The burden of metabolic risk factors in North Africa and the Middle East, 1990-2019: findings from the Global Burden of Disease Study

Background

The objective of this study is to investigate the trends of exposure and burden attributable to the four main metabolic risk factors, including high systolic blood pressure (SBP), high fasting plasma glucose (FPG), high body-mass index (BMI), and high low-density lipoproteins cholesterol (LDL) in North Africa and the Middle East from 1990 to 2019.

Methods

The data were retrieved from Global Burden of Disease Study 2019. Summary exposure value (SEV) was used for risk factor exposure. Burden attributable to each risk factor was incorporated in the population attributable fraction to estimate the total attributable deaths and disability-adjusted life-years (DALYs).

Findings

While age-standardized death rate (ASDR) attributable to high-LDL and high-SBP decreased by 26.5% (18.6-35.2) and 23.4% (15.9-31.5) over 1990-2019, respectively, high-BMI with 5.1% (-9.0-25.9) and high-FPG with 21.4% (7.0-37.4) change, grew in ASDR. Moreover, age-standardized DALY rate attributed to high-LDL and high-SBP declined by 30.2% (20.9-39.0) and 25.2% (16.8-33.9), respectively. The attributable age-standardized DALY rate of high-BMI with 8.3% (-6.5-28.8) and high-FPG with 27.0% (14.3-40.8) increase, had a growing trend. Age-standardized SEVs of high-FPG, high-BMI, high-SBP, and high-LDL increased by 92.4% (82.8-103.3), 76.0% (58.9-99.3), 10.4% (3.8-18.0), and 5.5% (4.3-7.1), respectively.

Interpretation

The burden attributed to high-SBP and high-LDL decreased during the 1990-2019 period in the region, while the attributable burden of high-FPG and high-BMI increased. Alarmingly, exposure to all four risk factors increased in the past three decades. There has been significant heterogeneity among the countries in the region regarding the trends of exposure and attributable burden. Urgent action is required at the individual, community, and national levels in terms of introducing effective strategies for prevention and treatment that account for local and socioeconomic factors.

Funding

Bill & Melinda Gates Foundation.

The effectiveness of fixed speed cameras on Iranian taxi drivers: An evaluation of the influential factors

Background

The adherence to speed limits can reduce deaths associated with road traffic injuries (RTIs) by more than a quarter. This study aimed to evaluate the effective factors on the speeding behavior of Iranian taxi drivers around fixed speed cameras.

Method

Telematics devices used in this study collected the location and speed of the vehicles. The units of analysis in this study were trips per camera, including 2.5 km before and after each camera. Linear regression analysis was used to identify kangaroo driving (KD), defined as trips with a significant V-shape in speed distribution around the camera. In the clustered camera zones, cameras were placed at regular intervals of approximately 3.5 km.

Findings

A total of 93,160 trips were recorded from 13,857,443 data points. There was an inverse association between drivers' age and KD with an odds ratio (OR) of 0.98 (95% confidence interval: 0.98-0.98). The intercity trips had a substantially higher probability of KD than urban trips (OR: 4.94 [4.73-5.16]). The tendency of drivers toward KD during the daylight hours vs. nighttime was significant for both urban (OR: 1.15 [1.06-1.25]) and intercity (OR: 1.18 [1.14-1.22]) trips. The 4 -8 a.m. period had the highest chance of KD in both urban (10.71% [7.41-14.53]) and intercity (44.13% [41.18-47.09]) trips. There was a significant decrease in the odds of KD inside the clustered camera zones (OR: 0.22 [0.20-0.25]).

Conclusion

The heterogeneous occurrence of KD in different locations and times indicates the necessity of evidence-based decision-making in urban planning to improve safe driving behaviors. The lower occurrence of KD in clustered camera zones could be a practical key to the effective control of speeding behaviors by helping in the efficient placement of cameras through sustainable development of cities and roads.

Quality of care of peptic ulcer disease worldwide: A systematic analysis for the global burden of disease study 1990–2019

Background

Peptic ulcer disease (PUD) affects four million people worldwide annually and has an estimated lifetime prevalence of 5−10% in the general population. Worldwide, there are significant heterogeneities in coping approaches of healthcare systems with PUD in prevention, diagnosis, treatment, and follow-up. Quantifying and benchmarking health systems’ performance is crucial yet challenging to provide a clearer picture of the potential global inequities in the quality of care.

Objective

The objective of this study was to compare the health-system quality-of-care and inequities for PUD among age groups and sexes worldwide.

Methods

Data were derived from the Global Burden of Disease Study 1990–2019. Principal-Component-Analysis was used to combine age-standardized mortality-to-incidence-ratio, disability-adjusted-life-years-to-prevalence-ratio, prevalence-to-incidence-ratio, and years-of-life-lost-to-years-lived-with-disability-into a single proxy named Quality-of-Care-Index (QCI). QCI was used to compare the quality of care among countries. QCI’s validity was investigated via correlation with the cause-specific Healthcare-Access-and-Quality-index, which was acceptable. Inequities were presented among age groups and sexes. Gender Disparity Ratio was obtained by dividing the score of women by that of men.

Results

Global QCI was 72.6 in 1990, which increased by 14.6% to 83.2 in 2019. High-income-Asia-pacific had the highest QCI, while Central Latin America had the lowest. QCI of high-SDI countries was 82.9 in 1990, which increased to 92.9 in 2019. The QCI of low-SDI countries was 65.0 in 1990, which increased to 76.9 in 2019. There was heterogeneity among the QCI-level of countries with the same SDI level. QCI typically decreased as people aged; however, this gap was more significant among low-SDI countries. The global Gender Disparity Ratio was close to one and ranged from 0.97 to 1.03 in 100 of 204 countries.

Conclusion

QCI of PUD improved dramatically during 1990–2019 worldwide. There are still significant heterogeneities among countries on different and similar SDI levels.

Global, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

Colorectal cancer is the third leading cause of cancer deaths worldwide. Given the recent increasing trends in colorectal cancer incidence globally, up-to-date information on the colorectal cancer burden could guide screening, early detection, and treatment strategies, and help effectively allocate resources. We examined the temporal patterns of the global, regional, and national burden of colorectal cancer and its risk factors in 204 countries and territories across the past three decades.

METHODS

Estimates of incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer were generated as a part of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 by age, sex, and geographical location for the period 1990-2019. Mortality estimates were produced using the cause of death ensemble model. We also calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer.

FINDINGS

Globally, between 1990 and 2019, colorectal cancer incident cases more than doubled, from 842 098 (95% uncertainty interval [UI] 810 408-868 574) to 2·17 million (2·00-2·34), and deaths increased from 518 126 (493 682-537 877) to 1·09 million (1·02-1·15). The global age-standardised incidence rate increased from 22·2 (95% UI 21·3-23·0) per 100 000 to 26·7 (24·6-28·9) per 100 000, whereas the age-standardised mortality rate decreased from 14·3 (13·5-14·9) per 100 000 to 13·7 (12·6-14·5) per 100 000 and the age-standardised DALY rate decreased from 308·5 (294·7-320·7) per 100 000 to 295·5 (275·2-313·0) per 100 000 from 1990 through 2019. Taiwan (province of China; 62·0 [48·9-80·0] per 100 000), Monaco (60·7 [48·5-73·6] per 100 000), and Andorra (56·6 [42·8-71·9] per 100 000) had the highest age-standardised incidence rates, while Greenland (31·4 [26·0-37·1] per 100 000), Brunei (30·3 [26·6-34·1] per 100 000), and Hungary (28·6 [23·6-34·0] per 100 000) had the highest age-standardised mortality rates. From 1990 through 2019, a substantial rise in incidence rates was observed in younger adults (age <50 years), particularly in high Socio-demographic Index (SDI) countries. Globally, a diet low in milk (15·6%), smoking (13·3%), a diet low in calcium (12·9%), and alcohol use (9·9%) were the main contributors to colorectal cancer DALYs in 2019.

INTERPRETATION

The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background

Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets.

Methods

The primary data sources were population-based serosurveys, claims and hospital discharges, cancer registries, vital registration systems, and published case series. We estimated chronic HBV infection and the burden of HBV-related diseases, defined as an aggregate of cirrhosis due to hepatitis B, liver cancer due to hepatitis B, and acute hepatitis B. We used DisMod-MR 2.1, a Bayesian mixed-effects meta-regression tool, to estimate the prevalence of chronic HBV infection, cirrhosis, and aetiological proportions of cirrhosis. We used mortality-to-incidence ratios modelled with spatiotemporal Gaussian process regression to estimate the incidence of liver cancer. We used the Cause of Death Ensemble modelling (CODEm) model, a tool that selects models and covariates on the basis of out-of-sample performance, to estimate mortality due to cirrhosis, liver cancer, and acute hepatitis B.

Findings

In 2019, the estimated global, all-age prevalence of chronic HBV infection was 4·1% (95% uncertainty interval [UI] 3·7 to 4·5), corresponding to 316 million (284 to 351) infected people. There was a 31·3% (29·0 to 33·9) decline in all-age prevalence between 1990 and 2019, with a more marked decline of 76·8% (76·2 to 77·5) in prevalence in children younger than 5 years. HBV-related diseases resulted in 555 000 global deaths (487 000 to 630 000) in 2019. The number of HBV-related deaths increased between 1990 and 2019 (by 5·9% [–5·6 to 19·2]) and between 2015 and 2019 (by 2·9% [–5·9 to 11·3]). By contrast, all-age and age-standardised death rates due to HBV-related diseases decreased during these periods. We compared estimates for 2019 in 194 WHO locations to WHO-GHSS 2020 targets, and found that four countries achieved a 10% reduction in deaths, 15 countries achieved a 30% reduction in new cases, and 147 countries achieved a 1% prevalence in children younger than 5 years. As of 2019, 68 of 194 countries had already achieved the 2030 target proposed in WHO Interim Guidance of an all-age HBV-related death rate of four per 100 000.

Interpretation

The prevalence of chronic HBV infection declined over time, particularly in children younger than 5 years, since the introduction of hepatitis B vaccination. HBV-related death rates also decreased, but HBV-related death counts increased as a result of population growth, ageing, and cohort effects. By 2019, many countries had met the interim seroprevalence target for children younger than 5 years, but few countries had met the WHO-GHSS interim targets for deaths and new cases. Progress according to all indicators must be accelerated to meet 2030 targets, and there are marked disparities in burden and progress across the world. HBV interventions, such as vaccination, testing, and treatment, must be strategically supported and scaled up to achieve elimination.

Funding

Bill & Melinda Gates Foundation.

The global burden of adolescent and young adult cancer in 2019: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND

In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults.

METHODS

Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults.

FINDINGS

There were 1·19 million (95% UI 1·11-1·28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59·6 [54·5-65·7] per 100 000 person-years) and high-middle SDI countries (53·2 [48·8-57·9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14·2 [12·9-15·6] per 100 000 person-years) and middle SDI (13·6 [12·6-14·8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23·5 million (21·9-25·2) DALYs to the global burden of disease, of which 2·7% (1·9-3·6) came from YLDs and 97·3% (96·4-98·1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally.

INTERPRETATION

Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts.

FUNDING

Bill & Melinda Gates Foundation, American Lebanese Syrian Associated Charities, St Baldrick's Foundation, and the National Cancer Institute.

How the scientific community responded to the COVID-19 pandemic: A subject-level time-trend bibliometric analysis

BACKGROUND

COVID-19 has triggered an avalanche of research publications, the various aspects of which need to be assessed. The objective of this study is to determine the scientific community's response patterns to COVID-19 through a bibliometric analysis of the time-trends, global contribution, international collaboration, open-access provision, science domains of focus, and the behavior of journals.

METHODS

The bibliographic records on COVID-19 literature were retrieved from both PubMed and Scopus. The period for searching was set from November 1, 2019, to April 15, 2021. The bibliographic data were coupled with COVID-19 incidence to explore possible association, as well as World Bank indicators and classification of economies.

RESULTS

A total of 159132 records were included in the study. Following the escalation of incidences of COVID-19 in late 2020 and early 2021, the monthly publication count made a new peak in March 2021 at 20505. Overall, 125155 (78.6%) were national, 22548 (14.2%) were bi-national, and 11429 (7.2%) were multi-national. Low-income countries with 928 (66.8%) international publications had the highest percentage of international. The open-access provision decreased from 85.5% in February 2020 to 62.0% in April 2021. As many as 82841 (70.8%) publications were related to health sciences, followed by life sciences 27031 (23.1%), social sciences 20291 (17.3%), and physical sciences 15141 (12.9%). The top three medical subjects in publications were general internal medicine, public health, and infectious diseases with 28.9%, 18.3%, and 12.6% of medical publications, respectively.

CONCLUSIONS

The association between the incidence and publication count indicated the scientific community's interest in the ongoing situation and timely response to it. Only one-fifth of publications resulted from international collaboration, which might lead to redundancy without adding significant value. Our study underscores the necessity of policies for attraction of international collaboration and direction of vital funds toward domains of higher priority.