Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes affect global populations. GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for individuals within a population, based on global mortality rates and the population's age structure. Comparatively, the observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19, and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to those used in previous GBD rounds. The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke). While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their age-standardised mortality rates globally. Four other leading causes have also shown large declines in global age-standardised mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles. Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this, neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19 was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6-47·0) in 1990 to 63·4 years (63·1-63·7) in 2023. For males, mean age increased from 45·4 years (45·1-45·7) to 61·2 years (60·7-61·6), and for females it increased from 48·5 years (48·1-48·8) to 65·9 years (65·5-66·3), from 1990 to 2023. The highest all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for females reached 80·9 years (80·9-81·0) and for males 74·8 years (74·8-74·9). By comparison, the lowest all-cause mean age at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5-38·4) for females and 35·6 years (35·2-35·9) for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income super-region, which also had an observed mean...

Background: Vitamin-D deficiency is linked to a wide range of chronic and infectious diseases. Body of literature suggested that the prevalence of this deficiency can have geographical variation. Although vitamin D deficiency is frequently reported in the South Asian population, the scarcity of systematic reviews and meta-analysis means the true extent of the disease and the underlying factors causing it are poorly characterized.Methods: A systematic search was performed using two databases (PubMed and Scopus) and one search engine (Google Scholar) for original studies on the South Asian population (published from January 1, 2001, to December 31, 2019). Following the search, a random effect meta-analysis was performed to calculate population-level weighted average, the pooled prevalence of deficiency, and heterogeneity of vitamin D among different countries and genders; in addition to South Asia as a whole.Results: Our study, based on our selection criteria was narrowed down to a total of 44,717 participants; which spanned over 65 studies from five South Asian countries. Overall, the pooled prevalence of deficiency was 68% [95% CI: 64 to 72%] with significant heterogeneity (I² = 98%;p = 0.00). The average level of vitamin D ranged from 4.7 to 32 ng/mL, with a weighted mean of 19.15 ng/mL (weighted standard deviation 11.59 ng/mL). The highest prevalence of vitamin D deficiency was found in Pakistan (73%;95% CI: 63 to 83%) followed by Bangladesh (67%; 95% CI: 50 to 83%), India (67%; 95% CI: 61 to 73%), Nepal (57%; 95% CI: 53 to 60%) and Sri Lanka (48%; 95% CI: 41 to 55%), respectively. This finding indicated a high degree of heterogeneity among the population. (I² = 98.76%), Furthermore, a gender-wise analysis suggested that in South Asia, the prevalence of vitamin D deficiency was higher in females than males.Conclusion: Our findings reveal highly prevalent and variable vitamin D deficiency among the adults of different South Asian countries. Findings from this review would be helpful to generate hypotheses and explore the factors affecting the inter-country variability, alongside strengthening evidence for governments to prioritize mitigation strategies in this region.

The World Health Organization (WHO) 2030 agenda for Sustainable Development Goals (SDGs target 3.4) identifies non-communicable diseases (NCDs) as a key challenge for sustainable development. As one of the major NCD risks, here, we estimated the prevalence of overweight/obesity in adults and assessed country-economic variations using meta-analysis. The latest STEPwise approach to NCD risk factor surveillance (STEPS) report of WHO member states studied on overweight/obesity from 2000 to 2020 were reviewed and related data were assessed further. The prevalence of overweight/obesity was pooled using the random effects model. The subgroup analysis and meta-regression were performed based on countries' economic status obtained from the World Bank's country development index 2019. Study heterogeneity and publication bias were also observed. Out of 73 studies with 469,766 participants analyzed, the highest overweight/obesity prevalence was found in American Samoa (93.5 %), while Democratic People's Republic of Korea had the lowest prevalence (4.4 %). The overall weighted pooled prevalence of overweight/obesity regardless of countries economic status was 37.0 % [95 % CI: 33 %-42 %]. There was significant heterogeneity in the prevalence of overweight/obesity (I2 = 99.91 %; p < 0.001). Subgroup analysis revealed a higher prevalence in high-income countries [60 %; 95 % CI: 47 %-72 %]. Meta-regression revealed a significant (p = 0.001) association and a 14 % increase chance of having overweight/obesity with increasing economic status. The prevalence of overweight/obesity is high worldwide, especially in high-income countries that demands a large-scale awareness campaigns and effective initiatives to control overweight/obesity and the associated risk factors of adults of these countries.

Background: Hypertension, itself being a major chronic condition, is one of the most significant risk factors for premature cardiovascular diseases and mortality. Hypertension is responsible for 13% of global deaths and three-quarters of the world’s hypertensive population reside in low- and middle-income countries. Bangladesh is one of those countries that experiencing an epidemiological transition from communicable to non-communicable diseases, a nutritional transition from a traditional diet to process and fast food, and an increase in a sedentary lifestyle, resulting in increased hypertension prevalence. We carried out a systematic review and meta-analysis to identify existing research on hypertension prevalence in Bangladesh, summarize findings and assess its temporal change. Methods: We searched MEDLINE, EMBASE and PubMed and relevant references to identify studies on the prevalence of hypertension in Bangladesh. We used Random-effects meta-analysis to pool the prevalence estimates and performed subgroup analyses. We assessed heterogeneity, a trend in prevalence of hypertension and publication bias in selected studies. Results: Our search initially identified 735 articles and after removing duplicates, reviewing titles and abstracts, and screening full texts, 53 studies were finally selected. The studies comprised 305,432 subjects and reported overall, gender-specific, geographical location specific and criteria specific prevalence of hypertension. We identified the range of hypertension prevalence is from 1.10% to 75.0% and the overall weighted pooled prevalence of hypertension is 20.0%. An extremely high heterogeneity (I² = 99.53%; Cochran Q-statistic p < 0.001) was observed in the prevalence of hypertension. Consequently, we performed subgroup analysis based on gender, age group and geographical location of the study participants, the cut-off level used to define hypertension, and the types of hypertension reported and presented our findings accordingly. An overall increasing trend of hypertension prevalence is also observed. Conclusions: The prevalence of hypertension is high and rising in Bangladesh. Strategies targeting prevention are required to mitigate a further increase in the prevalence and reduce the morbidity and mortality associated with it.

Metabolic syndrome (MS) is a cluster of health problems that set the stage for serious health conditions and places individuals at higher risk of cardiovascular disease, diabetes and stroke. The worldwide prevalence of MS in the adult population is on the rise and Bangladesh is no exception. According to some epidemiological study, MS is highly prevalent in Bangladesh and has increased dramatically in last few decades. To provide a clear picture of the current situation, we conducted a systematic review and meta-analysis with an objective to assess the prevalence of metabolic syndrome among the Bangladeshi population using data already published in the scientific literature. We searched MEDLINE, EMBASE and PubMed and manually checked references of all identified relevant publications that described the prevalence of MS in Bangladesh. Random effects meta-analysis was used to pool the prevalence. Heterogeneity was explored using formal tests and subgroup analyses. Study quality and publication bias was also explored. Electronic and grey literature search retrieved 491 potentially relevant papers. After removing duplicates, reviewing titles and abstracts and screening full texts, 10 studies were finally selected. Most of the studies were conducted in rural populations and study participants were mostly females. The weighted pooled prevalence of metabolic syndrome regardless of gender and criteria used to define metabolic syndrome, was 30.0% with high heterogeneity observed. Weighted pooled prevalence of metabolic syndrome is higher in females (32%) compared to males (25%) though not statistically significant (p = 0.434). Prevalence was highest (37%) when Modified NCEP ATP III criteria was used to define MS, while it was lowest (20%) when WHO criteria was used. In most cases, geographical area (urban/rural) was identified as a source of heterogeneity between the studies. Most of the studies met study quality assessment criteria’s except adequate sample size criteria and evidence of small study effect was also detected. The prevalence of metabolic syndrome is high and rising in Bangladesh. Strategies aimed at primary prevention are required to mitigate a further increase in the prevalence and for the reduction of the morbidity and mortality associated with metabolic syndrome.

Background: Cardiovascular disease (CVD) is a group of conditions affecting the functioning of the heart or blood vessels and is one of the leading causes of death globally. Like other countries, CVD prevalence is also rising among the adults in Bangladesh. Epidemiological studies have shown not only a high CVD prevalence but also a significant increase in its prevalence in Bangladesh in the last few decades. To have a better understanding of the current CVD prevalence scenario, we conducted this systematic review and meta-analysis. Our objective was to assess the prevalence of CVD among the Bangladeshi adult population using evidence from the published scientific literature. Methods: Electronic databases such as MEDLINE, Embase and PubMed were searched. We also manually checked the references of all relevant publications that describe the prevalence of CVD in Bangladeshi adults. To pool the CVD prevalence, we used random-effects meta-analysis. We assessed heterogeneity using both the formal tests and the subgroup analyses. We also assessed study quality and examined publication bias. Results: We retrieved 755 potentially relevant papers through searches of electronic and gray literature, of which only 13 met inclusion criteria after the screening and were included in this review. Of the studies that met inclusion criteria, three were carried out in rural populations, five in both urban and rural populations and two in strictly urban populations. Male and female participation in the studies was almost equal. The weighted pooled prevalence of CVD was 5.0%, regardless of the types of CVD, gender and geographical location of the study participants. There was also a high heterogeneity in the observed CVD prevalence. Weighted pooled prevalence of overall CVD in the Bangladeshi population was higher in urban areas (8%) compared to rural areas (2%). However, no such difference was observed in terms of gender (3% for both males and females). The highest reported prevalence (21%) was for heart disease, while the lowest reported prevalence (1%) was for stroke. Sources of heterogeneity were often unexplained. The criteria used to assess study quality were fulfilled by only a few studies, and adequate sample size criteria was missed by almost all of them. In addition, there was evidence of small-study effects. Conclusion: A high CVD prevalence along with an upward trend was observed in Bangladeshi adults. Proper strategies are required for primary prevention of CVD so that a further increase can be alleviated and the morbidity and mortality associated with it can be reduced.