Background: Deaths from homicide are a major public health challenge – not only because of their direct impact on premature mortality, but because homicides profoundly affect the health and wellbeing of communities and society as a whole. This study provides a quantification of the global burden of homicide, with attention to its geographic distribution, temporal trends, variation across age and sex, type of lethal means, and its relationship to wealth inequality. Methods: We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to produce estimates of the number of deaths and age-standardised mortality rates of homicide globally, regionally, and for 204 countries and territories from 1990 to 2023 and disaggregated these results by age and sex. In addition, we reanalysed the data to calculate relative rankings of countries by time, mean age at death, age-specific and sex-specific trends, and correlation between the Gini coefficient with homicide mortality rates. GBD 2023 estimates of homicide deaths were broken down into three collectively comprehensive and mutually exclusive categories: those by firearms, sharp objects, and by other means. We additionally calculated the fraction of all homicides that each fatal category represents by location, age, sex, and year. We used the Gini coefficient in our analysis to identify regional disparities and provide a quantitative measure to understand how income inequality is related to rates of homicide. We acquired data from vital registration, verbal autopsy, police records, and mortality surveillance from GBD 2023. Uncertainty intervals (UIs) were generated using the 2.5th and 97.5th percentiles from a 250-draw distribution for each metric. Findings: Globally, from 1990 to 2023, there were 15.0 million (95% UI 13.8–16.4) homicide deaths. In 2023, there were 436 000 deaths (384 000–508 000), including 350 000 male deaths (300 000–427 000) and 85 600 female deaths (67 600–117 000). Ranking countries based on homicide mortality rates showed that 61 countries shifted into lower deciles, indicating relative improvement, while 65 countries moved to higher deciles, indicating relative worsening. There were 78 countries that remained in the same decile group relative to other countries. Homicide is a highly geographically concentrated cause of death that continuously ranks among the top ten causes of death in four regions, while global progress has stalled over the past decade. When measuring the relationship between homicide and wealth inequality through the Gini coefficient, we found a statistically significant positive relationship globally. This relationship holds true for different types of lethal means, across different super-regions, and between males and females. Additionally, we found that a smaller percentage of homicide victims were female when firearms were used, but a higher percentage were female when other means were used. Interpretation: Although most forms of violence – including homicide – are considered preventable through targeted public health approaches, global homicide rates have remained largely unchanged since 1990, apart from the considerable declines throughout the 2000s. This decline is marked by the post-Soviet transition in eastern Europe and central Asia, following the instability and crisis created by the fall of the USSR, and by concurrent improvements in central Latin America. In regard to type of lethal means, our findings identify a critical divergence in homicide profiles: the Americas remain dominated by male-centric firearm mortality, while other regions exhibit a disproportionate burden of female homicides perpetrated by non-firearm means. These distinct epidemiological patterns suggest that global homicide prevention cannot rely on uniform strategies; rather, it requires precision policy-making that addresses regional weapon availability and sex-specific risk factors to achieve measurable declines in mortality.

Aim: Diabetes mellitus is a growing non-communicable disease (NCD) imposing major health and economic burdens in Ethiopia. While prior national and subnational estimates have been published using Global Burden of Disease (GBD) 2019 data, this study provides novel, updated estimates reflecting newly delineated regional boundaries and recent socio-demographic shifts using GBD 2023 data. We aimed to estimate the national and subnational burden and trends of diabetes mellitus in Ethiopia from 1990 to 2023. Methods: This analysis is part of the GBD 2023 study, a collaborative effort between the Ethiopian Public Health Institute and the Institute for Health Metrics and Evaluation. Estimates were generated using standard GBD modeling tools [DisMod-MR 2.1 and Cause of Death Ensemble modeling (CODEm)] for incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and DALYs [with 95% uncertainty intervals (UI)] across Ethiopia’s regions and city administrations. Results: In 2023, Ethiopia’s age-standardized prevalence of all forms of diabetes mellitus (type 1 and type 2 combined) was 2,996.4 (95% UI: 2,704.8–3,269.5) cases per 100,000 population. Type 2 diabetes accounted for nearly 99% of cases. The Somali region had the lowest prevalence (2,243.1 per 100,000), about 45% lower than in Sidama (4,066.4 per 100,000), highlighting marked regional disparities. The age-standardized DALY rate was 1,124.2 per 100,000. While high fasting plasma glucose was the leading proximal risk factor, high body mass index ranked as the top upstream modifiable risk factor (264.1 DALYs per 100,000). Conclusions: This study highlights the substantial and unevenly distributed burden of diabetes mellitus in Ethiopia, driven predominantly by type 2 diabetes and modifiable metabolic risk factors. These findings call for tailored, region-specific strategies, such as targeted obesity prevention in high-prevalence urban centers and strengthened health system capacity in high-mortality pastoral regions to curb the future burden and align with global NCD targets.

Leukaemias are malignant neoplasms that affect the bone marrow, compromising the production of functional blood cells. In Brazil, leukaemia is the 13th most frequent cancer and the most common among individuals up to 20 years old. This study analysed the incidence and mortality of acute and chronic myeloid and lymphoid leukaemias in Brazil from 1990 to 2021, using adjusted and estimated data from the Global Burden of Diseases Study 2021. This is an ecological time-series study with age-standardised rates, expressed per 100,000 inhabitants. Trends were assessed using Joinpoint regression, considering the average annual percentage change. The results indicated an increase in the incidence of chronic lymphocytic leukaemia (CLL) and Acute Myeloid Leukaemia in males, as well as an increase in AML-related mortality in both sexes. On the other hand, a reduction in the incidence and mortality of acute lymphocytic leukaemia (ALL) and chronic myeloid leukaemia (CML) was observed in both sexes. ALL-related mortality also decreased in females, whereas CLL-related mortality increased in males. According to age group and sex, varied trends were observed for these neoplasms. These findings highlight the need for further studies on haematologic neoplasms to inform public health policies, foster research on targeted therapies and promote advancements in the management of these diseases in Brazil.

Road traffic injuries (RTIs) represent a significant global public health issue, particularly in low- and middle-income countries like Brazil. Despite the high mortality rates and associated costs, there is limited comprehensive literature addressing long-term mortality resulting from RTIs. Most research tends to focus on rates and hospitalization figures while neglecting the connection between hospitalizations and causes of death, partly due to the challenges of follow-up studies. This study employed record-linkage methodology to create a database that includes both hospitalization and mortality records. The aim was to estimate all-cause and cause-specific relative risks (RR) of death among inpatients due to road traffic accidents, compared to those hospitalized for other reasons, over a time span of three months to ten years. A retrospective cohort study examined hospitalization data for RTIs and mortality from 2000 to 2015 using Brazil's Unified Health System (Sistema Único de Saúde - SUS in Portuguese), excluding any obstetrics-related admissions and deaths, and calculated RR stratified by sex and age over 15 years old. The findings indicated a significantly higher mortality risk of 3.23 (95% Uncertainty Interval: 3.08- 3.39) for individuals previously hospitalized for RTIs compared to others during follow-up. Males aged 15- 29 and 30- 59, especially those with motorcycle, vehicle, or pedestrian injuries, exhibited an elevated mortality risk compared to other inpatients. Furthermore, individuals with prior RTIs experienced increased mortality risks from substance use disorders, violence, and suicide. This research may enhance our understanding of the complex factors associated with road traffic injuries, underscoring the importance of recognizing how RTIs contribute to long-term mortality to inform better prevention strategies and policies.

Type 2 diabetes is a major and growing public health challenge worldwide, contributing substantially to premature mortality and disability. Increasing evidence suggests that long-term exposure to air pollution, plays an important role in the development and progression of type 2 diabetes. Countries with high levels of ambient air pollution may therefore experience a disproportionate diabetes burden attributable to environmental exposure. In Iran, where both diabetes prevalence and air pollution levels are high, national- and subnational-level evidence on the burden of type 2 diabetes attributable to air pollution remains limited. This study aimed to estimate the national and provincial burden of type 2 diabetes attributable to air pollution in Iran using data from the Global Burden of Disease (GBD) 2021 study. We used the GBD 2021 data in order to estimate mortality and disability-adjusted life years (DALYs) due to type 2 diabetes attributable to air pollution in Iran from 1990 to 2021. Exposure to air pollution included both ambient fine particulate matter and household air pollution from solid fuels, assessed using GBD exposure models that integrate satellite observations, ground-based measurements, and chemical transport modeling. The population-attributable fraction (PAF) was calculated to quantify the contribution of air pollution to type 2 diabetes using established GBD comparative risk assessment methods. Estimates were produced at national and provincial levels and stratified by age, sex, and year. In 2021, air pollution was responsible for 2,872.92 (95

Background 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. Methods 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. Findings 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. Interpretation 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. Copyright (c) 2026 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

Background: Lower respiratory tract infections (LRTIs) remain a leading cause of morbidity and mortality worldwide, with a disproportionate impact in low- and middle-income regions. Reliable, up-to-date burden estimates are essential for informing public health strategies, particularly in Latin America and the Caribbean, where respiratory infections remain a persistent challenge. High incidence strains the healthcare system capacity and quality, while prevention and management strategies remain limited or heterogeneous across countries. Methods: We analysed estimates from the Global Burden of Disease (GBD) 2023 study to quantify the burden of LRTIs in Latin America and the Caribbean between 1990 and 2023. Cause-specific estimates of mortality, incidence, and disability-adjusted life years (DALYs), expressed as years of life lost (YLL) plus years lived with disability (YLD), were extracted from the GBD Results Tool. Estimates were produced following the standardised GBD protocol, coordinated by the Institute for Health Metrics and Evaluation (IHME), which synthesises multiple data sources using validated statistical models. Findings: Globally, LRTIs accounted for 41·0 (36·0–48·0) deaths per 100 000 person-years in 2023, representing a 33·2% decline from 62 (53·0–72·0) per 100 000 in 1990. Within Latin America and the Caribbean, trends were heterogeneous across countries. Mortality rates declined substantially in Chile (from 48·0 [44·1–51·8] to 27·9 [24·1–31·4] deaths per 100 000; annualized rates of change [ARC] -1·63) and Mexico (from 36·3 [33·3–39·8] to 28·2 [24·6–32·3]; ARC -0·76), while reductions were most pronounced among children under five years, notably in Brazil (from 150·6 [131·2–175·2] to 18·5 [15·9–21·3] per 100 000; ARC -6·16) and Chile (from 55·1 [50·6–60·1] to 5·4 [4·3–6·5]; ARC -6·79). DALY rates also declined markedly in several countries, with the largest reductions observed in Peru (from 5771·5 [4896·0–6845·4] to 1629·9 [1357·9–1940·8] per 100 000; ARC -3·76) and Mexico (from 2359·6 [2123·0–2619·1] to 825·5 [727·2–927·7]; ARC -3·13). Following a sustained decline in incidence from 1990 to 2019, the post-COVID-19 era saw a marked reversal across all age groups, with incidence rates rising steadily through 2023, most notably among children under five years in Brazil (ARC +7·919) and Suriname (ARC +8·844), and older adults over 70 years in Cuba (ARC +5·050) and Chile (ARC +5·138). Based on aetiological causes, in 2023 Streptococcus pneumoniae remained the leading agent of LRTI mortality in the region (7·84 [6·99–8·92] deaths per 100 000), followed by Staphylococcus aureus (3·36 [3·02–3·69] deaths per 100 000). Interpretation: LRTIs remain a leading cause of death and disability in Latin America and the Caribbean, yet our findings demonstrate substantial progress in reducing mortality and DALY burden over three decades. We document marked heterogeneity across countries and age groups, with the greatest gains among children under five years old. Shifts in pathogen distribution are evident: S. pneumoniae persists as the leading cause of LRTI mortality, while S. aureus and non-tuberculous mycobacteria (NTM) have emerged as increasingly important contributors. The post-COVID period has reversed prior incidence trends across all age groups, underscoring the vulnerability of regional health systems to pandemic disruptions. These findings highlight the urgent need for sustained investment in vaccination programmes, equitable access to care, and strengthened epidemiological surveillance to reduce the burden of LRTI in the region.

Background: Antimicrobial resistance (AMR) is recognised as one of the most significant and intricate challenges to global health. Although reports emanating from the WHO Western Pacific Region are increasingly recognising the implications of antibiotic resistance on human health, there is an urgent need for more precise estimates to gain a better understanding of the exact extent of the problem. Here, we present a comprehensive time-trend analysis of regional and country-level AMR burden estimates in the WHO Western Pacific Region (WPR) between 1990 and 2021, with forecasts up to 2050. Methods: We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR across 11 infectious syndromes, 22 bacterial pathogens, and 84 pathogen–drug combinations for the WHO Western Pacific Region and its constituent countries between 1990 and 2021. Data inputs were drawn from multiple sources, including mortality registration systems, surveillance platforms, hospital records, systematic literature reviews, and other relevant datasets. The modelling framework comprised five key components: estimation of deaths in which infection had a role, the proportion of infectious deaths attributable to specific syndromes, allocation of syndrome-specific deaths to individual pathogens, the percentage of a given pathogen resistant to an antimicrobial drug of interest, and quantification of the excess mortality risk or prolonged infection duration associated with resistance. These elements were combined to estimate disease burden under two counterfactual scenarios: AMR-attributable burden (assuming drug-resistant infections were replaced by drug-susceptible infections) and AMR-associated burden (assuming infections were prevented altogether). Country-level estimates were produced using predictive statistical models, and forecasts of AMR burden were generated through 2050. Uncertainty was quantified by constructing 95% uncertainty intervals (UIs) based on the 2.5th and 97.5th percentiles of 500 draws propagated through the multi-stage computational pipeline, with model performance assessed through out-of-sample cross-validation. Findings: We estimated 1 150 000 deaths (95% UI 1 000 000–1 290 000) associated with bacterial AMR and 213 000 deaths (182 000–245 000) attributable to bacterial AMR across 32 locations in the Western Pacific Region in 2021. Over the past 31 years, AMR mortality trends showed substantial variation across countries of the region and different age groups. Between 1990 and 2021, deaths among children under 5 years dropped by 87.3%, while those among adults aged 70 and older rose by 88.9%. Three pathogens were associated with more than 50% of all deaths (both associated with and attributable to AMR) in 2021: Staphylococcus aureus, Streptococcus pneumoniae, and Escherichia coli. By using age-standardised mortality rates, we showed that the Solomon Islands (121.3 [93.0–150.0]) and Kiribati (121.0 [93.0–150.0]) were the countries with the highest age-standardised mortality rates (ASMR) associated with AMR, while Kiribati also had the highest ASMR attributable to AMR 30.9 (24.1–37.8) per 100 000 population in 2021. Conversely, the country with the lowest burden in WPR in 2021 was New Zealand, whereas Australia had the lowest ASMR in 1990. Our forecasts show that an estimated 1 840 000 deaths (1 460 000–2 230 000) associated with AMR and 402 000 deaths (322 000–480 000) attributed to AMR could occur in this region in 2050. Interpretation: We have demonstrated a clear and tangible impact of the WHO Western Pacific Region on the overall estimated global burden of AMR over 30 years, revealing considerable fatal and non-fatal burden of key resistant bacterial pathogens and pathogen–drug combinations. Despite inherent limitations related to data availability, our estimates can serve as a valuable resource for informed decision-making regarding resource allocation and funding—emphasising the need for collaborative, multi-sectoral initiatives among nations to effectively address the complex challenges posed by AMR. Funding: Wellcome Trust, and the UK Department of Health and Social Care using aid funding managed by the Fleming Fund.

Neglected Tropical Diseases (NTDs) comprises over 20 preventable infectious illness that disproportionately affecting low- and middle-income countries, including Ethiopia. Although national control initiatives have expanded since 2013, evidence on recent national and subnational burden trends remains limited. This study aimed to assess trends in mortality and disability-adjusted life years attributable to neglected tropical diseases in Ethiopia at national and subnational level from 1990 to 2023. We used data from the Global Burden of Disease 2023 study to estimate age-standardized and age-specific mortality and Disability-Adjusted Life Years (DALYs) attributable to neglected tropical diseases. Results are presented as absolute numbers and age-standardized rates (per 100,000 population), disaggregated by disease, sex, region, and year from 1990 to 2023, with 95% uncertainty intervals. In 2023, the national age-standardized DALY rate for all NTDs was 708.3 where, schistosomiasis accounted the largest share ( 228.7; 95% UI: 145.4–375.0 ) , followed by other NTDs ( 104.4; 95% UI: 59.7–171.4), trachoma (100.0; 95% UI: 67.4–144.9), and rabies (78.3; 95% UI: 9.5–257.9), together contributed to over three-quarters DALYs due to NTDs. The national age-standardized mortality rate was 5.98 mostly contributed by schistosomiasis (2.01; 95% UI: 1.72–2.38) and rabies (1.40; 95% UI: 0.18–4.58). Substantial regional variation was observed, with Addis Ababa recording the lowest (200.5 and 1.2) and Afar the highest (860.3 and 8.9) DALYs and mortality rate due to all NTDs respectively. Between 1990 and 2023, DALYs and mortality rate declined by 87.5% and 91.6%, respectively, although declines slowed after 2010. During 2010–2023, increases in DALYs and mortality due to schistosomiasis were observed in Addis Ababa (+25%) and Harari (+13%), while trachoma increased in Oromia (+9%). NTDs continue to impose a substantial burden of disability and mortality in Ethiopia, with pronounced regional disparities and a slowing pace of progress in recent years. The observed stagnation or increases in specific NTDs at the subnational level highlight the need for sustained monitoring and targeted control strategies.

Abstract Background Accurate underlying cause of death (CoD) data is critical for informing public health policy, but inaccurate CoD assignment, here called garbage code (GC) deaths, compromise CoD research and monitoring. Since 1997, GCs have consistently made up over 20% of all underlying CoDs in Sweden, but the distribution of GC deaths by sociodemographic status of the deceased remains poorly understood. Methods We used the Swedish Cause of Death Register containing 2.50 million death records from 1997 to 2023. We mapped each record to the Global Burden of Disease (GBD) project cause list and categorized GC deaths by disease groups. We calculated the fraction of deaths that were GCs by individual age, sex, region of death, and highest educational attainment. We performed redistribution of GCs onto well-defined CoDs and assessed the odds of GC assignment with a binomial logistic regression. Results Since 1997, Sweden has coded at least 23% of deaths to GCs each year with 25.5% coded to GCs in 2023. The lowest educated consistently received more GC deaths, with 45.8% more GC deaths relative to non-GC deaths between ages 20 and 39 compared to the highest educated, and there were more GC deaths in (1) infections, (2) blood and endocrine diseases, (3) injuries, (4) cancers, and (5) maternal, neonatal, and congenital (MNC) diseases in 2023. GC deaths among the highest educated have continued to increase in infections, injuries, cardiovascular, digestive, and MNC diseases. After redistribution, well-defined death counts among the lowest educated increased by over 20% in 13 of the leading 20 CoDs in Sweden. Our model suggested low education increased the likelihood of having a GC by 12.8% (11.4%-14.2%) compared to the highest educated. This was second to point estimates of standardized age at death (25.2% [24.8%-25.6%]) and exceeded sex (12.1% [11.4%-12.8%] increase for males) and region (at most 7.3% [6.6%-8.1%] decrease for death outside of Stockholm). Conclusions We found consistent trends of high GC level in Sweden with doctors assigning more GCs to the lowest educated. Our results reveal stark sociodemographic disparities in CoD coding in Sweden and it is probable that similar disparities would be found elsewhere. This underscores the need for improving procedures and national guidelines in CoD assignment to correctly represent all social groups in research.

Importance:Homicide is one of the leading causes of death in the US, especially among adolescents and adults younger than 45 years. While geographic, racial and ethnic, and sex differences in homicide rates have been documented, a comprehensive assessment across all sociodemographics is needed. Objective:To assess variation in US homicide rates from 2000 to 2019 across geographic location, race and ethnicity, sex, and age. Design, Setting, and Participants:This cross-sectional study used deidentified death records from the National Vital Statistics System and population estimates from the National Center for Health Statistics for all individuals living in the US from January 1, 2000, to December 31, 2019. Data analysis was completed in April 2023. Exposure:County, race and ethnicity (American Indian or Alaska Native, Asian or Pacific Islander, Black, Hispanic or Latino, and White), age (0-14, 15-24, 25-44, 45-64, and ≥65 years), and sex (female and male) as reported on death certificates. Main Outcomes and Measures:The main outcome was homicide rates per 100 000 individuals. Validated small-area estimation models were used to estimate county-level homicide rates by race and ethnicity, age, and sex (50 unique populations). Estimates were corrected for race and ethnicity misclassification on death certificates and were age standardized. Results:Between 2000 and 2019, there were 367 827 (95% uncertainty interval [UI], 366 683-369 046) homicides in the US, with decedents most commonly being male (77.7% [95% UI, 77.5%-77.8%]), aged 15 to 44 years (69.8% [95% UI, 69.6%-69.9%]), and Black (46.0% [95% UI, 45.5%-46.5%]). The highest homicide rates were among Black males aged 15 to 24 years (74.6 [95% UI, 72.3-77.0] per 100 000 population) and 25 to 44 years (70.0 [95% UI, 68.4-71.4] per 100 000 population) followed by American Indian and Alaska Native males aged 15 to 24 years (24.5 [95% UI, 19.2-31.0] per 100 000 population) and 25 to 44 years (33.5 [95% UI, 28.6-38.8] per 100 000 population). Homicide rates higher than 100 deaths per 100 000 population among American Indian or Alaska Native or Black males aged 15 to 44 years were observed in 143 counties; more than 25% of counties with this homicide level among Black males were in Arkansas, Louisiana, and Mississippi, and all counties with this homicide level among American Indian or Alaska Native males were in North Carolina. Despite national homicide rates remaining stable over the study period (6.1 [95% UI, 6.0-6.2] per 100 000 population for both years; incidence rate difference, 0.04 [95% UI, -0.16 to 0.07]), homicide rates increased in most counties (range, 1631 of 3051 [53.5%] to 1406 of 1488 [94.5%]) among American Indian or Alaska Native, Black, and White males and females younger than 65 years. Conclusions and Relevance:In this cross-sectional study of US homicide rates, substantial variation was found across and within county, race and ethnicity, sex, and age groups; American Indian and Alaska Native and Black males aged 15 to 44 years had the highest rates of homicide. The findings highlight several populations and places where homicide rates were high, but awareness and violence prevention remains limited.

BACKGROUND:Non-malignant tumors of the CNS contribute substantially to the morbidity and mortality from CNS tumors. It is critical to understand the epidemiology of non-malignant CNS tumors separately from CNS malignancies to inform resource allocation and policy since treatment and prognosis can differ. High-quality international data on non-malignant CNS tumor burden are needed to accomplish this goal. METHODS:We assessed the cancer registry and vital registration data available to the Global Burden of Disease study by its inclusion of non-malignant CNS tumors, reporting on the availability of data over time and by the World Bank income group. We analyzed preliminary age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and proportions of CNS tumors by behavior for adults, children, and all ages. RESULTS:Non-malignant CNS tumors were reported separately in 17.2% (N = 66) of registry reports and in aggregate with malignant CNS tumors in 18.0% (N = 69) of reports. Only 7 low- and middle-income countries (LMICs) had data reporting CNS tumors separately by behavior. Across all ages combined, the median ASIR of non-malignant CNS tumor data was 0.31 (interquartile range: 0.15-0.50) and ASMR was 0.24 (0.10-0.44) per 100,000 in LMICs compared to median ASIR of 3.62 (2.62-4.97) and ASMR of 0.32 (0.16-0.65) in high-income countries (HICs). A larger proportion of incident CNS tumors were reported as non-malignant in HIC data than LMIC data (P < .0001). CONCLUSIONS:Our study alludes to current challenges in understanding global non-malignant CNS tumor burden and a need for increased international data collection. Further research is needed to comprehensively investigate opportunities for future data inclusion.

BACKGROUND:Prostate cancer (PCa) is the second most prevalent cancer globally and a major cause of disability and mortality. Survival rates heavily depend on the stage at which the disease is diagnosed, with substantial geographical variations in the burden of the disease. METHODS:The Global Burden of Disease (GBD) Study 2021 provides detailed national and subnational estimates for the burden of PCa in Italy. This study reports incident cases and age-standardized incidence rates (ASIR), deaths and age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs) and age-standardized DALYs rates (ASDR), as well as the average annual rate of change (ARC). The PCa-related survival is investigated using the mortality-to-incidence ratio (MIR) for 1990 and 2021. Italian estimates were compared with Global and High-middle Socio-Demographic Index (SDI) countries. RESULTS:GBD 2021 estimated 39,016 new PCa cases, 10,662 deaths, and 173,048 DALYs for Italy in 2021. The average ARC for ASIR was 0.14, while the average ARC for ASMR and ASDR were -0.29 and -0.31, respectively. MIR dropped from 38.0 in 1990 to 23.8 in 2021. At the subnational level, ASIR increased in seven regions, with no regions showing a decrease, while ASMR and ASDR fell significantly in 17 regions. Italy outperformed both global and high-middle SDI countries in reducing PCa mortality and improving survival rates. CONCLUSIONS:PCa remains a critical health issue in Italy. The reduction in ASMR and ASDR indicates progress in early diagnosis and treatment. However, subnational disparities in incidence and mortality highlight the need for targeted healthcare interventions.

BACKGROUND:Diet is an important risk factor for ischemic heart disease (IHD), but its effects on IHD and trends in the North Africa and Middle East (NAME) region are unknown. We aimed to evaluate the burden of different dietary risk factors on mortality and disability-adjusted life-years (DALYs) attributable to IHD in the NAME region from 1990 to 2019. METHODS:The data and estimations were extracted from the Global Burden of Disease (GBD) 2019 Global Health Data Exchange. The proportion of IHD burden due to dietary risks was estimated through a comparative risk assessment approach. We calculated the mortality and DALYs rate attributable to diet for IHD using disease-specific population attributable fractions. RESULTS:The age-standardized rate of IHD mortality and DALYs attributed to dietary risk in the NAME region were 102.1 (95% uncertainty interval (UI): 81.0-121.1) and 2060.6 (95% UI: 1630.7-2471.2), respectively. These rates were higher than the global estimates for mortality (62.4 [95% UI: 51.0-73.6]) and DALYs (1271.3 [95% UI: 1061.3-1473.8]) and were greater in men than in women. Suboptimal diet contributed to 46.6% of IHD mortality and 49.5% of related DALYs. Low whole-grain intake was the leading dietary risk across all countries and years, responsible for 44.5 [95% UI: 18.6-57.1] IHD mortalities and 912.8 [95% UI: 369.7-1177.8] DALYs per 100,000. CONCLUSION:Despite a decline in the burden of IHD attributable to diet in the NAME region, it remains substantially high. There exists considerable potential for enhancing dietary quality, particularly through the increased incorporation of whole grains.

As doenças crônicas não transmissíveis (DCNT) são a principal causa de morbimortalidade no Brasil. O estudo visa verificar se a meta de redução das DCNT dos Objetivos de Desenvolvimento Sustentável (ODS) até 2030 será alcançada por meio da análise das tendências da probabilidade incondicional de morte prematura entre 1990 e 2021 no Brasil e nas 27 Unidades Federadas. Realizou-se estudo de série temporal sobre a probabilidade de morte prematura (30-69 anos) por DCNT (doenças cardiovasculares, neoplasias, doenças respiratórias crônicas e diabetes mellitus), com base nos dados do Global Burden of Disease Study de 2021. Foram utilizados modelos de regressão por pontos de inflexão (joinpoint) para estimar tendências, além de projeções até 2030 por meio do modelo de Holt. As desigualdades regionais foram avaliadas com base nos quintis do índice sociodemográfico (SDI, acrônimo em inglês). A probabilidade de morte prematura por DCNT reduziu de 0,233 (1990) para 0,152 (2021) (AAPC = -1,3; p < 0,001), com declínio em todos os quintis do SDI. A mortalidade foi consistentemente maior entre os homens. As projeções indicam que a meta de redução de 1/3 até 2030 provavelmente não será alcançada, especialmente nos quintis de menor SDI, com variações segundo o sexo. Apesar da tendência de queda, persistem desigualdades regionais e sociais. Melhorias no acesso à saúde e em políticas públicas contribuíram para o declínio observado, mas desafios permanecem, como o enfraquecimento das políticas de controle de fatores de risco, a influência dos determinantes comerciais da saúde e os efeitos da pandemia de COVID-19.

BACKGROUND:Over the past two decades, the Italian National Health Service has been gradually decentralised, with Italy's 21 regional governments now responsible for managing their health services. This change, coupled with austerity measures and a steadily ageing population, has adversely affected universal health coverage and equity, exacerbating inequalities and regional disparities. This study aimed to analyse time trends and subnational differences in the burden of disease from 2000 to 2019, and from 2019 to 2021 to capture the effects of the COVID-19 pandemic. METHODS:This study uses estimates for Italy from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. We analyse trends and geographical differences in disease burden from 2000 to 2021. Metrics include life expectancy, health-adjusted life expectancy (HALE), years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) observed at national, macroregional, and subnational levels. Percent changes in rates, with both all-age and age-standardised rates, and 95% uncertainty intervals (95% UIs) are reported. FINDINGS:Life expectancy at birth in Italy increased from 79·6 years in 2000 to 83·4 years in 2019, dropped to 82·2 years in 2020 due to COVID-19, and recovered slightly to 82·7 years in 2021. HALE was 70·9 years (95% UI 67·4-73·8) in 2021. Substantial regional disparities were observed: in general, despite higher YLD rates, northern regions had better health outcomes, with higher life expectancy and HALE and lower YLL rates compared with southern regions. Overall, the top causes of YLDs were low back pain (1556·5 [1098·5-2080·2]), falls (926·2 [638·8-1253·8]), and headache disorders (858·0 [173·7-1808·2]). Anxiety and depressive disorders both had substantial increases in the period from 2019 to 2021 (19·8% and 17·3%, respectively). YLDs for Alzheimer's disease and diabetes increased substantially from 2000 to 2019 and 2019 to 2021 (70·6% and 3·0% for Alzheimer's disease and 46·8% and 7·9%, respectively for each timepoint). YLL rates declined for ischaemic heart disease from 2000 (-29·9% in 2019), but increased for Alzheimer's disease and other dementias (54·5%). DALY rates decreased overall from 2000 to 2019, but rose again in 2021 due to the COVID-19 pandemic. INTERPRETATION:The study highlights considerable regional disparities in Italy's health outcomes, driven by demography, heterogeneous health service quality, and economic inequalities. Addressing the increasing burden of Alzheimer's disease, diabetes, and mental health disorders, as well as regional disparities, requires strengthened preventive measures, equitable health service access, and socioeconomic policies, both at the national and regional levels. FUNDING:Bill & Melinda Gates Foundation.

Resumo Descrever a evolução temporal das principais causas de mortalidade em Minas Gerais (MG), Brasil, e verificar a associação com indicadores socioeconômicos. Estudo ecológico misto em que foram calculadas taxas de mortalidade padronizadas por idade, por 100 mil habitantes, por doenças crônicas não transmissíveis (DCNT), doenças transmissíveis, neonatais e nutricionais (TNN) e causas externas (CE), para 853 municípios de MG, segundo dados do estudo Carga Global de Doenças (GBD), nos triênios 2000 a 2002 (T1), 2009 a 2011 (T2) e 2016 a 2018 (T3). Entre T1 e T3 predominou a mortalidade por DCNT; houve decréscimo de 22,4% das taxas por DCNT (553,6 para 429,9) e de 29% da s taxas por TNN (83 para 58,9), e acréscimo de 3,5% por CE (62,2 para 64,4). Os coeficientes de correlação foram positivos (R > 0,70; p < 0,05) e foram encontrados taxas mais elevadas de mortalidade em áreas de pior status socioeconômico.

To describe the temporal evolution of the main causes of mortality in Minas Gerais (MG), Brazil, and to verify the association with socioeconomic indicators. This is a mixed ecological study in which age-standardized mortality rates were calculated per 100,000 inhabitants due to noncommunicable diseases (NCDs), communicable, neonatal and nutritional diseases (NNDs) and external causes (ECs) for 853 municipalities in MG, according to data from the Global Burden of Disease (GBD) study, in the three-year periods 2000 to 2002 (T1), 2009 to 2011 (T2) and 2016 to 2018 (T3). Between T1 and T3, mortality due to NCDs predominated; there was a 22.4% decrease in the rates for NCDs (553.6 to 429.9) and a 29% decrease in the rates for NCDs (83 to 58.9), and a 3.5% increase in EC (62.2 to 64.4). The correlation coefficients were positive (R > 0.70; p < 0.05) and higher mortality rates were found in areas with worse socioeconomic status.

Interpersonal violence against women (VAW), particularly femicide, remains a critical public health concern in Africa. Although age-standardized death rates have declined between 1990 and 2021, overall rates remain significantly higher than the global average. To better understand this issue, we conducted a descriptive analysis using modeled estimates from the Global Burden of Disease 2021 study to examine femicide trends across 54 African countries from 1990 to 2021. We assessed mortality using age-standardized mortality rates and morbidity using disability-adjusted life years. We found that mortality associated with physical violence involving sharp objects decreased over time, whereas no declines were observed in firearm-related or other forms of violence. Substantial variations emerged among countries, with some showing notable improvements and others experiencing worsening rates. Wide disparities in female-to-male homicide ratios underscored differing vulnerabilities across the continent. Moreover, the mean ages of female homicide victims varied considerably, pointing to possible age-specific risk factors. Despite some overall declines, femicide rates in Africa remain high, highlighting the need for context-specific strategies. Strengthening and localizing research efforts will help refine modeled estimates and enhance our understanding of femicide in Africa, thereby informing effective strategies to reduce VAW and improve their safety across the continent.