Cohort Effects Research Articles

Time trends in malaria incidence from 1992 to 2021 in high-risk regions: An age‑period‑cohort analysis based on the Global Burden of Disease study 2021.

Malaria, caused by plasmodium parasites, remains one of the world's most significant infectious diseases due to its high incidence and mortality. This study aims to analyze malaria incidence globally, identify high-risk regions, and examine long-term trends in incidence to provide important evidence for malaria eradication. We used data from the Global Burden of Disease Study 2021, applying the age-period-cohort model to estimate the effects of age, period, and cohort on malaria incidence from 1992 to 2021. We calculated the net drift (overall annual percentage change), local drift (annual percentage change for each age group), longitudinal age curves (expected longitudinal age-specific rates), and period (cohort) relative risks. In 2021, the global age-standardized incidence rate of malaria declined to 3485.3 per 100,000 (95% uncertainty interval [UI]: 2804.5-4435.7), a 5.24% decrease since 1992. Sub-Saharan Africa has the highest age-standardized rate at 20,225.9 per 100,000 (95% UI: 16,033.5-25,862.6), accounting for 92% of all new cases globally. From 1992 to 2021, age-standardized malaria incidence rates generally declined across highest-risk regions, although Sub-Saharan Africa saw the smallest decline, with a net drift of -0.74% (95% confidence interval: -1.32 to 0.17). The 0-4 age group faces the highest risk, which decreases with age. Malaria continues to threaten public health in Sub-Saharan Africa, particularly among the 0-4 age group. Efforts should focus on enhancing access to malaria control measures and implementing targeted public health policies for priority groups.

Trends and age-period-cohort effect on incidence of brucellosis from 2006 to 2020 in China

Brucellosis remains a major public health challenge in China and globally. This study analyzed long-term trends in brucellosis incidence in China from 2006 to 2020, assessed the effects of age, period, and birth cohort, and projected future incidence up to 2030. Data on brucellosis were obtained from the Data-center of China Public Health Science, and temporal trends in incidence rates were analyzed using joinpoint regression, while an age-period-cohort model evaluated the effects of age, period, and cohort. A Bayesian age-period-cohort model was applied for future projections. From 2006 to 2020, 586,371 brucellosis cases were reported, with an upward trend in age-standardized incidence rates for both males and females, showing average annual percent changes of 3.37 % and 4.61 %, respectively. The age-period-cohort model revealed that age, period, and cohort all influenced incidence, with males facing higher rates. High-risk groups were identified among those aged 50–84, particularly in the 65–69 age range, where incidence was highest and showed the most significant annual increase. Period risk initially rose then declined, while later-born cohorts had higher risks. Projections indicate a continued rise in brucellosis incidence. Targeted prevention and control measures are recommended, especially for older adults and males.

Age and sex as key determinants of multiple sclerosis incidence in Spain: a comprehensive analysis using the global burden of disease database (1990-2019).

To explore trends in multiple sclerosis incidence rates in Spain between 1990 and 2019. We use data from the Global Burden of Disease Study 2019 to calculate age-standardised incidence rates of multiple sclerosis and identify significant changes over time using the Joinpoint regression model. We also use the Age-Period-Cohort model to understand the separate influences of age, historical period, and birth cohort on these trends. Between 1990 and 2019, Spain reported 31,152 cases of multiple sclerosis, with an average annual growth rate of 1.3%, slightly higher in men (1.40%) than in women (1.28%). Joinpoint analysis revealed non-parallel trends of incidence between sexes, with men experiencing increases and declines along five differentiated periods, while women showed increasing rates until 2015, followed by stabilization. The incidence of multiple sclerosis increased over time in both sexes achieving an average annual increase of 1.6% for men and 1.4% for women. Individuals born in the early to mid-20th century experienced a different trajectory compared to later generations. For both sexes, their MS risk steadily climbed from the mid-20th century, reaching a peak in the 1970s and 1980s for men and potentially later in the 1990s for women. This peak was then followed by a plateauing of risk in subsequent years. Overall, this study offers valuable insights into MS incidence trends in Spain, highlighting sex disparities, age effects, and generational patterns. Further research is needed to understand the complex interplay of age, period, and cohort effects, as well as regional and environmental factors contributing to risk of new cases of multiple sclerosis.

Stochastic Mortality Models with Birth Cohort Effects in Older People: A Systematic Review

As populations age, comprehending the factors that influence mortality rates becomes ever more critical. Age, period and birth cohort are now acknowledged as essential determinants in analyzing (and projecting) mortality trends. This systematic review investigates the impact of birth cohort effects on mortality rates among individuals aged 60 and older, with a particular emphasis on stochastic mortality models. A thorough literature search was performed to identify studies published over the past three decades that examine stochastic mortality models incorporating birth cohort effects in older adults. Five primary mortality models were assessed and data were extracted concerning study characteristics, participant demographics and mortality outcomes. The findings underscore the significance of cohort effects in mortality modeling, particularly for senior demographics. These effects encompass social and historical elements that shape generational health; thus, they enhance the precision of mortality projections and guide effective policy formulation. Stochastic models that integrate cohort effects were shown to more accurately capture distinct mortality trends. This indicates that exposure to advancements in healthcare and environmental influences, significantly affects mortality results among older cohorts. However, this review identifies several challenges in model estimation and proposes avenues for future inquiry. It advocates for adapting models to more accurately mirror the unique characteristics of aging populations, improving validation techniques for mortality models and applying the results to real-world contexts to bolster decision-making in public health and social policy.

Random cohort effects and smooth structures for mortality modelling and forecasting: A mixed-effects Gaussian process time series approach

The issue of population ageing has become a critical challenge for many developed nations in recent decades, and urgent action is needed to address this concern. Despite numerous efforts have been made to tackle the risks associated with increased longevity, the problem remains unresolved. The Cairns-Blake-Dowd (CBD) model, widely recognised as a leading approach for mortality modelling at older ages, incorporates cohort effects parameters into its parsimonious design. This article proposes a new mixed-effects Gaussian process time series approach that not only considers random cohort effects but also ensures smoothness across age ranges. By adopting Gaussian process, this novelty allows the proposed method naturally accounts for all uncertainties of the estimated parameters without requiring any pre-specified constraints and provides more accurate results. Through two empirical applications using male and female mortality data, we demonstrate the exceptional capabilities of our approach, which outperforms the CBD models with cohorts in short-, mid-, and long-term forecasting of mortality rates from various developed countries. Our proposed approach offers a significant improvement in forecast accuracy and shows a valuable contribution to the field of cohort mortality modelling.

Changing Patterns of Lung Cancer Mortality in Andalusia: Insights From Age-period-cohort Analysis and Historical Smoking Trends

IntroductionLung cancer remains one of the leading causes of cancer death worldwide. This study examines lung cancer mortality trends in Andalusia, Spain, from 2003 to 2022, focusing on gender differences and the influence of age, period and cohort effects. Material and methodsThis longitudinal ecological study analyzed lung cancer mortality data in Andalusia from 2003 to 2022, using age-period-cohort (A-P-C) and joinpoint regression models. Mortality rates were calculated by sex, age group, and standardized to the 2013 European Standard Population. ResultsBetween 2003 and 2022, Andalusia recorded 68,480 lung cancer deaths, with a significant gender disparity. Male mortality decreased (−1.9%), while female mortality increased (3.5%). Joinpoint analysis revealed a notable rise in female mortality rates after 2015. Age-specific analyses showed decreasing rates for men across all age groups, with a sharper decline for younger men. Women experienced increasing rates, particularly among those aged 35–64. The A-P-C model identified significant cohort effects, with decreasing rate ratios for men and increasing ones for women, reflecting historical smoking patterns. ConclusionsLung cancer mortality in Andalusia has exhibited a stark gender divide, reflecting the region's historical smoking patterns. While declining rates among men and younger women indicate the efficacy of tobacco control measures, the persistent rise in female mortality underscores the enduring effects of past smoking habits. These findings emphasize the imperative for ongoing public health initiatives and gender-specific interventions to mitigate the burden of lung cancer in Andalusia.

Lung function outcomes in adults born extremely preterm across three decades of advancing perinatal medicine.

Advances in perinatal medicine from 1980 to 2000 improved survival in extremely preterm (EP) neonates. Long-term effects of these developments remain unclear, and we aimed to investigate potential cohort effects on adult lung function. Three 18-year-old population-based cohorts born at ≤28 weeks gestation or with birthweight ≤1000 g during 1982-85, 1991-92 and 1999-2000 and term-controls underwent spirometry, body plethysmography, and tests of lung diffusing capacity, bronchodilator reversibility, and airway hyperresponsiveness. We used Welch's t-tests to compare term- with EP-born as a group and split by bronchopulmonary dysplasia (BPD), and regression models to test group/cohort interactions. In all EP-born cohorts, z-scores for FEV1, FEV1/FVC, FEF25%-75%, DLCO and KCO were reduced compared with term-born. For the 82-85, 91-92 and 99-00 cohorts, deficits for z-FEV1 and z-DLCO were 1.23 and 0.53; 0.68 and 0.92; and 0.51 and 0.57, respectively (p ≤0.01 for all). Cohort analyses showed stable lung function across the three cohorts overall, but improvements across cohorts for the BPD subgroups in z-FEV1, z-FEV1/FVC, and z-FEF25%-75%. Adults born EP across three formative decades of neonatal care had stable lung function overall, with notable improvements in BPD subgroups across cohorts.

Prevalence and determinants of dyslipidemia in 2338 Dutch childhood cancer survivors: a DCCS-LATER 2 study.

Childhood cancer survivors (CCS) face an increased risk of early cardiovascular disease (CVD). In our nationwide CCS cohort, we assessed the prevalence and determinants of dyslipidemia, a well-established risk factor for accelerated atherosclerosis and CVD. Prevalence of dyslipidemia was cross-sectionally assessed in 2338 adult CCS and compared to adults with no cancer history (Lifelines, n = 132 226). Dyslipidemia was defined by multiple classifications as well as lipid abnormalities to investigate the impact on prevalence and determinants. Logistic regression models, adjusted for age, sex, and BMI, were used to assess the cohort effect on presence of dyslipidemia. Determinants of dyslipidemia were identified through multivariable logistic regression. CCS (median age 34.7 year, median follow-up 27.1 year) had significantly increased odds of dyslipidemia compared to the reference cohort according to all classifications (NCEP-ATP-III, WHO, EGIR, CTCAEv.4.03). In survivors without lipid-lowering agents (n = 2007), lipid abnormalities were present in 20.6% (triglycerides > 1.7 mmol/L), 30.3% (HDL-c < 1.0/1.3 mmol/L (male/female)), 29.9% (total cholesterol > 5.2 mmol/L), 7.3% (LDL-c > 4.1 mmol/L), and 7.7% (apolipoprotein-B > 130 mg/dL). Compared to references without lipid-lowering agents (n = 126 631), survivors had increased odds of high triglycerides (aOR = 1.89, 95% CI = 1.68-2.13), low HDL-c (aOR = 2.73, 95% CI = 2.46-3.03), and high apolipoprotein-B (aOR = 1.84, 95% CI = 1.53-2.20). Sex, age, BMI, physical activity, abdominal/pelvic, cranial, and total body irradiation, alkylating agents, smoking, growth hormone deficiency, and diabetes mellitus were associated with (≥1 definition of) dyslipidemia in CCS. CCS is at increased risk of dyslipidemia, with various modifiable and non-modifiable determinants identified, underscoring the importance of survivor-specific risk assessment tools to control cardiovascular morbidity and mortality in this high-risk population.

Efficacy and Safety of a Diet Enriched with EPA and DHA, Turmeric Extract and Hydrolysed Collagen in Management of Naturally Occurring Osteoarthritis in Cats: A Prospective, Randomised, Blinded, Placebo- and Time-Controlled Study.

This study evaluated a therapeutic diet high in eicosapentaenoic (EPA) and docosahexaenoic acid (DHA) of marine source (EPA:DHA ratio 0.69:1), turmeric extract, and hydrolysed collagen in cats (N = 30) with naturally occurring osteoarthritis (OA) over a 13-week (W) period, followed by a 4-W washout, using four previously validated pain/functional outcomes. Compared to the placebo diet, the therapeutic diet significantly improved peak vertical force (p = 0.017; W16, 64% responders), correlating to enhanced weight bearing; stair assay compliance (p < 0.001; W16, 87% responders), reflecting reduced fatigue related to OA pain; night-time actimetry (cohort effect; p = 0.05, 67% responders), suggesting greater spontaneous mobility and comfort; and MI-CAT(V) score (cohort effect; p < 0.001, 80% responders), indicating reduced functional impairments. The earliest therapeutic response was observed at W06, marked by an inflection point between actimetric linear regressions of both cohorts, confirmed by significant MI-CAT(V) differences (p < 0.007; W08; W12; W16). The MI-CAT(V) clinical metrology instrument was validated for inter-rater reliability, minimal placebo effect (<15% responders), and OA severity clustering. Despite baseline differences in biomechanical assessments (p < 0.05), both moderate and severe OA clusters responded equally positively to the therapeutic diet. Based on all outcomes, the therapeutic diet showed promise for the long-term management of feline OA, with no observed side effects.

Effect of choline alfoscerate in older adult patients with dementia: an observational study from the claims data of national health insurance

BackgroundCholine alfoscerate, a cholinergic precursor with limited evidence of efficacy in dementia management, has been used for various cognitive impairments in Korea. Partly due to its insurance coverage, this agent appears to incur significant expense for the insurance system. Thus, we aimed to describe choline alfoscerate prescription patterns and analyze their long-term effects in an older adult cohort with dementia.MethodsThis observational study used the National Health Insurance Service Senior Cohort Dataset. Choline alfoscerate -naïve patients who were diagnosed with dementia between 2003 and 2014 with at least 12 months of follow-up were selected. Time-dependent Cox regression was employed to estimate the association between drug exposure and the risk of treatment failure events.ResultsThere were 11,463 eligible participants, of whom approximately 73% were female, and 19% had been exposed to choline alfoscerate. According to the main regression survival analysis, the association between longitudinal choline alfoscerate use and the risk of progression events related to treatment failure was unclear. However, a significant decrease of nearly 20% in the risk of all-cause mortality was associated with choline alfoscerate exposure, and a slight reduction in progression regarding treatment failure was observed with CA use only during the early stages of diagnosis. Age, sex, insurance premiums, several comorbidities and concurrent medications were significantly associated with the probability of the events according to the multivariate models.ConclusionsFurther analyses are needed to confirm the early-stage and long-term effectiveness of choline alfoscerate in specific populations, which will help in considering its reimbursement.Graphical abstract

Temporal dynamics of unmet long-term care needs in China: an age period cohort analysis

Abstract Rapid demographic changes and heavy reliance on informal care pose significant challenges to meeting long-term care (LTC) needs in China. Understanding changes in unmet LTC needs across different times and places can inform future LTC system planning and care resource allocation, identifying emerging care needs and services gaps in different regions. Drawing on data from 6,030 urban and 5,070 rural residents in the Chinese Longitudinal Health Longevity Survey 2005–2017/18, this study investigates variations in unmet LTC needs across different age groups, periods and birth cohorts among Chinese older adults and their place-based rural–urban differences. We applied the age-period-cohort interaction model to disentangle the three temporal processes, and found that, overall, rural older adults experienced higher risk of unmet LTC needs and had larger variation in age effects, yet the age, period and cohort effects on unmet needs among rural older people differed from their urban counterparts. Although ‘younger’ older adults (aged below 85) had fewer care needs than older adults, they had a higher risk of experiencing unmet needs. The risk of having unmet needs did not change significantly over the 12 years, though unmet LTC needs were more pronounced among more-recent cohorts than previous generations, especially in urban areas. The findings contribute to the social gerontology debate regarding changing patterns in unmet LTC needs, and provide crucial policy insights, underscoring the necessity of targeted interventions to address ‘younger’ older adults’ care needs and increased investmed in the formal LTC system to tackle the escalating care gap.

Trends in the practice environment of Chinese healthcare professionals from 2008 to 2023: an age period cohort analysis

BackgroundHealthcare practice environment plays a vital role in evaluation and the development of health sector in China. However, there are few comprehensive reviews and studies focusing on its state and changing trends. This study aimed to examine the dynamic trends in Chinese healthcare professionals’ perceptions of their practice environment from 2008 to 2023 using age period cohort (APC) analysis.MethodsFour national cross-sectional surveys of healthcare professionals were conducted in 2008, 2013, 2018, and 2023. APC analysis was performed to distinguish effects of age, period and cohort. Covariates like gender, department, job satisfaction, and doctor–patient relationships were also analyzed.ResultsBetween 2008 and 2023, healthcare professionals' perceptions of their practice environment first declined and then improved. Those aged 28–38 during 2013–2018 and born between 1978 and 1988 had the most negative perceptions. After 2018, perceptions improved, peaking in 2023. Those under 23 and over 43 exhibited larger age effects. Birth cohorts after 1993 also had more positive effects. Controlling for covariates attenuated APC effects. Females, those in obstetrics and emergency medicine, nurses, technicians, and administrators perceived better environments. Higher job satisfaction and doctor–patient relationship harmony are also associated with more positive perceptions. Income matching efforts and perceptions of promotion fairness had positive impacts, while increasing severity of physical fatigue and psychological anxiety negatively influenced perceptions of the practice environment.ConclusionsThe APC analysis provided nuanced insights into evolving practitioner perceptions amid healthcare reforms in China. Tailored policies focused on career stage and generation are needed to address disruptions and sustain improvements. Monitoring feedback on reforms and changes is essential for optimizing the practice environment over time.

Gallbladder cancer incidence and mortality rate trends in China: analysis of data from the population-based cancer registry

BackgroundGallbladder cancer is a major health concern in China, and awareness of the associated incidence and mortality rates is particularly important given the aging population.ObjectiveTo determine trends in gallbladder cancer incidence and mortality rates over 12 years and quantitatively analyze the influence of demographic factors on these rates in China.MethodsWe performed a retrospective study of 98,860 Chinese citizens using the Chinese Cancer Registry, a national database. Gallbladder cancer incidence and mortality data pertaining to patients treated between 2005 and 2017 were collected. Joinpoint regression models were used to estimate the annual percentage change (APC) and average APC (AAPC). We used age-period-cohort analyses and decomposition methods to investigate differing trends in incidence and mortality.ResultsThe age-standardized gallbladder cancer incidence and mortality rates in China trended downward between 2005 and 2017, with AAPCs of -2.023% and -1.603%, respectively. Coefficients of age effect for incidence rate increased with age up to 70 years and peaked at 70–79 years, while coefficients of age effect for the mortality rate showed a consistent increase with age. Both coefficients of period for incidence and mortality rates increased in more recent periods; in terms of the cohort effect, coefficients of cohort for rates generally decreased in later birth years but showed a partial rise between 1982 and 1996. The crude incidence rates of gallbladder cancer according to demographic and non-demographic factors were 626.09% and -526.09% respectively (366.23% and -266.23% among men, and 6068.93% and -5968.93% among women, respectively). The rates were 543.01% and -443.01%, respectively, in urban areas and were 68.22% and 31.78%, respectively, in rural areas. The mortality rates according to demographic and non-demographic factors were -495.93% and 595.93%, respectively (-1763.10% and -1863.10% for men and -270.56% and -370.56% for women, respectively). These rates were -930.33% and 1030.33%, respectively, in urban areas and were 101.48% and -1.48%, respectively, in rural areas.ConclusionsThe overall standardized gallbladder cancer incidence and mortality rates in China are trending downward, but not sufficiently so. Proper living and eating habits should be encouraged while exploring the establishment of long-term, standardized gallbladder cancer screening programs.

Investigating the impact of the COVID-19 pandemic on the nutritional status of infants and toddlers: insights from China

BackgroundA comprehensive understanding of the impact of the COVID-19 pandemic on childhood nutrition is crucial for devising effective mitigation strategies. However, existing knowledge regarding the pandemic’s effect on childhood nutritional status remains limited. Furthermore, research focusing on young children aged 0–3 years is scarce.MethodsLeveraging the outbreak that originated in Wuhan in Dec 2019, the epicenter of China’s first and largest outbreak, and national survey and statistical yearbook data, this study conducted a natural experimental analysis with the consideration of geographical exposure, temporal exposure and survey cohort effects to investigate the pandemic’s impacts on varying nutritional indicators of infants and toddlers aged 0–36 months. A comprehensive set of sensitivity analyses, robustness checks and falsification tests were conducted. The potential heterogeneities across socioeconomic and age groups were also examined.ResultsThe pandemic was robustly predictive of a higher weight-for-age z-score (WAZ) and length/height-for-age z-score (HAZ), and a lower likelihood of underweight. The effects of the pandemic on increasing WAZ and reducing underweight were more pronounced among children from economically disadvantaged backgrounds or aged 0–12 months. Additionally, the increasing HAZ was primarily among children from households with lower family income. Moreover, the pandemic was negatively linked to the body mass index (BMI)-for-age z-score (BAZ) of children residing in more developed cities, and positively linked to overweight/obesity among children aged 13–24 months.ConclusionsThis study adds to a more comprehensive understanding of the impact of the COVID-19 pandemic on childhood nutrition. Notably, the findings highlight that weight gain attributable to the pandemic was predominantly among vulnerable children from disadvantaged backgrounds and younger age groups, who were already at a higher risk of overweight/obesity before the pandemic. Consequently, our findings imply the necessity of greater caution to the widened gap in childhood malnutrition post-pandemic. Furthermore, the study emphasizes the importance of implementing adaptable strategies with the consideration of social justice to safeguard all children’s right to optimal growth from exogenous shocks and to achieve the children-related SDGs by 2030.

Is honesty valued today?: New evidence from Thailand

AbstractObjectivesAs a fundamental ethical principle, honesty plays a pivotal role in trust‐building, social cohesion, and effective governance. This study examined how honesty was valued in Thailand, an upper middle‐income Asian economy steeped in Buddhist values. It also explored the relationship between honesty and socioeconomic characteristics.MethodsUsing primary data from 1230 Bangkok residents aged 18–75, collected through stratified multi‐stage sampling, an instrument to measure honesty was developed and validated. Honesty was operationalized with three components: truthfulness, respect for ownership, and accountability. Ordinary Least Squares (OLS) and Tobit regression analyses were performed.ResultsHonesty was valued highly in Thai society. The average scores for accountability and respect for ownership were notably higher than for truthfulness. Socioeconomic characteristics, including gender, age, birth cohort, place of birth, religiosity, and self‐rated economic status, were statistically associated with overall honesty and influenced the three components of honesty differently. The effects of age and birth cohorts were distinct. Younger birth cohorts were associated with a higher level of honesty. However, within each cohort, honesty increased with age.ConclusionsThis study proposes recommendations aimed at promoting honesty in Thai society and provides ideas for future studies.

Burden of Liver Cancer Attributable to Hepatitis B and Alcohol Globally, in China, and for Five Sociodemographic Index Regions from 1990 to 2021: A Population-based Study.

Liver cancer is a digestive system malignancy that poses a significant public health challenge globally. This study aimed to analyze and compare the epidemiological trends of liver cancer attributed to hepatitis B (LCHB) and alcohol use (LCAL) over the past 32 years. Data on mortality and disability-adjusted life years for LCHB and LCAL in China, globally, and across five sociodemographic index regions were obtained from the Global Burden of Disease 2021 database and comprehensively analyzed. In 2021, the global and Chinese death counts and disability-adjusted life years attributed to LCHB and LCAL showed substantial increases compared to 1990. China had the highest number of deaths from LCHB and LCAL among 204 countries and regions. Gender and age disparities were notable, with males and those aged 40-75 years bearing a higher burden than females and other age groups. Global age-period-cohort analysis revealed an escalating risk of death from LCHB with age, alongside a lower risk in younger cohorts and more recent periods. The mortality risk for LCAL also increased with age but exhibited distinct cohort and period effects compared to LCHB. Decomposition analysis indicated that shifts in the global burden of LCHB and LCAL were influenced by population growth, with population aging playing a crucial role in China. A significant burden of LCHB and LCAL persists, highlighting the need for tailored prevention, screening, and control strategies to mitigate their incidence, as well as the identification of advanced therapeutics to reduce mortality.

Time trends in maternal hypertensive disorder incidence in Brazil, Russian Federation, India, China, and South Africa (BRICS): an age-period-cohort analysis for the GBD 2021

ObjectivesMaternal hypertensive disorder (MHD) is a leading cause of significant maternal and fetal mortality and morbidity. The BRICS nations are crucial in the global MHD landscape, given their large populations and varied healthcare infrastructures. This investigation evaluates the incidence trends of MHD in BRICS countries from 1992 to 2021.Study design and methodsData on the number, all-age rate, age-standardized rate (ASR), and the relative change of MHD incidence from this study were sourced from the Global Burden of Disease (GBD) 2021 public dataset to investigate temporal trends in MHD incidence over three decades globally and in BRICS countries. The age-period-cohort (APC) model was used to estimate net drift, local drift, age-specific curves, and period (cohort) relative risks.ResultsA 15.87% increase in global MHD cases, alongside a 13.40% decrease in age-standardized incidence rates from 1992 to 2021. MHD incidence rates are declining across various BRICS age groups, except in China and Russian Federation, where most groups exhibit increasing trends. Annual net drift in MHD incidence ranges from − 4.25% in India to 2.38% in China. A shift in the age distribution of MHD cases from younger to older within the childbearing age range is observed in all BRICS nations. Countries exhibit similar age-effect patterns, with decreasing risk with increasing age, and varying period and cohort effects, indicative of differential control measures and temporal incidence trends.ConclusionsGlobal and BRICS-specific reductions in MHD incidence vary in magnitude. Customized preventive strategies, leveraging existing resources, are advisable for BRICS nations to address pregnancy complications. Enhancing primary healthcare and maternal care quality, particularly for older mothers, is imperative.

Global burden of type 2 diabetes mellitus from 1990 to 2021, with projections of prevalence to 2044: a systematic analysis across SDI levels for the global burden of disease study 2021.

We aimed to assess temporal trends in type 2 diabetes mellitus (T2DM)-related deaths and disability-adjusted life years (DALYs) at global and cross-social demographic index (SDI) levels, using data from the Global Burden of Disease (GBD) in 2021. We used geospatial mapping to visualize the global distribution of T2DM-related mortality and DALYs in 2021. Joinpoint regression assessed annual and average percent changes in DALYs and deaths from 1990 to 2021 across SDI regions. Age-period-cohort modeling examined the effects of age, period, and cohort on trends. Decomposition analysis evaluated the impact of population growth, aging, and epidemiological changes on DALY trends. A stratified projection forecasted future T2DM burden by age and sex from 2020 to 2044. T2DM-related mortality and DALYs were highest in low-SDI regions. Globally, T2DM-related deaths and DALYs have increased, with the most rapid rise in low and low-middle SDI regions, driven by population growth and epidemiological shifts. High-SDI countries showed a slower increase in DALYs, influenced more by aging. Age-period-cohort analysis indicated higher DALY rates in later birth cohorts and recent periods, especially in high-SDI regions. Future projections show a significant increase in the 70-74 age group and a gradual rise in other age groups. The burden of T2DM is projected to continue increasing, especially in low-SDI and low-middle SDI regions, where population growth and epidemiological shifts are the main contributors. This underscores the need for targeted, region-specific healthcare policies, preventive strategies, and age-specific interventions to address the increasing T2DM burden globally.

Long-term trends in the burden of breast cancer in China over three decades: a joinpoint regression and age-period-cohort analysis based on Global Burden of Disease 2021.

We analyzed the trends in breast cancer (BC) morbidity, prevalence, and mortality among Chinese residents from 1990 to 2021. We then used joinpoint regression to further assess BC morbidity and mortality. We screened the morbidity, mortality, and prevalence of BC in Chinese residents (1990-2021) from the Global Burden of Disease. We used age-period-cohort (APC) modeling to assess the effects of age, period, and cohort on BC morbidity and mortality separately. We also used the joinpoint model to characterize trends in BC morbidity and mortality in China. From 1990 to 2021, age-standardized rates of morbidity have risen significantly, whereas mortality has declined. We discovered that the risk of morbidity and death rose with age by using the APC model. We also found that mortality and morbidity roughly continued to increase over time, and finally, we found that the later the birth cohort, the lower the mortality and the higher the morbidity. From 1990 to 2021, the burden of BC disease in China will continue to rise, and the situation of BC prevention and control will remain severe. Therefore, regular imaging and palpation examinations should be performed in the regular population over 40 years of age. When treating patients with BC, healthcare workers should develop individualized treatment plans to further reduce mortality.

The impact of the 2012 student fees increase on the mental health of British graduates: a cohort study

PurposeFinancial difficulties are associated with poor student mental health, although the 2012 tuition fees increase for British students had little impact on student mental health in the first two years at university. This study aims to examine the mental health of British graduates before and after this fees increase to determine the impact on mental health several years after graduation.Design/methodology/approachThis study conducted an online cohort study with 327 British students who started university before and after the 2012 fees increase. Participants completed measures of current economic hardship and symptoms of depression, anxiety, stress, general mental health and suicidality. Multiple regression was used to examine the impact of cohort (pre- and post-2012 fees increase), tuition fees amount and economic hardship on mental health.FindingsGreater economic hardship was positively correlated with all mental health variables. Starting university after the fees increased and/or paying greater fees was associated with increased depression, anxiety, stress and suicidality, with little impact on general mental health. When economic hardship was covaried, the strength of cohort effects reduced but remained significant.Originality/valueTo the best of the authors’ knowledge, this is the first study to show that the 2012 tuition fees increase for British students increased depression, anxiety, stress and suicidality in graduates many years after graduation, owing to additional financial strain.