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

Understanding Epidemiology of Physical Activity and Sedentary Behaviour Among Adults in Haryana: Insights from the ICMR-INDIAB Study [ICMR-INDIAB-19]

INTRODUCTION

Physical inactivity contributes to non-communicable disease (NCD) health burden, making it essential to study and address this issue at a population level. The present research aims to explore the patterns of physical activity (PA) in Haryana through a subgroup analysis of the national Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study.

METHODS

This study was conducted between December 2018 and July 2019 in Haryana and included 3918 adult participants. Physical activity was assessed using the validated MDRF Physical Activity Questionnaire (MPAQ), which has domain-wise assessments of PA. Weighted prevalence was estimated using state-specific sampling weights, and associations between PA, anthropometric and biochemical profiles were assessed using bivariate analysis done using Student's unpaired t tests, one-way analysis of variance (ANOVA), or chi-square tests. Factors describing the likelihood of being active were ascertained using a multivariable nominal regression analysis.

RESULTS

About 73% of the study participants were physically inactive, and only 27% were moderately to vigorously active. The time spent in different PA domains varied significantly across sociodemographic variables, including sex, education, region, occupation, and socioeconomic status. Participants from the middle socioeconomic class spent more time in work-related PA, compared to low and upper-class participants who spent more time in general and transport-related PA. There were significant statistical differences between active and non-active groups concerning their mean blood glucose levels, body mass index, waist circumference and systolic blood pressure, but the differences in the lipid profile were non-significant. However, regression analysis showed higher odds of being physically active among younger participants, men, residents in rural areas, and those having fewer years of education.

CONCLUSION

We highlight the alarmingly high prevalence of physical inactivity across different segments of society in Haryana with significant sociodemographic disparities. Considering the increasing prevalence of NCDs, it is high time to prioritise health promotion measures and inculcate more physical activity amongst the population to achieve health-related sustainable development goals.

The burden of ischemic heart disease among women of childbearing age in China from 1990 to 2021, and projections for the next 15 years

BACKGROUND

There are no studies on the burden of ischemic heart disease (IHD) among women of childbearing age (WCBA) in China. This study aims to describe the IHD burden among WCBA in China from 1990 to 2021, predict the trends over the next 15 years, and identify the contributing factors associated with IHD-related deaths.

METHODS

The data was extracted from the Global Burden of Disease Database 2021. The Direct age-standardized method was used to estimate the age-standardized (AS) prevalence rate (ASPR), mortality rate (ASMR), incidence rate (ASIR), and disability-adjusted life years rate (ASDR) of IHD among WCBA. Joinpoint regression analysis was used to analyze the Annual Percent Change and Average Annual Percent Change from 1990 to 2021. The Autoregressive Integrated Moving Average model was used to predict the trend over the next 15 years.

RESULTS

From 1990 to 2021, the ASPR and ASIR increased by 17.44% and 25.83%, culminating in 616.50 (95% UI, 498.42-762.38) and 79.93 (95% UI, 49.43-113.88) cases per 100,000 individuals. Conversely, the ASMR and ASDR declined to 5.17 (95% UI, 4.14-6.33) and 261.24 (95% UI, 212.03-318.03) cases per 100,000 individuals. Over the next 15 years, the ASPR is projected to increase by 25.74%, culminating in 775.20 (95% UI, 637.98-912.42) cases per 100,000 individuals. The main contributor to increased IHD-related deaths among WCBA in China was high low-density lipoprotein.

CONCLUSIONS

Despite the significant decline in the ASMR and ASDR of IHD among WCBA in China over the last 30 years, the ASPR and ASIR continue to increase. Additionally, the ASPR is projected to rise over the next 15 years. These findings emphasize that effective measures and timely interventions are needed to reduce the disease burden.

Global Sociodemographic Disparities in Ischemic Heart Disease Mortality According to Sex, 1980 to 2021

BACKGROUND

Mortality due to ischemic heart disease (IHD) has declined in countries with high socioeconomic development. Whether these declines extend to other settings, and whether socioeconomic development influences IHD mortality among men and women differently, is unknown.

METHODS

We obtained annual data on sex-specific IHD mortality rates for countries/territories in the GBD study (Global Burden of Disease) from 1980 to 2021. The sociodemographic index (SI), a measure of socioeconomic development, was retrieved for each country/territory. Age-adjusted IHD mortality rates were modeled as a smooth function of sex, year, and SI.

RESULTS

From 1980 to 2021, IHD mortality rates did not decrease in low SI settings for men or women. In contrast, mortality rates relative to 1980 declined by >25% in average SI settings (age-adjusted mortality per 100 000, 153-107 for women and 218-161 for men) and >50% in high SI settings (age-adjusted mortality per 100 000, 162-69 for women and 258-114 for men). Comparing the 20th versus 80th percentile of SI in 2021 (corresponding to lower versus higher socioeconomic development), mortality rates were 81% higher for men and 111% higher for women living in socioeconomically deprived settings (P for difference by sex: 0.01), although absolute differences were larger in men. The association of low SI with higher IHD mortality was especially pronounced for mortality attributable to environmental/occupational risk factors (eg, particulate matter air pollution, lead exposure, and extremes of temperature), with mortality rates being 174% higher among women and 199% higher among men.

CONCLUSIONS

Across the past 4 decades, low socioeconomic development was associated with no improvement in IHD mortality rates for men or women, in contrast to the large reductions observed in settings with high socioeconomic development. In contemporary settings, socioeconomic deprivation is associated with larger relative excess mortality in women and larger absolute excess mortality in men.

Sex disparities in health of older adults in India: assessing the morbidity-mortality paradox through disability-free life expectancy

Background

Older adults face substantial sex gaps in health. In many contexts, females live longer than males, but their time spent with disability is also higher. Our study assesses (i) the sex gap (female-male) in health through life expectancy and healthy life expectancy and (ii) the morbidity-mortality paradox among older adults aged 60 and above in India and its states.

Methods

We utilized data on age-specific death rates obtained from the Sample Registration System and age-specific disability prevalence from the Longitudinal Ageing Survey (LASI) in India. We estimated abridged life tables between age groups 60-64 to 85 + using Greville's method. We then combined the disability data obtained from LASI with the constructed life tables using Sullivan's method to estimate disability-free life expectancy (DFLE) and life expectancy with disability (DLE). Finally, we decomposed the sex gap in DFLE and DLE into mortality and disability components using a stepwise replacement decomposition method.

Results

At the national level, life expectancy at age 60 for males were 17.4 years and for females 19.2 years, indicating a female mortality advantage of 1.8 years. At the state level, the sex gap ranged between 5.1 years in Jammu & Kashmir and -1.1 years in Jharkhand. The disability prevalence was higher among females compared to males at the national level and in all states. The decomposition result indicates that 98% of the mortality advantage of females at the national level was spent in disability. The disability disadvantage of females over their mortality advantage was highest in Uttar Pradesh; 93% of additional years of life were spent with disability. The disability disadvantage of females over their mortality advantage was lowest in Rajasthan where only 9% of additional years were spent in disability. Stepwise replacement decomposition of the sex gap in DFLE by age groups shows that as age increases, the contribution of mortality effects decreases, whereas disability effects increase.

Conclusions

We find evidence of a morbidity-mortality paradox in India nationally and sub-nationally. As the sex gap in health and its implications vary across the states of India, policies to address these inequities must also vary across the states.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41118-025-00247-2.

Time trends in multiple myeloma incidence and mortality across the BRICS from 1992 to 2021 and projection to 2046

OBJECTIVE

This study evaluates the long-term trends in Multiple Myeloma (MM) incidence, mortality, and Age-Period-Cohort (APC) effects in the BRICS nations (Brazil, Russia, India, China, and South Africa).

METHODS

Data on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and 95% uncertainty intervals (UIs), were obtained from the Global Burden of Disease Study 2021. Joinpoint regression model was used to estimate the average annual percentage change (AAPC) and annual percentage change (APC) trends from 1992 to 2021, and the Age-Period-Cohort model evaluated nonlinear impacts of age, period, and cohort effects. Projections to 2046 were calculated using Bayesian APC modeling.

RESULTS

From 1992 to 2021, MM incidence and death cases in the BRICS nations increased nearly four to fivefold, with ASIR and ASMR nearly doubling. China and India had lower ASIR and ASMR than other BRICS countries despite accounting for over half of cases and deaths. South Africa consistently had the highest ASIR and ASMR in both 1992 and 2021. China experienced a significant increase in ASIR (AAPC 4.92%, p < 0.001) and ASMR (AAPC 4.07%, p < 0.001) over the past three decades. MM incidence and mortality increased with aging, and the age effect on MM was more pronounced among individuals aged greater than 40 years. Birth cohorts' impact on MM varied greatly between BRICS, with China suffering the largest risk increase among those born after the 1970s. Projections indicate ASIR and ASMR will reach 2.44 and 1.82 per 100,000 by 2046, continuing to rise across the BRICS nations.

CONCLUSIONS

MM burden is rapidly increasing in the BRICS, closely tied to population aging. Targeted strategies addressing each country's unique challenges are essential as the burden continues to grow.

The effect of menopause on the associations between dietary intake and the 20-year incidence of cardiovascular disease in women: the ATTICA cohort study (2002-2022)

OBJECTIVES

The purpose of this study was to elucidate associations between incident cardiovascular disease and dietary risk factors in women classified by their menopausal status.

STUDY DESIGN

The ATTICA Study is a prospective cohort study initiated in 2001-2002 with a representative sample of 3042 adults (mean age 45 years) from the Attica region (Greece); follow-up examinations were performed after 5, 10, and 20 years Of the participants, 1528 (50.2 %) were women, of whom 65 % had not experienced menopause (35 % were in postmenopause at baseline). The sample for the present analysis comprised the 1001 women who had undergone cardiovascular assessment at the 20-year follow-up. Dietary habits were assessed through a validated food frequency questionnaire; the MedDietScore (range 0-55) evaluated adherence to the Mediterranean dietary pattern.

MAIN OUTCOME MEASURES

Cumulative fatal and non-fatal incidence of cardiovascular disease.

RESULTS

Compared with women before menopause, postmenopausal women had an unfavorable risk profile for cardiovascular disease -including dietary habits- at baseline examination, which was not fully explained by age. At the 20-year follow-up, postmenopausal women exhibited a higher cumulative incidence of cardiovascular disease (post-menopause: 813/1000; before-menopause: 71/1000; p-value = 0.011); age-adjusted analysis revealed that postmenopausal women had a 4.38 times (95 % CI 2.08, 9.21) higher risk of cardiovascular disease, compared with their counterparts. Higher MedDietScore was associated with a significant reduction in the 20-year risk of cardiovascular disease, with more prominent associations observed among postmenopausal women.

CONCLUSION

These findings highlight the urgent need for targeted public health initiatives to encourage preventive dietary strategies in women from an early age.

Global, region and country burden of osteoarthritis at different sites in middle-aged and elderly populations from 1990 to 2021: a systematic analysis of the 2021 global burden of disease study

Objective

To explore the burden and trend of osteoarthritis (OA) at different sites in middle-aged and elderly people (45 years and older) from 1990 to 2021.

Methods

Age-standardized incidence rates, prevalence rates, disability-adjusted life years (Daly) rates and average annual percent change were used to quantify the disease burden and trend of OA at different sites. Decomposition analysis was conducted to explore the impact of three population-level determinants on the burden of OA and the distribution of OA burden inequality in the Socio-Demographic Index (SDI) across countries.

Results

The age-standardized prevalence rate had increased by 8.9%, and the OA cases had increased by 2.41 times compared to 1990. The incidence and prevalence of knee, hip and hand OA decreased sequentially, while high SDI regions tended to have higher age-standardized incidence rates, prevalence rates, and Daly rates. Decomposition analysis revealed that 85.9% of the increase in OA age-standardized Daly rates was attributable to population growth. This increase was most pronounced in high SDI populations for hip OA and middle SDI populations for knee and hand OA. From 1990 to 2021, the inequality in overall OA burden between countries had decreased. The absolute inequality gap for hand OA had narrowed the most significantly (45.3%), which followed by knee OA (11.9%), while the inequality gap for hip OA has slightly increased.

Conclusion

In summary, all parts of the OA burden in middle-aged and elderly people had steadily increased from 1990 to 2021, which calls to implement personalized prevention targeting different parts of OA.

Temporal trend and attributable risk factors of cardiovascular disease burden for adults 55 years and older in 204 countries/territories from 1990 to 2021: an analysis for the Global Burden of Disease Study 2021

AIMS

The ageing global population and overall population growth have significantly increased the burden of cardiovascular diseases (CVDs). This study aims to examine global temporal trends in the incidence, disability-adjusted life years (DALYs), and mortality rates of both overall and type-specific CVDs among adults aged 55 and older from 1990 to 2021, with a focus on identifying changes over time, regional disparities, and the key risk factors contributing to this burden.

METHODS AND RESULTS

We analysed data from the Global Burden of Disease Study 2021, covering 204 countries and territories. Trends in age-standardized rates of incidence, DALY, and mortality for both overall and specific types of CVDs were assessed, alongside the impact of key risk factors. Between 1990 and 2021, global age-standardized incidence, DALY, and mortality rates showed a declining trend, with estimated annual percentage changes of -0.39, -1.30, and -1.11, respectively. However, due to overall population growth and ageing, the absolute number of CVD cases continued to rise. Regions with high-middle socio-demographic index (SDI) exhibited the highest incidence and mortality rates, while high SDI regions saw the greatest declines. Men had higher age-standardized rates of CVD incidence, DALY, and mortality compared with women. The burden increased with age, with the oldest age groups (80+ years) showing the highest rates. High systolic blood pressure was the leading modifiable risk factor, contributing to more than half of the CVD-related DALY globally. Other major risk factors included high LDL cholesterol, smoking, and ambient particulate matter pollution.

CONCLUSION

While age-standardized rates of CVD incidence, DALY, and mortality have declined over the past three decades, the total burden of CVDs continues to rise due to population ageing and growth. These findings highlight the need for targeted prevention strategies in regions with high CVD burden, particularly those with lower socioeconomic status.

Cohort profile: the CORDELIA study (Collaborative cOhorts Reassembled Data to study mEchanisms and Longterm Incidence of chronic diseAses)

The CORDELIA Study (Collaborative Cohorts Reassembled Data to Study Mechanisms and Long-term Incidence of Chronic Diseases) combines 35 Spanish population cohorts to investigate the clinical, environmental, genetic, and omics determinants of cardiovascular disease in the Southern European population. It aims to conduct the largest genome-wide association study to date on cardiovascular disease in this population, improve predictions of cardiovascular incidence using genomic and clinical data, and identify subgroups that would benefit most from targeted pharmacological and lifestyle interventions. CORDELIA includes 196,632 individuals (ages 18-84, 54% female, 96% born in Spain, 20% with higher education, recruited from 1989 to 2020, with follow-up periods ranging from 5 to 30 years), with DNA samples available for 117,342 participants (60%). Of the participants, 24% were current smokers, 43% hypertensive, 11% diabetic, 15% medicated with lipid-lowering drugs, 44% overweight, and 27% obese. If not already available, genotyping is being performed using the Axiom™ Spain Biobank array (~ 750,000 variants, including 115,000 specific and 50,000 rare functional variants from the Spanish population). The cohort also includes incident events (coronary heart disease, stroke, heart failure, peripheral artery disease, hypertension, diabetes); date and cause of death; and harmonized data on risk factors (body mass index, waist circumference, lipid profile, blood pressure, glucose, creatinine), lifestyle (smoking, physical activity, diet, alcohol), and socioeconomic status. 99,019 participants (50%) also provide plasma samples. CORDELIA will significantly contribute to understanding the complex interplay of risk factors contributing to cardiovascular disease and advance the fields of precision medicine and public health in Southern European individuals.

Global burden and cross-country inequalities in gallbladder and biliary tract cancer (1990-2021) with projections to 2050: insights from the global burden of disease study 2021

Background

Gallbladder and biliary tract cancer (GBTC) presents a worldwide health challenge with a poor prognosis. Previous studies indicated an escalating burden and potential health inequalities, necessitating an updated investigation.

Methods

This study utilized data from the Global Burden of Disease (GBD) study, covering 204 countries from 1990 to 2021. Joinpoint regression evaluated temporal trends in age-standardized incidence rates (ASIR) and age-standardized disability-adjusted life years rates (ASDR) for GBTC. The Bayesian age-period-cohort (BAPC) model projected disease burden up to 2050. Inequality analysis assessed disparities by genders across countries, and decomposition analysis determined the contributions of demographic and epidemiological factors.

Results

From 1990 to 2021, the incident cases of GBTC increased from 107,797 to 216,768, while Disability-Adjusted Life Years (DALYs) rose from 2,326,089 years to 3,732,121. Joinpoint regression analysis revealed a global decrease in ASIR (AAPC = -0.39, 95% CI: -0.49 to -0.28) and ASDR (AAPC = -0.97, 95% CI: -1.07 to -0.88). Gender disparities were notable, with a polar reversal observed: females exhibited consistently higher ASDR levels across three decades, although both ASDR and ASIR showed continuous decreases. In contrast, males experienced a decreased ASDR but increased ASIR, with both metrics eventually surpassing those of females. The projection model also suggested diverging ASIR trends between genders. Cross-country inequality analysis revealed persistent disparities, where higher SDI countries continue to bear a greater burden, and global improvement in health equity for males remains insufficient. Decomposition analysis indicated that population growth and ageing were primary drivers of disease burden increase, whereas epidemiological changes contributed to a reduction, particularly in higher SDI quintiles.

Conclusion

Despite improvements, GBTC burden is still greater in high SDI regions compared to lower SDI areas, contrary to expectations. Unexpected polar reversal of gender differences warrants further attention.

Six-Axis, Physiological Activity Profiles Create a More Challenging Cellular Environment in the Intervertebral Disc Compared to Single-Axis Loading

Bioreactors provide a valuable way to explore interactions between the mechanical and biological environments of the intervertebral disc (IVD), but the replication of ecologically valid loading protocols is a huge challenge. The aim of this study was to address this through the combination of time use survey data and six-axis load data from in vivo measurements during functional movements and activities of daily living to create population-based activity profiles, which were employed using a unique six-axis bioreactor and a whole-organ bovine tail IVD model. The results of the study show that six-axis activity profiles create a more challenging environment compared to single-axis loading or unloaded controls, resulting in lower cell viability in both the nucleus pulposus and annulus fibrosus regions of the IVD. Additionally, the six-axis activity profile representing a more active lifestyle led to an even lower cell viability in the annulus fibrosus, which may be due to the increased strains in this region of the IVD during activities of daily living. These findings highlight the importance of considering a wide range of activities and lifestyles in the development and evaluation of regenerative therapies and preventative interventions for IVD, if they are to be successfully translated to the clinical setting.

Global, regional, and national burden of congenital musculoskeletal and limb anomalies, 1990-2021: a systematic analysis of the global burden of disease in 2021

BACKGROUND

Congenital musculoskeletal and limb (CML) anomalies are uncommon, multifactorial conditions whose global incidence trends remain underexplored. This study delineates the epidemiology and temporal evolution of CML anomalies from 1990 to 2021.

METHODS

We extracted data from the 2021 global burden of disease (GBD) Study, stratifying by sex, region, country and socio-demographic index (SDI). We calculated age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and estimated annual percentage change (EAPC). Decomposition analysis quantified the contributions of population growth, aging, and epidemiological change. Projections to 2031 were made using an autoregressive integrated moving average (ARIMA) model. Health inequities were assessed via the slope index of inequality (SII) and concentration index (CI).

RESULTS

Global epidemiological patterns of CML anomalies exhibited significant disparities between 1990 and 2021. Brunei Darussalam demonstrated the highest ASIR, while Afghanistan and the United Mexican States recorded the highest ASMR and ASPR, respectively. Absolute case and death burdens predominantly clustered in populous nations, with India and China reporting the highest absolute numbers. ARIMA modeling projected a 0.85% increase in incident cases (from 2,437,890.12 to 2,458,596.45), a 25.46% decrease in mortality (from 13,599.83 to 10,137.02), and a 3.55% increase in prevalence (from 18,549,408.27 to 19,207,414.19) by 2031. Decomposition analyses revealed that population growth was the primary driver of increased cases in middle SDI regions, whereas epidemiological transitions and aging were the main contributors to mortality reductions. In lower-middle SDI regions, concurrent demographic expansion and epidemiological changes amplified case burdens. Health inequality significantly increased, with the incidence CI rising from 0.28 to 0.35 and the mortality CI from 0.34 to 0.42 between 1990 and 2021. Significant correlations were observed between EAPC and baseline ASIR/ASMR, with declining trends in mortality and rising prevalence driven by population growth and epidemiological transitions.

CONCLUSION

From 1990 to 2021, CML anomalies' incidence and mortality exhibited divergent trends across SDI strata, with less favorable outcomes in lower-SDI countries. Tailored interventions are essential to mitigate the growing burden in these settings.

Global burden of motor neuron disease: unraveling socioeconomic disparities, aging dynamics, and divergent future trajectories (1990-2040)

BACKGROUND AND OBJECTIVES

Motor neuron disease (MND) is a progressive neurodegenerative disorder associated with high morbidity and mortality. With global aging, the burden of MND is expected to increase, particularly in regions with rapidly aging populations. This study utilizes Global Burden of Disease (GBD) 2021 data to assess the global and regional MND burden from 1990 to 2021, examining trends by age, sex, and socio-demographic index (SDI), and projecting future trends to 2040.

METHODS

Data from the GBD 2021 database for the years 1990-2021 were analyzed to evaluate age-standardized prevalence rates (ASPR), incidence rates (ASIR), mortality rates (ASMR), and disability-adjusted life years (DALYs) for MND across SDI regions, age groups, and sexes. Temporal trends were explored using joinpoint regression analysis, while future projections were generated using the Bayesian age-period-cohort (BAPC) model for 2021-2040.

RESULTS

From 1990 to 2021, global MND prevalence increased by 68.43%, reaching 272,732 cases, while the age-standardized prevalence rate (ASPR) slightly declined, reflecting the influence of population aging. Although global incidence increased by 74.54%, the age-standardized incidence rate (ASIR) showed a modest decline, suggesting improvements in diagnostic practices. Mortality and DALY rates continued to rise globally, with high-SDI regions bearing the highest burden. Projections indicate that by 2040, global MND prevalence will decline slightly, while incidence, mortality, and DALYs will continue to rise in low- and middle-SDI regions due to aging populations.

DISCUSSION

The global MND burden is heavily influenced by aging, particularly in high-SDI regions. Although incidence rates have slightly decreased, mortality and disability burdens are increasing, highlighting ongoing challenges in disease management and treatment. The findings stress the importance of age-targeted interventions, improving healthcare access, and addressing socio-economic disparities to mitigate the future impact of MND, particularly in low- and middle-SDI regions.

A cross-sectional analysis based on GBD data: trends in the global, regional, and national burden of pelvic organ prolapse from 1990 to 2021

Background

Pelvic organ prolapse (POP) is a prevalent condition affecting millions of women globally. Understanding its temporal trends and regional disparities is essential for effective public health interventions.

Methods

A cross-sectional analysis was conducted using data from the Global Burden of Disease (GBD) study, examining trends in POP incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021. We analyzed the estimated annual percentage change (EAPC) and explored the association with the socio-demographic index (SDI).

Results

From 1990 to 2021, global POP cases increased from approximately 8.4 million to 14.0 million, while the age-standardized incidence rate (ASIR) declined from 374.84 to 317.51 per 100,000 population (EAPC = -0.46). Deaths rose from 281 to 486, but the age-standardized death rate (ASDR) remained stable. DALYs increased from 232,432 to 389,358, with a decrease in age-standardized DALY rate (EAPC = -0.59). Low-SDI regions exhibited the highest ASIR, ASDR, and DALYs in 2021.

Conclusion

The global burden of pelvic organ prolapse has increased in absolute numbers, although age-standardized rates have declined. Low-SDI regions continue to face the highest burden, highlighting the need for targeted healthcare interventions.

Trends in the burden of chronic diseases attributable to diet-related risk factors from 1990 to 2021 and the global projections through 2030: a population-based study

Background

The global burden of diet-related chronic diseases and their future projections remain unclear. To address this gap, we present the latest data on deaths and disability-adjusted life years attributable to dietary factors from 1990 to 2021, focusing on noncommunicable diseases worldwide. Additionally, we provide predictions of mortality rates across different age groups through 2030.

Methods

Data from the Global Burden of Disease Study 2021 were analyzed to evaluate correlations between dietary factors and trends in chronic disease burden over a 30-year period. Moreover, we predicted the burden of chronic dietary diseases up to 2030.

Results

From 1990 to 2021, global age-standardized mortality rates and disability-adjusted life year (DALY) rates associated with dietary factors decreased by approximately one-third for neoplasms and cardiovascular diseases (CVDs). In high sociodemographic index (SDI) regions, neoplasm-related deaths showed a stronger correlation with dietary factors, particularly high red meat intake. In cardiovascular diseases, the leading dietary factors are low-grain diets, whereas in diabetes, it is due to increased intake of processed meat. In low-SDI regions, diets low in vegetables showed the strongest association with neoplasm-related mortality, while diets low in fruits were significantly linked to CVD and diabetes burden. High-sodium diet was a significant risk factor for CVD in the middle-SDI regions. Moreover, the 2030 projections indicated a decline in mortality from neoplasms and CVDs, with a slight increase in mortality rates from diabetes.

Conclusion

The global burden of chronic diseases linked to dietary factors shows varying trends across different countries and regions, particularly influenced by their economic development levels. This variation underscores the necessity of enhancing dietary structures to mitigate chronic disease prevalence and foster overall health.

Association of platelet-to-high-density lipoprotein cholesterol ratio and its cumulative exposure with cardiovascular disease risk: a prospective cohort study in Chinese population

Objective

This study aimed to investigate the association of platelet-to-high-density lipoprotein cholesterol ratio (PHR) and its cumulative exposure with cardiovascular disease (CVD) risk.

Methods

The investigation utilized data from the China Health and Retirement Longitudinal Study (CHARLS). Platelet-to-high-density lipoprotein cholesterol ratio was calculated as platelet count (×10⁹/L)/high-density lipoprotein cholesterol (mmol/L), and a cumulative platelet-to-high-density lipoprotein cholesterol ratio (Cumulative PHR) was derived for longitudinal assessment. Multivariable logistic regression models were used to evaluate the association between PHR, cumulative PHR, and CVD risk across three models with increasing adjustments for confounders. Restricted cubic splines (RCS) regressions were utilized to examine if there were non-linear relationships. Subgroup analyses were conducted to enhance the reliability of the study findings. Furthermore, predictive performance was assessed using concordance index (C-index), net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results

A total of 7,063 participants aged 45 and older were included, of whom 1,433 (20.29%) experienced a cardiovascular disease. Participants with CVD had higher PHR (167.93 vs. 156.84, P < 0.001) and Log PHR (5.12 vs. 5.06, P < 0.001) values compared to non-CVD participants. Multivariable logistic regression revealed that Log PHR was independently associated with CVD risk [Odds ratio (OR) per-unit: 1.30, 95% confidence interval (CI): 1.13-1.49, P < 0.001; OR per- standard deviation (SD): 1.13, 95% CI: 1.06-1.21, P < 0.001]. Log cumulative PHR showed similar associations (OR per-unit: 1.34, 95% CI: 1.05-1.71, P = 0.02). Participants in the highest quartile of Log PHR had a nearly 1.32-fold higher risk of CVD compared to the lowest quartile (OR: 1.32, 95% CI: 1.10-1.57, P = 0.002). Addition of Log PHR and Log cumulative PHR slightly improved predictive performance metrics of baseline model.

Conclusion

Both Log PHR and Log cumulative PHR are independently associated with increased CVD risk and slightly improved the predictive performance of the baseline risk model. Future research should focus on its clinical implementation and integration into existing risk assessment frameworks.

Global Burden of type 2 diabetes in non-elderly individuals 1990 to 2021 and projections for 2050: a systematic analysis of the 2021 Global Burden of Disease

BACKGROUND

Type 2 diabetes (T2D) is increasingly becoming a major global health challenge. However, research on T2D in non-elderly populations remains insufficient.

METHODS

We analyzed data from the Global Burden of Disease (GBD) study in 2021, focusing on diabetes-related indicators among individuals aged 15 to 59 across 204 countries and regions. This included prevalence, incidence, mortality, and Disability-Adjusted Life Years (DALYs), categorized into 21 GBD regions according to the Sociodemographic Index (SDI). We employed join-point regression and Bayesian Age-Period-Cohort models to assess trends from 1990 to 2021 and forecast from 2021 to 2050.

RESULTS

The global age-standardized incidence rate increased from 196.3 per 100,000 (95 % UI, 145.2-257.4) in 1990 to 361.1 per 100,000 (95 % UI, 275.2-458.4) in 2021. The prevalence, mortality rate, and DALYs exhibit a similar upward trend. Although both men and women have experienced rises in prevalence, incidence, mortality rate, and DALYs, men continue to lead these metrics across nearly all age groups. Low-middle SDI countries bear the most severe disease burden. A high body mass index is a major risk factor in this population. It is estimated that by 2050, approximately 1.195 billion non-elderly individuals worldwide will have T2D, with epidemiological changes being the primary driver of this disease burden.

CONCLUSIONS

This study on the burden of T2D reveals that its prevalence among non-elderly individuals is steadily increasing and is projected to affect over a billion people worldwide by 2050. Targeted measures are crucial to tackle this global health challenge for this population.

RAGE/AP-1/OTR signaling pathway in rat hippocampus DG involved in CUS induced depressive-like behaviors

There has been a growing body of evidence indicating that the oxytocin (OT) system plays a significant role in the neurophysiology of chronic stress-related mood disorders in recent years. However, the precise alterations for the OT system in response to chronic stress and the underlying mechanism remains unclear. The present study demonstrated that chronic unpredictable stress (CUS) resulted in a reduction in the expression of RAGE and OTR, as well as an inhibition of AP-1 phosphorylation. RAGE knockdown in hippocampus DG induced depressive-like behaviors, down-regulated the OTR protein and mRNA levels, and reduced the AP-1 phosphorylation. The administration of OT via the nasal route reversed the depressive-like behaviors induced by RAGE knockdown, increased the levels of BDNF expression and AP-1 phosphorylation. On the other hand, RAGE over-expression in the hippocampus DG resisted the effects of CUS on depression-like behaviors, AP-1 phosphorylation, and OTR expression. These finding suggested that RAGE signaling pathway is involved in CUS induced depressive-like behaviors at least partially by regulating OTR expression.

Global, regional, and national burden of cardiovascular diseases attributable to metabolic risks across all age groups from 1990 to 2021: an analysis of the 2021 global burden of disease study data

OBJECTIVE

The objective is to evaluate the temporal trends in the burden of cardiovascular diseases attributable to metabolic risk factors from 1990 to 2021 and to project the burden over the subsequent 30 years.

METHODS

A joinpoint regression model was employed to estimate the annual percentage change in cardiovascular disease mortality attributable to metabolic risk factors, utilizing data from the Global Burden of Disease (GBD) 2021. An age-period-cohort analysis was conducted to evaluate the effects of age, period, and cohort. A frontier analysis was employed to investigate the correlation between the prevalence of cardiovascular disease attributable to metabolic risk factors and socio-demographic trends. An autoregressive integrated moving average (ARIMA) model was subsequently constructed to forecast future cardiovascular disease burden.

RESULTS

Between 1990 and 2021, the global age-standardized mortality rate (ASMR) of cardiovascular diseases attributable to metabolic factors exhibited a consistent decline (Average Annual Percent Change (AAPC) = -1.28, 95% CI [-1.42, -1.14], P < 0.01). However, the absolute number of deaths increased from 8.326 million to 13.595 million. The most substantial reduction in ASMR was observed in the High Socio-Demographic Index (SDI) region (AAPC = -2.98, 95% CI [-3.10, -2.86], P < 0.01), whereas the reductions were relatively smaller in the Low-middle SDI and Low SDI regions. The ARIMA model predicts a decline in global cardiovascular disease mortality over the next three decades, with the most pronounced decrease anticipated in the high-middle SDI region and smaller declines expected in the middle SDI and low SDI regions.

CONCLUSION

Notwithstanding a global decline in age-standardized mortality and disability-adjusted life year (DALY) rates, the burden of cardiovascular diseases attributable to metabolic factors remains significant worldwide. Targeted interventions must be implemented without delay, particularly for males and populations in low and middle SDI regions, to mitigate the impact of metabolic factors on public health.

A comparative analysis of the burden, trends and inequalities of tracheal, bronchus, and lung cancer in India from 2000 to 2021: A systematic analysis for the Global Burden of Disease study 2021

BACKGROUND

Understanding the tracheal, bronchus, and lung (TBL) cancer burden caused by tobacco exposure in India can help local governments implement targeted measures for prevention and treatment of the disease.

METHODS

The burden of TBL cancer deaths and disability-adjusted life years (DALYs) attributable to tobacco exposure from 2000 to 2021 were presented by age, sex, and region. A Joinpoint model was used to analyze temporal trends of the disease, while decomposition analysis was conducted to quantify the contributions of population growth, aging, and epidemiological changes. In addition, the age-period-cohort (APC) model was implemented to assess the effects of age, period, and cohort on tobacco-related TBL cancer deaths and DALYs burden. Finally, age-standardized deaths and DALYs rates for TBL cancer attributable to tobacco exposure were projected through 2035.

RESULTS

In 2021, Mizoram recorded the highest age-standardized rates of TBL cancer deaths and DALYs attributable to tobacco exposure, regardless of sex. Uttar Pradesh and West Bengal consistently exhibited the highest number of deaths and DALYs associated with tobacco exposure across the three age groups analyzed. Population growth and aging are the primary drivers behind the increasing burden of TBL cancer. Overall, the risk of tobacco-related lung cancer death increased with age. There are differential period and cohort effects between male and female populations. In the future, the increase in age-standardized rates of deaths and DALYs attributable to secondhand smoke exposure will be more pronounced among males.

CONCLUSION

Despite ongoing efforts to control the tobacco epidemic, the burden of TBL cancer related to tobacco remains high in India. Each state in India should adopt targeted measures based on local conditions to address the health threats posed by tobacco.

Second hand smoke attributable disease burden in 204 countries and territories, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND

We aimed to estimate the changes in, second hand smoke (SHS) and potential drivers of its health outcome from 1990 to 2021 worldwide.

METHODS

The data was derived from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, which covered 204 countries and territories. We reported SHS changes by sex, year and sociodemographic index (SDI) level (a summary measure that identifies where countries or other geographic areas sit on the spectrum of development) from 1990 to 2021. We analyzed the risk-outcome pairs among all age groups to estimate disease burden attributable to SHS exposure and also did a decomposition method to attribute changes in all-cause SHS attributable deaths or disability-adjusted life years (DALYs) to population growth, population aging, and mortality change.

RESULTS

Worldwide, the age-standardized summary exposure values (SEV) of SHS exposure in 2021 was 30.6% (28.9 to 31.6) for males and 38.0% (35.5 to 39.0) for females, with a percentage change of -0.2 (-0.2 to -0.1) and -0.3 (-0.3 to -0.2), respectively, since 1990. Among the top 10 countries with the highest SEV, there were mainly high-middle SDI countries for male and low-middle SDI and middle SDI countries for female, respectively. Secondly, about 1.29 million deaths (0.68-1.90) and 34.90 million DALYs (17.95-52.21) were attributable to SHS exposure, and about half of them took place in two countries (China and India). Ischemic heart disease (IHD) (29.67%), chronic obstructive pulmonary disease (COPD) (19.04%), and lower respiratory infections (LRIs) (10.87%) were the three leading causes of SHS associated deaths. Lastly, since 2010, the number of SHS related death significantly increased due to population growth and population aging, despite a decrease in mortality attributable to SHS exposure.

CONCLUSION

Globally, the age-standardized SEV of SHS exposure decreased from 1990 to 2021. Since 2010, the increased number of deaths attributable to SHS exposure was mainly attributable to population growth and aging.

Global Burden of Eye Injuries in Children and Adolescents, 1990 to 2021: A Systematic Analysis From the Global Burden of Disease Study

PURPOSE

Eye injuries are a leading cause of monocular vision impairment and disability in children and adolescents. Unlike adults, eye injuries in children exhibit significant age specificity, with worse visual outcomes due to immature vision, the risk of long-term damage, and amblyopia. However, research on the global distribution and trends of eye injury burdens in this population is limited.

DESIGN

Retrospective population-based trend study.

METHODS

This study analyzes the burden of eye injuries among children and adolescents aged 0 to 19 years globally, regionally, and nationally, using data from the 2021 Global Burden of Disease study. We evaluated the epidemiological characteristics of eye injuries by calculating incidence, years lived with disability (YLD), age-standardized incidence rates (ASIR), and age-standardized YLD rates (ASYR). Temporal trends in ASIR and ASYR from 1990 to 2021 were assessed using joinpoint regression analysis, expressed as average annual percentage changes. The analysis was further stratified by sex, age, and sociodemographic index (SDI) to explore trends in different subgroups.

RESULTS

In 2021, the global ASIR and ASYR for children and adolescents were 434.24 per 100,000 (95% confidence interval [CI], 305.17-603.22) and 3.19 per 100,000 (95% CI, 0.96-6.99), respectively, indicating a decline since 1990. Regions with high SDI showed the highest incidence of eye injuries. Australasia, Southern Latin America, and Western Europe had the highest ASIRs and ASYRs in both 1990 and 2021. From 1990 to 2021, Afghanistan, Yemen, Libya, the Central African Republic, and Chile experienced the most significant increases in pediatric eye injuries. Global data show that boys have an eye injury incidence rate approximately 1.8 times higher than that of girls. In 2021, the incidence of eye injuries among children and adolescents increased with age. The primary causes include foreign bodies, exposure to mechanical forces, and falls.

CONCLUSIONS

Despite observed declines in incidence and YLD, the burden of eye injuries in children and adolescents remains substantial. These findings underscore the urgent need for the development and implementation of targeted preventive education initiatives and ocular protection protocols on a global scale.

Multi-sector determinants of implementation and sustainment for non-specialist treatment of depression and post-traumatic stress disorder in Kenya: a concept mapping study

BACKGROUND

The global shortage of trained mental health workers disproportionately impacts mental health care access in low- and middle-income countries. In Kenya, effective strategies are needed to scale-up the workforce to meet the demand for depression and post-traumatic stress disorder treatment. Task-shifting - delegating specific tasks to non-specialist workers - is one workforce expansion approach. However, non-specialist workers remain underutilized in Kenya due to a paucity of research on how to scale-up and sustain such service models.

METHODS

Purposive sampling was used to recruit experts from policy, healthcare practice, research, and mental health advocacy roles in Kenya (N = 30). Participants completed concept mapping activities to explore factors likely to facilitate or hinder a collaborative Ministry of Health-researcher training of the mental health non-specialist workforce. Participants brainstormed 71 statements describing determinants and implementation strategies, sorted and rated the importance and changeability of each. Multidimensional scaling and hierarchical cluster analysis quantified relationships between statements. The Exploration, Preparation, Implementation, and Sustainment (EPIS) framework guided cluster interpretation activities.

RESULTS

Twelve determinant clusters were identified: 1) Current workforce characteristics, 2) Exploration considerations, 3) Preparation considerations, 4) Sustainment considerations, 5) Inner context implementation processes and tools, 6) Local capacity and partnerships, 7) Financing for community health teams, 8) Outer context resource allocation/policy into action, 9) Workforce characteristics to enhance during implementation, 10) Workforce implementation strategies, 11) Cross-level workforce strategies, and 12) Training and education recommendations. Cluster 8 was rated the most important and changeable.

CONCLUSION

Concept mapping offers a rapid, community-engaged approach for identifying determinants and implementation strategies to address workforce shortages. Organizing results by EPIS phases can help prioritize strategy deployment to achieve implementation goals. Scale-up and sustainment of the non-specialist workforce in Kenya requires formal partnerships between the Ministry of Health and community health worker teams to distribute financial resources and collaboratively standardize training curriculum.

Quantifying the loss of healthy life expectancy due to population ageing: health benefit estimation from a global perspective

STUDY OBJECTIVE

Investing in health to improve healthy life expectancy (HLE) is fundamental to create a demographic dividend. However, how dramatic population ageing affects HLE remains unknown. This study aims to quantify and project the major diseases and injuries attributed to changes in population size and age structure that contributed to substantial losses in HLE.

METHODS

Using data from 188 countries in the Global Burden of Disease Study 2021 and World Population Prospects 2024, we assessed the correlation between HLE and total dependency ratios. Furthermore, we decomposed the mortality and disability burden attributable to changes in population size as well as age structure for 22 disease and injury categories and then quantified the loss of HLE due to the attributable burden. Additionally, we projected the loss of HLE due to priority diseases in 2030, while considering the impact of population ageing.

RESULTS

From 2010 to 2019, globally, the mortality and disability burden attributable to age structure caused 0.40 years and 0.71 years of HLE loss, while for population size, these two estimates were 1.18 years and 1.00 years. By 2030, the mortality and disability burden attributable to age structure may lead to 0.76 years and 0.89 years of HLE loss, while for population size, these two predictions will be 1.21 years and 1.17 years.

DISCUSSION

Population size growth is a consistent and crucial contributor to HLE losses. Reaping the second demographic dividend requires eliminating the double burden of premature death caused by infectious and chronic diseases, whereas gaining the sustainable third demographic dividend requires investments in healthy and successful ageing.

Global Trends and Regional Differences in the Burden of Infective Endocarditis, 1990-2021: An Analysis of the Global Burden of Disease Study 2021

BACKGROUND

The study aimed to offer detailed insights into the global, regional, and national burden of IE in 2021, while also examining the temporal trends of IE from 1990 to 2021.

METHODS

Data on the absolute numbers and age-standardized rates (ASR) of incidence, deaths, and disability-adjusted life years (DALYs) related to IE were sourced from the Global Burden of Disease Study (GBD) 2021. The estimated annual percentage changes (EAPC) of ASR were calculated to quantify the temporal trends. Furthermore, joinpoint regression models were used to identify the temporal trends and the primary joinpoint year of ASR.

RESULTS

Globally, the age-standardized incidence rate (ASIR) for IE increased with an EAPC of 1.00 (95%CI: 0.93-1.08) from 9.35 per 100 000 population in 1990 to 12.61 per 100 000 population in 2021. Despite a rise in the absolute number of death cases and DALYs related to IE, the age-standardized mortality rate (ASMR) has remained stable (EAPC 0.06, 95%CI: -0.10-0.22), and the age-standardized DALYs rate (ASDR) has exhibited a decline (EAPC - 0.34, 95%CI: -0.45-0.24) between 1990 and 2021. Males bore a higher burden of IE compared to females, with the peak burden gradually shifting towards older individuals. In 2021, the ASIR for IE exhibited an increase with the rise in socio-demographic index (SDI) quintiles, with the highest ASIR observed in the high SDI region (15.77 per 100 000 population). Moreover, the highest growth rates of ASIR, ASMR, and ASDR were also noted in the high SDI region. On the other hand, the ASMR (1.34 per 100 000 population) and ASDR (40.71 per 100 000 population) for IE were relatively high in the low SDI region. Joinpoint analysis demonstrated that the ASIR, ASMR, and ASDR did not experience any sudden surges either globally or across different SDI regions after 2007.

CONCLUSIONS

The burden of IE remained relatively high, characterized by a rising ASIR and a stable ASMR on a global scale. This burden was notably prominent among males, the elderly, and in the high and low SDI regions. Region-specific prevention and management strategies might be warranted to reduce the burden of IE.

TNF induces catabolism in human cartilaginous endplate cells in 3D agarose culture under dynamic compression

Intervertebral disc (IVD) degeneration is the leading cause of low back pain in young adults, and the cartilaginous endplate (CEP) is likely to play a key role in early IVD degeneration. To elucidate the effects of pro-inflammatory cytokines on the mechanobiology of the CEP, human CEP cells were seeded into 2% agarose, dynamically compressed up to 7%, and stimulated with tumor necrosis factor (TNF). It was hypothesized that dynamic compression would be sufficient to induce anabolism, while stimulation with TNF would induce catabolism. TNF was sufficient to induce a catabolic, time-dependent response in human CEP cells through downregulation of anabolic gene expression and increased secretion of pro-inflammatory proteins associated with herniated discs, bacteria inhibition, and pain. However, 7% strain or scaffold material, agarose, may not lead to full activation of integrins and downregulation of pro-inflammatory pathways, demonstrated in part through the unchanged gene expression of integrin subunits α5 and β1.

The epidemiology of asthma and its attributable risk factors from 1990 to 2021: A systematic analysis based on the Global Burden of Disease Study 2021 and Mendelian Randomization Studies

OBJECTIVES

Asthma is a commonly occurring condition due to chronic inflammation of the lower respiratory tract. This study aims to assess the global burden of asthma from 1990 to 2021 and the mortality trends caused by specific risk factors.

STUDY DESIGN

Systematic analysis based on the Global Burden of Disease Study 2021 and Mendelian Randomization studies.

METHODS

Based on a global asthma scale spanning from 1990 to 2021, we performed a secondary analysis to explore the incidence, mortality, and disability-adjusted life-years (DALYs), along with risk factors for asthma. Mendelian randomization (MR) analyses were performed to verify the results.

RESULTS

In 2021, there were 41,555,628 incident cases of asthma worldwide. Cases of asthma decreased by 0.09 % (95 % uncertainty interval [UI]: 0.12,0.06) from 1990 to 2021. Over the past three decades, asthma-associated deaths increased from 374,377 (95 % UI: 304,600-492,653) to 436,192 (95 % UI: 357,795-555,604). The global incidence rate decreased from 736.99 (95 % UI: 615.03-905.18) to 516.70 (95 % UI: 425.36-646.13) per 100,000 population; the asthma-associated mortality rate decreased from 9.64 (95 % UI: 7.76-12.80) to 5.20 (95 % UI: 4.27-6.59) per 100,000 population. Age-specific incidence and prevalence rates peaked in individuals under nine years old. The prevalence and incidence rates of asthma were relatively higher in individuals in countries with higher Socio-demographic Index (SDI); however, mortality and DALYs rates of individuals with asthma showed a reverse trend. Globally, occupational asthmagens, body mass index, smoking, and air pollution were key risk factors for asthma-associated mortality and DALYs in 2021. MR analyses further confirmed the strongly related correlation between body mass index, occupational asthmagens and asthma.

CONCLUSIONS

Although a mild decrease in total incidence cases of asthma was observed from 1990 to 2021, asthma has still continued to pose a life-threatening burden worldwide overall. Generally, asthma frequently occurred at younger ages and is more prevalent in high-SDI countries, indicating that specific periodic and regional features exist. Improved understanding of the epidemiology of asthma could facilitate future interventions to better manage the disease globally and support future investigation on the diagnosis and treatment of asthma.

Burden of Congenital Heart Anomalies in North Africa and the Middle East, 1990 to 2021: A Systematic Analysis for the Global Burden of Disease Study 2021

BACKGROUND

Congenital heart anomalies (CHAs) remain a significant global health burden despite advances in diagnosis and management. Data on CHA burden in North Africa and the Middle East region are scarce. This study aimed to estimate CHA trends from 1990 to 2021.

METHODS AND RESULTS

Using the Global Burden of Disease Research 2021 database, we assessed CHA incidence, prevalence, mortality, and disability-adjusted life years (DALYs), stratified by age, sex, and sociodemographic index (SDI) at regional and national levels. Decomposition analysis was used to evaluate the impact of population growth on CHA incidence. In 2021, CHAs caused 35 272 deaths (95% uncertainty interval [UI], 28 067-43 670) and 3 181 543 DALYs (95% UI, 2 544 864-3 899 408) in the North Africa and the Middle East region. Incidence and prevalence increased by 13% (95% CI, 10-17) and 70% (95% CI, 67-74), respectively, whereas CHA-related deaths and DALYs declined by 63% (95% CI, 28-73). Infants <12 months of age accounted for 74.9% of deaths and DALYs, with half occurring within the first month. High-SDI countries had the lowest CHA-related DALYs, whereas middle-SDI countries showed the most substantial decline in mortality. Decomposition analysis highlighted that the actual CHA incidence is lower than expected despite population growth.

CONCLUSIONS

Although CHA incidence and prevalence increased, mortality and DALYs decreased, particularly in middle-SDI countries. The highest burden was among infants, with better outcomes in higher-SDI nations. More effective strategies are needed to reduce the preventable childhood deaths related to CHAs in the North Africa and the Middle East region.

The role of community pharmacists in managing common headache disorders, and their integration within structured headache services: position statement on behalf of the European Headache Federation (EHF) and Lifting The Burden (LTB: the Global Campaign against Headache), with the formal endorsement of the International Pharmaceutical Federation

In the sustainable development goals (SDG) context of seeking universal health coverage, the expanding gap between the supply of specialized and primary health-care providers of headache-related health care and the care needs of the very large number of people affected by headache is a formidable but not insoluble public-health challenge. Structured headache services provide a cost-effective framework wherein controlled patient flows enable the care needs of people with headache to be met at appropriate levels, but these services may still be overwhelmed by inappropriate demand.Community pharmacists are an underutilized resource, potentially well able to provide the solution. To do so, they must, as a profession, be integrated into structured headache services.What remains to be determined is how to achieve this integration in an encouraging climate for change, which recognises the potential for relieving strained health-care systems and meeting a range of health-care needs by expanding pharmacists' scope of practice.This position statement on behalf of the European Headache Federation (EHF) and Lifting The Burden (LTB) is formally endorsed by the International Pharmaceutical Federation (FIP).

Neuron-Derived Extracellular Vesicles: Emerging Regulators in Central Nervous System Disease Progression

The diagnosis and exploration of central nervous system (CNS) diseases remain challenging due to the blood-brain barrier (BBB), complex signaling pathways, and heterogeneous clinical manifestations. Neurons, as the core functional units of the CNS, play a pivotal role in CNS disease progression. Extracellular vesicles (EVs), capable of crossing the BBB, facilitate intercellular and cell-extracellular matrix (ECM) communication, making neuron-derived extracellular vesicles (NDEVs) a focal point of research. Recent studies reveal that NDEVs, carrying various bioactive substances, can exert either pathogenic or protective effects in numerous CNS diseases. Additionally, NDEVs show significant potential as biomarkers for CNS diseases. This review summarizes the emerging roles of NDEVs in CNS diseases, including Alzheimer's disease, depression, traumatic brain injury, schizophrenia, ischemic stroke, Parkinson's disease, amyotrophic lateral sclerosis, and multiple sclerosis. It aims to provide a novel perspective on developing therapeutic and diagnostic strategies for CNS diseases through the study of NDEVs.

Metabolic Syndrome Evolution and Cardio-Kidney-Metabolic Multimorbidity: Implications for Targeted Prevention

BACKGROUND

Metabolic syndrome (MetS) is an important criterion for clinicians in assessing cardio-kidney-metabolic diseases, yet the association between longitudinal evolution of MetS and cardio-kidney-metabolic disease multimorbidity remains unclear.

OBJECTIVES

The purpose of this study was to investigate the extent of increased multimorbidity risk in individuals recovered from MetS and investigate the mediation of Life's Essential 8 (LE8) score on MetS transition patterns and risk of multimorbidity.

METHODS

A cohort study using data from the Kailuan study (2006-2010) was conducted. Cox regression models were used to assess the association of MetS evolution with multimorbidity and its components. Survival mediation analysis was used to calculate the mediation proportion.

RESULTS

A total of 36,201 participants were included. During a median follow-up of 12.02 years, 930 participants developed a multimorbidity. Not only the persistent metabolic disorder group (HR: 2.95 [95% CI: 2.41-3.60]) and the MetS progression group (HR: 1.70 [95% CI: 1.39-2.06]) but also the MetS recovery group (HR: 1.87 [95% CI: 1.48-2.36]) were associated with an elevated risk compared with the sustained metabolic health group. LE8 score mediated the association between MetS progress, MetS recover, and persistent MetS and incident cardio-kidney-metabolic multimorbidity, accounting for 24.1% (95% CI: 11.4-44.0), 25.7% (95% CI: 16.4-37.7), and 19.5% (95% CI: 13.7-26.9) of the proportion mediated, respectively.

CONCLUSIONS

Both current MetS and a history of metabolic disorder, even in the absence of current MetS, may increase the risk of multimorbidity. Prevention targeting the LE8 may help reduce the risk and provide new perspectives for early intervention.

Ketogenic diet attenuates neuroinflammation and restores hippocampal neurogenesis to improve CUMS induced depression-like behavior in mice

The ketogenic diet (KD) has been proposed as a potential treatment for depression. However, the underlying mechanisms remain poorly understood. This study aimed to evaluate further the effects of KD on chronic unpredictable mild stress (CUMS)-induced depression in mice and investigate the underlying mechanisms. The results demonstrated that KD intervention significantly alleviated CUMS-induced depression-like behaviors, as evidenced by a decrease in immobility time in the forced swimming test and tail suspension test, an increase in distance traveled in the open field test, and a greater preference for sucrose in the sucrose preference test. KD alleviated neuroinflammation by reducing the levels of glial cell activation markers Iba-1 and GFAP, inhibiting the expression of inflammatory factors IL-1β, TNF-α, and COX-2, and suppressing the overactivation of the TLR4/MyD88/NF-κB signaling pathway. Furthermore, KD increased the number of DCX-, BrdU-, and PSD95-positive cells in the hippocampus and enhanced the BDNF/TrkB/CREB and Wnt/β-catenin signaling pathways, thereby promoting hippocampal neurogenesis. These findings suggested that KD alleviated CUMS-induced depression-like behaviors in mice by reducing neuroinflammation, enhancing neurotrophic signaling, and promoting hippocampal neurogenesis, thereby providing a mechanistic basis for its potential as a novel dietary antidepressant therapy.

The global, regional, and national burden and trends of anxiety disorders among women of childbearing age from 1990 to 2021: Estimates from the global burden of disease study 2021

BACKGROUND

Anxiety disorders are prevalent, early-onset mental illnesses that have a major negative impact on society and the economy globally. Comprehensive research on the global prevalence and evolving patterns of anxiety disorders in women of childbearing age (WCBA) is lacking.

METHODS

We computed estimated annual percentage changes (EAPCs) to evaluate trends in the incidence and Disability-Adjusted Life Years (DALYs) rates of anxiety disorders using the three primary WCBA indicators for anxiety disorders: prevalence, incidence, and DALYs, which were taken from the Global Burden of Disease (GBD) database from 1990 to 2021.

RESULTS

The number of prevalent cases increased from 120.2 million in 1990 to 224.8 million in 2021. The number of new cases increased from 17.406 million in 1990 to 30.730 million in 2021. Anxiety disorders is more prevalent in women, particularly those of reproductive age (15-49 years). Over the past 32 years, the global changes of Age-standardized incidence rate (ASIR) and Age-standardized prevalence rate (ASPR) were relatively stable. The results of differential smoothing and ARR model fitting showed that the long term risks showed a fluctuating downward trend in the long run, but showed a significant abnormal increase after 2020.

CONCLUSION

The relative increase in the incidence of anxiety disorders and DALYs in the WCBA over 32 years remains high. Our results can help different countries or regions in the world to develop more reasonable prevention and control measures for anxiety disorders, so as to reduce the serious economic and social burden caused by the disease.

Global burden of ischemic stroke in adults aged 60 years and older from 1990 to 2021: Population-based study

BACKGROUND

Ischemic stroke is an important public health problem. However, comprehensive data on its burden in aging populations is limited. The aim of this study is to provide an up-to-date assessment of the prevalence, incidence, mortality, disability-adjusted life years, and risk factors for ischemic stroke globally in adults aged 60 years and older from 1990 to 2021 based on population changes.

METHODS

The Global Burden of Diseases, Injuries, and Risk Factors Study 2021 served as the data source for this study. Average annual percentage changes were estimated over the study period to quantify temporal patterns and assess trends in age-standardized rates of the prevalence, incidence, mortality, and disability-adjusted life-years of ischemic stroke.

RESULTS

The significant increase in the prevalence and incidence of ischemic stroke is mainly related to population ageing and the significant increase in the number of people over 60 years of age, with the significant increase in the population over 60 years of age being the main driving force, while epidemiological changes have had the opposite effect. Critically, using the entire age population for calculations will prompt us to underestimate the burden of ischemic stroke. The burden of ischemic stroke disease is highest in older men than in older women, and the age-standardized prevalence rates, incidence rates, mortality rates, and disability-adjusted life-years rates are 26-35% higher in men than in women. High-middle sociodemographic index and Sub-Saharan Africa regions suffer the heaviest burden. Ischemic stroke health inequities widen, with less developed regions bearing a heavier ischemic stroke burden and the disparity in that burden becoming more pronounced over time.

CONCLUSION

Population aging is the primary driver of the growing burden of ischemic stroke. Our findings indicate that prevention and control of this disease remain critical public health challenges. Targeted interventions addressing modifiable risk factors could significantly reduce the global burden of ischemic stroke.

The burden of colorectal cancer attributable to high body mass index in China: findings from 1990 to 2021 and prediction to 2035

BACKGROUND

Colorectal cancer (CRC) incidence and mortality are rising in China, with high body mass index (BMI) established as a significant risk factor. However, comprehensive evidence regarding the BMI-attributable CRC burden in the Chinese population remains limited.

OBJECTIVE

This study aims to analyze the trend of CRC burden attributable to high BMI (BMI ≥ 25 kg/m2) in China from 1990 to 2021 and to predict its development from 2022 to 2035, in order to provide a scientific foundation for the formulation of public health policies.

METHODS

We analyzed data from the Global Burden of Disease Study 2021 (GBD 2021) to assess the BMI-attributable CRC burden in China from 1990 to 2021. Temporal trends were analyzed using Joinpoint regression models. Future projections through 2035 were generated using Bayesian age-period-cohort (BAPC) modeling. The Das Gupta method was used to explore the contribution of population growth, aging, and epidemiologic factors to these burden changes.

RESULTS

From 1990 to 2021, China's BMI-attributable CRC burden increased substantially, with ASMR and ASDR rising at annual rates of 2.393% (95% CI 2.306-2.481) and 2.305% (95% CI 2.188-2.422), respectively. The mortality and disability-adjusted life years (DALYs) rate both increased with age. Males showed higher burden rates in most age groups. Projections indicate continued increases in ASMR (2.43% annually) and ASDR (2.44% annually) through 2035. Epidemiological factors were the primary drivers, contributing 99.73% to mortality changes and 44.81% to DALYs changes.

CONCLUSIONS

The BMI-attributable CRC burden in China shows a concerning upward trajectory that is predicted to continue, with epidemiologic factors playing a major role. Urgent public health interventions targeting obesity prevention, lifestyle modification, and expanded CRC screening are needed to mitigate this growing burden.

Trends in liver cancer rehabilitation needs, disease burden, and attributable risk factors in China, 1990-2021

This study investigates trends in liver cancer rehabilitation needs, disease burden, and attributable risk factors in China from 1990 to 2021 using data from the Global Burden of Disease Study 2021. Key metrics included age-standardized prevalence (ASPR), years lived with disability (YLDs), and risk factor attribution. Between 1990 and 2021, the number of liver cancer patients requiring rehabilitation surged by 100.1% (132,779 to 265,539 cases), with YLDs rising by 102.8% (22,981 to 46,602). While ASPR and age-standardized YLD rates (ASYR) showed modest declines (ASPR: - 0.1% annual change; ASYR: - 0.23%), males exhibited a disproportionately higher burden, with 2021 cases and YLDs 2.98- and 2.74-fold greater than females, respectively. Risk factor analysis revealed smoking (14.0%), drug use (11.5%), and alcohol consumption (11.4%) as primary contributors, while metabolic factors like high BMI (7.5%) and fasting plasma glucose (1.9%) demonstrated accelerating impacts (YLDs EAPC: + 4.47% and + 1.31%, respectively). Aging populations and shifting etiologies drove increased rehabilitation demands, particularly among those ≥ 80 years. These findings underscore urgent needs for gender-specific interventions targeting modifiable risks and integrated nursing rehabilitation strategies to mitigate China's growing liver cancer burden.

Low back pain among the working-age population: from the global burden of disease study 2021

BACKGROUND

The burden of low back pain in the global working-age population (WAP) is substantial and exhibits unique characteristics. This study aimed to evaluate global, regional, and national trends in low back pain prevalence among the WAP over a 32-year period.

METHODS

We utilized data from the 2021 Global Burden of Disease (GBD) study to evaluate the global impact of low back pain in the WAP from 1990 to 2021. A secondary analysis focused on temporal trends and a decomposition analysis of low back pain.

RESULTS

From 1990 to 2021, there was a continuous decrease in the rate of low back pain among the global WAP. The age-standardized incidence rate (ASIR) decreased from 4,111 (95% uncertainty interval [UI]: 2,682-5,619) to 3,676 (95% UI: 2,563-5,021), with an annual average percentage change (AAPC) of -0.36. The age-standardized prevalence rate (ASPR) decreased from 9,731 (95% UI: 7,061-12,970) to 8,632 (95% UI: 6,296-11,517), with an AAPC of -0.39. The age-standardized disability-adjusted life years (DALYs) rate (ASDR) decreased from 1,108 (95% UI: 686-1,650) to 982 (95% UI: 608-1,460), with an AAPC of -0.39. However, the number of low back pain cases in the global WAP continued to increase. Regions with a middle Socio-demographic Index (SDI), South Asia, China, and India carried a heavier burden of low back pain in the WAP. The burden was also greater among females, with the gender gap continuing to widen. Decomposition analysis revealed that population growth and population aging were the predominant driving factors.

CONCLUSIONS

Despite the overall reduction in the ASIR, ASPR, and ASDR of low back pain among WAP, it remained a leading cause of disability worldwide. More attention needs to be paid to the low back pain burden among WAP in middle-SDI regions, countries with a large population base, and females. Significant gender and regional disparities persist within WAP, highlighting the necessity for targeted preventive and therapeutic interventions to alleviate the burden of low back pain and reduce the risks of disability.

Trends in the global, national, and regional burden of breast cancer among adolescents and young adults from 1990 to 2021: Analyses of the 2021 global burden of disease study

BACKGROUND

This study was devised to evaluate the burden of breast cancer (BC) among adolescents and young adults (AYAs) between 1990 and 2021.

METHODS

BC burden among AYAs (15-39 years of age) was analyzed by examining the associated age-standardized incidence rate, age-standardized prevalence rate, age-standardized death rate, and age-standardized disability-adjusted life year (DALY) rates between 1990 and 2021 at the global, national, and regional levels, together with corresponding analyses of health inequality and decomposition analyses.

RESULTS

In 2021, the respective global age-standardized incidence rate, age-standardized prevalence rate, age-standardized death rate, and age-standardized DALYs for BC were 5.87 (5.39,6.41), 49.35 (45.46,53.86), 1.37 (1.24,1.51), and 80.8 (72.84,89.23), which respectively showed increases of 33.4 %, 35.2 %, 1.5 %, and 3.3 % compared to the rate of 1990. While women comprise the vast majority of all BC cases, a higher average annual percent change was observed for males relative to females at the global level. The average annual percent change for BC incidence, prevalence, death, and DALYs among men AYAs (2.59, 2.49, 1.06, 1.10) were all higher than the corresponding values among women (0.91, 0.96, 0.02, 0.09). Regional and national differences in disease burden were observed. BC disease burden was significantly positively correlated with socio-demographic index (SDI). Similar trends were observed in terms of female disease burden, whereas disease burden of male patients was negatively related to SDI. In decomposition analyses, the primary factors associated with changes in age-standardized DALY rates were identified as aging and population growth. Health inequality analyses revealed that the burden of BC among AYAs was particularly concentrated in lower-income countries.

CONCLUSIONS

These results highlight that the burden of BC among AYAs has grown in recent decades, while also emphasizing the need to be attentive to the rising occurrence of male BC. Lower-income regions also faced a heavier BC-related burden as compared to more affluent nations. Efforts to reduce the disease burden associated with BC may thus hinge on government-based initiatives focused on improving overall national economic strength and medical system quality.

Paediatric anaemia prevalence trends in the Eastern Mediterranean Region: a 20-year analysis by income level

Background

Anaemia is a significant global public health issue, especially in low-income countries, where it influences children's mental and physical development. Anaemia is a common public health problem in the Eastern Mediterranean Region (EMR), although long-term, income-stratified analyses at the regional level are scarce. This study investigated trends in anaemia prevalence among children aged 6-59 months from 21 countries in the EMR between 2000 and 2019, correlating differences in these trends with each country's national income.

Methods

We analysed data collected by the World Health Organization (WHO) on the prevalence of anaemia in children aged 6-59 months between 2000 and 2019 in 21 EMR countries at five-year intervals. Data on national income classifications were taken from the World Bank. The data were subject to statistical analysis using SPSS, Excel and GraphPad Prism to determine the associations between anaemia prevalence and income groups.

Results

The average anaemia prevalence among children in the EMR decreased from 40.56% in 2000 to 34.25% in 2019 - an absolute change of -6.3%. The number of countries with a prevalence above 40% fell from seven in 2000 to six in 2019. Oman, Yemen and Sudan had some of the highest prevalences, and the UAE witnessed a slight increase, despite being a high-income country. Anaemia prevalence was significantly associated with national income (P < 0.001), but outliers suggest that income alone does not fully explain the observed trends. In 2019, the prevalence of anaemia in the EMR remained greater than the global average.

Conclusions

Between 2000 and 2019, the prevalence of anaemia in children aged 6-59 months decreased significantly in the EMR. Despite this progress, there are still disparities between the prevalence of anaemia in low-income and high-income countries. Therefore, income is not the only factor associated with declines in anaemia prevalence. The fact that reduction rates plateaued after 2015 reinforces the significance of implementing new, innovative health programmes to minimise anaemia.

The burden of viral skin diseases in the Middle East and North Africa region, 1990-2021

OBJECTIVE

To report the prevalence, incidence, and Years Lived with Disability (YLD) due to viral skin diseases (VSD) in the MENA region from 1990 to 2021, focusing on age, sex, and socio-demographic index (SDI) using GBD 2021 data.

METHODS

Data on the burden of VSD were sourced from the Global Burden of Disease (GBD) 2021 study, covering 21 countries in the MENA region. The results included the counts and age-standardised rates per 100,000 population, along with the associated 95 % uncertainty intervals (UIs).

RESULTS

In 2021, the MENA region exhibited an age-standardised prevalence rate of 1257.6 cases per 100,000 population for VSD and an incidence rate of 990.5 cases per 100,000. Prevalence rates peaked sharply in the 5-9 age group before declining with age for both sexes, indicating a higher burden in younger populations. A strong positive relationship existed between the YLD rate and SDI, suggesting an increased burden of VSD with higher SDIs.

CONCLUSION

This study highlights the increasing burden of viral skin diseases (VSD) in the MENA region, especially among younger populations, with males also experiencing a slightly higher burden than females. Given the influence of multiple factors, a comprehensive strategy focusing on data systems, healthcare delivery, and regional collaboration is vital. Addressing these areas will help mitigate VSD's impact and improve health outcomes.

Peripheral arterial disease prevalence among sepsis hospitalizations and associated outcomes

OBJECTIVE

Sepsis is common, deadly, and exacerbated by comorbid conditions. Atherosclerotic cardiovascular disease (ASCVD), including coronary artery disease (CAD) and peripheral artery disease (PAD), are risk factors for sepsis with minimal data on the association between PAD and outcomes. We aimed to evaluate the prevalence of ASCVD and the association between ASCVD and in-patient mortality and limb outcomes among sepsis hospitalizations.

METHODS

We generated ASCVD prevalence estimates among survey-weighted adult sepsis hospitalizations within the National Inpatient Sample (2016-2020). We included hospitalizations with a primary diagnosis of sepsis and excluded nonadult patients (<18 years), and those with missing outcome data (ie, in-hospital mortality) and demographic data (ie, age, sex, and race/ethnicity). Associations between ASCVD and in-hospital mortality and major or transmetatarsal amputation among sepsis hospitalizations were evaluated using Cox regression, adjusting for demographics (age, sex, race/ethnicity, and income) and comorbidities (diabetes mellitus, end-stage renal disease, cerebrovascular disease, and hypertension). Subgroup analyses were conducted to assess moderation of the association between ASCVD and outcomes by antithrombotic therapy.

RESULTS

Of 174,776,160 estimated hospitalizations (age, mean ± standard error, 50 ± 0.2 years; 44% male; 65% White), 5.5% (5.5%-5.6%) had a primary diagnosis of sepsis (age 69 ± 0.1; 51% male; 70% White); of which, 9.5% (9.3%-9.6%) had a secondary diagnosis of PAD (age 73 ± 0.05; 58% male; 73% White). PAD was associated with 18% higher adjusted risk of in-hospital mortality (95% confidence interval [CI], 1.17-1.20) and 4.36 times the risk of major or transmetatarsal amputation (95% CI, 4.18-4.56). Sepsis hospitalizations with joint ASCVD had the highest risk of in-hospital mortality (adjusted hazard ratio [aHR], 1.34; 95% CI, 1.31-1.36) compared with those with CAD alone (aHR, 1.25; 95% CI, 1.24-1.27) or PAD alone (aHR, 1.23; 95% CI, 1.21-1.26). Yet patients with PAD who were hospitalized for sepsis had a higher risk of in-hospital major or transmetatarsal amputation (aHR, 5.03; 95% CI, 4.76-5.32) compared with those with joint ASCVD (aHR, 3.89; 95% CI, 3.66-4.14); CAD was expectedly not associated with amputation (aHR, 1.05; 95% CI, 0.999-1.1). Subgroup analyses revealed significant interactions between ASCVD and antithrombotic therapy, such that, among those taking antithrombic therapy, the associations between ASCVD and in-hospital mortality (P < .001) and amputation (P < .05) were smaller when compared with the associations examined in the whole sample.

CONCLUSIONS

Sepsis and ASCVD are common and associated with a higher risk of adverse outcomes. PAD diagnosis occurred among 9.5% of sepsis hospitalizations and, mirroring CAD, increased the risk of in-hospital mortality by approximately 25%. Expectedly, PAD was associated with a higher risk of in-hospital amputation. Antithrombotic therapies, a staple of ASCVD medical optimization, reduced the risk of in-hospital amputation and mortality among patients with PAD hospitalized for sepsis. Medical optimization may improve outcomes in patients with sepsis and ASCVD.

Trends in fatal paediatric unintentional injury: what is going on?

In recent years, the reduction in rates of fatal unintentional injuries to children in the USA has not only plateaued, beginning before the pandemic, but has reversed, with increases across most mechanisms of injury. This study seeks to understand the reasons for this trend, focusing on unintentional injuries to children aged 1-14 years in 2001-2023 and on injuries with the highest fatality rates and with the most substantial increases in the last few years.The highest rate of fatalities and most substantial changes were due to motor vehicle crashes, drowning, fires and burns. Many factors that are associated with the risk of injury fatality actually decreased in prevalence over the last decade while the fatality rates were plateauing and then increasing. These include improved motor vehicle and highway and roadway safety designs, lower rates of cigarette smoking, more homes with carbon monoxide alarms, fewer mobile homes, higher life-jacket use, fewer small recreational boats and decreases in child poverty. Increases in emotional and behavioural disorders are not likely responsible for changes in unintentional injury fatalities in this age group. An important contributor to injury, particularly among the racial groups experiencing the greatest change in the mortality trajectory, is the sociocultural economic environment in which children live, learn and play. Smartphone use by teens and caregivers was the one risk factor which dramatically increased over the last decade, and distraction from mobile phone use stands out as likely the greatest culprit in this increase in fatalities.

Global burden and trend of substance use disorders, self-harm, and interpersonal violence from 1990 to 2021, with projection to 2040

BACKGROUND

Alcohol use disorders (AUD), drug use disorders (DUD), interpersonal violence, and self-harm are a major public health concern globally, with high rates of disability, morbidity, and mortality associated with this. This study aims to estimate the disease burden, trends, projections, and disparities of AUD, DUD, interpersonal violence, and self-harm among all ages and sexes from 1990 to 2021.

METHODS

This study is a secondary analysis utilizing data from the Global Burden of Disease (GBD) 2021 in 204 countries and territories. The incidence, deaths, and disability-adjusted life years (DALYs), projection, and the inequality were estimated for AUD, DUD, interpersonal violence, and self-harm among all age and sex.

RESULTS

In 2021, there were 55.78 (46.56-64.31) million new cases of AUD, 13.61 (11.63-15.67) million new cases of DUD, 29.40 (26.17-32.65) million new cases of interpersonal violence, 5.49 (4.6-6.5) million new cases of self-harm globally. By 2040, AUD is forecasted to be 51.98 (29-74.97) million, DUD will be 13.81 (9.23-18.39) million, 36.01 (15.25-56.78) million for interpersonal violence, and 10.55 (3.16-17.94) million for self-harm. In terms of gender and age distribution, males had higher incidence, mortality, and DALYs for AUD, DUD, and interpersonal violence compared to females. Females had higher incidence of self-harm, while males had higher mortality. By age group, individuals aged 15-49 bore the highest burden of DUD, interpersonal violence, and self-harm, while those aged 50-74 had the highest burden of AUD. The burden of these conditions is closely related to the socio-demographic index (SDI). High- and middle-high SDI regions had a heavier burden of AUD, DUD, and self-harm, while low- and middle-low SDI regions had a heavier burden of interpersonal violence. Additionally, from 1990 to 2021, health inequalities for AUD and self-harm decreased, while those for DUD and interpersonal violence increased.

CONCLUSIONS

From 1990 to 2021, the disease burden of AUD, DUD, interpersonal violence, and self-harm exhibited specific patterns across different genders, age groups, and regions. Multilevel interventions should be initiated, with a focus on reducing inequalities through resource allocation and policy support.

Long-Term Health Improvements and Economic Performance Among Individuals With Diabetes

Importance

Advances in diabetes detection and treatment have mitigated the risks of serious complications and death, but little is known about whether economic outcomes for people with diabetes have similarly improved.

Objective

To assess whether associations between diagnosed diabetes and labor market outcomes have changed over time.

Design, Setting, and Participants

This cross-sectional study analyzed data from the National Health Interview Survey from 1998 to 2018. The sample was nationally representative of the US population aged 40 to 64 years. Average marginal effects, the regression-adjusted difference in probability of outcomes between people with and without diabetes, pooled by 3-year periods (1998-2000 to 2016-2018), were estimated with controls for demographics, education, and comorbid health risks. Behavioral Risk Factor Surveillance (BRFSS) data from 1993 to 2023 were included in robustness analyses. Data were analyzed from September 2023 to November 2024.

Exposure

Diagnosed diabetes, defined based on respondents' self-report that they have ever been diagnosed by a medical professional.

Main Outcomes and Measures

The main outcomes were labor force participation and any Supplemental Security Income or Social Security Disability Insurance income receipt. Secondary outcomes included reporting health limitations for any activities, health limitations for work, any nights in hospital, and receiving health care 10 or more times in the past year.

Results

The study included 249 712 individuals, 25 177 with diabetes. The weighted population was 50% female, 12% Hispanic, 11% non-Hispanic Black, 72% non-Hispanic White, and 5% multiracial or other race (Alaska Native or American Indian, Asian, or nonspecified). In the weighted population from 1998 to 2000, 46% of people with diabetes were 55 years and older, while 27% of people without diabetes were 55 years and older. In the weighted population from 2016 to 2018, 56% of people with diabetes were 55 years and older, while 38% of people without diabetes were 55 years and older. The average marginal effect of diabetes on probability of labor force participation was -10.9 percentage points (95% CI, -13.0 to -8.9) from 1998 to 2000 and -11.0 percentage points (95% CI, -13.0 to -9.1) from 2016 to 2018; for people who received Supplemental Security Income or Social Security Disability Insurance income, it was 4.4 percentage points (95% CI, 3.3-5.5) and 4.9 percentage points (95% CI, 3.7-6.0) from 1998 to 2000 and 2016 to 2018, respectively. During the same period, average marginal effects for all examined health outcomes significantly improved. Similar patterns were observed using BRFSS data, but with a slight improvement in labor force participation between 2017 to 2019 and 2021 to 2023.

Conclusions and Relevance

This cross-sectional study demonstrated that while people with diabetes experienced meaningful health improvements, they saw little progress in economic performance. Changing patient selection appears to play a role. Future research is needed to disentangle the paradox.

Hearts apart: exploring sex disparity in the global and regional burden of ischemic heart disease; a systematic analysis from the global burden of disease study 1990-2021

BACKGROUND

Worldwide, ischemic heart disease is less prevalent in women than in men, but this gap has narrowed in recent decades. This study aims to evaluate trends and gender differences in the global burden of ischemic heart disease (IHD) across demographics and regions from 1990 to 2021.

METHODS

We utilized the data of the Global Burden of Disease Study from 1990 to 2021. The standard epidemiological measurements, including incidence, prevalence, mortality rates, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs), were obtained to estimate the burden of IHD concerning age, sex, and the sociodemographic index, allowing for comparisons over time.

RESULTS

The sex parity ratio (SPR), defined as the ratio of females to males, has increased globally. The SPR of age-standardized prevalence (ASPR) and age-standardized incidence (ASIR) rose from 0.610 to 0.631 in 1990 to 0.653 and 0.670 in 2021, respectively. From 1990 to 2021, the SPRs for ASPR and ASIR of IHD increased across all age groups. However, the SPRs for the age-standardized mortality rate (ASMR) and the age-standardized DALY rates (ASDR) of IHD declined. This decrease in the SPR for both ASMR and ASDR of IHD was observed in most regions of this study.

CONCLUSIONS

While progress has been made in reducing the burden of IHD, the increasing sex disparities in specific regions and age groups emphasize the need for continuous monitoring, adaptive health policies, and sex-specific healthcare practices to ensure equitable health outcomes for all populations.

CLINICAL TRIAL NUMBER

not applicable.

Global, Regional, and National Burden of Stroke on Children and Adolescents Aged Under 20 Years From 1990 to 2021, With Projections of Disability-Adjusted Life Year to 2050: A Comprehensive Demographic Analysis for the Global Burden of Disease Study 2021

BACKGROUND

Stroke in children is a global epidemic.

METHODS

Data on stroke, including incidence, DALYs, mortality, and associated risk factors from 1990 to 2021, were obtained from the Global Burden of Disease (GBD) study, 2021. Estimated annual percentage changes were calculated to evaluate changes in the age-standardized rates of incidence (ASIR), DALYs (ASDR), and mortality (ASMR), as well as trends by age, sex, and sociodemographic index (SDI). Projections of DALYs to 2050 were made.

RESULTS

In 2021, there were 310,133 incident stroke cases, accounting for 24,807 deaths and 2,414,655 DALYs among children and adolescents. The global ASIR, ASDR, and ASMR for stroke were 11.8, 93.9, and 1.0 per 100,000 population, respectively. Middle-to-low-SDI regions accounted for 81.6% of incident cases, 90.2% of DALYs, and 92.7% of deaths. A reversed V-shaped association was observed between SDI and ASRs. Children < 1 year had the highest ASRs, with rates generally decreasing with age, and the highest incidence of hemorrhagic stroke. Adolescents aged 15-19 years had the highest incidence of ischemic stroke. Non-optimal temperature contributed the most to the DALYs and death rates for stroke. By 2050, it is projected that 282,404 DALYs will be lost due to stroke.

CONCLUSIONS

Stroke burden varies by the GBD region, country, age, sex, and SDI. Despite declines in ASRs, stroke remains a significant burden, especially in middle-to-low-SDI regions, among children < 1 year, and among those with intracerebral hemorrhage. Non-optimal temperature emerges as the leading modifiable risk factor for children stroke; targeted interventions can prevent this.

Burden of disease in the Belt and Road countries from 1990 to 2021: analysis of estimates from the Global Burden of Disease 2021

BACKGROUND

As a newly emerging collaborative platform to boost regional growth and prosperity, the Belt and Road Initiative (BRI) has great potential to promote global health development. However, the overall health status of BRI countries remains unclear. We analyzed the health patterns and its geographical distribution in 149 BRI countries from 1990 to 2021.

METHODS

Using the Global Burden of Disease 2021 (GBD 2021) online database, we examined time trends, country and income variations in death rate and disability-adjusted life years (DALY) rate, and compared the trends and projected 2030 values for ten key health-related Sustainable Development Goals (SDGs) indicators among the 149 BRI countries.

RESULTS

The number of deaths and DALYs of BRI countries represented 62.9-66.0% of global deaths and 64.8-66.8% of global DALYs between 1990 and 2021, and both the overall age-standardized death rate and DALY rate continued to be higher in BRI countries than in non-BRI countries throughout the time period studied. Great variations existed across the 149 BRI countries for both level of and changes in age-standardized death rate and DALY rate. The 2030 targets for six health-related SDGs indicators will not be reached in over 70% of BRI countries according to the previous changing speed trajectory.

CONCLUSIONS

Our findings demonstrate that BRI countries face a heavy burden of disease that varies across countries, although health outcomes have improved since 1990. Progress toward 2030 targets for six key health-related SDGs indicators in most BRI countries was slow. These findings support calls for more health collaborations, aid programs, and other health service to reduce health disparities across the BRI countries.

Burden of neurological disorders in China and its provinces, 1990-2021: Findings from the global burden of disease study 2021

BACKGROUND

The burden of neurological disorders in China has not been systematically analyzed. We aim to provide a comprehensive estimation of the national and subnational neurological burden across China from the Global Burden of Disease Study (GBD) 2021.

METHODS

We assessed burden estimates for 16 neurological disorders by age, sex, and province from 1990 to 2021, with prevalence, death, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). We performed decomposition analysis to determine contributing factors for DALYs and used the socio-demographic index (SDI) to assess relations with development level.

FINDINGS

In 2021, there were 468.29 million prevalent cases of neurological disorders in China, corresponding to 78.10 million DALYs. Intracerebral hemorrhage was the leading cause of DALYs, followed by ischemic stroke, dementias, and migraine. DALYs of neurological disorders were higher in males than females, peaking at 70-74 years. From 1990 to 2021, the number and age-standardized rate of DALYs significantly decreased for idiopathic epilepsy and subarachnoid hemorrhage, primarily attributed to the reduction in YLLs, while the number of DALYs disproportionately increased for dementias, Parkinson's disease, and ischemic stroke contributed by population aging. The age-standardized DALY rates of seven neurological disorders had more than 5-fold variation between western and eastern provinces, despite reduced burdens with rising SDI.

CONCLUSIONS

Neurological disorders pose a large and growing burden on public health, primarily driven by population aging. Our findings could inform priority setting and targeted strategies to optimize neurological service delivery.

FUNDING

The funding information is presented in the acknowledgments.

Global, Regional, and National Burden of Trachoma: Cross-Country Inequalities, 1990-2021, with Projections to 2040

INTRODUCTION

In this work, we aim to evaluate the trends and cross-country inequalities of the global trachoma burden from 1990 to 2021 and to project its burden to 2040.

METHODS

This study was a systematic analysis of the Global Burden of Diseases Study (GBD) 2021. Estimates for the prevalence and disability-adjusted life-years (DALYs) of trachoma were extracted from the GBD 2021 database. Epidemiological characteristics of trachoma were reported at the global, regional, and national levels. Trend analysis, decomposition analysis, and health inequality analysis were used. The global trachoma burden was further projected to 2040 via Bayesian age-period-cohort analysis.

RESULTS

Globally, 1,414,047 people were estimated to have trachoma in 2021, with an age-standardized prevalence rate of 16.37 per 100,000 population. Between 1990 and 2021, the prevalent cases and DALY numbers of trachoma decreased by 30.2% and 34.4%, respectively. In 2021, Eastern Sub-Saharan Africa was the region, and Ethiopia was the country with the highest number of trachoma cases. Decomposition analysis revealed that the reduction in the global burden was attributed primarily to epidemiological changes. From 1990 to 2021, countries with lower sociodemographic indices (SDIs) disproportionately bore the heaviest burden. While the prevalence and DALY rates are projected to decrease from 2022 to 2040, the prevalent cases and DALY numbers are expected to increase.

CONCLUSIONS

Over the past three decades, the global burden of trachoma has decreased significantly, but SDI-related inequalities among countries have persisted. Despite reductions in the prevalence rate, the number of patients with trachoma is projected to increase from 2022 to 2040. Our study provides valuable insights into the elimination of trachoma worldwide.