To determine whether the implementation of the Life-Sustaining Treatment Decision Act (LSTDA) in South Korea affected the age-standardized incidence rate (ASIR) of in-hospital cardiac arrest (IHCA) and in-hospital mortality. Retrospective, population-based cohort study. Nationwide administrative health database in South Korea. A total of 380,488 adult patients (≥ 18 yr) who underwent in-hospital cardiopulmonary resuscitation between January 2013 and December 2023. Cases from the implementation year (2018) were excluded to minimize transitional bias. None. The primary outcomes were the annual ASIR of IHCA and in-hospital mortality. The study population was divided into pre-LSTDA (2013-2017; n = 147,385) and post-LSTDA (2019-2023; n = 233,103) periods. Multivariable logistic regression revealed that the post-LSTDA period was associated with significantly lower in-hospital mortality compared with the pre-LSTDA period (adjusted odds ratio, 0.90; 95% CI, 0.88-0.92; p < 0.001). Regarding incidence, segmented linear regression analysis showed that before the LSTDA, the ASIR increased significantly by 6.5 cases per 100,000 population per year (95% CI, 1.6-11.4; p < 0.001). After implementation, the upward trend decelerated (slope change, -5.4; 95% CI, -12.8 to 1.5; p = 0.177), indicating a shift toward a decline in the growth of IHCA events. The enactment of the LSTDA was associated with a significant improvement in survival outcomes and a deceleration in the rising incidence of IHCA. These findings suggest that the legal framework for end-of-life decision-making effectively facilitates the withholding of medically nonbeneficial resuscitation, thereby optimizing the allocation of critical care resources toward patients with better reversible potential.

The impact of socioeconomic status on paediatric out-of-hospital cardiac arrest incidence and outcomes in Western Australia: a population-based cohort study.

Global burden, temporal trends and cross-national inequalities of the comorbidity between depressive disorder and hormone-dependent tumors in women of reproductive ages from 1990 to 2021: A population-based analysis with projections to 2036.

Tuberculosis (TB) remains a major public health challenge in Thailand, a high-burden country undergoing both epidemiological transition and pandemic-related disruption. This study examined temporal and spatial patterns of age-standardized TB incidence from 2012 to 2023 across Thailand's 13 health regions and 77 provinces. This nationwide ecological study used annual TB case notifications (2012-2023) for all 77 Thai provinces from Thailand's National Disease Surveillance System (Report 506), Bureau of Epidemiology, with mid-year and age-stratified provincial populations. Age-standardized incidence rates (ASR) were calculated using the WHO World Standard Population (2000-2025). Temporal trends were assessed by Joinpoint regression with Bayesian-Information-Criterion model selection (maximum 2 joinpoints) and validated by generalized additive models. Spatial clustering was evaluated by Global Moran's I and Local Indicators of Spatial Association (LISA) under queen contiguity, with sensitivity analyses across alternative weights and Benjamini-Hochberg false-discovery-rate correction. Provinces were classified into long-term trend categories combining effect size (AAPC) and significance, and COVID-19 impact was quantified by 2019-2023 ASR percent change. National TB incidence declined substantially from 2012 to 2023, although marked regional heterogeneity persisted. Five health regions showed the strongest long-term reductions: region 3 [AAPC: - 20.51, 95% confidence interval (CI): - 33.00 to - 13.77], region 9 (- 19.42, 95% CI: - 28.98 to - 8.57), region 4 (- 17.53, 95% CI: - 23.64 to - 12.89), region 11 (- 11.79, 95% CI: - 22.16 to - 0.04), and region 13 (- 11.19, 95% CI: - 22.44 to - 3.74). Region 6 showed an early decline followed by stabilisation, and region 12 showed a mid-period increase before a post-2019 reduction. Thailand has achieved substantial overall reductions in TB incidence over the past decade, but pronounced regional and provincial disparities persist. Localized hot-spots, biphasic regional trajectories that may reflect surveillance and programmatic transitions, and compound vulnerability during the COVID-19 period underscore the need for geographically targeted monitoring, equitable resource allocation, and pro-poor interventions to sustain progress toward TB elimination.

A population-based study of esophageal adenocarcinoma (EAC) incidence in Akita Prefecture (2007-2014) revealed a surge beginning around 2010. Using the same registry, we extended the analysis through 2024 to examine recent EAC trends in the prefecture. We used the Akita Prefecture collaborative, hospital-based cancer registry, which captures > 90% of cancers in the region. Registered esophageal cancers were histologically classified as squamous cell carcinoma, EAC, and unspecified neoplasm. Temporal changes in the number of and proportion of EAC cases, as well as the age-standardized incidence rates (ASRs; per 100,000 person-years, directly standardized to the 1985 Japanese model population), were estimated for 2010-2024. The estimated annual percent change (EAPC) was also calculated. The number of EAC cases increased from 38 (2010-2014) to 72 (2020-2024), and the proportion among all esophageal cancers rose from 2.3% to 4.7%. The ASR increased from 0.39 (2010-2014) to 0.45 (2015-2019) and 0.77 (2020-2024) per 100,000 person-years. From 2010 to 2024, ASR showed a significant upward trend (EAPC 8.37% [95% confidence interval, 4.32-12.57]; p < 0.0001), largely driven by men. Using the most recent data from Akita's hospital-based registry, we demonstrate that both the number and incidence of EAC approximately doubled between 2010-2014 and 2020-2024, indicating that the upward trend that began around 2010 has persisted.

Prostate cancer (PCa) is a major public health challenge in the United States. This study analyzed the long-term trends in PCa burden from 1990 to 2021 and provides projections for future trends. Data were obtained from the Global Burden of Disease 2021 database to evaluate PCa burden metrics in the United States and globally, including incidence, prevalence, mortality, and disability-adjusted life years. Temporal trends were assessed using joinpoint regression analysis, while age-period-cohort models were applied to evaluate the effects of age, period, and birth cohort. Decomposition analysis was performed to quantify the contributions of population growth, population aging, and epidemiological changes to variations in PCa burden. Future trends through 2036 were projected using a Bayesian age-period-cohort model. Relative to global estimates, the burden of PCa remained higher in the United States throughout the study period. In 2021, PCa imposed a significant burden on males in the United States, particularly among individuals aged 65 to 69. An estimated 2,671,779 prevalent cases, 297,836 incident cases, and 44,032 deaths were recorded. The age-standardized incidence rate and age-standardized prevalence rate in the United States exceeded the corresponding global estimates, reaching 108.04 and 967.87 per 100,000 population, respectively. Although age-standardized rates generally declined between 1990 and 2021, the absolute numbers of incident and prevalent cases continued to increase, indicating that an increasing number of individuals are living with PCa. Among U.S. states, Louisiana had the highest burden, whereas Hawaii had the lowest. Decomposition analysis revealed that population aging and population growth increased the burden of PCa, whereas epidemiological changes partially offset these increases. Projections suggested a gradual increase in the burden of PCa through 2036. These findings highlight the need for targeted public health strategies to reduce the future burden of PCa in the United States.

This study evaluated the epidemiological burden and temporal trends of mental disorders in Vietnam from 1990 to 2023 and projected the future burden through 2040. Global Burden of Disease Study 2023 data were used to analyze the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), and age-standardized disability-adjusted life-year rate (ASDAR) by age, sex, and diagnostic subtype. Temporal trends were quantified using the estimated annual percentage change (EAPC), and Pearson correlation analysis examined associations with Vietnam's human development index (HDI). Bayesian structural time series (BSTS) models were used to forecast the burden through 2040. In 2023, approximately 9.1 million individuals in Vietnam had mental disorders, with 2.94 million annual incident cases and 1.41 million disability-adjusted life-years. Depressive disorders ranked highest across all metrics, and females consistently had higher age-standardized rates than males. Age-standardized rates increased significantly from 1990 to 2023: ASIR, 1.10% EAPC (95% confidence interval [CI], 0.87%-1.33%); ASPR, 0.27% EAPC (95% CI, 0.21%-0.33%); and ASDAR, 0.52% EAPC (95% CI, 0.46%-0.58%). Mental disorder burden was strongly positively correlated with HDI (r=0.773-0.909, all p<0.001). BSTS models projected continued increases through 2040 (ASPR, 9,003.75; ASIR, 3,307.11; ASDAR, 1,408.05 per 100,000 population). Mental disorders constitute an escalating public health challenge in Vietnam, with the burden increasing steadily over 3 decades and projected to continue rising through 2040. Reorientation toward an integrated, community-based care model, alongside targeted workforce expansion and systematic integration of mental health services into primary care, is essential to mitigate this growing burden.

Motivated by studies on early-onset colorectal cancer (EO CRC, below 50 years) from the United States (US) and elsewhere, this study aimed to provide national incidence trends of EO CRC for Germany. We retrieved colorectal cancer cases (ICD-10 codes C18-C20) using pooled data from German cancer registries with high-quality data. Appendix (C18.1) was excluded from the main analyses and investigated separately. We calculated age-standardised incidence rates (ASR) by calendar year, age group, sex, tumour site, histological subtype, tumour size, grading and estimated corresponding average annual percent changes (AAPC). For comparison, US cancer registry data was drawn from the Surveillance, Epidemiology, and End Results programs 21 population-based registries (SEER 21). From 2003 to 2023, ASRs of EO CRC (C18-C20 excluding C18.1) increased for men (AAPC: 0.8%) and women (AAPC: 0.9%) in Germany. By 10-year age groups, the increase was limited to men and women aged 20-29 years (AAPC males: 3.3%; AAPC females: 3.9%) and 30-39 years (AAPC males: 2.2%; AAPC females: 2.0%). For appendix cancer (C18.1), ASRs were rising for all age groups below 50 years of age. Increases for both colorectal cancer (excluding the appendix) and appendix cancer tended to be higher for cancers with good prognosis (neuroendocrine neoplasms, small size, low grading). In contrast to the US, Germany had a substantially lower EO CRC incidence in 2003 that increased at a slower pace. It is important to monitor future EO CRC incidence trends. The causes of the observed trends remain unclear.

BackgroundCholangiocarcinoma (CCA) is a rare and aggressive malignancy of the bile ducts with a poor prognosis. Although its incidence and mortality are increasing, the true burden of disease is likely underestimated due to underdiagnosis and limitations in coding systems. Population-based studies describing subtype-specific (ICD-11) epidemiology, clinical characteristics, and outcomes remain scarce and are urgently needed. This study aimed to characterize real-world CCA incidence, treatment patterns, and survival in Gipuzkoa, Spain.MethodsAll CCA patients at Donostia University Hospital, the central referral center for CCA in Gipuzkoa, were included (2010-2024). Clinical, treatment, and outcome data were collected. Population based age-standardized incidence (ASIR) and mortality rates (ASMR) were calculated. ctDNA and germline DNA from 147 patients underwent whole-exome sequencing.ResultsA total of 727 patients were included, 79.2% with histological confirmation. Median age was 72 years, 65% male. lntrahepatic CCA (iCCA) was most frequent (48%), followed by distal (dCCA, 30%} and perihilar (pCCA, 21 %). ASIR rose during the retrospective period (0.63-4.16) and plateaued prospectively (4.24-5.99), with highest rates for iCCA. ASMR showed a similar trend. Common risk factors included alcohol intake. smoking, overweight/obesity, and diabetes. Median overall survival was 10.25 months, shortest in pCCA and longest in dCCA. ctDNA analysis revealed actionable alterations, including FGFR2 fusions (5%), IDH1 (7%), BRAF (6%), and ERBB2(7%).ConclusionsCCA incidence is rising. Accurate case identification, standardized diagnostics with biopsy confirmation, and close monitoring improve recognition. lntrahepatic CCA is the most frequent subtype, followed by distal and perihilar CCA.

Burden of Malaria and Dengue Across Global, Asian, and Chinese Populations Based on GBD 2021 Data: A Quantitative Assessment of Importation Risks to China.

Young-onset dementia (YOD), defined as dementia with symptom onset before the age of 65, is associated with distinct and often complex care needs that differ from those with late-onset dementia. Current national data on YOD incidence, prevalence, and demographic characteristics are limited, underscoring the importance of prospective studies to inform policy and tailored care services. We conducted two prospective one-year prevalence and incidence studies using active case-finding in two Dutch catchment areas, one urban and one more rural region, between 2020 and 2022. Individuals with YOD making use of care services were registered in an online database. Data on dementia subtype, living situation, and migration background were collected to explore regional variation. We identified 372 individuals with YOD in the urban Rotterdam area, and 209 in the more rural Eindhoven-De Kempen area. Age-standardized prevalence per 100,000 individuals, standardized to the Dutch population, was 77.3 in the Rotterdam region, and 66.1 in the Eindhoven-De Kempen region for ages 30-69 years, and 46.3 and 36,9, respectively, for ages 30-64 years. Corresponding age-standardized incidence rates were 24.2 and 23.5 for ages 30-69 years, and 13.9 in both regions for ages 30-64 years. Alzheimer's disease was the most common diagnosis in both areas. Compared with Eindhoven-De Kempen, the Rotterdam region had significantly more vascular dementia cases (p < 0.05 for incidence, and p < 0.001 for prevalence) and longer diagnostic delays (2.2 vs. 1.3 years between first GP consultation and diagnosis). Most individuals lived at home (76.4% and 85.4% resp. in Rotterdam and Eindhoven-De Kempen) and 30.8% in Rotterdam and 12.5% in Eindhoven-De Kempen had a migration background. Extrapolation of incidence figures suggests that between 14,655 and 20,340 individuals were living with YOD in the Netherlands in 2021. This study estimates the number of people living with YOD in the Netherlands. In addition, our findings show regional variation in dementia subtypes, a high proportion of people with YOD living at home, and a substantial proportion of people with YOD with a migration background. These insights underline the importance of region‑specific, person‑centered, culture sensitive YOD care at home.

Malignant mesothelioma (MM) in Spain reflects historical asbestos consumption that peaked in the 1970s. Despite a 2002 ban, the absence of a national registry complicates burden estimation. We aimed to characterise incidence trends and generational risk patterns over 25 years. This ecological study analysed Global Burden of Disease 2023 incidence data for Spain (1999-2023). Age-standardised incidence rates (ASIR) were calculated using the 2013 European Standard Population. Temporal trends were assessed via joinpoint regression. Age-period-cohort (A-P-C) modelling disentangled the independent effects of age, period, and birth cohort by sex. In men, ASIRs increased from 1·55 to 1·94 per 100,000 (1999-2012), followed by a significant decline after 2016 (annual percentage change [APC] - 2·3%, 95% CI - 3·9- - 1·3; p < 0·001). In women, rates remained low and stable (0.45-0.50 per 100,000), with a modest increase over time (average annual percentage change 0.6%, p < 0.001). A-P-C modelling in men revealed a significant negative net drift (- 1·45% per year, p < 0·001) and strong birth cohort effects peaking in the 1944 cohort, with marked risk reduction in those born after 1964 (relative risk < 0·70). Women showed no significant cohort or period effects and minimal temporal variation. Spain shows evidence of a meaningful epidemiological transition in its mesothelioma epidemic. The significant decline in male incidence since 2016 is consistent with the 2002 asbestos ban and the progressive ageing-out of heavily exposed cohorts.

Environmental and Occupational Risks in Asthma Burden: A Global Analysis of Trends, Disparities, and Future Projections for Ages 5-39.

To evaluate temporal trends in upper respiratory infection (URI) burden among children and adolescents in East Asia from 1990 to 2023 and project trajectories through 2035 using Global Burden of Disease 2023 data. URI incidence, mortality, and disability-adjusted life years (DALYs) for ages 5 to 19 years were extracted for China, DPR of Korea, Japan, Mongolia, Republic of Korea, and globally. Age-standardized rates (age-standardized incidence rate, age-standardized mortality rate, and age-standardized DALYs rate [ASDR]) and estimated annual percentage change were used to assess temporal trends. The socio-demographic index evaluated burden relative to development. Decomposition, age-period-cohort, and Bayesian APC (BAPC) analyses quantified drivers and projected trends through 2035. In 2023, Japan had the highest age-standardized incidence rate (253,071.04 per 100,000) and Mongolia the lowest (105,719.25 per 100,000). Age-standardized mortality rate declined significantly across all countries, most markedly in China (EAPC = −10.97). Burden was greatest at ages 5 to 9 and slightly higher in males. Japan and Republic of Korea showed ASDR substantially exceeding socio-demographic index -expected levels (eff_diff = 43.09 and 37.31). Globally, absolute DALYs increased, driven by population growth and age structure change, partially offset by epidemiological improvement; in East Asian countries, epidemiological improvement was the primary driver of DALYs reduction. Cohort analysis showed generational risk reduction, with a transient period-effect upturn in China during 2019 to 2023. BAPC projections indicate continued global ASDR decline through 2035, rising trends in Japan and Democratic People’s Republic of Korea, and a rebound followed by a plateau in China. URI burden among East Asian children and adolescents has broadly declined but with marked country heterogeneity; Japan and Republic of Korea bear a disproportionately high burden relative to their development level, highlighting the need for targeted prevention strategies.

Maternal sepsis and maternal infections (MSMIs) pose significant risks to maternal, fetal, and neonatal health. This study examines the burden trends of MSMIs in China from 1990 to 2021, comparing them with global patterns. The burden of MSMIs in China and worldwide was evaluated using data from the Global Burden of Disease (GBD) spanning 1990-2021. Temporal trends were assessed through Joinpoint regression, calculating average annual percentage changes (AAPC) with 95% confidence intervals. Future burden projections up to 2036 were estimated using ARIMA modeling. Cross-regional comparisons were conducted to identify variations in disease impact. Between 1990 and 2021, China exhibited distinct trends in the burden of MSMIs compared to global patterns. The country's age-standardized incidence rate (ASIR) declined from 29.62 to 23.95 per 100,000, reflecting an annual reduction of -0.73%, in contrast to a global increase to 37.40. Mortality indicators showed significant declines, with China's age-standardized mortality rate (ASMR) dropping by 77.7% to 4.04 (-5.10% per year), compared to a 56.9% global reduction. Disease burden indicators demonstrated accelerated improvements, as China's age-standardized disability-adjusted life years rate (ASDR) fell by 78.3% to 93.73 (-5.31% per year), exceeding the global reduction of 53.1%. Prevalence patterns showed a contraction in China's age-standardized prevalence rate (ASPR) to 390.24 (-0.47% per year), whereas international prevalence rose to 513.68. Age-stratified analysis revealed inverse relationships: ASIR declined progressively with aging, while mortality and disability indicators intensified in older populations, differing from the bimodal prevalence distribution that peaked in middle age. From 1990 to 2021, China experienced a significant decline in the MSMIs burden, diverging from rising global trends. Projections suggest this divergence will persist, with China's burden continuing to decrease by 2036, while global rates increase. Urgent targeted interventions are needed for high-risk regions and populations.

IntroductionHealth issues regarding autoimmune diseases in men have been neglected. We here investigated temporal trends in burden of autoimmune diseases in men and assessed inequities in healthcare access and quality worldwide.MethodsThis ecological, descriptive time-series analysis using Global Burden of Disease estimates included men with autoimmune diseases at all ages covering 204 countries and territories from 1990 to 2021. Age-standardised rates of incidence, prevalence, mortality, disability-adjusted life-years (DALYs), years lived with disability (YLDs) and years of life lost (YLLs) and average annual percentage change were calculated. Global trends were stratified by age, sociodemographic index (SDI), region and country. Overall Quality of Care Index (QCI) and three selected age groups including young (aged 0–14 years), working (aged 15–64 years) and postworking (aged 65+ years) QCI were calculated globally, regionally and nationally.ResultsGlobally, the burden of autoimmune diseases in men significantly decreased from 1990 to 2021. However, in high SDI countries, age-standardised incidence rate increased from 2005, and age-standardised prevalence and YLDs rates increased from 2015. In 2021, significant disparities in QCI scores persisted across SDI levels, with the overall QCI ranging from 74.97 in low–middle countries to 90.55 in high SDI countries. Remarkable ranges in QCI scores between low SDI countries and high SDI countries for the young, working and postworking groups were also detected, with estimates of 82.94 to 92.18, 74.76 to 89.59 and 68.18 to 85.78, respectively. Absolute convergence in QCI was estimated in all these three age groups, with the most prominent convergence in the young group.ConclusionsProgress towards controlling autoimmune diseases in men varied widely, with substantially high mortality in low and low–middle SDI countries. Significant inequities in healthcare access and quality persisted across sociodemographic development levels and age groups. Healthcare systems need to improve healthcare access and quality for working and postworking populations while simultaneously maintaining performance among young individuals.

Global, Regional, and National Burden of Caries Among Women of Childbearing Age From 1990 to 2021 and Prediction.

Nonrheumatic valvular heart disease is an increasing public health concern. This study assessed the burden and quality of care for nonrheumatic valvular heart disease in Asia and at the global level from 1990 to 2021, and projected trends to 2050 using data from the GBS (Global Burden of Disease Study) 2021. Incidence, age-standardized incidence rate, deaths, age-standardized mortality rate, disability-adjusted life years, and age-standardized disability-adjusted life years rate were analyzed. A time-series model (autoregressive integrated moving average was used for forecasting future trends. A quality-of-care index was constructed through principal component analysis, and future quality-of-care index trends were projected using a Bayesian age-period-cohort model. From 1990 to 2021, both incident nonrheumatic valvular heart disease cases and age-standardized incidence rate increased globally and in Asia, whereas age-standardized mortality rate and age-standardized disability-adjusted life years rate declined. Projections suggest that incident cases will continue to rise through 2050, with age-standardized incidence rate decreasing globally but remaining relatively stable in Asia. Although Asia has lower age-standardized rates than the global average, its projected age-standardized incidence rate increase is greater. Disease burden varied by age and sex, with incidence peaking at 70 to 74 years. Mortality exceeded that of men among women after age 70 to 74. Nonrheumatic aortic valve disease contributed to the greatest burden. Quality-of-care index improved markedly from 1990 to 2021 globally and in Asia, but recent gains have slowed, suggesting a plateau in care improvement. Nonrheumatic valvular heart disease burden is rising, especially in aging Asian populations. Despite declining mortality and improved care quality, increasing incidence and slowing quality-of-care index gains may intensify future health system pressures.

IntroductionThe diagnosis of adult hematologic malignancies primarily originating in the bone marrow (BM) requires comprehensive evaluation. In many cases, a definitive diagnosis necessitates referring patients from peripheral healthcare centers to tertiary hospitals. This study aimed to analyze incidence patterns and age-specific trends of such malignancies over a decade at one national tertiary hospital in Indonesia.MethodsA retrospective cross-sectional study was conducted using bone marrow aspiration (BMA) results from patients suspected of having primary BM hematologic malignancies. Procedures were performed in the Division of Hematology and Medical Oncology, Department of Internal Medicine, and analyses were conducted in the Department of Clinical Pathology at Sardjito Hospital between 2012 and 2022. Sex and age data were collected to calculate crude incidence rates (CIR), age-specific incidence rates (ASR), and age-standardized incidence rates (ASIR).ResultA total of 3,144 cases were analyzed and the results showed that the incidence of myeloid lineage malignancies was higher than lymphoid, predominantly in males. ASR showed that Myeloproliferative Neoplasms (MPN) and Myelodysplastic Syndromes (MDS) increased with age. Acute Myeloid Leukemia (AML) remained stable in younger age groups but increased significantly in older adults. Acute Lymphoblastic Leukemia (ALL) was more common in younger individuals, particularly in the 20–24 age group. Meanwhile, the incidences of Chronic Lymphocytic Leukemia (CLL) and Multiple Myeloma (MM) increased with age. A linear regression analysis of incidence trends over the years showed no statistically significant trend.ConclusionThis study provides essential epidemiological evidence on hematological malignancies of primary BM origin in Indonesia, showing the predominance of myeloid lineage malignancies and distinct age-related patterns. These findings may support age-targeted awareness, early detection strategies, and coordinated national efforts to address the growing burden of hematologic malignancies in adults.

Global burden of bipolar disorder in 204 countries and territories, 1990-2021: a systematic analysis of temporal trends, demographic disparities, and SDI associations for the Global Burden of Disease Study 2021.