World Bank Regions Research Articles

Global trend of cervical cancer among women aged 55 and older from 2010 to 2019: An analysis by socio-demographic index and geographic regions.

This study describes the 2010-2019 trend of cervical cancer (CC) in women over 55 by socio-demographic index (SDI) and geographical regions. We obtained data on CC annually from 2010 to 2019 from the 2019 Global Burden of Disease Study (GBD) to analyze the incidence, death and prevalence rates, and disability-adjusted life years (DALYs) associated with CC across different parameters such as global trend, age groups, SDI, continents, World Bank Regions, World Health Organization (WHO) regions, GBD regions, and National and territorial division. This analysis covers data from 204 countries and territories from 1990 to 2019. There were 236,228 CC incidence cases worldwide in 2019, which is a 1.27-fold increase from 2010. Global CC deaths also increased to 169,304 cases in 2019, reflecting a 1.24-fold increase. CC prevalence increased to 769,925 cases in 2019, representing a 1.4-fold rise. The number of CC DALYs globally increased to 3,835,979 cases in 2019, reflecting a 1.24-fold increase. Incidence, death, prevalence, and DALY numbers of CC increased across all age groups females in the 65-69 years age group experienced the highest increase. Middle SDI countries had the highest incidence, death, prevalence, and DALY numbers, while low SDI countries showed increasing trends. Asia exhibited the highest incidence, death, prevalence, and DALY numbers of CC. Upper middle-income countries had the highest incidence, death, prevalence, and DALY numbers, with the highest decreases in these rates except the prevalence rate. The Western Pacific Region showed the highest incidence, death, prevalence, and DALY numbers, with declining rate trends. The Republic of Kiribati showed the highest incidence, death, prevalence, and DALY numbers. Based on the study results, it is clear that although the global trend of epidemiological indicators of CC is decreasing, the largest proportion of the decreasing trend is related to developing countries. But in regions of Africa and Asia that have a lower level of development, sometimes these indicators show upward trends, which shows the worsening of the problem in these regions and the need for serious policies and plans to implement comprehensive vaccination, screening, and promotion interventions. People's awareness is necessary in the field of better disease control.

Uncovering gaps in women's authorship: A big data analysis in academic surgery.

Women are underrepresented in surgical authorship. Using big data analyses, we aimed to investigate women's representation as first and last authors in surgical publications worldwide and identify underlying predictors. We retrieved eligible surgical journals using Scimago Journal & Country Rank 2021. We queried articles indexed in PubMed from selected journals published between January 2018 and April 2022. We used the EDirect tool to extract bibliometric data, including first and last authors' names, primary affiliation country, and publication year. Countries and dependent territories were classified following World Bank income levels and regions. Women's representation was predicted from forenames using the Gender-API software. Citations were included if gender accuracy was ≥80%. We analyzed 210,853 citations containing both first and last authors' forenames, representing 158 countries and 14 territories. Women constituted 23.8% (50,161/210,853) of the first and 14.7% (31,069/210,853) of the last authors. High-income economies had more women as first authors than other income categories (p<0.001), but fewer women as last authors than upper-middle- and lower-middle-income economies (p<0.001). The odds of the first author being a woman were more than three times higher when the last author was also a woman (OR 3.21, 95% CI 3.13-3.30) and vice versa (OR 3.25, 95% CI 3.16-3.34) after adjusting for income level and publication year. Women remain globally underrepresented in surgical authorship. Our findings urge concerted global efforts to overcome identified disparities.

Global and regional prevalence of Cronobacter sakazakii in powdered milk and flour

Cronobacter sakazakii (Cz) infections linked with powdered milk/flour (PMF) are on the increase in recent times. The current study aimed at assessing worldwide and regional prevalence of Cz in PMF. Cz-PMF-directed data were conscientiously mined in four mega-databases via topic-field driven PRISMA protocol without any restriction. Bivariate analysis of datasets was conducted and then fitted to random-intercept logistic mixed-effects regressions with leave-one-study-out-cross-validation (LOSOCV). Small-study effects were assayed via Egger’s regression tests. Contributing factors to Cz contamination/detection in PMF were determined using 1000-permutation-bootstrapped meta-regressions. A total of 3761 records were found out of which 68 studies were included. Sample-size showed considerable correlation with Cz positivity (r = 0.75, p = 2.5e−17), Milkprod2020 (r = 0.33, p = 1.820e−03), and SuDI (r = − 0.30, p = 4.11e−03). The global prevalence of Cz in PMF was 8.39% (95%CI 6.06–11.51, PI: 0.46–64.35) with LOSOCV value of 7.66% (6.39–9.15; PI: 3.10–17.70). Cz prevalence in PMF varies significantly (p < 0.05) with detection methods, DNA extraction method, across continents, WHO regions, and world bank regions. Nation, detection method, world bank region, WHO region, and sample size explained 53.88%, 19.62%, 19.03%, 15.63%, and 9.22% of the true differences in the Cz prevalence in PMF, respectively. In conclusion, the results indicated that national will power in the monitoring and surveillance of Cz in PMF matched with adequate sample size and appropriate detection methods will go a long way in preventing Cz contamination and infections.

Evolving trends in prostate cancer: Disparities across income levels and global regions (1990-2019).

25 Background: Prostate Cancer, the third most commonly diagnosed cancer in 2020 and the fifth leading cause of cancer mortality worldwide, has exhibited significant disparities in global prevalence and impact over recent decades. This study assesses the trends in incidence, mortality, and disability-adjusted life years from prostate cancer in the World Bank regions based on country income levels from 1990 to 2019. Methods: The Global Burden of Disease Study database was used to extract Age-standardized incidence rates (ASIR), age-standardized (ASDR), and life years (DALYs) for prostate cancer from different World Bank regions based on income levels from 1990 to 2019. Annual percentage change was also acquired. Mortality-to-incidence ratios (MIR) were then computed. Trends were assessed using Joinpoint regression. Results: Between 1990 and 2019, ASIRs increased across all income levels, with the greatest growth in the upper middle income (+64.7%). While ASDRs decreased in high income, upper middle income, and lower middle income levels, they notably increased in low income levels (+14.3%). DALYs decreased in high income and upper middle income levels, primarily in the high income (-25.7%), and increased in lower middle and low income levels, primarily in the low income (+13.8%). MIRs decreased in all countries, with the largest decrease in high income levels (-50%). In the last 30 years, high income countries have consistently observed the highest ASIR (2019: 77.5/100,000). However, in 1990 high income countries also had the highest ASDRs and DALYs. Interestingly, by 2019 this pattern shifted, with low income surpassing high income countries in both. Conclusions: Over the last 30 years, the incidence of prostate cancer has been rising regardless of income level. Despite the universal decrease of MIRs implying improved outcomes, screening, and therapeutical strategies, the contrasting trends in ASDRs and DALYs across income levels underscore the disparities in health outcomes. Higher income countries experienced highest cancer incidence but also the highest decrease in the mortality rates while lower income countries faced the opposite challenges with lower increase but higher mortality rates. [Table: see text]

Burnout increased among university students during the COVID-19 pandemic: a systematic review and meta-analysis

Generally, university students are at risk of burnout. This likely was exacerbated during the COVID-19 pandemic. We aimed to investigate burnout prevalence among university students during the COVID-19 pandemic and examine its distribution across countries, sexes, fields of study, and time-period. PubMed, EMBASE, PsycINFO, World Health Organization’s Global COVID-19 database, Scopus, Epistemonikos, ERIC and Google Scholar were searched (protocol: https://doi.org/10.17605/OSF.IO/BYRXW). Studies were independently screened and extracted. Random-effects meta-analysis was performed. Study quality was appraised, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. We identified 44 primary studies comprising 26,500 students. Global prevalence rates were 56.3% for high emotional exhaustion (EE), 55.3% for high cynicism (CY) and 41.8% for low personal accomplishment (PA). Prevalence of EE, CY, and PA domains varied significantly across fields of study, countries and WHO and World Bank regions, but not sex. All studies demonstrated good internal validity, although substantial heterogeneity existed between studies. The certainty of evidence was rated as moderate. Considering its potentially severe consequences, burnout is a significant public health concern. The development and implementation of evidence-based localized interventions at organizational and individual levels are necessary to mitigate burnout.

Global Burden of Chronic Obstructive Pulmonary Disease Through 2050

Chronic obstructive pulmonary disease (COPD) is a respiratory condition that is associated with significant health and economic burden worldwide. Previous studies assessed the global current-day prevalence of COPD, but to better facilitate resource planning and intervention development, long-term projections are needed. To assess the global burden of COPD through 2050, considering COPD risk factors. In this modeling study, historical data on COPD prevalence was extracted from a recent meta-analysis on 2019 global COPD prevalence, and 2010 to 2018 historical prevalence was estimated using random-effects meta-analytical models. COPD risk factor data were obtained from the Global Burden of Disease database. To project global COPD prevalence to 2050, generalized additive models were developed, including smoking prevalence, indoor and outdoor air pollution, and development indices as predictors, and stratified by age, sex, and World Bank region. The models estimated that the number of COPD cases globally among those aged 25 years and older will increase by 23% from 2020 to 2050, approaching 600 million patients with COPD globally by 2050. Growth in the burden of COPD was projected to be the largest among women and in low- and middle-income regions. The number of female cases was projected to increase by 47.1% (vs a 9.4% increase for males), and the number of cases in low- and middle-income regions was expected to be more than double that of high-income regions by 2050. In this modeling study of future COPD burden, projections indicated that COPD would continue to affect hundreds of millions of people globally, with disproportionate growth among females and in low-middle income regions through 2050. Further research, prevention, and advocacy are needed to address these issues so that adequate preparation and resource allocation can take place.

Global patterns and temporal trends in ovarian cancer morbidity, mortality, and burden from 1990 to 2019

Abstract Objectives Ovarian cancer (OC) is the deadliest gynecological cancer in the world. Deeper knowledge over time is the basis for global studies to design and implement effective measures to reduce inequalities; this study was conducted to investigate the trend of OC incidence and management in the world from 1990 to 2019. Methods We obtained crude numbers and age-standardized rate (ASRs) of OC annually from the 2019 Global Burden of Disease (GBD) study to examine OC’s morbidity, mortality rates, and disability-adjusted life years (DALYs) based on age group, sociodemographic index (SDI), WHO regions, continents, World Bank regions, and GBD regions from 1990 to 2019 in 204 countries and territories. The relative change (%) and average Annual Percent Change (AAPC) were used to display the epidemiological trend. Results Globally, the number of OC incidents increased from 141,706 in 1990 to 294,422 in 2019. Despite the age-standardized incidence rate (ASIR) in regions with high SDI having a downward trend, these areas recorded the highest incidence cases and ASIR in 2019. Although the World Bank high-income level had the most frequent incidence cases and ASIR, the ASIR in these regions decreased from 1990 to 2019. Among the continents, Europe and America have the highest ASIR but experienced a decreasing trend from 1990 until 2019 in ASIR. The age-standardized mortality rate (ASMR) in the World Bank high-income level experienced a decreasing trend in 1990–2019. In contrast, in the middle, low-middle, and low SDI regions, the death number increased approximately 3.5–4.1 times, and the ASMR had a significant increase from 0.5 in the middle to 0.75 in the low-middle SDI. Globally, the DALY cases of OC rose from 2,732,666 in 1990 to 5,359,737 in 2019; almost doubling. A significant decrease in the DALYs ASR was observed in seven GBD regions. The most pronounced decrease was found in Australia. Conclusions The trend of OC incidence and burden and approximate mortality were stable from 1990 to 2019; especially in lower socioeconomic areas and low-income countries; while the incidence ASR of this cancer in the high SDI regions decreased from 1990 to 2019. The key to reducing OC remains in primary prevention. Approaches such as weight loss, a healthy lifestyle and diet, promoting childbearing and breastfeeding, and recommending the use of oral contraceptives in eligible individuals can have a protective effect against this silent killer.

Global health burden and cost of lead exposure in children and adults: a health impact and economic modelling analysis

Lead exposure is a worldwide health risk despite substantial declines in blood lead levels following the leaded gasoline phase-out. For the first time, to our knowledge, we aimed to estimate the global burden and cost of intelligence quotient (IQ) loss and cardiovascular disease mortality from lead exposure. In this modelling study, we used country blood lead level estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. We estimated IQ loss (presented as estimated loss in IQ points with 95% CIs) in the global population of children younger than 5 years using the blood lead level-IQ loss function from an international pooled analysis. We estimated the cost of IQ loss, which was calculated only for the proportion of children expected to enter the labour force, as the present value of loss in lifetime income from the IQ loss (presented as cost in US dollars and percentage of gross domestic product with a range). We estimated cardiovascular deaths (with 95% CIs) due to lead exposure among people aged 25 years or older using a health impact model that captures the effect of lead exposure on cardiovascular disease mortality that is mediated through mechanisms other than hypertension. Finally, we used values of statistical life to estimate the welfare cost of premature mortality (presented as cost in US dollars and percentage of GDP). All estimates were calculated by World Bank income classification and region (for low-income and middle-income countries [LMICs] only) for 2019. We estimated that children younger than 5 years lost 765 million (95% CI 443-1098) IQ points and that 5 545 000 (2 305 000-8 271 000) adults died from cardiovascular disease in 2019 due to lead exposure. 729 million of the IQ points lost (95·3% of the total global IQ loss) and 5 004 000 (90·2% of total) cardiovascular disease deaths due to lead exposure occurred in LMICs. IQ loss in LMICs was nearly 80% higher than a previous estimate. Cardiovascular disease deaths were six times higher than the GBD 2019 estimate. The global cost of lead exposure was US$6·0 trillion (range 2·6-9·0) in 2019, which was equivalent to 6·9% (3·1-10·4) of the global gross domestic product. 77% (range 70-78) of the cost was the welfare cost of cardiovascular disease mortality, and 23% (22-30) was the present value of future income losses from IQ loss. Our findings suggest that global lead exposure has health and economic costs at par with PM2·5 air pollution. However, much work remains to improve the quality of blood lead level measurement data, especially in LMICs. The Korea Green Growth Trust Fund and the World Bank's Pollution Management and Environmental Health Program.

Global estimates of rehabilitation needs and disease burden in tracheal, bronchus, and lung cancer from 1990 to 2019 and projections to 2045 based on the global burden of disease study 2019.

The global cancer burden is substantial and spiraling. Although rehabilitation specialists could offer assistance, oncologic rehabilitation is still underutilized and not a routine part of clinical oncology guidelines worldwide. Global investigations of disease prevalence and years lived with disability (YLDs) for tracheal, bronchus, and lung (TBL) cancer are valuable for facilitating clinical practice improvement and health resource management. The objective of this study is to report the global estimates of rehabilitation needs and disease burden of TBL cancers from 1990 to 2019 and provide predictions for 2045. To estimate the need for rehabilitation, the data used from the Global Burden of Disease Study 2019 to calculate the prevalence, YLDs, and the attributable risk factors of TBL cancer. The Bayesian age-period-cohort model and Auto-Regressive Integrated Moving Average model were established to forecast the future health burden. All analyses were done at the global level and then some in the aggregation with the seven World Bank regions. All the data were analyzed by R software (x64 version 4.2.1) and Microsoft Excel (version 2019). Globally in 2019, 3,212,307 cases of TBL cancer (95% UI 2,937,037-3,488,346) could have benefitted from rehabilitation, contributing to 544,215 (95% UI 396,134-700,099) YLDs. Over the past 30 years, the age-standardized rate (ASR) of prevalence (EAPC = 0.51) and YLDs (EAPC = 0.03) increased. Throughout this period, the global prevalence and YLDs counts were greater in males than females. The ASR of prevalence and YLDs are projected to show a slight downward trend by 2045 on the global scale, the overall prevalence and YLDs due to TBL cancer are likely to increase further, but all indicators show a growing trend in females. TBL cancer remains one of the major public health issues globally. According to the forecasted results, the burden of YLDs due to TBL cancer will continue to rise, and the increment is higher in females than males. A rising number of patients worldwide will benefit from rehabilitation services in the future to achieve precise control and management throughout the TBL cancer patient lifecycle.

Socioeconomic indices guided linear mixed-effects and meta-regression modelling of the temporal, global and regional prevalence of Helicobacter pylori in environmental waters: A class I carcinogen

Environmental waters (EW) substantially lend to the transmission of Helicobacter pylori (Hp). But the increase in Hp infections and antimicrobial resistance is often attributed to socioeconomic status. The connection between socioeconomic status and Hp prevalence in EW is however yet to be investigated. This study aimed to assess the impacts of socioeconomic indices (SI: continent, world bank region (WBR), world bank income (WBI), WHO region, Socio-demographic Index (SDI quintile), Sustainable Development Index (SuDI), and Human Development Index (HDI)) on the prevalence of Hp in EW. Hp-EW data were fitted to a generalized linear mixed-effects model and SI-guided meta-regression models with a 1000-resampling test. The worldwide prevalence of Hp in EW was 21.76% [95% confidence interval [CI]: 10.29–40.29], which declined significantly from 59.52% [43.28–74.37] in 1990–99 to 19.36% [3.99–58.09] in 2010–19 and with increasing trend in 2020–22 (33.33%, 22.66–45.43). Hp prevalence in EW was highest in North America (45.12%, 17.07–76.66), then Europe (22.38%, 5.96–56.74), South America (22.09%, 13.76–33.49), Asia (2.98%, 0.02–85.17), and Africa (2.56%, 0.00–99.99). It was negligibly different among sampling settings, WBI, and WHO regions demonstrating highest prevalence in rural location [42.62%, 3.07–94.56], HIEs [32.82%, 13.19–61.10], and AMR [39.43%, 19.92–63.01], respectively. However, HDI, sample size, and microbiological method robustly predict Hp prevalence in EW justifying 26.08%, 21.15%, and 16.44% of the true difference, respectively. In conclusion, Hp is highly prevalence in EW across regional/socioeconomic strata and thus challenged the uses of socioeconomic status as surrogate for hygienic/sanitary practices in estimating Hp infection prevalence.

Schoolchildren's Oral Health Along the Belt and Road

BackgroundThe Belt and Road Initiative (BRI) aims to strengthen China's connectivity with the world and, in doing so, improve health and well-being. There is a dearth of information relating to schoolchildren's oral health to inform oral health–related BRI initiatives. The aim of this research was to report on the oral health status of 12-year-old children across BRI countries and determine variations in oral health regarding geographic regions (BRI routes) and country-income levels. MethodDental caries experience of 12-year-old children was obtained from the World Health Organization's (WHO) database. BRI countries were classified into BRI routes and country income level. Data were assessed for completeness and contemporariness. Variations in dental caries experiences were examined across BRI routes and with respect to country income levels. ResultsDental caries experience data were available in the WHO database for most BRI countries (95.7%, 135/141). Most dental caries data were collected pre-2010 (74.1%, 74/135). The mean number of decayed, missing, and filled teeth (DMFT) was approximately 2 (weighted mean, 1.7; SD, 1.2). Variations in DMFT existed with respect to BRI routes—WHO regions (P < .001) and World Bank regions (P < .001)—and with respect to country income levels (P < .01). ConclusionsDental caries data for 12-year-old schoolchildren are readily available (in the WHO database) for most BRI countries, although the data are not very current. In addition, dental caries experience varies with respect to BRI routes (geographic locations) and country income levels. These findings have implications by way of situation analyses to inform oral health–related BRI initiatives.

Excess Global Blood Pressure Associated With Fine Particulate Matter Air Pollution Levels Exceeding World Health Organization Guidelines

Excess Global Blood Pressure Associated With Fine Particulate Matter Air Pollution Levels Exceeding World Health Organization Guidelines

Global Veterinary Diagnostic Laboratory Equipment Management and Sustainability and Implications for Pandemic Preparedness Priorities1.

Substantial investments into laboratories, notably sophisticated equipment, have been made over time to detect emerging diseases close to their source. Diagnostic capacity has expanded as a result, but challenges have emerged. The Equipment Management and Sustainability Survey was sent to the Veterinary Services of 182 countries in mid-2019. We measured the status of forty types of laboratory equipment used in veterinary diagnostic laboratories. Of the 68,455 items reported from 227 laboratories in 136 countries, 22% (14,894/68,455) were improperly maintained, and 46% (29,957/65,490) were improperly calibrated. Notable differences were observed across World Bank income levels and regions, raising concerns about equipment reliability and the results they produce. Our results will advise partners and donors on how best to support low-resource veterinary laboratories to improve sustainability and fulfill their mandate toward pandemic prevention and preparedness, as well as encourage equipment manufacturers to spur innovation and develop more sustainable products that meet end-users' needs.

Assessment of integrated patterns of human-animal-environment health: a holistic and stratified analysis

BackgroundData-driven research is a very important component of One Health. As the core part of the global One Health index (GOHI), the global One Health Intrinsic Drivers index (IDI) is a framework for evaluating the baseline conditions of human-animal-environment health. This study aims to assess the global performance in terms of GOH-IDI, compare it across different World Bank regions, and analyze the relationships between GOH-IDI and national economic levels.MethodsThe raw data among 146 countries were collected from authoritative databases and official reports in November 2021. Descriptive statistical analysis, data visualization and manipulation, Shapiro normality test and ridge maps were used to evaluate and identify the spatial and classificatory distribution of GOH-IDI. This paper uses the World Bank regional classification and the World Bank income groups to analyse the relationship between GOH-IDI and regional economic levels, and completes the case studies of representative countries.ResultsThe performance of One Health Intrinsic Driver in 146 countries was evaluated. The mean (standard deviation, SD) score of GOH-IDI is 54.05 (4.95). The values (mean SD) of different regions are North America (60.44, 2.36), Europe and Central Asia (57.73, 3.29), Middle East and North Africa (57.02, 2.56), East Asia and Pacific (53.87, 5.22), Latin America and the Caribbean (53.75, 2.20), South Asia (52.45, 2.61) and sub-Saharan Africa (48.27, 2.48). Gross national income per capita was moderately correlated with GOH-IDI (R2 = 0.651, Deviance explained = 66.6%, P < 0.005). Low income countries have the best performance in some secondary indicators, including Non-communicable Diseases and Mental Health and Health risks. Five indicators are not statistically different at each economic level, including Animal Epidemic Disease, Animal Biodiversity, Air Quality and Climate Change, Land Resources and Environmental Biodiversity.ConclusionsThe GOH-IDI is a crucial tool to evaluate the situation of One Health. There are inter-regional differences in GOH-IDI significantly at the worldwide level. The best performing region for GOH-IDI was North America and the worst was sub-Saharan Africa. There is a positive correlation between the GOH-IDI and country economic status, with high-income countries performing well in most indicators. GOH-IDI facilitates researchers' understanding of the multidimensional situation in each country and invests more attention in scientific questions that need to be addressed urgently.Graphical

A256 INCIDENCE OF CIRRHOSIS AMONG RECENT IMMIGRANTS AND REFUGEES TO ONTARIO, CANADA : A POPULATION-BASED COHORT STUDY

Abstract Background The burden of cirrhosis is increasing in North America where a significant proportion of the population (~20%) is comprised of recent immigrants and refugees. However, the incidence of cirrhosis among this population has not been described. Purpose The aim of this study was to describe the incidence of cirrhosis among recent immigrants and refugees to Ontario, Canada stratified by cirrhosis etiology and region of origin and compare incidence rates to those of Canadian-born and long-term residents. Method This is a population-based cohort study from Ontario, Canada from 2000-2017 using healthcare data housed at ICES. Individuals with incident cirrhosis using a 5-year lookback were identified along with cirrhosis etiology using validated algorithms. Recent immigrants and refugees to Ontario (since 1985) and their World Bank region of origin were defined based on linkage to the Immigration, Refugees, and Citizenship Canada’s Permanent Resident database. Adjusted incidence rates of cirrhosis by immigration status, etiology, and region of origin were calculated and differences in rates were compared between recent immigrants and refugees to long-term residents (born in Canada or arriving before 1985) using age and sex adjusted Poisson regression to calculate rate ratios (RR). Result(s) In total, n=25,054 recent immigrants/refugees with incident cirrhosis were identified. 59% were male, median age was 49 years (IQR 39-61), 99% resided in urban areas and 31% resided in neighbourhoods of the lowest income quintile. The most common regions of origin were East Asia and Pacific (n=8,121; 32%), South Asia (n=5,576; 22%), Europe and Central Asia (n=4,454; 18%) and Latin America/Caribbean (n=3,216; 13%). The majority had NAFLD cirrhosis (n=13,972; 55%), followed by HBV (n=4,648; 19%), ALD (n=2,957; 12%), and HCV (n=2,635; 11%). Cirrhosis incidence stratified by etiology varied by region of origin, with HBV highest among the East Asia and Pacific and Sub-Saharan Africa cohort (Figure 1b), HCV among Sub-Saharan Africa and South Asia (Figure 1c), ALD among European/Central Asia and South Asia (Figure 1d), and NAFLD among the Latin America/Caribbean, Middle East/North Africa, and South Asian populations (Figure 1e). When comparing age and sex adjusted incidence of cirrhosis by etiology and immigration status, rates were lower among recent immigrants/refugees for all causes compared to long-term residents (all RR &amp;lt;1.0; Figure 1a,c-f) with the exception of HBV where it was over 4-fold higher (Figure 1b). Image Conclusion(s) Rates of HBV cirrhosis are substantially higher among migrants to Ontario while rates of all other causes of cirrhosis are lower, likely explained by the healthy immigrant effect. NAFLD has emerged as the most common etiology of cirrhosis among migrants with rates approaching those of Canadian-born and long-term residents. These data add to our understanding of the evolving epidemiology of cirrhosis and the contribution of other etiologies outside of viral hepatitis among immigrants. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

A244 SIMILAR RISK OF INCIDENT HEPATOCELLULAR CARCINOMA IN IMMIGRANTS/REFUGEES WITH HEPATITIS B CIRRHOSIS REGARDLESS OF THEIR REGION OF ORIGIN

Abstract Background In Canada, over 75% of new immigrants/refugees come from HBV-endemic areas. Whether the risk of hepatocellular carcinoma (HCC) in immigrants/refugees with HBV cirrhosis is associated with their region of origin has not been reported. Purpose The aim of our study was to describe the epidemiology of HCC in foreign-born individuals with HBV cirrhosis stratified by region of origin. Method Population-based retrospective cohort study using administrative healthcare data in Ontario, Canada. Recent immigrants/refugees with HBV (sAg+ or DNA+) and cirrhosis from 2000–2017 were identified and stratified by World Bank region of origin by linkage to the Immigration, Refugees and Citizenship Canada Permanent Resident Database. Individuals were followed until HCC, death, liver transplant, or end of study (2020). The 1-, 5-, and 10-year cumulative incidences (CI) of HCC were calculated. Using adjusted competing risks regression, the subdistribution hazard ratios (sHR) for HCC were calculated with region of origin as the main exposure where death/LT were competing events. Result(s) 4,438 immigrants/refugees were included (64% male, median age 47 years [IQR 37–56], 72% Asia/Pacific, 9% South Asia, 6% Sub-Saharan Africa, 3% Latin America/Caribbean, 7% Europe/Central Asia, 3% Middle East/North Africa) with 430 (10%) developing incident HCC over a median of 7.9 years (IQR 4.5-11.7). Age at HCC diagnosis was lowest in those from Sub-Saharan Africa (53 years IQR [44-58]). Overall, the annual incidence of HCC was 1.14/100 person-years. The CI of HCC at 1-, 5-, and 10 years was highest in those from Latin American/Caribbean (6.8%, 10.3%, and 13.1%), East Asia/Pacific (4.5%, 7.7%, 10.3%) and South Asia (4.0%, 7.2%, 10.3%). After adjusted competing risk regression (Table), decompensated cirrhosis (sHR 2.5; 95% CI 1.7–3.5), male sex (sHR 2.2; 95% CI 1.7–2.7), and age (sHR 1.05, 95% CI 1.04–1.06) were independently associated with HCC, while region of origin was not. Conclusion(s) Among immigrants/refugees with HBV cirrhosis, HCC is associated with male sex, older age, and decompensated cirrhosis but not with their region of origin. Efforts ensuring timely detection and evaluation of HBV in immigrants/refugees with a goal to prevent development of decompensated cirrhosis and provide early detection of HCC should be aggressively pursued regardless of their region of origin. Please acknowledge all funding agencies by checking the applicable boxes below None Disclosure of Interest None Declared

Incidence of Cirrhosis Among Recent Immigrants and Refugees to Ontario, Canada.

The epidemiology of cirrhosis among immigrants to North America has not been described. Using population-level data from Ontario, Canada, recent immigrant and refugees with incident cirrhosis were identified and stratified by World Bank region of origin and cirrhosis etiology. Incidence rates were described based on region of origin and etiology and compared with those in Canadian-born/long-term residents. A total of 25,054 immigrants/refugees were identified with rates of cirrhosis lower compared with those in Canadian-born/long-term residents for all etiologies except hepatitis B virus likely explained by the healthy immigrant effect. Nonalcoholic fatty liver disease was the most common etiology of cirrhosis among immigrants and refugees.

Developing Consensus on Priority Pediatric Otolaryngology-Head and Neck Surgery Conditions and Procedures.

The aim of this study was to develop an international expert consensus on priority pediatric otolaryngology-head and necksurgery (OHNS) conditions and procedures for which all national health systems globally should be capable of managing. The Delphi method is a multiround online questionnaire and was administered internationally to otolaryngologists with a focus on pediatric populations. This study was administered in parallel to a Delphi survey focusing on adult OHNS conditions amongst adult otolaryngology experts. International online survey. In round 1, participants listed the top 15 pediatric otolaryngological conditions and top 15 pediatric otolaryngology procedures for their World Bank region. In round 2, participants ranked round 1 responses in order of global importance on a 5-point Likert scale. In round 3, participants reranked conditions and procedures that did not achieve consensus, defined as at least 70% of the round 2 Likert responses being ranked as either "important" or "very important." Descriptive statistics were calculated for each round. The survey was distributed to 35 experts globally, with a 40% (n = 14) response rate. Fifty percent (n = 7) of participants were from low- and middle-income countries, with at least 1 participant from each World Bank region. A list of 28 consensus surgical procedures and 11 consensus conditions were identified. This Delphi survey method of world experts in pediatric otolaryngology identified a core list of medical conditions and surgical procedures that should be a part of every national health system's clinical goals of treatment, research, and capacity building.

Global, regional and national burden, incidence, and mortality of cervical cancer.

Among gynecological cancers, cervical cancer is the most common cause of cancer-related death in developing countries. This study analyzes the incidence, mortality, and burden of cervical cancer using the Global Burden of Disease (GBD) 2019 study. The GBD (2019) data on cervical cancer was extracted from the Global Health Data Exchange (GHDx) query tool. Age-standardized rate (ASR) incidence, deaths, lost years of life (YLLs), years of life with disabilities (YLDs), and adjusted years of life with disabilities (DALYs) of cervical cancer in women were extracted. Data were extracted globally for 204 countries and groups based on a socio-demographic index (SDI), World Health Organization (WHO) regions, continents, World Bank regions, and 22 GBD regions. The higher standardized age incidence of cervical cancer is in lower SDI countries, Africa, the African region (According to the WHO), and Sub-Saharan Africa (According to GBD regions). The highest deaths of ASR is in countries with low SDI, low-income group, Africa, the African region (According to the World Health Organization), and Sub-Saharan Africa (According to GBD regions). According to SDI classification, the highest DALYs ASR is in low SDI countries, World Bank Low-income countries, African and then American continents, African region, Sub-Saharan Africa, and then Latin America & Caribbean-WB (Based on GBD regions). In 2019, incidence, mortality, and DALYs of cervical cancer mostly affected countries with lower socioeconomic status. Given that cervical cancer is highly preventable, access to screening services and the presence of trained and knowledgeable health care staff can reduce illness, suffering, and death caused by this malignancy. It is recommended to use the national and international potentials to reduce the incidence of this malignancy.

Global and regional prevalence of Helicobacter pylori in drinking waters: A sustainable, human development and socio-demographic indices based meta-regression-modelling

Helicobacter pylori (Hp) transmission dynamics via drinking water (DW) has a far much higher direct and indirect public health disease burden than previously thought. This study aimed to assess the global prevalence of Hp in DW, distributions across regions and socioeconomic indices (continent, world bank income, Human Development Index (HDI), Sustainable Development Index (SuDI), Socio-Demographic Index (SDI) quintile, and WHO regions). Hp-DW related data mined from five databases until 10/12/2022 according to PRISMA standard were quality-appraised and fitted to a generalized linear mixed-effects model. Sub-group analysis and meta-regression-modelling coupled with a 1000-permutation test (⁎) were conducted. The global prevalence of Hp in DW was 15.7% (95% confidence interval [CI]: 7.98–27.5), which varied significantly by sampling methods (Moore swabbing (61.0% [0.00–100.0]) vs. grab sampling (13.68%[6.99–25.04])) and detection technique (non-culture (21.35%[9.13–42.31]) vs. cultured-based methods (Psubgroup < 0.01)). The period 1990–99 had the highest prevalence (41.24% [0.02–99.97]). Regarding regional designations, Hp prevalence in DW was significantly different being highest in North America (61.82% [41.03–79.02]) by continents, AMR (42.66% [20.81–67.82]) by WHO group, high HDI (24.64% [10.98–46.43]) by HDI group and North America (61.90% [2.79–98.93]) by world bank region (Psubgroup < 0.01). Generally, sample preparation, SuDI grouping, and detection/confirmation techniques, have significant effects on the detection/prevalence of Hp in DW (Psubgroup < 0.01). Hp prevalence in DW was not significantly different among rural and urban DW (Psubgroup = 0.90), world bank income groups (Psubgroup = 0.15), and SDI quintiles (Psubgroup = 0.07). Among the predictors examined, only sample size (p < 0.1, R∗2(coefficient of determinant) = 15.29%), continent (p∗val = 0.04), HDI (p∗val = 0.02), HDI group (p∗val = 0.05), and microbiological methods (p < 0.1; R∗2=28.09 %) predicted Hp prevalence in DW robustly. In conclusion, Hp prevalence is still endemic in DW regardless of the regional designations/improve DW supplies.