Age-Period-Cohort Analysis of Type-Specific Stroke Morbidity and Mortality in China

Global, regional, and national epidemiology of ischemic stroke from 1990 to 2021

BACKGROUND AND PURPOSE

This study aims to examine the global, regional, and national burden of ischemic stroke from 1990 to 2021.

METHOD

We used data from the Global Burden of Disease (GBD) 2021 database to comprehensively assess ischemic stroke indicators globally, regionally, and in 204 countries, including incidence, deaths, disability-adjusted life years (DALYs), estimated annual percentage change (EAPC), and Joinpoint regression analysis.

RESULTS

In 2021, there were a total of 7,804,449 cases of ischemic stroke globally (95% uncertainty interval = 6,719,760-8,943,692), with an age-standardized incidence rate (ASIR) of 92.39. This represents a declining trend compared to 1990, with an EAPC of -0.67 (95% confidence interval [CI] = -0.76 to -0.58). Mortality and DALY rates also showed a downward trend (EAPC in age-standardized mortality rate: -1.83, 95% CI = -1.92 to -1.74; EAPC in age-standardized DALY rate = -1.59, 95% CI = -1.68 to -1.50). The burden of ischemic stroke was inversely correlated with gross domestic product. Regionally, from 2014 to 2021, the Caribbean experienced the fastest increase in ASIR (annual percent change = 0.15, 95% CI = 0.13 to 0.18). Among 204 countries, North Macedonia had the highest incidence, mortality, and DALY rates. In addition to metabolic risks, particulate matter pollution and low temperatures were significant environmental and occupational risk factors for ischemic stroke. Smoking and a diet high in sodium were identified as key behavioral risk factors.

CONCLUSIONS

Ischemic stroke remains a serious global health challenge, and our results from this cross-sectional study suggest that the burden of disease remains high in Eastern Europe, East Asia, Central Asia, and Sub-Saharan Africa.

Trends and age-period-cohort effect on incidence of hepatitis B from 2008 to 2022 in Guangzhou, China

Hepatitis B virus (HBV) infection is highly prevalent in Guangzhou, China. This study aimed to examine the long-term trend of HB incidence from 2008 to 2022 and the independent impacts of age, period, and cohort on the trends. HBV data were collected from the China Information System for Disease Control and Prevention. Joinpoint regression was utilized to examine temporal trends, and an age-period-cohort model was employed to estimate the effects of age, period, and cohort. A total of 327,585 HBV cases were included in this study. The incidence of chronic and acute HB showed a decreasing trend in Guangzhou over the past 15 years, with an average annual percent change of - 4.31% and - 16.87%, respectively. Age, period, and cohort all exerted significant effects. The incidence of HB was higher in males than in females and non-central areas compared to central areas. Age groups of 0-4 years and 15-24 years were identified as high-risk groups. The period relative risks for chronic HB incidence decreased initially and then stabilized. Cohorts born later had lower risks. Chronic HB incidences remain high in Guangzhou, especially among males, younger individuals, and residents of non-central areas. More efforts are still needed to achieve hepatitis elimination targets.

Global, regional, and national time trends in mortality for stroke, 1990-2019: An age-period-cohort analysis for the global burden of disease 2019 study and implications for stroke prevention

BACKGROUND

Despite the fact that stroke is the second leading cause of death globally, a comprehensive and comparable assessment of mortality, and epidemiologic trends has not been conducted for most regions.We estimated the global and regional burden of stroke from 1990 to 2019 using data from the 2019 Global Study of Diseases, Injuries, and Risk Factors.

METHODS

For the period between 1990 and 2019, we used an age-period-cohort model to calculate the annual percentage changes in mortality (net drifts), local drifts, and period and cohort relative risks (period/cohort effects). Meanwhile, to quantify the temporal trends in stroke age-standardised mortality rate (ASMR), Average annual percentage changes (AAPCs) were determined by sex, area. With the potential to uncover disparities and treatment gaps in stroke care, this approach enables the examination and differentiation of age, period, and cohort effects in mortality trends.

FINDINGS

Global stroke deaths in 2019 were 6,552,725 (95% UI 5,995,200 to 7,015,139). Between 1990 and 2019, the ASMR declined globally by 36.43% (95% UI -41.65 to -31.2), with decreases in all SDI quintiles. The net drift in stroke mortality from 1990 to 2019 varied from -2.83% per year (95% confidence interval [CI]:-3.39 to -2.77) in countries with a high Socio-demographic Index (SDI) to -1.21% per year (95% CI: -1.26 to -1.16) in countries with a low SDI. During the past 30 years, favorable mortality reductions were generally found in high-SDI countries (net drift = -3.1% [95% CI: -3.4 to -2.8] per year) and high-middle SDI countries (-2.8% [-3.0 to -2.6]). However, 31 of 204 countries had either increasing trends (net drifts≥0.0%) or stagnated reductions (≥ - 0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts among high and high-middle SDI countries, with the exceptions of Kuwait, Ukraine, Kazakhstan, Guam, RussianFederation, Lithuania, Turkey, Montenegro, Serbia, Bosnia and Herzegovin, and Bulgaria.

INTERPRETATION

Notwithstanding mortality from stroke has increased globally over the past 30 years, adverse period and cohort effects have been found in many countries, calling into question the adequacy of healthcare for stroke patients of all ages. These lapses have a significant impact on the likelihood of achieving the Sustainable Development Goal (SDG) targets on mortality from age 60+ and NCDs.

Block Copolymer Nanomicelle-Encapsulated Curcumin Attenuates Cerebral Ischemia Injury and Affects Stem Cell Marker Expression by Inhibiting lncRNA GAS5

Stroke has become the most common cause of death among residents in China, among which ischemic stroke accounts for the vast majority reaching 70% to 80%. It is of great importance to actively investigate the protective mechanism of cerebral ischemia injury after IS (ischemic stroke). We constructed cerebral ischemia injury models in vivo MACO rat and in vitro (oxygen-glucose deprivation cell model) and set up different interference groups. RT-PCR (reverse transcription PCR) was conducted to detect the expression of lncRNA in neuronal cells, brain tissue, and plasma of different groups, and ELISA (enzyme-linked immunosorbent assay) and western blot were used to detect the expression of the protein in neuronal cells, brain tissue, and plasma of different groups. Cell activity was detected by the CCK-8 assay, while cell apoptosis was examined by TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) assay. In the rats' neuronal cells and brain tissue, curcumin can inhibit the expression of lncRNA GAS5 (long noncoding RNA growth arrest-specific 5). In oxygen-glucose-deprived neuronal cells in vitro, curcumin and low-expressed lncRNA GAS5 can enhance cell activity and decline cell apoptosis, but the addition of curcumin and overexpressed lncRNA GAS5 can make this phenomenon disappear. In neuronal cells, plasma, and brain tissue, curcumin and the low-expressed lncRNA GAS5 can inhibit the expression of IL-1β (interleukin 1 beta), TNF-α (tumor necrosis factor alpha), IL-6 (interleukin 6), Sox2 (SRY-box transcription factor 2), Nanog, and Oct4 (octamer-binding transcription factor 4). However, overexpressed lncRNA GAS5 and curcumin made the inhibitory effect disappear. In conclusion, this study demonstrated that curcumin could inhibit the expression of lncRNA GAS5, thereby inhibiting the expression of inflammation-related factors IL-1β, TNF-α, and IL-6, and ultimately achieve the purpose of attenuating cerebral ischemic cell damage. However, curcumin and lncRNA GAS5 may not alleviate cerebral ischemic cell damage by affecting stem cell differentiation.

Musculoskeletal Disorder Burden and Its Attributable Risk Factors in China: Estimates and Predicts from 1990 to 2044

Musculoskeletal disorders are one of the three major disabling diseases in the world. However, the current disease burden in China is not well-known. This study aimed to explore the burden and risk factors of musculoskeletal disorders in China from 1990 to 2019, predicting the incidence trend from 2020 to 2044. All data were extracted from the Global Burden of Disease Study 2019 (GBD 2019). Joinpoint regression and age-period-cohort (APC) models were selected to analyze the epidemic trend, and descriptive analyses of the time trends and age distributions of risk factors were performed. The Bayesian APC model was used to foresee the incidence trend from 2020 to 2044. The results indicated that the burden of musculoskeletal disorders is higher in women and older adults. Its attributable risk factors were found to be tobacco, a high body mass index, kidney dysfunction and occupational risks. In 2044, musculoskeletal disorders in China showed a downward trend for 35-59-year-olds and a slight upward trend for 30-34- and 65-84-year-olds. The 70-74 year age group saw the largest increase in incidence at 4.66%. Overall, the incidence increased with age. Therefore, prevention and control policies should focus on women and the elderly, and health interventions should be carried out based on risk factors.

Trends of ischemic heart disease mortality attributable to household air pollution during 1990-2019 in China and India: an age-period-cohort analysis

Cardiovascular diseases (CVD) caused by household air pollution (HAP) have sparked widespread concern globally in the recent decade. Meanwhile, increased ischemic heart disease (IHD) mortality has been the leading cause of worldwide CVD deaths. Both China and India experienced a high IHD burden and high exposure to HAP. The present study aimed to estimate and compare the long-term trends of HAP-attributable IHD mortality in the two countries. The data of this study were extracted from the Global Burden of Diseases (GBD) Study 2019. The age-period-cohort (APC) analysis was utilized to estimate the independent trends of the age, period, and cohort effects from 1990 to 2019. The age-standardized mortality rates (ASMRs) of HAP-attributable IHD have fallen faster in China than in India for both sexes. The local drift and net drift values were < 0 for all age groups in both countries. The age effects in both countries and sexes increased with time, suggesting age is a risk factor for IHD; conversely, period and cohort effects in China demonstrated a faster decline in both genders than in India. It indicated that China has been more successful than India in decreasing HAP-attributable IHD mortality.

The epidemic of stroke mortality attributed to high body mass index in mainland China: Current trends and future prediction

Background

High body mass index (BMI) is an important risk factor for stroke. The aim of this study was to assess the long-term trend of high BMI-attributed stroke mortality and make projections through 2030.

Methods

Data were extracted from the Global Burden of Disease Study 2019 and World Population Prospects 2019. An age-period-cohort framework was used in the analysis.

Results

From 1990 to 2019, the age-standardized mortality rate (ASMR) of high BMI-attributed stroke among females decreased by 15.2%, while among males, it increased by 31.1%. All of the age groups studied showed an increasing pattern over the last 30 years in males, and in female, the age groups encompassing participants who were 25-69 years old showed a decreasing pattern. In the same birth cohort, high BMI-attributable stroke mortality rates increased exponentially with age in both sexes. For females, the period rate ratios (RR) showed a downward trend after 2000-2004, and the cohort RR also showed a downward trend after the birth cohort 1930-1934. For males, the period RR showed an upward trend, but this increase was halted in the most recent period, and the cohort RRs showed a monotonic increasing pattern. It was projected that the ASMR of high BMI-attributed stroke would decrease among females and increase among males in the near future and that the proportion of elderly individuals with death due to high BMI-attributed stroke was projected to increase.

Conclusions

Over the last three decades, the high BMI-attributed stroke mortality rate decreased among females and increased among males, and these trends are projected to continue in the future. In addition, the proportion of elderly individuals with high BMI-attributed stroke mortality was projected to increase gradually in both men and women. More health-promoting efforts are needed, especially for elderly individuals and males.

Age-Period-Cohort Analysis of Ischemic Heart Disease Morbidity and Mortality in China, 1990-2019

BACKGROUND

The disease burden of ischemic heart disease (IHD) continues to increase. This study aimed to assess the age, period, and cohort effects on the long-term trends of IHD incidence and mortality in China from 1990 to 2019.

METHODS AND RESULTS

The data were obtained from the Global Burden of Disease Study (GBD) 2019, and the age-standardized incidence/mortality rate (ASIR/ASMR) was calculated. The age-period-cohort (APC) model, which is a generalized linear model revealing the correlation of disease rate and attained age, period, and cohort, was applied to estimate the net drift (estimated annual percentage change [EAPC]s), the local drifts (age-specific EAPCs), the age, period, and cohort effects. The analyses elucidated that the ASIR and ASMR of IHD declined after 2013. The net drift of incidence was 0.212% in females, and the net drift of mortality was 0.371% in males. The local drifts of mortality were above 0 in males aged 20-84 years and in females aged 65-84 years. The age effects showed elevated trends during the study period. The period effects declined after 2013. The cohort effects of mortality in males were higher than that in females.

CONCLUSIONS

The decrease of ASIR and ASMR indicated that measures to prevent IHD have been effective in China. However, the cardiovascular health of the elderly and males should be considered in future policy decisions.

Age–Period–Cohort Analysis of Long Trend of Mortality for Stroke and Subtypes Attributed to High SBP in Chinese Adults

Stroke has been found as the leading cause of death in China, and high systolic blood pressure (SBP) has been indicated as a critical risk factor of stroke mortality. Accordingly, in this article, the aims were to investigate the long-term trends of mortality in terms of stroke and subtypes arising from high SBP stratified by age and gender among Chinese adults. The data of this article originated from the global burden of disease (GBD) study database. The age, period, and cohort effects were examined with the age–period–cohort model (APC). The age-standardized mortality of stroke attributed to high SBP in China has been significantly declining from 1990 to 2019. As indicated by the result of APC analysis, substantially rising age effects have been exerted on stroke and subtypes from 25 to 84 years of both genders, whereas the age effect on women increased less rapidly than that on men. As opposed to the above result, the period and cohort effects were reported to show similar monotonous decrease trends, and stroke of women more significantly declined than that of men (significantly with p &lt; 0.05 for all). All types of stroke mortality arising from high SBP were indicated to change. The risk of death was identified to be most remarkably reduced in high SBP-attributable subarachnoid hemorrhage (SAH), whereas intracerebral hemorrhage (ICH) and ischemic stroke (IS) decreased at approximately the same rate. People born in the later birth cohorts or living in recent periods had a lower risk of stroke death, whereas men and elder groups were considered as the high-risk populations for stroke mortality due to high SBP. Although the stroke mortality relating to high SBP in China was declining, ICH and IS would continue to be the first and second lethal subtypes of stroke. In contrast to the above finding, SAH accounted for the minimum proportion of deaths and the maximum reduction in period and cohort effects. Thus, it is of high significance to introduce advanced hypertension control technology and knowledge regarding healthy lifestyles.