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Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation.
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
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Jeffrey J;Hegazi, Omar E;Heidari, Golnaz;Heidari, Mohammad;Heidari-Foroozan, Mahsa;Helfer, Bartosz;Hendrie, Delia;Herrera-Serna, Brenda Yuliana;Herteliu, Claudiu;Hesami, Hamed;Hezam, Kamal;Hill, Catherine L;Hiraike, Yuta;Holla, Ramesh;Horita, Nobuyuki;Hossain, Md Mahbub;Hossain, Sahadat;Hosseini, Mohammad-Salar;Hosseinzadeh, Hassan;Hosseinzadeh, Mehdi;Hosseinzadeh Adli, Ahmad;Hostiuc, Mihaela;Hostiuc, Sorin;Hsairi, Mohamed;Hsieh, Vivian Chia-rong;Hsu, Rebecca L;Hu, Chengxi;Huang, Junjie;Hultström, Michael;Humayun, Ayesha;Hundie, Tsegaye Gebreyes;Hussain, Javid;Hussain, M Azhar;Hussein, Nawfal R;Hussien, Foziya Mohammed;Huynh, Hong-Han;Hwang, Bing-Fang;Ibitoye, Segun Emmanuel;Ibrahim, Khalid S;Iftikhar, Pulwasha Maria;Ijo, Desta;Ikiroma, Adalia I;Ikuta, Kevin S;Ikwegbue, Paul Chukwudi;Ilesanmi, Olayinka Stephen;Ilic, Irena M;Ilic, Milena D;Imam, Mohammad Tarique;Immurana, Mustapha;Inamdar, Sumant;Indriasih, Endang;Iqhrammullah, Muhammad;Iradukunda, Arnaud;Iregbu, Kenneth Chukwuemeka;Islam, Md Rabiul;Islam, Sheikh Mohammed Shariful;Islami, Farhad;Ismail, Faisal;Ismail, Nahlah Elkudssiah;Iso, Hiroyasu;Isola, Gaetano;Iwagami, Masao;Iwu, Chidozie C D;Iyamu, Ihoghosa Osamuyi;Iyer, Mahalaxmi;J, Linda Merin;Jaafari, Jalil;Jacob, Louis;Jacobsen, Kathryn H;Jadidi-Niaragh, Farhad;Jafarinia, Morteza;Jafarzadeh, Abdollah;Jaggi, Khushleen;Jahankhani, Kasra;Jahanmehr, Nader;Jahrami, Haitham;Jain, Nityanand;Jairoun, Ammar Abdulrahman;Jaiswal, Abhishek;Jamshidi, Elham;Janko, Mark M;Jatau, Abubakar Ibrahim;Javadov, Sabzali;Javaheri, Tahereh;Jayapal, Sathish Kumar;Jayaram, Shubha;Jebai, Rime;Jee, Sun Ha;Jeganathan, Jayakumar;Jha, Anil K;Jha, Ravi Prakash;Jiang, Heng;Jin, Yingzhao;Johnson, Olatunji;Jokar, Mohammad;Jonas, Jost B;Joo, Tamas;Joseph, Abel;Joseph, Nitin;Joshua, Charity Ehimwenma;Joshy, Grace;Jozwiak, Jacek Jerzy;Jürisson, Mikk;K, Vaishali;Kaambwa, Billingsley;Kabir, Ali;Kabir, Zubair;Kadashetti, Vidya;Kadir, Dler Hussein;Kalani, Rizwan;Kalankesh, Laleh R;Kalankesh, Leila R;Kaliyadan, Feroze;Kalra, Sanjay;Kamal, Vineet Kumar;Kamarajah, Sivesh Kathir;Kamath, Rajesh;Kamiab, Zahra;Kamyari, Naser;Kanagasabai, Thanigaivelan;Kanchan, Tanuj;Kandel, Himal;Kanmanthareddy, Arun R;Kanmiki, Edmund Wedam;Kanmodi, Kehinde Kazeem;Kannan S, Suthanthira;Kansal, Sushil Kumar;Kantar, Rami S;Kapoor, Neeti;Karajizadeh, Mehrdad;Karanth, Shama D;Karasneh, Reema A;Karaye, Ibraheem M;Karch, André;Karim, Asima;Karimi, Salah Eddin;Karimi Behnagh, Arman;Kashoo, Faizan Zaffar;Kasnazani, Qalandar Hussein Abdulkarim;Kasraei, Hengameh;Kassebaum, Nicholas J;Kassel, Molly B;Kauppila, Joonas H;Kaur, Navjot;Kawakami, Norito;Kayode, Gbenga A;Kazemi, Foad;Kazemian, Sina;Kazmi, Tahseen Haider;Kebebew, Getu Mosisa;Kebede, Adera Debella;Kebede, Fassikaw;Keflie, Tibebeselassie S;Keiyoro, Peter Njenga;Keller, Cathleen;Kelly, Jaimon Terence;Kempen, John H;Kerr, Jessica A;Kesse-Guyot, Emmanuelle;Khajuria, Himanshu;Khalaji, Amirmohammad;Khalid, Nauman;Khalil, Anees Ahmed;Khalilian, Alireza;Khamesipour, Faham;Khan, Ajmal;Khan, Asaduzzaman;Khan, Gulfaraz;Khan, Ikramullah;Khan, Imteyaz A;Khan, M Nuruzzaman;Khan, Maseer;Khan, Mohammad Jobair;Khan, Moien AB;Khan, Zeeshan Ali;Khan suheb, Mahammed Ziauddin;Khanmohammadi, Shaghayegh;Khatab, Khaled;Khatami, Fatemeh;Khatatbeh, Haitham;Khatatbeh, Moawiah Mohammad;Khavandegar, Armin;Khayat Kashani, Hamid Reza;Khidri, Feriha Fatima;Khodadoust, Elaheh;Khorgamphar, Mohammad;Khormali, Moein;Khorrami, Zahra;Khosravi, Ahmad;Khosravi, Mohammad Ali;Kifle, Zemene Demelash;Kim, Grace;Kim, Jihee;Kim, Kwanghyun;Kim, Min Seo;Kim, Yun Jin;Kimokoti, Ruth W;Kinzel, Kasey E;Kisa, Adnan;Kisa, Sezer;Klu, Desmond;Knudsen, Ann Kristin Skrindo;Kocarnik, Jonathan M;Kochhar, Sonali;Kocsis, Timea;Koh, David S Q;Kolahi, Ali-Asghar;Kolves, Kairi;Kompani, Farzad;Koren, Gerbrand;Kosen, Soewarta;Kostev, Karel;Koul, Parvaiz A;Koulmane Laxminarayana, Sindhura Lakshmi;Krishan, Kewal;Krishna, Hare;Krishna, Varun;Krishnamoorthy, Vijay;Krishnamoorthy, Yuvaraj;Krohn, Kris J;Kuate Defo, Barthelemy;Kucuk Bicer, Burcu;Kuddus, Md Abdul;Kuddus, Mohammed;Kuitunen, Ilari;Kulimbet, Mukhtar;Kulkarni, Vishnutheertha;Kumar, Akshay;Kumar, Ashish;Kumar, Harish;Kumar, Manasi;Kumar, Rakesh;Kumari, Madhulata;Kumie, Fantahun Tarekegn;Kundu, Satyajit;Kurmi, Om P;Kusnali, Asep;Kusuma, Dian;Kwarteng, Alexander;Kyriopoulos, Ilias;Kyu, Hmwe Hmwe;La Vecchia, Carlo;Lacey, Ben;Ladan, Muhammad Awwal;Laflamme, Lucie;Lagat, Abraham K;Lager, Anton C J;Lahmar, Abdelilah;Lai, Daphne Teck Ching;Lal, Dharmesh Kumar;Lalloo, Ratilal;Lallukka, Tea;Lam, Hilton;Lám, Judit;Landrum, Kelsey R;Lanfranchi, Francesco;Lang, Justin J;Langguth, Berthold;Lansingh, Van Charles;Laplante-Lévesque, Ariane;Larijani, Bagher;Larsson, Anders O;Lasrado, Savita;Lassi, Zohra S;Latief, Kamaluddin;Latifinaibin, Kaveh;Lauriola, Paolo;Le, Nhi Huu Hanh;Le, Thao Thi Thu;Le, Trang Diep Thanh;Ledda, Caterina;Ledesma, Jorge R;Lee, Munjae;Lee, Paul H;Lee, Seung Won;Lee, Shaun Wen Huey;Lee, Wei-Chen;Lee, Yo Han;LeGrand, Kate E;Leigh, James;Leong, Elvynna;Lerango, Temesgen L;Li, Ming-Chieh;Li, Wei;Li, Xiaopan;Li, Yichong;Li, Zhihui;Ligade, Virendra S;Likaka, Andrew Tiyamike Makhiringa;Lim, Lee-Ling;Lim, Stephen S;Lindstrom, Megan;Linehan, Christine;Liu, Chaojie;Liu, Gang;Liu, Jue;Liu, Runben;Liu, Shiwei;Liu, Xiaofeng;Liu, Xuefeng;Llanaj, Erand;Loftus, Michael J;López-Bueno, Rubén;Lopukhov, Platon D;Loreche, Arianna Maever;Lorkowski, Stefan;Lotufo, Paulo A;Lozano, Rafael;Lubinda, Jailos;Lucchetti, Giancarlo;Lugo, Alessandra;Lunevicius, Raimundas;Ma, Zheng Feei;Maass, Kelsey Lynn;Machairas, Nikolaos;Machoy, Monika;Madadizadeh, Farzan;Madsen, Christian;Madureira-Carvalho, Áurea M;Maghazachi, Azzam A;Maharaj, Sandeep B;Mahjoub, Soleiman;Mahmoud, Mansour Adam;Mahmoudi, Alireza;Mahmoudi, Elham;Mahmoudi, Razzagh;Majeed, Azeem;Makhdoom, Irsa Fatima;Malakan Rad, Elaheh;Maled, Venkatesh;Malekzadeh, Reza;Malhotra, Armaan K;Malhotra, Kashish;Malik, Ahmad Azam;Malik, Iram;Malta, Deborah Carvalho;Mamun, Abdullah A;Mansouri, Pejman;Mansournia, Mohammad Ali;Mantovani, Lorenzo Giovanni;Maqsood, Sajid;Marasini, Bishnu P;Marateb, Hamid Reza;Maravilla, Joemer C;Marconi, Agustina M;Mardi, Parham;Marino, Mirko;Marjani, Abdoljalal;Martinez, Gabriel;Martinez-Guerra, Bernardo Alfonso;Martinez-Piedra, Ramon;Martini, Daniela;Martini, Santi;Martins-Melo, Francisco Rogerlândio;Martorell, Miquel;Marx, Wolfgang;Maryam, Sharmeen;Marzo, Roy Rillera;Masaka, Anthony;Masrie, Awoke;Mathieson, Stephanie;Mathioudakis, Alexander G;Mathur, Manu Raj;Mattumpuram, Jishanth;Matzopoulos, Richard;Maude, Richard James;Maugeri, Andrea;Maulik, Pallab K;Mayeli, Mahsa;Mazaheri, Maryam;Mazidi, Mohsen;McGrath, John J;McKee, Martin;McKowen, Anna Laura W;McLaughlin, Susan A;McPhail, Steven M;Mechili, Enkeleint A;Medina, John Robert Carabeo;Mediratta, Rishi P;Meena, Jitendra Kumar;Mehra, Rahul;Mehrabani-Zeinabad, Kamran;Mehrabi Nasab, Entezar;Mekene Meto, Tesfahun;Meles, Gebrekiros Gebremichael;Mendez-Lopez, Max Alberto Mendez;Mendoza, Walter;Menezes, Ritesh G;Mengist, Belayneh;Mentis, Alexios-Fotios A;Meo, Sultan Ayoub;Meresa, Haftu Asmerom;Meretoja, Atte;Meretoja, Tuomo J;Mersha, Abera M;Mesfin, Bezawit Afework;Mestrovic, Tomislav;Mettananda, Kukulege Chamila Dinushi;Mettananda, Sachith;Meylakhs, Peter;Mhlanga, Adquate;Mhlanga, Laurette;Mi, Tianyue;Miazgowski, Tomasz;Micha, Georgia;Michalek, Irmina Maria;Miller, Ted R;Mills, Edward J;Minh, Le Huu Nhat;Mini, GK;Mir Mohammad Sadeghi, Pouya;Mirica, Andreea;Mirijello, Antonio;Mirrakhimov, Erkin M;Mirutse, Mizan Kiros;Mirzaei, Maryam;Misganaw, Awoke;Mishra, Ashim;Misra, Sanjeev;Mitchell, Philip B;Mithra, Prasanna;Mittal, Chaitanya;Mobayen, Mohammadreza;Moberg, Madeline E;Mohamadkhani, Ashraf;Mohamed, Jama;Mohamed, Mouhand F H;Mohamed, Nouh Saad;Mohammad-Alizadeh-Charandabi, Sakineh;Mohammadi, Soheil;Mohammadian-Hafshejani, Abdollah;Mohammadifard, Noushin;Mohammed, Hassen;Mohammed, Hussen;Mohammed, Mustapha;Mohammed, Salahuddin;Mohammed, Shafiu;Mohan, Viswanathan;Mojiri-Forushani, Hoda;Mokari, Amin;Mokdad, Ali H;Molinaro, Sabrina;Molokhia, Mariam;Momtazmanesh, Sara;Monasta, Lorenzo;Mondello, Stefania;Moni, Mohammad Ali;Moodi Ghalibaf, AmirAli;Moradi, Maryam;Moradi, Yousef;Moradi-Lakeh, Maziar;Moradzadeh, Maliheh;Moraga, Paula;Morawska, Lidia;Moreira, Rafael Silveira;Morovatdar, Negar;Morrison, Shane Douglas;Morze, Jakub;Mosser, Jonathan F;Motappa, Rohith;Mougin, Vincent;Mouodi, Simin;Mousavi, Parsa;Mousavi, Seyed Ehsan;Mousavi Khaneghah, Amin;Mpolya, Emmanuel A;Mrejen, Matías;Mubarik, Sumaira;Muccioli, Lorenzo;Mueller, Ulrich Otto;Mughal, Faraz;Mukherjee, Sumoni;Mulita, Francesk;Munjal, Kavita;Murillo-Zamora, Efrén;Musaigwa, Fungai;Musallam, Khaled M;Mustafa, Ahmad;Mustafa, Ghulam;Muthupandian, Saravanan;Muthusamy, Raman;Muzaffar, Muhammad;Myung, Woojae;Nagarajan, Ahamarshan Jayaraman;Nagel, Gabriele;Naghavi, Pirouz;Naheed, Aliya;Naik, Ganesh R;Naik, Gurudatta;Nainu, Firzan;Nair, Sanjeev;Najmuldeen, Hastyar Hama Rashid;Nakhostin Ansari, Noureddin;Nangia, Vinay;Naqvi, Atta Abbas;Narasimha Swamy, Sreenivas;Narayana, Aparna Ichalangod;Nargus, Shumaila;Nascimento, Bruno Ramos;Nascimento, Gustavo G;Nasehi, Samar;Nashwan, Abdulqadir J;Natto, Zuhair S;Nauman, Javaid;Naveed, Muhammad;Nayak, Biswa Prakash;Nayak, Vinod C;Nazri-Panjaki, Athare;Ndejjo, Rawlance;Nduaguba, Sabina Onyinye;Negash, Hadush;Negoi, Ionut;Negoi, Ruxandra Irina;Negru, Serban Mircea;Nejadghaderi, Seyed Aria;Nejjari, Chakib;Nena, Evangelia;Nepal, Samata;Ng, Marie;Nggada, Haruna Asura;Nguefack-Tsague, Georges;Ngunjiri, Josephine W;Nguyen, Anh Hoang;Nguyen, Dang H;Nguyen, Hau Thi Hien;Nguyen, Phat Tuan;Nguyen, Van Thanh;Niazi, Robina Khan;Nielsen, Katie R;Nigatu, Yeshambel T;Nikolouzakis, Taxiarchis Konstantinos;Nikoobar, Ali;Nikoomanesh, Fatemeh;Nikpoor, Amin Reza;Ningrum, Dina Nur Anggraini;Nnaji, Chukwudi A;Nnyanzi, Lawrence Achilles;Noman, Efaq Ali;Nomura, Shuhei;Noreen, Mamoona;Noroozi, Nafise;Norrving, Bo;Noubiap, Jean Jacques;Novotney, Amanda;Nri-Ezedi, Chisom Adaobi;Ntaios, George;Ntsekhe, Mpiko;Nuñez-Samudio, Virginia;Nurrika, Dieta;Nutor, Jerry John;Oancea, Bogdan;Obamiro, Kehinde O;Oboh, Mary Aigbiremo;Odetokun, Ismail A;Odogwu, Nkechi Martina;O'Donnell, Martin James;Oduro, Michael Safo;Ofakunrin, Akinyemi O D;Ogunkoya, Abiola;Oguntade, Ayodipupo Sikiru;Oh, In-Hwan;Okati-Aliabad, Hassan;Okeke, Sylvester Reuben;Okekunle, Akinkunmi Paul;Okonji, Osaretin Christabel;Olagunju, Andrew T;Olaiya, Muideen Tunbosun;Olatubi, Matthew Idowu;Oliveira, Gláucia Maria Moraes;Olufadewa, Isaac Iyinoluwa;Olusanya, Bolajoko Olubukunola;Olusanya, Jacob Olusegun;Oluwafemi, Yinka Doris;Omar, Hany A;Omar Bali, Ahmed;Omer, Goran Latif;Ondayo, Maureene Auma;Ong, Sokking;Onwujekwe, Obinna E;Onyedibe, Kenneth Ikenna;Ordak, Michal;Orisakwe, Orish Ebere;Orish, Verner N;Ortega-Altamirano, Doris V;Ortiz, Alberto;Osman, Wael M S;Ostroff, Samuel M;Osuagwu, Uchechukwu Levi;Otoiu, Adrian;Otstavnov, Nikita;Otstavnov, Stanislav S;Ouyahia, Amel;Ouyang, Guoqing;Owolabi, Mayowa O;Ozten, Yaz;P A, Mahesh Padukudru;Padron-Monedero, Alicia;Padubidri, Jagadish Rao;Pal, Pramod Kumar;Palicz, Tamás;Palladino, Claudia;Palladino, Raffaele;Palma-Alvarez, Raul Felipe;Pan, Feng;Pan, Hai-Feng;Pana, Adrian;Panda, Paramjot;Panda-Jonas, Songhomitra;Pandi-Perumal, Seithikurippu R;Pangaribuan, Helena Ullyartha;Panos, Georgios D;Panos, Leonidas D;Pantazopoulos, Ioannis;Pantea Stoian, Anca Mihaela;Papadopoulou, Paraskevi;Parikh, Romil R;Park, Seoyeon;Parthasarathi, Ashwaghosha;Pashaei, Ava;Pasovic, Maja;Passera, Roberto;Pasupula, Deepak Kumar;Patel, Hemal M;Patel, Jay;Patel, Sangram Kishor;Patil, Shankargouda;Patoulias, Dimitrios;Patthipati, Venkata Suresh;Paudel, Uttam;Pazoki Toroudi, Hamidreza;Pease, Spencer A;Peden, Amy E;Pedersini, Paolo;Pensato, Umberto;Pepito, Veincent Christian Filipino;Peprah, Emmanuel K;Peprah, Prince;Perdigão, João;Pereira, Marcos;Peres, Mario F P;Perianayagam, Arokiasamy;Perico, Norberto;Pestell, Richard G;Pesudovs, Konrad;Petermann-Rocha, Fanny Emily;Petri, William A;Pham, Hoang Tran;Philip, Anil K;Phillips, Michael R;Pierannunzio, Daniela;Pigeolet, Manon;Pigott, David M;Pilgrim, Thomas;Piracha, Zahra Zahid;Piradov, Michael A;Pirouzpanah, Saeed;Plakkal, Nishad;Plotnikov, Evgenii;Podder, Vivek;Poddighe, Dimitri;Polinder, Suzanne;Polkinghorne, Kevan R;Poluru, Ramesh;Ponkilainen, Ville T;Porru, Fabio;Postma, Maarten J;Poudel, Govinda Raj;Pourshams, Akram;Pourtaheri, Naeimeh;Prada, Sergio I;Pradhan, Pranil Man Singh;Prakasham, Thejeswar N;Prasad, Manya;Prashant, Akila;Prates, Elton Junio Sady;Prieto Alhambra, Daniel;PRISCILLA, TINA;Pritchett, Natalie;Purohit, Bharathi M;Puvvula, Jagadeesh;Qasim, Nameer Hashim;Qattea, Ibrahim;Qazi, Asma Saleem;Qian, Gangzhen;Qiu, Suli;Qureshi, Maryam Faiz;Rabiee Rad, Mehrdad;Radfar, Amir;Radhakrishnan, Raghu Anekal;Radhakrishnan, Venkatraman;Raeisi Shahraki, Hadi;Rafferty, Quinn;Raggi, Alberto;Raghav, Pankaja Raghav;Raheem, Nasiru;Rahim, Fakher;Rahim, Md Jillur;Rahimi-Movaghar, Vafa;Rahman, Md Mosfequr;Rahman, Mohammad Hifz Ur;Rahman, Mosiur;Rahman, Muhammad Aziz;Rahmani, Amir Masoud;Rahmani, Shayan;Rahmanian, Vahid;Rajaa, Sathish;Rajput, Prashant;Rakovac, Ivo;Ramasamy, Shakthi Kumaran;Ramazanu, Sheena;Rana, Kritika;Ranabhat, Chhabi Lal;Rancic, Nemanja;Rane, Amey;Rao, Chythra R;Rao, Indu Ramachandra;Rao, Mithun;Rao, Sowmya J;Rasali, Drona Prakash;Rasella, Davide;Rashedi, Sina;Rashedi, Vahid;Rashidi, Mohammad-Mahdi;Rasouli-Saravani, Ashkan;Rasul, Azad;Rathnaiah Babu, Giridhara;Rauniyar, Santosh Kumar;Ravangard, Ramin;Ravikumar, Nakul;Rawaf, David Laith;Rawaf, Salman;Rawal, Lal;Rawassizadeh, Reza;Rawlley, Bharat;Raza, Rabail Zehra;Razo, Christian;Redwan, Elrashdy Moustafa Mohamed;Rehman, Faizan Ur;Reifels, Lennart;Reiner Jr, Robert C;Remuzzi, Giuseppe;Reyes, Luis Felipe;Rezaei, Maryam;Rezaei, Nazila;Rezaei, Negar;Rezaeian, Mohsen;Rhee, Taeho Gregory;Riaz, Mavra A;Ribeiro, Antonio Luiz P;Rickard, Jennifer;Riva, Hannah R;Robinson-Oden, Hannah Elizabeth;Rodrigues, Célia Fortuna;Rodrigues, Mónica;Roever, Leonardo;Rogowski, Emma Lynn Best;Rohloff, Peter;Romadlon, Debby Syahru;Romero-Rodríguez, Esperanza;Romoli, Michele;Ronfani, Luca;Roshandel, Gholamreza;Roth, Gregory A;Rout, Himanshu Sekhar;Roy, Nitai;Roy, Priyanka;Rubagotti, Enrico;Ruela, Guilherme de Andrade;Rumisha, Susan Fred;Runghien, Tilleye;Rwegerera, Godfrey M;Rynkiewicz, Andrzej;S N, Chandan;Saad, Aly M A;Saadatian, Zahra;Saber, Korosh;Saber-Ayad, Maha Mohamed;SaberiKamarposhti, Morteza;Sabour, Siamak;Sacco, Simona;Sachdev, Perminder S;Sachdeva, Rajesh;Saddik, Basema;Saddler, Adam;Sadee, Bashdar Abuzed;Sadeghi, Ehsan;Sadeghi, Erfan;Sadeghian, Farideh;Saeb, Mohammad Reza;Saeed, Umar;Safaeinejad, Fahimeh;Safi, Sher Zaman;Sagar, Rajesh;Saghazadeh, Amene;Sagoe, Dominic;Saheb Sharif-Askari, Fatemeh;Saheb Sharif-Askari, Narjes;Sahebkar, Amirhossein;Sahoo, Soumya Swaroop;Sahoo, Umakanta;Sahu, Monalisha;Saif, 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2024-01-01
Abstract
Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11699/86047
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.