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Background: Central Asia is known to face various ecological challenges that constitutes major risk factors for Parkinson's disease (PD). This study examines the burden of PD in Central Asia, a region where data on neurological disorders is notably sparse. Methods: Building on the latest Global Burden of Disease Study (GBD 2021), this study investigates the Years of Life Lost (YLLs), Years Lived with Disability (YLDs), and Disability-Adjusted Life Years (DALYs) associated with PD in Central Asia and its countries from 1990 to 2021. The authors calculated average annual percent change (AAPC) to analyze trends, and compared individual country estimates to global figures. Additionally, incorporating data from the World Bank, both Bayesian hierarchical and non-hierarchical frequentist regression models were employed to assess their impact on DALYs. Results: The DALYs varied across the study period, primarily driven by YLLs. While YLLs showed a uniform trend, YLDs were mostly incremental. Kazakhstan had the highest estimates across all metrics and was the only country aligned with global patterns. Age- and sex-specific estimates revealed substantial variations, with notably high figures found in male subjects from Tajikistan. The YLLs, YLDs, and DALYs for Kazakhstan, Uzbekistan, and Turkmenistan saw a significant increase in AAPCs. In contrast, Kyrgyzstan and Tajikistan saw declines, likely attributable to civic conflict and inter-country differences in population structure. Further comparison of DALY trends revealed significant deviations for all countries from the global pattern. Conclusion: This study showed an overall increase in PD burden from 1990 to 2021. These findings underscore the need for targeted strategies to reduce PD burden, with a particular focus on Kazakhstan. Integrating historical information is crucial for discussing the plausible mechanisms in studies sourced from the GBD. [ABSTRACT FROM AUTHOR]

• The study reveals a three-fold increase in both incidence and prevalence of epilepsy. • Throughout the study period, 153,532 DALYs were lost due to epilepsy. • Organic, including symptomatic, mental disorders were the most comorbid conditions. • Mortality was significantly associated with systemic atrophies and cerebral palsy. This study is designed to estimate the epidemiology of epilepsy in Kazakhstan, using a large-scale administrative health database during 2014–2020. Using the Unified National Electronic Health System of Kazakhstan over a seven-year span, we explored incidence and prevalence rates, disability-adjusted life years (DALY), and all-cause mortality. Regression models using Cox proportional hazards were used to analyze the sociodemographic, mental, behavioral, and neurological factors affecting survival. Overall analyses were performed using STATA (V.16). The total cohort comprised of 82,907 patients, with a significant increase in the incidence of epilepsy from 26.15 in 2014 to 88.80 in 2020 per 100,000 people. Similar trends were observed in the prevalence rates, which tripled from 26.06 in 2014 to 73.10 in 2020. While mortality rates fluctuated, the elderly and children had the greatest rates of 9.97 and 2.98 per 1000 person-years respectively. DALYs revealed a substantial disease burden, with 153,532 DALYs (824.5 per 100,000) being lost during the study period. A few comorbidities, such as cerebral palsy (adjusted hazard ratio (aHR) 2.23) and central nervous system atrophy (aHR, 27.79), markedly elevated all-cause mortality. Furthermore, extrapyramidal and movement disorders (aHR 2.16, p = 0.06) and demyelinating diseases of the central nervous system (aHR 6.36, p = 0.06) showed a trend toward increased mortality risk. To the best of our knowledge, this is the first study from Central Asia exploring a large epilepsy cohort. The findings highlight the need for targeted interventions to address the growing burden of epilepsy, particularly among children, male sex, and those with neurological comorbities. [ABSTRACT FROM AUTHOR]

Purpose: Due to climate change, the severity and length of heat waves are increasing, and this trend is likely to continue while mitigation efforts are insufficient. These climatic events cause overheating inside buildings, which increases mortality. Adaptation measures reduce overheating but induce environmental impacts, including on human health. This study aims to integrate the overheating-related effects on human health in building LCA to provide a design aid combining mitigation and adaptation. Methods: In a novel approach, an existing building LCA tool is utilised to evaluate life cycle impacts, including damage to human health expressed in DALYs. The overheating risk is then evaluated using an existing dynamic thermal simulation (DTS) tool and prospective climatic data. Overheating is expressed as a degree-hour (DH) indicator, which integrates both the severity (temperature degrees over a comfort threshold) and the duration (hours). By assuming proportionality between DALYs and DH × area in a first step, the 2003 heat wave mortality data, 2003 climatic data, and a simplified model of the national residential building stock were used to identify a characterisation factor, which can then be used to evaluate DALYs corresponding to any building using DH obtained by thermal simulation. Results: The proposed overheating model not only allows to derive a characterisation factor for overheating to be used in building LCA but also provides practical insights. The first estimation of the characterisation factor is 1.35E-8DALY. DH-1.m-2. The method was tested in a case study corresponding to a social housing apartment building in France built in 1969 without insulation. The thickness of insulation implemented in the renovation works was varied. For this specific case study, the contribution of overheating is significant, ranging from 1.1E-5DALY.m-2.y-1 to 2.2E-5DALY.m-2.y-1, comparable to the contribution of heating. DTS and LCA results found an optimal thickness, minimising the human health indicator in DALYs. This underscores the potential of active cooling to reduce human health impacts, especially if it consumes electricity produced by a photovoltaic system integrated in the building. Conclusion: Combining DTS and LCA makes it possible to evaluate damage indicators on human health, including building life cycles (e.g., material and energy) and overheating-related impacts. An application on a case study shows this method's feasibility and gives a first order of magnitude of overheating health impacts induced by buildings. A more sophisticated model could replace the assumed proportionality between DALYs and DH. [ABSTRACT FROM AUTHOR]

Abstract Background Central Asia is known to face various ecological challenges that constitutes major risk factors for Parkinson’s disease (PD). This study examines the burden of PD in Central Asia, a region where data on neurological disorders is notably sparse. Methods Building on the latest Global Burden of Disease Study (GBD 2021), this study investigates the Years of Life Lost (YLLs), Years Lived with Disability (YLDs), and Disability-Adjusted Life Years (DALYs) associated with PD in Central Asia and its countries from 1990 to 2021. The authors calculated average annual percent change (AAPC) to analyze trends, and compared individual country estimates to global figures. Additionally, incorporating data from the World Bank, both Bayesian hierarchical and non-hierarchical frequentist regression models were employed to assess their impact on DALYs. Results The DALYs varied across the study period, primarily driven by YLLs. While YLLs showed a uniform trend, YLDs were mostly incremental. Kazakhstan had the highest estimates across all metrics and was the only country aligned with global patterns. Age- and sex-specific estimates revealed substantial variations, with notably high figures found in male subjects from Tajikistan. The YLLs, YLDs, and DALYs for Kazakhstan, Uzbekistan, and Turkmenistan saw a significant increase in AAPCs. In contrast, Kyrgyzstan and Tajikistan saw declines, likely attributable to civic conflict and inter-country differences in population structure. Further comparison of DALY trends revealed significant deviations for all countries from the global pattern. Conclusion This study showed an overall increase in PD burden from 1990 to 2021. These findings underscore the need for targeted strategies to reduce PD burden, with a particular focus on Kazakhstan. Integrating historical information is crucial for discussing the plausible mechanisms in studies sourced from the GBD.

Abstract Background A large fraction of the disease burden in the Italian population is due to behavioral risk factors. The objective of this work is to provide a tool to estimate the impact of preventive interventions that reduce the exposure to smoking and sedentary lifestyle of the Italian population, with the goal of selecting optimal interventions. Methods We construct a Markovian model that simulates the state of each subject of the Italian population. The model predicts the distribution of subjects in each health status and risk factor status for every year of the simulation. Based on this distribution, the model provides a rich output summary, such as the number of incident and prevalent cases for each tracing disease and the Disability Adjusted Life Years (DALY), used to assess the impact of preventive interventions, and how this impact is shaped in time. Results This paper focuses on the methodological aspects of the model. The proposed model is flexible and can be applied to estimate the impact of complex interventions on the two risk factors and adapted to consider different cohorts. We validate the model by simulating the evolution of the Italian population from 2009 to 2017 and comparing the output with historical data. Furthermore, as a case-study, we simulate a counterfactual scenario where both tobacco and sedentary lifestyle are eradicated from the Italian population in 2019 and estimate the impact of such intervention over the following 20 years. Conclusions We propose a Markovian model to estimate how interventions on smoking and sedentary lifestyle can affect the reduction of the disease burden, and validate the model on historical data. The model is flexible and allows to extend the analysis to consider more risk factors in future research. However, we are aware that, given the ever-increasing availability of data, it is necessary in the future to increase the complexity of the model, to be closer to reality and to provide decision-making support to the policy-makers.

Abstract Background The objective of this study is to estimate the burden of selected immunization-preventable infectious diseases in Spain using the Burden of Communicable Diseases in Europe (BCoDE) methodology, as well as focusing on the national immunization programme and potential new inclusions. Methods The BCoDE methodology relies on an incidence and pathogen-based approach to calculate disease burden via disability-adjusted life year (DALY) estimates. It considers short and long-term sequelae associated to an infection via outcome trees. The BCoDE toolkit was used to populate those trees with Spanish-specific incidence estimates, and de novo outcome trees were developed for four infections (herpes zoster, rotavirus, respiratory syncytial virus [RSV], and varicella) not covered by the toolkit. Age/sex specific incidences were estimated based on data from the Spanish Network of Epidemiological Surveillance; hospitalisation and mortality rates were collected from the Minimum Basic Data Set. A literature review was performed to design the de novo models and obtain the rest of the parameters. The methodology, assumptions, data inputs and results were validated by a group of experts in epidemiology and disease modelling, immunization and public health policy. Results The total burden of disease amounted to 163.54 annual DALYs/100,000 population. Among the selected twelve diseases, respiratory infections represented around 90% of the total burden. Influenza exhibited the highest burden, with 110.00 DALYs/100,000 population, followed by invasive pneumococcal disease and RSV, with 25.20 and 10.57 DALYs/100,000 population, respectively. Herpes zoster, invasive meningococcal disease, invasive Haemophilus influenza infection and hepatitis B virus infection ranked lower with fewer than 10 DALYs/100,000 population each, while the rest of the infections had a limited burden (

Abstract Background Clonorchiasis has significant socioeconomic importance in endemic areas; however, studies investigating the disease burden in specific sub-regions are lacking. This study aims to address the gap by quantifying the current disease burden caused by clonorchiasis in Guangdong province and assessing its distribution characteristics. Methods Comprehensive measures, including prevalence rates, disability-adjusted life years (DALYs), and direct medical costs, were used to assess the disease burden of clonorchiasis. To estimate the prevalence rate, the number of infections was divided by the examined population, based on the annual surveillance data on clonorchiasis cases during 2016–2021. The calculation of DALYs was based on the epidemiological parameters according to the definition issued by the World Health Organization. Cost data of clonorchiasis were utilized to quantify the direct medical costs. The distribution characteristics of disease burden were assessed through comparisons of groups of population defined by geographic area, time, and characteristics of people. Results In 2021, clonorchiasis posed a significant disease burden in Guangdong Province. The prevalence rate was found to be 4.25% [95% CI (4.02%, 4.49%)], with an associated burden of DALYs of 406,802.29 [95% CI (329,275.33, 49,215,163.78)] person-years. The per-case direct medical costs of patients with clonorchiasis were estimated to be CNY 7907.2 (SD = 5154.4). Notably, while the prevalence rate and DALYs showed a steady decrease from 2016 to 2020, there was a rising trend in 2021. Spatial clustering of clonorchiasis cases and DALYs was also observed, particularly along the Pearl River and Han River. This suggests a concentration of the disease in these regions. Furthermore, significant differences in prevalence rates were found among various demographic groups, including sex, age, occupation, and education level. Additionally, patients with longer hospital stays were more likely to incur higher direct medical costs. Conclusions The burden of clonorchiasis in Guangdong Province remains high, despite significant progress achieved through the implementation of the prevention and control programs. It is suggested that measures should be taken based on the distribution characteristics to maximize the effectiveness of prevention and control, with a primary focus on key populations and areas. Graphical Abstract

Selenium (Se) deficiency among populations in Ethiopia is consistent with low concentrations of Se in soil and crops that could be addressed partly by Se-enriched fertilisers. This study examines the disease burden of Se deficiency in Ethiopia and evaluates the cost-effectiveness of Se agronomic biofortification. A disability-adjusted life years (DALY) framework was used, considering goiter, anaemia, and cognitive dysfunction among children and women. The potential efficiency of Se agronomic biofortification was calculated from baseline crop composition and response to Se fertilisers based on an application of 10 g/ha Se fertiliser under optimistic and pessimistic scenarios. The calculated cost per DALY was compared against gross domestic product (GDP; below 1–3 times national GDP) to consider as a cost-effective intervention. The existing national food basket supplies a total of 28·2 µg of Se for adults and 11·3 µg of Se for children, where the risk of inadequate dietary Se reaches 99·1 %–100 %. Cereals account for 61 % of the dietary Se supply. Human Se deficiency contributes to 0·164 million DALYs among children and women. Hence, 52 %, 43 %, and 5 % of the DALYs lost are attributed to anaemia, goiter, and cognitive dysfunction, respectively. Application of Se fertilisers to soils could avert an estimated 21·2–67·1 %, 26·6–67·5 % and 19·9–66·1 % of DALY via maize, teff and wheat at a cost of US$129·6–226·0, US$149·6–209·1 and US$99·3–181·6, respectively. Soil Se fertilisation of cereals could therefore be a cost-effective strategy to help alleviate Se deficiency in Ethiopia, with precedents in Finland. [ABSTRACT FROM AUTHOR]

Background: A large fraction of the disease burden in the Italian population is due to behavioral risk factors. The objective of this work is to provide a tool to estimate the impact of preventive interventions that reduce the exposure to smoking and sedentary lifestyle of the Italian population, with the goal of selecting optimal interventions. Methods: We construct a Markovian model that simulates the state of each subject of the Italian population. The model predicts the distribution of subjects in each health status and risk factor status for every year of the simulation. Based on this distribution, the model provides a rich output summary, such as the number of incident and prevalent cases for each tracing disease and the Disability Adjusted Life Years (DALY), used to assess the impact of preventive interventions, and how this impact is shaped in time. Results: This paper focuses on the methodological aspects of the model. The proposed model is flexible and can be applied to estimate the impact of complex interventions on the two risk factors and adapted to consider different cohorts. We validate the model by simulating the evolution of the Italian population from 2009 to 2017 and comparing the output with historical data. Furthermore, as a case-study, we simulate a counterfactual scenario where both tobacco and sedentary lifestyle are eradicated from the Italian population in 2019 and estimate the impact of such intervention over the following 20 years. Conclusions: We propose a Markovian model to estimate how interventions on smoking and sedentary lifestyle can affect the reduction of the disease burden, and validate the model on historical data. The model is flexible and allows to extend the analysis to consider more risk factors in future research. However, we are aware that, given the ever-increasing availability of data, it is necessary in the future to increase the complexity of the model, to be closer to reality and to provide decision-making support to the policy-makers. [ABSTRACT FROM AUTHOR]

Objective: Despite generating huge employment opportunities and profitable business, fishing is considered a dangerous occupation due to challenging weather conditions and exposure to unhealthy occupational factors and lifestyles, which contribute to various health issues. However, few studies have examined the health status of shrimp cultivators. Consequently, this study aims to estimate the age group-wise burden of non-communicable diseases (NCDs) among shrimp cultivators. Methods: Simple random sampling was employed for collecting data. The sample size was 357 shrimp cultivators. Disability-adjusted life years (DALY) and relative risk (RR) methods were used to measure the burden of NCDs among shrimp cultivators. This study reported the burden of NCDs per 100,000 shrimp cultivators. Results: The top five prevalence of NCDs per 100,000 shrimp cultivators were mental disorders (85,434), musculoskeletal diseases (26,325), digestive diseases (9,803), diabetes (5,882), and cardiovascular diseases (4,481). DALY per 100,000 shrimp cultivators was 33,407.59, while at the national level, it was 24,775.99 per 100,000 people across all age groups. The RR of NCDs among shrimp cultivators in terms of DALY was 1.35, indicating a 0.35 times higher burden of NCDs among shrimp cultivators than at the national level. The largest RR of NCDs was found among shrimp cultivators aged 15–49 years (1.85), followed by 50–69 years (1.09). The highest percentage changes in the burden of NCDs among shrimp cultivators, resulting from changes in the methods of estimating DALY, was observed in the age group of 70 years and above (−48.36%) followed by 15–49 years (−46.08%) and 50–69 years (−40.33%) when compared to the baseline method of estimating DALY without utilizing age weightage and discount rate. Conclusions: Focus should be given to improving the lifestyle and occupational factors of shrimp cultivators to mitigate the burden of NCDs. [ABSTRACT FROM AUTHOR]

Background: Stroke occurs when a blood vessel of the brain narrowed or completely blocked. Stroke and Alzheimer’s disease (AD) are the commonest diseases in elderly. Some studies confirm the association between AD and the increased risk of stroke. Methods: In present meta-analysis we conducted a systematic analysis on risk of stroke in AD patients. A thorough literature search was conducted using different databases, including Google Scholar and MEDLINE. The present metanalysis includes all the studies published from 2010 to 2023. We found more than 57,260 matching results and five were relevant to our area of interest and met all the selection criteria. Results: All the selected studies confirm the association of stroke with AD. The AD patients were al higher risk of stroke (ischemic and haemorrhagic) than the normal individuals. Conclusion: Present meta-analysis confirms the significant association of AD with stroke. There were only five studies available. To validate the results further evidences are required. [ABSTRACT FROM AUTHOR]

Even though active mobility is considered a sustainable way of travelling in urban environments, this might not always be the case because of a lack of infrastructure and poor road safety standards. This study assesses, under an economic point of view, the health benefits of a shift from private cars to active mobility for urban travels in Italy, considering both mortality and morbidity effects. The overall health effect is the result of positive (increased physical activity) and negative effects (increased air pollutant intake and increased road injury risk). Health impacts are measured using disability-adjusted life years and translated into monetary terms using either the value of a life year or the value of a statistical life. On average, the overall health effect of the modal shift is negative. This is largely due to the very high pedestrian and bike road injury rates in Italian cities. The negative effect of increased air pollution intake is negligible if compared with the effect of road injuries. In the case of bikes/e-bikes, the overall health effect is positive in cities characterised by good cycling infrastructure. [ABSTRACT FROM AUTHOR]

Background: Clonorchiasis has significant socioeconomic importance in endemic areas; however, studies investigating the disease burden in specific sub-regions are lacking. This study aims to address the gap by quantifying the current disease burden caused by clonorchiasis in Guangdong province and assessing its distribution characteristics. Methods: Comprehensive measures, including prevalence rates, disability-adjusted life years (DALYs), and direct medical costs, were used to assess the disease burden of clonorchiasis. To estimate the prevalence rate, the number of infections was divided by the examined population, based on the annual surveillance data on clonorchiasis cases during 2016–2021. The calculation of DALYs was based on the epidemiological parameters according to the definition issued by the World Health Organization. Cost data of clonorchiasis were utilized to quantify the direct medical costs. The distribution characteristics of disease burden were assessed through comparisons of groups of population defined by geographic area, time, and characteristics of people. Results: In 2021, clonorchiasis posed a significant disease burden in Guangdong Province. The prevalence rate was found to be 4.25% [95% CI (4.02%, 4.49%)], with an associated burden of DALYs of 406,802.29 [95% CI (329,275.33, 49,215,163.78)] person-years. The per-case direct medical costs of patients with clonorchiasis were estimated to be CNY 7907.2 (SD = 5154.4). Notably, while the prevalence rate and DALYs showed a steady decrease from 2016 to 2020, there was a rising trend in 2021. Spatial clustering of clonorchiasis cases and DALYs was also observed, particularly along the Pearl River and Han River. This suggests a concentration of the disease in these regions. Furthermore, significant differences in prevalence rates were found among various demographic groups, including sex, age, occupation, and education level. Additionally, patients with longer hospital stays were more likely to incur higher direct medical costs. Conclusions: The burden of clonorchiasis in Guangdong Province remains high, despite significant progress achieved through the implementation of the prevention and control programs. It is suggested that measures should be taken based on the distribution characteristics to maximize the effectiveness of prevention and control, with a primary focus on key populations and areas. [ABSTRACT FROM AUTHOR]

Background: The objective of this study is to estimate the burden of selected immunization-preventable infectious diseases in Spain using the Burden of Communicable Diseases in Europe (BCoDE) methodology, as well as focusing on the national immunization programme and potential new inclusions. Methods: The BCoDE methodology relies on an incidence and pathogen-based approach to calculate disease burden via disability-adjusted life year (DALY) estimates. It considers short and long-term sequelae associated to an infection via outcome trees. The BCoDE toolkit was used to populate those trees with Spanish-specific incidence estimates, and de novo outcome trees were developed for four infections (herpes zoster, rotavirus, respiratory syncytial virus [RSV], and varicella) not covered by the toolkit. Age/sex specific incidences were estimated based on data from the Spanish Network of Epidemiological Surveillance; hospitalisation and mortality rates were collected from the Minimum Basic Data Set. A literature review was performed to design the de novo models and obtain the rest of the parameters. The methodology, assumptions, data inputs and results were validated by a group of experts in epidemiology and disease modelling, immunization and public health policy. Results: The total burden of disease amounted to 163.54 annual DALYs/100,000 population. Among the selected twelve diseases, respiratory infections represented around 90% of the total burden. Influenza exhibited the highest burden, with 110.00 DALYs/100,000 population, followed by invasive pneumococcal disease and RSV, with 25.20 and 10.57 DALYs/100,000 population, respectively. Herpes zoster, invasive meningococcal disease, invasive Haemophilus influenza infection and hepatitis B virus infection ranked lower with fewer than 10 DALYs/100,000 population each, while the rest of the infections had a limited burden (< 1 DALY/100,000 population). A higher burden of disease was observed in the elderly (≥ 60 years) and children < 5 years, with influenza being the main cause. In infants < 1 year, RSV represented the greatest burden. Conclusions: Aligned with the BCoDE study, the results of this analysis show a persisting high burden of immunization-preventable respiratory infections in Spain and, for the first time, highlight a high number of DALYs due to RSV. These estimates provide a basis to guide prevention strategies and make public health decisions to prioritise interventions and allocate healthcare resources in Spain. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to investigate drug use disorders which are a major cause of Disability Adjusted Life Years (DALYs) in the Eastern Mediterranean Region (EMR). Methods: This article is a part of the global burden of diseases (GBD), injuries, and risk factors 2019 study. The GBD modeling approach was used to estimate population-level prevalence of drug use disorders. We combined these estimates with disability weights to calculate years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 1990–2019. Results: It is estimated that in 2019 in EMR around 3.4 million people have drug use disorder which has increased by 137% compared to 1990. Also, in 2019, DALY number for drug use disorders was 1217.9 (95% UI: 940.4, 1528.9) thousand years and 7645 (95% UI: 6793.7, 8567.9) deaths occurred. The DALY rate increased 39.6% in the region since1990, whereas the global rate increased by 24.4%. United Arab Emirates, Libya, and Iran were most affected by drug use disorders with the highest rates of age-standardized DALY in EMR in 2019. The most prevalent drug use disorder in the region is opioid use which is accountable for 80% of all drug use disorders DALYs. Conclusion: Despite many interventions, drug use disorders are still responsible for high rates of DALY in the region which has increased since 1990 in both males and females; more comprehensive policies, better control measures and proper education could reduce the adverse effects. [ABSTRACT FROM AUTHOR]

Public health spending (PHS) has been extensively investigated concerning population health outcomes (PHO), but its effectiveness has been less analysed. To this end, this study examines the association between domestic general government health expenditure (DGGHE) and PHO in terms of disability-adjusted life year (DALY) while testing the role of health system efficiency (HSE) in its effects. The under-five mortality(U5MR) is also used in the analysis to assess the effectiveness of services. The study uses publicly available data from 2008 to 2018 across forty-three countries in SSA and applies the GMM estimator based on linear and nonlinear moment conditions. The findings indicate that an increase in DGGHE was significantly associated with a decrease in DALY and U5MR, with the lowest decrease in countries with the lowest HSE scores. Therefore, the study urges governments in SSA countries to consider mechanisms that enhance health system efficiency while planning interventions based on increased spending on health. [ABSTRACT FROM AUTHOR]

The life cycle assessment (LCA) methodology currently covers a limited number of human health-related impact categories. Microbiological food safety is an essential aspect for the selection of an appropriate food production system and has been neglected in the LCA so far. A framework for the inclusion of a microbiological food safety indicator, expressed as disability-adjusted life year (DALY) value of the consumed food product to the human health damage category (end-point) was created, and applied in a case study model on the cooked-chilled meals as the ready-to-eat meals can be associated with the occurrence of foodborne illness cases and outbreaks. This study suggests a framework for the inclusion of microbiological risk caused by Bacillus cereus associated with the consumption of ready-to-eat meals (in Belgium) in the LCA. The results indicated that the microbiological risk of one package of the investigated ready-to-eat meal was 1.95 × 10−6 DALY, and the obtained DALY value was included as an impact category in the LCA methodology. Inclusion of other categories of food safety (including chemical safety hazards, pesticide residues, heavy metals, and mycotoxins) in LCA could be done in the same fashion. [ABSTRACT FROM AUTHOR]

BackgroundThis study used data from the Global Burden of Disease Study (GBD) database to systematically assess the magnitude of drug use disorders (DUD) burden between 1990 and 2021.MethodsThis study used GBD data to analyze the trends in ASIR, DALYs and other DUD indicators from 1990 to 2021, and compared them among different regions and countries. The Estimated Annual Percentage Change (EAPC) and its 95% Confidence Interval (CI) were calculated to assess the temporal and geographical disparities. ASIR and DALYs were used to evaluate the burden of DUDs, and socio-demographic index (SDI) was used to measure the socio-economic development level of each country.ResultsThe global ASIR of DUDs showed a slight downward trend (EAPC = −0.26). The age-standardized DALY rate (per 100,000) significantly declined from 1990 to 2021 (EAPC = −1.44). Among the regions, the high SDI region exhibited the most substantial increase in ASIR (EAPC = 0.65). On a regional level, the high-income North America region had the highest EAPC for both age-standardized DALYs and ASIR (EAPC = 4.82, 1.02, respectively). Nationally, the United States of America reported the largest increase in age-standardized DALY rates and EAPC for ASIR (EAPC of 4.88, 1.05, respectively), while South Africa had the most significant decrease in EAPC (EAPC of −3.62, −1.52, respectively). In 2021, the highest ASIR was observed in high-income North America at 520.07; Central Asia had the highest age-standardized DALY rate. Globally, age-standardized DALYs and ASIR for DUDs were generally higher in men than in women, and the burden of DUDs decreased with age.ConclusionThe global burden of DUDs has shown complex and changing trends over the last decades, with large differences in burden between regions and countries. This highlights the need for targeted public health policies and interventions in High income North America region and Eastern Europe.

Background: Ketapang District, located in West Kalimantan, is a region where rabies is endemic. The first human death from rabies was reported in 2014 and the problem persists to this day. In response, the government has implemented the one health approach to control rabies since 2017. This study aimed to assess the disease burden of rabies control using zDALY metrics. Methods: The zoonotic burden for human and animal was measured by developing Zoonotic Disability-Adjusted Life Years (zDALY), which combines DALY and local values of animals and their products, considering animal morbidity and mortality due to the disease (Animal Loss Equivalent/ALE). Data were gathered through interviews with victims or their families, dog owners, and secondary data from the Animal Husbandry Service, and the District Health Office. Results: Before implementing the one health approach, the zDALY value was 1,561.22 person-years (the zDALY rate: 109.53 years/100,000 people). After the intervention, the zDALY value was 1,808.86 person-years (the zDALY rate: 86.62 years/100,000 people). Conclusions: This reduction in the zDaly rate indicates that rabies control through the one health approach in Ketapang District was effective in alleviating the disease burden caused by rabies.

Medical diagnostics procedures involving the use of ionising radiation is one of the most intensively developing areas in medical diagnostics. At the same time, medical exposure of patients has a number of fundamental differences from other routine situations of planned exposure. As a rule, medical exposure is acute, and radiation doses in some types of examinations exceed the level of natural and man-made exposure associated with normal operation of radiation facilities. In such a situation, risk differentiation is of great importance, taking into account the different radiosensitivity of individual sex and age groups of patients. Radiation risks should be taken into account both when prescribing examinations involving the use of ionising radiation and when analysing the benefit-harm ratio associated with their application to specific patients. Another reason why risk assessment is an urgent task is the need to inform patients and/or their legal representatives about the health risks associated with the carrying out of examinations, including radiation risks. Within the framework of the present work, the risks associated with fluoroscopic examinations were assessed. To characterise the risk we used the DALY indicator, which is more and more frequently used in risk assessment, reflecting the possible number of lost years of healthy life as a result of radiation exposure during the study. The aim of the work was to calculate DALY values for different sex and age groups of patients from the Russian population during fluoroscopic examinations. To achieve this aim, the method of estimating the number of healthy life years lost due to exposure to ionising radiation, which was developed in the course of the research work, was used. The paper presents the results of calculating DALY values for three types of fluoroscopic examinations. This work represents the next step in the direction of harmonisation of radiation risk assessment methodology with the methodologies of risk assessment of other nature. One of the directions of using the calculation results is the development of methodological approaches to the calculation of sex- and age-dependent risk coefficients associated with medical exposure of patients. The analysis of the obtained results showed that the contribution of oncological diseases to the total radiation harm in older men was significantly higher than in women.

Chandan Kumar Swain,1 Himanshu Sekhar Rout,2 Mihajlo Jakovljevic3– 5 1Department of Analytical & Applied Economics, Utkal University, Vani Vihar, Bhubaneswar, Odisha, 751 004, India; 2Department of Analytical and Applied Economics & RUSA Centre of Excellence in Public Policy and Governance, Utkal University, Vani Vihar, Bhubaneswar, Odisha, 751 004, India; 3UNESCO - The World Academy of Sciences (TWAS), Trieste, Italy; 4Shaanxi University of Technology, Hanzhong, Shaanxi, 723099, People’s Republic of China; 5Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, SerbiaCorrespondence: Himanshu Sekhar Rout, Email hsrout@utkaluniversity.ac.inBackground: The lack of focus on the health status of shrimp cultivators by previous studies while the production of shrimp has been rising over the years after the introduction of the blue revolution in India. The present study estimated the burden of diseases among shrimp cultivators in India.Methods: Primary data were collected by using simple random sampling. The sample size was 357. The classification of diseases were made by using the international classification of diseases, tenth revision (ICD-10), version 2019. Disability-adjusted life years (DALY) were used to measure the health status of shrimp cultivators. DALY is the summation of the burden of disease from mortality and morbidity. Sensitive and uncertainty analysis was used by changing the value of the parameter and method, respectively.Results: The burden of disease among shrimp cultivators in 2020 ranges from 101.03 DALY based on equal age weightage, without discount rate, and potential life expectancy (DALY0,0,PLE) to 84.02 DALY based on unequal age weightage, discount rate, and standardized life expectancy (DALY1,0.03,SLE). The burden of disease per 100,000 shrimp cultivators was 28,477.74 DALY and 23,600.84 DALY when calculated by using DALY0,0,PLE and DALY1,0.03,SLE method, respectively. The higher burden of diseases from non-communicable diseases was followed by injury and communicable diseases for both methods. The disease burden from mortality was more than two-thirds of the total burden of disease and the rest from morbidity. The burden of disease among shrimp cultivators was sensitive to parameter changes because it changes between 92.10 DALY and 63.03 DALY with the change in the parameter. Uncertainty in the burden of disease among them was due to method variation, which ranges from 120.03 DALY to 74.06 DALY.Conclusion: The higher burden of non-communicable diseases, and the lower burden of communicable, and injuries per 100,000 shrimp cultivators compared to the national level in India.Keywords: shrimp cultivators, DALY, occupational hazard, epidemiology, India

Bhavani Shankara Bagepally,&ast; Sajith Kumar S,&ast; Akhil Sasidharan Health Technology Assessment Resource Centre, ICMR-National Institute of Epidemiology, Chennai, India&ast;These authors contributed equally to this workCorrespondence: Bhavani Shankara Bagepally, Email bagepally.bs@gov.inBackground: Efficient allocation of healthcare resources requires a comprehensive evaluation of healthcare spending and its impact on disease burden. This study aims to estimate the costs-per disability-adjusted life years (DALY) in India. Data from 2010 to 2019 on DALYs and health expenditure per capita (HEp) for individual states in India were utilised.Design and Methods: We followed the CHEERS statement 2022 to present our study’s methodology and outcomes. Pearson’s product-moment correlations were used to analyse associations between DALYs and HEp. A panel regression analysis was conducted using a log regression model to estimate changes in DALYs due to health expenditure changes. All costs are reported in Indian rupee (₹) along with its 95% CI, with a conversion factor of 1 US&dollar; = ₹82.4 applied.Results: The costs-per-DALY were estimated for each state and India. DALY was negatively correlated with HEp. The estimated mean cost-per-DALY for India was ₹82,112 (₹55,810 to ₹1,08,413) [&dollar;997 (&dollar;667 to &dollar;1316)]. The mean cost per-DALY varied across states, with value of ₹27,058 (₹22,250 to ₹31,866) [&dollar;328 (&dollar;270 to &dollar;387)] for states in the first quartile based on Human Development Index (HDI) and ₹2,69,175 (₹1,05,946 to ₹4,32,404) [&dollar;3267 (&dollar;1286 to &dollar;5248)] for those in fourth HDI quartile. States such as Gujarat (0.16), Karnataka (0.17) and Maharashtra (0.22) have lower, and Arunachal Pradesh has the highest cost-per-DALY to Gross state domestic product per-capita ratio (2.41), followed by Nagaland (1.45).Conclusion: Higher healthcare investment has a lower disease burden; however, reduction in DALY varies across states. Study findings provide evidence to aid the setting up of differential willingness-to-pay thresholds across Indian states for efficient and equitable healthcare resource allocation.Keywords: disease burden, DALY, cost per DALY, health expenditure

Abstract Importance Cardiovascular disease (CVD) remains the leading cause of mortality and morbidity. Compared with disease burden rates in 1990, significant reductions in Disability-Adjusted Life Years (DALYs) burden rates for CVD have been recorded. However, general DALYs rates have not changed in Indonesia in the past 30 years. Thus, assessing Indonesian CVD burdens will be an essential first step in determining primary disease interventions. Objective To determine the national and province-level burden of CVD from 1990 to 2019 in Indonesia. Design, Setting, and Participants A retrospective observational study was conducted using data from the Global Burden of Disease (GBD) 2019, provided by the Institute of Health Metrics and Evaluation (IHME), to analyze trends in the burden of CVD, including mortality, morbidity, and prevalence characteristics of 12 underlying CVDs. Exposures Residence in Indonesia. Main Outcomes and Measures Mortality, incidence, prevalence, death, and DALYs of CVD. Results All-age CVD deaths more than doubled from 292 thousand (95% UI: 246 to 339 thousand) in 1990 and increased to 659 thousand (95% UI: 542 to 747 thousand) in 2019. All CVDs recorded increased death rates, except for rheumatic heart disease (RHD) (− 69%) and congenital heart disease (CHD) (− 37%). Based on underlying diseases, stroke and ischemic heart disease (IHD) are still the leading causes of mortality and morbidity in Indonesia, whereas stroke and peripheral artery disease (PAD) are the most prevalent CVDs. Indonesia has the second worst CVD DALYs rates compared to ASEAN countries after Laos. At provincial levels, the highest CVD DALY rates were recorded in Bangka Belitung, South Kalimantan, and Yogyakarta. In terms of DALYs rate changes, they were recorded in West Nusa Tenggara (24%), South Kalimantan (18%), and Central Java (11%). Regarding sex, only RHD, and PAD burdens were dominated by females. Conclusions CVD mortality, morbidity, and prevalence rates increased in Indonesia from 1990 to 2019, especially for stroke and ischemic heart disease. The burden is exceptionally high, even when compared to other Southeast Asian countries and the global downward trend. GBD has many limitations. However, these data could provide policymakers with a broad view of CVD conditions in Indonesia.

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Cardiovascular diseases (CVD) represent a significant health problem worldwide and in Switzerland. Despite preventive measures and advances in treatment, cardiovascular diseases still lead to a significant number of hospitalizations in Switzerland (133 000 in 2021) and are for responsible for almost 1/3 of all deaths (19 600 in 2021). Emergency care for acute cardiovascular events now has a very high standard in Switzerland compared to other countries. However, there is a large discrepancy between evidence and daily practice (evidence-performance gap) in cardiovascular risk factor control, because a large percentage of patients do not achieve the goals of the guideline recommendations: 55% of hypertensives, 81% of patients with elevated LDL cholesterol and 44% of diabetics. In addition, 21% of people in Switzerland currently smoke, 42% are considered obese and 24% of people are sedentary. Therefore, primary and secondary prevention offers great potential for reducing the morbidity and mortality of cardiovascular diseases. Sub-optimal control of cardiovascular risk factors leads to preventable cardiovascular events and associated economic costs. Thus, cardiovascular diseases not only affect life expectancy, but also influence the years with reduced quality of life (disability-adjusted life years, DALY). In Switzerland, the main risk factors of cardiovascular diseases lead to a loss of 311 332 DALYs in total, 45 454 DALYs lost by hypertension, 64 445 DALYs lost due to hyperlipidema, 24 283 DALYs due to diabetes mellitus, 47 639 DALYs due to smoking, 21 170 DALYs lost by obesity)and 4 669 DALYs lost due to a lack of exercise. Assuming that one DALY is associated with a socioeconomic burden of CHF 99 417, the total socioeconomic cost of all cardiovascular diseases is 4% of gross domestic product (GDP). Furthermore, cardiovascular diseases caused a cost burden of CHF 27,8 billion in direct and indirect healthcare costs in 2021. [ABSTRACT FROM AUTHOR]

Importance: Cardiovascular disease (CVD) remains the leading cause of mortality and morbidity. Compared with disease burden rates in 1990, significant reductions in Disability-Adjusted Life Years (DALYs) burden rates for CVD have been recorded. However, general DALYs rates have not changed in Indonesia in the past 30 years. Thus, assessing Indonesian CVD burdens will be an essential first step in determining primary disease interventions. Objective: To determine the national and province-level burden of CVD from 1990 to 2019 in Indonesia. Design, Setting, and Participants: A retrospective observational study was conducted using data from the Global Burden of Disease (GBD) 2019, provided by the Institute of Health Metrics and Evaluation (IHME), to analyze trends in the burden of CVD, including mortality, morbidity, and prevalence characteristics of 12 underlying CVDs. Exposures: Residence in Indonesia. Main Outcomes and Measures: Mortality, incidence, prevalence, death, and DALYs of CVD. Results: CVD deaths have doubled from 278 million in 1990 to 651 million in 2019. All CVDs recorded increased death rates, except for rheumatic heart disease (RHD) (− 69%) and congenital heart disease (CHD) (− 37%). Based on underlying diseases, stroke and ischemic heart disease (IHD) are still the leading causes of mortality and morbidity in Indonesia, whereas stroke and peripheral artery disease (PAD) are the most prevalent CVDs. Indonesia has the second worst CVD DALYs rates compared to ASEAN countries after Laos. At provincial levels, the highest CVD DALY rates were recorded in Bangka Belitung, South Kalimantan, and Yogyakarta. In terms of DALYs rate changes, they were recorded in West Nusa Tenggara (24%), South Kalimantan (18%), and Central Java (11%). Regarding sex, only RHD, and PAD burdens were dominated by females. Conclusions: CVD mortality, morbidity, and prevalence rates increased in Indonesia from 1990 to 2019, especially for stroke and ischemic heart disease. The burden is exceptionally high, even when compared to other Southeast Asian countries and the global downward trend. GBD has many limitations. However, these data could provide policymakers with a broad view of CVD conditions in Indonesia. [ABSTRACT FROM AUTHOR]

We are still facing the devastating consequences of COVID‐19. At the beginning of this pandemic, lockdown and non‐pharmaceutical measures were the unique, effective strategy to overcome the ongoing outbreak. After almost a year, an exceptional effort gave the first efficient protective vaccines. Despite these significant advances, new challenges as its mass production and fair distribution emerge. Our work aims to address this balance by formulating an optimal epidemic control problem controlled by lockdown and vaccination but in a synchronized manner. In such a way that the sought‐after solution optimizes the burden and economic implications of COVID‐19 infections and deaths. Thus, we formulate an optimal control problem with a differential equation to describe the spread of COVID‐19. Our formulation measures the efficiency of these controls by a functional cost involving the burden of COVID‐19 quantified in DALYs and the costs regarding vaccination and lockdown. Then we minimize this cost subject to the controlled system and find optimal policies that are constant in time intervals of a given size. To this end, we apply the well‐established heuristic method known as differential evolution. One of the advantages of these policies relies on their practical implementation since the health authority has to make only a finite number of different decisions. Our methodology to find optimal policies allows changes in the dynamics, the cost functional, or how frequently the policymaker changes actions. We show how a well‐synchronized tradeoff between vaccination and lockdown could under‐peak of the outbreak, with a delicate balance to overcome possible economic consequences. [ABSTRACT FROM AUTHOR]

Rabies is a fatal disease occurring worldwide and especially in almost all the countries in Asia and Africa including Cameroon. Though animal and human rabies is prevalent in Cameroon, the epidemiology and socio-economic burden of the disease in the country is not known. Therefore, a 10-year (October 2004–April 2013) retrospective study on the incidence of animal and human rabies and its burden in Garoua, Ngaoundéré and Yaoundé in Cameroon was carried out. Records of human cases were extracted from the database of the regional hospitals, and animal cases from the databases of Centre Pasteur and National Veterinary Laboratory. The burden of the disease was assessed through the estimation of costs linked to preventive measures (vaccination), corrective procedures (Post Exposure Treatment), Disability-Adjusted Life Year (DALY) and overall societal cost of the disease. Overall, 56 rabies-suspected human deaths, corresponding to an incidence of 0.02 ± 0.00 ‱ and Animal Rabies Incidence (ARI) of 0.37 ± 0.00 % among 1844 suspected animal cases were recorded. The economic loss due to preventive measures of 326,046 ± 28,130.85 USD, related to corrective procedures of 806,741.25 ± 2,466.08 USD, and DALY of 1690.28 ± 4.76 years were estimated. This is the first study that highlights the enormous socio-economic burden associated with animal and human rabies in endemic parts of Cameroon and emphasizes on enhancing rabies eradication strategy focusing on the One Health approach.

ObjectiveThis study assesses the worldwide impact of ischemic stroke caused by ambient particulate matter pollution between 1990 and 2019, utilizing data from the Global Burden of Disease (GBD) 2019.MethodsAn analysis was conducted across various subgroups, including region, Socio-demographic Index (SDI) level, country, age, and gender. The study primarily examined metrics such as death cases, death rate, Disability-Adjusted Life Years (DALYs), DALY rate, and age-standardized indicators. The Estimated Annual Percentage Change (EAPC) was calculated to assess trends over time.ResultsThe study found a moderate increase in the global burden of ischemic stroke attributed to ambient particulate matter, with the age-standardized DALY rate showing an EAPC of 0.41. Subgroup analyses indicated the most substantial increases in Western Sub-Saharan Africa (EAPC 2.64), East Asia (EAPC 2.77), and Eastern Sub-Saharan Africa (EAPC 3.80). Low and middle SDI countries displayed the most notable upward trends, with EAPC values of 3.36 and 3.58 for age-standardized death rate (ASDR) and DALY rate, respectively. Specifically, countries like Equatorial Guinea, Timor-Leste, and Yemen experienced the largest increases in ASDR and age-standardized DALY rate. Furthermore, both death and DALY rates from ischemic stroke due to particulate matter showed significant increases with age across all regions.ConclusionThe study highlights the increasing worldwide health consequences of ischemic stroke linked to particulate matter pollution, particularly in Asia and Africa. This emphasizes the critical necessity for tailored public health interventions in these regions.

Abstract Objective Peripheral arterial disease (PAD) is a manifestation of atherosclerosis that affects the lower extremities and afflicts more than 200 million people worldwide. Because of limited resources, the need to provide quality care associated with cost control is essential for health policies. Our study concerns an interhospital comparison among seventeen Belgian hospitals that integrates the weighting of quality indicators and the costs of care, from the hospital perspective, for a patient with this pathology in 2018. Methods The disability-adjusted life years (DALYs) were calculated by adding the number of years of life lost due to premature death and the number of years of life lost due to disability for each in-hospital stay. The DALY impact was interpreted according to patient safety indicators. We compared the hospitals using the adjusted values ​​of costs and DALYs for their case mix index, obtained by relating the observed value to the predicted value obtained by linear regression. Results We studied 2,437 patients and recorded a total of 560.1 DALYs in hospitals. The in-hospital cost average [standard deviation (SD)] was €8,673 (€10,893). Our model identified the hospitals whose observed values were higher than predicted; six needed to reduce the costs and impacts of DALYs, six needed to improve one of the two factors, and four seemed to have good results. The average cost (SD) for the worst performing hospitals amounted to €27,803 (€28,358). Conclusions Studying the costs of treatment according to patient safety indicators permits us to evaluate the entire chain of care using a comparable unit of measurement.

Introduction Studies on economic evaluations of the 13-valent pneumococcal conjugate vaccine (PCV13) have been increasing over the last decade. No systematic reviews have synthesized the evidence of economic evaluations of the PCV13. Areas covered We systematically searched the literature which published on peer-reviewed journals from January 2010 to June 2022. The literature search was conducted in the following electronic databases: PubMed, Web of Science, Embase, the Cochrane Library, CNKI, Wanfang database, VIP database. We identified 1827 records from the database search. After excluding 511 duplicates, 1314 records were screened, of which 156 records were retained for the full-text reviews. A total of 44 studies were included in the review. Among the included studies, 33 studies were economic evaluations of PCV13 among children, and 11 studies were conducted among adults. The literature search initiated in April, 2022, and updated in June 2022. Expert opinion Vaccination with PCV13 was found to significantly reduce the mortality and morbidity of pneumococcal diseases and was cost-effective compared to no vaccine or several other pneumococcal vaccines (e.g. PCV10, PPV23). Future research is advised to expand economic evaluations of PCV13 combined with dynamic model to enhance methodologic rigor and prediction accuracy.

Abstract Objective To investigate the trends and patterns of the cancer burden among the elderly in different regions of India at a subnational level. Methods Data were extracted from the Global Burden of Disease (GBD) Studies India Compare 2019. Prevalence rate, disability‐adjusted life years (DALY), and annual percentage change techniques were used to analyze data. Results The three age groups with the highest prevalence of cancer were those aged 60–64 years, 65–69 years, and 70–74 years. In 2019, The prevalence of cancer among the elderly ranged from 7048.815 in Karnataka to 5743.040 in Jharkhand. Kerala has the most significant annual percentage change in the cancer prevalence rate of 0.291 between 1990 and 2019. The highest DALY rate was observed among individuals aged 80–84 years in 2019. That year, the DALY rate among the elderly was 8112.283 in India. The top five cancers with higher DALY rates among the elderly in India in 2019 were tracheal, bronchus, and lung cancer (908.473), colon and rectum cancer (752.961), stomach cancer (707.464), breast cancer (597.881), and lip and oral cavity cancer (557.637). Conclusion Elderly individuals demonstrated a higher vulnerable to cancer compared to other age groups. There is a need for state‐specific government intervention to minimize the risk of cancer among the elderly due to the heterogeneity in the burden of cancer across Indian states.

Background: We aimed to document the current state of exposure to low bone mineral density (BMD) and trends in attributable burdens between 2000 and 2019 globally and in different World Health Organization (WHO) regions using the Glob al Burden of Disease (GBD) study 2019. Methods: We reviewed the sex-region-specific summary exposure value (SEV) of low BMD and the all-ages numbers and age-standardized rates of disabili ty-adjusted life years (DALYs), years lived with disability (YLDs), years of life lost (YLLs), and deaths attributed to low BMD. We compared different WHO regions (Africa, the Easte rn Mediterranean Region, Europe, Region of the Americas, Southeast Asia, and Wes tern Pacific), age categories, and sexes according to the estimates of the GBD 2019 report. Results: The global age-standardized SEV of low BMD is estimated to be 2 0.7% in women and 11.3% in men in 2019. Among the WHO regions, Africa had the highest age-standardized SEV of low BMD in women (28.8% (95% uncertainty in terval 22.0–36.3)) and men (16.8% (11.5–23.8)). The lowest SEV was observed in Europe in both women (14.7% (9.9–21.0)) and men (8.0% (4.3–13.4)). An improving trend in th e global rate of DALY, death, and YLL was observed during 2000–2019 (−5.7%, −4.7%, and −11.9% change, respectively); however, the absolute numbers increased with the highest increase observed in global YLD (70.9%) and death numbers (67.6%). South east Asia Region had the highest age-standardized rates of DALY (303.4 (249.2–357.2) ), death (10.6 (8.5–12.3)), YLD (133.5 (96.9–177.3)), and YLL (170.0 (139–197.7)). Conclusions: Overall, the highest-burden attributed to low BMD was observed in the Southeast Asia Region. Knowledge of the SEV of low BMD and the attributed burden can increase the awareness of healthcare decision-makers to adopt appropriate strategies for early screening, and also strategies to prevent falls and fragility fractures and their consequent morbidity and mortality.

This study aimed to estimate the burden of diseases (BoD) from environmental cigarette smoke (ECS) exposure. More precisely, the study examined the prevalence of non-communicable diseases (NCDs) related to cigarette smoking in municipal staff based on a prospective cohort study. This cross-sectional study was designed among municipal employees, aged 25-55 years in Qazvin, Iran during 2019-2020. The data on cigarette smoking and environmental exposure were obtained using a standard questionnaire. Finally, systolic blood pressure (SBP) and diastolic blood pressure (DBP), fasting blood sugar (FBS), triglyceride (TG), high-density lipoprotein, and low-density lipoprotein were measured to assess the relation between active cigarette smoking and the prevalence of NCDs, including hypertension and diabetes in workers. The prevalence of cigarette smoking was 16.2%. In addition, 15% of staff were exposed to ECS. The prevalence of anemia and high TG levels in current cigarette smokers was 2.71 (P=0.024) and 1.4 times higher than among non-smokers (P=0.027). The total number of disability-adjusted life years (DALYs) caused by lung cancer, asthma, and ischemic heart disease (IHD) attributable to ECS was 0.65 per 1000 adults annually. Further, the number of 0.058 death was estimated per 1000 adults annually at the workplace. Most deaths were caused by IHD (79%), followed by lung cancer (12%) and asthma (9%). It was revealed that the number of DALYs and deaths attributable to secondhand smoke (SHS) was 0.34 and 0.3 vs. 0.028 and 0.029 per 1000 adults in men and women, respectively. The results demonstrated that exposure to ECS is an important factor in increasing the risk of the prevalence of NCDs and can increase the BoD attributable to cigarette smoking.

Abstract Background . Low back pain is one of the major causes of morbidity worldwide. Studies on low back pain quality of care are limited. This study aimed to evaluate the quality of care of low back pain worldwide and compare gender, age, and socioeconomic groups. Methods . This study used GBD data from 1990 to 2017 from the Institute for Health Metrics and Evaluation (IHME) website. Extracted data included low back pain incidence, prevalence, disability-adjusted life years (DALYs), and years lived with disability (YLDs). DALYs to prevalence ratio and prevalence to incidence ratio were calculated and used in the principal component analysis (PCA) to make a proxy of the quality-of-care index (QCI). Age groups, genders, and countries with different socioeconomic statuses regarding low back pain care quality from 1990 to 2017 were compared. Results The proxy of QCI showed a slight decrease from 36.44 in 1990 to 35.20 in 2017. High- and upper-middle-income countries showed a decrease in the quality of care from 43.17 to 41.57 and from 36.37 to 36.00, respectively, from 1990 to 2017. On the other hand, low and low-middle-income countries improved, from a proxy of QCI of 20.99 to 27.89 and 27.74 to 29.36, respectively. Conclusion . Despite improvements in the quality of care for low back pain in low and lower-middle-income countries between 1990 and 2017, there is still a large gap between these countries and higher-income countries. Continued steps must be taken to reduce healthcare barriers in these countries.

Abstract Lung cancer and liver cancer are the leading and third causes of cancer death, respectively. Both lung and liver cancer are with clear major risk factors. A thorough understanding of their burdens in the context of globalization, especially the convergences and variations among WHO regions, is useful in precision cancer prevention worldwide and understanding the changing epidemiological trends with the expanding globalization. The Global Burden of Disease (GBD) and WHO Global Health Observatory (GHO) database were analyzed to evaluate the burden metrics and risk factors of trachea, bronchus, and lung (TBL) cancer and liver cancer. Western Pacific Region (WPR) had the highest age-standardized incidence rate (ASIR) for both liver cancer (11.02 [9.62–12.61] per 100,000 population) and TBL cancer (38.82 [33.63–44.04] per 100,000 population) in 2019. Disability-adjusted life years (DALYs) for liver and TBL cancer elevated with the increasing sociodemographic index (SDI) level, except for liver cancer in WPR and TBL cancer in European Region (EUR). Region of the Americas (AMR) showed the biggest upward trends of liver cancer age-standardized rates (ASRs), as well as the biggest downward trends of TBL cancer ASRs, followed by Eastern Mediterranean Region (EMR). Alcohol use and smoking were the leading cause of liver and TBL cancer death in most WHO regions. Variances of ASRs for liver and TBL cancer among WHO memberships have been decreasing during the past decade. The homogenization and convergence of cancer burdens were also demonstrated in different agegroups and sexes and in the evolution of associated risk factors and etiology. In conclusion, our study reflects the variations and convergences in the liver and lung cancer burdens among the WHO regions with the developing globalization, which suggests that we need to be acutely aware of the global homogeneity of the disease burden that accompanies increasing globalization, including the global convergences in various populations, risk factors, and burden metrics. Graphical Abstract

Abstract Background High fasting plasma glucose (FPG) has been listed as one of the risk factors for bladder cancer. We here estimated the global, regional, and national levels of bladder cancer burden attributable to high FPG from 1990 to 2019. Methods Bladder cancer data attributable to high FPG were extracted from the Global Burden of Disease Study 2019, and analyzed by age, sex, year, and location. Age‐standardized rates were utilized to evaluate the burden between different populations. The temporal trend of the burden was estimated through the Joinpoint analysis. Results In 2019, high FPG contributed to 22,823.33 (95% uncertainty interval [UI], 4694.88–48,962.26) deaths and 399,654.91 (95% UI, 81,609.35–865,890.95) disability‐adjusted life years (DALYs) of bladder cancer globally. Since 1990, the global age‐standardized death and DALY rates of bladder cancer attributable to high FPG increased apparently by 39.18% and 41.48%, respectively. During the last 30 years, high FPG‐related age‐standardized death and DALY rates of bladder cancer have increased in all countries. In 2019, Central Europe showed the greatest high FPG‐related age‐standardized death and DALY rates of bladder cancer, but Andean Latin America had the lowest rates. Nationally, Lebanon showed the greatest high FPG‐related age‐standardized death and DALY rates of bladder cancer in 2019. High FPG‐attributable deaths and DALYs of bladder cancer were more considerable among males and older people. Countries with high SDI showed higher levels of age‐standardized death and DALY rates of bladder cancer due to high FPG and presented remarkable upward trends in rates in the last 30 years. Conclusions Globally, the high FPG‐associated bladder cancer burden has remarkably increased in all countries, and showed a higher level among countries with higher SDI. Monitoring FPG levels among patients with bladder cancer is critical to lower the corresponding burden.

The goal of this work is to perform a thorough investigation of the incidence, death and disability-adjusted life-years (DALYs) rates of breast cancer (BC) in local, regional, and worldwide contexts. It examines how variations in breast cancer incidence, death rates and DALYs are caused by elements including socioeconomic position, cultural norms and beliefs. Data were extracted from the Global Burden of Disease study 2019) and were calculated to quantify temporal trends in the age-standardized rates of BC incidence, deaths, and disability-adjusted life-years (DALYs) by region. From 1990 to 2019, the BC incidence, deaths, and DALYs increased worldwide by 128%, 84%, and 77%, respectively. The global age-standardized incidence rate increased, whereas both the age-standardized death rate and age-standardized DALY rate presented downward trends. In particular, Western Europe had the largest burden of BC, and globally, BC was more frequently reported in high-middle and high SDI regions. Expanding upon this thorough examination, the article suggests a range of focused, empirically supported tactics aimed at enabling healthcare decision-makers, physicians, and community leaders. Future BC preventive strategies should therefore focus on addressing the global health challenge of breast cancer, aiming to improve survival rates globally through the three pillars of health promotion, timely presentation and diagnosis, and comprehensive treatment and supportive care. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease. Objectives: This systematic review aimed to evaluate the disease burden of COPD in the Chinese population and to determine the factors influencing the economic burden of the disease. Design: This is a systematic review study. Data sources and methods: We searched PubMed, Web of Science, Embase, Chinese National Knowledge Infrastructure, WANGFANG Data, and VIP databases for studies regarding the disease burden of COPD in mainland China published before 31 December 2022. The Agency for Healthcare Research and Quality's recommendation rating tool assessed the cross-sectional studies' risk of bias. Results: A total of 45 studies were included. The disability-adjusted life years (DALYs) for COPD have generally decreased in the Chinese population over the past 30 years. The total number of DALYs due to COPD in China decreased from 26.12 million person-years to 19.92 million person-years, with an annual decline rate of 0.9%. Subjects aged 40 years and older make up the majority of those with COPD in the Chinese population, and the condition is more prevalent among males than females, in rural areas than urban places, and in the West than the East. The median direct medical cost of COPD ranges from 150 to 2014 USD per capita per year. Among 23 influencing factors, age, hospitalization days, hospital type, gender, and career were the most significant variables that had an impact on the economic burden of COPD patients. Conclusion: The overall burden of COPD in China has been decreasing over the past 30 years. But there is a lack of standardized indicators for the economic burden of COPD patients in China, and it is recommended to establish a unified standard. Registration: The systematic review protocol was prospectively registered with PROSPERO (No. CRD42023393429). Plain language summary: Disease burden of COPD in the Chinese population Chronic obstructive pulmonary disease (COPD) is one of the main contributors to the global burden of disease. This systematic review aimed to evaluate the disease burden of COPD in the Chinese population and to determine the factors influencing the economic burden of the disease. We searched PubMed, Web of Science, Embase, CNKI, WANGFANG Data, and VIP databases for studies regarding the disease burden of COPD in mainland China published before December 31, 2022. The Agency for Healthcare Research and Quality's (AHRQ) recommendation rating tool assessed the cross-sectional studies' risk of bias. The overall burden of COPD in China has been decreasing over the past 30 years. But there is a lack of standardized indicators for the economic burden of COPD patients in China, and it is recommended to establish a unified standard. [ABSTRACT FROM AUTHOR]

Assuring food safety is increasingly important in emerging and developing economies. Despite being a public good, food safety in these economies is often addressed through limited private sector innovations while the public health costs and impact of food-borne diseases are largely unknown. This study estimates annual private and public costs and benefits of a quality-based milk payment system (QBMPS) in Kenya. Private costs and benefits were estimated using a partial budget analysis. From a private perspective, results show that participating farmers benefit most from the QBMPS, with a net profit of about USD 0.02 USD/kg) from an additional investment cost USD 0.0125/kg to produce Grade A milk. The cooperatives and processor have a net loss of 0.025 USD/kg milk, mainly driven by testing and initial investment costs. Disease burden was calculated using the Disability Adjusted Life Years (DALYs), while direct and indirect health costs were calculated using an incidence-based analysis. We estimate an annual disease burden of 53,000 DALYs from milk-related infectious diseases and a generated health benefit of 13 KES/kg due to reduction in disease incidence if 15% of Kenya's milk goes through the QBMPS. These health benefits justify public and private sector support for a QBMPS. [ABSTRACT FROM AUTHOR]

Rice is the most important staple food for feeding nearly half of the world's population, and almost the entirety of the population of Asia. An increase in food demand leads to an increase in agricultural residues, resulting in impacts on human health and environmental consequences. The current study aimed to estimate the emission of primary and secondary fine particulate matter attributable to fertilizer from the open burning or rice straw in Cambodia in terms of country-specific characterization factors (CFs), and to estimate the human health and ecosystem impact of particulate matter formation and terrestrial acidification. Additionally, the study aimed to propose an alternative scenario to reduce the negative impact on human health and the ecosystem. Three scenarios were set to conduct the study's assessment, including a baseline scenario representing current farmer practices, including typical fertilizer application rates and open burning of rice straw after harvest (S0); a scenario reducing fertilizer use to 60% while still allowing open rice straw burning (S1); and a scenario with no open rice straw burning and a 60% reduction in fertilizer use (S2). Human health damage was calculated in units of Disability Adjusted Life Year (DALY), and ecosystem impact was expressed in the units of Potentially Disappeared Fraction of species (PDF/m²/yr) presented under the scenarios. The total human health impact of S0 was 5.35E+01 DALY, S1 was 5.27E+01 DALY, and S2 was 3.75E-01 DALY, while the total ecosystem impact of S0 was 4.38E-02 (PDF/m²/yr), S1 was 3.60E-02 (PDF/m²/yr), and S2 was 4.85E-03 (PDF/m²/yr). The results of this study indicated that minimizing the use of chemical fertilizer and zero open burning of agricultural waste can reduce the number of pollutants that affects human health and ecosystem soil acidification. It showed that reducing burning straw waste can reduce the toxins that affect human health by 99% and reduce the increase of soil acidity by 94%. [ABSTRACT FROM AUTHOR]