Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017

Trends and future burden of other musculoskeletal diseases in China (1990-2041): a comparative analysis with G20 countries using GBD data

BACKGROUND

Other musculoskeletal diseases (OMSDs), as a critical component of the global public health challenge, remain understudied in China. This study aims to systematically analyze the epidemiological characteristics and future trends of OMSDs in China from 1990 to 2021.

METHODS

Based on data from the Global Burden of Disease Study(GBD) 2021, this research focused on prevalence and years lived with disability (YLDs), which were compared with G20 countries. Joinpoint regression was used to identify trend breakpoints, age-period-cohort analysis evaluated the independent effects of age, period, and cohort, and the Autoregressive Integrated Moving Average (ARIMA) model predicted the disease burden through 2041.

RESULTS

Between 1990 and 2021, both age-standardized prevalence rates (ASPR) and YLDs rates(ASYR) of OMSDs in China showed upward trends. Two critical turning points in ASPR occurred during 2000-2005 (APC = 1.5%, 95% CI: 1.4-1.6) and 2005-2009 (APC = 0.9%, 95% CI: 0.7-1.0). Age effects indicated that relative risk (RR) first increased and then decreased with age, peaking at 60-64 years (RR = 3.62, 95% CI: 3.62-3.63). Period effects showed a rising trend, while cohort effects revealed declining prevalence and YLDs rates. Projections suggest a gradual increase in burden indicators through 2041. Compared to other G20 countries, China ranked eighth from the bottom in disease burden, approaching the level of Germany.

CONCLUSION

The burden of OMSDs in China continues to rise, particularly among women and the elderly. Although the current burden is at a mid-range level among G20 nations, population aging will exacerbate future challenges. To address this, advocating for healthy lifestyles, strengthening health education, and optimizing healthcare strategies are essential.

Trends and cross-country inequalities in the global, regional, and national burden of gallbladder and biliary tract cancer from 1990 to 2021, along with the predictions for 2035

BACKGROUND

The global burden of gallbladder and biliary tract cancer (GBTC) is on the rise.

METHODS

The incidence, mortality, and disability-adjusted life years (DALYs) of GBTC from 1990 to 2021 were obtained from the Global Burden of Diseases Study (GBD) 2021. The Bayesian Age-Period-Cohort (BAPC) model was also employed to project disease trends for the next 15 years.

RESULTS

In 2021, new GBTC cases observed globally amounted to 216,768, with 171,961 mortality and 3732,121 DALYs. From 1990-2021, a notable surge was recorded in the incidence of GBTC by 101 %, mortality by 74.26 %, and DALYs by 60.45 %. Regions with superior Socio-Demographic Index (SDI) reflected elevated incidence and mortality rates. However, a significant decrease was noticed in the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR). Despite a reduction in health disparities among countries, differences remain. Prognostications predict a continual decline in global ASIR and ASMR through 2035.

CONCLUSIONS

The study found that the burden of GBTC in incidences, mortalities, and DALYs has been on the rise, with some correlation with socio-economic development.

CT-derived fractional flow reserve on therapeutic management and outcomes compared with coronary CT angiography in coronary artery disease

OBJECTIVES

To determine the value of on-site deep learning-based CT-derived fractional flow reserve (CT-FFR) for therapeutic management and adverse clinical outcomes in patients suspected of coronary artery disease (CAD) compared with coronary CT angiography (CCTA) alone.

METHODS

This single-centre prospective study included consecutive patients suspected of CAD between June 2021 and September 2021 at our hospital. Four hundred and sixty-one patients were randomized into either CT-FFR+CCTA or CCTA-alone group. The first endpoint was the invasive coronary angiography (ICA) efficiency, defined as the ICA with nonobstructive disease (stenosis <50%) and the ratio of revascularization to ICA (REV-to-ICA ratio) within 90 days. The second endpoint was the incidence of major adverse cardiaovascular events (MACE) at 2 years.

RESULTS

A total of 461 patients (267 [57.9%] men; median age, 64 [55-69]) were included. At 90 days, the rate of ICA with nonobstructive disease in the CT-FFR+CCTA group was lower than in the CCTA group (14.7% vs 34.0%, P=.047). The REV-to-ICA ratio in the CT-FFR+CCTA group was significantly higher than in the CCTA group (73.5% vs. 50.9%, P=.036). No significant difference in ICA efficiency was found in intermediate stenosis (25%-69%) between the 2 groups (all P>.05). After a median follow-up of 23 (22-24) months, MACE were observed in 11 patients in the CT-FFR+CCTA group and 24 in the CCTA group (5.9% vs 10.0%, P=.095).

CONCLUSIONS

The on-site deep learning-based CT-FFR improved the efficiency of ICA utilization with a similarly low rate of MACE compared with CCTA alone.

ADVANCES IN KNOWLEDGE

The on-site deep learning-based CT-FFR was superior to CCTA for therapeutic management.

Management of Menopause Symptoms

This summary is an update on the treatment of menopause symptoms, to include vasomotor symptoms, genitourinary symptoms, and hair loss. Treatment options discussed for vasomotor symptoms include menopausal hormone therapy, nonhormonal medication options, and nonmedication treatments. Treatments for isolated genitourinary symptoms include topical estrogen, bazedoxifene, and dehydroepiandrosterone.

Cost-Effectiveness of Addressing Retinopathy of Prematurity in Rwanda

PURPOSE

With the expansion of neonatal care in sub-Saharan Africa (SSA), an increasing number of premature babies are at risk to develop retinopathy of prematurity (ROP). Previous studies have quantified the cost-effectiveness of addressing ROP in middle-income countries, but few have focused on SSA. This study estimates the cost of a national program for ROP screening and anti-VEGF injection treatment in Rwanda compared to the status quo.

METHODS

Medical cost data were collected from King Faisal Hospital in Rwanda (July 2022). Societal burden of vision loss included lost productivity and quality-adjusted life years (QALYs). Published data on epidemiology and natural history of ROP were used to estimate burden and sequelae of ROP in Rwanda. Cost of a national program for screening and treating a one-year birth cohort was compared to the status quo using a decision analysis model.

RESULTS

Cost of ROP screening and treatment was $738 per infant. The estimated equipment cost necessary for the startup of a national program was $58,667. We projected that a national program could avert 257 cases of blindness in the cohort and increase QALYs compared to the status quo. Screening and treatment for ROP would save an estimated $270,000 for the birth cohort from reductions in lost productivity.

CONCLUSION

The cost of screening and anti-VEGF treatment for ROP is substantially less than the indirect cost of vision loss due to ROP. Allocating additional funding towards expansion of ROP screening and treatment is cost-saving from a societal perspective compared to current practice.

Global variations and socioeconomic inequalities in lifetime risk of lip, oral cavity, and pharyngeal cancer: a population-based systematic analysis of GLOBOCAN 2022

BACKGROUND

In 2021, the World Health Organization (WHO) identified poor oral health as a major health expenditure burden. While lip, oral cavity, and pharyngeal cancers (LOCP) are an important group of diseases threatening oral health, there have been limited studies assessing global variations in lifetime risks (LR) according to socioeconomic inequalities.

MATERIALS AND METHODS

We obtained national incidence and mortality estimates of LOCP in 185 countries from the GLOBOCAN database of the International Agency for Research on Cancer (IARC), corresponding all-cause mortality, population data, and the Human Development Index (HDI, with higher values indicating superior socioeconomic level) through the United Nations, alongside oral health-related data through WHO and INDEXBOX. LR were calculated using the adjusted multiple primary method.

RESULTS

In 2022, the global LR of developing and dying from LOCP were 0.92% (95% CI: 0.92%-0.92%) and 0.48% (95% CI: 0.48%-0.48%), respectively, with the highest burden associated with cancers of the lip and oral cavity. The LR of being diagnosed with LOCP or dying from the disease were 2.24 (95% CI: 2.22-2.25) and 2.30 (95% CI: 2.27-2.33) times higher among males relative to females. The highest LR for lip and oral cavity, salivary gland, oropharynx, and hypopharynx cancers were largely concentrated in Australia/New Zealand, Europe, and North America; whereas nasopharynx cancer was more frequent in parts of Asia and Africa. The LR of developing and dying from LOCP were positively associated with HDI, dental healthcare expenditure, areca nut consumption, the availability of refined sugar, and early screening for oral diseases, and negatively associated with the prevalence of severe periodontal disease. Although the LR of LOCP decreased with age, the rate of decline was relatively slow until the age of 50, and even at age 70, there remained non-negligible risks.

CONCLUSION

Global variations in the LR of developing and dying from LOCP by subsite, sex and age reveal significant disparities by world region, socioeconomic levels and oral healthcare factors.

Multi objective optimization and experimental investigation of the stirring performance of a novel micro actuator

Fragmented thrombolytic micro-actuators, a novel vascular recanalization technology, demonstrate potential excellent stirring performance in narrow and curved blood vessels. Optimizing their structural parameters and conducting performance evaluations are key areas of research in this field. This study employs the finite element (FE) method to numerically investigate the effect of critical structural parameters on the stirring performance of a novel scissor-type thrombolytic micro-actuator. A quadratic predictive model for its tip amplitude and stirring force is established using the Response Surface Methodology (RSM). Subsequently, the Non-dominated Sorting Genetic Algorithm III (NSGA-III) is utilized for Multi-Objective Optimization to identify the optimal combination of structural parameters. A micro-actuator prototype is fabricated and experiments on its stirring performance are conducted. The results indicate that the slit beam thickness has the most significant effect on stirring performance. After optimization, the maximum tip amplitude and maximum stirring force of the micro-actuator improve by 61.33% and 80.19%, respectively. This research lays a solid foundation for the miniaturization and clinical application of fragmented thrombolytic micro-actuators.

Predictors of Mortality in Patients With Multiple Endocrine Neoplasia Type 1

OBJECTIVE

Multiple Endocrine Neoplasia Type 1 (MEN 1) is an autosomal dominant disease predisposing to hyperplasia and neoplasia in diverse endocrine tissues. Patients typically present with endocrine abnormalities before the age of 30 years and have reduced life expectancy. Our objective was to determine predictors of premature mortality in MEN 1.

DESIGN

Tertiary hospital based retrospective cohort study.

PATIENTS

One hundred and thirty patients with a common MEN1 genotype.

MEASUREMENTS

Kaplan-Meier survival analysis of median life expectancy (MLE).

RESULTS

The overall cohort MLE was 70.8 years. Sex and year of birth were not predictive of survival. A diagnosis before age 45 years of adrenal nodularity (MLE 51.8 years), hypergastrinaemia (MLE 66.2 years), or liver lesions (MLE 38.6) were associated with a significant reduction in survival (26.2 years, p < 0.01, 6.4 years, p = 0.03, and 30.3 years, p < 0.01 respectively) compared to being diagnosed with these conditions later in life. In contrast, diagnosis before age 45 years of pancreatic nodularity (MLE 68.9 years) and primary hyperparathyroidism (MLE 68.9 years) were not predictive of survival.

CONCLUSION

Patients with MEN 1 diagnosed before age 45 with adrenal nodularity, hypergastrinaemia or liver lesions had significantly reduced survival. The explanation for non-secretory and benign adrenal macronodular hyperplasia being associated with diminished life expectancy is unclear.

Determinants of child malnutrition and morbidity in Ethiopia: a structural equation modeling approach

Background

Childhood malnutrition and morbidity remain significant public health challenges in Ethiopia, highlighting the need to assess the risk factors contributing to these issues for effective prevention and control strategies. Thus, this study aims to investigate the underlying risk factors by employing a structural equation model to analyze malnutrition as a mediator in the relationship between selected factors and morbidity.

Methods

The study utilized data from the 2016 Ethiopia Demographic and Health Survey and a sample of 8,560 under-five children were considered. The structural equation model was used to examine the association between child malnutrition, morbidity, and potential risk factors. The structural equation model makes it possible to analyze malnutrition as a mediator of the association between selected risk factors and morbidity.

Results

Out of the 8,560 sampled children, 12.80% were wasted, 34.75% were stunted, 23.91% were underweight, 13.9% had fever, 11.2% had diarrhea, and 59.7% had anemia. Birth interval, wealth index household, place of delivery, size of child at birth, number of children, and socioeconomic condition had a significant direct effect on childhood malnutrition and morbidity. The time to get water, toilet facility, and child is a twin variables had direct effects on childhood malnutrition and had no significant direct effects on childhood morbidity. Time to get water, birth interval, toilet facility, wealth index of household, child is a twin, place of delivery, size of child, and number of children exhibited an indirect effect on morbidity through malnutrition.

Conclusions

The study revealed that there was a high prevalence of malnutrition and morbidity among under-five children in Ethiopia. Time to get water in min, place of delivery, size of child, and number of children showed a significant indirect and total effect on morbidity through malnutrition and socioeconomic conditions showed a significant total effect on morbidity via malnutrition. Implementing and extending programs such as community-based nutrition interventions for early childhood is critical, as early malnutrition showed long-term effects on growth and immunity, particularly in the regions of Affar, Dire Dawa, Gambela, Harari, Amhara, and Somali.

The Role of Viral Infections in Acute Kidney Injury and Mesenchymal Stem Cell-Based Therapy

Viruses may cause a wide range of renal problems. Furthermore, many kidney diseases may be brought on by viral infections. Both the primary cause and a contributing factor of acute kidney injury (AKI) may be viral infections. As an example, it is recommended that patients with dengue virus (DENV) infections undergo careful monitoring of their AKI levels. Also, researchers' data so far lend credence to the several hypothesized pathophysiological mechanisms via which AKI can develop in SARS-CoV- 2 infection. Thus, it is critical to comprehend how viral infections cause AKI. Finding an effective method of treating AKI caused by viruses is also vital. Thus, a potential cell-free method for treating AKI that uses regenerative and anti-inflammatory processes is mesenchymal stem cells (MSCs) and their exosomes (MSC-EXOs). MSCs alleviate tissue damage and enhance protective effects on damaged kidneys in AKI. Furthermore, MSC-EXOs have exhibited substantial regulatory impact on a range of immune cells and exhibit robust immune regulation in the therapy of AKI. Thus, in models of AKI caused by ischemia-reperfusion damage, nephrotoxins, or sepsis, MSCs and MSC-EXOs improved renal function, decreased inflammation, and improved healing. Therefore, MSCs and MSC-EXOs may help treat AKI caused by different viruses. Consequently, we have explored several innovative and significant processes in this work that pertain to the role of viruses in AKI and the significance of viral illness in the onset of AKI. After that, we assessed the key aspects of MSCs and MSC-EXOs for AKI therapy. We have concluded by outlining the current state of and plans for future research into MSC- and EXO-based therapeutic approaches for the treatment of AKI brought on by viruses.

The burden of mental disorders and substance abuse in the Middle East and North Africa (MENA) region: findings from the Global Burden of Disease Study

BACKGROUND

Mental disorders pose significant morbidity and mortality risks globally. Despite this, research on mental health in the Middle East and North Africa (MENA) region is scarce, hindered by social stigmas and limited healthcare expenditure. This study, utilizing the Global Burden of Disease (GBD) database, aims to address this gap by examining the prevalence, incidence, and demographic patterns of mental disorders in MENA.

METHODS

This ecological study draws on the GBD data to assess the prevalence and burden of mental disorders and substance abuse across the MENA region from 1990 to 2019. Utilizing age-standardized rates of prevalence and Disability-Adjusted Life Years (DALYs), we examine the evolving burden of mental disorders, variations among MENA countries, and trends in associated risk factors by age and gender.

RESULTS

From 1990 to 2019, the MENA region witnessed varying trends in mental disorders. The age-standardized prevalence rate in 2019 was 14,938 per 100,000 individuals, experiencing a 2.1% decrease overall. However, all-age prevalence surged by 86.2%. Disorders like schizophrenia and depressive disorders exhibited substantial increases, contrasting with a 128.1% rise in substance use disorders. Temporal analysis revealed fluctuations in DALY trends, capturing the dynamic nature of mental health burdens over time. Risk factors, including bullying victimization and intimate partner violence, underwent shifts, reflecting changing contributors to mental health burden.

CONCLUSION(S)

Despite a decrease in age-standardized prevalence rates in 2019, the substantial all-age prevalence rise demands attention. Temporal analysis unraveled nuanced trends, emphasizing the complex interplay of sociocultural factors. The shifting prominence of risk factors underscores the dynamic nature of mental health burdens, necessitating region-specific interventions that address both prevalence patterns and contributing factors. Future research should delve into the specific sociocultural determinants influencing the observed trends, allowing for tailored interventions to mitigate the burden of mental health disorders in the MENA region.

Analysis of the global burden and key risk factors of neonatal sepsis and other neonatal infections in 204 countries and territories, 1990-2021

Background

Neonatal infections, particularly neonatal sepsis, remain significant contributors to morbidity and mortality in pediatrics. This study aims to provide data support for health authorities to control neonatal infections by analyzing the burden of neonatal sepsis and other neonatal infectious (NSNIs) globally and the trends in their risk factors.

Methods

This study is based on the Global Burden of Disease (GBD) database, reviewing the burden and trends of neonatal sepsis and other infectious diseases from 1990 to 2021 at global, regional, and national levels. Descriptive statistics and Joinpoint regression analyses were employed to assess incidence rates, prevalence rates, mortality rates, and Disability-Adjusted Life Years (DALYs), with the Average Annual Percent Change (AAPC) used to quantify these trends.

Results

The findings reveal that from 1990 to 2021, the global incidence (AAPC = -0.8%, p < 0.01), prevalence (AAPC = -0.8%, p < 0.01), DALYs (AAPC = -0.9%, p < 0.01), and mortality rates (AAPC = -0.9%, p < 0.01) for neonatal sepsis and other neonatal infections showed a downward trend. The burden was notably higher in males than in females. Regional analysis indicated that the disease burden remains high in Africa and Southeast Asia, with DALYs of 367,540.10/100,000 and 180,599.79/100,000, respectively. Conversely, the burden in the Eastern Mediterranean and Western Pacific regions has been rising, with DALYs increasing from 53,165.45/100,000 in 2016 to 57,179.59/100,000 in 2021, and from 125,896.44/100,000 in 2018 to 131,698.77/100,000 in 2021. National-level data revealed that Sierra Leone, Chad, and Burkina Faso had significantly higher burdens compared to other countries, with DALYs of 534,090.25/100,000, 520,317.08/100,000, and 505,365.73/100,000 in 2021. An analysis of risk factors indicated that DALYs associated with ambient particulate matter pollution increased by 0.7% since 1990, while DALYs from Household air pollution in solid fuels decreased by 1.4%. Although the burden of diseases related to low birth weight and short gestation declined in many countries, an upward trend was observed in the Eastern Mediterranean and Western Pacific regions (DALYs increased from 88,653.41/100,000 in 2018 to 93,752.24/100,000 in the Eastern Mediterranean and from 28,813.84/100,000 in 2017 to 32,280.55/100,000 in the Western Pacific).

Conclusion

The analysis indicates that while the global burden of NSNIs has decreased, the situation remains serious in Africa and Southeast Asia, with a continuing rise in the burden of NSNIs in the Eastern Mediterranean and Western Pacific regions in recent years. Policymakers should prioritize improving healthcare facilities, increasing access to medical resources, and investing in maternal and neonatal care to effectively reduce the incidence of NSNIs.

Non-pharmacological rehabilitation for people living with advanced Parkinson's disease: A scoping review of interventions

BACKGROUND

Rehabilitation becomes increasingly important in the more advanced stages of Parkinson's Disease. As the disease reaches its more debilitating stages and pharmacological or surgical treatment becomes less relevant, non-pharmacological interventions including rehabilitation become key. Existing systematic interventions typically focus on individuals in the early to mid-stages of the disease. The objective of this scoping review was to identify and map the available evidence on non-pharmacological rehabilitation interventions for people living with advanced Parkinson's disease.

METHODS

This scoping review was conducted following the methodology for scoping reviews developed by the Joanna Briggs Institute. A systematic search was conducted in PubMed, EMBASE, CINAHL, and Cochrane. Studies published in English from 2000 to May 2024 were considered eligible and screened for relevance.

RESULTS

Thirteen studies were included. The majority of the interventions were experimental; one had a focus on feasibility and one had a mixed focus on effect and feasibility. Most interventions were referred to as either rehabilitation, training, or therapy, with the two feasibility interventions focusing on comprehensive assessment and referrals. The majority used modalities concerned with levels of functioning. Studies focusing on stage 4 (H&Y) Parkinson's disease were prominent.

CONCLUSIONS

This scoping review provides a foundational overview of existing non-pharmacological rehabilitation interventions for advanced Parkinson's disease, revealing a small yet diverse range of approaches, from single-disciplinary to multidisciplinary interventions. It offers initial insights that can point to areas where further research can solidify and expand effective, targeted care strategies for people living with advanced Parkinson's disease.

Edentulousness and the Likelihood of Becoming a Centenarian: Longitudinal Observational Study

Background

In recent decades, the global life expectancy has risen notably to approximately 73.5 years worldwide, coinciding with a rapid growth in the older adult population, which presents a significant public health challenge in promoting healthy aging and longevity.

Objective

This study aimed to prospectively investigate the link between edentulousness and the likelihood of reaching centenarian status among individuals aged 80 years and older.

Methods

Data from the Chinese Longitudinal Healthy Longevity Survey were analyzed. Logistic regression models were used to assess the relationship between edentulousness and the likelihood of becoming a centenarian. Demographic characteristics, lifestyle habits, and disease histories were adjusted as confounding factors. Several sensitivity analyses, including propensity score matching and 2-year lag analyses, were conducted to further assess the association between edentulousness and the likelihood of becoming a centenarian. The correlation between the number of natural teeth as a continuous variable and the likelihood of becoming a centenarian was evaluated as well.

Results

The study included 4239 participants aged 80-100 years. After adjusting for all covariates, the likelihood for becoming a centenarian increased in the nonedentulous group compared to the edentulous group (odds ratio [OR] 1.384, 95% CI 1.093-1.751). The relationship persisted after propensity score matching analysis (OR 1.272, 95% CI 1.037-1.561). The association remained statistically significant after excluding participants with a follow-up duration of less than 2 years (OR 1.522, 95% CI 1.083-2.140; P=.02). Furthermore, a significant positive association between the number of natural teeth and the likelihood of becoming a centenarian was found after adjusting for all covariates (OR 1.022, 95% CI 1.002-1.042; P=.03), which aligned with the main results of the study.

Conclusions

The findings revealed that the presence of natural teeth was linked to an increased probability of becoming a centenarian, underscoring the importance of maintaining oral health even in advanced age.

Mortality Projections, Regional Disparities in the Burden of Neonatal Disorders, and the Status of Achieving SDG Targets by 2030 in South Asia: Insights from the Global Burden of Disease Study 2021

BACKGROUND

Neonatal disorders represent a significant public health challenge, particularly in low- and middle-income countries, where they account for 79% of global neonatal mortality. South Asia, comprising countries such as India, Pakistan, Bangladesh, Nepal, and Bhutan, bears a disproportionately high burden, contributing to 38% of the world's neonatal deaths. Despite notable progress, South Asia remains off track in meeting the Sustainable development goals (SDG). This study aims to assess the current burden, trends in neonatal disorders, and forecast mortality rates across South Asian countries, providing insights to guide investment priorities and improve neonatal outcomes.

METHODS

Data for this study were sourced from the Global burden of disease (GBD) 2021 study, which utilizes a Bayesian meta-regression model to estimate mortality, prevalence, and disability-adjusted life years (DALYs). Spatial maps depicting the age-standardized prevalence rate and age-standardized mortality rate for neonatal disorders in South Asia were generated using QGIS software. Mortality forecasts for the period 2022-2031, attributed to various neonatal disorders, were produced employing the Auto-Regressive Integrated Moving Average model in R software. Additionally, an analysis of overall neonatal mortality trends from 1980 to 2021 was conducted, supplemented by a heat map that compares DALYs attributable to various neonatal disorders across South Asian countries in 2021.

RESULTS

Between 1980 and 2021, South Asia experienced a substantial decline in neonatal mortality rates, with India and Bangladesh leading the progress. Mortality decreased by 40%, while DALYs fell by 35%, despite a 15% increase in the prevalence. The prevalence of neonatal encephalopathy due to birth asphyxia and trauma surged by 355%, yet its mortality dropped by 31%. Pakistan recorded the highest neonatal mortality and disease burden, particularly for hemolytic disease and other neonatal jaundice and neonatal encephalopathy due to birth asphyxia and trauma. In India and Bangladesh, neonatal preterm birth and neonatal sepsis and other neonatal infections contributed most to mortality. Neonatal encephalopathy due to birth asphyxia and trauma accounted for the highest DALYs. Forecasts predict continued reductions in neonatal mortality across South Asia, except in Pakistan, where persistently high rates are expected till 2031.

CONCLUSION

For South Asian countries to meet the SDG target for neonatal mortality by 2030, intensified and continuous efforts are required. These efforts should focus on identifying high-risk pregnancies and improving the quality of care during childbirth to address the root causes and reduce preventable neonatal deaths.

Burden and trends of facial fractures in China and the United States based on GBD 2021 analysis

Facial fractures significantly impair functions related to respiration, vision, and speech, while also posing long-term cosmetic and psychological challenges. Regional disparities in the burden of facial fractures reflect variations in risk factors, healthcare accessibility, and preventive measures. This study investigates recent causes, trends, and the burden of facial fractures in China and the United States. Utilizing the Global Burden of Disease 2021 dataset, the study analyzed epidemiological data on facial fractures in China and the United States, focusing on age-standardized incidence rates and years lived with disability from 2010 to 2021. Estimated annual percentage changes (EAPC) were calculated to assess trends, while age- and sex-specific analyses provided further insights into population-specific patterns. Additionally, the primary etiologies of facial fractures in both countries were examined. Between 2010 and 2021, the incidence of facial fractures increased in both China and the United States, with a more pronounced rise in China (EAPC: 1.56%) compared to the United States (EAPC: 0.38%). In 2021, the highest incidence in China was observed among males aged 30-34 years, while in the United States, it was among males aged 20-24 years. Males consistently exhibited higher rates than females in both countries. Falls and road injuries were the leading causes of facial fractures in China, whereas falls and mechanical forces were predominant in the United States. The rising incidence of facial fractures in China and the United States highlights the need for targeted preventive strategies tailored to each country's specific risk factors and demographic patterns. These findings underscore the importance of addressing facial fractures as a global public health priority, with implications for policy-making and resource allocation to reduce the burden of these injuries worldwide.

Multimorbidity patterns and their associated factors among patients with type 2 diabetes in China: A hospital-based observational study

Introduction

Most patients with type 2 diabetes mellitus (T2DM) suffer from multimorbidity, but the multimorbidity patterns were not well understood. We aimed to ascertain the different multimorbidity patterns among T2DM patients and to explore the corresponding associated factors.

Method

The study included 3403 T2DM patients from Tianjin, China. Multimorbidity (including dyslipidemia, hypertension, hyperuricemia, cardiovascular diseases, chronic kidney disease, and chronic liver disease) was ascertained through medical records. Data were analyzed using latent class analysis and multi-nominal logistic regression.

Results

The leading 3 morbidity were dyslipidemia, cardiovascular diseases, and hypertension; and 16.9 % had multimorbidity. Four unique patterns were ascertained: multimorbidity-free, T2DM with cardiovascular diseases mainly, T2DM with dyslipidemia mainly, and T2DM with hypertension mainly. In the subsample of 1779 patients, greater BMI and LDL, and non-use of insulin were associated factors for cardiovascular disease patterns; older age, higher HDL, lower LDL, and insulin use for dyslipidemia patterns; male sex, higher TG and LDL, and non-use of insulin for hypertension patterns.

Conclusions

Dyslipidemia, cardiovascular diseases, and hypertension were the most common chronic conditions among T2DM patients. Four groups of T2DM-associated multimorbidity patterns were identified, and different patterns had varying associated factors. Our research findings highlight the significance of formulating personalized nursing measures for patients with different T2DM multimorbidity patterns.

The global epidemiology and health burden of the autism spectrum: findings from the Global Burden of Disease Study 2021

BACKGROUND

High-quality estimates of the epidemiology of the autism spectrum and the health needs of autistic people are necessary for service planners and resource allocators. Here we present the global prevalence and health burden of autism spectrum disorder from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 following improvements to the epidemiological data and burden estimation methods.

METHODS

For GBD 2021, a systematic literature review involving searches in PubMed, Embase, PsycINFO, the Global Health Data Exchange, and consultation with experts identified data on the epidemiology of autism spectrum disorder. Eligible data were used to estimate prevalence via a Bayesian meta-regression tool (DisMod-MR 2.1). Modelled prevalence and disability weights were used to estimate health burden in years lived with disability (YLDs) as the measure of non-fatal health burden and disability-adjusted life-years (DALYs) as the measure of overall health burden. Data by ethnicity were not available. People with lived experience of autism were involved in the design, preparation, interpretation, and writing of this Article.

FINDINGS

An estimated 61·8 million (95% uncertainty interval 52·1-72·7) individuals (one in every 127 people) were on the autism spectrum globally in 2021. The global age-standardised prevalence was 788·3 (663·8-927·2) per 100 000 people, equivalent to 1064·7 (898·5-1245·7) autistic males per 100 000 males and 508·1 (424·6-604·3) autistic females per 100 000 females. Autism spectrum disorder accounted for 11·5 million (7·8-16·3) DALYs, equivalent to 147·6 (100·2-208·2) DALYs per 100 000 people (age-standardised) globally. At the super-region level, age-standardised DALY rates ranged from 126·5 (86·0-178·0) per 100 000 people in southeast Asia, east Asia, and Oceania to 204·1 (140·7-284·7) per 100 000 people in the high-income super-region. DALYs were evident across the lifespan, emerging for children younger than age 5 years (169·2 [115·0-237·4] DALYs per 100 000 people) and decreasing with age (163·4 [110·6-229·8] DALYs per 100 000 people younger than 20 years and 137·7 [93·9-194·5] DALYs per 100 000 people aged 20 years and older). Autism spectrum disorder was ranked within the top-ten causes of non-fatal health burden for people younger than 20 years.

INTERPRETATION

The high prevalence and high rank for non-fatal health burden of autism spectrum disorder in people younger than 20 years underscore the importance of early detection and support to autistic young people and their caregivers globally. Work to improve the precision and global representation of our findings is required, starting with better global coverage of epidemiological data so that geographical variations can be better ascertained. The work presented here can guide future research efforts, and importantly, decisions concerning allocation of health services that better address the needs of all autistic individuals.

FUNDING

Queensland Health and the Bill & Melinda Gates Foundation.

Exploring the Pain Situation, Pain Impact, and Educational Preferences of Pain Among Adults in Mainland China, a Cross-Sectional Study

OBJECTIVES

This study aimed to investigate the pain situation, functional limitations, treatment used, care-seeking behaviors, and educational preferences of adults with pain in mainland China.

METHODS

An online questionnaire was developed through expert validation, and participants were recruited via social media platforms. Inclusion criteria required having access to the Internet and smartphones, while individuals with significant cognitive impairments or severe mental illness were excluded.

RESULTS

1566 participants, predominantly male (951) with a mean age of 30.24, were included. A total of 80.1% of the respondents reported experiencing pain, with over half suffering from chronic pain. Pain primarily affects the neck, lower back, and upper back, especially chronic low back pain. Pain significantly impacted various aspects of life, including mood, physical activity, work performance, family dynamics, and social relationships, particularly among chronic pain sufferers (p-value: < 0.001). Analgesics (66.9%) and self-management (80-94.3%) were the most used pain management strategies, with respondents with chronic pain reporting higher usage and effectiveness of medication than those with acute pain (p-value: < 0.001). Participants also expressed a greater interest in online education and psychotherapy interventions, especially through mobile applications.

CONCLUSIONS

Chronic pain is highly prevalent in mainland China, leading to emotional distress, decreased work competency, and social isolation, with a strong demand for pain education through smartphone applications.

Ambient air pollution and Alzheimer's disease and other dementias: a global study between 1990 and 2019

BACKGROUND

Emerging research found air pollution may be associated with incident Alzheimer's disease (AD) and other dementias. However, few studies have examined these associations at the global scale. This study aimed to assess the dynamic associations between ambient air pollution and the burden of AD and other dementias worldwide.

METHODS

This study synthesised 149 countries/territories between 1990 and 2019. These data include age-standardised mortality rate (ASMR) and disability-adjusted life-years (DALYs) of AD and other dementias, ambient air pollution (fine particulate matter [PM2.5], NO2 and O3 concentration) and a series of covariates were from various source. Average annual percentage changes (AAPCs) were calculated to investigate the temporal variations. Linear mixed models were adopted to assess the associations with single- and multi-pollutant separately. The associations between air pollution changes and the AD and other dementias were also examined using linear regression models. Stratified analyses by Global North-South divide and human development index were performed to explore the potential inequity in air pollution impacts.

RESULTS

During 1990-2019, the global ASMR, DALYs and O3 increased by 0.11%, 0.09%, and 0.17% per year, respectively. In contrast, PM2.5 and NO2 decreased by 0.33% and 0.14% per year, respectively. Each 10 µg/m3 increase in PM2.5 was associated with a 0.118 (95% confidence interval [CI]: 0.060 - 0.175) higher ASMR and 0.966 (95%CI: 0.321 - 1.611) higher DALYs after adjusting for all the covariates. The ASMR increased by 0.112 and the DALYs increased by 1.068 for each 10 µg/m3 increase in O3. The NO2-dementia associations were relatively weak. Stronger O3-dementia associations were found in the Global South than those in the Global North.

CONCLUSIONS

The burden of dementia is expected to increase globally, given the continuously expansion of the ageing population. Air pollution was found to be significantly associated with a higher burden of AD and dementia. As a persistent challenge in urban cities, air pollution demands strict regulatory control.

Trends and Association between Smoking and the Socio-Demographic Index Among 11 South American Countries, 1990-2019

OBJECTIVES

To examine prevalence trends in the use of smoked tobacco products in 11 South American (SA) countries (i.e., Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Suriname, Uruguay, and Venezuela) and their association with country-specific socio-demographic index (SDI) over 30 years.

DATA AND METHODS

The estimates of SDI and smoked tobacco prevalence stratified by age, sex, and country were extracted from the Global Burden of Disease Study (1990-2019) on individuals aged 15+. The annual percentage changes (APCs) of trends in country-specific prevalence of smoked tobacco were evaluated using Joinpoint regression. Correlation analysis was also used to explore the association between country-specific prevalence of smoked tobacco and their SDIs, a measure of developmental status considering income per capita, educational attainment, and total fertility rate.

RESULTS

While all SA countries showed an overall decline in smoked tobacco use prevalence between 1990 and 2019 (APCs between -0.52%-and -4.73%; p < 0.05), Bolivia and Ecuador showed a significant increasing trend (APCs of 0.34% and 0.20%). Country-specific SDI was strongly and significantly correlated (rs = -0.99 to -0.85) with smoking prevalence in SA countries, except for Ecuador and Bolivia (rs = 0.16 and 0.36, respectively).

CONCLUSION

In recent decades, most SA countries have experienced a significant reduction in the prevalence of smoked tobacco use, except Ecuador and Bolivia, where smoking rates have risen, showing a direct correlation with SDI. These findings can contribute to the design and implementation of strategies and policies for tobacco prevention and control in the SA region especially within the two affected countries - Ecuador and Bolivia.

Life table study of sublethal concentrations of emamectin benzoate against Spodoptera frugiperda (Lepidoptera, Noctuidae)

The fall armyworm, Spodoptera frugiperda J.E. Smith (Lepidoptera: Noctuidae), is a well-known agricultural pest in North and South America and has invaded Africa, the Far East, and Australia in the past decade. To investigate the integrated management of S. frugiperda, the sublethal impacts of emamectin benzoate were studied. Leaf-dipping bioassays were used to investigate the effects of sublethal (LC10 and LC30) concentrations of emamectin benzoate on S. frugiperda demographic parameters, and data were interpreted based on the age-stage, two-sex life table theory. The results showed that the developmental time of larvae was prolonged while the fecundity decreased after sublethal concentration treatment. Furthermore, the intrinsic and finite rates of increase, as well as the net reproductive rate, significantly declined following LC30 concentration exposure, whereas the average generation time was extended in comparison to the control group. The intrinsic rate of increase (rm) dropped to 0.14 (LC10) and 0.13 (LC30)/day, compared to the control group (0.18/day). The net reproductive rate (R0) dropped from 775.40 to 303.10 and 193.30 after the LC10 and LC30 concentration treatment, respectively. In this study, sublethal concentrations of emamectin benzoate adversely affected the developmental time, fecundity, and life table parameters of S. frugiperda.

Toxic heavy metals of agricultural products in developing countries and its human health risk assessment: A study from Iran

Food toxicity through heavy metals, particularly from cereal consumption, poses significant threats to human health. This study studied various toxic heavy metals (Pb, As, Cr, Cd, Co, Hg, and Ag) in cereal products and their human health risk assessment in Ilam province, Iran. This study analyzed 30 samples of the most commonly cultivated cereals (wheat, rice, corn, pea, and lentil) in Ilam province. ICP-MS was used to measure the concentrations of selected toxic heavy metals. According to the obtained results, only the rice samples had concentrations of As and Pb that exceeded Iran's national standards. Monte Carlo simulation showed that the 95th percentile (P95th) values of hazard quotient (HQ) for As in wheat and rice, Hg in wheat, and Pb in rice were above 1. Moreover, P95th values of incremental lifetime cancer risk (ILCR) for As in wheat and rice were above 10-4 The findings showed that the consumption of wheat and rice in the Ilam province was a potential source of exposure to As, Pb, and Hg. This study recommends the necessity of monitoring heavy metals in cereal products to protect human health.

Pooling the complex survey data across the 64 lower and middle-income countries: A study on antibiotic usage in under-five children

Background

Antibiotic exposure for fever/cough has been rising alarmingly, especially among children under five in low- and middle-income countries (LMICs). This excessive use could result in higher healthcare costs, and antibiotic resistance is an alarming trend in developing countries. As a result, it's crucial to look at the variables that affect antibiotic exposure and highlight the subgroups among whom antibiotic abuse is the most prevalent.

Methods

We used the most recent standard Demographic and Health Survey (DHS) data for 64 LMICs. Sample weights were employed in studies to ensure exact standard errors and estimate p-values. To analyze antibiotic exposures across countries, continents, economic levels, and the top and bottom ten countries with fever/cough, we conducted descriptive statistics. Additionally, we provided accompanying bar diagrams for each descriptive finding to enhance visual understanding. For geospatial analysis, we utilized ArcGIS, a powerful tool for mapping and spatial analysis.

Findings

We used data from 141,018 children under five who were reported to have had fever/cough recently in 64 LMICs. Among them, 30.4 % were exposed to antibiotics for fever/cough. Congo (68.7 %), Egypt (65.5 %), and Tajikistan (61.8 %) had the highest prevalence of antibiotic consumption across LMICs. On the other hand, Cameroon (0.3 %), Armenia (4.0 %), and Mauritania (6.1 %) had the lowest. In the final binary logistic regression, mothers that had any formal education (Primary: OR = 1.28, 95 % CI:1.07-1.53, Secondary: OR = 1.38, 95 % CI:1.14-1.67, Higher Education: OR = 1.69, 95 % CI:1.23-2.33) were more likely to expose their children to antibiotics for fever/cough than illiterate ones. Additionally, children in richer households (Richer: OR = 1.38, 95 % CI:1.15-1.66, Richest: OR = 1.46, 95 % CI:1.19-1.80) were more likely to receive antibiotics than those in poorer households.

Conclusions

Antibiotic exposure for fever/cough in children under five was relatively moderate across 64 LMICs. However, the rate was incredibly high in some LMICs and incredibly low in others. The researchers recommend that the countries with high and low percentages of antibiotic exposure investigate either any possibility of antibiotic abuse or proper healthcare service at the national level.

Childhood heart disease and parental emotional wellbeing: a predictive model to explain the perception of quality of life in children and adolescents

BACKGROUND

The number of people living with congenital heart disease (CHD) in 2017 was estimated to be 12 million, which was 19% higher than that in 1990. However, their death rate declined by 35%, emphasizing the importance of monitoring their quality of life due to its impact on several patient outcomes. The main objective of this study is to analyze how parents' psychosocial factors contribute to children's and adolescents' perceptions of their QoL, focusing on their medical condition. More specifically, we explore how parental psychological dimensions, such as anxiety and depression, are related to patients' health-related quality of life (HRQoL).

METHODS

We recruited 447 children aged 5 to 18 years with a CHD diagnosis and their parents (319 mothers and 229 fathers) from January to December 2018. Patients were referred to the Cardiology Department of "Bambino Gesù" Children's Hospital and participated in multidisciplinary standardized follow-up. Children and adolescents were submitted to a comprehensive evaluation by different physicians, including pediatric cardiologists, surgeons, and psychologists, at preset time frames. A series of standardized questionnaires were administered during psychological assessment.

RESULTS

The main findings show a negative correlation between mothers' anxiety and three patients' HRQoL subscales (Treatment II, Treatment anxiety, and Communication). Similarly, mothers' depression correlates negatively with other patients' HRQoL subscales (heart problems, symptoms, perceived physical appearance, cognitive problems, and communication). Fathers' anxiety and depression show negative correlations with only the subscale of Treatment II. More generally, the perceived quality of life of children and adolescents with CHD is influenced by their medical conditions as well as the parents' psychological dimensions.

CONCLUSIONS

Our findings suggest that the caregivers of pediatric patients with CHD are more exposed to psychological problems of anxiety and depression, which affect the perceived quality of life of their children. Longitudinal research with a healthy control group is recommended to further consolidate this evidence.

Convergences and Divergences in the Burden of Disease in Older People Across The Organisation for Economic Cooperation and Development Countries

BACKGROUND

The Organization for Economic Cooperation and Development (OECD) member states are heterogeneous in their social, economic, and health conditions.

AIMS

a) to analyze age-specific mortality rate (ASMR) and age-specific disability-adjusted life year (DALY) rate among older people in countries by age groups (65-74 years and 75+ years) and sex, and b) to estimate the association between age-specific DALY rate with Socio-Demographic Index (SDI) and with Healthcare Access and Quality Index (HAQI).

METHODS

Secondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The ASMR and the age-specific DALY rate were reported for the years 1990, 2005, and 2019. Correlation between age-specific DALY rate with SDI and HAQI was estimated.

RESULTS

There were differences in the level and change in ASMR and the age-specific DALY rates among OECD countries. Overall, men had a higher rate for both age groups in both indicators. Although the rates have been reduced between 1990 and 2019, some countries stand out for continuing to have higher rates than countries with better socioeconomic levels. The disease burden profile also differed between adults aged 65-74 years and those aged 75+ years. In almost all cases, there was a negative and statistically significant correlation between the age-specific DALY rate with SDI and HAQI.

CONCLUSIONS

The burden of mortality and DALY in OECD countries is convergent because they have decreased over time in all countries but diverge in the magnitude and speed of change.

Estimation of cause-specific mortality in Rakai, Uganda, using verbal autopsy 1999-2019

BACKGROUND

There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status.

OBJECTIVES

To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda.

METHODOLOGY

Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood.

RESULTS

Between 1999 and 2019, 63082 adults (15-60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33-5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61-12.28) to 3.27 (95% CI: 2.89-3.68) per 1000 pyo between 1999-2004 and 2015-2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively.

CONCLUSION

There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.

Kalanchoe crenata Andrews (Haw.) Improves Losartan's Antihypertensive Activity

BACKGROUND

Cardiovascular diseases constitute one of the leading causes of morbidity and mortality worldwide. Herbal medicines represent viable alternatives to the synthetic drugs currently employed in the control of hypertension. This study aimed to isolate and identify the chemical markers of Kalanchoe crenata and to investigate the antihypertensive and anti-matrix metalloproteinase (MMP2) activities of an aqueous extract of the leaves.

METHODS

The main constituents of the aqueous extract of K. crenata were separated by ultra-performance liquid chromatography-mass spectrometry, and their presence was identified by NMR spectroscopy. Renovascular hypertension was induced in male Wistar rats using the two-kidney one-clip method (HTN groups), while control animals (Sham groups) were submitted to Sham surgery. Six groups of 10 animals each were treated daily for eight weeks as follows: Sham 1 (carrier), Sham 2 (K. crenata extract), HTN.1 (carrier), HTN.2 (K. crenata extract), HTN 3 (losartan), and HTN 4 (K. crenata extract with losartan).

RESULTS

The main compounds of the extract were patuletin 3-O-(4″-O-acetyl-α-L-rhamnopyranosyl)-7-O-(3‴-O-acetyl-α-L-rhamnopyranoside) (1), patuletin 3-O-α-L-rhamnopyranosyl-7-O-L-rhamnopyranoside (2), and trans-caffeoyl-malic acid (3), with compounds 1 and 2 being chemical markers of the species. Significant reductions (p < 0.05) in systolic blood pressure and MMP2 (72kDa isoform) activity were observed in the HTN 4 group.

CONCLUSIONS

The association of K. crenata extract and losartan presented in vivo effects against hypertension.

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

BACKGROUND

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

METHODS

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

FINDINGS

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

INTERPRETATION

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

FUNDING

Bill & Melinda Gates Foundation.

Prevalence of Vision Loss in South and Central Asia in 2020: Magnitude and Temporal Trends

PURPOSE

To estimate the prevalence of vision loss for 2020 in South and Central Asia and analyze trends since 1990.

METHODS

In a systematic literature review, we estimated the prevalence of blindness, visual impairment (VI) and presbyopia-related VI in 1990,2000,2010, and 2020.

RESULTS

The study included 103 population-based studies. In South/Central Asia combined, age-standardized prevalence of blindness, moderate-to-severe VI (MSVI), moderate VI, severe VI, mild VI and presbyopia-related VI for all ages was 0.65% (95% uncertainty interval (UI):0.56/0.74), 5.06 (4.55/5.59), 4.40 (3.91/4.94), 0.65 (0.57/0.74), 3.21 (2.89/3.56), and 8.77 (6.37/11.48), respectively, with higher values for women than men. From 2000 to 2020, changes in age-standardized prevalence in South Asia were -36.85 (-36.94/-36.76), -7.01 (-7.13/-6.90), -5.86 (-5.99/-5.73), -13.96 (-14.09/-13.82), -9.55 (-9.66/-9.44), and -8.62 (-8.93/-8.31), respectively for men, and -38.50 (-38.59/-38.40), -10.12 (-10.22/-10.01), -9.23(-9.36/-9.10), -14.86 (-14.99/-14.73), -9.44 (-9.56/-9.33), and -7.78 (-8.09/-7.48), respectively for women. From 2000/2020, the changes in age-standardized prevalence figures in Central Asia were -21.44 (-21.58/-21.30), -2.75 (-2.87/-2.64), -2.17 (-2.30/-2.04), -7.12 (-7.26/-6.99), -5.36 (-5.48/-5.25), and -3.67(-4.02/-3.32), respectively for men, and -21.13 (-21.27/-20.99), -2.70 (-2.81/-2.58), -2.18 (-2.30/-2.05), -6.93 (-7.07/-6.80), -5.03 (-5.14/-4.91), and -2.65 (-3.00/-2.30), respectively, for women. In 2020, 11.94 million (9.98-14.07) and 0.30 million (0.24-0.36) individuals were blind, and 96.22 million (84.12-110.27) and 2.95 million (2.52-3.43) had MSVI in South Asia and Central Asia, respectively.

CONCLUSIONS

Despite a higher decrease between 2000 and 2020, the age-standardized prevalence of blindness and MSVI were higher in South Asia than in Central Asia in 2020. The number of people affected increased due to population growth and improved longevity.

Cross-species single-cell RNA-seq analysis reveals disparate and conserved cardiac and extracardiac inflammatory responses upon heart injury

The immune system coordinates the response to cardiac injury and controls regenerative and fibrotic scar outcomes in the heart and subsequent chronic low-grade inflammation associated with heart failure. Adult mice and humans lack the ability to fully recover while adult zebrafish spontaneously regenerate after heart injury. Here we profile the inflammatory response to heart cryoinjury in zebrafish and coronary artery ligation in mouse using single cell transcriptomics. We interrogate the extracardiac reaction to cardiomyocyte necrosis to assess the specific peripheral tissue and immune cell reaction to chronic stress. Cardiac macrophages play a critical role in determining tissue homeostasis by healing versus scarring. We identify distinct transcriptional clusters of monocytes/macrophages (mono/Mϕ) in each species and find analogous pairs in zebrafish and mice. However, the reaction to myocardial injury is largely disparate between mice and zebrafish. The dichotomous response to heart damage between the murine and zebrafish mono/Mϕ and/or the presence of distinct zebrafish mono/Mϕ subtypes may underlie the impaired regenerative process in adult mammals and humans. Our study furnishes a direct cross-species comparison of immune responses between regenerative and profibrotic myocardial injury models, providing a useful resource to the fields of regenerative biology and cardiovascular research.

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

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

Climate change, climate disasters and oncology care: a descriptive global survey of oncology healthcare professionals

PURPOSE

Climate disasters and climate change have implications for healthcare globally. As the number and intensity of climate disasters increase, it is important to understand the effects on healthcare. We conducted a global survey of oncology healthcare providers to identify awareness, experiences, and educational needs related to climate change.

METHODS

An existing climate and health survey was adapted to oncology. This IRB- approved, 30-item survey measured demographics, climate disaster awareness, effects on cancer care and educational needs. Healthcare professionals employed in oncology settings (practice, research, or academic) were eligible. The survey was disseminated via social media and professional organizations. Descriptive statistics were computed using SPSS.

RESULTS

154 responses from 26 countries were received from nurses (56%), physicians (19%), and other healthcare professionals (25%). Common climate change-related events impacting oncology care were extreme heat (63.8%) and heavy rains (52.2%). Respondents reported their workplace has a disaster plan for climate-related weather events (50.4%) or has taken steps to prepare for a climate-related weather event (48.5%). Respondents were aware that the planet has warmed significantly (98.7%), that healthcare contributes to greenhouse gas emissions (98.6%) and reported wanting to learn more about how climate change affects cancer care (88.3%). Preferred educational modalities include webinars (69%), e-learning (55%), journal articles (48.3%), conferences (46.3%) and podcasts (38.9%).

CONCLUSIONS

This global survey is the first to identify the awareness, experiences, and educational needs of oncology healthcare professionals related to climate change and climate disasters. Healthcare providers are positioned to take leadership roles related to climate and health.

Analysis of Factors Influencing Hospitalization Expenses of Patients With Gastric Cancer in Shanghai, 2014-2021: Based on Grey Relational Analysis and Structural Equation Modeling

OBJECTIVES

This study analyzed the basic condition and the influencing factors of hospitalization costs of patients with gastric cancer in Shanghai from 2014 to 2021, so as to provide a scientific reference for promoting the reform of the medical and healthcare system.

METHODS

The study data were obtained from the electronic medical record system of Shanghai Hospital. The grey relational analysis was applied to analyze the correlation strength of various expenses with hospitalization costs. The structural equation modeling was constructed to analyze the influences of factors on the hospitalization expenses, as well as the relationship between each factor.

RESULTS

A total of 23 335 study subjects were included. The results of grey relational analysis showed that the total cost of drugs had the strongest correlation with hospitalization expenses, followed by material expenses and surgery cost, whereas those of others were lower. The results of the structural equation modeling showed that age had the greatest influence on hospitalization expenses with a path coefficient of 0.618. Other influencing factors included surgery history, length of stay, hospital level, gender, and medical insurance.

CONCLUSIONS

The total cost of drugs had the strongest correlation with hospitalization expenses. Factors such as gender, age, and hospital level all affect the hospitalization expenses. In the future, it is necessary to take further measures to control the cost of drugs and constantly optimize the structure of hospitalization costs. Meanwhile, the reform of the medical and healthcare system should be deepened to reasonably regulate the medical behaviors and reduce the financial burden of patients.

Analysis of global prevalence, DALY and trends of inflammatory bowel disease and their correlations with sociodemographic index: Data from 1990 to 2019

BACKGROUND

Inflammatory bowel disease (IBD) is a kind of chronic inflammatory disorders of the gastrointestinal tract with diverse prevalence rates and patterns globally. Accurate comprehension of the disease's epidemiological characteristics is imperative for disease control and prevention all over the world.

OBJECTIVE

To provide the most updated estimates on the global burden of IBD using the 2019 Global Burden of Disease (GBD) study data, to systematically analyze the IBD epidemiological characteristics at the global, regional, and national levels including the prevalence, incidence, and disability-adjusted life years (DALY) rates, and to analyze the correlations of the socioeconomic development level with IBD epidemiological characteristics.

METHODS

We conducted an overall analysis of the global, regional, and national burden of IBD from 1990 to 2019, data from the 2019 GBD study. The GBD's classification of the world into 21 regions and 204 countries and territories facilitated a thorough examination. Age-standardized estimated annual percentage changes (EAPCs) were computed to assess the temporal trends in IBD age-standardized rates (ASRs), with age standardization employed to mitigate potential confounding effects from age structure. The sociodemographic Index (SDI) was used to correlate the socioeconomic development level with the epidemiological characteristics of IBD.

RESULTS

From 1990 to 2019, the global age-standardized prevalence, incidence, and DALY rates of IBD remained high. There was a slight downward trend in the global age-standardized incidence and DALY rates of IBD and men exhibited higher DALY rates than women. In 2019, high-income North America recorded the highest age-standardized prevalence, incidence, and DALY rates, while Oceania had the lowest age-standardized prevalence and incidence rates. South Asia had the lowest age-standardized DALY rates. The age-standardized mortality and DALY rates decreased as SDI values increased and remained higher than the expected levels over the past three decades. A negative correlation was observed between age-standardized DALY rates and SDI at the national level.

CONCLUSIONS

This analysis of the GBD 2019 database demonstrates that the overall global burden of IBD is still high. Meanwhile, an increasing disease burden is observed in the middle and low SDI locations.

Physical activity levels and musculoskeletal disease risk in adults aged 45 and above: a cross-sectional study

BACKGROUND

Musculoskeletal disease (MSD) is a major cause of disability among older adults, and understanding the role of physical activity (PA) in preventing these conditions is crucial. This study aimed to explore the association between PA levels and MSD risk among adults aged 45 and above, clarify the dose‒response relationship, and provide tailored guidelines.

METHODS

Using data from the China Health and Retirement Longitudinal Study (CHARLS), a cross-sectional analysis was conducted on 15,909 adults aged 45 and over. The study population was divided into MSD (n = 7014) and nMSD (n = 8895) groups based on musculoskeletal health status. PA levels were assessed using the International Physical Activity Questionnaire and categorized into low intensity physical activity (LIPA), moderate vigorous physical activity (MVPA), and vigorous physical activity (VPA). Multivariable logistic regression models and restricted cubic spline regression were used to examine the relationship between PA levels and MSD risk in middle-aged and older adults. Sensitivity analyses and stratified analyses were also performed.

RESULTS

The main outcome measures were musculoskeletal diseases prevalence and PA levels. MVPA and VPA reduced MSD risk by 19% [OR = 0.81, 95% CI (0.72, 0.90), P < 0.001] and 12% [OR = 0.88, 95% CI (0.79, 0.98), P < 0.05], respectively. What's more, after adjusting for confounding factors, VPA increased risk by 32% [OR = 1.32, 95% CI (1.04, 1.66), P < 0.05]. The relationship was nonlinear, showing a U-shaped pattern with age and hypertension status as significant moderators. The optimal PA energy expenditure was identified as approximately 1500 metabolic equivalents of tasks (METs) per week for adults aged 45-74, 1400 METs per week for those aged 75 and above, and 1600 METs per week for hypertensive adults aged 45 and older.

CONCLUSIONS

For adults aged 45 years and older, VPA significantly increases the risk of MSD. Adults aged 45 years and older should adjust their weekly METs based on their age. Additionally, those with hypertension should moderately increase their weekly METs to promote optimal musculoskeletal health.

Trend of gastrointestinal and liver diseases in China: Results of the Global Burden of Disease Study, 2019

BACKGROUND

China is one of the countries with the largest burden of gastrointestinal and liver diseases (GILD) in the world. The GILD constitutes various causes of mortality and disability. The study aimed to investigate the trend of GILD in China using the Global Burden of Diseases Study 2019 (GBD 2019) data resources from 1990 to 2019.

METHODS

The data on the age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) for GILD in China from 1990 to 2019 were collected from the GBD 2019 data resources. Furthermore, the ranking of the main causes of deaths and DALYs, as well as the trends of ASMR, DALYs, years of life lost (YLLs), and years of life lost due to disability (YLDs) per 1,000,000 in GILD were reported.

RESULTS

The ASMR and DALYs for stomach cancer, liver cancer, and esophageal cancer, which ranked top three among the GILDs from 1990 to 2019, were gradually decreasing. Significant decreases in the ASMR and DALYs were found in diarrheal diseases and acute hepatitis (A, E, and C). However, noteworthy increases were found in those of colon and rectum cancer (CRC) and pancreatic cancer. Trend of DALYs, mortality, and YLLs rates for most of GILD were decreasing from 1990 to 2019, except the burden of CRC and pancreatic cancer with an increasing trend. The DALYs, mortality and YLLs of most GILD diseases showed decreasing trends from 1990 to 2019, except the burden of CRC and pancreatic cancer with an increasing trends.

CONCLUSIONS

The result of the GBD 2019 showed that the rates of most GILDs decreased in China; however, gastrointestinal and liver cancer, such as stomach cancer still held the top ranking. Furthermore, the shift from infectious diseases to non-communicable causes among GILD burden is occurring.

Ophthalmologists' Perspective on Barriers to Cataract Surgery and Surgical Productivity in Ethiopia, Ghana, and Zambia: A Descriptive, Mixed-Methods Survey

PURPOSE

While progress was made towards the Vision 2020: The Right to Sight goals, Ethiopia, Ghana, and Zambia fell short of the recommended cataract surgical rate (CSR) on a national level. Post-operative cataract surgical outcomes are also lower compared to other regions. This study aimed to describe perceived barriers to cataract surgical uptake, factors related to surgeon surgical productivity, and surgical offerings in each of these countries.

METHODS

An online survey was sent to ophthalmologists practicing in Ethiopia, Ghana, and Zambia. Responses were collected between June 25, 2021 and January 30, 2022.

RESULTS

Responses were received from 122 ophthalmologists from Ethiopia, Ghana, and Zambia. The estimated participation rate was 47% (122/257). Distance to cataract surgical centres, lack of surgical centres, and lack of surgical equipment were among the top 10 most agreed upon barriers by respondents within each country. Many respondents reported that current financial reimbursement does not incentivise maximum productivity in themselves (56%, 68/122) or their staff (61%, 74/122). Surgeons proposed several ways to improve productivity incentives. Private practice was perceived to have the best reimbursement incentives (77%, 94/122), whereas government hospitals were least agreed upon (4%, 5/122). Discrepancies in timely post-operative refraction and eyeglasses disbursement were reported.

CONCLUSIONS

Overcoming the identified barriers, improving surgeon productivity, and addressing identified deficits in cataract care will likely reduce the backlog of cataract blindness while ensuring increasingly improved patient outcomes.

Revisiting Factors Influencing Under-Five Mortality in India: The Application of a Generalised Additive Cox Proportional Hazards Model

BACKGROUND

Despite the implementation of various preventive measures, India continues to experience an alarmingly high under-five mortality rate (U5MR). The most recent nationwide data on U5MRs has provided an opportunity to re-examine the associated factors of U5MRs using advanced techniques. This study attempted to identify the associated determinants of U5MRs via the generalised additive Cox proportional hazards method.

METHODS

This study analysed the fifth round of unit-level data for 213,612 children from the National Family Health Survey (NFHS-5) to identify the risk factors associated with U5MRs, employing a generalised additive Cox proportional hazards regression analysis.

RESULTS

The children who had a length of pregnancy of less than 9 months had a 2.621 (95% CI: 2.494, 2.755) times greater hazard of U5MRs than the children who had a gestational period of 9 months or more. The non-linear association with U5MRs was highest in the mother's age, followed by the mother's haemoglobin, the mother's education, and household wealth score. The relationships between the mother's age and the mother's haemoglobin level with the U5MR were found to be U-shaped.

CONCLUSIONS

This study highlights the importance of addressing maternal and socioeconomic factors while improving access to healthcare services in order to reduce U5MRs in India. Furthermore, the findings underscore the necessity for more sophisticated approaches to healthcare delivery that consider the non-linear relationships between predictor variables and U5MRs.

Global, regional, and national burden of inflammatory bowel disease, 1990-2021: Insights from the global burden of disease 2021

PURPOSE

The prevalence of inflammatory bowel disease (IBD) is on the rise worldwide. We utilizes data from the Global Burden of Diseases (GBD) 2021 to analyze the national-level burden of IBD, trends in disease incidence, and epidemiological characteristics.

METHODS

Detailed information on IBD was gathered from 204 countries and territories spanning 1990 to 2021, sourced from the GBD 2021. Calculations were performed for incidence rates, mortality rates, disease-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs). These trends were analyzed based on region, nationality, age, gender, and World Bank income level stratifications.

RESULTS

The global age-standardised incident rate (ASIR) of IBD increased from 4.22 per 100000 in 1990 to 4.45 per 100000 in 2021. However, the age-standardised mortality rate (ASMR) decreased from 0.60 per 100000 in 1990 to 0.52 per 100000 in 2021. Similarly, the age-standardised DALYs rate decreased from 21.55 per 100000 in 1990 to 18.07 per 100000 in 2021. Gender comparisons showed negligible differences in disease burden. The greatest increase in IBD-associated ASIR and ASMR occurred in World Bank upper-middle income region (EAPCs, 1.25) and World Bank high-income region (EAPCs, 1.00), respectively. Regionally, East Asia experienced the largest increase in ASIR (EAPCs, 2.89). Among 204 countries, China had the greatest increases in ASIR (EAPCs, 2.93), Netherlands had the highest ASMR in 2021 (2.21 per 100000).

CONCLUSIONS

Global incidence rate of IBD have been increasing from 1990 to 2021, while the DALYs and mortality have been decreasing. The escalating incident rates in select Asian regions deserves further attention.

Burden of major cancer types in Almaty, Kazakhstan

Globally, cancer is the second leading cause of death, with a growing burden also observed in Kazakhstan. This study evaluates the burden of common cancers in Almaty, Kazakhstan's major city, from 2017 to 2021, utilizing data from the Information System of the Ministry of Health. In Kazakhstan, most common cancers among men include lung, stomach, and prostate cancer, while breast, cervical, and colorectal cancers are predominant among women. Employing measures like disability-adjusted life years (DALYs), we found that selected cancer types accounted for a total DALY burden of 25,016.60 in 2021, with mortality contributing more than disability (95.2% vs. 4.7%) with the ratio of non-fatal to fatal outcomes being 1.4 times higher in women than in men. The share of non-fatal burden (YLD) proportion within DALYs increased for almost all selected cancer types, except stomach and cervical cancer over the observed period in Almaty. Despite the overall increase in cancer burden observed during the time period, a downward trend in specific cancers suggests the efficacy of implemented cancer control strategies. Comparison with global trends highlights the significance of targeted interventions. This analysis underscores the need for continuous comprehensive cancer control strategies in Almaty and Kazakhstan, including vaccination against human papillomavirus, stomach cancer screening programs, and increased cancer awareness initiatives.

Temporal trends in lower extremity amputation in Middle East and North Africa (MENA) region: analysis of the GBD dataset 1990-2019

BACKGROUND

Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019.

METHODS

The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time.

RESULTS

From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region.

CONCLUSION

The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region.

Toilet construction under the Swachh Bharat Mission and infant mortality in India

Improvement of water and sanitation conditions may reduce infant mortality, particularly in countries like India where open defecation is highly prevalent. We conducted a quasi-experimental study to investigate the association between the Swachh Bharat Mission (SBM)-a national sanitation program initiated in 2014-and infant (IMR) and under five mortality rates (U5MR) in India. We analyzed data from thirty-five Indian states and 640 districts spanning 10 years (2011-2020), with IMR and U5MR per thousand live births as the outcomes. Our main exposure was the district-level annual percentage of households that received a constructed toilet under SBM. We mapped changes in IMR and U5MR and toilet access at the district level over time. We fit two-way fixed effects regression models controlling for sociodemographic, wealth, and healthcare-related confounders at the district-level to estimate the association between toilets constructed and child mortality. Toilet access and child mortality have a historically robust inverse association in India. Toilets constructed increased dramatically across India following the implementation of SBM in 2014. Results from panel data regression models show that districts with > 30% toilets constructed under SBM corresponds with 5.3 lower IMR (p < 0.05), and 6.8 lower U5MR (p < 0.05). Placebo, falsification tests and robustness checks support our main findings. The post-SBM period in India exhibited accelerated reductions in infant and child mortality compared to the pre-SBM years. Based on our regression estimates, the provision of toilets at-scale may have contributed to averting approximately 60,000-70,000 infant deaths annually. Our findings show that the implementation of transformative sanitation programs can deliver population health benefits in low- and middle-income countries.

The spectrum of acute illness and mortality of children and adolescents presenting to emergency services in Sanghar district hospital, Pakistan: a prospective cohort study

OBJECTIVE

To describe presenting diagnoses and rates and causes of death by age category and sex among children with acute illness brought to a district headquarter hospital in Pakistan.

DESIGN

Prospective cohort study.

SETTING

Sanghar district headquarter hospital, Sindh, Pakistan between December 2019 and April 2020 and August 2020 and December 2020.

PARTICIPANTS

3850 children 0-14 years presenting with acute illness to the emergency and outpatient departments and 1286 children admitted to the inpatient department.

OUTCOME MEASURES

The primary outcome was Global Burden of Disease diagnosis category. Secondary outcomes were 28-day mortality rate, cause of death and healthcare delays, defined as delay in care-seeking, delay in reaching the healthcare facility and delay in appropriate treatment.

RESULTS

Communicable diseases were the most common presenting diagnoses among outpatients and among inpatients aged 1 month to 9 years. Non-communicable diseases and nutritional disorders were more common with increasing age. Few children presented with injuries. Newborn period (age <28 days) was associated with increased odds of death (OR 4.34 [95% CI 2.38 to 8.18], p<0.001, reference age 28 days-14 years) and there was no significant difference in odds of death between female vs male children (OR 1.12, 95% CI 0.6 to 2.04, p=0.72). 47 children died in the hospital (3.6%) and three (0.2%) died within 28 days of admission. Most children who died were <28 days old (n=32/50, 64%); leading diagnoses included neonatal sepsis/meningitis (n=13/50, 26%), neonatal encephalopathy (n=7/50, 14%) and lower respiratory tract infections (n=6/50, 12%). Delays in care-seeking (n=15) and in receiving appropriate treatment (n=12) were common.

CONCLUSION

This study adds to sparse literature surrounding the epidemiology of disease and hospital outcomes for children with acute illness seeking healthcare in rural Pakistan and, in particular, among children aged 5-14 years. Further studies should include public and private hospitals within a single region to comprehensively describe patterns of care-seeking and interfacility transfer in district health systems.

Burden of unintentional drowning in Indonesia: insights from the Global Burden of Disease Study 2019

INTRODUCTION

A high burden of unintentional fatal drowning has been reported in low- and middle-income countries. However, little is known about unintentional drowning in Indonesia.

METHODS

This population-based retrospective cohort study analysed unintentional drowning data for Indonesia sourced from The Global Burden of Disease Study 2019. Estimates of trends, mortality rates, incidence rates, years lived with disability (YLDs) and disability adjusted life years were generated.

RESULTS

A decline in unintentional drowning mortality rates was observed, with an average annual mortality rate of 2.58/100 000. Males were 1.81 (95% CI 1.79 to 1.84) times more likely than females to unintentionally drown. Average annual mortality rates were highest among the under-5 age group (9.67/100 000) and 70 and over (5.71/100 000 for males; 5.14/100 000 for females). Distributions of drowning deaths vary depending on region, with mortality rates higher in Papua, Kalimantan, Sulawesi, Maluku, Sumatra and Nusa Tenggara regions.

DISCUSSION

While a decline in drowning mortality rates in Indonesia was identified between 2005 and 2019, mortality rates for unintentional drowning remained high among children under 5 years, the elderly population and those residing in Papua, Kalimantan, Sulawesi, Maluku, Sumatra and Nusa Tenggara, warranting further focused attention.

CONCLUSION

A downward trend in the rate of unintentional drowning deaths in Indonesia is observed from 2005 onwards, with risk variation based on age, gender and region. The findings highlight the importance of addressing drowning as a cause of premature mortality and health system burden in Indonesia, including through enhancing drowning data collection systems and identifying drowning risk factors.

Benefit-Harm Analysis of Earlier Initiation of Triple Therapy for Prevention of Acute Exacerbation in Patients with Chronic Obstructive Pulmonary Disease

Rationale: Reducing the risk of exacerbation is a fundamental goal in managing stable chronic obstructive pulmonary disease (COPD). Guidelines recommend triple therapy (inhaled corticosteroids, long-acting muscarinic antagonists, and long-acting β-agonists) only as a stepup from dual therapy (long-acting muscarinic antagonists and long-acting β-agonists) for patients at continued high risk of exacerbation, because of the trade-off of an increased risk of pneumonia associated with inhaled corticosteroid-containing therapies. However, there is little evidence on the optimum timing of initiating triple therapy. Objectives: To perform a benefit-harm analysis to evaluate the net benefit of earlier initiation of triple therapy for the prevention of acute exacerbations in patients with COPD compared with standard timing recommended in current guidelines. Methods: We used a validated whole-disease microsimulation model of COPD in the Canadian general population aged ⩾40 years to determine the benefit versus harm of earlier initiation of triple therapy over a 20-year time horizon compared with standard care. We assessed net change in quality-adjusted life-years (QALYs) from the reduction in risk of acute exacerbations and the increased risk of treatment-related pneumonia in subgroups of patients with COPD defined by exacerbation history, symptoms, and disease severity. Model parameters were determined from clinical trials and other published literature. Key parameters were varied in one-way sensitivity analysis. Results: In patients at high risk of acute exacerbation (54.7% female; mean age, 74.0 yr; 68% Global Initiative for Chronic Obstructive Lung Disease grades I and II), earlier initiation of triple therapy was associated with a net QALY gain of 4.8 per 100 patients with COPD over 20 years compared with standard care. The net QALY gain increased to 5.9 per 100 patients in the subgroup of patients with a high symptom burden (modified Medical Research Council dyspnea scale score, >1). Earlier initiation remained net beneficial in all subgroup and sensitivity analysis scenarios. Conclusions: Modeling suggests that earlier initiation of triple therapy is likely to be net beneficial for patients at high risk of acute exacerbation, with an even greater benefit to patients with a high symptom burden. Further clinical research is needed to verify these findings in empirical studies.

The Burden of Plastic Surgery Related Disease in Canada: A Perspective Based on the 2019 Global Burden of Disease Study

Purpose: Identifying the burden of disease related to plastic and reconstructive surgery in Canada will provide timely population-based data, inform policy, and generate support for research funding. Methods and Patients: Data on the burden of disease (ie, prevalence, incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life years [DALYs]), were extracted from the Global Burden of Disease 2019 results tool for all available and relevant plastic surgery diseases. The economic burden of disease in Canadian dollars was calculated based on prior studies. Data are presented as either rates (per 100 000) or counts with the associated uncertainty interval. Results: In 2019, plastic surgery related conditions in Canada had an overall age-standardized DALY rate of 556 per 100 000 [463-664]. Of these conditions, breast cancer was responsible for approximately 50% of the overall burden of disease, with an age-standardized DALY rate of 268 per 100 000 [244-294] followed by squamous cell carcinoma (66 per 100 000 [45-94]) and thermal burns (61 per 100 000 [46-82]). Age-standardized incidence rates were highest for cellulitis (2654 per 100 000 [2502-2812]). Breast cancer had the highest age-standardized cost of care of all plastic surgery related diseases, at $5.1 billion, approximately half of the total age-standardized cost of $10.6 billion for included plastic surgery diseases. Conclusion: Plastic and reconstructive surgery related diseases, particularly breast cancer, thermal burns, and malignant melanoma, are responsible for a high burden of disease and significant cost to the Canadian healthcare system. These results will help guide national healthcare policy and should provide support to directing funding and research efforts toward impactful diseases facing the Canadian healthcare system.

Social determinants and work-related musculoskeletal disorders in Brazil

This study aimed to analyze the prevalence of work-related musculoskeletal disorders (WMSD) and their association with individual and contextual factors in the Brazilian population. This quantitative cross-sectional study used secondary data from the Brazilian National Health Survey from August 2013 to February 2014. The dependent variable included WMSD, and independent variables were analyzed as individual and contextual factors. WMSD was mostly prevalent in females, individuals aged 43 to 59 years, with chronic physical or mental disorders, reporting frequent sleep disorders, and performing integrative and complementary health practices, physical exercise or sports, and heavy physical activity or housework. Regarding contextual factors, high social classes and proportion of individuals with formal work were associated with a high prevalence of WMSD, whereas a high Gini index was associated with a low prevalence. Thus, a high prevalence of WMSD in the Brazilian population was associated with individual and contextual factors, which should be the target of health professionals for actions of promotion, prevention, and intervention at individual or collective care levels.

Effects of Lower Limb Proprioceptive Training on Balance and Trunk Control Among the Adult Stroke Population

Background and objective Balance and trunk control are major concerns among older adults during stroke rehabilitation. Loss of proprioception in the affected limb has a greater influence on motor learning and reeducation during balance training. Available studies stress the relevance of strength and functional training in regaining balance and trunk control. Proprioception training, in addition to available rehabilitation, can optimize the balance among this population. Our study aimed to find out the effects of proprioceptive training on balance and trunk control among the chronic stroke population. Methodology Out of 45 subjects enrolled at the Indian Head Injury Foundation, New Delhi, India, 30 subjects were selected based on selection criteria and randomized into two groups using the chit method, with 15 subjects in each group. The control group received conventional training, which included a range of motion, stretching, and strengthening exercises, while the intervention group received additional proprioceptive training five days per week for four consecutive weeks. Subjects were assessed on the Berg Balance Scale and Trunk Control Test for balance and trunk control on day one and after four weeks. A paired t-test was used to analyze the difference within the groups, and unpaired t-tests were used between the groups, keeping p < 0.05 as a significance level. Results After four weeks of intervention, statistically significant improvements were seen in the balance and trunk control groups, with p < 0.05 in both groups. However, a significant improvement in balance was observed in the experimental group when compared across groups (p = 0.001), whereas no statistically significant improvement in trunk control was found (p = 0.061). Conclusion We conclude that proprioceptive training and conventional physiotherapy both help to improve balance. Proprioceptive training is better for improving balance, but it has no significant effects on trunk control. It is likely that an extended intervention time or a different form of intervention may be required to achieve substantial gains in these areas. Future research might look at other outcome measures or the impacts of other types of therapies to see which ones are most helpful at increasing trunk control.