Burden Of Disease Research Articles

HHI: How housing intervention programmes are improving health outcomes for children in New Zealand

ObjectivesIt is estimated that around 30,000 New Zealand (NZ) children are hospitalised each year for preventable conditions related to poor-quality housing. To combat the high levels of housing-related illness in NZ, the Healthy Homes Initiative (HHI) was established. The HHI is a government-funded, multicomponent housing intervention programme operating with the aim of reducing the incidence of housing-related illness in children. The objective of this study was to evaluate the impact of the HHI programme on health outcomes of participating families. ApproachThe Integrated Data Infrastructure (IDI) is a database of linked microdata maintained by Statistics NZ. Deidentified HHI referral data were linked to the IDI, and we used government administrative data to explore the impact of the HHI on health outcomes. ResultsThe HHI dataset linked to the IDI provided referral information for over 21,000 participants of the programme. Characteristics of the cohort included a higher proportion of participants who identified as Māori or Pacific Islander and lower socio-economic status than the general NZ population. Odds ratios were calculated for all variables in the model and showed lower odds of hospitalisation associated with participation in the HHI programme. ConclusionThis study demonstrates how housing-intervention programmes can improve health outcomes for those at risk of illness related to housing. These programmes are imperative for addressing the burden of disease and significant health inequities driven by exposure to substandard housing in NZ. This study shows how data linkage methods and administrative data can be used to evaluate large-scale government housing programmes.

Toxicologic Pathology Forum*: mRNA Vaccine Safety-Separating Fact From Fiction.

SARS-CoV-2 spread rapidly across the globe, contributing to the death of millions of individuals from 2019 to 2023, and has continued to be a major cause of morbidity and mortality after the pandemic. At the start of the pandemic, no vaccines or anti-viral treatments were available to reduce the burden of disease associated with this virus, as it was a novel SARS coronavirus. Because of the tremendous need, the development of vaccines to protect against COVID-19 was critically important. The flexibility and ease of manufacture of nucleic acid-based vaccines, specifically mRNA-based products, allowed the accelerated development of COVID-19 vaccines. Although mRNA-based vaccines and therapeutics had been in clinical trials for over a decade, there were no licensed mRNA vaccines on the market at the start of the pandemic. The rapid development of mRNA-based COVID-19 vaccines reduced serious complications and death from the virus but also engendered significant public concerns, which continue now, years after emergency-use authorization and subsequent licensure of these vaccines. This article summarizes and addresses some of the safety concerns that continue to be expressed about these vaccines and their underlying technology.

Evaluating Health Canada’s Proposed Front-of-Pack Labelling Policy: Burden of Healthcare Use Attributed to Health Canada’s Proposed Front-of-Pack Labelling Policy

The economic burden of disease due to consumption of poor diet costs billions of dollars annually to the Canadian healthcare system. This project is in response to the growing interest in the use of nutrient profiling systems on front-of-package (FOP) nutrition labels in Canada. There is a high demand for simplified healthy eating messaging. Health Canada announced improving food environments is a priority in the Healthy Eating Strategy and will implement the mandatory FOP label policy in 2026. Two Ontario-based studies examined the impacts of health behaviors (smoking, alcohol consumption, poor diet and physical inactivity) attributed to hospital bed-days and costs. They found 36% of hospital use was attributable to all health behaviours resulting in 900,000 bed-days annually. Between 2004-2013, 22% of healthcare costs totalling $89.4 billion were attributable to the four health behaviours. These are likely underestimates as diet was measured based on fruit/vegetables frequency. The objective is to evaluate Health Canada’s Proposed FOP policy on hospital bed-days. Detailed dietary data from the nationally representative cross-sectional national survey data Canadian Community Heath Survey-Nutrition 2004 linked to Discharge Abstract Database (2004-14) for hospital use will be used for analysis. Data-driven methodology will be employed and development of multivariable risk models using zero-inflated negative binomial regression with multiple exposure groups to test a dose-response. Results are undergoing, will be ready September 2024. This is the first study to analyze Health Canada’s proposed FOP policy related to economic outcomes. These findings will provide evidence-based recommendations to policymakers on nutrition policy.

The development and validation of a survey to measure fecal-oral child exposure to zoonotic enteropathogens: The FECEZ Enteropathogens Index.

Child exposure to animal feces and associated enteropathogens contribute to a significant burden of disease in low- and middle-income countries. However, there are no standardized, validated survey-based approaches to enable accurate assessment of child exposure to zoonotic enteropathogens. We developed and validated a survey-based measure of exposure, the fecal-oral child exposure to zoonotic enteropathogens Index (the FECEZ Enteropathogens Index). First, we identified critical attributes of child exposure through in-depth interviews (IDIs) in Ecuador among individuals who care for animals (n = 29) and mothers of children under two years old (n = 58), and through a systematic review of existing exposure measures. Second, based on these findings, we developed a 105-question survey and administered it to 297 mothers with children under age five. Third, we refined the survey, using principal component analysis to determine the optimal number of components. The final index consisted of 34 items across two sub-domains: the child Environment and child Behavior. Lastly, we compared index scores to two commonly used, unvalidated measures of child exposure-maternal reported household animal ownership and presence of animal feces. Using the FECEZ Enteropathogens Index revealed varying degrees of exposure in our study population, with only two children having no exposure. In contrast, if we had used animal ownership or the presence of animal feces as a measure of exposure, 44% and 33% of children would have been classified as having no exposure, respectively. These common binary exposure measures may be inadequate because they do not provide sufficient information to identify the relative risk of zoonotic pathogen exposure. The FECEZ Enteropathogens Index overcomes this limitation, advancing our ability to assess exposure by quantifying the multiple components of child exposure to zoonotic enteropathogens with higher resolution. Additional testing and evaluation of the index is needed to ensure its reliability, validity, and cross-cultural equivalence in other contexts.

Understanding the fatal burden of COVID-19 in residential aged care homes in Australia: Using linked data to generate evidence

AimTo quantify the impact of the pandemic on fatal burden of disease among those living in residential aged care homes (RACH) in Australia. MethodsUsing Residential Aged Care data linked to Death Registrations (Jan 2016 to 11 Aug 2022), we estimated years of life lost per person-year (YLL/py) among people living in RACH. Additional linkage of notifications data from the state of Victoria enabled comparisons of average survival times between notified COVID-19 cases and matched non-cases living in RACH using COVID-19. ResultsCOVID-19 deaths were low in 2020 and 2021 (610 and 260 deaths, respectively) but increased in 2022 (3230 deaths). Years of life lost due to COVID-19 was low in 2020 and 2021 (1.2% and 0.5% of the total YLL/py, respectively) but increased substantially in 2022 (8.3% of the total YLL/py). However, there was little evidence that YLLs/py overall increased in the pandemic (range: 0.87 to 0.93 in 2016-2019 and 0.85 to 0.88 in 2020-2022). Results describing differences in survival between notified COVID-19 cases and non-cases are forthcoming. ConclusionWe observed no substantial increase in overall fatal burden of disease among the RACH population during the pandemic period. While COVID-19 case numbers increased in 2022 relative to 2020-2021, this was offset with better survival among cases over time, reflecting, at least in part, decreasing disease severity, high uptake of COVID-19 vaccines and antiviral medications.

Characteristics and real-world medication persistence of people living with HIV treated with DTG/3TC or BIC/FTC/TAF: a hospital claims database study in Japan

BackgroundAs the life expectancy of people living with human immunodeficiency virus (HIV) (PLWH) has improved, chronic disease burden and polypharmacy have increased in PLWH. Simplification of the antiretroviral therapy (ART) regimen for PLWH has become crucial. The real-world treatment patterns and medication persistence of the 2-drug single-tablet regimen (STR), dolutegravir/lamivudine (DTG/3TC), compared to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) prescribed were investigated.MethodsThis retrospective, database study extracted data from a hospital-based medical claims database in Japan. The changes in ART distributions by year during the identification period between January 1, 2018 and December 31, 2021 were observed. Patients with disease record of HIV-1 infection and prescribed DTG/3TC or BIC/FTC/TAF as the first prescription of STR during the identification period were divided into two cohorts; DTG/3TC cohort and BIC/FTC/TAF cohort, respectively. Patient without medication records more than 3 months and no future data more than 6 months were excluded. Patients’ characteristics were compared between the DTG/3TC cohort and the BIC/FTC/TAF cohort by Mantel–Haenszel test to adjust for age. Medication persistence was compared between the two cohorts by evaluating the continuation rates using Kaplan–Meier methods, using the log-rank test to assess the difference between the Kaplan–Meier curves. The median time-to-first prescription was compared between the two cohorts by Kaplan–Meier methods.ResultsPrescriptions of DTG/3TC and BIC/FTC/TAF increased steadily from 2019 to 2021 after the release year of each STR. There was no significant difference in the time-to-first prescription (p = 0.3). A total of 959 patients were included, with 120 patients and 839 patients on DTG/3TC and BIC/FTC/TAF, respectively. The proportion of dyslipidemia at baseline was significantly higher in the DTG/3TC cohort than in the BIC/FTC/TAF cohort after adjusting for mean age (p = 0.002). There was no significant difference in medication persistence between the two cohorts (p = 0.91).ConclusionThis study showed that DTG/3TC was likely to be selected for elderly patients and those with chronic disease in real-world clinical practice, which seems in accordance with the treatment strategy recommended by guidelines. Comparable medication persistence was observed with both regimens, aligning with findings from other countries. The 2-drug single-tablet regimen DTG/3TC may be an important ART regimen for PLWH with multiple morbidities and polypharmacy in an aging society. Due to the limitations of the database, further research to assess viral loads, emergence of resistance and adverse events will be encouraged.

Are our patients becoming more complex? Trends in comorbidity and functional dependence in General Medicine 2011-2019.

Anecdotally, patients don't seem to be more unwell than they were 10 years ago, yet they still seem more 'complex'. The aim of this study was to use an objective measure to assess the trend in complexity of general medicine patients over a 9-year period. Complexity was pragmatically defined as a composite of comorbidity plus dependence/frailty. We selected 100 consecutive patients discharged from General Medicine at Monash Medical Centre (a tertiary hospital in Melbourne, Australia) in the month of April of each year from 2011 to 2019. For each patient, we retrospectively calculated their burden of comorbidity and their degree of dependency/frailty. Comorbidity was measured using the Charlson Comorbidity Index (CCI), and dependence/frailty was assessed using the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Braden Scale (BS). The BS is a pressure injury risk assessment tool. Additional demographic data were collected, including length of stay, admission and discharge residence, 30-day readmission rate and inpatient mortality. There was no statistically significant change in the CCI or the Katz ADL. The median BS did however significantly decrease from 19 in 2011 to 16 in 2019 (P = 0.006), reflecting an increased risk of pressure injuries. Despite a stable level of comorbidity, our finding of a decreasing BS score may suggest that patients are becoming more dependent. This increase in dependency rather than a change in chronic disease burden may be the cause of apparent increasing patient complexity.

Variation in worldwide incidence of Guillain-Barré syndrome: a population-based study in urban China and existing global evidence

Background and objectivesGeographical variation existed in the incidences of Guillain-Barré syndrome (GBS), but no national population-based study has evaluated the incidences of GBS in China. This study aimed to estimate the incidence of GBS in urban China and evaluate the worldwide variation in the incidence of GBS.MethodsFirstly, we did a population-based study to calculate the incidence of GBS in urban China based on the National Urban Medical Insurance database from 2013 to 2017. To identify GBS cases, natural language processing was used first for handling the lengthy and unstructured diagnostic information and then checked by prestigious neurologists. Secondly, a systematic review and meta-analysis were performed to analyze the incidence of GBS worldwide. Up to July 4, 2022, Medline, Embase, and Web of Science were retrieved to identify the population-based studies regarding the incidence of GBS. The basic information and the statistics regarding incidence were extracted. Quality assessment considered sample representativeness, condition assessment, and statistical methods.ResultsA total of 1.44 billion person-years in insurance data was covered, with 3,534 GBS cases identified. The annual incidences of GBS in urban China between 2013 and 2017 ranged from 0.41 (95% CI: 0.27 to 0.58) to 0.58 (95% CI: 0.38 to 0.82) per 100,000 person-years. The incidence was the highest in Northwest China and the lowest in Northeast China. The meta-analysis included 122 articles. The quality assessment showed that the quality scores of 43.3% of studies were ≥ 0.75 (the total score is 1). The global incidence of GBS was 1.12 (95% CI: 0.98 to 1.27) per 100,000 person-years. The incidences in West Europe, South Asia, and North Europe were higher, while the incidences in Australia and New Zealand, Southeast Asia, and North Africa were lower. The incidence of enteric infections was positively associated with the incidence of GBS (coefficient=0.0000185, P=0.007). The incidence in Europe, Australia, and America rose significantly from 1960 to 2020 (coefficient=0.01, t=2.52, P=0.015).DiscussionThere is a clear regional variation of the GBS incidence at both national and global levels. Careful control of enteric infections should be conducted to reduce the disease burden.

Larval crowding enhances dengue virus loads in Aedes aegypti, a relationship that might increase transmission in urban environments.

Climate change and urbanization will alter the global distribution of disease vectors, changing the disease burden in yet unpredictable ways. Aedes aegypti is a mosquito responsible for transmitting dengue, Zika, chikungunya, and yellow fever viruses that breeds in containers associated with urban environments. We sought to understand how ambient temperature and larval densities in the immature aquatic phases determine adult life history traits and dengue virus loads post-infection. We predicted that larval crowding and high temperatures would both lead to smaller mosquitoes that might struggle to invest in an immune response and, hence, would exhibit high viral loads. We first examined larval densities from urban and rural areas via a meta-analysis. We then used these data to inform a laboratory-based 2x2 design examining the interacting effects of temperature (21 vs. 26°C) and density (0.2 vs. 0.4 larvae/mL) on adult life history and dengue virus loads. We found that urban areas had an ~8-fold increase in larval densities compared to more rural sites. In the lab, we found that crowding had more impact on mosquito traits than temperature. Crowding led to slower development, smaller mosquitoes, less survival, lower fecundity, and higher viral loads, as predicted. The higher temperature led to faster development, reduced fecundity, and lower viral loads. The virus-reducing effect of higher temperature rearing was, however, overwhelmed by the impact of larval crowding when both factors were present. These data reveal complex interactions between the environmental effects experienced by immature mosquitoes and adult traits. They especially highlight the importance of crowding with respect to adult viral loads. Together, these data suggest that urban environments might enhance dengue virus loads and, therefore, possibly transmission, a concerning result given the increasing rates of urbanization globally.

Understanding the transmission of bacterial agents of sapronotic diseases using an ecosystem-based approach: A first spatially realistic metacommunity model.

Pathogens such as bacteria, fungi and viruses are important components of soil and aquatic communities, where they can benefit from decaying and living organic matter, and may opportunistically infect human and animal hosts. One-third of human infectious diseases is constituted by sapronotic disease agents that are natural inhabitants of soil or aquatic ecosystems. They are capable of existing and reproducing in the environment outside of the host for extended periods of time. However, as ecological research on sapronosis is infrequent and epidemiological models are even rarer, very little information is currently available. Their importance is overlooked in medical and veterinary research, as well as the relationships between free environmental forms and those that are pathogenic. Here, using dynamical models in realistic aquatic metacommunity systems, we analyze sapronosis transmission, using the human pathogen Mycobacterium ulcerans that is responsible for Buruli ulcer. We show that the persistence of bacilli in aquatic ecosystems is driven by a seasonal upstream supply, and that the attachment and development of cells to aquatic living forms is essential for such pathogen persistence and population dynamics. Our work constitutes the first set of metacommunity models of sapronotic disease transmission, and is highly flexible for adaptation to other types of sapronosis. The importance of sapronotic agents on animal and human disease burden needs better understanding and new models of sapronosis disease ecology to guide the management and prevention of this important group of pathogens.

Risk Factors for Bacterial Keratitis and Severe Disease in Hydrogel Contact Lens Users: A Multicenter Case-Control Study and Case-Only Analysis.

To assess risk factors for contact lens (CL)-related bacterial keratitis, cases and high-risk controls were enrolled. Using high-risk controls can help elucidate whether certain CL types or modalities are attributable to disease burden if risky wear patterns are similar between the cases and controls. This analysis identified whether such CL factors were associated with the occurrence of bacterial keratitis. In addition, a case-only analysis determined CL factors associated with severe disease. From 2018 to 2021, 158 controls were enrolled at University Hospitals of Cleveland Eye Institute, and 153 bacterial keratitis cases were enrolled across 14 sites in the United States. Cases were soft CL wearers with either culture-proven bacterial keratitis or a corneal infiltrate with an overlying epithelial defect within the central 4 mm of the cornea, uveitis, or significant pain. Fungal, protozoan, or nonsoft CL wear-related microbial keratitis cases were excluded. Controls were recruited from high-risk CL wearers with no history of disease. All participants completed a questionnaire related to demographics, type of CL used, wearing schedule, lens handling practices, and storage case handling. Cases with ulcer/infiltrate size ≥2 mm in size, presence of hypopyon, or had fortified antibiotics prescribed were classified as severe keratitis. Univariate and multivariable logistic regression was used to assess association of CL variables with the occurrence of bacterial keratitis as well as occurrence of severe disease among the cases only. Compared with the control cohort, cases were older (mean age 45.6 vs. 38.9 years), had more males (42.5% vs. 23.6%), and had more current or former smokers (41.7% vs. 12.9%). There were no significant associations between CL material (silicone hydrogel vs. not) or CL type (daily disposable vs. reusable) and occurrence of bacterial keratitis. More than two-thirds (67.3%) of cases were classified as severe. Among cases only, univariate analyses found current smokers to have increased risk of severe disease (OR=2.87; 95% CI 1.13-7.26, P=0.03). Adjusting for age, sex, and smoking among the cases only, daily disposable lenses were protective against severe disease (OR=0.32; 95% CI 0.11-0.89, P=0.03). Reusable lenses increased risk of severe microbial keratitis between 3.0- and 4.4-fold compared with compliant daily disposability. Compared with a high-risk control cohort, no specific lens factors were associated with occurrence of CL-associated bacterial keratitis. Among cases only, current smokers and patients wearing reusable lenses are at increased risk of severe keratitis. Daily disposable lenses were protective even when noncompliance to daily disposability was considered.

Impact of Child Respiratory Syncytial Virus-Confirmed Infections on Caregivers in Japan: A Web-Based Survey

Background/Objectives: Despite being the leading cause of acute lower respiratory tract infections in infants, the impact of respiratory syncytial virus (RSV) on the caregivers of infected children remains largely unexplored. This study is the first in Japan to examine the psychological, social, and economic burdens on caregivers of infants infected with RSV. Methods: An online questionnaire survey was used to understand the circumstances surrounding RSV infection and the psychological, social, and economic burdens on caregivers. Equal numbers of infants aged either <6 or ≥6 months were enrolled. Results: A total of 606 caregivers were included in the final analysis. Notably, 36.1% of the infants were hospitalized. Most caregivers (91.4%) felt anxious about their infants’ RSV infection, and more than half (55.8%) answered that their anxiety interfered with their daily lives. Caregivers whose daily routines were disrupted due to concerns about RSV infection were more likely to hospitalize infants, particularly for extended stays. Infection significantly affected family dynamics, hindering normal daily activities and escalating stress, which in turn led to conflicts and arguments among family members (30.4%). Regarding the financial burden, most caregivers incurred medical expenses (34.2%). Additionally, 76.9% of caregivers expressed interest in the hypothetical RSV vaccination. Conclusions: In Japan, caregivers of infants with RSV experience had significant psychological burden regardless of whether the treatment is outpatient or inpatient. In addition, a non-negligible proportion of caregivers suffer from societal and economic burdens. This study lays the groundwork for all stakeholders to fully comprehend the comprehensive disease burden of child RSV infections.

Identification of neutrophil extracellular trap-related biomarkers in non-alcoholic fatty liver disease through machine learning and single-cell analysis

Non-alcoholic Fatty Liver Disease (NAFLD), noted for its widespread prevalence among adults, has become the leading chronic liver condition globally. Simultaneously, the annual disease burden, particularly liver cirrhosis caused by NAFLD, has increased significantly. Neutrophil Extracellular Traps (NETs) play a crucial role in the progression of this disease and are key to the pathogenesis of NAFLD. However, research into the specific roles of NETs-related genes in NAFLD is still a field requiring thorough investigation. Utilizing techniques like AddModuleScore, ssGSEA, and WGCNA, our team conducted gene screening to identify the genes linked to NETs in both single-cell and bulk transcriptomics. Using algorithms including Random Forest, Support Vector Machine, Least Absolute Shrinkage, and Selection Operator, we identified ZFP36L2 and PHLDA1 as key hub genes. The pivotal role of these genes in NAFLD diagnosis was confirmed using the training dataset GSE164760. This study identified 116 genes linked to NETs across single-cell and bulk transcriptomic analyses. These genes demonstrated enrichment in immune and metabolic pathways. Additionally, two NETs-related hub genes, PHLDA1 and ZFP36L2, were selected through machine learning for integration into a prognostic model. These hub genes play roles in inflammatory and metabolic processes. scRNA-seq results showed variations in cellular communication among cells with different expression patterns of these key genes. In conclusion, this study explored the molecular characteristics of NETs-associated genes in NAFLD. It identified two potential biomarkers and analyzed their roles in the hepatic microenvironment. These discoveries could aid in NAFLD diagnosis and management, with the ultimate goal of enhancing patient outcomes.

Changes in Access to Alcohol-Based Hand Rub and Hand Hygiene Adherence among Healthcare Workers after a Hand Rub Production and Distribution Program in Rural Uganda before and during the COVID-19 Pandemic.

During the COVID-19 pandemic, the use of alcohol-based hand rubs (ABHRs) was critical for improving hand hygiene (HH) among healthcare workers (HCWs). Before and during the pandemic, we supported district-led production and district-wide distribution of ABHRs and one-time provision of portable handwashing stations to select healthcare facilities (HCFs) in five rural districts in Uganda. Comparison between baseline and follow-up assessments showed an overall increase in access to HH materials and HH adherence (HHA; handwashing with soap and water or use of ABHR) among HCWs. However, large differences in the changes in HH material coverage and HHA across districts may have been heavily influenced by the COVID-19 disease burden and its risk perception when the assessments were conducted. Using data collected at multiple time points before and during the pandemic across districts and estimating and controlling for pandemic effects in an exploratory multivariate analysis, the adjusted odds ratio of HHA in district HCFs was 4.6 (95% CI: 1.8-11.8) after (versus before) the ABHR intervention. This increase appeared to be primarily in larger HCFs, where the perceived need for ABHRs may have been greater. Additional strategies are needed to further increase HHA, especially in the smallest HCFs, among laboratory technicians and nurses and before patient contact. However, district-scale ABHR interventions seemed successful in ensuring the continued availability of HH materials.

WP3.8 - Estimating the Disease Burden and Epidemiological Characteristics of Burn Injuries in the United Kingdom: a systematic analysis of the global burden of disease study 2019

Abstract Background Burn injuries pose a substantial public health challenge globally, with profound physical, psychosocial, and financial consequences for individuals, households, and communities. This study aims to assess the disease burden and epidemiological characteristics of burn injuries in the United Kingdom (UK). Methods Utilising data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we estimated the prevalence, age-standardised incidence, and years lived with disability (YLD) for burn injuries in the UK. Burn injuries were further classified based on the total burn surface area (TBSA), distinguishing between <20% and >= 20% TBSA. Result In 2019, the age-standardised incidence rate of burn injuries in the UK was estimated at 330.65 per 100,000 (268.59-409.52). Incidence rates have demonstrated a stable downtrend since 1990. Over 90% of burn injuries in the UK were categorised as <20% TBSA. Younger age groups experienced a higher disease burden. England exhibited the highest age-standardised incidence rate of burn injuries (344.98 per 100,000), along with a threefold higher rate of burn injuries >20% TBSA (29.64 per 100,000) compared to Wales, Northern Ireland, and Scotland. The burden of disability attributed to burn injuries in the UK was estimated at 84.38 YLD per 100,000 (49.16-139.56), with the highest burden observed in England (88.90 per 100,000). Conclusion This study underscores the substantial disease burden imposed by burn injuries in the UK, alongside disparities in their distribution and warrant further studies in addressing the social and economic determinants of burn injuries.

Burden changes in notifiable infectious diseases in Taiwan during the COVID-19 pandemic.

This study aimed to assess the impact of the COVID-19 pandemic on the disease burden of Taiwan's notifiable infectious diseases (NIDs). We compared disease burdens between the pandemic and pre-pandemic year of 2020 (with non-pharmaceutical interventions (NPIs)) and 2010 (without NPIs), respectively, to understand the overall pandemic impact on NIDs in Taiwan. Forty-three national NIDs were analyzed using the Statistics of Communicable Diseases and Surveillance Report by estimating the premature death and disability via different transmission categories, sex, and age groups. The study evaluated the impact of diseases by assessing the years lost due to death (YLLs), the duration of living with disability (YLDs), and the overall disability-adjusted life years (DALYs) by measuring both the severity of the illness and its duration. Taiwan recorded 1,577 (2010) and 1,260 (2020) DALYs per million population and lost 43 NIDs, decreasing 317 DALYs per million population. Tuberculosis, HIV/AIDS and acute hepatitis B/D were the leading causes of DALYs, accounting for 89% (2010) and 77% (2020). Overall, this study provided the first insight of changes in disease burdens in NIDs between pre- and post-COVID-19 based on a nationwide viewpoint for further preventive measures and interventions to be focused on specific diseases by associated health administrations and policies.

Basivertebral Nerve Ablation for Treatment of Lower Back Pain

Lower back pain (LBP) is a widely prevalent global health issue, affecting over half a billion people and remaining the leading cause of years lived with disability (YLDs). LBP significantly impacts healthcare systems, with substantial costs related to surgical procedures and lost workdays. Vertebrogenic back pain (VBP), characterized by specific clinical symptoms and associated with Modic changes (MC) in vertebral endplates, best seen on MRI, is a significant subset of LBP. This paper explores the pathophysiology, diagnosis, and current reports and studies focusing on VBP and the role of basivertebral nerve (BVN) ablation as a therapeutic intervention. Multiple studies, including randomized controlled trials (RCTs) and meta-analyses, demonstrate the efficacy of BVN ablation in reducing pain and improving function in patients with chronic LBP associated with MC.

WP4.14 - Association of Socioeconomical Status and Disparity In Paediatric Burn: Results From The Global Burden Of Disease Study 2019

Abstract Background Burn represents a significant contributor to both morbidity and mortality in the paediatric population and is closely related to socioeconomic and geographic factors but is often overlooked. This study aims to estimate the unbalanced distributions, temporal trends and quality of care in paediatric burn. Methods Data focusing on paediatric population (<20 years old) was sourced from the Global Burden of Disease (GBD) Study 2019 stratified by Socio-demographic Index (SDI) and WHO region, including incidence, mortality and disability-adjusted life-years (DALYs). Joinpoint regression analysis and principal component analysis were conducted to compute the temporal trend and quality of care (QCI) index respectively. Result In 2019, 3,719,806 paediatric burn cases were reported, resulting in 23,986 deaths and 2,240,311 DALYs globally. Over 40% of deaths and DALYs attributable to burn occur in the African region, despite the region accounting for around 20% of the total incidence. The age-standardised incidence rate (ASIR) from 2010-2019 was 0.419 per 100,000 but death (ASDR) and DALYs (ASDALYs) were reduced at the rate of 3.04 per 100,000 and 2.92 per 100,000 respectively. The global QCI for paediatric burn was 88 with a proportional trend observed across SDI quintiles Significant association in between SDI scores and gender disparity and quality of care was observed. Conclusion This study highlights the significant burden of paediatric burn and its disproportionate global distribution. Preventive measures, enhancing access to quality healthcare, and addressing the social and economic determinants of burn should be addressed in future studies.

Global Burden of Inflammatory Bowel Disease Among Children and Adolescents: A Comprehensive Analysis (1990–2019)

ObjectiveWe summarize the global, regional, and national burden of inflammatory bowel disease (IBD) in children and adolescents from 1990 to 2019.MethodsBased on the Global Burden of Disease Study 2019, the data of IBD in children and adolescents were analyzed by sex, age, year, and location. Joinpoint analysis was applied to assess the temporal trend of the disease burden.ResultsFrom 1990 to 2019, the incidence of IBD in children and adolescents increased by 22.8%, from 20,897.42 to 25,658.55 cases, especially in high SDI region. During the same period, the DALY numbers decreased by 53.5%, from 243,081.06 to 113,119.86, with all SDI regions experiencing a clear drop in DALYs except high SDI regions. In 2019, early-onset IBD incidence and DALY numbers were reported at 2,053.52 (95% UI: 1,575.62 to 2,677.49) and 73,797.46 (95% UI: 43,655.86 to 105,998.63), respectively.ConclusionEarly-onset IBD in children and adolescents remains a significant global health concern. The disease burden has not improved in developed countries over the past 30 years, highlighting the need for targeted interventions.

Factors That Influence Medical Retrieval Decisions in Remote Central Australia

Introduction Medical retrieval services play a key role in the transportation of unwell patients from remote communities across Australia. Decision to retrieve a patient from a remote community is dependent on unique characteristics of remote locations and thus different to urban and rural retrievals. The study aims to explore various factors that affect medical practitioner decisions to retrieve patients from remote central Australian communities. Methods Semi-structured interviews were conducted with 36 staff involved in medical retrieval processes in central Australia. The data collection and analyses were part of a broader study evaluating a newly implemented medical retrieval model in central Australia. All interviews were recorded and transcribed. Transcripts were co-coded inductively by two researchers using NVivo software. Similar codes were grouped into themes, one of which related to the range of factors that affect decisions to retrieve a patient or request a retrieval which is the focus of this paper. Results: Decision-making about who, when and how to retrieve patients was complex and involved trade-offs. Severity of patient illness, resource availability (e.g. transport infrastructure, remote area staff workload and fatigue), the skills, experience and relationships with community of primary health care and medical retrieval staff, strength of primary health care systems in remote communities, specific primary health care and retrieval policies, and innovations in disease prevention and management influenced medical retrieval decisions. Conclusion: It is critical to understand that both general and contextual factors unique to remote communities affect medical retrieval decisions. Decisions are highly complex and necessitate trade-offs, frequently related to resource scarcity, which are somewhat different from those of urban retrieval services. Resource allocation in the context of providing retrieval services for remote populations must account for differences in burden of disease, cultural requirements, workforce characteristics and overall access to health care compared to urban populations.