http://hdl.handle.net/10453/35217 2026-09-24T01:19:12Z http://hdl.handle.net/10453/196084 Title: Adolescent health across Asia Pacific, 2000–23: a systematic analysis for the Global Burden of Disease Study 2023 Authors: Cini, KI; Dumuid, D; Abbsar, I; Li, L; Priambodo, DA; A, B; Abdullah, MA; Abdullah,; Aboagye, RG; Acharya, S; Addo, IY; Adegoke, NA; Adhikary, RK; Adiga, U; Adnan, M; Adnani, QES; Adonteng-Kissi, O; Afrifa-Yamoah, E; Agung, FH; Ahmad, A; Ahmad, K; Ahmad, N; Ahmad, T; Ahmed, JM; Ahmed, M; Ahmed, S; Akalanka, KHM; Akhtar, MN; Akosile, W; Al Hasan, SM; Al Zaabi, OAM; Alam, K; Alam, MK; Alam, MJ; Alhumaidi, A; Ali, I; Ali, MD; Ali, R; Aljunid, SM; Almazan, JU; Al-Mekhlafi, HM; Ananda, RA; Anandakumar, A; Anderlini, D; Anderson, DB; Annadurai, K; Ansari, S; Anyasodor, AE; Apostol, GLC; Arafat, M; Arooj, M; Aryastami, NK; Aryntayeva, N; Asdaq, SMB; Ashraf, J; Ashraf, MS; Ashraf, S; Ashraf, T; Aslam, MS; Asri, Y; Atalykova, Z; Atreya, A; Awan, SJ; Awan, UA; Azad, AKM; Aziz, MY; Bai, R; Balakrishnan, P; Balakrishnan, S; Balhara, YPS; Bandara, RP; Bandy, A; Bandyopadhyay, S; Banik, R; Barkat, MA; Barker-Collo, SL; Barua, L; Bashir, S; Beeraka, NM; Begum, GS; Behera, P; Behera, SM; Bele, S; Bente Kamal Tune, SN; Bhadoria, P; Bhandari, R; Bhati, AK; Bhattacharjee, P; Bhattacharya, S; Bhattarai, AH; Bhatti, GK; Bhatti, JS; Bhatti, R; Bi, H; Biswas, B; Biswas, MS; Biswas, M; Borschmann, R; Bui, LP; Byrne, H Abstract: Background: The Asia Pacific region is home to more than half of the world's 1·93 billion adolescents (aged 10–24 years). Addressing adolescent health in this region is of global importance, but to date a systematic analysis of key contributors to disease in adolescents has not been done, which is a barrier to responsive action. This systematic analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 aims to provide a comprehensive assessment of adolescent health across the Asia Pacific region, at both the subregional and national levels, encompassing burden of disease, mortality, and prevalence of adolescent risk factors. Methods: As part of GBD 2023, we obtained estimates for cause-specific mortality, disability-adjusted life-years (DALYs), and risk factor prevalence by sex for adolescents aged 10–24 years and 5-year age groups (10–14 years, 15–19 years, and 20–24 years) across 44 countries and territories (hereafter referred to collectively as Asia Pacific), grouped by seven UN subregions, from 2000 to 2023. We extracted GBD 2023 population counts and estimates of number and rate (per 100 000 population) for mortality and disease burden (DALYs). Risk prevalence estimates were obtained directly from the Institute for Health Metrics and Evaluation, and binge drinking estimates were sourced from WHO. Estimates are reported with 95% uncertainty intervals (UIs) where possible. UIs were estimated by running 250 draws of the posterior distribution, ordering the draws, and selecting the 2·5th and 97·5th percentiles for each metric. Findings: In 2023, in adolescents across Asia Pacific, there were 637 496 deaths and a total disease burden of 115·8 million DALYs, representing 34·1% of global adolescent deaths and 40·6% of the global adolescent burden of disease. Non-communicable diseases (NCDs; particularly mental disorders) were the leading causes of disease burden and mortality (64·8% of DALYs and 43·9% of deaths). Unintentional and transport injuries were also leading causes of death (14·7% of deaths due to transport injury and 13·3% of deaths due to unintentional injury) and leading causes of disease burden particularly among males in south-eastern Asia. In Melanesia, Micronesia, and some parts of south-eastern Asia (Cambodia, Indonesia, Laos, the Philippines, and Timor-Leste), respiratory infections and tuberculosis remained important contributors. Southern Asia had the largest reduction (1·5% per year) in all-cause DALYs over the study period, and Australia and New Zealand (0·2% per year) had the smallest, with females in Australia and New Zealand showing a slight increase contrary to regional trends. Eastern Asia had the largest reduction (2·8% per year) in all-cause mortality rate and Melanesia (0·8% per year) the smallest. Risk factors generally had between-subregion and within-subregion variation; however, some regional trends stood out, with overweight and obesity increasing in all countries across the region, and binge drinking increasing in more countries than not. In 2023, prevalence of smoking in males exceeded that in females in every country, from 40% difference in Timor-Leste to less than 1% difference in Australia. Anaemia prevalence is decreasing in all countries, but female prevalence was higher and reducing at a slower rate than in males. Bullying prevalence was slightly higher in Polynesia, Micronesia, and Melanesia combined, Australia and New Zealand, and eastern Asia compared with southern and south-eastern Asian subregions. Interpretation: Several patterns were consistent across the region: the dominance of mental disorders and NCDs, the universal rise in overweight and obesity (particularly high in Oceanic countries but increasing rapidly in south and south-eastern Asia), and persistent sex-specific challenges across subregions: unintentional injuries and smoking in males, and anaemia in females. Actions to tackle shared risk factors (while accounting for context-specific local health profiles, workforce deficits, cultural factors, and health system capacity) should not be forgone due to local variation. Future research could focus on subnational variation, intersecting inequalities, and multi-sectoral interventions targeting shared risk factors. Priority actions should include regional investment in adolescent mental health services and obesity prevention, targeted injury reduction strategies for high-risk populations, and sex-specific approaches to smoking cessation and anaemia reduction, delivered through local health systems with the capacity and cultural responsiveness to meet local needs. Funding: Gates Foundation and Australian Government. 2026-10-01T00:00:00Z http://hdl.handle.net/10453/196072 Title: Identifying Super Spreaders in Multilayer Networks Authors: Czuba, M; Stolarski, M; Piróg, A; Bielak, P; Bródka, P Editors: Lynce, I; Murano, N; Vallati, M; Villata, S; Chesani, F; Milano, M; Omicini, A; Dastani, M Abstract: Identifying super-spreaders can be framed as a subtask of the influence maximisation problem. It seeks to pinpoint agents within a network that, if selected as single diffusion seeds, disseminate information most effectively. Multilayer networks, a specific class of heterogeneous graphs, can capture diverse types of interactions (e.g., physical-virtual or professional-social), and thus offer a more accurate representation of complex relational structures. In this work, we introduce a novel approach to identifying super-spreaders in such networks by leveraging graph neural networks. To this end, we construct a dataset by simulating information diffusion across hundreds of networks - to the best of our knowledge, the first of its kind tailored specifically to multilayer networks. We further formulate the task as a variation of the ranking prediction problem based on a four-dimensional vector that quantifies each agent's spreading potential: (i) the number of activations; (ii) the duration of the diffusion process; (iii) the peak number of activations; and (iv) the simulation step at which this peak occurs. Our model, TopSpreadersNetwork, comprises a relationship-agnostic encoder and a custom aggregation layer. This design enables generalisation to previously unseen data and adapts to varying graph sizes. In an extensive evaluation, we compare our model against classic centrality-based heuristics and competitive deep learning methods. The results, obtained across a broad spectrum of real-world and synthetic multilayer networks, demonstrate that TopSpreadersNetwork achieves superior performance in identifying high-impact nodes, while also offering improved interpretability through its structured output. 2025-10-21T00:00:00Z http://hdl.handle.net/10453/196021 Title: Global, regional, and national burden of HIV/AIDS, 1990–2023, with the estimated burden attributable to intimate partner violence and forecasted impacts of funding cuts through 2030: results from the Global Burden of Disease Study 2023 Authors: GBD 2023 HIV Collaborators*,; Sun, J Abstract: BACKGROUND: Despite a general improvement in the HIV burden over the past two decades, gendered social determinants including intimate partner violence (IPV) continue to affect women's vulnerability to HIV, which could be further exacerbated as resources dwindle over the coming years. Our study aimed to quantify recent trends in the HIV burden, the magnitude of the HIV burden associated with IPV, and the potential impact of declining financial support globally. METHODS: Using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework, we estimated annual HIV incidence, prevalence, and mortality for 204 countries and territories from 1990 to 2023, disaggregated by age and sex. Input data included national HIV programme reports, population-based serosurveys, clinical and vital registration data, and systematically reviewed literature. Countries and territories were grouped according to the availability and completeness of HIV prevalence and mortality data, with tailored modelling approaches applied for each group. To characterise the potential contributions of IPV to the HIV burden, time series estimates of IPV prevalence by location and effect size estimates were combined to generate population attributable fractions of the HIV burden. To forecast future trends and assess the potential impact of reductions in development assistance for health, we used a non-parametric stochastic frontier approach to estimate how funding levels could affect antiretroviral therapy (ART) coverage. Adjustments in future ART coverage were integrated into our forecasts, altering projected rates of HIV-related incidence and mortality. We compared scenarios with and without funding cuts, quantifying the potential epidemiological effects of reduced ART availability by sex. FINDINGS: Between 2003 and 2023, the annual number of new HIV infections declined globally, from 2·85 million (95% uncertainty interval [UI] 2·76-2·96) to 2·06 million (1·88-2·29). Meanwhile, HIV-related deaths decreased from a peak of 1·71 million (1·61-1·83) in 2004 to 0·83 million (0·73-0·96) in 2023. The number of people living with HIV rose from 26·3 million (25·5-27·3) in 2003 to 42·4 million (40·3-44·4) in 2023, reflecting improved survival associated with ART expansion. Although females continued to have higher prevalence of HIV than males in 2023 (23·4 million [22·2-24·6] vs 19·1 million [17·6-20·5]), the gap in incidence between females and males has substantially declined. Regionally, sub-Saharan Africa had the greatest declines in both incidence (64·3%; 58·0-68·6) and mortality (74·6%; 70·4-78·5) between 2003 and 2023, while central Europe, eastern Europe, and central Asia recorded the highest increases in incidence rates (232·1%; 146·5-299·1) and mortality rates (37·8%; 31·2-45·5) during this period. IPV was associated with an estimated 10·7% (1·6-20·4) of HIV-related deaths among females aged 15 years and older globally in 2023, corresponding to 40 700 (6400-80 600) deaths, with the highest population attributable fractions observed in Oceania (17·4%; 2·8-33·1), central sub-Saharan Africa (14·2%; 2·1-29·4), and eastern sub-Saharan Africa (13·2%; 2·0-25·3). Forecasts indicate that funding reductions could decrease ART coverage by 8·1% globally between 2025 and 2030, resulting in approximately 1·6 million new HIV infections among females and 1·3 million new HIV infections among males, alongside 790 600 and 670 600 HIV-related deaths, respectively. These impacts are primarily concentrated in sub-Saharan Africa. INTERPRETATION: Despite two decades of substantial progress, the global HIV response remains highly sensitive to gendered social determinants and funding stability. The potential contribution of IPV to HIV-related mortality among women underscores the need for integrated interventions that address violence prevention and post-violence care alongside HIV treatment. The projected effects of funding cuts-millions of additional infections and deaths-highlight the fragility of the gains achieved and the urgent need to protect HIV financing. Achieving and sustaining the UNAIDS 2030 targets will require renewed investment, gender-responsive programming, and resilient health systems capable of providing equitable access to care. FUNDING: Gates Foundation and the US National Institute of Allergy and Infectious Diseases. 2026-09-30T00:00:00Z http://hdl.handle.net/10453/196020 Title: Global, regional, and national burden of road injuries 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023 Authors: GBD 2023 Road Injuries Collaborators,; Sun, J Abstract: Background Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 UN General Assembly’s proclamation of the Second Decade of Action for Road Safety (2021–30), targeting a 50% reduction in road traffic deaths and serious injuries by 2030. The aim of this study is to provide estimates to monitor progress and identify intervention gaps. Methods As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool Disease Modelling-Meta-Regression version 2.1 and cause-specific mortality with the Cause of Death Ensemble model, both incorporating location-specific covariates to support interpolation. Years of life lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics were calculated with 95% uncertainty intervals (UIs). Findings In 2023, there were 50·9 million (95% UI 46·1–56·1) road injury incident cases, 1·34 million (1·04–1·58) deaths, and 75·3 million (59·8–89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10–39 years. Between 1990 and 2023, age-standardised incidence decreased by 38·3% (95% UI 36·9–39·7) and mortality decreased by 32·3% (6·1–49·0), but progress varied widely by World Bank income group. Mortality in low-income countries (43·8 [95% UI 31·7–56·0] deaths per 100 000 population) was approximately six times higher than in high-income countries (7·5 [7·1–7·9] deaths per 100 000), despite the high-income countries showing the highest age-standardised incidence rates (858·1 [95% UI 781·9–947·1] cases per 100 000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the USA, saw increases. More severe injuries tended to occur in low-income and middle-income countries. Interpretation Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post-crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential. 2026-07-20T00:00:00Z