Alcohol consumption is a well-established risk factor for multiple cancer types, yet its contribution to the global cancer burden remains insufficiently quantified. This study systematically assesses the global, regional, and national burden of alcohol-attributable cancers (AAC) from 1990 to 2021. AAC mortality and disability-adjusted life-years (DALYs), as well as corresponding age-standardized rates, were extracted from the Global Burden of Disease (GBD) 2021 database. Temporal trends were evaluated using Joinpoint regression, and future burden was projected with a Bayesian age-period-cohort (BAPC) model. Decomposition analysis quantified the contributions of population growth, aging, and epidemiological changes, while frontier analysis evaluated the efficiency of AAC control across countries. Between 1990 and 2021, global AAC deaths increased from 195,525 to 343,370, despite a decline in the age-standardized deaths rate (ASDR) from 4.87 to 3.97 per 100,000 (AAPC: -0.67%; 95% CI -0.79 to -0.55). Similar trends were observed for DALYs, with a 23% reduction in the age-standardized DALYs rate. Socioeconomic disparities persisted, with high-SDI regions experiencing a decline in ASDR despite rising absolute deaths, while low-SDI regions exhibited minimal change. Regionally, East Asia exhibited the highest AAC burden, whereas high-income North America had the lowest burden but showed a slight increase in ASDR. Liver, esophageal, and colorectal cancers accounted for the largest AAC burden. Decomposition analysis identified population aging and growth as primary contributors to increasing AAC burden, while frontier analysis highlighted disparities in AAC control, with Mongolia exhibiting the highest prevention gap. Projections suggest a continued decline in ASDR, while the absolute AAC burden is expected to rise. Although the ASDR of AAC has declined globally and is expected to further decrease over the next 25years, the absolute burden of AAC continues to grow. Hence, enhancing and refining global alcohol control policies is necessary to alleviate the global burden of AAC.

Tuberculosis preventive therapy (TPT) is critical in interrupting progression to disease, transmission and reducing incidence rates. Nonetheless, high costs have been barriers towards the expansion of shorter patient-friendly drug regimens. In 2019, a Unitaid-led deal reduced rifapentine costs by over 70%, facilitating Brazil's implementation of 3 months of rifapentine+isoniazid (3HP), a short-course TPT regimen, in its public health system. We evaluated the health and economic impact of Brazil's implementation of this patient-friendly regimen for short-course TPT. We analysed surveillance data on 171 174 individuals initiating TPT from January 2019 to December 2024. A mixed-effects spatiotemporal Bayesian model estimated quarterly TPT initiation trends under (1) observed 3HP rollout versus a no-3HP counterfactual (Q3 2021-Q4 2024) and (2) projected universal 3HP coverage (Q1 2025-Q4 2027) versus extended no-3HP adoption. Cost-effectiveness analysis quantified active tuberculosis (TB) cases and disability-adjusted life-years (DALYs) averted, alongside costs, incremental cost-effectiveness ratios, net monetary benefits (NMBs) and return on investment of TPT under each 3HP coverage scenario. From 2022 to 2024, 3HP scale-up produced 37 508.4 (95% credible intervals (CrIs) 31 405.2 to 43 631.6) additional TPT initiations, averted an estimated 15 002 DALYs (95% CrI 8985.6 to 21 031.15) and yielded NMBs of US$122.7 million (95% CrI US$63.8 to US$198.2 million). Under a proposed universal coverage (2025-2027), projected gains included 72 080.1 (95% CrI 62 323.7 to 81 836.4) additional individuals starting TPT, with subsequent 26 139 DALYs averted (95% CrI 14 117 to 38 762) and NMBs of US$214.5 million (95% CrI US$103.0 to US$362.8 million), indicating strong economic dominance over no-3HP adoption. Finally, TPT with 3HP's implementation was estimated to return US$1.31 (95% CrI US$0.97 to US$1.62) to the health system for every US$1 invested. In Brazil, large-scale implementation of a patient-friendly short-course regimen (3HP) was effective and likely cost-saving for a resource-strained public health system. Our evaluation provides robust, real-world evidence that implementing this regimen improved TPT coverage and completion nationwide while reducing costs and TB disease burden.

Oral disorders are among the most prevalent diseases globally, yet their burden in Southeast Asia remains poorly characterized. Understanding regional patterns is critical for health planning and prevention. We analysed data from the Global Burden of Disease 2021 study to assess the prevalence, incidence, and disability-adjusted life years of oral disorders across the 10 Association of Southeast Asian Nations (ASEAN) member states from 1990 to 2021. Indicators were age-standardized and analysed by sex, age, country, and socio-demographic index. Oral disorders accounted for nearly half of all-cause prevalence and around 1% of total disease burden in 2021. From 1990 to 2021, prevalent cases rose by over 50% and incident cases by more than 30%, while age-standardized rates showed slight declines. Population growth and ageing were the primary drivers of these increases. Caries of permanent teeth contributed the largest share, followed by periodontal disease and edentulism. Higher socio-demographic index correlated with lower overall burden but a higher proportion of periodontal disease. These findings indicate that oral health remains a major source of morbidity across ASEAN despite modest epidemiologic improvement. Demographic pressures continue to offset gains from prevention and care. Expanding prevention and primary oral healthcare - including sugar reduction, fluoridation, and sealant or varnish programs - could substantially reduce disability and unmet need. Routine regional surveillance using harmonized indicators is essential to guide equitable policy and investment within the post-2025 ASEAN health agenda.

Temporal trends and projections of asthma in North Africa and Middle East: insights from global burden of disease 2023.

A novel high-entropy TiVCrMoC3Tx assisted LDI MS for serum metabolic fingerprint in rheumatoid arthritis.

Global trend and disparity in the burden of ischemic stroke attributable to high body-mass index from 1990 to 2021 and projection to 2050: a systematic analysis based on the Global Burden of Disease Study 2021.

Dissecting incidence and mortality inequalities of six types of liver diseases in 39 alcohol-dominant countries and 93 virus-dominant countries under the aging context: Insights from the Global Burden of Disease Study 2021.

The evolving global burden of kidney cancer: A comparative analysis of trends in China and worldwide with projections to 2041.

Ischemic stroke (IS) persists as a major global health challenge. This study assesses IS burden, epidemiological trends, and associations with the Socio-demographic Index (SDI) across China and G20 nations (1990-2021), projecting trends to 2031 to inform resource prioritization. Utilizing Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR), disability-adjusted life years (DALYs), and mortality-to-incidence ratio (MIR) using Joinpoint regression (trends), autoregressive integrated moving average (projections), and Pearson correlation (SDI linkage), stratified by age and sex. From 1990 to 2021, China experienced rising crude IS incidence (+27.4%) contrasting with G20 declines. Although ASMR and DALYs decreased globally, China's ASMR initially increased (1999-2004) before declining, unlike sustained G20 reductions. China's ASIR rose 35.7% versus a 15.6% G20 reduction. Projections indicate stable ASMR with rising ASIR in China, diverging from declining ASMR and stable ASIR in the G20. SDI-linked disparities persisted, with China's ASIR/ASMR exceeding G20 averages relative to SDI. China's distinct trajectory-characterized by rising incidence and delayed mortality decline-underscores the necessity for tailored interventions. Addressing SDI-driven disparities is essential for equitable global prevention and care strategies.

Injury and illness burden in sports has traditionally been quantified using severity and time-loss metrics, which focus narrowly on days missed from sport. These measures fail to capture the full spectrum of health consequences, particularly those associated with non-time-loss injuries, chronic conditions, and lingering impairments following return to play. To address this gap, we propose the disability-adjusted sporting year (DASY), a novel metric adapted from the public health framework of disability-adjusted life years (DALYs). The DASY incorporates both the immediate and long-term health impact of sport-related injuries and illnesses by summing years of sport lost (YSL) and years lived with injury (YLI), weighted by condition-specific disability weights derived from broad population surveys. By anchoring assessments in athlete health rather than sport participation alone, the DASY enables a more comprehensive, equitable, and athlete-centered approach to surveillance, clinical decision making, and policy development. This manuscript outlines the theoretical foundation, calculation framework, and potential applications of the DASY metric, with the goal of advancing how health burden is evaluated in sport. By shifting the focus from return-to-play timelines to overall health loss, the DASY aligns athlete welfare more closely with broader public health standards and offers a robust tool for comparative risk assessment across sporting contexts.

Cost-Effectiveness of Food Fortification for Reducing Global Malnutrition: A Systematic Review of Economic Evaluations Across 63 Countries.

Cardiovascular-kidney-metabolic (CKM) syndrome remains highly prevalent worldwide and is associated with substantial mortality. As diet is a key modifiable determinant in the development and progression of CKM syndrome, this study aimed to investigate the associations between dietary nutrient intake and CKM syndrome to inform prevention and management strategies. We integrated data from the Global Burden of Disease (GBD) study and the National Health and Nutrition Examination Survey (NHANES) to provide both global and individual-level insights. Global age-standardized disability-adjusted life years (ASDR) and age-standardized mortality rates (ASMR) attributable to dietary risks were analyzed for six CKM-related diseases. Multinomial logistic regression and weighted Poisson regression were used to assess associations between 26 dietary nutrients and CKM syndrome stages and mortality, and a nutrient-based mortality risk prediction model and nomogram were further developed and validated. Marked regional variations in ASDR and ASMR were observed, particularly in Eastern Europe. Significant differences in nutrient intake patterns were found across CKM syndrome stages. Lower potassium and higher sodium intake were associated with advanced CKM stages. Cholesterol intake was associated with increased all-cause mortality risk, whereas higher intakes of dietary fiber, choline, vitamin K, and PFA 20:4 were associated with reduced mortality risk. The nutrient-based nomogram demonstrated good predictive performance for mortality risk in CKM syndrome. In conclusion, this study integrates global burden estimates with individual-level nutrient data to characterize dietary determinants of CKM syndrome progression and mortality, highlighting modifiable nutrient targets and providing a data-driven framework for dietary risk prediction.

Global welfare-based economic burden of gastric cancer and projections to 2050.

To explore the geographical and risk factor trends associated with type 2 diabetes mellitus using Global Burden of Disease (GBD) data (1990-2021). Age-standardized T2DM incidence, prevalence, mortality and disability-adjusted life years (DALYs) were extracted from the GBD for 204 countries stratified by sociodemographic index (SDI). Trends were analysed using joinpoint regression to compute average annual percentage changes (AAPCs) and mapping. Age-standardized burden estimates were calculated across 5-year age groups. Risk factor attribution was performed using Bayesian meta-regression and spatiotemporal analysis, illustrating the relative importance of each risk factor by bubble plots. From 1990 to 2021, the global age-standardized incidence rate of T2DM increased (AAPC = 1.83%), with the most pronounced rises in low-middle SDI regions. Mortality slightly increased globally (AAPC = 0.30%) but declined in high-SDI regions. The burden was highest in middle-aged and elderly populations, with a concerning increase in adolescent cases. High body mass index (BMI) was the leading risk factor, estimated to account for 44.5% (95% UI: 19.0%-65.2%) of deaths and 51.9% (95% UI: 24.7%-71.5%) of DALYs in 2021, followed by ambient particulate matter pollution and physical inactivity. The contribution of dietary risks and air pollution varied significantly across SDI regions. Our analysis identifies high BMI, ambient air pollution and physical inactivity as the primary risk drivers of the global T2DM burden. All indicators increased most markedly in low-middle SDI regions, with substantial disparities across age and sex groups. These findings underscore the need for risk-specific and region-tailored preventive strategies.

Spatiotemporal co-occurrence and shared exposure profiles of adolescent depressive disorders and asthma worldwide and in China (GBD 2021, 1990-2021): an ecological study with bidirectional two-sample Mendelian randomization.

Abdominal wall hernias are common, largely non-fatal surgical conditions that impose substantial disability when untreated. Contemporary guidelines emphasize standardized evaluation and repair to reduce recurrence and chronic pain and to optimize population health impact. This study aims to assess the burden and trends of hernia in Arabian Gulf Region from 1990 to 2023. A comparative, multi-country analysis was conducted for Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates using Global Burden of Disease (GBD) 2023 estimates. Outcomes included age-standardized incidence (ASIR), prevalence (ASPR), years lived with disability (YLDs), and disability-adjusted life years (DALYs), reported per 100,000 by year (1990-2023), sex, and age. Temporal trends were evaluated with Joinpoint regression to derive average annual percent change (AAPC). Forecasts to 2033 applied linear regression, Exponential Smoothing (ETS), ARIMA, and Neural Network Autoregression (NNAR) models; the best model for each indicator-country-sex combination was selected using root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE), with 95% prediction intervals. Analyses were performed in R (forecast package) and the NCI Joinpoint program. In 2023, the Gulf Cooperation Council (GCC) recorded approximately 1.1 million prevalent hernia cases. While absolute counts rose 12.4% since 1990, attributable to population aging, age-standardized metrics declined across countries and sexes. YLDs comprised 75%-80% of DALYs, confirming a predominantly non-fatal burden. Male prevalence exceeded female prevalence in all states; Qatar and Bahrain formed a higher-burden cluster, whereas the United Arab Emirates and Saudi Arabia exhibited lower rates. Age-specific analyses showed marked improvements at 60-79years but persistent or paradoxical increases in ≥85years. Forecasts indicated continued declines in ASIR/ASPR to 2033, with vigilance warranted for very-elderly cohorts. The GCC experienced sustained reductions in age-standardized hernia burden since 1990 despite rising absolute numbers from demographic change. Findings support guideline-concordant expansion of elective repair, registry-based quality measurement, and targeted capacity for the oldest adults to further compress disability.

Human papillomavirus (HPV) vaccination is a global strategy for the prevention of cervical cancer (CC). Although Australia and the United States (US) have achieved high coverage, the cumulative HPV rate of the first vaccination for Japanese females born in 2008 was approximately 55%, despite policy efforts. This study compared the situation in Japan with that in Australia and the US, where vaccination rates are higher. We conducted a unified benefit-risk assessment using disability-adjusted life year (DALY) rates to quantify the expected net value (ENV) of HPV vaccination programs per 100,000 eligible girls in Australia (2013-2020), the US (2013-2020), and Japan (2013-2024). Data on vaccination coverage, adverse events (AEs), and CC incidence were sourced from national health agencies and the Global Burden of Disease Study 2019. The vaccination coverage was 78.3% in Australia, 50.1% in the US, and 21.4% in Japan during the survey period. The ENV gained were 52.9 for Australia, 56.7 for the US, and 23.4 for Japan, reflecting differences in vaccination rates and CC burden. Across countries, the reporting rate of AEs was <0.05%, with most reports related to nervous system disorders and nonspecific symptoms. The benefit-to-risk ratio in Japan improved 7.9-fold after the resumption of active vaccination recommendations in 2021, largely owing to reduced reports of AEs. Japan's lower ENV gained compared to those of Australia and the US is primarily attributable to its low vaccination coverage and higher DALY rate for CC. HPV vaccination programs in Australia and the US have demonstrated strong benefit-risk profiles. Achieving vaccination rates comparable to those in Australia and the US can substantially improve outcomes. Japan's recent policy changes and educational initiatives have reduced AE concerns; however, further efforts are needed to raise the coverage of international benchmarks.

The Global Burden of Disease (GBD) study quantifies the burden of polycystic ovary syndrome (PCOS) but does not include PCOS-specific attributable risks. We combined GBD 2023 Summary Exposure Value (SEV) profiling with Mendelian randomization (MR) to identify and prioritize potential drivers of PCOS burden. We analyzed PCOS incidence, prevalence, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) from 1990 to 2023. Temporal trends were assessed using Estimated Annual Percentage Change (EAPC) and Joinpoint regression. Within the European Union (EU), we evaluated associations between disease burden and Socio-demographic Index (SDI) and cross-checked these findings against Human Development Index (HDI) and Universal Health Coverage (UHC). Expert-screened SEVs were correlated with country-level age-standardized incidence rate (ASIR) using Pearson correlation with Benjamini-Hochberg adjustment; significant exposures were then clustered. Two-sample MR was used to test the effect of nitrogen dioxide (NO2) on PCOS risk, accompanied by standard sensitivity analyses. In 2023, the EU ASIR exceeded the global level despite a smaller EAPC, with marked heterogeneity across countries. SDI was positively correlated with PCOS ASRs. SEV screening identified eight exposures associated with ASIR, of which childhood sexual abuse and NO2 pollution most clearly distinguished high- from low-ASIR countries. MR analysis supported a positive association between genetically predicted NO2 exposure and PCOS risk (IVW OR 6.60, 95% CI 1.85-23.58; P = 0.00365), with broadly consistent results across sensitivity analyses. Combining SEV profiling with MR offers a practical approach for prioritizing modifiable drivers of PCOS burden within the GBD framework. NO2 demonstrated a causal signal, suggesting that air pollution control may represent a viable target for PCOS prevention.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a critical global health threat, particularly for older adults. Understanding its precise burden and the associated health inequalities in the elderly population is crucial for informed policy-making. Using data from the Global Burden of Disease 2021 study, we analyzed deaths and disability-adjusted life years attributable to and associated with CRKP in individuals aged ≥ 65 years from 1990 to 2021. We calculated age-standardized rates, assessed temporal trends via average annual percentage change (AAPC), and quantified health inequalities using the Slope Index of Inequality (SII) and Relative Concentration Index. Frontier analysis identified countries with the greatest potential for burden reduction. The CRKP burden in the elderly increased substantially over the past three decades, as the age-standardized mortality rate associated with CRKP more than doubled from 7.44 (95% CI: 5.65 to 9.23) to 16.17 (95% CI: 13.1 to 19.25) per 100,000 (AAPC = 2.54, p < 0.001), with the most rapid increases occurring in South Asia, Eastern Europe, and Latin America. Conversely, high-income regions such as Western Europe witnessed substantial declines. Health inequalities widened markedly, as the absolute mortality gap (SII) associated with CRKP expanded from -8.69 (95% CI: -11.25,-6.14) to -41.96 (95% CI: -46.97,-36.95), an approximate fivefold increase. Frontier analysis further revealed significant potentially avoidable burden in low- and middle-income countries, independent of socioeconomic development. Formal assessment of socioeconomic trends and health inequalities demonstrates an increasing concentration of the CRKP burden in low- and middle-income regions, exacerbating global health inequities. Combating this requires integrated strategies that combine antimicrobial stewardship and infection control with broader improvements in health care infrastructure and social determinants.

Fine particulate matter (PM 2.5 ) poses significant health and economic burdens, particularly in developing regions, such as Southeast Asia. This study assesses the health impacts and economic costs of PM 2.5 formation in Thailand and evaluates mitigation policies to reduce these effects by 2037. Analyses at the city to national level examine major emission sources, including road transport, industry, power generation, household activities, open burning of agricultural waste, livestock, fertilizer application, and forest fires. Without intervention, health impacts are projected to increase by 22 % from 2022 levels, reaching 403,373 disability-adjusted life years (DALYs) annually and resulting in an economic burden of 301 billion Thai Baht (THB) per year. Scenario analysis identifies the best integrated mitigation strategy, which includes E -Buses, reducing energy consumption in industry and power generation, banning agricultural residue open burning, and decreasing forest fire hotspots. This strategy could reduce health impacts by up to 70 % and could yield an economic benefit of approximately 211 billion THB annually. A ban on agricultural burning is identified as one of the most effective interventions, potentially eliminating 38 % of the health burden in Thailand. Findings highlight the urgency of comprehensive, multi-sectoral policies to mitigate PM 2.5 pollution, with emphasis on agricultural waste management and enhanced emission controls. These insights provide a framework for other Southeast Asian countries facing similar air pollution challenges. • PM 2.5 reduction policy effectiveness in 77 cities and Thailand were assessed. • Agricultural waste burning contributes 38 % of total health impacts. • Most effective policy yield an economic benefit of 170 billion THB. • Agricultural waste burning ban saves 140 billion THB in health-related costs. • Banning agricultural waste open burning is the most effective measure.