vo, Bay (35147075900)
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    Volovici, Victor (56493195800)
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    Vu, Giang Thu (57202424871)
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    Waheed, Yasir (35303643700)
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    Ward, Paul (7402101951)
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    Wen, Yi Feng (57219805195)
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    Yahyazadeh Jabbari, Seyed Hossein (26029029100)
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    Yang, Lin (57189045362)
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    Yaya, Sanni (55191139800)
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    Yazie, Taklo Simeneh Yazie (57207254034)
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    Yeshaw, Yigizie (57197818606)
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    Yonemoto, Naohiro (57204947657)
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    Younis, Mustafa Z. (8549393000)
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    Yousefi, Zabihollah (9743306100)
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    Yu, Chuanhua (57208140344)
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    Yuce, Deniz (57514476300)
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    Yunusa, Ismaeel (57202137670)
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    Zadnik, Vesna (57202975428)
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    Zare, Fariba (57189627158)
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    Zastrozhin, Mikhail Sergeevich (56728932200)
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    Zastrozhina, Anasthasia (57210832491)
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    Zhang, Jianrong (56966801100)
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    Zhong, Chenwen (59289905900)
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    Zhou, Linghui (57200969310)
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    Zhu, Cong (57215121592)
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    Ziapour, Arash (57202571078)
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    Zimmermann, Ivan R. (55907922000)
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    Fitzmaurice, Christina (57212628757)
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    Murray, Christopher J.L. (57224556036)
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    Force, Lisa M. (57188548035)
    IMPORTANCE The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. OBJECTIVE To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. EVIDENCE REVIEW The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). FINDINGS In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. CONCLUSIONS AND RELEVANCE The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world. © 2022 American Medical Association. All rights reserved.
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    Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019
    (2022)
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    Naghavi, Mohsen (57207906323)
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    Schmidt, Maria Inês (7404398885)
    Background: Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings: In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation: Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Publication
    Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019
    (2022)
    Cousin, Ewerton (57194620705)
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    Duncan, Bruce B. (35476478500)
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    Lim, Stephen S. (57201800433)
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    Kandel, Sandhya Neupane (57222966618)
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    Nguyen, Huong Lan Thi (57226837406)
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    Noubiap, Jean Jacques (55490374000)
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    Nowak, Christoph (56519458900)
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    Onwujekwe, Obinna E. (7003992855)
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    Palladino, Raffaele (57215205417)
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    Podder, Vivek (57201487580)
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    Timalsina, Binod (59537205600)
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    Tovani-Palone, Marcos Roberto (56644977900)
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    Tran, Bach Xuan (57209107515)
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    Tripathy, Jaya Prasad (55290251600)
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    Car, Lorainne Tudor (48561867100)
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    Vladimirov, Sergey Konstantinovitch (57195959162)
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    Vu, Giang Thu (57202424871)
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    Wubishet, Befikadu Legesse (57200671454)
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    Xu, Xiaoyue (59560820600)
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    Xu, Suowen (35303824800)
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    Jabbari, Seyed Hossein Yahyazadeh (57207954055)
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    Yatsuya, Hiroshi (6603908304)
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    Yazie, Taklo Simeneh Yazie (57207254034)
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    Yi, Siyan (16837551600)
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    Zaman, Sojib Bin (57193070058)
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    Zamanian, Maryam (57201292465)
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    Zamora, Nelson (58338303800)
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    Zastrozhin, Mikhail Sergeevich (56728932200)
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    Zastrozhina, Anasthasia (57210832491)
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    Zhang, Zhi-Jiang (56068578400)
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    Zhong, Chenwen (59289905900)
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    Zmaili, Mohammad (57188702157)
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    Zumla, Alimuddin (7006170723)
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    Naghavi, Mohsen (57207906323)
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    Schmidt, Maria Inês (7404398885)
    Background: Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods: We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990–2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals. Findings: In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (−28·4 to −2·9) for all diabetes, and by 21·0% (–33·0 to −5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (−13·6% [–28·4 to 3·4]) and for type 1 diabetes (−13·6% [–29·3 to 8·9]). Interpretation: Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    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
    (2024)
    Schumacher, Austin E. (57209276410)
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    Kyu, Hmwe Hmwe (57217040073)
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    Aali, Amirali (57819452000)
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    Abbafati, Cristiana (54917122400)
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    Abbasgholizadeh, Rouzbeh (59152412000)
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    Abbasi, Madineh Akram (57193923353)
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    Alalalmeh, Samer O. (57997924800)
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    Alanezi, Fahad Mashhour (57213607595)
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    Albashtawy, Mohammed (57203680806)
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    Aldridge, Robert W. (57209842885)
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    Al-Gheethi, Adel Ali Saeed (57195533166)
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    Alhalaiqa, Fadwa Alhalaiqa Naji (54895003400)
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    Al-Hanawi, Mohammed Khaled (57195715156)
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    Ali, Abid (57822712300)
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    Ali, Syed Shujait Shujait (57188688612)
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    Ali, Zahid (57190013456)
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    Amugsi, Dickson A. (24461463800)
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    Andrade, Pedro Prata (58155276500)
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    Andrei, Catalina Liliana (36543507200)
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    Andrei, Tudorel (24179349400)
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    Antony, Catherine M. (57218881089)
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    Lee, Wei-Chen (57394248700)
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    Lee, Yo Han (57193632340)
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    Legesse, Samson Mideksa (57562395800)
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    Leigh, James (22957414600)
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    Lenzi, Jacopo (57200000691)
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    Leong, Elvynna (56462346200)
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    Lerango, Temesgen L. (58124758800)
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    Li, Ming-Chieh (56144176300)
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    Li, Wei (59638602600)
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    Li, Xiaopan (54389570600)
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    Li, Yichong (57218426673)
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    Li, Zhihui (56346333300)
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    Libra, Massimo (6603852432)
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    Ligade, Virendra S. (15769728900)
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    Likaka, Andrew Tiyamike Makhiringa (55151159300)
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    Lim, Lee-Ling (56988527400)
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    Lin, Ro-Ting (15123000400)
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    Lin, Shuzhi (57397981100)
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    Lioutas, Vasileios-Arsenios (36114439100)
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    Listl, Stefan (35759488300)
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    Liu, Jue (56797105100)
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    Liu, Simin (58636394800)
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    Liu, Xiaofeng (57193764777)
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    Livingstone, Katherine M. (55466317400)
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    Llanaj, Erand (57204154387)
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    Lo, Chun-Han (57216207024)
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    Loreche, Arianna Maever (58094114300)
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    Lorenzovici, László (57200941835)
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    Lotfi, Mojgan (37109768200)
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    Lotfizadeh, Masoud (55853761600)
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    Lozano, Rafael (57570224000)
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    Lubinda, Jailos (56700387300)
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    Lucchetti, Giancarlo (35790096500)
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    Lugo, Alessandra (55227636600)
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    Lunevicius, Raimundas (57216165063)
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    Ma, Jianing (58040920000)
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    Ma, Stefan (7403723389)
    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. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    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
    (2024)
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    Maled, Venkatesh (59317098500)
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    Malhotra, Kashish (57224508895)
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    Malik, Ahmad Azam (57198682313)
    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. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    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
    (2024)
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    Aali, Amirali (57819452000)
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    Ababneh, Hazim S. (57371604000)
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    Abate, Yohannes Habtegiorgis (58492166600)
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    Abbafati, Cristiana (54917122400)
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    Abbasgholizadeh, Rouzbeh (59152412000)
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    Abbasian, Mohammadreza (9846109700)
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    Abbasi-Kangevari, Mohsen (57193543882)
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    Abbastabar, Hedayat (57212441848)
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    Abdelmasseh, Michael (57356690000)
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    Khanmohammadi, Shaghayegh (57216530776)
    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. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Publication
    Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
    (2020)
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    Meitei, Wahengbam Bigyananda (57209140259)
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    Mekonnen, Teferi (57215662987)
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    Melese, Addisu (56901393600)
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    Memiah, Peter T.N. (57217207827)
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    Memish, Ziad A. (7005059350)
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    Mendoza, Walter (57216905642)
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    Menezes, Ritesh G. (55517099900)
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    Mengesha, Endalkachew Worku (57216203521)
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    Mengesha, Meresa Berwo (57210570181)
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    Mensah, George A. (57196028147)
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    Mereke, Alibek (57205595662)
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    Mereta, Seid Tiku (57203628211)
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    Meretoja, Tuomo J. (57219008708)
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    Miazgowski, Tomasz (6701404689)
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    Michalek, Irmina Maria (56982945900)
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    Mihretie, Kebadnew Mulatu (57214781514)
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    Miller, Ted R. (7403948600)
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    Mills, Edward J. (57205301363)
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    Milne, George J. (9434770500)
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    Mini, G.K. (12800865800)
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    Miri, Mohammad (56938228400)
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    Mirica, Andreea (57188983765)
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    Mirrakhimov, Erkin M. (57508336100)
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    Mirzaei, Hamed (37034594600)
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    Mirzaei, Maryam (56902299800)
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    Mirzaei, Roya (55745833800)
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    Mirzaei-Alavijeh, Mehdi (57201700997)
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    Misganaw, Awoke Temesgen (57202808713)
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    Mitchell, Philip B. (35354747000)
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    Mithra, Prasanna (36018632500)
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    Moazen, Babak (57204324006)
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    Moghadaszadeh, Masoud (57200791890)
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    Mohajer, Bahram (57039225300)
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    Mohamad, Osama (36342663600)
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    Mohamadi, Efat (57202198397)
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    Mohammad, Dara K. (43161421200)
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    Mohammad, Yousef (6603403710)
    Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Publication
    Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
    (2020)
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    West, J. Jason (8669110000)
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    Yano, Yuichiro (57196965200)
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    Yazdi-Feyzabadi, Vahid (56017415700)
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    Yeheyis, Tomas Y. (57219861340)
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    Yip, Paul (7102503720)
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    Younis, Mustafa Z. (8549393000)
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    Younker, Theodore Patrick (57209007213)
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    Yousefi, Bahman (55661388000)
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    Yousefi, Zabihollah (9743306100)
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    Yousefinezhadi, Taraneh (57039201000)
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    Yousuf, Abdilahi Yousuf (57219860971)
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    Yu, Chuanhua (57208140344)
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    Yusefzadeh, Hasan (55887807200)
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    Moghadam, Telma Zahirian (57201718494)
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    Zamani, Mohammad (59866744200)
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    Zamanian, Maryam (57201292465)
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    Zandian, Hamed (57205175627)
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    Zastrozhin, Mikhail Sergeevich (56728932200)
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    Zhang, Yunquan (56568510200)
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    Zhang, Zhi-Jiang (56068578400)
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    Zhao, Jeff T. (57221069965)
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    Zhao, Xiu-Ju George (8360350900)
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    Zhao, Yingxi (57194059646)
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    Zheng, Peng (57213707656)
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    Zhou, Maigeng (57054557200)
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    Ziapour, Arash (57202571078)
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    Zimsen, Stephanie R. M. (57196078433)
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    Lim, Stephen S. (57201800433)
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    Murray, Christopher J.L. (57224556036)
    Background: Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. Methods: GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk–outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk–outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk–outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. Findings: The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51–12·1) deaths (19·2% [16·9–21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12–9·31) deaths (15·4% [14·6–16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253–350) DALYs (11·6% [10·3–13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0–9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10–24 years, alcohol use for those aged 25–49 years, and high systolic blood pressure for those aged 50–74 years and 75 years and older. Interpretation: Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050
    (2024)
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    Vollset, Stein Emil (57196315778)
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    Ahmed, Mohammed (57205316302)
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    Ahmed, Saeed (59458562000)
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    Ahmed, Syed Anees (56943018400)
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    Al-Gheethi, Adel Ali Saeed (57195533166)
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    Ali, Abid (57822712300)
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    Al-Tawfiq, Jaffar A. (9436438200)
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    Alzoubi, Karem H. (8579544200)
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    Al-Zyoud, Walid Adnan (57202970794)
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    Ancuceanu, Robert (35728302200)
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    Andrews, Jason R. (15058787200)
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    Anuoluwa, Iyadunni Adesola (57266075700)
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    Arafat, Mosab (56380109600)
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    Thangaraju, Pugazhenthan (55854329500)
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    Tigoi, Caroline Chepngeno (55022812700)
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    Tiwari, Krishna (58560409500)
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    Tovani-Palone, Marcos Roberto (56644977900)
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    Tran, Thang Huu (58158086500)
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    Tumurkhuu, Munkhtuya (59156725100)
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    Turner, Paul (7402095559)
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    Ullah, Noor (59271934200)
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    Ullah, Saeed (57218515071)
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    Vaithinathan, Asokan Govindaraj (58309502900)
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    Valenti, Mario (57212270726)
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    Vos, Theo (57223885848)
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    Vu, Huong T.L. (39262770000)
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    Waheed, Yasir (35303643700)
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    Walker, Ann Sarah (59630522200)
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    Walson, Judd L. (57203254111)
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    Wangrangsimakul, Tri (57202318704)
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    Wertheim, Heiman F.L. (6602423153)
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    Williams, Phoebe C.M. (57195258843)
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    Wolde, Asrat Arja (57226497047)
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    Wozniak, Teresa M. (10540392000)
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    Wu, Felicia (55700782200)
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    Wu, Zenghong (57208700583)
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    Yadav, Mukesh Kumar Kumar (7102892913)
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    Yahaya, Zwanden Sule (57196374777)
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    Yon, Dong Keon (57193675906)
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    Yusuf, Hadiza (57191630259)
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    Zakham, Fathiah (37064030100)
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    Zamagni, Giulia (57303993500)
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    Zhang, Haijun (59340699800)
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    Zhang, Zhi-Jiang (56068578400)
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    Zielińska, Magdalena (58491440100)
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    Zumla, Alimuddin (7006170723)
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    Zyoud, Sa’ed H.H. (58486874500)
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    Zyoud, Samer H. (57220556938)
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    Hay, Simon I. (7101875313)
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    Stergachis, Andy (7006802396)
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    Sartorius, Benn (12788526800)
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    Cooper, Ben S. (7401623515)
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    Dolecek, Christiane (35784177100)
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    Murray, Christopher J.L. (57224556036)
    Background: Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts. Methods: We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen–drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level. Findings: In 2021, we estimated 4·71 million (95% UI 4·23–5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00–1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000–372 000] and 57 200 attributable deaths [34 100–80 300] in 1990, to 550 000 associated deaths [500 000–600 000] and 130 000 attributable deaths [113 000–146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000–834 000) in 1990, to 1·03 million associated deaths (909 000–1·16 million) in 2021, and from 127 000 attributable deaths (82 100–171 000) in 1990, to 216 000 (168 000–264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56–2·26) deaths attributable to AMR and 8·22 million (6·85–9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2–69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5–89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (–6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8–102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08–13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths. Interpretation: This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050. Funding: UK Department of Health and Social Care's Fleming Fund using UK aid, and the Wellcome Trust. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021
    (2024)
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    Yi, Siyan (16837551600)
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    Yigit, Vahit (57222328239)
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    Yon, Dong Keon (57193675906)
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    Yonemoto, Naohiro (57204947657)
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    Yu, Chuanhua (57208140344)
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    Zakham, Fathiah (37064030100)
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    Zangiabadian, Moein (57219666210)
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    Zeukeng, Francis (55536099300)
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    Zhang, Haijun (57217088114)
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    Zhao, Yang (58957226600)
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    Zheng, Peng (57213707656)
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    Zielinska, Magdalena (58491440100)
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    Salomon, Joshua A. (56745638600)
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    Reiner, Robert C. (57203229088)
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    Naghavi, Mohsen (57207906323)
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    Vos, Theo (57223885848)
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    Hay, Simon I. (7101875313)
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    Murray, Christopher J. L. (57224556036)
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    Kyu, Hmwe Hmwe (57217040073)
    Background: Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. Methods: We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990–2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. Findings: We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5–14 years, 6·29% (5·05 to 7·70) in those aged 15–49 years, 5·72% (4·02 to 7·39) in those aged 50–69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5–14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15–49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50–69 years, and a 3·29% (–5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (–713 to 2180) fewer deaths. Interpretation: Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Global, regional, and national burden of meningitis and its aetiologies, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
    (2023)
    Wunrow, Han Yong (57218375682)
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    Bender, Rose G. (57219860604)
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    Gray, Authia P. (57442982500)
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    Demessa, Berecha Hundessa (58537470400)
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    Dervišević, Emina (57209465870)
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    ;
    Kyu, Hmwe Hmwe (57217040073)
    Background: Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we aimed to assess incident cases and deaths due to acute infectious meningitis by aetiology and age from 1990 to 2019, for 204 countries and territories. Methods: We modelled meningitis mortality using vital registration, verbal autopsy, sample-based vital registration, and mortality surveillance data. Meningitis morbidity was modelled with a Bayesian compartmental model, using data from the published literature identified by a systematic review, as well as surveillance data, inpatient hospital admissions, health insurance claims, and cause-specific meningitis mortality estimates. For aetiology estimation, data from multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature studies were analysed by use of a network analysis model to estimate the proportion of meningitis deaths and cases attributable to the following aetiologies: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococcus, Escherichia coli, Klebsiella pneumoniae, Listeria monocytogenes, Staphylococcus aureus, viruses, and a residual other pathogen category. Findings: In 2019, there were an estimated 236 000 deaths (95% uncertainty interval [UI] 204 000–277 000) and 2·51 million (2·11–2·99) incident cases due to meningitis globally. The burden was greatest in children younger than 5 years, with 112 000 deaths (87 400–145 000) and 1·28 million incident cases (0·947–1·71) in 2019. Age-standardised mortality rates decreased from 7·5 (6·6–8·4) per 100 000 population in 1990 to 3·3 (2·8–3·9) per 100 000 population in 2019. The highest proportion of total all-age meningitis deaths in 2019 was attributable to S pneumoniae (18·1% [17·1–19·2]), followed by N meningitidis (13·6% [12·7–14·4]) and K pneumoniae (12·2% [10·2–14·3]). Between 1990 and 2019, H influenzae showed the largest reduction in the number of deaths among children younger than 5 years (76·5% [69·5–81·8]), followed by N meningitidis (72·3% [64·4–78·5]) and viruses (58·2% [47·1–67·3]). Interpretation: Substantial progress has been made in reducing meningitis mortality over the past three decades. However, more meningitis-related deaths might be prevented by quickly scaling up immunisation and expanding access to health services. Further reduction in the global meningitis burden should be possible through low-cost multivalent vaccines, increased access to accurate and rapid diagnostic assays, enhanced surveillance, and early treatment. Funding: Bill & Melinda Gates Foundation. © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Publication
    Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: A systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
    (2019)
    Frank, Tahvi D. (57203197110)
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    Carter, Austin (57201756395)
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    Jahagirdar, Deepa (57213764835)
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    Biehl, Molly H. (57196041812)
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    Douwes-Schultz, Dirk (57196081398)
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    Larson, Samantha Leigh (57204569813)
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    Arora, Megha (57196080797)
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    Dwyer-Lindgren, Laura (50461317900)
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    Steuben, Krista M. (57208867341)
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    Abbastabar, Hedayat (57212441848)
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    Abu-Raddad, Laith Jamal (14032724700)
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    Abyu, Direslgne Misker (56507277900)
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    Adabi, Maryam (57190491886)
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    Adebayo, Oladimeji M. (57194329853)
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    Adekanmbi, Victor (53463192900)
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    Adetokunboh, Olatunji O. (56598104300)
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    Ahmadi, Alireza (56336080700)
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    Ahmadi, Keivan (59396073300)
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    Alam, Noore (57202437697)
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    Albertson, Samuel B. (57204573505)
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    Alvis-Guzman, Nelson (57210741239)
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    Bojia, Hunduma Amensisa (57211141151)
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    Burugina Nagaraja, Sharath B.N. (46961272800)
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    Butt, Zahid A. (57202522739)
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    Cahuana-Hurtado, Lucero (57207890731)
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    Campuzano Rincon, Julio Cesar (6505846919)
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    Christopher, Devasahayam J. (57209863533)
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    Daryani, Ahmad (16021522200)
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    Das Neves, José (57208073193)
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    Demoz, Gebre Teklemariam (57202214514)
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    Dhungana, Govinda Prasad (24066372700)
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    Diaz, Daniel (56644152500)
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    Do, Huyen Phuc (57200737094)
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    Eftekhari, Aziz (56829076800)
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    El Sayed Zaki, Maysaa (57203666922)
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    El-Jaafary, Shaimaa I. (34869528300)
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    El-Khatib, Ziad (54908919000)
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    Endries, Aman Yesuf (57216324852)
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    Fatima, Batool (55510228900)
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    Fernandes, Eduarda (34770207500)
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    Filip, Irina (55570061400)
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    Fischer, Florian (55508208800)
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    Folayan, Morenike Oluwatoyin (56725310700)
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    Foroutan, Masoud (58948371300)
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    Fukumoto, Takeshi (26531100300)
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    Fullman, Nancy (57211064970)
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    Garcia-Basteiro, Alberto L. (57200187168)
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    Gayesa, Reta Tsegaye (57225049499)
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    Gebremedhin, Ketema Bizuwork (57200529247)
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    Gebremeskel, Gebreamlak Gebremedhn (57748459200)
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    Gebreyohannes, Kelali Kalaye (57212023716)
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    Gedefaw, Getnet Azeze (57204453564)
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    Gelaw, Belayneh K. (56449077900)
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    Gesesew, Hailay Abrha (56412148300)
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    Geta, Birhanu (57208190927)
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    Gezae, Kebede Embaye (57204561611)
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    Ghadiri, Keyghobad (55409170000)
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    Ghashghaee, Ahmad (57194174020)
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    Ginindza, Themba T.G. (24468039800)
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    Gugnani, Harish Chander (7005567008)
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    Guimarães, Rafael Alves (56534712800)
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    Haile, Michael Tamene (57204564050)
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    Hailu, Gessessew Bugssa (57219637263)
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    Haj-Mirzaian, Arvin (57210768364)
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    Haj-Mirzaian, Arya (57226201352)
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    Hamidi, Samer (24366336000)
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    Handanagic, Senad (55803954400)
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    Handiso, Demelash Woldeyohannes (57201501075)
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    Hanfore, Lolemo Kelbiso (57208341706)
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    Hasanzadeh, Amir (57193162243)
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    Hassankhani, Hadi (26436359700)
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    Hassen, Hamid Yimam (57188660707)
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    Hay, Simon I. (7101875313)
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    Henok, Andualem (57196451824)
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    Hoang, Chi Linh (57205123375)
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    Hosgood, H. Dean (56353204400)
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    Hosseinzadeh, Mehdi (57201880569)
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    Hsairi, Mohamed (57209033943)
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    Ibitoye, Segun Emmanuel (57212027408)
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    Idrisov, Bulat (57208773503)
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    Ikuta, Kevin S. (57211541916)
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    Ilesanmi, Olayinka Stephen (54782692800)
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    Irvani, Seyed Sina Naghibi (57202975543)
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    Iwu, Chinwe Juliana (56904084900)
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    Jacobsen, Kathryn H. (26029163100)
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    James, Spencer L. (57202557998)
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    Jorjoran Shushtari, Zahra (57200135800)
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    Kabir, Ali (23050698400)
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    Kadel, Rajendra (57196080325)
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    Kassa, Tesfaye Dessale (58686045600)
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    Kayode, Gbenga A. (53463867400)
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    Kebede, Mihiretu M. (56781219700)
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    Kefale, Adane Teshome (57194507694)
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    Kengne, Andre Pascal (7801322838)
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    Khader, Yousef Saleh (55654192600)
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    Khafaie, Morteza Abdullatif (55608324700)
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    Khalid, Nauman (57204561542)
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    Khan, Ejaz Ahmad (57218791274)
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    Khan, Junaid (57203436148)
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    Olagunju, Andrew T. (26029995700)
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    Olagunju, Tinuke O. (57203076824)
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    Olum, Solomon (57201392598)
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    Oppong Asante, Kwaku (55521479400)
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    Oren, Eyal (36815569400)
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    Otstavnov, Stanislav S. (57204561394)
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    Mahesh, P.A. (57202421244)
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    Padubidri, Jagadish Rao (58295062300)
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    Pourshams, Akram (6507521541)
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    Rahimi-Movaghar, Afarin (8696686900)
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    Rahimi-Movaghar, Vafa (6507646446)
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    Rawaf, Salman (6602475959)
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    Reta, Melese Abate (57219956463)
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    Rezai, Mohammad Sadegh (55273796300)
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    Rios González, Carlos Miguel (57194781192)
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    Merdassa Roro, Elias E.M. (57217207043)
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    Silva, Diego Augusto Santos (36985158000)
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    Silveira, Dayane Gabriele Alves (57190284103)
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    Singh, Jasvinder A. (7404421736)
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    Sisay, Malede Mequanent M. (57211322781)
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    Soshnikov, Sergey (57195195606)
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    Stein, Dan J. (55769747595)
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    Sufiyan, Mu'awiyyah Babale (58294633600)
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    Sunguya, Bruno F. (57209060557)
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    Tekelemedhin, Shishay Wahdey (57204566273)
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    Temesgen, Habtamu Denekew (57205011874)
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    Teshale, Manaye Yihune (57204566390)
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    Tovani-Palone, Marcos Roberto (56644977900)
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    Tran, Bach Xuan (57209107515)
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    Uthman, Olalekan A. (23026328100)
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    Zewale, Taye Abuhay (57209219258)
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    Ziapour, Arash (57202571078)
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    Zodpey, Sanjay (7003415080)
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    Naghavi, Mohsen (57207906323)
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    Vollset, Stein Emil (57196315778)
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    Wang, Haidong (16507828100)
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    Lim, Stephen S. (57201800433)
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    Kyu, Hmwe Hmwe (57217040073)
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    Murray, Christopher J.L. (55481130700)
    Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package - a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce agesex- specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact. © 2019 The Author(s).
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    Global, regional, and national incidence, prevalence, and mortality of HIV, 1980-2017, and forecasts to 2030, for 195 countries and territories: A systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017
    (2019)
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    Rawaf, Salman (6602475959)
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    Reis, Cesar (56611469700)
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    Renjith, Vishnu (56468022200)
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    Reta, Melese Abate (57219956463)
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    Rezai, Mohammad Sadegh (55273796300)
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    Rios González, Carlos Miguel (57194781192)
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    Merdassa Roro, Elias E.M. (57217207043)
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    Sahraian, Mohammad Ali (55886074600)
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    Tekelemedhin, Shishay Wahdey (57204566273)
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    Tovani-Palone, Marcos Roberto (56644977900)
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    Tran, Khanh Bao (57201651536)
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    Ullah, Irfan (56992676600)
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    Unnikrishnan, Bhaskaran (12790012100)
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    Uthman, Olalekan A. (23026328100)
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    Veisani, Yousef (55370882600)
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    Vladimirov, Sergey Konstantinovitch (57195959162)
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    Wada, Fiseha Wadilo (57194049305)
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    Waheed, Yasir (35303643700)
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    Yu, Chuanhua (57208140344)
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    Zenebe, Zerihun Menlkalew (57200737185)
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    Zewale, Taye Abuhay (57209219258)
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    Ziapour, Arash (57202571078)
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    Zodpey, Sanjay (7003415080)
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    Naghavi, Mohsen (57207906323)
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    Vollset, Stein Emil (57196315778)
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    Wang, Haidong (16507828100)
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    Lim, Stephen S. (57201800433)
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    Kyu, Hmwe Hmwe (57217040073)
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    Murray, Christopher J.L. (55481130700)
    Background Understanding the patterns of HIV/AIDS epidemics is crucial to tracking and monitoring the progress of prevention and control efforts in countries. We provide a comprehensive assessment of the levels and trends of HIV/AIDS incidence, prevalence, mortality, and coverage of antiretroviral therapy (ART) for 1980-2017 and forecast these estimates to 2030 for 195 countries and territories. Methods We determined a modelling strategy for each country on the basis of the availability and quality of data. For countries and territories with data from population-based seroprevalence surveys or antenatal care clinics, we estimated prevalence and incidence using an open-source version of the Estimation and Projection Package - a natural history model originally developed by the UNAIDS Reference Group on Estimates, Modelling, and Projections. For countries with cause-specific vital registration data, we corrected data for garbage coding (ie, deaths coded to an intermediate, immediate, or poorly defined cause) and HIV misclassification. We developed a process of cohort incidence bias adjustment to use information on survival and deaths recorded in vital registration to back-calculate HIV incidence. For countries without any representative data on HIV, we produced incidence estimates by pulling information from observed bias in the geographical region. We used a re-coded version of the Spectrum model (a cohort component model that uses rates of disease progression and HIV mortality on and off ART) to produce agesex- specific incidence, prevalence, and mortality, and treatment coverage results for all countries, and forecast these measures to 2030 using Spectrum with inputs that were extended on the basis of past trends in treatment scale-up and new infections. Findings Global HIV mortality peaked in 2006 with 1·95 million deaths (95% uncertainty interval 1·87-2·04) and has since decreased to 0·95 million deaths (0·91-1·01) in 2017. New cases of HIV globally peaked in 1999 (3·16 million, 2·79-3·67) and since then have gradually decreased to 1·94 million (1·63-2·29) in 2017. These trends, along with ART scale-up, have globally resulted in increased prevalence, with 36·8 million (34·8-39·2) people living with HIV in 2017. Prevalence of HIV was highest in southern sub-Saharan Africa in 2017, and countries in the region had ART coverage ranging from 65·7% in Lesotho to 85·7% in eSwatini. Our forecasts showed that 54 countries will meet the UNAIDS target of 81% ART coverage by 2020 and 12 countries are on track to meet 90% ART coverage by 2030. Forecasted results estimate that few countries will meet the UNAIDS 2020 and 2030 mortality and incidence targets. Interpretation Despite progress in reducing HIV-related mortality over the past decade, slow decreases in incidence, combined with the current context of stagnated funding for related interventions, mean that many countries are not on track to reach the 2020 and 2030 global targets for reduction in incidence and mortality. With a growing population of people living with HIV, it will continue to be a major threat to public health for years to come. The pace of progress needs to be hastened by continuing to expand access to ART and increasing investments in proven HIV prevention initiatives that can be scaled up to have population-level impact. © 2019 The Author(s).
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    Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019
    (2021)
    Paulson, Katherine R. (57203437789)
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    Sidemo, Negussie Boti (57204638690)
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    Sigfusdottir, Inga Dora (57214359118)
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    Sigurvinsdottir, Rannveig (56006396200)
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    Silva, João Pedro (57204703526)
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    Silverberg, Jonathan I.S. (6603664613)
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    Simonetti, Biagio (16310420300)
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    Singh, Balbir Bagicha (16680213100)
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    Singh, Jasvinder A. (7404421736)
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    Singhal, Deepika (48361953900)
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    Sinha, Dhirendra Narain (7201637609)
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    Skiadaresi, Eirini (37100428500)
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    Skryabin, Valentin Yurievich (57226830981)
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    Skryabina, Anna Aleksandrovna (57218875198)
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    Sleet, David A. (57195363799)
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    Sobaih, Badr Hasan (57202564080)
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    Sobhiyeh, Mohammad Reza (35280718200)
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    Soltani, Shahin (56767763700)
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    Soriano, Joan B. (7101973935)
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    Spurlock, Emma Elizabeth (57218543838)
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    Sreeramareddy, Chandrashekhar T. (57212263335)
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    Steiropoulos, Paschalis (55965229900)
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    Stokes, Mark A. (7102859000)
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    Stortecky, Stefan (36515745900)
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    Sufiyan, Mu'awiyyah Babale (58294633600)
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    Abdulkader, Rizwan Suliankatchi (57226205764)
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    Sulo, Gerhard (16242476100)
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    Swope, Carolyn B. (57204309763)
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    Sykes, Bryan L. (57218362022)
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    Szeto, Mindy D. (57218347447)
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    Szócska, Miklós (13410278600)
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    Tabarés-Seisdedos, Rafael (6602981102)
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    Tadesse, Eyayou Girma (57221591705)
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    Taherkhani, Amir (57203973738)
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    Tamiru, Animut Tagele (57218877788)
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    Tareque, Md Ismail (58298394400)
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    Tehrani-Banihashemi, Arash (57204006020)
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    Temsah, Mohamad-Hani (56115852000)
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    Tesfay, Fisaha Haile (57203977293)
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    Tessema, Gizachew Assefa (57196316304)
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    Tessema, Zemenu Tadesse (57211312128)
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    Thankappan, Kavumpurathu Raman (57202955435)
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    Thapar, Rekha (36337431900)
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    Tolani, Musliu Adetola (57200450515)
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    Tovani-Palone, Marcos Roberto (56644977900)
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    Traini, Eugenio (57211137081)
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    Tran, Bach Xuan (57209107515)
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    Tripathy, Jaya Prasad (55290251600)
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    Tsapparellas, Giorgos (57218836859)
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    Tsatsakis, Aristidis (35596169100)
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    Car, Lorainne Tudor (48561867100)
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    Uddin, Riaz (53064875600)
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    Ullah, Anayat (57215320706)
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    Umeokonkwo, Chukwuma David (57204448015)
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    Unim, Brigid (37862108700)
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    Unnikrishnan, Bhaskaran (12790012100)
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    Upadhyay, Era (6505961711)
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    Usman, Muhammad Shariq (57203046075)
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    Vacante, Marco (23037085900)
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    Vaezi, Maryam (55644006900)
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    Tahbaz, Sahel Valadan (57216154072)
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    Valdez, Pascual R. (57202115577)
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    Vasankari, Tommi Juhani (57200592416)
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    Venketasubramanian, Narayanaswamy (56804702100)
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    Verma, Madhur (57189521090)
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    Violante, Francesco S. (7003555890)
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    Vlassov, Vasily (57211633239)
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    Vo, Bay (35147075900)
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    Vu, Giang Thu (57202424871)
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    Wado, Yohannes Dibaba (55845842100)
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    Waheed, Yasir (35303643700)
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    Wamai, Richard G. (23969762700)
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    Wang, Yanping (57215440165)
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    Wang, Yanzhong (59417336500)
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    Wang, Yuan-Pang (8576812100)
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    Ward, Paul (7402101951)
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    Werdecker, Andrea (57208964895)
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    Westerman, Ronny (57218361023)
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    Wickramasinghe, Nuwan Darshana (55326938000)
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    Wilner, Lauren B. (57193699787)
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    Wiysonge, Charles Shey (6507441509)
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    Wu, Ai-Min (57203702647)
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    Wu, Chenkai (57188764904)
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    Xie, Yang (57218877069)
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    Jabbari, Seyed Hossein Yahyazadeh (57207954055)
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    Yamagishi, Kazumasa (35231751500)
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    Yandrapalli, Srikanth (56512389300)
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    Yaya, Sanni (55191139800)
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    Yazdi-Feyzabadi, Vahid (56017415700)
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    Yip, Paul (7102503720)
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    Yonemoto, Naohiro (57204947657)
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    Yoon, Seok-Jun (24823148900)
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    Younis, Mustafa Z. (8549393000)
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    Yousefi, Zabihollah (9743306100)
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    Yousefinezhadi, Taraneh (57039201000)
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    Yu, Chuanhua (57208140344)
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    Yusuf, Sifat Shahana (56478251200)
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    Zaidi, Syed Saoud (57218882927)
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    Zaman, Sojib Bin (57193070058)
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    Zamani, Mohammad (59866744200)
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    Zamanian, Maryam (57201292465)
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    Zastrozhin, Mikhail Sergeevich (56728932200)
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    Zastrozhina, Anasthasia (57210832491)
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    Zhang, Yunquan (56568510200)
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    Zhang, Zhi-Jiang (56068578400)
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    Zhao, Xiu-Ju George (8360350900)
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    Ziapour, Arash (57202571078)
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    Hay, Simon I. (7101875313)
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    Murray, Christopher J.L. (57224556036)
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    Wang, Haidong (16507828100)
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    Kassebaum, Nicholas J. (57202562224)
    Background: Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods: We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings: Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3–74·0) in 2000 to 37·1 (33·2–41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8–29·5) in 2000 to 17·9 (16·3–19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05–10·30) in 2000 and 5·05 million (4·27–6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53–4·02]) in 2000 to 48% (2·42 million; 2·06–2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71–0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27–1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35–2·58; 37% [95% UI 32–43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation: Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Funding: Bill & Melinda Gates Foundation. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019
    (2021)
    Jahagirdar, Deepa (57213764835)
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    Walters, Magdalene K. (58375486400)
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    Novotney, Amanda (57224408265)
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    Brewer, Edmond D. (57274988200)
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    Frank, Tahvi D. (57203197110)
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    Carter, Austin (57201756395)
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    Biehl, Molly H. (57196041812)
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    Abbastabar, Hedayat (57212441848)
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    Abhilash, E.S. (57226827662)
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    Abu-Gharbieh, Eman (24586714800)
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    Abu-Raddad, Laith Jamal (14032724700)
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    Adekanmbi, Victor (53463192900)
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    Adeyinka, Daniel Adedayo (35223041800)
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    Adnani, Qorinah Estiningtyas Sakilah (57211604149)
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    Afzal, Saira (7004381116)
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    Aghababaei, Soodabeh (57191370945)
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    Alanezi, Fahad Mashhour (57213607595)
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    Andrei, Catalina Liliana (36543507200)
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    Quintanilla, Beatriz Paulina Ayala (55598298700)
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    Ayza, Muluken Altaye (57216492115)
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    Azari, Samad (56396696500)
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    Darshan, B.B. (36602364600)
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    Banach, Maciej (22936699500)
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    Bärnighausen, Till Winfried (23011726900)
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    Barra, Fabio (57201953956)
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    Belay, Habtamu Gebrehana (57193909190)
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    Berheto, Tezera Moshago (56382955400)
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    Bezabhe, Woldesellassie Mequanint (55932461200)
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    Bezabih, Yihienew Mequanint (57209397638)
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    Bhagavathula, Akshaya Srikanth (56398498300)
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    Briko, Nikolay Ivanovich (7004344976)
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    Buonsenso, Danilo (36607486700)
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    Choudhari, Sonali Gajanan (55760057300)
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    Chu, Dinh-Toi (56239816300)
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    Couto, Rosa A.S. (56132363700)
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    Cowden, Richard G. (56463772700)
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    Dachew, Berihun Assefa (56289825700)
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    Dahlawi, Saad M.A. (57189234459)
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    Dai, Xiaochen (57221591169)
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    Dandona, Lalit (7007017243)
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    Dandona, Rakhi (57203043697)
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    das Neves, José (57208073193)
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    Degenhardt, Louisa (7004040033)
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    Demeke, Feleke Mekonnen (57204717669)
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    Desta, Abebaw Alemayehu (57224144903)
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    Deuba, Keshab (55619379400)
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    Dhamnetiya, Deepak (56884613200)
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    Dhungana, Govinda Prasad (24066372700)
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    Diaz, Daniel (56644152500)
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    El Sayed Zaki, Maysaa (57203666922)
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    Elayedath, Rajesh (56226366100)
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    Elhadi, Muhammed (57212082248)
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    El-Jaafary, Shaimaa I. (34869528300)
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    Endries, Aman Yesuf (57216324852)
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    Ezeonwumelu, Ifeanyi Jude (57203432749)
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    Ezzikouri, Sayeh (16836144700)
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    Farahmand, Mohammad (57147377700)
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    Faraon, Emerito Jose A. (57195414019)
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    Fasanmi, Abidemi Omolara (57224144667)
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    Ferrero, Simone (57190137236)
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    Desideri, Lorenzo Ferro (57201549628)
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    Filip, Irina (55570061400)
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    Folayan, Morenike Oluwatoyin (56725310700)
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    Foroutan, Masoud (58948371300)
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    Gad, Mohamed M. (57203749611)
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    Gadanya, Muktar A. (25957587400)
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    Gaidhane, Abhay Motiramji (25031248900)
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    Garg, Tushar (57681919400)
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    Gebreyohannes, Eyob Alemayehu (57192104040)
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    Gesesew, Hailay Abrha (56412148300)
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    Ghadiri, Keyghobad (55409170000)
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    Ghashghaee, Ahmad (57194174020)
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    Gilani, Syed Amir (37008269900)
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    Ginindza, Themba G. (24468039800)
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    Glăvan, Ionela-Roxana (57094897500)
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    Glushkova, Ekaterina Vladimirovna (57208983629)
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    Golechha, Mahaveer (36006347600)
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    Gugnani, Harish Chander (7005567008)
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    Gupta, Bhawna (56763353100)
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    Gupta, Sapna (57217857409)
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    Gupta, Veer Bala (57194978364)
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    Gupta, Vivek Kumar (35073936800)
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    Hamidi, Samer (24366336000)
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    Handanagic, Senad (55803954400)
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    Hargono, Arief (57208225627)
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    Hasaballah, Ahmed I. (56002305300)
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    Hassanipour, Soheil (57191513993)
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    Hayat, Khezar (57219918947)
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    Hezam, Kamal (57199187791)
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    Holla, Ramesh (55270371800)
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    Hoque, Mohammad Enamul (55337968200)
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    Hosseini, Mostafa (57204569481)
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    Hosseinzadeh, Mehdi (57201880569)
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    Hsairi, Mohamed (57209033943)
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    Hussain, Rabia (7103224786)
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    Ibitoye, Segun Emmanuel (57212027408)
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    Idrisov, Bulat (57208773503)
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    Ikuta, Kevin S. (57211541916)
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    Ilic, Irena M. (57210823522)
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    Ilic, Milena D. (7102981394)
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    Irvani, Seyed Sina Naghibi (57202975543)
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    Islam, M. Mofizul (55468827000)
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    Ismail, Nahlah Elkudssiah (57885381900)
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    Itumalla, Ramaiah (57212472658)
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    Iyamu, Ihoghosa Osamuyi (57219860603)
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    Joseph, Nitin (35292547200)
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    Korshunov, Vladimir Andreevich (57203303920)
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    Laxminarayana, Sindhura Lakshmi Koulmane (57196152832)
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    Koyanagi, Ai (57197741912)
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    Kumar, Manasi (21739940700)
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    Kwarteng, Alexander (54079844900)
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    Lal, Dharmesh Kumar (57222488984)
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    Landires, Iván (15063040000)
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    Lasrado, Savita (36632480900)
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    Lassi, Zohra S. (35769584500)
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    Lazarus, Jeffrey V. (55431519100)
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    Lee, Jane Jean-Hee (41261785200)
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    Lee, Yeong Yeh (56191149300)
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    LeGrand, Kate E. (57216789066)
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    Lin, Christine (57219861546)
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    Liu, Xuefeng (37050047900)
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    Maddison, Emilie R. (57196084094)
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    El Razek, Hassan Magdy Abd (57195948755)
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    Zastrozhin, Mikhail Sergeevich (56728932200)
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    Zastrozhina, Anasthasia (57210832491)
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    Zhang, Zhi-Jiang (56068578400)
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    Salomon, Joshua A. (56745638600)
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    Eaton, Jeffrey W. (58553535300)
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    Naghavi, Mohsen (57207906323)
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    Dwyer-Lindgren, Laura (50461317900)
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    Wang, Haidong (16507828100)
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    Lim, Stephen S. (57201800433)
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    Hay, Simon I. (7101875313)
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    Murray, Christopher J.L. (57224556036)
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    Kyu, Hmwe H. (57217040073)
    Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Global, regional, and national sex-specific burden and control of the HIV epidemic, 1990–2019, for 204 countries and territories: the Global Burden of Diseases Study 2019
    (2021)
    Jahagirdar, Deepa (57213764835)
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    Novotney, Amanda (57224408265)
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    Adekanmbi, Victor (53463192900)
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    Gebreyohannes, Eyob Alemayehu (57192104040)
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    Hosseinzadeh, Mehdi (57201880569)
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    Hussain, Rabia (7103224786)
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    Ibitoye, Segun Emmanuel (57212027408)
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    Idrisov, Bulat (57208773503)
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    Ilic, Milena D. (7102981394)
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    Irvani, Seyed Sina Naghibi (57202975543)
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    Islam, M. Mofizul (55468827000)
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    Ismail, Nahlah Elkudssiah (57885381900)
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    Laxminarayana, Sindhura Lakshmi Koulmane (57196152832)
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    Lal, Dharmesh Kumar (57222488984)
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    Lee, Jane Jean-Hee (41261785200)
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    Lee, Yeong Yeh (56191149300)
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    LeGrand, Kate E. (57216789066)
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    Lin, Christine (57219861546)
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    Liu, Xuefeng (37050047900)
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    Maddison, Emilie R. (57196084094)
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    El Razek, Hassan Magdy Abd (57195948755)
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    Mahasha, Phetole Walter (28767805500)
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    Majeed, Azeem (7102027801)
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    Makki, Alaa (57224607101)
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    Malik, Ahmad Azam (57198682313)
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    Manamo, Wondimu Ayele (57191836792)
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    Mansournia, Mohammad Ali (34570618600)
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    Martins-Melo, Francisco Rogerlândio (57204796807)
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    Masoumi, Seyedeh Zahra (55769011500)
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    Memish, Ziad A. (7005059350)
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    Mengesha, Endalkachew Worku (57216203521)
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    Miller, Ted R. (7403948600)
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    Munro, Sandra B. (7004622934)
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    Nachega, Jean B. (6701544088)
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    Nagarajan, Ahamarshan Jayaraman (57204562074)
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    Narayana, Aparna Ichalangod (26530691100)
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    Kandel, Sandhya Neupane (57222966618)
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    Nguefack-Tsague, Georges (55198921200)
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    Nixon, Molly R. (57204562047)
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    Nnaji, Chukwudi A. (57204873792)
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    Nyirenda, Thomas Elliot (6603775882)
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    Olagunju, Andrew T. (26029995700)
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    Olakunde, Babayemi Oluwaseun (55251697700)
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    Owopetu, Oluwatomi Funbi (57219110616)
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    Kan, Fatemeh Pashazadeh (57222966726)
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    Postma, Maarten J. (7006296502)
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    Syed, Zahiruddin Quazi (36337182700)
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    Radfar, Amir (57194428768)
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    Radhakrishnan, Raghu Anekal (7103113006)
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    Rahman, Mosiur (55457953000)
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    Ram, Pradhum (55961669800)
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    Ranabhat, Chhabi Lal (56719695500)
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    Ranasinghe, Priyanga (6602322079)
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    Rao, Chythra R. (35771430100)
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    Rao, Sowmya J. (57195423591)
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    Rathi, Priya (57216633909)
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    Rawaf, David Laith (57209228052)
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    Rawaf, Salman (6602475959)
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    Regassa, Lemma Demissie (57208704471)
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    Rezahosseini, Omid (57194737361)
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    Roshchin, Denis O. (57194175724)
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    Rwegerera, Godfrey M. (56033523400)
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    Saeed, Umar (36612315100)
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    Moghaddam, Sahar Saeedi (56071020000)
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    Salem, Marwa Rashad (57194137372)
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    Santric-Milicevic, Milena M. (57211144346)
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    Schutte, Aletta Elisabeth (57216814352)
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    Seylani, Allen (57222325334)
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    Shaikh, Masood Ali (57203122601)
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    Shaka, Mohammed Feyisso (57205107107)
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    Shamshad, Hina (24722237000)
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    Shannawaz, Mohammed (56349680200)
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    Shin, Jae Il (57964880100)
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    Singh, Jasvinder A. (7404421736)
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    Skryabin, Valentin Yurievich (57226830981)
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    Skryabina, Anna Aleksandrovna (57218875198)
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    Somayaji, Ranjani (6507727557)
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    Spurlock, Emma Elizabeth (57218543838)
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    Sufiyan, Mu'awiyyah Babale (58294633600)
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    Tadesse, Birkneh Tilahun (56811144600)
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    Tadesse, Eyayou Girma (57221591705)
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    Tamiru, Animut Tagele (57218877788)
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    Tarkang, Elvis Enowbeyang (55351474900)
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    Taveira, Nuno (6602731390)
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    Tekalegn, Yohannes (57201033519)
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    Tesfay, Fisaha Haile (57203977293)
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    Tessema, Gizachew Assefa (57196316304)
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    Thapar, Rekha (36337431900)
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    Tovani-Palone, Marcos Roberto (56644977900)
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    Traini, Eugenio (57211137081)
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    Tran, Bach Xuan (57209107515)
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    Tsai, Alexander C. (35362700200)
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    Tusa, Biruk Shalmeno (57216200356)
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    Ullah, Saif (57219395828)
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    Umeokonkwo, Chukwuma David (57204448015)
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    Unnikrishnan, Bhaskaran (12790012100)
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    Tahbaz, Sahel Valadan (57216154072)
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    Villafañe, Jorge Hugo (57197861057)
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    Vladimirov, Sergey Konstantinovitch (57195959162)
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    Vo, Bay (35147075900)
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    Vongpradith, Avina (57216661011)
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    Vu, Giang Thu (57202424871)
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    Waheed, Yasir (35303643700)
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    Wamai, Richard G. (23969762700)
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    Wang, Guan (55503825500)
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    Wang, Yanzhong (59417336500)
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    Ward, Paul (7402101951)
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    Westerman, Ronny (57218361023)
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    Winkler, Andrea Sylvia (58323746700)
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    Yadav, Lalit (57211483937)
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    Jabbari, Seyed Hossein Yahyazadeh (57207954055)
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    Yazie, Taklo Simeneh (57207254034)
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    Yi, Siyan (16837551600)
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    Yiğit, Vahit (57222328239)
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    Yirdaw, Birhanu Wubale (57219148502)
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    Yonemoto, Naohiro (57204947657)
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    Yu, Chuanhua (57208140344)
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    Yunusa, Ismaeel (57202137670)
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    Zastrozhin, Mikhail Sergeevich (56728932200)
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    Zastrozhina, Anasthasia (57210832491)
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    Zhang, Zhi-Jiang (56068578400)
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    Zumla, Alimuddin (7006170723)
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    Salomon, Joshua A. (56745638600)
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    Eaton, Jeffrey W. (58553535300)
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    Naghavi, Mohsen (57207906323)
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    Dwyer-Lindgren, Laura (50461317900)
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    Wang, Haidong (16507828100)
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    Lim, Stephen S. (57201800433)
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    Hay, Simon I. (7101875313)
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    Murray, Christopher J.L. (57224556036)
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    Kyu, Hmwe H. (57217040073)
    Background: The sustainable development goals (SDGs) aim to end HIV/AIDS as a public health threat by 2030. Understanding the current state of the HIV epidemic and its change over time is essential to this effort. This study assesses the current sex-specific HIV burden in 204 countries and territories and measures progress in the control of the epidemic. Methods: To estimate age-specific and sex-specific trends in 48 of 204 countries, we extended the Estimation and Projection Package Age-Sex Model to also implement the spectrum paediatric model. We used this model in cases where age and sex specific HIV-seroprevalence surveys and antenatal care-clinic sentinel surveillance data were available. For the remaining 156 of 204 locations, we developed a cohort-incidence bias adjustment to derive incidence as a function of cause-of-death data from vital registration systems. The incidence was input to a custom Spectrum model. To assess progress, we measured the percentage change in incident cases and deaths between 2010 and 2019 (threshold >75% decline), the ratio of incident cases to number of people living with HIV (incidence-to-prevalence ratio threshold <0·03), and the ratio of incident cases to deaths (incidence-to-mortality ratio threshold <1·0). Findings: In 2019, there were 36·8 million (95% uncertainty interval [UI] 35·1–38·9) people living with HIV worldwide. There were 0·84 males (95% UI 0·78–0·91) per female living with HIV in 2019, 0·99 male infections (0·91–1·10) for every female infection, and 1·02 male deaths (0·95–1·10) per female death. Global progress in incident cases and deaths between 2010 and 2019 was driven by sub-Saharan Africa (with a 28·52% decrease in incident cases, 95% UI 19·58–35·43, and a 39·66% decrease in deaths, 36·49–42·36). Elsewhere, the incidence remained stable or increased, whereas deaths generally decreased. In 2019, the global incidence-to-prevalence ratio was 0·05 (95% UI 0·05–0·06) and the global incidence-to-mortality ratio was 1·94 (1·76–2·12). No regions met suggested thresholds for progress. Interpretation: Sub-Saharan Africa had both the highest HIV burden and the greatest progress between 1990 and 2019. The number of incident cases and deaths in males and females approached parity in 2019, although there remained more females with HIV than males with HIV. Globally, the HIV epidemic is far from the UNAIDS benchmarks on progress metrics. Funding: The Bill & Melinda Gates Foundation, the National Institute of Mental Health of the US National Institutes of Health (NIH), and the National Institute on Aging of the NIH. © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    Publication
    The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019
    (2022)
    Tran, Khanh Bao (57201651536)
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    Lang, Justin J. (57189384487)
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    Compton, Kelly (57205330541)
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    Xu, Rixing (57204186670)
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    Acheson, Alistair R. (57912642400)
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    Henrikson, Hannah Jacqueline (57219861283)
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    Kocarnik, Jonathan M. (56041211800)
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    Penberthy, Louise (57219572912)
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    Aali, Amirali (57819452000)
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    Abbas, Qamar (57242462200)
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    Abbasi, Behzad (57204089435)
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    Abbasi-Kangevari, Mohsen (57193543882)
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    Abdelmasseh, Michael (57356690000)
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    Abd-Elsalam, Sherief (57189845325)
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    Abdelwahab, Ahmed Abdelwahab (57862779500)
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    Abdulkadir, Hanan Abdulkadir (57226323460)
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    Akunna, Chisom Joyqueenet (57214884531)
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    Alanezi, Fahad Mashhour (57213607595)
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    Alessy, Saleh Ali (57212489869)
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    Algammal, Abdelazeem M. (55953589200)
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    Al-Hanawi, Mohammed Khaled (57195715156)
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    Ali, Beriwan Abdulqadir (57208356112)
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    Ali, Liaqat (55646005400)
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    Ali, Syed Shujait (57188688612)
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    Al-Maweri, Sadeq Ali Ali (36023535700)
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    Alonso, Nivaldo (7004026436)
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    Al-Raddadi, Rajaa M. (57219673720)
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    Al-Rifai, Rami H. Hani (57196124575)
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    Al-Sabah, Salman Khalifah (23566537100)
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    Ameyaw, Edward Kwabena (57194076624)
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    Aminian Dehkordi, Javad Javad (57202949214)
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    Amirzade-Iranaq, Mohammad Hosein (57194381354)
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    Amu, Hubert (57190183918)
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    Amusa, Ganiyu Adeniyi (36934039400)
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    Ancuceanu, Robert (35728302200)
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    Anderson, Jason A. (57204563525)
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    Animut, Yaregal Animut (57205385197)
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    Anoushiravani, Amir (16038674600)
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    Anoushirvani, Ali Arash (13608892000)
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    Ansari-Moghaddam, Alireza (57192807651)
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    Ansha, Mustafa Geleto (57195329453)
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    Antony, Benny (55776194600)
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    Anwar, Sumadi Lukman (55251130100)
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    Anyasodor, Anayochukwu Edward (57192947419)
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    Argaw, Ayele Mamo (57440825700)
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    Ariffin, Hany (7004238528)
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    Aripov, Timur (35104283700)
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    Arshad, Muhammad (25722979300)
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    Aruleba, Raphael Taiwo (57200625209)
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    Asaad, Malke (57209296864)
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    Asemahagn, Mulusew A. (56376379400)
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    Asemi, Zatollah (36738697900)
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    Asghari-Jafarabadi, Mohammad (57226675591)
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    Ashraf, Tahira (56366752600)
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    Assadi, Reza (57203677411)
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    Athar, Mohammad (58948211800)
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    Athari, Seyyed Shamsadin (26653399600)
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    Atout, Maha Moh’d Wahbi (57195251851)
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    Attia, Sameh (57191255716)
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    Aujayeb, Avinash (6504403791)
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    Ausloos, Marcel (7101798907)
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    Avila-Burgos, Leticia (8530790100)
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    Singh, Jitendra Kumar (56770483800)
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    Singh, Paramdeep (57202809996)
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    Singh, Surjit (55740397100)
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    Sinha, Dhirendra Narain (7201637609)
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    Sinke, Abiy H. (57195329519)
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    Siraj, Md. Shahjahan (57216886120)
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    Sitas, Freddy (7003393668)
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    Siwal, Samarjeet Singh (56225532200)
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    Skryabin, Valentin Yurievich (57226830981)
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    Skryabina, Anna Aleksandrovna (57218875198)
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    Socea, Bogdan (32267661900)
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    Soeberg, Matthew J. (24734336300)
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    Sofi-Mahmudi, Ahmad (57216854132)
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    Solomon, Yonatan (57220875005)
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    Soltani-Zangbar, Mohammad Sadegh (57189099987)
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    Song, Suhang (57194455017)
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    Song, Yimeng (57194728629)
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    Sorensen, Reed J.D. (57196918748)
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    Soshnikov, Sergey (57195195606)
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    Sotoudeh, Houman (14054801700)
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    Sowe, Alieu (57208392783)
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    Sufiyan, Mu’awiyyah Babale (58294633600)
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    Suk, Ryan (57197819192)
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    Suleman, Muhammad (57196800921)
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    Suliankatchi Abdulkader, Rizwan (57226832737)
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    Sultana, Saima (57404748200)
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    Sur, Daniel (57194064798)
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    Szócska, Miklós (13410278600)
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    Tabaeian, Seidamir Pasha (57217530354)
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    Tabarés-Seisdedos, Rafael (6602981102)
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    Tabatabaei, Seyyed Mohammad (55935372700)
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    Tabuchi, Takahiro (55177892400)
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    Tadbiri, Hooman (57138410000)
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    Taheri, Ensiyeh (54997206100)
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    Taheri, Majid (57196608691)
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    Taheri Soodejani, Moslem (57200541349)
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    Takahashi, Ken (55741242600)
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    Talaat, Iman M. (7801465176)
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    Tampa, Mircea (55324899600)
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    Tan, Ker-Kan (16745396700)
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    Tat, Nathan Y. (57820156400)
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    Tat, Vivian Y. (57221326673)
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    Tavakoli, Ahmad (57189869940)
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    Tavakoli, Arash (57819456000)
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    Tehrani-Banihashemi, Arash (57204006020)
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    Tekalegn, Yohannes (57201033519)
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    Tesfay, Fisaha Haile (57203977293)
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    Thapar, Rekha (36337431900)
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    Thavamani, Aravind (57202135529)
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    Thoguluva Chandrasekar, Viveksandeep (57207827433)
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    Thomas, Nihal (7401830494)
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    Thomas, Nikhil Kenny (57218603966)
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    Ticoalu, Jansje Henny Vera (57580368800)
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    Tiyuri, Amir (57201850751)
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    Tollosa, Daniel Nigusse (57197807985)
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    Topor-Madry, Roman (57211182892)
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    Touvier, Mathilde (8877033300)
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    Tovani-Palone, Marcos Roberto (56644977900)
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    Traini, Eugenio (57211137081)
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    Tran, Mai Thi Ngoc (57225047867)
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    Tripathy, Jaya Prasad (55290251600)
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    Ukke, Gebresilasea Gendisha (57208651311)
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    Ullah, Irfan (56992676600)
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    Ullah, Saif (57219395828)
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    Ullah, Sana (56402784100)
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    Unnikrishnan, Bhaskaran (12790012100)
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    Vacante, Marco (23037085900)
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    Vaezi, Maryam (55644006900)
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    Valadan Tahbaz, Sahel (57356986200)
    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. Funding: Bill & Melinda Gates Foundation. © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
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    The global, regional, and national burden of colorectal cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
    (2019)
    Safiri, Saeid (56009654100)
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    Sepanlou, Sadaf G. (36248136000)
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    Ikuta, Kevin S. (57211541916)
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    Salimzadeh, Hamideh (23052386900)
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    Delavari, Alireza (14007282700)
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    Ansari, Reza (58085864000)
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    Roshandel, Gholamreza (14034446800)
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    Merat, Shahin (6603772416)
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    Fitzmaurice, Christina (57212628757)
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    Force, Lisa M. (57188548035)
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    Nixon, Molly R. (57204562047)
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    Abegaz, Kedir Hussein (57200726326)
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    Ali, Raghib (57196506541)
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    Aljunid, Syed Mohamed (6504304159)
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    Almadi, Majid Abdulrahman Hamad (55665024700)
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    Borzì, Antonio M. (57200199389)
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    Briko, Andrey Nikolaevich (57202792237)
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    Carvalho, Félix (7103070417)
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    Castañeda-Orjuela, Carlos A. (35769124700)
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    Cerin, Ester (14522064200)
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    Chiang, Peggy Pei-Chia (59846886500)
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    Chido-Amajuoyi, Onyema Greg (57204176505)
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    Daryani, Ahmad (16021522200)
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    El Sayed, Iman (7004479194)
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    Emamian, Mohammad Hassan (55181897800)
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    Endries, Aman Yesuf (57216324852)
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    Esteghamati, Alireza (11240321100)
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    Etemadi, Arash (7004686554)
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    Farzadfar, Farshad (57195049611)
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    Fernandes, Eduarda (34770207500)
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    Fernandes, João C. (35274726800)
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    Filip, Irina (55570061400)
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    Fischer, Florian (55508208800)
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    Ghaseni-Kebria, Fatemeh (55375323600)
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    Ghashghaee, Ahmad (57194174020)
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    Gorini, Giuseppe (56509988200)
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    Hafezi-Nejad, Nima (57216814261)
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    Haj-Mirzaian, Arvin (57210768364)
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    Haj-Mirzaian, Arya (57226201352)
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    Hasanpour-Heidari, Susan (57205330189)
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    Hasanzadeh, Amir (57193162243)
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    Hassanipour, Soheil (57191513993)
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    Hay, Simon I. (7101875313)
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    Hoang, Chi Linh (57205123375)
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    Hostiuc, Mihaela (51763789200)
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    Ilesanmi, Olayinka Stephen (54782692800)
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    Ilic, Milena D. (7102981394)
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    Innos, Kaire (57217314902)
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    Irvani, Seyed Sina Naghibi (57202975543)
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    Islami, Farhad (56926442900)
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    Jaca, Anelisa (57191066193)
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    Jafari Balalami, Nader (57211139609)
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    Jafarinia, Morteza (57194211648)
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    James, Spencer L. (57202557998)
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    Kengne, Andre Pascal (7801322838)
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    Khazaei, Salman (55420466900)
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    Khosravi Shadmani, Fatemeh (55661985900)
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    Kim, Daniel (57223019104)
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    Kisa, Adnan (6603346067)
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    Kocarnik, Jonathan M. (56041211800)
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    Kopec, Jacek A. (7006284395)
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    Kumar, Vivek (57459719500)
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    La Vecchia, Carlo (36063266200)
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    Lopez, Alan D. (7401455668)
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    Lopukhov, Platon D. (57191340780)
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    Majeed, Azeem (7102027801)
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    Mantovani, Lorenzo Giovanni (7006357517)
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    Meier, Toni (36678887300)
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    Mir, Seyed Mostafa (56715133100)
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    Mirzaei, Hamed (37034594600)
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    Mohammad Gholi Mezerji, Naser (57552959000)
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    Mohammadian-Hafshejani, Abdollah (55602206500)
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    Mohammadoo-Khorasani, Milad (56085853400)
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    Mohammed, Shafiu (57838689000)
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    Mohebi, Farnam (55633844600)
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    Mokdad, Ali H. (7004813962)
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    Monasta, Lorenzo (7801520497)
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    Moossavi, Maryam (56176927500)
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    Moradi, Ghobad (48161434000)
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    Moradpour, Farhad (55540661600)
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    Moradzadeh, Rahmatollah (55179399300)
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    Nahvijou, Azin (18837247000)
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    Naik, Gurudatta (56020694000)
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    Najafi, Farid (21743304900)
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    Nazari, Javad (57207759174)
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    Negoi, Ionut (57200640014)
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    Negru, Serban (6602216697)
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    Nguyen, Cuong Tat (56531347200)
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    Nguyen, Trang Huyen (59142352200)
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    Ningrum, Dina Nur Anggraini (57195329470)
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    Ogbo, Felix Akpojene (57200737136)
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    Olagunju, Andrew T. (26029995700)
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    Olagunju, Tinuke O. (57203076824)
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    Pana, Adrian (57191837583)
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    Zhang, Zhi-Jiang (56068578400)
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    Murray, Christopher J L. (55481130700)
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    ;
    Malekzadeh, Reza (7005197760)
    Background: Data about the global, regional, and country-specific variations in the levels and trends of colorectal cancer are required to understand the impact of this disease and the trends in its burden to help policy makers allocate resources. Here we provide a status report on the incidence, mortality, and disability caused by colorectal cancer in 195 countries and territories between 1990 and 2017. Methods: Vital registration, sample vital registration, verbal autopsy, and cancer registry data were used to generate incidence, death, and disability-adjusted life-year (DALY) estimates of colorectal cancer at the global, regional, and national levels. We also determined the association between development levels and colorectal cancer age-standardised DALY rates, and calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. All of the estimates are reported as counts and age-standardised rates per 100 000 person-years, with some estimates also presented by sex and 5-year age groups. Findings: In 2017, there were 1·8 million (95% UI 1·8–1·9) incident cases of colorectal cancer globally, with an age-standardised incidence rate of 23·2 (22·7–23·7) per 100 000 person-years that increased by 9·5% (4·5–13·5) between 1990 and 2017. Globally, colorectal cancer accounted for 896 000 (876 300–915 700) deaths in 2017, with an age-standardised death rate of 11·5 (11·3–11·8) per 100 000 person-years, which decreased between 1990 and 2017 (−13·5% [–18·4 to −10·0]). Colorectal cancer was also responsible for 19·0 million (18·5–19·5) DALYs globally in 2017, with an age-standardised rate of 235·7 (229·7–242·0) DALYs per 100 000 person-years, which decreased between 1990 and 2017 (−14·5% [–20·4 to −10·3]). Slovakia, the Netherlands, and New Zealand had the highest age-standardised incidence rates in 2017. Greenland, Hungary, and Slovakia had the highest age-standardised death rates in 2017. Numbers of incident cases and deaths were higher among males than females up to the ages of 80–84 years, with the highest rates observed in the oldest age group (≥95 years) for both sexes in 2017. There was a non-linear association between the Socio-demographic Index and the Healthcare Access and Quality Index and age-standardised DALY rates. In 2017, the three largest contributors to DALYs at the global level, for both sexes, were diet low in calcium (20·5% [12·9–28·9]), alcohol use (15·2% [12·1–18·3]), and diet low in milk (14·3% [5·1–24·8]). Interpretation: There is substantial global variation in the burden of colorectal cancer. Although the overall colorectal cancer age-standardised death rate has been decreasing at the global level, the increasing age-standardised incidence rate in most countries poses a major public health challenge across the world. The results of this study could be useful for policy makers to carry out cost-effective interventions and to reduce exposure to modifiable risk factors, particularly in countries with high incidence or increasing burden. Funding: Bill & Melinda Gates Foundation. © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

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