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Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean age at death lower than the expected value. We examined global mortality patterns over the past three decades, highlighting-with enhanced estimation methods-the impacts of major events such as the COVID-19 pandemic, in addition to broader trends such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition. This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and deepening our understanding of where targeted resources could be applied to further reduce preventable sources of mortality. We provide essential insights into global and regional health disparities, identifying locations in need of targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease, particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are affecting all nations, albeit at different paces and scales. Gates Foundation.
Better evaluation of the contribution of the main diseases, injuries, and risk factors for mortality and life expectancy is crucial for more efficient policy making at the national and subnational levels in Iran. The aim of this study is to assess the effect of emerging causes of mortality on health, specifically COVID-19, which can help policy makers implement preventive measures in similar situations. In this systematic analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we present estimates of cause-specific mortality at the national and subnational levels in Iran from 1990 to 2023. New to this iteration of GBD, we present a decomposition analysis of the contribution of specific causes of death to net gain or loss in life expectancy across 31 provinces of Iran. We used an array of data sources including censuses, vital registration, and surveys for national and subnational estimates. The two leading causes of death in Iran were ischaemic heart disease and stroke in both 1990 and 2019. However, in 2020 and 2021, the COVID-19 pandemic displaced the leading causes of death, ranking first with age-standardised mortality rates of 286·2 deaths (95% uncertainty interval 267·9-310·5) per 100 000 in 2020 and 250·0 deaths (233·2-272·5) per 100 000 in 2021. COVID-19 ranked second and tenth in 2022 and 2023, respectively. Life expectancy at birth for both sexes combined declined from 78·0 years (77·7-78·1) in 2019 to 74·3 years (74·0-74·4) in 2020. It steadily recovered to 78·8 years (78·5-79·2) in 2023. COVID-19 was the main cause of loss in life expectancy, by 4·19 years, between 2019 and 2020. There was a net gain of 12·4 years in life expectancy in Iran from 1990 to 2023. The net gain at the national level can be mostly attributed to reduced mortality from ischaemic heart disease (2·61 years), stroke (1·63 years), neonatal disorders (1·26 years), transport injuries (0·88 years), and neoplasms (0·64 years). The decline in mortality rates of major causes continued to 2023 despite the pandemic. An exception was Alzheimer's disease, which showed a 4·0% increase in rate between 2019 and 2023 and led to a net loss of 0·04 years in life expectancy since 1990. Diabetes led to a net loss of 0·09 years since 1990. There were variations between provinces in terms of age-standardised rates and the net change in life expectancy before and after the COVID-19 pandemic. The COVID-19 pandemic disrupted the rising trend of life expectancy in Iran, varying across provinces. Findings show that the health-care infrastructure and policies in Iran were not efficient in controlling the pandemic in 2020 and 2021, mainly due to inadequate vaccination coverage and timeliness, specifically for vulnerable subgroups. Sanctions may have aggravated the effect of COVID-19 on loss in life expectancy of Iranians. Despite the pandemic, the declining trend in age-standardised rates for top causes of mortality has continued to 2023, leading to a full recovery of life expectancy and underscoring the ultimate resilience of Iran's health system. Gates Foundation.
For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant). Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity. Gates Foundation and Bloomberg Philanthropies.
The 2023 iteration of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimated prevalence, incidence, and health burden for 375 diseases and injuries, including 12 mental disorders. We assess past, current, and emerging trends in the prevalence and burden of mental disorders across sexes and age groups, for 21 regions, 204 countries and territories, and by Socio-demographic Index (SDI) quintile, from 1990 to 2023. Mental disorders included in GBD 2023 were anxiety disorders, major depressive disorder, dysthymia, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, anorexia nervosa, bulimia nervosa, idiopathic developmental intellectual disability, and a residual category of other mental disorders. A literature review identified epidemiological data for each disorder. These were analysed via a Bayesian meta-regression to estimate prevalence by disorder, sex, age, location, and year. Disorder-specific prevalence was multiplied by disability weights representing the severity of health loss associated with each disorder to estimate years lived with disability (YLDs). Deaths due to anorexia nervosa were assessed with a Cause of Death Ensemble modelling strategy to estimate deaths by sex, age, location, and year, and then multiplied by the standard life expectancy at age of death to estimate years of life lost (YLLs). YLDs equalled disability-adjusted life-years (DALYs) for all mental disorders except anorexia nervosa (the only mental disorder considered as an underlying cause of death in GBD), for which DALYs represented the sum of YLDs and YLLs. We presented prevalence, deaths, YLDs, YLLs, and DALYs as counts, age-specific rates per 100 000 population, and age-standardised rates per 100 000 population. We estimated 1·17 billion (95% uncertainty interval 1·06-1·31) prevalent cases of mental disorders globally in 2023, equivalent to an age-standardised prevalence rate of 14 210·7 cases (12 849·5-15 940·1) per 100 000 population. These estimates represented a 95·5% (75·0-121·2) increase in prevalent cases and 24·2% (11·4-41·4) increase in age-standardised prevalence rate between 1990 and 2023. All mental disorders showed increases in prevalent cases between 1990 and 2023, while notable increases were seen in age-standardised prevalence rates for anxiety disorders, major depressive disorder, dysthymia, anorexia nervosa, bulimia nervosa, schizophrenia, and conduct disorder. There were an estimated 171 million (127-228) DALYs due to mental disorders globally across sex and age in 2023, equivalent to an age-standardised DALY rate of 2070·5 DALYs (1519·1-2750·5) per 100 000 population. Mental disorders contributed to 6·1% (4·8-7·6) of all-cause DALYs in 2023, making them the fifth leading cause of global DALYs (up from 12th in 1990). DALYs were almost entirely composed of YLDs. Mental disorders were the leading cause of YLDs in 2023 (up from second in 1990), explaining 17·3% (14·8-20·6) of all-cause global YLDs. Leading causes of mental disorder DALYs were anxiety disorders (ranked 11th among the 304 diseases and injuries at Level 4 of the GBD cause hierarchy), major depressive disorder (15th), and schizophrenia (41st). Globally in 2023, mental disorder age-standardised DALY rates were higher among females (2239·6 [1643·7-3014·1] per 100 000) than among males (1900·2 [1399·8-2510·8] per 100 000), and peaked in the 15-19 years age group (2617·3 [1850·6-3696·8] per 100 000). All locations showed increased mental disorder DALY rates in 2023 compared with 1990, ranging across countries and territories from 1302·4 (952·7-1683·7) per 100 000 in Viet Nam to 3555·8 (2661·9-4715·0) per 100 000 in the Netherlands. Across SDI quintiles, DALY rates ranged from 1853·0 (1352·1-2469·3) per 100 000 for middle SDI to 2184·1 (1606·1-2890·3) per 100 000 for high SDI. A significant health burden was imposed by mental disorders in all countries and territories in 2023, irrespective of the health resources available. In some instances, this burden has increased over time and is unevenly distributed across populations. Stronger surveillance systems, particularly in low-income and middle-income countries, are required. Additionally, we need more coordinated and inclusive policies to reduce the burden through early treatment and prevention, tailored to sex and age differences across locations. Responding to the mental health needs of our global population, especially those most vulnerable, is an obligation, not a choice. Gates Foundation, Queensland Health, and University of Queensland.
Cardiovascular diseases (CVDs) are the leading cause of mortality and are among the foremost causes of disability globally. CVD burden has continued to increase in most countries since 1990, with trends driven by changing exposures to harmful risk factors, population growth, and population aging. We report estimates of global, national, and subnational CVD burden, including 18 subdiseases and 12 associated modifiable risk factors. We analyzed change in CVD burden from 1990 to 2023 and identified drivers of change including population growth, population aging, and risk factor exposure. The Global Burden of Disease (GBD) 2023 study, a multinational collaborative research study, quantified burden due to 375 diseases including CVD burden and identified drivers of change from 1990 to 2023 using all available data and statistical models. GBD 2023 estimated the population-level burden of diseases in 204 countries and territories from 1990 to 2023. CVDs were the leading cause of disability-adjusted life years (DALYs) and deaths estimated in the GBD. As of 2023, there were 437 million (95% UI: 401 to 465 million) CVD DALYs globally, a 1.4-fold increase from the number in 1990 of 320 million (292 to 344 million). Ischemic heart disease, intracerebral hemorrhage, ischemic stroke, and hypertensive heart disease were the leading cardiovascular causes of DALYs in 2023 globally. As of 2023, age-standardized CVD DALY rates were highest in low and low-middle Socio-demographic Index (SDI) settings and lowest in high SDI settings. The number of CVD deaths increased globally from 13.1 million (95% UI: 12.2 to 14.0 million) in 1990 to 19.2 million (95% UI: 17.4 to 20.4 million) in 2023. The number of prevalent cases of CVD more than doubled since 1990, with 311 million (95% UI: 294 to 333 million) prevalent cases of CVD in 1990 and 626 million (95% UI: 591 to 672 million) prevalent cases in 2023 globally. A total of 79.6% (95% UI: 75.7% to 82.5%) of CVD burden is attributable to modifiable risk factors 347 million [95% UI: 318 to 373 million] DALYs in 2023). Globally, high systolic blood pressure, dietary risks, high low-density lipoprotein cholesterol, and air pollution were the modifiable risks responsible for most attributable CVD burden in 2023. Since 1990, changes in exposure to modifiable risk factors have had mixed effects on CVD burden, with increases in high body mass index, high fasting plasma glucose, and low physical activity leading to higher burden, while reductions in tobacco usage have mitigated some of these increases. Population growth and population aging were the main drivers of the increasing burden since 1990, adding 128 million (95% UI: 115 to 139 million) and 139 million (95% UI: 126 to 151 million) CVD DALYs to the increase in CVD burden since 1990. CVD remains the leading cause of disease burden and death worldwide with the greatest burden in low, low-middle, and middle SDI regions. Large variation exists in CVD burden even for countries at similar levels of development, a gap explained substantially by known, modifiable risk factors that are inadequately controlled. The decades-long increase in CVD burden was the result of population growth, population aging, and increased exposure to a subset of risk factors led by metabolic risks. Countries will need to adopt effective health system and public health strategies if they are to progress in achieving global goals to reduce the burden of CVD.
We aimed to review and analyze the status of Medical Parasitology course including current problems and challenges on human resources, infrastructure, research capacities, educational and investigative priorities in Iran, and to develop a roadmap and future development in this field. A questionnaire was prepared to obtain information on Medical Parasitology departments in the country followed by field visits in many cases to collect data on the status of the faculty members, laboratory experts, physical spaces, laboratory equipment, microscopic slides, training Parasitology techniques, research projects and theses, published articles and books, access to Parasitology journals, books and e-books during 2022-2023. A roadmap and future development for Medical Parasitology in Iran and the formulation of a desirable status concerning short term to long-term goals was compiled. While prominent strengths such as capable research laboratories, experienced faculty, suitable educational spaces, active research centers, the existence of centers for keeping and working with laboratory animals, international and national collaborations are seen in a number of medium to large centers, shortcomings related to expert human resources, lack of educational equipment and slides, the need to upgrade especially in practical subjects, journal clubs, and lab meetings, research infrastructure such as laboratory animal houses, budget for theses and research projects urgently need attention. Among 132 universities, faculties, and educational-research centers training personnel in allied medical sciences disciplines, a considerable number lack Parasitology specialists. Iran has a strong foundation in Medical Parasitology. However, using non-permanent faculty paid per course in medical education undermines quality and strains resources, exacerbating shortages. Universities must implement tailored strategic plans for parasitology, regularly updated to strengthen education, research, and health services, ensuring sustained excellence in training and public health contributions.
Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050. Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer. In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5·6% (-12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3). Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment. Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.
Comprehensive, comparable, and timely estimates of demographic metrics-including life expectancy and age-specific mortality-are essential for evaluating, understanding, and addressing trends in population health. The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause, and risk. This study-part of the latest GBD release, GBD 2023-aims to provide new and updated estimates of all-cause mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex correlation structures in demographic data across age and time. We used 24 025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as well as 660 subnational units in 20 countries and territories, for the years 1950-2023. For the first time, we used complete birth history data for ages 5-14 years, age-specific sibling history data for ages 15-49 years, and age-specific mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce 95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the 25th and 975th ordered values from a 1000-draw posterior distribution. In 2023, 60·1 million (95% UI 59·0-61·1) deaths occurred globally, of which 4·67 million (4·59-4·75) were in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of annual deaths globally increased by 35·2% (32·2-38·4) over the 1950-2023 study period, during which the global age-standardised all-cause mortality rate declined by 66·6% (65·8-67·3). Trends in age-specific mortality rates between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in east Asia (67·7% decrease); the largest increases in mortality for those aged 5-14 years, 25-29 years, and 30-39 years occurring in high-income North America (11·5%, 31·7%, and 49·9%, respectively); and the largest increases in mortality for those aged 15-19 years and 20-24 years occurring in Eastern Europe (53·9% and 40·1%, respectively). We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 5-14 years (87·3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950-2021 period) and for females aged 15-29 years (61·2% higher), as well as lower than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged 50 years and older (13·2% lower), reflecting advances in our modelling approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019, there were considerable improvements, from 51·2 (50·6-51·7) years for females and 47·9 (47·4-48·4) years for males in 1950 to 76·3 (76·2-76·4) years for females and 71·4 (71·3-71·5) years for males in 2019. Second, this period was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74·7 (74·6-74·8) years for females and 69·3 (69·2-69·4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in 2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76·3 [76·0-76·6] years for females and 71·5 [71·2-71·8] years for males). 194 (95·1%) of 204 countries and territories experienced at least partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61·8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across countries and territories. Long-term mortality trends also varied considerably between age groups and locations, demonstrating the diverse landscape of health outcomes globally. This analysis identified several key differences in mortality trends from previous estimates, including higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19 pandemic (2020-23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes, and SDI levels in recent years as well as over the entire 1950-2023 study period provide crucial information for governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared to address the world's health needs, particularly in populations with higher rates of mortality than previously known. The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development, implementation, and evaluation around the world. Gates Foundation.
A 3-year-old cow which suffered from anorexia and high fever for the last 2 days was investigated at farmer door step. Detailed examination of cow showed high temperature (40.5 °C, pale conjunctival mucous membrane, increased size of pre-scapular lymph nodes and severe tick infestation. Examination of blood smear showed the presence of Theileria spp. Haematological values showed low value of hemoglobin (4 gm/dl), TEC (2.3×106/μl), PCV (14%) with mild leukocytosis (14.5×103/μl). The biochemical values were almost within the normal reference range except for AST (88U/L). PCR amplification of the hsp70 gene was done from genomic DNA which was isolated from cattle blood and the results showed amplification of approx. 270 bp. In silico analysis of the generated DNA sequence confirm the species of the parasite as T. annulata and the phylogenetic inference of the generated sequence (MH178373) showed cladding with Theileria infecting domesticate bovines. This study proposed the use of heat-shock protein 70 (hsp70) gene of Theileria species for inter-species characterization and phylogeny. Treatment with intra-muscular single dose of Buparvaquone (Intas Pharmaceutical Pvt. Ltd., India; 2.50mg kg-1along with intra-muscular anti-pyrectic drugs Meloxicam and Paracetamol combination (Intas Pharmaceutical Pvt. Ltd., India;15 mg kg-1 q24)for 2 days and oral preparation of haematinics (Intas Pharmaceutical Pvt. Ltd., India; 50 ml q24) for 10 days. This is the first report on molecular detection of Theileria annulata infection from cattle in Tripura, as per available scientific literature.
Hydatidosis is one of the common parasitic diseases common to both humans and animals with global spread. The disease is very important from both public health and economic perspectives. The parasite presents with highly diverse genetic features, including a different genotype which affect the life cycle of the parasite, its transmission routes, pathogenicity, immunogenicity, response to drugs, epidemiology and disease control. Therefore, we aimed to identify the genotype of hydatid cysts isolated from slaughtered animals in Sabzevar and Neyshabour slaughterhouses by sequencing and high-resolution melting curve analysis. Out of 35 hydatid cyst samples, including 19 from sheep (15 liver and 4 lung samples) and 16 from cattle (9 liver and 7 lung samples) were included in this study. After the extraction of protoscoleces and DNA, a high-resolution melting curve analysis method was used to identify the genotype of the samples using pre-determined G1, G3, and G6 standard samples. Out of 35 hydatid cyst samples, 89.5% G1 and 10.5% G6 were detected in sheep samples, and 93.7% G1 and 6.3% G6 were detected in cattle samples. Results showed in the Sabzevar City, dominant genotype there was G1 and COX1 gene considered a perfect biomarker in a molecular identification and phylogenetic study of this parasite. G1 was the most prevalent in samples of hydatid cysts (both sheep and cattle) in Sabzevar, while in Neyshabour samples, G1 and G6 were the most dominant types.
In the leishmaniasis parasitic infection, parasite escapes from the immune system of host or prevents macrophage apoptosis. It seems generating transgenic parasites to express proapoptotic proteins can accelerate the apoptosis of infected macrophage and prevent Leishmania differentiation. Hence, we investigated the efficacy of transgenic L. tropica expressing mLLO-BAX-SMAC in expediting macrophage apoptosis. This study was performed at the Department of Parasitology and Mycology, School of Medicine, Isfahan University of Medical Sciences (2022 to 2023), Isfahan, Iran. mLLO-Bax-Smac coding sequence cloned in the pLexyNeo2 was entered into the L. tropica genome using homologous recombination. PCR, Western blot, and hemolysis tests were used to confirm integration accuracy. In addition, the apoptosis percentage of transgenic L. tropica- infected macrophages was assayed by flow-cytometry. The proper integration of the mLLO-Bax-Smac fragment into the 18srRNA locus of L. tropica and mLLO -BAX-SMAC fusion protein expression was approved. Furthermore, results of flow cytometry showed the mean percentage of apoptosis among the groups is different and transgenic L. tropica leads to a decrease in the apoptosis time of infected macrophages compared to the wild type of Leishmania and to an increase in the immune system response. The data suggest the transgenic L. tropica can be used as an experimental model to expedite apoptosis of Leishmania-infected macrophage.
We aimed to investigate the seroepidemiology of Toxoplasma gondii infection among women of childbearing age in Gonabad City, northeastern Iran, to assess the prevalence of infection and identify associated risk factors. A cross-sectional study was conducted from March to April 2022 in Gonabad, Khorasan Razavi Province, northeastern Iran. A total of 320 blood samples were collected from consenting women of reproductive age. Each participant provided 5 mL of blood for serological analysis to detect anti-Toxoplasma IgG and IgM antibodies. Demographic and behavioral data were collected using a structured questionnaire. The mean age of participants was 29.74 ± 10.9 years. Of the 320 samples, 58 (18.12%) tested positive for anti-Toxoplasma IgG antibodies, while 1 (0.3%) tested positive for IgM antibodies. In addition, 81.9% of participants were seronegative. No significant associations were observed between anti-Toxoplasma antibodies and marital status, education level, vegetable washing practices, egg cooking methods, milk consumption, or fertility status. However, significant correlations were found between seropositivity and contact with cats (P= 0.01) and meat consumption (P< 0.05). The majority of women of childbearing age in Gonabad remain susceptible to T. gondii infection, highlighting the risk of primary infection during pregnancy. To mitigate the risk of congenital toxoplasmosis, serological screening for Toxoplasma infection is recommended for women of childbearing age, coupled with targeted health education on transmission routes and preventive measures.
Schistosomiasis is the second most prevalent global parasitic endemic, following malaria. It is caused by trematodes of the Schistosoma genus. We aimed to evaluate the incidence of urinary schistosomiasis and the associated risk factors in educational institutions. The investigation was conducted in two primary schools in Abougoudam and Chokoyan City, Chad from December 2021 to February 2022. Parasitological analyses were performed at the laboratory of Abeche Provincial Hospital and Chemistry and Microbiology Laboratory of National Higher Institute of Science and Techniques of Abeche (INSTA) in Chad. In the study 273 scholars, namely 136 males (49.82%) and 137 girls (50.18%), from two primary schools in two localities, were enrolled. The overall prevalence of Schistosoma haematobium was 42.86%. Boys had a prevalence of 44.85%, while females had a prevalence of 40.88% (P>0.05). The prevalence in the Chokoyan locality was 53.38%, while it was 32.86% in the Abougoudam locality (P<0.05). The prevalence of pupils in the [5-10] age group was 29.73%, while that of the [11-15] age group was 51.85% (P<0.05). 100% of the pupils who were afflicted were administered 40 mg/kg praziquentel. S. haematobium is present in both localities; therefore, health education campaigns should be implemented to prevent the onset of this parasitosis and to facilitate the establishment of a national program to combat helminthiasis. S. haematobium bilharziasis continues to be a significant public health issue in Chad.
The present study was carried out to investigate the prevalence of intestinal microsporidia in patients with intellectual disabilities in the rehabilitation centers of Hormozgan Province in south of Iran, using microscopic and molecular methods. The current cross-sectional study was conducted on 119 stool samples obtained from patients with intellectual disabilities. Acid-fast trichrome staining was used to detect parasites. Moreover, all of the stool samples were assessed for the presence of microsporidia DNA by the PCR method. The mean age of the subjects was 29 (±12.3) years. All stool samples were examined for microsporidia infection, and only one case of Enterocytozoon was detected in one of the samples. The results of the nested-PCR test on 119 stool samples showed one case of infection with Enterocytozoon bieneusi, corresponding to a prevalence of 0.84%. The nested-PCR test for Encephalitozoon intestinalis detected no infections in any of the stool samples. The overall prevalence of microsporidia among patients with intellectual disabilities in Hormozgan rehabilitation centers is low and limited to E. bieneusi.
Sarcocystis spp. is zoonotic parasitic pathogen endangering the safety of meat and derived meat products. This study was carried on for determination of presence of Sarcocystis species in mincemeat in Tabriz (Iran) using single-stranded conformation polymorphism (SSCP) method. Thirty samples of mixed ground meat were collected from butchers and DNA was extracted. The 18S rRNA gene fragment of S. cruzi and S. hominis species in the extracted DNA amplified by PCR using one pair specific primers, which resulted in 937 bp length fragments in parasite-positive samples. The results showed that 11 samples out of 30 (36%) were positive for S. cruzi and S. hominis species. The SSCP technique products of gene indicated 4 SSCP patterns (A, B, C and D) among study samples on 18S rRNA gene of S. cruzi and S. hominis. Contamination with Sarcocystis species in minced meat sold in Tabriz City in Iran is relatively high, which is of particular importance from a health point of view. This study was currently by SSCP technique on minced meat for the first time, based on the primers in the 18S rRNA gene locus, there are polymorphisms in S. cruzi and S. hominis species. Due to the relatively high level of Sarcocystis contamination in minced meats in Tabriz, the necessary hygienic measures should be must implemented. Also, there was polymorphism in S. cruzi and S. homonis.
Child labor (CL) is the exploitation of children through any work or activity that interferes with their ability to attend school or is harmful to their mental, physical, social, or moral well-being. Unfortunately, child laborers are a shadow population for which specific information on the prevalence of intestinal parasites is not available; we aimed to estimate the prevalence of intestinal parasites among child laborers in Karaj-Alborz, Iran. The present study was conducted with a cross-sectional design between 2020 and 2022 in Karaj-Alborz, Central Iran. Two hundred and three stool samples were collected from working children in Karaj and its suburbs. The samples were examined for the presence of intestinal parasites at Alborz University of Medical Sciences using parasitological techniques (e.g., t smear, Formalin-Ether concentration, modified tri-chrome staining, and Ziehl-Neelsen staining). The prevalence of intestinal parasites in CLs was estimated at 76% (156/203), of which 76.4% (155/156) were associated with protozoa and 1/203 (0.5%) with helminths. The highest prevalence was related to the protozoan Blastocystis hominis (89 cases (43.8%)), and among the pathogens, 11 cases (5.4%) of Giardia duodenalis were isolated. The significant and alarming prevalence of intestinal parasites in CLs requires preventive, supportive, and therapeutic measures for this vulnerable population. Further attention should focus on the health status of child laborers in future studies.
We aimed to investigate the genetic diversity and population structure of Echinococcus granulosus using various cyst materials from the parasite obtained from humans in eastern Türkiye. We used cyst samples from 61 patients diagnosed with hydatid cysts by the Department of Thoracic Surgery and Department of Radiology at Atatürk University Faculty of Medicine between 2019 and 2023. Microscopic examination of protoscolex in cyst samples was performed, and, if available, the patients' ELISA IgG results were obtained from the hospital automation system. Two primer pairs revealed DNA regions specific to E. granulosus (12S rRNA and mt-COX1). Sequence analysis was performed on samples found positive for mt-COX1 PCR, and a phylogenetic tree was constructed from the resulting data. The rate of scolex in microscopic examination was 31/61 (50.8%), and the ELISA IgG positivity rate was 36/51 (70.6%). As a result of PCR analysis of 12S rRNA and mt-COX1 gene regions of 61 cyst samples, positivity was determined in 48 (78.7%) samples. As a result of PCR product sequence analysis, it was found that all samples were of the E. granulosus sensu stricto (G1, G3) genotype. Lung cyst alone was detected in 25 (40.9%) cases, while only liver cyst was detected in 15 (24.6%) cases. In 13 (21.3) cases, cysts were present in both the lungs and the liver. The genotype of E. granulosus isolates obtained from cyst material from patients diagnosed with hydatid cysts in Erzurum and surrounding provinces was a domestic sheep strain (G1, G3).
We sought to determine how often Blastocystis. occurs and which sub-types predominate in patients suffering from diarrhea in Van, Türkiye. We enrolled 200 volunteers-100 with diarrhea and 100 healthy controls-and examined their stool samples both by light microscopy and by PCR amplification of the 18S SSU rRNA gene. DNA sequences from 14 positive PCR amplicons were analyzed for the 18S SSU rDNA gene, and the subtypes were identified by sequence analysis of the PCR amplicons. Blastocystis was identified in 20 of 100 diarrheal patients (20%) and in 16 of 100 controls (16%). Among patients, the highest carriage rate was seen in females (21.6%), whereas in the control group it was males who showed the greatest prevalence (20.7%). When stratified by age, individuals aged 11-18 years exhibited the highest positivity: 40% in the patient cohort and 21.4% among controls. No significant differences emerged between patient and control groups with respect to age or sex overall, although the comparison of under-18s (23%) versus those 19 and older (10.3%) reached statistical significance (P = 0.013). Statistical analysis did not reveal any link between Blastocystis carriage and gastrointestinal symptoms. Sequencing of positive diarrheal samples showed that subtype 1 (ST1) accounted for 71.4% and subtype 2 (ST2) for 28.6% of cases. The dominance of ST1 in diarrheal patients supports the subtypepathogenicity relationship; however, further studies involving a large number of symptomatic and asymptomatic individuals are required to elucidate this relationship more precisely.
The use of nanocarriers in combination with other treatments shows significant promise in addressing drug-resistant diseases, particularly malaria. Given the high prevalence of drug-resistant malaria, research into innovative therapies is crucial. This study focuses on a nanoform of chitosan, a biodegradable polymer, combined with Crocus sativus (saffron) and chloroquine to enhance their antimalarial effects. Saffron extract and chloroquine were separately conjugated with chitosan, followed by confirmation tests to determine conjugation efficiency. Both chloroquine-resistant and sensitive strains of Plasmodium falciparum were cultured to calculate the IC50 values of various treatments in vitro. This study was conducted at the School of Public Health, Tehran University of Medical Sciences, Tehran, Iran in 2024. Confirmation tests (FTIR, DLS, Zeta potential, TEM) verified proper drug conjugation to nanocomposites, with observed nanosize, the percentage of conjugation was 64.4% for chloroquine and 42.9% for saffron. Toxicity and hemolysis tests confirmed safe doses. The IC50s values for Chloroquine, Nanoparticle-Chloroquine, Saffron, and Nanoparticle-Saffron were 0.3, 0.8, 42.5, and 6.24 μg/ml, respectively, for the sensitive strain, and 5, 1, 12.5, and 3.12 μg/ml, respectively, for the resistant strain. Combination therapy with the fixed ratio method showed synergistic effects. Statistical analysis revealed synthesized nanocomposites' superior inhibition of P. falciparum growth compared to non-nano. Significant differences were observed in some cases (P< 0.05). Utilizing nanocarriers and combination therapy is an appropriate strategy for addressing drug resistance. Saffron's anti-malarial effects on P. falciparum were notably increased when linked to chitosan nanocomposites. Furthermore, employing a fixed ratio technique enhanced the therapeutic effectiveness of saffron when combined with chloroquine and chloroquine-nanocomposites across all concentrations.
In wildlife, the identification of parasitic infections should be pursued seriously in countries facing endangered species of animals in their geographical territories. We aimed to increase understanding of the possible role of wildlife herbivore reservoirs in the emergence of helminth infections in Kermanshah Province, western Iran. Sixty-five feces from Gazelle (Gazella subgutturosa) (N = 36 samples) and wild goat (Capra aegagrus) (N = 14 samples) were investigated. The samples were microscopically examined for gastrointestinal helminth eggs, and genomic DNA was extracted from the identified eggs. The internal transcribed spacer 2 (ITS2) region of ribosomal DNA was amplified and sequenced. Phylogenetic analysis of the nucleotide sequences confirmed the species identity. The most common species circulating in the hosts were Teladorsagia circumcincta, Marshallagia spp., and Nematodirus oiratianus, all of which are reported in the wildlife in western Iran for the first time. These findings emphasize the importance of continuously assessing the parasite status of wildlife and similar routine surveillance in domestic environments to detect and manage potential zoonotic parasite species.