Attributable Risk Factors Research Articles

Musculoskeletal Disorder Burden and Its Attributable Risk Factors in China: Estimates and Predicts from 1990 to 2044.

Musculoskeletal disorders are one of the three major disabling diseases in the world. However, the current disease burden in China is not well-known. This study aimed to explore the burden and risk factors of musculoskeletal disorders in China from 1990 to 2019, predicting the incidence trend from 2020 to 2044. All data were extracted from the Global Burden of Disease Study 2019 (GBD 2019). Joinpoint regression and age-period-cohort (APC) models were selected to analyze the epidemic trend, and descriptive analyses of the time trends and age distributions of risk factors were performed. The Bayesian APC model was used to foresee the incidence trend from 2020 to 2044. The results indicated that the burden of musculoskeletal disorders is higher in women and older adults. Its attributable risk factors were found to be tobacco, a high body mass index, kidney dysfunction and occupational risks. In 2044, musculoskeletal disorders in China showed a downward trend for 35-59-year-olds and a slight upward trend for 30-34- and 65-84-year-olds. The 70-74 year age group saw the largest increase in incidence at 4.66%. Overall, the incidence increased with age. Therefore, prevention and control policies should focus on women and the elderly, and health interventions should be carried out based on risk factors.

Burden of occupational cancer in Brazil and federative units, 1990-2019.

To analyze the spatiotemporal distribution of the burden of occupational cancer in Brazil and federative units between 1990 and 2019. Data were extracted from the Global Burden of Disease (GBD) study. Deaths from cancer whose attributable risk factor was occupational carcinogens were considered. Spatial analysis was performed with the first and last years of the series (1990 and 2019). Age-adjusted mortality rates were used to estimate the global Moran's Index (Moran's I), and the local indicator of spatial association (LISA) to identify clusters in the country with the respective statistical significance. The occupational cancer mortality rate, adjusted for age, was analyzed based on its trend for Brazil and federative units, in the period between 1990 and 2019. Between 1990 and 2019, occupational cancer mortality rate showed a decreasing trend (R2=0.62; p<0.001) as well as the burden of disease indicator - DALY (R2=0.84; p<0.001). However, mortality is increasing in most states, suggesting that a minority of federative units induce the country's global trend. There is also the development of a spatial pattern of autocorrelation, indicating clusters of states with low mortality and DALY rates in the Northeast and high values in the South of the country. The overall decreasing trend in the trend of occupational cancer masks the heterogeneity across states. This scenario may be associated with the diversity of economic activities, and suggests a decentralized and equitable plan for occupational cancer surveillance.

Global Disease Burden and Attributable Risk Factor Analysis of Asthma in 204 Countries and Territories From 1990 to 2019.

Asthma is a common chronic inflammatory respiratory tract disease with high morbidity and mortality. The global trends in asthma burden remain poorly understood, and asthma incidence has increased during the worldwide coronavirus disease 2019 (COVID-19) pandemic. This study aimed to provide a comprehensive view of the global distribution of asthma burden and its attributable risk factors from 1990 to 2019. Based on the Global Burden of Disease Study 2019 Database, asthma incidence, deaths, disability-adjusted life years (DALYs), the corresponding age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), age-standardized DALY rate, and estimated annual percentage change were analyzed according to age, sex, sociodemographic index (SDI) quintiles, and locations. Risk factors contributing to asthma deaths and DALYs were also investigated. Globally, the asthma incidence increased by 15%, but deaths and DALYs decreased. The corresponding ASIR, ASDR, and age-standardized DALY rate also decreased. The high SDI region had the highest ASIR, and the low SDI region had the highest ASDR. The ASDR and age-standardized DALY rate were negatively correlated with the SDI. The low-middle SDI region, particularly South Asia, showed the highest asthma-related deaths and DALYs. The incidence peak was under 9 years old, and more than 70% of all deaths occurred in the population over 60 years old. Smoking, occupational asthmagens, and a high body mass index were the main risk factors for asthma-related mortality and DALYs, and their distributions varied between sexes. Globally, the asthma incidence has increased since 1990. The greatest asthma burden is borne by the low-middle SDI region. The 2 groups that need special attention are those under 9 years old and those over 60 years old. Targeted strategies are needed to reduce the asthma burden based on geographic and sex-age characteristics. Our findings also provide a platform for further investigation into the asthma burden in the era of COVID-19.

ПОПУЛЯЦИОННЫЕ СОЦИАЛЬНО-ЭКОНОМИЧЕСКИЕ ПРЕДИКТОРЫ ЗАБОЛЕВАЕМОСТИ ВЗРОСЛОГО НАСЕЛЕНИЯ ИНСУЛИННЕЗАВИCИМЫМ ДИАБЕТОМ В РЕГИОНАХ

A steady increase in the incidence of type 2 diabetes and aggravation of socio-economic problems substantiate the need to analyze the population attributable risk factors for diabetes, determined by the status of the regional economy standard of living. The purpose of the study was to assess the socio-economic gradient of incidence of non-insulin dependent diabetes mellitus in adults in two regions within one federal district in Russia, differing in the level of economic performance and well-being of the population. Material and methods. The retrospective analysis for the period 2005-2019 includes official statistics on the gross regional product and average monthly income per capita, the share of persons with income below the subsistence minimum, the employment index, the share of employees with higher professional education, and Gini coefficient in the Republic of Tatarstan (RT) and the Republic of Mari El (RME). The study evaluated the normality of distribution, dynamics in indicators by the trendline coefficient of determination (R2), statistical significance of the differences in time series. The indicators were analyzed calculating the Spearman coefficient with a 95% confidence interval (CI) year-on-year and with a lag (lag effect). At all stages, the value of statistical probability (p) was indicated, the critical level of which was assumed to be 0.05. To identify multiple internal relationships between socio-economic indicators, they were grouped by the component method and factorial complexes were identified. Based on the results of the multiple correlation and regression analysis, models of impact of these complexes on type 2 diabetes incidence have been constructed. The study used Statistica 6 program and AtteStat Add-in Microsoft Excel, version 12.0.5. Results. In 2005-2019, the increase in type 2 diabetes incidence in adult population in the Mari El Republic was determined to be statistically significant and higher (p=0.01) than the one in the Republic of Tatarstan, where there was only an upward trend in the indicator. The socio-economic indicators of the Republic of Tatarstan were higher and characterized by higher growth rates than the ones in the Mari El Republic (p=0.0008) with a weak interregional convergence. Differences in the closeness and degree of significance of correlations between diabetes incidence in adult population and macroeconomic indicators between regions were determined to be insignificant. The main difference was the magnitude of the lag in incidence, reaching 9-10 years against the socio-economic indicators, the grouping of which by the component method in both regions combined into a generalizing economic factor, with the exception of Gini coefficient. The ranks and magnitude of the contribution of factorial complexes had the following interregional differences: in the Republic of Tatarstan, Gini coefficient was more significant in diabetes incidence, whereas in the Mari El Republic it was the generalizing economic factor. Conclusion. Results of the analysis of the nature of interrelations (strength, statistical significance, vector and prolongation) of the new cases of type 2 diabetes and socio-economic indicators in the regions, depending on the state of the economy and the standard of living, are the basis of the effective programs on decreasing morbidity.

Global burden of type 2 diabetes in adolescents and young adults, 1990-2019: systematic analysis of the Global Burden of Disease Study 2019

ObjectiveTo estimate the global burden of type 2 diabetes in adolescents and young adults (aged 15-39 years) from 1990 to 2019.DesignSystematic analysis.Data sourceGlobal Burden of Disease Study 2019. Participants aged...

Clinical Pediatric Exercise Laboratories, Reactive Balance, Sleep, and Muscle Stimulation Considerations

Clinical Pediatric Exercise Laboratories, Reactive Balance, Sleep, and Muscle Stimulation Considerations

Global, regional, and national burden and attributable risk factors of neurological disorders: The Global Burden of Disease study 1990-2019.

Neurological disorders are a major and increasing global health challenge, which accounts for a substantial portion of the disease burden worldwide. The aim of this systematic analysis is to present the most comprehensive and up-to-date estimates of disease burden, epidemiological trends, and attributable risk factors of neurological disorders at global, regional, and national levels. We extracted data of 18 neurological disorders from the Global Burden of Disease 2019 study database. The burden of neurological disorders was measured using the incidence, prevalence, mortality, and disability-adjusted life years (DALYs), and further described according to age, sex, year, geographical location and socio-demographic Index (SDI). All estimates were presented with corresponding 95% uncertainty intervals (UIs). Globally, in 2019, there were nearly 10 million deaths and 349 million DALYs due to neurological disorders. Among the 18 neurological disorders, stroke was the biggest contributor to DALYs (143232.18 [95%UI 133095.81-153241.82] in thousands) and deaths (6552.72 [95%UI 5995.20-7015.14] in thousands), followed by neonatal encephalopathy due to birth asphyxia and trauma. From 1990 to 2019, the DALYs of neurological diseases belonging to the communicable, maternal, neonatal and nutritional categories showed a sharp decrease, while Alzheimer's disease and other dementias and Parkinson's disease showed a large increase. Neurological disorders exhibited different profiles in different regions and age groups. A significant correlation between the SDI and the age-standardized DALY rates was also found except for Alzheimer's disease and other dementias. In addition, risk factors such as high systolic blood pressure, low birth weight and short gestation period, and metabolic risk contribute significantly to neurological disorders. The overall burden of neurological disorders has increased from 1990 to 2019, especially for non-communicable neurological disorders. The substantial variations of burden across regions emphasize the need for region-specific interventional strategies and allocation of resources based on priorities.

Global burden of calcific aortic valve disease and attributable risk factors from 1990 to 2019.

Calcific aortic valve disease (CAVD) was highly prevalent among developed countries and caused numerous deaths. Based on the Global Burden of Disease 2019, this study was designed to present comprehensive epidemiological information, attributable risks, and relevant factors. All data were available online via the Global Health Data Exchange (GHDx). In this study, we analyzed the global incidence, prevalence, deaths, and disability-adjusted life years (DALYs) of CAVD across different regions from 1990 to 2019. We applied the estimated annual percentage changes (EAPCs) to evaluate the change trends and their attributable risks. In addition, we explored several relevant factors. From 1990 to 2019, the incidence cases, prevalence cases, CAVD-related deaths, and DALYs of CAVD gradually increased globally. However, the age-standardized death rate (ASDR) was relatively stable, and the age-standardized DALYs rate gradually declined during the past 30 years. Males and elderly individuals were more likely to suffer from CAVD. High systolic blood pressure (SBP) was the predominant attributable risk of disease burden that presented a global downward trend (death: EAPC = -0.68, 95% CI -0.77~-0.59, P < 0.001; DALYs: EAPC = -0.99, 95% CI -1.09 to -0.89, P < 0.001). Alcohol consumption (R = 0.79, P < 0.001), smoking prevalence (R = 0.75, P < 0.001), and calcium (R = 0.72, P < 0.001) showed a positive correlation with the age-standardized incidence rate (ASIR), whereas classic monsoon region (R = -0.68, P < 0.001) and mean temperature (R = -0.7, P < 0.001) showed a negative correlation with age-standardized incidence rate (ASIR). Besides, medical and healthcare resources presented a positive correlation with ASIR. Meanwhile, similar relationships were found in age-standardized prevalence rate (ASPR), ASDR, and age-standardized DALY rate (ASDALYR). CAVD displays widely varied spatial distribution around the world, of which high SDI regions have the highest burdens. Age is a powerful factor and hypertension a predominant attributable risk factor. Moreover, controlling blood pressure, avoiding smoking, reducing alcohol consumption, and so on, could effectively reduce the burden of CAVD.

The burden of chronic obstructive pulmonary disease and its attributable risk factors in the Middle East and North Africa region, 1990–2019

BackgroundChronic obstructive pulmonary disease (COPD) is a preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. The present study reported the burden of COPD, and its attributable risk factors, in the Middle East and North Africa (MENA) region between 1990 and 2019, by age, sex and socio-demographic index (SDI).MethodsData from the Global Burden of Disease (GBD) 2019 study were used to report the burden of COPD in the MENA countries. The prevalence, deaths, and disability-adjusted life-years (DALYs) were presented as counts and age-standardised rates per 100,000 population, with their associated 95% uncertainty intervals (UIs).ResultsIn 2019, the regional age-standardised point prevalence and rates of death due to COPD were 2333.9 (2230.1, 2443.6) and 26.1 (22.2, 29.5) per 100,000, which represent a 30.6% (28.2%, 33.0%) increase and an 18.0% (2.8%, 30.9%) decrease, respectively, since 1990. The regional age-standardised DALY rate in 2019 was 649.1 (574.6, 717.7) per 100,000, which had decreased by 11.8% (0.9%, 21.1%) since 1990. Turkey had the highest age-standardised point prevalence in 2019 [3287.1 (3187.4, 3380.3)], while Afghanistan had the highest age-standardised death [40.4 (24.2, 52.6)] and DALY [964.5 (681.8, 1203.2)] rates. The regional age-standardised point prevalence, death and DALY rates in 2019 increased with advancing age and were higher in males in almost all age groups. There was a U-shaped association between SDI and the burden of COPD over the period 1990 to 2019. Moreover, in 2019 smoking (43.7%), ambient particulate matter pollution (22.8%) and occupational particulate matter (11.4%) had the largest proportion of attributable DALYs for both sexes.ConclusionsCOPD is one of the leading causes of death and disability in the MENA region, although the age-standardised burden has decreased over the last 30 years. Nevertheless, COPD accounted for a substantial number of deaths and DALYs, especially among the elderly. Programs targeting risk factors, like smoking, should be taken into consideration.

Global Burden, Risk Factors, and Trends of Non-Hodgkin Lymphoma in 2020 and Projections to 2040: A Population-Based Study

Background: Non-Hodgkin lymphoma (NHL) is one of the major health problems worldwide, but the global burden and trends of NHL have not been extensively assessed. We aimed to describe the disease burden, risk factors, trends in incidence and mortality of NHL globally. Methods: We collected up-to-date incidence and mortality data of NHL from the GLOBOCAN 2020, focusing on geographic disparities worldwide. The incidence trends of NHL in 42 countries over 15 years were examined, while mortality trends of 39 countries were calculated by data extracted from cancer registries. Prevalence data from the World Health Organization database was used to estimate the attributable risk factors in the development of NHL. Future burden estimates for incidence and mortality in 2040 were calculated by applying population projections in 2020. We reported incidence and mortality by sex and age alongside corresponding age-standardized rates and the average annual percentage change. Results: In 2020, there were an estimated 545,000 new cases and 260,000 deaths of NHL globally. The age-standardized incidence rates (ASIR) varied drastically across world areas, at least 10-fold in both sexes, with the highest rates observed in Australia and New Zealand. A great burden of NHL was recognized in high-income countries as the highest incidence rates were in Australia and New Zealand (ASIR, 12.5), Northern America (ASIR, 12.0), and Northern Europe (ASIR, 11.4) (Figure 1). Conversely, countries with a low human development index (HDI), such as those in North Africa, encountered a larger mortality burden in NHL than in highly-developed countries. In terms of different continents or regions, higher mortality rates were seen in Melanesia (ASR, 4.0), North Africa (ASR, 3.7), and Micronesia (ASR, 3.6). Considering the global trends of incidence, it was found that most developed countries had a trend of steady growth, while some low HDI countries have relatively large fluctuations in the incidence. In subgroups of different genders, close to 20 populations exhibited higher ASIRs for women than men. Observed trends also differed across age groups. The incidence of NHL increased in 34 populations (AAPCs, 4.9 to 0.1) among individuals aged 60 years or older. Taking into account differences in NHL burden across countries, we also reported estimated burden of NHL by HDI category. Considering all 185 countries, the ASIRs of NHL rose with HDI levels (= 0.41, P < 0.001), whereas the ASMRs of NHL were not associated with the levels of HDI (= 0, P = 0.754). HIV was generally believed to be a possible contributing factor to the development of some types of NHL, we presented the linear relation between the magnitude of the NHL incidence, HIV prevalence, and the level of HDI which seemly constricted to very high HDI countries. Regarding associated lifestyle risk factors, higher incidence of NHL was linked to a higher prevalence of obesity (β = 0.399, P < 0.001), a decreased prevalence of diabetes (β = -0.468, P <0.001) and hypertension (β = -0.386, P <0.001) based on the multivariate linear regression. As a result, countries with higher incidence were more likely to have a higher prevalence of obesity. In terms of demographic change, NHL incident cases are projected to rise to approximately 778,000 by 2040. Conclusions: In this pooled analysis, we provided evidence for the growing incidence trends in NHL, particularly among women and elderly populations. Despite the stable or downward mortality trends observed in most countries, the marked increase in the older population is still a public health issue that requires more attention. Future efforts should be directed to cultivating health awareness and formulating effective and locally tailored cancer prevention strategies, especially in most developing countries. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

COVID-19-associated 2020 lockdown: a study on atmospheric black carbon fall impact on human health.

The mean mass concentrations of black carbon (BC), biomass burning (BC)bb, and fossil fuel combustion (BC)ff have been estimated during March-May 2020 (during the COVID-19 outbreak) and March-May 2019 at a semiarid region of Agra over the Indo-Gangetic basin region. The daily mean mass concentration of BC in 2020 and 2019 was 3.9 and 6.9µgm-3, respectively. The high monthly mean mass concentration of BC was found to be 4.7, 3.4 and 3.3µgm-3 in Mar-2020, Apr-2020, and May-2020, respectively, whereas in Mar-2019, Apr-2019, and May-2019 was 7.7, 7.5 and 5.4µgm-3, respectively. The absorption coefficient (babs) and absorption angstrom exponent (AAE) of black carbon were calculated. The highest mean AAE was 1.6 in the year 2020 (Mar-May 2020) indicating the dominance of biomass burning. The mean mass concentration of fossil fuel (BC)ff and biomass burning (BC)bb is 3.4 and 0.51µgm-3, respectively, in 2020 whereas 6.4 and 0.73µgm-3, respectively, in 2019. The mean fraction contribution of BC with fossil fuel (BC)ff was 82.1 ± 13.5% and biomass burning (BC)bb was 17.9 ± 4.3% in 2020, while in 2019, fossil fuel (BC)ff was 86.7 ± 13.5% and biomass burning (BC)bb was 13.3 ± 6.7%. The population-weighted mean concentration of BC, fossil fuel (BC)ff, and biomass burning (BC)bb has been calculated. The health risk assessment of BC has been analyzed in the form of attributable relative risk factors and attributed relative risk during the COVID-19 outbreak using AirQ + v.2.0 model. The attributable relative risk factors of BC were 20.6% in 2020 and 29.4% in 2019. The mean attributed relative risk per 10,000,000 populations at 95% confidence interval (CI) due to BC was 184.06 (142.6-225.2) in 2020 and 609.06 (418.3-714.6) in 2019. The low attributed factor and attributed relative risk in 2020 may be attributed to improvements in air quality and a fall in the emission of BC. In 2020, due to the COVID-19 pandemic, the whole country faced the biggest lockdown, ban of the transportation of private vehicles, trains, aircraft, and construction activities, and shut down of the industry leading to a fall in the impact of BC on human health. Overall, this was like a blessing in disguise. This study will help in future planning of mitigation and emission control of air pollutants in large and BC in particular. It only needs a multipronged approach. This study may be like torch bearing to set path for mitigation of impacts of air pollution and improvement of air quality.

Incidence, risk and impact of unplanned ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study

Background: Unplanned readmissions to Intensive Care Units (ICUs) result in increased morbidity, mortality, and ICU resource utilisation (e.g. prolonged mechanical ventilation), and as such, is a widely utilised metric of quality of critical care. Most of the evidence on incidence, characteristics, associated risk factors and attributable outcomes of unplanned readmission to ICU are from studies performed in high-income countries This study explores the determinants of risk attributable to unplanned ICU readmission in four ICUs in Kathmandu, Nepal. Methods: The registry-embedded eCRF reported data on case mix, severity of illness, in-ICU interventions (including organ support), ICU outcome, and readmission characteristics. Data were captured in all adult patients admitted between September 2019 and February 2021. Population and ICU encounter characteristics were compared between those with and without readmission. Independent risk factors for readmission were assessed using univariate analysis. Results: In total 2948 patients were included in the study. Absolute unplanned ICU readmission rate was 5.60 % (n=165) for all four ICUs. Median time from ICU discharge to readmission was 3 days (IQR=8,1). Of those readmitted, 29.7% (n=49) were discharged at night following their index admission. ICU mortality was higher following readmission to ICU(p=0.016) and mortality was increased further in patients whose primary index discharge was at night(p= 0.019). Primary diagnosis, age, and use of organ support in the first 24hrs of index admission were all independently attributable risk factors for readmission. Conclusions: Unplanned ICU readmission rates were adversely associated with significantly poorer outcomes, increased ICU resource utilisation. Clinical and organisational characteristics influenced risk of readmission and outcome.

Burden of atrial fibrillation and its attributable risk factors from 1990 to 2019: An analysis of the Global Burden of Disease study 2019.

Understanding the pattern and trend of the atrial fibrillation (AF) burden are essential for developing effective preventive strategies. The purpose of this study was to estimate AF burdens and risk factors in 204 countries and territories between 1990 and 2019. Data were extracted from the Global Burden of Disease 2019, including incidence, death, disability-adjusted life-years (DALYs), and the attributable risk factors. In order to quantify changes in the age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and age-standardized DALY rate between 1990 and 2019, the estimated annual percentage change (EAPC) was used. Also, AF burden was assessed in relation to the Socio-demographic Index (SDI). Globally, there were 4,720,324 incident cases, 117,038 deaths and 8,393,635 DALYs in 2019. There were no significant changes in ASIR, ASDR, or age-standardized DALY rates from 1990 to 2019. Although the burden and trend of AF varied in different regions and countries, the ASIR, ASDR and age-standardized DALY rate were positively correlated with SDI. Furthermore, the burden of AF was higher in males and elderly. The age-standardized DALY rate worldwide was primarily attributable to high systolic blood pressure, followed by high body-mass index, alcohol use, smoking, diet high in sodium and lead exposure. AF remained a major public health challenge worldwide, with substantial variation at regional and national levels. There is an urgent need to increase public awareness about AF risk factors and to bring about cost-effective interventions for AF in order to reduce its future burden.

Trends in the global burden of oral cancer joint with attributable risk factors: Results from the global burden of disease study 2019

ObjectivesTo investigate the characteristics of risk factors for oral cancer and the disease burden they caused. Materials and methodsData from GBD2019, where the EAPC was calculated to understand mortality trends and the APC model was used for the analysis of age characteristics. ResultsOverall oral cancer mortality showed a promising downward trend [EAPC = −0.05 (−0.08 to −0.02)]. Oral cancer mortality attributable to tobacco chewing alone showed a significant upward trend [EAPC = 0.44 (0.36–0.52)]. Males are the majority of oral cancer deaths, while the disease burden of oral cancer in females could be largely attributable to chewing tobacco. The age of death attributable to each risk factor for oral cancer is concentrated between 45 and 74 years. Mortality for oral cancer caused by alcohol and smokeless tobacco was increasing in younger age groups (age < 45), and this trend was more pronounced in middle and middle-high SDI areas. The disease burden of oral cancer in high SDI regions was mainly attributed to alcohol consumption, while in middle and lower SDI regions it was mainly attributed to tobacco. ConclusionSmokeless tobacco proved a critical factor in the significant regional distribution of oral cancer. Oral cancer is on the increase in younger age groups. According to the characteristics of the distribution of risk factors, in traditionally high-incidence regions, such as India and Pakistan, oral cancer kept the highest ASDR, but was not experiencing the fastest growth rate. Additionally, it was oral cancer in middle SDI regions that needs more attention.

S3138 Primary Hepatic Angiosarcoma: A Rare Cause of Decompensated Pseudo-Cirrhosis and Acute Liver Failure

Introduction: Primary hepatic angiosarcoma (PHA) is a rare aggressive endothelial cell tumor which is seen in patients in their 60s and 70s with 3:1 male predominance. Industrial exposure to vinyl chloride, radium, chronic arsenic ingestion, anabolic steroid use, and iatrogenic exposure to thorotrast radiocontrast are some of the known etiologies for the development of PHA. Whereas, in most cases, attributable risk factors are rarely identified. Case Description/Methods: A 68-year-old male patient with NIDDM presented with chest pain and abdominal distension. Examination revealed marked ascites, abdominal tenderness, and bilateral leg edema. Labs were significant for thrombocytopenia and cholestatic pattern of liver enzymes with AST 94, ALT 47, ALP 413, T bilirubin 5.7. Paracentesis was negative for SBP or malignant cytology and was indicative of portal hypertensive ascites. Tumor marker workup was positive for CA 19-9 106.1, whereas negative for CEA 1.82, and AFP 2.7. CT A/P showed multifocal large heterogeneous enhancing lesions in the liver which were biopsied showing diffuse proliferation of abnormal vascular endothelial cells staining positive for CD34 and a diagnosis of PHA was made. With multifocal lesions, the patient was started on paclitaxel chemotherapy, which was eventually stopped with worsening liver function. The hospital course was complicated by hepatic encephalopathy and coagulopathy. The patient and the family later chose to transition to palliative therapy for comfort (Figure 1). Discussion: PHA is a rare and aggressive tumor with poor outcomes and an average survival rate of less than a year. Early diagnosis is challenging as it presents with nonspecific abdominal symptoms. With progression, PHA can present as decompensated pseudocirrhosis due to compression of liver parenchyma leading to portal hypertension. Contrast-enhanced US and CT can help in diagnosis by showing lesions characteristic of central non-enhancement and peripheral irregular enhancement in the arterial and portal phase, and complete wash-out in the late phase. A definitive diagnosis of PHA is established via histopathological analysis with immunohistochemistry staining but can make diagnosis more challenging due to the potential of associated bleeding. Surgical excision with negative surgical margins is the standard treatment for PHA which is localized and resectable. Multifocal and metastatic PHA is a radio-resistant tumor with a paucity of treatment options, however, TACE and/or salvage chemotherapy can be potentially attempted.Figure 1.: CT Abdomen pelvis showing multiple mass lesions occupying most of liver parenchyma.

Cross-sectional study of passive opiate smoking in relation to stroke and some of stroke attributable risk factors in women

Opiate use is related to neuropathological disorders, stroke and stroke attributable risk factors. However, secondary exposure to opiate in relation to the above-mentioned complications is studied only in animal models and remains to be evaluated in human populations. We tested whether passive exposure to opiate is associated with stroke and the known stroke predictive factors. We carried out a cross-sectional study of 1541 never smoker women who participated in the Rafsanjan Cohort Study (RCS) with their husbands (2015–2017 recruitment phase). RCS is one of the 19 geographic districts of the Prospective Epidemiological Research Studies in Iran (PERSIAN cohort study). Unadjusted and adjusted multiple logistic regression analyses were performed to evaluate the relationship between second-hand opiate exposure (husband opiate smoking after marriage) and the odds ratio of stroke and the following stroke risk factors and predictive parameters: overweight/obesity (BMI > 25), cholesterol (chol) > 200 mg/dl, fasting blood sugar (FBS) > 125 mg/dl, low density lipoprotein (LDL) > 100 mg/dl, triglyceride (TG) > = 150 mg/dl, hypertension, diabetes, and chronic headache. We observed a significant increased adjusted odds ratio (OR) of stroke (OR = 3.43, 95% CI:1.33–8.82) and its risk factors LDL > 100 mg/dl (OR = 1.37, 95% CI:1.01–1.87) and FBS > 125 mg/dl (OR = 1.58, 95% CI:1.08–2.30) in women associated with husbands’ opiate smoking. This relationship was observed after adjusting for the confounding parameters including age, education years, and first-degree family history of the relevant diseases. The increased odds ratio for stroke and high LDL displayed a dose-sensitive trend with years of husband’s opiate smoking after marriage (respective p-trends: 0.02 & 0.01). We did not observe a significant association between passive opiate smoking and high TG, high Chol or the diseases diabetes, hypertension and chronic headache. However, 89% increased odds ratio of chronic headache was observed to be associated with passive opiate smoking for more than 10 years (OR = 1.89, 95% CI:1.02–3.50). We found an increased risk of stroke and high LDL and FBS in women associated with passive opiate smoking. Furthermore, a dose-sensitive connection was found between the risks of stroke, high LDL and chronic headache with the years of passive opiate exposure. Our results point to the necessity of the future analyses, which further assess whether passive opiate exposure could be considered as an independent risk factor for stroke and metabolic diseases.

Analysis and forecast of burden of pancreatic cancer along with attributable risk factors in Asia countries between 1990 and 2019

Objective: To analyze the disease burden of pancreatic cancer in major Asian countries and forecast the burden of that in China, which helps to provide reference for the prevention and control of pancreatic cancer. Methods: Data on disease burden of pancreatic cancer among global and major Asian countries from on the Global Burden of Disease (GBD) 2019 were collected to describe burden distribution through the absolute numbers or standardized rates of incidence, death and disability adjusted life years (DALY) by year, sex and socio-demographic index. Estimated annual percentage changes (EAPC) was used to assess the trend of standardized rate. The proportion of deaths attributable to risk factors for pancreatic cancer in 2019 was used to compare by age, sex and region. ARIMA model was performed with R language to predict change of age-standardized incidence and death rates of pancreatic cancer from 2020 to 2029. Results: From 1990 to 2019, the standardized incidence rates of pancreatic cancer in China increased from 3.17/100 000 to 5.78/100 000, and the standardized death rate increased from 3.34/100 000 to 5.99/100 000. The increases exceeded other high-income Asia countries. In the past three decades, the standardized incidence, death and DALY rates of pancreatic cancer in global have increased year by year. Among the major countries in Asia, China has the highest growth rate of disease burden (EAPC of standardized incidence rates=2.32%, 95% CI: 2.10%-2.48% and EAPC of standardized death rate=2.25%, 95% CI: 2.03%-2.42%). In addition, incidence and death rates of pancreatic cancer in China are expected to continue on the rise between 2000 and 2029 by ARIMA model. Incidence rate is expected to increase 15.92% and death rate is expected to increase 15.86%. Conclusions: The standardized incidence and death rates of pancreatic cancer in China increase year by year with an increasing trend for the burden of disease. The disease burden of pancreatic cancer is expected to rise due to the increase and aging of the population. Preventive measures should be adopted to decrease the burden of the pancreatic cancer.

Global cirrhosis prevalence trends and attributable risk factors-an ecological study using data from 1990-2019.

Cirrhosis is a major public health issue worldwide with significant morbidity and mortality. We aimed to explore the time series associations between varying levels of risk factors and cirrhosis prevalence and predict the cirrhosis prevalence under alternative scenarios to consolidate evidence for further intervention plans. We collected data of cirrhosis and its risk factors from 1990 to 2019 across 178 countries and used a generalized linear mixed model to explore the time series associations between cirrhosis and risk factors. We simulated scenarios with varying levels of risk factors and investigated benefits gained from the control of risk factors compared with the status quo. The global cirrhosis prevalence varied geographically, with the highest observed in East and Southeast Asia, mainly due to high hepatitis prevalence. Our study revealed that each 1% increase in prevalence of hepatitis B and C, cirrhosis prevalence would correspondingly increase 0.028% and 0.288%. There would be approximately 392.15 million fewer cirrhosis patients if the goals of a 65% reduction in prevalence of hepatitis and a 10% reduction in alcohol consumption were achieved. Given that cirrhosis prevalence has different risk factors depending on geography, it is important to identify an appropriate set of interventions for cirrhosis that are adapted to the epidemiological situation in a specific country. Interventions targeting hepatitis may have a significant impact on global cirrhosis prevalence, therefore, the adoption of specific interventions for hepatitis in high-burden regions and high-risk groups is warranted to lower the global burden of cirrhosis.

Burden of esophageal cancer and its attributable risk factors in 204 countries and territories from 1990 to 2019.

BackgroundEsophageal cancer is a global health concern. Regularly updated data about the burden of esophageal cancer are essential for formulating specific public policies. We aimed to estimate the global, regional, and national burden and trends of esophageal cancer and its attributable risk factors from 1990 to 2019, by age, sex and socio-demographic index (SDI).MethodsData about the incidence, death, disability-adjusted life-years (DALYs), and age-standardized rates were collected from Global Burden of Disease study 2019. Estimated annual percentage changes were used to quantify the temporal trends of age-standardized rates. Moreover, the risk factors attributable to esophageal cancer deaths were also presented.ResultsThere were 534,563 incident cases and 498,067 deaths in 2019, contributing to 11,666,017 DALYs. The absolute numbers of incidence, death, and DALYs had increased from 1990 to 2019, contrasting with declined changes in their corresponding age-standardized rates. The burden of esophageal cancer varied across different regions and countries, and the age-standardized rates were negative with SDI. Almost half of the esophageal cancer was concentrated in China. Males accounted for most of the burden of esophageal cancer, and the onset age tended to be older. The death of esophageal cancer was primarily attributable to smoking, followed by alcohol use, high body mass index, diet low in fruits and diet low in vegetables.ConclusionThe burden of esophageal cancer was heterogeneous across regions and countries by sex, age, and SDI, providing information for governments that may help to formulate more targeted policies.

The Burden of Gout and Its Attributable Risk Factors in the Middle East and North Africa Region, 1990 to 2019.

This study reported the burden of gout and its attributable risk factors in the Middle East and North Africa (MENA) region between 1990 and 2019 by age, sex, and sociodemographic index (SDI). Data on the prevalence, incidence, and years lived with disability (YLD) due to gout were obtained from the Global Burden of Disease 2019 study for the 21 countries in the MENA region, from 1990 to 2019. In 2019, the regional age-standardized point prevalence and annual incidence rates of gout were 509.1 and 97.7 per 100,000 population, which represent a 12% and 11.1% increase since 1990, respectively. Moreover, in 2019 the regional age-standardized YLD rate was 15.8 per 100,000 population, an 11.7% increase since 1990. In 2019, Qatar and Afghanistan had the highest and lowest age-standardized YLD rates, respectively. Regionally, the age-standardized point prevalence of gout increased with age up to the oldest age group, and it was more prevalent among males in all age groups. In addition, there was an overall positive association between SDI and the burden of gout between 1990 and 2019. In 2019, high BMI (46.1%) was the largest contributor to the burden of gout in the MENA region. There were large intercountry variations in the burden of gout, but in general, it has increased in MENA over the last 3 decades. This increase is in line with the global trends of gout. However, the age-standardized YLD rate change was higher in MENA than at the global level.