Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions

Formulation of value added chicken meatballs by addition of Centella leaf (Centella asiatica) extracts

The study was conducted to find out the effect of different levels of Centella (Thankuni) leaf (Centella asiatica) extracts on chicken meatballs. Chicken meatballs sample were divided into four different treatments viz. 0, 1, 2 and 3% Centella leaf extracts group as T0 , T1 , T2 and T3, respectively. Days of intervals were 0, 15, 30 and 45 days. A 4×4 factorial experiment in completely randomized design having three replications per treatment was used for data analyses. Samples were preserved at -20˚C for 45 days. Sensory, proximate, physicochemical, biochemical and microbiological analyses were determined. Color, flavor, tenderness, Juiciness and overall acceptability were increased at different treatment levels significantly (p&lt;0.001). DM content decreased (51.19 to 47.78%) significantly (p&lt;0.001) at different treatment levels. On the contrary, DM content increased (47.39 to 51.53%) significantly (p&lt;0.001) with the days of intervals. The EE decreased (10.75 to 9.09%) significantly (p&lt;0.001) at different treatment level. The CP (19.05 to 20.46%) and Ash content (2.07 to 2.18%) at different treatment levels increased significantly (p&lt;0.05). Ultimate pH (6.03 to 6.12) was increased at different treatment levels significantly (p&lt;0.001). The cooking loss (26.30 to 23.62%) was decreased significantly (p&lt;0.001) with the advancement of days of intervals. The FFA (0.36 to 0.28%), POV (3.33 to 2.76) and TBARS values (0.29 to 0.23) were decreased significantly (p&lt;0.001) at different treatment levels. The TVC (5.05 to 4.39), TCC (1.10 to 1.01), and TYMC (1.34 to 1.10) decreased significantly (p&lt;0.05) at different treatment levels. On the basis of sensory attributes, proximate, physicochemical traits, biochemical and microbial analysis showed that 3% Centella leaf extracts can be recommended for formulation of value added chicken meatballs.</jats:p

Influence of growth promoters on fourteen gerbera (Gerbera jamesonii) cultivars

Applications of plant growth promoters influenced plants growth and have a quicker effect on vegetative growth as well as flower yield of flowering crops. That’s why an experiment was accomplished in the Department of Horticulture, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh to observe the effect of the growth promoters on Gerbera cultivars. Fourteen gerbera cultivars viz. V1= Sweet pink with black centre, V2= Yellow with black centre, V3= Reddish orange with black centre, V4= Red with yellow centre, V5= White with yellow centre, V6= Purplish pink with yellow centre, V7= Yellow, V8= Creamy yellow with yellow centre, V9= Magenta with black centre, V10= Red with black centre, V11= Bright orange with yellow centre, V12= Magenta pink with black centre, V13= Orange with yellow centre, V14= Yellow with greenish centre were used as factor A in this experiment. Factor B was growth chemicals denoted as T0 (control), T1 (4-CPA), T2 (Flora) and T3 (GA3). This experiment was organised in Randomized Complete Block Design with three replications. In this study, V6 showed the highest head diameter but V1 showed the highest flower head diameter when treated with GA3 (T3). Again in all other cases, V1 showed the best performance and among the growth chemicals GA3 (T3) was observed best, Flora (T2) showed better performance than 4-CPA (T1).</jats:p

Decolorization of Reactive Dyes from Aqueous Solution Using Combined Coagulation-Flocculation and Photochemical Oxidation (UV/H₂O₂)

Removal of reactive dyes from wastewater is a great environmental concern. Attempts were made to study the performance of a coupling process of coagulation-flocculation (CF) and photochemical oxidation (PCO) for the removal of two reactive dyes (Reactive Black 5 (RB 5) and Reactive Orange 12 (RO 12)) from aqueous solution. The CF experiments were conducted using alum as coagulant and polyacrylamide as coagulant aid whereas the PCO tests were carried out using H2O2 in the presence of UV light irradiation. Effects of various process parameters such as pH, coagulant dose and coagulant aid dose on the CF process, and H2O2 dose and UV exposure time on the PCO method have been studied. The study reveals that only the CF process is not sufficient to treat the dye solution. The CF step could remove 52.30% and 41.38% of RB 5 and RO 12, respectively. At the best conditions of process parameters, the combined CF-PCO method results in color removals of 87.10% and 82.53% for RB 5 and RO 12, respectively. The combined process of CF and UV/H2O2 may be a useful treatment technique for wastewater contaminated with reactive dyes.</jats:p

Individual and organisational interactions, learning and information sharing in a multi-country implementation-focused quality of care network for maternal, newborn and child health: a social network analysis

AbstractThe Network for Improving Quality of Care for Maternal, Newborn and Child Health (QCN) was established to build a cross-country platform for joint-learning around quality improvement implementation approaches to reduce mortality. This paper describes and explores the structure of the QCN in four countries and at global level.Using Social Network Analysis (SNA), this cross-sectional study maps the QCN networks at global level and in four countries (Bangladesh, Ethiopia, Malawi and Uganda) and assesses the interactions among actors involved. A pre-tested closed-ended structured questionnaire was completed by 302 key actors in early 2022 following purposeful and snowballing sampling. Data were entered into an online survey tool, and exported into Microsoft Excel for data management and analysis. This study received ethical approval as part of a broader evaluation.The SNA identified 566 actors across the four countries and at global level. Bangladesh, Malawi and Uganda had multiple-hub networks signifying multiple clusters of actors reflecting facility or district networks, whereas the network in Ethiopia and at global level had more centralized networks. There were some common features across the country networks, such as low overall density of the network, engagement of actors at all levels of the system, membership of related committees identified as the primary role of actors, and interactions spanning all types (learning, action and information sharing). The most connected actors were facility level actors in all countries except Ethiopia, which had mostly national level actors.The results reveal the uniqueness and complexity of each network assessed in the evaluation. They also affirm the broader qualitative evaluation assessing the nature of these networks, including composition and leadership. Gaps in communication between members of the network and limited interactions of actors between countries and with global level actors signal opportunities to strengthen QCN.</jats:p

Predictors of actual five-year survival and recurrence after pancreatoduodenectomy for ampullary adenocarcinoma: results from an international multicentre retrospective cohort study

Background: Pancreatoduodenectomy (PD) is recommended in fit patients with a resectable ampullary adenocarcinoma (AA). We aimed to identify predictors of five-year recurrence/survival. Methods: Data were extracted from the Recurrence After Whipple's (RAW) study, a multicentre retro-spective study of PD patients with a confirmed head of pancreas or periampullary malignancy (June 1st, 2012-May 31st, 2015). Patients with AA who developed recurrence/died within five-years were compared to those who did not.Results: 394 patients were included and actual five-year survival was 54%. Recurrence affected 45% and the median time-to-recurrence was 14 months. Local only, local and distant, and distant only recurrence affected 34, 41 and 94 patients, respectively (site unknown: 7). Among those with recurrence, the most common sites were the liver (32%), local lymph nodes (14%) and lung/pleura (13%). Following multivariable tests, number of resected nodes, histological T stage &gt; II, lymphatic invasion, perineural invasion (PNI), peripancreatic fat invasion (PPFI) and &gt;1 positive resection margin correlated with increased recurrence and reduced survival. Furthermore, &gt;1 positive margin, PPFI and PNI were all associated with reduced time-to-recurrence.Conclusions: This multicentre retrospective study of PD outcomes identified numerous histopathological predictors of AA recurrence. Patients with these high-risk features might benefit from adjuvant therapy

A global experiment on motivating social distancing during the COVID-19 pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment ( n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e., a controlling message) compared with no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared with the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing. Controlled motivation was associated with more defiance and less long-term behavioral intention to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges. </jats:p

A Global Experiment on Motivating Social Distancing during the COVID-19 Pandemic

Finding communication strategies that effectively motivate social distancing continues to be a global public health priority during the COVID-19 pandemic. This cross-country, preregistered experiment (n = 25,718 from 89 countries) tested hypotheses concerning generalizable positive and negative outcomes of social distancing messages that promoted personal agency and reflective choices (i.e., an autonomy-supportive message) or were restrictive and shaming (i.e. a controlling message) compared to no message at all. Results partially supported experimental hypotheses in that the controlling message increased controlled motivation (a poorly-internalized form of motivation relying on shame, guilt, and fear of social consequences) relative to no message. On the other hand, the autonomy-supportive message lowered feelings of defiance compared to the controlling message, but the controlling message did not differ from receiving no message at all. Unexpectedly, messages did not influence autonomous motivation (a highly-internalized form of motivation relying on one’s core values) or behavioral intentions. Results supported hypothesized associations between people’s existing autonomous and controlled motivations and self-reported behavioral intentions to engage in social distancing: Controlled motivation was associated with more defiance and less long-term behavioral intentions to engage in social distancing, whereas autonomous motivation was associated with less defiance and more short- and long-term intentions to social distance. Overall, this work highlights the potential harm of using shaming and pressuring language in public health communication, with implications for the current and future global health challenges.</p