Characterising acute and chronic care needs: insights from the Global Burden of Disease Study 2019

Abstract

Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global Burden of Diseases Study 2019 were classified into acute or chronic care categories. Data were analysed by age, sex, and socio-demographic index, presenting total numbers and contributions to burden metrics such as Disability-Adjusted Life Years (DALYs), Years Lived with Disability (YLD), and Years of Life Lost (YLL). Approximately 68% of DALYs were attributed to chronic care, while 27% were due to acute care. Chronic care needs increased with age, representing 86% of YLDs and 71% of YLLs, and accounting for 93% of YLDs from sequelae. These findings highlight that chronic care needs far exceed acute care needs globally, necessitating health systems to adapt accordingly.

Chronic care manages long-term, progressive conditions, while acute care handles short-term ones. Here, authors show chronic conditions account for most of the global health burden, with 68% of DALYs and 93% of YLDs attributed to chronic care needs.

Introduction

The provision of healthcare services involves addressing a wide range of medical needs, each requiring specific attention and resources. Among these needs, two distinct categories stand out: chronic care and acute care¹. Chronic care focuses on the management and long-term treatment of medical conditions that are persistent, progressive despite treatment, and typically incurable. In contrast, acute care involves conditions that have a short, relatively severe course, and potentially curable or reversible^2–6. Some chronic conditions, such as HIV/AIDS or Tuberculosis (TB), have an infectious origin, while others, like cardiovascular diseases, cancer and type 2 diabetes, are classified as non-communicable diseases (NCDs). Globally, these three NCDs account for around 50% of all deaths in 2016⁷. In the United States of America (USA), it is estimated that 100 million people have at least one chronic disease, and managing these diseases accounted for 75% of national health expenditure⁸. In Tanzania, Setel et al.⁵ undertook a reclassification of the traditional categorization of diseases, namely communicable diseases, NCDs, and injuries, into acute or chronic groups. This reclassification aimed to align with the specific care needs associated with each condition, and found that 86% of disability-adjusted life years (DALYs) could be attributed to chronic diseases. In addition, acute diseases and injuries can have non-fatal health outcomes, known as sequelae, and these must also be considered^9,10.

With the increase in the prevalence of NCDs¹¹ and advancements in medical treatments that transform communicable diseases like HIV/AIDS into chronic conditions¹², health systems need to integrate various factors to effectively plan, deliver, and sustain long-term healthcare. This includes primary, secondary and tertiary prevention. The management of chronic diseases poses a significant challenge for health systems worldwide¹³, spanning all the different World Health Organization (WHO)’s health system building blocks, including health policies, financing, delivery of care, access to medicines, leadership and governance, information management, and quality and safety^13,14. There have been numerous calls, including from the WHO, for a shift in health systems from reactive acute care responses to proactive and preventive chronic care^13,15–17.

The distinction between acute and chronic care in healthcare is crucial, as previously reported by the WHO Universal Health Coverage (UHC) compendium and the Disease Control Priorities Network (DCP-3). UHC aims to ensure that all individuals have access to essential healthcare services without encountering financial hardships, emphasizing equitable access to both acute and chronic care¹⁸. DCP-3, on the other hand, provides a comprehensive understanding of disease burdens and interventions, shedding light on effective strategies for addressing chronic conditions and their associated care needs within healthcare systems¹⁹. DCP-3 also acknowledges that the pursuit of essential UHC will differ across countries based on unique cost structures, epidemiological needs, and national priorities²⁰. Integrating the principles outlined in these frameworks allows for a more holistic approach to healthcare planning and delivery, emphasizing not only the treatment of acute conditions but also the management and prevention of chronic illnesses which, ultimately, has the overarching goal of improving health outcomes and promoting overall well-being. Understanding the dynamics and requirements of both acute and chronic care is therefore vital for creating robust healthcare systems capable of meeting the diverse and evolving needs of populations worldwide.

In this work we aim to characterise the burden of acute and chronic care needs using estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

Results

Diseases and injuries

Global DALYs, YLDs and YLLs attributed to acute and chronic care needs

Globally, the leading cause of DALYs was ischemic heart disease (chronic care) followed by lower respiratory infections (acute care). Six out of the ten top leading causes of DALYs were related to chronic care needs (Supplementary Figs. 1 and 2). Only around 27% of all-cause, all-age DALYs were attributable to conditions that required acute care, while around 68% were attributed to conditions that required chronic care. Around 5% of DALYs could not be attributed to acute or chronic needs (Fig. 1b and Supplementary Fig 1). Globally, 7% and 38% of YLDs and YLLs, respectively, were attributed to conditions requiring acute care across all age groups, whereas corresponding figures for conditions requiring chronic care were 86%, and 59%, respectively (Fig. 1).

Fig. 1. Number and percentage of DALYs, YLDs, and YLLs attributed to acute and chronic care conditions.

Left figures show number and right figures show percentage of global (a, b) disability-adjusted life years (DALYs), (c, d) years lived with disability (YLDs), and (e, f) years of live lost (YLLs) according to the care needs classification (i.e.: acute [green], chronic [blue], and undetermined [yellow]) by age group.

Larger numbers and percentages of DALYs, YLDs, and YLLs were attributable to chronic care needs in people 25 years old and above. In contrast higher DALYs and YLLs attributed to acute care needs were observed in the first five years of life (Fig. 1). As a proportion, YLDs attributed to conditions requiring chronic care tended to be higher than the ones attributed to acute care needs while the contrary is observed for YLLs in people below 25 years old, where conditions requiring acute care needs represented a higher number and proportion of YLLs (Fig. 1d and 1f).

DALYs, YLDs and YLLs by location

When assessing metrics by country, a larger proportion of DALYs was attributed to chronic versus acute conditions across most countries and territories, except for certain countries in Central Africa (details for numbers and percentages of DALYs, YLDs, and YLLs attributed to acute and chronic care needs conditions by country are provided in Supplementary Tables 2 and 3). In some countries in Africa and Asia, DALYs attributed to conditions that required acute care were around or exceeded 50% of the total. Niger had the highest burden attributed to conditions that required acute care (72% of DALYs), and Italy had the lowest burden (6% of DALYs) (Supplementary Table 3).

When assessing the burden of care needs by SDI, a gradient was found in the proportion of DALYs attributed to conditions with acute care needs. Acute care needs were higher in low SDI locations (52%), decreasing (11%) as SDI increased for countries and territories characterized by a high SDI (Fig. 2). When assessing absolute numbers, middle SDI countries and territories had the highest DALYs attributable to chronic care needs (Fig. 2).

Fig. 2. All-age number and percentage of Dalys by socio-demographic Index using the care needs classification.

All-age number and percentage of disability-adjusted life years (DALYs) for 293 conditions classified according to their care needs classification (i.e., acute [green], chronic [blue], and undetermined [yellow]) by Socio-Demographic Index (SDI).

A higher burden of DALYs and YLLs of both types of care needs was observed in males when compared to females (Supplementary Fig. 3). In contrast, for YLDs, women showed a slightly higher burden (Supplementary Fig. 4). Of note, larger differences for DALYs and YLLs were observed between males and females for conditions requiring acute care (Supplementary Figs. 3,  5). For example, all-age DALYs and YLLs for men in high-middle SDI countries were almost double of what was found for women (Supplementary Figs. 3 and 5).

Most DALYs and YLDs attributed to chronic care needs increased with age across SDI country categories (Supplementary Figs. 6 and 7). In the age groups under 25 years old, YLLs attributed to conditions requiring acute care were higher than conditions requiring chronic care. This is the opposite for the age groups 25 years of age or older. (Supplementary Fig. 7).

Sequelae

Global YLDs attributed to sequelae requiring acute and chronic care

In 2019, 93.1% of all-cause and all-age YLDs were attributed to sequelae that required chronic care, 6.3% were attributed to sequelae that required acute care, and 0.6% that could not be attributed to acute or chronic care needs (Supplementary Fig. 8). This pattern was found in most countries and territories, with some variation. (Supplementary Table 5).

Globally, the number of YLDs increased with age, being higher in people aged 50-59 years when compared to the other age categories. As age increased, the percentage of YLDs attributed to chronic (versus acute) sequelae also increased, ranging from 56% at 1 to 4 years of age to more than 90% in age groups older than 25 years. (Fig. 3).

Fig. 3. Number and percentage of YLDs for both sexes by age group using the care needs classification for sequelae.

Number (a) and percentage (b) of global years lived with disability (YLDs) according to the care needs classification (i.e.: acute [green], chronic [blue], and undetermined [yellow]) by age group.

The sequelae accounting for the greatest YLDs by acute, chronic and undetermined care needs are shown in Supplementary Figs. 8 and 9. Type 2 diabetes sequelae were associated with the largest number of YLDs, and chronic care needs accounted for 8 out of 10 conditions with disabling sequelae (Supplementary Fig. 9).

YLDs attributed to acute and chronic sequelae by location

The proportion of YLDs attributed to sequelae with chronic care needs ranged from 59% in Liberia, to 98% in the USA and Niue (Supplementary Table 5). When grouping the location by SDI, in low SDI countries and territories, YLDs attributed to sequelae with chronic care needs were slightly lower (80.3%) than the global proportion (93%). In high-SDI countries and territories this proportion was 98% (Fig. 4).

Fig. 4. All-age number and percentage of YLDs by care needs classification and SDI attributed to sequelae.

All-age number and percentage of years lived in disability for 379 sequelae classified by their care needs classification (i.e: acute [green], chronic [blue], and undetermined [yellow]) by Socio-demographic Index (SDI).

When disaggregating by sex, all-age YLDs attributed to sequelae requiring chronic care were slightly higher in women living in low and low-middle SDI countries and in men living in high SDI countries when compared to their counterparts (Supplementary Fig. 10). In contrast, YLDs attributed to acute sequelae were slightly higher in women living in high SDI and in men living in low to middle SDI countries. Also, a higher number of YLDs were observed in older ages independently of SDI (Supplementary Fig. 11).

Discussion

This study aimed to quantify the burden of acute and chronic care for diseases and injuries and sequelae. Worldwide, two-thirds of all-cause, all-age DALYs were attributed to conditions that required chronic care. The proportion of DALYs attributed to chronic care needs was low in early life but increased as age increased. Of the 10 conditions associated with the greatest DALYs across age groups, 6 required chronic care. This burden was also reflected in all-age YLDs and YLLs with 86% and 59% of the overall burden attributable to conditions with chronic care needs, respectively. For both, conditions having acute and chronic care needs, DALYs and YLLs were slightly and consistently higher in men than in women, while YLDs were higher in women. Additionally, there was a socioeconomic gradient, with low SDI countries having the greatest proportion of DALYs and YLLs from acute care conditions and high SDI countries the greatest proportion of DALYs and YLLs from chronic care conditions. Except for the low SDI countries, in the rest of the territories by SDI, the proportion of DALYs from chronic care conditions was above 60%. Eight out of the top 10 sequelae were linked to chronic care needs, with complications related to type 2 diabetes being the leading condition associated with the largest number of YLDs due to sequelae.

The analysis conducted in this study highlights the overwhelming global burden of chronic care needs. While acute care needs still outweigh those for chronic care in Africa, decreases in childhood mortality²¹ and increasing life expectancy will translate to an increase in chronic and degenerative conditions²². Globally, health systems require a “paradigm shift”¹³ theorized by Wagner et al.²³ with their Chronic Care Model, which the WHO further developed into the Innovative Care for Chronic Conditions Framework (ICCCF)¹³. The ICCCF highlights that policy, health system, community and individuals and their carers are all necessary to develop a propitious environment for chronic care management¹³. Different challenges exist at each of these levels, both globally and in low SDI countries. At a policy level, it is argued that one of the prerequisites for addressing chronic care is UHC, ensuring the absence of financial barriers to care²⁴. All SDI groups face different challenges related to chronic diseases due to their cost.²⁵. For countries with low and middle SDI, in the process of implementing UHC, the challenge lies in integrating costly chronic diseases into their UHC packages²⁶. In high SDI countries, given the overwhelming burden of chronic care needs, these represent a threat to UHC due to the cost of these diseases.

At a system level, various elements need to be put in place to ensure the continuity of care across ages as well as disease progression to not only prevent or delay the onset of chronic conditions, but also their sequalae²⁷. The focus on primary health care (PHC) and healthcare delivery structures alone, fails to recognize the complexity of the management of chronic diseases and the multifactorial determinants of health, including household, neighborhood, community, economic, and societal factors. Many health systems, especially at the PHC level, do not have the tools to address this²⁸. The ICCCF highlights the importance of health professionals serving as a links between the health system and the community, which is a key consideration for guaranteeing continuity of chronic care beyond the walls of the formal health system²⁹. This is especially important as the onus of chronic care is on the individual and their caregivers³⁰. Studies have shown the challenges chronic disease management for individuals within the community ranging from financial challenges, individuals feeling like a burden on their families or lacking the understanding to manage their condition³¹. Poorly managed chronic care can itself result in acute and downstream chronic sequelae, highlighting the self-perpetuating cycle that can result from inadequate systems to optimize care. As shown in this study, type 2 diabetes sequalae had the largest number of YLDs, confirming overall challenges in the management of such a condition both in low- and high-income settings resulting in poor control and resulting in complications and increased mortality^32,33.

Amenable mortality, which measures deaths that can be avoided with timely and effective healthcare, can provide an insight into how access to and quality healthcare varies worldwide and over time³⁴. Reports using this metric have shown a worldwide improvement in the quality of health systems³⁵, although it should be mentioned that there is great heterogeneity in death patterns when assessing the healthcare systems across countries, regions, or globally^35,36.

As previously reported, the conventional broad cause classification approach may be limited because it is based on an arbitrary list of conditions that depends on the medical definition used³⁴. Acknowledging that this may vary not only among the definitions used but also among the scenarios assessed, a more overarching approach, like the one used in the present study, classifying all the conditions based on the type of care they require, either acute or chronic⁵, may be more useful when it comes to assessed and plan around the healthcare. The WHO within the ICCCF calls for integration of care. In many contexts such integration has happened for HIV/AIDS³⁷, but is still failing for those with other chronic diseases. The result of integration of care is for the individual to have a continuum of care needs met across ages and conditions³⁸. For health professionals, this integration requires coordination and cooperation with different medical specialties as well as actors outside the formal health system. Finally, for policy makers, it is the recognition of how different policies may impact health. This was especially true during the COVID-19 pandemic, when people with chronic diseases were not only at higher risk of complications from COVID-19 but are also vulnerable to the disruptions in care that were caused by the epidemic and required a range of supportive services from the government^39,40. Beyond strengthening health systems to manage those already with chronic diseases, governments need to also invest in health prevention and promotion activities at a societal level.

On the other hand, certain health conditions, such as ischemic heart disease, stroke, and type 2 diabetes, among others, exhibit both chronic and acute manifestations. While our study primarily aimed to offer a comprehensive overview of chronic and acute care needs over recent decades, many chronic conditions pose intricate challenges due to their acute manifestations that require different health system responses beyond chronic continuous care. Additionally, it must also be considered that people with chronic conditions must also deal with acute presentation conditions⁴¹. Recognizing the urgency associated with managing acute episodes within chronic diseases underscores further critical considerations for health system preparedness for more effective health planning and resource allocation. Understanding the interplay between major chronic diseases and their acute phases or acute infectious events is a crucial direction for future research.

Furthermore, the presence of multimorbidity, where patients experience multiple chronic conditions simultaneously, poses significant challenges for healthcare delivery and patient outcomes. However, GBD data does not allow the assessment of multimorbidity. Addressing multimorbidity requires comprehensive strategies considering patients' complex health needs, which is crucial for guiding efforts to enhance the preparedness of the health system⁴². Our study, despite the current data limitations, intrinsically underscores the importance of considering multimorbidity when evaluating chronic care requirements.

Previous studies have identified and described the overall limitations of the GBD data^11,42,43. In our study and other studies using GBD Study data, we acknowledge a fundamental limitation in calculating YLDs. The current GBD methodology, especially since 2010, utilises a prevalence-based approach for YLD estimations⁹. This approach involves multiplying the prevalence of a sequela by the associated disability weight, without explicitly factoring in disease duration. Consequently, there is a risk of overestimating YLDs, especially for chronic conditions, particularly in settings where high treatment coverage can enable longer lifespans for affected individuals. Additionally, the accuracy of GBD estimates is highly dependent on the quality of the data sources⁴³. Considering the vast scope of the study, covering 204 countries and territories, with numerous diseases, injuries, and sequelae, different locations may exhibit variations in data quality, particularly in resource-poor settings⁴⁴. Furthermore, the GBD methodology itself has been subject to discussion due to its complex and evolving nature⁴⁵. However, it is important to note that the GBD continually improves its statistical models and analysis, incorporating data and methodological updates to enhance the accuracy and timeliness of its results¹¹. In this study, a limitation arises from the coding of acute versus chronic care needs for both conditions and sequelae. It is acknowledged that the chronicity of certain conditions may vary in different settings. Nevertheless, the option for "undetermined" was available to address such circumstances, with a relatively small percentage falling into this category (around 4% to 5%).

This study highlights the need for further research in various areas related to the burden of chronic conditions. These areas include examining gender differences in the burden, addressing the training needs of healthcare professionals, understanding the impact on caregivers, assessing the economic consequences for individuals, households, and health systems, implementing person-centered care approaches, evaluating policy environments in the context of Universal Health Coverage (UHC), considering psychological factors and their effects on individuals and families, exploring innovative service delivery models, examining the impact of COVID-19, and assessing how prevention and health promotion efforts can influence morbidity and mortality⁴⁶.

Globally, many healthcare systems have been designed, and are still struggling, to respond to acute conditions. However, they are not adequately organized to address chronic conditions or sequelae. This study provides much needed information to develop national and global policies to address the actual and increasing burden of chronic diseases. Presenting the burden of disease in this way enhances the traditional view of the global burden of disease and sequelae which has been largely focused on single diseases or conditions. This current approach is more suitable for our future health strategy where health services will be managed and delivered in a way making them more integrated and person-centered. Population-based strategies with a multidisciplinary approach for disease prevention and management aggressively pursued and promoted at the national and global level. This is possible through efficient community engagement, identifying structural and systemic determinants of health, and collective sharing and learning across countries. High-quality long-term care for chronic conditions and its sequelae is essential and health systems and societies must embrace this transformation as a priority.

Methods

Overview

The GBD 2019 estimates, among other health metrics, years lived with disability (YLDs), years of life lost (YLLs) and DALYs. All estimates generated and reported are in accordance with the Guidelines for Accurate and Transparent Health Estimates Reporting⁴⁷. For this paper, 297 diseases and injuries, and 379 sequelae were classified according to whether these required chronic or acute care, adapting the approach used by Setel et al.⁵ and is described in Section “Classification of conditions according to their care needs” of this paper.

Data description

The GBD 2019 compiles burden of health metrics from 204 countries and territories that are grouped into 21 regions and seven super-regions^{11,46,48–51}. Here, data are presented by location, which refers to countries and territories as well as to socio-demographic index (SDI, a composite average of income per capita, average educational attainment, and fertility rates in females categorized by low SDI, low-middle SDI, middle SDI, high-middle SDI, and high SDI).

The number of DALYs, YLDs, and YLLs by locations, age and sex categories were extracted using the GHDx (Global Health Data Exchange) tool (http://ghdx.healthdata.org) from the Institute for Health Metrics and Evaluation (IHME). For sequelae, only numbers of YLDs are available by request to IHME. These were requested and obtained by location, age, and sex.

Data were extracted for nine age categories for diseases and injuries (<1 year, 1 to 4, 5 to 9, 10 to 14, 15 to 19, 20 to 24, 25 to 49, 50 to 69, 70+ years), and for 12 age categories for sequelae (1 to 4, 5 to 9, 10 to 14, 15 to 19, 20 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, 45 to 49, 50 to 69, 70+ years), both aggregated and disaggregated by sex.

All visualisations and graphs presented in this study were created using Power BI (version 2.116.921.0), ensuring clarity and accessibility in data representation.

Causes of diseases and injuries

The GBD 2019 list of diseases and injuries has a hierarchical organisation. Level 1 comprises three groups of conditions: communicable, maternal, neonatal, and nutritional diseases (Group A); non-communicable diseases (Group B); and injuries (Group C). These Level 1 aggregates are subdivided at Level 2 into 22 cause groupings, Group A is divided into seven sub-groups, Group B into twelve sub-groups, and Group C, in three. The disaggregation into Levels 3 and 4 contains the finest level of detail for causes captured in GBD 2019. For this study, the complete list of Levels 3 and 4 diseases and injuries (Supplementary Table 1) was extracted and classified based on the given care needs for the specific condition (see Section “Classification of conditions according to their care needs”).

Sequelae

The GBD 2019 Sequelae, defined as the direct consequences of diseases and injuries, do not have a hierarchical organisation. The complete list of sequelae, containing 379 items, were classified based on their care needs (see Section “Classification of conditions according to their care needs”). The full list is included in Supplementary Table 4.

Classification of conditions according to their care needs

For each disease and sequelae, two physicians (BA and JC) ascertained if the care needs of the condition were acute or chronic, independently. To aid in this classification, the approach used by Setel et al.⁵ was adapted and the definitions of the United States National Library of Medicine thesaurus Medical Subject Headings (MeSH) were used⁶. The definition used for conditions that require chronic care was: “Condition which has one or more of the following characteristics: they are permanent, leave residual disability, are caused by non-reversible pathological alteration, require special training of the patient for rehabilitation, or may be expected to require a long period of supervision, observation, or care. Additionally, the condition is either incurable or requires more than a month of appropriate treatment”^5,6. For conditions requiring acute care, the definition used was: “Condition having a short and relatively severe course. Potentially curable within a month of current appropriate treatment”.^5,6 The definitions were extended to include sequelae as well. Those, despite their association with chronic diseases, have been classified independently based on their unique care needs. This ensures a distinct classification, irrespective of their linkage to chronic conditions.

Any discrepancies or inconsistencies were thoroughly examined and resolved through discussions, involving a third party (CA-R), to reach a consensus. Additionally, the classifications made were reviewed and confirmed by colleagues at IHME, providing further validation to the decisions.

In line with Setel et al.⁵, injuries causing YLDs were classified as having chronic care needs, while injuries causing YLLs were classified as having acute care needs. This is the reason Injuries are classified as Chronic / Acute in Supplementary Table 1. The number of YLDs and YLLs was extracted for each condition and added to obtain the number of DALYs. Some conditions fall into the definition of both acute and chronic, depending on different factors. In this case the conditions were classified as undetermined, then fitted separate. (Supplementary Table 1 for diseases and injuries, and Supplementary Table 4, for sequelae).

Reporting summary

Further information on research design is available in Nature Portfolio Reporting Summary linked to this article.

Author contributions

Please see the Supplementary Information for more detailed information about individual author contributions to the research, divided into the following categories: managing the overall research enterprise; writing the first draft of the manuscript; primary responsibility for applying analytical methods to produce estimates; primary responsibility for seeking, cataloging, extracting, or cleaning data; designing or coding figures and tables; providing data or critical feedback on data sources; developing methods or computational machinery; providing critical feedback on methods or results; drafting the manuscript or revising it critically for important intellectual content; and managing the estimation or publications process.

Peer review

Peer review information

Nature Communications thanks Paolo (A) Cortesi, and Kjell (A) Johansson for their contribution to the peer review of this work. A peer review file is available.

Data availability

All data can be accessed at:Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2020. Available from https://vizhub.healthdata.org/gbd-results/. If any required data, such as specific categorised sequelae data, are not available, requests can be sent to engage@healthdata.org, and they will respond in the coming days to assist with the request.

Competing interests

A M Abdel-Azeem reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Arab Society for Fungal Conservation as the President, the International Mycological Association on the Executive Committee, and the African Mycological Association as the President; outside the submitted work. M R M Abrigo reports stock or stock options from Diliman Doctors’ Hospital; outside the submitted work. G Addolorato reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Study of Alcohol-related Liver Disease in Europe, as a committee member; outside the submitted work. S Afzal reports support for the present manuscript from King Edward Medical University for study materials, library facilities, internet, journals and e-books and other learning; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from King Edward Medical University and collaborative partners including the University of Johns Hopkins, University of California, University of Massachusetts, and University of Lahore; support for attending meetings and/or travel from King Edward Medical University; participation on a Data Safety Monitoring Board or Advisory Board with National Bioethics Committee Pakistan, King Edward Medical University Institutional Ethical Review Board, Ethical Review Board Fatima Jinnah Medical University and Sir Ganga Ram Hospital; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Pakistan Association of Medical Editors, Fellow of Faculty of Public Health Royal Colleges UK (FFPH), Society of Prevention, Advocacy and Research, King Edward Medical University (SPARK), member of Pakistan Society of Infectious Diseases; and other support from King Edward Medical University. J Alonso reports support for the present manuscript from Departament de Recerca I Universitats of the Generalitat de Catalunya (AGAUR 2021 SGR 00624). H Amare reports stock or stock options from GSK; outside the submitted work. R Ancuceanu reports consulting fees from Abbvie; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbvie, Sandoz, B. Braun, and Laropharm; outside the submitted work. M H Antwi reports support for the present manuscript from the Bill and Melinda Gates Foundation. The funders of the study had no role in study design; collection, analysis and interpretation of data, or writing of the report. H Ariffin reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Amgen; outside the submitted work. J Ärnlöv reports payment or honoraria for lectures from AstraZeneca and Novartis; participation on a Data Safety Monitoring Board or Advisory Board with AstraZeneca, Boerhinger Ingelheim, and Astella; outside the submitted work. A A Asadi-Pooya reports royalties or licenses from Oxford University Press; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Cobel Daru; outside the submitted work. T Astell-Burt reports grants or contracts from ARC Future Fellowship, Medical Research Futures Fund, and the National Health and Medical Research Council; outside the submitted work. P Atorkey reports support for the present manuscript from the Australian College of Applied Professions and Hunter Medical Research Institute. O O Ayinde reports grants or contracts from a research grant from Medical Research Council; support for attending meetings and/or travel from the British Medical Journal Global Health Grant; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the ASIDO Foundation as the Director of Policy and Research; outside the submitted work. T W BÃrnighausen reports grants or contracts 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-Kroner-Fresenius-Foundation, Wellcome Trust, Bill and Melinda Gates Foundation, KfW, UNAIDS, WHO; consulting fees for KfW on the OSCAR initiative in Viet Nam; participation on a Data Safety Monitoring Board or Advisory Board with the NIH-funded study “Health Options”, German National Committee on the “Future of Public Health Research and Education”, EDCTP Evaluation, UNAIDS Evaluation Expert Advisory Committee, National Institute of Health Study section member on Population and Publica Health Approaches to HIV/AIDS (PPAH), 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)”, University of Pennsylvania (UPenn) Population Aging Researching Center (PARC); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Global Health Hub Germany as a Co-chair; outside the submitted work. J L Baker reports grants or contracts from Novo Nordisk Foundation, World Cancer Research Fund, and the Independent Research Council Denmark; consulting fees from Novo Nordisk Denmark; support for attending meetings and/or travel from the European Association for the Study of Obesity; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the European Association for the Study of Obesity; outside the submitted work. O C Baltatu reports support for the present manuscript from the National Council for Scientific and Technological Development (CNPq, 304224/2022-7), and Anima Institute; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Technology Park São José dos Campos – Center for Innovation in Health Technologies (CITS) and Afya- UNINOVAFAPI. S L Barker-Collo payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Auckland University of Technology; participation on a Data Safety Monitoring Board or Advisory Board with Auckland University of Technology’s National Institute of Stroke and Applied Neurorehabilitation; outside the submitted work. B T Baune reports royalties or licenses from Elsevier, Springer; consulting fees from LivaNova, Janssen, Boehringer-Ingelheim, Otsuka/Lundbeck; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from LivaNova, Janssen, Boehringer-Ingelheim, Otsuka/Lundbeck; support for attending meetings and/or travel from LivaNova, Janssen, Otsuka/Lundbeck; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Network of Pharmacogenomics and Transcriptomics at the ECNP as a Chair; outside the submitted work. M L Bell reports support for the present manuscript from the National Institutes of Health (NIH); grants or contracts from US EPA, National Institutes of Health (NIH), High Tide Foundation, Health Effects Institute, Yale Women Faculty Forum, Environmental Defense Fund, Wellcome Trust Foundation, Yale Climate Change and Health Center, Robert Wood Johnson Foundation; consulting fees from Clinique; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Colorado School of Public Health, Duke University, University of Texas, Data4Justice, Korea University, Organization of Teratology Information Specialist, University of Pennsylvania, Boston University, IOP Publishing, National Institutes of Health (NIH), Health Canada, PAC-10, UKRI, AXA Research Fund Fellowship, Harvard University, and University of Montana; support for attending meetings and/or travel from Colorado School of Public Health, University of Texas, Duke University, Boston University, University of Pennsylvania, and Harvard University; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Fifth National Climate Assessment, Lancet Countdown, US EPA Clean Air Scientific Advisory Committee (CASAC), Johns Hopkins EHE Advisory Board, Harvard University on an external advisory committee for training grant, WHO Global Air Pollution and Health Technical on an advisory group, and National Academies as a panel/committee member. L Belo reports support from Fundação para a Ciência Tecnologia (FCT) project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and project LA/P/0140/2020 of i4HB; outside the submitted work. B Bikbov reports grants or contracts from European Commission and Lombardy Region; support for attending meetings and/or travel from the European Renal Association; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the International Society of Nephrology as a member of the advocacy working group; outside the submitted work. A Biswas reports consulting fees from INTAS Pharmaceuticals, Lupin Limited; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Roche Diagnostics India Private Limited; support for attending meetings and/or travel from Sun Pharmaceuticals; outside the submitted work. G Britton reports grants or contracts from Sistema Nacional de Investigacion (063-2023), Secretaría Nacional de Ciencia, Tecnología e Innovación (FID-228-2022); outside the submitted work. J Brown reports grants or contracts from the National Health and Medical Research Council, Australian Research Council; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from University of Adelaide; outside the submitted work. R Buchbinder reports grants or contracts from the Australian National Health and Medical Research Council (NHMRC), Arthritis Australia, Australian Medical Research Future Fund (MRFF), Cabrini Foundation, HCF Foundation; royalties or licesnse from UpToDate; outside the submitted work. M Carvalho reports support from Fundação para a Ciência Tecnologia (FCT) project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and project LA/P/0140/2020 of i4HB; outside the submitted work. J M Castaldelli-Maia reports grants or contracts from the French National Institute for Cancer, Pfizer, and Sanofi; consulting fees from L’Oreal; outside the submitted work. A L Catapano reports grants or contracts from Sanofi, Eli Lilly, Mylan, Sanofi Regeneron, and Amgen; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Amgen, Astrazeneca, Aegerion, Amryt, Amarin, Daiichi Sankyo, Esperion, Inois Pharmaceutical, Medscape, Kowa, Mylan, Merck, Menarini, Novartis, Peer Voice, Pfizer, Recordati, Regeneron, Sanoz, Sanofi, and The Corpus; outside the submitted work. C R Cederroth reports grants or contracts from GENDER-NET GNP-182; outside the submitted work. H Christensen payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from BMI, Bayer, Boehringer Ingelheim, University of Bern; participation on a Data Safety Monitoring Board or Advisory Board with Bayer and PHRI; outside the submitted work. S W M Christensen reports support for the present manuscript from Leona M. and Harry B. Helmsley Charitable Trust via the Addressing the Challenge and Constraints of Insulin Sources and Supply study. D J Christopher reports grants or contracts from the Department of Biotechnology in India, Translational Health Science and Technology Institute (THSTI), National Institutes of Health (NIH), UK R&I Global Challenges Research Fund via the Institute of Global Innovation, University of Birmingham, UK, German Centre for Infectious Disease Research (DZIF), The Regents of the University of California (UCSF); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Cipla, Zydus, Lupin, Abbot, Astra, Pfizer; support for attending meetings and/or travel from Lupin, Cipla, Zydus; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with CMC, IRB, and the Indian Council of Medical Research; outside the submitted work. J Conde reports grants or contracts from the European Research Council starting grant; patents planned, issued, or pending from functionalized nanoparticles and compositions for cancer treatment and methods, and TRPV2 Antagonists; outside the submitted work. X Dai reports support for the present manuscript from the Institute for Health Metrics and Evaluation (IHME). S Das reports grants or contracts from the Bureau of Intelligence and Research (INR) Department of Science and Technology; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the American Association of Clinical Chemistry as a personalized medicine division member HEA division member, and member of women in global health; outside the submitted work. A K Demetriades payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Stryker, Integra, and Safe Orthopedics; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the European Association of Neurosurgical Societies (EANS) as a board member, the Global Neuro Foundation as a board member, and the AO Spine Knowledge Forum Degenerative Spine conditions as a steering committee member; outside the submitted work. M Derese reports support for the present manuscript from Leona M. and Harry B. Helmsley Charitable Trust via the Addressing the Challenge and Constraints of Insulin Sources and Supply study. D Dias da Silva reports grants or contracts from the Faculty of Pharmacy of University of Porto, Escola Superior de Saúde Instituto Politécnico de Leiria, and Instituto Universitário de Ciências da Saúde (IUCS); consulting fees from Albert Labs, Eurox Pharma; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the Faculty of Pharmacy of University of Porto, Escola Superior de Saúde Instituto Politécnico de Leiria, and Instituto Universitário de Ciências da Saúde (IUCS); support for attending meetings and/or travel from Eurox Pharma; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Portuguese Association of Forensic Sciences (APCF) as a member of the board; receipt of equipment, materials, drugs, medical writing, gifts or other services from Albert Labs and Eurox Pharma; outside the submitted work. H L Esayas reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arba Minch University; outside the submitted work. S Farhang Dehghan reports support for the present manuscript from Leona M. and Harry B. Helmsley Charitable Trust via the Addressing the Challenge and Constraints of Insulin Sources and Supply study. A Faro reports support for the present manuscript from the National Council for Scientific and Technological Development (CNPq, Brazil). X Feng reports grants or contracts from NHMRC Career Development Fellowship, Medical Research Futures Fund, National Health and Medical Research Council (NHMRC); outside the submitted work. I Filip reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Avicenna Medical and Clinical Research Institute; outside the submitted work. D Flood reports grants or contracts from the National Institute of Health (NIH); consulting fees from the World Health Organization (WHO); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Maya Health Alliance as an unpaid staff physician; outside the submitted work. M Freitas reports grants or contracts from CEEC (Individual 2020.04126.CEECIND/CP1596/CT0006) and LAQV/REQUIMTE under the reference LA/P/0008/2020; outside the submitted work. P A Gaal reports support for the present manuscript 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). S Gaihre reports support for the present manuscript from the Institute of Applied Health Sciences (IAHS), School of Medicine, Medical Sciences and Nutrition (SMMSN), University of Aberdeen, UK. L Göbölös reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS 2023) in Busan, Korea; outside the submitted work. N G M Gomes reports grants or contracts from Fundação para a Ciência Tecnologia (FCT); outside the submitted work. B N G Goulart reports stock or stock options in Pfizer and Takeda at NYSE; outside the submitted work. A Guha reports grants or contracts from the American Heart Association-Strategically Focused Research Network Grant in Disparities in Cardio-Oncology (#847740, #863620) and the Department of Defense Prostate Cancer Research Program's Physician Research Award (#HT94252310158); consulting fees from Novartis, Pfizer, and Myovant; outside the submitted work. V K Gupta reports grants or contracts from the National Health and Medical Research Council (NHMRC) of Australia; outside the submitted work. Amr Hassan reports consulting fees from Novartis, Sanofi Genzyme, Biologix, Merck, Hikma Pharma, Janssen, Inspire Pharma, Future Pharma, Elixir Pharma; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Allergan, Merck, Biologix, Janssen, Roche, Sanofi Genzyme, Bayer, Hikma Pharma, Al Andalus, Chemipharm, Lundbeck, Inspire Pharma, Future Pharma and Habib Scientific Office, and Everpharma; support for attending meetings and/or travel from Novartis, Allergan, Merck, Biologix, Janssen, Roche, Sanofi Genzyme, Bayer, Hikma Pharma, Al Andalus, Chemipharm, Inspire Pharma, Habib Scientific Office, and Everpharma; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Indian Health Service (IHS) as a board member; outside the submitted work. I M Ilic reports support for the present manuscript from the Ministry of Education, Science and Technological Development, Republic of Serbia (project 175042, 2011-2023). M D Ilic reports support for the present manuscript from the Ministry of Education, Science and Technological Development, Republic of Serbia (project 451-03-47/2023-01/200111). S M S Islam reports support for the present manuscript from the National Health and Medical Research Council (NHMRC) of Australia and the National Heart Foundation of Australia; grants or contracts from the NHMRC and the National Heart Foundation of Australia; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the ESC Heart Failure Association as a committee member, and the WHO-ITU Global Initiative on AI for Health as a group leader. N E Ismail reports leadership or fiduciary roles in board, society, committee or advocacy groups, unpaid with the Malaysian Academy of Pharmacy as a council member and the Bursar; outside the submitted work. I O Iyamu reports grants or contracts from the Canadian Institute for Health Research and the University of British Columbia (UBC) fellowship; support for attending meetings and/or travel from the University of British Columbia (UBC) Designing for People research cluster; outside the submitted work. M Jakovljevic reports grants or contracts through the Grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. V Jha reports consulting fees from GSK, Boehringer Ingelheim, Travere, Vera, Otsuka, Baxter Healthcare; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Bayer and GSK; participation on a Data Safety Monitoring Board or Advisory Board with Zydus Lifesciences; outside the submitted work. T Joo reports support for the present manuscript from the National Research, Development and Innovation Office in Hungary (RRF- 2.3.1-21-2022-00006, Data-Driven Division of National Laboratory for Health Security). A Joseph reports grants or contracts from American College of Gastroenterology; outside the submitted work. J J Jozwiak payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis and Adamed; outside the submitted work. J H Kempen reports support for the present manuscript from the National Eye Institute, Massachusetts Eye and Ear Global Surgery Program, Sight for Souls, Research to Prevent Blindness; grants or contracts from USAID/American Schools and Hospitals Abroad; participation on a Data Safety Monitoring Board or Advisory Board with Gilead; stock or stock options from Betaliq and Tarsier Pharma. J Khubchandani reports grants or contracts from Teva Pharmaceuticals; outside the submitted work. M Kivimäki reports grants or contracts from Wellcome Trust (221854/Z/20/Z), Medical Research Council (R024227), National Institute on Aging (R01AG062553) and Academy of Finland, Finland (350426); outside the submitted work. P Kolkhir reports consulting fees from ValenzaBio; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis; support for attending meetings and/or travel from Takeda; outside the submitted work. K Krishan reports other non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India; outside the submitted work. B Lacey reports support for the present manuscript from UK Biobank, funded largely by the UK Medical Research Council and Wellcome. T Lallukka reports support for the present manuscript from Academy of Finland (Grant #330527) and Social Insurance Institution of Finland (Grant 29/26/2020); grants or contracts from Finnish Centre for Pensions and The Juho Vainio Foundation. J Lám reports support for the present manuscript from the 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). B Langguth reports grants or contracts from Bayhost, the German Research Foundation, the German Bundesministerium für Bildung und Forschung, Neuromod, the European Union's Horizon 2020 research and innovation programme (European School for Interdisciplinary Tinnitus Research (ESIT), Grant agreement number 722046; Unification of Treatments and Interventions for Tinnitus Patients (UNITI) Grant Agreement Number 848261); royalties or licenses from Springer; consulting fees from Neuromod, Schwabe, Rovi; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medical Tribune, Schwabe, Rovi; payment for expert testimony; participation on a Data Safety Monitoring Board or Advisory Board with Neuromond and Rovi; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Neuromod, Retex, Morpheus, DGHP, HSN; stock or stock options in Sea Pharma; outside the submitted work. M B Laurens reports grants or contracts from UM1AI148689 Infectious Diseases Clinical Research Consortium 7/1/21-11/30/23: Exposure-response evaluation of IV artesunate in children with severe malaria; DMID 19-0007 DON in Pediatric Cerebral Malaria: A Phase 1 Dose-Escalation Safety Study NIH 1U01AI155300-01A1; BioNTech 2/23-11/24, Safety, Tolerability, and Immunogenicity of an investigational mRNA-based vaccine for malaria; A Phase 3, Randomized, Stratified, Observer-Blind, Placebo-Controlled Study to Evaluate the Efficacy, Safety, and Immunogenicity of mRNA-1273 SARS-CoV-2 Vaccine in Adults Aged 18 Years and Older, NIH HHSN272201300022I, Vaccine and Treatment Evaluation Units 2 12/13/2021; Development of a CRISPR-based Rapid Diagnostic Test for Point of Care Diagnosis of Malaria, University of Maryland Medical Center Innovation Challenge; A Phase 1 Challenge Study to Evaluate Safety, Immunogenicity and Efficacy of a Malaria Vaccine (rCSP adjuvanted with GLA-LSQ), in Healthy Adults, DMID 13-0088; NIH HHSN272201300022I, Vaccine and Treatment Evaluation Units Accelerating Availability and Access to Typhoid Conjugate Vaccines (TyVAC 2.0) The Bill & Melinda Gates Foundation, INV-030857; outside the submitted work. M-C Li reports grants or contracts from the National Science and Technology Council, Taiwan (NSTC 112-2410-H-003-031); outside the submitted work. L-L Lim reports grants or contracts from Boehringer Ingelheim, Abbott, Zuellig Pharma, Novartis; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca, Abbott, Boehringer Ingelheim, Novo Nordisk, Roche, Zuellig Pharma, and Servier; outside the submitted work. G Liu reports support for the present manuscript from the Lung Foundation Australia. G Lopes reports grants or contracts from the Portuguese Foundation for Science and Technology (FCT) under the Scientific Employment Stimulus-Individual Call (CEECIND/01768/2021); outside the submitted work. G Lucchetti reports support for the present manuscript as a Grantee of the Research Productivity Scholarship – Level 1D (Medicine) - Brazilian National Council for Scientific and Technological Development (CNPq), Brazil. P W Mahasha reports support for attending meetings and/or travel from the South African Medical Research Council, Department of Nuclear Medicine, School of Medicine, University of Pretoria, Discipline of Traditional Medicine, School of Nursing and Public Health, University of KwaZulu Natal; participation on a Data Safety Monitoring Board or Advisory Board as a member of International Community Advisory Group for STANDING Together, an editorial board member of the Journal Current Research in Public Health (CRPH), and an associate editorial board member of the Journal of Frontiers in Reproductive Health section HIV and STIs; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Federation of Infectious Diseases Societies of Southern Africa (FIDSSA) as a member, the International Society for Infectious Diseases (ISID) as a member, the COVID-19 Clinical Research Coalition as a member, the Global Burden of Disease Collaborator Network as a member, the Scholars Academic and Scientific Society (SAS) (FSASS) as a fellow member, and the South African Council for Natural Scientific Professions (SACNASP) as a member; outside the submitted work. M A Mahmoud reports grants or contracts from the Deputyship for Research and Innovation, Ministry of Education in Saudi Arabia (project 445-5-133). J N Malagón-Rojas reports support for attending meetings and/or travel from the PIMENTO COST Project; outside the submitted work. L G Mantovani reports support for the present manuscript from the Italian Ministry of Health to Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Istituto Auxologico Italiano, Milano, Italy. S Martini reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Faculty of Public Health Universitas, Airlangga, Surabaya, Indonesia as the Dean; outside the submitted work. E Mathews reports grants or contracts from Wellcome DBT India Alliance funding; outside the submitted work. A G Mathioudakis reports grant or contracts from the National Institute for Health and Care Research (NIHR, UK) clinical lectureship, and NIHR Manchester Biomedical Research Centre. R J Maude reports support for the present manuscript from Wellcome Trust (grant 220211) as it provides core funding for Mahidol Oxford Tropical Medicine Research. A-F A Mentis reports funding from MilkSafe: a novel pipeline to enrich formula milk using omics technologies, a research co-financed by the European Regional Development Fund of the European Union and Greek national funds through the Operational Program Competitiveness, Entrepreneurship and Innovation, under the call RESEARCH - CREATE - INNOVATE (project code: T2EDK-02222), as well as from ELIDEK (Hellenic Foundation for Research and Innovation, MIMS-860); payment or expert testimony as an external peer-reviewer for Fondazione Cariplo, Italy; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Systematic Reviews journal as an editorial board member, Annals of Epidemiology journal and Translational Psychiatry Journal as Associate Editor; other support as a scientific officer at the BGI Group; outside the submitted work. T R Miller reports grants or contracts from AB InBec Foundation, National Institute of Mental Health (NIMH), National Institute of Health (NIH) and the National Cancer Institute (NCI); payment for expert testimony from Mobile, Alabama County Board of Health, New Mexico, Nevada, and Michigan; outside the submitted work. J J Miranda reports grants or contracts from the Alliance for Health Policy and Systems Research (HQHSR1206660), Bloomberg Philanthropies (grant 46129, via University of North Carolina at Grant support, Chapel Hill School of Public Health), FONDECYT via CIENCIACTIVA/CONCYTE C, British Council, British Embassy and the Newton-Paulet Fund (223-2018, 224-2018), DFID/MRC/Wellcome Global Health Trials (MR/M007405/1), Fogarty International Center (R21TW009982, D71TW010877, R21TW011740), Grand Challenges Canada (0335-04), International Development Research Center Canada (IDRC 106887, 108167), Inter- American Institute for Global Change Research (IAI CRN3036), National Cancer Institute (1P20CA217231), National Heart, Lung and Blood Institute (HHSN268200900033C, 5U01HL114180, 1UM1HL134590), National Institute of Mental Health (1U19MH098780), Swiss National Science Foundation (40P740-160366), UKRI BBSRC (BB/T009004/1), UKRI EPSRC (EP/V043102/1), UKRI MRC (MR/P008984/1, MR/P024408/1, MR/P02386X/1), Wellcome (074833/Z/04/Z, 093541/Z/10/Z, 103994/Z/14/Z, 107435/Z/15/Z, 205177/Z/16/Z, 214185/Z/18/Z, 218743/Z/19/Z) and the World Diabetes Foundation (WDF15-1224), and Health Action International; participation on a Data Safety Monitoring Board or Advisory Board with DSMB, Nigeria Sodium Study (NaSS) Trial Steering Committee, INTEnsive care bundle with blood pressure Reduction in Acute Cerebral hemorrhage Trial (INTERACT 3) Unpaid International Advisory Board, Latin American Brain Health institute (BrainLat), Universidad Adolfo Ibáñez (Chile) Unpaid Consultative Board, Programa de Gastronomía, Facultad de Estudios Unpaid Interdisciplinarios, Pontificia Universidad Católica del Perú Advisory Board, InterAmerican Heart Foundation (IAHF); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid as a co-Chair of the Independent Group of Scientists (IGS), 2023 Global Sustainable Development Report, United Nations; member of the Scientific Expert Committee, Global Data Collaborative for CV Population Health, World Health Federation, Microsoft, and Novartis Foundation; member of the Scientific and Technical Advisory Committee (STAC), Alliance for Health Policy and Systems Research, World Health Organization; member of the WHO Technical Advisory Group on NCD-related Research and Innovation (TAG/RI), Noncommunicable Diseases Department, World Health Organization; member of the Advisory Scientific Committee, Instituto de Investigación Nutricional (Peru). S Mohammed reports support for the present manuscript from the Bill and Melinda Gates Foundation. N Moka reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Kentucky Society of Clinical Oncology as a treasurer; outside the submitted work. L Monasta reports support for the present manuscript from the Italian Ministry of Health to the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italia (RC 34/2017). R S Moreira reports grants or contracts from the National Council for Scientific and Technological Development, CNPq Research Productivity Scholarship 316607/2021-5. M E Morris reports grants or contracts from the National Health and Medical Research Council Australia (NHMRC GNT1152853 2019-2023) Partnership Grant, “A public-private partnership to reduce falls in Australian hospitals”; outside the submitted work. S D Morrison reports grants or contracts from the Seattle Children’s Academic Enrichment Fund; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Swedish Hospital CME honoraria; outside the submitted work. U O Mueller reports grants or contracts from the German National Cohort Study (grant #10ER2301C); outside the submitted work. B R Nascimento reports grants or contracts from CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico Research Productivity Grant number 312382/2019-7), Edwards Lifesciences Foundation Research Grant for Global Health (Improving the Prevention and Detection of Heart Valve Disease Across the Lifespan, 2023) FAPEMIG (Fundação de Amparo a Pesquisa do Estado de Minas Gerais Research Grant number APQ-000627-20; outside the submitted work. G Natarajan reports grants or contracts from the project, “Study of prevalence of chronic kidney disease of Unknown etiology among Agricultural workers of Tamilnau”, funded by Tamilnadu Health System Reform Programme, and DRAKI (Dialysis requiring Acute Kidney injury) follow-up study, funded by Indian Council of Medical research (ICMR); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Indian Society of Nephrology as a chairman on the scientific committee; outside the submitted work. S Nomura reports support for the present manuscript from the Ministry of Education, Culture, Sports, Science and Technology of Japan (MEXT). B Norrving participation on a Data Safety Monitoring Board or Advisory Board with Simbec-Orion; outside the submitted work. F C A Obi reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Health Systems Global as a board member, and the African Health Economics and Policy Association as an executive team member; outside the submitted work. O O Odukoya reports grants or contracts from Fogarty International Center of the National Institutes of Health under award number K43TW010704; outside the submitted work. A Ojagbemi reports grants or contracts from the National Institute for Health and Care Research (NIHR) and Wellcome Global Health Research Partnership International Intermediate Fellowship (ref: 220684/Z/20/Z); outside the submitted work. A P Okekunle reports grants or contracts from the National Research Foundation of Korea (2020H1D3A1A04081265); outside the submitted work. O O Oladunjoye reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Pri-Med; outside the submitted work. A B Oliveira reports support for attending meetings and/or travel from the International Headache Society; outside the submitted work. A Ortiz reports grants or contracts from IIS-Fundacion Jimenez Diaz UAM; grants from Sanofi and consultancy or speaker fees or travel support from Advicciene, Astellas, Astrazeneca, Amicus, Amgen, Boehringer Ingelheim, Fresenius Medical Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Mundipharma, Kyowa Kirin, Lilly, Alexion, Freeline, Idorsia, Chiesi, Otsuka, Novo-Nordisk, Sysmex and Vifor Fresenius Medical Care Renal Pharma and is Director of the Catedra Mundipharma-UAM of diabetic kidney disease and the Catedra Astrazeneca-UAM of chronic kidney disease and electrolytes; outside the submitted work. A Otoiu reports grants or contracts from Bucharest University for Economic Studies and the European Commission: Horizon 2020; support for attending meetings and/or travel from Bucharest University for Economic Studies; outside the submitted work. P K Pal reports grants or contracts from the 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 as Faculty/Speaker/Author from the International Parkinson and Movement Disorder Society, and Movement Disorder Societies of Korea, Taiwan and Bangladesh; support for attending meetings and/or travel from the International Parkinson and Movement Disorder Society, and Movement Disorder Societies of Korea, Taiwan and Bangladesh; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid as the past President of Indian Academy of Neurology, the past Secretary of Asian and Oceanian subsection of International Parkinson and Movement Disorder Society (MDS-AOS), Editor-in-Chief of Annals of Indian Academy of Neurology, Co-Chair of the Education Committee of International Parkinson and Movement Disorder Society (IPMDS), President of the Parkinson Society of Karnataka, Chair of Infection Related Movement Disorders Study Group of MDS, member of Rare Movement Disorders Study Group of International Parkinson and Movement Disorder Society (IPMDS), member of Education Committee of IPMDS & IAPRD, member of Rating Scales Education and Training Program Committee of IPMDS, member of Neurophysiology Task Force of IPMDS, member of Movement Disorders in Asia Study Group, member of Post-Stroke Movement Disorders, member of Ataxia Study Group of IPMDS, member of Ataxia Global Initiative; outside the submitted work. T Palicz reports support for the present manuscript from the 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). R Palladino reports grants or contracts from UK MS Society; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Sanofi and MSD; outside the submitted work. S R Pandi-Perumal reports royalties or licenses from Springer; outside the submitted work. A E Peden reports support for the present manuscript from the Australian National Health and Medical Research Council (NHMRC) Emerging Leadership Fellowship (APPID: APP2009306). J Perdigão reports support for the present manuscript from Fundação para a Ciência e Tecnologia (FCT) researching funding. R G Pestell reports grants or contracts from the National Institute of Health (NIH) (grant 1R43HL164131-01A1); support for attendance at research meetings by parent institution (Baruch S. Blumberg Institute) June 12, 2023 Melbourne Australia Immune Oncology Therapy for Breast Cancer July 20, 2023 8th World Congress on cancer research and therapy., Frankfurt, Germany AACR Annual Meeting, 2023, San Antonio breast Cancer meeting 2022; the following patents planned, issued, or pending: WO2004037983 US patent number 8,076,318; EP2399129, EU patent application no. 10744303.8 (issued in France, Germany and the UK under patent number EP2399129); US Patent application 14/090,538 (publication number 20,160,139,132; US 2012-00398-05A1; AU 2012225232 Australian issued Patent No. 2012225232; US Patent issued 9,453,836; US 10,952,415; US 16/363,981; JP 7003083; EP 2683643; US Patent 13/520,759 US Provisional Application No. 61/292,749; US Provisional Patent Application 62/183,08; US Provisional Patent Application 62/035,929; Publication Number US 20120039805 Appl no. 13/202,318; Provisional Application No. 62/948,301; Provisional Application No 63093772; Provisional Patent Application Serial No. 63/178,633; EP3947431A1; Application No. 62/286,533 U.S. Provisional Patent Application Serial No. 63/178,633; U.S. Application No. 17/167,578; U.S. Application No. 15/275,050; U.S. Application No. 16/363,981; outside the submitted work. M R Phillips reports grants or contracts from Global Alliance for Chronic Diseases- National Natural Science Foundation of China (NSFC. No. 81761128031), Global Alliance of Chronic Diseases/Chinese National Natural Science Foundation of China (NSFC, No. 81761128031), National Institute of Mental Health (grant MH108385 R01), National Institutes of Health (5RO1MH127631); outside the submitted work. C D Pond reports grants or contracts from the Valley to Coast Charitable research grants; consulting fees from the University of Sydney; Latrobe University; University of Melbourne, NSW Health, Sydney North Primary Health Network, Hunter New England Central Coast Primary Health Network, Brisbane North Primary Care Network, Royal Australian College of General Practitioners; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Dementia Training Australia, Health Education Training Institute, Roche, Biogen, Palliative Care Australia; payment for expert testimony from Legal Aid NSW; support for attending meetings and/or travel from Palliative Care Australia for the WONCA Conference 2023; participation in a data safety monitoring board or advisory board with the Happi Mind Project; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with a special interest group in ageing and health, WONCA World GP Organization as a chair; outside the submitted work. M J Postma reports stock or stock options with PAG BV and Health=Ecore; outside the submitted work. N Prasad reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the International Society and Indian Society of Nephrology; outside the submitted work. A Radfar reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Avicenna Medical and Clinical Research Institute; outside the submitted work. V Radhakrishnan reports grants or contracts from the Conquer Cancer Foundation and St Jude Children’s Research Hospital; outside the submitted work. A Rahman reports support for the present manuscript from Charles Sturt University; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Australia New Zealand Regional Science Association International Inc (ANZRSAI) as the secretary of the executive council; outside the submitted work. A Riad reports support for the present manuscript from the Ministry of Education, Youth and Sports of the Czech Republic, NPO “Systemic Risk Institute” (project LX22NPO5101). A L P Ribeiro reports support for the present manuscript from Brazilian public research agencies, CNPq (310790/2021-2 and 465518/2014-1) and by FAPEMIG (PPM-00428-17 and RED-00081-16). Funders did not influence the content of the study. M Rodrigues reports support for the present manuscript from the Centre of Studies in Geography and Spatial Planning, funded by national funds through the Foundation for Science and Technology (FCT) under the reference UIDB/04084/2020. L Ronfani reports support for the present manuscript from the Italian Ministry of Health, funding received by the Institute for Maternal and Child Health IRCCS Burlo Garofolo (project “Ricerca Corrente 34/2017”). M Sabbatucci reports support for attending meetings and/or travel from Travel Grant Programme 2022 for Editorial Board Members from the Journal of Clinical Medicine (JCM) for conference participation; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Editorial Board of Journal of Clinical Medicine (JCM) as an unpaid member, the Board of the Global AMR R&D hub as an unpaid member, and GHSA (action package AMR and action package Surveillance) as an unpaid national representative; outside the submitted work. S Sacco reports grants or contracts from Novartis and Uriach; consulting fees from Novartis, Allergan-Abbvie, Teva, Lilly, Lundbeck, Pfizer, NovoNordisk, Abbott, AstraZeneca; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Allergan-Abbvie, Teva, Lilly, Lundbeck, Pfizer, NovoNordisk, Abbott, AstraZeneca; support for attending meetings/travel from Lilly, Novartis, Teva, and Lundbeck; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the European Stroke Organization as the president elect, and the European Headache Federation as the second vice-president; receipt of equipment, materials, drugs, medical writing, gifts or other services from Allergan-Abbvie and NovoNordisk; outside the submitted work. P S¬ Sachdev reports grants or contract from the National Health and Medical Research Council of Australia and the National Institutes of Health (NIH) USA; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Biogen Australia and Roche Australia; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with VASCOG Society on the executive committee; outside the submitted work. J Sanabria reports support for attending meetings and/or travel from the National Institute of Health (NIH) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); participation on a Data Safety Monitoring Board or Advisory Board with Quality Assessment and Assurance Department of Surgery; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with ASTS, IHPBA, AASLD, and SSAT; outside the submitted work. N Scarmeas reports grants or contracts from NovoNordisc - Local PI of recruiting site for multinational, multicenter industry sponsored phase III treatment trial for Alzheimer's disease; participation on a Data Safety Monitoring Board or Advisory Board with Albert Einstein College of Medicine (NIH funded study) as the Chair of Data Safety Monitoring Board; outside the submitted work. M P Schlaich reports grants or contracts from National Health and Medical Research Council of Australia (NHMRC) and the Medical Research Foundation RPH; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medtronic and Abbott; support for travel from Medtronic and Abbott; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Hypertension Australia as the president; outside the submitted work. A S Shalash payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Movement Disorders Society; outside the submitted work. S Sharma reports grants or contracts from the International Association for the Study of Pain John J Bonica Postdoctoral Fellowship; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the International Association for the Study of Pain (IASP) Congress in Toronto in 2022; support for attending meetings and/or travel from the International Association for the Study of Pain (IASP) Congress in Toronto in 2022; participation on a Data Safety Monitoring Board or Advisory Board with METEOR-2 Trial; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the IASP Pain Mind and Movement Special Interest Group as an unpaid board member, and the Global Alliance of Partners for Pain Advocacy as a board member; all outside the submitted work. V Shivarov reports other financial support from ICON plc; outside the submitted work. S Shrestha reports other financial or non-financial support from School of Pharmacy, Monash University Malaysia and awarded with the Graduate Research Merit Scholarship to pursue doctoral studies; outside the submitted work. L M L R Silva reports grants or contracts from project CENTRO-04-3559-FSE-000162, Fundo Social Europeu (FSE); outside the submitted work. J A Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, PK Med, Two labs Inc., Adept Field Solutions, Clinical Care options, Clearview Healthcare Partners, 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 and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the speaker’s bureau of Simply Speaking; support for attending meetings and/or travel from the steering committee of OMERACT; participation on a Data Safety Monitoring Board or Advisory Board as a member of the FDA Arthritis Advisory Committee; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid as a steering committee member of the OMERACT, with the Veteran Affairs Rheumatology Field Advisory Committee as a Chair, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as an Editor; 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., 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 the European Research Council, European Union’s Horizon 2020 research innovation program, and Region Zealand; royalties or licenses from Munksgaard and TrustMe-Ed; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Nestlé Health Science; other support as the co-founder of GLA:D; outside the submitted work. R Somayaji reports grants or contracts from Cystic Fibrosis Foundation, Canadian Institutes of Health Research, University of Calgary, and Vertex Pharmaceuticals; consulting fees from Phase I trial for Clarametyx Inc; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Vertex Pharmaceuticals; participation on a Data Safety Monitoring Board or Advisory Board for Oncovir Inc and Cystic Fibrosis Foundation; outside the submitted work. S Song reports grants or contracts from the University of Georgia and Georgia Clinical and Translational Science Awards (CTSA) program; outside the submitted work. D J Stein reports other financial or non-financial support from Discovery Vitality, Johnson & Johnson, Kanna, L’Oreal, Lundbeck, Orion, Sanofi, Servier, Takeda and Vistagen; outside the submitted work. M A Stokes reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Stanford Neurodiversity Summit 2022 and SIKON 2022; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with The Australasian Society for Autism Research as President, Kidsafe Victoria as Vice President, and the Council of the Aged as Director; outside the submitted work. P S Suchdev reports grants or contracts from the Centers for Disease Control and Prevention and the Bill and Melinda Gates Foundation; outside the submitted work. J Sundström reports stock or stock options in Anagram kommunikation AB and Symptoms Europe AB; outside the submitted work. M Szócska report support for the present manuscript from the National Research, Development and Innovation office in Hungary (grant RRF-2.3.1-21-2022-00006). R Tabarés-Seisdedos reports grants or contracts from Spanish Ministry of Science and Innovation, Institute of Health Carlos III (PID2021-129099OB-I00) and the GENERALITAT VALENCIANA (CIPROM/2022/58); outside the submitted work. S K Tadakamadla reports grants or contracts from the National Health and Medical Research Council Early Career Fellowship; outside the submitted work. M Tonelli reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the International Society of Nephrology; outside the submitted work. D R Uezono reports other financial or non-financial support from Roche (Philippines) Inc; outside the submitted work. E Upadhyay reports published patents for a system and method of reusable filters for anti-pollution mask, a system and method for electricity generation through crop stubble by using microbial fuel cells, a system for disposed personal protection equipment (PPE) into biofuel through pyrolysis and method, and a novel herbal pharmaceutical aid for formulation of gel and method thereof; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Indian Meteorological Society, Jaipur Chapter (India) as joint secretary and DSTPURSE Program as member secretary; outside the submitted work. H G C Van Spall reports support for the present manuscript from the Canadian Institute of Health Research. D Vervoort reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Global Alliance for Rheumatic and Congenital Hearts as an unpaid board member; other financial or non-financial support from the Canadian Institutes of Health Research (Vanier Canada Graduate Scholarship); outside the submitted work. Z Wang reports grants or contracts from The Fred Hollows Foundation, McGill University Global Health Scholars Program, Fonds de recherche du Québec – Santé, and the China Scholarship Council; consulting fees from The Fred Hollows Foundations; support for attending meetings and/or travel from the Graduate Mobility Award from McGill University, and The Fred Hollows Foundations; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Consortium of Universities for Global Health Trainee Advisory Committee; outside the submitted work. A Waris reports support for the present manuscript from Leona M. and Harry B. Helmsley Charitable Trust via the Addressing the Challenge and Constraints of Insulin Sources and Supply study. M Y Wei reports grants or contracts from the National Institutes of Health; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Society of General Internal Medicine on the research committee as a chair; outside the submitted work. A D Woolf reports leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the Global Alliance for Musculoskeletal Health as a co-chair; outside the submitted work. H Xu reports support for the present manuscript from National Institute on Minority Health and Health Disparities (NIMHD) U54MD012530; grants or contracts from the National Institute on Aging (NIA) (R21AG075228); support for attending meetings and/or travel from the National Institute on Aging (NIA) (R13AG054139). X Xu reports support for the present manuscript from the National Heart Foundation of Australia and the Scientia Program, University of New South Wales, Australia; outside the submitted work. S Zadey payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Think Global Health, Harvard Public Health; support for attending meetings and/or travel from Gates Foundation for IDM Symposium 2023, Lancet Commission for Commission meeting 2023, MoHFW for G-20 Youth Health Meet, New Delhi 2023 Duke University for KCMC Fieldwork 2023; participation on a Data Safety Monitoring Board or Advisory Board with Nivarana, India; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with ASAR India as a board member and G4 Alliance as a council member; outside the submitted work. F Zakaryaei reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Kurdistan University of Medical Science in 2021, the 11th International Virtual Seminar On COVID-19- Part II (SciTech CentralCOVID-19); patents planned, issued or pending: a composite fixator of nasogastric tube and Foley catheter, Iran (Patent No.104989); outside the submitted work. J-D Zeitoun reports consulting fees from Takeda and AbbVie; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boehringer Ingelheim; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Posos; stock or stock options in Allurion; other financial or non-financial support as a founding partner at Inato; outside the submitted work. B Ziaeian reports support for the present manuscript from NHLBI grant funding and the American Heart Association (AHA); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the AHA Guideline Committee on Performance Measures and the AHA Guideline Committee on Clinical Practice. L J Zuhlke reports support for the present manuscript from the National Research Foundation of South Africa (NRFSA), as well as the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, via the African Research Leader Award (MR/S005242/1), the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the Mid-Career Scientist Programme from funding received from the South African National Treasury (the content hereof is the sole responsibility of the authors and do not necessarily represent the official views of the SAMRC); leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with the World Heart Federation, The Non-Communicable Disease Alliance, Food Forward South Africa and the Human Frontier Science Program. A Zumla reports other financial or non-financial support from the Pan African Network for Rapid Research, Response, and Preparedness for Infectious Diseases Epidemics Consortium (PANDORA-ID-NET), European and Developing Countries Clinical Trials Partnership the EU Horizon 2020 Framework Programme (EDCTP-RIA2016E-1609); outside the submitted work.

Supplementary information

The online version contains supplementary material available at 10.1038/s41467-025-56910-x.