Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

Global burden of occupational injury-related transport and unintentional injuries in 204 countries: trends from 1990 to 2021 with a 15-year forecast

OBJECTIVES

This study aimed to estimate the burden of transport and unintentional injuries attributable to occupational injury from 1990 to 2021 and provided a 15-year forecast.

METHODS

Age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years (DALYs) rate (ASDR) attributable to occupational injury were analyzed using the estimated annual percentage change (EAPC) for transport and unintentional injuries from 1990 to 2021. Future injury forecasts were derived using Bayesian age-period-cohort (BAPC) model.

RESULTS

Between 1990 and 2021, ASMR and ASDR from occupational injury-related transport and unintentional injuries declined in most countries. The Republic of Korea saw the largest reductions, with EAPC for transport injuries at -12.40 (ASMR); and -12.01(ASDR), and for unintentional injuries at -10.65; -8.81, respectively. Males consistently had higher mortality and DALYs rates compared to females. Projections indicate that the mortality and DALYs rates will continue to decrease until 2036, suggesting improvements in occupational injury prevention.

CONCLUSIONS

This study found that ASMR and ASDR of occupational injury decreased. The prediction results show that the burden of occupational injury is still heavy and is a major public health problem, which highlights the need for regions to develop measures to reduce the burden of occupational injury.

Significant Stenosis Without Thrombus: Is It the Third Most Common Morphology of Acute Coronary Syndrome?

Background

Significant stenosis without thrombus (SSWT) is sometimes observed in patients with acute coronary syndrome (ACS). However, its incidence and clinical features remains unclear.

Method

This substudy of the TACTICS registry included patients with ACS (n = 702) undergoing emergency percutaneous coronary intervention using optical coherence tomography. Using this registry data, we compared the clinical features of SSWT in patients with ACS. Major adverse cardiac events were defined as cardiac death, nonfatal myocardial infarction, heart failure, or ischemia-driven revascularization at 1 year.

Results

Plaque rupture (PR; n = 411, 59.1%) and plaque erosion (PE; n = 178, 25.6%) were the 2 major morphologies, followed by SSWT (n = 64, 9.1%) and calcified nodule (CN; n = 28, 4.0%). Patients with SSWT were slightly older than those with PR and PE, but younger than those with CN. In the SSWT, non-ST elevation myocardial infarction was the main type of ACS, followed by unstable angina and ST-elevation myocardial infarction (63%, 22%, and 15%, respectively). Lesions were less complex with a lower proportion of type B2 or C, shorter procedure time, lower proportion of multivessel disease, and lower syntax score, which led to a lower incidence of major adverse cardiac events.

Conclusion

SSWT was the third most common morphology of ACS, with clinical features different from those of PR, PE, and CN.

Liang-Ge-San attenuates virus-induced acute lung injury by targeting FXR-mediated ACE2 downregulation to modulate the formation of the cytokine storm

BACKGROUND

Traditional Chinese medicine has been recognized for its significant role in treating acute lung injury (ALI) due to its distinct therapeutic advantages. Liang-Ge-San (LGS), a formulation from the ancient "Taiping Huimin Hejiju Fang", is believed to possess beneficial effects for treating ALI. However, LGS's precise mechanisms and efficacy in addressing viral ALI remain inadequately explored.

PURPOSE

To evaluate LGS's therapeutic effects and underlying mechanisms in treating viral-induced ALI.

METHODS

The protective effects of LGS were examined in a Polyinosinic-polycytidylic acid [Poly(I:C)]-induced ALI model using real-time quantitative PCR, enzyme-linked immunosorbent assay, and histopathological analysis. A bioinformatics approach combined with network pharmacology was utilized to ascertain the key targets of LGS in viral pneumonia. The pharmacodynamic mechanisms of LGS in viral ALI were further validated through immunofluorescence, overexpression, short hairpin RNA, chromatin immunoprecipitation, and target agonist assays.

RESULTS

LGS administration resulted in a reduction of IL-1β, IL-6, and TNF-α levels, along with a decrease in macrophage infiltration, pulmonary damage, and pneumonedema following the Poly(I:C) challenge. Bioinformatics and network pharmacology analyses suggested that Farnesyl X receptor (FXR) and angiotensin converting enzyme 2 (ACE2) are potential therapeutic targets for LGS in viral pneumonia. Further experiments revealed that LGS suppressed the expression of FXR, ACE2, and NF-κB-p65 in Poly(I:C)-infected cells. Notably, overexpression of FXR counteracted the repressive effects of LGS, while ACE2 expression remained unchanged in FXR-knockdown RAW264.7 cells upon treatment with Poly(I:C) or LGS. Additionally, LGS inhibited the interaction between FXR and ACE2 transcriptional promoters. In vivo, LGS attenuated the Poly(I:C)-induced upregulation of FXR, ACE2, IL-1β, IL-6, and TNF-α in ALI zebrafish and mice models, effects that could be reversed by chenodeoxycholic acid (CDCA), an FXR agonist. Moreover, LGS markedly alleviated weight loss, improved survival rates, reduced lung index, diminished viral load, and inhibited lung pathological changes in H1N1-PR8-induced ALI mice. IL-1β, IL-6, TNF-α, INF-γ, FXR, ACE2, small heterodimer partner, and NF-κB-p65 levels were markedly reduced by LGS, with these effects being reversed by CDCA.

CONCLUSION

This investigation provides the first evidence that FXR/ACE2 signaling is pivotal in acute respiratory viral infections, while LGS demonstrates antiviral activity against viral-induced ALI. LGS inhibits ACE2 expression induced by viral infection via FXR inhibition and modulates the cytokine storm, thus alleviating viral ALI. These findings suggest that LGS may be a promising treatment strategy for treating viral ALI.

Trends in Utilization of Glucose- and Weight-Lowering Medications After Tirzepatide Approval in the United States : A Population-Based Cohort Study

BACKGROUND

Recent trends in use of tirzepatide, a dual glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide receptor agonist (RA), versus other glucose-lowering medications (GLMs) and weight-lowering medications (WLMs) remain unexplored.

OBJECTIVE

To describe trends in insurance claims for GLMs and WLMs after tirzepatide approval.

DESIGN

Population-based cohort study.

SETTING

Claims data from a large U.S. commercial database (January 2021 to December 2023).

PARTICIPANTS

Adults (aged ≥18 years) with type 2 diabetes (T2D) and without diabetes with dispensations for GLMs and WLMs. Any use was defined as medication dispensation regardless of prior use. Incident use was defined as dispensation without use in the preceding year.

MEASUREMENTS

Monthly trends in medication dispensations before and after tirzepatide market entry. Tirzepatide uptake was additionally compared with initial postapproval uptake of other GLMs and WLMs.

RESULTS

Tirzepatide dispensations increased markedly among adults with T2D prescribed GLMs, reaching 12.3% of all GLM dispensations by December 2023. Similar patterns were observed for sodium-glucose cotransporter-2 inhibitors (14.5% to 24.4%) and GLP-1 RAs (19.5% to 28.5%). Dispensations of other GLMs, including metformin, declined. Among adults without diabetes but prescribed WLMs, tirzepatide (0.0% to 40.6%) and semaglutide (2.4 mg) (0.0% to 32.2%) dispensations increased sharply, but semaglutide (2.0 mg) was the most frequently dispensed WLM, increasing from 37.8% to 45.7%. Dispensations of other WLMs declined. Similar trends were observed among incident users. Tirzepatide uptake was more rapid and sustained compared with initial postapproval periods for other medications.

LIMITATION

Generalizability to U.S. adults without commercial health insurance is uncertain.

CONCLUSION

These findings highlight the sharp uptake of tirzepatide after U.S. market entry and enhance understanding of the rapidly shifting landscape of prescribing patterns for GLMs and WLMs.

PRIMARY FUNDING SOURCE

National Institute of Diabetes and Digestive and Kidney Diseases.

Evaluating disability, comorbidities and risk factors after TB treatment: an 18-24 month follow-up

BACKGROUND

Several countries have developed national strategic plans to address post-TB disability and comorbidities. However, their feasibility and added value within routine programmatic settings remain undocumented.

METHODS

We followed up individuals who successfully completed TB treatment at 11 health facilities in China between 2022-2023. Within the programmatic setting, we assessed health status, on-going symptoms, comorbidities, risk factors and disability (measured by 6-minute walking test [6MWT]) 18-24 months after treatment completion.

RESULTS

Of 586 individuals who completed TB treatment, 503 (86%) were reassessed. Compared with end of TB treatment, there were significant increases in cough (11.0% versus 6.4%), untreated diabetes (3.2% versus <1.0%), high blood pressure (13.1% versus 8.9%), cigarette smoking (12.7% versus 5.2%) and excessive alcohol consumption (5.8% versus 1.2%). Other conditions remained similar with 27.0% still disabled (6MWT<400m). 78 (13%) patients died or were lost-to-follow-up, with risk factors at end of treatment including on-going symptoms (RR1.7, 95%CI 1.1-2.7), high blood pressure (RR2.3, 95%CI 1.2-4.1) and undernutrition (RR2.6, 95%CI 1.7-3.9). Nine patients had recurrent TB. Employment status remained unchanged, with 47.5% still unemployed 18-24 months later.

CONCLUSIONS

TB survivors experienced substantial multimorbidity 18-24 months post-TB treatment. Health services must integrate long-term care strategies to address these ongoing health challenges.

Global burden of road injuries and their attributable risk factors from 1990 to 2021: A systematic analysis for the global burden of disease study 2021

Objective: To systematically estimate the burden of road injuries and associated risk factors. Methods: Data on incidence, deaths, and disability-adjusted life years (DALYs) with 95 % uncertainty intervals, by age, sex, sociodemographic index, region, and country, from 1990 to 2021, were obtained from the Global Burden of Disease Study 2021. In addition, we obtained the numbers of DALYs and deaths attributed to risk factors. Joinpoint regression analysis was used to calculate the average annual percentage changes and 95 % confidence intervals (CIs). Results: In 2021, the incident cases of road injuries were 50.3 million (95 % uncertainty interval: 45.7 to 55.2) globally, with an age-standardized incidence (ASIR) of 627.8 per 100,000 population (95 % uncertainty interval: 570.6 to 688.1). From 1990 to 2021, the ASIR was decreased by an average of 1.52 (95 % CI: -1.55 to -1.49) per year. Substantial heterogeneity was observed, particularly among youth aged 25-29 years, males, and high-income North America. Road injuries caused 65.1 million (95 % uncertainty interval: 60.7 to 69.9) DALYs and 1195.7 thousand (95 % uncertainty interval: 1118.2 to 1275.7) deaths in 2021. High burden was observed in older people, males, Central Sub-Saharan Africa, and countries with low income. Motor vehicles (36.6 %) and pedestrians (36.8 %) were the main causes of death. In particular, 72.2 % of road injuries were attributable to occupational injuries for males, while 57.7 % were attributable to low bone mineral density for females. Conclusion: This study suggests a decreasing global burden of road injuries. Nonetheless, road safety remains a significant global public health issue.

Global, regional and national epidemiology of anemia attributable to chronic kidney disease, 1990-2021

Background

Chronic kidney disease (CKD) presents a significant global health challenge, with anemia frequently manifesting in the more advanced stages. This study aimed to evaluate the global burden and cross-country inequality of CKD-related anemia from 1990 to 2021.

Methods

Data on CKD-related anemia were extracted from the Global Burden of Disease 2021 study. Trends in prevalence, years lived with disability (YLDs) and corresponding estimated annual percentage changes (EAPCs) from 1990 to 2021 were analyzed at global, regional and national levels. Health inequity analysis methodologies were employed to evaluate cross-country inequality based on sociodemographic index.

Results

In 2021, global CKD-related anemia cases reached 63 751 624 [95% uncertainty interval (UI), 59 045 051-68 372 650], representing a 96.24% increase from 1990 (32 486 224; 95% UI 30 356 876-35 047 084). Notwithstanding this increase, global prevalence [EAPC -0.27; 95% confidence interval (CI) -0.34 to -0.21] and YLDs rates (EAPC -0.66; 95% CI -0.70 to -0.62) generally declined. Females were disproportionately affected, comprising 55.75% of prevalence cases and 65.87% of YLDs numbers in 2021. From 1990 to 2021, the burden increased in individuals with CKD-related anemia associated with type 1 diabetes. Significant cross-country inequalities in prevalence were observed and persisted [slope index of inequality: 255.04 (389.56-120.51) in 1990 to 423.30 (572.78-273.81) in 2021; health concentration index: -0.09 (-0.12 to -0.07) in 1990 to -0.14 (-0.17 to -0.11) in 2021].

Conclusions

Despite the global decline in prevalence and YLDs rates of CKD-related anemia, the number of cases continued to increase, and the burden disproportionately concentrated in less developed countries and territories. This investigation also revealed a gender disparity and the influence of specific causes.

Umbrella Review of Systematic Reviews and Meta-Analyses on Consumption of Different Food Groups and Risk of Type 2 Diabetes Mellitus and Metabolic Syndrome

Type 2 diabetes is a major contributor to the burden of chronic diseases globally. Most cases of type 2 diabetes are preventable through healthy lifestyle modifications in diet and physical activity. This systematic umbrella review presents a comprehensive overview of the evidence about the associations between risk of type 2 diabetes and metabolic syndrome with 13 food groups, including refined and whole grains, fruits, vegetables, nuts, legumes, fish and fish products, eggs, dairy/milk, sugar-sweetened beverages, processed meat, and unprocessed red and white meat. We present these relationships in per-serving and with high-versus-low comparisons. After doing a systematic search in MEDLINE, Embase, Web of Science, and Epistemonikos (registered with PROSPERO: CRD42024547606), we screened 5074 references published until May 15, 2024, and included 67 articles. This included 46 meta-analyses on risk of type 2 diabetes with half a million participants, 17 meta-analyses on risk of metabolic syndrome, and 4 meta-analyses on risk of diabetes-related mortality. Based on quality assessments using AMSTAR-2, 25 of the 67 studies were classified as high-quality studies, 8 as moderate, 12 as low, and 22 as critically low quality. Our results showed that a high intake of whole grains was associated with a lower risk of type 2 diabetes (metaevidence: moderate) and metabolic syndrome (metaevidence: low), with a similar tendency also for a high intake of fruits and vegetables (metaevidence: moderate). In contrast, the high intakes of processed meat (metaevidence: high), red meat (metaevidence: moderate), and sugar-sweetened beverages (metaevidence: moderate) were associated with a higher risk of type 2 diabetes. For the other food groups, the associations were generally neutral and not statistically significant. The heterogeneity was high for most food groups except fruits, indicating potential differences within each of the food groups in association with type 2 diabetes.

Metabolome-wide association identifies ferredoxin-1 (FDX1) as a determinant of cholesterol metabolism and cardiovascular risk in Asian populations

The burden of cardiovascular disease is rising in the Asia-Pacific region, in contrast to falling cardiovascular disease mortality rates in Europe and North America. Here we perform quantification of 883 metabolites by untargeted mass spectroscopy in 8,124 Asian adults and investigate their relationships with carotid intima media thickness, a marker of atherosclerosis. Plasma concentrations of 3beta-hydroxy-5-cholestenoate (3BH5C), a cholesterol metabolite, were inversely associated with carotid intima media thickness, and Mendelian randomization studies supported a causal relationship between 3BH5C and coronary artery disease. The observed effect size was 5- to 6-fold higher in Asians than Europeans. Colocalization analyses indicated the presence of a shared causal variant between 3BH5C plasma levels and messenger RNA and protein expression of ferredoxin-1 (FDX1), a protein that is essential for sterol and bile acid synthesis. We validated FDX1 as a regulator of 3BH5C synthesis in hepatocytes and macrophages and demonstrated its role in cholesterol efflux in macrophages and aortic smooth muscle cells, using knockout and overexpression models.

The global burden of mesothelioma and its association with asbestos bans, 1990-2021: a population-based study

BACKGROUND

Mesothelioma, as a lethal consequence of asbestos exposure, poses a significant threat to high-risk populations. The Global Burden of Disease (GBD) 2021 update provides an opportunity to examine current mesothelioma epidemiology and assess whether asbestos bans have effectively reduced mesothelioma incidence over a longer time span than covered in existing literature.

METHODS

Annual cases and age-standardized rates (ASRs, reported per 100,000 person-years) of incidence, death, disability-adjusted life-years, and probability of death associated with mesothelioma among different age groups were obtained from patients in 204 countries and territories diagnosed with mesothelioma between 1990 and 2021. Estimated annual percentage changes (EAPCs) and period analysis of ASRs were employed to evaluate temporal trends in incidence and mortality. Data on global asbestos consumption and bans were collected from various sources to investigate their relationship with mesothelioma burdens.

RESULTS

In 2021, global incident cases of mesothelioma slightly increased to 31,908 [29,643, 34,115], with 23,184 [21,553, 24,941] in males and 8,724 [7,784, 9,580] in females, up from 31,173 [28,821, 33,090] in 2019, and approximately double the number in 1990 (16,493 [15,325, 17,783]). Australasia, Western Europe, and Southern Sub-Saharan Africa ranked in the top three for all ASRs. The United Kingdom and Australia had the highest ASRs globally, while the Northern Mariana Islands, El Salvador, Syrian Arab Republic, Iran (Islamic Republic of), Saudi Arabia, and Palestine had the lowest ASRs in 2021. Most countries with asbestos bans continued to exhibit declining trends in ASRs from 2019 to 2021.

CONCLUSIONS

Global asbestos bans have demonstrated sustained effectiveness in controlling mesothelioma. Accelerated implementation of asbestos bans in developing nations coupled with deeper exploration of mesothelioma pathogenesis would aid in enhancing primary prevention efforts. Although the mesothelioma burden is more severe in high-income regions, ASRs have decreased more notably in high and upper-middle socio-demographic indexes (SDIs) tiers with generally more comprehensive and earlier asbestos bans compared to other locations. The burden of female mesothelioma has shown slower remission compared to males in many regions recently, underscoring the importance of non-occupational exposures.

Global trends and disparities in gallbladder and biliary tract cancers: insights from the global burden of disease study 2021

BACKGROUND

Gallbladder and biliary tract cancers (GBC and BTC) are highly malignant, with poor prognoses and substantial regional variability in the disease burden. Although advances in medical science have improved outcomes in high-income regions, low- and middle-income regions continue to face rising incidence and mortality rates owing to delayed detection and treatment. Understanding the global trends and risk factors of GBC and BTC is essential for targeted interventions to reduce disease burden.

METHODS

A retrospective analysis of GBC and BTC was conducted using the 2021 Global Burden of Disease study. Data from 204 countries and territories between 1990 and 2021 were analyzed for incidence, mortality, and disability-adjusted life years stratified by age, sex, and sociodemographic index (SDI). Trends were quantified using age-standardized rates and estimated annual percentage changes.

RESULTS

In 2021, 216,768 new cases and 171,961 deaths were reported globally, with age-standardized incidence and mortality rates of 2.6 and 2.0 per 100,000, respectively. The high-income Asia-Pacific and Latin American regions exhibited the highest disease burdens. While global age-standardized rates declined estimated annual percentage changes for incidence: -0.44; mortality: -0.97), low-SDI regions experienced increases. High BMI emerged as the leading risk factor, contributing to 12% of the disability-adjusted life years. Projections indicate a stable incidence but rising mortality by 2036.

CONCLUSION

Although the global age-standardized rates of GBC and BTC are decreasing, disparities persist, with low-SDI regions experiencing increasing burdens. Targeted interventions addressing modifiable risk factors such as obesity, along with improved healthcare infrastructure and early detection, are critical for mitigating this global health challenge.

A systematic review with a Burden of Proof meta-analysis of health effects of long-term ambient fine particulate matter (PM2.5) exposure on dementia

Previous studies have indicated increased dementia risk associated with fine particulate matter (PM2.5) exposure; however, the findings are inconsistent. In this systematic review, we assessed the association between long-term PM2.5 exposure and dementia outcomes using the Burden of Proof meta-analytic framework, which relaxes log-linear assumptions to better characterize relative risk functions and quantify unexplained between-study heterogeneity (PROSPERO, ID CRD42023421869). Here we report a meta-analysis of 28 longitudinal cohort studies published up to June 2023 that investigated long-term PM2.5 exposure and dementia outcomes. We derived risk-outcome scores (ROSs), highly conservative measures of effect size and evidence strength, mapped onto a 1-5-star rating from 'weak and/or inconsistent evidence' to 'very strong and/or consistent evidence'. We identified a significant nonlinear relationship between PM2.5 exposure and dementia, with a minimum 14% increased risk averaged across PM2.5 levels between 4.5 and 26.9 µg m-3 (the 15th to 85th percentile exposure range across included studies), relative to a reference of 2.0 µg m-3 (n = 49, ROS = 0.13, two stars). We found a significant association of PM2.5 with Alzheimer's disease (n = 12, ROS = 0.32, three stars) but not with vascular dementia. Our findings highlight the potential impact of air pollution on brain aging.

Short-course treatment for community-acquired pneumonia in adults aged less than 65 years in Japan: A descriptive study using large healthcare claims database

INTRODUCTION

In community-acquired pneumonia (CAP), short-course treatment is not inferior in effectiveness compared to conventional treatment durations, and clinical guidelines recommend 5-7-day-long treatments. However, it remains unclear how widely this practice is adopted in Japan. This study aimed to clarify the treatment duration of CAP in Japan using a large healthcare claims database.

METHODS

We used health insurance claims data provided by JMDC Inc. (Tokyo, Japan) and included patients aged 18-64 years diagnosed with CAP who began antibiotic treatment between January 1, 2013, and December 31, 2022. Short-course treatment was defined as ≤ 7 d. Analyses were conducted separately for inpatient and outpatient cases, and the annual trends were also investigated.

RESULTS

Overall, 25,572 patients (3367 inpatients and 22,205 outpatients) were included in the analysis. Short-course treatment was administered to 1087 (32 %) inpatients and 15,614 (70 %) outpatients. The proportion of short-course treatments during the 10-year study period was 31-35 % for inpatient cases and 67-72 % for outpatient cases, with no marked changes over the years.

CONCLUSIONS

The proportion of inpatients receiving short-course treatments for CAP was low. In Japan, especially for inpatient cases, further efforts are required to optimize the duration of CAP treatment.

Xuebijing injection reduces COVID-19 patients' mortality as influenced by the neutrophil to lymphocyte platelet ratio

OBJECTIVE

Xuebijing injection has been recommended as a therapeutic approach for individuals with severe and critical COVID-19. This study aims to explore the correlation of neutrophil to lymphocyte platelet ratio (NLPR) with the severity and prognosis of COVID-19, and the effect of XBJ on the prognosis of patients with COVID-19 in different inflammatory states.

METHODS

This was a retrospective study conducted at Wuhan Union Hospital in China. COVID-19 patients admitted between November 1, 2022 and February 1, 2023 were included. In predicting prognosis for individuals with COVID-19, new inflammatory indicators were used, and their prognostic value was assessed by using Cox regression models and receiver operating characteristic curves. Furthermore, a calculation was made to determine the cutoff value for NLPR. Relative risk and Cox regression models were used to examine the effects of Xuebijing injection on prognosis in patient cohorts that had been stratified by the NLPR cutoff.

RESULTS

This research included 455 participants with COVID-19, with a mean age of 72 years. Several inflammatory indicators were found to be strongly correlated with prognosis, and NLPR shows the greatest predictive power. Patients with NLPR > 3.29 exhibited a mortality rate of 17.3%, which was 6.2 times higher than in patients with NLPR ≤ 3.29. Importantly, providing Xuebijing injection to patients with NLPR > 3.29 was associated with a lower risk of 60-day all-cause mortality. However, there was no discernible improvement in survival among patients with NLPR ≤ 3.29 who received Xuebijing injection.

CONCLUSION

NLPR is the most reliable inflammatory marker for predicting prognosis among individuals with COVID-19, and can accurately identify individuals who may benefit from Xuebijing injection. Please cite this article as: Liao M, Zhang LT, Bai LJ, Wang RY, Liu Y, Han J, Liu LH, Qi BL. Xuebijing injection reduces COVID-19 patients mortality as influenced by the neutrophil to lymphocyte platelet ratio. J Integr Med. 2025; 23(3): 282-288.

Global Burden of Lip and Oral Cavity Cancer From 1990 to 2021 and Projection to 2040: Findings From the 2021 Global Burden of Disease Study

BACKGROUND

The aim of this study was to estimate the global burden of lip and oral cavity cancer (LOC) and its trends in different genders, age groups, regions, and countries globally.

METHODS

Data were sourced from the Global Burden of Disease 2021 study.

RESULTS

During the 32-year period, a 92.92% and 113.94% increase was estimated in the absolute counts of LOC deaths and disability-adjusted life years (DALYs), respectively. Throughout the 32-year period, males exhibited higher age-standardized rates (ASRs) of incidence (ASIRs), prevalence (ASPRs), mortality (ASMRs), and DALYs (ASDRs) related to LOC. The age group of 60-64 years consistently recorded the highest numbers of new and prevalent cases across the years 1990, 2019, and 2021. In 2019 and 2021, the highest ASMR and ASDR were observed in individuals aged 95 years and older. Regions with low-middle and low socio-demographic index (SDI) consistently showed higher ASMRs and ASDRs associated with LOC from 1990 to 2021. Eastern Europe, South, North, and Southeast Asia exhibited a concentration of countries with higher ASIRs, ASPRs, ASMRs, and ASDRs in 2021. South Asia maintained high levels of ASIRs, ASPRs, ASMRs, and ASDRs in 2021. In 2021, Palau recorded the highest ASIR, ASPR, ASMR, and ASDR, followed by Pakistan. Projections indicate that ASIR, ASPR, ASMR, and ASDR are expected to increase by 7.40%, 10.10%, 2.85%, and 4.60%, respectively, from 2021 to 2040.

CONCLUSION

LOC remains a critical public health concern that requires immediate attention, particularly among certain demographics such as males, aged 60-64 or 95 and older, as well as in low- and middle-SDI regions, particularly Eastern Europe, South Asia (notably Pakistan), North Asia, and Southeast Asia.

Associations between main ambient air pollutants and ischaemic heart disease risk in the UK biobank: A prospective cohort study

OBJECTIVES

Air pollutants have been associated with multiple cardiovascular diseases, but evidence on the long-term and combined effects of air pollutants on the incidence of ischaemic heart disease (IHD) remains limited.

STUDY DESIGN

Prospective cohort study.

METHODS

A total of 398,547 participants from the UK Biobank were included in this prospective cohort study. Concentrations of air pollutants were calculated using the Land Use Regression (LUR) model, including particulate matter (PM) [PM2.5, PM10-2.5, PM10] and nitrogen oxides (NOx and NO2). Cox proportional hazards models and restricted cubic spline models were utilised to detect associations between air pollutants and IHD incidence. A novel air pollution score was proposed to indicate the synergistic effect of five air pollutants by combining variance contribution and eigenvalue of each pollutant in principal components analysis (PCA).

RESULTS

In a median follow-up of 12.5 years, 23,721 of 398,547 participants were diagnosed with IHD. For every 1-μg/m3 increase, the risk of IHD was 1.026 (95 % confidence interval [CI]: 1.012-1.040) and 1.002 (95 % CI: 1.001-1.003) for PM2.5 and NOx, respectively. This study found that for every increase in quartile of PM2.5 level, the hazard ratios (HRs) for IHD were 1.035 (95 % CI: 0.998-1.073), 1.043 (95 % CI: 1.005-1.082) and 1. 063 (95 % CI: 1.022-1.106) compared with the lowest quartile. Long-term estimated exposure to multiple air pollutants showed a significant association with elevated risk of IHD (HRs = 1.029, 95 % CI: 1.007-1.051) and the exposure-response curve was linear.

CONCLUSIONS

Among UK adults, long-term and synchronous exposure to multiple air contaminants was associated with an increased risk of IHD.

Burden of cancer attributable to high body mass index: A systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

High body mass index (BMI) is a well-established cancer risk factor. Reliable, updated data are essential for guiding public health policies and designing effective interventions to reduce the cancer burden associated with high BMI.

METHODS

Data from the Global Burden of Disease Study 2021 on cancer burden attributable to high BMI were analysed globally, stratified by sex, age, geographic region, cancer type, and socio-demographic index (SDI). Temporal trends in age-standardized rates from 1990 to 2021 were evaluated using estimated annual percentage changes.

RESULTS

In 2021, cancer attributable to high BMI resulted in 356.74 thousand deaths (95% uncertainty interval: 146.12-581.01) and 8.89 million (3.75-14.38) Disability-Adjusted Life Years (DALYs), with females bearing the largest burden. From 1990 to 2021, age-standardized rates of high BMI-related cancer deaths increased by 0.35% annually, while DALYs rose by 0.42% annually. In 2021, the burden of cancer deaths and DALYs attributable to high BMI varied considerably across geographical regions. Low-middle SDI regions experienced the largest increases in death and DALY rates attributable to high BMI, while these rates declined in high SDI regions. Colon and rectum cancers accounted for the greatest number of deaths and DALYs, while pancreatic cancer showed the most rapid growth in attributable burden.

CONCLUSIONS

High BMI is a major contributor to the global cancer burden, with significant variation by sex, cancer type, region, and SDI level. Targeted public health strategies are urgently needed to mitigate the growing impact of overweight and obesity on cancer.

LncRNA SERPINB9P1 Mitigates Cerebral Injury Induced by Oxygen‒Glucose Deprivation/Reoxygenation by Interacting with HSPA2

Dysregulation of long non-coding RNAs (lncRNAs) is implicated in the pathophysiology of ischemic stroke (IS). However, the molecular mechanism of the lncRNA SERPINB9P1 in IS remains unclear. Our study aimed to explore the role and molecular mechanism of the lncRNA SERPINB9P1 in IS. This study revealed downregulation of the lncRNA SERPINB9P1 in the peripheral blood of IS patients, which was corroborated by the GSE140275 dataset. Furthermore, high lncRNA SERPINB9P1 expression was associated with lower National Institutes of Health Stroke Scale (NIHSS) scores and favorable outcome. Clinically, lncRNA SERPINB9P1 expression was correlated with inflammation and coagulation parameters in IS patients. Furthermore, lncRNA SERPINB9P1 silencing inhibited cell viability, induced apoptosis and inflammatory response under oxygen-glucose deprivation/reperfusion ; however, these effects were reversed upon its overexpression. Additionally, Chromatin Isolation by RNA Purification and mass spectrometry (CHIRP-MS) and western blot confirmed that the lncRNA SERPINB9P1 was involved in the pathological process of IS through binding to heat shock protein 2 (HSPA2). HSPA2 was upregulated in IS patients, and its protein interaction network was significantly enriched in IS-related pathways. In conclusion, the lncRNA SERPINB9P1 may ameliorate neurological injury in IS patients by interacting with the HSPA2 protein and engaging in IS-related pathways, providing new insights into treatment strategies for IS.

Association between dental floss use and atherosclerotic cardiovascular disease in American adults

BACKGROUND

Atherosclerotic cardiovascular disease (ASCVD) remains a major cause of global morbidity and mortality. Emerging research suggests that oral hygiene practices, particularly dental floss use, may reduce the risk of ASCVD.

OBJECTIVES

The purpose of this study was to examine the association between dental floss use and ASCVD prevalence.

METHODS

Data from NHANES participants who completed home interviews and dental evaluations were analyzed. ASCVD was defined as angina, stroke, myocardial infarction, or coronary artery disease. Dental floss use was self-reported over the past seven days. Covariates included demographic, socioeconomic, lifestyle, and clinical factors. Weighted logistic regression was used to assess the relationship between dental floss use and ASCVD prevalence.

RESULTS

This study included a total sample of 7253 participants with a mean age of 53.8±14.6 years. The sample consisted of 47.6 % male participants. The ethnic composition included 64.3 % Non-Hispanic White. Regular dental floss use was correlated with a lower likelihood of developing ASCVD and Stringent Criteria (infarction or stroke), with ORs of 0.76 (95 % CI: 0.60, 0.97) p=0.028 and 0.68 (95 % CI: 0.49, 0.94) p=0.022, respectively. Flossing 3-4 days/week was associated with reduced ASCVD risk, OR = 0.57 (95 % CI: 0.38, 0.84) p=0.006. Similar reductions were seen for stringent criteria: flossing 3-4 days/week: OR = 0.57 (95 % CI: 0.32, 0.99) p=0.047, flossing ≥5 days/week: OR = 0.69 (95 % CI: 0.47, 1.00) p=0.049.

CONCLUSIONS

Regular dental floss use may reduce the risk of ASCVD. These results support the inclusion of oral hygiene practices in cardiovascular disease prevention strategies.

Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990-2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Diarrhoeal diseases claim more than 1 million lives annually and are a leading cause of death in children younger than 5 years. Comprehensive global estimates of the diarrhoeal disease burden for specific age groups of children younger than 5 years are scarce, and the burden in children older than 5 years and in adults is also understudied. We used results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to assess the burden of, and trends in, diarrhoeal diseases overall and attributable to 13 pathogens, as well as the contributions of associated risk factors, in children and adults in 204 countries and territories from 1990 to 2021.

METHODS

We used the Cause of Death Ensemble modelling strategy to analyse vital registration data, verbal autopsy data, mortality surveillance data, and minimally invasive tissue sampling data. We used DisMod-MR (version 2.1), a Bayesian meta-regression tool, to analyse incidence and prevalence data identified via systematic reviews, population-based surveys, and claims and inpatient data. We calculated diarrhoeal disability-adjusted life-years (DALYs) as the sum of years of life lost (YLLs) and years lived with disability (YLDs) for each location, year, and age-sex group. For aetiology estimation, we used a counterfactual approach to quantify population-attributable fractions (PAFs). Additionally, we estimated the diarrhoeal disease burden attributable to the independent effects of risk factors using the comparative risk assessment framework.

FINDINGS

In 2021, diarrhoeal diseases caused an estimated 1·17 million (95% uncertainty interval 0·793-1·62) deaths globally, representing a 60·3% (50·6-69·0) decrease since 1990 (2·93 million [2·31-3·73] deaths). The most pronounced decline was in children younger than 5 years, with a 79·2% (72·4-84·6) decrease in diarrhoeal deaths. Global YLLs also decreased substantially, from 186 million (147-221) in 1990 to 51·4 million (39·9-65·9) in 2021. In 2021, an estimated 59·0 million (47·2-73·2) DALYs were attributable to diarrhoeal diseases globally, with 30·9 million (23·1-42·0) of these affecting children younger than 5 years. Leading risk factors for diarrhoeal DALYs included low birthweight and short gestation in the neonatal age groups, child growth failure in children aged between 1-5 months and 2-4 years, and unsafe water and poor sanitation in older children and adults. We estimated that the removal of all evaluated diarrhoeal risk factors would reduce global DALYs from 59·0 million (47·2-73·2) to 4·99 million (1·99-10·0) among all ages combined. Globally in 2021, rotavirus was the predominant cause of diarrhoeal deaths across all ages, with a PAF of 15·2% (11·4-20·1), followed by norovirus at 10·6% (2·3-17·0) and Cryptosporidium spp at 10·2% (7·03-14·3). In children younger than 5 years, the fatal PAF of rotavirus was 35·2% (28·7-43·0), followed by Shigella spp at 24·0% (15·2-37·9) and adenovirus at 23·8% (14·8-36·3). Other pathogens with a fatal PAF greater than 10% in children younger than 5 years included Cryptosporidium spp, typical enteropathogenicEscherichia coli, and enterotoxigenic E coli producing heat-stable toxin.

INTERPRETATION

The substantial decline in the global burden of diarrhoeal diseases since 1990, particularly in children younger than 5 years, supports the effectiveness of health interventions such as oral rehydration therapy, enhanced water, sanitation, and hygiene (WASH) infrastructure, and the introduction and scale-up of rotavirus vaccination. Targeted interventions and preventive measures against key risk factors and pathogens could further reduce this burden. Continued investment in the development and distribution of vaccines for leading pathogens remains crucial.

FUNDING

Bill & Melinda Gates Foundation.

The shifting global landscape of low Back pain attributable to high body mass index: Burden, growth, and inequalities

Background

Low back pain (LBP) is the leading global cause of years lived with disability (YLD), with high body mass index (BMI) recognized as a significant and modifiable risk factor. While prior research has linked high BMI to LBP, comprehensive global assessments of the burden attributable to high BMI are scarce.

Methods

We analyzed data from the Global Burden of Disease (GBD) study (1990-2021) to estimate global and regional YLDs of LBP attributable to high BMI, stratified by age, sex, and socio-demographic index (SDI). The Autoregressive Integrated Moving Average (ARIMA) model projected the future burden to 2050.

Results

From 1990 to 2021, global YLDs of LBP attributable to high BMI nearly doubled, reaching 8.4 million (95 % uncertainty interval: 0.8-17.4), with an age-standardized rate of 97.7 per 100,000. Burdens rose across all regions, with the steepest increases in middle- and lower-SDI areas. Women consistently experienced nearly double the burden compared to men. High-income North America had the largest YLD counts, while South Asia showed the fastest growth. YLDs peaked among individuals aged 40-70, with an emerging burden in the 20-40 age group. Projections suggest disproportionate increases in high- and high-middle-SDI regions by 2050.

Conclusion

The rising burden of LBP attributable to high BMI underscores the urgent need for targeted public health strategies. Integrating BMI management and musculoskeletal health initiatives into healthcare policies could mitigate LBP-related disability and enhance global population health outcomes.

Assessing the risk of acute kidney injury associated with a four-drug regimen for heart failure: a ten-year real-world pharmacovigilance analysis based on FAERS events

BACKGROUND

The four-drug regimen for heart failure with reduced ejection fraction (HFrEF) significantly reduces the risks of hospitalization and mortality. To identify key adverse drug events (ADEs) warranting attention with this regimen, we conducted a real-world pharmacovigilance analysis based on the FDA Adverse Event Reporting System (FAERS) events.

RESEARCH DESIGN AND METHODS

We collected ADE reports of the four-drug regimen from FAERS that matched this regimen over a 10-year period. Disproportionality analysis and subgroup analysis were performed using four algorithms. Time-to-onset (TTO) analysis was used to assess the temporal risk patterns of ADE occurrence. Lastly, logistic regression was applied to investigate the relationship-value between patient characteristics and ADEs.

RESULTS

A total of 1,237 cases with 6,580 ADE reports were collected. Disproportionality analysis identified the most frequent ADEs as hypotension, acute kidney injury (AKI), and hyperkalemia. TTO analysis revealed a median TTO of 39 days for all important medical events, and the median TTO for AKI was 28 days, both fitting an early failure curve.

CONCLUSION

In the comprehensive management of HFrEF with the four-drug regimen, in addition to routine monitoring of ADEs such as hypotension and hyperalemia, early-onset AKI should be a particular focus.

Comprehensive geriatric assessment for frail older people with chronic kidney disease to increase attainment of patient-identified goals: Statistical analysis plan for a cluster-randomised controlled trial

BACKGROUND

Frailty is highly prevalent in older people with chronic kidney disease (CKD) and associated with more complex healthcare needs. As part of person-centred care, healthcare planning should be tailored to the individual's needs and their desired outcomes. Comprehensive Geriatric Assessment (CGA) is an intervention which can help facilitate this by identifying a person's medical, functional, and psychosocial problems, and then tailoring a coordinated, targeted management plan. The GOAL trial was designed to establish whether, compared to usual care, a CGA would better enable a person to achieve their own set goals, as measured by Goal Attainment Scaling (GAS). This paper presents the statistical analysis plan (SAP) for the GOAL trial.

METHODS

The GOAL trial is a pragmatic, multi-centre, superiority, open-label, cluster-randomised controlled trial designed to enrol 500 frail, older people (Frailty Index >0.25, aged ≥65 or ≥ 55 years if First Nations people) with moderate to severe CKD (estimated glomerular filtration rate < 59 mL/min/1.73m2) across 16 hospital sites in Australia, and 12 months of follow-up. The primary question (effect of CGA on GAS at 3 months) will be modelled using mixed-effects linear regression. The SAP details the analysis and reporting methods.

CONCLUSIONS

The SAP described here resulted from an iterative, collaborative effort among statisticians and clinician leads of the GOAL trial. Specification of statistical methods prior to trial completion will contribute to unbiased analyses of the collected data.

TRIAL REGISTRATION

ClinicalTrials.govNCT04538157.

Insights from autopsy-initiated pathological studies of the pathogenesis and clinical manifestations of atherosclerosis and ischemic heart disease: Part I. Atherosclerosis

CONTEXT

Ischemic heart disease (IHD) due to coronary atherosclerosis constitutes the leading cause of morbidity and mortality worldwide. This review was undertaken to document the historical basis for our contemporary understanding of atherosclerosis-based disease and to provide a rationale for continued support for autopsy-based research to make further progress in reducing the morbidity and mortality from atherosclerosis-related disease.

OBJECTIVES

To analyze the contributions of the autopsy-initiated pathological studies to complement and validate other lines of investigation in determining the pathology and pathogenesis of the leading worldwide cause of morbidity and mortality, namely, atherosclerosis and its major complications of coronary atherosclerosis, ischemic heart disease, coronary thrombosis, acute myocardial infarction, and sudden cardiac death.

DATA SOURCES

Systematic search on PubMed to gather relevant studies concerning autopsy studies and reviews of the pathology and pathogenesis of atherosclerosis, ischemic heart disease, coronary atherosclerosis, coronary thrombosis, myocardial infarction, and sudden cardiac death CONCLUSIONS: Extensive published reports have confirmed the continuing importance of the autopsy as a powerful tool to understand the pathogenesis, clinical features, and therapeutic options for major diseases. This specifically has been shown by the analysis of atherosclerosis and its major manifestation of ischemic heart disease, as presented in this (Part I) and its companion (Part II) review. Autopsy-initiated pathological studies have documented the prevalence and natural history of atherosclerosis in different human populations in relationship to the prevalence of risk factors and established that the clinically silent phase of the disease begins in the first decades of life. Insights from these studies have been essential in developing and evaluating strategies for continued progress in preventing and controlling the disability and death associated with atherosclerotic heart disease.

Global, Regional, and National Temporal Trend and Patterns of Change in the Burden of Asthma From 1990 to 2021: An Analysis of the Global Burden of Disease Study 2021

BACKGROUND

Asthma presents a significant challenge to the global healthcare systems and imposes a heavy socioeconomic burden. Previous studies had geographical limitations and lacked comprehensive global analysis. The study utilises data from the 2021 Global Burden of Disease (GBD) study to assess the global, regional, and national burden of asthma from 1990 to 2021. It examines disease trends, highlights health inequalities and aims to provide scientific evidence for future public health strategies and the optimisation of resource allocation.

METHODS

Data from GBD 2021 were used to estimate the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of asthma across 21 global regions and 204 countries and territories from 1990 to 2021. Temporal trends were analysed, and the relationship between asthma burden and the socio-demographic index (SDI) was examined using a smoothing spline model. Analyses included the slope index of inequality and the concentration index to assess health disparities, frontier analysis to estimate achievable outcomes based on development levels, and decomposition analysis to identify the drivers of changes in DALYs number.

RESULTS

Over the past three decades, the age-standardised burden of asthma has declined, with age-standardised mortality and DALY rates decreasing by 46% and 44%, respectively. However, the absolute number of deaths has increased by 17%, particularly among females, especially in low and low-middle SDI regions. Significant health inequalities persist, with high-SDI regions benefiting from better asthma control, while low-SDI regions face disproportionate burdens due to healthcare disparities. Frontier analysis highlights gaps between current and optimal disease burden levels, while low-SDI regions require increased investment in asthma control. Aging, population growth, and epidemiological changes are key drivers of asthma burden trends. High body mass index (BMI) remains the leading risk factor, while smoking and occupational exposures continue to contribute significantly.

CONCLUSIONS

The global burden of asthma has declined, yet significant regional disparities persist, with low-SDI regions experiencing higher mortality and DALYs due to limited healthcare access and environmental risks. High BMI, smoking and occupational exposures remain key contributors, requiring targeted public health interventions and lifestyle modifications.

Mortality of Gastrointestinal Cancers Attributable to Smoking, Alcohol, and Metabolic Risk Factors, and its Association With Socioeconomic Development Status 2000-2021

OBJECTIVE

Gastrointestinal (GI) cancers account for one-third of global cancer mortality, with nearly half being preventable. This study updates the global burden of GI cancers attributed to major risk factors.

METHODS

We utilized data from the Global Burden of Disease Study 2021 to examine trends in death and age-standardized death rates related to GI cancers caused by smoking, alcohol, high body mass index (BMI), and high fasting blood glucose (FBG) from 2000 to 2021. Trends were analyzed based on countries' developmental status using a sociodemographic index (SDI).

RESULTS

In 2021, there were 1.12 million GI cancer deaths related to smoking, alcohol, high BMI, and high FBG, which was 53.6% higher than in 2000. The largest proportion of GI cancer mortality was attributed to smoking (43.3%), followed by alcohol (20.6%), high FBG (20.5%), and high BMI (15.6%). The increases in GI cancer deaths between 2000 and 2021 were related to high BMI (+102.54%) and FBG (+107.69%), particularly in liver and pancreatic cancer. In 2021, GI cancer mortality in low, low-middle, and middle SDI countries represented 44.3% of the global GI cancer mortality attributed to smoking, 41.9% for alcohol, 34.3% for high BMI, and 31.6% for high FBG. Since 2000, these proportions have increased by +4.5% for smoking, +7.6% for alcohol, + 12.3% for high BMI, and +6.4% for high FBG.

CONCLUSION

From 2000 to 2021, GI cancer mortality increased substantially, driven primarily by obesity and alcohol. Lower SDI countries are increasingly contributing to the global GI cancer burden.

Inequity of NIH cancer funding in the United States: an ecological study predicting funding based on disease burden from 2008 through 2023

Background

Disease burden has been used to predict National Institutes of Health (NIH) funding but included diseases with little underlying relationship. Here we focus on cancers to create a more appropriate model to allow for more targeted scrutinization of funding allocation.

Methods

An ecological study using NIH funding data (2008-2023) was performed. Inclusion of cancers was based on their presence in the NIH Research Portfolio Online Reporting Tool and the 2021 Global Burden of Disease (GBD) study. Disability-adjusted life years (DALY) were collected and to evaluate the impact of public interest, Google Trends data was used. Multivariable linear regression determined appropriate funding based on disease burden and public interest. To quantify how each cancer's funding differed from model predictions residual values were used to calculate the percent over/under funding.

Findings

Fifteen cancers met inclusion criteria. Neuroblastoma had the greatest ratio of funding to DALYs per 100,000 people (US$14,000,000) while lung cancer had the lowest (US$300,000). Stomach cancer was the most underfunded (197.9% [95% CI: 136.0%, 276.2%]) while brain cancer was the most overfunded (64.1% [95% CI: 53.8%, 72.1%]). Even at their lowest funding values in the study period brain, breast, and colorectal cancer all had greater than 40% overfunding. Contrarily, the lowest annual funding for leukemia, uterine, and stomach cancer received less than 150% of expected funding. Despite its overfunding brain cancer had an increase in DALYs in the study period.

Interpretation

Modeling by disease category demonstrated disparities in funding indicating the need for reevaluation for possible funding inequities. The year-by-year approach taken in this study will drive the ability for future research to better understand NIH funding decisions. Additionally, the role of public interest in research funding needs to be further evaluated to ensure that popularity does not override disease burden, in funding decisions.

Funding

No Funding.

Temporal trends, disease burden and attributable risk factors of stomach and colorectal cancers among 31 countries and territories in Western Pacific region, 20002021

Objective

This study aimed to describe the updated disease burden and temporal trends of stomach cancer (SC) and colorectal cancer (CRC), and to explore potential influence factors of the two cancers in the Western Pacific region (WPR).

Methods

Estimates of incidence, deaths, and disability-adjusted life years (DALYs) for SC and CRC were obtained from the Global Burden of Disease Study 2021. Trends in age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) were assessed. A decomposition analysis was conducted to quantify the role of three factors (i.e., population aging, population growth, and epidemiological change) driving DALY changes between 2000 and 2021. Pearson correlation analysis was used to examine the association between cancer burden and Socio-demographic Index (SDI) at the national level in 2021.

Results

In 2021, the WPR accounted for 61.77% of global incident SC cases and 43.07% of global incident CRC cases. From 2000 to 2021, the ASIR, ASMR, and ASDR of SC and the ASMR and ASDR of CRC decreased, whereas the ASIR of CRC increased by an average of 1.32% per year. Among the 31 WPR countries and territories, China had the highest number of incident cases, deaths, and DALYs for both cancers in 2021. Epidemiology change was the primary driver to the reduction of DALYs for SC, while population aging and population growth contributed to the increase of DALYs for CRC. Additionally, ASMR (r=-0.37, P=0.041) and ASDR (r=-0.43, P=0.016) of SC were negatively correlated with SDI in 2021, whereas positive correlations were observed between SDI and ASIR (r=0.74, P<0.001), ASMR (r=0.47, P=0.008), and ASDR (r=0.36, P=0.044) for CRC.

Conclusions

SC and CRC continue to pose considerable public health threats in the WPR. Targeted prevention and control strategies should be prioritized, particularly in high-burden and resource-limited countries.

The disease burden of kidney cancer in Asian countries and regions from 1990 to 2021: a study based on the Global Burden of Disease database

Background

There are huge differences in the disease burden of kidney cancer (KC) between countries and regions in Asia. Therefore, we conducted this study to investigate the KC burden and attributable risk factors in Asia.

Methods

We obtained data on the incidence, prevalence, mortality, disability adjusted life years, sociodemographic index (SDI), and attributable risk factors of KC in Asian countries and regions from 1990 to 2021 in the Global Burden of Disease database. Joinpoint regression was used to analyze the overall trend of the change in KC burden in Asia. The health inequalities of KC in Asia were evaluated. The correlation between SDI and KC burden was assessed. Autoregressive integrated moving average was used to predict the KC burden in the next 15 years. The age-period-cohort model evaluated the relative risk (RR) of the KC burden in different dimensions. In addition, frontier analyses were performed in this study. Finally, comprehensive analyses of the attributable risk factors of KC were performed.

Results

The KC burden in Asia showed a significant upward trend from 1990 to 2021. The KC burden was mainly concentrated in relatively wealthy countries and regions (high SDI). In the next 15 years, the KC burden would rise further. The RR of KC generally increased with age and period, and decreased with birth cohorts. The most concerning risk factor for KC was high body mass index (HBMI), and the KC burden attributed to HBMI also indicated a significant upward trend and was positively correlated with SDI.

Conclusions

The KC burden in Asian countries and regions is still rising. Therefore, targeted medical interventions are needed to improve early diagnosis and treatment of KC.

Knowledge, attitude, and practice regarding venous thromboembolism prophylaxis: A multicenter cross-sectional study of medical staff in Guinea

OBJECTIVES

To investigate the awareness of medical staff regarding venous thromboembolism (VTE) prophylaxis in Guinea.

METHODS

The survey was completed from June 1, 2023 to August 1, 2023 through filling out self-designed questionnaire including four parts containing demographic data, knowledge, attitude, and practice regarding VTE prophylaxis. Cronbach's alpha values were used to analyze the internal consistency of the questionnaire. The results were analyzed using chi-square tests at a 95% significance level.

RESULTS

Of the 245 medical staff invited to participate in the survey, 211 (86.1%) responded. Cronbach's alpha value of the questionnaire was 0.92. The overall correct response rate for knowledge was 61.5 ± 11.7%, and there were no significant differences between hospitals, sexes, professions, educational levels, departments, and working years (P > 0.05). The overall affirmative response rates for attitude and practice were 65.3% ± 18.4% and 74.8 ± 13.4%, respectively. The affirmative rate of nurses was higher than that of clinicians in the aspects of attitude (69.51 ± 20.2% vs. 63.0 ± 18.1%) and practice (82.1 ± 16.9% vs. 70.4 ± 10.8%); however, no significant difference was found (P > 0.05).

CONCLUSIONS

The knowledge level, attitude, and practice regarding VTE prophylaxis among medical staff in Guinea were generally poor. We suggest that medical institutions provide appropriate VTE prophylaxis-related trainings.

Temporal trends of low back pain burden and joinpoint and age-period-cohort analysis in China from 1990 to 2021

BACKGROUND

The burden of low back pain (LBP) is increasing rapidly. This study aimed to analyze the temporal trends of the LBP burden in China from 1990 to 2021.

METHODS

Data from the Global Burden of Disease (GBD) 2021 were used to examine the crude and age-standardized rates, along with their uncertainty interval (UI), for incidence, prevalence and disability adjusted life years (DALYs) per 100,000 for LBP, stratified by sex. The joinpoint regression model was applied to calculate the annual percent change (APC) and corresponding 95% confidence interval (CI) for the LBP burden. Additionally, an age-period-cohort analysis was conducted to assess the temporal trends in the LBP burden.

RESULTS

In 2021, LBP affected 100,093,745 individuals in China. The crude incidence, prevalence and DALYs rates were 3.05% (95% UI: 2.64-3.46%), 7.04% (95% UI: 6.12-7.94%) and 794.08 per 100,000 (95% UI: 557.48-1077.36), respectively. From 1990 to 2021, the age-standardized incidence, prevalence and DALYs rates declined annually by 0.71% (95% CI: 0.67-0.75%), 0.79% (95% CI: 0.75-0.83%), and 0.79% (95% CI: 0.75-0.84%), respectively. The LBP burden was higher in females than in males, with incidence rates rising with age. From the age of 45 onward, women exhibited significantly higher incidence rates than men. Over the past three decades, both period-specific and cohort-specific LBP incidence showed a downward trend.

CONCLUSION

LBP remains a substantial public health burden in China, with variations across sex, age, period and cohort. Targeted healthcare policies and resource allocation should be prioritized for high-risk populations, particularly older adults and females.

Synergistic impact of air pollution and artificial light at night on memory disorders: a nationwide cohort analysis

BACKGROUND

Air pollutants and outdoor artificial light at night (ALAN) are known health risks, with established effects on respiratory and cardiovascular health. However, their impact on cognitive function, particularly neurodegenerative diseases like Alzheimer's, remains poorly understood.

METHODS

Using data from the China Health and Retirement Longitudinal Study (CHARLS) and the China Family Panel Studies (CFPS), including 44,689 participants, memory impairment (Memrye) was defined by self-reported memory-related diseases. Cox regression models were applied to assess the relationship between pollutants, ALAN exposure, and Memrye. Interaction analyses evaluated the combined effects using relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (S). Biomarker analyses and stepwise causal mediation examined the underlying mechanisms.

RESULTS

Air pollutants and ALAN were significantly associated with Memrye (p < 0.05), with hazard ratios (HR) ranging from 1.010 to 1.343. Synergistic effects were observed, such as for PM2.5 and ALAN, with RERI, AP, and S values of 0.65 (0.33, 0.97), 0.30 (0.26, 0.34), and 1.43 (1.21, 1.65), respectively. Biomarker analyses showed significant correlations between pollutants, glucose, cholesterol, and uric acid, while ALAN was negatively associated with glucose and uric acid. Mediation analyses indicated that PM2.5, NO2, and ALAN indirectly affected Memrye through biomarkers, accounting for 1.07-8.28% of the total effects.

CONCLUSION

Air pollution and ALAN exposure are linked to memory impairment, with combined effects potentially amplifying risk. Biomarkers play a key role in mediating these effects, suggesting a need for targeted public health measures to mitigate these environmental health risks.

Global trends and cross-country inequalities in spinal cord injury attributable to falls: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND CONTEXT

Falls are the leading cause of spinal cord injury (SCI), imposing profound disability, mortality, and socioeconomic burden. However, the global trends, regional patterns, and health disparities in SCI attributable to falls remain inadequately explored.

PURPOSE

To provide a comprehensive analysis of the global, regional, and national burden of SCI attributable to falls from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 database. This study identifies epidemiologic trends, quantifies cross-country inequalities, and forecasts future challenges.

STUDY DESIGN/SETTING

A cross-sectional study utilizing data from the GBD 2021.

PATIENT SAMPLE

Patients from 204 countries and territories who sustained SCI due to falls.

OUTCOME MEASURES

Age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized years lived with disability (YLDs).

METHODS

Data were extracted from the GBD 2021. Descriptive analyses were conducted to evaluate ASIR, ASPR, and ASYR globally and across socio-demographic index (SDI) quintiles. Temporal trends were evaluated using joinpoint regression and age-period-cohort models. Decomposition analysis quantified the impact of aging, population growth, and epidemiologic shifts on the burden. Frontier analysis and inequality assessments assessed disparities, while Bayesian modeling forecasted the burden through 2035.

RESULTS

Between 1990 and 2021, global age-standardized rates of SCI attributable to falls declined in high-SDI regions but increased in middle- and low-SDI regions. Australasia and Western Europe had the highest burden in 2021, while East Asia and Oceania exhibited the fastest-growing trends. Population growth was the primary driver of the global burden increase, as revealed by decomposition analysis. Inequality assessments uncovered widening SDI-related disparities, with both absolute and relative inequalities. Projections through 2035 indicate a continued rise in the burden in the coming decades.

CONCLUSIONS

SCI attributable to falls poses a significant and growing global health challenge, with stark regional and socioeconomic disparities. While high-SDI regions have seen progress, rising burdens in low- and middle-SDI areas demand urgent, region-specific preventive measures and equitable healthcare interventions. Policymakers must act decisively to address demographic transitions, reduce disparities, and prioritize fall prevention strategies to mitigate the growing burden.

Global, regional, and national burden of myocarditis and its attributable risk factors in 204 countries and territories from 1990 to 2021: updated systematic analysis

Background

Comprehending the current epidemiological trends and risk factors of myocarditis is crucial for guiding future targeted prevention and treatment strategies.

Methods

Utilizing data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021, we conducted a secondary analysis of the incidence, prevalence, death, and disability-adjusted life years (DALYs) of myocarditis by sex, age group and socio-demographic index (SDI) across 204 countries and territories from 1990 to 2021. And non-optimal temperatures, defined as same-day exposure to ambient temperatures deviating from the minimum death risk threshold, were identified as risk-factors for myocarditis-related death and DALYs.

Results

From 1990 to 2021, the global prevalence of myocarditis increased from 320,623 (95% uncertainty interval: 268,557 to 371,912) to 505,030 (432,295 to 587,819). Concurrently, the age-standardized prevalence rate (ASPR) per 100,000 people also saw a slight increase (no statistical significance) from 6.35 (5.37 to 7.36) to 6.41 (5.48 to 7.44). However, the age-standardized incidence rate (ASIR), age-standardized death rate (ASDR) and age-standardized DALY rate (ASYR) exhibited declines, with estimated annual percentage changes of -0.20 (-0.23 to -0.17), -1.37 (-1.81 to -0.92) and -1.71 (-1.95 to -1.46), respectively. SDI quintile analysis showed that the high SDI quintile had the highest ASIR and ASPR, while the middle and high-middle SDI quintiles exhibited the highest ASDR and ASYR. Furthermore, the burden of myocarditis was notably high among males and older adult populations. Non-optimal temperature, particularly low temperature, emerged as a key risk factor for myocarditis-related ASDR and ASYR.

Conclusion

Although the ASIR, ASDR and ASYR for myocarditis exhibited decreasing trends from 1990 to 2019, further efforts are needed to develop targeted public health strategies, especially for low SDI regions, males, and older adult populations.

Interaction of accelerometer-measured physical activity and genetic risk on cardiovascular diseases: a prospective cohort study from UK Biobank

Objectives

This study aimed to evaluate the interactions of physical activity and polygenic risk score (PRS) on risks of atrial fibrillation, coronary heart disease (CHD), hypertension, and ischaemic stroke.

Methods

This study included 91 629 participants from UK Biobank in this study, all of whom had worn a wrist-worn accelerometer for 7 consecutive days. We computed total volume of physical activity (TPA) and time spent in moderate to vigorous intensity physical activity (MVPA) and light intensity physical activity (LPA). Cox proportional hazard models were used to evaluate associations of physical activity with the four cardiovascular outcomes. Interactions between physical activity and PRS were investigated on multiplicative and additive scales.

Results

During a median follow-up of 7.9 years, 3811 atrial fibrillation, 3994 CHD, 7345 hypertension and 1001 ischaemic stroke cases were recorded. TPA, MVPA and LPA were all negatively associated with risks of the four cardiovascular outcomes, generally independent of genetic risk. Association between LPA and atrial fibrillation was U-shaped among low-PRS stratum (p=0.01), and association between TPA and hypertension was attenuated with genetic risk increasing (p=0.02). Attributable risk (AR) of inactivity was higher in the high-PRS population. For example, increasing MVPA resulted in a twofold greater reduction in CHD cases among individuals with high PRS (AR=2.17%) than among those with low PRS (AR=1.09%).

Conclusions

Increasing physical activity, including LPA, was associated with a reduced risk of cardiovascular diseases. The extent of this benefit may differ among individuals with different genetic risks.

Association of Transient Global Amnesia (TGA) With Dietary Intake of Vitamin B12

BACKGROUND

Transient global amnesia (TGA), which is described as short-term amnesia, may be influenced by some dietary components involved in brain function. The aim of the present study was to assess the connection between TGA and dietary intake of vitamin B12.

METHODS

This cross-sectional study was conducted on 258 people with TGA and 520 people without TGA in Sabzevar, Iran. All participants were screened for TGA (ICD-10 code: G45.4). A validated Food Frequency Questionnaire (FFQ) was utilized to estimate the dietary intake of vitamin B12. Different models of logistic regression were used to determine the association between TGA and dietary intake of vitamin B12 after adjusting the confounders.

RESULTS

There was an inverse association between the risk of TGA and the intake of vitamin B12 (OR = 0.94, CI 95%: 0.89-0.99, p = .02, effect size: -0.04). The result did not change after adjustment for age, gender, education, job, and marital status (OR = 0.93, CI 95%: 0.88-0.98, p = .01, effect size: -0.03). The result remained significant after additional adjustments for body mass index (BMI) and physical activity (OR = 0.94, CI 95%: 0.89-0.99, p = .03, effect size: -0.04), and after further adjustments for the underlying diseases, including diabetes, hypertension, and stroke (OR = 0.86, CI 95%: 0.81-0.92, p < .01, effect size: -0.10).

CONCLUSION

Vitamin B12 deficiency may increase the risk of TGA and should be considered as a potential concern for people at risk for TGA. Further studies are needed to validate these findings and to discover the underlying mechanisms of the effects of vitamin B12 on TGA.

Caries Is the Hub of a Complex Network of Chronic Diseases across the Life Decades

Caries precedes periodontitis; both may predict fatal noncommunicable diseases (NCDs) decades in advance. However, the complex network of relationships between these and other NCDs remains unclear. Understanding the intricate nonlinear connections among NCDs from the early life stages holds profound significance for public health management strategies to prevent NCDs. Accordingly, we modeled the connections among NCDs and identified the underlying patterns in the US population from childhood to elderhood. Indicators of metabolic risks, diabetes, and cancer, as well as cardiovascular, autoimmune, mental, respiratory, and oral diseases, were collected from National Health and Nutrition Examination Survey data (2011-2012 and 2013-2014 cycles), encompassing 4 age groups of Americans aged 1 to ≥60 y. Diseases were represented as nodes in the complex network analysis, and edges indicated their co-occurrences. To characterize the networks, we computed degree, betweenness, eigenvector, local transitivity, assortative mixing, Shannon entropy, and cluster coefficients. Caries was the central hub in all models. Caries and obesity were linked since the first years of life, and with age, new diseases became connected, increasing network complexity with Shannon entropy from -2.79 to -4.07. Depression plays an essential role in adult life; however, episodes of forgetting and mental confusion surpass depression's significance in elderhood. The centrality of diabetes, cardiovascular disease, and cancer increases with age, peaking at ≥60 y, with diabetes being the most prominent. All groups had coefficients indicating that NCDs were highly connected, with cluster coefficients of 0.85 to 0.98 and assortativity mixing of -0.23 to -0.06. Caries was the central element over the decades, with the other diseases orbiting around it. It was mainly linked to overweight/obesity from early childhood. Integrated strategies targeting shared risk factors for caries and obesity can boost childhood health and potentially affect the development of other NCDs later.

Burden of Urological Cancers in the Labour Force from 1990 to 2021 and Projections to 2050

BACKGROUND

Urological cancers represent an increasing public health concern in the labour force, mainly including prostate cancer (PCA), kidney cancer (KCA), testicular cancer (TCA), and bladder cancer (BLCA). Limited data exist on their occurrence, deaths, and disability-adjusted life years (DALYs). The objective of this study was to analyse three-decade trends in these cancers globally and forecast future patterns.

METHODS

The study used Global Burden of Disease 2021 data from 1990 to 2021 to evaluate urological cancer stats, including prevalence, incidence, mortality, and DALYs. For people aged 15-64 years, it was then manually age-standardized once. Herein, we employed a range of analytical techniques, including decomposition analysis, a Bayesian Age-Period-Cohort model, a Concentration index and slope index, and frontier analysis, to examine the trends in 204 countries and regions. Furthermore, the relationship between the Socio-Demographic Index (SDI) and the burden of disease is addressed.

RESULTS

Over the past 30 years, PCA, TCA, and KCA rates have risen among the global labour force population. North America, North Asia, and Europe have high incidence and mortality rates. TCA mortality and BLCA and TCA prevalence are expected to continue rising globally until 2050. Urological cancer impacts vary by region and development with more burden in areas with a higher SDI.

CONCLUSIONS

Urological cancers represent a substantial disease burden on labour force populations, emphasizing the imperative for targeted interventions and healthcare resources for affected populations. It is therefore crucial to have a comprehensive understanding of the global and regional epidemiological trends, as well as the findings of health economics studies.

Global, regional, and national trends in ischaemic stroke burden and risk factors among adults aged 20 + years (1990-2021): a systematic analysis of data from the Global Burden of Disease study 2021 with projections into 2050

Background

The objective was to provide standardized, comprehensive, and updated estimates of the global, regional, and national burdens of and risk factors for ischaemic stroke (IS) in adults aged 20 years and older.

Methods

This was a population-based study (Global Burden of Disease, Injuries and Risk Factors Study 2021). Adults aged 20 years and older from 204 countries and territories and 811 subnational locations from 1990 to 2021 were included. The primary outcomes were IS-related age-standardized prevalence, mortality, disability-adjusted life years (DALYs), average annual percentage change (AAPC), and risk factors associated with DALYs.

Results

From 1990 to 2021, the global age-standardized prevalence of IS decreased from 1,309 (95% UI 1,151 to 1,481) to 1,266 (95% UI 1,120 to 1,423) cases per 100,000 population, with an average annual decrease of -0.12%. However, the prevalence increased notably in the middle sociodemographic index (SDI) regions and East Asia but remained stable in Southeast Asia. The total number of IS cases still increased significantly from 33.2 million to 68.4 million. During the same period, the overall age-standardized mortality for IS decreased from 116 to 70 cases per 100,000 population, with an average annual change of -1.60%. Similarly, the overall age-standardized DALYs for IS decreased by 35%, with an average annual change of -1.36%. The decrease in both the age-standardized mortality and DALY rates was correlated with the SDI, with the most rapid decrease occurring in high-SDI regions. Conversely, in subregions of southern sub-Saharan Africa, an increase was observed. Males consistently faced a greater burden of IS across all subgroups. High systolic blood pressure and high low-density lipoprotein cholesterol (LDL-C) levels consistently represented the most significant risk factors contributing to DALYs from 1990 to 2021.

Conclusion

Globally, the total IS caseload has increased. Targeted strategies, such as metabolic risk control in high-SDI regions, low-cost interventions in middle-/low-SDI regions, and improved neuroimaging infrastructure in sub-Saharan Africa, are needed. Future research should focus on subtype-specific burdens, the legacy effects of COVID-19, and intervention cost effectiveness to guide policymakers in developing efficient strategies to combat the global burden of ischaemic stroke.

Genetic Correlations and Causalities between Alzheimer's Disease and 35 Biomarkers in Blood and Urine

Alzheimer's disease (AD) is an age-related neurodegenerative disorder characterized by insidious and gradual onset. Identifying biomarkers associated with the early stages of AD is crucial for delaying its progression. In this study, we aimed to identify AD-related biomarkers in blood and urine by integrating genetic correlation analysis, shared genetic loci identification, and causal inference using linkage disequilibrium score regression (LDSC), conjunction false discovery rate (conjFDR), generalized summary data-based Mendelian randomization (GSMR) and two-sample Mendelian randomization (MR). To enhance robustness and minimize sample bias, we cross-validated findings using different AD GWAS datasets. Across multiple AD GWASs, we consistently observed nominally significant genetic correlations: AD was positively correlated with albumin (ALB) and negatively correlated with cystatin C (CYS) and urea (BUN). MR analysis further suggested that genetic predisposition to higher level of ALB and lower level of non-albumin protein (NAP) can represent risk factors for AD. In reverse MR analysis, a higher genetic risk for AD can predispose individuals to higher levels of ratio of aspartate aminotransferase to alanine aminotransferase (AST2ALT) and estimated glomerular filtration rate (EGFR), as well as lower level of creatinine (CRE). Overall, this study provides insights into the genetic correlations and causal relationships between AD and several biomarkers, offering potential candidates for AD diagnosis and management.

Preventive Effect of Upland Pigmented Potatoes Against LPS-Induced Inflammation in THP-1 Macrophages

Aim of this study was to compare the in vitro anti-inflammatory activity of three commercial potato varieties cultivated upland, Kennebec, Desirée, and Bleuet, whose extracts,   based on chemical analyses, were considered chlorogenic acid (CGA)-, carotenoid-, and anthocyanin-rich, respectively. To this aim, THP-1-derived macrophages were pretreated with extracts and then challenged with LPS. While at supraphysiological doses (50 µM), all three extracts significantly counteracted LPS-induced TNF-α, IL-1β, and IL-6, at more physiologically relevant doses (1-5 µM), only Desirée and Bleuet showed anti-inflammatory activity. We hypothesized that the high CGA content in Bleuet extract might interfere with anthocyanins. Supporting this, adding CGA to pure pelargonidin 3-glucoside and peonidin 3-glucoside reduced their anti-inflammatory activity. Similarly, the isolated anthocyanin fraction from Bleuet (ACN fraction) exhibited stronger anti-inflammatory effects than the whole Bleuet extract, and the addition of CGA to the ACN fraction significantly reduced its anti-inflammatory effect. Molecular docking simulations suggested that glucose transporters GLUT-1, GLUT-3, and SGLT-1 could be involved in this antagonist-like interaction. In conclusion, extracts from pigmented varieties Desirée and Bleuet counteracted LPS-induced inflammation in THP-1 macrophages at plasma-relevant doses. Furthermore, CGA could compete with anthocyanins for glucose transporters, limiting their cellular uptake and, consequently, their anti-inflammatory activity.

Age-period-cohort analysis of autism spectrum disorders-related prevalence and DALYs: based on the Global Burden Of Disease Study 2021

Background

The Sustainable Development Goals (SDGs) call for systematic monitoring to optimize child development outcomes. As a developmental disorder affecting children and adults, Autism Spectrum Disorder (ASD) not only impacts individual social functioning but also places a burden on families and society. A detailed analysis of the latest global burden data on ASD can assist stakeholders in formulating support policies and interventions, thereby helping to meet the health needs of ASD.

Methods

We used data from the Global Burden of Disease Study 2021 (GBD 2021), compiled by the Institute for Health Metrics and Evaluation (IHME). Data were obtained through the Global Health Data Exchange (GHDx) and covered 204 countries and territories from 1990 to 2019. Variables included ASD-related prevalence, mortality, disability-adjusted life years (DALYs), age-standardized rates, and the sociodemographic index (SDI).

Results

Exposure to autism spectrum disorders contributed to 61823540 prevalence and 11544038 DALYs globally in 2021. Males and younger adults were high-risk populations. Higher socio-demographic index (SDI) regions were high-risk areas. The disease burden varied considerably across the GBD regions and the countries. From 1990 to 2021, the number of cases increased. The predicted results showed that the disease burden for both genders would still increase from 2022 to 2046. Countries or regions with a higher SDI have greater burden improvement potential.

Conclusion

The global burden of ASD has shown a continuous upward trend, with some differences observed across gender, age groups, and SDI regions. In terms of gender, the burden of ASD among females may be underestimated. Regarding age groups, the aging process has highlighted the urgent need to address ASD in the elderly population. High-SDI regions should place greater emphasis on improving diagnostic methods and implementing precise interventions, while middle- and low-SDI regions should focus on raising public awareness and enhancing screening capabilities.

Spatiotemporal trends in hernia disease burden and health workforce correlations in aging populations: a global analysis with projections to 2050

BACKGROUND

Inguinal, femoral, and abdominal wall hernias represent significant health and economic burdens globally, particularly among adults aged 45 and older. In 2021, the Global Burden of Disease Study reported 1.72 million new cases, 6.75 million prevalent cases, and over 41,000 deaths in this population. While age-standardized rates have declined with improved healthcare, absolute burden continues to rise due to population growth and aging. Gender disparities remain pronounced, with men experiencing sevenfold higher incidence than women. This study analyzes global hernia trends, determinants, future projections, and the association between health workforce distribution and hernia burden to inform targeted interventions.

METHODS

Using data from the Global Burden of Disease Study 2021, we analyzed incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for inguinal, femoral, and abdominal wall hernias. Long-term trends were assessed using average annual percentage change (EAPC), with decomposition analyses exploring factors influencing disease burden changes. Spatial and temporal patterns were examined using age-period-cohort and frontier analyses. We conducted health inequality analyses and utilized eight time-series machine learning models to project disease burden from 2022 to 2050. Additionally, we analyzed correlations between health workforce distribution and hernia burden across 204 countries and territories for 1990 and 2019.

RESULTS

In 2021, global incidence of hernias was 1,720,177, with 6,748,203 prevalent cases and 41,834 deaths among individuals aged 45 years and older. Although age-standardized incidence rate (ASIR) decreased from 153.98/100,000 in 1990 to 112.29/100,000 in 2021 (EAPC = -0.83%, 95% CI: -0.95% to -0.70%), and age-standardized mortality rate (ASMR) decreased from 3.19/100,000 to 1.86/100,000 (EAPC = -1.77%, 95% CI: -1.94% to -1.59%), absolute burden continued increasing. Socioeconomic differences were significant, with higher ASIR in high SDI areas (141.94/100,000) than low SDI areas (104.60/100,000) in 2021, but much higher ASMR in low SDI areas (4.14/100,000) than high SDI areas (1.23/100,000). Decomposition analysis revealed population growth as the main driver of increased disease burden, contributing 173.80% to incidence increases. Age-period-cohort analysis showed incidence peaked in the 65-69 age group (RR = 1.43, 95% CI: 1.42-1.43). Male ASIR in 2021 (203.41/100,000) was approximately 7.3 times higher than female ASIR (27.94/100,000). Correlation analyses revealed significant negative associations between pharmaceutical personnel density and hernia disease burden, with correlation coefficients strengthening from 1990 (DALYs: r = -0.39, p < 0.001) to 2019 (DALYs: r = -0.57, p < 0.001). Similar trends were observed for dentistry personnel (DALYs: r = -0.26 in 1990 to r = -0.47 in 2019, p < 0.001). Countries with high hernia burden (Guatemala, Paraguay, Indonesia) consistently demonstrated lower health workforce density compared to low-burden countries. ARIMA model projections showed that by 2050, ASIR would increase slightly from 112.32/100,000 in 2022 to 112.64/100,000, with absolute new cases increasing by 19.70%. ASMR is projected to increase from 1.84/100,000 to 2.11/100,000, with deaths increasing by 8.50%.

CONCLUSIONS

Despite declining age-standardized rates for inguinal, femoral, and abdominal wall hernias, absolute disease burden continues increasing due to demographic factors. Socioeconomic development significantly impacts disease patterns, with higher morbidity but lower mortality in high SDI areas. The strong negative correlation between pharmaceutical and dentistry personnel density and hernia burden suggests potential protective effects of healthcare workforce investment, particularly in resource-constrained settings. Future projections indicate growing absolute burden despite relatively stable age-standardized rates, highlighting the urgent need to strengthen preventive measures, improve treatments, and strategically allocate health workforce resources to address this growing public health challenge.

Pathogenic profiles and lower respiratory tract microbiota in severe pneumonia patients using metagenomic next-generation sequencing

INTRODUCTION

The homeostatic balance of the lung microbiota is important for the maintenance of normal physiological function of the lung, but its role in pathological processes such as severe pneumonia is poorly understood.

METHODS

We screened 34 patients with community-acquired pneumonia (CAP) and 12 patients with hospital-acquired pneumonia (HAP), all of whom were admitted to the respiratory intensive care unit. Clinical samples, including bronchoalveolar lavage fluid (BALF), sputum, peripheral blood, and tissue specimens, were collected along with traditional microbiological test results, routine clinical test data, and clinical treatment information. The pathogenic spectrum of lower respiratory tract pathogens in critically ill respiratory patients was characterized through metagenomic next-generation sequencing (mNGS). Additionally, we analyzed the composition of the commensal microbiota and its correlation with clinical characteristics.

RESULTS

The sensitivity of the mNGS test for pathogens was 92.2% and the specificity 71.4% compared with the clinical diagnosis of the patients. Using mNGS, we detected more fungi and viruses in the lower respiratory tract of CAP-onset severe pneumonia patients, whereas bacterial species were predominant in HAP-onset patients. On the other hand, using mNGS data, commensal microorganisms such as Fusobacterium yohimbe were observed in the lower respiratory tract of patients with HAP rather than those with CAP, and most of these commensal microorganisms were associated with hospitalization or the staying time in ICU, and were significantly and positively correlated with the total length of stay.

CONCLUSION

mNGS can be used to effectively identify pathogenic pathogens or lower respiratory microbiome associated with pulmonary infectious diseases, playing a crucial role in the early and accurate diagnosis of these conditions. Based on the findings of this study, it is possible that a novel set of biomarkers and predictive models could be developed in the future to efficiently identify the cause and prognosis of patients with severe pneumonia.