Annual Age-standardized Rates Research Articles

Cancer mortality predictions for 2024 in selected Asian countries and Australia with focus on stomach cancer.

We estimated cancer mortality figures in five major Asian countries and Australia for 2024, focusing on stomach cancer, a leading cause of cancer-related deaths in Eastern Asia. We computed country- and sex-specific annual age-standardized rates (ASRs) for total cancers and the 10 most common cancer sites, using WHO and the United Nations Population Division databases from 1970 to 2021 or the latest available year. We predicted figures for 2024 and estimated the number of avoided cancer deaths in 1994-2024. All cancers combined ASR declined between 2015-2019 and 2024 across considered countries and sexes. In 2024, the lowest predicted male rate is in the Philippines (75.0/100 000) and the highest in Australia (94.2/100 000). The Republic of Korea is predicted to have the lowest female ASR (42.1/100 000) while the Philippines the highest (74.5/100 000). Over the last three decades, 121 300 deaths were estimated to be avoided in Hong Kong SAR, 69 500 in Israel, 1 246 300 in Japan, 653 300 in the Republic of Korea, 303 300 in Australia, and 89 700 among Philippine men. Mortality from stomach cancer has been decreasing since 1970 in all considered countries and both sexes. Significant decreases are at all age groups Male rates remain, however, high in Japan (8.7/100 000) and the Republic of Korea (6.2/100 000). Declining cancer mortality is predicted in the considered countries, notably reducing stomach cancer burden. Stomach cancer, however, remains a major public health issue in East Asia.

Deaths from Excessive Alcohol Use - United States, 2016-2021.

Deaths from causes fully attributable to alcohol use have increased during the past 2 decades in the United States, particularly from 2019 to 2020, concurrent with the onset of the COVID-19 pandemic. However, previous studies of trends have not assessed underlying causes of deaths that are partially attributable to alcohol use, such as injuries or certain types of cancer. CDC's Alcohol-Related Disease Impact application was used to estimate the average annual number and age-standardized rate of deaths from excessive alcohol use in the United States based on 58 alcohol-related causes of death during three periods (2016-2017, 2018-2019, and 2020-2021). Average annual number of deaths from excessive alcohol use increased 29.3%, from 137,927 during 2016-2017 to 178,307 during 2020-2021; age-standardized alcohol-related death rates increased from 38.1 to 47.6 per 100,000 population. During this time, deaths from excessive alcohol use among males increased 26.8%, from 94,362 per year to 119,606, and among females increased 34.7%, from 43,565 per year to 58,701. Implementation of evidence-based policies that reduce the availability and accessibility of alcohol and increase its price (e.g., policies that reduce the number and concentration of places selling alcohol and increase alcohol taxes) could reduce excessive alcohol use and alcohol-related deaths.

Global trends in the incidence and prevalence of pneumoconiosis in 204 countries/territories from 1990 to 2019

Objective: To analyze the changing trend of incidence and prevalence of pneumoconiosis globally, and provide scientific basis for the formulation of health policy. Methods: In June 2022, through the Global Health Data exchange (GHDx) query tool (http: //ghdx.healthdata.org/gbd-results-tool) , the pneumoconiosis incidence and prevalence data was downloaded and organized. Estimated annual percentage change (EAPC) and age-standardized rate (ASR) were used to estimate the trends of pneumoconiosis from 1990 to 2019. EAPC was estimated by linear regression model based on ASR. Results: The overall ASR of the incidence and prevalence of pneumoconiosis decreased from 1990 to 2019, and their EAPCs were-0.85% (95%CI: -1.11%--0.60%) and -0.78% (95%CI: -1.08%--0.49%) . Over the past 30 years, the incidence and prevalence of pneumoconiosis in all SDI areas showed decreasing trends, especially in high SDI areas, their EAPCs were -1.46% (95%CI: -1.76%--1.15%) and -1.99% (95%CI: -2.44%--1.53%) . 110 countries/areas showed increasing trends in age standardized incidence rate (ASIR) , with Iran and Georgia showing the most pronounced upward trend, their EAPCs were 5.32% (95%CI: 4.43%-6.22%) and 4.39% (95%CI: 3.81%-4.97%) . 125 countries/areas showed anincreasing trends in prevalence ASR, with Iran had the fastest rise in prevalence (EAPC=6.40%, 95%CI: 5.33%-7.49%) . Conclusion: Although decreasing trends in the burden of pneumoconiosis are observed globally from 1990 to 2019, but the burden of pneumoconiosis in low-and middle-income countries or regions are still heavy. We need more effective strategies to prevent and reduce the burden of pneumoconiosis.

Global burden of atrial fibrillation/flutter: Trends from 1990 to 2019 and projections until 2044

AimsAtrial fibrillation/atrial flutter (AF/AFL) is a critical public health issue worldwide, and its epidemiological patterns have changed over the decades. This work aimed to assess the global trends of AF/AFL and attributable risks from 1990 to 2019. Methods and resultsThe present study utilized data from the Global Burden of Disease Study 2019 to examine the temporal trends, attributable risks, and projections of AF/AFL. The estimated annual percentage change (EAPC) and age-standardized rate (ASR) were employed for this purpose. The findings revealed that in 2019, AF/AFL accounted for 4.72 million incident cases, 59.70 million prevalent cases, 0.32 million deaths, and 8.39 million disability-adjusted life years (DALYs). Furthermore, the results indicated that males under 70 years of age had a higher incidence, prevalence, and DALYs than females, while the rates were similar for both genders between 70 and 74 years. However, this pattern was reversed in individuals over the age of 75, with females exhibiting a higher total incidence, prevalence, and DALYs than males. The age-standardized rates (ASRs) of prevalence, incidence, mortality, and DALYs increased with an increase in the socio-demographic index (SDI). The three primary contributors to AF/AFL were high systolic blood pressure, high body-mass index, and smoking. Majority of risk factors exhibited a unimodal distribution, with a peak between the ages of 50 and 70. ConclusionsThe disease burden of AF/AFL is still severe worldwide and getting worse. To encourage prevention and treatment, systematic regional surveillance of AF/AFL should be put in place.

Temporal trends of thyroid cancer between 2010 and 2019 in Asian countries by geographical region and SDI, comparison with global data.

This study aims to describe temporal trends of thyroid cancer (ThC) from 2010 to 2019, in Asian countries by geographical region and sociodemographic index, compared with global data. Annual case data and age-standardized rates (ASRs) of epidemiological indicators of ThC cancer data were collected from the 2019 Global Burden of Disease (GBD) study from 2010 to 2019 in 49 countries and territories in Asia. The relative difference (%) between years was used to show comparative variations of ASRs for the indicators studied. The female/male ratio was calculated by dividing female ASRs by male ASRs. Also, these rates were compared between the age group ≥70 years old and younger age groups. In 2019, more than 50% of ThC cases and deaths occurred in Asian countries. A total of 53% of ThC patients lived in Asia and more than 60% of the global burden of ThC was imposed on Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALYs number of ThC cancer increased over 1.28-, 1.26-, 1.3-, and 1.2-fold, in Asia, respectively. During this period, the age-standardized incidence rate (ASIR) and the age-standardized prevalence rate (ASPR) of ThC cancer increased by 5% and 8%, respectively, while the age-standardized death rate (ASDR) and the age-standardized DALYs rate (DALYs ASR) of ThC cancer decreased by 6% and 4%, respectively. These trends are different from what happens in other continents. In 2019, age-specific incidence, death, prevalence, and DALY cases of ThC cancer were peaking at 50-54, 75-79, 50-54, and 55-59 years, respectively. In 2019, the highest ASIR and ASPR of ThC cancer was observed in high-income Asia Pacific countries and the highest ASDR and DALYs ASR in Southeast Asia countries. Only high-income Asia Pacific countries experienced a decreasing trend in ASIR and ASPR from 2010 to 2019. ASDR and DALYs ASR have the highest decreasing trend in high-income Asia Pacific. In 2019, among high SDI Asian countries, the Republic of Korea had the highest ASIR and ASPR, and Brunei Darussalam had the highest ASDR and DALYs ASR. The highest ASIR, ASDR, ASPR, and DALY ASR of ThC cancer was found in Lebanon and Malaysia (high-middle SDIs), Vietnam (middle SDIs), and Cambodia and Palestine (low-middle SDIs). Among low SDI Asian countries, Pakistan had the highest ASIR, ASDR, ASPR, and DALY ASR of ThC cancer. All indicators for most countries were higher in women than men. More than half of the burden of thyroid cancer is imposed on the residents of the Asian continent. Although the incidence and prevalence of this cancer in Asian countries is lower than that of the world, America, and Europe, the highest rate of death from thyroid cancer occurs in Asia and they witness the highest burden of the disease. Therefore, it seems that implementing early detection strategies and increasing access to treatment facilities in Asia is one of the necessities of thyroid cancer control in its residents.

Global burden and inequality of maternal and neonatal disorders: based on data from the 2019 Global Burden of Disease study.

Maternal and neonatal disorders account for substantial health loss across the lifespan from early childhood. These problems may be related to health inequality. To provide evidence for improvement in health policies regarding maternal and neonatal disorder inequity. This was a population-based cross-sectional study based on 2019 Global Burden of Disease data. Annual cases and age-standardized rates (ASRs) of incidence, prevalence, death, and disability-adjusted life-years (DALYs) in maternal and neonatal disorders between 1990 and 2019 were collected from the 2019 Global Burden of Disease study. Concentration curves and concentration indices were used to summarize the degree of socioeconomic-related inequality. For maternal disorders, the global ASRs of incidence, prevalence, death and DALYs were 2889.4 (95% uncertainty interval (UI), 2562.9-3251.9), 502.9 (95% UI 418.7-598.0), 5.0 (95% UI 4.4-5.8) and 324.9 (95% UI 284.0-369.1) per 100000 women in 2019, respectively. The ASRs of maternal disorders were all obviously reduced and remained pro-poor from 1990 to 2019. In neonatal disorders, the global ASRs of incidence, prevalence, death and DALYs were 363.3 (95% UI 334.6-396.8), 1239.8 (95% UI 1142.1-1356.7), 29.1 (95% UI 24.8-34.5) and 2828.3 (95% UI 2441.6-3329.6) per 100000 people in 2019, respectively. The global ASRs of incidence, death and DALYs in neonatal disorders have remained pro-poor. However, the socioeconomic-related fairness in the ASR of neonatal disorder prevalence is being levelled. The global burden of maternal and neonatal disorders has remained high, and socioeconomic-related inequality (pro-poor) tended not to change between 1990 and 2019.

Global Epidemiology of Cirrhosis: Changing Etiological Basis and Comparable Burden of Nonalcoholic Steatohepatitis between Males and Females

Introduction: The etiology of liver diseases has changed significantly, but its impact on the comparative burden of cirrhosis between males and females is unclear. We estimated sex differences in the burden of cirrhosis across 204 countries and territories from 2010 to 2019. Methods: We analyzed temporal trends in the burden of cirrhosis using the methodology framework of the 2019 Global Burden of Disease study. We estimated annual frequencies and age-standardized rates (ASRs) of cirrhosis incidence, death, and disability-adjusted life-years (DALYs) by sex, region, country, and etiology. Results: In 2019, the frequency of incident cases, deaths, and DALYs due to cirrhosis was 1,206,125, 969,068, and 31,781,079 in males versus 845,429, 502,944, and 14,408,336 in females, respectively. From 2010 to 2019, the frequency of cirrhosis deaths increased by 9% in males and 12% in females. Incidence ASRs remained stable in males but increased in females, while death ASRs declined in both. Death ASRs for both sexes declined in all regions, except in the Americas where they remained stable. In 2019, alcohol was the leading cause of cirrhosis deaths in males, and hepatitis C in females. Death ASRs declined for all etiologies in both sexes, except in nonalcoholic steatohepatitis (NASH). The ratio of female-to-male incidence ASRs in 2019 was lowest in alcohol(0.5), and highest in NASH(1.3), while the ratio of female-to-male death ASRs was lowest in alcohol(0.3) and highest in NASH(0.8). Conclusion: The global burden of cirrhosis is higher in males. However, incidence and death ASRs from NASH cirrhosis in females are comparable to that of males.

Global, regional, and national burden of liver cancer due to non-alcoholic steatohepatitis, 1990-2019: a decomposition and age-period-cohort analysis.

Identifying past temporal trends in non-alcoholic steatohepatitis (NASH)-associated liver cancer (NALC) can increase public awareness of the disease and facilitate future policy development. Annual deaths and age-standardized death rates (ASDR) for NALC from 1990 to 2019 were collected from the Global Burden of Disease (GBD) 2019 study. The long-term trend and the critical inflection of mortality of NALC were detected by Joinpoint analysis. Age-period-cohort analysis was employed to evaluate the effects of age, period, and cohort. Last, decomposition analysis was used to reveal the aging and population growth effects for NALC burden. Between 1990 and 2019, the ASDR of NALC witnessed an overall declining trend on a global scale, with a decrease in females and a stable trend in males. However, the global ASDR demonstrated a significant upward trend from 2010 to 2019. Southern sub-Saharan Africa and Southeast Asia have the highest NALC burdens, while high socio-demographic index (SDI) region experienced the fastest escalation of NALC burdens over 30 years. The decomposition analysis revealed that population growth and aging were the primary catalysts behind the increase in global NALC deaths. Age-period-cohort analyses showed that NALC mortality declined the fastest among females aged 40-45 years in high SDI region, accompanied by a deteriorating period effect trend during the period of 2010-2019. The global absolute deaths and ASDR of NALC have witnessed a rise in the past decade, with populations exhibiting considerable disparities based on sex, age, and region. Population growth, aging, and metabolism-related factors were the main factors behind the increase in global NALC deaths.

Rising incidence and impact of early-onset colorectal cancer in the Asia-Pacific with higher mortality in females from Southeast Asia: a global burden analysis from 2010 to 2019.

Early-onset colorectal cancer (CRC) is a growing global health concern, especially in the Asia-Pacific region. However, comprehensive research on this topic from the region is lacking. Our study aims to investigate trends in early-onset CRC in Asia over 10years, filling this research gap. This study utilized data from the Global Burden of Disease Study 2019 to assess temporal trends in early-onset CRC in the Asia-Pacific. The analysis included estimating annual frequencies and age-standardized rates (ASRs) of early-onset CRC incidence, death, and disability-adjusted life-years (DALYs) by gender. The incidence of early-onset CRC significantly increased in both regions with higher increase and in the Western Pacific region. Notable increases were observed among males in the Western Pacific and females in Southeast Asia (SEA). Mortality rates remained stable in the Western Pacific but increased by 10.6% in SEA, especially among females. DALYs due to CRC also increased significantly in SEA, with a greater rise among females. The Western Pacific had the highest CRC incidence, and in SEA, the mortality rate was higher in females than males. Our study reveals a substantial increase in early-onset CRC in the Asia-Pacific underscoring the urgency for effective interventions. Thus, a comprehensive approach comprising controlled risk reduction, health promotion to heightened disease awareness, and implementation of effective screening strategies should be executed timely to mitigate the burden of early-onset CRC.

Global Epidemiology and Burden of Elderly-Onset Inflammatory Bowel Disease: A Decade in Review.

Inflammatory bowel disease (IBD), once thought to impact younger individuals, now manifests in approximately 10% of patients over 65, characterized by a heightened vulnerability to complications and greater diagnostic intricacies than conventional cases. However, comprehensive global epidemiological data regarding elderly-onset IBD are currently insufficient. Our study addresses this critical gap by analyzing trends in elderly-onset IBD over a decade, encompassing the estimation of annual frequencies and age-standardized rates of elderly-onset IBD burden for both genders, stratifying the data by geographical and sociodemographic factors. Our research highlights a notable increase in the proportion of elderly-onset IBD, constituting around 13% of all IBD cases. We observed a rising incidence in males, contrasted by a decreasing trend in females. The highest surge in incidence rates was seen in the Western Pacific region in both genders, but the highest burden was observed in America. Countries with high sociodemographic index (SDI) carried the greatest burden of elderly-onset IBD, while countries with low SDI had the least. The mortality and disability-adjusted life years (DALYs) rates trend downward in most regions. This study underscores an increasing incidence and proportion of IBD, particularly in elderly-onset IBD, particularly in males. While mortality and DALYs are decreasing in most regions, the overall burden remains highest in America and high-SDI countries. Effective public health interventions and comprehensive studies are required to tackle this mounting burden.

Burden of esophageal cancer between 2010 and 2019 in Asian countries by geographical region and sociodemographic index: A comparison with global data.

The aim of this study was to describe the trends in incidence, mortality, and burden of esophageal cancer (EC) in Asia from 2010 through 2019 and compare with other global continental data. We collected EC data from the 2019 Global Burden of Disease study from 2010 to 2019 in 49 countries and territories in Asia based on the sociodemographic index (SDI). For all locations, annual case data and age-standardized rates (ASRs) were extracted to investigate the EC incidence, prevalence, mortality, and disability-adjusted life-years (DALYs). The ASR relative difference (%) between years and the male/female (M/F) ratio were calculated. Data are reported in values and 95% uncertainty interval (UI). In 2019, more than 70% of EC new cases, deaths, prevalence, and DALYs occurred in Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALY number of EC increased over 1.10-, 1.07-, 1.14-, and 1.03-fold, in Asia. During this period, the age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), age-standardized prevalence rate (ASPR), and age-standardized DALYs rate (DALYs ASR) of EC decreased by 18, 21, 14, and 22%, respectively. The rate of decline in Asia is higher than in the world and other continents. In 2019, age-specific incidence, death, prevalence, and DALY cases of EC cancer peaked at 65-74, 70-74, 65-69, and 65-69 years, respectively. In 2019, the highest ASIR, ASDR, ASPR, and DALYs ASR of EC were observed in East Asian countries, while having the highest decreasing trend. In 2019, among high SDI Asian countries, Taiwan had the highest ASIR, ASPR, and DALYs ASR, and the United Arab Emirates had the highest ASDR. Among high-middle SDIs, Kazakhstan had the highest ASIR, ASPR, ASDR, and DALYs ASR; among middle SDIs, China had the highest ASIR, ASDR, and ASPR, and Viet Nam had the highest DALYs ASR; among low-middle SDIs, Mongolia had the highest ASIR, ASDR, ASPR, and DALY ASR of EC cancer. Among low SDI Asian countries, Pakistan had the highest ASIR and ASPR, and DALY ASR for EC cancer. For four indicators, in most countries, the ratio of men was higher than women, and in some countries, this ratio reached more than 10 times. Although the rate of decline in incidence, death, prevalence and burden of EC in Asia was higher than in other areas in the last 10 years, more than 70% of these amounts occur in Asia. Therefore, it appears that adopting appropriate strategies in the field of identifying and controlling modifiable risk factors for EC, implementing screening programs, and timely diagnosis and treatment will help in reducing the burden of this disease in Asian countries.

Current status and temporal trend in incidence, death, and burden of esophageal cancer from 1990-2019.

Esophageal cancer (EC) is one of the world's most unknown and deadly cancers. This study aimed to provide updated epidemiological indicators and the recent trend of EC by age group, gender, and geographical region in the world. Annual case data and age-standardized rates (ASRs) of epidemiological indicators of EC were collected from the 2019 Global Burden of Disease (GBD) study from 1990 to 2019 in 204 countries and territories based on the sociodemographic index (SDI). Relative difference (%), average annual percentage change (AAPC), and the male/female ratio were calculated. Data are reported in values and 95% confidence interval (CI). EC age-standardized incidence rates (ASIR) decreased by 19%, age-standardized death rates (ASDR) decreased by 25%, and disability-adjusted life-years ASR (DALYs ASR) decreased by 30% from 1990 to 2019. The higher number of EC cases was in men aged 50 to 69 years and in women aged over 70. From 1990 to 2019, Middle SDI countries experienced a decline in the ASIR and ASDR of EC. The High SDI countries had an increasing ASDR trend. In World Bank High-Income countries, the ASIR of EC has remained unchanged and decreased in other regions. The Asia continent has the highest rate of incidence, mortality, and burden of EC and the highest rate of reduction. East Asia, Southern Sub-Saharan Africa, and Eastern Sub-Saharan Africa respectively have the highest ASIR of EC. Central Asia has experienced the greatest decrease in the ASIR and ASDR of EC, the countries of Central Europe had a steady ASIR and High-Income North America had an increasing trend in ASIR and ASDR. The burden of EC shows a decreasing trend worldwide. Central and East Asia regions have the highest rate and the highest increase in the burden of EC. Based on great variation in the geographical distribution of epidemiological indicators of EC, investigating the reasons for this diversity requires more studies to be conducted in the field of prevention, distribution of risk factors, and implementation of screening methods with high cost-effectiveness, and access to treatment methods. The provision of regional solutions may be more effective than global strategies.

1315-P: Examining Excess Hospitalizations in People With vs. Without Diabetes—A National U.S. Study

Background: A diversification of diabetes-related complications has been observed due, in part, to declines in cardiovascular mortality and increases in time spent living with diabetes. We examined leading causes of excess hospitalizations among people with vs. without diabetes. Methods: We used the 2019 National Inpatient Sample (numerator) and the 2019 Behavioral Risk Factor Surveillance Survey (denominator), weighted to reflect the U.S. population, to estimate rates of cause-specific hospitalizations in adults (≥18 years) with and without diabetes defined by ICD codes (numerator) and self-report (denominator). Annual age-standardized hospitalization rates were determined using three-digit ICD-10 codes, with excess risk and rate ratios reported. We grouped the top ten causes of excess hospitalizations as 1) traditional (e.g., vascular diseases); 2) emerging (e.g., liver disease); or 3) other complications. Results: Americans with diabetes are at increased risk of hospitalization for most conditions, ranging from a 3% [rate ratio (RR): (1.00-1.05)] to a 9-fold increased risk [RR: 9.00 (8.96-9.04)]. The major causes for excess hospitalization in people with vs. without diabetes, according to traditional, emerging, or other complications are reported in Table 1. Conclusions: The conditions responsible for excess hospitalizations in people with diabetes are more diverse than previously recognized. Disclosure J.L. Harding: None. T.S. Uppal: None. D. Tomic: None. M.K. Ali: Research Support; Merck & Co., Inc. Advisory Panel; Bayer Inc., Eli Lilly and Company. D.J. Magliano: None.

The epidemiology of benzodiazepine-related toxicity in Ontario, Canada: a population-based descriptive study

ObjectivesDespite the widespread use of prescription benzodiazepines, there are few studies examining trends and patterns of benzodiazepine-related toxicity. We describe the epidemiology of benzodiazepine-related toxicity in Ontario, Canada.MethodsWe conducted a population-based, cross-sectional study of Ontario residents who had an emergency department visit or hospitalization for benzodiazepine-related toxicity between January 1, 2013 and December 31, 2020. We reported annual crude and age-standardized rates of benzodiazepine-related toxicity overall, by age, and by sex. In each year, we characterized the history of benzodiazepine and opioid prescribing among people who experienced benzodiazepine-related toxicity, and reported the percentage of encounters with opioid, alcohol, or stimulant co-involvement.ResultsBetween 2013 and 2020, there were 32,674 benzodiazepine-related toxicity encounters among 25,979 Ontarians. During this period, the crude rate of benzodiazepine-related toxicity declined overall, from 28.0 to 26.1 per 100,000 population (age-standardized rate: 27.8 to 26.4 per 100,000), but increased among young adults aged 19 to 24 (39.9 to 66.6 per 100,000 population). Moreover, by 2020, the percentage of encounters associated with active benzodiazepine prescriptions had declined to 48.9%, while the percentage of encounters that had opioid, stimulant, or alcohol co-involvement rose to 28.8%.ConclusionBenzodiazepine-related toxicity has declined in Ontario overall, but has increased among youth and young adults. Furthermore, there is growing co-involvement of opioids, stimulants, and alcohol, which may reflect the recent emergence of benzodiazepines in the unregulated drug supply. Multifaceted public health initiatives comprising harm reduction, mental health supports, and promotion of appropriate prescribing are needed to reduce benzodiazepine-related harm.

Temporal trends in acute coronary syndrome hospitalisation rates: a comparison of administrative diagnosis coding and cardiac biomarker testing

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Victor Chang Cardiac Research Institute. Background/aims Accurate monitoring of trends in acute coronary syndromes (ACS) provides important information on the impacts of primary and secondary prevention. Use of cardiac troponin (cTn) assays with increasing sensitivity and specificity during the past 20 years have likely increased the rates of diagnosis of myocardial infarction (MI), particularly NSTEMI. We aimed to determine the correlation of ICD-coded ACS hospitalisation rates with biomarker-classified ACS rates to inform population-level monitoring of ACS trends in Australia. Methods We used linked hospitalisation, emergency department, mortality, and pathology data from all tertiary hospitals in Western Australia (WA). We identified all patients aged >20years with a principal diagnosis of STEMI or NSTEMI (ICD-10-AM I21.0-I21.4) or unstable angina (UA) (ICD-10-AM I20.0) from 2001-2017. Creatine kinase (CK) and cTn test results including high-sensitivity (hs-Tn) assays were classified as elevated based on the ESC/AHA Universal Definition using the upper reference limit value for each assay. We calculated age-standardised rates (ASRs) for ICD-10 coded STEMI, NSTEMI and UA hospitalisations, and those which were cTn positive (cTn+), or any biomarker positive including CK (Bm+). We assessed annual ASR ratios over time (reference: ICD-coded rates) and estimated annual % changes in admissions using Poisson regression models adjusting for 5-year age-group and sex. Results The cohort comprised 143,231 ICD-coded ACS hospitalisations for 91,701 patients. 60.5% of the patients were male and 95.2% of the ACS hospitalisations had linked cardiac biomarker records. Despite slightly lower ASRs, Bm+ based rates were consistent with patterns in ICD-coded admissions in both MI sub-types (Figure) with no significant differences stratified by sex. Average annual decline in STEMI admissions was -3.7% (95% CI -4.1%,-3.4%) and -3.2% (95% CI -3.6%, -2.9%) in ICD-coded and Bm+ hospitalisations respectively. The annual rise in ICD-coded NSTEMI ASRs was 4.1% (95% CI 3.9%, 4.4%) which correlated with the 4.4% (95% CI 4.1%, 4.7%) annual rise in Bm+ ACS hospitalisations. The age-standardised rate ratios of ICD-coded to Bm+ were 1.27 and 1.28 for STEMI and NSTEMI respectively in 2001 and remained consistent at 1.29 and 1.30 for STEMI and NSTEMI respectively in 2017, although this was not the case for cTn+:ICD-coded rate ratios. There was an inverse trend between ASRs of ICD-coded NSTEMI and UA over the study period which correlated with use of increasingly sensitive cTn assays. The proportion of UA admissions with Bm+ was consistently low (21%) over the study period. Conclusions Despite shifts from CK to cTn and hs-Tn assays during our study period, the present study highlights the validity of using linked hospitalisation data to monitor long term trends in ACS based on cardiac biomarker positivity. Figure legend. Age-standardised hospitalisation rates by classification status in ACS subtypes.

Temporal trends of tracheal, bronchus, and lung cancer between 2010 and 2019, in Asian countries by geographical region and sociodemographic index, comparison with global data.

This study aimed to describe the trends in incidence, mortality, and burden of tracheal, bronchial and lung (TBL) cancer in Asia from 2010 through 2019 and compare with global and other continental data. We collected TBL cancer data from the 2019 Global Burden of Disease (GBD) study from 2010 to 2019 in 49 countries and territories in Asia. For all locations, annual case data and age-standardized rates (ASRs) were used to investigate the incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of TBL from 2010 to 2019. The relative difference (%) between years was used to show comparative variations of ASRs for the indicators studied. In 2019, more than 55% of TBL cancer cases and deaths occurred in Asian countries. A total of 57% of lung cancer patients lived in Asia and almost 60% of the global burden of lung cancer was imposed on Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALYs number of TBL cancer increased over 1.34-, 1.31-, 1.31-, and 1.26-fold, in Asia. During this period, the age-standardized incidence rate (ASIR), the age-standardized death rate (ASDR), the age-standardized prevalence rate (ASPR), and the age-standardized DALYs rate (DALYs ASR) of TBL cancer decreased by 1, 3, 4, and 4%, respectively. While at the same time, the decreasing trend of these rates globally and in America and in Europe happened faster. In 2019, age-specific incidence, death, prevalence, and DALY cases of TBL cancer were peaking at 65-74, 70-74, 65-69, and 65-69 years, respectively. In 2019, the highest ASIR, ASDR, and DALYs ASR of TBL cancer was observed in East Asia countries and the highest ASPR in high-income Asia Pacific countries. Central Asia and high-income Asia Pacific countries experienced a decreasing trend in ASIR and ASDR, and the South Asia countries experienced the highest increasing trend from 2010 to 2019. ASPR only decreased in Central Asia, and DALYs ASR only increased in South Asia. In 2019, among high sociodemographic index (SDI) Asian countries, Brunei Darussalam had the highest ASIR, ASDR, and DALYs ASR and the Republic of Korea had the highest ASPR. Among high-middle SDIs, Turkey and Georgia; among middle SDIs, China and Armenia; among low-middle SDIs, Mongolia and the Democratic People's Republic of Korea had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Among low SDI Asian countries, Pakistan had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Most of the global burden of lung cancer occurs in Asian countries, and the decreasing trend of incidence, death, prevalence, and burden of this cancer in these countries is slower than in other regions. Therefore, the implementation of necessary measures in order to reduce the process of this cancer is considered urgent.

The burden of skin and subcutaneous diseases: findings from the global burden of disease study 2019.

The small number of existing integrative studies on the global distribution and burden of all types of skin and subcutaneous diseases hinders relevant comparisons. This study aimed to determine the latest distribution, epidemiological differences, and factors potentially influencing each skin and subcutaneous disease and the policy implications. Data on the skin and subcutaneous diseases were obtained from the Global Burden of Disease Study 2019. The incidence, disability-adjusted life years (DALYs), and deaths due to skin and subcutaneous diseases in 204 countries and regions from 1990 to 2019 were analyzed and stratified by sex, age, geographical location, and sociodemographic index (SDI). The annual age-standardized rate of change in the incidence was obtained to evaluate temporal trends. Of 4,859,267,654 (95% uncertainty interval [UI], 4,680,693,440-5,060,498,767) new skin and subcutaneous disease cases that were identified, most were fungal (34.0%) and bacterial (23.0%) skin diseases, which accounted for 98,522 (95% UI 75,116-123,949) deaths. The burden of skin and subcutaneous diseases measured in DALYs was 42,883,695.48 (95%UI, 28,626,691.71-63,438,210.22) in 2019, 5.26% of which were years of life lost, and 94.74% of which were years lived with disability. The highest number of new cases and deaths from skin and subcutaneous diseases was in South Asia. Globally, most new cases were in the 0-4-year age group, with skin and subcutaneous disease incidence slightly higher in men than in women. Fungal infections are major contributors to skin and subcutaneous diseases worldwide. Low-middle SDI states had the highest burden of skin and subcutaneous diseases, and this burden has increased globally. Targeted and effective management strategies based on the distribution characteristics of each country are, thus, required to reduce the burden of skin and subcutaneous diseases.

The Global Burden of Disease attributable to low physical activity and its trends from 1990 to 2019: An analysis of the Global Burden of Disease study.

Low physical activity (LPA) is associated with several major non-communicable diseases (NCDs) and premature mortality. In this study, we aimed to assess the global burden and trends in disease attributable to LPA (DALPA) from 1990 to 2019. Annual age-standardized disability-adjusted life years (DALYs) and death rates of DALPA [all-cause and five specific causes (ischaemic heart disease, diabetes mellitus, stroke, colon and rectal cancer, and breast cancer)] by sex, age, geographical region and social deprivation index (SDI) score from 1990 to 2019 were available from the Global Burden of Disease (GBD) study 2019. The estimated annual percentage changes (EAPCs) were calculated to quantify the changing trend. A generalized linear model (GLM) was used to explore the relationship between DALYs/death rates of DALPA and sociodemographic factors. Globally, in 2019, the age-standardized DALYs and death rates of DALPA were 198.42/100,000 (95% UI: 108.16/100,000-360.32/100,000) and 11.10/100,000 (95% UI: 5.66/100,000-19.51/100,000), respectively. There were 15.74 million (8.51-28.61) DALYs and 0.83 million (0.43-1.47) deaths attributable to LPA. Overall, age-standardized DALYs and death rates presented significant downward trends with EAPCs [-0.68% (95% CI: -0.85- -0.50%) for DALYs and -1.00% (95% CI: -1.13- -0.86%) for deaths] from 1990 to 2019. However, age-standardized DALYs and death rates of diabetes mellitus attributable to LPA were substantially increased [EAPC: 0.76% (95% CI: 0.70-0.82%) for DALYs and 0.33% (95% CI: 0.21-0.51%) for deaths]. In the 15-49 age group, DALPA presented significant upward trends [EAPC: 0.74% (95% CI: 0.58-0.91%) for DALYs and 0.31% (95% CI: 0.1-0.51%) for deaths]. The GLM revealed that higher gross domestic product and current health expenditure (% of GDP) were negatively associated with DALYs and death rates of DALPA. Although global age-standardized DALYs and death rates of DALPA presented downward trends, they still cause a heavy burden worldwide. These rates showed upward trends in the diabetic and 15-49 age groups, which need more attention and health interventions.

Epidemiological trends of hand osteoarthritis from 1990 to 2019: Estimates from the 2019 Global Burden of Disease study.

Hand osteoarthritis (OA) is a chronic progressive disease characterized by disabling pain in the hand, with a high clinical burden. This study is designed to assess the epidemiological patterns of hand OA from 1990 to 2019 and analyze its secular trends based on sex, age, and socio-demographic index (SDI) at global, regional, and national levels. Data on the incidence and disability-adjusted life years (DALYs) of hand OA were extracted from the 2019 Global Burden of Disease (GBD), and their respective age-standardized rates (ASRs) were calculated. The estimated annual percentage changes (EAPCs) in ASR were calculated to assess the prevalent trends of the incidence and DALYs of hand OA over the recent three decades. The relationship between ASR and SDI was analyzed by Pearson's correlation analysis. The incidence of hand OA increased from 371.30 million in 1990 to 676.02 million in 2019, increasing by 82.07%, whereas its age-standardized incidence rate (ASIR) decreased, with a downward trend [EAPC = -0.34; 95% confidence interval: -0.39--0.28]. With the changes in age, the incidence of hand OA exhibited a unimodal distribution before 70 years of age, peaking at 50-54 years, while its incidence had an upward trend in the >70 years age groups. Overall, hand OA-related DALYs increased in the recent 30 years. Meanwhile, its annual age-standardized DALY rate decreased, with EAPCs of -0.35 (95% CI, -0.38 --0.32). The DALYs increased with age. In 2019, the ASIR and age-standardized DALY rate were positively associated with the SDI regions. The incidence and DALYs presented predominance in female patients. The burden of hand OA over the recent three decades displayed obvious geographical diversity. The incident cases of hand OA increased globally from 1990 to 2019, while the ASIR and age-standardized DALY rate decreased. However, in many countries and regions, there was a rising trend of ASR related to incidence and DALYs. In addition, the prevalence revealed geographical, sex, and age diversity. Thus, governments and medical institutions should reallocate medical resources based on the epidemiological characteristics of hand OA.

Global and national trends in years of life lost and years lived with disability caused by three common gastrointestinal cancers from 1990 to 2019

BackgroundGastrointestinal cancers are a critical global cancer burden, and tracking their trends would inform the health policies.MethodsTrends of years of life lost (YLLs) and years lived with disability (YLDs) caused by three common gastrointestinal cancers were estimated using annual percentage change (EAPC) and age-standardized rate (ASR). Data was extracted from the Global Burden of Disease study 2019.ResultsThe ASR per 100,000 population-year of YLLs caused by esophageal cancer, stomach cancer, and colorectal cancer were 137.98, 264.15, and 282.51 in 2019, respectively. Their overall trends of YLLs declined during 1990–2019, with the respective EAPCs being − 1.42 (95% Confidence Interval [CI]: − 1.71 to − 1.13), − 2.13 (95%CI: − 2.29 to − 1.96), and − 0.25 (95%CI: − 0.30 to − 0.19). Meanwhile, decreasing trends of YLDs caused by esophageal cancer and stomach cancer were observed, in which the EAPCs were − 0.67 (95%: − 0.94 to − 0.40) and − 0.85 (95%CI: − 0.97 to − 0.73), respectively. However, an increasing trend was seen in that of colorectal cancer (EAPC = 0.83, 95%CI: 0.77 to 0.89). Among countries, the largest decrease in trend of YLLs was that of stomacher cancer in the Republic of Korea (EAPC = − 5.88, 95%CI: − 6.07 to − 5.69). However, pronounced increasing trend of YLDs caused by colorectal cancer occurred in China (EAPC = 4.40, 95%CI: 4.07 to 4.72).ConclusionsDecreasing trends in YLLs and YLDs caused by esophageal cancer, stomach cancer, and colorectal cancer were observed in most countries and regions, indicating that the great progress had been achieved over the past decades. However, the cancer burden was geographical heterogeneity, and cost-effective measures were still required to decline the burden caused by gastrointestinal cancers.