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In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Bill & Melinda Gates Foundation.

Background Cancer remains a major cause of mortality and a significant economic burden in China. Exploring the disparities in cancer patterns and control strategies between China and developed countries may offer valuable insights for policy formulation and enhance cancer management efforts. This study examined the incidence, mortality, and disability‐adjusted life year (DALY) burden of cancer in China, and compared these metrics with those observed in the United States (US) and the United Kingdom (UK). Methods Data on cancer incidence, mortality, and DALYs for China, the US, and the UK were sourced from the GLOBOCAN 2022 online database and the Global Burden of Disease 2021 study (GBD 2021). We utilized Joinpoint regression models to analyze trends in cancer incidence and mortality across these countries, calculating annual percent changes (APCs) and determining the optimal joinpoints. Results In 2022, China recorded around 4,824,703 new cancer cases and 2,574,176 cancer‐related deaths, contributing to 71,037,170 DALYs. China exhibited a lower cancer incidence rate compared to the US and the UK. Although cancer‐related mortality in China is slightly lower than that in the UK, it is significantly higher than that in the US. Additionally, China experienced significantly higher DALY rates compared to both the US and UK. The cancer landscape in China was also undergoing significant changes, with a rapid rise in the incidence and burden of lung, colorectal, breast, cervical, and prostate cancers. Meanwhile, the incidence and burden of stomach cancer continued to decline. Although the incidence of liver and esophageal cancers was decreasing, the burden of liver cancer was increasing, while the burden of esophageal cancer remained largely unchanged. Conclusions The cancer profile of China is shifting from that of a developing country to one more typical of a developed country. The ongoing population aging and the rise in unhealthy lifestyles are expected to further escalate the cancer burden in China. Consequently, it is crucial for Chinese authorities to revise the national cancer control program, drawing on successful strategies from developed countries, while also accounting for the regional diversity in cancer types across China.

Background Information about global and local epidemiology and trends of skin cancers is limited, which increases the difficulty of cutaneous cancer control. Methods To estimate the global spatial patterns and temporal trends of skin cancer burden. Based on the GBD 2019, we collected and analyzed numbers and age‐standardized rates (ASR) of skin cancer incidence, disability‐adjusted life years (DALYs) and mortality (ASIR, ASDR, and ASMR) in 204 countries from 1990 through 2019 were estimated by age, sex, subtype (malignant skin melanoma [MSM], squamous‐cell carcinoma [SCC], and basal‐cell carcinoma [BCC]), Socio‐demographic Index (SDI), region, and country. Temporal trends in ASR were also analyzed using estimated annual percentage change. Results Globally, in 2019, there were 4.0 million BCC, 2.4 million SCC, and 0.3 million MSM. There were approximately 62.8 thousand deaths and 1.7 million DALYs due to MSM, and 56.1 thousand deaths and 1.2 million DALYs were attributed to SCC, respectively. The men had higher ASR of skin cancer burden than women. The age‐specific rates of global skin cancer burden were higher in the older adults, increasing trends observed from 55 years old. Geographically, the numbers and ASR of skin cancers varied greatly across countries, with the largest burden of ASIR in high SDI regions. However, an unexpected increase was observed in some regions from 1990 to 2019, such as East Asia, and Sub‐Saharan Africa. Although there was a slight decrease of the ASMR and ASDR, the global ASIR of MSM dramatically increased, 1990–2019. Also, there was a remarkable increase in ASR of BCC and SCC burden. Conclusions Skin cancer remains a major global public health threat. Reducing morbidity and mortality strategies such as primary and secondary prevention should be reconsidered, especially in the most prevalent and unexpected increased regions, especially for those areas with the greatest proportions of their population over age 55. Main results of this systematic analysis showed that globally, in addition to a slight fall in mortality of melanoma, there was a dramatic increase in skin cancers burden from 1990 to 2019. Geographically, an unexpected increase was observed in some territories, 1990–2019, such as East Asia and Sub‐Saharan Africa, which were usually considered as low incidence areas in the past. Globally, increased efforts are needed in skin cancer prevention, especially, in regions with a high and/or increased burden of cutaneous cancer.

Background The European Union (EU) faces many health-related challenges. Burden of diseases information and the resulting trends over time are essential for health planning. This paper reports estimates of disease burden in the EU and individual 27 EU countries in 2019, and compares them with those in 2010. Methods We used the Global Burden of Disease 2019 study estimates and 95% uncertainty intervals for the whole EU and each country to evaluate age-standardised death, years of life lost (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) rates for Level 2 causes, as well as life expectancy and healthy life expectancy (HALE). Results In 2019, the age-standardised death and DALY rates in the EU were 465.8 deaths and 20,251.0 DALYs per 100,000 inhabitants, respectively. Between 2010 and 2019, there were significant decreases in age-standardised death and YLL rates across EU countries. However, YLD rates remained mainly unchanged. The largest decreases in age-standardised DALY rates were observed for “HIV/AIDS and sexually transmitted diseases” and “transport injuries” (each -19%). “Diabetes and kidney diseases” showed a significant increase for age-standardised DALY rates across the EU (3.5%). In addition, “mental disorders” showed an increasing age-standardised YLL rate (14.5%). Conclusions There was a clear trend towards improvement in the overall health status of the EU but with differences between countries. EU health policymakers need to address the burden of diseases, paying specific attention to causes such as mental disorders. There are many opportunities for mutual learning among otherwise similar countries with different patterns of disease. Key-points • This article, systematically analysing GBD 2019 study estimates, presents an overview of the state of health in the European Union in 2019, compared to 2010. • There was an improvement in the overall health status of the EU, despite substantial differences between Member States. • Cardiovascular diseases and neoplasms are the major contributors to the overall burden of diseases in the EU in 2019. • The age-standardised rate of years lived with disability due to mental disorders has been increasing and is expected to increase even more because of the COVID-19 pandemic. • This report provides a framework upon which to base further region- and country-specific health policies and interventions, to support health planning and priority setting.

Background: Gastric cancer (GC) remains a major global health burden, yet US trends often obscure disparities hidden within national averages. Although incidence and mortality have declined overall, profound geographic, racial, and socioeconomic differences persist. Few studies have systematically examined how demographic composition and social determinants jointly shape GC burden across states. Methods: We analyzed Global Burden of Disease 2021 estimates for GC incidence, mortality, and disability‑adjusted life years (DALYs) from 1990 to 2021 across 50 US states and the District of Columbia. Outcomes were stratified by age, sex, race/ethnicity, and sociodemographic index. Multivariable and mediation models assessed how income and education modified racial and ethnic disparities. Results: While national GC rates declined over three decades, the burden remained concentrated in states with large immigrant and low‑income populations, including Hawaii, the District of Columbia, Mississippi, and New Mexico. States with higher Asian populations exhibited roughly fourfold greater incidence than those with larger Hispanic populations. Income and education together mediated 22%–31% of racial and ethnic disparities, demonstrating that socioeconomic position—not race alone—drives much of the observed heterogeneity. Conclusions: This state‑level sociodemographic analysis reveals the structural underpinnings of US GC inequities within a broader global context of uneven early‑life risk and population diversity. By linking racial composition, income, and education to disease burden, it identifies modifiable pathways for prevention and policy action. Viewed as a case study for migrant‑receiving countries, these findings underscore the importance of equity‑informed strategies—such as Helicobacter pylori screening, nutrition interventions, and targeted resource allocation—to address persistent GC disparities globally.

Background Although the global burden of lung cancer has generally declined in recent decades, the variation in onset age‐related trends remains insufficiently explored. In the current study, we aimed to systematically evaluate the most update temporal trends in incidence, mortality and DALYs of early, middle, and late‐onset lung cancer (EOLC, MOLC, and LOLC) from 1990 to 2021, with stratifications of gender, location, and socio‐demographic development. Methods We retrieved cross‐sectional data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The global, regional, and national burden of lung cancer from 1990 to 2021 was evaluated primarily by age‐standardized rates of incidence (ASIR), mortality (ASMR), and DALYs (ASDR). Joinpoint regression analysis was employed to assess temporal trends and turning point years. Frontier analysis was applied to examine the lowest achievable DALYs, and cross‐country inequalities were evaluated sing the slope index of inequality (SII) and concentration index. We also forecasted the burden from 2022 to 2035. Results The global ASIR of EOLC decreased from 4.81 per 100,000 in 1990 to 3.13 in 2021 (AAPC: −1.38, 95% confidence interval [CI]: −1.53 to −1.22, p < 0.001), with a steeper decline in males (AAPC: −1.79) compared to females (AAPC: ‐0.63). MOLC incidence also declined from 92.77 to 72.47 per 100,000 (AAPC: ‐0.81, 95% CI: −0.9 to −0.73, p < 0.01), while LOLC demonstrated a slight increase from 195.39 to 225.8 per (AAPC: 0.43, 95% CI: 0.37 to 0.5, p < 0.01). Notably, LOLC in females showed a consistent rise in incidence rate (AAPC: 1.13, 95% CI: 1.05 to 1.21, p < 0.01). In contrast to EOLC and MOLC, 11, 10, and 9 out of 21 GBD regions showed a rising trend for ASIR, ASMR, and ASDR of LOLC, respectively. East Asia showed the steepest increase in ASIR (from 229.26 in 1990 to 375.90 in 2021, AAPC = 1.6, 95% CI: 1.31 to 1.89, p < 0.001) of LOLC. Moreover, according to socio‐demographic index (SDI) quintiles, the middle SDI region demonstrated the largest rise in ASIR of LOLC. Frontier analysis revealed that countries with higher SDIs had a greater capacity for reducing lung cancer burdens. Cross‐country inequalities of lung cancer burden in females were found to improve much slower than in males. The projections implied that, although lung cancer would generally decline in the next decade, the incidence, mortality, and DALY rates of LOLC in females might remarkably increase. Conclusions The global incidence, mortality, and DALY rates of lung cancer showed a general decline from 1990 to 2021. However, concerning trends of LOLC burden, especially among females and in specific regions or countries, were observed in this study. This study could help to guide more targeted prevention and intervention strategies for lung cancer control.

Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions. Bill & Melinda Gates Foundation.

Background Decubitus ulcers (DUs) represent a substantial global public health challenge, significantly diminishing patient quality of life and increasing the incidence of infection and early mortality. Given the rapidly aging populations in major East Asian economies, including China, Japan, South Korea, and Taiwan (Province of China), a comparative analysis of the DU burden across these regions is lacking. Methods Leveraging data from the Global Burden of Disease (GBD) 2021 study, this study quantified the epidemiological burden of DUs globally and specifically within China, Japan, South Korea, and Taiwan (Province of China) during the period 1990–2021. Analyses evaluated key metrics including incidence, mortality, and disability-adjusted life years (DALYs), presenting both absolute counts and age-standardized rates (ASRs). Temporal trends in these burden estimates were assessed using Joinpoint regression analysis to identify significant inflection points. Future burden projections were generated via autoregressive integrated moving average (ARIMA) modeling. Comprehensive stratification by sex, age group, geographical region, and temporal interval was performed throughout all analyses. Results Between 1990 and 2021, the global disease burden of DUs escalated markedly, with incident cases surging by 116.03% to an estimated 2.5 million worldwide in 2021. China recorded the largest absolute increase, with cases rising from 163,510 to over 397,310 (+ 142.99%), alongside dramatic upticks in mortality (from 240 to 3,130 deaths, + 1188.89%) and DALYs (+ 417.70%). Japan and South Korea also experienced substantial growth in incidence (from 68,090 to 152,660 and 16,480 to 39,840, respectively) and mortality. Taiwan (Province of China) exhibited the highest relative increase in incidence (+ 194.53%, reaching 4,950 cases in 2021), though its overall disease burden remained comparatively modest. Age-standardized rate analyses revealed divergent trends: China was the sole region with significant increases in incidence, mortality, and DALY rates, whereas Taiwan (Province of China) demonstrated the most significant reductions, and both South Korea and global rates generally declined. Males exhibited a higher disease burden, particularly in China, and the elderly—especially those aged 80 and above—were at greatest risk, with demographic aging identified as a key contributing factor. Forecasts for the coming decade suggest a continued upward trajectory in total DU cases across all examined countries and regions, with China projected to experience the most pronounced absolute increase. Conclusions DUs continue to represent a significant and escalating public health concern, especially within China. The increasing prevalence of an aging population serves as a primary catalyst, underscoring the urgent need for the deployment of regionally tailored and demographically stratified (notably by age and sex) healthcare policies and precision-based interventions. These results provide critical evidence to inform the optimization of DU management and the mitigation of geographic disparities. Subsequent research should prioritize the exploration of socioeconomic determinants and the enhancement of healthcare accessibility.

Background Migraine is a prevalent neurological disorder causing significant suffering and imposing a substantial burden on healthcare systems. Utilizing data from the Global Burden of Disease Study (GBD) 2021, this study comprehensively analyzes the current status, historical trends (1990–2021), and future projections of migraine burden in China and other G20 countries. The aim is to provide scientific evidence to inform evidence‐based health strategies. Methods We analyzed GBD 2021 data to calculate migraine incidence, prevalence, disability‐adjusted life years (DALYs), and years lived with disability (YLDs) from 1990 to 2021. Statistical analyses characterized these metrics across age, sex, year, geographical region, and the sociodemographic index (SDI). Trends in China and other G20 countries were tracked. Future trends (2022–2050) were projected using exponential smoothing (ES) and autoregressive integrated moving average (ARIMA) models. The Bayesian age‐period‐cohort (BAPC) model quantified the effects of age, period, and cohort factors on incidence, elucidating long‐term burden drivers. Result Migraine burden exhibited significant age dependency, with a bimodal age pattern. A pronounced gender disparity was evident, with females bearing a consistently higher burden across all metrics (e.g., prevalence approximately twice that of males). From 1990 to 2021, the migraine burden demonstrated a dual‐track trajectory: An overall increase in total burden accompanied by a widening gender gap. Predictive models project a concerning future: Without effective interventions, the migraine burden during 2030–2050 will feature further escalation of the gender imbalance. The BAPC model indicates a projected century‐long intensification of the migraine burden. Conclusions The migraine disease burden possesses distinct age and sex dimensions, revealing significant disparities across SDI regions, countries, age groups, and genders. The escalating burden necessitates targeted interventions and public health initiatives, particularly in regions and populations disproportionately affected. Based on GBD 2021 data, this analysis of historical trends and current situation overviews the global burden of migraines from 1990 to 2021.

Background Sexual transmission accounts for a substantial proportion of HIV infections. Although some countries are experiencing an upward trend in HIV infections, there has been a lack of studies assessing the global burden of HIV/AIDS acquired through sexual transmission. We assessed the global, regional, and national burdens of HIV/AIDS acquired through sexual transmission from 1990 to 2019. Methods Data on deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALY) of HIV/AIDS acquired through sexual transmission in 204 countries and territories from 1990 to 2019 were retrieved from the Global Burden of Disease Study (GBD) 2019. The burdens and trends were evaluated using the age-standardised rates (ASR) and estimated annual percentage change (EAPC). Results Globally, HIV/AIDS acquired through sexual transmission accounted for ~695.8 thousand (95% uncertainty interval 628.0-811.3) deaths, 33.0million (28.7-39.9) YLLs, 3.4million (2.4-4.6) YLDs, and 36.4million (32.2-43.1) DALYs in 2019. In 2019, Southern sub-Saharan Africa (11350.94), Eastern sub-Saharan Africa (3530.91), and Western sub-Saharan Africa (2037.74) had the highest ASR of DALYs of HIV/AIDS acquired through sexual transmission per 100,000. In most regions of the world, the burden of HIV/AIDS acquired through sexual transmission has been increasing from 1990 to 2019, mainly in Oceania (EAPC 17.20, 95% confidence interval 12.82-21.75), South Asia (9.00, 3.94-14.30), and Eastern Europe (7.09, 6.35-7.84). Conclusions HIV/AIDS acquired through sexual transmission results in a major burden globally, regionally, and nationally.