Fertility, mortality, migration, and population scenarios for 195 countries and territories from 2017 to 2100: a forecasting analysis for the Global Burden of Disease Study

Management of pastoral development in the third world: by Stephen Sandford Published in association with the Overseas Development Institute, London, by John Wiley, Chichester, UK, 1983, 293 pp

SummaryBackgroundAccurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019.Methods8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric.FindingsThe global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019.InterpretationOver the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring.FundingBill & Melinda Gates Foundation.

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

SummaryBackgroundPrevious Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) studies have reported national health estimates for Ethiopia. Substantial regional variations in socioeconomic status, population, demography, and access to health care within Ethiopia require comparable estimates at the subnational level. The GBD 2019 Ethiopia subnational analysis aimed to measure the progress and disparities in health across nine regions and two chartered cities.MethodsWe gathered 1057 distinct data sources for Ethiopia and all regions and cities that included census, demographic surveillance, household surveys, disease registry, health service use, disease notifications, and other data for this analysis. Using all available data sources, we estimated the Socio-demographic Index (SDI), total fertility rate (TFR), life expectancy, years of life lost, years lived with disability, disability-adjusted life-years, and risk-factor-attributable health loss with 95% uncertainty intervals (UIs) for Ethiopia's nine regions and two chartered cities from 1990 to 2019. Spatiotemporal Gaussian process regression, cause of death ensemble model, Bayesian meta-regression tool, DisMod-MR 2.1, and other models were used to generate fertility, mortality, cause of death, and disability rates. The risk factor attribution estimations followed the general framework established for comparative risk assessment.FindingsThe SDI steadily improved in all regions and cities from 1990 to 2019, yet the disparity between the highest and lowest SDI increased by 54% during that period. The TFR declined from 6·91 (95% UI 6·59–7·20) in 1990 to 4·43 (4·01–4·92) in 2019, but the magnitude of decline also varied substantially among regions and cities. In 2019, TFR ranged from 6·41 (5·96–6·86) in Somali to 1·50 (1·26–1·80) in Addis Ababa. Life expectancy improved in Ethiopia by 21·93 years (21·79–22·07), from 46·91 years (45·71–48·11) in 1990 to 68·84 years (67·51–70·18) in 2019. Addis Ababa had the highest life expectancy at 70·86 years (68·91–72·65) in 2019; Afar and Benishangul-Gumuz had the lowest at 63·74 years (61·53–66·01) for Afar and 64.28 (61.99-66.63) for Benishangul-Gumuz. The overall increases in life expectancy were driven by declines in under-5 mortality and mortality from common infectious diseases, nutritional deficiency, and war and conflict. In 2019, the age-standardised all-cause death rate was the highest in Afar at 1353·38 per 100 000 population (1195·69–1526·19). The leading causes of premature mortality for all sexes in Ethiopia in 2019 were neonatal disorders, diarrhoeal diseases, lower respiratory infections, tuberculosis, stroke, HIV/AIDS, ischaemic heart disease, cirrhosis, congenital defects, and diabetes. With high SDIs and life expectancy for all sexes, Addis Ababa, Dire Dawa, and Harari had low rates of premature mortality from the five leading causes, whereas regions with low SDIs and life expectancy for all sexes (Afar and Somali) had high rates of premature mortality from the leading causes. In 2019, child and maternal malnutrition; unsafe water, sanitation, and handwashing; air pollution; high systolic blood pressure; alcohol use; and high fasting plasma glucose were the leading risk factors for health loss across regions and cities.InterpretationThere were substantial improvements in health over the past three decades across regions and chartered cities in Ethiopia. However, the progress, measured in SDI, life expectancy, TFR, premature mortality, disability, and risk factors, was not uniform. Federal and regional health policy makers should match strategies, resources, and interventions to disease burden and risk factors across regions and cities to achieve national and regional plans, Sustainable Development Goals, and universal health coverage targets.FundingBill & Melinda Gates Foundation.

Hip fractures are associated with a high risk of death; among those who survive a hip fracture, many experience substantial decreases in quality of life. A comprehensive understanding of the epidemiology and burden of hip fractures by country, age, gender, and sociodemographic factors would provide valuable information for healthcare policymaking and clinical practice. The Global Burden of Disease (GBD) study 2019 was a global-level study estimating the burden of 369 diseases and injuries in 204 countries and territories. An exploration and additional analysis of the GBD 2019 would provide a clearer picture of the incidence and burden of hip fractures. Using data from the GBD 2019, we asked, (1) What are the global, regional, and national incidences of hip fractures, and how did they change over a recent 30-year span? (2) What is the global, regional, and national burden of hip fractures in terms of years lived with disability, and how did it change over that same period? (3) What is the leading cause of hip fractures? (4) How did the incidence and years lived with disability of patients with hip fractures change with age, gender, and sociodemographic factors? This was a cross-sectional study. Participant data were obtained from the GBD 2019 ( http://ghdx.healthdata.org/gbd-results-tool ). The GBD study is managed by the WHO, coordinated by the Institute of Health Metrics and Evaluation, and funded by the Bill and Melinda Gates Foundation. It estimates the burden of disease and injury for 204 countries by age, gender, and sociodemographic factors, and can serve as a valuable reference for health policymaking. All estimates and their 95% uncertainty interval (UI) were produced using DisMod-MR 2.1, a Bayesian meta-regression tool in the GBD 2019. In this study, we directly pulled the age-standardized incidence rate and years lived with disability rate of hip fractures by location, age, gender, and cause from the GBD 2019. Based on these data, we analyzed the association between the incidence rate and latitude of each country. Then, we calculated the estimated annual percentage change to represent trends from 1990 to 2019. We also used the Spearman rank-order correlation analysis to determine the correlation between the incidence or burden of hip fractures and the sociodemographic index, a composite index of the income per capita, average years of educational attainment, and fertility rates in a country. Globally, hip fracture incidences were estimated to be 14.2 million (95% UI 11.1 to 18.1), and the associated years lived with disability were 2.9 million (95% UI 2.0 to 4.0) in 2019, with an incidence of 182 (95% UI 142 to 231) and 37 (95% UI 25 to 50) per 100,000, respectively. A strong, positive correlation was observed between the incidence rate and the latitude of each country (rho = 0.65; p < 0.001). From 1990 to 2019, the global incidence rate for both genders remained unchanged (estimated annual percentage change 0.01 [95% confidence interval -0.08 to 0.11]), but was slightly increased in men (estimated annual percentage change 0.11 [95% CI 0.01 to 0.2]). The years lived with disability rate decreased slightly (estimated annual percentage change 0.66 [95% CI -0.73 to -0.6]). These rates were standardized by age. Falls were the leading cause of hip fractures, accounting for 66% of all patients and 55% of the total years lived with disability. The incidence of hip fractures was tightly and positively correlated with the sociodemographic index (rho 0.624; p < 0.001), while the years lived with disability rate was slightly negatively correlated (rho -0.247; p < 0.001). Most hip fractures occurred in people older than 70 years, and women had higher incidence rate (189.7 [95% UI 144.2 to 247.2] versus 166.2 [95% UI 133.2 to 205.8] per 100,000) and years lived with disability (38.4 [95% UI 26.9 to 51.6] versus 33.7 [95% UI 23.1 to 45.5] per 100,000) than men. Hip fractures are common, devastating to patients, and economically burdensome to healthcare systems globally, with falls being the leading cause. The age-standardized incidence rate has slightly increased in men. Many low-latitude countries have lower incidences, possibly because of prolonged sunlight exposure. Policies should be directed to promoting public health education about maintaining bone-protective lifestyles, enhancing the knowledge of osteoporosis management in young resident physicians and those in practice, increasing the awareness of osteoporosis screening and treatment in men, and developing more effective antiosteoporosis drugs for clinical use. Level III, prognostic study.

Global need: including rehabilitation in health system strengthening

Non-Hodgkin lymphoma (NHL) constitutes a significant portion of the global cancer burden and associated mortality. However, a comprehensive understanding of NHL's scale and trends remains limited, underscoring the need for evidence-based epidemiological research to inform healthcare decisions and planning effectively. Incidence, mortality, and disability-adjusted life-years (DALYs) estimates, along with 95% uncertainty intervals (UIs), were derived from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. This study delineates NHL epidemiology by sex and age categories globally, regionally, and nationally. It examines NHL burden trends from 1990 to 2021 across various dimensions, analyzes burden breakdowns by population size, age structure, and epidemiologic changes, assesses cross-country inequalities using WHO-endorsed health equity methodologies, and projects NHL burden changes over the next 30 years. Notably, it explores how social development levels influence NHL epidemiological patterns and utilizes frontier analysis to evaluate health potential across different countries and regions. In 2021, 604,554 individuals (95% UI: 558,229–648,746) were diagnosed with NHL, and NHL-related deaths totaled 267,061 (95% UI: 246,095–288,696). From 1990 to 2021, the total number of newly diagnosed cases rose from 255,668 (95% UI: 242,749–272,801) to 604,554 (95% UI: 558,229–648,746); deaths grew from 146,657 (95% UI: 136,931–160,542) to 267,061 (95% UI: 246,095–288,696); and DALYs surged from 5,199,945 (95% UI: 4,797,150–5,770,129) to 7,766,063 (95% UI: 7,130,942–8,486,078). At the regional level, Andean Latin America had the highest ASIR, with 20.2 cases per 100,000 people (95% UI 16.13–25.26). At the national level, Peru recorded the highest age-standardized incidence rate (24.00 [95% UI 17.61–31.1] per 100,000). High-SDI regions exhibited sharp declines in age-standardized DALYs rates. Cross-country inequality increased from 22.68 DALYs per 100,000 in 1990, to 66.26 in 2021. Population growth appeared to have the most significant influence on incidence rates. Frontier analysis reveals that middle and upper-middle SDI countries have greater potential for health improvements. It is projected that the age-standardized rates (ASR) for mortality and DALYs will continue to decline up to 2051. Over the past three decades, NHL burden has intensified, necessitating increased health resources to address challenges associated with aging populations. Currently, high-SDI countries experience the highest NHL incidence and mortality rates, while developing nations with moderate to low-middle SDI levels must enhance efforts to manage the rising NHL burden effectively.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00277-025-06559-9.

Since the beginning of this century, we as a nation have made progress in all sectors including health. There has been a significant reduction in under-five and neonatal mortality in the country, reduction in fertility ratio, and increase in life expectancy at birth, although there are substantial variations between the states in the magnitude and rate of decline in these indices.[12] This has become possible through various schemes to provide nutrition to women and children, antenatal care of pregnant mothers, ensuring institutional delivery, good neonatal care, universal immunization, and education of girls. India has also made progress in reducing mortality rates from infectious diseases. Despite debates about policies and what we have achieved versus what could have been achieved, these are rays of hope for India. As Franklin D. Roosevelt said, "We have always held to the hope, the belief, the conviction that there is a better life, a better world, beyond the horizon." The Global Burden of Disease has recently forecasted that continued trends in female educational attainment and access to contraception would hasten declines in fertility and slow population growth worldwide across all societies. A sustained total fertility ratio lower than the replacement level in many countries, including China and India, would have economic, social, environmental, and geopolitical consequences.[3] Therefore, we are going to experience a change in population dynamics in the next few decades. India's population will rise to its peak by middle of this century to 1.68 billion, and will gradually decline thereafter to 1.1 billion in 2100 [Figure 1]. This will primarily be due to a decline in fertility ratio, which will be 1.3 in 2100 from present-day 2.1. The reduction in fertility ratio is observed in all castes, creeds, religions, and across all socioeconomic strata of Indian society.Figure 1: India's population change between 1990 and 2017 and forecasted data based on the Global Burden of Disease 2017 dataThe life expectancy will increase from 70.2 in females and 67.8 in males in 2017 to 80.7 and 78, respectively, in 2100. This will have a big impact on the economy as old persons are generally considered as nonproductive and consume more healthcare resources. As the population will age, there will be a reduction in the young working population. However, India will still have the most number of working people (between 25 and 64 years) in the world [Figure 2]. It is also predicted that economic growth will make India the third-largest economy by 2050 in the world.[3]Figure 2: Population age structure for males and females in 1990, 2019 (reference scenario), and 2100 (reference scenario). Forecasted data based on the Global Burden of Disease 2017 resultsThe number of pediatric and young population will reduce in the next few decades with the rise of elderly population [Figure 3a and b]. Increase in the number of old and retired persons will have a remarkable effect on health care. The burden of infectious diseases will reduce paving the way for the rise of noncommunicable diseases (NCDs). The protracted course of NCDs will increase the burden of people living with disabilities, the economic impact of which will be enormous. As we have been witnessing in Indian society, there is an increase in psychiatric illnesses including depression and suicide due to changes in societal aspirations, family conflict, unemployment, and many more. This will continue to pose a challenge for India in the coming days. The increasing burden of NCDs with more disability-adjusted life years and years of life lost due to these diseases will significantly affect the health resources of the country.Figure 3: (a and b) Number of working-age adults from 1950 to 2100 in the reference scenario in the ten most populous countries in 2017As many factors affecting human health are not restricted by geographical boundaries, international agreement is vital to restrict climate change, environmental pollution, poverty alleviation, and control of infections which have the risk of global transmission. Needless to say, we are passing through a time with despair and hopelessness in many fronts. The inevitable climate change and its consequences on nature and human health are probably the most important issue which is a great cause for concern. The world is going to be warmer by 5°C by turn of this century[4] and its impact on the glaciers, with consequent flooding of coastal areas and frequent occurrences of natural disasters will greatly affect human life in near future. Second, the socioeconomic disparity across the continents with conflicts resulting in civil wars at the national level and small-to full-scale wars at the regional and global level will also impact human health. Third, environmental pollution has a great impact on human health. We are already witnessing the rising incidences of NCDs such as cancers, respiratory diseases, stroke, cardiovascular diseases, and dementia. Environmental pollution has been implicated to many of these NCDs. Fourth, the pandemic of unknown infections, including zoonotic viruses, is also a serious threat to humanity in coming years. The memory of the COVID-19 pandemic is still afresh and future pandemic is looming large on our head. India's ascend to global platform demands its leadership in all these fronts, ensuring consensus in providing more funds to health and social sectors, and supporting underdeveloped nations so that "Health for All" becomes an achievable goal. In the coming years, India will conquer many infectious diseases and the darkness of illiteracy. With the largest number of working people, India will become the third-largest economy in the next three decades. However, providing health care to every Indian is still a distant reality. With the rising cost of health care and lack of insurance of vast majority of the population, the dream of universal health care will remain unfulfilled unless we take some important policy decisions urgently. We have been listening to political debates for more resource allocation for public health, and free health care for all Indians. But no one underscores the importance of these, we need to broaden our vision. Health is inseparable from many other aspects of public life. That providing education to all, particularly girls improves maternal and child health indices are well-established. Investing on the universal availability of safe and potable drinking water, proper sewage disposal, improvement of hygiene, and strengthening public distribution system to provide food for all are equally important for the improvement of health of the nation. Technological advancement for lesser dependence on fossil fuel with reduction of carbon emission may not have an immediate impact but will help achieve a healthy world liveable for future generations, a demand which cannot be ignored. India's progress and rise in the world stage require not only increase in its GDP and defense superiority but also all-round development of all health indices.

36-fold higher estimate of deaths attributable to red meat intake in GBD 2019: is this reliable?

As a continent with 54 independent states Africa’s diversity is often highlighted but frequently forgotten when fertility is discussed. Fifty and more years ago to consider that all African countries and societies had a single fertility pattern (large numbers of children) and single trend (unchanging over time) was a valid characterization. Since the 1960s however that uniformity has disappeared replaced by substantial inter- and intra-country differences in fertility patterns and trends that render previous perceptions of continent-wide homogeneity obsolete. In this chapter we consider two African countries—Ghana and Kenya—whose fertility patterns and trends and their determinants have been well documented (Bongaarts 2008; Garenne 2008; Machiyama 2010; Shapiro and Gebreselassie 2008; Sneeringer 2009). Both countries have benefited from regularWorld Fertility Surveys (WFS) and Demographic and Health Surveys (DHS) that record trends in fertility family planning (FP) and other relevant indicators. The recently introduced Performance Monitoring and Accountability 2020 (PMA2020) surveys monitor progress since 2012 for the FP2020 initiative and occasional Situation Analysis and Service Provision Assessment surveys have also detailed the readiness of the health system in both countries to make quality FP services available. Ghana and Kenya share some common history: both have relatively strong health system legacies from the period of British colonialization; both were among the earliest countries to achieve independence; they were the first two African countries that developed policies to address population growth in the 1960s; and both have received substantial and sustained resources over several decades from many external donors and technical assistance organizations explicitly intended to increase the availability and quality of family planning services. However they are composed of cultures that are both diverse within each country and markedly different in many ways between the two countries. The two countries demonstrate remarkably different pathways in fertility and family planning patterns and trends from the 1970s to the present. We highlight some of the key differences and similarities explain why they have occurred and identify insights that could inform a wider understanding of fertility transitions and the role of family planning in other African countries. (excerpt)

To assess the changing patterns of heart failure (HF) in China from 1990 to 2021, providing evidence for informed healthcare strategies. Data on prevalence, years lived with disability (YLDs), and their corresponding 95% uncertainty intervals (UI) were obtained from the Global Burden of Disease (GBD) Study 2021. The joinpoint regression model, the age-period-cohort model, and the autoregressive integrated moving average (ARIMA) model were utilized for more in-depth analysis. In 2021, 13 099 727 (95% UI, 11 320 895 to 15 376 467) individuals lived with HF and this illness accounted for 1 290 810 (95% UI, 865 894 to 1 775 731) YLDs in China. The burden of HF is more pronounced in males and the elderly, with ischaemic heart disease having become the leading cause since 2002. The age-standardized rates of prevalence and YLDs increased at average annual percentage changes of 0.23% (95% CI, 0.20 to 0.26) and 0.25% (95% CI, 0.23 to 0.27), respectively. The curve of local drift showed a downward trend with age. Both the period and cohort rate ratios have increased significantly over the last 30 years. By 2031, the age-standardized rates of prevalence will decrease to 678.69 (95% CI, 640.75 to 716.63), while the age-standardized rates of YLDs will increase to 69.19 (95% CI, 66.95 to 71.43). The burden and risk of HF in China remains a major concern. The implementation of comprehensive strategies should be taken into consideration, including strengthening the primary healthcare system, enhancing public health education, and promoting cardiac rehabilitation.

SummaryBackgroundStroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide information to health systems and policy makers on more than 300 causes of disease and injury, including stroke. The results presented here are the estimates of burden due to overall stroke and ischaemic and haemorrhagic stroke from GBD 2016.MethodsWe report estimates and corresponding uncertainty intervals (UIs), from 1990 to 2016, for incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs). DALYs were generated by summing YLLs and YLDs. Cause-specific mortality was estimated using an ensemble modelling process with vital registration and verbal autopsy data as inputs. Non-fatal estimates were generated using Bayesian meta-regression incorporating data from registries, scientific literature, administrative records, and surveys. The Socio-demographic Index (SDI), a summary indicator generated using educational attainment, lagged distributed income, and total fertility rate, was used to group countries into quintiles.FindingsIn 2016, there were 5·5 million (95% UI 5·3 to 5·7) deaths and 116·4 million (111·4 to 121·4) DALYs due to stroke. The global age-standardised mortality rate decreased by 36·2% (−39·3 to −33·6) from 1990 to 2016, with decreases in all SDI quintiles. Over the same period, the global age-standardised DALY rate declined by 34·2% (−37·2 to −31·5), also with decreases in all SDI quintiles. There were 13·7 million (12·7 to 14·7) new stroke cases in 2016. Global age-standardised incidence declined by 8·1% (−10·7 to −5·5) from 1990 to 2016 and decreased in all SDI quintiles except the middle SDI group. There were 80·1 million (74·1 to 86·3) prevalent cases of stroke globally in 2016; 41·1 million (38·0 to 44·3) in women and 39·0 million (36·1 to 42·1) in men.InterpretationAlthough age-standardised mortality rates have decreased sharply from 1990 to 2016, the decrease in age-standardised incidence has been less steep, indicating that the burden of stroke is likely to remain high. Planned updates to future GBD iterations include generating separate estimates for subarachnoid haemorrhage and intracerebral haemorrhage, generating estimates of transient ischaemic attack, and including atrial fibrillation as a risk factor.FundingBill & Melinda Gates Foundation

10577 Background: Cancer is a major cause of morbidity and mortality worldwide, and global efforts to reduce health loss from cancer require systematic estimates that can measure progress from national to global levels. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019), we examined global cancer burden in order to highlight areas where cancer burden is inequitably distributed and to inform cancer control efforts around the world. Methods: Using estimation methods from GBD 2019, we analyzed the incidence, mortality, years lived with disability, years of life lost (YLLs), and disability-adjusted life years (DALYs) for 29 cancer groups and 204 countries and territories from 2010 to 2019. Cancer burden was compared to health burden from other categories of diseases and injuries in the GBD. Results were assessed globally and by socio-demographic index (SDI), a summary measure of income per capita, average educational attainment, and total fertility rate. Point estimates and 95% Uncertainty Intervals (UIs) are reported. Results: There were 23.6 million (95% UI 22.2-24.9 million) incident cancer cases globally in 2019 (17.2 [15.9-18.5] million excluding non-melanoma skin cancer), and 10.0 (9.36-10.6) million cancer deaths. There were 250 (235-264) million DALYs globally due to cancer, 97% of which came from years of life lost. The leading five cancers by DALYs in 2019 were: tracheal, bronchus, and lung cancer (45.9 [42.3-49.3] million); colon and rectum cancer (24.3 [22.6-25.7] million); stomach cancer (22.2 [20.3-24.1] million); breast cancer (20.6 [19.0-22.2] million; and liver cancer (12.5 [11.4-13.7] million). Compared to other diseases and injuries in the GBD, cancer was responsible for the second-highest number of deaths, YLLs, and DALYs globally in 2019. These rankings of cancer burden differed by SDI quintile: cancer was the leading cause of absolute DALYs in high SDI countries but was ranked 10th in low SDI countries. From 2010-2019, the number of global cancer cases increased by 26.3% (20.3-32.3%), deaths by 20.9% (14.2-27.6%), and DALYs by 16.0% (9.29-22.8%). The largest annualized rate of change in absolute cases and deaths over this period occurred in the low and low-middle SDI quintiles. Conclusions: Cancer cases and deaths are growing globally, with the largest relative growth over the last decade occurring in low to middle SDI countries. Improvements in cancer prevention efforts and ensuring access to timely diagnosis and care will be necessary to make equitable progress in reducing the global burden of cancer.

BackgroundMaternal morbidity and mortality, encompassing pregnancy-related complications and obstetric disorders, pose a persistent global health challenge with significant multigenerational consequences. As the second leading cause of disability-adjusted life years (DALYs) among women of reproductive age globally, these conditions exert profound impacts on perinatal outcomes and intergenerational health equity. The Global Burden of Disease Study (GBD), recognized as the most comprehensive epidemiological surveillance system, provides critical evidence for optimizing maternal health policies through systematic quantification of disease burden patterns. This multinational study employs GBD 2021 data to conduct a spatiotemporal analysis of maternal disorder burden across 21 GBD regions and 204 countries and territories from 1990 to 2021, utilizing standardized metrics including DALYs, prevalence rates, and mortality incidence.MethodsThis population-based multinational investigation employed systematically collected epidemiological evidence from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021, with data acquisition was conducted through the standardized Global Health Data Exchange platform (https://vizhub.healthdata.org/gbd-results/.GBD Results Tool; data retrieval date: November 11, 2024). We systematically analyzed temporal trends in maternal disorder burden from 1990 to 2021 using a standardized analytical framework stratified across three dimensions: age cohorts (10–54 years), 21 GBD-defined geographical regions, and socio-demographic index (SDI) quintiles—a composite metric integrating income, education, and fertility rates. The burden quantification employed five core metrics: (1) Disability-adjusted life years (DALYs): Integrating years of life lost (YLLs) and years lived with disability (YLDs). (2) Mortality counts: Absolute maternal deaths by etiology. (3) Estimated annual percentage change (EAPC). (4) Age-standardized mortality rate (ASMR). (5) Age-standardized DALYs rate (ASDR): Adjusted using the GBD reference population structure. All estimates reported with 95% uncertainty interval (UI) derived from 1,000 Bayesian posterior draws.ResultsQuantitative analysis of the Global Burden of Disease (GBD) 2021 dataset reveals significant advancements in maternal health metrics. Between 1990 and 2021, maternal mortality decreased by 60% (age-standardized mortality rate [ASMR]: 12.45 to 4.87 per 100,000), with disability-adjusted life years (DALYs) declining by 43.5% (age-standardized DALY rate [ASDR]: 780.8 to 315.3 per 100,000). The estimated annual percentage change (EAPC) for mortality (-3.1%, 95% CI: -3.2 to -2.99) and DALYs (-3.0%, 95% CI: -3.1 to -2.89) underscores sustained global progress. Maternal abortion and miscarriage (-4.67% EAPC), Maternal hemorrhage (-4.06% EAPC), and Maternal obstructed labor and uterine rupture (-3.68% EAPC) drove maternal mortality reductions. Maternal mortality peaked at ages 20–24 globally, with variations in high-income regions (peaks at 25–34 years). Hemorrhage dominated in sub-Saharan Africa, whereas high-income regions prioritized hypertensive disorder management. The highest maternal mortality remained in low-SDI regions, with a substantial 63% decrease (51.85 to 19.44 per 100,000), while high-SDI regions showed minimal changes. Disease burden from hemorrhage, hypertensive disorders, and abortion declined significantly, while ectopic pregnancy saw stagnation. Regional trends revealed substantial improvements in Southern Asia, while Sub-Saharan Africa remained challenged.ConclusionsThe significant decline in global maternal mortality and DALYs over the past three decades highlights the progress made in improving maternal health. However, the persistent disparities across regions and SDI levels underscore the need for targeted interventions. The findings emphasize the importance of continued surveillance and monitoring of maternal health indicators to guide policy and resource allocation. Strengthening the healthcare systems, particularly in low-SDI regions, is crucial to further reduce the burden of maternal disorders.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-23814-w.

BackgroundRefraction disorders are the leading cause of visual impairment worldwide. This study investigates the global burden and trends of refraction disorders from 1990 to 2021, with projections extending to 2050.MethodsData on prevalence and disability-adjusted life years (DALYs) for refraction disorders, along with their 95% uncertainty intervals (UIs), were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The study provides a comprehensive analysis of the epidemiology of refraction disorders at global, regional, and national levels. It examines trends from 1990 to 2021 from multiple dimensions, including overall and localized changes. Burden decomposition was performed to assess contributions from population size, age structure, and epidemiological changes. Cross-country inequalities were quantified using standard health equity methods recommended by the World Health Organization. Future changes in the burden of refraction disorders were also projected through 2050.ResultsAccording to GBD 2021 estimates, there were 159,765,917 prevalent cases (95% UI: 142,526,915–178,698,348) and 6,618,600 DALYs (95% UI: 4,599,082–9,528,676) due to refraction disorders globally in 2021. From 1990 to 2021, prevalence and DALYs rates demonstrated a steady decline, although prevalence numbers, incidence numbers, and rates were consistently higher among females compared to males. Decomposition analysis showed that aging, population growth, and epidemiological changes contributed 36.25%, 76.92%, and − 13.18%, respectively, to changes in the age-standardized prevalence rate (ASR). The concentration index declined from − 0.17 (95% CI: −0.21 to − 0.13) in 1990 to − 0.10 (95% CI: −0.13 to − 0.07) in 2021, indicating a reduction in SDI-related inequalities. By 2050, the ASR for prevalence and DALYs is projected to decline to 1815.27 (95% UI: 534.15–3096.40) and 69.11 (95% UI: 21.45–116.77), respectively.ConclusionThe global burden of refraction disorders decreased significantly from 1990 to 2021 and is expected to decline further by 2050. Females continue to experience a greater burden compared to males. Population growth emerged as the primary driver of changes in the ASR of prevalence and DALYs. While countries with low socio-demographic index (SDI) face a disproportionately high burden, SDI-related inequalities have gradually lessened over time.