Joinpoint Regression Analysis Research Articles

Spatial and temporal analysis of thyroid cancer incidence in Guilan Province, Northern Iran, 2009–2018

BackgroundThyroid cancer is one of the most common malignancies of the endocrine system, the fifth most common malignancy in women worldwide, and the second most common cancer in women over 50 in 2019. It is the sixth most common cancer in both sexes and the third most common cancer in women in Guilan province. This study was conducted to describe the geographic variation and investigate any changes in the trend of the thyroid cancer incidence rate. MethodsThis study was conducted on the data of the Guilan University of Medical Sciences cancer registration system. The crude and age-standardized incidence rate was calculated per 100,000 person-years. Joinpoint regression analysis evaluated the time trends and annual percent changes (APC). The incidence rate was estimated separately for each city and high-risk areas were shown on the province map using GIS software. Results1742 cases of thyroid cancer (83.7 % in women and 16.3 % in men) were registered in Guilan province from 2009 to 18. The incidence of thyroid cancer was 5.1-fold higher in women than men. The results of the joinpoint regression analysis showed that the age-standardized incidence rate of thyroid cancer in both sexes has increased significantly over ten years (APC: 26.4; 95 %CI: 22.5–30.4), (P-value < 0.001). In our study, Astaneh-ye Ashrafiyeh, Lahijan, and Langarud cities were identified as high-risk areas of the province for both sexes. ConclusionThe trend of incidence of thyroid cancer in Guilan province is increasing. Also, a wide geographical variation was found in the incidence of thyroid cancer.

Global, regional, and national burden of thalassemia, 1990–2021: a systematic analysis for the global burden of disease study 2021

Anemia is a significant contributor to the global disease burden, of which thalassemia is the most common hereditary anaemic disease. Previous estimates were based on data that were geographically limited and lacked comprehensive global analysis. This study provides the prevalence, incidence, mortality and disability-adjusted life years (DALYs) of thalassemia in 204 countries and regions of thalassemia between 1990 and 2021, focusing on the age structure and time trends of the disease burden. To provide effective information for health policy, allocation of medical resources and optimization of patient management programs. Using the standardised Global Burden of Disease (GBD) methodologies, we aimed to derive a more precise representation of the health burden posed by thalassemia by considering four distinct types of epidemiological data, namely the incidence at birth, prevalence, mortality and DALYs. The presented data were meticulously estimated and displayed both as numerical counts and as age-standardised rates per 100,000 persons of the population, accompanied by uncertainty interval (UI) to highlight potential statistical variability. The temporal trends spanning the years 1990-2021 were subjected to a rigorous examination utilizing Joinpoint regression analysis. This methodological approach facilitated the computation of the annual percentage change (APC) and the average annual percentage change (AAPC), along with their corresponding 95% confidence intervals (CIs). Globally, the age-standardized prevalence rates (ASPR), age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and age-standardized DALYs rates for thalassemia in 2021 were 18.28 per 100,000 persons (95% UI 15.29-22.02), 1.93 per 100,000 persons (95% UI 1.51-2.49), 0.15 per 100,000 persons(95% UI 0.11-0.20), and 11.65 per 100,000 persons (95% UI 8.24-14.94), respectively. Compared to 1990, these rates have decreased by 0.18 (95% UI-0.22 to-0.14), 0.25 (95% UI-0.30 to-0.19), 0.48 (95% UI-0.60 to-0.28), and 0.49 (95% UI-0.62 to-0.29) respectively. In 2021, the ASIR of thalassemia was highest in East Asia at 7.35 per 100,000 persons (95% UI 5.37-10.04), and ASMR was highest in Southeast Asia at 0.37 per 100,000 persons (95% UI 0.29-0.45).Gender comparisons showed negligible differences in disease burden, with the highest prevalence noted in children under five, decreasing with age. The global ASPR and ASMR declined from 1990 to 2021 overall, though an increasing trend in prevalence was found among the elderly. Joinpoint analysis revealed that the global ASPR increased between 2018 and 2021 (APC=9.2%, 95% CI: 4.8%-13.8%, P<0.001), ASIR decreased (APC=-7.68%, 95% CI:-10.88% to-4.36%, P<0.001), and there was a significant rise in ASMR from 2019 to 2021 (APC=4.8%, 95% CI: 0.1%-9.6%, P<0.05). Trends in ASPR and ASMR varied across regions, with notable changes in South Asia. The global burden of thalassemia, reflected in its prevalence, incidence, mortality, and DALYs, exhibits significant disparities. Geographic and demographic shifts in disease distribution have been observed from 1990 to 2021, with an overall decrease in burden, yet an increase in cases among the elderly population. Analysis of epidemiological trends over time highlights the influence of health policies and significant public health interventions on thalassemia outcomes. There data are crucial for healthcare professionals, policymakers, and researchers to refine and enhance management strategies, aiming to further mitigate thalassemia's global impact. National Natural Science Foundation of China; Guizhou Province Science and Technology Project; Guizhou Province Science and Technology Foundation of Health Commission.

Two decades of influenza and pneumonia mortality trends: Demographics, regional shifts and disparities in the United States: 1999 to 2020

In the 20th century, influenza and pneumonia constituted the largest proportion of infectious disease deaths in the United States. Despite progress in management, US mortality trends for these diseases have not been thoroughly investigated. We aim to examine the patterns of influenza and pneumonia-related deaths among US residents. Crude death rates and age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using influenza and pneumonia mortality data (International Classification of Diseases, 10th revision codes: J09-J18) from the CDC WONDER database. Annual percentage changes with a 95% confidence interval were determined using joinpoint regression analysis. Average annual percentage changes were computed as the weighted average of annual percentage changes. From 1999 to 2020, US influenza and pneumonia deaths totaled 1,257,088 (AAMR: 17.09), with a significantly decreasing AAMR (-2.94). Males had a higher AAMR (20.13) than females (15.02). Non-Hispanic American Indians had the highest AAMR (20.44), while Hispanics had the lowest AAMR (13.91). The Northeast had the highest AAMR (18.02). All other regions had similar AAMRs. Rural regions had a consistently higher AAMR (19.80) than urban regions (AAMR: 16.51). Tailoring interventions towardhigh-risk groups can enhance the effectiveness of preventive measures, vaccination, and healthcare access.

Infant, Neonatal, and Post-neonatal Mortality in Greece: A Nationwide Time-Trend Analysis.

Infant mortality is a crucial perinatal measure and is also regarded as an important public health indicator. This study aimed to comprehensively present time trends in infant, neonatal, and post-neonatal mortality in Greece. The annual infant mortality rate (IMR), the neonatal mortality rate (NMR), and the post-neonatal mortality rate (PNMR) were calculated based on official national data obtained from the Hellenic Statistical Authority, spanning 67 years from 1956 to 2022. The time trends of the mortality rates were evaluated using joinpoint regression analysis, and the annual percent changes (APC) and the overall average annual percent change (AAPC) were calculated with a 95% confidence interval (95% CI). The IMR exhibited accelerating declines over more than 50 years, with an APC of -1.9 (-2.8 to -1.0) from 1956 to 1968, -5.4 (-5.6 to -5.2) from 1968 to 1999, and -7.3 (-8.9 to -5.7) between 1999 and 2008. In 2008, IMR reached its all-time low of 2.7 per 1,000 live births, down 16.6-fold from its peak at 44.1 per 1,000 live births in 1957. This improving trend was reversed following the onset of the economic crisis in the country, leading to a 57% increase in IMR from 2008 to 2016, with an upward trend APC of 3.4 (1.2 to 5.5). In the recent period 2016-2022, there was an improvement with an APC of -3.7 (-6.2 to -1.1), resulting in an IMR of 3.1 per 1,000 live births in 2022. The decrease in IMR was estimated to have prevented 209,109 infant deaths in the country from 1958 to 2022. From 1956 to 2022, the IMR decreased with an AAPC of -3.9 (-4.3 to -3.4), while the PNMR saw a decline with an AAPC of -4.5 (-5.1 to -3.9) and the NMR with an AAPC of -3.2 (-3.7 to -2.6). Greece achieved an impressive decrease in infant mortality rates, but this progress was halted and completely reversed during the economic crisis. Although there have been some recent improvements after the country's economic recovery, the rates have yet to reach pre-crisis levels.

Liver Cancer Incidence in Kazakhstan: Fifteen-Year Retrospective Study.

The aim is to study the trends of liver cancer (LC) incidence in the regional context in Kazakhstan. The retrospective study was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. Between 2005 and 2019, 13,510 cases of LC were documented, comprising 59.3% males and 40.7% females. Most diagnoses were seen in age groups 55-59 years (13.3%) to 75-79 years (11.7%). LC patients' average age increased from 63.6 to 64.5 years. Incidence rates per 100,000 peaked at ages 65-69 years (35.1±1.0) and 70-74 years (43.3±1.0). LC incidence notably rose in the 70-74 years age group (APC=+0.89), contrasting with declining trends in younger age groups. Regional incidence variations revealed diverse patterns, mostly demonstrating unimodal increases, and some regions displaying bimodal growth. The age-standardized incidence rate was 5.7±0.1 per 100,000, declining from 2005 to 2012 (APC: -3.93), then rising until 2019 (APC: +1.13). Gender-specific standardized rates showed varied trends. Analyses of standardized indicators indicated declining trends in most regions but increased values in specific areas. Thematic maps classified incidence rates based on standardized indicators: low (up to 5.22), average (5.22 to 7.11), high (above 7.11 per 100,000 for the entire population). The study on liver cancer in Kazakhstan reveals marked gender and age differences. The standardized incidence rate among men was twofold greater than that among women. A distinct rise in cases was noted among individuals aged 70-74 years. Regional variations in incidence were evident. These findings emphasize the necessity for focused research to comprehend the causes behind these differences, enabling customized interventions for Kazakhstan's population.

Changing trends in the disease burden of uterine cancer globally from 1990 to 2019 and its predicted level in 25 years.

We aim to evaluate the global, regional, and national burden of Uterine Cancer (UC) from 1990 to 2019. We gathered UC data across 204 countries and regions for the period 1990-2019, utilizing the Global Burden of Disease Database (GBD) 2019 public dataset. Joinpoint regression analysis was employed to pinpoint the year of the most significant changes in global trends. To project the UC trajectory from 2020 to 2044, we applied the Nordpred analysis, extrapolating based on the average trend observed in the data. Furthermore, the Bayesian Age-Period-Cohort (BAPC) model with integrated nested Laplace approximations was implemented to confirm the stability of the Nordpred analysis predictions. Globally, the age-standardized rate (ASR) of incidence for UC has increased from 1990 to 2019 with an Average Annual Percentage Change (AAPC) of 0.50%. The ASR for death has declined within the same period (AAPC: -0.8%). An increase in the ASR of incidence was observed across all Socio-demographic Index (SDI) regions, particularly in High SDI regions (AAPC: 1.12%), while the ASR for death decreased in all but the Low SDI regions. Over the past 30 years, the highest incidence rate was observed in individuals aged 55-59 (AAPC: 0.76%). Among 204 countries and regions, there was an increase in the ASR of incidence in 165 countries and an increase in the ASR of deaths in 77 countries. Our projections suggest that both the incidence and death rates for UC are likely to continue their decline from 2020 to 2044. UC has significantly impacted global health negatively, with its influence stemming from a range of factors including geographical location, age-related and racial disparities, and SDI.

Temporal trends in the prevalence and death of ischemic heart disease in women of childbearing age from 1990 to 2019: a multilevel analysis based on the Global Burden of Disease Study 2019.

Our objective is to describe the current prevalence and death of ischemic heart disease (IHD) in women of childbearing age (WCBA) at the global, regional, and national levels and to analyze its temporal trends from 1990 to 2019. WCBA was defined as women aged 15-49 years. Estimates and 95% Uncertainty Intervals (UI) of IHD prevalence and death numbers for seven age groups were extracted from the 2019 Global Burden of Disease Study. The age-standardized prevalence and death rate (ASPR and ASDR) of IHD in WCBA was estimated using the direct age-standardization method. Joinpoint regression analysis was used to calculate average annual percent change (AAPC) to represent the temporal trends from 1990 to 2019. Between 1990 and 2019, the global ASPR of IHD experienced a 3.21% increase, culminating in 367.21 (95% UI, 295.74-430.16) cases per 100,000 individuals. Conversely, the ASDR decreased to 11.11 (95% UI, 10.10-12.30) per 100,000 individuals. In 2019, among the five sociodemographic index (SDI) regions, the highest ASPR was observed in the high-middle SDI region, whereas the highest ASDR was found in the low-middle SDI region. Regionally, the Caribbean reported the highest ASPR (563.11 per 100,000 individuals; 95% UI, 493.13-643.03), and Oceania reported the highest ASDR (20.20 per 100,000 individuals; 95% UI, 13.01-31.03). At the national level, Trinidad and Tobago exhibited the highest ASPR (730.15 per 100,000 individuals; 95% UI, 633.96-840.13), and the Solomon Islands had the highest ASDR (77.77 per 100,000 individuals; 95% UI, 47.80-121.19). Importantly, over the past three decades, the global ASPR has seen a significant increase [AAPC = 0.11%, 95% Confidence Interval (CI): 0.09-0.13; P < 0.001], while the ASDR has demonstrated a significant decreasing trend (AAPC = -0.86%, 95% CI: -1.11 to -0.61; P < 0.001). Air pollution, tobacco use, high systolic blood pressure, elevated body mass index, dietary risks, and high LDL cholesterol have been identified as the leading six risk factors for IHD-related deaths among WCBA in 2019. Despite the significant decline in the global ASDR for IHD among WCBA over the last thirty years, the ASPR continues to escalate. We need to remain vigilant about the increased burden of IHD in WCBA. It calls for aggressive prevention strategies, rigorous control of risk factors, and the enhancement of healthcare coverage to mitigate the disease burden of IHD among WCBA in forthcoming years.

Temporal Fluctuations of Suicide Mortality in Japan from 2009 to 2023 Using Government Databases.

In Japan, suicide mortalities consistently decreased before the COVID-19 pandemic (from 2009 to 2019) but, conversely, increased after the pandemic outbreak from 2020 to 2022. To provide up-to-date suicide statistics in Japan, this study determined the temporal fluctuations of standardized suicide mortalities (SMRs), disaggregated by sex and age, by joinpoint regression analysis using the government suicide database, named the "Basic Data on Suicide in Region". From January 2009 to December 2023, three temporal fluctuation patterns of SMRs pertaining to working age and older adults were detected, such as attenuations of decreasing trends before the COVID-19 pandemic (from around the mid-2010s), a sharply increasing trend that coincided with the pandemic outbreak, and gradually decreased during the pandemic, but no changes at the end of the COVID-19 pandemic. In particular, the SMRs of working-age females sharply increased concurrently with the pandemic outbreak, whereas those of males did not change. However, before the pandemic, decreasing trends of the SMRs of working-age males diminished in the mid-2010s, but those of females consistently decreased. The SMRs of working-age males indicated non-significant but sharply increasing trends in early 2022, a trend that was not observed for females. In contrast to working-age adults, the SMRs of adolescents already began to increase in the mid-2010s and also indicated consistently increasing trends between the periods during and after the pandemic. These results suggest, contrary to our expectations, that the impacts of both the outbreak and end of the COVID-19 pandemic were limited regarding the increase in SMRs from 2020. Therefore, when revising suicide prevention programs in the post-COVID-19 era, it should be noted that focusing on pandemic-associated factors alone is not sufficient.

Trends and disparities in colorectal cancer hospitalizations and outcomes: a 10-year joinpoint trend study

Background Colorectal cancer (CRC) poses a significant burden on healthcare systems globally. Sociodemographic factors intricately influence CRC epidemiology, yet their impact on inpatient care remains underexplored. This study aimed to assess trends in CRC hospitalization and the effect of sociodemographic factors on outcomes of CRC patients. Methods A retrospective longitudinal analysis was conducted using data from the Healthcare Cost and Utilization Project National Inpatient Sample. Trends in CRC admissions were assessed, stratified by sociodemographic variables. Disparities in hospital-associated outcomes were examined. Statistical methods included multivariable regression and joinpoint regression analysis. Results The prevalence of CRC hospitalizations uptrended from 760 per 100,000 hospitalizations in 2010 to 841 per 100,000 hospitalizations in 2019 (P trend < 0.001). The mean age decreased from 67 to 66 years (P < 0.001). Male gender and White race were predominant across the study period. Inpatient mortality decreased from 4.5% in 2010 to 4.16% in 2019 (P trend = 0.033). On sex subgroup analysis, men had a significantly higher mortality rate (P = 0.034). Racially, Blacks had the highest mortality rate (P = 0.550) and only Whites showed a significant decline in mortality over the study period (P = 0.003). Hospitalization length decreased while total hospital charges increased. Conclusion Our study highlights sociodemographic disparities in CRC outcomes, emphasizing the need for targeted interventions to address inequity in screening, diagnosis, and treatment. Continued research is needed to inform effective healthcare practices in mitigating these disparities and improving survival outcomes.

Shifts in Diagnostic Testing for Headache in the Emergency Department, 2015 to 2021

Subarachnoid hemorrhage is typically diagnosed by noncontrast head computed tomography (CT); lumbar puncture is recommended if computed tomography is nondiagnostic, although CT cerebral angiography has been promoted as an alternative to lumbar puncture in this diagnostic pathway. The outcomes of this debate in practice have not been studied. To determine whether CT cerebral angiography use has increased in lieu of lumbar puncture among emergency department (ED) patients with headache, with an increase in unruptured intracranial aneurysm detection. This retrospective cohort study took place in 21 community EDs of an integrated health care system in Northern California between 2015 and 2021. Participants were adult (aged >17 years) health plan members with a chief concern of headache. Exclusions were prior diagnoses of subarachnoid hemorrhage, unruptured intracranial aneurysm, cerebral arteriovenous malformation, or cerebrospinal fluid shunt. Data were analyzed from October to November 2023. CT cerebral angiography and/or lumbar puncture during the ED encounter. Primary and secondary outcomes were 14-day and 90-day unruptured intracranial aneurysm detection, respectively. Safety outcomes were missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. The annual incidence of unruptured intracranial aneurysm detection was normalized to the incidence of subarachnoid hemorrhage (UIA:SAH ratio). Average annualized percentage changes were quantified using joinpoint regression analysis. Among 198 109 included ED encounters, the mean (SD) age was 47.5 (18.4) years; 140 001 patients (70.7%) were female; 29 035 (14.7%) were Black or African American, 59 896 (30.2%) were Hispanic or Latino, and 75 602 (38.2%) were White. Per year, CT cerebral angiography use increased (18.8%; 95% CI, 17.7% to 20.3%) and lumbar punctures decreased (-11.1%; 95% CI, -12.0% to -10.4%), with a corresponding increase in the 14-day UIA:SAH ratio (3.5%; 95% CI, 0.9% to 7.4%). Overall, computed tomography cerebral angiography use increased 6-fold relative to lumbar puncture, with a 33% increase in the detection of UIA. Results were similar at 90 days and robust to sensitivity analyses. Subarachnoid hemorrhage (1004 cases) and bacterial meningitis (118 cases) were misdiagnosed in 5% and 18% of cases, respectively, with no annual trends (P = .34; z1003 = .95 and P = .74; z117 = -.34, respectively). In this cohort study of ED patients with headache, increases in CT cerebral angiography use were associated with fewer lumbar punctures and higher detection of unruptured intracranial aneurysms, with no significant change in missed diagnoses of subarachnoid hemorrhage or bacterial meningitis. While this shift in diagnostic strategy appeared safe in the short-term, the long-term consequences remain unclear.

Global, regional, and national burden of stroke from 1990 to 2019: A temporal trend analysis based on the Global Burden of Disease Study 2019.

Stroke is the second leading cause of death and the leading cause of disability worldwide. However, how the prevalence of stroke varies across the world is uncertain. The aim of this study was to analyze temporal trends of prevalence for stroke, including ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) at the global, regional, and national levels. The age-standardized prevalence rates (ASPR) of stroke, IS, ICH, and SAH, along with their corresponding 95% uncertainty intervals (UI), were derived from data in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This provides estimates for the burden of 369 diseases and injuries globally in 2019, as well as their temporal trends over the past 30 years. Joinpoint regression analysis was used to analyze the 1990-2019 temporal trends by calculating the annual percentage change (APC) and average annual percentage change (AAPC), as well as their 95% confidence interval (CI). In 2019, the global ASPR of stroke was 1240.263 per 100,000 population (95% UI: 1139.711 to 1352.987), with ASPRs generally lower in Europe compared to other regions. Over the period from 1990 to 2019, a significant global decrease in ASPR was observed for stroke (AAPC -0.200, 95% CI: -0.215 to -0.183), IS (AAPC -0.059%, 95% CI: -0.077 to -0.043), SAH (AAPC -0.476, 95% CI: -0.483 to -0.469), and ICH (AAPC -0.626, 95% CI: -0.642 to -0.611). The trends of ASPR of stroke, IS, SAH, and ICH varied significantly across 204 countries and territories. Our findings highlight significant global disparities in stroke prevalence, emphasizing the need for ongoing monitoring and intensified efforts in developing regions to reduce the global burden of stroke.

Global burden of rheumatoid arthritis among adolescents and young adults aged 10-24 years: A trend analysis study from 1990 to 2019.

In recent decades, there has been a global increase in the burden of rheumatoid arthritis (RA) among adolescents and young adults (AYAs), making it a significant public health issue. However, our understanding of the disease burden, harm, and influencing factors of RA in this population remains insufficient. This study aimed to assess the trends in RA burden among AYAs aged 10-24 years from 1990 to 2019 at the global, regional, and national levels. Incidence, prevalence, and disability-adjusted life years (DALYs) rate per 100,000 population, as well as average annual percentage changes (AAPCs), of RA among individuals aged 10-24 years were reported globally, regionally, and nationally based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). These global trends were further analyzed by age, sex, and Sociodemographic index (SDI). Joinpoint regression analysis was used to determine the year in which the most significant changes in global trends occurred. Globally, the incidence of RA among AYAs increased from 4.98 per 100,000 population in 1990 to 5.41 per 100,000 population in 2019, with an AAPCs of 0.29 (95%CI: 0.26, 0.32, p < 0.001). The most significant increase occurred in 2000, while the most significant decrease occurred in 2014. The prevalence increased from 34.11 per 100,000 population in 1990 to 36.34 per 100,000 population in 2019, with an AAPCs of 0.22 (95%CI: 0.19, 0.24, p<0.001); The most significant increase was observed in 2000, and the most significant decrease occurred in 2014. DALYs rate with RA were 5.96 per 100,000 population in 1990 and 5.79 per 100,000 population in 2019 for AYAs, with an average decrease of 0.1 years per year (AAPCs = -0.1, 95%CI: -0.2, -0.01, p = 0.04). In terms of gender, the incidence, prevalence, and DALYs rate were higher for females compared to males during the same period. Regarding age, the incidence, prevalence, and DALYs rate increased with increasing age. Based on the SDI quintile, the incidence, prevalence, and DALYs rate of RA were highest in countries with high SDI and lowest in countries with low SDI from 1990 to 2019. However, the relationship between incidence and SDI is non-linear. In terms of regions, Tropical Latin America exhibited the highest incidence, prevalence, and DALYs rate, while Andean Latin America experienced the most rapid increase in incidence and prevalence. Southern Latin America saw the fastest growth in DALYs rate, whereas Southern Sub-Saharan Africa witnessed the most significant decline. In conclusion, the study revealed an overall increase in the incidence and prevalence of RA among adolescents and young adults (AYAs) over the past three decades, while DALYs rate remained relatively stable. Furthermore, the incidence, prevalence, and DALYs rate of RA were found to increase with age. Fortunately, recent proactive preventive measures and treatment methods have shown promising results. Moving forward, it is crucial to prioritize the female population and AYAs patients in order to further alleviate the global burden of RA.

Chronic lead exposure and burden of cardiovascular disease during 1990-2019: a systematic analysis of the global burden of disease study.

Cardiovascular diseases (CVD) are the leading causes of death and disability worldwide. Lead exposure is an important risk factor for CVD. In our study, we aimed to estimate spatial and temporal trends in the burden of cardiovascular disease associated with chronic lead exposure. The data collected for our study were obtained from Global Burden of Disease (GBD) study 2019 and analyzed by age, sex, cause, and location. To assess the temporal trends in burden of CVD attributable to chronic lead exposure over 30 years, we used Joinpoint regression analysis. In 2019, the number of lead exposure-attributable CVD deaths and disability-adjusted life-years (DALYs) were 0.85 and 17.73 million, 1.7 and 1.4 times more than those observed in 1990, respectively. However, the corresponding age-standardized rates (ASR) of death and DALY gradually decreased from 1990 to 2019, especially from 2013 to 2019. Over the last 30 years, among 21 GBD regions and 204 countries and territories, the High-income Asia Pacific and the Republic of Korea experienced the largest reductions in age-standardized DALY and death rates, while Central Asia and Afghanistan experienced the largest increases. Males and the elderly population suffered higher death rates and DALY burdens than females and the young population. Furthermore, we observed that higher socio-demographic index (SDI) regions demonstrated lower ASR of death and DALY rates. In 2019, the low and low-middle SDI regions, especially South Asia, exhibited the highest burden of CVD attributable to lead exposure. Our study provides a thorough understanding of the burden of CVD attributable to chronic lead exposure. The findings confirm the significance of implementing lead mitigation strategies and increasing investment in CVD prevention and treatment. These measures are crucial in reducing the burden of CVD and promoting public health on a global scale.

Prostate cancer burden in major BRICS countries, 1990-2019: findings from the 2019 global burden of disease study.

This study assessed prostate cancer burden and trends in major BRICS countries (Brazil, Russia, India, China, and South Africa) from 1990 to 2019. Utilizing Global Burden of Disease Study 2019 data, we calculated age-standardized rates for prostate cancer incidence, prevalence, mortality, and disability-adjusted life years (DALYs) with 95% uncertainty intervals (UIs). Joinpoint regression analysis determined the average annual percentage change (AAPC) for trend characterization. Prostate cancer ranked highest in China for incidence, prevalence, mortality, and DALYs. In 2019, Brazil had the highest age-standardized incidence rate (ASIR) [55.029 (95% UI: 47.744-81.831)] and age-standardized prevalence rate (ASPR) [372.511 (95% UI: 327.549-549.128)], while South Africa recorded the highest age-standardized mortality rate (ASMR) [42.241 (95% UI: 32.146-47.933)], and age-standardized DALY rate (ASDR) [666.085 (95% UI: 522.626-764.612)]. ASIR and ASPR increased significantly over three decades (AAPC > 0), with varying ASMR and ASDR trends. Prostate cancer poses a significant public health challenge. While incidence and prevalence rise, mortality declines in China, India, and Brazil. Tailored health policies are crucial to address diverse disease burden characteristics.

Global burden of young-onset gastric cancer: a systematic trend analysis of the global burden of disease study 2019

BackgroundWhile gastric cancer is generally declining globally, the temporal trend of young-onset (< 40 years) gastric cancer remains uncertain. We performed this analysis to determine the temporal trends of young-onset gastric cancer compared to late-onset cancer (≥ 40 years).MethodsWe extracted cross-sectional data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The burden of gastric cancer from 1990 to 2019 was assessed through indicators including incidence and mortality rates, which were classified at global, national, and regional levels, and according to socio-demographic indexes (SDI) and age or sex groups. Joinpoint regression analysis was used to identify specific years with significant changes. The correlation between AAPC with countries' average SDI was tested by Pearson’s Test.ResultsThe global incidence rate of young-onset gastric cancer decreased from 2.20 (per 100,000) in 1990 to 1.65 in 2019 (AAPC: − 0.95; 95% confidence interval [CI] − 1.25 to − 0.65; P < 0.001). Late-onset cancer incidence also decreased from 59.53 (per 100,000) in 1990 to 41.26 in 2019 (AAPC: − 1.23; 95% CI − 1.39 to − 1.06, P < 0.001). Despite an overall decreasing trend, the incidence rate of young-onset cancer demonstrated a significant increase from 2015 to 2019 (annual percentage change [APC]: 1.39; 95% CI 0.06 to 2.74; P = 0.041), whereas no upward trend was observed in late-onset cancer. Mortality rates of young- and late-onset cancer both exhibited a significant decline during this period (AAPC: − 1.82; 95% CI − 2.15 to − 1.56; P < 0.001 and AAPC: − 1.69, 95% CI − 1.79 to − 1.59; P < 0.001). The male-to-female rate ratio for incidence and mortality in both age groups have been increasing since 1990. While countries with high SDI have had a greater decline in the incidence of late-onset gastric cancer (slope of AAPC change: − 0.20, P = 0.004), it was not observed in young-onset cancer (slope of AAPC change: − 0.11, P = 0.13).ConclusionsThe global incidence and mortality rates of both young- and late-onset gastric cancer have decreased since 1990. However, the incidence rate of young-onset cancer has demonstrated a small but significant upward trend since 2015. There was disparity in the decline in young-onset gastric cancer among male and high SDI countries. These findings could help to inform future strategies in preventing gastric cancer in younger individuals.

Global, regional, and national burdens of early onset pancreatic cancer in adolescents and adults aged 15-49 years from 1990 to 2019 based on the Global Burden of Disease Study 2019: a cross-sectional study.

Early-onset pancreatic cancer (EOPC) in younger populations (age ≤50 years) is likely to be a more aggressive phenotype characterized by poor differentiation. The emerging analysis of the global burden of EOPC is limited and outdated. To systematically investigate the burden and trend of EOPC based on global populations. In this systematic analysis based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, the authors present the number of cases, age-standardized rates (ASRs) per 100000 population, and risk factors for 204 countries and territories. The average annual percentage changes (AAPCs) for the incidence, mortality, and disability-adjusted life-years (DALYs) of EOPC were calculated using joinpoint regression analysis. According to the GBD 2019 estimates, there were 36852 new cases of EOPC and 32004 related deaths. East Asia had the highest number of cases, with 11401 incidences and 10149 deaths. The ASRs were 0.94 per 100000 individuals for incidence and 0.81 per 100000 for mortality. From 1990 to 2019, the age-standardized incidence increased by 46.9%, mortality increased by 44.6%, and DALYs increased by 41.9% globally. In trend analysis, the global incidence (AAPC, 1.26), mortality (AAPC, 1.24), and DALYs (AAPC, 1.25) of EOPC showed an increasing pattern. The ASRs of incidence, mortality, and DALYs of EOPC in Africa, America, and Asia exhibited a continuous upward trend, while the trend in Europe was fluctuating. Asian males exhibited the fastest growth in incidence (AAPC, 2.15) and mortality (AAPC, 2.13), whereas males in the Americas experienced the slowest increase in new cases (AAPC, 0.72) and deaths (AAPC, 0.67). A certain proportion of EOPC DALYs were attributable to known risk factors: tobacco smoking (13.3%), high BMI, 5.6%, and high fasting plasma glucose 3.2%. Integrating the socio-demographic index (SDI), ASRs of incidence and mortality initially increased with rising SDI, reaching a peak in central Europe (1.5 per 100000 <ASRs <2.0 per 100000), and decreased with further increase in SDI in 2019. The findings offer valuable insights into the global distribution and magnitude of the EOPC burden. The burden is increasing at a rapid pace worldwide, particularly in Asia, and is notably high in central and eastern Europe. This highlights the need for additional preventive control efforts targeting high-risk populations.

Incidence trends of kidney cancer in China from 1990 to 2019: A joinpoint and age-period-cohort analysis.

Occupational carcinogens, smoking, and obesity are believed to be the main causing agents of kidney cancer. China is undergoing rapid industrialization, and hence the people's lifestyles have witnessed tremendous changes. However, the trend of kidney cancer incidence during the late 20th and early 21st centuries remains unexplored in China. Data from the Global Burden of Diseases (GBD; 2019) was retrieved for the incidence of kidney cancer from 1990 to 2019. The rates of disease average annual percentage changes (AAPC) were assessed using joinpoint regression analysis. Age-period-cohort (APC) model was used to assess age, period, and cohort effects on the incidence of the disease simultaneously. An increase in age-standardized incidence rates (ASIR) of kidney cancer was observed from 1990 to 2019 in total residents (1.33 - 4.24), men (1.56 - 6.15), and women (1.11 - 2.31) per 100,000 population suggesting a more obvious increase in males than in females. A consistent increase in age effects was observed in all age groups, especially in males. On the other hand, the 70 - 74 age group in females showed greater age effects. In addition, the period effects analysis showed that the incidence of kidney cancer increased with time. Moreover, the analysis of cohort effects showed a decrease in the disease in birth cohorts, especially before 1940. The incidence of kidney cancer is increasing rapidly in China. The kidney cancer burden will rise in the next decades due to population aging, environmental pollution, occupation, food safety, and so on. Results of this study suggest that more etiological studies should be performed to identify the driving factors for kidney cancer trends, and appropriate preventive measures should be implemented for the age-, period-, and cohort-related factors in the population.

Global, regional, and national burden of inguinal, femoral, and abdominal hernias: a systematic analysis of prevalence, incidence, deaths, and DALYs with projections to 2030.

Hernias, particularly inguinal, femoral, and abdominal, present a global health challenge. While the Global Burden of Disease (GBD) study offers insights, systematic analyses of hernias remain limited. This research utilizes the GBD dataset to explore hernia implications, combining current statistics with 2030 projections and frontier analysis. We analyzed data from the 2019 GBD Study, focusing on hernia-related metrics: prevalence, incidence, deaths, and disability-adjusted life years (DALYs) across 204 countries, grouped into 21 GBD regions by the SDI (SDI). Data analysis incorporated relative change calculations, Annual Percentage Change (APC), Average Annual Percentage Change (AAPC), and Joinpoint Regression Analysis. The study also employed frontier analysis and the Bayesian Age-Period-Cohort model for trend prediction up to 2030. Analyses utilized R version 4.2.3. From 1990 to 2019, global hernia cases surged by 36%, reaching over 32.5 million, even as age-standardized rates declined. A similar pattern was seen in mortality and DALYs, with absolute figures rising but age-standardized rates decreasing. Gender data between 1990 and 2020 showed consistent male dominance in hernia prevalence, even as rates for both genders fell. Regionally, Andean Latin America had the highest prevalence, with Qatar and Bulgaria noting significant increases and decreases, respectively. Frontier analyses across 204 countries linked higher SDIs with reduced hernia prevalence. Yet, some high SDI countries, like Qatar and the UK, deviated unexpectedly. Predictions up to 2030 anticipate increasing hernia prevalence, predominantly in males, while death rates are expected to decline. DALYs, after declining, are stabilizing. Our analysis reveals a complex interplay between socio-demographic factors and hernia trends, emphasizing the need for targeted healthcare interventions. Despite advancements, vigilance and continuous research are essential for optimal hernia management globally.

The spatiotemporal epidemiological study on human brucellosis in shenyang, China from 2013 to 2022

BackgroundEpidemiological characteristics of human brucellosis (HB) have changed over the last decade. In this study, we depicted the spatiotemporal features of HB in Shenyang, China, from 2013 to 2022 and the objective was to visualise spatiotemporal patterns and identify high-risk regions with the purpose to provide evidence for HB prevention and control. MethodsWe performed an observational epidemiological study using HB data obtained from the National Notifiable Disease Reporting System (NNDRS). Joinpoint regression analysis was employed to determine the changing trends in the annual incidence. A vector boundary map of Shenyang was used to visualise spatial distribution. Spatial autocorrelation was identified using both global and local Moran's autocorrelation coefficients, while hotspot areas were determined using the Getis-Ord statistic. ResultsA combined sum of 4103 HB cases were analysed, and the average level of annual incidence of HB was 5.52 per 100,000. The incidence of HB showed obvious seasonality, with a notable peak observed from April to July (summer peak). The annual incidence in Shenyang has been on the rise since 2013, with an annual percentage change (APC) of 6.39% (95%CI 1.29%, 12.39%). Xinmin County exhibited the most elevated average annual incidence rate, with Faku County ranking second. The average annual incidence in rural areas exhibited a significantly greater disparity compared to suburban areas (P < 0.001), whereas the incidence rate in suburban areas demonstrated a significantly higher contrast when compared to urban areas (P < 0.001). A clustered distribution of the annual incidence of HB was observed for all years from 2013 to 2022. Abnormally high values were found in suburban areas, and no abnormally high values were found after 2017. The low-low clustering areas were found in urban as well as suburban areas from 2013 to 2022. Hotspots (P < 0.05) were located in rural areas, while cold spots (P < 0.05) were found in both urban and suburban areas. Since 2020, there have been no hotspots in Shenyang. ConclusionsRural areas are high-risk areas for HB and may be key to controlling HB epidemics. Although the annual incidence of HB in rural areas has increased, owing to the stability of spatial relationships and the disappearance of hotspots, there is little possibility of outbreaks; however, stricter monitoring should be applied in rural areas to prevent the emergence of new transmission routes.

Epidemiology of Uterine Cancer in Sarawak, Borneo, A 20-Year Review.

This study aimed to determine the epidemiology of uterine cancer in Sarawak, Malaysia, using data from a population-based cancer registry. The study population included all women diagnosed with uterine cancer in Sarawak, Malaysia between January 1996 and December 2015. Data on demographic and clinical characteristics were obtained from the Sarawak Cancer Registry. The crude incidence rate, age-standardized incidence rate (ASR), and incidence risk ratios (IRR) were calculated. Joinpoint regression analyses were performed to assess trends in incidence rates. A total of 811 women were diagnosed with primary uterine cancer during the study period. The overall crude incidence rate for uterine cancer in Sarawak for the period 1996-2015 was 3.7 per 100,000. The ASR was 4.4 per 100,000 with a 95% CI (4.1-4.8). The ASR in 2011-2015 is 1.6 times higher than the ASR of uterine cancer in 1996-2000. Higher incidence rates were observed in women aged 40-59 years and those aged 60 years and above. Chinese women had the highest ASR, followed by Malay and Iban women. Joinpoint regression analyses showed a significant increase in cases of uterine cancer among all ethnic groups and age groups. The incidence of primary uterine cancer in Sarawak, Malaysia, has increased over the past 20 years, with higher incidence rates observed in older age groups and among Chinese women. The findings suggest the need for continued efforts to improve the prevention, early detection, and treatment of uterine cancer in Sarawak.