Years Of Life Lost Rates Research Articles

Effects of population aging on quality of life and disease burden: a population-based study

BackgroundAs population aging intensifies, it becomes increasingly important to elucidate the casual relationship between aging and changes in population health. Therefore, our study proposed to develop a systematic attribution framework to comprehensively evaluate the health impacts of population aging.MethodsWe used health-adjusted life expectancy (HALE) to measure quality of life and disability-adjusted life years (DALY) to quantify the burden of disease for the population of Guangzhou. The HALE and DALY projections were generated using both the Bayesian age-period-cohort models and the population prediction models. Changes in HALE and DALY between 2010–2020 and 2020–2030 were decomposed to isolate the effects of population aging. Three scenarios were analyzed to examine the relative relationship between disease burden and population aging. In Scenarios 1 and 2, the disease burden rates in 2030 were assumed to either remain at 2020 levels or follow historical trends. In Scenario 3, it was assumed that the absolute numbers of years of life lost (YLL) and years lived with disability (YLD) in 2030 would remain unchanged from the 2020 levels.ResultsBetween 2010 and 2020, 56.24% [69.73%] of the increase in male [female, values in brackets] HALE was attributable to the mortality effects in the population aged 60 and over, while − 3.74% [− 9.29%] was attributable to the disability effects. The increase in DALY caused by changes in age structure accounted for 72.01% [46.68%] of the total increase in DALY. From 2020 to 2030, 61.43% [69.05%] of the increase in HALE is projected to result from the mortality effects in the population aged 60 and over, while − 3.88% [4.73%] will be attributable to the disability effects. The increase in DALY due to changes in age structure is expected to account for 102.93% [100.99%] of the total increase in DALY. In Scenario 1, YLL are projected to increase by 45.0% [54.7%], and YLD by 31.8% [33.8%], compared to 2020. In Scenario 2, YLL in 2030 is expected to decrease by − 2.9% [− 1.3%], while YLD will increase by 12.7% [14.7%] compared to 2020. In Scenario 3, the expected YLL rates and YLD rates in 2030 would need to be reduced by 15.3% [15.4%] and 15.4% [15.6%], respectively, compared to 2020.ConclusionsThe disability effects among the elderly population hinder improvements in quality of life, while changes in age structure are the primary driver of disease burden accumulation. To mitigate the excess disease burden caused by population aging, it is essential to achieve a reduction of more than 15% in the disease burden by 2030 compared to 2020. Our proposed attribution framework evaluates the health impacts of population aging across two dimensions: quality of life and disease burden. This framework enables comparisons of these effects over time and across different regions.

Socio-economic inequality in the nutritional deficiencies among the world countries: evidence from global burden of disease study 2019

BackgroundSocioeconomic inequality in nutritional status as one of the main social determinants of health can lead to inequality in health outcomes. In the present study, the socioeconomic inequality in the burden of nutritional deficiencies among the countries of the world using Global Burden of Disease (GBD) data was investigated.MethodsBurden data of nutritional deficiencies and its subsets including protein-energy malnutrition, iodine deficiency, vitamin A deficiency, and dietary iron deficiency form GBD study and Human Development Index (HDI), a proxy for the socio-economic status of countries, from united nations database were collected. After descriptive statistics, the concentration index (CI) curve was used to measure socioeconomic inequality. CI for nutritional deficiencies was estimated based on Disability Adjusted Life Years (DALY), Years Lived with Disability (YLD), Years of Life Lost (YLL), prevalence, incidence and death indices. Moreover, CI of DALY and prevalence was estimated and reported for four nutritional deficiencies subgroups.ResultsCIs for DALY, YLD, YLL, prevalence, incidence and death rate show negative values and their, which indicates the concentration of nutritional deficiencies burden among lower HDI countries. The highest value of CI (lowest inequality) for DALY was related to iodine deficiency (-0.3401) and the lowest (highest inequality) was related to vitamin A deficiency (-0.5884). Also, the highest value of CI for prevalence was related to protein-energy malnutrition (-0.1403) and the lowest was related to vitamin A deficiency (-0.4308). Results also show the inequality in DALY was greater than the disparity in prevalence for all subgroups of nutritional deficiencies.ConclusionsInequality in burden of nutritional deficiencies and protein-energy malnutrition, iodine deficiency, vitamin A deficiency and dietary iron deficiency are concentrated in countries with low HDI, so there is pro- poor inequality. Findings indicate that although malnutrition occurs more in low-income countries, due to the weakness of health care systems in these countries, the inequality in the final consequences of malnutrition such as DALY becomes much deeper. More attention should be paid to the development of prevention and primary treatment measures in low HDI countries, such as improving nutrition-related health education, nutritional support and early aggressive treatment, and also eliminating hunger.

National and Subnational Trends of Mortality and Years of Life Lost Due to Stroke and Its Subtypes in Young Adults in China, 2005-2020.

The incidence of stroke among young adults was rising globally, but the death burden of stroke in young adults in China is lacking. We aimed to examine the temporal trends in mortality and years of life lost (YLLs) caused by stroke among young adults from 2005 to 2020 across China. Based on the data from the National Mortality Surveillance System in China, we estimated the number and age-standardized rate of mortality and YLLs due to stroke and its subtypes among young adults aged 15-49 years during 2005-2020, for both China and its 31 mainland provinces. During 2005-2020, the age-standardized mortality rate of stroke among young adults aged 15-49 years in China decreased by 21.0%, from 5.9/100,000 to 4.7/100,000, and the YLL rate decreased from 286.9/100,000 to 229.5/100,000. The age-standardized mortality rate among young adults due to intracerebral hemorrhage (ICH) showed a significant downward trend with a decrease of 26.3% while that of ischemic stroke (IS) and subarachnoid hemorrhage (SAH) decreased by 4.5% and 0.6%, respectively. In 2020, the mortality rate of ICH was 3.5 times higher than that of IS (3.3/100,000 vs 0.9/100,000) among young adults in China. The male/female ratio of age-standardized mortality rate of stroke in young adults increased from 2.0 in 2005 to 3.1 in 2020. The age-standardized mortality rate of IS and SAH in young men increased by 11.0% and 2.5%, respectively. In 2020, Tibet (18.4/100,000), Jilin (10.4/100,000), and Qinghai (8.3/100,000) were the top 3 provinces holding the highest age-standardized mortality rate due to stroke among young adults. Tibet was found to have the highest mortality rate due to ICH and SAH while that of IS was higher in northeast China. In China, the death burden caused by ICH among young adults was substantially higher than that of IS. The increasing death burden of IS and SAH among young men requires special attention. Evidence-based intervention strategies are needed to improve the outcomes of stroke and alleviate the death burden due to stroke among young adults in Chinese population.

Trend analysis of drowning mortality and years of life lost (YLL) in the south of Iran, 2004–2019

Background and Aims: Drowning is defined as a process with consequences ranging from death to survival without continuous injury. This study was conducted to determine the mortality rate and the years of life lost (YLL) due to drowning in Fars Province. Methods: All deaths due to drowning in Fars Province were obtained from the electronic population-based death registration system (EDRS). Crude and age-standardized mortality rate, YLL, and YLL rate data were calculated, and joinpoint regression was used to examine the trend. Results: During the study period (2004–2019), 910 deaths due to drowning occurred in Fars Province. Of these, 80.5% (733 cases) were reported in men and 41.0% (373 cases) were in the age group of 15–29 years. Crude mortality rate had decreasing trends in male and stable trends in female. The total YLL due to drowning during the 16-year study period were 19,583 (0.62 per 1000 people) in men and 4797 (0.15 per 1000 people) in women. According to the joinpoint regression analysis, the 16-year trend of YLL rate due to premature mortality in males was decreasing. The annual percent change (APC) was -6.0% [95% confidence interval (95% CI) -8.4 to -3.5, p < 0.001] and stable trends in female (APC = - 5.4%; 95% CI -11.8 to 1.4, p = 0.108). Conclusion: Although the trend of crude and standardized mortality rates and YLL due to drowning in men decreased during 2004–2019, these trends have been constant in women. Therefore, the need to invest in the implementation and evaluation of drowning prevention interventions cannot be ignored.

Gender Differences in Years of Life Lost resulting from the 2015 Gorkha Earthquake in Nepal

Abstract Background Nepal has a history of regular natural hazards, including significant earthquakes and floods. Previous studies have shown that females, particularly younger females, are more likely to die due to disasters compared to males. This study aimed to explore gender differences in mortality - measured in Years of Life Lost (YLL) - caused by the 2015 Gorkha earthquake across 41 districts of Nepal. Methods Mortality counts were derived from the Nepal Police Report. YLL was estimated by multiplying mortality counts (stratified by age, gender, and district) by age-conditional life expectancy from the 2019 Global Burden of Disease reference life table. Both absolute numbers and rates of YLL per 100,000 population were calculated. YLL per deaths, stratified by age-gender-and-location, were estimated and compared. Male-to-female YLL rate ratios were estimated as well, and compared across districts. Results The 2015 Gorkha earthquake resulted in 8,950 deaths (females: 56.1% versus males: 43.9%), accounting for 526,617 YLL. Males had a slightly higher number of YLL per death (59.2) compared to females (58.5); this is mainly due to the different number of deaths between males and females. YLL per deaths ranged from 65.4 (Rautahat district) to 0 (in several districts) among males and, from 65.3 (Rautahat district) to 0 (in several districts) among females. The YLL rate per 100,000 population was higher for females (3,158 per 100,000) than for males (2,575 per 100,000). Approximately 40% of the districts had male-to-female YLL rate ratios of less than one, which can be partly explained by the gender distribution of the population at rik of dying due to earthquake. Conclusions The study found relatively higher YLL per death for males and higher YLL rates for females. This underscores the necessity to further investigate the factors that contribute to fatalities from earthquakes, especially in lower middle income countries such as Nepal. Key messages • Gender disparities in mortality following the 2015 Gorkha earthquake in Nepal were addressed using Years of Life Lost (YLLs); males had higher YLL per death, while females had higher YLL rates. • Exploring the factors that contribute to earthquake-related fatalities should be a priority for disaster mitigation strategies.

All-cause Years of life lost due to death at municipality level in Norway. Association to educational attainment and median income

Abstract Background Norway, with 5.5 million people spread across 356 municipalities, has pursued an active policy to reduce social and geographical health inequalities. Despite, studies find significant health disparities linked to socioeconomic factors at the individual-level, although evidence at larger geographical-levels has been mixed. We used a key burden of disease (BoD) metric, Years of Life Lost (YLL), to examine spatial health inequities among Norwegian municipalities and their association with socioeconomic factors. Methods We analysed data from all residents in Norwegian municipalities with over 1000 inhabitants as of January 1, 2019. Data was sourced from the National Population Register and Statistics Norway. All-cause YLL were calculated based on age-specific aspirational life expectancy obtained from GBD 2019. Deprivation was measured using educational attainment and median income, categorized into quartiles. Geographical maps illustrating municipality-level all-cause age-standardised YLL rates for males and females were generated. Negative binomial regression models assessed associations between socioeconomic factors and YLL rates, adjusting for age, sex, and an index of centralisation. Results High-deprivation municipalities exhibited a 9% higher YLL rate in terms of education (Incidence Rate Ratio [IRR] = 1.09, 95% Confidence Interval [CI] = 1.01-1.17) and a 10% higher YLL rate in terms of income (IRR = 1.10, 95% CI = 1.02-1.08) compared to the least deprived, translating to absolute differences of 1391 and 1466 YLL per 100,000 population, respectively. Additionally, we discuss the potential expansion of this study to incorporate cause-specific outcomes and other BoD metrics based on previous county-level analyses. Conclusions Our study demonstrates the feasibility of using BoD methods to assess geographical deprivation and premature mortality at the municipality level, providing valuable insights for public health policy targeted at small administrative areas.

Burden of inflammatory bowel disease in Belgium, 2020

Abstract Inflammatory bowel disease (IBD) comprises digestive disorders resulting from non-infectious inflammation of the colon and gastrointestinal tract. With its global prevalence on the rise, IBD poses significant challenges to healthcare systems. There is a need for more accurate disease burden estimates to guide decision-making processes within the health sector. As a part of the Belgian national burden of disease study (BeBOD), this study aims to estimate the burden of IBD in Belgium based on locally available data. We estimated the Belgian IBD burden in 2020 in terms of mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life years (DALYs). As there is no single comprehensive data source on prevalence of IBD in Belgium, a critical appraisal of existing local and national data sources was conducted. Prevalence data were combined with disability weights to yield YLDs. YLLs were calculated using the most recent Global Burden of Disease (GBD) 2019 reference life table and the number of deaths caused by non-infective IBD (ICD-10 K50-52). Cause of death data were extracted from Statbel, the Belgian statistical office. The best available data source to estimate the IBD prevalence in Belgium was a widespread network of general practitioners. The prevalence of IBD was 1.5% in 2020. The prevalence-based YLD for IBD was 220 YLDs per 100 000, while the YLL rate was 11.5 per 100 000. We estimated 26 276 DALYs caused by IBD in 2020. Of the total DALYs caused by IBD, 5% were due to YLLs and 95% were due to YLDs. Our burden estimates for IBD in Belgium were however higher than those of the GBD study. IBD imposes a low fatal burden, whereas the burden of morbidity is more prominent. Our findings could be useful for policy makers to justify and prioritize resource allocation. Integrating the current research in BeBOD will allow monitoring the burden of IBD over time. Key messages • Inflammatory bowel disease is characterized by a substantial non-fatal burden due to chronic relapsing and persistent symptoms. • National inflammatory bowel disease burden estimates are useful to guide decision-making within the health sector.

Regional inequalities in years of life lost within the European Economic Area: Using the Gini coefficient and slope index of inequality to assess spatial disparities

Abstract Background Health inequalities have been linked to reduced life expectations. This study aimed to investigate regional variations in all-cause years of life lost (YLLs) in European Economic Area (EEA) countries prior to the COVID-19 pandemic. Methods Demographic data were extracted from Eurostat for 1390 small regions 32 EEA countries. Age-standardised sex specific YLL rates per 100,000 population in 2019 were estimated for EEA regions (Eurostat NUTS level 3) using methodologies derived from the Global Burden of Disease study. Relative spatial disparities were evaluated using the Gini coefficient (GC) and absolute spatial disparities assessed using the slope index of inequality (SII). Results Between EEA countries, relative geographical inequality in age-standardized YLL rates was higher than within them, slightly more so for males (GC = 16.96% [95% CI = 16.26-17.65]) than females (14.22% [13.62-14.82]). Among females, the UK (11.21% [95% CI 10.11-12.30]), Greece, and Croatia had the highest relative spatial inequality, while Ireland (3.37% [2.26-4.48]), Slovakia, and the Netherlands had the lowest. For males, Belgium (10.76% [9.34-12.17]), the UK, and Croatia exhibited the highest relative spatial inequality, while Ireland (1.99% [1.18-2.81]), Lithuania, and Slovakia had the lowest. Germany had the largest absolute geographical inequality in YLLs among females (SII=16.86% [16.28 to 17.44]), followed by Estonia and the UK. Among males, Estonia had the largest absolute spatial inequality (36.60% [-10.88 to 84.07]), followed by Latvia and Hungary. Ireland had the lowest absolute spatial inequality for both females and males. Conclusions Relative and absolute disparities in premature mortality rates are evident across regions of the EEA, both within countries and across the entire region. These findings offer insights for national and local stakeholders, aiding them in customising public health interventions to target spatial health disparities.

Impact of Noncommunicable Diseases on Years of Life Lost in FB&H During the COVID-19 Pandemic

Abstract This study aims to comprehensively investigate the impact of noncommunicable diseases (NCDs) on years of life lost (YLL) within the Federation of Bosnia and Herzegovina (FB&H) across distinct phases: pre-pandemic, pandemic, and post-pandemic periods. Given that NCDs currently represent more than half of the global disease burden, our focus lies in assessing YLL specifically for cerebral infarction (I63-I64) and diabetes mellitus (E10-E14). Conducting a retrospective data analysis, we utilized mortality data sourced from the Institute for Statistics of FB&H to quantify YLL. This assessment involved multiplying age-specific mortality figures by the remaining life expectancy at the corresponding age, utilizing the GBD 2019 life expectancy table. Examining the period between 2019 and 2022, our analysis aimed to elucidate the pandemic’s potential influence on NCD burden, through the examination of age-standardized YLL rates based on the world standard population. In 2019, YLL attributable to I63-I64 for both sexes totaled 41,244 in 2019, escalating to 44,790 in 2020, and subsequently decreasing to 39,439 and 32,055 in the pandemic years of 2021 and 2022, respectively. For diabetes mellitus (E10-E14), YLL in 2019 amounted to 23,675, with figures for 2020, 2021, and 2022 standing retrospectively at 24,329, 24,114, 19,125. The increase in 2020 may be attributed, in part, to initial healthcare hesitancy during the pandemic’s onset, leading to delayed treatment and heightened mortality rates. Furthermore, patients who died in 2020 from C-19 without being tested may have skewed mortality registration by inflating rates attributed to pre-existing conditions. The declining rates thereafter could be due to a harvesting pandemic effect, in that people who were previously ill died prematurely from C-19. These insights show the pandemic’s profound impact on NCD-related mortality, underscoring the urgent need for targeted interventions and healthcare strategies. Key messages • A substantial reduction in years of life lost (YLL) related to certain noncommunicable diseases was observed during the pandemic. • The pandemic significantly influenced mortality among individuals with noncommunicable diseases, driven partly by healthcare hesitancy and potential misregistration of causes of death.

Trend of gastrointestinal and liver diseases in China: Results of the Global Burden of Disease Study, 2019.

China is one of the countries with the largest burden of gastrointestinal and liver diseases (GILD) in the world. The GILD constitutes various causes of mortality and disability. The study aimed to investigate the trend of GILD in China using the Global Burden of Diseases Study 2019 (GBD 2019) data resources from 1990 to 2019. The data on the age-standardized mortality rates (ASMR) and disability-adjusted life years (DALYs) for GILD in China from 1990 to 2019 were collected from the GBD 2019 data resources. Furthermore, the ranking of the main causes of deaths and DALYs, as well as the trends of ASMR, DALYs, years of life lost (YLLs), and years of life lost due to disability (YLDs) per 1,000,000 in GILD were reported. The ASMR and DALYs for stomach cancer, liver cancer, and esophageal cancer, which ranked top three among the GILDs from 1990 to 2019, were gradually decreasing. Significant decreases in the ASMR and DALYs were found in diarrheal diseases and acute hepatitis (A, E, and C). However, noteworthy increases were found in those of colon and rectum cancer (CRC) and pancreatic cancer. Trend of DALYs, mortality, and YLLs rates for most of GILD were decreasing from 1990 to 2019, except the burden of CRC and pancreatic cancer with an increasing trend. The DALYs, mortality and YLLs of most GILD diseases showed decreasing trends from 1990 to 2019, except the burden of CRC and pancreatic cancer with an increasing trends. The result of the GBD 2019 showed that the rates of most GILDs decreased in China; however, gastrointestinal and liver cancer, such as stomach cancer still held the top ranking. Furthermore, the shift from infectious diseases to non-communicable causes among GILD burden is occurring and is likely to continue with many public health strategies implications.

Mortality Rate and Years of Life Lost Due to Ischemic Heart Disease in Southern Iran between 2004 and 2019: A Population-Based Study.

Cardiovascular diseases (CVDs) account for one-third of all deaths worldwide. In this cross-sectional study, we extracted all death records from the Electronic Death Registration System categorized as ischemic heart disease (IHD) based on age, gender, and the year of death according to ICD-10 for this cross-sectional analysis. The Fars province is situated in southern Iran with a population of about 4 million. An analysis of years of life lost (YLL) resulting from premature death from IHD was conducted using the World Health Organization's 2015 YLL framework. The trend of the YLL rates was investigated using joinpoint regression. In the Fars province, IHD was the cause of 46969 deaths throughout a 16-year study period, (2004 to 2019). Among these, 26,503 (56.4%) were men. The crude death rates per 100000 population for men and women were 84.2 and 66.5, respectively. The total YLL due to premature death due to IHD, during the 16-year study period, was 287625 in male, 209665 in female. The joinpoint regression showed a declining trend in the YLL rate associated with premature death. Annual Percent Change (APC) was -0.6% (95% CI -6.9 to 6.1, P=0.851) for males and -1.5% (95% CI -5.2 to 2.2, P=0.418) for females. The trends of the standardized mortality rate, YLL, and crude mortality rate held steady throughout a 16-year period. Planning for comprehensive primary and secondary prevention and increasing public knowledge of IHD are necessary.

Mortality Rate and Years of Life Lost Due to Breast and Gynecologic Cancers in Southern Iran 2004-2019: A Population-Based Study.

There is an increase in the incidence of breast and gynecologic cancers in Iran during the last three decades. Literature is inadequate about the Years of Life Lost (YLL) attributed to these cancers in Iran. Mortality data due to these cancers amongst females aged >20 yr from 2004 to 2019 was acquired from "Electronic Death Registry System", Fars Province, Iran. Using local health centers' databases and national census reports from 1996 to 2016, the age-standardized incidence rate (ASR) per 100,000 people were estimated. YLLs were calculated using the WHO's 2015 "YLL template". During 2004-2019, 1886 and 829 deaths occurred due to breast and gynecologic cancers, respectively. The ASR due to breast and gynecologic cancers showed a significant increasing trend (P<0.001 for each). The total YLL due to breast, cervical/uterine/vaginal/vulvar, and ovary cancers' deaths in the 16-year period were 33,077, 7,172 and 6,584 yr, respectively. The highest YLLs were observed in 50-59-year-old females, followed by 40-49- and 60-69-year-old females. The 16- year trend of YLL rate due to premature mortality in breast cancer, ovary cancer and cervix cancer was increasing: annual percent change (APC) was 7.6% (95% CI: 5.5-9.7, P<0.001), 19.0% (95% CI: 12.2-26.1, P<0.001) and 9.2% (95% CI: -9.2 to 31.3, P>0.05, respectively. Mortality rate and YLLs due to breast and gynecologic cancers have been increased in southern Iran during the last twenty years. Early detection programs and allocating treatments at early stages should be prioritized.

Mortality and disease burden of oral cancer in China: a time-trend analysis on the China Death Surveillance Database from 2006 to 2021

BackgroundOral cancer is one of the most common cancers in China and seriously threaten life and health of Chinese people. We analysed the trends and disparities of oral cancer mortality rates and the disease burden of oral cancer in China from 2006 to 2021 to provide a reference for its prevention and control.MethodsAnnual death data for oral cancer was gleaned from the China Death Surveillance Database. The age-standardized mortality rate (ASMR), annual percentage change (APC), and average APC (AAPC) were used to analyze the trend of mortality. Loss of life expectancy (LLE) and years of life lost (YLL) were adopted to assess disease burden.ResultsFrom 2006 to 2021, the overall ASMR of oral cancer lightly declined (AAPC: − 0.97%; 95% CI: − 1.89%, − 0.04%), and the similar trend was observed among females (AAPC: − 1.22%; 95% CI: − 1.89%, − 0.55%). The ASMR of males was 2.31–3.16 times higher than that of females per year. The median of LLE for overall, males and females caused by oral cancer from 2006 to 2021 were 0.05, 0.06 and 0.03 years, respectively. There was a decrease of standardized YLL rate from 2006 to 2021 for overall (AAPC: − 1.31%, 95% CI: − 2.24% ~ − 0.37%) and for female (AAPC: − 1.63%, 95% CI: − 2.30% ~ − 0.95%). ASMR in urban areas was 1.02–1.28 times higher than that in rural areas from 2006 to2011, but 0.85–0.97 times lower in urban areas than that in rural areas from 2018 to 2021. The disease burden was higher in urban areas than in rural areas in 2006, whereas the reverse was observed in 2021.ConclusionsThere are severe health gaps and disparities in trends between sexes and different areas in China. Males and rural populations need to be focused on targeted interventions for the main influencing factors.

Liver Cancer Mortality Disparities at a Fine Scale Among Subpopulations in China: Nationwide Analysis of Spatial and Temporal Trends.

China has the highest number of liver cancers worldwide, and liver cancer is at the forefront of all cancers in China. However, current research on liver cancer in China primarily relies on extrapolated data or relatively lagging data, with limited focus on subregions and specific population groups. The purpose of this study is to identify geographic disparities in liver cancer by exploring the spatial and temporal trends of liver cancer mortality and the years of life lost (YLL) caused by it within distinct geographical regions, climate zones, and population groups in China. Data from the National Death Surveillance System between 2013 and 2020 were used to calculate the age-standardized mortality rate of liver cancer (LASMR) and YLL from liver cancer in China. The spatial distribution and temporal trends of liver cancer were analyzed in subgroups by sex, age, region, and climate classification. Estimated annual percentage change was used to describe liver cancer trends in various regions, and partial correlation was applied to explore associations between LASMR and latitude. In China, the average LASMR decreased from 28.79 in 2013 to 26.38 per 100,000 in 2020 among men and 11.09 to 9.83 per 100,000 among women. This decline in mortality was consistent across all age groups. Geographically, Guangxi had the highest LASMR for men in China, with a rate of 50.15 per 100,000, while for women, it was Heilongjiang, with a rate of 16.64 per 100,000. Within these regions, the LASMR among men in most parts of Guangxi ranged from 32.32 to 74.98 per 100,000, whereas the LASMR among women in the majority of Heilongjiang ranged from 13.72 to 21.86 per 100,000. The trend of LASMR varied among regions. For both men and women, Guizhou showed an increasing trend in LASMR from 2013 to 2020, with estimated annual percentage changes ranging from 10.05% to 29.07% and from 10.09% to 21.71%, respectively. Both men and women observed an increase in LASMR with increasing latitude below the 40th parallel. However, overall, LASMR in men was positively correlated with latitude (R=0.225; P<.001), while in women, it showed a negative correlation (R=0.083; P=.04). High LASMR areas among men aligned with subtropical zones, like Cwa and Cfa. The age group 65 years and older, the southern region, and the Cwa climate zone had the highest YLL rates at 4850.50, 495.50, and 440.17 per 100,000, respectively. However, the overall trends in these groups showed a decline over the period. Despite the declining overall trend of liver cancer in China, there are still marked disparities between regions and populations. Future prevention and control should focus on high-risk regions and populations to further reduce the burden of liver cancer in China.

Global disease burden attributable to kidney dysfunction, 1990–2019: A health inequality and trend analysis based on the global burden of disease study

ObjectiveThis study aimed to evaluate the burden of kidney dysfunction (KD), assess socioeconomic inequalities, and project trends in the future. MethodsData on deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were from Global Burden of Disease Study 2019. The Joinpoint regression model was utilized to analyze the temporal trend by the annual percentage change (APC). The slope index and concentration index were employed to evaluate cross-country disparities. The future trend was predicted using an age-period-cohort analysis. ResultsIn the past three decades, the death numbers of KD increased from 1,571,720 to 3,161,552, DALYs from 42,090,331 to 76,486,945, YLDs from 5,003,267 to 11,282,484, and YLLs from 37,087,065 to 65,204,461, respectively. The age-standardized rate (ASR) of deaths, DALYs, and YLLs exhibited a declining trend. The ASR of YLDs increased until 2017, then decreased. The slope index and concentration index for DALYs increased from 248.1 to 351.9 and from 40.70 to 57.8. In the future, the ASR of deaths, DALYs, YLDs, and YLLs will remain stable, while their numbers will continue to rise, except for YLLs. ConclusionsThe disease burden of KD remained serious. Tailored interventions should be developed based on national contexts.

Trends and levels of the global, regional, and national burden of appendicitis between 1990 and 2021: findings from the Global Burden of Disease Study 2021

Appendicitis is a common surgical emergency that poses a large clinical and economic burden. Understanding the global burden of appendicitis is crucial for evaluating unmet needs and implementing and scaling up intervention services to reduce adverse health outcomes. This study aims to provide a comprehensive assessment of the global, regional, and national burden of appendicitis, by age and sex, from 1990 to 2021. Vital registration and verbal autopsy data, the Cause of Death Ensemble model (CODEm), and demographic estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) were used to estimate cause-specific mortality rates (CSMRs) for appendicitis. Incidence data were extracted from insurance claims and inpatient discharge sources and analysed with disease modelling meta-regression, version 2.1 (DisMod-MR 2.1). Years of life lost (YLLs) were estimated by combining death counts with standard life expectancy at the age of death. Years lived with disability (YLDs) were estimated by multiplying incidence estimates by an average disease duration of 2 weeks and a disability weight for abdominal pain. YLLs and YLDs were summed to estimate disability-adjusted life-years (DALYs). In 2021, the global age-standardised mortality rate of appendicitis was 0·358 (95% uncertainty interval [UI] 0·311-0·414) per 100 000. Mortality rates ranged from 1·01 (0·895-1·13) per 100 000 in central Latin America to 0·054 (0·0464-0·0617) per 100 000 in high-income Asia Pacific. The global age-standardised incidence rate of appendicitis in 2021 was 214 (174-274) per 100 000, corresponding to 17 million (13·8-21·6) new cases. The incidence rate was the highest in high-income Asia Pacific, at 364 (286-475) per 100 000 and the lowest in western sub-Saharan Africa, at 81·4 (63·9-109) per 100 000. The global age-standardised rates of mortality, incidence, YLLs, YLDs, and DALYs due to appendicitis decreased steadily between 1990 and 2021, with the largest reduction in mortality and YLL rates. The global annualised rate of decline in the DALY rate was greatest in children younger than the age of 10 years. Although mortality rates due to appendicitis decreased in all regions, there were large regional variations in the temporal trend in incidence. Although the global age-standardised incidence rate of appendicitis has steadily decreased between 1990 and 2021, almost half of GBD regions saw an increase of greater than 10% in their age-standardised incidence rates. Slow but promising progress has been observed in reducing the overall burden of appendicitis in all regions. However, there are important geographical variations in appendicitis incidence and mortality, and the relationship between these measures suggests that many people still do not have access to quality health care. As the incidence of appendicitis is rising in many parts of the world, countries should prepare their health-care infrastructure for timely, high-quality diagnosis and treatment. Given the risk that improved diagnosis may counterintuitively drive apparent rising trends in incidence, these efforts should be coupled with improved data collection, which will also be crucial for understanding trends and developing targeted interventions. Bill and Melinda Gates Foundation.

The burden and trends of child and maternal malnutrition across the regions in Ethiopia, 1990-2019: The Global Burden of Disease Study 2019.

Child malnutrition is the main contributor to the disease burden in Ethiopia. The objective of this study was to determine the prevalence and trends of child malnutrition and maternal anemia in Ethiopia at the national and regional state levels between 1990 and 2019. We used all accessible data sources and analyzed prevalence, death, and years of life lost (YLL) due to child malnutrition and maternal anemia across nine regions and two chartered cities in Ethiopia, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. The burden and trends of child and maternal malnutrition and anemia at the national level, across the regions, and in cities were assessed. Point estimates with 95% uncertainty intervals (UI) are presented. Of the 190,173 total under-5 deaths in Ethiopia in 2019, 108,864 (95% UI: 83,544-141,718; 57·2%, 51·3-62·7) were attributed to malnutrition. The prevalence of stunting, underweight, and wasting was 37·0%, 27·0%, and 7·0%, respectively, in 2019. The YLL rate attributable to child malnutrition declined from 251,964 per 100,000 population (95% UI: 218,720-287,559) in 1990 to 57,615 (95% UI: 44,190-75,015) in 2019. The YLL rate of wasting, stunting, and underweight in Ethiopia was 18,566 per 100,000 population (95% UI: 12,950-26,123), 3,290 (95% UI: 1,443-5,856), and 5,240 (95% UI: 3,608-7,312) in 2019, respectively. Gambella showed the highest YLL rate reduction among regions, with a 98·2% change for stunting, 95·9% for wasting, and 97·9% for underweight between 1990 and 2019. The prevalence of anemia among under-5 children in Ethiopia was 62·0% (95% UI: 59·1%-65·1%) in 2019. Somali has the highest child anemia prevalence, 84·4% (95% UI: 79·8%-88·8%), compared to others in 2019. The prevalence of anemia in women of reproductive age (15-49 years) in Ethiopia was 20·4% (95% UI: 19·0%-21·8%) in 2019. The prevalence of child malnutrition and maternal anemia in Ethiopia remains high compared to national, WHO, and UNICEF 2030 targets in all indicators of child malnutrition and anemia despite several interventions in the last three decades. The YLL rate due to child malnutrition was high, with regional variations. In conjunction with other sectors, especially agriculture, the National Nutrition Program and other nutrition initiatives must make greater efforts with short-term and long-term interventions to improve access and better nutrition.

Trend Analysis of Unintentional Fall Mortality and Years of Life Lost in the Fars Province of Iran, 2004-2019

Background: Unintentional falls are one of the main causes of death and a significant burden on victims, families, and communities. This study aimed to determine the trend analysis of mortality rate and years of life lost (YLL) due to unintentional falls in Fars Province, Iran. Methods: All deaths due to unintentional fall in Fars Province, central Iran from the electronic population-based death registration system (EDRS) were obtained. Crude and age-standardized mortality rate, YLL and YLL rate data were calculated and to examine the trend, joinpoint regression was used. Results: During the 16-year study period (2004-2019), 1816 deaths due to falls occurred in Fars Province. Crude mortality rate had stable trend in men and increasing trend in women. The total years of life lost due to falls, were 25,437 in men and 5,720 in women. According to the joinpoint regression analysis, the 16-year trend of YLL rate due to premature mortality was decreasing in males. The annual percent change (APC) was -2.8% (95% CI -4.5 to -1.0, P=0.005). However, there were stable trends for females, APC was 3.5% (95% CI -1.8 to 9.1, P=0.181). Conclusion: Due to the increase in mortality caused by falls in women and stable trend in men, there is an urgent need to plan and implement preventive strategies to reduce the incidence of injuries caused by falls. Home and behavioral modifications such as increasing home lighting, providing handrails on stairs and bathrooms, and educating the people may play an important role in reducing fall deaths.

Prevalence and Burden of Multiple Sclerosis in China, 1990-2019: Findings From the Global Burden of Disease Study 2019.

Multiple sclerosis (MS) is the leading cause of neurologic disability in young adults, but the burden caused by MS in China is lacking. We aimed to comprehensively describe the prevalence and health loss due to MS by demographic and geographical variables from 1990 to 2019 across China. Data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019). We used GBD methodology to systematically analyze the prevalence, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) due to MS by age, sex, and location from 1990 to 2019 in mainland China and its provinces. We also compared the MS burden in China with the world and other Group of 20 (G20) countries. In 2019, 42,571 (95% uncertainty interval [UI] 33,001-53,329) individuals in China had MS, which doubled from 1990. The age-standardized prevalence rate of MS was 2.32 per 100,000 (95% UI 1.78-2.91), which increased by 23.31% (95% UI 20.50-25.89) from 1990, with most of the growth occurring after 2010. There was a positive latitudinal gradient with the increasing prevalence from south to north across China. The total DALYs caused by MS were 71,439 (95% UI 58,360-92,254) in 2019, ranking China third among G20 countries. Most of the MS burden in China derived from premature mortality, with the higher fraction of YLLs than that at the global level and most other G20 countries. From 1990 to 2019, the age-standardized DALY and YLL rate had nonsignificant changes; however, the age-standardized YLD rate substantially increased by 23.33% (95% UI 20.50-25.89). The geographic distribution of MS burden varied at the provincial level in China, with a slight downward trend in the age-standardized DALY rates along with increasing Socio-Demographic Index over the study period. Although China has a low risk of MS, the substantial and increasing prevalent cases should not be underestimated. The high burden due to premature death and geographic disparity of MS burden reveals insufficient management of MS in China, highlighting the needs for increased awareness and effective intervention.

Trend Analysis of Suicide Mortality and Years of Life Lost from 2016 to 2021 in Southern Iran.

Suicide as the commonest psychiatric emergency imposes a heavy burden on communities. We aimed to evaluate the years of life lost (YLLs) due to premature death from suicide in Kohgiluyeh and Boyer-Ahmad Province, Iran. Data regarding suicidal deaths were extracted from the Forensic Medicine Organization. The YLL of each year were calculated among gender and age groups. The YLL calculation was performed using the 2015 WHO excel calendars template. The Join Point Regression method was used to examine the trend of the crude mortality rate, the standardized mortality rate, and the YLL rate. Overall, 572 people died by suicide between 2016 and 2021 (63.5% in males and 36. 5% in females). The main method of death in most cases was hanging (52.8%). The total YLL due to premature death in the 6 year- period was 9248 (4.2 per 1000 persons) in males, 5602 (2.6 per 1000 persons) in females. Hanging (7909) compromised the largest YLL category between different methods of suicide. According to the joinpoint regression analysis, the 6-year trend of YLL rate due to premature mortality was increasing in males: the annual percent change (APC) was 4.8% (95% CI 1.0 to 8.7, P=0.024) and stable trend for females. The YLL was higher in men than in women. Effective training interventions should be designed and implemented to reduce the incidence of suicide.