Quantile regression is a powerful tool for detecting exposure-outcome associations given covariates across different parts of the outcome's distribution, but has two major limitations when the aim is to infer the effect of an exposure. Firstly, the exposure coefficient estimator may not converge to a meaningful quantity when the model is misspecified, and secondly, variable selection methods may induce bias and excess uncertainty, rendering inferences biased and overly optimistic. In this paper, we address these issues via partially linear quantile regression models which parametrize the conditional association of interest, but do not restrict the association with other covariates in the model. We propose consistent estimators for the unknown model parameter by mapping it onto a nonparametric main effect estimand that captures the (conditional) association of interest even when the quantile model is misspecified. This estimand is estimated using the efficient influence function under the nonparametric model, allowing for the incorporation of data-adaptive procedures such as variable selection and machine learning. Our approach provides a flexible and reliable method for detecting associations that is robust to model misspecification and excess uncertainty induced by variable selection methods. The proposal is illustrated using simulation studies and data on annual health care costs associated with excess body weight.

BACKGROUND: Information on Years of Life Lost (YLL) is instrumental in determining the mortality impact of disasters at the population level. YLL due to the 2015 Gorkha earthquake in Nepal, along with associated demographic disparities, has not yet been systematically studied. We therefore estimated YLL due to the 2015 Gorkha earthquake in Nepal and examined disparities by age, sex, and district. METHODS: Earthquake-specific deaths were sourced from the 2017 Nepal Police Report and disaggregated from broad age groups into 5-year intervals using a smooth, shape-preserving cubic interpolation approach that combines district-level population structures with age-specific mortality patterns. YLL were calculated by multiplying deaths in each age group by the remaining life expectancy from the 2021 Global Burden of Disease (GBD) reference life table. A sensitivity analysis was performed using the 2019 national life table for Nepal. Reporting follows the Standardised Reporting Of Burden Of Disease (STROBOD) statement. RESULTS: The earthquake caused an estimated 8,951 deaths across 41 districts, resulting in 473,280 YLL and 2,685 per 100,000. YLL rates were higher in females (2,998 per 100,000) than in males (2,365 per 100,000). Individuals under 20 years accounted for 55% of total YLL. Male-to-female YLL ratios ranged from 0.15 (Parsa) to 6.14 (Solukhumbu). YLL rates were 27% lower for males and 21% lower for females when based on the Nepal rather than the GBD life table. CONCLUSIONS: YLL due to the 2015 Gorkha earthquake varied considerably by age and sex, and estimates were influenced by the choice of life table. The 2015 Gorkha earthquake ranked among the top five leading causes of YLL in Nepal in 2015. Future research should integrate morbidity data, refine age-specific mortality estimates, and strengthen disaster risk reduction strategies targeting vulnerable groups.

Ischemic heart disease (IHD) and stroke are the leading causes of mortality and morbidity worldwide. Disability-adjusted life years (DALYs) are one of the most commonly used health gap summary measures in public health and have become an important metric for quantifying disease burdens. The main objectives of this study were to quantify the disease burden of IHD and stroke for sub-national regions of France in 2017 and to assess the relationship between social deprivation score of FDep (French Deprivation Index) and age-standardized DALY rates (ASDRs) for these diseases. We used national databases to capture mortality and morbidity data for IHD and stroke: the Center for Epidemiology on Medical Causes of Deaths (INSERM-CépiDc) and the French National Health Data system (SNDS). We applied disability weights and severity proportions retrieved from GBD (Global Burden of Disease) 2019 study to calculate the years lived with disability (YLD). DALYs estimates were calculated by combining the years of life lost due to premature mortality (YLL) and YLD for sub-national regions. In 2017, the age-standardized DALY rates per 100 000 population were: 1191 (95

BACKGROUND:Foodborne diseases are important causes of illness and death. The first estimates of their burden were published by WHO in 2015. We updated WHO estimates of the global, regional, subregional, and national foodborne disease burden caused by 42 infectious and chemical hazards in 2021, including time trends for 2000-21. METHODS:We provide a high-level summary of foodborne disease burden, expressed as incidence, deaths, and disability-adjusted life-years (DALYs). Data for burden estimation were provided from a WHO-commissioned series of systematic reviews on the incidence, aetiology, sequelae, and case fatality or mortality of the hazards. Data were analysed using hierarchical meta-regression modelling with geographical clustering and a global linear time trend, disease-specific computational models, and uncertainty propagation through Monte Carlo simulations to calculate 95% uncertainty intervals. Attribution to foodborne transmission was principally based on a structured expert judgement process. Economic impact was measured as lost productivity. FINDINGS:For 2021, foodborne transmission of the 42 hazards caused 866 million (95% uncertainty interval 680-1090) illnesses, 1·52 million (0·783-2·51) deaths, and 57·1 million (39·4-81·1) DALYs. Inorganic arsenic, lead, and non-typhoidal Salmonella enterica (diarrhoeal and invasive disease) resulted in the most DALYs. The greatest burden of foodborne disease was in the African and South-East Asia regions. The incidence in children younger than 5 years was 2·7 times higher than in people aged 5 years or older, resulting in 4·3 times the rate of DALYs. The total burden from all hazards decreased over time. In 2021, these 42 hazards resulted in productivity losses of US$310 billion in nominal terms, and US$647 billion after adjusting for purchasing power parity. INTERPRETATION:Foodborne diseases causes a burden similar to that from tuberculosis, HIV and AIDS, or malaria. The high burden of both communicable and non-communicable foodborne diseases requires countries to prioritise developing strategies to improve the safety of the food supply. FUNDING:WHO.

BACKGROUND:We updated WHO estimates of the global, regional, and national foodborne disease burden caused by chemical hazards. We estimated incidence, mortality, and disability-adjusted life-years (DALYs) of aflatoxins B1 and M1, inorganic arsenic, lead, methylmercury, cadmium, dioxin, peanut allergy, and cassava cyanide for 2000-21. METHODS:We used data from systematic reviews, established dose-response relationships, the Global Burden of Disease Study 2021, and, where applicable, a structured expert judgment study. We used disease-specific models and a hierarchical meta-regression model with geographical clustering and global linear time trend with uncertainty propagation. FINDINGS:In 2021, the nine foodborne chemicals caused 6·26 million (95% uncertainty interval [UI] 3·36-10·30) cases, 1·12 million (0·40-2·10) deaths, and 29·8 million (12·9-53·1) DALYs globally. Inorganic arsenic and lead caused the highest burden. Cardiovascular diseases due to inorganic arsenic and lead caused 88·9% of foodborne chemical deaths and 76·5% of foodborne chemical DALYs. The greatest DALY rate was estimated for the South-East Asia region, with 789 DALYs (272-1660) per 100 000 people mostly due to inorganic arsenic and lead (94·2%). The region of the Americas carried the highest foodborne chemical DALY rate in children younger than 5 years, with 749 DALYs (435-1260) per 100 000 children, mainly due to the effect of methylmercury on intellectual disability (91·0%). DALY rates from dioxin showed the steepest decrease from 2000 to 2021. INTERPRETATION:Dietary exposure to chemicals causes a substantial global disease burden. An integrated response with ongoing non-communicable disease prevention efforts is key. Granular assessment including subnational exposure contexts is essential to ensure equity. FUNDING:WHO.

BACKGROUND:Foodborne diseases cause substantial illness and death globally. We updated WHO estimates of the burden caused by non-diarrhoeal enteric disease hazards: Brucella spp; Clostridium botulinum; hepatitis A virus; Listeria monocytogenes; Mycobacterium bovis,Mycobacteriumcaprae, and Mycobacteriumorygis; invasive non-typhoidal Salmonella enterica (iNTS); S enterica serotypes Paratyphi A, B, and C; and S enterica serotype Typhi (S Typhi). METHODS:We estimated illnesses, deaths, and disability-adjusted life-years (DALYs) for 194 countries for 2000-21 using data from systematic reviews, the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study 2021, a structured expert judgement study, and WHO country consultations. We used disease-specific computational models and hierarchical metaregression modelling with geographical clustering, a global linear time trend, and uncertainty propagation. FINDINGS:In 2021, transmission of these eight hazards by food collectively caused 24·0 million illnesses (95% uncertainty interval 16·9-31·7), 106 000 deaths (63 900-169 000), and 7·26 million DALYs (4·15-12·0). S Typhi, iNTS, and hepatitis A virus caused most DALYs. The greatest burden was in the WHO African region, followed by the South-East Asia region. Mortality was 5·2 times higher and DALY rates were 8·3 times higher in children younger than 5 years compared with people aged 5 years and older. The burden for all hazards, except L monocytogenes, decreased from 2000 to 2021, with S Typhi replacing iNTS as the leading cause of foodborne DALYs. INTERPRETATION:Non-diarrhoeal enteric diseases still cause considerable foodborne disease burden, despite decreases over time. Vulnerable populations, particularly children in low-income countries, bear the greatest burden. Integrated efforts including vaccination, food safety, clean water, sanitation, hygiene, and improved health-care access are required. FUNDING:WHO.

Post-acute organ complications following COVID-19 hospitalization and potential socioeconomic inequalities therein are understudied. In this case-control study, we use individual-level data from three national health and social registries in Belgium to assess whether COVID-19 hospitalization increases the risk of post-acute organ complications within one year among 59,351 hospitalized adults without preexisting conditions affecting the specific organ system under study at baseline. In addition, we identify socioeconomic patterns in the development of these organ complications. Overlap propensity score (PS)-weighted odds ratios (ORs) and adjusted odds ratios (aORs) were estimated. All analyses were stratified between severe and critical COVID-19 hospitalization, with the latter defined by intensive care unit admission and/or the onset of acute respiratory distress syndrome. We found significant cardiovascular (overlap PS-weighted OR 1.19, 95% CI 1.03-1.37) and pulmonary (overlap PS-weighted OR 2.05, 95% CI 1.80-2.34) complications within one year following severe COVID-19 hospitalization compared to non-COVID-19 hospitalization, with particularly higher odds following critical COVID-19 hospitalization. Among severe COVID-19 patients, those with low income, compared to those with high income, had higher odds of post-acute pulmonary complications (aOR 1.53, 95% CI 1.05-2.25). Long-term care should prioritize monitoring organ complications following COVID-19 hospitalization, especially after critical illness.

BACKGROUND:Over 10 years ago, WHO estimates of hazard-specific foodborne disease burdens showed that parasites exert considerable health burdens globally. We updated these estimates, focusing on 14 invasive parasitic diseases. METHODS:Incidences, deaths, and disability-adjusted life-year (DALY) burdens were estimated for each parasitic disease from 2000 to 2021, using data from systematic reviews and the Global Burden of Diseases, Injuries, and Risk Factors Study. For some diseases, structured expert judgement was used to estimate proportions of foodborne infection. Data were pooled via hierarchical meta-regression models with uncertainty propagated through Monte Carlo simulations following disease-specific computational models defined by incidence rates and probability parameters. FINDINGS:We estimated that 277 million illnesses were caused by potentially foodborne invasive parasites, with approximately 171 million attributable to foodborne transmission. Considerable heterogeneity by parasite, in magnitude and uncertainty, was observed. Of 4·89 million foodborne DALYs associated with these diseases, highest contributions were from Taenia solium (1·3 million) and Clonorchis sinensis (0·921 million), both also associated with most foodborne deaths. Burden was greatest in the region of the Americas, predominantly due to Chagas disease, followed by the African region, where neurocysticercosis-associated epilepsy caused most burden. Burdens decreased globally from 2000 to 2021, except in the Western Pacific region, where the burden, predominantly associated with clonorchiasis, is rising. INTERPRETATION:Foodborne parasitoses cause considerable suffering, with some populations and regions particularly at risk. These data provide a baseline by which effects of interventions can be assessed and emphasis directed to those parasites exerting the greatest burden. FUNDING:WHO.

BACKGROUND:Current risk assessments of cardiovascular disease (CVD) outcomes attributable to transportation noise rely on estimates from the 2018 WHO Environmental Noise Guidelines. Since the publication of these guidelines, several studies have been conducted to determine the association between transportation noise sources and CVD; however, recent meta-analyses have not derived updated exposure-response functions. OBJECTIVE:We reviewed epidemiological evidence linking long-term exposure to road traffic, railway, and aircraft noise with non-fatal and fatal myocardial infarction, ischemic heart disease, stroke, and ischemic stroke, and derived exposure-response functions using the conventional and Burden of Proof (BoP) methodologies. METHODS:We systematically searched databases for cohort or case-control studies that determined the associations between non-fatal and/or fatal myocardial infarction, ischemic heart disease, stroke, and ischemic stroke and long-term exposure to road traffic, railway, aircraft noise in general populations. Exposure-response functions were generated using the conventional natural cubic splines and Burden of Proof Risk Function approaches. RESULTS:Twenty-six studies met our eligibility criteria. Road traffic noise was associated with 1% increase in the combined risk of stroke incidence and mortality (RR = 1.01, 95%CI: 1.00-1.02, p-value = 0.04), and with 5% increase under the BoP framework (RR = 1.05, 95%UI: 1.03-1.07). Railway noise was associated with 1% increase in myocardial infarction outcomes (RR = 1.01, 95%CI: 1.01-1.01, p-value < 0.0001), and with 16% increase under the BoP framework (RR = 1.16 95%UI: 1.07-1.26). Of the twelve risk-outcome pairs examined, five showed no evidence of association, four showed weak evidence, and the remainder lacked credible evidence or did not meet the BoP criteria. Compared with the natural splines approach, the BoP framework produced more plausible exposure-response curves. SIGNIFICANCE:This study adds to the existing literature by providing a comprehensive comparison of the association between long-term exposure to transportation noise sources and CVD outcomes using both conventional and BoP methodologies. IMPACT STATEMENT:This is the first study to apply the conventional meta-regression and Burden of Proof methodologies to systematically quantify and evaluate associations between long-term exposure to transportation noise sources (i.e., road traffic, railway, and aircraft) and combined risk of fatal and non-fatal cardiovascular disease outcomes, including myocardial infarction, ischemic heart disease, stroke, and ischemic stroke. The application of these two approaches to deriving exposure-response functions provides additional insights into the quantification of the burden of disease attributable to transportation noise. Our findings using the Burden of Proof framework on transportation noise and CVD outcomes advance the integration of an additional environmental risk factor and propose new risk-outcome pairs for potential inclusion in the Global Burden of Disease study.

BackgroundSocial inequalities remain a major determinant of mortality across Europe. This study aimed first to quantify cause-specific premature mortality across urban and rural areas in mainland France during the pre-pandemic period, taking into account social inequalities, and second to assess the extent of these social inequalities using the population attributable fraction (PAF) approach.MethodsCause-specific deaths were identified from the French national mortality database and linked to municipality-level deprivation quintiles using French-European Deprivation Index (F-EDI). Residual life expectancy at age of death was defined according to the Global Burden of Disease (GBD) 2019 reference life table. Age-standardized years of life lost rates (ASYRs) were calculated by sex, deprivation quintile, and rural-urban setting. Social inequalities in mortality were assessed using absolute and relative gaps between the least and most deprived quintiles (Q1-Q5) and PAF, with Q1 as the reference.ResultsASYRs for Level 1 GBD causes increased consistently with area deprivation in both urban and rural mainland France. Non-communicable diseases accounted for most premature mortality (85-90% of total YLL) in both sexes, followed by injuries and communicable, maternal, neonatal, and nutritional causes. In urban areas, 18-31% of cause-specific premature mortality was attributed to social inequalities, compared with 8-20% in rural areas, with higher contributions among males. The absolute difference in ASYRs was slightly larger in rural than urban areas for both sexes (females: 2,854 vs. 2,463; males: 6,607 vs. 5,618). Relative inequalities were similar across both settings (females: 1.30; males: 1.39, comparing Q5 with Q1). By cause, breast cancer showed the largest inequality among females (11-12% higher in Q5), while lung cancer exhibited the highest disparity among males (75% higher in Q5 in urban areas and 43% in rural areas).ConclusionsSocial inequalities substantially contributed to cause-specific premature mortality in pre-pandemic mainland France. ASYRs increased with deprivation in both urban and rural areas and were consistently higher among males. The persistent deprivation gradient and higher PAFs highlight the particularly marked impact of social inequalities in urban areas. These findings provide a pre-pandemic baseline for evaluating post-COVID-19 trends in premature mortality and health disparities in France.

Background: Food-based dietary guidelines (FBDGs) provide recommendations on diets that aim to decrease disease risk and environmental impact, while remaining culturally acceptable for the population. Using mathematical optimization to define such diets, these objectives can be operationalized as components of the objective function. Objectives: To 1) derive an indicator that quantifies diet-related disease burden and 2) evaluate different weighting schemes within a three-dimensional diet optimization model. Design: To address objective 1), disability-adjusted life years (DALYs) from the Global Burden of Disease Study (GBD) and a diet-specific burden estimate based on observational data were transformed into a model-compatible indicator using linear interpolation. To address objective 2), a linear diet optimization model was developed. It included constraints on nutrients and acceptability, and a three-objective function that minimized disease burden (DALYs), environmental impact (greenhouse gas emissions and land use), and, as a proxy for cultural acceptability, deviation from the observed diet. Forty-two model variations with different weighting schemes were computed and compared regarding component outcomes. Results: In proof-of-concept analyses, the derived health indicator aligned closely with values reported in the literature: 90% (based on GBD) and 99% (based on the observational data) of diet-related DALYs were captured. Among the 42 model variations, strong synergies were observed between health and environmental outcomes. Optimizing exclusively for disease burden or environmental impact resulted in substantial deviations from the observed diet, underscoring the importance of considering cultural acceptability. Model stability improved with the inclusion of all three components. Conclusion: The proposed methodology enables the integration of DALYs and provides insights about various weighting schemes to establish a diet optimization model that minimizes disease burden, environmental impact, and deviation from the observed diet, and serves as the basis to derive FBDG for Germany.

Background Fascioliasis, caused by Fasciola hepatica and Fasciola gigantica, is a global veterinary problem in livestock and an emerging zoonotic disease in various countries. Here we present prevalence estimates of Fasciola spp. in all host and environmental compartments involved in the life cycle and identified risk factors associated with Fasciola transmission in a rural community in north-central Vietnam. Methodology/principal findings We conducted a cross-sectional survey in a community in Nghe An province where fascioliasis is reported to be endemic and inhabitants commonly consume raw vegetables. Applying a simple random and cluster sampling approach, we collected 1137 stool and 1390 blood samples from 1396 human participants. From 664 buffaloes and cattle, we collected 656 fecal and 534 blood samples. We also collected 340 lymnaeid snails and 233 water plant samples. Human and livestock fecal samples were examined by copro-microscopy, while blood samples were screened by ELISA to detect Fasciola serum antibodies. We examined infections in snails using PCR and contamination of water plants deploying an in-house technique. Descriptive analysis and logistic regression models were applied to estimate the prevalence of and risk factors for Fasciola infections. While the prevalence of Fasciola infections was very low in humans (0% by copro-microscopy; 0.07% by ELISA), it was high in livestock (51.5% by copro-microscopy; 54.1% by ELISA). In the multivariable analysis, age was the only factor associated with Fasciola infections in livestock. Fasciola could not be detected in any of the sampled water plants or lymnaeid snails. Conclusion/significance This study indicated a high prevalence of Fasciola infections in livestock and a very low prevalence in humans in a rural community in north-central Vietnam. It is recommended to implement a control program to reduce the infection rate in buffaloes and cattle. Furthermore, health education activities for livestock owners should be carried out in Fasciola endemic areas.

Ageing populations and increasing prevalence of overweight are two of the main healthcare challenges worldwide. In 2023–2024, 49.7

BACKGROUND:Foodborne diseases cause significant illness and death globally. We updated WHO estimates of the burden caused by diarrhoeal hazards commonly transmitted by food: Campylobacter jejuni, Campylobacter coli, and other thermotolerant Campylobacter species; Cryptosporidium spp; Cyclospora cayetanensis; Entamoeba histolytica; enteroaggregative Escherichia coli; enteropathogenic E coli; enterotoxigenic E coli; Giardia duodenalis; norovirus; rotavirus; non-typhoidal Salmonella enterica; Shiga toxin-producing E coli; Shigella spp; and Vibrio cholerae. METHODS:We estimated illnesses, deaths, and disability-adjusted life-years (DALYs) for 194 countries for the period 2000-21 using data from systematic reviews; the Global Burden of Diseases, Injuries, and Risk Factors Study 2021; a structured expert judgement study; and country consultations. We used disease-specific computational models, and a hierarchical meta-regression model with geographical clustering, a global linear time trend, and uncertainty propagation. FINDINGS:In 2021, the 14 diarrhoeal hazards caused 666 million (95% UI 483-884) illnesses, 265 000 deaths (196 000-351 000), and 15·2 million (11·6-19·1) DALYs from foodborne transmission. Shigella spp, Campylobacter, and rotavirus caused the most DALYs from foodborne transmission. The greatest burden was in the African region (773·5 DALYs [95% UI 559·7-1033·3] per 100 000 population due to foodborne transmission). Mortality rates were 7·1 times higher and DALY rates 18·9 times higher in children younger than 5 years than in people aged 5 years or older. While the overall foodborne burden decreased between 2000 (692·3 DALYs [517·9-938·1] per 100 000 population) and 2021 (193·6 [147·2-243·0] per 100 000), this trend was not consistent for all hazards. INTERPRETATION:Diarrhoeal hazards continue to cause a substantial foodborne disease burden, despite decreases over time. Children in low-income countries bear the greatest burden. Prevention requires concerted efforts, including expanding global diarrhoeal disease prevention efforts beyond water, sanitation, and hygiene and vaccination to include improvements in the safety of the food supply. FUNDING:WHO.

BackgroundCigarette smoking is a major contributor to disability and premature death worldwide. Given the impact of smoking on population health, it is important to understand trends and socio-demographic patterns that can be most informative to public health planning. The objectives of this study are to establish a time series of cigarette smoking in Belgium, forecast future smoking prevalence, and examine socio-demographic patterns in smoking.MethodsUsing six waves of the Belgian Health Interview Survey (1997-2018), we modelled smoking prevalence and forecast trends to 2040 with a Bayesian generalized linear model incorporating population projections by age, sex, region, and educational attainment to capture demographic shifts over time.ResultsBased on modelled estimates anchored on BHIS data from 1997 to 2018, smoking prevalence in Belgium declined from 29.6% (95% CI: 25.0-34.6%) in 1997 to 17.2% (95% CI: 12.5-23.5%) in 2025. Model projections indicate a further decrease to 12.9% (95% CI: 7.3-22.4%) by 2040. In 2025, men are estimated to smoke at about 1.4 times the rate of women-20.2% (95% CI: 14.9-27.6%) versus 14.2% (95% CI: 10.2-19.6%)-a gap expected to narrow but persist by 2040 (14.5%, 95% CI: 8.4-25.6% vs. 11.2%, 95% CI: 6.3-19.3%). Across regions, the steepest decline is projected in Flanders (from 28.5% to 11.4%), followed by Brussels-Capital (31.1% to 13.3%) and Wallonia (31.0% to 15.5%), which is expected to remain the highest. Socioeconomic inequalities also persist: by 2040, smoking prevalence is projected to range from 19.0% (95% CI: 12.2-36.2%) among those with lower secondary education to 7.5% (95% CI: 4.7-13.1%) among those with more than secondary education.ConclusionsSmoking prevalence in Belgium is declining and is projected to continue this downward trend. However, persistent inequalities by sex, educational attainment, and age may result in uneven health benefits across the population. Addressing these disparities through targeted tobacco control measures will be crucial to ensuring equitable health gains for all.

Identifying the sources of foodborne diseases is crucial for guiding national food safety strategies and supporting policies that promote safe and sustainable food production. Here we present global estimates of the proportions of burden of disease attributable to foodborne transmission, other major transmission pathways, and specific food categories for 29 viral, bacterial, parasitic, and chemical hazards, based on a structured expert judgement (SEJ) study commissioned by the World Health Organization (WHO) and supervised by the WHO Foodborne Disease Burden Epidemiology Reference Group (FERG) for 2021-2025. One-hundred forty-six experts provided 1463 assessments across 17 subregions within six WHO regions. The assessments were analyzed using Cooke's Classical Model and reviewed by FERG. Results showed that 13 of the 29 hazards were mainly (>50%) attributable to foodborne transmission, with non-typhoidal Salmonella (59-74%) and Campylobacter (45-71%) estimated to be predominantly foodborne in nearly all subregions. While plant-based foods were important sources of several pathogens, such as hepatitis A virus (63-74%) and Cryptosporidium (60-95%), foods of animal origin, including poultry, beef, eggs, seafood, and dairy products, remain critical intervention targets for several others, e.g., Campylobacter (86-97%), Salmonella (77-92%), Shiga toxin-producing E. coli (67-96%), and Listeria monocytogenes (50-85%). Regional differences in attributions highlight the influence of local epidemiological patterns, food systems, sanitation, and cultural practices. These estimates provide a global, uncertainty-quantified knowledge base to guide context-specific food safety interventions and future empirical data collection. Given persistent data gaps, SEJ remains a feasible approach to generate evidence supporting efforts to reduce the burden of foodborne diseases.

Abstract Background Foodborne diseases cause substantial global morbidity and mortality, yet remain largely unattended. To support countries to address this public health concern, the World Health Assembly Resolution 73.5 called for strengthening global food safety efforts and led to the development of the WHO Global Strategy for Food Safety 2022–2030, adopted at the 75th WHA (2022). To this end, the World Health Organization (WHO) reconvened the Foodborne Disease Burden Epidemiology Reference Group (FERG) to advise and support the work to generate updated global, regional, and national estimates of the foodborne disease burden for the reference period 2000–2021. Methods We developed an incidence-based framework expanding coverage to 42 foodborne hazards. Standardized systematic reviews, Global Health Estimates and Global Burden of Disease envelopes, and United Nations population data informed the evidence base. Missing epidemiological data were imputed using Bayesian hierarchical meta-regression models. Disease models mapped acute and chronic health outcomes, applying updated disability weights, life tables, and probabilistic Monte Carlo calculations to estimate incidence, mortality, Years Lived with Disability, Years of Life Lost and Disability-Adjusted Life Years for all 194 WHO Member States. Transparency and analysis reproducibility were ensured through availed open source R packages and standardized workflows. Results The computational framework provides annual, country-level estimates with improved internal consistency and an expanded hazard scope compared with the WHO 2015 edition. Advances include refined modelling, enhanced uncertainty propagation, and broader inclusion of microbial, parasitic, and chemical hazards. Persistent data gaps—especially in high-burden regions—were filled through extensive imputation. Conclusions The computational framework for the WHO 2026 edition delivers the most comprehensive and transparent assessment of the global burden of foodborne diseases to date. Despite remaining limitations, it enables routine monitoring, supports evaluation of global food safety efforts, and highlights priorities for strengthening national data systems.

Alcohol use is associated with a high burden of disease, resulting in economic consequences. In Belgium, 77% of the population over the age of 15 regularly consume alcohol. Therefore, the objective of this study is to provide updated estimates of the annual healthcare costs and productivity losses among the Belgian population. Data from the 2018 Belgian Health Interview Survey (BHIS) were linked with health insurance claims data. Healthcare costs were calculated on individuals' alcohol use patterns (current, former, abstainer). Lost productivity costs were calculated by multiplying the number of absence days by the national average wage cost per day. Univariate and multivariable regression analysis with negative binomial distribution and log link were performed to evaluate the average healthcare costs and indirect costs in relation to alcohol use, sociodemographic characteristics, and (behavioural) risk factors. Data from 10 829 individuals were available, of which 47.7% were men. A total of 76% subjects indicated that they currently drink alcohol. Compared to abstainers, significantly lower costs were found for current drinkers (€-470; P = .002). When looking at former drinkers, a significantly higher cost (€889; P = .02) was found compared with individuals who indicated that they never used alcohol. Taking into account that 7% of the Belgian population were former drinkers in 2018, the national costs for former drinkers equates to €711 288 900. Results of our study show that alcohol use has a large economic impact on the Belgian society. Especially former drinkers have a substantial impact on direct medical costs.