Global, regional, and national burdens of traumatic brain injury in adolescents and young adults aged 10-24 years from 1990 to 2021: A secondary analysis of the Global Burden of Disease Study 2021

Global, regional, and national burdens of traumatic brain injury in adolescents and young adults aged 10-24 years from 1990 to 2021: A secondary analysis of the Global Burden of Disease Study 2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Global, regional, and national burdens of traumatic brain injury in adolescents and young adults aged 10-24 years from 1990 to 2021: A secondary analysis of the Global Burden of Disease Study 2021 Nanyu Yao, Yunfei li, Weiming Liu, Liang Wu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7613312/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Jan, 2026 Read the published version in Discover Public Health → Version 1 posted 13 You are reading this latest preprint version Abstract Background Traumatic brain injury (TBI) remains a critical global public health challenge, yet gaps in the evidence limit an understanding of its age-specific epidemiological profiles among adolescents and young adults. The aim of our analysis is to generate actionable evidence for tailoring prevention strategies and context-specific interventions aligned with the global epidemiological dataset in this population from 1990 to 2021. Methods We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, which reported on TBI-related years lived with disability (YLDs), prevalence, and annual average percentage change (AAPC) per 100,000 people. Joinpoint regression analysis was used to identify years with significant trend shifts. We also performed stratified analyses by age, sex, and sociodemographicindex (SDI). Furthermore, we used the Bayesian age-period-cohort (BAPC) model to project the TBI burden through 2030. Results From 1990 to 2021, the prevalence of TBI among adolescents and young adults decreased from 191·3 per 100,000 people [177 to 208·9] to 128·3 per 100,000 people [117·8 to 139·1] (AAPC -1·28 [95% CI-1·31 to -1·26], p<0·001). Specific changes in the prevalence of TBI occurred in 2001, 2005, 2010, and 2017. Regionally, eastern sub-Saharan Africa had the most substantial reduction in prevalence rate (AAPC=-2·34[-2·62 to -2·05]) and YLD rates (AAPC=-2·32[-2·62 to -2·02]). The prevalence rate of TBI and YLDs attributable to TBI decreased in most countries except the Syrian Arab Republic, Yemen, Libya, Haiti, and the Central African Republic. Eritrea showed the most pronounced reduction in the TBI prevalence rate (AAPC=-7·6 95% UI: -7·76 to -7·45). The prevalence rate substantially decreasedin both sexes. The AAPC was -1·3 (95% CI -1·33 to -1·27) for males, which was comparable to the AAPC of -1·28 (95% CI -1·34 to -1·23) observed in females. Thelargest decrease in TBI prevalence from 1990 to 2021 was found among individuals aged 10-14 years (AAPC=-1·45[-1·49 to -1·41]). In terms of the SDI quintile, the most pronounced reductions in TBI prevalence and YLD rates occurred in the high-SDI quintile countries. Among all causes of TBI, falls constitute the leading etiology, with its proportional contribution rising steadily from 31·9% in 1990 to 37·7% in 2021. However,the BAPC analysis predicted that the prevalence of TBI and YLDs attributable to TBI would increasefrom 2022 to 2030. Conclusions The global burden of TBI in adolescents and young adults aged 10-24 years decreased from 1990 to 2021. This study is the first to report the global disease burden and temporal trends of TBI in adolescents and young adults. Although the disease burden has decreased in most regions, attention should still be givento specific regions to strengthen policy development and disease management. Traumatic brain injury Prevalence Years lived with disability GBD 2021 Adolescents Young adults Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Traumatic brain injury (TBI) is increasingly recognized as a neurological disease that threatens global health. (GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators 2019 ) Research indicates that approximately 50 million new cases of traumatic brain injury (TBI) occur globally each year. (GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators 2019 ) While the global incidence of TBI in adults has been systematically analyzed and evaluated, few studies have reported results in adolescents and young adults aged 10–24 years. During their developmentally active stages, children and adolescents are at significantly greater risk of TBI because of unintentional injury such as falls, sports-related impacts, or road traffic accidents.(“Environmental modifications to rehabilitate social behavior deficits after acquired brain injury” 2023) According to WHO statistics, approximately 10 million children in the world seek medical treatment for TBI every year,(“Brain health” n.d.) which leads to TBI in children and adolescents accounting for 20%-30% of all TBI cases, which is one of the common causes of emergency visits and places a considerable burden on global health problems and economic conditions.(Brown et al. 2022 ; Mariajoseph et al. 2022 ; Moore et al. 2024 ) In addition, the nervous systems of adolescents and young adults aged 10–24 years are still developing, so TBI may have longer-term effects, such as on cognitive function, behavioral problems, or mood disorders.(Ledoux et al. 2022 ; Mayer et al. 2018 ) Mild illness may lead to irreversible cognitive impairment presenting as poor concentration and learning ability, memory loss, and impaired language function, whereas emotional illness may cause long-term mental health problems such as anxiety disorders, posttraumatic stress disorders, and severe TBI, which may also lead to lifelong disability.(Iverson et al. 2017 ) TBI in adolescents and young adults presents multifaceted and unique challenges in both pathophysiological mechanisms and clinical management.(Cruz-Haces et al. 2017 ) These challenges arise not only from the inherent vulnerability of developing neurophysiological systems but also from distinct neurobehavioral profiles, systemic delays in diagnosis and intervention, and the amplified cascade of secondary injuries.(Bonfield et al. 2014 ; Ledoux et al. 2022 ) Children and adolescents are also different from adults in that some children have poor expression skills, some hidden problems are not easy to detect, and diagnosis and treatment are often delayed, resulting in a serious risk of sequelae.(“A population-based study of inflicted traumatic brain injury in young children | traumatic brain injury | JAMA | JAMA network” n.d.) At the sociological level, adolescent TBI not only disrupts the personal development trajectory(“Centers for disease control and prevention | CDC” n.d.) but also exacerbates the burden of family care and socioeconomic costs.(“Centers for disease control and prevention | CDC” n.d.) Previous studies have shown that the prevalence of TBI in children and adolescents varies widely across countries, but no studies have analyzed data concerning this disease in different countries or regions. Therefore, the aim of this study is to describe global trends in the prevalence of TBI and disability-adjusted life years in children and adolescents from 1990 to 2021; stratify global trends by age group, sex, and sociodemographic index (SDI); reveal regional and national trends; provide insights for management and targeted programs in health planning and resourcing inform; and provide the basis for policy and implementation strategies aimed at mitigating the impact of TBI. Methods Data sources and case definitions This analysis was based on data obtained from the Global Burden of Disease Study (GBD) 2021, which is presently being coordinated by the Institute for Health Metrics and Evaluation (IHME). The GBD 2021 study was published in 2024 and included epidemiologic assessments of 288 causes of death, 371 diseases and injuries, and 88 risk factors across 204 countries and territories.(GBD 2021 Diseases and Injuries Collaborators 2024 ) The 10th iteration of the international classification of disease codes for TBI were F07·2,F07·8,F08·81,F07·89,F07·9,S06,S07,T90·2,and T90·5. We employed multiple metrics to determine the global burden of TBI in the adolescents and young adults, including incidence, prevalence, years lived with disability and the sociodemographic index. The WHO defines the 10–19 year age group as adolescents on the basis of their physiological, psychological, and social development characteristics.(“The age of adolescence - PubMed” n.d.) In our study, to enable a more detailed analytical investigation, we categorized adolescents and young adults into three age-specific subgroups: younger adolescents (aged 10–14 years), older adolescents (aged 15–19 years), and young adults (aged 20–24 years). Years lived with disability (YLDs) reflects nonfatal health loss, derived by multiplying the age-adjusted prevalence of TBI-related sequelae by their corresponding GBD disability weights, which range from 0 (full health) to 1 (death). The sociodemographic index (SDI) is a comprehensive indicator designed to evaluate national and regional development status and is calculated on the basis of income per capita, average years of education among individuals aged 15 years and older, and the total fertility rate for women under 25 years of age. In GBD 2021, SDI values (ranging from 0 to 1) were categorized into five quintiles: high, high-middle, middle, low-middle, and low-SDI regions. Higher SDI values are correlated with advanced national development, longer education attainment, and lower fertility rates. To analyze the global burden of TBI across diverse demographic dimensions, the population was stratified into distinct subgroups by age, sex, geographic region, and SDI quintile for comparative assessment. Statistical analysis In this study, we analyzed the prevalence, YLDs and underlying etiological trends of TBI across different regions, countries, and SDI levels, stratified by age subgroups (10–14 years, 15–19 years, and 20–24 years) and sex (male and female). The prevalence and YLDs with 95% uncertainty intervals (UIs) were the main indicators used to describe the TBI burden of adolescents and young adults. To assess temporal trends, we employed joinpoint regression analysis to calculate the annual percentage change (APC) and average annual percentage change (AAPC) with corresponding 95% confidence intervals (CIs). The APC reflects the annual rate of change in the aforementioned metrics, whereas the AAPC, derived through geometric weighting of the APC values, provides a consolidated measure of the overall average trend over multiple years. This approach simplifies complex temporal patterns into a single metric, where an AAPC > 0 indicates a cumulative increase and an AAPC < 0 signifies a decrease relative to baseline values. For our analysis, AAPCs were calculated for three intervals: 1990–1999, 2000–2009, and 2010–2021. A pivotal component of the joinpoint regression framework is the identification of statistically significant inflection points (joinpoints) over the 32-year span (1990–2021). This method iteratively evaluates annual trends to detect years with marked shifts in the TBI burden. By fitting segmented linear models on a log-transformed scale, we derived the most parsimonious model describing the data. A model with k joinpoints divides the timeline into k + 1 linear segments; a null model (k = 0) corresponds to a monotonic trend. The optimal number of joinpoints was determined through permutation testing (Monte Carlo simulation, 10,000 iterations) and the weighted Bayesian information criterion (WBIC) to balance model fit and complexity. We subsequently employed a Bayesian Age-Period-Cohort (BAPC) model, calibrated with epidemiological data and sociodemographic covariates from the Global Burden of Disease (GBD) database, to project the global burden of TBI (including prevalence and YLDs) among adolescents and young adults aged 10–24 years through 2030. All the statistical analyses were conducted using R software (version 4·3·2). A 2-sided p value < 0·05 was considered statistically significant. Results Global trends The prevalence of TBI demonstrated a significant and progressive decline over the three-decade period from 1990–2021 (AAPC − 1·28 [95% UI -1·31 to -1·26], p < 0.001) among adolescents and young adults aged 10–24 years. Moreover, the rate of decline observed from 2010–2021 (AAPC − 1·64 [95% UI -1·72 to -1·6]) exceeded those documented during both the 1990–1999 (AAPC − 1·06 95% UI -1·11 to -0·98) and 2000–2009 (AAPC − 1·13 95%UI -1·2 to -1·06) periods. The TBI prevalence in 2021 (128·3 per 100,000 population [ 117·8 to 139·1]) was lower than the prevalence in 1990 (191·3 per 100,000 population [177 to 208·9]). In 2021, there were 0·24 million (95% CI 0·22 to 0·26) TBI cases in adolescents and young adults, comprising 0·16 (95% CI 0·15 to 0·18) million male patients and 0·079 (95% CI 0·072 to 0·087) million female patients. Furthermore, the global YLDs from TBI decreased from 1990 to 2021 (AAPC of -1·3 95% UI from − 1·34 to -1·26) (Table 1 ). The joinpoint regression analysis revealed statistically significant changes in the prevalence of TBI in 2001, 2005, 2010, and 2017 (Fig. 1 ). Table 1 Global AAPC in prevalence and YLDs of TBI in adolescents and young adults of 10–24 years old. Year Prevalence YLDs AAPC (95%CI) P value AAPC (95%CI) P value 1990-99 -1·06 (-1·11 to -0·98) < 0·001 -1·03 (-1·09 to -0·94) < 0·001 2000-09 -1·13 (-1·2 to -1·06) < 0·001 -1·11 (-1·19 to -1·03) < 0·001 2010-21 -1·64 (-1·72 to -1·6) < 0·001 -1·67 (-1·73 to -1·63) < 0·001 1990–2021 -1·3 (-1·34 to -1·27) < 0·001 -1·3 (-1·34 to -1·26) < 0·001 AAPC, average annual percentage change; YLDs, years lost due to disability; CI, confidence interval. Global trends by sex Overall, sex-stratified analysis revealed a marked decrease in the prevalence of TBI among both males and females from 1990 to 2021 (Table 2 ). The AAPC was − 1·3 (95% UI -1·33 to -1·27) for males, which was comparable to the AAPC of -1·28 (95% UI -1·34 to -1·23) observed in females. The prevalence has substantially decreased over the past three decades (1990–2021) in both sexes. In 2021, the prevalence per 100,000 people in males (168 [95% CI 154·8–182·7]) was 1·9-fold greater than that in females (86·6 [95% CI 79·1–94·6]). Table 2 The YLDs and prevalence of TBI in adolescents and young adults of 10–24 years old, and their temporal trends from 1990 to 2021 at the global and regional levels. Cases (n), 1990 YLDs (per 100,000 population), 1990 Cases (n), 2021 YLDs (per 100,000 population), 2021 AAPC, 1990- 2021 P value Cases (n), 1990 Prevalence (per 100,000 population), 1990 Cases (n), 2021 Prevalence (per 100,000 population), 2021 AAPC, 1990–2021 P value Global 446340·4 (316427·3-601905·6) 28·8 (20·5–38·9) 366026·8 (258535–491474·7) 19·4 (13·7–26) -1·28 (-1·31 to -1·25) < 0·001 2960144·5 (2737972·7-3232185·8) 191·3 (177–208·9) 2422398·4 (2224582·8-2626047) 128·3 (117·8-139·1) -1·28 (-1·31 to -1·26) < 0·001 Sex Male 301405·2 (213451·3-406657·7) 38·3 (27·2–51·7) 248098·4 (174188·3-333134·2) 25·6 (18–34·4) -1·28 (-1·31 to -1·25) < 0·001 1985923·5 (1831102·6-2189087·4) 252·6 (232·9-278·5) 1625678·4 (1497974·5-1767418·2) 168 (154·8-182·7) -1·3 (-1·33 to -1·27) < 0·001 Female 144935·2 (101694·8-197043·3) 19 (13·4–25·9) 117928·4 (83211·9-158999·1) 12·8 (9–17·3) -1·34 (-1·39 to -1·28) < 0·001 974221 (908319·4-1043547·8) 128 (119·3-137·1) 796719·9 (727661·3-870604·5) 86·6 (79·1–94·6) -1·28 (-1·34 to -1·23) < 0·001 Age, group, years 10–14 91593·3 (64688·9-126943·9) 17·1 (12·1–23·7) 73258·3 (52644·8-99273·2) 11 (7·9–14·9) -1·46 (-1·51 to -1·41) < 0·001 610888·6 (560259·8-667047·9) 114 (104·6-124·5) 489052·9 (443051·3-540992·4) 73·4 (66·5–81·2) -1·45 (-1·49 to -1·41) < 0·001 15–19 142399·7 (99505·9-194486) 27·4 (19·2–37·4) 113661·4 (80151·1-154777·2) 18·2 (12·8–24·8) -1·32 (-1·35 to -1·29) < 0·001 943054·2 (863612·1-1036423·3) 181·6 (166·3-199·5) 752592·3 (680795·8-827340) 120·6 (109·1-132·6) -1·32 (-1·34 to -1·28) < 0·001 20–24 212347·4 (150506·7-284623·2) 43·2 (30·6–57·8) 179107·2 (126419·6-238948·7) 30 (21·2–40) -1·17 (-1·19 to -1·15) < 0·001 1406201·6 (1299869·1-1537469·8) 285·8 (264·2-312·4) 1180753·1 (1089856·7-1278563) 197·7 (182·5-214·1) -1·18 (-1·2 to -1·17) < 0·001 Sociodemographic index High 60037 (40947·1-82343·4) 30·7 (20·9–42) 37046·5 (24823·4-51700·7) 20 (13·4–27·9) -1·45 (-1·51 to -1·4) < 0·001 431184·9 (395583·8-474816·6) 220·2 (202–242·4) 266258·7 (243500·5-294348·2) 143·5 (131·2-158·6) -1·45 (-1·51 to -1·39) < 0·001 High-middle 102610·6 (71221·7-140671·5) 36·2 (25·1–49·6) 55204·9 (38027·8-77125·8) 24·4 (16·8–34·1) -1·26 (-1·33 to -1·19) < 0·001 677322·4 (635492·3-724723·1) 238·7 (223·9-255·4) 367064·7 (340684·4-397850) 162·5 (150·8-176·1) -1·24 (-1·31 to -1·17) < 0·001 Middle 163738·5 (115589·8-219185·7) 29·8 (21·1–39·9) 115216·4 (81413·2-153529·7) 20·8 (14·7–27·8) -1·13 (-1·18 to -1·1) < 0·001 1062220·2 (985545·5-1145275) 193·5 (179·6-208·7) 751401·6 (688258·6-816930·4) 135·9 (124·5-147·8) -1·11 (-1·16 to -1·08) < 0·001 Low-middle 83065·9 (58762·8-112236·4) 23 (16·2–31) 93303·6 (66104·2-125225·9) 16·9 (12–22·7) -1·03 (-1·08 to -0·96) < 0·001 545684·4 (498247–610374·5) 150·9 (137·7-168·7) 609267·8 (561467·5-659203·5) 110·2 (101·6-119·3) -1·04 (-1·09 to -0·99) < 0·001 Low 36381·3 (26141·8-49528·5) 23·4 (16·8–31·8) 64809·9 (47122–84273·3) 17·5 (12·8–22·8) -1·02 (-1·19 to -0·85) < 0·001 240396·4 (198209·2-315855) 154·4 (127·3-202·9) 425468·2 (372848·6-490645·2) 115·2 (100·9-132·8) -0·92 (-1·13 to -0·76) < 0·001 Region Andean Latin America 3523 (2525·7-4768·6) 28·6 (20·5–38·7) 3507·9 (2421·3-4912·1) 20·3 (14–28·5) -1·12 (-1·18 to -1·07) < 0·001 23039·4 (20394·1-26896·3) 187·2 (165·7-218·5) 22943·7 (21347·8-24879·4) 132·9 (123·7-144·1) -1·15 (-1·19 to -1·1) < 0·001 Australasia 2154·5 (1476·3-3027·7) 44·8 (30·7–62·9) 2000·5 (1340–2804·4) 34·9 (23·4–48·9) -0·82 (-0·83 to -0·8) < 0·001 16257 (14328·9-18695·3) 337·9 (297·8-388·6) 15152 (13242·5-17602) 264·1 (230·8-306·8) -0·8 (-0·81 to -0·79) < 0·001 Caribbean 2714·8 (1853·8-3728·4) 25·4 (17·4–34·9) 5084·4 (3679–6771·3) 44·9 (32·5–59·8) 1·74 (1·15 to 2·29) < 0·001 17707·9 (16676·1-18831·6) 165·8 (156·2-176·3) 33544·4 (25652·4-46345·1) 296·1 (226·5-409·1) 1·77 (1·15 to 2·4) < 0·001 Central Asia 7389·5 (5092·3-10007·6) 37·3 (25·7–50·5) 5883·1 (4097–8197·2) 26·6 (18·5–37) -0·97 (-1·09 to -0·85) < 0·001 48417·3 (44864·2-52473·6) 244·1 (226·2-264·6) 38694·7 (35736·8-41833·1) 174·9 (161·5-189·1) -0·98 (-1·08 to -0·88) < 0·001 Central Europe 17357·8 (11665·1-24057·4) 59·4 (40–82·4) 7818·5 (5262·7-10947·2) 43·1 (29–60·4) -1·03 (-1·08 to -0·99) < 0·001 113977·2 (105006–123172·6) 390·4 (359·6-421·8) 51516·8 (46939·7-56674·8) 284·1 (258·8-312·5) -1·03 (-1·07 to -1) < 0·001 Central Latin America 25707·4 (18128·5-34360·8) 47·4 (33·4–63·3) 19468·7 (13141·3-26724·8) 29·9 (20·2–41·1) -1·46 (-1·54 to -1·39) < 0·001 168919 (152011·2-189256·7) 311·3 (280·2-348·8) 127041·7 (117700·6-137077·6) 195·3 (181–210·8) -1·48 (-1·56 to -1·4) < 0·001 Central Sub-Saharan Africa 3802·7 (2716·7-5064·8) 22 (15·7–29·3) 7053·1 (4839·7-9662·4) 15·7 (10·8–21·5) -1·12 (-1·34 to -0·92) < 0·001 25060·8 (22253·4-28793) 144·8 (128·6-166·4) 45918·5 (42213·8-50085·8) 102·2 (93·9-111·4) -1·17 (-1·34 to -1) < 0·001 East Asia 98886·2 (68274·2-136623·5) 26·6 (18·3–36·7) 45431·1 (31014·2-62126·9) 18·7 (12·8–25·6) -1·14 (-1·21 to -1·09) < 0·001 635257·1 (595473·2-675356·5) 170·7 (160–181·5) 292541·9 (271783·4-316004·1) 120·4 (111·8-130) -1·14 (-1·22 to -1·08) < 0·001 Eastern Europe 30434·3 (20772·4-41599·4) 64·4 (44–88·1) 12847·5 (8771·7-17577·1) 38·9 (26·6–53·3) -1·63 (-1·69 to -1·6) < 0·001 198175·6 (185206·6-213994·8) 419·6 (392·1-453·1) 83791·6 (77639·5-91565) 254 (235·3-277·5) -1·63 (-1·68 to -1·6) < 0·001 Eastern Sub-Saharan Africa 16097·9 (11357·6-22618·7) 26 (18·3–36·5) 18830·4 (13029·7-25330·2) 12·9 (9–17·4) -2·32 (-2·62 to -2·02) < 0·001 105652·1 (81837·8-143637·2) 170·3 (131·9-231·5) 123342·7 (113034·1-137356·7) 84·8 (77·7–94·4) -2·34 (-2·62 to -2·05) < 0·001 High-income Asia Pacific 11399·9 (7929·5-15831·9) 27·1 (18·8–37·6) 4333·6 (2943·1-6181·5) 16·6 (11·3–23·7) -1·59 (-1·62 to -1·56) < 0·001 84217·3 (76759·4-93704·2) 199·9 (182·2-222·4) 32131·2 (28847·2-36358·8) 123·1 (110·5-139·3) -1·57 (-1·6 to -1·55) < 0·001 High-income North America 16267·2 (11047·9-22434·7) 26·6 (18·1–36·7) 9957·9 (6666·6-13767·5) 14 (9·4–19·3) -2·08 (-2·13 to -2·02) < 0·001 120049·2 (109272·3-133793·8) 196·2 (178·6-218·7) 73669·3 (67226·8-81716·4) 103·4 (94·3-114·6) -2·09 (-2·14 to -2·04) < 0·001 North Africa and Middle East 50691·8 (36921·7-67159·5) 46·5 (33·9–61·7) 53942·4 (38862·3-70302·3) 33·2 (23·9–43·3) -1·08 (-1·14 to -1·01) < 0·001 331430·5 (289379·6-399714·2) 304·3 (265·7-367) 353296·1 (302313·2-420339·2) 217·7 (186·3-259) -1·04 (-1·11 to -0·99) < 0·001 Oceania 336·3 (226·5-463·3) 16·1 (10·8–22·1) 768·7 (538·8-1041·1) 19·1 (13·4–25·8) 0·49 (0·28 to 0·71) < 0·001 2174·3 (2022·6-2324·1) 103·9 (96·7-111·1) 4958·7 (4490·6-5510·2) 123 (111·4-136·6) 0·52 (0·4 to 0·66) < 0·001 South Asia 60751·1 (42196·7-82470·6) 18·2 (12·6–24·7) 77102·7 (54475·1-102849·7) 14·7 (10·4–19·6) -0·75 (-0·86 to -0·65) < 0·001 400566·8 (369727·5-434429·1) 119·8 (110·5-129·9) 505944·7 (465105–551396·3) 96·2 (88·4-104·9) -0·76 (-0·85 to -0·68) < 0·001 Southeast Asia 38330·6 (26919·4-51980·4) 25·8 (18·1–35) 31517·6 (22943·4-41800·4) 18·4 (13·4–24·4) -1·1 (-1·22 to -1·01) < 0·001 248756·9 (221085·8-302126·7) 167·7 (149–203·6) 205117·3 (184722·7-230780·9) 119·9 (108–135) -1·09 (-1·22 to -0·98) < 0·001 Southern Latin America 3316·1 (2210·2-4626·7) 25·1 (16·7–35) 3807·4 (2585·7-5369·7) 24·8 (16·9–35) -0·04 (-0·06 to -0·02) < 0·001 24933·1 (21667·4-28867·2) 188·4 (163·7-218·1) 28640·6 (25033·5-33012·7) 186·7 (163·2-215·3) -0·03 (-0·05 to -0·01) 0·0016 Southern Sub-Saharan Africa 4560·8 (3230–6214·7) 26·7 (18·9–36·4) 3686 (2507·1-5086·4) 16·9 (11·5–23·3) -1·47 (-1·49 to -1·45) < 0·001 29398·7 (27100·7-31989·8) 172·1 (158·6-187·3) 23701·7 (22144·9-25451) 108·7 (101·5-116·7) -1·48 (-1·49 to -1·46) < 0·001 Tropical Latin America 18974·5 (13084·4-26252·1) 39·6 (27·3–54·9) 16500·8 (11543·6-22602·3) 32·6(22·8–44·7) -0·62 (-0·63 to -0·61) < 0·001 124098·3 (114468·4-135234·3) 259·3 (239·2-282·6) 107648·2 (98277–118988·4) 212·8 (194·3-235·3) -0·64 (-0·65 to -0·62) < 0·001 Western Europe 25102·6 (16959–34948·5) 30·5 (20·6–42·5) 15624·6 (10569·9-22144·9) 21·7 (14·7–30·7) -1·11 (-1·12 to -1·1) < 0·001 185715·6 (168035–206208·1) 225·9 (204·4-250·9) 116221 (103068·9-132486·1) 161·2 (143–183·8) -1·09 (-1·1 to -1·08) < 0·001 Western Sub-Saharan Africa 8541·2 (5824·4-11564·7) 14·3 (9·7–19·3) 20860·1 (14847·3-28636·4) 12·9 (9·2–17·7) -0·26 (-0·33 to -0·2) < 0·001 56340·4 (52602·5-60111·4) 94·1 (87·9-100·4) 136581·7 (126365·4-147848) 84·6 (78·3–91·6) -0·32 (-0·39 to -0·26) < 0·001 Abbreviation: AAPC, age-standardized rates and average annual percent changes; UI, uncertainty interval; CI, confidence interval. Global trends by age group Globally, over the three-decade period from 1990–2021, the largest decrease in the prevalence of TBI was found among individuals aged 10–14 years (AAPC=-1·45[-1·49 − 1·41]), which was greater than the decline rates documented in the 15–19 years (AAPC=-1·32[-1·34 − 1·28]) and 20–24-years (AAPC=-1·18[-1·2 − 1·17]) age groups (Table 2 ). Specifically, the prevalence in the 10–14-year age group declined from 114 (95% UI 104·6–124·5) per 100,000 people in 1990 to 73·4 (95% UI 66·5–81·2) per 100,000 people in 2021. Similarly, the 15–19-year cohort showed a reduction from 181·8 (95% UI 166·3–199·5) per 100,000 people to 120·6 (95% UI 109·1–132·6) per 100,000 people, whereas the 20–24-year cohort exhibited a decrease from 285·8 (95% UI 264·2–312·4) per 100,000 people to 197·7 (95% UI 182·5–214·1) per 100,000 people over the same period. These age-stratified patterns suggest an inverse association between age and the magnitude of TBI prevalence reduction within the 10–24-year demographic. Global trends by SDI From the SDI perspective, all five SDI quintiles exhibited declining trends in TBI prevalence between 1990 and 2021 (Table 2 ). The most pronounced reduction in the TBI prevalence per 100,000 people occurred in the high-SDI quintile countries (from 220·2[202–242·4] to 143·5[131·2 to 158·6]; AAPC=-1·45[-1·51 to -1·39]). However, the highest prevalence rates consistently clustered in the high–middle-SDI quintile countries, decreasing from 238·7 (95% UI 223·9–255·4) to 162·5 (95% UI 150·8–176·1) per 100,000 people over this period. In contrast, the highest absolute case burden remained concentrated in middle-SDI nations, with case counts declining from 1062220·2 (95% UI 985545·5-1145275) in 1990 to 751401·6 (95% UI 688258·6-816930·4) in 2021, consistently surpassing other SDI strata throughout the three-decade interval. Notably, the magnitude of the reduction in the prevalence of TBI correlated positively with national development levels, as quantified by the SDI. This gradient pattern was paralleled by similar declines in YLDs across all SDI quintiles. However, a distinct epidemiological profile emerged: the low- and low-middle-SDI quintiles presented nearly identical rates of YLD reduction, deviating from the steeper gradients observed in the higher-SDI groups. Regional trends Regional analyses revealed heterogeneous trends in TBI prevalence per 100,000 people between 1990 and 2021, with all regions demonstrating decreases of varying magnitudes. Eastern sub-Saharan Africa experienced the most substantial reduction, with the prevalence decreasing from 170·3 (95% UI 131·9 to 231·5) to 84·8 (95% UI 77·7 to 94·4) (AAPC=-2·34[-2·62 to -2·05]) (Table 2 ). This contrasts sharply with southern Latin America, where the prevalence showed minimal change, declining marginally from 188·4 (95% UI 163·7 to 218·1) to 186·7 (95% UI 163·2 to 215·3) (AAPC= -0·03[-0·05 to -0·01]). Notably, the Caribbean and Oceania exhibited divergent epidemiological patterns, with the prevalence increasing (from 165·8 [156·2-176·3] to 296·1 [226·5 to 409·1]; AAPC = 1·77 [1·15 to 2·4]) and (from 103·9 [96·7-111·1] to 123 [111·4 to 136·6]; AAPC = 0·52 [0·4 to 0·66]), respectively, over the three-decade period. Despite eastern Sub-Saharan Africa's marked progress, the prevalence of TBI in 2021 has remained marginally higher than western Sub-Saharan Africa's rate of 84·6 (95% UI: 78·3–91·6). In particular, the Caribbean emerged as the global epicenter of TBI burden by 2021, with a prevalence of 296·1 (95% UI: 226·5 to 409·1) per 100,000 people. YLDs attributable to TBI paralleled these prevalence trends across regions, demonstrating similar geographical gradients in both magnitude and direction of change (Table 2 & Fig. 2 ). National trends At the national level, most countries demonstrated declining trends in prevalence and YLDs, whereas a subset presented increasing prevalence. Notable increases were observed in the Syrian Arab Republic, Yemen, Libya, Haiti, and the Central African Republic. The Syrian Arab Republic had the most substantial increase, with the prevalence of TBI increasing from 171·3 (95% UI:151·9 to 208) per 100,000 people in 1990 to 565·9(95% CI:343·5 to 907·4) per 100,000 people (AAPC = 4·08 95% UI: 3·56 to 4·61) in 2021. In addition, Haiti had the highest national prevalence of 577·2(95% CI: 383·4 to 894·8) per 100,000 people in 2021. Among countries with declining trends, Eritrea showed the most pronounced reduction, decreasing from 946·6 (95% UI:526·6 to 1,573·3) per 100,000 people in 1990 to 87·5 (95% UI:81·5–95·3) per 100,000 people in 2021 (AAPC=-7·6 95% UI: -7·76 to -7·45). Madagascar recorded the lowest 2021 prevalence at 64·8 (95% UI: 60·3–69·7) per 100,000 people. Parallel trends emerged regarding YLDs between 1990 and 2021. The Syrian Arab Republic presented the largest increase in YLDs (26·0 [17·5–35·7] to 83·4 [54·8–124·0] per 100,000; AAPC = 3·99 [3·63–4·30]), whereas Eritrea presented the steepest decline (143·8 [89·4–231·8] to 13·5 [9·1–19·0] per 100,000 people; AAPC= -7·61 [-7·82 to -7·4]) (Supplementary Table S1 & Fig. 2 ). Causes of TBI From 1990 to 2021, TBI etiologies were attributed predominantly to nine major causes: motorcyclist road injuries, pedestrian road injuries, falls, physical violence by other means, other transport injuries, motor vehicle road injuries, cyclist road injuries, other road injuries, and other unspecified causes. Falls consistently constituted the leading etiology, with its proportional contribution rising steadily from 31·9% in 1990 to 37·7% in 2021. Among road injury subtypes, motorcyclist road injuries initially increased, followed by a decrease (from 5·3% to 6·13% to 5·72%), whereas pedestrian (from 10·7% to 5·8%), motor vehicle (from 13·9% to 10·4%), and cyclist (from 5·2% to 4·5%) road injuries demonstrated progressive reductions in the proportional burden over the study period. Notably, physical violence by other means maintained a stable share of TBI etiologies throughout the three-decade interval, with minimal fluctuations in its proportional contribution (1990: 10·99%; 2021: 10·98%). These epidemiological patterns underscore the shifting landscape of TBI cause, with falls emerging as an increasingly dominant driver of the global TBI burden (Fig. 3 & Fig. 4 ). Predictions of TBI burden We concluded that the prevalence and YLDs showed an increasing trend from 2022 to 2030 (Fig. 5 ). Globally, there will be 2489403 (95% CI: 123691–7048780) TBI cases in adolescents and young adults aged 10–24 years in 2030. Discussion Our study provides the first systematic assessment of the global, regional, and national burdens of TBI among adolescents and young adults aged 10–24 years from 1990 to 2021, including prevalence rates and YLDs. Our findings indicate a sustained decline in prevalence rates and YLDs over the past three decades, particularly in high-SDI quintile countries, which is likely attributable to advancements in health care accessibility and trauma prevention policies. Notably, however, the TBI burden in high-SDI regions remains substantial, potentially linked to persistent high-risk behaviors and improved diagnostic sensitivity. Compared with populations aged ≥ 25 years, adolescents and young adults exhibit distinct TBI etiology profiles and intervention priorities.(Dewan et al. 2016 ; Maas et al. 2017 ) While adult TBI predominantly correlates with occupational injuries, alcohol-related incidents, and falls in older adults,(Maas et al. 2017 ; L et al. 2025 ) younger populations face heightened vulnerability due to underdeveloped risk perceptions, peer pressure, and emerging recreational trends.(McCrory et al. 2017 ) Furthermore, the overlap of TBI recovery phases with critical educational and vocational developmental stages may exacerbate long-term neurofunctional sequelae, contributing to human capital loss—a dimension inadequately addressed in current public health frameworks. In 2021, the global YLDs and prevalence rates of TBI exhibited marked regional heterogeneity. The highest YLDs were concentrated in the Caribbean and European regions and Oceania, whereas high-income North America demonstrated a relatively lower disease burden. This distribution pattern may be closely linked to underdeveloped road transport infrastructure, insufficient health care resources, and high rates of violence in developing regions.(Tropeano et al. 2019 ) For example, widespread motorcycle use and lax enforcement of traffic regulations in West Africa contributed to elevated TBI cases associated with road accidents, whereas rapid urbanization-related construction hazards and ongoing violent conflicts exacerbated TBI risks in parts of Southeast Asia.(GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators 2019 ; Venturini et al. 2019 ) Notably, despite their lower YLDs, high-income regions such as Western Europe and North America reported prevalence rates as high as 210·9 (184·4–243·6) per 100,000 people in certain areas. This discrepancy may reflect the enhanced diagnostic capacity for mild TBI within robust health care systems. However, whether a higher prevalence translates to increased long-term disability risk requires further investigation incorporating injury severity stratification.(Darji et al. 2025 ) From 1990 to 2021, most regions presented declining trends in both YLDs and prevalence rates, with negative AAPCs. These improvements likely stem from global advancements in traffic safety legislation (e.g., mandatory helmet laws, drunk-driving regulations) and violence prevention initiatives. Nevertheless, the Caribbean exhibited a positive AAPC in YLDs, indicating persistently escalating TBI burdens that demand targeted interventions, including infrastructure upgrades and trauma care system strengthening.(Lepard et al. 2021 ) Our analysis further elucidates the complexity of TBI etiology and its spatiotemporal evolution. While road traffic incidents remain the predominant cause of TBI among adults, our findings indicate that falls constitute the leading etiology of TBI in adolescents and young adults aged 10–24 years.(Maas et al. 2022 ) This pattern may be attributed to developmental factors in this population, including high physical activity levels, frequent participation in sports (e.g., basketball, skateboarding, cycling), and risk-prone behaviors that increase susceptibility to balance loss or collisions.(Nigrovic and Kuppermann 2019 ) Additionally, legal driving age restrictions in most countries likely reduce youth exposure to road traffic incidents, thereby diminishing their contribution to the burden of TBI in this demographic.(Lepard et al. 2021 ) Road traffic-related injuries—encompassing motor vehicle, motorcycle, pedestrian, and bicycle collisions—remain critical contributors to TBI globally, with pronounced disparities across socioeconomic contexts.(Maas et al. 2017 ) In low- and middle-income countries (LMICs), particularly Southeast Asia and West Africa, motorcycle collisions account for a disproportionately high share of TBI cases, reflecting regional dependencies on motorcycles as the primary transportation.(Dawood et al. 2025 ; Tropeano et al. 2019 ) Conversely, high-income countries such as the United States and Canada have experienced marked declines in motor vehicle-related TBI incidence since 2000, likely driven by multisectoral interventions, including airbag standardization, enhanced road infrastructure, and stricter adolescent driver education programs.(Lepard et al. 2021 ) Notably, the TBI etiological profile exhibited subtle yet epidemiologically significant shifts after 2020.(Troy et al. 2023 ) During the COVID-19 pandemic, lockdown policies precipitated transient declines in traffic-related injuries, paralleled by rising proportions of domestic violence-related TBIs and indoor sports injuries. These dynamic trends underscore the necessity for adaptive public health policies to address injury pattern fluctuations during large-scale societal disruptions.(G et al. 2022 ) Sex-stratified data revealed that compared with female adolescents, male adolescents presented substantially greater prevalence rates and YLDs attributable to TBI. This disparity may be attributable to males' heightened engagement in high-risk recreational activities and suboptimal adherence to protective equipment protocols. 21 Furthermore, sociocultural tolerance of risk-taking behaviors among males may exacerbate this gap. Notably, projected female TBI rates have progressively converged toward male levels in recent years, suggesting that evolving gender roles—including increased female participation in competitive sports—may be reshaping TBI epidemiological profiles. Neuroendocrine factors, particularly androgen-mediated effects on risk-reward appraisal during male adolescence, may further amplify susceptibility to injury-inducing decisions.(McCrory et al. 2017 ) Geospatial analyses demonstrate pronounced heterogeneity in sex-specific TBI burden: regions with conservative sociocultural norms exhibit wider sex-based disparities, whereas areas with higher gender parity indices show attenuated differences.(Kaplan et al. 2023 ; Venturini et al. 2024 ) These patterns collectively underscore the inextricable linkage between sociocultural determinants and sex-disaggregated TBI burden distributions. Our findings have critical implications for TBI management policies and targeted interventions. In high-burden regions, priorities should include upgrading road infrastructure, enforcing helmet-use mandates, and implementing community-based violence prevention programs. For example, following the 2011 Utøya Island mass shooting in Norway, global reassessments of youth safety protocols prompted strengthened protective measures in educational settings across multiple jurisdictions. In high-income settings, enhanced long-term monitoring of mild TBI cases is warranted to mitigate chronic disability risk. Effective TBI prevention demands multisectoral collaboration spanning transportation, education, and judicial systems. Innovations such as real-time mobile-based surveillance of hazardous road segments or school curricula that integrate injury prevention literacy could yield population-level benefits. Furthermore, AI-driven triage protocols in emergency departments may improve the diagnostic accuracy for TBI in low- and middle-income countries. Adolescents and young adults, who are undergoing critical neurodevelopmental transitions, face compounded risks: TBI may precipitate cascading neuropsychiatric sequelae, including cognitive decline and mental health disorders.(Cruz-Haces et al. 2017 ) Consequently, rehabilitation frameworks should integrate neuropsychological rehabilitation alongside physical recovery, complemented by economic subsidies for low-income households to disrupt cycles of medical impoverishment.(Kacperski and Arthur 2016 ) This study has several limitations. First, the GBD estimates rely on nationally reported statistics that may not fully capture the epidemiology of TBI in low-income regions because of systematic underreporting or misclassification. Second, insufficient granularity in TBI severity stratification precludes the differentiation of long-term disability burdens between mild and severe cases. Third, emerging risk determinants such as climate change were not included in the analytical framework, despite their growing relevance to injury patterns. Future investigations should employ multidisciplinary frameworks that integrate multicenter clinical datasets with geographic information systems to elucidate the interactions between environmental exposures and social determinants of TBI. Declarations Ethics approval and consent to participate Not applicable. The study did not involve human subjects; analyses utilized anonymous, publicly accessible population-level estimates. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from the GBD Results Tool- https://vizhub.healthdata.org/gbd-results-tool Competing interests The authors declare that they have no competing interests. Funding No funding sources. Authors' contributions YNY and LYF were involved in data collection, analysis and interpretation, and drafted and critically reviewed the intellectual content of the paper. LWM, and WL revised the original manuscript. LYF and YNY were involved in data analysis. All authors reviewed and approved the final version of the manuscript. YNY was the guarantor of this work and therefore had full access to all data in the study and is responsible for the completeness of the data and the accuracy of the data analysis. Acknowledgements Not applicable. References A population-based study of inflicted traumatic brain injury in young children | traumatic brain injury | JAMA | JAMA network. (n.d.). https://jamanetwork.com/journals/jama/fullarticle/197032. Accessed 25 April 2025 Bonfield, C. M., Naran, S., Adetayo, O. A., Pollack, I. F., & Losee, J. E. (2014). 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Pediatrics , 144 (6), e20191495. https://doi.org/10.1542/peds.2019-1495 The age of adolescence - PubMed. (n.d.). https://pubmed.ncbi.nlm.nih.gov/30169257/. Accessed 29 June 2025 Tropeano, M. P., Spaggiari, R., Ileyassoff, H., Park, K. B., Kolias, A. G., Hutchinson, P. J., & Servadei, F. (2019). A comparison of publication to TBI burden ratio of low- and middle-income countries versus high-income countries: How can we improve worldwide care of TBI? Neurosurgical Focus , 47 (5), E5. https://doi.org/10.3171/2019.8.FOCUS19507 Troy, B. M., Fraser Doh, K., Linden, A. F., Xiang, Y., Gillespie, S., & Agarwal, M. (2023). Changes in pediatric injuries sustained while engaged in activities where helmet usage is recommended during the COVID-19 pandemic. Injury Epidemiology , 10 (Suppl 1), 38. https://doi.org/10.1186/s40621-023-00449-2 Venturini, S., Still, M. E. H., Hutchinson, P. J., & Gwinnutt, J. M. (2024). Is pre-injury socioeconomic status associated with outcomes in patients with traumatic brain injury? A systematic review. Journal of Neurotrauma , 41 (7–8), 789–806. https://doi.org/10.1089/neu.2022.0341 Venturini, S., Still, M. E. H., Vycheth, I., Nang, S., Vuthy, D., & Park, K. B. (2019). The National Motorcycle Helmet Law at 2 Years: Review of Its Impact on the Epidemiology of Traumatic Brain Injury in a Major Government Hospital in Cambodia. World Neurosurgery , 125 , 320–326. https://doi.org/10.1016/j.wneu.2019.01.255 Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterials.docx Cite Share Download PDF Status: Published Journal Publication published 28 Jan, 2026 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 09 Dec, 2025 Reviews received at journal 08 Dec, 2025 Reviewers agreed at journal 02 Dec, 2025 Reviews received at journal 24 Nov, 2025 Reviews received at journal 18 Nov, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers invited by journal 17 Nov, 2025 Editor invited by journal 07 Nov, 2025 Editor assigned by journal 17 Sep, 2025 Submission checks completed at journal 17 Sep, 2025 First submitted to journal 14 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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14:09:16","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":159783,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7613312/v1/76fa4c4bf21b8d2292bde4e7.html"},{"id":96797916,"identity":"8e0069fb-3505-4cfc-9585-ad247106768f","added_by":"auto","created_at":"2025-11-26 08:02:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":544444,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eJoinpoint regression analysis of global YLDs (A) and prevalence (B) in adolescents and young adults aged 10-24 years from 1990 to 2021. The y-axes presented are truncated. The x-axes indicate time. AAPC, average annual percentage change; YLDs, years lost due to disability;TBI, Traumatic brain injury.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7613312/v1/c333f0eb80ad849ceef00ca7.png"},{"id":96797923,"identity":"e1cdbb5d-7d7f-47f6-8512-52a7e2d09256","added_by":"auto","created_at":"2025-11-26 08:02:21","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":748412,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eGlobal map of 2021 TBI YLDs (A) and prevalence (B) and AAPC in YLDs (C) and prevalence (D) from 1990 to 2021.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7613312/v1/e577d7d56e8d86d58d9c4d92.png"},{"id":96797926,"identity":"6a63972a-4b21-476e-ad8b-3f06448e6e3b","added_by":"auto","created_at":"2025-11-26 08:02:21","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":481224,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe proportion of prevalence cases of Traumatic brain injury (TBI) due to each cause from 1990 to 2021.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7613312/v1/a9069d36c974c4ac155205c2.png"},{"id":96916673,"identity":"c2c592ac-40b0-4f0c-a8d7-a227cf20f18b","added_by":"auto","created_at":"2025-11-27 14:08:49","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":834272,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAge-standardized incidence composition of traumatic brain injury across Global Burden of Disease (GBD) 2021 regions.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-7613312/v1/1b2cd5da25fc8e4a50bc3af3.png"},{"id":96917607,"identity":"168fb348-4c45-4ce6-a2b1-ecf8bc22f4cd","added_by":"auto","created_at":"2025-11-27 14:10:12","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":202400,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePrevalence (A) and years lived with disability (YLDs, B) of traumatic brain injury from 1990 to 2021 with projections to 2030, stratified by sex. Bar charts represent case counts, and the deep red line indicates rates. The black dashed line marks 2020 data.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure5.png","url":"https://assets-eu.researchsquare.com/files/rs-7613312/v1/a99e4b15159f9dbbb44b9c5e.png"},{"id":101690397,"identity":"683cf6bd-db02-4c07-9e79-acac75c76994","added_by":"auto","created_at":"2026-02-02 16:00:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4355370,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7613312/v1/d574af13-dbfb-4ab5-af5d-44c6a57f2856.pdf"},{"id":96917474,"identity":"607c6097-096f-4abb-bfcc-1e26b90b3619","added_by":"auto","created_at":"2025-11-27 14:09:46","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":1273035,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-7613312/v1/5210013950ec52ebb9b44df8.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Global, regional, and national burdens of traumatic brain injury in adolescents and young adults aged 10-24 years from 1990 to 2021: A secondary analysis of the Global Burden of Disease Study 2021","fulltext":[{"header":"Introduction","content":"\u003cp\u003eTraumatic brain injury (TBI) is increasingly recognized as a neurological disease that threatens global health. (GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) Research indicates that approximately 50\u0026nbsp;million new cases of traumatic brain injury (TBI) occur globally each year. (GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) While the global incidence of TBI in adults has been systematically analyzed and evaluated, few studies have reported results in adolescents and young adults aged 10\u0026ndash;24 years. During their developmentally active stages, children and adolescents are at significantly greater risk of TBI because of unintentional injury such as falls, sports-related impacts, or road traffic accidents.(\u0026ldquo;Environmental modifications to rehabilitate social behavior deficits after acquired brain injury\u0026rdquo; 2023) According to WHO statistics, approximately 10\u0026nbsp;million children in the world seek medical treatment for TBI every year,(\u0026ldquo;Brain health\u0026rdquo; n.d.) which leads to TBI in children and adolescents accounting for 20%-30% of all TBI cases, which is one of the common causes of emergency visits and places a considerable burden on global health problems and economic conditions.(Brown et al. \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mariajoseph et al. \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Moore et al. \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2024\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eIn addition, the nervous systems of adolescents and young adults aged 10\u0026ndash;24 years are still developing, so TBI may have longer-term effects, such as on cognitive function, behavioral problems, or mood disorders.(Ledoux et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e; Mayer et al. \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2018\u003c/span\u003e) Mild illness may lead to irreversible cognitive impairment presenting as poor concentration and learning ability, memory loss, and impaired language function, whereas emotional illness may cause long-term mental health problems such as anxiety disorders, posttraumatic stress disorders, and severe TBI, which may also lead to lifelong disability.(Iverson et al. \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) TBI in adolescents and young adults presents multifaceted and unique challenges in both pathophysiological mechanisms and clinical management.(Cruz-Haces et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) These challenges arise not only from the inherent vulnerability of developing neurophysiological systems but also from distinct neurobehavioral profiles, systemic delays in diagnosis and intervention, and the amplified cascade of secondary injuries.(Bonfield et al. \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2014\u003c/span\u003e; Ledoux et al. \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) Children and adolescents are also different from adults in that some children have poor expression skills, some hidden problems are not easy to detect, and diagnosis and treatment are often delayed, resulting in a serious risk of sequelae.(\u0026ldquo;A population-based study of inflicted traumatic brain injury in young children | traumatic brain injury | JAMA | JAMA network\u0026rdquo; n.d.) At the sociological level, adolescent TBI not only disrupts the personal development trajectory(\u0026ldquo;Centers for disease control and prevention | CDC\u0026rdquo; n.d.) but also exacerbates the burden of family care and socioeconomic costs.(\u0026ldquo;Centers for disease control and prevention | CDC\u0026rdquo; n.d.)\u003c/p\u003e\u003cp\u003ePrevious studies have shown that the prevalence of TBI in children and adolescents varies widely across countries, but no studies have analyzed data concerning this disease in different countries or regions. Therefore, the aim of this study is to describe global trends in the prevalence of TBI and disability-adjusted life years in children and adolescents from 1990 to 2021; stratify global trends by age group, sex, and sociodemographic index (SDI); reveal regional and national trends; provide insights for management and targeted programs in health planning and resourcing inform; and provide the basis for policy and implementation strategies aimed at mitigating the impact of TBI.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData sources and case definitions\u003c/h2\u003e\u003cp\u003eThis analysis was based on data obtained from the Global Burden of Disease Study (GBD) 2021, which is presently being coordinated by the Institute for Health Metrics and Evaluation (IHME). The GBD 2021 study was published in 2024 and included epidemiologic assessments of 288 causes of death, 371 diseases and injuries, and 88 risk factors across 204 countries and territories.(GBD 2021 Diseases and Injuries Collaborators \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) The 10th iteration of the international classification of disease codes for TBI were F07\u0026middot;2,F07\u0026middot;8,F08\u0026middot;81,F07\u0026middot;89,F07\u0026middot;9,S06,S07,T90\u0026middot;2,and T90\u0026middot;5. We employed multiple metrics to determine the global burden of TBI in the adolescents and young adults, including incidence, prevalence, years lived with disability and the sociodemographic index.\u003c/p\u003e\u003cp\u003eThe WHO defines the 10\u0026ndash;19 year age group as adolescents on the basis of their physiological, psychological, and social development characteristics.(\u0026ldquo;The age of adolescence - PubMed\u0026rdquo; n.d.) In our study, to enable a more detailed analytical investigation, we categorized adolescents and young adults into three age-specific subgroups: younger adolescents (aged 10\u0026ndash;14 years), older adolescents (aged 15\u0026ndash;19 years), and young adults (aged 20\u0026ndash;24 years). Years lived with disability (YLDs) reflects nonfatal health loss, derived by multiplying the age-adjusted prevalence of TBI-related sequelae by their corresponding GBD disability weights, which range from 0 (full health) to 1 (death).\u003c/p\u003e\u003cp\u003eThe sociodemographic index (SDI) is a comprehensive indicator designed to evaluate national and regional development status and is calculated on the basis of income per capita, average years of education among individuals aged 15 years and older, and the total fertility rate for women under 25 years of age. In GBD 2021, SDI values (ranging from 0 to 1) were categorized into five quintiles: high, high-middle, middle, low-middle, and low-SDI regions. Higher SDI values are correlated with advanced national development, longer education attainment, and lower fertility rates. To analyze the global burden of TBI across diverse demographic dimensions, the population was stratified into distinct subgroups by age, sex, geographic region, and SDI quintile for comparative assessment.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eIn this study, we analyzed the prevalence, YLDs and underlying etiological trends of TBI across different regions, countries, and SDI levels, stratified by age subgroups (10\u0026ndash;14 years, 15\u0026ndash;19 years, and 20\u0026ndash;24 years) and sex (male and female). The prevalence and YLDs with 95% uncertainty intervals (UIs) were the main indicators used to describe the TBI burden of adolescents and young adults. To assess temporal trends, we employed joinpoint regression analysis to calculate the annual percentage change (APC) and average annual percentage change (AAPC) with corresponding 95% confidence intervals (CIs). The APC reflects the annual rate of change in the aforementioned metrics, whereas the AAPC, derived through geometric weighting of the APC values, provides a consolidated measure of the overall average trend over multiple years. This approach simplifies complex temporal patterns into a single metric, where an AAPC\u0026thinsp;\u0026gt;\u0026thinsp;0 indicates a cumulative increase and an AAPC\u0026thinsp;\u0026lt;\u0026thinsp;0 signifies a decrease relative to baseline values. For our analysis, AAPCs were calculated for three intervals: 1990\u0026ndash;1999, 2000\u0026ndash;2009, and 2010\u0026ndash;2021.\u003c/p\u003e\u003cp\u003eA pivotal component of the joinpoint regression framework is the identification of statistically significant inflection points (joinpoints) over the 32-year span (1990\u0026ndash;2021). This method iteratively evaluates annual trends to detect years with marked shifts in the TBI burden. By fitting segmented linear models on a log-transformed scale, we derived the most parsimonious model describing the data. A model with k joinpoints divides the timeline into k\u0026thinsp;+\u0026thinsp;1 linear segments; a null model (k\u0026thinsp;=\u0026thinsp;0) corresponds to a monotonic trend. The optimal number of joinpoints was determined through permutation testing (Monte Carlo simulation, 10,000 iterations) and the weighted Bayesian information criterion (WBIC) to balance model fit and complexity.\u003c/p\u003e\u003cp\u003eWe subsequently employed a Bayesian Age-Period-Cohort (BAPC) model, calibrated with epidemiological data and sociodemographic covariates from the Global Burden of Disease (GBD) database, to project the global burden of TBI (including prevalence and YLDs) among adolescents and young adults aged 10\u0026ndash;24 years through 2030.\u003c/p\u003e\u003cp\u003eAll the statistical analyses were conducted using R software (version 4\u0026middot;3\u0026middot;2). A 2-sided p value\u0026thinsp;\u0026lt;\u0026thinsp;0\u0026middot;05 was considered statistically significant.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eGlobal trends\u003c/h2\u003e\u003cp\u003eThe prevalence of TBI demonstrated a significant and progressive decline over the three-decade period from 1990\u0026ndash;2021 (AAPC \u0026minus;\u0026thinsp;1\u0026middot;28 [95% UI -1\u0026middot;31 to -1\u0026middot;26], p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) among adolescents and young adults aged 10\u0026ndash;24 years. Moreover, the rate of decline observed from 2010\u0026ndash;2021 (AAPC \u0026minus;\u0026thinsp;1\u0026middot;64 [95% UI -1\u0026middot;72 to -1\u0026middot;6]) exceeded those documented during both the 1990\u0026ndash;1999 (AAPC \u0026minus;\u0026thinsp;1\u0026middot;06 95% UI -1\u0026middot;11 to -0\u0026middot;98) and 2000\u0026ndash;2009 (AAPC \u0026minus;\u0026thinsp;1\u0026middot;13 95%UI -1\u0026middot;2 to -1\u0026middot;06) periods. The TBI prevalence in 2021 (128\u0026middot;3 per 100,000 population [ 117\u0026middot;8 to 139\u0026middot;1]) was lower than the prevalence in 1990 (191\u0026middot;3 per 100,000 population [177 to 208\u0026middot;9]). In 2021, there were 0\u0026middot;24\u0026nbsp;million (95% CI 0\u0026middot;22 to 0\u0026middot;26) TBI cases in adolescents and young adults, comprising 0\u0026middot;16 (95% CI 0\u0026middot;15 to 0\u0026middot;18) million male patients and 0\u0026middot;079 (95% CI 0\u0026middot;072 to 0\u0026middot;087) million female patients. Furthermore, the global YLDs from TBI decreased from 1990 to 2021 (AAPC of -1\u0026middot;3 95% UI from \u0026minus;\u0026thinsp;1\u0026middot;34 to -1\u0026middot;26) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The joinpoint regression analysis revealed statistically significant changes in the prevalence of TBI in 2001, 2005, 2010, and 2017 (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eGlobal AAPC in prevalence and YLDs of TBI in adolescents and young adults of 10\u0026ndash;24 years old.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eYear\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003ePrevalence\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eYLDs\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAAPC (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAAPC (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eP value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1990-99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1\u0026middot;06 (-1\u0026middot;11 to -0\u0026middot;98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1\u0026middot;03 (-1\u0026middot;09 to -0\u0026middot;94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2000-09\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1\u0026middot;13 (-1\u0026middot;2 to -1\u0026middot;06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1\u0026middot;11 (-1\u0026middot;19 to -1\u0026middot;03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2010-21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1\u0026middot;64 (-1\u0026middot;72 to -1\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1\u0026middot;67 (-1\u0026middot;73 to -1\u0026middot;63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1990\u0026ndash;2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-1\u0026middot;3 (-1\u0026middot;34 to -1\u0026middot;27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e-1\u0026middot;3 (-1\u0026middot;34 to -1\u0026middot;26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eAAPC, average annual percentage change; YLDs, years lost due to disability; CI, confidence interval.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eGlobal trends by sex\u003c/h3\u003e\n\u003cp\u003eOverall, sex-stratified analysis revealed a marked decrease in the prevalence of TBI among both males and females from 1990 to 2021 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The AAPC was \u0026minus;\u0026thinsp;1\u0026middot;3 (95% UI -1\u0026middot;33 to -1\u0026middot;27) for males, which was comparable to the AAPC of -1\u0026middot;28 (95% UI -1\u0026middot;34 to -1\u0026middot;23) observed in females. The prevalence has substantially decreased over the past three decades (1990\u0026ndash;2021) in both sexes. In 2021, the prevalence per 100,000 people in males (168 [95% CI 154\u0026middot;8\u0026ndash;182\u0026middot;7]) was 1\u0026middot;9-fold greater than that in females (86\u0026middot;6 [95% CI 79\u0026middot;1\u0026ndash;94\u0026middot;6]).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe YLDs and prevalence of TBI in adolescents and young adults of 10\u0026ndash;24 years old, and their temporal trends from 1990 to 2021 at the global and regional levels.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"16\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c15\" colnum=\"15\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c16\" colnum=\"16\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCases (n), 1990\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eYLDs (per 100,000 population),\u003c/p\u003e\u003cp\u003e1990\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003eCases (n), 2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eYLDs (per 100,000 population), 2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eAAPC,\u003c/p\u003e\u003cp\u003e1990-\u003c/p\u003e\u003cp\u003e2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eP\u003c/p\u003e\u003cp\u003evalue\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c11\"\u003e\u003cp\u003eCases (n), 1990\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003ePrevalence (per 100,000 population),\u003c/p\u003e\u003cp\u003e1990\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003eCases (n), 2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003ePrevalence (per 100,000 population), 2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c15\"\u003e\u003cp\u003eAAPC,\u003c/p\u003e\u003cp\u003e1990\u0026ndash;2021\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c16\"\u003e\u003cp\u003eP\u003c/p\u003e\u003cp\u003evalue\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlobal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e446340\u0026middot;4\u003c/p\u003e\u003cp\u003e(316427\u0026middot;3-601905\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e28\u0026middot;8\u003c/p\u003e\u003cp\u003e(20\u0026middot;5\u0026ndash;38\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e366026\u0026middot;8 (258535\u0026ndash;491474\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19\u0026middot;4\u003c/p\u003e\u003cp\u003e(13\u0026middot;7\u0026ndash;26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;28\u003c/p\u003e \u003cp\u003e(-1\u0026middot;31 to -1\u0026middot;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2960144\u0026middot;5 (2737972\u0026middot;7-3232185\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e191\u0026middot;3 (177\u0026ndash;208\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e2422398\u0026middot;4 (2224582\u0026middot;8-2626047)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e128\u0026middot;3 (117\u0026middot;8-139\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;28\u003c/p\u003e \u003cp\u003e(-1\u0026middot;31 to -1\u0026middot;26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e301405\u0026middot;2 (213451\u0026middot;3-406657\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e38\u0026middot;3 (27\u0026middot;2\u0026ndash;51\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e248098\u0026middot;4 (174188\u0026middot;3-333134\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e25\u0026middot;6 (18\u0026ndash;34\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;28\u003c/p\u003e\u003cp\u003e(-1\u0026middot;31 to -1\u0026middot;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1985923\u0026middot;5 (1831102\u0026middot;6-2189087\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e252\u0026middot;6 (232\u0026middot;9-278\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1625678\u0026middot;4 (1497974\u0026middot;5-1767418\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e168 (154\u0026middot;8-182\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;3\u003c/p\u003e\u003cp\u003e(-1\u0026middot;33 to -1\u0026middot;27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e144935\u0026middot;2 (101694\u0026middot;8-197043\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e19 (13\u0026middot;4\u0026ndash;25\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e117928\u0026middot;4 (83211\u0026middot;9-158999\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12\u0026middot;8 (9\u0026ndash;17\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;34\u003c/p\u003e\u003cp\u003e(-1\u0026middot;39 to -1\u0026middot;28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e974221 (908319\u0026middot;4-1043547\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e128 (119\u0026middot;3-137\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e796719\u0026middot;9 (727661\u0026middot;3-870604\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e86\u0026middot;6 (79\u0026middot;1\u0026ndash;94\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;28\u003c/p\u003e\u003cp\u003e(-1\u0026middot;34 to -1\u0026middot;23)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge, group, years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u0026ndash;14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e91593\u0026middot;3 (64688\u0026middot;9-126943\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e17\u0026middot;1 (12\u0026middot;1\u0026ndash;23\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e73258\u0026middot;3 (52644\u0026middot;8-99273\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e11 (7\u0026middot;9\u0026ndash;14\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;46\u003c/p\u003e\u003cp\u003e(-1\u0026middot;51 to -1\u0026middot;41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e610888\u0026middot;6 (560259\u0026middot;8-667047\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e114 (104\u0026middot;6-124\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e489052\u0026middot;9 (443051\u0026middot;3-540992\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e73\u0026middot;4 (66\u0026middot;5\u0026ndash;81\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;45\u003c/p\u003e\u003cp\u003e(-1\u0026middot;49 to -1\u0026middot;41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e142399\u0026middot;7 (99505\u0026middot;9-194486)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e27\u0026middot;4 (19\u0026middot;2\u0026ndash;37\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e113661\u0026middot;4 (80151\u0026middot;1-154777\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e18\u0026middot;2 (12\u0026middot;8\u0026ndash;24\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;32\u003c/p\u003e\u003cp\u003e(-1\u0026middot;35 to -1\u0026middot;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e943054\u0026middot;2 (863612\u0026middot;1-1036423\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e181\u0026middot;6 (166\u0026middot;3-199\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e752592\u0026middot;3 (680795\u0026middot;8-827340)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e120\u0026middot;6 (109\u0026middot;1-132\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;32\u003c/p\u003e\u003cp\u003e(-1\u0026middot;34 to -1\u0026middot;28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e212347\u0026middot;4 (150506\u0026middot;7-284623\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e43\u0026middot;2 (30\u0026middot;6\u0026ndash;57\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e179107\u0026middot;2 (126419\u0026middot;6-238948\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e30 (21\u0026middot;2\u0026ndash;40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;17\u003c/p\u003e\u003cp\u003e(-1\u0026middot;19 to -1\u0026middot;15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1406201\u0026middot;6 (1299869\u0026middot;1-1537469\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e285\u0026middot;8 (264\u0026middot;2-312\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e1180753\u0026middot;1 (1089856\u0026middot;7-1278563)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e197\u0026middot;7 (182\u0026middot;5-214\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;18\u003c/p\u003e\u003cp\u003e(-1\u0026middot;2 to -1\u0026middot;17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSociodemographic index\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60037\u003c/p\u003e\u003cp\u003e(40947\u0026middot;1-82343\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e30\u0026middot;7\u003c/p\u003e\u003cp\u003e(20\u0026middot;9\u0026ndash;42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e37046\u0026middot;5\u003c/p\u003e\u003cp\u003e(24823\u0026middot;4-51700\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u003c/p\u003e\u003cp\u003e(13\u0026middot;4\u0026ndash;27\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;45\u003c/p\u003e\u003cp\u003e(-1\u0026middot;51 to -1\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e431184\u0026middot;9 (395583\u0026middot;8-474816\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e220\u0026middot;2 (202\u0026ndash;242\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e266258\u0026middot;7 (243500\u0026middot;5-294348\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e143\u0026middot;5 (131\u0026middot;2-158\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;45\u003c/p\u003e\u003cp\u003e(-1\u0026middot;51 to -1\u0026middot;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh-middle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e102610\u0026middot;6 (71221\u0026middot;7-140671\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e36\u0026middot;2\u003c/p\u003e\u003cp\u003e(25\u0026middot;1\u0026ndash;49\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e55204\u0026middot;9\u003c/p\u003e\u003cp\u003e(38027\u0026middot;8-77125\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e24\u0026middot;4 (16\u0026middot;8\u0026ndash;34\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;26\u003c/p\u003e\u003cp\u003e(-1\u0026middot;33 to -1\u0026middot;19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e677322\u0026middot;4 (635492\u0026middot;3-724723\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e238\u0026middot;7 (223\u0026middot;9-255\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e367064\u0026middot;7 (340684\u0026middot;4-397850)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e162\u0026middot;5 (150\u0026middot;8-176\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;24\u003c/p\u003e\u003cp\u003e(-1\u0026middot;31 to -1\u0026middot;17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e163738\u0026middot;5 (115589\u0026middot;8-219185\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e29\u0026middot;8\u003c/p\u003e\u003cp\u003e(21\u0026middot;1\u0026ndash;39\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e115216\u0026middot;4 (81413\u0026middot;2-153529\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u0026middot;8\u003c/p\u003e\u003cp\u003e(14\u0026middot;7\u0026ndash;27\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;13\u003c/p\u003e\u003cp\u003e(-1\u0026middot;18 to -1\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e1062220\u0026middot;2 (985545\u0026middot;5-1145275)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e193\u0026middot;5 (179\u0026middot;6-208\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e751401\u0026middot;6 (688258\u0026middot;6-816930\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e135\u0026middot;9 (124\u0026middot;5-147\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;11\u003c/p\u003e\u003cp\u003e(-1\u0026middot;16 to -1\u0026middot;08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow-middle\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e83065\u0026middot;9\u003c/p\u003e\u003cp\u003e(58762\u0026middot;8-112236\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003cp\u003e(16\u0026middot;2\u0026ndash;31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e93303\u0026middot;6\u003c/p\u003e\u003cp\u003e(66104\u0026middot;2-125225\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16\u0026middot;9\u003c/p\u003e\u003cp\u003e(12\u0026ndash;22\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;03\u003c/p\u003e\u003cp\u003e(-1\u0026middot;08 to -0\u0026middot;96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e545684\u0026middot;4 (498247\u0026ndash;610374\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e150\u0026middot;9 (137\u0026middot;7-168\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e609267\u0026middot;8 (561467\u0026middot;5-659203\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e110\u0026middot;2 (101\u0026middot;6-119\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;04\u003c/p\u003e\u003cp\u003e(-1\u0026middot;09 to -0\u0026middot;99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36381\u0026middot;3\u003c/p\u003e\u003cp\u003e(26141\u0026middot;8-49528\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e23\u0026middot;4\u003c/p\u003e\u003cp\u003e(16\u0026middot;8\u0026ndash;31\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e64809\u0026middot;9\u003c/p\u003e\u003cp\u003e(47122\u0026ndash;84273\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e17\u0026middot;5\u003c/p\u003e\u003cp\u003e(12\u0026middot;8\u0026ndash;22\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;02\u003c/p\u003e\u003cp\u003e(-1\u0026middot;19 to -0\u0026middot;85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e240396\u0026middot;4 (198209\u0026middot;2-315855)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e154\u0026middot;4 (127\u0026middot;3-202\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e425468\u0026middot;2 (372848\u0026middot;6-490645\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e115\u0026middot;2 (100\u0026middot;9-132\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-0\u0026middot;92\u003c/p\u003e\u003cp\u003e(-1\u0026middot;13 to -0\u0026middot;76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAndean Latin America\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3523\u003c/p\u003e\u003cp\u003e(2525\u0026middot;7-4768\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e28\u0026middot;6\u003c/p\u003e\u003cp\u003e(20\u0026middot;5\u0026ndash;38\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e3507\u0026middot;9 (2421\u0026middot;3-4912\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e20\u0026middot;3\u003c/p\u003e\u003cp\u003e(14\u0026ndash;28\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;12\u003c/p\u003e\u003cp\u003e(-1\u0026middot;18 to -1\u0026middot;07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e23039\u0026middot;4 (20394\u0026middot;1-26896\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e187\u0026middot;2 (165\u0026middot;7-218\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e22943\u0026middot;7 (21347\u0026middot;8-24879\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e132\u0026middot;9 (123\u0026middot;7-144\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;15\u003c/p\u003e\u003cp\u003e(-1\u0026middot;19 to -1\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAustralasia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2154\u0026middot;5\u003c/p\u003e\u003cp\u003e(1476\u0026middot;3-3027\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e44\u0026middot;8\u003c/p\u003e\u003cp\u003e(30\u0026middot;7\u0026ndash;62\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e2000\u0026middot;5 (1340\u0026ndash;2804\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e34\u0026middot;9\u003c/p\u003e\u003cp\u003e(23\u0026middot;4\u0026ndash;48\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0\u0026middot;82\u003c/p\u003e\u003cp\u003e(-0\u0026middot;83 to -0\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e16257 (14328\u0026middot;9-18695\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e337\u0026middot;9 (297\u0026middot;8-388\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e15152 (13242\u0026middot;5-17602)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e264\u0026middot;1 (230\u0026middot;8-306\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-0\u0026middot;8\u003c/p\u003e\u003cp\u003e(-0\u0026middot;81 to -0\u0026middot;79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaribbean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2714\u0026middot;8\u003c/p\u003e\u003cp\u003e(1853\u0026middot;8-3728\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e25\u0026middot;4\u003c/p\u003e\u003cp\u003e(17\u0026middot;4\u0026ndash;34\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e5084\u0026middot;4\u003c/p\u003e\u003cp\u003e(3679\u0026ndash;6771\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e44\u0026middot;9\u003c/p\u003e\u003cp\u003e(32\u0026middot;5\u0026ndash;59\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1\u0026middot;74\u003c/p\u003e\u003cp\u003e(1\u0026middot;15 to 2\u0026middot;29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e17707\u0026middot;9 (16676\u0026middot;1-18831\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e165\u0026middot;8 (156\u0026middot;2-176\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e33544\u0026middot;4 (25652\u0026middot;4-46345\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e296\u0026middot;1 (226\u0026middot;5-409\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e1\u0026middot;77\u003c/p\u003e\u003cp\u003e(1\u0026middot;15 to 2\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral Asia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7389\u0026middot;5\u003c/p\u003e\u003cp\u003e(5092\u0026middot;3-10007\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e37\u0026middot;3\u003c/p\u003e\u003cp\u003e(25\u0026middot;7\u0026ndash;50\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e5883\u0026middot;1\u003c/p\u003e\u003cp\u003e(4097\u0026ndash;8197\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e26\u0026middot;6\u003c/p\u003e\u003cp\u003e(18\u0026middot;5\u0026ndash;37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0\u0026middot;97\u003c/p\u003e\u003cp\u003e(-1\u0026middot;09 to -0\u0026middot;85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e48417\u0026middot;3 (44864\u0026middot;2-52473\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e244\u0026middot;1 (226\u0026middot;2-264\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e38694\u0026middot;7 (35736\u0026middot;8-41833\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e174\u0026middot;9 (161\u0026middot;5-189\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-0\u0026middot;98\u003c/p\u003e\u003cp\u003e(-1\u0026middot;08 to -0\u0026middot;88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral Europe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17357\u0026middot;8\u003c/p\u003e\u003cp\u003e(11665\u0026middot;1-24057\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e59\u0026middot;4\u003c/p\u003e\u003cp\u003e(40\u0026ndash;82\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e7818\u0026middot;5\u003c/p\u003e\u003cp\u003e(5262\u0026middot;7-10947\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e43\u0026middot;1\u003c/p\u003e\u003cp\u003e(29\u0026ndash;60\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;03\u003c/p\u003e\u003cp\u003e(-1\u0026middot;08 to -0\u0026middot;99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e113977\u0026middot;2 (105006\u0026ndash;123172\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e390\u0026middot;4 (359\u0026middot;6-421\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e51516\u0026middot;8 (46939\u0026middot;7-56674\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e284\u0026middot;1 (258\u0026middot;8-312\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;03\u003c/p\u003e\u003cp\u003e(-1\u0026middot;07 to -1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral Latin America\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25707\u0026middot;4\u003c/p\u003e\u003cp\u003e(18128\u0026middot;5-34360\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e47\u0026middot;4\u003c/p\u003e\u003cp\u003e(33\u0026middot;4\u0026ndash;63\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e19468\u0026middot;7\u003c/p\u003e\u003cp\u003e(13141\u0026middot;3-26724\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e29\u0026middot;9\u003c/p\u003e\u003cp\u003e(20\u0026middot;2\u0026ndash;41\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;46\u003c/p\u003e\u003cp\u003e(-1\u0026middot;54 to -1\u0026middot;39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e168919 (152011\u0026middot;2-189256\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e311\u0026middot;3 (280\u0026middot;2-348\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e127041\u0026middot;7 (117700\u0026middot;6-137077\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e195\u0026middot;3 (181\u0026ndash;210\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;48\u003c/p\u003e\u003cp\u003e(-1\u0026middot;56 to -1\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCentral Sub-Saharan Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3802\u0026middot;7\u003c/p\u003e\u003cp\u003e(2716\u0026middot;7-5064\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003cp\u003e(15\u0026middot;7\u0026ndash;29\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e7053\u0026middot;1\u003c/p\u003e\u003cp\u003e(4839\u0026middot;7-9662\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15\u0026middot;7\u003c/p\u003e\u003cp\u003e(10\u0026middot;8\u0026ndash;21\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;12\u003c/p\u003e\u003cp\u003e(-1\u0026middot;34 to -0\u0026middot;92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e25060\u0026middot;8 (22253\u0026middot;4-28793)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e144\u0026middot;8 (128\u0026middot;6-166\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e45918\u0026middot;5 (42213\u0026middot;8-50085\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e102\u0026middot;2 (93\u0026middot;9-111\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;17\u003c/p\u003e\u003cp\u003e(-1\u0026middot;34 to -1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEast Asia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e98886\u0026middot;2\u003c/p\u003e\u003cp\u003e(68274\u0026middot;2-136623\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e26\u0026middot;6\u003c/p\u003e\u003cp\u003e(18\u0026middot;3\u0026ndash;36\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e45431\u0026middot;1\u003c/p\u003e\u003cp\u003e(31014\u0026middot;2-62126\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e18\u0026middot;7\u003c/p\u003e\u003cp\u003e(12\u0026middot;8\u0026ndash;25\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;14\u003c/p\u003e\u003cp\u003e(-1\u0026middot;21 to -1\u0026middot;09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e635257\u0026middot;1 (595473\u0026middot;2-675356\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e170\u0026middot;7 (160\u0026ndash;181\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e292541\u0026middot;9 (271783\u0026middot;4-316004\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e120\u0026middot;4 (111\u0026middot;8-130)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;14\u003c/p\u003e\u003cp\u003e(-1\u0026middot;22 to -1\u0026middot;08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEastern Europe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30434\u0026middot;3\u003c/p\u003e\u003cp\u003e(20772\u0026middot;4-41599\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e64\u0026middot;4\u003c/p\u003e\u003cp\u003e(44\u0026ndash;88\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e12847\u0026middot;5\u003c/p\u003e\u003cp\u003e(8771\u0026middot;7-17577\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e38\u0026middot;9\u003c/p\u003e\u003cp\u003e(26\u0026middot;6\u0026ndash;53\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;63\u003c/p\u003e\u003cp\u003e(-1\u0026middot;69 to -1\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e198175\u0026middot;6 (185206\u0026middot;6-213994\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e419\u0026middot;6 (392\u0026middot;1-453\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e83791\u0026middot;6 (77639\u0026middot;5-91565)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e254 (235\u0026middot;3-277\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;63\u003c/p\u003e\u003cp\u003e(-1\u0026middot;68 to -1\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEastern Sub-Saharan Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16097\u0026middot;9\u003c/p\u003e\u003cp\u003e(11357\u0026middot;6-22618\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003cp\u003e(18\u0026middot;3\u0026ndash;36\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e18830\u0026middot;4\u003c/p\u003e\u003cp\u003e(13029\u0026middot;7-25330\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12\u0026middot;9\u003c/p\u003e\u003cp\u003e(9\u0026ndash;17\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-2\u0026middot;32\u003c/p\u003e\u003cp\u003e(-2\u0026middot;62 to -2\u0026middot;02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e105652\u0026middot;1 (81837\u0026middot;8-143637\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e170\u0026middot;3 (131\u0026middot;9-231\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e123342\u0026middot;7 (113034\u0026middot;1-137356\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e84\u0026middot;8 (77\u0026middot;7\u0026ndash;94\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-2\u0026middot;34\u003c/p\u003e\u003cp\u003e(-2\u0026middot;62 to -2\u0026middot;05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh-income Asia Pacific\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11399\u0026middot;9\u003c/p\u003e\u003cp\u003e(7929\u0026middot;5-15831\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e27\u0026middot;1\u003c/p\u003e\u003cp\u003e(18\u0026middot;8\u0026ndash;37\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e4333\u0026middot;6\u003c/p\u003e\u003cp\u003e(2943\u0026middot;1-6181\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16\u0026middot;6 (11\u0026middot;3\u0026ndash;23\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;59\u003c/p\u003e\u003cp\u003e(-1\u0026middot;62 to -1\u0026middot;56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e84217\u0026middot;3 (76759\u0026middot;4-93704\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e199\u0026middot;9 (182\u0026middot;2-222\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e32131\u0026middot;2 (28847\u0026middot;2-36358\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e123\u0026middot;1 (110\u0026middot;5-139\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;57\u003c/p\u003e\u003cp\u003e(-1\u0026middot;6 to -1\u0026middot;55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh-income North America\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16267\u0026middot;2\u003c/p\u003e\u003cp\u003e(11047\u0026middot;9-22434\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e26\u0026middot;6\u003c/p\u003e\u003cp\u003e(18\u0026middot;1\u0026ndash;36\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e9957\u0026middot;9\u003c/p\u003e\u003cp\u003e(6666\u0026middot;6-13767\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14\u003c/p\u003e\u003cp\u003e(9\u0026middot;4\u0026ndash;19\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-2\u0026middot;08\u003c/p\u003e\u003cp\u003e(-2\u0026middot;13 to -2\u0026middot;02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e120049\u0026middot;2 (109272\u0026middot;3-133793\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e196\u0026middot;2 (178\u0026middot;6-218\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e73669\u0026middot;3 (67226\u0026middot;8-81716\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e103\u0026middot;4 (94\u0026middot;3-114\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-2\u0026middot;09\u003c/p\u003e\u003cp\u003e(-2\u0026middot;14 to -2\u0026middot;04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNorth Africa and Middle East\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50691\u0026middot;8\u003c/p\u003e\u003cp\u003e(36921\u0026middot;7-67159\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e46\u0026middot;5\u003c/p\u003e\u003cp\u003e(33\u0026middot;9\u0026ndash;61\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e53942\u0026middot;4 (38862\u0026middot;3-70302\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e33\u0026middot;2 (23\u0026middot;9\u0026ndash;43\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;08\u003c/p\u003e\u003cp\u003e(-1\u0026middot;14 to -1\u0026middot;01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e331430\u0026middot;5 (289379\u0026middot;6-399714\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e304\u0026middot;3 (265\u0026middot;7-367)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e353296\u0026middot;1 (302313\u0026middot;2-420339\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e217\u0026middot;7 (186\u0026middot;3-259)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;04\u003c/p\u003e\u003cp\u003e(-1\u0026middot;11 to -0\u0026middot;99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOceania\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e336\u0026middot;3\u003c/p\u003e\u003cp\u003e(226\u0026middot;5-463\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e16\u0026middot;1\u003c/p\u003e\u003cp\u003e(10\u0026middot;8\u0026ndash;22\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e768\u0026middot;7\u003c/p\u003e\u003cp\u003e(538\u0026middot;8-1041\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19\u0026middot;1 (13\u0026middot;4\u0026ndash;25\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0\u0026middot;49\u003c/p\u003e\u003cp\u003e(0\u0026middot;28 to 0\u0026middot;71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e2174\u0026middot;3 (2022\u0026middot;6-2324\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e103\u0026middot;9 (96\u0026middot;7-111\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e4958\u0026middot;7 (4490\u0026middot;6-5510\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e123 (111\u0026middot;4-136\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e0\u0026middot;52\u003c/p\u003e\u003cp\u003e(0\u0026middot;4 to 0\u0026middot;66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouth Asia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60751\u0026middot;1\u003c/p\u003e\u003cp\u003e(42196\u0026middot;7-82470\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e18\u0026middot;2\u003c/p\u003e\u003cp\u003e(12\u0026middot;6\u0026ndash;24\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e77102\u0026middot;7\u003c/p\u003e\u003cp\u003e(54475\u0026middot;1-102849\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e14\u0026middot;7\u003c/p\u003e\u003cp\u003e(10\u0026middot;4\u0026ndash;19\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0\u0026middot;75\u003c/p\u003e\u003cp\u003e(-0\u0026middot;86 to -0\u0026middot;65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e400566\u0026middot;8 (369727\u0026middot;5-434429\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e119\u0026middot;8 (110\u0026middot;5-129\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e505944\u0026middot;7 (465105\u0026ndash;551396\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e96\u0026middot;2 (88\u0026middot;4-104\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-0\u0026middot;76\u003c/p\u003e\u003cp\u003e(-0\u0026middot;85 to -0\u0026middot;68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSoutheast Asia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38330\u0026middot;6\u003c/p\u003e\u003cp\u003e(26919\u0026middot;4-51980\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e25\u0026middot;8\u003c/p\u003e\u003cp\u003e(18\u0026middot;1\u0026ndash;35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e31517\u0026middot;6\u003c/p\u003e\u003cp\u003e(22943\u0026middot;4-41800\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e18\u0026middot;4\u003c/p\u003e\u003cp\u003e(13\u0026middot;4\u0026ndash;24\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;1\u003c/p\u003e\u003cp\u003e(-1\u0026middot;22 to -1\u0026middot;01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e248756\u0026middot;9 (221085\u0026middot;8-302126\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e167\u0026middot;7 (149\u0026ndash;203\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e205117\u0026middot;3 (184722\u0026middot;7-230780\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e119\u0026middot;9 (108\u0026ndash;135)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;09\u003c/p\u003e\u003cp\u003e(-1\u0026middot;22 to -0\u0026middot;98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouthern Latin America\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3316\u0026middot;1\u003c/p\u003e\u003cp\u003e(2210\u0026middot;2-4626\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e25\u0026middot;1\u003c/p\u003e\u003cp\u003e(16\u0026middot;7\u0026ndash;35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e3807\u0026middot;4\u003c/p\u003e\u003cp\u003e(2585\u0026middot;7-5369\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e24\u0026middot;8\u003c/p\u003e\u003cp\u003e(16\u0026middot;9\u0026ndash;35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0\u0026middot;04\u003c/p\u003e\u003cp\u003e(-0\u0026middot;06 to -0\u0026middot;02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e24933\u0026middot;1 (21667\u0026middot;4-28867\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e188\u0026middot;4 (163\u0026middot;7-218\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e28640\u0026middot;6 (25033\u0026middot;5-33012\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e186\u0026middot;7 (163\u0026middot;2-215\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-0\u0026middot;03\u003c/p\u003e\u003cp\u003e(-0\u0026middot;05 to -0\u0026middot;01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e0\u0026middot;0016\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSouthern Sub-Saharan Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4560\u0026middot;8\u003c/p\u003e\u003cp\u003e(3230\u0026ndash;6214\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e26\u0026middot;7\u003c/p\u003e\u003cp\u003e(18\u0026middot;9\u0026ndash;36\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e3686\u003c/p\u003e\u003cp\u003e(2507\u0026middot;1-5086\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e16\u0026middot;9\u003c/p\u003e\u003cp\u003e(11\u0026middot;5\u0026ndash;23\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;47\u003c/p\u003e\u003cp\u003e(-1\u0026middot;49 to -1\u0026middot;45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e29398\u0026middot;7 (27100\u0026middot;7-31989\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e172\u0026middot;1 (158\u0026middot;6-187\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e23701\u0026middot;7 (22144\u0026middot;9-25451)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e108\u0026middot;7 (101\u0026middot;5-116\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;48\u003c/p\u003e\u003cp\u003e(-1\u0026middot;49 to -1\u0026middot;46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTropical Latin America\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18974\u0026middot;5\u003c/p\u003e\u003cp\u003e(13084\u0026middot;4-26252\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e39\u0026middot;6\u003c/p\u003e\u003cp\u003e(27\u0026middot;3\u0026ndash;54\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e16500\u0026middot;8\u003c/p\u003e\u003cp\u003e(11543\u0026middot;6-22602\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e32\u0026middot;6(22\u0026middot;8\u0026ndash;44\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0\u0026middot;62\u003c/p\u003e\u003cp\u003e(-0\u0026middot;63 to -0\u0026middot;61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e124098\u0026middot;3 (114468\u0026middot;4-135234\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e259\u0026middot;3 (239\u0026middot;2-282\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e107648\u0026middot;2 (98277\u0026ndash;118988\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e212\u0026middot;8 (194\u0026middot;3-235\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-0\u0026middot;64\u003c/p\u003e\u003cp\u003e(-0\u0026middot;65 to -0\u0026middot;62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWestern Europe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25102\u0026middot;6\u003c/p\u003e\u003cp\u003e(16959\u0026ndash;34948\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e30\u0026middot;5\u003c/p\u003e\u003cp\u003e(20\u0026middot;6\u0026ndash;42\u0026middot;5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e15624\u0026middot;6\u003c/p\u003e\u003cp\u003e(10569\u0026middot;9-22144\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e21\u0026middot;7 (14\u0026middot;7\u0026ndash;30\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-1\u0026middot;11\u003c/p\u003e\u003cp\u003e(-1\u0026middot;12 to -1\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e185715\u0026middot;6 (168035\u0026ndash;206208\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e225\u0026middot;9 (204\u0026middot;4-250\u0026middot;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e116221 (103068\u0026middot;9-132486\u0026middot;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e161\u0026middot;2 (143\u0026ndash;183\u0026middot;8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-1\u0026middot;09\u003c/p\u003e\u003cp\u003e(-1\u0026middot;1 to -1\u0026middot;08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWestern Sub-Saharan Africa\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8541\u0026middot;2\u003c/p\u003e\u003cp\u003e(5824\u0026middot;4-11564\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e14\u0026middot;3\u003c/p\u003e\u003cp\u003e(9\u0026middot;7\u0026ndash;19\u0026middot;3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e20860\u0026middot;1\u003c/p\u003e\u003cp\u003e(14847\u0026middot;3-28636\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e12\u0026middot;9\u003c/p\u003e\u003cp\u003e(9\u0026middot;2\u0026ndash;17\u0026middot;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e-0\u0026middot;26\u003c/p\u003e\u003cp\u003e(-0\u0026middot;33 to -0\u0026middot;2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c11\"\u003e\u003cp\u003e56340\u0026middot;4 (52602\u0026middot;5-60111\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c12\"\u003e\u003cp\u003e94\u0026middot;1 (87\u0026middot;9-100\u0026middot;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e136581\u0026middot;7 (126365\u0026middot;4-147848)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e84\u0026middot;6 (78\u0026middot;3\u0026ndash;91\u0026middot;6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c15\"\u003e\u003cp\u003e-0\u0026middot;32\u003c/p\u003e\u003cp\u003e(-0\u0026middot;39 to -0\u0026middot;26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c16\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0\u0026middot;001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"16\"\u003eAbbreviation: AAPC, age-standardized rates and average annual percent changes; UI, uncertainty interval; CI, confidence interval.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eGlobal trends by age group\u003c/h2\u003e\u003cp\u003eGlobally, over the three-decade period from 1990\u0026ndash;2021, the largest decrease in the prevalence of TBI was found among individuals aged 10\u0026ndash;14 years (AAPC=-1\u0026middot;45[-1\u0026middot;49\u0026thinsp;\u0026minus;\u0026thinsp;1\u0026middot;41]), which was greater than the decline rates documented in the 15\u0026ndash;19 years (AAPC=-1\u0026middot;32[-1\u0026middot;34\u0026thinsp;\u0026minus;\u0026thinsp;1\u0026middot;28]) and 20\u0026ndash;24-years (AAPC=-1\u0026middot;18[-1\u0026middot;2\u0026thinsp;\u0026minus;\u0026thinsp;1\u0026middot;17]) age groups (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Specifically, the prevalence in the 10\u0026ndash;14-year age group declined from 114 (95% UI 104\u0026middot;6\u0026ndash;124\u0026middot;5) per 100,000 people in 1990 to 73\u0026middot;4 (95% UI 66\u0026middot;5\u0026ndash;81\u0026middot;2) per 100,000 people in 2021. Similarly, the 15\u0026ndash;19-year cohort showed a reduction from 181\u0026middot;8 (95% UI 166\u0026middot;3\u0026ndash;199\u0026middot;5) per 100,000 people to 120\u0026middot;6 (95% UI 109\u0026middot;1\u0026ndash;132\u0026middot;6) per 100,000 people, whereas the 20\u0026ndash;24-year cohort exhibited a decrease from 285\u0026middot;8 (95% UI 264\u0026middot;2\u0026ndash;312\u0026middot;4) per 100,000 people to 197\u0026middot;7 (95% UI 182\u0026middot;5\u0026ndash;214\u0026middot;1) per 100,000 people over the same period. These age-stratified patterns suggest an inverse association between age and the magnitude of TBI prevalence reduction within the 10\u0026ndash;24-year demographic.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eGlobal trends by SDI\u003c/h3\u003e\n\u003cp\u003eFrom the SDI perspective, all five SDI quintiles exhibited declining trends in TBI prevalence between 1990 and 2021 (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The most pronounced reduction in the TBI prevalence per 100,000 people occurred in the high-SDI quintile countries (from 220\u0026middot;2[202\u0026ndash;242\u0026middot;4] to 143\u0026middot;5[131\u0026middot;2 to 158\u0026middot;6]; AAPC=-1\u0026middot;45[-1\u0026middot;51 to -1\u0026middot;39]). However, the highest prevalence rates consistently clustered in the high\u0026ndash;middle-SDI quintile countries, decreasing from 238\u0026middot;7 (95% UI 223\u0026middot;9\u0026ndash;255\u0026middot;4) to 162\u0026middot;5 (95% UI 150\u0026middot;8\u0026ndash;176\u0026middot;1) per 100,000 people over this period. In contrast, the highest absolute case burden remained concentrated in middle-SDI nations, with case counts declining from 1062220\u0026middot;2 (95% UI 985545\u0026middot;5-1145275) in 1990 to 751401\u0026middot;6 (95% UI 688258\u0026middot;6-816930\u0026middot;4) in 2021, consistently surpassing other SDI strata throughout the three-decade interval. Notably, the magnitude of the reduction in the prevalence of TBI correlated positively with national development levels, as quantified by the SDI. This gradient pattern was paralleled by similar declines in YLDs across all SDI quintiles. However, a distinct epidemiological profile emerged: the low- and low-middle-SDI quintiles presented nearly identical rates of YLD reduction, deviating from the steeper gradients observed in the higher-SDI groups.\u003c/p\u003e\n\u003ch3\u003eRegional trends\u003c/h3\u003e\n\u003cp\u003e Regional analyses revealed heterogeneous trends in TBI prevalence per 100,000 people between 1990 and 2021, with all regions demonstrating decreases of varying magnitudes. Eastern sub-Saharan Africa experienced the most substantial reduction, with the prevalence decreasing from 170\u0026middot;3 (95% UI 131\u0026middot;9 to 231\u0026middot;5) to 84\u0026middot;8 (95% UI 77\u0026middot;7 to 94\u0026middot;4) (AAPC=-2\u0026middot;34[-2\u0026middot;62 to -2\u0026middot;05]) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). This contrasts sharply with southern Latin America, where the prevalence showed minimal change, declining marginally from 188\u0026middot;4 (95% UI 163\u0026middot;7 to 218\u0026middot;1) to 186\u0026middot;7 (95% UI 163\u0026middot;2 to 215\u0026middot;3) (AAPC= -0\u0026middot;03[-0\u0026middot;05 to -0\u0026middot;01]). Notably, the Caribbean and Oceania exhibited divergent epidemiological patterns, with the prevalence increasing (from 165\u0026middot;8 [156\u0026middot;2-176\u0026middot;3] to 296\u0026middot;1 [226\u0026middot;5 to 409\u0026middot;1]; AAPC\u0026thinsp;=\u0026thinsp;1\u0026middot;77 [1\u0026middot;15 to 2\u0026middot;4]) and (from 103\u0026middot;9 [96\u0026middot;7-111\u0026middot;1] to 123 [111\u0026middot;4 to 136\u0026middot;6]; AAPC\u0026thinsp;=\u0026thinsp;0\u0026middot;52 [0\u0026middot;4 to 0\u0026middot;66]), respectively, over the three-decade period. Despite eastern Sub-Saharan Africa's marked progress, the prevalence of TBI in 2021 has remained marginally higher than western Sub-Saharan Africa's rate of 84\u0026middot;6 (95% UI: 78\u0026middot;3\u0026ndash;91\u0026middot;6). In particular, the Caribbean emerged as the global epicenter of TBI burden by 2021, with a prevalence of 296\u0026middot;1 (95% UI: 226\u0026middot;5 to 409\u0026middot;1) per 100,000 people. YLDs attributable to TBI paralleled these prevalence trends across regions, demonstrating similar geographical gradients in both magnitude and direction of change (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u0026amp; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eNational trends\u003c/h2\u003e\u003cp\u003eAt the national level, most countries demonstrated declining trends in prevalence and YLDs, whereas a subset presented increasing prevalence. Notable increases were observed in the Syrian Arab Republic, Yemen, Libya, Haiti, and the Central African Republic. The Syrian Arab Republic had the most substantial increase, with the prevalence of TBI increasing from 171\u0026middot;3 (95% UI:151\u0026middot;9 to 208) per 100,000 people in 1990 to 565\u0026middot;9(95% CI:343\u0026middot;5 to 907\u0026middot;4) per 100,000 people (AAPC\u0026thinsp;=\u0026thinsp;4\u0026middot;08 95% UI: 3\u0026middot;56 to 4\u0026middot;61) in 2021. In addition, Haiti had the highest national prevalence of 577\u0026middot;2(95% CI: 383\u0026middot;4 to 894\u0026middot;8) per 100,000 people in 2021. Among countries with declining trends, Eritrea showed the most pronounced reduction, decreasing from 946\u0026middot;6 (95% UI:526\u0026middot;6 to 1,573\u0026middot;3) per 100,000 people in 1990 to 87\u0026middot;5 (95% UI:81\u0026middot;5\u0026ndash;95\u0026middot;3) per 100,000 people in 2021 (AAPC=-7\u0026middot;6 95% UI: -7\u0026middot;76 to -7\u0026middot;45). Madagascar recorded the lowest 2021 prevalence at 64\u0026middot;8 (95% UI: 60\u0026middot;3\u0026ndash;69\u0026middot;7) per 100,000 people. Parallel trends emerged regarding YLDs between 1990 and 2021. The Syrian Arab Republic presented the largest increase in YLDs (26\u0026middot;0 [17\u0026middot;5\u0026ndash;35\u0026middot;7] to 83\u0026middot;4 [54\u0026middot;8\u0026ndash;124\u0026middot;0] per 100,000; AAPC\u0026thinsp;=\u0026thinsp;3\u0026middot;99 [3\u0026middot;63\u0026ndash;4\u0026middot;30]), whereas Eritrea presented the steepest decline (143\u0026middot;8 [89\u0026middot;4\u0026ndash;231\u0026middot;8] to 13\u0026middot;5 [9\u0026middot;1\u0026ndash;19\u0026middot;0] per 100,000 people; AAPC= -7\u0026middot;61 [-7\u0026middot;82 to -7\u0026middot;4]) (Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e \u0026amp; Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eCauses of TBI\u003c/h2\u003e\u003cp\u003eFrom 1990 to 2021, TBI etiologies were attributed predominantly to nine major causes: motorcyclist road injuries, pedestrian road injuries, falls, physical violence by other means, other transport injuries, motor vehicle road injuries, cyclist road injuries, other road injuries, and other unspecified causes. Falls consistently constituted the leading etiology, with its proportional contribution rising steadily from 31\u0026middot;9% in 1990 to 37\u0026middot;7% in 2021. Among road injury subtypes, motorcyclist road injuries initially increased, followed by a decrease (from 5\u0026middot;3% to 6\u0026middot;13% to 5\u0026middot;72%), whereas pedestrian (from 10\u0026middot;7% to 5\u0026middot;8%), motor vehicle (from 13\u0026middot;9% to 10\u0026middot;4%), and cyclist (from 5\u0026middot;2% to 4\u0026middot;5%) road injuries demonstrated progressive reductions in the proportional burden over the study period. Notably, physical violence by other means maintained a stable share of TBI etiologies throughout the three-decade interval, with minimal fluctuations in its proportional contribution (1990: 10\u0026middot;99%; 2021: 10\u0026middot;98%). These epidemiological patterns underscore the shifting landscape of TBI cause, with falls emerging as an increasingly dominant driver of the global TBI burden (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u0026amp; Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003ePredictions of TBI burden\u003c/h2\u003e\u003cp\u003eWe concluded that the prevalence and YLDs showed an increasing trend from 2022 to 2030 (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Globally, there will be 2489403 (95% CI: 123691\u0026ndash;7048780) TBI cases in adolescents and young adults aged 10\u0026ndash;24 years in 2030.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e Our study provides the first systematic assessment of the global, regional, and national burdens of TBI among adolescents and young adults aged 10\u0026ndash;24 years from 1990 to 2021, including prevalence rates and YLDs. Our findings indicate a sustained decline in prevalence rates and YLDs over the past three decades, particularly in high-SDI quintile countries, which is likely attributable to advancements in health care accessibility and trauma prevention policies. Notably, however, the TBI burden in high-SDI regions remains substantial, potentially linked to persistent high-risk behaviors and improved diagnostic sensitivity.\u003c/p\u003e\u003cp\u003eCompared with populations aged\u0026thinsp;\u0026ge;\u0026thinsp;25 years, adolescents and young adults exhibit distinct TBI etiology profiles and intervention priorities.(Dewan et al. \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Maas et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) While adult TBI predominantly correlates with occupational injuries, alcohol-related incidents, and falls in older adults,(Maas et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; L et al. \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2025\u003c/span\u003e) younger populations face heightened vulnerability due to underdeveloped risk perceptions, peer pressure, and emerging recreational trends.(McCrory et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) Furthermore, the overlap of TBI recovery phases with critical educational and vocational developmental stages may exacerbate long-term neurofunctional sequelae, contributing to human capital loss\u0026mdash;a dimension inadequately addressed in current public health frameworks.\u003c/p\u003e\u003cp\u003eIn 2021, the global YLDs and prevalence rates of TBI exhibited marked regional heterogeneity. The highest YLDs were concentrated in the Caribbean and European regions and Oceania, whereas high-income North America demonstrated a relatively lower disease burden. This distribution pattern may be closely linked to underdeveloped road transport infrastructure, insufficient health care resources, and high rates of violence in developing regions.(Tropeano et al. \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) For example, widespread motorcycle use and lax enforcement of traffic regulations in West Africa contributed to elevated TBI cases associated with road accidents, whereas rapid urbanization-related construction hazards and ongoing violent conflicts exacerbated TBI risks in parts of Southeast Asia.(GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e2019\u003c/span\u003e; Venturini et al. \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2019\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eNotably, despite their lower YLDs, high-income regions such as Western Europe and North America reported prevalence rates as high as 210\u0026middot;9 (184\u0026middot;4\u0026ndash;243\u0026middot;6) per 100,000 people in certain areas. This discrepancy may reflect the enhanced diagnostic capacity for mild TBI within robust health care systems. However, whether a higher prevalence translates to increased long-term disability risk requires further investigation incorporating injury severity stratification.(Darji et al. \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2025\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eFrom 1990 to 2021, most regions presented declining trends in both YLDs and prevalence rates, with negative AAPCs. These improvements likely stem from global advancements in traffic safety legislation (e.g., mandatory helmet laws, drunk-driving regulations) and violence prevention initiatives. Nevertheless, the Caribbean exhibited a positive AAPC in YLDs, indicating persistently escalating TBI burdens that demand targeted interventions, including infrastructure upgrades and trauma care system strengthening.(Lepard et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eOur analysis further elucidates the complexity of TBI etiology and its spatiotemporal evolution. While road traffic incidents remain the predominant cause of TBI among adults, our findings indicate that falls constitute the leading etiology of TBI in adolescents and young adults aged 10\u0026ndash;24 years.(Maas et al. \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e) This pattern may be attributed to developmental factors in this population, including high physical activity levels, frequent participation in sports (e.g., basketball, skateboarding, cycling), and risk-prone behaviors that increase susceptibility to balance loss or collisions.(Nigrovic and Kuppermann \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) Additionally, legal driving age restrictions in most countries likely reduce youth exposure to road traffic incidents, thereby diminishing their contribution to the burden of TBI in this demographic.(Lepard et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eRoad traffic-related injuries\u0026mdash;encompassing motor vehicle, motorcycle, pedestrian, and bicycle collisions\u0026mdash;remain critical contributors to TBI globally, with pronounced disparities across socioeconomic contexts.(Maas et al. \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) In low- and middle-income countries (LMICs), particularly Southeast Asia and West Africa, motorcycle collisions account for a disproportionately high share of TBI cases, reflecting regional dependencies on motorcycles as the primary transportation.(Dawood et al. \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2025\u003c/span\u003e; Tropeano et al. \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e2019\u003c/span\u003e) Conversely, high-income countries such as the United States and Canada have experienced marked declines in motor vehicle-related TBI incidence since 2000, likely driven by multisectoral interventions, including airbag standardization, enhanced road infrastructure, and stricter adolescent driver education programs.(Lepard et al. \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2021\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eNotably, the TBI etiological profile exhibited subtle yet epidemiologically significant shifts after 2020.(Troy et al. \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2023\u003c/span\u003e) During the COVID-19 pandemic, lockdown policies precipitated transient declines in traffic-related injuries, paralleled by rising proportions of domestic violence-related TBIs and indoor sports injuries. These dynamic trends underscore the necessity for adaptive public health policies to address injury pattern fluctuations during large-scale societal disruptions.(G et al. \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e2022\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eSex-stratified data revealed that compared with female adolescents, male adolescents presented substantially greater prevalence rates and YLDs attributable to TBI. This disparity may be attributable to males' heightened engagement in high-risk recreational activities and suboptimal adherence to protective equipment protocols.\u003csup\u003e21\u003c/sup\u003e Furthermore, sociocultural tolerance of risk-taking behaviors among males may exacerbate this gap. Notably, projected female TBI rates have progressively converged toward male levels in recent years, suggesting that evolving gender roles\u0026mdash;including increased female participation in competitive sports\u0026mdash;may be reshaping TBI epidemiological profiles. Neuroendocrine factors, particularly androgen-mediated effects on risk-reward appraisal during male adolescence, may further amplify susceptibility to injury-inducing decisions.(McCrory et al. \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2017\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eGeospatial analyses demonstrate pronounced heterogeneity in sex-specific TBI burden: regions with conservative sociocultural norms exhibit wider sex-based disparities, whereas areas with higher gender parity indices show attenuated differences.(Kaplan et al. \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e2023\u003c/span\u003e; Venturini et al. \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2024\u003c/span\u003e) These patterns collectively underscore the inextricable linkage between sociocultural determinants and sex-disaggregated TBI burden distributions.\u003c/p\u003e\u003cp\u003eOur findings have critical implications for TBI management policies and targeted interventions. In high-burden regions, priorities should include upgrading road infrastructure, enforcing helmet-use mandates, and implementing community-based violence prevention programs. For example, following the 2011 Ut\u0026oslash;ya Island mass shooting in Norway, global reassessments of youth safety protocols prompted strengthened protective measures in educational settings across multiple jurisdictions. In high-income settings, enhanced long-term monitoring of mild TBI cases is warranted to mitigate chronic disability risk. Effective TBI prevention demands multisectoral collaboration spanning transportation, education, and judicial systems. Innovations such as real-time mobile-based surveillance of hazardous road segments or school curricula that integrate injury prevention literacy could yield population-level benefits. Furthermore, AI-driven triage protocols in emergency departments may improve the diagnostic accuracy for TBI in low- and middle-income countries.\u003c/p\u003e\u003cp\u003eAdolescents and young adults, who are undergoing critical neurodevelopmental transitions, face compounded risks: TBI may precipitate cascading neuropsychiatric sequelae, including cognitive decline and mental health disorders.(Cruz-Haces et al. \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) Consequently, rehabilitation frameworks should integrate neuropsychological rehabilitation alongside physical recovery, complemented by economic subsidies for low-income households to disrupt cycles of medical impoverishment.(Kacperski and Arthur \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e2016\u003c/span\u003e)\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, the GBD estimates rely on nationally reported statistics that may not fully capture the epidemiology of TBI in low-income regions because of systematic underreporting or misclassification. Second, insufficient granularity in TBI severity stratification precludes the differentiation of long-term disability burdens between mild and severe cases. Third, emerging risk determinants such as climate change were not included in the analytical framework, despite their growing relevance to injury patterns. Future investigations should employ multidisciplinary frameworks that integrate multicenter clinical datasets with geographic information systems to elucidate the interactions between environmental exposures and social determinants of TBI.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. The study did not involve human subjects; analyses utilized anonymous, publicly accessible population-level estimates.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the GBD Results Tool- https://vizhub.healthdata.org/gbd-results-tool\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e No funding sources.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYNY and LYF were involved in data collection, analysis and interpretation, and drafted and critically reviewed the intellectual content of the paper. LWM, and WL revised the original manuscript. LYF and YNY were involved in data analysis. All authors reviewed and approved the final version of the manuscript. YNY was the guarantor of this work and therefore had full access to all data in the study and is responsible for the completeness of the data and the accuracy of the data analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eA population-based study of inflicted traumatic brain injury in young children | traumatic brain injury | JAMA | JAMA network. (n.d.). https://jamanetwork.com/journals/jama/fullarticle/197032. Accessed 25 April 2025\u003c/li\u003e\n \u003cli\u003eBonfield, C. M., Naran, S., Adetayo, O. A., Pollack, I. F., \u0026amp; Losee, J. E. (2014). 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A comparison of publication to TBI burden ratio of low- and middle-income countries versus high-income countries: How can we improve worldwide care of TBI? \u003cem\u003eNeurosurgical Focus\u003c/em\u003e, \u003cem\u003e47\u003c/em\u003e(5), E5. https://doi.org/10.3171/2019.8.FOCUS19507\u003c/li\u003e\n \u003cli\u003eTroy, B. M., Fraser Doh, K., Linden, A. F., Xiang, Y., Gillespie, S., \u0026amp; Agarwal, M. (2023). Changes in pediatric injuries sustained while engaged in activities where helmet usage is recommended during the COVID-19 pandemic. \u003cem\u003eInjury Epidemiology\u003c/em\u003e, \u003cem\u003e10\u003c/em\u003e(Suppl 1), 38. https://doi.org/10.1186/s40621-023-00449-2\u003c/li\u003e\n \u003cli\u003eVenturini, S., Still, M. E. H., Hutchinson, P. J., \u0026amp; Gwinnutt, J. M. (2024). Is pre-injury socioeconomic status associated with outcomes in patients with traumatic brain injury? A systematic review. \u003cem\u003eJournal of Neurotrauma\u003c/em\u003e, \u003cem\u003e41\u003c/em\u003e(7\u0026ndash;8), 789\u0026ndash;806. https://doi.org/10.1089/neu.2022.0341\u003c/li\u003e\n \u003cli\u003eVenturini, S., Still, M. E. H., Vycheth, I., Nang, S., Vuthy, D., \u0026amp; Park, K. B. (2019). The National Motorcycle Helmet Law at 2 Years: Review of Its Impact on the Epidemiology of Traumatic Brain Injury in a Major Government Hospital in Cambodia. \u003cem\u003eWorld Neurosurgery\u003c/em\u003e, \u003cem\u003e125\u003c/em\u003e, 320\u0026ndash;326. https://doi.org/10.1016/j.wneu.2019.01.255\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Traumatic brain injury, Prevalence, Years lived with disability, GBD 2021, Adolescents, Young adults","lastPublishedDoi":"10.21203/rs.3.rs-7613312/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7613312/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTraumatic brain injury (TBI) remains a critical global public health challenge, yet gaps in the evidence limit an understanding of its age-specific epidemiological profiles among adolescents and young adults. The aim of our analysis is to generate actionable evidence for tailoring prevention strategies and context-specific interventions aligned with the global epidemiological dataset in this population from 1990 to 2021.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, which reported on TBI-related years lived with disability (YLDs), prevalence, and annual average percentage change (AAPC) per 100,000 people. Joinpoint regression analysis was used to identify years with significant trend shifts. We also performed stratified analyses by age, sex, and sociodemographicindex (SDI). Furthermore, we used the Bayesian age-period-cohort (BAPC) model to project the TBI burden through 2030.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFrom 1990 to 2021, the prevalence of TBI among adolescents and young adults decreased from 191·3 per 100,000 people [177 to 208·9] to 128·3 per 100,000 people [117·8 to 139·1] (AAPC -1·28 [95% CI-1·31 to -1·26], p\u0026lt;0·001). Specific changes in the prevalence of TBI occurred in 2001, 2005, 2010, and 2017. Regionally, eastern sub-Saharan Africa had the most substantial reduction in prevalence rate (AAPC=-2·34[-2·62 to -2·05]) and YLD rates (AAPC=-2·32[-2·62 to -2·02]). The prevalence rate of TBI and YLDs attributable to TBI decreased in most countries except the Syrian Arab Republic, Yemen, Libya, Haiti, and the Central African Republic. Eritrea showed the most pronounced reduction in the TBI prevalence rate (AAPC=-7·6 95% UI: -7·76 to -7·45). The prevalence rate substantially decreasedin both sexes. The AAPC was -1·3 (95% CI -1·33 to -1·27) for males, which was comparable to the AAPC of -1·28 (95% CI -1·34 to -1·23) observed in females. Thelargest decrease in TBI prevalence from 1990 to 2021 was found among individuals aged 10-14 years (AAPC=-1·45[-1·49 to -1·41]). In terms of the SDI quintile, the most pronounced reductions in TBI prevalence and YLD rates occurred in the high-SDI quintile countries. Among all causes of TBI, falls constitute the leading etiology, with its proportional contribution rising steadily from 31·9% in 1990 to 37·7% in 2021. However,the BAPC analysis predicted that the prevalence of TBI and YLDs attributable to TBI would increasefrom 2022 to 2030.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe global burden of TBI in adolescents and young adults aged 10-24 years decreased from 1990 to 2021. This study is the first to report the global disease burden and temporal trends of TBI in adolescents and young adults. Although the disease burden has decreased in most regions, attention should still be givento specific regions to strengthen policy development and disease management.\u003c/p\u003e","manuscriptTitle":"Global, regional, and national burdens of traumatic brain injury in adolescents and young adults aged 10-24 years from 1990 to 2021: A secondary analysis of the Global Burden of Disease Study 2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-26 08:02:16","doi":"10.21203/rs.3.rs-7613312/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-09T14:32:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-09T03:59:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80229343933520299478046707020445278337","date":"2025-12-02T07:56:09+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-24T16:32:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-18T16:01:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"333232366542341154822581195923313575706","date":"2025-11-18T02:59:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80229343933520299478046707020445278337","date":"2025-11-17T08:46:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"284417825004808214613660840319572517651","date":"2025-11-17T08:14:47+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-17T06:11:00+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-07T08:16:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-17T06:28:53+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-17T06:26:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-09-14T14:50:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cc8d074b-f8ac-4336-9e14-c5e805c2815f","owner":[],"postedDate":"November 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-02T15:59:57+00:00","versionOfRecord":{"articleIdentity":"rs-7613312","link":"https://doi.org/10.1186/s12982-026-01413-3","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2026-01-28 15:58:01","publishedOnDateReadable":"January 28th, 2026"},"versionCreatedAt":"2025-11-26 08:02:16","video":"","vorDoi":"10.1186/s12982-026-01413-3","vorDoiUrl":"https://doi.org/10.1186/s12982-026-01413-3","workflowStages":[]},"version":"v1","identity":"rs-7613312","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7613312","identity":"rs-7613312","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}