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Incidence of liver cancer as one of the most common cancers worldwide and become the significant contributor for the mortality among cancer patients. The disease burden, risk factors, and trends in incidence and mortality of liver cancer globally was described subsequently estimated the projections of liver cancer incidence or mortality by 2040. Data regarding age-standardized incidence and mortality rates for liver cancer was obtained from multiple databases, including GLOBOCAN 2020, CI5 volumes I-XI, WHO mortality database, and Global Burden of Disease (GBD)-2019. Concentrating on worldwide variations, this thorough analysis offers insights into patterns of incidence and mortality based on gender and age. Our findings encompass significant indicators, including age-standardized rates (ASRs), average annual percentage change (AAPC), and future projections extending up to the year 2040. Liver cancer holds the sixth position in terms of most frequently diagnosed cancers and stands as the sixth leading cause of cancer-related deaths worldwide in 2020, accounting for 905,677 new cases and 782,000 fatalities. Additionally, liver cancer contributed to 12,528,421 age-standardized disability-adjusted life years (DALYs), with an age-standardized DALYs rate of 161.92 in 2019 worldwide. The age-specific incidence rates exhibited significant variations across different regions, showing a fivefold difference in males and females. A significant increase in incidence was observed in North Europe and Asia, while North African countries reported a higher mortality burden (ASR, 10 per 100,000) compared to developed countries. Since last few years, the incidence and mortality rates have increased and attained Annual Average Percentage Change (AAPC) incidence rate of 7.7 (95% CI 3.9-11.6) for men and the highest AAPC mortality rate of 12.2 (95% CI 9.5-15.0) for women. In 2019, Western Europe emerged as the high-risk region for DALYs related to smoking and alcohol consumption, while high-income North America carried a high risk for DALYs associated with a high body-mass index. The projected trend indicates a surge in new liver cancer incident cases, expected to rise from around 905,347 to an estimated 1,392,474 by 2040. This study described the evidence pertinent to higher incidence trends in liver cancer, particularly among both young and older adults, encompassing males and females, as well as those who are HIV-infected and HBsAg positive. A significant rise in the young population poses a significant public health concern that warrants attention from healthcare professionals to prioritize the promotion of health awareness and the development of effective cancer prevention strategies, particularly in many developing countries., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics approval This study does not involve any animal or human experimental models. Hence, ethical approval is not required. Consent for publication Not applicable., (© 2024. The Author(s).)

Background: Exposure to trichloroethylene (TCE) in occupations is associated with an increased risk of kidney cancer (KC). However, there is a lack of comprehensive study on the global burden of occupational exposure to TCE-related KC., Methods: Epidemiological data on occupational TCE exposure-associated KC from 1990 to 2021 were obtained from Global Burden of Disease (GBD) 2021 study, including death counts and disability-adjusted life years (DALYs). Global burden of this disease was stratified by genders, age, socio-demographic index (SDI) quintiles, GBD subcontinental regions, and countries. The estimated annual percentage change (EAPC) was calculated to illustrate trends over the last 32 years, and forecasts were conducted to predict the disease burden until 2050., Results: In 2021, the global age-standardized death rate (ASDR) of occupational TCE exposure-related KC was 0.0009 (95 %UI: 0.0002-0.0016) per 100,000 persons, and the age-standardized DALY rate (ASDAR) was 0.0284 (95 %UI: 0.0062-0.0522) per 100,000 individuals. The disease showed significant heterogeneity by sex and age, with males bearing a notably higher burden, and the burden being concentrated in the 50-79 year-old group. Major burdens were focused in middle to high-middle SDI regions, especially in Southern Latin America (Uruguay, Argentina, and Chile). Over 32 years, the burden of occupational TCE exposure-associated KC has gradually increased, with projections indicating continued growth to 2050, particularly among males and individuals aged 50-79. Regions like high-middle SDI areas, North America, High-income North America, Southern Sub-Saharan Africa, saw the most significant increases. Correlation analyses indicated a positive association between ASDR and ASDAR with SDI, while EAPC showed a notable negative correlation with SDI. Decomposition analyses reveals three global population determinants that positively contributed to the increase in deaths, but negatively impacted DALYs., Conclusion: This study highlights a significant rising trend of occupational TCE exposure-associated KC from 1990 to 2021 and projected to 2050, with an emphasis on the disease burden in men, elderly population, and middle to high-middle SDI regions, underscoring the impact of occupational TCE exposure on KC., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

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., Competing Interests: Declarations Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Rare infectious diseases of poverty (rIDPs) involve more than hundreds of tropical diseases, which dominantly affect people living in impoverished and marginalized regions and fail to be prioritized in the global health agenda. The neglect of rIDPs could impede the progress toward sustainable development. This study aimed to estimate the disease burden of rIDPs in 2021, which would be pivotal for setting intervention priorities and mobilizing resources globally., Methods: Leveraging data from the Global Burden of Disease Study 2021, the study reported both numbers and age-standardized rates of prevalence, mortality, disability-adjusted life-years (DALYs), years lived with disability, and years of life lost of rIDPs with corresponding 95% uncertainty intervals (UIs) at global, regional, and national levels. The temporal trends between 1990 and 2021 were assessed by the joinpoint regression analysis. A Bayesian age-period-cohort model was used to project the disease burden for 2050., Results: In 2021, there were 103.76 million (95% UI: 102.13, 105.44 million) global population suffered from rIDPs with an age-standardized DALY rate of 58.44 per 100,000 population (95% UI: 42.92, 77.26 per 100,000 population). From 1990 to 2021, the age-standardized DALY rates showed an average annual percentage change of - 0.16% (95% confidence interval: - 0.22, - 0.11%). Higher age-standardized DALY rates were dominated in sub-Saharan Africa (126.35 per 100,000 population, 95% UI: 91.04, 161.73 per 100,000 population), South Asia (80.80 per 100,000 population, 95% UI: 57.31, 114.10 per 100,000 population), and countries with a low socio-demographic index. There was age heterogeneity in the DALY rates of rIDPs, with the population aged under 15 years being the most predominant. Females aged 15-49 years had four-times higher age-standardized DALY rates of rIDPs than males in the same age. The projections indicated a slight reduction in the disease burden of rIDPs by 2050., Conclusions: There has been a slight reduction in the disease burden of rIDPs over the past three decades. Given that rIDPs mainly affect populations in impoverished regions, targeted health strategies and resource allocation are in great demand for these populations to further control rIDPs and end poverty in all its forms everywhere., Competing Interests: Declarations Ethics approval and consent to participate The protocol of the GBD 2021 has been approved by the research ethics board at the University of Washington. The GBD 2021 shall be conducted in full compliance with University of Washington policies and procedures, as well as applicable federal, state, and local laws. The study was carried out in the public domain secondary database, without any nominal identity, hence, the ethical approval was exempted. Consent for publication Not applicable. Competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024. The Author(s).)

Background: Gallbladder and biliary tract cancer (GBTC) is a significant health burden in China, exacerbated by the rising prevalence of high body mass index (BMI). Understanding the trends and factors contributing to mortality and disability associated with GBTC is crucial for targeted public health interventions., Methods: We utilized data from the Global Burden of Disease (GBD) Study to assess the burden of GBTC attributable to high BMI in China from 1990 to 2021. Age-standardized rates of deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) were analyzed. Joinpoint regression and decomposition analyses were conducted to evaluate trends and identify contributing factors, including aging, population growth, and epidemiological changes. Gender-specific differences were also assessed., Results: In 2021, GBTC deaths attributable to high BMI in China reached 4,053, with males experiencing a higher overall burden than females, particularly in older age groups. While females showed a higher mortality and overall burden in the 60 to 79 age range, this trend reversed in older age brackets, with males experiencing steeper increases in mortality and disability-related indicators beyond age 80. The age-standardized DALYs rate mirrored this pattern, with higher rates in males in advanced age groups. From 1990 to 2021, China saw a steady increase in GBTC burden attributable to high BMI, contrasting with a global decline. Joinpoint analysis indicated marked rises in mortality and DALYs rates after 2005, especially in males. Decomposition analysis identified population growth and aging as major drivers of increased deaths, while epidemiological changes primarily contributed to rising DALYs, with a stronger impact observed in males., Conclusions: The burden of GBTC attributable to high BMI in China has increased substantially over the last three decades, driven by population growth, aging, and epidemiological shifts. The trends highlight a growing gender disparity, with males experiencing a greater rise in mortality and disability. Public health strategies targeting obesity and metabolic risk factors are critical to mitigating the increasing GBTC burden., Competing Interests: Declarations Ethics approval and consent to participate This study utilized publicly available, de-identified data from the GBD database. As such, it did not involve direct contact with human participants or the collection of personal health information. Therefore, no ethical approval or informed consent was required. The research adhered to the principles outlined in the Declaration of Helsinki, ensuring ethical conduct in the use of secondary data for public health research. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To describe temporal trends in the incidence and disability-adjusted life years (DALYs) of rheumatoid arthritis (RA) across sociodemographic index (SDI) quintiles and sexes from 1990 to 2019., Methods: Data on RA incidence and DALYs with a 95% uncertainty interval from 1990 to 2019 were extracted from the Global Burden of Disease 2019. Subsequently, trends across SDI quintiles and sexes from 1990 to 2019 were determined using joinpoint regression and age-period-cohort analyses., Results: A significant upward trend in the global age-standardised incidence rate (ASIR) of RA was observed for both sexes from 1990 to 2019 (average annual per cent change (AAPC): 0.214, 95% CI 0.179 to 0.249, p<0.001). Specifically, the ASIR of RA for both sexes demonstrated a significant increasing trend at all SDI levels, with the highest AAPC observed in the low SDI regions. A non-significant increasing trend in the global age-standardised DALYs rate (ASDR) of RA was observed for both sexes from 1990 to 2019 (AAPC: 0.017, 95% CI -0.051 to 0.085, p=0.621). Varying trends in ASDR were observed for both sexes and across SDI quintiles. Additionally, diverse age-period-cohort patterns in incidence and DALYs were observed across SDI quintiles and sexes., Conclusion: The significant heterogeneity observed in the temporal trends of the incidence and DALYs of RA across SDI quintiles and sexes suggests potential disparities in the prevention, management and treatment of RA. Therefore, establishment of practical and customised healthcare initiatives for specific populations across SDI quintiles and sexes and allocation of supplementary health resources to high-risk populations are crucial for effective management of RA., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: We aimed to assess temporal trends in type 2 diabetes mellitus (T2DM)-related deaths and disability-adjusted life years (DALYs) at global and cross-social demographic index (SDI) levels, using data from the Global Burden of Disease (GBD) in 2021., Methods: We used geospatial mapping to visualize the global distribution of T2DM-related mortality and DALYs in 2021. Joinpoint regression assessed annual and average percent changes in DALYs and deaths from 1990 to 2021 across SDI regions. Age-period-cohort modeling examined the effects of age, period, and cohort on trends. Decomposition analysis evaluated the impact of population growth, aging, and epidemiological changes on DALY trends. A stratified projection forecasted future T2DM burden by age and sex from 2020 to 2044., Results: T2DM-related mortality and DALYs were highest in low-SDI regions. Globally, T2DM-related deaths and DALYs have increased, with the most rapid rise in low and low-middle SDI regions, driven by population growth and epidemiological shifts. High-SDI countries showed a slower increase in DALYs, influenced more by aging. Age-period-cohort analysis indicated higher DALY rates in later birth cohorts and recent periods, especially in high-SDI regions. Future projections show a significant increase in the 70-74 age group and a gradual rise in other age groups., Conclusion: The burden of T2DM is projected to continue increasing, especially in low-SDI and low-middle SDI regions, where population growth and epidemiological shifts are the main contributors. This underscores the need for targeted, region-specific healthcare policies, preventive strategies, and age-specific interventions to address the increasing T2DM burden globally., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 He, Wang, Xu, Gong, Liu and Guan.)

Background: Pancreatitis is a significant global health concern with rising incidence, complex management, and substantial mortality. This study aimed to assess global and regional trends in pancreatitis from 1990 to 2021 and project future trends to 2050 using data from the Global Burden of Disease (GBD) Study 2021., Methods: We analyzed GBD 2021 data to evaluate age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life years (DALYs) rates of pancreatitis. Regional trends, gender disparities, and correlations with the Socio-demographic Index (SDI) were examined. Key risk factors, including alcohol consumption, smoking, and metabolic disorders such as hyperlipidemia, were extracted and evaluated. A Bayesian age-period-cohort model (BAPC) was used for future projections., Results: From 1990 to 2021, global pancreatitis cases increased from 1.73 million to 2.75 million, representing a rise of 59%. Despite this, ASIR decreased slightly from 37.62 to 32.81 per 100,000, a 12.8% reduction. Deaths rose from 68,490 to 122,416, an increase of 78.7%, while ASMR decreased from 1.69 to 1.45 per 100,000, a reduction of 14.2%. DALYs increased from 2.58 million to 4.10 million (59%). Significant regional variations were found, with Eastern Europe showing the highest ASIR, ASMR, and DALY rates. Projections indicate continued declines in ASIR, ASMR, and DALYs through 2050., Conclusions: While global age-standardized rates of pancreatitis have declined, significant regional and socioeconomic disparities persist. Targeted prevention efforts, particularly in high-burden areas like Eastern Europe, and addressing modifiable risk factors such as alcohol use are crucial for reducing the future burden of pancreatitis., (© 2024. The Author(s).)

Objective: This study aims to systematically evaluate the burden of low back pain(LBP) in the middle-aged population across global regions and between genders, assess the major risk factors and their impacts, and project the burden to 2050, providing a scientific basis for global preventive actions., Methods: This study utilized The Global Burden of Disease(GBD) 2021 database. First, we integrated the population data of the 45-49, 50-54, and 55-59 age groups provided by the GBD using a weighted average method to calculate the Disability-adjusted life years(DALYs) rate for the middle-aged population aged 45 to 59 years. Subsequently, we analyzed the trends in the burden of LBP globally and across regions from 1990 to 2021, with a focus on stratified data by country, risk factors (e.g., high BMI), and gender. Finally, we employed the Bayesian Age-Period-Cohort(BAPC) model to predict future trends in LBP burden from 2021 to 2050., Results: Globally, from 1990 to 2021, the DALY rate for the 45-59 age group with LBP decreased from 875.45(95%UI: 534.57-1340.68) per 100,000 people to 747.92 (450.55-1,161.66), with an EAPC of -0.46 (95%UI: -0.50 to -0.43). Despite the decline in DALY rates, the total number of DALYs due to LBP increased from 5,515,080.64 (95%UI: 3,367,626.11-8,445,931.67) in 1990 to 9,816,401.64 (95%UI: 5,913,142.33-15,249,187.03) in 2021, a rise of 4,301,321. High Socio-Demographic Index (SDI) regions were the most affected, with a DALY rate of 933.03 (95%UI: 557.90-1,420.60) per 100,000 in 2021. Among risk factors, high BMI showed the most significant increase, with DALY rates rising from 153.64 (95%UI: 15.94-334.63) per 100,000 in 1990 to 209.09 (95%UI: 22.16-452.58) in 2021, and an EAPC of 1.08 (95%UI: 1.02 to 1.14). Gender differences revealed a DALY rate of 705.39 (95%UI: 431.21-1,078.96) per 100,000 for males and 803.62 (95%UI: 471.69-1,266.63) per 100,000 for females in 2021. Projections based on the BAPC model suggest that by 2050, global DALYs due to LBP will increase to 11,626,643.07, with females expected to account for 6,725,763.24 and males for 4,900,879.84, indicating a greater burden for females., Conclusion: This study highlights the global burden and trends of LBP in the middle-aged population. Although the DALY rate for the 45-59 age group decreased from 1990 to 2021, the total number of DALYs increased significantly due to population aging. In this context, the burden of LBP in low-middle SDI regions has remained largely unchanged and remains substantial, while high-SDI regions, despite some decline, continue to bear the highest overall burden. High BMI continues to contribute significantly to the rising LBP burden, particularly in middle-aged populations, and demands urgent attention. Gender differences indicate that females bear a greater LBP burden than males, with the gap widening over time. Effective preventive and intervention measures are urgently needed to mitigate the future burden of LBP., (© 2024. The Author(s).)

Background: Intracerebral hemorrhage (ICH) in young adults demands greater attention, given its poor prognosis; however, there has been a paucity of epidemiological data. The objective of this study is to estimate the temporal trends and distribution characteristics of the disease burden in 204 countries or territories between 1990 and 2021., Methods and Results: The data, including incidence, mortality, prevalence, and disability-adjusted life year (DALY) rates were sourced from the Global Burden of Diseases Study 2021. From 1990 to 2021, there was a significant decline in the global incidence (estimated annual percentage change=-1.05), mortality (estimated annual percentage change=-0.92), and DALY (estimated annual percentage change=-1.00) rates of ICH in young adults. In 2021, the highest incidence, mortality, and DALY rates were observed in Southeast Asia, East Asia, and Oceania. Globally, high systolic blood pressure, smoking, and ambient particulate matter pollution were identified as the primary contributors to the largest proportion of DALYs associated with ICH in young adults. The health inequality of ICH in young adults has been reduced over the past 3 decades., Conclusions: There is a considerable degree of heterogeneity in the global burden of ICH in young adults. A decline in the incidence, mortality, prevalence, and DALY rates has been observed from 1990 to 2021, however, the number of absolute cases has increased. These results will enable health care professionals, policymakers, and researchers to refine the implementation of cost-effective policies, the allocation of health care resources, and the management of patients to further mitigate the burden of ICH in young adults.

Background: Nonrheumatic valvular heart disease (NRVD) is increasingly becoming a significant public health concern, particularly among older people. In the context of population aging, a detailed report on the epidemiological trends of NRVD is crucial for policymakers to effectively allocate health care resources. This study aimed to explore these trends using data from the GBD (Global Burden of Disease) 2019 study., Methods and Results: We assessed the changing trends of the incidence, mortality, and disability-adjusted life years rates for NRVD by calculating the estimated annual percentage change for each. Additionally, we examined the impact of a region's level of social development on NRVD epidemiological trends and identified key risk factors contributing to NRVD-related deaths. Between 1990 and 2019, the global incidence of NRVD showed a gradual increase, with an estimated annual percentage change of 0.39 (95% CI, 0.30-0.48). The data revealed that women and older people are more likely to develop NRVD. High-sociodemographic index countries exhibited higher age-standardized incidence and mortality rates compared with low- and middle-sociodemographic index countries. The most significant risk factor for NRVD-related mortality was identified as high systolic blood pressure., Conclusions: Over the past 3 decades, the burden of NRVD has intensified, indicating a need for more health care resources to address this issue, which is closely associated with an aging population. Currently, high-sociodemographic index countries report the highest incidences and deaths due to NRVD. However, low- and middle-sociodemographic index countries should also implement measures to manage the rapidly increasing burden of NRVD.

Larynx cancer poses a significant public health challenge in China, with rising incidence and mortality rates over the past decades. Understanding the long-term trends and underlying factors is crucial for effective intervention and policy formulation. Data were utilized from the global burden of disease (GBD) Study 2021 to analyze the incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) due to larynx cancer in China from 1990 to 2021. Joinpoint regression analysis identified key changes in trends, while age-period-cohort (APC) analysis and decomposition analysis quantified the contributions of aging, epidemiological changes, and population growth to these trends. Our study found a significant increase in the incidence and prevalence of larynx cancer in China, particularly among males. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) for males were substantially higher than those for females. Decomposition analysis revealed that aging was the primary driver of increasing incidence and mortality rates, while epidemiological changes had a mitigating effect. Joinpoint analysis identified periods of rapid urbanization and economic growth as key turning points for increased incidence. Bayesian APC models projected a continued upward trend in incidence rates up to 2030. The rising burden of larynx cancer in China underscores the need for targeted public health interventions, including smoking cessation programs, environmental pollution control, and early detection strategies. Addressing gender disparities and implementing effective prevention measures are crucial to mitigating the impact of larynx cancer in China., (© 2024. The Author(s).)

Aims: The global historical and projected health impacts of the escalating burden of obesity on young adults, who are particularly susceptible to weight gain during transitional life stages, remain insufficiently understood., Materials and Methods: Using data from the Global Burden of Disease Study 2019, we analysed the disability-adjusted life-years (DALYs) and deaths attributable to high body mass index (BMI) among young adults aged 20-44 years globally and by age, sex, year, location and disease between 1990 and 2019. Future projections until 2050 were further assessed., Results: The global burden for young adults attributable to high BMI more than doubled from 1990 to 2019, reaching 24,509.8 (95% uncertainty interval [UI] 20,191.8-28,966.0) thousand for DALYs and 321.9 (258.3-384.2) thousand for deaths. Males had a higher burden and faster increase than females. The burden escalated with advancing age. From 1990 to 2019, regions with middle Socio-demographic Index (SDI) replaced regions with high-middle SDI to have the highest age-standardized rates of DALYs and deaths, while regions with low-middle SDI witnessed the largest rise. Stroke, ischaemic heart disease and diabetes mellitus were consistently the top three causes of high BMI-related burden, together accounting for 74.7% (70.8-78.4) for DALYs and 81.2% (77.6-84.2) for deaths in 2019. By 2050, the age-standardized rates of DALYs due to high BMI tripled that in 1990, with the corresponding rates for deaths expected to double. Among the 10 most populous countries, India was projected to have the highest rates and the fastest increase in both DALYs and deaths by 2050., Conclusions: The escalating disease burden attributable to high BMI in young adults, marked by notable demographic and geographic variations, highlights the urgent need for tailored public health interventions on weight management during young adulthood., (© 2024 John Wiley & Sons Ltd.)

Background: Type 2 diabetes mellitus (T2DM) poses a major global health burden, yet epidemiological research on low physical activity's (LPA) impact is limited. This study examines LPA's global effect on T2DM., Methods: Analyzing Global Burden of Disease Database (GBD) 2019, we explored LPA-attributable T2DM deaths and Disability-Adjusted Life Years (DALYs) from 1990 to 2019, stratified by year, gender, country, and SDI regions. Estimated Annual Percentage Change (EAPC) assessed trends, and Bayesian models predicted future patterns., Results: In 2019, LPA accounted for a substantial 8.5% of T2DM deaths and 6.9% of DALYs, representing a noticeable rise since 1990. Age-standardized mortality rates (ASMR) and disability-adjusted life years rates (ASDR) increased globally, particularly in low Socio-Demographic Index (SDI) regions. High and high-middle SDI regions saw a decrease in ASMR, while all regions generally saw an upward trend in ASDR. Projections for 2050 suggest a declining ASMR but an increasing ASDR, indicating a continuing burden of T2DM despite potential mortality reductions., Conclusion: LPA significantly impacts T2DM, particularly in low SDI regions. Promotion of physical activity is crucial to reduce this burden, particularly in regions where the disease's impact is most severe., Competing Interests: Declaration of competing interest There is no competing interest among authors., (Copyright © 2024. Published by Elsevier Masson SAS.)

Objective: This study is designed to estimate the epidemiology of epilepsy in Kazakhstan, using a large-scale administrative health database during 2014-2020., Methods: 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)., Results: 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., Conclusion: 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., Competing Interests: Declaration of competing interest None., (Copyright © 2024 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Objective: This study explores the global disease burden associated with high Body Mass Index (BMI) from 1990 to 2021, using data from the Global Burden of Disease Study 2021 (GBD 2021)., Methods: We applied Joinpoint regression to assess trends in deaths and Disability-Adjusted Life Years (DALYs) and employed ARIMA models to project future BMI-related burdens., Results: From 1990 to 2021, global deaths linked to high BMI surged by 153.97%, rising from 1.46 million to 3.71 million. DALYs increased by 167.57%, with the highest rises in North Africa, the Middle East, and South Asia. Women, particularly those aged 75 and above, experienced the most significant burden, with a faster rate of increase in disease burden compared to men post-2000. Future projections indicate a continued rise in BMI-related health impacts, particularly in low- and middle-income countries., Conclusions: The global disease burden attributable to high BMI is increasing rapidly, particularly in low- and middle-income regions. Targeted public health interventions, especially for women and the elderly, are crucial to addressing this growing health challenge., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aim: Elevated body mass index (BMI) presents a significant public health challenge in the United States, contributing to considerable morbidity, mortality and economic burden. This study investigates the health burden of overweight and obesity in the United States from 1990 to 2021, leveraging the Global Burden of Disease data set to analyse trends, disparities and potential determinants of high BMI-related health outcomes., Materials and Methods: Our study focused on the United States, analysing trends in disability-adjusted life years (DALY) and deaths attributable to high BMI, defined as a BMI of 25 kg/m 2 or higher for adults. Statistical analyses included estimated annual percentage change (EAPC) in age-standardized DALY rates and age-standardized death rates. Pearson correlation was performed between EAPCs and the socio-demographic index (SDI), with significance set at p < 0.05., Results: From 1990 to 2021, age-standardized DALY rates attributable to high BMI increased by 24.9%, whereas the age-standardized death rates increased by 5.2%. Age disparities showed DALYs peaking at 60-64 years for males and 65-69 years for females, with deaths peaking at 65-69 years for males and 90-94 years for females. A strong negative correlation was found between the EAPC in age-standardized DALY and death rates and the SDI., Conclusions: Overweight and obesity significantly impact public health in the United States, especially among older adults and lower socio-demographic regions. Comprehensive public health strategies integrating behavioural, technological and environmental interventions are crucial. Future research should focus on longitudinal studies, personalized interventions and policy-driven approaches to address the multifaceted influences on high BMI., (© 2024 John Wiley & Sons Ltd.)

Background: Sternum and rib fractures represent a significant global health concern, contributing to morbidity and disability on a worldwide scale. However, there is a notable lack of recent epidemiological data detailing the global and regional burden of these fractures., Methods: We undertook a systematic analysis of the prevalence of sternum and rib fractures at the global, regional, and national levels in 2019, while also examining time trends spanning from 1990 to 2019. To achieve this, we extracted data from the Global Burden of Disease Study 2019, enabling us to determine incidence, prevalence, years lived with disability (YLDs), and their corresponding age-standardized rates., Results: In 2019, there were 4.1 million incident cases and 2 million prevalent cases of sternum and rib fractures worldwide. These figures represent increases of 43.7 % and 64.1 %, respectively, since 1990. YLDs also exhibited a notable increase, rising by 62.4 % to reach 190,834 cases. However, since 1990, their equivalent age-standardized rates, which ranged from 5.5 % to 7.1 %, have decreased. Notably, China had the greatest incidence (1.2 million cases), prevalence (573,000 cases), and number of YLDs (55,400 cases), all in 2019. The greatest age-standardized incidence rate (143/100,000) and age-standardized prevalence rate (65/100,000) were both recorded in Greenland in the same year. It's critical to emphasize that men experience these fractures at considerably higher rates than women. Around 70 % of incident instances included unintentional injuries worldwide and across all regions. High-socioeconomic regions had the highest rates of incidence, prevalence, and YLDs, albeit these rates have declined by 6.4 % to 7.1 % since 1990, whereas low-middle and low-income areas have had rises., Conclusions: This study, which spans the years 1990 to 2019, provides a thorough and current assessment of the global burden attributed to sternum and rib fractures. In terms of nations, regions, sociodemographic index (SDI) levels, age groups, genders, and reasons, it reveals significant variances and trends. The knowledge obtained from this study can be extremely useful in formulating health policy, allocating resources, and developing methods to prevent these injuries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Common metabolic diseases, such as type 2 diabetes mellitus (T2DM), hypertension, obesity, hypercholesterolemia, and metabolic dysfunction-associated steatotic liver disease (MASLD), have become a global health burden in the last three decades. The Global Burden of Disease, Injuries, and Risk Factors Study (GBD) data enables the first insights into the trends and burdens of these metabolic diseases from 1990 to 2021, highlighting regional, temporal and differences by sex., Methods: Global estimates of disability-adjusted life years (DALYs) and deaths from GBD 2021 were analyzed for common metabolic diseases (T2DM, hypertension, obesity, hypercholesterolemia, and MASLD). Age-standardized DALYs (mortality) per 100,000 population and annual percentage change (APC) between 1990 and 2021 were estimated for trend analyses. Estimates are reported with uncertainty intervals (UI)., Results: In 2021, among five common metabolic diseases, hypertension had the greatest burden (226 million [95 % UI: 190-259] DALYs), whilst T2DM (75 million [95 % UI: 63-90] DALYs) conferred much greater disability than MASLD (3.67 million [95 % UI: 2.90-4.61]). The highest absolute burden continues to be found in the most populous countries of the world, particularly India, China, and the United States, whilst the highest relative burden was mostly concentrated in Oceania Island states. The burden of these metabolic diseases has continued to increase over the past three decades but has varied in the rate of increase (1.6-fold to 3-fold increase). The burden of T2DM (0.42 % [95 % UI: 0.34-0.51]) and obesity (0.26 % [95 % UI: 0.17-0.34]) has increased at an accelerated rate, while the rate of increase for the burden of hypertension (-0.30 % [95 % UI: -0.34 to -0.25]) and hypercholesterolemia (-0.33 % [95 % UI: -0.37 to -0.30]) is slowing. There is no significant change in MASLD over time (0.05 % [95 % UI: -0.06 to 0.17])., Conclusion: In the 21st century, common metabolic diseases are presenting a significant global health challenge. There is a concerning surge in DALYs and mortality associated with these conditions, underscoring the necessity for a coordinated global health initiative to stem the tide of these debilitating diseases and improve population health outcomes worldwide., Competing Interests: Declaration of competing interest John D. Ryan received consultancy fees from Falk, Gilead, Pfizer and a speaker honorarium from Takeda. Luca Valenti reports consulting fees from Gilead, Pfizer, Astra Zeneca, Novo Nordisk, Intercept pharmaceuticals, Diatech Pharmacogenetics, IONIS, Viatris; honoraria from MSD, Gilead, AlfaSigma, AbbVie, Resalis, grants from Gilead. Alice Pik-Shan Kong has received research grants and/or speaker honoraria from Abbott, Astra Zeneca, Bayer, Boehringer Ingelheim, Dexcom, Eli-Lilly, Kyowa Kirin, Merck Serono, Nestle, Novo-Nordisk, Pfizer and Sanofi and Zuellig Pharma. Gregory Y. H. Lip serves as consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, Daiichi-Sankyo, Anthos. He is a National Institute for Health and Care Research (NIHR) Senior Investigator and co-PI of the AFFIRMO project on multimorbidity in AF (grant agreement No 899871), TARGET project on digital twins for personalised management of atrial fibrillation and stroke (grant agreement No 101136244) and ARISTOTELES project on artificial intelligence for management of chronic long term conditions (grant agreement No 101080189), which are all funded by the EU's Horizon Europe Research & Innovation programme. Anoop Misra has received honorarium from Abbott, Roche, Jannsen, Boehringer Ingelheim, Lupin, Cipla, US Vitamins, and Novo Nordisk. Christopher D. Byrne has received grant support from Echosens. Wah-Kheong Chan is a consultant or advisory board member for Abbott, Roche, Abbvie, Boehringer Ingelheim and Novo Nordisk; and a speaker for Abbott, Novo Nordisk, Echosens, Viatris and Hisky Medical. Christos S. Mantzoros reports grants through his institution from Merck, Massachusetts Life Sciences Center and Boehringer Ingelheim, has received grants through his Institution and personal consulting fees from Coherus Inc. and AltrixBio, he reports personal consulting fees and support with research reagents from Ansh Inc., collaborative research support from LabCorp Inc., reports personal consulting fees from Olympus, Genfit, Lumos, Novo Nordisk, Amgen, Biodexa, Laekna, Corcept, Intercept, 89 Bio, Madrigal, Aligos, Esperion and Regeneron, travel support and fees from UptoDate, TMIOA, Elsevier, and the Cardio Metabolic Health Conference. Ming-Hua Zheng has received honoraria for lectures from AstraZeneca, Hisky Medical Technologies and Novo Nordisk, consulting fees from Boehringer Ingelheim. No other disclosures were reported., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To systematically analysis the burden and trends of blindness and vision loss for those aged ≥55 years from 1990 to 2019 and to predict trends over the next few years., Methods: The data were extracted from the Global Burden of Disease Study (GBD) 2019. Trends from 1990 to 2019 were calculated using average annual percentage change (AAPC) by joinpoint regression analysis. Bayesian age-period-cohort (BAPC) models were used to predict future trends., Results: In 2019, the global prevalence of blindness and vision loss was 471.1 million with 15.9 million disability-adjusted life-years (DALYs) for those aged ≥55 years. These numbers will reach 640.3 million cases and 18.9 million DALYs in 2030. The prevalence rate (per 100,000 population) increased from 32,137.8 (95% uncertainty interval [UI], 26,307.9-39,246.3) in 1990 to 33,509 (95% UI, 27,435.5-40,996.2) in 2019, with an AAPC of 0.143 (95% confidence interval [CI], 0.125-0.161; P  < 0.001). The DALY rate (per 100,000 population) decreased from 632.9 (95% UI, 447.7-870.9) in 1990 to 579.3 (95% UI, 405.2-803.4) in 2019, with an AAPC of -0.293 (95% CI, -0.323-[-]0.263). Although the prevalence rates of cataracts, age-related macular degeneration, glaucoma, and near vision loss showed increasing trends from 1990 to 2019, the DALY rates indicated a downward trend for all blindness-causing diseases. The burden is heavier for women and in low Socio-demographic Index (SDI) regions., Conclusions: Despite a decline from 2001 to 2019, the burden of blindness and vision loss, measured by prevalence and DALYs, continues to rise after adjusting for population growth and aging. Blindness and vision loss are significant public health burdens, especially for women and in low-SDI regions., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Chronic infection with hepatitis C virus (HCV) has a long-term impact on hepatic consequences. A comprehensive evaluation of the global burden of HCV-related health outcomes can help to develop a global HCV prevention and treatment program., Methods: We used the 2019 Global Burden of Disease (GBD) Study to comprehensively investigate burden and temporal trends in incidence, mortality and disability-adjusted life-years (DALYs) of HCV-related diseases, including liver cancer and cirrhosis and other liver diseases across 264 countries and territories from 2010 to 2019., Results: Globally, there were 152 225 incident cases, 141 811 deaths and approximately 2.9 million DALYs because of HCV-related liver cancer, and 551 668 incident cases, 395 022 deaths and about 12.2 million DALYs because of HCV-related cirrhosis in 2019. Worldwide, during the 2010-2019 period, liver cancer incidence declined, however, there was a 62% increase in cirrhosis incidence. In 2019, the Eastern Mediterranean was the region with the highest rates of incidence and mortality of both liver cancer and cirrhosis. Africa was the region with the fastest-growing trend of incidence of cirrhosis in the 2010-2019 period [annual percentage change (APC) = 2.09, 95% confidence interval (CI): 1.93-2.25], followed by the Western Pacific region (APC = 1.17, 95% CI: 1.09-1.22). Americas were the only region observing increased trends in liver cancer and cirrhosis mortality (APC = 0.70 and 0.12, respectively). We identified three patterns of temporal trends of mortality rates of liver cancer and cirrhosis in countries that reported HCV treatment rates., Conclusion: Urgent measures are required for diagnosis, treatment and research on HCV-related cirrhosis at global, regional and country levels, particularly in Africa, the Western Pacific and the Eastern Mediterranean., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Gynecological diseases ranked second among new cases of noncommunicable diseases in women of reproductive age in 1990 and 2019 globally. The aim of this study was to estimate the disease burden of gynecological diseases and describe their trends in women of all ages from 1990 to 2019., Methods: Using data from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), authors examined the incidence, disability-adjusted life years, and deaths from gynecological diseases by age in 204 countries and territories worldwide from 1990 to 2019. Analyses were conducted in 2022., Results: Globally, the age-standardized incidence rate and age-standardized disability-adjusted life year rate (ASDR) of gynecological diseases decreased by -0.176% and -0.245%, respectively from 1990 to 2019. Low socioeconomic development index countries had the highest age-standardized incidence rate and ASDR in 2019. The age-specific incidence rate of gynecological diseases in women aged 15-29 years increased from 1990 to 2019, and the 20-24-year age group increased the greatest by 0.21%. Polycystic ovary syndrome and other types of benign disorders contributed to the major increase., Conclusions: Although the disease burden of gynecological diseases decreased slightly between 1990 and 2019 globally, it remained highest in low socioeconomic development index countries. The disease burden in 20-24-year age group exhibited the fastest growth, with polycystic ovary syndrome and other types of benign disorders playing a significant role. Urgent and effective measures should be taken to target different age groups, types of gynecological disease, and regions with high disease burdens., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Increasing evidence has shown that dietary behaviors are closely correlated with the carcinogenesis and progression of many types of cancer. However, few studies have assessed the global diet-related burden of cancer. This study aimed to estimate the pooled burdens and trends of five types of cancers attributable to dietary behaviors., Methods: Data regarding cancer attributable to dietary behaviors were extracted from the Global Burden of Disease study 2019, including the death cases and age-standardized death rates, and disability-adjusted life years (DALYs) estimated according to diseases, age, sex, the socio-demographic index (SDI) and location., Results: According to the Global Burden of Disease study 2019, five types of cancer were affected by dietary behaviors: colon and rectum cancer; tracheal, bronchus and lung cancer; stomach cancer; esophageal cancer and breast cancer. Unhealthy dietary behaviors for cancer caused a total of 605.4 thousand deaths and 13951.3 thousand DALYs globally. The burden of cancer attributable to dietary risks was higher for men than for women. The highest age-standardized death rates in 2019 were observed in southern Latin America, and the lowest rates were observed in North Africa and the Middle East. The greatest increases in the age-standardized death rates, from 1990 to 2019, were found in Western Sub-Saharan Africa, with the greatest decreases in Central Asia. The highest attributable proportions of death or DALYs were colon and rectum cancer. The greatest diet-related cancer burden was observed in regions with a high-middle SDI., Conclusion: Global age-standardized deaths and DALYs rates attributable to diet-related cancer are considerable and cause a substantial burden. Successful population-wide initiatives targeting unhealthy dietary behaviors would reduce this burden., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: High levels of low-density lipoprotein cholesterol (LDL-C) can lead to the occurrence and development of atherosclerosis, which is one of the important risk factors for ischemic stroke (IS). However, details regarding the evolution of the IS burden attributable to high LDL-C in China has not been available. The objective of this study was to examine the changes over time, from 1990 to 2019, in the burden of IS attributed to high levels of LDL-C in China and to estimate the individual impacts of age, period, and cohort on the burden of IS associated with high LDL-C., Methods: Detailed data on IS burden attributable to high LDL-C from 1990 to 2019 in China were extracted from the Global Burden of Disease (GBD) Study 2019. The numbers and age-standardized rates of IS-related mortality and disability-adjusted life years (DALYs) attributable to high LDL-C were assessed by age and sex. The annual percentage change (APC) and average annual percentage change (AAPC) in the burden of IS due to high LDL-C were analyzed using Joinpoint regression model. The age-period-cohort analysis was carried out to assess the individual impacts of age, period, and cohort on the trends over time of mortality and DALY rate., Results: The number of IS-related deaths and DALYs due to high LDL-C in China were 182.7 thousand and 4.43 million in 2019, respectively, both more than double the corresponding numbers reported in 1990. However, despite these increased, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) remained unchanged. In 2019, men under 84 years of age had higher death and under 79 years of age had higher DALYs than women. However, above these ages, the gender disparities were reversed. Furthermore, age-specific rates of death, as well as DALY of IS attributable to high LDL-C in 2019 increased with age for both women and men, except for death in adults over 95 years old; and were greater in men than in women. From 1990 to 2019, males consistently had a higher ASMR and ASDR than females in China. During 1990-2019, the ASMR in women slightly decreased before 1997, sharply increased from 1997 to 2004, and then continuously decreased from 2004 to 2019, with an overall AAPC value of -0.4% (95% CI -0.8%, -0.0%). However, for the ASMR of men in China, the overall trend is upward and the AAPC is 0.5%(95% CI 0.1%, 0.8%). The ASDR in women and men had the similar trend as the ASMR over the time, with an AAPC of -0.4% (95% CI -0.7%, -0.1%) and 0.3% (95% CI 0.1%, 0.5%), respectively. The age-period-cohort analysis indicated a rise in period effects and a decline in cohort effects on mortality and DALY rate associated with IS caused by high LDL-C in both genders. Age effect on mortality rates from IS due to high LDL-C showed an exponential increased with age in all women and men except for the 60-69 age group and over 95 age group. The age relative risk of IS DALY rate due to high LDL-C increased with age in both genders except for 65-74 age group and over 95 age group., Conclusions: From 1990 to 2019, the burden of IS caused by high LDL-C in China significantly increased among both sexes combined and among men, while significantly decreased among women. Elderly have a substantial burden of IS attributable to high LDL-C. Therefore, effective and tailored strategies based on gender and age for IS primary prevention and management of IS and high LDL-C are urgently needed in China., (© 2024. The Author(s).)

Background: This 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., Methods: This 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., Results: The 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., Conclusion: The 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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Qi, Wang and Fang.)

Background: Cirrhosis comprises a significant health challenge in the Middle East and North African (MENA) region impacting healthcare systems and communities. This study sought to investigate trends in the burden of cirrhosis and other chronic liver disease, different etiologies, deaths, and the disability burden utilizing data from the Global Burden of Disease (GBD) database., Methods: Analyzing epidemiological trends from 1990 to 2021 across 21 MENA countries, this research utilized data on age-standardized incidence rates (ASIR), age-standardized death rates, and age-standardized disability-adjusted life years (DALYs) to evaluate the burden of cirrhosis and other chronic liver disease. The study also examined national variations and sociodemographic relationships., Results: The study identified a 114.9% increase in cirrhosis and other chronic liver disease incidence within the MENA region between 1990 and 2021, with 7,344,030 incident cases reported in 2021. The ASIR showed a steeper rise in females (9.6%) compared to males (7.0%). Etiology-specific analysis revealed an increase in the ASIR for MASLD related cirrhosis and other chronic liver disease by 22.2%, while those due to alcohol as well as hepatitis B and C decreased by 28.1%, 59.3%, and 30%, respectively. Despite the rising incidence, overall age-standardized death rates across all etiologies decreased by 54.3%, with DALYs showing a 51.4% decrease during the same period. Country-specific trends varied significantly, with Oman recording the highest annual ASIR increase (0.64%), and Qatar observing the most substantial annual reduction in age-standardized death rates (-2.88%)., Conclusion: The study highlights evolving trends in cirrhosis and other chronic liver disease within the MENA region, emphasizing the necessity for comprehensive, etiology, and gender-specific interventions. Despite an increasing incidence, the observed improvements in mortality rates and age-standardized disability burden indicate progress in public health efforts to mitigate cirrhosis's impact. These findings point to the complex nature of cirrhosis outcomes and the urgent need for tailored strategies to manage its increasing burden effectively., (© 2024. The Author(s).)

The incidence of thyroid cancer (TC) is increasing annually worldwide, with a growing burden. This study aims to analyze temporal trends in the burden of TC by age and sex in China and globally from 1990 to 2021, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) rates, and to predict future trends. We obtained data on TC in China and globally from 1990 to 2021 from the Global Burden of Disease (GBD) database. Using the Joinpoint regression model, we calculated and analyzed the trends in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALYs rate (ASDR). Specifically, we estimated the annual percent change (APC), the average annual percent change (AAPC), and the corresponding 95% confidence intervals (95% CI) for each metric. Additionally, we conducted a decomposition analysis to investigate the impact of aging, population growth, and epidemiological factors on the incidence and mortality rates of TC. Furthermore, the autoregressive integrated moving average (ARIMA) model was employed to predict the burden of TC from 2022 to 2036.  From 1990 to 2021, the ASIR for TC in China increased from 1.249 (95% uncertainty interval [UI]: 1.009-1.473) per 100,000 to 2.473 (95% UI: 1.993-3.088) per 100,000. Conversely, the ASMR decreased from 0.473 (95% UI: 0.403-0.550) per 100,000 to 0.387 (95% UI: 0.307-0.472) per 100,000. Both males and females demonstrated an upward trajectory in ASIR. However, while the ASMR for females decreased, that for males showed an overall increase despite a decline in the last decade. The age of peak onset for TC ranged from 30 to 79 years, whereas the age of peak mortality was between 50 and 89 years. The analysis using the AAPC indicates that the growth in the ASIR (AAPC = 2.242, 95% CI: 2.112-2.371) and ASPR (AAPC = 2.975, 95% CI: 2.833-3.117) in China exceeds the global rate. Furthermore, the reduction in ASMR (AAPC = -0.651, 95% CI: -0.824 - -0.479) and ASDR (AAPC = -0.590, 95% CI: -0.787 - -0.392) in China is also more pronounced than globally. Decomposition analysis indicates that the increasing TC burden in China is primarily driven by population aging, whereas globally, population growth plays a more significant role. Projections based on predictive models suggest that from 2021 to 2036, the ASIR for both China and the global population is expected to continue rising, while the ASMR is anticipated to decline further.  The incidence rates of TC in China and globally have shown a continuous upward trend, which is expected to persist over the next 15 years. Additionally, although the number of male TC cases is relatively lower compared to females, the overall ASMR and ASDR for males have shown an upward trend, despite a slight decline in recent years. This highlights the need to enhance prevention, diagnosis, and treatment measures, and to develop differentiated screening and treatment strategies based on age and sex., (© 2024. The Author(s).)

Background: Hepatitis B remains a significant global health concern with widespread communicability. Nevertheless, data on its burden and trends in children and adolescents were limited. We aim to evaluate the global, regional, and national trends of total burden related to hepatitis B in children and adolescents aged 0-19 years from 1990 to 2021., Methods: The age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were calculated by the Global Burden of Disease (GBD) study from 1990 to 2021. These indicators were stratified by sex, age, socio-demographic index (SDI), and disease stage. We calculated the correlation between them and SDI. The temporal trends were examined using the annual average percentage change (AAPC) and joinpoint regression., Results: The global age-standardized incidence of hepatitis B in children and adolescents decreased from 1385.20 per 100,000 population in 1990 to 418.68 per 100,000 population in 2021, with an AAPC of -3.76%. Similarly, age-standardized DALYs decreased from 70.78 per 100,000 population to 36.31 per 100,000 population, with an AAPC of -2.13%. The age-standardized prevalence (AAPC - 3.53%) and mortality (AAPC - 2.09%) of hepatitis B also decreased significantly. From 1990 to 2021, the age-standardized incidence and prevalence among males exhibited a higher trend compared to females, although both declined over time. These two indicators also decreased across all age subgroups, with consistently higher rates observed in the 15-19 age group compared to other age groups. The burden of hepatitis B demonstrated a notable reduction in countries with high-middle SDI, while it was highest in countries with low SDI. In 2021, Central sub-Saharan Africa and West sub-Saharan Africa reported the highest age-standardized incidence. For age-standardized DALYs, South Asia was the only region to experience an increase (AAPC 1.09%), while East Asia showed the largest decline (AAPC - 7.58%). Alcohol and drug use remained important risk factors for DALYs among people aged 15-19 years. Furthermore, the impact of drug use on disease burden was increasing, particularly in high-SDI countries., Conclusions: The global burden and trends of hepatitis B decreased significantly in children and adolescents, exhibiting regional and national variations. Management of alcohol and drug use remains a major challenge for people aged 15-19 years., (© 2024. The Author(s).)

Background: A high body mass index (hBMI) is one of the major risk factors for ischemic stroke (IS), although independent estimates of the global burden and trend of IS attributable to hBMI are unclear., Methods: Study data were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study and analysed by age, sex, year, and geographical location. The sociodemographic index (SDI) and the human development index (HDI) were used as indicators of national socioeconomic status. Geographic distributions and trends were assessed by calculating the estimated annual percentage change (EAPC). Associations between the age-standardized death rate (ASMR) or disability-adjusted life year rate (DALY) and socioeconomic status were analysed., Results: Deaths and DALYs increased worldwide from 1990-2021, with increases of 95.74% for the former and 133.00% for the latter; the ASMR and ASDR decreased, with an ASMR and ASDR-related EAPCs of -1.10 (95% CI: -1.24--0.96) and 0.04 (95% CI:-0.47-0.55), respectively; women had greater numbers of deaths and DALYs, and the majority of deaths and DALYs were shared by those aged ≥ 70. The highest burden rates were shared by Eastern Europe, North Africa, the Middle East, and Central Asia. The ASMR-related EAPCs were associated with the ASMR in 1990 (R = -0.35, P < 0.001) and the SDI in 2021 in different countries (R = -0.66, P < 0.001); these patterns were similar to those of the ASDR; the HDI in 2021 was associated with the ASMR-related EAPC (R = -0.71, P < 0.001) and the ASDR-related EAPC in different countries (R = -0.71, P < 0.001)., Conclusions: The number of deaths and DALYs from ischemic stroke attributable to hBMI worldwide increased substantially from 1990-2021. Successful population-wide initiatives targeting hBMI may mitigate a wide range of burdens on this disease. Taking into account variations in the SDI burden, future prevention and control strategies must be developed and implemented according to country-specific development status., (© 2024. The Author(s).)

Background: Cardiovascular diseases (CVDs) and neoplasms are leading causes of mortality worldwide., Objective: This study aims to provide a comprehensive analysis of the mortality burden and disability-adjusted life years (DALYs) attributable to CVDs and neoplasms in Western Europe, investigate associated risk factors, and identify regional disparities. Additionally, the study evaluates the effectiveness of the Action Plan for the Prevention and Control of Non-Communicable Diseases (NCDs) in promoting healthier lives in the region., Methods: The study collected data on mortality and DALYs due to CVDs and cancers from 24 Western European countries using the Global Burden of Disease Study 2021. The analysis explored age, sex, and country-specific patterns, as well as risk factors contributing to these deaths. Additionally, the study examined time trends by calculating the annual percent change in mortality rates from 1990 to 2021 by region and cause., Results: In 2021, CVDs and neoplasms accounted for 27.8% and 27.1% of total deaths in Western Europe, with age-standardized death rates of 106.8 and 125.8 per 100,000, respectively. The top two CVDs in this region were ischemic heart disease and stroke, with age-standardized death rates of 47.27 (95% uncertainty interval [UI] 50.42-41.45) and 27.06 (95% UI 29.17-23.00), respectively. Similarly, the top two neoplasms were lung cancer and colorectal cancer, with age-standardized death rates of 26.4 (95% UI 27.69-24.47) and 15.1 (95% UI 16.25-13.53), respectively. Between 1990 and 2021, CVD mortality rates decreased by 61.9%, while cancer rates decreased by 28.27%. Finland had the highest CVD burden (39.5%), and Monaco had the highest rate of cancer-related deaths (34.8%). Gender differences were observed, with males experiencing a higher burden of both CVDs and cancer. Older individuals were also more at risk. Smoking had a stronger impact on CVD mortality and DALYs in males, while a higher Human Development Index was associated with increased cancer deaths and DALYs in females., Conclusions: The study findings highlight the substantial burden of NCDs, particularly CVDs and cancer, in Western Europe. This underscores the critical need for targeted interventions and effective implementation of the Action Plan for the Prevention and Control of NCDs to achieve the goal of ensuring healthy lives for all., (© Sumaira Mubarik, Shafaq Naeem, Hui Shen, Rabia Mubarak, Lisha Luo, Syeda Rija Hussain, Eelko Hak, Chuanhua Yu, Xiaoxue Liu. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org).)

Background: Cancer poses a significant public health challenge in India, making it crucial to predict its future impact for effective healthcare planning. This study forecast cancer incidence, mortality, and disability-adjusted life years (DALYs) in India from 2022 to 2031., Methods: We extracted age-standardized data on incidence, prevalence, DALYs, and mortality from 1990 to 2021 from the Global Burden of Disease (GBD) study. We used Decadal Average Percentage Change techniques to identify trends in cancer burden over decades and the Autoregressive Integrated Moving Average (ARIMA) method were used for forecasting. The ARIMA (2,2,2) model was identified as the best for predicting cancer incidence, ARIMA (0,3,3) for DALYs, and ARIMA (0,2,2) for mortality., Results: The cancer incidence rate is expected to rise from 529.40 (95% CI: 525.41-533.38) in 2022 to 549.17 (95% CI: 487.43-610.92) per 100,000 population in 2031. The DALYs rate is projected to decrease from 2001.53 (95% CI: 1964.24-2038.82) in 2022 to 1842.08 (95% CI: 1273.57-2410.60) per 100,000 population in 2031, indicating improvements in cancer burden management. Mortality rates are forecasted to increase slightly, from 71.52 (95% CI: 69.91-73.12) in 2022 to 73.00 (95% CI: 60.88-85.11) per 100,000 population in 2031. Overall, while incidence and mortality rates show a slight upward trend, the DALYs rate is projected to decrease, reflecting potential advancements in cancer management and treatment over the forecast period., Conclusions: Over the next decade, cancer incidence and mortality are expected to increase in India, highlighting the need for enhanced prevention, early detection, and proper treatment strategies. Despite these increases, the anticipated decrease in DALYs suggests potential advancements in cancer management, warranting further investigation into the drivers of this positive trend and measures to sustain it., (© 2024. The Author(s).)

Background: Air pollution-related neoplasms are a major global public health issue and are one of the leading causes of death worldwide. Air pollution is one of the important risk factors of air pollution-related neoplasms and is associated with a variety of air pollution-related neoplasms.The primary objective of this study was to estimate the epidemiological patterns of death rates and disability-adjusted life years (DALYs) associated with air pollution-related neoplasms on a global scale, covering the period from 1990 to 2019. Furthermore, we aimed to predict the trends in these epidemiological patterns up to 2050. By achieving these goals, our study seeks to provide a comprehensive understanding of the potential causes underlying the observed disparities in neoplasm-related health outcomes, ultimately contributing to the development of effective strategies for addressing this major public health issue., Methods: Based on data from the 2019 Global Burden of Disease (GBD) study, the indicators of the air pollution-related neoplasms disease burden was the numbers and age-standardized rates (ASR) of deaths and disability-adjusted life years (DALYs) from 1990 to 2019. First, we compared the burden of air pollution-related neoplasms and temporal trends by gender, age, socio-demographic index (SDI), region, and country. Furthermore, driving factors and improvement potential were evaluated using decomposition and frontier analysis. Finally, forecasting analyses of the changing trend in the burden of air pollution-related neoplasm up to 2050 was conducted based on time series forecasting models., Results: In 2019, air pollution-related neoplasms accounted for 387.45 million (95 % UI 288.04-490.06 million) deaths and 8951.97 million (95 % UI 6680.89-11342.60 million) DALYs globally. Deaths and DALYs demonstrated an upward trend from 1990 to 2019, while their ASR showed a downward trend. The disease burden and the decline degree of males were both significantly higher than that of females, and the high burden was mainly in the elderly groups. The middle SDI region possessed the highest burden with the most significant upward trend, while the high SDI region had the lowest burden with the most significant downward trend. Decomposition analyses represented that the increase in the overall deaths and DALYs of air pollution-related neoplasms was mainly driven by population growth. The predictive analyses expected that the deaths and DALYs of air pollution-related neoplasms will continue to rise, while their corresponding ASR will decrease by 2050., Conclusion: The global burden of air pollution-related neoplasms remained high, and deaths and DALYs will be on upward trends up to 2050, with differences among genders, ages, SDI levels, GBD regions, and countries. It is essential to understand the air pollution-related neoplasm burden and contributing epidemiological factors for implementing effective and factor-tailored interventions to reduce the global burden., Competing Interests: Declaration of Competing Interest All authors disclosed no relevant relationships, (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Iron deficiency (ID) remains the leading cause of anemia, affects a vast number of persons globally, and continues to be a significant global health burden. Comprehending the patterns of ID burden is essential for developing targeted public health policies., Methods: Using data from the Global Burden of Disease (GBD) 2021 study for the years 1990-2021, the XGBoost model was constructed to predict prevalence and disability-adjusted life years (DALYs) for the period 2022-2050, based on key demographic variables. Shapley Additive exPlanations (SHAP) values were applied to interpret the contributions of each variable to the model's predictions. Additionally, the Age-Period-Cohort (APC) model was used to evaluate the effects of age, period, and birth cohort on both prevalence and DALYs. The relationship between the Socio-Demographic Index (SDI) and ID's age-standardized prevalence rate (ASPR) as well as the age-standardized DALYs rate (ASDR) was also analyzed to assess the influence of socioeconomic development on disease burden., Results: The global prevalent cases of ID grew from 984.61 million in 1990 to 1270.64 million in 2021 and are projected to reach 1439.99 million by 2050. Similarly, global DALYs from ID increased from 28.41 million in 1990 to 32.32 million in 2021, with a projected rise to 36.13 million by 2050. The ASPR declined from 18,204/100,000 in 1990 to 16,433/100,000 in 2021, with an estimated annual percentage change (EAPC) of -0.36% over this period. It is expected to decrease further to 15,922 by 2050, with an EAPC of -0.09% between 2021 and 2050. The ASDR was 518/100,000 in 1990 and 424/100,000 in 2021, with an EAPC of -0.68% from 1990 to 2021. It is expected to remain relatively stable at 419/100,000 by 2050, with an EAPC of -0.02% between 2021 and 2050. In 2021, the highest ASPRs were recorded in Senegal (34,421/100,000), Mali (34,233/100,000), and Pakistan (33,942/100,000). By 2050, Mali (35,070/100,000), Senegal (34,132/100,000), and Zambia (33,149/100,000) are projected to lead. For ASDR, Yemen (1405/100,000), Mozambique (1149/100,000), and Mali (1093/100,000) had the highest rates in 2021. By 2050, Yemen (1388/100,000), Mali (1181/100,000), and Mozambique (1177/100,000) are expected to remain the highest. SHAP values demonstrated that gender was the leading predictor of ID, with age and year showing negative contributions. Females aged 10 to 60 consistently showed higher prevalence and DALYs rates compared to males, with the under-5 age group having the highest rates for both. Additionally, men aged 80 and above exhibited a rapid increase in prevalence. Furthermore, the ASPR and ASDR were significantly higher in regions with a lower SDI, highlighting the greater burden of ID in less developed regions., Conclusions: ID remains a significant global health concern, with its burden projected to persist through 2050, particularly in lower-SDI regions. Despite declines in ASPR and ASDR, total cases and DALYs are expected to rise. SHAP analysis revealed that gender had the greatest influence on the model's predictions, while both age and year showed overall negative contributions to ID risk. Children under 5, women under 60, and elderly men aged 80+ were the most vulnerable groups. These findings underscore the need for targeted interventions, such as improved nutrition, early screening, and addressing socioeconomic drivers through iron supplementation programs in low-SDI regions.

Objective: Uterine cancer (UC) is one of the prevalent malignancies in the female reproductive system. Estimating the burden trends of UC is crucial for developing effective prevention strategies at the national level. However, there has been no comprehensive analysis of the UC burden in China. We focused on the evaluation of the burden trends of UC in China over the past 32 years to provide a 15-year projection, comparing it with global levels., Methods: Data on incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were extracted from Global Burden of Disease (GBD) 2021 to describe the burden of UC in China. Joinpoint regression analysis was employed to describe the temporal trends of UC in China and globally over the past 32 years. A Bayesian age-period-cohort model was utilized to predict the trends of UC in the next 15 years. Spearman correlation analysis was used to compare the relationship between ASIR, ASPR, ASMR, ASDR, and SDI in UC in China and globally. Changes in ASMR and ASDR in UC caused by high BMI in China and globally from 1990 to 2021 were explored., Results: In 2021, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of UC in China were 6.65, 46.52, 1.24, and 37.86 (per 100,000 population) respectively. Compared to 1990, the ASMR and ASDR decreased by 48.63% and 48.15% respectively, while the ASIR and ASPR increased by 17.79% and 37.67% respectively. Globally, the burden of UC followed a similar trend in China, with increasing ASIR and ASPR, and decreasing ASMR and ASDR, although the magnitude of increase and decrease was smaller than in China. Joinpoint regression analysis results showed an overall upward trend in ASIR and ASPR for both China and global UC, while an overall downward trend was observed in ASMR and ASDR. Age-specific analysis revealed that during the period from 1990 to 2021, the age groups with the highest incidence, prevalence, mortality, and DALYs for UC in China generally occurred at earlier ages compared to the global pattern. It is projected that over the next 15 years, the burden of UC in China will continue to increase at a higher rate than the global level. Spearman correlation analysis showed that ASIR and ASPR of UC in China and the world were significantly positively correlated with SDI (p < 0.05), and ASMR and ASDR were significantly negatively correlated with SDI (p < 0.001). High BMI is a risk factor affecting the mortality rate and DALYs of UC in both China and globally, with the increase in ASMR and ASDR due to high BMI being greater in China than globally., Conclusion: The incidence and prevalence burden of UC among Chinese and global women have shown an increasing trend over the past 32 years, while the mortality and DALYs have decreased. The projected burden of UC in China is anticipated to continue rising at a higher rate than the global level over the next 15 years. Given the large population in China, the government needs to strengthen screening and prevention strategies to mitigate the burden of UC., (© 2024. The Author(s).)

Objective: Exploring changing trends in the burden caused by overweight and obesity among children and adolescents from 1990 to 2019 at the global, regional, and national levels, based on data from the Global Burden of Disease study (GBD) 2019., Methods: The annual number and rate of deaths and disability-adjusted life years (DALYs) associated with a high BMI among children and adolescents at global, regional, and national levels by age groups, sexes, and the sociodemographic index from 1990 to 2019 were collected from the GBD study 2019. Change percentage for number, and the estimated annual percentage changes (EAPCs) for rate were calculated to determine the temporal trends., Results: From 1990 to 2019, global high BMI-related deaths decreased by 34% but DALYs increased by 48%. Death rates in females were higher than in males, although both showed decreasing trends. For the rate of DALYs, both sexes showed increasing trends, but since 1999, the rate in males has surpassed that in females. A high BMI had the greatest impact on children under 5 years of age, and the burden in other age groups continued to increase. Regionally, High-income Asia Pacific experienced the fastest decrease in death rate (EAPC=-9.57), and East Asia saw the fastest increase in the DALYs rate (EAPC= 3.47). Globally, as age increases, the proportion of disease burden attributed to a high BMI in females generally increases., Conclusions: Our findings emphasize the urgent need to improve efforts to prevent children and adolescents becoming overweight and obese., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Song, Zhou, Feng, Fu and Liu.)

Objectives: To assess the global burden of atrial fibrillation (AF) attributable to high body mass index (BMI) from 1990 to 2021 and analyze its spatiotemporal distribution characteristics., Study Design: An observational study based on GBD 2021 data., Methods: Data on AF burden due to high BMI were obtained from the Global Burden of Disease Study (GBD) 2021. Estimated annual percentage change (EAPC) was calculated to evaluate temporal trends in age-standardized rates of deaths and disability-adjusted life years (DALYs) over 30 years., Results: In 2021, high BMI-related AF caused 27,000 deaths and 725,000 DALYs globally, a 376% increase since 1990. Females and the elderly (aged 70+) bore a higher burden. Upper-middle-income regions surpassed high-income regions in AF burden. Australasia had the highest age-standardized rates, while High-income Asia Pacific and South Asia had the lowest. South Asia showed rapid growth in age-standardized death rates., Conclusion: The global burden of high BMI-related AF varies across regions and time, threatening global health, especially for females and the elderly. Targeted strategies are needed to reduce AF and obesity., (© 2024. The Author(s).)

Background: Promoting health equity has been a worldwide goal, but serious challenges remain globally and within China. Multiple decomposition of the sources and determinants of health inequalities has significant implications for narrowing health inequalities and improve health equity., Methods: Life expectancy (LE), healthy life expectancy (HALE), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life-year (DALY) rates in 31 provinces of mainland China were selected as health status indicators, obtained from the Global Burden of Disease (GBD) database. Temporal convergence analysis was used to test the evolving trends of health status. Dagum's Gini coefficient decomposition was used to decompose the overall Gini coefficient based on intraregional and interregional differences. Oaxaca-Blinder decomposition was used to calculate contributions of determinants to interregional differences. The factor-decomposed Gini coefficient was used to analyze the absolute and marginal contribution of each component to overall Gini coefficients., Results: From 1990-2019, China witnessed notable improvements in health status measured by LE, HALE, ASMR and age-standardized DALY rates.Nevertheless, the three regions (East, Central and West) exhibited significant inter-regional differences in health status, with the differences between the East and West being the largest. The adjusted short-term conditional β-convergence model indicated that the inter-provincial differences in LE, HALE, ASMR, and age-standardized DALY rates significantly converged at annual rates of 0.31%, 0.35%, 0.19%, and 0.28% over 30 years. The overall Gini coefficients of LE, HALE, and age-standardized DALY rates decreased, while the ASMR exhibited an opposite trend. Inter-regional and intra-regional differences accounted for >70% and <30% of overall Gini coefficients, respectively. Attribution analysis showed that socioeconomic determinants explained 85.77% to 91.93% of the eastern-western differences between 2010-2019, followed by health system determinants explaining 7.79% to 11.61%. The source-analysis of Gini coefficients of ASMR and age-standardized DALY rates revealed that noncommunicable diseases (NCDs) made the largest and increasing absolute contribution, while communicable, maternal, neonatal, and nutritional diseases (CMNNDs) had a diminishing and lower impact. However, NCDs exerted a negative marginal effect on the Gini coefficient, whereas CMNNDs exhibited a positive marginal effect, indicating that controlling CMNNDs may be more effective in reducing health inequities., Conclusions: Regional differences are a major source of health inequities in China. Prioritizing prevention and control of CMNNDs, rather than NCDs, may yield more pronounced impacts on reducing health inequalities from the perspective of marginal effect, although NCDs remain the largest absolute contributor to health inequalities., (© 2024. The Author(s).)

Introduction: Metabolic risk factors significantly elevate the risk of cardiovascular diseases (CVDs) and are recognized as one of the primary contributors to these conditions. This study explored the trends and percentage changes in disability-adjusted life years (DALYs) attributable to metabolic risk factors for CVD from 1990 to 2019. Methods: Data from the Global Burden of Disease study was utilized to depict changes across metabolic risk factors by sociodemographic indices and sex groups. The Mann-Kendall test was employed to ascertain the significance of these trends. Results: The findings indicate that the DALY percentage change over these years was more pronounced in low-middle and middle Socio-demographic Index (SDI) countries than in others. The most substantial percentage increase, approximately 60%, was observed in regions with low SDI, attributed to high body mass index (BMI). On average, the greatest DALYs were associated with high systolic blood pressure (SBP). Moreover, the trend for high low-density lipoprotein cholesterol and high SBP declined in countries with high SDI. Conclusions: It can be concluded that to mitigate the global mortality and morbidity from heart diseases, there needs to be a focused emphasis on managing metabolic risk factors, particularly in low-Middle and middle SDI countries.

Background: Depression is a leading cause of disability and poor health worldwide and is expected to rank first worldwide by 2030. The aim of this study is to analyze the transition and trend of depression burden in China and various income-level countries by utilizing the Global Burden of Disease (GBD) database and the Joinpoint regression model. This analysis seeks to comprehend the variations in the burden of depression across different income regions and evaluate their developmental patterns., Methods: Based on the GBD 2019 open dataset, this study extracted data on YLD (Years Lived with Disability), DALY (Disability-Adjusted Life Years), and incidence related to depression. The analysis focused on the period between 1990 and 2019, covering global data and distinguishing between high-income, upper-middle-income, lower-middle-income, low-income countries, and China. We utilized the Joinpoint regression model to fit the spatiotemporal trend changes among different income-level countries. Pairwise comparisons were conducted to examine the parallelism and to determine if the differences in trend changes among various regions were statistically significant., Results: From 1990 to 2019, the age-standardized YLD and DALY for depression female were higher than that in male. The YLD total change rate of depression men was higher than that of women. China exhibited the largest disparity in total YLD change rates between genders, reaching 0.08. During 1990 to 2019, the incidence of depression in 2005-2019 increased among females in middle to high-income countries, low-income countries, and China as compare to that of 1990-2005. Notably, China shown the most increase the incidence rate of females (from -0.4 % to 0.84 %). China experienced the most significant change in the YLD of depression during this period (AAPC = 0.45, 95 % CI = 0.41, 0.48, P < 0.01). China's YLD/Incidence rate was higher compared to the global, HICs, UMCs, LMCs, and LICs. In China, the YLD/incidence rate of depression began to rise in 1994, peaking around 2010, and then gradually declining. Since 2010, the growth rate of depression DALYs in China has been higher than the global average, high-income countries, upper-middle-income countries, lower-middle-income countries, and low-income countries. The DALY's AAPC value for the HLCs was the highest (AAPC = 0.24, 95 % CI = 0.22, 0.25, P < 0.01). The UMCs, in comparison to other regions, incidence rate had the highest AAPC value (AAPC = 0.48, 95 % CI = 0.46, 0.50, P < 0.01)., Conclusions: Given the significant variations in the burden of depression across countries with different income levels, future strategies aimed at reducing the burden of depression should adopt tailored and differentiated approaches according to each country's specific needs and developmental stages., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest related to this research study. The study was supported by the National Natural Science Foundation of China for the Youth Foundation project and preliminary research, as well as the Scientific Research Project of Jilin Provincial Department of Education. However, the funding agencies played no role in the study design, data collection, analysis and interpretation, or manuscript preparation. All authors involved in this study have reviewed and approved the final version of the manuscript and have no financial or personal relationships that could potentially influence their objectivity in conducting or interpreting the research., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Establishing effective pharmacovigilance systems globally is challenging due to the need for comprehensive epidemiological data on pharmacovigilance-related events, particularly in countries at different stages of development., Aim: This study aimed to determine magnitude and drivers of change in the global and regional burden of pharmacovigilance-related events from 1990 to 2019, analyzing variations between age groups and sex, providing data support for policymakers to adjust their pharmacovigilance policies., Method: Pharmacovigilance-related events were defined as Adverse Effects of Medical Treatment (AEMT) and Drug Use Disorders (DUD) in the Global Burden of Diseases, Injuries, and Risk Factors Study 2019. Time trend analysis utilized joinpoint regression, age-period-cohort model, and decomposition method. Disease burden was measured in incidence, deaths, and disability-adjusted life years (DALYs)., Results: The global burden of pharmacovigilance-related events remained high, driven predominantly by population growth. Children and older adults were identified as particularly susceptible groups. Across various regions and periods of the socio-demographic index (SDI), the risk of death from AEMT showed a decreasing trend. In contrast, the incidence of AEMT and both the incidence and death rates from DUD showed a stable or worsening trend. Significant regional disparities in the burden of these diseases were noted between different SDI levels., Conclusion: The study underscores the critical need for robust pharmacovigilance systems worldwide. The observed trends in the burden of pharmacovigilance-related events offer a clear direction for countries to refine and strengthen their pharmacovigilance policies and practices., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Limited studies have evaluated the global burden, trends, and cross-country inequalities for urinary tract infections (UTIs) in adolescents and young adults (AYAs)., Methods: Age-standardized incidence rate, age-standardized mortality rate, and age-standardized Disability-Adjusted Life Years (DALYs) rate were used to describe the UTI burden. The estimated annual percentage changes were calculated to evaluate the temporal trends from 1990 to 2019. The slope index of inequality and concentration index were utilized to quantify the distributive inequalities., Results: From 1990 to 2019, a significant increase in age-standardized incidence rate (estimated annual percentage change =0.22%, 95% confidence interval 0.19%-0.26%) was found for UTIs in AYAs, and the increasing trend was more pronounced in males than females. Significant decreases in age-standardized mortality rate and age-standardized DALY rate were found in females but not in males. The slope index of inequality changed from 21.80 DALYs per 100,000 in 1990 to 20.91 DALYs per 100,000 in 2019 for UTIs in AYAs. Moreover, the concentration index showed -0.23 in 1990 and -0.14 in 2019., Discussion: Countries with lower sociodemographic development levels shouldered a disproportionately higher UTI burden., Conclusions: UTIs remain an ongoing health burden for AYAs globally, with substantial heterogeneities found across countries, sex, and age groups., (Copyright © 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts., Methods: We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level., Findings: In 2021, we estimated 4·71 million (95% UI 4·23-5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00-1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000-372 000] and 57 200 attributable deaths [34 100-80 300] in 1990, to 550 000 associated deaths [500 000-600 000] and 130 000 attributable deaths [113 000-146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000-834 000) in 1990, to 1·03 million associated deaths (909 000-1·16 million) in 2021, and from 127 000 attributable deaths (82 100-171 000) in 1990, to 216 000 (168 000-264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56-2·26) deaths attributable to AMR and 8·22 million (6·85-9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2-69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5-89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (-6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8-102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08-13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths., Interpretation: This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050., Funding: UK Department of Health and Social Care's Fleming Fund using UK aid, and the Wellcome Trust., Competing Interests: Declaration of interests U Abubaker reports leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with the Early Career Pharmaceutical Group of the International Pharmaceutical Federation between January 2021 – December 2023, outside the submitted work. S Afzal reports payment or honoraria for educational events and Webinars with King Edward Medical University and collaborative partners including University of Johns Hopkins, University of California, and University of Massachusetts; participation on a Data Safety Monitoring Board or Advisory Board with National Bioethics Committee Pakistan, King Edward Medical University Institutional Ethical Review Board, and Ethical Review Board Fatima Jinnah Medical University and Sir Ganga Ram Hospital; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with Pakistan Association of Medical Editors, Faculty of Public Health Royal Colleges UK (FFPH), with Society of Prevention, Advocacy And Research, King Edward Medical University. (SPARK), and the Pakistan Society of Infectious Diseases; other financial or non-financial interests as Dean of Public Health and Preventive Medicine King Edward Medical University, Chief Editor Annals of King Edward Medical University since 2014, Director Quality Enhancement Cell King Edward Medical University, and Member Research and Publications Higher Education Commission Pakistan; all outside the submitted work. R Ancuceanu reports consulting fees from Abbvie; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Abbvie, Laropharm, Reckitt, and Merck Romania; support for attending meetings and/or travel from Merck Romania; all outside the submitted work. J R Andrews reports support for the present manuscript from Bill and Melinda Gates Foundation (funding for the Surveillance for Enteric Fever in Asia Project Study); grants or contracts from NIH for typhoid and tuberculosis studies; royalties from UpToDate on typhoid clinical management; outside the submitted work. D T Araki reports support for their participation in the present manuscript through their employment at the Institute for Health Metrics and Evaluation (IHME), and support for attending meetings and/or travel from IHME outside the submitted work. A Beloukas reports grants or contracts from Gilead and GSK/ViiV through their institution; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Gilead and GSK/ViiV through their institution; support for attending meetings and/or travel from Gilead and GSK/ViiV through their institution; Receipt of FOC reagents from Cepehid; all outside the submitted work. J A Berkley reports support for the present manuscript from the Bill & Melinda Gates Foundation through payments to their university. S Bhaskar reports grants or contracts from Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT), Grant-in-Aid for Scientific Research (KAKENHI) (P23712), JSPS and the Australian Academy of Science, and JSPS International Fellowship (P23712); leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with Rotary District 9675, Sydney, Australia, Global Health & Migration Hub Community, Global Health Hub Germany, Berlin, Germany, PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health, Journal of Aging Research & BMC Medical Research Methodology, College of Reviewers, Canadian Institutes of Health Research (CIHR), Government of Canada, World Headache Society, Bengaluru, India, Cariplo Foundation, Milan, Italy, National Cerebral and Cardiovascular Center, Department of Neurology, Suita, Osaka, Japan, and Cardiff University Biobank, Cardiff, UK; all outside the submitted work. C S Brown reports other financial or non-financial interests through participation in short-term, anonymous, and indirect market research with companies Sermo, Atheneum, and M3, all outside the submitted work. E Chung reports support for the present manuscript in part by the National Institutes of Health (NICHD T32HD007233 to EC). S J Dunachie reports support for the present manuscript from UK Fleming Fund at Department of Health and Social Care, Bill & Melinda Gates Foundation, and Wellcome Trust through their employment, and from the UK National Institute of Health and Care Research through a Global Research Professorship (NIHR300791); grants or contracts from UKRI (MR/W02067X/1 and MR/W020653/1), US Defense Threat Reduction Agency, Wellcome Drug Resistant Infections Discretionary Award, and the UK Dept of Health & Social Care; consulting fees from the Scottish Parliament and Wellcome; participation on the Data Monitoring Committee for UK STABILISE study of BCG vaccine in COPD; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as a member of New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG), Chair of Wellcome SEDRIC subgroup on data standards and harmonisation in antimicrobial resistance, UK, member of Variant Technical Group for SARS-CoV-2 for UK Health Security Agency, UK, Expert advisor to WHO's Global Antimicrobial Resistance Surveillance System (GLASS), Geneva, Switzerland, and a Member of World Health Organization Guidelines Development Group on Treatment of Ebola, Geneva, Switzerland; all outside the submitted work. T Eckmanns leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with a speaker working group infection control German society of infection control and microbiology. N A Feasey reports grants from Wellcome Programme Grant: ACORN, and Wellcome Programme Grant: ADILA through payments to their institute, outside the submitted work. I M Ilic reports support for their participation in the current manuscript from Ministry of Education, Science and Technological development, Republic of Serbia, project No 175042, 2011-2023. N E Ismail reports leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, as Bursar and Council Member of the Malaysian Academy of Pharmacy and as a Committee Member of Education Chapter, Malaysian Pharmacists Society; all outside the submitted work. T Joo reports support for their participation in the current manuscript from EU under EU4HEALTH programme (AMR-EDUcare – EduCation on Antimicrobial REsistance for the health workforce). M Lee reports support for their participation in the current manuscript from the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2023S1A3A2A05095298). L Monasta reports support for their participation in the current manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017) through payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. C E Moore reports participation on a Data Safety Monitoring Board or Advisory Board as a Member of Advisory board for MRC grant, Advisory group for WHO Medically Important Antimicrobial List, Member of the Steering group for the REVIVE study , Member of Advisory board for CABBAG, and as a Member of Advisory board for RADAAR; Leadership or fiduciary role, unpaid, in a microbiology society as Co-chair of Impact and Influence group of Knocking Out AMR project; all outside the submitted work. A J Pollard reports grants or contracts from Gates Foundation, Wellcome, Cepi, MRC, NIHR, AstraZeneca, EC, and the Serum Institute of India, all as payments to their institution; royalties or licenses with AstraZeneca through their institution; consulting fees from Shionogi; leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, as Chair of DHSC's Joint Committee on Vaccination and Immunisation, a Member of WHOs SAGE until 2022, and Chair of WHOs Salmonella TAG; receipt of equipment, materials, drugs, medical writing, gifts or other services from Moderna; all outside the submitted work. L F Reyes reports grants or contracts from GSK, MSD, and Pfizer; consulting fees from GSK, MSD, and Pfizer; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from GSK, MSD, and Pfizer; payment for expert testimony from GSK, MSD, and Pfizer; support for attending meetings and/or travel from GSK and Pfizer; stock or stock options in GSK; all outside the submitted work. Y L Samodra reports grants or contracts from Taipei Medical University; a leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with the Benang Merah Research Center, Indonesia; and other financial or non-financial interests in bertakon.com as founder; all outside the submitted work. E A F Simões reports grants or contracts from Astra Zeneca Inc, Merck & Co., Pfizer Inc, Icosavax Inc, Johnson and Johnson, and Enanta Pharmaceuticals; consulting fees from Merck & Co., Pfizer Inc, Sanofi Pasteur, Cidara Therapeutics, Icosavax Inc, Nuance Pharmaceuticals, GSK, Enanta, and Gilead; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Pfizer Inc and Astra Zeneca; support for attending meetings and/or travel from Astra Zeneca, Sanofi, and Pfizer Inc; participation on a Data Safety Monitoring Board or Advisory Board with AbbVie Inc, GlaxoSmithKline plc, and Moderna Inc; all through their institution and outside the submitted work. P Turner reports grants or contracts from the Wellcome Trust through the ACORN AMR surveillance network project (University of Oxford); support for attending meetings and/or travel from the World Health Organization for attendance at the AMR Diagnostic Initiative Meeting (July 2023); all outside the submitted work. P C M Williams reports grants or contracts from National Health and Medical Research Council administered by the University of Sydney; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events ECCMID & WSPID for conferences between 2022 and 2024; support for attending meetings and/or travel from ECCMID & WSPID; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with the World Society of Paediatric Infectious Diseases and the Australasian and New Zealand Paediatric Infectious Diseases Society; all outside the submitted work. G Zamagni reports support for their participation in the present manuscript from the Italian Ministry of Health (Ricerca Corrente 34/2017), payments made to the Institute for Maternal and Child Health IRCCS Burlo Garofolo. M Zielińska other financial or non-financial interests in AstraZeneca as an employee, outside the submitted work. A Zumla reports support for their participation in the current manuscript from the Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET) funded by the EDCTP - the EU Horizon 2020 Framework Programme, the UK NIHR, a Mahathir Science Award, and EU-EDCTP Pascoal Mocumbi Prize; participation on a Data Safety Monitoring Board or Advisory Board, unpaid, with the WHO Infection Prevention and Control Committee; leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with the University of Bolton School of Medicine; outside the submitted work., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: The rapid population aging in China has been a big challenge to achieve the goal of ending the global tuberculosis (TB) epidemic. This study aimed to describe the temporal trend of TB burden in China during 1990 ∼ 2019 and to evaluate the effect of age, period, and birth cohort on domestic TB burden, with a specific focus on the elderly., Methods: The trends of incidence, mortality, and disability-adjusted life years (DALYs) of TB among human immunodeficiency virus (HIV) negative people were described using the data from the Global Burden of Disease 2019 study. Join-point regression model was applied to calculate the average annual percentage change (AAPC) of TB burden for different age groups. Age-period-cohort (APC) model was fitted for incidence and mortality, and relative risks (RR) were computed for each age group., Results: In 2019, the highest TB deaths (5.23 thousand, 95% uncertainty interval [UI]: 4.38 ∼ 6.17) and DALYs (155.18 thousand, 95%UI: 126.47 ∼ 190.55) were observed in the HIV-negative population aged 70 ∼ 74 years in China. The proportion of those aged ≥ 60 years in newly diagnosed TB patients without HIV coinfection increased from 23.82% in 1990 to 37.54% in 2019, while TB deaths rose from 48.70 to 68.64%. During the past 30 years, the AAPC of age-standardized mortality (-7.77, confidence interval [CI]: -8.44∼ -7.10) and DALYs (-7.48, 95% CI: -7.98∼ -6.97) among HIV-negative individuals have shown a decrease, while much slower in the age groups above 70-year-old. The period effect and cohort effect contributed to the decline of TB incidence and mortality, but the age effect led to increasing TB mortality, especially among the ages of 85 ∼ 89 years (RR = 4.59, 95% CI: 4.25 ∼ 4.95)., Conclusions: The burden of TB remains considerable in the elderly population in China. More actions should be taken to improve case finding and the quality of TB healthcare for this high-risk population., (© 2024. The Author(s).)

Background: The global status of chronic kidney disease (CKD) is underestimated, particularly the burden on adolescents and young adults (early-onset, aged 15-39)., Objective: We aim to investigate the pattern and trend of early-onset CKD from 1990 to 2019., Methods: We analyzed age-specific rates of early-onset CKD incidence, death, and disability-adjusted life years (DALY) using Global Burden of Disease Study 2019 data. We examined the global, regional, national, gender-based, age group-based, and temporal changes of early-onset CKD burden from 1990 to 2019, as well as proportional DALY attributions of various risk factors., Results: From 1990 to 2019, the global age-specific incidence rate (per 100,000 population) significantly increased from 25.04 (95% confidence interval 18.51, 31.65) to 32.21 (23.73, 40.81) for early-onset CKD. However, the global age-specific death rate significantly decreased from 2.96 (2.76, 3.15) to 2.86 (2.61, 3.11), and the age-specific DALY rate remained stable. Regarding sociodemographic indexes (SDI), countries with middle SDI had the highest incidence rates and the fastest increasing trends, while those with low and low-middle SDI experienced the highest death and DALY rates. Women had a generally higher age-specific incidence rate than men, whereas men showed higher age-specific death and DALY rates. In addition, the burdens of CKD increased with age among adolescents and young adults. Moreover, the main attributable risk factors for DALY of early-onset CKD were high systolic blood pressure (SBP), fasting plasma glucose (FPG), and body mass index (BMI)., Conclusion: The age-specific incidence rate of early-onset CKD increased significantly from 1990 to 2019, and the age-specific DALY rate remained stable. High SBP, high FPG, and high BMI were the primary risk factors. Targeted prevention and healthcare measures should be developed considering age, gender, and region., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Sun, Ming, Song, Chen, Yang, Sun, Zheng, Tong, Ma and Wan.)

Background: The burden of common urologic diseases, including benign prostatic hyperplasia (BPH), urinary tract infections (UTI), urolithiasis, bladder cancer, kidney cancer, and prostate cancer, varies both geographically and within specific regions. It is essential to conduct a comprehensive and precise assessment of the global burden of urologic diseases., Methods: We obtained data on incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for the aforementioned urologic diseases by age, sex, location, and year from the Global Burden of Disease (GBD) 2021. We analyzed the burden associated with urologic diseases based on socio-demographic index (SDI) and attributable risk factors. The trends in burden over time were assessed using estimated annual percentage changes (EAPC) along with a 95% confidence interval (CI)., Results: In 2021, BPH and UTI were the leading causes of age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR), with rates of 5531.88 and 2782.59 per 100,000 persons, respectively. Prostate cancer was the leading cause of both age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR), with rates of 12.63 and 217.83 per 100,000 persons, respectively. From 1990 to 2021, there was an upward trend in ASIR, ASPR, ASMR, and ASDR for UTI, while urolithiasis showed a downward trend. The middle and low-middle SDI quintile levels exhibited higher incidence, prevalence, mortality, and DALYs related to UTI, urolithiasis, and BPH, while the high and high-middle SDI quintile levels showed higher rates for the three cancers. The burden of these six urologic diseases displayed diverse age and sex distribution patterns. In 2021, a high body mass index (BMI) contributed to 20.07% of kidney cancer deaths worldwide, while smoking accounted for 26.48% of bladder cancer deaths and 3.00% of prostate cancer deaths., Conclusions: The global burden of 6 urologic diseases presents a significant public health challenge. Urgent international collaboration is essential to advance the improvement of urologic disease management, encompassing the development of effective diagnostic screening tools and the implementation of high-quality prevention and treatment strategies., (© 2024. The Author(s).)

Aim: Ischemic heart disease (IHD) represents a major cardiovascular condition heavily influenced by dietary factors. This study endeavors to assess the global, regional, and temporal impact of low-fiber diets on the burden of IHD., Method: Leveraging data from the Global Burden of Disease (GBD) 2019 study, we analyzed the worldwide burden of IHD resulting from diet low in fiber using indices including death and disability-adjusted life years (DALY). This burden was further segmented based on variables including regions and countries. To track the evolution from 1990 to 2019, we utilized the Joinpoint regression model to estimate the temporal trend of IHD burden stemming from low-fiber diets., Results: In 2019, a total of 348.85 thousand (95%UI: 147.57, 568.31) deaths and 7942.96 thousand (95%UI: 3373.58,12978.29) DALY (95% UI: 707.88, 1818) of IHD were attributed to diet low in fiber globally. These figures correspond to 3.82% of all IHD deaths and 4.36% of total IHD DALYs. The age-standardized death and DALY rates per 100,000 individuals were 4.48 (95% UI: 1.90,7.27) and 97.4(95%UI: 41.44, 158.88) respectively. However, significant regional disparities emerged in these age-standardized rates, with South Asia and Central Asia experiencing the highest rates. Between 1990 and 2019, we observed that most regions displayed a downward trend of the age-standardized DALY and death rate of IHD resulting from low-fiber diets, except for Central Sub-Saharan Africa and Southern Sub-Saharan Africa., Conclusion: Our analysis underscores the substantial toll of IHD associated with low-fiber diets, particularly considering the significant regional variations. Therefore, it is imperative to sustain efforts to implement effective measures aimed at enhancing fiber intake worldwide, particularly in countries with lower socio-demographic indices., (© 2024. The Author(s).)

Background: The objective of this study is to evaluate the global burden of ischemic heart disease (IHD) attributable to High body mass index (HBMI) by utilizing data from Global Burden of Disease (GBD) 2019., Methods: This study utilized data from the GBD 2019 to examine the impact of HBMI on deaths and disability-adjusted life years (DALYs). The analysis focused on age-standardized rates and considered a 30-year time frame. Trends were assessed using estimated annual percentage changes (EAPCs)., Results: Since 1990, a significant global increase in IHD attributable to HBMI has been observed. This increase is particularly notable among elderly males and in regions with low-middle Socio-Demographic Index (SDI), such as Central Asia and Eastern Europe. In 2019, IHD globally resulted in 1,662,339 deaths and 41,369,773 DALYs. Despite the high age-standardized death rate (20.73 per 100,000) and DALY rate (499.41 per 100,000), a declining trend was noted. This trend is reflected by the EAPCs of -0.35 for DALYs and - 0.67 for deaths. Notably, males and middle SDI countries exhibited higher rates of IHD, whereas high SDI regions such as High-income Asia Pacific and Western Europe showed decreasing trends in IHD., Conclusion: Over the past three decades, there has been a significant increase in IHD caused by HBMI, especially in low-middle and low SDI regions. This highlights the importance of targeted interventions in addressing this issue. Notably, regions including Central Asia, Eastern Europe, North Africa, and the Middle East have been heavily affected., (© 2024. The Author(s).)

Background: Benign prostatic hyperplasia (BPH) is a prevalent urological disease in elderly males. However, few studies have estimated the temporal and spatial distributions of the BPH burden in male adults aged 60 years and over at the global, national, and regional scales., Methods: Leveraging the Global Burden of Disease, Injuries, and Risk Factors Study, we estimated the global epidemiological trends in the prevalence, incidence, and disability-adjusted life-years (DALYs) of BPH in 204 countries and 21 regions and 5 sociodemographic index (SDI) regions in males aged 60 years and over between 1990 and 2019. The average annual percentage changes (AAPCs) in age-specific rates were estimated to quantify overall trends. We estimated the contribution of population aging and epidemiological alterations in disease burden via composition analysis., Results: Over the past three decades, the global prevalent cases, incident cases and DALYs of BPH have increased, ranging from 118.78 to 121.22%. The global number of prevalent BPH cases reached 79 million in people aged 60 years and older in 2019. The prevalence, incidence, and DALYs rates gradually increased, with AAPCs of 0.02, 0.02, and 0.01, respectively. Low-middle, middle, and low SDI regions experienced rapid increases in the number of prevalent cases of BPH. In 2019, China, India, and United States of America bore the largest burden of prevalent cases among people aged 60 years and over. The three regions with the highest prevalence rates of BPH were Eastern Europe, Central Latin America, and Andean Latin America. The increased prevalence was attributed to population growth (94.93%), epidemiological changes (3.45%), and aging (1.62%), globally., Conclusions: BPH is a global health issue that imposes substantial economic burdens on most countries, particularly males aged 60 years and over. Effective health decisions are imperative for BPH prevention and treatment., (© 2024. The Author(s).)

Background: Lower extremity amputations (LEAs) significantly contribute to mortality and morbidity, often resulting from peripheral artery disease and diabetes mellitus (DM). Traumatic injuries also account for many LEAs. Despite the global burden, the epidemiology of LEAs, particularly in the Middle East and North Africa (MENA) region, remains underexplored. This study utilizes the Global Burden of Disease (GBD) dataset to analyze temporal trends in LEAs in the MENA region from 1990 to 2019., Methods: The study utilized the 2019 GBD dataset, which includes estimates for incidence, prevalence, and disability-adjusted life-years (DALYs) across 369 diseases. Age-standardized incidence rates (ASIRs) for LEAs were extracted for 21 MENA countries. Trends were analyzed using percentage change calculations and Joinpoint regression to identify significant shifts in LEA rates over time., Results: From 1990 to 2019, male LEA rates generally decreased, while female rates increased. Significant increases in LEA rates were observed in Syria, Yemen, and Afghanistan, correlating with periods of conflict and instability. Conversely, countries like Iraq, Palestine, Sudan, Lebanon, Iran, and Kuwait saw marked decreases. The study highlighted a complex interplay of socio-political factors, natural disasters, and chronic diseases like DM in shaping LEA trends across the region., Conclusion: The study reveals variable LEA trends in the MENA region, influenced by conflicts, natural disasters, and chronic diseases. These findings underscore the need for targeted public health interventions, improved healthcare access, and robust data collection systems to reduce the burden of LEAs and improve patient outcomes in the MENA region., (© 2024. The Author(s).)

Background: This study examines global trends in acquired immune deficiency syndrome (AIDS) incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2019, focusing on regional disparities in AIDS incidence, mortality, and DALYs across various levels of socio-demographic index (SDI). It also investigates variations in AIDS incidence, mortality, and DALYs across different age groups, and projects specific trends for the next 25 years., Methods: Comprehensive data on AIDS from 1990 to 2019 in 204 countries and territories was obtained from a GBD study. This included information on AIDS incidence, mortality, DALYs, and age-standardized rates (ASRs). Projections for AIDS incidence and mortality over the next 25 years were generated using the Bayesian age-period-cohort model., Results: From 1990 to 2019, the global incidence of HIV cases increased from 1,989,282 to 2,057,710, while the age-standardized incidence rate (ASIR) decreased from 37.59 to 25.24 with an estimated annual percentage change (EAPC) of -2.38. The ASIR exhibited an upward trend in high SDI and high-middle SDI regions, a stable trend in middle SDI regions, and a downward trend in low-middle SDI and low SDI regions. In regions with higher SDI, the ASIR was higher in males than in females, while the opposite was observed in lower SDI regions. Throughout 1990 to 2019, the age-standardized death rate (ASDR) and age-standardized DALY rate remained stable, with EAPCs of 0.24 and 0.08 respectively. Countries with the highest HIV burden affecting women and children under five years of age are primarily situated in lower SDI regions, particularly in sub-Saharan Africa. Projections indicate a significant continued decline in the age-standardized incidence and mortality rates of AIDS over the next 25 years, for both overall and by gender., Conclusions: The global ASIR decreased from 1990 to 2019. Higher incidence and death rates were observed in the lower SDI region, indicating a greater susceptibility to AIDS among women and < 15 years old. This underscores the urgent need for increased resources to combat AIDS in this region, with focused attention on protecting women and < 15 years old as priority groups. The AIDS epidemic remained severe in sub-Saharan Africa. Projections for the next 25 years indicate a substantial and ongoing decline in both age-standardized incidence and mortality rates., (© 2024. The Author(s).)