Assessment of temporal instability in the applied ecology and conservation evidence base

Outcomes of meta-analyses are increasingly used to inform evidence-based decision making in various research fields. However, a number of recent studies have reported rapid temporal changes in magnitude and significance of the reported effects which could make policy-relevant recommendations from meta-analyses to quickly go out of date. We assessed the extent and patterns of temporal trends in magnitude and statistical significance of the cumulative effects in meta-analyses in applied ecology and conservation published between 2004 and 2018. Of the 121 meta-analyses analysed, 93% showed a temporal trend in cumulative effect magnitude or significance with 27% of the datasets exhibiting temporal trends in both. The most common trend was the early study effect when at least one of the first 5 years effect size estimates exhibited more than 50% magnitude difference to the subsequent estimate. The observed temporal trends persisted in majority of datasets once moderators were accounted for. Only 5 datasets showed significant changes in sample size over time which could potentially explain the observed temporal change in the cumulative effects. Year of publication of meta-analysis had no significant effect on presence of temporal trends in cumulative effects. Our results show that temporal changes in magnitude and statistical significance in applied ecology are widespread and represent a serious potential threat to use of meta-analyses for decision-making in conservation and environmental management. We recommend use of cumulative meta-analyses and call for more studies exploring the causes of the temporal effects.

Temporal trends and risk factors of perioperative cardiac events in patients over 80 years old with coronary artery disease undergoing noncardiac surgery: a high-volume single-center experience, 2014-2022

BACKGROUND

Temporal trends and risk factors of perioperative cardiac events (PCEs) in patients over 80 years old with coronary artery disease (CAD) undergoing noncardiac surgery are still unclear.

METHODS

We retrospectively reviewed 1478 patients over 80 years old, with known CAD undergoing selective noncardiac surgery in a single center (2014-2022). Patients were divided into three equal time groups based on the discharge date (2014-2016, 2017-2019, and 2020-2022), with 367, 473, and 638 patients in Groups 1-3, respectively. Perioperative clinical variables were extracted from the electronic medical records database. The primary outcome was the occurrence of PCEs intraoperatively or during hospitalization postoperatively, defined as any of the following events: myocardial infarction, heart failure, nonfatal cardiac arrest, and death.

RESULTS

PCEs occurred in 180 (12.2%) patients. Eight independent risk factors were associated with PCEs, including four clinical factors (body mass index < 22 kg/m2, history of myocardial infarction, history of heart failure, and general anesthesia) and four preoperative laboratory results (hemoglobin < 110 g/L, albumin < 40 g/L, creatinine > 120 μmol/L, and potassium <3.6 mmol/L). Significant rising trends were seen over the 9-year study period in the incidence of PCEs and independent risk factors including history of myocardial infarction, history of heart failure, general anesthesia, preoperative hemoglobin < 110 g/L, preoperative albumin < 40 g/L, and preoperative creatinine > 120 μmol/L (P for trend <0.05).

CONCLUSION

The incidence and independent risk factors of PCEs in patients over 80 years old with CAD undergoing noncardiac surgery showed significant rising trends over the last 9-year period.

Temporal trend analysis of acute hepatitis B virus infection in China, 1990-2019

China faces challenges in meeting the World Health Organization (WHO)'s target of reducing hepatitis B virus (HBV) infections by 95% using 2015 as the baseline. Using Global Burden of Disease (GBD) 2019 data, joinpoint regression models were used to analyse the temporal trends in the crude incidence rates (CIRs) and age-standardized incidence rates (ASIRs) of acute HBV (AHBV) infections in China from 1990 to 2019. The age-period-cohort model was used to estimate the effects of age, period, and birth cohort on AHBV infection risk, while the Bayesian age-period-cohort (BAPC) model was applied to predict the annual number and ASIRs of AHBV infections in China through 2030. The joinpoint regression model revealed that CIRs and ASIRs decreased from 1990 to 2019, with a faster decline occurring among males and females younger than 20 years. According to the age-period-cohort model, age effects showed a steep increase followed by a gradual decline, whereas period effects showed a linear decline, and cohort effects showed a gradual rise followed by a rapid decline. The number of cases of AHBV infections in China was predicted to decline until 2030, but it is unlikely to meet the WHO's target. These findings provide scientific support and guidance for hepatitis B prevention and control.

Updated disease distributions, risk factors, and trends of laryngeal cancer: a global analysis of cancer registries

BACKGROUND

Though the laryngeal cancer only has 1% of the total cancer cases and related deaths, it is a type of head and neck cancers with the highest prevalence. This study aims to investigate the epidemiological trend of laryngeal cancer with updated data on the global distribution of the disease burden.

MATERIALS AND METHODS

The incidence and mortality rate of laryngeal cancer was extracted from GLOBOCAN (2020), Cancer Incidence in Five Continents series I-X, WHO mortality database , the Nordic Cancer Registries , and the Surveillance, Epidemiology, and End Results Program. The Global Health data exchanges for the prevalence of its associated risk factors. A Joinpoint regression analysis was used to calculate Average Annual Percentage Change (AAPC).

RESULTS

The age-standardised rate (ASR) of laryngeal cancer incidence and mortality were 2.0 and 1.0 per 100 000 worldwide. The Caribbean (ASR=4.0) and Central and Eastern Europe (ASR=3.6) had the highest incidence and mortality rate. Incidence and risk factors associated with laryngeal cancer included tobacco usage, alcohol consumption, poor diet, obesity, diabetes, hypertension, and lipid disorders. There was an overall decreasing trend in incidence, especially for males, but an increasing incidence was observed in female populations and younger subjects.

CONCLUSIONS

As overall global trends of laryngeal cancer have been decreasing, especially for the male population, this could possibly be attributed to reduced tobacco use and alcohol consumption. Decrease in mortality may be due to improved diagnostic methods and accessibility to treatment, yet disparity in trend remains potentially because of differences in the level of access to surgical care. Disparities in temporal trends across countries may require further research and exploration to determine other underlying factors influencing this.

Disease burden, risk factors, and temporal trends of eye cancer: A global analysis of cancer registries

BACKGROUND

This study aims to investigate the global disease burden, risk factors, and temporal trends of eye cancer by sex and age group.

METHODS

Databases including Cancer Incidence in Five Continents volumes I-XI, the Nordic Cancer Registries, the Surveillance, Epidemiology, and End Results Program and the WHO IARC mortality database were accessed to extract incidence and mortality data. Joinpoint regression analyses were conducted to evaluate the Average Annual Percentage Change of the incidence and mortality.

RESULTS

The age-standardised rates of eye cancer incidence and mortality were 0.49 and 0.08 globally in 2020. Higher incidence rates were observed in Sub-Saharan Africa (ASR = 4.06), Western Europe (ASR = 0.89), and Northern Europe (ASR = 0.84), but higher mortality was observed only in Sub-Saharan Africa (ASR = 1.59). Lower HDI, higher prevalence of UV exposure and lower prevalence of several lifestyle habits and metabolic syndromes were associated with higher incidence and mortality. There was an overall stable incidence trend and a decreasing mortality trend. Notably, all countries reporting decreasing trend in mortality were in the Asian or European region.

CONCLUSIONS

Although higher incidence was observed in both African and European regions, only the Sub-Saharan Africa region reported high mortality, indicating inequity in the access of healthcare and treatment resource. Higher prevalence of UV exposure was associated with both higher incidence and mortality. Education should be provided to increase the awareness of eye protection. An overall declining mortality trend was found, but it was limited to only Asian and European countries.

Global, Regional, and National Burden of Myocarditis in 204 Countries and Territories From 1990 to 2019: Updated Systematic Analysis

BACKGROUND

Myocarditis is characterized by high disability and mortality, and imposes a severe burden on population health globally. However, the latest global magnitude and secular trend of myocarditis burden have not been reported.

OBJECTIVE

This study aimed to delineate the epidemiological characteristics of myocarditis burden globally for optimizing targeted prevention and research.

METHODS

Based on the Global Burden of Disease Study 2019, the myocarditis burden from 1990 to 2019 was modeled using the Cause of Death Ensemble tool, DisMod-MR, and spatiotemporal Gaussian regression. We depicted the epidemiology and trends of myocarditis by sex, age, year, region, and sociodemographic index (SDI). R program version 4.2.1 (R Project for Statistical Computing) was applied for all statistical analyses, and a 2-sided P-value of <.05 was considered statistically significant.

RESULTS

The number of incident cases (1,268,000) and deaths (32,450) associated with myocarditis in 2019 increased by over 1.6 times compared with the values in 1990 globally. On the other hand, the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) decreased slightly from 1990 to 2019. The disability-adjusted life years (DALYs) decreased slightly in the past 3 decades, while the age-standardized DALY rate (ASDR) decreased greatly from 18.29 per 100,000 person-years in 1990 to 12.81 per 100,000 person-years in 2019. High SDI regions always showed a more significant ASIR. The ASIR slightly decreased in all SDI regions between 1990 and 2019. Middle SDI regions had the highest ASMR and ASDR in 2019. Low SDI regions had the lowest ASMR and ASDR in 2019. The age-standardized rates (ASRs) of myocarditis were higher among males than among females from 1990 to 2019 globally. All ASRs among both sexes had a downward trend, except for the ASMR among males, which showed a stable trend, and females had a more significant decrease in the ASDR than males. Senior citizens had high incident cases and deaths among both sexes in 2019. The peak numbers of DALYs for both sexes were noted in the under 1 age group in 2019. At the national level, the estimated annual percentage changes in the ASRs had significant negative correlations with the baseline ASRs in 1990.

CONCLUSIONS

Globally, the number of incident cases and deaths associated with myocarditis have increased significantly. On the other hand, the ASRs of myocarditis showed decreasing trends from 1990 to 2019. Males consistently showed higher ASRs of myocarditis than females from 1990 to 2019 globally. Senior citizens gradually predominated in terms of myocarditis burden. Policymakers should establish targeted control strategies based on gender, region, age, and SDI; strengthen aging-related health research; and take notice of the changes in the epidemic characteristics of myocarditis.

Exploring preventive factors against insufficient antibody positivity rate for foot-and-mouth disease in pig farms in South Korea: a preliminary ecological study

BACKGROUND

Foot-and-mouth disease (FMD) is a highly contagious viral disease in livestock that has tremendous economic impact nationally. After multiple FMD outbreaks, the South Korean government implemented a vaccination policy for efficient disease control. However, during active surveillance by quarantine authorities, pig farms have reported an insufficient antibody positivity rate to FMD.

OBJECTIVE

In this study, the spatial and temporal trends of insufficiency among pig farms were analyzed, and the effect of the number of government veterinary officers was explored as a potential preventive factor.

METHODS

Various data were acquired, including national-level surveillance data for antibody insufficiency from the Korea Animal Health Integrated System, the number of veterinary officers, and the number of local pig farms. Temporal and geographical descriptive analyses were conducted to overview spatial and temporal trends. Additionally, logistic regression models were employed to investigate the association between the number of officers per pig farm with antibody insufficiency. Spatial cluster analysis was conducted to detect spatial clusters.

RESULTS

The results showed that the incidence of insufficiency tended to decrease in recent years (odds ratio [OR], 0.803; 95% confidence interval [95% CIs], 0.721-0.893), and regions with a higher density of governmental veterinary officers (OR, 0.942; 95% CIs, 0.918-0.965) were associated with a lower incidence.

CONCLUSIONS

This study implies that previously conducted national interventions would be effective, and the quality of government-provided veterinary care could play an important role in addressing the insufficient positivity rate of antibodies.

Spatiotemporal Trends Spanning Three Decades Show Toxic Levels of Chemical Contaminants in Marine Mammals

Despite their ban and restriction under the 2001 Stockholm Convention, persistent organic pollutants (POPs) are still widespread and pervasive in the environment. Releases of these toxic and bioaccumulative chemicals are ongoing, and their contribution to population declines of marine mammals is of global concern. To safeguard their survival, it is of paramount importance to understand the effectiveness of mitigation measures. Using one of the world's largest marine mammals strandings data sets, we combine published and unpublished data to examine pollutant concentrations in 11 species that stranded along the coast of Great Britain to quantify spatiotemporal trends over three decades and identify species and regions where pollutants pose the greatest threat. We find that although levels of pollutants have decreased overall, there is significant spatial and taxonomic heterogeneity such that pollutants remain a threat to biodiversity in several species and regions. Of individuals sampled within the most recent five years (2014-2018), 48% of individuals exhibited a concentration known to exceed toxic thresholds. Notably, pollutant concentrations are highest in long-lived, apex odontocetes (e.g., killer whales (Orcinus orca), bottlenose dolphins (Tursiops truncatus), and white-beaked dolphins (Lagenorhynchus albirostris)) and were significantly higher in animals that stranded on more industrialized coastlines. At the present concentrations, POPs are likely to be significantly impacting marine mammal health. We conclude that more effective international elimination and mitigation strategies are urgently needed to address this critical issue for the global ocean health.

Schizophrenia Patients Discharged on Clozapine Plus Long-Acting Injectable Antipsychotics From a Public Psychiatric Hospital in Taiwan, 2006-2021

BACKGROUND

Some schizophrenia patients treated with clozapine experience an inadequate response and adherence problems. The purpose of this study was to compare time to rehospitalization within 6 months in schizophrenia patients discharged on 3 clozapine regimens. Additionally, the temporal trend of prescription rate in each group was also explored.

METHODS

Schizophrenia patients discharged from the study hospital from January 1, 2006, to December 31, 2021, (n = 3271) were included in the analysis. The type of clozapine prescribed at discharge was divided into 3 groups: clozapine plus long-acting injectable antipsychotics (clozapine + LAIs), clozapine plus other oral antipsychotics (clozapine + OAPs), and clozapine monotherapy. Survival analysis was used to compare time to rehospitalization within 6 months after discharge among the 3 groups. The temporal trend in the prescription rate of each group was analyzed using the Cochran-Armitage Trend test.

RESULTS

Patients discharged on clozapine + LAIs had a significantly longer time to rehospitalization than those on clozapine + OAPs or clozapine monotherapy. The prescription rates of clozapine + LAIs and clozapine + OAPs significantly increased over time, whereas the prescription rates of clozapine monotherapy significantly decreased.

CONCLUSIONS

Compared with the clozapine + OAPs group, the clozapine + LAIs group had a lower risk of rehospitalization and a lower dose of clozapine prescribed. Therefore, if a second antipsychotic is required for patients who are taking clozapine alone, LAIs should be considered earlier.

Global incidence, risk factors and trends of vulvar cancer: A country-based analysis of cancer registries

Vulvar cancer is an uncommon malignancy. Vulvar cancer alarmed the public health problem in terms of the cost of diagnostic and medical treatments and psychical health of females. Our study aims to provide a thorough analysis of the global disease burden, related risk factors and temporal incidence trends of vulvar cancer in population subgroups. Data from Global Cancer Observatory and the Cancer Incidence in Five Continents Plus were used for the vulvar cancer incidence. Age-standardized rates (ASR) were used to depict the incidence of vulvar cancer. The 10-year trend of incidence was assessed using joinpoint regression with average annual percentage change and 95% confidence intervals in various age groups, while its correlations with risk factors were investigated using linear regression. Higher ASR were found in Western Europe (2.4), Northern America (1.9), Northern Europe (1.9), Australia and New Zealand (1.8) and Eastern Africa (1.4). The associated risk factors of higher vulvar cancer incidence were gross domestic product per capita, Human Development Index, higher prevalence of smoking, alcohol drinking, unsafe sex and human immunodeficiency virus infection. The overall trend of vulvar cancer incidence was increasing. An increasing trend was found in older females while a mixed trend was observed in younger females. The disease burden of vulvar cancer follows a bimodal pattern according to its two histologic pathways, affecting women in both developed and developing regions. Smoking cessation, sex education and human papillomavirus vaccination programs should be promoted among the general population. Subsequent studies can be done to explore the reasons behind the increasing trend of vulvar cancer.

Assessment of the temporal trend and daily profiles of the dietary purine intake among Chinese residents during 2014 to 2021

The incidence of hyperuricemia is on the rise in China, primarily due to dietary habits. However, limited data exists regarding dietary purine intake in the country. This study aimed to estimate the daily dietary purine intake among Chinese residents from 2014 to 2021 and evaluate the temporal trend using joinpoint regression analysis. The analysis revealed an annual percentage change (APC) of 0.8% (95% CI: 0.1-1.5%) in dietary purine intake prior to the joinpoint (2014-2019). Following the joinpoint (2019-2021), the APC significantly increased to 6.5% (95% CI: 3.3-9.8%), indicating a noteworthy upward trend (p = 0.045). Furthermore, the average daily purine intake varied significantly among different regions of China, with the southern region showing the highest dietary intake of purines. Considering the diverse contributions of various food sources to dietary purine intake, it was observed that meat consumption had the greatest impact, accounting for 36.2% of purine intake, followed by cereals consumption (25.3%) and vegetables and edible fungi (24.2%). These findings hold significance for dietary intervention and management strategies aimed at reducing purine intake among the population.

Temporal Trends in Heart Failure Management and Outcomes: Insights From a Japanese Multicenter Registry of Tertiary Care Centers

Background The management of heart failure (HF) has markedly changed, due to changes in demographics and the emergence of novel pharmacotherapies. However, detailed analyses on the temporal trends in characteristics and outcomes among patients with HF are scarcely available. This study aimed to assess the temporal trends over 11 years in clinical management and outcomes in patients with HF. Methods and Results We analyzed data from a multicenter registry of hospitalized patients with acute HF, including 6877 patients registered from 2011 to 2021. Age-adjusted mortality was calculated using standardized mortality ratios. During the study period, mean age increased from 75.2 years in 2011 to 2012 to 76.4 years in 2020 to 2021 (P for trend <0.001). The proportion of HF with reduced ejection fraction (HFrEF, left ventricular ejection fraction <40%) remained constant (from 43.4% to 42.7%, P for trend=0.38). The median duration of hospital stays (from 15 to 17 days, P for trend<0.001) had increased. As for the implementation of guideline-directed medical therapy, the use of mineralocorticoid receptor antagonist at discharge increased in patients with HFrEF (from 44.3% to 60.2%, P for trend<0.001). There was also an increase in the use of sodium-glucose cotransporter-2 inhibitors following their approval for use. The age-adjusted 1-year mortality decreased in patients with HFrEF (from 18.0% to 9.3%, P for trend<0.001) but not in patients with non-HFrEF (left ventricular ejection fraction ≥40%; from 9.2% to 9.5%, P for trend=0.79). Conclusions Hospitalized patients with HF have been aging over the past decade. Their long-term outcomes after discharge have improved predominantly because of decreased mortality in patients with HFrEF.

Prevalence and temporal trends of prostate diseases among inpatients with cardiovascular disease: a nationwide real-world database survey in Japan

Introduction

Benign prostate hyperplasia (BPH) and prostate cancer (PCa) are major prostate diseases that potentially share cardiometabolic risk factors and an elevated risk for cardiovascular disease (CVD). However, the prevalence of prostate diseases among patients with established CVD remains unclear.

Materials and methods

This nationwide retrospective study assessed the prevalence and temporal trend of prostate diseases (i.e., BPH or PCa) among patients hospitalized for CVDs in Japan. We used a claims database (the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination), which included data on 6,078,487 male patients recorded from 1,058 hospitals between April 2012 and March 2020. We conducted the Cochran-Armitage trend test and calculated the adjusted odds ratio (aOR) with 95% confidence intervals (CIs).

Results

The prevalence of prostate diseases over the entire study period was 5.7% (BPH, 4.4%; PCa, 1.6%). When dividing the overall cohort into age categories (<65, 65-74, and ≥75 years old), the prevalence was 1.1%, 4.7%, and 9.9%, respectively (P for trend <0.05). In addition, the annual prevalence showed a modest increasing trend over time. Patients admitted for heart failure (HF) were significantly associated with a higher incidence of coexisting prostate diseases than those admitted for non-HF causes [aOR 1.02 (95% CI, 1.01-1.03)] or acute coronary syndrome [aOR 1.19 (95% CI, 1.17-1.22)].

Conclusions

The nationwide real-world database revealed that the prevalence of prostate diseases is increasing among patients hospitalized for CVD, particularly HF. Attention to detailed causality and continued surveillance are needed to further clarify the clinical characteristics of prostate diseases among patients with CVD.

Changing trends of disease burden of stroke from 1990 to 2019 and its predictions among the Chinese population

Objective

This study aimed to understand the temporal trends in the disease burden of stroke and its attributable risk factors in China, along with the future trends in the next 25 years, that is important for effective prevention strategies and improvement, and to provide new insights into the age- and sex-specific incidence, prevalence, mortality, disability-adjusted life-years (DALYs) and their trends from 1990 to 2019, and the prediction in the next 25 years.

Methods

The Global Burden of Disease Study (2019) was used to extract the data on age- and sex-specific incidence, mortality, and disability-adjusted life-years (DALYs) of stroke in China, 1990-2019. We estimated the estimated annual percentage change (EAPC) to access the temporal trends of the disease burden of stroke. The R package called Nordpred was used to perform an age-period-cohort analysis to predict the prevalence of stroke.

Results

The number of incidence cases, deaths, and DALYs of stroke increased from 1990 to 2019. Overall downward trends were observed in the age-standardized incidence rate (ASIR) from 1990 to 2019. Significant temporal trends in mortality and DALYs of stroke were observed. High systolic blood pressure, smoking, and high-sodium diet were the main driving forces for stroke. The DALYs lost attributable to smoking were different for male and female patients. In the next 25 years, the number of new cases and deaths from stroke should continue to increase. The ASIR and age-standardized mortality rate (ASMR) should show a downward trend among male and female patients.

Conclusion

Despite the overall rates of stroke declined over the period from 1990 to 2019, the absolute number of people affected by stroke has substantially increased. There has been a substantial increase in the burden of stroke due to risk factors and will continue to increase in the next 25 years.

Human footprints in the Global South accelerate biomass carbon loss in ecologically sensitive regions

Human activities have placed significant pressure on the terrestrial biosphere, leading to ecosystem degradation and carbon losses. However, the full impact of these activities on terrestrial biomass carbon remains unexplored. In this study, we examined changes in global human footprint (HFP) and human-induced aboveground biomass carbon (AGBC) losses from 2000 to 2018. Our findings show an increasing trend in HFP globally, resulting in the conversion of wilderness areas to highly modified regions. These changes have altered global biomes' habitats, particularly in tropical and subtropical regions. We also found accelerated AGBC loss driven by HFP expansion, with a total loss of 19.99 ± 0.196 PgC from 2000 to 2018, especially in tropical regions. Additionally, AGBC is more vulnerable in the Global South than in the Global North. Human activities threaten natural habitats, resulting in increasing AGBC loss even in strictly protected areas. Therefore, scientifically guided planning of future human activities is crucial to protect half of Earth through mitigation and adaptation under future risks of climate change and global urbanization.

Age-related trends in the incidence of metastatic colorectal cancer from 2010 to 2019 in the USA

Aim: To evaluate temporal changes in metastatic colorectal cancer (mCRC), incidence, and use of chemotherapy treatment by age group using real-world data (RWD) from the USA. Methods: A retrospective, observational study describing temporal trends in mCRC incidence and FOLFOXIRI treatment by age group using a nationwide database of commercially and Medicare Advantage-insured patients from 2010 to 2019. Results: Incidence of mCRC increased by 22.1 and 14.9% in the 18-49 and 50-64 years cohorts, respectively, and decreased by 21.6% in the ≥65 years cohort. Overall, younger patients were more likely to receive FOLFOXIRI treatment versus older patients. Conclusion: The shifting age distribution of mCRC should be considered when recommending screening and treatment. Further research is needed to inform age-specific treatment guidelines.

Current status and temporal trend in incidence, death, and burden of esophageal cancer from 1990-2019

BACKGROUND

Esophageal cancer (EC) is one of the world's most unknown and deadly cancers. This study aimed to provide updated epidemiological indicators and the recent trend of EC by age group, gender, and geographical region in the world.

METHODS

Annual case data and age-standardized rates (ASRs) of epidemiological indicators of EC were collected from the 2019 Global Burden of Disease (GBD) study from 1990 to 2019 in 204 countries and territories based on the sociodemographic index (SDI). Relative difference (%), average annual percentage change (AAPC), and the male/female ratio were calculated. Data are reported in values and 95% confidence interval (CI).

RESULTS

EC age-standardized incidence rates (ASIR) decreased by 19%, age-standardized death rates (ASDR) decreased by 25%, and disability-adjusted life-years ASR (DALYs ASR) decreased by 30% from 1990 to 2019. The higher number of EC cases was in men aged 50 to 69 years and in women aged over 70. From 1990 to 2019, Middle SDI countries experienced a decline in the ASIR and ASDR of EC. The High SDI countries had an increasing ASDR trend. In World Bank High-Income countries, the ASIR of EC has remained unchanged and decreased in other regions. The Asia continent has the highest rate of incidence, mortality, and burden of EC and the highest rate of reduction. East Asia, Southern Sub-Saharan Africa, and Eastern Sub-Saharan Africa respectively have the highest ASIR of EC. Central Asia has experienced the greatest decrease in the ASIR and ASDR of EC, the countries of Central Europe had a steady ASIR and High-Income North America had an increasing trend in ASIR and ASDR. The burden of EC shows a decreasing trend worldwide. Central and East Asia regions have the highest rate and the highest increase in the burden of EC.

CONCLUSION

Based on great variation in the geographical distribution of epidemiological indicators of EC, investigating the reasons for this diversity requires more studies to be conducted in the field of prevention, distribution of risk factors, and implementation of screening methods with high cost-effectiveness, and access to treatment methods. The provision of regional solutions may be more effective than global strategies.

Global, region and national trends and age-period-cohort effects in colorectal cancer burden from 1990 to 2019, with predictions to 2039

Nowadays, colorectal cancer (CRC) is the second leading cause of cancer deaths and contributes to a gradually increasing disease burden. We aimed to estimate the secular trends of global CRC burden, the effect of age, period, and birth cohort, and project the global burden over time. Based on the epidemiological CRC data from 1990 to 2019 in 204 countries and territories from GBD 2019, the estimated annual percentage change (EAPC), was calculated from a linear model and joinpoint regression model. We utilized an age-period-cohort model to reckon age, period, and birth cohort effects on CRC age-standardized rate. The burden of CRC was projected by conducting the BAPC model. Globally, there was a slight decline in the age-standardized DALY rate, which was more apparent in females, with high SDI regions and in Australia and Western Europe areas. Meanwhile, our model predicts a weaker increase in morbidity (EAPC of 0.37) and a speedier reduction in mortality (EAPC of -0.66) by the next 20 years. The relative risk of period for high SDI regions decreased from 1.08 (95%UI: 1.06-1.1) in 1990-1994 to 0.85 (95%UI:0.83-0.88) in 2015-2019, but worsens in low and middle SDI regions. The local drifts were more than 1 in the 30-34 and 35-39 age groups, indicating the rising tide of early-onset CRC. Given the gender and region-specific CRC, targeted efforts to reduce the prevalence of risk factors, improve screening coverage rates, and strengthen foundational medical facilities are necessary.

Temporal Trends of Legacy and Emerging PFASs from 2011 to 2021 in Agricultural Soils of Eastern China: Impacts of the Stockholm Convention

The spatial variation and temporal trends of legacy and emerging per- and polyfluoroalkyl substances (PFASs) from 2011 to 2021 in agricultural soils of Eastern China, which is one of the largest PFAS production and consumption regions in the world, were evaluated. We found that PFOS concentration decreased by 28.2% during this period. Given that agricultural soils are sinks for persistent organic pollutants (POPs), our results suggest that the implementation of the Stockholm Convention and its indirect effects, combined with a voluntary phaseout, are effective for controlling PFOS pollution in agricultural soils in China. In addition, our results show that 19 out of 28 PFASs were detected in >40% of the samples, with concentrations being 17.6-1950 pg/g with a median of 373 pg/g. Further, legacy PFASs were major components, accounting for 63.8% of total PFASs. Based on the source appointment of PFASs via the Positive Matrix Factorization (PMF) model, the contribution ratio of consumer product industries has steadily increased from 6.10 to 26.2%, while both legacy and novel fluoropolymer industries have declined from 24.2 to 1.50 and 19.1 to 5.40%, further confirming the effectiveness of the Convention.

Trends of bisphenol A occurrence in canned food products from 2008-2020

It is known that the industry already abandoned the use of bisphenol A (BPA)-based epoxy resins as internal coatings for some canned food products (e.g. infant formula, soups). The presence of bisphenol A (BPA) in foods has also been extensively investigated, especially since late 2000. However, information on temporal trends of BPA occurrence in foods is very limited. It is not clear if BPA-based epoxy resins are still being used in internal coating for many other canned foods and if the overall exposure to BPA through consumption of canned foods has significantly decreased. As part of the Canadian total diet study (TDS) program, we have been analysing food samples for BPA since 2008. In this study, results of BPA in samples of different composite canned foods from 2008-2020 TDS were reported. Clear temporal trends were observed for canned fish and soups, with BPA levels being significantly reduced since 2014 for canned fish products and 2017 for canned soups. Temporal trends were not observed for canned evaporated milk, luncheon meats, and vegetables, with even the highest levels of BPA being detected in recent samples for evaporated milk (57 ng/g), luncheon meats (56 ng/g), and baked beans (103 ng/g). This seems to indicate that BPA-based epoxy resins are still being used in the internal coatings for these canned foods products. Thus, analysis of canned food samples for BPA should be continued for exposure assessment.

Soil Chromium Accumulation in Industrial Regions across China: Pollution and Health Risk Assessment, Spatial Pattern, and Temporal Trend (2002-2021)

This study conducted a nationwide specific assessment of soil chromium (Cr) contamination status in 506 of China's industrial regions. The overall soil Cr concentrations were 0.74-37,967.33 mg/kg, and the soil Cr content in 4.15% of the regions exceeded the reference screening value (2500 mg/kg). Geochemical accumulation index (I_geo) and monomial potential ecological risk index (E) revealed Cr salt production and tanning were the primary control industries. The non-carcinogenic risks posed by Cr salt production and tanning industries were higher than the national average values, and children were the most vulnerable groups. The heavily polluted regions were mainly located at the Yangtze River Delta, the Bohai Rim, the Pearl River Delta, the Yangtze River Basin, and the Yellow River Basin. The Yangtze River Delta was further identified as the high priority control area based on the class distribution of I_geo and E. Regression analysis showed the soil Cr concentrations in industrial regions increased during 2002-2009 and then turned into a declining trend in 2009-2021. This paper gives detailed insights into soil Cr pollution status in industrial regions across China and the results may serve as references for formulating tailored control measures for different industries and areas.

Fall-Related Hospitalizations in Elderly People: Temporal Trend and Spatial Distribution in Brazil

This study aims to identify the temporal variation and the spatial dependence structure of the hospitalization rate for falls in the elderly residing in Brazil in the period between 2010 and 2021. This ecological study employs secondary data from the Brazilian Ministry of Health about the fall-related hospitalization of people aged 60 years old and over. A time-series analysis was carried out, employing the joinpoint model. For the spatial analysis, the Moran autocorrelation technique was employed. In Brazil, between 2010 and 2021, there were 1,270,341 hospitalizations for falls recorded among the elderly in the Brazilian Hospitalization System. There was a continuous upward trend between 2010 and 2019 for all age groups, female and male, and all Brazilian regions. The trend stabilized between 2019 to 2021. The North and Northeast regions had faster upward trends among all Brazilian regions, and there was also a faster upward trend among women compared to men. A high-high pattern in hospitalization incidence was noticed from 2011 to 2019 in the states of São Paulo, Minhas Gerais, Paraná, and Mato Grosso do Sul. The results of this study provide subsidies for Brazilian health authorities to implement more efficient public policies to improve the quality of life of elderly people.

Trends of Incidence, Mortality, and Risk Factors for Lower Respiratory Infections among Children under 5 Years in China from 2000 to 2019

BACKGROUND

Understanding the temporal trends in the burden of lower respiratory tract infections (LRI) and their attributable risk factors in children under 5 years is important for effective prevention strategies.

METHODS

We used incidence, mortality, and attributable risk factors of LRI among children under 5 years from the Global Burden of Diseases database to analyze health patterns in 33 provincial administrative units in China from 2000 to 2019. Trends were examined using the annual average percentage change (AAPC) by the joinpoint regression method.

RESULTS

The rates of incidence and mortality for under-5 LRI in China were 18.1 and 4134.3 per 100,000 children in 2019, with an AAPC decrease of 4.1% and 11.0% from 2000, respectively. In recent years, the under-5 LRI incidence rate has decreased significantly in 11 provinces (Guangdong, Guangxi, Guizhou, Hainan, Heilongjiang, Jiangxi, Qinghai, Sichuan, Xinjiang, Xizang, and Zhejiang) and remained stable in the other 22 provinces. The case fatality ratio was associated with the Human Development Index and the Health Resource Density Index. The largest decline in risk factors of deaths was household air pollution from solid fuels.

CONCLUSIONS

The burden of under-5 LRI in China and the provinces has declined significantly, with variation across provinces. Further efforts are needed to promote child health through the development of measures to control major risk factors.

Geriatric drug trials on solid tumor are scarce worldwide

Background

Conducting geriatric trials is the most feasible way to address the vast underrepresentation of older adults in clinical trials of cancer therapies. This study is a globally comprehensive examination of geriatric trials for solid tumor worldwide over the last decade.

Methods

Up-to-date information on cancer drug trials in older adults aged over 59 years from the beginning of 2012 to the end of 2021 was collected from Trialtrove and Pharmaprojects. The number of identified trials was the dependent variable and corresponding analysis was conducted from the perspective of time trend, status quo and comparisons by region and country, sponsor type and cancer type, study status and phase.

Results

A total of 292 geriatric cancer drug trials were identified, of which 287 were single-region studies, 219 were initiated by academic groups, and 55 (18.8%) were terminated. Decreasing trends in the annual number of all trials (-9.2% per year) and the annual number of trials by academic groups (-9.4%) were observed over time. Of the geriatric trials, 183 were conducted in Asia; this number was significantly higher than that in Europe (74), North America (37), Oceania (4), and South America (1). Similar difference was found in participation rate in trials by academic groups ranging from 71.7% in Asia to 0.5% in South America. Of the trials, 19 and 97 were initiated before drug and indication approval, respectively, and the remaining 176 were initiated after indication approval. Phase II trials accounted for the highest proportion of trials (213, 72.9%), while phase I trials accounted for the lowest proportion (14, 4.8%). Trials by academic groups had a higher termination rate (21.5% vs. 11.0%) and fewer were phase IV trials (8.2% vs. 21.9%). Treatment was explored for 16 different cancers, with lung, colorectal and breast cancers being the most common.

Conclusion

Geriatric trials of solid tumor drugs are scarce and partially prematurely terminated. Moreover, the number of geriatric trials has decreased and differs according to region. Global guidance and regulatory supervision are needed to facilitate the acquisition of adequate evidence on drug risk-benefit profiles in older adults, and thus to achieve high-quality care and safe medication.

Mpox, Caused by the MPXV of the Clade IIb Lineage, Goes Global

Mpox is a great public health concern worldwide currently; thus, a global primary epidemiological analysis of mpox and a phylogenetic analysis of currently circulating MPXV strains based on open-source data is necessary. A total of 83,419 confirmed cases with 72 deaths were reported from 7 May to 23 December 2022, representing an ongoing increasing trend. Mpox was largely restricted to being endemic in children in West Africa (WA) before 2022, and it mainly spread from animals to humans. Our analysis highlights that mpox has not only spread across regions within Africa but has also led to most infection events outside Africa. Currently, mpox has been dominated by human-to-human spread in 110 countries, with the majority of cases distributed in the non-endemic regions of Europe and North America. These data indicate that the geographic range, transmission route, vulnerable populations, and clinical manifestations of mpox have changed, which suggests that the niche of mpox has the potential to change. Remarkably, approximately 38,025 suspected mpox cases were recorded in West and Central Africa during 1970-2022, which implied that the epidemiology of mpox in the two regions remained cryptic, suggesting that strengthening the accuracy of molecular diagnosis on this continent is a priority. Moreover, 617 mpox genomes have been obtained from 12 different hosts; these data imply that the high host diversity may contribute to its ongoing circulation and global outbreak. Furthermore, a phylogenetic analysis of 175 MPXV genome sequences from 38 countries (regions) showed that the current global mpox outbreak was caused by multiple sub-clades in the clade IIb lineage. These data suggest that MPXV strains from the clade IIb lineage may play a predominated role in the spread of mpox worldwide, implying that the current mpox outbreak has a single infection source. However, further investigations into the origin of the new global mpox outbreak are necessary. Therefore, our analysis highlights that adjusted timely interventive measures and surveillance programs, especially using cheap and quick strategies such as wastewater monitoring the DNA of MPXV in Africa (WA), are important for uncovering this disease's transmission source and chain, which will help curb its further spread.

Changing trends of the disease burden of non-rheumatic valvular heart disease in China from 1990 to 2019 and its predictions: Findings from global burden of disease study

Objective

China has an increasing burden of non-rheumatic valvular heart disease (NRVHD) as the aging of the population is deepening. The aim was to assess the age and sex-specific prevalence and DALYs of NRVHD in China from 1990 to 2019 and to predict the burden in the next 25 years.

Methods

The Global Burden of Disease Study (2019) was used to extract the data of age- and sex-specific incidence, mortality, and disability-adjusted life years (DALYs) of NRVHD in China, 1990-2019. We estimated the annual percentage change (EAPC) to access the temporal trends of the disease burden of NRVHD. The R package called Nordpred was used to perform an age-period-cohort analysis to predict the prevalence of NRVHD in the next 25 years.

Results

The number of incident cases of NRVHD increased from 93.16 thousand in 1990 to 325.05 thousand in 2019. Overall upward trends were observed in the age-standardized incidence rate (ASIR) from 1990 to 2019. Significant temporal trends in mortality and DALYs of NRVHD were observed. High systolic blood pressure, high sodium diet, and lead exposure were the main driving forces for NRVHD. In the next 25 years, the number of new cases and deaths of NRVHD should continue to increase to 390.64 thousand and 10.0 thousand, respectively. The ASIR should show an upward trend, while the ASMR should show a downward trend among men and women.

Conclusion

In China, the overall rates of NRVHD have increased over the past 30 years, and there has been a substantial increase in the burden of NRVHD due to population growth and aging and will continue to increase in the next 25 years. Our results can help shape a multifactorial approach and public policy to reduce the NRVHD burden throughout China.

The temporal trend of disease burden attributable to metabolic risk factors in China, 1990-2019: An analysis of the Global Burden of Disease study

Background and aims

The disease burden attributable to metabolic risk factors is rapidly increasing in China, especially in older people. The objective of this study was to (i) estimate the pattern and trend of six metabolic risk factors and attributable causes in China from 1990 to 2019, (ii) ascertain its association with societal development, and (iii) compare the disease burden among the Group of 20 (G20) countries.

Methods

The main outcome measures were disability-adjusted life-years (DALYs) and mortality (deaths) attributable to high fasting plasma glucose (HFPG), high systolic blood pressure (HSBP), high low-density lipoprotein (HLDL) cholesterol, high body-mass index (HBMI), kidney dysfunction (KDF), and low bone mineral density (LBMD). The average annual percent change (AAPC) between 1990 and 2019 was analyzed using Joinpoint regression.

Results

For all six metabolic risk factors, the rate of DALYs and death increased with age, accelerating for individuals older than 60 and 70 for DALYs and death, respectively. The AAPC value in rate of DALYs and death were higher in male patients than in female patients across 20 age groups. A double-peak pattern was observed for AAPC in the rate of DALYs and death, peaking at age 20-49 and at age 70-95 plus. The age-standardized rate of DALYs increased for HBMI and LBMD, decreased for HFPG, HSBP, KDF, and remained stable for HLDL from 1990 to 2019. In terms of age-standardized rate of DALYs, there was an increasing trend of neoplasms and neurological disorders attributable to HFPG; diabetes and kidney diseases, neurological disorders, sense organ diseases, musculoskeletal disorders, neoplasms, cardiovascular diseases, digestive diseases to HBMI; unintentional injuries to LBMD; and musculoskeletal disorders to KDF. Among 19 countries of Group 20, in 2019, the age-standardized rate of DALYs and death were ranked fourth to sixth for HFPG, HSBP, and HLDL, but ranked 10th to 15th for LBMD, KDF, and HBMI, despite the number of DALYs and death ranked first to second for six metabolic risk factors.

Conclusions

Population aging continuously accelerates the metabolic risk factor driven disease burden in China. Comprehensive and tight control of metabolic risk factors before 20 and 70 may help to mitigate the increasing disease burden and achieve healthy aging, respectively.

Temporal Trends of Inflammatory Bowel Disease Burden in China from 1990 to 2030 with Comparisons to Japan, South Korea, the European Union, the United States of America, and the World

Purpose

To identify and predict the epidemiological burden and trends of inflammatory bowel disease (IBD) in China and compare them globally.

Methods

We collected incidence, prevalence, deaths, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and the age-standardized rates (ASRs) of IBD from 1990 to 2019 in China, four developed countries and the world, from the Global Burden of Disease Study 2019. The average annual percentage change (AAPC) was calculated to evaluate the temporal trends.

Results

From 1990 to 2019, the numbers of incident and prevalent cases, age-standardized incidence rate (ASIR), and age-standardized prevalence rate (ASPR) of IBD increased in China, regardless of gender and age; decreased YLLs and increased YLDs caused a stable number of DALYs; the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) decreased. In 2019, the ASIR, ASPR, ASMR, and ASDR were 3.01/100,000 person-years (/100,000) (95% UI: 2.59, 3.50), 47.06/100,000 (95% UI: 40.05, 54.99), 0.30/100,000 (95% UI: 0.24, 0.35), and 13.1/100,000 (95% UI: 10.29, 16.31), respectively; almost all disease burden data were higher in males. In 2017, the ASDR in different socio-demographic index provinces ranged from 24.62/100,000 (95% UI: 16.95, 33.81) to 63.97/100,000 (95% UI: 44.61, 91.48). When compared globally, the ASIR and ASPR in China had opposite trends and the highest AAPCs. In 2019, the ASIR and ASPR in China were in the middle of the world and lower than in some developed countries. The numbers and ASRs of incidence, prevalence, and DALYs were expected to increase by 2030.

Conclusion

The IBD burden in China significantly increased from 1990 to 2019 and was expected to rise further by 2030. China had the world's opposite and most dramatic trends in ASIR and ASPR from 1990 to 2019. Strategies should be adjusted to adapt to the significantly increased disease burden.

Trends in the Prevalence of Chronic Non-Communicable Diseases and Multimorbidity across Socioeconomic Gradients in Rural Southwest China

OBJECTIVES

This study aimed to determine the changing prevalence of five chronic non-communicable diseases (NCDs)- hypertension, coronary heart disease (CHD), stroke, chronic obstructive pulmonary disease (COPD), and asthma-- and its multimorbidity (refers to the co-existence of two or more chronic diseases in an individual) across socioeconomic spectra in rural southwest China.

MEASUREMENTS

Two cross-sectional health interviews and examination surveys were conducted among individuals aged ≥35 years in rural China. An individual socioeconomic position (SEP) index was constructed using principal component analysis. Anthropometric measurements, blood pressure, and post-bronchodilator spirometry tests were recorded for each participant.

RESULTS

The mean age and proportion of men was 56.1 years and 48.4% in 2011, while was 56.6 years and 49.4% in 2021. From 2011 to 2021, the overall prevalence of hypertension, stroke and COPD increased from 26.1%, 1.1%, and 8.7% to 40.4%, 2.4%, and 12.8%, respectively (P < 0.01), while prevalence of CHD (2.1% vs. 2.2%) and asthma (1.4% vs. 1.5%) did not differ between the two study years (P > 0.05). The prevalence of NCDs multimorbidity increased from 2.3% to 9.7%, and was also observed among subgroups categorized by sex, age, ethnicity, level of education, income, and SEP (P < 0.01). In addition, the relative increases in the prevalence of multimorbidity were greater among men, old individuals, ethnic minorities, and those with low level of education and low SEP. Both in 2011 and 2021, ethnic minorities and individuals with lower level of education and low SEP had a higher prevalence of multimorbidity of the five studied chronic NCDs than their counterparts (P <0.01).

CONCLUSIONS

The prevalence of NCDs multimorbidity increased substantially across all socioeconomic gradients in rural southwest China. Future interventions to further manage NCDs and their multimorbidity must be tailored to address socioeconomic factors.

Health Impacts of High BMI in China: Terrible Present and Future

Temporal trends and future expectations of health effects due to high body mass index (BMI) remain uncertain in China. The trends of high-BMI-related death in China were evaluated and predicted until 2040 using data and methods from the Global Burden of Disease study. The absolute numbers and age-standardized rates of death and disability-adjusted life years (DALYs) were also calculated by age, gender, and cause. From 1990 to 2019, the high-BMI-related death percent, number and rate were all significantly increased in China, and death rate may exceed that globally in the next 10 years. High BMI caused more deaths and DALYs for men than for women, and the gap appeared to increase over time. In 2019, the burden of high BMI among ages 0−14 and 15−19 for children and adolescents were lower than that among adults (>20 years). The most common cause of death associated with high BMI was stroke, followed by ischemic heart disease and hypertensive heart disease. High BMI burden is a significant public health challenges in China. BMI surveillance and evaluation of evidence-based preventive strategies should be immediately initiated in Chinese residents due to the rapid increase in the burden of high BMI.

Racial and regional disparities of triple negative breast cancer incidence rates in the United States: An analysis of 2011-2019 NPCR and SEER incidence data

Objective

Triple negative breast cancer (TNBC) is a more aggressive subtype resistant to conventional treatments with a poorer prognosis. This study was to update the status of TNBC and the temporal changes of its incidence rate in the US.

Methods

Women diagnosed with breast cancer during 2011-2019 were obtained from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology and End Results (SEER) Program SEER^*Stat Database which covers the entire population of the US. The TNBC incidence and its temporal trends by race, age, region (state) and disease stage were determined during the period.

Results

A total of 238,848 (or 8.8%) TNBC women were diagnosed during the study period. TNBC occurred disproportionally higher in women of Non-Hispanic Black, younger ages, with cancer at a distant stage or poorly/undifferentiated. The age adjusted incidence rate (AAIR) for TNBC in all races decreased from 14.8 per 100,000 in 2011 to 14.0 in 2019 (annual percentage change (APC) = -0.6, P = 0.024). Incidence rates of TNBC significantly decreased with APCs of -0.8 in Non-Hispanic White women, -1.3 in West and -0.7 in Northeastern regions. Women with TNBC at the age of 35-49, 50-59, and 60-69 years, and the disease at the regional stage displayed significantly decreased trends. Among state levels, Mississippi (20.6) and Louisiana (18.9) had the highest, while Utah (9.1) and Montana (9.6) had the lowest AAIRs in 2019. New Hampshire and Indiana had significant and highest decreases, while Louisiana and Arkansas had significant and largest increases in AAIR. In individual races, TNBC displayed disparities in temporal trends among age groups, regions and disease stages. Surprisingly, Non-Hispanic White and Hispanic TNBC women (0-34 years), and Non-Hispanic Black women (≥70 years) during the entire period, as well as Asian or Pacific Islander women in the South region had increased trends between 2011 and 2017.

Conclusion

Our study demonstrates an overall decreased trend of TNBC incidence in the past decade. Its incidence displayed disparities among races, age groups, regions and disease stages. Special attention is needed for a heavy burden in Non-Hispanic Black and increased trends in certain groups.

Prevalence of type 1 and type 2 diabetes in children and adolescents in Germany from 2002 to 2020: A study based on electronic health record data from the DPV registry

BACKGROUND

To provide estimates of the nationwide prevalence of type 1 diabetes (T1D) and type 2 diabetes (T2D) in individuals younger than 20 years of age in Germany from 2002 to 2020 and to identify trends.

METHODS

Data were obtained from the electronic health record "Diabetes Prospective Follow-up Registry (DPV)" specific to diabetes care. Prevalence was estimated based on prevalent cases at the end of each year for the years 2002, 2008, 2014, and 2020 per 100 000 persons assuming a Poisson distribution and directly age- and/or sex-standardized to the population in 2020. Individuals younger than 20 years of age with a clinical diagnosis of T1D or 10-19-year-olds with T2D were eligible for inclusion in the study.

RESULTS

The standardized T1D prevalence per 100 000 persons was 138.9 (95% CI: 137.1; 140.6) in 2002 and 245.6 (243.1; 248.0) in 2020. The standardized T2D prevalence per 100 000 persons was 3.4 (3.1; 3.8) in 2002 and 10.8 (10.1; 11.5) in 2020. The annual percent change (APC) in prevalence declined over the three periods 2002-2008/2008-2014/2014-2020 (T1D: 6.3% [3.6%; 9.0%]/3.1% [0.7%; 5.5%]/0.5% [-1.7%; 2.85], T2D: 12.3% [5.3%; 20.8%]/4.7% [-0.6%; 10.3%]/3.0% [-1.8%; 8.0%]). From 2014 to 2020, the highest APCs were observed among 15-19-year-olds (T1D: 2.5% [1.3%; 3.6%], T2D: 3.4% [-0.5%; 7.5%]).

CONCLUSIONS

The increase in diabetes prevalence has slowed, but medical care should be prepared for an increase in adolescents with diabetes.

Spatiotemporal trends of disease burden of edentulism from 1990 to 2019: A global, regional, and national analysis

Background

Understanding the spatiotemporal trends in disease burden of edentulism is critical to reducing disease burden of edentulism and deploying medical resources. We assessed the changing patterns of disease burden of edentulism at global, regional, and national levels from 1990 to 2019.

Methods

Data on incident cases, prevalent cases, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of edentulism were extracted from the Global Burden of Disease 2019 Study. We calculated the estimated annual percentage change (EAPC) to quantify spatiotemporal trends in the ASRs of edentulism.

Results

In 2019, the number of prevalent cases and DALYs of edentulism were 35.2 and 9.6 million, and the ASPR and ASDR were 43.12/1,000 and 1.18/1,000, with EAPCs of -0.18 [95% confidence interval (CI): -0.28, -0.09] and -0.16[95% CI: -0.26, -0.07] from 1990 to 2019, respectively. Females and the elderly had a higher burden of edentulism. Although the ASPR, ASDR, and ASIR in the high SDI, high-middle SDI, and middle SDI regions showed a decreasing or stable trend, the absolute disease burdens of edentulism in these regions were still high. Although the absolute disease burdens of low SDI and low-middle SDI were low, their ASPR and ASDR showed an upward trend. In countries with high initial disease burden or high SDI, ASPR, ASDR, and ASIR showed stable or declining trends.

Conclusion

The absolute disease burden due to edentulism was increasing in many countries and regions. Countries should reduce the disease burden caused by edentulism by adopting measures including the prevention and treatment of dental caries and periodontal disease.

The global decline in the sensitivity of vegetation productivity to precipitation from 2001 to 2018

The sensitivity of vegetation productivity to precipitation (S_ppt ) is a key metric for understanding the variations in vegetation productivity under changing precipitation and predicting future changes in ecosystem functions. However, a comprehensive assessment of S_ppt over all the global land is lacking. Here, we investigated spatial patterns and temporal changes of S_ppt across the global land from 2001 to 2018 with multiple streams of satellite observations. We found consistent spatial patterns of S_ppt with different satellite products: S_ppt was highest in dry regions while low in humid regions. Grassland and shrubland showed the highest S_ppt , and evergreen needle-leaf forest and wetland showed the lowest. Temporally, S_ppt showed a generally declining trend over the past two decades (p < .05), yet with clear spatial heterogeneities. The decline in S_ppt was especially noticeable in North America and Europe, likely due to the increase in precipitation. In central Russia and Australia, however, S_ppt showed an increasing trend. Biome-wise, most ecosystem types exhibited significant decrease in S_ppt , while grassland, evergreen broadleaf forest, and mixed forest showed slight increases or non-significant changes in S_ppt . Our finding of the overall decline in S_ppt implies a potential stabilization mechanism for ecosystem productivity under climate change. However, the revealed S_ppt increase for some regions and ecosystem types, in particular global grasslands, suggests that grasslands might be increasingly vulnerable to climatic variability with continuing global climate change.

Preservatives in non-cosmetic products: Increasing human exposure requires action for protection of health

The widespread use of skin sensitizing preservatives is well-known. Contact allergy to preservatives is often caused by their presence in cosmetic products. Preservative use in non-cosmetic products is less well-known. We have reviewed European Union (EU) legislations on classification and labelling, biocides and cosmetics, concerning conditions for use of the most used sensitizing preservatives (including formaldehyde-releasing substances, isothiazolinones and parabens). We have analysed temporal trends in their use in non-cosmetic products (tonnes, number of products, concentrations), based on annual reports to the Swedish Products Register 1995-2018; and we discuss implications for stakeholders. Major changes over time are that the use of most of the preservatives has increased by tonnes and/or by number of products, and that several use concentrations have declined following harmonized classification as a skin sensitizer with low concentration limits for this classification. We conclude that the massive increase in use of preservatives is alarming, and that urgent action is needed for protection of health. Their use in non-cosmetic products is broad, increasing and often undisclosed. In the EU, legislations concerning chemicals can provide relevant restrictions to reduce their use and associated health risks, monitored by efficient surveillance. Prevention would be benefited by better coordination between legislations.

Spatial and temporal analysis of liver cancer mortality in Yunnan province, China, 2015-2019

Liver cancer is a major public health challenge. Few published studies reported temporal trend and geographical distribution of liver cancer mortality in China, especially in less developed southwest regions with higher liver cancer incidence. In the current study, we obtained liver cancer mortality data from population-based death surveillance system in Yunnan province in 2015-2019. The mortality of liver cancer was analyzed by using the joinpoint regression model. The space distribution of liver cancer mortality in 129 counties and districts in Yunnan province was illustrated by using the ArcGIS software. Moran's I method was used to estimate the global and local spatial autocorrelation of liver cancer mortality. Analytical results revealed that from 2015 to 2019, the average mortality rate of liver cancer in Yunnan province was 12.96/100,000, with an average annual growth rate of 6.26% (p < 0.05). Higher liver cancer mortality was found in rural areas and in males. Moreover, people aged 45-50 years experienced a steep increase in liver cancer mortality rate. High-high cluster was mainly consisted of areas with higher hepatitis virus infection rate or severe intravenous drug use problem. Our study results suggest a heavy burden of liver cancer in southwest China Yunnan province. Comprehensive intervention measures need to be developed and implemented.

Temporal Trend of COVID-19 Vaccine Acceptance and Factors Influencing International Travellers

The COVID-19 pandemic has seen disrupted international travel due to travel restrictions and public health measures aimed at containing the spread of the virus. With increasing evidence of the COVID-19 vaccines' ability to mitigate disease severity, reopening tourism is desirable to promote the recovery of the global economy. However, the COVID-19 vaccine and vaccination passport for international travellers remains an ongoing debate. Little is known of the acceptance of these and the influencing factors among this population group. Therefore, this study sought to determine the temporal trend in COVID-19 vaccine acceptance and influencing factors among international travellers. A cross-sectional study was conducted using a self-administered questionnaire among international travellers who visited the Thai Travel Clinic, Hospital for Tropical Diseases, Mahidol University, Thailand from June 2021 to December 2021 (3 different variants dominated during this period). Study data were analyzed using SPSS software, version 23. Chi-square was used to demonstrate associations. Binary logistic regression was used to evaluate the magnitude of effect, demonstrated by odds ratio with 95% confidence interval. All significant variables were included in a multinomial logistic regression model to estimate adjusted odds ratios. The study enrolled 1068 travellers, 719 (67.3%) Thai and 349 (32.7%) foreign travellers. Most travellers were female (55.4%) and aged 18-30 years. The three main purposes for visiting the clinic were: for study, visiting friends and relatives, and returning to their home country. The overall COVID-19 vaccine acceptance rate among the travellers was 96.2%. The temporal trend of acceptance among Thai and non-Thai travelers varied from 93-99% and 93-100%, respectively. Vaccine efficacy, protective duration of the vaccine, risk of infection, and travel plan were factors strongly associated with COVID-19 vaccine acceptance. In conclusion, the COVID-19 vaccine acceptance rate among these international travellers was very high. The safe and effective reopening of tourism to international travellers will facilitate economic recovery.

Growing alcohol use preceding death by suicide among women compared with men: age-specific temporal trends, 2003-18

BACKGROUND AND AIMS

In the United States, until 2018 both the prevalence of heavy alcohol use and the suicide mortality rate increased among men and women; however, women had experienced a notably higher increase in both. As heavy alcohol use may have contributed to the observed sex disparity in the suicide mortality rate increase, the aim of the current study was to estimate the temporal trend of the sex- and age-group-specific proportion of suicides that were alcohol-involved in the United States.

DESIGN

Using restricted-access data from the National Violent Death Reporting System, we performed joinpoint regression analyses to investigate temporal trends in the sex- and age-group (young adults = 18-34 years; middle-aged adults = 35-64 years; and older adults = 65+ years)-specific proportion of suicides that were alcohol-involved.

SETTING

United States.

PARTICIPANTS

A total of 115 202 suicide decedents 18+ years of age from 2003 to 2018.

MEASUREMENTS

The sex- and age-group-specific proportion of suicides that were alcohol-involved, among all suicide decedent, for which the decedent had a blood alcohol concentration (BAC) (a) ≥ 0.04 g/dl and (b) ≥ 0.08 g/dl.

FINDINGS

For 2003-18, the proportion of suicides that were alcohol-involved wherein the decedent had a BAC ≥ 0.08 g/day significantly increased on average annually for women of all age groups [young women: 2.80%, 95% confidence interval (CI) = 1.86%, 3.75%; middle-aged women: 2.20%, 95% CI = 1.20%, 3.21%; older women: 10.48%, 95% CI = 1.17%, 20.65%], while only middle-aged men experienced a significant average annual percentage increase (0.81%, 95% CI = 0.003%, 1.62%).

CONCLUSION

In the United States between 2003 and 2018, alcohol use preceding death by suicide increased among women compared with men.

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.

Cross-Generational Impacts of Diet Shift on Bisphenol Analogue Loads in Indo-Pacific Humpback Dolphins (Sousa chinensis)

Bisphenol analogues (BPs) are ubiquitous pollutants to marine organisms as endocrine disruptive chemicals. However, the residue contamination and the trophic transfer of BPs in the apex predator nearshore dolphins are poorly studied. Here, we measured the concentrations of six BPs, including bisphenol A (BPA), bisphenol AF (BPAF), bisphenol B (BPB), bisphenol F (BPF), bisphenol P (BPP), and bisphenol S (BPS) in the liver of Indo-Pacific humpback dolphin (Sousa chinensis) (n = 75) collected from the Pearl River Estuary during a period with significant dietary changes (2004-2020). BPA and BPAF were the dominant components of the residue ∑BPs in the liver, with a proportion of 80%. Sex, maturity, and stranding location had no significant effects on BP levels. The generalized additive models indicated that BPA levels in juveniles and adults decreased from 2004 to 2013 while increasing from 2013 to 2020. The temporal trend of BPA levels was likely driven by the shift of the dominant diet from Harpadon nehereus to Thryssa spp. The concurrent increase of BPA loads in calves and juveniles and adults over the recent decades suggested that the diet-mediated variations of maternal BPA levels could be redistributed to their offspring.

How Have Global River Widths Changed Over Time?

Changes in a river's width reflect natural and anthropogenic impacts on local and upstream/downstream hydraulic and hydrologic processes. Temporal variation of river width also impacts biogeochemical exchange and reflects geomorphologic evolution. However, while global maps of mean river width and dynamic water surface extent exist, there is currently no standardized global assessment of river widths that documents changes over time. Therefore, we made repeated width measurements from Landsat images for all rivers wider than 90 m collected from 1984 to 2020 (named Global LOng-term river Width, GLOW), which consists of ∼1.2 billion cross-sectional river width measurements, with an average of 3,000 width measurements per 10-km reach. With GLOW, we investigated the temporal variations of global river width, quantified by the interquartile range (IQR) and temporal trend. We found that 85% of global rivers have a width IQR <150 m. We also found that 37% of global river segments show significant temporal trends in width over the past 37 years, and this number is higher (46%) for human-regulated rivers. Further, we leveraged machine learning to identify the most important factors explaining river width variations and revealed that these driving factors are significantly different between free-flowing and non-free-flowing rivers. Specifically, the most important factor driving temporal variations in river width is the climate for free-flowing rivers, and is soil condition for human-impacted rivers. Finally, we anticipate that this study and the public release of GLOW will improve the understanding of river dynamics and catalyze additional interdisciplinary studies.

Long-term risk of cardiovascular disease mortality among classic Hodgkin lymphoma survivors

BACKGROUND

The temporal trend of cardiovascular disease (CVD) mortality in patients with classic Hodgkin lymphoma (cHL) throughout follow-up remains unclear. This study aimed to assess this temporal trend in patients with cHL.

METHODS

This multicenter cohort included 15,889 patients with cHL diagnosed between 1983 and 2015, covering all ages. The proportional mortality ratio, cumulative incidence of cause-specific mortality accounting for competing risk, standard mortality ratio, and absolute excess risk were analyzed.

RESULTS

Among patients in stage I and stage II cHL, the proportional mortality ratio for CVD exceeded that for cHL, after approximately 60 or 120 months of follow-up, respectively. For almost all the patients with stage I or stage II disease, the cumulative incidence of CVD mortality exceeded that of cHL and other neoplasms over time. In recent decades, the risk of cHL mortality declined sharply, but the risk of CVD mortality among patients with cHL declined quite slowly or even remained unchanged among some populations. Patients with stage I or stage II disease experienced a higher risk of CVD mortality than the general population in almost all follow-up intervals. The absolute excess CVD risk among patients in stage I reached 48.5.

CONCLUSIONS

The risk of CVD mortality exceeded that of cHL and other neoplasms and became the leading cause of death over time, among patients with stage I or stage II disease. More effective measures should be taken to reduce the risk of CVD mortality.

LAY SUMMARY

Among patients with stage I and stage II classic Hodgkin lymphoma (cHL), the proportional mortality ratio of cardiovascular disease (CVD) exceeded that of cHL after approximately 60 or 120 months of follow-up, respectively. For almost all the patients with stage I or stage II disease, the cumulative incidence of CVD mortality exceeded that of cHL and other neoplasms over time. In the past several decades, the risk of cHL mortality declined sharply, but the risk of CVD mortality among patients with cHL declined quite slowly or even unchanged among some populations. CVD exceeded cHL and has become the leading cause of death over time.

Global incidence, mortality and temporal trends of cancer in children: A joinpoint regression analysis

BACKGROUND/METHODS

The Cancer Incidence in Five Continents Time Trends, Nordic Cancer Registries, Surveillance, Epidemiology and End Results, WHO Mortality databases were assessed to extract the Age-Standardised Rates (ASR) of cancer incidence and mortality among children aged 0-14 years old. By using the ASRs, the country-specific Average Annual Percentage Change (AAPC) and its corresponding 95% confidence interval (CI) were calculated to determine the epidemiological cancer trend.

RESULTS

In 2020, the highest incidence of childhood cancer was found in countries with higher Human Development Index (HDI) (ASR = 15.7), yet the highest mortality was found in countries with lower HDIs (ASR = 4.8). As for incidence, seven countries had positive AAPC among boys; Slovakia (AAPC_2001-2010  = 4.98, 95% CI [1.66-8.40]), Ecuador (AAPC_2003-2012  = 4.07, 95% CI [0.67-7.59]) and Thailand (AAPC_2003-2012  = 3.69, 95% CI [0.37-7.11]) had the highest AAPC. Among girls, three countries had positive AAPC, which included Belarus (AAPC_2003-2012  = 3.18, 95% CI [1.11, 5.29]), Canada (AAPC_2003-2012  = 2.83, 95% CI [1.60, 4.07]) and Korea (AAPC_2003-2012  = 1.76, 95% CI [0.23-3.32]). There was an overall decreasing trend of mortality. However, increased mortality was observed in two countries: Ecuador for boys (AAPC_2007-2016  = 1.72, 95% CI [0.27-3.19]) and Austria for girls (AAPC_2008-2017  = 4.11, 95% CI [0.38-7.98]).

CONCLUSIONS

The largest mortality and mortality to incidence ratio of childhood cancer were found in low-income countries. There was a substantial increasing trend of childhood cancer incidence, while overall its mortality has been decreasing over the past decade. More studies are needed to confirm the drivers behind these epidemiologic trends.

Nontargeted Identification and Temporal Trends of Per- and Polyfluoroalkyl Substances in a Fluorochemical Industrial Zone and Adjacent Taihu Lake

Various per- and polyfluoroalkyl substances (PFASs) remain undiscovered and unexplored in the environment. The goals of this study were to discover new species of PFASs in effluent and surface waters from a fluorochemical industrial zone, and to assess their concentration, distribution, and temporal trends in the adjacent natural environment. In total, 83 emerging PFASs from 14 classes were identified, 22 of which were reported for the first time. Authentic standards were synthesized for 13 per- and polyfluoroalkyl ether carboxylic acids (PFECAs), thereby greatly expanding the scope of PFAS-targeted monitoring. The newly identified compounds accounted for 27%-95% of the total PFAS concentrations. Of note, a novel diether carboxylic acid, 2-[2-(trifluoromethoxy)hexafluoropropoxy]tetrafluoropropanoic acid (C7 HFPO-TA) was detected at an extremely high concentration in the fluorochemical zone effluent (447 000 ng/L) and at a median concentration in the fluorochemical zone surface water (670 ng/L), with detectable levels also found in the natural environment, that is, Wangyu River (23 ng/L) and Taihu Lake (5.6 ng/L). The distinct geographic distribution of C7 HFPO-TA suggests transport from the industrial point source to Taihu Lake via the Wangyu River. The concentration of C7 HFPO-TA in Taihu Lake, along with that of many other emerging PFASs, continued to grow in three sampling campaigns from 2016 to 2021. Considering the environmental persistence and toxicity of structurally similar PFECAs (e.g., HFPO-DA), studies on C7 HFPO-TA are urgently needed.

Survival trends of patients with non-metastatic gastric adenocarcinoma in the US and European countries: the impact of decreasing resection rates

BACKGROUND

We previously observed decreasing resection rates of non-metastatic gastric adenocarcinoma (GaC) in the US and some European countries. If and to what extent these trends affect the trends in overall survival (OS) of patients with non-metastatic GaC at the population level remain unclear. This large international population-based cohort study aimed to assess the impact of the previously observed decreasing resection rates on multivariable-adjusted trends in the long-term OS of patients with non-metastatic GaC.

METHODS

Individual-level data of patients with non-metastatic GaC were obtained from the national cancer registries of the Netherlands, Belgium, Sweden, Norway, and Slovenia, and the US Surveillance, Epidemiology, and End Results database. We analyzed data for each country separately. Associations between year of diagnosis and OS were assessed using Cox proportional hazards regression model with adjustment for multiple prognostic variables, with and without including resection and chemotherapy as potential explanatory variables.

RESULTS

A total of 66,398 non-metastatic GaC patients diagnosed in 2003-2016 were analyzed, with an accumulated follow-up of 172,357 person-years. Without adjustment for resection, OS was improved only slightly in the US [hazard ratio (HR)_{per year} = 0.99; HR_{≥ vs. <2010} = 0.96], and no improvement was observed in the investigated European countries, with OS even worsening in Sweden (HR_{per year} = 1.03; HR_{≥ vs. <2010} = 1.17). After adjusting for resection, the increasing OS trend became stronger in the US (HR_{per year} = 0.98; HR_{≥ vs. <2010} = 0.88), and the temporal trend became insignificant in Sweden. In Slovenia (HR_{per year} = 0.99; HR_{≥ vs. <2010} = 0.92) and Norway (HR_{per year} = 0.97; HR_{≥ vs. <2010} = 0.86), improved OS over time emerged after resection adjustment. Improved OS in patients undergoing resection was observed in the US, the Netherlands, and Norway. Adjustment for chemotherapy did not alter the observed associations. Stratified analyses by tumor location showed mostly similar results with the findings in all patients with non-metastatic GaCs regarding the associations between year of diagnosis and survival.

CONCLUSIONS

OS of patients with non-metastatic GaC mostly did not improve in selected European countries and was even worsened in Sweden, while it was slightly increased in the US in the early 21^st century. Progress in OS of patients with non-metastatic GaC seems to have been impeded to a large extent by decreasing rates of resection.

Global magnitude of encephalitis burden and its evolving pattern over the past 30 years

OBJECTIVE

We aimed to estimate the spatiotemporal patterns of the encephalitis burden along with its attributable risk factors at the national, regional, and global levels, which may be helpful in guiding targeted prevention and treatment programs.

METHODS

Based on available data sources, the incidence, mortality, and disability-adjusted life years (DALYs) of encephalitis in 204 countries and regions from 1990 to 2019 were reconstructed by the Global Burden of Disease Study 2019 using the Cause of Death Ensemble model, spatiotemporal Gaussian process regression, and DisMod-MR 2.1. We conducted a systematic analysis on the epidemiological characteristics of encephalitis in detail by gender, region, and age over the past three decades.

RESULTS

Globally, 1,444,720 incident cases, 89,900 deaths, and 4.80 million DALYs related to encephalitis were estimated in 2019. The age-standardized incidence rate and age-standardized mortality rate (ASMR) decreased from 23.17 and 2.18 to 19.33 and 1.19 per 100,000 person-years over the past 30 years, respectively. However, beginning in 2011-2013, the burden of encephalitis has shown an inflection point, with a further decline of the ASRs ceasing. Lower socio-demographic index (SDI) regions in South Asia, Western and Eastern Sub-Saharan Africa had the highest burden of encephalitis in 2019. During the past three decades, most countries of South Asia achieved significant control of the burden. In contrast, developed countries with a higher SDI have shown a notable increase in ASMR and age-standardized DALYs rate. Children and older adults have always been high-risk groups for encephalitis.

CONCLUSION

Although the global burden of encephalitis has decreased in the past 30 years, a further decline stopped from 2011-2013. The diverse burden in different regions calls for differentiated management, and the persistent high burden in some low-SDI regions and the increased burden in developed countries with higher SDIs deserve more attention.

ABBREVIATIONS

ASDR: age-standardized DALY rate, ASIR: age-standardized incidence rate, ASMR: age-standardized mortality rate, ASR: age-standardized rate, CI: confidence interval, DALY: disability-adjusted life-year, EAPC: estimated annual percentage change, GBD: Global Burden of Disease Study, HAP: household air pollution from solid fuels, HSE: herpes simplex encephalitis, HSV: herpes simplex virus, ICD: International Classification of Diseases, JE: Japanese encephalitis, PCR: polymerase chain reaction, SDI: socio-demographic index, TBE: tick-borne encephalitis, UI: uncertainty interval.

Distribution, Risk Factors, and Temporal Trends for Lung Cancer Incidence and Mortality: A Global Analysis

BACKGROUND

Lung cancer ranks second for cancer incidence and first for cancer mortality. Investigation into its risk factors and epidemiologic trends could help describe geographical distribution and identify high-risk population groups.

RESEARCH QUESTION

What is the global incidence, mortality, associated risk factors, and temporal trends of lung cancer by sex, age, and country?

STUDY DESIGN AND METHODS

Data on incidence and mortality were retrieved from the Global Cancer Observatory (GLOBOCAN), Cancer Incidence in Five Continents series I-X, World Health Organization (WHO) mortality database, the Nordic Cancer Registries (NORDCAN), and the Surveillance, Epidemiology, and End Results Program (SEER). We searched the WHO Global Health Observatory data repository for age-adjusted prevalence of current smoking. The Average Annual Percentage Change (AAPC) of the trends were obtained by Joinpoint Regression.

RESULTS

The age-standardized rate of incidence and mortality were 22.4 and 18.0 per 100,000 globally. The lung cancer incidence and mortality were associated with Human Development Index (HDI), Gross Domestic Products (GDP), and prevalence of smoking. For incidence, more countries had increasing trends in females but decreasing trends in males (AAPC, 1.06 to 6.43 for female; -3.53 to -0.64 for male). A similar pattern was found in those 50 years or older, whereas those aged younger than 50 years had declining incidence trends in both sexes in most countries. For mortality, similar to incidence, 17 of 48 countries showed decreasing trends in males and increasing trends in females (AAPC, -3.28 to -1.32 for male, 0.63 to 3.96 for female).

INTERPRETATION

Most countries had increasing trends in females but decreasing trends in males and in lung cancer incidence and mortality. Tobacco related measures and early cancer detection should be implemented to control the increasing trends of lung cancer in females, and in regions identified as having these trends. Future studies may explore the reasons behind these epidemiological transitions.

Current and Future Trends of Low and High Molecular Weight Polycyclic Aromatic Hydrocarbons in Surface Water and Sediments of China: Insights from Their Long-Term Relationships between Concentrations and Emissions

In this study, we analyzed the temporal trend of polycyclic aromatic hydrocarbons (PAHs) in China using data reported over the past 20 years. We found that the total concentrations of low molecular weight PAHs (C_ΣLPAHs) in surface water and sediments were positively correlated with their total emissions (E_ΣLPAHs), which increased between 2000 and 2008, then decreased until 2017. Additionally, the total concentrations of high molecular weight PAHs (C_∑HPAHs) in surface water and sediments were positively correlated with their total emissions (E_ΣHPAHs), which increased significantly from 2000 to 2014 and then plateaued. Two future scenarios were assessed to explore C_∑LPAHs and C_∑HPAHs in surface water and sediments. PAH emissions were reduced by technological improvement in 2030 for coal consumption in Scenario 1 and for control of biomass burning in Scenario 2. Scenario 1 was more efficient than Scenario 2 in reducing C_∑HPAHs in the surface water and sediments of China for the areas where C_ΣHPAHs in surface water exceeded the annual average standard (i.e., 30 ng L^-1), with reductions of 38 and 24% in Scenarios 1 and 2, respectively. The observed relationships in this study can provide tools for emission reduction policies in the future.

Age- and Sex-Specific Differences in Multimorbidity Patterns and Temporal Trends on Assessing Hospital Discharge Records in Southwest China: Network-Based Study

Background

Multimorbidity represents a global health challenge, which requires a more global understanding of multimorbidity patterns and trends. However, the majority of studies completed to date have often relied on self-reported conditions, and a simultaneous assessment of the entire spectrum of chronic disease co-occurrence, especially in developing regions, has not yet been performed.

Objective

We attempted to provide a multidimensional approach to understand the full spectrum of chronic disease co-occurrence among general inpatients in southwest China, in order to investigate multimorbidity patterns and temporal trends, and assess their age and sex differences.

Methods

We conducted a retrospective cohort analysis based on 8.8 million hospital discharge records of about 5.0 million individuals of all ages from 2015 to 2019 in a megacity in southwest China. We examined all chronic diagnoses using the ICD-10 (International Classification of Diseases, 10th revision) codes at 3 digits and focused on chronic diseases with ≥1% prevalence for each of the age and sex strata, which resulted in a total of 149 and 145 chronic diseases in males and females, respectively. We constructed multimorbidity networks in the general population based on sex and age, and used the cosine index to measure the co-occurrence of chronic diseases. Then, we divided the networks into communities and assessed their temporal trends.

Results

The results showed complex interactions among chronic diseases, with more intensive connections among males and inpatients ≥40 years old. A total of 9 chronic diseases were simultaneously classified as central diseases, hubs, and bursts in the multimorbidity networks. Among them, 5 diseases were common to both males and females, including hypertension, chronic ischemic heart disease, cerebral infarction, other cerebrovascular diseases, and atherosclerosis. The earliest leaps (degree leaps ≥6) appeared at a disorder of glycoprotein metabolism that happened at 25-29 years in males, about 15 years earlier than in females. The number of chronic diseases in the community increased over time, but the new entrants did not replace the root of the community.

Conclusions

Our multimorbidity network analysis identified specific differences in the co-occurrence of chronic diagnoses by sex and age, which could help in the design of clinical interventions for inpatient multimorbidity.

Occurrence of Idiopathic Pulmonary Fibrosis in Italy: Latest Evidence from Real-World Data

The aim of the study was to evaluate the trend in the incidence of idiopathic pulmonary fibrosis (IPF) in a real-world setting of the Marche region, a region of Central Italy, between 2014 and 2019. This observational prospective study was based on administrative databases of hospital discharges and drug prescriptions. All adult residents in the Marche Region with a first prescription of antifibrotic drugs, or a first hospitalization with a diagnosis of IPF during the study period, were identified as incident cases of IPF. A multiple Poisson regression analysis was used to estimate the IPF incidence trend, adjusted for age, sex, and health conditions. The mean incidence rate was 9.8 cases per 100,000 person-years. A significant increasing trend of 6% per year was observed. The incidence rates were significantly higher in males than females, older subjects, and those with poorer health conditions. To our knowledge, this is the first study evaluating incidences of IPF over a 6-year period in Italy, combining hospital discharge and drug prescription databases. The study highlights that the combined use of two secondary sources is a reliable strategy to accurately identify new cases of IPF when the appropriate disease registry is lacking.