Changing life expectancy in European countries 1990–2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021

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Vervoort D. Villafane J.H. Violante F.S. Vizzielli G. Vodden A. Vollset S.E. Vos T. Wafa H.A. Wang Y. Wassie E.G. Weerakoon K.G. Westerman R. Wickramasinghe N.D. Willeit P. Wojewodzic M.W. Wolf A.W. Wolfe C.D.A. Wyper G.M.A. Xu X. Yasufuku Y. Yaya S. Yezli S. Yiǧit A. Yon D.K. Yu C. Zakham F. Zanghi A. Zastrozhin M. Zeariya M.G.M. Zhang L. Zhang Z. Zhong C.C. Zhu B. Ziafati M. Zielińska M. Zweck E. Zyoud S.H. Newton J.N.
March 2025 Elsevier Ltd

The Lancet Public Health
2025 #10 Issue 3 e172 - e188 pp.

Background: Decades of steady improvements in life expectancy in Europe slowed down from around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to assess how changes in risk factors and cause-specific death rates in different European countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic. Methods: We used data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to compare changes in life expectancy at birth, causes of death, and population exposure to risk factors in 16 European Economic Area countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden) and the four UK nations (England, Northern Ireland, Scotland, and Wales) for three time periods: 1990–2011, 2011–19, and 2019–21. Changes in life expectancy and causes of death were estimated with an established life expectancy cause-specific decomposition method, and compared with summary exposure values of risk factors for the major causes of death influencing life expectancy. Findings: All countries showed mean annual improvements in life expectancy in both 1990–2011 (overall mean 0·23 years [95% uncertainty interval [UI] 0·23 to 0·24]) and 2011–19 (overall mean 0·15 years [0·13 to 0·16]). The rate of improvement was lower in 2011–19 than in 1990–2011 in all countries except for Norway, where the mean annual increase in life expectancy rose from 0·21 years (95% UI 0·20 to 0·22) in 1990–2011 to 0·23 years (0·21 to 0·26) in 2011–19 (difference of 0·03 years). In other countries, the difference in mean annual improvement between these periods ranged from –0·01 years in Iceland (0·19 years [95% UI 0·16 to 0·21] vs 0·18 years [0·09 to 0·26]), to –0·18 years in England (0·25 years [0·24 to 0·25] vs 0·07 years [0·06 to 0·08]). In 2019–21, there was an overall decrease in mean annual life expectancy across all countries (overall mean –0·18 years [95% UI –0·22 to –0·13]), with all countries having an absolute fall in life expectancy except for Ireland, Iceland, Sweden, Norway, and Denmark, which showed marginal improvement in life expectancy, and Belgium, which showed no change in life expectancy. Across countries, the causes of death responsible for the largest improvements in life expectancy from 1990 to 2011 were cardiovascular diseases and neoplasms. Deaths from cardiovascular diseases were the primary driver of reductions in life expectancy improvements during 2011–19, and deaths from respiratory infections and other COVID-19 pandemic-related outcomes were responsible for the decreases in life expectancy during 2019–21. Deaths from cardiovascular diseases and neoplasms in 2019 were attributable to high systolic blood pressure, dietary risks, tobacco smoke, high LDL cholesterol, high BMI, occupational risks, high alcohol use, and other risks including low physical activity. Exposure to these major risk factors differed by country, with trends of increasing exposure to high BMI and decreasing exposure to tobacco smoke observed in all countries during 1990–2021. Interpretation: The countries that best maintained improvements in life expectancy after 2011 (Norway, Iceland, Belgium, Denmark, and Sweden) did so through better maintenance of reductions in mortality from cardiovascular diseases and neoplasms, underpinned by decreased exposures to major risks, possibly mitigated by government policies. The continued improvements in life expectancy in five countries during 2019–21 indicate that these countries were better prepared to withstand the COVID-19 pandemic. By contrast, countries with the greatest slowdown in life expectancy improvements after 2011 went on to have some of the largest decreases in life expectancy in 2019–21. These findings suggest that government policies that improve population health also build resilience to future shocks. Such policies include reducing population exposure to major upstream risks for cardiovascular diseases and neoplasms, such as harmful diets and low physical activity, tackling the commercial determinants of poor health, and ensuring access to affordable health services. Funding: Gates Foundation.

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Department of Primary Care and Public Health, University of East Anglia, Norwich, United Kingdom
Norwich Medical School, University of East Anglia, Norwich, United Kingdom
Office for Health Improvement and Disparities, Department of Health and Social Care, London, United Kingdom
Academic Public Health England, Department of Health and Social Care, London, United Kingdom
Office for Health Improvement and Disparity, Department of Health and Social Care, London, United Kingdom
Department of Legal and Economic Studies, La Sapienza University, Rome, Italy
Department of Public Health and Infectious Diseases, La Sapienza University, Rome, Italy
Hull York Medical School, University of Hull, Hull, United Kingdom
Department of Mathematics and Sciences, Ajman University, Ajman, United Arab Emirates
Department of Medicine, Memorial University, St. Johns, NL, Canada
Postgraduate Department, University of Sierrasur, Miahuatlan de Porfirio Diaz, Mexico
Yhteiskuntadatatieteen Keskus, University of Helsinki, Helsinki, Finland
Department of Public Health, University of Helsinki, Helsinki, Finland
Department of Internal Medicine, Federal Medical Centre, Abuja, Nigeria
Research Center for Immunodeficiencies, Tehran University of Medical Sciences, Tehran, Iran
Non-communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
Iranian Research Center for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran
Cardiac Primary Prevention Research Center, Tehran University of Medical Sciences, Tehran, Iran
Department of Cardiac Electrophysiology, Tehran University of Medical Sciences, Tehran, Iran
School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
NeuroTRACT Association, Tehran University of Medical Sciences, Tehran, Iran
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran
Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
Department of Medical Biochemistry and Biophysics, Stockholm, Sweden
Department of Global Public Health, Stockholm, Sweden
Department of Neuro-biology, Care Science and Society, Stockholm, Sweden
Department of Neurobiology, Care Sciences, and Society, Stockholm, Sweden
Department of Molecular Medicine and Surgery, Stockholm, Sweden
Karolinska Institutet (Karolinska Institute), Stockholm, Sweden
Department of Clinical Sciences, University of Sharjah, Sharjah, United Arab Emirates
Department of Basic Biomedical Sciences, University of Sharjah, Sharjah, United Arab Emirates
Clinical Sciences Department, University of Sharjah, Sharjah, United Arab Emirates
Department of Finance and Economics, University of Sharjah, Sharjah, United Arab Emirates
College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
Department of Biopharmaceutics and Clinical Pharmacy, University of Jordan, Amman, Jordan
Medical Research Center, Hamad Medical Corporation, Doha, Qatar
Nursing & Midwifery Research Department (NMRD), Hamad Medical Corporation, Doha, Qatar
Department of Biochemistry and Molecular Medicine, Alfaisal University, Riyadh, Saudi Arabia
College of Graduate Health Sciences, University of Tennessee, Memphis, TN, United States
School of Medicine, University of Sydney, Sydney, NSW, Australia
School of Architecture, Design, and Planning, University of Sydney, Sydney, NSW, Australia
Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
School of Population Health, University of New South Wales, Sydney, NSW, Australia
Internal Medicine and Alcohol Related Disease Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
Department of Medical and Surgical Sciences, Università Cattolica di Roma (Catholic University of Rome), Rome, Italy
Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, TX, United States
Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, United States
Department of Biochemistry, Osun State University, Osogbo, Nigeria
Department of Pharmacology and Therapeutics, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Microbiology, University of Medical Sciences, Ondo, Ondo, Nigeria
Department of Veterinary Medicine, University of Ibadan, Ibadan, Nigeria
Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
Department of Periodontology and Community Dentistry, University of Ibadan, Ibadan, Nigeria
Department of Veterinary Public Health and Preventive Medicine, University of Ibadan, Ibadan, Nigeria
Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
Department of Medicine, University of Ibadan, Ibadan, Nigeria
Department of Public Health Sciences, Queens University, Kingston, ON, Canada
School of Medicine and Psychology, Australian National University, Canberra, ACT, Australia
Public Health Foundation of India, Gandhinagar, India
Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
Department of Womens and Childrens Health, Uppsala University, Uppsala, Sweden
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
Department of Medical Cell Biology, Uppsala University, Uppsala, Sweden
Department of Medical Sciences, Uppsala University, Uppsala, Sweden
Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan
Unit of Basic Medical Sciences, University of Khartoum, Khartoum, Sudan
Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
Brody School of Medicine, East Carolina University, Greenville, NC, United States
Department of Computer Science, East Carolina University, Greenville, NC, United States
Department of Internal Medicine, University of Patras, Patras, Greece
Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, Patras, Greece
Department of Cardiology, Fudan University, Shanghai, China
Department of Communicable Diseases, Ministry of Health, Muscat, Oman
Middle East, Eurasia, and Africa Influenza Stakeholders Network, Muscat, Oman
Division of Public Health Sciences, Washington University in St. Louis, St. Louis, MO, United States
Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
Department of Adult Health and Critical Care, College of Nursing, Sultan Qaboos University, Muscat, Oman
Department of Geography, Sultan Qaboos University, Muscat, Oman
Institute of Health Informatics, University College London, London, United Kingdom
Department of Health Informatics, University College London, London, United Kingdom
Surgical Biotechnology Department, University College London, London, United Kingdom
Department of Population Health Sciences, University College London, London, United Kingdom
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States
Department of Bacteriology, Immunology, and Mycology, Suez Canal University, Ismailia, Egypt
Global Centre for Environmental Remediation, University of Newcastle, Newcastle, NSW, Australia
Cooperative Research Centre for Contamination Assessment and Remediation of the Environment, Newcastle, NSW, Australia
Department of Zoology, Abdul Wali Khan University Mardan, Mardan, Pakistan
Department of Medical Rehabilitation (Physiotherapy), University of Maiduguri, Maiduguri, Nigeria
Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
Center for Biotechnology and Microbiology, University of Swat, Swat, Pakistan
Department of Pathophysiology and Transplantation, Milan, Italy
Department of Food, Environmental and Nutritional Sciences, Milan, Italy
Università Degli Studi di Milano (University of Milan), Milan, Italy
Cystic Fibrosis Center, Fondazione IRCCS Ospedale Maggiore Policlinico, Milan, Italy
Institute of Health and Wellbeing, Federation University Australia, Melbourne, VIC, Australia
School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
School of Physics, Mathematics and Computing, The University of Western Australia, Perth, WA, Australia
Dobney Hypertension Centre, The University of Western Australia, Perth, WA, Australia
Information and Communication Technology Research Pole (Lab-STICC), ENSTA Bretagne, Brest, France
Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
Department of Emergency Medicine, Sanaa University, Sanaa, Yemen
Pediatric Emergency Medicine Department, St. Christophers Hospital for Children, Philadelphia, PA, United States
Department of Family and Community Medicine, University of Jeddah, Jeddah, Saudi Arabia
Lisbon Institute of Global Mental Health, Nova University of Lisbon, Lisbon, Portugal
Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka, Nigeria
Department of Biomedical Engineering, German Jordanian University, Amman, Jordan
Spiritual Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
Centre for Sensorimotor Performance, The University of Queensland, Brisbane, QLD, Australia
Neurology Department, Royal Brisbane and Womens Hospital, Brisbane, QLD, Australia
Department of Cardiology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Legal Medicine and Bioethics, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Department of Pharmacology, All India Institute of Medical Sciences, Jodhpur, India
All India Institute of Medical Sciences, Bhubaneswar, India
Regenerative Medicine, Organ Procurement and Transplantation Multi-disciplinary Center, Guilan University of Medical Sciences, Rasht, Iran
Department of Social Medicine and Epidemiology, Guilan University of Medical Sciences, Rasht, Iran
Rural Health Research Institute, Charles Sturt University, Orange, NSW, Australia
Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Center for International Health, Ludwig Maximilians University, Munich, Germany
CyberKnife Center, Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Department of Ophthalmology, Iran University of Medical Sciences, Tehran, Iran
Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
Department of Health Economics, Iran University of Medical Sciences, Tehran, Iran
College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
College of Art and Science, Ottawa University, Surprise, AZ, United States
School of Life Sciences, Arizona State University, Tempe, AZ, United States
Department of Veterinary Pharmacology and Toxicology, University of Ilorin, Ilorin, Nigeria
School of Public Health, Imperial College London, London, United Kingdom
Department of Brain Sciences, Imperial College London, London, United Kingdom
National Heart & Lung Institute, Imperial College London, London, United Kingdom
WHO Collaborating Centre for Public Health Education and Training, Imperial College London, London, United Kingdom
Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
The George Institute for Global Health, Imperial College London, London, United Kingdom
Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy
School of Health and Social Studies, Dalarna University, Falun, Sweden
Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
Northumbria HealthCare NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
School of Business, University of Leicester, Leicester, United Kingdom
Department of Health Sciences, University of Leicester, Leicester, United Kingdom
Department of Statistics and Econometrics, Bucharest University of Economic Studies, Bucharest, Romania
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom
Institute of Biotechnology and Genetic Engineering, The University of Agriculture, Peshawar, Pakistan
ASIDE Healthcare, Lewes, DE, United States
Faculty of Medicine, October 6 University, 6th of October City, Egypt
Department of Population Medicine, Qatar University, Doha, Qatar
School of Health Sciences, Orebro University, Orebro, Sweden
Swedish Institute of Disability Research, Örebro University, Örebro, Sweden
Department of Forensic Science, Government Institute of Forensic Science Nagpur, Nagpur, India
Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur, India
School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Heart Failure Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
International Medical School, Management and Science University, Alam, Malaysia
Center for Clinical Research and Prevention, Bispebjerg University Hospital, Frederiksberg, Denmark
Department of Forensic Sciences, Government Institute of Forensic Sciences, Nagpur, Nagpur, India
Heidelberg Institute of Global Health (HIGH), Heidelberg University, Heidelberg, Germany
Department of Ophthalmology, Heidelberg University, Heidelberg, Germany
T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
Center for Primary Care, Harvard University, Boston, MA, United States
Harvard Business School, Harvard University, Boston, MA, United States
Department of Global Health and Social Medicine, Harvard University, Boston, MA, United States
International Diabetes Federation, São Paulo, Brazil
International Diabetes Federation, Brussels, Belgium
Department of Public and Environmental Health, University of the Gambia, Banjul, Gambia
Department of Epidemiology, University of Florida, Gainesville, FL, United States
Division of Pulmonary, Critical Care, and Sleep, University of Florida, Gainesville, FL, United States
College of Medicine, University of Florida, Gainesville, FL, United States
Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
University Institute of Food Science and Technology, The University of Lahore, Lahore, Pakistan
Department of Animal Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal
Coimbra Chemistry Centre, University of Coimbra, Coimbra, Portugal
Coimbra Institute for Biomedical Imaging and Translational Research, University of Coimbra, Coimbra, Portugal
Department of Medical Education, University of Nevada Las Vegas, Las Vegas, NV, United States
Department of Health Sciences (DISSAL), University of Genoa, Genova, Italy
Department of Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
Department of Psychiatry, University of Münster, Münster, Germany
Department of Psychiatry, Melbourne Medical School, Melbourne, VIC, Australia
Department of Mental Health, AUSL Romagna, Ravenna, Italy
Department of Neurology, University Hospital of Dijon, Dijon, France
Dijon Stroke Registry, University of Burgundy, Dijon, France
School of the Environment, Yale University, New Haven, CT, United States
Department of Dermatology, Yale University, New Haven, CT, United States
Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT, United States
Department of Genetics, Yale University, New Haven, CT, United States
Department of Internal Medicine, Yale University, New Haven, CT, United States
School of Health Policy and Management, Korea University, Seoul, South Korea
Department of Biological Sciences, University of Porto, Porto, Portugal
Research Unit on Applied Molecular Biosciences (UCIBIO), University of Porto, Porto, Portugal
Associated Laboratory for Green Chemistry (LAQV), University of Porto, Porto, Portugal
Department of Chemical Sciences, University of Porto, Porto, Portugal
Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal
Faculty of Engineering, University of Porto, Porto, Portugal
MEDCIDS, Faculty of Medicine of the University of Porto, University of Porto, Porto, Portugal
Epidemiology Research Unit (EPIUnit), University of Porto, Porto, Portugal
Department of Biomedical Sciences, University of West Attica, Athens, Greece
National AIDS Reference Center of Southern Greece, University of West Attica, Athens, Greece
Faculty of Medicine, Universidade Católica Portuguesa (Catholic University of Portugal), Sintra, Portugal
Center for Interdisciplinary Research in Health (CIIS), Universidade Católica Portuguesa (Catholic University of Portugal), Lisbon, Portugal
Department of Public Health, North Dakota State University, Fargo, ND, United States
Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, United States
Institute of Applied Health Research, University of Nottingham, Nottingham, United Kingdom
School of Medicine, Division of Ophthalmology & Visual Sciences, University of Nottingham, Nottingham, United Kingdom
Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, United Kingdom
Global Health Neurology Lab, NSW Brain Clot Bank, Sydney, NSW, Australia
Division of Cerebrovascular Medicine and Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, Bologna, Italy
Department of Biomedical and Neuro-motor Science, University of Bologna, Bologna, Italy
UOC Clinica Neurologica, IRCCS Istituto Delle Scienze Neurologiche di Bologna (Institute of Neurological Sciences of Bologna), Bologna, Italy
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
Center for International Health, University of Bergen, Bergen, Norway
Department of Research, Cancer Registry of Norway, Oslo, Norway
Facultad de Salud (Faculty of Health), Universidad Santiago de Cali (Santiago de Cali University), Cali, Colombia
Department of Medicine, University Ferhat Abbas of Setif, Setif, Algeria
Department of Epidemiology and Preventive Medicine, University Hospital Saadna Abdenour, Setif, Algeria
Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
School of Psychology, University of Southampton, Southampton, United Kingdom
Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
Faculty of Medicine, University of Southampton, Southampton, United Kingdom
Department of Epidemiology and Evidence-Based Medicine, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
Department of Paediatrics and Paediatric Infectious Diseases, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS (Agostino Gemelli University Polyclinic IRCCS), Rome, Italy
Global Health Research Institute, Università Cattolica Del Sacro Cuore (Catholic University of Sacred Heart), Rome, Italy
Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
School of Pharmacy, The University of Jordan, Amman, Jordan
Faculty of Health Sciences, Ankara University, Ankara, Turkey
Department of Health Management (Direzione Sanitaria), IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
Interdisciplinary Research Center for Health Science, SantAnna School of Advanced Studies, Pisa, Italy
Oncological Network, Prevention and Research Institute, Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
Dermatology Unit, Department of Medicine and Surgery, University of Insubria, Varese, Italy
PhD Program in Molecular and Translational Medicine (DIMET), University of Milan Bicocca, Milan, Italy
Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
Department of Psychiatry, University of São Paulo, São Paulo, Brazil
Division of Country Health Policies and Systems (CPS), World Health Organisation, Italy
Mental Health Flagship, World Health Organization (WHO), Copenhagen, Denmark
Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
Department of Food, Environmental and Nutritional Sciences, University of Milan, Milan, Italy
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
MultiMedica Sesto San Giovanni IRCCS, Sesto San Giovanni, Italy
Department of Medical, Surgical, and Health Sciences, University of Trieste, Trieste, Italy
Public Health Unit, University Health Agency Giuliano-Isontina (ASUGI), Trieste, Italy
Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
School of Public Health, University of Hong Kong, Hong Kong
Department of Urban Planning and Design, University of Hong Kong, Hong Kong
Institute of Clinical Physiology, Italian National Council of Research, Pisa, Italy
Department of Biology, Al-Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
Department of Medicine, National University of Singapore, Singapore, Singapore
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
Department of Community Medicine, Jawaharlal Nehru Medical College, Wardha, India
The Interdisciplinary Research Group on Biomedicine and Health, VNU International School (VNUIS), Hanoi, Viet Nam
Faculty of Applied Sciences, VNU International School (VNUIS), Hanoi, Viet Nam
Department of Paediatric Surgery, Federal Medical Centre, Umuahia, Nigeria
Health Data Research UK, London, United Kingdom
Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
Department of Child and Adolescent Psychiatry, New York University, New York, NY, United States
Department of Population Health, New York University, New York, NY, United States
Department of Family Medicine and Public Health, University of California, La Jolla, San Diego, CA, United States
Department of Diagnostic and Therapeutic Technologies, Cooperativa de Ensino Superior Politécnico e Universitário, Vila Nova de Famalicão, Portugal
Research Center for Child Psychiatry, University of Turku, Turku, Finland
Heart Center, University of Turku, Turku, Finland
Department of Clinical Neurosciences, University of Turku, Turku, Finland
Centre for Public Health, Queens University, Belfast, United Kingdom
Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Catania, Italy
Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
Department of Public Health, Haramaya University, Harar, Ethiopia
Department of Clinical Toxicology, Guys and St. Thomas NHS Foundation Trust, London, United Kingdom
Faculty of Life Sciences and Medicine, Kings College London, London, United Kingdom
Department of Twin Research and Genetic Epidemiology, Kings College London, London, United Kingdom
School of Population Health and Environmental Sciences, Kings College London, London, United Kingdom
School of Life Course and Population Sciences, Kings College London, London, United Kingdom
Department of Biochemistry, Ministry of Health and Welfare, New Delhi, India
Department of Legal Medicine, Psychiatry and Pathology, Universidad Complutense de Madrid (Complutense University of Madrid), Madrid, Spain
Department of Neurosurgery, University of Edinburgh, Edinburgh, United Kingdom
Department of Neurosurgery, National Health Service (NHS) Scotland, Edinburgh, United Kingdom
St Pauls Eye Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
2nd Cardiology Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
School of Medicine, First Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Second Department of Cardiology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
Department of Translational Physiology, Infectiology and Public Health, Ghent, Belgium
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, India
Department of Epidemiology, Sunway University, Selangor, Malaysia
Department of Epidemiology, Maastricht University, Maastricht, Netherlands
Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
Health Science Center, University of Texas, Houston, TX, United States
Cardio-Thoraco-Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
South Plainfield, NJ, United States
Department of Epidemiology and Biostatistics, University of Health and Allied Sciences, Ho, Ghana
Department of Population and Behavioural Sciences, University of Health and Allied Sciences, Ho, Ghana
Faculty of Science and Humanities, SRM Institute of Science and Technology, Kattankulathur, India
Department of Infection and Tropical Medicine, University of Sheffield, Sheffield, United Kingdom
Department of Conservative Dentistry with Endodontics, Medical University of Silesia, Katowice, Poland
School of Nursing and Midwifery, La Trobe University, Melbourne, VIC, Australia
School of Nursing and Midwifery, La Trobe University, Bundoora, VIC, Australia
Centre for Global Health Inequalities Research (CHAIN), Norwegian University of Science and Technology, Trondheim, Norway
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
Faculty of Science and Health, University of Portsmouth, Hampshire, United Kingdom
Almoosa College of Health Sciences, Al Ahsa, Saudi Arabia
School of Population and Global Health, McGill University, Montreal, QC, Canada
Faculty of Medicine, University of Tripoli, Tripoli, Libya
Houston Methodist Hospital, Houston, TX, United States
Department of Pediatrics, University of Texas, Dallas, TX, United States
Department of Biomedical Sciences, Humanitas University, Milan, Italy
Dermatology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
Research Centre for Healthcare and Community, Coventry University, Coventry, United Kingdom
Faculty of Health and Life Sciences, Coventry University, Coventry, United Kingdom
Department of Periodontology and Community Dentistry, University College Hospita, Ibadan, Ibadan, Nigeria
Department of Medicine, University College Hospital, Ibadan, Ibadan, Nigeria
Department of Food Hygiene and Quality Control, University of Tehran, Tehran, Iran
Epidemiology and Biostatistics Unit, IRCCS Pascale, Naples, Italy
Dissemination Division, National Institute of Statistics, Lisbon, Portugal
Activity Planning and Control Unit, Directorate-General of Health (DGS), Lisbon, Portugal
Department of Biology, Salahaddin University-Erbil, Erbil, Iraq
Department of Statistics, Salahaddin University-Erbil, Erbil, Iraq
Department of Chemistry, Salahaddin University-Erbil, Erbil, Iraq
Department of Biology, Cihan University-Erbil, Erbil, Iraq
Department of Business Administrations, Cihan University-Erbil, Erbil, Iraq
Department of Medical Biochemical Analysis, Cihan University-Erbil, Erbil, Iraq
Department of Veterinary Tropical Diseases, University of Pretoria, Pretoria, South Africa
School of Health Systems & Public Health, University of Pretoria, Pretoria, South Africa
Animal Production and Health Division (EMPRES), Food and Agriculture Organization of the United Nations, Rome, Italy
Department of Biology and Medicine, Brown University, Providence, RI, United States
Laboratory of Experimental Medicine, Kazakh National Medical University, Almaty, Kazakhstan
Research and Publication Activity Division, Kazakh National Medical University, Almaty, Kazakhstan
Department of Infectious Diseases and Public Health, City University of Hong Kong, Hong Kong
Department of Pharmacy, Wollega University, Nekemte, Ethiopia
Department of Nursing, Wollega University, Nekemte, Ethiopia
National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
Division of Neurology, University of Toronto, Toronto, ON, Canada
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
Division of Neurosurgery, University of Toronto, Toronto, ON, Canada
Department of Translational Medicine, University of Piemonte Orientale, Italy, Novara, Italy
Center for Public Health Research, University of Milan Bicocca, Monza, Italy
Laboratory of Public Health, IRCCS Istituto Auxologico Italiano, Milan, Italy
Department of Social Sciences, University of Nicosia, Nicosia, Cyprus

Department of Primary Care and Public Health
Norwich Medical School
Office for Health Improvement and Disparities
Academic Public Health England
Office for Health Improvement and Disparity
Department of Legal and Economic Studies
Department of Public Health and Infectious Diseases
Hull York Medical School
Department of Mathematics and Sciences
Department of Medicine
Postgraduate Department
Yhteiskuntadatatieteen Keskus
Department of Public Health
Department of Internal Medicine
Research Center for Immunodeficiencies
Non-communicable Diseases Research Center
Iranian Research Center for HIV/AIDS (IRCHA)
Cardiac Primary Prevention Research Center
Department of Cardiac Electrophysiology
School of Medicine
Sina Trauma and Surgery Research Center
NeuroTRACT Association
Digestive Diseases Research Institute
Department of Neurology
Sina Hospital
Department of Medical Biochemistry and Biophysics
Department of Global Public Health
Department of Neuro-biology
Department of Neurobiology
Department of Molecular Medicine and Surgery
Karolinska Institutet (Karolinska Institute)
Department of Clinical Sciences
Department of Basic Biomedical Sciences
Clinical Sciences Department
Department of Finance and Economics
College of Medicine
Department of Biopharmaceutics and Clinical Pharmacy
Medical Research Center
Nursing & Midwifery Research Department (NMRD)
Department of Biochemistry and Molecular Medicine
College of Graduate Health Sciences
School of Medicine
School of Architecture
Centre for Social Research in Health
School of Population Health
Internal Medicine and Alcohol Related Disease Unit
Department of Medical and Surgical Sciences
Department of Obstetrics and Gynecology
Department of Family Medicine
Department of Biochemistry
Department of Pharmacology and Therapeutics
Department of Microbiology
Department of Veterinary Medicine
Department of Epidemiology and Medical Statistics
Department of Periodontology and Community Dentistry
Department of Veterinary Public Health and Preventive Medicine
Faculty of Public Health
Department of Medicine
Department of Public Health Sciences
School of Medicine and Psychology
Public Health Foundation of India
Maternal and Child Health Division
Department of Womens and Childrens Health
Department of Surgical Sciences
Department of Medical Cell Biology
Department of Medical Sciences
Institute of Endemic Diseases
Unit of Basic Medical Sciences
Swiss Tropical and Public Health Institute
Brody School of Medicine
Department of Computer Science
Department of Internal Medicine
Department of Internal Medicine and Infectious Diseases
Department of Cardiology
Department of Communicable Diseases
Middle East
Division of Public Health Sciences
Department of Surgery
Department of Adult Health and Critical Care
Department of Geography
Institute of Health Informatics
Department of Health Informatics
Surgical Biotechnology Department
Department of Population Health Sciences
Institute for Health Metrics and Evaluation
Department of Health Metrics Sciences
Department of Bacteriology
Global Centre for Environmental Remediation
Cooperative Research Centre for Contamination Assessment and Remediation of the Environment
Department of Zoology
Department of Medical Rehabilitation (Physiotherapy)
Department of Rehabilitation Sciences
Center for Biotechnology and Microbiology
Department of Pathophysiology and Transplantation
Department of Food
Università Degli Studi di Milano (University of Milan)
Cystic Fibrosis Center
Institute of Health and Wellbeing
School of Public Health and Preventive Medicine
School of Physics
Dobney Hypertension Centre
Information and Communication Technology Research Pole (Lab-STICC)
Department of Allied Medical Sciences
Department of Rehabilitation Sciences
Institute of Public Health
College of Medicine and Health Sciences
Department of Emergency Medicine
Pediatric Emergency Medicine Department
Department of Family and Community Medicine
Lisbon Institute of Global Mental Health
Clinical Pharmacy and Pharmacy Management
Department of Biomedical Engineering
Spiritual Health Research Center
Nephrology and Urology Research Center
Centre for Sensorimotor Performance
Neurology Department
Department of Cardiology
Department of Legal Medicine and Bioethics
Department of Pharmacology
All India Institute of Medical Sciences
Regenerative Medicine
Department of Social Medicine and Epidemiology
Rural Health Research Institute
Department of Sociology and Social Work
Center for International Health
CyberKnife Center
Health Management and Economics Research Center
School of Medicine
Department of Ophthalmology
Research Center of Pediatric Infectious Diseases
Department of Health Economics
College of Pharmacy
College of Art and Science
School of Life Sciences
Department of Veterinary Pharmacology and Toxicology
School of Public Health
Department of Brain Sciences
National Heart & Lung Institute
WHO Collaborating Centre for Public Health Education and Training
Department of Primary Care and Public Health
The George Institute for Global Health
Faculty of Pharmaceutical Sciences
Department of Cardiovascular
School of Health and Social Studies
Department of Community Medicine and Global Health
Northumbria HealthCare NHS Foundation Trust
School of Business
Department of Health Sciences
Department of Statistics and Econometrics
Leeds Institute of Rheumatic and Musculoskeletal Medicine
Institute of Biotechnology and Genetic Engineering
ASIDE Healthcare
Faculty of Medicine
Department of Population Medicine
School of Health Sciences
Swedish Institute of Disability Research
Department of Forensic Science
Rashtrasant Tukadoji Maharaj Nagpur University
School of Medicine
Heart Failure Research Center
Neuroscience Research Center
International Medical School
Center for Clinical Research and Prevention
Department of Forensic Sciences
Heidelberg Institute of Global Health (HIGH)
Department of Ophthalmology
T.H. Chan School of Public Health
Center for Primary Care
Harvard Business School
Department of Global Health and Social Medicine
International Diabetes Federation
International Diabetes Federation
Department of Public and Environmental Health
Department of Epidemiology
Division of Pulmonary
College of Medicine
Heidelberg Institute of Global Health (HIGH)
University Institute of Food Science and Technology
Department of Animal Sciences
Faculty of Pharmacy
Coimbra Chemistry Centre
Coimbra Institute for Biomedical Imaging and Translational Research
Department of Medical Education
Department of Health Sciences (DISSAL)
Department of Nuclear Medicine
Department of Psychiatry
Department of Psychiatry
Department of Mental Health
Department of Neurology
Dijon Stroke Registry
School of the Environment
Department of Dermatology
Department of Radiology and Biomedical Imaging
Department of Genetics
Department of Internal Medicine
School of Health Policy and Management
Department of Biological Sciences
Research Unit on Applied Molecular Biosciences (UCIBIO)
Associated Laboratory for Green Chemistry (LAQV)
Department of Chemical Sciences
Institute for Research and Innovation in Health (i3S)
Faculty of Engineering
MEDCIDS
Epidemiology Research Unit (EPIUnit)
Department of Biomedical Sciences
National AIDS Reference Center of Southern Greece
Faculty of Medicine
Center for Interdisciplinary Research in Health (CIIS)
Department of Public Health
Division of Gastroenterology and Hepatology
Institute of Applied Health Research
School of Medicine
Institute of Applied Health Research
NIHR Global Health Research Unit on Global Surgery
Global Health Neurology Lab
Division of Cerebrovascular Medicine and Neurology
Department of Biomedical and NeuroMotor Sciences
Department of Medical and Surgical Sciences
Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM)
Department of Biomedical and Neuro-motor Science
UOC Clinica Neurologica
Department of Global Public Health and Primary Care
Center for International Health
Department of Research
Facultad de Salud (Faculty of Health)
Department of Medicine
Department of Epidemiology and Preventive Medicine
Department of Psychiatry
Department of Public Health and Primary Care
Division of Clinical Epidemiology and Aging Research
School of Primary Care
School of Psychology
Southampton Clinical Trials Unit
Faculty of Medicine
Department of Epidemiology and Evidence-Based Medicine
Department of Paediatrics and Paediatric Infectious Diseases
Department of Woman and Child Health and Public Health
Global Health Research Institute
Department of Health Care Management
School of Pharmacy
Faculty of Health Sciences
Department of Health Management (Direzione Sanitaria)
Interdisciplinary Research Center for Health Science
Oncological Network
Dermatology Unit
PhD Program in Molecular and Translational Medicine (DIMET)
Faculty of Health Sciences
Department of Psychiatry
Division of Country Health Policies and Systems (CPS)
Mental Health Flagship
Department of Pharmacological and Biomolecular Sciences
Department of Food
Department of Clinical Sciences and Community Health
MultiMedica Sesto San Giovanni IRCCS
Department of Medical
Public Health Unit
Mary MacKillop Institute for Health Research
School of Public Health
Department of Urban Planning and Design
Institute of Clinical Physiology
Department of Biology
Department of Medicine
Saw Swee Hock School of Public Health
Department of Community Medicine
The Interdisciplinary Research Group on Biomedicine and Health
Faculty of Applied Sciences
Department of Paediatric Surgery
Health Data Research UK
Nova Medical School
Department of Child and Adolescent Psychiatry
Department of Population Health
Department of Family Medicine and Public Health
Department of Diagnostic and Therapeutic Technologies
Research Center for Child Psychiatry
Heart Center
Department of Clinical Neurosciences
Centre for Public Health
Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia
Department of Biomedical and Biotechnological Sciences
Department of General Surgery and Medical-Surgical Specialties
Department of Public Health
Department of Clinical Toxicology
Faculty of Life Sciences and Medicine
Department of Twin Research and Genetic Epidemiology
School of Population Health and Environmental Sciences
School of Life Course and Population Sciences
Department of Biochemistry
Department of Legal Medicine
Department of Neurosurgery
Department of Neurosurgery
St Pauls Eye Unit
Department of Ophthalmology
2nd Cardiology Department
School of Medicine
Second Department of Cardiology
Department of Epidemiology and Public Health
Department of Translational Physiology
Sheffield Teaching Hospitals NHS Foundation Trust
Division of Pathology
Department of Epidemiology
Department of Epidemiology
Care and Public Health Research Institute (CAPHRI)
Health Science Center
Cardio-Thoraco-Vascular Department
South Plainfield
Department of Epidemiology and Biostatistics
Department of Population and Behavioural Sciences
Faculty of Science and Humanities
Department of Infection and Tropical Medicine
Department of Conservative Dentistry with Endodontics
School of Nursing and Midwifery
School of Nursing and Midwifery
Centre for Global Health Inequalities Research (CHAIN)
Department of Circulation and Medical Imaging
Faculty of Science and Health
Almoosa College of Health Sciences
School of Population and Global Health
Faculty of Medicine
Houston Methodist Hospital
Department of Pediatrics
Department of Biomedical Sciences
Dermatology Unit
Research Centre for Healthcare and Community
Faculty of Health and Life Sciences
Department of Periodontology and Community Dentistry
Department of Medicine
Department of Food Hygiene and Quality Control
Epidemiology and Biostatistics Unit
Dissemination Division
Activity Planning and Control Unit
Department of Biology
Department of Statistics
Department of Chemistry
Department of Biology
Department of Business Administrations
Department of Medical Biochemical Analysis
Department of Veterinary Tropical Diseases
School of Health Systems & Public Health
Animal Production and Health Division (EMPRES)
Department of Biology and Medicine
Laboratory of Experimental Medicine
Research and Publication Activity Division
Department of Infectious Diseases and Public Health
Department of Pharmacy
Department of Nursing
National Institute of Environmental Health
Division of Neurology
Institute of Health Policy
Division of Neurosurgery
Department of Translational Medicine
Center for Public Health Research
Laboratory of Public Health
Department of Social Sciences

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