Dissecting incidence and mortality inequalities of six types of liver diseases in 39 alcohol-dominant countries and 93 virus-dominant countries under the aging context: Insights from the Global Burden of Disease Study 2021.

Global Disease Burden From Acute Glomerulonephritis 1990–2019

Background:To date, no study has evaluated trends in the burden of alcohol-induced cirrhosis and other chronic liver diseases based on the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2019 study. Herein, we report on the global burden of alcohol-induced cirrhosis and other chronic liver diseases in terms of age, sex, and sociodemographic index (SDI) from 1990 to 2019, based on analysis of GBD 2019 data.Methods:The estimated annual percentage change (EAPC) was calculated to determine the trends in the age-standardized incidence and mortality rates and disability-adjusted life years (DALYs) for alcohol-induced cirrhosis and other chronic liver diseases.Results:From 1990 to 2019, the global age-standardized incidence rate showed an upward trend (EAPC = 0.10), whereas the global age-standardized mortality rate and DALYs showed a downward trend (EAPC = − 0.88 and − 0.89, respectively). Low-(187.08 in 2019) and low-middle (178.11 in 2019)SDI regions had much higher age-standardized DALYs. Eastern Europe saw the largest increases in the age-standardized mortality rate and DALYs. Lithuania had the largest increase in mortalities caused by alcohol-induced cirrhosis and other chronic liver diseases(EAPC = 4.61). The age-standardized mortality rates and DALYs were higher in men than in women.Conclusion:From 1990 to 2019, the age-standardized incidence rate of alcohol-induced cirrhosis and other chronic liver diseases increased globally; however, both the age-standardized mortality rate and DALYs caused by alcohol-induced cirrhosis and other chronic liver diseases showed decreasing trends. Future studies should devise preventive strategies for low and low-middle SDI regions, Eastern Europe, Lithuania, and other high-risk regions.

Global health burden of cirrhosis and other chronic liver diseases (CLDs) due to non-alcoholic fatty liver disease (NAFLD): A systematic analysis for the global burden of disease study 2019

SummaryBackgroundCirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories.MethodsWe used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries.FindingsIn 2017, cirrhosis caused more than 1·32 million (95% UI 1·27–1·45) deaths (440 000 [416 000–518 000; 33·3%] in females and 883 000 [838 000–967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000–948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3–2·6) of total deaths globally in 2017 compared with 1·9% (1·8–2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2–22·3) per 100 000 population in 1990 to 16·5 (15·8–18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8–38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8–10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3–4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4–133·4] per 100 000 in 2017). There were 10·6 million (10·3–10·9) prevalent cases of decompensated cirrhosis and 112 million (107–119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI.InterpretationCirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH.FundingBill & Melinda Gates Foundation.

Background:Chronic liver disease (CLD), mainly non-alcoholic fatty liver disease (NAFLD), is a significant public health concern worldwide. This study aims to quantify the burden of NAFLD in CLD globally and within China, using data from the Global Burden of Disease (GBD) Study 2021, providing crucial insights for global and local health policies.Methods:The study used comprehensive data from the GBD study 2021. It included estimates of prevalence, incidence, mortality, and disability-adjusted life years (DALYs). Age-standardized rates and average annual percent change (AAPC) from 2011 to 2021 were reported. A meticulous decomposition analysis was conducted.Results:In 2021, there were 1582.5 million prevalent cases, 47.6 million incident cases, 1.4 million deaths, and 44.4 million DALYs attributable to CLD, globally. Among these, NAFLD has emerged as the predominant cause, accounting for 78.0% of all prevalent CLD cases (1234.7 million) and 87.2% of incident cases (41.5 million). Correspondingly, NAFLD had the highest age-standardized prevalence (15,017.5 per 100,000 population) and incidence (876.5 per 100,000 population) rates among CLDs. In addition, China’s CLD age-standardized prevalence rate was 21,659.5 per 100,000 population, and the age-standardized incidence rate was 752.6 per 100,000 population, higher than the global average. From 2011 to 2021, the global prevalence rate of CLD increased slowly (AAPC = 0.17), consistent with the trend in China (AAPC = 0.23). Furthermore, the prevalence rate of NAFLD rose significantly in China (AAPC = 1.30) compared with the global average (AAPC = 0.91). Decomposition analysis also showed the worldwide increase in deaths and DALYs for NAFLD, which were primarily attributable to population growth and aging.Conclusions:The burden of CLD and NAFLD remains substantial globally and within China in terms of high prevalence and incidence. As such, this underscores the need for targeted prevention and treatment strategies. These findings emphasize the importance of continued surveillance and research to mitigate the growing impact of liver diseases on global and Chinese health systems.

Background:China is one of the countries with the largest burden of gastrointestinal and liver diseases (GILD) in the world. The GILD constitutes various causes of mortality and disability. The study aimed to investigate the trend of GILD in China using the Global Burden of Diseases Study 2019 (GBD 2019) data resources from 1990 to 2019.Methods:The data on the age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) for GILD in China from 1990 to 2019 were collected from the GBD 2019 data resources. Furthermore, the ranking of the main causes of deaths and DALYs, as well as the trends of ASMR, DALYs, years of life lost (YLLs), and years of life lost due to disability (YLDs) per 1,000,000 in GILD were reported.Results:The ASMR and DALYs for stomach cancer, liver cancer, and esophageal cancer, which ranked top three among the GILDs from 1990 to 2019, were gradually decreasing. Significant decreases in the ASMR and DALYs were found in diarrheal diseases and acute hepatitis (A, E, and C). However, noteworthy increases were found in those of colon and rectum cancer (CRC) and pancreatic cancer. Trend of DALYs, mortality, and YLLs rates for most of GILD were decreasing from 1990 to 2019, except the burden of CRC and pancreatic cancer with an increasing trend. The DALYs, mortality and YLLs of most GILD diseases showed decreasing trends from 1990 to 2019, except the burden of CRC and pancreatic cancer with an increasing trends.Conclusions:The result of the GBD 2019 showed that the rates of most GILDs decreased in China; however, gastrointestinal and liver cancer, such as stomach cancer still held the top ranking. Furthermore, the shift from infectious diseases to non-communicable causes among GILD burden is occurring.

Objective: To comprehensively understand the disease burden of liver cirrhosis and other chronic liver diseases caused by alcohol use in China from 1990 to 2019, as well as to predict the trends in disease burden from 2020 to 2030. Methods: The analysis utilized data from the Global Burden of Disease study in 2019 (GBD2019). Key indicators such as incidence rate, mortality rate, disability-adjusted life years (DALY), years of life lost due to premature mortality, and years lived with disability were selected to describe the disease burden of alcohol-related liver cirrhosis and other chronic liver diseases in China from 1990 to 2019. The estimated annual percentage change (EAPC) was used to depict the temporal trends in disease burden. Furthermore, a Bayesian age-period-cohort (BAPC) model was constructed using R software to predict the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of alcohol-related liver cirrhosis and other chronic liver diseases in China from 2020 to 2030. Results: From 1990 to 2019, the incidence of alcohol-related liver cirrhosis and other chronic liver diseases in China showed an upward trend, with an EAPC of 0.31% (95%CI: 0.10%-0.52%). However, the DALY declined, with an EAPC of -2.81% (95%CI: -2.92% - -2.70%). The ASMR showed a downward trend, with an EAPC of -2.55% (95%CI: -2.66% - -2.45%). The highest incidence of cirrhosis of liver caused by alcohol and other chronic liver diseases was reported in the age group of 35-49 years, while the ASMR increased gradually with age, with a significant rise after the age of 30. The age-standardized DALY rate peaked between the ages of 55 and 64. The disease burden indicators for males were consistently higher than those for females during the same period. According to the predictions of the BAPC model, from 2020 to 2030, the ASIR for cirrhosis of liver caused by alcohol and other chronic liver diseases in the entire population of China was projected to increase from 3.45/100 000 in 2020 to 3.78/100 000 in 2030, a growth of 9.57%. Conversely, the ASMR was expected to decrease from 1.45/100 000 in 2020 to 1.24/100 000 in 2030, a reduction of 14.48%. Conclusions: The disease burden of cirrhosis of liver caused by alcohol and other chronic liver diseases remained serious in China, especially in men and the middle-aged to elderly population. There is a pressing need to prioritize attention and resources towards these groups. Despite the projected decrease in ASMR, the ASIR continued to rise and is expected to persist in its upward trend until 2030.

e22569 Background: Liver cancer remains a leading cause of cancer-related deaths in the United States and high BMI is a key risk factor, which contributes to the increasing incidence, prevalence, and mortality of liver cancer, emphasizing the need for targeted interventions and prevention strategies. Methods: Using the Global Burden of Disease (GBD) Study 2021 Results Tool, the age-standardized mortality rate (ASMR)and disability-adjusted life years (DALYs) rate were extracted, considering high BMI as a risk factor for liver cancer in the US from 1991 to 2021. Data was stratified by year, gender, and location. Mortality trends were analyzed using Joinpoint regression, and annual percentage change (APC) was calculated. Results: The Age-standardized mortality rate (ASMR) due to liver cancer attributable to high BMI showed a notable increase, rising from 0.29 per 100,000 population in 1991 (95% CI: 0.12 – 0.51) to 0.90 in 2021 (APC 7.01%, 95% CI: 0.39 – 1.47). Overall, liver cancer DALYs rose from 7.85 (95% CI: 3.18–13.61) in 1991 to 23.20 (APC 6.52%, 95% CI: 10.21–37.33) in 2021. The Joinpoint Trend Analysis reveals distinct patterns in ASMR - starting 1991-2001, APC was 5.85%, indicating a sharp rise, followed by slow growth in 2001-2007 with APC of 3.27%, followed by a resurgence to 4.58% from 2007- 2010. After 2010, the trend slowed further, with APCs of 2.57% (2010–2017) and 0.92% (2017–2021). Among males, ASMR increased from 0.39 (95% CI: 0.16–0.71) in 1991 to 1.32 (APC 7.95%, 95% CI: 0.57–2.14) in 2021, reflecting rise in the burden. For females, the ASMR increase was less pronounced, going from 0.21 (95% CI: 0.08–0.35) in 1991 to 0.53 (APC 5.08%, 95% CI: 0.23–0.86) in 2021. Analysis of ASMR for liver cancer attributable to high BMI from 1991 to 2021 reveals that all states demonstrated an upward trajectory in ASMR. The District of Columbia had the highest burden in 2021, with an ASMR of 1.21 (95% CI: 0.50–2.07), followed by Texas (ASMR: 1.166)and Alaska (ASMR: 1.162) while In 2021, Utah had the lowest burden with an ASMR of 0.66 (95% CI: 0.27–1.12), followed by New York (ASMR: 0.692) and New Jersey (ASMR: 0.735). However from 1991-2021, the District of Columbia is identified as having the lowest APC of 3.279% in ASMR. Conversely, Oklahoma shows the highest APC at 13%. Conclusions: In conclusion, liver cancer mortality and DALYs attributable to high BMI have significantly increased in the U.S. from 1991 to 2021, with notable state-level variations. These findings underscore the need for targeted interventions to address obesity and reduce its impact on liver cancer outcomes.

BackgroundExamining the distribution of the burden of different communicable and non-communicable diseases and injuries worldwide can present proper evidence to global policymakers to deal with health inequality. The present study aimed to determine socioeconomic inequality in the burden of 25 groups of diseases between countries around the world in 2019.MethodsIn the current study data according to 204 countries in the world was gathered from the Human Development Report and the Global Burden of Diseases study. Variables referring to incidence, prevalence, years of life lost (YLL), years lived with disability (YLD) and disability adjusted life years (DALY) resulting by 25 groups of diseases and injuries also human development index was applied for the analysis. For measurement of socioeconomic inequality, concentration index (CI) and curve was applied. CI is considered as one of the popular measures for inequality measurement. It ranges from − 1 to + 1. A positive value implies that a variable is concentrated among the higher socioeconomic status population and vice versa.ResultsThe findings showed that CI of the incidence, prevalence, YLL, YLD and DALY for all causes were − 0.0255, − 0.0035, − 0.1773, 0.0718 and − 0.0973, respectively. CI for total Communicable, Maternal, Neonatal, and Nutritional Diseases (CMNNDs) incidence, prevalence, YLL, YLD and DALY were estimated as − 0.0495, − 0.1355, − 0.5585, − 0.2801 and − 0.5203, respectively. Moreover, estimates indicated that CIs of incidence, prevalence, YLL, YLD and DALY for Non-Communicable Diseases (NCDs) were 0.1488, 0.1218, 0.1552, 0.1847 and 0.1669, respectively. Regarding injuries, the CIs of incidence, prevalence, YLL, YLD and DALY were determined as 0.0212, 0.1364, − 0.1605, 0.1146 and 0.3316, respectively. In the CMNNDs group, highest and lowest CI of DALY were related to the respiratory infections and tuberculosis (− 0.4291) and neglected tropical diseases and malaria (− 0.6872). Regarding NCDs, the highest and lowest CI for DALY is determined for neoplasms (0.3192) and other NCDs (− 0.0784). Moreover, the maximum and minimum of CI of DALY for injuries group were related to the transport injuries (0.0421) and unintentional injuries (− 0.0297).ConclusionsThe distribution of all-causes and CMNNDs burden were more concentrated in low-HDI countries and there are pro-poor inequality. However, there is a pro-rich inequality for NCDs’ burden i.e. it was concentrated in high-HDI countries. On the other hand, the concentration of DALY, YLD, prevalence, and incidence in injuries was observed in the countries with higher HDI, while YLL was concentrated in low-HDI countries.

Global and regional burden of alcohol-associated liver disease and alcohol use disorder in the elderly

Non-alcoholic fatty liver disease (NAFLD) is considered to be an important driver of the increasing burden of chronic liver disease (CLD) worldwide. It is necessary to analyze the burden of CLD due to NAFLD (CLD-NAFLD) systematically. Data related to CLD-NAFLD burden from 2012 to 2021 were obtained from the Global Burden of Disease Study (GBD) 2021. The temporal trend of the incidence and disability-adjusted life years (DALYs) was quantified by average annual percentage change (AAPC). The driving factors of the incidence/DALYs change were explored through decomposition analysis. Slope index and concentration index were employed to investigate cross-country health inequalities. During 2012-2021, the global age-standardized incidence rate (ASIR) of CLD-NAFLD increased from 551.52 to 592.78 (per 100,000 population), while the age-standardized DALY rate (ASDR) decreased from 31.92 to 30.90 (per 100,000 population). North Africa and Middle East had the highest age-standardized prevalence rate (ASPR), East Asia experienced the most rapid increase in ASIR, and Caribbean exhibited the most substantial increase in ASDR. Decomposition analysis showed that the main factors driving the increase in incident cases were population growth and epidemiologic changes, whereas population aging and population growth were the main driving factors for the increase of DALYs. There was cross-country health inequality in the DALYs, which showed a decreasing trend from 2012 to 2021. However, the health inequality in incidence was not significant. The burden of CLD-NAFLD continues to increase. Health policy makers must develop corresponding strategies for the primary health care of metabolic diseases.

Stroke is the second leading cause of death and the third leading cause of disability-adjusted life-years (DALYs) worldwide.1Lozano R Naghavi M Foreman K et al.Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2095-2128Summary Full Text Full Text PDF PubMed Scopus (9517) Google Scholar, 2Murray CJ Vos T Lozano R Naghavi M et al.Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2197-2223Summary Full Text Full Text PDF PubMed Scopus (6098) Google Scholar Moreover, the global burden of stroke is increasing. Between 1990 and 2010, the number of stroke-related deaths increased by 26% and DALYs by 19%.1Lozano R Naghavi M Foreman K et al.Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2095-2128Summary Full Text Full Text PDF PubMed Scopus (9517) Google Scholar, 2Murray CJ Vos T Lozano R Naghavi M et al.Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2197-2223Summary Full Text Full Text PDF PubMed Scopus (6098) Google Scholar Is this epidemic of stroke global or regional, and what is the explanation? A systematic review3Feigin VL Lawes CM Bennett DA Barker-Collo SL Parag V Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.Lancet Neurol. 2009; 8: 355-369Summary Full Text Full Text PDF PubMed Scopus (1830) Google Scholar of 56 population-based studies of the incidence and early case fatality of stroke, published from 1970 to 2008, showed that, in ten low-income and middle-income countries, the age-adjusted incidence of stroke more than doubled, from 52 per 100 000 person-years in 1970–79 to 117 per 100 000 person years in 2000–08—an increase of 5·6% per year. However, the incidence of stroke in 18 high-income countries almost halved, from 163 to 94 per 100 000 person-years—a decrease of 1% per year.3Feigin VL Lawes CM Bennett DA Barker-Collo SL Parag V Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review.Lancet Neurol. 2009; 8: 355-369Summary Full Text Full Text PDF PubMed Scopus (1830) Google Scholar These data suggest divergent patterns of stroke epidemiology in different socioeconomic regions of the world, but might be subject to selection or sampling bias because of sampling of only ten of the world's low-income and middle-income countries over four decades, and diagnostic or stroke classification bias because of a failure to distinguish major pathological subtypes of stroke (ie, ischaemic vs haemorrhagic), which have different diagnostic criteria, causes, and outcomes. In The Lancet Global Health, Rita Krishnamurthi and colleagues from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and Stroke Expert Group estimate the incidence, mortality, and DALYs of first-ever ischaemic and haemorrhagic stroke (intracerebral and subarachnoid haemorrhage) in all 21 regions of the world in 1990, 2005, and 2010.4Krishnamurthi RV Feigin VL Forouzanfar MH Mensah GA et al.on behalf of the Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2010 Study)the GBD Stroke Experts GroupGlobal and regional burden of ischaemic and haemorrhagic strokes in 1990–2010: findings from the Global Burden of Disease Study 2010.Lancet Glob Health. 2013; (published online Oct 24.)http://dx.doi.org/10.1016/S2214-109X(13)70089-5Google Scholar The investigators derived the estimates from a systematic review of all relevant studies published between 1990 and 2010. 119 studies were identified in which pathological subtypes of stroke were confirmed by brain imaging or autopsy in at least 70% of cases. Specific analytical techniques were used to calculate regional and country-specific estimates of incidence and mortality rates and DALYs lost, by age group and country income status. Surprisingly, the major finding is that, in 2010, most of the global burden of stroke was due to haemorrhagic, not ischaemic, stroke. Haemorrhagic stroke constituted a third (31·5%) of the 16·9 million incident stroke events (20% in the high-income countries and 37% in the low-income and middle- income countries), which is higher than hitherto appreciated.4Krishnamurthi RV Feigin VL Forouzanfar MH Mensah GA et al.on behalf of the Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2010 Study)the GBD Stroke Experts GroupGlobal and regional burden of ischaemic and haemorrhagic strokes in 1990–2010: findings from the Global Burden of Disease Study 2010.Lancet Glob Health. 2013; (published online Oct 24.)http://dx.doi.org/10.1016/S2214-109X(13)70089-5Google Scholar However, despite being only half as common as ischaemic stroke, haemorrhagic stroke caused more than half (51·7%) of the 5·9 million stroke-related deaths, and three fifths (61·5%) of the 102·2 million DALYs lost throughout the world. The number of years of life lost were greater with haemorrhagic stroke because it affected people at a younger age (mean 65·1 years [SD 0·11]) than did ischaemic stroke (73·1 years [0·10]) and had a higher case fatality (57% vs 25%). The second major finding is that most of the burden of ischaemic and haemorrhagic stroke is in low-income and middle-income countries, which bear 63% of incident ischaemic strokes and 80% of haemorrhagic strokes, 57% of deaths due to ischaemic stroke and 84% due to haemorrhagic stroke, and 64% of DALYs lost due to ischaemic stroke and 86% due to haemorrhagic stroke. The average age of incident and fatal ischaemic and haemorrhagic strokes was 6 years younger in low-income and middle-income countries than in high-income countries. The third finding is that most of the burden of ischaemic and haemorrhagic stroke is in people younger than 75 years, who bear 62% of incident ischaemic strokes and 78% of haemorrhagic strokes, and 63% of DALYs lost due to ischaemic stroke and 83% due to haemorrhagic stroke. The fourth finding is that, over the past two decades (1990–2010) the absolute number of people with incident ischaemic stroke has increased significantly by 37% and incident haemorrhagic stroke by 47%, the number of deaths due to ischaemic stroke by 21% and haemorrhagic stroke by 20%, and the number of DALYs lost due to ischaemic stroke by 18% and haemorrhagic stroke by 14%. The increase in absolute numbers has arisen despite a reduction in the age-standardised incidence of ischaemic stroke by 13% and haemorrhagic stroke by 19%, a reduction in the mortality rates of ischaemic stroke by 37% and haemorrhagic stroke by 38%, and a reduction in DALYs rates of ischaemic stroke by 34% and haemorrhagic stroke by 39%. The reduction in rates probably shows improved education, prevention, diagnosis, treatment, and rehabilitation of stroke. The increase in absolute numbers, despite a reduction in rates, is presumably because global population growth and increasing life expectancy have increased the denominator by a greater proportion than the increasing number of stroke events has increased the numerator. The fifth finding is that the incidence of haemorrhagic stroke in low-income and middle-income countries is one rate that has increased over the past two decades (22% increase, 95% CI 5–30), particularly in people younger than 75 years (19%, 5–30). Indeed, low-income and middle-income countries had a 40% higher incidence, 77% higher mortality, and 65% higher DALY rates of haemorrhagic stroke than did high-income countries. Krishnamurthi and colleagues' results suggest that key priorities in the quest to reduce the global and regional burden of stroke are prevention of haemorrhagic stroke, particularly in low-income and middle-income countries, and in people younger than 75 years. Most haemorrhagic strokes can be attributed to hypertension and an unhealthy lifestyle (eg, physical inactivity, obesity, unhealthy diet, alcohol excess, and smoking; table).5Lawes CM Vander Hoorn S Rodgers A for the International Society of HypertensionGlobal burden of blood-pressure-related disease, 2001.Lancet. 2008; 371: 1513-1518Summary Full Text Full Text PDF PubMed Scopus (1708) Google Scholar, 6O'Donnell MJ Xavier D Liu L et al.on behalf of the INTERSTROKE investigatorsRisk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.Lancet. 2010; 376: 112-123Summary Full Text Full Text PDF PubMed Scopus (2049) Google ScholarTableRisk factors for haemorrhagic stroke in 663 cases of acute first haemorrhagic stroke (within 5 days of symptom onset) compared with 3000 controls with no history of stroke who were matched with cases for age and sex, assessed in 22 countries between 2007 and 20106O'Donnell MJ Xavier D Liu L et al.on behalf of the INTERSTROKE investigatorsRisk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study.Lancet. 2010; 376: 112-123Summary Full Text Full Text PDF PubMed Scopus (2049) Google ScholarPrevalenceOdds ratio (99% CI)Population-attributable riskControlsCasesHistory of hypertension954/2996 (32%)399/662 (60%)3·8 (3·0–4·8)44% (37–52%)Regular physical activity362/2994 (12%)45/662 (7%)0·7 (0·4–1·1)28% (7–67%)Waist-to-hip ratio (T3 vs T1)984/2960 (33%)231/655 (35%)1·4 (1·02–1·9)26% (14–43%)Diet risk score (T3 vs T1)904/2982 (30%)221/658 (34%)1·4 (1·01–2·0)24% (12–43%)Alcohol intake*More than 30 drinks per month or binge drinker. T3=tertile 3. T1=tertile 1.324/2989 (11%)108/660 (16%)2·0 (1·3–3·0)15% (8–24%)Current smokers732/2994 (24%)207/662 (31%)1·4 (1·1–2·0)9% (4–20%)Psychosocial stress440/2987 (15%)124/654 (19%)1·2 (0·9–1·7)3% (1–16%)Data are n/N (%), unless otherwise indicated. Multivariable model adjusted for age, sex and region.* More than 30 drinks per month or binge drinker. T3=tertile 3. T1=tertile 1. Open table in a new tab Data are n/N (%), unless otherwise indicated. Multivariable model adjusted for age, sex and region. Population-based mass strategies to reduce consumption of salt, calories, alcohol, and tobacco by improving education and the environment will complement high-risk strategies of identifying those at risk of haemorrhagic (and ischaemic) stroke, thus empowering these individuals to improve their lifestyle behaviours and, if necessary, lower their mean blood pressure and blood pressure variability with appropriate doses of antihypertensive drugs.7Rose G Strategy of prevention: lessons from cardiovascular disease.Br Med J. 1981; 282: 1847-1851Crossref PubMed Scopus (800) Google Scholar, 8Hankey GJ Nutrition and the risk of stroke.Lancet Neurol. 2012; 11: 66-81Summary Full Text Full Text PDF PubMed Scopus (62) Google Scholar, 9Law MR Morris JK Wald NJ Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies.BMJ. 2009; 338: b1665Crossref PubMed Scopus (2008) Google Scholar, 10Webb AJS Fischer U Mehta Z Rothwell PM Effects of antihypertensive-drug class on interindividual variation in blood pressure and risk of stroke: a systematic review and meta-analysis.Lancet. 2010; 375: 906-915Summary Full Text Full Text PDF PubMed Scopus (563) Google Scholar I declare that I have no conflicts of interest. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010Although age-standardised mortality rates for ischaemic and haemorrhagic stroke have decreased in the past two decades, the absolute number of people who have these stroke types annually, and the number with related deaths and DALYs lost, is increasing, with most of the burden in low-income and middle-income countries. Further study is needed in these countries to identify which subgroups of the population are at greatest risk and who could be targeted for preventive efforts. Full-Text PDF Open Access

Cardiovascular disease burden attributable to dietary risk factors from 1990 to 2019: A systematic analysis of the Global Burden of Disease study

BackgroundMaternal morbidity and mortality, encompassing pregnancy-related complications and obstetric disorders, pose a persistent global health challenge with significant multigenerational consequences. As the second leading cause of disability-adjusted life years (DALYs) among women of reproductive age globally, these conditions exert profound impacts on perinatal outcomes and intergenerational health equity. The Global Burden of Disease Study (GBD), recognized as the most comprehensive epidemiological surveillance system, provides critical evidence for optimizing maternal health policies through systematic quantification of disease burden patterns. This multinational study employs GBD 2021 data to conduct a spatiotemporal analysis of maternal disorder burden across 21 GBD regions and 204 countries and territories from 1990 to 2021, utilizing standardized metrics including DALYs, prevalence rates, and mortality incidence.MethodsThis population-based multinational investigation employed systematically collected epidemiological evidence from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021, with data acquisition was conducted through the standardized Global Health Data Exchange platform (https://vizhub.healthdata.org/gbd-results/.GBD Results Tool; data retrieval date: November 11, 2024). We systematically analyzed temporal trends in maternal disorder burden from 1990 to 2021 using a standardized analytical framework stratified across three dimensions: age cohorts (10–54 years), 21 GBD-defined geographical regions, and socio-demographic index (SDI) quintiles—a composite metric integrating income, education, and fertility rates. The burden quantification employed five core metrics: (1) Disability-adjusted life years (DALYs): Integrating years of life lost (YLLs) and years lived with disability (YLDs). (2) Mortality counts: Absolute maternal deaths by etiology. (3) Estimated annual percentage change (EAPC). (4) Age-standardized mortality rate (ASMR). (5) Age-standardized DALYs rate (ASDR): Adjusted using the GBD reference population structure. All estimates reported with 95% uncertainty interval (UI) derived from 1,000 Bayesian posterior draws.ResultsQuantitative analysis of the Global Burden of Disease (GBD) 2021 dataset reveals significant advancements in maternal health metrics. Between 1990 and 2021, maternal mortality decreased by 60% (age-standardized mortality rate [ASMR]: 12.45 to 4.87 per 100,000), with disability-adjusted life years (DALYs) declining by 43.5% (age-standardized DALY rate [ASDR]: 780.8 to 315.3 per 100,000). The estimated annual percentage change (EAPC) for mortality (-3.1%, 95% CI: -3.2 to -2.99) and DALYs (-3.0%, 95% CI: -3.1 to -2.89) underscores sustained global progress. Maternal abortion and miscarriage (-4.67% EAPC), Maternal hemorrhage (-4.06% EAPC), and Maternal obstructed labor and uterine rupture (-3.68% EAPC) drove maternal mortality reductions. Maternal mortality peaked at ages 20–24 globally, with variations in high-income regions (peaks at 25–34 years). Hemorrhage dominated in sub-Saharan Africa, whereas high-income regions prioritized hypertensive disorder management. The highest maternal mortality remained in low-SDI regions, with a substantial 63% decrease (51.85 to 19.44 per 100,000), while high-SDI regions showed minimal changes. Disease burden from hemorrhage, hypertensive disorders, and abortion declined significantly, while ectopic pregnancy saw stagnation. Regional trends revealed substantial improvements in Southern Asia, while Sub-Saharan Africa remained challenged.ConclusionsThe significant decline in global maternal mortality and DALYs over the past three decades highlights the progress made in improving maternal health. However, the persistent disparities across regions and SDI levels underscore the need for targeted interventions. The findings emphasize the importance of continued surveillance and monitoring of maternal health indicators to guide policy and resource allocation. Strengthening the healthcare systems, particularly in low-SDI regions, is crucial to further reduce the burden of maternal disorders.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-23814-w.

BackgroundPulmonary arterial hypertension (PAH) is a severe and progressive lung disease that significantly impairs patients’ health and imposes heavy clinical and economic burdens. Currently, there is a lack of comprehensive epidemiological analysis on the global burden and trends of PAH.MethodsWe estimated the prevalence, mortality, disability-adjusted life years (DALYs) of PAH from 1990 to 2021 using the results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). The average annual percentage changes were used to estimate the trends of PAH across 21 regions and 204 countries and territories.ResultsFrom 1990 to 2021, the number of prevalent cases and deaths associated with PAH worldwide increased by 81.5 and 48.4%. However, the age-standardized prevalence rate of PAH remained relatively stable, while the age-standardized mortality rate and DALYs declined. In 2021, the global age-standardized prevalence rate of PAH was 2.28 per 100,000, with 1.78 per 100,000 in males and 2.75 per 100,000 in females. The age-standardized mortality rate of PAH globally was 0.27 per 100,000, and the age-standardized DALYs was 8.24 per 100,000. Among the 21 regions, Western Europe had the highest age-standardized prevalence rate (3.56 per 100,000), while North Africa and the Middle East had the highest age-standardized mortality rate (0.44 per 100,000) and DALYs (14.81 per 100,000). Additionally, older individuals and females are at higher risk of PAH. The age-standardized mortality rate and DALYs associated with PAH increase with age, peaking in the 95+ age group. As the sociodemographic index increased, the age-standardized prevalence rates showed an upward trend, while both the age-standardized mortality rates and DALYs exhibited a downward trend.ConclusionFrom 1990 to 2021, the overall trend of PAH burden presents regional and national variations and differs by age, sex, and sociodemographic index. These findings emphasize the importance of implementing targeted interventions to alleviate the burden of PAH.