Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Relationship between kidney function and healthy life expectancy: A historical cohort study

BACKGROUND

The impact of chronic kidney disease (CKD) on healthy life expectancy and healthcare costs requires research. This study examined associations between CKD and healthy life expectancy, and its economic burden.

METHODS

This study of community-dwelling adults residing in Hakui City, Ishikawa Prefecture, Japan used data from the National Health Insurance database between 2012 and 2022. Participants were grouped by baseline estimated glomerular filtration rate (eGFR) (< 45, ≥ 45 to < 60, ≥60 to < 75, ≥75 to < 90, and ≥ 90 mL/min/1.73 m²). The primary endpoint was a composite of becoming a care level ≥ 2 or death. Multivariable Cox proportional hazards models were used to calculate the risk regarding time to the primary endpoint. Secondary endpoints were the annual medical and long-term care costs.

RESULTS

The 5,592 participants had a mean follow-up of 6.4 years. The hazard ratio was 1.86 (95% confidence interval [CI]: 1.35 to 2.55) for the eGFR < 45 group and 1.60 (95% CI: 1.13 to 2.25) for the eGFR ≥ 90 group, both compared with the eGFR ≥ 60 to < 75 group. Both annual costs were significantly higher in the lower eGFR groups than in the higher eGFR groups. For the eGFR < 45 group, the median medical care cost was 0.38 million yen/year in all participants and the median long-term care cost was 0.40 million yen/year in primary endpoint achievers. A lower eGFR was correlated with longer unhealthy years of life.

CONCLUSIONS

Higher and lower eGFRs were associated with increased risks of reduced healthy life expectancy. A lower eGFR was associated with higher medical and long-term care costs.

Sociodemographic index-age differences in the global prevalence of cardiovascular diseases, 1990-2019: a population-based study

BACKGROUND

This study aims to assess the global burden and trends in cardiovascular diseases (CVDs) prevalence, stratified by sociodemographic index (SDI) categories and age groups, across 204 countries and territories.

METHODS

Utilizing data from the Global Burden of Disease Study 2019, this study analyzed trends in the age-standardized prevalence rate of overall and type-specific CVDs, including rheumatic heart disease, ischemic heart disease, stroke, hypertensive heart disease, non-rheumatic valvular heart disease, cardiomyopathy and myocarditis, atrial fibrillation and flutter, peripheral artery disease, endocarditis, and other cardiovascular and circulatory diseases. Age-standardized prevalence rates were stratified by SDI categories (low, low-middle, middle, high-middle, and high) and age groups (0-14, 15-49, 50-69, and ≥ 70 years). The corresponding average annual percentage change was calculated to assess temporal trends.

RESULTS

From 1990 to 2019, the global age-standardized prevalence rate per 100,000 population for CVD decreased from 6728.04 (95% UI 6394.55 to 7059.66) to 6431.57 (95% UI 6109.95 to 6759.8), with an average annual percent change of -0.15% (95% CI -0.17 to -0.13). When stratified by SDI category, the age-standardized prevalence rate of CVD decreased significantly in high-middle and high SDI countries but increased in middle, low-middle, and low SDI countries. By age group, the age-standardized prevalence rate of CVD declined in the 50-69 and ≥ 70 years groups but increased in the 0-14 and 15-49 years groups. SDI levels were negatively associated with faster increases in the age-standardized prevalence rate of CVD across all ages and age groups. Low SDI countries consistently showed the highest age-standardized prevalence rates of CVD in the younger age groups (0-14 and 15-49 years), while high-middle SDI countries had the highest rates in the older age groups (50-69 and ≥ 70 years). The age-standardized prevalence rate of CVD was negatively associated with SDI levels in the 0-14 and 15-49 years groups and positively associated with SDI levels in the 50-69 and ≥ 70 years groups. Type-specific CVDs such as rheumatic heart disease, other cardiovascular and circulatory diseases, non-rheumatic valvular heart disease, and hypertensive heart disease showed increased age-standardized prevalence rates from 1990 to 2019.

CONCLUSIONS

This study highlights significant disparities in CVD prevalence across sociodemographic and age groups. While the global prevalence of CVD has generally decreased, the rise in CVD prevalence in lower SDI countries and younger populations calls for tailored intervention strategies. Addressing these disparities is crucial to mitigating the growing burden of CVD and promoting cardiovascular health on a global scale.

Trends in cutaneous melanoma mortality and incidence in European Union 15+ countries between 1990 and 2019

BACKGROUND

Cutaneous melanoma (CM) is the leading cause of skin cancer mortality with associated high healthcare costs. Up-to-date reporting of epidemiological trends for CM is required to project future trends, assess the burden of disease and aid evaluation of new diagnostic, therapeutic and preventative strategies.

OBJECTIVES

To describe the trends in CM mortality, incidence, mortality-to-incidence indices (MIIs) and disability-adjusted life years (DALYs) over the last three decades.

METHODS

A population-based cross-sectional study of the Global Burden of Disease (GBD) database between 1990 and 2019 was performed. Nineteen high-income countries with similar health expenditure and classified as having high-quality mortality data including the United Kingdom, the United States, Australia and selected European Union countries were included. Annual age-standardized incidence rates (ASIRs), age-standardized death rates (ASDRs) and DALYs for each country were extracted. Mortality-to-incidence indexes were calculated by dividing the ASDR by the ASIR. Trends were described using Joinpoint regression analysis.

RESULTS

Almost all countries demonstrated increasing ASDR in males over the observation period with greatest percentage increase in Greece (+87%), and there was greater heterogeneity between countries in females. CM mortality was greater for males than females in all countries. Most recent Joinpoint analysis shows significantly decreasing mortality in all countries except the United Kingdom (+0.5% males between 2007 and 2019, +0.1% females between 2002 and 2019). Incidence rates increased in all countries, with evidence of plateau from 2015 onwards. While MIIs cannot be used as a proxy for survival, statistically significant decreases in MII were observed in all countries. Overall, DALYs remained static.

CONCLUSIONS

Over the past 30 years, CM mortality and incidence has increased in most EU15+ countries. There is evidence that in recent years, CM mortality is decreasing. The burden of disease as assessed using DALYs has remained mostly unchanged. Future work should not solely focus on expensive innovative therapies, but also on optimizing primary prevention.

Global, regional, and national burden of malignant neoplasm of bone and articular cartilage in adults aged 65 years and older, 1990-2021: a systematic analysis based on the global burden of disease study 2021

BACKGROUND

This study aims to delineate the global, regional, and national burden of malignant neoplasms of bone and articular cartilage (MNBAC) among individuals aged 65 years and older from 1990 to 2021, stratified by age, sex, and sociodemographic index (SDI).

METHODS

We harnessed data from the Global Burden of Disease Study 2021 to evaluate the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) associated with MNBAC among individuals aged 65 years and older across 204 countries and territories between 1990 and 2021. The socio-demographic Index (SDI) served as a metric to examine the influence of socioeconomic development on the burden of MNBAC. Furthermore, joinpoint regression analysis was employed to identify the years marked by the most significant temporal changes over the study period.

RESULTS

In 2021, an estimated 163,561 prevalent cases of MNBAC were recorded among individuals aged ≥ 65 years, alongside 28,100 newly diagnosed cases, 27,588 deaths, and 508,202 DALYs. The age-standardized rates per 100,000 population were 21.30 for prevalence, 3.69 for incidence, 3.66 for mortality, and 65.85 for DALYs. Notably, Cuba reported the highest prevalence rate (42.42), while the Philippines exhibited the greatest DALY burden (161.78). Egypt demonstrated the highest incidence (7.44) and mortality rates (8.90). A significant inverse correlation was observed between age-standardized DALY rates and SDI across regions.

CONCLUSIONS

This analysis underscores the substantial global burden of MNBAC among older adults, accentuating the imperative for tailored public health interventions, alongside advancements in diagnostic and therapeutic approaches, particularly within resource-constrained settings.

Global burden and trends in pre- and post-menopausal gynecological cancer from 1990 to 2019, with projections to 2040: a cross-sectional study

BACKGROUND

The global burden and trends in gynecological cancer (GC) by menopausal status worldwide remain unclear.

METHODS

Data on the number of incident cases and deaths, as well as age-standardized rates (ASR) and risk factors for GC in pre- and post-menopausal women were obtained from the Global Burden of Disease (GBD) Study 2019. The estimated annual percent change was calculated to quantify the temporal trend of GC burden by menopausal status between 1990 and 2019. The Bayesian age-period-cohort model was used to predict the trends in age-standardized incidence and mortality rates for pre- and post-menopausal GC during 2020-2040.

RESULTS

In 2019, an estimated 400 146 pre-menopausal and 879 476 post-menopausal GC cases were newly diagnosed worldwide, with ~111 420 and 442 821 GC-related deaths occurring in each menopausal group, respectively. The majority of both pre- and post-menopausal GC cases in low-to-middle-SDI regions was due to cervical cancer. In high- and high-middle-SDI regions, pre-menopausal GC was primarily attributed to cervical cancer, while post-menopausal GC was mainly attributed to uterine cancer. Additionally, the contribution of uterine cancer to GC was higher among post-menopausal women than pre-menopausal women, across all SDI levels and geographical regions. ASIRs either remained stable or increased from 1990 to 2019 worldwide for both pre- and post-menopausal GC [an average change of 0.03% (95% CI -0.02 to 0.08) and 0.09% (0.05-0.13) per year, respectively]. However, the age-standardized mortality rates (ASMRs) declined by an annual average of 0.86% (95% CI -0.92 to -0.8) and 0.63% (95% CI -0.66 to -0.6) globally during the same period. The risk-attributable proportion of post-menopausal GC deaths was higher than that of pre-menopausal GC and increased with increasing SDI. The projections indicate an increasing trend in the burden of pre-menopausal GC from 2020 to 2040, while the burden of post-menopausal GC is expected to decline.

CONCLUSIONS

GC continues to be a significant public health concern worldwide, with notable regional and demographic disparities in the burden based on menopausal status. Policymakers and healthcare providers must be proactively aware of these evolving trends and tailor age-appropriate and region-specific screening strategies, as well as allocate resources accordingly.

Decoding the disproportionate risk factor landscape of global type 2 diabetes burden in adults: An attribution analysis from 1990 to 2050

INTRODUCTION

Limited systematic assessments of risk factor contributions to the global burden of type 2 diabetes (T2D) across subpopulations hinder targeted policies and resource allocation.

MATERIALS AND METHODS

Utilizing the Global Burden of Disease study (GBD) 2019, we analyzed the disability-adjusted life-years (DALYs) for T2D attributable to 15 risk factors in adults (aged 25+ years) globally and by sex, age, Socio-demographic Index (SDI), and GBD region, from 1990 to 2019. Additionally, we assessed future trends of these risk factors through 2050.

RESULTS

High body-mass index (BMI) emerged as the predominant risk factor in all subpopulations in 2019, with its impact projected to double by 2050. During 1990-2019, males were more affected by smoking, while females by secondhand smoke and household air pollution. The related DALYs increased with age, except for high BMI and smoking peaking at 60-74 years. In 2019, diet high in processed meat ranked second in high SDI regions, contrasting with household air pollution in low SDI regions. National disparities were observed, with Fiji recording the highest rates of DALYs related to both high BMI and dietary risks in 2019, which were approximately 50 and 15 times higher than those observed in Japan, respectively.

CONCLUSIONS

Tailored interventions targeting major contributing risk factors specific to each subpopulation are key to the success of the global combat against T2D.

Bundled measures for China's food system transformation reveal social and environmental co-benefits

Food systems are essential for the achievement of the United Nations Sustainable Development Goals in China. Here, using an integrated assessment modelling framework that considers country-specific pathways and covers 18 indicators, we find that most social and environmental targets for the Chinese food system under current trends are not aligned with the United Nations Agenda 2030. We further quantify the impacts of multiple measures, revealing potential trade-offs in pursuing strategies aimed at public health, environmental sustainability and livelihood improvement in isolation. Among the individual packages of measures, a shift towards healthy diets exhibits the lowest level of trade-offs, leading to improvements in nutrition, health, environment and livelihoods. In contrast, focusing efforts on climate change mitigation and ecological conservation, or promoting faster socioeconomic development alone, have trade-offs between social and environmental outcomes. These trade-offs could be minimized by bundling all three aspects of measures.

Global burden of neonatal preterm birth: A systematic analysis for the global burden of disease study 2019

OBJECTIVES

Addressing the research gap on neonatal preterm birth's global impact, this study aims to present a detailed analysis of its incidence and mortality rates from 1990 to 2019, capturing the disease burden's evolution during this timeframe.

METHODS

We analyzed Global Burden of Disease Study 2019 data across 204 countries to assess age-standardized incidence, prevalence, mortality, and DALYs for neonatal preterm birth from 1990 to 2019, along with EPAC and risk factors.

RESULTS

From 1990 to 2019, EPAC for neonatal death at 0-6 days was -1.75 %, and DALYs was -1.75 %. For deaths under 5 years, EPAC was -2.23 %, and DALYs was -2.19 %. Key risk factors for neonatal preterm birth DALYs included low birth weight, gestational age, ambient air pollution, and household pollution from solid fuels.

CONCLUSIONS

Preterm birth notably increases neonatal risks at 0-6 days and under 5 years. Our study shows diseased disease burdens in these periods. Preventive strategies, such as reducing household and ambient air pollution, are crucial for preterm birth reduction. Tailored regional interventions are essential.

Global, regional, and national burdens of mild traumatic brain injuries from 1990 to 2019: findings from the Global Burden of Disease Study 2019 - a cross-sectional study

BACKGROUND

The objective of this study was to utilize data from the Global Burden of Disease Study (GBD) 2019 to estimate the patterns and prevalence of mild traumatic brain injury (mTBI) from 1990 to 2019, with the intention of informing the development of efficacious intervention strategies.

MATERIAL AND METHODS

Data from the GBD 2019 were examined to determine the prevalence, incidence, and rates of years lived with disability (YLDs) associated with mTBI across global geographic populations from 1990 to 2019. To assess temporal patterns, estimated annual percentage changes (EAPCs) and age-standardized rates were computed. Additionally, an age-period-cohort model (APC model) framework was employed to analyze potential trends in incidence based on age, period, and birth cohort.

RESULTS

In 2019, there were a total of 12 268.5 thousand incident cases (95% uncertainty interval [UI] 992.66-1602.07), 11 482.5 thousand prevalent cases (95% UI 107.59-123.52), and 1366.9 thousand YLDs (95% UI 96.36-183.35) of mTBI worldwide. The age-standardized rates (ASRs) of incidence, prevalence, and YLDs exhibited a decline from 1990 to 2019. Across all age groups, males had higher prevalence, incidence, and YLD rates. Furthermore, middle-aged and elderly adults experienced a greater disease burden. The primary causes of the global mTBI burden in 2019 were falls and road injuries. According to the APC model, the age effect trend exhibited a similar pattern across individual sociodemographic index (SDI) groups, characterized by an initial increase, followed by a decrease and a subsequent increase. Regarding the period effect, each SDI group demonstrated variation, with the middle SDI group notably displaying a consistent increase. Furthermore, in terms of the birth effect, the middle-SDI group experienced the most substantial and continuous increase.

CONCLUSION

The global incident cases and prevalent cases of mTBI increased significantly from 1990 to 2019, with a heavier burden observed in males, older adults, and in low SDI such as Afghanistan. More efforts are needed in the prevention and management of mTBI, such as reducing the incidence of falls among older people and building safer road transport facilities to reduce the burden of mTBI.

Global burden and trends of testicular cancer in adolescents and young adults from 1990 to 2021, with predictions to 2035

Testicular cancer predominantly affects adolescents and young adults (AYAs) aged 15-39 years. This study analyzed the global, regional, and national burden of testicular cancer among AYAs (1990 to 2021). Data from the Global Burden of Disease study was used to calculate age-standardized rates of incidence (ASIR), prevalence (ASPR), and disability-adjusted life years (ASDR). Trends were assessed using the Joinpoint regression and Bayesian age-period-cohort models, with projections up to 2035. Results showed the global ASIR of 4.05 (95% CI: 3.80-4.35), ASPR of 31.05 (95% CI: 28.88-33.68), and ASDR of 24.82 (95% CI: 22.99-26.91) per 100,000 in 2021, respectively. From 1990 to 2021, ASIR and ASPR increased, while ASDR remained relatively stable. Significant geographical disparities were observed, with Europe and Latin America showing higher burdens compared to Asia and Africa. The 25-29 age group had the highest age-specific rate of incidence (5.58; 95% UI: 5.25-5.97) and disability-adjusted life years (34.09; 95% UI: 31.55-37.11) per 100,000, while the 30-34 age group had the highest age-specific prevalence rate (43.12; 95% UI: 40.51-46.56) per 100,000 in 2021. By 2035, the global numbers of incidence and prevalence cases were projected to increase, with DALYs and age-standardized rates declining. These findings are crucial for informing global strategies in testicular cancer prevention.

Hearing modulation affects Alzheimer's disease progression linked to brain inflammation: a study in mouse models

BACKGROUND

Recent studies have identified hearing loss (HL) as a primary risk factor for Alzheimer's disease (AD) onset. However, the mechanisms linking HL to AD are not fully understood. This study explored the effects of drug-induced hearing loss (DIHL) on the expression of proteins associated with AD progression in mouse models.

METHODS

DIHL was induced in 5xFAD and Tg2576 mice aged 3 to 3.5 weeks using kanamycin (700 mg/kg, subcutaneous) and furosemide (600 mg/kg, intraperitoneal). The accumulation and expression of beta-amyloid (Aβ), ionized calcium-binding adaptor molecule 1 (Iba1), and glial fibrillary acidic protein (GFAP) were measured through immunohistochemistry and immunoblotting. Additionally, the expression of proteins involved in the mammalian target of rapamycin (mTOR) pathway, including downstream effectors p70 ribosomal S6 kinase (p70S6K) and S6, as well as proinflammatory cytokines, was analyzed.

RESULTS

Compared to control conditions, HL led to a significant increase in the accumulation of Aβ in the hippocampus and cortex. Elevated levels of neuroinflammatory markers, including Iba1 and GFAP, as well as proinflammatory cytokines such as interleukin-1β (IL-1β), IL-6, and tumor necrosis factor-alpha (TNF-α), were observed. Moreover, DIHL enhanced phosphorylation of mTOR, p70S6K, and S6, indicating activation of the mTOR pathway.

CONCLUSIONS

HL significantly increases Aβ accumulation in the brain. Furthermore, HL activates astrocytes and microglia, leading to increased neuroinflammation and thereby accelerating AD progression. These findings strongly suggest that HL contributes autonomously to neuroinflammation, highlighting the potential for early intervention in HL to reduce AD risk.

Age- and sex-disaggregated disease burden among the older persons in India

BACKGROUND

In the context of the increasing number and proportion of population aged 60 years or more in India, it is imperative to understand their health needs for ensuring healthy ageing.

METHODS

Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we identified the top ten causes of disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) disaggregated by sex and age groups (60-64 years, 65-69 years, 70-74 years, 75-79 years, and ≥ 80 years) for India in 2019. We analysed the proportional contribution of individual causes to the total DALYs due to communicable diseases (CMNNDs), non-communicable diseases (NCDs), and injuries disaggregated by age and sex. We report the state-level heterogeneity in the crude DALY rate for CMNNDs, NCDs, and injuries for older persons disaggregated by sex. Additionally, we reviewed if the data capture of service delivery indicators on older persons were age- and sex-disaggregated in the Health and Wellness Centres (HWCs), and in the National Programs aimed at the Health Care for the Elderly (NPHCE), Prevention and Control of Non-communicable Diseases (NP-NCD), Control of Blindness and Visual Impairment (NPCBVI), Prevention & Control of Deafness (NPPCD), the Mental Health Program (NMPH), and the AYUSH Musculoskeletal Disorders Program (MSDP) within the context of disease burden.

RESULTS

The older persons accounted for a total of 136.1 million DALYs (29.1% of the total DALYs) in 2019 of which 77.9% were from NCDs, 14.8% from CMNNDs, and 7.3% from injuries, and nearly two-thirds of DALYs were accounted by YLLs. In NCDs, cardiovascular diseases, chronic respiratory diseases, neoplasms, diabetes and kidney diseases, and musculoskeletal disorders accounted for nearly 80% of DALYs for both sexes. There were variations in the magnitude of disease burden by specific diseases and conditions between females and males, and by age groups within both sexes particularly for injuries and CMNNDs. Injuries accounted for more YLDs than YLLs, ranging between 5.9%-15.2% for females and 15.3%-17.3% for males, with the females having a higher contribution to total injury related DALYs due to falls as compared to the males (54.4% vs 36.6%), whereas the males had a higher contribution to total DALYs due to road injuries (33.8% vs 19.4%). There was substantial variation in the crude DALY rates of major disease groups by the two sexes across the states of India in 2019. The crude DALY rate for CMNNDs varied between 3.6 times -3.7 times between the states for females and males, respectively; NCDs varied between 1.3 times -1.9 times, and injuries varied 2.0 times -1.7 times. The capture of service utilisation indicators was not age- or sex-disaggregated in NPHCE, NPCBVI, NMHP, MSDP, and HWCs; sex-disaggregation was available in NP-NCD but not age-disaggregation; sex-disaggregated data was available for many service indicators in NPPCD but with no age disaggregation beyond 50 years and more. Only NP-NCD and NPPCD allowed for data capture by disease/condition or severity of disease/condition for the older persons whereas the other programs including NPHCE did not allow for much disaggregated understanding by the type of services availed.

CONCLUSIONS

This comprehensive assessment of the differentials in disease burden among older persons across age, sex and states of India, and the gaps identified in the service utilisation data capture by age and sex for the older persons in the national health programs can provide crucial inputs for strengthening the on-going public health policy and programmatic efforts aimed at improving the health and well-being of the growing older population in India.

Disease burden and health inequality of older adults with edentulism and the projected trend until 2040: based on the global burden of disease study 2021

OBJECTIVES

To comprehensively analyze the current situation and the trends over the next 21 years, focusing on health inequalities related to edentulism among the elderly across global regions.

MATERIALS AND METHODS

Data on edentulism in older adults were collected from the 2021 global burden of disease (GBD) study. Disease burden trends were analyzed using a joinpoint model. We used the Slope Index of Inequality (SII) and the Concentration Index (CI) to assess health inequalities. A Bayesian age-period-cohort (BAPC) model was used to analyze the projected trend of prevalence up to 2040.

RESULTS

The number of incident, prevalent, and years lived with disability (YLD) cases of edentulism in older adults is increasing globally, while the rate is declining. According to the analysis of health inequality, the burden of edentulism among older adults was gradually concentrated in countries with lower Sociodemographic Index (SDI). Significant downward trends were expected in the global age-standardized prevalence rate (ASPR) of edentulism for both genders from 2020 to 2040; however, the number is increasing.

CONCLUSIONS

Taken together, the burden of edentulism in older people remains high and generally shifts from higher-SDI countries to lower-SDI countries. There are great differences between countries, and effective measures should be taken in countries with poorer economies.

CLINICAL RELEVANCE

The disease burden of edentulism in older adults is gradually shifting towards lower SDI countries. It is crucial to optimize the utilization and allocation of healthcare resources to reduce health inequities in edentulism in older adults.

Burden of chronic obstructive pulmonary disease attributable to non-optimal temperature, 1990-2044: six countries on the same isotherm

BACKGROUND

With the frequent occurrence of extreme weather worldwide, non-optimal temperature increased the risk of death from respiratory diseases. The burden of non-optimal temperature on chronic obstructive pulmonary disease (COPD) was quantitatively assessed, and its influencing factors were discussed to provide a basis for the prevention and treatment of COPD.

METHODS

Based on GBD 2019, we characterized the age-standardized mortality rate (ASMR) and years of life lost rate (ASYR) of COPD attributable to non-optimal temperature in three groups of countries at different isotherms (China and USA, South Africa and Australia, Iraq and Portugal) between 1990 and 2019. We constructed the age-period-cohort model to analyze age, period and cohort effects on mortality and the Bayesian age-period-cohort model to predict ASMR in six countries. We analyzed the relationship of socio-demographic index (SDI) with ASMR and ASYR by restricted cubic spline and quantile regression using data from 21 GBD regions.

RESULTS

ASMR of COPD attributable to non-optimal temperature in 2019 was 11.03/100,000 (China), 5.62/100,000 (USA), 2/100,000 (Australia), 0.93/100,000 (Iraq), 3.74/100,000 (Portugal), 4.13/100,000 (South Africa). Low temperature had a greater impact on COPD. The mortality showed an increasing trend with age, the period effect only showed a decreasing trend in China, and cohort effect showed a decreasing trend. The higher COPD burden was concentrated in areas with SDI values of 0.39-0.78. Implied quantile regression of mortality to SDI fit was meaningful at P5 and P75, and ASYR was at P5, P25, P75, and P95. We predicted an upward trend in COPD ASMR over the next 25 years only in the USA.

CONCLUSIONS

In COPD burden caused by non-optimal temperature, low temperature played a more important role, and it was affected by sex, age, period, cohort and SDI. Over the next 25 years, ASMR in COPD was predicted to decline in all countries except the USA.

The Burden of Peripheral Artery Disease in China From 1990 to 2019 and Forecasts for 2030: Findings From the Global Burden of Disease Study 2019

Objectives

The incidence of peripheral arterial disease (PAD) in China is increasing. We aim to conduct a comprehensive analysis of the burden of PAD.

Methods

We collected information from 1990 to 2019 in the Global Burden of Disease (GBD 2019) study. Joinpoint regression analysis was used to calculate the annual percentage change (APC). Trends in incidence, mortality and DALYs were forecasted by Bayesian age-period-cohort (BAPC) analysis.

Results

In 2019, the number of new cases and prevalence of PAD in China accounted for nearly a quarter of the global proportion. The age-standardized incidence rate (ASIR) declined after rising until 2005. The age-standardized death rate (ASDR) maintained an upward trend. The DALYs was 0.16 million. Incidence, prevalence and DALYs are predominantly female, except for mortality, which is predominantly male. Smoking predominantly affected males, while hypertension and diabetes had a greater impact on females. By 2030, ASDR is elevated, predominantly in males. ASIR and age-standardized DALY rate decline, predominantly in females.

Conclusion

It is urgent for China to develop strategies based on the specific distribution characteristics of the PAD burden.

Global, regional, and national mortality burden attributable to air pollution from landscape fires: a health impact assessment study

BACKGROUND

Landscape fire-sourced (LFS) air pollution is an increasing public health concern in the context of climate change. However, little is known about the attributable global, regional, and national mortality burden related to LFS air pollution.

METHODS

We calculated country-specific population-weighted average daily and annual LFS fine particulate matter (PM2·5) and surface ozone (O3) during 2000-19 from a validated dataset. We obtained the relative risks (RRs) for both short-term and long-term impact of LFS PM2·5 and O3 on all-cause, cardiovascular, and respiratory mortality. The short-term RRs were pooled from community-specific standard time-series regressions in 2267 communities across 59 countries or territories. The long-term RRs were obtained from published meta-analyses of cohort studies on all-source PM2·5 and O3. Annual mortality, population, and socio-demographic data for each country or territory were extracted from the Global Burden of Diseases Study 2019. These data were used to estimate country-specific annual deaths attributable to LFS air pollution using standard algorithms.

FINDINGS

Globally, 1·53 million all-cause deaths per year (95% empirical confidence interval [eCI] 1·24-1·82) were attributable to LFS air pollution during 2000-19, including 0·45 million (0·32-0·57) cardiovascular deaths and 0·22 million respiratory deaths (0·08-0·35). LFS PM2·5 and O3 contributed to 77·6% and 22·4% of the total attributable deaths, respectively. Over 90% of all attributable deaths were in low-income and middle-income countries, particularly in sub-Saharan Africa (606 769 deaths per year), southeast Asia (206 817 deaths), south Asia (170 762 deaths), and east Asia (147 291 deaths). The global cardiovascular attributable deaths saw an average 1·67% increase per year (ptrend <0·001), although the trends for all-cause and respiratory attributable deaths were not statistically significant. The five countries with the largest all-cause attributable deaths were China, the Democratic Republic of the Congo, India, Indonesia, and Nigeria, although the order changed in the second decade. The leading countries with the greatest attributable mortality rates (AMRs) were all in sub-Saharan Africa, despite decreasing trends from 2000 to 2019. North and central America, and countries surrounding the Mediterranean, showed increasing trends of all-cause, cardiovascular, and respiratory AMRs. Increasing cardiovascular AMR was also observed in southeast Asia, south Asia, and east Asia. In 2019, the AMRs in low-income countries remained four times those in high-income countries, though this had reduced from nine times in 2000. AMRs negatively correlated with a country-specific socio-demographic index (Spearman correlation coefficients r around -0·60).

INTERPRETATION

LFS air pollution induced a substantial global mortality burden, with notable geographical and socioeconomic disparities. Urgent actions are required to address such substantial health impact and the associated environmental injustice in a warming climate.

FUNDING

Australian Research Council, Australian National Health and Medical Research Council.

Trends and levels of the global, regional, and national burden of pulmonary arterial hypertension from 1990 to 2021: findings from the global burden of disease study 2021

Background

Pulmonary arterial hypertension (PAH) is a severe and progressive lung disease that significantly impairs patients' health and imposes heavy clinical and economic burdens. Currently, there is a lack of comprehensive epidemiological analysis on the global burden and trends of PAH.

Methods

We estimated the prevalence, mortality, disability-adjusted life years (DALYs) of PAH from 1990 to 2021 using the results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). The average annual percentage changes were used to estimate the trends of PAH across 21 regions and 204 countries and territories.

Results

From 1990 to 2021, the number of prevalent cases and deaths associated with PAH worldwide increased by 81.5 and 48.4%. However, the age-standardized prevalence rate of PAH remained relatively stable, while the age-standardized mortality rate and DALYs declined. In 2021, the global age-standardized prevalence rate of PAH was 2.28 per 100,000, with 1.78 per 100,000 in males and 2.75 per 100,000 in females. The age-standardized mortality rate of PAH globally was 0.27 per 100,000, and the age-standardized DALYs was 8.24 per 100,000. Among the 21 regions, Western Europe had the highest age-standardized prevalence rate (3.56 per 100,000), while North Africa and the Middle East had the highest age-standardized mortality rate (0.44 per 100,000) and DALYs (14.81 per 100,000). Additionally, older individuals and females are at higher risk of PAH. The age-standardized mortality rate and DALYs associated with PAH increase with age, peaking in the 95+ age group. As the sociodemographic index increased, the age-standardized prevalence rates showed an upward trend, while both the age-standardized mortality rates and DALYs exhibited a downward trend.

Conclusion

From 1990 to 2021, the overall trend of PAH burden presents regional and national variations and differs by age, sex, and sociodemographic index. These findings emphasize the importance of implementing targeted interventions to alleviate the burden of PAH.

GBD 2021 US Burden of Disease Collaborators. The burden of diseases, injuries, and risk factors by state in the USA, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides a comprehensive assessment of health and risk factor trends at global, regional, national, and subnational levels. This study aims to examine the burden of diseases, injuries, and risk factors in the USA and highlight the disparities in health outcomes across different states.

METHODS

GBD 2021 analysed trends in mortality, morbidity, and disability for 371 diseases and injuries and 88 risk factors in the USA between 1990 and 2021. We used several metrics to report sources of health and health loss related to specific diseases, injuries, and risk factors. GBD 2021 methods accounted for differences in data sources and biases. The analysis of levels and trends for causes and risk factors within the same computational framework enabled comparisons across states, years, age groups, and sex. GBD 2021 estimated years lived with disability (YLDs) and disability-adjusted life-years (DALYs; the sum of years of life lost to premature mortality and YLDs) for 371 diseases and injuries, years of life lost (YLLs) and mortality for 288 causes of death, and life expectancy and healthy life expectancy (HALE). We provided estimates for 88 risk factors in relation to 155 health outcomes for 631 risk-outcome pairs and produced risk-specific estimates of summary exposure value, relative health risk, population attributable fraction, and risk-attributable burden measured in DALYs and deaths. Estimates were produced by sex (male and female), age (25 age groups from birth to ≥95 years), and year (annually between 1990 and 2021). 95% uncertainty intervals (UIs) were generated for all final estimates as the 2·5th and 97·5th percentiles values of 500 draws (ie, 500 random samples from the estimate's distribution). Uncertainty was propagated at each step of the estimation process.

FINDINGS

We found disparities in health outcomes and risk factors across US states. Our analysis of GBD 2021 highlighted the relative decline in life expectancy and HALE compared with other countries, as well as the impact of COVID-19 during the first 2 years of the pandemic. We found a decline in the USA's ranking of life expectancy from 1990 to 2021: in 1990, the USA ranked 35th of 204 countries and territories for males and 19th for females, but dropped to 46th for males and 47th for females in 2021. When comparing life expectancy in the best-performing and worst-performing US states against all 203 other countries and territories (excluding the USA as a whole), Hawaii (the best-ranked state in 1990 and 2021) dropped from sixth-highest life expectancy in the world for males and fourth for females in 1990 to 28th for males and 22nd for females in 2021. The worst-ranked state in 2021 ranked 107th for males (Mississippi) and 99th for females (West Virginia). 14 US states lost life expectancy over the study period, with West Virginia experiencing the greatest loss (2·7 years between 1990 and 2021). HALE ranking declines were even greater; in 1990, the USA was ranked 42nd for males and 32nd for females but dropped to 69th for males and 76th for females in 2021. When comparing HALE in the best-performing and worst-performing US states against all 203 other countries and territories, Hawaii ranked 14th highest HALE for males and fifth for females in 1990, dropping to 39th for males and 34th for females in 2021. In 2021, West Virginia-the lowest-ranked state that year-ranked 141st for males and 137th for females. Nationally, age-standardised mortality rates declined between 1990 and 2021 for many leading causes of death, most notably for ischaemic heart disease (56·1% [95% UI 55·1-57·2] decline), lung cancer (41·9% [39·7-44·6]), and breast cancer (40·9% [38·7-43·7]). Over the same period, age-standardised mortality rates increased for other causes, particularly drug use disorders (878·0% [770·1-1015·5]), chronic kidney disease (158·3% [149·6-167·9]), and falls (89·7% [79·8-95·8]). We found substantial variation in mortality rates between states, with Hawaii having the lowest age-standardised mortality rate (433·2 per 100 000 [380·6-493·4]) in 2021 and Mississippi having the highest (867·5 per 100 000 [772·6-975·7]). Hawaii had the lowest age-standardised mortality rates throughout the study period, whereas Washington, DC, experienced the most improvement (a 40·7% decline [33·2-47·3]). Only six countries had age-standardised rates of YLDs higher than the USA in 2021: Afghanistan, Lesotho, Liberia, Mozambique, South Africa, and the Central African Republic, largely because the impact of musculoskeletal disorders, mental disorders, and substance use disorders on age-standardised disability rates in the USA is so large. At the state level, eight US states had higher age-standardised YLD rates than any country in the world: West Virginia, Kentucky, Oklahoma, Pennsylvania, New Mexico, Ohio, Tennessee, and Arizona. Low back pain was the leading cause of YLDs in the USA in 1990 and 2021, although the age-standardised rate declined by 7·9% (1·8-13·0) from 1990. Depressive disorders (56·0% increase [48·2-64·3]) and drug use disorders (287·6% [247·9-329·8]) were the second-leading and third-leading causes of age-standardised YLDs in 2021. For females, mental health disorders had the highest age-standardised YLD rate, with an increase of 59·8% (50·6-68·5) between 1990 and 2021. Hawaii had the lowest age-standardised rates of YLDs for all sexes combined (12 085·3 per 100 000 [9090·8-15 557·1]), whereas West Virginia had the highest (14 832·9 per 100 000 [11 226·9-18 882·5]). At the national level, the leading GBD Level 2 risk factors for death for all sexes combined in 2021 were high systolic blood pressure, high fasting plasma glucose, and tobacco use. From 1990 to 2021, the age-standardised mortality rates attributable to high systolic blood pressure decreased by 47·8% (43·4-52·5) and for tobacco use by 5·1% (48·3%-54·1%), but rates increased for high fasting plasma glucose by 9·3% (0·4-18·7). The burden attributable to risk factors varied by age and sex. For example, for ages 15-49 years, the leading risk factors for death were drug use, high alcohol use, and dietary risks. By comparison, for ages 50-69 years, tobacco was the leading risk factor for death, followed by dietary risks and high BMI.

INTERPRETATION

GBD 2021 provides valuable information for policy makers, health-care professionals, and researchers in the USA at the national and state levels to prioritise interventions, allocate resources effectively, and assess the effects of health policies and programmes. By addressing socioeconomic determinants, risk behaviours, environmental influences, and health disparities among minority populations, the USA can work towards improving health outcomes so that people can live longer and healthier lives.

FUNDING

Bill & Melinda Gates Foundation.

Trends in mortality due to tracheal, bronchial, and lung cancer across the BRICS: An age-period-cohort analysis based on the Global Burden of Disease Study 1990-2019

BACKGROUND

Tracheal, bronchus, and lung cancer (TBL) is a major cause of mortality and top contributor to productivity loss in large emerging economies such as the BRICS (Brazil, Russia, India, China, and South Africa). We examined the time trends of TBL mortality across the BRICS to better understand the disease burden in these countries and inform public health and healthcare resource allocation.

METHODS

TBL mortality-related data between 1990 and 2019 were obtained from the Global Burden of Disease Study 2019 and analyzed using age-period-cohort models. Net drift (local drift) was used to describe the expected age-adjusted TBL mortality rate over time overall (each age group); the longitudinal age curve was used to reflect the age effect; the period rate ratios (RRs) were used to reflect the period effect; and the cohort RR was used to reflect the cohort effect.

RESULTS

In 2019, there were 958.3 thousand TBL deaths across the BRICS, representing 46.9% of the global TBL deaths. From 1990 to 2019, the age-standardized mortality rate (ASMR) of TBL decreased in Russia, Brazil, and South Africa while increased in China and India, with the largest reduction reported in Russia (-29.6%) and the largest increase in China (+22.4%). India showed an overall increase (+15.7%) in TBL mortality but the mortality risk decreased among individuals born after 1990 (men) and 1995 (women). Although South Africa and Brazil experienced an overall decline in TBL mortality, their recent birth cohorts, such as Brazilian individuals born after 1985 (men) and 1980 (women), and South African men born after 1995, had an increasing TBL mortality risk. China has experienced an overall increase in TBL mortality, with the mortality risk rising among individuals born after 1995 for both men and women. Russia, which had the highest TBL mortality among the BRICS countries in 1990, has demonstrated significant improvement over the past three decades.

CONCLUSIONS

Over the past 30 years, the BRICS accounted for an increasing proportion of global TBL mortality. TBL mortality increased in older women in all the BRICS countries except Russia. Among the recent birth cohort, the risk of TBL mortality increased in Brazil, China, and South Africa. More effective efforts are needed in the BRICS to reduce the burden of TBL and help achieve the United Nation's Sustainable Development Goals.

The global, regional, and national burden of urolithiasis in 204 countries and territories, 2000-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Urolithiasis is a common urological problem that is associated with high morbidity. A comprehensive assessment of the non-fatal and fatal health trends of urolithiasis by age, sex, and geography over time is necessary to inform policy to control this surgically managed non-communicable disease.

METHODS

This study was conducted using the standard GBD methodology and analytic tools. Cause-specific mortality rate (CSMR) was estimated using vital registration and verbal autopsy data and the Cause of Death Ensemble model (CODEm) modelling tool. CSMR estimates and incidence data from medical insurance claims and hospital discharges were analysed using a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to estimate age-, sex-, and location-specific incidence of urolithiasis between 2000 and 2021. Disability-adjusted life-years (DALYs) were the sum of years of life lost (YLL) and years lived with disability (YLDs). YLLs due to urolithiasis were calculated by multiplying the estimated number of deaths by the standard life expectancy at the age of death. YLDs were estimated by multiplying the disability weight by the symptomatic proportion of urolithiasis cases. The Global Burden of Diseases study used de-identified data, approved by the University of Washington IRB (Study Number 9060).

FINDINGS

There were 106 million (95% UI 88.3-129.0) incident cases of urolithiasis in 2021, of which 67% were in men (71.1 million [59.4-86.2)]). The global number of incident cases, deaths, and DALYs increased by 26.7% (23.8-29.8), 60.3% (41.5-84.7), and 34.5% (24.6-47.3), respectively, between 2000 and 2021. The global age-standardised incidence rate of urolithiasis experienced a significant decrease of 17.5% (14.7-20.0), while the age-standardised DALYs rate saw a reduction of 15.1% (6.8-21.3). Twelve GBD regions showed declining trends in the age-standardised incidence rate of urolithiasis between 2000 and 2021, and the remaining nine GBD regions had an increasing trend of age-standardised rates of urolithiasis. A significant increase in the age-standardised incidence rate of urolithiasis was observed in Central America, Tropical Latin America, and the Caribbean regions, whereas notable decline was observed in east Asia, eastern Europe, central Europe, and high-income North America. It was observed that the global age-standardised death rate was less than 0.5 per 100,000 across all GBD regions and less than 1 per 100,000 across all SDI quintiles, with fairly stable global age-standardised death rates of urolithiasis between 2000 and 2021. The age-standardised incidence rate of urolithiasis was 837 (688-1034) in low SDI regions and 1443 (12,108-1734) in high-middle SDI regions. Furthermore, the age-standardised DALY rate showed a decreasing trend across all SDI quintiles over the same period: high-middle SDI (-28.9% [-34.4 to -23.0]), middle SDI (-22.6% [-30.5 to -10.9]), and low-middle SDI (-2.9% [-15.8 to 12.9]).

INTERPRETATION

Global urolithiasis incidence and DALY rates have decreased, while the death rate has stabilised worldwide, showing significant variability among regions, SDI levels, and countries. This could be due to effective preventive measures c on urolithiasis risk factors, effective public health education, lifestyle changes, and early interventions and improved health care access at the global level. This analysis offers relevant insights into global, regional, and country-specific urolithiasis trends.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national burden of HIV/AIDS, 1990-2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021

BACKGROUND

As set out in Sustainable Development Goal 3.3, the target date for ending the HIV epidemic as a public health threat is 2030. Therefore, there is a crucial need to evaluate current epidemiological trends and monitor global progress towards HIV incidence and mortality reduction goals. In this analysis, we assess the current burden of HIV in 204 countries and territories and forecast HIV incidence, prevalence, and mortality up to 2050 to allow countries to plan for a sustained response with an increasing number of people living with HIV globally.

METHODS

We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 analytical framework to compute age-sex-specific HIV mortality, incidence, and prevalence estimates for 204 countries and territories (1990-2021). We aimed to analyse all available data sources, including data on the provision of HIV programmes reported to UNAIDS, published literature on mortality among people on antiretroviral therapy (ART) identified by a systematic review, household surveys, sentinel surveillance antenatal care clinic data, vital registration data, and country-level case report data. We calibrated a mechanistic simulation of HIV infection and natural history to available data to estimate HIV burden from 1990 to 2021 and generated forecasts to 2050 through projection of all simulation inputs into the future. Historical outcomes (1990-2021) were simulated at the 1000-draw level to support propagation of uncertainty and reporting of uncertainty intervals (UIs). Our approach to forecasting utilised the transmission rate as the basis for projection, along with new rate-of-change projections of ART coverage. Additionally, we introduced two new metrics to our reporting: prevalence of unsuppressed viraemia (PUV), which represents the proportion of the population without a suppressed level of HIV (viral load <1000 copies per mL), and period lifetime probability of HIV acquisition, which quantifies the hypothetical probability of acquiring HIV for a synthetic cohort, a simulated population that is aged from birth to death through the set of age-specific incidence rates of a given time period.

FINDINGS

Global new HIV infections decreased by 21·9% (95% UI 13·1-28·8) between 2010 and 2021, from 2·11 million (2·02-2·25) in 2010 to 1·65 million (1·48-1·82) in 2021. HIV-related deaths decreased by 39·7% (33·7-44·5), from 1·19 million (1·07-1·37) in 2010 to 718 000 (669 000-785 000) in 2021. The largest declines in both HIV incidence and mortality were in sub-Saharan Africa and south Asia. However, super-regions including central Europe, eastern Europe, and central Asia, and north Africa and the Middle East experienced increasing HIV incidence and mortality rates. The number of people living with HIV reached 40·0 million (38·0-42·4) in 2021, an increase from 29·5 million (28·1-31·0) in 2010. The lifetime probability of HIV acquisition remains highest in the sub-Saharan Africa super-region, where it declined from its 1995 peak of 21·8% (20·1-24·2) to 8·7% (7·5-10·7) in 2021. Four of the seven GBD super-regions had a lifetime probability of less than 1% in 2021. In 2021, sub-Saharan Africa had the highest PUV of 999·9 (857·4-1154·2) per 100 000 population, but this was a 64·5% (58·8-69·4) reduction in PUV from 2003 to 2021. In the same period, PUV increased in central Europe, eastern Europe, and central Asia by 116·1% (8·0-218·2). Our forecasts predict a continued global decline in HIV incidence and mortality, with the number of people living with HIV peaking at 44·4 million (40·7-49·8) by 2039, followed by a gradual decrease. In 2025, we projected 1·43 million (1·29-1·59) new HIV infections and 615 000 (567 000-680 000) HIV-related deaths, suggesting that the interim 2025 targets for reducing these figures are unlikely to be achieved. Furthermore, our forecasted results indicate that few countries will meet the 2030 target for reducing HIV incidence and HIV-related deaths by 90% from 2010 levels.

INTERPRETATION

Our forecasts indicate that continuation of current levels of HIV control are not likely to attain ambitious incidence and mortality reduction targets by 2030, and more than 40 million people globally will continue to require lifelong ART for decades into the future. The global community will need to show sustained and substantive efforts to make the progress needed to reach and sustain the end of AIDS as a public threat.

FUNDING

The Bill & Melinda Gates Foundation and the National Institute of Allergy and Infectious Diseases.

Global, regional, and national burden of type 2 diabetes mellitus attributable to particulate matter pollution from 1990 to 2021: An analysis of the global burden of disease study 2021

AIMS

The study uses GBD 2021 data to measure the type 2 diabetes mellitus (T2DM) burden linked to particulate matter pollution (PM2.5) exposure, highlighting environmental factors as rising contributors to the disease.

METHODS

We used advanced methods like Joinpoint regression and decomposition analysis to track PM2.5 exposure's effects on T2DM, analyzing its burden by Socio-demographic indices (SDI) to find high-risk areas for targeted interventions.

RESULTS

In 2021, the global burden of T2DM attributable to PM2.5 exposure reached 12,904,493 DALYs, a substantial increase from 1990. The age-standardized mortality rates (ASMR) and age-standardized death rates (ASDR) showed an upward trend, with males exhibiting a higher disease burden than females. The burden was highest in lower SDI quintiles, with faster growth rates in ASDR and ASMR compared to higher SDI regions. The population attributable fractions (PAFs) for ASDR and ASMR due to PM2.5 were 17.07 % and 17.47 %, respectively, with higher PAFs in lower SDI regions.

CONCLUSION

Our results show that air pollution significantly affects global T2DM rates, necessitating policies to lower PM2.5 and boost health system resilience. Ongoing monitoring and research are key to crafting strategies against pollution's health effects.

Burden of gastrointestinal cancers among adolescent and young adults in Asia-Pacific region: trends from 1990 to 2019 and future predictions to 2044

BACKGROUND

Gastrointestinal cancer is a significant cause of cancer incidence and mortality. Nevertheless, the epidemiology of the burden among adolescents and young adults (AYAs, aged 15-39 years) remains limited in the Asia-Pacific region, despite the region's significant population. This study aims to explore the gastrointestinal cancer burden among AYAs in the Asia-Pacific region for the year 2019, while also analysing trends from 1990 to 2019 and projecting future trends up to 2044.

METHODS

Annual case numbers, age-standardized rates of incidence, death, and disability-adjusted life-years (DALYs) and their estimated annual percentage changes (EAPCs) for gastrointestinal cancers were derived from the Global Burden of Disease, Injuries, and Risk Factors Study 2019. Trends over the next 25 years have also been predicted.

RESULTS

In 2019, there were 117,714 incident cases, 61,578 deaths and 3,483,053 DALYs due to gastrointestinal cancers in the Asia-Pacific region, accounting for 68.5%, 67.6% and 72.4%, respectively, of global gastrointestinal cancers in this population. The highest age-standardized rates occurred in countries with a middle Socio-demographic Index. From 1990 to 2019, there was a decline in the age-standardized rates of incidence, death and DALY attributed to gastrointestinal cancers, with EAPC of -1.10, -2.48 and -2.44, respectively. These rates are expected to stabilize over 25 years, with notable variations in individual gastrointestinal cancers.

CONCLUSIONS

Gastrointestinal cancers among AYAs in the Asia-Pacific region have posed a significant burden over the past 30 years and are expected to persist in the coming years.

Pharmacokinetics of Antiretroviral Drugs in Older People Living with HIV, Part II: Drugs Licensed Before 2005

BACKGROUND AND OBJECTIVE

Advances in antiretroviral therapy led to an increase in life expectancy among people living with human immunodeficiency virus (HIV). As aging is characterized by several physiological changes that can influence pharmacokinetics (PK), this systematic review aims to describe the impact of aging on the PK of antiretrovirals (ARV) approved by the Food and Drug Administration (FDA) before 2005.

METHODS

Searches were performed in BVS, EMBASE, and PubMed databases for publications until June 2024. Peer-reviewed published studies were included if they met the following criteria: adults (≥ 18 years) living with HIV; reporting at least one PK parameter or plasma concentration of any ARV approved by the US FDA before 2005 and still used in the clinic: lamivudine (3TC), emtricitabine (FTC), tenofovir disoproxil fumarate (TDF), abacavir (ABC), zidovudine (ZDV), efavirenz (EFV), nevirapine (NVP), atazanavir (ATV), lopinavir (LPV), ritonavir (RTV), tipranavir (TPV), and fosamprenavir (FPV); PK parameters stratified per age group as young (aged 18-49 years) or older (age ≥ 50 years) adults; and manuscripts published in English, Portuguese, or Spanish. All studies were evaluated for risk of bias. The review protocol was registered in the PROSPERO database (registration no. CRD42023463092).

RESULTS

Among 106 studies included, only 22 evaluated the PK of participants aged 50 years or older and only 5 studies compared the PK between young and older adults for ATV, RTV, EFV, and 3TC. Our analysis revealed an increase in minimal concentration (Cmin) values for LPV, RTV, and ATV in older adults. While increased values of the area under the curve (AUC) and maximum concentration (Cmax) were observed in older adults using ATV, 3TC, and FTC, no differences in PK were apparent between young and older adults for ABC and EFV, with no estimation possible for ZDV.

CONCLUSION

Exposure to 3TC, TDF, FTC, ATV, LPV, and RTV increases with age, while exposure to ABC and EFV appears to be unaffected. Despite the large quantity of data on PK in young adults, there is still a gap in knowledge about the effects of aging on the PK of these ARVs.

Trends in avoidable mortality from cardiovascular diseases in the European Union, 1995-2020: a retrospective secondary data analysis

Background

Certain causes of death can be avoided with access to timely prevention and treatment. We quantified trends in avoidable deaths from cardiovascular diseases for European Union (EU) countries from 1995 to 2020 and examined variations by demographics, disease characteristics, and geography.

Methods

Retrospective secondary data analysis of avoidable cardiovascular mortality using the WHO Mortality Database. Avoidable causes of death were identified from the OECD and Eurostat list (which uses an age threshold of 75 years). Regression models were used to identify changes in the trends of age-standardized mortality rates and potential years of life lost.

Findings

From 1995 to 2020, 11.4 million deaths from cardiovascular diseases in Europe were avoidable, resulting in 213.1 million potential life years lost. Avoidable deaths were highest among males (7.5 million), adults 65-74 years (6.8 million), and with the leading cause of death being ischemic heart disease (6.1 million). From its peak in 1995 until 2020, avoidable mortality from cardiovascular diseases has decreased by 57% across the EU. The difference in avoidable cardiovascular diseases mortality between females and males, and between Eastern and Western Europe has reduced greatly, however gaps continue to persist.

Interpretation

Avoidable mortality from cardiovascular diseases has decreased substantially among EU countries, although improvement has not been uniform across diseases, demographic groups or regions. These trends suggest additional policy interventions are needed to ensure that improvements in mortality are continued.

Funding

World Health Organization, Regional Office for Europe.

Causes and global, regional, and national burdens of traumatic brain injury from 1990 to 2019

PURPOSE

Traumatic brain injury (TBI), currently a major global public health problem, imposes a significant economic burden on society and families. We aimed to quantify and predict the incidence and severity of TBI by analyzing its incidence, prevalence, and years lived with disability (YLDs). The epidemiological changes in TBI from 1990 to 2019 were described and updated to provide a reference for developing prevention, treatment, and incidence-reducing measures for TBI.

METHODS

A secondary analysis was performed on the incidence, prevalence, and YLDs of TBI by sex, age group, and region (n = 21,204 countries and territories) between 1990 and 2019 using the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Proportions in the age-standardized incidence rate due to underlying causes of TBI and proportions of minor and moderate or severe TBI were also reported.

RESULTS

In 2019, there were 27.16 million (95% uncertainty intervals (UI): 23.36 - 31.42) new cases of TBI worldwide, with age-standardized incidence and prevalence rates of 346 per 100,000 population (95% UI: 298 - 401) and 599 per 100,000 population (95% UI: 573 - 627), respectively. From 1990 to 2019, there were no significant trends in global age-standardized incidence (estimated annual percentage changes: -0.11%, 95% UI: -0.18% - -0.04%) or prevalence (estimated annual percentage changes: 0.01%, 95% UI: -0.04% - 0.06%). TBI caused 7.08 million (95% UI: 5.00 - 9.59) YLDs in 2019, with age-standardized rates of 86.5 per 100,000 population (95% UI: 61.1 - 117.2). In 2019, the countries with higher incidence rates were mainly distributed in Central Europe, Eastern Europe, and Australia. The 2019 global age-standardized incidence rate was higher in males than in females. The 2019 global incidence of moderate and severe TBI was 182.7 per 100,000 population, accounting for 52.8% of all TBI, with falls and road traffic injuries being the main causes in most regions.

CONCLUSIONS

The incidence of moderate and severe TBI was slightly higher in 2019, and TBI still accounts for a significant portion of the global injury burden. The likelihood of moderate to severe TBI and the trend of major injury under each injury cause from 1990 to 2019 and the characteristics of injury mechanisms in each age group are presented, providing a basis for further research on injury causes in each age group and the future establishment of corresponding policies and protective measures.

Deciphering the sex gap in global life expectancy: the impact of female-specific cancers 1990-2019

BACKGROUND

Females live longer than males, which results in a sex gap in life expectancy. This study examines the contribution of female cancers to this differential by world region and country over the period 1990-2019 with special focus to the 15-69 years age group.

METHODS

Cause-specific mortality data for 30 cancers, including 4 female-specific cancers from 238 countries and territories, were retrieved from the Global Burden of Disease Study 2019. Using life table techniques and demographic decomposition analysis, we estimated the contribution of cancer deaths to the sex gap in life expectancy by age and calendar period.

RESULTS

At ages 15-69 years, females had a higher life expectancy than males in 2019. Countries with the largest sex gaps or the largest female advantage in life expectancy were in Eastern Europe and Northern Asia, Latin America, and Southern Africa. In contrast, countries with the smallest sex gaps were mainly located in Northern Africa, Northern America, and Northern Europe. The contribution of female-specific cancers to sex gaps in life expectancy were largely negative, ranging from -0.15 years in the Western Pacific to -0.26 years in the Eastern Mediterranean region, implying that the disproportionately higher premature cancer mortality among females contributed to a reduction in the female life expectancy advantage.

CONCLUSION

Female-specific cancers are important determinants of sex gaps in life expectancy. Their negative impact on life expectancy at working and reproductive age groups has far-reaching consequences for society. Increasing the availability and access to prevention, screening, timely diagnosis, and effective treatment can reduce this gap.

The disability-adjusted life years (DALYs), prevalence and incidence of scabies, 1990-2021: A systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND

Current literature lacks a recent global analysis of scabies. This study aims to analyze the burden and epidemiological characteristics of scabies using data from the Global Burden of Disease (GBD) 2021 study.

METHODOLOGY/PRINCIPAL FINDINGS

The analysis assessed disability-adjusted life years (DALYs), prevalence, and incidence of scabies from 1990 to 2021, stratified by geographic location, socio demographic index (SDI), gender, and age. In 2021, scabies caused 5.3 million DALYs, 206.6 million prevalence, and 622.5 million incidence, primarily affecting children and young people. The burden was heaviest in middle SDI regions and lowest in high SDI regions. Oceania, Tropical Latin America, and East Asia ranked as the top three regions in global scabies burden. Nationally, Fiji, Guam, Tonga, Tuvalu, and Northern Mariana Islands had the highest age-standardised DALY rates. From 1990 to 2021, global age-standardized rates (ASRs) of DALYs, prevalence, and incidence for scabies declined, while the absolute numbers increased. These ASRs showed an upward trend in high and high-middle SDI regions, with significant increases in Central Latin America and high-income North America. Larger burden increases were observed in Sri Lanka, the United States of America, and Mexico compared to other countries and territories. In terms of age, these ASRs increased from 40, particularly for women and the elderly.

CONCLUSIONS/SIGNIFICANCE

The global scabies burden was higher in tropical regions, particularly among children and young people, in 2021. Between 1990 and 2021, the burden increased in higher SDI regions, Central Latin America, and high-income North America, warranting focused attention. Additionally, the rising burden among adults over 40, particularly women and the elderly, highlighted the need for targeted interventions.

Trends in disease burden and risk factors of asthma from 1990 to 2019 in Belt and Road Initiative countries: evidence from the Global Burden of Disease Study 2019

This study outlines asthma burden trends across age, sex, regions and risk factors in 'Belt and Road' (B&R) countries from 1990 to 2019 using the Global Burden of Disease Study 2019 data. Incidence, mortality, prevalence, years lived with disability (YLDs), disability-adjusted life years (DALYs) and risk factors for asthma were measured. India, China and Indonesia bore the heaviest burden in 2019. Despite the significant decline in the average annual percent change for age-standardized mortality and years of life lost from 1990 to 2019, increases were observed in several East Asian, Central Asian, North African and Middle Eastern countries between 2010 and 2019. For both sexes, YLDs decreased in most B&R countries but increased in Montenegro, Saudi Arabia, Armenia, Vietnam and Oman. YLDs in Georgia, the United Arab Emirates and Albania increased in males but decreased in females. YLDs increased for those aged <15 years in Central Asia and Europe, while China's 50-74-year age group showed the lowest YLD change. High body mass index (BMI) led to increased YLDs in East, Central and Southeast Asia; North Africa; and the Middle East. Conclusively, asthma burden varies significantly by country. Tailoring control efforts to specific regions, sex and high BMI could enhance asthma management.

Temporal trends and projections in the global burden of neck pain: findings from the Global Burden of Disease Study 2019

ABSTRACT

Data were obtained from the Global Burden of Disease study 2019. Joinpoint regression model was used to analyze the temporal trends from 1990 to 2019 of neck pain burden, focusing on age-standardized incidence rates, age-standardized prevalence rates, and age-standardized years lived with disability (YLDs) rates at the global, regional, and national levels. The age-period-cohort analysis was used to estimate the effects of age (5-99 years), period (1990-2019), and cohort (1893-2012) at the global, regional, and national levels. Future projections for the global burden of neck pain from 2020 to 2044 were estimated using the nordpred age-period-cohort model. From 1990 to 2019, the global incidence, prevalence cases, and YLDs counts of neck pain have increased by 71.89%, 98.21%, and 78.17%, respectively. The joinpoint analysis indicated significant shifts in the global trends of age-standardized neck pain burden, which varied across regions and nations. The age-period-cohort model indicated that the neck pain burden was predominantly concentrated in middle-aged and older age, with period and cohort effects showing minimal variation from 1990 to 2019. Compared with 2019, the incident cases, prevalent cases, and YLDs counts of neck pain were projected to increase by 134%, 142%, and 140% by 2044. The global burden of neck pain has persisted at a relatively elevated level from 1990 to 2019, with projections indicating a continuing upward trend. Future research is urgently needed to better understand the predictors and clinical course of neck pain and to enhance prevention and management strategies.

The Self-Reported Human Health Impacts of Disaster on People in India: A Cross-Sectional Analysis of the Longitudinal Aging Study India

INTRODUCTION

The human health impacts of disaster are predicted to increase in frequency and severity due to the effects of climate change. This has impacts on all nations, but understanding disaster-related health impacts in highly populous nations, such as India, will help to inform risk preparedness and reduction measures for large proportions of the global population.

PROBLEM

Disaster-related human health impacts in India were examined via the use of survey data to inform risk reduction.

METHODS

A cross-sectional analysis of Wave 1 (2017-2018) data from the Longitudinal Aging Study India (LASI) was conducted to explore the impact of both natural and human-induced disasters on the self-reported health of people 45 years and above, as well as their partners (irrespective of age). Descriptive statistics, chi square tests of association, odds ratio, and logistic regression were used to analyze the data by socio-demographics, geographic location, and health concern type.

RESULTS

Out of a total 72,250 respondents, 2,301 (3.5%) reported disaster-related health impacts, of which 90.1% were significant. Rural residents and those with no education were more likely to be affected. Droughts were most commonly responsible for affecting human health (41.7%), followed by floods (24.0%). Two-thirds of the sample reported psychological trauma and one-in-five experienced chronic illness.

DISCUSSION

The LASI study presents an important first understanding of the self-reported human health impacts of disasters, both natural and human-induced in India. Findings indicate social determinants such as education level and rurality impact risk of disaster-related health impacts, while mental health concerns represent the biggest disaster-related health concern.

CONCLUSION

Future waves of LASI should be examined to determine if human health impacts are increasing due to the effects of climate change, as well as the vulnerability of an aging cohort.

National and subnational burden of mental disorders in Iran (1990-2019): findings of the Global Burden of Disease 2019 study

BACKGROUND

Mental and behavioural disorders account for a large proportion of the burden of diseases in Iran. Identifying the pattern of change can help in policy making and provision of mental health services. We aimed to analyse the burden of mental disorders (excluding substance use disorders) in Iran at national and subnational levels with data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019.

METHODS

We used data from 1990 to 2019 on anxiety disorders, attention-deficit hyperactivity disorder, autism spectrum disorders, bipolar disorder, conduct disorder, depressive disorders, eating disorders, idiopathic developmental intellectual disability, schizophrenia, and other mental disorders in Iran and its 31 provinces. We calculated total disability-adjusted life-years (DALYs), age-standardised DALYs, and prevalence rates in 1990 and 2019, as well as the percentage change between these time periods.

FINDINGS

Mental disorders accounted for 1 159 410 (4·6%) of 25 007 732 all-cause DALYs in Iran in 1990 and 2 053 871 (10·3%) of 19 828 721 in 2019. Although total DALYs for mental disorders increased by 77·1% (95% uncertainty interval 76·7 to 77·6%) during this period, age-standardised DALY rate increased by 1·8% (-4·1 to 7·7%). The overall patterns of change were similar at the subnational level as the national level, although the rates differed between provinces with a highest-to-lowest ratio of 1·22 for age-standardised DALY rates in 2019.

INTERPRETATION

The increase in the burden of mental disorders in Iran is higher than the general trend in the world. The slight change in age-standardised DALYs suggests that the increase is mainly attributable to changes in the size and structure of the population. Considering the absolute and relative increase in the burden of mental disorders during the past 30 years at national and provincial levels, there is an urgent need to address the determinants of mental health and upgrade mental health services across all levels of care in Iran.

FUNDING

Bill & Melinda Gates Foundation.

Global burden due to modifiable risk factors for autoimmune diseases, 1990-2021: Temporal trends and socio-demographic inequalities

BACKGROUND

Autoimmune diseases arise from a combination of non-modifiable risk factors, such as gender and genetic predispositions, and modifiable factors, including lifestyle choices and environmental exposures. Given the potential to alter modifiable risk factors, this study aims to evaluate the global burden, temporal trends, and inequalities of autoimmune diseases attributed to modifiable risk factors from 1990 to 2021. The study will provide up-to-date evidence to inform strategies for mitigating the impact of these risk factors on autoimmune diseases worldwide.

METHODS

Data on the global burden of autoimmune diseases attributed to modifiable risk factors were obtained from the Global Burden of Diseases study 2021. Temporal trends in age standardized disability-adjusted life-years (DALYs) rates were evaluated by estimated annual percentage changes (EAPC). Spearman rank correlation test was used to explore the association between two variables. Slope index of inequality (SII) and concentration index (CI) were used to evaluated the absolute and relative inequalities in DALY rates and numbers, respectively.

RESULTS

From 1990 to 2021, type 1 diabetes mellitus (T1DM) due to high temperature has shown an increasing trend in global age standardized DALY rates (EAPC = 0.88, 0.58 to 1.18), whereas all other autoimmune diseases due to specific risk factors have generally exhibited decreasing trends. Across Socio-demographic Index (SDI) quintiles, notable increases were observed in high SDI countries for T1DM due to high temperature (EAPC = 1.36, 0.92 to 1.80), in low and low-middle SDI countries for multiple sclerosis (MS) due to smoking (EAPC = 0.25, 0.23 to 0.27; 0.22, 0.21 to 0.23, respectively), and in low-middle SDI countries for asthma due to high body-mass index (BMI) (EAPC = 0.25, 0.20 to 0.29). In 2021, significant positive associations were observed between SDI and age-standardized DALY rates for rheumatoid arthritis (RA) and MS due to smoking, as well as T1DM due to low temperatures across 204 countries and territories (all P < 0.05). In contrast, all other autoimmune diseases attributed to certain risk factors exhibited significant negative associations (all P < 0.05). Women displayed higher global age-standardized DALY rates for asthma due to high BMI (44.1 per 100,000 population), while men exhibited higher global age-standardized DALY rates for all other autoimmune diseases due to specific risk factors. Except for narrowed inequalities in DALY rates for asthma due to smoking (SII = 20.4, 13.0 to 27.8 in 1990 to 6.7, 2.8 to 10.6 in 2021) and in DALY numbers for asthma due to high BMI (CI = 17.3, 24.5 to 9.5 in 1990 to -0.3, 8.2 to -8.6 in 2021), both absolute and relative SDI-related inequalities have remained stable for all other autoimmune diseases linked to specific risk factors.

CONCLUSIONS

Over the past three decades, substantial progress has been achieved in reducing global age-standardized DALY rates for autoimmune diseases attributed to modifiable risk factors, except for T1DM attributed to high temperatures. Despite these advancements, SDI-related inequalities have remained stable for most of these diseases attributed to risk factors, underscoring the urgent need for targeted public health strategies to address these persistent disparities.

Global, regional and national trends in the burden of low bone mineral density from 1990 to 2030: A Bayesian age-period-cohort modeling study

Low bone mineral density (LBMD) remains a global public health concern. To provide deeper insights, we retrieved and calibrated LBMD death and Disability-Adjusted Life Years (DALYs) data from the Global Burden of Disease 2021 (GBD 2021) database. We calculated the age-standardized rate (ASR) and estimated annual percentage change (EAPC) to delineate LBMD trends across sexes, age groups, Sociodemographic Index (SDI) regions, and countries. Spearman rank order correlation analysis was used to explore the relationship between SDI and ASR. Additionally, we constructed Bayesian age-period-cohort (BAPC) models to predict future trends in LBMD up to 2030, with the mean absolute percentage error (MAPE) used to evaluate prediction accuracy. Our analyses revealed that global deaths related to LBMD nearly doubled, from 250,930 in 1990 to 463,010 in 2021, and are projected to rise to 473,690 by 2030. However, the ASR exhibited an opposite trend, decreasing from 17.91 per 100,000 in 1990 to 15.77 per 100,000 in 2021, and is expected to further decline to 13.64 per 100,000 by 2030. The EAPC indicated descending trends in 1990-2021 and 2022-2030. Trends in LBMD varied across different subgroups by sex, age, and location. Males are projected to continue experiencing higher death numbers than females, though the gap is narrowing. The 90 to 94 age group consistently had the highest ASR from 1990 to 2030. Lower SDI remains a critical factor contributing to the higher burden of LBMD. Spearman rank order correlation analysis showed a negative correlation between SDI and ASR. We categorized 6 distinct trends in ASR across different countries, with most expected to experience a decline by 2030. The MAPE value (0.038 < 0.1) indicated that the BAPC model produced reliable predictions even under the COVID-19 pandemic.

Sex disparity in the burden of NCDs and its four main subgroups in Iran 1990-2019: a systematic analysis from the global burden of disease study 2019

Objectives

The significant health differences between sexes in Iran in terms of burden of non-communicable diseases (NCDs) point to the urgency of developing policies. We aim to explore sex disparities in NCDs.

Methods

We used Global Burden of Disease 2019 study to compare estimates of incidence, prevalence, disability-adjusted life years (DALYs), years lived with disabilities (YLDs), years of life lost (YLLs), and deaths among sexes for NCDs, and their main subgroups; neoplasms, cardiovascular diseases (CVDs), chronic respiratory diseases (CRDs), diabetes mellitus (DM) during 1990-2019.

Results

In 2019, there were 62,476,274 (59517167.5, 65759931) incident NCDs in men and 78758640.6 (75222093.7, 82272935.8) in women. There were 7734064.3 (6744951.2, 8846192) DALYs in men and 7760484.2 (6496609, 9218299.9) in women. Fatal estimates (deaths and YLLs) of NCDs were higher for men, while non-fatal estimates (prevalence, YLDs) were higher for women. Men were superior in all burden indices of NCDs subgroups, except for all indices of DM and YLDs in CVDs. Compared to 1990-2010, the period 2010-2019 confirmed a marked stagnation in decline rates of burden indices, as well as an increase in incidence and prevalence which was more pronounced among men. Despite shrinking sex gaps in NCDs subgroups since 1990, sex gap in DM is widening in 2019.

Conclusions

There is a notable sex disparity in NCDs prevalence in Iran, which has become increasingly evident in DM burden. It will be imperative to continue monitoring sexual differences in NCDs burden to determine if disease rates between sexes continue to diverge in the future.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-024-01489-1.

Evolution of endometrial cancer incidence patterns in Hong Kong: A three-decade analysis with future projections

Objective

This study provides a comprehensive analysis of endometrial cancer incidence trends in Hong Kong over the past three decades. It aims to evaluate the impact of demographic shifts and epidemiological factors, including age, birth cohort, and diagnosis period, on the incidence rates. The study also projects future trends in endometrial cancer cases up to 2030 and assesses the contributions of these factors using a detailed decomposition approach.

Material and methods

The analysis is based on endometrial cancer data obtained from the Hong Kong Cancer Registry. Age-period-cohort (APC) modeling was utilized to investigate the effects of different age groups, historical periods, and birth cohorts on the changing incidence patterns. The study projects future trends using a Bayesian APC framework, integrating historical data and expert insights for robust predictions. Additionally, a decomposition analysis was conducted to disentangle the contributions of demographic changes (aging and population growth) and epidemiological shifts (risk factors such as obesity and reproductive behaviors) to the increasing cases.

Results

Between 1992 and 2021, there were 19,214 recorded cases of endometrial cancer in Hong Kong. Age-standardized and crude incidence rates showed consistent increases, rising from 7.4 per 100,000 person-years in 1992 to 31.0 per 100,000 in 2020. Incidence trends rose significantly across all age groups, with the highest increase seen in women aged 50-65. Projections indicate that the upward trend will continue, with an estimated 1718 cases by 2030. Demographic factors, particularly population aging, and evolving epidemiological trends contribute jointly to the incidence rise.

Conclusions

The findings reveal a steady increase in endometrial cancer incidence among Hong Kong women, primarily driven by demographic aging and shifts in risk factors. The study underscores the need for targeted public health measures and resource allocation for early detection and effective management strategies, emphasizing the importance of addressing modifiable risk factors such as obesity and reproductive health behaviors.

Trends in disease burden of type 2 diabetes, stroke, and hypertensive heart disease attributable to high BMI in China: 1990-2019

Background

High body mass index (BMI) is a significant risk factor for non-communicable diseases; however, its impact on disease burden in China remains understudied. This study aimed to analyze trends in the burden of type 2 diabetes mellitus (T2DM), stroke, and hypertensive heart disease (HHD) attributable to high BMI in China from 1990 to 2019.

Methods

We utilized data from the Global Burden of Disease 2019 study, quantifying disease burden through years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs). Joinpoint regression analysis was employed to determine temporal trends.

Results

The study revealed distinct gender-specific temporal trends. Men exhibited a consistent increase in disease burden across all three conditions. Women showed more nuanced patterns: a gradual rise in T2DM burden, an inverted U-shaped trend for stroke, and a U-shaped trend for HHD in terms of age-standardized DALYs. Age-specific analysis demonstrated that the burden of T2DM and stroke peaked in the 70-74-year age group, whereas HHD-related DALYs continued to increase with advancing age.

Conclusions

Our findings underscore the need for tailored obesity prevention and management strategies in Chinese healthcare settings, emphasizing early screening and intervention for high BMI, particularly in middle-aged and older adults.

Global, regional, and national burden of gastrointestinal cancers among adolescents and young adults from 1990 to 2019, and burden prediction to 2040

BACKGROUND

Gastrointestinal (GI) cancers have heavily burdened public health. Few studies reported GI cancer burden among adolescents and young adults (AYA). To address this gap, we explored the burden of GI cancer among people aged 15-39.

METHODS

We retrieved data from the Global Burden of Disease Study 2019 Data Resources. The average annual percent change (AAPC) of rates was calculated by linear regression analysis of the natural logarithm. Bayesian age-period-cohort model was applied to predict the future burden.

RESULTS

In 2019, there were 171,857 (95% uncertain interval [95% UI]: 157,092-187,974) new GI cancer cases with a rate of 5.79/100,000 (95% UI: 5.29-6.33) and 91,033 (95% UI: 83,156-99,399) deaths at a rate of 3.07/100,000 (95% UI: 2.80-3.35) among AYA. The number of prevalent cases and disability-adjusted life years (DALYs) were 722,573 (95% UI: 660,806-789,476) and 5,151,294 (95% UI: 4,706,065-56,188,77), with rates of 24.35/100,000 (95% UI: 22.27-26.60) and 173.57/100,000 (95% UI: 158.57-189.32) respectively. The overall rates of mortality (AAPC = -1.281, p < 0.001) and DALY (AAPC = -1.283, p < 0.001) of GI cancers declined during the past 30 years, while the incidence rate (AAPC = -0.270, p = 0.074) remained stable and the prevalence rate (AAPC = 1.066, p < 0.001) increased. The burden of colorectal cancer (CRC) and pancreatic cancer increased, while those of stomach cancer (SC) and liver cancer (LC) declined. Among the 21 GBD regions, East Asia exhibited the highest burden, while within the five SDI regions, high-middle SDI locations showed the highest rates across all four indicators. CRC, SC, and LC emerged as the primary culprits, attaining a position within the top ten absolute DALYs for all AYA cancers. There were predicted to be 315,792 new cases and 174,068 deaths of GI cancers among AYA in 2040.

CONCLUSIONS

Despite the decrease in mortality and DALY rates of GI cancers among AYA, they remain prevalent. The burden varied with locations, SDI levels, sexes, and cancer types. Sufficient attention and multi-party cooperation are needed to control the widespread public health issue.

Estimating adult mortality based on maternal orphanhood in populations with HIV/AIDS

In countries without adequate death registration systems, adult mortality is often estimated using orphanhood-based methods. The HIV pandemic breaches several assumptions of these methods, for example, by increasing the correlation between maternal and child survival. Using microsimulations we generated 1,152 populations facing HIV epidemics and evaluated different orphanhood-based estimates against the underlying mortality rates. We regressed survivorship probabilities on proportions of respondents with surviving mothers, adjusting for trends in seroprevalence and coverage of antiretroviral therapy, to obtain new coefficients. We tested the different methods on survey and census data from 16 African countries with high HIV prevalence. We found that the original orphanhood method underestimates mortality during an AIDS epidemic, but better estimates can be obtained using new coefficients applied to synthetic measures of maternal survival. The resulting estimates agree well with those of the United Nations Population Division. Orphanhood-based estimates can fill data gaps in adult mortality, including in countries with high HIV prevalence.

The global burden of colorectal cancer attributable to high body-mass index in 204 countries and territories: findings from 1990 to 2021 and predictions to 2035

Background

The association between high body-mass index (BMI) and colorectal cancer (CRC) has been confirmed and gained attention. However, a detailed understanding of the disease burden of high BMI and CRC remains lacking.

Objective

This study aimed to assess the temporal and geographical trends of CRC deaths and disability-adjusted life years (DALYs) caused by high BMI globally from 1990 to 2021, providing effective guidance for developing prevention and treatment strategies.

Methods

We used data from the 2021 Global Burden of Disease study to assess the global, regional, and national Deaths, DALYs, age-standardized mortality rate (ASMR), and age-standardized DALY rates (ASDR) caused by CRC related to high BMI, and further calculated the estimated annual percentage change (EAPC). We also considered factors such as gender, age, and sociodemographic index (SDI). We explore the relationship between EAPC and ASMR/ASDR (1990) and between EAPC and SDI (2021). Further, the autoregressive integrated moving average (ARIMA) model was applied to predict the disease burden from 2022 to 2035. The risk factors were calculated by Population Attributable Fraction (PAF).

Results

In 2021, CRC caused by high BMI resulted in 99,268 deaths (95% Uncertainty Interval (UI): 42,956-157,949) and 2,364,664 DALYs (95% UI: 1,021,594-3,752,340) globally, with ASMR and ASDR being 1.17 per 100,000 population (95% UI: 0.51-1.87) and 27.33 per 100,000 population (95% UI: 11.8-43.37), respectively. The disease burden was higher in males and the elderly, with significant differences between regions and sociodemographic groups. From 1990 to 2021, the ASMR for CRC associated with high BMI revealed little change globally, while the ASDR revealed an upward trend. The burden of CRC caused by high BMI has shifted from high SDI regions to low and low-middle SDI regions. Additionally, from 2022 to 2035, ASMR and ASDR are expected to increase in males, while ASMR and ASDR in females are expected to remain relatively stable.

Conclusion

From 1990 to 2021, the number of deaths and DALYs related to high BMI-associated CRC globally, as well as ASMR and ASDR, continue to rise. We predict that ASMR and ASDR may further increase by 2035, making it crucial to take timely and targeted interventions.

Global, regional, and national stillbirths at 20 weeks' gestation or longer in 204 countries and territories, 1990-2021: findings from the Global Burden of Disease Study 2021

BACKGROUND

Stillbirth is a devastating and often avoidable adverse pregnancy outcome. Monitoring stillbirth levels and trends-in a comprehensive manner that leaves no one uncounted-is imperative for continuing progress in pregnancy loss reduction. This analysis, completed as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, methodically accounted for different stillbirth definitions with the aim of comprehensively estimating all stillbirths at 20 weeks or longer for 204 countries and territories from 1990 to 2021.

METHODS

We extracted data on stillbirths from 11 412 sources across 185 of 204 countries and territories, including 234 surveys, 231 published studies, 1633 vital statistics reports, and 10 585 unique location-year combinations from vital registration systems. Our final dataset comprised 11 different definitions, which were adjusted to match two gestational age thresholds: 20 weeks or longer (reference) and 28 weeks or longer (for comparisons). We modelled the ratio of stillbirth rate to neonatal mortality rate with spatiotemporal Gaussian process regression for each location and year, and then used final GBD 2021 assessments of fertility and all-cause neonatal mortality to calculate total stillbirths. Secondary analyses evaluated the number of stillbirths missed with the more restrictive gestational age definition, trends in stillbirths as a function of Socio-demographic Index, and progress in reducing stillbirths relative to neonatal deaths.

FINDINGS

In 2021, the global stillbirth rate was 23·0 (95% uncertainty interval [UI] 19·7-27·2) per 1000 births (stillbirths plus livebirths) at 20 weeks' gestation or longer, compared to 16·1 (13·9-19·0) per 1000 births at 28 weeks' gestation or longer. The global neonatal mortality rate in 2021 was 17·1 (14·8-19·9) per 1000 livebirths, corresponding to 2·19 million (1·90-2·55) neonatal deaths. The estimated number of stillbirths occurring at 20 weeks' gestation or longer decreased from 5·08 million (95% UI 4·07-6·35) in 1990 to 3·04 million (2·61-3·62) in 2021, corresponding to a 39·8% (31·8-48·0) reduction, which lagged behind a global improvement in neonatal deaths of 45·6% (36·3-53·1) for the same period (down from 4·03 million [3·86-4·22] neonatal deaths in 1990). Stillbirths in south Asia and sub-Saharan Africa comprised 77·4% (2·35 million of 3·04 million) of the global total, an increase from 60·3% (3·07 million of 5·08 million) in 1990. In 2021, 0·926 million (0·792-1·10) stillbirths, corresponding to 30·5% of the global total (3·04 million), occurred between 20 weeks' gestation and 28 weeks' gestation, with substantial variation at the country level.

INTERPRETATION

Despite the gradual global decline in stillbirths between 1990 and 2021, the overall number of stillbirths remains substantially high. Counting all stillbirths is paramount to progress, as nearly a third-close to 1 million in total-are left uncounted at the 28 weeks or longer threshold. Our findings draw attention to the differential progress in reducing stillbirths, with a high burden concentrated in countries with low development status. Scarce data availability and poor data quality constrain our capacity to precisely account for stillbirths in many locations. Addressing inequities in universal maternal health coverage, strengthening the quality of maternal health care, and improving the robustness of data systems are urgently needed to reduce the global burden of stillbirths.

FUNDING

Bill & Melinda Gates Foundation.

The influential factors of anxiety among caregivers of children with CL/P: a path analysis based on diathesis-stress theoretical model

BACKGROUND

This study aims to validate a hypothesized model of the relationships between optimism, resilience, coping, parenting stress, perceived social support, and anxiety, as well as their influencing factors and consequences among caregivers of children diagnosed with cleft lip and/or palate (CL/P).

METHODS

A hypothesized model was proposed based on diathesis-stress theoretical model and existing literature. A convenience sample of two CL/P treatment centers in China was collected between April 2019 and July 2020. Various well-validated instruments were used to collect 248 valid data points. Descriptive statistics and correlations were computed to assess model fitness and path analysis was performed to investigate direct and indirect effects.

RESULTS

The results revealed that the average level of anxiety among caregivers of children suffering from CL/P was 3.00 (0.00,6.00). The fitness of the modified path model was evaluated using various measures, including χ2/df = 1.806, GFI = 0.989, RFI = 0.916, IFI = 0.990, CFI = 0.989, TLI = 0.960, RMSEA = 0.0570. Parenting stress had the greatest direct associated with anxiety, followed by perceived social support. Moreover, indirect relations to anxiety were observed for optimism, resilience, and coping, which were mediated through perceived social support and parenting stress.

CONCLUSION

In summary, this work suggests that both parenting stress and perceived social support in caregivers of children suffering from CL/P are associated with anxiety. Therefore, developing effective intervention approaches targeting key factors might potentially instrumental to alleviate anxiety.

The association of multidimensional frailty with metabolic syndrome and low-grade inflammation in community-dwelling older adults in the Netherlands: a Lifelines cohort study

BACKGROUND

Preventing metabolic syndrome (MetS) and frailty in older adults is crucial for healthy aging. The association between MetS and physical frailty is well-documented, with low-grade inflammation as potential explanation. However, the association between MetS and frailty as a multidimensional concept, and the association of low-grade inflammation with presence of MetS and frailty, is yet unclear. Therefore, we examined these associations low-grade inflammation in a large cohort of community-dwelling older adults.

METHODS

This cross-sectional study was performed among adults aged ≥ 65 years enrolled in the Dutch Lifelines population cohort. MetS was defined according to the Joint Interim Statement of 2009. Frailty was measured by the Groningen Frailty Indicator (GFI), which consists of 15 self-reported items on both physical and psychosocial functioning, with a score ≥ 4 indicating presence of frailty. The association between MetS and its five components and frailty was assessed using logistic regression models. Low-grade inflammation was represented by high-sensitivity C-reactive protein (hsCRP) level. The association of hsCRP level with presence of MetS and frailty was assessed using multinomial logistic regression in a sub-cohort with available hsCRP measurements.

RESULTS

Of 11,552 adults (52.1% women) included, the prevalences of MetS and frailty were 28% and 15%, respectively. MetS was positively associated with frailty after adjusting for relevant covariates (OR: 1.37; 95% CI: 1.22-1.53). MetS components elevated blood pressure was most strongly associated with frailty. In the sub-cohort of 3896 participants, high hsCRP was associated with presence of MetS and frailty (OR: 1.31; 95% CI: 1.15-1.51), and MetS alone (OR: 1.44; 95% CI: 1.33-1.56), but not to frailty alone. A higher hsCRP level was associated with a higher score on the physical domain of frailty (b: 0.06; 95% CI: 0.03-0.08).

CONCLUSIONS

Presence of MetS is associated with presence of frailty indicated by a multidimensional index in a large group of Dutch older adults. Low-grade inflammation, indicated by plasma hsCRP level, was found to be associated with both presence of MetS and frailty and presence of MetS alone. Increased hsCRP levels were associated with the physical component of frailty, but not with frailty as a multidimensional concept.

Worldwide Burden of Retinoblastoma from 1990 to 2021

INTRODUCTION

The aim of the study was to report the global, regional, and national burden of retinoblastoma between 1990 and 2021, by age, sex, and sociodemographic index (SDI).

METHODS

We leveraged the Global Burden of Disease 2021 Study to elucidate the epidemiological landscape of retinoblastoma, encompassing prevalence, incidence, mortality, and disability-adjusted life years (DALYs) across 204 nations and territories spanning the period from 1990 to 2021. The SDI was employed to evaluate the interplay between socioeconomic development and the burden of retinoblastoma.

RESULTS

In 2021, global estimates unveiled 57,333 prevalent cases of retinoblastoma, yielding 6,274 incident cases, 2,762 deaths, and 243,204 DALYs. Globally, the age-standardized prevalence, incidence, mortality, and DALY rates for retinoblastoma in 2021 were 0.86, 0.09, 0.04, and 3.65 per 100,000 population, respectively. Tokelau, Kenya, and Portugal demonstrated the highest age-standardized prevalence and incidence rates of retinoblastoma in 2021. The global prevalence of retinoblastoma peaks among children aged 2-4 years and subsequently declines with increasing age. At the regional level, the correlation between SDI and age-standardized prevalence rates for retinoblastoma manifested a V-shaped pattern.

CONCLUSIONS

This comprehensive examination of retinoblastoma epidemiological trends underscores the imperative for heightened vigilance and more efficacious therapeutic interventions, especially within resource-limited environments. The findings accentuate the need for targeted strategies to address the disparate burden of retinoblastoma across diverse socioeconomic landscapes.

The Paradox of Digital Health: Why Middle-Aged Adults Outperform Young Adults in Health Management Utilization via Technology

Background/Objectives: Globally, life expectancy has been increasing with South Korea focusing on improving health to enhance quality of life. The COVID-19 pandemic further emphasized the need for digital transformation in healthcare, accelerating digital health adoption. This study explores the digital divide between 'Digital Natives (20-39 Y)' and 'Digital Immigrants (40-69 Y)', focusing on digital device usage and confidence. Methods: This study utilized national survey data from the Digital Health Literacy Survey Results and Policy Implications, focusing on differences in digital device use and confidence between young adults (20-39 Y) and middle-aged adults (40-69 Y). The participants comprised 1000 adults aged 20 to 69 in the Republic of Korea. Respondents were queried about their use of digital health tools, such as wearable devices and mobile apps. Confidence in using digital systems and managing health via digital tools was assessed using a five-point Likert scale. Results: The findings indicated that while young adults have lower rates of using digital devices for healthcare, they exhibit higher confidence in using such devices. In contrast, middle-aged adults, despite having lower confidence, report higher usage of digital devices for healthcare purposes. Conclusions: This study explored differences in digital confidence and healthcare usage between age groups and aimed to propose effective health management strategies based on digital accessibility.

A new method for estimating recent adult mortality from summary sibling histories

BACKGROUND

In low- and middle-income countries with limited death registration statistics, adult mortality rates are commonly estimated through sibling survival histories (SSH). In full SSH, respondents are asked about either the age, or the age and time of death, of each of their siblings in turn. Full SSH allow direct mortality estimation but can be time-consuming to collect. In this study, we introduce a new indirect estimation method using summary SSH, requiring only a limited set of questions to produce recent mortality estimates.

METHODS

We developed a set of 192 microsimulations representing a wide range of fertility and mortality patterns, and reconstructed summary SSH within these simulations as if they had been collected from adults aged 15-49. For each age group of respondents, we calculated coefficients that convert the proportion of adult siblings who died in the previous 5 years into age-specific mortality rates. We then evaluated the performance of this new method with real data, using 154 Demographic and Health Surveys.

RESULTS

The new indirect method provides mortality rates that are consistent with direct estimates from full SSH. Across all DHS, the mean absolute percentage error in the risk of dying in adulthood (ages 15-49) is 6% for both men and women. In all but one survey, 95% confidence intervals around the direct and indirect estimates overlap. As with direct estimates of adult mortality from SSH, the indirect estimates remain, however, lower than those of the Population Division of the United Nations.

CONCLUSIONS

Summary questions on sibling survival can be included in censuses and rapid turn-around surveys for the measurement of recent adult mortality.

Quantifying the Strain: A Global Burden of Disease (GBD) Perspective on Musculoskeletal Disorders in the United States Over Three Decades: 1990-2019

Background: Musculoskeletal (MSK) disorders significantly contribute to global disability, especially in high-income countries. Yet, comprehensive studies on their epidemiological burden in the United States (US) are limited. Our study aims to fill this gap by characterizing the MSK disease burden in the US using Global Burden of Disease (GBD) data from 1990 to 2019. Methods: We conducted an ecological study using descriptive statistical analyses to examine age-standardized prevalence and disability-adjusted life years (DALY) rates of MSK disorders across different demographics and states. The study also assessed the impact of risk factors segmented by age and sex. Results: From 1990 to 2019, the burden of MSK disorders in the US increased significantly. Low back pain was the most prevalent condition. Age-standardized prevalence and DALY rates increased by 6.7% and 17.6%, respectively. Gout and other MSK disorders saw the most significant rise in DALY rates. Females experienced higher rates than males, and there were notable geographic disparities, with the District of Columbia having the lowest and North Dakota and Iowa the highest DALY rates. Smoking, high BMI, and occupational risks emerged as primary risk factors. Conclusions: Our study highlights the escalating burden of MSK disorders in the US, revealing significant geographic and sex disparities. These findings highlight the urgent need for targeted health interventions, policy formulation, and public health initiatives focusing on lifestyle and workplace modifications. Region- and sex-specific strategies are crucial in effectively managing MSK conditions, considering the influence of various risk factors.

Global burden and cross-country inequalities in diseases associated with high body mass index from 1990 to 2019: Result from the Global Burden of Disease Study 2019

BACKGROUND

High body mass index (BMI) has gradually become an increased risk factor for the global burden of diseases (GBD). As the disease burden and the number of elders globally increase, it is crucial for policymakers to realise the associations between high BMI and disease burden worldwide in a timely manner and to develop effective interventions for different countries and ages.

METHODS

We used the GBD 2019 database to analyse the deaths and disability-adjusted life-years (DALYs) in the disease burden associated with high BMI and indicated the health inequality at the global, regional, and national levels. We applied the slope index of inequality and concentration index, two standard metrics of absolute and relative gradient inequality recommended by the World Health Organization (WHO), to quantify the distributive inequalities in the burden of diseases associated with high BMI. These rates were reported per 100 000 population as crude incidence rates, death rates, and DALYs rates. All the estimates were generated with a 95% uncertainty interval (UIs).

RESULTS

Globally, we revealed that an estimated age-standardised mortality rate associated with high BMI is 6.26 million (95% UIs = 3.99, 8.91). The age-standardised DALYs rate is 19.32 million (95% UIs = 12.77, 26.40), and the global population attributable fraction was 9% (95% UIs = 5, 12) in 2019. The largest number of high-BMI-related deaths in women mainly concentrated in the age group of 65-79 years, whereas the largest number in men was in the age group of 60-69 years. The age-standardised DALYs rate of diseases associated with high BMI was larger in the high-middle and middle socio-demographic index (SDI) (population attributable fraction (PAF) = 11 and PAF = 9) regions than those with high SDI (PAF = 1) and low SDI (PAF = 5) regions.

CONCLUSIONS

In this study, our results showed that the disease burden of global deaths and DALYs associated with high BMI has substantially increased between 1990-2019. Furthermore, we demonstrated that countries with higher SDI development levels shoulders higher burden of diseases associated with high BMI. Future policies to prevent and reduce the burden should be developed and implemented based on country-specific development status.

Global health inequalities in the burden of interstitial lung disease and pulmonary sarcoidosis from 1990 to 2021

BACKGROUND

Interstitial lung disease and pulmonary sarcoidosis remain serious medical problems worldwide. This study aims to assess the global burden and health inequalities of interstitial lung disease and pulmonary sarcoidosis between 1990 and 2021.

METHODS

Data on disability-adjusted life years (DALYs) due to interstitial lung disease and pulmonary sarcoidosis were obtained from the Global Burden of Diseases, Injuries and Risk Factors Study 2021. The slope index of inequality (SII) and concentration index were used to assess cross-national health inequality.

RESULTS

There were 2,237,269 (95% uncertainty interval: 1,839,500 to 2,555,200) DALYs due to interstitial lung disease and pulmonary sarcoidosis in males and 1,804,881 DALYs (1,465,707 to 2,216,376) in females in 2021. The age-standardized DALY rate of interstitial lung disease and pulmonary sarcoidosis increased from 37.1 (30.6 to 45.4) per 100,000 in 1990 to 47.6 (41.3 to 53.2) per 100,000 in 2021. Countries with high socio-demographic index (SDI) showed the greatest increase in the age-standardized DALY rate of interstitial lung disease and pulmonary sarcoidosis during the past 32 years (53.4%, 45.1 to 62.2%). The SII increased from 19.6 (95% confidence interval: 11.6 to 27.5) in 1990 to 53.4 (39.7 to 67.1) in 2021. The concentration index increased from 0.15 (0.08 to 0.21) in 1990 to 0.23 (0.16 to 0.32) in 2021.

CONCLUSION

The burden of interstitial lung disease and pulmonary sarcoidosis increased and remained high in the high-SDI quintile. More attention must be given to reducing the burden of interstitial lung disease and pulmonary sarcoidosis.