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Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

July 15, 2022
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Summary

Background

The well being risks related to average alcohol consumption proceed to be debated. Small quantities of alcohol may decrease the threat of some well being outcomes however enhance the threat of others, suggesting that the general threat relies upon, partly, on background illness charges, which fluctuate by area, age, intercourse, and 12 months.

Methods

For this analysis, we constructed burden-weighted dose–response relative threat curves throughout 22 well being outcomes to estimate the theoretical minimal threat publicity stage (TMREL) and non-drinker equivalence (NDE), the consumption stage at which the well being threat is equal to that of a non-drinker, utilizing illness charges from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 areas, together with 204 nations and territories, by 5-year age group, intercourse, and 12 months for people aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the inhabitants consuming dangerous quantities of alcohol.

Findings

The burden-weighted relative threat curves for alcohol use diversified by area and age. Among people aged 15–39 years in 2020, the TMREL diversified between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) customary drinks per day, and the NDE diversified between 0·002 (0–0) and 1·75 (0·698–4·30) customary drinks per day. Among people aged 40 years and older, the burden-weighted relative threat curve was J-shaped for all areas, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) customary drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) customary drinks per day. Among people consuming dangerous quantities of alcohol in 2020, 59·1% (54·3–65·4) had been aged 15–39 years and 76·9% (73·0–81·3) had been male.

Interpretation

There is robust proof to assist suggestions on alcohol consumption various by age and location. Stronger interventions, significantly these tailor-made in the direction of youthful people, are wanted to cut back the substantial world well being loss attributable to alcohol.

Funding

Bill & Melinda Gates Foundation.

Introduction

Alcohol use accounted for 1·78 million (95% uncertainty interval [UI] 1·39–2·27) deaths in 2020 and was the main threat issue for mortality amongst males aged 15–49 years (Bryazka D, unpublished). The relationship between average alcohol use and well being is advanced, as proven in a number of earlier research.

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Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

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National, regional, and world burdens of illness from 2000 to 2016 attributable to alcohol use: a comparative threat evaluation research.

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Risk thresholds for alcohol consumption: mixed analysis of individual-participant information for 599 912 present drinkers in 83 potential research.

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Alcohol consumption in relation to cardiovascular ailments and mortality: a systematic evaluation of Mendelian randomization research.

Alcohol consumption at any stage is related to well being loss from a number of ailments, together with liver cirrhosis, breast most cancers, and tuberculosis, in addition to accidents.

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The extra you drink, the tougher you fall: a systematic evaluation and meta-analysis of how acute alcohol consumption and damage or collision threat enhance collectively.

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Alcohol consumption and threat of liver cirrhosis: a systematic evaluation and meta-analysis.

At the identical time, some research have discovered that consumption of small quantities of alcohol lowers the threat of cardiovascular ailments and sort 2 diabetes.

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Alcohol consumption, ingesting patterns, and ischemic coronary heart illness: a narrative evaluation of meta-analyses and a systematic evaluation and meta-analysis of the impression of heavy ingesting events on threat for average drinkers.

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Alcohol and sort 2 diabetes. A evaluation.

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Association of alcohol consumption with morbidity and mortality in sufferers with heart problems: authentic information and meta-analysis of 48,423 males and girls.

As a corollary, the quantity of alcohol that minimises well being loss is more likely to rely upon the distribution of underlying causes of illness burden in a given inhabitants. Since this distribution varies extensively by geography, age, intercourse, and time, the stage of alcohol consumption related to the lowest threat to well being would rely upon the age construction and illness composition of that inhabitants.

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Implications of cardioprotective assumptions for nationwide ingesting pointers and alcohol hurt monitoring programs.

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  • Sherk A
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Does ingesting inside low-risk pointers forestall hurt? Implications for high-income nations utilizing the worldwide mannequin of alcohol harms and insurance policies.

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WHO
Global standing report on alcohol and well being 2018.

Two portions are crucially related when formulating efficient, evidence-based pointers and alcohol-control insurance policies: the theoretical minimal threat publicity stage (TMREL), which represents the stage of consumption that minimises well being loss from alcohol for a inhabitants, and the non-drinker equivalence (NDE) stage, which measures the stage of alcohol consumption at which the threat of well being loss for a drinker is equal to that of a non-drinker. The majority of research thus far take into account one or a small subset of well being outcomes related to alcohol consumption at a time, though a number of broader systematic meta-analyses have been carried out.

1

  • Griswold MG
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Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

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4

  • Rehm J
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The relationship between completely different dimensions of alcohol use and the burden of disease-an replace.

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17

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A meta-analysis of alcohol consumption and the threat of 15 ailments.

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18

  • Xi B
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  • Yan Y
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Relationship of alcohol consumption to all-cause, cardiovascular, and cancer-related mortality in U.S. adults.

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19

Alcohol consumption ranges as in contrast with ingesting habits in predicting all-cause mortality and cause-specific mortality in present drinkers.

Findings from these research fluctuate of their estimates of the TMREL. Several research have discovered proof of a J-shaped relationship between alcohol use and all-cause mortality.

3

  • Wood AM
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Risk thresholds for alcohol consumption: mixed analysis of individual-participant information for 599 912 present drinkers in 83 potential research.

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18

  • Xi B
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  • Yan Y
  • Mi J
Relationship of alcohol consumption to all-cause, cardiovascular, and cancer-related mortality in U.S. adults.

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20

  • Patra J
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Impact of physique mass and alcohol consumption on all-cause and liver mortality in 240 000 adults in the United States.

However, others have reported that the all-cause or attributable trigger burden weighted TMREL of alcohol is zero customary drinks per day.

1

  • Griswold MG
  • Fullman N
  • Hawley C
  • et al.
Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

, 

21

  • Habtemichael LH
  • Djekic D
  • Rosengren AR
  • et al.
Alcohol consumption in younger males and threat of coronary heart failure and all-cause mortality—a cohort research.

Uncertainty about the impact of alcohol on all-cause well being loss outcomes from variations in the relative illness composition between research, conflicting research on particular person well being outcomes, variations in research covariates and strategies, estimation of ingesting patterns, in addition to points referring to choice bias.

22

  • Fillmore KM
  • Stockwell T
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  • Kerr W
Moderate alcohol use and decreased mortality threat: systematic error in potential research and new hypotheses.

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23

  • Wallach JD
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Evaluation of confounding in epidemiologic research assessing alcohol consumption on the threat of ischemic coronary heart illness.

Research in context

Evidence earlier than this research

The risks of average alcohol use on well being outcomes have been extensively studied and debated for a few years. Studies have thought-about the well being impacts related to alcohol consumption by a selection of approaches, starting from exploring the results on a single illness, to contemplating a number of well being outcomes, to utilizing all-cause mortality as an final result. Several systematic evaluations have additionally been printed on this subject, and lately a number of publications have used Mendelian randomisation to discover the affiliation between alcohol use and well being outcomes. Overall, the findings have diversified, which partly contributes to this subject being controversial and a topic of debate. Several research have discovered proof of a J-shaped relationship between alcohol use and all-cause mortality or burden; in different phrases, at low ranges of consumption, alcohol lowers the threat of all-cause mortality, whereas above some threshold it will increase the threat. However, different research, together with a publication by the GBD 2016 Alcohol Collaborators in The Lancet in 2018, have reported that the stage of alcohol consumption that minimises well being loss is zero customary drinks per day. The obvious contradiction in findings throughout current research highlights the significance of persevering with to review this subject and updating the proof base as extra info turns into obtainable. Importantly, few earlier research analysing the results of alcohol consumption on all-cause mortality have thought-about how the relationship between alcohol use and well being is contingent on background charges of illness. We did a systematic evaluation of the literature by which we searched PubMed and earlier printed meta-analyses utilizing search phrases corresponding to “alcohol” and “drinking behavior”, phrases regarding research outcomes corresponding to “risk”, “odds ratio”, and “hazard ratio”, and phrases regarding the particular causes included in the research, corresponding to “ischemic heart disease” or “tuberculosis”. We searched for research printed as much as Dec 31, 2019; the search was restricted to English language publications.

Added worth of this research

In this systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, we estimated ranges of alcohol consumption that minimise well being loss utilizing up to date systematic evaluations and meta-regressions, constructing on outcomes from GBD 2016 and incorporating region-specific background charges of ailments and accidents inside our evaluation. To the greatest of our data, that is the first research to think about the implications of background charges of illness on ranges of alcohol consumption that minimise well being loss. We up to date the beforehand printed systematic evaluation and meta-regressions to think about all printed research by to December, 2019, reporting on the affiliation between alcohol and the six alcohol-attributable well being outcomes accounting for the highest quantity of world disability-adjusted life-years. We discovered inadequate proof for an affiliation between alcohol use and one of these outcomes and subsequently omitted it from additional analysis. This analysis has yielded up to date relationships on the relative threat of mortality for 5 causes, at varied ranges of alcohol consumption, which we mixed with relative threat estimates from GBD 2016 for a further 17 outcomes. We used this info, together with info on the burden of illness from these 22 ailments and accidents, to estimate the stage of alcohol consumption that minimises well being loss individually for every age group, intercourse, 12 months, and area. In addition to estimating the stage of consumption that’s related to minimising well being loss, referred to as the theoretical minimal threat publicity stage (TMREL), we additionally estimated the stage of alcohol consumption at which the threat to well being for a drinker is equal to that of a non-drinker—a amount we discuss with as the non-drinker equivalence.

Implications of all the obtainable proof

Our outcomes are according to earlier findings at the world stage, and at the identical time the extra nuanced analysis carried out on this research strongly means that statements, pointers, and suggestions on the optimum stage of alcohol consumption have to take into accounts the background charges of ailments and accidents for every inhabitants. We present clear proof that the stage of alcohol consumption that minimises well being loss varies considerably throughout populations and stays zero or very near zero for a number of inhabitants teams, significantly younger adults. At the identical time, small quantities of alcohol consumption are related to improved well being outcomes in populations that predominantly face a excessive burden of cardiovascular ailments, significantly older adults in lots of world areas. Given these findings, we suggest a modification of current coverage pointers to deal with emphasising differential optimum consumption ranges by age, somewhat than the present observe of recommending completely different consumption ranges by intercourse. This research highlights the significance of prioritising interventions focused at minimising alcohol consumption amongst younger adults.

Importantly, no research thus far has examined the variation in the theoretical minimal threat of alcohol consumption by geography, age, intercourse, and time, conditioned on background charges of illness. National dietary pointers on low-risk ingesting, corresponding to these in the USA, UK, France, and Australia, base suggestions on research of the threat of alcohol use on all-cause mortality and some cause-specific outcomes.

24

Dietary Guidelines Advisory Committee
Scientific Report of the 2020 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Agriculture and Secretary of Health and Human Services.

, 

25

UK Department of Health
UK Chief Medical Officers’ Alcohol Guidelines Review. Summary of the proposed new pointers.

, 

26

Santé Publique France
Alcool et santé: améliorer les connaissances et réduire les risques.

, 

27

NHMRC
Australian pointers to cut back well being risks from ingesting alcohol.

This complicates interpretation of the threat of alcohol use on mortality, given three features of all-cause mortality. First, causal pathways between alcohol use and cause-specific outcomes can differ, creating a number of confounding constructions that aren’t readily adjustable when embedded inside fashions analysing the results of alcohol use on all-cause mortality.

28

  • Stockwell T
  • Zhao J
  • Panwar S
  • Roemer A
  • Naimi T
  • Chikritzhs T
Do “moderate” drinkers have decreased mortality threat? A systematic evaluation and meta-analysis of alcohol consumption and all-cause mortality.

Second, all-cause mortality contains non-causally associated outcomes, additional rising the menace to inside validity for proof produced from analysing the results of alcohol use on all-cause mortality. Third, and most significantly for the current research, the composition of causes inside all-cause mortality can differ considerably between populations, altering the proportional threat of mortality attributable to alcohol use throughout these populations.

1

  • Griswold MG
  • Fullman N
  • Hawley C
  • et al.
Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

, 

29

Why the relationship between stage of alcohol-use and all-cause mortality can’t be addressed with meta-analyses of cohort research.

In tandem, these options restrict the applicability of figuring out minimal threat exposures on the foundation of observational information on alcohol use and all-cause mortality.

In this research, we used the distribution of causes of disability-adjusted life-years (DALYs) in every inhabitants, together with alcohol consumption patterns from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020, to estimate the TMREL and NDE for every area, age group, intercourse, and 12 months from 1990 to 2020. Using these estimates, we quantified the proportion of the inhabitants consuming alcohol in quantities exceeding these thresholds by location, age, intercourse, and 12 months, serving as a information for focusing on alcohol management efforts.

This manuscript was produced as half of the GBD Collaborator Network and in accordance with the GBD Protocol.

30

Institute for Health Metrics and Evaluation
Protocol for the world burden of ailments, accidents, and threat components research (GBD).

Methods

Overview

GBD is the most complete effort thus far to grasp the altering well being challenges round the world.

31

  • Murray CJL
  • Aravkin AY
  • Zheng P
  • et al.
Global burden of 87 threat components in 204 nations and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.

In the most up-to-date revision, GBD 2020, estimates had been produced for the mortality and well being burden from 287 causes of dying, 370 ailments and accidents, and 88 threat components in 204 nations and territories by 5-year age teams and intercourse from 1990 to 2020. As half of GBD 2020, we estimated the TMREL and NDE of alcohol consumption for 21 areas by 5-year age group, intercourse, and 12 months for people aged 15–95 years and older from 1990 to 2020 (Bryazka D, unpublished). Using the comparative threat evaluation framework, we additionally quantified the inhabitants consuming alcohol in dangerous quantities, by 5-year age group, nation or territory, intercourse, and 12 months. In the following sections, we offer an summary of our strategies. This research adheres to the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) assertion.

32

  • Stevens GA
  • Alkema L
  • Black RE
  • et al.
Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER assertion.

Estimating dose–response relative risks

As half of GBD, a earlier systematic literature evaluation and meta-analysis was printed in 2018 that included 592 cohort and case-control research throughout 23 outcomes related to alcohol use.

1

  • Griswold MG
  • Fullman N
  • Hawley C
  • et al.
Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

These outcomes included ischaemic stroke, intracerebral haemorrhage, ischaemic coronary heart illness, hypertensive coronary heart illness, atrial fibrillation and flutter, lip and oral cavity most cancers, nasopharynx most cancers, different pharynx most cancers, oesophageal most cancers, larynx most cancers, colon and rectum most cancers, breast most cancers, liver most cancers, sort 2 diabetes, cirrhosis and different continual ailments of the liver, pancreatitis, idiopathic epilepsy, tuberculosis, decrease respiratory an infection, transport accidents, unintentional accidents, self-harm, and interpersonal violence. As half of this earlier meta-analysis, dose–response relative threat curves for every of these outcomes had been estimated by use of a Bayesian meta-regression instrument, DisMod ODE.

1

  • Griswold MG
  • Fullman N
  • Hawley C
  • et al.
Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

, 

33

An integrative metaregression framework for descriptive epidemiology.

For GBD 2020, we up to date this evaluation for the six alcohol-attributable outcomes that accounted for the best quantity of world DALYs: ischaemic coronary heart illness, ischaemic stroke, intracerebral haemorrhage, sort 2 diabetes, tuberculosis, and decrease respiratory an infection. Through the replace, we included 71 extra research. After evaluating all obtainable proof, we discovered inadequate proof for a relationship between alcohol use and decrease respiratory an infection. Based on these outcomes, we eliminated this as a threat–final result pair for GBD 2020 and from this analysis, leading to 22 remaining relative threat curves. Further particulars of the systematic evaluation, together with search strings, inclusion standards, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) stream diagrams, and relative threat curves are supplied in appendix 1 (pp 18–47).
Using the up to date information for these 5 outcomes, we revised the relative threat curves related to every final result utilizing the meta-regression Bayesian, regularised, trimmed (MR-BRT) meta-regression instrument. MR-BRT is a instrument that’s effectively suited to the advanced job of estimating the dose–response threat affiliation between alcohol and well being as a result of it’s doesn’t implement a log-linear useful type, as an alternative parameterising the log relative threat as a B-spline (Zheng P, Institute for Health Metrics and Evaluation, private communication). It makes use of an ensemble strategy for knot choice of splines primarily based on stage of publicity, and incorporates unexplained between-study heterogeneity into the uncertainty of the relative threat estimates. To regulate for features of research design that contribute to bias in relative risks, we included covariates for research reference group, adjustment for sick quitter bias, intercourse, age, inhabitants representativeness, final result reporting technique, publicity measurement timing, geographical representativeness, final result measure (incidence versus mortality), and adjustment for confounders in threat estimation. The MR-BRT instrument makes use of a generalised Lasso strategy to pick out the most related bias covariates to regulate for in the closing mannequin. A full checklist of the confounders examined and included in every of these 5 fashions is summarised on in appendix 1 (p 15). Consistent with the earlier systematic evaluation,

1

  • Griswold MG
  • Fullman N
  • Hawley C
  • et al.
Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

we utilised a reference group of non-drinkers. We estimated parameter uncertainty utilizing 1000 attracts from the posterior distribution, sampled at 1 g intervals of pure alcohol consumption between 0 g and 100 g per day. Further particulars of the meta-regression strategy can be found in appendix 1 (pp 14–16).

Estimating TMREL and NDE

The TMREL and NDE are primarily based on mixture, burden-weighted relative threat curves throughout well being outcomes related to alcohol use. Burden was quantified with DALY charges for every area, age, intercourse, and 12 months obtained from GBD 2020 (Bryazka D, unpublished). DALYs are the sum of years of life misplaced (capturing the impact of untimely mortality) and years lived with incapacity (capturing the impact of morbidity). For every area, age, intercourse, and 12 months, we produced all-attributable trigger relative threat curves as a weighted common of cause-specific relative threat curves, with weights primarily based on the share of the general DALY charges from every trigger. The step-by-step course of and method for computing the weighted all-attributable trigger curves are supplied in appendix 1 (p 16). Using these estimates, we computed the TMREL and NDE by area, age, intercourse, and 12 months. Uncertainty in the relative threat curve, primarily based on 1000 attracts of every cause-specific relative threat curve and 1000 attracts of DALY charges used for weighting, was propagated to the estimates of TMREL and NDE. All estimates are introduced to a few important figures. An instance of a weighted all-attributable trigger alcohol relative threat curve, for all 22 alcohol related causes mixed, is proven in figure 1.

Figure 1Exemplifying a weighted all-attributable trigger alcohol relative threat curve

Show full caption

Points mark the theoretical minimal threat publicity stage and non-drinker equivalence stage. The shaded areas denote consumption ranges with a decrease threat (inexperienced) and better threat (purple), in comparison with no consumption. The strong line signifies the imply mixture relative threat estimate, whereas the shaded space displays the 95% uncertainty interval of the mixture relative threat estimate. One customary drink is equal to 10 g of pure ethanol.

Since alcohol use contributes to the DALY charges which are used as weighting components when developing the TMREL and NDE, we did a sensitivity analysis that utilised risk-deleted DALY charges as different weights. We generated risk-deleted DALY charges by multiplying the DALY price of every trigger by the complement of the cause-specific population-attributable fraction attributable to alcohol (Bryazka D, unpublished). Additionally, our weighted attributable-cause relative threat curves had been primarily based on solely 22 of 24 well being outcomes since no relative threat curves might be computed for alcohol use dysfunction or alcoholic cardiomyopathy attributable to the paucity of research on dose–response relative risks. To assess whether or not inclusion of these two outcomes may probably have an effect on the TMREL and NDE ranges, we did a second sensitivity analysis by which we generated conservative hypothetical relative threat features for alcohol use dysfunction and alcoholic cardiomyopathy and re-computed TMREL and NDE ranges that mirror all 24 alcohol-associated outcomes. Additional particulars of the sensitivity analyses are introduced in the appendix (p 17).

Estimating prevalence of alcohol use and alcohol consumption

To estimate the proportion of the inhabitants consuming alcohol in extra of the NDE, estimates of alcohol consumption in items of grams of pure ethanol consumed per day, on common, by present drinkers for 204 nations and territories, by age, intercourse, and 12 months, had been obtained from GBD 2020 (Bryazka D, unpublished). Briefly, this course of combines supply-side information, family survey information, and administrative information, which permits us to regulate for under-reporting attributable to self-report bias in surveys, account for unrecorded alcohol consumption, and regulate for consumption amongst vacationers. Current drinkers had been outlined as people who had consumed no less than one customary drink in the previous 12 months. To facilitate interpretation, we report estimates in phrases of customary drinks per day, the place one customary drink is outlined as 10 g of pure ethanol, according to earlier GBD publications (Bryazka D, unpublished).

1

  • Griswold MG
  • Fullman N
  • Hawley C
  • et al.
Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

Further particulars on estimation of the prevalence of alcohol use and alcohol consumption have been printed beforehand.

1

  • Griswold MG
  • Fullman N
  • Hawley C
  • et al.
Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

Role of the funding supply

The funder of the research had no function in research design, information assortment, information analysis, information interpretation, or writing of the report.

Results

The distribution of DALYs arising from outcomes related to alcohol by GBD super-region, age, and intercourse for 2020 are proven in figure 2. The TMREL and NDE by area, age, and intercourse for 2020 are proven in figure 3. Overall, we discovered that the TMREL remained low regardless of geography, age, intercourse, or time, various between 0 (95% UI 0–0) and 1·87 (0·500–3·30) customary drinks per day. As a outcome of the variations in the trigger distributions throughout world areas, each the TMREL and NDE diversified by area. The TMREL and NDE didn’t fluctuate considerably by intercourse or 12 months. There was important variation in the TMREL and the NDE throughout ages, with youthful age teams having a lot decrease TMREL and NDE ranges than older adults. In 2020, the TMREL diversified between 0 (0–0) and 0·603 (0·400–1·00) customary drinks per day amongst people aged 15–39 years and between 0·114 (0–0·403) and 1·87 (0·500–3·30) customary drinks per day amongst people aged 40 years and older. The NDE diversified between 0·002 (0–0) and 1·75 (0·698–4·30) customary drinks per day amongst people aged 15–39 years and between 0·193 (0–0·900) and 6·94 (3·40–8·30) customary drinks per day amongst people aged 40 years and older. This outcome was primarily pushed by variations in the main causes of dying and illness burden throughout ages, as seen in figure 2. Overall, we didn’t observe any important variations in the TMREL and NDE between males and females in any age group. In all super-regions, amongst people aged 15–39 years, accidents accounted for the majority of alcohol-related DALYs in 2020. Globally, on this age vary, all accidents accounted for 66·3% (95% UI 65·1–67·5) of alcohol-related DALYs for males and 47·9% (46·0–49·8) of alcohol-related DALYs for females; transport accidents comprised 25·9% (25·0–27·0) of alcohol-related DALYs amongst males and 12·7% (12·0–13·4) amongst females, self-harm comprised 11·7% (10·1–13·3) of alcohol-related DALYs amongst males and 12·3% (10·8–13·8) amongst females, and interpersonal violence comprised 12·4% (11·8–13·0) of alcohol-related DALYs amongst males and 6·70% (5·90–7·69) amongst females. The TMREL amongst males aged 15–39 years in 2020 was 0·136 (0–0·400) customary drinks per day. Among females aged 15–39 years in 2020, the TMREL was 0·273 (0–0·500) customary drinks per day. The NDE was 0·249 (0–1·00) customary drinks per day amongst males and 0·546 (0–1·30) customary drinks per day amongst females. The variations in the TMREL and the NDE between females and males weren’t statistically important.

Figure thumbnail gr2

Figure 2Relative proportions of DALYs for causes related to alcohol use, by GBD super-region, age group, and intercourse, in 2020

Show full caption

The proportions signify the weights related to every cause-specific relative threat curve when developing every all-cause relative threat curve. The inexperienced shades signify causes with a decrease threat at low ranges of consumption, in comparison with no consumption. The crimson and purple shades signify causes with a wholly dangerous impact in any respect ranges of consumption. The black line separates causes for which average alcohol use lowers threat from causes with a wholly dangerous impact. Diabetes contains solely sort 2 diabetes. Cancers embody lip and oral cavity most cancers, nasopharynx most cancers, different pharynx most cancers, oesophageal most cancers, larynx most cancers, colon and rectum most cancers, breast most cancers, and liver most cancers. Cirrhosis contains cirrhosis and different continual ailments of the liver. Infectious illness contains tuberculosis. Injuries contains transport accidents, unintentional accidents, self-harm, and interpersonal violence. Other causes embody pancreatitis, idiopathic epilepsy, hypertensive coronary heart illness, and atrial fibrillation and flutter. DALY=disability-adjusted life-year.

Figure thumbnail gr3

Figure 3Mean theoretical minimal threat publicity ranges (A) and non-drinker equivalence ranges (B), in items of customary drinks per day, by area, age group, and intercourse, in 2020

In people aged 40–64 years, the well being outcomes contributing to the alcohol-related burden shifted to continual well being situations, together with heart problems and most cancers. In this inhabitants, ischaemic coronary heart illness comprised 24·1% (95% UI 23·0–25·3) of alcohol-related DALYs amongst males and 19·5% (18·0–21·0) amongst females, and intracerebral haemorrhage comprised 10·3% (9·61–10·9) of alcohol-related DALYs amongst males and 11·7% (10·7–12·8) amongst females, whereas accidents, corresponding to transport or unintentional accidents, remained important sources of burden, comprising 23·0% (21·7–24·4) of alcohol-related DALYs amongst males and 16·7% (15·3–18·3) of alcohol-related DALYs amongst females. Health outcomes for which average alcohol use is related to a decrease threat constituted an rising portion of the trigger distribution on this age group, leading to a greater TMREL and NDE than in people aged 15–39 years. The world TMREL amongst people aged 40–64 years in 2020 was 0·527 (0·400–1·00) customary drinks per day amongst males and 0·562 (0·400–0·800) customary drinks per day amongst females. The world NDE in 2020 was 1·69 (0·800–3·20) customary drinks per day amongst males and 1·82 (1·00–3·10) customary drinks per day amongst females. As in the youthful age group, the variations in the TMREL and the NDE between females and males aged 40–64 years weren’t statistically important.

Among people aged 65 years and older, the main causes of illness burden had been cardiovascular ailments. In 2020, ischaemic coronary heart illness was accountable for 31·5% (95% UI 30·3–32·7) of all alcohol-related DALYs amongst males and 29·7% (28·2–31·2) amongst females, intracerebral haemorrhage was accountable for 11·6% (10·9–12·4) of all alcohol-related DALYs amongst males and 10·9% (10·1–11·8) amongst females, and ischaemic stroke was accountable for 14·2% (13·5–14·9) of all alcohol-related DALYs amongst males and 16·0% (15·2–16·7) amongst females. As a outcome, on this inhabitants the TMREL was greater than in the youthful age teams and was estimated to be 0·636 (0·500–1·00) customary drinks per day amongst males and 0·656 (0·500–1·00) customary drinks per day amongst females, whereas the NDE was estimated to be 3·19 (1·50–5·20) customary drinks per day amongst males and 3·51 (1·70–5·50) customary drinks per day amongst females. The variations in the TMREL and the NDE between males and females aged 65 years and older weren’t important.

The distribution of the causes of illness burden for a given age group diversified considerably throughout areas, leading to regional variations in TMRELs and NDEs, significantly in people aged 40 years and older. For instance, amongst people aged 55–59 years in north Africa and the Middle East, 30·7% (95% UI 27·3–34·6) of alcohol-related DALYs had been attributable to heart problems, 12·6% (11·0–14·3) had been attributable to cancers, and 0·37% (0·27–0·55) had been attributable to tuberculosis. By distinction, on this identical age group in central sub-Saharan Africa, 20·1% (17·2–23·8) of alcohol-related DALYs had been attributable to heart problems, 9·80% (8·31–11·7) had been attributable to cancers, and 10·1% (6·03–14·1) had been attributable to tuberculosis. As a outcome, the TMRELs for this age group had been 0·876 (0·500–2·00) customary drinks per day in north Africa and the Middle East and 0·596 (0·300–2·00) customary drinks per day in central sub-Saharan Africa. The NDEs additionally diversified, with an NDE of 3·89 (1·50–5·90) customary drinks per day in north Africa and the Middle East and 1·53 (0·600–4·70) customary drinks per day in central sub-Saharan Africa. The TMRELs and NDEs for every area by age and intercourse for 1990, 2000, 2010, and 2020 are proven in appendix 2 (pp 3–31).
The distribution of the main causes of DALYs diversified barely between sexes, with accidents making up a bigger share of distributions for males than for females. This resulted in imply TMRELs and NDEs that had been bigger amongst females in comparison with males of the identical area, age, and 12 months. When taking uncertainty under consideration, these variations weren’t important. However, a bigger proportion of males in comparison with females eat alcohol, and their common stage of consumption can also be considerably greater. As a outcome, younger males stood out as the group with the highest stage of dangerous alcohol consumption (figure 4).

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Figure 4Proportion of the inhabitants consuming dangerous quantities of alcohol, outlined as consumption in extra of the imply non-drinker equivalence stage, by intercourse and age group, in 2020

Globally, 1·03 billion (95% UI 0·851–1·19) males (35·1% [29·1–40·7] of the male inhabitants aged ≥15 years) and 312 million (199–432) females (10·5% [6·72–14·6] of the feminine inhabitants aged ≥15 years) consumed alcohol in quantities exceeding the NDE in 2020; the quantity and proportion of folks consuming alcohol in extra of the NDE, together with the share change since 1990 in the proportion of folks consuming alcohol in extra of the NDE, by age group, intercourse, and location is reported in table 1. Since 1990, the world proportion of drinkers consuming alcohol in extra of the NDE has not modified considerably. Although the proportion of the inhabitants consuming dangerous quantities of alcohol stayed at the identical stage over the previous three a long time, the quantity of folks consuming dangerous quantities of alcohol elevated from 983 million (718–1190) in 1990 to 1·34 billion (1·06–1·62) in 2020, pushed by inhabitants development. Overall, amongst people consuming dangerous quantities of alcohol in 2020, 76·9% (73·0–81·3) had been male.

Table 1Number and proportion of inhabitants consuming in extra of the non-drinker equivalence, and share change since 1990 by nation, age group, and intercourse, for 2020

Data in parentheses are 95% uncertainty intervals. All information are introduced to a few important figures.

Harmful consumption was predominantly concentrated amongst people aged 15–39 years, who had the lowest TMRELs and NDEs (figure 4). Of the 1·34 billion (95% UI 1·06–1·62) people consuming alcohol in extra of the NDE in 2020, 59·1% (54·3–65·4) had been aged 15–39 years. Of these, 75·5% (70·3–80·7) had been male (595 million [489–658]). Australasia (83·2% [71·1–86·9]), western Europe (79·3% [67·1–84·5]), and central Europe (78·3% [68·1–83·5]) had the highest percentages of males aged 15–39 years consuming dangerous quantities of alcohol (table 1). Among females in the identical age group, Australasia (77·7% [65·3–82·0]), western Europe (64·3% [44·3–73·6]), and southern Latin America (59·0% [42·0–67·8]) had the highest charges of dangerous alcohol consumption. By distinction, solely 6·55% (4·79–8·43) of people consuming alcohol in extra of the NDE globally had been older than 65 years (appendix 2 pp 54–83). Between 1990 and 2019, 14 nations had important will increase in the prevalence of dangerous alcohol consumption, 55 nations had important decreases, and in 135 nations the prevalence didn’t change considerably (table 1).
Importantly, these outcomes weren’t delicate to our strategy to developing the weighted attributable-cause relative threat curves which are used to calculate the TMREL and NDE. The TMREL and NDE for every of the sensitivity situations are proven in appendix 2 (pp 39–41). By together with extra threat to well being from alcohol use problems and alcoholic cardiomyopathy, that are 100% attributable to alcohol use, the TMREL decreased by a median of 0·058 (95% UI 0·00–0·30) customary drinks per day in state of affairs A (for alcohol use dysfunction and alcoholic cardiomyopathy, relative risks linearly enhance with consumption to a most relative threat of three at 4 customary drinks per day, at which level they plateau by ten customary drinks), 0·092 (0·00–0·50) customary drinks per day in state of affairs B (relative risks linearly enhance with consumption to a most of 5, at 4 customary drinks per day for alcohol use dysfunction and alcoholic cardiomyopathy), and 0·146 (0·00–0·60) customary drinks per day in state of affairs C (relative risks linearly enhance with consumption to a most of 10, at 4 customary drinks per day for alcohol use dysfunction and alcoholic cardiomyopathy), whereas the NDE decreased by a median of 0·188 (0·00–0·90) customary drinks per day in state of affairs A, 0·310 (0·00–1·30) customary drinks per day in state of affairs B, and 0·508 (0·00–2·10) customary drinks per day in state of affairs C. The best variations had been noticed in males in jap Europe, the place alcohol use dysfunction is particularly prevalent, in addition to in people aged 30–54 years, amongst whom DALY charges from alcohol use dysfunction are the best (appendix 2 pp 39–41; Bryazka D, unpublished).
Our outcomes weren’t delicate to the adjustments in relative threat estimates for the 5 up to date outcomes, in comparison with the complete set of relative threat estimates printed in GBD 2016 (appendix 2 pp 43–53).

1

  • Griswold MG
  • Fullman N
  • Hawley C
  • et al.
Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

The world, age-standardised, both-sexes TMREL primarily based on the full set of GBD 2016 relative threat estimates and GBD 2020 DALY charges was 0·534 (95% UI 0·00–1·00) customary drinks per day, in comparison with 0·511 (0·400–0·700) customary drinks per day primarily based on the GBD 2020 relative threat estimates and GBD 2020 DALY charges, whereas the beforehand printed world, age-standardised, both-sexes TMREL was 0·00 (0·00–0·80) customary drinks per day in 2016 primarily based on GBD 2016 relative threat estimates and GBD 2016 DALY charges (table 2).

1

  • Griswold MG
  • Fullman N
  • Hawley C
  • et al.
Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

Table 2Global, age-standardised, both-sexes theoretical minimal threat publicity stage and non-drinker equivalence estimates primarily based on varied iterations of GBD estimates

Data in parentheses are 95% uncertainty intervals. Data are reported to a few important figures. GBD=Global Burden of Diseases, Injuries, and Risk Factors Study. DALY=disability-adjusted life-year. NA=not relevant.

Discussion

We present that the estimation of the well being results related to alcohol use requires consideration of each the relationship between alcohol consumption and illness outcomes, and the noticed illness charges in every inhabitants. We discovered that the population-level well being risks related to low ranges of alcohol consumption diversified throughout areas and had been better for youthful populations than for older populations. Although we didn’t discover important variations in the risks of unwell well being by intercourse or by 12 months, we did discover that males made up 76·9% (95% UI 73·0–81·3) of the inhabitants consuming dangerous quantities of alcohol in 2020. Notably, 1·03 billion (0·851–1·19) males and 312 million (199–432) females drank dangerous quantities of alcohol in extra of the NDE in 2020. Harmful use of alcohol was significantly concentrated in males aged 15–39 years, primarily in Australasia, western Europe, and central Europe. These findings spotlight the want for tailor-made pointers that discourage alcohol consumption amongst younger folks, in addition to alcohol management insurance policies and interventions which are focused particularly in the direction of younger males.

Understanding the variation in the stage of alcohol consumption that minimises the threat of unwell well being for populations can support in setting efficient consumption pointers, supporting alcohol management insurance policies, monitoring progress in decreasing dangerous alcohol use, and designing public well being threat messaging.

3

  • Wood AM
  • Kaptoge S
  • Butterworth AS
  • et al.
Risk thresholds for alcohol consumption: mixed analysis of individual-participant information for 599 912 present drinkers in 83 potential research.

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16

WHO
Global standing report on alcohol and well being 2018.

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34

  • Rehm J
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  • Shield Ok
What is the greatest indicator of the dangerous use of alcohol? A story evaluation.

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35

  • Chisholm D
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Are the “best buys” for alcohol management nonetheless legitimate? An replace on the comparative cost-effectiveness of alcohol management methods at the world stage.

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36

  • Brand DA
  • Saisana M
  • Rynn LA
  • Pennoni F
  • Lowenfels AB
Comparative analysis of alcohol management insurance policies in 30 nations.

, 

37

  • Ferreira-Borges C
  • Esser MB
  • Dias S
  • Babor T
  • Parry CDH
Alcohol management insurance policies in 46 African nations: alternatives for enchancment.

, 

38

  • Burton R
  • Henn C
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  • et al.
A speedy proof evaluation of the effectiveness and cost-effectiveness of alcohol management insurance policies: an English perspective.

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39

  • Howard SJ
  • Gordon R
  • Jones SC
Australian alcohol coverage 2001–2013 and implications for public well being.

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40

  • Neufeld M
  • Ferreira-Borges C
  • Gil A
  • Manthey J
  • Rehm J
Alcohol coverage has saved lives in the Russian Federation.

Most alcohol consumption pointers for the normal inhabitants mix suggestions to keep away from alcohol use with the definition of lower-risk alcohol consumption thresholds, which are likely to fluctuate between 8 g and 42 g of alcohol per day for females, and between 10 g and 52 g of alcohol per day for males.

41

Governmental customary drink definitions and low-risk alcohol consumption pointers in 37 nations.

Generally, thresholds are one customary drink better for males than for girls, and some lower-risk thresholds are framed in items of weekly consumption that include a advice to keep away from alcohol completely for a number of days of the week.

In our analysis, the population-specific TMRELs ranged between 0 (95% UI 0–0) and 0·603 (0·400–1·00) customary drinks per day amongst people aged 15–39 years throughout world areas, and the NDEs ranged between 0 (0–0) and 1·75 (0·698–4·30) customary drinks per day amongst people aged 15–39 years throughout world areas in 2020. Even if a conservative strategy is taken and the decrease certain of the uncertainty interval is used to set coverage suggestions somewhat than the imply, this means that the really helpful stage of alcohol consumption in current low consumption suggestions is just too excessive for youthful populations. Our estimates, primarily based on presently obtainable proof, additionally don’t assist low consumption pointers that differ by intercourse. Given the identified difficulties related to translating proof into adjustments in shopper behaviour, clear messaging round updates to ingesting pointers can be essential to make sure the full enhancements are realised.

One key distinction between this research and current suggestions on alcohol consumption is that our estimates deal with minimising well being loss throughout all alcohol-attributable outcomes in a inhabitants. Thresholds exist for completely different functions; in phrases of damage prevention, a number of nations have moved to a zero-tolerance threshold that’s according to proof of the completely dangerous impact of alcohol consumption on accidents. Furthermore, individual-level versus population-level threat minimisation will rely upon individual-level components, together with comorbid situations and the use of prescribed drugs, that are extra prevalent amongst older populations. Our outcomes for older adults ought to be interpreted in the context of their extra uncertainty.

42

  • Moore AA
  • Whiteman EJ
  • Ward KT
Risks of mixed alcohol/treatment use in older adults.

, 

43

  • Ryan M
  • Merrick EL
  • Hodgkin D
  • et al.
Drinking patterns of older adults with continual medical situations.

Approaches to minimising individual-level threat are past the scope of this research and have to take into accounts not solely alcohol use and particular well being outcomes, but in addition interactions between environmental, genetic, and behavioural components, in addition to the societal and well being system context of people.

Broadly, this analysis highlights the want to think about the current prevalence of ailments and accidents for particular populations when figuring out the whole harms posed by a threat issue. Although the organic results of alcohol are unlikely to vary throughout populations, besides in the case of particular genetic interactions corresponding to variants in alcohol dehydrogenase, illness charges fluctuate considerably throughout areas, age, intercourse, and time.

44

The genetics of alcohol metabolism: function of alcohol dehydrogenase and aldehyde dehydrogenase variants.

For instance, alcohol use poses a better threat to inhabitants well being in areas with a excessive prevalence of tuberculosis than in areas with low prevalence. Although this consideration is maybe most vital for setting efficient coverage suggestions for risks with each dangerous and protecting relationships with illness, corresponding to alcohol use and crimson meat consumption, it has implications for all threat components. As nations navigate the epidemiological transition and their background charges of illness evolve from infectious ailments and accidents to non-communicable ailments, coverage suggestions might want to evolve as effectively.

It is vital to think about our findings in the context of these printed by the GBD 2016 Alcohol Collaborators in 2018.

1

  • Griswold MG
  • Fullman N
  • Hawley C
  • et al.
Alcohol use and burden for 195 nations and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016.

Compared to that report, the analysis introduced right here contains three main adjustments: we up to date 5 of the relative threat curves; we weighted the relative threat curves utilizing DALY charges estimated as half of GBD 2020 somewhat than GBD 2016; and we estimated the TMREL individually for every area, age, intercourse, and 12 months. Although the GBD 2016 Alcohol Collaborators discovered that the world, age-standardised, both-sexes TMREL was zero customary drinks per day, computing the world TMREL with the first two of these updates, we discovered that the world TMREL was nonetheless fairly low, at 0·511 (95% UI 0·400–0·700) customary drinks per day. Re-estimating the TMREL with up to date 2020 DALY weights however the former relative threat curves suggests a world TMREL of 0·534 (0–1·00) customary drinks per day. Region-specific, age-specific, and sex-specific variations between these approaches are summarised in appendix 2 (pp 45–55). Importantly, the variations throughout TMREL by area and age maintain even with the relative threat curves estimated in 2016. The extra nuanced analysis in the current research, the place we explored the risks to unwell well being by age and area, represents a main step ahead in our understanding of how one can minimise well being loss attributable to alcohol consumption throughout the world.

One problem related to utilizing observational research to measure the causal impact of alcohol consumption on well being is the potential for the introduction of varied kinds of bias, together with reverse causation, choice bias, and residual confounding. Mendelian randomisation is a technique that makes an attempt to mitigate bias by utilizing genetic variation as a proxy for threat publicity.

5

  • Millwood IY
  • Walters RG
  • Mei XW
  • et al.
Conventional and genetic proof on alcohol and vascular illness aetiology: a potential research of 500 000 males and girls in China.

, 

6

  • van de Luitgaarden IAT
  • van Oort S
  • Bouman EJ
  • et al.
Alcohol consumption in relation to cardiovascular ailments and mortality: a systematic evaluation of Mendelian randomization research.

Although a small quantity of Mendelian randomisation research have been carried out on alcohol use thus far, a latest meta-analysis reported that these carried out on heart problems and diabetes had diversified of their findings, with 67% of research on heart problems and 75% of research on diabetes reporting a null affiliation with alcohol.

6

  • van de Luitgaarden IAT
  • van Oort S
  • Bouman EJ
  • et al.
Alcohol consumption in relation to cardiovascular ailments and mortality: a systematic evaluation of Mendelian randomization research.

However, solely 5 of 24 research examined whether or not alcohol had a non-linear relationship with these well being outcomes. As extra Mendelian randomisation research from numerous populations are more and more printed, they’ve the potential to enhance the proof base, and estimates ought to be recurrently revised to mirror new proof.

This research had varied limitations that ought to be taken under consideration when deciphering the findings. First, we didn’t incorporate patterns of ingesting, and subsequently didn’t distinguish between people who sometimes have interaction in heavy episodic ingesting and those that eat the identical quantity of alcohol over a number of days.

45

  • Chrystoja BR
  • Rehm J
  • Manthey J
  • Probst C
  • Wettlaufer A
  • Shield KD
A systematic comparability of the world comparative threat assessments for alcohol.

Manthey and colleagues

46

  • Manthey J
  • Shield KD
  • Rylett M
  • Hasan OSM
  • Probst C
  • Rehm J
Global alcohol publicity between 1990 and 2017 and forecasts till 2030: a modelling research.

estimated that in 2018, 20% of adults engaged in heavy episodic ingesting—the consumption of 60 g or extra of alcohol on a single event—over the previous month. Second, attributable to a paucity of research reporting a dose–response relationship between the threat of alcohol use and incidence of and mortality from alcohol use problems, the burden of alcohol use problems was not included in the TMREL calculation. As proven by the sensitivity analyses, which used conservative hypothetical relative threat curves for alcohol use dysfunction and alcoholic cardiomyopathy, inclusion of these ailments ends in barely decrease estimates of TMREL and NDE, significantly amongst males in jap Europe and in people aged 30–54 years globally. The decreases in the TMREL and NDE in the sensitivity situations had been discovered to be fairly small, since the threat of these two situations is more likely to be concentrated at greater ranges of consumption and in youthful adults, leading to minimal impression on estimates of the TMREL and NDE. Third, though we tried to regulate for the impacts of confounding and bias in our meta-regressions, it’s potential that relative threat estimates didn’t account and regulate for all sources of bias, together with measurement bias and choice bias, in addition to the potential impacts of reverse causality. Fourth, research reporting the relative risks of alcohol use had been primarily based on self-reported alcohol consumption, which is topic to social desirability and recall biases. Fifth, we didn’t take into account variations in threat by sort or high quality of alcohol. Sixth, the weights used inside the weighted alcohol-attributable relative threat curve used DALY estimates that might be attributable to alcohol use. However, this limitation would solely have had a marginal impact on estimates of the TMREL and NDE. Seventh, our estimates of the proportion of the inhabitants consuming alcohol in extra of the NDE had been derived from alcohol consumption information collected by 2019. Because of delays in routine information assortment on threat components triggered by the COVID-19 pandemic, we forecasted our estimates to acquire a time sequence by 2020. As a outcome, the estimates don’t mirror adjustments in consumption patterns related to the pandemic.

47

  • Grossman ER
  • Benjamin-Neelon SE
  • Sonnenschein S
Alcohol consumption throughout the COVID-19 pandemic: a cross-sectional survey of US adults.

Last, our outcomes didn’t embody well being situations with burgeoning proof indicating a relationship with alcohol use, corresponding to main depressive dysfunction, generalised nervousness dysfunction, or dementia, given the present shortage of enough proof to assist a meta-analysis and the potential for reverse causality. Inclusions of these outcomes may cut back estimates of the TMREL and NDE.

In conclusion, the relationship between average alcohol use and well being is advanced and has raised a nice deal of controversy in the scientific literature. Given that the obtainable proof means that low ranges of alcohol consumption are related to a decrease threat of some illness outcomes and an elevated threat of others, alcohol consumption suggestions ought to take note of the full epidemiological profile that features the background charges of illness inside populations. The findings of this research assist the growth of tailor-made pointers and suggestions on alcohol consumption by age and throughout areas and spotlight that current low consumption thresholds are too excessive for youthful populations in all areas. Additionally, our outcomes recommend that pointers mustn’t incorporate sex-specific suggestions, given the absence of variation in TMREL and NDE by intercourse throughout geographies and places. Finally, recognising that the majority of the world’s inhabitants consuming dangerous quantities of alcohol are younger adults and predominantly younger males, with a purpose to minimise well being loss attributable to alcohol consumption it is very important prioritise interventions focused at these demographic teams.

GBD 2020 Alcohol Collaborators

Dana Bryazka, Marissa B Reitsma, Max G Griswold, Kalkidan Hassen Abate, Cristiana Abbafati, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Amir Abdoli, Mohammad Abdollahi, Abu Yousuf Md Abdullah, E S Abhilash, Eman Abu-Gharbieh, Juan Manuel Acuna, Giovanni Addolorato, Oladimeji M Adebayo, Victor Adekanmbi, Kishor Adhikari, Sangeet Adhikari, Qorinah Estiningtyas Sakilah Adnani, Saira Afzal, Wubetu Yimam Agegnehu, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Sajjad Ahmad, Tauseef Ahmad, Ali Ahmadi, Sepideh Ahmadi, Haroon Ahmed, Tarik Ahmed Rashid, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Md Zakiul Alam, Dejene Tsegaye Alem, Kefyalew Addis Alene, Yousef Alimohamadi, Atiyeh Alizadeh, Kasim Allel, Jordi Alonso, Saba Alvand, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Sohrab Amiri, Robert Ancuceanu, Jason A Anderson, Catalina Liliana Andrei, Tudorel Andrei, Jalal Arabloo, Muhammad Arshad, Anton A Artamonov, Zahra Aryan, Malke Asaad, Mulusew A Asemahagn, Thomas Astell-Burt, Seyyed Shamsadin Athari, Desta Debalkie Atnafu, Prince Atorkey, Alok Atreya, Floriane Ausloos, Marcel Ausloos, Getinet Ayano, Martin Amogre Ayanore, Olatunde O Ayinde, Jose L Ayuso-Mateos, Sina Azadnajafabad, Melkalem Mamuye Azanaw, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Ahmed Y Azzam, Ashish D Badiye, Nasser Bagheri, Sara Bagherieh, Mohan Bairwa, Shankar M Bakkannavar, Ravleen Kaur Bakshi, Awraris Hailu Balchut/Bilchut, Tilxrnighausen, Fabio Barra, Amadou Barrow, Pritish Baskaran, Luis Belo, Derrick A Bennett, Isabela M Bensenor, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Ashish Bhalla, Nikha Bhardwaj, Pankaj Bhardwaj, Sonu Bhaskar, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Bagas Suryo Bintoro, Elena A Elena Blokhina, Belay Boda Abule Bodicha, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Hermann Brenner, Nikolay Ivanovich Briko, Andre R Brunoni, Zahid A Butt, Chao Cao, Yin Cao, Rosario Cárdenas, Andre F Carvalho, Márcia Carvalho, Joao Mauricio Castaldelli-Maia, Giulio Castelpietra, Luis F S Castro-de-Araujo, Maria Sofia Cattaruzza, Promit Ananyo Chakraborty, Jaykaran Charan, Vijay Kumar Chattu, Akhilanand Chaurasia, Nicolas Cherbuin, Dinh-Toi Chu, Nandita Chudal, Sheng-Chia Chung, Chuchu Churko, Liliana G Ciobanu, Massimo Cirillo, Rafael M Claro, Simona Costanzo, Richard G Cowden, Michael H Criqui, Natália Cruz-Martins, Garland T Culbreth, Berihun Assefa Dachew, Omid Dadras, Xiaochen Dai, Giovanni Damiani, Lalit Dandona, Rakhi Dandona, Beniam Darge Daniel, Anna Danielewicz, Jiregna Darega Gela, Kairat Davletov, Jacyra Azevedo Paiva de Araujo, Antonio Reis de Sá-Junior, Sisay Abebe Debela, Azizallah Dehghan, Andreas Ok Demetriades, Meseret Derbew Molla, Rupak Desai, Abebaw Alemayehu Desta, Diana Dias da Silva, Daniel Diaz, Lankamo Ena Digesa, Mengistie Diress, Milad Dodangeh, Deepa Dongarwar, Fariba Dorostkar, Haneil Larson Dsouza, Bereket Duko, Bruce B Duncan, Kristina Edvardsson, Michael Ekholuenetale, Frank J Elgar, Muhammed Elhadi, Mohamed A Elmonem, Aman Yesuf Endries, Sharareh Eskandarieh, Azin Etemadimanesh, Adeniyi Francis Fagbamigbe, Ildar Ravisovich Fakhradiyev, Fatemeh Farahmand, Carla Sofia e Sá Farinha, Andre Faro, Farshad Farzadfar, Ali Fatehizadeh, Nelsensius Klau Fauk, Valery L Feigin, Rachel Feldman, Xiaoqi Feng, Zinabu Fentaw, Simone Ferrero, Lorenzo Ferro Desideri, Irina Filip, Florian Fischer, Joel Msafiri Francis, Richard Charles Franklin, Peter Andras Gaal, Mohamed M Gad, Silvano Gallus, Fabio Galvano, Balasankar Ganesan, Tushar Garg, Mesfin Gebrehiwot Damtew Gebrehiwot, Teferi Gebru Gebremeskel, Mathewos Alemu Gebremichael, Tadele Regasa Gemechu, Lemma Getacher, Motuma Erena Getachew, Abera Getachew Obsa, Asmare Getie, Amir Ghaderi, Mansour Ghafourifard, Alireza Ghajar, Seyyed-Hadi Ghamari, Lilian A Ghandour, Mohammad Ghasemi Nour, Ahmad Ghashghaee, Sherief Ghozy, Franklin N Glozah, Ekaterina Vladimirovna Glushkova, Justyna Godos, Amit Goel, Salime Goharinezhad, Mahaveer Golechha, Pouya Goleij, Mohamad Golitaleb, Felix Greaves, Michal Grivna, Giuseppe Grosso, Temesgen Worku Gudayu, Bhawna Gupta, Rajeev Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Nima Hafezi-Nejad, Arvin Haj-Mirzaian, Brian J Hall, Rabih Halwani, Tiilahun Beyene Handiso, Graeme J Hankey, Sanam Hariri, Josep Maria Haro, Ahmed I Hasaballah, Hossein Hassanian-Moghaddam, Simon I Hay, Khezar Hayat, Golnaz Heidari, Mohammad Heidari, Delia Hendrie, Claudiu Herteliu, Demisu Zenbaba Heyi, Kamal Hezam, Mbuzeleni Mbuzeleni Hlongwa, Ramesh Holla, Md Mahbub Hossain, Sahadat Hossain, Seyed Kianoosh Hosseini, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Guoqing Hu, Junjie Huang, Salman Hussain, Segun Emmanuel Ibitoye, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Lalu Muhammad Irham, M Mofizul Islam, Rakibul M Islam, Sheikh Mohammed Shariful Islam, Hiroyasu Iso, Ramaiah Itumalla, Masao Iwagami, Roxana Jabbarinejad, Louis Jacob, Mihajlo Jakovljevic, Zahra Jamalpoor, Elham Jamshidi, Sathish Kumar Jayapal, Umesh Umesh Jayarajah, Ranil Jayawardena, Rime Jebai, Seyed Ali Jeddi, Alelign Tasew Jema, Ravi Prakash Jha, Har Ashish Jindal, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Robel Hussen Kabthymer, Bhushan Dattatray Kamble, Himal Kandel, Girum Gebremeskel Kanno, Neeti Kapoor, Ibraheem M Karaye, Salah Eddin Karimi, Bekalu Getnet Kassa, Rimple Jeet Kaur, Gbenga A Kayode, Mohammad Keykhaei, Himanshu Khajuria, Rovshan Khalilov, Imteyaz A Khan, Moien AB Khan, Hanna Kim, Jihee Kim, Min Seo Kim, Ruth W Kimokoti, Mika Kivimäki, Vitalii Klymchuk, Ann Kristin Skrindo Knudsen, Ali-Asghar Kolahi, Vladimir Andreevich Korshunov, Ai Koyanagi, Kewal Krishan, Yuvaraj Krishnamoorthy, G Anil Kumar, Narinder Kumar, Nithin Kumar, Ben Lacey, Tea Lallukka, Savita Lasrado, Jerrald Lau, Sang-woong Lee, Wei-Chen Lee, Yo Han Lee, Lee-Ling Lim, Stephen S Lim, Stany W Lobo, Platon D Lopukhov, Stefan Lorkowski, Rafael Lozano, Giancarlo Lucchetti, Farzan Madadizadeh, Áurea M Madureira-Carvalho, Soleiman Mahjoub, Ata Mahmoodpoor, Rashidul Alam Mahumud, Alaa Makki, Mohammad-Reza Malekpour, Narayana Manjunatha, Borhan Mansouri, Mohammad Ali Mansournia, Jose Martinez-Raga, Francisco A Martinez-Villa, Richard Matzopoulos, Pallab Ok Maulik, Mahsa Mayeli, John J McGrath, Jitendra Kumar Meena, Entezar Mehrabi Nasab, Ritesh G Menezes, Gert B M Mensink, Alexios-Fotios A Mentis, Atte Meretoja, Bedasa Taye Merga, Tomislav Mestrovic, Junmei Miao Jonasson, Bartosz Miazgowski, Ana Carolina Micheletti Gomide Nogueira de Sá, Ted R Miller, GK Mini, Andreea Mirica, Antonio Mirijello, Seyyedmohammadsadeq Mirmoeeni, Erkin M Mirrakhimov, Sanjeev Misra, Babak Moazen, Maryam Mobarakabadi, Marcello Moccia, Yousef Mohammad, Esmaeil Mohammadi, Abdollah Mohammadian-Hafshejani, Teroj Abdulrahman Mohammed, Nagabhishek Moka, Ali H Mokdad, Sara Momtazmanesh, Yousef Moradi, Ebrahim Mostafavi, Sumaira Mubarik, Erin C Mullany, Beemnet Tekabe Mulugeta, Efrén Murillo-Zamora, Christopher J L Murray, Julius C Mwita, Mohsen Naghavi, Mukhammad David Naimzada, Vinay Nangia, Biswa Prakash Nayak, Ionut Negoi, Ruxandra Irina Negoi, Seyed Aria Nejadghaderi, Samata Nepal, Sudan Prasad Prasad Neupane, Sandhya Neupane Kandel, Yeshambel T Nigatu, Ali Nowroozi, Khan M Nuruzzaman, Chimezie Igwegbe Nzoputam, Kehinde O Obamiro, Felix Akpojene Ogbo, Ayodipupo Sikiru Oguntade, Hassan Okati-Aliabad, Babayemi Oluwaseun Olakunde, Gláucia Maria Moraes Oliveira, Ahmed Omar Bali, Emad Omer, Doris V Ortega-Altamirano, Adrian Otoiu, Stanislav S Otstavnov, Bilcha Oumer, Mahesh P A, Alicia Padron-Monedero, Raffaele Palladino, Adrian Pana, Songhomitra Panda-Jonas, Anamika Pandey, Ashok Pandey, Shahina Pardhan, Tarang Parekh, Eun-Kee Park, Charles D H Parry, Fatemeh Pashazadeh Kan, Jay Patel, Siddhartha Pati, George C Patton, Uttam Paudel, Shrikant Pawar, Amy E Peden, Ionela-Roxana Petcu, Michael R Phillips, Marina Pinheiro, Evgenii Plotnikov, Pranil Man Singh Pradhan, Akila Prashant, Jianchao Quan, Amir Radfar, Alireza Rafiei, Pankaja Raghav Raghav, Vafa Rahimi-Movaghar, Azizur Rahman, Md Mosfequr Rahman, Mosiur Rahman, Amir Masoud Rahmani, Shayan Rahmani, Chhabi Lal Ranabhat, Priyanga Ranasinghe, Chythra R Rao, Drona Prakash Rasali, Mohammad-Mahdi Rashidi, Zubair Ahmed Ratan, David Laith Rawaf, Salman Rawaf, Lal Rawal, Andre M N Renzaho, Negar Rezaei, Saeid Rezaei, Mohsen Rezaeian, Seyed Mohammad Riahi, Esperanza Romero-Rodríguez, Gregory A Roth, Godfrey M Rwegerera, Basema Saddik, Erfan Sadeghi, Reihaneh Sadeghian, Umar Saeed, Farhad Saeedi, Rajesh Sagar, Amirhossein Sahebkar, Harihar Sahoo, Mohammad Ali Sahraian, KM Saif-Ur-Rahman, Sarvenaz Salahi, Hamideh Salimzadeh, Abdallah M Samy, Francesco Sanmarchi, Milena M Santric-Milicevic, Yaser Sarikhani, Brijesh Sathian, Ganesh Kumar Saya, Mehdi Sayyah, Maria Inês Schmidt, Aletta Elisabeth Schutte, Michaël Schwarzinger, David C Schwebel, Abdul-Aziz Seidu, Nachimuthu Senthil Kumar, SeyedAhmad SeyedAlinaghi, Allen Seylani, Feng Sha, Sarvenaz Shahin, Fariba Shahraki-Sanavi, Shayan Shahrokhi, Masood Ali Shaikh, Elaheh Shaker, Murad Ziyaudinovich Shakhmardanov, Mehran Shams-Beyranvand, Sara Sheikhbahaei, Rahim Ali Sheikhi, Adithi Shetty, Jeevan Ok Shetty, Damtew Solomon Shiferaw, Mika Shigematsu, Rahman Shiri, Reza Shirkoohi, Ok M Shivakumar, Velizar Shivarov, Parnian Shobeiri, Roman Shrestha, Negussie Boti Sidemo, Inga Dora Sigfusdottir, Diego Augusto Santos Silva, Natacha Torres da Silva, Jasvinder A Singh, Surjit Singh, Valentin Yurievich Skryabin, Anna Aleksandrovna Skryabina, David A Sleet, Marco Solmi, YONATAN SOLOMON, Suhang Song, Yimeng Song, Reed J D Sorensen, Sergey Soshnikov, Ireneous N Soyiri, Dan J Stein, Sonu Hangma Subba, Miklós Szócska, Rafael Tabarés-Seisdedos, Takahiro Tabuchi, Majid Taheri, Ker-Kan Tan, Minale Tareke, Elvis Enowbeyang Tarkang, Gebremaryam Temesgen, Worku Animaw Temesgen, Mohamad-Hani Temsah, Kavumpurathu Raman Thankappan, Rekha Thapar, Nikhil Kenny Thomas, Chalachew Tiruneh, Jovana Todorovic, Marco Torrado, Mathilde Touvier, Marcos Roberto Tovani-Palone, Mai Thi Ngoc Tran, Sergi Trias-Llimós, Jaya Prasad Tripathy, Alireza Vakilian, Rohollah Valizadeh, Mehdi Varmaghani, Shoban Babu Varthya, Tommi Juhani Vasankari, Theo Vos, Birhanu Wagaye, Yasir Waheed, Mandaras Tariku Walde, Cong Wang, Yanzhong Wang, Yuan-Pang Wang, Ronny Westerman, Nuwan Darshana Wickramasinghe, Abate Dargie Wubetu, Suowen Xu, Kazumasa Yamagishi, Lin Yang, Gesila Endashaw E Yesera, Arzu Yigit, Vahit Yiğit, Ayenew Engida Ayenew Engida Yimaw, Dong Keon Yon, Naohiro Yonemoto, Chuanhua Yu, Siddhesh Zadey, Mazyar Zahir, Iman Zare, Mikhail Sergeevich Zastrozhin, Anasthasia Zastrozhina, Zhi-Jiang Zhang, Chenwen Zhong, Mohammad Zmaili, Yves Miel H Zuniga, Emmanuela Gakidou.

Affiliations

Institute for Health Metrics and Evaluation (D Bryazka BA, M B Reitsma BS, J A Anderson BS, R Feldman BS, E C Mullany BA, G T Culbreth PhD, X Dai PhD, Prof L Dandona MD, Prof R Dandona PhD, Prof V L Feigin PhD, Prof S I Hay FMedSci, Prof S S Lim PhD, Prof R Lozano MD, T Mestrovic PhD, A H Mokdad PhD, Prof C J L Murray DPhil, Prof M Naghavi PhD, G A Roth MD, R J D Sorensen PhD, Prof T Vos PhD, Prof E Gakidou PhD), Department of Health Metrics Sciences, School of Medicine (X Dai PhD, Prof R Dandona PhD, Prof S I Hay FMedSci, Prof S S Lim PhD, Prof R Lozano MD, A H Mokdad PhD, Prof C J L Murray DPhil, Prof M Naghavi PhD, G A Roth MD, Prof T Vos PhD, Prof E Gakidou PhD), Division of Cardiology (G A Roth MD), Department of Global Health (R J D Sorensen PhD), University of Washington, Seattle, WA, USA; Social and Economic Welfare Unit (M G Griswold MA), RAND Corporation, Santa Monica, CA, USA; Department of Nutrition and Dietetics (Ok H Abate PhD), Jimma University, Jimma, Ethiopia; Department of Juridical and Economic Studies (C Abbafati PhD), Department of Public Health and Infectious Diseases (M S Cattaruzza PhD), La Sapienza University, Rome, Italy; Social Determinants of Health Research Center (M Abbasi-Kangevari MD, Z Abbasi-Kangevari BSc, M Azangou-Khyavy MD, S Ghamari MD, Prof H Hassanian-Moghaddam MD, A Kolahi MD, M Rashidi MD), Department of Epidemiology (A Ahmadi PhD), School of Advanced Technologies in Medicine (S Ahmadi PhD), Department of Pharmacology (A Haj-Mirzaian MD), Obesity Research Center (A Haj-Mirzaian MD), Functional Neurosurgery Research Center (E Jamshidi PharmD), Department of Health & Community Medicine (A Kolahi MD), School of Medicine (S Nejadghaderi MD), Student Research Committee (S Rahmani MD), Medical Ethics and Law Research Center (M Taheri PhD), Shahid Beheshti University of Medical Sciences, Tehran, Iran; Non-Communicable Diseases Research Center (NCDRC) (Z Abbasi-Kangevari BSc, Z Aryan MD, S Azadnajafabad MD, M Azangou-Khyavy MD, Prof F Farzadfar DSc, S Ghamari MD, M Keykhaei MD, M Malekpour MD, S Momtazmanesh MD, S Rahmani MD, M Rashidi MD, N Rezaei PhD, M Varmaghani PhD), The Institute of Pharmaceutical Sciences (TIPS) (Prof M Abdollahi PhD), School of Pharmacy (Prof M Abdollahi PhD), Department of Epidemiology and Biostatistics (Y Alimohamadi PhD, M Mansournia PhD), Liver and Pancreatobiliary Diseases Research Center (S Alvand MD), Multiple Sclerosis Research Center (S Eskandarieh PhD, Prof M Sahraian MD), Department of Pathology (A Etemadimanesh MD), School of Medicine (N Hafezi-Nejad MD, M Mayeli MD, S Momtazmanesh MD, A Nowroozi BMedSc), Digestive Diseases Research Institute (S Hariri MD, H Salimzadeh PhD), Department of Psychiatry (R Jabbarinejad MD, S Shahrokhi MD), Students’ Scientific Research Center (SSRC) (M Keykhaei MD), Tehran Heart Center (E Mehrabi Nasab MD), Faculty of Medicine (E Mohammadi MD, E Shaker MD, P Shobeiri MD), Sina Trauma and Surgery Research Center (Prof V Rahimi-Movaghar MD), Endocrinology and Metabolism Research Institute (N Rezaei PhD), Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors (S SeyedAlinaghi PhD), Cancer Research Center (R Shirkoohi PhD), Cancer Biology Research Center (R Shirkoohi PhD), Department of Pharmacology, School of Medicine (M Zahir MD), Tehran University of Medical Sciences, Tehran, Iran; Zoonoses Research Center (A Abdoli PhD), Department of Public Health (Y Sarikhani PhD), Jahrom University of Medical Sciences, Jahrom, Iran; School of Planning, Faculty of Environment (A Abdullah MSc), School of Public Health and Health Systems (Z A Butt PhD), University of Waterloo, Waterloo, ON, Canada; Department of Botany (E S Abhilash PhD), Sree Narayana Guru College Chelannur, Kozhikode, India; Clinical Sciences Department (E Abu-Gharbieh PhD, Prof R Halwani PhD), College of Medicine (Prof R Halwani PhD), Mass Communication Department (A Makki PhD), Sharjah Institute for Medical Research (B Saddik PhD), University of Sharjah, Sharjah, United Arab Emirates; Department of Epidemiology and Population Health (Prof J M Acuna MD), Khalifa University, Abu Dhabi, United Arab Emirates; FIU Robert Stempel College of Public Health & Social Work (Prof J M Acuna MD), Department of Epidemiology (R Jebai MPH), Florida International University, Miami, FL, USA; Department of Internal Medicine (Prof G Addolorato MD), Catholic University of Rome, Rome, Italy; College of Medicine (O M Adebayo MD), Psychiatry Department (O O Ayinde MSc), Department of Medicine (A S Oguntade MSc), University College Hospital, Ibadan, Ibadan, Nigeria (O O Ayinde MSc); Department of Obstetrics and Gynecology (V Adekanmbi PhD), The Office of Health Policy & Legislative Affairs (W Lee PhD), University of Texas, Galveston, TX, USA; School of Public Health & Department of Community Medicine (Ok Adhikari PhD), Chitwan Medical College & Teaching Hospital, Bharatpur, Nepal; Public Health Section (Ok Adhikari PhD), Himalayan Environment and Public Health Network (HEPHN), Chitwan, Nepal; Biodesign Center for Environmental Health Engineering (S Adhikari MS), Arizona State University, Tempe, AZ, USA; Faculty of Medicine (Q E S Adnani PhD), Universitas Padjadjaran (Padjadjaran University), Bandung, Indonesia; Department of Community Medicine (Prof S Afzal PhD), King Edward Memorial Hospital, Lahore, Pakistan; Department of Public Health (Prof S Afzal PhD), Public Health Institute, Lahore, Pakistan; Public Health Department (W Y Agegnehu BHlthSci), Mizan-Tepi University, Mizan-Teferi, Ethiopia; Department of Internal Medicine (M Aggarwal MD), Department of Cardiovascular Medicine (M M Gad MD), Heart and Vascular Institute (M Zmaili MD), Cleveland Clinic, Cleveland, OH, USA; The Australian Centre for Public and Population Health Research (ACPPHR) (B O Ahinkorah MPH, E Ok Ameyaw MPhil), University of Technology Sydney, Sydney, NSW, Australia; College of Nursing (A R Ahmad PhD), International Relations & Diplomacy, Ranya – Al Sulaimaniyah, Iraq; Department of International Relations & Diplomacy (A R Ahmad PhD), Tishk International University, Erbil, Iraq; Department of Health and Biological Sciences (S Ahmad PhD), Abasyn University, Peshawar, Pakistan; Department of Epidemiology and Health Statistics (T Ahmad MS), Southeast University, Nanjing, China; Department of Epidemiology and Biostatistics (A Ahmadi PhD, A Mohammadian-Hafshejani PhD), Community-Oriented Nursing Midwifery Research Center (M Heidari PhD), Medical Plants Research Center, Basic Health Sciences Institute (R Sadeghian PhD), Department of Health in Disasters and Emergencies (R Sheikhi BHlthSci), Shahrekord University of Medical Sciences, Shahrekord, Iran; Department of Biosciences (H Ahmed PhD), COMSATS Institute of Information Technology, Islamabad, Pakistan; Department of Computer Science and Engineering (T Ahmed Rashid PhD), University of Kurdistan Hewler, Erbil, Iraq; Department of Public Health (C J Akunna DMD), The Intercountry Centre for Oral Health (ICOH) for Africa, Jos, Nigeria; Department of Public Health (C J Akunna DMD), Federal Ministry of Health, Garki, Nigeria; Geriatric and Long Term Care Department (H Al Hamad MD, B Sathian PhD), Rumailah Hospital (H Al Hamad MD), Hamad Medical Corporation, Doha, Qatar; Department of Population Sciences (M Alam MSS), University of Dhaka, Dhaka, Bangladesh; Department of Nursing (D T Alem MSc), Debre Markos University, Debremarkos, Ethiopia; Faculty of Health Sciences (Ok A Alene MPH), School of Public Health (G Ayano MSc, B A Dachew PhD, B Duko MPH, D Hendrie PhD, T R Miller PhD), Curtin University, Perth, WA, Australia; Wesfarmers Centre of Vaccines and Infectious Diseases (Ok A Alene MPH), Telethon Kids Institute, Perth, WA, Australia; Pars Advanced and Minimally Invasive Medical Manners Research Center (Y Alimohamadi PhD), Health Management and Economics Research Center (J Arabloo PhD), School of Medicine (M Dodangeh MD), Department of Medical Laboratory Sciences (F Dorostkar PhD), Preventive Medicine and Public Health Research Center (S Goharinezhad PhD), Minimally Invasive Surgery Research Center (A Kabir MD, S Salahi MD), The Five Senses Health Institute (S Rezaei MD), Trauma and Injury Research Center (M Taheri PhD), Department of Epidemiology (R Valizadeh PhD), Iran University of Medical Sciences, Tehran, Iran (F Pashazadeh Kan BSN); Department of Pharmacognosy (A Alizadeh MSc), Tehran University of Medical Sciences, tehran, Iran; Department of Disease Control (Ok Allel MSc), Department of Non-Communicable Disease Epidemiology (M Iwagami PhD), Department of Non-communicable Disease Epidemiology (S Trias-Llimós PhD), London School of Hygiene & Tropical Medicine, London, UK; Institute for Global Health (Ok Allel MSc), Department of Health Informatics (S Chung PhD), Department of Epidemiology and Public Health (Prof M Kivimäki PhD), Institute of Cardiovascular Science (A S Oguntade MSc), University College London, London, UK; Research Program of Epidemiology and Public Health (J Alonso MD), Pompeu Fabra University, Barcelona, Spain; Department of Experimental and Health Sciences (J Alonso MD), Biomedical Research Networking Center in Epidemiology and Public Health (CiberESP), Madrid, Spain; Research Group in Hospital Management and Health Policies (Prof N Alvis-Guzman PhD), Universidad de la Costa (University of the Coast), Barranquilla, Colombia; Research Group in Health Economics (Prof N Alvis-Guzman PhD), University of Cartagena, Cartagena, Colombia; School of Pharmacy (F Amare MSc), School of Public Health (B T Merga MPH), Department of Psychiatry (M T Walde MSc), Haramaya University, Harar, Ethiopia; Behavioral Sciences Research Center (S Amiri PhD), Baqiyatallah University of Medical Sciences, Tehran, Iran; Pharmacy Department (Prof R Ancuceanu PhD), Cardiology Department (C Andrei PhD), Internal Medicine Department (M Hostiuc PhD), Department of Legal Medicine and Bioethics (S Hostiuc PhD), Department of General Surgery (I Negoi PhD), Department of Anatomy and Embryology (R I Negoi PhD), Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Department of Statistics and Econometrics (Prof T Andrei PhD, Prof M Ausloos PhD, Prof C Herteliu PhD, A Mirica PhD, A Otoiu PhD, A Pana MD, I Petcu PhD), Bucharest University of Economic Studies, Bucharest, Romania; Center of Biotechnology and Microbiology (M Arshad PhD), University of Peshawar, Peshawar, Pakistan; Department of Biophysics (A A Artamonov PhD), Russian Academy of Sciences, Moscow, Russia; Brigham and Women’s Hospital (Z Aryan MD), T.H. Chan School of Public Health (Prof T W Bärnighausen MD, P M S Pradhan MD), Harvard University, Boston, MA, USA; Department of Plastic Surgery (M Asaad MD), University of Texas, Houston, TX, USA; School of Public Health (M A Asemahagn PhD), Department of Health System and Health Economics (D D Atnafu MPH), Department of Psychiatry (M Tareke MSc), Department of Nursing (W A Temesgen PhD), Bahir Dar University, Bahir Dar, Ethiopia; School of Health and Society (Prof T Astell-Burt PhD, Z Ratan MSc), University of Wollongong, Wollongong, NSW, Australia; Menzies Centre for Health Policy (Prof T Astell-Burt PhD), Chapter of Addiction Medicine (Prof H Hassanian-Moghaddam MD), Sydney Medical School (S Islam PhD), Save Sight Institute (H Kandel PhD), NHMRC Clinical Trials Centre (R A Mahumud PhD), Department of Public Health (Ok Nuruzzaman PhD), University of Sydney, Sydney, NSW, Australia; Department of Immunology (S Athari PhD), Zanjan University of Medical Sciences, Zanjan, Iran; School of Medicine and Public Health (P Atorkey MPhil), University of Newcastle, Newcastle, NSW, Australia; Hunter New England Population Health, Wallsend, NSW, Australia (P Atorkey MPhil); Department of Forensic Medicine (A Atreya MD), Lumbini Medical College, Palpa, Nepal; Gastroenterology Department (F Ausloos MD), University of Liège, Liège, Belgium; School of Business (Prof M Ausloos PhD), University of Leicester, Leicester, UK; School of Indigenous Studies (G Ayano MSc), Medical School (Prof G J Hankey MD), University of Western Australia, Perth, WA, Australia; Department of Health Policy Planning and Management (M A a Ayanore PhD), Institute of Health Research (M Immurana PhD), Department of Population and Behavioural Sciences (E E Tarkang PhD), University of Health and Allied Sciences, Ho, Ghana; Department of Health Economics (M A a Ayanore PhD), Centre for Health Policy Advocacy Innovation & Research in Africa (CHPAIR-Africa), Accra, Ghana; Department of Psychiatry (Prof J L Ayuso-Mateos PhD), Universidad Autónoma de Madrid (Autonomous University of Madrid), Madrid, Spain; Biomedical Research Networking Center for Mental Health Network (CiberSAM) (Prof J L Ayuso-Mateos PhD), National School of Public Health (A Padron-Monedero PhD), Institute of Health Carlos III, Madrid, Spain; Department of Public Health (M M Azanaw MPH), Department of Midwifery (B G Kassa MSc), Debre Tabor University, Debre Tabor, Ethiopia; School of Medicine (A Azari Jafari MD, S Mirmoeeni MD), Shahroud University of Medical Sciences, Shahroud, Iran; Faculty of Medicine (A Y Azzam MBBCh), October 6 University, sixth October City, Egypt; Department of Forensic Science (A D Badiye MSc, N Kapoor MSc), Government Institute of Forensic Science, Nagpur, India; Research School of Population Health (N Bagheri PhD, Prof N Cherbuin PhD), Australian National University, Canberra, ACT, Australia; Health Research Institute (N Bagheri PhD), University of Canberra, Canberra, ACT, Australia; School of Medicine (S Bagherieh BSc), Department of Environmental Health Engineering (A Fatehizadeh PhD), Research Institute for Primordial Prevention of Non-Communicable Disease (S Hariri MD), Department of Biostatistics and Epidemiology (E Sadeghi PhD), Isfahan University of Medical Sciences, Isfahan, Iran; Centre for Community Medicine (M Bairwa MD), Department of Preventive Oncology (J Ok Meena MD), Department of Psychiatry (Prof R Sagar MD), All India Institute of Medical Sciences, New Delhi, India; Department of Forensic Medicine and Toxicology (S M Bakkannavar MD), Kasturba Medical College, Mangalore (R Holla MD), Department of Community Medicine (C R Rao MD), Manipal Academy of Higher Education, Manipal, India; Division of Reproductive Biology Maternal, Child Health & Nutrition (RBMCH&N) (R Ok Bakshi MD), Indian Council of Medical Research, New Delhi, India (Prof L Dandona MD); Department of Public Health (A H Balchut/Bilchut PhD, L Getacher MPH), Department of Psychiatry (A D Wubetu MSc), Debre Berhan University, Debre Berhan, Ethiopia; Heidelberg Institute of Global Health (HIGH) (Prof T W Bärnighausen MD, B Moazen MSc), Heidelberg University, Heidelberg, Germany; Academic Unit of Obstetrics and Gynecology (F Barra MD), Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI) (Prof S Ferrero PhD), University Eye Clinic (L Ferro Desideri MD), University of Genoa, Genoa, Italy; Department of Public & Environmental Health (A Barrow MPH), University of The Gambia, Brikama, The Gambia; Epidemiology and Disease Control Unit (A Barrow MPH), Ministry of Health, Kotu, The Gambia; Department of Community Medicine and Family Medicine (P Baskaran MD, P Bhardwaj MD, Prof P R Raghav MD), Department of Anatomy (Prof N Bhardwaj MD), School of Public Health (P Bhardwaj MD), Department of Pharmacology (J Charan MD, R J Kaur PhD, S Singh DM, S B Varthya MD), Department of Surgical Oncology (Prof S Misra MCh), All India Institute of Medical Sciences, Jodhpur, India; Biological Sciences Department (L Belo PhD), Research Unit on Applied Molecular Biosciences (UCIBIO) (L Belo PhD, M Carvalho PhD), Department of Medicine (Prof N Cruz-Martins PhD), Laboratory of Toxicology (Prof D Dias da Silva PhD), Associated Laboratory for Green Chemistry (LAQV) (Á M Madureira-Carvalho PhD), Department of Chemistry (M Pinheiro PhD), University of Porto, Porto, Portugal; Nuffield Department of Population Health (D A Bennett PhD, B Lacey PhD), University of Oxford, Oxford, UK; Department of Internal Medicine (I M Bensenor PhD, Prof A R Brunoni PhD), Department of Psychiatry (Prof A R Brunoni PhD, Prof J Castaldelli-Maia PhD, Y Wang PhD), University of São Paulo, São Paulo, Brazil; Department of Social and Clinical Pharmacy (A S Bhagavathula PharmD), Charles University, Hradec Kralova, Czech Republic; Institute of Public Health (A S Bhagavathula PharmD), College of Medicine and Health Sciences (Prof M Grivna PhD), Family Medicine Department (M A Khan MSc), United Arab Emirates University, Al Ain, United Arab Emirates; Institutes of Applied Health Research and Translational Medicine (N Bhala PhD), Queen Elizabeth Hospital Birmingham, Birmingham, UK; Institute of Applied Health Research (N Bhala PhD), University of Birmingham, Birmingham, UK; Department of Internal Medicine (Prof A Bhalla MD), Post Graduate Institute of Medical Education and Research, Chandigarh, India; Neurovascular Imaging Laboratory (S Bhaskar PhD), NSW Brain Clot Bank, Sydney, NSW, Australia; Department of Neurology and Neurophysiology (S Bhaskar PhD), South West Sydney Local Heath District and Liverpool Hospital, Sydney, NSW, Australia; Department of Statistical and Computational Genomics (Ok Bhattacharyya MSc), National Institute of Biomedical Genomics, Kalyani, India; Department of Statistics (Ok Bhattacharyya MSc), University of Calcutta, Kolkata, India; Department of Anatomy (V S Bhojaraja MD), Department of Biochemistry (J Ok Shetty MD), Royal College of Surgeons in Ireland Medical University of Bahrain, Busaiteen, Bahrain; Department of Health Behaviour, Environment and Social Medicine (B Bintoro MD), Gadjah Mada University (Universitas Gadjah Mada), Sleman, Indonesia; Center of Health and Behavior and Promotion (B Bintoro MD), Universitas Gadjah Mada (Gadjah Mada University), Sleman, Indonesia; Valdman Institute of Pharmacology (E A E Blokhina MD), First Pavlov Medical University of St.Petersburg, St. Petersburg, Russia; Biomedical Sciences Department (B B A Bodicha MSc), School of Public Health, College of Medicine and Health Sciences (C Churko MPH, N B Sidemo MPH), College of Medicine and Health Sciences (B D Daniel MSc), Department of Comprehensive Nursing (L E Digesa MSc), Department of Epidemiology and Biostatistics (M A Gebremichael MPH), Health Informatics Department (B T Mulugeta MSc), Department of Midwifery (B Oumer MPH, G Temesgen MSc), School of Nursing, College of Medicine and Health Sciences (G E E Yesera MSc), Arba Minch University, Arba Minch, Ethiopia; Department of Internal Medicine (A Boloor MD), Department of Forensic Medicine and Toxicology, Kasturba Medical College Mangalore (H L Dsouza MD), Department of Community Medicine (N Joseph MD, N Kumar MD, R Thapar MD), Department of Obstetrics and Gynaecology (A Shetty MS), Manipal Academy of Higher Education, Mangalore, India; Department of Oncology (C Bosetti PhD), Department of Environmental Health Sciences (S Gallus DSc), Mario Negri Institute for Pharmacological Research, Milan, Italy; Department of Epidemiology (D Braithwaite PhD), University of Florida, Gainesville, FL, USA; Cancer Population Sciences Program (D Braithwaite PhD), University of Florida Health Cancer Center, Gainesville, FL, USA; Division of Clinical Epidemiology and Aging Research (Prof H Brenner MD), German Cancer Research Center, Heidelberg, Germany; Department of Epidemiology and Evidence-Based Medicine (Prof N I Briko DSc, E V Glushkova PhD, V A Korshunov PhD, P D Lopukhov PhD), Institute for Leadership and Health Management (S Soshnikov PhD), I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Al Shifa School of Public Health (Z A Butt PhD), Al Shifa Trust Eye Hospital, Rawalpindi, Pakistan; Program in Physical Therapy (C Cao MPH), Washington University in St. Louis, St. Louis, MO, USA; Department of Surgery (Y Cao DSc), Washington University in St. Louis, Saint Louis, MO, USA; Department of Health Care (Prof R Cárdenas DSc), Metropolitan Autonomous University, Mexico City, Mexico; IMPACT Strategic Research Center (the Institute for Mental and Physical Health and Clinical Translation) (A F Carvalho MD), School of Medicine (V Gupta PhD), Deakin University, Geelong, VIC, Australia; Faculty of Health Sciences (M Carvalho PhD), University Fernando Pessoa, Porto, Portugal; Department of Medicine (G Castelpietra PhD), University of Udine, Udine, Italy; Department of Mental Health (G Castelpietra PhD), Healthcare Agency “Friuli Occidentale”, Pordenone, Italy; Department of Psychiatry (L F S Castro-de-Araujo PhD), School of Health Sciences (A Meretoja MD), Department of Pediatrics (Prof G C Patton MD), University of Melbourne, Melbourne, VIC, Australia; School of Population and Public Health (P A Chakraborty MPH, D P Rasali PhD), University of British Columbia, Vancouver, BC, Canada; Department of Community Medicine (V Chattu MD), Datta Meghe Institute of Medical Sciences, Sawangi, India; Saveetha Medical College (V Chattu MD), Saveetha University, Chennai, India; Department of Oral Medicine and Radiology (A Chaurasia MD), King George’s Medical University, Lucknow, India; Center for Biomedicine and Community Health (D Chu PhD), VNU-International School, Hanoi, Vietnam; Department of Medical Science (N Chudal Medical Student), Medical University of Vienna, Vienna, Austria; Health Data Research UK, London, UK (S Chung PhD); Adelaide Medical School (L G Ciobanu PhD), University of Adelaide, Adelaide, SA, Australia; School of Pharmacy and Medical Sciences (L G Ciobanu PhD), University of South Australia, Adelaide, SA, Australia; Department of Public Health (Prof M Cirillo MD, R Palladino MD), University of Naples Federico II, Naples, Italy; Department of Nutrition (Prof R M Claro PhD), Department of Maternal and Child Nursing and Public Health (Prof A C Micheletti Gomide Nogueira de Sá MSc), Federal University of Minas Gerais, Belo Horizonte, Brazil; Department of Epidemiology and Prevention (S Costanzo PhD), IRCCS Neuromed, Pozzilli, Italy; Department of Psychology (R G Cowden PhD), University of the Free State, Park West, South Africa; Department of Family Medicine and Public Health (Prof M H Criqui MD), University of California San Diego, La Jolla, CA, USA; Health sciences (Prof N Cruz-Martins PhD), Institute of Research and Advanced Training in Health Sciences and Technologies (CESPU), Famalicão, Portugal; Department of Epidemiology (B A Dachew PhD), Department of Biochemistry (M Derbew Molla MSc), Department of Surgical Nursing (A A Desta MSc), Department of Human Physiology (M Diress MSc), Department of Clinical Midwifery (T W Gudayu MPH), School of Midwifery (A E A Yimaw MSc), University of Gondar, Gondar, Ethiopia; School of Public Health (O Dadras DrPH), Walailak University, Thai Buri, Thailand; Department of Global Public Health and Primary Care (O Dadras DrPH), University of Bergen, Bergen, Norway; IRCCS Istituto Ortopedico Galeazzi (Galeazzi Orthopedic Institute IRCCS) (G Damiani MD), University of Milan, Milan, Italy; Department of Dermatology (G Damiani MD), Case Western Reserve University, Cleveland, OH, USA; Department of Research (A Pandey PhD), Public Health Foundation of India, Gurugram, India (Prof L Dandona MD, Prof R Dandona PhD, G Kumar PhD); Department of Human Nutrition (A Danielewicz PhD), Uniwersytet Warmińsko-Mazurski w Olsztynie (University of Warmia and Mazury in Olsztyn), Olsztyn, Poland; Department of Public Health (J Darega Gela MPH), Ambo University, Ambo, Ethiopia; Health Research Institute (Ok Davletov PhD), Al Farabi Kazakh National University, Almaty, Kazakhstan; Department of Psychiatry (J A P de Araujo MD), Federal University of São Paulo, São Paulo, Brazil; Department of Psychiatry (J A P de Araujo MD), Centro de Estudos Clínica APICE, Salvador, Brazil; Department of Medical Clinic (Prof A R de Sá-Junior PhD), Department of Physical Education (Prof D A S Silva PhD), Federal University of Santa Catarina, Florianópolis, Brazil; School of Public Health (S Debela MPH), Salale University, Fiche, Ethiopia; Department of Epidemiology and Community Medicine (A Dehghan PhD), Non-Communicable Diseases Research Center (NCDRC), Fasa, Iran; Department of Neurosurgery (A Ok Demetriades MD), Global Health Governance Programme (J Patel), University of Edinburgh, Edinburgh, UK; Neurosurgery Department (A Ok Demetriades MD), National Health Service (NHS) Scotland, Edinburgh, UK; Division of Cardiology (R Desai MBBS), Atlanta Veterans Affairs Medical Center, Decatur, GA, USA; Center of Complexity Sciences (Prof D Diaz PhD), National Autonomous University of Mexico, Mexico City, Mexico; Faculty of Veterinary Medicine and Zootechnics (Prof D Diaz PhD), Autonomous University of Sinaloa, Culiacán Rosales, Mexico; Center of Excellence in Health Equity, Training and Research (D Dongarwar MS), Baylor College of Medicine, Houston, TX, USA; Forensic Medicine and Toxicology (H L Dsouza MD), Kasturba Medical College Mangalore, Mangalore, India; School of Public Health (B Duko MPH), Hawassa University, Hawassa, Ethiopia; Postgraduate Program in Epidemiology (Prof B B Duncan MD, Prof M I Schmidt MD), Federal University of Rio Grande do Sul, Porto Alegre, Brazil; College of Science, Health and Engineering (Ok Edvardsson PhD), La Trobe University, Bundoora, VIC, Australia; Department of Epidemiology and Medical Statistics (M Ekholuenetale MSc, A F Fagbamigbe PhD), Faculty of Public Health (M Ekholuenetale MSc), Department of Health Promotion and Education (S E Ibitoye MPH), University of Ibadan, Ibadan, Nigeria; School of Population and Global Health (Prof F J Elgar PhD), McGill University, Montreal, QC, Canada; Faculty of Medicine (M Elhadi MD), University of Tripoli, Tripoli, Libya; Egypt Center for Research and Regenerative Medicine (ECRRM), Cairo, Egypt (M A Elmonem PhD); Public Health Department (A Y Endries MPH), St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia; Population and Behavioural Sciences Division (A F Fagbamigbe PhD), University of St Andrews, St Andrews, UK; Head of the Laboratory of Experimental Medicine (I R Fakhradiyev PhD), Kazakh National Medical University, Almaty, Kazakhstan; Department of Literature and Humanities (F Farahmand BSc), Islamic Azad University, Kermanshah, Iran; Dissemination Division (C S e Farinha MSc), National Institute of Statistics, Lisbon, Portugal; Activity Planning and Control Unit (C S e Farinha MSc), Directorate-General of Health (DGS), Lisbon, Portugal; Department of Psychology (Prof A Faro PhD), Federal University of Sergipe, São Cristóvão, Brazil; Torrens University Australia, Adelaide, SA, Australia (N Ok Fauk MSc); Institute of Resource Governance and Social Change, Kupang, Indonesia (N Ok Fauk MSc); National Institute for Stroke and Applied Neurosciences (Prof V L Feigin PhD), Auckland University of Technology, Auckland, New Zealand; Research Center of Neurology, Moscow, Russia (Prof V L Feigin PhD); School of Population Health (X Feng PhD), School of Medicine (P Ok Maulik PhD), School of Public Health and Community Medicine (A E Peden PhD, Prof A E Schutte PhD), University of New South Wales, Sydney, NSW, Australia; National Institute of Environmental Health (X Feng PhD), Chinese Center for Disease Control and Prevention, Beijing, China; Department of Epidemiology and Biostatistics (Z Fentaw MPH), Department of Environmental Health (M G D Gebrehiwot PhD), Department of Anatomy, College of Medicine and Health Sciences (C Tiruneh MSc), College of Medicine and Health Sciences School of Public Health Department of Public Health Nutrition (B Wagaye MPH), Wollo University, Dessie, Ethiopia; Psychiatry Department (I Filip MD), Kaiser Permanente, Fontana, CA, USA; School of Health Sciences (I Filip MD), A.T. Still University, Mesa, AZ, USA; Institute of Public Health (F Fischer PhD), Charité Universitätsmedizin Berlin (Charité Medical University Berlin), Berlin, Germany; Department of Family Medicine and Primary Care (J M Francis PhD), University of the Witwatersrand, Johannesburg, South Africa; School of Public Health, Medical, and Veterinary Sciences (R C Franklin PhD), James Cook University, Douglas, QLD, Australia; Health Services Management Training Centre (P A Gaal PhD, T Joo MSc), Faculty of Health and Public Administration (M Szócska PhD), Semmelweis University, Budapest, Hungary; Department of Applied Social Sciences (P A Gaal PhD), Sapientia Hungarian University of Transylvania, Târgu-Mureş, Romania; Gillings School of Global Public Health (M M Gad MD), University of North Carolina Chapel Hill, Chapel Hill, NC, USA; Department of Biomedical and Biotechnological Sciences (Prof F Galvano PhD, G Grosso PhD), University of Catania, Catania, Italy; Neurorehabilitation and Robotics Laboratory, Department of Biomedical Engineering (B Ganesan PhD), Jockey Club School of Public Health and Primary Care (J Huang MD, C Zhong MD), The Chinese University of Hong Kong, Hong Kong, China; Department of Occupational Therapy (B Ganesan PhD), Mahatma Gandhi Occupational Therapy College, Jaipur, India; Department of Radiology (T Garg MBBS), King Edward Memorial Hospital, Mumbai, India; Department of Reproductive & Family Health (T G Gebremeskel MPH), Aksum University, Axum, Ethiopia; Medical Biochemistry Department (T R Gemechu MSc), Anatomy Department (D S Shiferaw MSc), Department of Biomedical Science (D S Shiferaw MSc), Madda Walabu University, Goba, Ethiopia; Department of Public Health (M E Getachew MPH), Wollega University, Nekemte, Ethiopia; School of Psychology (A Getachew Obsa MA), Addis Ababa University, Addis Ababa, Ethiopia; School of Nursing, College of Medicine and Health Sciences (A Getie MSc), Arba Minch University, Arbaminch, Ethiopia; Department of Addiction Studies (A Ghaderi PhD), Kashan University of Medical Sciences, Kashan, Iran; Department of Medical Surgical Nursing (M Ghafourifard PhD), Social Determinants of Health Research Center (S Karimi PhD), Anesthesiology and Critical Care Department (Prof A Mahmoodpoor MD), Tabriz University of Medical Sciences, Tabriz, Iran; Mount Auburn Hospital (A Ghajar MD), Harvard Medical School, Cambridge, MA, USA; Department of Epidemiology and Population Health (L A Ghandour PhD), American University of Beirut, Beirut, Lebanon; E-Learning Center, Faculty of Health (M Ghasemi Nour MD), Applied Biomedical Research Center (A Sahebkar PhD), Biotechnology Research Center (A Sahebkar PhD), Social Determinants of Health Research Center (M Varmaghani PhD), Mashhad University of Medical Sciences, Mashhad, Iran; School of Public Health (A Ghashghaee BSc), Qazvin University of Medical Sciences, Qazvin, Iran; Department of Radiology (S Ghozy MD), Mayo Clinic, Rochester, MN, USA; Department of Social and Behavioural Sciences (F N Glozah PhD), University of Ghana, Accra, Ghana; Department of Laboratories (J Godos PhD), Oasi Research Institute, Troina, Italy; Department of Gastroenterology (Prof A Goel DM), Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India; Health Systems and Policy Research (M Golechha PhD), Indian Institute of Public Health, Gandhinagar, India; Department of Genetics (P Goleij MSc), Sana Institute of Higher Education, Sari, Iran; Department of Nursing (M Golitaleb PhD), Arak University of Medical Sciences, Arak, Iran; Department of Primary Care and Public Health (F Greaves PhD, R Palladino MD, Prof S Rawaf MD), WHO Collaborating Centre for Public Health Education and Training (D L Rawaf MD), Imperial College London, London, UK; Health Improvement Directorate (F Greaves PhD), Academic Public Health England (Prof S Rawaf MD), Public Health England, London, UK; Department of Public Health and Preventive Medicine (Prof M Grivna PhD), Charles University, Prague, Czech Republic; Department of Public Health (B Gupta PhD), Torrens University Australia, Melbourne, VIC, Australia; Department of Preventive Cardiology (Prof R Gupta MD), Eternal Heart Care Centre & Research Institute, Jaipur, India; Department of Medicine (Prof R Gupta MD), Mahatma Gandhi University Medical Sciences, Jaipur, India; Toxicology Department (S Gupta MSc), Shriram Institute for Industrial Research, Delhi, Delhi, India; Department of Clinical Medicine (Prof V Ok Gupta PhD), Macquarie University, Sydney, NSW, Australia; Department of Radiology and Radiological Science (N Hafezi-Nejad MD, S Sheikhbahaei MD), Johns Hopkins University, Baltimore, MD, USA; NYU Shanghai, Shanghai, China (B J Hall PhD); School of Public Health (T B Handiso MPH), Wolaita Sodo University, Wolaita Sodo, Ethiopia; Department of Neurology (Prof G J Hankey MD), Sir Charles Gairdner Hospital, Perth, WA, Australia; Research Unit (J M Haro MD), University of Barcelona, Barcelona, Spain; Biomedical Research Networking Center for Mental Health Network (CiberSAM), Barcelona, Spain (J M Haro MD); Department of Zoology and Entomology (A I Hasaballah PhD), Al Azhar University, Cairo, Egypt; Institute of Pharmaceutical Sciences (Ok Hayat MS), University of Veterinary and Animal Sciences, Lahore, Pakistan; Department of Pharmacy Administration and Clinical Pharmacy (Ok Hayat MS), Xian Jiaotong University, Xian, China; Independent Consultant, Santa Clara, CA, USA (G Heidari MD); School of Business (Prof C Herteliu PhD), London South Bank University, London, UK; Public Health, Enviromental Health, Epidemiology and Health Education Department (D Z Heyi MPH), Madda Walabu University, Robe, Goba Town, Ethiopia; Department of Applied Microbiology (Ok Hezam PhD), Taiz University, Taiz, Yemen; Department of Microbiology (Ok Hezam PhD), Nankai University, Tianjin, China; School of Nursing and Public Health Medicine (M M Hlongwa PhD), University of KwaZulu-Natal, Durban, South Africa; Social and Environmental Health Research (M Hossain MPH), Nature Study Society of Bangladesh, Khulna, Bangladesh; Department of Health Promotion and Community Health Sciences (M Hossain MPH), Texas A&M University, College Station, TX, USA; Department of Public Health and Informatics (S Hossain MS), Jahangirnagar University, Dhaka, Bangladesh; Department of Interventional Cardiology (S Hosseini MD), Hamedan University of Medical Sciences, Hamadan, Iran; Pattern Recognition and Machine Learning Lab (M hosseinzadeh PhD), Gachon University, 1342 Seongnamdaero, Sujeonggu, Seongnam 13120, South Korea; Clinical Legal Medicine Department (S Hostiuc PhD), National Institute of Legal Medicine Mina Minovici, Bucharest, Romania; Department of Epidemiology and Health Statistics (Prof G Hu PhD), (*2020*) South University, Changsha, China; Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (S Hussain PhD), Institute of Biostatistics and Analyses (S Hussain PhD), Masaryk University, Brno, Czech Republic; Faculty of Medicine (I M Ilic PhD, Prof M M Santric-Milicevic PhD), School of Public Health and Health Management (Prof M M Santric-Milicevic PhD), Faculty of Medicine, Institute of Social Medicine (J Todorovic PhD), University of Belgrade, Belgrade, Serbia; Department of Epidemiology (Prof M D Ilic PhD), University of Kragujevac, Kragujevac, Serbia; Faculty of Pharmacy (L M Irham BPharm), University of Ahmad Dahlan, Yogyakarta, Indonesia; School of Psychology and Public Health (M Islam PhD), La Trobe University, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine (R M Islam PhD), Monash University, Melbourne, VIC, Australia; Institute for Physical Activity and Nutrition (S Islam PhD), Deakin University, Burwood, VIC, Australia; Public Health Department of Social Medicine (Prof H Iso MD), Graduate School of Medicine (Prof Ok Yamagishi MD), Osaka University, Suita, Japan; Department of Health Management (R Itumalla PhD), University of Hail, Hail, Saudi Arabia; Department of Health Services Research (M Iwagami PhD), Research and Development Center for Health Services (Prof Ok Yamagishi MD), University of Tsukuba, Tsukuba, Japan; Department of Physical Medicine & Rehabilitation (R Jabbarinejad MD), Northwestern University, Chicago, IL, USA; Research and Development Unit (L Jacob MD), Biomedical Research Networking Center for Mental Health Network (CiberSAM), Sant Boi de Llobregat, Spain; Faculty of Medicine (L Jacob MD), University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France; Institute of Advanced Manufacturing Technologies (Prof M Jakovljevic PhD), Peter the Great St. Petersburg Polytechnic University, St. Petersburg, Russia; Institute of Comparative Economic Studies (Prof M Jakovljevic PhD), Hosei University, Tokyo, Japan; Trauma Research Center (Z Jamalpoor PhD), Aja University of Medical Sciences, Tehran, Iran; Division of Pulmonary Medicine (E Jamshidi PharmD), Lausanne University Hospital (CHUV), Lausanne, Switzerland; Centre of Studies and Research (S Jayapal PhD), Ministry of Health, Muscat, Oman; Postgraduate Institute of Medicine (U U Jayarajah MD), Department of Physiology (R Jayawardena PhD), Department of Pharmacology (P Ranasinghe PhD), University of Colombo, Colombo, Sri Lanka; Department of Surgery (U U Jayarajah MD), National Hospital, Colombo, Sri Lanka; School of Exercise and Nutrition Sciences (R Jayawardena PhD), School of Public Health and Social Work (M T N Tran PhD), Queensland University of Technology, Brisbane, QLD, Australia; Department of Laboratory Sciences, School of Allied Medical Sciences (S Jeddi MSc), Abadan University of Medical Sciences, Abadan, Iran; Department of Public Health (A Jema MPH), Madda Walabu University, Bale Goba, Ethiopia; Department of Community Medicine (R P Jha MSc), Dr. Baba Saheb Ambedkar Medical College & Hospital, Delhi, India; Department of Community Medicine (R P Jha MSc, B D Kamble MD), Banaras Hindu University, Varanasi, India; National Health System Resource Centre (H Jindal MD), Ministry of Health & Family Welfare, New Delhi, India; Institute of Molecular and Clinical Ophthalmology Basel, Basel, Switzerland (Prof J B Jonas MD); Department of Ophthalmology (Prof J B Jonas MD), Heidelberg University, Mannheim, Germany; Gastrointestinal and Liver Diseases Research Center (F Joukar PhD), Caspian Digestive Disease Research Center (F Joukar PhD), Guilan University of Medical Sciences, Rasht, Iran; Department of Family Medicine and Public Health (J J Jozwiak PhD), University of Opole, Opole, Poland; Institute of Family Medicine and Public Health (M Jürisson PhD), University of Tartu, Tartu, Estonia; School of Public Health (R H Kabthymer MSc, G G Kanno MSc), Dilla University, Dilla, Ethiopia; Department of Community Medicine and Family Medicine (B D Kamble MD), All India Institute of Medical Sciences, Hyderabad, India; Sydney Eye Hospital (H Kandel PhD), South Eastern Sydney Local Health District, Sydney, NSW, Australia; School of Health Professions and Human Services (I M Karaye MD), Hofstra University, Hempstead, NY, USA; International Research Center of Excellence (G A Kayode PhD), Institute of Human Virology Nigeria, Abuja, Nigeria; Julius Centre for Health Sciences and Primary Care (G A Kayode PhD), Utrecht University, Utrecht, Netherlands; Amity Institute of Forensic Sciences (H Khajuria PhD, B P Nayak PhD), Amity University, Noida, India; Department of Biophysics and Biochemistry (Prof R Khalilov PhD), Baku State University, Baku, Azerbaijan; Russian Institute for Advanced Study (Prof R Khalilov PhD), Moscow State Pedagogical University, Moscow, Russia; Department of Pediatrics (I A Khan MD), Rutgers University, New Brunswick, NJ, USA; Primary Care Department (M A Khan MSc), NHS North West London, London, UK; College of Medicine (H Kim BN), Ewha Womans University, Seoul, South Korea; Department of Preventive Medicine (J Kim MSc), Korea University, Seoul, South Korea; Department of Genomics and Digital Health (M Kim MD), Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Seoul, South Korea; Public Health Center (M Kim MD), Ministry of Health and Welfare, Wando, South Korea; Department of Nutrition (R W Kimokoti MD), Simmons University, Boston, MA, USA; Department of Public Health (Prof M Kivimäki PhD, Prof T Lallukka PhD), University of Helsinki, Helsinki, Finland; Community-based Services Development (V Klymchuk DSc), Mental Health for Ukraine Project, Lviv, Ukraine; Laboratory of Social Psychology (V Klymchuk DSc), Institute of Social and Political Psychology, Kyiv, Ukraine; Department of Disease Burden (A S Knudsen PhD), Norwegian Institute of Public Health, Bergen, Norway; Biomedical Research Networking Center for Mental Health Network (CIBERSAM) (A Koyanagi MD), San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain (A Koyanagi MD); Department of Anthropology (Prof Ok Krishan PhD), Panjab University, Chandigarh, India; Community Medicine Department (Y Krishnamoorthy MD), Employees’ State Insurance Model Hospital, Chennai, India; Department of Orthopaedics (Prof N Kumar MS), Medanta Hospital, Lucknow, India; National Institute for Health Research (NIHR) Oxford Biomedical Research Centre, Oxford, UK (B Lacey PhD); Department of Otorhinolaryngology (S Lasrado MS), Father Muller Medical College, Mangalore, India; Department of Surgery (J Lau MPH, Ok Tan PhD), National University of Singapore, Singapore, Singapore; Pattern Recognition and Machine Learning Lab (Prof S Lee PhD), Gachon University, Seongnam, South Korea; Graduate School of Public Health (Y Lee PhD), Ajou University, Suwon-si, South Korea; Department of Medicine (L Lim MRCP), University of Malaya, Kuala Lumpur, Malaysia; Department of Medicine and Therapeutics (L Lim MRCP), The Chinese University of Hong Kong, Shatin, China; Department of Professional and Medical Education (S W Lobo PhD), Meharry Medical College, Nashville, TN, USA; Department of Biomedical Sciences (S W Lobo PhD), Mercer University, Macon, GA, USA; Institute of Nutritional Sciences (Prof S Lorkowski PhD), Friedrich Schiller University Jena, Jena, Germany; Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Jena, Germany (Prof S Lorkowski PhD); School of Medicine (Prof G Lucchetti PhD), Federal University of Juiz de Fora, Juiz de Fora, Brazil; Department of Biostatistics and Epidemiology (F Madadizadeh PhD), Yazd University of Medical Sciences, Yazd, Iran; Instituto de Investigação e Formação Avançada em Ciências e Tecnologias da Saúde (Institute for Research and Advanced Training in Health Sciences and Technologies) (Á M Madureira-Carvalho PhD), Instituto Universitário de Ciências da Saúde (University Institute of Health Sciences), Gandra, Portugal; Cellular and Molecular Biology Research Center, Health Research Institute (Prof S Mahjoub PhD), Department of Clinical Biochemistry (Prof S Mahjoub PhD), Babol University of Medical Sciences, Babol, Iran; Department of Psychiatry (N Manjunatha MD), National Institute of Mental Health and Neurosciences, Bengalore, India; Substance Abuse Prevention Research Center (B Mansouri PhD), Kermanshah University of Medical Sciences, Kermanshah, Iran; Psychiatry Department (J Martinez-Raga PhD), Hospital Universitario Doctor Peset, Valencia, Spain; Department of Medicine (J Martinez-Raga PhD, Prof R Tabarés-Seisdedos PhD), University of Valencia, Valencia, Spain; Teaching Department (Prof F A Martinez-Villa MSc), Mexican Institute of Social Security, Culiacan Rosales, Mexico; Burden of Disease Research Unit (R Matzopoulos PhD), Alcohol, Tobacco & Other Drug Research Unit (Prof C D H Parry PhD), Risk and Resilience in Mental Disorders Unit (Prof D J Stein MD), South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine (R Matzopoulos PhD), University of Cape Town, Cape Town, South Africa; Research Division (P Ok Maulik PhD), The George Institute for Global Health, New Delhi, India; Queensland Brain Institute (Prof J J McGrath MD), The University of Queensland, Brisbane, QLD, Australia; National Centre for Register-based Research (Prof J J McGrath MD), Aarhus University, Aarhus, Denmark; Forensic Medicine Division (Prof R G Menezes MD), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; Department of Epidemiology and Health Monitoring (G B M Mensink PhD), Robert Koch Institute, Berlin, Germany; University Research Institute (A A Mentis MD), National and Kapodistrian University of Athens, Athens, Greece; Neurology Unit (A Meretoja MD), Helsinki University Hospital, Helsinki, Finland; University Centre Varazdin (T Mestrovic PhD), University North, Varazdin, Croatia; School of Public Health and Community Medicine (J Miao Jonasson PhD), University of Gothenburg, Gothenburg, Sweden; Center for Innovation in Medical Education (B Miazgowski MD), Pomeranian Medical University, Szczecin, Poland (B Miazgowski MD); Pacific Institute for Research & Evaluation, Calverton, MD, USA (T R Miller PhD); Global Institute of Public Health (Prof G Mini PhD), Ananthapuri Hospitals and Research Institute, Trivandrum, India; Women’s Social and Health Studies Foundation, Trivandrum, India (Prof G Mini PhD); Department of Medical Sciences (A Mirijello MD), IRCCS Casa Sollievo della Sofferenza General Hospital (IRCCS Home for the Relief of Suffering General Hospital), San Giovanni Rotondo, Italy; Internal Medicine Programme (Prof E M Mirrakhimov PhD), Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan; Department of Atherosclerosis and Coronary Heart Disease (Prof E M Mirrakhimov PhD), National Center of Cardiology and Internal Disease, Bishkek, Kyrgyzstan; Institute of Addiction Research (ISFF) (B Moazen MSc), Frankfurt University of Applied Sciences, Frankfurt, Germany; Noncommunicable Disease Research Center (M Mobarakabadi MD), Hamadan University of Medical Sciences, Tehran, Iran; Department of Neurosciences (M Moccia PhD), Federico II University, Naples, Italy; Internal Medicine Department (Y Mohammad MD), Pediatric Intensive Care Unit (M Temsah MD), King Saud University, Riyadh, Saudi Arabia; Department of Epidemiology (S Nejadghaderi MD, E Shaker MD), Epidemiology Department (S Shahin MD), Department of International Studies (P Shobeiri MD), Non-Communicable Diseases Research Center (NCDRC), Tehran, Iran (E Mohammadi MD); Dental Basic Sciences Department (T A Mohammed MSc), University of Duhok, Duhok, Iraq; Oncology Department (N Moka MD), Appalachian Regional Healthcare, Hazard, KY, USA; Internal Medicine (N Moka MD), University of Kentucky, Lexington, KY, USA; Social Determinants of Health Research Center (Y Moradi PhD), Kurdistan University of Medical Sciences, Kurdistan, Iran; Department of Medicine (E Mostafavi PhD), Stanford Cardiovascular Institute (E Mostafavi PhD), Stanford University, Palo Alto, CA, USA; Department of Epidemiology and Biostatistics (S Mubarik MS, Prof C Yu PhD), School of Medicine (Z Zhang PhD), Wuhan University, Wuhan, China; Epidemiology, Family Medicine Unit 19 (E Murillo-Zamora PhD), Mexican Institute of Social Security, Colima, Mexico; Postgraduate Program in Medical Sciences (E Murillo-Zamora PhD), Universidad de Colima, Colima, Mexico; Department of Internal Medicine (J C Mwita MD, G M Rwegerera MD), University of Botswana, Gaborone, Botswana; Laboratory of Public Health Indicators Analysis and Health Digitalization (M Naimzada MD, S S Otstavnov PhD), Moscow Institute of Physics and Technology, Dolgoprudny, Russia; Experimental Surgery and Oncology Laboratory (M Naimzada MD), Kursk State Medical University, Kursk, Russia; Suraj Eye Institute, Nagpur, India (V Nangia MD); Department of General Surgery (I Negoi PhD), Emergency Hospital of Bucharest, Bucharest, Romania; Cardio-Aid, Bucharest, Romania (R I Negoi PhD); Department of Community Medicine (S Nepal MD), Kathmandu University, Palpa, Nepal; National Centre for Suicide Research and Prevention (S P Neupane PhD), University of Oslo, Norway; Specialist Oral Health Center for Western Norway Department (S P Neupane PhD), Oral Health Center of Expertise in Rogaland, Rogland, Norway; Estia Health Blakehurst (S Neupane Kandel BSN), Estia Health, Sydney, NSW, Australia; Institute for Mental Health and Policy (Y T Nigatu PhD), Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Population Science (Ok Nuruzzaman PhD), Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh; Center of Excellence in Reproductive Health Innovation (CERHI) (C I Nzoputam MPH), University of Benin, Benin City, Nigeria; Centre for Rural Health (Ok O Obamiro PhD), University of Tasmania, Hobart, TAS, Australia; Translational Health Research Institute (F A Ogbo PhD), Western Sydney University, Sydney, NSW, Australia; Health Promotion Research Center (H Okati-Aliabad PhD, F Shahraki-Sanavi PhD), Zahedan University of Medical Sciences, Zahedan, Iran; Community Prevention and Care Services (B O Olakunde PhD), National AIDS Control Committee, Abuja, Nigeria; Cardiology Department (G M M Oliveira PhD), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; Diplomacy and Public Relations Department (A Omar Bali PhD), University of Human Development, Sulaymaniyah, Iraq; Mass Communication Department (E Omer PhD), Ajman University, Dubai, United Arab Emirates; Health Systems Research Center (D V Ortega-Altamirano DrPH), National Institute of Public Health, Cuernavaca, Mexico; Department of Project Management (S S Otstavnov PhD), National Research University Higher School of Economics, Moscow, Russia; Department of Respiratory Medicine (Prof M P A DNB), Jagadguru Sri Shivarathreeswara Academy of Health Education and Research, Mysore, India; Department of Health Metrics (A Pana MD), Center for Health Outcomes & Evaluation, Bucharest, Romania; Privatpraxis, Heidelberg, Germany (S Panda-Jonas MD); Research Department (A Pandey MPH), Research Section (U Paudel PhD), Nepal Health Research Council, Kathmandu, Nepal; Research Department (A Pandey MPH), Public Health Research Society Nepal, Kathmandu, Nepal; Vision and Eye Research Institute (Prof S Pardhan PhD), Anglia Ruskin University, Cambridge, UK; Department of Health Administration and Policy (T Parekh MSc), George Mason University, Fairfax, VA, USA; Department of Medical Humanities and Social Medicine (Prof E Park PhD), Kosin University, Busan, South Korea; Department of Psychiatry (Prof C D H Parry PhD), Stellenbosch University, Cape Town, South Africa; School of Dentistry (J Patel), University of Leeds, Leeds, UK; Skills Innovation and Academic Network (SIAN) Institute (S Pati PhD), Association for Biodiversity Conservation and Research (ABC), Odisha, India; Population Health Theme (Prof G C Patton MD), Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Faculty of Humanities and Social Sciences (U Paudel PhD), Department of Community Medicine, Institute of Medicine (P M S Pradhan MD), Tribhuvan University, Kathmandu, Nepal; Department of Genetics (S Pawar PhD), Department of Internal Medicine (R Shrestha PhD), Yale University, New Haven, CT, USA; College of Public Health, Medical and Veterinary Sciences (A E Peden PhD), James Cook University, Townsville, NSW, Australia; Shanghai Mental Health Center (Prof M R Phillips MD), Shanghai Jiao Tong University, Shanghai, China; Department of Psychiatry (Prof M R Phillips MD), Department of Health and Behavior Studies (Prof I D Sigfusdottir PhD), Columbia University, New York, NY, USA; Research School of Chemistry and Applied Biomedical Sciences (E Plotnikov PhD), Tomsk Polytechnic University, Tomsk, Russia; Mental Health Research Institute (E Plotnikov PhD), Tomsk National Research Medical Center of the Russian Academy of Sciences, Tomsk, Russia; Department of Biochemistry (Prof A Prashant PhD), Jagadguru Sri Shivarathreeswara University, Mysuru, India; School of Public Health (J Quan MD), University of Hong Kong, Hong Kong, China; College of Medicine (A Radfar MD), University of (*2020*) Florida, Orlando, FL, USA; Department of Immunology (Prof A Rafiei PhD), Molecular and Cell Biology Research Center (Prof A Rafiei PhD), Mazandaran University of Medical Sciences, Sari, Iran; Data Mining Research Unit (DaMRA) (A Rahman PhD), Charles Sturt University, Wagga Wagga, NSW, Australia; Department of Population Science and Human Resource Development (Prof M Rahman PhD, M Rahman DrPH), University of Rajshahi, Rajshahi, Bangladesh; Future Technology Research Center (A Rahmani PhD), National Yunlin University of Science and Technology, Yunlin, Taiwan (province of China); Research Department (C L Ranabhat PhD), Policy Research Institute, Kathmandu, Nepal; Health and Public Policy Department (C L Ranabhat PhD), Global Center for Research and Development, Kathmandu, Nepal; Data Analytic Services Department (D P Rasali PhD), British Columbia Centre for Disease Control, Vancouver, BC, Canada; Department of Biomedical Engineering (Z Ratan MSc), Khulna University of Engineering and Technology, Khulna, Bangladesh; University College London Hospitals, London, UK (D L Rawaf MD); School of Health, Medical and Applied Sciences (L Rawal PhD), CQ University, Sydney, NSW, Australia; School of Medicine (Prof A M N Renzaho PhD), Translational Health Research Institute (Prof A M N Renzaho PhD), Western Sydney University, Campbelltown, NSW, Australia; Eye and Skull Base Research Centers (S Rezaei MD), Rassoul Akram Hospital, Tehran, Iran; Department of Epidemiology and Biostatistics (Prof M Rezaeian PhD), Department of Neurology (A Vakilian MD), Non-communicable Diseases Research Center (A Vakilian MD), Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Cardiovascular Diseases Research Center (S Riahi PhD, F Saeedi MD), Birjand University of Medical Sciences, Birjand, Iran; Clinical and Epidemiological Research in Primary Care (GICEAP) (E Romero-Rodríguez PhD), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Cordoba, Spain; Research and Development (Prof U Saeed PhD), Islamabad Diagnostic Center Pakistan, Islamabad, Pakistan; Biological Production Division (Prof U Saeed PhD), National Institute of Health, Islamabad, Pakistan; Department of Development Studies (H Sahoo PhD), International Institute for Population Sciences, Mumbai, India; Health Systems and Population Studies Division (Ok Saif-Ur-Rahman MPH), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh; Department of Public Health and Health Systems (Ok Saif-Ur-Rahman MPH), Nagoya University, Nagoya, Japan; Advanced Therapy Medicinal Products Department (S Salahi MD), Royan Institution, Tehran, Iran; Department of Entomology (A M Samy PhD), Ain Shams University, Cairo, Egypt; Department of Biomedical and Neuromotor Sciences (F Sanmarchi MD), University of Bologna, Bologna, Italy; Health Policy Research Center (Y Sarikhani PhD), Shiraz University of Medical Sciences, Shiraz, Iran; Faculty of Health & Social Sciences (B Sathian PhD), Bournemouth University, Bournemouth, UK; Department of Preventive and Social Medicine (G Saya MD), Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India; Education Development Center (M Sayyah MD), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; The George Institute for Global Health, Sydney, NSW, Australia (Prof A E Schutte PhD); Department of Methodology and Innovation in Prevention (M Schwarzinger MD), University Hospital of Bordeaux, France, Bordeaux, France; University of Bordeaux, Inserm UMR 1219-Bordeaux Population Health (M Schwarzinger MD), Inserm, Bordeaux, France; Department of Psychology (D C Schwebel PhD), School of Medicine (Prof J A Singh MD), University of Alabama at Birmingham, Birmingham, AL, USA; Department of Population and Health (A Seidu MPhil), University of Cape Coast, Cape Coast, Ghana; College of Public Health, Medical and Veterinary Sciences (A Seidu MPhil), James Cook University, Townsville, QLD, Australia; Department of Biotechnology (Prof N Senthil Kumar PhD), Mizoram University, Aizawl, India; National Heart, Lung, and Blood Institute (A Seylani BS), National Institute of Health, Rockville, MD, USA; Center for Biomedical Information Technology (F Sha PhD), Shenzhen Institutes of Advanced Technology, Shenzhen, China; Neuroimmunulogy Department (S Shahrokhi MD), Universal Scientific Research Network (USERN), Tehran, Iran; Independent Consultant, Karachi, Pakistan (M A Shaikh MD); Infectious Diseases Department (Prof M Z Shakhmardanov PhD), Department of Infectious Diseases and Epidemiology (A A Skryabina MD), Pirogov Russian National Research Medical University, Moscow, Russia; School of Medicine (M Shams-Beyranvand MSc), Alborz University of Medical Sciences, Karaj, Iran; National Institute of Infectious Diseases, Tokyo, Japan (M Shigematsu PhD); Finnish Institute of Occupational Health, Helsinki, Finland (R Shiri PhD); Public Health Dentistry Department (Prof Ok M Shivakumar PhD), Krishna Institute of Medical Sciences Deemed to be University, Karad, India; Department of Clinical Immunology and Hematology (V Shivarov PhD), Sofiamed University Hospital, Sofia, Bulgaria; Department of Genetics (V Shivarov PhD), Sofia University “St. Kliment Ohridiski”, Sofia, Bulgaria; Department of Psychology (Prof I D Sigfusdottir PhD), Reykjavik University, Reykjavik, Iceland; Portuguese Institute of Sport and Youth, Lisbon, Portugal (N T d Silva MPsych); Medicine Service (Prof J A Singh MD), US Department of Veterans Affairs (VA), Birmingham, AL, USA; Department No.16 (V Y Skryabin MD), Moscow Research and Practical Centre on Addictions, Moscow, Russia; Division of Injury Prevention (Prof D A Sleet PhD), The Bizzell Group, Atlanta, GA, USA; Rollins School of Public Health (Prof D A Sleet PhD), Emory University, Atlanta, GA, USA; Department of Psychiatry (M Solmi MD), University of Ottawa, Ottawa, ON, Canada; Department of Nursing (Y SOLOMON MSc), Dire Dawa University, Dire Dawa, Ethiopia; Taub Institute for Research on Alzheimer’s Disease and the Aging Brain (S Song PhD), Columbia University Medical Center, New York, NY, USA; Department of Land Surveying and Geo-Informatics (Y Song PhD), Hong Kong Polytechnic University, Hong Kong, China; Laboratory of Public Health Indicators Analysis and Health Digitalization (S Soshnikov PhD), Moscow Institute of Physics and Technology, Moscow, Russia; Hull York Medical School (I N Soyiri PhD), University of Hull, Hull City, UK; Department of Community Medicine and Family Medicine (Prof S H Subba MD), All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, India; Carlos III Health Institute (Prof R Tabarés-Seisdedos PhD), Biomedical Research Networking Center for Mental Health Network (CiberSAM), Madrid, Spain; Cancer Control Center (T Tabuchi MD), Osaka International Cancer Institute, Osaka, Japan; HIV Health Promotion Division (E E Tarkang PhD), HIV/AIDS Prevention Research Network, Cameroon, Kumba, Cameroon; Department of Public Health and Community Medicine (Prof Ok R Thankappan MD), (*2020*) University of Kerala, Kasaragod, India; Gastroenterology Department (N Ok Thomas MD), PSG Institute of Medical Sciences and Research, Coimbatore, India; Psychiatry and Medical Psychology Department (M Torrado PhD), University of Lisbon, Lisbon, Portugal; Child and Adolescent Mental Health Services (CAMHS) (M Torrado PhD), Hospital Garcia de Orta, Almada, Portugal; Nutritional Epidemiology Research Team EREN (M Touvier PhD), National Institute for Health and Medical Research INSERM, Paris, France; Health, Medicine and Human Biology (M Touvier PhD), Sorbonne Paris Nord University, Bobigny, France; Department of Pathology and Legal Medicine (M R Tovani-Palone PhD), University of São Paulo, Ribeirão Preto, Brazil; Modestum LTD, London, UK (M R Tovani-Palone PhD); Health Informatic Department, Nursing and Midwifery Faculty (M T N Tran PhD), Hanoi Medical University, Ha Noi, Vietnam; Department of Community Medicine (J P Tripathy MD), All India Institute of Medical Sciences, Nagpur, India; UKK Institute, Tampere, Finland (Prof T J Vasankari MD); Faculty of Medicine and Health Technology (Prof T J Vasankari MD), Tampere University, Tampere, Finland; Infection Prevention & Control and Water, Sanitation and Hygiene Unit (B Wagaye MPH), Ethiopian Public Health Institute, Addis Ababa, Ethiopia; Foundation University Medical College (Prof Y Waheed PhD), Foundation University Islamabad, Islamabad, Pakistan; Department of Medicine (C Wang MPH), Vanderbilt University, Nashville, TN, USA; School of Population Health and Environmental Sciences (Y Wang PhD), King’s College London, London, UK; Competence Center of Mortality-Follow-Up of the German National Cohort (R Westerman DSc), Federal Institute for Population Research, Wiesbaden, Germany; Department of Community Medicine (N D Wickramasinghe MD), Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka; Department of Endocrinology, First Affiliated Hospital (Prof S Xu PhD), University of Science and Technology of China, Hefei, China; School of Medicine and Dentistry (Prof S Xu PhD), University of Rochester, Rochester, NY, USA; Cancer Epidemiology and Prevention Research (L Yang PhD), Alberta Health Services, Calgary, BC, Canada; Department of Oncology (L Yang PhD), University of Calgary, Calgary, AB, Canada; Department of Health Management (A Yigit PhD, V Yiğit PhD), Süleyman Demirel Üniversitesi (Süleyman Demirel University), Isparta, Turkey; Department of Pediatrics (D Yon MD), Kyung Hee University, Seoul, South Korea; Department of Neuropsychopharmacology (N Yonemoto PhD), National Center of Neurology and Psychiatry, Kodaira, Japan; Department of Public Health (N Yonemoto PhD), Juntendo University, Tokyo, Japan; Duke Global Health Institute (S Zadey MS), Duke University, Durham, NC, USA; Faculty of Medicine (M Zahir MD), Islamic Azad University, Tehran, Iran; Research and Development Department (I Zare BSc), Sina Medical Biochemistry Technologies, Shiraz, Iran; Department of Bioengineering and Therapeutic Sciences (Prof M S Zastrozhin PhD), University of California San Francisco, San Francisco, CA, USA; Addictology Department (Prof M S Zastrozhin PhD), Russian Medical Academy of Continuous Professional Education, Moscow, Russia; Peoples’ Friendship University of Russia, Moscow, Russia (A Zastrozhina PhD); Health Technology Assessment Unit (Y H Zuniga BS), Department of Health Philippines, Manila, Philippines; #MentalHealthPH, Inc., Quezon City, Philippines (Y H Zuniga BS).

Contributors

Please see appendix 1 (pp 50–55) for extra detailed details about particular person writer contributions to the analysis, divided into the following classes: managing the general analysis enterprise; writing the first draft of the manuscript; main duty for making use of analytical strategies to supply estimates; main duty for searching for, cataloguing, extracting, or cleansing information; designing or coding figures and tables; offering information or crucial suggestions on information sources; growing strategies or computational equipment; offering crucial suggestions on strategies or outcomes; drafting the manuscript or revising it critically for vital mental content material; and managing the estimation or publications course of. Members of the core analysis staff for this subject space had full entry to the underlying information used to generate estimates introduced on this Article. All different authors had entry to and reviewed estimates as half of the analysis analysis course of, which incorporates extra levels of formal evaluation.

Data sharing

For entry to the information used for this particular analysis earlier than the full publication of GBD 2020, please contact Emmanuela Gakidou at [email protected] .

Declaration of pursuits

O M Adebayo stories grants or contracts from Merck Foundation and Servier Nigeria; fee or honoraria for lectures, displays, audio system bureaus, manuscript writing, or academic occasions from Merck Foundation; assist for attending conferences or journey from Servier Nigeria; and a management or fiduciary function in a board, society, committee or advocacy group, paid or unpaid, with the Nigerian Association of Resident Doctors; all exterior the submitted work. S Afzal stories honorary participation on the Institutional Review Board of King Edward Medical University (Lahore, Pakistan), the Quality Enhancement Cell at Fatima Jinnah Medical University (Lahore, Pakistan), and the Corona Expert Advisory Group (Pakistan); an unpaid management or fiduciary function in board, society, committee or advocacy group, with the Pakistan Society of Community Medicine & Public Health, Pakistan Association of Medical Editors, and Pakistan Society of Medical Infectious Diseases; all exterior the submitted work. R Ancuceanu stories consulting charges from AbbVie; fee or honoraria for lectures, displays, audio system bureaus, manuscript writing or academic occasions from AbbVie, B. Braun Medical, Sandoz, and Laropharm; all exterior the submitted work. P Atorkey stories assist for the current manuscript by way of funding from the School of Medicine and Public Health, The University of Newcastle (Callaghan, NSW, Australia), and infrastructure assist from Hunter New England-Population Health and Hunger Medical Research Institute, Australia. M Ausloos stories a analysis grant from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI (undertaking quantity: PN-III-P4-ID-PCCF-2016-0084, title: “Understanding and modelling time-space patterns of psychology-related inequalities and polarization”) exterior the submitted work. T Bärnighausen stories grants from the European Union (Horizon 2020 and EIT Health), German Research Foundation (DFG), US National Institutes of Health, German Ministry of Education and Research, Alexander von Humboldt Foundation, Else-Kröner-Fresenius-Foundation, Wellcome Trust, Bill & Melinda Gates Foundation, KfW, Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization; consulting charges from KfW for the OSCAR initiative in Vietnam; participation on a Data Safety Monitoring Board or Advisory Board with National Institutes of Health (US)-funded research “Healthy Options” (PIs: Smith Fawzi, Kaaya) as Chair of the Data Safety and Monitoring Board, with the German National Committee on the “Future of Public Health Research and Education”, as chair of the scientific advisory board to the EDCTP Evaluation, as a member of the UNAIDS Evaluation Expert Advisory Committee, as a National Institutes of Health (US) Study Section Member on Population and Public Health Approaches to HIV/AIDS (PPAH), with the US National Academies of Sciences, Engineering, and Medicine’s Committee for the “Evaluation of Human Resources for Health in the Republic of Rwanda under the President’s Emergency Plan for AIDS Relief (PEPFAR)”, with the University of Pennsylvania Population Aging Research Center (PARC) as an External Advisory Board Member; management or fiduciary function in a board, society, committee or advocacy group, paid or unpaid, with the Global Health Hub Germany (which was initiated by the German Ministry of Health) as a co-chair; all exterior the submitted work. S M M Bhaskar stories grants or contracts from the NSW Ministry of Health, Australia; a management or fiduciary function in a board, society, committee or advocacy group, paid or unpaid, with the Rotary Club of Sydney as board director, with the International Rotary Fellowship of Healthcare Professionals (UK) as board director, with Global Health & Migration Hub Community, Global Health Hub Germany, Berlin as a chair or supervisor; all exterior the submitted work. J M Castaldelli-Maia stories grants or contracts from Pfizer (Independent Grants for Learning and Change) and the French National Institute for Cancer (INCa); consulting charges from L’Oreal Mental Health Wellness International Board; all exterior the submitted work. S Costanzo stories a analysis grant from the European Foundation for Alcohol Research (ERAB) (ID EA1767; 2018-2020); fee or honoraria for lectures, displays, audio system bureaus, manuscript writing or academic occasions from The Dutch Beer Institute Foundation – The Brewers of Europe as a member of the Organizing Committee and speaker for the ninth European Beer and Health Symposium (Bruxelles 2019), and for giving a lecture at the thirteenth European Nutrition Conference FENS 2019 (Dublin), sponsored by the Beer and Health Initiative (The Dutch Beer Institute basis – The Brewers of Europe); all exterior the submitted work. I Filip stories monetary or non-financial assist from the Avicenna Medical and Clinical Research Institute (California, USA). R C Franklin stories management or fiduciary function in board, society, committee or advocacy group, paid or unpaid with Kidsafe, Farmsafe, Royal Life Saving Society – Australia, and PHAA – Injury Prevention SIG exterior the submitted work. C Herteliu stories analysis grants from the Romanian Ministry of Research Innovation and Digitalization, MCID (ID-585-CTR-42-PFE-2021, Jan 2022-Jun 2023, “Enhancing institutional performance through development of infrastructure and transdisciplinary research ecosystem within socio-economic domain – PERFECTIS”), the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI (PN-III-P4-ID-PCCF-2016-0084, October, 2018, to September, 2022, “Understanding and modelling time-space patterns of psychology-related inequalities and polarization”; PN-III-P2-2.1-SOL-2020-2-0351, June, 2020, to October, 2020, “Approaches within public health management in the context of COVID-19 pandemic”), and the Ministry of Labour and Social Justice, Romania (30/PSCD/2018, September, 2018, to June, 2019, “Agenda for skills Romania 2020-2025”), all exterior the submitted work. J J Jozwiak stories fee or honoraria for lectures, displays, audio system bureaus, manuscript writing or academic occasions from Teva Pharmaceuticals, Amgen, Synexus, Boehringer Ingelheim, ALAB Laboratories, and Zentiva, exterior the submitted work. M Kivimäki stories assist for the current manuscript from the Wellcome Trust (221854/Z/20/Z), the UK Medical Research Council (MR/S011676/1), the US National Institute on Aging (R01AG056477), and the Academy of Finland (350426) in the type of analysis grants to their establishment. Ok Krishan stories non-financial assist from the UGC Centre of Advanced Study (Phase II), Department of Anthropology, Panjab University, Chandigarh, India, exterior the submitted work. S Lorkowski stories grants or contracts paid to his establishment from Akcea Therapeutics Germany; consulting charges from Danone, Novartis Pharma, Swedish Orphan Biovitrum (SOBI), and Upfield; fee or honoraria for lectures, displays, speaker’s bureaus, manuscript writing, or academic occasions from Akcea Therapeutics Germany, Amarin Germany, Amedes Holding, Amgen, Berlin-Chemie, Boehringer Ingelheim, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Janssen-Cilag, Lilly Deutschland, Novartis, Novo Nordisk, F Hoffmann-La Roche (Roche), Sanofi-Aventis, SYNLAB Holding Deutschland, and SYNLAB Akademie; assist for attending conferences or journey from Amgen; and participation on a information security monitoring board or advisory board for Akcea Therapeutics Germany, Amgen, Daiichi Sankyo Deutschland, Novartis, and Sanofi-Aventis; all exterior the submitted work. A M Madureira-Carvalho stories grants or contracts from Instituto Universitário de Ciências da Saúde (Gandra, Portugal); consulting charges from Albert Labs and Eurox Pharma paid to her and her establishment; a management or fiduciary function in a board, society, committee or advocacy group, paid or unpaid, with the Portuguese Association of Forensic Sciences (APCF); all exterior the submitted work. A-F A Mentis stories grants or contracts from “MilkSafe: A novel pipeline to enrich formula milk using omics technologies”, a analysis co-financed by the European Regional Development Fund of the European Union and Greek nationwide funds by the Operational Program Competitiveness, Entrepreneurship and Innovation, underneath the name RESEARCH – CREATE – INNOVATE (undertaking code: T2EDK-02222), in addition to from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860); inventory or inventory choices in a household vineyard; and assist from BGI Group as a scientific officer; all exterior the submitted work. C D H Parry stories grants or contracts from the South African Medical Research Council paid to their establishment; consulting charges paid to them from the World Health Organization (WHO) and the University of Cape Town (Cape Town, South Africa); fee or honoraria for a lecture on alcohol & NCDs in 2020 from the University of Cape Town; assist for attending conferences or journey from UCT African Union 2022, UN Office on Drugs & Crime 2019, and WHO assembly on alcohol in Uganda 2021; participation on a Data Safety Monitoring Board or Advisory Board with the UK SPECTRUM Project (multi college) Global Advisory Board, and the UN Office on Drugs & Crime WDR Scientific Advisory Board, each unpaid; all exterior the submitted work. G A Roth stories assist for the current manuscript from the Bill & Melinda Gates Foundation by way of a analysis grant to their establishment. G A Roth stories grants or contracts from the American Heart Association, the American College of Cardiology, and the National Heart, Lung, and Blood Institute paid to their establishment, exterior the submitted work V Shivarov stories monetary assist from ICON plc. J A Singh stories consulting charges from Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs, Adept Field Solutions, Clinical Care Options, Clearview Healthcare Partners, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM, Trio Health, Medscape, WebMD, and Practice Point Communications, the National Institutes of Health, and the American College of Rheumatology; fee or honoraria for lectures, displays, audio system’ bureaus, manuscript writing, or academic occasions from Simply Speaking; assist for attending conferences or journey from the steering committee of OMERACT; participation on a Data Safety Monitoring Board or Advisory Board with the US Food and Drug Administration Arthritis Advisory Committee; management or fiduciary function in board, society, committee or advocacy group, paid or unpaid, with OMERACT as a steering committee member, with the Veterans Affairs Rheumatology Field Advisory Committee as Chair (unpaid), and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis and editor and director (unpaid); inventory or inventory choices in TPT Global Tech, Vaxart Pharmaceuticals, Aytu BioPharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics, Seres Therapeutics, Tonix Pharmaceuticals and Charlotte’s Web Holdings, and beforehand owned inventory choices in Amarin, Viking, and Moderna Pharmaceuticals; all exterior the submitted work.

Acknowledgments

Research reported on this publication was supported by the Bill & Melinda Gates Foundation. S Afzal acknowledges the assist for mental contributions to this manuscript by the Department of Community Medicine and Epidemiology at King Edward Medical University, Lahore, Pakistan. T Bärnighausen was supported by the Alexander von Humboldt Foundation by the Alexander von Humboldt Professor award, funded by the German Federal Ministry of Education and Research. L Belo acknowledges assist from FCT in the scope of the undertaking UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the undertaking LA/P/0140/2020 of i4HB. D Bennett is supported by the UK Medical Research Council Population Health Research Unit at the University of Oxford (Oxford, UK). M Carvalho acknowledges assist from FCT in the scope of the undertaking UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the undertaking LA/P/0140/2020 of i4HB. L Castro-de-Araujo was funded by the Medical Research Council (UK), Grant no. MR/T03355X/1 and by the National Institute of Mental Health Grant no. R01MH128911. FJ Elgar is supported by the Canada Research Chairs program. F Greaves acknowledges assist from the NIHR Applied Research Collaboration for NW London. V Ok Gupta acknowledges funding assist from the National Health and Medical Research Council (NHMRC), Australia. VB Gupta acknowledges funding assist from the National Health and Medical Research Council (NHMRC), Australia. C Herteliu is partially supported by a grant from the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, undertaking quantity PN-III-P4-ID-PCCF-2016-0084. C Herteliu is partially supported by a grant from the Romanian Ministry of Research Innovation and Digitalization, MCID, undertaking quantity ID-585-CTR-42-PFE-2021. S Hussain was supported by the Operational Programme Research, Development and Education –Project, Postdoc2MUNI “(No. CZ.02.2.69/0.0/0.0/18_053/0016952). S M S Islam is funded by the National Health and Medical Research Council and acquired funding from the National Heart Foundation of Australia. The Serbian half of this GBD-related contribution has been co-financed by Grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. M Kivimaki was supported by the Wellcome Trust (221854/Z/20/Z), the UK Medical Research Council (MR/S011676/1), the US National Institute on Aging (R01AG056477), and the Academy of Finland (350426). Ok Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. B Lacey acknowledges assist from the UK Biobank, funded largely by the UK Medical Research Council and Wellcome. S Lorkowski acknowledges institutional assist from the Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD) Halle-Jena-Leipzig (Germany; German Federal Ministry of Education and Research; grant settlement quantity 01EA1808A). G Lucchetti acquired a productiveness scholarship from the Brazilian National Council for Scientific and Technological Development — CNPq (Level 1D). J McGrath was supported by the Danish National Research Foundation (Niels Bohr Professor). J McGrath is employed by the Queensland Centre for Mental Health Research (Australia), which receives assist from the Queensland Health Department. C Parry acknowleges the South African Medical Research Council. A Peden is supported by a National Health and Medical Research Council Emerging Leadership Fellowship (Grant ID: APP2009306). M R Phillips was supported partly by the Global Alliance for Chronic Diseases – National Natural Science Foundation of China (NSFC. No. 81761128031). M Pinheiro acknowledges FCT for funding by program DL 57/2016 – Norma transitória. A Rahman acknowledges the assist from the Data Science Research Unit in Charles Sturt University (Bathurst, NSW, Australia). U Saeed wish to acknowledge the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges assist from Ain Shams University (Cairo, Egypt) and the Egyptian Fulbright Mission Program. N Senthil Kumar acknowledges the DBT, New Delhi sponsored Advanced State Level Biotech Hub (BT/NER/143/SP44475/2021), Mizoram University (Aizawl, Mizoram, India) for facilitating this work. F Sha is supported by the Shenzhen Science and Technology Program (Grant No. KQTD20190929172835662). A Shetty acknowledges Kasturba Medical College (Mangalore, India) and Manipal Academy of Higher Education (Manipal, India) for all the educational assist. R Shrestha acknowledges a profession growth award from the National Institutes of Health (K01DA051346). D Silva was financed partly by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and is supported partly by CNPq – Brazil (309589/2021-5). D Sleet acknowledges partial assist from Veritas Management Group, Inc and The Bizzell Group, LLC. S Trias-Llimós acknowledges analysis funding from the Juan de la Cierva-Formación program of the Spanish Ministry of Science and Innovation (FJC-2019-039314-I).

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Supplementary Materials

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Article Info

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DOI: https://doi.org/10.1016/S0140-6736(22)00847-9

Copyright

© 2022 The Author(s). Published by Elsevier Ltd.

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Linked Articles

  • Complex relationship between well being and average alcohol use
    • In The Lancet, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 Alcohol Collaborators1 provide a further study to systematically determine thresholds for low-risk alcohol consumption while considering background rates of disease. Overall, the authors estimated the amount of alcohol that minimises health risks to be between 0 (95% uncertainty interval 0–0) and 1·87 (0·50–3·30) standard drinks per day. Levels of zero, or very close to zero, were observed among individuals aged 15–39 years (ranging from 0 to 0·603 standard drinks per day), but higher levels were reported for individuals aged 40 years and older (ranging from 0·114 to 1·87 standard drinks per day).

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