Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050.

METHODS

Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively.

FINDINGS

In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%.

INTERPRETATION

Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.

FUNDING

Bill & Melinda Gates Foundation.

Job insecurity and mental health related outcomes among the humanitarian workers during COVID-19 pandemic: a cross-sectional study

Background

The COVID-19 remains a public health burden that has caused global economic crises, jeopardizing health, jobs, and livelihoods of millions of people around the globe. Several efforts have been made by several countries by implementing several health strategies to attenuate the spread of the pandemic. Although several studies indicated effects of COVID-19 on mental health and its associated factors, very little is known about the underlying mechanism of job insecurity, depression, anxiety, and stress in Bangladesh. Therefore, this study determined the prevalence of job insecurity and depression, anxiety, stress as well as the association between job insecurity, mental health outcomes also contributing determinants amongst humanitarian workers during the COVID-19 pandemic in Bangladesh.

Methods

We conducted a web-based cross-sectional study among 445 humanitarian workers during the COVID-19 pandemic in six sub-districts of Cox’s bazar district of Bangladesh between April and May 2021. The questionnaire was composed of socio-demographic, lifestyle and work related factors. Psychometric instruments like job insecurity scale and depression, anxiety also stress scale (DASS-21) were employed to assess the level of job insecurity and mental health outcomes (depression, anxiety and stress). STATA software version 14 was employed to perform statistical analyses.

Results

The prevalence of job insecurity was 42%. The odds of job insecurity was higher in Kutubdia and Pekua (AOR = 3.1, 95% CI 1.36, 7.22) Teknaf (AOR = 2.9, 95% CI 1.33, 6.41), the impact of dissatisfaction on salary (AOR = 2.3, 95% CI 1.49, 3.58) was evident with job insecurity. The prevalence of moderate to severe depression, anxiety and stress among humanitarian worker were (26%, 7%), (25%, 10%) and (15%, 7%) respectively. Further, the region of work, being female, marital status, work environment, and salary dissatisfaction were contributing factors for poor mental health outcomes. Those with job insecurity were almost 3 times more likely to experience depression (AOR = 2.7, 95% CI 1.85, 4.04), anxiety (AOR = 2.6, 95% CI 1.76, 3.71) and stress (AOR: 2.8; 95% CI 1.89, 4.26), respectively.

Conclusion

Our findings highlight that job security remains essential to help tackle the severity of depression, anxiety and stress in humanitarian workers. The results reflected the critical importance of local and international NGOs addressing poor mental health conditions of their employees to prevent mental health outbreaks.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00974-7.

An Offenders-Offenses Shared Component Spatial Model for Identifying Shared and Specific Hotspots of Offenders and Offenses: A Case Study of Juvenile Delinquents and Violent Crimes in the Greater Toronto Area

Objectives

We attempted to apply the Bayesian shared component spatial modeling (SCSM) for the identification of hotspots from two (offenders and offenses) instead of one (offenders or offenses) variables and developed three risk surfaces for (1) common or shared by both offenders and offenses; (2) specific to offenders, and (3) specific to offenses.

Methods

We applied SCSM to examine the joint spatial distributions of juvenile delinquents (offenders) and violent crime (offenses) in the York Region of the Greater Toronto Area at the dissemination area level. The spatial autocorrelation, overdispersion, and latent covariates were adjusted by spatially structured and unstructured random effect terms in the model. We mapped the posterior means of the estimated shared and specific risks for identifying the three risk surfaces and types of hotspots.

Results

Results suggest that about 50% and 25% of the relative risks of juvenile delinquents and violent crimes, respectively, could be explained by the shared component of offenders and offenses. The spatially structured terms attributed to 48% and 24% of total variations of the delinquents and violent crimes, respectively. Contrastingly, the unstructured random covariates influenced 3% of total variations of the juvenile delinquents and 51% for violent crimes.

Conclusions

The Bayesian SCSM presented in this study identifies shared and specific hotspots of juvenile delinquents and violent crime. The method can be applied to other kinds of offenders and offenses and provide new insights into the clusters of high risks that are due to both offenders and offenses or due to offenders or offenses only.

Age- and Sex-Specific Association Between Vegetation Cover and Mental Health Disorders: Bayesian Spatial Study

BACKGROUND

Despite growing evidence that reduced vegetation cover could be a putative risk factor for mental health disorders, the age- and the sex-specific association between vegetation and mental health disorder cases in urban areas is poorly understood. However, with rapid urbanization across the globe, there is an urgent need to study this association and understand the potential impact of vegetation loss on the mental well-being of urban residents.

OBJECTIVE

This study aims to analyze the spatial association between vegetation cover and the age- and sex-stratified mental health disorder cases in the neighborhoods of Toronto, Canada.

METHODS

We used remote sensing to detect urban vegetation and Bayesian spatial hierarchical modeling to analyze the relationship between vegetation cover and mental health disorder cases. Specifically, an Enhanced Vegetation Index was used to detect urban vegetation, and Bayesian Poisson lognormal models were implemented to study the association between vegetation and mental health disorder cases of males and females in the 0-19, 20-44, 45-64, and ≥65 years age groups, after controlling for marginalization and unmeasured (latent) spatial and nonspatial covariates at the neighborhood level.

RESULTS

The results suggest that even after adjusting for marginalization, there were significant age- and sex-specific effects of vegetation on the prevalence of mental health disorders in Toronto. Mental health disorders were negatively associated with the vegetation cover for males aged 0-19 years (-7.009; 95% CI -13.130 to -0.980) and for both males (-4.544; 95% CI -8.224 to -0.895) and females (-3.513; 95% CI -6.289 to -0.681) aged 20-44 years. However, for older adults in the 45-64 and ≥65 years age groups, only the marginalization covariates were significantly associated with mental health disorder cases. In addition, a substantial influence of the unmeasured (latent) and spatially structured covariates was detected in each model (relative contributions>0.7), suggesting that the variations in area-specific relative risk were mainly spatial in nature.

CONCLUSIONS

As significant and negative associations between vegetation and mental health disorder cases were found for young males and females, investments in urban greenery can help reduce the future burden of mental health disorders in Canada. The findings highlight the urgent need to understand the age-sex dynamics of the interaction between surrounding vegetation and urban dwellers and its subsequent impact on mental well-being.

Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020

BACKGROUND

The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year.

METHODS

For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol.

FINDINGS

The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male.

INTERPRETATION

There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol.

FUNDING

Bill & Melinda Gates Foundation.

Understanding the Differential Impact of Vegetation Measures on Modeling the Association between Vegetation and Psychotic and Non-Psychotic Disorders in Toronto, Canada

Considerable debate exists on whether exposure to vegetation cover is associated with better mental health outcomes. Past studies could not accurately capture people's exposure to surrounding vegetation and heavily relied on non-spatial models, where the spatial autocorrelation and latent covariates could not be adjusted. Therefore, a suite of five different vegetation measures was used to separately analyze the association between vegetation cover and the number of psychotic and non-psychotic disorder cases in the neighborhoods of Toronto, Canada. Three satellite-based and two area-based vegetation measures were used to analyze these associations using Poisson lognormal models under a Bayesian framework. Healthy vegetation cover was found to be negatively associated with both psychotic and non-psychotic disorders. Results suggest that the satellite-based indices, which can measure both the density and health of vegetation cover and are also adjusted for urban and environmental perturbations, could be better alternatives to simple ratio- and area-based measures for understanding the effect of vegetation on mental health. A strong dominance of spatially structured latent covariates was found in the models, highlighting the importance of adopting a spatial approach. This study can provide critical guidelines for selecting appropriate vegetation measures and developing spatial models for future population-based epidemiological research.

Analyzing spatial and space-time clustering of facility-based deliveries in Bangladesh

Background

A spatial and temporal study of the distribution of facility-based deliveries can identify areas of low and high facility usage and help devise more targeted interventions to improve delivery outcomes. Developing countries like Bangladesh face considerable challenges in reducing the maternal mortality ratio to the targets set by the Sustainable Development Goals. Recent studies have already identified that the progress of reducing maternal mortality has stalled. Giving birth in a health facility is one way to reduce maternal mortality.

Methods

Facility delivery data from a demographic surveillance site was analyzed at both village and Bari (comprising several households with same paternal origins) level to understand spatial and temporal heterogeneity. Global spatial autocorrelation was detected using Moran’s I index while local spatial clusters were detected using the local Getis G_i* statistics. In addition, space-time scanning using a discrete Poisson approach facilitated the identification of space-time clusters. The likelihood of delivering at a facility when located inside a cluster was calculated using log-likelihood ratios.

Results

The three cluster detection approaches detected significant spatial and temporal heterogeneity in the distribution of facility deliveries in the study area. The hot and cold spots indicated contiguous and relocation type diffusion and increased in number over the years. Space-time scanning revealed that when a parturient woman is located in a Bari inside the cluster, the likelihood of delivering at a health facility increases by twenty-seven times.

Conclusions

Spatiotemporal studies to understand delivery patterns are quite rare. However, in resource constraint countries like Bangladesh, detecting hot and cold spot areas can aid in the detection of diffusion centers, which can be targeted to expand regions with high facility deliveries. Places and periods with reduced health facility usages can be identified using various cluster detection techniques, to assess the barriers and facilitators in promoting health facility deliveries.

Electronic supplementary material

The online version of this article (10.1186/s41182-019-0170-9) contains supplementary material, which is available to authorized users.

Using geospatial techniques to develop an emergency referral transport system for suspected sepsis patients in Bangladesh

Background

A geographic information system (GIS)-based transport network within an emergency referral system can be the key to reducing health system delays and increasing the chances of survival, especially during an emergency. We employed a GIS to design an emergency transport system for the rapid transfer of pregnant or early post-partum women, newborns, and children under 5 years of age with suspected sepsis under the Interrupting Pathways to Sepsis Initiative (IPSI) project.

Methods

A GIS database was developed by mapping the villages, roads, and relevant physical features of the study area. A travel-time algorithm was developed to incorporate the time taken by different modes of local transport to reach the health complexes. These were used in a network analysis to identify the shortest routes to the hospitals from the villages, which were categorized into green, yellow, and red zones based on their proximity to the nearest hospitals to provide transport facilities. An emergency call-in centre established for the project managed the transport system, and its data was used to assess the uptake of this transport system amongst distant communities.

Results

Fifteen pre-existing and two new routes were identified as the shortest routes to the health complexes. The call-in centre personnel used this route information to direct both patients and transport drivers to the nearest transport hubs or pick-up points. Adherence with referral advice was high in areas where the IPSI transport operated. Over the study period, the utilisation of the project’s transport doubled and referral compliance from distant zones similarly increased.

Conclusions

The GIS system created for this study facilitated rapid referral of patients in emergency from distant zones, using locally available transport and resources. The methodology described in this study to develop and implement an emergency transport system can be applied in similar, rural, low-income country settings.

Exploring spatial and temporal patterns of visceral leishmaniasis in endemic areas of Bangladesh

Background

Visceral leishmaniasis is a considerable public health burden on the Indian subcontinent. The disease is highly endemic in the north-central part of Bangladesh, affecting the poorest and most marginalized communities. Despite the fact that visceral leishmaniasis (VL) results in mortality, severe morbidity, and socioeconomic stress in the region, the spatiotemporal dynamics of the disease have largely remained unexplored, especially in Bangladesh.

Methods

Monthly VL cases between 2010 and 2014, obtained from subdistrict hospitals, were studied in this work. Both global and local spatial autocorrelation techniques were used to identify spatial heterogeneity of the disease. In addition, a spatial scan test was used to identify statistically significant space-time clusters in endemic locations of Bangladesh.

Results

Global and local spatial autocorrelation indicated that the distribution of VL was spatially autocorrelated, exhibiting both contiguous and relocation-type of diffusion; however, the former was the main type of VL spread in the study area. The spatial scan test revealed that the disease had ten times higher incidence rate within the clusters than in non-cluster zones. Both tests identified clusters in the same geographic areas, despite the differences in their algorithm and cluster detection approach.

Conclusion

The cluster maps, generated in this work, can be used by public health officials to prioritize areas for intervention. Additionally, initiatives to control VL can be handled more efficiently when areas of high risk of the disease are known. Because global environmental change is expected to shift the current distribution of vectors to new locations, the results of this work can help to identify potentially exposed populations so that adaptation strategies can be formulated.

Environmental factors associated with the distribution of visceral leishmaniasis in endemic areas of Bangladesh: modeling the ecological niche

Background

Visceral leishmaniasis (VL) is a parasitic infection (also called kala-azar in South Asia) caused by Leishmania donovani that is a considerable threat to public health in the Indian subcontinent, including densely populated Bangladesh. The disease seriously affects the poorest subset of the population in the subcontinent. Despite the fact that the incidence of VL results in significant morbidity and mortality, its environmental determinants are relatively poorly understood, especially in Bangladesh. In this study, we have extracted a number of environmental variables obtained from a range of sources, along with human VL cases collected through several field visits, to model the distribution of disease which may then be used as a surrogate for determining the distribution of Phlebotomus argentipes vector, in hyperendemic and endemic areas of Mymensingh and Gazipur districts in Bangladesh. The analysis was carried out within an ecological niche model (ENM) framework using a maxent to explore the ecological requirements of the disease.

Results

The results suggest that VL in the study area can be predicted by precipitation during the warmest quarter of the year, land surface temperature (LST), and normalized difference water index (NDWI). As P. argentipes is the single proven vector of L. donovani in the study area, its distribution could reasonably be determined by the same environmental variables. The analysis further showed that the majority of VL cases were located in mauzas where the estimated probability of the disease occurrence was high. This may reflect the potential distribution of the disease and consequently P. argentipes in the study area.

Conclusions

The results of this study are expected to have important implications, particularly in vector control strategies and management of risk associated with this disease. Public health officials can use the results to prioritize their visits in specific areas. Further, the findings can be used as a baseline to model how the distribution of the disease caused by P. argentipes might change in the event of climatic and environmental changes that resulted from increased anthropogenic activities in Bangladesh and elsewhere.