Age-specific Rates Research Articles

Global burden and trends of severe periodontitis among women of childbearing age, 1990-2021.

The global burden and trend of severe periodontitis, as well as its association with sociodemographic development, among women of childbearing age (WCBA) have been unclear so far. This study aims to assess the epidemiological pattern of severe periodontitis in WCBA from 1990 to 2021 and provide projections through 2040. Data on the incidence, prevalence, and disability-adjusted life years (DALYs) of severe periodontitis among WCBA from 1990 to 2021 were retrieved from the Global Burden of Disease (GBD) study 2021. The Bayesian age-period-cohort model was run to project the age-standardized incidence rate (ASIR) through 2040. In 2021, an estimated 26,315,786 incident cases, 257,234,399 prevalent cases, and 1,680,425 DALYs were reported globally. From 1990 to 2021, a consistent annual increase in the age-standardized rate of severe periodontitis was observed, and the ASIR is projected to continue to rise until 2040. Additionally, the burden of severe periodontitis demonstrated a downward trend with increasing sociodemographic development. In 2021, age-specific rates of severe periodontitis increased with age, with the most significant changes occurring in younger age groups. The rising global burden of severe periodontitis, along with regional and age variations, highlights the urgent need for innovative prevention and healthcare strategies to reduce this burden among WCBA globally. Women of childbearing age (WCBA) represent nearly a quarter of the global population, yet there is a significant gap in consistent global and regional surveillance data on severe periodontitis in this group. Our study revealed that severe periodontitis among WCBA poses a substantial public health challenge worldwide. From 1990 to 2021, the age-standardized rate of severe periodontitis increased globally, with the most significant rise observed in regions with middle socioeconomic development. This condition disproportionately affects women in their prime years, with the fastest growth seen among younger WCBA. It is essential that healthcare providers recognize the gender disparities and societal factors related to socioeconomic development that contribute to the risk of severe periodontitis in this population. To address this issue effectively, it is crucial to develop region- and age-specific prevention strategies, as well as targeted healthcare interventions.

The prevalence of aortic stenosis in Māori undergoing clinically indicated echocardiography compared to New Zealand Europeans.

There are limited data on the prevalence of calcific aortic valve disease (CAVD) in Māori and known inequities in outcomes after aortic valve intervention. Our study aimed to investigate the prevalence of CAVD in Māori. Data from initial clinically indicated echocardiograms performed between 2010 to 2018 in patients aged ≥18 years were linked to nationally collected outcome data. Ethnicity was defined using protocols from the Ministry of Health. Of the 23,635 patients, 1,312 (5.6%) identified as Māori, and 22,323 (94.4%) as European. Prevalence of aortic stenosis was 5.3% in Māori and 9.9% in Europeans. Age-specific prevalence did not differ between the two groups. Māori with CAVD were more than twice as likely to have advanced cardiac impairment (right ventricular dysfunction) than Europeans (10.1% vs 4.6, p<0.001). Age-specific CAVD rates did not differ between Māori and Europeans, though Māori had a higher proportion of advanced cardiac impairment, which is likely unrelated to CAVD. Differences in population structure likely explain the difference in overall prevalence of CAVD. The improving life expectancy in Māori may lead to increasing incidence of CAVD, thus strategies to improve detection and medical management of CAVD should begin as soon as possible.

Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study.

Nearly 3% of adults have attention-deficit and hyperactivity disorder (ADHD), although in the UK, most are undiagnosed. Adults with ADHD on average experience poorer educational and employment outcomes, worse physical and mental health and are more likely to die prematurely. No studies have yet used mortality data to examine the life expectancy deficit experienced by adults with diagnosed ADHD in the UK or worldwide. This study used the life-table method to calculate the life-expectancy deficit for people with diagnosed ADHD using data from UK primary care. A matched cohort study using prospectively collected primary care data (792 general practices, 9 561 450 people contributing eligible person-time from 2000-2019). We identified 30 039 people aged 18+ with diagnosed ADHD, plus a comparison group of 300 390 participants matched (1:10) by age, sex and primary care practice. We used Poisson regression to estimate age-specific mortality rates, and life tables to estimate life expectancy for people aged 18+ with diagnosed ADHD. Around 0.32% of adults in the cohort had an ADHD diagnosis, ~1 in 9 of all adults with ADHD. Diagnoses of common physical and mental health conditions were more common in adults with diagnosed ADHD than the comparison group. The apparent reduction in life expectancy for adults with diagnosed ADHD relative to the general population was 6.78 years (95% CI: 4.50 to 9.11) for males, and 8.64 years (95% CI: 6.55 to 10.91) for females. Adults with diagnosed ADHD are living shorter lives than they should. We believe that this is likely caused by modifiable risk factors and unmet support and treatment needs in terms of both ADHD and co-occurring mental and physical health conditions. This study included data from adults with diagnosed ADHD; the results may not generalise to the entire population of adults with ADHD, the vast majority of whom are undiagnosed.

Neonatal mortality in 2001-2017 in France: A cause-specific and spatiotemporal analysis.

In France, the infant mortality rate had a long period of decline, but it stopped decreasing after 2010 and then rose. Neonatal mortality is a large part of infant mortality. The aim of this study was thus to describe its main changes, by cause of death and gestational age, and the main changes in socio-spatial distribution, from 2001 to 2017. For this purpose, we investigated data on neonatal deaths reported in France from 2001 to 2017. Crude, cause-specific and gestational age-specific neonatal mortality rates were computed and an ecological analysis, according to several contextual factors at commune level, was performed using quasi-Poisson regressions. The average neonatal mortality rate was 2.42 per 1000 live births in France during the study period, showing an increase from 2011 onwards. This increase was mostly related to perinatal conditions and more births at very low gestational age. Gestational age-specific neonatal mortality rates did not increase during the period. The analysis of socio-spatial factors showed increased mortality rates in large cities, deprived areas and cities with higher percentages of migrants. This study suggests that a shift in the distribution of gestational age at birth toward low gestational ages may have contributed to the rise in neonatal mortality in France. Furthermore, there is notable spatial heterogeneity in neonatal mortality. Nevertheless, this observation poorly explains the specificity of the high level and recent upsurge in infant mortality in France, in contrast to its European counterparts.

The burden of chronic kidney disease attributable to high sodium intake: a longitudinal study in 1990–2019 in China

ObjectiveElevated sodium consumption is associated with increased risk for chronic kidney disease (CKD) and data for this disease burden attributable to high sodium intake in China from 1990 to 2019 are scarce in China. Our study aims to estimate and present the national burden of CKD attributable to high sodium intake, as well as its profile.MethodsThe regional disease burden data from the China Center for Food Safety Risk Assessment (CFSA) from 1990 to 2019 were compiled based on the methodology of GBD 2019. CKD burden [deaths and disability-adjusted life years (DALYs)] was quantified according to population group (age, gender) and regions categories (province, SDI). The estimated annual percentage change (EAPC) in age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) were calculated to describe long-term trends.ResultsTotally, the number of deaths of CKD attributable to high sodium intake reached 95,000, with DALYs amounting to 2.59 million person-years in 2019, while the trends of ASMR (EAPC: -0.31, 95%CI: −0.46, −0.17%) and ASDR (−0.33, 95%CI: −0.48, −0.18%) were down during the observation period. The age-specific numbers and rates of deaths, as well as DALYs increase with age are higher in males than in females. Significant disparities in CKD burden attributable to high sodium intake were observed across provinces and SDI regions. In both 1990 and 2019, the number of deaths and DALYs were higher in middle SDI regions, while low-middle SDI regions had highest ASMR and ASDR. The EAPC of ASDR was found to be significantly negatively correlated with the 1990 ASDR (ρ = −0.393, p = 0.024), and the EAPC of ASMR and ASDR were also significantly negatively correlated with the 2019 SDI (ASMR:ρ = −0.571, p &amp;lt; 0.001; ASDR:ρ = −0.368, p = 0.035).ConclusionHigh sodium intake accounted for a sizeable burden of disease from 1990 to 2019 in China, also presents sexual and geographic variations. Despite a slight decreasing trend exists, the absolute number increased as much as twofold, particularly among males and seniors. Targeting to reduce sodium intake remains a priority, and progress requires systematic monitoring and evaluation, particularly in middle SDI regions that are experiencing rising trends and low-middle SDI regions being susceptible to approaches.

Comparative Analysis of Human Mortality Models: Insights from Denmark and the Netherlands

This study provides a comparative analysis of human mortality models for Denmark and the Netherlands from 1970 to 2008, using data from the Human Mortality Database (HMD). The analysis explores mortality trends across age groups and genders, highlighting key patterns and differences between the two countries. The Lee-Carter model is applied to analyze mortality dynamics, while the Gompertz model estimates age-specific mortality rates, both proving effective in capturing long-term trends. The study finds consistent differences between male and female mortality, with men experiencing higher mortality rates across all age groups in both countries. Mortality rates have declined significantly over time due to advancements in healthcare, socioeconomic improvements, and better living conditions. To project future mortality trends, the Random Walk with Drift model is used, offering insights into longevity and life expectancy for both populations. The results emphasize the need for ongoing public health improvements and policies to address the challenges posed by aging populations

Change trend of disease burden of chronic kidney disease mortality in Chongqing, 2012-2023

Objective: To analyze change trend of disease burden of chronic kidney disease (CKD) mortality between 2012 and 2023 in Chongqing, and provide suggestion for CKD prevention. Methods: The mortality data of CKD were collected from Chongqing death registration between 2012 and 2023 according to International Classification of Diseases 10th. The data were analyzed to calculate mortality rate, standardized mortality rate, age specific mortality rate, and the rate of years of life lost (YLL) and proportion by using software SPSS 26.0. The mortality rate of CKD between men and women, urban area and rural area were compared by χ2 test. The change trend was described by average annual percent of change (AAPC). Results: The mortality rate and standardized mortality rate of CKD were 7.94/100 000 and 4.63/100 000 respectively in 2012 and 6.70/100 000 and 2.79/100 000 respectively in 2023 in Chongqing. The difference in change of CKD mortality rate was not significant (AAPC=-0.79%, t=-1.60, P=0.273). However, the standardized mortality rate of CKD decreased by 3.59% (t=-3.98, P=0.003) from 2012 to 2023. The mortality rate of CKD was higher in men than in women in 2014 and 2022, the differences were significant (all P<0.05). The standardized mortality rate of CKD in men and women decreased by 3.17% and 4.11% respectively between 2012 and 2023, the difference was significant (all P<0.05). The mortality rate of CKD had been higher in urban area than in rural area since 2016 (all P<0.05). During this period, the mortality rate and standardized mortality rate of CKD in urban area remained stable, but the mortality rate and standardized mortality rate of CKD in rural area showed average annual decreases of 2.21% and 4.90%, the differences were significant (all P<0.05). The proportion of CKD due to hypertension decreased, but the proportion of CKD due to diabetes and other causes increased. The rate of age standardized YLL of CKD showed an average annual decrease of 2.83%, the differences were significant (P=0.011). Conclusions: The standardized mortality rate and age standardized YLL of CKD decreased from 2012 to 2023 in Chongqing. Men, urban residents and the elderly are key populations in CKD prevention.

Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture-recapture analysis.

Accurate mortality estimates help quantify and memorialise the impact of war. We used multiple data sources to estimate deaths due to traumatic injury in the Gaza Strip between Oct 7, 2023, and June 30, 2024. We used a three-list capture-recapture analysis using data from Palestinian Ministry of Health (MoH) hospital lists, an MoH online survey, and social media obituaries. After imputing missing values, we fitted alternative generalised linear models to the three lists' overlap structure, with each model representing different possible dependencies among lists and including covariates predictive of the probability of being listed; we averaged the models to estimate the true number of deaths in the analysis period (Oct 7, 2023, to June 30, 2024). Resulting annualised age-specific and sex-specific mortality rates were compared with mortality in 2022. We estimated 64 260 deaths (95% CI 55 298-78 525) due to traumatic injury during the study period, suggesting the Palestinian MoH under-reported mortality by 41%. The annualised crude death rate was 39·3 per 1000 people (95% CI 35·7-49·4), representing a rate ratio of 14·0 (95% CI 12·8-17·6) compared with all-cause mortality in 2022, even when ignoring non-injury excess mortality. Women, children (aged <18 years), and older people (aged ≥65 years) accounted for 16 699 (59·1%) of the 28 257 deaths for which age and sex data were available. Our findings show an exceptionally high mortality rate in the Gaza Strip during the period studied. These results underscore the urgent need for interventions to prevent further loss of life and illuminate important patterns in the conduct of the war. None.

Burden of female-specific cancers in China from 1990 to 2021: A systematic analysis for the Global Burden of Disease Study 2021.

Breast cancer and reproductive system cancers remain significant public health threats for Chinese women. This study aimed to evaluate the latest epidemiological patterns and trends of four female-specific cancers in China. The year- and age-specific estimates of the incidence, mortality, and disability-adjusted life-years (DALYs) associated with breast, cervical, ovarian, and uterine cancers in China from 1990 to 2021 were generated from the Global Burden of Disease, Injuries, and Risk Factors 2021 study. The epidemiological characteristics were analyzed with age-period-cohort models. A Bayesian age-period-cohort model was applied to forecast disease burden from 2022 to 2050. In 2021, China reported 385.84 thousand (95% uncertainty interval [UI], 294.10-489.01 thousand) incident cases of female breast cancer, followed by cervical cancer (132.79 thousand [95% UI, 95.96-172.60 thousand]), uterine cancer (72.02 thousand [95% UI, 53.31-100.00 thousand]), and ovarian cancer (41.24 thousand [95% UI, 30.30-54.55 thousand]). Breast cancer ranked as the primary cause of cancer-related deaths, followed by cervical cancer. The age-specific incidence rate for breast, cervical, ovarian, and uterine cancers are projected to occur in the age groups 60-64 years, 55-59 years, 65-69 years, and 60-64 years, respectively. Breast, ovarian, and uterine cancer cases are projected to rise by 2050, which will exceed those recorded in 2021. Various inequities have been identified across four types of cancers affecting women, which underscores the need for tailored national cancer control strategies. Emphasis should be placed on primary prevention and screening for breast and cervical cancers, whereas efforts for uterine and ovarian cancers should focus on implementing early diagnosis and treatment measures. This study examines the burdens and trends of breast, cervical, ovarian, and uterine cancers among Chinese women from 1990 to 2021. In 2021, breast cancer emerged as the most prevalent, followed by cervical, uterine, and ovarian cancers, with breast cancer also exhibiting the highest mortality rate. The age groups projected to exhibit the highest incidence rates for breast, cervical, ovarian, and uterine cancers are 60-64 years, 55-59 years, 65-69 years, and 60-64 years, respectively. Projections indicate that by 2050, the incidence of breast, ovarian, and uterine cancers will surpass 2021 levels, which underscores the necessity for targeted prevention, early detection, and treatment strategies.

Declines in HIV Incidence and Prevalence and Predictors Among Adolescents and Young Adults: An Observational Cohort Study, Rakai, Uganda, 2005-2020.

HIV acquisition among adolescents and young adults (AYA, 15-24 years) is influenced by individual factors, community factors, and public policies and programs. We explored the association of HIV incidence and prevalence with these factors over time among AYA in Rakai, Uganda. We examined trends over nine survey rounds (2005-2020) of the Rakai Community Cohort Study (RCCS), an open population-based surveillance cohort of individuals living in 30 continuously followed communities in south-central Uganda (n= 35,938 person rounds). We evaluated the associations between individual and community-level factors including HIV community viremia (CV, a measure of community-level ART use and HIV prevalence) and HIV incidence and prevalence. Logistic GEE, Poisson GLM and univariate models were run for HIV prevalence, HIV incidence, and predictors of interest, respectively. HIV incidence and prevalence declined over time after round 14 (2010-2011) by 66% among AYA men and after round 17 (2015-16) by 60% among young women. Between survey round 11 (2007-2008) and round 19 (2017-2019), the proportions reporting being sexually experienced declined from 58% to 38% in adolescent men (15-19) and from 65% to 35% among adolescent women. The prevalence of VMMC among adolescent men increased from 20% in round 11 to 79% in round 19. At the community-level, we found substantial increases in ART use among PLHIV ( 5% in round 11 and 86% in round 19) with corresponding declines in community viremia. In multivariable analyses, a combination of individual and community-level factors were found to predict HIV incidence and prevalence among AYA, notably VMMC among young men and community viremia among young women. Declines in HIV incidence and prevalence occurred first among AYA men and later among AYA women. These coincided with declines in sexual experience and with public policies that increased access to VMMC and ART. Combination HIV prevention with AYA needs to address risk factors at multiple levels. This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD, grants R01HD091003, RO1HD070769, R01HD050180, R01 HD074949, and P2CHD058486), the National Institute of Allergy and Infectious Diseases (grants R01AI143333, R01AI110324, U01AI100031, U01AI075115, R01AI110324, R01AI102939, and K01AI125086-01), the National Institute of Mental Health (grants R01MH115799, R01MH107275, R01 MH128232, F31MH134699), and the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases. SAG, JSS, ISC, TL, YW, ES, SH, AND PK conceived and designed the study. ISC, JT and YW oversaw data cleaning and statistical analysis and directly accessed and verified the underlying data reported in the manuscript. AK and DM accessed the data, created the figures for the resubmission and edited the text. AK and DTL, FN, DS, JK, MKG, MJW, LWC, FMS oversaw data collection. All authors had full access to the data in the study, participated in the interpretation of data and revising the manuscript, and had final responsibility for the decision to submit for publication. Evidence before this study: Age-specific rates of HIV incidence are often highest among AYA and particularly young women. Risk factors for HIV infection among AYA include earlier sexual initiation, multiple partners, and inconsistent condom use. Combination prevention including community-wide uptake of ART and male medical circumcision has been associated with declines in HIV incidence in Rakai, Uganda in the overall population. 1,2 A 2019 review of HIV incidence among adolescent girls and young women from 10 high-prevalence African countries found that few studies have examined incidence over time, and among those that there was limited evidence of incidence declines. 3 Added value of this study: Using data from 2005-2020 and the Rakai Community Cohort Study (RCCS) in southcentral Uganda, we found evidence that community-level factors including community viremia and ART use, VMMC among young men, and declines in sexual experience were associated with lower risk of HIV acquisition and seroprevalent infection among AYA. Declining HIV incidence and prevalence over time among AYA coincided with policy changes expanding access to ART and VMMC.Implications of all the available evidence: Age of sexual initiation and community-level factors play critical roles in HIV transmission in Rakai and in declines over time in youth HIV incidence and prevalence. HIV prevention for AYA needs to address individual factors and public policies to improve access to ART and VMMC.

Serosurvey of Bovine Viral Diarrhea Virus in Cattle in Southern Japan and Estimation of Its Transmissibility by Transient Infection in Nonvaccinated Cattle.

Bovine viral diarrhea (BVD) is caused by the BVD virus (BVDV) and has been reported worldwide in cattle. To estimate BVDV circulation among cattle where few BVD cases were reported in southern Japan, 1910 serum samples collected from 35 cattle farms without a BVD outbreak were investigated to detect antibodies against BVDV-1 and BVDV-2 using an indicator virus with a cytopathogenic effect and the luciferase gene, respectively. Neutralizing antibodies against BVDV-1 and BVDV-2 were detected more frequently in 18 vaccinated farms than in 17 nonvaccinated farms. In the nonvaccinated farms, 9.6%, 1.8%, and 13.8% of the cattle were estimated to have a history of infection with BVDV-1, BVDV-2, and both, respectively. The median rate of within-herd anti-BVDV-1 seropositivity among cattle in the nonvaccinated farms was 22.0%; however, a high within-herd seropositivity (>50%) was confirmed in the two farms. The force of infection, basic reproduction number, and annual probability of BVDV-1 infection were estimated as 0.072 (95% confidence interval [CI]: 0.062-0.084), 0.36 (95% CI: 0.31-0.42), and 0.73% (95% CI: 0.61-0.87%), respectively, using the age-specific positive rate of anti-BVDV-1 antibodies. These parameters should be further applicable for developing epidemiological models which illustrate the BVDV dynamics in the field.

Convergences and Divergences in the Burden of Disease in Older People Across The Organisation for Economic Cooperation and Development Countries

BackgroundThe Organization for Economic Cooperation and Development (OECD) member states are heterogeneous in their social, economic, and health conditions. Aimsa) to analyze age-specific mortality rate (ASMR) and age-specific disability-adjusted life year (DALY) rate among older people in countries by age groups (65–74 years and 75+ years) and sex, and b) to estimate the association between age-specific DALY rate with Socio-Demographic Index (SDI) and with Healthcare Access and Quality Index (HAQI). MethodsSecondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The ASMR and the age-specific DALY rate were reported for the years 1990, 2005, and 2019. Correlation between age-specific DALY rate with SDI and HAQI was estimated. ResultsThere were differences in the level and change in ASMR and the age-specific DALY rates among OECD countries. Overall, men had a higher rate for both age groups in both indicators. Although the rates have been reduced between 1990 and 2019, some countries stand out for continuing to have higher rates than countries with better socioeconomic levels. The disease burden profile also differed between adults aged 65–74 years and those aged 75+ years. In almost all cases, there was a negative and statistically significant correlation between the age-specific DALY rate with SDI and HAQI. ConclusionsThe burden of mortality and DALY in OECD countries is convergent because they have decreased over time in all countries but diverge in the magnitude and speed of change.

Ethnicity and breast cancer incidence in over 329500 women in England in 2011-2019.

Previous studies have reported an overall lower breast cancer incidence in women from Asian and Black backgrounds compared with white women. Age standardised and age specific incidence rates in the largest specific ethnicities within Asian and Black groups are not reported. Data on population size and the age distribution of women in five ethnic groups of interest (white British, Black African, Black Caribbean, Indian and Pakistani) were extracted from the Office for National Statistics 2001, 2011 and 2021 census data for England. Cancer registrations for invasive breast cancer (ICD-10 C50) in women in England aged ≥25 years during 2011-2019 with a recorded ethnicity were extracted from the National Cancer Registration and Analysis Service. Age standardised (ASIRs) and age specific (ASRs) incidence rates in five ethnic groups of interest were calculated. 329655 women who were aged ≥25 years and in one of the five ethnic groups of interest had a record of an incident C50 cancer registration during 2011-2019. The ASIR was highest for white women (199.6 (95% CI 198.9-200.3)), and lowest for Black African women (118.2 (95% CI 111.6-125.1)). The ASRs for invasive breast cancer were generally lower in women from minority ethnic groups compared to white women in all age groups examined except for younger Black Caribbean women. There are significant differences in breast cancer incidence rates between women from specific ethnicities. This requires further investigation in large scale prospective studies considering potential differences by ethnicity in known risk factors for breast cancer.

Epidemiology and survival analysis according to the histologic subtype of pancreatic cancer: a population-based cohort study.

This study investigated epidemiologic features of patients with pancreatic cancer in Korea, according to the histologic subtypes. The Korea Central Cancer Registry data on patients with pancreatic cancer from 1999 to 2019 were reviewed. The 101,446 patients with pancreatic cancer (C25 based on the International Classification of Diseases, 10th revision) were allocated according to the following morphological codes: A, endocrine; B, carcinoma excluding cystic and mucinous; C, cystic or mucinous; D, acinar cell; and E, sarcoma and soft tissue tumor. The distribution of each pancreatic cancer subtype group in Korea from 1999 to 2019 was as follows: A, n = 3,101 (3.1%); B, n = 95,051 (93.7%); C, n = 2,856 (2.8%); D, n = 299 (0.3%); and E, n = 139 (0.1%). In group B, 49.2% of patients were aged >70 years, and half of them did not receive treatment within 4 months of diagnosis. In addition, only 30.9% of the patients were in the localized and regional stage in which surgical treatment was possible. Pancreatic cancer occurred more frequently in females than in males only in group C. Between 1999 and 2019, the average annual percentage changes in the age-specific incidence rates were positive in groups A (13.9%, P < 0.001), B (1.0%, P < 0.001), and C (6.5%, P = 0.025). Significant improvements in 5-year survival rates over time were observed in subtypes A, B, and C. The subgroups of pancreatic cancer show different epidemiologic features, including incidences, treatment rates, and prognoses.

Trends in the incidence of the Epstein-Barr virus-associated malignancies extranodal NK/T-cell lymphoma and nasopharyngeal carcinoma in Taiwan.

Nasopharyngeal carcinoma (NPC) and extranodal NK/T-cell lymphoma (ENKTL) are associated with the Epstein-Barr virus (EBV). The current study aimed to evaluate the trends in the incidence of ENKTL and NPC in Taiwan within the last 15-30 years. To assess the incidence of ENKTL from 2008 to 2021 and NPC from 1995 to 2021, an epidemiological study was performed using population-based registry data from the Taiwan Cancer Registry. The secular trends in the annual incidence rates were expressed as average annual percent change (AAPC). During the study period, 872 new ENKTL diagnoses and 39412 new NPC diagnoses were reported. The annual age-adjusted incidence rates of ENKTL and NPC decreased significantly, with an AAPC of -2.47 (p = 0.014) and -1.16 (p < 0.001), respectively. The incidence rates of NPC from 1995 to 2021 in the 20-44-, 45-64-, and ≥65-year-old age groups decreased from 5.23 to 4.42 per 100,000 person-years (AAPC = -0.45, p = 0.011), from 15.28 to 11.36 per 100,000 person-years (AAPC = -1.21, p < 0.001), and from 10.48 to 7.24 per 100,000 person-years (AAPC = -1.91, p < 0.001), respectively. The age-specific incidence rates of ENKTL in the 45-64-year-old age group significantly decreased from 0.46 to 0.32 per 100,000 person-years during 2008-2021 (AAPC = -3.37, p = 0.008). The incidence of ENKTL between 2008 and 2021 in the 20-44- and ≥65-year-old age groups also decreased from 0.16 to 0.11 per 100,000 person-years and from 0.87 to 0.79 per 100,000 person-years, respectively. Interestingly, the EBV seroprevalence in Taiwan remained stable from 1984 to 2007. Nonetheless, there was a downward trend in the EBV seroprevalence in early childhood, with a decrease of approximately 20% in children aged 4 years and nearly 50% in children aged <2 years. Based on these findings, the downward trend in the incidence of NPC/ENKTL could be affected by the decline in early EBV infection rates. Considering that the EBV seroprevalence remained stable but the incidence rate of early EBV infection decreased during the same period, delayed EBV infection or factors other than EBV might play an important role in the downward trend in the incidence of NPC/ENKTL in Taiwan. Nevertheless, further investigations should be performed to assess these results.

Trends of early-onset colorectal cancer in Singapore: an epidemiological study of a multi-ethnic population.

Colorectal cancer (CRC) incidence and mortality in those aged 50 years and above have decreased over the last 2 decades. However, there is a rising incidence in CRC among individuals under 50 years of age, termed early-onset colorectal cancer (EOCRC). EOCRC patients are more advanced stage at diagnosis and may suffer more psychosocial, emotional and financial distress. Our study examines the epidemiological shifts of CRC in Singapore, a multiethnic country. CRCs diagnosed at age 20 and above from 1968 to 2019 were identified from the Singapore Cancer Registry. Patient characteristics included gender, ethnicity and age of diagnosis of CRC. Population information was obtained from the Department of Statistics Singapore. Age specific incidence rates (ASR) and age standardized incidence rates (ASIR) were calculated. The cohort was divided into 3 age groups: 20 - 49, 50 - 64 and ≥65 years. Temporal trends of incidence rates were modelled with Joinpoint Regression. Birth cohort models were fitted using the National Cancer Institute (NCI) age-period-cohort analysis tool. Cancer-specific survival analysis was performed with Cox proportional hazards model. 53044 CRCs were included, and 6183 (11.7%) adults aged 20 to 49 years were diagnosed with EOCRC. ASR of EOCRC rose from 5 in 1968 to 9 per 100,000 in 1996 at 2.1% annually and rose to 10 per 100,000 in 2019 at 0.64% annually. The ASR for CRC among adults 50 to 64 years rose at 3% annually from 1968 to 1987 and plateaued from 1987 while the ASR for adults aged 65 and above rose at 4.1% from 1968 to 1989 and 1.3% annually from 1989 to 2003 but decreased from 2003 onwards at 1% annually. There is a continued rise in the ASR of EOCRC among males (APC: 1.5%) compared to females (APC: 0.41%) and a significant increase in APC for early-onset rectal cancer at 1.5% yearly. Compared to the 1950 - 1954 birth reference cohort, the 1970 - 1984 birth cohort had a significantly higher incidence rate ratio (IRR) of 1.17 - 1.36 for rectal cancer while there was no significant change for colon cancer in later cohorts. There were differences in CRC trends across the 3 ethnic groups. Malays had a rapid and persistent rise in ASR of CRC across all age groups (APC: 2- 3%) while amongst young Chinese, only the ASR of rectal cancer is increasing (APC: 1.5%). EOCRC patients had better survival compared to patients diagnosed at 65 years and above (HR 0.73, 95% CI 0.67 - 0.79, P <0.001) after adjusting for covariates. The rise in incidence of rectal cancer among young adults especially among Chinese and Malays in Singapore highlights the need for further research to diagnose CRC earlier and reduce cancer-related morbidity and mortality.

Incidence of and Risk of Mortality After Hip Fractures in Rheumatoid Arthritis Relative to the General Population.

Osteoporosis, a known complication of rheumatoid arthritis (RA), increases the risk of hip fracture, which is associated with high morbidity and mortality. Fracture risk estimates in patients with RA treated with contemporary treatment strategies are lacking. The objectives were (1) estimate age-specific and sex-specific incidence rates and compare the risk of hip fractures in RA relative to age-matched and sex-matched general population controls, and (2) compare the risk of all-cause mortality in RA and general population controls after hip fracture. A longitudinal study of a population-based incident cohort of patients with RA diagnosed between 1997 and 2009, followed until 2014, with age-matched and sex-matched controls from the general population of British Columbia, using administrative health data. Hip fracture outcomes (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes 820.0 or 820.2; ICD-10-Canada code S72.0 to S72.2) and mortality at predefined intervals after fracture (in hospital, 90 days, 1-year, 5-year) were identified. Hip fracture incidence rates for RA and controls, and incidence rate ratios (IRRs), were calculated. Cox proportional hazards models compared hip fracture and mortality risk in RA versus controls; logistic regression compared in-hospital mortality risk. Overall, 1,314 hip fractures over 360,521 person-years were identified in 37,616 individuals with RA and 2,083 over 732,249 person-years in 75,213 controls, yielding a 28% greater fracture risk in RA (IRR 1.28 [95% confidence interval 1.20-1.37]). Mean age at time of fracture was slightly younger for RA than controls (79.6 ± 10.8 vs 81.6 ± 9.3 years). Postfracture mortality risk at one-year and five-years did not differ between RA and general population controls. Results were similar in a sensitivity analysis including only individuals with RA who received disease-modifying antirheumatic drugs. People with RA had a greater risk of hip fractures, but no greater risk of mortality post fracture, than the general population. The relative risk of hip fractures observed was not as high as previously reported, likely reflecting better treatment of inflammation and management of osteoporosis and its risk factors.

Hepatocellular carcinoma national burden across different geographical regions in the United States between 2001 and 2020.

While prior data showed an increasing incidence of hepatocellular carcinoma (HCC) in the United States, there are limited comprehensive and comparative data on the geographical variations of HCC trends in different demographic-specific populations. To evaluate sex and age-specific incidence rates and time trends in different geographical regions in the United States. Age-adjusted HCC incidence rates were collected from the United States Cancer Statistics (USCS) database which covers approximately 98% of the population in the United States. HCC rates were stratified by sex, age, and geographical region. annual percentage change (APC) and average APC (AAPC) were estimated using Joinpoint Regression. A pairwise comparison was conducted between sex-specific trends. There were 467344 patients diagnosed with HCC in the United States in the USCS database between 2001 and 2020. The rates and trends varied by geographical region. When looking at the West region (115336 patients), incidence rates of HCC were overall increasing and also increasing in older adults. However, when evaluating younger adults, HCC incidence rates decreased in men but not in women with a sex-specific absolute AAPC-difference of 2.15 (P = 0.005). When evaluating the Midwest region (84612 patients), similar results were seen. While incidence rates were increasing in the overall population and in older adults as well, they were decreasing in younger men but not in women with a sex-specific absolute AAPC-difference of 1.61 (P < 0.001). For the Northeast region (87259 patients), the analysis showed similar results with decreasing HCC incidence rates in younger men but not counterpart women (Sex-specific AAPC-difference = 3.26, P < 0.001). Lastly, when evaluating the south (180137 patients), the results were also decreasing in younger men but not in women (Sex-specific AAPC-difference = 2.55, P < 0.001). Nationwide analysis covering around 98% of the United States population shows an increasing incidence of HCC across all geographical regions, most notably in the South. While younger men experienced decreasing HCC incidence, younger women had a stable trend and this was noted across all regions as well. Our study offers insight into the epidemiology of HCC in different demographic groups across various United States geographical regions. While the reasons contributing to our findings are unclear, they can be related to sex and regional disparities in healthcare access and utilization. Future research is warranted to characterize the temporal change in HCC risk factors across different United States regions.

No evidence that breast cancer occurs at higher rates among young Arab women

Background: Breast cancer is often thought to occur at a younger age among Arab women based on the mean or median age at diagnosis, or the proportion of women diagnosed with breast cancer at a young age. Objective: To compare age-specific breast cancer incidence rates among women from selected Arab countries with selected high- and middle-income countries. Methods: We examined population-based, age-specific, national or regional breast cancer incidence data for 2008–2012 and 2013–2017 from Australia, Brazil, Canada, Germany, Japan, United Kingdom, and United States of America, and compared them with data from Algeria, Bahrain, Jordan, Kuwait, Morocco, Qatar, and Saudi Arabia. Results: Breast cancer incidence among young women in the selected Arab countries was comparable to, or even lower than, the selected high- and middle-income countries. In contrast to the continued increase in rates observed in the high- and middle-income countries, the rates tended to plateau or decrease among older Arab women. Age-standardized incidence rates were lower than crude rates in the Arab countries. Conclusion: We found no evidence that Arab women are at higher risk of developing breast cancer at a younger age. The high number of cases among them was probably due to the younger population structure. These findings are important for refining breast cancer screening policies in the region.

Bayesian age-period-cohort projection of cancers in Iran: a modeling study

IntroductionCancer is a significant public health issue in Iran, and its incidence has been on the rise in recent years. The objective of this study is to predict the incidence of total cancer in Iran using a Bayesian age-period-cohort (APC) model.MethodsUtilizing age-period-cohort modeling, this study assessed the multifaceted effects of age, period, and cohort on cancer incidence during the period spanning 2005 to 2017. Key metrics, including the net drift (representing the overall annual percentage change), local drift (indicating annual percentage changes within specific age groups), and longitudinal age curves (depicting expected age-specific rates over time), were computed. Moreover, the evaluation encompassed an analysis of period and cohort relative risks. To project the future age-standardized incidence rates of cancers from 2018 to 2027, Bayesian age-period-cohort analysis integrated nested Laplace approximations.ResultThe age-standardized incidence rate and the absolute number of cancer cases in Iran showed an upward trend. The net drift was 1.79% (95% confidence interval, CI: 0.87% to 2.72%) for males and 3.31% (95% CI: 2.49% to 4.14%) for females. Local drifts remained consistently above zero for all age groups from 2005 to 2017, except for the under-5 age group in both males and females, and the 45–49 and 50–54 age groups in females. After accounting for period deviations, the risk of cancer incidence exhibited an exponential increase with age for both sexes. Based on the Bayesian age-period-cohort analysis, it is estimated that there will be around 210,701 new cancer cases in 2027. Moreover, the Age-Standardized Rate (ASR) for cancer is anticipated to reach 240.32 per 100,000 by 2027. The forecasts indicate a rise in cancer incidence rates across all age groups for both males and females.ConclusionThis study underscores the urgency of implementing targeted preventive strategies aligned with demographic shifts and lifestyle factors. Emphasizing the role of robust cancer registries, it advocates for continuous monitoring to inform evidence-based interventions.