12 research outputs found
Tobacco Consumption and the Menace of Oral Cancer in Karachi (Mohammad Mohiuddin Alamgir)
No full textOral cancer is among the leading cancer type in South Central Asian men. In India, oral cancer isthe leading cancer type among men and third most common cancer among women1 Oralprecancerous lesions (PCLs) such as leukoplakia and submucous fibrosis have a variablyreported incidence from 0.4% to 24% from different parts of the world with a transformation rateof 2–12% to frank malignancies.2 In Pakistan, cancer of the oral cavity and pharynx are amongstthe commonest type of cance
“To Own, or not to Own?” A multilevel analysis of intellectual property right policies' on academic entrepreneurship
No full textThe political environment around universities has led them to create an infrastructure to manage academic inventions. While some consider that the advantages of a university entrepreneurial structure outweigh any potential negative effects, others question their detrimental effect on academic scientists’ entrepreneurial behavior. However, this debate remains unresolved as none of these two views have been fully empirically supported. Using multilevel models for a population of 2230 professors in 27 universities in Canada (82 individuals per unit on average), we test the effect of three features of institutional intellectual property right policy characteristics, namely, property rights (ownership regime), control rights (obligation to disclose and option to commercialize), and income-sharing schemes (when commercialization involves the university or an individual inventor) on two commercial behaviors of faculty members, namely, formal commercialization (patent and spinoff creation), and informal commercialization (consulting and commercial agreement). Our results suggest that contrary to most of the literature, academic inventors’ behavior is influenced not by the invention ownership regime but by the control rights in place and the sharing of income between the university and the academic inventors. The findings have some implications for the importance of an ownership regime and the ineffectiveness of institutional policies which create contradictory motivations for academic entrepreneurs. It suggests some directions for future research using multilevel models.The author acknowledges financial assistance and support from the Social Sciences and Humanities Research Council and the Natural Sciences and Engineering Research Council of Canada.Peer Reviewe
The implementation of rural poor programmes in Bangladesh.
No full textThis study explores the initiatives of the public and private sector
in the context of the alleviation of poverty of the rural poor in
Bangladesh. The central thesis is that the public sector has made a
significant departure, at least in theory, towards the
conceptualisation of the rural poor programme in a way that the
private sector, particularly the non-governmental organisations, have
been performing for the last two decades.
This study emphasises the recognition by the NGOs, particularly the
"moderate ones, that the nature of both the problems and the
solutions change in the process. Bangladesh Rural Advancement
Committee (BRAC), the "moderate" NGO under study, has gone through a
"learn as it goes", responsive, inductive process. This study argues
quite the contrary with the public sector initiative. It was only
prior to the preparation of the Third Five Year Plan that debates were
initiated to seriously criticise the rather sterile two-tier
cooperative model for rural poor mobilisation around employment
generation and acquisition of assets. Presently, BRDB opened the
"flood-gate", which so long prevented the NGOs to contribute to the
formulation of the training module of BRDB rural poor programme
towards human development and institution building.
Although it has been argued that "moderate" NGOs, like BRAC, are
not institutions setting about to prove a specific model or theory of
development in a dogmatic or absolutist sense, it would be difficult
to say that they are not guided by an ideology, as this study argues,
when the NGOs themselves have accepted the "Freire-type-conscientisation", which in itself is a loaded concept. This study
presents a "mobilising" NGO, where the concept of "conscientisation"
has been shown to transcend the limits of present day thinking of
moderate NGOs
Chimeric 2C10R4 anti-CD40 antibody therapy is critical for long-term survival of GTKO.hCD46.hTBM pig-to-primate cardiac xenograft
No full textFull author list omitted for brevity. For full list of authors see article.Preventing xenograft rejection is one of the greatest challenges of transplantation medicine. Here, we describe a reproducible, long-term survival of cardiac xenografts from alpha 1-3 galactosyltransferase gene knockout pigs, which express human complement regulatory protein CD46 and human thrombomodulin (GTKO.hCD46.hTBM), that were transplanted into baboons. Our immunomodulatory drug regimen includes induction with anti-thymocyte globulin and alphaCD20 antibody, followed by maintenance with mycophenolate mofetil and an intensively dosed alphaCD40 (2C10R4) antibody. Median (298 days) and longest (945 days) graft survival in five consecutive recipients using this regimen is significantly prolonged over our recently established survival benchmarks (180 and 500 days, respectively). Remarkably, the reduction of alphaCD40 antibody dose on day 100 or after 1 year resulted in recrudescence of anti-pig antibody and graft failure. In conclusion, genetic modifications (GTKO.hCD46.hTBM) combined with the treatment regimen tested here consistently prevent humoral rejection and systemic coagulation pathway dysregulation, sustaining long-term cardiac xenograft survival beyond 900 days
Olfati Savoji and Rawaih Gulshan Qutbshahi
No full textOlfati Savoji was an 11th-century Shiite poet who served at the court of Abdullah Qutbshah. In addition to composing poetry in celebration of him, Savoji also authored two treatises, namely "Riyaz al-Sana'i Qutbshahi" and "Rawaih Gulshan Qutbshahi," as a tribute to Abdullah Qutbshah. The novels of Gulshan Qutbshahi have been erroneously attributed to Olfati Yazdi by most tazkira writers. However, based on historical and stylistic data, it is clear that these works actually belong to Muslim Olfati Savoji. Therefore, the attribution to Olfati Yazdi is false. Rawaih Golshan is a concise work that includes an introduction, seven fragrances, and a conclusion. It employs a combination of prose and structured language, reminiscent of artificial and technical texts. The treatise provides a detailed account of Abdullah Qutbshah, his military forces, servants, royal palaces, renowned festivities, and holidays, as well as the enchanting aspects of Hyderabad. Olfati authored the document in the year 1051. Olfati has directed his endeavors towards ensuring the phonetic equilibrium of the text and the cadence of the words. Hence, the utilization of various puns, rhyming prose, and other verbal devices, such as the employment of sequential additions and repetition throughout the entire piece, is truly remarkable. In addition, he has employed arrays, such as similes and contrasts, to establish proportionality and semantic equilibrium within phrases.IntroductionThe influx of Muslim Iranians to India commenced under the reign of Sultan Mahmud in the late 7th century, leading to the establishment of indigenous administrations in the southern and central regions of India. Sultan Qoli founded the Qutbshah dynasty. Abdullah Qutbshah, the fifth monarch of the Qutbshah dynasty, was born in 1023 AH and became king in 1035 AH. He remained alive until the year 1083 AH and held the throne for approximately 48 years. The reign of Abdullah was a highly prosperous and successful phase of Qutbshahi control in India. During this time, numerous poets, writers, and scientists from Iran migrated there and enjoyed a life of abundance and contentment. Among them was Olfati Savoji.Olfati Savoji was a prominent Shia poet during the 11th century of the Hijri calendar. He served as a poet and writer in the court for approximately 38 years, starting from 1045 Hijri until the end of Abdullah Qutbshah's reign in 1083. He authored two treatises, "Riyaz al-Sana'i Qutbshahi" and "Rowaih Golshan Qutbshahi," as well as several poems. Olfati Savoji arrived in Isfahan upon the demise of Sultan Abdullah and passed away somewhere between 1087 and 1090. The same city likely laid him to rest.Literature ReviewWhile discussing the state of Olfati Savoji, Nasrabadi, Khoshgo, Arzoo, and Mohammad Mozafar Hossein Saba neglected to mention the passing of Golshan Qutbshahi. In his Tazkira Mahbub al-Zalaman, Sufi Malkapuri reported the spirits of Golshan Qutbshehi; however, he attributed this information to Alfati Yazdi. Ahmed Golchin Ma'ani identified the erroneous nature of Sufi's statements regarding the attribution of Golshan Qutbshahi's customs to Olfati Yazdi and highlighted this discrepancy. Sufi's error has also influenced other publications. In his book "Mir Muhammad Momin Aster Abadi, the Promoter of Shi'ism in South India," Mohiuddin Qadri accurately quotes the statements of Golshan Qutbshahi but acknowledges that he has not personally read Golshan Qutbshahi's memoirs. In the book "Looking at the History of Hyderabad Deccan," on page 84, Mojtabi Karmi and in the article "Persian Language and Literature in India," Amir Hasan Abedi have both made the same error. They mistakenly assigned Riyad al-Sana'i and Ravaih Golshan to Olfati Yazdi and Fereshteh Koshki. Additionally, Olfati Yazdi edited and published Gulshan Qutbshehi's memoirs under the name Fereshte Koshki. Nabi has presented Olfati Savoji as a significant figure in the realms of Indian and Persian literature, based on the testimony of Nasrabadi.MethodologyThis article will begin by presenting the framework of Golshan Qutbshehi's novels. We will then conduct an analysis to explore the linguistic (phonetic, lexical, and syntactic) and literary characteristics of Golshan Qutbshehi's novels. I shall refrain from discussing the intellectual aspect of al-Fati's work, as it lacks logical ideas and instead focuses solely on the visual depiction of buildings, flowers, fruits, and similar subjects.ConclusionOlfati Savoji, not Olfati Yazdi, is the author of Golshan Qutbshahi's novel. This is due to Olfati Yazdi's service under Ali Qali Khan of Zaman, an Akbari commander who met his demise in 974 AH. Olfati Yazdi passed away either in the same year or the following year, which was 48 or 49 years before Abdullah Qutbshah was born and 76 or 77 years before Golshan Qutbshahi, the author of Rawaih (1051), was born. Moreover, stylistic similarities and historical evidence point to the same individual as the author of both Golshan's books and Riyad al-Sana'i. The Ravih of Golshan Qutbshehi consists of an introductory section, seven Ravihs, and a concluding section.A) Olfati commenced the book by uttering a couple of phrases in admiration of Hazrat Bari Ta'ala, followed by the recitation of a naat in honor of the Holy Prophet (PBUH). Subsequently, he referenced a quotation from Ali Ibn Abi Talib (PBUH). Subsequently, he commended Abdullah Qutbshah for his benevolence towards Ali (a.s.) and the family of Rasoolullah, as well as for his efforts in advancing Shiism in Telangana. He then bestowed the title "Rowaih Golshan Qutbshahi" on his work, which was penned in the year 1051 Hijri.B) The content of the book: In the initial publication, Olfati describes Abdullah Qutbshah as exceptional and remarkable in the global context due to five distinct qualities: The following qualities are: 1. justice; 2. dignity; 3. good nature; 4. generosity; and 5. courage.In the second Raiha, the author begins by describing the royal palaces, buildings, and significant resorts. Next, he introduces three government officials from Abdullah's court. The first is Nawab Allami Ibn Khatun, who achieved the position of Peshwai, or Nawabi, in 1038. The second is Nawab Madar Ilhami, Mir Mohammad Saeed Ardestani, who became Mir Jamalgi, or Minister, in 1047. Lastly, there is Mr. Debir al-Mulk Olfati did not explicitly identify the secretary; however, it is possible that Mullah Muhammad Ali is the individual in question.In the third stanza, he depicts Hyderabad; in the fourth verse, it portrays the regal gathering and festivities. The fifth smell depicts the vast number of warriors and the courage of the soldiers, as well as the war elephants, greyhound horses, and the weaponry used by Abdullah Qutbshah's cavalry.Olfati composed a poem consisting of 59 verses in the Masnavi genre, depicting the festive gathering of Abdullah, the bartender, in the sixth stanza.In the seventh chapter, Golshan's flavors are introduced, and he receives overwhelming appreciation for his novel.The book's completion date, which coincides with its start date, is 1051 Hijri.c) Conclusion: Golshan's poems conclude with a concluding note named "Latifa Ghaibi" and five verses in Mamdouh's supplication. Latifah Ghaibi provides an elucidation of the numerical correlation between the number of letters in the name "Sultan Abdullah" and his nickname "Qutabshahan Zaman," both of which consist of 12 letters, in reference to his religious affiliation, which is Twelve Imam Shia.The book's stylistic characteristics: Olfati Savoji has composed Golshan's novels in a manner reminiscent of artificial and technical literature, with the exception that he employed straightforward and commonly used vocabulary, refraining from including Arabic phrases and poetry except on three occasions. Furthermore, he abstained from utilizing unfamiliar similes, metaphors, and complex expressions.Some of its primary stylistic characteristics include the following: Olfati’s primary focus in the phonetic segment lies in the melodic qualities of words and the cadence of sentences. In order to achieve phonetic equilibrium, he has extensively employed the technique of double assurance, wherein certain sections of the text bear resemblance to the lines of a poem. Occasionally, certain lengthy and brief lines have converged in a manner resembling structures like Mastzad and Rabai. Within the syntactic segment, Olfati places particular emphasis on composition and frequently employs similes and metaphors in supplementary structures. Olfati has employed similes and metaphors and subsequently incorporated sarcasm as part of their expressive repertoire. He has focused more on achieving harmony by utilizing similes and contrasts among the original spiritual arrays
The burden of unintentional drowning: global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study.
No full textFranklin RC, Peden AE, Hamilton EB, et al. The burden of unintentional drowning: global, regional and national estimates of mortality from the Global Burden of Disease 2017 Study. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention. 2020:injuryprev-2019-043484.BACKGROUND: Drowning is a leading cause of injury-related mortality globally. Unintentional drowning (International Classification of Diseases (ICD) 10 codes W65-74 and ICD9 E910) is one of the 30 mutually exclusive and collectively exhaustive causes of injury-related mortality in the Global Burden of Disease (GBD) study. This study's objective is to describe unintentional drowning using GBD estimates from 1990 to 2017.; METHODS: Unintentional drowning from GBD 2017 was estimated for cause-specific mortality and years of life lost (YLLs), age, sex, country, region, Socio-demographic Index (SDI) quintile, and trends from 1990 to 2017. GBD 2017 used standard GBD methods for estimating mortality from drowning.; RESULTS: Globally, unintentional drowning mortality decreased by 44.5% between 1990 and 2017, from 531956 (uncertainty interval (UI): 484107 to 572854) to 295210 (284493 to 306187) deaths. Global age-standardised mortality rates decreased 57.4%, from 9.3 (8.5 to 10.0) in 1990 to 4.0 (3.8 to 4.1) per 100000 per annum in 2017. Unintentional drowning-associated mortality was generally higher in children, males and in low-SDI to middle-SDI countries. China, India, Pakistan and Bangladesh accounted for 51.2% of all drowning deaths in 2017. Oceania was the region with the highest rate of age-standardised YLLs in 2017, with 45434 (40850 to 50 539) YLLs per 100000 across both sexes.; CONCLUSIONS: There has been a decline in global drowning rates. This study shows that the decline was not consistent across countries. The results reinforce the need for continued and improved policy, prevention and research efforts, with a focus on low- and middle-income countries. © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ
Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023
No full textBackground: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: Gates Foundation
Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019
No full textBackground Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.
Methods We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017).
Findings In 2019 there were 1.49 million deaths (95% uncertainty interval 1.39-1.59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32.7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32.1% were due to communicable, nutritional, or maternal causes; 27.0% were due to non-communicable diseases; and 8.2% were due to self-harm. Since 1950, deaths in this age group decreased by 30.0% in females and 15.3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1.3% in males and 1.6% in females, almost half that of males aged 1-4 years (2.4%), and around a third less than in females aged 1-4 years (2.5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9.5% to 21.6%.
Interpretation Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Bill & Melinda Gates Foundation
Global age-sex-specific all-cause mortality and life expectancy estimates for 204 countries and territories and 660 subnational locations, 1950–2023: a demographic analysis for the Global Burden of Disease Study 2023
No full textComprehensive, 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
The global, regional, and national burden of cancer, 1990–2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023
No full textBackground: 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. Methods: 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. Findings: 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). Interpretation: 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. Funding: Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation
