Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Global burden of disease attributable to metabolic risk factors in adolescents and young adults aged 15-39, 1990-2021

BACKGROUND

Metabolic risk factors are a significant cause of global burden among adolescents and young adults, but there is a lack of attention to the burden attributable to these metabolic risk factors globally.

AIMS

This study aims to provide comprehensive estimates of five important metabolic risk factors and the attributable disease burden in people aged 15-39 years from 1990 to 2021, based on the Global Burden of Disease Study (GBD) database.

METHODS

Global total deaths and disability-adjusted life years (DALYs) were used to describe the burden attributable to five common metabolic risk factors, including high fasting plasma glucose (FPG), high low-density lipoprotein cholesterol (LDL-C), high systolic blood pressure (SBP), high body mass index (BMI), and kidney dysfunction, in adolescents and young adults. The estimated annual percentage changes (EAPC) of DALYs were utilized to depict the trends from 1990 to 2021.

RESULTS

From 1990 to 2021, the DALY rates attributable to all metabolic risk factors showed a globally significant upward trend, with EAPC reaching 33.0 % (27.4-38.7). Compared to females, males had a heavier burden and a more significant increase in deaths and DALYs attributable to metabolic risk factors. High BMI and high FPG have become the top two metabolic risk factors in 2021, with summary exposure variables (SEV) rising by 84.2 % and 53.6 %, respectively. Low-middle socio-demographic index (SDI), middle SDI, and high SDI regions experienced upward regional trends in DALY rates, while low SDI regions remained stable. Among 204 countries and territories, 101 (49.5 %) showed a significant increase in DALY rates, as indicated by the EAPC.

CONCLUSIONS

There is a substantial global burden attributable to metabolic risk factors in adolescents and young adults in 2021, especially high BMI and high FPG. This calls for further investigation and intervention to address this emerging trend.

Progress in research and development of biodegradable metallic vascular stents

Vascular stents are an essential tool in cardiovascular interventional therapy, and their demand is growing with the increasing incidence of cardiovascular diseases. Compared with permanent stents, which are prone to in-stent restenosis, and drug-eluting stents, which may cause late stent thrombosis, biodegradable stents offer advantages. After providing early radial support to prevent elastic recoil, biodegradable stents gradually degrade, allowing the vessel to regain its natural physiological contractility and undergo positive remodeling. A review of the current mainstream biodegradable metal stents, magnesium-based, iron-based, and zinc-based alloys, shows promising findings in both preclinical and clinical research. Magnesium-based stents exhibit good operability and low thrombosis rates, but their limitations include rapid degradation, hydrogen evolution, and significant pH changes in the microenvironment. Iron-based stents demonstrate excellent mechanical strength, formability, biocompatibility, and hemocompatibility, but their slow corrosion rate hampers broader clinical application; accelerating degradation remains key. Zinc-based alloys have a moderate degradation rate but relatively low mechanical strength; enhancing stent strength by alloying with other elements is the main improvement direction for zinc-based stents.

A bibliometric analysis of African dental research and the sustainable development goals, 2016-2023

Background

The successful implementation of the 2030 sustainable development Agenda in Africa requires active participation from all sectors, including the dental research sector. The aim of this study was to review dental research published by authors affiliated with institutions in African countries from 2016 to 2023, to map papers related to the sustainable development goals (SDGs), and to identify areas of emphasis and gaps in SDGs-related papers on oral health in Africa.

Methods

We conducted a bibliometric analysis of dental literature in Africa (2016-2023) using Scival for performance analysis and VOSviewer for science mapping. The papers addressing and not addressing the SDGs were compared regarding impact, authorship metrics and key phrases. We identified the topic clusters with the greatest number of papers. The key phrase co-occurrence networks and the authors and countries collaboration networks were mapped.

Results

There were 4,173 papers and 622 (14.9%) addressed the SDGs, especially SDG3. SDGs papers had greater impact and were more likely to be published in open access journals than non-SDGs papers. Egypt, Nigeria and South Africa had the greatest number of papers and citations. Four of the top ten authors were females. Most of the top ten journals were open access and only three were in quartile 1 (Q1) journals. Springer and Elsevier were the top publishers. The top research clusters addressed rehabilitative care including implants, endodontics, ceramics and zirconia. SDGs papers, however, addressed oral hygiene in caries prevention and to control systemic diseases. Collaboration networks were affected by geographic location and languages. Dental research in Africa is concentrated in three countries and mainly addresses rehabilitative care. SDGs papers had an impact above the global average and addressed prevention and non-communicable diseases.

Conclusions

There is minimal yet increasing contribution of African countries to the evidence on oral health and the SDGs. The focus is on a limited number of SDGs, and publications are from very few countries in Africa. There is a need to focus oral health-related SDGs research on addressing local problems.

Sociocultural and Clinical Determinants of Sexual Dysfunction in Perimenopausal Women with and Without Breast Cancer

Breast cancer survivorship is a recognized risk factor for sexual dysfunction, with various clinical, sociocultural, and psychological factors potentially interacting differently across populations. This study compared sexual dysfunction, anxiety, and depression between females with breast cancer and those without, aiming to identify associated factors. A total of 362 females participated, including 227 with sexual dysfunction and 135 controls. Among them, 195 are breast cancer survivors, while 167 have no personal history of cancer. Key variables were analyzed using Student's t-test for quantitative data and Fisher's exact test for categorical data, while logistic regression models were used to assess the association between sexual dysfunction and various factors. Multivariate analysis revealed that, in sexually active females, breast cancer survivorship increased the odds of sexual dysfunction 2.7-fold (95% CI: 1.17-6.49; p = 0.020). Anxiety was significantly associated with sexual dysfunction, regardless of cancer status (AdOR 6.00; 95% CI: 2.50-14.43; p < 0.001). The interaction between cancer survival and anxiety further increased the odds of sexual dysfunction by more than 11-fold (AdOR 11.55; 95% CI: 3.81-35.04; p < 0.001). Additionally, obesity was found to be a protective factor among cancer survivors (AdOR 0.149; 95% CI: 0.027-0.819; p = 0.029). In conclusion, breast cancer has a significant impact on sexual function, with psychological factors like anxiety playing a crucial role. Addressing these issues requires a holistic, patient-centered approach that considers the complex interplay of physical, emotional, and sociocultural factors.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

FUNDING

Bill & Melinda Gates Foundation.

Predictive Value of dsDNA and Nucleosomes as Neutrophil Extracellular Traps-Related Biomarkers for COVID-19 in Older Patients

Background

Previous studies have demonstrated that neutrophil extracellular traps (NETs) are crucial in infectious diseases. This study aims to evaluate the clinical value of NET-related biomarkers in identifying the risk of COVID-19 and diagnosing the disease.

Methods

This study involved 32 patients who tested positive for COVID-19 via polymerase chain reaction (PCR) between April and August 2023. During the same period, 30 healthy volunteers were enrolled as a control group. The principal biomarkers related to NETs are citrullinated histone H3 (CitH3), double-stranded DNA (dsDNA), myeloperoxidase-DNA complex (MPO-DNA), and Nucleosome. Elevated levels in two or more of these biomarkers indicate raised NET concentrations. Multivariable logistic regression analysis was employed to assess whether NET-related biomarkers were the independent risk factor of COVID-19. The diagnostic value of NET-related biomarkers in COVID-19 was further evaluated using receiver operating characteristic (ROC) curve analysis. Statistical procedures were executed in SPSS software (version 24.0, USA).

Results

Compared with the control group, patients infected with COVID-19 had higher levels of dsDNA and nucleosomes (P < 0.001). Correlation analysis revealed a positive correlation between dsDNA levels and neutrophil count (r = 0.309, P = 0.015) as well as between nucleosome levels and neutrophil count (r = 0.446, P < 0.001). Further analysis showed that dsDNA and nucleosomes were independent risk factors for COVID-19 infection. ROC curve analysis showed that dsDNA area under the curve (AUC) = 0.777, 95% confidence interval (CI), 0.661-0.893, P < 0.001, and nucleosomes (AUC = 0.884, 95% CI, 0.778-0.991, P < 0.001) had well diagnostic value in the diagnosing COVID-19 infection.

Conclusion

NET-related biomarkers, dsDNA and nucleosomes, were independent risk factors of COVID-19 infection and potentially useful biomarkers in diagnosing COVID-19 infection in older patients.

Unpacking occupational and sex divides to understand the moderate progress in life expectancy in recent years (France, 2010's)

PURPOSE

The growth in life expectancy (LE) slows down recently in several high-income countries. Among the underlying dynamics, uneven progress in LE across social groups has been pointed out. However, these dynamics has not been extensively studied, partly due to data limitations. In this paper, we explore this area for the 2010 decade using recent French data.

METHODS

We utilize the recent change in French census mortality follow-up data (EDP) and apply P-spline models to estimate LEs across five occupational classes (OCs) and indicators of lifespan heterogeneity (edagger) within these OCs, for seven triennial periods (2011-2013 to 2017-2019).

RESULTS

First, we found a similar ranking of OCs along the LE gradient over time and across sexes, from manual workers to higher-level OCs. Noteworthy, the lowest LE in women overlaps with the highest one in men drawing a sex-OC gradient. Second, we observe varying progress of LEs. In women, LE increases in higher-level OCs meanwhile it levels off in manual workers, so that the OCs gap widens (up to 3.4 years in 2017-2019). Conversely, in men LE stalls in higher-level OCs and increases in manual workers so that the gap, which is much larger than in women (+5.7 years in 2017-2019), is tending to narrow. Finally, the lifespan homogenizes in OCs only when LE is low.

CONCLUSION

Overall, the limited LE progress in France results from LE stalling in the middle of the sex-OC gradient, though LE increases at both ends. At the lower end, LE progress and lifespan homogenization suggest that laggards benefit recently improvements achieved earlier in other OCs. At the upper end, LE progress may come from a vanguard group within higher-lever OC, benefiting new sources of improvements. These findings underscore the need for further research to explore the diverse mortality dynamics coexisting in the current health landscape.

Disease Burden of Parkinson's Disease in Asia and Its 34 Countries and Territories from 1990 to 2021: Findings from the Global Burden of Disease Study 2021

INTRODUCTION

The increasing global population and aging have made Parkinson's disease (PD) a significant public health concern. Comprehensive evaluations of PD burden trends in Asian subregions and countries are lacking. This study investigated PD burden in Asia from 1990 to 2021, categorized by age, sex, and region.

METHODS

Data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were analyzed to assess the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) across five Asian subregions and 34 countries/territories, using joinpoint regression, decomposition analysis, frontier analysis, and Bayesian models to examine changes, influencing factors, and predict future trends.

RESULTS

In 2021, the age-standardized PD incidence and prevalence in Asia were higher than the global average, particularly in East Asia (24.16 and 243.46/100,000, respectively). From 1990 to 2021, the incidence of PD in Asia rose by 198.01%, its prevalence rose by 284.35%, mortality rose by 111.27%, and DALY rose by 144.45%. Males consistently presented a greater PD burden than females did, with a growing sex gap over time. PD burden increased with age, especially among those aged 65 years and older. Population aging was the primary driver of new PD cases, and increasing etiological factors led to more patients. Inequalities in the PD burden have increased between high- and low-income areas, with low-income regions being more affected. By 2036, PD incidence is projected to increase in all subregions except the high-income Asia-Pacific region, with males experiencing a higher rate of increase.

CONCLUSION

The PD burden in Asia has significantly increased over the past three decades, particularly in middle-aged and elderly males, middle- and low-SDI countries, and individuals already suffering from PD. The increasing incidence and aging population necessitate the reallocation of medical resources, improved chronic disease management systems, stronger public health interventions, and sustainable development efforts. Research into etiological factors, pathogenesis, early diagnosis, preventive interventions, and regional management is critical.

Global burden of low back pain and its attributable risk factors from 1990 to 2021: a comprehensive analysis from the global burden of disease study 2021

Background

This study aimed to examine the evolving trends in the global burden of low back pain (LBP) from 1990 to 2021 and predicted disease burden until 2035.

Materials and methods

LBP-related data were obtained from the Global Health Data Exchange (GHDx) query tool. All estimates and their 95% uncertainty intervals (UIs) were generated using DisMod-MR 2.1, a Bayesian meta-regression tool in Global Burden of Disease, Injury, and Risk Factor Study (GBD) 2021. Data processing and visualization were conducted using The R Programming Language software version 4.3.2 and Joinpoint 4.7.

Results

In 2021, approximately 628.8 million people worldwide were affected by LBP, with approximately 266.9 million new incident cases and age-standardized incidence rate (ASIR) of 3176.6 per 100,000. Compared with 1990, although the ASIR and age-standardized disability-adjusted life years rate (ASDALYsR) decreased, absolute numbers increased significantly. Projections for 2035 reveal a continued decline in ASIR and ASDALYsR for LBP. The LBP burden varied by the sociodemographic index quintile and GBD region, with the highest ASIR and ASDALYsR observed in Central Europe and the greatest decrease in East Asia. Globally, women bear a higher burden of LBP than men, with middle-aged populations experiencing the heaviest burden. Occupational ergonomic factors, high body mass index, and smoking remain the primary risk factors for LBP, with occupational ergonomic factors contributing the most to the overall burden.

Conclusion

Despite a projected decline in incidence, the global burden of LBP persists, exhibiting significant regional and gender disparities. To mitigate its future burden, precise and effective prevention and control strategies targeting high-risk factors are imperative.

Global maternal health country typologies: A framework to guide policy

Maternal mortality remains a large challenge in global health. Learning from the experience of similar countries can help to accelerate progress. In this analysis we develop a typology of country groupings for maternal health and provide guidance on how policy implications vary by country typology. We used estimates from the Global Maternal Health (GMatH) microsimulation model, which was empirically calibrated to a range of fertility, process, and mortality indicators and provides estimates for 200 countries and territories. We used the 2022 estimates of the maternal mortality ratio (MMR) and lifetime risk of maternal death (LTR) and used a k-means clustering algorithm to define groups of countries based on these indicators. We estimated the means of other maternal indicators for each group, as well as the mean impact of different policy interventions. We identified 7 groups (A-G) of country typologies with different salient features. High burden countries (A-B) generally have MMRs above 500 and LTRs above 2%, and account for nearly 25% of global maternal deaths. Countries in these groups are estimated to benefit most from improving access to family planning and increasing facility births. Middle burden countries (C-E) generally have MMRs between 100-500 and LTRs between 0.5%-3%. Countries in these groups account for 55% of global maternal deaths and would benefit most from increasing facility births and improving quality of care. Low burden countries (F-G) generally have MMRs below 100 and LTRs below 0.5%, account for 20% of global maternal deaths, and would benefit most from improving access to family planning and community-based interventions and linkages to care. Indicators vary widely across groups, but also within groups, highlighting the importance of considering multiple indicators when assessing progress in maternal health. Policy impacts also differ by country typology, providing policymakers with information to help prioritize interventions.

Time trends in maternal hypertensive disorder incidence in Brazil, Russian Federation, India, China, and South Africa (BRICS): an age-period-cohort analysis for the GBD 2021

OBJECTIVES

Maternal hypertensive disorder (MHD) is a leading cause of significant maternal and fetal mortality and morbidity. The BRICS nations are crucial in the global MHD landscape, given their large populations and varied healthcare infrastructures. This investigation evaluates the incidence trends of MHD in BRICS countries from 1992 to 2021.

STUDY DESIGN AND METHODS

Data on the number, all-age rate, age-standardized rate (ASR), and the relative change of MHD incidence from this study were sourced from the Global Burden of Disease (GBD) 2021 public dataset to investigate temporal trends in MHD incidence over three decades globally and in BRICS countries. The age-period-cohort (APC) model was used to estimate net drift, local drift, age-specific curves, and period (cohort) relative risks.

RESULTS

A 15.87% increase in global MHD cases, alongside a 13.40% decrease in age-standardized incidence rates from 1992 to 2021. MHD incidence rates are declining across various BRICS age groups, except in China and Russian Federation, where most groups exhibit increasing trends. Annual net drift in MHD incidence ranges from - 4.25% in India to 2.38% in China. A shift in the age distribution of MHD cases from younger to older within the childbearing age range is observed in all BRICS nations. Countries exhibit similar age-effect patterns, with decreasing risk with increasing age, and varying period and cohort effects, indicative of differential control measures and temporal incidence trends.

CONCLUSIONS

Global and BRICS-specific reductions in MHD incidence vary in magnitude. Customized preventive strategies, leveraging existing resources, are advisable for BRICS nations to address pregnancy complications. Enhancing primary healthcare and maternal care quality, particularly for older mothers, is imperative.

Analysis of Stroke Burden in China from 1990 to 2021 and Projections for the Next Decade

INTRODUCTION

This study aimed to describe the temporal trends of stroke burden in different age and sex groups in China from 1990 to 2021, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), and to compare these data with global figures.

METHODS

Using data from the Global Burden of Disease database from 1990 to 2021, we analyzed changes in stroke burden in China and globally. The average annual percentage change (AAPC) was calculated using Joinpoint software to reflect trends. Stroke burden differences across various age groups and sexes were compared, and the ARIMA model was utilized for future projections.

RESULTS

Between 1990 and 2021, the age-standardized incidence rate (ASIR) of stroke in China decreased from 226.938 to 204.753 per 100,000, while the global ASIR decreased from 180.973 to 141.553 per 100,000. The age-standardized prevalence rate (ASPR) in China increased from 1,167.425 to 1,301.42 per 100,000, whereas the global ASPR decreased from 1,201.111 to 1,099.31 per 100,000. The age-standardized mortality rate (ASMR) in China fell from 242.18 to 138.029 per 100,000, while the global ASMR decreased from 144.313 to 87.454 per 100,000. China's age-standardized DALY rate (ASDR) declined from 4,834.791 to 2,648.025 per 100,000, whereas the global ASDR decreased from 3,078.952 to 1,886.196 per 100,000. The AAPCs for ASIR, ASPR, ASMR, and ASDR in China were -0.370%, 0.326%, -1.793%, and -1.933%, respectively, compared to -0.291%, -0.807%, -1.601%, and -1.570% globally from 1990 to 2021. Age and sex significantly influenced the stroke burden, with higher incidence and mortality rates in males than in females. Projections for the next decade indicate that stroke incidence in China will remain stable, with an expected rise in ASPR, and declines in ASMR and ASDR. Globally, ASIR is expected to decline, while ASPR will rise, and ASMR and ASDR will continue to decrease.

CONCLUSION

From 1990 to 2021, the incidence, mortality, and DALYs of stroke in China have decreased, while the prevalence has increased. Stroke burden is age-related, with higher prevalence in older adults and higher mortality in the elderly. Males are more susceptible to stroke and have a higher risk of death. Over the next decade, stroke prevalence in China is expected to rise, posing challenges due to population aging, even as mortality and disability rates decline. Sustained public health efforts will be necessary.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Global burden of zoonotic infectious diseases of poverty, 1990-2021

BACKGROUND

The zoonotic infectious diseases of poverty (zIDPs) are a group of diseases contributing to global poverty, with significant impacts on a substantial population. This study aims to describe the global, regional, and national burden of zIDPs-schistosomiasis, cystic echinococcosis, cysticercosis, and food-borne trematodiases (FBTs)-to support policy making and resource allocation for their control and elimination.

METHODS

Data of zIDPs from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 were retrieved from 1990 to 2021. The age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rate were described and the estimated annual percentage changes (EAPCs) were calculated to quantify their burden and temporal trends. Spearman correlation analysis was conducted to examine the relationship between age-standardized rates and Socio-demographic Index (SDI).

RESULTS

In 2021, these zIDPs exhibited a certain level of ASPRs and age-standardized DALY rates, while maintaining relatively low ASMRs. Noticeably, schistosomiasis presented the highest ASPR of 1914.299 (95% UI: 1378.920, 2510.853 per 100,000 population) and an age-standardized DALY rate of 21.895 (95% UI: 12.937, 37.278 per 100,000 population) among the zIDPs. The tapestry of burden-woven predominantly through low and lower-middle SDI regions-stretched across Africa, Latin America, and parts of Asia. From 1990 to 2021, a kaleidoscopic shift was observed globally as ASPRs, ASMRs, and age-standardized DALY rates declined significantly, as reflected by the EAPC values. Negative correlations were observed between the ASPRs, ASMRs, age-standardized DALY rates of schistosomiasis (r value = - 0.610, - 0.622 and - 0.610), cystic echinococcosis (- 0.676 of ASMR, - 0.550 of age-standardized DALYs), cysticercosis (- 0.420, - 0.797 and - 0.591) and the SDI. In contrast, a slight positive correlation was noted between the ASPR, age-standardized DALY rates of FBTs and SDI with r value of 0.221 and 0.213, respectively.

CONCLUSION

The burden of zIDPs declined across almost all endemic regions from 1990 to 2021, yet still predominated in low and low-middle SDI regions. Substantial challenges exist to achieve the goal of control and elimination of zIDPs, and integrated approaches based on One Health need to be strengthened to improve health outcomes.

Long-term trends and future projections of larynx cancer burden in China: a comprehensive analysis from 1990 to 2030 using GBD data

Larynx cancer poses a significant public health challenge in China, with rising incidence and mortality rates over the past decades. Understanding the long-term trends and underlying factors is crucial for effective intervention and policy formulation. Data were utilized from the global burden of disease (GBD) Study 2021 to analyze the incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to larynx cancer in China from 1990 to 2021. Joinpoint regression analysis identified key changes in trends, while age-period-cohort (APC) analysis and decomposition analysis quantified the contributions of aging, epidemiological changes, and population growth to these trends. Our study found a significant increase in the incidence and prevalence of larynx cancer in China, particularly among males. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for males were substantially higher than those for females. Decomposition analysis revealed that aging was the primary driver of increasing incidence and mortality rates, while epidemiological changes had a mitigating effect. Joinpoint analysis identified periods of rapid urbanization and economic growth as key turning points for increased incidence. Bayesian APC models projected a continued upward trend in incidence rates up to 2030. The rising burden of larynx cancer in China underscores the need for targeted public health interventions, including smoking cessation programs, environmental pollution control, and early detection strategies. Addressing gender disparities and implementing effective prevention measures are crucial to mitigating the impact of larynx cancer in China.

The global burden of enteric fever, 2017-2021: a systematic analysis from the global burden of disease study 2021

Background

Enteric fever is a major public health challenge in developing countries. We conducted a systematic analysis from the Global Burden of Diseases 2021 Study to provide updated estimates of enteric fever's burden.

Methods

We presented estimates for incident cases and deaths, age-standardized incidence and mortality rates, years of life lost (YLLs), and case-fatality rates spanning the study period of 2017-2021, stratified by region, country, socio-demographic index (SDI), and age group. Random-effects Poisson regression for longitudinal data was used to estimate the association between SDI and case-fatality rates, adjusting for antimicrobial resistance patterns.

Findings

In 2021, there were 9.3 million global cases of enteric fever (95% uncertainty interval: 7.3-11.9) and 107.5 thousand deaths (56.1-180.8). The age-standardized incidence rate decreased from 152/100,000 person-years (118-195) in 2017 to 128/100,000 person-years (100-163) in 2021, and the mortality rate decreased from 1.87/100,000 person-years (0.95-3.18) to 1.50/100,000 person-years (0.78-2.54). There were wide geographical differences, with South Asia contributing the most cases and deaths. Age-standardized incidence exceeded the threshold for "high burden" of enteric fever (100/100,000 person-years) in 23 countries in 2021.Children under five accounted for 40% of deaths and 47% of YLLs, with incidence and mortality peaking during the second year. Case-fatality was highest in low SDI countries and showed a global trend toward reduction, except among children aged 1-4 years. After adjusting for the prevalence of multidrug resistance, fluoroquinolone non-susceptibility, and third-generation cephalosporin resistance, a higher SDI was associated with a lower case-fatality rate, with a 1.1% (0.7-1.7) reduction for each percentage point increase in SDI.

Interpretation

Despite notable improvements, several countries still showed a high burden of enteric fever, which remains a significant global health concern, especially among children under five. Although enhancing water and sanitation systems is crucial, the most significant reductions in the global disease burden are likely to be achieved through broader vaccine coverage. This includes the use of typhoid conjugate vaccines, which are effective in infants and young children and offer extended protection, along with improved data collection and surveillance to guide vaccine distribution efforts across high-incidence areas.

Funding

This work was partially supported by "Ricerca Corrente" funding from Italian Ministry of Health to IRCCSHumanitas Research Hospital.

Global, Regional, and National Burden of Cardiovascular Disease, 1990-2021: Results From the 2021 Global Burden of Disease Study

Background Cardiovascular diseases (CVD), including coronary artery disease, ischemic heart disease, stroke, cardiomyopathy, and atrial fibrillation and flutter, are the leading cause of mortality worldwide, resulting in significant economic and health costs. Recognizing trends and geographical differences in the global burden of CVD facilitates health authorities in particular nations to assess the disease burden and forecast future epidemiological trends. Public health authorities in each country can better understand the differences in disease data and, by learning from the experiences and practices of successful countries and considering the characteristics of their diseases, allocate health resources more rationally and formulate more targeted healthcare strategies to reduce the disease burden. This study aims to comprehensively assess CVD trends and geographic variations from 1990 to 2021. Methods This study focuses on analyzing global trends in the epidemiology of all-age CVD incidence and death over the past 30 years. A vital registration system, cause-of-death inference records, and a cause-of-death ensemble model (CODEm) were used to estimate cause-specific mortality for CVD, with CODEm estimates adjusted using a cause-of-death correction (CoDCorrect) algorithm. Incidence data were extracted from insurance claims and inpatient discharge sources and analyzed with Disease Modeling Meta-Regression, Version 2.1 (DisMod-MR 2.1). Data were extracted from the 2021 Global Burden of Disease Study (GBD 2021) on the number of incident cases and deaths, as well as age-standardized incidence rates (ASIR) and age-standardized death rates (ASDR) for CVD for each year from 1990 to 2021. We visualized and reported this data at the global, regional, and national levels. To explore the association between the burden of CVD and sociodemographic factors, we used the sociodemographic index (SDI), which categorizes the world's 204 nations into five SDI regions. Because the GBD results are a combination of data and estimates, 95% uncertainty intervals (UI) are provided for each count and rate (per 100,000 populations). Results Globally, the number of CVD incident cases and deaths increased from 34.74 million and 12.33 million in 1990 to 66.81 million and 19.42 million in 2021, representing a 92.3% and 57.5% rise, respectively. However, the global ASIR and ASDR for CVD have decreased by 10.4% and 34.3%, respectively, since 1990. Notably, among the 21 regions of the world, the ASIR for CVD is on a downward trend from 1990 to 2021, except for East and Central Asia, where the ASIR for CVD increased by 3% and 14.3%, respectively. Similarly, the global ASDR for CVD is only on an upward trend in sub-Saharan Africa, increasing by 12%, while all other regions are on a downward trend. Among the five SDI regions, the high SDI region has much lower ASIR and ASDR compared to the world average, and these rates have decreased significantly over the years. Conclusion Despite a significant increase in the number of CVD incident cases and deaths worldwide over the last three decades, ASIR and ASDR have been declining. Over the past 30 years, both ASIR and ASDR for CVD have declined significantly in high SDI areas, while CVD continues to pose a serious public health threat in regions with low SDI.

Temporal trend and attributable risk factors of Alzheimer's disease and other dementias burden in China: Findings from the Global Burden of Disease Study 2021

INTRODUCTION

We examined the burden of Alzheimer's disease and other dementias (ADOD) and attributable factors at the national and provincial levels in China.

METHODS

Using the Global Burden of Diseases Study 2021, we estimated incidence, prevalence, mortality rate, disability-adjusted life years (DALYs), and the ratio of years lived with disability (YLD) to DALYs for ADOD in China. Estimated annual percentage changes (EAPCs) were used to quantify the temporal trends from 1990 to 2021.

RESULTS

In 2021, China experienced the highest ADOD burden among Group of 20 member nations. The EAPCs for age-standardized rates for incidence, age-standardized rates for prevalence, and age-standardized mortality rate were 0.41 (uncertainty intervals [UIs] 0.34-0.49); 0.44 (UI: 0.36-0.52); and -0.19 (UI: -0.23 to -0.15), respectively. Between 1990 and 2021, the number of people with ADOD increased by 322.18% and DALYs associated with ADOD increased by 272.71%; most of these increases were explained by population aging.

DISCUSSION

Considering the aging Chinese population, targeted strategies to prevent dementia are urgently needed.

HIGHLIGHTS

China experienced the highest dementia burden among Group of 20 member nations. High body mass index, high fasting plasma glucose, and smoking were major risk factors for Alzheimer's disease and other dementias (ADOD) burden. Since 1990, the incidence and prevalence of ADOD increased substantially in China. The mortality rate related to ADOD decreased consistently. Considering the aging Chinese population, targeted strategies are urgently needed.

Global burden of drug use disorders by region and country, 1990-2021

Background

This study used data from the Global Burden of Disease Study (GBD) database to systematically assess the magnitude of drug use disorders (DUD) burden between 1990 and 2021.

Methods

This study used GBD data to analyze the trends in ASIR, DALYs and other DUD indicators from 1990 to 2021, and compared them among different regions and countries. The Estimated Annual Percentage Change (EAPC) and its 95% Confidence Interval (CI) were calculated to assess the temporal and geographical disparities. ASIR and DALYs were used to evaluate the burden of DUDs, and socio-demographic index (SDI) was used to measure the socio-economic development level of each country.

Results

The global ASIR of DUDs showed a slight downward trend (EAPC = -0.26). The age-standardized DALY rate (per 100,000) significantly declined from 1990 to 2021 (EAPC = -1.44). Among the regions, the high SDI region exhibited the most substantial increase in ASIR (EAPC = 0.65). On a regional level, the high-income North America region had the highest EAPC for both age-standardized DALYs and ASIR (EAPC = 4.82, 1.02, respectively). Nationally, the United States of America reported the largest increase in age-standardized DALY rates and EAPC for ASIR (EAPC of 4.88, 1.05, respectively), while South Africa had the most significant decrease in EAPC (EAPC of -3.62, -1.52, respectively). In 2021, the highest ASIR was observed in high-income North America at 520.07; Central Asia had the highest age-standardized DALY rate. Globally, age-standardized DALYs and ASIR for DUDs were generally higher in men than in women, and the burden of DUDs decreased with age.

Conclusion

The global burden of DUDs has shown complex and changing trends over the last decades, with large differences in burden between regions and countries. This highlights the need for targeted public health policies and interventions in High income North America region and Eastern Europe.

Interconnected mental health symptoms: network analysis of depression, anxiety, stress, and burnout among psychiatric nurses in the context of the COVID-19 pandemic

Background

Mental health symptoms such as anxiety, depression, stress, and burnout are common among healthcare workers. However, the interconnections among them remain under-explored. This study aimed to address the interrelationships among these symptoms in psychiatric nurses.

Methods

We conducted a nationwide survey in the early stage of the COVID-19 pandemic (January to March 2021) to investigate the interconnectedness of depression, anxiety, stress, and burnout among psychiatric nurses. Using network analysis, we identified central symptoms, important bridge symptoms, and the correlations among these central symptoms.

Results

Of the 9,224 psychiatric nurses (79.2% female) included in the statistical analyses, 27.6% reported clinically significant depression, 31.2% anxiety, 14.5% stress, and 23.8% burnout. Network analysis revealed that stress had the highest expected influence (EI) value (0.920) and the highest strength among all nodes. The node for depression scored the highest in both closeness and betweenness. Emotional exhaustion (EE) had the highest bridge expected influence (BEI) of 0.340, with the strongest intergroup association between EE and depression. No significant differences were found in gender or frontline work experience (all p > 0.05).

Conclusions

Burnout, depression, anxiety, and stress are relatively common among psychiatric nurses in the context of the COVID-19 pandemic. While anxiety was the most prevalent, stress emerged as the core symptom, and depression as an important bridging node. Interventions targeting the core symptoms and bridging nodes may improve the mental health of psychiatric nurses.

How can interventions of building renovation and household energy conversion effectively improve the physical and mental health outcomes? A systematic review and meta-analysis

Household energy efficiency measures can effectively reduce indoor air pollution and positively impact the health of residents, but there is no conclusive evidence on the effectiveness of different energy efficiency measures for various diseases. This study used systematic review and meta-analysis to research the effects of two interventions on residents’ physical and mental health: building renovation (heating, insulation, double-glazed windows and ventilation) and household energy conversion (stove upgrading and clean energy use). A total of 79 papers published between 1977 and 2023 were reviewed in this study, providing comprehensive meta-analytic evidence on the effectiveness of energy efficiency measures. The results show that household energy-saving measures have a minor but significant positive influence on residents’ physical and mental health, with the effect on mental health being larger than the impact on physical health. Stove upgrading is advantageous in respiratory and cardiovascular diseases; insulation can greatly reduce the risk of skin diseases; heating is beneficial in sensory and digestive diseases; and clean energy use can successfully mitigate integrative diseases. Furthermore, a combination of heating and insulation measures has the most favourable influence on mental health conditions such as depression, anxiety and social isolation. The study findings can help residents, policymakers and relevant organizations take appropriate interventions to promote residents’ physical and mental health.

Global, regional, and national total burden related to hepatitis B in children and adolescents from 1990 to 2021

BACKGROUND

Hepatitis B remains a significant global health concern with widespread communicability. Nevertheless, data on its burden and trends in children and adolescents were limited. We aim to evaluate the global, regional, and national trends of total burden related to hepatitis B in children and adolescents aged 0-19 years from 1990 to 2021.

METHODS

The age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were calculated by the Global Burden of Disease (GBD) study from 1990 to 2021. These indicators were stratified by sex, age, socio-demographic index (SDI), and disease stage. We calculated the correlation between them and SDI. The temporal trends were examined using the annual average percentage change (AAPC) and joinpoint regression.

RESULTS

The global age-standardized incidence of hepatitis B in children and adolescents decreased from 1385.20 per 100,000 population in 1990 to 418.68 per 100,000 population in 2021, with an AAPC of -3.76%. Similarly, age-standardized DALYs decreased from 70.78 per 100,000 population to 36.31 per 100,000 population, with an AAPC of -2.13%. The age-standardized prevalence (AAPC - 3.53%) and mortality (AAPC - 2.09%) of hepatitis B also decreased significantly. From 1990 to 2021, the age-standardized incidence and prevalence among males exhibited a higher trend compared to females, although both declined over time. These two indicators also decreased across all age subgroups, with consistently higher rates observed in the 15-19 age group compared to other age groups. The burden of hepatitis B demonstrated a notable reduction in countries with high-middle SDI, while it was highest in countries with low SDI. In 2021, Central sub-Saharan Africa and West sub-Saharan Africa reported the highest age-standardized incidence. For age-standardized DALYs, South Asia was the only region to experience an increase (AAPC 1.09%), while East Asia showed the largest decline (AAPC - 7.58%). Alcohol and drug use remained important risk factors for DALYs among people aged 15-19 years. Furthermore, the impact of drug use on disease burden was increasing, particularly in high-SDI countries.

CONCLUSIONS

The global burden and trends of hepatitis B decreased significantly in children and adolescents, exhibiting regional and national variations. Management of alcohol and drug use remains a major challenge for people aged 15-19 years.

The burden, trends, and projections of low back pain attributable to high body mass index globally: an analysis of the global burden of disease study from 1990 to 2021 and projections to 2050

Objective

To systematically evaluate the global burden and trends of low back pain(LBP) associated with high Body Mass Index (BMI) and project future trends up to 2050 using Bayesian Age-Period-Cohort (BAPC) model, providing scientific evidence for prioritizing global preventive actions.

Methods

Utilizing data from the Global Burden of Disease (GBD) 2021 study, this research analyzes the disease burden of low back pain linked to high BMI globally, with Disability-Adjusted Life Years (DALYs) as the primary metric. We examined trends by gender, age, and exposure rate using Estimated Annual Percentage Change (EAPC) and projected future trends with the BAPC model.

Results

In 2021, high BMI-related low back pain accounted for 8,363,759 DALYs, with an age-standardized rate of 97.66 per 100,000 population and an EAPC of 1.14. The DALYs rate varied significantly by country, with the United States, Australia, and Eastern Europe experiencing the highest rates, all exceeding 225 per 100,000 population. The burden has increased globally, with notable rises in China, Southeast Asia, South Asia, and Africa, where EAPCs surpassed 2.5. Regions with medium and high Socio-Demographic Index (SDI) showed the most substantial increases, with the DALY rate in high SDI areas rising from 118.84 to 161.80 per 100,000, and in medium SDI areas from 41.92 to 79.10 per 100,000. Throughout the period from 1990 to 2021, females consistently experienced a higher burden of high BMI-related low back pain than males, with their DALY rate increasing from 92.01 to 126.29 per 100,000. The impact of high BMI on low back pain intensified with age, peaking in the 70-74 age group at 294.13 per 100,000, and then declining to 196.43 per 100,000 in those aged 95 and above. The BAPC model projects that by 2050, the number of DALYs will reach 15,558,278, an increase of 7,806,121 from 2021.

Conclusion

From 1990 to 2021, the global burden of low back pain attributable to high BMI has intensified, particularly affecting females, younger elderly, and developed regions. With increasing global aging and obesity rates, the burden is expected to continue rising rapidly without sustained and effective targeted interventions.

The Interplay Between the Built Environment, Health, and Well-Being—A Scoping Review

Objective: This scoping review aims to investigate the complex interplay between the built environment, health, and well-being and to provide a comprehensive overview of the knowledge needed for crucial health and well-being enhancement in cities. Method: A scoping review method has been chosen using four databases. The first sample was reduced from 2819 papers to 71 papers by implementing exclusion criteria, snowballing, and direct searches to find a relevant final sample. Results: Built environmental elements such as the neighborhood, urban architecture, activities, public spaces, greenery, lights, safety, aesthetics, and amenities were identified to be impactful on health and well-being outcomes. The two-way association of each environmental factor and its criteria with specific types of health and well-being issues such as cancer, cardiovascular diseases, stress, etc. was determined to identify solutions and ways for improvement. Conclusions: This scoping review provides a comprehensive overview of the intricate interplay between the built environment, health, and well-being. By synthesizing existing knowledge of the built environmental factors, it explores the basis for evidence-based strategies to enhance health and well-being. By illuminating theoretical knowledge of the built environment on health and well-being, our findings will provide a deeper foundation of sources and practical insights for related fields.

Global burden of major depressive disorders attributable to intimate partner violence against women: Magnitude, temporal trends, and regional inequalities

AIMS

This study aimed to analyze the temporal trends, spatial heterogeneities, and potential improvements in the burden of major depressive disorders (MDD) attributable to intimate partner violence (IPV) against women across 21 global burden of disease (GBD) regions, and 204 countries and territories from 1990 to 2019.

METHODS

We evaluated the burden of MDD attributable to IPV against women, as measured in disability-adjusted life years (DALYs) per 100,000 people across 21 GBD regions and 204 GBD countries and territories, using data from the 2019 GBD Study. The average annual percentage change (AAPC) of the DALY age-standardized rates (ASRs) was used to reflect trends over time. LOESS and quantile regression were used to model the relationship between the five GBD sociodemographic index (SDI) categories and DALY ASRs. Frontier analysis determined the minimum achievable DALY ASR associated with developmental status, as measured by the SDI.

RESULTS

The overall AAPC in age-standardized DALY rates for MDD attributable to IPV declined globally between 1990 and 2019. Despite the overall global decline (AAPC -0.08 [95 % UI -0.2, 0.03]), certain GBD regions, particularly high-income North America and Central Latin America, have experienced increases in DALY ASRs. The relationship between SDI and MDD burden showed a U-shaped variability, with low-SDI regions consistently exhibiting higher and stable DALY rates. Frontier analysis revealed that several countries, regardless of their SDI, have substantial gaps between observed and potentially achievable DALY rates, indicating areas for targeted intervention to reduce the burden of MDD due to IPV.

CONCLUSIONS

Significant spatial and temporal heterogeneity in MDD due to IPV was observed globally from 1990 to 2019, highlighting the substantial potential for improvement in various countries. Protective measures should be customized to suit the unique cultural contexts, developmental statuses, and regional disparities of each country.

[Temporal trend of the global prevalence rate of tension-type headache in children and adolescents in 1990-2021]

OBJECTIVES

To investigate the prevalence of tension-type headache (TTH) in children and adolescents aged 0-19 years globally in 1990-2021, and to provide a basis for the prevention and treatment of TTH.

METHODS

Based on the Global Burden of Disease Study data, the age-standardized prevalence distribution of TTH and its changing trend were analyzed among the children and adolescents aged 0-19 years, with different sexes, age groups, sociodemographic index (SDI) regions and countries/territories.

RESULTS

The age-standardized prevalence rate (ASPR) of TTH in children and adolescents aged 0-19 globally in 2021 was 17 339.89/100 000, which was increased by 1.73% since 1990. The ASPR in females was slightly higher than that in males (1990: 17 707.65/100 000 vs 16 403.78/100 000; 2021: 17 946.29/100 000 vs 16 763.09/100 000). The ASPR in adolescence was significantly higher than that in school-aged and preschool periods (1990: 27 672.04/100 000 vs 10 134.16/100 000; 2021: 28 239.04/100 000 vs 10 059.39/100 000). Regions with high SDI exhibited a higher ASPR than the other regions, with significant differences in prevalence rates across different countries. From 1990 to 2021, there was a slight increase in global ASPR, with an average annual percentage change (AAPC) of 0.06%. Females experienced a smaller increase than males based on AAPC (0.04% vs 0.07%). There was reduction in ASPR in preschool and school-aged groups, with an AAPC of -0.02%, while there was a significant increase in ASPR in adolescence, with an AAPC of 0.07%. ASPR decreased in regions with low-middle and low levels of SDI, with an AAPC of -0.02% and -0.04%, respectively, while it increased in regions with middle SDI, with an AAPC of 0.24%.

CONCLUSIONS

There is a consistent increase in the ASPR of TTH in children and adolescents aged 0-19 years globally, with significant differences across sexes, age groups, SDI regions and countries/territories.

Anti-Inflammatory and Neuroprotective Polyphenols Derived from the European Olive Tree, Olea europaea L., in Long COVID and Other Conditions Involving Cognitive Impairment

The European olive tree, Olea europaea L., and its polyphenols hold great therapeutic potential to treat neuroinflammation and cognitive impairment. This review examines the evidence for the anti-inflammatory and neuroprotective actions of olive polyphenols and their potential in the treatment of long COVID and neurodegenerative diseases such as Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS). Key findings suggest that olive polyphenols exhibit antioxidant, anti-inflammatory, neuroprotective, and antiviral properties, making them promising candidates for therapeutic intervention, especially when formulated in unique combinations. Recommendations for future research directions include elucidating molecular pathways through mechanistic studies, exploring the therapeutic implications of olive polyphenol supplementation, and conducting clinical trials to assess efficacy and safety. Investigating potential synergistic effects with other agents addressing different targets is suggested for further exploration. The evidence reviewed strengthens the translational value of olive polyphenols in conditions involving cognitive dysfunction and emphasizes the novelty of new formulations.

Mortality salience and helping behavior amidst public crisis: cross-sectional evidence during COVID-19

Background

As a real mortality salience, a public crisis would have a major impact on individual minds, behaviors, and lifestyles. COVID-19 provides us with a stark real-world example to understand these implications. Previous research has revealed that some individuals become more willing to help the infected at the risk of their own lives, while others become more self-centered and indifferent during COVID-19. To explain this paradoxical phenomenon, our study used two rival mediators in the relationship between mortality salience and helping behavior during COVID-19: death anxiety and death reflection.

Methods

A cross-sectional survey was conducted among Chinese college students (N = 684) during the pandemic. We used a parallel mediation model to explore the mediating roles of death anxiety and death reflection in the relationship between mortality salience and helping behavior during COVID-19.

Results

The results of our study indicate two key findings. First, mortality salience is negatively related to helping behavior during COVID-19 via death anxiety. This suggests that individuals with higher levels of mortality salience experienced increased death anxiety, which in turn led to a decrease in helping behavior. Second, mortality salience is positively related to helping behavior during COVID-19 via death reflection. This indicates that individuals with higher levels of mortality salience engaged in deeper reflection on death, which subsequently resulted in an increase in helping behavior.

Conclusion

Our study provides valuable insights into the complex relationship between mortality salience and helping behaviors in the time of public crisis, and can help lead to more positive attitudes toward public crisis events such as COVID-19.

Time trends in anxiety disorders incidence across the BRICS: an age-period-cohort analysis for the GBD 2021

Background

Anxiety disorders are a significant global mental health concern, contributing to substantial disability-adjusted life years (DALYs) and imposing considerable social and economic burdens. Understanding the epidemiology of anxiety disorders within the BRICS nations (Brazil, Russian Federation, India, China, and South Africa) is essential due to their unique socio-economic landscapes and ongoing transformations.

Methods

This study utilized data from the Global Burden of Disease (GBD) 2021 database to evaluate anxiety disorder incidence trends in BRICS countries from 1992 to 2021. The Age-Period-Cohort (APC) model with an intrinsic estimator (IE) algorithm was employed to disentangle the effects of age, period, and cohort on incidence rates. Data were categorized into 5-year age groups, and 95% uncertainty intervals (UIs) were calculated to account for data variability.

Results

From 1992 to 2021, the global number of anxiety disorders cases increased by 73.44%, with age-standardized incidence rates rising by 21.17%. Among BRICS nations, India experienced the largest increase in cases (113.30%), while China had the smallest increase (2.79%). Globally, young (15-49 years) and oldest (80-94 years) age groups showed predominantly positive local drift values, indicating rising incidence rates. Brazil and India mirrored this trend, while China and South Africa mostly exhibited negative local drift values. Russia Federation had mixed trends with younger groups showing negative and older groups positive local drift values. The incidence of anxiety disorders exhibited an "M-shaped" age pattern with peaks at 10-14 and 35-39 years. Period effects were stable globally but varied in BRICS countries, with Brazil showing a decline and India an increase. Cohort effects were stable globally but showed increasing trends in Brazil and India post-1955-1959 cohort.

Conclusion

This study highlights a significant increase in anxiety disorders incidence globally and within BRICS nations over the past three decades, with marked variations across countries. The distinct trends observed in age, period, and cohort effects call for age-specific and gender-sensitive mental health policies. Continuous monitoring, research, and tailored public health strategies are essential to address the rising burden of anxiety disorders and improve mental health outcomes in these rapidly evolving regions.

Burden of cardiovascular disease among the Western Pacific region and its association with human resources for health, 1990-2021: a systematic analysis of the Global Burden of Disease Study 2021

Background

A comprehensive profile of cardiovascular disease (CVD) burden and human resources for health (HRH) distribution in the WHO Western Pacific region has yet to be presented. Studies on the relationship between HRH and CVD in this region are limited. We aimed to describe CVD trends and HRH density in the Western Pacific region and explore the association of HRH with CVD burden.

Methods

Estimates of CVD deaths and disability-adjusted life years (DALYs) were obtained from the Global Burden of Disease Study (GBD) 2021, and the annual density of HRH was retrieved from GBD 2019. We presented trends in CVD burden and HRH density across 31 Western Pacific countries. Spearman rank correlation analysis and generalized linear models were used to examine associations between CVD burden and HRH density.

Findings

In 2021, CVD caused six million deaths and 125 million DALYs in the Western Pacific region, accounting for 39.4% and 22.5% of all-cause deaths and DALYs. From 1990 to 2021, the number of CVD deaths and DALYs increased by 94.9% and 57.3% in this region, whereas the age-standardized rate of CVD deaths and DALYs declined in all countries. In 2021, stroke and ischemic heart disease were the leading causes in the Western Pacific region, and a 32-year increase in CVD burden was primarily driven by aortic aneurysm, lower extremity peripheral arterial disease, endocarditis, and atrial fibrillation and flutter. In 2019, there was an approximately 20-fold difference in HRH density across 31 countries from the lowest in Papua New Guinea to the highest in Australia. HRH density was negatively related to the age-standardized rate of CVD deaths (r s  = -0.74) and DALYs (r s  = -0.73), especially strong associations between CVD burden and the density of dentistry personnel, aides & emergency medical workers, and medical laboratory technicians.

Interpretation

CVD remains a pressing public health issue in the Western Pacific region where noticeable shortages in health workers exist. The negative associations between CVD burden and HRH density suggest that health workers, especially dentistry personnel, aides & emergency medical staff, and medical laboratory technicians merit more investment to reduce the CVD burden.

Funding

National Natural Science Foundation of China (82073573 to ZZ; 82273654 to YS).

Functional evaluation of TMEM176B and its predictive role for severe respiratory viral infection through integrated analysis of single-cell and bulk RNA-sequencing

Transmembrane protein 176B (TMEM176B), localized mainly on the endosomal membrane, has been reported as an immune regulatory factor in malignant diseases. However, the biological function of this molecule remains undetermined during respiratory viral infections. To investigate the functions and prognostic value of this gene, six gene sets were selected from the Gene Expression Omnibus database for research. First, the function of TMEM176B and its co-expressed genes were evaluated at different levels (cell, peripheral blood, lung tissue). Afterwards, a machine learning algorithm was utilized to analyze the relationship between TMEM176B and its interacting genes with prognosis. After importance evaluation and variable screening, a prognostic model was established. Finally, the reliability of the model was further verified through external data sets. In vitro experiments were conducted to validate the function of TMEM176B. TMEM176B and its co-expressed genes are involved in multiple processes such as inflammasome activation, myeloid immune cell development, and immune cell infiltration. Machine learning further screened 27 interacting gene modules including TMEM176B as prognostic models for severe respiratory viral infections, with the area under the ROC curve (AUCs) of 0.986 and 0.905 in derivation and external validation sets, respectively. We further confirmed that viral load as well as NLRP3 activation and cell death were significantly enhanced in TMEM176B-/- THP-1-differentiated macrophages via in vitro experiments. Our study revealed that TMEM176B is involved in a wide range of biological functions in respiratory viral infections and has potential prognostic value, which is expected to bring new insights into the clinical management of severe respiratory viral infection hosts.

National burden and risk factors of diabetes mellitus in China from 1990 to 2021: Results from the Global Burden of Disease study 2021

BACKGROUND

In recent years, the prevalence and mortality rates of diabetes have been rising continuously, posing a significant threat to public health and placing a heavy burden on the population. This study was conducted to describe and analyze the burden of diabetes in China from 1990 to 2021 and its attributable risk factors.

METHODS

Utilizing data from the Global Burden of Disease Study 2021, we analyzed the incidence, prevalence, and disability-adjusted life years (DALYs) of type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in China from 1990 to 2021. We extracted sex- and age-specific data on diabetes, focusing on DALYs, years lived with disability, and years of life lost. Bayesian meta-regression and spatiotemporal Gaussian process regression were used to estimate disease parameters. Age-standardized rates (ASRs) and estimated annual percentage changes (EAPC) were calculated using direct standardization and log-linear regression. The population-attributable fractions were also determined for each risk factor.

RESULTS

In 2021, the absolute number of incident diabetes mellitus (DM) cases was estimated at 4003543.82, including 32 000 T1DM and 3971486.24 T2DM cases. The ASRs were 244.57 for DM, 2.67 for T1DM, and 241.9 for T2DM (per 100 000 population). The absolute number of prevalent DM cases was 117288553.93, including 1442775.09 T1DM and 115845778.84 T2DM cases. The ASRs were 6142.29 for DM, 86.78 for T1DM, and 6055.51 for T2DM (per 100 000 population). In 2021, there were 178475.73 deaths caused by DM, with an ASR of mortality of 8.98 per 100 000 population. The DALYs due to DM in 2021 were 11713613.86, with an ASR of 585.43 per 100 000 population and an EAPC of 0.57. This increase can be attributed to several factors, including high body mass index, air pollution, and dietary habits.

CONCLUSIONS

The burden of diabetes is considerable, with high prevalence and incidence rates, highlighting the urgent need for public health interventions. Addressing factors like high fasting plasma glucose, body mass index, air pollution, and dietary risks through effective interventions is critical.

Burden of disease attributable to high body mass index: an analysis of data from the Global Burden of Disease Study 2021

BACKGROUND

Obesity represents a major global health challenge with important clinical implications. Despite its recognized importance, the global disease burden attributable to high body mass index (BMI) remains less well understood.

METHODS

We systematically analyzed global deaths and disability-adjusted life years (DALYs) attributable to high BMI using the methodology and analytical approaches of the Global Burden of Disease Study (GBD) 2021. High BMI was defined as a BMI over 25 kg/m2 for individuals aged ≥20 years. The Socio-Demographic Index (SDI) was used as a composite measure to assess the level of socio-economic development across different regions. Subgroup analyses considered age, sex, year, geographical location, and SDI.

FINDINGS

From 1990 to 2021, the global deaths and DALYs attributable to high BMI increased more than 2.5-fold for females and males. However, the age-standardized death rates remained stable for females and increased by 15.0% for males. Similarly, the age-standardized DALY rates increased by 21.7% for females and 31.2% for males. In 2021, the six leading causes of high BMI-attributable DALYs were diabetes mellitus, ischemic heart disease, hypertensive heart disease, chronic kidney disease, low back pain and stroke. From 1990 to 2021, low-middle SDI countries exhibited the highest annual percentage changes in age-standardized DALY rates, whereas high SDI countries showed the lowest.

INTERPRETATION

The worldwide health burden attributable to high BMI has grown significantly between 1990 and 2021. The increasing global rates of high BMI and the associated disease burden highlight the urgent need for regular surveillance and monitoring of BMI.

FUNDING

National Natural Science Foundation of China and National Key R&D Program of China.

Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050

BACKGROUND

Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts.

METHODS

We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level.

FINDINGS

In 2021, we estimated 4·71 million (95% UI 4·23-5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00-1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000-372 000] and 57 200 attributable deaths [34 100-80 300] in 1990, to 550 000 associated deaths [500 000-600 000] and 130 000 attributable deaths [113 000-146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000-834 000) in 1990, to 1·03 million associated deaths (909 000-1·16 million) in 2021, and from 127 000 attributable deaths (82 100-171 000) in 1990, to 216 000 (168 000-264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56-2·26) deaths attributable to AMR and 8·22 million (6·85-9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2-69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5-89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (-6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8-102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08-13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths.

INTERPRETATION

This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050.

FUNDING

UK Department of Health and Social Care's Fleming Fund using UK aid, and the Wellcome Trust.

Trends and Distribution of Life Expectancy and Health-Adjusted Life Expectancy - Asia-Pacific Region, 1990-2021

What is already known about this topic?

The Asia-Pacific region is the most populous and diverse globally, encompassing nations with both the longest and shortest life expectancies (LE). However, less is known about the health-adjusted life expectancy (HALE) situation in this region.

What is added by this report?

This study found diversity in the levels and trends of HALE among countries in the Asia-Pacific region, with HALE in 2021 ranging from 49.87 years in Afghanistan to 74.96 years in Singapore. The largest HALE increase from 1990 to 2021 was observed in the Lao People's Democratic Republic and the smallest in Fiji. HALE continually increased as SDI increased, but different patterns of HALE across countries varied by SDI level.

What are the implications for public health practice?

The diversity among these countries provides a prerequisite and scientific basis for promoting the achievement of health goals in the Asia-Pacific region through multilateral and bilateral cooperation.

Differences in ischemic heart disease between males and females using predictive artificial intelligence models

<b>Background: </b>Cardiovascular health and preventative strategies are influenced by the sex of the individuals. To forecast cardiac events or detect ischemic heart disease (IHD) early, machine-learning algorithms can analyze complex patient data patterns. Early detection allows for lifestyle changes, medication management, or invasive treatments to slow disease progression and improve outcomes.<br /> <b>Aim</b>: To compare and predict the differences in the primary sources of IHD burden between males and females in various age groups, geographical regions, death versus alive, and comorbidity levels.<br /> <b>Methods: </b>A predictive and retrospective design was implemented in this study. Electronic health records were extracted, which were equally distributed among males and females with IHD. The dataset consisted of patients who were admitted between 2015 and 2022. Two of the eight models generated by Modeler software were implemented in this study: the Bayesian network model, which achieved the highest area under curve score (0.600), and the Chi-squared automatic interaction detection (CHAID) model, which achieved the highest overall accuracy score (57.199%).<br /> <b>Results: </b>The study sample included 17,878 men and women, 58% of whom had no comorbidities and 1.7% who died. Age, the Charlson comorbidity index score, and geographical location all predicted IHD, but age was more influential. Bayesian network analysis showed that IHD odds were highest in males 40-59 and females 60-79, with the highest mortality risk in females 80-100. North and south Jordan had higher IHD rates and middle-aged males from north and middle governorates had higher IHD rates according to CHAID.<br /> <b>Conclusion: </b>By using artificial intelligence, clinicians can improve patient outcomes, treatment quality, and save lives in the fight against cardiovascular illnesses. To predict IHD early, machine-learning algorithms can analyze complex patient data patterns to improve outcomes.

Global burden of benign prostatic hyperplasia, urinary tract infections, urolithiasis, bladder cancer, kidney cancer, and prostate cancer from 1990 to 2021

BACKGROUND

The burden of common urologic diseases, including benign prostatic hyperplasia (BPH), urinary tract infections (UTI), urolithiasis, bladder cancer, kidney cancer, and prostate cancer, varies both geographically and within specific regions. It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.

METHODS

We obtained data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for the aforementioned urologic diseases by age, sex, location, and year from the Global Burden of Disease (GBD) 2021. We analyzed the burden associated with urologic diseases based on socio-demographic index (SDI) and attributable risk factors. The trends in burden over time were assessed using estimated annual percentage changes (EAPC) along with a 95% confidence interval (CI).

RESULTS

In 2021, BPH and UTI were the leading causes of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR), with rates of 5531.88 and 2782.59 per 100,000 persons, respectively. Prostate cancer was the leading cause of both age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR), with rates of 12.63 and 217.83 per 100,000 persons, respectively. From 1990 to 2021, there was an upward trend in ASIR, ASPR, ASMR, and ASDR for UTI, while urolithiasis showed a downward trend. The middle and low-middle SDI quintile levels exhibited higher incidence, prevalence, mortality, and DALYs related to UTI, urolithiasis, and BPH, while the high and high-middle SDI quintile levels showed higher rates for the three cancers. The burden of these six urologic diseases displayed diverse age and sex distribution patterns. In 2021, a high body mass index (BMI) contributed to 20.07% of kidney cancer deaths worldwide, while smoking accounted for 26.48% of bladder cancer deaths and 3.00% of prostate cancer deaths.

CONCLUSIONS

The global burden of 6 urologic diseases presents a significant public health challenge. Urgent international collaboration is essential to advance the improvement of urologic disease management, encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.

Comparative analysis of pediatric pulmonary and extrapulmonary tuberculosis: A single-center retrospective cohort study in Syria

Background

Tuberculosis (TB) is a global public health challenge, contributing significantly to morbidity and mortality worldwide. This research aims to investigate the epidemiology, clinical characteristics, diagnostic methods, and early mortality rate among pediatric patients with pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) who were admitted to a hospital in Syria.

Methods

This retrospective cohort study was conducted at the University Children's Hospital in Syria, involving pediatric patients diagnosed with TB between January 2013 and January 2023. Data were collected from medical records and encompassed socio-demographic characteristics, diagnostic methods, clinical presentation, chest radiography findings, and patient outcomes. Statistical analysis was performed using SPSS version 25.

Results

A total of 129 patients were included in the study, with 26.4 % diagnosed with PTB and 73.6 % with EPTB. The most common types of EPTB were lymphatic (25.6 %) and gastrointestinal (17.1 %). Patients with PTB and EPTB did not differ significantly in terms of age, weight, or gender. Significant cough was more common in PTB cases (67.6 %), while lymphadenopathy was more prevalent in EPTB cases (48.4 %). Chest X-ray abnormalities were found in 58.1 % of patients, with PTB patients more likely to have abnormal findings (97.1 %). Microbiological confirmation was higher in PTB cases (76.5 %) compared to EPTB cases (25.3 %). The overall mortality rate was 14 %, with higher mortality observed in patients with EPTB (16.8 %), particularly in cases of TB meningitis.

Conclusion

Our study highlights the epidemiological challenges of TB among hospitalized children, with a focus on the complexities of diagnosing and managing EPTB. We emphasize the urgent need for enhanced diagnostic and management strategies, particularly in conflict zones like Syria, where TB control efforts face significant obstacles. Prompt solutions are imperative to improve outcomes, given the high occurrence of EPTB and its associated mortality rates. Clinical recommendations stress the need for comprehensive contact histories and awareness of varied clinical presentations in pediatric TB diagnosis.

Global burden of cardiovascular diseases: projections from 2025 to 2050

AIMS

The prediction of future trends in cardiovascular disease (CVD) mortality and their risk factors can assist policy-makers in healthcare planning. This study aims to project geospatial trends in CVDs and their underlying risk factors from 2025 to 2050.

METHODS AND RESULTS

Using historical data on mortality and disability-adjusted life years (DALYs) from the Global Burden of Disease (GBD) 2019 study, encompassing the period of 1990 to 2019, Poisson regression was performed to model mortality and DALYs associated with CVD and its associated risk factors from 2025 to 2050. Subgroup analysis was based on GBD super-regions. Between 2025 and 2050, a 90.0% increase in cardiovascular prevalence, 73.4% increase in crude mortality, and 54.7% increase in crude DALYs are projected, with an expected 35.6 million cardiovascular deaths in 2050 (from 20.5 million in 2025). However, age-standardized cardiovascular prevalence will be relatively constant (-3.6%), with decreasing age-standardized mortality (-30.5%) and age-standardized DALYs (-29.6%). In 2050, ischaemic heart disease will remain the leading cause of cardiovascular deaths (20 million deaths) while high systolic blood pressure will be the main cardiovascular risk factor driving mortality (18.9 million deaths). Central Europe, Eastern Europe, and Central Asia super-region is set to incur the highest age-standardized cardiovascular mortality rate in 2050 (305 deaths per 100 000 population).

CONCLUSION

In the coming decades, the relatively constant age-standardized prevalence of global CVD suggests that the net effect of summative preventative efforts will likely continue to be unchanged. The fall in age-standardized cardiovascular mortality reflects the improvement in medical care following diagnosis. However, future healthcare systems can expect a rapid rise in crude cardiovascular mortality, driven by the ageing global populace. The continued rise in CVD burden will largely be attributed to atherosclerotic diseases.

REGISTRATION

Not applicable.

Global, regional, and national burden of acute myeloid leukemia, 1990-2021: a systematic analysis for the global burden of disease study 2021

BACKGROUND

Acute myeloid leukemia (AML), as the most common subtype of leukemia in adults, is characterised by rapid progression and poor prognosis. In the context of the rapid development of medical technology and the complexity of social factors, a detailed report describing the latest epidemiological patterns of AML is important for decision makers to allocate healthcare resources effectively.

METHODS

Our research utilized the latest data sourced from the Global Burden of Disease (GBD) 2021. To delineate the burden of AML, we comprehensively described the incidence, deaths, disability-adjusted life years (DALYs), and the associated age-standardized rates per 100,000 persons (ASR) spanning from 1990 to 2021 stratifies according to age, sex, socio-demographic index (SDI), and nationality. Additionally, we extracted and analyzed data about the risk factors that contribute to AML-related deaths and DALYs.

RESULTS

According to our study, the incidence of AML has continued to rise globally from 79,372 in 1990 to 144,645 in 2021 and AML affected the male and the elderly populations disproportionately. Furthermore, there was a significant positive correlation between the burden of AML and the SDI value. Developed nations generally exhibited higher age-standardized incidence rate, age-standardized death rate, and age-standardized disability-adjusted life year rate than the developing nations. We also analyzed the prevalence of smoking, high body mass index, and occupational benzene and formaldehyde exposure in the AML population in different SDI regions. Moreover, smoking and high body mass index were more prevalent in developed countries, whereas occupational exposure to these chemicals was the predominant risk factor in developing countries.

CONCLUSION

The global burden of AML has increased over the past 32 years, with rising morbidity and mortality. The incidence of AML is differentially distributed across different SDI countries or regions. AML incidence is higher in the elderly and in men. The proportions of smoking, high body mass index, and occupational exposure to benzene and formaldehyde varied by region. The findings highlight the need for region-specific prevention and call for future research on preventive strategies and new treatments to lower AML incidence and improve patient outcomes.

The effects of food affordability on life expectancy in emerging countries

The relationship between food prices and life expectancy in emerging countries has significant implications for public health and socioeconomic development in these regions. This study examines this relationship using a dataset of 120 emerging economies over the period 2000–2021, employing the dynamic panel threshold and system generalized method of moments (GMM) models. Our findings reveal a nonlinear inverted U‐shaped relationship where beyond a specific threshold, higher food prices tend to shorten life expectancy. We also reveal the disproportionate burden placed on low‐income countries when food prices rise, in comparison to middle‐income countries and highlight the profound impact of economic disparities on public health. Moreover, we identify several channels through which food prices affect life expectancy. Specifically, we reveal that income, undernutrition, and mental health disorders represent potential mediating factors affecting food prices–life expectancy nexus. We also shed light on the severe implications of economic crises on public health, emphasizing the close connection between economic events and indicators of human health. These insights have direct implications for policymakers, offering valuable guidance in the context of fluctuating food prices.

Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021

BACKGROUND

Appendicitis is a common surgical emergency that poses a large clinical and economic burden. Understanding the global burden of appendicitis is crucial for evaluating unmet needs and implementing and scaling up intervention services to reduce adverse health outcomes. This study aims to provide a comprehensive assessment of the global, regional, and national burden of appendicitis, by age and sex, from 1990 to 2021.

METHODS

Vital registration and verbal autopsy data, the Cause of Death Ensemble model (CODEm), and demographic estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) were used to estimate cause-specific mortality rates (CSMRs) for appendicitis. Incidence data were extracted from insurance claims and inpatient discharge sources and analysed with disease modelling meta-regression, version 2.1 (DisMod-MR 2.1). Years of life lost (YLLs) were estimated by combining death counts with standard life expectancy at the age of death. Years lived with disability (YLDs) were estimated by multiplying incidence estimates by an average disease duration of 2 weeks and a disability weight for abdominal pain. YLLs and YLDs were summed to estimate disability-adjusted life-years (DALYs).

FINDINGS

In 2021, the global age-standardised mortality rate of appendicitis was 0·358 (95% uncertainty interval [UI] 0·311-0·414) per 100 000. Mortality rates ranged from 1·01 (0·895-1·13) per 100 000 in central Latin America to 0·054 (0·0464-0·0617) per 100 000 in high-income Asia Pacific. The global age-standardised incidence rate of appendicitis in 2021 was 214 (174-274) per 100 000, corresponding to 17 million (13·8-21·6) new cases. The incidence rate was the highest in high-income Asia Pacific, at 364 (286-475) per 100 000 and the lowest in western sub-Saharan Africa, at 81·4 (63·9-109) per 100 000. The global age-standardised rates of mortality, incidence, YLLs, YLDs, and DALYs due to appendicitis decreased steadily between 1990 and 2021, with the largest reduction in mortality and YLL rates. The global annualised rate of decline in the DALY rate was greatest in children younger than the age of 10 years. Although mortality rates due to appendicitis decreased in all regions, there were large regional variations in the temporal trend in incidence. Although the global age-standardised incidence rate of appendicitis has steadily decreased between 1990 and 2021, almost half of GBD regions saw an increase of greater than 10% in their age-standardised incidence rates.

INTERPRETATION

Slow but promising progress has been observed in reducing the overall burden of appendicitis in all regions. However, there are important geographical variations in appendicitis incidence and mortality, and the relationship between these measures suggests that many people still do not have access to quality health care. As the incidence of appendicitis is rising in many parts of the world, countries should prepare their health-care infrastructure for timely, high-quality diagnosis and treatment. Given the risk that improved diagnosis may counterintuitively drive apparent rising trends in incidence, these efforts should be coupled with improved data collection, which will also be crucial for understanding trends and developing targeted interventions.

FUNDING

Bill and Melinda Gates Foundation.

Impact of sustainable supply chain management practices on competitive advantage and organizational performance in the manufacturing sector

Purpose

The purpose of this study is to examine the impact of sustainable supply chain management (SSCM) practices on both competitive advantage (CA) and organizational performance (OP) in the manufacturing sector in Ethiopia.

Design/methodology/approach

Data for the study were collected from a sample of 221 manufacturing companies operating in the four manufacturing groups/sectors in Ethiopia. In addition, data analysis was performed using the partial least squares method, which is a variance-based Structural Equation Modeling approach in the Smart-PLS software version (SmartPLS 4.0).

Findings

Based on the statistical analysis of the collected data, it demonstrates that SSCM has a significant and positive impact on both competitive advantage and organizational performance. Furthermore, statistical findings offer proof of the clear connection between competitive advantage and organizational performance. Moreover, competitive advantage indirectly mediates the relationship between SSCM and OP.

Research limitations/implications

The primary limitation of this research is its reliance on a cross-sectional design. The generalizability of the findings obtained from the present study may be hindered. The variable under investigation in this research assessed organizational performance, a concept that is widely acknowledged to be extremely dynamic.

Practical implications

The study provides managers and researchers with valuable information on Sustainable Supply Chain Management strategies and how they influence competitive advantage and organizational performance in commercial and industrial environments.

Originality/value

This paper adds to the body of knowledge by providing new data and empirical insights into the relationship between SSCM practices and the performance of manufacturing companies in Ethiopia.

The compounding impact of the social determinants of health and COVID-19 on the mental health of young workers in Canada during the COVID-19 pandemic: A qualitative, arts-based study

The COVID-19 pandemic, a global health crisis, was acutely felt in the labour market for many young workers. Importantly, precarious employment, identified as an emergent social determinant of health, may negatively affect the mental health and well-being of young workers. To this end, we engaged with young workers to understand their workplace needs and challenges in the COVID-19 era and hear their recommendations for action. Semi-structured interviews and a graphic recording focus group were conducted with 33 young workers aged 18-26 years old in Manitoba, Canada, who had worked a minimum of 30 hours per week prior to COVID-19 onset and were living independent of their parents. Analysis involved delineating units of meaning from the data, clustering these to form thematic statements and extracting themes. Second-level analysis involved applying themes and sub-themes to a social determinants of health framework. The multifaceted, compounding realities of young workers' pre-COVID-19 employment situations were amplified by the COVID-19 pandemic, adversely impacting young worker's mental health. Unique findings from this study highlight the generational differences in this cohort, who are opposed to participating in fragmented systemic structures (neoliberalism) and inequitable employment conditions, and who yearn for social inclusion and work-life balance. Their recommendations for government and employers call for permanent and stable employment opportunities, economic and mental health supports, and space to be heard and valued, as they navigate the many life course challenges as emerging adults. Societies are dependent on young workers to develop and support the Canadian economy for future generations. Thus, it is a critical that recommendations proposed by young workers in this study be acted upon and implemented to provide an equitable, stable, and supportive future for young workers in Canada and beyond.

The global incidence and trends of three common flavivirus infections (Dengue, yellow fever, and Zika) from 2011 to 2021

Background

Flavivirus pose a continued threat to global health, yet their worldwide burden and trends remain poorly quantified. We aimed to evaluate the global, regional, and national incidence of three common flavivirus infections (Dengue, yellow fever, and Zika) from 2011 to 2021.

Methods

Data on the number and rate of incidence for the three common flavivirus infection in 204 countries and territories were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The estimated annual percent change (EAPC) was calculated to quantify the temporal trend during 2011-2016, 2016-2019, and 2019-2021, respectively.

Results

In 2021, an estimated 59,220,428 individuals were infected globally, comprising 58,964,185 cases of dengue, 86,509 cases of yellow fever, and 169,734 cases of Zika virus infection. The age-standardized incidence rate (ASIR) of the three common flavivirus infections increased by an annual average of 5.08% (95% CI 4.12 to 6.05) globally from 2011 to 2016, whereas decreased by an annual average of -8.37% (95% CI -12.46 to -4.08) per year between 2016 to 2019. The ASIR remained stable during 2019-2021, with an average change of 0.69% (95% CI -0.96 to 2.37) per year globally for the three common flavivirus infections. Regionally, the burden of the three common flavivirus infections was primarily concentrated in those regions with middle income, such as South Asia, Southeast Asia, and Tropical Latin America. Additionally, at the country level, there was an inverted "U" relationship between the SDI level and the ASI. Notably, an increase in the average age of infected cases has been observed worldwide, particularly in higher-income regions.

Conclusion

Flavivirus infections are an expanding public health concern worldwide, with considerable regional and demographic variation in the incidence. Policymakers and healthcare providers must stay vigilant regarding the impact of COVID-19 and other environmental factors on the risk of flavivirus infection and be prepared for potential future outbreaks.

Introducing CRAFT: The Center for Research and Advancement in Fragments and molecular Targets

We introduce the Center for Research and Advancement in Fragments and Molecular Targets (CRAFT), a pioneering research center established in 2021 through a collaboration between the University of São Paulo (USP) and the Federal University of Goiás (UFG). CRAFT integrates fragment-based drug discovery (FBDD), artificial intelligence (AI), and structural biology to develop novel therapeutic strategies. We have created fragment and target libraries and utilize AI models to streamline the drug discovery process. We invite the global scientific community to collaborate with us in addressing neglected diseases, with the goal of enhancing research capabilities and fostering scientific innovation across Latin America.

Impact of COVID-19 on adverse reactions to subcutaneous specific immunotherapy in children:a retrospective cohort study

BACKGROUND

COVID-19 is a new infectious disease. To investigate whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases the adverse reactions of subcutaneous specific immunotherapy (SCIT) in children.

METHODS

This study was conducted by collecting relevant data from children who underwent house dust mite SCIT from April 3, 2021, to March 18, 2023, including information on the time of COVID-19 infection, symptoms, and adverse reactions after each allergen injection. A mixed effects model was used to analyze the changes in adverse reactions before and after the COVID-19 infection.

RESULTS

Among the records of adverse reactions from 2658 injections in 123 children who underwent SCIT, the overall adverse reaction rate before COVID-19 infection was 39.8% and 30.0% after COVID-19 infection. Compared with pre-infection with COVID-19, the risks of overall adverse reactions, local adverse reactions, and systemic adverse reactions of immunotherapy after COVID-19 infection were reduced (odds ratio [OR] = 0.24, 0.31, and 0.28, all P < 0.05). Among the local adverse reactions, the incidence of the unvaccinated group was the highest (15.3% vs. 7.1%). The incidence of overall and local adverse reactions to SCIT decreased in 2-vaccinated COVID-19 recipients (OR = 0.29-0.31, P < 0.05).

CONCLUSIONS

In children, SARS-CoV-2 infection does not increase the incidence of adverse reactions to SCIT. This finding can provide a basis for the implementation of allergen-specific immunotherapy (AIT) during the COVID-19 pandemic.