Disease Burden Patterns Research Articles

Global burden and trends of leukemia attributable to high body mass index risk in adults over the past 30 years.

High BMI (Body Mass Index) is a significant factor impacting health, with a clear link to an increased risk of leukemia. Research on this topic is limited. Understanding the epidemiological trends of leukemia attributable to high BMI risk is crucial for disease prevention and patient support. We obtained the data from the Global Burden of Disease Study, analyzing the ASR (age-standardized rates), including ASDR (age-standardized death rate) and age-standardized disability-adjusted life years (DALYs) rate, and estimated annual percentage change (EAPC) by gender, age, country, and region from 1990 to 2019. In 2019, deaths and DALYs have significantly increased to 21.73 thousand and 584.09 thousand. The global age-standardized death and DALYs rates have slightly increased over the past 30 years (EAPCs: 0.34 and 0.29). Among four common leukemia subtypes, only CML (Chronic Myeloid Leukemia) exhibited a significant decrease in ASDR and age-standardized DALYs rate, with EAPC of -1.74 and -1.52. AML (Acute Myeloid Leukemia) showed the most pronounced upward trend in ASDR, with an EAPC of 1.34. These trends vary by gender, age, region, and national economic status. Older people have been at a significantly greater risk. Females globally have borne a higher burden. While males have shown an increasing trend. The regions experiencing the greatest growth in ASR were South Asia. The countries with the largest increases were Equatorial Guinea. However, It is worth noting that there may be variations among specific subtypes of leukemia. Regions with high Socio-demographic Index (SDI) have had the highest ASR, while low-middle SDI regions have shown the greatest increase in these rates. All ASRs values have been positively correlated with SDI, but there has been a turning point in medium to high SDI regions. Leukemia attributable to high BMI risk is gradually becoming a heavier burden globally. Different subtypes of leukemia have distinct temporal and regional patterns. This study's findings will provide information for analyzing the worldwide disease burden patterns and serve as a basis for disease prevention, developing suitable strategies for the modifiable risk factor.

Global, regional, and national burden and trends analysis of gallbladder and biliary tract cancer from 1990 to 2019 and predictions to 2030: a systematic analysis for the Global Burden of Disease Study 2019.

Our aim was to explore the disease burden caused by gallbladder and biliary tract cancer globally, regionally, and nationally, by age and sex. The absolute number of cases and age-standardized rates (ASR) of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) due to gallbladder and biliary tract cancer were extracted from the Global Burden of Disease (GBD) Study 2019. We estimated the trends in disease burden by calculating the percentage change in the absolute number of cases and the estimated annual percentage change (EAPC) in ASR, by social development index (SDI), region, nation, sex, and age. From 1990 to 2019, the number of incident cases, prevalent cases, deaths, and DALYs worldwide significantly increased by 1.85-fold, 1.92-fold, 1.82-fold, and 1.68-fold, respectively. However, the age-standardized rates of incidence, prevalence, mortality, and DALYs tend to decrease globally over time. Nevertheless, heterogeneous disease burden patterns exist between geographic regions due to different geographical risk factors, distinct epidemiologically predominant gallbladder and biliary tract cancer subtypes, and potential genetic predispositions or ethnicity. Additionally, socioeconomic status mediates the regional variation in disease burden, with increasing SDI or HDI scores associated with downward trends in the age-standardized rates of incidence, prevalence, mortality, and DALYs. Older individuals and females are at higher risk of gallbladder and biliary tract cancer, but the increasing burden of early-onset gallbladder and biliary tract cancer is a cause for concern, especially for those living in lower SDI areas and males. High BMI is the primary risk factors underlying gallbladder and biliary tract cancer, accounted for 15.2% of deaths and 15.7% DALYs globally in 2019. Our study comprehensively elucidated the distribution and dynamic trends of gallbladder and biliary tract cancer burden over the past three decades, from multiple dimensions. These findings emphasize the importance of promoting a healthy lifestyle as a population-level cancer prevention strategy and tailoring cancer control actions based on localized risk factors and the epidemic profiles of gallbladder and biliary tract cancer by anatomical subtype.

Spatial and temporal patterns of disease burden attributable to high BMI in Belt and Road Initiative countries, 1990-2019.

This study aimed to analyse the spatial and temporal patterns of disease burden attributed to high BMI (DB-hBMI) from 1990 to 2019 in Belt and Road Initiative (BRI) countries, in light of increasing hBMI prevalence worldwide. The study was a secondary analysis of Global Burden of Disease 2019 (GBD 2019) that analysed (using Joinpoint regression analysis) numbers and the age-standardised rate of mortality and disability-adjusted life years (DALY) of hBMI-induced diseases and their trends from 1990 to 2019 and in the final decade. GBD 2019 study data for BRI countries were categorised by country, age, gender and disease. GBD 2019 data were used to analyse DB-hBMI in BRI countries. In 2019, China, India and Russia reported the highest mortality and DALY among BRI countries. From 1990 to 2019, the age-standardised DALY increased in Southeast Asia and South Asia, whereas many European countries saw declines. Notably, Bangladesh, Nepal and Vietnam showed the steepest increases, with average annual percentage change (AAPC) values of 4·42%, 4·19% and 4·28%, respectively (all P<0·05). In contrast, Israel, Slovenia and Poland experienced significant reductions, with AAPC values of -1·70%, -1·63% and -1·58%, respectively (all P<0·05). The most rapid increases among males were seen in Vietnam, Nepal and Bangladesh, while Jordan, Poland and Slovenia recorded the fastest declines among females. Across most BRI countries, the burden of diabetes and kidney diseases related to hBMI showed a significant uptrend. DB-hBMI varies significantly by region, age, gender and disease type across BRI countries. It can pose a substantial threat to public health.

The future of evolutionary medicine: sparking innovation in biomedicine and public health.

Evolutionary medicine - i.e. the application of insights from evolution and ecology to biomedicine - has tremendous untapped potential to spark transformational innovation in biomedical research, clinical care and public health. Fundamentally, a systematic mapping across the full diversity of life is required to identify animal model systems for disease vulnerability, resistance, and counter-resistance that could lead to novel clinical treatments. Evolutionary dynamics should guide novel therapeutic approaches that target the development of treatment resistance in cancers (e.g., via adaptive or extinction therapy) and antimicrobial resistance (e.g., via innovations in chemistry, antimicrobial usage, and phage therapy). With respect to public health, the insight that many modern human pathologies (e.g., obesity) result from mismatches between the ecologies in which we evolved and our modern environments has important implications for disease prevention. Life-history evolution can also shed important light on patterns of disease burden, for example in reproductive health. Experience during the COVID-19 (SARS-CoV-2) pandemic has underlined the critical role of evolutionary dynamics (e.g., with respect to virulence and transmissibility) in predicting and managing this and future pandemics, and in using evolutionary principles to understand and address aspects of human behavior that impede biomedical innovation and public health (e.g., unhealthy behaviors and vaccine hesitancy). In conclusion, greater interdisciplinary collaboration is vital to systematically leverage the insight-generating power of evolutionary medicine to better understand, prevent, and treat existing and emerging threats to human, animal, and planetary health.

Thalamic pathology in frontotemporal dementia: Predilection for specific nuclei, phenotype-specific signatures, clinical correlates, and practical relevance.

Frontotemporal dementia (FTD) phenotypes are classically associated with distinctive cortical atrophy patterns and regional hypometabolism. However, the spectrum of cognitive and behavioral manifestations in FTD arises from multisynaptic network dysfunction. The thalamus is a key hub of several corticobasal and corticocortical circuits. The main circuits relayed via the thalamic nuclei include the dorsolateral prefrontal circuit, the anterior cingulate circuit, and the orbitofrontal circuit. In this paper, we have reviewed evidence for thalamic pathology in FTD based on radiological and postmortem studies. Original research papers were systematically reviewed for preferential involvement of specific thalamic regions, for phenotype-associated thalamic disease burden patterns, characteristic longitudinal changes, and genotype-associated thalamic signatures. Moreover, evidence for presymptomatic thalamic pathology was also reviewed. Identified papers were systematically scrutinized for imaging methods, cohort sizes, clinical profiles, clinicoradiological associations, and main anatomical findings. The findings of individual research papers were amalgamated for consensus observations and their study designs further evaluated for stereotyped shortcomings. Based on the limitations of existing studies and conflicting reports in low-incidence FTD variants, we sought to outline future research directions and pressing research priorities. FTD is associated with focal thalamic degeneration. Phenotype-specific thalamic traits mirror established cortical vulnerability patterns. Thalamic nuclei mediating behavioral and language functions are preferentially involved. Given the compelling evidence for considerable thalamic disease burden early in the course of most FTD subtypes, we also reflect on the practical relevance, diagnostic role, prognostic significance, and monitoring potential of thalamic metrics in FTD. Cardinal manifestations of FTD phenotypes are likely to stem from thalamocortical circuitry dysfunction and are not exclusively driven by focal cortical changes.

Spatiotemporal trends of disease burden of edentulism from 1990 to 2019: A global, regional, and national analysis.

Understanding the spatiotemporal trends in disease burden of edentulism is critical to reducing disease burden of edentulism and deploying medical resources. We assessed the changing patterns of disease burden of edentulism at global, regional, and national levels from 1990 to 2019. Data on incident cases, prevalent cases, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) of edentulism were extracted from the Global Burden of Disease 2019 Study. We calculated the estimated annual percentage change (EAPC) to quantify spatiotemporal trends in the ASRs of edentulism. In 2019, the number of prevalent cases and DALYs of edentulism were 35.2 and 9.6 million, and the ASPR and ASDR were 43.12/1,000 and 1.18/1,000, with EAPCs of -0.18 [95% confidence interval (CI): -0.28, -0.09] and -0.16[95% CI: -0.26, -0.07] from 1990 to 2019, respectively. Females and the elderly had a higher burden of edentulism. Although the ASPR, ASDR, and ASIR in the high SDI, high-middle SDI, and middle SDI regions showed a decreasing or stable trend, the absolute disease burdens of edentulism in these regions were still high. Although the absolute disease burdens of low SDI and low-middle SDI were low, their ASPR and ASDR showed an upward trend. In countries with high initial disease burden or high SDI, ASPR, ASDR, and ASIR showed stable or declining trends. The absolute disease burden due to edentulism was increasing in many countries and regions. Countries should reduce the disease burden caused by edentulism by adopting measures including the prevention and treatment of dental caries and periodontal disease.

Trends and patterns of North Korea's disease burden from 1990 to 2019: Results from Global Burden of Disease study 2019.

Evidence for the trends and patterns of disease burden in North Korea is limited, and in-depth analysis based on several health outcomes for a better understanding remains challenging. Therefore, we aimed to investigate the trends and patterns of disease burden in North Korea between 1990 and 2019. We used data from the Global Burden of Diseases (GBD) 2019 study to analyze the North Korean disease burden in comparison with four groups: global, South Korea, low-sociodemographic index (SDI) countries, Central and Eastern Europe, and Central Asia (former socialist countries). We also examined changes in the disease burden between 1990 and 2019 by disease category and age group. In 2019, in North Korea, death rates and disability-adjusted life years (DALYs) rates were reduced by 22.2% and 30.7%, respectively, compared to 1990. The rates showed similar trends and patterns to that in former socialist countries. However, these reductions were lower than those of the global rates and rates in low-SDI countries and South Korea. Death rates and DALY rates for under five years dramatically decreased by more than 78%, similar to the trend in South Korea. In contrast, the decline in the death rates and DALY rates of adults was less than those worldwide and in low-SDI countries and South Korea. The burden of diseases among those aged ≥30 years increased largely due to the persistently high burden of non-communicable diseases (NCDs). Cardiovascular diseases, neoplasms, and chronic respiratory diseases were the leading causes of the disease burden in both 1990 and 2019. North Korea's disease burden patterns and trends show clear improvements over the past 30 years but suggest that the current challenges of NCDs in the country are very serious. NCDs should be no longer neglected and should be prioritized in public health agendas in North Korea.

Clusters of anatomical disease-burden patterns in ALS: a data-driven approach confirms radiological subtypes

Amyotrophic lateral sclerosis (ALS) is associated with considerable clinical heterogeneity spanning from diverse disability profiles, differences in UMN/LMN involvement, divergent progression rates, to variability in frontotemporal dysfunction. A multitude of classification frameworks and staging systems have been proposed based on clinical and neuropsychological characteristics, but disease subtypes are seldom defined based on anatomical patterns of disease burden without a prior clinical stratification. A prospective research study was conducted with a uniform imaging protocol to ascertain disease subtypes based on preferential cerebral involvement. Fifteen brain regions were systematically evaluated in each participant based on a comprehensive panel of cortical, subcortical and white matter integrity metrics. Using min–max scaled composite regional integrity scores, a two-step cluster analysis was conducted. Two radiological clusters were identified; 35.5% of patients belonging to ‘Cluster 1’ and 64.5% of patients segregating to ‘Cluster 2’. Subjects in Cluster 1 exhibited marked frontotemporal change. Predictor ranking revealed the following hierarchy of anatomical regions in decreasing importance: superior lateral temporal, inferior frontal, superior frontal, parietal, limbic, mesial inferior temporal, peri-Sylvian, subcortical, long association fibres, commissural, occipital, ‘sensory’, ‘motor’, cerebellum, and brainstem. While the majority of imaging studies first stratify patients based on clinical criteria or genetic profiles to describe phenotype- and genotype-associated imaging signatures, a data-driven approach may identify distinct disease subtypes without a priori patient categorisation. Our study illustrates that large radiology datasets may be potentially utilised to uncover disease subtypes associated with unique genetic, clinical or prognostic profiles.

Potential years of life lost due to PM2.5-bound toxic metal exposure: Spatial patterns across 60 cities in China

To clarify the spatial patterns of disease burden caused by toxic metals in fine particulate matter (PM2.5) across China, annual concentration levels of typical toxic metals in PM2.5 over 60 cities of China were retrieved. Then, potential years of life lost (PYLL) attributable to toxic metal (As, Cd, Cr (VI), Mn, and Ni) exposure was calculated from health risk assessments and lifetable estimates. The results show that Cr(VI) and As were the most polluted metals and greatly exceeded the recommended annual values in the National Ambient Air Quality Standard of China. PYLL for each death (mean ± standard deviation) of 19.8 ± 4.5 years was observed for lung cancer, followed closely by COPD and pneumonia. Furthermore, the PYLL rate (years per 100,000 people) attributable to exposure to these toxic metals was 457 (male: 505, female: 402) years for different cities; therein, Cr(VI) contributed the highest PYLL among these toxic metals, with a proportion of 72.7% (male: 75.3%, female: 69.5%), followed by As of 16.4% (male: 13.8%, female: 19.8%). The concentration level and PYLL both showed large spatial variability, of which the top-ranking cities were observed to be affected by well-developed metal-related industries and coal-powered industrial sectors.

Phenotypic categorisation of individual subjects with motor neuron disease based on radiological disease burden patterns: A machine-learning approach

Motor neuron disease is an umbrella term encompassing a multitude of clinically heterogeneous phenotypes. The early and accurate categorisation of patients is hugely important, as MND phenotypes are associated with markedly different prognoses, progression rates, care needs and benefit from divergent management strategies. The categorisation of patients shortly after symptom onset is challenging, and often lengthy clinical monitoring is needed to assign patients to the appropriate phenotypic subgroup. In this study, a multi-class machine-learning strategy was implemented to classify 300 patients based on their radiological profile into diagnostic labels along the UMN-LMN spectrum. A comprehensive panel of cortical thickness measures, subcortical grey matter variables, and white matter integrity metrics were evaluated in a multilayer perceptron (MLP) model. Additional exploratory analyses were also carried out using discriminant function analyses (DFA). Excellent classification accuracy was achieved for amyotrophic lateral sclerosis in the testing cohort (93.7%) using the MLP model, but poor diagnostic accuracy was detected for primary lateral sclerosis (43.8%) and poliomyelitis survivors (60%). Feature importance analyses highlighted the relevance of white matter diffusivity metrics and the evaluation of cerebellar indices, cingulate measures and thalamic radiation variables to discriminate MND phenotypes. Our data suggest that radiological data from single patients may be meaningfully interpreted if large training data sets are available and the provision of diagnostic probability outcomes may be clinically useful in patients with short symptom duration. The computational interpretation of multimodal radiology datasets herald viable diagnostic, prognostic and clinical trial applications.

Frontotemporal Pathology in Motor Neuron Disease Phenotypes: Insights From Neuroimaging.

Frontotemporal involvement has been extensively investigated in amyotrophic lateral sclerosis (ALS) but remains relatively poorly characterized in other motor neuron disease (MND) phenotypes such as primary lateral sclerosis (PLS), progressive muscular atrophy (PMA), spinal muscular atrophy (SMA), spinal bulbar muscular atrophy (SBMA), post poliomyelitis syndrome (PPS), and hereditary spastic paraplegia (HSP). This review focuses on insights from structural, metabolic, and functional neuroimaging studies that have advanced our understanding of extra-motor disease burden in these phenotypes. The imaging literature is limited in the majority of these conditions and frontotemporal involvement has been primarily evaluated by neuropsychology and post mortem studies. Existing imaging studies reveal that frontotemporal degeneration can be readily detected in ALS and PLS, varying degree of frontotemporal pathology may be captured in PMA, SBMA, and HSP, SMA exhibits cerebral involvement without regional predilection, and there is limited evidence for cerebral changes in PPS. Our review confirms the heterogeneity extra-motor pathology across the spectrum of MNDs and highlights the role of neuroimaging in characterizing anatomical patterns of disease burden in vivo. Despite the contribution of neuroimaging to MND research, sample size limitations, inclusion bias, attrition rates in longitudinal studies, and methodological constraints need to be carefully considered. Frontotemporal involvement is a quintessential clinical facet of MND which has important implications for screening practices, individualized management strategies, participation in clinical trials, caregiver burden, and resource allocation. The academic relevance of imaging frontotemporal pathology in MND spans from the identification of genetic variants, through the ascertainment of presymptomatic changes to the design of future epidemiology studies.

Spatiotemporal analysis of 11 years of Chlamydia trachomatis data from southern China

BackgroundUrogenital Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection (STI) globally. Reviews suggest high and persistently endemic STI epidemics in low and middle income countries. However population-based prevalence estimates in these settings are less common, underscoring the need for analyses of available data to characterize patterns of disease burden. We identified spatio-temporal clusters and key behavioral, social, or environmental factors contribution to transmission in order to inform the prioritization and targeting of evidence based interventions. MethodsUsing 11 years of data (2006–2016) from the chlamydia case report system of Guangdong, China, we identified county level spatio-temporal hot and cold spots using the Getis-Ord Gi* statistic and discrete Poisson models in SaTScan 9.6. We also estimated associations between observed distribution patterns and area-level demographic, social, and economic factors using quasi-Poisson regression models that controlled for annual counts of certified laboratories to account for fluctuations in location-specific detection capacity. FindingsCluster analysis indicates an expanding chlamydia epidemic in Guangdong, with cases clustered in regions of greatest economic activity. Greater male-to-female sex ratio (RR, 3.63; 95% CI, 1.41–9.45) and greater urbanicity (RR, 2.44; 95% CI, 1.98–2.99) were predictive of higher chlamydia case occurrence. InterpretationWe found that chlamydia case occurrence in Guangdong province has been accelerating over the past 11 years and that its expansion is tied to indicators of social and economic development. These estimates not only identify high prevalence regions to target but also areas where data gaps potentially remain. The salience of sex ratios and urbanicity may best be understood through the lens of China's modern history of labor migration which has reshaped the gender dynamics and health access landscape of urban China. Future chlamydia control efforts will require a population-based approach focused on reengaging sexually active adults of diverse economic and migratory backgrounds. FundingThis was an unfunded study using routinely collected public health data.

The data used to build the models: Pertussis morbidity and mortality burden considering various Brazilian data sources

BackgroundPertussis is associated with significant disease burden in children worldwide. In addition to its cyclical nature, resurgences of pertussis cases, hospitalizations and deaths have been reported by many countries. We describe the dynamics of pertussis in Brazil, a middle-income country that has experienced a resurgence and that provides good quality data to allow building a dynamic transmission disease model. MethodsWe conducted a descriptive analysis of pertussis burden considering data from the national disease surveillance system, national hospitalization information system and national mortality registry. Study period was 2000–2016. Absolute numbers and rates per 100,000 inhabitants over time, by age sub-groups and geographical regions are presented. ResultsFrom 2000 to 2016, a total of 37,299 reported pertussis cases, 25,240 hospitalizations, and 601 deaths due to pertussis were reported. Although the outcomes – pertussis cases, hospitalizations, and deaths – come from independent information systems, our results document low disease burden with periodic increases every 3–4 years during the years 2000–2010, followed by a sharp increase which peaked in 2014. In both periods, disease burden is concentrated in young children, while its more serious outcomes – hospitalizations and deaths, are concentrated in infants. Pre-outbreak and outbreak disease burden as well as timing of peak during the outbreak period vary by states and within geographical regions, representing valuable resources of data for modelling purposes. ConclusionConsistent disease burden patterns were observed over time in Brazil using a variety of data sources. Given the scarcity of good epidemiological data on pertussis available from low- and middle-income countries, our reported data provide valuable information for the assessment of the public health impact and cost-effectiveness modelling studies of newer strategies to prevent and control pertussis. These data were used to build and calibrate a national dynamic transmission model, which was used to evaluate the cost-effectiveness of maternal immunization.Clinical Trial registry name and registration number: Not applicable.

S1361 Healthcare Resource Use and Associated Costs in the Three Years Following the Initial Diagnosis of Diabetic or Idiopathic Gastroparesis: A Retrospective Claims Analysis

INTRODUCTION: Diabetic gastroparesis (DG) and idiopathic gastroparesis (IG) are the two most common forms of gastroparesis (GP). Because of the limited treatment options, many patients (pts) have inadequate symptom control which may lead to increased healthcare resource use (HRU). This study aimed to quantify the economic burden in HRU and associated costs of DG/IG in the United States over the 3 years (yrs) after first GP diagnosis (dx). METHODS: Adults newly diagnosed with DG or IG were identified in Optum’s de-identified Clinformatics® Data Mart Database (Q1-2007 to Q1-2019). Pts were continuously enrolled for ≥1 yr before and ≥1 yr after their first GP dx (index date). For controls without GP dx, index dates were randomly selected. Pts with DG/IG were matched 1:1 to controls using a mixed approach of exact matching (i.e., age, sex, complete yrs of follow-up post-index) and propensity score matching (i.e., income, education, index yr, Charlson Comorbidity Index [CCI] comorbidities, diabetic complications [DG only]). All-cause HRU and direct healthcare costs per person-year (PPY) were compared between DG/IG cases and matched controls in the 3 yrs post index date. RESULTS: DG and IG cohorts included 18,015 and 14,305 pts (mean age: 62 and 54 yrs; 34% and 24% males), respectively. DG/IG pts had a high comorbidity burden at baseline (DG: 34% chronic pulmonary disease, 29% renal disease; IG: 28% chronic pulmonary disease). Demographics and CCI comorbidities were balanced between GP pts and controls (Table 1). DG/IG pts had significantly higher annual HRU compared to matched controls in the first 3 yrs post-index, with the highest gap observed in Yr 1 (Figure 1). Healthcare costs were also significantly higher for DG/IG pts vs. controls across all 3 yrs post-index (mean total cost differences PPY: DG Yr 1 $34,885, Yr 2 $28,071, Yr 3 $25,606; IG Yr 1 $23,176, Yr 2 $16,627, Yr 3 $14,396; see Figure 2 for Yr 1 cost breakdown by service setting). Patterns of disease burden did not change in a sensitivity analysis with additional adjustment for conditions associated with GP (e.g., anemia, anxiety disorder). CONCLUSION: This study showed a substantial economic burden of both DG and IG among adults, highest in the first yr after dx and persistent over 3 yrs. In the first yr after dx, DG and IG pts had healthcare costs approximately two-fold higher than for the matched controls, emphasizing the need for more effective treatments that may reduce the burden of illness.Table 1Figure 1Figure 2

Age-standardized mortality, disability-adjusted life-years and healthy life expectancy in different cultural regions of Guangdong, China: a population-based study of 2005\u20132015

BackgroundGuangdong province is dominated by three cultural regions: Canton, Hakka and Hoklo. However, little is known about the disease burden within these regions, particularly because different population,environmental and socioeconomic risk factors might cause different patterns of mortality, disability-adjusted life-years (DALY), life expectancy and healthy life expectancy (HALE). We aimed to compare the patterns of disease burden in Canton, Hakka and Hoklo regions between 2005 and 2015.MethodWe calculated the mortality, YLL, YLD for 116 diseases for different cultural regions between 2005 and 2015. We calculated the DALYs for 116 causes as the sum of YLLs and YLDs. We estimated the life expectancy and HALE by using sex-specific mortality rates and YLDs for the three cultural regions.ResultsWith a respective reduction of 22.3, 15.8 and 17.8% in 2015 compared with 2005, the age-standardized DALY rates in 2015 was 19,988.0, 14,396.5 and 20,436.6 in Hakka, Canton and Hoklo region. Canton region had a significantly lower mortality and DALYs in most diseases, followed by Hoklo and Hakka regions. The life expectancy and HALE at birth were highest in Canton region in both 2005 and 2015, than in Hoklo and Hakka region.ConclusionsOur findings call for improved public health care via the refinement of policy and effective measures for disease prevention. Understanding the environmental and culture-related risk factors of diseases in Hoklo and Hakka regions may help inform public health sectors to reduce the disease burden and the between-region inequality.

Pulmonary Hypertension Registry: a single-center experience in Egypt

Introduction Pulmonary hypertension is a life-threatening progressive disease that eventually leads to disability and death. Aim To establish the first single-center registry for pulmonary hypertension in Egypt, Kasr Al-Ainy Hospitals, Cairo University, to characterize the pattern of disease burden in terms of survival. Patients and methods Patient enrollment was performed over 2 years with a 5-year follow-up, and the following were recorded: demographic data, clinical presentation, hemodynamic changes, and the 1-, 3-, and 5-year survival rates in groups I and IV, who were potentially treatable. Results A total of 104 patients were enrolled, 65 patients completed the investigational panel, including right heart catheterization. A total of 54 (83.1%) patients belonged to group I, and 11 (16.9%) patients belonged to group IV. Idiopathic pulmonary arterial hypertension was present in 38.5% of the patients, bilharzial pulmonary arterial hypertension in 15.4%, and connective tissue diseases in 18.5%. The mean age was 37.8±12 years; the male : female ratio was 1 : 2.4. Of the patients, 85% presented with functional class II or III disease, and the mean 6-min walk distance was 256±98 m. The hemodynamic parameters were: mean pulmonary artery pressure: 47±10 mmHg; cardiac index: 2.29±0.5; pulmonary vascular resistance: 11±4; and mixed venous oxygen saturation: 59.6±7. Conclusion Idiopathic pulmonary arterial hypertension is the most common cause of pulmonary arterial hypertension in Egypt. Patients with connective tissue diseases have delayed referrals, leading to poor hemodynamic parameters and survival. Bilharziasis is not currently common. The 1-, 3-, and 5-year overall survival rates of group I were 90.9, 81.5, and 75.93%, respectively.

The incidence and histological patterns of oesophageal cancer in Sri Lanka from 2001 to 2010: Analysis of national cancer registry data.

An increase in global incidence of oesophageal cancer has been reported in the last few decades. We conducted this study to examine trends in oesophageal cancer in Sri Lanka. A retrospective cohort evaluation of newly diagnosed patients with oesophageal cancer during 2001-2010 was performed using population-based data published by the Sri Lanka National Cancer Control Programme. A total of 10,626 (male: female=1:1.06, mean age: 62years) oesophageal cancers were analysed. Of those, 1,553(14.6%) were classified as non-specific carcinoma. Of the remaining, 88% (n=7,986) were squamous cell carcinoma (SCC) and 10.5% (n=956) were adenocarcinoma. The WHO age-standardised incidence was observed to have increased from 5.78 per 100,000 in 2001 (95% CI=5.41-6.16) to 6.23 per 100,000 in 2010 (95%CI=5.86-6.60). WHO age-standardised incidence of SCC has increased from 4.09 to 4.97 per 100,000 from 2001 to 2010 (p<.05 for trend, estimated annual percentage change (EAPC)=3.6, 95% CI=0.9-6.3) while incidence of adenocarcinoma showed a greater proportional increase from 0.33 to 0.7 per 100,000 from 2001 to 2010 (p<.05 for trend, EAPC=7.1, 95% CI=2.1-12.4). A statistically significant increase in the incidence of oesophageal cancer in Sri Lanka was noted, with greater proportional increases of adenocarcinomas and cancers in men. Further studies including tumour stage and mortality may help better understand changing patterns of disease burden.

Going through the motions: incorporating movement analyses into disease research.

Though epidemiology dates back to the 1700s, most mathematical representations of epidemics still use transmission rates averaged at the population scale, especially for wildlife diseases. In simplifying the contact process, we ignore the heterogeneities in host movements that complicate the real world, and overlook their impact on spatiotemporal patterns of disease burden. Movement ecology offers a set of tools that help unpack the transmission process, letting researchers more accurately model how animals within a population interact and spread pathogens. Analytical techniques from this growing field can also help expose the reverse process: how infection impacts movement behaviours, and therefore other ecological processes like feeding, reproduction, and dispersal. Here, we synthesise the contributions of movement ecology in disease research, with a particular focus on studies that have successfully used movement-based methods to quantify individual heterogeneity in exposure and transmission risk. Throughout, we highlight the rapid growth of both disease and movement ecology and comment on promising but unexplored avenues for research at their overlap. Ultimately, we suggest, including movement empowers ecologists to pose new questions, expanding our understanding of host-pathogen dynamics and improving our predictive capacity for wildlife and even human diseases.

Disparities in health burden, health-care facilities, and resources among countries in China's Belt and Road Initiative: a mixed methods study

BackgroundIn 2015, China launched the Belt and Road Initiative (BRI; also known as the Silk Road Economic Belt and the 21st-Century Maritime Silk Road), a trade and infrastructure network to promote international collaboration. We aimed to compare health burden, health-care facilities, and resources among countries participating in the BRI, to help understand health needs, develop health promotion programmes, and facilitate collaboration on global health. MethodsIn a mixed methods study, data from 1990 to 2015 were collected from the WHO, UN, and World Bank database for key health indicators and social, economic, and environmental factors (eg, gross domestic product) for China and 65 other countries participating in the BRI. We used linear and logistic regression and multilevel models in the analysis, examining impact associations of the selected health indicators and social, economic, and environmental factors. FindingsWe noted large variation and shifts over time in patterns of disease burden, availability of health-care facilities (eg, numbers of doctors, nurses, hospitals, and beds), and context factors across the 66 countries. During 2000–14, life expectancy increased in almost all countries except for Iraq and Syria, by 3·9 years on average. Life expectancy was positively associated with gross domestic product per person, stronger in higher quintiles. Since 1990, mortality in children younger than 5 years has declined by 74%, from 62 deaths per 1000 livebirths in 1990 to 16 per 1000 livebirths in 2015, an annual fall of 3·0%. Economic, social, and environmental factors were closely associated with health indicators and health-care facilities and the disparities in them. InterpretationLarge variations exist in disease burden, availability of health-care facilities, and economic, social, and environmental factors across the BRI countries. This initiative provides good opportunities to study the effect of context factors and international collaboration on health outcomes. FundingChinese Medical Board (GNL 16-262), Xi'an Jiaotong University.

Interpretation of rotavirus-positivity patterns across India

To analyze variation in rotavirus-positivity using simple alternative statistical measures. Hospital-based rotavirus surveillance among children admitted with acute gastroenteritis between 2005 and 2009. Prevalence, adjusted proportions and symmetrized index were calculated. Rotavirus prevalence was 40% (range 37% - 44%). Adjusted proportion analysis revealed higher level of deviation from annual prevalence in seasons (December to February and September to November); age groups (<12 months and 12-23 months) and regions (East and South). Analysis of symmetrized index revealed higher estimates of variation in all years, except in 2006. Proposed statistical measures are useful as refined measures to study extent of disease spread in surveillance programmes, aiding evaluation of the load and pattern of disease burden in different regions over time.