Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

Global, regional, and national burden and trends of tension-type headache among adolescents and young adults (15-39 years) from 1990 to 2021: findings from the Global Burden of Disease study 2021

The prevalence of tension-type headache (TTH) is extremely high worldwide, but comprehensive global epidemiological studies targeting the specific age group of 15-39 years remain relatively limited. This study utilized data from the Global Burden of Disease 2021 (GBD 2021) study to analyze the incidence, prevalence, and disability-adjusted life years (DALYs) associated with TTH, and identified temporal trends using the estimated annual percentage change (EAPC). The study also investigated the association between the burden of TTH and the Socio-demographic Index (SDI). From 1990 to 2021, the global burden of TTH increased, with a 38% rise in prevalence cases and incidence cases. Across SDI regions, middle SDI region experienced the most significant growth in TTH cases, while high SDI regions showed a decline. Globally, the 35-39 age group faces a more severe disease burden, with prevalence cases at 188.27 (95% UI: 123.88-252.96) million, incidence cases at 61.82 (95% UI: 39.02-87.97) million, and DALYs cases at 461.94 (95% UI: 118.38-1494.8) thousand. From 1990 to 2021, the global epidemiological burden of TTH has shown a sustained increase. The most pronounced rise occurred in middle SDI regions, highlighting the urgent need for targeted public health strategies to enhance the quality of life among AYAs affected by TTH.

Commodified upbringings: A narrative review on commercial determinants of child and adolescent mental health

INTRODUCTION

The mental health of children and adolescents has become a major global health concern, with increasing diagnoses and use of psychotropic drugs. The commercial determinants of health (CDoH) paradigm links economic and social forces to health outcomes. Highlighting the influence of industries such as food, pharmaceuticals, technology, social media, gambling, alcohol, tobacco and pornography on the mental health of this population is crucial.

MATERIALS AND METHODS

This narrative review synthesises existing literature on the impact of commercial determinants on child and adolescent mental health. A comprehensive search was conducted using PubMed, PsycINFO and Google Scholar, covering publications from 2000 to 2024. The review focused on peer-reviewed articles, reports and relevant grey literature examining the influence of commercial practices on mental health.

RESULTS AND DISCUSSION

The review found 45 studies from different countries and industries, highlighting how commercial practices and exposure to their content negatively impact children's and adolescents' mental health. Beyond traditional industries like tobacco, food and alcohol, the review explores others. Social media use is associated with increased anxiety and depression due to social comparison and cyberbullying. Easy access to pornographic content distorts perceptions of relationships and sexuality, contributing to anxiety, depression and behavioural disorders. The gambling industry's normalisation of betting through advertising influences addictive behaviour from an early age. Aggressive marketing by the pharmaceutical industry can lead to excessive or inappropriate use of diagnostic labels and psychotropic medications, exacerbating mental health problems and posing significant ethical and public health challenges.

CONCLUSION

Commercial determinants significantly impact child and adolescent mental health, necessitating a multifaceted approach to address these challenges. Parents and children's education, implementation of public policies and regulation of harmful commercial practices are essential to protect and promote mental health in future generations. Understanding and mitigating the effects of CDoH are crucial for ensuring a healthy developmental environment for children.

Epidemiological and sociodemographic transitions in the global burden and risk factors for Alzheimer's disease and other dementias: a secondary analysis of GBD 2021

BACKGROUND

The study aimed to analyze the long-term trends in the global burden of Alzheimer's disease and other dementias(ADOD) in different regions, and assess the association between socio-demographic index(SDI) and disease burden.

METHODS

We extracted data on the incidence, mortality, disability-adjusted life-years(DALYs), and age-standardized rates related to ADOD, as disease burden measures from 1990 to 2021. The joinpoint regression, quantile regression and restricted cubic splines were adopted to estimate the temporal trends and relationships with SDI. Risk factors for deaths and DALYs were also analyzed.

RESULTS

Globally, 9.84 million cases of ADOD occurred in 2021, with 1.95 million ADOD-related deaths, causing 36.33 million DALYs. ADOD incidence, mortality and DALYs all increased from 1990 to 2021. Regional and sex variations persisted, with the fastest increase in age-standardized death rate in low-middle SDI quintiles, experienced the highest estimated annual percentage changes (0.41[0.31,0.52]). The incidence of ADOD increased more rapidly as SDI increased in areas that have historically shown lower incidence compared to other areas. In regions with higher mortality or DALYs burden, these indicators decreased relatively faster as SDI increased. High fasting plasma glucose was the main risk factor, particularly in high SDI region, with an increasing trend in attributable burden. The burden attributable to high BMI was increasing, whereas the burden associated with smoking steadily decreased.

CONCLUSION

ADOD poses a significant and escalating challenge to healthcare sustainability, with persistent regional and gender disparities. By learning from successful ADOD management in certain nations, we can proactively reduce health burdens and bridge disparities between countries at various developmental levels.

Burden and projections of malignant neoplasm of bone and articular cartilage in China: an analysis for the global burden of disease study 2021

BACKGROUND

Malignant neoplasm of bone and articular cartilage (MNBAC) represents one of the most prevalent malignant tumours among adolescents. Assessing its disease burden trends is critical for formulating prevention strategies. This study aims to evaluate the temporal trends of MNBAC burden in China, project future trajectories over the next 15 years, and compare these patterns with global benchmarks.

METHODS

Data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease (GBD) database 2021. Joinpoint regression analysed temporal trends, while decomposition analysis was used to investigate the impact of aging, population growth, and epidemiological factors on the deaths and DALYs rates of MNBAC. Additionally, we conducted BPAC model to project future trends to 2036. Spearman correlation assessed associations between the burden of MNBAC and the socio-demographic Index (SDI).

RESULTS

In 2021, China's age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), age-standardised mortality rate (ASMR) and age-standardised DALYs rate (ASDR) for MNBAC were 1.42, 9.16, 0.93, and 29.52 per 100,000 population, respectively. Compared to 1990, these metrics increased by 118.46%, 125.62%, 60.34%, and 46.43%. Age-specific analyses revealed a bimodal burden pattern globally, peaking in adolescent and elderly populations. Joinpoint regression identified fluctuating trends in China (initial declining, subsequent rise, and then in decline), contrasting with global pattern. Decomposition analysis indicated that the increasing MNBAC burden in China was primarily driven by population aging and epidemiological changes, whereas globally, population growth played a more significant role. Projections indicated modest declines in MNBAC burden for China and globally by 2036. Spearman correlation analysis showed that the ASIR and ASPR of MNBAC in China and globally were significantly positively correlated with SDI (P < 0.05), and the ASMR and ASDR of MNBAC were also positively correlated with SDI, but not significantly.

CONCLUSIONS

This analysis underscores the substantial burden of MNBAC in China, surpassing global trends. While projections suggest gradual declines, the persistent high disability burden in youth and elderly populations necessitates strengthened screening protocols and prevention strategies. These findings provide critical epidemiological evidence for optimizing MNBAC management policies.

Global, regional and national burdens of alcoholic cardiomyopathy among the working-age population, 1990-2021: a systematic analysis

OBJECTIVES

Alcoholic cardiomyopathy (ACM) results from chronic alcohol misuse and primarily affects the working-age population (15-64 years). The global age-standardized rates (ASRs) of ACM disease burden declined slightly from 1990 to 2021, but the absolute cases increased, especially in high‒medium sociodemographic index (SDI) regions such as Eastern Europe. The aim of this study was to inform strategies to combat this preventable yet escalating health issue.

METHODS

We calculated estimated annual percentage changes (EAPCs) to quantify the dynamics of prevalence, deaths, and disability-adjusted life years (DALYs) for ACM. Decomposition analysis quantifies the contributor of disease burden in ACM. Additionally, we employed a health inequality analysis with two core indicators, the slope index (SI) and the concentration index (CIN), to assess national differences in the burden of ACM in relation to the SDI. Frontier analysis was used to identify preventable burdens with respect to optimized alcohol policies, particularly in high-middle SDI countries. Finally, we applied a Bayesian age‒cohort (BAPC) model to project the ACM burden to 2035.

RESULTS

This study revealed that the ASRs of prevalence, deaths, and DALYs decreased slightly from 1990 to 2021, whereas absolute cases of ACM continued to increase globally. Global income-based health disparities in ACM have intensified over the past 32 years, with high SDI populations disproportionately favoured. Population growth was the main driver of the increased ACM burden. The global burden of ACM is expected to increase in the future according to the BAPC model.

CONCLUSIONS

The global burden of ACM continues to rise, primarily due to population ageing and insufficient prevention policies. This burden disproportionately impacts working-age populations, who face heightened vulnerability due to alcohol accessibility, premature mortality, and reduced workforce productivity. Moreover, economic growth paradoxically coincides with increased alcohol-related harm in regions with high-middle socioeconomic development-the alcohol control paradox. Projections highlight an urgent need for tailored alcohol control strategies, including stricter regulation and early cardiac screening in high-risk groups, to mitigate workforce productivity loss and align public health priorities with sustainable development goals.

Perceived criticism and depressive symptoms among adults aged 50 years and older: a 17-year population-based cohort study

The longitudinal association between perceived criticism and depressive symptoms has not been fully elucidated in older adults. We aimed to explore the above association and the modifying role of sex in older adults. Data were from the English Longitudinal Study of Ageing (waves 1-9; 2002-2019). Depressive symptoms were assessed with the 8-item version of the Center for Epidemiologic Studies-Depression Scale, and a cut-off value of ≥4 was used to define clinically significant depressive symptoms. We included participants aged ≥50 years and without depressive symptoms at baseline, and established four dynamic prospective cohorts to explore the associations of perceived criticism from spouses (n = 8155), children (n = 9049), other immediate family members (OIFM, n = 9370), and friends (n = 9736) with depressive symptoms, respectively. In the full-adjusted model, compared with perceived no spouse criticism, perceived some (hazard ratio [HR], 1.36; 95% confidence interval [CI], 1.18-1.55) and a lot (HR, 2.24; 95% CI, 1.85-2.72) were associated with higher risks of depressive symptoms, but perceived a little was not (HR, 1.05; 95% CI, 0.92-1.20). Compared with perceived no child criticism, perceived a little (HR, 1.24; 95% CI, 1.12-1.36), some (HR, 1.50; 95% CI, 1.33-1.68), and a lot (HR, 2.02; 95% CI, 1.62-2.52) were associated with higher risks of depressive symptoms, and perceived criticism from OIFM and friends showed similar results. Sex significantly modified the above associations, and females were more susceptible to four types of perceived criticism than males. Our findings emphasize the benefits of reducing criticism of older adults in preventing their depressive symptoms.

Incidence trends in paediatric psoriasis 1990-2021: findings from the Global Burden of Disease Study 2021

BACKGROUND

Paediatric psoriasis is a chronic inflammatory skin disease that poses unique challenges in diagnosis and management. While studies from high-income countries have reported increasing trends in incidence, data regarding the incidence of paediatric psoriasis worldwide remain scarce.

OBJECTIVE

To provide a comprehensive description of the incidence of paediatric psoriasis at the global, regional and national levels.

METHODS

We used data from the Global Burden of Disease Study 2021 to analyse trends in the incidence of paediatric psoriasis between 1990 and 2021. Incidence rates were stratified by age, sex and sociodemographic index (SDI). The estimated annual percentage change (EAPC) was used to quantify the temporal trends.

RESULTS

In 2021, there were 664 100 cases of paediatric psoriasis globally, with an incidence rate of 33.0 per 100 000 children. Over the study period, the global incidence increased by 0.21% (95% confidence interval 0.18-0.25%) per year, with more pronounced increases observed in regions categorized as low SDI and middle SDI. The highest incidence rates were recorded in regions categorized as high SDI, such as High-income North America (70.5 per 100 000) and Western Europe (67.5 per 100 000). Notably, the largest increases in incidence occurred in regions such as sub-Saharan Africa. At the national level, 189 countries/territories experienced significant increases in the incidence of paediatric psoriasis, while only 5 countries saw a decline. Incidence was higher in girls across all age groups, and the most pronounced increase was seen in children aged less than 5 years.

CONCLUSIONS

The incidence of paediatric psoriasis has increased significantly in recent years, particularly in regions categorized as low SDI and middle SDI, underscoring the need for improved diagnosis, early intervention and targeted public health strategies.

Global, Regional and National Burden of Stomach Cancer and Its Prediction in 25 Years: A Cross-Sectional Study of the Global Burden of Disease Study 2021

Aims/Background Given the tremendous threat of stomach cancer (SC) to global public health, detailed information and dynamic updates on the SC health burden are needed to mitigate the repercussions. In this article, we present a systematic analysis of the global burden and trends of SC using data from the Global Burden of Disease (GBD) Study 2021, aiming to provide insights for forming effective global management and prevention strategies. Methods Stomach cancer incidence, prevalence, mortality, disability-adjusted life years (DALYs) and the corresponding age-standardized rates (ASRs) were estimated. Then, trends of the disease burden were analyzed using the estimated annual percentage changes (EAPC). Lastly, we made a unique attempt to use two powerful and versatile techniques, autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models, to provide more comprehensive and accurate forecasts for future trends in the disease burden. Results Despite the steady decreasing trend in age-standardized rates, the total numbers of incidence, prevalence, and deaths all increased from 1990 to 2021. Subgroup analysis demonstrated great disparities in different age and gender groups, sociodemographic index (SDI) quintiles, GBD regions and countries. Both the ARIMA and ES models demonstrated a persistent rise in SC cases and a concurrent decline in ASRs, with the trend being more pronounced in males. Conclusion Since SC is already a significant health issue globally, it is expected that the estimated disease burden will continue to rise in the future. Therefore, global coordinated efforts are needed to implement effective screening projects, consolidate preventive measures and formulate targeted treatments to alleviate the SC burden.

The global burden of bladder, kidney, and prostate cancers attributable to smoking from 1990 to 2021 and projections for the next two decades: A cross-sectional study

INTRODUCTION

Smoking increases the risk of bladder and kidney cancers and is associated with a poorer prognosis in prostate cancer (PCa) patients, which poses a significant health and socioeconomic burden. Understanding the epidemiologic trends of urological cancers attributable to smoking is critical to developing targeted prevention strategies. This study examines global trends in the three urological cancers attributable to smoking from 1990 to 2021 and projects future trends over the next two decades.

METHODS

Data were obtained from the Global Burden of Disease (GBD) 2021. Metrics included deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR), with uncertainty intervals (UIs). Burden comparisons were stratified by sex, age, and sociodemographic index (SDI). Temporal trends were analyzed using Joinpoint regression to calculate annual percentage change (APC) and average annual percentage change (AAPC), with 95% confidence intervals (CIs). Future trends were predicted using the autoregressive integrated moving average (ARIMA) model.

RESULTS

Compared with 1990, the number of deaths of bladder cancer, kidney cancer and PCa attributable to smoking increased by 43%, 67%, and 31%, and the number of DALYs increased by 31%, 52%, and 29% in 2021. However, the corresponding age-standardized rates showed a downward trend (AAPCASMR of bladder cancer, -1.53; AAPCASDR of bladder cancer, -1.68; AAPCASMR of kidney cancer, -0.89; AAPCASDR of kidney cancer, -1.11; AAPCASMR of PCa, -2.10; AAPCASDR of PCa, -1.97). The burden was higher among males than females, with the highest burden observed in high-SDI regions. The ASMR and ASDR were found to have a non-linear positive correlation with SDI (RASMR of bladder cancer=0.574, p<0.001; RASDR of bladder cancer=0.580, p<0.001; RASMR of kidney cancer=0.792, p<0.001; RASDR of kidney cancer=0.783, p<0.001; RASMR of PCa=0.417, p<0.001; RASDR of PCa=0.436, p<0.001), although the greatest improvements over the past three decades were observed in high-SDI regions. Joinpoint regression analysis indicated a downward trend in global deaths and DALYs burden, and the ARIMA model predicted that the burden of related diseases will continue to decline through 2041 (ASMRbladder cancer=0.44; ASDRbladder cancer=8.56; ASMRkidney cancer=0.13; ASDRkidney cancer=2.82; ASMRPCa=0.28; ASDRPCa=4.28).

CONCLUSIONS

Smoking has imposed a substantial disease burden on urological cancers over the past three decades. While overall ASDR and ASMR are declining, the disease burden remains high among men, especially those in high-SDI areas. This emphasizes the need for increased tobacco control for these populations or regions.

Global incidence trends and projections of Alzheimer disease and other dementias: an age-period-cohort analysis 2021

Background

Alzheimer disease (AD) is a growing global health issue, with incidence varying by gender, age, and region. Understanding these trends is essential for developing effective prevention strategies as the population ages. Unlike previous Global Burden of Disease (GBD) studies that primarily focussed on prevalence and mortality, we offer a novel perspective by examining historical incidence trends and projecting future patterns of AD and other dementias using advanced analytical approaches.

Methods

We used data from 204 countries and 21 global regions from the GBD 2021 database. We applied the age-period-cohort (APC) model to analyse historical incidence trends, and the Bayesian APC (BAPC) model to forecast future incidence from 2022-36. These models help reveal changes related to age, period, and birth cohort and enable forecasting of future trends - analytical perspectives not provided in the original GBD data sets or their supplementary documents.

Results

Between 1992-2021, global AD cases increased from 4.078 million to 9.837 million, while the global age-standardised incidence rate (ASIR) remained relatively stable, rising slightly from 117.7 to 119.8 per 100 000. ASIR increased significantly in high-middle and middle-sociodemographic index regions, but declined in the low-sociodemographic index regions. Women consistently exhibited higher incidence rates than men across all regions. Projections indicate that 2036 global AD cases will reach 19.117 million, with an ASIR of 418.92 per 100 000.

Conclusions

While global ASIR has remained stable, the number of AD cases continues to rise due to population ageing, particularly in middle- and high-income regions. Low-income regions face additional challenges due to limited health care resources. Gender disparities and unequal access to health care contribute to the variations in disease burden. These findings emphasise the need to prioritise early diagnosis and implement targeted interventions to reduce future disease burdens and address global health care inequalities.

Global Epidemiology of Early-Onset Digestive System Malignancy: A Systematic Analysis for the Global Burden of Disease Study 2021

BACKGROUND AND AIM

The researches on the global burden of digestive system malignancy in young populations were limited. This study aimed to comprehensively investigate the burden of early-onset digestive system malignancy (often defined as cancers diagnosed below the age of 50) based on the Global Burden of Disease 2021.

METHODS

Data of incidence, prevalence, deaths, disability-adjusted life years (DALYs), and risk factors for the five major early-onset digestive system malignancies, including early-onset esophageal cancer (EOEC), early-onset gastric cancer (EOGC), early-onset liver cancer (EOLC), early-onset pancreatic cancer (EOPC), and early-onset colorectal cancer (EOCRC), were extracted from GBD 2021. The average annual percent change (AAPC) was calculated using joinpoint regression analysis. The Bayesian age-period-cohort (BAPC) model was utilized to predict the burden up to 2030.

RESULTS

From 1990 to 2021, the age-standardized incidence rate (ASIR) of early-onset digestive system malignancies, except for EOCRC (AAPC, 0.37), showed a decreasing pattern. Meanwhile, the age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of early-onset digestive system malignancy presented a downward trend. Notably, high-middle sociodemographic index (SDI) countries experienced higher disease burdens. Dietary risk factors, tobacco, alcohol consumption, and metabolic factors were the main risk factors. The ASIR of EOEC and EOCRC was projected to increase in 2030, whereas the trend for EOGC, EOLC, and EOPC was projected to decrease.

CONCLUSIONS

Early-onset digestive system malignancy presented notable heterogeneity across gender, geography, and cancer types. This emphasizes the urgency of addressing the public health challenge of early-onset digestive system malignancy.

From Fear to Hope: Understanding Preparatory and Anticipatory Grief in Women with Cancer-A Public Health Approach to Integrating Screening, Compassionate Communication, and Psychological Support Strategies

Prolonged grief disorder, also known as post-loss grief, was officially recognized in the International Classification of Diseases (ICD-11) after years of debate within the mental health community. However, while post-loss grief gained recognition, anticipatory and preparatory grief, which occur before a loss, have remained underexplored. Preparatory grief affects individuals nearing the end of life, while anticipatory grief impacts the loved ones of those who are about to die. These grief types are particularly prevalent among women, who are more vulnerable to their emotional and psychological challenges. The primary aim of this study was to investigate preparatory grief in women diagnosed with cancer and anticipatory grief in their loved ones, with the goal of developing management guidelines. The secondary objective was to identify protective factors, such as psychotherapeutic interventions and systemic support, to alleviate grief-related distress. This review synthesized evidence from the PubMed and Cochrane databases, covering studies from 1968 to 2020 and after the COVID-19 pandemic in 2023. The results revealed that anticipatory grief was common among loved ones, leading to increased emotional distress, while cancer patients experienced preparatory grief, facing both emotional and practical challenges. Both types of grief were associated with altered stress responses, such as lower diurnal cortisol levels. Psychotherapeutic interventions, particularly early and systemic psychotherapy, were found to effectively reduce symptoms of both anticipatory and preparatory grief, improving coping strategies and emotional well-being. The study concluded that empowering coping strategies and social support played key roles in enhancing emotional outcomes for both patients and their families.

Global burden of low back pain from 1990 to 2021: a comprehensive analysis of risk factors and trends using the Global Burden of Disease Study 2021

BACKGROUND

This study comprehensively assesses low back pain-related risk factors and the global burden from a multi-dimensional perspective, aiming to provide scientific evidence for disease prevention.

METHODS

Data from the Global Burden of Disease (GBD) database spanning from 1990 to 2021 were incorporated into this study. We conducted an analysis of baseline data, as well as gender and age subgroup data. Additionally, we introduced the Age-Period-Cohort (APC) and decomposition analysis models to clarify the independent effects of factors such as age, period, cohort, population growth, population aging and changes in epidemiological trends on the disease burden. The Estimated Annual Percentage Change (EAPC) was used to measure the temporal trends of health indicators. To enhance practical applicability, we constructed a model that integrates frontier analysis with health inequality assessment. Furthermore, the Autoregressive Integrated Moving Average (ARIMA) model was employed to forecast trends in LBP over the next 15 years.

RESULTS

In 2021, the global age-standardized prevalence of low back pain decreased by 11.06% compared to that in 1990. However, the number of affected individuals increased from 386.7 million to 628.8 million. Concurrently, the age-standardized Disability-Adjusted Life Years (DALYs) rate declined by 11.22% relative to 1990, while total DALYs rose from 43,386,225 to 70,156,962. The results derived from multiple models indicate that higher socio-demographic index levels, advancing age, female sex and occupational ergonomics-related factors may contribute to disparities in the burden of low back pain. Furthermore, this unequal health gap appears to be widening over time.

CONCLUSIONS

Disease burden of low back pain exhibit varying manifestations across different regions and temporal dimensions. Higher levels of the Socio-Demographic Index(SDI), increasing age, female gender and adverse occupational ergonomic factors may be important risk elements for the burden of low back pain. Meanwhile, certain changes in epidemiological trends may alleviate this burden to some extent. In the absence of effective intervention measures, the gaps in health inequality engendered by the aforementioned diverse factors are likely to expand continuously. In light of this, it is crucial to actively develop systematic, comprehensive and targeted health prevention strategies.

Combined effect of heatwaves and residential greenness on the risk of stroke among Chinese adults: A national cohort study

Heatwaves have been associated with an increased risk of stroke, while residential greenness may offer protective benefits. This prospective cohort study examined 22,702 participants aged 35 years or older, with no prior history of cardiovascular disease (CVD), from the China Hypertension Survey (CHS) conducted between 2012 and 2015. Participants were followed up between 2018 and 2019. Heatwaves were defined as daily maximum temperatures exceeding the 92.5th percentile of the warm season for at least three consecutive days. Residential greenness was quantified using the Normalized Difference Vegetation Index (NDVI) within buffers of 300, 500, and 1000 m from participants' residences. Multivariable Cox proportional hazards models evaluated the independent and combined effects of heatwaves and greenness on stroke risk, while restricted cubic spline analyses explored nonlinear relationships. Interaction effects were assessed using both multiplicative and additive Cox regression models. During follow-up, 597 stroke events occurred. Each additional 3-day increase in heatwave days was associated with an increased stroke risk (HR: 1.19, 95 % CI: 1.08-1.31). Interaction analyses demonstrated a synergistic effect between heatwaves and lower residential greenness (NDVI300 m, NDVI500 m and NDVI1000 m) on stroke risk, with significant additive(RERI > 0, P < 0.05) and multiplicative interactions (HR > 1, P < 0.05). The strongest protective effects of greenness were observed within a 500 m buffer zone, particularly for individuals under 60 years, rural residents, and those with higher educational attainment. This study highlights the potential benefits of enhancing greenness for cardiovascular health and provides valuable insights for environmental governance and public health policy in China.

Trends in the global, regional, and national burden of cardiovascular diseases attributed to high systolic blood pressure from 1990 to 2021 and projections to 2045: a systematic analysis based on GBD 2021 data

BACKGROUND

Cardiovascular disease (CVD) remains the leading cause of death and disability worldwide, and high systolic blood pressure (HSBP) is considered among its most critical modifiable risk factors. This study analyzed the temporal trends of the global burden of CVD attributed to HSBP from 1990 to 2021, examined its relationships with age, period, and birth cohort, and projected future trends to 2045.

METHODS

The study employed a joinpoint regression model to evaluate the temporal trends of CVD burden attributed to HSBP from 1990 to 2021 and used an Age-Period-Cohort (APC) model to analyze the effects of age, period, and cohort. Additionally, a Bayesian Age-Period-Cohort (BAPC) model was applied to project the disease burden trends up to 2045.

RESULTS

From 1990 to 2021, the absolute number of deaths and DALYs (disability-adjusted life years) of CVD attributed to HSBP increased significantly. However, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) showed a consistent declining trend. The study highlights significant regional differences, with the disease burden increasing most markedly in regions with a middle Socio-Demographic Index (SDI) and decreasing most significantly in high SDI regions. Additionally, the study revealed gender differences, with the decline in ASMR and ASDR was more pronounced in females, while males exhibited a higher overall disease burden than females. Projections from the BAPC model indicate that from 2022 to 2045, the absolute number of deaths and DALYs will continue to rise, while ASMR and ASDR will decline further.

CONCLUSIONS

This study conducted a comprehensive analysis of CVD attributed to HSBP globally, highlighting significant sex, age, and regional differences in disease burden as well as their temporal trends. The findings underscore the importance of targeted prevention strategies, particularly for high-risk populations. This study provides valuable insights for policymakers to formulate effective interventions to reduce the global disease burden.

Global Burden of Kidney Cancer Attributable to High Body Mass Index in Adults Aged 60 and Older from 1990 to 2021 and Projections to 2040: A Systematic Analysis for the Global Burden of Disease Study

Background

With global aging, cancer burden rises. Kidney cancer is significantly influenced by high body mass index (BMI), especially in the elderly. This study analyzes the burden of kidney cancer attributable to high BMI in those aged ≥60, clarifying causes and future trends.

Methods

Using Global Burden of Disease (GBD) 2021 study, we assessed kidney cancer burden due to high BMI in population aged ≥60 from 1990 to 2021, comparing deaths, disability-adjusted life years (DALYs), age-standardized rate (ASR) of DALYs (ASDR), and mortality (ASMR). Stratified by Socio-Demographic Index (SDI), region, sex, and age, we evaluated spatiotemporal trends and inequalities. Finally, the Bayesian Age-Period-Cohort (BAPC) model predicted burden changes through 2040.

Results

From 1990 to 2021, DALYs and deaths from high BMI-induced kidney cancer in those aged ≥60 increased by 165.82% and 186.39%, driven by population growth. In 2021, ASDR was 45.55/100,000 and ASMR 2.39/100,000. Regional differences were significant. DALYs and deaths expanded, especially in those aged ≥95. Males had higher burden than females. SDI correlated positively with ASDR and ASMR (r>0, P<0.05). Health inequalities continue to rise. By 2040, burden is projected to rise, especially in low-middle and low SDI regions, more in males.

Conclusion

This study shows a significant increase in kidney cancer burden due to high BMI in those aged ≥60 over 32 years, driven by population growth. Disparities across regions, genders, and age groups highlight the need for targeted prevention and early intervention, especially for high-risk groups (males, elderly, low-middle SDI regions), to reduce burden and optimize healthcare resource allocation.

Trends in rheumatoid arthritis burden in China and globally, 1990-2021: A longitudinal study based on the GBD database

BACKGROUND

Rheumatoid arthritis (RA) is a chronic autoimmune disease that imposes significant health and economic burdens worldwide, particularly in developing countries such as China.

METHOD

In this study, the Global Burden of Disease, The GBD database system stratified the incidence,prevalence,death and disability-adjusted life years (DALYs) of RA in China and the world from 1990 to 2021 by age, sex and period. Joinpoint Regression Program 5.1.0 was then used to calculate average annual percent change (AAPC) and 95% confidence interval (95% confidence interval). CI) to identify trends in disease burden. In addition, data collation using WPS allows for the comparison of RA burdens across different age groups, genders and time points in China and globally, and the data is rigorously screened and processed to ensure accuracy and comparability.

RESULTS

From 1990 to 2021, ASIR of RA in China increased by 0.54%, while the global ASIR rose by 0.41%.The number of RA cases in China increased cumulatively by 133%, compared to a global increase of 125.21%.Simultaneously, ASPR in China and globally increased by 17% and 14.44%, respectively.Regarding mortality, although the number of RA-related deaths increased in both China and globally, ASMR decreased by 26.23% in China and 22.86% globally.The trend in ASDR was consistent with ASMR, with declines of 0.40% in China and 1.46% globally.Furthermore, the study revealed significant gender disparities in RA both in China and globally, with women experiencing higher incidence, prevalence, mortality, and DALYs than men.The burden of RA increased significantly with age, particularly among middle-aged and older adults aged 45 and above.

CONCLUSION

Over the past 30 years, the burden of RA in China and globally has undergone significant changes.The study found that while RA related mortality and DALYs have slightly decreased in China and globally, the incidence and prevalence rates have continued to rise, particularly among women and middle-aged to elderly populations.Population aging and changes in lifestyle are key drivers of the increasing RA burden, with women showing higher susceptibility and burden due to their unique physiological characteristics and societal roles.The study highlights the need to strengthen early screening and intervention, optimize personalized treatment plans, and pay special attention to the unique needs of elderly and female populations.Additionally, promoting healthy lifestyles, improving primary healthcare services, and implementing supportive policies can effectively alleviate the health and socioeconomic burden of RA, ensuring a better quality of life for patients.

Global, regional, and national burden of female infertility and trends from 1990 to 2021 with projections to 2050 based on the GBD 2021 analysis

Female infertility represents a significant reproductive health issue that critically affects global fertility rates. In this study, we utilized the most recent data from the Global Burden of Disease (GBD) study 2021. Initially, we assessed the global burden by the number of female infertility prevalence and disability-adjusted life years (DALYs), along with the age-standardized rate (ASR) per 100,000 individuals, stratified by age, sociodemographic index (SDI), nationality, and region. Furthermore, linear regression models were employed to examine the temporal trends of disease burden from 1990 to 2021. Cluster analysis facilitated the evaluation of disease burden change patterns across different GBD regions. Lastly, the autoregressive composite moving average model was applied to forecast future disease burdens. In 2021, the global prevalence of female infertility was estimated at 110,089,459, contributing to 6,210,145 DALYs, there was an observed increase of 84.44% in prevalence and 84.43% in DALYs since 1990. The highest burden occurred among individuals aged 35-39, with the most rapid increase observed in the 30-34 age group. The burden of female infertility displayed considerable variability across GBD regions and countries, with areas of high-medium SDI facing elevated risks. Projections indicate a continuing rise in the ASR of prevalence and DALYs for female infertility over the next 2 decades. The global burden of female infertility has intensified from 1990 to 2021, with notable disparities across different SDI regions and countries. Women aged 35-39 face the highest risk, and there is a trend toward earlier onset of infertility.

Burden of Skin Cancer in Older Adults From 1990 to 2021 and Modelled Projection to 2050

Importance

Skin cancer is a significant public health threat in the aging population, yet data on its burden and trends are limited.

Objective

To evaluate the global burden of skin cancer among adults 65 years or older from 1990 to 2021, and to project its change to 2050.

Design, Setting, and Participants

In this observational study, population-based registry data were extracted from the Global Burden of Diseases (GBD) Study 2021. The database covers 204 countries and territories, ensuring global applicability of the results. Data analysis was conducted from June 9, 2024, to February 18, 2025.

Main Outcomes and Measures

Age-standardized rates of prevalence, incidence, deaths, and disability-adjusted life-years (DALYs) were calculated per 100 000 population. Estimated rates of disease burden were calculated for 2050.

Results

A worldwide total of 153 993 melanoma, 1 463 424 squamous cell carcinoma (SCC), and 2 802 354 basal cell carcinoma (BCC) instances were estimated for 2021. SCC exhibited the highest age-standardized rate of prevalence (236.91 per 100 000 population; 95% uncertainty interval [UI], 188.23-303.82), deaths (6.16 per 100 000 population; 95% UI, 5.13-6.87), and DALYs (95.50 per 100 000 population; 95% UI, 81.65-106.39), whereas BCC displayed the highest incidence rate (371.97 per 100 000 population; 95% UI, 310.75-439.58). The disease burden was notably greater in male individuals than in female individuals. During the observation period, the global burden of skin cancer among older people demonstrated a general upward trend. Decomposition analysis indicated that population growth was the primary contributor to this increase. Health-inequality analysis revealed a disproportionately higher burden shouldered by countries with higher sociodemographic index (SDI) levels. Frontier analysis identified the countries with considerable potential to mitigate skin cancer. It was anticipated that only incidence and prevalence rates attributable to keratinocyte cancer (KC), along with DALYs rate related to BCC, would increase by 2050.

Conclusions and Relevance

The older population (particularly male individuals and those living in high-SDI countries) is facing a substantial growing burden of skin cancer. Despite the relative incompleteness of KC data and lack of race and ethnicity data, these results highlight the urgency for more effective prevention and management strategies targeting high-risk groups.

Global Burden and Risk Factors of Stroke in Young Adults, 1990 to 2021: A Systematic Analysis of the Global Burden of Disease Study 2021

BACKGROUND

This study aimed to estimate the disease burden of ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and overall stroke among young adults (aged 15-49 years) in 204 countries and territories from 1990 to 2021, along with the associated risk factors.

METHODS

GBD (Global Burden of Disease Study) 2021 data were used to assess the burden and trends via age-standardized rates and their estimated annual percentage changes.

RESULTS

Although age-standardized rates generally declined from 1990 to 2021, the number of incident and prevalent stroke cases among young adults increased by 36% (95% uncertainty interval, 31%-41%) and 41% (95% uncertainty interval, 38%-43%), respectively. Notably, from 2015 to 2021, the age-standardized incidence of ischemic stroke and subarachnoid hemorrhage among young adults increased, with estimated annual percentage changes of 0.65 (95% CI, 0.39-0.92) and 0.58 (95% CI, 0.47-0.69), respectively. High systolic blood pressure was the primary risk factor for stroke-related disability-adjusted life-years among young adults. However, other risk factors varied by region, with higher proportions of smoking, high low-density lipoprotein cholesterol, and high body mass index in high sociodemographic index regions, and higher proportions of household air pollution from solid fuels and diet low in vegetable in low sociodemographic index regions. From 1990 to 2021, the total number of stroke-related disability-adjusted life-years among young adults due to risk factors increased by 12% (95% uncertainty interval, 2%-22%), driven principally by high systolic blood pressure, ambient particulate matter pollution, high body mass index, high low-density lipoprotein cholesterol, and high fasting blood glucose.

CONCLUSIONS

Since 2015, there has been a concerning rebound in the age-standardized incidence rates of ischemic stroke and subarachnoid hemorrhage among young adults globally. Given regional and sociodemographic index variations in risk factors, targeted and cost-effective policies and interventions are urgently needed to reduce stroke burden in this demographic.

Chronic Obstructive Pulmonary Disease (COPD): Developments in Pharmacological Treatments

The immediate goals of pharmacological management in chronic obstructive pulmonary disease (COPD) are to minimise symptoms and improve exercise performance. The longer-term goals are to reduce the future risk of exacerbations, lung function decline and mortality. It is now recognised that a subset of COPD patients have type 2 inflammation, which is identified by the presence of higher blood eosinophil counts (BEC). Individuals with higher BEC show a greater response to pharmacological interventions targeting type 2 inflammation, including inhaled corticosteroids and the monoclonal antibody, dupilumab. The use of BEC as a biomarker to guide pharmacological treatment has enabled a precision medicine approach in COPD. This article reviews recent advances in the pharmacological treatment of COPD, encompassing the optimum use of inhaled combination treatments and the evidence to support the use of the novel inhaled phosphodiesterase inhibitor ensifentrine and monoclonal antibodies in patients with COPD.

The health impact of identifying a person with tuberculosis through systematic screening

Screening populations at high risk for tuberculosis might improve clinical outcomes and reduce transmission, but the value and cost-effectiveness of population-based screening depend on the uncertain health impact of early tuberculosis detection. In this Personal View, we propose a framework for estimating the incremental health impact of systematic screening, including effects on tuberculosis morbidity, mortality, sequelae, and transmission. Our framework accounts for the timing of screening, relative to when routine diagnosis might occur and when health effects become inevitable. We also account for the heterogeneous duration of tuberculosis, as people with longer disease courses (associated with lower mortality but more transmission) are more likely to be detected by screening. Finally, we use this framework to estimate that population-based chest x-ray screening interventions might avert 2·4 disability-adjusted life-years per person (95% uncertainty interval 0·8-7·4) found to have tuberculosis through screening-well within the cost-effectiveness thresholds for many programmes with published costs.

Global, regional and national burden of injuries caused by fire, heat, and hot substances from 1990 to 2021

BACKGROUND

Burn injuries, which are caused by fire, heat, and hot substances, are considered a chronic condition due to their long-term effects on the health of affected individuals. Moreover, burn injuries constitute a significant public health issue that cannot be overlooked within the global healthcare system.

MATERIALS AND METHODS

This study comprehensively analyzed the burden of burn injuries, focusing on variations by Socio-Demographic Index (SDI) levels and Global Burden of Disease (GBD) regions, sex-based disparities, Frontier analysis, and future trend forecasting using the Bayesian Age-Period-Cohort (BAPC) model.

RESULTS

Compared to 1990, the global burden of burn injuries decreased in most regions worldwide in 2021. The majority of regions showed a negative Estimated Annual Percentage Change (EAPC), indicating a continuous decline in Age-Standardized Rate (ASR) annually. And the ASR decreased with the increasing SDI. Moreover, the forecasted trend from 2021 to 2030, indicates a continued decline with a well-fitted projection model.

CONCLUSIONS

Despite the observed and projected decline in global ASR of burn, the burden of burn remains a significant concern that should not be underestimated.

Early maternal separation potentiates the impact of later social isolation in inducing depressive-like behavior via oxidative stress in adult rats

RATIONALE

Individuals who have experienced early life stress (ELS) are more vulnerable to later life stress induced depression, which might attribute to ELS potentiated impact of later life stress. The presumption and neurobiological mechanisms involved require further validation and elucidation.

OBJECTIVES

To investigate impact of pre-weaning maternal separation (MS) on post-weaning social isolation (SI) in inducing depressive-like behavior, and involvement of central oxidative stress, glutamatergic and brain-derived neurotrophic factor (BDNF)/tyrosine kinase receptor B (TrkB) signaling in the process.

METHODS

Male offspring were exposed to MS, SI or maternal separation and social isolation (MSSI) stress, respectively. Subjects were treated with saline, antioxidant diallyl disulfide (DADS) (30 mg/kg, i.g.) or antidepressant fluoxetine (10 mg/kg, i.p.), for two weeks before behavioral tests in adolescents or adults. Depressive-like behavior was assessed with sucrose preference, forced swim and tail suspension tests. Concentrations of 4-hydroxynonenal (4-HNE), glutathione and superoxide dismutase in hippocampus and serum, and hippocampal protein expressions of glutamate transporter 1 (GLT-1), BDNF and TrkB were assessed by western blotting analysis.

RESULTS

MSSI, rather than MS or SI, induced significant depressive-like behavior, in adults but not adolescents. Consistently, only MSSI significantly elevated 4-HNE, whereas inhibited GLT-1, BDNF and TrkB in adult hippocampus. MSSI induced behavioral and biochemical abnormalities in adults were reversed by DADS or fluoxetine treatment.

CONCLUSIONS

Early MS age-dependently potentiates later SI impact in inducing depressive-like behavior in male rats, through elevating oxidative stress and interrupting glutamatergic and BDNF/TrkB signaling in the brain. Results further suggest antioxidant treatment as a promising anti-depressant avenue.

Differentiating the impact of non-optimum temperature and temperature variability on cause-specific cerebrovascular mortality: An individual-level, case-crossover study in Shanghai, China

BACKGROUND

Cerebrovascular mortality exhibits seasonal variation, but the roles of temperature and temperature variability (TV) in cause-specific cerebrovascular mortality remain unclear.

METHODS

This individual-level time-stratified case-crossover research collected individual cerebrovascular death records during 2005-2021 in Shanghai, China. TV was calculated as the standard deviation of daily minimum and maximum temperature over consecutive days. Conditional logistic regression models combined with distributed lag nonlinear models were utilized to evaluate the cumulative exposure-response associations.

RESULTS

Based on a total of 388,823 cerebrovascular deaths, we found that exposure to extreme cold, extreme heat, and greater TV was significantly related to increased cause-specific cerebrovascular mortality. Extreme cold exhibited the strongest impact on hemorrhagic stroke [relative risk (RR) = 1.84; 95 % confidence interval (CI): 1.50, 2.26], followed by hemorrhagic stroke sequelae [1.75 (95 % CI: 1.25, 2.45)] and cerebrovascular sequelae [1.71 (95 % CI: 1.58, 1.86)]. Extreme heat showed the largest effect on cerebrovascular sequelae [1.35 (95 % CI: 1.29, 1.41)], followed by ischemic stroke sequelae [1.34 (95 % CI: 1.28, 1.41)]. TV was associated with the largest percentage increase in ischemic stroke sequelae [2.12 % (95 % CI: 1.35 %, 2.90 %)], followed by cerebrovascular sequelae [1.95 % (95 % CI: 1.23 %, 2.68 %)]. Stratified analyses revealed stronger associations in the elders, singles, and those with low education.

CONCLUSIONS

This case-crossover study provides the first-hand evidence that extreme temperatures and TV may elevate the risk of cause-specific cerebrovascular mortality, which underscore the urgency of implementing targeted protective measures for cerebrovascular patients facing extreme weather events, particularly among aging populations in megacities under climate change.

Worldwide burden and cross-regional health inequalities of high BMI-attributable colorectal cancer by gender from 1990 to 2021, with predictions through 2041

PURPOSE

To analyze the worldwide, regional, and national burden and trends of colorectal cancer (CRC) attributable to high body mass index (BMI) by gender from 1990 to 2021 and to forecast the burden through 2041.

METHODS

Data on deaths and disability-adjusted life years (DALYs) of CRC attributable to high BMI were obtained from the Global Burden of Disease (GBD) Study 2021. Disparities and trends in CRC due to high BMI burden were analyzed globally and regionally, with stratification by gender and age subgroups. An autoregressive integrated moving average (ARIMA) model was employed to project the future burden through 2041.

RESULTS

In 2021, the global age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of CRC attributable to high BMI were estimated at 1.17 [95% uncertainty interval (UI): 0.51 to 1.87] and 27.33 (95% UI: 11.80 to 43.37) per 100,000 population, respectively. Both metrics showed a modest increase from 1990 to 2021. During this period, the population attributable fraction (PAF) of CRC deaths due to high BMI increased steadily. Similarly, the PAF of CRC DALYs caused by high BMI also showed a continuous rise. High socio-demographic index (SDI) regions, Central Europe and countries such as Hungary and Slovakia, recorded the highest ASMR and ASDR in 2021. Projections indicate that the global ASMR will decrease by 1%, while the ASDR will increase by 4.23% by 2041.

CONCLUSION

The global burden of CRC attributable to high BMI remains substantial and is projected to persist, with considerable regional and national variability. These findings emphasize the need for targeted public health interventions and policies to address this preventable risk factor.

Long-term safety and tolerability of zavegepant 10-mg nasal spray with concomitant use of anti-calcitonin gene-related peptide monoclonal antibodies or other select preventive migraine medications: Results from a phase 2/3 open-label study

OBJECTIVE

To evaluate the safety and tolerability of zavegepant (ZAV) when used as needed for acute treatment of migraine in patients taking concomitant preventive migraine medications (anti-calcitonin gene-related peptide monoclonal antibodies [CGRP mAbs] or other select preventive migraine medications [OSPs]).

BACKGROUND

People with migraine often use preventive and acute treatments concomitantly for breakthrough attacks. ZAV 10-mg nasal spray is the first intranasal, small-molecule CGRP receptor antagonist approved for the acute treatment of migraine with or without aura in adults.

METHODS

This was a subgroup analysis of data from a multicenter, single-arm, open-label, phase 2/3 clinical trial that assessed the safety and tolerability of ZAV for the acute treatment of migraine. Participants self-administered 1 ZAV dose/day as needed up to 8 times/month for up to 52 weeks to treat migraine attacks of any severity. Participants were categorized into five cohorts based on their current or concomitant use of preventive treatments: ZAV + CGRP mAbs, ZAV + OSPs, ZAV + CGRP mAbs or OSPs, ZAV monotherapy (ZAVmono), and the overall study population. Adverse events (AEs), clinical laboratory results, and vital signs data were evaluated and summarized descriptively.

RESULTS

A total of 603 participants self-administered ≥1 dose of ZAV and 341 participants (56.6%) completed the study. Among the 603 ZAV-treated participants, 39 (6.5%) received ZAV + CGRP mAbs, 72 (11.9%) received ZAV + OSPs, 103 (17.1%) received ZAV + CGRP mAbs or OSPs (eight participants received both CGRP mAbs and OSPs), and 500 (82.9%) received ZAVmono. Baseline characteristics were similar across cohorts. The mean number of ZAV doses self-administered per month was similar across cohorts (3.1-3.3). The proportion of participants experiencing an AE was similar across cohorts (range: 73.6-76.9%). The most frequent AEs were dysgeusia (range across cohorts: 28.2-41.7%), nasal discomfort (9.7-15.4%), COVID-19 (7.2-8.7%), nausea (4.2-10.3%), back pain (4.4-15.4%), throat irritation (4.4-12.8%), and nasal congestion (5.2-7.7%). Most AEs had mild-to-moderate severity and resolved without treatment. The proportion of participants who discontinued due to an AE was similar across cohorts (range: 4.2-7.7%). No serious AEs related to ZAV treatment occurred. The proportion of participants who experienced a local-irritation AE was similar across cohorts (range: 49.4-51.4%), as was the proportion who experienced a hepatic-related AE (3.8-7.7%). No AEs related to medication-overuse headache, suicidality, or cardiovascular events occurred. No clinically meaningful trends in laboratory test results or vital signs were observed.

CONCLUSION

Self-administration of ZAV 10-mg nasal spray for the acute treatment of migraine up to 8 times/month for up to 52 weeks appeared well-tolerated irrespective of concomitant use of CGRP mAbs or OSPs.

Burden and trend of maternal sepsis and other maternal infections in BRICS countries from 1990 to 2021

BACKGROUND

Maternal septicemia and other maternal infections (MSMIs) continue to pose considerable challenges to public health on a global scale. However, comprehensive data on their impacts and trends are limited, particularly in BRICS countries, which include Brazil, Russian Federation, India, China, and South Africa. This study aims to compare the global epidemiological trends of MSMIs from 1990 to 2021 to MSMIs trends in BRICS countries and examine the relationship of disease burden with age and social development.

METHODS

Using data from the Global Burden of Disease database, this study analyzed the prevalence, incidence, death, and disability-adjusted life years (DALYs) of MSMIs from 1990 to 2021 globally and in BRICS countries. Temporal trends were assessed through estimated annual percentage change (EAPC) and percentage change. Joinpoint regression analysis was employed to rigorously evaluate time trends, allowing for the calculation of annual percentage change (APC) and average annual percentage change (AAPC), with corresponding 95% confidence intervals (CI).

RESULTS

In 2021, South Africa showed the highest prevalence of MSMIs (156.54 per 100,000), while the Russian Federation exhibited the highest incidence (1,001.51 per 100,000). Deaths and DALYs of MSMIs were lowered in BRICS countries compared to global averages. Between 1990 and 2019, India experienced the greatest decline in both incidence (EAPC = -2.68%) and prevalence (EAPC = -2.65%). Despite the global decline, regional variations in incidence were observed. In China, the incidence increased significantly between 2010 and 2014 (APC = 4.15%; 95% CI: 3.59-4.71%; P < 0.001). Similarly, in the Russian Federation, the incidence rose during three distinct periods: 2000-2004 (APC = 2.52%; 95% CI: 2.0-3.05%; P < 0.001), 2004-2010 (APC = 5.2%; 95% CI: 4.95-5.44%; P < 0.001), and 2010-2015 (APC = 1.79%; 95% CI: 1.46-2.12%; P < 0.001).

CONCLUSION

MSMIs remain prevalent globally, imposing a substantial disability burden, particularly in BRICS countries. While China exhibits relatively low disease burdens, South Africa faces high prevalence, and global deaths and DALYs from MSMIs remain elevated.

Genetic predictors of longevity and survival in cellular homeostasis genes: A case-control study

BACKGROUND

Longevity is defined by the ability to maintain both physical and mental health throughout a long life and may results from adaptive mechanisms that mitigate aging's detrimental effects.

METHODS

The 20-year follow-up study of 3,312 unrelated individuals aged 18-114 years from the Volga-Ural region of Eurasia investigated variants in cellular homeostasis genes IGF1, PIK3R1, AKT1, MTOR, NFE2L2, KEAP1, HIF1A, TP53, and SIRT1, to identify associations with clinical aging phenotypes and healthy longevity.

RESULTS

In men, KEAP1 (rs1048290) CC genotype was a longevity and survival marker (OR = 2.39, P = 3E-05, HR = 0.54, P = 2.4E-03). NFE2L2 (rs6721961) TT genotype was linked to higher mortality (HR = 1.77, P = 0.031), particularly combined with KEAP1 (rs1048290) G and AKT1 (rs3803304) C alleles (HR = 2.8, P = 0.023). In women, AKT1 (rs3803304) C allele interacted with NFE2L2 (rs6721961) TT genotype (SF = 0.13, P = 3.6E-03), and was linked to longevity (OR = 2.22, P = 6.3E-03) and protection against cerebrovascular diseases (OR = 0.62, P = 5.1E-03). AKT1 (rs3803304) GG genotype, along with HIF1A (rs11549465) T and SIRT1 (rs3758391) T alleles (SF = 2.52, P = 1.5E-03), promoted survival (HR = 0.71, P = 0.014). In men, HIF1A (rs11549465) TT genotype predicted cardiovascular mortality (HR = 7.5, P = 5.5E-03). SIRT1 (rs3758391) TT genotype was associated with improved survival in individuals with diabetes (HR = 0.4, P = 5.8E-03) and multimorbidity (HR = 0.48, P = 0.025).

CONCLUSION

Variants in NFE2L2, KEAP1, SIRT1, AKT1, and HIF1A, along with their interactions, were significantly associated with survival in age-related diseases and healthy longevity.

Health inequalities in disease burden of dementia and early-onset dementia: findings from the Global Burden of Disease 2021 study

BACKGROUND

Given the increasing aging global population and advancements in dementia action plans, the latest disparities in the dementia burden may evolve. This study aimed to analyze and compare temporal trends at regional, national, and sociodemographic levels to provide evidence for public health planning and resource prioritization.

METHODS

The age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (DALYs) rate (ASDR) were derived from the Global Burden of Disease 2021 study. Estimated annual percentage changes (EAPCs) were calculated to quantify their temporal trends. Correlations between EAPC and the human resources for health (HRH) were assessed using Pearson correlation analysis.

RESULTS

Although the ASPR and ASIR remained stable or decreased globally, they both greatly increased in East Asia (ASPR: EAPC = 0.43; 95% CI 0.35, 0.51; ASIR: EAPC = 0.40; 95% CI 0.33, 0.47). For early-onset dementia, the ASPR (range of EAPC = 0.03-0.17) and ASIR (range of EAPC = 0.05-0.19) in the 45 to 59 years age group increased in North Africa and Middle East, particularly among females (ASPR: range of EAPC = 0.08-0.21; ASIR: range of EAPC = 0.09-0.2). Although the ASMR and ASDR both decreased globally and in high socio-demographic index region, they both increased greatly in South Asia (ASMR: EAPC = 0.7; 95% CI 0.66, 0.75; ASDR: EAPC = 0.40; 95% CI 0.37, 0.43). For early-onset dementia, the ASMR (range of EAPC = 0.43-0.78) and ASDR (range of EAPC = 0.19-0.33) in the 40 to 59 years age group had increased in Central Sub-Saharan Africa, particularly among females (ASMR: range of EAPC = 0.5-0.86; ASDR: range of EAPC = 0.19-0.4). Negative correlations were observed between the EAPC in ASPR, ASIR, ASMR and ASDR with various types of HRH at the national level.

CONCLUSIONS

Although there has been progresses in controlling the global trends of dementia incidence, prevalence, and mortality, significant regional and national inequalities remain evident. More importantly, the early-onset dementia burden is increasing significantly among females in the African region, underscoring the critical need for healthcare systems that address dementia across the early midlife span.

Analysis of therapeutic adherence to antidepressants and associated factors in patients with depressive disorder: A population-based cohort study

BACKGROUND

Non-adherence to antidepressants is a common problem that can significantly impact health outcomes in patients with depressive disorders. The aim of this study was to assess antidepressant adherence rates and identify factors associated with non-adherence in a population-based cohort of patients with depressive disorders, using real-world data.

METHODS

This retrospective, population-based cohort study used real-world data from patients diagnosed with depression in the Canary Islands, Spain, between 2013 and 2021. Adherence to antidepressants was assessed using the Medication Possession Ratio (MPR) over a 12-month follow-up period. Patients were classified as adherent if they had an MPR ≥ 0.8. To assess the association with sociodemographic, clinical, and lifestyle variables, multivariate logistic regression models were performed.

RESULTS

Among the 39,800 patients included, the overall adherence rate to antidepressants was 31.02 %. Older age, female sex, and the presence of multiple comorbidities were significantly associated with higher adherence rates. In contrast, alcohol, and tobacco use, as well as inadequate nutrition, were significantly linked with lower adherence.

CONCLUSION

Non-adherence to antidepressants is a highly prevalent problem in patients with depressive disorders. The findings of this study highlight the importance of identifying factors that influence adherence and developing specific interventions to improve treatment outcomes in this population.

Temporal Trends in Adverse Effects of Medical Treatment Among Chinese Children and Adolescents, 1990-2021: Evidence From the Global Burden of Disease 2021 Study

OBJECTIVES

To evaluate the longitudinal patterns of the burden of adverse effects of medical treatment (AEMT) in children and adolescents in China from 1990 to 2021.

METHODS

Data used in this study were obtained from public data sets of the Global Burden of Disease 2021. AEMT was defined as harm resulting from procedures, treatments, or other contacts with the health care system. The case number, crude rates, and age-standardised rates (ASR) of incidence, deaths, and disability-adjusted life-years (DALYs), grouped by age and sex, were the primary outcomes for evaluating the burden of AEMT in Chinese children and adolescents (<20 y). The Age-Period-Cohort (A-P-C) model was used to analyze the changes in AEMT incidence rate by distinguishing the contributions of age, period, and cohort effects.

RESULTS

In China, the case number and ASR of incidence, deaths, and DALYs in children and adolescents showed significant decreasing trends from 1990 to 2021. In 2021, there were 85,649 incident cases, 369 deaths, and 31,833 DALYs. Age subgroup analysis demonstrated a substantial reduction in the burden of AEMT across 9 age groups. The A-P-C analysis indicated the highest incidence rate of AEMT in children under 5 years of age, and there were predominantly favorable trends in period and birth cohort effects.

CONCLUSION

Although the burden of AEMT in children and adolescents in China has decreased significantly from 1990 to 2021, patient safety for children under 5 years of age still needs attention, especially for neonates.

The global burden of Klebsiella pneumoniae-associated lower respiratory infection in 204 countries and territories, 1990-2021: Findings from the global burden of disease study 2021

This study investigates the global epidemiological burden of lower respiratory infections (LRI) attributable to Klebsiella pneumoniae from 1990-2021, using data from the Global Burden of Disease Study (GBD) 2021. The findings reveal that globally, disability-adjusted life years (DALYs) from Klebsiella pneumoniae-associated LRI decreased from 16,701,044 (95% UI: 14,220,055-19,183,469) in 1990-6,935,440 (95% UI: 5,953,328-8,007,786) in 2021, while deaths declined from 239,367 (95% UI: 212,553-268,072) -175,783 (95% UI: 158,749-193,924). The age-standardized DALYs rate dropped from 313.1 (95% UI: 266.6-359.7)-87.9 (95% UI: 75.4-101.5), and the death rate decreased from 4.5 (95% UI: 4.0-5.0)-2.2 (95% UI: 2.0-2.5). In 2021, the highest rates were observed in Oceania and Sub-Saharan Africa, particularly in Central African Republic, Niger, and Zimbabwe, while the lowest rates were found in Australasia, High-income North America, Eastern Europe, and East Asia, especially in the UAE, Australia, and Qatar. Higher rates were noted among both males and females under 10 and over 65 years old. Although most regions experienced decreases in age-standardized rates(ASR) from 1990-2021, Southern Latin America exhibited an increase. Additionally, age-standardized DALYs and death rates generally declined with increasing socio-demographic index (SDI). The global burden of LRI due to Klebsiella pneumoniae significantly decreased over the study period, but lower SDI regions, children, and the elderly remain vulnerable and require targeted interventions to further reduce this burden.

Global Trends in Childhood Acute Lymphoblastic Leukemia Burden and Quality of Care Inequalities Across Regions, 1990 to 2021: A Systematic Analysis Using Global Burden of Disease Study 2021 Data

OBJECTIVE

To reveal the global trends in the burden and quality of care for childhood ALL from 1990 to 2021, along with inequalities in quality of care across regions, thus identifying regions requiring targeted interventions for optimizing health care resource allocation.

METHODS

Utilizing Global Burden of Disease Study 2021 data, this research analyzed the temporal trends in the global burden of childhood ALL from 1990 to 2021. The quality of care index (QCI) was used to quantify care quality, and the gender disparity ratio (GDR) was used to assess gender disparities. Trend analyses were conducted using the estimated annual percentage change (EAPC), and the associations between QCI, GDR, and the sociodemographic index (SDI) were explored. Inequalities in QCI and GDR across regions were evaluated using the slope index of inequality (SII) and health inequality concentration index.

RESULTS

From 1990 to 2021, the incidence and death rates, as well as disability-adjusted life years (DALYs) and years of life lost (YLLs) due to childhood ALL, significantly decreased. However, the number of prevalence and prevalence crude rate increased by 66.818% and 37.923%, respectively. Global care quality continued to improve, with an EAPC of 2.566 (95% CI: 2.488-2.645). In 2021, regions with high QCI were concentrated in high-income areas like Western Europe, while low QCI regions were primarily in low-income areas like sub-Saharan Africa and Oceania. Although the health inequality concentration index of global quality of care decreased from 0.550 in 1990 to 0.395 in 2021, the SII increased from 35.396 to 87.141. Care quality was consistently higher in females than in males, particularly in low and low-middle SDI regions, while the disparities in high and middle SDI regions were gradually narrowing.

CONCLUSION

Despite the gradual decrease in the burden of childhood ALL globally and the steady improvement in quality of care, absolute inequalities remain a significant challenge. Future efforts should focus on increasing health care resource allocation in low SDI regions, enhancing international cooperation, improving the quality and accessibility of care in priority regions, and promoting global health equity.

Global burden of skin and subcutaneous diseases: an update from the Global Burden of Disease Study 2021

The global burden of dermatitis and scabies remains high among skin diseases. Basal cell carcinoma has been the fastest growing skin disease since 1990. Children, adolescents and the elderly had higher disability-adjusted life years from skin disease than other age groups.

Potential Role of CD99 Signaling Pathway in Schwann Cell Dysfunction in Diabetic Foot Ulcers Based on Single-Cell Transcriptome Analysis

Background: Schwann cell (SC) dysfunction contributes to the delayed healing of diabetic foot ulcers (DFUs). However, the underlying molecular mechanism regarding the unregulated SC function is poorly understood. Thus, we examined the single-cell transcriptome data from different DFU states focusing on SC characteristics. Methods: The single-cell RNA sequencing (scRNA-seq) data of DFU was obtained from the Gene Expression Omnibus (GEO) database, covering foot skin samples from nondiabetic patients, diabetic patients without DFU, DFU healers, and DFU nonhealers. After scRNA-seq data processing, downscaling, and cell cluster identification, cell communication analysis was performed by the CellChat package. Furthermore, we subclustered SC populations and ran the trajectory inference and pseudotime analysis to investigate the dynamic changes in SC. Finally, the significant pathways were validated with a db/db mouse wound model. Results: scRNA-seq analysis revealed different SC percentages and gene markers across the DFU groups. We identified that the CD99 signaling pathway was upregulated in the DFU nonhealer group. In the db/db mouse wound model, we observed that CD99 was highly expressed in the demyelinated area of the peripheral nerve fibers. Conclusion: Our study elucidated that the CD99 pathway activation may play a crucial role in SC dysfunction of DFU, providing insights into the peripheral glia regulation mechanism and potential therapeutic target of DFU.

Global burden of vertebral fractures from 1990 to 2021 and projections for the next three decades

BACKGROUND

Vertebral fractures are linked to significant disability and mortality risks. Yet, existing studies on their global burden are outdated and lack predictive foresight.

METHODS

Public data from the 2021 GBD study were analyzed to assess the global burden and epidemiological trends of vertebral fractures. The annual percentage change (EAPC) was calculated to represent temporal trends from 1990 to 2021. Machine learning was used to predict the global burden of vertebral fractures over the next 30 years.

RESULTS

From 1990 to 2021, the global burden of vertebral fractures significantly decreased. The age-standardized incidence rates (ASIR) showed the largest decline in Eastern Sub-Saharan Africa (EAPC: -1.5; 95% CI: -2.0 to -1.0), while North Africa and the Middle East were the only regions to report an increase (EAPC: 0.3; 95% CI: 0.1 to 0.5). For age-standardized prevalence rates (ASPR), High-income Asia Pacific saw the steepest decline (EAPC: -1.4; 95% CI: -1.5 to -1.2), while the Caribbean experienced the largest increase (EAPC: 0.8; 95% CI: 0.4 to 1.3). Similarly, in terms of age-standardized years lived with disability rates (ASYR), the most substantial reduction occurred in High-income Asia Pacific (EAPC: -1.4; 95% CI: -1.5 to -1.3), with the Caribbean again showing the greatest rise (EAPC: 0.8; 95% CI: 0.3 to 1.2). Males generally exhibited higher age-standardized rates (ASRs) than females, although females aged 65-70 years old surpassed males. Predictive models suggest continued declines in global ASIR, ASPR, and ASYR by 2050.

CONCLUSIONS

Our study shows a steady reduction in the global burden of vertebral fractures from 1990 to 2021. Nevertheless, disparities remain across regions, with a positive correlation between ASRs with SDI.

Association between ambient fine particulate matter constituents and mortality and morbidity of cardiovascular and respiratory diseases: A systematic review and meta-analysis

Existing studies have explored the associations between short-term or long-term exposures to PM2.5 constituents and mortality and morbidity outcomes related to all-causes, natural causes and the cardiopulmonary system, but the results are still inconclusive. To explore the associations between short-term and long-term exposures to ambient PM2.5 constituents with mortality and morbidity outcomes of all-cause, natural, cardiovascular and respiratory diseases. We comprehensively searched PubMed, Embase, Web of Science and Scopus electronic databases to identify studies until 28, August 2023. We estimated the pooled relative risk (RR) with 95 % confidence interval (CI) using random-effect models. Then we explored potential sources of heterogeneity across different studies by subgroup and meta-regression analysis. A total of 67 articles were included in the meta-analysis. We found that short-term exposures to PM2.5 carbon-containing constituents (black carbon and organic carbon) and metal iron showed the most consistent associations with the eight health outcomes among different PM2.5 constituents. Meanwhile, only long-term exposures to nitrate ions and silicon in PM2.5 showed significant positive associations with cardiovascular and natural mortality outcomes. Additionally, subgroup and meta-regression analyses highlight that geographical region and age group are primary sources of heterogeneity. The current meta-analysis reveals potential key PM2.5 constituents associated with elevated risk of mortality and morbidity of cardiovascular and respiratory diseases. Thus, greater attention should be directed toward establishing exposure limits for specific PM2.5 constituents to protect public health and alleviate the associated burden of diseases.

Rising colorectal cancer burden attributable to high body mass index in China from 1990 to 2021: a comprehensive analysis using the global burden of disease study

Background

Colorectal cancer (CRC) attributable to high body mass index (BMI) has become a significant public health issue in China. This study analyzes the burden of CRC attributable to high BMI from 1990 to 2021, exploring trends in mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs).

Methods

Data were obtained from the Global Burden of Disease Study (GBD) database. Age- and sex-specific mortality, DALYs, YLDs, and YLLs rates were analyzed for 2021, and temporal trends were examined from 1990 to 2021. Joinpoint and age-period-cohort (APC) analyses were conducted to identify shifts in burden and contributing factors. Decomposition analysis was applied to assess the impact of aging, population growth, and epidemiological changes.

Results

In 2021, 19,418 CRC deaths were attributable to high BMI in China, with a higher burden observed in males. The total DALYs reached 507,316, and YLLs accounted for 482,925. From 1990 to 2021, age-standardized mortality rates increased by 2.43-fold, while DALYs and YLLs increased by 2.33-fold and 2.24-fold, respectively. The most dramatic increase was seen in YLDs, with a 5.17-fold rise. Epidemiological changes contributed most to the increases in deaths and DALYs, followed by aging, while population growth had the least impact.

Conclusions

The burden of CRC attributable to high BMI in China has grown significantly over the past three decades, with males disproportionately affected. Aging and epidemiological changes are the main drivers of this trend, underscoring the need for targeted interventions to reduce the CRC burden.

Prevalence, disability, and economic impact of migraine in Spain: a nationwide population-based study

BACKGROUND

This study updates data on migraine prevalence in Spain, examining regional variations, healthcare resource utilization (HCRU), and patient-reported outcomes (PROs).

METHODS

Cross sectional study using data from the 2022 National Health and Wellness Survey, an online survey of Spanish residents aged 18 or older. Respondents diagnosed with migraine by a physician and who reported at least one migraine in the past year were considered active migraine cases.

RESULTS

The study included 7,002 respondents, 930 of whom had physician-diagnosed active migraine. The estimated one-year prevalence of migraine in Spain was 13.1% (95% confidence interval [CI] 12.8-13.4%), with higher rates in females (17.7%, 95% CI 17.2-18.3%) than in males (8.2%, 95% CI 7.8-8.6%). Migraine prevalence varied across Spain's regions, ranging from 8.1% (95% CI 5.2-11.0%) in Navarre to 19.1% in Cantabria (95% CI 15.6-22.6%). Prevalence was the highest among individuals earning below the median income (14.7%, 95% CI 14.1-15.4%). In the preceding month, 75.3% of patients experienced < 4 migraine days, 15.3% 4-9 migraine days, 4.1% 10-14 migraine days, and 5.3% ≥15 migraine days. Severe disability from migraine was reported by 20.4% of respondents. One in ten people reported using a preventive treatment for migraine. The mean SF-12 scores for mental and physical health were 37.8 and 42.1, respectively, both below the general population norm of 50. The mean EQ-5D summary score was 0.8, indicating reduced quality of life and the PHQ-9 detected severe depressive symptoms in 8.8% of individuals. Work productivity was affected by migraine, with a mean work productivity loss of 35.8%. HCRU in the preceding 6 months was high, with 68.4% having visited at least once a general practitioner, 14.2% a neurologist, 45.6% the emergency room, and 11.8% being hospitalized. The annual cost per person with migraine was estimated at €6,704, primarily driven by indirect costs related to productivity loss.

CONCLUSIONS

Migraine prevalence remains high in Spain, causing a substantial burden and representing a major public health problem. Despite the availability of effective treatments, their usage is limited. Improving migraine management should be prioritized to enhance health outcomes and reduce societal burden.

Epidemiological trends and forecasts in stroke at global, regional and national levels

BACKGROUND

Stroke, characterized as ischemic or hemorrhagic, leads to severe morbidity, mortality, and recurrence. This research analyzed stroke epidemiological trends from 1990-2021.

METHODS

The Global Burden of Disease database provided stroke data including incidence, mortality, and disability-adjusted life-years (DALYs). Age-standardized rates (ASRs) and Estimated Annual Percent Changes (EAPC) measured incidence and mortality shifts. The sociodemographic index (SDI) was explored alongside stroke burden. Forecasting of stroke trends until 2035 utilized the Bayesian age-period-cohort (BAPC) model. The factors influencing the variability of stroke burden were subjected to decomposition analysis for a more in-depth examination. Additionally, frontier analysis was employed to visually illustrate the opportunities for alleviating burden in each nation or region, taking into account their respective stages of development.This study utilized the slope index of inequality (SII) and the concentration index, as defined by the World Health Organization (WHO), to assess absolute and relative inequalities in disease burden.

RESULTS

From 1990-2021, global stroke incidence increased by 15.03 %, with an overall decline in age-standardized incidence rate (ASIR). Lower in females than males, the incidence rise was larger in females. Stroke mortality declined by 2.60 % overall, with a rise in male mortality and decrease in female mortality. DALYs increased, with a 10.67 % decline by rate per 100,000 people. Eastern Europe, Central Asia, and East Asia experienced the highest incidence rates, with the greatest ASIR decline in the high-income Asia Pacific region. The decomposition analysis revealed a notable rise in Disability-Adjusted Life Years (DALYs) within the middle Socio-Demographic Index (SDI) quintile region, where factors such as aging and population growth were identified as primary contributing elements. Additionally, the frontier analysis indicated that nations or regions categorized within higher SDI quintiles are likely to exhibit greater potential for improvement. Projections for 2035 anticipate increased stroke cases alongside further ASIR and ASMR declines. Cross-country inequality analysis suggests that both absolute and relative health inequalities associated with the stroke burden have escalated during the period from 1990 to 2021.

CONCLUSION

Despite rising global stroke incidence and DALYs, decreases were seen in ASIR and ASMR since 1990. Incidence rates increased most quickly in females, with regional variation observable. High systolic blood pressure remained a key risk factor. Future efforts should target prevention and treatment to mitigate sex, age, and regional stroke disparities.

Global burden of mental disorders in 204 countries and territories, 1990-2021: results from the global burden of disease study 2021

BACKGROUND

Mental disorders, one of the leading causes of the global health-related burden, which has been exacerbated by the emergence of the COVID-19 pandemic (2019-2021). In this study, we aim to provide global, regional, and national estimates of the mental disorders burden from 1990 to 2021, including during the COVID-19.

METHODS

We collected data from the Global Burden of Disease Study 2021 (GBD 2021) on the incidence, disability-adjusted life years (DALYs), age-standardized incidence rate (ASIR), and age-standardized DALY rate (ASR) of 12 mental disorders from 204 countries and regions. The socio-demographic index (SDI) was used to evaluate the correlation between mental disorders burden and different regions. We utilized joinpoint regression analysis to estimate the average annual percentage change (AAPC).

RESULTS

In 2021, there were 444,397,716 incident cases and 155,418,119 DALYs globally from mental disorders. From 1990 to 2021, there was an upward trend in both ASIR [15.23% (12.97-17.60%)] and ASR [17.28% (15.06-19.44%)]. In 2021, the highest ASIR was observed in Central Sub-Saharan Africa (8706.11), while the lowest was in East Asia (3340.99). Australia (2787.87) had the highest ASR. Nationally, Greenland, Greece, the United States, and Australia had the highest ASRs. During the COVID-19 pandemic, aside from East Asia, both the ASIR showed an upward trend in the five SDI and other GBD regions. In 2021, the ASR for females was higher than that for males. Among the 12 subtypes, major depressive disorder (557.87) and anxiety disorders (524.33) had the highest ASR. Major depressive disorder ranked first in ASR in 13 of the 21 regions worldwide. Despite the overall upward trend in DALYs for mental disorders [AAPC: 5.96; 95%CI: (4.99, 6.92)], the ASR exhibited varying trends among different subtypes, with anxiety disorders experiencing the most significant increase.

CONCLUSIONS

GBD 2021 showed that the burden of mental disorders has increased over the past three decades, with notable regional disparities. High SDI regions and females should be paid more attention. To alleviate future burdens, providing comprehensive mental health support, establishing effective mental health knowledge dissemination and tailored interventions are in great need.

CLINICAL TRIAL NUMBER

Not applicable.

Global, regional, and national burden of neonatal disorders and subtypes attributable to air pollution from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

Exposure to air pollution is associated with the development of numerous neonatal diseases (NDs). This study aimed to evaluate the worldwide changes in the burden of NDs attributable to air pollution from 1990 to 2021.

METHODS

The 2021 Global Burden of Disease Study (GBD) reported neonatal deaths attributable to air pollution and the associated age-standardized rates and disability-adjusted life years (DALYs). To assess the global burden of NDs and the subtypes, age-standardized DALY rates (ASDARs) and age-standardized death rates (ASDRs) were employed. The estimated annual percentage change (EAPC) was used to track global and regional temporal trends from 1990 to 2021. Spearman's rank correlation coefficients were applied to evaluate the relationship between the sociodemographic index (SDI), ASDARs, and ASDRs for NDs. The slope inequality index and concentration index were derived from health inequality analyses to measure international disparities. Finally, frontier analysis were employed to determine optimal burden for NDs at corresponding SDI levels.

RESULTS

In 2021, the air pollution-related NDs resulted in 496,966 deaths and 44,737,311 DALYs worldwide. The burden for NDs showed a decreasing trend globally in past three decades. Neonatal preterm birth was the most severe subtype of NDs in 2021. With the global and regional increase in the SDI, the ASDR and ASDAR for five NDs subtypes have decreased. Significant absolute and relative income disparities in the burden of DALYs and mortality due to NDs were observed worldwide. Frontier analysis indicated inverse correlations between the ASDR/ASDAR and SDI, with the Solomon Islands, a low SDI country, showing the smallest overall differences.

CONCLUSION

Although the burden of air pollution-induced NDs has decreased, it remains a significant public health concern, with regional disparities. More nuanced policies and preventive measures are needed to reduce the burden of NDs.

Identification and validation of SLC16A8 as a prognostic biomarker in clear cell renal cell carcinoma: a six-gene solute carrier signature

Solute carrier (SLC) proteins are essential for nutrient transport, influencing tumor metabolism and growth while preserving cellular homeostasis. Despite the critical biological functions of these transporters, their applicability as therapeutic targets in clear cell renal cell carcinoma (ccRCC) remains largely unexplored. In the current study, we analyzed transcriptomic data and discovered 77 differentially expressed SLC genes in ccRCC, with 24 demonstrating predictive potential. Using Lasso regression, we developed a prognostic signature comprising six key genes: SLC2A3, SLC11A1, SLC14A1, SLC16A8, SLC22A6, and SLC28A1. This signature demonstrated strong diagnostic performance and served as an independent predictor of patient survival. Further analysis integrating clinical variables and risk scores enabled the construction of nomograms, which exhibited high predictive accuracy for patient outcomes. Immune profiling revealed distinct infiltration patterns between risk groups: high-risk patients showed elevated levels of memory B cells, activated CD4+ T cells, regulatory T cells (Tregs), M0 macrophages, and neutrophils. In contrast, their low-risk counterparts showed M1 macrophages, resting dendritic cells, and resting mast cells. Validation experiments confirmed that SLC16A8 was significantly overexpressed in ccRCC tissues compared to normal samples, correlating with poor prognosis. Functional studies demonstrated that SLC16A8 knockdown impaired tumor progression in vitro. Consistent with these findings, in vivo experiments demonstrated reduced tumor growth upon SLC16A8 knockdown. Mechanistically, decreased SLC16A8 attenuated PI3K/AKT signaling, suggesting a potential regulatory pathway in ccRCC progression. In summary, we established a six-gene SLC signature with significant prognostic value in ccRCC. Among these genes, SLC16A8 emerged as a promising biomarker and therapeutic target, warranting further investigation.

Ningbo Schizophrenia Cohort (NSC)-a longitudinal ambispective cohort based on electronic health records: cohort profile

PURPOSE

Electronic health records (EHR) passively generate large datasets on real-world patient populations in easily retrievable form, allowing the cost-efficient and timely execution of epidemiological cohorts on a broad array of topics. However, EHR-based cohorts specialising in mental disorders have not yet been reported. Ningbo has made significant achievements in healthcare data management in China. This study, relying on the Ningbo Mental Health Information System and the Ningbo Regional Health Information Platform, has established the Ningbo Schizophrenia Cohort (NSC), providing an exemplary study for cohort studies on schizophrenia.

PARTICIPANTS

This population-based ambispective cohort study included patients with schizophrenia aged 18-65 years at the time of diagnosis who were eligible for healthcare services in Ningbo, China. Participants were identified using the Ningbo Mental Health Information System between 1 January 2010, and 31 December 2023. Once an individual enters the NSC, they are followed up continuously until death or relocation. A total of 26 899 patients with schizophrenia are included in the NSC.

FINDINGS TO DATE

Among 26 899 patients, 55.4% were female and 53.1% had less than 7 years of education. Until 31 December 2023, 4505 deaths occurred, and 97.83% of patients had at least one electronic medical record. The median age at diagnosis for non-survivors (median (IQR): 40 (29-51) years) was higher than that of survivors (median (IQR): 34 (26-45) years).

FUTURE PLANS

The NSC will continue to collect longitudinal data to capture the full life cycle of schizophrenia, including pre-onset, diagnosis, follow-up, recovery or death. This will result in a continuous, complete and multidimensional EHR for patients with schizophrenia. Planned future research aims to generate new real-world evidence on the aetiology of schizophrenia, investigate comorbidities to facilitate co-management and develop predictive models for schizophrenia and related cardiovascular diseases.

TRIAL REGISTRATION NUMBER

NCT06370793.

Global, regional, and national burden of depressive disorders among women of childbearing age, 1990-2021: a joinpoint regression analysis for the Global Burden of Disease Study 2021

Background

Depressive disorders, as a mental disorder, are prevalent among women, particularly women of childbearing age (WCBA). However, comprehensive epidemiological studies on this population appear to be limited globally. To investigate the longitudinal epidemiology of depressive disorders among women aged 15-49 years worldwide.

Method

Estimates of annual incidence, prevalence, and disability-adjusted life years (DALYs) of depressive disorders for seven age groups (15-49 years) of women were extracted from the 2021 Global Burden of Disease Study, including 95% uncertainty intervals (UI). Age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR), and age-standardized DALYs rates (ASDR) of depressive disorders in this population were estimated using direct age-standardization. Joinpoint regression analysis was employed to assess temporal trends in depressive disorders among this cohort from 1990 to 2021.

Result

From 1990 to 2021, ASIR, ASPR, and ASDR of depressive disorders among WCBA increased globally. Regionally, incidence, prevalence, and DALYs rates rose in high-income areas such as North America, while a decline was observed in East Asia. Among 204 countries, Greenland, the United States of America, and Greece reported the highest ASIR, ASPR, and ASDR in 2021, with Mexico exhibiting the fastest increase. Additionally, from 2019 to 2021, most countries and regions worldwide experienced a continuous rise in the burden of depressive disorders among WCBA.

Conclusion

Our study provides accurate age-standardized estimates, facilitating effective comparisons across different regions. We found a sharp increase in the global burden of depressive disorders among WCBA in almost all countries and regions after 2019, highlighting an urgent need for governments to develop flexible health policies to mitigate the escalating threat of depressive disorders in this demographic.

Identification of causal plasma metabolite biomarkers for ischemic stroke using Mendelian randomization and mediation analysis

The Global Burden of Disease Study 2021 reports that stroke remains a leading cause of death, with ischemic stroke (IS) presenting significant challenges in screening, prevention, and treatment. We explored the causal effects of 1,400 plasma metabolites on IS outcomes using a two-sample Mendelian randomization (MR) framework. We assessed causal relationships between IS and 11 common clinical risk factors and further examined these relationships for metabolites. Mediation analysis identified mechanisms for metabolites affecting both IS and its risk factors. Finally, a phenome-wide association study (PheWAS) MR analysis evaluated the side effects and additional indications of IS-associated metabolites across 3,948 phenotypes from the UKBB GWAS. Nineteen metabolites showed a causal relationship with IS. MR analysis confirmed body mass index (BMI), high-density lipoprotein (HDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), and type 2 diabetes (T2D) as risk factors for IS. Among 136 metabolites associated with at least one IS risk factor, 132 were linked to risk factors but not directly to IS. BMI, DBP, and coffee intake mediated the causal relationship between IS and the levels of 1-stearoyl-GPG (18:0), 1-oleoyl-2-linoleoyl-GPE (18:1/18:2), Octadecadienedioate (C18:2-DC), and X-24,951. Phe-MR analysis indicated that these metabolites were protective and affected other indications similarly to IS. Our findings reveal causal pathways and identify four potential biomarkers for IS, providing new insights for its screening, prevention, and treatment.

Higher all-cause mortality risk in depression with physical comorbidities: Evidence from the longitudinal study of the survey of health, ageing and retirement in Europe

BACKGROUND

Depression and diagnosed physical diseases are separately linked to higher mortality in the elderly, but mortality risks in depression in the context of physical comorbidities remain unclear.

METHODS

Data from waves 4-8 of the Survey of Health, Ageing and Retirement in Europe were analyzed, covering 15 physical diseases. Depression was assessed with the EURO-D scale. Kaplan-Meier curves evaluated all-cause survival between individuals with and without depression considering the number of comorbid physical diseases. The Apriori algorithm identified physical comorbidity patterns in patients with depression. Cox regression models calculated hazard ratios (HRs) and 95 % CIs for depression versus non-depression across different physical disease numbers and patterns.

RESULTS

Among 8134 European elderly (58 % women, mean age 73 years old), median follow-up was 7.83 years. Kaplan-Meier curves showed decreasing all-cause survival with increasing numbers of comorbid physical diseases in both two groups, with higher mortality in the depression group than the non-depression group. Cox models revealed that individuals with depression and 0, 1, 2, or ≥ 3 physical diseases had higher mortality risks than those without depression and physical diseases. The Apriori algorithm identified 11 comorbidity patterns associated with depression, with stroke (HR = 1.94, 95 % CI: 1.20-3.12) and fractures (HR = 1.90, 95 % CI: 1.33-2.72) posing the highest all-cause mortality risks for individuals with depression.

CONCLUSIONS

There are significant differences in all-cause mortality risk between individuals with and without depression when considering numbers and patterns of physical diseases. Identifying high-risk comorbidities offers valuable insights for early prevention and clinical management of comorbid physical and mental conditions.

Global burden and trends of self-harm from 1990 to 2021, with predictions to 2050

Background

Self-harm has become a major public health problem globally. Data on the burden of self-harm in this study were taken from the GBD 2021. This study aimed to quantify historical trends (1990-2021) in the global burden of self-harm across genders, age groups, and regions, and project future changes (2022-2050) through Bayesian forecasting models.

Methods

Based on the seven GBD super-regions, the burden of self-harm was analyzed by region, age, and gender from 1990 to 2021. Hierarchical statistical approach was used to predict trends in global and regional changes in the burden of self-harm, 2022-2050.

Result

In 2021, the global DALYs and death counts from self-harm were 33.5 million (95% UI: 31.3-35.8) and 746.4 thousand (95% UI: 691.8-799.8). The region with the highest number of DALYs and deaths is South Asia and the highest age-standardized rates of DALYs and mortality were in central Europe, eastern Europe, and central Asia. Globally, the burden of self-harm was higher for males than for females. DALYs rates were highest among adolescents and young adults (20-29 years), whereas mortality rates showed a predominantly age-progressive pattern with the highest burden observed in middle-aged and older populations, albeit with a modest decline in the oldest age groups. Forecasting models showed a sustained decline in the global burden of self-harm from 2022-2050.

Conclusion

The results highlight the need for policymakers to allocate resources to high-burden regions (e.g., South Asia and Eastern Europe), to implement gender- and age-specific prevention programs, and to strengthen cross-sectoral collaboration to address the underlying social determinants of self-harm. The findings call for strengthened mental health services and targeted interventions to effectively respond to and reduce the devastating impact of self-harm on individuals and the global community.

Temporal trend in non-melanoma skin cancer mortality in China, 1992-2021: an analysis for the global burden of disease study 2021

Introduction

Non - melanoma skin cancer (NMSC) is a widespread malignant neoplasm affecting the skin globally. In China, over the past 30 years, the prevalence and incidence of NMSC have changed significantly, yet mortality rate (MR) data is scarce. The aim is to assess the MR data of NMSC patients worldwide from 1992 to 2021, analyze its temporal trends, and provide valuable epidemiological information for future prevention and management strategies of NMSC.

Methods

Using data from the Global Burden of Disease Study 2021 (GBD 2021), we analyzed crude mortality rate (CMR), age-standardized mortality rate (ASMR), and sex- and age-specific mortality trends, with temporal patterns assessed through longitudinal comparisons.

Results

The MR for NMSC has shown an upward trend globally. From 1992 to 2021, both the CMR and ASMR for NMSC have increased substantially. The global ASMR has risen by approximately 30% during this period. Males have a higher ASMR compared to females, and the elderly population exhibits an accelerated and elevated ASMR trend for NMSC. In China, the mortality of NMSC is on the rise, with the current male MR exceeding that of females. Although the ASMR is projected to decline by 2030, the number of mortality cases is expected to increase, especially among males. The MR for NMSC shows a significant bias towards the elderly demographic.

Discussion

The increasing mortality of NMSC, both globally and in China, highlights the importance of effective prevention and management strategies. In addition to implementing prevention and intervention measures in susceptible populations, it is crucial to establish a screening framework for NMSC to detect minor symptoms in a timely manner. This will help in early diagnosis and potentially reduce the mortality rate associated with NMSC. Thank you for your editorial support.