Cohort Effects Research Articles

Analysis and prediction of the age-period-cohort model of disease burden of rheumatoid arthritis in China from 1990 to 2019

Using the Global Burden of Disease Study 2019 (GBD 2019) database, the Joinpoint regression model was used to analyze the trend of rheumatoid arthritis (RA) incidence and the standardized disability-adjusted life years (DALY) rate in China. The age, period, and cohort effects were discussed based on the age-period-cohort model. The grey prediction model GM (1, 1) was used to fit the trend of incidence and the standardized DALY rate of RA and predict the incidence and standardized DALY rate of RA in China from 2020 to 2034. From 1990 to 2019, the incidence, standardized incidence, and standardized DALY rate of RA showed a gradual upward trend, with an average annual increase of 1.41% (95%CI 1.32%-1.44%, P<0.001); 0.10% (95%CI 0.01%-0.14%, P<0.001); and 1.91% (95%CI 1.82%-2.12%, P<0.001). The results of the age-period-cohort model showed that the longitudinal age curve of the incidence of RA from 1990 to 2019 showed a trend of increasing first and then decreasing, reaching a peak in the 60-64 years age group. The longitudinal age curve of the standardized DALY rate showed a gradual upward trend, reaching the peak in the 85-89 years age group. The results of period effect showed that the risk of RA increased first and then decreased from 1990 to 2019, with the highest risk from 2010 to 2014, and the risk of incidence was RR=1.03 (95%CI 1.00-1.06). The risk of DALY showed a fluctuating change, with a trend of decreasing first, then increasing, and then decreasing again. The highest risk of DALY in 2005-2009 period was RR=1.03 (95%CI 1.02-1.05). The results of the cohort effect showed that the later the birth, the higher the risk of morbidity and DALY. From 2020 to 2034, the projected incidence and standardized DALY rate of RA in China showed an upward trend. RA remains a major public health challenge. From 1990 to 2019, the incidence, standardized incidence, and standardized DALY rate of RA in China showed an increasing trend, which were affected by age, period effect, and cohort effect to varying degrees. Although the burden of RA in China is lower than the global average, it is still essential to take active preventive measures to reduce the burden of RA and identify and treat RA early.

Phase 1/2 study of FOG-001, a first-in-class direct β-catenin:TCF inhibitor, in patients with colorectal cancer, hepatocellular carcinoma, and other locally advanced or metastatic solid tumors.

TPS322 Background: Wnt/B-catenin pathway activation, which is frequently present in most colorectal cancers and a variety of other solid tumors, is associated with poor prognosis and resistance to immunotherapy. FOG-001 is a Helicon peptide that competitively inhibits the interaction between β-catenin and the T-cell factor (TCF) family of transcription factors. Experiments in patient-derived-xenograft (PDX) models of colorectal cancer (CRC) and hepatocellular carcinoma (HCC) have demonstrated that FOG-001 can inhibit tumor growth and promote tumor regression when administered as monotherapy or in combination with immune checkpoint inhibitors or standard of care therapies, including bevacizumab and 5-FU. Methods: This first-in-human, Phase 1/2, multicenter, open-label, dose escalation (Part 1) and dose-expansion (Part 2) study evaluates the safety/tolerability, pharmacokinetics (PK), pharmacodynamics (PD), and anti-tumor effects of FOG-001 as monotherapy and in combination with other anti-cancer therapies. Eligible patients must have received at least one prior systemic anti-cancer therapy and either progressed on, not responded to, or be unfit for available therapies. In Part 1, FOG-001 is administered intravenously, either weekly or every other week, at escalating dose levels evaluated sequentially in a standard 3+3 design as monotherapy in patients with: (1a) microsatellite stable (MSS) CRC or any solid tumor with a documented Wnt/b-catenin pathway activating mutation (WPAM) and (1c) HCC with WPAM. Part 1b will evaluate PD effects in cohorts of approximately six patients with MSS CRC. Upon selection of the preliminary recommended Phase 2 dose from Part 1a for weekly dosing, combination dose escalation (1d) evaluates the safety/tolerability, PK and anti-tumor effects of FOG-001 in CRC patients combined with FOLFOX+bevacizumab, anti-PD-1/PD-L1 (also includes other solid tumors with known WPAM), or trifluridine/tipiracil+bevacizumab. Part 2 dose expansion evaluates FOG-001 monotherapy in MSS CRC, HCC, and other solid tumors with documented WPAM. Combination dose expansion evaluates the combinations initially evaluated in Part 1d. Primary endpoints are safety/tolerability and preliminary anti-tumor effects (objective response rate). Secondary endpoints are PK, PD, and other anti-tumor responses (e.g., best objective response, duration of response, and progression free survival). Enrollment in Parts 1 and 2 is ongoing in the USA. Clinical trial information: NCT05919264 .

Birth cohort effects in appendiceal adenocarcinoma incidence across the United States.

90 Background: Appendiceal adenocarcinoma incidence rates are increasing across all age groups, sexes and histological subtypes in the United States. Birth cohort patterns of appendiceal adenocarcinomas can provide us with new, etiologic clues into these rising rates but have not been examined for this rare malignant tumor type. We estimated appendiceal adenocarcinoma incidence rates across birth cohorts in the United States. Methods: Using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program data from eight population-based cancer registries, we identified a total of 4,858 persons aged 20+ years when diagnosed with a pathologically-confirmed primary appendiceal adenocarcinoma (non-mucinous, mucinous, goblet cell, signet ring cell carcinoma) between 1975 and 2019. Birth cohorts (1900-1904 to 1990-1994) were created using five-year age groups and time periods. The ratio of age-specific incidence rates was estimated in each birth cohort relative to the 1945-1949 birth cohort and reported as incidence rate ratios (IRRs) with 95% confidence intervals (CI). Results: Compared to persons born in 1945-1949, appendiceal adenocarcinoma incidence rates more than tripled among persons born in 1980-1984 (IRR 3.41, 95%CI 2.54-4.56) and quadrupled among persons born in 1985-1989 (IRR 4.62, 95%CI 3.12-6.82). For all tumor histological types, age-specific appendiceal adenocarcinoma incidence rates increased across successive birth cohorts after 1945-1949—although to varying degrees reported across histological types (e.g., 1980-1984: mucinous adenocarcinoma: IRR 2.71, 95% CI 1.73-4.26; non-mucinous adenocarcinoma: IRR 2.60, 95% CI 1.46-4.63; goblet cell adenocarcinoma: IRR 4.95, 95% CI 2.77-8.85). Conclusions: There are strong, yet distinct birth cohort effects for appendiceal adenocarcinomas across histological subtypes that remain unexplained. These patterns signal that recent exposure changes may be influencing this increasing disease risk for Generation X and Millennials now entering mid-adulthood. With the trend toward more non-operative management of appendicitis, another significant consideration for providers is to keep occult appendiceal tumors in the differential diagnosis of patients who present in this way. The current absence of appendiceal cancer prevention and screening modalities emphasizes the importance of efforts to support earlier detection in a rare malignancy where clinical trials have been historically very limited. Moreover, as similar trends have been reported in other gastrointestinal cancers, this is also suggestive of potential shared exposures contributing to this rising cancer burden across generations.

Global, regional and national burden of lung cancer attributable to occupational carcinogens, 1990-2019: A study of trends, inequalities and predictions based on GBD 2019.

Lung cancer, a leading cause of cancer-related mortality, is significantly influenced by occupational carcinogens. This study aimed to assess and predict global, regional and national trends of lung cancer burden attributable to occupational carcinogens. Data on the lung cancer burden attributable to nine occupational carcinogens were obtained from the Global Burden of Disease Study 2019. Regions were categorized by the Socio-Demographic Index (SDI). Descriptive statistics, Joinpoint regression, and Age-Period-Cohort (APC) models were employed to analyze trends in mortality and Disability-Adjusted Life Years (DALYs). Using the Slope Index of Inequality and Concentration Index, health inequalities were quantified. The ARIMA-LSTM model was developed to predict the burden from 2020 to 2030. From 1990-2019, lung cancer deaths and DALYs due to occupational carcinogens increased. Global age-standardized mortality (ASMR) and DALY (ASDR) rates declined, while middle and lower SDI regions increased. Joinpoint regression and APC analysis revealed that the local drift, period, and cohort effects exhibited increasingly unfavorable trends in lower SDI regions, while they were decreasing trends in higher SDI regions. Conversely, age effects increased similarly across all SDI regions. Health inequalities worsened over time. The ARIMA-LSTM model demonstrated global ASMR and ASDR would decrease, while low-middle and low SDI regions were expected to experience substantial increases from 2020 to 2030. Health inequality of lung cancer burden attributable to occupational carcinogens remained a critical concern, underscoring the urgent need for targeted occupational health policies for low and low-middle SDI regions.

P1200 Increasing rate of hospitalization for inflammatory bowel disease is an age-related effect: A Canadian population-based study

Abstract Background Inflammatory bowel diseases (IBDs), including Crohn’s Disease (CD) and Ulcerative Colitis (UC), are chronic diseases that pose significant challenges to patients and healthcare systems. To understand trends in the risk of all-cause hospitalization for individuals with CD and UC we explored age, period, and cohort effects in Canada. Methods We utilized repeated cross-sectional survey data from the 2005-2014 Canadian Community Health Survey (CCHS) to identify individuals with self-reported CD or UC. These individuals were linked to their hospitalization records from the Discharge Abstract Database (DAD) and were followed for three years. Cross-classified random-effects two-level models were used to estimate fixed effects for age and its quadratic term (level 1) and random effects for time periods and birth cohorts (level 2), adjusted for sex, on the risk of hospitalization within three years. Results An estimated 84,000 CD and 113,000 UC individuals were eligible for study inclusion. From this, an estimated 30,250 and 39,890 all-cause hospitalizations occurred within three years post-entry into the study for CD and UC individuals, respectively. Broadly, the risk of hospitalization within three-years increased with age and across birth-cohorts, with older cohorts experiencing greater risks of hospitalization. A small, but statistically significant temporal effect was identified for both CD and UC groups. Within birth cohorts, the risk of hospitalization increased across ages for CD, but in individuals with UC, the risk of hospitalization decreased across ages, except for the two oldest birth cohorts. Conclusion Overall, results support the hypothesis that age effects are primarily responsible for fluctuations in the risk of hospitalizations1. Risk of all-cause hospitalization has remained relatively stable from 2005 to 2014 in Canada and differences across time periods may be a consequence of the age-distribution at each time period. As the prevalence of CD and UC continues to rise and the Canadian population continues to be comprised of growing number of older-aged individuals, increasing the allocation of healthcare resources to prevent age-related risks of hospitalizations would be beneficial to reduce hospital burdens.

State or family? Navigating the changing public attitudes towards eldercare responsibilities in China

Public attitudes towards welfare have long been central to welfare state theory. This study examines the evolving public perceptions regarding the allocation of eldercare responsibilities between the state and family in China. Using data from the Chinese General Social Survey spanning 2010–2021, we analyze age, period, and birth cohort effects on public attitudes towards eldercare. Our findings indicate that as individuals age, there is a growing preference for government responsibility in eldercare, highlighting the role of self-interest in shaping welfare attitudes. Notably, attitudinal shifts across birth cohorts deviate from the modernization hypothesis, revealing a tendency among those born in the 1970s and 1980s to view eldercare as a family obligation. Over the last decade, public attitudes towards eldercare have oscillated from an initial embrace of modern perspectives to a return to traditional views, potentially due to demographic pressures on the pension system. This study not only fills empirical gaps in the field but also carries significant policy implications for China’s evolving eldercare landscape.

A simulation study showed that linear regression and Mann-Whitney test can be used to analyse the Days Alive and at Home by day 30 (DAH30) outcome in a randomized controlled trial.

The aims of the work were to consider the properties of the DAH30 from a statistical perspective, and to conduct a simulation study exploring the use of simple (unadjusted) linear regression and Mann-Whitney test as the method of analysis reflect realised analysis options. The days alive and at home by day 30 (DAH30) has been proposed a patient-centric outcome, and clinically relevant outcome suitable for clinical trials. It has unusual statistical properties, and suitability of standard statistical analysis methods is unclear. The properties of DAH30 were reviewed. Simulations based upon 1:1 allocation in a RCT based upon empirical data were conducted reflecting different additive and realised (reflecting the DAH30) treatment effects, sample sizes and distributions with varying and central locations and zero value level. A variety of metrics were used to assess performance (including bias, coverage, rejection rate). Linear regression provided a valid estimate of the unadjusted average treatment effect with an additive treatment. This was confirmed in terms of bias, estimation of variance, rejection rate in the absence of an effect, and coverage of the 95% confidence interval for the true realised effect. Mann-Whitney provided greater (power) than linear regression in some situations. Simple linear regression is a reasonable analytic option for the DAH30 for estimating the average treatment effect in the RCT cohort (i.e. an intention to treat, or "treatment policy" estimand) where zero-inflation is relatively low. Mann-Whitney test in some circumstances (small effects and smaller samples sizes) provides better ability (like for like) to detect a difference between the groups.

Age-period-cohort analysis of self-harm incidence rates by gender in Iran among individuals aged 10–39 years, 1990–2019

This study investigates trends and patterns in self-harm incidence rates among individuals aged 10–39 years in Iran from 1990 to 2019. Using Age-Period-Cohort (APC) analysis, it aims to identify significant age, period, and cohort effects, and to highlight gender-specific trends for effective prevention strategies. Utilizing data from the Global Burden of Disease (GBD) study, we performed an APC analysis to assess trends in self-harm incidence rates by gender. Data was stratified into six age groups and six five-year periods, and analyzed using the APC Web Tool from the National Cancer Institute. The average incidence rates of self-harm attempts and deaths among individuals aged 10–39 years were 93.87 and 7.55 per 100,000 individuals, respectively. Females had 1.75 times higher attempt rates than males, while males had 1.62 times higher death rates. The APC analysis revealed that males experienced stable self-harm rates over time, while females showed a significant decline. Peak incidence for both genders occurred at age 22.5 years. Self-harm incidence rates show younger females are more vulnerable to self-harm, but there has been a general decline in incidences over time, particularly for more recent cohorts but the stability of rates across ages and the lower rates in more recent cohorts highlighted in male.

Long-term trends in the incidence of male breast cancer and nomogram for predicting survival in male breast cancer patients: a population-based epidemiologic study

Male breast cancer (MBC) is rare, and due to the absence of male-specific screening programs, many patients are diagnosed at advanced stages and older ages. This study aims to analyze the long-term trend of MBC incidence and develop a competing risk model to improve survival rates. MBC data from the Surveillance, Epidemiology, and End Results (SEER) database (1975–2019) were analyzed using the Age-Period-Cohort (APC) model to examine trends in age, period, and birth cohort effects of MBC incidence. A competing risk model was used to build a nomogram predicting breast cancer-specific survival (BCSS) for MBC patients, with model accuracy assessed using the concordance index (C-index) and calibration curves. These results were compared with the nomogram established by Cox model. Comparisons were made with traditional AJCC staging system using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). APC analysis showed MBC incidence increases with age, while period and birth cohort effects were not significant. A total of 2,057 patients were included in the competing risk analysis, which identified factors like older age, estrogen receptor (ER) negative, progesterone receptor (PR) negative, and advanced AJCC stage as being associated with shorter survival. The competing risk model demonstrated excellent predictive ability, surpassing the AJCC staging system in both accuracy and clinical utility. In contrast, the Cox regression model overestimated the risk of endpoint events and failed to provide accurate effect estimates. The high incidence and poor prognosis of MBC in the elderly population emphasize the need for improved screening and early diagnosis in high-risk groups. Our competing risk model, compared to the Cox model, more accurately reflects real-world conditions. Additionally, we have developed a competing risk nomogram to assist in identifying high-risk individuals and guiding clinical decision-making.

Stroke Subtypes Mortality Attributable to Smoking in China: A Study Based on the Global Burden of Disease Database 2021

Background: The objective of this study was to analyze long-term trends in ischemic stroke (IS), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH) mortality from smoking in China from 1992 to 2021, to provide scientific advice on stroke prevention and treatment in China. Methods: The mortality data of smoking-related stroke and its subtypes in China during 1992–2021 were collected from the Global Burden of Disease 2021. Joinpoint regression model and Age-period-cohort (APC) model were used for trend analysis. Results: The age-standardized mortality rate of stroke and subtypes caused by smoking showed a decreasing trend in China from 1992 to 2021. The decline was greater for women than for men. According to APC model analysis, the age effect showed that ICH and IS showed an increasing trend, while SAH increased first and then decreased. The results of the cohort effect were similar to those of the period effect, with relative risk decreasing for all subtypes. The local drift showed that the stroke and subtypes in males showed a “U” shaped trend, a relatively stable trend for stroke and is in females, and a downward trend for SAH and ICH. Conclusions: Over the past 30 years, the burden of stroke and stroke subtype deaths attributable to smoking in China has decreased. However, future efforts should focus on preventing ICH. Strengthening tobacco control legislation, particularly targeting older men and young people, is crucial for further reducing smoking-related stroke risk.

Epidemiological trends and age-period-cohort effects on ischemic stroke burden across the BRICS-plus from 1992 to 2021

BackgroundIschemic stroke, accounting for 85% of stroke cases, leads to severe disabilities and increased mortality. Its global incidence rose by 87.55% from 1990 to 2019, posing significant health and economic burdens. The BRICS-plus nations—Brazil, Russia, India, China, South Africa, and five others—represent a large global population, presenting unique public health challenges. This study aims to evaluate the epidemiological trends and variations in the burden of ischemic stroke across BRICS-plus nations in a timely manner.MethodsData on the number, all-age rate, age-standardized rate, and relative change in ischemic stroke disability-adjusted life years (DALYs) from 1992 to 2021 within BRICS-plus were obtained from the Global Burden of Disease Study (GBD) 2021. Relationships between the DALYs rate and the Socio-demographic Index (SDI) were evaluated using Pearson correlation analyses. Additionally, age-period-cohort modeling was employed to estimate net drift, local drift, age, period, and cohort effects over the past three decades.ResultsFrom 1992 to 2021, total DALYs due to ischemic stroke increased by 47.14%, while the age-standardized DALYs rate decreased by 33.79%. All BRICS-plus countries exhibited a declining trend in the age-standardized DALYs rate over the past three decades. Egypt reported the highest age-standardized DALYs rate (2,462.60 per 100,000 population) in 2021, whereas the most substantial reduction of 59.37% was observed in Brazil. The annual net drift in the ischemic stroke DALYs rate ranged from -3.04% for Brazil to -0.48% for Egypt among the ten countries. A significant positive correlation was observed between the DALYs rate of ischemic stroke and SDI values. Countries exhibited similar age effect patterns, with an increasing risk of DALYs rate with advancing age. Period and cohort effects highlighted declines in observed nations, indicating improved ischemic stroke management strategies.ConclusionThe burden of ischemic stroke showed an overall declining trend across the BRICS-plus from 1992 to 2021, but persistent health inequalities between these countries were driven by socioeconomic disparities. Furthermore, it emphasizes the necessity for targeted interventions across age, period, and cohort dimensions to address the distinct challenges posed by ischemic stroke in these rapidly developing countries.

Trends and analysis of risk factor differences in the global burden of chronic kidney disease due to type 2 diabetes from 1990 to 2021: A population-based study.

Chronic kidney disease (CKD) is a significant contributor to the global burden of disease. Among its causes, chronic kidney disease due to type 2 diabetes (CKD-T2D) is the primary subtype. This study aims to provide an updated assessment of the global disease burden of CKD-T2D from 1990 to 2021. It will analyse the trends in the global burden of CKD-T2D and the differences in risk factors, as well as project changes over the next 15 years. The data for this study were derived from the Global Burden of Disease, Injuries, and Risk Factors Study (GBD) 2021. Estimates of prevalence, incidence, deaths and disability-adjusted life years (DALYs) for CKD-T2D, along with their 95% uncertainty intervals (UIs), were extracted. The trends in CKD-T2D burden from 1990 to 2021 were analysed from overall and local perspectives. An age-period-cohort model was used to estimate the age, period and cohort effects on the prevalence and incidence of CKD-T2D between 1990 and 2021. A decomposition analysis was conducted to assess the contribution of population size, age structure and epidemiological changes to the burden of CKD-T2D. Population-attributable fractions were determined for each risk factor, and a difference analysis was conducted. Additionally, projections were made regarding changes in the burden of CKD-T2D over the next 15 years. In 2021, the global burden of CKD-T2D remained significant, with a total of 107 559 955 cases. The age-standardized prevalence rate (ASPR) was 1259.63 per 100 000 people. The age-standardized incidence rate (ASIR) was 23.07 per 100 000 people, and the age-standardized death rate (ASDR) was 5.72 per 100 000 people. The age-standardized disability-adjusted life years (DALYs) was 131.08 per 100 000. The global burden of CKD-T2D showed variation across different socio-demographic index (SDI) regions. In 2021, the overall burden of CKD-T2D continued to rise, with the age effect increasing with age. Both prevalence and incidence risks showed an upward trend over time. Decomposition analysis indicated that population growth and ageing were the primary contributors to the global burden of DALYs related to CKD-T2D. Metabolic risk factors such as high fasting plasma glucose and high body mass index (BMI) are the most significant attributable risk factors. It is projected that by 2036, the trends in ASPR, ASIR, ASDR and age-standardized DALYs will stabilize. However, ASIR and age-standardized DALYs are expected to continue rising, and the number of cases of prevalence, incidence, mortality and DALYs will persist in their upward trend. CKD-T2D imposes a significant global disease burden, with health disparities and unequal disease outcomes continuing to worsen across countries and regions due to differences in socio-economic development levels. This burden is primarily driven by population growth, ageing and metabolic risks such as obesity, hyperglycaemia and hypertension. Although the rate of increase in disease burden may slow over the next 15 years, the number of cases is expected to rise substantially. Therefore, enhancing prevention, early screening and effective treatment interventions, particularly in high-risk areas, is crucial for reducing the disease burden and narrowing health disparities.

Genome-wide association study unravels mechanisms of brain glymphatic activity

Brain glymphatic activity, as indicated by diffusion-tensor imaging analysis along the perivascular space (ALPS) index, is involved in developmental neuropsychiatric and neurodegenerative diseases, but its genetic architecture is poorly understood. Here, we identified 17 unique genome-wide significant loci and 161 candidate genes linked to the ALPS-indexes in a discovery sample of 31,021 individuals from the UK Biobank. Seven loci were replicated in two independent datasets. Genetic signals located at the 2p23.3 locus yielded significantly concordant effects in both young and aging cohorts. Genetic correlation and polygenic overlap analyses indicate a common underlying genetic mechanism between the ALPS-index, ventricular volumes, and cerebrospinal fluid tau levels, with GMNC (3q28) and C16orf95 (16q24.2) as the shared genetic basis. Our findings enhance the understanding of the genetics of the ALPS-index and provide insight for further research into the neurobiological mechanisms of glymphatic clearance activity across the lifespan and its relation to neuropsychiatric phenotypes.

The incidence trends of papillary thyroid carcinoma in Belarus during the post-Chernobyl epoch.

The increase of papillary thyroid cancer (PTC) rate among children who were exposed to post-Chernobyl 131-I release was reported only four years after the accident, first in Belarus where the heaviest fallout happened. The evolution of the occurrence of thyroid carcinoma based on the age-period-cohort analysis and the effects of age, period, and birth cohort on time trends aimed to reveal if post-Chernobyl follicular cells irradiation still has been impacting on incidence rate of papillary thyroid carcinoma nowadays. The Belarusian Cancer Registry was used to identify patients with PTC diagnosed during the years 1980-2019. The incidence trends were analysed using Join-point regression software. The highest peak of age-specific incidence curve was shown during the years 1980-2001 in the age group of 15-19 years old that was associated also with short-latency cases of post-Chernobyl PTC. This is the same age group that demonstrated significant growth of the incidence rate during the years 2006-2019, largely because of the increasing number of non-exposed patients with PTC (p < 0.001). Influence of post-Chernobyl exposure also can be seen in the young adults age-groups of patients (for 20-24 years old during the years 1980-2003 and 2013-2019, p < 0.001; for 25-29 years old during the years 1980-1999 and 1999-2011, p < 0.001). After the Chernobyl accident, epidemiological waves that reflect the age shift of the group of children exposed to 131-I have consistently emerged. Currently, the incidence rate continues to increase only in the cohort of patients aged 20-44 years.

Temporal trends and attributable risk factors of chronic kidney disease burden in Fujian Province, 1990-2019

Objective: To understand the burden of chronic kidney disease (CKD) and its risk factors in Fujian Province during 1990-2019. Methods: Based on the Global Burden of Disease Study 2019, the incidence rate, mortality rate and disability-adjusted life years (DALYs) of CKD in Fujian from 1990 to 2019 were calculated. An age-period-cohort model was used to estimate the effects of age, period, and cohort on age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of CKD. Comparative risk assessment theory was used to calculate the potential attributable DALYs due to risk factors. Results: In 2019, the ASIR of CKD in Fujian exceeded the national average. The ASIR of CKD showed an increasing trend from 1990 to 2019, but the ASMR and ASDR of CKD exhibited decreasing trends during the same period. In 2019, the ASIR of CKD was higher in women than in men, while the ASMR and ASDR were higher in men than in women. Age-period-cohort analysis indicated that ASIR, ASMR, and ASDR of CKD increased with age. The period effect for ASIR decreased first before increase, while the period effect for ASMR and ASDR displayed fluctuating trends. The cohort effect showed an upward trajectory for ASIR, but a stable status before downward trajectories for ASMR and ASDR. Compared with 1990, except the increase in the ASDR of CKD attributed to high BMI and high temperatures, the ASDR of CKD attributed to other risk factors all showed decreases in 2019. However, the ASDR attributed to high sodium intake remained higher compared with the global average. Conclusion: The burden of CKD remains heavy in Fujian, and it is necessary to reduce the attributable risk factors, such as high sodium intake and high BMI, to address this problem.

Chinese burden of depressive disorders from 1990 to 2021 and prediction for 2030: analysis of data from the global burden of disease study 2021

BackgroundThis study aims to examine the temporal changes in the incidence, prevalence, and disability-adjusted life years (DALYs) of depressive disorders as well as its association with age, period, and birth cohort among Chinese from 1990 to 2021, and forecast the future trends of incidence rates and numbers from 2022 to 2030.MethodsData for analysis were obtained from the Global Burden of Disease (GBD) 2021. Joinpoint analysis was used to calculate the annual percentage change (APC) and average annual percent change (AAPC) to describe the rates of depressive disorders. Age, period, and cohort model was utilized to disentangle age, period, and birth cohort effects on rates of depressive disorders. Bayesian age-period-cohort (BAPC) analysis was capitalized to forecast the incidence rates and numbers for different sexes and age groups from 2022 to 2030.ResultsThe age-standardized incidence (ASIR, AAPC: -0.35 [95%CI: -0.65, -0.04]), prevalence (ASPR, AAPC: -0.20 [95%CI: -0.24, -0.16]), and DAYLs (AAPC: -0.28 [95%CI: -0.51, -0.05]) rates of both sexes showed a downward trend from 1990 to 2021, despite a volatility growth in recent years (APC in 2019–2021 of ASPR: 0.96 [95%CI: 0.70, 1.23]). Females exhibited a higher burden of depressive disorders compared to males but experienced a more rapid rate of reduction changes. The burden of depressive disorders was most owing to the age effect and period effect in recent years. The ASIR was predicted to decrease in the whole population (males in 2030: 1,546.3 per 100,000 people; females in 2030: 2,465.8 per 100,000 people), but in children, adolescents, and the elderly demonstrate unfavorable trends in the future.ConclusionThe burden of depressive disorders decreased in China from 1990 to 2021 in terms of age-standardized rates, but increased in recent years. Children, adolescents, and the elderly are the risk groups for future depressive disorders. Considering the large population, the increasing fewer children, and the aging trend, as well as the possible long-term effects of COVID-19 on human psychological burden, more sex-age-sensitive social healthcare programs should be considered in the future to minimize the burden of depressive disorders in China.

Global, regional, and national incidence and mortality for enteric infections from 1990 to 2019

BackgroundEnteric infections are among the most common infectious diseases. The aim of this article was to track the global trends in morbidity and mortality from enteric infections in 204 countries or territories from 1990 to 2019.MethodsData were obtained from the Global Burden of Disease 2019 study. Average annual percentage changes (AAPCs) in age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) were calculated to quantify trends in enteric infections. Age-period-cohort models were used to estimate the annual percentage changes from 0 to 4 to 80 − 84 years (local drifts), period and cohort effects between 1990 and 2019 in different socio-demographic index (SDI) regions.ResultsIn 2019, there were 6.59 billion incident cases of enteric infections, and caused 1,748,251 deaths worldwide. From 1990 to 2019, the trend in the global ASIR of enteric infections was relatively stable, but that of ASMR declined (AAPC=-3.30, 95% confidence interval [CI]: -3.54 to -3.07), and global mortality decreased in all age groups. Meanwhile, decreasing trends in ASMR were observed in 173 countries/territories (P < 0.05), particularly in North Macedonia and Kazakhstan. The low and low-middle SDI areas showed decreasing trends in ASIR and ASMR for enteric infections. However, an increasing trend was observed in high SDI regions, especially among older people aged over 60 years.ConclusionsThe global incidence of enteric infections did not change significantly between 1990 and 2019, but the mortality showed a significantly downward trend. The global burden of enteric infections remains serious in children under 5 years and in low and low-middle SDI regions.

Age, period and cohort processes in chronic obstructive pulmonary disease related emergency department visit rate in Taiwan, 2001-2015.

Emergency room (ER) physicians must deal with patients with clinically suspected symptoms, such as dyspnea, cough, and increased sputum production, on the frontlines of medical care if patients present with severe chronic obstructive pulmonary disease (COPD). This study aims to investigate the longitudinal tendencies of COPD-related ER visits. A total of 360,313 patients were included in this study. The COPD-related ER visit rates between 2001 and 2015 were categorized using the International Classification of Disease (ICD) codes (496). The effects of age, period, and cohort on COPD-related ER visit rates were determined using an age-period-cohort (APC) model. Age was associated with a high risk of COPD in the pediatric and older populations. A significant increase was observed in the period effect, from 2001 to 2015. The cohort effect tended to oscillate from 1918 to 1973, and was reversed in the latest cohort. Furthermore, the COPD-related ER visit rate increased between 2001 and 2015 in both men and women. Age, period, and cohort were observed to increase COPD visit rates. The APC model can be used to determine trends in COPD-related ER visits.

Disease burden of tuberculosis in China from 1990 to 2021 and its prediction to 2036.

Tuberculosis (TB) is one of the oldest infectious diseases and continues to be a major killer of human beings. This paper was designed to provide insights into the disease burden of TB. The data was retrieved and downloaded from the latest GBD database. Joinpoint regression was done for the temporal trend analysis. The age-period-cohort model was introduced to get further insights into the independent effects of age, period, and cohort. The BAPC model was utilized to predict ASIR and ASMR from 2022 to 2036. From 1990 to 2021, the ASPR dropped from 31,446 (95% UI: 27,902 to 35,142) to 30,557 (95% UI: 27,693 to 33,531) per 100,000 people, and ASDALYR dropped from 719 (95% UI: 611, 837) to 76 (95% UI: 63, 94) per 100,000 people with an AAPC of -7.009 (95% CI: -7.219, -6.799). ASIR and ASMR decreased from 109 (95% UI: 95, 125) to 36 (95% UI: 33, 40) and from 20 (95% UI: 17, 24) to 2 (95% UI: 2, 3) per 100,000 people, respectively. Men had a higher TB burden than women. The age-period-cohort analysis showed the age effect represented significant fluctuations with a valley at age 5 for incidence rate, and a similar but relatively simple pattern for death rate. Period effect and cohort effect showed both incidence and mortality rates significantly decreased with advancing time points and more recent birth cohorts. At the current decline rate, the ASIR and ASMR would be 26.12 (95%CI: 15.75, 36.48) per 100,000 people and 1.13 (95%CI: 0.45, 1.81) per 100,000 people in 2030, respectively. And the ASIR would be 21.96 (95%CI: 6.14, 37.79) per 100,000 people in 2035. TB burden in China has decreased significantly overall in the past years. However, it is still hard to achieve the national goal of "End TB" by 2035, which means more effective strategies for TB prevention and control are urgently needed. Effective strategies aimed at men should include increasing awareness of tuberculosis among both the general population and healthcare workers, promoting smoking cessation and alcohol reduction, enhancing disease screening and treatment access, and providing psychological support and care.

Analysis and comparison of the trends in burden of spinal cord injury in China and worldwide from 1990 to 2021: an analysis of the global burden of disease study 2021.

Spinal cord injury (SCI) is a globally prevalent neurological condition, often resulting in motor, sensory, and autonomic dysfunctions that lead to permanent disability. However, outdated epidemiological data hinder the development and implementation of effective public health policies. This study aimed to examine and compare trends in the burden of spinal cord injury-specifically incidence, prevalence, and years lived with disability (YLD)-in China and worldwide from 1990 to 2021, and to project these trends over the next 15 years. This study analyzed the characteristics of the SCI burden in China and globally, examining changes in incidence, prevalence, and years lived with disability (YLD) using open data from the Global Burden of Disease database covering 1990 to 2021. Additionally, Joinpoint and age-period-cohort (APC) analyses were conducted to provide insights into the epidemiological characteristics of the SCI burden. The autoregressive integrated moving average (ARIMA) model was then applied to project SCI trends for the next 15 years. In 2021, the prevalence and incidence of SCI in China reached 2,766,277 and 99,363 cases, respectively, marking increases of 63.27 and 43.27% since 1990. From 1990 to 2021, the age-standardized prevalence rate (ASPR) of SCI decreased significantly, with an estimated annual percentage change (EAPC) of -0.34 (95% CI: -0.60 to-0.07). At the gender level, SCI prevalence and incidence were higher in men than in women. Joinpoint analysis revealed a significant decrease in the APC of the age-standardized incidence rate (ASIR) from 1990 to 2011 (APC = -0.98, p < 0.05), followed by a notable increase from 2011 to 2021 (APC = 2.05, p < 0.05). For ASPR, a significant decrease occurred from 2001 to 2005 (APC = -4.80, p < 0.05), while subsequent periods showed an increasing trend, particularly between 2010 and 2018 (APC = 1.43, p < 0.05) and 2018-2021 (APC = 2.84, p < 0.05). In terms of age-standardized YLD rates (ASYR), China experienced an overall downward trend from 1990 to 2010 (APC = -0.56 for 1990-2001; -5.97 for 2001-2005; -1.01 for 2005-2010, p < 0.05), followed by a slight upward trend post-2010, with fluctuations from 2010 and 2018 (APC = 0.88) and 2018-2021 (APC = 2.49, p < 0.05). Age-period-cohort analysis showed that the risk of SCI incidence increased with age in China, though both period and cohort effects demonstrated a significant downward trend. Projections indicate that by 2036, the ASIR and ASPR for SCI in China will reach 6 and 146 cases per 100,000 people, respectively. The number and burden of SCI in China and globally have increased in the past. Among them, men and older people are more likely to develop SCI than women and younger people. Although the ASPR and ASIR for SCI are predicted to show a downward trend over the next 15 years, policy makers should continue to consider interventions to minimize the risk.