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Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990-2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021

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LANCET INFECTIOUS DISEASES 2025年第5期25卷 519-536页

作者： Kyu, Hmwe Hmwe Vongpradith, Avina Dominguez, Regina-Mae Villanueva Ma, Jianing Albertson, Samuel B. Novotney, Amanda Khalil, Ibrahim A. Troeger, Christopher E. Doxey, Matthew C. Ledesma, Jorge R. Sirota, Sarah Brooke Bender, Rose Grace Swetschinski, Lucien R. Cunningham, Matthew Spearman, Sandra Abate, Yohannes Habtegiorgis Abd Al Magied, Abdallah H. A. Abd ElHafeez, Samar Abdoun, Meriem Abera, Bayeh Abidi, Hassan Aboagye, Richard Gyan Abtew, Yonas Derso Abualruz, Hasan Abu-Gharbieh, Eman Abukhadijah, Hana J. Aburuz, Salahdein Addo, Isaac Yeboah Adekanmbi, Victor Adetunji, Charles Oluwaseun Oluwaseun Adeyeoluwa, Temitayo Esther Adhikary, Ripon Kumar Adnani, Qorinah Estiningtyas Sakilah Adra, Saryia Adzigbli, Leticia Akua Afolabi, Aanuoluwapo Adeyimika Afzal, Muhammad Sohail Afzal, Saira Agampodi, Suneth Buddhika Agide, Feleke Doyore Ahinkorah, Bright Opoku Ahmad, Aqeel Ahmad, Sajjad Ahmed, Ali Ahmed, Ayman Ahmed, Haroon Ahmed, Saeed Akinosoglou, Karolina Akter, Ema Al Awaidy, Salah Alajlani, Muaaz M. Alam, Khurshid Albakri, Almaza Albashtawy, Mohammed Aldhaleei, Wafa A. Algammal, Abdelazeem M. Al-Gheethi, Adel Ali Saeed Ali, Abid Syed Shujait Ali Ali, Waad Alif, Sheikh Mohammad Aljunid, Syed Mohamed Al-Marwani, Sabah Almazan, Joseph Uy Al-Mekhlafi, Hesham M. Almustanyir, Sami Alqahatni, Saleh A. Alrawashdeh, Ahmad Al-Rifai, Rami H. Alsabri, Mohammed A. Altaf, Awais Altirkawi, Khalid A. Alvis-Guzman, Nelson Alvis-Zakzuk, Nelson J. Alyahya, Mohammad Sharif Ibrahim Al-Zyoud, Walid A. Amugsi, Dickson A. Andrei, Catalina Liliana Antoni, Sebastien Anuoluwa, Boluwatife Stephen Anuoluwa, Iyadunni Adesola Anwari, Saleha Anwar Palwasha Apostol, Geminn Louis Carace Arabloo, Jalal Arafat, Mosab Aravkin, Aleksandr Y. Areda, Demelash Aregawi, Brhane Berhe Aremu, Abdulfatai Arndt, Michael Benjamin Asgedom, Akeza Awealom Ashraf, Tahira Athari, Seyyed Shamsadin Atreya, Alok Ayele, Firayad Azadi, Davood Azhar, Gulrez Shah Aziz, Shahkaar Azzam, Ahmed Y. Babu, Giridhara Rathnaiah Taghanaki, Pegah Bahrami Bahramian, Saeed Balakrishna Department of Health Metrics Sciences School of Medicine Institute for Health Metrics and Evaluation University of Washington Seattle 98195 WA United States Institute for Health Metrics and Evaluation University of Washington Seattle WA United States Department of Health Metrics Sciences School of Medicine University of Washington Seattle WA United States Center for Biostatistics Ohio State University Columbus OH United States Department of Global Health University of Washington Seattle WA United States Urban Indian Health Institute Seattle Indian Health Board Seattle WA United States School of Medicine Yale University New Haven CT United States Department of Clinical Governance and Quality Improvement Aleta Wondo General Hospital Aleta Wondo Ethiopia College of Pharmacy Ajman University Ajman United Arab Emirates Department of Epidemiology Alexandria University Alexandria Egypt Department of Medicine University of Sétif Algeria Sétif Algeria Department of Health Sétif Algeria Department of Medical Microbiology Bahir Dar University Bahir Dar Ethiopia Department of Biology Ghent University Ghent Belgium Laboratory Technology Sciences Department Yasuj University of Medical Sciences Yasuj Iran Department of Family and Community Health University of Health and Allied Sciences Ho Ghana Department of Biomedical Science Arba Minch University Arba Minch Ethiopia Department of Nursing Al Zaytoonah University of Jordan Amman Jordan Amman Jordan Department of Clinical Sciences Sharjah United Arab Emirates Department of Biopharmaceutics and Clinical Pharmacy University of Jordan Amman Jordan Medical Research Center-Academic Health System Hamad Medical Corporation Doha Qatar College of Pharmacy University of Jordan Amman Jordan Department of Therapeutics United Arab Emirates University Al Ain United Arab Emirates School of Medicine University of Sydney Sydney NSW Australia Centre for Social Research in Health University of New South Wales Syd

Background Diarrhoeal diseases claim more than 1 million lives annually and are a leading cause of death in children younger than 5 years. Comprehensive global estimates of the diarrhoeal disease burden for specific age groups of children younger than 5 years are scarce, and the burden in children older than 5 years and in adults is also understudied. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to assess the burden of, and trends in, diarrhoeal diseases overall and attributable to 13 pathogens, as well as the contributions of associated risk factors, in children and adults in 204 countries and territories from 1990 to 2021. Methods We used the Cause of Death Ensemble modelling strategy to analyse vital registration data, verbal autopsy data, mortality surveillance data, and minimally invasive tissue sampling data. We used DisMod-MR (version 2.1), a Bayesian meta-regression tool, to analyse incidence and prevalence data identified via systematic reviews, population-based surveys, and claims and inpatient data. We calculated diarrhoeal disability-adjusted life-years (DALYs) as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for each location, year, and age-sex group. For aetiology estimation, we used a counterfactual approach to quantify population-attributable fractions (PAFs). Additionally, we estimated the diarrhoeal disease burden attributable to the independent effects of risk factors using the comparative risk assessment framework. Findings In 2021, diarrhoeal diseases caused an estimated 1.17 million (95% uncertainty interval 0.793-1.62) deaths globally, representing a 60.3% (50.6-69.0) decrease since 1990 (2.93 million [2.31-3.73] deaths). The most pronounced decline was in children younger than 5 years, with a 79.2% (72.4-84.6) decrease in diarrhoeal deaths. Global YLLs also decreased substantially, from 186 million (147-221) in 1990 to 51.4 million (39.9-65.9) in 2021. In 2021, an esti

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Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

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The Lancet 2023年第10397期402卷 203-234页

作者： Ong, Kanyin Liane Stafford, Lauryn K. McLaughlin, Susan A. Boyko, Edward J. Vollset, Stein Emil Smith, Amanda E. Dalton, Bronte E. Duprey, Joe Cruz, Jessica A. Hagins, Hailey Lindstedt, Paulina A. Aali, Amirali Abate, Yohannes Habtegiorgis Abate, Melsew Dagne Abbasian, Mohammadreza Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Mohsen ElHafeez, Samar Abd Abd-Rabu, Rami Abdulah, Deldar Morad Abdullah, Abu Yousuf Md Abedi, Vida Abidi, Hassan Aboagye, Richard Gyan Abolhassani, Hassan Abu-Gharbieh, Eman Abu-Zaid, Ahmed Adane, Tigist Demssew Adane, Denberu Eshetie Addo, Isaac Yeboah Adegboye, Oyelola A. Adekanmbi, Victor Adepoju, Abiola Victor Adnani, Qorinah Estiningtyas Sakilah Afolabi, Rotimi Felix Agarwal, Gina Aghdam, Zahra Babaei Agudelo-Botero, Marcela Arriagada, Constanza Elizabeth Aguilera Agyemang-Duah, Williams Ahinkorah, Bright Opoku Ahmad, Danish Ahmad, Rizwan Ahmad, Sajjad Ahmad, Aqeel Ahmadi, Ali Ahmadi, Keivan Ahmed, Ali Ahmed, Luai A. Ahmed, Syed Anees Ajami, Marjan Akinyemi, Rufus Olusola Al Hamad, Hanadi Al Hasan, Syed Mahfuz AL-Ahdal, Tareq Mohammed Ali Alalwan, Tariq A. Al-Aly, Ziyad AlBataineh, Mohammad T. Alcalde-Rabanal, Jacqueline Elizabeth Alemi, Sharifullah Ali, Hassam Alinia, Tahereh Aljunid, Syed Mohamed Almustanyir, Sami Al-Raddadi, Rajaa M. Alvis-Guzman, Nelson Amare, Firehiwot Ameyaw, Edward Kwabena Amiri, Sohrab Amusa, Ganiyu Adeniyi Andrei, Catalina Liliana Anjana, Ranjit Mohan Ansar, Adnan Ansari, Golnoosh Ansari-Moghaddam, Alireza Anyasodor, Anayochukwu Edward Arabloo, Jalal Aravkin, Aleksandr Y. Areda, Demelash Arifin, Hidayat Arkew, Mesay Armocida, Benedetta Arnlov, Johan Artamonov, Anton A. Arulappan, Judie Aruleba, Raphael Taiwo Arumugam, Ashokan Aryan, Zahra Asemu, Mulu Tiruneh Asghari-Jafarabadi, Mohammad Askari, Elaheh Asmelash, Daniel Astell-Burt, Thomas Athar, Mohammad Athari, Seyyed Shamsadin Atout, Maha Moh'd Wahbi Avila-Burgos, Leticia Awaisu, Ahmed Azadnajafabad, Sina Darshan, B.B. Babamohamadi, Hassan Badar, Muhammad Badawi, Alaa Badiye, Ashish D. Baghcheghi, Nayereh Baghe Institute for Health Metrics and Evaluation School of Medicine General Medicine Service Department of Veterans Affairs Seattle WA United States Department of Health Metrics Sciences School of Medicine Faculty of Medicine France Department of Clinical Governance and Quality Improvement Aleta Wondo Hospital Aleta Wondo Ethiopia Department of Nursing Woldia University Woldia Ethiopia Department of Nursing Department of Orthopedic Surgery Orthopaedic Surgery Social Determinants of Health Research Center Non-communicable Diseases Research Center Epidemiology Department Evidence-Based Practice Center Community and Maternity Nursing Unit University of Duhok Duhok Iraq School of Planning Faculty of Environment Department of Public Health Sciences Penn State College of Medicine Pennsylvania State University Hershey PA United States Biocomplexity Institute Virginia Tech Blacksburg VA United States College of Medicine Department of Public Health Laboratory Technology Sciences Department Department of Family and Community Health University of Health and Allied Sciences Ho Ghana Research Center for Immunodeficiencies Department of Biosciences and Nutrition Karolinska University Hospital Huddinge Sweden Clinical Sciences Department Department of Surgery Department of Surgery Department of Obstetrics & Gynecology College of Graduate Health Sciences University of Tennessee Memphis TN United States Department of Obstetrics & Gynecology Department of Clinical and Psychosocial Epidemiology Department of Anesthesia and Critical Care Centre for Social Research in Health Quality and Systems Performance Unit Cancer Institute NSW Sydney NSW Australia Department of Public Health and Tropical Medicine HIV and Infectious Diseases Department Jhpiego Abuja Nigeria Adolescent Research and Care Department Adolescent Friendly Research Initiative and Care Ado Ekiti Nigeria Department of Epidemiology Department of Epidemiology and Medical Statistics Department of Family Medicine McMaster University

Background: Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. Methods: Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined;these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs;defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims;type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative r

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Adolescent self-construal across cultures: Measurement invariance of the Aspects of Identity Questionnaire-IV in 30 countries

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Journal of Research on Adolescence 2025年第2期35卷 e70017页

作者： Jovanović, Veljko Adams, Sabirah Al Banna, Md. Hasan Aritio-Solana, Rebeca Aryanto, Christ Billy Avsec, Andreja Bakhshi, Ali Bender, Michael Berjot, Sophie Betancourth Zambrano, Sonia Brajša-Žganec, Andreja Broche-Pérez, Yunier Buzea, Carmen Cabello, Rosario Carreca, Valentina Cassibba, Rosalinda Cavazos-Arroyo, Judith Daemi, Fatemeh Díaz-Guerra, Diego D. Džida, Marija Eidelsburger, Mona Fernández-Berrocal, Pablo Fernández-Castillo, Evelyn Fonseca-Pedrero, Eduardo Frackowiak, Tomasz Freire, Teresa Gavrilov-Jerković, Vesna Gjoneska, Biljana Guerrero-Alcedo, Jesús Hillekens, Jessie Höfer, Stefan Kabir, Md. Humyon Iqbal, Naved Jámbori, Szilvia Joshanloo, Mohsen Kaliterna Lipovčan, Ljiljana Kavčič, Tina Kowal, Marta Krstevska Taseva, Marija Tong, Kwok Kit Lazić, Milica Manrique-Millones, Denisse Misiak, Michal Musso, Pasquale Obradović, Vojana Ortuño Sierra, Javier Orzea, Ioana Özaslan, Ahmet Park, Joonha Pašić, Marija Pilkauskaitė Valickienė, Rasa Puente-Díaz, Rogelio Puerta-Sierra, Lizbeth Ristevska Dimitrovska, Gordana Roberts, S. Craig Ronauli, Puji Tania Savahl, Shazly Serapinas, Danielius Kuan, Sok Ian Sorokowska, Agnieszka Sorokowski, Piotr Sulejmanović, Dijana Sultana, Mst Sadia Yuen, Sze Man Szél, Erzsébet Šakan, Dušana Tilga, Henri Tomašević, Aleksandar Unanue, Wenceslao Unanue, Jesús van Egmond, Marieke Yıldırım, Murat Zager Kocjan, Gaja Zamarian, Laura Zotović-Kostić, Marija Department of Psychology Faculty of Philosophy University of Novi Sad Novi Sad Serbia Academic Development Programme University of Cape Town Cape Town South Africa Faculty of Nutrition and Food Science Patuakhali Science and Technology University Patuakhali Bangladesh Educational Sciences Department University of La Rioja Logroño Spain Faculty of Psychology Atma Jaya Catholic University of Indonesia Jakarta Indonesia Department of Psychology Faculty of Arts University of Ljubljana Ljubljana Slovenia State Welfare Organization of Iran Tehran Iran Department of Social Psychology Tilburg University Tilburg Netherlands Université de Reims Champagne-Ardenne C2S Reims France Teacher University of Nariño Nariño Pasto Colombia Institute of Social Sciences Ivo Pilar Zagreb Croatia Prisma Behavioral Center West Palm Beach FL United States Department of Social Sciences and Communication Faculty of Sociology and Communication Transilvania University of Brasov Brasov Romania Department of Developmental and Educational Psychology Faculty of Psychology University of Málaga Málaga Spain Department of Education Psychology Communication University of Bari Bari Italy Centro Interdisciplinario de Posgrados Universidad Popular Autónoma del Estado de Puebla Puebla Mexico Faculty of Psychology and Educational Sciences Islamic Azad University Central Tehran Branch Tehran Iran Psychology Department Universidad Central Marta Abreu de Las Villas Villa Clara Cuba Department of Psychology Leopold Franzens University Innsbruck Austria Department of Basic Psychology Faculty of Psychology University of Málaga Málaga Spain Institute of Psychology University of Wroclaw Wroclaw Poland School of Psychology University of Minho Braga Portugal Macedonian Academy of Sciences and Arts Skopje North Macedonia Carrera de Psicología Facultad de Ciencias de la Salud Universidad Científica del Sur Lima Peru Department of Developmental Psychology Tilburg University Tilburg Netherla

Despite the critical role of culture in understanding adolescent self and identity, there is a lack of cross-culturally validated measures of adolescent self-construal. The present study evaluated cross-national measurement invariance of the Aspects of Identity Questionnaire-IV (AIQ-IV), assessing four dimensions of self-construal: personal, relational, public, and collective. The sample included 16,795 adolescents aged 14–19 years from 30 countries across four continents. The four-factor structure of the AIQ-IV obtained using exploratory structural equation modeling (ESEM) was supported in the vast majority of countries. Exact invariance testing using multi-group ESEM supported configural invariance, indicating that the overall structure of the AIQ-IV was similar across countries. Full scalar invariance was supported only on a subset of countries (i.e., when tests were conducted using European countries grouped by UN geographical regions). An alignment approach provided evidence for the approximate invariance of the ESEM model, with 15.6% of parameters showing noninvariance and allowing for comparison of latent means. The largest number of noninvariant parameters was evident in Asian countries, with items assessing collective-interdependent aspects of identity showing the most variation across countries. A comparison of mean levels of identity orientations across countries revealed that culture-level dimensions of collectivism–individualism do not translate simply into individual-level dimensions of self-construal. © 2025 Society for Research on Adolescence.

关键词： adolescence culture identity measurement invariance self self-construal

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Global investments in pandemic preparedness and COVID-19: development assistance and domestic spending on health between 1990 and 2026

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The Lancet Global Health 2023年第3期11卷 e385-e413页

作者： Micah, Angela E. Bhangdia, Kayleigh Cogswell, Ian E. Lasher, Dylan Lidral-Porter, Brendan Maddison, Emilie R. Nguyen, Trang Nhu Ngoc Patel, Nishali Pedroza, Paola Solorio, Juan Stutzman, Hayley Tsakalos, Golsum Wang, Yifeng Warriner, Wesley Zhao, Yingxi Zlavog, Bianca S. Abbafati, Cristiana Abbas, Jaffar Abbasi-Kangevari, Mohsen Abbasi-Kangevari, Zeinab Abdelmasseh, Michael Abdulah, Deldar Morad Abedi, Aidin Abegaz, Kedir Hussein Abhilash, E.S. Aboagye, Richard Gyan Abolhassani, Hassan Abrigo, Michael R.M. Abubaker Ali, Hiwa Abu-Gharbieh, Eman Adem, Mohammed Hussien Afzal, Muhammad Sohail Ahmadi, Ali Ahmed, Haroon Ahmed Rashid, Tarik Aji, Budi Akbarialiabad, Hossein Akelew, Yibeltal Al Hamad, Hanadi Alam, Khurshid Alanezi, Fahad Mashhour Alanzi, Turki M. Al-Hanawi, Mohammed Khaled Alhassan, Robert Kaba Aljunid, Syed Mohamed Almustanyir, Sami Al-Raddadi, Rajaa M. Alvis-Guzman, Nelson Alvis-Zakzuk, Nelson J. Amare, Azmeraw T. Ameyaw, Edward Kwabena Amini-Rarani, Mostafa Amu, Hubert Ancuceanu, Robert Andrei, Tudorel Anwar, Sumadi Lukman Appiah, Francis Aqeel, Muhammad Arabloo, Jalal Arab-Zozani, Morteza Aravkin, Aleksandr Y. Aremu, Olatunde Aruleba, Raphael Taiwo Athari, Seyyed Shamsadin Avila-Burgos, Leticia Ayanore, Martin Amogre Azari, Samad Baig, Atif Amin Bantie, Abere Tilahun Barrow, Amadou Baskaran, Pritish Basu, Sanjay Batiha, Abdul-Monim Mohammad Baune, Bernhard T. Berezvai, Zombor Bhardwaj, Nikha Bhardwaj, Pankaj Bhaskar, Sonu Boachie, Micheal Kofi Bodolica, Virginia Botelho, João Silva Botelho Braithwaite, Dejana Breitborde, Nicholas J.K. Busse, Reinhard Cahuana-Hurtado, Lucero Catalá-López, Ferrán Chansa, Collins Charan, Jaykaran Chattu, Vijay Kumar Chen, Simiao Chukwu, Isaac Sunday Dadras, Omid Dandona, Lalit Dandona, Rakhi Dargahi, Abdollah Debela, Sisay Abebe Denova-Gutiérrez, Edgar Desye, Belay Dharmaratne, Samath Dhamminda Diao, Nancy Doan, Linh Phuong Dodangeh, Milad dos Santos, Wendel Mombaque Doshmangir, Leila Dube, John Eini, Ebrahim El Sayed Zaki, Maysaa El Tantawi, Maha Enyew, Daniel Berhanie Institute for Health Metrics and Evaluation University of Washington Seattle WA United States Department of Applied Mathematics University of Washington Seattle WA United States Department of Health Metrics Sciences School of Medicine University of Washington Seattle WA United States Nuffield Department of Medicine University of Oxford Oxford United Kingdom Department of Juridical and Economic Studies La Sapienza University Rome Italy Antai College of Economics Shanghai Jiao Tong University Shanghai China Non-communicable Diseases Research Center Tehran University of Medical Sciences Tehran Iran Research Center for Immunodeficiencies Tehran University of Medical Sciences Tehran Iran Multiple Sclerosis Research Center Tehran University of Medical Sciences Tehran Iran Children’s Medical Center Tehran University of Medical Sciences Tehran Iran Department of Epidemiology and Biostatistics Tehran University of Medical Sciences Tehran Iran Tehran Heart Center Tehran University of Medical Sciences Tehran Iran Faculty of Medicine Tehran University of Medical Sciences Tehran Iran National Institute for Health Research Tehran University of Medical Sciences Tehran Iran Department of Pharmacology Tehran University of Medical Sciences Tehran Iran Department of Cardiology Tehran University of Medical Sciences Tehran Iran Sina Trauma and Surgery Research Center Tehran University of Medical Sciences Tehran Iran Digestive Diseases Research Institute Tehran University of Medical Sciences Tehran Iran Department of Neurology Tehran University of Medical Sciences Tehran Iran Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran Department of Epidemiology Shahid Beheshti University of Medical Sciences Tehran Iran Department of Health Economics and Statistics Shahid Beheshti University of Medical Sciences Tehran Iran Department of Neurosurgery Shahid Beheshti University of Medical Sciences Tehran Iran Ophthalmic R

Background: The COVID-19 pandemic highlighted gaps in health surveillance systems, disease prevention, and treatment globally. Among the many factors that might have led to these gaps is the issue of the financing of national health systems, especially in low-income and middle-income countries (LMICs), as well as a robust global system for pandemic preparedness. We aimed to provide a comparative assessment of global health spending at the onset of the pandemic;characterise the amount of development assistance for pandemic preparedness and response disbursed in the first 2 years of the COVID-19 pandemic;and examine expectations for future health spending and put into context the expected need for investment in pandemic preparedness. Methods: In this analysis of global health spending between 1990 and 2021, and prediction from 2021 to 2026, we estimated four sources of health spending: development assistance for health (DAH), government spending, out-of-pocket spending, and prepaid private spending across 204 countries and territories. We used the Organisation for Economic Co-operation and development (OECD)'s Creditor Reporting System (CRS) and the WHO Global Health Expenditure Database (GHED) to estimate spending. We estimated development assistance for general health, COVID-19 response, and pandemic preparedness and response using a keyword search. Health spending estimates were combined with estimates of resources needed for pandemic prevention and preparedness to analyse future health spending patterns, relative to need. Findings: In 2019, at the onset of the COVID-19 pandemic, US$9·2 trillion (95% uncertainty interval [UI] 9·1–9·3) was spent on health worldwide. We found great disparities in the amount of resources devoted to health, with high-income countries spending $7·3 trillion (95% UI 7·2–7·4) in 2019;293·7 times the $24·8 billion (95% UI 24·3–25·3) spent by low-income countries in 2019. That same year, $43·1 billion in development assistance was provided

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National identity predicts public health support during a global pandemic (vol 13, 517, 2022)

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NATURE COMMUNICATIONS 2022年第1期13卷 1-14页

作者： Van Bavel, Jay J. Cichocka, Aleksandra Capraro, Valerio Sjastad, Hallgeir Nezlek, John B. Pavlovic, Tomislav Alfano, Mark Gelfand, Michele J. Azevedo, Flavio Birtel, Michele D. Cislak, Aleksandra Lockwood, Patricia L. Ross, Robert Malcolm Abts, Koen Agadullina, Elena Aruta, John Jamir Benzon Besharati, Sahba Nomvula Bor, Alexander Choma, Becky L. Crabtree, Charles David Cunningham, William A. De, Koustav Ejaz, Waqas Elbaek, Christian T. Findor, Andrej Flichtentrei, Daniel Franc, Renata Gjoneska, Biljana Gruber, June Gualda, Estrella Horiuchi, Yusaku Huynh, Toan Luu Duc Ibanez, Agustin Imran, Mostak Ahamed Israelashvili, Jacob Jasko, Katarzyna Kantorowicz, Jaroslaw Kantorowicz-Reznichenko, Elena Krouwel, Andre Laakasuo, Michael Lamm, Claus Leygue, Caroline Lin, Ming-Jen Mansoor, Mohammad Sabbir Marie, Antoine Mayiwar, Lewend Mazepus, Honorata McHugh, Cillian Minda, John Paul Mitkidis, Panagiotis Olsson, Andreas Otterbring, Tobias Packer, Dominic J. Perry, Anat Petersen, Michael Bang Puthillam, Arathy Riano-Moreno, Julian C. Rothmund, Tobias Santamaria-Garcia, Hernando Schmid, Petra C. Stoyanov, Drozdstoy Tewari, Shruti Todosijevic, Bojan Tsakiris, Manos Tung, Hans H. Umbres, Radu G. Vanags, Edmunds Vlasceanu, Madalina Vonasch, Andrew Yucel, Meltem Zhang, Yucheng Abad, Mohcine Adler, Eli Akrawi, Narin Mdarhri, Hamza Alaoui Amara, Hanane Amodio, David M. Antazo, Benedict G. Apps, Matthew Ay, F. Ceren Ba, Mouhamadou Hady Barbosa, Sergio Bastian, Brock Berg, Anton Bernal-Zarate, Maria P. Bernstein, Michael Bialek, Michal Bilancini, Ennio Bogatyreva, Natalia Boncinelli, Leonardo Booth, Jonathan E. Borau, Sylvie Buchel, Ondrej Cameron, C. Daryl Carvalho, Chrissie F. Celadin, Tatiana Cerami, Chiara Chalise, Hom Nath Cheng, Xiaojun Cian, Luca Cockcroft, Kate Conway, Jane Cordoba-Delgado, Mateo Andres Crespi, Chiara Crouzevialle, Marie Cutler, Jo Cypryanska, Marzena Dabrowska, Justyna Daniels, Michael A. Davis, Victoria H. Dayley, Pamala N. Delouvee, Sylvain Denkovski, Ognjan Dezecache, Guillaume Dhaliwal, Nathan A. Diato, Department of Psychology and Neural Science New York University New York NY USA Department of Psychology University of Amsterdam Amsterdam Netherlands School of Psychology University of Kent Canterbury England Department of Economics Middlesex University London London England Department of Strategy and Management Norwegian School of Economics Bergen Norway SWPS University of Social Sciences and Humanities Poznań Poland Department of Psychological Sciences College of William and Mary Williamsburg VA USA Institute of Social Sciences Ivo Pilar Zagreb Croatia Department of Philosophy Macquarie University Sydney NSW Australia Stanford Graduate School of Business Stanford University Stanford CA USA Institute of Communication Science Friedrich-Schiller University Jena Jena Germany School of Human Sciences Institute for Lifecourse Development University of Greenwich London England Department of Experimental Psychology University of Oxford Oxford England Center for Human Brain Health School of Psychology University of Birmingham Birmingham England Department of Psychology Macquarie University Sydney NSW Australia KU Leuven Leuven Belgium National Research University Higher School of Economics (HSE) Moscow Russia De La Salle University Manila Philippines Department of Psychology University of the Witwatersrand Johannesburg South Africa Department of Political Science Aarhus University Aarhus Denmark X University Toronto Canada Department of Government Dartmouth College Hanover NH USA Department of Psychology University of Toronto Toronto ON Canada Gatton College of Business and Economics University of Kentucky Lexington KY USA Department of Mass Communication National University of Science and Technology (NUST) Islamabad Pakistan Department of Management Aarhus University Aarhus Denmark Center for Advanced Hindsight Duke University Durham NC USA Faculty of Social and Economic Sciences Comenius University Bratislava Slovakia IntraMed B

Changing collective behaviour and supporting non-pharmaceutical interventions is an important component in mitigating virus transmission during a pandemic. In a large international collaboration (Study 1,N= 49,968 across 67 countries), we investigated self-reported factors associated with public health behaviours (e.g., spatial distancing and stricter hygiene) and endorsed public policy interventions (e.g., closing bars and restaurants) during the early stage of the COVID-19 pandemic (April-May 2020). Respondents who reported identifying more strongly with their nation consistently reported greater engagement in public health behaviours and support for public health policies. Results were similar for representative and non-representative national samples. Study 2 (N= 42 countries) conceptually replicated the central finding using aggregate indices of national identity (obtained using the World Values Survey) and a measure of actual behaviour change during the pandemic (obtained from Google mobility reports). Higher levels of national identification prior to the pandemic predicted lower mobility during the early stage of the pandemic (r= −0.40). We discuss the potential implications of links between national identity, leadership, and public health for managing COVID-19 and future pandemics.

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Getting Undergraduates Ready for China’s Belt and Road Initiative (BRI) Through an Overseas Experiential learning Project

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China and the World 2021年第3期4卷

作者： Andrew Min Han Chin Thomas Menkhoff Hans-Dieter Evers Hoong Hui Daniel Gn Kevin Koh Chester Wey Lee Patrick H. M. Loh Linda Low Sebastian Tan Teng Seng Teo Natalie Yap Lee Kong Chian School of Business Singapore Management University (SMU) 81 Victoria Street Singapore 188065 Singapore Andrew Chin Min Han graduated from Tsinghua University in Beijing China with a Tsinghua–MIT Sloan International Master of Business Administration degree under the Singapore Government’s Asian Business Fellowship (ABF) scholarship program. He is the Program Director of Singapore Management University (SMU) Executive Certificate in China Business and of the SMU Internationalisation Series. He teaches as an Adjunct Faculty of Strategy and Organisation at the SMU Lee Kong Chian School of Business since January 2017. He teaches effectively in English and Chinese. With over 23 years of experience in education and publishing industry in Asia Andrew Chin’s multi-sector career has enabled him to experience the full spectrum of the education industry in his roles as the Singapore EDB Officer handling the World-Class University portfolio and the Specialist Information and Publishing Industry portfolio Chief Representative and Country Manager (China) at Thomson Learning (Fortune 500 company) and Co-founder and CEO for an early childhood education business. Andrew was a Business Development Director (Universities) at Sodexo Group (Fortune 500 company) for the Asia-Pacific region. After working 10 years in Beijing China Andrew returned to Singapore in 2012 to work closely with the top leadership at Singapore Management University on the SMU China & East Asia Initiatives. Thomas Menkhoff is the Professor of Organisational Behaviour & Human Resources (Education) at the Lee Kong Chian School of Business Singapore Management University (SMU). Two of his recent publications include: (i) Menkhoff Thomas Ning Kan Siew Evers Hans-Dieter and Chay Yue Wah eds. Living in Smart Cities: Innovation and Sustainability (New Jersey: World Scientific Publishing 2018) and (ii) Chay Yue Wah Menkhoff Thomas and Low Linda eds. China’s Belt and Road Initiative — Understanding the Dynamics of a Global Transfor

In this paper, we explain how an experiential learning course and study tour to Gansu Province (People’s Republic of China) enabled undergraduates at the Singapore Management University (SMU) to acquire 21st-century competencies and higher-order thinking skills by analyzing and evaluating specific aspects of China’s Belt and Road Initiative (BRI) and China–Singapore (Chongqing) Connectivity Initiative — New International Land–Sea Trade Corridor (CCI-ILSTC) with emphasis on developing viable Go-To-Market (GTM) strategies aimed at selling Gansu produce in four Southeast Asian markets. We share how the course was designed to support the attainment of key learning goals and discuss how we turned pedagogical aspirations into concrete learning outcomes. We introduce key aspects of the so-called “SMU-XO” project that the students conducted in partnership with an industry partner, Pacific International Lines (PIL), and discuss how the project work helped learners to gain global competency by (i) examining critical issues related to BRI such as multi-modal infrastructure connectivity, (ii) appreciating the local perspectives of project stakeholders in Lanzhou and Shanghai and (iii) successfully interacting with people from different cultures, namely China, Indonesia, Vietnam, Malaysia and Thailand.

关键词： Experiential learning Singapore China Belt and Road Initiative (BRI)

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Separated by Removal: The Impact of Parental Deportation on Latina/o Children’s Postsecondary educational Goals

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Diaspora, Indigenous, and Minority education 2016年第3期10卷 169-181页

作者： Macías, Luis Fernando Collet, Bruce Anthony Department of Teaching and Learning Multicultural and Equity Studies in Education The Ohio State University United States School of Educational Foundations Leadership and Policy College of Education & Human Development Bowling Green State University United States

This research examines the impact of parental deportation on Latino/a adolescents’ postsecondary aspirations. Based on interviews with students, their families, and site observations, the study finds that for some adolescents who held college aspirations prior to the deportation, this type of abrupt parental removal negatively affects their perception of safety and stability in their home and school environments (i.e., microsystem) (Bronfenbrenner, 2005). Where this vulnerability is not countered with emotional, economic, and institutional support, it can hinder their development of the social capital (Coleman, 1988;Stanton-Salazar, 2001) that would be conducive to their higher educational aspirations. © 2016 Taylor & Francis.

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Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019

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Nature communications 2025年第1期16卷 4235-4235页

作者： Cecilia Anza-Ramirez J. Jaime Miranda Benedetta Armocida Jorge César Correia Harriette Gillian Christine Van Spall David Beran Amirali Aali Kalkidan Hassen Abate Semagn Mekonnen Abate Cristiana Abbafati Mohsen Abbasi-Kangevari Zeinab Abbasi-Kangevari Zahra Aryan Sina Azadnajafabad Mohammadreza Azangou-Khyavy Seyyed-Hadi Ghamari Mohammad Keykhaei Javad Khanali Sara Momtazmanesh Fateme Montazeri Shayan Rahmani Mohammad-Mahdi Rashidi Nazila Rezaei Negar Rezaei Sahar Saeedi Moghaddam Hossein Hassanian-Moghaddam Ali-Asghar Kolahi Ali Nikoobar Hedayat Abbastabar Ahmed M. Abdel-Azeem Michael Abdelmasseh Juan Sanabria Sherief Abd-Elsalam Ahmed Abdelwahab Gholamreza Abdoli Mohammad Abdollahi Meriem Abdoun Deldar Morad Abdulah Abu Yousuf Md Abdullah Ame Mehadi Abdurehman Getachew Abebe Aidin Abedi Chirag P. Doshi Vida Abedi Hassan Abidi Richard Gyan Aboagye Hassan Abolhassani Nima Rezaei Lucas Guimarães Abreu Michael R. M. Abrigo Yonas Derso Abtew Hiwa Abubaker Ali Eman Abu-Gharbieh Hiba Jawdat Barqawi Rabih Halwani Maha Mohamed Saber-Ayad Iman M. Talaat Ahmed Abu-Zaid Manfred Mario Kokou Accrombessi Juan Manuel Acuna Denberu Eshetie Adane Tigist Demssew Adane Isaac Yeboah Addo Giovanni Addolorato Oluwafemi Atanda Adeagbo Victor Adekanmbi Miracle Ayomikun Adesina Isaac Iyinoluwa Olufadewa Olatunji O. Adetokunboh Daniel Adedayo Adeyinka Qorinah Estiningtyas Sakilah Adnani Aanuoluwapo Adeyimika Afolabi Olayinka Stephen Ilesanmi Muhammad Sohail Afzal Saira Afzal Gina Agarwal Prerna Agarwal Pradyumna Agasthi Anurag Agrawal Marcela Agudelo-Botero Adolfo Martinez-Valle Bright Opoku Ahinkorah Aqeel Ahmad Sajjad Ahmad Sohail Ahmad Tauseef Ahmad Ali Ahmadi Siamak Sabour Keivan Ahmadi Sanjay Basu Sepideh Ahmadi Ali Ahmed Shaun Wen Huey Lee Ayman Ahmed Haroon Ahmed Jivan Qasim Ahmed Gahin Abdulraheem Tayib Yahya Yahya Luai A. Ahmed Iffat Elbarazi Syed Mahboob Shah Janardhana P. Aithala Marjan Ajami Budi Aji Hossein Akbarialiabad Yibeltal Akelew Meisam Akhlaghdoust Elham Jamshidi Addis Aklilu Azene Tesfaye Melat Woldemariam Maxwell Ak CRONICAS Center of Excellence in Chronic Diseases Universidad Peruana Cayetano Heredia Lima Peru School of Medicine Universidad Peruana Cayetano Heredia Lima Peru Sydney School of Public Health Faculty of Medicine and Health University of Sydney Sydney NSW Australia Faculty of Epidemiology and Population Health London School of Hygiene & Tropical Medicine London UK Division of Tropical and Humanitarian Medicine University of Geneva Geneva Switzerland Department of Cardiovascular Endocrine-metabolic Diseases and Aging Istituto Superiore di Sanità Rome Italy Division of Endocrinology Diabetology Nutrition and Therapeutic Patient Education Department of Medicine Geneva University Hospitals Geneva Switzerland Department of Medicine and Department of Health Research Evidence and Impact McMaster University Hamilton ON Canada Research Institute of St. Joe’s Hamilton ON Canada Population Health Research Institute Hamilton Canada Geneva University Hospitals Geneva Switzerland Faculty of Medicine Mashhad University of Medical Sciences Mashhad Iran Department of Nutrition and Dietetics Jimma University Jimma Ethiopia Anesthesiology Department Dilla University Addis Ababa Ethiopia Department of Juridical and Economic Studies La Sapienza University Rome Italy Non-Communicable Diseases Research Center Tehran University of Medical Sciences Tehran Iran Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran Brigham and Women’s Hospital Harvard University Boston MA USA Students’ Scientific Research Center (SSRC) Tehran University of Medical Sciences Tehran Iran School of Medicine Tehran University of Medical Sciences Tehran Iran School of Medicine Shahid Beheshti University of Medical Sciences Tehran Iran Endocrinology and Metabolism Research Institute Tehran University of Medical Sciences Tehran Iran Chapter of Addiction Medicine University of Sydney Sydney NSW Australia Advanced Diagnostic and Intervent

Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly. © 2025. The Author(s).

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Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

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eClinicalMedicine 2023年 64卷 102193-102193页

作者： Wu, Dongze Jin, Yingzhao Xing, Yuhan Abate, Melsew Dagne Abbasian, Mohammadreza Abbasi-Kangevari, Mohsen Abbasi-Kangevari, Zeinab Abd-Allah, Foad Abdelmasseh, Michael Abdollahifar, Mohammad-Amin Abdulah, Deldar Morad Abedi, Aidin Abedi, Vida Abidi, Hassan Aboagye, Richard Gyan Abolhassani, Hassan Abuabara, Katrina Abyadeh, Morteza Addo, Isaac Yeboah Adeniji, Kayode Nelson Adepoju, Abiola Victor Adesina, Miracle Ayomikun Adnani, Qorinah Estiningtyas Sakilah Afarideh, Mohsen Aghamiri, Shahin Agodi, Antonella Agrawal, Anurag Arriagada, Constanza Elizabeth Aguilera Ahmad, Aqeel Ahmad, Danish Ahmad, Sohail Ahmadi, Ali Ahmed, Ayman Aithala, Janardhana P. Ajadi, Abdullateef Abiodun Ajami, Marjan Akbarzadeh-Khiavi, Mostafa Alahdab, Fares AlBataineh, Mohammad T. Alemi, Sharifullah Al-Gheethi, Adel Ali Saeed Ali, Liaqat Alif, Sheikh Mohammad Almazan, Joseph Uy Almustanyir, Sami Alqahtani, Jaber S. Alqasmi, Ibrahim Altaf, Ihsan Ullah Khan Alvis-Guzman, Nelson Alvis-Zakzuk, Nelson J. Al-Worafi, Yaser Mohammed Aly, Hany Amani, Reza Amu, Hubert Amusa, Ganiyu Adeniyi Andrei, Catalina Liliana Ansar, Adnan Ansariniya, Hossein Anyasodor, Anayochukwu Edward Arabloo, Jalal Arefnezhad, Reza Arulappan, Judie Asghari-Jafarabadi, Mohammad Ashraf, Tahira Atata, Jamila Abdulhamid Athari, Seyyed Shamsadin Atlaw, Daniel Atout, Maha Moh'd Wahbi Aujayeb, Avinash Awan, Asma Tahir Ayatollahi, Haleh Azadnajafabad, Sina Azzam, Ahmed Y. Badawi, Alaa Badiye, Ashish D. Bagherieh, Sara Baig, Atif Amin Bantie, Berihun Bantie Barchitta, Martina Bardhan, Mainak Barker-Collo, Suzanne Lyn Barone-Adesi, Francesco Batra, Kavita Bayileyegn, Nebiyou Simegnew Behnoush, Amir Hossein Belgaumi, Uzma Iqbal Bemanalizadeh, Maryam Bensenor, Isabela M. Beyene, Kebede A. Bhagavathula, Akshaya Srikanth Bhardwaj, Pankaj Bhaskar, Sonu Bhat, Ajay Nagesh Bitaraf, Saeid Bitra, Veera R. Boloor, Archith Bora, Kaustubh Botelho, João Silva Buchbinder, Rachelle Calina, Daniela Cámera, Luis Alberto Carvalho, Andre F. Chan, Jeffrey Shi Kai Chattu, Vijay Kumar Abebe, Endeshaw Chekol Department of Rheumatology and Immunology Sichuan Provincial People's Hospital School of Medicine University of Electronic Science and Technology of China China Department of Medicine & Therapeutics The Chinese University of Hong Kong Hong Kong Department of Paediatrics The Chinese University of Hong Kong Hong Kong School of Pharmacy The Chinese University of Hong Kong Hong Kong Jockey Club School of Public Health and Primary Care The Chinese University of Hong Kong Hong Kong Department of Nursing Woldia University Woldia Ethiopia Department of Orthopedic Surgery Harvard University Boston MA United States Postgraduate Medical Education Harvard University Boston MA United States Maternal Fetal Care Center Harvard University Boston MA United States Department of Health Policy and Oral Epidemiology Harvard University Boston MA United States Division of General Internal Medicine Harvard University Boston MA United States Department of Orthopaedic Surgery Shahid Beheshti University of Medical Sciences Tehran Iran Social Determinants of Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran Department of Biotechnology Shahid Beheshti University of Medical Sciences Tehran Iran Department of Epidemiology Shahid Beheshti University of Medical Sciences Tehran Iran National Nutrition and Food Technology Research Institute Shahid Beheshti University of Medical Sciences Tehran Iran Department of Immunology Shahid Beheshti University of Medical Sciences Tehran Iran Department of Neurology Shahid Beheshti University of Medical Sciences Tehran Iran Department of Medical Genetics Shahid Beheshti University of Medical Sciences Tehran Iran Center for Comprehensive Genetic Services Shahid Beheshti University of Medical Sciences Tehran Iran Cancer Research Center Shahid Beheshti University of Medical Sciences Tehran Iran Department of Health Economics and Statistics Shahid Beheshti University of Medical Sciences Tehran Iran Functional Neuro

Background: The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods: We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings: In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation: The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rh

关键词： Global burden of disease study Immune-mediated inflammatory disease Incidence Trend

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Mapping geographical inequalities in childhood diarrhoeal morbidity and mortality in low-income and middle-income countries, 2000-17: analysis for the Global Burden of Disease Study 2017 (vol 395, pg 1779, 2020)

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LANCET 2020年第10239期395卷 1762-1762页

作者： Reiner, R. C., Jr. Hay, S., I Institute for Health Metrics and Evaluation University of Washington Seattle WA United States Department of Global Health School of Medicine University of Washington Seattle WA United States Department of Health Metrics Sciences School of Medicine University of Washington Seattle WA United States College of Health and Medical Sciences Haramaya University Harar Ethiopia Department of Epidemiology and Biostatistics Haramaya University Harar Ethiopia Department of Medical Laboratory Sciences Haramaya University Harar Ethiopia School of Nursing and Midwifery Haramaya University Harar Ethiopia School of Pharmacy Haramaya University Harar Ethiopia School of Public Health Haramaya University Harar Ethiopia Haramaya University Harar Ethiopia Advanced Diagnostic and Interventional Radiology Research Center Tehran University of Medical Sciences Tehran Iran Cancer Biology Research Center Tehran University of Medical Sciences Tehran Iran Cancer Research Institute Tehran University of Medical Sciences Tehran Iran Department of Economics and Management Sciences for Health Tehran University of Medical Sciences Tehran Iran Department of Environmental Health Engineering Tehran University of Medical Sciences Tehran Iran Department of Epidemiology and Biostatistics Tehran University of Medical Sciences Tehran Iran Department of Health Management and Economics Tehran University of Medical Sciences Tehran Iran Department of Microbiology Tehran University of Medical Sciences Tehran Iran Department of Pharmacology Tehran University of Medical Sciences Tehran Iran Digestive Diseases Research Institute Tehran University of Medical Sciences Tehran Iran Endocrinology and Metabolism Research Center Tehran University of Medical Sciences Tehran Iran Hematology-Oncology and Stem Cell Transplantation Research Center Tehran University of Medical Sciences Tehran Iran Iran National Institute of Health Research Tehran University of Medical Sciences Tehran Iran Metabolomics and

SummaryBackgroundAcross low-income and middle-income countries (LMICs), one in ten deaths in children younger than 5 years is attributable to diarrhoea. The substantial between-country variation in both diarrhoea incidence and mortality is attributable to interventions that protect children, prevent infection, and treat disease. Identifying subnational regions with the highest burden and mapping associated risk factors can aid in reducing preventable childhood diarrhoea. MethodsWe used Bayesian model-based geostatistics and a geolocated dataset comprising 15 072 746 children younger than 5 years from 466 surveys in 94 LMICs, in combination with findings of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017, to estimate posterior distributions of diarrhoea prevalence, incidence, and mortality from 2000 to 2017. From these data, we estimated the burden of diarrhoea at varying subnational levels (termed units) by spatially aggregating draws, and we investigated the drivers of subnational patterns by creating aggregated risk factor estimates. FindingsThe greatest declines in diarrhoeal mortality were seen in south and southeast Asia and South America, where 54·0% (95% uncertainty interval [UI] 38·1–65·8), 17·4% (7·7–28·4), and 59·5% (34·2–86·9) of units, respectively, recorded decreases in deaths from diarrhoea greater than 10%. Although children in much of Africa remain at high risk of death due to diarrhoea, regions with the most deaths were outside Africa, with the highest mortality units located in Pakistan. Indonesia showed the greatest within-country geographical inequality; some regions had mortality rates nearly four times the average country rate. Reductions in mortality were correlated to improvements in water, sanitation, and hygiene (WASH) or reductions in child growth failure (CGF). Similarly, most high-risk areas had poor WASH, high CGF, or low oral rehydration therapy coverage. InterpretationBy co-analysing geospatial trends in dia

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