Age-standardised Disability-adjusted Life-years Rates Research Articles

Global, regional and national burden of CKD in children and adolescents from 1990 to 2019.

Chronic kidney disease(CKD) is one of the most prevalent non-communicable health concerns in children and adolescents worldwide; however, data on its incidence, prevalence, disability-adjusted life years (DALYs) and trends in the population are limited. We aimed to assess the global, regional and national trends in CKD burden in children and adolescents. In this trend analysis based on the 2019 Global Diseases, Injuries, and Risk Factors Study, CKD incidence, prevalence and DALYs rates per 100000 population for children and adolescents were reported at the global, regional and national levels, as well as the average annual percentage change (AAPC). These global trends were analyzed by age, sex, region and socio-demographic index (SDI). Globally, the overall incidence of CKD (all stages including kidney replacement therapy) in children and adolescents showed an increasing trend [AAPC 0.44 (95% confidence interval 0.36-0.52)] between 1990 and 2019. Similarly, the overall prevalence of CKD also showed an upward trend [AAPC 0.46 (0.42-0.51)]. However, the DALYs of CKD showed a continuous decreasing trend [AAPC -1.18 (-1.37 to -0.99)]. The population aged 15-19 years had the largest CKD incidence increase during this period. The largest increase in age-standardized incidence rate (ASIR) was in middle SDI countries [AAPC 0.56 (0.45-0.67)]. The relationship between the ASIR and SDI showed an inverse U-shaped correlation while the relationship between the age-standardized DALYs rate (ASDR) and SDI showed an inverse trend with SDI. Among adolescents (15-19 years), the ASIR continued to increase for five causes of CKD, owing to type 2 diabetes mellitus and hypertension. Most of the disease burden was concentrated in countries with a lower SDI. Andean Latin America and Central Latin America showed the largest increases in CKD ASIR between 1990 and 2019. The burden of CKD in children and adolescents has increased worldwide, especially in regions and countries with a lower SDI.

Burden of liver cancer due to hepatitis C from 1990 to 2019 at the global, regional, and national levels.

Liver cancer due to hepatitis C (LCDHC) is one of the leading causes of cancer-related deaths worldwide, and the burden of LCDHC is increasing. We aimed to report the burden of LCDHC at the global, regional, and national levels in 204 countries from 1990 to 2019, stratified by etiology, sex, age, and Sociodemographic Index. Data on LCDHC were available from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study 2019. Numbers and age-standardized mortality, incidence, and disability-adjusted life year (DALY) rates per 100,000 population were estimated through a systematic analysis of modeled data from the GBD 2019 study. The trends in the LCDHC burden were assessed using the annual percentage change. Globally, in 2019, there were 152,225 new cases, 141,810 deaths, and 2,878,024 DALYs due to LCDHC. From 1990 to 2019, the number of incidences, mortality, and DALY cases increased by 80.68%, 67.50%, and 37.20%, respectively. However, the age-standardized incidence, mortality, and DALY rate had a decreasing trend during this period. In 2019, the highest age-standardized incidence rates (ASIRs) of LCDHC were found in high-income Asia Pacific, North Africa and the Middle East, and Central Asia. At the regional level, Mongolia, Egypt, and Japan had the three highest ASIRs in 2019. The incidence rates of LCDHC were higher in men and increased with age, with a peak incidence in the 95+ age group for women and the 85-89 age group for men in 2019. A nonlinear association was found between the age-standardized rates of LCDHC and sociodemographic index values at the regional and national levels. Although the age-standardized rates of LCDHC have decreased, the absolute numbers of incident cases, deaths, and DALYs have increased, indicating that LCDHC remains a significant global burden. In addition, the burden of LCDHC varies geographically. Male and older adult/s individuals have a higher burden of LCDHC. Our findings provide insight into the global burden trend of LCDHC. Policymakers should establish appropriate methods to achieve the HCV elimination target by 2030 and reducing the burden of LCDHC.

The burden of brain and central nervous system cancers in Asia from 1990 to 2019 and its predicted level in the next twenty-five years

BackgroundPrimary brain and central nervous system cancer (collectively called CNS cancers) cause a significant burden to society. The purpose of this study was to evaluate the trends in the burden of CNS cancers from 1990 to 2019 and to predict the incidence and mortality rates and the corresponding numbers for the next 25 years to help countries to understand the trends in its incidence and mortality, and to make better adjustments or formulation of policies and allocation of resources thereby reducing the burden of the disease.MethodsThe 2019 Global Burden of Disease Study provided incidence rates, death rates, and disability-adjusted life year (DALY) data in Asia from 1990 to 2019. To reflect the trends in the age-standardized incidence, mortality, and DALY rates, the estimated annual percentage change (EAPC) was determined. The Bayesian age-period cohort (BAPC) model was employed to predict the burden of CNS cancers in the next 25 years.ResultsThe incidence, death, and DALY rates of CNS cancers all increased from 1990 to 2019. The age-standardized incidence rate (ASIR) for CNS cancers increased from 9.89/100,000 in 1990 to 12.14/100,000 in 2019, with an EAPC of 0.69 (95% confidence interval (CI): 0.65, 0.73). The ASDR and the age-standardized DALY rate both decreased, with EAPCs of − 0.08 and − 0.52, respectively. Before 2005, the age-standardized DALY rate in East Asia was much greater in females than in males, while in Central Asia, the age-standardized death and DALY rates in males both increased sharply after 2000. In contrast to 1990, the caseload increased for the 55–70 years age group. The number of deaths decreased sharply among individuals aged younger than 20 years, especially in East Asia, accounting for only 5.41% of all deaths. The age group with the highest mortality rate was > 60 years, especially in Japan. The ASIR will continue to increase in Asia from 2020 to 2044, and the ASDR will gradually diminish. The incidence and number of deaths from CNS cancers in Asia are expected to increase over the next 25 years, especially among females.ConclusionsThe study identified an increasing trend in morbidity, mortality and disability-adjusted life-years (DALYs), with differences in age-standardized morbidity rates for different population groups. In addition, it is noteworthy that the burden of disease (as measured by disability-adjusted life-years (DALYs)) is higher among women in Central Asia compared with other regions. ASIR will continue to increase over the next 25 years, with the increase in female cases and mortality expected to be more pronounced. This may need to be further substantiated by additional research, on the basis of which health authorities and policymakers can better utilize limited resources and develop appropriate policies and preventive measures.

The Burden of Gastric Cancer Attributable to High Sodium Intake: A Longitudinal Study from 1990 to 2019 in China.

Excessive intake of sodium is a crucial risk factor of gastric cancer. However, it is still unclear whether the profile of gastric cancer burden is attributable to high sodium intake in China. This study aims to evaluate the levels and trends of gastric cancer burden attributable to high sodium intake across China from 1990 to 2019. We acquired data from the GBD (Global Burden of Disease Study) 2019 via the Global Health Data Exchange query tool. The details of regions from 1 January 1990 to 31 December 2019 from the China National Center for Food Safety Risk Assessment were also used. We conducted an integrated analysis on the gastric cancer burden attributable to high sodium intake among Chinese residents. The gastric cancer-related deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR), all being calculated to be attributable to sodium intake, were reckoned as separated by age, sex, SDI, and regions. Then, the estimated annual percentage change (EAPC) was regarded as the secular trends of gastric cancer's ASMR and ASDR due to high sodium intake from 1990 to 2019. We further explored the associations between SDI (Socio-demographic index) and the ASMR and ASDR. The rates were calculated per 100,000 population as age-standardized rates. Briefly, the number of gastric cancer-related deaths and DALYs being attributed to high sodium intake were 37,131.48 (95% UI: 833.14 to 138,478.72) and 873,813.19 (95% UI: 19,283.13 to 3,220,231.82) in 2019; both have increased by a third since 1990. However, the ASMR decreased with an EAPC of -1.72% (95% CI: -2.11% to -1.33%), while ASDR increased with an EAPC of 0.36% (95% CI: 0.08% to 0.68%), respectively. The age-specific numbers and rates of deaths, as well as DALYs of gastric cancer being attributed to high sodium intake, elevated gradually with age. And, they were higher in males than in females. The gastric cancer burden being attributed to high sodium intake in 2019 and its temporal trends from 1990 to 2019 varied greatly by SDI quintile and geographic locations. There was a strong negative association between the EAPC in ASMR and SDI in 2019 (ρ = -0.642, p < 0.001). The EAPC in ASDR and SDI also exhibited a negative connection in 2019 (ρ = -0.538, p = 0.0012). Overall, using a longitudinal sample from different regions, the study presented that gastric cancer burden attributed to high sodium intake still exists seriously and varies remarkably by regions, sex, and age across China. The disparity of socioeconomic status on disease burden also exists. Integrated and precise approaches for gastric cancer prevention are anticipated in the future.

Global burden of leukemia attributable to occupational exposure to formaldehyde from 1990 to 2019.

The objective of this study was to evaluate the worldwide burden of leukemia owing to occupational exposure to formaldehyde (OEF) from 1990 to 2019. Data on leukemia due to OEF were obtained from the Global Burden of Disease Study (GBD) 2019. By region, age, sex, and disease subtype, the numbers and age-standardized rates (ASRs) associated with deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) were analyzed. Annual average percentage change (AAPC) was used to estimate disease burden trends from 1990 to 2019. To measure the risk of leukemia due to OEF, the population attributable fraction (PAF) was introduced. From 1990 to 2019, the number of deaths, DALYs, YLLs, and YLDs for leukemia caused by OEF increased by 44%, 34%, 33%, and 124%, respectively. Regarding the change in ASRs, the age-standardized YLDs (ASYLDs) rate of leukemia due to OEF, which was 38.03% (AAPC = 1.17 [95% confidence interval [CI] 1.11, 1.23]), indicated an increased trend. But the age-standardized mortality rate (ASMR), age-standardized DALY (ASDALY) rate, and age-standardized YLL (ASYLL) rate showed decline trends, with - 11.90% (AAPC = - 0.41 [95% CI - 0.45, - 0.37]), - 14.19% (AAPC = - 0.5 [95% CI - 0.55, - 0.45]), and - 14.97% (AAPC = - 0.53 [95% CI - 0.58, - 0.48]), respectively. In terms of PAFs, there were increasing trends in PAFs of age-standardized deaths, ASDALYs, ASYLLs, and ASYLDs for leukemia caused by OEF, with 20.15% (95% uncertainty interval [UI] 11.76%, 30.25%), 36.28% (95% UI 21.46%, 53.42%), 51.91% (95% UI 35.05%, 72.07%), and 36.34% (95% UI 21.58%, 53.63%), respectively. Across the socio-demographic index (SDI) regions, the leukemia burden caused by OEF was concentrated in middle and high-middle SDI regions. Besides, OEF poses a more serious risk for acute leukemia among the leukemia subtype. Globally, leukemia caused by OEF remains a public health burden. Policies must be developed to avoid the burden of leukemia caused by OEF.

Self-harm and interpersonal violence due to high temperature from the global burden of disease study 2019: A 30-year assessment

BackgroundThe impact of global warming on health due to climate change is increasingly studied, but the global burden of self-harm and interpersonal violence attributable to high temperature is still limited. This study aimed to systematically assess the burden of self-harm and interpersonal violence attributable to high temperature globally or by region and climate zone from 1990 to 2019. MethodsWe obtained the global, regional, and national deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMR), and age-standardized disability-adjusted life year rates (ASDR) of self-harm and interpersonal violence due to high temperature from 1990 to 2019 through the Global Burden of Disease Study (GBD) 2019. The burden of self-harm and interpersonal violence due to high temperature was estimated by age, sex, climate zone, the socio-demographic index (SDI), and the healthcare access and quality index (HAQ). Average annual percentage changes (AAPCs) in ASMR and ASDR were calculated for 1990–2019 using the Joinpoint model. ResultsFrom 1990 to 2019, the global deaths and DALYs related to self-harm and interpersonal violence due to high temperature increased from 20,002 (95% UI, 9243 to 41,928) and 1,107,216 (95% UI, 512,062 to 2,319,477) to 26,459 (95% UI, 13,574 to 47,265) and 1,382,487 (95% UI, 722,060 to 2,474,441), respectively. However, the ASMR and ASDR showed varying degrees of decreasing trends, with decreases of 13.36% and 12.66%, respectively. The ASMR was high and declining in low and low-middle SDI regions, particularly in tropical and subtropical regions. In addition, SDI and HAQ index were negatively correlated with ASMR in 204 countries and regions. ConclusionsThe global burden of self-harm and interpersonal violence attributed to high temperature has decreased over the past 30 years, but the number of deaths and DALYs continues to rise. Climate change continues to make heat stress a significant risk factor for self-harm and interpersonal violence worldwide.

Global burden of stomach cancer attributable to smoking from 1990 to 2019 and predictions to 2044

ObjectivesThis study aimed to assess the global temporal trends of stomach cancer attributable to smoking from 1990 to 2019 and to predict the global burden by 2044. Study designThis was a comprehensive analysis based on data provided by the Global Burden of Disease Study 2019. MethodsBased on the Global Burden of Disease Study 2019, mortality, disability-adjusted life years (DALYs), and corresponding age-standardised rates of stomach cancer attributable to smoking by sociodemographic index (SDI), region, country, sex, and age were used to assess temporal trends from 1990 to 2019 by calculating the average annual percentage change (AAPC). In addition, the global burden of stomach cancer attributable to smoking up to 2044 was predicted using age–period–cohort models. ResultsGlobally, in 2019, 17.96% of stomach cancer deaths (1.72 million) and 17.15% of stomach cancer DALYs (38.13 million) were attributable to smoking, representing an increase compared to 1990; however, smoking-attributable age-standardised rates of mortality (ASMRs) and DALYs (ASDRs) significantly declined to 2.12/100,000 and 45.82/100,000 in 2019, respectively. While stomach cancer ASMR and ASDR attributable to smoking decreased in all regions and in most countries, they increased by >10% in some countries. A positive correlation was found between SDI and age-standardised rates (rASMR = 0.28, P < 0.01; rASDR = 0.29, P < 0.01). By 2044, although global age-standardised rates for smoking-attributable stomach cancer are predicted to decline, deaths and DALYs are estimated to increase to 2.22 million and 42.14 million, respectively. ConclusionsStomach cancer deaths and DALYs attributable to smoking have increased over the past 30 years and will continue to increase. Consequently, targeted prevention efforts and tobacco-control strategies need to be further developed and improved.

Evolving trends and burden of iron deficiency among children, 1990-2019: a systematic analysis for the global burden of disease study 2019.

We aimed to provide a timely, comprehensive, and reliable assessment of the burden of iron deficiency (ID) in children between 1990 and 2019 at the global, regional, and national levels to inform policymakers in developing locally appropriate health policies. Data related to ID among children younger than 15 years old were analyzed by sex, age, year, socio-demographic index (SDI), and location according to the Global Burden of Disease Study 2019 (GBD 2019). Age-standardized rates were used to compare the burden between different regions and countries. Furthermore, the Joinpoint regression model was used to assess temporal trends from 1990 to 2019. In 2019, the number of prevalent cases and disability-adjusted life years (DALYs) for ID in children were 391,491,699 and 13,620,231, respectively. The global age-standardized prevalence and DALY rates for childhood ID in 2019 were 20,146.35 (95% confidence interval: 19,407.85 to 20,888.54) and 698.90 (466.54 to 1015.31) per 100,000, respectively. Over the past 30 years, the global prevalence of ID among children has been highest in low-SDI regions, particularly in Western Sub-Saharan Africa, South Asia, and Eastern Sub-Saharan Africa. Since 1990, the prevalence and DALY of ID in children have been declining in most geographic regions. Nationally, Ecuador, China, and Chile have shown the most significant decreases in prevalence. The greatest decline in age-standardized DALY rate was observed in Ecuador, while Burkina Faso experienced the highest increase. Bhutan had the highest prevalence and DALY rates in 2019. On the age level, the prevalence was relatively higher among the <5 years age group. At the gender dimension, the prevalence of ID in children overall was more pronounced in girls than in boys, as was the case for DALY. Although the burden of ID in children has been declining, this disease remains a major public health problem, especially in countries with low SDI. Children younger than 5 years of age are an important group for whom targeted measures are needed to reduce the burden of ID.

Changing Trends in the Global Burden of Cataract Over the Past 30 Years: Retrospective Data Analysis of the Global Burden of Disease Study 2019.

Cataracts now account for the largest proportion of the global burden of blindness and vision loss. Understanding the changing trends in the global burden of cataracts over the past 30 years and the next 15 years is of clear significance for the prevention and control of cataracts in key populations. As far as we know, research on the future burden of cataracts is lacking. This study aims to assess the global burden of cataracts over the past 30 years by using age-period-cohort modeling and to estimate trends in the next 15 years. Data were obtained from the Global Burden of Disease Study 2019, the United Nations Development Programme, and the WHO (World Health Organization) Global Health Observatory data repository. The assessment of trends and disparities in the number and rate of disability-adjusted life years (DALYs) for cataracts from 1990 to 2019 was conducted. The association between the age-standardized DALY rate (ASDR) and the socio-demographic index (SDI), human development index (HDI), national levels of particulate matter <2.5 μm in diameter (PM2.5), and ambient ultraviolet radiation (UVR) was determined using linear regression analysis. Additionally, we used the Nordpred (Harald Fekjær and Bjørn Møller) age-period-cohort model to predict the cataract burden from 2020 to 2034. Globally, the number of DALYs due to cataract increased from 3,492,604 (95% uncertainty interval [UI] 2,481,846-4,719,629) in 1990 to 6,676,281 (95% UI 4,761,210-9,006,193) in 2019. The ASDRs due to cataract decreased from 93.17 (95% UI 66.14-125.32) in 1990 to 82.94 (95% UI 59.06-111.75) in 2019, with an average annual percentage change of -0.37 (95% CI -0.44 to -0.3; P<.001). Age, female sex, air pollution, smoking, high fasting plasma glucose levels, and a high body mass index were risk factors for the burden of cataracts. SDI and HDI were negatively correlated with ASDRs of cataracts, while PM2.5 and UVR were positively associated with them. Higher DALY rates were also associated with lower SDI (R2=0.1939; P<.001), lower HDI (R2=0.2828; P<.001), national PM2.5 concentration (R2=0.1874; P<.001), and ambient UVR levels (R2=0.2354; P<.001). The prediction model suggested that the number of DALYs due to cataract will continue to rise globally, while the cataract DALY rate will continue to decrease. While the ASDR of cataracts has decreased, there has been a notable increase in the number of DALYs over the past 30 years. Projections suggest that the global burden of cataracts will continue to rise over the next 15 years. To address this challenge, appropriate prevention and treatment policies must be implemented.

Long-term trends in the burden of colorectal cancer in Europe over three decades: a joinpoint regression and age-period-cohort analysis.

The burden of colorectal cancer (CRC) in Europe is at a high level, but the epidemiological features have not yet been systematically studied. This study aimed to provide a timely and reliable assessment of the burden and trends of CRC in Europe to provide a scientific basis for its prevention and treatment. We analyzed data on CRC in 44 European countries between 1990 and 2019 from the Global Burden of Disease study (GBD) 2019. In addition, the joinpoint regression model was applied to reflect temporal trends. The age-period-cohort model was constructed to explore age, period, and birth cohort effects that influence the risk of morbidity and mortality. In Europe, new cases, disability-adjusted life years (DALYs) and deaths of CRC rose by 70.01%, 22.88% and 38.04% from 1990 to 2019, respectively. The age-standardized incidence rate (ASIR) has increased, while age-standardized DALY rate and age-standardized mortality rate (ASMR) have declined. We found that men experienced a significantly higher CRC burden than women. Age-period-cohort analysis showed that the risk of incidence and mortality increased with age and time; and it was lower in the later-born cohort than the earlier-born cohort. ASIR for CRC in Europe generally trended upwards from 1990 to 2019, stabilizing in recent years but still at a high level. CRC burden varied considerably in different countries. There was a pronounced gender difference in CRC burden, and middle-aged and older men should be a priority population for CRC prevention and treatment.

Epidemiological analysis reveals a surge in inflammatory bowel disease among children and adolescents: A global, regional, and national perspective from 1990 to 2019 - insights from the China study.

The burden of inflammatory bowel disease (IBD) among children and adolescents is rising globally, with substantial variation in levels and trends of disease in different countries and regions, while data on the burden and trends were sparse in children and adolescents. We aimed to assess the trends and geographical differences in children and adolescents aged zero to 19 in 204 countries and territories over the past 30 years. Data on IBD among children and adolescents was collected from the Global Burden of Disease (GBD) 2019 database from 1990 to 2019. We used the GBD data and methodologies to describe the change in the burden of IBD among children and adolescents involving prevalence, incidence, disability-adjusted life years (DALYs), and mortality. Globally, the IBD prevalence cases increased between 1990 and 2019. Annual percentage changes (AAPC) = 0.15; 95% confidence interval (CI) = 0.11-0.19, and incidence cases of IBD increased from 20 897.4 (95% CI = 17 008.6-25 520.2 in 1990 to 25 658.6 (95% CI = 21 268.5-31 075.6) in 2019, representing a 22.78% increase, DALYs cases decreased between 1990 and 2019 (AAPC = -3.02; 95% CI = -3.15 to -2.89), and mortality cases of IBD decreased from 2756.5 (95% CI = 1162.6-4484.9) in 1990 to 1208.0 (95% CI = 802.4-1651.4) in 2019, representing a 56.17% decrease. Decomposition analysis showed that IBD prevalence and incidence increased significantly, and a trend exhibited a decrease in underlying age and population-adjusted IBD DALYs and mortality rates. Correlation analysis showed that countries with high health care quality and access (HAQ) had relatively higher IBD age-standardised prevalence rate (ASPR) and age-standardised incidence rate (ASIR), but lower age-standardised DALYs rate (ASDR) and age-standardised mortality rate (ASMR). Global prevalence and incidence rate of IBD among children and adolescents have been increasing from 1990 to 2019, while the DALYs and mortality have been decreasing. Rising prevalence and rising incidence in areas with historically low rates will have crucial health and economic implications.

Global, regional, and national burden of neurological disorders in 204 countries and territories worldwide.

We aimed to determine the incidence and disability-adjusted life-years (DALYs) of neurological disorders worldwide from 1990 to 2019. We obtained age-standardised incidence and DALY rates of neurological disorders in 204 countries and territories from 1990 to 2019 from the Global Burden of Disease (GBD) database. We determined trends stratified by age, sex, region, country, and Social Development Index (SDI) and the risk factors contributing to DALYs associated with these neurological disorders. The largest increases in the age-standardised incidence rates of neurological disorders in 1990-2019 occurred in four regions (East Asia: estimated annual percentage change (EAPC) = 0.19, tropical Latin America: EAPC = 0.07, Southern Latin America: EAPC = 0.03, Western Europe: EAPC = 0.03) and three countries (China: EAPC = 0.20, Ecuador: EAPC = 0.13, Italy: EAPC = 0.13). We observed the largest increases in age-standardised incidence rates for Parkinson disease, idiopathic epilepsy, and bipolar disorder, and in age-standardised DALY rates for Alzheimer disease and other dementias. High-SDI regions showed the highest EAPC for age-standardised incidence rates of Parkinson disease, depression, and motor neuron disease, and age-standardised DALY rates of neurological disorders. There is a need to control the increase in age-standardised incidence rates of neurological disorders in East Asia, tropical Latin America, Southern Latin America, and Western Europe, particularly in China, Ecuador, and Italy.

Gender differences in the burden of multiple sclerosis in China from 1990 to 2019 and its 25-year projection: An analysis of the Global Burden of Diseases Study.

Multiple sclerosis (MS) is a crippling, chronic, gender-related disease that causes burdens to individuals and society. China has a considerable and increasing population of MS. We aim to analyze the gender disparities in the burden of MS in China and predict the trends. The study was conducted based on the Global Burden of Disease Study 2019. Data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) of MS in China from 1990 to 2019 was descriptively analyzed by year, gender, and age group. The Nordpred package in R (version 4.2.2) was used for age-period-cohort analysis to predict the all-ages numbers and age-standardized rates of incidence, prevalence, deaths, and DALYs in China from 2020 to 2044. The number of prevalent cases of MS in 2019 reached 18,143.56 (95% uncertainty intervals [UI]: 13,997.71-22,658.60) in males and 24,427.11 (95% UI: 18,906.02-30,530.21) in females in China. The peak age of prevalence was shifted from 40-44 years in 1990 to 45-49 years in 2019 in females but remained unchanged in males. In contrast to the increased age-standardized prevalence rate, the age-standardized death rate (ASDR) and age-standardized DALYs rate showed downward trends, which were more significant in females. Different from the global, Chinese males showed lower prevalence but higher deaths and DALYs than females for age-standardized rates and numbers. In the next 25 years, the patient population will remain large and peak around 44,599.78 in 2025-2029. The ASDR, age-standardized DALYs rate, and DALYs number were expected to decrease. The improvements in deaths and DALYs will be more significant in females. Males with MS had a lower prevalence but higher deaths and DALYs than females in China. The ASDR and age-standardized DALYs rate have reduced over the past 30 years and were expected to continue decreasing, especially in females. The burden of MS will remain notable in the next 25 years.

Statewide Burden and Trends of Acute Myeloid Leukemia Attributable to Smoking in the United States of America from 1990-2019: A Benchmarking and Comparative Analysis

Background: Smoking has long been associated with an increased risk of various cancers, and it plays a significant role in deaths related to Acute Myeloid Leukemia (AML), accounting for 1.69% of all cancer-related deaths in the United States of America (USA). Additionally, among all other risk factors contributing to AML development, smoking is responsible for a staggering 77.2% of AML-related deaths. However, there is a large statewide variation within the USA concerning AML burden. Comparable and consistent state-level measures of total AML burden have not been produced previously. Method: Using the Global Burden of Disease methodology “AML attributable to smoking” mortality, and disability-adjusted life years (DALYs) were analyzed by age group, sex and year from 1990-2019 for all residents in the USA using standardized approaches for data processing and statistical modeling. Results were produced in total number and age-standardized rate. The findings were reported both in absolute numbers and age- standardized rates. Results: The total number of deaths attributed to AML due to smoking showed an increase from 2,230 (95% uncertainty interval (UI): 1,159-3,275) in 1990 to 3,918 (95% UI: 1,833- 6,003) in 2019. Similarly, the DALYs (Disability-Adjusted Life Years) associated with AML increased from 52,843 (95% UI: 30,918-75,041) in 1990 to 81,356 (95% UI: 43,328-121,964) in 2019. However, the age-standardized mortality rate (ASMR) remained relatively stable, with no major difference observed (0.7 deaths per 100,000 95% UI: 0.38-1.02) in 1990 compared to 0.7 (95% UI: 0.35-1.05) in 2019. In contrast the age-standardized DALYs rate (ASDALR) decreased from 17.51 to 15.3 per 100,000 from 1990 to 2019. Regarding the highest annual percentage of change (APC) in total number of deaths due to AML, Nevada observed the greatest increase at 275% followed by Alaska at 236% and Arizona at 179% from 1990 to 2019. In contrast, the District of Columbia was the only state that showed a decrease in APC for total deaths with a decline of 6%. Analyzing ASMR, Indiana, and West Virginia observed the highest APC at 28% each, followed by Kentucky at 23%. Conversely, California experienced the highest decrease in ASMR APC, showing a decline of 30% from 1990 to 2019. Regarding age groups, the 95+ age group observed the highest APC increase in ASMR and ASDALR at 363% and 356%, respectively, followed by the 90-94 age group, which had an ASMR APC increase of 307% and ASDALR APC increase of 305%. Moreover, males exhibited a higher APC increase in the total number of deaths compared to females, with percentages of 85% and 62%, respectively, from 1990 to 2019. Conclusion: Large disparities in the total burden of AML attributable to smoking persist between US states despite marked improvements in management. Our findings show that a substantial proportion of AML cases in the United States are attributed to smoking, making it a modifiable risk factor for this aggressive hematologic malignancy. Healthcare professionals and policymakers should utilize this evidence to reinforce anti-smoking initiatives and raise public awareness about the link between smoking and AML.

Global Burden and Trends of Multiple Myeloma in High-Income North America Countries between 1990-2019, with Projections of Deaths to 2040: A Benchmarking Analysis for the Global Burden of Disease Study 2019

Background: Multiple myeloma (MM), a malignant neoplasm originating from plasma cells, imposes a considerable health burden in high-income North America (HINA). It ranks as the 14th leading cause of cancer-related deaths and disability in HINA countries. This study aims to assess the epidemiological aspects of MM, including its incidence, prevalence, mortality rates, and non-fatal health outcomes across HINA countries over the last three decades (1990-2019) with projections of deaths up to 2040. Methods: Using the Global Burden of Disease methodology, we evaluated MM prevalence, incidence, mortality, and disability-adjusted life years (DALYs) based on age group, sex, and year across HINA from 1990 to 2019, utilizing standardized approaches and statistical modeling. We employed a regression framework to forecast MM deaths through 2040, and the results were presented in absolute counts and age-standardized rates (per 100,000 person-years). Results: The absolute prevalence of MM increased from 42,637 (95% uncertainty interval (UI): 35,449-44,970) in 1990 to 101,994 (95% UI: 86,889-127,309) in 2019. Similarly, deaths increased from 11,200 (95% UI: 9,435-11,633) to 19,941 (95% UI: 18,012-22,919) during 1990-2019, and DALYs increased from 235,334 (95% UI: 194,820-244,361) in 1990 to 388,955 (95% UI: 360,494-478,317) in 2019. The age-standardized incidence rate (ASIR) increased from 4.32 (95% UI: 3.62-4.5) to 4.8 (95% UI: 4.12-5.87) cases per 100,000 persons from 1990-2019. However, the annual percentage of change (APC) in age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDALR) decreased by 1% and 8%, respectively, from 1990-2019. Among HINA countries, Canada observed the highest APC increase in total deaths (111%), followed by Greenland (110%) and the United States (75%) during 1990-2019. In terms of age groups, the 70-74 age group observed the highest number of incidences (5,257), deaths (3,336), and DALYs (67,310) in 2019. The 80+ age group exhibited the highest APC in total deaths, incidence, and DALYs from 1990-2019. Furthermore, males experienced a higher burden compared to females over the last three decades. The projected number of MM deaths in HINA is expected to reach 28,904 (95% UI: 22,690-37,300) by 2040. Conclusion: This study reveals the secular trend of MM burden in HINA, indicating a significant increase in MM cases and its impact on public health. MM accounted for 2.295% of deaths among all cancer-related deaths in HINA in 2019. The burden of MM has been on the rise in general from 1990 to 2019 and is predicted to continue increasing over the next two decades. Notably, there is a noticeable disparity in MM burden, with higher prevalence in males compared to females. Age and cohort effects appear to play a significant role, with elevated risk observed among elderly individuals and those from earlier-born cohorts. Nonetheless, continuous surveillance, data collection, and research efforts are crucial to monitor evolving epidemiological trends and inform evidence-based policies aimed at mitigating the impact of multiple myeloma on individuals and society in the region.

Global Burden and Disparities in Hematologic Malignancies: A Comparative Analysis from 1990 to 2019

Introduction : To explore disparities in socio-demographic development levels across countries and comprehensively examine the burden of hematologic malignancies (HMs), including leukemia, Hodgkin lymphoma(HL), non-Hodgkin lymphoma(NHL), multiple myeloma(MM), as well as myeloproliferative neoplasm(MPN). Method s：We obtained the estimates, along with their 95% uncertainty interval (UI), for disability-adjusted life-years (DALYs) related to various HMs from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. We illustrated the age-standardized DALYs rate for these malignancies across 204 countries, along with the global distribution of DALYs rates by age and sex. In order to assess the disparities in the burden of hematologic malignancies, we employed two recommended metrics by the World Health Organization (WHO), namely the slope index of inequality and the concentration index, which quantify absolute and relative gradient inequality, respectively. R esults：In 2019, across 204 countries, there were remarkable variations in the age-standardized DALYs rate for leukemia, HL, NHL, MM, and MPN, with distinct age and sex distributions significantly impacting the global rate of DALYs. The slope index of inequality changed from 28.20 (95% CI: -0.87 to 57.27) in 1990 to 46.03 (95% CI: 26.36 to 65.69) in 2019 for leukemia, from 37.87 (95% CI: 30.32 to 45.41) in 1990 to 45.99 (95% CI: 38.16 to 53.82) in 2019 for AML, from -1.60 (95% CI: -6.57 to 3.36) in 1990 to -2.17 (95% CI: -4.73 to 0.38) in 2019 for CML , from 2.14 (95% CI: -6.59 to 10.86) in 1990 to -10.86 (95% CI: -16.02 to -5.70) in 2019 for ALL, from 12.98 (95% CI: 9.46 to 16.50) in 1990 to 22.42 (95% CI: 17.53 to 27.31) in 2019 for CLL, from -37.44 (95% CI: -57.29 to -17.61) in 1990 to -13.63 (95% CI: -25.69 to -1.56) in 2019 for other leukemia, from 6.97 (95% CI: 1.82 to 12.12) in 1990 to 0.45 (95% CI: -2.90 to 3.79) in 2019 for HL, from 73.00 (95% CI: 55.40 to 90.61) in 1990 to 102.83 (95% CI: 87.33 to 118.32) in 2019 for NHL, from 37.90 (95% CI: 30.19 to 45.62) in 1990 to 77.31 (95% CI: 66.34 to 88.28) in 2019 for MM, from 15.56 (95% CI: 12.97 to 18.15) in 1990 to 30.15 (95% CI: 25.72 to 34.58) in 2019 for MPN. The concentration index showed 0.18 (95% CI: 0.13 to 0.23) in 1990 and 6.95 (95% CI: 6.63 to 7.26) in 2019 for leukemia, 19.22 (95% CI: 17.63-20.80) in 1990 and 17.61 (95% CI: 16.85-18.38) in 2019 for AML, -20.84 (95% CI: -25.58 to -16.10) in 1990 and -20.75 (95% CI: -22.55 to -18.95) in 2019 for CML, -2.83 (95% CI: -3.22 to -2.45) in 1990 and -4.72 (95% CI: -5.05 to -4.39) in 2019 for ALL,37.75 (95% CI: 36.03 to 39.47) in 1990 and 29.12 (95% CI: 27.62 to 30.63) in 2019 for CLL, -3.14 (95% CI: -3.59 to -2.69) in 1990 and 8.56 (95% CI: 7.95 to 9.17) in 2019 for other leukemia,-0.63 (95% CI: -0.68 to -0.58) in 1990 and -13.44 (95% CI: -14.45 to -12.43) in 2019 for HL, 23.25 (95% CI: 22.55 to 23.96) in 1990 and 19.34 (95% CI: 18.55 to 20.13) in 2019 for NHL, 39.05 (95% CI: 37.10 to 41.01) in 1990 and 36.53 (95% CI: 34.66 to-38.40) in 2019 for MM,47.18 (95% CI: 43.52 to 50.84) in 1990 and 47.30 (95%CI: 44.31 to 50.30) in 2019 for MPN. C onclusion：The age-standardized DALYs rate exhibits significant heterogeneity across all countries, alongside variations in the age and sex distribution of the global rate of DALYs for HMs. Moreover, countries with higher levels of socio-demographic development bear a disproportionate burden of HMs, and the extent of these inequalities related to socio-demographic development levels has worsened over time.

Global, regional, and national burdens of hypertensive heart disease from 1990 to 2019 ：A multilevel analysis based on the global burden of Disease Study 2019

AimThis study aimed to describe the prevalence, deaths, and disability-adjusted life-years (DALYs) of hypertensive heart disease (HHD) at the global, regional, and national levels and analyze epidemiological trends. MethodWe extracted global estimates of prevalence, deaths, and DALYs related to HHD in 204 countries and regions from the 2019 Global Burden of Diseases Study. Average annual percent change (AAPC) was calculated to represent temporal trends. Joinpoint regression models were used to analyze time trends from 1990 to 2019. Finally, the decomposition analysis showed the driving factors of burden changes. ResultsFrom 1990 to 2019, the global prevalence of HHD cases increased by 138 %, reaching 18,598,025 cases (95 % uncertainty interval [UI]: 13,544,365–24,898,411). DALYs also rose by 154 %, reaching 21,508,002 (95 % UI, 16,400,051–23,899,879). The death rate increased to 14.95 (95 % UI, 11.11–16.52) per 100,000 people. Of the five sociodemographic index (SDI) regions, the prevalence rate related to HHD was the highest in the high-middle SDI region. In contrast, the death and DALY rate related to HHD were the highest in the middle SDI region. In other regions, the prevalence rate was the highest in East Asia (548.87 per 100,000 people; 95 % UI, 395.40–747.83), and the death rate was the highest in Central Europe (42.64 per 100,000 people; 95 % UI, 30.58–49.38). At the national level, the Cook Islands had the highest prevalence rate for HHD (703.08 per 100,000 people; 95 % UI, 532.87–920.72), Bulgaria had the highest death rate (75.08 per 100,000 people; 95 % UI, 46.38–92.81), and Afghanistan had the highest DALY rate (1374.12 per 100,000 people; 95 % UI, 467.17–2020.70). High body mass index, a diet high in sodium, alcohol use, lead exposure, high temperature, and low temperature were identified as risk factors for death and DALYs related to HHD in 2019. Aging and population growth were the major drivers of prevalence, death, and DALYs. Finally, over the past 30 years, the global age-standardized prevalence rate (ASPR) of HHD has significantly risen (AAPC = 0.21 %, 95 % confidence interval [CI]: 0.17–0.24; P < 0.001), while the age-standardized deaths rate (ASDR) has shown significant declining trends (AAPC = −0.86 %, 95 % CI: 1.00 to −0.71; P < 0.001), and age-standardized DALY rates (AAPC = −1.08 %, 95 % CI: 1.23 to −0.93; P < 0.001). ConclusionDespite a significant decline in the global ASDR and age-standardized DALY rate of HHD over the past 30 years, the ASPR continues to rise. The burden of HHD is more heavily skewed towards non-high-income economies. Active prevention, control of risk factors, and improvement of medical protection levels to address the disease burden caused by population growth and aging are needed.

Burden of diseases attributable to excess body weight in the Middle East and North Africa region, 1990–2019

High body mass index (BMI), or excess body weight (EBW), represents a significant risk factor for a range of diseases, including cardiovascular diseases and cancers. The study sought to determine the burden of diseases attributable to EBW in the Middle East and North Africa (MENA) region from 1990 and 2019. The analysis also included an exploration of this burden by age, sex, underlying cause, and sociodemographic index (SDI). We utilized publicly available data from the Global Burden of Disease (GBD) study 2019 to identify the deaths and disability-adjusted life-years (DALYs) of diseases associated with EBW in MENA, spanning the period from 1990 to 2019. The GBD estimated the mean BMI and the prevalence of EBW using hierarchical mixed-effects regression, followed by spatiotemporal Gaussian process regression to determine the most accurate BMI distribution through comparison with actual data. In 2019, there were an estimated 538.4 thousand deaths (95% UI 369.9–712.3) and 17.9 million DALYs (12.9–23.1) attributable to EBW in the region. The DALYs attributable to EBW were higher in men (9.3 million [6.5–12.4]) than in women (8.5 million [6.4–10.8]). The age-standardized death and DALY rates for the diseases associated with EBW increased by 5.1% (− 9.0–25.9) and 8.3% (− 6.5–28.8), respectively, during the study period which was not significant. Egypt had the highest age-standardized mortality rate due to EBW (217.7 [140.0, 307.8]), while Yemen (88.6 [45.9, 143.5]) had the lowest. In 2019, the highest number of DALYs occurred among individuals aged 60 to 64 years old. Furthermore, we found a positive association between a nation's SDI and the age-standardized DALY rate linked to EBW. Cardiovascular disease emerged as the leading contributor to the EBW burden in MENA. The disease burden attributable to EBW showed a non-significant increase in MENA from 1990 to 2019.

Global burden of ischemic heart disease associated with high red and processed meat consumption: an analysis of 204 countries and territories between 1990 and 2019

BackgroundMultiple studies have indicated an association between red and processed meat consumption and the incidence of ischemic heart disease (IHD). In this study, we aimed to assess the burden of IHD caused by a diet high in red and processed meat in 204 countries and territories between 1990 and 2019, using data from the Global Burden of Disease (GBD) 2019.MethodsWe extracted data from the GBD 2019, which included the number of deaths, age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and age-standardized DALYs rates (ASDR) attributed to IHD caused by a diet high in red and processed meat. We then calculated the burden of IHD attributable to a high intake of red and processed meat in each country and territory, stratified by age, sex, and socio-demographic index (SDI).ResultsGlobally, a high intake of red meat was responsible for 351,200 (95% uncertainty interval (UI): 559,000–642,700) deaths from IHD in 2019, while a high intake of processed meat was associated with 171,700 (95% UI: 30,100–320,000) deaths from IHD. Between 1990 and 2019, while the corresponding age-standardized rates declined, the numbers of deaths and DALYs increased. China had the highest number of deaths [98,386.9 (95% UI: 14,999.3–189,812.7)] caused by a high intake of red meat, while United States of America [33,129.6 (95% UI: 7,150–59,593.8)] was associated with the highest number of deaths caused by high intake of processed meat for IHD in 2019. Males experienced a greater burden of IHD caused by a high intake of red and processed meat than females. The ASMR and ASDR of IHD attributed to a high intake of red meat decreased in countries with high SDI, high-middle SDI and low SDI, while the ASMR and ASDR of IHD attributed to a high intake of processed meat decreased only in countries with high SDI and high-middle SDI.ConclusionAlthough there is a decline in the ASMR and ASDR of IHD caused by a high intake of red and processed meat, there is also an increase in deaths and DALYs number globally. Additionally, there is a heterogeneous burden of IHD related to a high intake of red and processed meat across regions and countries, with males experiencing a greater burden than females. Implementing targeted policies and interventions is required to reduce the burden of IHD caused by a high intake of red and processed meat.

Mortality and disability-adjusted life years in North Africa and Middle East attributed to kidney dysfunction: a systematic analysis for the Global Burden of Disease Study 2019.

The study aimed to estimate the attributable burden to kidney dysfunction as a metabolic risk factor in the North Africa and Middle East (NAME) region and its 21 countries in 1990-2019. The data used in this study were obtained from the Global Burden of Diseases (GBD) 2019 study, which provided estimated measures of deaths, disability-adjusted life years (DALYs), and other epidemiological indicators of burden. To provide a better insight into the differences in the level of social, cultural, and economic factors, the Socio-Demographic Index (SDI) was used. In the NAME region in 2019, the number of deaths attributed to kidney dysfunction was 296 632 (95% uncertainty interval: 249 965-343 962), which was about 2.5 times higher than in the year 1990. Afghanistan, Egypt, and Saudi Arabia had the highest, and Kuwait, Turkey, and Iran (Islamic Republic of) had the lowest age-standardized rate of DALYs attributed to kidney dysfunction in the region in 2019. Kidney dysfunction was accounted as a risk factor for ischemic heart disease, chronic kidney disease, stroke, and peripheral artery disease with 150 471, 111 812, 34 068, and 281 attributable deaths, respectively, in 2019 in the region. In 2019, both low-SDI and high-SDI countries in the region experienced higher burdens associated with kidney dysfunction compared to other countries. Kidney dysfunction increases the risk of cardiovascular diseases burden and accounted for more deaths attributable to cardiovascular diseases than chronic kidney disease in the region in 2019. Hence, policymakers in the NAME region should prioritize kidney disease prevention and control, recognizing that neglecting its impact on other diseases is a key limitation in its management.