Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023
- PMID: 41092926
- DOI: 10.1016/S0140-6736(25)01637-X
Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023
Abstract
Background: For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions.
Methods: The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010-23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution.
Findings: Total numbers of global DALYs grew 6·1% (95% UI 4·0-8·1), from 2·64 billion (2·46-2·86) in 2010 to 2·80 billion (2·57-3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0-14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31-1·61) global DALYs in 2010, increasing to 1·80 billion (1·63-2·03) in 2023, alongside a concurrent 4·1% (1·9-6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176-209] DALYs), stroke (157 million [141-172]), and diabetes (90·2 million [75·2-107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0-107·5]), depressive disorders (26·3% [11·6-42·9]), and diabetes (14·9% [7·5-25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837-917) in 2010 to 681 million (642-736) in 2023, and a 25·8% (22·6-28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7-61·0) for diarrhoeal diseases, 42·9% (38·0-48·0) for HIV/AIDS, and 42·2% (23·6-56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6-22·0) and 24·8% (7·4-36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7-19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18-1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation-with high SBP accounting for 8·4% (6·9-10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories-behavioural, metabolic, and environmental and occupational-risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8-37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0-11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023-eg, declining by 54·4% (38·7-65·3) for unsafe sanitation, 50·5% (33·3-63·1) for unsafe water source, and 45·2% (25·6-72·0) for no access to handwashing facility, and by 44·9% (37·3-53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [-2·7 to 15·6]; non-significant).
Interpretation: Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors-eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG-including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic-the complex interaction of multiple health risks, social determinants, and systemic challenges-will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity.
Funding: Gates Foundation and Bloomberg Philanthropies.
Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of interests D Abramov reports payment or honoraria for speakers bureaus from Bayer and AstraZeneca; participation on an Advisory Board with BridgeBio; receipt of equipment, materials, drugs, medical writing, gifts, or other services from Bayer in the form of medical writing assistance; all outside the submitted work. D Adzrago reports support for the present manuscript from the Intramural Research Program of the National Institutes of Health (NIH), and support for attending meetings and/or travel from the Intramural Research Program of the National Institutes of Health (NIH) outside the submitted work. The contributions of the NIH author(s) were made as part of their official duties as NIH federal employees, are in compliance with agency policy requirements, and are considered Works of the United States Government. However, the findings and conclusions presented in this paper are those of the author(s) and do not necessarily reflect the views of the NIH or the US Department of Health and Human Services. 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C Agostinis Sobrinho reports grants or contracts from Fundação para a Ciência e Tecnologia (FCT) via grant CEECINST/00093/2021/CP2815/CT0001, outside the submitted work. A Amin reports the following patents pending: US20200253891A1; Method of Liver Cancer Treatment with Safranal-Based Formulations, US20200254049A1; Combination Therapy for Cancer, US20200253890A1; Suppression and Inhibition of CDC25B with Safranal-Based Formulations; all outside the submitted work. R Ancuceanu reports consulting fees from AbbVie and Merck Romania; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie, Laropharm, Reckitt, Merck Romania, and MagnaPharm; support for attending meetings and/or travel from Merck Romania and Reckitt; all outside the submitted work. 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Neither the European Union nor the granting authority can be held responsible for them), and from National Research, Development and Innovation Office in Hungary (RRF- 2.3.1-21-2022-00006, Data-Driven Health Division of National Laboratory for Health Security. J J Jozwiak reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Adamed, Amgen, Boehringer Ingelheim, Servier, Novo Nordisk; all outside the submitted work. M K Kashyap reports grants or contracts from Indian Council of Medical Research (ICMR), New Delhi - Grant # 5/13/55/2020/NCD-III; patents planned, issued or pending: 202311003940 (Indian Patent-Pending), 202311058515 (Indian Patent-Pending); all outside the submitted work. J H Kempen reports salary support via institution for the present manuscript from Sight for Souls and Mass Eye and Ear Global Surgery Program; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with Sight for Souls (a US 501c3 charity) as Board President; all outside the submitted work. M Kivimäki reports grants or contracts paid to their university from the Wellcome Trust (221854/Z/20/Z), Medical Research Council (MR/Y014154/1), and Research Council of Finland (350426), outside the submitted work. J M Kocarnik reports support for the present manuscript from Institute for Health Metrics and Evaluation as an employee, the Gates Foundation for funding to his institution, and American Lebanese Syrian Associated Charities for funding to his institution. 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M-C Li reports grants or contracts from the National Science and Technology Council, Taiwan (NSTC 113-2314-B-003-002) and the “Higher Education Sprout Project” of National Taiwan Normal University.; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with Journal of the American Heart Association as Technical Editor; all outside the submitted work. W-Z Li reports support for the present manuscript from the National Natural Science Foundation of China (82303338) and the Grant of State Key Laboratory of Respiratory Disease (SKLRD-Z- 202401). D Lindholm reports stock or stock options in AstraZeneca during time of employment (>2·5 years ago); other financial or non-financial interests with AstraZeneca as a former employee (>2·5 years ago); all outside the submitted work. H Liu reports other financial or non-financial interests as a mentor of the National Medical Research Association (NMRA, UK), a member of British Society for Cardiovascular Research (BSCR, UK), and a member of Cardiovascular Analytics Group (CVAG, HKSAR of China); all are non-profit academic associations; all outside the submitted work. J Liu reports support for the present manuscript from the National Natural Science Foundation (72474005) and Beijing Natural Science Foundation (L222027); royalties or licenses from the National Natural Science Foundation (72474005) and Beijing Natural Science Foundation (L222027); all outside the submitted work. V Lohner reports support for the present manuscript from Marga and Walter Boll Foundation, Kerpen, Germany. S Lorkowski reports grants or contracts paid to their institution from dsm-firmenich (formerly DSM Nutritional Products); consulting fees from Danone, Novartis Pharma, and Swedish Orphan Biovitrum (SOBI); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AMARIN Germany, Amedes Holding, AMGEN, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Janssen-Cilag, Lilly Deutschland, Novartis Pharma, Novo Nordisk Pharma, Roche Pharma, Sanofi-Aventis, Swedish Orphan Biovitrum (SOBI), SYNLAB Holding Deutschland; support for attending meetings and/or travel from AMGEN; participation on a Data Safety Monitoring Board or Advisory Board with AMGEN, Daiichi Sankyo Deutschland, Novartis Pharma, Sanofi-Aventis; all outside the submitted work. K S-K Ma reports grants or contracts from the International Team for Implantology, outside the submitted work. H R Marateb reports grants or contracts from Universitat Politècnica de Catalunya Barcelona Tech – UPC, outside the submitted work. S Masi reports grants or contracts from Servier via personal contracts for consulting activities, lectures, presentations, manuscript writing and educational events, Tuscany Region via grants for research projects in the field of arterial hypertension and management of SARS-CoV2 infection, and Italian Ministry of University and Research via grants for research projects in the field of heart failure; consulting fees from Servier; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Servier; support for attending meetings and/or travel from Servier; participation on a Data Safety Monitoring Board or Advisory Board with Servier; all outside the submitted work. R J Maude reports support for the present manuscript from Wellcome Trust. This research was supported in part by Wellcome Trust [Grant number 220211] as it provides core funding for Mahidol Oxford Tropical Medicine Research and contributes to his salary. He is required by Wellcome to acknowledge this grant in all publications. S A Meo reports grants or contracts from Ongoing Research Funding Program (ORF-2025-47), King Saud University, Riyadh, Saudi Arabia, outside the submitted work. T R Miller reports grants or contracts from AB InBev Foundation, National Institute of Mental Health (USA), Santa Clara County Public Health Department (California); payment for expert testimony from lawyers representing state & local plaintiffs in opioid litigation; all outside the submitted work. L Monasta 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. C E Moore reports participation on a Data Safety Monitoring Board or Advisory Board with Gwen Knight as Advisory Board member for her MRC grant on AMR, no payment made, with Leonid Chindelevitch as Advisory Board member for his UKRI grant on AMR, no payment made, with Wendy Thompson as Deputy Chair on the advisory board for the Tackling antimicrobial resistance across dentistry in Sub-Saharan Africa, travel claimed for meeting, and with Regional AMR Data Analysis for Advocacy, Response, and Policy (RADAAR) as Member of the Technical Advisory Group (TAG) of the IVI-led and Fleming Fund resourced project RADAAR Phase-2, no payment made; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with Microbiology Society as Co-chair for the Impact and Influence committee and co-lead for the Knocking Out AMR project, travel claimed for meetings; all outside the submitted work. R d S Moreira reports grants or contracts from CNPq (National Council for Scientific and Technological Development) for the CNPq Research Productivity Scholarship (scholarship registration number 316607/2021-5), outside the submitted work. J F Mosser reports support for the present manuscript from the Gates Foundation via grant funding; grants or contracts from Gavi; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Providence Health & Services; support for attending meetings and/or travel from the Gates Foundation; all outside the submitted work. S Nomura reports support for the present manuscript from Ministry of Education, Culture, Sports, Science and Technology of Japan (24H00663) and Precursory Research for Embryonic Science and Technology from the Japan Science and Technology Agency (JPMJPR22R8). B Oancea reports support for the present manuscript from Ministry of Research, Innovation and Digitalization through the Core Program of the National Research, Development and Innovation Plan 2022- 2027, project no. PN 23-02-0101-Contract No. 7N/2023; PNRR/2022/C9/MCID/I8 project 760096. S Onie reports support for the present manuscript from National Health and Medical Research Council, Australia; consulting fees from World Health Organization for the amount of USD$9,000 from November 2023 to date; support for attending meetings and/or travel from Suicide Prevention Australia for travel and attendance fees for annual conference and International Association for Suicide Prevention for conference attendance fees; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with International Association for Suicide Prevention as Vice President and Indonesian Association for Suicide Prevention as President; stock or stock options in Wellspring Indonesia, a local mental health clinic in Indonesia (not majority shareholder); all outside the submitted work. R Ornello reports consulting fees from Teva; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Eli Lilly, Teva, AbbVie, Bayer, Pfizer, Lundbeck, Organon; support for attending meetings and/or travel from Teva and Novartis; participation on an Advisory Board with Eli Lilly and AbbVie; receipt of equipment, materials, drugs, medical writing, gifts or other services from Novartis; all outside the submitted work. A Ortiz reports grants or contracts from Sanofi paid to their institution The Fundación Jiménez Díaz Health Research Institute (IIS-FJD UAM) and as Director of the Catedra Astrazeneca-UAM of chronic kidney disease and electrolytes paid to their institution Universidad Autonoma de Madrid (UAM); 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 and Vifor Fresenius Medical Care Renal Pharma and Spafarma; support for attending meetings and/or travel from Astellas, Astrazeneca, Fresenius Medical Care, Boehringer- Ingelheim, Sanofi-Genzyme, Chiesi, Sobi, and Bayer; 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; leadership or fiduciary roles in other board, society, committee or advocacy group, unpaid, with Council ERA. SOMANE; all outside the submitted work. P K Pal reports grants or contracts paid to their institution from Indian Council of Medical Research (ICMR), Department of Science & Technology (DST)-Science and Engineering Research Board, Department of Biotechnology (DBT), DST-Cognitive Science Research Initiative, Wellcome Trust UK-India Alliance DBT, PACE scheme of BIRAC, Michael J. Fox Foundation, SKAN (Scientific Knowledge for Ageing and Neurological ailments)-Research Trust; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the International Parkinson and Movement Disorder Society, and Movement Disorder Societies of Korea, Taiwan and Bangladesh, Japanese Society of Neurology, Teva Pharmaceutical Industries and Elsevier Inc (payment of one-thirds of the honorarium to their institute); support for attending meetings and/or travel from the National Institute of Mental Health and Neurosciences (NIMHANS), International Parkinson and Movement Disorder Society, and Movement Disorder Societies of Korea, Taiwan and Bangladesh, Japanese Society of Neurology and Asian Oceanian Congress of Neurology; leadership or fiduciary roles in other board, society, committee or advocacy group with Indian Academy of Neurology as Past President, Asian and Oceanian subsection of International Parkinson and Movement Disorder Society (MDS-AOS) as Past Secretary, Annals of Movement Disorders as Past Editor-in-Chief, the Parkinson Society of Karnataka as President, Infection Related Movement Disorders Study Group of MDS as Chair, Rare Movement Disorders Study Group of International Parkinson and Movement Disorder Society (IPMDS) as a Member, Education Committee of IAPRD as a Member, Rating Scales Education and Training Program Committee of IPMDS as a Member, Neurophysiology Study Group of IPMDS as a Member, Movement Disorders in Asia Study Group as a Member, Post-Stroke Movement Disorders as a Member, Ataxia Study Group of IPMDS as a Member, Ataxia Global Initiative as a Member, Movement Disorders Society of India as President, and the Education Committee of International Parkinson and Movement Disorder Society (IPMDS) as Chair—all unpaid posts except Annual Leadership stipend for 2023–2025, of which one-thirds to be paid to their institute; all outside the submitted work. R F Palma-Alvarez reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Angelini, Casen Recordati, Lundbeck, Neuraxpharm, Rubió, Servier, and Takeda; support for attending meetings and/or travel from Angelini, Italfarmaco, Advanz Pharma, Takeda, and Lundbeck; all outside the submitted work. S K Panda reports support for the present manuscript from Siksha ‘O’ Anusandhan (Deemed to be University) via a salary; grants or contracts from File no. 17-59/2023-24/CCRH/Tech./Coll./ICMR- Diabetes/960] as co-investigator; all outside the submitted work. G D Panos reports support for attending meetings and/or travel (expenses covered without receiving direct payment) from Bayer Greece and Roche Hellas; all outside the submitted work. R Passera reports participation on a Data Safety Monitoring Board or Advisory Board with 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), unpaid; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with the EBMT Statistical Committee, European Society for Blood and Marrow Transplantation, Paris (France) as a member, and the IRB/IEC Comitato Etico AO SS. Antonio e Biagio Alessandria-ASL AL-VC (Italy) as a past Member (2020–2023); all outside the submitted work. A E Peden reports support for the present manuscript from the [Australian] National Health and Medical Research Council (Grant Number: APP2009306). V C F Pepito reports grants or contracts from Sanofi Consumer Healthcare to conduct studies on self-care in the Philippines, and Zuellig Family Foundation for writing manuscripts on health systems strengthening; all outside the submitted work. M A Piradov reports leadership or fiduciary roles in other board, society, committee, or advocacy group, paid or unpaid, with the Journal Annals of Clinical and Experimental Neurology as Editor-in-Chief, outside the submitted work. C D Pond reports grants or contracts paid to their university from Medical Research Futures Fund Australian Government (11 grants) and Department of Health and Ageing (1 grant); consulting fees from HNECC Primary Health Network for consulting on vertical integration project, Melbourne University for consulting on biomarkers project, Brain Health Collective for consulting on dementia, and Royal Australian College of General Practitioners for chairing research committee and related activities; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Dementia Training Australia and Melbourne University; support for attending meetings and/or travel from Royal Australian College of General Practitioners for travel related to role as chair of the Research Committee; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with Research Foundation Board, RACGP as a Member; all outside the submitted work. S Rege reports leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Medication Adherence and Persistence (MAP) Special Interest Group (SIG) as Operational Lead, Editorial Board of Pharmacoepidemiology section within Frontiers in Pharmacology as Review Editor, PLOS ONE Editorial Board as Academic Editor, and Pain Management as Editorial Board Member; all 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. Y L Samodra reports grants or contracts from NSTC – Institute of Epidemiology and Preventive Medicine, NTU, Taiwan for a post-doctoral fellow contract; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with Benang Merah Research Center, Indonesia as Co-Founder; other financial or non-financial interests with Jago Beasiswa (idebeasiswa.com) as a scholarship mentor; all outside the submitted work. V Sharma reports other financial or non-financial interests with DFSS (MHA)‘s research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University, Chandigarh, India, outside the submitted work. J I Shin reports other financial or non-financial interests with Lee Youn Jae fellowship (JIS), outside the submitted work. V Shivarov reports patents planned, issued or pending with the Bulgarian Patent Office; other financial or non-financial interests with ICON plc in the form of a salary; all outside the submitted work. D D Silva reports grants or contracts from E2S|P.Porto, Porto, Portugal for contract as Adjunct Professor and CISA@LAQV|REQUIMTE for financial support as Integrated Researcher; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Faculty of Medicine of University of Porto, Portugal and Faculty of Pharmacy of University of Porto, Portugal; support for attending meetings and/or travel from E2S|P.Porto, Porto, Portugal and Erasmus+ Mobility; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with the Portuguese Association of Forensic Sciences (APCF) as Directory Board Member; all outside the submitted work. J P Silva reports support for the present manuscript from Portuguese Foundation for Science and Technology for payment of a salary (contract with reference 2021.01789.CEECIND/CP1662/CT0014). L M L R Silva reports grants or contracts from SPRINT, Sport Physical Activity and Health Research e Innovation Center, Polytechnic of Guarda, 6300-559 6 Guarda, Portugal; and collaborate with RISE - UBI, Health Sciences Research Centre, University of Beira Interior, 6201-506 Covilhã, Portugal; all outside the submitted work. J A 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, FocusForward, Navigant Consulting, Spherix, MedIQ, Jupiter Life Science, UBM LLC, Trio Health, Medscape, WebMD, 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 OMERACT, an international organization that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, as past steering committee member to attend their meeting every 2 years; participation on a Data Safety Monitoring Board or Advisory Board with FDA Arthritis Advisory Committee (unpaid); leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as a past steering committee member of the OMERACT; 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; all outside the submitted work. S T Skou reports grants or contracts from European Union's Horizon 2020 research innovation program (payment to the hospital, grant agreement No 945377) and Region Zealand (payment to the hospital, program grant from Region Zealand (Exercise First)); royalties or licenses from Munksgaard for book chapters and TrustMe-Ed for online lecture; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Nestlé Health Science for presentation at webinar on osteoarthritis; other financial or non-financial interests as co-founder of GLA:D, ® a not-for profit initiative hosted at University of Southern Denmark aimed at implementing clinical guidelines for osteoarthritis in clinical practice; all outside the submitted work. J D Stanaway reports support for the present manuscript from Gates Foundation via grants to institution; grants or contracts paid to institution from Open Philanthropy and Novo Nordisk Foundation, outside the submitted work. D J Stein reports consultancy honoraria from Discovery Vitality, Kanna, L’Oreal, Lundbeck, Orion, Servier, Seaport Therapeutics, Takeda, and Wellcome, outside the submitted work. J Sundström reports direct or indirect stock ownership in companies (Anagram kommunikation AB, Sence Research AB, Symptoms Europe AB, MinForskning AB) providing services to companies and authorities in the health sector including Amgen, AstraZeneca, Bayer, Boehringer, Eli Lilly, Gilead, GSK, Göteborg University, Itrim, Ipsen, Janssen, Karolinska Institutet, LIF, Linköping University, Novo Nordisk, Parexel, Pfizer, Region Stockholm, Region Uppsala, Sanofi, STRAMA, Takeda, TLV, Uppsala University, Vifor Pharma, WeMind; all outside the submitted work. R Tabarés-Seisdedos reports grants or contracts from Valencian Regional Government's Ministry of Education (PROMETEO/CIPROM/2022/58) and 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; all outside the submitted work. J H V Ticoalu reports leadership or fiduciary roles in other board, society, committee, or advocacy group, paid or unpaid, with Benang Merah Research Center, Indonesia as Co-Founder; all outside the submitted work. D Trico reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca, Eli Lilly, and Novo Nordisk; patents planned, issued or pending with AstraZeneca; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with EASD Early Career Academy and EASD Committee on Clinical Affairs; receipt of equipment, materials, drugs, medical writing, gifts or other services from Abbott and PharmaNutra; all outside the submitted work. S J Tromans reports grants or contracts paid to University of Leicester, their institution, as part of the 2023/4 Adult Psychiatric Morbidity Survey team, collecting epidemiological data on community-based adults living in England (a contracted study from NHS Digital, via the Department of Health and Social Care. Contributions on chapters of the 2023/4 Adult Psychiatric Morbidity Survey report), as 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 autistic people, as lead on a study from the National Institute for Health and Care Research related to reviewing a national training programme for health and social care professionals relating to learning disability and autism, and as co-applicant on study funded by the National Institute for Health and Care Research related to Identification, recording, and reasonable adjustments for people with a learning disability and autistic people in NHS electronic clinical record systems; support for attending meetings and/or travel from the Royal College of Psychiatrists for conference events due to their academic secretary role in the faculty of the Psychiatry of Intellectual Disability, and as event organizer and/or speaker; 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 Disability, Advances in Autism, BMC Psychiatry, and BJPsych Open, and as Editor of Psychiatry of Intellectual Disability Across Cultures (Oxford University Press) for which they received royalties; outside the submitted work. E Upadhyay reports patents planned, issued or pending for A system and method of reusable filters for anti-pollution mask (Published); a system and method for electricity generation through crop stubble by using microbial fuel cells (Published); A system for disposed personal protection equipment (PPE) into biofuel through pyrolysis and method (Published); A novel herbal pharmaceutical aid for formulation of gel and method thereof (Published); Herbal drug formulation for treating lung tissue degenerated by particulate matter exposure (Published); a method to transform cow dung into the wall paint by using natural materials and composition thereof (Filed); Biodegradable packaging composition and method of preparation thereof (Filed); Eco-friendly bio-shoe polish from banana and turmeric (Filed); Honey-based polyherbal syrup composition to treat air pollution-induced inflammation and preparation method thereof (Filed); Process for preparing a caffeine free, antioxidant and nutrient rich beverage (Filed); leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with Meteorological Society, Jaipur (India) as Executive Council Member, Indian Chapter and DSTPURSE Program as Member Secretary; all outside the submitted work. E Vounzoulaki reports grants or contracts from a National Institute for Health and Care Research (NIHR)(UK) Development and Skills Enhancement (DSE) Award until July 2026, outside the submitted work. P Willeit reports consulting fees from Novartis Pharmaceuticals, outside the submitted work. Y Yasufuku reports grants or contracts from Shionogi & Co., Ltd., paid from the joint research fund provided by this pharmaceutical company to The University of Osaka, outside the submitted work. S Zadey reports writing honoraria from Think Global Health and Hindu; leadership or fiduciary roles in other board, society, committee or advocacy group, paid or unpaid, with Association for Socially Applicable Research as Board Member, Lancet Citizens’ Commission on Reimagining India's Health System as Fellow, G4 Alliance Asia Working Group as Chair, Blood DESERT Coalition as Fellow, and Nivarana as Advisory Board Member; all outside the submitted work. J Zhao reports support for the present manuscript from Fundamental Research Funds for the Central Universities (2024BSSXM20). M Zielińska reports other financial or non-financial interests with Alexion, AstraZeneca Rare Disease as an employee, outside the submitted work. L J Zühlke reports grants or contracts from the Division of Research Capacity Development, Foreign Commonwealth and Development Office, UK, National Research Foundation of South Africa, South African Medical Research Council, (grant number Mid-Career Scientist Program, MR/S005242/1), and as Member of RHD Vaccine Advisory Committee of the LeDucq Foundation, outside the submitted work.
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