24 research outputs found
Undernutrition and associated factors among adults with mental and neurological disorders in public health hospitals, Eastern Ethiopia, 2019: a cross-sectional study
No full textAbstract Background Poor nutritional status can be consequence of impaired mental health that may lead to involuntary weight gain, weight loss, or deficiency of essential nutrients. However, little has been documented about the nutritional status of adults with mental disorders and the contributing factors in low-income countries like Ethiopia. The aim of this study was to assess the magnitude of undernutrition and associated factors among adults with mental disorders in public hospitals of Eastern Ethiopia. Methods Institution-based, cross-sectional study was conducted among 507 adults with mental disorders from March 1, 2019 to April 1, 2019. Interviewer administered pretested structured questionnaire was used to collect data. Anthropometric data were collected using calibrated weighing scale and height measuring board. Descriptive statistics was computed to describe the data. Bivariable and multivariable logistic regression analyses were applied to identify factors associated with the undernutrition. Odds ratio alongside 95% confidence interval (CI) were estimated to measure the strength of the association. Level of statistical significance was declared at p-value less than 0.05. Results Undernutrition affected 62.7%; 95% CI: (58.3%, 67.7%) of the patients. Undernutrition was associated with meal frequency < 3 per day (adjusted odds ratio [(AOR = 2.07, 95% CI: (1.18, 3.63)], use of multiple medication (adjusted odds ratio [(AOR = 3.02, 95% CI: (1.88, 4.84)], being non-smoker [(AOR = 0.50, 95%CI: (0.25, 0.91)], and use of prescribed diet [(AOR = 0.45, 95%CI: (0.26, 0.78)]. Conclusions The magnitude of undernutrition was high among the study participants. Multiple medication, cigarette smoking, frequency of meal and taking prescribed diet were significantly associated with undernutrition. Nutrition education for patients with mental disorders and their caregivers about the impact of taking multiple medication and substance use needs to be emphasized alongside nutritional screening and support to improve their nutritional status
Explaining consequences of employment insecurity: The dynamics of scarring in the United Kingdom, Poland and Norway
No full textThis deliverable presents three country studies on scarring effects of early employment insecurity in the United Kingdom, Poland and Norway. Traditional analysis of scarring effects has favoured the analysis of the impact of the experience of unemployment on the experience of subsequent unemployment (state dependence) and the monetary costs of previous unemployment in terms of lower subsequent wages (see e.g. Arulampalam, Booth and Taylor 2000; Arulampalam, Gregg and Gregory 2001). The three present country studies go beyond the traditional analysis of scarring effects in order to better understand the trade-offs experienced by young female and male workers when faced with an insecure labour market integration. With national longitudinal data, original methodological designs and research focus, each study contributes in an original way to the research literature. All three studies pay special attention to gender and education as potential moderating variables of scarring effects
The impact of PTSD on risk of cardiometabolic diseases: a national patient cohort study in Norway
No full textBackground: Posttraumatic stress disorder (PTSD) is associated with cardiometabolic diseases, concurrent anxiety, alcohol use disorder and depression. The relationship between PTSD and cardiometabolic diseases are still unclear, and less is known about the effects of socioeconomic status, comorbid anxiety, comorbid alcohol use disorder and comorbid depression. The study, therefore, aims to examine the risk of developing cardiometabolic diseases including type 2 diabetes mellitus over time in PTSD patients, and to what extent socioeconomic status, comorbid anxiety, comorbid alcohol use disorder and comorbid depression attenuate associations between PTSD and risk of developing cardiometabolic diseases. Method: A retrospective, register-based cohort study with 6-years follow-up of adult (> 18 years) PTSD patients (N = 7 852) compared with the general population (N = 4 041 366), was performed. Data were acquired from the Norwegian Patient Registry and Statistic Norway. Cox proportional regression models were applied to estimate hazard ratios (HRs) (99% confidence intervals) of cardiometabolic diseases among PTSD patients. Results: Significantly (p < 0.001) higher age and gender adjusted HRs were disclosed for all cardiometabolic diseases among PTSD patients compared to the population without PTSD, with a variation in HR from 3.5 (99% CI 3.1-3.9) for hypertensive diseases to HR = 6.5 (5.7-7.5) for obesity. When adjusted for socioeconomic status and comorbid mental disorders, reductions were observed, especially for comorbid depression, for which the adjustment resulted in HR reduction of about 48.6% for hypertensive diseases and 67.7% for obesity. Conclusions: PTSD was associated with increased risk of developing cardiometabolic diseases, though attenuated by socioeconomic status and comorbid mental disorders. Health care professionals should be attentive towards the burden and increased risk that low socioeconomic status and comorbid mental disorders may represent for PTSD patients' cardiometabolic health. Keywords: Alcohol use disorder; Cardiovascular diseases; Cohort study; Comorbidity; Depression; Diabetes mellitus; Epidemiology; Metabolic diseases; Posttraumatic stress disorder; Register data. © 2023. The Author(s).publishedVersio
Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
No full textBackground: accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: to estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. Findings: during the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Interpretation: fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. Funding: Bill & Melinda Gates Foundation.</p
Global Fertility in 204 Countries and Territories, 1950–2021, with Forecasts to 2100: A Comprehensive Demographic Analysis for the Global Burden of Disease Study 2021
No full textBackground
Accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios.
Methods
To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline.
Findings
During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world\u27s livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Interpretation: Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world.
Funding
Bill & Melinda Gates Foundation
Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
No full textBackground: Accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios. Methods: To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline. Findings: During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction. Interpretation: Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world. Funding: Bill & Melinda Gates Foundation
Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
No full textBackground: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation
Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
No full textBackground: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.
Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.
Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.
Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere.publishedVersio
Global fertility in 204 countries and territories, 1950-2021, with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
No full textBackground
Accurate assessments of current and future fertility—including overall trends and changing population age structures across countries and regions—are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to inform policies involving resource and health-care needs, labour supply, education, gender equality, and family planning and support. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 produced up-to-date and comprehensive demographic assessments of key fertility indicators at global, regional, and national levels from 1950 to 2021 and forecast fertility metrics to 2100 based on a reference scenario and key policy-dependent alternative scenarios.
Methods
To estimate fertility indicators from 1950 to 2021, mixed-effects regression models and spatiotemporal Gaussian process regression were used to synthesise data from 8709 country-years of vital and sample registrations, 1455 surveys and censuses, and 150 other sources, and to generate age-specific fertility rates (ASFRs) for 5-year age groups from age 10 years to 54 years. ASFRs were summed across age groups to produce estimates of total fertility rate (TFR). Livebirths were calculated by multiplying ASFR and age-specific female population, then summing across ages 10–54 years. To forecast future fertility up to 2100, our Institute for Health Metrics and Evaluation (IHME) forecasting model was based on projections of completed cohort fertility at age 50 years (CCF50; the average number of children born over time to females from a specified birth cohort), which yields more stable and accurate measures of fertility than directly modelling TFR. CCF50 was modelled using an ensemble approach in which three sub-models (with two, three, and four covariates variously consisting of female educational attainment, contraceptive met need, population density in habitable areas, and under-5 mortality) were given equal weights, and analyses were conducted utilising the MR-BRT (meta-regression—Bayesian, regularised, trimmed) tool. To capture time-series trends in CCF50 not explained by these covariates, we used a first-order autoregressive model on the residual term. CCF50 as a proportion of each 5-year ASFR was predicted using a linear mixed-effects model with fixed-effects covariates (female educational attainment and contraceptive met need) and random intercepts for geographical regions. Projected TFRs were then computed for each calendar year as the sum of single-year ASFRs across age groups. The reference forecast is our estimate of the most likely fertility future given the model, past fertility, forecasts of covariates, and historical relationships between covariates and fertility. We additionally produced forecasts for multiple alternative scenarios in each location: the UN Sustainable Development Goal (SDG) for education is achieved by 2030; the contraceptive met need SDG is achieved by 2030; pro-natal policies are enacted to create supportive environments for those who give birth; and the previous three scenarios combined. Uncertainty from past data inputs and model estimation was propagated throughout analyses by taking 1000 draws for past and present fertility estimates and 500 draws for future forecasts from the estimated distribution for each metric, with 95% uncertainty intervals (UIs) given as the 2·5 and 97·5 percentiles of the draws. To evaluate the forecasting performance of our model and others, we computed skill values—a metric assessing gain in forecasting accuracy—by comparing predicted versus observed ASFRs from the past 15 years (2007–21). A positive skill metric indicates that the model being evaluated performs better than the baseline model (here, a simplified model holding 2007 values constant in the future), and a negative metric indicates that the evaluated model performs worse than baseline.
Findings
During the period from 1950 to 2021, global TFR more than halved, from 4·84 (95% UI 4·63–5·06) to 2·23 (2·09–2·38). Global annual livebirths peaked in 2016 at 142 million (95% UI 137–147), declining to 129 million (121–138) in 2021. Fertility rates declined in all countries and territories since 1950, with TFR remaining above 2·1—canonically considered replacement-level fertility—in 94 (46·1%) countries and territories in 2021. This included 44 of 46 countries in sub-Saharan Africa, which was the super-region with the largest share of livebirths in 2021 (29·2% [28·7–29·6]). 47 countries and territories in which lowest estimated fertility between 1950 and 2021 was below replacement experienced one or more subsequent years with higher fertility; only three of these locations rebounded above replacement levels. Future fertility rates were projected to continue to decline worldwide, reaching a global TFR of 1·83 (1·59–2·08) in 2050 and 1·59 (1·25–1·96) in 2100 under the reference scenario. The number of countries and territories with fertility rates remaining above replacement was forecast to be 49 (24·0%) in 2050 and only six (2·9%) in 2100, with three of these six countries included in the 2021 World Bank-defined low-income group, all located in the GBD super-region of sub-Saharan Africa. The proportion of livebirths occurring in sub-Saharan Africa was forecast to increase to more than half of the world's livebirths in 2100, to 41·3% (39·6–43·1) in 2050 and 54·3% (47·1–59·5) in 2100. The share of livebirths was projected to decline between 2021 and 2100 in most of the six other super-regions—decreasing, for example, in south Asia from 24·8% (23·7–25·8) in 2021 to 16·7% (14·3–19·1) in 2050 and 7·1% (4·4–10·1) in 2100—but was forecast to increase modestly in the north Africa and Middle East and high-income super-regions. Forecast estimates for the alternative combined scenario suggest that meeting SDG targets for education and contraceptive met need, as well as implementing pro-natal policies, would result in global TFRs of 1·65 (1·40–1·92) in 2050 and 1·62 (1·35–1·95) in 2100. The forecasting skill metric values for the IHME model were positive across all age groups, indicating that the model is better than the constant prediction.
Interpretation
Fertility is declining globally, with rates in more than half of all countries and territories in 2021 below replacement level. Trends since 2000 show considerable heterogeneity in the steepness of declines, and only a small number of countries experienced even a slight fertility rebound after their lowest observed rate, with none reaching replacement level. Additionally, the distribution of livebirths across the globe is shifting, with a greater proportion occurring in the lowest-income countries. Future fertility rates will continue to decline worldwide and will remain low even under successful implementation of pro-natal policies. These changes will have far-reaching economic and societal consequences due to ageing populations and declining workforces in higher-income countries, combined with an increasing share of livebirths among the already poorest regions of the world.publishedVersio
Global fertility in 204 countries and territories, 1950–2021, with forecasts to 2100 : a comprehensive demographic analysis for the Global Burden of Disease Study 2021
No full textNatalia V Bhattacharjee, Austin E Schumacher, Amirali Aali, Yohannes Habtegiorgis Abate, Rouzbeh Abbasgholizadeh, Mohammadreza Abbasian, Mohsen Abbasi-Kangevari, Hedayat Abbastabar, Samar Abd ElHafeez, Sherief Abd-Elsalam, Mohammad Abdollahi, Mohammad-Amin Abdollahifar, Meriem Abdoun, Auwal Abdullahi, Mesfin Abebe, Samrawit Shawel Abebe, Olumide Abiodun, Hassan Abolhassani, Meysam Abolmaali, Mohamed Abouzid, Girma Beressa Aboye, Lucas Guimarães Abreu, Woldu Aberhe Abrha, Michael R M Abrigo, Dariush Abtahi, Hasan Abualruz, Bilyaminu Abubakar, Eman Abu-Gharbieh, Niveen ME Abu-Rmeileh, Tadele Girum Girum Adal, Mesafint Molla Adane, Oluwafemi Atanda Adeagbo Adeagbo, Rufus Adesoji Adedoyin, Victor Adekanmbi, Bashir Aden, Abiola Victor Adepoju, Olatunji O Adetokunboh, Juliana Bunmi Adetunji, Daniel Adedayo Adeyinka, Olorunsola Israel Adeyomoye, Qorinah Estiningtyas Sakilah Adnani, Saryia Adra, Rotimi Felix Afolabi, Shadi Afyouni, Muhammad Sohail Afzal, Saira Afzal, Shahin Aghamiri, Antonella Agodi, Williams Agyemang-Duah, Bright Opoku Ahinkorah, Austin J Ahlstrom, Aqeel Ahmad, Danish Ahmad, Firdos Ahmad, Muayyad M Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmed, Ayman Ahmed, Haroon Ahmed, Luai A Ahmed, Meqdad Saleh Ahmed, Syed Anees Ahmed, Marjan Ajami, Budi Aji, Gizachew Taddesse Akalu, Hossein Akbarialiabad, Rufus Olusola Akinyemi, Mohammed Ahmed Akkaif, Sreelatha Akkala, Hanadi Al Hamad, Syed Mahfuz Al Hasan, Mohammad Al Qadire, Tareq Mohammed Ali AL-Ahdal, Samer O Alalalmeh, Tariq A Alalwan, Ziyad Al-Aly, Khurshid Alam, Rasmieh Mustafa Al-amer, Fahad Mashhour Alanezi, Turki M Alanzi, Almaza Albakri, Mohammed Albashtawy, Mohammad T AlBataineh, Hediyeh Alemi, Sharifullah Alemi, Yihun Mulugeta Alemu, Ayman Al-Eyadhy, Adel Ali Saeed Al-Gheethi, Khalid F Alhabib, Noora Alhajri, Fadwa Alhalaiqa Naji Alhalaiqa, Robert Kaba Alhassan, Abid Ali, Beriwan Abdulqadir Ali, Liaqat Ali, Mohammed Usman Ali, Rafat Ali, Syed Shujait Shujait Ali, Sheikh Mohammad Alif, Mohammad Aligol, Mehran Alijanzadeh, Mohammad A M Aljasir, Syed Mohamed Aljunid, Sabah Al-Marwani, Joseph Uy Almazan, Hesham M Al-Mekhlafi, Omar Almidani, Mahmoud A Alomari, Basem Al-Omari, Jaber S Alqahtani, Ahmed Yaseen Alqutaibi, Rajaa M Al-Raddadi, Salman Khalifah Al-Sabah, Awais Altaf, Jaffar A Al-Tawfiq, Khalid A Altirkawi, Deborah Oyine Aluh, Farrukh Jawad Alvi, Nelson Alvis-Guzman, Hassan Alwafi, Yaser Mohammed Al-Worafi, Hany Aly, Safwat Aly, Karem H Alzoubi, Edward Kwabena Ameyaw, Tarek Tawfik Amin, Alireza Amindarolzarbi, Mostafa Amini-Rarani, Sohrab Amiri, Irene Gyamfuah Ampomah, Dickson A Amugsi, Ganiyu Adeniyi Amusa, Robert Ancuceanu, Deanna Anderlini, Pedro Prata Andrade, Catalina Liliana Andrei, Tudorel Andrei, Abhishek Anil, Sneha Anil, Adnan Ansar, Alireza Ansari-Moghaddam, Catherine M Antony, Ernoiz Antriyandarti, Saeid Anvari, SALEHA ANWAR, Razique Anwer, Anayochukwu Edward Anyasodor, Jalal Arabloo, Razman Arabzadeh Bahri, Elshaimaa A Arafa, Mosab Arafat, Ana Margarida Araújo, Aleksandr Y Aravkin, Abdulfatai Aremu, Timur Aripov, Mesay Arkew, Benedetta Armocida, Johan Ärnlöv, Mahwish Arooj, Anton A Artamonov, Judie Arulappan, Raphael Taiwo Aruleba, Ashokan Arumugam, Mohsen Asadi-Lari, Zatollah Asemi, Saeed Asgary, Mona Asghariahmadabad, Mohammad Asghari-Jafarabadi, Mubarek Yesse Ashemo, Muhammad Ashraf, Tahira Ashraf, Marvellous O Asika, Seyyed Shamsadin Athari, Maha Moh'd Wahbi Atout, Alok Atreya, Avinash Aujayeb, Marcel Ausloos, Abolfazl Avan, Amlaku Mulat Aweke, Getnet Melaku Ayele, Seyed Mohammad Ayyoubzadeh, Sina Azadnajafabad, Rui M S Azevedo, Ahmed Y Azzam, Muhammad Badar, Ashish D Badiye, Soroush Baghdadi, Nasser Bagheri, Sara Bagherieh, Najmeh Bahmanziari, Ruhai Bai, Atif Amin Baig, Jennifer L Baker, Abdulaziz T Bako, Ravleen Kaur Bakshi, Madhan Balasubramanian, Ovidiu Constantin Baltatu, Kiran Bam, Maciej Banach, Soham Bandyopadhyay, Biswajit Banik, Palash Chandra Banik, Hansi Bansal, Mehmet Firat Baran, Martina Barchitta, Mainak Bardhan, Erfan Bardideh, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Francesco Barone-Adesi, Hiba Jawdat Barqawi, Amadou Barrow, Sandra Barteit, Zarrin Basharat, Asma'u I J Bashir, Hameed Akande Bashiru, Afisu Basiru, João Diogo Basso, Sanjay Basu, Abdul-Monim Mohammad Batiha, Kavita Batra, Bernhard T Baune, Mohsen Bayati, Tahmina Begum, Emad Behboudi, Amir Hossein Behnoush, Maryam Beiranvand, Diana Fernanda Bejarano Ramirez, Alehegn Bekele, Sefealem Assefa Belay, Uzma Iqbal Belgaumi, Michelle L Bell, Olorunjuwon Omolaja Bello, Apostolos Beloukas, Isabela M Bensenor, Zombor Berezvai, Alemshet Yirga Berhie, Amiel Nazer C Bermudez, Paulo J G Bettencourt, Akshaya Srikanth Bhagavathula, Nikha Bhardwaj, Pankaj Bhardwaj, Prarthna V Bhardwaj, Sonu Bhaskar, Vivek Bhat, Gurjit Kaur Bhatti, Jasvinder Singh Bhatti, Manpreet S Bhatti, Rajbir Bhatti, Antonio Biondi, Catherine Bisignano, Atanu Biswas, Raaj Kishore Biswas, Veera R Bitra, Tone Bjørge, Elye Bliss, Micheal Kofi Boachie, Anca Vasilica Bobirca, Virginia Bodolica, Aadam Olalekan Bodunrin, Eyob Ketema Bogale, Kassawmar Angaw Bogale, Milad Bonakdar Hashemi, Berrak Bora Basara, Souad Bouaoud, Dejana Braithwaite, Michael Brauer, Nicholas J K Breitborde, Dana Bryazka, Norma B Bulamu, Danilo Buonsenso, Katrin Burkart, Richard A Burns, Yasser Bustanji, Nadeem Shafique Butt, Zahid A Butt, Florentino Luciano Caetano dos Santos, Daniela Calina, Ismael R Campos-Nonato, Fan Cao, Shujin Cao, Angelo Capodici, Giulia Carreras, Andrea Carugno, Carlos A Castañeda-Orjuela, Giulio Castelpietra, Maria Sofia Cattaruzza, Arthur Caye, Luca Cegolon, Francieli Cembranel, Ester Cerin, Joshua Chadwick, Yaacoub Chahine, Chiranjib Chakraborty, Julian Chalek, Jeffrey Shi Kai Chan, Periklis Charalampous, Vijay Kumar Chattu, Sarika Chaturvedi, Malizgani Paul Chavula, An-Tian Chen, Haowei Chen, Simiao Chen, Gerald Chi, Fatemeh Chichagi, Ju-Huei Chien, Patrick R Ching, William C S Cho, Sungchul Choi, Bryan Chong, Hitesh Chopra, Sonali Gajanan Choudhari, Devasahayam J Christopher, Dinh-Toi Chu, Isaac Sunday Chukwu, Eric Chung, Sheng-Chia Chung, Zinhle Cindi, Iolanda Cioffi, Raffaela Ciuffreda, Rafael M Claro, Kaleb Coberly, Alyssa Columbus, Haley Comfort, Joao Conde, Michael H Criqui, Natália Cruz-Martins, Silvia Magali Cuadra-Hernández, Sriharsha Dadana, Omid Dadras, Tukur Dahiru, Zhaoli Dai, Bronte Dalton, Giovanni Damiani, Aso Mohammad Darwesh, Jai K Das, Saswati Das, Mohsen Dashti, Anna Dastiridou, Claudio Alberto Dávila-Cervantes, Kairat Davletov, Aklilu Tamire Debele, Shayom Debopadhaya, Somayeh Delavari, Ivan Delgado-Enciso, Dessalegn Demeke, Berecha Hundessa Demessa, Xinlei Deng, Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Hardik Dineshbhai Desai, Rupak Desai, Vinoth Gnana Chellaiyan Devanbu, Arkadeep Dhali, Kuldeep Dhama, Meghnath Dhimal, Vishal R Dhulipala, Diana Dias da Silva, Daniel Diaz, Michael J Diaz, Adriana Dima, Delaney D Ding, M Ashworth Dirac, Thanh Chi Do, Thao Huynh Phuong Do, Camila Bruneli do Prado, Sushil Dohare, Wanyue Dong, Mario D'Oria, Wendel Mombaque dos Santos, Leila Doshmangir, Robert Kokou Dowou, Ashel Chelsea Dsouza, Haneil Larson Dsouza, Viola Dsouza, John Dube, Joe Duprey, Andre Rodrigues Duraes, Senbagam Duraisamy, Oyewole Christopher Durojaiye, Sulagna Dutta, Laura Dwyer-Lindgren, Paulina Agnieszka Dzianach, Arkadiusz Marian Dziedzic, Alireza Ebrahimi, Hisham Atan Edinur, Kristina Edvardsson, Ferry Efendi, Terje Andreas Eikemo, Michael Ekholuenetale, Maha El Tantawi, Noha Mousaad Elemam, Ghada Metwally Tawfik ElGohary, Muhammed Elhadi, Legesse Tesfaye Elilo, Omar Abdelsadek Abdou Elmeligy, Mohamed A Elmonem, Mohammed Elshaer, Ibrahim Elsohaby, Amir Emami Zeydi, Luchuo Engelbert Bain, Sharareh Eskandarieh, Francesco Esposito, Kara Estep, Farshid Etaee, Natalia Fabin, Adeniyi Francis Fagbamigbe, Saman Fahimi, Aliasghar Fakhri-Demeshghieh, Luca Falzone, Ali Faramarzi, MoezAlIslam Ezzat Mahmoud Faris, Sam Farmer, Andre Faro, Abidemi Omolara Fasanmi, Ali Fatehizadeh, Nelsensius Klau Fauk, Pooria Fazeli, Valery L Feigin, Seyed-Mohammad Fereshtehnejad, Abdullah Hamid Feroze, Pietro Ferrara, Nuno Ferreira, Getahun Fetensa, Irina Filip, Florian Fischer, Joanne Flavel, Nataliya A Foigt, Morenike Oluwatoyin Folayan, Artem Alekseevich Fomenkov, Behzad Foroutan, Matteo Foschi, Kayode Raphael Fowobaje, Kate Louise Francis, Alberto Freitas, Takeshi Fukumoto, John E Fuller, Blima Fux, Peter Andras Gaal, Muktar A Gadanya, Abhay Motiramji Gaidhane, Yaseen Galali, Silvano Gallus, Aravind P Gandhi, Balasankar Ganesan, Mohammad Arfat Ganiyani, M.A. Garcia-Gordillo, Naval Garg, Rupesh K Gautam, Federica Gazzelloni, Semiu Olatunde Gbadamosi, Miglas W Gebregergis, Mesfin Gebrehiwot, Tesfay Brhane Gebremariam, Tesfay B B Gebremariam, Teferi Gebru Gebremeskel, Yohannes Fikadu Geda, Simona Roxana Georgescu, Urge Gerema, Habtamu Geremew, Motuma Erena Getachew, Peter W Gething, MohammadReza Ghasemi, Ghazal Ghasempour Dabaghi, Afsaneh Ghasemzadeh, Fariba Ghassemi, Ramy Mohamed Ghazy, Sailaja Ghimire, Asadollah Gholamian, Ali Gholamrezanezhad, Mahsa Ghorbani, Aloke Gopal Ghoshal, Arun Digambarrao Ghuge, Artyom Urievich Gil, Tiffany K Gill, Matteo Giorgi, Alem Girmay, James C Glasbey, Laszlo Göbölös, Amit Goel, Ali Golchin, Mahaveer Golechha, Pouya Goleij, Sameer Vali Gopalani, Houman Goudarzi, Alessandra C Goulart, Anmol Goyal, Simon Matthew Graham, Michal Grivna, Shi-Yang Guan, Giovanni Guarducci, Mohammed Ibrahim Mohialdeen Gubari, Mesay Dechasa Gudeta, Stefano Guicciardi, Snigdha Gulati, David Gulisashvili, Damitha Asanga Gunawardane, Cui Guo, Anish Kumar Gupta, Bhawna Gupta, Manoj Kumar Gupta, Mohak Gupta, Sapna Gupta, Veer Bala Gupta, Vijai Kumar Gupta, Vivek Kumar Gupta, Annie Haakenstad, Farrokh Habibzadeh, Najah R Hadi, Nils Haep, Ramtin Hajibeygi, Sebastian Haller, Rabih Halwani, Randah R Hamadeh, Nadia M Hamdy, Sajid Hameed, Samer Hamidi, Qiuxia Han, Alexis J Handal, Graeme J Hankey, Md Nuruzzaman Haque, Josep Maria Haro, Ahmed I Hasaballah, Ikramul Hasan, Mohammad Jahid Hasan, S.M. Mahmudul Hasan, Hamidreza Hasani, Md Saquib Hasnain, Amr Hassan, Ikrama Hassan, Soheil Hassanipour, Hadi Hassankhani, Simon I Hay, Jeffrey J Hebert, Omar E Hegazi, Mohammad Heidari, Bartosz Helfer, Mehdi Hemmati, Brenda Yuliana Herrera-Serna, Claudiu Herteliu, Kamran Hessami, Kamal Hezam, Yuta Hiraike, Nguyen Quoc Hoan, Ramesh Holla, Nobuyuki Horita, Md Mahbub Hossain, Mohammad Bellal Hossain Hossain, Hassan Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mohamed Hsairi, Vivian Chia-rong Hsieh, Chengxi Hu, Junjie Huang, M Mamun Huda, Ayesha Humayun, Javid Hussain, Nawfal R Hussein, Hong-Han Huynh, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Pulwasha Maria Iftikhar, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Leeberk Raja Inbaraj, Afrin Iqbal, Md. Rabiul Islam, Nahlah Elkudssiah Ismail, Hiroyasu Iso, Gaetano Isola, Masao Iwagami, Mahalaxmi Iyer, Linda Merin J, Jalil Jaafari, Louis Jacob, Farhad Jadidi-Niaragh, Khushleen Jaggi, Kasra Jahankhani, Nader Jahanmehr, Haitham Jahrami, Akhil Jain, Nityanand Jain, Ammar Abdulrahman Jairoun, Mihajlo Jakovljevic, Elham Jamshidi, Sabzali Javadov, Tahereh Javaheri, Sathish Kumar Jayapal, Shubha Jayaram, Sun Ha Jee, Jayakumar Jeganathan, Anil K Jha, Ravi Prakash Jha, Heng Jiang, Mohammad Jokar, Jost B Jonas, Tamas Joo, Nitin Joseph, Charity Ehimwenma Joshua, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Vaishali K, Billingsley Kaambwa, Abdulkareem Kabir, Ali Kabir, Hannaneh Kabir, Zubair Kabir, Rizwan Kalani, Leila R Kalankesh, Feroze Kaliyadan, Sanjay Kalra, Rajesh Kamath, Sagarika Kamath, Tanuj Kanchan, Edmund Wedam Kanmiki, Kehinde Kazeem Kanmodi, Suthanthira Kannan S, Sushil Kumar Kansal, Rami S Kantar, Neeti Kapoor, Mehrdad Karajizadeh, Manoochehr Karami, Ibraheem M Karaye, Faizan Zaffar Kashoo, Hengameh Kasraei, Nicholas J Kassebaum, Molly B Kassel, Joonas H Kauppila, Foad Kazemi, sara Kazeminia, John H Kempen, Evie Shoshannah Kendal, Kamyab Keshtkar, Mohammad Keykhaei, Himanshu Khajuria, Amirmohammad Khalaji, Nauman Khalid, Anees Ahmed Khalil, Alireza Khalilian, Faham Khamesipour, Ajmal Khan, Asaduzzaman Khan, Ikramullah Khan, M Nuruzzaman Khan, Maseer Khan, Mohammad Jobair Khan, Moien AB Khan, Young-Ho Khang, Shaghayegh Khanmohammadi, Khaled Khatab, Armin Khavandegar, Hamid Reza Khayat Kashani, Feriha Fatima Khidri, Moein Khormali, Mohammad Ali Khosravi, Mahmood Khosrowjerdi, Wondwosen Teklesilasie Kidane, Zemene Demelash Kifle, Julie Sojin Kim, Min Seo Kim, Ruth W Kimokoti, Kasey E Kinzel, Girmay Tsegay Kiross, Adnan Kisa, Sezer Kisa, Ali-Asghar Kolahi, Farzad Kompani, Gerbrand Koren, Oleksii Korzh, Soewarta Kosen, Sindhura Lakshmi Koulmane Laxminarayana, Kewal Krishan, Varun Krishna, Vijay Krishnamoorthy, Barthelemy Kuate Defo, Connor M Kubeisy, Burcu Kucuk 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