Age-standardized Mortality Research Articles

Burden of chronic obstructive pulmonary disease attributable to non-optimal temperature, 1990–2044: six countries on the same isotherm

BackgroundWith the frequent occurrence of extreme weather worldwide, non-optimal temperature increased the risk of death from respiratory diseases. The burden of non-optimal temperature on chronic obstructive pulmonary disease (COPD) was quantitatively assessed, and its influencing factors were discussed to provide a basis for the prevention and treatment of COPD.MethodsBased on GBD 2019, we characterized the age-standardized mortality rate (ASMR) and years of life lost rate (ASYR) of COPD attributable to non-optimal temperature in three groups of countries at different isotherms (China and USA, South Africa and Australia, Iraq and Portugal) between 1990 and 2019. We constructed the age-period-cohort model to analyze age, period and cohort effects on mortality and the Bayesian age-period-cohort model to predict ASMR in six countries. We analyzed the relationship of socio-demographic index (SDI) with ASMR and ASYR by restricted cubic spline and quantile regression using data from 21 GBD regions.ResultsASMR of COPD attributable to non-optimal temperature in 2019 was 11.03/100,000 (China), 5.62/100,000 (USA), 2/100,000 (Australia), 0.93/100,000 (Iraq), 3.74/100,000 (Portugal), 4.13/100,000 (South Africa). Low temperature had a greater impact on COPD. The mortality showed an increasing trend with age, the period effect only showed a decreasing trend in China, and cohort effect showed a decreasing trend. The higher COPD burden was concentrated in areas with SDI values of 0.39–0.78. Implied quantile regression of mortality to SDI fit was meaningful at P5 and P75, and ASYR was at P5, P25, P75, and P95. We predicted an upward trend in COPD ASMR over the next 25 years only in the USA.ConclusionsIn COPD burden caused by non-optimal temperature, low temperature played a more important role, and it was affected by sex, age, period, cohort and SDI. Over the next 25 years, ASMR in COPD was predicted to decline in all countries except the USA.

Current status and trends in thalassemia burden across South, East and Southeast Asia, 1990–2021 a systematic analysis for the global burden of disease study 2021

ObjectiveThalassemia, an inherited hemoglobin synthesis disorder, imposes a significant health burden in Asian regions with high prevalence. Detailed patterns and trends of the disease across countries and territories within these regions remain underexplored. Our study focuses on the disease burden indices of thalassemia within the four GBD-defined Asian regions and the twenty-five included countries and territories. It provides insights into the gender-age distribution, temporal changes, and economic aspects of the thalassemia burden.MethodsData on thalassemia prevalence, incidence, mortality, and Disability-Adjusted Life Years (DALYs) were extracted from the Global Burden of Disease (GBD) 2021 study for South, East, Southeast, and high-income Asia regions, encompassing the relevant countries and territories from 1990 to 2021. The Average Annual Percent Change (AAPC) in age-standardized rates of thalassemia was determined to assess temporal trends. Age-gender cohort proportions were considered. The economic aspect of the disease burden and frontier analysis were evaluated using the GBD Socio-Demographic Index and Global Health Expenditure data.ResultsSoutheast Asia exhibited notably high age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate among the four studied Asian regions in 2021. The East Asia region had recorded the highest age-standardized incidence rate (ASIR). A general decline in disease burden indices across the four regions from 1990 to 2021 was evident, with the exception of ASIR in Southeast Asia. The ASMR was highest among pediatric population under five years old, with a significant male preponderance. An unusual increase in ASMR was detected among females of childbearing age and the elderly within the studied region. Further analysis had identified six high-burden countries and territories, particularly those with low-middle Socio-Demographic Index (SDI) rankings and limited health expenditure.ConclusionAlthough the overall burden of thalassemia has decreased substantially, the disease burden was influenced by gender, age, geography, temporal trends, and economic factors in distinct manners. Based on the current SDI, many countries and regions still have greater improvement potential in the disease burden. There is a necessity for enhanced attention and resource allocation, particularly in low-middle and low SDI countries, with an emphasis on policies that promote early diagnosis and comprehensive care.

Temporal and spatial trends in gastric cancer burden in the USA from 1990 to 2021: findings from the global burden of disease study 2021

BackgroundGastric cancer (GC) is a significant public health concern in the USA, and its burden is on the rise.MethodsThis study utilized the latest data from the Global Burden of Disease (GBD) study. We provided descriptive statistics on the incidence, prevalence, mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of GC across the USA and states. By calculating percentage changes and average annual percentage changes (AAPC), along with conducting age-period-cohort analysis, we assessed the trends in the burden of GC. Decomposition analysis was then performed, followed by the application of an autoregressive integrated moving average (ARIMA) model to forecast changes in ASRs through 2036.ResultsFrom 1990 to 2021, the number of incidence and prevalence of GC in the USA increased, but age-standardized incidence rates (ASIR) trended downward (AAPC = -0.73, 95% confidence interval [CI]: -0.77 to -0.68) and age-standardized prevalence rates (ASPR) (AAPC = -0.99, 95% CI: -1.08 to -0.9) showed a decreasing trend. In addition, the number of deaths, DALYs, age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR) in GC showed a decreasing trend. The burden of GC was significantly higher in males compared to females. In addition, we found that the highest incidence and prevalence in females was in the age group of 75-79 years, whereas the highest incidence and prevalence in males was in the age group of 70-74 years.ConclusionGC is a major public health issue in the USA. Although ASIR, ASPR, ASMR, and ASDR for GC are decreasing, the number of incidence and prevalence of GC in the USA remains high, and the disease burden of GC in the USA remains high. Strengthening preventive interventions, particularly for men and patients over the age of 60, will be crucial in the future.

Global burden of Alzheimer’s disease and other dementias attributed to metabolic risks from 1990 to 2021: results from the global burden of disease study 2021

ObjectiveThe risk of Alzheimer’s disease (AD) and other dementias increases with greater global exposure to metabolic risks, making this a crucial public health issue. This study aimed to report the metabolism-attributable global burden of AD and other dementias from 1990 to 2021.MethodsThe Global Burden of Disease Study (GBD) 2021 collected data on the number of deaths and disability-adjusted life-years (DALYs) related to AD and other dementias caused by metabolic risks, including high fasting plasma glucose (FPG) and high body mass index (BMI). The analysis assessed the disease burden and temporal patterns worldwide, examining data by region, country, level of social development, age group, and sex.ResultsGlobally, the count of AD and other dementia-related deaths due to metabolic risks grew from 98,608 to 399,824, a 4.1-fold increase. For dementias related to high FPG and high BMI, the age-standardized mortality rates (ASMR) and age-standardized DALY rate (ASDR) increased with age and were higher in females than in males. In 2021, the highest burden was observed in high-income North America. The ASMR and ASDR have grown worldwide between 1990 and 2021. The burden of metabolism-related AD and other dementias was positively correlated with the Socio-Demographic Index (SDI), with higher ASMR and ASDR in high SDI regions but showing more pronounced increases in low and low-middle SDI regions.ConclusionsMetabolism-related global burden of AD and other dementias is increasing, particularly among women and in high-income regions. Targeted prevention programs for dementia should be developed, along with early interventions for risk factors.

Epidemiological shifts in chronic kidney disease: a 30-year global and regional assessment

BackgroundChronic kidney disease (CKD) presents a growing global health challenge, with significant variability in disease burden across different regions and countries. This study aimed to analyze the trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for CKD from 1990 to 2019, utilizing data from the Global Burden of Disease Study.MethodsWe conducted an in-depth study on the global and age-standardized incidence, prevalence, mortality, and DALYs of CKD, and assessed trends over a 30-year period. Additionally, we explored the associations between healthcare access and quality (HAQ), the Socio-Demographic Index (SDI), and CKD. Furthermore, we conducted a detailed analysis of six risk factors closely related to CKD, and based on these findings, provided strong evidence for enhancing the management of CKD.ResultsIn 2019, there were 18,986,903 cases of CKD, with an average annual percent change (AAPC) of 1.82 (95% CI = 1.8 to 1.82) in incidence since 1990. The age-standardized incidence rate increased from 192.45 per 100,000 in 1990 to 233.65 per 100,000 in 2019. Prevalence also rose, with a total of 69,729,430 cases in 2019 and an AAPC of 1.19 (95% CI = 1.19 to 1.2). Mortality and DALYs have increased correspondingly, with the mortality rate reaching 18.29 per 100,000 and total DALYs at 41,538,592 in 2019. The analysis showed that higher HAQ levels are associated with better outcomes in terms of lower mortality and DALY rates, whereas lower HAQ levels correlate with poorer outcomes. In addition, high fasting plasma glucose and high systolic blood pressure are the main contributors to CKD-related deaths, with their population attributable fraction (PAF) significantly decreasing as the SDI decreases.ConclusionThe burden of CKD has significantly increased over the past three decades, influenced by demographic changes and variations in healthcare quality and access. Effective public health strategies and improvements in healthcare delivery are needed to address the disparities in CKD outcomes globally.

Assessing antimicrobial use patterns in Christian Health Association of Malawi (CHAM) health facilities: A cross-sectional study protocol.

The threat of antimicrobial resistance (AMR) in Malawi is high with reported mortality of 19,300 annually, the 23rd highest age-standardised mortality. One of the drivers of AMR is misuse of antibiotics, a phenomenon that has not been adequately researched in Malawi. This study aims to investigate antimicrobial use using health facility, prescribing and patient indicators in Christian Health Association of Malawi (CHAM) health facilities. This will be a multiple cross-sectional study, which will collect data from facilities (22), prescriptions (660), and patients (303). Data will be collected using KoboToolbox v2021, and exported into Microsoft Excel version 2016 for cleaning and coding. Variables will be categorised according to the antimicrobial use indicators. The study will use STATA Version 14 statistical software for data analysis. Subsequently, facilities will be entered into ArcGIS Version 10.7.1 to map hotspots of irrational antimicrobial use. The study will run from October 2024 to June 2025. This study will provide detailed information on frequently used antimicrobials, the cost of antimicrobials relative to medicine budget, the intensity of exposure to antimicrobials, the availability of antimicrobials, patients' understanding of antimicrobials use, and availability of important documents for antimicrobial use. Secondarily, the study will unravel the prevalence of irrational antimicrobial use, the main factors contributing to it, and location where irrational use is most prevalent. These findings will inform the national antimicrobial stewardship action plan, aiming to safeguard the available antimicrobials.

Smoking-attributable peptic ulcer disease mortality worldwide: trends from 1990 to 2021 and projections to 2046 based on the global burden of disease study

ObjectiveSmoking is a major risk factor for peptic ulcer disease (PUD) mortality. This study aims to analyze global trends in smoking-attributable PUD mortality from 1990 to 2021 and project future trends to 2046.MethodsData were obtained from the Global Burden of Disease Study 2021. We calculated age-standardized mortality rates (ASMR) and estimated annual percentage changes (EAPC) for smoking-attributable PUD mortality. Bayesian Age-Period-Cohort models were used to project future trends.ResultsFrom 1990 to 2021, global smoking-attributable PUD deaths decreased from 48,900 to 29,400, with the ASMR declining from 1.2 to 0.3 per 100,000 (EAPC: −4.25%). High-income regions showed faster declines, while some low- and middle-income countries experienced slower progress or even increases. Projections suggest a continued global decline in smoking-attributable PUD mortality to 2046, with persistent regional disparities. By 2046, the global ASMR is expected to decrease to approximately 0.1 per 100,000, with higher rates persisting in certain regions such as the Solomon Islands (3.7 per 100,000) and Cambodia (1.6 per 100,000).ConclusionWhile global smoking-attributable PUD mortality has significantly decreased and is projected to continue declining, substantial regional disparities persist. These findings underscore the need for targeted tobacco control interventions, particularly in high-risk regions, to further reduce the global burden of smoking-attributable PUD mortality.

The Burden of Peripheral Artery Disease in China From 1990 to 2019 and Forecasts for 2030: Findings From the Global Burden of Disease Study 2019

ObjectivesThe incidence of peripheral arterial disease (PAD) in China is increasing. We aim to conduct a comprehensive analysis of the burden of PAD.MethodsWe collected information from 1990 to 2019 in the Global Burden of Disease (GBD 2019) study. Joinpoint regression analysis was used to calculate the annual percentage change (APC). Trends in incidence, mortality and DALYs were forecasted by Bayesian age-period-cohort (BAPC) analysis.ResultsIn 2019, the number of new cases and prevalence of PAD in China accounted for nearly a quarter of the global proportion. The age-standardized incidence rate (ASIR) declined after rising until 2005. The age-standardized death rate (ASDR) maintained an upward trend. The DALYs was 0.16 million. Incidence, prevalence and DALYs are predominantly female, except for mortality, which is predominantly male. Smoking predominantly affected males, while hypertension and diabetes had a greater impact on females. By 2030, ASDR is elevated, predominantly in males. ASIR and age-standardized DALY rate decline, predominantly in females.ConclusionIt is urgent for China to develop strategies based on the specific distribution characteristics of the PAD burden.

Global, Regional, and National Burden of Tracheal, Bronchus, and Lung Cancer in 2022: Evidence from the GLOBOCAN Study

Background: Tracheal Bronchus and Lung cancers (TBL) represent one of the leading causes of cancer deaths worldwide. This study aimed to examine the disease and economic burden of TBL cancers in 185 countries worldwide in 2022. Methods: The estimates of TBL cancer incidence and mortality (counts and age-standardized rates) were obtained from the GLOBOCAN 2022 data produced by the International Agency for Research on Cancer. Mortality-to-incidence ratios (MIR) were utilized as a proxy of 5-year survival rates. Multivariate regression was utilized to examine the association between TBL cancer burden and tobacco use prevalence. Results: Globally, there were 2.48 million incident cases and 1.82 million deaths due to TBL cancers in 2022. Males accounted for 63.4% of incident cases (1.57 million) and 67.85% of TBL deaths (1.23 million) in 2022. For both sexes combined, the age-standardized rate was 23.1 per 100,000, and the age-standardized mortality rate was 16.8/100,000. The Mortality-to-incidence ratio (MIR) at the global level stood at 0.71. Eastern Asia had the largest burden of TBL cancers among the 21 UN-defined regions, with around 51% of incident cases (1.24 million) and 46.9% of global deaths (851,876), followed by Northern America (incidence: 257,284; deaths: 150,675) and Eastern Europe (incidence: 158,141; deaths: 126,840). At the country level, human development index (HDI) and adult tobacco use prevalence could explain 67% and 64% variation in ASIR and ASMR, respectively. HDI was statistically significantly related to MIR, explaining a 48% variation in MIR. Conclusions: With 1.9 million deaths in 2022, TBL cancer is a significant global cause of mortality. Despite the knowledge and awareness of smoking and lung cancer, adult smoking rates remain high in many countries, including the United States and China. Renewed and sustained global efforts are needed to reduce smoking prevalence and PM2.5 levels, particularly in China and low- and middle-income countries.

Burden of chronic obstructive pulmonary disease attributable to ambient ozone pollution across China and its provinces, 1990-2021: An analysis for the Global Burden of Disease Study 2021.

Epidemiological studies have demonstrated a causal relationship between ambient ozone (O3) and mortality from chronic obstructive pulmonary disease (COPD), which is the only outcome considered in the Global Burden of Disease Study 2021 for O3. This study aims to evaluate the temporal trend and spatial distribution of the COPD burden attributable to O3 across China from 1990 to 2021. The ambient O3 concentrations in China were estimated. Based on the methodology framework and standard analytical methods applied in the Global Burden of Disease Study 2021, we estimated the annual number, age-standardized rate, and percentage of deaths and disability-adjusted life-years (DALYs) from COPD attributable to O3 pollution during 1990-2021 at the national and provincial levels in China. In 2021, a total of 125.7 (95% uncertainty interval [UI], 26.4-228.3) thousand deaths and 1917.5 (95% UI, 398.7-3504.6) thousand DALYs from COPD were attributable to ambient O3 pollution in China, accounting for 9.8% (95% UI, 2.1-17.0%) and 8.1% (95% UI, 1.8-14.1%) of the total COPD deaths and DALYs, respectively. Generally, a higher burden was observed among males, the elderly, and the population residing in regions with worse health conditions. The age-standardized rates of COPD deaths and DALYs per 100,000 populations ranged from 0.5 (95% UI, 0-1.4) and 8.1 (95% UI, 0.7-20.9) in Hong Kong to 22.8 (95% UI, 3.9-43.5) and 396.6 (95% UI, 68.9-763.7) in Xizang. From 1990 to 2021, there was a notable decrease in the age-standardized rates of COPD deaths (68.2%, 95% UI, 60.1-74.9%) and DALYs (71.5%, 95% UI, 63.7-77.6%), especially in regions with poor health conditions. However, the attributable numbers and percentages changed relatively marginally. Ambient O3 pollution is a major contributor to the COPD burden in China. Our findings highlight the significant spatial heterogeneity across different provinces and underscore the implementation of geographically tailored policies to effectively reduce O3 pollution and alleviate the associated disease burden.

Global epidemiological profile in nasopharyngeal carcinoma: a prediction study

ObjectivesThis study delineates the global nasopharyngeal carcinoma’s (NPC) incidence and mortality across 185 countries in 2020 and projects the disease’s burden by 2040.DesignA prediction study.SettingCountries within the 20 world regions.ParticipantsGlobal...

An explainable AI framework for spatiotemporal risk factor analysis in public health: a case study of cardiovascular mortality in South Korea

ABSTRACT Understanding environmental disease risk factor analysis at the district level is essential for gaining valuable insights into regional disease variations, offering a broader perspective compared to individual-level studies. Recently, explainable artificial intelligence (XAI) has received increasing attention in the analysis of factors affecting public health. However, previous purely data-driven XAI-based risk factor analyses faced challenges in capturing regional effect of environmental variables, leading to confusion regarding key spatiotemporal risk factors. Therefore, this study proposes a framework that includes two complementary XAI-based risk factor analyses following two assumptions. Regionally rescaled environmental variables must account for the unequal effects on environmental factors, which are likely influenced by variations in adaptation capacity to weather conditions and differences in exposure-response relationships to air pollutants. District-level disease distribution highlights geographic disparity in sociodemographic vulnerability, whereas temporal variation in diseases by district underscores temporal environmental impacts. Based on these two hypotheses, we rescaled environmental variables using two complementary schemes: one that employs the district-level disease distribution as the target variable, and another that utilizes the temporal residual of the disease within each district. We evaluated this framework by analyzing the association between cardiovascular age-standardized mortality rate (CVD-ASMR) and various risk factors in South Korea from 2010 to 2019, using high-performing random forest and light gradient boosting models with additive Shapley explanation. Compared to previous purely data-driven XAI-based analyses, the proposed schemes achieved significantly better results in capturing regional exposure-response relationships. In two complementary schemes, the most explainable factor to districts with high CVD-ASMR was low education level related to sociodemographic vulnerability, whereas the most explainable factors to high temporal CVD-ASMR patterns were low greenness and high air pollution levels. In addition, the two complementary schemes enabled us to reasonably analyze the interaction effect of the two risk factors, i.e. temperature and air pollutants. Furthermore, high CVD-ASMR and its high temporal variation were observed in situations of high sociodemographic vulnerability with poor air quality. These findings provide insightful public health planning for sustainable cities and society by pinpointing high-risk areas and tailoring strategies to address regional environmental challenges.

Lung cancer incidence and mortality in trend and prediction between 2012-2030 in Shandong Province, using a Bayesian age-period-cohort model.

Lung cancer is one of the most common cancers in Shandong Province, China. Projecting future cancer trend is crucial for planning cancer control. We aimed to examine the trend of lung cancer incidence and mortality from 2012 to 2023, and predict the lung cancer burden to 2030 in Shandong. Data of lung cancer incidence and mortality from 2012 to 2023 were obtained from the Shandong Cancer Registries. The average annual percentage change (AAPC) was used to quantify the trend of the lung cancer age-standardised rate using Joinpoint software. Bayesian age-period-cohort model was used to predict lung cancer incidence and mortality from 2024 to 2030. The age-standardised incidence rate (ASIR) remained stable from 2012 to 2023. The ASIR in males decreased with an AAPC of -1.350%, while the ASIR in females increased with an AAPC of 2.429%. The age-standardised mortality rate (ASMR) decreased with an AAPC of -2.911%. This trend was also observed in males (AAPC=-2.513%), females (AAPC=-3.632%), urban areas (AAPC=-3.267%) and rural areas (AAPC=-2.603%). For our predictions, the ASIR will increase to 49.21 per 100,000 until 2030, with an AAPC of 1.873%. This upward trend is expected for females and urban areas, with an AAPC of 4.496% and 4.176%, while it is not observed for males and rural areas. The ASMR is expected to remain stable up to 2030, and this trend will maintain both in males and females. The ASMR will exhibit an upward trend (AAPC=1.100%) in urban areas and a downward trend (AAPC=-0.915%) in rural areas. The ASIR of lung cancer will increase until 2030, while the ASMR of lung cancer is expected to remain stable in Shandong. It is necessary to take further preventive measures such as strengthening tobacco control, enhancing health education and expanding screening efforts.

Cancer mortality and geographic inequalities: a detailed descriptive and spatial analysis of social determinants across US counties, 2018–2021

ObjectiveIn the United States, cancer mortality rates continue to decline, yet geographic and racial disparities persist and are particularly evident in the Delta region, characterized by high economic distress and disease burden. We examined cancer mortality patterns by demographic groups across geographic region (Delta vs non-Delta) and investigated the influence of macro-level social determinants of health (SDoH) in cancer death. Study design and methodsThis observational study included cancer death records of individuals aged ≥20 years from 2018 to 2021 in the United States. County-level characteristics were ascertained through the linkage of multiple national administrative and community surveys. We estimated age-standardized mortality rates (ASR) and rate ratios. We calculated the adjusted relative risks by county-level SDoH (geographic region, rurality, household income, income inequality, health insurance, and education) and other factors using age-adjusted multivariate quasi-Poisson regression. ResultsIn 2018–2021, approximately 2.4 million cancer deaths occurred in the United States. We observed important declines in the Black-White disparities, from 16.6% in 2018 (ASR = 289.9 vs 248.6 per 100,000) to 12.1% in 2021 (281.1 vs 250.8) in the Delta region and from 15.9% (254.9 vs 219.9) to 10.7% (240.6 vs 217.3) in the non-Delta region, though Black men in the Delta region remained the highest rate (ASR2021 = 346.9 per 100,000). County-level analyses provided strong evidence of geographic inequality and the role of SDoH, particularly education and income inequality. ConclusionsUnfavorable SDoH are associated with increased cancer death risk. Region-specific health policies and interventions in the Delta region are essential to advance cancer health equity.

Global Trend of MASH-associated Liver Cancer A Systematic Analysis from the Global Burden of Disease 2021.

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH) are the leading causes of liver disease and are emerging as the main risk factors for primary liver cancer (PLC). However, updated global data on MASH remain scarce. This study analyzed data from the Global Burden of Disease (GBD) study between 2000 and 2021 to assess the age-standardized incidence, mortality, and disability-adjusted life years (DALYs) from MASH-associated PLC, stratified by geographical region, sociodemographic index, age, and sex. There were 42,290 incident cases, 40,920 deaths, and 995,470 DALYs from PLC globally. Global incidence (+98%), death (+93%), and DALYs (+76%) from MASH-associated PLC increased steeply over the study period. Among different etiologies, only MASH-associated PLC had increased mortality rates (APC: +0.46, 95% CI 0.33 to 0.59%). Africa and low sociodemographic index countries exhibited the highest age-standardized incidence, death, and DALYs from MASH-associated PLC. DALYs increased in females (annual percent change [APC]: 0.24%, 95% Confidence Interval [CI] 0.06 to 0.42%) while remaining stable in males. Americas experienced the highest percentage increase in age-standardized incidence rate (APC: 2.09%, 95% CI 2.02 to 2.16%), age-standardized death rate (APC: 1.96%, 95% CI 1.69 to 2.23%), and age-standardized DALYs (APC: 1.96%, 95% CI 1.63 to 2.30%) from MASH-associated PLC. Over the past two decades, the burden of MASH-associated PLC has risen, though there are sociodemographic and geographic disparities. This necessitates urgent strategies across the globe to mitigate the epidemic of MASH-associated PLC as well as its metabolic drivers.

Quantifying the Impact: Burden of Ischemic Heart Disease Attributable to Kidney Dysfunction in the United States Over last Three Decades

Background: Ischemic Heart Disease (IHD) remains the primary cause of death and disability in the United States. Among various risk factors, the role of Kidney Dysfunction (KD) in exacerbating IHD has not been fully explored, particularly on a state-by-state basis. This study seeks to delineate the consistent burden of IHD attributable to KD throughout the U.S from 1990 to 2019.Method: We estimated the deaths, Disability Adjusted Life Years (DALYs), and Years Lived with Disability (YLDs) by age, sex, year, and location across the U.S. These were quantified in absolute numbers and age-standardized rates (ASR) per 100,000 people.Results: The study found significant increases in the annual percentage change (APC) from 2010-2019: deaths rose by 17% (95% Uncertainty Interval [UI]: 14-20%), DALYs by 18% (15-22%), and YLDs by 21% (16-27%). State-specific increases in age-standardized mortality rates (ASMR) were highest in Vermont at 5%, followed by New Mexico at 3%. Conversely, the District of Columbia saw a significant decrease of 16%. Vermont also showed the largest rise in DALY rates at 7%, and Florida in YLD rates at 3%. The age group of 90-94 years exhibited the highest number of deaths, while the 75-79 age group showed the greatest DALYs in 2019. Men consistently bore a heavier burden than women, with significant differences in APC across deaths, DALYs, and YLDs from 2010-2019.Conclusion: IHD due to KD accounted for 16.67% of all IHD deaths in 2019, with older adults and men experiencing a markedly increased burden. These findings underscore the need for integrated care approaches and strong health policies to effectively manage the interplay between these serious health conditions.

All-cause and cause-specific mortality inequalities between people with and without disability: a nationwide data linkage study in Australia

Without high-quality statistics on mortality inequalities, designing policies to improve the health of people with disability is challenging. We aim to quantify mortality inequalities experienced by people with disability in Australia. In this nationwide, data linkage study we used Census mortality linked data (2011-20) to construct a cohort of Australians aged 0-74 years. Disability was measured as requiring assistance or supervision in core daily activities. We estimated age-standardised and age-specific mortality rates, and absolute and relative mortality inequalities between people with and without disability. 15 216 195 people were included in the study, comprising 7 763 047 females and 7 453 148 males. Of the participants, 258 109 (3·5%) males and 228 658 (2·9%) females reported disability, with 462 990 deaths occurring over 138 540 359 person-years of follow-up. Per 100 000 person-years, there were 2067 (95% CI 2043-2091) more deaths in males and 1697 (1677-1718) more deaths in females with disability (3·69 and 4·64 times higher, respectively) than those without disability. Cancer and cardiovascular disease had the highest absolute inequalities, with rate differences of 462 (95% CI 449-476) for males and 368 (356-379) for females for cancer, and 471 (95% CI 459-483) for males and 333 (324-342) for females for cardiovascular disease. Less common causes among people without disability-neurological conditions, chronic lung diseases, endocrine diseases, and digestive diseases-are relatively common among people with disability, translating to high relative mortality inequalities. The largest relative inequalities were from neurological conditions, with rate ratios of 9·66 (95% CI 9·31-10·02) for males and 11·61 (11·13-12·10) for females. Relative and absolute inequalities were also substantial for unintentional injury and for suicide mortality. Age-specific mortality was consistently higher in people with disability. The leading contributors to absolute inequalities shifted from neurological conditions in younger ages to cancer, cardiovascular diseases, and chronic lung diseases in older ages. People with disability experience large mortality inequalities. Identifying intervention-amenable factors contributing to these inequalities should be a priority. Targeted interventions and policy reforms to create a more inclusive social and health-care environment for people with disability might be necessary. The University of Melbourne.

The global, regional, and national burden of urolithiasis in 204 countries and territories, 2000–2021: a systematic analysis for the Global Burden of Disease Study 2021

Urolithiasis is a common urological problem that is associated with high morbidity. A comprehensive assessment of the non-fatal and fatal health trends of urolithiasis by age, sex, and geography over time is necessary to inform policy to control this surgically managed non-communicable disease. This study was conducted using the standard GBD methodology and analytic tools. Cause-specific mortality rate (CSMR) was estimated using vital registration and verbal autopsy data and the Cause of Death Ensemble model (CODEm) modelling tool. CSMR estimates and incidence data from medical insurance claims and hospital discharges were analysed using a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to estimate age-, sex-, and location-specific incidence of urolithiasis between 2000 and 2021. Disability-adjusted life-years (DALYs) were the sum of years of life lost (YLL) and years lived with disability (YLDs). YLLs due to urolithiasis were calculated by multiplying the estimated number of deaths by the standard life expectancy at the age of death. YLDs were estimated by multiplying the disability weight by the symptomatic proportion of urolithiasis cases. The Global Burden of Diseases study used de-identified data, approved by the University of Washington IRB (Study Number 9060). There were 106 million (95% UI 88.3-129.0) incident cases of urolithiasis in 2021, of which 67% were in men (71.1 million [59.4-86.2)]). The global number of incident cases, deaths, and DALYs increased by 26.7% (23.8-29.8), 60.3% (41.5-84.7), and 34.5% (24.6-47.3), respectively, between 2000 and 2021. The global age-standardised incidence rate of urolithiasis experienced a significant decrease of 17.5% (14.7-20.0), while the age-standardised DALYs rate saw a reduction of 15.1% (6.8-21.3). Twelve GBD regions showed declining trends in the age-standardised incidence rate of urolithiasis between 2000 and 2021, and the remaining nine GBD regions had an increasing trend of age-standardised rates of urolithiasis. A significant increase in the age-standardised incidence rate of urolithiasis was observed in Central America, Tropical Latin America, and the Caribbean regions, whereas notable decline was observed in east Asia, eastern Europe, central Europe, and high-income North America. It was observed that the global age-standardised death rate was less than 0.5 per 100,000 across all GBD regions and less than 1 per 100,000 across all SDI quintiles, with fairly stable global age-standardised death rates of urolithiasis between 2000 and 2021. The age-standardised incidence rate of urolithiasis was 837 (688-1034) in low SDI regions and 1443 (12,108-1734) in high-middle SDI regions. Furthermore, the age-standardised DALY rate showed a decreasing trend across all SDI quintiles over the same period: high-middle SDI (-28.9% [-34.4 to-23.0]), middle SDI (-22.6% [-30.5 to-10.9]), and low-middle SDI (-2.9% [-15.8 to 12.9]). Global urolithiasis incidence and DALY rates have decreased, while the death rate has stabilised worldwide, showing significant variability among regions, SDI levels, and countries. This could be due to effective preventive measures c on urolithiasis risk factors, effective public health education, lifestyle changes, and early interventions and improved health care access at the global level. This analysis offers relevant insights into global, regional, and country-specific urolithiasis trends. Bill & Melinda Gates Foundation.

Sociodemographic characteristics of maternal mortality in Japan: An analysis of national data from 2010 to 2022

ObjectiveThere is a paucity of studies investigating sociodemographic characteristics of maternal mortality in Japan. In this study, we investigated the sociodemographic factors associated with maternal mortality in Japan using national data. Materials and methodsThe Vital Statistics data in Japan (birth and mortality data) from 2010 to 2022 were used in the analysis. Region, maternal age group, maternal nationality, maternal marital status, and the main type of occupation in the household (household occupation) were used as sociodemographic variables. The maternal mortality ratio per 100,000 live births, maternal age group-specific maternal mortality ratio, and the maternal mortality ratio standardized by maternal age group were calculated by the sociodemographic characteristics. ResultsA total of 12,535,198 live births and 457 maternal deaths were included in the analysis. The age-standardized maternal mortality ratio of metropolitan areas was the lowest among regions. The age-standardized maternal mortality ratio of non-Japanese mothers was approximately twice as high as that of Japanese mothers, and the ratio of unmarried mothers was approximately five times as high as that of married mothers. The age-standardized maternal mortality ratio of households with a full-time worker in a larger company and unemployed households was the lowest and highest, respectively, among household occupations, and that of unemployed households was approximately nine times as high as that of households with a full-time worker in a larger company. ConclusionsSome sociodemographic factors, such as maternal marital status and type of household occupation, were associated with maternal mortality in Japan.

Exploring the global impact of obesity and diet on dementia burden: the role of national policies and sex differences.

Obesity is a significant modifiable risk factor for dementia. This study aims to quantify the global impact of obesity on dementia burden and examine how national strategies for managing overweight/obesity and dietary factors influence dementia prevalence and mortality, with a focus on sex-specific differences. We used data from the Global Burden of Disease (GBD) and World Health Organization (WHO) to evaluate the association between obesity age-standardized prevalence rate (ASPR) and dementia age-standardized mortality rate (ASMR) and ASPR across 161 countries. A two-step multivariate analysis adjusted for socioeconomic and lifestyle factors was performed. Temporal trends in dementia were analyzed based on the presence of national obesity management strategies and varying dietary scores. A 1% increase in national obesity prevalence was associated with a 0.36% increase in dementia mortality (OR: 1.0036; 95% CI: 1.0028-1.0045) in males and 0.12% in females (OR: 1.0012; 95% CI: 1.0007-1.0018). A 1% increase in national obesity ASPR was associated with an increase in ASPR of dementia by 0.26% for males (OR: 1.0026, 95% CI: 1.0024-1.0028) and 0.05% for females (OR: 1.0005, 95% CI: 1.0004-1.0006). Males exhibited a higher susceptibility to obesity-related dementia. Countries with national obesity management strategies showed a significantly greater reduction in dementia mortality, particularly among females (P = 0.025). Higher dietary scores were associated with a more significant decrease in dementia prevalence across both sexes. Rising obesity prevalence is linked to increased dementia burden globally, with males being more vulnerable to this relationship. National management of overweight/obesity and healthier dietary habits may help mitigate the dementia burden, emphasizing the need for integrated public health interventions.