Five insights from the Global Burden of Disease Study 2019

Global, Regional, and National Levels and Trends in the Burden of Pressure Ulcer from 1990 to 2019: A Systematic Analysis for the Global Burden of Disease 2019

Pressure ulcer (PU) is a type of chronic ulcer, placing a high burden not only on patients' families but also on national healthcare systems globally. To determine the level, trends, and burden of PU worldwide and to provide an essential foundation for building targeted public policies on PUs at the national, regional, and global levels, data on PU were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disability-adjusted life years (DALYs), and deaths of PUs in 204 countries and regions from 1990 to 2019 were calculated and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. A total of 3,170,796 new cases (95% uncertainty interval (UI), 3,499,729-2,875,433 cases) of PU were identified globally in 2019, more than 55% of which were among male individuals, and most of the new cases were concentrated in those 75-90 years of age. The burden of PU measured in DALYs was 481 423 (95% UI, 583 429-374 334) in 2019, 73% and 27% of which could be attributed to years of life lost (YLLs) and years lived with disability (YLDs), respectively. The burden increased gradually from 1990 to 2019 (from 267 846 [360 562-211 024] to 481 423 [95% UI, 583 429-374 334]). A total of 24 389 deaths were attributed to PU (95% UI, 31 260.82-17 299). The EAPC of incidence, DALYs, and deaths were negative in most regions, the age-standardized rate (ASR) of incidence, DALYs, and deaths were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with the SDI levels, universal health coverage (UHC), and gross domestic product (GDP), which shows that the ASRs of PU decreased as the economy developed and countries' healthcare system performances improved.

Formulae for calculating subgroup disease burden from overall and reported or assumed relative burden estimates

Background

The risk of disease varies across populations based on factors like age, sex, race, ethnicity, socioeconomic status, and underlying medical conditions. Subgroup or subpopulation data are critical in planning, executing and evaluating public health interventions. However, most studies report the values for the overall (total) population with little or no information on the subgroups. As a result, finding subgroup specific data can be challenging.

Objective

In this report, a set of formulae that can be used to calculate subgroup or subpopulation data using the overall estimates and the reported or assumed relative estimates were derived.

Methods

A simple numerical example was used to illustrate the methodology. Next, symbolic formula for calculating the burden (e.g., incidence, prevalence, or average cost) for 3 (and extended to n number of) subgroups or subpopulations were derived. To account for uncertainty in the data, two statistical methods were used to estimate confidence intervals for the point estimates.

Results

The derived formulae indicated that each subgroup or subpopulation's burden (incidence, prevalence, or average cost) can be calculated as the overall burden adjusted by the ratio of that subgroup or subpopulation's relative burden to the sum of the proportion-weighted relative burden (incidence, prevalence, or average cost) of all the subgroups or subpopulations within the population.

Conclusion

These formulae can help to avoid or minimize potential quantitative and qualitative errors in subgroup or subpopulation disease burden estimates used for health research, interventions and/or policy analyses or deliberations.

Comprehensive analysis of stroke epidemiology in Vietnam: Insights from GBD 1990-2019 and RES-Q 2017-2023

Background

Stroke is a significant health burden in Vietnam, with substantial impacts on mortality, morbidity, and healthcare resources. An up-to-date report on stroke epidemiology and associated risk factors in Vietnam was missing.

Method

We analyzed the data published in the Global Burden of Disease (GBD) 2019, in combination with the first-time analysis of the Registry of Stroke Care Quality Improvement (RES-Q) initiative in Vietnam from 2017 to 2023.

Findings

Comparative analysis globally revealed that Vietnam had one of the highest stroke incidence and prevalence rates in Southeast Asia and ranked 4th in stroke mortality among 11 neighbouring countries. In the RES-Q dataset, 95,696 patients (77 %) were ischemic stroke, 23,203 (18 %) were intracerebral haemorrhage, and 2816 (2 %) were subarachnoid haemorrhage. In GBD 2019, stroke was the leading cause of death among cardiovascular diseases in Vietnam, accounting for 135,999 fatalities. The incidence of stroke was 222 (95 % UIs 206-242) per 100,000 population, with a prevalence of 1541 (1430-1679) per 100,000. Results align with the report from the RES-Q dataset in two megacities of Vietnam: Hanoi (incidence rate of 168.9, prevalence rate of 1182.2) and Ho Chi Minh City (incidence rate of 207.1, prevalence rate of 1221.8). Key risk factors for stroke mortality are high systolic blood pressure (79,000 deaths), unhealthy dietary (43,000 deaths), high fasting plasma glucose (35,000 deaths), and air pollution (33,000 deaths). Incidence is lower in rural Vietnam, but availability and quality of care are higher in megacities.

Interpretation

The results promote a further understanding of stroke and risk factors for the Vietnamese population and suggest prevention and treatment strategies for the Vietnamese government, including facility and capacity improvement and applications of advanced technologies.

Global, regional, and National levels and trends in burden of dental caries and periodontal disease from 1990 to 2035: result from the global burden of disease study 2021

BACKGROUND

The global burden of dental caries (DC) and periodontal disease (PD) has evolved significantly from 1990 to 2021, influenced by demographic shifts and socioeconomic factors in oral health interventions. This study aims to analyze historical trends, project future trajectories to 2035, and identify inequalities to inform equitable oral health policy development.

METHODS

Utilizing data from the Global Burden of Disease Study (GBD), which integrates epidemiological records from systematic reviews, survey data preparation, disease registries, and case notifications, we conducted an observational analysis based on historical population-level data from 1990 to 2021.We analyzed the incidence, prevalence, and their corresponding age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) for caries of deciduous teeth (CDT), caries of permanent teeth (CPT) and periodontal disease (PD). Bayesian age-period-cohort (BAPC) models with Integrated Nested Laplace Approximation (INLA) were employed to forecast trends through 2035, integrating second-order smoothing effects, overdispersion adjustments, and uncertainty quantification via 1,000 Monte Carlo simulations (95% UI) with future precision expressed as 95% confidence intervals (CI).

RESULTS

From 1990 to 2021, CDT prevalence declined regionally, while PD remained prevalent, particularly among middle-aged and elderly populations in high-burden regions like Sub-Saharan Africa and Southeast Asia. Significant gender disparities were noted, with females experiencing comparable deciduous DC in early childhood, whereas males showed dominant PD rates in middle/older ages. Low-income regions still face high burdens despite progress. Projections to 2035 suggest a CDT resurgence and aging-driven PD persistence.

CONCLUSIONS

DC and PD persist as major public health issues, shaped by gender, age, and regional disparities. The projected resurgence of childhood DC and persistent PD prevalence by 2035 underscore the need for targeted interventions. Tailored public health initiatives are essential to mitigate long-term impacts and improve global oral health outcomes.

Burden of female diseases among adolescents and young adults aged 10-24 years in South Asia and Sub-Saharan Africa, 1990-2021: a systematic analysis from the Global Burden of Disease Study 2021

INTRODUCTION

Female diseases pose significant challenges in South Asia and Sub-Saharan Africa, particularly among adolescent girls and young women, who often receive insufficient attention.

OBJECTIVES

To report patterns and trends of female diseases among adolescent girls and young females aged 10-24 years in South Asia and Sub-Saharan Africa from 1990 to 2021.

METHODS

We used data from the Global Burden of Disease Study 2021 for 51 countries in South Asia and Sub-Saharan Africa between 1990 and 2021. Joinpoint Regression was used to calculate annual average percentage changes and 95 % confidence intervals to quantify temporal trends.

RESULTS

In 2021, South Asia and Sub-Saharan Africa had high mortality rates of maternal disorders of 6.04 (95 % uncertainty intervals 5.02, 7.39) and 17.69 (14.37, 21.78) per 100,000 population, respectively. The mortality rates for female cancers were approximately 0.98 in both regions, and the incidence rates for gynecological diseases were 16472.83 and 14480.99, per 100,000 population, respectively. From 1990 to 2021, there was an increasing trend in the number of maternal disorder deaths in Sub-Saharan Africa, as well as in all metric rates for most female cancers in both regions, and disability-adjusted life years, prevalence, and incidence rates for gynecological diseases in South Asia. Several female diseases varied across countries and were increasingly affecting younger adolescents aged 10-14 years in both regions. Although countries with lower Socio-demographic Index had a heavier burden of female diseases, no significant association was observed between the Universal Health Coverage effective coverage index and death rates for female cancers or gynecological diseases.

CONCLUSIONS

The burden of female diseases remains high among young females in South Asia and Sub-Saharan Africa, with younger adolescents being particularly affected. This underscores the urgent need for targeted interventions and increased investment in healthcare infrastructure to reduce the burden of female diseases in these regions.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Zinc deficiency as possible link between immunosenescence and age-related diseases

As global life expectancy increases, research reveals a critical challenge in aging: the progressive deterioration of immune function, termed immunosenescence. This age-related immune decline is characterized by a complex dysregulation of immune responses, which leaves older adults increasingly vulnerable to infections, chronic inflammatory states, and various degenerative diseases. Without intervention, immunosenescence significantly contributes to morbidity and mortality among the elderly, intensifying healthcare burdens and diminishing quality of life on both individual and societal levels. This review explores the essential role of zinc, a trace element critical for immune health, in mitigating the impact of immunosenescence and slowing the cascade of immunological dysfunctions associated with aging. By modulating the activity of key immune cells and pathways, zinc supplementation emerges as a promising approach to strengthen immunity, reduce oxidative stress, and counteract "inflammaging," a state of chronic, low-grade inflammation that accelerates tissue damage and drives disease progression. Zinc's involvement in cellular defense and repair mechanisms across the immune system highlights its ability to enhance immune cell functionality, resilience, and adaptability, strengthening the body's resistance to infection and its ability to manage stressors that contribute to diseases of aging. Indeed, zinc has demonstrated potential to improve immune responses, decrease inflammation, and mitigate the risk of age-related conditions including diabetes, depression, cardiovascular disease, and vision loss. Given the prevalent barriers to adequate zinc intake among older adults, including dietary limitations, decreased absorption, and interactions with medications, this review underscores the urgent need to address zinc deficiency in aging populations. Recent findings on zinc's cellular and molecular effects on immune health present zinc supplementation as a practical, accessible intervention for supporting healthier aging and improving quality of life. By integrating zinc into targeted strategies, public health efforts may not only sustain immunity in the elderly but also extend healthy longevity, reduce healthcare costs, and potentially mitigate the incidence and impact of chronic diseases that strain healthcare systems worldwide.

Validation of a Slovenian version of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ) for use with patients in family medicine

BACKGROUND

Chronic non-communicable diseases are the world's leading cause of death and disability. The emerging field of lifestyle medicine requires equipping healthcare professionals with instruments, knowledge, skills and competencies. Measuring an individual's lifestyle with a valid and reliable instrument is the first step in promoting it. The aim of the study was to validate the Slovenian adaptation of the Healthy Lifestyle and Personal Control Questionnaire (HLPCQ).

METHODS

A cross-sectional study was conducted among 666 questionnaire participants, and they were adult participants (aged 18 and above) from family medicine practices with cardiovascular diseases (CVDs) risk factors (e.g., hypertension, high cholesterol) but without a diagnosis of acute CVDs. The questionnaire included demographic data and anthropological measures and a translated English HLPCQ questionnaire. The instrument was translated using the forward-backwards translation method. The study was conducted in accordance with the principles of the World Medical Association Declaration of Helsinki. In addition to assessing the construct validity of the questionnaire, exploratory and confirmatory factor analyses were used to determine content and face validity, and internal consistency reliability.

RESULTS

The mean age of male participants was 41.34 (± 13.220) years, the mean age of female participants was 40.31 (± 11.905) years. The Cronbach's alpha was 0.852, and all questionnaire subscales had positive correlations. Sampling adequacy was confirmed by the Kaiser-Meyer-Olkin (KMO) index (0.851), and Bartlett's test of sphericity was significant (χ² = 4647.694, p < 0.001), indicating suitability for Principal Component Analysis (PCA). PCA revealed a five-factor solution, accounting for 50.67% of the total variance.

CONCLUSIONS

The most influential factors for a healthy lifestyle were daily routine, healthy dietary choices, avoidance of harmful dietary habits, organized physical activity, and social and mental balance. The Slovenian version had high factor validity and reliability. It can be used in Slovenian Community Health Centre to assess an individual's control over various lifestyle dimensions. The instrument also holds potential for use in public health initiatives, supporting early identification of lifestyle-related risk factors and promoting preventive care strategies in the primary care setting.

Evolving global trends in PCOS burden: a three-decade analysis (1990-2021) with projections to 2036 among adolescents and young adults

Background

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting adolescent and young adult females, yet global data on its burden and trends remains limited.

Methods

We analyzed data from the Global Burden of Disease Study 2021 for females aged 10-24 years in 204 countries (1990-2021). Metrics included cases, age-standardized incidence (ASIR), prevalence (ASPR), disability-adjusted life years (ASDR), and average annual percentage changes (AAPCs). Future trends (2022-2036) and disease reduction gaps were assessed.

Results

From 1990 to 2021, global PCOS cases increased by 56% (incidence), 59% (prevalence), and 58% (DALYs). ASIR rose from 49.45 to 63.26 per 100,000, with an AAPC of 0.8. Southeast Asia, East Asia, and Oceania had the fastest growth, while high-SDI regions bore the highest burden. Girls aged 10-14 showed the steepest age-specific increase. Nationally, the largest increases occurred in Equatorial Guinea, Maldives, and Myanmar, while Italy saw a decline. Forecasts through 2036 indicate continued increases in ASIR (+8.32%), ASPR (+10.87%), and ASDR (+10.39%). Frontier analysis highlighted unachieved reduction potential, especially in high-SDI countries.

Conclusions

PCOS burden among adolescents and young adults has significantly risen globally with disparities by region, SDI, and age, warranting urgent and equitable public health strategies.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

National cohort study on cardiometabolic index and incident stroke in middle-aged and older adults in China

Background The Cardiometabolic Index (CMI), a novel marker integrating central obesity and lipid metabolism, serves as a comprehensive indicator of metabolic health. While CMI has been linked to metabolic disorders like diabetes and cardiovascular diseases, its role in predicting stroke risk remains unclear. This study examines the association between CMI and stroke risk in Chinese adults aged 45 and older, highlighting its potential as a predictive tool for public health.

METHODS

Data from the China Health and Retirement Longitudinal Study (CHARLS) were analyzed. Participants were divided into CMI quartiles. Stroke incidence was the primary endpoint. Cox proportional hazards models evaluated the CMI-stroke risk association. Kaplan-Meier curves compared stroke incidence across quartiles, while restricted cubic splines (RCS) assessed non-linear trends. Subgroup analyses verified robustness.

RESULTS

Among 7,821 participants (47 % male), 418 strokes (5.3 %) occurred over a mean follow-up of 7 years. Higher CMI was significantly associated with increased stroke risk [HR, 1.153 (95 % CI: 1.048-1.269), P = 0.004]. RCS revealed a non-linear rise in stroke risk with increasing CMI (P for nonlinearity = 0.005). No significant interactions were observed between CMI and subgroups (all P > 0.05).

CONCLUSION

Elevated CMI correlates with higher stroke risk in middle-aged and older Chinese adults. Incorporating CMI into routine assessments could improve early stroke prevention strategies, addressing the increasing burden of cerebrovascular disease in aging populations.

Global and regional burden of breast cancer attributable to high BMI, 1990-2036: A comprehensive analysis

OBJECTIVES

This study aimed to assess global, regional, and national trends in breast cancer burden attributable to high body mass index (BMI) from 1990 to 2021 and provide projections up to 2036 using data from the Global Burden of Disease (GBD) 2021 study.

STUDY DESIGN

Systematic analysis of the GBD 2021 dataset.

METHODS

We extracted high BMI-related breast cancer data from the GBD 2021 dataset, covering 204 countries and territories. Age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs) were calculated to analyze temporal patterns and regional differences. Future trends were projected using the Bayesian age-period-cohort (BAPC) model.

RESULTS

In 2021, high BMI contributed to 44,707 breast cancer deaths and 1,041,309 DALYs globally, reflecting a 138.5 % and 142.7 % increase, respectively, compared to 1990. While global age-standardized mortality and DALY rates remained relatively stable, the absolute burden significantly increased, particularly in low- and middle-SDI regions. High-SDI regions exhibited the highest age-standardized rates, but low-SDI regions showed the fastest growth. Projections indicate that the global burden of breast cancer due to high BMI will continue to rise until 2036, driven by increasing obesity rates and insufficient healthcare resources.

CONCLUSIONS

High body mass index is a major driver of the global breast cancer burden, showing increasing trends not only in high-income regions but more prominently in low-SDI regions. Effective strategies, including public health interventions targeting obesity management, are needed to control the rising burden.

Building Local Capacity in a Low-Resource Setting to Increase Access to Health Care: An Evaluation of Blood Pressure Monitoring Training

Cardiovascular risk factors such as hypertension are common and largely uncontrolled in Malawi. In this low-resource setting, Community Health Workers (CHWs) can increase access to home-based blood pressure (BP) monitoring. The purpose of this study is to evaluate the effectiveness of a CHW training focused on BP monitoring and referral criteria, as well as the accuracy of referral decision-making and documentation. The participants were a purposive sample of all active home-based palliative care CHWs at St. Gabriel's Hospital (n = 60) located in Namitete, Malawi, serving over 250,000 people within a 50 km radius. This was a retrospective cross-sectional study conducted in December 2020 using both quantitative (descriptive, paired t-test) and qualitative (thematic) analysis. Participants showed significantly greater knowledge on the post-test (M = 8.98, SD = 1.213) compared to the pretest (M = 7.96, SD = 1.231), t (54)-5.0557.475, p < .001. All participants who attended both days of training demonstrated competency on a skills checklist in 100% of the rehabilitation and BP monitoring skills taught. Through document analysis of record books, referral decisions for patients with hypertension were 87.57% accurate and 81.07% of entries (n = 713) were complete. Participants reported the lack of both transportation and equipment as barriers to their work. They reported trainings, supplies, and support from the hospital as facilitators to their work. This study shows that BP can be monitored in remote villages, accurate referrals can be made, and stroke prevention education can be provided. These interventions increase the chances of more equitable care for this vulnerable population in a resource-limited setting.

Global, regional, and national burden and risk factors of ischemic heart disease, 1990-2021: an analysis of the global burden of disease study

Background

With a rapidly growing and aging world population, ischemic heart disease (IHD) remains a major burden. This study aimed to reassess the prevalence trend of IHD from 1990 to 2021 from multiple dimensions to improve the shortcomings of the existing studies and provide a solid scientific basis for policymakers.

Methods

This study extracted data on the prevalence, incidence, mortality, disability-adjusted life years (DALYs), and associated risk factors of IHD from the global burden of disease (GBD) 2021 study. Descriptive, decomposition, and risk factor analyses were used to provide insights into the epidemiologic patterns of IHD from 1990 to 2021 and project the burden of IHD from 2022 to 2045. Potential differences in burden and risk factors based on age, sex, 21 GBD geographic regions, five social development index (SDI) regions, and 204 countries are highlighted.

Results

Globally, the age-standardized prevalence rate (ASPR) of IHD is increasing, while the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (ASDR) are decreasing. ASPR, ASIR, ASMR, and ASDR were highest in the low-middle SDI regions and lowest in the high SDI regions. ASMR and ASDR were highest in Nauru and lowest in Portugal. Men had an overall heavier burden of IHD than women; the 65-69 age group had the largest burden, and those aged >95 years had the highest crude incidence rate. In addition, the burden of IHD was negatively correlated with SDI across regions and countries, while decomposition analyses suggest that the main reasons for the current increase in the burden of IHD are aging and population growth. Risk factors have changed relatively little over the 32 years, with metabolic risk still ranking first. We forecast that the absolute burden of IHD will continue to increase till 2045; however, ASIR, ASMR, and ASDR will gradually decline.

Conclusion

From 1990 to 2021, the global burden of IHD generally increased and varied across regions, sex, and age groups. Due to increasing population growth and aging, there is an urgent need for strategically directed measures to reduce the burden of IHD.

Global burden trends and forecasts for MAFLD in adolescents and young adults from 1990 to 2021

Metabolic-dysfunction associated fatty liver disease (MAFLD) is a widespread chronic liver condition that has been steadily increasing among adolescents and young adults in recent years, posing a major global public health concern. This study aims to conduct an in-depth analysis of the Global Burden of Disease (GBD) 2021 data on MAFLD, focusing on prevalence, incidence, and disability-adjusted life years (DALY) for individuals aged 15-39, spanning the period from 1990 to 2021. This research examines data from the GBD study covering 1990 to 2021 to assess the prevalence, incidence, and DALYs associated with of MAFLD in adolescents and young adults aged 15-39. The analysis is broken down by socioeconomic status, geographic regions, and specific countries. Advanced statistical methods, including the estimated annual percentage change (EAPC) and Bayesian age-period-cohort (BAPC) modeling, were used to deliver the most current and thorough epidemiological assessment of MAFLD in this demographic. In 2021, the estimated global cases of non-alcoholic fatty liver disease among adolescents and young adults reached approximately 423 million, representing a 75.31% increase from 1990. The age-standardized prevalence rate (ASPR) was 14,221.32 cases per 100,000 population, and the age-standardized incidence rate (ASIR) was 977.61 cases per 100,000 population in 2021. Between 1990 and 2021, the ASPR, ASIR, age-standardized DALY rate, and age-standardized mortality rate showed a continuous upward trend, with EAPC of 0.84, 0.79, 0.65, and 0.81, respectively. Regions with Middle and Low-middle Socio-Demographic Index (SDI), as well as High-middle SDI, emerged as "hotspots" for MAFLD prevalence, particularly in North Africa, the Middle East, East Asia, and South Asia. Males exhibited higher prevalence rates compared to females, and the rates continued to increase across all adolescents and young adult age groups. By 2050, the ASPR for MAFLD among this population is projected to reach 16,101 cases per 100,000, signaling an alarming trend. Over the last 30 years, the burden of metabolic-dysfunction associated fatty liver disease has significantly increased among adolescents and young adults worldwide. To counter this rising global health concern, it is crucial to develop and implement targeted and effective interventions tailored to socio-economic settings.

Celery seed derived reconstituted lipid nanoparticles as an innate neuron-targeted neuroprotective nanomedicine for ischemic stroke treatment

BACKGROUND

Ischemic stroke (IS) is the leading cause of worldwide death while the discovery and effective delivery of neuroprotective agents for satisfied IS treatment is still challenging.

RESULTS

In this study, we discover that celery seed (CS) derived reconstituted lipid nanoparticles (CS-rLNPs) can effectively penetrate across blood-brain barrier (BBB) with increased distribution to the brain. Especially, CS-rLNPs show innate neuron-targeting ability to primarily bind to neuron in the cerebral ischemic area, which is not reported by any parallel studies. Moreover, CS-rLNPs are found to exert therapeutic effects on IS, which effectively restore the function of model mice. Further studies reveal that the therapeutic effects are realized through TLR4/MyD88/NF-κB p65 pathway regulated anti-inflammation and anti-apoptosis mechanisms.

CONCLUSIONS

Therefore, CS-rLNPs can serve as a neuron-targeted neuroprotective nanomedicine for IS treatment.

Global Trends in the Incidence, Prevalence and Disability-Adjusted Life Years of Leprosy from 1990 to 2019: An Age-Period-Cohort Analysis Using the Global Burden of Disease Study 2019

Background

Leprosy is a neglected tropical disease, with approximately 200,000 new cases reported worldwide every year. Although there are numerous studies on the epidemiology of leprosy, the age, period, and cohort effects remain poorly understood.

Objective

We present an overview of trends in leprosy incidence, prevalence and disability-adjusted life years worldwide from 1990 to 2019 and associations with age, period, and birth cohort. Data for analysis were obtained from the Global Burden of Disease Study 2019.

Methods

We described incident case, prevalent case, age-standardised incidence, prevalence and disability-adjusted life years rates of leprosy from 1990 to 2019. Subsequently, we calculated overall annual percentage changes, annual percentage changes, and the relative risks of period and cohort using an age-period-cohort model.

Results

From 1990 to 2019, the global age-standardized incidence rate of leprosy decreased from 1.48 per 100,000 to 0.65 per 100,000. Additionally, countries with low Socio-Demographic Index (SDI) demonstrated higher age-standardised incidence, prevalence and disability-adjusted life years rate. The age-standardised incidence, prevalence and disability-adjusted life years rate were significantly higher in males compared to females. Furthermore, the impact of age on leprosy increased with age, peaking at 25-35 years, with the highest prevalence rates observed in the 35-40 age group. Notably, the peak age of leprosy onset increases with SDI. Both the period and cohort effects on leprosy incidence and prevalence showed decreasing trend in middle SDI, low-middle SDI and low SDI countries in recent 30 years and birth cohort later than 1905. However, unfavorable period and cohort effects were noted in high SDI regions.

Conclusion

Leprosy incidence, prevalence and disability-adjusted life years have significantly decreased globally, but remain high in areas with lower SDI. Developing regions should increase public awareness of leprosy risk factors, develop effective control policies to better manage and prevent the disease.

Burden of gastrointestinal cancers in Asia, 1990-2019

OBJECTIVES

Gastrointestinal (GI) cancers are a major cause of morbidity and mortality worldwide. However, there has been no comprehensive assessment of GI cancers in Asia.

STUDY DESIGN

This was an epidemiological study.

METHODS

The study calculated the incidence and deaths of six common GI cancers in Asia between 1990 and 2019 using data from the Global Burden of Disease study. The data are presented by sex, age, year, location, and risk factors, and are shown as counts and rates.

RESULTS

In 2019, the age-standardized incidence rates (ASIR) for colorectal, esophageal, gallbladder and biliary tract (GBTC), liver, pancreatic, and stomach cancers were 23.88, 8.24, 2.77, 7.97, 5.41, and 19.77, respectively. The age-standardized death rates (ASDR) for colorectal, esophageal, GBTC, liver, pancreatic, and stomach cancers were 12.49, 7.73, 2.53, 7.22, 5.47, and 14.67, respectively. From 1990 to 2019, there was an increasing trend in incidence and deaths for esophageal, liver, and stomach cancer, while a decreasing trend was observed in colorectal, GBTC, and pancreatic cancer. The burden of GI cancer increased successively in older generations and was higher in males than in females. Furthermore, this burden varied significantly across Asian subregions and countries. Dietary risks, smoking, alcohol use, and high BMI contribute to GI cancer mortality.

CONCLUSIONS

GI cancers continue to be the primary contributor to the tumor burden in Asia, with increasing absolute numbers but varying age-standardized measures over the past three decades.

Patient decision aids for hip and knee arthroplasty decision-making: a scoping review protocol

INTRODUCTION

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are effective methods carried out widely in patients with end-stage hip and knee osteoarthritis (OA). Despite the trend towards shared decision-making in surgical decisions, patients often struggle to fully participate due to a lack of informational support. Patient decision aids (PtDAs) which provide evidence-based sources of health information can address this issue and facilitate shared decision-making. However, most existing studies and systematic reviews focus on the effects of PtDAs in the decision-making process for THA and TKA, with little attention given to a comprehensive scoping review of the range and scope of research in this area. Therefore, this review aims to assess the state of the literature on PtDAs for THA and TKA, describe the features of PtDAs for patients with OA who are considering primary elective THA or TKA and identify the questions in the implementation of decision-making.

METHODS AND ANALYSIS

This scoping review will be conducted according to the framework recommended by Arksey and O'Malley. The search will be limited to articles written in English and Chinese, while the publication date restriction is from 'inception' to 'February 2025'. Studies on PtDAs for patients with OA considering primary elective THA and TKA will be considered for inclusion. Five electronic databases will be searched (CINAHL, Pubmed, Embase, PsycINFO and Web of Science). Studies for inclusion will be selected independently by two review authors. Data will be extracted using a predefined data extraction form. Findings will be presented in tabular form. A narrative description of the evidence will complement the tabulated results.

ETHICS AND DISSEMINATION

This scoping review does not require ethical approval, as it will involve a secondary analysis of existing literature. Findings will be published in a peer-reviewed journal.

REGISTRATION DETAILS

Open Science Framework (https://doi.org/10.17605/OSF.IO/9JCG3).

Trends and analysis of risk factor differences in the global burden of chronic kidney disease due to type 2 diabetes from 1990 to 2021: A population-based study

BACKGROUND

Chronic kidney disease (CKD) is a significant contributor to the global burden of disease. Among its causes, chronic kidney disease due to type 2 diabetes (CKD-T2D) is the primary subtype. This study aims to provide an updated assessment of the global disease burden of CKD-T2D from 1990 to 2021. It will analyse the trends in the global burden of CKD-T2D and the differences in risk factors, as well as project changes over the next 15 years.

METHODS

The data for this study were derived from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. Estimates of prevalence, incidence, deaths and disability-adjusted life years (DALYs) for CKD-T2D, along with their 95% uncertainty intervals (UIs), were extracted. The trends in CKD-T2D burden from 1990 to 2021 were analysed from overall and local perspectives. An age-period-cohort model was used to estimate the age, period and cohort effects on the prevalence and incidence of CKD-T2D between 1990 and 2021. A decomposition analysis was conducted to assess the contribution of population size, age structure and epidemiological changes to the burden of CKD-T2D. Population-attributable fractions were determined for each risk factor, and a difference analysis was conducted. Additionally, projections were made regarding changes in the burden of CKD-T2D over the next 15 years.

RESULTS

In 2021, the global burden of CKD-T2D remained significant, with a total of 107 559 955 cases. The age-standardized prevalence rate (ASPR) was 1259.63 per 100 000 people. The age-standardized incidence rate (ASIR) was 23.07 per 100 000 people, and the age-standardized death rate (ASDR) was 5.72 per 100 000 people. The age-standardized disability-adjusted life years (DALYs) was 131.08 per 100 000. The global burden of CKD-T2D showed variation across different socio-demographic index (SDI) regions. In 2021, the overall burden of CKD-T2D continued to rise, with the age effect increasing with age. Both prevalence and incidence risks showed an upward trend over time. Decomposition analysis indicated that population growth and ageing were the primary contributors to the global burden of DALYs related to CKD-T2D. Metabolic risk factors such as high fasting plasma glucose and high body mass index (BMI) are the most significant attributable risk factors. It is projected that by 2036, the trends in ASPR, ASIR, ASDR and age-standardized DALYs will stabilize. However, ASIR and age-standardized DALYs are expected to continue rising, and the number of cases of prevalence, incidence, mortality and DALYs will persist in their upward trend.

CONCLUSION

CKD-T2D imposes a significant global disease burden, with health disparities and unequal disease outcomes continuing to worsen across countries and regions due to differences in socio-economic development levels. This burden is primarily driven by population growth, ageing and metabolic risks such as obesity, hyperglycaemia and hypertension. Although the rate of increase in disease burden may slow over the next 15 years, the number of cases is expected to rise substantially. Therefore, enhancing prevention, early screening and effective treatment interventions, particularly in high-risk areas, is crucial for reducing the disease burden and narrowing health disparities.

Perspectives on the decriminalisation of suicide in Pakistan: historical context, societal impacts, and the way forward

This Viewpoint provides a comprehensive review of the historical context, legal frameworks, and societal implications associated with the criminalisation of suicide in Pakistan, along with the process that was utilised for the decriminalisation of suicide. The context focuses on the importance of decriminalising suicide, presenting evidence and insights into how the criminalisation of suicide has impacted individuals, families, and the healthcare system. The process of decriminalising suicide in Pakistan focuses on the public awareness strategies, emphasising the key role that the stories of people with lived experience of mental illness played in shifting the societal attitudes and misconceptions related to suicide. Through discussions of the challenges faced in the process of repealing Section 325 of the Pakistan Penal Code (PPC), we emphasise the need for continued public awareness efforts to address the religious misconceptions related to suicide. With the implementation of the law still pending, we argue that decriminalising suicide aligns with the development of a National Suicide Prevention Strategy. The Viewpoint also presents recommendations for government representatives, public health professionals, policymakers, and other stakeholders to utilise our learnings to develop a robust suicide prevention strategy with a multisectoral approach, strengthening the medical system to respond to mental health emergencies.

The global burden and trends of asthma from 1990 to 2021, and its changes during the COVID-19 pandemic: An observational study

OBJECTIVES

This study aims to comprehensively analyze the global burden and trends of asthma, along with their variations during the COVID-19 pandemic.

STUDY DESIGN

An observational study.

METHODS

The data on age-standardized rates of incidence (ASIR), prevalence (ASPR), and deaths (ASDR) for asthma were accessed from the Global Burden of Disease 2021. Estimated annual percentage changes (EAPCs) and annual percent changes (APCs) were calculated to describe secular trends. The rate differences between the average rates of 2020-2021 and those of 2018-2019 represent the change in the burden of asthma before and during the COVID-19 pandemic.

RESULTS

In 2021, the global ASIR, ASPR, and ASDR of asthma were 516.70, 3340.12, and 5.2 per 100,000, with EAPCs of -1.04 %, -1.59 %, and -2.03 %, respectively. However, from 2018 to 2021, the global ASIR and ASPR of asthma showed a significant upward trend, with APCs of 0.41 % (95 % CI: 0.11 %-0.86 %) and 0.28 % (95 % CI: 0.04 %-0.69 %), respectively. During the COVID-19 pandemic, the global ASIR and ASPR increased significantly (rate differences were 5.26 and 23.10 per 100,000, respectively), especially in the high SDI regions (rate differences were 16.28 and 51.05 per 100,000, respectively), and among children aged under 5 (rate differences were 12.73 and 82.09 per 100,000, respectively).

CONCLUSION

During the COVID-19 pandemic period in 2020-2021, the incidence and prevalence of asthma have exhibited an upward trend globally, especially in high SDI regions and among children under 5 years old. This necessitates increased attention and intervention.

Global, regional, and national burdens of ischemic heart disease in the older adults aged 60-89 years: a systematic analysis for the Global Burden of Disease Study 2019

Background

Ischemic heart disease (IHD) places a heavy burden on individual and public health. Nevertheless, comprehensive assessments of the burden of IHD in the elderly are absent. It is imperative to update the burden of IHD in older adults and predict the trends.

Methods

The absolute numbers and age-standardized rates (ASRs) of prevalence, mortality, and disability-adjusted life-years (DALYs) for IHD among people aged 60-89 years from 1990 to 2019 were analyzed based on the Global Burden of Disease Study 2019 (GBD 2019). Joinpoint regression analysis was utilized to evaluate the epidemiologic trend of IHD in the elderly from 1990 to 2019. Bayesian age-period-cohort model was used to predict the burden of IHD among the elderly from 2020 to 2034.

Results

Age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized DALY rate (ASDR), and age-standardized mortality rate (ASMR) of IHD in older adults have declined slightly over the past 30 years. In 2019, the ASPR, ASIR, ASDR, and ASMR among the elderly with IHD were 14,280.53 (95% UI, 12,301.34-16,610.6), 1,445.21 (1,142-1,793.58), 11,225.74 (10,342.09-11,960.64), and 675.24 (614.21-721.75) per 100,000. The burden of IHD was significantly higher in older men than in women during the study period. In terms of socio-demographic index (SDI), countries and territories with lower SDI bore a more severe burden of IHD. The burden of IHD in the elderly varied considerably across countries. Uzbekistan had the largest increase in rates of prevalence, incidence, DALY, and mortality. The projections show a downward trend in DALY and mortality rates for IHD in older adults from 2020 to 2034, but incidence and prevalence will increase.

Conclusion

From 1990 to 2019, the worldwide burden of IHD among the elderly witnessed a decline. The IHD burden varied significantly across countries and territories. Policymakers should rationalize the allocation of health resources and implement effective prevention and treatment strategies to reduce the burden of IHD among the elderly in economically less developed countries and regions.

A comprehensive prognostic and immunological analysis of hexokinase domain containing protein-1 (HKDC1) in pan-cancer

Background

Currently, research on the role of hexokinase domain-containing protein-1 (HKDC1) in neoplasm metabolism remains sparse. This study seeks to conduct a thorough investigation of HKDC1's potential functions across thirty-three different tumor types, utilizing data obtained from The Cancer Genome Atlas (TCGA).

Method

We conducted a thorough data extraction from the TCGA database, subsequently employing R (version 4.2.2) and its associated software packages for detailed analysis. Our investigation centered on evaluating the differential expression and prognostic significance of HKDC1, while also examining its connections to tumor heterogeneity, mutation profiles, and RNA modifications. Furthermore, we analyzed the relationship between HKDC1 expression and tumor immunity utilizing the TIMER analysis approach.

Results

A comprehensive analysis of various tumor types has revealed that HKDC1 is significantly upregulated in many malignant tumors. Importantly, patients with elevated HKDC1 levels in their tumor tissues often experience poorer prognoses. The association between HKDC1 expression, immune cell infiltration, and the existence of immune checkpoints suggests a possible connection between the tumor microenvironment and HKDC1, alongside tumor advancement. Gene set enrichment analysis (GSEA) further substantiates the idea that HKDC1 may play a role in several critical pathways and biological processes associated with neoplasm. Additionally, the overexpression of HKDC1 is influenced by promoter methylation and alterations in DNA copy number amplification. Furthermore, in vitro experiments demonstrated that silencing HKDC1 resulted in a marked reduction in the proliferation, migration, and invasion capabilities of neoplasm cells.

Conclusion

Our initial pan-cancer analysis provided a comprehensive understanding of the oncogenic roles of HKDC1 across diverse cancer types. Moreover, HKDC1 has the potential to serve as a significant prognostic biomarker.

Association of cardiometabolic index and new-onset stroke in middle-aged and elderly Chinese: a national prospective cohort study

BACKGROUND AND AIMS

The Cardiometabolic Index (CMI), a novel metabolic marker, has been associated with various metabolic diseases in previous studies. However, its relationship with stroke risk remains underexplored. This study investigates the potential correlation between CMI and stroke risk among Chinese adults aged 45 and older.

METHODS

In the China Health and Retirement Longitudinal Study (CHARLS), participants were categorized into four groups based on CMI quartiles. The primary outcome was the incidence of new strokes during the follow-up period. A Cox proportional hazards model was used to analyze the relationship between CMI and stroke risk among the elderly. Kaplan-Meier survival analysis compared incidence rates across CMI levels, and restricted cubic splines (RCS) assessed potential non-linear relationships between CMI and stroke. Subgroup analyses verified the robustness of these findings.

RESULTS

The study included 6620 patients (45% male), with 417 new stroke cases reported over an average follow-up of seven years. Multivariate analysis indicated a significant association between increased CMI and higher stroke risk [HR, 1.132 (1.021-1.273), P = 0.003]. The RCS model revealed a nonlinear increase in stroke risk with rising CMI levels (P for nonlinearity = 0.006). No significant interactions were detected between CMI and the selected subgroups (all P values for interaction > 0.05).

CONCLUSION

CMI significantly correlates with stroke risk in the elderly Chinese population, suggesting its potential utility in early risk stratification.

Burden of malaria in the Comoros, 1990-2021: findings from the global burden of disease study 2021

Background

Malaria is a major public health issue in the Comoros. Analyzing the malaria burden will aid in designing prevention, control, and eradication strategies based on scientific evidence.

Methods

We retrieved data from the 2021 Global Burden of Disease (GBD) database to assess the malaria burden in the Comoros in 2021, stratified by sex and age. The indicators used to measure this burden included the absolute numbers and rates of incidence, prevalence, and mortality, as well as disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs). Decomposition analysis was used to quantify the contributions of demographic aging, population growth, and epidemiological changes to the malaria burden from 1990 to 2021. Joinpoint regression analysis was employed to examine temporal trends in the malaria burden over this period.

Results

In 2021, females, particularly those under 40, had a higher overall malaria burden than males, except for the age-standardized incidence rate (ASIR) and the age-standardized mortality rate (ASMR). Individuals under 30 years of age experienced approximately 52% of new malaria episodes, 68% of prevalent cases, and 62% of YLDs. Children under 5 and those aged 15 to 30 accounted for about 41% of malaria-related deaths, 54% of YLLs, and 53% of DALYs. Between 1990 and 2021, the malaria burden in the Comoros declined substantially, with age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and DALY rates (ASDR) decreasing by over 85%. Decomposition analysis indicated that epidemiological changes played a pivotal role in reducing disease burden. Over the past 32 years, the average annual percentage change (AAPC) in the ASPR was statistically significant at -7.60% (t = -2.68, p < 0.05). Moreover, the annual percentage change (APC) in ASIR and ASPR showed the most significant decline from 2012 to 2015, with APCs of -70.47% (t = -3.01, p < 0.05) and - 66.55% (t = -14.94, p < 0.05), respectively.

Conclusion

This study indicates that women under 40, school-aged children, and adults under 30 in the Comoros bear a higher malaria burden. Although current malaria control measures are effective, achieving a malaria-free status will require integrated strategies.

Diversity of intestinal microbiota and inflammatory cytokines after severe trauma

Accumulating evidence has reported that the intestinal microbiota could play important roles in the occurrence and progression of severe trauma. However, the hypothesized potential targeted intestinal microbiota to mediate and regulate the levels of inflammatory cytokines and promote rapid recovery of body after severe trauma remains unclear. This study was aimed to explore the changes and correlation of intestinal microbiota and inflammatory cytokines in rats with severe crush and fracture trauma. The controlled laboratory study design was used, and a crush and fracture severe trauma rat model was established. 16S rRNA high-throughput gene sequencing and ELISA were used to analyze the changes in intestinal microbiota and inflammatory cytokines within one week after trauma. The correlation between intestinal microbiota and inflammatory cytokines was also analyzed. Loss of overall diversity and expansion of intestinal microbiota in the rats due to severe trauma was observed. Specifically, there was a significant increase in the abundance of Muribaculaceae [LDA (Linear Discriminant Analysis)-value = 4.814, P = 0.014] after severe trauma, while Prevotella (LDA-value = 5.235, P = 0.020) and Alloprevotella (LDA-value = 4.443, P = 0.015) were slightly lower in the trauma group than in the control group. The levels of inflammatory cytokines (IL-1α, IL-6, IL-8 and TNF-α) in the trauma group decreased from the first day to the third day and continued to increase until one week after the trauma. Prevotellaceae_UCG_001 was correlated with TNF-a (R = 0.411, P = 0.033); Lactobacillus was negatively correlated with IL-6 (R = - 0.434, P = 0.024) and IL-1α (R = - 0.419, P = 0.030) and positively correlated with IL-8 (R = 0.391, P = 0.045); and Lachnospiraceae_NK4A136_group (R = - 0.559, P = 0.027) and Muribaculaceae (R = - 0.568, P = 0.024) were negatively correlated with IL-8. Severe trauma shows stress-like activities by negatively modulating intestinal microbiota and affecting certain inflammatory cytokines contributing to host health, which implies that the regulation of potentially targeted intestinal microbiota, and further mediating and maintaining the homeostasis of inflammatory cytokines, is expected to promote the accelerating recovery of the body after severe trauma.

Causal associations of frailty and type 2 diabetes mellitus: A bidirectional Mendelian randomization study

Type 2 diabetes mellitus (T2DM) is a common metabolic disease that can lead to a wide range of complications and impose a significant economic burden to society. Frailty is a disease associated with the accumulation of health deficits that may affect the quality of life of T2DM patients. This Mendelian randomization (MR) study explores the bidirectional causality between T2DM and frailty. All the data was available online at the IEU OpenGWAS project for this study, with the original data for T2DM coming from the pooled statistics of 468,298 participants in the UK biobank, and for frailty from the pooled summary statistics of a total of 175,226 participants in the UK biobank and Swedish TwinGene. The populations were all of European ancestry. Inverse variance weighting (IVW) was the main analytical method for assessing the causal effects of exposure and outcome, in addition, we also complemented weighted median and MR-Egger methods. Heterogeneity tests were performed with Cochran Q statistic and I2 statistic, and horizontal pleiotropy tests were detected through an intercept term in the MR-Egger regression model and MR-PRESSO. A sensitivity analysis was further performed with the leave-one-out method to estimate the impact of individual genetic variants on the overall outcomes. At the gene level, we identified 63 single nucleotide polymorphisms (SNPs) associated with T2DM and 14 SNPs associated with frailty for MR analysis. In the bidirectional MR analysis, the MR-Egger intercept and MR-PRESSO revealed no horizontal pleiotropy (P > .05), while significant heterogeneities were found by the heterogeneity test (P < .05). IVW results showed that frailty significantly increased the risk of T2DM (OR = 2.33, 95% confidence interval [CI] = 1.66-3.26, P < .001), and the similar result existed in the reverse MR analysis (OR = 1.04, 95% CI = 1.02-1.06, P < .001). A bidirectional causal relationship exists between T2DM and frailty, with intervention for either disease reducing the risk of the other.

The burden of cardiovascular disease in children in Asian countries (1990-2021): Systematic analysis and projection of the burden of disease

Background

Cardiovascular disease (CVD) is the leading global cause of death and health loss. The epidemiology and factors influencing CVD in children are unique, making it essential to first evaluate current and future trends to guide interventions and reduce the disease burden.

Objective

To analyze the incidence, mortality, and disability-adjusted life years (DALY) of CVD in children aged 0-14 from 1990 to 2021, and explore global disease burden, risk factors, and trends over the next 30 years. The study focuses on China, Japan, South Korea, India, and Singapore to aid in developing targeted prevention and treatment strategies.

Methods

Using data from the Global Burden of Disease Study (GBD) 1990-2021, we assessed age- and sex-specific morbidity, mortality, and DALY of CVD in Asian children aged 0-14 and computed the EAPC. We analyzed risk factors, specific causes, and projected prevalence trends through 2050 using the Bayesian Age-Period-Cohort (BAPC) model.

Results

From 1990 to 2021, CVD incidence among Asian children aged 0-14 decreased by 8.03 % (95 % UI:13.63 to -4.02). Mortality saw a significant drop of 67.98 % (95 % UI:73.73 to -62.23), with the greatest decline in children aged 2-4, and the highest death rate in those under 1 year. Disability and mortality patterns were similar across gender, age, etiology, and overall trends. In 2021, South Asia had the highest rates of morbidity, mortality, and disability. Rates varied significantly, with Mongolia exhibiting the highest rate and Cyprus the lowest, showing a sixfold difference. Rheumatic heart disease (RHD) and intracerebral hemorrhage were the most critical diseases needed attention. Abnormal temperatures were identified as a risk factor associated with CVD outcomes in children. The burden of CVD is projected to increase in various regions and countries across Asia.

Conclusion

The burden of CVD continues to challenge children aged 0-14 in Asia. Enhancing our understanding of pediatric CVD epidemiology, addressing risk factors, and reinforcing prevention and control measures are essential for reducing this burden.

Racial and regional disparities in the risk of noncommunicable disease between sub-Saharan black and European white patients

OBJECTIVES

Greater vulnerability of Black vs. White individuals to cardiovascular disease (CVD) and chronic kidney disease (CKD) is well charted in the United States, but studies involving sub-Saharan blacks are scarce.

METHODS

Baseline data (2021-2024) were collected in 168 sub-Saharan Blacks and 93 European Whites in an ongoing clinical trial (NCT04299529), using standardized patient selection criteria. Data included clinical and biochemical risk factors, ECG and echocardiographic traits, Framingham CVD risk, CKD grades (KDIGO 2024), self-assessed symptoms (WHO questionnaire), and urinary proteomic profiles predictive of left ventricular dysfunction (LVD) and CKD, HF1, and CKD273, respectively. Racial comparisons rested on unadjusted and multivariable-adjusted analyses.

RESULTS

Despite being younger (60.4 vs. 68.3 years), blacks had a worse risk profile, as evidenced by higher diabetes prevalence, higher BMI, faster heart rate, unfavourable serum cholesterol fractions, lower estimated glomerular filtration rate, microalbuminuria, and sedentary lifestyle. This resulted in blacks having higher 10-year CVD risk, higher heart age (index of vascular ageing with chronological age as reference), and a worse CKD grades. In both races, CKD273 increased with CKD grade, but CKD273 and HF1 were not different by race. These observations were robust in subgroup and adjusted analyses.

CONCLUSION

This study did not differentiate host (genetic, molecular, and pathogenic) from environmental drivers of disease. Nonetheless, the findings call for a multipronged and comprehensive implementation of innovative health policies in sub-Saharan countries. Education, research, empowerment of stakeholders, and international learned societies connecting experts from a wide array of disciplines should vigorously sustain this effort.

Global, Regional, and National Disease Burden and Prediction Analysis of Colorectal Cancer Attributable to Tobacco, Alcohol, and Obesity From 1990 to 2030

Background

Colorectal cancer (CRC) ranks among the highest in incidence and mortality rates globally. A significant portion of Colorectal cancer cases and deaths can be attributed to modifiable risk factors, with smoking, alcohol use, and high body mass index (BMI) being the three most prominent. However, the impact of these risk factors on Colorectal cancer across regions, genders, and age groups remains insufficiently characterized.

Methods

Utilizing data from the Global Burden of Disease (GBD) study 2019, restrictive cubic splines (RCS) and quantile regression analyses are applied to explore the relationship between the Socio-Demographic Index (SDI) and ASMR or ASDR. Additionally, gender differences, changes across different SDI levels, and age group trends in smoking, alcohol use, and high BMI over the 30-year period are analyzed. The Bayesian age-period-cohort (BAPC) model is employed to predict mortality trends from 2020 to 2030, aiming to explore the epidemiological and sociodemographic transitions in the Colorectal cancer disease burden attributed to smoking, alcohol use, and high BMI.

Results

In 2019, the number of colorectal cancer deaths globally attributable to risk factors as smoking, alcohol consumption, and obesity increased to 142,931, 52,495, and 85,882 cases respectively, collectively accounting for approximately one-third of all Colorectal cancer-related deaths. Notably, there is an upward trend in early-onset Colorectal cancer mortality associated with these factors.

Discussion

To reduce the burden of Colorectal cancer, it is recommended to enhance health education, promote smoking cessation and alcohol moderation, and increase the coverage and participation in Colorectal cancer screening, which are crucial for lowering Colorectal cancer mortality rates. These findings are vital for the development of public health policies and intervention measures to reduce the global disease burden. They provide guidance for Colorectal cancer prevention across different regions, genders, and age groups worldwide.

Advances in modeling periodontal host-microbe interactions: insights from organotypic and organ-on-chip systems

Periodontal disease, a chronic inflammatory condition affecting the supporting structures of teeth, is driven by an imbalanced interaction between the periodontal microbiota and the host inflammatory response. Beyond its local impact, periodontal disease is associated with systemic conditions such as diabetes mellitus, cardiovascular disease, and inflammatory bowel disease, emphasizing the importance of understanding its mechanisms. Traditional pre-clinical models, such as monolayer cultures and animal studies, have provided foundational insights but are limited by their physiological relevance and ethical concerns. Recent advancements in tissue engineering and microfluidic technologies have led to the development of three-dimensional (3D) organotypic culture models and organ-on-chip systems that more closely mimic native tissue microenvironments. This review provides an overview of the evolution of methods to study periodontal host-microbe interactions, from simple 2D monolayer cultures to complex 3D organotypic and microfluidic organ-on-chip (OoC) models. We discuss various fabrication strategies, host-microbe co-culture techniques, and methods for evaluating outcomes in these advanced models. Additionally, we highlight insights gained from gut-on-chip platforms and their potential applications in periodontal research and understanding oral-systemic links of periodontal disease. Through a comprehensive overview of current advancements and future directions, this review provides insights on the transformative potential of OoC technology in periodontal research, offering new avenues for studying disease mechanisms and developing therapeutic strategies.

Lepalvir: Biomaterial efficacy and safety for patients with acute ischemic stroke

Lepalvir, derived from inflamed rabbit skin inoculated with vaccinia virus, has potential neuroprotective and anti-inflammatory effects. We conducted a phase II, multicenter, randomized, blind, placebo-controlled trial investigating the efficacy and safety of Lepalvir for acute ischemic stroke (AIS). Participants aged 18-80 years with AIS in the anterior circulation and a National Institutes of Health Stroke Scale (NIHSS) score of 4-24 within 48 h post-onset were randomized to receive high-dose (192U), low-dose (96U) Lepalvir, or saline placebo for 14 days. The primary outcome was the proportion of patients achieving a modified Rankin Scale (mRS) score ≤ 1 at day 90 (D90) post-randomization. Among 238 patients, no significant difference in mRS score at D90 was observed across groups, yet a higher percentage in the high-dose group achieved a mRS score ≤ 1 at D90, compared to the control and low-dose group. No significant safety concerns were noted. While functional improvement was not significantly different at D90, Lepalvir showed a favorable safety profile and potential at the higher dosage, warranting further phase III investigation.

Discrepancies in neglected tropical diseases burden estimates in China: comparative study of real-world data and Global Burden of Disease 2021 data (2004-2020)

OBJECTIVES

To assess the discrepancies between real-world data and the Global Burden of Disease (GBD) 2021 estimates for six neglected tropical diseases in China. Additionally, to evaluate the applicability of the GBD model within the Chinese context and to assess the effectiveness of China's historical prevention and control policies for neglected tropical diseases.

DESIGN

Comparative study of real-world data and GBD 2021 (2004-2020).

MAIN OUTCOME MEASURES

Disability adjusted life years (DALYs).

METHODS

DALYs based on reported data for leprosy, echinococcosis, schistosomiasis, visceral leishmaniasis, dengue, and rabies from 2004 to 2020 were compared with the estimated DALYs from the GBD 2021 database. Additionally, we combined and analysed China's historical policies on prevention and control of neglected tropical diseases with real-world DALYs.

DATA SOURCES

Reported data were sourced from the Chinese Center for Disease Control and Prevention's China Public Health Science data centre and related reports. Data for GBD 2021 and GBD 2019 were obtained from GBD databases. These data included all of China's 31 provinces (including autonomous regions and municipalities) and the Xinjiang Production and Construction Corps.

RESULTS

The total real-world DALYs based on reported data of six neglected tropical diseases decreased from 260 000 person years in 2004 to 19 000 person years in 2020, with a 93% (241 000/260 000 person years) reduction. The 17 year average real-world DALYs from 2004 to 2020 versus the GBD 2021 estimates for the same period were 42 v 500 for leprosy, 960 v 11 000 for echinococcosis, 64 000 v 98 000 for schistosomiasis, 56 v 16 000 for visceral leishmaniasis, 190 v 780 for dengue, and 47 000 v 67 000 for rabies. The ratios of the GBD estimates to the real-world DALYs for the six neglected tropical diseases were 17 for leprosy, 11 for echinococcosis, 1.5 for schistosomiasis, 280 for visceral leishmaniasis, 4.2 for dengue, and 1.4 for rabies.

CONCLUSIONS

The findings indicate that reliance solely on global estimates, such as those of the GBD, may not sufficiently capture the dynamics of neglected tropical diseases in China. Integrating local epidemiological data into global health assessments is crucial to develop accurate and effective public health policies. This study highlights the importance of continuously updating and improving data collection and surveillance methods to adapt public health strategies to evolving disease patterns.

Trends and projections of hypertensive heart disease burden in China: a comprehensive analysis from 1990 to 2030

BACKGROUND

Hypertensive heart disease (HHD) is a significant public health concern in China. We intend to provide an updated estimate of the burden of HHD in China between 1990 and 2030.

METHODS

HHD prevalence, mortality, and disability-adjusted life years (DALYs) data were obtained from Global Burden of Disease (GBD) 2019 databases. Temporal trends of HHD from 1990 to 2019 were analyzed using Joinpoint regression models, and projections through 2030 were estimated by Bayesian age-period-cohort model.

RESULTS

In 2020, an estimated 334,695 newly prevalent cases and 13,196 deaths due to HHD occurred in China. From 1990 to 2019, age-standardized rate of prevalence (ASPR), mortality (ASMR) and DALYs (ASDR) showed a decreasing trend. The behavior-related risk, diet risk and excessive BMI were the most common reasons of death in HHD. According to our prediction, ASMRs and ASDRs will continue to decrease from 2020 to 2030. However, ASPRs will have a moderate rise.

CONCLUSION

HHD continues to pose a significant threat to public health in China. To achieve the Healthy China 2030 objective, a tailored approach involving comprehensive strategies is essential. These strategies should include, but are not limited to, enhancing public awareness about hypertension through educational campaigns, improving access to healthcare services for early diagnosis and treatment, implementing policies to promote healthy lifestyles, such as regular physical activity and a balanced diet, and strengthening the surveillance and monitoring systems to track the prevalence and impact of HHD over time.

Stakeholder Perspectives on Community Participation and Ownership in Community Mental Health Policy and Services: Mixed Methods Study in Ghana

Addressing the mental healthcare needs of the population at the Primary Health Care (PHC) level has gained global consensus as a key strategy to realising the mental health targets of the United Nations (UN) Sustainable Development Goals (SDGs), especially SDG3. This research explored the question 'What is the nature and level of community participation and ownership in the development and integration of mental healthcare service provision at the PHC, especially at Community Health Planning and Services Centre (CHPS) level(s) in Ghana?'. A cross-sectional study that adopted concurrent mixed quantitative and qualitative research methods was undertaken to explore and answer the question. The quantitative data of the study was collected through a survey questionnaire. Key informant interviews and focus group discussions were used to collect the qualitative data. Thematic analysis with the use of NVivo 12 was applied for the qualitative field data and Stata SE16 used for quantitative data. Data triangulation strategy was used to report both the qualitative and quantitative data sets. The study findings show that community participation and ownership was low, requiring more concerted efforts to engender that into mental health care policy and services development and implementation to realise the seamless integration of mental healthcare into general healthcare at the PHC level. Community participation and ownership will substantially enhance the (re-)organisation and resourcing of mental health services in Ghana to make them more responsive and inclusive.

Impact of the National Essential Public Health Service Package on Blood Pressure Control in Chinese People With Hypertension: Retrospective Population-Based Longitudinal Study

Background

The National Essential Public Health Service Package (NEPHSP) was launched in 2009 to tackle poor blood pressure control in Chinese people with hypertension; however, it's effect is still unclear.

Objective

In a retrospective population-based longitudinal study, we aimed to evaluate effect of the NEPHSP on blood pressure control.

Methods

A total of 516,777 patients registered in the NEPHSP were included. The blood pressure control data were assessed based on the Residence Health Record System dataset. We longitudinally evaluated the effects of the NEPHSP on blood pressure control by analyzing changes in blood pressure at quarterly follow-ups. Both the degree and trend of the blood pressure changes were analyzed. We conducted stratified analysis to explore effects of the NEPHSP on blood pressure control among subgroups of participants with specific characteristics.

Results

The mean baseline systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 147.12 (SD 19.88) mm Hg and 85.11 (SD 11.79) mm Hg, respectively. The control rates of baseline SBP and DBP were 39.79% (205,630/516,777) and 69.21% (357,685/516,777). Compared to baseline, the mean SBP decreased in each quarter by 5.06 mm Hg (95% CI -5.11 to -5.00; P<.001), 6.69 mm Hg (95% CI; -6.74 to -6.63; P<.001), 10.30 mm Hg (95% CI -10.34 to -10.23; P<.001), and 6.63 mm Hg (95% CI -6.68 to -6.57; P<.001). The SBP control rates increased in each quarter to 53.12% (274,493/516,777; β coefficient=0.60, 95% CI 0.59-0.61; P<.001), 56.61% (292,537/516,777; β coefficient=0.76, 95% CI 0.75-0.77; P<.001), 63.4% (327,648/516,777; β coefficient=1.08, 95% CI 1.07-1.09; P<.001), and 55.09% (284,711/516,777; β coefficient=0.69, 95% CI 0.68-0.70; P<.001). Compared to baseline, the mean DBP decreased in each quarter by 1.75 mm Hg (95% CI -1.79 to -1.72; P<.001), 2.64 mm Hg (95% CI -2.68 to -2.61; P<.001), 4.20 mm Hg (95% CI -4.23 to -4.16; P<.001), and 2.64 mm Hg (95% CI -2.68 to -2.61; P<.001). DBP control rates increased in each quarter to 78.11% (403,641/516,777; β coefficient=0.52, 95% CI 0.51-0.53; P<.001), 80.32% (415,062/516,777; β coefficient=0.67, 95% CI 0.66-0.68; P<.001), 83.17% (429,829/516,777; β coefficient=0.89, 95% CI 0.88-0.90; P<.001), and 79.47% (410,662/516,777; β coefficient=0.61, 95% CI 0.60-0.62; P<.001). The older age group had a larger decrease in their mean SBP (β coefficient=0.87, 95% CI 0.85-0.90; P<.001) and a larger increase in SBP control rates (β coefficient=0.054, 95% CI 0.051-0.058; P<.001). The participants with cardiovascular disease (CVD) had a smaller decrease in their mean SBP (β coefficient=-0.38, 95% CI -0.41 to -0.35; P<.001) and smaller increase in SBP control rates (β coefficient=-0.041, 95% CI -0.045 to -0.037; P<.001) compared to the blood pressure of participants without CVD.

Conclusions

The NEPHSP was effective in improving blood pressure control of Chinese people with hypertension. Blood pressure control of older individuals and those with CVD need to be intensified.

The global magnitude and temporal trend of hypertensive heart disease burden attributable to high sodium intake from 1990 to 2021

BACKGROUND

The relationship between high sodium intake (HSI) and hypertensive heart disease (HHD) has been confirmed. However, notable regional disparities exist in implementing effective measures to control sodium intake. This study was carried out to estimate the spatiotemporal trends in the burden of HHD attributable to HSI.

METHODS

Data obtained from the Global Burden of Disease Study 2021 were analyzed, considering factors such as age, gender, year, and region. Joinpoint regression analysis was applied to investigate the temporal trends in the HHD burden resulting from HSI over the past 32 years.

RESULTS

From 1990 to 2021, the global cases of HHD increased significantly annually. The age-standardized prevalence rates showed a slow gradual increase. However, both the age-standardized death and disability-adjusted life-year (DALY) rates decreased. Specifically, HSI was responsible for 29.2% of total HHD deaths and 30.4% of total DALYs in 1990 but only 22.8% of total HHD deaths and 23.4% of total DALYs in 2021. A greater burden from HSI exposure was observed among men, older adults and people living in middle and low sociodemographic index (SDI) countries and regions. Moreover, over the 32-year period, Guam and Colombia demonstrated the highest reduction in age-standardized death and DALY rates, respectively.

CONCLUSION

Globally, the age-standardized burden of HHD due to HSI has demonstrated a decline. Although some areas have effectively managed this issue, it remains a challenge in specific areas. Hence, it is crucial to examine and implement the strategies adopted by successful nations to further mitigate this burden.

Incidence, case fatality, and functional outcome of intracerebral haemorrhage, according to age, sex, and country income level: a systematic review and meta-analysis

Background

Intracerebral haemorrhage (ICH) accounts for approximately 28% of all strokes worldwide. ICH has a high case fatality, and only few survivors recover to independent living. Over the past decades, demographic changes, and changes in prevalence and management of risk factors may have influenced incidence. Widespread implementation of stroke units and improved care in general may have affected case fatality and outcome. We aimed to update the evidence on incidence, case fatality, and functional outcome of ICH, according to age, sex, and country income level.

Methods

We systematically searched PubMed and Embase from 2008 to April 2023 for prospective population-based studies on incidence, case fatality, or functional outcome of first-ever ICH. We excluded studies in which less than 80% of cases was confirmed with imaging or autopsy. Quality of the studies was assessed based on the used case finding methods. We used inverse variance-based random-effects meta-analyses to pool the crude incidence, case fatality at 1 month, and the percentage of patients with good functional outcome after 3, 6, or 12 months, as defined by the authors of the individual studies. Time trends were assessed using weighted linear meta-regression. Funnel plots were constructed to study publication bias. The review was registered on PROSPERO (CRD42023413314).

Findings

We identified 70 eligible studies, describing 19,470 ICH patients from 26 different countries. Of these, 62 studies reported on crude incidence, 41 on case fatality, and 10 on functional outcome. Overall crude incidence was 29.2 per 100,000 person-years (95% CI 23.3-36.4; I2 = 100%). Incidence was lower in women than in men and increased with age. Incidence was highest in lower-middle income countries, followed by high and upper-middle income countries. Case fatality at 1 month was 35.5% (95% CI 32.3-38.9; I2 = 90%). The percentage of patients with good functional outcome (mRS 0-2 in nine studies, mRS 0-3 in one) after 3-12 months was 31.2% (95% CI 24.7-38.6; I2 = 76%). We found no time trends in incidence, case fatality, or functional outcome.

Interpretation

Our results demonstrate the persistently high burden and devastating consequences of ICH, stressing the need for better preventive strategies and acute treatments.

Funding

None.

The Global Burden of Polycystic Ovary Syndrome in Women of Reproductive Age: Findings from the GBD 2019 Study

Purpose

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder and the primary cause of anovulatory infertility among women aged 15-49 years. Despite its significance, it has been largely overlooked in global health discussions, with persistently high prevalence and incidence rates. This public health challenge necessitates attention both domestically and internationally. Between 1990 and 2017, the age-standardized prevalence of female infertility and associated DALYs rose by 0.70% and 0.396%, respectively. Economically, addressing women's endocrine and metabolic health can bolster the overall well-being of the female population using existing resources. For judicious utilization of available resources, data regarding the burden of PCOS is pivotal for comprehending women's health status and for devising and refining policies related to women's endocrine health. Consequently, this study scrutinizes and assesses the age-standardized PCOS incidence rate and DALYs for 1990 and 2019, traces the trends of these metrics from 1990 to 2019, examines the composition of various populations and diseases, and offers international comparisons. This aims to furnish critical insights for future health policy development and adjustments in the realm of female endocrine and metabolic health.

Patients and Methods

This study employed the Global Health Data Exchange to obtain PCOS burden data based on GBD 2019. It collected incidence, DALYs, and age-standardized rates (ASRs) from 1990 to 2019 across global, regional, national, and SDI quintile levels, spanning 21 regions and 204 countries. To analyze trends, ASRs and estimated annual percentage changes (EAPCs) were calculated, with standardization crucial for comparability. EAPC was derived using a generalized linear model with a Gaussian distribution.

Results

The global burden of PCOS increased significantly from 1990 to 2019, with estimated annual percentage change (EAPCs) of 0.56 for incidence and 0.83 for DALYs. The highest incidence rates were observed in the High-income Asia Pacific region, particularly in Japan and New Zealand, while the lowest rates were in Central Europe. Equatorial Guinea and Qatar exhibited the most pronounced increases in incidence and DALYs, attributed to urbanization and enhanced healthcare infrastructure. The incidence and DALYs of PCOS showed variation across SDI quintiles, with the greatest burden found in the middle-SDI quintile. Women between the ages of 20-29 years had the highest incidence and DALYs, emphasizing the importance of targeted interventions during this critical period. In contrast, regions with lower SDI levels, such as Central and Eastern Europe, reported the lowest burdens of PCOS, likely due to underdiagnosis and limited healthcare resources.

Conclusion

From 1990 to 2019, there was a significant increase in the global burden of PCOS, with variations seen across regions and SDI quintiles. Countries such as Italy, Japan, New Zealand, and Australia had the highest burdens, while Central and Eastern Europe had the lowest. The age group most affected was women aged 20-29 years, emphasizing the necessity for targeted interventions.

A 32-year trend analysis of lower respiratory infections in children under 5: insights from the global burden of disease study 2021

Objectives

Lower respiratory infections are the most significant health threat to children under 5 years old, leading to the highest disease burden across all age groups. This study aims to provide an up-to-date assessment of the global burden of lower respiratory infections in children under 5 years of age.

Methods

This study utilizes data and methodologies from the Global Burden of Disease Study 2021 to analyze changes in the burden of lower respiratory infections from 1990 to 2021, focusing on incidence, mortality, and disability-adjusted life years. A jointpoint model is employed to calculate trends and the average annual percentage change in the disease burden among children under 5 years old over the period 1990-2021. Additionally, frontier analysis is used to visually depict the potential for burden reduction in each country or region based on their level of development.

Results

In 2021, the global burden of lower respiratory infections in children under 5 years old included 37,828,159 incidence cases, 501,909.50 deaths, and 44,779,174.70 disability-adjusted life years. From 1990 to 2021, the global burden of LRIs in this age group showed a marked decline. Incidence, mortality, and disability-adjusted life years decreased by 54.02, 37.57, and 39.49%, respectively. The average annual percent change for age-standardized incidence rate, age-standardized mortality rate, and age-standardized disability-adjusted life years rate were -3.35, -4.53%, and -4.52%, respectively. The disease burden was notably higher in children under 1 year old compared to those aged 2-4 years and the overall under-5 age group, with significant gender differences observed. Additionally, there was a strong negative correlation between the burden of lower respiratory infections in children under 5 and the socio-demographic index. Frontier analysis indicated that countries or regions with higher socio-demographic index values showed greater potential for reducing the burden.

Conclusion

The global burden of lower respiratory infections in children under 5 years old has declined significantly from 1990 to 2021. However, given the substantial disease burden, particularly in low-SDI countries, it is crucial to address risk factors and implement more effective interventions to further reduce the impact of lower respiratory infections on this vulnerable population.

The Global Burden and Trends of Legionella spp. Infection-Associated Diseases from 1990 to 2021: An Observational Study

BACKGROUND

Legionella infections are a major global health issue, yet there's limited research on their impact and trends. We aimed to systematically analyzed the long-term trends in Legionella spp. infection-associated diseases (LSIADs) burden from 1990 to 2021.

METHODS

Age-standardized disability-adjusted life years (ASR-DALYs) and age-standardized death rates (ASDRs) of LSIADs from 1990 to 2021 were accessed from the Global Burden of Disease (GBD) 2021, which utilized the Bayesian hierarchical meta-regression tool and the Cause of Death Ensemble model to estimate these metrics. Trends in disease burden across age, sex, region, and Socio-Demographic Index (SDI) levels were estimated using annual percentage changes (EAPCs) and annual percentage changes (APCs).

RESULTS

Globally, the ASR-DALYs and ASDRs for LSIADs in 2021 were 24.74 and 0.86 per 100,000, respectively, with the highest rates observed in regions with low SDI. From 1990 to 2021, while the overall burden of LSIADs showed a downward trend, the highest ASR-DALYs (101.85 per 100,000) and ASDRs (8.15 per 100,000) were observed in individuals over 70 years of age, accompanied by a corresponding increase in deaths (EAPCs = 0.17%, 95% CI: 0.09-0.26%). Furthermore, increases in ASR-DALYs and ASDRs for LSIADs were also noted among those aged 15-49 years (EAPCs = 0.43% and 0.57%, respectively) and those aged 50-69 years (EAPCs = 0.14% and 0.09%, respectively).

CONCLUSION

Higher disease burdens and increasing trends have been observed in specific age groups and regions, which require the implementation of water quality management plans, enhanced readiness of health facilities, and improved sanitation infrastructure.

The global, regional, and national patterns of change in the burden of bacterial pyoderma from 1990 to 2019 and the forecast for the next decade

Pyoderma, commonly known as impetigo, is a bacterial skin infection causing pus formation, prevalent globally, especially in resource-poor areas. It affects both children and adults, including those with conditions like diabetes. Despite its significant impact and economic burden, research on its global epidemiology is limited. This study aims to address this gap by analyzing pyoderma trends from 1990 to 2019 using GBD data. The study aims to analyze global trends in pyoderma epidemiology from 1990 to 2019 using GBD data. Specifically, it investigates Age-Standardized Incidence Rate (ASIR), Mortality Rate (ASMR), and Disability-Adjusted Life Years Rate (ASDR) across 204 countries. Additionally, it provides insights into demographic and socioeconomic factors influencing pyoderma prevalence. Furthermore, it forecasts pyoderma's development trends for the next decade to inform public health strategies. Data were sourced from the GBD 2019 database, comprising various sources such as censuses, surveys, and registries. Estimates for pyoderma incidence, mortality, and DALYs, along with their 95% uncertainty intervals (UI), were retrieved. The Sociodemographic Index (SDI) was used to assess socioeconomic status, and statistical calculations were performed using the WHO Health Equity Assessment Toolkit and R software (v4.3.2). From 1990 to 2019, the Age-Standardized Incidence Rate (ASIR) and Age-Standardized Mortality Rate (ASMR) of impetigo increased, while the Age-Standardized Disability-Adjusted Life Years Rate (ASDR) declined. Significant global geographical heterogeneity persists, closely associated with the Sociodemographic Index (SDI). Children under 5 and the elderly are particularly at risk, with lower SDI nations bearing higher burdens. Population growth and aging contribute to this rise, with disparities in impetigo trends persisting among countries and regions with varying SDI levels, expected to continue until 2030. Pyoderma exhibits significant heterogeneity across age, gender, and geography, with pronounced disparities evident in underdeveloped regions or countries. Therefore, prioritizing policy formulation and implementing tailored prevention and treatment strategies for high-risk populations are imperative to alleviate the disease burden effectively. Such targeted approaches are crucial in addressing the global impact of pyoderma.

Changes in Cardiovascular Health, Genetic Risk, and Cardiometabolic Diseases: Evidence From a Large-Scale Cohort Study

BACKGROUND

Evidence has firmly established the association between superior cardiovascular health (CVH) and reduced susceptibility to cardiometabolic diseases (CMDs). In reality, CVH experiences dynamic fluctuations throughout individuals' lifespans. However, the association between changes in CVH and the impact on CMDs among individuals with different genetic risks remains unclear.

METHODS AND RESULTS

Based on a large-scale community-based cohort, we evaluated the association between baseline CVH (n=289 069), changes in CVH between 2 examinations (n=37 702), and the risk of CMDs and its individual components (ischemic heart disease, type 2 diabetes, and stroke) using Cox proportional hazards models, leveraging detailed repeatedly assessed lifestyle information and genetic data. Estimations were also stratified by age groups (≤65 years, >65 years) and genetic risk groups, defined by the tertiles of the polygenic risk score for CMDs components. Population-attributable fractions and relative risk reduction were calculated to assess the potential benefits of improvement in CVH in preventing CMDs. For participants whose baseline CVH ranged from ideal to poor, an ascending trend was exhibited in the risk of CMDs overall, as well as its individual components. Based on a median of 5.4-year follow-up after the reassessment of CVH, individuals with an enhancement from intermediate to ideal CVH demonstrated a 36% lower risk of CMDs (hazard ratio [HR], 0.64 [95% CI, 0.53-0.77]; P<0.001), compared with those with constantly intermediate CVH, while those deteriorating from intermediate to poor faced a 44% higher risk (HR, 1.44 [95% CI, 1.17-1.78]; P<0.001). Interestingly, changes in CVH exerted a more pronounced impact on CMD risk within younger populations (≤65 years) (Pinteraction=0.006). Notably, among participants with a high genetic risk of ischemic heart disease, those who improved their CVH status from intermediate to ideal exhibited a 50% lower risk of ischemic heart disease (HR, 0.50 [95% CI, 0.34-0.74]; P<0.001), compared with those with constantly intermediate CVH.

CONCLUSIONS

Individuals with better baseline CVH exhibited a lower risk of CMDs. Enhancement in CVH significantly mitigates the risk of CMDs, especially when efforts are made before the age of 65 years and within high genetic risk groups. These findings underscore the importance of interventions aimed at promoting cardiovascular well-being across entire populations, offering valuable insights for targeted preventive strategies and healthcare interventions.

Long-term trends in the burden of pulmonary arterial hypertension in China and worldwide: new insights based on GBD 2021

Background

Pulmonary arterial hypertension (PAH) poses a significant health challenge globally, with China experiencing a notable increase in its burden. Understanding the trends and factors contributing to PAH is crucial for developing effective public health strategies.

Methods

This study utilized data from the Global Burden of Disease (GBD) 2021 database to estimate the burden of PAH in China and worldwide from 1990 to 2021. A Bayesian age-period-cohort (BAPC) model was employed to analyze differences in PAH burden across age, gender, and time periods, and to project global epidemiological trends until 2036.

Results

From 1990 to 2021, the incidence and prevalence of PAH in China increased by 80.59% and 86.74%, respectively. The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) showed an annual percentage change (AAPC) of -0.07% and 0.25%, respectively. Conversely, the age-standardized disability-adjusted life year (DALY) rate and age-standardized mortality rate (ASMR) have been declining since 1990, with AAPC of -1.90% and -1.26%, respectively. Females and the 50-70 years age group experienced a higher PAH burden compared to males. Projections indicate that ASPR, ASMR, and age-standardized death rate (ASDR) will stabilize with minimal variation over the next decade.

Discussion

The findings highlight the age-related burden of PAH in China, particularly affecting older populations and women. The projected stabilization of PAH metrics over the next decade underscores the need for continued monitoring and targeted interventions. This study's comprehensive analysis of PAH burden over three decades provides valuable insights for policymakers and healthcare providers, necessitating concerted efforts to address this critical health issue.

Global trends in melanoma burden: A comprehensive analysis from the Global Burden of Disease Study, 1990-2021

BACKGROUND

Melanoma, a significant global health concern, has shown evolving epidemiologic trends. Accurate estimation of melanoma's burden is essential for public health strategies and interventions.

OBJECTIVES

This study aims to estimate the incidence, mortality, and disability-adjusted life years for melanoma, stratified by region, gender, and age group, from 1990 to 2021.

METHODS

Using data from the Global Burden of Disease 2021, we analyzed melanoma incidence, mortality rates, and disability-adjusted life years in 204 countries from 1990 to 2021. These metrics were age-standardized and stratified by age, sex, Socio-Demographic Index, region, and country. The estimated annual percentage change was calculated to track temporal trends.

RESULTS

Our study shows a substantial global increase in melanoma incidence, with significant disparities between genders and age groups. Higher Socio-Demographic Index regions had increased incidence rates, while global mortality declined, likely due to improved detection and treatment.

LIMITATIONS

The reliance on estimates and models may introduce bias due to variability in disease definitions, diagnostic criteria, and data collection methods.

CONCLUSION

This study underscores the dynamic nature of melanoma's burden and the need for targeted, age-specific, and gender-specific interventions. Continued research is essential to address the growing challenges posed by melanoma.

The global, regional, and national patterns of change in the burden of nonmalignant upper gastrointestinal diseases from 1990 to 2019 and the forecast for the next decade

BACKGROUND

Nonmalignant upper gastrointestinal diseases, including peptic ulcer disease (PUD), gastritis and duodenitis (GD), and gastroesophageal reflux disease (GERD), significantly challenge global healthcare. These conditions not only impact patient health but also highlight socioeconomic development issues and healthcare system accessibility and efficiency. Utilizing the Global Burden of Disease database, this study aims to comprehensively assess the global burden of PUD, GD, and GERD, examining their association with the sociodemographic index (SDI).

METHODS

Employing data from the Global Burden of Disease 2019 database, this study analyzed the disability-adjusted life years for PUD, GD, and GERD. We integrated the SDI with the inequality slope index and concentration index for an international health inequality analysis, assessing disparities in the burden of these nonmalignant upper gastrointestinal diseases. Decomposition analysis was conducted to determine the effects of population growth, aging, and epidemiological change on disease burden. Frontier analysis was performed to identify potential improvement areas and disparities among countries by development status. Disease time trends were depicted using a Joinpoint regression model, and the Bayesian age-period-cohort model projected the disease burden up to 2030.

RESULTS

Between 1990 and 2019, the age-standardized disability-adjusted life years rates for nonmalignant upper gastrointestinal diseases declined. However, global geographic heterogeneity remained evident and closely linked to the SDI. Notably, low-SDI countries experienced higher disease burdens. Population growth and aging emerged as principal contributors to the increasing disease burden. Despite development levels, many countries have considerable potential for reducing the burden of these diseases. Furthermore, significant variations in the time trends of nonmalignant upper gastrointestinal diseases were observed among countries and regions with different SDI levels, a pattern expected to continue through 2030.

CONCLUSION

Nonmalignant upper gastrointestinal diseases demonstrate notable heterogeneity across age, sex, and geography, with the disparities most marked in underdeveloped regions or countries. Consequently, it is imperative to focus research on policy development and to enact prevention and treatment strategies tailored to high-risk groups. This targeted approach is essential for effectively mitigating the disease burden.

Understanding the stroke burden in Saudi Arabia: Trends from 1990 to 2019 and forecasting through time series analysis

OBJECTIVES

To describe age-standardized incidence and disability-adjusted life years (DALYs) of ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) in the Kingdom of Saudi Arabia (KSA) from 1990 to 2019 and forecast these variables using the Global Burden of Diseases (GBD) data over the next years (2020-2030).

METHODS

Poisson regression models were employed to identify significant changes in incidence rate ratios (IRRs) and DALY rates for different stroke types. For time series models, the autoregressive integrated moving average (ARIMA) and exponential smoothing state space (ETS) models were used for forecasting.

RESULTS

The study demonstrated an increasing trend in the age-standardized incidence rate per 100,000 different types of strokes over the last 30 years, with a slight decrease in ICH and SAH types in 2015, followed by a continued increase. The prediction models indicated a sustained increase in the 3 types of strokes, accompanied by a decrease in DALYs. As regards DALYs, the trend for IS and ICH has been slowly and steadily increasing; however, there will be a modest decrease in DALYs rates for SAH during the next decade.

CONCLUSION

Stroke rates in KSA have increased over 3 decades, mainly among women and older individuals, and have a slow sustained increase over the forecasted period (2020-2030); thus, proactive strategies and healthcare interventions are required.

Utilizing intricate care networks: An ethnography of patients and families navigating palliative care in a resource-limited setting

BACKGROUND

The increase in non-communicable disease burdens and aging populations has led to a rise in the need for palliative care across settings. In resource-limited settings such as Indonesia, however, notably in rural areas, there is a lack of professional palliative care. Little is known about specific palliative care navigation, as previous studies have mostly focused on cancer care navigation. A locally tailored approach is crucial.

AIM

To explore how patients and families navigate palliative care and the problems they experience.

DESIGN

An ethnographic study using in-depth interviews and observations, analyzed using reflexive thematic analysis.

SETTING/PARTICIPANTS

Interviews with 49 participants (patients, family caregivers, and health professionals) and 12 patient-family unit observations in Banyumas, Indonesia.

THE ANALYSIS

Patients and families navigated palliative care through different strategies: (1) helping themselves, (2) utilizing complementary and alternative medicine, (3) avoiding discussing psychological issues, (4) mobilizing a compassionate and advocating community, and (5) seeking spiritual care through religious practices.

CONCLUSIONS

Our participants used intricate care networks despite limited resources in navigating palliative care. Several problems were rooted in barriers in the healthcare system and a lack of palliative care awareness among the general public. Local primary health centers could be potential palliative care leaders by building upon pre-existing programs and involving community health volunteers. Cultivating a shared philosophy within the community could strengthen care collaboration and support.

Dose-Response Effects of MittEcho, a Measurement Feedback System, in an Indicated Mental Health Intervention for Children in Municipal and School Services in Norway

Including routine client feedback can increase the effectiveness of mental health interventions for children, especially when implemented as intended. Rate of implementation, or dose, of such feedback interventions has been shown to moderate results in some studies. Variation in implementation and use of client feedback may also contribute to the mixed results observed within the feedback literature. This study evaluates dose-response associations of client feedback using a novel Measurement Feedback System (MFS) within an indicated group intervention. The primary aim was to determine whether the rate of MFS implementation predicts symptom reduction in anxiety and depression among school-aged children. The secondary aim was to assess whether the rate of MFS implementation influences children's satisfaction with the group intervention or their dropout rates. Data were collected via a randomized factorial study (clinicaltrials.gov NCT04263558) across 58 primary schools in Norway. Children aged 8 to 12 years (N = 701) participated in a group-based, transdiagnostic intervention targeting elevated symptoms of anxiety or depression. Half of the child groups also received the feedback intervention using the MittEcho MFS. Group leaders (N = 83), recruited locally, facilitated the interventions. The MFS dose was measured using the Implementation Index, which combines the use of MFS by both children and providers (group leaders) into a single dose variable. Results showed no significant additional effect of dose of MFS on change in depression or anxiety scores, on user satisfaction with the intervention or on intervention dropout. The discussion addresses potential reasons for these non-significant findings and implications for MFS implementation in preventive, group-based interventions in school settings.