Ebrahim Eini

Background: Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Methods: Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. Findings: In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6-4.3) with a prevalence of 454.6 million cases (417.4-499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4-225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9-3.6) deaths. With 262.4 million (224.1-309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Interpretation: Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries.

BACKGROUND: Air pollution is the sixth highest risk factor for attributable disability-adjusted life-years (DALYs) in North Africa and the Middle East, but the relative importance of different subtypes of air pollution and any potential differences in their health effects by population demographics or country-level socioeconomic factors have not been fully explored. The objective of this study was to investigate the effect of high ambient particulate matter less than 2·5 μm in size (PM) and ambient ozone air pollution on disease burden, mortality, and life expectancy in 21 countries in the North Africa and the Middle East super-region from 1990 to 2019 using the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study estimates. METHODS: The study data were derived from GBD 2019, examining data from 1999 to 2019 in North Africa and the Middle East. In this study, the types of air pollution investigated included PM pollution and ambient ozone pollution. PM pollution itself was categorised as household air pollution from solid fuels and ambient PM pollution. The burden attributable to each risk factor, directly or indirectly, was incorporated in the population attributable fraction to estimate the total attributable deaths and DALYs. The summary exposure value (SEV) as the relative risk-weighted prevalence of exposure was extracted to compare the distribution of excess risk times the exposure level in a population where everyone is at maximum risk and ranges from zero (no excess risk exists in a population) to 100 (highest risk). The effect of air pollution on life expectancy was estimated via a cause-deleted life table analysis. FINDINGS: The age-standardised DALYs rate attributable to air pollution declined by 44·5%, from 4884·2 (95% uncertainty interval 4381·5-5555·4) to 2710·4 (2317·3-3125·6) per 100 000 from 1990 to 2019. Afghanistan (6992·3, 5627·7-8482·7), Yemen (4212·4, 3241·3-5418·1), and Egypt (4034·8, 3027·7-5138·6) had the highest age-standardised DALYs rates attributable to air pollution in 2019 per 100 000, whereas Türkiye (1329·2, 1033·7-1654·7), Jordan (1447·3, 1154·2-1758·5), and Iran (1603·0, 1404·7-1813·8) had the lowest rates. During the study period, the age-standardised SEV of air pollution (PM and ambient ozone in total) decreased by 10·9% (5·8-17·7%) in the super-region, whereas the SEV of ambient ozone pollution alone increased by 7·7% (0·7-14·3%). Among the components of PM pollution, the SEV of ambient PM pollution increased by 40·1% (25·2-63·7%); however, the SEV of household air pollution from solid fuels decreased by 70·6% (64·1-77·0%). Among the investigated types of air pollution, 98·9% of the DALYs from air pollution in the super-region were attributable to PM pollution. If air pollution had been lowered to the theoretical minimum risk exposure levels for 2019, then the average life expectancy would have been 1·6 years higher. INTERPRETATION: The burden attributable to air pollution substantially decreased in the study period across the super-region as a whole. Most of the burden from air pollution is attributed to PM pollution, the exposure to which has substantially increased in the past three decades. Interventions and policies that reduce population exposure to PM pollution could potentially increase the average life expectancy in the super-region. This finding calls for concerted efforts from governments and public health authorities in the super-region to tackle air pollution as an important threat to population health. FUNDING: Bill & Melinda Gates Foundation.

BACKGROUND: The burden of neurological conditions in north Africa and the Middle East is increasing. We aimed to assess the changes in the burden of neurological conditions in this super-region to aid with future decision making. METHODS: In this analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 data, we examined temporal trends of disability-adjusted life-years (DALYs; deaths and disabilities combined), deaths, incident cases, and prevalent cases of 14 major neurological conditions and eight subtypes in 21 countries in the north Africa and the Middle East super-region. Additionally, we assessed neurological DALYs due to 22 potentially modifiable risk factors, within four levels of classification, during the period 1990-2019. We used a Bayesian modelling estimation approach, and generated 95% uncertainty intervals (UIs) for final estimates on the basis of the 2·5th and 97·5th percentiles of 1000 draws from the posterior distribution. FINDINGS: In 2019, there were 441·1 thousand (95% UI 347·2-598·4) deaths and 17·6 million (12·5-24·7) neurological DALYs in north Africa and the Middle East. The leading causes of neurological DALYs were stroke, migraine, and Alzheimer's disease and other dementias (hereafter dementias). In north Africa and the Middle East in 2019, 85·8% (82·6-89·1) of stroke and 39·9% (26·4-54·7) of dementia age-standardised DALYs were attributable to modifiable risk factors. North Africa and the Middle East had the highest age-standardised DALY rates per 100 000 population due to dementia (387·0 [172·0-848·5]), Parkinson's disease (84·4 [74·7-103·2]), and migraine (601·4 [107·0-1371·8]) among the global super-regions. Between 1990 and 2019, there was a decrease in the age-standardised DALY rates related to meningitis (-75·8% [-81·1 to -69·5]), tetanus (-88·2% [-93·9 to -76·1]), stroke (-32·0% [-39·1 to -23·3]), intracerebral haemorrhage (-51·7% [-58·2 to -43·8]), idiopathic epilepsy (-26·2% [-43·6 to -1·1]), and subarachnoid haemorrhage (-62·8% [-71·6 to -41·0]), but for all other neurological conditions there was no change. During 1990-2019, the number of DALYs due to dementias, Parkinson's disease, multiple sclerosis, ischaemic stroke, and headache disorder (ie, migraine and tension-type headache) more than doubled in the super-region, and the burden of years lived with disability (YLDs), incidence, and prevalence of multiple sclerosis, motor neuron disease, Parkinson's disease, and ischaemic stroke increased both in age-standardised rate and count. During this period, the absolute burden of YLDs due to head and spinal injuries almost doubled. INTERPRETATION: The increasing burden of neurological conditions in north Africa and the Middle East accompanies the increasing ageing population. Stroke and dementia are the primary causes of neurological disability and death, primarily attributable to common modifiable risk factors. Synergistic, systematic, lifetime, and multi-sectoral interventions aimed at preventing or mitigating the burden are needed. FUNDING: Bill & Melinda Gates Foundation. TRANSLATIONS: For the Persian, Arabic and Turkish translations of the abstract see Supplementary Materials section.

Histórico: A carga global de infecções respiratórias inferiores (IRLs) e fatores de risco correspondentes em crianças maiores de 5 anos e adultos não foi estudada de forma tão abrangente quanto em crianças menores de 5 anos. Avaliamos a carga e as tendências de IRLs e fatores de risco em todas as faixas etárias por sexo, para 204 países e territórios. Métodos: Nesta análise de dados para o Estudo de Carga Global de Doenças, Lesões e Fatores de Risco (GBD) 2019, usamos pneumonia ou bronquiolite diagnosticada por médico como nossa definição de caso para IRLs. Incluímos os códigos 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7 e 487–489 da Classificação Internacional de Doenças da 9ª edição e os códigos A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4 e U04–U04.9 da Classificação Internacional de Doenças da 10ª edição. Usamos a estratégia de modelagem Cause of Death Ensemble para analisar 23.109 anos-local de dados de registro vital, 825 anos-local de dados de registro vital de amostra, 1.766 anos-local de dados de autópsia verbal e 681 anos-local de dados de vigilância de mortalidade. Usamos o DisMod-MR 2.1, uma ferramenta de metarregressão bayesiana, para analisar dados de incidência e prevalência específicos de idade e sexo identificados por meio de revisões sistemáticas da literatura, dados de pesquisas populacionais e dados de reivindicações e internação. Além disso, estimamos a mortalidade específica de idade e sexo LRI que é atribuível aos efeitos independentes de 14 fatores de risco. Descobertas: Globalmente, em 2019, estimamos que houve 257 milhões (intervalo de incerteza de 95% [UI] 240–275) de episódios de incidentes de LRI em homens e 232 milhões (217–248) em mulheres. No mesmo ano, os LRIs foram responsáveis ​​por 1,30 milhões (95% UI 1,18–1,42) mortes masculinas e 1,20 milhões (1,07–1,33) mortes femininas. As taxas de incidência e mortalidade padronizadas por idade foram 1,17 vezes (95% UI 1,16–1,18) e 1,31 vezes (95% UI 1,23–1,41) maiores em homens do que em mulheres em 2019. Entre 1990 e 2019, as taxas de incidência e mortalidade de LRI diminuíram em taxas diferentes entre as faixas etárias e um aumento nos episódios de LRI e mortes foi estimado entre todas as faixas etárias adultas, com homens com 70 anos ou mais tendo o maior aumento em episódios de LRI (126,0% [95% UI 121,4–131,1]) e mortes (100,0% [83,4–115,9]). Durante o mesmo período, os episódios de LRI e mortes em crianças menores de 15 anos foram estimados como diminuídos, e o maior declínio foi observado para mortes por LRI em homens menores de 5 anos (–70,7% [–77,2 a –61,8]). Os principais fatores de risco para mortalidade por LRI variaram entre faixas etárias e sexo. Mais da metade das mortes globais por LRI em crianças menores de 5 anos foram atribuídas ao emagrecimento infantil (fração atribuível à população [PAF] 53,0% [95% UI 37,7–61,8] em homens e 56,4% [40,7–65,1] em mulheres), e mais de um quarto das mortes por LRI entre aqueles com idades entre 5 e 14 anos foram atribuídas à poluição do ar doméstico (PAF 26,0% [95% UI 16,6–35,5] para homens e PAF 25,8% [16,3–35,4] para mulheres). PAFs de mortes de homens LRI atribuídas ao tabagismo foram de 20,4% (95% UI 15,4–25,2) em pessoas de 15 a 49 anos, 30,5% (24,1–36,9) em pessoas de 50 a 69 anos e 21,9% (16,8–27,3) em pessoas com 70 anos ou mais. PAFs de mortes de mulheres LRI atribuídas à poluição do ar doméstico foram de 21,1% (95% UI 14,5–27,9) em pessoas de 15 a 49 anos e 18,2% (12,5–24,5) em pessoas de 50 a 69 anos. Para mulheres com 70 anos ou mais, o principal fator de risco, material particulado ambiental, foi responsável por 11,7% (95% UI 8,2–15,8) das mortes por LRI. Interpretação: Os padrões e o progresso na redução da carga de LRIs e os principais fatores de risco para mortalidade variaram entre as faixas etárias e os sexos. O progresso observado em crianças menores de 5 anos foi claramente resultado de intervenções direcionadas, como vacinação e redução da exposição a fatores de risco. Intervenções semelhantes para outras faixas etárias poderiam contribuir para a realização de várias metas dos Objetivos de Desenvolvimento Sustentável, incluindo a promoção do bem-estar em todas as idades e a redução das desigualdades em saúde. Intervenções, incluindo o enfrentamento de fatores de risco como emagrecimento infantil, tabagismo, poluição por material particulado ambiental e poluição do ar doméstico, evitariam mortes e reduziriam as disparidades em saúde