GBD 数据库的发文思路及策略

Background Leprosy is a chronic bacterial infection caused by Mycobacterium leprae, which may lead to physical disability, stigma, and discrimination. The chronicity of the disease and disabilities are the prime contributors to the disease burden of leprosy. The current figures of the disease burden in the 2017 global burden of disease study, however, are considered to be under-estimated. In this study, we aimed to systematically review the literature and perform individual patient data meta-analysis to estimate new disability weights for leprosy, using Health-Related Quality of Life (HRQOL) data. Methodology/principal findings The search strategy included all major databases with no restriction on language, setting, study design, or year of publication. Studies on human populations that have been affected by leprosy and recorded the HRQOL with the Short form tool, were included. A consortium was formed with authors who could share the anonymous individual-level data of their study. Mean disability weight estimates, sorted by the grade of leprosy disability as defined by WHO, were estimated for individual participant data and pooled using multivariate random-effects meta-analysis. Eight out of 14 studies from the review were included in the meta-analysis due to the availability of individual-level data (667 individuals). The overall estimated disability weight for grade 2 disability was 0.26 (95%CI: 0.18–0.34). For grade 1 disability the estimated weight was 0.19 (95%CI: 0.13–0.26) and for grade 0 disability it was 0.13 (95%CI: 0.06–0.19). The revised disability weight for grade 2 leprosy disability is four times higher than the published GBD 2017 weights for leprosy and the grade 1 disability weight is nearly twenty times higher. Conclusions/significance The global burden of leprosy is grossly underestimated. Revision of the current disability weights and inclusion of disability caused in individuals with grade 0 leprosy disability will contribute towards a more precise estimation of the global burden of leprosy.

Summary Background Regularly updated data on stroke and its pathological types, including data on their incidence, prevalence, mortality, disability, risk factors, and epidemiological trends, are important for evidence-based stroke care planning and resource allocation. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) aims to provide a standardised and comprehensive measurement of these metrics at global, regional, and national levels. Methods We applied GBD 2019 analytical tools to calculate stroke incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and the population attributable fraction (PAF) of DALYs (with corresponding 95% uncertainty intervals [UIs]) associated with 19 risk factors, for 204 countries and territories from 1990 to 2019. These estimates were provided for ischaemic stroke, intracerebral haemorrhage, subarachnoid haemorrhage, and all strokes combined, and stratified by sex, age group, and World Bank country income level. Findings In 2019, there were 12·2 million (95% UI 11·0–13·6) incident cases of stroke, 101 million (93·2–111) prevalent cases of stroke, 143 million (133–153) DALYs due to stroke, and 6·55 million (6·00–7·02) deaths from stroke. Globally, stroke remained the second-leading cause of death (11·6% [10·8–12·2] of total deaths) and the third-leading cause of death and disability combined (5·7% [5·1–6·2] of total DALYs) in 2019. From 1990 to 2019, the absolute number of incident strokes increased by 70·0% (67·0–73·0), prevalent strokes increased by 85·0% (83·0–88·0), deaths from stroke increased by 43·0% (31·0–55·0), and DALYs due to stroke increased by 32·0% (22·0–42·0). During the same period, age-standardised rates of stroke incidence decreased by 17·0% (15·0–18·0), mortality decreased by 36·0% (31·0–42·0), prevalence decreased by 6·0% (5·0–7·0), and DALYs decreased by 36·0% (31·0–42·0). However, among people younger than 70 years, prevalence rates increased by 22·0% (21·0–24·0) and incidence rates increased by 15·0% (12·0–18·0). In 2019, the age-standardised stroke-related mortality rate was 3·6 (3·5–3·8) times higher in the World Bank low-income group than in the World Bank high-income group, and the age-standardised stroke-related DALY rate was 3·7 (3·5–3·9) times higher in the low-income group than the high-income group. Ischaemic stroke constituted 62·4% of all incident strokes in 2019 (7·63 million [6·57–8·96]), while intracerebral haemorrhage constituted 27·9% (3·41 million [2·97–3·91]) and subarachnoid haemorrhage constituted 9·7% (1·18 million [1·01–1·39]). In 2019, the five leading risk factors for stroke were high systolic blood pressure (contributing to 79·6 million [67·7–90·8] DALYs or 55·5% [48·2–62·0] of total stroke DALYs), high body-mass index (34·9 million [22·3–48·6] DALYs or 24·3% [15·7–33·2]), high fasting plasma glucose (28·9 million [19·8–41·5] DALYs or 20·2% [13·8–29·1]), ambient particulate matter pollution (28·7 million [23·4–33·4] DALYs or 20·1% [16·6–23·0]), and smoking (25·3 million [22·6–28·2] DALYs or 17·6% [16·4–19·0]). Interpretation The annual number of strokes and deaths due to stroke increased substantially from 1990 to 2019, despite substantial reductions in age-standardised rates, particularly among people older than 70 years. The highest age-standardised stroke-related mortality and DALY rates were in the World Bank low-income group. The fastest-growing risk factor for stroke between 1990 and 2019 was high body-mass index. Without urgent implementation of effective primary prevention strategies, the stroke burden will probably continue to grow across the world, particularly in low-income countries. Funding Bill & Melinda Gates Foundation.

Summary 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.

Summary 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.

Summary Background Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. Methods Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. Findings In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. Interpretation Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers. Funding Bill & Melinda Gates Foundation.

BACKGROUND Kidney failure with replacement therapy (KFRT) such as dialysis or transplantation represents a severe stage of chronic kidney disease (CKD) and poses a major global health burden. Although many CKD cases are diagnosed in the earlier stages, the greatest risk occurs when CKD progresses to KFRT. Despite its considerable financial and imposing impact on public health, there is a notable gap in international policies addressing CKD and KFRT. To bridge this gap and help policy makers and health systems effectively tackle the public health challenge of KFRT, a better understanding of the disease burden is essential. Thus, this analysis aims to provide a detailed overview of the global prevalence of KFRT and its associated aetiologies with estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2023. METHODS This study defined KFRT as individuals on maintenance dialysis for 90 days or more or those who have undergone a kidney transplant, aligning with the Kidney Disease: Improving Global Outcomes (KDIGO) 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Renal registries served as the primary data sources. Prevalence and underlying aetiology estimates (type 1 diabetes, type 2 diabetes, hypertension, glomerulonephritis, and other causes) were generated with DisMod-MR 2.1, an epidemiological Bayesian mixed-effects meta-regression modelling tool. Both all-age and age-standardised estimates were reported and accompanied with 95% uncertainty intervals (UIs). FINDINGS In 2023, the number of global cases of KFRT was 4·59 million (95% UI 4·17-5·08) for both sexes and all ages, with an age-standardised prevalence of 50·7 (46·1-56·0) per 100 000 population. Over the past three decades, there has been a steady increase in KFRT prevalence globally. The highest prevalence was found in the GBD high-income regions, while the lowest was observed in sub-Saharan Africa. KFRT prevalence was generally higher in countries classified within the World Bank's high-income and upper-middle-income groups, while lower prevalence was more common in countries within the World Bank's low-income and lower-middle-income groups. Additionally, a pronounced sex disparity was identified, where male dialysis and transplant prevalence estimates were consistently higher than those for females in most countries. Type 2 diabetes and hypertension were among the leading associated aetiologies of KFRT globally. From 1990 to 2023, the all-age and age-standardised prevalence estimates across the ascribed aetiologies increased for KFRT, with the largest increases associated with type 2 diabetes and hypertension. INTERPRETATION KFRT affects approximately 5 million people globally, with high treatment and mortality costs. Our study unveiled considerable geographical variation in KFRT prevalence, which should be seen as indicators of health-care system opportunities. As the prevalence of the leading aetiologies of KFRT-type 2 diabetes and hypertension-continues to rise, there is a crucial need to prioritise the development and implementation of cost-effective strategies aimed at preventing CKD and its progression to KFRT, particularly in low-resource settings. These preventive efforts must happen in tandem with efforts to expand capacity for dialysis and transplant services. FUNDING Gates Foundation.

Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. Funding Bill & Melinda Gates Foundation.

We aimed to quantify the risk, mortality, and burden of suicide among autistic persons. We searched PubMed, Embase, and PsycINFO on 5th April 2023 for sources reporting the relative risk (RR) of suicide or suicide attempt among autistic persons (PROSPERO registration: CRD42021265313). Autism spectrum prevalence and suicide mortality and years of life lost (YLLs), were sourced from the Global Burden of Disease Study 2021. RRs pooled via meta-regression and health metrics estimates were used to estimate the excess suicide mortality and YLLs among autistic persons. We sourced 983 unique studies of which ten studies met inclusion criteria, consisting of 10.4 million persons. The pooled RR for suicide for autistic persons was 2·85 (95% UI: 2·05-4·03), which was significantly higher for autistic females than autistic males. No evidence of publication bias was detected via inspection of funnel plot and Egger's test. Globally, we estimated 13 400 excess suicide deaths among autistic persons in 2021, equating to 1·8% of all suicide deaths and 621 000 excess YLLs. Studies were limited in number and geographical coverage. Effective suicide prevention strategies for autistic persons may substantially reduce the fatal burden of suicides globally and reduce the health burden experienced within this population.

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

Background Inflammatory bowel disease (IBD) epidemiology has changed rapidly in recent years. We aimed to provide a systematic report of the burden of IBD at a state level in the United States (US), and to study the age- and sex-specific trends of incidence, prevalence and mortality rates for the past 3 decades. Methods Using the Global Burden of Disease (GBD) 2019 Study Database, we examined the incidence, prevalence and mortality rate, and the disability-adjusted life-years from GBD 2019 at national and state level from 1990-2019. Results There was an overall decrease in incidence and prevalence rates of IBD in the US from 1990-2019, while a simultaneous increase in the overall mortality rates was identified. However, a distinct trend of increasing incidence and prevalence rates emerged starting in 2000, with incidence rates rising from 21 cases per 100,000 persons in 2000 to 23 cases per 100,000 persons in 2019. From 1990-2019, incidence and prevalence decreased in males at a higher rate than in females. However, mortality rates increased more in females than males. Incidence rates were highest in Midwestern and Eastern states, and were lowest across the northern Great Plains and Western states, with the highest incidence noted in Michigan (31 cases per 100,000 persons). California had the greatest decrease in incidence rates from 1990-2019 (-63.3%). Conclusion Our results concerning recent trends and geographic variations in IBD offer policymakers crucial insights for informed decision-making in policy, research, and investment, facilitating more effective strategies and allocation of resources.

Summary Background The mental disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, eating disorders, idiopathic developmental intellectual disability, and a residual category of other mental disorders. We aimed to measure the global, regional, and national prevalence, disability-adjusted life-years (DALYS), years lived with disability (YLDs), and years of life lost (YLLs) for mental disorders from 1990 to 2019. Methods In this study, we assessed prevalence and burden estimates from GBD 2019 for 12 mental disorders, males and females, 23 age groups, 204 countries and territories, between 1990 and 2019. DALYs were estimated as the sum of YLDs and YLLs to premature mortality. We systematically reviewed PsycINFO, Embase, PubMed, and the Global Health Data Exchange to obtain data on prevalence, incidence, remission, duration, severity, and excess mortality for each mental disorder. These data informed a Bayesian meta-regression analysis to estimate prevalence by disorder, age, sex, year, and location. Prevalence was multiplied by corresponding disability weights to estimate YLDs. Cause-specific deaths were compiled from mortality surveillance databases. The Cause of Death Ensemble modelling strategy was used to estimate death rate by age, sex, year, and location. The death rates were multiplied by the years of life expected to be remaining at death based on a normative life expectancy to estimate YLLs. Deaths and YLLs could be calculated only for anorexia nervosa and bulimia nervosa, since these were the only mental disorders identified as underlying causes of death in GBD 2019. Findings Between 1990 and 2019, the global number of DALYs due to mental disorders increased from 80·8 million (95% uncertainty interval [UI] 59·5–105·9) to 125·3 million (93·0–163·2), and the proportion of global DALYs attributed to mental disorders increased from 3·1% (95% UI 2·4–3·9) to 4·9% (3·9–6·1). Age-standardised DALY rates remained largely consistent between 1990 (1581·2 DALYs [1170·9–2061·4] per 100 000 people) and 2019 (1566·2 DALYs [1160·1–2042·8] per 100 000 people). YLDs contributed to most of the mental disorder burden, with 125·3 million YLDs (95% UI 93·0–163·2; 14·6% [12·2–16·8] of global YLDs) in 2019 attributable to mental disorders. Eating disorders accounted for 17 361·5 YLLs (95% UI 15 518·5–21 459·8). Globally, the age-standardised DALY rate for mental disorders was 1426·5 (95% UI 1056·4–1869·5) per 100 000 population among males and 1703·3 (1261·5–2237·8) per 100 000 population among females. Age-standardised DALY rates were highest in Australasia, Tropical Latin America, and high-income North America. Interpretation GBD 2019 showed that mental disorders remained among the top ten leading causes of burden worldwide, with no evidence of global reduction in the burden since 1990. The estimated YLLs for mental disorders were extremely low and do not reflect premature mortality in individuals with mental disorders. Research to establish causal pathways between mental disorders and other fatal health outcomes is recommended so that this may be addressed within the GBD study. To reduce the burden of mental disorders, coordinated delivery of effective prevention and treatment programmes by governments and the global health community is imperative. Funding Bill & Melinda Gates Foundation, Australian National Health and Medical Research Council, Queensland Department of Health, Australia.

Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. Findings We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4–19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30–2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35–2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20–30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. Funding Bill & Melinda Gates Foundation.

The study aimed to offer detailed insights into the global, regional, and national burden of IE in 2021, while also examining the temporal trends of IE from 1990 to 2021. Data on the absolute numbers and age-standardized rates (ASR) of incidence, deaths, and disability-adjusted life years (DALYs) related to IE were sourced from the Global Burden of Disease Study (GBD) 2021. The estimated annual percentage changes (EAPC) of ASR were calculated to quantify the temporal trends. Furthermore, joinpoint regression models were used to identify the temporal trends and the primary joinpoint year of ASR. Globally, the age-standardized incidence rate (ASIR) for IE increased with an EAPC of 1.00 (95%CI: 0.93–1.08) from 9.35 per 100 000 population in 1990 to 12.61 per 100 000 population in 2021. Despite a rise in the absolute number of death cases and DALYs related to IE, the age-standardized mortality rate (ASMR) has remained stable (EAPC 0.06, 95%CI: -0.10-0.22), and the age-standardized DALYs rate (ASDR) has exhibited a decline (EAPC − 0.34, 95%CI: -0.45–0.24) between 1990 and 2021. Males bore a higher burden of IE compared to females, with the peak burden gradually shifting towards older individuals. In 2021, the ASIR for IE exhibited an increase with the rise in socio-demographic index (SDI) quintiles, with the highest ASIR observed in the high SDI region (15.77 per 100 000 population). Moreover, the highest growth rates of ASIR, ASMR, and ASDR were also noted in the high SDI region. On the other hand, the ASMR (1.34 per 100 000 population) and ASDR (40.71 per 100 000 population) for IE were relatively high in the low SDI region. Joinpoint analysis demonstrated that the ASIR, ASMR, and ASDR did not experience any sudden surges either globally or across different SDI regions after 2007. The burden of IE remained relatively high, characterized by a rising ASIR and a stable ASMR on a global scale. This burden was notably prominent among males, the elderly, and in the high and low SDI regions. Region-specific prevention and management strategies might be warranted to reduce the burden of IE.

Background Dementia is a syndrome characterized by a decline in cognitive function, with Alzheimer's disease (AD) being the most common type. Updated global statistics on the burden of AD and other dementias provide critical insights for guiding prevention and treatment strategies. Objective To estimate the global, regional, and national burden and attributable risk factors of AD and other dementias from 1990 to 2021. Methods This cross-sectional study utilized the 2021 Global Burden of Disease (GBD) dataset from 204 countries and territories. The analysis focused on individuals aged 40 years and older with AD and other dementias and included data on incidence, all-cause and cause-specific mortality, disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs). These trends were stratified by region, country, age, sex, and Socio-Demographic Index (SDI). Results From 1990 to 2021, global DALYs attributable to AD and other dementias rose from 3.83 million to 9.84 million. Age-standardized rates (ASRs) of incidence and DALYs increased for both sexes, with a more pronounced rise in males. ASRs for incidence, prevalence, and DALYs were positively correlated with SDI. Smoking was identified as the primary risk factor for dementia burden among males, whereas obesity was the leading risk factor for females. Conclusions The global burden of AD and other dementias has significantly increased from 1990 to 2021, especially in high-SDI regions. While females have a higher overall risk, the burden has grown more rapidly in males. These findings highlight the need for targeted interventions to address aging populations and reduce dementia risk factors.

Background: The incidence of non-rheumatic valvular heart diseases (NRVHD) has shown an increasing trend. However, most studies have overlooked the impact of gender on the disease. Female patients, as a specific subgroup, have rarely been discussed independently. It is essential to conduct separate epidemiological studies to understand the latest epidemiological data for female NRVHD patients and to raise awareness among researchers and clinicians. Methods: Data from the Global Burden of Disease (GBD) 2021 database were retrieved to obtain epidemiological data on female NRVHD from both global and regional perspectives, covering 204 countries and territories. Joinpoint regression, age-period-cohort analysis, decomposition, and predictive analyses were employed to further examine the epidemiological data. Results: The incidence of female NRVHD patients has shown a continuous upward trend and is expected to persist in the future, particularly in regions with high and high-middle Socio-Demographic Index (SDI). However, in low and lower-middle SDI regions, patients experience relatively higher Disability-Adjusted Life Years (DALYs) and Years Lived with Disability (YLDs), with a greater number of heart failure cases attributed to NRVHD. Decomposition analysis indicates that the increase in the incidence of NRVHD and its subtypes is primarily driven by population growth and aging. Conclusions: With economic development and population aging, female NRVHD remains a significant healthcare burden for countries worldwide. Low- and middle-SDI regions should implement tertiary prevention strategies to address the impending shift in the spectrum of valvular heart diseases. Further clinical research should focus on female patients as a distinct subgroup of NRVHD, exploring the unique aspects of the disease in this population.

While gastric cancer is generally declining globally, the temporal trend of young-onset (< 40 years) gastric cancer remains uncertain. We performed this analysis to determine the temporal trends of young-onset gastric cancer compared to late-onset cancer (≥ 40 years). We extracted cross-sectional data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The burden of gastric cancer from 1990 to 2019 was assessed through indicators including incidence and mortality rates, which were classified at global, national, and regional levels, and according to socio-demographic indexes (SDI) and age or sex groups. Joinpoint regression analysis was used to identify specific years with significant changes. The correlation between AAPC with countries' average SDI was tested by Pearson’s Test. The global incidence rate of young-onset gastric cancer decreased from 2.20 (per 100,000) in 1990 to 1.65 in 2019 (AAPC: − 0.95; 95% confidence interval [CI] − 1.25 to − 0.65; P < 0.001). Late-onset cancer incidence also decreased from 59.53 (per 100,000) in 1990 to 41.26 in 2019 (AAPC: − 1.23; 95% CI − 1.39 to − 1.06, P < 0.001). Despite an overall decreasing trend, the incidence rate of young-onset cancer demonstrated a significant increase from 2015 to 2019 (annual percentage change [APC]: 1.39; 95% CI 0.06 to 2.74; P = 0.041), whereas no upward trend was observed in late-onset cancer. Mortality rates of young- and late-onset cancer both exhibited a significant decline during this period (AAPC: − 1.82; 95% CI − 2.15 to − 1.56; P < 0.001 and AAPC: − 1.69, 95% CI − 1.79 to − 1.59; P < 0.001). The male-to-female rate ratio for incidence and mortality in both age groups have been increasing since 1990. While countries with high SDI have had a greater decline in the incidence of late-onset gastric cancer (slope of AAPC change: − 0.20, P = 0.004), it was not observed in young-onset cancer (slope of AAPC change: − 0.11, P = 0.13). The global incidence and mortality rates of both young- and late-onset gastric cancer have decreased since 1990. However, the incidence rate of young-onset cancer has demonstrated a small but significant upward trend since 2015. There was disparity in the decline in young-onset gastric cancer among male and high SDI countries. These findings could help to inform future strategies in preventing gastric cancer in younger individuals.

Background & aims The global incidence of inflammatory bowel disease (IBD) has markedly increased over past several decades. Gender-specific differences have been observed in the epidemiology, manifestation, and prognosis of IBD. Given these distinctions, a focused analysis of the latest epidemiological trends in female patients is essential for advancing targeted healthcare. Methods A comprehensive analysis of IBD incidence, mortality, and disability-adjusted life years (DALYs) in females was performed using data from the Global Burden of Disease (GBD) study from 1990 to 2021, with stratifications by age, region, country, and sociodemographic index (SDI). Results In 2021, approximately 187,134 females were diagnosed with IBD globally. Incidence rates were highest among females aged 30–60, with disease burden increasing significantly with age in older populations. Geographically, High-Income North America had the highest IBD burden in females in 2021, while Australasia experienced the most significant increase from 1990 to 2021 (estimated average percentage changes (EAPC) = 1.13, 95% CI 0.8–1.46). Nationally, 75 countries and territories showed upward trends in the age-standardized DALYs (disability-adjusted life years) rate (ASDR), with the steepest rise observed in Mauritius (EAPC = 2.28, 95% CI 0.82–3.76). DALYs due to IBD in females also increased across all SDI regions, showing a positive correlation between SDI and ASDR. Conclusions The global burden of IBD in females has significantly risen from 1990 to 2021, with marked age, regional and SDI-based differences. Incidence rates are higher in high-income regions in Europe and North America, with the sharpest increases observed in East Asia, highlighting the need for age and region-specific IBD management strategies.

Objective Endometriosis (EMT) is a prevalent gynecological disorder characterized by chronic pain, menstrual irregularities, and infertility. This study aims to evaluate the global burden of EMT from 1990 to 2021 and to project trends up to 2050. Methods Data from the Global Burden of Disease (GBD) 2021 database were utilized to analyze mortality, incidence, prevalence, and disability-adjusted life years (DALYs). Trends were assessed using age-standardized rates (ASR) and estimated annual percentage change (EAPC). Future burdens were projected using ARIMA and exponential smoothing models. Results In 2021, there were 3,447,126 new cases of EMT reported globally. The age-standardized incidence rate (ASIR) experienced a decline of 1.07% from 1990 to 2021, while the age-standardized prevalence rate (ASPR) decreased by 0.95%. The incidence of EMT peaked among women aged 20–24 years, whereas mortality rates increased with advancing age. Projections suggest that by 2050, EMT-related deaths will rise to 68 cases, and the number of disability-adjusted life years (DALYs) will increase to 2,260,948, despite ongoing declines in both ASIR and ASPR. Conclusion Although the incidence and prevalence rates of EMT are declining, the disease burden remains significant among women of reproductive age. The anticipated rise in mortality and disability-adjusted life years (DALYs) in the future underscores the necessity for targeted public health policies. This study provides evidence to inform global prevention strategies. Future research should investigate the effects of population aging and lifestyle changes on the burden of EMT.

Background Gastroesophageal reflux disease (GERD) is a common chronic digestive disorder characterized by the reflux of gastroduodenal contents into the esophagus, causing uncomfortable symptoms and potential tissue damage. It affects over 1 billion people worldwide, imposing substantial economic and health burdens. Notably, women of childbearing age face unique challenges due to hormonal fluctuations, pregnancy, and gender-specific social roles, yet systematic global analyses of GERD burden in this population remain scarce. Methods This study evaluated the global, regional, and national burden of GERD among WCBA from 1990 to 2021 and projected trends through 2050. Data were sourced from the 2021 Global Burden of Disease (GBD) study, including incidence, prevalence, years lived with disability (YLDs), and their age-standardized rates. Temporal trends were analyzed using joinpoint regression (average annual percentage change, AAPC), and future projections were generated via Bayesian age-period-cohort models. Associations with the Socio-demographic Index (SDI) were explored. Results Globally, the number of incident and prevalent GERD cases among WCBA increased by 64.09% and 66.44% from 1990 to 2021, reaching almost 99.1 million and 245.2 million in 2021, respectively. The AAPCs for age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized YLD rate (ASYR) were 0.24, 0.23, and 0.23, respectively. Regionally, South Asia had the highest absolute burden, while Tropical Latin America had the highest ASRs. Nationally, the Republic of India reported the highest incidence, the People's Republic of China the highest prevalence, Brazil the highest ASRs, and Norway the lowest. SDI was negatively correlated with GERD burden, with the most notable upward trends in middle SDI regions. By age, burden increased with age and peaked in the 25–29 years group. Joinpoint analysis showed accelerated growth post-2011. Projections to 2,050 forecast continued rises in incidence, prevalence, and ASRs. Conclusion The global GERD burden among WCBA is increasing, with marked regional, national, and SDI-related disparities. Physiological characteristics, lifestyle changes, and healthcare accessibility are key drivers. Targeted interventions such as strengthening primary care, lifestyle guidance, and region-specific policies are critical to mitigate risks. This study fills a research gap, providing evidence to inform global strategies for GERD prevention and management in this population.

Abstract Background Estonia, a small country defined by NUTS2 regions, faces challenges in assessing health disparities across its different counties when using global health data such as the Global Burden of Disease (GBD). Recognizing this limitation, Estonia initiated independent burden of disease studies in Estonia since 2013, with the findings being biennially published through the health statistics database of the National Institute for Health Development. The objective of this research is to assess the strengths and limitations inherent in various methods when calculating the years of life lost due to premature mortality (YLLs). Methods The approach to assess the burden of disease in Estonia differs somewhat from the Global Burden of Disease (GBD) methodology. One key distinction lies in our utilization of a national life expectancy table and our presentation of results at the LAU1 regional level. These burden of disease studies utilize region-specific life tables supplied by Statistics Estonia, categorized by county and gender, to compute Years of Life Lost (YLLs), offering an opportunity to pinpoint and tackle regional health issues. Results Since the calculation of YLL (Years of Life Lost) in these past studies has relied upon Estonia’s regionalized life tables, categorized by county and gender, the results exhibit substantial disparities when juxtaposed with the Global Burden of Disease study conducted by the Institute for Health Metrics and Evaluation (IHME). Conclusions This research aims to delve deeper into these variations, examining the challenges related to methodology, the availability, and the quality of data, and most importantly, knowledge translation. Our own burden of disease studies empowers us to formulate informed policy recommendations precisely tailored to the distinctive needs of each county, thereby facilitating targeted interventions, and driving improvements in overall public health outcomes.

Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is key for policy making. Low back pain is the leading cause of disability in terms of years lived with disability (YLDs). Due to sparse data, a current limitation of GDB is that a uniform severity distribution is presumed based on 12-Item Short Form Health Survey scores derived from US Medical Expenditure Panel Surveys (MEPS). We present a novel approach to estimate the effect of exposure to health interventions on the severity of low back pain by country and over time. Methods We extracted treatment effects for ten low back pain interventions from the Cochrane Database, combining these with coverage data from the MEPS to estimate the hypothetical severity in the absence of treatment in the USA. Severity across countries was then graded using the Health Access and Quality Index, allowing estimates of averted and avoidable burden under various treatment scenarios. Findings We included 210 trials from 36 Cochrane systematic reviews in the network analysis. The pooled effect sizes (measured as a standardised mean difference) for the most effective intervention classes were –0·460 (95% uncertainty interval –0·606 to –0·309) for a combination of psychological and physical interventions and –0·366 (–0·525 to –0·207) for surgery. Globally, access to treatment averted an estimated 17·6% (14·8 to 23·8) of the low back pain burden in 2020. If all countries had provided access to treatment at a level estimated for Iceland with the highest Health Access and Quality Index score, an extra 9·1% (6·4 to 11·2) of the burden of low back pain could be avoided. Even with full coverage of optimal treatment, a large proportion (65·9% [56·9 to 70·4]) of the low back pain burden is unavoidable. Interpretation This methodology fills an important shortcoming in the GBD by accounting for low back pain severity variations over time and between countries. Assumptions of unequal treatment access increased YLD estimates in resource-poor settings, with a modest decrease in countries with higher Health Access and Quality Index scores. Nonetheless, the large proportion of unavoidable burden indicates poor intervention efficacy. This method, applicable to other GBD conditions, provides policy makers with insights into health gains from improved treatment and underscores the importance of investing in research for new interventions. Funding Bill and Melinda Gates Foundation and Queensland Health.

Summary Background GLOBOCAN 2020 and Global Burden of Disease (GBD) 2019 are the two most established global online cancer databases. It is important to examine the differences between the two platforms, to attempt to explain these differences, and to appraise the quality of the data. There are stark differences for lip and oral cancers (LOC) and we attempt to explain these by detailed analysis of ten countries at the extremes of differences. Methods Age-standardised incidence rates (ASIR) of LOC were obtained from GLOBOCAN 2020 and GBD 2019. Five countries with the greatest and smallest fold differences were selected. A systematic search of PubMed and Embase electronic databases was then performed to identify publications reporting the incidence of LOC in the selected countries between 2015 and 2022. Specifically, data sources of the articles were examined and evaluated. Findings For LOC, greatest differences were found in Papua New Guinea, Vietnam, China, Pakistan, and Indonesia (group A). In contrast, the United States of America (USA), Brazil, France, Germany, and India (group B) had the least differences between the two databases. Interpretation It is not surprising that when GLOBOCAN and GBD could not obtain high-quality or accessible LOC data from national or local cancer registries, as in group A, discrepancies would be seen between the two online databases. In contrast, where only minor differences were seen between GLOBOCAN and GBD, as in group B, presumptively due to those countries having well-established cancer registries and healthcare administrative systems, the literature is more consistent. Moreover, many studies have grouped lip and oral cavity with pharynx and categorised outputs as “oral and oropharyngeal cancer” or “oral cavity and pharynx cancer”. Those categorisations lacked subsite accuracy and failed to realise that oral cancer and oropharyngeal cancer have completely different etiological factors, pathogeneses, prognosis, and treatment outcomes. Funding This research received no specific grant or funding from any funding agency in the public, commercial, or not-for-profit sectors, and the authors received no financial support for the research, authorship, and/or publication of this article.

This epidemiological study leverages data from the Global Burden of Disease (GBD) database spanning from 1990 to 2021 to analyze the global burden of oral cancer. The research aims to provide a comprehensive assessment of the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASDR), and disability-adjusted life years (DALYs) for oral cancer, examining trends over three decades. The study used age standardized rate (ASRs) as an indicator of oral cancer epidemiological data. Trend analysis uses estimated annual percentage change (EAPC) to track changes in oral cancer indicators. The study identifies a global increase in oral cancer incidence, mortality, and DALYs. From 1990 to 2021, the global incidence rate increased significantly from 3.26 (95% UI 3.14–3.41) to 5.34 (95% UI 4.94–5.70), the global mortality rate rose from 1.83 (95% UI 1.73–1.92) to 2.64 (95% UI 2.42–2.84), and the global estimate of DALYs increased from 55.05 (95% UI 52.38–57.97) to 74.44 (95% UI 67.50–80.44). High-risk regions include Palau and certain areas in Asia. Middle SDI regions show the most significant growth, while economically underdeveloped areas like parts of Africa show less significant trends. The research underscores the need for heightened awareness, surveillance, and prevention efforts, especially in regions with high oral cancer incidence. Policymakers are urged to implement screening programs and public health education to combat the disease.

Multidrug-resistant tuberculosis (MDR-TB) has become a major global public health issue, which has worsened over time owing to changes in disease-related trends. This study aimed to determine global trends in MDR-TB among children and adolescents for strategic health planning. A secondary analysis was performed on MDR-TB burden among children and adolescents (<20 years) at the global, regional, and national levels based on sociodemographic index (SDI) quintiles from 1990 to 2019, using the Global Burden of Disease (GBD) 2019 database. In 2019, 67,710.82 (95% uncertainty interval [UI]: 38,823.61 to 110,582.03) incidents of MDR-TB were reported among children and adolescents aged <20 years worldwide. The global incidence rate has increased from 1990 to 2019, with the estimated annual percentage change (EAPC) at 4.15% (95% UI: 1.10–12.19%), particularly in low- and low-middle SDI regions. The top three highest incidence rates were observed in Southern sub-Saharan Africa, Eastern Europe, and South Asia. The mortality and disability-adjusted life years (DALYs) rates (0.62 [95% UI: 0.28–1.14] and 55.19 [95% UI: 25.24–100.74] cases per 100,000, respectively) were higher among children aged <5 years than those in older age groups in 2019. The global burden of MDR-TB among children and adolescents has increased from 1990 to 2019, particularly in regions with lower SDI. Extensive collaborative research and interventions are needed to mitigate this disease burden to secure the health of our future generation. MDR-TB disease burden in children and adolescents using GBD 2019 database was analyzed. In total, 67710.82 MDR-TB cases were identified in children and adolescents in 2019. Global MDR-TB burden in children and adolescents has risen over the past 30 years. MDR-TB disease burden is negatively correlated with the sociodemographic index. MDR-TB disease burden varies across countries and age groups. MDR-TB disease burden in children and adolescents using GBD 2019 database was analyzed. In total, 67710.82 MDR-TB cases were identified in children and adolescents in 2019. Global MDR-TB burden in children and adolescents has risen over the past 30 years. MDR-TB disease burden is negatively correlated with the sociodemographic index. MDR-TB disease burden varies across countries and age groups.

Background Recurrent headaches in headache disorders adversely impact quality of life and job. Migraines and tension-type headache TTH) are the most common primary headaches and a prominent cause of disability globally. However, few research compare headache illness burden in China, India, the United States (US), and Japan. Methods Global and Chinese, the US, Indian, and Japanese migraine and TTH incidence, prevalence, and disability-adjusted life years were taken from the GBD database for 1990–2021. The data is studied utilizing decomposition analysis, health inequality research, joinpoint regression model, and Bayesian Average Annual Percentage Change (BAPC) model. Results The study found that migraine mostly affects women aged 15–49, while TTH are evenly distributed across gender and age. The worldwide average annual percentage change (AAPC) in disease-adjusted life years (DALYs) for migraine and TTH from 1990 to 2021 was 0.0357, a statistically significant trend (p < 0.001), as determined using joinpoint analysis. China exhibited the quickest rise in migraine and TTH incidence and prevalence, as well as the age-standardized rate (ASR) of DALYs, of the four nations analyzed. The US had the highest value of these indicators. Forecasting models reveal that without policy action, migraine prevalence will grow but TTH prevalence would stay unchanged. Decomposition research showed that population expansion is the major cause of migraines and TTH, which will be slightly alleviated by population aging. Health disparities across economic growth areas lessened between 1990 and 2021, according to the report. Conclusion Globally and in China, migraine and TTH incidence and burden have increased since 1990. Migraines are becoming more common in young and middle-aged women, so headache treatment professionals should invest more in patient education to raise awareness and improve self-management to reduce disease burden and medical costs.

Objectives We aimed to provide the most updated estimates on the global burden of inflammatory bowel disease (IBD) to improve management strategies. Design We extracted data from the Global Burden of Disease (GBD) 2019 database to evaluate IBD burden with different measures in 204 countries and territories from 1990 to 2019. Setting Studies from the GBD 2019 database generated by population-representative data sources identified through a literature review and research collaborations were included. Participants Patients with an IBD diagnosis. Outcomes Total numbers, age-standardised rates of prevalence, mortality and disability-adjusted life-years (DALYs), and their estimated annual percentage changes (EAPCs) were the main outcomes. Results In 2019, there were approximately 4.9 million cases of IBD worldwide, with China and the USA having the highest number of cases (911 405 and 762 890 (66.9 and 245.3 cases per 100 000 people, respectively)). Between 1990 and 2019, the global age-standardised rates of prevalence, deaths and DALYs decreased (EAPCs=−0.66,–0.69 and −1.04, respectively). However, the age-standardised prevalence rate increased in 13 out of 21 GBD regions. A total of 147 out of 204 countries or territories experienced an increase in the age-standardised prevalence rate. From 1990 to 2019, IBD prevalent cases, deaths and DALYs were higher among females than among males. A higher Socio-demographic Index was associated with higher age-standardised prevalence rates. Conclusions IBD will continue to be a major public health burden due to increasing numbers of prevalent cases, deaths and DALYs. The epidemiological trends and disease burden of IBD have changed dramatically at the regional and national levels, so understanding these changes would be beneficial for policy makers to tackle IBD.

Objective Building on established evidence linking excess body fatness to increased risk of ovarian cancer, this research aims to assess the global and regional disease burden of ovarian cancer attributable to high body mass index (BMI) from 1990 to 2021 using data from the Global Burden of Disease (GBD) study. Here, we specifically focus on quantifying trends in age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life year rates (ASDR) to elucidate evolving epidemiological patterns and regional disparities. Methods Comprehensive data were extracted from the GBD 2021 database to analyze trends in ASMR, ASDR, absolute deaths, and disability-adjusted life years (DALYs) attributable to high BMI-related ovarian cancer from 1990 to 2021, stratified by global, regional, and socio-demographic index (SDI) quintiles. The key methodological approaches included Joinpoint regression analysis to identify significant temporal changes in ASMR and ASDR trends and correlation analysis to determine associations between disease burden (ASMR/ASDR) and SDI. Additionally, future projections for ASMR and ASDR burdens from 2022 to 2050 were generated using a Bayesian Age-Period-Cohort (BAPC) framework, accounting for demographic shifts and inherent uncertainties. Results Between 1990 and 2021, global ASMR and ASDR for ovarian cancer attributable to high BMI remained relatively stable. However, the absolute number of deaths and DALYs increased substantially over this period. ASMR and ASDR exhibited a strong positive correlation with SDI, with the highest burden observed in regions with SDI values between 0.7 and 0.8. While high-SDI regions experienced the greatest burden in both 1990 and 2021, an overall declining trend was observed. Conversely, regions across other SDI quintiles exhibited an increasing burden. BAPC projections suggest a continued global increase in the ovarian cancer burden attributable to high BMI, with global ASMR projected to reach 1.64 (95% uncertainty level (UI): 1.35–1.93) and ASDR to reach 54.63 (95% UI: 45.41–63.84) by 2050. Conclusion This study highlights persistent and significant regional disparities in the ovarian cancer burden attributable to high BMI, strongly associated with SDI, and projects a concerning increase in the future global burden. Our collective findings underscore the urgent need for targeted and proactive interventions to mitigate the impact of high BMI on ovarian cancer outcomes worldwide.

Objectives The burden of chronic kidney disease (CKD) is increasing globally, with significant variations in disease levels and trends across different countries and regions. Currently, despite a wealth of research reporting data on adult and paediatric populations, there has been a lack of in-depth focus on the burden of CKD in adolescents and young adults (AYA). We aim to assess the global prevalence of CKD among AYA. Design We implemented a cross-sectional study. Data sources A systematic retrieval of data was conducted from the Global Burden of Disease (GBD) database, primarily using the most recent updated information from 2021. Data extraction and synthesis We used GBD data and methodologies to characterise the changes in CKD burden among AYA, including incidence rates, death rates and disability-adjusted life years (DALYs). Additionally, we employed decomposition analysis, frontier analysis and health inequality analysis to investigate the prevalence of CKD in countries or regions with varying levels of socioeconomic development. Results On a global scale, between 1990 and 2021, the number of AYA with CKD increased from 232025.4 (95% UI 153243.5–323838.5) in 1990 to 387070.1 (95% UI 287311.6–508428.3) in 2021. For AYA, the primary causes of CKD are other and unspecified causes (congenital anomalies of the kidney and urinary tract, etc), followed by glomerulonephritis. Over the past 30 years, the decline in CKD burden among AYA has been most significant in countries like China, Japan, South Korea, Spain, Portugal, Russia, France and Italy. In contrast, the countries or regions with the fastest-growing CKD burden are Somalia, Mozambique, Chad, Uganda, Niger and Angola in sub-Saharan Africa, followed by Afghanistan, Saudi Arabia, Yemen, Iraq and Pakistan in the Middle East or South Asia. Despite improvements over the decades, the burden of CKD among AYA remains concentrated in low-income countries and populations with poorer economic conditions. Conclusion From 1990 to 2021, the death and DALYs burden of CKD among AYA globally remained relatively stable, but the incidence rate is steadily increasing. AYA in sub-Saharan Africa, the Middle East and parts of South Asia tolerate the highest burden, particularly in countries with lower socioeconomic status. To prevent worsening inequalities associated with socioeconomic development, there is an emphasis on the importance of increasing investments in kidney health for AYA in low-income countries.

Introduction: The success of cardiac surgical techniques and progress of interventional therapies prolonged the life expectancy patients with congenital heart anomalies (CHA). Reduction of mortality and extension of lifespan exacerbated the burden of non-fatal comorbidities. Developmental intellectual disability (DID) is the most substantial non-fatal comorbidities of pediatric patients with CHA. However, no epidemiological study describe the global burden of DID attributable to CHA (DID-CHA). Research Question: What was the global burden, regional inequality, and age specific discrepancy of DID-CHA? Goal: The aim of this study is to address the gap of lacking epidemiological data of global burden, regional inequality, and age discrepancy of DID-CHA. Methods: This was a secondary analysis study by utilizing impairment data of GBD study 2021. Data was collected from the website of Institute for Health Metrics and Evaluation (IHME, query tool: https://ghdx.healthdata.org/gbd-2021 ). The prevalence, disability adjusted life years (DALYs), and their calculayted annual percentage changes (EAPC) across global, both sexes, seven regions, five SDI regions, and 204 countries and territories from 1990 to 2021 were investigated. Results: In 2021, the global number of DID-CHA cases was 1.05 million (95% UI: 0.83 to 1.24 million) with an age-standardized prevalence rates of 15.71 per 100,000 (95% UI: 12.36 to 18.58). From 1990 to 2021, the EAPC of prevalence was -0.15 (95% CI: -0.16 to -0.13). Regional inequality of disease burden of DID-CHA remained prevalent worldwide. Pediatric population, especially neonates and infants, had a more substatial disease burden of DID-CHA compared to adults aged over 20 years. Conclusions: This is the first study that thoroughly describe the global prevalence, regional inequality, and age discrepancy of the burden on DID-CHA, by utilizing the public data of GBD 2021. DID-CHD is believed to be a progressive issues for the whole-life management of CHD. Future efforts on resource allocation for neurodevelopmental disability in population with CHD should be comparable with the expenditure in reducing CHD mortality. Persistent regional socioeconomic disparities will definitely move to impact the discrepant burden of DID-CHA. Increasing socioeconomic resources aimed at improving DID-CHA outcomes should prioritize in neonate and infants with CHA, as they represent the most critically affected age groups.

AIMS This study aimed to describe the burden of mental disorders, substance use disorders, and self-harm among young people in Asia from 1990 to 2021 by key demographics and to project these trends to 2035. METHODS This study is a secondary analysis of data from the Global Burden of Disease (GBD) 2021 study, a publicly available repository of comprehensive global health estimates maintained by the Institute for Health Metrics and Evaluation (IHME). We analyzed prevalence, incidence, and disability-adjusted life years. Trends were assessed using average annual percent change, while a Bayesian age-period-cohort model projected future prevalence. Correlations with the Socio-demographic Index (SDI) were also examined. RESULTS In 2021, the rates per 100,000 young people in Asia were 13,854 (95 % UI, 12,243-15,607) for mental disorders, 1211 (95 % UI, 960-1501) for substance use disorders, and 54 (95 % UI, 42-70) for self-harm. Mental disorder prevalence was higher in males aged 15-19 and females aged 20-24. Countries with the highest burden included the Republic of Korea, Japan, and India. SDI showed a significant positive correlation with substance use disorder prevalence. Projections to 2035 indicate an increase in mental disorders, a decrease in self-harm, and an overall decrease in substance use, although rates are expected to rise among females. CONCLUSIONS The mental health burden among young people in Asia is significant and projected to worsen. Countries should prioritize the development of evidence-based mental health services for young people.

Introduction: Road traffic injuries pose a significant public health and economic burden in Algeria, particularly among young, active populations. Despite the global adoption of DALY and QALY metrics for health planning, Algeria’s fragmented data systems hinder accurate burden estimation. This paper proposes an integrated national database framework to enhance the reliability of BoD metrics, support evidence-based policymaking, and guide targeted interventions for improved road safety and health outcomes. Objectives: This paper aims to develop a policy framework for integrating health, transport, and demographic data systems in Algeria to improve the accuracy of DALY and QALY metrics and support effective road traffic injury interventions. Methods: This study uses a qualitative, policy-focused approach that combines comparative analysis and institutional feasibility assessment to improve DALY and QALY estimations in Algeria. Drawing on secondary sources from WHO, IHME, and national agencies in Sweden and Australia, the methodology involves four steps: benchmarking international data systems, mapping Algeria’s current databases, analyzing stakeholder roles, and projecting improvements in BoD metrics from data integration. The process aligns global best practices with Algeria’s institutional context to inform a practical framework for enhancing road injury data quality and supporting evidence-based public health and transport policy. Results: The study revealed major obstacles to generating accurate DALY and QALY estimates in Algeria due to fragmented institutions, inconsistent technical standards, legal limitations, and human resource shortages. Data on traffic injuries are dispersed across ministries with limited coordination or interoperability. A proposed National Integrated Road Injury Data System (NIRIDS) addresses these issues through a modular, interoperable architecture linking health, police, mortality, and survey data. Key stakeholders and governance structures are identified, with a phased implementation strategy beginning with urban pilots and scaling nationally. The framework emphasizes secure data sharing, digital infrastructure upgrades, and the need for strong political and institutional commitment. Conclusions: Algeria must modernize its approach to road traffic injury prevention through integrated, data-driven systems. Establishing NIRIDS, supported by legal reform, governance structures, digital infrastructure, and international partnerships, will enable accurate BoD metrics, guide resource allocation, and improve health policy, safety interventions, and long-term outcomes.

Background The 16 Southern Africa Development Community (SADC) countries remain the epicentre of the HIV/AIDS epidemic with the largest number of people living with HIV/AIDS. Anti-retroviral treatment (ART) has improved survival and prevention of mother-to-child transmission (PMTCT) of HIV, but the disease remains a serious cause of mortality. We conducted a descriptive epidemiological analysis of HIV/AIDS burden for the 16 SADC countries using secondary data from the Global Burden of Diseases, Injuries and Risk Factor (GBD) Study. Methods The GBD study is a systematic, scientific effort by the Institute for Health Metrics and Evaluation (IHME) to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors by age, sex, and geographies for specific points in time. We analyzed the following outcomes: mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to HIV/AIDS for SADC. Input data for GBD was extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service utilisation, disease notifications, and other sources. Country- and cause-specific HIV/AIDS-related death rates were calculated using the Cause of Death Ensemble model (CODEm) and spatiotemporal Gaussian process regression (ST-GPR). Deaths were multiplied by standard life expectancy at each age-group to calculate YLLs. Cause-specific mortality was estimated using a Bayesian meta-regression modelling tool, DisMod-MR. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases to calculate YLDs. Crude and age-adjusted rates per 100,000 population and changes between 1990 and 2017 were determined for each country. Results In 2017, HIV/AIDS caused 336,175 deaths overall in SADC countries, and more than 20 million DALYs. This corresponds to a 3-fold increase from 113,631 deaths (6,915,170 DALYs) in 1990. The five leading countries with the proportion of deaths attributable to HIV/AIDS in 2017 were Botswana at the top with 28.7% (95% UI; 23.7–35.2), followed by South Africa 28.5% (25.8–31.6), Lesotho, 25.1% (21.2–30.4), eSwatini 24.8% (21.3–28.6), and Mozambique 24.2% (20.6–29.3). The five countries had relative attributable deaths that were at least 14 times greater than the global burden of 1.7% (1.6–1.8). Similar patterns were observed with YLDs, YLLs, and DALYs. Comoros, Seychelles and Mauritius were on the lower end, with attributable proportions less than 1%, below the global proportion. Conclusions Great progress in reducing HIV/AIDS burden has been achieved since the peak but more needs to be done. The post-2005 decline is attributed to PMTCT of HIV, resources provided through the US President’s Emergency Plan For AIDS Relief (PEPFAR), and behavioural change. The five countries with the highest burden of HIV/AIDS as measured by proportion of death attributed to HIV/AIDS and age-standardized mortaility rate were Botswana, South Africa, Lesotho, eSwatini, and Mozambique. SADC countries should cooperate, work with donors, and embrace the UN Fast-Track approach, which calls for frontloading investment from domestic or other sources to prevent and treat HIV/AIDS. Robust tracking, testing, and early treatment are required, as well as refinement of individual treatment strategies for transient individuals in the region.

Abstract Background: Cancer is one of the leading causes of death globally, but its burden is not uniform. GLOBOCAN 2020 has newly updated the estimates of cancer burden. This study summarizes the most recent changing profiles of cancer burden worldwide and in China and compares the cancer data of China with those of other regions. Methods: We conducted a descriptive secondary analysis of the GLOBOCAN 2020 data. To depict the changing global profile of the leading cancer types in 2020 compared with 2018, we extracted the numbers of cases and deaths in 2018 from GLOBOCAN 2018. We also obtained cancer incidence and mortality from the 2015 National Cancer Registry Report in China when sorting the leading cancer types by new cases and deaths. For the leading cancer types according to sex in China, we summarized the estimated numbers of incidence and mortality, and calculated China's percentage of the global new cases and deaths. Results: Breast cancer displaced lung cancer to become the most leading diagnosed cancer worldwide in 2020. Lung, liver, stomach, breast, and colon cancers were the top five leading causes of cancer-related death, among which liver cancer changed from the third-highest cancer mortality in 2018 to the second-highest in 2020. China accounted for 24% of newly diagnosed cases and 30% of the cancer-related deaths worldwide in 2020. Among the 185 countries included in the database, China's age-standardized incidence rate (204.8 per 100,000) ranked 65th and the age-standardized mortality rate (129.4 per 100,000) ranked 13th. The two rates were above the global average. Lung cancer remained the most common cancer type and the leading cause of cancer death in China. However, breast cancer became the most frequent cancer type among women if the incidence was stratified by sex. Incidences of colorectal cancer and breast cancer increased rapidly. The leading causes of cancer death varied minimally in ranking from 2015 to 2020 in China. Gastrointestinal cancers, including stomach, colorectal, liver, and esophageal cancers, contributed to a massive burden of cancer for both sexes. Conclusions: The burden of breast cancer is increasing globally. China is undergoing cancer transition with an increasing burden of lung cancer, gastrointestinal cancer, and breast cancers. The mortality rate of cancer in China is high. Comprehensive strategies are urgently needed to target China's changing profiles of the cancer burden.

Objective This study assesses the impact of obesity on life expectancy for 26 European national populations and the USA over the 1975–2012 period. Design Secondary analysis of population-level obesity and mortality data. Setting European countries, namely Austria, Belarus, Belgium, the Czech Republic, Denmark, Estonia, Finland, France, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Poland, Portugal, the Russian Federation, Slovakia, Spain, Sweden, Switzerland, Ukraine and the UK; and the USA. Participants National populations aged 18–100 years, by sex. Measurements Using data by age and sex, we calculated obesity-attributable mortality by multiplying all-cause mortality (Human Mortality Database) with obesity-attributable mortality fractions (OAMFs). OAMFs were obtained by applying the weighted sum method to obesity prevalence data (non-communicable diseases (NCD) Risk Factor Collaboration) and European relative risks (Dynamic Modeling for Health Impact Assessment (DYNAMO- HIA)). We estimated potential gains in life expectancy (PGLE) at birth by eliminating obesity-attributable mortality from all-cause mortality using associated single-decrement life tables. Results In the 26 European countries in 2012, PGLE due to obesity ranged from 0.86 to 1.67 years among men, and from 0.66 to 1.54 years among women. In all countries, PGLE increased over time, with an average annual increase of 2.68% among men and 1.33% among women. Among women in Denmark, Switzerland, and Central and Eastern European countries, the increase in PGLE levelled off after 1995. Without obesity, the average increase in life expectancy between 1975 and 2012 would have been 0.78 years higher among men and 0.30 years higher among women. Conclusions Obesity was proven to have an impact on both life expectancy levels and trends in Europe. The differences found in this impact between countries and the sexes can be linked to contextual factors, as well as to differences in people’s ability and capacity to adopt healthier lifestyles.

Background: Early-onset type 2 diabetes (T2D) is an increasingly serious public health issue, particularly in China. This study aimed to analyze the characteristics of disease burden, secular trend, and attributable risk factors of early-onset T2D in China. Methods: Using data from the Global Burden of Disease (GBD) 2021, we analyzed the age-standardized rate (ASR) of incidence, disability-adjusted life years (DALYs), and mortality rates of T2D among individuals aged 15 to 39 years in China from 1990 to 2021. Joinpoint regression analysis was employed to analyze secular trend, calculating the average annual percent change (AAPC). We also examined changes in the proportion of early-onset T2D within the total T2D burden and its attributable risk factors. Results: From 1990 to 2021, the ASR of incidence of early-onset T2D in China increased from 140.20 [95% uncertainty interval (UI): 89.14 to 204.74] to 315.97 (95% UI: 226.75 to 417.55) per 100,000, with an AAPC of 2.67% (95% CI: 2.60% to 2.75%, P < 0.001). DALYs rose from 116.29 (95% UI: 78.51 to 167.05) to 267.47 (95% UI: 171.08 to 387.38) per 100,000, with an AAPC of 2.75% (95% CI: 2.64% to 2.87%, P < 0.001). Mortality rates slightly decreased from 0.30 (95% UI: 0.24 to 0.38) to 0.28 (95% UI: 0.23 to 0.34) per 100,000, with an AAPC of −0.22% (95% CI: −0.33% to −0.11%, P < 0.001). The 15 to 19 years age group showed the fastest increase in incidence (AAPC: 4.08%, 95% CI: 3.93% to 4.29%, P < 0.001). The burden was consistently higher and increased more rapidly among males compared to females. The proportion of early-onset T2D within the total T2D burden fluctuated but remained higher than global levels. In 2021, high body mass index (BMI) was the primary attributable risk factor for DALYs of early-onset T2D (59.85%, 95% UI: 33.54% to 76.65%), and its contribution increased substantially from 40.08% (95% UI: 20.71% to 55.79%) in 1990, followed by ambient particulate matter pollution (14.77%, 95% UI: 8.24% to 21.24%) and diet high in red meat (9.33%, 95% UI: −1.42% to 20.06%). Conclusion: The disease burden of early-onset T2D in China is rapidly increasing, particularly among younger populations and males. Despite a slight decrease in mortality rates, the continued rapid increase in incidence and DALYs indicates a need for strengthened prevention and management strategies, especially interventions targeting younger age groups. High BMI and environmental pollution emerge as primary risk factors and should be prioritized in future interventions.

The global burden of dental caries (DC) and periodontal disease (PD) has evolved significantly from 1990 to 2021, influenced by demographic shifts and socioeconomic factors in oral health interventions. This study aims to analyze historical trends, project future trajectories to 2035, and identify inequalities to inform equitable oral health policy development. Utilizing data from the Global Burden of Disease Study (GBD), which integrates epidemiological records from systematic reviews, survey data preparation, disease registries, and case notifications, we conducted an observational analysis based on historical population-level data from 1990 to 2021.We analyzed the incidence, prevalence, and their corresponding age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) for caries of deciduous teeth (CDT), caries of permanent teeth (CPT) and periodontal disease (PD). Bayesian age-period-cohort (BAPC) models with Integrated Nested Laplace Approximation (INLA) were employed to forecast trends through 2035, integrating second-order smoothing effects, overdispersion adjustments, and uncertainty quantification via 1,000 Monte Carlo simulations (95% UI) with future precision expressed as 95% confidence intervals (CI). From 1990 to 2021, CDT prevalence declined regionally, while PD remained prevalent, particularly among middle-aged and elderly populations in high-burden regions like Sub-Saharan Africa and Southeast Asia. Significant gender disparities were noted, with females experiencing comparable deciduous DC in early childhood, whereas males showed dominant PD rates in middle/older ages. Low-income regions still face high burdens despite progress. Projections to 2035 suggest a CDT resurgence and aging-driven PD persistence. DC and PD persist as major public health issues, shaped by gender, age, and regional disparities. The projected resurgence of childhood DC and persistent PD prevalence by 2035 underscore the need for targeted interventions. Tailored public health initiatives are essential to mitigate long-term impacts and improve global oral health outcomes.

Background The burden and disability associated with headaches are conceptualized and measured differently at patients’ and populations’ levels. At the patients’ level, through patient-reported outcome measures (PROMs); at population level, through disability weights (DW) and years lived with a disability (YLDs) developed by the Global Burden of Disease Study (GBD). DW are 0–1 coefficients that address health loss and have been defined through lay descriptions. With this literature review, we aimed to provide a comprehensive analysis of disability in headache disorders, and to present a coefficient referring to patients’ disability which might inform future GBD definitions of DW for headache disorders. Methods We searched SCOPUS and PubMed for papers published between 2015 and 2023 addressing disability in headache disorders. The selected manuscript included a reference to headache frequency and at least one PROM. A meta-analytic approach was carried out to address relevant differences for the most commonly used PROMs (by headache type, tertiles of medication intake, tertiles of females’ percentage in the sample, and age). We developed a 0–1 coefficient based on the MIDAS, on the HIT-6, and on MIDAS + HIT-6 which was intended to promote future DW iterations by the GBD consortium. Results A total of 366 studies, 596 sub-samples, and more than 133,000 single patients were available, mostly referred to cases with migraine. Almost all PROMs showed the ability to differentiate disability severity across conditions and tertiles of medication intake. The indexes we developed can be used to inform future iterations of DW, in particular considering their ability to differentiate across age and tertiles of medication intake. Conclusions Our review provides reference values for the most commonly used PROMS and a data-driven coefficient whose main added value is its ability to differentiate across tertiles of age and medication intake which underlie on one side the increased burden due to aging (it is likely connected to the increased impact of common comorbidities), and by the other side the increased burden due to medication consumption, which can be considered as a proxy for headache severity. Both elements should be considered when describing disability of headache disorders at population levels.

Summary Background High-quality estimates of the epidemiology of the autism spectrum and the health needs of autistic people are necessary for service planners and resource allocators. Here we present the global prevalence and health burden of autism spectrum disorder from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 following improvements to the epidemiological data and burden estimation methods. Methods For GBD 2021, a systematic literature review involving searches in PubMed, Embase, PsycINFO, the Global Health Data Exchange, and consultation with experts identified data on the epidemiology of autism spectrum disorder. Eligible data were used to estimate prevalence via a Bayesian meta-regression tool (DisMod-MR 2.1). Modelled prevalence and disability weights were used to estimate health burden in years lived with disability (YLDs) as the measure of non-fatal health burden and disability-adjusted life-years (DALYs) as the measure of overall health burden. Data by ethnicity were not available. People with lived experience of autism were involved in the design, preparation, interpretation, and writing of this Article. Findings An estimated 61·8 million (95% uncertainty interval 52·1–72·7) individuals (one in every 127 people) were on the autism spectrum globally in 2021. The global age-standardised prevalence was 788·3 (663·8–927·2) per 100 000 people, equivalent to 1064·7 (898·5–1245·7) autistic males per 100 000 males and 508·1 (424·6–604·3) autistic females per 100 000 females. Autism spectrum disorder accounted for 11·5 million (7·8–16·3) DALYs, equivalent to 147·6 (100·2–208·2) DALYs per 100 000 people (age-standardised) globally. At the super-region level, age-standardised DALY rates ranged from 126·5 (86·0–178·0) per 100 000 people in southeast Asia, east Asia, and Oceania to 204·1 (140·7–284·7) per 100 000 people in the high-income super-region. DALYs were evident across the lifespan, emerging for children younger than age 5 years (169·2 [115·0–237·4] DALYs per 100 000 people) and decreasing with age (163·4 [110·6–229·8] DALYs per 100 000 people younger than 20 years and 137·7 [93·9–194·5] DALYs per 100 000 people aged 20 years and older). Autism spectrum disorder was ranked within the top-ten causes of non-fatal health burden for people younger than 20 years. Interpretation The high prevalence and high rank for non-fatal health burden of autism spectrum disorder in people younger than 20 years underscore the importance of early detection and support to autistic young people and their caregivers globally. Work to improve the precision and global representation of our findings is required, starting with better global coverage of epidemiological data so that geographical variations can be better ascertained. The work presented here can guide future research efforts, and importantly, decisions concerning allocation of health services that better address the needs of all autistic individuals. Funding Queensland Health and the Bill & Melinda Gates Foundation.

BACKGROUND Blood transfusions are an important resource of every health-care system, with often limited supply in low-income and middle-income countries; however, the degree of unmet need for blood transfusions is often unknown. We therefore aimed to estimate the blood transfusion need and supply at national level to determine gaps in transfusion services globally. METHODS We did a modelling study involving 195 countries and territories. We used blood component preparation data from 2011-13 to estimate blood availability for 180 (92%) of 195 countries from the WHO Global Status Report on Blood Safety and Availability. We calculated disease-specific transfusion needs per prevalent case for 20 causes in the USA using the National (Nationwide) Inpatient Sample dataset between the years 2000 and 2014, and the State Inpatient Databases between 2003 and 2007 from the Healthcare Cost and Utilization Project. Using prevalence estimates for the USA from the Global Burden of Disease (GBD) 2017 study, we estimated the ideal disease specific-transfusion rate as the lowest rate from the years 2000 to 2014. We applied this rate to GBD prevalence results for 195 countries to estimate transfusion needs. Unmet need was the difference between the estimated supply and need. FINDINGS In 2017, the global blood need was 304 711 244 (95% uncertainty interval [UI] 293 064 637-314 049 479) and the global blood supply was 272 270 243 (268 002 639-276 698 494) blood product units, with a need-to-supply ratio of 1·12 (95% UI 1·07-1·16). Of the 195 countries, 119 (61%) did not have sufficient blood supply to meet their need. Across these 119 countries, the unmet need totalled 102 359 632 (95% UI 93 381 710-111 360 725) blood product units, equal to 1849 (1687-2011) units per 100 000 population globally. Every country in central, eastern, and western sub-Saharan Africa, Oceania, and south Asia had insufficient blood to meet their needs. INTERPRETATION Our data suggest that the gap between need and supply is large in many low-income and middle-income countries, and reinforce that the WHO target of 10-20 donations per 1000 population is an underestimate for many countries. A continuous expansion and optimisation of national transfusion services and implementation of evidence-based strategies for blood availability is needed globally, as is more government support, financially, structurally, and through establishment of a regulatory oversight to ensure supply, quality, and safety in low-income and middle-income countries. FUNDING National Institutes of Health.

The global prevalence of alopecia areata (AA) is estimated to be around 2%. However, the global disease burden of AA and current research hotspots in this field have received limited attention. The disability adjusted life years (DALYs), incidence rates, and prevalence rates of AA from 1990 to 2019 were collected from the Global burden of disease (GBD) 2019 database and analyzed using R software to elucidate the temporal trend in disease burden associated with AA. VOSviewer software was employed to cluster keywords within the field of AA for identification of research hotspots. On a global scale, areas with low socio-demographic index (SDI) exhibited the highest increase in DALYs, incidence rates, and prevalence rates for AA from 1990 to 2019, while regions with high SDI observed the most substantial decrease. However, it is noteworthy that high SDI regions continued to bear the highest burden of AA. AA imposes a higher disease burden on women than men within the same age bracket. Young individuals (aged between 25 and 39 years) experience a greater disease burden compared to other age cohorts. Bibliometric analysis reveals that recent research focus in the field of AA primarily revolves around clinical trials and evaluating various treatment modalities such as Janus kinases (JAK) inhibitors and platelet rich plasma. The disease burden of AA may still be on the rise worldwide. This study further validates the gender- and region-specific impacts of AA and its associated burden, offering valuable guidance for prevention strategies and resource allocation. JAK inhibitors and platelet rich plasma are currently favored by researchers, and further high-quality studies are required to assess their long-term efficacy and safety more comprehensively.

BACKGROUND Pelvic inflammatory disease (PID), often caused by sexually transmitted infections (STIs), poses significant health threat to women of childbearing age (WCBA). This study assessed the global prevalence trends and research landscape of STIs-related PID. METHODS This study integrated GBD 2021 data and bibliometric analysis. Joinpoint regression calculated Average annual percentage change (AAPC) for age-standardized prevalence rate (ASPR) from 1990 to 2021. Decomposition analyses assessed the contributions of population growth, aging, and epidemiological changes to the prevalence trends for last 32 years. The Bayesian age-period-cohort (BAPC) model projected ASPR from 2022 to 2040, and the Nordpred model conducted a sensitivity analysis of the prediction results, which validated the findings' reliability. 1726 related publications were retrieved from the WOS Core Collection database. Bibliometric information was extracted with VOSviewer software for visualization. RESULTS In 2021, an estimated 1,009,957.64 cases of PID due to STIs occurred among WCBA globally, with chlamydial infection accounting for approximately 23%, gonococcal infection (4.98%), and other STIs (72.03%). From 1990 to 2021, the global ASPR of STIs-related PID increased by AAPC of 0.13%, with the largest increase observed among women in the 20-24 years age group. Regionally, the highest ASPR was observed in low SDI regions in 2021, while the fastest increase occurred in middle SDI regions over the last 32 years. Decomposition analyses highlighted the population growth as a key driver of global prevalence rise, accounting for 78.5 %. The global ASPR of STIs-related PID is projected to continue rising from 2022 to 2040. Bibliometric analysis showed stable research on STIs and PID, with an increased citation rate. The United States was the leading contributor. Research focused on chlamydia trachomatis, with recent studies exploring the vaginal microbiome, resistance and protective immunity. CONCLUSIONS This study performed an epidemiological assessment and bibliometric analysis of the PID attributable to STIs burden globally, informing policy-making and research directions.

Abstract Objective This study aims to systematically analyze the disease burden and epidemiological characteristics of depression among women of childbearing age (WCBA) globally and across regions from 1990 to 2021, as well as explore the current research status and hotspots. Methods Data from the 2021 Global Burden of Disease, Injuries, and Risk Factors Study (GBD 2021) were used to examine age-standardized incidence rates (ASIR) and disability-adjusted life years (DALYs) of depression among WCBA by region, age, and socio-demographic index (SDI) level. Relevant literature was retrieved from the Web of Science Core Collection, with bibliometric analyses (temporal-spatial distribution, themes, keywords) performed via VOSviewer and CiteSpace. Results In 2021, there were ~133 million new global cases of depression among WCBA, with an ASIR of 6,808.01 per 100,000 population. Incidence rose significantly since 1990, accelerating from 2019 to 2021. High SDI regions had higher ASIR, age-standardized DALY rates (ASDR), and average annual percentage change (AAPC). Globally, incidence peaked at 45−49 years with age growth, but younger WCBA (15−29 years) in high SDI regions had higher ASIR. Bibliometric analysis showed rapid research expansion in recent years, covering pregnancy, risk factors, and obesity, with “polycystic ovary syndrome” and “oxidative stress” as emerging hotspots. Conclusion The study highlights the rising global burden of depression among WCBA and disparities across regions, socioeconomic backgrounds, and age groups, providing scientific evidence for targeted public health interventions.

BACKGROUND Depression is a leading cause of disability and poor health worldwide and is expected to rank first worldwide by 2030. The aim of this study is to analyze the transition and trend of depression burden in China and various income-level countries by utilizing the Global Burden of Disease (GBD) database and the Joinpoint regression model. This analysis seeks to comprehend the variations in the burden of depression across different income regions and evaluate their developmental patterns. METHODS Based on the GBD 2019 open dataset, this study extracted data on YLD (Years Lived with Disability), DALY (Disability-Adjusted Life Years), and incidence related to depression. The analysis focused on the period between 1990 and 2019, covering global data and distinguishing between high-income, upper-middle-income, lower-middle-income, low-income countries, and China. We utilized the Joinpoint regression model to fit the spatiotemporal trend changes among different income-level countries. Pairwise comparisons were conducted to examine the parallelism and to determine if the differences in trend changes among various regions were statistically significant. RESULTS From 1990 to 2019, the age-standardized YLD and DALY for depression female were higher than that in male. The YLD total change rate of depression men was higher than that of women. China exhibited the largest disparity in total YLD change rates between genders, reaching 0.08. During 1990 to 2019, the incidence of depression in 2005-2019 increased among females in middle to high-income countries, low-income countries, and China as compare to that of 1990-2005. Notably, China shown the most increase the incidence rate of females (from -0.4 % to 0.84 %). China experienced the most significant change in the YLD of depression during this period (AAPC = 0.45, 95 % CI = 0.41, 0.48, P < 0.01). China's YLD/Incidence rate was higher compared to the global, HICs, UMCs, LMCs, and LICs. In China, the YLD/incidence rate of depression began to rise in 1994, peaking around 2010, and then gradually declining. Since 2010, the growth rate of depression DALYs in China has been higher than the global average, high-income countries, upper-middle-income countries, lower-middle-income countries, and low-income countries. The DALY's AAPC value for the HLCs was the highest (AAPC = 0.24, 95 % CI = 0.22, 0.25, P < 0.01). The UMCs, in comparison to other regions, incidence rate had the highest AAPC value (AAPC = 0.48, 95 % CI = 0.46, 0.50, P < 0.01). CONCLUSIONS Given the significant variations in the burden of depression across countries with different income levels, future strategies aimed at reducing the burden of depression should adopt tailored and differentiated approaches according to each country's specific needs and developmental stages.

Depression has been reported as one of the most prevalent psychiatric illnesses globally. This study aimed to obtain information on the global burden of depression and its associated spatiotemporal variation, by exploring the correlation between the global burden of depression and the social development index (SDI) and associated risk factors. Using data from the Global Burden of Disease study from 1990 to 2019, we described the prevalence and burden of disease in 204 countries across 21 regions, including sex and age differences and the relationship between the global disease burden and SDI. The age-standardized rate and estimated annual percentage change were used to assess the global burden of depression. Individuals with documented depression globally ranged from 182,183,358 in 1990 to 290,185,742 in 2019, representing an increase of 0.59%. More patients experienced major depressive disorder than dysthymia. The incidence and disability-adjusted life years of depression were the highest in the 60–64 age group and much higher in females than in males, with this trend occurring across all ages. The age-standardized incidence and adjusted life-years-disability rates varied with different SDI levels. Relevant risk factors for depression were identified. National governments must support research to improve prevention and treatment interventions.

Background We aimed to document the current state of exposure to low bone mineral density (BMD) and trends in attributable burdens between 2000 and 2019 globally and in different World Health Organization (WHO) regions using the Global Burden of Disease (GBD) study 2019. Methods We reviewed the sex-region-specific summary exposure value (SEV) of low BMD and the all-ages numbers and age-standardized rates of disability-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), and deaths attributed to low BMD. We compared different WHO regions (Africa, the Eastern Mediterranean Region, Europe, Region of the Americas, Southeast Asia, and Western Pacific), age categories, and sexes according to the estimates of the GBD 2019 report. Results The global age-standardized SEV of low BMD is estimated to be 20.7% in women and 11.3% in men in 2019. Among the WHO regions, Africa had the highest age-standardized SEV of low BMD in women (28.8% (95% uncertainty interval 22.0–36.3)) and men (16.8% (11.5–23.8)). The lowest SEV was observed in Europe in both women (14.7% (9.9–21.0)) and men (8.0% (4.3–13.4)). An improving trend in the global rate of DALY, death, and YLL was observed during 2000–2019 (−5.7%, −4.7%, and −11.9% change, respectively); however, the absolute numbers increased with the highest increase observed in global YLD (70.9%) and death numbers (67.6%). Southeast Asia Region had the highest age-standardized rates of DALY (303.4 (249.2–357.2)), death (10.6 (8.5–12.3)), YLD (133.5 (96.9–177.3)), and YLL (170.0 (139–197.7)). Conclusions Overall, the highest-burden attributed to low BMD was observed in the Southeast Asia Region. Knowledge of the SEV of low BMD and the attributed burden can increase the awareness of healthcare decision-makers to adopt appropriate strategies for early screening, and also strategies to prevent falls and fragility fractures and their consequent morbidity and mortality.

Background Injury is one of the leading causes of mortality and disability worldwide. It is a major contributor to the overall burden of disease. This study aimed to analyze the temporal trend, research focus and future direction of research related to injury burden. Methods Publications on injury burden published between January 1998 and September 2022 were extracted from the Web of Science Core Collection (WoSCC) through topic advanced search strategy. Microsoft Excel, RStudio, VOSviewer, and CiteSpace were used to extract, integrate, and visualize bibliometric information. Results A total of 2916 articles and 783 reviews were identified. The number of publications on injury burden showed a steady upward trend. The United States of America (USA) (n=1628) and the University of Washington (n=1036) were the most productive country and institution. High-income countries started research in this domain earlier, while research in low- and middle-income countries began in recent years. Lancet was the most influential journal. Public, environmental occupational health, general medicine and neurology were the predominant research domains. Based on keyword co-occurrence analysis, the research focus was divided into five clusters: injury epidemiology and prevention, studies related to the global burden of disease (GBD), risk factors for injury, clinical management of injury, and injury outcome assessment and economic burden. Conclusion The burden of injury has drawn increasing attention from various perspectives over the years. The research field on injury burden is also becoming more and more extensive. However, there are some gaps among different countries or regions, and more attention needs to be paid to low and middle-income countries.

Leukemia, a group of malignant tumors, has been a significant public health concern due to its high incidence and mortality rates. This study aimed to provide an in-depth analysis of the global leukemia burden from 1990 to 2021 using the Global Burden of Disease (GBD) database, focusing on trends in incidence, mortality, and Disability-Adjusted Life Years (DALYs) across different regions, genders, and age groups including forecasting future trends. Data were sourced from the GBD study, utilizing the Global Health Data Exchange (GHDx) query tool. We employed descriptive, trend, cluster, and forecasting analyses using age-standardized rates (ASRs) and the Estimated Annual Percentage Change (EAPC) to quantify changes over time. Hierarchical clustering and forecasting models, including ARIMA and Exponential Smoothing (ES), were utilized to predict future trends. Notably, ARIMA and ES smoothing parameters were meticulously identified and estimated. The analysis of global leukemia burden from 1990 to 2021, as reflected by DALYs, indicates a downward trend, with the number of DALYs estimated to have decreased from 578,020 (401,241–797,570) in 1990 to 302,902 (206,475–421,952) in 2021, corresponding to an EAPC of -0.94 (-1.01—-0.88). Notably, it is important to highlight that there is variability in these estimates across different regions and demographic groups, which should be interpreted with caution due to potential data limitations. High-income regions generally showed a decreased leukemia burden, while some middle- and low-income countries exhibited an opposite trend. Males displayed higher leukemia incidence, mortality, and DALY rates compared to females. The oldest age groups, mainly those aged 95 and above, experienced the most significant changes, with the highest EAPC observed in this demographic. Geographical and Socio-demographic Index (SDI)–based analyses further highlighted the heterogeneity in leukemia burden. Additionally, forecasting models project a continued decrease in leukemia burden, emphasizing the importance of ongoing public health strategies. The study indicates overall progress in reducing the leukemia burden at a global level due to medical advancements. However, specific regions and demographic groups, particularly males and the elderly, continue to face challenges. Socioeconomic status significantly impacts healthcare outcomes, with a need for resource distribution and healthcare system strengthening in low-income areas. The findings call for nuanced public health strategies tailored to socioeconomic contexts and sustained research and healthcare infrastructure efforts.

Drug use disorders (DUDs) have emerged as one of the most significant public health crises, exerting a substantial influence on both community health and socio-economic progress. The United States (US) also suffers a heavy burden, it is necessary to figure out the situation from multiple perspectives and take effective measures to deal with it. Therefore, using the data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2021, we evaluated this topic. Annual data on DUDs-related burden were collected from the GBD study 2021. We calculated the indicator of estimated annual percentage change (EAPC) to evaluate the changing trend of burden. The Bayesian model for age-period-cohort was introduced to forecast the burden. In 2021, the number and age-standardized rate of prevalence were particularly prominent, with 12,146.95 thousand and 3821.43 per 100,000, respectively. Higher burden was also observed in males, 15–45 years old populations, and opioid use disorders subtype. From 1990 to 2021, the DUDs-related burden increased in the US and all states, especially in West Virginia; and the national death-related burden with the highest increase (EAPC = 7.96). Other significant inverse associations were seen between EAPC, age-standardized rates, and socio-demographic index (SDI). Moreover, in the next 14 years, the projected DUDs burden remains exigent. The burden of DUDs in the US is heavy and has been enlarging. This study proposes that greater attention should be paid to the strategies in males, the younger population, opioid use disorders, and low-SDI states implemented by decision-makers to achieve goals such as reducing burden.

BACKGROUND Ischemic stroke (IS) poses a major public health challenge in China, with a growing burden linked to high body mass index (BMI). This study analyzes trends and gender differences in the disease burden of high BMI-associated IS from 1990 to 2021. METHODS Using the GBD 2021 database, we assessed mortality, DALYs, YLDs, and YLLs. Methods included bibliometric analysis, decomposition analysis, joinpoint regression, age-period-cohort modeling, ARIMA forecasting, and multivariate logistic regression with CHARLS 2011 data. RESULTS Decomposition highlighted rate effects as the main driver of increasing stroke burden. All age-standardized rates (ASMR, ASDR, ASYLD, ASYLL) rose significantly from 1990-2021, with higher burdens in males. EAPCs ranged from 2.46% to 4.47%. A brief decline occurred during 2004-2007, followed by sustained growth. Men aged 40-80 faced significantly higher mortality risk. High BMI (≥25 kg/m²) raised stroke risk (OR=1.36), especially in men (OR=1.56), with actual incidence 56-70% higher than predicted. CONCLUSION The disease burden of high BMI-associated IS continues to rise, disproportionately affecting males. Targeted interventions-particularly for middle-aged and younger men-and integrated weight management are urgently needed.

BACKGROUND AND AIM To explore effective preventive strategies for stroke, it is of paramount importance to systematically assess its risk factors. Leveraging the Global Burden of Disease (GBD) data, this study aims to retrospectively analyze the long-term trends and epidemiological characteristics of stroke in China. METHODS AND RESULTS Drawing on the GBD 2021 data, this study conducted a comprehensive analysis of the burden of stroke in the Chinese population, encompassing prevalence, incidence, mortality, years of life lost (YLL), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Subsequently, we examined the temporal trends of these indicators and employed a Joinpoint regression analysis coupled with an age-period-cohort (APC) model to precisely dissect mortality and incidence patterns. Furthermore, we delved into the attributable burden of stroke. The results indicated that the prevalence of stroke in China reached 26 million in 2021, representing a 104.26 % increase since 1990. Compared to 1990, the number of DALYs attributable to stroke increased by 45.25 %. Joinpoint analysis revealed a declining trend in incidence rates, while mortality rates showed a significant reduction. The APC model fitting outcomes suggested that prevalence rates were higher in recent generations than in the past, with an increase observed within the same age cohort. Notably, in 2019, the primary burden of cardiovascular diseases (CVDs) stemmed from metabolic risks, particularly hypertension, followed by air pollution particulate matter as an environmental risk factor. CONCLUSIONS Given China's vast population base and rapid aging process, the burden of stroke has emerged as a significant public health concern.

No abstract available

Subarachnoid hemorrhage (SAH) is a subtype of hemorrhagic stroke characterized by high mortality and low rates of full recovery. This study aimed to investigate the epidemiological characteristics of SAH between 1990 and 2021. Data on SAH incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021 were obtained from the Global Burden of Disease Study (GBD) 2021. Estimated annual percentage changes (EAPCs) were calculated to evaluate changes in the age-standardized rate (ASR) of incidence and mortality, as well as trends in SAH burden. The relationship between disease burden and sociodemographic index (SDI) was also analyzed. In 2021, the incidence of SAH was found to be 37.09% higher than that in 1990; however, the age-standardized incidence rates (ASIRs) showed a decreased [EAPC: -1.52; 95% uncertainty interval (UI) -1.66 to -1.37]. Furthermore, both the number and rates of deaths and DALYs decreased over time. It was observed that females had lower rates compared to males. Among all regions, the high-income Asia Pacific region exhibited the highest ASIR (14.09/100,000; 95% UI 12.30/100,000 − 16.39/100,000) in 2021, with an EPAC for ASIR < 0 indicating decreasing trend over time for SAH ASIR. Oceania recorded the highest age-standardized mortality rates (ASMRs) and age-standardized DALYs rates among all regions in 2021 at values of respectively 8.61 (95% UI 6.03 − 11.95) and 285.62 (95% UI 209.42 − 379.65). The burden associated with SAH primarily affected individuals aged between 50 − 69 years old. Metabolic risks particularly elevated systolic blood pressure were identified as the main risk factors contributing towards increased disease burden associated with SAH when compared against environmental or occupational behavioral risks evaluated within the GBD framework. The burden of SAH varies by gender, age group, and geographical region. Although the ASRs have shown a decline over time, the burden of SAH remains significant, especially in regions with middle and low-middle SDI levels. High systolic blood pressure stands out as a key risk factor for SAH. More specific supportive measures are necessary to alleviate the global burden of SAH.

OBJECTIVE To present a global overview of the current research landscape and emerging trends in mechanical thrombectomy (MT) for acute ischemic stroke (AIS) over the past decade. METHODS A thorough search was conducted on the Web of Science on May 20, 2024, focusing on original articles and reviews in English. Bibliometric tools were employed to make a network analysis and visual representation. Additionally, data on disability-adjusted life years (DALYs), prevalence, and incidence of ischemic strokes were extracted from the Global Burden of Disease database. RESULTS 7776 papers were included, indicating a steady increase from 169 to 1311 between 2014 and 2023. The United States led in core publications with 2887 papers. The incidence and DALYs of ischemic stroke have continued to rise in Asia but have recently declined in North America and European countries. The University of Calgary emerged as the leading institution and Goyal M was the most prolific author. Neurointerventional Surgery was the top-contributing journal with 790 articles. The analysis identified 6,332 keywords forming 5 clusters, with 'mechanical thrombectomy' serving as the largest cluster, focusing mainly on interventional thrombectomy techniques for AIS. The term 'tissue plasminogen activator' exhibited strong burst strength of 46.58. Keywords such as 'injury', 'diagnosis', 'posterior circulation', and 'severity' burst in 2020 and lasted until 2024. CONCLUSION Interest in MT for AIS was progressively increasing. Future research directions may include minimizing intraoperative injuries, refining diagnostic techniques, investigating interventions for posterior circulation, and tailoring thrombectomy strategies based on stroke severity and LVO etiology.

Introduction: Since more children with congenital heart disease (CHD) are surviving, policy changes are needed to improve their survival and quality of life. Global data and a literature review were systematically analyzed using The Global, Regional, and National Burden of CHDs, Global Burden of Disease (GBD) Study, published in The Lancet Child & Adolescent Health , which provided estimates of mortality from CHD. Objective: To outline studies with CHDs and the concept of burden as a possible contributor to the achievement of sustainable development goals (SDGs) over time. Methods: Bibliographic references and related authors (2005 to 2022) were researched and analyzed. Web of Science (WoS), Clarivate Analytics, was chosen as the source database to outline the results through bibliometric analysis, which is characterized by a quantitative and statistical technique to understand and measure new issues, as well as identify some trends in current research, regarding the issue of burden in CHDs. Results: Sixty-five selected publications were found according to the bibliographic survey using the keywords “Burden CHDs.” Afterwards, bibliometric analysis was performed, filtering the following results: years of publication; countries/regions; authors and number of citations; citation analysis; WoS index; types of documents; and research areas. The results are presented as figures. Conclusion: The concept of burden addressing the issue of CHD has been used with great propriety for the development of goals for care of CHDs, mainly in the last decade, highlighting the year 2020.

No abstract available

Background Pneumoconiosis, a group of occupational lung diseases caused by prolonged inhalation of mineral dust, remains a critical global health threat due to persistent workplace exposures in high-risk industries such as mining, construction, and artificial stone processing. These occupational hazards are exacerbated by inadequate dust control measures, insufficient use of personal protective equipment (PPE), and underreporting in low-and middle-income countries (LMICs). Emerging industries, including engineered stone fabrication, have introduced new risks, leading to accelerated silicosis among younger workers. Despite global efforts to improve occupational safety, socio-economic disparities, regulatory gaps, and public health crises such as the COVID-19 pandemic have further complicated disease management. This study analyzes trends in the global burden of pneumoconiosis from 1990 to 2021, providing evidence to inform post-pandemic strategies for occupational health equity and dust exposure mitigation. Methods The data for this study were sourced from the Global Burden of Disease (GBD) 2021 database, utilizing age-standardized incidence rates (ASIR), prevalence rates (ASPR), mortality rates (ASDR), and disability-adjusted life years (DALYs) as the primary assessment indicators. Dynamic changes in the burden of pneumoconiosis were analyzed by estimating the annual percentage changes (EAPCs). The correlation between the Socio-Demographic Index (SDI) and the burden of pneumoconiosis was examined using Pearson correlation tests. Additionally, we conducted decomposition and inequality analyses and Bayesian Age-Period-Cohort (BAPC) to assess trends and distribution related to the pneumoconiosis burden. Results The global incidence of pneumoconiosis increased from 42,187.99 cases in 1990 to 62,866.45 cases in 2021, accompanied by a rise in mortality rates. Notably, the burden of pneumoconiosis remains disproportionately higher among men than women across nearly all regions. The highest incidence and mortality rates were recorded in the age group of 80 years and older, with a pronounced gender disparity, particularly in East Asia and High-income North America. These rates were generally elevated in low-income and lower-middle-income regions, where males exhibited significantly higher ASIR and ASDR compared to females. No correlation was found between the SDI values and the pneumoconiosis burden. Additionally, absolute inequality among SDI countries decreased from 1990 to 2021, whereas relative inequality demonstrated an upward trend during the same period.

BACKGROUND Artisanal small-scale gold mining (ASGM) is the world's largest anthropogenic source of mercury emission. Gold miners are highly exposed to metallic mercury and suffer occupational mercury intoxication. The global disease burden as a result of this exposure is largely unknown because the informal character of ASGM restricts the availability of reliable data. OBJECTIVE To estimate the prevalence of occupational mercury intoxication and the disability-adjusted life years (DALYs) attributable to chronic metallic mercury vapor intoxication (CMMVI) among ASGM gold miners globally and in selected countries. METHODS Estimates of the number of artisanal small-scale gold (ASG) miners were extracted from reviews supplemented by a literature search. Prevalence of moderate CMMVI among miners was determined by compiling a dataset of available studies that assessed frequency of intoxication in gold miners using a standardized diagnostic tool and biomonitoring data on mercury in urine. Severe cases of CMMVI were not included because it was assumed that these persons can no longer be employed as miners. Cases in workers' families and communities were not considered. Years lived with disability as a result of CMMVI among ASG miners were quantified by multiplying the number of prevalent cases of CMMVI by the appropriate disability weight. No deaths are expected to result from CMMVI and therefore years of life lost were not calculated. Disease burden was calculated by multiplying the prevalence rate with the number of miners for each country and the disability weight. Sensitivity analyses were performed using different assumptions on the number of miners and the intoxication prevalence rate. FINDINGS Globally, 14-19 million workers are employed as ASG miners. Based on human biomonitoring data, between 25% and 33% of these miners-3.3-6.5 million miners globally-suffer from moderate CMMVI. The resulting global burden of disease is estimated to range from 1.22 (uncertainty interval [UI] 0.87-1.61) to 2.39 (UI 1.69-3.14) million DALYs. CONCLUSIONS This study presents the first global and country-based estimates of disease burden caused by mercury intoxication in ASGM. Data availability and quality limit the results, and the total disease burden is likely undercounted. Despite these limitations, the data clearly indicate that mercury intoxication in ASG miners is a major, largely neglected global health problem.

Background Understanding comorbidity and its burden characteristics is essential for policymakers and healthcare providers to allocate resources accordingly. However, several definitions of comorbidity burden can be found in the literature. The main reason for these differences lies in the available information about the analyzed diseases (i.e., the target population studied), how to define the burden of diseases, and how to aggregate the occurrence of the detected health conditions. Methods In this manuscript, we focus on data from the Italian surveillance system PASSI, proposing an index of comorbidity burden based on the disability weights from the Global Burden of Disease (GBD) project. We then analyzed the co-presence of ten non-communicable diseases, weighting their burden thanks to the GBD disability weights extracted by a multi-step procedure. The first step selects a set of GBD weights for each disease detected in PASSI using text mining. The second step utilizes an additional variable from PASSI (i.e., the perceived health variable) to associate a single disability weight for each disease detected in PASSI. Finally, the disability weights are combined to form the comorbidity burden index using three approaches common in the literature. Results The comorbidity index (i.e., combined disability weights) proposed allows an exploration of the magnitude of the comorbidity burden in several Italian sub-populations characterized by different socioeconomic characteristics. Thanks to that, we noted that the level of comorbidity burden is greater in the sub-population characterized by low educational qualifications and economic difficulties than in the rich sub-population characterized by a high level of education. In addition, we found no substantial differences in terms of predictive values of comorbidity burden adopting different approaches in combining the disability weights (i.e., additive, maximum, and multiplicative approaches), making the Italian comorbidity index proposed quite robust and general.

BackgroundArtisanal small-scale gold mining (ASGM) is a poverty-driven activity practiced in over 70 countries worldwide. Zimbabwe is amongst the top ten countries using large quantities of mercury to extract gold from ore. This analysis was performed to check data availability and derive a preliminary estimate of disability-adjusted life years (DALYs) due to mercury use in ASGM in Zimbabwe.MethodsCases of chronic mercury intoxication were identified following an algorithm using mercury-related health effects and mercury in human specimens. The sample prevalence amongst miners and controls (surveyed by the United Nations Industrial Development Organization in 2004 and the University of Munich in 2006) was determined and extrapolated to the entire population of Zimbabwe. Further epidemiological and demographic data were taken from the literature and missing data modeled with DisMod II to quantify DALYs using the methods from the Global Burden of Disease (GBD) 2004 update published by the World Health Organization (WHO). While there was no disability weight (DW) available indicating the relative disease severity of chronic mercury intoxication, the DW of a comparable disease was assigned by following the criteria 1) chronic condition, 2) triggered by a substance, and 3) causing similar health symptoms.ResultsMiners showed a sample prevalence of 72% while controls showed no cases of chronic mercury intoxication. Data availability is very limited why it was necessary to model data and make assumptions about the number of exposed population, the definition of chronic mercury intoxication, DW, and epidemiology. If these assumptions hold, the extrapolation would result in around 95,400 DALYs in Zimbabwe’s total population in 2004.ConclusionsThis analysis provides a preliminary quantification of the mercury-related health burden from ASGM based on the limited data available. If the determined assumptions hold, chronic mercury intoxication is likely to have been one of the top 20 hazards for population health in Zimbabwe in 2004 when comparing with more than 130 categories of diseases and injuries quantified in the WHO’s GBD 2004 update. Improving data quality would allow more accurate estimates. However, the results highlight the need to reduce a burden which could be entirely avoided.

Background Silicosis, a severe lung disease caused by inhaling silica dust, predominantly affects workers in industries such as mining and construction, leading to a significant global public health challenge. The purpose of this study is to analyze the current disease burden of silicosis and to predict the development trend of silicosis in the future the world by extracting data from the GBD database. Methods We extracted and analyzed silicosis prevalence, incidence, mortality, and disability-adjusted life years (DALYs) data from the Global Burden of Disease 2019 program for 204 countries and territories from 1990 to 2019. The association between the Sociodemographic Index (SDI) and the burden of age-standardized rates (ASRs) of DALYs has been examined at the regional level. Jointpoint regression analysis has been also performed to evaluate global burden trends of silicosis from 1990 to 2019. Furthermore, Nordpred age-period-cohort analysis has also been projected to predict future the burden of silicosis from 2019 to 2044. Results In 2019, global ASRs for silicosis prevalence, incidence, mortality, and DALYs were 5.383, 1.650, 0.161, and 7.872%, respectively which are lower than that in 1990. The populations of 45–59 age group were more susceptible to silicosis, while those aged 80 or above suffered from higher mortality and DALY risks. In 2019, the most impacted nations by the burden of silicosis included China, the Democratic People’s Republic of Korea, and Chile. From 1990 to 2019, most regions observed a declining burden of silicosis. An “M” shaped association between SDI and ASRs of DALYs for silicosis was observed from 1990 to 2019. The age-period-cohort analysis forecasted a decreasing trend of the burden of silicosis from 2019 to 2044. Conclusion Despite the overall decline in the global silicosis burden from 1990 to 2019, some regions witnessed a notable burden of this disease, emphasizing the importance of targeted interventions. Our results may provide a reference for the subsequent development of appropriate management strategies.

In artisanal small-scale gold mining, mercury is used for gold-extraction, putting miners and nearby residents at risk of chronic metallic mercury vapor intoxication (CMMVI). Burden of disease (BoD) analyses allow the estimation of the public health relevance of CMMVI, but until now there have been no specific CMMVI disability weights (DWs). The objective is to derive DWs for moderate and severe CMMVI. Disease-specific and generic health state descriptions of 18 diseases were used in a pairwise comparison survey. Mercury and BoD experts were invited to participate in an online survey. Data were analyzed using probit regression. Local regression was used to make the DWs comparable to the Global Burden of Disease (GBD) study. Alternative survey (visual analogue scale) and data analyses approaches (linear interpolation) were evaluated in scenario analyses. A total of 105 participants completed the questionnaire. DWs for moderate and severe CMMVI were 0.368 (0.261–0.484) and 0.588 (0.193–0.907), respectively. Scenario analyses resulted in higher mean values. The results are limited by the sample size, group of interviewees, questionnaire extent, and lack of generally accepted health state descriptions. DWs were derived to improve the data basis of mercury-related BoD estimates, providing useful information for policy-making. Integration of the results into the GBD DWs enhances comparability.

Summary Background Exposure to ambient air pollution increases morbidity and mortality, and is a leading contributor to global disease burden. We explored spatial and temporal trends in mortality and burden of disease attributable to ambient air pollution from 1990 to 2015 at global, regional, and country levels. Methods We estimated global population-weighted mean concentrations of particle mass with aerodynamic diameter less than 2·5 μm (PM2·5) and ozone at an approximate 11 km × 11 km resolution with satellite-based estimates, chemical transport models, and ground-level measurements. Using integrated exposure–response functions for each cause of death, we estimated the relative risk of mortality from ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, and lower respiratory infections from epidemiological studies using non-linear exposure–response functions spanning the global range of exposure. Findings Ambient PM2·5 was the fifth-ranking mortality risk factor in 2015. Exposure to PM2·5 caused 4·2 million (95% uncertainty interval [UI] 3·7 million to 4·8 million) deaths and 103·1 million (90·8 million 115·1 million) disability-adjusted life-years (DALYs) in 2015, representing 7·6% of total global deaths and 4·2% of global DALYs, 59% of these in east and south Asia. Deaths attributable to ambient PM2·5 increased from 3·5 million (95% UI 3·0 million to 4·0 million) in 1990 to 4·2 million (3·7 million to 4·8 million) in 2015. Exposure to ozone caused an additional 254 000 (95% UI 97 000–422 000) deaths and a loss of 4·1 million (1·6 million to 6·8 million) DALYs from chronic obstructive pulmonary disease in 2015. Interpretation Ambient air pollution contributed substantially to the global burden of disease in 2015, which increased over the past 25 years, due to population ageing, changes in non-communicable disease rates, and increasing air pollution in low-income and middle-income countries. Modest reductions in burden will occur in the most polluted countries unless PM2·5 values are decreased substantially, but there is potential for substantial health benefits from exposure reduction. Funding Bill & Melinda Gates Foundation and Health Effects Institute.

Global estimates of prevalence, deaths, and disability-adjusted life years (DALYs) from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were examined for metabolic diseases (type 2 diabetes mellitus [T2DM], hypertension, and non-alcoholic fatty liver disease [NAFLD]). For metabolic risk factors (hyperlipidemia and obesity), estimates were limited to mortality and DALYs. From 2000 to 2019, prevalence rates increased for all metabolic diseases, with the greatest increase in high socio-demographic index (SDI) countries. Mortality rates decreased over time in hyperlipidemia, hypertension, and NAFLD, but not in T2DM and obesity. The highest mortality was found in the World Health Organization Eastern Mediterranean region, and low to low-middle SDI countries. The global prevalence of metabolic diseases has risen over the past two decades regardless of SDI. Urgent attention is needed to address the unchanging mortality rates attributed to metabolic disease and the entrenched sex-regional-socioeconomic disparities in mortality.

Summary Background Sepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. It is considered a major cause of health loss, but data for the global burden of sepsis are limited. As a syndrome caused by underlying infection, sepsis is not part of standard Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates. Accurate estimates are important to inform and monitor health policy interventions, allocation of resources, and clinical treatment initiatives. We estimated the global, regional, and national incidence of sepsis and mortality from this disorder using data from GBD 2017. Methods We used multiple cause-of-death data from 109 million individual death records to calculate mortality related to sepsis among each of the 282 underlying causes of death in GBD 2017. The percentage of sepsis-related deaths by underlying GBD cause in each location worldwide was modelled using mixed-effects linear regression. Sepsis-related mortality for each age group, sex, location, GBD cause, and year (1990–2017) was estimated by applying modelled cause-specific fractions to GBD 2017 cause-of-death estimates. We used data for 8·7 million individual hospital records to calculate in-hospital sepsis-associated case-fatality, stratified by underlying GBD cause. In-hospital sepsis-associated case-fatality was modelled for each location using linear regression, and sepsis incidence was estimated by applying modelled case-fatality to sepsis-related mortality estimates. Findings In 2017, an estimated 48·9 million (95% uncertainty interval [UI] 38·9–62·9) incident cases of sepsis were recorded worldwide and 11·0 million (10·1–12·0) sepsis-related deaths were reported, representing 19·7% (18·2–21·4) of all global deaths. Age-standardised sepsis incidence fell by 37·0% (95% UI 11·8–54·5) and mortality decreased by 52·8% (47·7–57·5) from 1990 to 2017. Sepsis incidence and mortality varied substantially across regions, with the highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia. Interpretation Despite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa. Funding The Bill & Melinda Gates Foundation, the National Institutes of Health, the University of Pittsburgh, the British Columbia Children's Hospital Foundation, the Wellcome Trust, and the Fleming Fund.

Summary Background Health system planning requires careful assessment of chronic kidney disease (CKD) epidemiology, but data for morbidity and mortality of this disease are scarce or non-existent in many countries. We estimated the global, regional, and national burden of CKD, as well as the burden of cardiovascular disease and gout attributable to impaired kidney function, for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. We use the term CKD to refer to the morbidity and mortality that can be directly attributed to all stages of CKD, and we use the term impaired kidney function to refer to the additional risk of CKD from cardiovascular disease and gout. Methods The main data sources we used were published literature, vital registration systems, end-stage kidney disease registries, and household surveys. Estimates of CKD burden were produced using a Cause of Death Ensemble model and a Bayesian meta-regression analytical tool, and included incidence, prevalence, years lived with disability, mortality, years of life lost, and disability-adjusted life-years (DALYs). A comparative risk assessment approach was used to estimate the proportion of cardiovascular diseases and gout burden attributable to impaired kidney function. Findings Globally, in 2017, 1·2 million (95% uncertainty interval [UI] 1·2 to 1·3) people died from CKD. The global all-age mortality rate from CKD increased 41·5% (95% UI 35·2 to 46·5) between 1990 and 2017, although there was no significant change in the age-standardised mortality rate (2·8%, −1·5 to 6·3). In 2017, 697·5 million (95% UI 649·2 to 752·0) cases of all-stage CKD were recorded, for a global prevalence of 9·1% (8·5 to 9·8). The global all-age prevalence of CKD increased 29·3% (95% UI 26·4 to 32·6) since 1990, whereas the age-standardised prevalence remained stable (1·2%, −1·1 to 3·5). CKD resulted in 35·8 million (95% UI 33·7 to 38·0) DALYs in 2017, with diabetic nephropathy accounting for almost a third of DALYs. Most of the burden of CKD was concentrated in the three lowest quintiles of Socio-demographic Index (SDI). In several regions, particularly Oceania, sub-Saharan Africa, and Latin America, the burden of CKD was much higher than expected for the level of development, whereas the disease burden in western, eastern, and central sub-Saharan Africa, east Asia, south Asia, central and eastern Europe, Australasia, and western Europe was lower than expected. 1·4 million (95% UI 1·2 to 1·6) cardiovascular disease-related deaths and 25·3 million (22·2 to 28·9) cardiovascular disease DALYs were attributable to impaired kidney function. Interpretation Kidney disease has a major effect on global health, both as a direct cause of global morbidity and mortality and as an important risk factor for cardiovascular disease. CKD is largely preventable and treatable and deserves greater attention in global health policy decision making, particularly in locations with low and middle SDI. Funding Bill & Melinda Gates Foundation.

Summary Background Ischemic stroke remains a major contributor to global mortality and morbidity. This study aims to provide an updated assessment of rates in ischemic stroke prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021, specifically focusing on including prevalence investigation alongside other measures. The analysis is stratified by sex, age, and socio-demographic index (SDI) at global, regional, and national levels. Methods Data for this study was obtained from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). To quantify temporal patterns and assess trends in age-standardized rates of ischemic stroke prevalence (ASPR), incidence (ASIR), mortality (ASDR), and DALYs, estimated annual percentage changes (EAPCs) were computed over the study period. The analyses were disaggregated by gender, 20 age categories, 21 GBD regions, 204 nations/territories, and 5 SDI quintiles. R statistical package V 4.4.2 was performed for statistical analyses and plot illustrations. Findings In 2021, the global burden of ischemic stroke remained substantial, with a total of 69,944,884.8 cases with an ASPR of 819.5 cases per 100,000 individuals (95% UI: 760.3–878.7). The ASIR was 92.4 per 100,000 people (95% UI: 79.8–105.8), while the ASDR was 44.2 per 100,000 persons (95% UI: 39.3–47.8). Additionally, the age-standardized DALY rate was 837.4 per 100,000 individuals (95% UI: 763.7–905). Regionally, areas with high-middle SDI exhibited the greatest ASPR, ASIR, ASDR, and age-standardized DALY rates, whereas high SDI regions had the lowest rates. Geospatially, Southern Sub-Saharan Africa had the highest ASPR, while Eastern Europe showed the highest ASIR. The greatest ASDR and age-standardized DALY rates were observed in Eastern Europe, Central Asia, as well as North Africa, and the Middle East. Among countries, Ghana had the highest ASPR, and North Macedonia had both the highest ASIR and ASDR. Furthermore, North Macedonia also exhibited the highest age-standardized DALY rate. Interpretation Regions with high-middle and middle SDI continued to experience elevated ASPR, ASIR, ASDR and age-standardized DALY rates. The highest ischemic stroke burden was observed in Southern Sub-Saharan Africa, Central Asia, Eastern Europe, and the Middle East. Funding None.

Summary Background Obesity represents a major global health challenge with important clinical implications. Despite its recognized importance, the global disease burden attributable to high body mass index (BMI) remains less well understood. Methods We systematically analyzed global deaths and disability-adjusted life years (DALYs) attributable to high BMI using the methodology and analytical approaches of the Global Burden of Disease Study (GBD) 2021. High BMI was defined as a BMI over 25 kg/m2 for individuals aged ≥20 years. The Socio-Demographic Index (SDI) was used as a composite measure to assess the level of socio-economic development across different regions. Subgroup analyses considered age, sex, year, geographical location, and SDI. Findings From 1990 to 2021, the global deaths and DALYs attributable to high BMI increased more than 2.5-fold for females and males. However, the age-standardized death rates remained stable for females and increased by 15.0% for males. Similarly, the age-standardized DALY rates increased by 21.7% for females and 31.2% for males. In 2021, the six leading causes of high BMI-attributable DALYs were diabetes mellitus, ischemic heart disease, hypertensive heart disease, chronic kidney disease, low back pain and stroke. From 1990 to 2021, low-middle SDI countries exhibited the highest annual percentage changes in age-standardized DALY rates, whereas high SDI countries showed the lowest. Interpretation The worldwide health burden attributable to high BMI has grown significantly between 1990 and 2021. The increasing global rates of high BMI and the associated disease burden highlight the urgent need for regular surveillance and monitoring of BMI. Funding 10.13039/501100001809National Natural Science Foundation of China and National Key R&D Program of China.

Summary 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.

84 Background: Colorectal cancer (CRC) burdens vary across North America and Asia due to screening, diet, and metabolic risks. We contrasted temporal trends, age-sex patterns, and risk-factor disparities. Methods: Data were obtained using the Institute for Health Metrics and Evaluation Global Burden of Disease (GBD) 2021 Results Tool.Trends were summarized with estimated annual percentage change (EAPC, 1990–2021). Age-standardized incidence (ASIR), death, and DALY rates were analyzed by region/subregion and sex. Age-stratified crude mortality and DALYs identified high-burden subgroups. Risk attribution was assessed using DALY percentages and temporal risk-factor (RF) rankings from 1990 to 2021. Statistics were performed in Microsoft Excel. Results: ASIR declined in High-Income North America (HI-NA; EAPC −0.80%/y) but rose in East Asia (+1.75%/y), Southeast Asia (+1.45%/y), South Asia (+0.46%/y), and High-Income Asia-Pacific (HI-AP; +0.33%/y); Central Asia was ~stable (−0.15%/y). Age patterns: male incidence exceeded female through most ages, with female incidence/deaths surpassing in the oldest groups. Examples: HI-NA incidence peaks: males 70–74y (20,275.87), females ≥85y (18,583.52); deaths peak at ≥85y (males 7,584.57; females 11,963.02). HI-AP shows analogous late-life peaks (male ≥85y deaths 10,729.30; female ≥85y 19,288.32). South Asia uniquely shows female-higher incidence/deaths at 15–59y, reversing after 60y. Southeast and Central Asia display male-higher burdens to ~75–79y, with female predominance ≥80y; East Asia has male-higher across ages but similar age-peak structure by sex. Across regions, the largest gender disparity in attributable burden is consistently seen in diet low in milk. Processed/red meat burdens are highest in HI-NA (12.09; 16.21) and substantial in East Asia (red meat 15.80). Diet low in calcium is highest in Southeast Asia (26.07). High BMI shows minimal sex disparity in HI-NA/HI-AP; alcohol disparity is slightly greater in East Asia. Conclusions: CRC incidence is falling in HI-NA but rising across Asia,fastest in East and Southeast Asia, with late-life female predominance in several regions. Prevention priorities include boosting calcium/dairy access in Asia, reducing red/processed meat in HI-NA, and risk-adapted screening that anticipates rapid Asian increase. ASIR (per 100,000) by region and year; EAPC 1990–2021 (both sexes). Region 1990 2000 2010 2021 EAPC (%/y) High-Income North America 47.34 49.08 43.70 38.75 −0.80 High-Income Asia-Pacific 39.72 44.15 45.68 44.89 +0.33 East Asia 19.08 20.94 25.89 31.60 +1.75 Southeast Asia 11.28 13.34 15.66 17.70 +1.45 Central Asia 12.90 10.38 10.88 10.82 −0.15 South Asia 4.69 4.86 4.86 5.65 +0.46

Background Drug use disorders (DUDs) is a serious global health crisis, particularly affecting adolescents and young people. The increasing prevalence of DUDs has led to the development of chronic diseases, including cancer, although it has significant impacts on health and life, it is often overlooked in research. Method This study utilized GBD 2021 data to assess the burden of four drug use disorders in the young adult population. The data, covering 1991 to 2021, included metrics such as age-sex-year incidence, prevalence, deaths, and disability-adjusted life years (DALYs). Age-standardized rates were used for comparing burden across years and regions, and joinpoint analysis evaluated trends. The Bayesian Age-Period-Cohort model was employed to project future burden. The study also examined the relationship between DUDs burden and socio-economic conditions using the Social Development Index (SDI) and stratified data by WHO regions. Additionally, population attributable fractions were calculated within the GBD comparative risk assessment framework. Results Cannabis use disorder (CUDs) emerged as the most prevalent, the ASPR was 617.22/100,000 in 2021. The highest age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR) was observed in OUDs, at (1.46 [1.37-1.55]) and (236.61[185.21-292.47]), respectively. The region of the Americas accounted for the largest proportion of this burden. Opioid use disorders (OUDs) exhibited a notable rising trend, with the age-standardized prevalence rate (ASPR) of 359.62/100,000 in 2021, with a concentration primarily in the European region and the region of the Americas. Male had a higher burden of DUDs than female in the young adults. The burden of DUDs was mainly concentrated under the age of 25, especially CUDs and OUDs. The ASMR and ASDR of DUDs also showed significant growth trends in high SDI areas. Drug use’s contribution to cancer risk, particularly liver cancer due to hepatitis C virus (HCV), had been progressively increasing. Conclusions The burden of OUDs and CUDs, continued to escalate annually, especially among young adult males who face heightened risks. Notably, drug use is increasingly contributing to liver cancer mortality and DALYs, emphasizing the urgency of interventions. This study provides evidence for evaluating the burden transfer between different demographic data.

Background Thyroid cancer, a leading type of endocrine cancer, accounts for 3–4% of all cancer diagnoses. This study aims to analyse and compare thyroid cancer patterns in China and the Group twenty (G20) countries, and predict these trend for the upcoming two decades. Methods This observational longitudinal study utilised data from the Global Burden of Disease (GBD) study 2019. We used metrics including incidence, mortality, mortality-incidence ratio (MIR), age-standardised rate (ASR) and average annual percent change (AAPC) to examine thyroid cancer trends. Joinpoint regression analysis was used to identify periods manifesting notable changes. The association between sociodemographic index (SDI) and AAPC were investigated. The autoregressive integrated moving average (ARIMA) model was used to predict thyroid cancer trends from 2020 to 2040. Results From 1990 to 2019, thyroid cancer incidence cases in China increased by 289.6%, with a higher AAPC of age-standardised incidence rate (ASIR) in men. Contrastingly, the G20 demonstrated a smaller increase, particularly among women over 50. Despite the overall age-standardised mortality rate (ASMR) was higher in the G20, the increase in mortality was less pronounced than in China. Age-standardised incidence rate increased across all age groups and genders, with a notable rise among men aged 15–49. ASMR decreased in specific age groups and genders, especially among women. Conversely, the ASMR significantly increased in group aged over 70. The MIR exhibited a declining trend, but this decrease was less noticeable in men and the group aged over 70. Joinpoint analysis pinpointed significant shifts in overall ASIR and ASMR, with the most pronounced increase in ASIR during 2003–2011 in China and 2003–2010 in the G20. Predictions suggested a continual ASIR uptrend, especially in the 50–69 age group, coupled with a predicted ASMR downturn among the elderly by 2040. Moreover, the proportion of thyroid cancer deaths attributable to high body mass index (BMI) escalated, with significant increase in Saudi Arabia and a rise to 7.4% in China in 2019. Conclusions Thyroid cancer cases in incidence and mortality are escalating in both China and the G20. The increasing trend may be attributed to factors beyond overdiagnosis, including environmental and genetic factors. These findings emphasise the necessity for augmenting prevention, control, and treatment strategies. They also highlight the significance of international collaboration in addressing the global challenge posed by thyroid cancer.

Background: The clinical outcome for patients with chronic myeloid leukemia (CML) has changed dramatically in the past two decades, especially after the rise of Tyrosine Kinase Inhibitors. Conversely, the outcome has been worse for countries with lower socioeconomic statuses. Comprehensive epidemiological research is warranted to evaluate the global burden of CML based on SDI. Method: Our team used data from the Global Burden of disease (GBD) 2021 database. The analysis was done using the Institute of Health metrics and evaluation (IHME) GBDx data tool. GBD estimated the burden of diseases, injuries, and risk factors for 204 countries and territories and selected subnational locations. Incidence, death, disability-adjusted life-years (DALYs), and its corresponding age-standardized rate between 1990 to 2021 were used to describe the distribution of CML burden according to age, sex, social-demographic index (SDI). Results: The incidence of CML globally in 2021 was 35830 .87(95%, 27938.95-42,581.45) as compared to 39481.75(95%, 33292.61- 45117.18) in 1990. The Estimated total percentage change in incidence has decreased in High SDI and High Middle SDI countries; however, it has increased in Middle, Low Middle, and Low SDI countries. There were 29220.42 (95%, 23525.47-34250.55) deaths in 1990, distributed as 4% in Low SDI, 14% in Low Middle SDI, 21% in Middle SDI, 23% in high middle SDI and 38% in High SDI countries. Similarly, there were 23159.13(95%, 17502.80-28477.39) deaths due to CML in 2021. Deaths were distributed as 7% in Low SDI, 23% in Low Middle SDI, 28% in Middle SBI, 18% in High Middle SDI and 24% in High SDI Countries. The absolute change in the percentage of deaths decreased globally by -0.21 (-0.01 to -0.34). The absolute change in the percentage of death decreased in High SDI and high middle SDI countries and increased in Middle SDI, Low middle SDI, and Low SDI countries. The Absolute Percentage Change in DALY in 2020 compared to 1990 decreased -0.36(95%, -0.14 to -0.50) globally. All categories of countries based on SDI had decreased DALY except Low SDI countries, which had an increased absolute change in DALY of 0.17. Similar results were obtained when data was stratified by age and sex. Conclusion The disease burden of CML has decreased globally, especially in countries with higher SBI, in the past three decades. The increase in incidence and death rates was mainly observed in lower SDI countries. Increasing resources and aid to lower SDI countries can help to decrease the global burden of CML.

Background Hypertension remains the leading risk factor for cardiovascular disease (CVD) worldwide, and its impact in Brazil should be assessed in order to better address the issue. We aimed to describe trends in prevalence and burden of disease attributable to high systolic blood pressure (HSBP) among Brazilians ≥ 25 years old according to sex and federal units (FU) using the Global Burden of Disease (GBD) 2017 estimates. Methods We used the comparative risk assessment developed for the GBD study to estimate trends in attributable deaths and disability-adjusted life-years (DALY), by sex, and FU for HSBP from 1990 to 2017. This study included 14 HSBP-outcome pairs. HSBP was defined as ≥ 140 mmHg for prevalence estimates, and a theoretical minimum risk exposure level (TMREL) of 110–115 mmHg was considered for disease burden. We estimated the portion of deaths and DALYs attributed to HSBP. We also explored the drivers of trends in HSBP burden, as well as the correlation between disease burden and sociodemographic development index (SDI). Results In Brazil, the prevalence of HSBP is 18.9% (95% uncertainty intervals [UI] 18.5–19.3%), with an annual 0.4% increase rate, while age-standardized death rates attributable to HSBP decreased from 189.2 (95%UI 168.5–209.2) deaths to 104.8 (95%UI 94.9–114.4) deaths per 100,000 from 1990 to 2017. In spite of that, the total number of deaths attributable to HSBP increased 53.4% and HSBP raised from 3rd to 1st position, as the leading risk factor for deaths during the period. Regarding total DALYs, HSBP raised from 4th in 1990 to 2nd cause in 2017. The main driver of change of HSBP burden is population aging. Across FUs, the reduction in the age-standardized death rates attributable to HSBP correlated with higher SDI. Conclusions While HSBP prevalence shows an increasing trend, age-standardized death and DALY rates are decreasing in Brazil, probably as results of successful public policies for CVD secondary prevention and control, but suboptimal control of its determinants. Reduction was more significant in FUs with higher SDI, suggesting that the effect of health policies was heterogeneous. Moreover, HSBP has become the main risk factor for death in Brazil, mainly due to population aging.

Lung cancer and liver cancer are the leading and third causes of cancer death, respectively. Both lung and liver cancer are with clear major risk factors. A thorough understanding of their burdens in the context of globalization, especially the convergences and variations among WHO regions, is useful in precision cancer prevention worldwide and understanding the changing epidemiological trends with the expanding globalization. The Global Burden of Disease (GBD) and WHO Global Health Observatory (GHO) database were analyzed to evaluate the burden metrics and risk factors of trachea, bronchus, and lung (TBL) cancer and liver cancer. Western Pacific Region (WPR) had the highest age-standardized incidence rate (ASIR) for both liver cancer (11.02 [9.62–12.61] per 100,000 population) and TBL cancer (38.82 [33.63–44.04] per 100,000 population) in 2019. Disability-adjusted life years (DALYs) for liver and TBL cancer elevated with the increasing sociodemographic index (SDI) level, except for liver cancer in WPR and TBL cancer in European Region (EUR). Region of the Americas (AMR) showed the biggest upward trends of liver cancer age-standardized rates (ASRs), as well as the biggest downward trends of TBL cancer ASRs, followed by Eastern Mediterranean Region (EMR). Alcohol use and smoking were the leading cause of liver and TBL cancer death in most WHO regions. Variances of ASRs for liver and TBL cancer among WHO memberships have been decreasing during the past decade. The homogenization and convergence of cancer burdens were also demonstrated in different agegroups and sexes and in the evolution of associated risk factors and etiology. In conclusion, our study reflects the variations and convergences in the liver and lung cancer burdens among the WHO regions with the developing globalization, which suggests that we need to be acutely aware of the global homogeneity of the disease burden that accompanies increasing globalization, including the global convergences in various populations, risk factors, and burden metrics.

Introduction : To explore disparities in socio-demographic development levels across countries and comprehensively examine the burden of hematologic malignancies (HMs), including leukemia, Hodgkin lymphoma(HL), non-Hodgkin lymphoma(NHL), multiple myeloma(MM), as well as myeloproliferative neoplasm(MPN). Method s：We obtained the estimates, along with their 95% uncertainty interval (UI), for disability-adjusted life-years (DALYs) related to various HMs from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. We illustrated the age-standardized DALYs rate for these malignancies across 204 countries, along with the global distribution of DALYs rates by age and sex. In order to assess the disparities in the burden of hematologic malignancies, we employed two recommended metrics by the World Health Organization (WHO), namely the slope index of inequality and the concentration index, which quantify absolute and relative gradient inequality, respectively. R esults：In 2019, across 204 countries, there were remarkable variations in the age-standardized DALYs rate for leukemia, HL, NHL, MM, and MPN, with distinct age and sex distributions significantly impacting the global rate of DALYs. The slope index of inequality changed from 28.20 (95% CI: -0.87 to 57.27) in 1990 to 46.03 (95% CI: 26.36 to 65.69) in 2019 for leukemia, from 37.87 (95% CI: 30.32 to 45.41) in 1990 to 45.99 (95% CI: 38.16 to 53.82) in 2019 for AML, from -1.60 (95% CI: -6.57 to 3.36) in 1990 to -2.17 (95% CI: -4.73 to 0.38) in 2019 for CML , from 2.14 (95% CI: -6.59 to 10.86) in 1990 to -10.86 (95% CI: -16.02 to -5.70) in 2019 for ALL, from 12.98 (95% CI: 9.46 to 16.50) in 1990 to 22.42 (95% CI: 17.53 to 27.31) in 2019 for CLL, from -37.44 (95% CI: -57.29 to -17.61) in 1990 to -13.63 (95% CI: -25.69 to -1.56) in 2019 for other leukemia, from 6.97 (95% CI: 1.82 to 12.12) in 1990 to 0.45 (95% CI: -2.90 to 3.79) in 2019 for HL, from 73.00 (95% CI: 55.40 to 90.61) in 1990 to 102.83 (95% CI: 87.33 to 118.32) in 2019 for NHL, from 37.90 (95% CI: 30.19 to 45.62) in 1990 to 77.31 (95% CI: 66.34 to 88.28) in 2019 for MM, from 15.56 (95% CI: 12.97 to 18.15) in 1990 to 30.15 (95% CI: 25.72 to 34.58) in 2019 for MPN. The concentration index showed 0.18 (95% CI: 0.13 to 0.23) in 1990 and 6.95 (95% CI: 6.63 to 7.26) in 2019 for leukemia, 19.22 (95% CI: 17.63-20.80) in 1990 and 17.61 (95% CI: 16.85-18.38) in 2019 for AML, -20.84 (95% CI: -25.58 to -16.10) in 1990 and -20.75 (95% CI: -22.55 to -18.95) in 2019 for CML, -2.83 (95% CI: -3.22 to -2.45) in 1990 and -4.72 (95% CI: -5.05 to -4.39) in 2019 for ALL,37.75 (95% CI: 36.03 to 39.47) in 1990 and 29.12 (95% CI: 27.62 to 30.63) in 2019 for CLL, -3.14 (95% CI: -3.59 to -2.69) in 1990 and 8.56 (95% CI: 7.95 to 9.17) in 2019 for other leukemia,-0.63 (95% CI: -0.68 to -0.58) in 1990 and -13.44 (95% CI: -14.45 to -12.43) in 2019 for HL, 23.25 (95% CI: 22.55 to 23.96) in 1990 and 19.34 (95% CI: 18.55 to 20.13) in 2019 for NHL, 39.05 (95% CI: 37.10 to 41.01) in 1990 and 36.53 (95% CI: 34.66 to-38.40) in 2019 for MM,47.18 (95% CI: 43.52 to 50.84) in 1990 and 47.30 (95%CI: 44.31 to 50.30) in 2019 for MPN. C onclusion：The age-standardized DALYs rate exhibits significant heterogeneity across all countries, alongside variations in the age and sex distribution of the global rate of DALYs for HMs. Moreover, countries with higher levels of socio-demographic development bear a disproportionate burden of HMs, and the extent of these inequalities related to socio-demographic development levels has worsened over time.

Primary central nervous system (CNS) cancers remain a leading global cause of mortality and morbidity. However, comparative analyses between China and global regions during the 1990–2021 period remain lacking in the existing literature.Leveraging data from the Global Burden of Disease Study 2021 (GBD 2021), this study addresses this gap by providing a comparison of primary CNS cancer trends in China and global regions from 1990 to 2021. Through systematic analysis of temporal trends in age- and sex-specific burdens of primary CNS cancers in China—including incidence, prevalence, mortality, and disability-adjusted life years (DALYs)—this study establishes a novel comparative framework aligned with global disease burden metrics. Leveraging the most recent data from the GBD 2021, we elucidate disparities in disease burden and evolving trends between China and global regions. These updated findings provide critical insights for optimizing resource allocation and informing tailored interventions. Using open data from the GBD 2021 database, we analyzed characteristics of CNS cancer burden in China and globally from 1990 to 2021, including changes in incidence, prevalence, mortality, and DALYs.We employed Joinpoint regression analysis to calculate the average annual percentage change (AAPC) with 95% confidence intervals (95%CI), evaluating temporal trends in CNS cancer burden.A comparative analysis was conducted across multiple dimensions (age, sex, and time periods) to examine differences in CNS cancer burden between China and other world regions. From 1990 to 2021, the age-standardized incidence rate (ASIR) of CNS cancers in China increased from 4.69 to 6.12 per 100,000 population, while the global ASIR rose from 3.75 to 4.28 per 100,000.The age-standardized prevalence rate (ASPR) in China increased from 9.68 to 21.23 per 100,000, compared with a global increase from 8.66 to 12.01 per 100,000.China’s age-standardized mortality rate (ASMR) declined from 4.05 to 3.63 per 100,000, whereas the global ASMR showed a marginal increase from 3.04 to 3.06 per 100,000.The age-standardized DALY rate (ASDR) decreased from 174.36 to 134.15 per 100,000 in China, with a corresponding global decline from 119.88 to 107.91 per 100,000.The average annual percentage changes (AAPCs) were 0.86%, 2.53%, -0.34%, and − 0.87% for ASIR, ASPR, ASMR, and ASDR in China, respectively, compared with global AAPCs of 0.42%, 1.06%, 0.01%, and − 0.35%.Age and sex exhibited differential impacts on CNS cancer burden. From 1990 to 2021, China experienced sustained increases in both ASIR and ASPR of CNS cancers, indicating a growing disease burden.The disease burden exhibited significant age and sex disparities: males showed higher ASIR, ASMR, and ASDR, whereas females had higher ASPR.Age-specific analysis revealed higher ASIR, ASPR, ASMR and ASDR among pediatric and elderly populations in China.Given China’s large population and accelerating aging demographics, CNS cancers remain a major public health challenge.We recommend developing targeted surveillance strategies for aging and high-risk populations, establishing a comprehensive “prevention-diagnosis-rehabilitation” management framework.This would facilitate a paradigm shift from passive treatment to proactive prevention, systematically alleviating the public health burden of CNS tumors.

Decubitus ulcers (DUs) represent a substantial global public health challenge, significantly diminishing patient quality of life and increasing the incidence of infection and early mortality. Given the rapidly aging populations in major East Asian economies, including China, Japan, South Korea, and Taiwan (Province of China), a comparative analysis of the DU burden across these regions is lacking. Leveraging data from the Global Burden of Disease (GBD) 2021 study, this study quantified the epidemiological burden of DUs globally and specifically within China, Japan, South Korea, and Taiwan (Province of China) during the period 1990–2021. Analyses evaluated key metrics including incidence, mortality, and disability-adjusted life years (DALYs), presenting both absolute counts and age-standardized rates (ASRs). Temporal trends in these burden estimates were assessed using Joinpoint regression analysis to identify significant inflection points. Future burden projections were generated via autoregressive integrated moving average (ARIMA) modeling. Comprehensive stratification by sex, age group, geographical region, and temporal interval was performed throughout all analyses. Between 1990 and 2021, the global disease burden of DUs escalated markedly, with incident cases surging by 116.03% to an estimated 2.5 million worldwide in 2021. China recorded the largest absolute increase, with cases rising from 163,510 to over 397,310 (+ 142.99%), alongside dramatic upticks in mortality (from 240 to 3,130 deaths, + 1188.89%) and DALYs (+ 417.70%). Japan and South Korea also experienced substantial growth in incidence (from 68,090 to 152,660 and 16,480 to 39,840, respectively) and mortality. Taiwan (Province of China) exhibited the highest relative increase in incidence (+ 194.53%, reaching 4,950 cases in 2021), though its overall disease burden remained comparatively modest. Age-standardized rate analyses revealed divergent trends: China was the sole region with significant increases in incidence, mortality, and DALY rates, whereas Taiwan (Province of China) demonstrated the most significant reductions, and both South Korea and global rates generally declined. Males exhibited a higher disease burden, particularly in China, and the elderly—especially those aged 80 and above—were at greatest risk, with demographic aging identified as a key contributing factor. Forecasts for the coming decade suggest a continued upward trajectory in total DU cases across all examined countries and regions, with China projected to experience the most pronounced absolute increase. DUs continue to represent a significant and escalating public health concern, especially within China. The increasing prevalence of an aging population serves as a primary catalyst, underscoring the urgent need for the deployment of regionally tailored and demographically stratified (notably by age and sex) healthcare policies and precision-based interventions. These results provide critical evidence to inform the optimization of DU management and the mitigation of geographic disparities. Subsequent research should prioritize the exploration of socioeconomic determinants and the enhancement of healthcare accessibility.

BackgroundIn calculations of burden of disease using disability-adjusted life years, disability weights are needed to quantify health losses relating to non-fatal outcomes, expressed as years lived with disability. In 2012 a new set of global disability weights was published for the Global Burden of Disease 2010 (GBD 2010) study. That study suggested that comparative assessments of different health outcomes are broadly similar across settings, but the significance of this conclusion has been debated. The aim of the present study was to estimate disability weights for Europe for a set of 255 health states, including 43 new health states, by replicating the GBD 2010 Disability Weights Measurement study among representative population samples from four European countries.MethodsFor the assessment of disability weights for Europe we applied the GBD 2010 disability weights measurement approach in web-based sample surveys in Hungary, Italy, Netherlands, and Sweden. The survey included paired comparisons (PC) and population health equivalence questions (PHE) formulated as discrete choices. Probit regression analysis was used to estimate cardinal values from PC responses. To locate results onto the 0-to-1 disability weight scale, we assessed the feasibility of using the GBD 2010 scaling approach based on PHE questions, as well as an alternative approach using non-parametric regression.ResultsIn total, 30,660 respondents participated in the survey. Comparison of the probit regression results from the PC responses for each country indicated high linear correlations between countries. The PHE data had high levels of measurement error in these general population samples, which compromises the ability to infer ratio-scaled values from discrete choice responses. Using the non-parametric regression approach as an alternative rescaling procedure, the set of disability weights were bounded by distance vision mild impairment and anemia with the lowest weight (0.004) and severe multiple sclerosis with the highest weight (0.677).ConclusionsPC assessments of health outcomes in this study resulted in estimates that were highly correlated across four European countries. Assessment of the feasibility of rescaling based on a discrete choice formulation of the PHE question indicated that this approach may not be suitable for use in a web-based survey of the general population.

Background The prevalence and burden of disease resulting from obesity have increased worldwide. In Brazil, more than half of the population is now overweight. However, the impact of this growing risk factor on disease burden remains inexact. Using the 2017 Global Burden of Disease (GBD) results, this study sought to estimate mortality and disability-adjusted life years (DALYs) lost to non-communicable diseases caused by high body mass index (BMI) in both sexes and across age categories. This study also aimed to describe the prevalence of overweight and obesity throughout the states of Brazil. Methods Age-standardized prevalence of overweight and obesity were estimated between 1990 and 2017. A comparative risk assessment was applied to estimate DALYs and deaths for non-communicable diseases and for all causes linked to high BMI. Results The prevalence of overweight and obesity increased during the period of analysis. Overall, age-standardized prevalence of obesity in Brazil was higher in females (29.8%) than in males (24.6%) in 2017; however, since 1990, males have presented greater rise in obesity (244.1%) than females (165.7%). Increases in prevalence burden were greatest in states from the North and Northeast regions of Brazil. Overall, burden due to high BMI also increased from 1990 to 2017. In 2017, high BMI was responsible for 12.3% (8.8–16.1%) of all deaths and 8.4% (6.3–10.7%) of total DALYs lost to non-communicable diseases, up from 7.2% (4.1–10.8%), and 4.6% (2.4-6.0%) in 1990, respectively. Change due to risk exposure is the leading contributor to the growth of BMI burden in Brazil. In 2017, high BMI was responsible for 165,954 deaths and 5,095,125 DALYs. Cardiovascular disease and diabetes have proven to be the most prevalent causes of deaths, along with DALYs caused by high BMI, regardless of sex or state. Conclusions This study demonstrates increasing age-standardized prevalence of obesity in all Brazilian states. High BMI plays an important role in disease burdens in terms of cardiovascular diseases, diabetes, and all causes of mortality. Assessing levels and trends in exposures to high BMI and the resulting disease burden highlights the current priority for primary prevention and public health action initiatives focused on obesity.

Background: Dietary risk factors constitute some of the leading risk factors for cardiovascular disease in Iran. The current study reports the burden of ischemic heart disease (IHD) attributable to a low omega-3 fatty acids intake in Iran using the data of the Global Burden of Disease (GBD) Study 2010. Methods: We used data on Iran for the years 1990, 2005, and 2010 derived from the GBD Study conducted by the Institute for Health Metrics and Evaluation (IHME) in 2010. Using the comparative risk assessment, we calculated the proportion of death, years of life lost, years lived with disability, and disability-adjusted life years (DALYs) caused by IHD attributable to a low omega-3 fatty acids intake in the GBD studies from 1990 to 2010. Results: In 1990, a dietary pattern low in seafood omega-3 fatty acids intake was responsible for 423 (95% uncertainty interval [UI], 300 to 559), 3000 (95% UI, 2182 to 3840), and 4743 (95% UI, 3280 to 6047) DALYs per 100000 persons in the age groups of 15 to 49 years, 50 to 69 years, and 70+ years — respectively — in both sexes. The DALY rates decreased to 250 (95% UI, 172 to 331), 2078 (95% UI, 1446 to 2729), and 3911 (95% UI, 2736 to 5142) in 2010. The death rates per 100000 persons in the mentioned age groups were 9 (95% UI, 6 to 12), 113 (95% UI, 82 to 144), and 366 (95% UI, 255 to 469) in 1990 versus 6 (95% UI, 4 to 7), 76 (95% UI, 53 to 99), and 344 (95% UI, 241 to 453) in 2010. The burden of IHD attributable to diet low in seafood omega-3 was 1.3% (95% UI, 0.97 to 1.7) of the total DALYs in 1990 and 2.0% (95% UI, 1.45 to 2.63) in 2010 for Iran. Conclusion: The findings of the GBD Study 2010 showed a declining trend in the burden of IHD attributable to a low omega-3 fatty acids intake in a period of 20 years. Additional disease burden studies at national and sub-national levels in Iran using more data sources are suggested for public health priorities and planning public health strategies.

Background Since the Global Burden of Disease study (GBD) has become more comprehensive, data for hundreds of causes of disease burden, measured using Disability Adjusted Life Years (DALYs), have become increasingly available for almost every part of the world. However, undergoing any systematic comparative analysis of the trends can be challenging given the quantity of data that must be presented. Methods We use the GBD data to describe trends in cause-specific DALY rates for eight regions. We quantify the extent to which the importance of ‘major’ DALY causes changes relative to ‘minor’ DALY causes over time by decomposing changes in the Gini coefficient into ‘proportionality’ and ‘reranking’ indices. Results The fall in regional DALY rates since 1990 has been accompanied by generally positive proportionality indices and reranking indices of negligible magnitude. However, the rate at which DALY rates have been falling has slowed and, at the same time, proportionality indices have tended towards zero. These findings are clearest where the focus is exclusively upon non-communicable diseases. Notably, large and positive proportionality indices are recorded for sub-Saharan Africa over the last decade. Conclusion The positive proportionality indices show that disease burden has become less concentrated around the leading causes over time, and this trend has become less prominent as the DALY rate decline has slowed. The recent decline in disease burden in sub-Saharan Africa is disproportionally driven by improvements in DALY rates for HIV/AIDS, as well as for malaria, diarrheal diseases, and lower respiratory infections.

Accurate assessment of population health status and trend is critical for evidence-based decision making in public health. And this information often referred to as the “burden of disease”. The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013), which was conducted by the Institute for Health Metrics and Evaluation (IHME), provides a systematic approach to estimate comprehensive, consistent, and comparable measures of disease burden due to diseases, injuries, and associated risk factors. GBD 2013 results are important input to assist decision maker in identifying emerging threats to population health and opportunities for prevention. It is also a useful tool for comparative health system assessment, planning and evaluating public health programs and preventive interventions. Tobacco smoke, including smoking and exposure to second-hand smoke (SHS), continues to be the leading global cause of preventable death. The global effort such as the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) demonstrates global political

Diabetic mellitus (DM) poses a significant challenge and stress to global health, comparing the burden of disease in the world’s three most populous countries while projecting changes in trends in age-standardized rate (ASR) -deaths and disability adjusted life years (DALYs) up to 2050. Using GBD2021 data, we examined DM trends in China, US, India and globally for 1990–2021, and projected deaths and DALYs for DM (types 1 and 2) for 2022–2050 using Bayesian age-period-cohort (BAPC) model. It was found that the ASR-DALYs and deaths for T1DM are trending downward globally, while those for T2DM are trending upward. In terms of gender differences, the burden of T1DM by gender was insignificant, whereas the burden of disease was significantly higher in men with T2DM than in women. The burden of disease for T1DM peaks around the ages of 40–44 years, while the burden of disease for T2DM peaks at 65–69 years. Population growth and ageing are major factors influencing the disease burden of diabetes. The projection of ASR-deaths and DALYs globally for 2022–2050 showed a decreasing trend in T1DM and an increasing trend in T2DM (especially in China and India). The increasing burden of T2DM disease globally and in three countries by 2050 should be taken seriously.

No abstract available

This year marked the launch of the Global Burden of Disease (GBD) 2021 study, the first presentation of the study to incorporate the devastating direct, and indirect, worldwide impacts from the COVID-19 pandemic on population health. Understanding how the study differs from its predecessors is important to inform the innumerable secondary research opportunities from its use. Population Health Metrics prioritise the appraisal of innovative GBD research that moves the dial beyond reporting population health trends already available from the variety of publicly available GBD data visualisations and tools. Burden of disease studies remain a prominent area of research that contribute towards Population Health Metrics achieving its aim of publishing research that informs advances in the science of population health assessment internationally, nationally, and locally. It also remains important that we appraise the gaps in the GBD study, particularly those which are potentially of high impact in policy-influencing discussions. Innovative local and national research has an important role to play in influencing the development of the future GBD study, as well as research which utilises GBD estimates in innovative ways to achieve positive policy impact.

Oral disorders are major global health issues, affecting 3.5 billion people and imposing significant economic burdens. This study analyzed the distribution and trends of oral disorder burden globally and in China from 1990 to 2021, aiming to inform resource allocation and prevention strategies. Data from the Global Burden of Disease (GBD) 2021 database were used to evaluate the incidence, prevalence, and years lived with disability (YLDs) of oral disorders. All statistical analyses and data visualizations were conducted using R. In 2021, the burden of oral disorders in China accounted for a significant proportion of the global burden. The incidence, prevalence, and YLDs increased by 15.49%, 52.44%, and 86.86% respectively compared with 1990. The global burden also showed an upward trend during the same period. The relevant indicators in China are at a relatively low level, and disparities were observed among regions with different sociodemographic indices (SDI). Oral disorder burden is on the rise globally, with females, children, adolescents, and the elderly being the key affected groups. Regions with middle SDI bear a heavier burden. This study provides a scientific basis for the formulation of relevant policies and emphasizes the necessity of interventions for specific groups.

Abstract   The Global Burden of Disease (GBD) 2023 study offers the most comprehensive and systematic assessment of health trends, disease burden, mortality, and risk factors across countries and regions. Its methodological rigor and global comparability make it a powerful tool for informing public health strategies and resource allocation decisions. As health systems across Europe face growing pressures - from demographic shifts and chronic disease burdens and health inequities the evidence-based planning has never been more essential. This workshop aims to present and critically discuss a European perspective on the GBD 2023 findings, with a focus on how its metrics and insights can support the formulation, prioritization, and implementation of effective health policies across diverse European settings. Participants will explore both the advantages and limitations of applying GBD data in the European context. Specifically, we will examine the relevance of GBD indicators such as Disability-Adjusted Life Years (DALYs), Years of Life Lost (YLLs), and risk factor attributions for aligning national policies with measurable health needs. These metrics allow for comparisons across time, populations, and health conditions - making them highly valuable for strategic planning. At the same time, the workshop will address key challenges in using GBD data at the national and regional level. These include differences in local epidemiological data accessibility, variations in health system structures, and the political and institutional factors that shape how evidence is used in policymaking. The complexity of translating global health estimates into actionable insights for countries with diverse public health priorities will be a central theme. A unique contribution of this session will be the inclusion of country-specific experiences from several countries of different level of health and health system development, like Poland, Sweden and Slovenia. These case studies will illustrate how national health information systems and local databases can be integrated with or compared against GBD results. Presenters will discuss health assessments complements or challenges local monitoring systems and the practical implications for public health planning, funding, and evaluation. The session will conclude with a moderated discussion that reflects on the broader strategic value of GBD 2023 for Europe. Participants will be invited to consider how GBD data can be more effectively integrated into EU-wide and national health governance frameworks, and what steps are needed to ensure that these global tools support locally relevant, equitable health improvements. Key messages • GBD 2023 provides robust, comparable health metrics (e.g., DALYs, YLLs, risk factor attributions) that can enhance evidence-based policy design across diverse European health systems. • Effective integration of GBD data into European and national health strategies requires careful adaptation to local contexts, accounting for differences in data quality, priorities, and system.

Background: Tuberculosis (TB) persists as a leading global health threat. Current surveillance is fragmented, and the surgical burden of drug-resistant forms remains poorly quantified. Methods: Using GBD 2021 (1990–2050) and WHO-GHO (2000–2021), we estimated mortality, incidence, prevalence, and disability-adjusted life years (DALYs) for 204 countries by age, sex, and four TB subtypes: latent tuberculosis infection (LTBI), drug-susceptible tuberculosis (DS-TB), multidrug-resistant tuberculosis (MDR-TB), and extensively drug-resistant tuberculosis (XDR-TB). We compared WHO and GBD figures in eight high-burden countries, applied joinpoint regression to project trends, and quantified risk-factor contributions. Results: In 2021, global TB rates per 100,000 were: prevalence 236.14 (95% UI 214.51–260.20), incidence 103.00 (92.21–114.91), deaths 13.96 (12.61–15.72), and DALYs 580.26 (522.37–649.82). Sociodemographic index (SDI) gradients were steepest for XDR-TB. Smoking, high alcohol use and elevated fasting glucose explained >0.1% of DS-TB DALYs each. WHO-GBD mortality diverged in Bangladesh, Nigeria, and the Democratic Republic of the Congo; incidence differed markedly in Indonesia and the Philippines. Projections indicate rising mortality after 2030 in Indonesia and the Western Pacific under high-risk scenarios. Conclusions: XDR-TB is emerging as the fastest-growing threat. Discrepancies between WHO and GBD compromise resource allocation; harmonisation is urgently needed, especially for surgical services planning in Indonesia and the Western Pacific.

Background Down syndrome (DS), a neurodevelopmental disorder caused by a chromosomal abnormality, poses a major burden on global health. Analyzing the disease burden of DS, both in China and globally, is crucial for refining public health strategies. Methods Using the Global Burden of Disease (GBD) 2021 database, we examined age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life year rate (ASDR) for DS in China and globally from 1990 to 2021. Joinpoint regression analysis was applied to identify temporal trends by calculating the annual percent change (APC) and average annual percent change (AAPC). A bayesian age-period-cohort (BAPC) model was further employed to project prevalence changes from 2022 to 2036. Results From 1990 to 2021, China’s ASIR decreased from 1.68 per 100,000 to 1.18 per 100,000, compared to a global reduction from 1.27 per 100,000 to 0.97 per 100,000. Similarly, ASPR in China fell from 28.01 per 100,000 to 24.8 per 100,000, while globally it dropped from 27.98 per 100,000 to 21.07 per 100,000. Notably, China experienced steeper declines in ASMR (EAPC = −4.18%) and ASDR (EAPC = −3.87%) compared to the global averages (−0.44% and −0.69%, respectively). Joinpoint regression analysis shows that from 1990 to 2021, China’s ASIR (AAPC = −1.15, p < 0.001), ASPR (AAPC = −0.39, p < 0.001), ASDR (AAPC = −2.87, p < 0.001), and ASMR (AAPC = −3.08, p < 0.001) for DS all decreased. The SDI was negatively correlated with ASMR (R = −0.68, p < 0.001) and ASDR (R = −0.66, p < 0.001) but positively associated with ASIR (R = 0.55, p < 0.001) and ASPR (R = 0.80, p < 0.001). Projections from the BAPC model suggest that the ASPR of DS will continue to decline both in China and globally through 2036. Conclusion From 1990 to 2021, the disease burden of DS declined in China and globally. China’s decline in ASMR and ASDR outpaced the global level, though ASIR and ASPR remained higher. To further reduce DS burden, future efforts should prioritize early identification, counseling for informed decision-making, and equitable access to quality lifelong multidisciplinary support for affected individuals.

Background Most epidemiological studies on dementia in China have focused on the elderly population, with a lack of systematic comparisons between the burden of young-onset dementia (YOD) and late-onset dementia (LOD). Methods Based on data from the Global Burden of Disease (GBD) study, this research systematically evaluated changes in the burden of YOD and LOD in China over different time periods. The analysis employed average annual percentage change (AAPC), Bayesian age-period-cohort (BAPC) modeling, decomposition analysis, risk factor attribution analysis, health inequality analysis, and frontier analysis. Results AAPC analysis showed that the growth rate of YOD has significantly outpaced that of LOD since 2012. Forecasting results indicated that the age-standardized rates for both YOD and LOD are expected to continue rising in the future. Decomposition analysis revealed that between 1990 and 2021, the main drivers of the increasing YOD burden shifted from population growth to epidemiological changes and population aging, whereas population growth remained the dominant driver for LOD. Risk factor analysis indicated that the impact of high BMI on both YOD and LOD has become increasingly pronounced. Health inequality and frontier analyses suggested that, although disparities in YOD and LOD burden across different SDI regions were not significant, there remains substantial room for improvement in managing both conditions in China. Conclusion In recent years, YOD has exhibited a more rapid increase compared to LOD, with its driving forces gradually shifting from population-related factors to epidemiological transitions. This highlights the need to strengthen identification and intervention strategies targeting younger and middle-aged populations. Tobacco use, high fasting plasma glucose, and high BMI are key modifiable risk factors shared by both YOD and LOD, with particular attention needed on the sustained impact of high BMI. Although international disparities in health inequality are not pronounced, China still holds considerable potential for improvement in the prevention and control of both YOD and LOD. Future interventions should be more forward-looking, systematic, and tailored to specific population groups.

Other musculoskeletal diseases (OMSDs), as a critical component of the global public health challenge, remain understudied in China. This study aims to systematically analyze the epidemiological characteristics and future trends of OMSDs in China from 1990 to 2021. Based on data from the Global Burden of Disease Study(GBD) 2021, this research focused on prevalence and years lived with disability (YLDs), which were compared with G20 countries. Joinpoint regression was used to identify trend breakpoints, age-period-cohort analysis evaluated the independent effects of age, period, and cohort, and the Autoregressive Integrated Moving Average (ARIMA) model predicted the disease burden through 2041. Between 1990 and 2021, both age-standardized prevalence rates (ASPR) and YLDs rates(ASYR) of OMSDs in China showed upward trends. Two critical turning points in ASPR occurred during 2000—2005 (APC = 1.5%, 95% CI: 1.4—1.6) and 2005—2009 (APC = 0.9%, 95% CI: 0.7—1.0). Age effects indicated that relative risk (RR) first increased and then decreased with age, peaking at 60—64 years (RR = 3.62, 95% CI: 3.62—3.63). Period effects showed a rising trend, while cohort effects revealed declining prevalence and YLDs rates. Projections suggest a gradual increase in burden indicators through 2041. Compared to other G20 countries, China ranked eighth from the bottom in disease burden, approaching the level of Germany. The burden of OMSDs in China continues to rise, particularly among women and the elderly. Although the current burden is at a mid-range level among G20 nations, population aging will exacerbate future challenges. To address this, advocating for healthy lifestyles, strengthening health education, and optimizing healthcare strategies are essential.

Background: Understanding cardiovascular mortality is key for shaping public health priorities. Two major sources in the U.S.—CDC WONDER and the Global Burden of Disease (GBD) study—report mortality differently. While CDC WONDER reflects death certificate data, GBD employs modeling techniques and redistributes ill-defined ("garbage") codes to improve cause of death attribution. Prior comparisons have focused on ischemic heart disease and stroke, but other cardiovascular conditions remain understudied. Methods: We examined trends in valvular heart disease (I34.0-I37.9), hypertensive heart disease (I11.0, I11.9), peripheral arterial disease (I70.2), infective endocarditis (I38), and aortic aneurysm (I71) using both databases from 1999–2020. Annual U.S. mortality data from GBD and CDC WONDER were analyzed. For each condition, absolute deaths and crude mortality rates (CMRs) per 100,000 population were extracted. Percent change from 1999 to 2020 was calculated. CMRs were reported with 95% uncertainty intervals (UI) for GBD and 95% confidence intervals (CI) for CDC WONDER. Results: Substantial differences were found between the databases. Valvular heart disease deaths rose by 38.8% (GBD) and 32.2% (CDC). CMRs increased from 7.15 (UI: 7.62–6.18) to 8.33 (9.12–6.74) in GBD and from 11.8 (CI: 11.7–11.9) to 13.2 (13.1–13.4) in CDC. Hypertensive heart disease exhibited the most pronounced increase where deaths rose by 147.2% (GBD) and 474.7% (CDC). GBD CMRs rose from 10.6 (11.2–9.46) to 22.0 (23.62–19.21); CDC from 8.9 (9.2–8.9) to 43.8 (44.3–43.8). Peripheral arterial disease deaths rose 20.9% (GBD) but fell 50.4% (CDC). CMRs changed from 3.21 (3.45–2.82) to 3.26 (3.55–2.78) in GBD and from 0.6 (0.6–0.7) to 0.3 (0.3–0.3) in CDC. Infective endocarditis deaths increased by 41.9% (GBD) and 36.4% (CDC). CMRs rose from 2.4 (2.53–2.17) to 2.86 (3.07–2.50) in GBD and from 3.3 (3.4–3.3) to 3.8 (3.9–3.8) in CDC. Aortic aneurysm deaths declined 31.6% (GBD) and 18.9% (CDC). GBD CMRs fell from 6.19 (6.45–5.63) to 3.55 (3.76–3.15); CDC from 7.9 (8.0–7.8) to 5.4 (5.5–5.3). Conclusion: Cardiovascular mortality trends varied significantly between GBD and CDC WONDER. Differences were especially striking in hypertensive heart disease and peripheral arterial disease, likely due to methodological variation in death coding and redistribution. Awareness of these discrepancies is crucial for interpreting national mortality data and informing policy.

Objectives To compare the global burden of myocardial disease (MD) and ischemic heart disease (IHD) attributable to high and low temperatures, and to examine demographic and socio-economic disparities over time. Methods We analyzed disability-adjusted life years (DALYs) and mortality for MD and IHD attributable to high and low temperatures, stratified by sex, age, region, and socio-demographic index (SDI). Decomposition analysis quantified the contributions of population growth, aging, and epidemiological changes. Projections were generated using an age-period-cohort model. Results Between 1990 and 2021, high temperature-related MD and IHD burdens increased [Estimated Annual Percent Change (EAPC): +1.26 and +1.68%, respectively], whereas low temperature burdens declined (EAPC: −1.87 and −1.73%) but remained considerably higher overall. MD disproportionately affected children under five and adults over 80, while IHD rarely appeared under 30 yet rose markedly from midlife onward. Heat-related MD and IHD burdens rose with SDI < 0.5 and declined above 0.5; cold-related burdens decreased consistently above SDI 0.75 but varied irregularly below this threshold. Central Asia exhibited the greatest heat- and cold-related burdens for both MD and IHD, whereas North Africa and the Middle East were particularly susceptible to heat. Population growth primarily fueled heat-related burdens, whereas cold-related burdens were more driven by aging and population change. Projections to 2040 indicate continuing increases in heat-related burdens, potentially exacerbating health disparities. Conclusions Heat-attributable IHD is the fastest-growing threat, while MD remains critical for very young and older adult populations under extreme temperatures. Disparities across age, SDI, and geography highlight the urgency for targeted interventions.

Background Cardiovascular diseases (CVDs) are not only the primary cause of mortality in China but also represent a significant financial burden. The World Health Organization highlight that as China undergoes rapid socioeconomic development, its disease spectrum is gradually shifting towards that of developed countries, with increasing prevalence of lifestyle-related diseases such as ischemic heart disease and stroke. We reviewed the rates and trends of CVDs incidence, mortality and disability-adjusted life years (DALYs) burden in China and compared them with those in the United States (US) and Japan for formulating CVDs control policies. Methods Data on CVDs incidence, death and DALYs in China, the US and Japan were obtained from the GBD 2019 database. The Joinpoint regression model was used to analyze the trends in CVDs incidence and mortality in China, the US and Japan, calculate the annual percentage change and determine the best-fitting inflection points. Results In 2019, there were approximately 12,341,074 new diagnosed cases of CVDs in China, with 4,584,273 CVDs related deaths, causing 91,933,122 DALYs. The CVDs age-standardized incidence rate (ASIR) in China (538.10/100,000) was lower than that in the US and globally, while age-standardized death rate (ASDR) (276.9/100,000) and age-standardized DALY rate (6,463.47/100,000) were higher than those in the two regions. Compared with the US and Japan, from 1990 to 2019, the CVDs incidence rate in China showed an increasing trend, with a lower annual decrease in ASDR and a younger age structure of disease burden. Furthermore, the disease spectrum in China changed minimally, with stroke, ischemic heart disease, and hypertensive heart disease being the top three leading CVDs diseases in terms of incidence and disease burden, also being the major causes of CVDs in the US and Japan. Conclusion The prevention and control of CVDs is a global issue. The aging population and increasing unhealthy lifestyles will continue to increase the burden in China. Therefore, relevant departments in China should reference the established practices for CVDs control in developed countries while considering the diversity of CVDs in different regions when adjusting national CVDs control programs.

Background This article aimed to compare the EAT-Lancet Commission’s “Planetary Health Diet” (PHD) with the Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease Study 1990-2017 (GBD2017) dietary and other risk factor data. In the PHD/GBD comparison, we also intended to show the relevance of a new multiple regression analysis methodology with dietary and non-dietary risk factors (independent variables) for noncommunicable disease (NCD) deaths/100000/year in males and females 15-69 years old from 1990 to 2017 (NCDs, dependent variable). Methods We formatted worldwide GBD2017 dietary risk factors and NCD data on 1120 worldwide cohorts to obtain 7846 population-weighted cohorts. Each cohort represented about one million people, totaling about 7.8 billion people from 195 countries. With an empirically derived methodology, we compared the PHD animal- and plant-sourced food recommended ranges (kilocalories/day=KC/d) with optimal dietary ranges (KC/d) from GBD cohort data. Using GBD data subsets with low and high animal food consumption cohorts, our new GBD multiple regression formula derivation methodology equated risk factor formula coefficients to their population-attributable risk percents (PAR%s). Results We contrasted PHD recommendations for the available 14 dietary risk factors (KC/d means and ranges) with our GBD analysis methodology’s optimal ranges for each dietary variable (KC/d mean and range): PHD beef, lamb, and pork mean: 30 KC/d (range: 0-60 KC/d)/GBD processed meat: 8.86 (1.69-16.03)+GBD red meat: 44.52 (20.37-68.68), PHD fish: 40 (0-143)/GBD: 19.68 (3.45-35.90), PHD whole milk or equivalents: 153 (0-306)/GBD: 40.00 (18.89-61.11), PHD poultry: 62 (0-124)/GBD: 56.10 (24.13-88.07), PHD eggs: 19 (0-37)/GBD: 19.42 (9.99-28.86), PHD: saturated oils 96 (0-96)/GBD added saturated fatty acids (SFA): 116.55 (104.04-129.07), PHD all added sugars: 120 (0-120)/GBD sugary beverages: 286.37 (256.99-315.76), PHD tubers or starchy vegetables: 39 (0-78)/GBD potatoes: 84.16 (75.75-92.58)+GBD sweet potatoes: 9.21 (4.05-14.37), PHD fruits: 126 (63-189)/GBD: 63.03 (21.61-113.71), PHD vegetables: 78.32 (9.48-196.14)/GBD: 85.05 (66.75-103.36), PHD nuts: 291 (0-437)/GBD nuts and seeds: 10.97 (5.95-15.98), PHD whole grains: 811 (811/811)/GBD: 56.14 (50.53-61.76), PHD legumes: 284 (0-379)/GBD: 59.93 (45.43-74.43), and total animal food PHD: (0/400)/GBD: 329.84 (212.49-447.19). Multiple regression low and high animal food subsets’ (animal foods mean=147.09 KC/d versus animal foods mean=482.00 KC/d) formulas each with 28 dietary and non-dietary risk factors (independent variables) accounted for 52.53% and 28.83% of their respective total formula PAR%s with NCDs (dependent variable). Conclusions GBD data modeling supported many but not all the PHD dietary recommendations. GBD data suggested that the amount of consumption of animal foods was the dominant determinate of NCDs of countries globally. Adding to the univariate associations, multiple regression risk factor formulas with risk factor coefficients equated to their PAR%s further elucidated dietary influences on NCDs. This paper and the soon-to-be-released IHME GBD2021 (1990-2021) data should help inform the EAT-Lancet 2.0 Commission’s work.

ABSTRACT Even with a reduced burden of malaria in sub-Saharan Africa (SSA), differences remain in the rate of change among countries and sub-regions. We used data from the Global Burden of Disease Study 2019 to establish the relationship between Development Assistance for Health (DAH) and governance and trends in malaria burden in SSA. The trend was estimated using the Joinpoint regression program and the Institute of Health Metrics and Evaluation’s DAH database, and World Bank Governance Indicators to analyze the DAH and governance respectively from 2000 to 2017 and used two-way fixed effects to establish their association with the trend in the period. The findings showed decreases in SSA’s age-standardised rates for disability-adjusted life years (ASDR) (−47% (95% uncertainty interval (UI) −69% to −14%)), deaths (−38% (95% UI −65% to −3%)), incidence (−35% (95% UI −44% to −25%)), and prevalence (−34% (95% UI −43% to −24%)). Decreases in ASDR were associated with increases in DAH (β −134.18, standard error (SE) 27.26) and governance scores (β −246.19, SE 39.13). The association between reductions in malaria burden and increases in DAH and in governance scores shows the need for accelerated funding of malaria programs and advocacy for better disease governance in malaria-endemic countries. Abbreviations: APC: Annual percentage change; ASDR: Age-standardised disability-adjusted life-year rate; ASIR: Age-standardised incidence rate; ASIR: Age-standardised incidence rate; ASMR: Age-standardised mortality rate; CSSA: Central sub-Saharan Africa; DAH: Development Assistance for Health; DALYs: Disability-adjusted life years; ESSA: Eastern sub-Saharan Africa; GBD: Global burden of disease; GHDx Global Health Data Exchange; IHME: Institute of Health Metrics and Evaluation; SDGs: Sustainable Development Goals; SSA: Sub-Saharan Africa; SSSA: Southern sub-Saharan Africa; UNSD: United Nations Statistics Division; USD: United States dollars; WGI: World Bank Governance Indicators; WHO: World Health Organization; WSSA: Western sub-Saharan Africa

Background and aims Cardiometabolic diseases (CMDs), including cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM), remain major global health challenges. High alcohol use (HAU) is a modifiable risk factor. This study quantified the global, regional, and temporal trends in the burdens of CMDs attributable to HAU from 1990 to 2021 and projected trends to 2040. Methods and results Global Burden of Disease 2021 (GBD 2021) estimates for 204 countries and territories were analyzed to quantify HAU-attributable deaths, disability-adjusted life years (DALYs), and age-standardized mortality and DALY rates (ASMRs, ASDRs). HAU-attributable burdens were interpreted as model-based scenario estimates under the GBD 2021 comparative risk assessment framework, and not as individual-level causal effects. Associations with the Sociodemographic Index (SDI) were assessed. Trends in rates were summarized using estimated annual percentage change (EAPC) as a descriptive metric derived from log-linear regression on GBD age-standardized rate estimates, and projections were generated with a Bayesian age–period–cohort model. Although global HAU exposure declined, HAU-attributable deaths and DALYs from CVD and T2DM increased, with higher burdens among males and middle-aged adults. From 1990 to 2021, EAPCs based on age-standardized rates suggested modest declines in HAU-attributable CVD-related ASMR and ASDR (−1.53 and −1.31), whereas HAU-attributable T2DM ASMR and ASDR showed an overall increasing tendency (0.48 and 1.83), particularly in low- and middle-SDI regions. Eastern and Central Europe had the highest HAU-attributable CVD burden; Oceania and Central Latin America had the highest T2DM burden. By 2040, under a business-as-usual continuation of recent trends, scenario-based projections suggest that deaths attributable to HAU could rise substantially (on the order of 70% for CVD and nearly three-fold for T2DM), with widening sex disparities and greater quantitative uncertainty for CVD than for T2DM. Conclusion Despite declining alcohol exposure, the burden of CMDs attributable to HAU is escalating–especially for T2DM, males, and populations in low and middle SDI regions. Region-specific interventions and stronger alcohol-control policies are urgently needed.

BACKGROUND Maternal disorders (MDs) remain a major global public health concern. However, comparative assessments integrating the long-term burden of MD subcategories at both global and national levels, particularly in China, and their associations with demographic and policy-related factors remain limited. This study aimed to evaluate temporal trends in MD burden and investigate key drivers, with a focus on women of advanced maternal age. METHODS Data on incidence, disability-adjusted life years (DALYs), and corresponding age-standardized rates (ASIR and ASDR) for six MD categories were obtained from the Global Burden of Disease (GBD) Study 2021. Temporal trends were examined using Joinpoint regression. Age-period-cohort (APC) models were applied to assess age, period, and cohort effects. Decomposition analysis was conducted to quantify the contributions of population growth, population aging, and epidemiologic changes to the increasing MD burden among pregnant and postpartum women aged 30-54. RESULTS From 1990 to 2021, China achieved substantial reductions in ASIR and ASDR across all six MD categories, exceeding global declines. Nevertheless, incidence burden increased among women aged ≥30, particularly those aged 30-34 and older, driven by positive local drifts. Globally, DALY rates associated with miscarriage and abortion increased among women younger than 30. APC analyses indicated sustained declines in mortality and disability severity worldwide, whereas China experienced periodic increases in incidence risk beginning with the 2010 period and the 1997 birth cohort. Decomposition analysis identified population growth as the primary contributor to the rising MD burden among Chinese women aged 30-54. CONCLUSIONS Despite marked progress in reducing MD burden, China may face emerging challenges from the shifting MD burden patterns in specific population subgroups, likely related to fertility policy changes, delayed childbearing, lifestyle and cultural factors, and population expansion. Strengthened screening, targeted interventions for high-risk populations, and age-specific reproductive health strategies are urgently needed.

In recent years, global accessibility to large ‘big data’ repositories that enable ‘open research’ – such as the UK Biobank, National Health and Nutrition Examination Survey (NHANES), and Global Burden of Disease (GBD) datasets – has created unprecedented opportunities for researchers worldwide to conduct secondary data analyses. This development is particularly beneficial for early-career researchers in low- and middle-income countries (LMICs), as it lets them access large and otherwise costly datasets without the need for local infrastructure, potentially curbing brain drain. However, through our work at the Journal of Global Health (JoGH), we have identified emerging concerns that must be addressed to help preserve the integrity and scientific value of this otherwise positive trend. These include: the risk of ‘paper mills’ mass-producing superficial papers with questionable authorship practices; duplicate publications produced through republishing already available results or by multiple groups testing the same hypothesis using identical datasets and methods without awareness of each other’s work; proliferation of false-positive findings due to inadequate adjustment for multiple testing in large datasets; and the inappropriate or undisclosed use of artificial intelligence (AI) tools in generating manuscripts. To counter these issues while continuing to support legitimate and innovative secondary data analyses, JoGH is introducing guidelines for authors submitting such work for consideration and peer review. These guidelines require authors to declare transparently: their previous published work based on similar datasets or hypotheses; the originality of their research question and design in the context of other similar research; their awareness of related published studies using the same dataset; how they addressed multiple testing statistically; and the role of AI, if any, in manuscript preparation or data analysis. A new, mandatory section in such submitted manuscripts – ‘Adherence to JoGH’s Guidelines for Reporting Analyses of Big Data Repositories Open to the Public (GRABDROP)’ – will summarise these declarations, with full details provided in a supplemental file. This proactive editorial policy aims to safeguard scientific quality while empowering global researchers. By improving transparency and accountability, JoGH seeks to ensure that the benefits of open big data are not undermined by unethical or careless practices. We suggest that other publishers engage in an open discussion on how to address these challenges and consider adopting JoGH’s GRABDROP guidelines or similar measures to maintain trust in scientific outputs derived from secondary analyses. Through these steps, JoGH remains committed to fostering reproducible and equitable global health research.

Abstract The burden of disease (BOD) approach, originating with the Global Burden of Disease (GBD) study in the 1990s, has become a cornerstone for population health monitoring. Despite the widespread use of the Disability-Adjusted Life Year (DALY) metric, variations in methodological approaches and reporting inconsistencies hinder comparability across studies. To tackle this issue, we set out to develop guidelines for reporting DALY calculation studies to improve the transparency and comparability of BOD estimates. The development of the STROBOD statement began within the European Burden of Disease Network, evolving from initial concepts discussed in workshops and training sessions focused on critical analysis of BOD studies. In 2021, a working group was formed to refine the preliminary version into the final Standardised Reporting of Burden of Disease studies (STROBOD) statement, consisting of 28 items structured across six main sections. These sections cover the title, abstract, introduction, methods, results, discussion, and open science, aiming to ensure transparency and standardization in reporting BOD studies. Notably, the methods section of the STROBOD checklist encompasses aspects such as study setting, data inputs and adjustments, DALY calculation methods, uncertainty analyses, and recommendations for reproducibility and transparency. A pilot phase was conducted to test the efficacy of the STROBOD statement, highlighting the importance of providing clear explanations and examples for each reporting item. The inaugural STROBOD statement offers a crucial framework for standardizing reporting in BOD research, with plans for ongoing evaluation and potential revisions based on user feedback. While the current version focuses on general BOD methodology, future iterations may include specialized checklists for distinct applications such as injury or risk factor estimation, reflecting the dynamic nature of this field.

Gretchen Stevens and colleagues present the GATHER statement, which seeks to promote good practice in the reporting of global health estimates.

Background Gastric cancer (GC) is the fifth most common malignancy and the third leading cause of cancer-related mortality worldwide. Although incidence is higher in men, GC remains a significant health issue for women of reproductive age (15–49 years) due to biological, hormonal, and socioeconomic factors. However, this population has been underrepresented in cancer surveillance. This study assessed global, regional, and national GC burden among women from 1990 to 2021 and projected future trends to 2050 using Global Burden of Disease (GBD) 2021 data. Methods We analyzed GBD 2021 data from 204 countries and territories for females aged 15–49. Indicators included incidence, mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs). Temporal trends were quantified using estimated annual percentage change (EAPC) and Joinpoint regression, stratified by Socio-demographic Index (SDI). Forecasts to 2050 were derived from age-period-cohort modeling. This study follows GATHER guidelines. Results From 1990 to 2021, the GC burden in women aged 15–49 declined globally: ASPR decreased from 10.42 to 5.41 per 100,000 (EAPC −2.11), ASIR from 4.61 to 2.13 (EAPC −2.56), ASMR from 2.02 to 0.89 (EAPC −3.02), and ASDR from 59.6 to 23.8 per 100,000 (EAPC −3.00). High-SDI regions achieved the steepest reductions, while low-SDI regions showed modest progress. The burden peaked in women aged 45–49. By 2050, ASIR is projected to reach 2.81 per 100,000 persons (95% CI: 2.06, 3.56), reflecting an increase relative to 2021, largely in low- and middle-SDI countries. Conclusions Despite overall global declines, substantial regional and socioeconomic disparities persist. High-SDI regions benefit from improved healthcare and screening, whereas low-SDI regions face slower progress. Strengthening H. pylori screening, early detection, dietary interventions, and healthcare equity is essential. Region-specific strategies are needed to further reduce the GC burden among women of reproductive age.

The burden of disease (BOD) approach, originating with the Global Burden of Disease (GBD) study in the 1990s, has become a cornerstone for population health monitoring. Despite the widespread use of the Disability-Adjusted Life Year (DALY) metric, variations in methodological approaches and reporting inconsistencies hinder comparability across studies. To tackle this issue, we set out to develop guidelines for reporting DALY calculation studies to improve the transparency and comparability of BOD estimates. The development of the STROBOD statement began within the European Burden of Disease Network, evolving from initial concepts discussed in workshops and training sessions focused on critical analysis of BOD studies. In 2021, a working group was formed to refine the preliminary version into the final Standardised Reporting of Burden of Disease studies (STROBOD) statement, consisting of 28 items structured across six main sections. These sections cover the title, abstract, introduction, methods, results, discussion, and open science, aiming to ensure transparency and standardization in reporting BOD studies. Notably, the methods section of the STROBOD checklist encompasses aspects such as study setting, data inputs and adjustments, DALY calculation methods, uncertainty analyses, and recommendations for reproducibility and transparency. A pilot phase was conducted to test the efficacy of the STROBOD statement, highlighting the importance of providing clear explanations and examples for each reporting item. The inaugural STROBOD statement offers a crucial framework for standardizing reporting in BOD research, with plans for ongoing evaluation and potential revisions based on user feedback. While the current version focuses on general BOD methodology, future iterations may include specialized checklists for distinct applications such as injury or risk factor estimation, reflecting the dynamic nature of this field.

ABSTRACT Background: Generating estimates of health indicators at the global, regional, and country levels is increasingly in demand in order to meet reporting requirements for global and country targets, such as the sustainable development goals (SDGs). However, such estimates are sensitive to availability of input data, underlying analytic assumptions, variability in statistical techniques, and often have important limitations. From a user perspective, there is often a lack of transparency and replicability. In order to define best practices in reporting data and methods used to calculate health estimates, the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) working group developed a minimum checklist of 18 items that must be reported within each study publishing health estimates, so that users may make an assessment of the quality of the estimate. Objective: We conducted a scoping review to assess the state of reporting amongst a cross-sectional sample of studies published prior to the publication of GATHER. Methods: We generated a sample of UN reports and journal articles through a combination of a Medline search and hand-searching published health estimates. From these studies we extracted the percentage of studies correctly reporting each item on the checklist, the proportion of items reported per study (the GATHER performance score), and how this score varied depending on study type. Results: The average proportion of items reported per study was 0.47, and the poorest-performing items related to documentation and availability of input data, availability of the statistical code used and the subsequent output data, and a complete detailed description of all the steps of the data analysis. Conclusions: Methods for health estimates are not currently fully reported, and the implementation of the GATHER guidelines will improve the availability of information required to make an assessment of study quality.

Report on the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized disability-adjusted life years (ASDR) of osteoarthritis and their trends at the global, regional, and national levels using data from the Global Burden of Disease (GBD) 2021 study. We conducted a cross-sectional study to assess the burden of osteoarthritis in relation to age, sex, and socio-demographic indices (SDI) using data from the GBD 2021 study. The ASIR, ASPR, and ASDR at global, regional, and national levels were extracted. The estimated annual percentage change (EAPC) from 1990 to 2021 was then calculated using SDIs, complemented by cluster and frontier analyses. In 2021, there were 606.98 million cases of osteoarthritis globally, with the ASIR increasing from 489.78 to 535 cases per 100,000 individuals between 1990 and 2021 (EAPC 0.33 [95% CI: 0.31–0.35]). This considerable rise was evident across all age groups (especially within the middle-aged group aged 30–60 years), gender groups, SDI quintiles and GBD regions. The East and Southeast Asian regions are concurrently experiencing a notable surge in the ASIR, ASPR, and ASDR associated with osteoarthritis. Frontier analyses indicate that Japan and Singapore possess the highest unrealized health potential. By 2021, the global burden of osteoarthritis had shifted substantially toward East and Southeast Asia, with an especially pronounced surge among middle-aged adults (30–60 years). These observations underscore the imperative for clinicians to recognize osteoarthritis as an emerging midlife health challenge in these regions, calling for earlier diagnosis, tailored preventive strategies, and revised clinical guidelines to address this evolving demographic landscape. Key Points • This study reveals a sharply escalating burden of osteoarthritis among middle-aged adults (30–60 years) in East and Southeast Asia, underscoring an urgent need for clinicians to strengthen early detection and optimize management strategies in this population. • The migration of osteoarthritis’s epicenter to Asia underscores the pressing need for region-specific clinical guidelines and interventions, particularly in nations with substantial unmet health potential such as Japan and Singapore. Key Points • This study reveals a sharply escalating burden of osteoarthritis among middle-aged adults (30–60 years) in East and Southeast Asia, underscoring an urgent need for clinicians to strengthen early detection and optimize management strategies in this population. • The migration of osteoarthritis’s epicenter to Asia underscores the pressing need for region-specific clinical guidelines and interventions, particularly in nations with substantial unmet health potential such as Japan and Singapore.

Reducing the burden of death due to infection is an urgent global public health priority. Previous studies have estimated the number of deaths associated with drug-resistant infections and sepsis and found that infections remain a leading cause of death globally. Understanding the global burden of common bacterial pathogens (both susceptible and resistant to antimicrobials) is essential to identify the greatest threats to public health. To our knowledge, this is the first study to present global comprehensive estimates of deaths associated with 33 bacterial pathogens across 11 major infectious syndromes. We estimated deaths associated with 33 bacterial genera or species across 11 infectious syndromes in 2019 using methods from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, in addition to a subset of the input data described in the Global Burden of Antimicrobial Resistance 2019 study. This study included 343 million individual records or isolates covering 11 361 study-location-years. We used three modelling steps to estimate the number of deaths associated with each pathogen: deaths in which infection had a role, the fraction of deaths due to infection that are attributable to a given infectious syndrome, and the fraction of deaths due to an infectious syndrome that are attributable to a given pathogen. Estimates were produced for all ages and for males and females across 204 countries and territories in 2019. 95% uncertainty intervals (UIs) were calculated for final estimates of deaths and infections associated with the 33 bacterial pathogens following standard GBD methods by taking the 2·5th and 97·5th percentiles across 1000 posterior draws for each quantity of interest. From an estimated 13·7 million (95% UI 10·9-17·1) infection-related deaths in 2019, there were 7·7 million deaths (5·7-10·2) associated with the 33 bacterial pathogens (both resistant and susceptible to antimicrobials) across the 11 infectious syndromes estimated in this study. We estimated deaths associated with the 33 bacterial pathogens to comprise 13·6% (10·2-18·1) of all global deaths and 56·2% (52·1-60·1) of all sepsis-related deaths in 2019. Five leading pathogens-Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Klebsiella pneumoniae, and Pseudomonas aeruginosa-were responsible for 54·9% (52·9-56·9) of deaths among the investigated bacteria. The deadliest infectious syndromes and pathogens varied by location and age. The age-standardised mortality rate associated with these bacterial pathogens was highest in the sub-Saharan Africa super-region, with 230 deaths (185-285) per 100 000 population, and lowest in the high-income super-region, with 52·2 deaths (37·4-71·5) per 100 000 population. S aureus was the leading bacterial cause of death in 135 countries and was also associated with the most deaths in individuals older than 15 years, globally. Among children younger than 5 years, S pneumoniae was the pathogen associated with the most deaths. In 2019, more than 6 million deaths occurred as a result of three bacterial infectious syndromes, with lower respiratory infections and bloodstream infections each causing more than 2 million deaths and peritoneal and intra-abdominal infections causing more than 1 million deaths. The 33 bacterial pathogens that we investigated in this study are a substantial source of health loss globally, with considerable variation in their distribution across infectious syndromes and locations. Compared with GBD Level 3 underlying causes of death, deaths associated with these bacteria would rank as the second leading cause of death globally in 2019; hence, they should be considered an urgent priority for intervention within the global health community. Strategies to address the burden of bacterial infections include infection prevention, optimised use of antibiotics, improved capacity for microbiological analysis, vaccine development, and improved and more pervasive use of available vaccines. These estimates can be used to help set priorities for vaccine need, demand, and development. Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care, using UK aid funding managed by the Fleming Fund.

Heart failure (HF) remains a significant public health challenge globally. This study aims to systematically analyze the global HF disease burden from 1990 to 2021 across temporal, spatial, and demographic dimensions to provide evidence for targeted prevention and control strategies. Using data from the Global Burden of Disease (GBD) 2021 study, we analyzed the global HF burden through prevalent cases, years lived with disability (YLDs), and age-standardized rates per 100,000 population. Temporal trends were evaluated using estimated annual percentage change (EAPC) and joinpoint regression analysis. The relationship between the Socio-demographic Index (SDI) and disease burden was explored through Pearson correlation analysis, while attribution analysis identified the main causes of HF. When appropriate, analyses were stratified by 5 SDI regions, 21 GBD regions, 204 countries and territories, 20 age groups, and both sexes. Global HF prevalence and YLDs burden showed substantial increases from 1990 to 2021, with age-standardized prevalence increasing from 641.14 to 676.68 per 100,000 population. Notably, high-SDI regions exhibited a declining burden since 2019, indicating a potential global turning point. High-income North America bears the heaviest burden while South Asia shows the fastest growth rate. The correlation between disease burden and SDI level was negligible. The disease burden in males consistently exceeded that in females, with prevalence and YLDs rates rising sharply after age 60. The main causes and their attributable proportions were: ischemic heart disease (34.53%), hypertensive heart disease (22.53%), other cardiomyopathies (7.61%), chronic obstructive pulmonary disease (6.51%), and congenital heart anomalies (5.69%), with their distribution patterns differing across age groups and regions. Global burden of HF increased significantly over recent decades, with a potential turning point in 2019 and marked regional disparities. It is essential to prioritize regions with heavy burdens or rapid growth rates, strengthen the management of major causes, and monitor HF burden trends in the post-COVID era.

To devise effective preventive measures, a profound understanding of the evolving patterns and trends in atrial fibrillation (AF) and atrial flutter (AFL) burdens is pivotal. Our study was designed to quantify the burden and delineate the risk factors associated with AF and AFL across 204 countries and territories spanning 1990-2021. Data pertaining to AF and AFL were sourced from the Global Burden of Disease Study 2021. The burden of AF/AFL was evaluated using metrics such as incidence, disability-adjusted life years (DALYs), deaths, and their corresponding age-standardized rates (ASRs), stratified by age, sex, socio-demographic index (SDI), and human development index (HDI). The estimated annual percentage change was employed to quantify changes in ASRs. Population attributable fractions were calculated to determine the proportional contributions of major risk factors to age-standardized AF/AFL deaths. This analysis encompassed the period from 1990 to 2021. Globally, in 2021, there were 4.48 million incident cases [95% uncertainty interval (UI): 3.61-5.70], 8.36 million DALYs (95% UI: 6.97-10.13) and 0.34 million deaths (95% UI: 0.29-0.37) attributed to AF/AFL. The AF/AFL burden in 2021, as well as its trends from 1990 to 2021, displayed substantial variations based on gender, SDI quintiles, and geographical regions. High systolic blood pressure emerged as the leading contributor to age-standardized AF/AFL incidence, prevalence, death, and DALY rate globally among all potential risk factors, followed closely by high body mass index. Our study underscores the enduring significance of AF/AFL as a prominent public health concern worldwide, marked by profound regional and national variations. Despite the substantial potential for prevention and management of AF/AFL, there is a pressing imperative to adopt more cost-effective strategies and interventions to target modifiable risk factors, particularly in areas where the burden of AF/AFL is high or escalating.

As the global aging issue grows, dementia, particularly Alzheimer's disease (AD), has become a major public health challenge for everyone. This study utilizes the Global Burden of Disease (GBD) database to analyze trends in the epidemiology of AD and other dementias from 1990 to 2021 and to predict future burdens to 2040. We examined global, regional, and national data on AD and other dementias, focusing on incidence, prevalence, and Disability-Adjusted Life Years (DALYs). Joinpoint regression analysis was employed to identify significant changes in trends over time. The effects of age, period, and birth cohort on the risk of AD and other dementias were analyzed. Additionally, the impact of aging, population growth, and epidemiological changes on DALYs was assessed across different Socio-demographic Index (SDI) quintiles. The global burden of AD and other dementias has significantly increased, with the highest incidence, prevalence, and DALYs observed in East Asia. A notable increase in prevalence was observed in females over 65 years compared to males. Joinpoint regression analysis revealed substantial changes in trends in 1995, 2005, 2011, and 2019, with a noticeable acceleration post-2011, especially after 2019. Age was a significant risk factor, with a sharp increase in risk after 60 years of age. Epidemiological changes had a minor impact globally but varied by region and gender. Bayesian age-period-cohort modeling predicts sustained growth through 2040, with age-standardized incidence and prevalence rates projected to reach 144.85 and 821.80 per 100,000 respectively, driven predominantly by aging populations in high SDI regions and demographic expansion in low SDI regions. The global burden of AD and other dementias is escalating, with a pronounced increase expected by 2040. This study highlights the need for targeted interventions, particularly in regions with higher burdens and among older populations. The findings underscore the importance of considering SDI, age, and gender when planning public health strategies to address the growing challenge of AD and other dementias.

We aimed to analyse the global, regional, and national burdens of hip fractures in older adults from 1990 to 2021, with projections to 2050, on the basis of data from the GBD 2021 study. We employed a joinpoint model to analyse trends in the burden of hip fractures from 1990‒2021. The estimated annual percentage change (EAPC) was used to quantify temporal trends over this period. We evaluated the relationship between the social development index and the burden of hip fracture in elderly people and conducted a health inequality analysis. Additionally, we applied Long-short Term Memory (LSTM) networks to forecast burden trends of hip fractures up to 2050. The global age-standardized incidence rate (ASIR) for hip fractures in older adults rose from 781.56 per 100,000 in 1990 to 948.81 in 2021. The 2021 age-standardized prevalence rate (ASPR) was 1,894.07, and the age-standardized YLD rate (ASDR) was 173.52. From 1990 to 2021, the incidence and prevalence increased by 168.71 % and 173.07 %, respectively, while the burden of DALYs decreased. Future trends were projected via the LSTM. The burden and risk factors for hip fractures varied significantly by sex, country, and region. Population and aging are primary contributors to the rising incidence of elderly hip fractures, with falls being the leading direct cause. From 1990 to 2021, the global burden of hip fractures in the elderly population, especially among older women, steadily increased. Population ageing highlights the urgent need for targeted public health interventions and resource allocation, including early diagnosis, effective prevention strategies, and region-specific management approaches.

Brain and central nervous system (CNS) cancers present significant health challenges globally, characterized by increasing incidence and mortality rates. This study utilizes data from the Global Burden of Disease (GBD) 2021 to analyze trends and project future burdens. We calculated age-standardized rates (ASRs) of incidence, mortality, and disability-adjusted life years (DALYs) for brain and CNS cancers from 1990 to 2021. Trends were analyzed using estimated annual percentage change, and future projections were made with an Autoregressive Integrated Moving Average (ARIMA) model. Correlations between the socio-demographic index (SDI) and ASR were also examined. The study revealed a 106% increase in incidence number and a 63.67% rise in death number over the study period. The ARIMA model predicts declines in incidence, mortality, and DALYs by 2040. Higher incidence rates were observed in high SDI regions, while greater mortality occurred in low SDI areas, indicating significant disparities. These findings underscore the need for targeted interventions and sustained healthcare investments to manage the global burden of brain and CNS cancers effectively. The projected declines suggest potential effectiveness of current public health strategies but highlight the importance of addressing socio-demographic disparities.

Vector-borne parasitic infectious diseases associated with poverty (referred to as vb-pIDP), such as malaria, leishmaniasis, lymphatic filariasis, African trypanosomiasis, Chagas disease, and onchocerciasis, are highly prevalent in many regions around the world. This study aims to characterize the recent burdens of and changes in these vb-pIDP globally and provide a comprehensive and up-to-date analysis of geographical and temporal trends. Data on the prevalence and disability-adjusted life years (DALYs) of the vb-pIDP were retrieved from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021 for 21 geographical regions and 204 countries worldwide, from 1990-2021. The age-standardized prevalence rate and DALYs rate by age, sex, and sociodemographic index (SDI) were calculated to quantify temporal trends. Correlation analysis was performed to examine the relationship between the age-standardized rate and the SDI. Over the past 30 years, the age-standardized prevalence rate and DALYs rate of these vb-pIDP have generally decreased, with some fluctuations. The distribution of vb-pIDP globally is highly distinctive. Except for Chagas disease, the age-standardized prevalence rate and DALYs rate of other vb-pIDP were highest in low-SDI regions by 2021. Malaria had the highest age-standardized prevalence rate (2336.8 per 100,000 population, 95% UI: 2122.9, 2612.2 per 100,000 population) and age-standardized DALYs rate (806.0 per 100,000 population, 95% UI: 318.9, 1570.2 per 100,000 population) among these six vb-pIDP globally. Moreover, significant declines in the age-standardized prevalence rate and DALYs rate have been observed in association with an increase in the SDI . Globally, 0.14% of DALYs related to malaria are attributed to child underweight, and 0.08% of DALYs related to malaria are attributed to child stunting. The age-standardized prevalence rate and DALY rates for the vb-pIDP showed pronounced decreasing trends from 1990-2021. However, the vb-pIDP burden remains a substantial challenge for vector-borne infectious disease control globally and requires effective control strategies and healthcare systems. The findings provide scientific evidence for designing targeted health interventions and contribute to improving the prevention and control of infectious diseases.

Ischemic heart disease (IHD) is the leading cause of global deaths. Environmental exposures contribute substantially to IHD burden, yet their combined effects across socio-demographic strata remain poorly characterized. This study aimed to systematically evaluate the global burden of IHD attributable to environmental factors, analyzing its temporal trends, geographical patterns, and Age-Period-Cohort (APC) effects across different socio-demographic index regions from 1990 to 2021. Data for this study were obtained from the Global Burden of Disease 2021 (GBD 2021) public dataset to investigate age-standardized deaths rates and disability-adjusted life years (DALYs) rates of IHD attributable to environmental factors from 1990 to 2021. Environmental factors included particulate matter pollution, non-optimal temperature, and lead exposure. Countries were categorized into five socio-demographic index (SDI) levels. The APC analysis model was employed to disentangle age, period, and cohort effects. Data processing and visualization were conducted using R version 4.4.3. Between 1990 and 2021, global environmental IHD deaths rates decreased by 31.13% and DALYs rates by 29.85%. High SDI regions achieved 70.39% reduction in deaths rates, while low SDI regions showed only 3.13% decrease. Particulate matter pollution remained the predominant environmental contributor with the highest burdens in South Asia, the Middle East, and North Africa. APC analysis revealed that environmental-related IHD burden increased exponentially with age, with earlier birth cohorts showing substantially higher Risk Ratios (RR). Males consistently demonstrated higher burden than females across all environmental factors. IHD burden attributable to environmental factors shows a declining trend globally but with notable regional and gender disparities. Policymakers in low SDI regions should integrate environmental health into development strategies, high-pollution burden regions should strengthen air quality monitoring and emission control, climate-sensitive regions need to implement temperature adaptation planning, and historically industrialized regions should enhance lead exposure monitoring while ensuring occupational protection for males and environmental health safeguards for the older adults.

This study aimed to describe the temporal trends in the age and sex burdens of lower respiratory infections (LRIs) in China and globally from 1990 to 2021 and to analyze their epidemiological characteristics to formulate corresponding strategies to control LRIs. This study utilized open data from the Global Burden of Disease (GBD) database from 1990 to 2021 to assess the burden of disease based on the prevalence, incidence, mortality, years lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of LRIs in China and globally. Moreover, a comprehensive comparative analysis of the epidemiological characteristics of LRIs in China and globally was conducted via the Joinpoint regression model, age-period-cohort model (APC model), and stratified analysis of the study method from multiple dimensions, such as age, sex, and period. Finally, we used an autoregressive integrated moving average (ARIMA) model to predict the disease burden in LRIs over the next 15 years. From 1990 to 2021, China's age-standardized incidence, deaths, and disability-adjusted life year (DALY) rates per 100,000 people decreased from 5,481.13 (95% CI: 5,149.05, 5,836.35) to 2,853.81 (95% CI: 2,663.94, 3,067.55), from 60.65 (95% CI. 52.96, 66.66) to 14.03 (95% CI: 11.68, 17) and from 3,128.39 (95% CI: 2,724.11, 3,579.57) to 347.67 (95% CI: 301.28, 402.94). The global age-standardized incidence, deaths, and DALY rates per 100,000 people, on the other hand, decreased from 6,373.17 (95% CI: 5,993.51, 6,746.04) to 4,283.61 (95% CI: 4,057.03, 4,524.89) and from 61.81 (95% CI: 56.66, 66.74) to 28.67 (95% CI: 25.92, 31.07) and from 3,472.9 (95% CI: 3,090.71, 3,872.11) to 1,168.8 (95% CI: 1,016.96, 1,336.95). The decline in the aforementioned indicators is greater in the female population than in the male population, and the decrease in China is more pronounced than the global trend. In China, the age-standardized incidence and mortality rates of LRIs showed an annual average percentage change (AAPC) of -2.12 (95% CI: -2.20, -2.03) and -4.77 (95% CI: -5.14, -4.39), respectively. Globally, the age-standardized incidence and mortality rates for LRIs decreased by -1.28 (95% CI: -1.37, -1.18) and -2.47 (95% CI: -2.61, -2.32). By 2036, the incidence of lower respiratory infections (LRI) among men and women in China is projected to decrease by 36.55 and 46.87%, respectively, while the mortality rates are expected to decline to 12.67% for men and increase by 71.85% for women. In comparison, the global decline in LRI incidence is lower than that observed in China, yet the reduction in mortality rates is greater globally than in China. Age-standardized incidence, mortality and disability-adjusted life years (DALYs) decreased more in China than at the global level between 1990 and 2021. Compared with the previous period, the COVID-19 pandemic has led to a significant decrease in the disease burden of LRIs. As the population continues to age, the disease burden of LRIs in the old adult population will become a major new public health challenge.

To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU. Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY). Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165m vs. 2005: 82m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (>4%), ADHD (5%) in the young, and dementia (1-30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke. In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century.

Pelvic inflammatory disease (PID) is a widespread female public problem worldwide. And it could lead to infertility, preterm labor, chronic pelvic pain, and ectopic pregnancy (EP) among reproductive-aged women. This study aimed to assess the global burden and trends as well as the chaning correlation between PID and EP in reproductive-aged women from 1990 to 2019. The data of PID and EP among reproductive-aged women (15 to 49 years old) were extracted from the Global Burden of Disease study 2019. The disease burden was assessed by calculating the case numbers and age-standardized rates (ASR). The changing trends and correlation were evaluated by calculating the estimated annual percentage changes (EAPC) and Pearson's correlation coefficient. In 2019, the ASR of PID prevalence was 53.19 per 100,000 population with a decreasing trend from 1990 (EAPC: - 0.50), while the ASR of EP incidence was 342.44 per 100,000 population with a decreasing trend from 1990 (EAPC: - 1.15). Globally, PID and EP burdens changed with a strong positive correlation (Cor = 0.89) globally from 1990 to 2019. In 2019, Western Sub-Saharan Africa, Australasia, and Central Sub-Saharan Africa had the highest ASR of PID prevalence, and Oceania, Eastern Europe, and Southern Latin America had the highest ASR of EP incidence. Only Western Europe saw significant increasing PID trends, while Eastern Europe and Western Europe saw increasing EP trends. The highest correlations between PID and EP burden were observed in Burkina Faso, Laos, and Bhutan. General negative correlations between the socio-demographic index and the ASR of PID prevalence and the ASR of EP incidence were observed at the national levels. PID and EP continue to be public health burdens with a strong correlation despite slightly decreasing trends detected in ASRs globally. Effective interventions and strategies should be established according to the local situation by policymakers.

Long-term lead exposure damages the central nervous system, with chronic poisoning strongly linked to intellectual developmental disability (IDD) and disproportionately affecting children and adolescents. Using the Global Burden of Disease (GBD) 2021 database, this study analyzed temporal, spatial, and population-specific trends in lead-attributable IDD burden among global children/adolescents (1990-2021) and projected trends to 2040 to inform global public health strategies. GBD 2021 data characterized global, regional, and national distributions of lead-attributable IDD burden. Associations with sex, age, and Socio-Demographic Index (SDI) were evaluated via Years Lived with Disability (YLDs) and Age-Standardized YLD Rate (ASYR). Joinpoint regression quantified annual burden changes, and the Nordpred model projected 2021-2040 trends. Globally, ASYR fell from 58.088 to 38.718 per 100,000 (AAPC = -1.297%, P < 0.001), with high-SDI countries seeing a 54.0% reduction (AAPC = -2.486%) versus 32.8% in low-SDI regions. Paradoxically, low-SDI YLDs rose by 39.7%. In 2021, ASYR peaked in 15-19-year-olds at 39.906 (males) and 41.146 (females). South Asia, led by India (119.30 per 100,000), remained a high-burden hotspot. SDI correlated negatively with ASYR (ρ = -0.76, P < 0.001), with projections showing global YLDs declining to 863,352 person-years by 2040 (ASYR = 33.057). While global progress has been made in reducing lead exposure-induced IDD, South Asia and low-SDI nations bear persistently high burdens. Strengthened international collaboration and targeted lead reduction policies are critical to advancing health equity for young people. • Trend of the global disease burden of IDD attributed to lead exposure in the total population from 1990 to 2019. • Trend of the global disease burden of IDD attributed to lead exposure in children and adolescents from 1990 to 2021, with projections up to 2040.

Liver cancer is the sixth most prevalent cancer globally and the third leading cause of cancer-related mortality, with more than three-quarters of a million deaths. This has presented a significant challenge and imposed considerable strain on global public health systems. Therefore, evaluating the updated global burden of liver cancer and its recent trends in incidence and mortality is highly important, as it provides valuable insights for shaping public health policies and improving clinical practices. The data in our article were obtained from the Global Burden of Disease Study 2021 (GBD 2021), which is available at https://vizhub.healthdata.org/gbd-results/ . In this study, liver cancer mortality and incidence were estimated via the cause of death ensemble (CODEm) model for every combination of sex, age, location, and year. The incidence was modelled with DisMod-MR 2.1, a Bayesian meta-regression tool. A linear regression model was employed to explore the temporal trend of these rates, formulated as y = α + βx + ε, where x represents the calendar year and y signifies the natural logarithm of the rate. For both incidence and mortality, the estimated annual percentage change (EAPC) was computed via the formula 100 × (e First, 529,000 cases were newly diagnosed, with an age-standardized incidence rate (ASIR) of 6.15 per 100,000 people. In terms of etiology, the incidence of liver cancer caused by metabolic factors has tended to increase. Additionally, the incidence of liver cancer was greater in males and older populations. Several specific regions presented liver cancer burdens that overwhelmingly surpassed the expected age-standardized rates (ASRs) each year from 1990 to 2021, regardless of their respective sociodemographic index (SDI) scores. Our findings reveal that liver cancer continues to pose a significant public health challenge. These findings suggest that targeted interventions are needed to address both the infectious and non-infectious drivers of liver cancer in different socioeconomic settings. Hence, continued efforts in prevention through vaccination, antiviral therapies, and strategies to combat metabolic diseases are crucial for reducing the global burden of liver cancer in the coming decades.

There are limited epidemiological data on myocarditis in children aged 0-14 years. This study aims to investigate the trends in incidence, mortality, disability-adjusted life years (DALYs), and corresponding estimated annual percentage change (EAPC) of myocarditis in children aged 0-14 years from 1990 to 2021. We utilized the 2021 Global Burden of Disease, Injuries, and Risk Factors Study (GBD) analytical tools to examine the incidence, mortality, and DALYs of myocarditis in children aged 0-14 years, considering factors such as age, sex, region, sociodemographic index (SDI), and data from 204 countries or regions. In 2021, a total of 155.45/1000 people cases of myocarditis were reported globally in children. The cases of myocarditis in children increased from 143.80/1000 people (95% uncertainty interval [UI], 93.13-214.67) in 1990 to 155.45/1000 people (95% UI, 100.31-232.31) in 2021, increasing by 8.1% (95% UI, 6.04-9.73%). Over 30 years, the global incidence rate decreased from 8.27 (95% UI, 5.35-12.34) to 7.73 (95% UI, 4.99-11.55) per 100,000 population. The myocarditis-associated mortality rate decreased from 0.36 (95% UI, 0.25-0.51) to 0.13 (95% UI, 0.10-0.16) per 100,000 population. In 2021, the highest incidence of myocarditis in children occurred in High SDI regions. Regionally, High-income Asia Pacific had the greatest increase in incidence (EAPC, 0.25; 95% CI, 0.22-0.28). Japan had the highest incidence rate of myocarditis in children, while Haiti reported the highest myocarditis-associated mortality rate and DALYs rate. Globally, environmental/occupational risk, nonoptimal temperature, high temperature, and low temperature were key risk factors for myocarditis-associated mortality in children. Between 1990 and 2021, myocarditis in children saw declining mortality and DALYs but rising incidence, especially in males. Children under 1 year face higher mortality and DALY rates despite lower incidence, stressing early diagnosis. High SDI regions report higher incidence but lower mortality, while low SDI areas need standardized treatment. Japan had the highest 2021 incidence, and China had the most deaths. Underscoring the urgency for enhanced medical resources, comprehensive research into the disease's etiology, and improved prevention strategies.

Low physical activity (LPA) is associated with cardiovascular and cerebrovascular pathologies. This study aimed to assess the prevalence of several noncommunicable diseases relating to LPA. Using the 2021 Global Burden of Disease data set, we modelled LPA-related disease burdens across 204 countries and territories, quantifying mortality counts, age-standardised mortality rates, and disability-adjusted life years (DALYs) for five noncommunicable diseases. We conducted multivariable stratification analyses to assess variations by gender, age, and sociodemographic index (SDI) quintiles. We used age-period-cohort modelling to project burden trajectories, while applying counterfactual decomposition frameworks to delineate synergistic interactions between LPA and risk factors. We found that LPA accounted for 555 101 related deaths globally in 2021 across the five studied pathologies, mostly among individuals aged 60-94 years. Association between LPA-related disease burden and SDI followed a U-shaped distribution across regions and diseases. Among individuals aged 60-89 years, LPA-related deaths were significantly higher in women than in men, indicating a disproportionate burden on elderly females. Ischaemic heart disease (IHD) trends stabilised in low- and middle-SDI regions but declined significantly in high-SDI regions, underscoring global health disparities. From 2007 to 2011, LPA DALYs and mortality risk ratios for IHD, stroke, and lower extremity peripheral arterial disease declined from >1 to <1, whereas diabetes mellitus exhibited an opposite trend, highlighting LPA's persistent and significant impact on diabetes-related morbidity. Demographic shifts and epidemiological transitions were primary drivers of LPA-related disease burden across five pathologies. In high-SDI regions, epidemiological changes predominated, whereas population growth was a key factor in low- and middle-SDI regions. Synergistic interaction of these factors with LPA is projected to substantially amplify future disease burden. Physical activity should be increased among elderly women to address health risks associated with LPA. Likewise, urgent public health interventions are needed for LPA-related diabetes. As IHD burden rises in low- and middle-SDI regions, vascular disease care strategies require optimisation. Moreover, high-SDI regions should strengthen nationwide physical activity promotion, while low- and middle-SDI areas must enhance healthcare infrastructure and manage population growth to reduce LPA-related disease burdens.

Chronic diseases are accelerating globally, advancing across all regions and pervading all socioeconomic classes. Unhealthy diet and poor nutrition, physical inactivity, tobacco use, excessive use of alcohol and psychosocial stress are the most important risk factors. Periodontal disease is a component of the global burden of chronic disease, and chronic disease and periodontal disease have the same essential risk factors. In addition, severe periodontal disease is related to poor oral hygiene and to poor general health (e.g. the presence of diabetes mellitus and other systemic diseases). The present report highlights the global burden of periodontal disease: the ultimate burden of periodontal disease (tooth loss), as well as signs of periodontal disease, are described from World Health Organization (WHO) epidemiological data. High prevalence rates of complete tooth loss are found in upper middle-income countries, whereas the tooth-loss rates, at the time of writing, are modest for low-income countries. In high-income countries somewhat lower rates for edentulism are found when compared with upper middle-income countries. Around the world, social inequality in tooth loss is profound within countries. The Community Periodontal Index was introduced by the WHO in 1987 for countries to produce periodontal health profiles and to assist countries in the planning and evaluation of intervention programs. Globally, gingival bleeding is the most prevalent sign of disease, whereas the presence of deep periodontal pockets (≥6 mm) varies from 10% to 15% in adult populations. Intercountry and intracountry variations are found in the prevalence of periodontal disease, and these variations relate to socio-environmental conditions, behavioral risk factors, general health status of people (e.g. diabetes and HIV status) and oral health systems. National public health initiatives for the control and prevention of periodontal disease should include oral health promotion and integrated disease-prevention strategies based on common risk-factor approaches. Capacity building of oral health systems must consider the establishment of a financially fair service in periodontal care. Health systems research is needed for the evaluation of population-oriented oral health programs.

Osteoarthritis (OA) is a chronic degenerative joint disease with an increasing global burden, particularly among the working-age population. This study aims to analyze the temporal trends in OA burden by age and sex globally from 1990 to 2021, focusing on incidence, prevalence, and disability-adjusted life years (DALYs) rates, and to predict future trends. Using data from the Global Burden of Disease (GBD) database, which includes 204 countries and regions, we stratified the findings by the sociodemographic index (SDI). Age-standardized rates were used to calculate the estimated annual percentage change (EAPC) with corresponding 95% confidence intervals (95% CI). Additionally, a Bayesian Age-Period-Cohort (BAPC) model was employed to project future OA trends up to 2040.The results revealed a consistent increase in the global OA burden over the study period. Between 1990 and 2021, the number of OA cases in the working-age population increased from 16,420,160 to 35,494,218, representing a growth rate of 116.16%. Over the same period, prevalence and DALYs rose by 123.11% and 125%, respectively. Global age-standardized incidence rate (ASIR), prevalence rate (ASPR), and DALYs rate (ASDR) exhibited continuous upward trends, with annual percentage changes of 0.387%, 0.431%, and 0.46%, respectively. Notably, East Asia demonstrated the highest EAPC, reflecting a rapid rise in OA burden, while high-income North America exhibited minimal changes, indicating a relatively stable trend. Countries such as Equatorial Guinea, Mongolia, and Armenia also experienced significant increases in EAPC, underscoring emerging regional challenges.Further socioeconomic analysis highlighted disparities in OA burden. A significant positive correlation was observed between ASIR, ASPR, ASDR, and SDI. While low-SDI countries exhibited lower OA burdens, metrics were substantially higher in high-SDI countries. From 1990 to 2021, the gap between countries with the highest and lowest SDIs widened, underscoring growing global health inequalities. Projections based on the BAPC model suggest that by 2040, the incidence and prevalence of OA will continue to rise, with the number of cases expected to reach 38,800,395, particularly driven by notable increases among women.These findings highlight the urgent need for developing targeted public health strategies to mitigate the effect of OA on the working-age population and promote global health equity.

Glaucoma is a leading cause of irreversible blindness globally, with a particularly significant impact on middle-aged and older adults (aged 45 years and above), substantially affecting their quality of life and imposing considerable socio-economic burdens. Comprehensive assessments of the burden of glaucoma in this age group at global, regional, and national levels are crucial for shaping health policies and optimizing resource allocation. Data on the burden of glaucoma among individuals aged 45 years and above were obtained from the 2021 Global Burden of Disease (GBD) study. The Average Annual Percent Change (AAPC) was used to evaluate trends in glaucoma burden from 1990 to 2021 among this population. The Slope Index of Inequality (SII) and the Concentration Index (CI) were employed to analyze both absolute and relative health inequalities in the burden of glaucoma. An Age-Period-Cohort model focusing on the 45+ age group was fitted using the NORDPRED package to predict the future burden of glaucoma. Additionally, frontier analysis was conducted to assess the relationship between the burden of glaucoma and socio-demographic development in the older adult population, using non-parametric Data Envelopment Analysis (DEA) to define a boundary based on the level of development for the minimal achievable burden. In 2021, there were 5.34 million cases of glaucoma among the global population aged 45 years and above (95% UI: 4.22-6.45 million), with an age-standardized prevalence rate (ASPR) of 889.3 per 100,000 population (95% UI: 700.2-1078.5). The AAPC for glaucoma in this age group from 1990 to 2021 was -0.82 (95% CI: -0.85 to -0.8), indicating a downward trend in both ASPR and age-standardized DALY rate (ASDR) globally among middle-aged and older adults. At the regional level, areas with lower Socio-Demographic Index (SDI) exhibited higher ASPRs, whereas high SDI regions recorded lower rates. Nationally, countries such as Niger and Nigeria demonstrated the highest age-standardized rates within this demographic. Health inequality analyses revealed that countries with lower SDI bear a disproportionately higher burden of glaucoma among middle-aged and older adults. Predictions indicate that although the number of global cases in this age group may rise, the overall burden of glaucoma is expected to gradually decline. As one of the leading causes of blindness among middle-aged and older adults worldwide, glaucoma remains a significant public health concern. Although the absolute number of cases in individuals aged 45 years and above continues to rise due to population growth and aging, both the ASPR and ASDR have shown declining trends. This decline reflects meaningful progress in the prevention, diagnosis, and management of the disease. To address the ongoing increase in case numbers, targeted policy interventions are needed to ensure effective prevention and management strategies, contributing to the achievement of global sustainable development goals. Furthermore, frontier analysis identifying disparities between national development levels and the burden of glaucoma in the older adult population can aid in optimizing the allocation of global health resources.

To assess the discrepancies between real-world data and the Global Burden of Disease (GBD) 2021 estimates for six neglected tropical diseases in China. Additionally, to evaluate the applicability of the GBD model within the Chinese context and to assess the effectiveness of China's historical prevention and control policies for neglected tropical diseases. Comparative study of real-world data and GBD 2021 (2004-2020). Disability adjusted life years (DALYs). DALYs based on reported data for leprosy, echinococcosis, schistosomiasis, visceral leishmaniasis, dengue, and rabies from 2004 to 2020 were compared with the estimated DALYs from the GBD 2021 database. Additionally, we combined and analysed China's historical policies on prevention and control of neglected tropical diseases with real-world DALYs. Reported data were sourced from the Chinese Center for Disease Control and Prevention's China Public Health Science data centre and related reports. Data for GBD 2021 and GBD 2019 were obtained from GBD databases. These data included all of China's 31 provinces (including autonomous regions and municipalities) and the Xinjiang Production and Construction Corps. The total real-world DALYs based on reported data of six neglected tropical diseases decreased from 260 000 person years in 2004 to 19 000 person years in 2020, with a 93% (241 000/260 000 person years) reduction. The 17 year average real-world DALYs from 2004 to 2020 versus the GBD 2021 estimates for the same period were 42 The findings indicate that reliance solely on global estimates, such as those of the GBD, may not sufficiently capture the dynamics of neglected tropical diseases in China. Integrating local epidemiological data into global health assessments is crucial to develop accurate and effective public health policies. This study highlights the importance of continuously updating and improving data collection and surveillance methods to adapt public health strategies to evolving disease patterns.

There is a lack of analysis and prediction of the disease burden of Alzheimer's disease and other dementias (ADOD) in Asia. This study aims to explore the impact of ADOD on the Asian region during the period from 1990 to 2021. Data on ADOD in Asia from 1990 to 2021 were collected from the Global Burden of Disease (GBD) Study 2021. We analyzed the number and age-standardized rates (ASRs) of incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of ADOD from 1990 to 2021. Joinpoint regression analysis was performed, and the average annual percent changes (AAPCs) were calculated to evaluate the trends during this period. Subsequently, an auto - regressive integrated moving average (ARIMA) prediction model analysis was conducted to assess the trends in the next 30 years, aiming to report the epidemiology and disease burden of ADOD in Asia. According to the analysis of the GBD database in 2021, the deaths, DALYs, incidence, and prevalence of ADOD increased by 297.34 %, 249.54 %, 244.73 %, and 250.44 % in Asia from 1990 to 2021. The ASRs of incidence, prevalence, death, and DALYs in both males and females, which consistently increased over the study period, showed that the ASRs of all females were consistently higher than those of males in Asia from 1990 to 2021. During the period from 1990 to 2021, Qatar and the United Arab Emirates witnessed the greatest changes in the number of DALYs, incidence, and prevalence. Afghanistan and China had the highest age-standardized mortality rate (ASMR) in 2021. It is worth noting that high fasting blood glucose is the top risk factor for the onset of ADOD. Females are more susceptible to the risk factor of high body-mass index (BMI), while males are more likely to be affected by smoking. According to the analysis of the ARIMA prediction model, the disease burden of ADOD in Asia will continue to show an upward trend in the next 30 years. We should pay attention to the issue of population aging, attach importance to the intervention measures targeting the risk factors of ADOD, and formulate action plans to address the rising incidence of ADOD.

To investigate the current disease burden of chronic obstructive pulmonary disease (COPD) in China and globally using the Global Burden of Disease (GBD) data in 2019, as well as to analyse the changes in its risk factors, providing a scientific basis for the formulation of a comprehensive prevention and control strategy for COPD in China. An observational study based on the GBDs. Based on the GBD 2019 database, we obtained data on incidence, prevalence, mortality, disability-adjusted life years (DALYs) and corresponding age-standardised rates of COPD in China and the global, and analysed and described the changing trends of COPD burden in China and the global from 1990 to 2019. In 2019, the total number of COPD deaths in China was 1.04 (95% uncertainty intervals (95% UI): 0.89-1.27) million cases, the number of patients with COPD was 45.16 (95% UI: 41.13-49.62) million cases, and the number of new cases was 4.0 (95% UI: 3.6-4.4) million cases. DALYs were 74.4 (95% UI: 68.2-80.2) million years. Compared with 1990, the number of new incident cases and the overall prevalence of COPD in China in 2019 increased by 66.20% and 66.76%, respectively, which is lower than the overall global level. From 1990 to 2019, the age-standardized prevalence rate (ASPR), the age-standardized incidence rate (ASIR) and the age-standardized death rate (ASDR) in China and the global all showed a downward trend, and the rate of decline in China was much higher than the overall level of the world, indicating that China has made specific achievements in the prevention and treatment of COPD, but overall the disease burden of COPD is still hefty, and the number of affected individuals is still increasing.

Summarizing the epidemiology of major depressive disorder (MDD) at a global level is complicated by significant heterogeneity in the data. The aim of this study is to present a global summary of the prevalence and incidence of MDD, accounting for sources of bias, and dealing with heterogeneity. Findings are informing MDD burden quantification in the Global Burden of Disease (GBD) 2010 Study. A systematic review of prevalence and incidence of MDD was undertaken. Electronic databases Medline, PsycINFO and EMBASE were searched. Community-representative studies adhering to suitable diagnostic nomenclature were included. A meta-regression was conducted to explore sources of heterogeneity in prevalence and guide the stratification of data in a meta-analysis. The literature search identified 116 prevalence and four incidence studies. Prevalence period, sex, year of study, depression subtype, survey instrument, age and region were significant determinants of prevalence, explaining 57.7% of the variability between studies. The global point prevalence of MDD, adjusting for methodological differences, was 4.7% (4.4-5.0%). The pooled annual incidence was 3.0% (2.4-3.8%), clearly at odds with the pooled prevalence estimates and the previously reported average duration of 30 weeks for an episode of MDD. Our findings provide a comprehensive and up-to-date profile of the prevalence of MDD globally. Region and study methodology influenced the prevalence of MDD. This needs to be considered in the GBD 2010 study and in investigations into the ecological determinants of MDD. Good-quality estimates from low-/middle-income countries were sparse. More accurate data on incidence are also required.

Studies have reported estimates of the economic and health burden of COPD. They have been limited largely to current-day estimates or relatively short-term future projections. How will the regional and global economic and health burden of COPD evolve from 2025 to 2050, considering trends in COPD risk factors and an expanding population? To project the economic and health burden of COPD to 2050, an open cohort Markov model was developed. COPD costs were stratified by age, sex, and smoking status, and distributions of COPD severity grades were modeled based on global trends in smoking status, household air pollution, particulate matter ≤ 2.5 μm in diameter, and ozone. Direct costs, indirect costs, and the number of COPD exacerbations were projected to 2050. Data on the historic economic and health burden of COPD were obtained from the Global Burden of Disease (GBD) database, World Health Organization, and a recent meta-analysis. COPD risk factor data were obtained from the GBD database. By 2050, the global direct costs attributable to COPD are projected to be $24.35 trillion cumulatively ($3.89 trillion in 2025). Global indirect costs are estimated to be $15.43 trillion cumulatively by 2050 ($2.50 trillion in 2025), and 15.60 billion COPD exacerbations are projected to occur within that same period (2.28 billion in 2025). To mitigate the substantial projected economic and health burden of COPD, it is essential to focus on prevention by reducing risk factors such as smoking and air pollution. Additionally, health care policy reforms can improve access to effective treatments, and innovative approaches can enhance patient outcomes.

Age-related macular degeneration (AMD) is a growing public health concern worldwide, as one of the leading causes of vision impairment. We aimed to estimate global, national, and region-specific prevalence and disability-adjusted life-years (DALYs) along with tobacco as a modifiable risk factor to aid public policy addressing AMD. Data on AMD were extracted from the Global Burden of Disease, Injuries, and Risk Factor Study 2021 database in 204 countries and territories, 1990-2021. Vision impairment was defined and categorised by severity as follows: moderate to severe vision loss (visual acuity from <6/18 to 3/60) and blindness (visual acuity <3/60 or a visual field <10 degrees around central fixation). The burden of vision impairment attributable to AMD was subsequently estimated. These estimates were further stratified by geographical region, age, year, sex, Healthcare Access and Quality (HAQ) Index, and Socio-demographic Index (SDI) levels. Additionally, the effect of tobacco use, a modifiable risk factor, on the burden of AMD was analysed, and projections of AMD burden were estimated through to 2050. These projections also included scenario modelling to assess the potential effects of tobacco elimination. Globally, the number of individuals with vision impairment due to AMD more than doubled, rising from 3·64 million (95% uncertainty inverval [UI] 3·04-4·35) in 1990 to 8·06 million (6·71-9·82) in 2021. Similarly, DALYs increased by 91% over the same period, from 0·30 million (95% UI 0·21-0·42) to 0·58 million (0·40-0·80). By contrast, age-standardised prevalence and DALY rates declined, with prevalence rates decreasing by 5·53% (99·50 per 100 000 of the population [95% UI 83·16-118·04] in 1990 to 94·00 [78·32-114·42] in 2021) and DALY rates dropping by 19·09% (8·38 [5·70-11·53] to 6·78 [4·70-9·32]). These rates showed a consistent decrease in higher SDI quintiles, reflecting the negative correlation between HAQ Index and AMD burden. A general downward trend was observed from 1990 to 2021, with the largest age-standardised reduction occurring in the low-middle SDI quintile. The global contribution of tobacco to age-standardised DALYs decreased by 20%, declining from 12·45% (95% UI 7·73-17·37) in 1990 to 9·96% (6·12-14·06) in 2021. By 2050, the number of individuals affected by AMD is projected to increase from 3·40 million males (95% UI 2·81-4·17) in 2021 to 9·02 million (5·72-14·20) and from 4·66 million females (3·88-5·65) to 12·32 million (8·88-17·08). Eliminating tobacco use could reduce these numbers to 8·17 million males (5·59-11·92) and 11·15 million females (8·58-14·48) in 2050. While the total prevalence and DALYs due to AMD have steadily increased from 1990 to 2021, age-standardised prevalence and DALY rates have declined, probably reflecting the effect of population ageing and growth. The consistent decrease in age-standardised rates with higher SDI levels highlights the crucial role of health-care resources and public policies in mitigating AMD-related vision impairment. The downward trend observed from 1990 to 2021 might also be partially attributed to the reduced effect of tobacco as a modifiable risk factor, with declines in tobacco use seen globally and across all SDI quintiles. The burden of vision impairment due to AMD is projected to increase to about 21·34 million in 2050. However, effective tobacco regulation has the potential to substantially reduce AMD-related vision impairment, particularly in lower SDI quintiles where health-care resources are limited. Gates Foundation.

Acute viral hepatitis (AVH) represents an important global health problem; however, the progress in understanding AVH is limited because of the priority of combating persistent HBV and HCV infections. Therefore, an improved understanding of the burden of AVH is required to help design strategies for global intervention. Data on 4 major AVH types, including acute hepatitis A, B, C, and E, excluding D, were collected by the Global Burden of Disease (GBD) 2019 database. Age-standardized incidence rates and disability-adjusted life year (DALY) rates for AVH were extracted from GBD 2019 and stratified by sex, level of socio-demographic index (SDI), country, and territory. The association between the burden of AVH and socioeconomic development status, as represented by the SDI, was described. In 2019, there was an age-standardized incidence rate of 3,615.9 (95% CI 3,360.5-3,888.3) and an age-standardized DALY rate of 58.0 (47.3-70.0) per 100,000 person-years for the 4 major types of AVH. Among the major AVH types, acute hepatitis A caused the heaviest burden. There was a significant downward trend in age-standardized DALY rates caused by major incidences of AVH between 1990 and 2019. In 2019, regions or countries located in West and East Africa exhibited the highest age-standardized incidence rates of the 4 major AVH types. These rates were stratified by SDI: high SDI and high-middle SDI locations recorded the lowest incidence and DALY rates of AVH, whereas the low-middle SDI and low SDI locations showed the highest burden of AVH. The socioeconomic development status and burden of AVH are associated. Therefore, the GBD 2019 data should be used by policymakers to guide cost-effective interventions for AVH. We identified a negative association between socioeconomic development status and the burden of acute viral hepatitis. The lowest burden of acute viral hepatitis was noted for rich countries, whereas the highest burden of acute viral hepatitis was noted for poor countries.

While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria. In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation. In summary, these methods included estimating cause-specific mortality for every cause of injury, and then estimating incidence for every cause of injury. Non-fatal disability for each cause is then calculated based on the probabilities of suffering from different types of bodily injury experienced. GBD 2017 produced morbidity and mortality estimates for 38 causes of injury. Estimates were produced in terms of incidence, prevalence, years lived with disability, cause-specific mortality, years of life lost and disability-adjusted life-years for a 28-year period for 22 age groups, 195 countries and both sexes. GBD 2017 demonstrated a complex and sophisticated series of analytical steps using the largest known database of morbidity and mortality data on injuries. GBD 2017 results should be used to help inform injury prevention policy making and resource allocation. We also identify important avenues for improving injury burden estimation in the future.

As global aging intensifies, urological cancers pose increasing health and economic burdens. In China, home to one-fifth of the world's population, monitoring the distribution and determinants of these cancers and simulating the effects of health interventions are crucial for global and national health. With Global Burden of Disease (GBD) China database, the present study analyzed age-sex-specific patterns of incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) in China and its 34 provinces as well as the association between gross domestic product per capita (GDPPC) and these patterns. Importantly, a multi-attentive deep learning pipeline (iTransformer) was pioneered to model the spatiotemporal patterns of urological cancers, risk factors, GDPPC, and population, to provide age-sex-location-specific long-term forecasts of urological cancer burdens, and to investigate the impacts of risk-factor-directed interventions on their future burdens. From 1990 to 2021, the incidence and prevalence of urological cancers in China has increased, leading to 266,887 new cases (95% confidence interval: 205,304-346,033) and 159,506,067 (12,236,0000-207,447,070) cases in 2021, driven primarily by males aged 55+ years. In 2021, Taiwan, Beijing, and Zhejiang had the highest age-standardized incidence rate (ASIR) and age-standardized prevalence rates of urological cancer in China, highlighting significant regional disparities in the disease burden. Conversely, the national age-standardized mortality rate (ASMR) has declined from 6.5 (5.1-7.8) per 100,000 population in 1990 to 5.6 (4.4-7.2) in 2021, notably in Jilin [-166.7% (-237 to -64.6)], Tibet [-135.4% (-229.1 to 4.4)], and Heilongjiang [-118.5% (-206.5 to -4.6)]. Specifically, the national ASMR for bladder and testicular cancers reduced by -32.1% (-47.9 to 1.9) and -31.1% (-50.2 to 7.2), respectively, whereas prostate and kidney cancers rose by 7.9% (-18.4 to 43.6) and 9.2% (-12.2 to 36.5). Age-standardized DALYs, YLDs, and YLLs for urological cancers were consistent with ASMR. Males suffered higher burdens of urological cancers than females in all populations, except those aged <5 years. Regionally and provincially, high GDPPC provinces have the highest burden of prostate cancer, while the main burden in other provinces is bladder cancer. The main risk factors for urological cancers in 2021 are smoking [accounting for 55.1% (42.7-67.4)], high body mass index [13.9% (5.3-22.4)], and high fasting glycemic index [5.9% (-0.8 to 13.4)] for both males and females, with smoking remarkably affecting males and high body mass index affecting females. Between 2022 and 2040, the ASIR of urological cancers increased from 10.09 (9.19-10.99) to 14.42 (14.30-14.54), despite their ASMR decreasing. Notably, prostate cancer surpassed bladder cancer as the primary subcategory, with those aged 55+ years showing the highest increase in ASIR, highlighting the aging-related transformation of the urological cancer burden. Following the implementation of targeted interventions, smoking control achieved the greatest reduction in urological cancer burden, mainly affecting male bladder cancer (-45.8% decline). In females, controlling smoking and high fasting plasma glucose reduced by 5.3% and 5.8% ASMR in urological cancers. Finally, the averaged mean-square-Percentage-Error, absolute-Percentage-Error, and root-mean-square Logarithmic-Error of the forecasting model are 0.54 ± 0.22, 1.51 ± 1.26, and 0.15 ± 0.07, respectively, indicating that the model performs well. Urological cancers exhibit an aging trend, with increased incidence rates among the population aged 55+ years, making prostate cancer the most burdensome subcategory. Moreover, urological cancer burden is imbalanced by age, sex, and province. Based on our findings, authorities and policymakers could refine or tailor population-specific health strategies, including promoting smoking cessation, weight reduction, and blood sugar control. Bill & Melinda Gates Foundation.

Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518-724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764-1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74-30·0) DALYs were attributed to IPV among females and 32·2 million (16·4-52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15-49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (-1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (-1·92 to 13·1) DALYs due to schizophrenia in 2023. IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors. Gates Foundation.

This study aimed to assess the burden of respiratory tract cancers in China, the United States, India, and worldwide from 1990 to 2021. Also, forecast the evolution of respiratory tract cancers deaths and DALYs burden during 2022 to 2050. An epidemiological analysis. Based on the GBD 2021 data, this article analyzed and discussed the trends in burden of respiratory tract cancers in China, the United States, India, and the world from 1990 to 2021. Additionally, the Bayesian Age-Period-Cohort (BAPC) model was used to forecast the evolution of respiratory tract cancers deaths and DALYs burden during 2022 to 2050. The ASR-Deaths and ASR-DALYs for laryngeal and TBL cancers decreased globally. The burden of disease for TBL cancer increased in China and India (AAPC: 0.38 and 0.69), especially among Chinese women, while laryngeal cancer declined in India (AAPC: -0.69). In contrast, the burden of disease for both cancers declined substantially in the United States (-1.82 AAPC for laryngeal cancer and - 1.74 AAPC for TBL). A notable gender disparity existed in the burden of respiratory tumors, with males experienced a higher disease burden compared to females. In terms of age, the peak incidence of respiratory tract cancers predominantly occurred among individuals aged 65-74, indicating a clear tendency towards a higher prevalence among this age group. Population growth and ageing were primary factors influencing the mortality burden of larynx cancer, whereas epidemiological shifts in TBL cancer markedly impacted DALYs. The forecasted results for ASR-Deaths and ASR-DALYs worldwide from 2022 to 2050 indicated a decline in the burden of both larynx and TBL cancers. However, the deaths and DALYs of TBL cancer in China will show an upward trend, especially for females. The disease burden of respiratory tract cancers is a global health issue that needs attention, and situations vary from country to country, requiring personalized measures. Global strategies must address aging populations and socioeconomic disparities to reduce inequities in high-burden regions.

What is the global, regional and national burden of polycystic ovary syndrome (PCOS), particularly in adolescents, based on data from the Global Burden of Disease (GBD) 2021 study? Prevalence, incidence and years lived with disability (YLD) for PCOS were extracted from the GBD 2021 database, standardized via Bayesian meta-regression, and stratified by age, region and Socio-Demographic Index (SDI). Temporal trends (1990-2021) were presented, and future projections (to 2045) were modelled using autoregressive integrated moving average models. Between 1990 and 2021, the global prevalence of PCOS increased from 36.7 million [95% uncertainty interval (UI) 26.2-50.6] to 69.5 million (95% UI 49.5-95.7), and the incidence increased from 1.5 million (95% UI 1.1-2.0) to 2.3 million (95% UI 1.7-3.2). YLD nearly doubled during this period. Adolescents (age 15-19 years) showed the greatest increase in incidence, influenced by diagnostic improvements. Projection analyses suggested continued growth, particularly in middle-SDI regions, by 2045. The rising global burden of PCOS, particularly among adolescents, underscores the need for early screening, targeted interventions and socio-economic support, especially in resource-limited regions.

We aimed to analyse the trends, age distribution and disease burden of maternal sepsis and other maternal infections (MSMI) to improve management strategies. We extracted data from the global burden of disease (GBD) 2021 database to evaluate MSMI burden with different measures for the whole world, 21 GBD regions and 204 countries from 1990 to 2021. Studies from the GBD 2021 database generated by population-representative data sources identified through a literature review and research collaborations were included. Patients with an MSMI diagnosis. Total numbers, age-standardised rates (ASRs) of incidence, prevalence, mortality and disability-adjusted life years (DALYs) on MSMI from the GBD 2021 study and their estimated annual percentage changes (EAPCs) were the primary outcomes. There were 19 047 404 (95% uncertainty interval (UI) 14 608 563 to 24 086 486) annual incident cases, 2 376 876 (95% UI 1 678 868 to 3 421 377) prevalent cases at a single time point, 17 665 (95% UI 14 628 to 21 191) death cases and 1 144 233 (95% UI 956 988 to 1 352 034) DALYs of total MSMI in 2021. From 1990, the case number and ASRs of incidences and prevalence showed decreasing trends, while the case number and ASRs of mortality and DALYs gradually increased with time, reaching the peak in 2001, and then declined. In 2021, the ASRs of incidence, prevalence, mortality and DALYs sharply increased with age, which reached the peak in the 20-24 age group. The ASRs were decreased with increasing sociodemographic index (SDI). In 2021, it showed a positive correlation between EAPC and ASR of DALYs (r=0.3398, p<0.001). The disease burden in low-SDI regions far exceeded that of regions with higher SDI. The persistent disparities in the burden of MSMI between low- and high-SDI regions underscore the urgent need for context-specific interventions, including targeted healthcare infrastructure investments in central and western sub-Saharan Africa, integration of WHO's Maternal Sepsis Guidelines into national policies, and prioritisation of antenatal care access for women aged 20-24 years. These strategies align with sustainable development goals to reduce maternal mortality and achieve universal health coverage by 2030.

‌OBJECTIVE: To analyse trends in mental and substance use disorders among Asian children aged 5-14 years, identify key risk factors (eg, bullying, abuse, lead exposure) and compare gender/age disparities using Global Burden of Disease (GBD) 2021 data. ‌DESIGN: Cross-sectional analysis of the GBD 2021 database, focusing on prevalence, disability-adjusted life years (DALYs) and risk factor associations. ‌SETTING: Population-based study across Asian countries, examining the burdens of mental health, especially substance use disorders in high-prevalence regions. ‌PARTICIPANTS: Children aged 5-14 years in Asia, with gender-stratified subgroups (boys vs girls). ‌RESULT: Anxiety, conduct disorders and autism were primary contributors to mental health burdens. Substance use disorders, though less prevalent, rose notably among boys. Girls showed higher burdens of anxiety/depressive disorders. Bullying and childhood abuse were strongly linked to these conditions. Gender disparities in DALYs highlighted boys' vulnerability to substance use and girls to internalising disorders. ‌CONCLUSION: Urgent, region-specific interventions are needed to address bullying, lead exposure and abuse, with gender-sensitive strategies. The study calls for targeted research and policies to mitigate rising mental health challenges in Asian children.

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. 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. 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. 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. Bill & Melinda Gates Foundation.

Maternal disorders remain a significant global health challenge with inequalities across sociodemographic strata. This study examines the global burden of six maternal disorders—Maternal Hemorrhage, Maternal Sepsis and Other Maternal Infections, Maternal Hypertensive Disorders, Maternal Obstructed Labor and Uterine Rupture, Maternal Abortion and Miscarriage, and Ectopic Pregnancy—from 1990 to 2021, focusing on disease burden trends and disparities across sociodemographic indices. We analyzed Global Burden of Disease Study 2021 data for women aged 15 to 49 years, examining disability-adjusted life years (DALYs) and incidence rates. The Sociodemographic Index (SDI) was used to contextualize inequalities across 204 countries and territories. Slope and concentration indices quantified absolute and relative disparities. Decomposition analyses explored demographic and epidemiological drivers of DALYs changes, while joinpoint regression identified temporal trend shifts. Age-period-cohort analysis examined incidence patterns, and Bayesian age-period-cohort modeling projected future trends to 2044, with internal and external validation. Global maternal disorder burden declined substantially from 1990 to 2021, with DALYs rates decreasing from 1,609.33 to 622.97 per 100,000 women. However, while absolute disparities narrowed between high and low-SDI regions, relative inequalities persisted or increased for most disorders. Low-SDI regions experienced slower burden reductions, primarily driven by population growth offsetting epidemiological improvements. Decomposition analyses revealed that population growth remains a central barrier to progress, while epidemiological advances substantially reduced DALYs across all disorders. Projections through 2044 suggest continued incidence declines globally, with validated models indicating persistent inequities requiring sustained intervention. Despite overall global improvements in maternal health outcomes, persistent inequalities highlight the need for targeted interventions in low-SDI regions. Enhanced maternal healthcare access, improved nutrition programs, and strengthened health systems may help address these disparities and promote more equitable maternal health outcomes. The online version contains supplementary material available at 10.1186/s12889-025-24228-4.

Lower extremity peripheral arterial disease (PAD) is a significant health concern among older adults globally, affecting both mortality and quality of life. To evaluate the temporospatial trends and its risk factors in lower extremity PAD-related burden among adults aged 60 years and older from 1990 to 2021. This repeated cross-sectional study utilized data from the Global Burden of Disease Study 2021, encompassing 204 countries and territories. The study population included adults aged 60 years and older. Lower extremity PAD among older adults from January 1990 to December 2021. Primary outcomes included age-standardized prevalence rates (ASPR), mortality rates (ASMR), disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs). Trends were analyzed by age, sex, and sociodemographic index (SDI). Joinpoint regression analysis was used to identify significant trend changes. From 1990 to 2021, global trends showed decreases in lower extremity PAD-related prevalence, mortality, and DALYs. Significant geographical disparities were observed: high-SDI regions had the highest prevalence (11,171.66 per 100,000 in 2021) but showed declining trends (AAPC, -0.74; 95% CI, -0.80 to -0.68), while low-SDI regions had the lowest prevalence (4,842.40 per 100,000) but demonstrated increasing trends (AAPC, 0.22; 95% CI, 0.21 to 0.24). Regionally, although lower extremity PAD-related prevalence showed a decreasing trend in most regions from 1990 to 2021, there were still some regions with an increasing trend (North Africa and Middle East AAPC, 0.57; 95% CI, 0.55 to 0.59). Temporal analysis showed sex-specific divergent trends in recent years, with males exhibiting an upward trend since 2015 (APC, 0.15; 95% CI, 0.07 to 0.24), while females showed a slowed decline since 2014 (APC, -0.06; 95% CI, -0.12 to -0.01). Decomposition analysis identified population growth as the primary driver of PAD burden increase, with epidemiological changes showing contrasting effects across SDI regions. Among risk factors, high fasting glucose emerged as the leading contributor, while smoking's contribution decreased. This study revealed significant disparities in lower extremity PAD burden across different SDI levels and regions, with low-SDI countries facing an increasing burden. The contrasting trends between high- and low-SDI regions, coupled with varying risk factor patterns (particularly the rise in high fasting glucose and decline in smoking), suggest the need for targeted interventions in resource-limited settings to address this growing health challenge among older adults.

Ovarian cancer is the most common cause of gynecologic cancer-related deaths. We aimed to assess the global, regional, and national burdens and trends of Ovarian Cancer in Women Aged 45 + from 1990 to 2019 and Projections for 2050, utilizing data from the most recent Global Burden of Disease (GBD) 2021 database. Age-standardized rates of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were analyzed using GBD 2021 data. Temporal trends were assessed using estimated annual percentage change (EAPC). Regional disparities were examined via the Socio-Demographic Index (SDI). Age-Period-Cohort (APC) models assessed disease dynamics, while Bayesian APC (BAPC) modeling projected trends to 2050. In 2021, global ovarian cancer incidence, prevalence, mortality, and DALYs in women aged 45 + were 239,682; 843,405; 171,246; and 4,352,539, respectively. The global burden declined significantly from 1990 to 2021 and is projected to remain stable through 2050. However, regional disparities persist: High and High-middle SDI regions saw decreases, while Middle to Low SDI regions experienced increases. Burden increased with SDI up to 0.8, then declined. Population growth was the primary contributor, followed by epidemiologic transitions and aging. The 55-59 age group showed the highest morbidity and DALYs; mortality peaked at 65-69 years. Although the overall burden of ovarian cancer in women aged 45 + is declining globally, marked regional disparities underscore the need for tailored prevention and treatment strategies to further reduce disease impact and improve outcomes.

The global burden of disease study-which has been affiliated with the World Bank and the World Health Organisation (WHO) and is now housed in the Institute for Health Metrics and Evaluation (IHME)-has become a very important tool to global health governance since it was first published in the 1993 World Development Report. In this article, based on literature review of primary and secondary sources as well as field notes from public events, we present first a summary of the origins and evolution of the GBD over the past 25 years. We then analyse two illustrative examples of estimates and the ways in which they gloss over the assumptions and knowledge gaps in their production, highlighting the importance of historical context by country and by disease in the quality of health data. Finally, we delve into the question of the end users of these estimates and the tensions that lie at the heart of producing estimates of local, national, and global burdens of disease. These tensions bring to light the different institutional ethics and motivations of IHME, WHO, and the World Bank, and they draw our attention to the importance of estimate methodologies in representing problems and their solutions in global health. With the rise in the investment in and the power of global health estimates, the question of representing global health problems becomes ever more entangled in decisions made about how to adjust reported numbers and to evolving statistical science. Ultimately, more work needs to be done to create evidence that is relevant and meaningful on country and district levels, which means shifting resources and support for quantitative-and qualitative-data production, analysis, and synthesis to countries that are the targeted beneficiaries of such global health estimates.

Heart failure (HF) is a major endpoint of cardiovascular disease (CVD) and a growing global public health challenge. This study assessed the global burden of CVD-related HF from 1990 to 2021 and projected trends to 2050. Utilizing data from the Global Burden of Disease (GBD) 2021 study, we analyzed years lived with disability (YLD) and prevalence for CVD-related HF, stratified by sex, age, socio-demographic index (SDI), region, and specific CVD etiology. In 2021, CVD-related HF affected approximately 45.56 million individuals globally, causing 4.32 million YLD. The global age-standardized prevalence and YLD rates were 548.81 and 52.00 per 100,000 population, respectively, with higher rates in males. Hypertensive and ischemic heart disease were predominant causes, except in the under-20 age group where cardiomyopathy/myocarditis and rheumatic heart disease prevailed. From 1990 to 2021, global age-standardized prevalence and YLD rates increased, with the sharpest rise in the 20-54 age group, males and middle to high-middle SDI countries. Age-standardized prevalence and YLD rates declined for rheumatic heart disease, stroke, and non-rheumatic valvular heart disease-related HF, whereas most other etiologies exhibited upward trends, most notably atrial fibrillation/flutter and endocarditis. There were significant disparities in various CVD-related HF across sex, age, SDI country, and region in 2021 and from 1990 to 2021. By 2050, projections indicate that CVD-related HF will increase to varying degrees across sex, age, and specific CVD types. The global burden of CVD-related HF is substantial, escalating, and characterized by significant disparities across sex, age, SDI country, region, and CVD type. Urgent and targeted public health strategies are essential to mitigate this rising burden.

No abstract

Cancer is the second most common cause of death globally. Therefore, it is imperative to investigate cancer incidence, mortality rates, and disability-adjusted life years (DALYs) to enhance preventive measures and healthcare resource allocation. This study aimed to assess cancer burden and associated risk factors in 204 countries and territories between 1980 and 2021. We selected data on cancer incidence and mortality rates and associated risk factors from the global burden of disease (GBD) study tool for 204 countries and territories from 1990 to 2021 and 1980 to 2021. We estimated the age-standardized incidence (ASIR) and age-standardized deaths (ASDR) of 34 cancer types categorized as level 3 causes based on the GBD hierarchy. In 2021, cancer accounted for 14.57% (95% uncertainty interval: 13.65-15.28) of total deaths and 8.8% (7.99-9.67) of total DALYs in both sexes globally. ASIR and ASDR were 790.33 (694.43-893.01) and 116.49 (107.28-124.69), respectively. Additionally, females exhibited higher ASIR than males (923.44 versus 673.09), while males exhibited higher ASDR than females (145.69 versus 93.60). This indicates that policymakers should focus on the importance of gender equality in healthcare. Non-melanoma skin cancer exhibited the highest ASIR (74.10) in both sexes, while digestive cancers accounted for 39.29% of all cancer-related deaths, and Asia exhibited the heaviest cancer burden. In females, breast cancer exhibited the highest ASIR (46.40) and ASDR (14.55). In males, tracheal, bronchial, and lung cancer exhibited the highest ASIR (37.85) and ASDR (34.32), highlighting the urgent need for targeted tobacco control measures. Different cancers in various countries exhibit unique characteristics. Therefore, policymakers should formulate specific prevention and control strategies that reflect the cancer in their country. Tobacco was the primary level 2 risk factor for cancer DALYs in males. It accounted for 29.32% (25.32-33.14) of all cancer DALYs. Dietary risks, alcohol consumption, and air pollution accounted for 5.89% (2.01-10.73), 5.48% (4.83-6.11), and 4.30% (2.77-5.95) of male cancer DALYs, respectively. Therefore, policymakers should prioritize smoking regulation and other carcinogenic risks. Cancer is a significant public health concern globally. Understanding the common etiologies of different cancers is essential for developing effective control strategies and targeted interventions.

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. 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. 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. 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. UK Department of Health and Social Care's Fleming Fund using UK aid, and the Wellcome Trust.

Epilepsy is one of the most common serious neurological disorders and affects individuals of all ages across the globe. The aim of this study is to provide estimates of the epilepsy burden on the global, regional, and national levels for 1990-2021. Using well established Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) methodology, we quantified the prevalence of active idiopathic (epilepsy of genetic or unknown origin) and secondary epilepsy (epilepsy due to an underlying abnormality of the brain structure or chemistry), as well as incidence, death, and disability-adjusted life-years (DALYs) by age, sex, and location (globally, 21 GBD regions and seven super-regions, World Bank country income levels, Socio-demographic Index [SDI], and 204 countries) and their trends from 1990 to 2021. Vital registrations and verbal autopsies provided information about deaths, and data on the prevalence and severity of epilepsy, largely came from population representative surveys. All estimates were calculated with 95% uncertainty intervals (UIs). In 2021, there were 51·7 million (95% UI 44·9-58·9) people with epilepsy (idiopathic and secondary combined) globally, with an age-standardised prevalence of 658 per 100 000 (569-748). Idiopathic epilepsy had an age-standardised prevalence of 307 per 100 000 (235-389) globally, with 24·2 million (18·5-30·7) prevalent cases, and secondary epilepsy had a global age-standardised prevalence of 350 per 100 000 (322-380). In 2021, 0·7% of the population had active epilepsy (0·3% attributed to idiopathic epilepsy and 0·4% to secondary epilepsy), and the age-standardised global prevalence of epilepsy from idiopathic and secondary epilepsy combined increased from 1990 to 2021 by 10·8% (1·1-21·3), mainly due to corresponding changes in secondary epilepsy. However, age-standardised death and DALY rates of idiopathic epilepsy reduced from 1990 to 2021 (decline of 15·8% [8·8-22·8] and 14·5% [4·2-24·2], respectively). There were three-fold to four-fold geographical differences in the burden of active idiopathic epilepsy, with the bulk of the burden residing in low-income to middle-income countries: 82·1% (81·1-83·4) of incident, 80·4% prevalent (79·7-82·7), 84·7% (83·7-85·1) fatal epilepsy, and 87·9% (86·2-89·2) epilepsy DALYs. Although the global trends in idiopathic epilepsy deaths and DALY rates have improved in the preceding decades, in 2021 there were almost 52 million people with active epilepsy (24 million from idiopathic epilepsy and 28 million from secondary epilepsy), with the bulk of the burden (>80%) residing in low-income to middle-income countries. Better treatment and prevention of epilepsy are required, along with further research on risk factors of idiopathic epilepsy, good-quality long-term epilepsy surveillance studies, and exploration of the possible effect of stigma and cultural differences in seeking medical attention for epilepsy. Bill and Melinda Gates Foundation.

The global burden of sepsis, a life-threatening dysregulated host response to infection leading to organ dysfunction, remains challenging to quantify. We aimed to comprehensively estimate the global, regional, and national burden of sepsis, including the impact of the COVID-19 pandemic and underlying causes of sepsis-related deaths with co-occurring infectious syndromes. We used multiple cause-of-death, hospital, minimally invasive tissue sampling, and linked death certificate and hospital record data representing 149 million deaths, covering 4290 location-years with mortality estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to capture explicit and implicit sepsis cases and deaths. We estimated age-location-sex-specific fractions of sepsis-related deaths from 195 underlying causes of death and 22 infectious syndromes from 1990 to 2021 using binomial logistic regression models, and estimated sepsis-related deaths using GBD cause-specific mortality estimates. Using 250 million hospital admissions and 7·82 million deaths from hospital data, representing 1310 location-years, we modelled case fatality rates by use of binomial logistic regression, applied to sepsis death estimates to estimate sepsis incidence by age, location, and year. In 2021, we estimated 166 million (95% uncertainty interval 135-201) sepsis cases and 21·4 million (20·3-22·5) all-cause sepsis-related deaths globally, representing 31·5% of total global deaths. Sepsis-related deaths decreased between 1990 and 2019, followed by a surge in 2020 and 2021. As of 2021, individuals aged 15 years and older experienced increases across incidence (230%) and mortality (26·3%) since 1990. Those aged 70 years and older had the highest sepsis-related mortality in 2021 (9·28 million [8·74-9·86] deaths). Sepsis-related deaths from infectious underlying causes decreased from 11·8 million (11·1-12·5) in 1990 to 8·34 million (7·72-9·01) in 2019, then increased by 86·4% to 15·5 million (14·7-16·4) in 2021. Sepsis-related mortality due to non-infectious underlying causes of death increased from 4·69 million (4·35-5·05) in 1990 to 5·81 million (5·40-6·25) in 2021; the leading non-infectious underlying causes of death with sepsis were stroke, chronic obstructive pulmonary disease, and cirrhosis. In 2021, bloodstream infections inclusive of HIV and malaria (3·08 million [2·83-3·35]) and lower respiratory infections inclusive of COVID-19 (11·33 million [1·20-1·47]) were the most prominent infectious syndromes complicating sepsis-related deaths from non-infectious underlying causes, representing a consistent trend since 1990. The global burden of sepsis increased in 2020 and 2021, reversing progress from 1990. Sepsis incidence and mortality increased in people aged 15 years and older, especially those aged 70 years and older, and as a complication of non-infectious underlying causes of death such as stroke, primarily through bloodstream infections and lower respiratory infections. The global burden of sepsis is substantial, and sepsis is increasingly a complication of non-infectious causes of death. Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.

For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Gates Foundation and Bloomberg Philanthropies.

Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time. We used 24 025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution. In 2023, 60·1 million (95% UI 59·0-61·1) deaths occurred globally, of which 4·67 million (4·59-4·75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35·2% (32·2-38·4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66·6% (65·8-67·3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67·7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11·5%, 31·7%, and 49·9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53·9% and 40·1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87·3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61·2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13·2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51·2 (50·6-51·7) years for females and 47·9 (47·4-48·4) years for males in 1950 to 76·3 (76·2-76·4) years for females and 71·4 (71·3-71·5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74·7 (74·6-74·8) years for females and 69·3 (69·2-69·4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76·3 [76·0-76·6] years for females and 71·5 [71·2-71·8] years for males). 194 (95·1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61·8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally. This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world. Gates Foundation.

Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.

Chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD) and pulmonary sarcoidosis, are major global causes of mortality and morbidity. Although the COVID-19 pandemic has influenced acute respiratory health, its impact on chronic respiratory conditions remains unclear. We estimated the global, regional and national burden of chronic respiratory diseases from 1990 to 2023, including risk factors, and evaluated how these burdens have shifted during the COVID-19 pandemic using the Global Burden of Disease Study 2023. In 2023, chronic respiratory diseases accounted for 569.2 million (95% uncertainty interval (UI), 508.8-639.8) cases and 4.2 million (3.6-5.1) deaths. The age-standardized death rate declined by 25.7% globally from 1990 to 2023 despite an increase in ILD and pulmonary sarcoidosis. Mortality declined in younger males, especially for asthma, whereas older adults experienced a rise in ILD and pulmonary sarcoidosis. Smoking was the primary risk factor for COPD, whereas high body mass index and silica exposure were key risk factors for asthma and pneumoconiosis. During the pandemic, the incidence of chronic respiratory diseases increased modestly, but the decline in mortality rates became more pronounced, highlighting the need for sustained global attention and action to address their long-term burden.

Decades of steady improvements in life expectancy in Europe slowed down from around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to assess how changes in risk factors and cause-specific death rates in different European countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic. We used data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to compare changes in life expectancy at birth, causes of death, and population exposure to risk factors in 16 European Economic Area countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden) and the four UK nations (England, Northern Ireland, Scotland, and Wales) for three time periods: 1990-2011, 2011-19, and 2019-21. Changes in life expectancy and causes of death were estimated with an established life expectancy cause-specific decomposition method, and compared with summary exposure values of risk factors for the major causes of death influencing life expectancy. All countries showed mean annual improvements in life expectancy in both 1990-2011 (overall mean 0·23 years [95% uncertainty interval [UI] 0·23 to 0·24]) and 2011-19 (overall mean 0·15 years [0·13 to 0·16]). The rate of improvement was lower in 2011-19 than in 1990-2011 in all countries except for Norway, where the mean annual increase in life expectancy rose from 0·21 years (95% UI 0·20 to 0·22) in 1990-2011 to 0·23 years (0·21 to 0·26) in 2011-19 (difference of 0·03 years). In other countries, the difference in mean annual improvement between these periods ranged from -0·01 years in Iceland (0·19 years [95% UI 0·16 to 0·21] vs 0·18 years [0·09 to 0·26]), to -0·18 years in England (0·25 years [0·24 to 0·25] vs 0·07 years [0·06 to 0·08]). In 2019-21, there was an overall decrease in mean annual life expectancy across all countries (overall mean -0·18 years [95% UI -0·22 to -0·13]), with all countries having an absolute fall in life expectancy except for Ireland, Iceland, Sweden, Norway, and Denmark, which showed marginal improvement in life expectancy, and Belgium, which showed no change in life expectancy. Across countries, the causes of death responsible for the largest improvements in life expectancy from 1990 to 2011 were cardiovascular diseases and neoplasms. Deaths from cardiovascular diseases were the primary driver of reductions in life expectancy improvements during 2011-19, and deaths from respiratory infections and other COVID-19 pandemic-related outcomes were responsible for the decreases in life expectancy during 2019-21. Deaths from cardiovascular diseases and neoplasms in 2019 were attributable to high systolic blood pressure, dietary risks, tobacco smoke, high LDL cholesterol, high BMI, occupational risks, high alcohol use, and other risks including low physical activity. Exposure to these major risk factors differed by country, with trends of increasing exposure to high BMI and decreasing exposure to tobacco smoke observed in all countries during 1990-2021. The countries that best maintained improvements in life expectancy after 2011 (Norway, Iceland, Belgium, Denmark, and Sweden) did so through better maintenance of reductions in mortality from cardiovascular diseases and neoplasms, underpinned by decreased exposures to major risks, possibly mitigated by government policies. The continued improvements in life expectancy in five countries during 2019-21 indicate that these countries were better prepared to withstand the COVID-19 pandemic. By contrast, countries with the greatest slowdown in life expectancy improvements after 2011 went on to have some of the largest decreases in life expectancy in 2019-21. These findings suggest that government policies that improve population health also build resilience to future shocks. Such policies include reducing population exposure to major upstream risks for cardiovascular diseases and neoplasms, such as harmful diets and low physical activity, tackling the commercial determinants of poor health, and ensuring access to affordable health services. Gates Foundation.

Since its inception in 1974, the Essential Programme on Immunization (EPI) has achieved remarkable success, averting the deaths of an estimated 154 million children worldwide through routine childhood vaccination. However, more recent decades have seen persistent coverage inequities and stagnating progress, which have been further amplified by the COVID-19 pandemic. In 2019, WHO set ambitious goals for improving vaccine coverage globally through the Immunization Agenda 2030 (IA2030). Now halfway through the decade, understanding past and recent coverage trends can help inform and reorient strategies for approaching these aims in the next 5 years. Based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, this study provides updated global, regional, and national estimates of routine childhood vaccine coverage from 1980 to 2023 for 204 countries and territories for 11 vaccine-dose combinations recommended by WHO for all children globally. Employing advanced modelling techniques, this analysis accounts for data biases and heterogeneity and integrates new methodologies to model vaccine scale-up and COVID-19 pandemic-related disruptions. To contextualise historic coverage trends and gains still needed to achieve the IA2030 coverage targets, we supplement these results with several secondary analyses: (1) we assess the effect of the COVID-19 pandemic on vaccine coverage; (2) we forecast coverage of select life-course vaccines up to 2030; and (3) we analyse progress needed to reduce the number of zero-dose children by half between 2023 and 2030. Overall, global coverage for the original EPI vaccines against diphtheria, tetanus, and pertussis (first dose [DTP1] and third dose [DTP3]), measles (MCV1), polio (Pol3), and tuberculosis (BCG) nearly doubled from 1980 to 2023. However, this long-term trend masks recent challenges. Coverage gains slowed between 2010 and 2019 in many countries and territories, including declines in 21 of 36 high-income countries and territories for at least one of these vaccine doses (excluding BCG, which has been removed from routine immunisation schedules in some countries and territories). The COVID-19 pandemic exacerbated these challenges, with global rates for these vaccines declining sharply since 2020, and still not returning to pre-COVID-19 pandemic levels as of 2023. Coverage for newer vaccines developed and introduced in more recent years, such as immunisations against pneumococcal disease (PCV3) and rotavirus (complete series; RotaC) and a second dose of the measles vaccine (MCV2), saw continued increases globally during the COVID-19 pandemic due to ongoing introductions and scale-ups, but at slower rates than expected in the absence of the pandemic. Forecasts to 2030 for DTP3, PCV3, and MCV2 suggest that only DTP3 would reach the IA2030 target of 90% global coverage, and only under an optimistic scenario. The number of zero-dose children, proxied as children younger than 1 year who do not receive DTP1, decreased by 74·9% (95% uncertainty interval 72·1-77·3) globally between 1980 and 2019, with most of those declines reached during the 1980s and the 2000s. After 2019, counts of zero-dose children rose to a COVID 19-era peak of 18·6 million (17·6-20·0) in 2021. Most zero-dose children remain concentrated in conflict-affected regions and those with various constraints on resources available to put towards vaccination services, particularly sub-Saharan Africa. As of 2023, more than 50% of the 15·7 million (14·6-17·0) global zero-dose children resided in just eight countries (Nigeria, India, Democratic Republic of the Congo, Ethiopia, Somalia, Sudan, Indonesia, and Brazil), emphasising persistent inequities. Our estimates of current vaccine coverage and forecasts to 2030 suggest that achieving IA2030 targets, such as halving zero-dose children compared with 2019 levels and reaching 90% global coverage for life-course vaccines DTP3, PCV3, and MCV2, will require accelerated progress. Substantial increases in coverage are necessary in many countries and territories, with those in sub-Saharan Africa and south Asia facing the greatest challenges. Recent declines will need to be reversed to restore previous coverage levels in Latin America and the Caribbean, especially for DTP1, DTP3, and Pol3. These findings underscore the crucial need for targeted, equitable immunisation strategies. Strengthening primary health-care systems, addressing vaccine misinformation and hesitancy, and adapting to local contexts are essential to advancing coverage. COVID-19 pandemic recovery efforts, such as WHO's Big Catch-Up, as well as efforts to bolster routine services must prioritise reaching marginalised populations and target subnational geographies to regain lost ground and achieve global immunisation goals. The Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.

Chagas disease is a neglected tropical disease caused by the protozoan Trypanosoma cruzi, primarily transmitted by infected bugs, but also through contaminated food, transfusions, congenital transmission, and organ transplantation. Chagas disease has acute and chronic phases; the chronic phase can occur decades after infection, leading to complications such as heart failure, arrhythmias, and megaviscera. Accurate mortality and morbidity estimates are hindered by under-reporting and misclassification. Comprehensive and updated estimates are needed to improve global assessments of Chagas disease burden. We aim to provide a comprehensive description of global and regional burden of Chagas disease and its trends from 1990 to 2023. In this systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we produced estimates of Chagas disease deaths, years of life lost (YLLs), prevalence, incidence, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 204 countries and territories from 1990 to 2023 by age and sex. The GBD 2023 estimates supersede previous estimates for all years. For mortality estimates, we fit a cause of death ensemble model to vital registration data. For non-fatal estimates in endemic locations, we did a systematic review of seroprevalence data, defining a confirmed case as a confirmed diagnosis of T cruzi infection by two different positive tests (or a single ELISA or immunochromatographic test). After adjustment for the population at risk, we used a Bayesian compartmental model (DisMod-MR) to produce estimates. For non-endemic locations, we estimated prevalence on the basis of migration patterns and estimated prevalence from endemic countries. Prevalence of acute and chronic sequelae and corresponding disability weights were used to calculate YLDs. We estimated 10·5 million (95% uncertainty interval 9·4-11·7) Chagas disease prevalent cases in 2023 globally, a 16·1% (12·6-19·2) decrease compared with 1990. The global age-standardised Chagas disease prevalence rate declined by 55·0% (53·8-56·1) from 1990 to 2023, with rates decreasing across all endemic regions. The highest age-standardised Chagas disease prevalence rates in 2023 were in southern Latin America (2485·9 [2249·6-2707·7] per 100 000) and Andean Latin America (2313·8 [2093·7-2570·1] per 100 000). Non-endemic regions experienced notable increases in prevalence due to migration from endemic countries. The age distribution of cases shifted over time, peaking at older ages in 2023 (between age 45 years and 65 years) compared with 1990 (30-45 years). In 2023, there were 352 000 (308 000-398 000) new cases of Chagas disease globally, with the age-standardised rate decreasing by 55·1% (53·4-56·6) since 1990. There were 8420 (7480-9360) deaths globally in 2023. Age-standardised mortality decreased by 72·5% (68·9-75·4) globally from 1990 to 2023. In 2023, the highest age-standardised mortality rates were in tropical Latin America (2·2 [1·9-2·4] per 100 000) and Andean Latin America (0·92 [0·70-1·2] per 100 000). The GBD 2023 Chagas disease estimates are notably higher than previous GBD estimates, reflecting additional data and methodological improvements, and those published by the Pan American Health Organization. Nevertheless, these updated estimates show decreasing prevalence and incidence in endemic countries, highlighting the importance of socioeconomic development, housing conditions, and vector-control policies. Conversely, the increase in prevalence in non-endemic countries, mainly due to migration, requires new strategies for screening, early recognition, and access to care. Although the marked decrease in mortality and YLLs might be due to better access to care at different levels, the shift in age distribution highlights the importance of preparing and funding health systems for caring for older populations with advanced sequelae. Finally, the continuous refinement of data-source quality, including adequate coding and classification, is crucial for the accuracy of global estimates, which can ultimately drive health and social policies. The Gates Foundation, the World Heart Federation, and Novartis Pharma.

We aimed to update estimates of global vision loss due to age-related macular degeneration (AMD). We did a systematic review and meta-analysis of population-based surveys of eye diseases from January, 1980, to October, 2018. We fitted hierarchical models to estimate the prevalence of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness ( < 3/60) caused by AMD, stratified by age, region, and year. In 2020, 1.85 million (95%UI: 1.35 to 2.43 million) people were estimated to be blind due to AMD, and another 6.23 million (95%UI: 5.04 to 7.58) with MSVI globally. High-income countries had the highest number of individuals with AMD-related blindness (0.60 million people; 0.46 to 0.77). The crude prevalence of AMD-related blindness in 2020 (among those aged ≥ 50 years) was 0.10% (0.07 to 0.12) globally, and the region with the highest prevalence of AMD-related blindness was North Africa/Middle East (0.22%; 0.16 to 0.30). Age-standardized prevalence (using the GBD 2019 data) of AMD-related MSVI in people aged ≥ 50 years in 2020 was 0.34% (0.27 to 0.41) globally, and the region with the highest prevalence of AMD-related MSVI was also North Africa/Middle East (0.55%; 0.44 to 0.68). From 2000 to 2020, the estimated crude prevalence of AMD-related blindness decreased globally by 19.29%, while the prevalence of MSVI increased by 10.08%. The estimated increase in the number of individuals with AMD-related blindness and MSVI globally urges the creation of novel treatment modalities and the expansion of rehabilitation services.

Lower respiratory infections (LRIs) remain the world's leading infectious cause of death. This analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides global, regional, and national estimates of LRI incidence, mortality, and disability-adjusted life-years (DALYs), with attribution to 26 pathogens, including 11 newly modelled pathogens, across 204 countries and territories from 1990 to 2023. With new data and revised modelling techniques, these estimates serve as an update and expansion to GBD 2021. Through these estimates, we also aimed to assess progress towards the 2025 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) target for pneumonia mortality in children younger than 5 years. Mortality from LRIs, defined as physician-diagnosed pneumonia or bronchiolitis, was estimated using the Cause of Death Ensemble model with data from vital registration, verbal autopsy, surveillance, and minimally invasive tissue sampling. The Bayesian meta-regression tool DisMod-MR 2.1 was used to model overall morbidity due to LRIs. DALYs were calculated as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for all locations, years, age groups, and sexes. We modelled pathogen-specific case-fatality ratios (CFRs) for each age group and location using splined binomial regression to create internally consistent estimates of incidence and mortality proportions attributable to viral, fungal, parasitic, and bacterial pathogens. Progress was assessed towards the GAPPD target of less than three deaths from pneumonia per 1000 livebirths, which is roughly equivalent to a mortality rate of less than 60 deaths per 100 000 children younger than 5 years. In 2023, LRIs were responsible for 2·50 million (95% uncertainty interval [UI] 2·24-2·81) deaths and 98·7 million (87·7-112) DALYs, with children younger than 5 years and adults aged 70 years and older carrying the highest burden. LRI mortality in children younger than 5 years fell by 33·4% (10·4-47·4) since 2010, with a global mortality rate of 94·8 (75·6-116·4) per 100 000 person-years in 2023. Among adults aged 70 years and older, the burden remained substantial with only marginal declines since 2010. A mortality rate of less than 60 deaths per 100 000 for children younger than 5 years was met by 129 of the 204 modelled countries in 2023. At a super-regional level, sub-Saharan Africa had an aggregate mortality rate in children younger than 5 years (hereafter referred to as under-5 mortality rate) furthest from the GAPPD target. Streptococcus pneumoniae continued to account for the largest number of LRI deaths globally (634 000 [95% UI 565 000-721 000] deaths or 25·3% [24·5-26·1] of all LRI deaths), followed by Staphylococcus aureus (271 000 [243 000-298 000] deaths or 10·9% [10·3-11·3]), and Klebsiella pneumoniae (228 000 [204 000-261 000] deaths or 9·1% [8·8-9·5]). Among pathogens newly modelled in this study, non-tuberculous mycobacteria (responsible for 177 000 [95% UI 155 000-201 000] deaths) and Aspergillus spp (responsible for 67 800 [59 900-75 900] deaths) emerged as important contributors. Altogether, the 11 newly modelled pathogens accounted for approximately 22% of LRI deaths. This comprehensive analysis underscores both the gains achieved through vaccination and the challenges that remain in controlling the LRI burden globally. Furthermore, it demonstrates persistent disparities in disease burden, with the highest mortality rates concentrated in countries in sub-Saharan Africa. Globally, as well as in these high-burden locations, the under-5 LRI mortality rate remains well above the GAPPD target. Progress towards this target requires equitable access to vaccines and preventive therapies-including newer interventions such as respiratory syncytial virus monoclonal antibodies-and health systems capable of early diagnosis and treatment. Expanding surveillance of emerging pathogens, strengthening adult immunisation programmes, and combating vaccine hesitancy are also crucial. As the global population ages, the dual challenge of sustaining gains in child survival while addressing the rising vulnerability in older adults will shape future pneumonia control strategies. Gates Foundation.

A comprehensive understanding of temporal trends in the disease burden in Australia is lacking, and these trends are required to inform health service planning and improve population health. We explored the burden and trends of diseases and their risk factors in Australia from 1990 to 2019 through a comprehensive analysis of the Global Burden of Disease Study (GBD) 2019. In this systematic analysis for GBD 2019, we estimated all-cause mortality using the standardised GBD methodology. Data sources included primarily vital registration systems with additional data from sample registrations, censuses, surveys, surveillance, registries, and verbal autopsies. A composite measure of health loss caused by fatal and non-fatal disease burden (disability-adjusted life-years [DALYs]) was calculated as the sum of years of life lost (YLLs) and years of life lived with disability (YLDs). Comparisons between Australia and 14 other high-income countries were made. Life expectancy at birth in Australia improved from 77·0 years (95% uncertainty interval [UI] 76·9-77·1) in 1990 to 82·9 years (82·7-83·1) in 2019. Between 1990 and 2019, the age-standardised death rate decreased from 637·7 deaths (95% UI 634·1-641·3) to 389·2 deaths (381·4-397·6) per 100 000 population. In 2019, non-communicable diseases remained the major cause of mortality in Australia, accounting for 90·9% (95% UI 90·4-91·9) of total deaths, followed by injuries (5·7%, 5·3-6·1) and communicable, maternal, neonatal, and nutritional diseases (3·3%, 2·9-3·7). Ischaemic heart disease, self-harm, tracheal, bronchus, and lung cancer, stroke, and colorectal cancer were the leading causes of YLLs. The leading causes of YLDs were low back pain, depressive disorders, other musculoskeletal diseases, falls, and anxiety disorders. The leading risk factors for DALYs were high BMI, smoking, high blood pressure, high fasting plasma glucose, and drug use. Between 1990 and 2019, all-cause DALYs decreased by 24·6% (95% UI 21·5-28·1). Relative to similar countries, Australia's ranking improved for age-standardised death rates and life expectancy at birth but not for YLDs and YLLs between 1990 and 2019. An important challenge for Australia is to address the health needs of people with non-communicable diseases. The health systems must be prepared to address the increasing demands of non-communicable diseases and ageing. Bill & Melinda Gates Foundation.

Child growth failure (CGF), which includes underweight, wasting, and stunting, is among the factors most strongly associated with mortality and morbidity in children younger than 5 years worldwide. Poor height and bodyweight gain arise from a variety of biological and sociodemographic factors and are associated with increased vulnerability to infectious diseases. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to estimate CGF prevalence, the risk of infectious diseases associated with CGF, and the disease mortality, morbidity, and overall burden associated with CGF. In this analysis we estimated the all-cause and cause-specific (diarrhoea, lower respiratory tract infections, malaria, and measles) disability-adjusted life-years (DALYs) lost and mortality associated with stunting, wasting, underweight, and CGF in aggregate. We combined the burden associated with mild, moderate, and severe forms of CGF: stunting was defined as height-for-age Z scores (HAZ) less than -1, underweight was defined as weight-for-age Z scores (WAZ) less than -1, and wasting was defined as weight-for-height Z scores (WHZ) less than -1, according to WHO Child Growth Standards. Population-level continuous distributions of HAZ, WAZ, and WHZ were estimated for 2000 to 2023 using data from surveys, literature, and individual-level study data. The risk of incidence of, and mortality due to, diarrhoea, lower respiratory infections, malaria, and measles was separately estimated in a meta-regression framework from longitudinal cohort data for Z scores less than -1. Finally, fatal outcomes associated with these diseases were estimated with vital registration, verbal autopsy, and case-fatality data, while non-fatal outcomes were estimated with surveys as well as health-care utilisation and case reporting data. The exposure prevalence and relative risk estimates were from continuous distributions, allowing for direct assessment of the attributable fractions for mild, moderate, and severe stunting, underweight, wasting, and the combined impact of child growth failure within populations. All estimates were age-specific, sex-specific, geography-specific, and year-specific. We estimated that, in children younger than 5 years in 2023, CGF was associated with 79·4 million (95% uncertainty interval [UI] 47·0-106) DALYs lost and 880 000 (517 000-1 170 000) deaths. This represented 17·9% (10·6-23·8) of 444 million (434-457) total under-5 DALYs and 18·8% (11·1-25·0) of all 4·67 million (4·59-4·75) under-5 deaths. Compared to stunting (33·0 million [24·1-42·2] DALYs, 373 000 [272 000-477 000] deaths) and wasting (39·2 million [23·8-53·0] DALYs, 428 000 [256 000-583 000] deaths), childhood underweight was associated with the largest share of CGF-related disease burden: 52·2 million (21·9-75·1) DALYs and 573 000 (236 000-824 000) deaths in children younger than 5 years in 2023. CGF remains a leading factor associated with death and disability in children younger than 5 years, despite global attention and focused interventions to reduce the prevalence of associated CGF indicators. Our findings underscore the need for policies, strategies, and interventions that focus on all indicators of CGF to reduce its associated health burden. Gates Foundation.

Chronic respiratory diseases are an important global issue, particularly in Asia, where burden patterns vary widely across countries. With more than half the world's population living in Asia, understanding the national and regional burden of chronic respiratory diseases is essential; however, research on this area remains inadequate. We aimed to investigate the burden of chronic respiratory diseases in Asia at national and regional levels, and to identify key risk factors. The Global Burden of Diseases, Injuries, and Risk Factors Study 2023 provides estimates for assessing the burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD), and pulmonary sarcoidosis. We focused on 34 countries in Asia, encompassing the high-income Asia Pacific region and central, east, south, and southeast Asia. Estimates for age-standardised prevalence and disability-adjusted life-year (DALY) rates per 100 000 population, including 95% uncertainty intervals (UIs), were extracted by location, sex, year, and Socio-demographic Index (SDI). The average annual percentage change was calculated and presented as a percentage with 95% CIs. Estimates of modifiable attributable risk factors for DALYs and mortality were also included. In Asia, the age-standardised prevalence and DALY rates for chronic respiratory diseases generally declined from 1990 to 2023; however, the trend varied substantially by disease and country. In 2023, the age-standardised prevalence rate of COPD was highest in south Asia (3044·18 [95% UI 2748·67-3303·04] per 100 000 population), while the age-standardised asthma prevalence rate was highest in the high-income Asia Pacific region (4870·24 [4046·70-5962·78] per 100 000 population) and southeast Asia (4778·18 [3970·25-5735·61] per 100 000 population). Despite southeast Asia and the high-income Asia Pacific region having a similar age-standardised asthma prevalence rate, southeast Asia had a higher age-standardised DALY rate (508·67 [95% UI 394·89-669·92] per 100 000 population) compared with the high-income Asia Pacific region (204·40 [129·23-290·41] per 100 000 population). A decrease in the age-standardised DALY rate for chronic respiratory diseases was observed with increasing SDI, contrasting with its prevalence patterns. Age-standardised DALY rates of COPD decreased in all Asian countries except for Georgia (average annual percentage change 1·37 [95% CI 1·26-1·48]) and Kazakhstan (0·73 [0·55-0·93]), and age-standardised DALY rates of asthma decreased in all countries. Smoking and ambient particulate matter pollution were identified as leading attributable risk factors for chronic respiratory diseases across Asia. Household air pollution from solid fuels was a regionally pronounced risk factor for chronic respiratory diseases, particularly in south Asia (age-standardised DALY rate 657·58 [95% UI 485·04-880·45] per 100 000 population). Although smoking was a major risk factor in males, ambient particulate matter pollution and secondhand smoke emerged as important attributable risk factors for chronic respiratory diseases in females. Countries with lower SDI had markedly higher DALY rates, highlighting the need to address socioeconomic and health-care inequities. Household air pollution from solid fuels continues to impose a substantial but preventable burden in south Asia, calling for clean energy adoption and improved ventilation. Gates Foundation.

Urolithiasis is a common condition worldwide, marked by significant variations in lifetime risk across different regions, genders, and socioeconomic backgrounds. Understanding these disparities is crucial for developing effective public health strategies. This study aims to analyze these risks from 1990 to 2021 and project future trends in the incidence and mortality of urolithiasis. Data were obtained from the Global Burden of Disease (GBD) 2021 study, which provides comprehensive estimates on urolithiasis incidence, prevalence, and mortality across various demographics. Analyses were stratified by gender, age, Sociodemographic Index (SDI), and geographic regions, and included assessments of temporal trends and concentration indices (CIs). Additionally, AutoRegressive Integrated Moving Average (ARIMA) models were employed to project future trends regarding the lifetime risk of developing urolithiasis.The global lifetime risk of developing urolithiasis in 2021 was estimated at 62.95%, with the highest risks observed in Eastern Europe (89.20%), Southern Latin America (80.34%), and Central Asia (75.75%). Men exhibited a higher risk than women (70.40% vs. 50.34%). The global mortality risk from urolithiasis remained low at 0.03%, with the highest rates found in High-income Asia Pacific (0.07%) and Eastern Europe (0.06%). Notably, the lifetime risk of developing urolithiasis declined with advancing age, particularly after 40. ARIMA projections suggest a moderate increase in lifetime risk, potentially reaching nearly 70% by 2050, especially among females. Urolithiasis demonstrates significant global and regional disparities influenced by socioeconomic, environmental, and demographic factors. Comprehensive strategies that address these disparities will be essential for enhancing public health outcomes and reducing the incidence of urolithiasis worldwide.

Updated information on the burden of Alzheimer's disease and other forms of dementia are of great importance for evidence-based health care planning. However, such an estimate has been lacking in Chinese populations at both national and provincial levels. To estimate the temporal trends and the attributable burdens of selected risk factors of Alzheimer's disease and other forms of dementia in China. This is an observational description of the Global Burden of Diseases Study 2019 (GBD 2019). Data on incidence, mortality, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) of Alzheimer's disease and other forms of dementia were derived from the GBD 2019 study at both national and provincial levels in China. Six indicators were used: incidence, mortality, prevalence, DALYs, YLLs, and YLDs. Absolute numbers in detail by age, sex, region, and age-standardized rates (with 95% uncertainty intervals) were calculated. There were notable increasing trends in the number of deaths (247·9%), incidence (264·8%), prevalence (296·5%), DALYs (228·1%), YLDs (308·7%) and YLLs (201·7%) from 1990 to 2019, respectively. The corresponding age-standardized rates increased by 6·2%, 19·3%, 33·6%, 10·7%, 33·4% and 3·1%. Smoking, high body mass index, high fasting plasma glucose levels, and metabolic risks were the four leading risk factors. Higher burden was observed among females versus males and in the more developed regions. The disease burden in China were increasing substantially. Regional differences of the disease burden are accompanied by discrepancies of economic level and geographical location, as well as different levels of exposure to risk factors. Targeted prevention and control strategies are urgently needed to reduce the disease burden.

Stroke is a major public health concern requiring valid estimates for planning and evaluating health interventions. The GBD (Global Burden of Disease) studies have become a major source of information; however, data sources have historically been a limitation. We sought to compare stroke mortality estimates in Kazakhstan with those reported by the GBD study. Mortality data were extracted from the Unified Electronic Healthcare System of Kazakhstan (UNEHS). We used the autoregressive integrated moving average (ARIMA), Bayesian structural time-series (BSTS), and Extreme Gradient Boosting (XGBoost) to model data from the UNEHS and forecast its trends until 2030. The accuracy metrics were mean absolute error, root mean square error, and mean absolute percentage error. We calculated the standardized difference in mortality estimates between the databases for the observed and forecasted estimates. The BSTS, ARIMA, and XGBoost models revealed slight variations in accuracy metrics, which depended on forecasting horizons and mostly favored XGBoost. During 2014-2030, the absolute difference in death counts was 207,108 between the GBD and UNEHS. The GBD estimates were twice as many across both the observed and predicted periods, with a moderate standardized difference (0.73) when considering their average. This study showed a systematic difference between GBD and national data. We found that UNEHS estimates were not comparable despite our efforts to replicate the GBD methods. Further studies are needed to explore the discrepancies between the national or regional data and GBD. Current limitations related to primary data and reproducibility require caution when interpreting GBD findings.

The burden of cancer has been progressively increasing, with diet playing a key role in its development and progression. Previous studies on diet-related cancer burden mainly focused on individual factors or single cancer types. Therefore, this study aimed to analyze global trends in deaths and disability-adjusted life years (DALYs) associated with diet-related cancers from 1990 to 2021, predicting the burden up to 2035. Using bibliometric analysis and Global Burden of Disease (GBD) 2021 data, it examined mortality and DALY rates stratified by age, sex, cancer type, and region. Decomposition analysis assessed contributions of population growth, aging, and epidemiological transitions, while health inequalities were evaluated using inequality indices. Frontier analysis quantified gaps between current and minimum achievable burdens. Future trends for multiple tumors were projected using Bayesian Age-Period-Cohort (BAPC) modeling. The age-standardized death rate (ASDR) for diet-related cancers declined from 12.24 (95% UI: 3.32 to 22.78) per 100,000 in 1990 to 7.90 (95% UI: 2.45 to 13.85) in 2021, and the age-standardized DALYs rate decreased from 302.48 (95% UI: 80.53 to 565.63) to 189.62 (95% UI: 57.13 to 335.37) per 100,000. In 2021, the highest ASDR were recorded in Central Europe, and the largest age-standardized DALYs rate were documented in Southern Sub-Saharan Africa. The greatest disease burden was identified in high-middle sociodemographic index (SDI) regions. Colon and rectum cancers were most prominent, with high red meat intake as the leading dietary risk. We also found that a higher disease burden was observed in males compared to females, and the burden increased progressively with age. Decomposition analysis revealed population growth as the main driver of increasing burdens, partly offset by epidemiological changes. Health inequality driven by economic factors has decreased. BAPC modeling predicted a continued decline in the future burden of multiple cancers, except for breast cancer. While the burden of diet-related cancers is declining, challenges remain, particularly in older populations and higher SDI regions. Persistent health inequalities affect esophageal and stomach cancers. These findings can guide targeted strategies for prevention and control.

To explore the geographical pattern and temporal trend of autism spectrum disorders (ASD) epidemiology from 1990 to 2019, and perform a bibliometric analysis of risk factors for ASD. In this study, ASD epidemiology was estimated with prevalence, incidence, and disability-adjusted life-years (DALYs) of 204 countries and territories by sex, location, and sociodemographic index (SDI). Age-standardized rate (ASR) and estimated annual percentage change (EAPC) were used to quantify ASD temporal trends. Besides, the study performed a bibliometric analysis of ASD risk factors since 1990. Publications published were downloaded from the Web of Science Core Collection database, and were analyzed using CiteSpace. Globally, there were estimated 28.3 million ASD prevalent cases (ASR, 369.4 per 100,000 populations), 603,790 incident cases (ASR, 9.3 per 100,000 populations) and 4.3 million DALYs (ASR, 56.3 per 100,000 populations) in 2019. Increases of autism spectrum disorders were noted in prevalent cases (39.3%), incidence (0.1%), and DALYs (38.7%) from 1990 to 2019. Age-standardized rates and EAPC showed stable trend worldwide over time. A total of 3,991 articles were retrieved from Web of Science, of which 3,590 were obtained for analysis after removing duplicate literatures. "Rehabilitation", "Genetics & Heredity", "Nanoscience & Nanotechnology", "Biochemistry & Molecular biology", "Psychology", "Neurosciences", and "Environmental Sciences" were the hotspots and frontier disciplines of ASD risk factors. Disease burden and risk factors of autism spectrum disorders remain global public health challenge since 1990 according to the GBD epidemiological estimates and bibliometric analysis. The findings help policy makers formulate public health policies concerning prevention targeted for risk factors, early diagnosis and life-long healthcare service of ASD. Increasing knowledge concerning the public awareness of risk factors is also warranted to address global ASD problem.

The Lancet recently declared that it intends to "make mental health one of its campaign focal points". However, it has been silent on the role it might play in disseminating mental health research. To examine The Lancet's track record in publishing mental health research relative to its disease burden. Research articles (n = 733) published in The Lancet over a 2.5 year period (2003-2005) were coded according to the Global Burden of Disease (GBD) classification system and compared with data from the 2002 GBD study. A range of other characteristics including whether consumers were involved in the research process were coded. Mental health articles (excluding neurological and substance abuse) accounted for 1.8% of articles but are responsible for a worldwide YLD of 22.8% (25.4% high income countries) and DALYs of 9.0% (14.7% in high income countries). Despite its commendable mental health advocacy work, mental health research is under-represented in The Lancet. The journal should take steps to ensure that the dissemination of mental health research is not a neglected aspect of their advocacy activities.

This study aims to examine the temporal changes in the incidence, prevalence, and disability-adjusted life years (DALYs) of depressive disorders as well as its association with age, period, and birth cohort among Chinese from 1990 to 2021, and forecast the future trends of incidence rates and numbers from 2022 to 2030. Data for analysis were obtained from the Global Burden of Disease (GBD) 2021. Joinpoint analysis was used to calculate the annual percentage change (APC) and average annual percent change (AAPC) to describe the rates of depressive disorders. Age, period, and cohort model was utilized to disentangle age, period, and birth cohort effects on rates of depressive disorders. Bayesian age-period-cohort (BAPC) analysis was capitalized to forecast the incidence rates and numbers for different sexes and age groups from 2022 to 2030. The age-standardized incidence (ASIR, AAPC: -0.35 [95%CI: -0.65, -0.04]), prevalence (ASPR, AAPC: -0.20 [95%CI: -0.24, -0.16]), and DAYLs (AAPC: -0.28 [95%CI: -0.51, -0.05]) rates of both sexes showed a downward trend from 1990 to 2021, despite a volatility growth in recent years (APC in 2019-2021 of ASPR: 0.96 [95%CI: 0.70, 1.23]). Females exhibited a higher burden of depressive disorders compared to males but experienced a more rapid rate of reduction changes. The burden of depressive disorders was most owing to the age effect and period effect in recent years. The ASIR was predicted to decrease in the whole population (males in 2030: 1,546.3 per 100,000 people; females in 2030: 2,465.8 per 100,000 people), but in children, adolescents, and the elderly demonstrate unfavorable trends in the future. The burden of depressive disorders decreased in China from 1990 to 2021 in terms of age-standardized rates, but increased in recent years. Children, adolescents, and the elderly are the risk groups for future depressive disorders. Considering the large population, the increasing fewer children, and the aging trend, as well as the possible long-term effects of COVID-19 on human psychological burden, more sex-age-sensitive social healthcare programs should be considered in the future to minimize the burden of depressive disorders in China.

The study aimed to analyze the long-term trends in the global burden of Alzheimer's disease and other dementias(ADOD) in different regions, and assess the association between socio-demographic index(SDI) and disease burden. We extracted data on the incidence, mortality, disability-adjusted life-years(DALYs), and age-standardized rates related to ADOD, as disease burden measures from 1990 to 2021. The joinpoint regression, quantile regression and restricted cubic splines were adopted to estimate the temporal trends and relationships with SDI. Risk factors for deaths and DALYs were also analyzed. Globally, 9.84 million cases of ADOD occurred in 2021, with 1.95 million ADOD-related deaths, causing 36.33 million DALYs. ADOD incidence, mortality and DALYs all increased from 1990 to 2021. Regional and sex variations persisted, with the fastest increase in age-standardized death rate in low-middle SDI quintiles, experienced the highest estimated annual percentage changes (0.41[0.31,0.52]). The incidence of ADOD increased more rapidly as SDI increased in areas that have historically shown lower incidence compared to other areas. In regions with higher mortality or DALYs burden, these indicators decreased relatively faster as SDI increased. High fasting plasma glucose was the main risk factor, particularly in high SDI region, with an increasing trend in attributable burden. The burden attributable to high BMI was increasing, whereas the burden associated with smoking steadily decreased. ADOD poses a significant and escalating challenge to healthcare sustainability, with persistent regional and gender disparities. By learning from successful ADOD management in certain nations, we can proactively reduce health burdens and bridge disparities between countries at various developmental levels.

Stroke is a leading cause of disability and mortality worldwide, with rising incidence rates among youths and young adults aged 15-39 years. However, comprehensive assessments of stroke burden in this age group at global, regional, and national levels are limited. This study examines trends in stroke incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 using data from the Global Burden of Disease (GBD) study. Data from the GBD study (1990-2021) were analyzed to assess the age-standardized incidence, mortality, and DALYs related to stroke in individuals aged 15-39 years. The relationship between stroke burden and the Socio-Demographic Index (SDI) was explored across 204 countries and 21 regions. Trends were analyzed using the estimated annual percentage change (EAPC) and average annual percentage change (AAPC). This study reveals global, regional, and national trends in stroke burden among youths and young adults (15-39 years) from 1990 to 2021. In 2021, the global age-standardized stroke incidence was 757,234.61 cases, with 8.72 million DALYs and 122,742 stroke-related deaths. Although global incidence increased by 19.09%, age-standardized rates (ASRs) declined by 0.67% annually. DALYs and mortality rates also decreased globally. Notably, stroke burden increased in low and low-middle SDI regions. South Asia had the highest number of cases, while Oceania reported the highest mortality rate. These findings underscore regional disparities in stroke trends. Globally, metabolic risks (46.2%) and high systolic blood pressure (37.87%) are major contributors to stroke-related mortality.

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Gallbladder and biliary tract cancer (GBTC) is a serious disease burden. A comprehensive assessment of the disease burden is essential for improving prevention and treatment strategies. The estimated annual percentage change, Joinpoint regression analysis and age-period-cohort model (APCM) were used to comprehensively evaluate the current status and trend of GBTC burden from 1990 to 2021 from the Global Burden of Disease Study. From the perspective of deep learning, a hierarchical weighted long short-term memory network model (SW-LSTM) is proposed for trend prediction to overcome the shortcomings of traditional models. The global GBTC burden increased non-linearly with age, which was higher in women than in men. With the increase of SDI, the gender difference showed a decreasing trend. Significant period and cohort effects were observed for the indicators in the remaining regions except for some indicators in the low-and low-middle-SDI regions. Age-standardised indicators in the high, high-middle and middle SDI regions showed a downward trend, while the remaining regions showed an upward trend. The proportion of age-standardised mortality rate attributable to high BMI increased with the increase of SDI. The prediction results showed that the SW-LSTM model outperformed the APCM and ARIMA models in prediction accuracy. The SW-LSTM model proposed in this paper can provide more accurate prediction information to assist in the development of more targeted prevention strategies. In view of the impact of GBTC on global health, especially among women and the elderly, effective measures should be taken to reverse the increasing trend of GBTC.

We aimed to report an overview of trends in suicide mortality and years of life lost (YLLs) among adolescents and young adults aged 10-24 years by sex, age group, Socio-demographic Index (SDI), region and country from 1990 to 2021 as well as the suicide mortality with age, period and birth cohort effects. Estimates and 95% uncertainty intervals for suicide mortality and YLLs were extracted from the Global Burden of Diseases Study 2021. Joinpoint analysis was used to calculate the annual percentage change (APC) and average annual percentage change (AAPC) to describe the mortality and rate of YLLs trends. Age, period and cohort model was utilized to disentangle age, period and birth cohort effects on suicide mortality trends. Globally, suicide mortality and the rate of YLLs among adolescents and young adults both declined from 1990 to 2021 (AAPC: -1.6 [-2.1 to -1.2]). In 2021, the global number of suicide death cases was 112.9 thousand [103.9-122.2 thousand] and led to 7.9 million [7.2-8.6 million] YLLs. A significant reduction in suicide mortality was observed in all sexes and age groups. By SDI quintiles, the high SDI region (AAPC: -0.3 [-0.6 to 0.0]) had the slowest decline trend, and low-middle SDI region remained the highest suicide mortality till 2021 (7.8 per 100,000 population [6.9-8.6]). Most SDI regions showed generally lower period and cohort effects during the study period, whereas high SDI region showed more unfavourable risks, especially period and cohort effects in females. Regionally, Central Latin America (AAPC: 1.7 [1.1-2.3]), Tropical Latin America (AAPC: 1.5 [0.9-2.0]), High-income Asia Pacific (AAPC: 1.2 [0.7-1.7]) and Southern sub-Saharan Africa (AAPC: 0.8 [0.4-1.2]) had the significance increase in suicide mortality. In 2021, Southern sub-Saharan Africa had the highest mortality (10.5 per 100,000 population [8.6-12.5]). Nationally, a total of 29 countries had a significant upward trend in suicide mortality and rate of YLLs over the past three decades, and certain countries in low-middle and middle regions exhibited an extremely higher burden of suicide. Global suicide mortality and the rate of YLLs among adolescents and young adults both declined from 1990 to 2021, but obvious variability was observed across regions and countries. Earlier mental health education and targeted management are urgently required for adolescents and young adults in certain areas.

Depression in seniors is a growing public health concern worldwide. Despite the rising prevalence of depression in this demographic, comprehensive data on its burden and trends over an extended period remain limited. This study aims to assess the trends in the burden of depression among seniors from 1990 to 2021, utilizing the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) database, and to further explore the risk factors using China Health and Retirement Longitudinal Study (CHARLS) database and National Health and Nutrition Examination Survey (NHANES) database. We utilized data from the GBD 2021, reporting incidence and disability-adjusted life years (DALYs) per 100,000 population, average annual percentage change (AAPC), and risk factors at global, and regional levels. Trends were analyzed by age, sex, and social development index. Joinpoint regression identified significant changes in global trends. We established an interpretable machine learning (ML) model with high efficiency and robustness that identifies depression based on CHARLS (2015, 2018, &2020) and NHANES (2013-2020.3). We chose a best-performing eXtreme Gradient Boosting (XGB) with Genetic Algorithm (GA) for identification, and used SHapley Additive exPlanation (SHAP) to illustrate the potential risk factors. From 1990 to 2021, the overall global incidence of depression among seniors remained broadly stable (AAPC 0.01, 95% CI -0.07 to 0.08), although marked changes emerged in specific regions and population subgroups. The incidence of depressive disorders increased globally for males (AAPC 0.06 [95% CI -0.02 to 0.15]) while it decreased for females (AAPC -0.01 [95% CI -0.09 to 0.07]). Regional analysis showed the highest incidence rates in low-SDI countries, while middle-SDI countries experienced the most significant increases in the burden of depression (AAPC 0.25 [95% CI 0.17 to 0.34]). Risk factor analysis using machine learning models identified key predictors of depression in elderly populations in both China and the United States. The burden of depression among seniors has significantly shifted globally, with marked regional and demographic variations. These findings underscore the urgent need for targeted interventions, policy modifications, and early screening programs to address the rising burden of depression in this vulnerable age group. The use of advanced machine learning models provides valuable insights into the risk factors, facilitating the development of more effective and tailored intervention strategies.

Adolescent neurological disorders remain a leading cause of the global disease burden. This study aimed to provide an updated assessment and insights into the burden trends from 1990 to 2021. We calculated the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for common 10 prevalent neurological diseases in adolescents and young adults globally from 1990 to 2021. Data were presented by total numbers, sex, age, year, location, risk factors, Socio-Demographic Index (SDI), and expressed in counts and rates. In 2021, migraine (592.8 million, 95% UI 47.6-1,445.1), idiopathic epilepsy (204.8 million, 95% UI 152.8-279.5), and stroke (116.1 million, 95% UI 104.2-126.9) ranked as the top three neurological disorders globally in terms of DALYs. From 1990 to 2021, the absolute number of DALYs and deaths due to common neurological disorders significantly increased, although the age-standardized mortality rate slightly declined. Most disease burden increased with age, with a higher prevalence in females than in males. Furthermore, significant variations were observed between different diseases and regions, and the age-standardized DALY rates for most neurological disorders showed a significant positive correlation with the country's SDI value. Neurological disorders ranked second in global adolescent and young adults' DALYs and remained a key mortality driver. Persistent absolute burden despite declining age-standardized rates urges prioritized prevention policies and care strategies amid population growth.

Cardiovascular diseases (CVDs), principally ischemic heart disease (IHD) and stroke, are the leading cause of global mortality and a major contributor to disability. This paper reviews the magnitude of total CVD burden, including 13 underlying causes of cardiovascular death and 9 related risk factors, using estimates from the Global Burden of Disease (GBD) Study 2019. GBD, an ongoing multinational collaboration to provide comparable and consistent estimates of population health over time, used all available population-level data sources on incidence, prevalence, case fatality, mortality, and health risks to produce estimates for 204 countries and territories from 1990 to 2019. Prevalent cases of total CVD nearly doubled from 271 million (95% uncertainty interval [UI]: 257 to 285 million) in 1990 to 523 million (95% UI: 497 to 550 million) in 2019, and the number of CVD deaths steadily increased from 12.1 million (95% UI:11.4 to 12.6 million) in 1990, reaching 18.6 million (95% UI: 17.1 to 19.7 million) in 2019. The global trends for disability-adjusted life years (DALYs) and years of life lost also increased significantly, and years lived with disability doubled from 17.7 million (95% UI: 12.9 to 22.5 million) to 34.4 million (95% UI:24.9 to 43.6 million) over that period. The total number of DALYs due to IHD has risen steadily since 1990, reaching 182 million (95% UI: 170 to 194 million) DALYs, 9.14 million (95% UI: 8.40 to 9.74 million) deaths in the year 2019, and 197 million (95% UI: 178 to 220 million) prevalent cases of IHD in 2019. The total number of DALYs due to stroke has risen steadily since 1990, reaching 143 million (95% UI: 133 to 153 million) DALYs, 6.55 million (95% UI: 6.00 to 7.02 million) deaths in the year 2019, and 101 million (95% UI: 93.2 to 111 million) prevalent cases of stroke in 2019. Cardiovascular diseases remain the leading cause of disease burden in the world. CVD burden continues its decades-long rise for almost all countries outside high-income countries, and alarmingly, the age-standardized rate of CVD has begun to rise in some locations where it was previously declining in high-income countries. There is an urgent need to focus on implementing existing cost-effective policies and interventions if the world is to meet the targets for Sustainable Development Goal 3 and achieve a 30% reduction in premature mortality due to noncommunicable diseases.

Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level. We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI). Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (-3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer's disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4). China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system. China National Key Research and Development Program and Bill & Melinda Gates Foundation.

The Global Burden of Disease Study (GBD) began 30 years ago with the goal of providing timely, valid and relevant assessments of critical health outcomes. Over this period, the GBD has become progressively more granular. The latest iteration provides assessments of thousands of outcomes for diseases, injuries and risk factors in more than 200 countries and territories and at the subnational level in more than 20 countries. The GBD is now produced by an active collaboration of over 8,000 scientists and analysts from more than 150 countries. With each GBD iteration, the data, data processing and methods used for data synthesis have evolved, with the goal of enhancing transparency and comparability of measurements and communicating various sources of uncertainty. The GBD has many limitations, but it remains a dynamic, iterative and rigorous attempt to provide meaningful health measurement to a wide range of stakeholders.

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. To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. 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). 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. 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.

Understanding the temporal trend of the disease burden of stroke and its attributable risk factors in China, especially at provincial levels, is important for effective prevention strategies and improvement. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is to investigate the disease burden of stroke and its risk factors at national and provincial levels in China from 1990 to 2019. Following the methodology in the GBD 2019, the incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of stroke cases in the Chinese population were estimated by sex, age, year, stroke subtypes (ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage), and across 33 provincial administrative units in China from 1990 to 2019. Attributable mortality and DALYs of underlying risk factors were calculated by a comparative risk assessment. In 2019, there were 3·94 million (95% uncertainty interval 3·43-4·58) new stroke cases in China. The incidence rate of stroke increased by 86·0% (73·2-99·0) from 1990, reaching 276·7 (241·3-322·0) per 100 000 population in 2019. The age-standardised incidence rate declined by 9·3% (3·3-15·5) from 1990 to 2019. Among 28·76 million (25·60-32·21) prevalent cases of stroke in 2019, 24·18 million (20·80-27·87) were ischaemic stroke, 4·36 million (3·69-5·05) were intracerebral haemorrhage, and 1·58 million (1·32-1·91) were subarachnoid haemorrhage. The prevalence rate increased by 106·0% (93·7-118·8) and age-standardised prevalence rate increased by 13·2% (7·7-19·1) from 1990 to 2019. In 2019, there were 2·19 million (1·89-2·51) deaths and 45·9 million (39·8-52·3) DALYs due to stroke. The mortality rate increased by 32·3% (8·6-59·0) from 1990 to 2019. Over the same period, the age-standardised mortality rate decreased by 39·8% (28·6-50·7) and the DALY rate decreased by 41·6% (30·7-50·9). High systolic blood pressure, ambient particulate matter pollution exposure, smoking, and diet high in sodium were four major risk factors for stroke burden in 2019. Moreover, we found marked differences of stroke burden and attributable risk factors across provinces in China from 1990 to 2019. The disease burden of stroke is still severe in China, although the age-standardised incidence and mortality rates have decreased since 1990. The stroke burden in China might be reduced through blood pressure management, lifestyle interventions, and air pollution control. Moreover, because substantial heterogeneity of stroke burden existed in different provinces, improved health care is needed in provinces with heavy stroke burden. National Key Research and Development Program of China and Taikang Yicai Public Health and Epidemic Control Fund.

Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6-4.3) with a prevalence of 454.6 million cases (417.4-499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4-225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9-3.6) deaths. With 262.4 million (224.1-309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries.

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. 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. 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. 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. Bill & Melinda Gates Foundation.

Lip, oral, and pharyngeal cancers are important contributors to cancer burden worldwide, and a comprehensive evaluation of their burden globally, regionally, and nationally is crucial for effective policy planning. To analyze the total and risk-attributable burden of lip and oral cavity cancer (LOC) and other pharyngeal cancer (OPC) for 204 countries and territories and by Socio-demographic Index (SDI) using 2019 Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates. The incidence, mortality, and disability-adjusted life years (DALYs) due to LOC and OPC from 1990 to 2019 were estimated using GBD 2019 methods. The GBD 2019 comparative risk assessment framework was used to estimate the proportion of deaths and DALYs for LOC and OPC attributable to smoking, tobacco, and alcohol consumption in 2019. In 2019, 370 000 (95% uncertainty interval [UI], 338 000-401 000) cases and 199 000 (95% UI, 181 000-217 000) deaths for LOC and 167 000 (95% UI, 153 000-180 000) cases and 114 000 (95% UI, 103 000-126 000) deaths for OPC were estimated to occur globally, contributing 5.5 million (95% UI, 5.0-6.0 million) and 3.2 million (95% UI, 2.9-3.6 million) DALYs, respectively. From 1990 to 2019, low-middle and low SDI regions consistently showed the highest age-standardized mortality rates due to LOC and OPC, while the high SDI strata exhibited age-standardized incidence rates decreasing for LOC and increasing for OPC. Globally in 2019, smoking had the greatest contribution to risk-attributable OPC deaths for both sexes (55.8% [95% UI, 49.2%-62.0%] of all OPC deaths in male individuals and 17.4% [95% UI, 13.8%-21.2%] of all OPC deaths in female individuals). Smoking and alcohol both contributed to substantial LOC deaths globally among male individuals (42.3% [95% UI, 35.2%-48.6%] and 40.2% [95% UI, 33.3%-46.8%] of all risk-attributable cancer deaths, respectively), while chewing tobacco contributed to the greatest attributable LOC deaths among female individuals (27.6% [95% UI, 21.5%-33.8%]), driven by high risk-attributable burden in South and Southeast Asia. In this systematic analysis, disparities in LOC and OPC burden existed across the SDI spectrum, and a considerable percentage of burden was attributable to tobacco and alcohol use. These estimates can contribute to an understanding of the distribution and disparities in LOC and OPC burden globally and support cancer control planning efforts.

Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. In 2021, the global prevalence of anaemia across all ages was 24·3% (95% uncertainty interval [UI] 23·9-24·7), corresponding to 1·92 billion (1·89-1·95) prevalent cases, compared with a prevalence of 28·2% (27·8-28·5) and 1·50 billion (1·48-1·52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52·0 million (35·1-75·1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422·4 [95% UI 286·1-612·9]), haemoglobinopathies and haemolytic anaemias (89·0 [58·2-123·7]), and other neglected tropical diseases (36·3 [24·4-52·8]), collectively accounting for 84·7% (84·1-85·2) of anaemia YLDs. Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Bill & Melinda Gates Foundation.

Previous global analyses, with known underdiagnosis and single cause per death attribution systems, provide only a small insight into the suspected high population health effect of sickle cell disease. Completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, this study delivers a comprehensive global assessment of prevalence of sickle cell disease and mortality burden by age and sex for 204 countries and territories from 2000 to 2021. We estimated cause-specific sickle cell disease mortality using standardised GBD approaches, in which each death is assigned to a single underlying cause, to estimate mortality rates from the International Classification of Diseases (ICD)-coded vital registration, surveillance, and verbal autopsy data. In parallel, our goal was to estimate a more accurate account of sickle cell disease health burden using four types of epidemiological data on sickle cell disease: birth incidence, age-specific prevalence, with-condition mortality (total deaths), and excess mortality (excess deaths). Systematic reviews, supplemented with ICD-coded hospital discharge and insurance claims data, informed this modelling approach. We employed DisMod-MR 2.1 to triangulate between these measures-borrowing strength from predictive covariates and across age, time, and geography-and generated internally consistent estimates of incidence, prevalence, and mortality for three distinct genotypes of sickle cell disease: homozygous sickle cell disease and severe sickle cell β-thalassaemia, sickle-haemoglobin C disease, and mild sickle cell β-thalassaemia. Summing the three models yielded final estimates of incidence at birth, prevalence by age and sex, and total sickle cell disease mortality, the latter of which was compared directly against cause-specific mortality estimates to evaluate differences in mortality burden assessment and implications for the Sustainable Development Goals (SDGs). Between 2000 and 2021, national incidence rates of sickle cell disease were relatively stable, but total births of babies with sickle cell disease increased globally by 13·7% (95% uncertainty interval 11·1-16·5), to 515 000 (425 000-614 000), primarily due to population growth in the Caribbean and western and central sub-Saharan Africa. The number of people living with sickle cell disease globally increased by 41·4% (38·3-44·9), from 5·46 million (4·62-6·45) in 2000 to 7·74 million (6·51-9·2) in 2021. We estimated 34 400 (25 000-45 200) cause-specific all-age deaths globally in 2021, but total sickle cell disease mortality burden was nearly 11-times higher at 376 000 (303 000-467 000). In children younger than 5 years, there were 81 100 (58 800-108 000) deaths, ranking total sickle cell disease mortality as 12th (compared to 40th for cause-specific sickle cell disease mortality) across all causes estimated by the GBD in 2021. Our findings show a strikingly high contribution of sickle cell disease to all-cause mortality that is not apparent when each death is assigned to only a single cause. Sickle cell disease mortality burden is highest in children, especially in countries with the greatest under-5 mortality rates. Without comprehensive strategies to address morbidity and mortality associated with sickle cell disease, attainment of SDG 3.1, 3.2, and 3.4 is uncertain. Widespread data gaps and correspondingly high uncertainty in the estimates highlight the urgent need for routine and sustained surveillance efforts, further research to assess the contribution of conditions associated with sickle cell disease, and widespread deployment of evidence-based prevention and treatment for those with sickle cell disease. Bill & Melinda Gates Foundation.

Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies. In this analysis, we use the Institute for Health Metrics and Evaluation's Future Health Scenarios platform to forecast the effects of three smoking prevalence scenarios on all-cause and cause-specific YLLs and life expectancy at birth until 2050. YLLs were computed for each scenario using the Global Burden of Disease Study 2021 reference life table and forecasts of cause-specific mortality under each scenario. The reference scenario forecasts what could occur if past smoking prevalence and other risk factor trends continue, the Tobacco Smoking Elimination as of 2023 (Elimination-2023) scenario quantifies the maximum potential future health benefits from assuming zero percent smoking prevalence from 2023 onwards, whereas the Tobacco Smoking Elimination by 2050 (Elimination-2050) scenario provides estimates for countries considering policies to steadily reduce smoking prevalence to 5%. Together, these scenarios underscore the magnitude of health benefits that could be reached by 2050 if countries take decisive action to eliminate smoking. The 95% uncertainty interval (UI) of estimates is based on the 2·5th and 97·5th percentile of draws that were carried through the multistage computational framework. Global age-standardised smoking prevalence was estimated to be 28·5% (95% UI 27·9-29·1) among males and 5·96% (5·76-6·21) among females in 2022. In the reference scenario, smoking prevalence declined by 25·9% (25·2-26·6) among males, and 30·0% (26·1-32·1) among females from 2022 to 2050. Under this scenario, we forecast a cumulative 29·3 billion (95% UI 26·8-32·4) overall YLLs among males and 22·2 billion (20·1-24·6) YLLs among females over this period. Life expectancy at birth under this scenario would increase from 73·6 years (95% UI 72·8-74·4) in 2022 to 78·3 years (75·9-80·3) in 2050. Under our Elimination-2023 scenario, we forecast 2·04 billion (95% UI 1·90-2·21) fewer cumulative YLLs by 2050 compared with the reference scenario, and life expectancy at birth would increase to 77·6 years (95% UI 75·1-79·6) among males and 81·0 years (78·5-83·1) among females. Under our Elimination-2050 scenario, we forecast 735 million (675-808) and 141 million (131-154) cumulative YLLs would be avoided among males and females, respectively. Life expectancy in 2050 would increase to 77·1 years (95% UI 74·6-79·0) among males and 80·8 years (78·3-82·9) among females. Existing tobacco policies must be maintained if smoking prevalence is to continue to decline as forecast by the reference scenario. In addition, substantial smoking-attributable burden can be avoided by accelerating the pace of smoking elimination. Implementation of new tobacco control policies are crucial in avoiding additional smoking-attributable burden in the coming decades and to ensure that the gains won over the past three decades are not lost. Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

The Global Burden of Disease (GBD) study assesses health losses from diseases, injuries, and risk factors using disability-adjusted life-years, which need a set of disability weights to quantify health levels associated with non-fatal outcomes. The objective of this study was to estimate disability weights for the GBD 2013 study. We analysed data from new web-based surveys of participants aged 18-65 years, completed in four European countries (Hungary, Italy, the Netherlands, and Sweden) between Sept 23, 2013, and Nov 11, 2013, combined with data previously collected in the GBD 2010 disability weights measurement study. Surveys used paired comparison questions for which respondents considered two hypothetical individuals with different health states and specified which person they deemed healthier than the other. These surveys covered 183 health states pertinent to GBD 2013; of these states, 30 were presented with descriptions revised from previous versions and 18 were new to GBD 2013. We analysed paired comparison data using probit regression analysis and rescaled results to disability weight units between 0 (no loss of health) and 1 (loss equivalent to death). We compared results with previous estimates, and an additional analysis examined sensitivity of paired comparison responses to duration of hypothetical health states. The total analysis sample consisted of 30 230 respondents from the GBD 2010 surveys and 30 660 from the new European surveys. For health states common to GBD 2010 and GBD 2013, results were highly correlated overall (Pearson's r 0·992 [95% uncertainty interval 0·989-0·994]). For health state descriptions that were revised for this study, resulting disability weights were substantially different for a subset of these weights, including those related to hearing loss (eg, complete hearing loss: GBD 2010 0·033 [0·020-0·052]; GBD 2013 0·215 [0·144-0·307]) and treated spinal cord lesions (below the neck: GBD 2010 0·047 [0·028-0·072]; GBD 2013 0·296 [0·198-0·414]; neck level: GBD 2010 0·369 [0·243-0·513]; GBD 2013 0·589 [0·415-0·748]). Survey responses to paired comparison questions were insensitive to whether the comparisons were framed in terms of temporary or chronic outcomes (Pearson's r 0·981 [0·973-0·987]). This study substantially expands the empirical basis for assessment of non-fatal outcomes in the GBD study. Findings from this study substantiate the notion that disability weights are sensitive to particular details in descriptions of health states, but robust to duration of outcomes. European Centre for Disease Prevention and Control, Bill and Melinda Gates Foundation.

Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10-54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression-Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values-a metric assessing gain in forecasting accuracy-by comparing predicted versus observed ASFRs from the past 15 years (2007-21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63-5·06) to 2·23 (2·09-2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137-147), declining to 129 million (121-138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1-canonically considered replacement-level fertility-in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7-29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59-2·08) in 2050 and 1·59 (1·25-1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6-43·1) in 2050 and 54·3% (47·1-59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions-decreasing, for example, in south Asia from 24·8% (23·7-25·8) in 2021 to 16·7% (14·3-19·1) in 2050 and 7·1% (4·4-10·1) in 2100-but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40-1·92) in 2050 and 1·62 (1·35-1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. Bill & Melinda Gates Foundation.

Understanding potential trajectories in health and drivers of health is crucial to guiding long-term investments and policy implementation. Past work on forecasting has provided an incomplete landscape of future health scenarios, highlighting a need for a more robust modelling platform from which policy options and potential health trajectories can be assessed. This study provides a novel approach to modelling life expectancy, all-cause mortality and cause of death forecasts -and alternative future scenarios-for 250 causes of death from 2016 to 2040 in 195 countries and territories. We modelled 250 causes and cause groups organised by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) hierarchical cause structure, using GBD 2016 estimates from 1990-2016, to generate predictions for 2017-40. Our modelling framework used data from the GBD 2016 study to systematically account for the relationships between risk factors and health outcomes for 79 independent drivers of health. We developed a three-component model of cause-specific mortality: a component due to changes in risk factors and select interventions; the underlying mortality rate for each cause that is a function of income per capita, educational attainment, and total fertility rate under 25 years and time; and an autoregressive integrated moving average model for unexplained changes correlated with time. We assessed the performance by fitting models with data from 1990-2006 and using these to forecast for 2007-16. Our final model used for generating forecasts and alternative scenarios was fitted to data from 1990-2016. We used this model for 195 countries and territories to generate a reference scenario or forecast through 2040 for each measure by location. Additionally, we generated better health and worse health scenarios based on the 85th and 15th percentiles, respectively, of annualised rates of change across location-years for all the GBD risk factors, income per person, educational attainment, select intervention coverage, and total fertility rate under 25 years in the past. We used the model to generate all-cause age-sex specific mortality, life expectancy, and years of life lost (YLLs) for 250 causes. Scenarios for fertility were also generated and used in a cohort component model to generate population scenarios. For each reference forecast, better health, and worse health scenarios, we generated estimates of mortality and YLLs attributable to each risk factor in the future. Globally, most independent drivers of health were forecast to improve by 2040, but 36 were forecast to worsen. As shown by the better health scenarios, greater progress might be possible, yet for some drivers such as high body-mass index (BMI), their toll will rise in the absence of intervention. We forecasted global life expectancy to increase by 4·4 years (95% UI 2·2 to 6·4) for men and 4·4 years (2·1 to 6·4) for women by 2040, but based on better and worse health scenarios, trajectories could range from a gain of 7·8 years (5·9 to 9·8) to a non-significant loss of 0·4 years (-2·8 to 2·2) for men, and an increase of 7·2 years (5·3 to 9·1) to essentially no change (0·1 years [-2·7 to 2·5]) for women. In 2040, Japan, Singapore, Spain, and Switzerland had a forecasted life expectancy exceeding 85 years for both sexes, and 59 countries including China were projected to surpass a life expectancy of 80 years by 2040. At the same time, Central African Republic, Lesotho, Somalia, and Zimbabwe had projected life expectancies below 65 years in 2040, indicating global disparities in survival are likely to persist if current trends hold. Forecasted YLLs showed a rising toll from several non-communicable diseases (NCDs), partly driven by population growth and ageing. Differences between the reference forecast and alternative scenarios were most striking for HIV/AIDS, for which a potential increase of 120·2% (95% UI 67·2-190·3) in YLLs (nearly 118 million) was projected globally from 2016-40 under the worse health scenario. Compared with 2016, NCDs were forecast to account for a greater proportion of YLLs in all GBD regions by 2040 (67·3% of YLLs [95% UI 61·9-72·3] globally); nonetheless, in many lower-income countries, communicable, maternal, neonatal, and nutritional (CMNN) diseases still accounted for a large share of YLLs in 2040 (eg, 53·5% of YLLs [95% UI 48·3-58·5] in Sub-Saharan Africa). There were large gaps for many health risks between the reference forecast and better health scenario for attributable YLLs. In most countries, metabolic risks amenable to health care (eg, high blood pressure and high plasma fasting glucose) and risks best targeted by population-level or intersectoral interventions (eg, tobacco, high BMI, and ambient particulate matter pollution) had some of the largest differences between reference and better health scenarios. The main exception was sub-Saharan Africa, where many risks associated with poverty and lower levels of development (eg, unsafe water and sanitation, household air pollution, and child malnutrition) were projected to still account for substantive disparities between reference and better health scenarios in 2040. With the present study, we provide a robust, flexible forecasting platform from which reference forecasts and alternative health scenarios can be explored in relation to a wide range of independent drivers of health. Our reference forecast points to overall improvements through 2040 in most countries, yet the range found across better and worse health scenarios renders a precarious vision of the future-a world with accelerating progress from technical innovation but with the potential for worsening health outcomes in the absence of deliberate policy action. For some causes of YLLs, large differences between the reference forecast and alternative scenarios reflect the opportunity to accelerate gains if countries move their trajectories toward better health scenarios-or alarming challenges if countries fall behind their reference forecasts. Generally, decision makers should plan for the likely continued shift toward NCDs and target resources toward the modifiable risks that drive substantial premature mortality. If such modifiable risks are prioritised today, there is opportunity to reduce avoidable mortality in the future. However, CMNN causes and related risks will remain the predominant health priority among lower-income countries. Based on our 2040 worse health scenario, there is a real risk of HIV mortality rebounding if countries lose momentum against the HIV epidemic, jeopardising decades of progress against the disease. Continued technical innovation and increased health spending, including development assistance for health targeted to the world's poorest people, are likely to remain vital components to charting a future where all populations can live full, healthy lives. Bill & Melinda Gates Foundation.

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides a comprehensive assessment of health and risk factor trends at global, regional, national, and subnational levels. This study aims to examine the burden of diseases, injuries, and risk factors in the USA and highlight the disparities in health outcomes across different states. GBD 2021 analysed trends in mortality, morbidity, and disability for 371 diseases and injuries and 88 risk factors in the USA between 1990 and 2021. We used several metrics to report sources of health and health loss related to specific diseases, injuries, and risk factors. GBD 2021 methods accounted for differences in data sources and biases. The analysis of levels and trends for causes and risk factors within the same computational framework enabled comparisons across states, years, age groups, and sex. GBD 2021 estimated years lived with disability (YLDs) and disability-adjusted life-years (DALYs; the sum of years of life lost to premature mortality and YLDs) for 371 diseases and injuries, years of life lost (YLLs) and mortality for 288 causes of death, and life expectancy and healthy life expectancy (HALE). We provided estimates for 88 risk factors in relation to 155 health outcomes for 631 risk-outcome pairs and produced risk-specific estimates of summary exposure value, relative health risk, population attributable fraction, and risk-attributable burden measured in DALYs and deaths. Estimates were produced by sex (male and female), age (25 age groups from birth to ≥95 years), and year (annually between 1990 and 2021). 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws (ie, 500 random samples from the estimate's distribution). Uncertainty was propagated at each step of the estimation process. We found disparities in health outcomes and risk factors across US states. Our analysis of GBD 2021 highlighted the relative decline in life expectancy and HALE compared with other countries, as well as the impact of COVID-19 during the first 2 years of the pandemic. We found a decline in the USA's ranking of life expectancy from 1990 to 2021: in 1990, the USA ranked 35th of 204 countries and territories for males and 19th for females, but dropped to 46th for males and 47th for females in 2021. When comparing life expectancy in the best-performing and worst-performing US states against all 203 other countries and territories (excluding the USA as a whole), Hawaii (the best-ranked state in 1990 and 2021) dropped from sixth-highest life expectancy in the world for males and fourth for females in 1990 to 28th for males and 22nd for females in 2021. The worst-ranked state in 2021 ranked 107th for males (Mississippi) and 99th for females (West Virginia). 14 US states lost life expectancy over the study period, with West Virginia experiencing the greatest loss (2·7 years between 1990 and 2021). HALE ranking declines were even greater; in 1990, the USA was ranked 42nd for males and 32nd for females but dropped to 69th for males and 76th for females in 2021. When comparing HALE in the best-performing and worst-performing US states against all 203 other countries and territories, Hawaii ranked 14th highest HALE for males and fifth for females in 1990, dropping to 39th for males and 34th for females in 2021. In 2021, West Virginia-the lowest-ranked state that year-ranked 141st for males and 137th for females. Nationally, age-standardised mortality rates declined between 1990 and 2021 for many leading causes of death, most notably for ischaemic heart disease (56·1% [95% UI 55·1-57·2] decline), lung cancer (41·9% [39·7-44·6]), and breast cancer (40·9% [38·7-43·7]). Over the same period, age-standardised mortality rates increased for other causes, particularly drug use disorders (878·0% [770·1-1015·5]), chronic kidney disease (158·3% [149·6-167·9]), and falls (89·7% [79·8-95·8]). We found substantial variation in mortality rates between states, with Hawaii having the lowest age-standardised mortality rate (433·2 per 100 000 [380·6-493·4]) in 2021 and Mississippi having the highest (867·5 per 100 000 [772·6-975·7]). Hawaii had the lowest age-standardised mortality rates throughout the study period, whereas Washington, DC, experienced the most improvement (a 40·7% decline [33·2-47·3]). Only six countries had age-standardised rates of YLDs higher than the USA in 2021: Afghanistan, Lesotho, Liberia, Mozambique, South Africa, and the Central African Republic, largely because the impact of musculoskeletal disorders, mental disorders, and substance use disorders on age-standardised disability rates in the USA is so large. At the state level, eight US states had higher age-standardised YLD rates than any country in the world: West Virginia, Kentucky, Oklahoma, Pennsylvania, New Mexico, Ohio, Tennessee, and Arizona. Low back pain was the leading cause of YLDs in the USA in 1990 and 2021, although the age-standardised rate declined by 7·9% (1·8-13·0) from 1990. Depressive disorders (56·0% increase [48·2-64·3]) and drug use disorders (287·6% [247·9-329·8]) were the second-leading and third-leading causes of age-standardised YLDs in 2021. For females, mental health disorders had the highest age-standardised YLD rate, with an increase of 59·8% (50·6-68·5) between 1990 and 2021. Hawaii had the lowest age-standardised rates of YLDs for all sexes combined (12 085·3 per 100 000 [9090·8-15 557·1]), whereas West Virginia had the highest (14 832·9 per 100 000 [11 226·9-18 882·5]). At the national level, the leading GBD Level 2 risk factors for death for all sexes combined in 2021 were high systolic blood pressure, high fasting plasma glucose, and tobacco use. From 1990 to 2021, the age-standardised mortality rates attributable to high systolic blood pressure decreased by 47·8% (43·4-52·5) and for tobacco use by 5·1% (48·3%-54·1%), but rates increased for high fasting plasma glucose by 9·3% (0·4-18·7). The burden attributable to risk factors varied by age and sex. For example, for ages 15-49 years, the leading risk factors for death were drug use, high alcohol use, and dietary risks. By comparison, for ages 50-69 years, tobacco was the leading risk factor for death, followed by dietary risks and high BMI. GBD 2021 provides valuable information for policy makers, health-care professionals, and researchers in the USA at the national and state levels to prioritise interventions, allocate resources effectively, and assess the effects of health policies and programmes. By addressing socioeconomic determinants, risk behaviours, environmental influences, and health disparities among minority populations, the USA can work towards improving health outcomes so that people can live longer and healthier lives. Bill & Melinda Gates Foundation.

Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. Bill & Melinda Gates Foundation.

Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050. Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer. In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5·6% (-12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3). Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment. Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.

As mortality rates decline, life expectancy increases, and populations age, non-fatal outcomes of diseases and injuries are becoming a larger component of the global burden of disease. The Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) provides a comprehensive assessment of prevalence, incidence, and years lived with disability (YLDs) for 328 causes in 195 countries and territories from 1990 to 2016. We estimated prevalence and incidence for 328 diseases and injuries and 2982 sequelae, their non-fatal consequences. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between incidence, prevalence, remission, and cause of death rates for each condition. For some causes, we used alternative modelling strategies if incidence or prevalence needed to be derived from other data. YLDs were estimated as the product of prevalence and a disability weight for all mutually exclusive sequelae, corrected for comorbidity and aggregated to cause level. We updated the Socio-demographic Index (SDI), a summary indicator of income per capita, years of schooling, and total fertility rate. GBD 2016 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Globally, low back pain, migraine, age-related and other hearing loss, iron-deficiency anaemia, and major depressive disorder were the five leading causes of YLDs in 2016, contributing 57·6 million (95% uncertainty interval [UI] 40·8-75·9 million [7·2%, 6·0-8·3]), 45·1 million (29·0-62·8 million [5·6%, 4·0-7·2]), 36·3 million (25·3-50·9 million [4·5%, 3·8-5·3]), 34·7 million (23·0-49·6 million [4·3%, 3·5-5·2]), and 34·1 million (23·5-46·0 million [4·2%, 3·2-5·3]) of total YLDs, respectively. Age-standardised rates of YLDs for all causes combined decreased between 1990 and 2016 by 2·7% (95% UI 2·3-3·1). Despite mostly stagnant age-standardised rates, the absolute number of YLDs from non-communicable diseases has been growing rapidly across all SDI quintiles, partly because of population growth, but also the ageing of populations. The largest absolute increases in total numbers of YLDs globally were between the ages of 40 and 69 years. Age-standardised YLD rates for all conditions combined were 10·4% (95% UI 9·0-11·8) higher in women than in men. Iron-deficiency anaemia, migraine, Alzheimer's disease and other dementias, major depressive disorder, anxiety, and all musculoskeletal disorders apart from gout were the main conditions contributing to higher YLD rates in women. Men had higher age-standardised rates of substance use disorders, diabetes, cardiovascular diseases, cancers, and all injuries apart from sexual violence. Globally, we noted much less geographical variation in disability than has been documented for premature mortality. In 2016, there was a less than two times difference in age-standardised YLD rates for all causes between the location with the lowest rate (China, 9201 YLDs per 100 000, 95% UI 6862-11943) and highest rate (Yemen, 14 774 YLDs per 100 000, 11 018-19 228). The decrease in death rates since 1990 for most causes has not been matched by a similar decline in age-standardised YLD rates. For many large causes, YLD rates have either been stagnant or have increased for some causes, such as diabetes. As populations are ageing, and the prevalence of disabling disease generally increases steeply with age, health systems will face increasing demand for services that are generally costlier than the interventions that have led to declines in mortality in childhood or for the major causes of mortality in adults. Up-to-date information about the trends of disease and how this varies between countries is essential to plan for an adequate health-system response. Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.

Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4-61·9) in 1980 to 71·8 years (71·5-72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7-17·4), to 62·6 years (56·5-70·2). Total deaths increased by 4·1% (2·6-5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8-18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6-16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9-14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1-44·6), malaria (43·1%, 34·7-51·8), neonatal preterm birth complications (29·8%, 24·8-34·9), and maternal disorders (29·1%, 19·3-37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000-183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000-532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Bill & Melinda Gates Foundation.

Stillbirth is a devastating and often avoidable adverse pregnancy outcome. Monitoring stillbirth levels and trends-in a comprehensive manner that leaves no one uncounted-is imperative for continuing progress in pregnancy loss reduction. This analysis, completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, methodically accounted for different stillbirth definitions with the aim of comprehensively estimating all stillbirths at 20 weeks or longer for 204 countries and territories from 1990 to 2021. We extracted data on stillbirths from 11 412 sources across 185 of 204 countries and territories, including 234 surveys, 231 published studies, 1633 vital statistics reports, and 10 585 unique location-year combinations from vital registration systems. Our final dataset comprised 11 different definitions, which were adjusted to match two gestational age thresholds: 20 weeks or longer (reference) and 28 weeks or longer (for comparisons). We modelled the ratio of stillbirth rate to neonatal mortality rate with spatiotemporal Gaussian process regression for each location and year, and then used final GBD 2021 assessments of fertility and all-cause neonatal mortality to calculate total stillbirths. Secondary analyses evaluated the number of stillbirths missed with the more restrictive gestational age definition, trends in stillbirths as a function of Socio-demographic Index, and progress in reducing stillbirths relative to neonatal deaths. In 2021, the global stillbirth rate was 23·0 (95% uncertainty interval [UI] 19·7-27·2) per 1000 births (stillbirths plus livebirths) at 20 weeks' gestation or longer, compared to 16·1 (13·9-19·0) per 1000 births at 28 weeks' gestation or longer. The global neonatal mortality rate in 2021 was 17·1 (14·8-19·9) per 1000 livebirths, corresponding to 2·19 million (1·90-2·55) neonatal deaths. The estimated number of stillbirths occurring at 20 weeks' gestation or longer decreased from 5·08 million (95% UI 4·07-6·35) in 1990 to 3·04 million (2·61-3·62) in 2021, corresponding to a 39·8% (31·8-48·0) reduction, which lagged behind a global improvement in neonatal deaths of 45·6% (36·3-53·1) for the same period (down from 4·03 million [3·86-4·22] neonatal deaths in 1990). Stillbirths in south Asia and sub-Saharan Africa comprised 77·4% (2·35 million of 3·04 million) of the global total, an increase from 60·3% (3·07 million of 5·08 million) in 1990. In 2021, 0·926 million (0·792-1·10) stillbirths, corresponding to 30·5% of the global total (3·04 million), occurred between 20 weeks' gestation and 28 weeks' gestation, with substantial variation at the country level. Despite the gradual global decline in stillbirths between 1990 and 2021, the overall number of stillbirths remains substantially high. Counting all stillbirths is paramount to progress, as nearly a third-close to 1 million in total-are left uncounted at the 28 weeks or longer threshold. Our findings draw attention to the differential progress in reducing stillbirths, with a high burden concentrated in countries with low development status. Scarce data availability and poor data quality constrain our capacity to precisely account for stillbirths in many locations. Addressing inequities in universal maternal health coverage, strengthening the quality of maternal health care, and improving the robustness of data systems are urgently needed to reduce the global burden of stillbirths. Bill & Melinda Gates Foundation.

Hypertensive heart disease (HHD) significantly contributes to global morbidity and mortality, worsened by rising hypertension rates. This study aims to assess the burden of HHD from 1990 to 2021, analyzing prevalence, mortality, and disability-adjusted life years (DALYs) stratified by age, sex, and Sociodemographic Index (SDI). Utilizing data from the Global Burden of Disease 2021 project across 204 countries and 21 regions, the study calculated age-standardized rates and evaluated risk factors for prevention priorities. In 2021, there were 12.5 million HHD cases globally, resulting in 1.332 million deaths and 25.4622 million DALYs. Age-standardized rates were 148.3 for prevalence, 16.3 for deaths, and 301.6 for DALYs per 100,000 people, reflecting increases of 18.2% for prevalence but decreases for deaths (- 22%) and DALYs (- 25.8%) since 1990. Eastern Sub-Saharan Africa recorded the highest prevalence (291.8), while Bulgaria had the highest mortality (103.4) and DALY rates (1739.3). Age-specific trends showed that prevalence, deaths, and DALYs increased with age across genders, and at regional levels, DALYs decreased with higher SDI. Major contributing factors included high systolic blood pressure, metabolic risks, high body-mass index, unhealthy diet, alcohol use, and low fruit and vegetable intake. Despite advances in management, HHD remains a global health concern, especially in low-SDI areas. Efforts focused on modifiable risks, like hypertension control and dietary improvements, are essential to mitigate the burden of HHD.

The purpose of this study was to quantify the global burden of ischemic heart disease associated with lead exposure, utilizing data from the Global Burden of Disease (GBD) Study, 2021. Data on the burden of ischemic heart disease (IHD) associated with lead exposure were compiled globally from 1990 to 2021. These data were further stratified by dimensions including gender, age, GBD regions, and countries. Utilizing the Joinpoint regression model, we analyzed long-term trends in the burden of IHD disease associated with lead exposure and derived estimated annual percentage changes (EAPC). For future projections, we used an ARIMA model to predict potential trends in the burden of IHD disease associated with lead exposure over the next decade. The study's findings reveal that in 2021, there were 590,370 deaths attributed to IHD (95% UI (Uncertainty interval (UI) is derived from the Bayesian school of statistical analysis used in the GBD studies. Unlike the frequency school of thought, which constructs confidence intervals (CI), the Bayesian school of thought views probability as a measure of confidence in an event, and in this approach the actual mean is viewed as a random variable dependent on the data and prior knowledge, with UI indicating that there is a specific probability (e.g., 95%) that the actual mean will fall within the interval.): -83,778 to 1,233,628) and 11,854,661 disability-adjusted life years (DALYs) (95% UI: -1,668,553 to 24,791,275) globally due to lead exposure, reflecting an increasing and then stabilizing trend from 1990 to 2021. Comparative analysis across study regions indicated a higher disease burden for IHD in regions with lower Socio-Demographic Index (SDI) values, contrasting with the lower burden in regions with higher SDI values. Furthermore, IHD mortality and DALYs peak in the 70-80 age cohort, with males exhibiting higher rates compared to females. Decadal projections indicate a downward trend in IHD mortality and DALYs for regions with higher SDI, in contrast to an anticipated upward trend in regions with lower SDI. The global burden of ischemic heart disease associated with lead exposure is increasing, particularly in regions with low SDI values and within the elderly population. Considering the profound threat posed by lead exposure to the global burden of IHD, there is an imperative to consistently reinforce and execute robust prevention strategies to mitigate environmental lead exposure.

This study aimed to comprehensively assess the magnitude, temporal trends, and inequalities associated with socioeconomic development in neck pain (NP) based on the Global Burden of Disease Study 2019. An assessment of incidence and years of life with disability (YLD) at the global, regional, and country levels by age, sex and year was conducted for NP. Joinpoint regression (JPR) was used to analyze trends between 1990 and 2019. Decomposition analysis was used to explore the extent to which population growth, aging, and epidemiological changes influenced the changes in incidence and YLD. A Bayesian Age-Period-Cohort (BAPC) model was constructed to predict trends over the next 25 years. Concentration curve and concentration index were used to examine the cross-country relative inequality of the burden of NP at the socio-demographic index (SDI) level. In 2019, the global ASIR and ASDR of NP were 579.085 and 267.348 per 100,000 individuals, respectively. JPR analysis showed that the global ASIR and ASDR have decreased slightly over the past 30 years, although an increase was observed between 2011 and 2019. The BAPC model predicted that this upward trend would continue over the next 25 years. Decomposition analysis showed that the global increase in incidence and YLD in 2019 compared to 1990 was mainly driven by population growth. The burden of NP was higher in the middle-aged, old-age, and female groups, with differences in regional distribution. The analysis of cross-country inequality showed that the burden of NP was disproportionately concentrated in countries with a high SDI, and this phenomenon continued to increase over the 30-year study period. Globally, NP remains an important public health problem, and governments are urgently required to raise public awareness about NP and its risk factors, implement targeted prevention and control policies, and deliver the necessary health services.

Urolithiasis is a substantial public health concern, affects 10-15% of the world's population and imposing significant health and economic burdens. The BRICS-plus nations (Brazil, Russian Federation, India, China, South Africa, Saudi Arabia, Egypt, the United Arab Emirates, Iran, and Ethiopia) represent a block of countries with a fresh and invigorating approach to global health. This study aims to evaluate the epidemiological trends and geographic variations in the urolithiasis burden across these nations. Data on the number, all-age rate, age-standardized rate, and relative change in urolithiasis incidence from 1992 to 2021 within BRICS-plus were obtained from the Global Burden of Disease Study (GBD) 2021. Relationships between the age-standardized rate incidence and the Socio-demographic Index (SDI) were assessed using Pearson correlation analyses. Additionally, age-period-cohort modeling was employed to estimate net drift, local drift, age, period, and cohort effects over the past three decades. From 1992 to 2021, total urolithiasis cases increased by 41.89%, while the age-standardized incidence rate decreased by 20.72%, globally. Most BRICS countries, excluding Russian Federation, exhibited a declining trend in the age-standardized incidence rate over the past three decades. Russian Federation registered the highest age-standardized incidence rate (3525.62 per 100,000 population) in 2021, whereas the most substantial reduction of 44.32% was observed in China. The annual net drift ranged between - 2.47% in China to 1.16% in Brazil among the ten countries. A significant positive correlation was found between the incidence rate of urolithiasis and SDI values. Countries exhibited similar age effect patterns, with rates showing an initial increase followed by a decrease with advancing age, along with varying period and cohort effects, indicative of differential control measures and temporal burden trends. The age-standardized incidence rate of urolithiasis showed an overall declining trend across the BRICS-plus from 1992 to 2021. Significant health inequalities persist among these nations, which might partially be attributed to disparities in socio-economic circumstances. Furthermore, our findings emphasize the necessity for targeted interventions across age, period, and cohort dimensions and can guide the design of tailored public health strategies for specific nations and demographics.

Maternal hemorrhage remains the leading cause of maternal mortality worldwide, hindering progress toward Sustainable Development Goal (SDG) 3.1, which aims to reduce the global maternal mortality ratio (MMR) to less than 70 deaths per 100,000 livebirths by 2030. Comprehensive estimates of its global burden and inequalities are limited. Based on data from the Global Burden of Disease Study 2021, we assessed maternal hemorrhage burden across 204 countries from 1990 to 2021. Indicators included incidence, maternal mortality ratio (MMR), and disability-adjusted life years (DALYs). Temporal trends were analyzed using estimated/average annual percentage changes (EAPC/AAPC), and health inequality was quantified using the Slope Index of Inequality (SII) and Concentration Index (CI). The relationship between burden and Socio-demographic Index (SDI) was examined via LOESS and frontier analysis. Projections to 2030 were conducted using a Bayesian age-period-cohort model. From 1990 to 2021, the global age-standardized incidence rate decreased by 27.7% (from 495.93 to 358.57 per 100,000 population), and MMR declined by 58.2% (from 86.63 to 36.23 per 100,000 livebirths). South Asia and East Asia were the fastest decrease in ASIR (EAPC = -2.71 [-2.86 to -2.55]) and MMR (EAPC = -7.76 [-8.47 to -7.05]), respectively. In 2021, low-SDI regions bore the highest burden, with maternal mortality up to 93 times higher than in high-SDI regions. Inequality analysis showed narrowing absolute disparities (SII: -980.27 to -288.12) but widening relative inequalities (CI: -0.57 to -0.66). Adolescents (10-14 years) and women aged ≥ 35 years had elevated MMRs. Frontier analysis revealed inefficient outcomes in some high-SDI countries. By 2030, maternal hemorrhage is projected to cause approximately 13 million incident cases and 33,186 deaths. Despite global improvements, maternal hemorrhage persists as a major public health challenge with significant regional inequalities. Tailored strategies are urgently needed to reduce the burden in low-resource settings and accelerate progress toward SDG 3.1.

The aim of our study was to assess the impact of high body mass index (BMI) on type 2 diabetes mellitus (T2DM) in different Socio-Demographic Development Index (SDI) regions using data from the Global Burden of Disease (GBD) 2021 study. Using data from the GBD study, the burden of disease for T2DM was measured by analyzing the age-standardized disability-adjusted life year rate (ASDR) and age-standardized mortality rate (ASMR) for type 2 diabetes due to high BMI and the associated estimated annual percentage change (EAPC). Decomposition analyses, frontier analyses, and predictive models were used to analyze changes and influencing factors for each metric. The study revealed the significant global health burden of T2DM induced by high BMI, which EAPC of 1.82 with confidence intervals (CI) ranging from 1.78 to 1.87 for disability-adjusted life years (DALYs) and 0.85 with CIs ranging from 0.77 to 0.93 for mortality. The results of the analysis emphasized the geographic variability of T2DM disease burden associated with SDI Within the area covered by the study, a decreasing trend in ASMR for T2DM was observed in high SDI areas, with an EAPC value of - 1.07 and a confidence interval ranging from - 1.39 to - 0.76. At the same time, in the other SDI areas, the ASMR and ASDR for T2DM showed an increasing trend. In addition, the study noted that individuals in the 65- to 75-year-old age group accounted for a higher proportion of T2DM-related deaths and DALYs, with females affected at a greater rate than males. Projections for future trends indicate that the ASDR and ASMR for T2DM are expected to continue an upward trajectory over the next decade. This study investigates the variation in T2DM burden attributable to high BMI across regions with different SDI levels. The analysis reveals that, in high-SDI regions, the ASMR decreased from 1990 to 2021 and stabilized around 4.4 deaths per 100,000 people, while the ASDR increased, reaching approximately 416 cases per 100,000 people in 2021. Conversely, both ASDR and ASMR exhibited an upward trend in other SDI regions over the same period.

Globally, epidemiological data on sex chromosomal disorders of sex development (DSDs) remain scarce, prompting this study to examine their global disease burden and health inequalities, with a focus on Klinefelter syndrome (KS) and Turner syndrome (TS). We collected data on the incidence and prevalence of KS and TS from the GBD 2021 and analyzed by location, age, and socio-demographic index (SDI), using estimated annual percentage changes, Spearman's correlation analysis, health inequality analysis, and Bayesian age-period-cohort prediction models. The slope index of inequality and concentration index were employed to assess absolute and relative health inequalities across countries with varying SDI levels. In 2021, there were 68,357 incident cases of KS with an incidence rate of 102.12, and the prevalent cases reached 1,121,754, with an age-standardized prevalence rate (ASPR) of 29.68. For TS, there were 23,929 incident cases, with an incidence rate of 38.32, and 531,784 prevalent cases, with an ASPR of 14.47. The ASPR of KS showed an upward trend, while that of TS exhibited a downward trend. The prevalence of DSDs declined with age, most notably in the 0-9 age groups, with the slowest decline observed in high SDI regions. The highest incidence rate was in Sub-Saharan Africa, while the most significant growth was concentrated in Europe. Correlation analysis revealed a negative association or "U-shaped" relationship between the incidence rate of sex chromosomal DSDs and SDI. Inequality analysis indicated that low SDI countries bear a disproportionate burden, with SDI-related inequalities worsening over time, particularly in incidence rates. The burden of KS is forecast to grow modestly by 2036, contrasting with TS's expected gradual decline. Globally, KS has shown increasing impact among sex chromosomal DSDs, contrasting with TS. Persistent disparities across SDI regions highlight urgent needs for enhanced screening and long-term care in low SDI areas to reduce inequalities.

This study leveraged the Global Burden of Disease (GBD) 2021 database to comprehensively evaluate the trends in the disease burden of cystic echinococcosis (CE) in China from 1990 to 2021, situating its unique trajectory within the global context to inform targeted control strategies. Based on data from the GBD 2021 study, the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of CE were analyzed. Joinpoint regression was applied to calculate the average annual percentage change (AAPC), decomposition analysis was conducted to identify key driving factors, and frontier analysis was used to assess reduction potential. Subgroup analyses were stratified by age, sex, and region. Globally, the age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) of CE remained relatively stable from 1990 to 2021. In contrast, China experienced sharp increases in ASIR (AAPC = 2.94%) and ASPR (AAPC = 3.13%). Age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) declined globally and in China, though China's ASDR reduction (AAPC = -2.71%) lagged behind the global rate (AAPC = -4.0%). Decomposition analysis indicated that epidemiological deterioration was the primary driver of increased cases in China, while healthcare improvements contributed to reduced deaths and DALYs. Females had higher incidence and prevalence, particularly among those aged over 35, whereas males exhibited higher mortality and DALYs. The global CE burden was negatively correlated with the Sociodemographic Index (SDI). Although China approached the efficiency frontier in disease control, elevated ASPR and ASDR indicated persistent transmission and latent infections, suggesting further reduction potential. China faces rising CE incidence and prevalence despite improved outcomes, owing to delayed diagnosis and unbalanced resources. Aging and persistent exposure have worsened the burden, especially among middle-aged adults and females. Strategic priorities include enhanced prevention in the elderly, improved screening for women, intensified management of severe male cases, and balanced treatment/prevention approaches. SDI is a key determinant of CE burden, requiring focused interventions in low-SDI regions. Targeted monitoring of ASPR and ASDR is crucial to reduce the impact of historical transmission and achieve World Health Organization (WHO) targets.

Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and rates of stillbirths for these geographies and years. Gaussian process regression with data source adjustments for sampling and non-sampling bias was applied to synthesise input data for under-5 mortality for each geography. Age-specific mortality estimates were generated through a two-stage age-sex splitting process, and stillbirth estimates were produced with a mixed-effects model, which accounted for variable stillbirth definitions and data source-specific biases. For GBD 2015, we did a series of novel analyses to systematically quantify the drivers of trends in child mortality across geographies. First, we assessed observed and expected levels and annualised rates of decrease for under-5 mortality and stillbirths as they related to the Soci-demographic Index (SDI). Second, we examined the ratio of recorded and expected levels of child mortality, on the basis of SDI, across geographies, as well as differences in recorded and expected annualised rates of change for under-5 mortality. Third, we analysed levels and cause compositions of under-5 mortality, across time and geographies, as they related to rising SDI. Finally, we decomposed the changes in under-5 mortality to changes in SDI at the global level, as well as changes in leading causes of under-5 deaths for countries and territories. We documented each step of the GBD 2015 child mortality estimation process, as well as data sources, in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Globally, 5·8 million (95% uncertainty interval [UI] 5·7-6·0) children younger than 5 years died in 2015, representing a 52·0% (95% UI 50·7-53·3) decrease in the number of under-5 deaths since 1990. Neonatal deaths and stillbirths fell at a slower pace since 1990, decreasing by 42·4% (41·3-43·6) to 2·6 million (2·6-2·7) neonatal deaths and 47·0% (35·1-57·0) to 2·1 million (1·8-2·5) stillbirths in 2015. Between 1990 and 2015, global under-5 mortality decreased at an annualised rate of decrease of 3·0% (2·6-3·3), falling short of the 4·4% annualised rate of decrease required to achieve MDG4. During this time, 58 countries met or exceeded the pace of progress required to meet MDG4. Between 2000, the year MDG4 was formally enacted, and 2015, 28 additional countries that did not achieve the 4·4% rate of decrease from 1990 met the MDG4 pace of decrease. However, absolute levels of under-5 mortality remained high in many countries, with 11 countries still recording rates exceeding 100 per 1000 livebirths in 2015. Marked decreases in under-5 deaths due to a number of communicable diseases, including lower respiratory infections, diarrhoeal diseases, measles, and malaria, accounted for much of the progress in lowering overall under-5 mortality in low-income countries. Compared with gains achieved for infectious diseases and nutritional deficiencies, the persisting toll of neonatal conditions and congenital anomalies on child survival became evident, especially in low-income and low-middle-income countries. We found sizeable heterogeneities in comparing observed and expected rates of under-5 mortality, as well as differences in observed and expected rates of change for under-5 mortality. At the global level, we recorded a divergence in observed and expected levels of under-5 mortality starting in 2000, with the observed trend falling much faster than what was expected based on SDI through 2015. Between 2000 and 2015, the world recorded 10·3 million fewer under-5 deaths than expected on the basis of improving SDI alone. Gains in child survival have been large, widespread, and in many places in the world, faster than what was anticipated based on improving levels of development. Yet some countries, particularly in sub-Saharan Africa, still had high rates of under-5 mortality in 2015. Unless these countries are able to accelerate reductions in child deaths at an extraordinary pace, their achievement of proposed SDG targets is unlikely. Improving the evidence base on drivers that might hasten the pace of progress for child survival, ranging from cost-effective intervention packages to innovative financing mechanisms, is vital to charting the pathways for ultimately ending preventable child deaths by 2030. Bill & Melinda Gates Foundation.