Number Of DALYs Research Articles

Global, regional, and national burden of type 2 diabetes mellitus caused by high BMI from 1990 to 2021, and forecasts to 2045: analysis from the global burden of disease study 2021.

To produce estimates of the global burden of type 2 diabetes mellitus (T2DM) caused by high body mass index (high BMI) and its impact for 2021 and projections for 2045. We downloaded data from the Global Burden of Disease Study 2021(GBD 2021) to estimate the disease burden of T2DM caused by high BMI. Secondary analyses were performed by year, age, gender, region, and socio-demographic index (SDI). Globally, the all-ages number of T2DM-related deaths has increased significantly from 238.1 thousand to 723.7 thousand, representing a 203.9% increase since 1990. And the all-ages number of T2DM-raleted DALYs has raised from 10.4 million to 39.3 million, increased by 276.7% from 1990. The burden was expected to continue to increase to 1296.7 thousand by 2045 for all-ages number of deaths, and 85.5 million by 2045 for all-ages number of DALYs. The curves of T2DM-related burden showed an intersection for different genders around the age of 60, beyond which women exhibit a higher burden, compared to men. The disease burden of T2DM caused by high BMI shows a significant upward trend across all SDI groups, with a heavier burden on women, especially in the postmenopausal female population. In 2021, among the 204 countries and territories, the top 3 largest number of T2DM-related burden caused by high BMI occurred in China, India, and United States. The top three countries with highest T2DM-related rate caused by high BMI were Fiji, Marshall Islands, and Kiribati. Our study reveals that the disease burden of T2DM caused by high BMI is significantly increasing and is expected to continue rising in the future. Women bear a heavier burden, particularly postmenopausal women, and there are significant differences in the disease burden across different geographical regions, and socioeconomic statuses. Targeted considerations and specific strategies are essential to address these disparities, thereby improving public health and reducing the burden.

Undernutrition, and overweight and obesity: the two faces of malnutrition in Brazil, 1990-2019

Abstract Background The double burden of malnutrition consists of the coexistence of nutritional deficiencies (malnutrition and overweight/obesity. Approximately 2.28 billion children and adults are overweight, and more than 150 million children are malnourished. The Decade of Action on UN Nutrition and SDGs that broaden the focus to both sides of malnutrition: overweight/obesity and nutritional deficiencies. Objectives To analyze the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019. Methods: Study design This is an epidemiological time-series study. This study analyzed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardized mortality rate, and disability-adjusted life years (DALYs). This study also analyzed the correlation between the percentage variation of mortality rates and SDI. Results A decrease in the number of deaths (75%), mortality rate (75.1%), and DALYS (72%) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6%); however, the mortality rate (9.7) and DALYs (6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI. Conclusions Our study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality. Key messages • Overcome the malnutrition public policies are necessary to guarantee the human right to healthy and sustainable food, such as encouraging the production and commercialization of fruits & vegetables. • Overcoming undernutrition and excess weight requires public policies aimed at reducing social inequality and providing access to healthy food for all, and taxation of ultra-processed foods.

Headache disorders: a persistent public health challenge for the under 50s.

Currently, neurological diseases has surpassed cardiovascular diseases as the primary cause of global disease burden. Among these, headache disorders are the most prevalent and have emerged as the main cause of disability in people under 50 years old in recent years. Since the release of GBD 2021, there has been no comprehensive systematic exposition on the burden of headache among individuals under 50 years old and a forecast for future burdens. This study aims to quantify the global, regional, and national burden of headache disorders among people under 50 from 1992 to 2021 and to predict future trends in order to provide policy makers with precise and effective epidemiological evidence. This study extracted the incidence, prevalence, and DALYs data related to headache disorders in the 5-50 age group from the GBD 2021. After age-standardizing the data, we used joinpoint regression analysis and health inequity analysis to analyze the burden and temporal trend of headache disorders and predicted the future disease burden and changes based on the age-period-cohort model. By 2021, the case number of global incidence, prevalence and DALYs have increased by 35, 39, and 41%, respectively, over the past 30 years. The incidence and prevalence of tension-type headache (TTH) are significantly higher than those of migraine, but migraine causes greater health burdens. The burden is higher for female than for male. In terms of age, youth aged 25-29 years had the highest incidence in 2021, with an age-standardized rate (ASR) of 13,454.64 (95%CI, 9,546.96-18,361.36) per 100,000 population. Nationally, the highest ASR of incidence and prevalence are found in Norway, and the most damaging to health is found in Belgium. Among the five sociodemographic index (SDI) categories, the middle SDI has the highest number of cases (190 million in 2021). It is worth noting that the forecast shows that by 2046 the three indicators will reach 680 million, 2.33 billion, and 41 million, respectively, indicating that the burden of headache disorders in this age group will continue to persist. Globally, the burden of headache disorders in people under 50 years of age remains significant and has not improved over the past 30 years, especially in regions with high SDI. Headache problems will continue to pose a serious public health challenge for this age group for some time to come. This study reveals the burden and distribution of headache disorders in this age group, providing important basis for governments and policymakers to accurately and effectively allocate health care resources, strengthen prevention and management strategies, and respond to this global health problem.

Global burden of ischemic stroke attributable to high body mass index in 204 countries and territories, 1990–2021

BackgroundA high body mass index (hBMI) is one of the major risk factors for ischemic stroke (IS), although independent estimates of the global burden and trend of IS attributable to hBMI are unclear.MethodsStudy data were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study and analysed by age, sex, year, and geographical location. The sociodemographic index (SDI) and the human development index (HDI) were used as indicators of national socioeconomic status. Geographic distributions and trends were assessed by calculating the estimated annual percentage change (EAPC). Associations between the age-standardized death rate (ASMR) or disability-adjusted life year rate (DALY) and socioeconomic status were analysed.ResultsDeaths and DALYs increased worldwide from 1990–2021, with increases of 95.74% for the former and 133.00% for the latter; the ASMR and ASDR decreased, with an ASMR and ASDR-related EAPCs of -1.10 (95% CI: -1.24–-0.96) and 0.04 (95% CI:-0.47–0.55), respectively; women had greater numbers of deaths and DALYs, and the majority of deaths and DALYs were shared by those aged ≥ 70. The highest burden rates were shared by Eastern Europe, North Africa, the Middle East, and Central Asia. The ASMR-related EAPCs were associated with the ASMR in 1990 (R = -0.35, P < 0.001) and the SDI in 2021 in different countries (R = -0.66, P < 0.001); these patterns were similar to those of the ASDR; the HDI in 2021 was associated with the ASMR-related EAPC (R = -0.71, P < 0.001) and the ASDR-related EAPC in different countries (R = -0.71, P < 0.001).ConclusionsThe number of deaths and DALYs from ischemic stroke attributable to hBMI worldwide increased substantially from 1990–2021. Successful population-wide initiatives targeting hBMI may mitigate a wide range of burdens on this disease. Taking into account variations in the SDI burden, future prevention and control strategies must be developed and implemented according to country-specific development status.

Global burden of osteoarthritis from 1990 to 2019 attributable to high body mass index

IntroductionTo examine data from the Global Burden of Disease Study (GBD) 2019 to determine the global burden of osteoarthritis (OA) from 1990 to 2019 that is attributable to high body mass index (BMI).Material and methodsDisability-adjusted life years (DALYs) and age-standardized DALY rates, and their corresponding estimated annual percentage changes (EAPCs), were used to compare estimated OA burdens between countries and regions. Moreover, a comparative risk assessment framework was used to estimate the risks attributable to high BMI in terms of DALYs.ResultsFrom 1990 to 2019, the age-standardized DALY rate for OA attributable to high BMI increased significantly (EAPC = 1.45, 95% CI: 1.44, 1.47). Moreover, from 1990 to 2019, the age-standardized DALY rate and number of DALYs for OA attributable to high BMI increased less in women than in men. From 1990 to 2019, the age-standardized DALY rate for OA attributable to high BMI increased the most in South Asia (EAPC = 3.94). From 1990 to 2019, among 204 countries worldwide, the age-standardized DALY rate for OA attributable to high BMI increased the most in Equatorial Guinea (EAPC = 7.42). Also, the burden was higher in high-sociodemographic index (SDI) regions than in low-SDI regions.ConclusionsThe global burden of OA attributable to high BMI increased significantly from 1990 to 2019. In particular, this burden was higher in women than in men; primarily affected middle-aged and older adults; and was generally greater in high-SDI regions than in low-SDI regions.

The burden of neurological conditions in north Africa and the Middle East, 1990–2019: a systematic analysis of the Global Burden of Disease Study 2019

The burden of neurological conditions in north Africa and the Middle East is increasing. We aimed to assess the changes in the burden of neurological conditions in this super-region to aid with future decision making. In this analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 data, we examined temporal trends of disability-adjusted life-years (DALYs; deaths and disabilities combined), deaths, incident cases, and prevalent cases of 14 major neurological conditions and eight subtypes in 21 countries in the north Africa and the Middle East super-region. Additionally, we assessed neurological DALYs due to 22 potentially modifiable risk factors, within four levels of classification, during the period 1990-2019. We used a Bayesian modelling estimation approach, and generated 95% uncertainty intervals (UIs) for final estimates on the basis of the 2·5th and 97·5th percentiles of 1000 draws from the posterior distribution. In 2019, there were 441·1 thousand (95% UI 347·2-598·4) deaths and 17·6 million (12·5-24·7) neurological DALYs in north Africa and the Middle East. The leading causes of neurological DALYs were stroke, migraine, and Alzheimer's disease and other dementias (hereafter dementias). In north Africa and the Middle East in 2019, 85·8% (82·6-89·1) of stroke and 39·9% (26·4-54·7) of dementia age-standardised DALYs were attributable to modifiable risk factors. North Africa and the Middle East had the highest age-standardised DALY rates per 100 000 population due to dementia (387·0 [172·0-848·5]), Parkinson's disease (84·4 [74·7-103·2]), and migraine (601·4 [107·0-1371·8]) among the global super-regions. Between 1990 and 2019, there was a decrease in the age-standardised DALY rates related to meningitis (-75·8% [-81·1 to -69·5]), tetanus (-88·2% [-93·9 to -76·1]), stroke (-32·0% [-39·1 to -23·3]), intracerebral haemorrhage (-51·7% [-58·2 to -43·8]), idiopathic epilepsy (-26·2% [-43·6 to -1·1]), and subarachnoid haemorrhage (-62·8% [-71·6 to -41·0]), but for all other neurological conditions there was no change. During 1990-2019, the number of DALYs due to dementias, Parkinson's disease, multiple sclerosis, ischaemic stroke, and headache disorder (ie, migraine and tension-type headache) more than doubled in the super-region, and the burden of years lived with disability (YLDs), incidence, and prevalence of multiple sclerosis, motor neuron disease, Parkinson's disease, and ischaemic stroke increased both in age-standardised rate and count. During this period, the absolute burden of YLDs due to head and spinal injuries almost doubled. The increasing burden of neurological conditions in north Africa and the Middle East accompanies the increasing ageing population. Stroke and dementia are the primary causes of neurological disability and death, primarily attributable to common modifiable risk factors. Synergistic, systematic, lifetime, and multi-sectoral interventions aimed at preventing or mitigating the burden are needed. Bill & Melinda Gates Foundation. For the Persian, Arabic and Turkish translations of the abstract see Supplementary Materials section.

Undernutrition, and overweight and obesity: the two faces of malnutrition in Brazil, analysis of the Global Burden of Disease, 1990 to 2019

ObjectivesThe objective of this study was to analyse the global burden of disease attributable to undernutrition and high body mass index (BMI) in Brazil and its 27 states, as well as its association with the socio-demographic index (SDI) from 1990 to 2019. Study designThis is an epidemiological time-series study. MethodsThis study analysed the undernutrition and high BMI estimated by the Global Burden of Disease study conducted from 1990 to 2019 for Brazil and its states, using the following metrics: absolute number of deaths, standardised mortality rate, and disability-adjusted life years (DALYs). This study also analysed the correlation between the percentage variation of mortality rates and SDI. ResultsA decrease in the number of deaths (−75 %), mortality rate (−75.1 %), and DALYS (−72 %) attributable to undernutrition was found in Brazil and in all regions. As regarding the high BMI, an increase in the number of deaths was found (139.6 %); however, the mortality rate (−9.7) and DALYs (−6.4 %) declined in all regions, except in the North and Northeast regions, which showed an increase. A strong correlation was identified between undernutrition and high BMI with SDI. ConclusionOur study observed a double burden of malnutrition in Brazil, with a reduction in the burden of diseases due to malnutrition in Brazil and variation in the burden due to high BMI according to the socioeconomic status of the region. Public policies are necessary in order to guarantee the human right to a healthy and sustainable diet, together with food and nutrition security and a diminishing of social inequality.

Abstract WMP101: Global Burden of Stroke Attributable to High BMI in 38 OECD Countries From 1990-2019: A Benchmarking Systematic Analysis

Background: The global burden of stroke remains a significant public health challenge, with high body mass index (BMI) emerging as a notable and modifiable risk factor in Organization for Economic Co-operation and Development (OECD) countries. Method: Using Global burden of disease tool, deaths and disability adjusted life years due to Stroke attributable to High BMI were assessed by age, sex, year across the 38 OECD countries from 1990-2019. Result: The total number of deaths saw a decline from 148,031 (95%UI 85,206-219,328) in 1990 to 143,105 (95%UI: 85,383-209,533) in 2019. The annual percentage change (APC) in the total number of DALYs exhibited a decrease of 1% between 1990-2019. Notably, the most substantial increase in APC for deaths was observed in Turkey at 129%, followed by Mexico at 95% from 1990-2019. Conversely, Estonia displayed the most significant decrease in APC at 63%. In relation to DALYs, Turkey experienced the highest APC at 99%, followed by Costa Rica at 85% from 1990-2019. In 2019, the age group of 75-79 exhibited the highest number of deaths (22,709) while the age group of 65-69 had the highest DALYs (553,284). In terms of gender differences, males observed a 5% increase in APC for deaths, whereas females witnessed a 10% decrease in APC from 1990-2019. Conclusion: The global burden of stroke attributable to high BMI in OECD countries highlights the urgent need for comprehensive strategies to address the intertwined challenges of obesity and stroke. Efforts to prevent and manage obesity, coupled with targeted interventions to mitigate stroke risk factors, hold the promise of reducing the human, societal, and economic toll of this prevalent and debilitating condition.

The rising burden of non-communicable diseases in the Americas and the impact of population aging: a secondary analysis of available data

Public health progress in the Americas has reduced the burden of many infectious diseases, helping more people live longer lives. At the same time, the burden of non-communicable diseases (NCDs) is increasing. NCD prevention rightly focuses on lifestyle risk factors, social, and economic determinants of health. There is less published information on the importance of population growth and aging to the regional NCD burden. For 33 countries in the Americas, we used United Nations population data to describe rates of population growth and aging over two generations (1980-2060). We used World Health Organization estimates of mortality and disability (disability-adjusted life years, DALYs) to describe changes in the NCD burden between 2000 and 2019. After combining these data resources, we decomposed the change in the number of deaths and DALYs to estimate the percentage change due to population growth, due to population aging, and due to epidemiological advances, measured by changing mortality and DALY rates. In a supplement, we provide a summary briefing for each country. In 1980, the proportion of the regional population aged 70 and older was 4.6%. It rose to 7.8% by 2020 and is predicted to rise to 17.4% by 2060. Across the Americas, DALY rate reductions would have decreased the number of DALYs by 18% between 2000 and 2019 but was offset by a 28% increase due to population aging and a 22% increase due to population growth. Although the region enjoyed widespread reductions in rates of disability, these improvements have not been sufficiently large to offset the pressures of population growth and population aging. The region of the Americas is aging and the pace of this aging is predicted to increase. The demographic realities of population growth and population aging should be factored into healthcare planning, to understand their implications for the future NCD burden, the health system needs, and the readiness of governments and communities to respond to those needs. This work was funded in part by the Pan American Health Organization, Department of Noncommunicable Diseases and Mental Health.

The global burden of high fasting plasma glucose associated with zinc deficiency: Results of a systematic review and meta-analysis.

Non-communicable diseases (NCDs) account for the largest share of the global disease burden, and increasing evidence shows that zinc deficiency (ZD) contributes to NCDs by inducing oxidative stress, insulin resistance, and impaired lipid metabolism. A systematic review and meta-analysis was conducted to determine whether ZD was associated with fasting plasma glucose (FPG), a key risk factor for NCDs. A random effects meta-analysis was conducted to determine the strength of the association in the form of an odds ratio (OR) and subsequently the population attributable risk (PAR) with population prevalences of high FPG. The disease burden from high FPG attributable to ZD was expressed as disability adjusted life years (DALYS). Data from seven studies were obtained as part of the systematic review. The meta-analysis shows a significant (p<0.01) inverse relationship between ZD and high FPG (OR = 2.34; 95% CI: 1.16, 4.72). Globally, the PAR of ZD's contribution to high FPG is 6.7%, with approximately 8.2 million high FPG DALYs attributable to ZD. Cardiovascular diseases, diabetes, and chronic kidney diseases account for more than 90% of the total DALYs. Total DALYs attributable to ZD are largest in the "Southeast Asia, East Asia, and Oceania" and "High Income" Super Regions. While the disease burden is highest among populous countries (e.g., China, India, USA), the population-standardized DALYs are highest among island nations, particularly island nations in the South Pacific and Caribbean. While ZD accounts for a small share of the high FPG disease burden, the total number of DALYs far surpasses other estimates of the disease burden attributable to ZD, which focus on diarrheal diseases in childhood. Zinc interventions are urgently needed to help address the increasing disease burden from NCDs, and the double burden of malnutrition.

The global burden of disease attributable to metabolic risks in 204 countries and territories from 1990 to 2019

AimOur study aimed to survey the burden of disease attributed to metabolic risks (MRs) and secondary MR from 1990 to 2019. MethodsUsing methodological framework of the Global Burden of Disease Study 2019, we reported the global number, age-standardized rate and population attributable fraction of deaths and disability adjusted life years related to MRs and secondary MR. Furthermore, we analyzed the global burden caused by MRs and secondary MR in detail by gender, age, region, country, disease and Socio-demographic Index level. ResultsThe number (million) of deaths and DALYs caused by MRs was 18.6 and 462.8 in 2019, with an increase of 43.6 % and 75.0 % since 1990. However, the ASR of deaths and DALYs attributed to MRs had a decrease of 23.3 % and 17.0 % since 1990. The burden caused by MRs and secondary MR raised with age, and the burden was the heaviest in low - and middle-income countries, especially in Middle East & North Africa. For diseases, the heaviest burden attributed to MRs was observed in ischemic heart disease, followed by stroke. ConclusionThe burden of disease attributed to MRs has continued to rise in the past 30 years, particularly for men and low-middle SDI regions. Therefore, the government should take corresponding actions to reduce the impact of MRs on population health.

S-31-4: STROKE BURDEN AND HYPERTENSION IN THE ASIA-PACIFIC REGION

Background: Stroke is a major cause of death and disability globally, especially in particular in the Asia-Pacific region, which is home to more than 4 billion people. Among the modifiable risk factors for stroke, hypertension is the strongest, but controllable to confer large outcome benefits. Objective: To investigate the association between hypertension and stroke burden in Asia-Pacific countries. Design and Methods: Stroke burden, as defined as age- and sex-standardised disability-adjusted life-years lost (DALYs) per 100,000 persons attributed to stroke, in Asia Pacific countries was extracted from the Global Burden of Disease (GBD) Study 2010. The age- and sex-standardised prevalence (%) of hypertension, defined as systolic blood pressure &gt; 140 mmHg and diastolic blood pressure &gt; 90 mmHg among adults aged 18 years or older, in these same countries was obtained from the World Health Organisation (WHO) database for 2015. Linear correlation was then estimated by calculating Pearson's product-moment correlation coefficient. Results: The stroke burdens expressed in terms of DALYs were obtained for 26 countries in the Asia Pacific region. The number of DALYs varied widely. being the lowest in Australia (398.2/100,000) and New Zealand (440/100,000), and the highest in Mongolia (4,409.8/100,000) and Indonesia (3,382.2/100,000). The prevalence of hypertension, also highly variable, was lowest in South Korea (11.0%) and Singapore (14.6%), and highest in Pakistan (30.5%) and Nepal (29.6%). There was a modest positive correlation between DALYs attributed to stroke and hypertension prevalence (r = 0.49). Approximately one-quarter of the variance in the DALYs due to stroke was predictable from the variability in hypertension prevalence across the Asia-Pacific region (r2 = 0.24). Conclusion: Both the burden of stroke and hypertension prevalence vary widely among Asian Pacific countries. There is a modest positive correlation between the two parameters. A significant amount of the variability in stroke burden is attributable to the variability in hypertension prevalence.

Epidemiology of Bladder Cancer in the Arab World: 2019 Global Burden of Disease Data.

Urinary bladder cancer (UBC) has unique epidemiology. It is well known that some Arab countries have higher incidence of UBC due to certain risk factors, including schistosomiasis and smoking. We systematically reviewed the Global Burden of Disease study (GBD) database for the year 2019. We queried GBD study database using results tool for UBC in the 22 Arab countries and compared the age-standardized incidence rate (ASIR), death rate (ASDR), mortality-to-incidence ratio (MIR) and Disability-Adjusted Life Years (ASDALYs) in Arab countries with global values. The Arab population represents 5.6% of the global population. There was an estimated number of 27,503 patients diagnosed with UBC in 2019 in the Arab world. The ASIR for developing UBC in the Arab countries was 9.9/100,000; which is higher than the average global ASIR (6.5/100,000). Specifically, the ASIR was higher than the global average in 11 out of the 22 Arab countries. Notably, the age-specific incidence in Egypt showed that younger individuals had higher incidence of UBC than other countries, reflecting unique epidemiology. It is estimated that 10,532 patients died of UBC in the Arab world in 2019. The average mortality-to-incidence ratio (MIR) was estimated to be 0.448. The burden of UBC as estimated by the number of DALYs in the Arab world was 272,976 years representing 4% of cancer burden in Arab countries and 6.2% of the global DALYs related to UBC. UBC has high incidence in many Arab countries, particularly in North Africa. Risk factors are known and are modifiable, making prevention the most optimal way to reduce disease burden. High MIR in many Arab countries reflects suboptimal management and a window for improvement.

Global, regional, and national burden of cancers attributable to tobacco smoking in 204 countries and territories, 1990-2019.

BackgroundCancers are leading causes of mortality and morbidity, with smoking being recognized as a significant risk factor for many types of cancer. We aimed to report the cancer burden attributable to tobacco smoking by sex, age, socio‐demographic index (SDI), and cancer type in 204 countries and territories from 1990 to 2019.MethodsThe burden of cancers attributable to smoking was reported between 1990 and 2019, based upon the Comparative Risk Assessment approach used in the Global Burden of Disease (GBD) study 2019.ResultsGlobally, in 2019 there were an estimated 2.5 million cancer‐related deaths (95% UI: 2.3 to 2.7) and 56.4 million DALYs (51.3 to 61.7) attributable to smoking. The global age‐standardized death and DALY rates of cancers attributable to smoking per 100,000 decreased by 23.0% (−29.5 to −15.8) and 28.6% (−35.1 to −21.5), respectively, over the period 1990–2019. Central Europe (50.4 [44.4 to 57.6]) and Western Sub‐Saharan Africa (6.7 [5.7 to 8.0]) had the highest and lowest age‐standardized death rates, respectively, for cancers attributable to smoking. In 2019, the age‐standardized DALY rate of cancers attributable to smoking was highest in Greenland (2224.0 [1804.5 to 2678.8]) and lowest in Ethiopia (72.2 [51.2 to 98.0]). Also in 2019, the global number of DALYs was highest in the 65–69 age group and there was a positive association between SDI and the age‐standardized DALY rate.ConclusionsThe results of this study clearly illustrate that renewed efforts are required to increase utilization of evidence‐based smoking cessation support in order to reduce the burden of smoking‐related diseases.

Burden of diseases attributed to traffic noise in the metropolis of Tehran in 2017

Although road traffic noise is the most important source of environmental noise emission in large cities, little is known about health burden. The present study was conducted to estimate the burden of diseases attributed to traffic noise in the metropolis of Tehran in 2017. Using noise maps provided by the municipality of Tehran, we calculated population exposure distribution in term of Ldn and Lnight and the number of DALYs lost due to ischemic heart disease, hypertension, high sleep disturbance, annoyance and stroke endpoints based on the World Health Organization Environmental Noise Guidelines for the European Region. We applied published dose-response functions to estimate the traffic noise burden for high sleep disturbance and annoyance. We estimated 61,284 DALYs or 697 DALYs per 100,000 population attributed to traffic noise in Tehran for the reference year 2017. Highly sleep disturbance with a share of 58.74% of the DALYs was recognized as the most important contributor of disease burden, and noise annoyance with a share of 23.12% was ranked next. Ischemic heart disease (11.71%), stroke (5.12%), and hypertension (1.31%) were ranked third to fourth, respectively, in terms of the burden of disease caused by environmental noise. A considerable fraction of the population of Tehran lives in areas with an environmental noise higher than the standard level. The findings showed that traffic noise pollution is an important environmental risk factor in Tehran imposes the greatest burden on the community, mainly through highly sleep disturbance and noise annoyance endpoints.

Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

SummaryBackgroundThe mental disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were depressive disorders, anxiety disorders, bipolar disorder, schizophrenia, autism spectrum disorders, conduct disorder, attention-deficit hyperactivity disorder, eating disorders, idiopathic developmental intellectual disability, and a residual category of other mental disorders. We aimed to measure the global, regional, and national prevalence, disability-adjusted life-years (DALYS), years lived with disability (YLDs), and years of life lost (YLLs) for mental disorders from 1990 to 2019.MethodsIn this study, we assessed prevalence and burden estimates from GBD 2019 for 12 mental disorders, males and females, 23 age groups, 204 countries and territories, between 1990 and 2019. DALYs were estimated as the sum of YLDs and YLLs to premature mortality. We systematically reviewed PsycINFO, Embase, PubMed, and the Global Health Data Exchange to obtain data on prevalence, incidence, remission, duration, severity, and excess mortality for each mental disorder. These data informed a Bayesian meta-regression analysis to estimate prevalence by disorder, age, sex, year, and location. Prevalence was multiplied by corresponding disability weights to estimate YLDs. Cause-specific deaths were compiled from mortality surveillance databases. The Cause of Death Ensemble modelling strategy was used to estimate death rate by age, sex, year, and location. The death rates were multiplied by the years of life expected to be remaining at death based on a normative life expectancy to estimate YLLs. Deaths and YLLs could be calculated only for anorexia nervosa and bulimia nervosa, since these were the only mental disorders identified as underlying causes of death in GBD 2019.FindingsBetween 1990 and 2019, the global number of DALYs due to mental disorders increased from 80·8 million (95% uncertainty interval [UI] 59·5–105·9) to 125·3 million (93·0–163·2), and the proportion of global DALYs attributed to mental disorders increased from 3·1% (95% UI 2·4–3·9) to 4·9% (3·9–6·1). Age-standardised DALY rates remained largely consistent between 1990 (1581·2 DALYs [1170·9–2061·4] per 100 000 people) and 2019 (1566·2 DALYs [1160·1–2042·8] per 100 000 people). YLDs contributed to most of the mental disorder burden, with 125·3 million YLDs (95% UI 93·0–163·2; 14·6% [12·2–16·8] of global YLDs) in 2019 attributable to mental disorders. Eating disorders accounted for 17 361·5 YLLs (95% UI 15 518·5–21 459·8). Globally, the age-standardised DALY rate for mental disorders was 1426·5 (95% UI 1056·4–1869·5) per 100 000 population among males and 1703·3 (1261·5–2237·8) per 100 000 population among females. Age-standardised DALY rates were highest in Australasia, Tropical Latin America, and high-income North America.InterpretationGBD 2019 showed that mental disorders remained among the top ten leading causes of burden worldwide, with no evidence of global reduction in the burden since 1990. The estimated YLLs for mental disorders were extremely low and do not reflect premature mortality in individuals with mental disorders. Research to establish causal pathways between mental disorders and other fatal health outcomes is recommended so that this may be addressed within the GBD study. To reduce the burden of mental disorders, coordinated delivery of effective prevention and treatment programmes by governments and the global health community is imperative.FundingBill & Melinda Gates Foundation, Australian National Health and Medical Research Council, Queensland Department of Health, Australia.

Global trends and regional differences in the burden of anxiety disorders and major depressive disorder attributed to bullying victimisation in 204 countries and territories, 1999-2019: an analysis of the Global Burden of Disease Study.

This study aimed to analyse the temporal and spatial trends in the burden of anxiety disorders and major depressive disorder related to bullying victimisation on global, regional and country scales. Data were from the 2019 Global Burden of Disease (GBD) Study. We assessed the global disability-adjusted life years (DALYs, per 100 000 population) of anxiety disorders and major depressive disorder attributable to bullying victimisation by age, sex and geographical location. The percentage changes in age-standardised rates of DALYs were used to quantify temporal trends, and the annual rate changes across 204 countries and territories were used to present spatial trends. Furthermore, we examined the relationship between the sociodemographic index (SDI) and the burden of anxiety disorders as well as major depressive disorder attributable to bullying victimisation and its spatial and temporal characteristics globally. From 1990 to 2019, the global DALY rates of anxiety disorders and major depressive disorder attributable to bullying victimisation increased by 23.31 and 26.60%, respectively, with 27.27 and 29.07% for females and 18.88 and 23.84% for males. Across the 21 GBD regions, the highest age-standardised rates of bullying victimisation-related DALYs for anxiety disorders were in North Africa and the Middle East and for major depressive disorder in High-income North America. From 1990 to 2019, the region with the largest percentage increase in the rates of DALYs was High-income North America (54.66% for anxiety disorders and 105.88% for major depressive disorder), whereas the region with the slowest growth rate or largest percentage decline was East Asia (1.71% for anxiety disorders and -25.37% for major depressive disorder). In terms of SDI, this study found overall upward trends of bullying-related mental disorders in areas regardless of the SDI levels, although there were temporary downward trends in some stages of certain areas. The number and rates of DALYs of anxiety disorders and major depressive disorder attributable to bullying victimisation increased from 1990 to 2019. Effective strategies to eliminate bullying victimisation in children and adolescents are needed to reduce the burden of anxiety disorders and major depressive disorder. Considering the large variations in the burden by SDI and geographic location, future protective actions should be developed based on the specific cultural contexts, development status and regional characteristics of each country.

Burden of epilepsy in Latin America and The Caribbean: a trend analysis of the Global Burden of Disease Study 1990 – 2019

The epilepsy prevalence in Latin America and the Caribbean (LAC) had remained high over the last 20 years. Data on the burden of epilepsy are needed for healthcare planning and resource allocation. However, no systematic analysis had been performed for epilepsy burden in LAC. We extracted data of all LAC countries from the Global Burden of Disease (GBD) study from 1990 to 2019. Epilepsy burden was measured as prevalence, mortality, and disability-adjusted life-years (DALYs; defined by the sum of years of life lost [YLLs] for premature mortality and years lived with disability [YLDs]), by age, sex, year, and country. Absolute numbers, rates, and 95% uncertainty intervals were reported. We performed correlational analyses among burden metrics and Socio-demographic Index (SDI). The burden of epilepsy decreased around 20% in LAC, led by YLLs reduction. In 2019, 6·3 million people were living with active epilepsy of all causes (95% UI 5·3 - 7·4), with 3·22 million (95% UI 2·21 - 4·03) and 3·11 million (95% UI 2·21 to 4·03) cases of epilepsy with identifiable aetiology and idiopathic epilepsy, respectively. The number of DALYs represented the 9·51% (1.37 million, 95% UI 0·99 -1·86) of the global epilepsy burden in 2019. The age-standardized burden was 175·9 per 100 000 population (95% UI 119·4 - 253·3), which tend to have a bimodal age distribution (higher in the youth and elderly) and was driven by high YLDs estimates. The burden was higher in men and older adults, primarily due to high YLLs and mortality. Alcohol use was associated with 17% of the reported DALYs. The SDI estimates significantly influenced this burden (countries with high SDI have less epilepsy burden and mortality, but not prevalence or disability). The epilepsy burden has decreased in LAC over the past 30 years. Even though, LAC is still ranked as the third region with the highest global epilepsy burden. This reduction was higher in children, but burden and mortality increased for older adults. The epilepsy burden is disability predominant; however, the mortality-related estimates are still higher than in other regions. Alcohol consumption and countries' development are important determinants of this burden. There is an urgent need to improve access to epilepsy care in LAC, particularly for older adults. Strengthening primary care with online learning and telemedicine tools, and promoting risk factors modification should be prioritized in the region. This research was self-funded by the authors.

Disease Burden and Attributable Risk Factors of Alzheimer's Disease and Dementia in China from 1990 to 2019

Background: Updated information on the burden of Alzheimer's disease and other forms of dementia are of great importance for evidence-based health care planning. However, such an estimate has been lacking in Chinese populations at both national and provincial levels. Methods: The temporal trends and the attributable burdens of selected risk factors of Alzheimer's disease and dementia in China were reported through six indicators: incidence, mortality, prevalence, YLLs, YLDs, and DALYs. Findings: There were notable increasing trends in the number of deaths (247·9%), incidence (264·8%), prevalence (296·5%), YLDs (308·7%), YLLs (201·7%) and DALYs (228·1%) from 1990 to 2019, respectively. The corresponding age-standardized rates increased by 6·2%, 19·3%, 33·6%, 33·4%, 3·1% and 10·7%. Smoking, high body mass index, high fasting plasma glucose levels, and metabolic risks were the four leading risk factors. Higher burden was observed among females versus males and in the more developed regions. Interpretation: The disease burden in China were increasing substantially. Regional differences of the disease burden are accompanied by discrepancies of economic level and geographical location, as well as different levels of exposure to risk factors. Targeted prevention and control strategies are urgently needed to reduce the disease burden. Funding: National key Research and Development program of China [2020YFC2008705]. Declaration of Interest: None to declare.

Health and environmental impacts of replacing kerosene-based lighting with renewable electricity in East Africa

BackgroundLighting sources have been overlooked in previous estimates of the health burden attributable to household air pollution (HAP). However, lighting sources can be an important predictor of personal exposure to HAP in countries with limited access to electricity. We modeled the health and environmental impacts of hypothetical intervention scenarios that replace kerosene-based lighting with renewable electricity in East Africa. MethodsWe used comparative risk assessment methods to quantify the ischemic heart disease-, stroke-, lung cancer-, chronic obstructive pulmonary disease- and lower respiratory infection-related morbidity and mortality attributable to personal fine particulate matter (PM2.5) exposure due to kerosene-based lighting for residents of East Africa in 2015. We used health and demographic data from the Global Burden of Disease; PM2.5 exposure estimates from a previous study replacing kerosene-based lighting with solar lighting; and exposure-response functions from the literature to estimate the number of deaths and DALYs that could be avoided with increased scaling-up of the lighting source intervention. We estimated avoided black carbon emissions using emission factors from published literature. ResultsWe estimated that 6218, 10,092, 12,723 deaths and 409, 654, 814 hundred thousand DALYs could be avoided if 33%, 66%, and 100% respectively of households using kerosene-based lighting replaced it with electricity in East Africa in 2015. Including lighting fuel in estimates of deaths due to PM2.5 from household air pollution in the region would add a further 9% in addition to those from cooking with solid fuel. Full replacement of kerosene-based lighting with renewable electricity would have reduced black carbon emissions by 4.4 Gg/year or 3957 CO2eq Gg in 2015, with the largest emission reductions in Uganda and Kenya. ConclusionKerosene-based lighting is a non-negligible source of HAP in the region and should be included in assessments of the health burden attributable to HAP.