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AbstractObjectivesTo use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016.DesignSystematic analysis.Main outcome measuresCrude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education).ResultsThe total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817 000 (762 000 to 884 000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%).ConclusionsAge standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates.

In 2016, the estimated lifetime risk of stroke from the age of 25 years onward (as calculated from the results of the GBD Study) was 24.9%. This estimate varies according to country, region, and national level of social development. The risk increased by 8.9% from 1990 to 2016.

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.

The Millennium Declaration in 2000 brought special global attention to HIV, tuberculosis, and malaria through the formulation of Millennium Development Goal (MDG) 6. The Global Burden of Disease 2013 study provides a consistent and comprehensive approach to disease estimation for between 1990 and 2013, and an opportunity to assess whether accelerated progress has occured since the Millennium Declaration. To estimate incidence and mortality for HIV, we used the UNAIDS Spectrum model appropriately modified based on a systematic review of available studies of mortality with and without antiretroviral therapy (ART). For concentrated epidemics, we calibrated Spectrum models to fit vital registration data corrected for misclassification of HIV deaths. In generalised epidemics, we minimised a loss function to select epidemic curves most consistent with prevalence data and demographic data for all-cause mortality. We analysed counterfactual scenarios for HIV to assess years of life saved through prevention of mother-to-child transmission (PMTCT) and ART. For tuberculosis, we analysed vital registration and verbal autopsy data to estimate mortality using cause of death ensemble modelling. We analysed data for corrected case-notifications, expert opinions on the case-detection rate, prevalence surveys, and estimated cause-specific mortality using Bayesian meta-regression to generate consistent trends in all parameters. We analysed malaria mortality and incidence using an updated cause of death database, a systematic analysis of verbal autopsy validation studies for malaria, and recent studies (2010–13) of incidence, drug resistance, and coverage of insecticide-treated bednets. Globally in 2013, there were 1·8 million new HIV infections (95% uncertainty interval 1·7 million to 2·1 million), 29·2 million prevalent HIV cases (28·1 to 31·7), and 1·3 million HIV deaths (1·3 to 1·5). At the peak of the epidemic in 2005, HIV caused 1·7 million deaths (1·6 million to 1·9 million). Concentrated epidemics in Latin America and eastern Europe are substantially smaller than previously estimated. Through interventions including PMTCT and ART, 19·1 million life-years (16·6 million to 21·5 million) have been saved, 70·3% (65·4 to 76·1) in developing countries. From 2000 to 2011, the ratio of development assistance for health for HIV to years of life saved through intervention was US$4498 in developing countries. Including in HIV-positive individuals, all-form tuberculosis incidence was 7·5 million (7·4 million to 7·7 million), prevalence was 11·9 million (11·6 million to 12·2 million), and number of deaths was 1·4 million (1·3 million to 1·5 million) in 2013. In the same year and in only individuals who were HIV-negative, all-form tuberculosis incidence was 7·1 million (6·9 million to 7·3 million), prevalence was 11·2 million (10·8 million to 11·6 million), and number of deaths was 1·3 million (1·2 million to 1·4 million). Annualised rates of change (ARC) for incidence, prevalence, and death became negative after 2000. Tuberculosis in HIV-negative individuals disproportionately occurs in men and boys (versus women and girls); 64·0% of cases (63·6 to 64·3) and 64·7% of deaths (60·8 to 70·3). Globally, malaria cases and deaths grew rapidly from 1990 reaching a peak of 232 million cases (143 million to 387 million) in 2003 and 1·2 million deaths (1·1 million to 1·4 million) in 2004. Since 2004, child deaths from malaria in sub-Saharan Africa have decreased by 31·5% (15·7 to 44·1). Outside of Africa, malaria mortality has been steadily decreasing since 1990. Our estimates of the number of people living with HIV are 18·7% smaller than UNAIDS's estimates in 2012. The number of people living with malaria is larger than estimated by WHO. Incidence rates for HIV, tuberculosis, and malaria have all decreased since 2000. At the global level, upward trends for malaria and HIV deaths have been reversed and declines in tuberculosis deaths have accelerated. 101 countries (74 of which are developing) still have increasing HIV incidence. Substantial progress since the Millennium Declaration is an encouraging sign of the effect of global action. Bill & Melinda Gates Foundation.

Most of the Muslim societies of the world have entered a demographic transition from high to low fertility, and this process is accompanied by an increase in youth vis-a-vis other age groups. Political scientists and historians have debated whether such a \"youth bulge\" increases the potential for conflict or whether it represents a chance to accumulate wealth and push forward social and technological developments. This book introduces the discussion about youth bulge into social anthropology using Tajikistan, a post-Soviet country that experienced civil war in the 1990s, which is in the middle of such a demographic transition. Sophie Roche develops a social anthropological approach to analyze demographic and political dynamics, and suggests a new way of thinking about social change in youth bulge societies.

Virtually unnoticed in the contentious national debate over immigration is the significant demographic change about to occur as the first wave of the Baby Boom generation retires, slowly draining the workforce and straining the federal budget to the breaking point. In this forward-looking new book, noted demographer Dowell Myers proposes a new way of thinking about the influx of immigrants and the impending retirement of the Baby Boomers. Myers argues that each of these two powerful demographic shifts may hold the keys to resolving the problems presented by the other. Immigrants and Boomers looks to California as a bellwether state — where whites are no longer a majority of the population and represent just a third of residents under age twenty — to afford us a glimpse into the future impact of immigration on the rest of the nation. Myers opens with an examination of the roots of voter resistance to providing social services for immigrants. Drawing on detailed census data, Myers demonstrates that long-established immigrants have been far more successful than the public believes. Among the Latinos who make up the bulk of California’s immigrant population, those who have lived in California for over a decade show high levels of social mobility and use of English, and 50 percent of Latino immigrants become homeowners after twenty years. The impressive progress made by immigrant families suggests they have the potential to pick up the slack from aging boomers over the next two decades. The mass retirement of the boomers will leave critical shortages in the educated workforce, while shrinking ranks of middle-class tax payers and driving up entitlement expenditures. In addition, as retirees sell off their housing assets, the prospect of a generational collapse in housing prices looms. Myers suggests that it is in the boomers’ best interest to invest in the education and integration of immigrants and their children today in order to bolster the ranks of workers, taxpayers, and homeowners America they will depend on ten and twenty years from now. In this compelling, optimistic book, Myers calls for a new social contract between the older and younger generations, based on their mutual interests and the moral responsibility of each generation to provide for children and the elderly. Combining a rich scholarly perspective with keen insight into contemporary political dilemmas, Immigrants and Boomers creates a new framework for understanding the demographic challenges facing America and forging a national consensus to address them. DOWELL MYERS is professor of urban planning and demography at the University of Southern California.

Demographers have emphasized the importance of age in explaining the spread of COVID-19 and its impact on mortality. However, the relationship between COVID-19 mortality and age should be contextualized in relation to other causes of death. To compare the age pattern of COVID-19 mortality with other causes of death and across countries, and to use these regularities to impute age-specific death counts in countries with limited data. The COVID-19 mortality doubling time in a Gompertz context was compared with 65 major causes of death using US vital statistics. COVID-19 fatality doubling time was similarly compared across 27 countries and used for estimating death counts by age in Israel as a case in point. First, COVID-19 mortality increases exponentially with age at a Gompertz rate near the median of aging-related causes of death, as well as pneumonia and influenza. Second, COVID-19 mortality levels are 2.8 to 8.2 times higher than pneumonia and influenza across the adult age range. Third, the relationship between both COVID-19 mortality and fatality and age varies considerably across countries. The increase in COVID-19 mortality with age resembles the population rate of aging. Country differences in the age pattern of COVID-19 mortality and fatality may point to differences in underlying population health, standards of clinical care, or data quality.

Secondary dentine deposition is responsible for the decrease in the volume of the pulp cavity with age. Therefore, the volume of the pulp cavity can be considered as a predictor for estimating age. The aims of this study were to investigate the relationship strength between canine pulp volumes and chronological age from homogenous (approximately equal numbers of individuals in each age range) age distribution and to assess the effect of sex as predictor in age estimation. This study was performed on 719 subjects of Pakistani origin. Cone beam computed tomography images of 521 left maxillary and 681 left mandibular canines were collected from 368 females and 349 males aged from 15 to 65 years. Planmeca Romexis® software was used to trace the outline of the pulp cavity and to calculate pulp volumes. Regression analysis was performed to assess the correlation between pulp volumes considering with and without sex as a predictor with chronological age. The obtained results showed that mandibular canine pulp volume and sex have the highest predictive power (R2 = 0.33). The relationship between mandibular canine pulp volume and sex with chronological age demonstrates an odd S-shaped non-linear relationship. A statistically significant difference in volumes of pulp was found (p = 0.000) between males and females. The conclusion was that predictions using the pulp volume of the mandibular canine and sex produced the best estimates of chronological age.

Opioid-related mortality continues to rise across North America, and mortality rates have been further exacerbated by the COVID-19 pandemic. This study sought to provide an updated picture of trends of opioid-related mortality for Ontario, Canada between January 2003 and December 2020, in relation to age and sex. Using mortality data from the Office of the Chief Coroner for Ontario, we applied Bayesian Poisson regression to model age/sex mortality per 100,000 person-years, including random walks to flexibly capture age and time effects. Models were also used to explore how trends might continue into 2022, considering both pre- and post-COVID-19 courses. From 2003 to 2020, there were 11,633 opioid-related deaths in Ontario. A shift in the age distribution of mortality was observed, with the greatest mortality rates now among younger individuals. In 2003, mortality rates reached maximums at 5.5 deaths per 100,000 person-years (95% credible interval: 4.0-7.6) for males around age 44 and 2.2 deaths per 100,000 person-years (95% CI: 1.5-3.2) for females around age 51. As of 2020, rates have reached maximums at 67.2 deaths per 100,000 person-years (95% CI: 55.3-81.5) for males around age 35 and 16.8 deaths per 100,000 person-years (95% CI: 12.8-22.0) for females around age 37. Our models estimate that opioid-related mortality among the younger population will continue to grow, and that current conditions could lead to male mortality rates that are more than quadruple those of pre-pandemic estimations. This analysis may inform a refocusing of public health strategy for reducing rising rates of opioid-related mortality, including effectively reaching both older and younger males, as well as young females, with health and social supports such as treatment and harm reduction measures.

Age-adjusted COVID-19 mortality estimates have exposed a previously hidden excess mortality burden for the US Hispanic population. Multiple explanations have been put forth, including unequal quality/access to health care, higher proportion of pre-existing health conditions, multigenerational household composition, and disproportionate representation in telecommute-unfriendly occupations. However, these hypotheses have been rarely tested. We examine age-stratified patterns of Hispanic COVID-19 mortality vis-a-vis patterns of exposure to evaluate the multiple posited hypotheses. We use a combination of public and restricted data from the Centers of Disease Control and Prevention and leverage national and subnational race- and age-stratified COVID-19 mortality and case burdens/advantages to evaluate the workplace vulnerability hypothesis. We also use individual-level information on prior health conditions and mortality from the case data to assess whether observed patterns are consistent with the other hypotheses. Our results indicate that the disproportionate burdens for both COVID-19 case and mortality for the Hispanic population are largest among the working-age groups, supporting the hypothesis that workplace exposure plays a critical role in heightening vulnerability to COVID-19 mortality. We find little evidence to support the hypotheses regarding multigenerational household composition, pre-existing health conditions, or unequal quality/access to health care. Our findings point to the key roles played by age structure and differential exposure in contributing to the disproportionately severe impact of COVID-19 on the Hispanic population.