GBD | 2023年全球男性预期寿命为71.5岁，女性为76.3岁

摘要：D Adzrago reports support for the present manuscript from the National Institute on Minority Health and Health Disparities at the

《柳叶刀》（The Lancet）发表GBD 2023的最新分析，对1950年至2023年期间，全球204个国家和地区以及660个次国家地区的年龄-性别特定全因死亡率和预期寿命进行了人口统计学估算与分析。2023年，全球死亡总数为6010万，其中5岁以下儿童死亡约467万。2011年至2023年间，5岁以下儿童死亡率在东亚下降最多。从1950年到2023年，全球预期寿命显著改善，女性从51.2岁提高到76.3岁，男性从47.9岁提高到71.5岁。

背景

全面、可比且及时的人口统计指标（包括预期寿命和年龄特定死亡率）估计对于评估、理解和应对人口健康趋势至关重要。COVID-19凸显了及时获取全因死亡率估计的重要性，以便应对健康结果变化的趋势，并显示出对能够利用更易获得的全年龄段生命登记（VR）数据更快速地估计全因死亡率的人口学分析工具的强烈需求。全球疾病负担、伤害与风险因素研究（GBD）是一项持续进行的研究，旨在通过估计一系列流行病学指标来量化人类健康状况，涵盖时间、年龄、性别、地点、病因和风险因素。本研究是最新发布的GBD 2023的一部分，旨在利用一种新颖的统计模型，考虑人口数据在不同年龄和时间上的复杂相关结构，提供1950年至2023年的全因死亡率和预期寿命的更新估计值。

方法

我们利用来自生命登记、抽样登记、调查、人口普查及其他来源的24,025个数据源，估计了1950年至2023年间204个国家和地区以及20个国家的660个次国家地区中男性、女性及所有性别的全因死亡率，涵盖25个年龄组。首次使用了5–14岁完整出生史数据、15–49岁年龄组的年龄特定兄弟史数据以及健康与人口监测系统的年龄特定死亡数据。我们开发了一个整合参数和非参数方法的单一统计模型，称为OneMod，用于生成每个年龄-性别-地点组的全因死亡率估计值。OneMod包括两个主要步骤：一是利用广义线性模型工具进行详细的回归分析，考虑年龄特定的协变量（如社会人口指数SDI）和所有风险因素的人群归因分数（PAF）；二是对残差进行非参数分析，采用多变量核回归模型，平滑年龄和时间上的趋势，以灵活适应数据趋势而不出现过拟合。我们用皮尔逊残差校准渐近不确定性的估计，生成95%不确定区间（UI）和相应的1000次抽样。预期寿命通过标准人口统计方法，从年龄特定死亡率计算得出。每个指标的95% UI由1000次抽样后验分布的第25和第975个值确定。

结果

2023年，全球死亡总数为6010万（95% UI：5900万–6110万），其中5岁以下儿童死亡约467万（459万–475万）。由于自1950年以来人口大幅增长和老龄化，全球年度死亡人数在研究期间增加了35.2%（32.2%–38.4%），而全球年龄标准化全因死亡率在此期间下降了66.6%（65.8%–67.3%）。2011年至2023年间，不同年龄组和地区的年龄特定死亡率变化存在差异：5岁以下儿童死亡率在东亚下降最多（67.7%）；5–14岁、25–29岁和30–39岁年龄组死亡率在高收入的北美地区上升最多（分别为11.5%、31.7%、49.9%）；15–19岁和20–24岁年龄组死亡率在东欧地区上升最多（分别为53.9%和40.1%）。我们还发现，撒哈拉以南非洲地区5–14岁所有性别的儿童死亡率（比GBD 2021高87.3%）以及15–29岁女性死亡率（高61.2%）高于既往估计，而50岁及以上所有性别的死亡率（低13.2%）则低于既往估计，这反映了模型方法的改进。

全球预期寿命在研究期间表现出三种不同的趋势：首先，从1950年到2019年，预期寿命显著改善，女性从51.2岁（50.6–51.7）提高到76.3岁（76.2–76.4），男性从47.9岁（47.4–48.4）提高到71.4岁（71.3–71.5）；其次，受COVID-19疫情影响，2020年至2021年预期寿命有所下降，女性降至74.7岁（74.6–74.8），男性降至69.3岁（69.2–69.4）；最后，2022年和2023年进入疫情后恢复期，预期寿命基本回到疫情前（2019年）水平，女性为76.3岁（76.0–76.6），男性为71.5岁（71.2–71.8）。到2023年，204个国家和地区中有194个（95.1%）的年龄标准化死亡率在疫情后实现部分或者全部恢复，61.8%（126个国家和地区）恢复到或低于疫情前水平。不同国家和地区在疫情期间及之后的死亡率轨迹存在差异，长期死亡率趋势在不同年龄组和地区间也存在显著差异，展现了全球健康结果的多样性。

解释

本分析揭示了与既往估计相比的几个关键差异，包括撒哈拉以南非洲大部分地区的青少年死亡率更高、年轻成年女性死亡率更高，以及老年人群死亡率更低。研究还强调了疫情期间及之后（2020–2023年）各国及地区在全因死亡率变化的时间点和规模上的巨大差异。我们对近年来以及整个1950–2023年期间不同地区、年龄、性别和SDI水平的死亡率和预期寿命变化趋势的估计，为政府、政策制定者和公众提供了重要信息，以确保医疗保健系统、经济和社会能做好准备以应对全球健康需求，特别是在一些死亡率高于既往已知水平的人群中。本研究的估计为全球疾病负担研究提供了坚实的框架，也为全球政策制定、实施和评估奠定了宝贵的基础。 END

Funding

Gates Foundation.

Declaration of interests

D Adzrago reports support for the present manuscript from the National Institute on Minority Health and Health Disparities at the National Institutes of Health. D Adzrago's efforts are supported by the Division of Intramural Research at the National Institute on Minority Health and Health Disparities, National Institutes of Health (ZIA MD000015). Opinions and comments expressed in this Article belong to the author and do not necessarily reflect those of the US Government, Department of Health and Human Services, National Institutes of Health, and National Institute on Minority Health and Health Disparities; support for meetings and/or travel from the National Institute on Minority Health and Health Disparities at the National Institutes of Health, outside the submitted work. S Afzal reports support for the present manuscript from the Institute of Public Health, Lahore, Pakistan; grants or contracts by the Dean Institute of Public Health, Lahore, Pakistan; honoraria for experts, lectures, visiting speakers and educational seminars were provided by the Dean Institute of Public Health, Lahore, Pakistan; support for attending meetings and travel was provided by the Dean Institute of Public Health, Lahore, Pakistan; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid as a Member of the Pakistan Higher Education Commission Research Committee, Member of the Pakistan Medical and Dental Commission Research and Journals Committee, Member of the Pakistan National Bioethics Committee, Member of the Pakistan Society of Internal Medicine, Member of the Pakistan Association of Medical Editors, Member of the Medical Microbiology and Infectious Diseases Society, Fellow of LEADS (Cohort15), 2010, Fellow of the Faculty of Public Health UK, Fellow of the College of Physicians and Surgeons Pakistan; receipt of equipment, materials, drugs, and services including computer software and equipment from Bergen University Norway for research writing; and other financial or non-financial support from the Dean Public Health Institute of Public Health, Lahore, Pakistan; outside the submitted work. C Agostinis Sobrinho reports grants or contracts from Fundação para a Ciência e a Tecnologia (FCT)- (CEECINST/00093/2021/CP2815/CT0001); outside the submitted work. R Ancuceanu reports royalties or licenses from AbbVie and Merck Romania; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from AbbVie, Laropharm, Reckitt, and Merck Romania; and support for attending meetings and/or travel from Merck Romania and Reckitt; outside the submitted work. J Arnlov reports payment or honoraria for lecture fees, speakers bureaus, manuscript writing, or educational events from AstraZeneca, Boehringer Ingelheim, and Novartis; and participation on a Data Safety Monitoring Board or Advisory Board with AstraZeneca, Boehringer Ingelheim, and Astella; outside the submitted work. M S Aslam reports grants or contracts from Xiamen University Malaysia Research Fund (XMUMRF; grant number XMUMRF/2025-C15/ITCM/0006), Project title: Therapeutic and Toxicity Evaluation of Selected Medicinal Herbs for NAFLD: Exploring the Inter-Organelle Contact Sites Modulation Theory Role: Co-Investigator Dates: Jan 2025–Dec 2027 (ongoing) Internal XMUMRF research grant administered by Xiamen University Malaysia; funds disbursed to institutional research account only; no salary, honoraria, or personal payments to author, and grant number XMUMRF/2023-C11/ISEM/0041, project title: Children's Rights Education in the Early Years of Divorce: An Exploration of Adolescents’ Perspectives Role: Co-Investigator Dates: Jan 2023 – Dec 2025 (ongoing) Internal XMUMRF research grant administered by Xiamen University Malaysia; funds disbursed to institutional research account only; no salary, honoraria, or personal payments to author; outside the submitted work. R Bai reports support for the present manuscript from the Fundamental Research Funds for the Central Universities (number 3092301101). O C Baltatu reports support for the present manuscript from Alfaisal University, Anima Institute (AI) Research Professor Fellowship, National Council for Scientific and Technological Development Fellowship (CNPq, 304224/2022-7); Leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as Managing Partner, VividiWise Analytics and as a Biotech Advisory Board Member, São José dos Campos Technology Park – CITE; outside the submitted work. S Barteit reports grants or contracts from the Carl-Zeiss Foundation research grant and the German research foundation (DFG) research grant; stock or stock options from the CHEERS company; outside the submitted work. A Beloukas reports grants or contracts with Gilead (research grant and sponsorship to the University of West Attica) and GSK (research sponsorship to the University of West Attica); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Gilead and GSK (paid to the University of West Attica); support for attending meetings and/or travel from Gilead and GSK (paid to the University of West Attica); receipt of equipment, materials, drugs, services from Cepheid, and provided FOC reagents for a research project; outside the submitted work. 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C Herteliu is partially supported by the project “A better understanding of socio-economic systems using quantitative methods from Physics” funded by European Union – NextgenerationEU and Romanian Government, under National Recovery and Resilience Plan for Romania, contract number 760034/ 23.05.2023, cod PNRR-C9-I8-CF 255/ 29.11.2022, through the Romanian Ministry of Research, Innovation and Digitalization, within Component 9, Investment I8; outside the submitted work. A H Hoveidaei reports leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as Guest Editor of Frontiers in Sports and Active living, as Editorial Board Member of International Orthopaedics, Bone Reports, BMC Research Notes, PLoS One, Frontiers in Rehabilitation Sciences (unpaid); outside the submitted work. 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D Lindholm reports stock or stock options with AstraZeneca (during time of employment); other financial or non-financial interests as a former employee of AstraZeneca; outside the submitted work. J Liu reports support for the present manuscript and grants or contracts from the National Natural Science Foundation (72474005) and Beijing Natural Science Foundation (L222027). V Lohner reports support for the present manuscript from Marga and Walter Boll Foundation, Kerpen, Germany. E Lytvyak reports grants or contracts from University of Alberta (Principal Investigator), Advanz Pharma (Co-Principal Investigator), WCB Alberta (Co-Principal Investigator), CPSA (Co-Principal Investigator); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the Alberta Obesity Society; other financial or non-financial interests from the University of Alberta as an employee and from Alberta Health Services; outside the submitted work. 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A Ortiz reports grants or contracts from Sanofi (to institution: IIS-FJD UAM), grants to Universidad Autonoma de Madrid (UAM) as Director of the Catedra Astrazeneca-UAM of chronic kidney disease and electrolytes; consulting fees from Astellas, AstraZeneca, Bioporto, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Lilly, Chiesi, Otsuka, Novo Nordisk, and Sysmex; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Astellas, AstraZeneca, Bioporto, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Sobi, Menarini, Lilly, Chiesi, Otsuka, Novo Nordisk, Sysmex, Vifor Fresenius Medical Care Renal Pharma, and Spafarma; support for attending meetings and/or travel from Astellas, AstraZeneca, Fresenius Medical Care, Boehringer Ingelheim, Bayer, Sanofi-Genzyme, Chiesi, Sobi, Bayer, and participation on a data safety monitoring board or advisory board with Astellas, AstraZeneca, Boehringer Ingelheim, Fresenius Medical Care, Bayer, Sanofi-Genzyme, Chiesi, Otsuka, Novo Nordisk, and Sysmex; and leadership or fiduciary roles in board, society, committee or advocacy groups, unpaid as Council ERA with SOMANE; outside the submitted work. R Palma-Alvarez reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Casen Recordati, Angelini, Lundbeck, Rubió, Servier, Takeda, and Neuraxpharm; support for attending meetings and/or travel from Takeda, Advanz Pharma, Angelini, Italfarmaco, and Lundbeck; outside the submitted work. S Panda reports support for the present manuscript from Siksha ‘O’ Anusandhan (Deemed to be University); grants or contracts from file number 17-59/2023-24/CCRH/Tech./Coll./ICMR- Diabetes/960] as Co-Investigator, outside the submitted work. C I Panelo reports consulting fees from The Global Fund and the World Health Organization; participation on a DSMB or advisory board with University of the Philippines Manila Research Ethics Board: Member of Panel 2 (ongoing); leadership or fiduciary roles with the Culion Foundation as Elected Vice President and Board Member (2004 to present), Foundation for the Advancement of Clinical Epidemiology as Elected President (2018 to present); International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Philippine Chapter as Elected member of the Board (2024–2026); outside the submitted work. R Passero reports leadership or fiduciary roles in board, society, committee, or advocacy groups, unpaid as Member of the EBMT Statistical Committee, European Society for Blood and Marrow Transplantation, Paris, France (no payment received) and as Past member 2020–2023 (biostatistician) of the IRB/IEC Comitato Etico AO SS. Antonio e Biagio Alessandria-ASL AL-VC, Italy (no payment received); participation on a DSMB or advisory board member of the data safety monitoring board dello studio “Consolidation with ADCT-402 (loncastuximab tesirine) after immunochemotherapy: a phase II study in BTKi- treated/ineligible Relapse/Refractory Mantle Cell Lymphoma (MCL) patients’ - FIL, Fondazione Italiana Linfomi, Alessandria, Italy (no payment received); outside the submitted work. A Peden reports support for the present manuscript from the Australian National Health and Medical Research Council (grant number: APP2009306). V C Pepito reports grants or contracts from Sanofi Consumer Healthcare grant to do a study on self-care in the Philippines and from the Zuellig Family Foundation grant to write manuscripts on health systems strengthening; outside the submitted work. M Piradov reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid as Editor-in-Chief of Annals of Clinical and Experimental Neurology; outside the submitted work. S Rege reports leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as the Operational Lead – International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Medication Adherence and Persistence (MAP) Special Interest Group (SIG), Review Editor – Editorial Board of Pharmacoepidemiology section within Frontiers in Pharmacology, Academic Editor – PLoS One Editorial Board, and Editorial Board Member – Pain Management; outside the submitted work. M Rolfzen reports grants or contracts from the Society of Cardiovascular Anesthesiologists in-training grant; outside the submitted work. L Ronfani reports support for the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017, payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. P Sachdev reports grants or contracts from the National Health and Medical Research Council of Australia, APP1169489 (payment to institution) and National Institutes of Health, USA; grants 1RF1AG057531-01 and 2R01AG057531-02A1 (payment to institution); leadership or fiduciary roles in board, society, committee or advocacy groups, unpaid with the International Neuropsychiatric Association as Executive Board member, and World Psychiatric Association on the Planning Committee; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Alkem Labs for a lecture as part of the Frontiers of Psychiatry 2023 seminar, Mumbai, India, June 2023; support for attending meetings and/or travel for attendance of four meetings; participation on a DSMB or advisory board with Biogen Australia Medical Advisory committee in 2020 and 2021 Roche Australia Medical Advisory Committee in 2022 and Eli Lilly, Expert Advisory Panel, 2025; outside the submitted work. Y L Samodra reports grants or contracts from Taipei Medical University (Taiwan), Type A Doctoral Scholarship, EPM NTU & NSTC, Taiwan, postdoctoral fellow contract; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with Benang Merah Research Center, Indonesia (benangmerah.net); outside the submitted work. H Sarma reports support for the present manuscript from Bodoland University, Assam, India. A Schutte reports consulting fees from Medtronic, AstraZeneca, Sky Labs, and Omron; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Medtronic, AstraZeneca, Servier, Sanofi, Abbott, Omron, and Aktiaa; support for attending meetings and/or travel from Servier and Medtronic; outside the submitted work. F Shahkarami reports grants or contracts and payment or honoraria from Tehran University of Medical Sciences, School of Medicine, Department of Internal Medicine; outside the submitted work. V Sharma reports grants or contracts from DFSS (MHA)‘s research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University, Chandigarh, India; outside the submitted work. V Shivarov reports one patent from the Bulgarian patent office ; and other financial support from ICON plc (salary); outside the submitted work. L M L R da Silva reports grants or contracts from SPRINT - Sport Physical Activity and Health Research & Innovation Center, Polytechnic of Guarda, 6300-559 Guarda, Portugal and RISE-Health, Faculty of Health Sciences, University of Beira Interior, 6201-506 Covilhã, Portugal; outside the submitted work. J Singh reports consulting fees from ROMTech, Atheneum, ClearView Healthcare Partners, American College of Rheumatology, Yale, Hulio, Horizon Pharmaceuticals, DINORA, ANI/Exeltis, USA Inc., Frictionless Solutions, Schipher, Crealta/Horizon, Medisys, Fidia, PK Med, Two Labs Inc., Adept Field Solutions, Clinical Care options, Putnam Associates, Focus Forward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point Communications; and the National Institutes of Health; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Simply Speaking; support for attending meetings and/or travel from Simply Speaking; leadership or fiduciary role in other board, society, committee, or advocacy group, paid or unpaid as a past steering committee member of the OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, and as a Chair of the Veterans Affairs Rheumatology Field Advisory Committee, and as editor and the Director of the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis; stock or stock options in Atai Life Sciences, Kintara Therapeutics, Intelligent Biosolutions, Acumen Pharmaceutical, TPT Global Tech, Vaxart Pharmaceuticals, Atyu Biopharma, Adaptimmune Therapeutics, GeoVax Labs, Pieris Pharmaceuticals, Enzolytics Inc., Seres Therapeutics, Tonix Pharmaceuticals Holding Corp., Aebona Pharmaceuticals, and Charlotte's Web Holdings, Inc., and previously owned stock options in Amarin, Viking, and Moderna Pharmaceuticals; outside the submitted work. I Soyiri reports leadership or fiduciary roles in board, society, committee or advocacy groups, unpaid as Trustee of the Citizens Advice Bureau for Hull & East Riding, UK; outside the submitted work. J D Stanaway reports support for the present manuscript from the Gates Foundation (grants paid to institution); and grants or contracts from Novo Nordisk Foundation (grants paid to institution), outside the submitted work. R Tabares-Seisdedos reports grants or contracts from Valencian Regional Government's Ministry of Education (PROMETEO/CIPROM/2022/58 (the funders were not involved in the design of the manuscript or decision to submit the manuscript for publication, nor will they be involved in any aspect of the study's conduct) and grants or contracts from the Spanish Ministry of Science, Innovation and Universities (PID2021-129099OB-I00; the funders were not involved in the design of the manuscript or decision to submit the manuscript for publication, nor will they be involved in any aspect of the study's conduct); outside the submitted work. T Tabuchi reports grants or contracts from Daiichi Sankyo Healthcare, Workout-Plus LLC, Johnson & Johnson, EMMA, and Data Seed; outside the submitted work. J H V Ticoalu reports leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as co-founder of Benang Merah Research Center, Indonesia (benangmerah.net); outside the submitted work. M Titova reports support for the present manuscript from the state assignment of the Ministry of Science and Higher Education of the Russian Federation (themes number 122042600086-7 and number 122042700043-9). S Tromans reports grants or contracts from part of the 2023/4 Adult Psychiatric Morbidity Survey team, collecting epidemiological data on community-based adults living in England. This is a contracted study from NHS Digital, via the Department of Health and Social Care. S Tromans reports contributions and data collection for the 2023/4 Adult Psychiatric Morbidity Survey report; payments made to University of Leicester; being lead on a study funded by the National Institute for Health and Care Research Clinical Research Network, on optimizing the survey design for people with learning disability and autism; leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid as Academic Secretary for the Neurodevelopmental Psychiatry Special Interest Group and Psychiatry of Intellectual Disability Faculty at the Royal College of Psychiatrists; as Editorial Board Member for Progress in Neurology and Psychiatry, Advances in Mental Health and Intellectual Disabilities, Advances in Autism, BMC Psychiatry, and BJPsych Open, and as Editor of Psychiatry of Intellectual Disability Across Cultures (Oxford University Press); support for attending meetings and/or travel from the Royal College of Psychiatrists; outside the submitted work. G Tse reports leadership or fiduciary roles in board, society, committee, or advocacy groups, paid or unpaid with the International Society of Electrocardiology and the International Society for Holter and Noninvasive Electrocardiology; participation on a DSMB or advisory board as a member of the Core Steering Committee meeting for the International Cardiovascular and Respiratory Alliance and the International Society of Electrocardiology, International Society for Holter and Noninvasive Electrocardiology; outside the submitted work. E Upadhyay reports the following patents planned, issued or pending with The Office of the Controller General of Patents, Designs & Trade Marks (CGPDTM; https://iprsearch.ipindia.gov.in/PublicSearch/PublicationSearch/ApplicationStatus): “Eco-friendly bio-shoe polish from banana and turmeric” (Filed 202511021382), “Honey-based polyherbal syrup composition to treat air pollution-induced inflammation and preparation method thereof” (Filed 202511035171), “Process for preparing a caffeine free, antioxidant and nutrient rich beverage” (Filed 202511042794), “A system and method of reusable filters for anti-pollution mask” (Published 202011003559), “A system and method for electricity generation through crop stubble by using microbial fuel cells” (Published 202011008531), “A system for disposed personal protection equipment (PPE) into biofuel through pyrolysis and method” (Published 202111005659), “A novel herbal pharmaceutical aid for formulation of gel and method thereof” (Published 202111023333), “Herbal drug formulation for treating lung tissue degenerated by particulate matter exposure” (Published 202311035276), “A method to transform cow dung into the wall paint by using natural materials and composition thereof” (Filed 202311085452), “Biodegradable packaging composition and method of preparation thereof” (Filed 202511017848); leadership or fiduciary role in other board, society, committee, or advocacy group as an Executive Council Member for the Indian Meteorological Society, Jaipur Chapter (India) and a Member Secretary for the DSTPURSE Program; outside the submitted work. E Vounzoulaki reports grants or contracts from an NIHR DSE Award until July 2026; outside the submitted work. P Willeit reports consulting fees from Novartis Pharmaceuticals; outside the submitted work. J Wu reports grants or contracts from the National Heart, Lung, and Blood Institute (R38HL167238) and acknowledges previous funding from the American Society of Hematology Opportunities for the Next Generation of Research Scientists (HONORS) Award, outside the submitted work. Y Yasufuku reports grants or contracts from Shionogi & Co., Ltd; employment expenses are paid from the joint research fund provided by this pharmaceutical company to The University of Osaka; outside the submitted work. S Zadey reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid on the Board of the Association for Socially Applicable Research Fellow, the Lancet Citizens’ Commission on Reimagining India's Health System Chair, G4 Alliance Asia Working Group and as Fellow, Blood DESERT Coalition; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Think Global Health and Hindu; participation on a DSMB or advisory board with Nivarana - Advisory Board; outside the submitted work. G Zamagni reports support for the present manuscript from the Italian Ministry of Health through the contribution given to the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste – Italy. L Zuhlke reports royalties or license from Up to Date; consulting fees from Le DucQ; and leadership or fiduciary roles in board, society, committee or advocacy groups, unpaid with Food Forward SA; outside the submitted work. All other authors declare no competing interests.

中文翻译仅供参考，所有内容以英文原文为准。

https://doi.org/10.1016/S0140-6736(25)01330-3