Attributable Risk Factors Research Articles

Disability burden due to musculoskeletal conditions and low back pain in Australia: findings from GBD 2019

BackgroundTo report the national prevalence, years lived with disability (YLDs) and attributable risk factors for all musculoskeletal conditions and separately for low back pain (LBP), as well as compare the disability burden related to musculoskeletal with other health conditions in Australia in 2019.MethodsGlobal Burden of Disease (GBD) 2019 study meta-data on all musculoskeletal conditions and LBP specifically were accessed and aggregated. Counts and age-standardised rates, for both sexes and across all ages, for prevalence, YLDs and attributable risk factors are reported.ResultsIn 2019, musculoskeletal conditions were estimated to be the leading cause of YLDs in Australia (20.1%). There were 7,219,894.5 (95% UI: 6,847,113–7,616,567) prevalent cases of musculoskeletal conditions and 685,363 (95% UI: 487,722–921,471) YLDs due to musculoskeletal conditions. There were 2,676,192 (95% UI: 2,339,327–3,061,066) prevalent cases of LBP and 298,624 (95% UI: 209,364–402,395) YLDs due to LBP. LBP was attributed to 44% of YLDs due to musculoskeletal conditions. In 2019, 22.3% and 39.8% of YLDs due to musculoskeletal conditions and LBP, respectively, were attributed to modifiable GBD risk factors.ConclusionsThe ongoing high burden due to musculoskeletal conditions impacts Australians across the life course, and in particular females and older Australians. Strategies for integrative and organisational interventions in the Australian healthcare system should support high-value care and address key modifiable risk factors for disability such as smoking, occupational ergonomic factors and obesity.

Village doctors managing hypertension in rural China

High blood pressure is the leading attributable risk factor for preventable deaths globally. 1 GBD 2019 Risk Factors CollaboratorsGlobal burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020; 396: 1223-1249 Summary Full Text Full Text PDF PubMed Scopus (1527) Google Scholar About 1·4 billion people have hypertension worldwide, one-quarter of whom live in China where blood pressure control rates are poor, especially in rural areas (<10% among those with hypertension). 2 Li Y Yang L Wang L et al. Burden of hypertension in China: a nationally representative survey of 174 621 adults. Int J Cardiol. 2017; 227: 516-523 Summary Full Text Full Text PDF PubMed Scopus (143) Google Scholar , 3 Lu J Lu Y Wang X et al. Prevalence, awareness, treatment, and control of hypertension in China: data from 1·7 million adults in a population-based screening study (China PEACE Million Persons Project). Lancet. 2017; 390: 2549-2558 Summary Full Text Full Text PDF PubMed Scopus (521) Google Scholar , 4 Qin VM McPake B Raban MZ et al. Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample. BMC Health Serv Res. 2020; 20: 372 Crossref PubMed Scopus (10) Google Scholar A village doctor-led multifaceted intervention for blood pressure control in rural China: an open, cluster randomised trialCompared with enhanced usual care, village doctor-led intervention resulted in statistically significant improvements in blood pressure control among rural residents in China. This feasible, effective, and sustainable implementation strategy could be scaled up in rural China and other low-income and middle-income countries for hypertension control. Full-Text PDF

Burden of pancreatic cancer along with attributable risk factors in China from 1990 to 2019, and projections until 2030

ObjectivesUnderstanding epidemiology trends and patterns of pancreatic cancer in China from 1990 to 2019 and predicting the burden to 2030 will provide foundations for future policies development. MethodsWe collected incidence, mortality, and disability-adjusted life-years (DALYs) data of pancreatic cancer in China from 1990 to 2019 based on the Global Burden of Disease Study 2019. We calculated the estimated annual percentage change (EAPC) to depict the trends of pancreatic cancer burden and predicted the incidence and mortality in the next decade by using a Bayesian age-period-cohort analysis. ResultsThe number of incident cases sharply increased from 26.77 thousand in 1990 to 114.96 thousand in 2019, the age-standardized incidence rate (ASIR) nearly doubled from 3.17 per 100,000 in 1990 to 5.78 per 100,000 in 2019, with an EAPC of 2.32 (95% confidence interval [CI]: 2.12, 2.51). The mortality and DALYs presented a similar pattern with incidence. The dominant risk factor for pancreatic cancer was smoking, but the contribution of high body-mass index increased from 1990 to 2019. We projected that the incident cases and deaths of pancreatic cancer would increase to 218.79 thousand and 222.97 thousand, respectively, in 2030 with around 2 times growth. ConclusionsDuring the past three decades, the incidence, mortality and DALYs of pancreatic cancer gradually increased in China, and the absolute number and rate of pancreatic cancer burden would continue to rise over the next decade. Comprehensive policies and strategies need to be implemented to reduce the incidence and mortality.

The global, regional, national burden of nasopharyngeal cancer and its attributable risk factors (1990-2019) and predictions to 2035.

We aim to report the latest incidence, mortality, and disability-adjusted life-years (DALYs) between 1990 and 2019, by age, sex, sociodemographic index (SDI), and provide predictions to 2035. We use estimates from Global Burden of Disease, Injuries, and Risk Factors Study 2019 to analyze the incidence, mortality, and DALYs. All the estimates were shown as counts and age-standardized rates (ASR). In 2019, there were more than 176,501 (156,046 to 199,917) incidence cases, with ASRs of 2.1 (1.9 to 2.4). Nasopharyngeal cancer (NPC) accounted for 71,610 (65,442 to 77,625) deaths, with ASRs of 0.9 (0.8 to 0.9). NPC was also responsible for 2.34 million (2,139,753 to 2,536,657) DALYs, with ASRs of 28.0 (25.7 to 30.4). The count of all the new cases increased from 1990 to 2019. At the regional level, the highest age-standardized incidence rates were found in East Asia, the highest age-standardized death and DALY rates were shown in Southeast Asia. At the national level, the age-standardized incidence rates were highest in Singapore, and the age-standardized death and DALY rates were highest in Malaysia. The total numbers and rates of all the estimates were significantly higher among males than females across most of the age groups. The considerable burden of NPC was attributable to alcohol use, smoking, and occupational exposure to formaldehyde. A total of six GBD regions and 88 countries are projected to experience an increase in NPC ASRs between 2019 and 2035, respectively. Despite the current decline in age-standardized mortality and DALY rates globally, the age-standardized incidence rate has increased from 1990 to 2019, and continues to increase between 2020 and 2035, indicating that nasopharyngeal cancer remains a major health challenge worldwide. Prevention strategies should focus on modifiable risk factors, especially among males in East Asia.

Global magnitude of encephalitis burden and its evolving pattern over the past 30 years

We aimed to estimate the spatiotemporal patterns of the encephalitis burden along with its attributable risk factors at the national, regional, and global levels, which may be helpful in guiding targeted prevention and treatment programs. Based on available data sources, the incidence, mortality, and disability-adjusted life years (DALYs) of encephalitis in 204 countries and regions from 1990 to 2019 were reconstructed by the Global Burden of Disease Study 2019 using the Cause of Death Ensemble model, spatiotemporal Gaussian process regression, and DisMod-MR 2.1. We conducted a systematic analysis on the epidemiological characteristics of encephalitis in detail by gender, region, and age over the past three decades. Globally, 1,444,720 incident cases, 89,900 deaths, and 4.80 million DALYs related to encephalitis were estimated in 2019. The age-standardized incidence rate and age-standardized mortality rate (ASMR) decreased from 23.17 and 2.18 to 19.33 and 1.19 per 100,000 person-years over the past 30 years, respectively. However, beginning in 2011-2013, the burden of encephalitis has shown an inflection point, with a further decline of the ASRs ceasing. Lower socio-demographic index (SDI) regions in South Asia, Western and Eastern Sub-Saharan Africa had the highest burden of encephalitis in 2019. During the past three decades, most countries of South Asia achieved significant control of the burden. In contrast, developed countries with a higher SDI have shown a notable increase in ASMR and age-standardized DALYs rate. Children and older adults have always been high-risk groups for encephalitis. Although the global burden of encephalitis has decreased in the past 30 years, a further decline stopped from 2011 to 2013. The diverse burden in different regions calls for differentiated management, and the persistent high burden in some low-SDI regions and the increased burden in developed countries with higher SDIs deserve more attention.

The burden of aortic aneurysm in China from 1990 to 2019: findings from the Global Burden of Disease Study 2019

BackgroundAortic aneurysm (AA) is a global public health concern. However, little is known about the disease burden of AA in China.MethodsFollowing the general analytic strategy used in the Global Burden of Disease Study (GBD) 2019, we analyzed the mortality and years of life lost (YLLs) due to AA, stratified by sex, age, and province-level region in China from 1990 to 2019. The temporal trend of AA burden in China was analyzed and the main attributable risk factors for AA in China were also explored.ResultsIn China, the total AA deaths were 17,038 (95% UI: 14,392-19,980) in 2019, an increase of 136.1% compared with that in 1990, with an age-standardized death rate (ASDR) of 0.93 (95% UI: 0.79-1.08) per 100,000 person-years in 2019, a decrease of 6.8%. Meanwhile AA caused 378,578 (95% UI: 315,980-450,479) YLLs in 2019, an increase of 102.6% compared with that in 1990, with a crude YLL rate of 26.6 (95% UI: 22.2-31.7) per 100,000 person-years, an increase of 68.6%. The AA mortality and YLLs were higher in males than in females. AA caused most YLLs in the 65- to 75-year-old age group. The AA mortality and YLLs varied significantly among provinces in China, and the change in ASDR showed a negative correlation with the sociodemographic index of different provinces, namely, more decline of ASDR in developed provinces. High systolic blood pressure was shown to be the most significant attributable risk factor for AA burden in both males and females, and smoking was another major attributable risk factor, especially in males.ConclusionsThe disease burden of AA increased significantly from 1990 to 2019 in China, with higher mortality and YLLs in males, senior populations, and among residents of most western provinces in China. High systolic blood pressure and smoking were two major attributable risk factors for AA mortality in China.

Comparing and contrasting risk factors for heart failure in patients with and without history of myocardial infarction: data from HOMAGE and the UK Biobank.

AimsMyocardial infarction (MI) is among the commonest attributable risk factors for heart failure (HF). We compared clinical characteristics associated with the progression to HF in patients with or without a history of MI in the HOMAGE cohort and validated our results in UK Biobank.Methods and resultsDuring a follow‐up of 5.2 (3.5–5.9) years, 177 (2.4%) patients with prior MI and 370 (1.92%) patients without prior MI experienced HF onset in the HOMAGE cohort (n = 26 478, history of MI: n = 7241). Older age, male sex and higher heart rate were significant risk factors of HF onset in patients with and without prior MI. Lower renal function was more strongly associated with HF onset in patients with prior MI. Higher body mass index (BMI), systolic blood pressure and blood glucose were significantly associated with HF onset only in patients without prior MI (all p for interactions <0.05). In the UK Biobank (n = 500 001, history of MI: n = 4555), higher BMI, glycated haemoglobin, diabetes and hypertension had a stronger association with HF onset in participants without prior MI compared to participants with MI (all p for interactions <0.05).ConclusionThe importance of clinical risk factors associated with HF onset is dependent on whether the patient has had a prior MI. Diabetes and hypertension are associated with new‐onset HF only in the absence of MI history. Patients may benefit from targeted risk management based on MI history.

Sex differences in global disability-adjusted life years due to ischemic stroke: findings from global burden of diseases study 2019

To investigate the sex differences in disability-adjusted life years (DALYs) due to ischemic stroke (IS) by year, location and age. We extracted sex-specific data on DALYs number, age-standardized DALYs rate (ASDR) and all-age DALYs rate of IS by year, location and age from the Global Burden of Diseases study 2019. The estimated annual percentage changes (EAPC) were calculated to evaluate the temporal trend of ASDR. For both sexes, although the ASDR of IS slightly decreased from 1990 to 2019, there has been an 60.3% increase in DALYs number worldwide. Sex difference in DALYs number (men minus women) decreased from − 2.83 million in 1990 to 0.14 million in 2019, while the men to women’s ASDR ratio slightly increased from 1.10 in 1990 to 1.21 in 2019. The sex differences in IS DALYs showed remarkable regional variation. The largest sex differences in DALYs number and ASDR were in China and Vietnam. Middle-aged men had a higher IS DALYs than their age-matched counterparts. High systolic blood pressure accounted for the highest DALYs number in 2019, but the top three attributable risk factors that had the greatest sex differences were tobacco, dietary risk, and alcohol use. Sex differences in IS DALYs varied by year, location and age, mostly attributed to the disproportion of cardiovascular risk factors between sexes. Considering the population growth and aging, it is necessary to monitor the sex difference in IS DALYs in different populations and thus provide evidence for local administration to improve current preventive and management strategies of IS.

Burden of Peripheral Artery Disease and Its Attributable Risk Factors in 204 Countries and Territories From 1990 to 2019.

BackgroundData on burden of peripheral artery disease (PAD) and its attributable risk factors are valuable for policymaking. We aimed to estimate the burden and risk factors for PAD from 1990 to 2019.MethodsWe extracted the data on prevalence, incidence, death, years lived with disability (YLDs), and years of life lost (YLLs) from the Global Burden of Disease Study 2019 to measure PAD burden. Moreover, the attributable burden to PAD risk factors was also estimated.ResultsGlobally, in 2019, 113,443,017 people lived with PAD and 10,504,092 new cases occurred, resulting in 74,063 deaths, 500,893 YLDs, and 1,035,487 YLLs. The absolute numbers of PAD prevalent and incident cases significantly increased between 1990 and 2019, contrasting with the decline trends in age-standardized prevalence and incidence rates. However, no statistically significant changes were detected in the global age-standardized death or YLL rates. The burden of PAD and its temporal trends varied significantly by location, gender, age group, and social-demographic status. Among all potentially modifiable risk factors, age-standardized PAD deaths worldwide were primarily attributable to high fasting plasma glucose, followed by high systolic blood pressure, tobacco, kidney dysfunction, diet high in sodium, and lead exposure.ConclusionPAD remained a serious public health problem worldwide. More strategies aimed at implementing cost-effective interventions and addressing modifiable risk factors should be carried out, especially in regions with high or increasing burden.

Global epidemiology and prevention of colorectal cancer

Characterisation of the global variation in disease burden and temporal trends can provide important clues about disease aetiology and inform prevention strategies. Although previous studies have reported geographical and temporal trends in the incidence of and mortality due to colorectal cancer based on data from the GLOBOCAN database, 1 Sung H Ferlay J Siegel RL et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021; 71: 209-249 Crossref PubMed Scopus (13427) Google Scholar , 2 Arnold M Sierra MS Laversanne M Soerjomataram I Jemal A Bray F Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017; 66: 683-691 Crossref PubMed Scopus (2385) Google Scholar , 3 Lu B Li N Luo CY et al. Colorectal cancer incidence and mortality: the current status, temporal trends and their attributable risk factors in 60 countries in 2000–2019. Chin Med J. 2021; 134: 1941-1951 Crossref PubMed Scopus (7) Google Scholar , 4 Arnold M Abnet CC Neale RE et al. Global burden of 5 major types of gastrointestinal cancer. Gastroenterology. 2020; 159: 335-349 Summary Full Text Full Text PDF PubMed Scopus (305) Google Scholar data on disability-adjusted life years (DALYs) due to colorectal cancer and the contributing risk factors remain sparse. Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions. Full-Text PDF Open Access

Prevalence and Associated Risk Factors of Hypertension among Private and Public Secondary School Teachers in Benin City, Edo State, Nigeria

Hypertension is one of the major attributable risk factors for cardiovascular diseases. It affects both high and low income groups. There is need for constant research to be done to evaluate its prevalence. This study determined the prevalence and associated risk factors of hypertension among private and public secondary school teachers in Benin City, Edo State. A cross sectional study design was employed in this study. Twelve (12) schools in Benin City were selected using a multistage sampling technique and 252 teachers were equally drafted from both public and private secondary schools using the same technique. One hundred and twenty-six teachers each from both public and private secondary schools participated in the study. A constructive standardized questionnaires was used to collect data. Blood pressures of the participants were measured using a digital blood pressure apparatus. Anthropometric measurements such as the height, weight, BMI, waist circumference and hip circumference of the participants were also taken. The data was analyzed using Statistical Package and Service Solution (SPSS) version 22.0. Level of significance was set at p &lt; 0.05. Findings from the study revealed an overall prevalence of hypertension rate of (37.3%) for public secondary school teachers and (26.2%) for private secondary school teachers, though not statistically significant (p &lt; 0.05). Age was found to be a significant factor of hypertension (p = 0.001) among the private secondary school teachers. The ≤ 40 years, had the highest prevalence of hypertension (63.3%) than those aged ≥ 41 years (36.7%). While teachers in public secondary school aged ≥ 41 years recorded the highest prevalence of hypertension (80.0%) than those ages ≤ 40 years (20.0%). Monthly income showed a statistical significance with hypertension prevalence (p = 0.005) among teachers in private secondary schools, with higher number of hypertensive teachers (84.8%) earning ≤ ₦49,999. A higher number of hypertensive teachers (93.6%) in public secondary school earned ≥ ₦50,000, and monthly income did not have significant impact on hypertension prevalence among this study group. BMI also influenced hypertension prevalence among the surveyed public (p = 0.022) and private (p = 0.009) secondary school teachers with the prevalence being more among public (70.2%) compared to private secondary school teacher. Family history did not show significant impact on prevalence of hypertension. The result of this study showed a high prevalence of hypertension among the surveyed groups, therefore there is need for general public health education, periodic screening and monitoring of the blood pressure of teachers to be incorporated into the school health program.

Burden of oral cancer in Asia from 1990 to 2019: Estimates from the Global Burden of Disease 2019 study.

BackgroundOral cancer (OC) poses a threat to human health and imposes a heavy burden on countries. We assessed the burden imposed by OC on Asian nations from 1990 to 2019 based on gender and age.MethodsWe collected oral cancer data from the 2019 Global Burden of Disease study from 1990 to 2019 in 45 Asian countries and territories. Annual case data and age-standardised rates (ASRs) were used to investigate the incidence, mortality, and disability-adjusted life-years (DALYs) of OC based on age and gender from 1990 to 2019 in 45 Asian countries and territories. Estimated annual percentage changes (EAPCs) were used to assess incidence rate, mortality, and trends in DALYs.ResultsThe age-standardised incidence rate (ASIR) of OC increased from 1990 to 2019 with an EAPC of 0.32 (95% CI, 0.19–0.46), and the age-standardised death rate of OC remained stable at an EAPC of 0.08 (95%CI, from -0.06 to 0.21). The age-standardised DALYs of OC decreased at an EAPC of -0.16 (95%CI, from -0.30 to -0.02). The proportion of patients older than 70 years increased yearly in terms of incidence, mortality, and DALYs from 1990 to 2019. Of the DALYs, smoking was the main contributor in the Asian regions, and the largest contributor to DALYs in most Asian regions. Other contributors were alcohol use and chewing tobacco.ConclusionAlthough the burden of OC was declining in Asia, South Asia remained the region with the highest burden. OC caused the greatest burden in Pakistan, Taiwan China, and India. Therefore, measures should be taken to reduce the burden of oral cancer in high-risk regions and countries with attributable risk factors.

Breast Cancer Mortality Trends and Predictions to 2030 and Its Attributable Risk Factors in East and South Asian Countries.

BackgroundAmidst the rising breast cancer burden in Asia, we aim to predict the future mortality risk due to breast cancer and identify the risk-attributable deaths for breast cancer among East and South Asian countries.MethodsWe used country-level data to predict the trends in the next decade relating to female breast cancer mortality by employing data from 1990 to 2019 from the Global Burden of Disease 2019 study. We used the stochastic mortality modeling and prediction techniques to forecast the age-specific and risk-attributable breast cancer mortality trends at the regional and national levels of East and South Asia.ResultsThe number of deaths caused by the breast cancer is predicted to increase in East and South Asian countries in the next decade (2020–2030). Age-standardized death rate (ASDR) of breast cancer is predicted to increase by 7.0% from 9.20/100,000 (95% CI: 6.04–12.12) in 1990 to 9.88/100,000 (95% CI: 7.12–11.4) in 2030 in East Asia, and about 35% increase from 13.4/100,000 (95% CI: 9.21–16.02) in 1990 to 18.1/100,000 (95% CI: 13.23–21.10) in 2030 in South Asia. At the national level, the highest percent change in ASDR between 1990 and 2030 was reported in Pakistan (a 62% increase) and Nepal (a 47% increase). The highest percent change in breast cancer mortality between 2020 and 2030 for females of age group 80–84 years was observed in Pakistan [21.6, (95% CI, 20.6–94.7)], followed by Afghanistan [13.3 (4.0–80.8)], and Nepal [36.6 (11.1–125.7)] as compared to the other countries. In the females of aged 50–80 years, the predicted death rates were associated with high body mass index, high-fasting plasma glucose, and diet high in red meat, across the majority of countries under study. Furthermore, reductions in percent change in mortality rates occurred in several countries with increases in sociodemographic index (SDI), notably across high SDI countries.ConclusionBreast cancer mortality risk varies substantially across East and South Asian countries with higher mortality risk in low/middle SDI countries. Early detection using screening, awareness among females and health workers, and cost-effective and timely treatment of patients with breast cancer is vital in stemming the tide of breast cancer in the next decade.

Trends in Disease Burden of Chronic Lymphocytic Leukemia at the Global, Regional, and National Levels From 1990 to 2019, and Projections Until 2030: A Population-Based Epidemiologic Study.

BackgroundThe prognosis of chronic lymphocytic leukemia (CLL) has been improved dramatically, but there are limited studies focusing on CLL disease burden on a global scale. We aimed to evaluate the accurate assessment of the disease burden of CLL that may provide more detailed epidemiological information for rational policies.MethodsThe main source of the data was the Global Burden of Disease (GBD) study 2019. Incident cases, death cases, disability-adjusted life years (DALYs), and their corresponding age-standardized rates (ASRs) from 1990 to 2019 were used to describe the burden of CLL. Data about attributable risk factors were also extracted and analyzed. Bayesian age-period-cohort (BAPC) models were used to assess and project the incidence and mortality rates till 2030.ResultsGlobally, the incidence of CLL had been increasing. Deaths and DALYs decreased slightly. The burden of death and DALY is affected by socio-demographic index (SDI). The incidence rate, death rate, and DALY rate of CLL increased significantly with age. Male-to-female ratios of incidence rates varied in different SDI quintiles. Smoking, high body mass index, and occupational exposure to benzene or formaldehyde were the potential risk factors related to CLL. Global ASIRs might tend to increase until 2030, while ASDR would decrease until 2030.ConclusionThe disease burden of CLL decreased in higher SDI countries but increased in lower ones. Strategies for early detection of asymptomatic CLL, development of novel drugs, and measures against attributable factors should be implemented to combat CLL burden.

Global death burden and attributable risk factors of peripheral artery disease by age, sex, SDI regions, and countries from 1990 to 2030: Results from the Global Burden of Disease study 2019

Background and aimsPeripheral artery disease (PAD) is a prevalent cardiovascular disease. Understanding current and future disease burden of PAD and its attributable risk factors is critical for developing prevention measures targeting PAD and associated complications. MethodsWe analyzed the death burden of PAD and the trends of six risk factors from 1990 to 2019 using the updated 2019 Global Burden of Disease study database, and projected the next decade death burden using a Bayesian age-period-cohort (BAPC) model. ResultsThe global age-standardized mortality rate (ASMR) of PAD has a modest downward trend from 1990 to 2019. Regionally, ASMRs in higher-sociodemographic index (SDI) areas remained more remarkable than in lower-SDI areas by 2019, while the rate of increase in death burden in the lower-SDI regions increased rapidly over time. ASMR in males was greater than in females. In the population aged older than 40 years, the sex difference in PAD-associated mortality decreased with age. High fasting plasma glucose (FPG) became the primary risk factor for PAD-related death. The contributions of risk factors to PAD-related death varied by age group. Kidney dysfunction was the primary contributor to PAD-related death in people aged 40–59 years, particularly in women. ConclusionsThe global death burden of PAD has not substantially decreased over the three decades. There are large variations in the trend of PAD mortality and its attributable risk factors by SDI regions, sex, and age group. Targeted and effective strategies are needed for the management of PAD-related mortality in specific subgroups.

A Scoping Review of Non-Pharmacological, Non-Surgical Secondary Prevention Strategies in Ischaemic Stroke and TIA in National Stroke Guidelines and Clinical Audit Documents.

The Stroke Action Plan for Europe (2018–2030) calls for national-level secondary prevention plans that address lifestyle, in addition to prevention medications and surgical interventions. This scoping review examines national stroke care guideline and audit documents across WHO regions to identify non-pharmacological, non-surgical stroke secondary prevention recommendations and associated performance indicators. Using a snowballing methodology, 27 guideline documents met the inclusion criteria. Sixteen (59%) detailed, non-pharmacological, non-surgical stroke secondary prevention-addressing known, modifiable population attributable risk factors, of physical inactivity (N = 11), smoking (N = 11), unsafe alcohol consumption (N = 10), diet (N = 8), weight (N = 5), stress (N = 4) and depression (N = 2). Strategies recommended to address these risk factors were: assessment of stroke risk/risk factors (N = 4); provision of advice and information on reducing lifestyle related risk (N = 16); education and counselling for lifestyle behaviour change (N = 8) and onward referral for specialist management of risk (N = 4). Of the nine stroke audits/registries identified, only three (33%) included non-pharmacological, non-surgical quality indicators of documented provision of advice or information on the following: general lifestyle (N = 2); smoking cessation for current smokers (N = 2); reduction in alcohol consumption, where relevant (N = 1), exercise participation (N = 1) and diet (N = 1). Preventive quality indicators addressing the management of weight, stress or depression were absent. This review highlights current gaps in optimal stroke secondary prevention recommendations and their implementation.

Do deaths from competing risks influence COPD patterns in China and high socio-demographic index countries?: a cross-sectional analysis of summary statistics from the Global Burden of Disease Study 2017

ObjectiveTo explore possible reasons for the difference in chronic obstructive pulmonary disease (COPD) incidence/mortality rates between China and high socio-demographic index (SDI) countries.DesignA cross-sectional analysis of summary statistics from the...

Prevalence, Deaths and Disability-Adjusted-Life-Years (DALYs) Due to Type 2 Diabetes and Its Attributable Risk Factors in 204 Countries and Territories, 1990-2019: Results From the Global Burden of Disease Study 2019.

AimTo report the point prevalence, deaths and disability-adjusted-life-years (DALYs) due to type 2 diabetes and its attributable risk factors in 204 countries and territories during the period 1990-2019.MethodsWe used the data of the Global Burden of Disease (GBD) Study 2019 to report number and age-standardised rates per 100 000 population of type 2 diabetes. Estimates were reported with 95% uncertainty intervals (UIs).ResultsIn 2019, the global age-standardised point prevalence and death rates for type 2 diabetes were 5282.9 and 18.5 per 100 000, an increase of 49% and 10.8%, respectively, since 1990. Moreover, the global age-standardised DALY rate in 2019 was 801.5 per 100 000, an increase of 27.6% since 1990. In 2019, the global point prevalence of type 2 diabetes was slightly higher in males and increased with age up to the 75-79 age group, decreasing across the remaining age groups. American Samoa [19876.8] had the highest age-standardised point prevalence rates of type 2 diabetes in 2019. Generally, the burden of type 2 diabetes decreased with increasing SDI (Socio-demographic Index). Globally, high body mass index [51.9%], ambient particulate matter pollution [13.6%] and smoking [9.9%] had the three highest proportions of attributable DALYs.ConclusionLow and middle-income countries have the highest burden and greater investment in type 2 diabetes prevention is needed. In addition, accurate data on type 2 diabetes needs to be collected by the health systems of all countries to allow better monitoring and evaluation of population-level interventions.

The burden of stroke and its attributable risk factors in the Middle East and North Africa region, 1990\u20132019

Stroke is one of the leading causes of mortality and morbidity across the globe. Providing comprehensive data on the burden of stroke in the Middle East and North Africa (MENA) could be useful for health policy makers in the region. Therefore, this article reported the burden of stroke and its attributable risk factors between 1990 and 2019 by age, sex, type of stroke, and socio-demographic index. Data on the point prevalence, death, and disability-adjusted life-years (DALYs), due to stroke, were retrieved from the Global Burden of Disease study 2019 for the 21 countries located in the MENA region from 1990 to 2019. The counts and age-standardised rates (per 100,000) were presented, along with their corresponding 95% uncertainty intervals (UIs). In 2019, the regional age-standardised point prevalence and death rates of stroke were 1537.5 (95% UI: 1421.9–1659.9) and 87.7 (78.2–97.6) per 100,000, which represent a 0.5% (− 2.3 to 1.1) and 27.8% (− 35.4 to − 16) decrease since 1990, respectively. Moreover, the regional age-standardised DALY rate in 2019 was 1826.2 (1635.3–2026.2) per 100,000, a 32.0% (− 39.1 to − 23.3) decrease since 1990. In 2019, Afghanistan [3498.2 (2508.8–4500.4)] and Lebanon [752.9 (593.3–935.9)] had the highest and lowest age-standardised DALY rates, respectively. Regionally, the total number of stroke cases were highest in the 60–64 age group and was more prevalent in women in all age groups. In addition, there was a general negative association between SDI and the burden of stoke from 1990 to 2019. Also, in 2019, high systolic blood pressure [53.5%], high body mass index [39.4%] and ambient particulate air pollution [27.1%] made the three largest contributions to the burden of stroke in the MENA region. The stroke burden has decreased in the MENA region over the last three decades, although there are large inter-country differences. Preventive programs should be implemented which focus on metabolic risk factors, especially among older females in low SDI countries.

Projection of global burden and risk factors for aortic aneurysm – timely warning for greater emphasis on managing blood pressure

Rationale Aortic aneurysm (AA) is a serious condition that largely increases the risk of aortic dissection and sudden death. Exploring the global burden of disease and changes in risk factors for AA is essential for public health policy development. Objective To project the death burden from AA and its attributable risk factors in the following decade based on the epidemiological data over the past 30 years. Methods and Results We analysed the death burden of AA and trends of four risk factors from 1990–2019 using the updated 2019 Global Burden of Disease study database by Joinpoint regression analysis. Furthermore, we project the AA-related death burden for the next decade using the Bayesian age-period-cohort model. This study discovered that the global burden of death attributable to AA began to increase after decreasing for two decades. This upward trend will continue in the subsequent decade (average annual percent change: 0.318%, 95% CI: 0.288 to 0.348). Meanwhile, the disease burdens in all economic regions except high-middle socio-demographic index (SDI) regions will continuously increase in the next decade, with the fastest acceleration in the low-middle SDI region (average annual percent change: 1.183%, 95% CI: 1.166 to 1.200). Notably, high systolic blood pressure will surpass the contribution of smoking to become the most important risk factor for mortality due to AA. Conclusion This study discovered a rebounding trend in the aortic aneurysm-related death burden globally. High systolic blood pressure will be the top risk factor attributed to death from AA. Therefore, it should be considered as the first-degree risk factor in the guidance of AA management and criteria for population-based screening programs. Key messages The death burden of aortic aneurysms is beginning to rebound globally, and the trend will continue for the next decade. High systolic blood pressure will replace smoking as the most important risk factor associated with aortic aneurysm death.