Global, Regional, and National Burden of Tracheal, Bronchial, and Lung Cancer Attributable to Low Fruit Intake From 1990 to 2021

BackgroundPneumococcal infections remain a leading cause of preventable deaths among children and adolescents aged <20 years. Despite a global decrease in burden, significant regional and socioeconomic disparities, as well as long-term trends, are not fully understood.MethodsWe used data from the Global Burden of Disease Study 2021 (GBD 2021) to evaluate mortality and disability-adjusted life years (DALYs) attributable to pneumococcal infections among those aged 0–19 years across global, regional, and 204 national settings from 1990 to 2021. Temporal trends were assessed using estimated annual percentage change (EAPC), and Spearman correlation examined associations with the sociodemographic index (SDI). Decomposition analysis quantified the contributions of demographic and epidemiological drivers. Health inequality was assessed via the slope index of inequality (SII) and concentration index (CI). A Bayesian age-period-cohort (BAPC) model projected future burden to 2036.ResultsIn 2021, pneumococcal infections caused 179,354 deaths (95% UI: 142,347–217,280) and 15,757,828 DALYs (95% UI: 12,500,395–19,088,138) among individuals aged 0–19 years, with the highest burden in children under 5. From 1990 to 2021, global age-standardized mortality rate (ASMR) dropped from 36.18 to 6.80 per 100,000 (EAPC –4.89, 95% CI: −5.23 to −4.54). High-middle SDI regions had the largest decline (EAPC –8.63%), while Oceania had the smallest (EAPC –2.20%). Epidemiological changes were the main drivers of burden reduction, partly offset by population growth. The SII for ASMR and age-standardized DALY rate (ASDR) decreased from −83.91 to −11.19 and from −7,395.42 to −975.38, respectively, indicating a reduction in absolute inequality, while the CI for both increased from 0.47 to 0.55, suggesting a growing relative concentration of burden in high-SDI countries despite the persistently high absolute burden in low-SDI regions. BAPC projections indicate the global ASMR will fall to 1.59 per 100,000 (95% UI: 0.82–2.35) by 2036.ConclusionOver the past 30 years, the global burden of pneumococcal disease among children and adolescents has significantly declined. However, high burdens persist in low-SDI regions and among children under 5, with increasing relative inequalities. Strengthening vaccination coverage, healthcare systems, and interventions for high-risk populations is essential to further reduce the global burden.

ObjectivesData on health inequalities in inflammatory bowel disease (IBD) among women of childbearing age (WCBA, 15–49 years) across different countries are lacking. We aimed to assess the global incidence, disability-adjusted life year (DALY) burden and cross-country inequalities of IBD in WCBA from 1990 to 2021.DesignObservational study.SettingData were extracted from the Global Burden of Disease Study 2021.ParticipantsWomen aged 15–49 years diagnosed with IBD.Primary and secondary outcome measuresThe primary outcomes were the total numbers and age-standardised rates of incidence and DALYs. Secondary outcomes included (1) temporal trends, assessed using estimated annual percentage change (EAPC); (2) periods of significant change identified through joinpoint regression analysis and (3) health inequalities by sociodemographic index (SDI), assessed using the slope index of inequality (SII) and the concentration index.ResultsGlobally, from 1990 to 2021, the number of incident IBD cases among WCBA increased from 60 926 (95% uncertainty interval (UI) 50 342 to 74 910) to 98 975 (95% UI 80 568 to 124 089), and DALYs increased from 193 091 (95% UI 145 850 to 245 244) to 281 580 (95% UI 223 989 to 349 966). During the same period, the age-standardised incidence rate (ASIR) increased significantly (EAPC 0.22, 95% UI 0.1 to 0.34), whereas the age-standardised DALY rate (ASDR) decreased significantly (EAPC −0.28, 95% UI −0.35 to −0.21). In 2021, the highest ASIR (14.93 per 100 000, 95% UI 11.52 to 18.97) and ASDR (27.94 per 100 000, 95% UI 19.97 to 37.87) were observed in high-SDI regions. In contrast, the fastest increase in ASIR (EAPC 1.69, 95% UI 1.48 to 1.90) occurred in middle-SDI regions. High-middle-SDI regions exhibited the most pronounced decrease in ASDR (EAPC −0.8, 95% UI −0.92 to −0.67), whereas a notable upward trend in ASDR was found solely in low-SDI regions (EAPC 0.14, 95% UI 0.07 to 0.21). The SII for ASIR increased from 4.83 (95% CI 3.63 to 6.03) in 1990 to 6.26 (95% CI 4.90 to 7.63) in 2021, whereas the concentration index decreased from 0.35 (95% CI 0.25 to 0.44) to 0.24 (95% CI 0.16 to 0.33). The SII for ASDR decreased from 7.37 (95% CI 2.07 to 12.67) in 1990 to 5.97 (95% CI 1.38 to 10.56) in 2021, and the concentration index shifted from 0.13 (95% CI 0.06 to 0.2) in 1990 to −0.03 (95% CI −0.1 to 0.05) in 2021.ConclusionsIn 2021, the global incidence and ASDR burden remained concentrated in high-SDI countries, with significant regional disparities. From 1990 to 2021, health inequality in DALYs gradually shifted from high-income to low-income countries.

BackgroundHypertensive heart disease (HHD) is a major global contributor to cardiovascular-related disability. Although its burden has been previously described, detailed analyses of long-term disability trends by sociodemographic level and sex remain scarce. This study aimed to systematically assess global and subgroup-specific patterns in HHD-related disability-adjusted life years (DALYs) from 1990 to 2021.MethodsData from the Global Burden of Disease Study 2021 were used to evaluate age-standardized DALY rates for HHD across five socio-demographic index (SDI) levels and by sex from 1990 to 2021. Temporal trends were assessed using Joinpoint regression with estimated annual percent change (EAPC). Future rates through 2036 were projected using Bayesian age–period–cohort models. Decomposition analysis quantified contributions of population growth, aging, and epidemiologic changes, and risk-attributable DALYs were estimated for five modifiable exposures.ResultsGlobally, DALYs from HHD increased from 15.47 to 25.46 million (+ 64.6%) between 1990 and 2021, while the age-standardized DALY rate declined from 406.51 to 301.58 per 100,000 population (EAPC – 0.96; 95% CI – 0.98 to – 0.93). DALY counts rose and age-standardized DALY rate declined across all SDI levels, with the greatest reduction in middle-SDI regions (EAPC – 1.89; 95% CI – 2.17 to – 1.60) and notable decreases in high-middle SDI regions (EAPC – 1.06; 95% CI –1.68 to – 0.43). Rates in females remained consistently higher than in males, with projections suggesting persistent disparities through 2036. Decomposition analysis indicated that population aging and growth were the main contributors to DALY increases, partially offset by epidemiological improvements. High systolic blood pressure (− 100%) and elevated body mass index (− 50%) were the leading modifiable risk factors across SDI levels.ConclusionsDespite declines in age-standardized DALY rate, the absolute HHD burden continues to grow, particularly among women and in low-SDI regions. Targeted, equity-focused cardiovascular strategies are urgently needed to address these persistent disparities.Supplementary InformationThe online version contains supplementary material available at 10.1186/s41182-025-00791-9.

BACKGROUND Ovarian cancer (OC) is the third most common gynecologic malignancy worldwide, predominantly affecting middle-aged and elderly women.The prognosis for ovarian cancer is significantly better when detected in its early stages (1A and 1B), with a five-year survival rate of 92%. However, only 15% of ovarian cancer cases are diagnosed at these early stages. The majority of women are diagnosed with advanced-stage disease, typically at International Federation of Gynecology and Obstetrics (FIGO) stage III. Ovarian cancer is a diverse category of tumors, comprising various histological subtypes that arise from different origins.Epithelial tumors account for 90% of ovarian cancer cases.Invasive epithelial ovarian cancer primarily affects postmenopausal women, with 70% of cases diagnosed at an advanced stage. Despite progress in surgery and systemic therapies, the five-year survival rate for patients with advanced ovarian cancer remains under 30%. OBJECTIVE We aimed to assess the global, regional, and national burdens and trends of Ovarian Cancer in Women Aged 45+ from 1990 to 2019 and Projections for 2050,utilizing data from the most recent Global Burden of Disease (GBD) 2021 database. METHODS We analyzed the age-standardized rates of incidence, prevalence, mortality, and isability-adjusted life years (DALYs) for ovarian cancer in women aged 45 and older using data from the GBD 2021 study.Temporal trends were evaluated using estimated annual percentage change (EAPC) metrics. Regional differences were examined by stratifying the data according to the Socio-Demographic Index (SDI). Age-Period-Cohort (APC) modeling was employed to investigate disease dynamics across age groups and birth cohorts, while the Bayesian Age-Period-Cohort (BAPC) model is used to project global burden trends to 2050. RESULTS In 2021, the global incidence,prevalence，mortality, and disability-adjusted life years (DALYs) cases of ovarian cancer in 45+ middle-aged and older womenwere 239682.42，843405.02，171245.50，4352538.86，respectively. The global disease burden of ovarian cancer in middle-aged and older women is declining significantly from 1990 to 2021,From 2022 to 2050, no significant changes are expected in the burden of ovarian cancer among middle-aged and older women.However, there are significant differences in the burden of disease between countries and regions; the burden of ovarian cancer among middle-aged and older women in the High SDI and High-middle SDI regions has decreased significantly, while on the contrary, the burden of disease has increased significantly in the Middle SDI, Low-middle SDI, and Low SDI regions.Disease burden increased with SDI up to 0.8, then declined.Population growth contributed the most to disease burden, followed by epidemiologic changes and aging. The study also showed that 55-59 years of age had the highest number of morbidity, morbidity, and DALYs, and 65-69 years of age had the highest number of deaths. CONCLUSIONS Despite the overall decline in the global burden of ovarian cancer among middle-aged and older women, its complex distribution across populations and regions emphasizes the need for targeted prevention and treatment approaches. These strategies are essential to further reduce the burden of disease and improve patient prognosis.

Global, regional, and national burden of genitourinary cancers in 204 countries and territories, 1990–2021: a systematic analysis for the global burden of disease study 2021

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.

BackgroundMetabolic factors have an increasing impact on hypertensive heart disease (HHD). This study analyzes the global burden trends of HHD from 1990–2021, focusing on the contributions of high systolic blood pressure (HSBP) and high body mass index (BMI).MethodsThis study, based on the 2021 GBD database, analyzes the trends in deaths, disability-adjusted life-years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) attributable to HSBP and high BMI from 1990–2021 at global, regional, and national levels. The estimated annual percentage change (EAPC) is used to assess the temporal dynamics of the disease burden, and the relationship between the disease burden and the sociodemographic index (SDI) is explored.ResultsIn 2021, deaths and DALYs due to HSBP and high BMI significantly increased compared to 1990. However, the ASMR for HSBP-related HHD [EAPC: −0.68; 95% confidence interval (CI): −0.77 to −0.58] and ASDR (EAPC: −0.90; 95% CI: −0.99 to −0.80) showed a decreasing trend, while the ASMR for BMI-related HHD (EAPC: 0.33; 95% CI: 0.27–0.39) and ASDR (EAPC: 0.15; 95% CI: 0.10–0.21) exhibited an increasing trend. From 1990–2021, the regions with the largest increases in ASMR and ASDR for HSBP-related HHD were Eastern Europe and High-income North America, while the largest increases for BMI-related HHD were seen in High-income North America. Moreover, most of the top 10 countries with the largest increases in ASMR and ASDR due to HSBP and BMI were from Eastern Europe. Additionally, in 2021, China had the highest number of deaths and DALYs globally due to HSBP and high BMI-related HHD. At the SDI level, Low SDI regions had the highest ASMR and ASDR for both HSBP and BMI-related HHD in 2021, with a negative correlation to overall SDI. Furthermore, deaths, DALYs, ASMR, and ASDR due to HSBP and BMI in females were generally higher than in males after the ages of 64 and 54, respectively, with the disease burden mainly concentrated in middle-aged and elderly populations.ConclusionsMetabolic factors are major risk contributors to HHD, with a disproportionately higher burden of mortality and DALYs observed among older adults, particularly women in later life stages. Given these trends, early identification and intervention in key populations should be prioritized through targeted public health strategies and multilayered interventions to mitigate the global burden of HHD and alleviate its growing strain on healthcare systems.

BackgroundThe findings of the 2021 Global Burden of Disease (GBD) study can offer valuable insights for the development of screening and prevention strategies targeting ischemic heart disease (IHD). We aim to investigate trends in IHD incidence, mortality, and disability-adjusted life years (DALYs), while exploring associated risk factors for IHD-associated death from 1990 to 2021.MethodsThe cross-sectional study utilized data from the GBD 2021, covering 204 countries and regions. The analysis included individuals aged 55 and above. We analyzed the trends in IHD incidence, all cause and cause-specific deaths, DALYs, and corresponding estimated annual percentage changes (EAPCs) from 1990 to 2021. These indicators were further stratified by geographical region, country, age group, gender, and sociodemographic index (SDI).ResultsThe global incidence rate, mortality rate, and DALYs rate for individuals aged 55 and above with IHD have shown a decreasing trend. However, the number of incident cases, death cases, and DALYs has been increasing from 1990 to 2021. Both the high-middle and high SDI regions exhibit a significant decline in these rates from 1990 to 2021. However, the low SDI, low-middle SDI, and middle SDI regions show less noticeable changes. The region with low-middle SDI experiences the largest increase in mortality rate (EAPC: 0.38; 95%CI, 0.33–0.44) and DALYs rate (EAPC: 0.17; 95%CI, 0.12–0.22). The region with middle SDI experiences the largest increase in incidence rate (EAPC: 0.37; 95%CI, 0.27–0.46). Regionally, East Asia exhibits the greatest increase in incidence rate (EAPC: 0.94; 95% CI, 0.79–1.10), mortality rate (EAPC: 1.68; 95% CI, 1.40–1.94), and DALYs rate (EAPC: 0.94; 95% CI, 0.69–1.20). Among the 12 risk factors associated with mortality from IHD, high systolic blood pressure, dietary risks, high low-density lipoprotein (LDL) cholesterol levels, and air pollution are identified as the primary contributors to global mortality.ConclusionsThis study reveals that in high SDI regions, the incidence, mortality, and DALYs rate of IHD are declining. Conversely, in low to middle SDI regions, the disease burden of IHD is increasing. It highlights global inequality in IHD burden. Recommendations include early screening, risk management, and strengthening primary care, especially in middle and low SDI regions. Countries should also invest in environmental governance and air pollution control. Future research should focus on evaluating the effects of health policies in different countries, exploring the impact of socio-economic and cultural factors on the burden of IHD, and developing big data-based prediction models to optimize resource allocation and intervention strategies.

Colorectal cancer (CRC) and inflammatory bowel disease (IBD) are major, interrelated digestive disorders whose global burdens are evolving with demographic aging, lifestyle westernization, and uneven access to prevention and care. Despite substantial disease-specific analyses, decision-makers still lack an integrated, up-to-date synthesis that jointly quantifies the burdens of CRC and IBD across sociodemographic contexts and provides robust projections to guide equitable resource allocation. This study, using Global Burden of Disease (GBD) 2021 data, addresses these gaps by harmonizing standardized burden metrics, temporal trend analyses, and long-range forecasts to elucidate shared and distinct trajectories of CRC and IBD. It aims to uncover associations between the diseases and prioritize prevention strategies. We performed a cross-sectional analysis of GBD data for 1990-2021, covering 204 countries/territories, 21 GBD regions, and five sociodemographic index (SDI) strata. We estimated age-standardized incidence rates (ASIR), prevalence rates (ASPR), mortality rates (ASMR), and age-standardized disability-adjusted life year rate (ASDALYR), with two-sided P < 0.05 considered significant. Temporal changes were quantified using estimated annual percentage change (EAPC) and average annual/period percentage change. Future trajectories were projected using Bayesian age-period-cohort (BAPC) modeling. Analyses and visualization were conducted in R (v4.2.3) and JD_GBDR (v2.24). The study followed STROCSS reporting guidance. Globally, CRC incidence increased from 916.58 thousand in 1990 to 2194.14 thousand in 2021 (an increase of 139.38%), with pronounced heterogeneity across SDI strata. ASIR has been declining in high SDI regions since 2008 (EAPC=-0.25) but rising sharply in medium SDI areas (EAPC=1.38). CRC prevalence rose by 173.72% overall, with medium-SDI regions experiencing a particularly steep increase (~401.69% over 30years), contrasting with earlier peaks and partial stabilization in high-SDI settings. Although CRC deaths increased by 83.07% in absolute numbers, ASMR declined from 21.82 to 17.39, consistent with gains from screening and improved treatment in higher-SDI regions. Disability-adjusted life year rates rose 69.49%, while ASDALYR declined, indicating improved diagnostics and prevention. Projections show slow incidence growth to 2039 due to environmental risks, reversing post-2039 with prevention measures; ASPR growth slows, while ASMR and ASDALYR continue declining. For IBD, cases increased from 199.23 to 375.12 thousand (88.28%), with the fastest ASIR growth in medium-SDI regions (EAPC=1.54); high SDI areas slowed via biologics. Prevalence showed "increasing cases, decreasing rates," with ASPR dropping from 48.02 to 44.88/100 000. Deaths doubled, but ASMR fell to 0.52/100 000; ASDALYR decreased 2.89% in East Asia. Forecasts predict declines in all indicators from 2022 to 2050, with accelerated ASMR drops post-2030, reflecting treatment advancements. By jointly appraising CRC and IBD burdens, temporal trends, and long-range projections across 204 countries, this study provides the most comprehensive, policy-relevant synthesis to date. It delineates actionable disparities by SDI strata, clarifies the epidemiologic interrelationship between IBD and CRC risk, and offers decision-grade evidence to prioritize screening, lifestyle modification, and equitable access to effective therapies - thereby advancing global strategies for prevention and control.

Global burden due to modifiable risk factors for autoimmune diseases, 1990–2021: Temporal trends and socio-demographic inequalities

ObjectiveThis study assessed the global burden and trends of cardiovascular diseases attributable to secondhand smoke (CVD-SHS) from 1990 to 2021.MethodsThe global burden of disease (GBD) database was utilized to analyze estimated annual percentage change (EAPC), age-standardized mortality rates (ASMR), age-standardized DALY rates (ASDR), disability-adjusted life years (DALYs), and deaths due to CVD-SHS. Subsequently, further analysis was conducted by region, age group, sex, and socio-demographic index (SDI). Finally, Spearman correlation analyses were used to assess the correlation of ASDR and ASMR with SDI.ResultsFrom 1990 to 2021, global CVD-SHS deaths and DALYs increased by 34.5 and 23.1%, respectively, while ASMR and ASDR decreased by 41.8 and 42.0%. In 2021, CVD-SHS deaths totaled 694,692 (ASMR 8.31/100,000), with DALYs at 16,674,552 (ASDR 194.59/100,000). Regionally, the highest ASDR and ASMR were observed in low-middle and middle SDI regions, with minimal reductions in low SDI regions. Correlation analysis indicated that ASMR and ASDR, as well as their EAPCs, were negatively correlated with SDI. Moreover, CVD-SHS burden was higher in males and older age groups, predominantly affecting those aged 35 and above in lower SDI regions, and those aged 65 and above in high SDI regions.ConclusionFrom 1990 to 2021, the global, regional, and national burden of CVD-SHS showed a paradoxical trend: while ASMR and ASDR declined, the absolute number of deaths and DALYs continued to rise. The burden and its growth rate were negatively correlated with SDI, with the highest impacts observed in low- and middle-SDI regions, males, and older populations. Moreover, stroke-SHS showed a stronger negative correlation with SDI than IHD-SHS, suggesting subtype-specific disparities. These findings highlight the persistent and uneven burden of CVD-SHS worldwide and underscore the need for targeted, region- and disease-specific prevention strategies.

ObjectivesWe aimed to analyse the trends, age distribution and disease burden of maternal sepsis and other maternal infections (MSMI) to improve management strategies.DesignWe extracted data from the global burden of disease (GBD) 2021 database to evaluate MSMI burden with different measures for the whole world, 21 GBD regions and 204 countries from 1990 to 2021.SettingStudies from the GBD 2021 database generated by population-representative data sources identified through a literature review and research collaborations were included.ParticipantsPatients with an MSMI diagnosis.OutcomesTotal numbers, age-standardised rates (ASRs) of incidence, prevalence, mortality and disability-adjusted life years (DALYs) on MSMI from the GBD 2021 study and their estimated annual percentage changes (EAPCs) were the primary outcomes.ResultsThere were 19 047 404 (95% uncertainty interval (UI) 14 608 563 to 24 086 486) annual incident cases, 2 376 876 (95% UI 1 678 868 to 3 421 377) prevalent cases at a single time point, 17 665 (95% UI 14 628 to 21 191) death cases and 1 144 233 (95% UI 956 988 to 1 352 034) DALYs of total MSMI in 2021. From 1990, the case number and ASRs of incidences and prevalence showed decreasing trends, while the case number and ASRs of mortality and DALYs gradually increased with time, reaching the peak in 2001, and then declined. In 2021, the ASRs of incidence, prevalence, mortality and DALYs sharply increased with age, which reached the peak in the 20–24 age group. The ASRs were decreased with increasing sociodemographic index (SDI). In 2021, it showed a positive correlation between EAPC and ASR of DALYs (r=0.3398, p<0.001).ConclusionsThe disease burden in low-SDI regions far exceeded that of regions with higher SDI. The persistent disparities in the burden of MSMI between low- and high-SDI regions underscore the urgent need for context-specific interventions, including targeted healthcare infrastructure investments in central and western sub-Saharan Africa, integration of WHO’s Maternal Sepsis Guidelines into national policies, and prioritisation of antenatal care access for women aged 20–24 years. These strategies align with sustainable development goals to reduce maternal mortality and achieve universal health coverage by 2030.

Background: Smoking is the primary risk factor for tracheal, bronchus, and lung (TBL) cancer. Objective: This study aims to explore the epidemiological trends of smoking-attributable TBL cancer from 1990 to 2021. Methods: Mortality and disability-adjusted life-years (DALYs) data for smoking-related TBL cancer from 1990 to 2021 were sourced from the Global Burden of Disease Study (GBD) 2021. Estimated annual percentage changes (EAPCs) were calculated to evaluate trends in age-standardized mortality rates (ASMRs) and age-standardized DALY rates (ASDRs). Additionally, the relationship between disease burden, EAPCs, and the sociodemographic index (SDI) was assessed. Findings: Compared with 1990, both the mortality and DALYs due to smoking-related TBL cancer substantially increased by 2021. However, during this period, ASMR [EAPC: -0.97; 95% confidence interval (CI): -1.05 to -0.89] and ASDR (EAPC: -1.29; 95% CI: -1.37 to -1.22) demonstrated a downward trend. ASMR and ASDR in females were consistently lower than in males. In 2021, East Asia had the highest ASMR, while Central Europe recorded the highest ASDR, with Greenland exhibiting the highest ASMR and ASDR at the national level. Nationally, ASMR for smoking-related TBL cancer in 2021 showed a positive correlation with SDI, while the EAPC of both ASMR and ASDR from 1990 to 2021 displayed a negative correlation with SDI. Furthermore, in 2021, the greatest number of deaths from smoking-related TBL cancer occurred in individuals aged 70-74, while DALYs were highest in the 65-69 age group. Conclusions: The burden of smoking-related TBL cancer varies across age, sex, geography, and SDI regions. Tailored public health interventions aligned with these epidemiological characteristics are essential for alleviating the disease burden.

BackgroundStroke, a leading global cause of death and disability, has high alcohol consumption as a significant modifiable risk factor. Despite the known association, the global spatiotemporal burden and changing relationship between high alcohol use and stroke subtypes remain inadequately characterized. This study quantifies the global, regional, and national burden of stroke attributable to high alcohol intake from 1990 to 2021.MethodsUtilizing data from the Global Burden of Disease (GBD) 2021 study, we analyzed deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) for stroke attributable to high alcohol use. Metrics were age-standardized rates and stratified by sex, age, sociodemographic index (SDI), GBD region, and stroke subtype (ischemic stroke, intracerebral hemorrhage). Estimated annual percentage change (EAPC) quantified trends. Frontier analysis, decomposition analysis, and cross-country inequality analysis assessed socioeconomic disparities.ResultsGlobally, ASMR decreased by 40.28% (from 7.20 [95% UI 1.40–14.66] to 4.30 [1.00–8.39] per 100,000, EAPC = −1.81) and ASDR declined from 154.83 [33.98–299.48] to 97.89 [23.83–187.71] per 100,000 (EAPC = −1.63). While age-standardized YLL rates markedly improved (EAPC = −1.75), age-standardized YLD rates declined minimally (EAPC = −0.25), indicating persistent long-term disability burden. Significant disparities existed: males consistently bore a higher burden than females, though female ASMR declined more significantly (55.86% vs. 34.25%). High SDI regions showed substantial declines (e.g., ASMR EAPC = −3.28), but low-middle SDI regions experienced increasing ASMR (EAPC = 0.37) and ASDR (EAPC = 0.43), driven by rising YLDs and YLLs. Southeast Asia had the largest ASMR increase (EAPC = 2.86). National burdens were highest in Bulgaria, North Macedonia, and Vietnam. Ischemic stroke burden showed reducing socioeconomic inequality, but intracerebral hemorrhage burden increasingly concentrated in disadvantaged populations (SII = −47.40, CII = −0.19 in 2021). Frontier analysis identified Vietnam, Bulgaria, and Laos with the largest unrealized health potential. Decomposition revealed global DALYs increases were driven by population aging (92.5%) and growth (149.3%), partially offset by reduced age-specific rates (−141.8%).ConclusionGlobal stroke mortality attributable to high alcohol use declined significantly from 1990 to 2021, reflecting progress in prevention and acute care. However, minimal improvement in disability burden reveals critical gaps in long-term management and rehabilitation, creating a “survival-disability paradox.” Profound disparities persist across genders, regions, SDI levels, and stroke subtypes. Targeted policies addressing excessive alcohol consumption, tailored to regional contexts and focused on both prevention and comprehensive post-stroke care, are urgently needed, particularly in low-middle SDI regions and Southeast Asia, to mitigate disability and health inequities.

BackgroundDeclining estrogen in perimenopausal women reduces bone mineral density and increases bone fragility, elevating fall and fracture risk. This presents major challenges for patients and society, yet prior studies lack systematic analysis of this population. This study is the first to utilize mortality and disability-adjusted life years (DALYs) related to falls among perimenopausal women from the Global Burden of Disease (GBD) 2021 database, and to conduct a comprehensive and systematic analysis of the evolving burden of falls in perimenopausal women from 1990 to 2021, as well as to project trends through 2050. This study offers key guidance for optimizing healthcare resource allocation, enhancing patient management, and developing targeted prevention and intervention strategies.MethodsThis study used GBD 2021 data to systematically analyze fall-related mortality, DALYs, age-standardized rates (ASRs), and estimated annual percentage change (EAPC) among perimenopausal women, examining their associations with the Socio-demographic Index (SDI) at global, regional, and national levels. Joinpoint regression, decomposition, health inequality, and frontier analyses quantified trends, identified factors, and assessed disparities. This study also explored fall risk factors and utilized the Bayesian Age-Period-Cohort (BAPC) model to project global trends in fall burden among perimenopausal women from 2022 to 2050.ResultsBetween 1990 and 2021, global mortality attributable to falls among perimenopausal women surged by 116.99% (from 1.67 to 3.63 per 100,000), while DALYs increased by 38.31% (from 116.50 to 188.85 per 100,000). In contrast, age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) declined by 7.00% (EAPC = − 0.30) and 14.62% (EAPC = − 0.56), respectively. Decomposition analysis identified population growth as the predominant contributor to the escalation in mortality (162.91%), while epidemiological changes were the main reason for the reduction (− 63.63%). Marked heterogeneity was observed across SDI strata: low-middle SDI regions exhibited the steepest rise in mortality (138.00%), whereas high-SDI regions achieved the most pronounced reduction in ASMR (− 21.18%). Notably, high-income North America experienced an 106.62% increase in ASMR. The 50–54-year age cohort consistently represented the highest global burden, with low bone mineral density emerging as the principal risk factor. Projections to 2050 suggest ongoing declines in ASMR and ASDR, yet the absolute burden is expected to remain elevated due to persistent demographic expansion.ConclusionsBetween 1990 and 2021, the global burden of falls among perimenopausal women has exhibited a persistent upward trend, and projections indicate that this burden will likely remain at a high level in the future. This alarming situation underscores the urgent need for targeted interventions. Identifying key risk factors for falls in perimenopausal women is essential for guiding the allocation of public health resources and formulating precise intervention strategies. It is imperative to implement nationwide, cost-effective measures, such as osteoporosis and fall risk screening, the promotion of exercise programs that enhance muscle strength and balance, and, where appropriate, consideration of pharmacological interventions (such as estrogen) to reduce fall risk. This intervention will significantly reduce the risk of falls and associated burdens among perimenopausal women.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40520-025-03210-5.