To achieve a meaningful global health response to major depressive disorder (MDD) during the peripartum period, we need to understand its global distribution. We conducted a systematic literature review of the prevalence of MDD during the peripartum period, assessing sources of data heterogeneity and prevalence during pregnancy and the postpartum period.

BACKGROUND:Adjustment of haemoglobin concentrations for elevation is essential for anaemia assessments of both individuals and populations. Whereas the previous WHO anaemia definitions released in 2001 used an elevation adjustment derived from small sample sizes with limited representativeness, the 2024 WHO global anaemia definitions reflect empirical assessments across several geographies and settings derived from population-representative surveys. We aimed to assess the effect of these changes on estimates of global anaemia burden. METHODS:In this population-based modelling study, using an identical set of input data from population-based surveys, we created two datasets in parallel, where each input haemoglobin concentration was adjusted using the WHO 2001 and WHO 2024 elevation adjustment methods. We estimated mild, moderate, and severe anaemia prevalence by age and sex for 204 countries and territories from 1990 to 2023 for each dataset using spatiotemporal Gaussian process regression and ensemble distribution modelling. We then analysed the overall differences in anaemia prevalence and years lived with disability to assess the effect of the WHO 2024 elevation adjustment method on the global landscape of anaemia. Uncertainty was propagated in each step of the modelling process by sampling draws of the posterior distribution of each estimated quantity. FINDINGS:Global anaemia prevalence for all ages and both sexes in 2023 was estimated to be 26·4% (95% uncertainty interval [UI] 22·6-31·9) using the WHO 2024 elevation adjustment method, which was 2·4 percentage points (2·2-2·7) higher than the total anaemia prevalence estimated using the WHO 2001 method (24·0% [20·6-29·3]). This increase equates to 198 million (196-199) newly enumerated cases, increasing the rank of anaemia from the third to the second largest cause of disability globally. The largest absolute increases in anaemia prevalence were in locations between 500 m and 2000 m in elevation, which include countries in eastern sub-Saharan Africa, central Asia, central America, and South America. INTERPRETATION:Understanding the effect of anaemia requires unbiased and comparable estimates of anaemia burden. To our knowledge, we produced the first set of global estimates of anaemia burden by location, year, age, and sex using the WHO 2024 elevation adjustment method and compared them with estimates using the previous method. Policy makers should consider this modification when designing interventions to manage and prevent anaemia, particularly in regions most affected by changes in elevation adjustment. FUNDING:Gates Foundation.

BACKGROUND:For a meaningful global health response to major depressive disorder (MDD) during the peripartum period, its global distribution needs to be understood. The aim of this study was to conduct a systematic review of the prevalence of MDD during the peripartum period to assess sources of data heterogeneity and trends in prevalence during pregnancy and the postpartum period. METHODS:This systematic review and meta-regression quantified MDD during pregnancy and up to 12 months postpartum among women and girls aged 10-59 years, across world regions. We searched PubMed, Embase, PsycINFO, and grey literature sources for studies published between Jan 1, 1980, and Oct 23, 2025. We included data from cross-sectional or longitudinal surveys of women and girls assessing the prevalence of MDD during the peripartum period. MDD was defined with criteria from the DSM or ICD. Most studies included patients receiving perinatal care from hospitals with population-representative catchments. Preference was given to studies encompassing pregnancies of all gestational lengths; however, studies restricted to singleton or full-term births were included. Extracted prevalence data were non-identifiable and pre-aggregated from existing sources. Records generated in the electronic and grey literature searches were combined and titles, abstracts, and full texts were reviewed by AJF, PAM, JS, AMH, SMA, and PM. Their decisions and related disagreements were reviewed by senior authors (AJF and DFS). The meta-regression analysis quantified sources of measurement error within the available data and assessed the prevalence of MDD during the peripartum period and by location. We followed the PRISMA guidelines (PROSPERO ID CRD42022358108). Members of our authorship team have lived experience perspectives in mental disorders, but we did not consult individuals diagnosed with MDD during the peripartum period. FINDINGS:Of 31 812 potentially eligible studies, we screened the titles and abstracts of 25 616 studies, and included 1025 studies in the qualitative synthesis. We included 1505 prevalence datapoints from 780 studies eligible for stage two analysis, representing 2 018 198 women and girls from 90 countries and 19 world regions. Symptom scales identifying MDD symptoms overestimated its prevalence by between 71·3% (95% uncertainty interval [UI] 54·3-89·8) for the Edinburgh Postnatal Depression Scale in the postpartum period and 121·9% (91·7-156·8) for Patient Health Questionnaire during pregnancy, compared with diagnostic interview. MDD prevalence during the peripartum period was highest during the first 2 weeks postpartum (p<0·0001) and remained significantly elevated throughout the postpartum year (p<0·0001) compared with pregnancy. After adjusting for changes over the peripartum period and biases due to measurement error, the overall prevalence of MDD was 6·2% (95% UI 5·9-6·6) at any point in time during pregnancy and 6·8% (6·4-7·1) at any point in time during the postpartum year. Prevalence was highest in southern sub-Saharan Africa, ranging from 15·6% (12·7-19·1) during pregnancy to 16·6% (13·5-20·3) during the postpartum year; and south Asia, ranging from 13·7% (12·4-15·2) during pregnancy to 14·6% (13·1-16·1) during the postpartum year. The prevalence was lowest in high-income Asia Pacific, ranging from 3·1% (2·5-3·7) during pregnancy to 3·3% (2·8-3·9) during the postpartum year. INTERPRETATION:The prevalence of MDD was elevated during the entire peripartum period, and highest 2 weeks after giving birth. Our findings emphasise the need for increased integration of screening, prevention, and treatment of MDD during the peripartum period into existing models of care. FUNDING:Queensland Health, The University of Queensland, and Gates Foundation.

This study evaluated dose-response relationships between hemoglobin concentration in pregnancy and maternal and neonatal outcomes based on comprehensive systematic reviews using the Burden of Proof meta-analytic framework. Risk estimates accounting for uncertainty and quantitative star ratings were generated to assess evidence strength. Our analysis revealed that even small deviations above or below hemoglobin levels with the lowest predicted risk - particularly on the low end (anemia)-were associated with non-linear increased risks of all-cause maternal and neonatal mortality, postpartum hemorrhage, maternal sepsis, preterm birth, low birthweight and large-for-gestational-age. Across outcomes with at least moderate evidence strength (>2 stars), maternal hemoglobin levels associated with the lowest risk ranged from 109-135 g/L, challenging the appropriateness of fixed anemia thresholds. Even modest population-level shifts in hemoglobin distributions could meaningfully affect the burden of adverse outcomes, supporting more refined, trimester- and outcome-specific thresholds to better identify at-risk individuals and guide clinical interventions.

BACKGROUND:Timely and comprehensive antenatal care can improve maternal and perinatal health by enabling early detection and treatment of pregnancy complications. We estimated the content and timing of antenatal care visits for 131 low-income and middle-income countries (LMICs) from 1995 to 2023. METHODS:We systematically identified population-representative data sources capturing antenatal care timing and content. We selected five widely measured indicators of antenatal care screening and prevention services: iron supplementation, measurement of weight and blood pressure, and provision of blood and urine samples. We modelled the proportion of women with a livebirth reporting all five items (antenatal care content proportion), mean number of items reported (antenatal care content mean), proportion with first trimester antenatal care attendance, and mean number of antenatal care visits using spatiotemporal Gaussian process regression. FINDINGS:Across LMICs, the proportion of women with a livebirth who initiated antenatal care in the first trimester increased from 46·2% (95% uncertainty interval 42·2-49·9) in 1995 to 63·7% (62·8-64·5) in 2023, and the average number of antenatal care visits during pregnancy rose from 3·7 (3·4-4·0) to 6·0 (5·9-6·1). In 2023, 69·3% (68·4-70·1) of women with a livebirth received all five antenatal care items, a major increase from 1995 (25·9% [24·1-27·8]). In 2023, the proportion of women who attended antenatal care but did not receive all five items (26·2% [25·5-27·0]) exceeded those who did not attend antenatal care at all (7·1% [6·5-8·1]). The receipt of all five items also varied by geography: 79·2% (77·6-80·5) in Latin America and the Caribbean received all five items, compared with 59·8% (58·4-60·9) of women in sub-Saharan Africa. INTERPRETATION:Despite improvements in the receipt of basic elements of antenatal care from 1995 to 2023, health systems continue to miss opportunities to deliver important care to women who attend antenatal care. The identified gaps in coverage should be targeted for improvement to support receipt of timely and effective health care that improves maternal and neonatal health. FUNDING:The Gates Foundation.

Hemoglobinopathies and hemolytic anemias (HHA) are genetic blood disorders associated with diverse clinical complications, affecting an estimated 2.1 billion people worldwide. The World Health Organization (WHO) African Region accounts for approximately 425.8 million individuals, or 20% of the global HHA prevalence, yet comprehensive assessments of this burden have been lacking. We present the first systematic analysis of HHA burden in the WHO African Region from 2000-2021 using data from the Global Burden of Disease (GBD) 2021 study. We estimated regional, sex-, and age-specific rates (per 100,000 population) of mortality, incidence at birth, and years lived with disability (YLDs) in five-year intervals. Mortality estimates were generated using the Cause of Death Ensemble model (CODEm), supplemented with spatiotemporal Gaussian process regression. Incidence at birth was estimated using DisMod-MR 2.1, a Bayesian meta-regression tool, while YLDs were calculated by multiplying prevalence by disability weights reflecting severity and duration. Between 2000 and 2021, the WHO African Region experienced persistently higher age-standardized death rates from HHA compared to global levels, although regional mortality declined over the period. Sickle cell disorder (SCD) was the predominant contributor, with the highest mortality [3.68 deaths (95% UI 2.04-6.29) per 100,000] and disability burden [41.08 YLDs (95% UI 26.09-58.61)], while thalassemias contributed the least. Disability-adjusted life years (DALYs) were concentrated in western sub-Saharan Africa, accounting for 71.3% of the regional burden. Age-specific estimates revealed that children under five years faced a disproportionate share of mortality and disability. Despite overall declines in mortality, the WHO African Region continues to bear a disproportionate global burden of HHA, particularly affecting young children. These findings underscore the urgent need for strengthened newborn screening, early treatment, and health system interventions to reduce preventable deaths and disability.

Anaemia, a condition affecting more than 1 center dot 9 billion people worldwide, disproportionately affects children, adolescent girls, and women. Despite longstanding interventions and guidelines, most countries are not on track to meet global anaemia reduction targets, and cuts in global health funding in 2025 further threaten progress. This Lancet Haematology Commission aims to reinvigorate efforts to prevent and control anaemia by addressing key gaps in data, evidence, implementation, governance, and target-setting approaches.

INTRODUCTION:Untreated dental caries remains a significant global public health challenge, disproportionately affecting vulnerable populations and highlighting inequalities in health systems worldwide. Examining its distribution across diverse contexts is essential for guiding targeted interventions, informing public policies, and allocating resources more effectively. This study aims to provide a comprehensive global assessment of the distribution of untreated dental caries in 204 countries and territories, spanning the years 2000, 2010, and 2019, by dimensions of structural determinants of health. METHODS:This study employs an ecological design. This analysis describes the incidence, prevalence and years lived with disability (YLDs) due to untreated dental caries in permanent and deciduous teeth by structural determinants of health (dimensions of governance, macroeconomic policy, social policy, public policies and culture/societal values), for 204 countries and territories. Estimates of untreated caries in deciduous teeth by structural determinants were reported for children under 5 years of age, whereas estimates in permanent teeth were described for adolescents and adults aged between 15 and 49 years. Estimates were retrieved from the Global Health Data Exchange. RESULTS:There was a gradient of inequality between countries in terms of prevalence, YLDs, and the incidence of overt untreated caries. Countries that had better structural indicators had lower mean prevalence of untreated caries in primary teeth. In the permanent dentition, between-countries inequalities were not identified. Additionally, the mean prevalence was stable from 2010 to 2019. CONCLUSIONS:This study revealed possible cross-country inequalities in the burden of untreated caries in deciduous teeth that persisted over one decade. More developed countries experienced less disease burden. These findings show the need for targeted interventions to address the uneven burden of untreated dental caries worldwide. CLINICAL SIGNIFICANCE:This study underscores the need for targeted global health policies to reduce untreated dental caries, especially in countries with lower structural health determinants, highlighting cross-country inequalities in disease burden and the importance of addressing these disparities in both primary and permanent dentition.

ObjectiveTo assess the correlation between structural determinants - governance, macroeconomic policies, culture/societal values, and public and social policies - and the Universal Health Coverage (UHC) Effective Coverage Index in 2010 and 2019, in 204 countries and territories.MethodsThis ecological study analyzed UHC effective coverage in 204 countries and territories using estimates from the Global Burden of Disease (GBD) 2019 study. Structural determinants were examined across five dimensions. Spearman's correlation was used to examine the correlations.ResultsUHC showed a positive correlation with structural determinants in both years. In 2010, moderate correlations were observed for governance (ρ = 0.61), GDP (ρ = 0.69), SDI (ρ = 0.62), and government expenditure (ρ = 0.58). In 2019, governance (ρ = 0.56), GDP (ρ = 0.71), SDI (ρ = 0.66), and government expenditure (ρ = 0.48) remained significantly correlated with UHC. GDP and SDI consistently showed the strongest correlations in both periods.ConclusionCountries with more favorable structural conditions had greater UHC, emphasizing the influence of governance and socioeconomic context on health systems performance. Persistent disparities highlight the need for policies targeting social and economic inequalities to achieve universal health coverage globally.

Although iron deficiency is well documented, less is known about dietary involvement in symptomatic iron deficiency manifesting in medical conditions. In this study, we quantified the global burden of dietary iron deficiency, focusing on where inadequate dietary iron intake leads to clinical manifestations such as anemia. We analyzed data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to estimate dietary iron deficiency prevalence and disability-adjusted life years (DALYs), stratified by age, sex, geography and socio-demographic index (SDI) across 204 countries. In 2021, global age-standardized prevalence and DALY rates were 16,434.4 (95% uncertainty interval (UI), 16,186.2-16,689.0) and 423.7 (285.3-610.8) per 100,000 population, with rates decreasing by 9.8% (8.1-11.3) and 18.2% (15.4-21.1) from 1990 to 2021. A higher burden was observed in female individual (age-standardized prevalence, 21,334.8 (95% UI, 20,984.8-21,697.4); DALYs, 598.0 (402.6-854.4)) than in male individual ((age-standardized prevalence, 11,684.7 (11,374.6-12,008.8); DALYs, 253.0 (167.3-371.0)). High-SDI countries presented greater improvement, with a 25.7% reduction compared to 11.5% in low-SDI countries. Despite global improvements, dietary iron deficiency remains a major health concern with a global prevalence of 16.7%, particularly affecting female individuals, children and residents in low-SDI countries. Urgent interventions through supplementation, food security measures and fortification initiatives are essential.

Background:With major increases in facility births in low- and middle-income countries (LMICs) since 1995, a key question is what types of facilities met the increased demand. Understanding the evolving delivery landscape is crucial to informing debates about optimal models for balancing access, quality, and equity. We studied the distribution of delivery location by health facility level and sector (private versus public) in 130 LMICs from 1995 to 2023. Methods:We used 745 data sources with delivery location information in our analysis. We first categorised births as in-facility or not, then further classified facility births by level (hospital or lower-level) and sector (public or private). We used spatiotemporal Gaussian process regression to model the share of births by facility type from 1995 to 2023 and compared delivery patterns to development and health indicators. Findings:In 2023, 47.5% (95% uncertainty interval [UI] 46.4-48.6) of deliveries in LMICs were in public hospitals, 19.2% (18.3-20.2) were in private hospitals, 13.0% (12.3-13.8) were in lower-level public facilities, 2.0% (1.9-2.2) were in private lower-level facilities, and the remaining 18.2% (17.3-19.2) were outside health facilities. In 106 countries, more than half of deliveries were in public hospitals, while in 12 countries, public lower-level facilities provided care for more than half of births. In only two countries were private hospitals used for more than half of births, while in the remaining ten countries no facility type provided the majority of care. Between 1995 and 2023, nearly two-thirds (62.1%) of the 41.0 percentage-point increase in facility births was borne by public hospitals. Delivery in lower-level facilities was more common in countries with lower levels of development and higher neonatal mortality rates. Interpretation:The mix of delivery locations represents the diversity of health systems worldwide. Our analysis highlights the pivotal and growing role of public hospitals in delivery care, though public lower-level delivery care is common in high-mortality contexts. Policy makers should account for the facility mix and the complex roles of public and private sectors when designing strategies to improve maternal and perinatal outcomes. Funding:The Gates Foundation.

IntroductionChild malnutrition is the main contributor to the disease burden in Ethiopia. The objective of this study was to determine the prevalence and trends of child malnutrition and maternal anemia in Ethiopia at the national and regional state levels between 1990 and 2019.MethodsWe used all accessible data sources and analyzed prevalence, death, and years of life lost (YLL) due to child malnutrition and maternal anemia across nine regions and two chartered cities in Ethiopia, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The burden and trends of child and maternal malnutrition and anemia at the national level, across the regions, and in cities were assessed. Point estimates with 95% uncertainty intervals (UI) are presented.FindingsOf the 190,173 total under-5 deaths in Ethiopia in 2019, 108,864 (95% UI: 83,544-141,718; 57·2%, 51·3-62·7) were attributed to malnutrition. The prevalence of stunting, underweight, and wasting was 37·0%, 27·0%, and 7·0%, respectively, in 2019. The YLL rate attributable to child malnutrition declined from 251,964 per 100,000 population (95% UI: 218,720-287,559) in 1990 to 57,615 (95% UI: 44,190-75,015) in 2019. The YLL rate of wasting, stunting, and underweight in Ethiopia was 18,566 per 100,000 population (95% UI: 12,950-26,123), 3,290 (95% UI: 1,443-5,856), and 5,240 (95% UI: 3,608-7,312) in 2019, respectively. Gambella showed the highest YLL rate reduction among regions, with a 98·2% change for stunting, 95·9% for wasting, and 97·9% for underweight between 1990 and 2019. The prevalence of anemia among under-5 children in Ethiopia was 62·0% (95% UI: 59·1%-65·1%) in 2019. Somali has the highest child anemia prevalence, 84·4% (95% UI: 79·8%-88·8%), compared to others in 2019. The prevalence of anemia in women of reproductive age (15-49 years) in Ethiopia was 20·4% (95% UI: 19·0%-21·8%) in 2019.InterpretationThe prevalence of child malnutrition and maternal anemia in Ethiopia remains high compared to national, WHO, and UNICEF 2030 targets in all indicators of child malnutrition and anemia despite several interventions in the last three decades. The YLL rate due to child malnutrition was high, with regional variations. In conjunction with other sectors, especially agriculture, the National Nutrition Program and other nutrition initiatives must make greater efforts with short-term and long-term interventions to improve access and better nutrition.

Introduction: The Global Burden of Disease (GBD) study provides a unique opportunity to better understand fatal and nonfatal outcomes and their socioeconomic drivers in adults with congenital heart disease (ACHD). The aim of this study is to better understand trends in ACHD in the US and to analyze socioeconomic factors that may be correlated to geographic differences in patient outcomes. Methods: State specific data on mortality, prevalence, and disability adjusted life years (DALY) were acquired from GBD Database from 1990 to 2021 for ACHD patients aged 20 years and older in the USA. We subsequently correlated this data with median household income and percent uninsured in each state by using the US census bureau poverty and income data. Results: There are 292,625 (95% CI 258,956 – 342,906) adults > 20 years in the USA living with CHD in 2021 (compared to 212,366 in 1990). In 2021, ACHD was responsible for 1074 (CI 964 -1331) deaths and 62,244 (CI 51,820 – 76,301) DALYs ( FIGURE 1 ). Between 1990 and 2021 there was a decrease in rates of mortality (0.79 to 0.43/100,000) and DALYs (44 to 25/100,000). There is considerable variation by state. The state with the highest mortality and DALYs (West Virginia) also has one of the lowest median household incomes ($51,122). States with lower ACHD mortality have higher median household incomes (r 2 =0.612, p<0.001) ( FIGURE 2 ). The percent uninsured in each state also has a positive correlation with mortality (r 2 =0.142, p=0.006). Conclusion: The GBD study provides unique insight into ACHD mortality, prevalence, and disability and should be considered the gold standard for prevalence, disablity and mortality in the US. While mortality and disability rates have decreased from 1990 to 2021, ACHD patients living in states with lower median household income and higher percent uninsured have higher rates of mortality and disability. Investment into more equitable access to care is warranted for this population.

ObjectiveTo carry out a comprehensive description of edentulism estimates by the macro determinants of health in 2000, 2010, and 2019 worldwide.MethodsThis ecological study analyzed data from the Global Burden of Disease Study (GBD) to describe the incidence rate, prevalence rate and years lived with disability (YLDs) rate due to edentulism by macro determinants of health (governance, macroeconomic policy, social policy, public policies, societal values), for 204 countries and territories. The estimates were reported as rates (cases/100,000 people), for people of both sexes aged 55 years or older.ResultsCountries belonging to the least privileged categories of the macro determinants showed the lowest prevalence rate, incidence rate, and YLD rate due to edentulism for all exposures. Countries with low government expenditure on health showed the lowest prevalence rate of edentulism in 2000 (18972.1; 95%CI 15960.0 - 21984.3) and 2010 (16646.8; 95%CI: 14218.3-19075.4) than those with high government expenditure on health in 2000 (25196.6; 95%CI: 23226.9 - 27166.2) and 2010 (21014.7; 95%CI: 19317.9 - 22711.5). Countries with low SDI showed the lowest YLDs in 2000 (321.0, 95%CI: 260.1- 381.9), 2010 (332.0; 95%CI: 267.7-396.3), and 2019 (331.6; 95%CI: 266.6-396.5).ConclusionThe findings point to persistent inequalities in the distribution of edentulism between countries worldwide. The most privileged countries, with higher economic development, better governance, and better social and public policies, have shown higher rates of edentulism.Clinical SignificanceThis model must be reconsidered by advancing toward upstream and midstream strategies, beyond its conventional downstream clinical interventions.

BACKGROUND:Complete blood cell count-based ratios (CBRs), including the neutrophil-lymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR), are inflammatory markers associated with postoperative morbidity. Given the link between the surgical stress response and complications after total joint arthroplasty (TJA), this study aimed to evaluate whether higher preoperative CBR values predict greater postoperative benefits associated with dexamethasone utilization. METHODS:The Premier Healthcare Database was queried for adult patients who underwent primary, elective total hip or knee arthroplasty (THA or TKA). Multivariable logistic regression models using dexamethasone exposure and CBRs as independent variables assessed primary end points of 90-day postoperative complications and length of stay (LOS) of ≥3 days. The probability difference between the dexamethasone and non-dexamethasone groups for each primary end point was determined across all values of each CBR. Probability differences were compared across CBR quartiles. RESULTS:A total of 32,849 primary, elective TJAs (12,788 THAs [38.93%], 20,061 TKAs [61.07%]) performed between 2016 and 2021 were identified, and 22,282 (67.83%) of the patients received perioperative dexamethasone. Among patients with an NLR value of >1.00, those receiving dexamethasone had a lower probability of postoperative complications (all p < 0.05). Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients in the highest NLR quartile (≥4.67) compared with the lowest quartile (NLR <1.84) (p = 0.002). Among patients with an MLR value of ≥0.36, those receiving dexamethasone had significantly lower odds of postoperative complications. Dexamethasone was associated with lower odds of an LOS of ≥3 days among patients with an MLR of ≥0.33 (the 2 highest quartiles) compared with an MLR of <0.24 (the lowest quartile) (p = 0.039). CONCLUSIONS:Higher NLR and MLR values were associated with greater marginal benefit from perioperative dexamethasone treatment, establishing a modifiable link between adverse outcomes and perioperative inflammation in TJA. LEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The GBD 2021 Sickle Cell Disease Collaborators recently reported the results of their systematic survey of the global, regional, and national prevalence and mortality of sickle cell disease from 2000 to 2021, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. 1 GBD 2021 Sickle Cell Disease CollaboratorsGlobal, regional, and national prevalence and mortality burden of sickle cell disease, 2000–2021: a systematic analysis from the Global Burden of Disease Study 2021. Lancet Haematol. 2023; 10: e585-e599 Summary Full Text Full Text PDF Scopus (7) Google Scholar Although this study aims to provide much-needed data on the global epidemiology and natural history of sickle cell disease, we have serious concerns about the accuracy of the data. Global burden of sickle cell disease in 2021 – Authors' replyFor individual patients, diagnosis of sickle cell disease is paramount for facilitating intervention and treatment and alleviating suffering. However, as we hope is evident from our recent shared global experience of trying to understand the dynamics of the COVID-19 pandemic (and certainly holds true here), data collection alone is insufficient to inform public health efforts: it must also be accompanied by transparent and timely public sharing of data. Timeliness in data sharing is especially important when assessing trends in diseases like sickle cell disease, for which migration has the potential to rapidly shift the domestic landscape of a disease. Full-Text PDF

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24 center dot 3% (95% uncertainty interval [UI] 23 center dot 9-24 center dot 7), corresponding to 1 center dot 92 billion (1 center dot 89-1 center dot 95) prevalent cases, compared with a prevalence of 28 center dot 2% (27 center dot 8-28 center dot 5) and 1 center dot 50 billion (1 center dot 48-1 center dot 52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52 center dot 0 million (35 center dot 1-75 center dot 1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422 center dot 4 [95% UI 286 center dot 1-612 center dot 9]), haemoglobinopathies and haemolytic anaemias (89 center dot 0 [58 center dot 2-123 center dot 7]), and other neglected tropical diseases (36 center dot 3 [24 center dot 4-52 center dot 8]), collectively accounting for 84 center dot 7% (84 center dot 1-85 center dot 2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.