High-middle Socio-demographic Index Research Articles

Disparities by region, age, and sex in cardiovascular disease burden attributable to high fasting plasma glucose in China, 2010-2018: a nationwide, population-based study

Abstract Background Elaborating and understanding disparities in the burden of cardiovascular disease (CVD) attributable to high fasting plasma glucose (FPG) is important to improve diabetes prevention and promote cardiovascular health. In this study, we aimed to estimate the burden of CVD and its subtypes attributable to high FPG between 2010 and 2018 in China, by age, sex, region and socio-demographic index (SDI). Methods We pooled data on 791 373 people aged 25 years and older from three population-based surveys, and the temporal-spatial Bayesian hierarchical model was used to estimate age- specific, sex- specific, province- specific, and year-specific average FPG levels from 2010 to 2018. We estimated population attributable fraction for CVD by age and sex for 31 provinces. Data on CVD deaths at the provincial level were obtained from surveillance systems, which were used to compute death numbers and years of life lost (YLLs) due to CVD that could be attributed to high FPG using the counterfactual scenario of theoretical minimum risk level. We also decomposed changes in attributable burdens into four explanatory components, including population growth, population aging, risk exposure to FPG, and in risk-deleted mortality rates for CVD. Results In 2018, an estimated total of 512·29 thousand (95% uncertainty interval [UI] 488·60 to 538·65) adults aged 25 or older were attributable to high FPG in China, with 281·54 thousand (95%UI 267·89 to 295·05) of these deaths occurring in men and 229·75 thousand (95%UI 210·98 to 251·89) in women. The age composition of CVD mortality caused by high FPG suggested a trend toward older ages from 2010 to 2018 (Figure 1). High FPG accounted for 1 093·45 crude YLLs per 100 000 people (95%UI 1 059·13 to 1 131·73) due to FPG-related CVD in 2018, with substantial variation across provinces. The age-standardised CVD mortality rate attributable to high FPG increased by 3·99%, from 41·93 per 100 000 people (95%UI 40·07 to 43·88) in 2010 to 43·60 per 100 000 (95%UI 41·77 to 45·62) in 2018. In 2018, the higher age-standardised CVD mortality rate attributable to high FPG was observed in the high-middle SDI region and the middle SDI region. By province, the age-standardised mortality rate due to FPG-related CVD in both sexes combined varied from 21·31 per 100 000 people in Tibet to 77·66 per 100 000 people in Heilongjiang in 2018. Nationally, compared to 2010, exposure to high FPG and population aging in 2018 were the primary drivers of increased FPG-related deaths due to CVD (Figure 2). Conclusions The CVD burden attributable to high FPG was still large in China, and varied markedly across regions and provinces. Exposure to high FPG and population ageing were associated with substantial changes in the number of FPG-related CVD deaths between 2010 and 2018. Findings of this study emphasize the importance of developing population-specific tailored measures in China and other regions with similar condition.Figure 1Figure 2

The projected global burden of modifiable risk factors on cardiovascular disease from 2025 to 2100

Abstract Background Cardiovascular diseases (CVDs) are the primary cause of global mortality and morbidity. Controlling modifiable risk factors driving the CVD epidemic is a vital focus of primary prevention efforts worldwide. Understanding the epidemiological trends in these risk factors is therefore essential in designing effective countermeasures against CVDs for the years to come. Purpose This study aims to forecast the disability-adjusted life years (DALYs) associated with CVDs attributable to high systolic blood pressure (SBP), high body-mass index (BMI), high fasting plasma glucose (FPG), high low-density lipoprotein (LDL) and tobacco use from 2025 to 2100, stratified by GBD super-regions, sex, sociodemographic index (SDI), and age-groups. Methods Historical data on DALYs from 1990 to 2019 from the Global Burden of Disease (GBD) study was used to project DALYs associated with modifiable risk factors of CVDs from 2025 to 2100. Trends across GBD super-regions, sex, SDI, and age-groups were also examined. Results Between 2025 and 2100, age-standardised DALY rates (ASDR) per 100,000 population are forecasted to fall across all modifiable risk factors, with the greatest decline seen in tobacco use (-76.0%) and high LDL (-66.9%). Globally, high SBP and high BMI expect the greatest ASDR in 2100 (both 891 per 100,000 population), while tobacco use expects the least (213 per 100,000 population). High BMI is expected to rise 623.0% in South Asia and 221.5% in South-east Asia, East Asia and Oceania from 2025 to 2100, while high FPG is expected to rise 114.2% in North Africa and the Middle-east and 110.6% in South Asia. Females are expected to have lower overall and greater reductions in ASDR across all modifiable risk factors when compared to males from 2025 to 2100. Notably, males expect a 11.0% rise in high BMI worldwide across this period. The age-prevalence of modifiable risk factors is expected to be bimodal in 2100, highest in those aged 50-59 as well as 75-84 years old, possibly suggesting improvements in global screening efforts or the earlier development of metabolic dysfunction. All modifiable risk factors are predicted to fall in high and high-middle SDI regions from 2025 to 2100. In contrast, low, low-middle, and middle SDI regions expect a rise in high FPG and high BMI across this same time frame. The burden of modifiable CVD risk factors is expected to be highest in low-middle SDI regions in 2100, as compared to high-middle SDI regions in 2025. Conclusion While the global decline in ASDR of modifiable risk factors suggests overall improvements in the primary prevention of CVDs, regional spikes in high BMI and FPG calls for the implementation of timely, targeted interventions accounting for local trends in CVD. Moreover, the disproportionate metabolic burden expected in lower SDI regions in the coming decades requires concerted, international support to alleviate the global burden of CVDs.

Global, regional, and national total burden related to hepatitis B in children and adolescents from 1990 to 2021

BackgroundHepatitis B remains a significant global health concern with widespread communicability. Nevertheless, data on its burden and trends in children and adolescents were limited. We aim to evaluate the global, regional, and national trends of total burden related to hepatitis B in children and adolescents aged 0–19 years from 1990 to 2021.MethodsThe age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were calculated by the Global Burden of Disease (GBD) study from 1990 to 2021. These indicators were stratified by sex, age, socio-demographic index (SDI), and disease stage. We calculated the correlation between them and SDI. The temporal trends were examined using the annual average percentage change (AAPC) and joinpoint regression.ResultsThe global age-standardized incidence of hepatitis B in children and adolescents decreased from 1385.20 per 100,000 population in 1990 to 418.68 per 100,000 population in 2021, with an AAPC of -3.76%. Similarly, age-standardized DALYs decreased from 70.78 per 100,000 population to 36.31 per 100,000 population, with an AAPC of -2.13%. The age-standardized prevalence (AAPC − 3.53%) and mortality (AAPC − 2.09%) of hepatitis B also decreased significantly. From 1990 to 2021, the age-standardized incidence and prevalence among males exhibited a higher trend compared to females, although both declined over time. These two indicators also decreased across all age subgroups, with consistently higher rates observed in the 15–19 age group compared to other age groups. The burden of hepatitis B demonstrated a notable reduction in countries with high-middle SDI, while it was highest in countries with low SDI. In 2021, Central sub-Saharan Africa and West sub-Saharan Africa reported the highest age-standardized incidence. For age-standardized DALYs, South Asia was the only region to experience an increase (AAPC 1.09%), while East Asia showed the largest decline (AAPC − 7.58%). Alcohol and drug use remained important risk factors for DALYs among people aged 15–19 years. Furthermore, the impact of drug use on disease burden was increasing, particularly in high-SDI countries.ConclusionsThe global burden and trends of hepatitis B decreased significantly in children and adolescents, exhibiting regional and national variations. Management of alcohol and drug use remains a major challenge for people aged 15–19 years.

The global, regional, and national burden of myocarditis in 204 countries and territories, 1990-2021: Results from the Global Burden of Disease Study 2021.

To estimate the global burden of myocarditis in the general population from 1990 to 2021. Data on myocarditis were retrieved from the Global Burden of Disease Study 2021. Incidence, deaths, and disability-adjusted life years (DALYs), along with their age-standardized rates (ASRs) per 100 000 population, were used to measure the burden of myocarditis. Global, regional, and national analyses were performed for the period between 1990 and 2021. Further sub-analyses were conducted based on age group, sex, and sociodemographic index (SDI). In 2021, there were 1.3 million (95% uncertainty interval [UI]: 1.1 to 1.6) incident cases, 31.7 thousand (95% UI: 25.5 to 37.1) deaths, and 96.3 thousand (95% UI: 79.6 to 114.8) DALY cases globally. The ASRs of incidence, death, and DALYs significantly decreased from 1990 to 2021, with percentage changes of -3.9% (95% UI: -4.7% to -2.9%), -28.2% (95% UI: -42.2% to -12.5%), and -37.8% (95% UI: -50.5% to -24.3%), respectively. The global burden of myocarditis was higher in males, children, and the elderly. Additionally, the burden of myocarditis varied widely across different SDI regions, with high SDI regions having the highest ASR of incidence, and high-middle SDI regions having the highest ASRs of deaths and DALYs. Although the ASRs of incidence, deaths, and DALYs significantly decreased from 1990 to 2021, the global number of incidences, deaths, and DALYs increased substantially. Certain populations, including males, children, the elderly, and regions with advanced sociodemographic levels, experienced a heavier burden of myocarditis.

Global burden of benign prostatic hyperplasia, urinary tract infections, urolithiasis, bladder cancer, kidney cancer, and prostate cancer from 1990 to 2021

BackgroundThe burden of common urologic diseases, including benign prostatic hyperplasia (BPH), urinary tract infections (UTI), urolithiasis, bladder cancer, kidney cancer, and prostate cancer, varies both geographically and within specific regions. It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases.MethodsWe obtained data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for the aforementioned urologic diseases by age, sex, location, and year from the Global Burden of Disease (GBD) 2021. We analyzed the burden associated with urologic diseases based on socio-demographic index (SDI) and attributable risk factors. The trends in burden over time were assessed using estimated annual percentage changes (EAPC) along with a 95% confidence interval (CI).ResultsIn 2021, BPH and UTI were the leading causes of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR), with rates of 5531.88 and 2782.59 per 100,000 persons, respectively. Prostate cancer was the leading cause of both age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR), with rates of 12.63 and 217.83 per 100,000 persons, respectively. From 1990 to 2021, there was an upward trend in ASIR, ASPR, ASMR, and ASDR for UTI, while urolithiasis showed a downward trend. The middle and low-middle SDI quintile levels exhibited higher incidence, prevalence, mortality, and DALYs related to UTI, urolithiasis, and BPH, while the high and high-middle SDI quintile levels showed higher rates for the three cancers. The burden of these six urologic diseases displayed diverse age and sex distribution patterns. In 2021, a high body mass index (BMI) contributed to 20.07% of kidney cancer deaths worldwide, while smoking accounted for 26.48% of bladder cancer deaths and 3.00% of prostate cancer deaths.ConclusionsThe global burden of 6 urologic diseases presents a significant public health challenge. Urgent international collaboration is essential to advance the improvement of urologic disease management, encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies.

Disease burden of AIDS in last 30-year period and its predicted level in next 25-years based on the global burden disease 2019

BackgroundThis study examines global trends in acquired immune deficiency syndrome (AIDS) incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2019, focusing on regional disparities in AIDS incidence, mortality, and DALYs across various levels of socio-demographic index (SDI). It also investigates variations in AIDS incidence, mortality, and DALYs across different age groups, and projects specific trends for the next 25 years.MethodsComprehensive data on AIDS from 1990 to 2019 in 204 countries and territories was obtained from a GBD study. This included information on AIDS incidence, mortality, DALYs, and age-standardized rates (ASRs). Projections for AIDS incidence and mortality over the next 25 years were generated using the Bayesian age-period-cohort model.ResultsFrom 1990 to 2019, the global incidence of HIV cases increased from 1,989,282 to 2,057,710, while the age-standardized incidence rate (ASIR) decreased from 37.59 to 25.24 with an estimated annual percentage change (EAPC) of -2.38. The ASIR exhibited an upward trend in high SDI and high-middle SDI regions, a stable trend in middle SDI regions, and a downward trend in low-middle SDI and low SDI regions. In regions with higher SDI, the ASIR was higher in males than in females, while the opposite was observed in lower SDI regions. Throughout 1990 to 2019, the age-standardized death rate (ASDR) and age-standardized DALY rate remained stable, with EAPCs of 0.24 and 0.08 respectively. Countries with the highest HIV burden affecting women and children under five years of age are primarily situated in lower SDI regions, particularly in sub-Saharan Africa. Projections indicate a significant continued decline in the age-standardized incidence and mortality rates of AIDS over the next 25 years, for both overall and by gender.ConclusionsThe global ASIR decreased from 1990 to 2019. Higher incidence and death rates were observed in the lower SDI region, indicating a greater susceptibility to AIDS among women and < 15 years old. This underscores the urgent need for increased resources to combat AIDS in this region, with focused attention on protecting women and < 15 years old as priority groups. The AIDS epidemic remained severe in sub-Saharan Africa. Projections for the next 25 years indicate a substantial and ongoing decline in both age-standardized incidence and mortality rates.

Global prevalence and disability-adjusted life years of hypertensive heart disease: A trend analysis from the Global Burden of Disease Study 2019.

As hypertensive heart disease (HHD) presents a significant public health challenge globally, we analysed its global, regional, and national burdens and trends from 1990 to 2019. We used data from the Global Burden of Disease (GBD) 2019 study, focussing on the age-standardised prevalence rates (ASPRs) of HHD prevalence, age-standardised disability-adjusted life year (DALY) rates, average annual percentage change (AAPC), and risk factor attributions. We compared the HHD burden across sociodemographic index (SDI) strata, gender, age groups, and 204 countries and territories. In 2019, the global prevalence of HHD was estimated at 18 598 thousand cases, with DALYs reaching 21 508 thousand. From 1990 to 2019, the ASPRs increased (AAPC = 0.21; 95% confidence interval (CI) = 0.17, 0.24), while the age-standardised DALY rates decreased (AAPC = -0.45; 95% CI = -1.23, -0.93). We observed the highest increase in ASPRs in high-middle SDI quantile countries, and an overall negative correlation between age-standardised DALY rates and SDI. Individuals above 70 years of age were the most affected, particularly elderly women. There has been a significant increase in HHD burden attributed to high body mass index (BMI) since 1990. The burden of HHD is concentrated in the middle SDI quintile, with population ageing and growth being major drivers for the increase in DALYs. We identified opportunities for reducing age-standardised DALY rates in the middle SDI quintile or lower. Despite a declining trend in the age-standardised DALY rates, the ASPRs of HHD continue to rise, especially in high-middle SDI regions. Meanwhile, countries in middle and lower SDI quintiles face a higher burden of age-standardised DALY rates. Targeted attention towards elderly women and controlling high BMI, alongside enhancing hypertension and HHD management awareness, is crucial for reducing the global burden of HHD.

Age-period-cohort analysis of global, regional, and national pancreatic cancer incidence, mortality, and disability-adjusted life years, 1990–2019

BackgroundPancreatic cancer is one of the deadliest cancers in the world. In recent years, the incidence and mortality rates of pancreatic cancer have shown an increasing trend year by year. This study investigates the independent effects of age, period, and cohort on the global incidence, mortality, and disability-adjusted life years (DALYs) of pancreatic cancer from 1990 to 2019, and evaluates the differences in the burden of pancreatic cancer across regions with different Sociodemographic Index (SDI) levels.MethodsEstimating the impact of age, period, and cohort on pancreatic cancer disease burden in different SDI regions using age-period-cohort modeling with data (with 95% uncertainty intervals [UI]) from the Global Burden of Disease (GBD) Study 2019 and net drift of age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALY rates (ASDR) for pancreatic cancer in 120 countries.ResultsThe number of new cases of pancreatic cancer worldwide increased from 197,348 (95% UI: 188,604,203,971) in 1990 to 530,297 (486,175,573,635) in 2019, the number of deaths increased from 198,051 (189,329 to 204,763) in 1990 to 531,107 (491,948 to 566,537) in 2019, and the number of DALY increased from 4,647,207 (4,465,440 to 4,812,129) in 1990 to 11,549,016 (10,777,405 to 1,238,912) in 2019. The ASIR of the average levels in global pancreatic cancer increased from 5.22 (4.97 to 5.40) per 100,000 population to 6.57 (6.00 to 7.09) per 100,000 population, the ASMR increased from 5.34 (5.07 to 5.52) per 100,000 population to 6.62 (6.11 to 7.06) per 100,000 population, and the ASDR increased from 115.47 (110.82 to 119.60) per 100,000 population to 139.61 (130.18 to 149.14) per 100,000 population. The incidence, mortality, and DALY rates of pancreatic cancer increase with age globally and across all SDI regions, peaking in the 85–89 age group. In high and high-middle SDI regions, the growth rate for males is higher than for females before the age of 85, while females have a higher growth rate after 85. The 75–79 age group exhibits the highest DALY rate in high and high-middle SDI regions, significantly higher than the global and other SDI regions. From 1990 to 2019, the period effects of pancreatic cancer incidence, mortality, and DALY rates have increased significantly worldwide, while remaining almost unchanged in high and high-middle SDI regions. In contrast, period effects have significantly increased in middle, low-middle, and low SDI regions. Cohort effects are more pronounced in middle, low-middle, and low SDI regions.ConclusionsWith the aggravation of population aging, the incidence and mortality rates of pancreatic cancer in the world are increasing, and effective prevention and control measures can be achieved by reducing the exposure of risk factors. The APC model used in our analysis provides a novel approach to understanding the complex trends in the incidence, mortality, and disability-adjusted life years of pancreatic cancer. It can inform the development of targeted interventions to reduce the severe disease burden caused by pancreatic cancer.

Global burden of musculoskeletal disorders in children and adolescents from 1990 to 2021: a joint point regression and decomposition analysis.

The study aimed to investigate the pattern and trend of Musculoskeletal (MSK) disorders in people aged 5-19years from 1990 to 2021. The data was sourced from the Global Burden of Disease study 2021. The Age-standardized DALYs rates (ASDR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized incidence rate (ASIR) and their corresponding average annual percent change (AAPC) for MSK disorders were evaluated by sex, region, and sociodemographic index (SDI) quintiles. Globally, the ASPR of MSK disorders among children and adolescents increased per 100,000 population from 3048.66 (95% confidence interval [CI]: 2336.68-3887.02) in 1990 to 3105.46 (95% CI: 2421.09-3904.95) in 2021 (AAPC 0.06 [95% CI: 0.05-0.07]). In 2021, individuals aged 15-19 experienced the highest burden compared to those aged 5-9 and 10-14. In 2021, high SDI countries had the highest ASIR, ASPR, ASDR of MSK disorders. The AAPC of ASPR in high SDI countries showed a stark contrast to that in low SDI countries for the same period (AAPC 0.48 vs. AAPC -0.03). From 1990 to 2021, in low SDI and low-middle SDI countries, the increase in DALYs was primarily due to population growth. However, in middle SDI, high-middle, and high SDI countries, the increases were mainly due to epidemiological changes. Globally, patients aged 10-14 experienced better care compared to those in the 5-9 and 15-19 age groups. Specific preventive health measures are needed for females and adolescents aged 15-19 in high SDI countries.

Global burden, risk factor analysis, and prediction study of leukaemia from 1990 to 2030.

Leukaemia is a devastating disease with an incidence that progressively increases with advancing age. The World Health Organization has designated 2021-30 as the decade of healthy ageing, highlighting the need to address age-related diseases. We estimated the disease burden of leukaemia and forecasted it by 2030. Based on the Global Burden of Disease 2019 database, we systematically analysed the geographical distribution of leukaemia and its subtypes. We used Joinpoint regression and Bayesian age-period-cohort models to evaluate incidence and mortality trends from 1990 to 2019 and projections through 2030. We analysed five leukaemia subtypes and the impact of age, gender, and social development. Decomposition analysis revealed the effects of disease burden on ageing and population growth. We used frontier analysis to illustrate the potential of each country to reduce its burden based on its development levels. Globally, the absolute numbers of leukaemia incidence and mortality have increased, while the age-standardised rates (ASRs) have shown a decreasing trend. The disease burden was more pronounced in men, the elderly, and regions with a high socio-demographic index (SDI), where ageing and population growth played varying roles across subtypes. From 2000 to 2006, disease burdens were most effectively controlled. Global ASRs of incidence might stabilise, while ASRs of death are expected to decrease until 2030. Frontier analysis showed that middle and high-middle SDI countries have the most improvement potential. Smoking and high body mass index were the main risk factors for leukaemia-related mortality and disability-adjusted life years. The absolute number of leukaemia cases has increased worldwide, but there has been a sharp decline in ASRs over the past decade, primarily driven by population growth and ageing. Countries with middle and high-middle SDI urgently need to take action to address this challenge.

Impact of dietary risk on global ischemic heart disease: findings from 1990–2019

Ischemic heart disease (IHD) is a condition in which the heart is starved of oxygen. Knowing the dietary risk factors implementing appropriate nutritional interventions in this regard seems essential. Therefore, the present study was carried out to determine the epidemiological features of IHD affected by dietary risks. This study used data from the Global Burden of Disease (GBD) study. In this study, we collected information on death, years lived with disability (YLD), and disability-adjusted life years (DALYs) of IHD affected by dietary risks in one hundred thousand people with 95% confidence based on the direct Age Standard Rate (ASR). We applied these data based on the Socio-demographic Index (SDI). In 2019, the number of IHD deaths, YLDs, and DALYs attributable to dietary risks was 62.43 million (95% UI [50.97–73.63] per 100,000 population), 36.88 (95% UI [23.87–53.32] per 100,000 population), and 1271.32 (95% UI [1061.29–1473.75] per 100,000 population), respectively. We found that the lowest DALYs of IHD affected by dietary risks by ASR are for high SDI countries. Most dietary risk factors related to IHD in countries with high and high middle SDI were related to a diet high in red and processed meat, sodium, and low in legumes, but in countries with low and low middle SDI, it was related to a diet low in fiber, fruit, nuts and seeds, PUFA, seafood W3 fatty acids, vegetables and whole grain. Considering that the dietary risk factors related to IHD are different based on SDI, it is necessary to consider nutritional interventions according to SDI.

Global burden of stroke in adolescents and young adults (aged 15–39 years) from 1990 to 2019: a comprehensive trend analysis based on the global burden of disease study 2019

SummaryIntroductionThe incidence of stroke is rising among individuals aged 15–39. Insufficient research targeting this age group hampers the development of effective strategies. This study analyzes data from the Global Burden of Disease Study 2019 (GBD 2019) to examine trends from 1990 to 2019 and propose future interventions.MethodsData on ischemic strokes, intracerebral hemorrhage, and subarachnoid hemorrhage from 1990 to 2019 was collected from the Global Health Data Exchange (GHDx) platform. We used the Annual Average Percentage Change (AAPC) to assess global trends in incidence, prevalence, Disability-Adjusted Life Years (DALYs), and mortality rates across various stroke categories. Joinpoint models identified significant years of trend inflection. Trend analyses were segmented by age, gender, and Sociodemographic Index (SDI).FindingsFrom 1990 to 2019, the global incidence of ischemic stroke within the adolescents and young adults (AYAs) cohort declined from 1990 to 1999, further decreased from 2000 to 2009, and then increased from 2010 to 2019. The overall AAPC p-value showed no significant difference. Mortality rates for ischemic strokes were consistently reduced during this period. The overall incidence rate of intracerebral hemorrhage has exhibited a downward trend. Meanwhile, the incidence rate of subarachnoid hemorrhage decreased from 1990 to 2009, yet saw a resurgence from 2010 to 2019. Male ischemic stroke incidence grew more than female incidence, but both absolute incidence and rates were higher for females. Differences in SDI levels were observed, with the fastest increase in incidence occurring in low-middle SDI regions, followed by high SDI regions, and the smallest increase in low SDI regions. Conversely, the most rapid decline was noted in high-middle SDI regions, with no significant change observed in middle SDI regions.ConclusionA concerning trend of increasing ischemic stroke incidence, DALYs, and prevalence rates has emerged in the global 15–39 age group, especially among those aged 30–39. This increase is evident across regions with varying SDI classifications. To combat this alarming trend among adolescents and young adults, enhancing preventive efforts, promoting healthier lifestyles, strengthening the healthcare system’s responsiveness, and maintaining vigilant epidemiological monitoring is essential.

Global, regional, and national burden of ischemic stroke, 1990–2021: an analysis of data from the global burden of disease study 2021

Ischemic stroke remains a major contributor to global mortality and morbidity. This study aims to provide an updated assessment of rates in ischemic stroke prevalence, incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021, specifically focusing on including prevalence investigation alongside other measures. The analysis is stratified by sex, age, and socio-demographic index (SDI) at global, regional, and national levels. Data for this study was obtained from the 2021 Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). To quantify temporal patterns and assess trends in age-standardized rates of ischemic stroke prevalence (ASPR), incidence (ASIR), mortality (ASDR), and DALYs, estimated annual percentage changes (EAPCs) were computed over the study period. The analyses were disaggregated by gender, 20 age categories, 21 GBD regions, 204 nations/territories, and 5 SDI quintiles. R statistical package V 4.4.2 was performed for statistical analyses and plot illustrations. In 2021, the global burden of ischemic stroke remained substantial, with a total of 69,944,884.8 cases with an ASPR of 819.5 cases per 100,000 individuals (95% UI: 760.3-878.7). The ASIR was 92.4 per 100,000 people (95% UI: 79.8-105.8), while the ASDR was 44.2 per 100,000 persons (95% UI: 39.3-47.8). Additionally, the age-standardized DALY rate was 837.4 per 100,000 individuals (95% UI: 763.7-905). Regionally, areas with high-middle SDI exhibited the greatest ASPR, ASIR, ASDR, and age-standardized DALY rates, whereas high SDI regions had the lowest rates. Geospatially, Southern Sub-Saharan Africa had the highest ASPR, while Eastern Europe showed the highest ASIR. The greatest ASDR and age-standardized DALY rates were observed in Eastern Europe, Central Asia, as well as North Africa, and the Middle East. Among countries, Ghana had the highest ASPR, and North Macedonia had both the highest ASIR and ASDR. Furthermore, North Macedonia also exhibited the highest age-standardized DALY rate. Regions with high-middle and middle SDI continued to experience elevated ASPR, ASIR, ASDR and age-standardized DALY rates. The highest ischemic stroke burden was observed in Southern Sub-Saharan Africa, Central Asia, Eastern Europe, and the Middle East. None.

Global, regional, and national analyses of the burden of colorectal cancer attributable to diet low in milk from 1990 to 2019: longitudinal observational study.

Globally, diet low in milk is the third greatest risk factor for colorectal cancer (CRC). However, there has been a lack of detailed worldwide analysis of the burden and trends of CRC attributable to diet low in milk. We aim to assess the spatiotemporal trends of CRC-related mortality and disability-adjusted life-years (DALYs) attributable to diet low in milk at the global, regional, and national levels from 1990 to 2019. Data of mortality, DALYs, age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of CRC attributable to diet low in milk were extracted from the Global Burden of Disease (GBD) 2019 study. The burden of CRC attributable to diet low in milk was estimated using the ASMR and ASDR, while accounting for sex, age, country, and socio-demographic index (SDI). From 1990 to 2019, the estimated annual percentage change (EAPC) was calculated to clarify the temporal trends in the ASMR and ASDR attributable to diet low in milk. In 2019, there were 166,456 (95% UI = 107,221-226,027) deaths and 3,799,297 (95% UI = 2,457,768-5,124,453) DALYs attributable to diet low in milk, accounting for 15.3 and 15.6% of CRC-related deaths and DALYs in 2019. CRC-related deaths and DALYs attributed to diet low in milk increased by 130.5 and 115.4%, from 1990 to 2019. The burden of CRC attributable to diet low in milk varied notably among regions and nations. High-middle SDI regions had the highest ASDR and ASMR of CRC linked to diet low in milk, while there was a slight downward trend high SDI regions. Among geographical regions, East Asia had the highest number of CRC-related deaths and DALYs attributable to diet low in milk. Notably, the burden of CRC was highest in males and the elderly. With coefficients of -0.36 and -0.36, the EAPC in ASMR and ASDR was significantly inversely correlated with the Human Development Index in 2019. Globally, the number of CRC deaths attributable to diet low in milk has continued to increase over the last 30 years. Therefore, government and authorities should conduct education campaigns to encourage individuals to increase daily milk intake.

Association of Countries' Atopic Dermatitis Burden and Sociodemographic Index with Topical Calcineurin Inhibitor Utilization.

Background: There is limited knowledge on international trends in topical calcineurin inhibitor (TCI) utilization. Objective: To describe international TCI utilization trends from 2012 to 2019 and evaluate the relationship of country-level economic status, geographic location, and atopic dermatitis (AD) disease burden with drug utilization. Methods: We used IQVIA MIDAS® pharmaceutical quarterly sales data to attain country-level purchasing of TCIs in grams from 2012 to 2019. A multivariable linear regression estimated the association between countries' sociodemographic index (SDI), AD disability-adjusted life year (DALY) rates, and geographic location with TCI utilization. Results: A total of 68 countries were included in our analysis. From 2012 to 2019, overall TCI utilization increased by 66% but remained 11.2 times higher in high-sociodemographic compared with low-middle/low-sociodemographic countries. SDI and geographic location were associated with greater TCI utilization in multivariable analyses, whereas AD DALY rates were not. High-SDI countries used 21,476 grams (95% confidence interval [CI]: 11,915 to 31,036) and high-middle SDI countries used 9,403 grams (95% CI: -393 to 19,200) more TCIs per 100,000 people compared with low-middle/low-SDI countries, respectively. Northern hemisphere countries used 8,588 grams more TCIs per 100,000 people (95% CI: 612 to 16,564). Conclusions: We demonstrated greater TCI utilization among high-SDI compared with lower SDI countries.

Geographic and sociodemographic variations in disease burden, epidemiological trends, and risk factors of early-onset lung cancer: A global analysis.

11169 Background: Exploring the emerging trend of early-onset lung cancer (EOLC) burden is pivotal for guiding the implementation of preventive strategies among young adults. We aimed to provide a comprehensive examination of the geographic and sociodemographic variations in the disease burden, along with epidemiological trends and risk factors associated with EOLC over the past three decades. Methods: EOLC refers to lung cancer diagnosed in individuals aged 20-49 years. Utilizing the GBD 2019 data, we estimated the age-standardised incidence, mortality, and disability-adjusted life years (DALYs) rates for EOLC by sex, socio-demographic index (SDI) quintiles, and geographical location for the period from 1990 to 2019. We investigated the relationships between concomitant risk factors and EOLC incidence at national level, and calculated the DALYs attributable to risk factors. The relative contribution of population growth, population ageing, and epidemiological changes to the variations in burden of EOLC over study period was measured using the decomposition analysis. Incidence was forecast to 2040 using the Bayesian age-period-cohort model. Results: A total of 135,704 EOLC cases, equating to a age-standardised incidence rate of 4.0 (95% UI 3.6 to 4.3) per 100,000, were estimated in 2019 worldwide and was the second leading cause of cancer death among young adults, with higher disease burden occurred in males and those from middle and high-middle SDI regions. An overall decreasing trend in burden of EOLC was observed globally; such trends were more pronounced among males and followed a gradient across SDI levels, with the greater decrease observed in high and high-middle SDI regions. Sex, tobacco smoking prevalence, per capita cigarette-equivalent estimates, average age of smoking initiation, ambient ozone pollution, and GDP per capita were independently and significantly associated with EOLC incidence at the population level. Smoking remained the top contributor to burden of EOLC, with the exception of Andean Latin America, North Africa, and the low SDI regions, where ambient particulate matter pollution and household air pollution from solid fuels ranked as the foremost attributable risk factors. Population growth was the primary driver behind the global increase in EOLC cases in low and low-middle SDI regions, while epidemiological changes accounted for the most substantial reduction in EOLC cases across most regions. The global incidental cases of EOLC was projected to increase by 31.1% in 2040, with a more pronounced increase in females and those from high-middle and middle SDI locations. Conclusions: Our findings underscore significant geographic and sociodemographic disparities in the epidemiological burden of EOLC, emphasizing the necessity for policymakers to devise and apply region-specific, evidence-driven preventive strategies.

Global burden and socioeconomic impact of knee osteoarthritis: a comprehensive analysis.

To report the trend changes of the prevalence, incidence, and disability-adjusted life years (DALYs) of knee osteoarthritis (KOA) according to age, sex, sociodemographic index (SDI), and income. This analysis used estimates from the broader Global Burden of Disease (GBD) study 2019, which covered 201 countries from 1990 to 2019. National prevalence, incidence, and DALYs were shown by using ggplot2 and maps packages. Five-year intervals were used for age groupings. The Commonwealth and the World Bank income classifications were used for income grouping. Globally, there were ~364.58 million prevalent cases (females: 225.16 million), 29.51 million incident cases (females: 17.53 million), and 11.53 million DALYs (females: 7.09 million) due to KOA in 2019. The Western Pacific Region had a high endemicity of ~7,319.87 cases per 100,000 people (7.64%). Japan's prevalence rate (12,610.12 cases per 100,000 population) was 10 times that of Somalia (1,178.23) in 2019. In 200 countries (except the United Arab Emirates), the prevalence, incidence, and DALY rates of KOA in 2019 were higher among females than among males and increased with age up to the oldest age group. The prevalence was highest in the high-middle SDI countries, and the incidence and DALYs were highest in the middle SDI countries. There was a large burden of KOA worldwide, with some notable intercountry variation. Some countries had 10 times the burden of other countries. Increasing population awareness regarding the prevalence, incidence, and DALYs of KOA with a focus on the population in the Western Pacific Region is needed, particularly for older females. informs health policy development, and contributes to improving the efficiency, equity, and effectiveness of healthcare systems.

Global, regional, and national burden of atrial fibrillation/flutter related to metabolic risks over three decades: estimates from the global burden of disease study 2019.

Atrial fibrillation/atrial flutter (AF/AFL) remains a significant public health concern on a global scale, with metabolic risks playing an increasingly prominent role. This study aimed to investigate comprehensive epidemiological data and trends concerning the metabolic risks related-AF/AFL burden based on the data from the Global Burden of Disease study in 2019. The analysis of disease burden focused on numbers, age-standardized rates of deaths, disability-adjusted life years (DALYs), and estimated annual percentage change, while considering factors of age, sex, sociodemographic index (SDI), and locations. In 2019, there was a culmination of 137 179 deaths and 4 099 146 DALYs caused by metabolic risks related-AF/AFL worldwide, with an increase of 162.95% and 120.30%, respectively from 1990. High and high-middle SDI regions predominantly carried the burden of AF/AFL associated with metabolic risks, while a shift towards lower SDI regions had been occurring. Montenegro had the highest recorded death rate (7.6 per 100 000) and DALYs rate (146.3 per 100 000). An asymmetrically inverted V-shaped correlation was found between SDI and deaths/DALYs rates. Moreover, females and the elderly exhibited higher AF/AFL burdens, and young adults (over 40 years old) also experienced an annual increase. The global AF/AFL burden related to metabolic risks has significantly increased over the past three decades, with considerable spatiotemporal, gender-based, and age-related heterogeneity. These findings shed valuable light on the trends in the burden of metabolic risks related-AF/AFL and offered insights into corresponding strategies.

Socioeconomic characteristics, cancer mortality, and universal health coverage: A global analysis

Achieving universal health coverage (UHC) involves all individuals attaining accessible health interventions at an affordable cost. We examined current patterns and temporal trends of cancer mortality and UHC across sociodemographic index (SDI) settings, and quantified these association. We used data from the Global Burden of Disease Study 2019 and Our World in Data. The UHC effective coverage index was obtained to assess the potential population health gains delivered by health systems. The estimated annual percentage change (EAPC) with a 95% confidence interval (CI) was calculated to quantify the trend of cancer age-standardized mortality rate (ASMR). A generalized linear model was applied to estimate the association between ASMR and UHC. The high (EAPC= -0.9% [95% CI, -1.0%, -0.9%]) and high-middle (-0.9% [-1.0%, -0.8%]) SDI regions had the fastest decline in ASMR (per 100,000) for total cancers from 1990 to 2019. The overall UHC effective coverage index increased by 27.9% in the high-SDI quintile to 62.2% in the low-SDI quintile. A negative association was observed between ASMR for all-cancer (adjusted odds ratio [OR]= 0.87 [0.76, 0.99]), stomach (0.73 [0.56, 0.95]), breast (0.64 [0.52, 0.79]), cervical (0.42 [0.30, 0.60]), lip and oral cavity (0.55 [0.40, 0.75]), and nasopharynx (0.42 [0.26, 0.68]) cancers and high UHC level (the lowest as the reference). Our findings strengthen the evidence base for achieving UHC to improve cancer outcomes. This work is funded by the China National Natural Science Foundation and Chinese Academy of Medical Sciences Innovation Fund for Medical Science.

Global trends and differences in the burden of alcohol use disorders attributable to childhood sexual abuse by sex, age, and socio-demographic index: Findings from the Global Burden of Disease Study 2019

BackgroundChildhood sexual abuse (CSA) is a severe global problem associated with alcohol use disorder (AUD). Previous studies have confirmed this relationship; however, there is a lack of research on the disease burden of AUD attributable to CSA. ObjectiveTo analyze global spatiotemporal trends and differences in the disease burden of AUD attributable to CSA and its relationship with age, sex, and the sociodemographic index (SDI). Participants and settingData from the Global Burden of Disease 2019 Public Database. MethodsSummary exposure value (SEV) was used to evaluate CSA. Disability-adjusted life year (DALY), years lived with disability (YLD), years of life lost (YLL), and their annual rates of change were used to evaluate disease burden. Cluster analysis based on Ward's method was used to examine the global burden associated with age, sex, and SDI. A 95 % uncertainty intervals (UI), excluding 0, was considered statistically significant. ResultsIn 2019, 1.63 million (95 % UI 0.23–3.90 million) DALYs of AUD were caused by CSA and the age-standardized rates (ASRs) of DALY was 19.77 (95 % UI 2.78–47.46) globally. Annual rates of change in DALY of people over 65 years of age increased from 1990 to 2019 in all regions except the High-middle SDI regions. The ASRs of DALY of females in High SDI regions, were always at a much higher level than other SDI regions, and showed an upward trend from 1990 to 2019 (DALY 1990: 20.38 [95 % UI 2.87–47.77], 2019: 23.61 [95 % UI 3.55–54.94]). ConclusionsSubstantial geographical differences were observed in the burden of AUD attributable to CSA. The level of CSA exposure was inconsistent with the related burden of AUD in different regions according to the sociodemographic index. The burden of disease increased in the elderly population and in females in high sociodemographic index regions.