Socio-demographic Index Countries Research Articles

Global burden and cross-country inequalities in stroke and subtypes attributable to diet from 1990 to 2019.

The Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. To describe burden, and to explore cross-country inequalities according to socio-demographic index (SDI) for stroke and subtypes attributable to diet. Death and years lived with disability (YLDs) data and corresponding estimated annual percentage changes (EAPCs) were estimated by year, age, gender, location and SDI.Pearson correlation analysis was performed to evaluate the connections between age-standardized rates (ASRs) of death, YLDs, their EAPCs and SDI. We used ARIMA model to predict the trend. Slope index of inequality (SII) and relative concentration index (RCI) were utilized to quantify the distributive inequalities in the burden of stroke. A total of 1.74 million deaths (56.17% male) and 5.52 million YLDs (55.27% female) attributable to diet were included in the analysis in 2019.Between 1990 and 2019, the number of global stroke deaths and YLDs related to poor diet increased by 25.96% and 74.76% while ASRs for death and YLDs decreased by 42.29% and 11.34% respectively. The disease burden generally increased with age. The trends varied among stroke subtypes, with ischemic stroke (IS) being the primary cause of YLDs and intracerebral hemorrhage (ICH) being the leading cause of death. Mortality is inversely proportional to SDI (R = -0.45, p < 0.001). In terms of YLDs, countries with different SDIs exhibited no significant difference (p = 0.15), but the SII changed from 38.35 in 1990 to 45.18 in 2019 and the RCI showed 18.27 in 1990 and 24.98 in 2019 for stroke. The highest ASRs for death and YLDs appeared in Mongolia and Vanuatu while the lowest of them appeared in Israel and Belize, respectively. High sodium diets, high red meat consumption, and low fruit diets were the top three contributors to stroke YLDs in 2019. The burden of diet-related stroke and subtypes varied significantly concerning year, age, gender, location and SDI. Countries with higher SDIs exhibited a disproportionately greater burden of stroke and its subtypes in terms of YLDs, and these disparities were found to intensify over time. To reduce disease burden, it is critical to enforce improved dietary practices, with a special emphasis on mortality drop in lower SDI countries and incidence decline in higher SDI countries.

Global burden and cross-country inequalities in stroke and subtypes attributable to diet from 1990 to 2019

Data sourcesThe Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019.BackgroundTo describe burden, and to explore cross-country inequalities according to socio-demographic index (SDI) for stroke and subtypes attributable to diet.MethodsDeath and years lived with disability (YLDs) data and corresponding estimated annual percentage changes (EAPCs) were estimated by year, age, gender, location and SDI. Pearson correlation analysis was performed to evaluate the connections between age-standardized rates (ASRs) of death, YLDs, their EAPCs and SDI. We used ARIMA model to predict the trend. Slope index of inequality (SII) and relative concentration index (RCI) were utilized to quantify the distributive inequalities in the burden of stroke.ResultsA total of 1.74 million deaths (56.17% male) and 5.52 million YLDs (55.27% female) attributable to diet were included in the analysis in 2019.Between 1990 and 2019, the number of global stroke deaths and YLDs related to poor diet increased by 25.96% and 74.76% while ASRs for death and YLDs decreased by 42.29% and 11.34% respectively. The disease burden generally increased with age. The trends varied among stroke subtypes, with ischemic stroke (IS) being the primary cause of YLDs and intracerebral hemorrhage (ICH) being the leading cause of death. Mortality is inversely proportional to SDI (R = -0.45, p < 0.001). In terms of YLDs, countries with different SDIs exhibited no significant difference (p = 0.15), but the SII changed from 38.35 in 1990 to 45.18 in 2019 and the RCI showed 18.27 in 1990 and 24.98 in 2019 for stroke. The highest ASRs for death and YLDs appeared in Mongolia and Vanuatu while the lowest of them appeared in Israel and Belize, respectively. High sodium diets, high red meat consumption, and low fruit diets were the top three contributors to stroke YLDs in 2019.DiscussionThe burden of diet-related stroke and subtypes varied significantly concerning year, age, gender, location and SDI. Countries with higher SDIs exhibited a disproportionately greater burden of stroke and its subtypes in terms of YLDs, and these disparities were found to intensify over time. To reduce disease burden, it is critical to enforce improved dietary practices, with a special emphasis on mortality drop in lower SDI countries and incidence decline in higher SDI countries.

Global burden of HIV-negative multidrug- and extensively drug-resistant tuberculosis based on global burden of disease study 2021

BackgroundTuberculosis (TB), caused by Mycobacterium tuberculosis, remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022. Of particular concern is the emergence of drug-resistant TB, accounting for 15%–20% of TB deaths. It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB), drawing upon the comprehensive Global Burden of Disease (GBD) 2021 drug-resistant tuberculosis dataset. MethodsFrom the GBD 2021, data on incidence, prevalence, disability-adjusted life years (DALYs), and death of MDR-TB and XDR-TB from 1990 to 2021 were collected. We calculated the estimated annual percentage changes in age-standardized incidence rates (ASIR) and age-standardized death rate (ASDR), segmented by age, sex, and Socio-demographic Index (SDI). The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed. ResultsIn 2021, there were an estimated 443,680 population (95% uncertainty interval [UI]: 259,196–766,545 population) incident cases of MDR-TB, and an estimated 106,818 population (95% UI: 41,612–211,854 population) death cases of MDR-TB, while there were an estimated 24,036 population (95% UI: 17,144–34,587 population) incident cases of XDR-TB and 7,946 population (95% UI: 3,326–14,859 population) death cases of XDR-TB. The incidence and death cases of MDR-TB were lowest in high SDI regions, whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions. ConclusionThis study reported the disease burden of drug-resistant TB from 1990 to 2021. Until 2021, drug-resistant TB is still a serious problem in low SDI countries, especially for high-risk age populations with high-risk factors. Controlling drug-resistant TB requires effective control strategies and healthcare systems.

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

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

Changing trends in the global, regional, and national burden of iodine deficiency among adolescents and young adults: population-based study.

Globally, the iodine deficiency burden among adolescents has substantially decreased since 1990; however, low-SDI countries still bear a great burden. Implementation measures and monitoring systems should be strengthened to reduce the iodine deficiency burden, especially among adolescents. • Iodine deficiency can cause severe or irreversible developmental disorders, particularly in adolescents and young adults. • Universal Salt Iodization was implemented for ensuring appropriate iodine intake. • We found substantial declines in the prevalence rates of iodine deficiency among adolescents during the past three decades. Globally, the disability-adjusted life-year rate of iodine deficiency among adolescents decreased from 56.17 in 1990 to 35.38 in 2019. • Iodine deficiency among adolescents in low- sociodemographic index countries still bear a great burden.

Burden of gastrointestinal luminal tract cancer (GLC) from 2000 to 2019 in low SDI countries.

10558 Background: In regions with low social and economic development, gastrointestinal luminal cancer (GLC) poses a significant burden, and disparities in care are prevalent, leading to adverse disease outcomes but remain poorly studied. This study aims to assess the epidemiology of GLC in low Socio-demographic Index (SDI) regions. Methods: We analyzed temporal trends in the burden of GLC (Colorectal cancer, Esophageal cancer, Stomach cancer) using data from 2000 to 2019 from the Global Burden of Disease Study 2019. We conducted a comprehensive analysis of annual frequencies, age-standardized rates (ASRs), age-specific death rate (ASDR), and annual percentage change (APC) of luminal GI cancer incidence, death, and disability-adjusted life-years (DALYs) by sex, country, and cancer type. Results: In 2019, the frequency of incident cases due to colon cancer, esophageal cancer, and stomach cancer was 39,045, 28,132, and 43,188 respectively, with a male predominance. The number of death cases and DALYs is highest in stomach cancer, with 43,876 deaths and 1,233,251 DALYs, respectively. During 2000 to 2019, the ASDRs increased significantly for colon cancer (APC: 0.78% (0.71 to 0.84), while they decreased significantly for esophageal cancer (APC: -0.57% (-0.65 to -0.48)) and stomach cancer (APC: -1.1% (-1.26 to -0.96)). The highest ASDRs in colorectal cancer were noted in 2019 in Uganda (11.55 (9.24 - 13.75)), while the highest increase in APC in colorectal cancer was noted in Burkina Faso (APC: 1.27% (1.12 to 1.42)). Conclusions: In the preceding decade, the epidemiological landscape of GLC in low SDI countries has undergone dynamic shifts, demonstrating a heavier shift towards colorectal cancer. These findings warrant heightened awareness and strategic interventions to combat the disease.

Global, regional, and national burdens of cancer in children aged zero to nine years from 1990 to 2019.

The description of long-term trends in the cancer burden among children aged zero to nine years from 1990 to 2019 reveals significant changes in children's health. It helps in resource allocation and health policy planning. We analysed data on the incidence, mortality, and disability-adjusted life years (DALYs) by sex and age group in children aged zero to nine. Estimates of DALYs for children aged zero to nine years, appeared as part of the Global Burden of Diseases, Injuries, and Risk Factor Study 2019, by age, sex, and location for 1990-2019. We also provided estimations by the sociodemographic index (SDI) quintile, a systematic measure to indicate educational attainment, income per capita, and total fertility rate for those younger than 25 years. We used age-period-cohort models to investigate paediatric cancers prevalence, incidence, mortality, and DALYs rates and auto-regressive integrated moving average models to predict cancer in children of different age groups in males and females. A total of 6 224 010 DALY numbers for cancer cases occurred globally in 2019 among children aged zero to nine years. Additionally, the incidence of paediatric cancers in 2019 in the middle SDI countries was the highest, including 60 662 cases, and the highest mortality and DALYs cases of paediatric cancers were in the low SDI countries (25 502 and 2 199 790). The joinpoint regression analysis revealed that the trend of total cancer burden in age-standardised mortality rates and age-standardised DALYs rates showed a significant decrease with an average annual percentage change of -2.10 and -2.03 from 1990 to 2019. Furthermore, the paediatric cancer spectrum was changing. Other malignant neoplasms and other leukaemia were the major components of cancer in all age groups of children. The disease burden in children aged zero to nine years decreased significantly globally from 1990 to 2019. However, the overall prediction of childhood cancer increased slightly from 2020 to 2040. Our findings may help guide investments and inform policies. This highlights the necessity to improve current treatment measures and establish effective prevention strategies to reduce the cancer burden among children aged zero to nine years.

Socio-economic association of alcohol use disorder and cardiovascular and alcohol-associated liver disease from 2010to 2019.

Alcohol use leads to disabilities and deaths worldwide. It not only harms the liver but also causes alcohol use disorder (AUD) and heart disease. Additionally, alcohol consumption contributes to health disparities among different socio-economic groups. We estimated global and regional trends in the burden of AUD, liver disease, and cardiovascular disease from alcohol using the methodology of the Global Burden of Disease study. In 2019, the highest disability-adjusted life years rate per 100,000 population was due to AUD (207.31 [95% Uncertainty interval (UI) 163.71-261.66]), followed by alcohol-associated liver disease (ALD) (133.31 [95% UI 112.68-156.17]). The prevalence rate decreased for AUD (APC [annual percentage change] -0.38%) and alcohol-induced cardiomyopathy (APC -1.85%) but increased for ALD (APC 0.44%) and liver cancer (APC 0.53%). Although the mortality rate for liver cancer from alcohol increased (APC 0.30%), mortality rates from other diseases decreased. Between 2010 and 2019, the burden of alcohol-associated complications increased in countries with low and low-middle sociodemographic index (SDI), contributing more significantly to the global burden. The global burden of AUD, liver, and cardiovascular disease has been high and increasing over the past decade, particularly for liver complications. Lower SDI countries are contributing more to this global burden. There is a pressing need for effective strategies to address this escalating burden.

Trends and socioeconomic inequality of the burden of congenital abnormalities of the kidney and urinary tract among children and adolescents.

Although congenital abnormalities of the kidney and urinary tract (CAKUT) is the leading cause of childhood onset chronic kidney disease (CKD) and kidney failure, comprehensive information on the disease burden among children and adolescents globally is lacking. We aim to report the trends and socioeconomic inequality of CAKUT burden for people aged 0-24 years from 1990 to 2019·. We reported the prevalence, mortality and disability-adjusted life-years (DALYs) for CAKUT based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, quantified the association of disease burden and socio-demographic index (SDI), calculated the slope index of inequality (SII) the relative index of inequality (RII) and concentration index. In 2019, the global prevalence, mortality, and DALYs of CAKUT among individuals aged 0-24 years were 167.11 (95%Confident Interval 166.97, 167.25), 0.30 (0.29, 0.30), and 32.22 (32.16, 32.29) per 100 000 population. The greatest prevalence, mortality and DALYs were recorded in the 0-4 year age group. The greatest mortality and DALYs were recorded in low SDI countries and territories. During 1990 to 2019, the prevalence, mortality and DALYs decreased globally, while in low and low-middle countries and territories the reduction was much less slower. India, Nigeria and Pakistan had the highest DALYs. Saudi Arabia and China exhibited a markedly decrease of CAKUT burden. Globally for every 0.1 increase in SDI, there was a 20.53% reduction in mortality, a 16.31% decrease in DALYs, but a 0.38% rise in prevalence. Inequality for disease burden of varying SDI was increasing globally. Thus, specific preventive and health service measures are needed to reduce the global burden from CAKUT.

The burden of knee osteoarthritis worldwide, regionally, and nationally from 1990 to 2019, along with an analysis of cross-national inequalities.

To describe the disease burden of knee osteoarthritis (KOA) globally, regionally, and in 204 countries by age, sex, and sociodemographic index (SDI) from 1990 to 2019, and to explore cross-national inequalities across SDI. The Global Burden of Disease (GBD) 2019 database collected data on KOA worldwide from 1990 to 2019, including prevalence, incidence, years lived with disability (YLDs). The average annual percentage change (AAPC) was used to measure temporal trends. In addition, the inequality slope index and the health concentration index were calculated to quantify the unequal distribution of the burden of KOA across 204 countries worldwide. In 2019, the global age-standardized prevalence rate increased by 7.5% compared with 1990, and the age-standardized incidence rate increased by about 6.2%; The age-standardized YLDs rate increased by about 7.8%. In addition to the Republic of Korea and the United States of America, the disease burden of KOA has increased year by year in other countries around the world. The incidence of KOA was highest at ages 50-59, while the prevalence and rates of YLDs were highest at ages 75-84. The burden of KOA was higher in women than in men. Cross-country inequality suggests that the inequality in the burden of KOA between high SDI and low SDI countries becomes greater, and that countries with high SDI bear a disproportionately high burden. The global KOA burden has risen steadily between 1990 and 2019, and cross-national inequality gaps remain large. Targeted measures must therefore be taken to address this inequality and the increasing global KOA disease burden.

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

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

The burden of alcohol-related cardiovascular complications in young and middle-aged adults: rising burden of atrial fibrillation and hypertensive heart disease

Background and Aims The burden of alcohol-related complications is high and rising. However, there are notable deficiencies in comprehensive epidemiological study focusing on cardiovascular complications from alcohol, especially among young and middle-aged adults. We thus aimed to determine the burden of these conditions in young and middle-aged adults globally. Methods and Results We used data from the Global Burden of Disease Study 2019 and analysed the mortality and disability-adjusted life years of alcohol-associated cardiovascular complications in young and middle-aged adults. The findings were classified by sex, region, country, and Sociodemographic Index (SDI). The highest age-standardized death rates (ASDR) were observed in stroke 0.84 (95% UI 0.60–1.09), followed by alcoholic cardiomyopathy 0.57 (95% UI 0.47–0.66) per 100,000 population. The overall burden of alcohol-associated cardiovascular complications decreased globally but increased in atrial fibrillation and hypertensive heart disease. Regionally, most regions underwent a decrease in ASDR, but an increase was observed in Southeast Asia (+2.82%), Western Pacific (+1.48%), low-middle (+1.81%), and middle SDI (+0.75%) countries. Nevertheless, the ASDR and ASDALYs were highest in Europe. Conclusions The impact of alcohol-associated atrial fibrillation and hypertensive heart disease has increased over the last decades. Regarding region, the burden in Europe and the rising burden in Asia, require immediate public health policy to lessen these cardiovascular complications from alcohol in young and middle-aged adults.

Differential trends and patterns of sociodemographic disparities in burden of mental disorders, substance use disorder and self-harm across age groups: ecological study in 204 countries using the Global Burden of Disease Study 2019.

It is well-known that socioeconomic status is associated with mental illness at both the individual and population levels, but there is a less clear understanding of whether socioeconomic development is related to poor mental health at the country level. We aimed to investigate sociodemographic disparities in burden of mental disorders, substance use disorders and self-harm by age group. Estimates of age-specific disability-adjusted life years (DALY) rates for mental disorders, substance use disorders and self-harm from 1990 to 2019 for 204 countries were obtained. The sociodemographic index (SDI) was used to assess sociodemographic development. Associations between burden of mental health and sociodemographic development in 1990 and 2019 were investigated, and sociodemographic inequalities in burden of mental health from 1990 to 2019 by age were estimated using the concentration index. Differential trends in sociodemographic disparities in diseases across age groups were observed. For mental disorders, particularly depressive disorder and substance use disorders, DALY rates in high SDI countries were higher and increased more than those in countries with other SDI levels among individuals aged 10-24 and 25-49 years. By contrast, DALY rates for those over 50 years were lower in high SDI countries than in countries with other SDI levels between 1990 and 2019. A higher DALY rate among younger individuals accompanied a higher SDI at the country level. However, increased sociodemographic development was associated with decreased disease burden for adults aged ≥70 years. Strategies for improving mental health and strengthening mental health system should consider a broader sociocultural context.

Global burden of early-onset osteoarthritis, 1990–2019: results from the Global Burden of Disease Study 2019

ObjectivesEarly-onset osteoarthritis (OA) is an emerging health issue amidst the escalating prevalence of overweight and obesity. However, there are scant data on its disease, economic burden and attributable burden due...

Global trends in burden of type 2 diabetes attributable to physical inactivity across 204 countries and territories, 1990-2019.

To promote a comprehensive understanding of global trends and burden of type 2 diabetes attributable to physical inactivity. We utilized data regarding mortality, disability-adjusted life years (DALYs), as well as age-standardized mortality rates (ASMR) and DALYs rates (ASDR) derived from the global burden of disease study 2019 to evaluate the impact of physical inactivity on the prevalence of type 2 diabetes in 204 countries and territories over the period from 1990 to 2019. This method facilitated the analysis of the diabetes burden across different ages, genders, and regions. To determine the long-term progression of type 2 diabetes prevalence, we computed the estimated annual percentage change (EAPC) in burden rates. Globally, the number of deaths and DALYs from type 2 diabetes due to physical inactivity more than doubled between 1990 and 2019. Concurrently, there was an increase in the ASMR and ASDR, with EAPC of 0.26 (95% CI: 0.13-0.39) and 0.84 (95% CI: 0.78-0.89), respectively. As of 2019, the global ASMR and ASDR for physical inactivity stood at 1.6 (95% UI: 0.8-2.7) per 100 000 and 55.9 (95% UI: 27.2-97.6) per 100 000, respectively. Notable disparities were observed in the type 2 diabetes burden associated with physical inactivity worldwide, with higher sociodemographic index (SDI) countries experiencing lower ASDR and ASMR compared to lower SDI countries. Initially, females exhibited higher ASMR and ASDR than males, but this gender disparity in ASMR and ASDR has lessened in recent years. The mortality and DALYs rates associated with physical inactivity exhibit an inverted V-shaped pattern across various age groups, predominantly affecting the elderly population. Between 1990 and 2019, there was a marked rise in the worldwide burden of type 2 diabetes associated with physical inactivity, underscoring the role of physical inactivity as a key changeable risk factor in the global landscape of this disease. This necessitates additional research to explore the variables contributing to the varying levels of disease burden across different countries and between sexes. Furthermore, it calls for the formulation of public health policies aimed at guiding prevention tactics, promoting early detection, and enhancing the management of type 2 diabetes.

Global health inequality: analyses of life disparity and healthy life disparity.

Alongside average health measures, namely, life expectancy (LE) and healthy life expectancy (HLE), we sought to investigate the inequality in lifespan and healthy lifespan at the worldwide level with an alternative indicator. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we evaluated the global distribution of life disparity (LD) and healthy life disparity (HLD) for 204 countries and territories in 2019 by sex and socio-demographic index (SDI), and also explored the relationships between average and variation health indicators. Substantial gaps in all observed health indicators were found across SDI quintiles. For instance, in 2019, for low SDI, female LE and HLE were 67.3 years (95% confidence interval 66.8, 67.6) and 57.4 years (56.6, 57.9), and their LD and HLD were 16.7 years (16.5, 17.0) and 14.4 years (14.1, 14.7). For high SDI, female LE and HLE were greater [83.7 years (83.6, 83.7) and 70.2 years (69.3, 70.7)], but their LD and HLD were smaller [10.4 years (10.3, 10.4) and 7.9 years (7.7, 8.0)]. Besides, all estimates varied across populations within each SDI quintile. There were also gaps in LD and HLD between males and females, as those found in LE and HLE. In addition to the disadvantaged LE and HLE, greater LD and HLD were also found in low SDI countries and territories. This reveals the serious challenge in achieving global health equality. Targeted policies are thus necessary for improving health performance among these populations.

Global trends in deaths and disability-adjusted life years of diabetes attributable to second-hand smoke and the association with smoke-free policies

ObjectivesThe diabetic burden attributable to second-hand smoke (SHS) is a global public health challenge. We sought to explore the diabetic burden attributable to SHS by age, sex, and socioeconomic status during 1990–2019 and to evaluate the health benefit of smoke-free policies on this burden. Study designCross-sectional study. MethodsThe diabetic burden attributable to SHS was extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 dataset. Country-level smoke-free policies were obtained from the World Health Organization Global Health Observatory. The deaths or disability-adjusted life years (DALYs) were quantified, and the average annual percentage changes were calculated. Hierarchical linear mixed models were applied to evaluate the health effects. ResultsFrom 1990 to 2019, the absolute number of global deaths and DALYs of diabetes attributable to SHS has doubled, and the age-standardised rate has significantly increased. The disease burden was higher in females than in males and increased with increasing age. The SHS-related diabetic burden varied across regions and countries. Age-standardised death or DALY rates first increased and then decreased with increased Socio-demographic Index (SDI), peaking in the 0.60–0.70 range. In low to low-middle, and middle to high-middle SDI countries, SHS-related diabetic deaths and DALYs were significantly lower in countries with more than 3 smoke-free public places than in countries with 0–2 smoke-free public places. ConclusionsMore attention should be paid to females and the elderly, who bear a heavy SHS-related diabetic burden. Banning smoking in public places was associated with reduced burden of SHS-attributable diabetes, especially in low to middle social development countries.

Age-period-cohort analysis of incidence, mortality and disability-adjusted life years of esophageal cancer in global, regional and national regions from 1990 to 2019

ObjectiveIn view of the high incidence and mortality of esophageal cancer, the latest statistical data on the disease burden of esophageal cancer can provide strategies for cancer screening, early detection and treatment, and help to rationally allocate health resources. This study provides an analysis of the global disease burden and risk factors of esophageal cancer from 1990 to 2019.MethodsUsing the 2019 Global Burden of Disease, Injury and Risk Factor (GBD) data, we present the incidence, mortality and disability-adjusted life years (DALY) of esophageal cancer in 21 regions and 204 countries and different sociodemographic index (SDI) regions from 1990 to 2019. The age-period-cohort model was used to estimate the age, period, and cohort trend of esophageal cancer in different SDI regions. The estimated proportion of DALY attributable to each risk factor from 1990 to 2019.ResultsFrom 1990 to 2019, the number of new cases of esophageal cancer, the number of deaths and DALY increased by 67.07%, 55.97% and 42.13%, respectively, but age standardized incidence rate (ASIR), age standardized mortality rate (ASMR) and age standardized DALY rate (ASDR) decreased by 19.28%, 25.32% and 88.22%, respectively. Overall, the results of the age-period-cohort model showed that the incidence, mortality, and DALY rates in countries and regions with higher SDI levels showed a downward trend over time and with the passage of time. Conversely, there were no significant changes in incidence and mortality in countries and regions with low SDI levels. In the past 30 years, the incidence and death of esophageal cancer in the world has gradually changed to people over 80 years old, but the population aged 60–79 still accounts for the largest proportion. The global DALY in esophageal cancer is mainly attributable to smoking, followed by alcohol consumption and occupational exposure.ConclusionsAlthough ASIR, ASMR and ASDR have decreased significantly, esophageal cancer is still the main factor causing the disease burden worldwide. Public health administrators in low SDI and low-middle SDI countries are high-risk areas for esophageal cancer, and preventive control measures should be implemented to raise awareness, screening, and treatment of esophageal cancer in these areas. Tobacco and alcohol control and reduction of occupational hazards are key steps in reducing the burden of esophageal cancer.

The global incidence, mortality, and burden of uterine cancer in 2019 and correlation with SDI, tobacco, dietary risks, and metabolic risk factors: An ecological study.

Endometrial cancer (EC) is the sixth most common cancer among women worldwide. Since global studies are based on awareness of the incidence trend, mortality, geographical diversity, and level of social development and income of countries, this study was conducted to investigate the trend of uterine cancer (UC) in the world in 2019. Age-standardized rates (ASR) of incidence, deaths, prevalence, and disability-adjusted life years (DALYs) of UC, as well as targeted risk factors, were extracted from the Global Burden of Disease (GBD) online database 2019. Pearson correlation coefficient and SPSS 16 were used to calculate the correlation between risk factors and ASR of epidemiological indicators. Statistical significance was considered as p < 0.05. In 2019, the age-specific incidence and death rate of UC was peaking at 60-64 and 65-69 years, respectively. The highest age-standardized incidence rate per 100,000 people for UC has been reported in the Northern Mariana Islands, high sociodemographic index (SDI) countries, World Bank High-Income category, Europe continent and among World Health Organization (WHO) regions were found in the European Region. The highest age-standardized death rateper 100,000 people for UC has been reported in Grenada, high SDI countries, the World Bank High-Income category, Europe continent, and among WHO regions found in the European Region. In 2019, the age-standardized DALYs rate was 53.54 per 100,000 inhabitants, of which 48.49 cases were related to years of life lost (YLLs) and 5.05 cases were related to years lived with disability. According to GBD-2019, the highest incidence, mortality, and DALY of UC are in Europe. The evidence and traces of diversity can be seen in the inequalities of UC. Race, ethnicity, economic status, level of education and awareness, co-morbidities, access, grade, and histological type of tumor are the most important causes of this inequality.

Healthy life expectancy for 202 countries up to 2030: Projections with a Bayesian model ensemble.

Healthy life expectancy (HLE) projections are required for optimising social and health service management in the future. Existing studies on the topic were usually conducted by selecting a single model for analysis. We thus aimed to use an ensembled model to project the future HLE for 202 countries/region. We obtained data on age-sex-specific HLE and the sociodemographic index (SDI) level of 202 countries from 1990 to 2019 from the Global Burden of Disease (GBD) database and used a probabilistic Bayesian model comprised of 21 forecasting models to predict their HLE in 2030. In general, HLE is projected to increase in all 202 countries, with the least probability of 82.4% for women and 81.0% for men. Most of the countries with the lowest projected HLE would be located in Africa. Women in Singapore have the highest projected HLE in 2030, with a 94.5% probability of higher than 75.2 years, which is the highest HLE in 2019 across countries. Maldives, Kuwait, and China are projected to have a probability of 49.3%, 41.2% and 31.6% to be the new entries of the top ten countries with the highest HLE for females compared with 2019. Men in Singapore are projected to have the highest HLE at birth in 2030, with a 93.4% probability of higher than 75.2 years. Peru and Maldives have a probability of 48.7% and 35.3% being new top ten countries in male's HLE. The female advantage in HLE will shrink by 2030 in 117 countries, especially in most of the high SDI and European countries. HLE will likely continue to increase in most countries and regions worldwide in the future. More attention needs to be paid to combatting obesity, chronic diseases, and specific infectious diseases, especially in African and some Pacific Island countries. Although gender gaps may not be fully bridged, HLE could partially mitigate and even eliminate them through economic development and improvements in health care.