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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. Funding: Bill & Melinda Gates Foundation.
Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021
Vollset, Stein Emil;Ababneh, Hazim S;Abate, Yohannes Habtegiorgis;Abbafati, Cristiana;Abbasgholizadeh, Rouzbeh;Abbasian, Mohammadreza;Abbastabar, Hedayat;Abd Al Magied, Abdallah H A;Abd ElHafeez, Samar;Abdelkader, Atef;Abdelmasseh, Michael;Abd-Elsalam, Sherief;Abdi, Parsa;Abdollahi, Mohammad;Abdoun, Meriem;Abdullahi, Auwal;Abebe, Mesfin;Abiodun, Olumide;Aboagye, Richard Gyan;Abolhassani, Hassan;Abouzid, Mohamed;Aboye, Girma Beressa;Abreu, Lucas Guimarães;Absalan, Abdorrahim;Abualruz, Hasan;Abubakar, Bilyaminu;Abukhadijah, Hana Jihad Jihad;Addolorato, Giovanni;Adekanmbi, Victor;Adetunji, Charles Oluwaseun;Adetunji, Juliana Bunmi;Adeyeoluwa, Temitayo Esther;Adha, Rishan;Adhikary, Ripon Kumar;Adnani, Qorinah Estiningtyas Sakilah;Adzigbli, Leticia Akua;Afrashteh, Fatemeh;Afzal, Muhammad Sohail;Afzal, Saira;Agbozo, Faith;Agodi, Antonella;Agrawal, Anurag;Agyemang-Duah, Williams;Ahinkorah, Bright Opoku;Ahlstrom, Austin J;Ahmad, Aqeel;Ahmad, Firdos;Ahmad, Muayyad M;Ahmad, Sajjad;Ahmad, Shahzaib;Ahmed, Anisuddin;Ahmed, Ayman;Ahmed, Haroon;Ahmed, Safoora;Ahmed, Syed Anees;Akinosoglou, Karolina;Akkaif, Mohammed Ahmed;Akrami, Ashley E;Akter, Ema;Al Awaidy, Salah;Al Hasan, Syed Mahfuz;Al Mosa, Amjad S;Al Ta'ani, Omar;Al Zaabi, Omar Ali Mohammed;Alahdab, Fares;Alajlani, Muaaz M;Al-Ajlouni, Yazan;Alalalmeh, Samer O;Al-Aly, Ziyad;Alam, Khurshid;Alam, Noore;Alam, Tahiya;Alam, Zufishan;Al-amer, Rasmieh Mustafa;Alanezi, Fahad Mashhour;Alanzi, Turki M;Albakri, Almaza;Aldhaleei, Wafa A;Aldridge, Robert W;Alemohammad, Seyedeh Yasaman;Alemu, Yihun Mulugeta;Al-Gheethi, Adel Ali Saeed;Al-Hanawi, Mohammed Khaled;Ali, Abid;Ali, Amjad;Ali, Iman;Ali, Mohammed Usman;Ali, Rafat;Ali, Syed Shujait Shujait;Ali, Victor Ekoche;Ali, Waad;Al-Ibraheem, Akram;Alicandro, Gianfranco;Alif, Sheikh Mohammad;Aljunid, Syed Mohamed;Alla, François;Almazan, Joseph Uy;Al-Mekhlafi, Hesham M;Alqutaibi, Ahmed Yaseen;Alrawashdeh, Ahmad;Alrousan, Sahel Majed;Al-Sabah, Salman Khalifah;Alsabri, Mohammed A;Altaany, 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Giulia;Carugno, Andrea;Carvalho, Márcia;Castaldelli-Maia, Joao Mauricio;Castelpietra, Giulio;Cattaruzza, Maria Sofia;Caye, Arthur;Cegolon, Luca;Cembranel, Francieli;Cenko, Edina;Cerin, Ester;Chadban, Steven J;Chadwick, Joshua;Chakraborty, Chiranjib;Chakraborty, Sandip;Chalek, Julian;Chan, Jeffrey Shi Kai;Chandika, Rama Mohan;Chandy, Sara;Charan, Jaykaran;Chaudhary, Anis Ahmad;Chaurasia, Akhilanand;Chen, An-Tian;Chen, Haowei;Chen, Meng Xuan;Chen, Simiao;Cherbuin, Nicolas;Chi, Gerald;Chichagi, Fatemeh;Chimed-Ochir, Odgerel;Chimoriya, Ritesh;Ching, Patrick R;Chirinos-Caceres, Jesus Lorenzo;Chitheer, Abdulaal;Cho, Daniel Youngwhan;Cho, William C S;Choi, Dong-Woo;Chong, Bryan;Chong, Chean Lin;Chopra, Hitesh;Chu, Dinh-Toi;Chung, Eric;Chutiyami, Muhammad;Clayton, Justin T;Cogen, Rebecca M;Cohen, Aaron J;Columbus, Alyssa;Comfort, Haley;Conde, Joao;Connolly, Jon T;Cooper, Ezra E K;Cortese, Samuele;Cruz-Martins, Natália;da Silva, Alanna Gomes;Dadras, Omid;Dai, Xiaochen;Dai, Zhaoli;Dalton, Bronte E;Damiani, Giovanni;Dandona, Lalit;Dandona, Rakhi;Das, Jai K;Das, Saswati;Das, Subasish;Dash, Nihar Ranjan;Davletov, Kairat;De la Hoz, Fernando Pio;De Leo, Diego;Debopadhaya, Shayom;Delgado-Enciso, Ivan;Denova-Gutiérrez, Edgar;Dervenis, Nikolaos;Desai, Hardik Dineshbhai;Devanbu, Vinoth Gnana Chellaiyan;Dewan, Syed Masudur Rahman;Dhama, Kuldeep;Dhane, Amol S;Dhingra, Sameer;Dias da Silva, Diana;Diaz, Daniel;Diaz, Luis Antonio;Diaz, Michael J;Dima, Adriana;Ding, Delaney D;Do, Thao Huynh Phuong;do Prado, Camila Bruneli;Dodangeh, Masoud;Dodangeh, Milad;Doegah, Phidelia Theresa;Dohare, Sushil;Dong, Wanyue;D'Oria, Mario;Doshi, Rajkumar;Dowou, Robert Kokou;Dsouza, Haneil Larson;Dsouza, Viola;Dube, John;Dumith, Samuel C;Duncan, Bruce B;Duraes, Andre Rodrigues;Duraisamy, Senbagam;Durojaiye, Oyewole Christopher;Dushpanova, Anar;Dutta, Sulagna;Dzianach, Paulina Agnieszka;Dziedzic, Arkadiusz Marian;Eboreime, Ejemai;Ebrahimi, Alireza;Ebrahimi Kalan, Mohammad;Edinur, Hisham Atan;Efendi, 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Elmagzoub;Emeto, Theophilus I;Eshrati, Babak;Eslami, Majid;Esmaeili, Zahra;Fabin, Natalia;Fagbamigbe, Adeniyi Francis;Fagbule, Omotayo Francis;Falzone, Luca;Fareed, Mohammad;Farinha, Carla Sofia e Sá;Faris, MoezAlIslam Ezzat Mahmoud;Faro, Andre;Fasihi, Kiana;Fatehizadeh, Ali;Fauk, Nelsensius Klau;Fazylov, Timur;Feigin, Valery L;Fekadu, Ginenus;Feng, Xiaoqi;Fereshtehnejad, Seyed-Mohammad;Ferrara, Pietro;Ferreira, Nuno;Firew, Belete Sewasew;Fischer, Florian;Fitriana, Ida;Flavel, Joanne;Flor, Luisa S;Folayan, Morenike Oluwatoyin;Foley, Kristen Marie;Fonzo, Marco;Force, Lisa M;Foschi, Matteo;Freitas, Alberto;Fridayani, Ni Kadek Yuni;Fukutaki, Kai Glenn;Furtado, João M;Fux, Blima;Gaal, Peter Andras;Gadanya, Muktar A;Gallus, Silvano;Ganesan, Balasankar;Ganiyani, Mohammad Arfat;Gautam, Rupesh K;Gebi, Tilaye Gebru;Gebregergis, Miglas W;Gebrehiwot, Mesfin;Getacher, Lemma;Getahun, Genanew K A;Gething, Peter W;Ghadimi, Delaram J;Ghadirian, Fataneh;Ghafarian, Sadegh;Ghailan, Khalid Yaser;Ghasemi, MohammadReza;Ghasempour Dabaghi, Ghazal;Ghazy, Ramy Mohamed;Ghoba, Sama;Gholami, Ehsan;Gholamrezanezhad, Ali;Gholizadeh, Nasim;Ghorbani, Mahsa;Ghorbani Vajargah, Pooyan;Ghotbi, Elena;Gil, Artyom Urievich;Gill, Tiffany K;Girmay, Alem;Glasbey, James C;Glushkova, Ekaterina Vladimirovna;Gnedovskaya, Elena V;Göbölös, Laszlo;Goldust, Mohamad;Goleij, Pouya;Golinelli, Davide;Gopalani, Sameer Vali;Goulart, Alessandra C;Gouravani, Mahdi;Goyal, Anmol;Grivna, Michal;Grosso, Giuseppe;Guarducci, Giovanni;Gubari, Mohammed Ibrahim Mohialdeen;Guicciardi, Stefano;Guimarães, Rafael Alves;Gulati, Snigdha;Gulisashvili, David;Gunawardane, Damitha Asanga;Guo, Cui;Gupta, Anish Kumar;Gupta, Rahul;Gupta, Rajeev;Gupta, Renu;Gupta, Sapna;Gupta, Vijai Kumar;Haakenstad, Annie;Hadi, Najah R;Haep, Nils;Hafiz, Abdul;Haghmorad, Dariush;Haile, Demewoz;Hajj Ali, Adel;Hajj Ali, Ali;Haj-Mirzaian, Arvin;Halboub, Esam S;Haller, Sebastian;Halwani, Rabih;Hamagharib Abdullah, Kanaan;Hamdy, Nadia M;Hamoudi, Rifat;Hanifi, Nasrin;Hankey, Graeme J;Haq, Zaim Anan;Haque, Md Rabiul;Harapan, Harapan;Hargono, Arief;Haro, Josep Maria;Hasaballah, Ahmed I;Hasan, S. M. Mahmudul;Hasanian, Mohammad;Hasnain, Md Saquib;Hassan, Amr;Haubold, Johannes;Hay, Simon I;Hebert, Jeffrey J;Hegazi, Omar E;Heidari, Mohammad;Hemmati, Mehdi;Henson, Claire A;Herrera-Serna, Brenda Yuliana;Herteliu, Claudiu;Heydari, Majid;Hezam, Kamal;Hidayana, Irma;Hiraike, Yuta;Hoan, Nguyen Quoc;Holla, Ramesh;Hoogar, Praveen;Horita, Nobuyuki;Hossain, Md Mahbub;Hosseinzadeh, Hassan;Hosseinzadeh, Mehdi;Hostiuc, Mihaela;Hostiuc, Sorin;Hu, Chengxi;Huang, Junjie;Hultström, Michael;Hundie, Tsegaye Gebreyes;Hunt, Aliza J;Hushmandi, Kiavash;Hussain, Javid;Hussain, M. Azhar;Hussein, Nawfal R;Huynh, Hong-Han;Hwang, Bing-Fang;Ibitoye, Segun Emmanuel;Iftikhar, Pulwasha Maria;Ikiroma, Adalia I;Ikwegbue, Paul Chukwudi;Ilic, Irena M;Ilic, Milena D;Immurana, Mustapha;Isa, Mustafa Alhaji;Islam, Md. Rabiul;Islam, Sheikh Mohammed Shariful;Ismail, Faisal;Ismail, Nahlah Elkudssiah;Isola, Gaetano;Iwagami, Masao;Iyamu, Ihoghosa Osamuyi;Jacob, Louis;Jacobsen, Kathryn H;Jafarinia, Morteza;Jahankhani, Kasra;Jahanmehr, Nader;Jain, Nityanand;Jairoun, Ammar Abdulrahman;Jakhmola Mani, Dr Ruchi;Jamil, Safayet;Jamora, Roland Dominic G;Jatau, Abubakar Ibrahim;Javadov, Sabzali;Javaheri, Tahereh;Jayaram, Shubha;Jee, Sun Ha;Jeganathan, Jayakumar;Jiang, Heng;Jokar, Mohammad;Jonas, Jost B;Joseph, Nitin;Joshua, Charity Ehimwenma;Jürisson, Mikk;K, Vaishali;Kabir, Ali;Kabir, Zubair;Kadashetti, Vidya;Kalankesh, Laleh R;Kalra, Sanjay;Kamath, Ashwin;Kamath, Rajesh;Kamireddy, Arun;Kanaan, Mona;Kanchan, Tanuj;Kanmiki, Edmund Wedam;Kanmodi, Kehinde Kazeem;Kansal, Sushil Kumar;Karim, Asima;Karkhah, Samad;Kashoo, Faizan Zaffar;Kasraei, Hengameh;Kassel, Molly B;Katikireddi, Srinivasa Vittal;Kauppila, Joonas H;Kaur, Harkiran;Kayode, Gbenga A;Kazemi, Foad;Kazemian, Sina;Kebede, Fassikaw;Kendal, Evie Shoshannah;Kesse-Guyot, Emmanuelle;Khademvatan, Shahram;Khajuria, Himanshu;Khalaji, Amirmohammad;Khalid, Asaad;Khalid, Nauman;Khalilian, Alireza;Khamesipour, Faham;Khan, Fayaz;Khan, Mohammad Jobair;Khan, Moien AB;Khanmohammadi, Shaghayegh;Khatab, Khaled;Khatatbeh, Haitham;Khatatbeh, Moawiah Mohammad;Khatib, Mahalaqua Nazli;Khayat Kashani, Hamid Reza;Kheirallah, Khalid A;Khokhar, Manoj;Khormali, Moein;Khorrami, Zahra;Khosla, Atulya Aman;Khosravi, Majid;Khosrowjerdi, Mahmood;Khubchandani, Jagdish;Kifle, Zemene Demelash;Kim, Grace;Kim, Julie Sojin;Kim, Min Seo;Kim, Yun Jin;Kimokoti, Ruth W;Kisa, Adnan;Kisa, Sezer;Knibbs, Luke D;Knudsen, Ann Kristin Skrindo;Kochhar, Sonali;Kolahi, Ali-Asghar;Kompani, Farzad;Koren, Gerbrand;Korzh, Oleksii;Krishan, Kewal;Krishna, Varun;Krishnamoorthy, Vijay;Kucuk Bicer, Burcu;Kuddus, Md Abdul;Kuddus, Mohammed;Kuitunen, Ilari;Kujan, Omar;Kulimbet, Mukhtar;Kulkarni, Vishnutheertha;Kumar, G Anil;Kumar, Harish;Kumar, Nithin;Kumar, Rakesh;Kumar, Vijay;Kundu, Amartya;Kusuma, Dian;Kyei-Arthur, Frank;Kytö, Ville;Kyu, Hmwe Hmwe;La Vecchia, Carlo;Lacey, Ben;Ladan, Muhammad Awwal;Laflamme, Lucie;Lahariya, Chandrakant;Lai, Daphne Teck Ching;Lalloo, Ratilal;Lallukka, Tea;Lám, Judit;Lan, Qing;Lan, Tuo;Landires, Iván;Lanfranchi, Francesco;Langguth, Berthold;Lansingh, Van Charles;Laplante-Lévesque, Ariane;Larijani, Bagher;Larsson, Anders O;Lasrado, Savita;Lauriola, Paolo;Lawlor, Hilary R;Le, Huu-Hoai;Le, Long Khanh Dao;Le, Nhi Huu Hanh;Le, Thao Thi Thu;Le, Trang Diep Thanh;Leasher, Janet L;Lee, Doo Woong;Lee, Munjae;Lee, Paul H;Lee, Sang-woong;Lee, Seung Won;Lee, Shaun Wen Huey;Lee, Yo Han;Leigh, James;Leong, Elvynna;Li, Ming-Chieh;Libra, Massimo;Ligade, Virendra S;Lim, Lee-Ling;Lim, Stephen S;Limenh, Liknaw Workie;Lindholm, Daniel;Lindstedt, Paulina A;Listl, Stefan;Liu, Gang;Liu, Shiwei;Liu, Shuke;Liu, Xiaofeng;Liu, Xuefeng;Llanaj, Erand;López-Bueno, Rubén;López-Gil, José Francisco;Loreche, Arianna Maever;Lotufo, Paulo A;Lozano, Rafael;Lubinda, Jailos;Lucchetti, Giancarlo;Luo, Lisha;Lusk, Jay B;Lv, Lei;M Amin, Hawraz Ibrahim;Ma, Zheng Feei;Maass, Kelsey Lynn;Machairas, Nikolaos;Machoy, Monika;Madureira-Carvalho, Áurea M;Magdy Abd El Razek, Hassan;Maghazachi, Azzam A;Mahadeshwara Prasad, D. R.;Mahalleh, Mehrdad;Mahasha, Phetole Walter;Mahmoud, Mansour Adam;Mahmoudi, Elham;Mahmoudvand, Golnaz;Makama, Maureen;Malakan Rad, Elaheh;Malhotra, Kashish;Malik, Ahmad Azam;Malta, Deborah Carvalho;Manla, Yosef;Mansour, Ali;Mansouri, Mohammad Hadi;Mansouri, Pejman;Mansouri, Vahid;Mansourian, Marjan;Mansournia, Mohammad Ali;Marasini, Bishnu P;Marateb, Hamid Reza;Maravilla, Joemer C;Mardi, Parham;Marjani, Abdoljalal;Markazi Moghadam, Hamed;Marrugo Arnedo, Carlos Alberto;Martinez, Gabriel;Martinez-Piedra, Ramon;Martins-Melo, Francisco Rogerlândio;Martorell, Miquel;Marx, Wolfgang;Marzo, Roy Rillera;Masoudi, Sahar;Mathangasinghe, Yasith;Mathioudakis, Alexander G;Mathur, Medha;Mathur, Navgeet;Mathur, Neeta;Matozinhos, Fernanda Penido;Mattumpuram, Jishanth;Maude, Richard James;Maugeri, Andrea;Mayeli, Mahsa;Mazidi, Mohsen;Mazzotti, Antonio;McGrath, John J;McKee, Martin;McKowen, Anna Laura W;McPhail, Michael A;McPhail, Steven M;Mehmood, Asim;Mehrabani-Zeinabad, Kamran;Mehravar, Sepideh;Mekene 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Marie;Nguefack-Tsague, Georges;Ngunjiri, Josephine W;Nguyen, Anh Hoang;Nguyen, Dang H;Nguyen, Duc Hoang;Nguyen, Hau Thi Hien;Nguyen, Nhan;Nguyen, Nhien Ngoc Y;Nguyen, Phat Tuan;Nguyen, QuynhAnh P;Nguyen, Van Thanh;Nguyen Tran Minh, Duc;Niazi, Robina Khan;Nigatu, Yeshambel T;Niknam, Mahdieh;Nikoobar, Ali;Nikpoor, Amin Reza;Nikravangolsefid, Nasrin;Noman, Efaq Ali;Nomura, Shuhei;Noor, Syed Toukir Ahmed;Noroozi, Nafise;Nouri, Mehran;Nozari, Majid;Nri-Ezedi, Chisom Adaobi;Ntaios, George;Nunemo, Mengistu H;Nurrika, Dieta;Nutor, Jerry John;Nzoputam, Chimezie Igwegbe;Nzoputam, Ogochukwu Janet;Oancea, Bogdan;Obamiro, Kehinde O;Odetokun, Ismail A;Oduro, Michael Safo;Ogundijo, Oluwaseun Adeolu;Ogunfowokan, Adesola Adenike;Ogunkoya, Abiola;Oguntade, Ayodipupo Sikiru;Oh, In-Hwan;Ojo-Akosile, Tolulope R;Okati-Aliabad, Hassan;Okekunle, Akinkunmi Paul;Okonji, Osaretin Christabel;Olagunju, Andrew T;Olatubi, Matthew Idowu;Oliveira, Gláucia Maria Moraes;Olusanya, Bolajoko Olubukunola;Olusanya, Jacob Olusegun;Oluwafemi, Yinka Doris;Omar, Hany A;Omer, Goran Latif;Ong, Sokking;Onie, Sandersan;Onwujekwe, Obinna E;Opejin, Abdulahi Opejin;Ordak, Michal;Orish, Verner N;Ortiz, Alberto;Ortiz-Prado, Esteban;Osman, Wael M S;Ostojic, Sergej M;Ostroff, Samuel M;Osuagwu, Uchechukwu Levi;Otoiu, Adrian;Otstavnov, Stanislav S;Ouyahia, Amel;Owolabi, Mayowa O;Oyeyemi, Oyetunde T;Ozair, Ahmad;P A, Mahesh Padukudru;Padron-Monedero, Alicia;Padubidri, Jagadish Rao;Pal, Pramod Kumar;Palicz, Tamás;Pan, Feng;Pan, Hai-Feng;Panda-Jonas, Songhomitra;Pandey, Anamika;Pando-Robles, Victoria;Pangaribuan, Helena Ullyartha;Panos, Georgios D;Panos, Leonidas D;Pantazopoulos, Ioannis;Pantea Stoian, Anca Mihaela;Parikh, Romil R;Park, Eun-Kee;Park, Seoyeon;Park, Sungchul;Parsons, Nicholas;Parthasarathi, Ashwaghosha;Pasovic, Maja;Passera, Roberto;Patel, Jay;Pathan, Aslam Ramjan;Patil, Shankargouda;Patoulias, Dimitrios;Pawar, Shrikant;Pazoki Toroudi, Hamidreza;Pease, Spencer A;Peden, Amy E;Pedersini, Paolo;Pensato, Umberto;Pepito, Veincent Christian Filipino;Peprah, Prince;Pereira, Marcos;Pereira, Maria Odete;Perianayagam, Arokiasamy;Perico, Norberto;Perna, Simone;Pesudovs, Konrad;Petermann-Rocha, Fanny Emily;Pham, Hoang Tran;Philip, Anil K;Phillips, Michael R;Pigeolet, Manon;Piradov, Michael A;Pisoni, Enrico;Plotnikov, Evgenii;Poddighe, Dimitri;Polibin, Roman V;Poluru, Ramesh;Ponkilainen, Ville T;Popovic, Djordje S;Postma, Maarten J;Pour-Rashidi, Ahmad;Prabhu, Disha;Prada, Sergio I;Pradhan, Jalandhar;Pradhan, Pranil Man Singh;Prashant, Akila;Prates, Elton Junio Sady;Priscilla, Tina;Purnobasuki, Hery;Purohit, Bharathi M;Puvvula, Jagadeesh;Qasim, Nameer Hashim;Qattea, Ibrahim;Qazi, Asma Saleem;Qian, Gangzhen;Rabiee Rad, Mehrdad;Radhakrishnan, Venkatraman;Raeisi Shahraki, Hadi;Rafferty, Quinn;Raggi, Alberto;Raggi, Cat;Raheem, Nasiru;Rahim, Fakher;Rahim, Md Jillur;Rahimibarghani, Sarvenaz;Rahman, Md Mijanur Mijanur Rahman;Rahman, Mosiur;Rahman, Muhammad Aziz;Rahman, Tafhimur;Rahmani, Amir Masoud;Rahmanian, Mohammad;Rahmanian, Nazanin;Rahmati, Rahem;Rahmawaty, Setyaningrum;Raimondo, Diego;Raja, Adarsh;Rajput, Prashant;Ramadan, Majed;Ramasamy, Shakthi Kumaran;Ramazanu, Sheena;Ramteke, Pramod W;Rana, Kritika;Rana, Rishabh Kumar;Ranabhat, Chhabi Lal;Rane, Amey;Rao, Chythra R;Rao, Mithun;Rasella, Davide;Rashedi, Vahid;Rashid, Ahmed Mustafa;Rasouli-Saravani, Ashkan;Rastogi, Prateek;Rasul, Azad;Rathish, Devarajan;Rathnaiah Babu, Giridhara;Rauniyar, Santosh Kumar;Ravangard, Ramin;Rawaf, David Laith;Rawaf, Salman;Raza, Rabail Zehra;Redwan, Elrashdy Moustafa Mohamed;Reifels, Lennart;Reitsma, Marissa B;Remuzzi, Giuseppe;Rengasamy, Kannan RR;Reshmi, Bhageerathy;Resnikoff, Serge;Restaino, Stefano;Reyes, Luis Felipe;Rezaei, Nazila;Rezaei, Negar;Rezaei, Zahra Sadat;Rezaeian, Mohsen;Rhee, Taeho Gregory;Rickard, Jennifer;Robalik, Toshana;Robinson-Oden, Hannah Elizabeth;Rocha, Hermano Alexandre Lima;Rodrigues, Mónica;Rodriguez, Jefferson Antonio Buendia;Roever, Leonardo;Romadlon, Debby Syahru;Ronfani, Luca;Rony, Moustaq karim khan;Roshandel, Gholamreza;Rotimi, Kunle;Rout, Himanshu Sekhar;Roy, Bedanta;Rubagotti, Enrico;Ruela, Guilherme de Andrade;Rumisha, Susan Fred;Runghien, Tilleye;Russo, Michele;Saad, Aly M A;Saber, Korosh;Saber-Ayad, Maha Mohamed;Sabet, Cameron John;Sabour, Siamak;Sachdev, Perminder S;Saddler, Adam;Sadee, Bashdar Abuzed;Sadeghi, Masoumeh;Saeb, Mohammad Reza;Saeed, Umar;Safi, Sher Zaman;Sagar, Rajesh;Saghafi, Alireza;Sagoe, Dominic;Sahebkar, Amirhossein;Sahoo, Pragyan Monalisa;Sajid, Mirza Rizwan;Salam, Nasir;Salamati, Payman;Salami, Afeez Abolarinwa;Saleh, Mohamed A;Salehi, Leili;Salem, Marwa Rashad;Salemcity, Aanuoluwa James;Salimi, Sohrab;Samadi Kafil, Hossein;Samargandy, Saad;Samodra, Yoseph Leonardo;Samy, Abdallah M;Sanabria, Juan;Sanna, Francesca;Santric-Milicevic, Milena M;Sao Jose, Bruno Piassi;Saraswathy, Sivan Yegnanarayana Iyer;Saravanan, Aswini;Sarmiento-Suárez, Rodrigo;Sarode, Gargi Sachin;Sarode, Sachin C;Sartorius, Benn;Satpathy, Maheswar;Sayeed, Abu;Scarmeas, Nikolaos;Schaarschmidt, Benedikt Michael;Schinckus, Christophe;Schuermans, Art;Schumacher, Austin E;Schutte, Aletta Elisabeth;Schwebel, David C;Schwendicke, Falk;Selvaraj, Siddharthan;Semreen, Mohammad H;Senapati, Sabyasachi;Sengupta, Pallav;Senthilkumaran, Subramanian;Serban, Dragos;Sethi, Yashendra;Seylani, Allen;Shafie, Mahan;Shah, Pritik A;Shahbandi, Ataollah;Shahid, Samiah;Shahid, Wajeehah;Shahsavari, Hamid R;Shahwan, Moyad Jamal;Shaikh, Masood Ali;Shalash, Ali S;Shamekh, Ali;Shamim, Muhammad Aaqib;Shanawaz, Mohd;Shankar, Abhishek;Shannawaz, Mohammed;Sharath, Medha;Sharfaei, Sadaf;Sharifan, Amin;Sharifi-Rad, Javad;Sharma, Anupam;Sharma, Manoj;Sharma, Saurab;Sharma, Vishal;Shastry, Rajesh P;Shayan, Maryam;Shekhar, Shashank;Shenoy, Rekha R;Shetty, Mahabalesh;Shetty, Pavanchand H;Shetty, Premalatha K;Shi, Peilin;Shiani, Amir;Shigematsu, Mika;Shimels, Tariku;Shiri, Rahman;Shittu, Aminu;Shiue, Ivy;Shivakumar, K M;Shool, Sina;Shorofi, Seyed 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2024-01-01
Abstract
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. 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/11568/1235568
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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.