Global Burden Of Disease Project Research Articles

Economic evaluation of Maternal Depression Treatment in HIV (M-DEPTH) for perinatal depression among women living with HIV in Uganda: a cost-effectiveness analysis

ObjectiveWe conducted a cost-effectiveness analysis of an evidence-based collaborative care model for treatment of perinatal depression among women living with HIV in Uganda.DesignMaternal Depression Treatment in HIV (M-DEPTH) is a...

On the measurement of cause of death inequality.

Attempts at assessing heterogeneity in countries' mortality profiles often rely on measures of cause of death (CoD) diversity. Unfortunately, such indicators fail to take into consideration the degree of (dis)similarity among pairs of causes (e.g. 'transport injuries' and 'unintentional injuries' are implicitly assumed to be as dissimilar as 'transport injuries' and 'Alzheimer's disease')－an unrealistic and unduly restrictive assumption. We extend diversity indicators proposing a broader class of heterogeneity measures that are sensitive to the similarity between the causes of death one works with. The so-called 'CoD inequality' measures are defined as the average expected 'dissimilarity between any two causes of death'. A strength of the approach is that such measures are decomposable, so that users can assess the contribution of each cause to overall CoD heterogeneity levels-a useful property for the evaluation of public health policies. We have applied the method to 15 low-mortality countries between 1990 and 2019, using data from the Global Burden of Disease project. CoD inequality and CoD diversity generally increase over time across countries and sex, but with some exceptions. In several cases (notably, Finland), both indicators run in opposite directions. CoD inequality and diversity indicators capture complementary information about the heterogeneity of mortality profiles, so they should be analysed alongside other population health metrics, such as life expectancy and lifespan inequality.

Vertigo and its burden of disease—Results from a population‐based cohort study

AbstractObjectivesVertigo describes symptoms of abnormal movement of the environment or the patient's own body. As such, it affects patients' quality of life, prevents them from following their daily activities, and increases healthcare utilization. The Global Burden of Disease Project aims to quantify morbidity and mortality worldwide. In 2013, a separate disability weight for vertigo was introduced. The aim of this study is to estimate the symptom burden of disease caused by vertigo.MethodsThis study analyzes data from the Gutenberg Health Study (GHS). The GHS is a population‐based cohort study representative of the city of Mainz and its district. Participants were asked whether they suffered from vertigo and, if so, how bothered they felt by it, rating their distress on a six‐level scale from 1 = little stressful to 6 = extremely stressful.ResultsEight thousand five hundred and nineteen participants could be included in the study. The overall prevalence of vertigo was 21.6% (95%‐confidence interval [CI] [20.7%; 22.5%]). Vertigo prevalence peaked in the age group of 55–64 years. Vertigo annoyance averaged 2.42 (1.28). When an annoyance of 3–6 was considered bothersome, the prevalence of bothersome vertigo was 8.1 % (95%‐CI [7.5%; 8.7%]). Age‐standardized to the European Standard Population 2013, vertigo caused a burden of 2102 years lived with disability per 100,000 population.ConclusionIn this study, it was found that one in five people suffer at least occasionally from vertigo. This result suggests a significant burden of disease. This burden is reported at the symptom level. Future studies are needed to attribute the burden to specific causes.Level of Evidence2.

Prevalence and secular trends of four causes of blindness and visual impairment in Iran (1990-2019): a comparative study based on the Global Burden of Disease project's data.

The purpose of this study was to investigate the prevalence of cataracts, refractive disorders, age-related macular disease (AMD), and glaucoma, as well as their trends from 1990 to 2019 in Iran, in comparison with high-middle socio-demographic index (HMSDI) countries and the world, using the Global Burden of Disease (GBD) 2019 study. The GBD study provided data on the prevalence of blindness and visual impairment (VI), as well as four of their causes including cataracts, refractive disorders, age-related macular disease (AMD), and glaucoma. Using Joinpoint analysis, the annual percent change (APC) was calculated to assess the trend of change in prevalence in each category of diseases from 1990 to 2019, stratified by sex and age, for Iran, HMSDI countries, and the world. In 2019, refractive errors and cataracts were the most common causes of blindness and VI for both genders in Iran, HMSDI countries and the world. Iran had a higher age-standardized prevalence in all four categories of ophthalmologic disorders compared to HMSDI countries and the world for both genders in 2019. Additionally, the age-specific prevalence of all four disorders in 2019 was higher in Iran compared to HMSDI countries. However, in terms of trends of prevalence from 1990 to 2019, the rate of reduction for the four ophthalmologic disorders in Iran was higher than in HMSDI and the world for both males and females. Furthermore, Iran had a greater percentage of reduction in prevalence for all age groups in all four disorders compared to HMSDI countries. The prevalence of cataracts, refractive errors, AMD, and glaucoma in Iran was higher compared to HMSDI countries in 2019 for both sexes and all age groups, but the trends of prevalence for all four disorders from 1990 to 2019 in Iran had a higher slope of reduction compared to HMSDI countries for all ages and sexes.

Higher Risk of Many Physical Health Conditions in Sexual Minority Men: Comprehensive Systematic Review and Meta-Analysis in Gay- and Bisexual-Identified Compared with Heterosexual-Identified Men.

Purpose: The purpose of this study was to provide a systematic review and, where possible, meta-analysis on the prevalence of physical health conditions in sexual minority men (SMM, i.e., gay- and bisexual-identified men) compared with heterosexual-identified men. Methods: A systematic literature search in the databases MEDLINE, Embase, CENTRAL, CINAHL, and Web of Science was conducted on epidemiological studies on physical health conditions, classified in the Global Burden of Disease project and published between 2000 and 2021. Meta-analyses comparing odds ratios were calculated. Results: In total, 23,649 abstracts were screened, and 32 studies were included in the systematic review. Main findings were that (1) Largest differences in prevalence by sexual identity were found for chronic respiratory diseases, particularly asthma: overall, SMM were significantly almost 50% more likely to suffer from asthma than heterosexual men. (2) Evidence of higher prevalence was also found for chronic kidney diseases and headache disorders in gay men and for hepatitis B/C in both gay and bisexual men. (3) We found an overall trend that bisexual men were more affected by some of the physical health conditions compared with gay men (e.g., cardiovascular diseases, asthma). However, regarding cancer, headache disorders, and hepatitis, gay men were more affected. Conclusion: We found evidence of physical health disparities by sexual identity, suggesting more health issues in SMM. Since some of these findings rely on few comparisons or small samples of SMM only, this review is intended to be a vehement plea for routinely including sexual identity assessment in health research and clinical practice.

Estimating the cost impact of atrial fibrillation using a prospective cohort study and population-based controls

AimsAtrial fibrillation (AF) costs are expected to be substantial, but cost comparisons with the general population are scarce. Using data from the prospective Swiss-AF cohort study and population-based controls, we...

Estimation of migraine prevalence considering active and inactive states across different age groups

BackgroundMigraine is a very common headache disorder on the population level, characterized by symptomatic attacks (activity). For many people with migraine, the migraine symptoms intermittently or permanently cease during their lifetime (inactive migraine). The current diagnostic classification of migraine considers two states: active migraine (having migraine symptoms within the last year) and not having active migraine (including both individuals with inactive migraine and those who never had migraine). Defining a state of inactive migraine that has gone into remission may better capture the trajectories of migraine across the lifespan and contribute to a better understanding of its biological processes. We aimed to quantify the prevalence of never, active, and inactive migraine separately, using modern prevalence and incidence estimation methodology to better describe the complexity of migraine trajectories at the population level.MethodsUsing a multistate modeling approach, data from the Global Burden of Disease (GBD) study, and results from a population-based study, we estimated the transition rates by which individuals moved between migraine disease states and estimated prevalences of never, active and inactive migraine. We used data from the GBD project and a hypothetical cohort of 100,000 people with a starting age of 30 and 30 years of follow-up, both in Germany and globally, stratified by sex.ResultsIn Germany, the estimated rate of transition from active to inactive migraine (remission rate) increased after the age of 22.5 in women and 27.5 in men. The pattern for men in Germany was similar to the one observed on the global level. The prevalence of inactive migraine among women reaches 25.7% in Germany and 16.5% globally at age 60. For men, the inactive migraine prevalence estimates at the same age were 10.4% in Germany and 7.1% globally.ConclusionsConsidering an inactive migraine state explicitly reflects a different epidemiological picture of migraine across the lifecourse. We have demonstrated that many women of older ages may be in an inactive migraine state. Many pressing research questions can only be answered if population-based cohort studies collect information not only on active migraine but also on inactive migraine states.

The contribution of the exposome to the burden of cardiovascular disease.

Large epidemiological and health impact assessment studies at the global scale, such as the Global Burden of Disease project, indicate that chronic non-communicable diseases, such as atherosclerosis and diabetes mellitus, caused almost two-thirds of the annual global deaths in 2020. By 2030, 77% of all deaths are expected to be caused by non-communicable diseases. Although this increase is mainly due to the ageing of the general population in Western societies, other reasons include the increasing effects of soil, water, air and noise pollution on health, together with the effects of other environmental risk factors such as climate change, unhealthy city designs (including lack of green spaces), unhealthy lifestyle habits and psychosocial stress. The exposome concept was established in 2005 as a new strategy to study the effect of the environment on health. The exposome describes the harmful biochemical and metabolic changes that occur in our body owing to the totality of different environmental exposures throughout the life course, which ultimately lead to adverse health effects and premature deaths. In this Review, we describe the exposome concept with a focus on environmental physical and chemical exposures and their effects on the burden of cardiovascular disease. We discuss selected exposome studies and highlight the relevance of the exposome concept for future health research as well as preventive medicine. Wealso discuss the challenges and limitations of exposome studies.

Levels, trends, and determinants of cause-of-death diversity in a global perspective: 1990–2019

BackgroundWhile much is known about the leading causes of death (CoD) and how they have evolved over time, much less is known about the diversity of such causes of death. CoD diversity is an important marker of population health heterogeneity that has been largely overlooked in the study of contemporary health dynamics.MethodsWe provide regional and national estimates of CoD diversity from 1990 to 2019. We rely on data from the Global Burden of Disease project, using information on 21 CoD. Results are presented for 204 countries and territories, for women and men separately. CoD diversity is measured with the index of Fractionalization. Results are disaggregated by age and cause of death.ResultsCoD diversity has declined across world regions, except for Latin America and the Caribbean, the region of High-income countries and women in Central Europe, Eastern Europe, and Central Asia. Changes in mortality at adult and older ages have been mostly responsible for CoD diversity dynamics, except for the regions of South Asia and Sub-Saharan Africa, where infant and child mortality still play a non-negligible role. The relationship between CoD diversity, life expectancy, and lifespan inequality is strongly non-monotonic, with turning points differing by sex and indicator. Among longevity vanguard countries, further increases in life expectancy are associated with decreasing lifespan inequality but increasing CoD diversity.ConclusionAs mortality declines, there is no universal pathway toward low CoD diversity, thus casting doubts on the ability of Epidemiological Transition Theory to predict prospective CoD dynamics among high- and middle-mortality countries. Despite the postponement and increasing predictability of the ages at which individuals die, low-mortality populations are composed of an increasingly heterogenous mix of robust and frail individuals, thus increasing the diversity of health profiles among older persons – an issue that could potentially complicate further improvements in longevity.

STUDY OF METABOLIC SYNDROME AND DIABETES MELLITUS AMONG ISCHEMIC STROKE PATIENTS IN A TERTIARY HOSPITAL, NORTHERN KARNATAKA

Introduction: Stroke is significant global health problem and major cause of mortality and morbidity in developed countries and increasingly in low-middle income countries. In 2016, Global Burden of Disease project estimated the number of incident cases of stroke in India to be 1,175,778 and number of deaths due to stroke to be 9.4 million. Metabolic syndrome is known as an independent risk factor of stroke. Objectives: 1. To estimate prevalence of metabolic syndrome among Ischemic stroke patients. 2. To assess the association between metabolic syndrome and Ischemic stroke 3. To assess the association between Diabetes Mellitus type 2 and Ischemic stroke Methods: A observational study was performed on 100 out patients and inpatients admitted in Basaveshwara Teaching and General Hospital attached to Mahadevappa Rampure Medical College Kalaburagi for a period of 1 year. A detailed history was collected from qualifying patients using a pre-designed, structured proforma. Further, general examination and a detailed systemic examination, followed by relevant investigations (FBS: A blood sample is taken after an 8 hour overnight fast., Fasting Lipid Profile) were conducted and the results were noted. Results: Prevalence of metabolic syndrome in this study was 58 (58%) of them presented with metabolic syndrome. Higher prevalence was observed in 50-59 years age group 17 (74%) and among males 43 (64.3%). Smoking and diet were significantly associated with metabolic syndrome. Mean values of the components of metabolic syndrome were significantly higher in patients with metabolic syndrome. Prevalence of Diabetes was 73% and among them majority presented with metabolic syndrome. Diabetes Mellitus was significantly associated with stroke. Conclusion: In this study both metabolic syndrome and Diabetes Mellitus were significantly associated with stroke. Hence, they can be used as independent predictors for stroke.

Comprehensive systematic review and meta-analysis on physical health conditions in lesbian- and bisexual-identified women compared with heterosexual-identified women.

Sexual minority individuals experience discrimination, leading to mental health disparities. Physical health disparities have not been examined to the same extent in systematic reviews so far. To provide a systematic review and, where possible, meta-analyses on the prevalence of physical health conditions in sexual minority women (i.e. lesbian- and bisexual-identified women) compared to heterosexual-identified women. The study design is a systematic review with meta-analyses. A systematic literature search in MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science databases was conducted on epidemiologic studies on physical health conditions, classified in the Global Burden of Disease project, published between 2000 and 2021. Meta-analyses pooling odds ratios were calculated. In total, 23,649 abstracts were screened and 44 studies were included in the systematic review. Meta-analyses were run for arthritis, asthma, back pain, cancer, chronic kidney diseases, diabetes, headache disorders, heart attacks, hepatitis, hypertension, and stroke. Most significant differences in prevalence by sexual identity were found for chronic respiratory conditions, especially asthma. Overall, sexual minority women were significantly 1.5-2 times more likely to have asthma than heterosexual women. Furthermore, evidence of higher prevalence in sexual minority compared to heterosexual women was found for back pain, headaches/migraines, hepatitis B/C, periodontitis, urinary tract infections, and acne. In contrast, bisexual women had lower cancer rates. Overall, sexual minority women had lower odds of heart attacks, diabetes, and hypertension than heterosexual women (in terms of diabetes and hypertension possibly due to non-consideration of pregnancy-related conditions). We found evidence for physical health disparities by sexual identity. Since some of these findings rely on few comparisons only, this review emphasizes the need for routinely including sexual identity assessment in health research and clinical practice. Providing a more detailed picture of the prevalence of physical health conditions in sexual minority women may ultimately contribute to reducing health disparities.

Cardiometabolic deaths attributable to poor diet among Kuwaiti adults.

Nutrition transition towards a Western diet is happening in parallel with the rapidly increasing rates of cardiovascular disease and its risk factors in Kuwait. The cardiometabolic deaths attributable to poor diet have not been quantified among Kuwaiti adults. Using a Comparative Risk Assessment model that incorporated dietary intake data from Kuwait's first national nutrition survey, number of cardiometabolic deaths from the World Health Organization, and estimated associations of diet with cardiometabolic deaths from the Global Burden of Disease project, we estimated the number and proportion of cardiometabolic deaths attributable to suboptimal intake of 10 dietary factors among Kuwaiti adults ages 25+ years, and by population subgroups. An estimated 1,308 (95% uncertainty interval [UI] = 1,228-1,485) cardiometabolic deaths were attributed to suboptimal diet, accounting for 64.7% (95% UI = 60.7%-73.4%) of all cardiometabolic deaths in Kuwait in 2009. The low intake of nuts/seeds was associated with the highest estimated number and proportion of cardiometabolic deaths (n = 380, 18.8%), followed by high intake of sodium (n = 256, 12.6%), low intake of fruits (n = 250, 12.4%), low intake of vegetables (n = 236, 11.7%), low intake of whole grains (n = 201, 9.9%), and high intake of sugar-sweetened beverages (n = 201, 9.9%). The estimated proportions of cardiometabolic deaths attributable to suboptimal diet were higher in men (67.7%) than women (57.8%) and in younger adults aged 25-34 years (84.5%) than older adults aged ≥55 years (55.6%). Suboptimal dietary intake was associated with a very substantial proportion of cardiometabolic deaths among Kuwaiti adults in 2009, with young adults and men experiencing the largest proportion of diet-associated cardiometabolic deaths in Kuwait.

Socioeconomic and contextual determinants of the burden of disease attributable to metabolic risks in childhood.

We analyze the socioeconomic and political contextual determinants of the burden of disease attributable to three metabolic risks in children: kidney dysfunction, high fasting plasma glucose, and high body-mass index. We use data from 121 countries. We matched data of the Global Burden of Disease project, World Bank and United Nations databases. The burden of disease is measured with the Disability Adjusted Life Years lost. We explore associations with four groups of variables: (i) income level, which measures differences in socioeconomic conditions between countries; (ii) income inequality, which measures within country inequalities in the income distribution; (iii) health care expenditure, which measures the resources allocated to health and healthcare, and (iv) women empowerment, which we measure in terms of both educational and political participation. Our findings point toward the need to act at the root of the underlying factors underpinning the disease burden, namely: reducing between and, particularly, within-country income inequalities, increasing the role of expenditure on health, and ensuring women empowerment and girls education. To our knowledge, this is the first study that have identified the associations of these variables with the burden of disease that is specifically attributable to metabolic risks in childhood.

The incidence and prevalence of motor neurone disease in South Australia

Background Motor neurone disease (MND) is a neurodegenerative disease that leads to significant morbidity and mortality. The Global Burden of Disease (GBD) project estimated the MND all-age global prevalence is 4.5 (95% confidence interval (CI)=4.1–5.0) per 100,000 persons and the all-age incidence of 0.78 (95% CI = 0.71–0.86) per 100,000 person-years. Whether the prevalence and incidence of MND within South Australia using registry data is in keeping with these global estimates has not been studied. Objective To describe the prevalence and annual incidence rates (IRs) of MND in South Australia between 2017 and 2019. Methods A retrospective cohort study calculating the point prevalence of MND on 31 December 2017, 2018 and 2019 utilizing data from the Australasian Motor Neurone Disease Registry (AMNDR). The annual IRs between 2017 and 2019 were calculated using population data reported in the 2016 Australian census and age-standardized rates utilized the world population from the United Nations Population Division’s World Population Prospects. Results A total of 256 MND patients were identified, of whom 114 were alive on 31 December 2019. Based on the 2016 population of 1,676,653 persons, the estimated prevalence was 6.79 per 100,000 persons. The crude IR for the all-age South Australian population was 3.34 per 100,000 person-years (95% CI, 2.85–3.88). The estimated annual IRs based on those ≥20 yo were 4.98 (3.84–6.35), 3.68 (2.71–4.88), and 4.21 (3.17–5.49) per 100,000 person-years for 2017, 2018, and 2019, respectively. Conclusion The crude prevalence and incidence of MND in South Australia were considerably higher than global estimates. This may reflect higher rates of the disease or higher rates of case ascertainment compared to the GBD project.

The dynamics of cardiovascular and respiratory deaths attributed to long-term PM2.5 exposures in global megacities

Exposure to ambient fine particulate matter (PM2.5) air pollution is a significant driver of premature deaths. We estimate the number of cardiovascular and respiratory (CR) premature deaths attributed to long-term exposure to PM2.5 in 33 global megacities based on long-term remotely sensed observations from 2000 to 2019. Our analysis uses high-resolution (0.01 degree) PM2.5 concentration data and cause-specific integrated exposure-response (IER) functions developed for the Global Burden of Disease Project. From 2000 to 2019, PM2.5-related CR death rates per 1000 people increased in 6 of 33 megacities, decreased in 9, and remained constant in 18 megacities. The increase in PM2.5-related CR mortality in 11 megacities located in South and East Asia during the period 2000–2019 can be attributed to the increases in PM2.5 concentrations. All 33 megacities could avoid 30,248 (9 %), 62,989 (20 %), 128,457 (40 %), 198,462 (62 %) and all of the estimated 322,515 CR deaths attributed to PM2.5 pollution in 2019 if they were to attain the World Health Organization's four interim PM2.5 targets (IT-1, IT-2, IT-3, and IT-4) and the new air quality guideline (AQG), respectively. Major improvements in air quality are needed to reduce the number of CR deaths attributed to PM2.5 in South and East Asia, in addition to ny reductions that would likely follow shifts in the population structures of these megacities moving forward.

The health-adjusted dependency ratio as a new global measure of the burden of ageing: a population-based study

The old-age dependency ratio (OADR), which is the ratio of older people (aged ≥65 years) to working age people (aged 20-64 years), is the most common way to assess and compare the burden of population ageing in different countries. However, the relationship between chronological age and dependency varies widely across countries. We therefore present the health-adjusted dependency ratio (HADR), a new measure of ageing burden based on the ageing-related health of the adult population. In this population-based study we used health data for diseases and injuries for 2017 from the Global Burden of Disease project and population data for 2017 from the UN's Population Division to identify the number of adults (aged >20 years) in each country who have the same or higher ageing-related disease burden as the global average 65-year-old. We then calculated the HADR as the ratio of adults who were less healthy than the average 65-year-old (dependent population) to those in better health (supporting population) and compared the HADR with the OADR for 188 countries. We also used cross-sectional, bivariate regression analysis to investigate whether the HADR is a more powerful predictor of changes in per capita health-care expenditure than the OADR as a measure of predictive validity. Many demographically younger populations have an earlier onset of ageing-related disease, and many demographically older populations have a later onset. For instance, Pakistan has an OADR of 0·09 and an HADR of 0·19, and France has an OADR of 0·35 and an HADR of 0·13. Relative to the OADR, the HADR suggests that Asia, western Europe, and North America have a lower ageing burden, whereas central Asia, southern Asia, and Africa have a greater burden. While Japan and countries in western Europe have the highest OADR, Russia, Papua New Guinea, and countries in southeast Europe have the highest HADR. Relative to the OADR, the HADR suggests that there is much less variation in the burden of ageing across countries than has previously been assumed. HADR was also more closely associated with growth in health spending than the OADR. A 0·1 increase in the HADR was associated with a 2·9 percentage points larger growth rate in per capita spending (p=0·0001), and a 0·1-point increase in the OADR was associated with a 1·8 percentage point larger growth rate. The OADR probably overestimates the burden of population ageing in many demographically older countries and underestimates the ageing burden in many demographically younger countries, which implies that the challenges associated with ageing are more universal than previously thought, and that the world cannot easily be divided in a young and an old groups of nations. None.

Understanding the changing health of the Iranian people

The Iranian people have suffered much. At the end of the 1980s, Iran emerged from a decade-long war with Saddam Hussein's Iraq, experiencing the loss of at least 200 000 lives and massive economic damage.1 In 2006, international sanctions, imposed in response to Iran's nuclear programme, had inevitable consequences for health.2 Yet, despite these challenges, successive Iranian governments have undertaken two major health-system reforms. A new analysis in The Lancet by the Global Burden of Disease (GBD) 2019 Iran Collaborators3 based on data from 1990 to 2019 from the GBD project investigated health trends during these complex times.

OVERVIEW ON THALASSEMIA: A REVIEW ARTICLE

Thalassemia is a hereditary blood disorder which is passed down through families in which the body makes an abnormal form of hemoglobin. This disorder results in the destruction of red blood cell in large number, which leads to anemia. It is caused by mutation in the DNA of cells that make hemoglobin. Thalassemia should be prevented by premarital screening and prenatal diagnosis which is helpful in decreasing prevalence and future incidence of thalassemia. The most important problem in thalassemia patients are iron overload, cardiac arrhythmia, hepatitis, osteoporosis and endocrine disorder however there are typical signs and symptoms of anemia. People with thalassemia can get treatment as indicated by the degree of seriousness of their condition. Blood transfusion is the common treatment for thalassemia. This review presents the types, diagnosis, prevalence, complications and treatment of thalassemia. Thalassemias are a major public health issue in many populations which many health authorities fail to address. These requirements are notrecognized by measures such as the Global Burden of Disease project, which ranks thalassemia very low in terms of disability-adjusted life years (DALYs), and fails to consider that it ranks highly in the one to four-year-oldag egroup, making itanimportant contributor to under-5mortality. Thalassemia doesnot fulfil the criteria to be accepted as a target disease for neonatal screening. Nevertheless, dependingon the screening methodology, severe cases of thalassemia will be detected inmostneonatalscreening programs for sickle cell disease. This is very valuable because: (1) it helps to prepare the affected families for having asick childand (2) it is an important measure of secondary prevention.

Predicting the effectiveness of interventions on population-level sodium reduction: A simulation modeling study.

Background and AimsInterventions that significantly reduce dietary sodium intake are anticipated to decrease gastric cancer (GCa) burden. However, the optimal restriction strategies remain unknown at present. This study aims to understand where and to what extent policies modifying sodium consumption change the distribution of GCa burden, and the effects of potential salt reduction strategies in China.MethodsThe synthetic population in this microscopic simulation study is close to reality. We incorporated estimates of dietary patterns and GCa risk into the model of excess salt consumption. These estimates and simulated population were obtained from the China Health and Nutrition Survey, Global Burden of Disease Project, and the sixth census of China's National Bureau of Statistics, respectively.ResultsIn the no intervention scenario, we estimated that disease burdens due to excess sodium intake would be at 472.9 million disability‐adjusted life years (DALYs) nationally between 2010 and 2030 (95% credible interval [CrI]: 371.1–567.7). The GCa burden caused by high sodium is projected to have a disproportionate impact on the central and southern provinces of China (9.2 and 4.5 million DALYs, respectively). Implementing a cooking salt substitute strategy would be expected to avoid a larger portion of GCa burden (about 67.2%, 95% CrI: 66.8%–67.6%) than the salt‐restriction spoon program (about 16.7%, 95% CrI: 16.1%–17.4%).ConclusionDietary salt reduction policy is very powerfully effective in reducing the GCa burden overall. It is expected that proposed salt substitutes are more effective than traditional salt‐restriction spoons to avoid increased inequality.

Global, regional, and national time trends in mortality for congenital heart disease, 1990-2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study.

SummaryBackgroundCongenital heart disease (CHD) is the leading cause of morbidity and mortality from birth defects worldwide. We report an overview of trends in CHD mortality in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort.MethodsCause-specific CHD mortality estimates were derived from the Global Burden of Disease 2019 study. We utilised an age-period-cohort model to estimate overall annual percentage changes in mortality (net drifts), annual percentage changes from 0 to 4 to 65–69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. This approach allows for the examination and differentiation of age, period, and cohort effects in the mortality trends, with the potential to identify disparities and treatment gaps in cardiac care.FindingsCHD is the leading cause of deaths from non-communicable diseases (NCDs) in those under 20 years. Global CHD deaths in 2019 were 217,000 (95% uncertainty interval 177,000–262,000). There were 129 countries with at least 50 deaths. India, China, Pakistan, and Nigeria had the highest mortality, accounting for 39.7% of deaths globally. Between 1990 and 2019, the net drift of CHD mortality ranged from –2.41% per year (95% confidence interval [CI] –2.55, –2.67) in high Socio-demographic Index (SDI) countries to –0.62% per year (95% CI: –0.82, –0.42) in low-SDI countries. Globally, there was an emerging transition in the age distribution of deaths from paediatric to adult populations, except for an increasing trend of mortality in those aged 10–34 years in Mexico and Pakistan. During the past 30 years, favourable mortality reductions were generally found in most high-SDI countries like South Korea (net drift = –4.0% [95% CI –4.8 to –3.1] per year) and the United States (–2.3% [–2.5 to –2.0]), and also in many middle-SDI countries like Brazil (–2.7% [–3.1 to 2.4]) and South Africa (–2.5% [–3.2 to –1.8]). However, 52 of 129 countries had either increasing trends (net drifts ≥0.0%) or stagnated reductions (≥–0.5%) in mortality. The relative risk of mortality generally showed improving trends over time and in successively younger birth cohorts amongst high- and high-middle-SDI countries, with the exceptions of Saudi Arabia and Kazakhstan. 14 middle-SDI countries such as Ecuador and Mexico, and 16 low-middle-SDI countries including India and 20 low-SDI countries including Pakistan, had unfavourable or worsening risks for recent periods and birth cohorts.InterpretationCHD mortality is a useful and accessible indicator of trends in the provision of congenital cardiac care both in early childhood and across later life. Improvements in the treatment of CHD should reduce the risk for successively younger cohorts and shift the risk for all age groups over time. Although there were gains in CHD mortality globally over the past three decades, unfavourable period and cohort effects were found in many countries, raising questions about adequacy of their health care for CHD patients across all age groups. These failings carry significant implications for the likelihood of achieving the Sustainable Development Goal targets for under-5 years and NCD mortality.FundingSupported by the 10.13039/501100001809National Natural Science Foundation of China (81525002, 31971048, 82073573 to ZZ and HZ), Shanghai Outstanding Medical Academic Leader program (2019LJ22 to HZ), and Collaborative Innovation Program of Shanghai Municipal Health Commission (2020CXJQ01 to HZ), the Bill & Melinda Gates Foundation for the Global Burden of Disease Project (to NJK) and NHMRC fellowship administered through the University of Melbourne (to GCP).