Bayesian Age-Period-Cohort Prediction of Mortality of Type 2 Diabetic Kidney Disease in China: A Modeling Study

Global, regional and national trends in the burden of low bone mineral density from 1990 to 2030: A Bayesian age-period-cohort modeling study

Low bone mineral density (LBMD) remains a global public health concern. To provide deeper insights, we retrieved and calibrated LBMD death and Disability-Adjusted Life Years (DALYs) data from the Global Burden of Disease 2021 (GBD 2021) database. We calculated the age-standardized rate (ASR) and estimated annual percentage change (EAPC) to delineate LBMD trends across sexes, age groups, Sociodemographic Index (SDI) regions, and countries. Spearman rank order correlation analysis was used to explore the relationship between SDI and ASR. Additionally, we constructed Bayesian age-period-cohort (BAPC) models to predict future trends in LBMD up to 2030, with the mean absolute percentage error (MAPE) used to evaluate prediction accuracy. Our analyses revealed that global deaths related to LBMD nearly doubled, from 250,930 in 1990 to 463,010 in 2021, and are projected to rise to 473,690 by 2030. However, the ASR exhibited an opposite trend, decreasing from 17.91 per 100,000 in 1990 to 15.77 per 100,000 in 2021, and is expected to further decline to 13.64 per 100,000 by 2030. The EAPC indicated descending trends in 1990-2021 and 2022-2030. Trends in LBMD varied across different subgroups by sex, age, and location. Males are projected to continue experiencing higher death numbers than females, though the gap is narrowing. The 90 to 94 age group consistently had the highest ASR from 1990 to 2030. Lower SDI remains a critical factor contributing to the higher burden of LBMD. Spearman rank order correlation analysis showed a negative correlation between SDI and ASR. We categorized 6 distinct trends in ASR across different countries, with most expected to experience a decline by 2030. The MAPE value (0.038 < 0.1) indicated that the BAPC model produced reliable predictions even under the COVID-19 pandemic.

Predictors of Mortality Among Hemodialysis Patients at Al-Thora General Hospital, Ibb Governate, Yemen: A Retrospective Study

BACKGROUND

In addition to the global rise in the use of hemodialysis (HD) for end-stage renal disease, individuals receiving maintenance HD continue to have higher mortality rates than the general population. The mortality rates among HD patients in Yemen have not been studied because of the lack of a national registry system, and the impact of the disease on the country is yet to be evaluated. Our study aimed to assess the clinical characteristics and factors associated with mortality among patients with HD in a resource-limited setting.

MATERIALS AND METHODS

This retrospective study involved 4194 HD patients at the Nephrology Center of Al-Thora General Hospital, Ibb Governate, Yemen, between March 2014 and September 2023. Data on HD patients' demographic characteristics, risk factors, and comorbidities were gathered and analyzed. The Kaplan-Meier and log-rank tests were used to evaluate and compare survival curves, and the proportional Cox hazard model was used to investigate the factors associated with mortality.

RESULT

The mean age was 49.2 ± 16.5 years. The majority of cases were male (n= 2604, 62.1%) and from rural areas (3386, 80.7%), with 1226 (29.2%) living outside Ibb Governorate. Hepatitis C and B viruses were positive in 466 (11.1%) and 312 (7.4%) patients. The main comorbidity was hypertension (n= 3152, 75.2%), followed by diabetes mellitus (DM) (n= 1375, 32.8%). Five hundred and forty-eight patients died during the study period between 2017 and 2023, with an estimated mortality rate of 13.1%. The survival rates at 12, 24, 36, 48, and 60 months of follow-up were approximately 97.4%, 93.3%, 91.7%, 86.0%, and 74.6%, respectively. Predictive factors for mortality among HD patients in the Cox regression model were age >65 years (HR:1.41; 95 % CI: 1.15-1.74, p<0.001), cardiovascular disease (HR: 7.28; 95 % CI: 2.68-19.81, p<0.001), coming from other cities (HR: 1.32; 95% CI: 1.11-1.59, p= 0.002), DM (HR: 1.58; 95% CI: 1.23-2.01, p <0.001), and cerebral vascular accidents (HR:1.57; 95 % CI: 1.13-2.18, p= 0.007).

CONCLUSION

 Instead of a higher mortality rate in this study, coming from other cities, DM, cardiovascular disease, cerebral vascular accidents, and age >65 years were predictive factors for mortality in HD patients. The study underlines the necessity of planning new HD facilities, avoiding and treating comorbidities, managing them early to decrease mortality, and educating regional administrative decision-makers on effective implementation techniques.

Global spatiotemporal distributions of lymphoma from 1990 to 2019: A Joinpoint regression analysis based on the global burden of disease study 2019, and projections until 2044

Lymphoma is a dissimilar collection of malignant neoplasms arising from the clonal propagation of lymphocytes. It is conventionally classified into two categories: Hodgkin lymphoma and non-Hodgkin lymphoma. The purpose of this study is to analyze the temporal patterns in the incidence of lymphoma worldwide over the past few decades and forecast the future trends from 2020 to 2044. Data on HL and NHL were obtained from the Global Burden of Disease Study 2019. In an effort to estimate the incidence rate trend, the Joinpoint regression analysis model was exploited. What's more, to project the disease burden by 2044, the Bayesian age-period-cohort analysis was employed. In 2019, higher incidence rates were observed in males and the elderly for both subtypes. Over the last three decades, a significant decline in the age-standardized incidence rate of HL was observed, while NHL has shown an increasing trend. By 2044, the age-standardized incidence rate of HL is anticipated to decrease in males and increase in females, while that of NHL is expected to rise. This study presents a new assessment of the spatiotemporal distributions of lymphoma. Significant emphasis should be placed on the effective management and long-term monitoring of patients to mitigate the potential future impact of the disease.

Exploring the targets and molecular mechanism of glycyrrhetinic acid against diabetic nephropathy based on network pharmacology and molecular docking

BACKGROUND

Diabetic nephropathy (DN) stands as the most prevalent chronic microvascular complication of diabetes mellitus. Approximately 50% of DN patients progress to end-stage renal disease, posing a substantial health burden.

AIM

To employ network pharmacology and molecular docking methods to predict the mechanism by which glycyrrhetinic acid (GA) treats DN, subsequently validating these predictions through experimental means.

METHODS

The study initially identified GA targets using Pharm Mapper and the TCMSP database. Targets relevant to DN were obtained from the Genecards, OMIM, and TTD databases. The Venny database facilitated the acquisition of intersecting targets between GA and DN. The String database was used to construct a protein interaction network, while DAVID database was used to conducted Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis and Gene Ontology (GO) analysis. Molecular docking experiments were performed using Autodock software with selected proteins. Experimental validation was conducted using renal proximal tubular cells (HK-2) as the study subjects. A hyperglycemic environment was simulated using glucose solution, and the effect of GA on cell viability was assessed through the cell counting kit-8 method. Flow cytometry was employed to detect cell cycle and apoptosis, and protein immunoblot (western blot) was used to measure the expression of proteins of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway and insulin resistance pathway, including insulin receptor (INSR), PI3K, p-PI3K, AKT, p-AKT, and glycogen synthase kinase-3 (GSK3).

RESULTS

A total of 186 intersecting targets between GA and DN were identified, which were associated with 144 KEGG-related enrichment pathways, 375 GO biological process entries, 45 GO cellular component entries, and 112 GO cellular function entries. Molecular docking demonstrated strong binding of GA to mitogen-activated protein kinase (MAPK)-1, SRC, PIK3R1, HSP90AA1, CASPASE9, HARS, KRAS, and MAPK14. In vitro experiments revealed that GA inhibited HK-2 cell viability, induced cell cycle arrest at the G2/M phase, and reduced apoptosis with increasing drug concentration. Western blot analysis showed that GA differentially up-regulated GSK3 protein expression, up-regulated AKT/p-AKT expression, down-regulated INSR, AKT, p-AKT, PI3K, and p-PI3K protein expression, and reduced p-PI3K/PI3K levels under high glucose conditions.

CONCLUSION

GA may protect renal intrinsic cells by modulating the PI3K/AKT signaling pathway, thereby inhibiting HK-2 cell viability, reducing HK-2 cell apoptosis, and inducing cell cycle arrest at the G0/G1 phase.

Development and Validation of Prediction Models for All-Cause Mortality and Cardiovascular Mortality in Patients on Hemodialysis: A Retrospective Cohort Study in China

Purpose

This study aimed to develop two predictive nomograms for the assessment of long-term survival status in hemodialysis (HD) patients by examining the prognostic factors for all-cause mortality and cardiovascular (CVD) event mortality.

Patients and methods

A total of 551 HD patients with an average age of over 60 were included in this study. The patients' medical records were collected from our hospital and randomly allocated to two cohorts: the training cohort (n=385) and the validation cohort (n=166). We employed multivariate Cox assessments and fine-gray proportional hazards models to explore the predictive factors for both all-cause mortality and cardiovascular event mortality risk in HD patients. Two nomograms were established based on predictive factors to forecast patients' likelihood of survival for 3, 5, and 8 years. The performance of both models was evaluated using the area under the curve (AUC), calibration plots, and decision curve analysis.

Results

The nomogram for all-cause mortality prediction included seven factors: age ≥ 60, sex (male), history of diabetes and coronary artery disease, diastolic blood pressure, total triglycerides (TG), and total cholesterol (TC). The nomogram for cardiovascular event mortality prediction included three factors: history of diabetes and coronary artery disease, and total cholesterol (TC). Both models demonstrated good discrimination, with AUC values of 0.716, 0.722 and 0.725 for all-cause mortality at 3, 5, and 8 years, respectively, and 0.702, 0.695, and 0.677 for cardiovascular event mortality, respectively. The calibration plots indicated a good agreement between the predictions and the decision curve analysis demonstrated a favorable clinical utility of the nomograms.

Conclusion

Our nomograms were well-calibrated and exhibited significant estimation efficiency, providing a valuable predictive tool to forecast prognosis in HD patients.

Potential Gains in Health-Adjusted Life Expectancy by Reducing Burden of Noncommunicable Diseases in 188 Countries: A Population-Based Study

OBJECTIVES

This article quantifies the potential gains in health-adjusted life expectancy for people aged 30 to 70 years (HALE_[30-70]) by examining the reductions in disability in addition to premature mortality from noncommunicable diseases (NCDs).

METHODS

We extracted data from the Global Burden of Disease Study 2019 for 4 major NCDs (cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes mellitus) in 188 countries from 2010 to 2019. Estimates of the potential gains in HALE_[30-70] were based on a counterfactual analysis involving 3 alternative future scenarios: (1) achieve Sustainable Development Goals target 3.4 but do not make any progress on disability reduction, (2) achieve Sustainable Development Goals target 3.4 and eliminate NCD-related disability, and (3) eliminate all NCD-related mortality and disability.

RESULTS

In all scenarios, the high-income group has the greatest potential gains in HALE_[30-70], above the global average. For all specific causes, potential gains in HALE_[30-70] decrease as income levels fall. Across these 3 scenarios, the potential gains in HALE_[30-70] globally of reducing premature mortality for 4 major NCDs are 3.13 years, 4.53 years, and 7.32 years, respectively. In scenario A, all income groups have the greatest potential gains in HALE_[30-70] from diabetes and chronic respiratory diseases. In scenarios B and C, the high-income group has the greatest potential gains in HALE_[30-70] from cancer intervention, and the other income groups have the greatest potential gains in HALE_[30-70] from cardiovascular diseases intervention.

CONCLUSION

Reducing premature death and disability from 4 major NCDs at once and attaching equal importance to each lead to a sizable improvement in HALE_[30-70].

The Burden of Rheumatoid Arthritis: Findings from the 2019 Global Burden of Diseases Study and Forecasts for 2030 by Bayesian Age-Period-Cohort Analysis

BACKGROUND

Rheumatoid arthritis (RA) is a key health issue worldwide. Due to early identification and effective treatment strategies, the disease pattern of RA has also changed. However, the most comprehensive and up-to-date information about the burden of RA and its trends in subsequent years is lacking.

OBJECTIVE

this study aimed to report the global burden of RA by sex, age, region, and forecast for 2030.

METHOD

Publicly available data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used in this study. The trends in the prevalence, incidence, and disability-adjusted life years (DALYs) of RA from 1990 to 2019 were reported. The global burden of RA in 2019 was reported by a sex, age, and sociodemographic index (SDI). Finally, the trends in the following years were predicted by Bayesian age-period-cohort (BAPC) models.

RESULTS

Globally, the age-standardized prevalence rate increased from 207.46 (95% UI:189.99 to 226.95) in 1990 to 224.25 (95% UI: 204.94 to 245.99) in 2019, with an estimated annual percent change (EAPC) of 0.37% (95% CI: 0.32 to 0.42). Regarding the incidence, the age-standardized incidence rate (ASR) increased from 12.21 (95% UI: 11.13 to 13.38) to 13 (95% UI: 11.83 to 14.27) per 100,000 people from 1990 to 2019, with an EAPC of 0.3% (95% CI: 11.83 to 14.27). The age-standardized DALY rate also increased from 39.12 (95% UI: 30.13 to 48.56) per 100,000 people in 1990 to 39.57 (95% UI: 30.51 to 49.53) in 2019, with an EAPC of 0.12% (95% CI: 0.08% to 0.17%). There was no significant association between the SDI and ASR when the SDI was lower than 0.7, while there was a positive association between the SDI and ASR when the SDI was higher than 0.7 The BAPC analysis showed that the ASR was estimated to be up to 18.23 in females and approximately 8.34 per 100,000 people in males by 2030.

CONCLUSION

RA is still a key public health issue worldwide. The global burden of RA has increased over the past decades and will continue to increase in the coming years, and much more attention should be given to early diagnosis and treatment to reduce the burden of RA.

Hepatitis B and C mortality from 1990 to 2019 in China: a Bayesian age-period-cohort analysis

Background

Significant decreases in hepatitis B virus (HBV) and hepatitis C virus (HCV) infections have been observed in China, but both remain leading public health challenges. Estimating the components and trends in HBV and HCV mortality is vital for disease control planning. The current analysis investigated time trends in hepatitis B and C mortality and the relationships with age, period, and birth cohort from 1990 to 2019. We also made projections for 2030-2034 in China.

Methods

Mortality data related to hepatitis B and C were obtained from the Global Burden of Disease (GBD) study, which was stratified by complications, age, sex, and specific geographical locations. An age-period-cohort (APC) analytical framework was adopted to measure age, period, and cohort effects, which fits a log-linear Poisson model over a Lexis diagram of observed rates and quantifies the additive effects of age, period, and birth cohorts. We estimated longitudinal age curves (expected longitudinal age-specific rates), net drift (overall annual percentage change), local drift (annual percentage change in each age group), period, and cohort relative risks. A Bayesian APC analysis was used to project future age-specific hepatitis B and C deaths.

Results

In China, the age-standardized mortality rate (ASMR) of hepatitis B and C decreased by 67% and 58% from 1990 to 2019, respectively. The overall annual percentage changes in hepatitis B and C were -4.97% and -6.49% for males and -3.85% and -6.09% for females, respectively. After adjusting for period and cohort effects, we observed an exponential increase in hepatitis C mortality with age, with the Bell-like curves peaking at approximately 50 years old for hepatitis B. The Bayesian APC analysis projected that hepatitis B and C deaths would decrease dramatically by 42% and 22% for the periods 2016-2019 and 2030-2034, respectively. The declines in ASMRs related to hepatitis B and C were associated with the improvements in the Chinese Socio-Demographic Index.

Conclusions

Although the burden of hepatitis B and C mortality is likely to continue declining in China, the hepatitis B and C mortality was still high. Therefore, the national efforts should still be strengthened to achieve the global hepatitis elimination targets.

Gender disparity and temporal trend of liver cancer in China from 1990 to 2019 and predictions in a 25-year period

Objective

This study aims to reveal epidemiological features and trends of liver cancer (LC) in China.

Methods

We retrieved data from the Global Burden of Disease database 2019. Joinpoint regression was used to examine the temporal trend of LC. Future trends of LC were estimated using the Nordpred.

Results

The incidence, mortality, and disability-standardized life year (DALY) rate of LC declined in China from 1990 to 2019. Among >210,000 LC cases in 2019, the LC incidences were nearly 3.15 times higher in males than in females. LC cases and LC-associated deaths were mostly found among patients aged 65 to 69 years. The proportion of LC attributable to hepatitis B decreased over time, whereas the proportions of LC attributable to hepatitis C, alcohol use, and non-alcoholic steatohepatitis increased modestly from 1990 to 2019. The majority of LC-associated deaths could be traced to four risk factors: smoking (20%), drug use (13.6%), alcohol use (11.7%), and high body mass index (10.1%). Based on the Nordpred prediction, there will be a steady decline in the incidence (39.0%) and mortality (38.3%) of liver cancer over a 25-year period from 2020 to 2044.

Conclusion

The disease burden of liver cancer in China has declined over the past 30 years. However, it remains important to control liver cancer among high-risk populations, especially elderly males with obesity, alcohol use, tobacco use, and/or drug abuse.

Assessment of age, period, and cohort effects of lung cancer incidence in Hong Kong and projection up to 2030 based on changing demographics

The burden of lung cancer in Hong Kong continues to rise. We analyzed trends in lung cancer incidence and associations with age, period, and cohort from 1985 to 2019, made projections up to 2030 and examined the drivers of lung cancer incidence. We used age-period-cohort modeling to estimate age, period, and cohort effects on lung cancer incidence rates in Hong Kong between 1985 and 2019. We projected lung cancer incidence in Hong Kong from 2020 to 2030 using Bayesian age-period-cohort analysis with an integrated nested Laplace approximation. We decomposed changes in the number of lung cancer cases into population growth, population aging, and epidemiologic changes. From 1985 to 2019, the number of lung cancer incident cases in Hong Kong continued to rise, yet the age-standardized incidence rates have declined for both sexes while have fluctuated for females over the past two decades. The overall annual percentage change from 1985 to 2019 was -2.29 (95% CI, -2.53 to -2.05) for males and -0.86 (95% CI, -1.06 to -0.65) for females. Age-specific annual percentages for both sexes showed a decreasing trend in all age groups and were more pronounced for females older than 65 years and males younger than 65 years. Period effects for both sexes showed a similar monotonic downward pattern, with the downward trend slowing for females after 2000. The cohort effect declined monotonically for males and started to plateau for females after the 1945 birth cohort. It was projected that the incident cases of lung cancer in Hong Kong would continue to increase, with 4,435 male cases and 3,561 female cases in 2030. Demographic decomposition suggested that population growth and population aging play an important role in the change of lung cancer cases. Much progress has been made in reducing the incidence of lung cancer in Hong Kong, but this has been offset by demographic changes that will continue to increase the incident cases of lung cancer in Hong Kong, especially among females. There is an urgent need for continued public health policies and clinical programs for risk factor control and necessary screening.