Attributable Risk Factors Research Articles

Disease Burden and Attributable Risk Factors of Alzheimer's Disease and Dementia in China from 1990 to 2019

Background: Updated information on the burden of Alzheimer's disease and other forms of dementia are of great importance for evidence-based health care planning. However, such an estimate has been lacking in Chinese populations at both national and provincial levels. Methods: The temporal trends and the attributable burdens of selected risk factors of Alzheimer's disease and dementia in China were reported through six indicators: incidence, mortality, prevalence, YLLs, YLDs, and DALYs. Findings: There were notable increasing trends in the number of deaths (247·9%), incidence (264·8%), prevalence (296·5%), YLDs (308·7%), YLLs (201·7%) and DALYs (228·1%) from 1990 to 2019, respectively. The corresponding age-standardized rates increased by 6·2%, 19·3%, 33·6%, 33·4%, 3·1% and 10·7%. Smoking, high body mass index, high fasting plasma glucose levels, and metabolic risks were the four leading risk factors. Higher burden was observed among females versus males and in the more developed regions. Interpretation: The disease burden in China were increasing substantially. Regional differences of the disease burden are accompanied by discrepancies of economic level and geographical location, as well as different levels of exposure to risk factors. Targeted prevention and control strategies are urgently needed to reduce the disease burden. Funding: National key Research and Development program of China [2020YFC2008705]. Declaration of Interest: None to declare.

Colorectal cancer incidence and mortality: the current status, temporal trends and their attributable risk factors in 60 countries in 2000-2019.

Background:Globally, colorectal cancer (CRC) imposes a substantial burden on healthcare systems and confers considerable medical expenditures. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of CRC.Methods:We used data from the GLOBOCAN database to estimate CRC incidence and mortality worldwide in 2020 and their association with the human development index (HDI). Trends of age-standardized rates of incidence and mortality in 60 countries (2000–2019) were evaluated by Joinpoint regression analysis using data of Global Burden of Disease 2019. The association between exposure to country-level lifestyle, metabolic and socioeconomic factors obtained from the World Health Organization Global Health Observatory and World Bank DataBank data and CRC incidence and mortality was determined by multivariable linear regression.Results:CRC incidence and mortality varied greatly in the 60 selected countries, and much higher incidence and mortality were observed in countries with higher HDIs, and vice versa. From 2000 to 2019, significant increases of incidence and mortality were observed for 33 countries (average annual percent changes [AAPCs], 0.24–3.82) and 18 countries (AAPCs, 0.41–2.22), respectively. A stronger increase in incidence was observed among males (AAPCs, 0.36–4.54) and individuals <50 years (AAPCs, 0.56–3.86). Notably, 15 countries showed significant decreases in both incidence (AAPCs, −0.24 to −2.19) and mortality (AAPCs, −0.84 to −2.74). A significant increase of incidence among individuals <50 years was observed in 30 countries (AAPCs, 0.28–3.62). Countries with higher incidence were more likely to have a higher prevalence of alcohol drinking, higher level of cholesterol level, higher level of unemployment, and a poorer healthcare system.Conclusions:Some high-HDI countries showed decreasing trends in CRC incidence and mortality, whereas developing countries that previously had low disease burden showed significantly increased incidence and mortality trends, especially in males and populations ≥50 years, which require targeted preventive health programs.

Age-specific atrial fibrillation incidence, attributable risk factors and risk of stroke and mortality: results from the MORGAM Consortium

BackgroundThe main aim was to examine age-specific risk factor associations with incident atrial fibrillation (AF) and their attributable fraction in a large European cohort. Additionally, we aimed to examine risk...

Burden of Respiratory Infection and Tuberculosis Among US States from 1990 to 2019.

PurposeTo estimate the incidence, death, disability-adjusted life years (DALYs) and attributable risk factors for respiratory infection and tuberculosis (RIT) in the US from 1990 to 2019.MethodsFollowing the methodology framework and analytical strategies used in the Global Burden of Disease Study 2019, the incidence, death, DALYs and risk factors of RIT were examined by age, gender and states from 1990 to 2019 in the US. All estimates were calculated as counts, age-standardized rates per 100,000 people and percentage change, with 95% confidence intervals (CIs).ResultsIn 2019, the age-standardized incidence, death and DALY rates per 100,000 people of RIT were 339,703 (95% CI 303,184 to 382,354), 13.6 (95% CI 12.2 to 14.4) and 384.9 (95% CI 330.6 to 458.6), respectively. Among RIT causes, upper respiratory infection accounted for the large majority of RIT age-standardized incidence rate, while lower respiratory infection constituted the highest proportion of RIT age-standardized death and DALY rates. The age-standardized incidence, death and DALY rates of RIT in 2019 and their temporal trends since 1990 varied widely across states and socio-demographic index. Among all attributable risk factors, smoking was the leading one for age-standardized RIT deaths in 2019, followed by low temperature and alcohol use (the attributable fractions were 17.7%, 15.3% and 6.9%, respectively).ConclusionOur results suggest that RIT remained a major cause of health burden in the US, with large disparities persisting between US states. Intervention efforts for RIT hotspots, high-risk populations and modifiable risk factors are necessary.

May Measurement Month 2019: an analysis of blood pressure screening results from the United Kingdom and Republic of Ireland.

In the UK, heart and circulatory diseases account for 29% of all deaths (14% through coronary heart disease and 8% through stroke). In 2015, the prevalence of hypertension was 20% in the UK and 23% in the Republic of Ireland. In 2019, 14% of people registered with a UK general practice had hypertension and yet it was the attributable risk factor for around half of all deaths from coronary heart disease or stroke. We participated in May Measurement Month 2019 to increase awareness of blood pressure (BP) measurement, and to identify the proportion of undiagnosed hypertension and degree of uncontrolled hypertension in the community. The 2019 campaign set up screening sites within the community at places of worship, supermarkets, GP surgeries, workplaces, charity events, community pharmacies, gyms, and various other public places. We screened 10194 participants (mean age 51 ± 18 years, 60% women) and found that 1013 (9.9%) were on antihypertensive treatment, while 3408 (33.4%) had hypertension. Of the 3408 participants with hypertension, only 33.5% were aware of their condition despite 98.8% having previous BP measurements. In those on antihypertensive medication, only 38.2% had controlled BP (<140 and <90 mmHg). Our UK and Republic of Ireland data demonstrate concerning levels of undiagnosed hypertension and sub-optimal BP control in many individuals with a diagnosis. This evidence supports a critical need for better systematic community and primary care screening initiatives.

Global, regional and national burden of lung cancer and its attributable risk factors in 204 countries and territories, 1990-2019.

To explore the lung cancer burden and related risk factors in groups of different sex, ages and levels of sociodemographic index (SDI) at global, regional and national levels. Using newly released GBD 2019 data, we explored the trends of lung cancer burden and its related risk factors in groups of different sex, ages and levels of SDI at global, regional and national levels. The Global Health Data Exchange query tool was used to obtain the data. While lung cancer has an overall stable age-standardized incidence rate (ASIR), the death rate (ASDR) and disability-adjusted life-years (DALYs) rate (with even a trend of decline), it is still the number one malignant tumor. The ASIR and ASDR grew slowly in women worldwide. In 2019, High-income North America, East Asia and Central Europe ranked top three in ASIR, ASDR and age-standardized DALY rate, with growth in East Asia the highest. These three indicators were not in a single linear relation with SDI at a national level, and a peak appeared when SDI was about 0.8. The top three attributable risk factors to DALYs were smoking, particulate matter pollution and occupational carcinogens. Given the high heterogeneity in lung cancer burden among different populations, decision-makers should understand local epidemiological characteristics of lung cancer in detail to formulate effective policies. Stricter tobacco control and improvement in lung cancer screening and treatment are imperative.

The global burden of thyroid cancer and its attributable risk factor in 195 countries and territories: A systematic analysis for the Global Burden of Disease Study.

BackgroundThyroid cancer is a growing threat to human health. Few studies have explored trends of thyroid cancer and relationships with social development factors. In this study, we explored the trend and relationship based on GBD.MethodsBy using GBD study, we obtained detailed data of thyroid cancer. Incidence, mortality and DALY were used to assess epidemiological characteristics. ASR and EAPC were used to estimate the trend.ResultsGlobally, the incidence significantly increased from 1990 to 2017, especially in high‐income regions. Males and middle SDI region demonstrated a higher increase of age‐standardized incidence rates. Unlike incidence trend, mortality trend showed a minor increase, and even showed a decreasing trend in some regions such as Eastern Sub‐Saharan Africa. Additionally, the DALY trend also demonstrated a slightly increase with an EAPC of 0.77 (95% CI 0.73–0.81). More significant increase of DALY was found in males, middle SDI region and high‐income Asia Pacific. The incidence of thyroid cancer peaked in middle‐aged people, while the mortality and DALY peaked in elder‐aged. Moreover, the proportion of thyroid cancer deaths contributable to high BMI was highest in developed countries and middle‐aged people.ConclusionsThyroid cancer is a public health problem worldwide. Over‐diagnosis might be partly responsible for its rising trend. It remains us to revise the guidelines to avoid unnecessary burdens. Moreover, we should pay attention to the risk factors of thyroid cancer. More targeted measures should be formulated to improve potential environmental and lifestyle‐related factors which might contribute to rising trend of thyroid cancer.

Burden of pancreatic cancer along with attributable risk factors in Europe between 1990 and 2019, and projections until 2039.

Projecting the burden of pancreatic cancer over time provides essential information to effectively plan measures for its management and prevention. Here, we obtained data from the Global Burden of Disease (GBD) Study between 1990 and 2019, to model how pancreatic cancer will affect the 27 countries of the European Union (EU) plus the United Kingdom (the pre-Brexit EU-28) until 2039 by conducting the Bayesian age-period-cohort analysis. The number of new pancreatic cancer cases in the EU-28 was 59 000 in 1990, 109 000 in 2019 and projected to be 147 000 in 2039. This corresponded to 60 000, 109 000 and 155 000 for deaths, and a loss of 1.3 million, 2.0 million and 2.7 million for disability-adjusted life years (DALYs), respectively. The most pronounced increase of the crude incidence rate was observed and projected to be in the population older than 80 years. The age-standardized rate (ASR) of incidence, however, increased from 8.6 to 10.1 per 100 000 person-years during 1990-2019 but was projected to remain stable during 2019-2039. At the same time, our models only predicted a mild increase in the ASR of mortality until 2039. The fraction of pancreatic cancer mortality attributable to tobacco consumption decreased during 1990-2019, but we found upward trends for the attributable fractions for high fasting plasma glucose and high body mass index. In conclusion, a substantial increase in counts of incidence, mortality and DALYs lost of pancreatic cancer in the EU-28 is projected over the next two decades, which indicates the need for future health policies and interventions.

Global Burden of Aortic Aneurysm and Attributable Risk Factors from 1990 to 2017.

Background:To date, our understanding of the global aortic aneurysm (AA) burden distribution is very limited.Objective:To assess a full view of global AA burden distribution and attributable risk factors from 1990 to 2017.Methods:We extracted data of AA deaths, disability-adjusted life years (DALYs), and their corresponding age-standardized rates (ASRs), in general and by age/sex from the 2017 Global Burden of Disease (GBD) study. The current AA burden distribution in 2017 and its changing trend from 1990 to 2017 were separately showed. The spatial divergence was discussed from four levels: global, five social-demographic index regions, 21 GBD regions, and 195 countries and territories. We also estimated the risk factors attributable to AA related deaths.Results:Globally, the AA deaths were 167,249 with an age-standardized death rate (ASDR) of 2.19/100,000 persons in 2017, among which the elderly and the males accounted for the majority. Although reductions in ASRs were observed in developed areas, AA remained an important health issue in those relatively underdeveloped areas and might be much more important in the near future. AA may increasingly affect the elderly and the female population. Similar patterns of AA DALYs burden were noted during the study period. AA burden attributable to high blood pressure and smoking decreased globally and there were many heterogeneities in their distribution.Discussion:AA maintained an incremental public health issue worldwide. The change pattern of AA burden was heterogeneous across locations, ages, and sexes and it is paramount to improve resource allocation for more effective and targeted prevention strategies. Also, prevention of tobacco consumption and blood pressure control should be emphasized.

Temporal Trend and Attributable Risk Factors of Stroke Burden in China, 1990-2019: Findings From the Global Burden of Disease Study 2019

Background: Limited information exists on the temporal trend of the disease burden of stroke and its attributable risk factors in China, especially at provincial levels. The aim of this analysis from the Global Burden of Disease Study (GBD) 2019 is to investigate the disease burden of stroke and its risk factors at national and provincial levels of China from 1990 to 2019. Methods: Following the methodology in the GBD 2019, the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of stroke cases in the Chinese population were estimated by sex, age, year, three subcategories of stroke and across 33 province-level administrative units in China from 1990 to 2019. Attributable mortality and DALYs of underlying risk factors were calculated by a comparative risk assessment. Findings: The annual stroke incidence increased from 1.76 million in 1990 to 3.94 million in 2019; the age-standardised incidence rate declined from 221.5 per 100,000 population in 1990 to 200.8 per 100,000 population in 2019. Deaths due to stroke increased by 59.0%, reaching 2.19 million in 2019. The age-standardised mortality rate decreased by 39.8%, reaching 127.2 per 100,000 population in 2019. The number of stroke prevalence overall increased by 147.5% (from 11.62 million in 1990 to 28.76 million in 2019). From 1990 to 2019, the age-standardised prevalence rate increased by 13.2% for overall stroke and 33.5% for ischemic stroke, and decreased by 31.9% for intracerebral hemorrhage and 21.9% for subarachnoid hemorrhage. A substantial reduction was observed in the age-standardised DALYs rate (41.6%) of stroke from 1990 to 2019. Moreover, there were marked differences of these estimates stratified by sex, age, stroke subtype, and across province. High systolic blood pressure , high fasting blood glucose , p articulate matter pollution exposure , and smoking were four major risk factors for stroke burden in 2019. Interpretation: This study demonstrates that the disease burden of stroke is still severe for the Chinese population, although the age-standardised incidence and mortality rate have decreased since 1990. There was substantial variation of these estimates among different provinces which suggested the necessary of targeted stroke intervention. Blood pressure and blood glucose management through regular health care and air pollution control measures might help reduce the stroke burden in China. Funding Information: This work was supported by the National Key R&D Program of China (2018YFA0606200). The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. Declaration of Interests: The authors declare they have no actual or potential competing financial interests. Ethics Approval Statement: This study was approved by the Ethical Review Committee of the National Center for Chronic and Non-communicable Disease Control and Prevention of the Chinese Center for Disease Control and Prevention. No individual identifiable information was used in this study.

Disease burden and attributable risk factors of respiratory infections in China from 1990 to 2019

BackgroundThere was lack of data on the burdens and trends of upper and lower respiratory infections (URIs and LRIs) over the past three decades in China. MethodsWe estimated the incidence, mortality, and disability-adjusted life years (DALYs) due to upper and lower respiratory infections (URIs and LRIs) and attributable risk factors in China by a systematic analysis of the Global Burden of Disease 2019 study. Incidence, mortality, and DALYs were stratified by sex, age, and province. Risk factors for respiratory infections were analyzed from exposure data. FindingsThe age-standardized incidence rates of URIs and LRIs were 179,077 and 3926 per 100,000 persons in 2019, with a 7•52% and 35•07% decrease from 1990, respectively. Moreover, 2801 and 185,264 persons died of URIs and LRIs in 2019, respectively. DALYs for URIs and LRIs also decreased from 1,516,727 in 1990 to 928,617 in 2019 and from 38,278,504 in 1990 to 4,020,676 in 2019. The burden of URIs and LRIs were generally similar in males and females, but relatively higher in the new-borns and the elderly. Child malnutrition and low birth weight were the most important cause of age-standardized DALYs of LRIs and URIs, respectively. InterpretationFuture URI and LRI prevention strategies should focus on the maternal and child health, air pollution, and tobacco control, especially in young children and the elderly population. FundingNational Key R&D Program of China (2018YFA0606200); National Natural Science Foundation of China (82041021); Fundamental Research Funds for the Central Universities (20ykpy86) and Guangdong Basic and Applied Basic Research Foundation (2019A1515110003); Bill & Melinda Gates Foundation (No.: INV-006371).

Burden of Tracheal, Bronchus, and Lung Cancer and Its Attributable Risk Factors in 204 Countries and Territories, 1990 to 2019

IntroductionUnderstanding trends in the annual incidence, mortality, and disability-adjusted life-years (DALYs) for tracheal, bronchus, and lung (TBL) cancer globally is important to enable appropriate targeting of resources for prevention, clinical practice improvement, and research. The aim of this study was to determine the global, regional, and national burdens of TBL cancer in 204 countries and territories from 1990 to 2019 by age, sex, and sociodemographic index. MethodsEstimates were produced through various data inputs including the following: cancer registries (nsite-years = 5318), vital registration (nsite-years = 22,553), vital registration-sample (nsite-years = 825), and verbal autopsies (nsite-years = 516). Annual incidence, mortality, and DALYs were estimated and presented as counts and age-standardized rates per 100,000 population. ResultsThere were 2.3 million (95% uncertainty interval [UI]: 2.1–2.5) incident cases of TBL cancer, with an age-standardized annual incidence rate of 27.7 (95% UI: 25.3–30), which decreased by 2.6% (95% UI: −12.4 to 6.5) between 1990 and 2019. TBL cancer was responsible for 2 million (95% UI: 1.9–2.2) deaths globally with an age-standardized death rate of 25.2 (95% UI: 23.2–27), a decrease of 7.8% (95% UI: −15.9 to 0.2) between 1990 and 2019. Moreover, TBL accounted for 45.9 million (95% UI: 42.3–49.3) DALYs at the global level, with an age-standardized rate of 551.6 (95% UI: 509–593.1) DALYs per 100,000 population. The standardized DALY rate declined by 16.2% (95% UI: −24 to −8.2) from 1990 to 2019. Greenland (77.7 [95% UI: 64.4–90.6]), Monaco (75.6 [95% UI: 61.4–90.8]), and Montenegro (56.7 [95% UI: 46.5–68.9]) had the three highest age-standardized annual incidence rates. The aforementioned three countries also had the three highest age-standardized death and DALY rates of TBL cancer. Honduras (68% [95% UI: 14.5–137.7]), Cabo Verde (62.2% [95% UI: 24.1–101.3]), and Monaco (58.2% [95% UI: 19.2–109.7]) had the largest increase in age-standardized annual incidence rates for TBL cancer during 1990 to 2019. The largest increases were found in age-standardized death rates of TBL cancer in Honduras (67.1% [95% UI: 14.7–133.1]), Cabo Verde (64.4% [95% UI: 25–103.4]), and Mozambique (49.9% [95% UI: 7.9 –101.3]). Age-standardized annual incidence and death rates were higher in male than female individuals and increased with population aging. There were nonlinear but generally positive associations between age-standardized DALY rates with corresponding sociodemographic index of countries. Globally, smoking (62.4%), ambient particulate matter (15.3%), and high fasting plasma glucose (9.9%) had the top three highest percent of attributable DALYs owing to TBL cancer in 2019 for both sexes. ConclusionsThis study found a decline in burden globally but with some countries having an increase. These results are crucial to set priorities for prevention and treatment of TBL cancer and would be beneficial for policymakers, government officials, clinicians, and researchers.

The global, regional, and national burden of gallbladder and biliary tract cancer and its attributable risk factors in 195 countries and territories, 1990 to 2017: A systematic analysis for the Global Burden of Disease Study 2017.

The global burden of gallbladder and biliary tract cancer (GBTC) is increasing. A comprehensive evaluation of the burden is crucial to improve strategies for GBTC prevention and treatment. The incidence rates, mortality, and disability-adjusted life years (DALYs) of GBTC from 1990 to 2017 were extracted from the Global Burden of Diseases Study (GBD) 2017. Estimated annual percent changes (EAPCs) were calculated to quantify GBTC trends during the study period. Globally, there were 210,878 new cases, 173,974 deaths, and 3,483,046 DALYs because of GBTC in 2017. GBTC incidence increased by 76%, mortality increased by 65%, and DALYs increased by 52% from 1990 to 2017. In addition, relatively higher Socio-Demographic Index regions had greater incidence and death rates but greatly decreased age-standardized incidence rate (ASIR) and age-standardized death rate (ASDR). At the national level, Chile had the highest ASIR (10.38 per 100,000 population) and the highest ASDR (10.43 per 100,000 population) in 2017. The largest increases in ASIR (EAPC, 3.38) and ASDR (EAPC, 3.39) were observed in Georgia. Nonlinear associations were observed between the ASDR, the Socio-Demographic Index, and DALYs at the 21 GBD regional levels and at the national level. The proportions of GBTC age-standardized deaths and DALYs attributable to high body mass index were 15.4% and 16%, respectively. GBTC remains a major health burden worldwide. These findings are expected to prompt policymakers to establish a cost-effective method for the early diagnosis, prevention, and treatment of GBTC, reducing its modifiable risk factors and reversing its increasing trends. Although the rates of age-standardized incidence, death, and disability-adjusted life-years for gallbladder and biliary tract cancer decreased from 1990 to 2017, the numbers of these measures increased. Nonlinear associations existed between the age-standardized death rate, the Socio-Demographic Index, and disability-adjusted life-years at the 21 regional and national levels in the Global Burden of Disease Study.

Measuring the global, regional, and national burden of type 2 diabetes and the attributable risk factors in all 194 countries.

No detailed quantitative global, regional, or national estimates of the disability-adjusted life years (DALYs) of type 2 diabetes mellitus (T2DM) are available. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to estimate the global, regional, and national incidence rates and DALYs of T2DM, as well as the associated risk factors, in all 194 countries and territories by age, sex, and sociodemographic status during the period from 2007 to 2017. Globally, the age-standardized incidence and DALY rates increased by 3.23% and 5.07% during 2007 to 2017, respectively. The age-standardized incidence and DALY rates in 2017 and the corresponding percentage changes during 2007 to 2017 were highest in the low-middle sociodemographic index (SDI) quintile. Regionally, the highest 2017 age-standardized incidence and DALY rates were observed in Oceania, whereas the largest percentage increases in both rates during 2007 to 2017 were observed in Southeast Asia. Nationally, Iran, the United Kingdom, and Indonesia reported the largest percentage increases in the age-standardized incidence rates, whereas Georgia, Czech Republic, and Iran showed the largest percentage increases in the age-standardized DALY rates. Globally, the largest percentage increases in risk-attributable DALYs were associated with a high body mass index, low physical activity level, high fasting plasma glucose level, and high sugar-sweetened beverage and red meat consumption. The global T2DM age-standardized incidence and DALY rates increased globally between 2007 and 2017, especially in the low-middle SDI quintile, Southeast Asia.

The global, regional, and national burden of laryngeal cancer and the attributable risk factors in all countries and territories during 2007–2017

Background: Data for the global burden of laryngeal cancer (LC) are limited. Methods: We reported the incidence of, disability-adjusted life years (DALYs), and deaths due to LC by age, sex and by social-demographic index (SDI) in all countries and territories during 2007 to 2017, based on data from the Global Burden of Disease (GBD) 2017 study. We also assessed the risk factors for LC-associated DALYs and deaths through a comparative risk assessment framework. Results: Globally, from 2007 to 2017, the age-standardized incidence rate increased by 0.95%, the age-standardized DALY rate decreased by 8.75%, and the age-standardized death rate decreased by 7.66%. The age-standardized incidence, DALY, and death rates in 2017 were all the highest in the low SDI quintile. The middle SDI quintile witnessed the highest percentage changes in age-standardized incidence, DALY, and death rates during 2007-2017. At the GBD regional level, the highest age-standardized incidence, DALY, and death rates in 2017 occurred in the Caribbean, followed by South Asia. East Asia showed the largest increases in age-standardized incidence, DALY, and death rates from 2007 to 2017. At the national level, China and Jamaica reported the largest percentage increases in the age-standardized incidence, DALY, and death rates over the study period. Conclusion: The global age-standardized incidence of LC remain stable. However, the age-standardized DALY and death rates decreased significantly over the study period. Impact: Our findings will be beneficial for developing policies to reduce the disease burden of LC in particular regions or countries.

Disease Burden and Attributable Risk Factors of Alzheimer's Disease and Dementia in China from 1990 to 2019.

Updated information on the burden of Alzheimer's disease and other forms of dementia are of great importance for evidence-based health care planning. However, such an estimate has been lacking in Chinese populations at both national and provincial levels. To estimate the temporal trends and the attributable burdens of selected risk factors of Alzheimer's disease and other forms of dementia in China. This is an observational description of the Global Burden of Diseases Study 2019 (GBD 2019). Data on incidence, mortality, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) of Alzheimer's disease and other forms of dementia were derived from the GBD 2019 study at both national and provincial levels in China. Six indicators were used: incidence, mortality, prevalence, DALYs, YLLs, and YLDs. Absolute numbers in detail by age, sex, region, and age-standardized rates (with 95% uncertainty intervals) were calculated. There were notable increasing trends in the number of deaths (247·9%), incidence (264·8%), prevalence (296·5%), DALYs (228·1%), YLDs (308·7%) and YLLs (201·7%) from 1990 to 2019, respectively. The corresponding age-standardized rates increased by 6·2%, 19·3%, 33·6%, 10·7%, 33·4% and 3·1%. Smoking, high body mass index, high fasting plasma glucose levels, and metabolic risks were the four leading risk factors. Higher burden was observed among females versus males and in the more developed regions. The disease burden in China were increasing substantially. Regional differences of the disease burden are accompanied by discrepancies of economic level and geographical location, as well as different levels of exposure to risk factors. Targeted prevention and control strategies are urgently needed to reduce the disease burden.

Trends in disease burden of chronic myeloid leukemia at the global, regional, and national levels: a population-based epidemiologic study

BackgroundOutcomes of chronic myeloid leukemia (CML) has been improved dramatically in the past two decades, but survival levels of CML patients varied in regions. Comprehensive epidemiological research is necessary to evaluate the global burden of CML.MethodsAll data used in our study came from the Global Burden of Disease (GBD) study 2017. Incidence cases, death cases, disability-adjusted life-years (DALYs), and its corresponding age-standardized rate between 1990 to 2017 were used to describe the distribution of CML burden, according to age, sex, social-demographic index (SDI), and countries. Data about attributable risk factors contributing to CML deaths and DALYs were also extracted and analyzed.ResultsGlobally, the disease burden of CML gradually decreased from 1990 to 2017. Higher SDI countries achieved a remarkable effect on diminishing the CML burden. Conversely, due to population growth, the incidence cases, death cases, and DALYs of CML in lower SDI quintiles showed an upward trend. India had the most incidence cases and death cases of CML in the world. Additionally, smoking was the most significant attributable risk factor contributing to CML deaths and DALYs, followed by high body mass index.ConclusionThe disease burden of CML decreased globally, especially in higher SDI countries in the past 28 years. The increasing incidence cases and death cases were mainly observed in lower SDI countries. Additionally, strategies to control modifiable risk factors such as smoking and high body mass index might be useful in diminishing mortality and DALYs.

The High Prevalence of Negative Hepatitis B Surface Antibody (Anti-HBs) among Pregnant Women in Bandung, Indonesia: A Community-Based Study.

Background Hepatitis B virus (HBV) infection is a disease that creates a high global burden by affecting approximately 3.5% of the total world population. The main transmission of this disease is from mother to child (MTCT). HBV vaccination program was already initiated in Indonesia in 1987. However, after three decades, the HBV infection prevalence stays stagnant. This study aimed to explore the seroprevalence of HBV markers and the attributable risk factors of pregnant women at risk of transmitting HBV to their offspring. Method A cross-sectional study was conducted on pregnant women from primary midwifery and obstetric clinics across Bandung, Indonesia, to assess the HBsAg, anti-HBc, and anti-HBs serological markers. Questionnaire-based interviews were used to obtain the sociodemographic determinants. Logistic regression was applied to assess the association of each determinant factor to positive HBsAg or negative anti-HBs as a dependent variable, which was then reported as odds ratios (OR). Results A total of 196 subjects were recruited with 12/196 (6.1%) of them were positive HBsAg. After exclusions of those with positive HBsAg and anti-HBc, 24/175 (13.7%) women were isolated as positive anti-HBs, leaving 151/175 (86.3%) women with negative anti-HBs who were susceptible to HBV infection. Low body mass index (BMI) less than 18.5 kg/m2 was a risk factor for positive HBsAg with OR = 5.850 (95% CI 1.466-23.34), p = 0.012. Nevertheless, no significant determinant factor was associated with negative anti-HBs. Conclusion Most pregnant women in Bandung, Indonesia, are susceptible to HBV infection, as marked by the negative anti-HBs status.

Clinical Feature and Outcome of Childhood Status Epilepticus in a Teaching Hospital, Odisha, India.

ObjectivesThe main aim is to find out the clinical feature and outcome of status epilepticus (SE) in children managed in a teaching hospital. The secondary aim is to identify the risk factors influencing the adverse outcomes.MethodsIn this prospective cohort, children aged 1 month to 14 years with SE as per the International League Against Epilepsy’s new guideline (2016) who presented to the emergency department during the period of November 2017 to October 2019 were enrolled. Clinical profile, treatment, and outcome of cases (n = 94) were noted.ResultsThe majority of children, 60 (63.82%), were less than five years of age. Prior history of seizures was present in 33 (35.1%) cases, whereas 61 (64.9%) cases presented with SE as the first episode of seizure. In 14 (42.4%) previous seizure cases, SE was due to drug default. No response to first-line antiepileptic drug (AED) was seen in 84 (89.37%) cases. Acute symptomatic etiology was the commonest etiology of SE in 64 (68%) cases, of which neuro-infections accounted for 44 (46.80%) cases. Longer duration (>60 minutes) of status (p < 0.01), ventilator support (p < 0.0001), and circulatory impairment (p < 0.0001) were attributable risk factors for mortality. A total of 28 children died (mortality rate, 29.8%), and 11 showed the persistence of their neuro-deficit.ConclusionsNeuro-infection is the most common etiology of SE in children. Longer duration of SE, more lag time for receiving the first AED, respiratory failure, and presence of shock are independent predictors for poor outcome. Hence, cessation of convulsion at the earliest leads to improved outcomes.

Global, regional, and national burden of ischaemic heart disease and its attributable risk factors, 1990-2017: results from the Global Burden of Disease Study 2017.

AimsThe aim of this study was to estimate the burden and risk factors for ischaemic heart disease (IHD) in 195 countries and territories from 1990 to 2017.Methods and resultsData from the Global Burden of Disease Study 2017 were used. Prevalence, incidence, deaths, years lived with disability (YLDs), and years of life lost (YLLs) were metrics used to measure IHD burden. Population attributable fraction was used to estimate the proportion of IHD deaths attributable to potentially modifiable risk factors. Globally, in 2017, 126.5 million [95% uncertainty interval (UI) 118.6 to 134.7] people lived with IHD and 10.6 million (95% UI 9.6 to 11.8) new IHD cases occurred, resulting in 8.9 million (95% UI 8.8 to 9.1) deaths, 5.3 million (95% UI 3.7 to 7.2) YLDs, and 165.0 million (95% UI 162.2 to 168.6) YLLs. Between 1990 and 2017, despite the decrease in age-standardized rates, the global numbers of these burden metrics of IHD have significantly increased. The burden of IHD in 2017 and its temporal trends from 1990 to 2017 varied widely by geographic location. Among all potentially modifiable risk factors, age-standardized IHD deaths worldwide were primarily attributable to dietary risks, high systolic blood pressure, high LDL cholesterol, high fasting plasma glucose, tobacco use, and high body mass index in 2017.ConclusionOur results suggested that IHD remains a major public health challenge worldwide. More effective and targeted strategies aimed at implementing cost-effective interventions and addressing modifiable risk factors are urgently needed, particularly in geographies with high or increasing burden.