Annual Percentage Research Articles

Gender disparities and infective endocarditis burden in the United States and European Union: a comparative analysis

Abstract Background Despite improvement in diagnostics and treatment options, infective endocarditis (IE) remains a significant burden for healthcare systems. While high-income countries have improved diagnosis of IE, the progress in interventional cardiology with a rise in cardiac devices associated infections, and people migrations offset some of these gains. Purpose To the best of our knowledge, there is a lack of comparative data between high-income countries, including the United States (US) and European Union (EU). Methods We collected the age-standardized rates of incidence (ASIR), deaths (ASDR), and disability-adjusted life years (ASDALYs) in the US and EU from 1993 to 2019 with the Global Health Data Exchange query tool. The Bayesian geospatial regression analysis and estimated annual percentage change (EAPC) to quantify the trends in age-standardized rates (ASR) were used. The data were stratified based on the gender, year, and location. Results Males in the US had an overall ASIR of 17.2/100k with an increasing trend between 1993 and 2019, and an annual average rate of change of 0.8 % (EAPC of 0.8%). A similar trend and higher rates were noted in males in the EU, with ASIR of 20.9/100k and EAPC of 2.0%. For the same period, females in the US had lower ASIR than females in the EU (11.9/100k vs. 13.6/100k) , and lower annual percent change (1% vs. 1.3%). In the US, ASDR was higher in males than females (1.6/100k vs. 1.28/100k), but females had higher annual percentage change (EAPC of 2.7% in males and 3.3% in females). Compared to US, males and females in the EU had lower ASDR in 2019 (1.2/100k in males, and 1.0/100k in females) with lower annual percentage changes of 2.5% and 1.7%, respectively. The ASDALY was significantly higher in the US, for both males (34.6/100k) and females (25.5/100k), with a greater increase in an annual average rate of change of 2.7% in females than in males (2.2%). EU males had ASDALY of 24.9/100k with an EAPC of 1.8%, while females had 16.7/100K with an annual average increase of 1.2%. Figure 1, Table 1 Conclusion ASIR of IE appears to be higher in the EU for both males and females. Conversely, ASDR and ASDALY manifest higher rates in the US across both genders, with females notably demonstrating a higher annual percentage increase for these metrics. Further studies are needed to assess the nature of these differences and to inform health policies.The age-standardized rates in US and EUThe differences in the EAPC

Global variations in coronary revascularisation and acute myocardial infarction mortality between 2006-2020: a longitudinal, population-level analysis of 16 high-income nations from the OECD database

Abstract Background Revascularisation options for ischaemic heart disease (IHD) includes either, percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). Whilst PCI remains the preferred choice in ST-elevation myocardial infarction (STEMI)(1), several landmark trials have questioned its universal superiority (2,3), thus prompting re-evaluation of guidelines. A wide-scale contemporary overview of revascularisation trends is lacking. Purpose To examine the evolving pattern in PCI and CABG rates, alongside mortality from acute myocardial infarction (AMI) across a group of 16 high-income countries between 2006 and 2020. Methods Standardized PCI and CABG procedure rates alongside AMI age-standardised mortality rate (ASMR) were obtained from the Organisation for Economic Co-operation and Development (OECD) database. Data from 2006-2020 was extracted for; Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, United Kingdom (UK). Together, these countries are commonly known as the European Union (EU) 15+ and represent a cluster of high-income nations with comparable levels of health expenditure. Procedural trends including the estimated annual percentage change (EAPC) were evaluated using Joinpoint analysis whilst Locally Weighted Scatterplot Smoothing (LOESS) models was used to analysis trends in AMI mortality. Results Over 15 years, 14.0 million PCI and 2.8 million CABG procedures were recorded in total. PCI rates varied amongst nations (Figure 1), however showed an overall increase in 11 countries, led by Finland (+36.0%). The steepest increase was observed in France between 2012-2018 (EAPC 5.4, 95% CI: 4.8 – 6.1). The greatest overall decrease in PCI was observed in Luxemburg (-33.5%). The fastest decrease was seen during 2018-2020 in the UK (EAPC -7.2, 95% CI: -9.7 – -4.6). CABG rates declined overall in 15 countries (Figure 1), with Luxembourg (-71.3%), experiencing the largest fall and showing the steepest decline between 2014-2018 (EAPC -20.7, 95% CI: -28.3 – -12.3). Ireland was the only country to show an increase in CABG rate (+16.3%). Throughout the study period, the PCI-to-CABG ratio increased (Figure 2A), whilst AMI mortality decreased consistently across all countries (Figure 2B). Conclusion Despite evidence supporting CABG over PCI in specific scenarios, CABG rates have declined, and PCI rates have increased. This trend may be influenced by several factors including patient preference for less invasive procedures and advancements in interventional techniques. The varied use of PCI among these nations, alongside a sustained decline in AMI mortality rates, may be expected given the importance of optimal medical therapy in the management of IHD. The results further highlight the significance of factors beyond revascularisation in driving improved outcomes.PCI and CABG rates between 2006 and 2020PCI to CABG ratio and AMI mortality rate

Increasing trends in hypertension-related mortality in European Union 27 countries from 2011 to 2019

Abstract Background Arterial Hypertension (HT) is one of the most common chronic cardiovascular disease in adults and a leading cause of disability and mortality worldwide. However, update data regarding the HT-related mortality trends in Europe are lacking. Therefore, we assess the age- and sex- specific trends in HT-related mortality in the 27 European Union Member States (EU-27) between years 2011 and 2029. Methods Data were retrieved from the free publicly available EUROSTAT death certificate database to examine age-adjusted HT-related mortality rates (AAMR) (per 100.000 people) and relative average annual percentage change (AAPC) across all European Union 27 countries (EU27) from 2011 to 2019 using the International Classification of diseases, Tenth Revision (ICD-10) codes I10-I13 and I15. To calculate annual trends in HT-related mortality, we assessed the average annual percent change (AAPC) and relative 95% confidence intervals (CIs) using Joinpoint regression analysis. Results Over the study period, 254.540 HT-related deaths (157,081 males) were listed in EU27. Age-adjusted HT-related death increased from 9.12 to 10.7 per 100,000 people [AAPC: +1.5% (95% CI: 0.8-2.0), p<0.001]. Specifically, the HT-related mortality increased in males [AAPC: +1.8 (95% CI: 0.9-2.6) while decreased in women [AAPC: -1.1 (95% CI: -2.0 to 0.2), p=0.001]. Additionally, the HT-related mortality rates increased in northern [+1.5 (95% CI: 0.7 to 2.3), p<0.001] and eastern [AAPC: +3.9 (95% CI: 2.3 to 5.4), p<0.001] EU-27 states. Conversely, the AAMR plateaued in southern [AAPC: -0.1 (95% ci: 0.6 to 0.7), p=0.96)] and western EU-27 countries [AAPC: 1.0 (95% CI: -0.1 to 2.1, p=0.07] over the same period. Conclusions In EU27, HT-related mortality increased from 2011 to 2019, especially in men. However, significant disparities in HT-related mortality rates still exist between different European regions.

Trends in heart failure mortality in Sweden between 1997 and 2022.

Data from US have shown a reversal in the improvement of heart failure (HF)-related mortality over the last ~10 years. It is unknown whether these trends generalize to European universal healthcare systems. We assessed temporal trends in (i) HF-related mortality in the overall national population; and (ii) all-cause mortality following an incident HF diagnosis, overall and stratified by ejection fraction (EF), in Sweden between 1997 and 2022. Annual mortality rates with a HF diagnosis as underlying cause were extracted from the Cause of Death Register. All-cause mortality following incident HF was assessed in two HF cohorts derived from the National Patient Register (NPR) and the Swedish HF Registry (SwedeHF). Temporal trends were presented as average annual percentage change (AAPC). Between 1997 and 2022, age-adjusted HF-related mortality in the general population declined from 33.4 to 23.8 per 100 000 individuals (AAPC -2.15%, p < 0.001). In the HF cohort from NPR (n = 423 092), all-cause mortality at 1, 3, and 5 years following a first diagnosis of HF was 25%, 46%, and 58%, respectively, in 2022; 1-year mortality declined (AAPC -1.10%, p < 0.001) over time regardless of age or sex. In SwedeHF (n = 63 753), the decline in 1-year mortality was less steep with increasing EF (AAPC -2.64%, p < 0.001; -2.30%, p = 0.062; and -2.16%, p = 0.032 in EF <40%, 40-49%, and ≥50%, respectively). Heart failure-related mortality has declined over the last ~25 years in Sweden. All-cause mortality in patients with HF has also declined, more in HF with reduced than preserved EF, mirroring the different availability of life-saving treatments across the EF spectrum.

The Cardiovascular Disease Burden Associated with secondhand smoke, 1990-2019: an age-period-cohort analysis of the Global Burden of Disease study

Abstract Background Over the past three decades, global regions have shown significant differences in the burden of cardiovascular disease (CVD), and secondhand smoke is a major risk factor contributing to this burden. Nevertheless, a comprehensive understanding of the global trends and associations between second-hand smoke and cardiovascular disease is lacking. Methods Using data from the Global Burden of Disease (GBD) study 1990-2019, an age-period-cohort (APC) analysis was conducted to investigate trends in cardiovascular disease-related mortality in populations affected by secondhand smoke globally over the past 30 years and its association with age, period, and birth cohort. Results Over the past 30 years, the number of cardiovascular deaths caused by secondhand smoke has increased significantly worldwide, from 432.6 thousand in 1990 (95% UI: 357.4-508.3) to 598.5 thousand in 2019 (95% UI: 489.7-713.5), an increase of 38.4% (95% UI: 26.8%-49.5%). In 2019, cardiovascular disease accounted for 45.9% of all deaths attributable to secondhand smoke in both men and women globally. Among cardiovascular diseases, ischemic heart disease became the main component, accounting for 66.4% compared with stroke. The gender composition of cardiovascular deaths due to secondhand smoke is slightly lower in men (46.5%) than in women (53.5%). Longitudinal analyses using age-time-cohort models show that global CVD-related mortality from secondhand smoke has improved overall over the past three decades, but there are differences between regions, genders, and CVD subtypes. It is worth noting that the higher the socio-demographic index (SDI) level, the greater the reduction in mortality, with a staggering 39.1% reduction in high SDI areas (95% UI: 35.6%-42.3%), in sharp contrast to virtually no change in mortality in low SDI areas (0.1% (95% UI: -52.4%-62.2%)). During the period 2003-2007, cardiovascular disease-related mortality decreased significantly, with an average annual percentage change of -1.48%. Conclusion The study highlights the importance of using secondhand smoke as a modifiable risk factor for the global burden of cardiovascular disease. Further research is vital to understand the factors that lead to differences in countries and regions at different levels of development, gender differences and differences in cardiovascular disease subtypes.

Bias in Evaluating Trends of Thyroid Cancer Incidence between Rural and Urban Populations

Abstract Background Diagnosis of thyroid cancer is based on fine needle aspiration cytology of thyroid nodules, based on nodules’ sonographic appearance and size. The American Thyroid Association published new guidelines for management of thyroid nodules in 2009 and 2015, where in some cases, only follow-up of thyroid nodules without any other procedure is recommended. This may lead to a decrease in diagnosed thyroid cancer cases. We studied thyroid cancer trends in Israel between the Arab population who are more likely to be living in rural areas, and the Jewish population who predominantly living in urban areas, and assesses whether these guidelines were reflected in the trends. Methods Data on new thyroid cancer cases were retrieved for Jews and Arabs separately from the Israel National Cancer Registry. Trends in age standardized incidence rates between 1996-2019 were evaluated for the two population groups using joinpoint regression model. Population group was included in the regression models to compare the trends between the two groups. We also studied trends in treatment of thyroid cancer at Rambam Health Care Campus. Results In both populations, age standardized thyroid cancer incidence rate increased between 1996 and 2013. However, between 2013-2019, Annual Percentage Change continuously increased in Arabs, but decreased in Jews. In the hospital study, we found that the Arab patients were 30% more likely to have surgery for small tumors. Conclusions The decrease in thyroid cancer incidence in the Jewish population compared with the Arab population may be related to differences in implementing the 2009 guidelines, which do not recommend fine needle aspiration cytology for very small tumors. We have found evidence that these guidelines were not followed to the same extent among Arab community clinics. This may explain the persisting increasing trend among Arabs, and could be one of the possible explanations for the differences in trends between the two groups. Key messages • Updated Guidelines regarding thyroid cancer diagnosis may be differently implemented by rural and urban populations. • Trends assessment may be biased due to differences in guidelines implementation.

Inequalities in local funding cuts to environmental and regulatory service expenditure in England

Abstract Background The financial crisis in 2008 has led to governments across Europe introducing austerity measures. England has experienced significant financial cuts to local authority (LA) services. Environmental and regulatory (ER) services provide key functions in public protection such as, Food Safety (FS) and Animal and Public Health Infectious Disease Control (APH), services which are key infectious disease resilience. Here we investigate inequalities in local funding cuts to ER services by socioeconomic deprivation, LA type, and urbanicity, and impact on key ER service indicators. Methods This ecological study uses longitudinal modelling techniques to analyse trends in ER expenditure since the introduction of austerity and the inequalities present. We use Generalised Estimating Equations to estimate the annual percent change of ER service expenditure, and FS and APH expenditure between 2009/10 and 2020/21 in relation to deprivation, LA type and population density. Quasi-Poisson regression is used to assess impact of cuts on ER service indicators. Results Areas of higher deprivation had the largest reduction in expenditure, with ER and FS and APH cuts of 2% and of 23% respectively, compared to a 1% and 8% reduction in the least deprived areas. The share of ER expenditure spent on FS and APH decreased by 13% in the most deprived authorities compared to 6% in the least deprived areas. London boroughs had the greatest reductions in FS and APH expenditure, decreasing by 10%. Both ER and FS and APH expenditure decreased with increasing population density. Preliminary analysis shows inequalities in food business hygiene ratings in addition to other key ER service indicators since the introduction of these cuts. Conclusions The unequal distribution of cuts shows the need for increased and equitable investment into these services to enable resilience to infectious disease threats, and to prevent widening of health inequalities. Key messages • This work provides strong evidence of inequalities in local funding cuts to ER services and highlights where investment should be focused, in order to protect environmental and public health. • This work introduces the impact of local funding cuts on a vital public health service and lays the foundation for future work into the unequal impact of cuts to these services on health outcomes.

Mortality related to different circulatory diseases: a multiple causes of death analysis, 2008-2022

Abstract Background Mortality from circulatory diseases significantly increased in 2020 compared to pre-pandemic years in many countries. However, data were mostly limited to the underlying cause of death and to the first phases of the pandemic. Analyses of any mention of a disease in death certificates (multiple causes of death approach, MCOD) are more robust to changes in coding rules/practices and to the role of COVID-19 as a competing cause of death. Methods Mortality records were extracted from 2008 to 2022 among residents of the Veneto Region (Northeastern Italy, 4.9 million population). Based on MCOD, age-standardized mortality rates (2013 European standard) were computed for ischemic heart diseases (IHD), cerebrovascular diseases (CVD), atrial fibrillation (AF), and hypertensive diseases (HD). The annual percent change (APC) was estimated through the pre-pandemic period (2008-2019), and change in rates during pandemic years were computed compared to 2019. Results Before the pandemic, rates were steeply declining for IHD (APC -5.1%; 95%CI -5.5, -4.6) and CVD (-4.0%; -4.4, -3.5); mortality related to HD reduced at a slower pace (-1.9%; -2.3, -1.4), whereas AF-related mortality was increasing (+1.0%; 0.1, 1.8). During the first year of the pandemic, the growth in mortality compared to 2019 was +26% for HD, +18% for AF, +13% for CVD and +12% for IHD. In 2021-2022, rates for CVD and IHD returned to pre-pandemic levels; rates for HD reduced with respect to 2020 but remained above the baseline; AF-related mortality was still increasing. Conclusions The pandemic differentially impacted mortality associated to different circulatory diseases, depending on pre-existing long-term trends (increasing for AF) and on susceptibility to severe COVID-19 disease (higher for HD). Continuous surveillance based on MCOD is warranted to properly assess changes in mortality associated to specific circulatory diseases after the end of the pandemic. Key messages • Multiple causes of death analyses are warranted to assess how the pandemic affected pre-existing long term trends in cause-specific mortality. • Mortality related to different circulatory diseases increased in 2020, but pre-pandemic trends, the extent of the increase in 2020, and further changes observed in 2021-2022 largely diverged.

An increasing trend of overweight and obesity in the Japanese incident end-stage kidney disease population.

The global prevalence of overweight/obesity has been rising, and this trend is apparent in US and European incident end-stage kidney disease (ESKD) populations. We aimed to examine temporal trends in the prevalence of overweight/obesity and underweight among adult incident ESKD patients in Japan by year of dialysis initiation between 2006 and 2019 in comparison with those observed in the Japanese adult population during the same period. Using data from the Japanese Society of Dialysis Therapy Renal Data Registry and the National Health and Nutrition Survey, the sex-specific prevalence of overweight/obesity and that of underweight (BMI ≥ 25 kg/m2 and <18.5 kg/m2, respectively) were calculated, adjusted for age according to the 2019 Population Census via the direct method. Average annual percentage changes (AAPCs) and corresponding 95% confidence intervals (CIs) were calculated to examine trends. From 2006 to 2019, the age-adjusted prevalence of overweight/obesity in the incident ESKD population increased for males (AAPC 3.36 [95% CI, 2.70 to 4.09]) and females (AAPC 2.86 [95% CI, 1.65 to 4.19]). The age-adjusted prevalence of overweight/obesity in the general population increased for males (AAPC 0.87 [95% CI, 0.26 to 1.42]) but not for females (AAPC 0.01 [95% CI, -0.55 to 0.57]). The age-adjusted prevalence of underweight in the incident ESKD population significantly decreased but was higher than that in the general population for both sexes. An increasing trend of overweight/obesity was observed in the incident ESKD population in Japan. There is a pressing need to address both underweight and overweight/obesity in the incident ESKD population.

Trends and Disparities in Coronary Artery Disease and Obesity-Related Mortality in the United States From 1999-2022.

Almost half of the US adult population has obesity, which predisposes to atherosclerosis and can lead to poor prognosis in coronary artery disease (CAD). We aim to identify CAD and obesity-related mortality trends among adults in the United States stratified by age, sex, race and geographical location. The CDC-WONDER database was used to extract death certificate data for adults aged ≥ 25 years. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated, and temporal trends were described by calculating annual percent change (APC) and the average APC (AAPC) in the rates using Joinpoint regression analysis. From 1999 to 2022, a total of 273,761 CAD and obesity-related deaths were recorded in the United States. The AAMR increased consistently from 1999 to 2018 (APC: 4.3, 95% confidence interval (CI): 3.4-4.9) and surged thereafter till 2022 (APC: 11.4; 95% CI: 7.7-19.1). During the COVID-19 pandemic (2020-2022), AAMR almost doubled that of the rest of the study period. Additionally, the AAMR for males was nearly twice that of females. Non-Hispanic (NH) Blacks or African Americans displayed the highest AAMR, followed by NH Whites, Hispanic or Latino, and other NH populations. AAMRs showed minimal variation by census regions. Rural areas exhibited a higher AAMR (AAMR: 5.9, 95% CI: 5.8-5.9) than urban areas (AAMR: 4.4, 95% CI: 4.4-4.5). We observed increasing trends in CAD and obesity-related deaths throughout the study period reaching a peak during the COVID-19 pandemic.

Temporal trends of thyroid cancer in China and globally from 1990 to 2021: an analysis of the global burden of Disease Study 2021

The incidence of thyroid cancer (TC) is increasing annually worldwide, with a growing burden. This study aims to analyze temporal trends in the burden of TC by age and sex in China and globally from 1990 to 2021, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) rates, and to predict future trends. We obtained data on TC in China and globally from 1990 to 2021 from the Global Burden of Disease (GBD) database. Using the Joinpoint regression model, we calculated and analyzed the trends in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR). Specifically, we estimated the annual percent change (APC), the average annual percent change (AAPC), and the corresponding 95% confidence intervals (95% CI) for each metric. Additionally, we conducted a decomposition analysis to investigate the impact of aging, population growth, and epidemiological factors on the incidence and mortality rates of TC. Furthermore, the autoregressive integrated moving average (ARIMA) model was employed to predict the burden of TC from 2022 to 2036. From 1990 to 2021, the ASIR for TC in China increased from 1.249 (95% uncertainty interval [UI]: 1.009–1.473) per 100,000 to 2.473 (95% UI: 1.993–3.088) per 100,000. Conversely, the ASMR decreased from 0.473 (95% UI: 0.403–0.550) per 100,000 to 0.387 (95% UI: 0.307–0.472) per 100,000. Both males and females demonstrated an upward trajectory in ASIR. However, while the ASMR for females decreased, that for males showed an overall increase despite a decline in the last decade. The age of peak onset for TC ranged from 30 to 79 years, whereas the age of peak mortality was between 50 and 89 years. The analysis using the AAPC indicates that the growth in the ASIR (AAPC = 2.242, 95% CI: 2.112–2.371) and ASPR (AAPC = 2.975, 95% CI: 2.833–3.117) in China exceeds the global rate. Furthermore, the reduction in ASMR (AAPC = -0.651, 95% CI: -0.824 - -0.479) and ASDR (AAPC = -0.590, 95% CI: -0.787 - -0.392) in China is also more pronounced than globally. Decomposition analysis indicates that the increasing TC burden in China is primarily driven by population aging, whereas globally, population growth plays a more significant role. Projections based on predictive models suggest that from 2021 to 2036, the ASIR for both China and the global population is expected to continue rising, while the ASMR is anticipated to decline further. The incidence rates of TC in China and globally have shown a continuous upward trend, which is expected to persist over the next 15 years. Additionally, although the number of male TC cases is relatively lower compared to females, the overall ASMR and ASDR for males have shown an upward trend, despite a slight decline in recent years. This highlights the need to enhance prevention, diagnosis, and treatment measures, and to develop differentiated screening and treatment strategies based on age and sex.

Sex, Racial/Ethnic, and Regional Disparities in Pulmonary Embolism Mortality Trends in the USA, 1999-2020.

While the National Institutes of Health emphasize integrating sex as a biological variable into research, specific considerations of sex-related differences in pulmonary embolism (PE) mortality trends remain scarce. This study examines sex-based PE mortality trends across regional and demographic groups in the USA from 1999 to 2020. A retrospective analysis of National Center for Health Statistics mortality data from 1999 to 2020 was conducted. Using ICD-10 code I26, PE decedents were identified. Piecewise linear regression assessed sex-based temporal trends in PE mortality by age, race/ethnicity, and census region. Annual percentage changes and average annual percentage changes were derived using Weighted Bayesian Information Criteria. The 95% confidence intervals were estimated using the empirical quantile method. From 1999 to 2020, a total of 179,273 individuals died in the USA due to PE, resulting in an age-adjusted mortality rate of 2.5 per 100,000 persons (95% CI, 2.5-2.5). While men and women exhibited comparable rates in recent time segments and across most subcategories, a higher mortality trend among males compared to females was observed among non-Hispanic White and Hispanic individuals and residents of the Western US census region. These results remained robust even after excluding data from 2020, accounting for the potential impact of the COVID-19 pandemic. Our study highlights sex-based disparities in PE mortality trends in the USA from 1999 to 2020. Despite overall stable mortality rates, higher trends among males were evident in specific demographic groups and regions. These findings emphasize the importance of targeted interventions to mitigate PE-related mortality discrepancies across diverse populations.

Global burden, trends, and inequalities for typhoid and paratyphoid fever among children younger than 15years over the past 30years.

Typhoid and paratyphoid fever, collectively known as enteric fever, are systemic infections caused by Salmonella enterica and are highly prevalent in children. We aimed to describe the global burden, trends, and inequalities of enteric fever among children under 15years from 1990 to 2019 based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). In this secondary analysis of GBD 2019, we extracted data for incident cases, deaths, disability-adjusted life-years (DALYs) as measures of enteric fever burden. We estimated the average annual percentage changes (AAPC) in enteric fever incidence, mortality, and DALYs rate to quantify trends over time. Cross-country inequalities in enteric fever incidence were measured using the slope index of inequality and concentration index. In 2019, the global cases of typhoid and paratyphoid were 4 833 282 and 1 793 172, respectively, both lower than those in 1990. On secondary analysis, paratyphoid incidence decreased at a faster rate than typhoid from 1990 to 2009, whereas the incidence of paratyphoid (AAPC = -3.78, 95% CI: -4.07, -3.49) declined slower than that of typhoid (AAPC = -4.32, 95% CI: -4.50, -4.13) from 2010-2019 (P < 0.05) at the global level. The incidence burden of enteric fever increased in Australasia (AAPC = 1.28, 95% CI: 0.77, 1.78) and Western Europe (AAPC = 0.77, 95% CI: 0.44, 1.11). Death and DALYs burden in low socio-demographic index (SDI) region showed an stable trend. A significant reduction in SDI-related inequality occurred, with the concentration index falling from -0.31 in 1990 to -0.22 in 2019. The global disease burden of enteric fever and the magnitude of inequalities across countries have declined since 1990, but low SDI countries remain a region of concern. Travellers from Oceania and Western Europe to endemic regions should be particularly aware of the risk of enteric fever.

Global, Regional, and National Burden of Intracerebral Hemorrhage in Young Adults From 1990 to 2021: A Population-Based Study.

Intracerebral hemorrhage (ICH) in young adults demands greater attention, given its poor prognosis; however, there has been a paucity of epidemiological data. The objective of this study is to estimate the temporal trends and distribution characteristics of the disease burden in 204 countries or territories between 1990 and 2021. The data, including incidence, mortality, prevalence, and disability-adjusted life year (DALY) rates were sourced from the Global Burden of Diseases Study 2021. From 1990 to 2021, there was a significant decline in the global incidence (estimated annual percentage change=-1.05), mortality (estimated annual percentage change=-0.92), and DALY (estimated annual percentage change=-1.00) rates of ICH in young adults. In 2021, the highest incidence, mortality, and DALY rates were observed in Southeast Asia, East Asia, and Oceania. Globally, high systolic blood pressure, smoking, and ambient particulate matter pollution were identified as the primary contributors to the largest proportion of DALYs associated with ICH in young adults. The health inequality of ICH in young adults has been reduced over the past 3 decades. There is a considerable degree of heterogeneity in the global burden of ICH in young adults. A decline in the incidence, mortality, prevalence, and DALY rates has been observed from 1990 to 2021, however, the number of absolute cases has increased. These results will enable health care professionals, policymakers, and researchers to refine the implementation of cost-effective policies, the allocation of health care resources, and the management of patients to further mitigate the burden of ICH in young adults.

Global, regional, and national burden of brain and central nervous system cancers for males from 1990 to 2021 and its predicted level in the next 25 years.

A study of the global burden of cerebral and central nervous system (CNS) cancers from the Global Burden of Diseases (GBD) indicates that these cancers significantly contribute to morbidity and mortality internationally. To fully understand the global impact of CNS cancer, expanded research efforts are essential. We analyzed the temporal trend of the disease burden from 1990 to 2021 and made projections for the expected burden from 2020 through 2044. We tapped into GBD 2021 Study data to evaluate CNS cancer incidence and trends among males. Prevalence was assessed with DisMod-MR, trends via cluster analysis, and Estimated Annual Percentage Change (EAPC) calculated via linear regression. Forecasts for 2022-2044 used APC and BAPC models, with a P-value &lt; 0.05 considered significant. Analyses relied on R software 4.0.2. In 2021, males experienced between 148,118 and 232,469 new brain and CNS cancer cases, indicating increased global burden from 1990 to 2021. An observed link between the prevalence's EAPCs and Human Development Indices (HDIs) suggests higher incidence in more developed regions. Projections using the APC model suggest rising numbers of cases and losses in Disability-Adjusted Life Years (DALYs) from 2020 to 2044, while Age-Standardized Rates (ASRs) are expected to decrease overall. In summary, a higher Socio-Demographic Index (SDI) correlates with better outcomes for CNS cancer due to early medical interventions in regions with strong healthcare systems. This demonstrates the need for equitable healthcare policies that focus on improving diagnostic capabilities and professional training to enhance survival rates universally.

Global burden of soil-transmitted helminth infections, 1990–2021

BackgroundSoil-transmitted helminth (STH) infections can cause a significant disease burden. It is estimated that 1.5 billion people worldwide are infected with STHs, primarily in tropical and subtropical regions. This study aimed to assess the distribution of the global burden and trend of STH infections from 1990 to 2021.MethodsWe retrieved data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 on the age-standardized rates (ASRs) of prevalence and disability-adjusted life-years (DALYs) of STH infections for all age groups in 204 countries and territories from 1990 to 2021. The ASRs of prevalence and DALYs by age, gender, and socio-demographic index (SDI) were calculated to quantify the spatial distribution and temporal trend. Spearman correlation analysis was used to examine the relationship between ASR and SDI.ResultsIn 2021, there were an estimated 642.72 million cases and 1.38 million DALYs caused by STH infections worldwide. The age-standardized prevalence rate (ASPR) of STH infections was 8429.89 [95% uncertainty interval (UI): 7697.23, 9362.18 ] per 100,000 population globally. The ASPR of STH infections varied across 21 geographic regions in 2021, being mainly prevalent in most African and Latin American locations. The prevalence was higher in the groups of 5–19 years, especially the group of 5–9 years with the ASPR of 16,263 (95% UI: 14,877.06, 18,003.49) and ASR of DALYs of 40.69 (95% UI: 25.98, 60.91) per 100,000. The ASPR of STH infections showed an obvious decreasing trend worldwide (estimated annual percent change = − 4.03, 95% confidence interval: − 4.13, − 3.93) with variations in different species infections during the study years. At the regional level, the ASR of STH infections prevalence (r = − 0.8807, P < 0.0001) and DALYs (r = − 0.9069, P < 0.0001) were negatively correlated with SDI .ConclusionsSTH infections remain a public health problem in 2021, particularly in regions such as the middle parts of Africa and Americas, and in the 5–19 age populations. The reduction in the rate of prevalence and the loss of DALYs are negatively correlated with the increase in SDI. Enhancing political commitment, providing accurate preventive chemotherapy, and advancing techniques for surveillance and mapping systems are essential to achieve the target of ending STH infections as a public health problem by 2030.Graphical

Analysis of Alzheimer's Disease-Related Mortality Rates Among the Elderly Populations Across the United States: An Analysis of Demographic and Regional Disparities from 1999 to 2020.

Alzheimer's Disease (AD) is the leading cause of dementia and a significant public health concern, characterized by high incidence, mortality, and economic burden. This study analyzes the mortality patterns and demographic disparities in Alzheimer's disease-related deaths among the elderly population in the United States from 1999 through 2020. Alzheimer's disease mortality data for individuals 65 and older were obtained from the CDC WONDER database, utilizing ICD-10 codes G30.0, G30.1, G30.8, and G30.9 for identification. Demographic and regional variables included age, gender, race/ethnicity, place of death, urban- rural status, and geographic region. Crude death rates (CR) and age-adjusted mortality rates (AAMR) per 100,000 individuals were calculated. Joinpoint Regression Program 5.0.2 was used to analyze trends, calculating Annual Percentage Changes (APCs) and Average Annual Percentage Changes (AAPCs). From 1999 to 2020, 1,852,432 deaths were attributed to AD among individuals aged 65 and older. The AAMR increased from 128.8 in 1999 to 254.3 in 2020, with an AAPC of 2.99% (95% CI = 2.61-3.48). The age-adjusted mortality rate (AAMR) was higher in females (218.5) than in males (163.5). Among racial and ethnic groups, non-Hispanic whites had the highest AAMR, followed by Non-Hispanic Blacks and Hispanics. Regionally, the West reported the highest AAMR, while the Northeast recorded the lowest. Most deaths occurred in nursing homes (57.3%), with a significant portion also occurring at decedents' homes (22.4%). AD mortality rates in the U.S. have risen significantly, with notable disparities across age, gender, race, and geographic regions. These findings highlight the need for targeted interventions and research to address the growing burden of AD, particularly among the most affected demographic groups.

Trends and age-period-cohort analysis of leukemia incidence in Qidong from 1972 to 2021

Objective: To describe the epidemiological characteristics and trends of leukemia incidence in Qidong between 1972 and 2021, and provide guidelines for prevention and control measures and strategies. Methods: The cancer registry data was collected and analyzed on leukemia incidence during 1972-2021 in Qidong by sex, age and time. Crude incidence rate (CR), China age-standardized rate (ASRC), world age-standardized rate (ASRW), and average annual change percentage (AAPC) was calculated by Joinpoint software. Age-period-cohort (APC) model was used to analyze the influence of age, period and birth cohort on the changes in the incidence trend of leukemia patients. Results: From 1972 to 2021, there were 2 948 patients with leukemia in Qidong, accounting for 2.00% of all cancer new cases, CR of leukemia was 5.26/105, ASRC was 4.34/105, ASRW was 4.35/105. The truncated incidence of 35-64 years old was 5.29/105, the cumulative incidence rate between the ages of 0 and 74 years old was 0.40%, the cumulative risk was 0.40%. There were 1 608 male patients, the CR, ASRC, and the ASRW were 5.81/105, 4.88/105 and 4.85/105. The number of female patients were 1 340, and the CR, ASRC, and the ASRW were 4.71/105, 3.86/105 and 3.91/105, respectively. Temporal trends indicated significant upward trends in ASRC among both gender, males and females with AAPC values of 1.41% (P＜0.001), 1.15% (P＜0.001), and 1.73% (P＜0.001), respectively. The results of the APC model showed that the average net drift value of leukemia incidence in all age groups was 1.57% (95% CI, 1.24%-1.89%), and the highest value of local drift was 3.20% (95% CI, 1.63%-4.78%) in the 80~ years old group. The incidence of leukemia increased with age. With the passage of time, the risk of leukemia incidence increased gradually compared with the rate ratio of leukemia incidence (risk ratio [RR], 1.00) in 1992-1996, the RR of leukemia incidence increased from 0.70 during 1972-1976 to 1.57 during 2017-2021. The later the cohort was born, the greater the risk of leukemia incidence compared with the relative risk of leukemia incidence (RR, 1.00) in 1952-1956 cohort, the RR of leukemia incidence increased from 0.24 in the 1892-1896 cohort to 2.73 in the 2017-2021 cohort. Conclusions: The incidence of the leukemia has presented a rising trend in the past fifty years. Leukemia incidence increased with age, and the period and cohort effects on the risk of incidence increase. Further research is needed to investigate the risk factors related to leukemia.

Global, regional, and national total burden related to hepatitis B in children and adolescents from 1990 to 2021

BackgroundHepatitis B remains a significant global health concern with widespread communicability. Nevertheless, data on its burden and trends in children and adolescents were limited. We aim to evaluate the global, regional, and national trends of total burden related to hepatitis B in children and adolescents aged 0–19 years from 1990 to 2021.MethodsThe age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were calculated by the Global Burden of Disease (GBD) study from 1990 to 2021. These indicators were stratified by sex, age, socio-demographic index (SDI), and disease stage. We calculated the correlation between them and SDI. The temporal trends were examined using the annual average percentage change (AAPC) and joinpoint regression.ResultsThe global age-standardized incidence of hepatitis B in children and adolescents decreased from 1385.20 per 100,000 population in 1990 to 418.68 per 100,000 population in 2021, with an AAPC of -3.76%. Similarly, age-standardized DALYs decreased from 70.78 per 100,000 population to 36.31 per 100,000 population, with an AAPC of -2.13%. The age-standardized prevalence (AAPC − 3.53%) and mortality (AAPC − 2.09%) of hepatitis B also decreased significantly. From 1990 to 2021, the age-standardized incidence and prevalence among males exhibited a higher trend compared to females, although both declined over time. These two indicators also decreased across all age subgroups, with consistently higher rates observed in the 15–19 age group compared to other age groups. The burden of hepatitis B demonstrated a notable reduction in countries with high-middle SDI, while it was highest in countries with low SDI. In 2021, Central sub-Saharan Africa and West sub-Saharan Africa reported the highest age-standardized incidence. For age-standardized DALYs, South Asia was the only region to experience an increase (AAPC 1.09%), while East Asia showed the largest decline (AAPC − 7.58%). Alcohol and drug use remained important risk factors for DALYs among people aged 15–19 years. Furthermore, the impact of drug use on disease burden was increasing, particularly in high-SDI countries.ConclusionsThe global burden and trends of hepatitis B decreased significantly in children and adolescents, exhibiting regional and national variations. Management of alcohol and drug use remains a major challenge for people aged 15–19 years.

The burden, trends, and projections of low back pain attributable to high body mass index globally: an analysis of the global burden of disease study from 1990 to 2021 and projections to 2050.

To systematically evaluate the global burden and trends of low back pain(LBP) associated with high Body Mass Index (BMI) and project future trends up to 2050 using Bayesian Age-Period-Cohort (BAPC) model, providing scientific evidence for prioritizing global preventive actions. Utilizing data from the Global Burden of Disease (GBD) 2021 study, this research analyzes the disease burden of low back pain linked to high BMI globally, with Disability-Adjusted Life Years (DALYs) as the primary metric. We examined trends by gender, age, and exposure rate using Estimated Annual Percentage Change (EAPC) and projected future trends with the BAPC model. In 2021, high BMI-related low back pain accounted for 8,363,759 DALYs, with an age-standardized rate of 97.66 per 100,000 population and an EAPC of 1.14. The DALYs rate varied significantly by country, with the United States, Australia, and Eastern Europe experiencing the highest rates, all exceeding 225 per 100,000 population. The burden has increased globally, with notable rises in China, Southeast Asia, South Asia, and Africa, where EAPCs surpassed 2.5. Regions with medium and high Socio-Demographic Index (SDI) showed the most substantial increases, with the DALY rate in high SDI areas rising from 118.84 to 161.80 per 100,000, and in medium SDI areas from 41.92 to 79.10 per 100,000. Throughout the period from 1990 to 2021, females consistently experienced a higher burden of high BMI-related low back pain than males, with their DALY rate increasing from 92.01 to 126.29 per 100,000. The impact of high BMI on low back pain intensified with age, peaking in the 70-74 age group at 294.13 per 100,000, and then declining to 196.43 per 100,000 in those aged 95 and above. The BAPC model projects that by 2050, the number of DALYs will reach 15,558,278, an increase of 7,806,121 from 2021. From 1990 to 2021, the global burden of low back pain attributable to high BMI has intensified, particularly affecting females, younger elderly, and developed regions. With increasing global aging and obesity rates, the burden is expected to continue rising rapidly without sustained and effective targeted interventions.