11 research outputs found
Shiga toxin and beta-lactamases genes in Escherichia coli phylotypes isolated from carcasses of broiler chickens slaughtered in Iran
No full textTwo hundred and four Escherichia coli strains were isolated from external and visceral cavity surfaces of 102
slaughtered broiler carcasses. The isolates were screened to determine the phylogenetic background and presence of Shiga toxins (stx1, stx2), intimin (eae) and beta-lactamase (blaTEM, blaSHV) genes. Phylotyping results revealed that the E. coli isolates segregated in four phylogenetic groups A (56.86%), B1 (19.12%), B2 (4.90%) and
D (19.12%). PCR assays revealed that 13 isolates (6.37%) from 12 carcasses were positive for eae (12 isolates)
and/or stx2 (2) genes. The eae positive isolates belonged to phylogenetic groups A (A0, A1), B1, B2 (B22) and D
(D2). Two stx2 positive and seven eae positive isolates were recovered from visceral cavity surface, whereas
only 5 eae positive isolates were from the external surface of the carcasses. On the other hand, thirty one E. coli
strains isolated from visceral cavity and external surface of 26 carcasses carried the blaTEM (27) and blaSHV (4)
genes and belonged to different phylo-groups. This study suggests that broiler carcasses could be considered
as an important source of EPEC and STEC pathotypes in southeast of Iran; as well as the examined antibiotic resistance genes, which were carried by some isolates and could be transferred to pathogens through the food
chain
High prevalence of β-lactam and fluoroquinolone resistance in various phylotypes of Escherichia coli isolates from urinary tract infections in Jiroft city, Iran
No full textAbstract Background Urinary tract infection (UTI) is one of the most prevalent infectious diseases with worldwide health threatening. Antimicrobial resistant strains of Escherichia coli (E. coli) are a common cause of UTI which were identified as a treatment challenge. This study aimed to assay the prevalence of common β-lactam resistance genes including bla TEM, bla SHV, bla CTX-M and bla CMY and phenotypic resistance to commonly used β-lactam and fluoroquinolone antibiotics in UTIs. These factors were evaluated in various phylogenetic groups (phylotypes) of E. coli isolates. Real-time PCR was applied to detect β-lactam resistance genes and conventional PCR was used to determine the phylotypes. Phenotypic resistance against β-lactams (ceftazidime, cefotaxime, aztreonam and ceftriaxone) and fluoroquinolones (ciprofloxacin) were identified by the disc diffusion technique. The ability of extended spectrum β-lactamases (ESBLs) production in E. coli isolates was detected using the combined disc diffusion method. Results The prevalence of resistance genes were 89.6% for bla TEM, 44.3% for bla CTX-M, 6.6% for bla SHV and 0.9% for bla CMY. The two high prevalent phylotypes were B2 (29.2%) and D (17.9%) followed by E (14.1%), F (9.4%), C (6.6%) and 10.3% of isolates were unknown in phylotyping. Disc diffusion results showed high prevalence of antibiotic resistance to cefotaxime (88.6%), aztreonam (83%), ceftireaxon (77.3%), ceftazidime (76.4%) and ciprofloxacin (55.6%). Totally, 52.8% of isolates were found as phenotypical ESBL-producers. Conclusions This study’s results confirmed an explosion of antibiotic resistance amongst E. coli isolates from UTI against β-lactams and fluoroquinolones. Findings explain the necessity of deep changes in quantity and quality of drug resistance diagnosis and antibiotic therapy strategies. More studies are suggested to better and confident evaluations
Explanation People and Their Family Care Explanation of Them
No full textObjectives: Elder abuse (Doing or not done a single or repeated act That bothers or to cause harm to an elderly) is one of the social health problems in modern societies to rise and has a prominent role in prevention education The objective of this study was to investigate elderly abuse in Persian literature.
Methods & Materials: This study identified themes related to elder abuse in Persian literature and the educational structure were developed developed In this regard, poems of poets and authors of Persian literature Using the software for Dorj book including 178 of 101 literary Persian poet and author is known and ganjur Site including large number of poets and In cases where there was no electronic versions of books were read line by line And using a library of content analysis, subjects were studied
Results: The study defined types of elder abuse and elder abuse causes of elder abuse and how to prevent abuse of the elderly that each expression is detailed in the text
Conclusion: The results of the rich Persian literature could result in abuse of elderly has been considered from two aspects 1- denounced the abuse of older 2- culture of reverence and respect for the elderly in order to prevent abuse of the elderl
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Global, regional, and national burden of meningitis and its aetiologies, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019
No full textBackground Although meningitis is largely preventable, it still causes hundreds of thousands of deaths globally each year. WHO set ambitious goals to reduce meningitis cases by 2030, and assessing trends in the global meningitis burden can help track progress and identify gaps in achieving these goals. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we aimed to assess incident cases and deaths due to acute infectious meningitis by aetiology and age from 1990 to 2019, for 204 countries and territories. Methods We modelled meningitis mortality using vital registration, verbal autopsy, sample-based vital registration, and mortality surveillance data. Meningitis morbidity was modelled with a Bayesian compartmental model, using data from the published literature identified by a systematic review, as well as surveillance data, inpatient hospital admissions, health insurance claims, and cause-specific meningitis mortality estimates. For aetiology estimation, data from multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature studies were analysed by use of a network analysis model to estimate the proportion of meningitis deaths and cases attributable to the following aetiologies: Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococcus, Escherichia coli, Klebsiella pneumoniae, Listeria monocytogenes, Staphylococcus aureus, viruses, and a residual other pathogen category. Findings In 2019, there were an estimated 236 000 deaths (95 uncertainty interval UI 204 000-277 000) and 2.51 million (2.11-2.99) incident cases due to meningitis globally. The burden was greatest in children younger than 5 years, with 112 000 deaths (87 400-145 000) and 1.28 million incident cases (0.947-1.71) in 2019. Age-standardised mortality rates decreased from 7.5 (6.6-8.4) per 100 000 population in 1990 to 3.3 (2.8-3.9) per 100 000 population in 2019. The highest proportion of total all-age meningitis deaths in 2019 was attributable to S pneumoniae (18.1% 17.1-19.2), followed by N meningitidis (13.6% 12.7-14.4) and K pneumoniae (12.2% 10.2-14.3). Between 1990 and 2019, H influenzae showed the largest reduction in the number of deaths among children younger than 5 years (76.5% 69.5-81.8), followed by N meningitidis (72.3% 64.4-78.5) and viruses (58.2% 47.1-67.3). Interpretation Substantial progress has been made in reducing meningitis mortality over the past three decades. However, more meningitis-related deaths might be prevented by quickly scaling up immunisation and expanding access to health services. Further reduction in the global meningitis burden should be possible through low-cost multivalent vaccines, increased access to accurate and rapid diagnostic assays, enhanced surveillance, and early treatment. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021
No full textFunding: Bill & Melinda Gates Foundation.Peer ReviewedArticle signat per 1420 autors/es. Membres del GBD 2021 Forecasting Collaborators:
Stein Emil Vollset*, Hazim S Ababneh, Yohannes Habtegiorgis Abate, Cristiana Abbafati, Rouzbeh Abbasgholizadeh, Mohammadreza Abbasian, Hedayat Abbastabar, Abdallah H A Abd Al Magied, Samar Abd ElHafeez, Atef Abdelkader, Michael Abdelmasseh, Sherief Abd-Elsalam, Parsa Abdi, Mohammad Abdollahi, Meriem Abdoun, Auwal Abdullahi, Mesfin Abebe, Olumide Abiodun, Richard Gyan Aboagye, Hassan Abolhassani, Mohamed Abouzid, Girma Beressa Aboye, Lucas Guimarães Abreu, Abdorrahim Absalan, Hasan Abualruz, Bilyaminu Abubakar, Hana Jihad Jihad Abukhadijah, Giovanni Addolorato, Victor Adekanmbi, Charles Oluwaseun Adetunji, Juliana Bunmi Adetunji, Temitayo Esther Adeyeoluwa, Rishan Adha, Ripon Kumar Adhikary, Qorinah Estiningtyas Sakilah Adnani, Leticia Akua Adzigbli, Fatemeh Afrashteh, Muhammad Sohail Afzal, Saira Afzal, Faith Agbozo, Antonella Agodi, Anurag Agrawal, Williams Agyemang-Duah, Bright Opoku Ahinkorah, Austin J Ahlstrom, Aqeel Ahmad, Firdos Ahmad, Muayyad M Ahmad, Sajjad Ahmad, Shahzaib Ahmad, Anisuddin Ahmed, Ayman Ahmed, Haroon Ahmed, Safoora Ahmed, Syed Anees Ahmed, Karolina Akinosoglou, Mohammed Ahmed Akkaif, Ashley E Akrami, Ema Akter, Salah Al Awaidy, Syed Mahfuz Al Hasan, Amjad S Al Mosa, Omar Al Ta’ani, Omar Ali Mohammed Al Zaabi, Fares Alahdab, Muaaz M Alajlani, Yazan Al-Ajlouni, Samer O Alalalmeh, Ziyad Al-Aly, Khurshid Alam, Noore Alam, Tahiya Alam, Zufishan Alam, Rasmieh Mustafa Al-amer, Fahad Mashhour Alanezi, Turki M Alanzi, Almaza Albakri, Wafa A Aldhaleei, Robert W Aldridge, Seyedeh Yasaman Alemohammad, Yihun Mulugeta Alemu, Adel Ali Saeed Al-Gheethi, Mohammed Khaled Al-Hanawi, Abid Ali, Amjad Ali, Iman Ali, Mohammed Usman Ali, Rafat Ali, Syed Shujait Shujait Ali, Victor Ekoche Ali, Waad Ali, Akram Al-Ibraheem, Gianfranco Alicandro, Sheikh Mohammad Alif, Syed Mohamed Aljunid, François Alla, Joseph Uy Almazan, Hesham M Al-Mekhlafi, Ahmed Yaseen Alqutaibi, Ahmad Alrawashdeh, Sahel Majed Alrousan, Salman Khalifah Al-Sabah, Mohammed A Alsabri, Zaid Altaany, Ala’a B Al-Tammemi, Jaffar A Al-Tawfiq, Khalid A Altirkawi, Deborah Oyine Aluh, Nelson Alvis-Guzman, Mohammad Sami Al-Wardat, Yaser Mohammed Al-Worafi, Hany Aly, Mohammad Sharif Alyahya, Karem H Alzoubi, Walid Al-Zyoud, Reza Amani, Edward Kwabena Ameyaw, Tarek Tawfik Amin, Alireza Amindarolzarbi, Sohrab Amiri, Mohammad Hosein Amirzade-Iranaq, Hubert Amu, Dickson A Amugsi, Robert Ancuceanu, Deanna Anderlini, David B Anderson, Pedro Prata Andrade, Catalina Liliana Andrei, Tudorel Andrei, Erick Adrian Andrews, Abhishek Anil, Sneha Anil, Amir Anoushiravani, Catherine M Antony, Ernoiz Antriyandarti, Boluwatife Stephen Anuoluwa, Saeid Anvari, Anayochukwu Edward Anyasodor, Francis Appiah, Michele Aquilano, Juan Pablo Arab, Jalal Arabloo, Elshaimaa A Arafa, Mosab Arafat, Aleksandr Y Aravkin, Ali Ardekani, Demelash Areda, Brhane Berhe Aregawi, Abdulfatai Aremu, Hany Ariffin, Mesay Arkew, Keivan Armani, Anton A Artamonov, Ashokan Arumugam, Mohammad Asghari-Jafarabadi, Charlie Ashbaugh, Thomas Astell-Burt, Seyyed Shamsadin Athari, Prince Atorkey, Maha Moh’d Wahbi Atout, Avinash Aujayeb, Marcel Ausloos, Hamzeh Awad, Adedapo Wasiu Awotidebe, Haleh Ayatollahi, Jose L Ayuso-Mateos, Sina Azadnajafabad, Fahad Khan Azeez, Rui M S Azevedo, Muhammad Badar, Soroush Baghdadi, Mahboube Bagheri, Nasser Bagheri, Ruhai Bai, Jennifer L Baker, Abdulaziz T Bako, Senthilkumar Balakrishnan, Wondu Feyisa Balcha, Ovidiu Constantin Baltatu, Martina Barchitta, Erfan Bardideh, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Hiba Jawdat Barqawi, Sandra Barteit, Afisu Basiru, João Diogo Basso, Mohammad-Mahdi Bastan, Sanjay Basu, Matteo Bauckneht, Bernhard T Baune, Mohsen Bayati, Nebiyou Simegnew Bayileyegn, Amir Hossein Behnoush, Payam Behzadi, Maryam Beiranvand, Olorunjuwon Omolaja Bello, Luis Belo, Apostolos Beloukas, Maryam Bemanalizadeh, Isabela M Bensenor, Habib Benzian, Azizullah Beran, Zombor Berezvai, Robert S Bernstein, Paulo J G Bettencourt, Kebede A Beyene, Melak Gedamu Beyene, Devidas S Bhagat, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Dinesh Bhandari, Ravi Bharadwaj, Nikha Bhardwaj, Pankaj Bhardwaj, Ashish Bhargava, Sonu Bhaskar, Vivek Bhat, Natalia V Bhattacharjee, Gurjit Kaur Bhatti, Jasvinder Singh Bhatti, Manpreet S Bhatti, Mohiuddin Ahmed Bhuiyan, Catherine Bisignano, Bijit Biswas, Tone Bjørge, Virginia Bodolica, Aadam Olalekan Bodunrin, Milad Bonakdar Hashemi, Berrak Bora Basara, Hamed Borhany, Samuel Adolf Bosoka, Alejandro Botero Carvajal, Souad Bouaoud, Soufiane Boufous, Christopher Boxe, Edward J Boyko, Oliver J Brady, Dejana Braithwaite, Michael Brauer, Javier Brazo-Sayavera, Hermann Brenner, Colin Stewart Brown, Annie J Browne, Traolach Brugha, Dana Bryazka, Norma B Bulamu, Danilo Buonsenso, Katrin Burkart, Richard A Burns, Reinhard Busse, Yasser Bustanji, Zahid A Butt, Florentino Luciano Caetano dos Santos, Mehtap Çakmak Barsbay, Daniela Calina, Luciana Aparecida Campos, Shujin Cao, Angelo Capodici, Rosario Cárdenas, Giulia Carreras, Andrea Carugno, Márcia Carvalho, Joao Mauricio Castaldelli-Maia, Giulio Castelpietra, Maria Sofia Cattaruzza, Arthur Caye, Luca Cegolon, Francieli Cembranel, Edina Cenko, Ester Cerin, Steven J Chadban, Joshua Chadwick, Chiranjib Chakraborty, Sandip Chakraborty, Julian Chalek, Jeffrey Shi Kai Chan, Rama Mohan Chandika, Sara Chandy, Jaykaran Charan, Anis Ahmad Chaudhary, Akhilanand Chaurasia, An-Tian Chen, Haowei Chen, Meng Xuan Chen, Simiao Chen, Nicolas Cherbuin, Gerald Chi, Fatemeh Chichagi, Odgerel Chimed-Ochir, Ritesh Chimoriya, Patrick R Ching, Jesus Lorenzo Chirinos-Caceres, Abdulaal Chitheer, Daniel Youngwhan Cho, William C S Cho, Dong-Woo Choi, Bryan Chong, Chean Lin Chong, Hitesh Chopra, Dinh-Toi Chu, Eric Chung, Muhammad Chutiyami, Justin T Clayton, Rebecca M Cogen, Aaron J Cohen, Alyssa Columbus, Haley Comfort, Joao Conde, Jon T Connolly, Ezra E K Cooper, Samuele Cortese, Natália Cruz-Martins, Alanna Gomes da Silva, Omid Dadras, Xiaochen Dai, Zhaoli Dai, Bronte E Dalton, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Jai K Das, Saswati Das, Subasish Das, Nihar Ranjan Dash, Kairat Davletov, Fernando Pio De la Hoz, Diego De Leo, Shayom Debopadhaya, Ivan Delgado-Enciso, Edgar Denova-Gutiérrez, Nikolaos Dervenis, Hardik Dineshbhai Desai, Vinoth Gnana Chellaiyan Devanbu, Syed Masudur Rahman Dewan, Kuldeep Dhama, Amol S Dhane, Sameer Dhingra, Diana Dias da Silva, Daniel Diaz, Luis Antonio Diaz, Michael J Diaz, Adriana Dima, Delaney D Ding, Thao Huynh Phuong Do, Camila Bruneli do Prado, Masoud Dodangeh, Milad Dodangeh, Phidelia Theresa Doegah, Sushil Dohare, Wanyue Dong, Mario D’Oria, Rajkumar Doshi, Robert Kokou Dowou, Haneil Larson Dsouza, Viola Dsouza, John Dube, Samuel C Dumith, Bruce B Duncan, Andre Rodrigues Duraes, Senbagam Duraisamy, Oyewole Christopher Durojaiye, Anar Dushpanova, Sulagna Dutta, Paulina Agnieszka Dzianach, Arkadiusz Marian Dziedzic, Ejemai Eboreime, Alireza Ebrahimi, Mohammad Ebrahimi Kalan, Hisham Atan Edinur, Ferry Efendi, Terje Andreas Eikemo, Ebrahim Eini, Temitope Cyrus Ekundayo, Rabie Adel El Arab, Iman El Sayed, Osman Elamin, Noha Mousaad Elemam, Ghada Metwally Tawfik ElGohary, Muhammed Elhadi, Omar Abdelsadek Abdou Elmeligy, Adel B Elmoselhi, Mohammed Elshaer, Ibrahim Elsohaby, Mohd. Elmagzoub Eltahir, Theophilus I Emeto, Babak Eshrati, Majid Eslami, Zahra Esmaeili, Natalia Fabin, Adeniyi Francis Fagbamigbe, Omotayo Francis Fagbule, Luca Falzone, Mohammad Fareed, Carla Sofia e Sá Farinha, MoezAlIslam Ezzat Mahmoud Faris, Andre Faro, Kiana Fasihi, Ali Fatehizadeh, Nelsensius Klau Fauk, Timur Fazylov, Valery L Feigin, Ginenus Fekadu, Xiaoqi Feng, Seyed-Mohammad Fereshtehnejad, Pietro Ferrara, Nuno Ferreira, Belete Sewasew Firew, Florian Fischer, Ida Fitriana, Joanne Flavel, Luisa S Flor, Morenike Oluwatoyin Folayan, Kristen Marie Foley, Marco Fonzo, Lisa M Force, Matteo Foschi, Alberto Freitas, Ni Kadek Yuni Fridayani, Kai Glenn Fukutaki, João M Furtado, Blima Fux, Peter Andras Gaal, Muktar A Gadanya, Silvano Gallus, Balasankar Ganesan, Mohammad Arfat Ganiyani, Rupesh K Gautam, Tilaye Gebru Gebi, Miglas W Gebregergis, Mesfin Gebrehiwot, Lemma Getacher, Genanew K A Getahun, Peter W Gething, Delaram J Ghadimi, Fataneh Ghadirian, Sadegh Ghafarian, Khalid Yaser Ghailan, MohammadReza Ghasemi, Ghazal Ghasempour Dabaghi, Ramy Mohamed Ghazy, Sama Ghoba, Ehsan Gholami, Ali Gholamrezanezhad, Nasim Gholizadeh, Mahsa Ghorbani, Pooyan Ghorbani Vajargah, Elena Ghotbi, Artyom Urievich Gil, Tiffany K Gill, Alem Girmay, James C Glasbey, Ekaterina Vladimirovna Glushkova, Elena V Gnedovskaya, Laszlo Göbölös, Mohamad Goldust, Pouya Goleij, Davide Golinelli, Sameer Vali Gopalani, Alessandra C Goulart, Mahdi Gouravani, Anmol Goyal, Michal Grivna, Giuseppe Grosso, Giovanni Guarducci, Mohammed Ibrahim Mohialdeen Gubari, Stefano Guicciardi, Rafael Alves Guimarães, Snigdha Gulati, David Gulisashvili, Damitha Asanga Gunawardane, Cui Guo, Anish Kumar Gupta, Rahul Gupta, Rajeev Gupta, Renu Gupta, Sapna Gupta, Vijai Kumar Gupta, Annie Haakenstad, Najah R Hadi, Nils Haep, Abdul Hafiz, Dariush Haghmorad, Demewoz Haile, Adel Hajj Ali, Ali Hajj Ali, Arvin Haj-Mirzaian, Esam S Halboub, Sebastian Haller, Rabih Halwani, Kanaan Hamagharib Abdullah, Nadia M Hamdy, Rifat Hamoudi, Nasrin Hanifi, Graeme J Hankey, Zaim Anan Haq, Md Rabiul Haque, Harapan Harapan, Arief Hargono, Josep Maria Haro, Ahmed I Hasaballah, S. M. Mahmudul Hasan, Mohammad Hasanian, Md Saquib Hasnain, Amr Hassan, Johannes Haubold, Simon I Hay, Jeffrey J Hebert, Omar E Hegazi, Mohammad Heidari, Mehdi Hemmati, Claire A Henson, Brenda Yuliana Herrera-Serna, Claudiu Herteliu, Majid Heydari, Kamal Hezam, Irma Hidayana, Yuta Hiraike, Nguyen Quoc Hoan, Ramesh Holla, Praveen Hoogar, Nobuyuki Horita, Md Mahbub Hossain, Hassan Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Chengxi Hu, Junjie Huang, Michael Hultström, Tsegaye Gebreyes Hundie, Aliza J Hunt, Kiavash Hushmandi, Javid Hussain, M. Azhar Hussain, Nawfal R Hussein, Hong-Han Huynh, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Pulwasha Maria Iftikhar, Adalia I Ikiroma, Paul Chukwudi Ikwegbue, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Mustafa Alhaji Isa, Md. Rabiul Islam, Sheikh Mohammed Shariful Islam, Faisal Ismail, Nahlah Elkudssiah Ismail, Gaetano Isola, Masao Iwagami, Ihoghosa Osamuyi Iyamu, Louis Jacob, Kathryn H Jacobsen, Morteza Jafarinia, Kasra Jahankhani, Nader Jahanmehr, Nityanand Jain, Ammar Abdulrahman Jairoun, Dr Ruchi Jakhmola Mani, Safayet Jamil, Roland Dominic G Jamora, Abubakar Ibrahim Jatau, Sabzali Javadov, Tahereh Javaheri, Shubha Jayaram, Sun Ha Jee, Jayakumar Jeganathan, Heng Jiang, Mohammad Jokar, Jost B Jonas, Nitin Joseph, Charity Ehimwenma Joshua, Mikk Jürisson, Vaishali K, Ali Kabir, Zubair Kabir, Vidya Kadashetti, Laleh R Kalankesh, Sanjay Kalra, Ashwin Kamath, Rajesh Kamath, Arun Kamireddy, Mona Kanaan, Tanuj Kanchan, Edmund Wedam Kanmiki, Kehinde Kazeem Kanmodi, Sushil Kumar Kansal, Asima Karim, Samad Karkhah, Faizan Zaffar Kashoo, Hengameh Kasraei, Molly B Kassel, Srinivasa Vittal Katikireddi, Joonas H Kauppila, Harkiran Kaur, Gbenga A Kayode, Foad Kazemi, Sina Kazemian, Fassikaw Kebede, Evie Shoshannah Kendal, Emmanuelle Kesse-Guyot, Shahram Khademvatan, Himanshu Khajuria, Amirmohammad Khalaji, Asaad Khalid, Nauman Khalid, Alireza Khalilian, Faham Khamesipour, Fayaz Khan, Mohammad Jobair Khan, Moien AB Khan, Shaghayegh Khanmohammadi, Khaled Khatab, Haitham Khatatbeh, Moawiah Mohammad Khatatbeh, Mahalaqua Nazli Khatib, Hamid Reza Khayat Kashani, Khalid A Kheirallah, Manoj Khokhar, Moein Khormali, Zahra Khorrami, Atulya Aman Khosla, Majid Khosravi, Mahmood Khosrowjerdi, Jagdish Khubchandani, Zemene Demelash Kifle, Grace Kim, Julie Sojin Kim, Min Seo Kim, Yun Jin Kim, Ruth W Kimokoti, Adnan Kisa, Sezer Kisa, Luke D Knibbs, Ann Kristin Skrindo Knudsen, Sonali Kochhar, Ali-Asghar Kolahi, Farzad Kompani, Gerbrand Koren, Oleksii Korzh, Kewal Krishan, Varun Krishna, Vijay Krishnamoorthy, Burcu Kucuk Bicer, Md Abdul Kuddus, Mohammed Kuddus, Ilari Kuitunen, Omar Kujan, Mukhtar Kulimbet, Vishnutheertha Kulkarni, G Anil Kumar, Harish Kumar, Nithin Kumar, Rakesh Kumar, Vijay Kumar, Amartya Kundu, Dian Kusuma, Frank Kyei-Arthur, Ville Kytö, Hmwe Hmwe Kyu, Carlo La Vecchia, Ben Lacey, Muhammad Awwal Ladan, Lucie Laflamme, Chandrakant Lahariya, Daphne Teck Ching Lai, Ratilal Lalloo, Tea Lallukka, Judit Lám, Qing Lan, Tuo Lan, Iván Landires, Francesco Lanfranchi, Berthold Langguth, Van Charles Lansingh, Ariane Laplante-Lévesque, Bagher Larijani, Anders O Larsson, Savita Lasrado, Paolo Lauriola, Hilary R Lawlor, Huu-Hoai Le, Long Khanh Dao Le, Nhi Huu Hanh Le, Thao Thi Thu Le, Trang Diep Thanh Le, Janet L Leasher, Doo Woong Lee, Munjae Lee, Paul H Lee, Sang-woong Lee, Seung Won Lee, Shaun Wen Huey Lee, Yo Han Lee, James Leigh, Elvynna Leong, Ming-Chieh Li, Massimo Libra, Virendra S Ligade, Lee-Ling Lim, Stephen S Lim, Liknaw Workie Limenh, Daniel Lindholm, Paulina A Lindstedt, Stefan Listl, Gang Liu, Shiwei Liu, Shuke Liu, Xiaofeng Liu, Xuefeng Liu, Erand Llanaj, Rubén López-Bueno, José Francisco López-Gil, Arianna Maever Loreche, Paulo A Lotufo, Rafael Lozano, Jailos Lubinda, Giancarlo Lucchetti, Lisha Luo, Jay B Lusk, Lei Lv, Hawraz Ibrahim M Amin, Zheng Feei Ma, Kelsey Lynn Maass, Nikolaos Machairas, Monika Machoy, Áurea M Madureira-Carvalho, Hassan Magdy Abd El Razek, Azzam A Maghazachi, D. R. Mahadeshwara Prasad, Mehrdad Mahalleh, Phetole Walter Mahasha, Mansour Adam Mahmoud, Elham Mahmoudi, Golnaz Mahmoudvand, Maureen Makama, Elaheh Malakan Rad, Kashish Malhotra, Ahmad Azam Malik, Deborah Carvalho Malta, Yosef Manla, Ali Mansour, Mohammad Hadi Mansouri, Pejman Mansouri, Vahid Mansouri, Marjan Mansourian, Mohammad Ali Mansournia, Bishnu P Marasini, Hamid Reza Marateb, Joemer C Maravilla, Parham Mardi, Abdoljalal Marjani, Hamed Markazi Moghadam, Carlos Alberto Marrugo Arnedo, Gabriel Martinez, Ramon Martinez-Piedra, Francisco Rogerlândio Martins-Melo, Miquel Martorell, Wolfgang Marx, Roy Rillera Marzo, Sahar Masoudi, Yasith Mathangasinghe, Alexander G Mathioudakis, Medha Mathur, Navgeet Mathur, Neeta Mathur, Fernanda Penido Matozinhos, Jishanth Mattumpuram, Richard James Maude, Andrea Maugeri, Mahsa Mayeli, Mohsen Mazidi, Antonio Mazzotti, John J McGrath, Martin McKee, Anna Laura W McKowen, Michael A McPhail, Steven M McPhail, Asim Mehmood, Kamran Mehrabani-Zeinabad, Sepideh Mehravar, Tesfahun Mekene Meto, Endalkachew Belayneh Melese, Max Alberto Mendez Mendez-Lopez, Walter Mendoza, Ritesh G Menezes, George A Mensah, Laverne G Mensah, Alexios-Fotios A Mentis, Sultan Ayoub Meo, Atte Meretoja, Tuomo J Meretoja, Abera M Mersha, Tomislav Mestrovic, Kukulege Chamila Dinushi Mettananda, Sachith Mettananda, Adquate Mhlanga, Laurette Mhlanga, Tomasz Miazgowski, Irmina Maria Michalek, Ana Carolina Micheletti Gomide Nogueira de Sá, Ted R Miller, Le Huu Nhat Minh, Alireza Mirahmadi, Antonio Mirijello, Erkin M Mirrakhimov, Roya Mirzaei, Philip B Mitchell, Chaitanya Mittal, Madeline E Moberg, Atousa Moghadam Fard, Seyedehfatemeh Mohajelin, Ashraf Mohamadkhani, Ahmed Ismail Mohamed, Jama Mohamed, Mouhand F H Mohamed, Nouh Saad Mohamed, Ameen Mosa Mohammad, Soheil Mohammadi, Hussen Mohammed, Mustapha Mohammed, Shafiu Mohammed, Ali H Mokdad, Mariam Molokhia, Shaher Mohammad Momani, Sara Momtazmanesh, Lorenzo Monasta, Stefania Mondello, Mohammad Ali Moni, Fateme Montazeri, AmirAli Moodi Ghalibaf, Maryam Moradi, Yousef Moradi, Paula Moraga, Lidia Morawska, Rafael Silveira Moreira, Negar Morovatdar, Shane Douglas Morrison, Abbas Mosapour, Jonathan F Mosser, Elias Mossialos, Rohith Motappa, Vincent Mougin, Parsa Mousavi, Matías Mrejen, Sumaira Mubarik, Ulrich Otto Mueller, Francesk Mulita, Kavita Munjal, Efrén Murillo-Zamora, Khaled M Musallam, Ana-Maria Musina, Ghulam Mustafa, Woojae Myung, Ayoub Nafei, Ahamarshan Jayaraman Nagarajan, Pirouz Naghavi, Ganesh R Naik, Gurudatta Naik, Firzan Nainu, Soroush Najdaghi, Noureddin Nakhostin Ansari, Vinay Nangia, Sreenivas Narasimha Swamy, Shumaila Nargus, Delaram Narimani Davani, Bruno Ramos Nascimento, Gustavo G Nascimento, Abdallah Y Naser, Abdulqadir J Nashwan, Zuhair S Natto, Javaid Nauman, Samidi N K Navaratna, Muhammad Naveed, Nawsherwan , Biswa Prakash Nayak, Vinod C Nayak, Hadush Negash, Ionut Negoi, Ruxandra Irina Negoi, Seyed Aria Nejadghaderi, Chakib Nejjari, Soroush Nematollahi, Henok Biresaw Netsere, Marie Ng, Georges Nguefack-Tsague, Josephine W Ngunjiri, Anh Hoang Nguyen, Dang H Nguyen, Duc Hoang Nguyen, Hau Thi Hien Nguyen, Nhan Nguyen, Nhien Ngoc Y Nguyen, Phat Tuan Nguyen, QuynhAnh P Nguyen, Van Thanh Nguyen, Duc Nguyen Tran Minh, Robina Khan Niazi, Yeshambel T Nigatu, Mahdieh Niknam, Ali Nikoobar, Amin Reza Nikpoor, Nasrin Nikravangolsefid, Efaq Ali Noman, Shuhei Nomura, Syed Toukir Ahmed Noor, Nafise Noroozi, Mehran Nouri, Majid Nozari, Chisom Adaobi Nri-Ezedi, George Ntaios, Mengistu H Nunemo, Dieta Nurrika, Jerry John Nutor, Chimezie Igwegbe Nzoputam, Ogochukwu Janet Nzoputam, Bogdan Oancea, Kehinde O Obamiro, Ismail A Odetokun, Michael Safo Oduro, Oluwaseun Adeolu Ogundijo, Adesola Adenike Ogunfowokan, Abiola Ogunkoya, Ayodipupo Sikiru Oguntade, In-Hwan Oh, Tolulope R Ojo-Akosile, Hassan Okati-Aliabad, Akinkunmi Paul Okekunle, Osaretin Christabel Okonji, Andrew T Olagunju, Matthew Idowu Olatubi, Gláucia Maria Moraes Oliveira, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Yinka Doris Oluwafemi, Hany A Omar, Goran Latif Omer, Sokking Ong, Sandersan Onie, Obinna E Onwujekwe, Abdulahi Opejin Opejin, Michal Ordak, Verner N Orish, Alberto Ortiz, Esteban Ortiz-Prado, Wael M S Osman, Sergej M Ostojic, Samuel M Ostroff, Uchechukwu Levi Osuagwu, Adrian Otoiu, Stanislav S Otstavnov, Amel Ouyahia, Mayowa O Owolabi, Oyetunde T Oyeyemi, Ahmad Ozair, Mahesh Padukudru P A, Alicia Padron-Monedero, Jagadish Rao Padubidri, Pramod Kumar Pal, Tamás Palicz, Feng Pan, Hai-Feng Pan, Songhomitra Panda-Jonas, Anamika Pandey, Victoria Pando-Robles, Helena Ullyartha Pangaribuan, Georgios D Panos, Leonidas D Panos, Ioannis Pantazopoulos, Anca Mihaela Pantea Stoian, Romil R Parikh, Eun-Kee Park, Seoyeon Park, Sungchul Park, Nicholas Parsons, Ashwaghosha Parthasarathi, Maja Pasovic, Roberto Passera, Jay Patel, Aslam Ramjan Pathan, Shankargouda Patil, Dimitrios Patoulias, Shrikant Pawar, Hamidreza Pazoki Toroudi, Spencer A Pease, Amy E Peden, Paolo Pedersini, Umberto Pensato, Veincent Christian Filipino Pepito, Prince Peprah, Marcos Pereira, Maria Odete Pereira, Arokiasamy Perianayagam, Norberto Perico, Simone Perna, Konrad Pesudovs, Fanny Emily Petermann-Rocha, Hoang Tran Pham, Anil K Philip, Michael R Phillips, Manon Pigeolet, Michael A Piradov, Enrico Pisoni, Evgenii Plotnikov, Dimitri Poddighe, Roman V Polibin, Ramesh Poluru, Ville T Ponkilainen, Djordje S Popovic, Maarten J Postma, Ahmad Pour-Rashidi, Disha Prabhu, Sergio I Prada, Jalandhar Pradhan, Pranil Man Singh Pradhan, Akila Prashant, Elton Junio Sady Prates, Tina Priscilla, Hery Purnobasuki, Bharathi M Purohit, Jagadeesh Puvvula, Nameer Hashim Qasim, Ibrahim Qattea, Asma Saleem Qazi, Gangzhen Qian, Mehrdad Rabiee Rad, Venkatraman Radhakrishnan, Hadi Raeisi Shahraki, Quinn Rafferty, Alberto Raggi, Cat Raggi, Nasiru Raheem, Fakher Rahim, Md Jillur Rahim, Sarvenaz Rahimibarghani, Md Mijanur Mijanur Rahman Rahman, Mosiur Rahman, Muhammad Aziz Rahman, Tafhimur Rahman, Amir Masoud Rahmani, Mohammad Rahmanian, Nazanin Rahmanian, Rahem Rahmati, Setyaningrum Rahmawaty, Diego Raimondo, Adarsh Raja, Prashant Rajput, Majed Ramadan, Shakthi Kumaran Ramasamy, Sheena Ramazanu, Pramod W Ramteke, Kritika Rana, Rishabh Kumar Rana, Chhabi Lal Ranabhat, Amey Rane, Chythra R Rao, Mithun Rao, Davide Rasella, Vahid Rashedi, Ahmed Mustafa Rashid, Ashkan Rasouli-Saravani, Prateek Rastogi, Azad Rasul, Devarajan Rathish, Giridhara Rathnaiah Babu, Santosh Kumar Rauniyar, Ramin Ravangard, David Laith Rawaf, Salman Rawaf, Rabail Zehra Raza, Elrashdy Moustafa Mohamed Redwan, Lennart Reifels, Marissa B Reitsma, Giuseppe Remuzzi, Kannan RR Rengasamy, Bhageerathy Reshmi, Serge Resnikoff, Stefano Restaino, Luis Felipe Reyes, Nazila Rezaei, Negar Rezaei, Zahra Sadat Rezaei, Mohsen Rezaeian, Taeho Gregory Rhee, Jennifer Rickard, Toshana Robalik, Hannah Elizabeth Robinson-Oden, Hermano Alexandre Lima Rocha, Mónica Rodrigues, Jefferson Antonio Buendia Rodriguez, Leonardo Roever, Debby Syahru Romadlon, Luca Ronfani, Moustaq Karim Khan Rony, Gholamreza Roshandel, Kunle Rotimi, Himanshu Sekhar Rout, Bedanta Roy, Enrico Rubagotti, Guilherme de Andrade Ruela, Susan Fred Rumisha, Tilleye Runghien, Michele Russo, Aly M A Saad, Korosh Saber, Maha Mohamed Saber-Ayad, Cameron John Sabet, Siamak Sabour, Perminder S Sachdev, Adam Saddler, Bashdar Abuzed Sadee, Masoumeh Sadeghi, Mohammad Reza Saeb, Umar Saeed, Sher Zaman Safi, Rajesh Sagar, Alireza Saghafi, Dominic Sagoe, Amirhossein Sahebkar, Pragyan Monalisa Sahoo, Mirza Rizwan Sajid, Nasir Salam, Payman Salamati, Afeez Abolarinwa Salami, Mohamed A Saleh, Leili Salehi, Marwa Rashad Salem, Aanuoluwa James Salemcity, Sohrab Salimi, Hossein Samadi Kafil, Saad Samargandy, Yoseph Leonardo Samodra, Abdallah M Samy, Juan Sanabria, Francesca Sanna, Milena M Santric-Milicevic, Bruno Piassi Sao Jose, Sivan Yegnanarayana Iyer Saraswathy, Aswini Saravanan, Rodrigo Sarmiento-Suárez, Gargi Sachin Sarode, Sachin C Sarode, Benn Sartorius, Maheswar Satpathy, Abu Sayeed, Nikolaos Scarmeas, Benedikt Michael Schaarschmidt, Christophe Schinckus, Art Schuermans, Austin E Schumacher, Aletta Elisabeth Schutte, David C Schwebel, Falk Schwendicke, Siddharthan Selvaraj, Mohammad H Semreen, Sabyasachi Senapati, Pallav Sengupta, Subramanian Senthilkumaran, Dragos Serban, Yashendra Sethi, All
Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021
No full textBackground: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens
Burden of disease scenarios for 204 countries and territories, 2022-2050: a forecasting analysis for the Global Burden of Disease Study 2021
No full textBurden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021
No full textBackgroundFuture trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. MethodsUsing forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. FindingsIn the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). InterpretationGlobally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions. FundingBill & Melinda Gates Foundation
Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021
No full textBackgroundFuture trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050.MethodsUsing forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline.FindingsIn the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]).InterpretationGlobally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions.FundingBill & Melinda Gates Foundation.</p
Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021
No full textBurden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 202
