Breast cancer is the most common cancer among women globally, with incidence rates rising annually. However, systematic comparative studies on the burden of breast cancer among women of reproductive age in East Asian countries are currently lacking. This study utilized the Global Burden of Disease (GBD) 2021 database to extract incidence, prevalence, mortality, disability-adjusted life years (DALYs) for breast cancer among women of reproductive age in China, Japan, and South Korea. Cross-national comparisons were conducted using age-standardized rates (ASR), and estimated annual percentage change (EAPC) and average annual percentage change (AAPC) were calculated. Joinpoint regression analysis identified trend turning points, and ARIMA models projected trends for 2022-2036. From 1990 to 2021, China, Japan, and South Korea exhibited upward trends in age-standardized incidence rates (ASIR) and age-standardized prevalence rates (ASPR) for breast cancer (ASIR: China's EAPC = 2.17, Japan's EAPC = 0.93, South Korea's EAPC = 3.86). Age-standardized mortality rates (ASMR) and age-standardized DALYs rates (ASDR) generally declined in China and Japan but increased in South Korea (ASMR: China's EAPC = -1.10, Japan's EAPC = -0.64, South Korea's EAPC = 0.11). Projections for the next 15years indicate rising ASIR and ASPR in China, declining trends in Japan, and stabilization in South Korea; overall declines in ASMR and ASDR across all three countries. The findings emphasize the importance of enhanced, country-specific screening and prevention efforts for breast cancer among reproductive-age women in East Asia to address disparities in disease burden and early detection.

While previous studies have suggested a declining burden of heart failure (HF) in the general population, recent evidence indicates a concerning rise in prevalence among younger individuals. However, trends in women of childbearing age (WCBA) remain understudied. This study aims to provide a comprehensive analysis of HF burden trends in WCBA at global, regional, and national levels over the past three decades, exploring the effects of age, period, and birth cohort, and projecting future trajectories to 2040. HF prevalence and years lived with disability (YLDs) in WCBA were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The burden was analysed globally, regionally, and nationally, with the average annual percentage change (AAPC) calculated using joinpoint regression analysis to identify significant shifts. Age-period-cohort (APC) modelling was used to assess age, period, and cohort effects, and the Bayesian age-period-cohort (BAPC) framework was applied for projections stratified by socio-demographic index (SDI). Global HF prevalence in WCBA rose from 1.51 million in 1990 to 2.68 million in 2021, with an annual growth rate of 0.49%. The disease burden was highest among women aged 40-49 years, while the fastest growth rate occurred in the 15-19 age group. Low- and low-middle SDI regions had the highest age-standardized prevalence. Significant increases were seen in East Asia (AAPC = 1.50%) and Central Sub-Saharan Africa (AAPC = 0.34%), while North America showed a decline (AAPC = -0.51%). Major causes of HF included cardiomyopathy/myocarditis, rheumatic heart disease (RHD), congenital defects, ischaemic, and hypertensive heart disease, with the latter two rising as leading causes in older age groups (≥35 years), while cardiomyopathy and RHD were more prevalent in younger WCBA. Projections for 2040 suggest a decline in middle- and high-SDI regions, while other regions are expected to see an increase. The global HF burden in WCBA has risen over the past three decades, with worsening period and cohort risks. However, high-SDI regions may see a decline in prevalence, and tailored regional prevention and treatment strategies could help mitigate the increasing burden of HF in WCBA.

The burden of all cause death attributed to dietary risks in Iran based on joinpoint regression analysis from 2000 to 2021

The rapid economic development and demographic changes in Chinese society in the past 30 years may affect the prevalence of migraine. However, there are limited studies on the long-term trends and influencing factors of migraine burden in China. Using data from global burden of disease database (GBD2021), this study explores the changes in the migraine burden in China over a 30-year period and analyzes the main drivers. Joinpoint regression analysis was used to evaluate the temporal trend of migraine prevalence, incidence, and years lived with disability (YLDs), and the age-period-cohort (APC) model was used to evaluate the effects of age, time and birth cohort. Decomposition analysis were used to calculate the contribution of population growth, ageing, and epidemiological changes to the burden of disease. In the past 30 years, the age-standardized prevalence rate (ASPR) and YLDs rate of migraine in China have increased significantly, and the disease burden of women is higher than that of men, especially in people aged 30-54 years. The main driver of the rising burden of disease is population growth. APC analysis showed that the younger generation had a higher burden of disease, which may be related to modern lifestyles and stressors. The burden of migraine continues to increase in China, which is mainly affected by population growth and epidemiological changes. In the future, attention should be paid to high-risk groups, and lifestyle interventions and disease management should be strengthened to reduce the socio-economic burden.

Obesity prevalence in the United States has surged dramatically, yet comprehensive analysis of cardiovascular mortality patterns among adults with obesity remains lacking. We analyzed CDC WONDER Multiple Cause of Death data for adults aged ≥ 25 years in the United States (1999-2023), identifying deaths where cardiovascular disease was the underlying cause and obesity was a contributing cause. Age-adjusted mortality rates (AAMR) per 100,000 population were calculated. Joinpoint regression analysis identified temporal trends stratified by sex, age, race/ethnicity, and geographic region. Among 363,203 cardiovascular deaths, AAMR tripled from 3.40 to 10.34 per 100,000 (average annual percent change [AAPC]: +4.88%). Three distinct phases emerged: steady increase (1999-2018), pandemic acceleration (2018-2021, 12.22% annual increase), and recent decline (2021-2023). Men had higher mortality than women (12.69 vs. 8.06 per 100,000 in 2023). The 75-84 years group showed the steepest increase (AAPC: +5.66%). Non-Hispanic Black adults maintained the highest AAMR (18.30 per 100,000 in 2023). The South transformed from lowest to highest regional burden (AAPC: +5.52%). The disease spectrum shifted toward atherosclerotic and hypertensive conditions. Cardiovascular mortality among US adults with obesity tripled over 25 years, with widening disparities acrossdemographic and geographic groups, necessitating equitable public health interventions targeting high-risk populations.

ABSTRACT Objective Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder starting in childhood, often persisting into adulthood. Diagnosis rates have risen since the first U.S. estimates in the 1990s, with variations across sex, race/ethnicity, and other factors. This study explores ADHD diagnosis and treatment among U.S. children from 2016 to 2023, with a focus on identifying differences across sociodemographic and clinical characteristics. Methods Data from the National Survey of Children’s Health (NSCH; 2016‒2023) on parent-reported ADHD diagnoses and treatments among non-institutionalized U.S. children aged 3‒17 years were analyzed. Trends over time and across sociodemographic and clinical subgroups were assessed using logistic regression models and joinpoint regression analysis. Results ADHD diagnosis prevalence estimates were stable from 2016 to 2019 (8.6% to 8.8%), rising after the onset of the COVID-19 pandemic in 2020 to 10.5% in 2023. Yet, from 2016 to 2023, overall ADHD treatment rates declined (76.9% to 70.8%), particularly for medication treatment (62.5% to 53.0%), while behavioral treatment stayed steady (47.3% to 48.2%). ADHD diagnosis trends differed by race, insurance status, and ADHD severity, increasing only for children in Asian, White, and multiracial groups; with private insurance, and with mild or moderate ADHD. Treatment prevalence differences by sex narrowed over time, as medication use decreased for males and behavioral treatment increased for females, specifically adolescent females. Conclusions With a widening gap between the prevalence of ADHD diagnosis and treatment, fewer children are receiving recommended care than in the past. These results may inform interventions to improve healthcare access and address systemic barriers to treatment for all children with ADHD.

The COVID-19 pandemic impacted healthcare use, with mixed reports regarding impacts on antimicrobial resistance. The aim was to identify changes in healthcare utilisation and antibiotic prescribing related to the COVID-19 pandemic and quantify subsequent impacts on antibiotic resistance in clinical Escherichia coli isolates in Scotland. Data involving ∼490 000 people from January 2018 to March 2022 were analysed. Joinpoint regression analyses identified trend changes in healthcare encounters, and antibiotic use in community and hospital settings. Using these joinpoints as an 'intervention' timepoint, interrupted time series analysis quantified associated changes in proportions of E. coli blood and urine culture isolates that were antibiotic resistant and multidrug resistant (MDR). January 2020 was identified as the intervention point. From 26% resistant (not MDR) and 35% MDR among urine E. coli isolates immediately pre-intervention, there were changes in level of +2.5% (95%CI -0.4% to 5.4%) and trend of +0.3% (95%CI 0.1% to 0.5%) per month for resistant (not MDR), and level change of +0.4% (95%CI -2.0% to 2.8%) but trend change of -0.3% (95%CI -0.5% to -0.1%) per month for MDR. By 9 month post-intervention, compared with predicted levels without intervention, resistant (not MDR) proportions increased while MDR proportions decreased. Similar changes occurred among blood culture isolates, but with less certainty around estimates. Small but significant reductions in MDR E. coli resulted from COVID-19-related changes in healthcare and antibiotic use. The findings are critical for antimicrobial stewardship and infection control interventions and evaluation.

Decubitus ulcers (DUs) represent a substantial global public health challenge, significantly diminishing patient quality of life and increasing the incidence of infection and early mortality. Given the rapidly aging populations in major East Asian economies, including China, Japan, South Korea, and Taiwan (Province of China), a comparative analysis of the DU burden across these regions is lacking. Leveraging data from the Global Burden of Disease (GBD) 2021 study, this study quantified the epidemiological burden of DUs globally and specifically within China, Japan, South Korea, and Taiwan (Province of China) during the period 1990-2021. Analyses evaluated key metrics including incidence, mortality, and disability-adjusted life years (DALYs), presenting both absolute counts and age-standardized rates (ASRs). Temporal trends in these burden estimates were assessed using Joinpoint regression analysis to identify significant inflection points. Future burden projections were generated via autoregressive integrated moving average (ARIMA) modeling. Comprehensive stratification by sex, age group, geographical region, and temporal interval was performed throughout all analyses. Between 1990 and 2021, the global disease burden of DUs escalated markedly, with incident cases surging by 116.03% to an estimated 2.5million worldwide in 2021. China recorded the largest absolute increase, with cases rising from 163,510 to over 397,310 (+ 142.99%), alongside dramatic upticks in mortality (from 240 to 3,130 deaths, + 1188.89%) and DALYs (+ 417.70%). Japan and South Korea also experienced substantial growth in incidence (from 68,090 to 152,660 and 16,480 to 39,840, respectively) and mortality. Taiwan (Province of China) exhibited the highest relative increase in incidence (+ 194.53%, reaching 4,950 cases in 2021), though its overall disease burden remained comparatively modest. Age-standardized rate analyses revealed divergent trends: China was the sole region with significant increases in incidence, mortality, and DALY rates, whereas Taiwan (Province of China) demonstrated the most significant reductions, and both South Korea and global rates generally declined. Males exhibited a higher disease burden, particularly in China, and the elderly-especially those aged 80 and above-were at greatest risk, with demographic aging identified as a key contributing factor. Forecasts for the coming decade suggest a continued upward trajectory in total DU cases across all examined countries and regions, with China projected to experience the most pronounced absolute increase. DUs continue to represent a significant and escalating public health concern, especially within China. The increasing prevalence of an aging population serves as a primary catalyst, underscoring the urgent need for the deployment of regionally tailored and demographically stratified (notably by age and sex) healthcare policies and precision-based interventions. These results provide critical evidence to inform the optimization of DU management and the mitigation of geographic disparities. Subsequent research should prioritize the exploration of socioeconomic determinants and the enhancement of healthcare accessibility.

The analysis of cancer incidence trends in adolescents and young adults reveals a concerning increase. This observational study aims to investigate cancer incidence trends among young adults under 50, compared to older age trends, using the population-based Cancer Registry of the Veneto Region (Northeastern Italy) from 1987 to 2019. Yearly age-standardized cancer incidence rates per 100,000 individuals were obtained from the Veneto Tumour Registry for 24 tumor sites and all cancers combined. Temporal trends from 1987 to 2019 were analyzed for each cancer type, stratified by sex and age group at diagnosis (0-49, 50-64, and 65+ years). Significant changes in incidence trends were assessed by the annual percent change (APC), calculated through joinpoint regression analysis. Since 1987, the incidence rate of cancers among young adults decreased in males, while among females it increased until 2014 and then stabilized. One cancer showed increasing incidence in both sexes (invasive cutaneous melanoma), two in males (testicular, and multiple myeloma), and two more in females (breast, and Hodgkin disease). Four cancer sites showed a decline in both sexes (oral cavity, stomach, lung, and bladder), and four further cancers only in males (esophagus, rectum, larynx, and non-Hodgkin lymphoma). Two cancers showed complex trends (Corpus uteri, and thyroid in women). Eight cancers showed no significant changes in APCs. Cancer incidence data for young adults reveal a heterogeneous landscape. These findings provide valuable insights into the expected evolution of cancer epidemiology in young populations.

Trends in Mortality-Related to Peripheral Artery Disease and Chronic Obstructive Pulmonary Disease Comorbidity in the United States (1999-2023).

Alzheimer disease (AD) is a leading cause of mortality in the United States; yet, population-level mortality trends and disparities remain underexplored. This study aimed to evaluate AD-related mortality trends from 1999 to 2020 and assess disparities by demographic and geographic factors. Data were obtained from the CDC WONDER database. Deaths were identified using ICD-10 codes for AD (F01, F03, G30, G31.1) among individuals aged 45 years and older. Crude mortality rates (CMRs) and age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression analysis was used to assess trends, and disparities were analyzed by sex, race/ethnicity, age, urbanization, census region, and state. From 1999 to 2020, 6,697,209 deaths were attributed to AD (AAMR: 90.727). Mortality rates increased significantly (AAPC: 3.18). Females had higher AAMRs (94.31) than males (83.23). Non-Hispanic Black individuals had the highest AAMR (94.53), followed by non-Hispanic White (93.73), non-Hispanic American Indian (66.80), Hispanic (66.33), and non-Hispanic Asian individuals (46.16). Individuals aged 85 years and older had the highest CMR (3574.928). Rural areas had higher AAMRs (95.080) than urban areas (89.772). The Midwest had the highest AAMR (96.131), whereas the Northeast had the lowest (78.564). States such as South Carolina (119.789) and Tennessee (113.624) had higher AAMRs compared with New York (64.16) and Florida (68.677). Significant disparities exist in AD-related mortality across demographic and geographic groups. These findings highlight the need for targeted public health interventions, improved health care access, and early diagnostic efforts.

Gastric cancer (GC) remains a leading cause of cancer-related mortality worldwide. In Ecuador, GC was the primary cause of cancer-related deaths until 2013. Despite a general decline in GC mortality, significant regional and sex-based disparities persist. This study aimes to analyze trends in GC mortality by sex from 2004 to 2021 using Joinpoint regression analysis. We analyzed GC mortality data from the National Institute of Statistics and Censuses (INEC) for the period 2004-2021. Age-standardized mortality rates (ASMR) were calculated using the SEGI world standard population. Joinpoint regression was applied to estimate the annual percentage change (APC) in mortality trends. Additionally, we examined regional differences and identified provinces with the highest mortality rates based on the average from 2017-2021. GC mortality rates declined nationally, with an annual decrease of 1.9% in men and 2.2% in women. However, significant regional disparities were observed. In the Coastal region, mortality rates among men showed no significant decline, while the rates for women decreased by 2.4% annually. In the Highlands, GC mortality declined by 1.8% in men and 2.4% in women, while in the Amazon region, the decrease was 2.8% and 3.0% per year for men and women, respectively. The highest GC mortality rates in 2021 were observed in Bolívar, Santo Domingo, and Cotopaxi among men, and in Zamora Chinchipe, Cotopaxi, and Loja among women. Notably, while most provinces experienced a decline, Esmeraldas reported an increasing mortality trend of 2.8% annually from 2004 to 2021. Despite an overall decline in GC mortality in Ecuador, disparities persist across regions and between sexes. The faster decline in female mortality suggests potential differences in risk factors, healthcare access, or early detection efforts.

The burden of severe periodontitis in the United States: Insights from a population-based analysis.

Mental disorders represent a major public health challenge among women of childbearing age (WCBA, 15-49 years), yet comprehensive evidence on long-term trends, socioeconomic disparities, and future trajectories remains limited. Using data from the Global Burden of Disease (GBD) 2021, this study aimed to quantify the burden of mental disorders among WCBA from 1990 to 2021 and to project future trends. Incidence, prevalence, and disability-adjusted life years (DALYs) of mental disorders among WCBA were obtained from GBD 2021. Temporal trends from 1990 to 2021 were assessed using joinpoint regression analysis. Bayesian age-period-cohort (BAPC) modeling was applied to forecast the burden of ten major mental disorders for the next 15 years. Analyses were stratified by age group, geographic region, country, and socio-demographic index (SDI). In 2021, mental disorders imposed a substantial global burden among WCBA, with depressive and anxiety disorders accounting for the majority of cases. Marked geographic and socioeconomic disparities were observed, with consistently higher burdens in high-SDI regions. Age-specific patterns differed by disorder, with anxiety disorders peaking in younger women and depressive disorders peaking in midlife. Trend analyses revealed a decline in burden indicators between 2005 and 2010, followed by a pronounced rebound after 2019. Projections indicate that the incidence and prevalence of depressive and anxiety disorders will continue to rise, whereas the burden of bipolar disorder and schizophrenia is expected to stabilize or decline. The burden of mental disorders among WCBA shows substantial inequalities across regions and SDI levels and is projected to increase further for common disorders. These findings highlight the need for forward-looking, equity-oriented mental health policies, with targeted prevention, early intervention, and resource allocation strategies tailored to high-risk populations and regions.

Descriptive spatiotemporal analysis of reported incidence of hepatitis B and hepatitis C in China from 2005 to 2020.

Disparities and temporal trends in referral for bladder cancer diagnosis: A worsening epidemic.

Trends and disparities of cardiovascular mortality among adults with depression in the United States from 1999 to 2023.

Hepatitis A is the most common form of acute viral hepatitis, and its control is critical to achieving the 2030 viral hepatitis elimination target. We conducted a comprehensive assessment of hepatitis A incidence across 204 countries and regions from 1990 to 2021. Annual incident cases and age-standardized incidence rates (ASIR) of hepatitis A were obtained from the Global Burden of Disease (GBD) study 2021. Joinpoint regression analysis evaluated long-term trends in ASIR, while Age-Period-Cohort (APC) analysis assessed the independent effects of age, period, and cohort. Decomposition analysis determined the drivers behind temporal changes in disease incidence. The Slope Index of Inequality (SII) and Concentration Index (CI) were employed to quantify cross-national inequalities in incidence. From 1990 to 2021, global hepatitis A cases declined by 7.25%, with age-standardized incidence rates (ASIR) demonstrating a universal downward trend. The most substantial ASIR reductions occurred in low-middle socio-demographic index (SDI) quintiles, whereas low-SDI quintiles showed paradoxical ASIR declines (AAPC: -1.56 95% CI: -1.71 to -1.40) alongside a 39.44% (95%UI: 28.04 to 50.48) case surge. Cases remained concentrated in children under 5. The age-period-cohort analysis confirmed highest risk in young children, with period and cohort risks declining over time. Decomposition analysis identified population growth as the primary driver of case increases. Health inequality analysis showed persistent absolute disparities despite relative improvements. Although global hepatitis A incidence has declined over three decades, trends are highly heterogeneous and significant inequalities persist. Achieving equitable burden reduction requires differentiated strategies and enhanced international collaboration, particularly for low-resource settings.

Long-term adherence and results with faecal immunochemical test (FIT)-based colorectal cancer (CRC) screening are poorly characterised. To characterise adherence and results through seven rounds in an organised biennial FIT-based CRC screening programme. We determined per-round FIT-completion, FIT-positivity, CRC and high-risk-CRC precursor positive predictive values (PPVs) and CRC detection/1000-FIT-participants for all invitees versus an adherent cohort (entry 50-51 years; 66-100% rounds completed) versus comparable-age first-ever screenings from 2010 to 2023. Joinpoint and multivariable logistic regression analyses identified trends. Adherence was consistent, frequent, occasional, infrequent and never (defined as 100%, 66-99%, 33-65%, 1-32%, 0% of rounds offered) in 29.2%, 8.6%, 11.5%, 4.5% and 46.2% of 2.81 million individuals, respectively. In both the all-invitee population and the adherent cohort, the first round yielded the highest FIT positivity (5.8%, 4.4%), PPVs for CRC (5.1%, 3.3%) and high-risk precursors (20.4%, 13.1%), and CRC detection rates (2.65, 1.30 per 1000 participants), respectively. Beyond three rounds, outcomes stabilised at levels substantially lower than those observed in first-time screeners of the same age (eg, CRC-PPV in seventh round: 1.6-2.2% at median age 62-65 vs 6.6% for new screeners aged 62-63). Colonoscopy completion after a positive FIT was high (87.3%). After an initial round with the highest FIT-positivity and detection rates, screening outcomes stabilise at lower levels reflecting neoplasia removal and subsequent selection of a lower-risk population. Because detection rates remain clinically relevant even in an adherent cohort, early screening cessation after a sequence of normal biennial FITs is not justified.

Hand, foot, and mouth disease (HFMD), a widespread virus-induced infectious disease caused by enteroviruses, imposes a substantial disease burden. This study is to evaluate the impacts of EV-A71 vaccination and COVID-19 non-pharmaceutical interventions (NPI) intensity on HFMD epidemics. A retrospective study was performed based on surveillance data from 2009 to 2022 in Jiangxi Province, China. Joinpoint regression analysis was utilized to analyze long-term trends, wavelet analysis was adopted to explore seasonality and periodicity, spatiotemporal scanning was employed to identify clustering, a generalized linear model (GLM) was used to assess effects of EV-A71 vaccination coverage and NPI intensity on HFMD incidence, and the eXtreme Gradient Boosting (XGBoost) algorithm was employed to develop univariate time-series forecasting models for the incidence of HFMD caused by EV-A71, CVA16, and other EVs. A marked increase in the annual incidence of HFMD was observed from 2009 to 2016, with a subsequent decrease from 2017 to 2022. Increasing incidence was predominantly detected in the population aged >2 years, especially among those aged 5 to 9 years. The periodicity of HFMD was relatively stable at 12 months and 6 months from 2009 to 2019, but gradually extended to 16 months and 8 months. The proportion of EV-A71 pathogen cases decreased from 28% (Period I) to 0.4% (Period III). The proportion of reported cases aged>2 years demonstrated a chronological upward trend. The model revealed significant independent protection from vaccination and NPI, with the strongest protective effects during autumn and school summer vacation. The forecasts revealed an etiology shift of vaccine-controlled suppression of EV-A71, persistent cyclicality of CVA16, and rising dominance of other EVs. The overall incidence of HFMD declined across three periods, while the incidence in the older child populations increased. A shift in predominant HFMD pathogens was observed and predicted following the rollout of vaccination. Vaccination and NPI interventions are effective in reducing HFMD incidence. Not applicable.