Global burden and cross-country inequalities in autoimmune diseases from 1990 to 2019

Enhanced pre- and postnatal developmental toxicity (ePPND) study in non-human primates: Necessity, strategic approaches, and critical considerations

Nonclinical developmental and reproductive toxicity (DART) studies are crucial components of novel drug development, as they identify reproductive and developmental risks and ensure drug safety in populations such as pregnant women and women of childbearing potential (WOCBP). Rodents or rabbits are commonly used in nonclinical studies to evaluate DART for chemical compounds. However, for most antibody-based biopharmaceuticals, non-human primates (NHPs) are the only pharmacologically relevant species, necessitating the use of NHPs in DART studies. These studies pose significant challenges due to stringent design requirements, complex protocols, prolonged timelines, and high costs. A single well-designed NHP study, in which the test substance is administered from gestational day 20 until delivery (enhanced Pre- and Postnatal Developmental study, ePPND study), is preferable to conducting separate Embryo-Fetal Developmental (EFD) and Pre- and Postnatal Developmental (PPND) studies. This review highlights the scientific rationale for NHP-based ePPND studies as mandated by major regulatory agencies, discusses advanced methodologies, key challenges (including endpoint selection, experimental design optimization, and data interpretation with case examples), and offers guidance for ePPND design across antibody-based therapeutics.

Burden of Urological Cancers in the Labour Force from 1990 to 2021 and Projections to 2050

BACKGROUND

Urological cancers represent an increasing public health concern in the labour force, mainly including prostate cancer (PCA), kidney cancer (KCA), testicular cancer (TCA), and bladder cancer (BLCA). Limited data exist on their occurrence, deaths, and disability-adjusted life years (DALYs). The objective of this study was to analyse three-decade trends in these cancers globally and forecast future patterns.

METHODS

The study used Global Burden of Disease 2021 data from 1990 to 2021 to evaluate urological cancer stats, including prevalence, incidence, mortality, and DALYs. For people aged 15-64 years, it was then manually age-standardized once. Herein, we employed a range of analytical techniques, including decomposition analysis, a Bayesian Age-Period-Cohort model, a Concentration index and slope index, and frontier analysis, to examine the trends in 204 countries and regions. Furthermore, the relationship between the Socio-Demographic Index (SDI) and the burden of disease is addressed.

RESULTS

Over the past 30 years, PCA, TCA, and KCA rates have risen among the global labour force population. North America, North Asia, and Europe have high incidence and mortality rates. TCA mortality and BLCA and TCA prevalence are expected to continue rising globally until 2050. Urological cancer impacts vary by region and development with more burden in areas with a higher SDI.

CONCLUSIONS

Urological cancers represent a substantial disease burden on labour force populations, emphasizing the imperative for targeted interventions and healthcare resources for affected populations. It is therefore crucial to have a comprehensive understanding of the global and regional epidemiological trends, as well as the findings of health economics studies.

Global, regional and national trends in the epidemiology of rheumatoid arthritis from 1990 to 2021: an age-period-cohort effect analysis of the global burden of disease study 2021

BACKGROUND

Rheumatoid arthritis (RA) poses a significant global health challenge. This study examined trends in the incidence, prevalence and mortality of RA from 1990 to 2021 at global, regional and national levels, alongside age, period and cohort effects.

METHODS

Age-standardised rates (per 100 000 population) on RA incidence, prevalence and mortality were extracted from the Global Burden of Disease (GBD) study 2021. An age-period-cohort model estimated the overall annual percentage change (net drift), annual percentage change within each age group (local drift), and age/period/cohort relative risks.

RESULTS

Globally, from 1990 to 2021, the age-standardised incidence rate (ASIR) and the age-standardised prevalence rate (ASPR) of RA increased; while age-standardised mortality rate (ASMR) decreased. Low-middle sociodemographic index (SDI) region showed the most notable increases in incidence and prevalence, while high SDI region had the largest decline in RA mortality. The South-East Asia Region exhibited the most significant increases in incidence and prevalence, and the African Region had the greatest mortality decline. Ireland reported the highest ASIR and ASPR in 2021, while the Republic of Honduras had the highest ASMR. Age effects peaked at 65-69 years for incidence and 80-84 years for prevalence, with the mortality risk increased with age. Period effects indicated rising incidence and prevalence but declining mortality, while younger birth cohorts showed increasing risks of incidence and prevalence and decreasing mortality risk.

CONCLUSION

RA incidence and prevalence have risen globally, while mortality has declined. The regional, demographic and temporal variations underscore the need for targeted public health strategies to address the growing burden.

Epidemiological trends and risk factors of chronic obstructive pulmonary disease in young individuals based on the 2021 global burden of disease data (1990-2021)

OBJECTIVE

Recent studies have shown that chronic obstructive pulmonary disease (COPD) in young individuals cannot be ignored. This study aims to investigate the burden of COPD and its associated risk factors in individuals aged 15 to 49 years, with a particular focus on health inequities across different levels of socioeconomic development.

METHODS

By analyzing data from the Global Burden of Disease (GBD) 2021, we utilized statistical methods such as Joinpoint regression, frontier analysis, and health inequality analysis to evaluate the changes in the age-standardized disability-adjusted life year (DALY) rates (ASDR) and incidence rates (ASIR) of COPD among the global population aged 15-49 years from 1990 to 2021. We specifically examined the disparities in health across countries and regions with varying levels of socioeconomic development. Key risk factors, including particulate matter pollution, smoking, and occupational exposure, were analyzed.

RESULTS

The number of COPD cases among young people globally has significantly increased.While the global ASDR and ASIR of COPD in the 15-49 age group showed an overall declining trend, the burden of COPD remained high in low Sociodemographic Index (SDI) regions and there were significant health inequalities between countries. Particulate matter pollution (41.79%), smoking (19.81%), and occupational exposure (11.73%) were identified as the primary contributors to the burden of COPD in younger individuals. In low SDI regions, particulate matter pollution had a particularly significant impact, accounting for 58.65% of attributable proportion of DALYs, and remained at a persistently high level. Smoking continued to contribute significantly to the burden of COPD in high-income regions, notably in North America, where smoking accounted for 34.26% of DALYs in 2021.

CONCLUSION

Although there is a global downward trend in the burden of COPD among young people, significant health inequities persist in low SDI regions. The findings emphasize the need for more effective public health activities targeting younger populations and low SDI countries and regions, particularly in improving air quality, reducing smoking, and mitigating occupational exposures.

CLINICAL TRIAL NUMBER

Not applicable.

Development and validation of identification algorithms for five autoimmune diseases using electronic health records: a retrospective cohort study in China

Objective

This study aims to assess the identification algorithms for five autoimmune diseases-Hashimoto's thyroiditis, inflammatory bowel disease (IBD), primary immune thrombocytopenia (ITP), rheumatoid arthritis (RA), and type 1 diabetes (T1D)-using the Yinzhou Regional Health Information Platform (YRHIP) in China.

Methods

Diagnostic data was extracted from YRHIP's population registry (2010-2021), combining ICD-10 codes and Chinese medical terminology from outpatient, inpatient, and discharge records. Algorithms were validated through chart reviews, adhering to global clinical guidelines. Cases were adjudicated using electronic case report forms. We evaluated algorithm performance based on sensitivity and positive predictive value (PPV), with a 70% PPV threshold for optimization.

Results

Among all reviewed cases, we identified 136 cases for Hashimoto's thyroiditis, 65 for IBD, 76 for ITP, 130 for RA, and 43 for T1D. Algorithm performance varied across diseases: the final algorithm for Hashimoto's thyroiditis achieved optimal accuracy (sensitivity 97.44%, PPV 98.28%), followed by RA (sensitivity 100.00%, PPV 76.92%). Algorithms for IBD and ITP required synthesis of multiple data sources to achieve acceptable performance (IBD: sensitivity 79.66%, PPV 70.15%; ITP: sensitivity 62.50%, PPV 70.00%). For T1D, the final algorithm utilizing both admission and outpatient records yielded satisfactory results (sensitivity 84.09%, PPV 74.00%).

Conclusions

This study presents the first validated algorithms for identifying autoimmune diseases using EHR data in China, demonstrating satisfactory performance (PPV >70%) across all diseases. Our findings demonstrate that a combination of data sources is crucial for accurate case identification in complex autoimmune conditions, providing an important methodological foundation for future real-world studies in Chinese populations.

Application of Elastic networks and Bayesian networks to explore influencing factors associated with arthritis in middle-aged and older adults in the Chinese community

Bayesian networks (BNs) are an excellent machine learning algorithm for extensively exploring the influencing factors associated with many diseases. However, few researchers have used BNs to examine the influencing factors associated with arthritis in older adults in the Chinese community. Our aim has been to use BNs to construct a complex network of relationships between arthritis and its related influencing factors and to predict arthritis through Bayesian inference, thereby providing scientific references for its control and prevention. Data were downloaded from the 2015 China Health and Retirement Longitudinal Study (CHARLS) online database, a longitudinal survey of the middle-aged and older adults in China. Twenty-two variables such as smoking, depressive symptoms, age, and joint pain were included in this study. First, Elastic networks (ENs) were used to screen for features closely associated with arthritis, and we subsequently incorporated these features into the construction of the BNs model. We performed structural learning of the BNs based on the taboo algorithm and used the maximum likelihood method for parameter learning of the BNs. In total, 15,764 participants were enrolled in this study, which included 5,076 patients with arthritis. ENs identified 13 factors strongly associated with arthritis. The BNs consisted of 14 nodes and 24 directed edges. Among them, depressive symptoms and age were direct influences on arthritis, whereas gender was an indirect influence on the diseases. BNs graphically visualized the complex network of relationships between arthritis and its influences and predicted the development of arthritis through Bayesian inference. These results were in line with clinical practice. BNs thus have a wide range of application prospects.

Global burden of Alzheimer's disease and other dementias in adults aged 65 years and over, and health inequality related to SDI, 1990-2021: analysis of data from GBD 2021

INTRODUCTION

The disease burden of dementia in the elderly is predicted to rise, and dementia among older adults has become a crucial issue for public health. Quantifying the disease burden of dementia in the elderly can provide relevant areas and countries with scientific data to help them adjust their healthcare strategies.

METHODS

We analyzed the disease burden of Alzheimer's disease and other dementias among individuals aged 65 and older from 1990 to 2021; the relationship between mortality rates and disability-adjusted life years (DALYs) with socio-demographic index (SDI); conducted a frontier analysis of the disease burden across 204 countries; and quantified inequalities in age-standardized DALYs for Alzheimer's disease and other dementias using the slope inequality index and concentration index.

RESULTS

Globally, age-standardized DALYs and mortality rates for individuals aged 65 and older have declined over time. We find that the disease burden of dementia is significantly associated with SDI. High SDI countries have 169% higher baseline levels of dementia burden compared to low SDI countries, as estimated based on their current level of social development. Finally, our health inequality analyses reveal that while the overall trend of DALYs for dementia increases with SDI, the burden is primarily concentrated in populations with lower SDI, as non-developed countries account for the majority of the population.

CONCLUSION

The global population aged 65 and older experiences a significant reduction in healthy life expectancy due to dementia. The burden of disease in most countries is higher than the minimum disease burden associated with SDI in those countries. The burden of disease in low and middle SDI countries has been showing an increasing trend. The gap in disease burden among regions with different SDI levels is also continuously narrowing.

Global, regional and national disparities and temporal trends of common autoimmune disease burdens among children and adolescents from 1990 to 2019

INTRODUCTION

Previous evidence lacked a thorough review of the disparities of autoimmune diseases (AD) burdens among countries and regions, which led to an insufficient basis for developing country-specific developmental level relevant preventive measures. This study aimed to analyse disparities and trends of global, regional and national burden of common ADs in children and adolescents from 1990 to 2019 and to investigate the associations between specific ADs and varied country indexes.

METHODS

All data for four major ADs were obtained from the Global Burden of Diseases Study 2019. Age period-cohort modelling was conducted to disentangle age, period and birth cohort effects on AD incidence from 1990 to 2019. Local regression smoothing models were used to fit the correlation between AD burdens and sociodemographic index (SDI). Pearson's correlation was used to investigate varied country-level risk factors for disease burden.

RESULTS

A global increase in four common ADs incidence was observed from 1.57 million to 1.63 million between 1990 and 2019 in the 0-24 age group. The age-standardised incidence rate of overall four ADs showed substantial regional and global variation with the highest incidence in high SDI regions. The age, period and cohort distributions of AD incidence varied significantly, especially in high SDI countries. Relative to the expected level of age-standardised incidence associated with SDI, the distribution varied by regions depending on the specific ADs. Countries with higher levels of socioeconomic development, better quality of life and easier access to healthcare and the healthcare system showed lower disease burdens of ADs.

CONCLUSIONS

The incidence patterns and disease burdens of ADs varied considerably according to age, time period and generational cohort, across the world between 1990 and 2019. Incidences of ADs in children and adolescents were significantly correlated with indexes involving risks of the environment, human rights and health safety and quality of life.

Global, regional, and national burden of refraction disorders: findings from the global burden of disease study 2021 and projections to 2050

BACKGROUND

Refraction disorders are the leading cause of visual impairment worldwide. This study investigates the global burden and trends of refraction disorders from 1990 to 2021, with projections extending to 2050.

METHODS

Data on prevalence and disability-adjusted life years (DALYs) for refraction disorders, along with their 95% uncertainty intervals (UIs), were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The study provides a comprehensive analysis of the epidemiology of refraction disorders at global, regional, and national levels. It examines trends from 1990 to 2021 from multiple dimensions, including overall and localized changes. Burden decomposition was performed to assess contributions from population size, age structure, and epidemiological changes. Cross-country inequalities were quantified using standard health equity methods recommended by the World Health Organization. Future changes in the burden of refraction disorders were also projected through 2050.

RESULTS

According to GBD 2021 estimates, there were 159,765,917 prevalent cases (95% UI: 142,526,915-178,698,348) and 6,618,600 DALYs (95% UI: 4,599,082-9,528,676) due to refraction disorders globally in 2021. From 1990 to 2021, prevalence and DALYs rates demonstrated a steady decline, although prevalence numbers, incidence numbers, and rates were consistently higher among females compared to males. Decomposition analysis showed that aging, population growth, and epidemiological changes contributed 36.25%, 76.92%, and - 13.18%, respectively, to changes in the age-standardized prevalence rate (ASR). The concentration index declined from - 0.17 (95% CI: -0.21 to - 0.13) in 1990 to - 0.10 (95% CI: -0.13 to - 0.07) in 2021, indicating a reduction in SDI-related inequalities. By 2050, the ASR for prevalence and DALYs is projected to decline to 1815.27 (95% UI: 534.15-3096.40) and 69.11 (95% UI: 21.45-116.77), respectively.

CONCLUSION

The global burden of refraction disorders decreased significantly from 1990 to 2021 and is expected to decline further by 2050. Females continue to experience a greater burden compared to males. Population growth emerged as the primary driver of changes in the ASR of prevalence and DALYs. While countries with low socio-demographic index (SDI) face a disproportionately high burden, SDI-related inequalities have gradually lessened over time.

Global, regional and national burden of rheumatoid arthritis from 1990 to 2021, with projections of incidence to 2050: a systematic and comprehensive analysis of the Global Burden of Disease study 2021

BACKGROUND

To provide insights into rheumatoid arthritis (RA) epidemiological trends, including prevalence, incidence, disability-adjusted life years (DALYs), corresponding average annual percentage change (AAPC), gender disparities, regional variations, age-specific rates, socio-economic correlations, risk factors, and future projections.

METHODS

Data were extracted from the Global Burden of Disease Study (GBD) 2021. AAPC was calculated by joinpoint regression and two-sample Mendelian randomization (MR) analysis was performed to verify the causal relationship between the smoking factor and RA. The future incidence trend was predicted by the Bayesian age-period-cohort (BAPC) model.

RESULTS

Global age-standardized prevalence rate (ASPR) and age-standardized incidence rate (ASIR) increased significantly while age-standardized DALYs rate (ASDR) decreased from 1990 to 2021. Regional variations were pronounced, with Andean Latin America reporting the highest burden. Females consistently exhibited higher age-standardized rate (ASR) across all metrics. Age-specific prevalence, incidence, and DALYs rates peaked at different age groups, highlighting complex demographic dynamics. Socio-demographic index (SDI) analysis demonstrated a positive correlation between RA burden and socio-economic development. The two-sample MR analysis confirmed a causal effect between smoking and RA. From 2022 to 2050, the ASIR will increase moderately.

CONCLUSIONS

The study underscores the escalating burden of RA globally, emphasizing the need for healthcare providers to be aware of the effects of aging populations and other societal factors on the risk of developing RA, and to develop targeted interventions, including smoking cessation programs, age- and gender-appropriate healthcare, and early diagnosis strategies.

Trends in the global, regional, and national burden of bladder cancer from 1990 to 2021: an observational study from the global burden of disease study 2021

To evaluate the changing trend and cross-country inequality of bladder cancer (BC) burden over the past 30 years and further predict the trend until 2036. Based on the Global Burden of Disease (GBD) 2021 study, the global incidence, mortality, and disability-adjusted life years (DALYs) of bladder cancer from 1990 to 2021 were obtained. We described the distribution of BC at global, regional and national levels and overall/local trends. The age-period-cohort analysis, decomposition analysis and inequality analysis related to socio-demographic index (SDI) were conducted. Additionally, we predicted the future trend of BC burden using Bayesian age-period-cohort model. In the GBD 2021, the global incidence number of BC was 540,310, doubling compared to that in 1990. However, the age-standardized rate (ASR) drops from 6.90 to 6.35. The changes in bladder cancer mortality and DALYs are similar. The ratio of ASRs of burden between males and females is approximately 4:1. Interestingly, in regions with middle SDI, low-middle SDI, and low SDI, the ASR of incidence has shown an upward trend to varying degrees in recent 10 years. Central Europe has the highest ASR of DALYs. China bore the heaviest burden of bladder cancer and experienced the greatest increase in the burden of bladder cancer. Globally, population growth, aging, and epidemiological changes accounted for 89.83%, 83.91%, and - 73.74% of the changes in DALYs respectively. The absolute inequality related to the SDI increases significantly. The slope index of inequality for DALYs increases from 79.84 to 115.60, and the concentration index slightly decreases to 0.26 in 2021. The prediction showed that the ASRs of the three indicators of bladder cancer would continue to decline from 2022 to 2036. Despite a downward trend in ASRs from 1990 to 2021, the global bladder cancer burden has generally increased with regional and country variations. The burden growth pattern driven by population growth and aging may potentially increase the burden number in the future. Burden is concentrated in high-SDI countries and there are signs indicating a shift towards lower-SDI countries. These findings highlighted challenges in BC prevention and management.

LILRB4 as a novel immunotherapeutic target for multiple diseases

Immune checkpoints are critical for maintaining autoimmune homeostasis and are implicated in various autoimmune diseases, with their significance increasingly recognized. Investigating the functions and mechanisms of these checkpoints is essential for the development of more effective treatments. Leukocyte immunoglobulin-like receptor subfamily B member 4 (LILRB4) stands out as a unique immune checkpoint, with limited expression in most normal tissues but prominent presence in various hematological and solid tumors. It is also expressed on numerous immune and stromal cells, functioning as both a "Tumor Immune Checkpoint" and a "Tumor Stromal Immune Checkpoint." Due to its distinct expression profile, LILRB4 plays a pivotal role in tumors, autoimmune diseases, allergic reactions, and the maintenance of immune homeostasis during transplantation and pregnancy. A thorough understanding of its ligands, functions, mechanisms, and ongoing therapeutic strategies targeting LILRB4 will be crucial for the development of advanced therapeutic options. This review examines LILRB4 expression and function across multiple diseases and discusses therapeutic approaches targeting LILRB4 in various contexts. Additionally, the potential of combining current drugs with LILRB4-targeted therapies is explored. Challenges in developing LILRB4-targeting drugs are also addressed, offering valuable insights for future research.

Trend analysis and cross-national inequity analysis of immune-mediated inflammatory diseases in children and adolescents aged 10-24 from 1990 to 2021

Introduction

Immune-mediated inflammatory diseases (IMIDs) are chronic inflammatory diseases caused by immune system dysregulation, affecting multiple systems and organs. Children and adolescents aged 10-24 are among the high-risk groups, and the global burden is substantial.

Methods

Using the latest data from global burden of disease (GBD) 2021, we employed Joinpoint regression analysis, Socio-Demographic Index (SDI) correlation analysis, and cross-national equity analysis to elucidate the spatiotemporal differences in the burden of IMIDs among 10-24-year-olds from 1990 to 2021.

Results

The burden of IMIDs in adolescents aged 10-24, ranked by severity, includes asthma, atopic dermatitis (AD), psoriasis, diabetes, rheumatoid arthritis (RA), inflammatory bowel disease (IBD), and multiple sclerosis (MS). Among these, asthma, AD, psoriasis, RA, and MS are more prevalent in females. Compared to 1990, the incidence rates of asthma and AD decreased in 2021, while the rates of psoriasis, diabetes, and RA increased. IMIDs are more common in Western Europe and North America, with rising incidence rates in South America and Asia. Concentration indices and slope indices indicate that these diseases are primarily concentrated in high SDI regions, although the differences in incidence rates between countries are decreasing.

Conclusion

While focusing on high-incidence regions, we must also pay attention to the incidence of IMIDs in emerging regions such as Asia and South America. Only in this way can we effectively reduce the heavy burden that IMIDs place on younger people globally.

Smoking-attributable neurological health loss: age-specific burden and health disparities

BACKGROUND

Smoking is a significant risk factor for neurological disorders, yet its global impact on these conditions remains underexplored.

METHODS

Using Global Burden of Diseases 2021 data, we analysed trends in age-standardised disability-adjusted life-years (DALYs) and deaths attributable to smoking from 1990 to 2021 for three neurological disorders: stroke, Alzheimer's disease and other dementias, and Multiple Sclerosis. Socioeconomic disparities were assessed using the lope index of inequality and the relative concentration index. Bayesian age-period-cohort models were employed to forecast smoking-attributable burden through 2050.

RESULTS

Between 1990 and 2021, annual smoking-attributable DALYs and death rates slightly declined by -1.93% and -1.92%, respectively, but absolute numbers continued to rise, from 26.10 million to 30.18 million DALYs and from 0.93 million to 1.15 million deaths. Older adults (aged 60 and above) experienced the greatest burden, contributing 58.15% of DALYs and 75.57% of deaths in 2021. Smoking-attributable stroke was increasingly concentrated in low sociodemographic index regions, whereas disparities in dementias and multiple sclerosis were more pronounced in socioeconomically advantaged regions, particularly for multiple sclerosis.

CONCLUSIONS

This study identified an age-specific burden and widening disparities for neurological disorders attributable to smoking, with older adults disproportionately experiencing an escalating impact. Targeted prevention and equitable healthcare access tailored for older adults are critical to mitigating smoking-attributable neurological health loss.

Global burden and cross-country inequalities of nutritional deficiencies in adults aged 65 years and older, 1990-2021: population-based study using the GBD 2021

BACKGROUND/OBJECTIVES

Nutritional deficiencies remain significant public health issues in older populations globally. This study evaluates the burden, trends, and cross-country inequalities of four common nutritional deficiencies (protein-energy malnutrition, iodine deficiency, vitamin A deficiency, and dietary iron deficiency) in older adults from 1990 to 2021.

METHODS

Age-standardised prevalence, disability-adjusted life years (DALYs), and average annual percentage changes (AAPCs) of these deficiencies in people aged ≥ 65 years at global, regional, and national levels were estimated from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Cross-country inequalities in disease burden were quantified using the slope index and concentration index, standard health equity methods recommended by the World Health Organization.

RESULTS

Globally, age-standardised prevalence rates of protein-energy malnutrition increased from 1407.16 per 100 000 population in 1990 to 2015.58 in 2021, with an AAPC of 1.18 (1.08-1.28), showing significant changes in 2015 and 2019, which were turning points in the joinpoint regression. Age-standardised prevalence rates of iodine, vitamin A, and dietary iron deficiencies decreased, with AAPCs of -0.49 (-0.53 to -0.44), -3.24 (-3.27 to -3.20), and - 0.14 (-0.17 to -0.12), respectively. Except for an increase in the DALY rate of vitamin A deficiency (AAPC 0.40), the DALY rates of the other three deficiencies decreased. Inequality in the burden of protein-energy malnutrition and iodine deficiency between high- and low-income countries narrowed, while inequality for vitamin A and dietary iron deficiencies remained stable. Age-standardised DALY rates for all deficiencies decreased as sociodemographic index increased.

CONCLUSIONS

The global status of nutritional deficiency among older adults has improved since 1990, but the increasing prevalence of protein-energy malnutrition requires attention. Additionally, cross-country health inequalities persist, necessitating more efficient public health measures.

Global, Regional and National Burden of Maternal Obstructed Labour and Uterine Rupture, 1990-2021: Global Burden of Disease Study 2021

BACKGROUND

Maternal obstructed labour and uterine rupture (MOLUR) are among the major maternal labour complications that threaten maternal and child health.

OBJECTIVE

The objective of this study was to systematically analyse the global burden of MOLUR using the Global Burden of Disease 2021 (GBD 2021) database to inform further improvements in maternal-related public health policies.

METHODS

Incidence and disability-adjusted life-year (DALY) data on MOLUR from 1990 to 2021 were collected in the GBD 2021. The joinpoint and Bayesian age-period-cohort models were used to analyse and predict time burden trends. The slope index and concentration index were used to evaluate health inequality. Frontier analysis was used to visualise the potential for burden reduction in individual countries or territories.

RESULTS

In 2021, 13,471,093 (95% uncertainty interval [UI] 8,938,373, 19,008,282) incident cases of MOLUR were reported worldwide, which caused 1,067,270 (95% UI 896,161, 1,275,042) DALYs. Over the past three decades, there has been an overall downward trend in the age-standardised incidence rate (ASIR) and age-standardised DALY rate (ASDR) of MOLUR globally, with the ASIR decreasing from 554.0 (95% UI 355.6, 786.3) per 100,000 in 1990 to 347.0 (95% UI 228.8, 489.4) in 2021. The ASDR decreased from 65.4 (95% UI 56.0, 75.7) per 100,000 in 1990 to 27.0 (95% UI 22.7, 32.2) in 2021. By 2040, the global ASIRs and ASDRs projections for MOLUR will likely continue to decline. Socioeconomic-related inequalities are narrowing, but the burden remains concentrated in low socioeconomically developed countries. Israel and Afghanistan showed the largest differences from the frontier boundaries of ASIR and ASDR.

CONCLUSIONS

Although the global burden of MOLUR has declined in the last three decades, it remains high and is still concentrated in economically underdeveloped countries. The reduction in DALYs attributable to MOLUR globally reflects significant progress in improving maternal health and reducing complications of childbirth.

Distributions and trends in the global burden of young-onset tracheal, bronchus, and lung cancer by region, age, and sex from 1990 to 2021: An age-period-cohort analysis

BACKGROUND

The young onset Tracheal, Bronchus, and Lung Cancer (TBLC) exhibits distinct gene mutations and clinical characteristics. With worsening air pollution, the incidence of young onset TBLC is increasing, resulting in significant economic burdens. The specific epidemiology of the disease burden remains elusive.

METHODS

The updated Global Burden of Disease (GBD) 2021 study was employed. This study reports on the disease burden trends of young TBLC (≤54 years) and its risk factors. Data is presented as counts and age-standardized rates (ASRs) per 100,000 people across different age groups, years, sexes, sociodemographic levels (SDI), and geographic locations (global, regional, and national). An age-period-cohort (APC) model was used to analyze longitudinal curves on age, period, and cohort effects for young TBLC. Decomposition analysis broke down temporal changes into three factors: population aging, population growth, and epidemiological change, to quantify the changes and identify their causes. An inequality index was applied to examine the inequality of disease burden of young TBLC by sex across different SDI levels between 1990 and 2021.

RESULTS

From 1990-2021, the global number of individuals under 55 diagnosed with TBLC increased from 320,715 to 489,080, representing a 52 % rise. However, the age-standardized rates of prevalence (Average annual percentage changes (AAPC) -0.05 %), incidence (AAPC -0.59 %), mortality (AAPC -0.88 %), and disability-adjusted life-years (DALYs) (AAPC -0.92 %) all showed a notable decline tendency. In 2021, there were 258,360 new diagnoses and 207,000 deaths from young TBLC, with ASRs of incidence and mortality at 6.43 and 5.49 per 100,000, respectively. Regionally, East Asia bore the highest burden, with about 117,730 new young TBLC cases and an ASR of 12.01 per 100,000 people. Decomposition analysis indicated that population growth was the primary driver for the increased prevalence of young TBLC. While tobacco-related DALYs for young TBLC decreased globally, tobacco remains the leading risk factor. In contrast, air pollution-related DALYs have significantly increased in middle and lower SDI regions. Over the past two decades, the burden of young TBLC among females has grown substantially, with increased inequality observed in 2021. Tobacco was the largest contributor to the PAF of young female DALYs in high SDI regions, whereas air pollution was the leading contributor in other SDI regions.

CONCLUSION

While the total number of young TBLC cases has been on the rise trend, primarily due to population changes, the ASRs of young TBLC burdens have decreased over the past two decades. In 2021, East Asia recorded the highest ASRs for young TBLC in terms of prevalence, incidence, and mortality. Tobacco remains the primary risk factor for young TBLC, and the DALYs burden from tobacco use has significantly decreased. However, the incidence of TBLC among non-smoking young females has grown rapidly over the past two decades, mainly due to air pollution, leading to increased inequality.

Global, regional and national burden of neuroblastoma and other peripheral nervous system tumors, 1990 to 2021 and predictions to 2035: visualizing epidemiological characteristics based on GBD 2021

BACKGROUND

Neuroblastoma (NB) is the most common extracranial malignant solid tumor in children, accounting for >15 % of cancer-related deaths in children. We analyzed the epidemiological statistical indicators of neuroblastoma and other peripheral nervous system tumors patients from 1990 to 2021 in Global Burden of Disease (GBD) 2021 database, aiming to provide valuable insights for public health interventions and clinical practices.

METHODS

Based on the GBD 2021 database, this study analyzed the incidence, mortality, prevalence, and Disability-Adjusted Life-Years (DALYs) of neuroblastoma and other peripheral nervous system tumors from 1990 to 2021, stratified by sociodemographic development index (SDI) and geographic regions. Cross-country inequalities analysis was conducted to quantify the SDI-related inequality of disease burden across countries. In addition, the average annual percentage change (AAPC) and Age-Period-Cohort (APC) model were used to evaluate the trend of disease burden, while the global burden of disease to 2035 was predicted by Bayesian Age-Period-Cohort (BAPC) model.

FINDINGS

This study reported the disease burden of neuroblastoma and other peripheral nervous system tumors in GBD 2021 database for the first time. Globally, the incidence and mortality of neuroblastoma have increased year by year from 1990 to 2021, especially in regions with low SDI, such as South Asia and sub-Saharan Africa, where the burden of disease has increased significantly. Regions with high SDI, such as North America and Western Europe, have seen a reduction in disease burden due to higher levels of medical care and earlier diagnosis. The age distribution shows that children under 5 years of age are mainly affected, especially in low- and middle-income areas. In addition, the incidence is slightly higher in men than in women. The BAPC model predicts that the global incidence, mortality, and DALYs of neuroblastoma will continue to increase until 2035.

INTERPRETATION

Significant regional and population variation in neuroblastoma and other peripheral nervous system tumors worldwide, with a particularly high disease burden in low SDI areas with limited medical resources. This trend highlights the urgent need for global public health interventions and resource allocation, particularly in low-income countries. Future research should focus on improving early diagnosis, risk stratification and target therapy in order to reduce the global burden of disease and improve patients' prognosis.

FUNDING

This study was supported by National Natural Science Foundation of China (No. 82293662, No 82172357 and No 81930066), Key project of Shanghai "Science and Technology Innovation Action Plan (22JC1402304) and Research fund of Shanghai Municipal Health Bureau (No. 2019cxjq03).

Cross-Country Inequalities in Disease Burden and Quality of Care of Stroke, 1990-2021: A Systematic Analysis of the Global Burden of Disease Study 2021

BACKGROUND AND PURPOSE

This study aims to assess the disease burden and care quality along with cross-country inequalities for stroke at global, regional, and national levels from 1990 to 2021.

METHODS

Data on stroke were extracted from the Global Burden of Disease (GBD) study 2021 for the globe, five sociodemographic index (SDI) regions, 21 GBD regions, and 204 countries/territories. The disease burden was quantified using the age-standardized disability-adjusted life years rate (ASDR). Quality of care (QoC) was evaluated through the age-standardized QoC index (QCI). To assess cross-country disparities in both disease burden and age-standardized QCI, the slope index of inequality (SII) and the concentration index were utilized.

RESULTS

From 1990 to 2021, the global ASDR of stroke decreased from 3078.95 (95% uncertainty interval [UI]: 2893.58, 3237.34) to 1886.20 (95% UI: 1738.99, 2017.90) per 100,000 population, while the age-standardized QCI improved from 50.79 to 64.61. However, the results of inequalities showed worsening inequalities in both ASDR and QCI, with lower SDI countries shouldering a disproportionate burden and higher SDI countries maintaining higher QoC. The SII and concentration index for ASDR indicated a worsening inequality among lower SDI countries, with SII increasing to -2616.44 and the concentration index increasing to -0.1119 in 2021. Meanwhile, the SII and concentration index for age-standardized QCI showed a worsening inequality among higher SDI countries, with SII of 27.48 and concentration index of 0.0922 in 2021.

CONCLUSIONS

Despite notable global advancements, significant disparities in stroke still exist, particularly in lower SDI regions facing high disease burdens and substandard care.

Global Trends of Early, Middle, and Late-Onset Lung Cancer From 1990 to 2021: Results From the Global Burden of Disease Study 2021

BACKGROUND

Although the global burden of lung cancer has generally declined in recent decades, the variation in onset age-related trends remains insufficiently explored. In the current study, we aimed to systematically evaluate the most update temporal trends in incidence, mortality and DALYs of early, middle, and late-onset lung cancer (EOLC, MOLC, and LOLC) from 1990 to 2021, with stratifications of gender, location, and socio-demographic development.

METHODS

We retrieved cross-sectional data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The global, regional, and national burden of lung cancer from 1990 to 2021 was evaluated primarily by age-standardized rates of incidence (ASIR), mortality (ASMR), and DALYs (ASDR). Joinpoint regression analysis was employed to assess temporal trends and turning point years. Frontier analysis was applied to examine the lowest achievable DALYs, and cross-country inequalities were evaluated sing the slope index of inequality (SII) and concentration index. We also forecasted the burden from 2022 to 2035.

RESULTS

The global ASIR of EOLC decreased from 4.81 per 100,000 in 1990 to 3.13 in 2021 (AAPC: -1.38, 95% confidence interval [CI]: -1.53 to -1.22, p < 0.001), with a steeper decline in males (AAPC: -1.79) compared to females (AAPC: -0.63). MOLC incidence also declined from 92.77 to 72.47 per 100,000 (AAPC: -0.81, 95% CI: -0.9 to -0.73, p < 0.01), while LOLC demonstrated a slight increase from 195.39 to 225.8 per (AAPC: 0.43, 95% CI: 0.37 to 0.5, p < 0.01). Notably, LOLC in females showed a consistent rise in incidence rate (AAPC: 1.13, 95% CI: 1.05 to 1.21, p < 0.01). In contrast to EOLC and MOLC, 11, 10, and 9 out of 21 GBD regions showed a rising trend for ASIR, ASMR, and ASDR of LOLC, respectively. East Asia showed the steepest increase in ASIR (from 229.26 in 1990 to 375.90 in 2021, AAPC = 1.6, 95% CI: 1.31 to 1.89, p < 0.001) of LOLC. Moreover, according to socio-demographic index (SDI) quintiles, the middle SDI region demonstrated the largest rise in ASIR of LOLC. Frontier analysis revealed that countries with higher SDIs had a greater capacity for reducing lung cancer burdens. Cross-country inequalities of lung cancer burden in females were found to improve much slower than in males. The projections implied that, although lung cancer would generally decline in the next decade, the incidence, mortality, and DALY rates of LOLC in females might remarkably increase.

CONCLUSIONS

The global incidence, mortality, and DALY rates of lung cancer showed a general decline from 1990 to 2021. However, concerning trends of LOLC burden, especially among females and in specific regions or countries, were observed in this study. This study could help to guide more targeted prevention and intervention strategies for lung cancer control.

A 32-year trend analysis of lower respiratory infections in children under 5: insights from the global burden of disease study 2021

Objectives

Lower respiratory infections are the most significant health threat to children under 5 years old, leading to the highest disease burden across all age groups. This study aims to provide an up-to-date assessment of the global burden of lower respiratory infections in children under 5 years of age.

Methods

This study utilizes data and methodologies from the Global Burden of Disease Study 2021 to analyze changes in the burden of lower respiratory infections from 1990 to 2021, focusing on incidence, mortality, and disability-adjusted life years. A jointpoint model is employed to calculate trends and the average annual percentage change in the disease burden among children under 5 years old over the period 1990-2021. Additionally, frontier analysis is used to visually depict the potential for burden reduction in each country or region based on their level of development.

Results

In 2021, the global burden of lower respiratory infections in children under 5 years old included 37,828,159 incidence cases, 501,909.50 deaths, and 44,779,174.70 disability-adjusted life years. From 1990 to 2021, the global burden of LRIs in this age group showed a marked decline. Incidence, mortality, and disability-adjusted life years decreased by 54.02, 37.57, and 39.49%, respectively. The average annual percent change for age-standardized incidence rate, age-standardized mortality rate, and age-standardized disability-adjusted life years rate were -3.35, -4.53%, and -4.52%, respectively. The disease burden was notably higher in children under 1 year old compared to those aged 2-4 years and the overall under-5 age group, with significant gender differences observed. Additionally, there was a strong negative correlation between the burden of lower respiratory infections in children under 5 and the socio-demographic index. Frontier analysis indicated that countries or regions with higher socio-demographic index values showed greater potential for reducing the burden.

Conclusion

The global burden of lower respiratory infections in children under 5 years old has declined significantly from 1990 to 2021. However, given the substantial disease burden, particularly in low-SDI countries, it is crucial to address risk factors and implement more effective interventions to further reduce the impact of lower respiratory infections on this vulnerable population.

A systematic epidemiological trends analysis study in global burden of multiple myeloma and 29 years forecast

Multiple myeloma is a prevalent hematologic cancer. This investigation analyzes the latest global, regional, and national data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021. Data on the incidence, prevalence, disability-adjusted life years, and mortality rates of multiple myeloma, including estimates and 95% uncertainty intervals, were sourced from the 2021 Global Burden of Diseases Study. Furthermore, we explored the trends affecting the multiple myeloma burden from 1990 to 2021, breaking it down by demographic, age, and epidemiological factors. By 2021, the global incidence of multiple myeloma involved 148,754.63 reported cases, with confidence intervals ranging from 131,780.43 to 162,049.23. Worldwide, the number of mortality attributed to multiple myeloma reached 116,359.63, with the confidence interval lying between 103,078.62 and 128,470.57, and an age-standardized mortality rate of 1.37 per 100,000 individuals, the confidence interval for which was 1.22 to 1.52. There was a consistent increase in the incidence, prevalence, and disability-adjusted life years associated with multiple myeloma. Most of the disease burdens were seen in high income countries though its incidence is on the rise in low-income countries. Forecast for the years 2022-2050 showed the further increase in the incidence, prevalence, disability-adjusted life years, and age-standardized death rates of multiple myeloma.

Hepatobiliary and pancreatic manifestations in inflammatory bowel disease: an umbrella review of meta-analyses

Background

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), can affect the hepatobiliary system and pancreas, substantially impacting the life quality of patients.

Objectives

To evaluate the quality of evidence and comprehensively assess the validity of associations of IBD with hepatobiliary and pancreatic diseases.

Design

We performed an umbrella review of existing meta-analyses in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) recommendations.

Data sources and methods

We systematically searched PubMed, Embase, and Web of Science from inception to April 2024, to identify and appraise meta-analyses examining IBD and risk of hepatobiliary and pancreatic manifestations. Methodologic quality was assessed with A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the strength of evidence was graded according to prespecified criteria.

Results

A total of 14 meta-analyses of observational studies were included. The strongest-validity evidence suggested the significant associations between IBD and risk of gallstones (odds ratio (OR) = 1.72; 95% confidence interval (CI) = 1.40-2.12) and acute pancreatitis (OR = 3.11; 95% CI = 2.93-3.30). Highly suggestive evidence indicated a significantly increased risk of hepatobiliary cancer in UC (incidence rate ratio (IRR) = 2.05; 95% CI = 1.52-2.76) and CD (IRR = 2.31; 95% CI = 1.25-4.28). In addition, highly suggestive evidence indicated that IBD was associated with portal venous system thrombosis. Suggestive evidence showed a significantly higher prevalence of primary sclerosing cholangitis, non-alcoholic fatty liver disease, autoimmune hepatitis, and autoimmune pancreatitis in IBD patients than in the general population.

Conclusion

The associations between IBD and multiple hepatobiliary and pancreatic disorders showed varying levels of evidence and magnitude of risk. Further high-quality primary studies are needed to identify IBD patients who are more at risk and would benefit the most from screening and prevention programs.

Trial registration PROSPERO

CRD42023451461.

Artificial intelligence-based cardiovascular/stroke risk stratification in women affected by autoimmune disorders: a narrative survey

Women are disproportionately affected by chronic autoimmune diseases (AD) like systemic lupus erythematosus (SLE), scleroderma, rheumatoid arthritis (RA), and Sjögren's syndrome. Traditional evaluations often underestimate the associated cardiovascular disease (CVD) and stroke risk in women having AD. Vitamin D deficiency increases susceptibility to these conditions. CVD risk prediction in AD can benefit from surrogate biomarker for coronary artery disease (CAD), such as carotid ultrasound. Due to non-linearity in the CVD risk stratification, we use artificial intelligence-based system using AD biomarkers and carotid ultrasound. Investigate the relationship between AD and CVD/stroke markers including autoantibody-influenced plaque load. Second, to study the surrogate biomarkers for the CAD and gather radiomics-based features such as carotid intima-media thickness (cIMT), and plaque area (PA). Third and final, explore the automated CVD/stroke risk identification using advanced machine learning (ML) and deep learning (DL) paradigms. Analysed biomarker data from women with AD, including carotid ultrasonography imaging, clinical parameters, autoantibody profiles, and vitamin D levels. Proposed artificial intelligence (AI) models to predict CVD/stroke risk accurately in AD for women. There is a strong association between AD duration and elevated cIMT/PA, with increased CVD risk linked to higher rheumatoid factor (RF) and anti-citrullinated peptide antibodies (ACPAs) levels. AI models outperformed conventional methods by integrating imaging data and disorder-specific factors. Interdisciplinary collaboration is crucial for managing CVD/stroke in women with chronic autoimmune diseases. AI-based assisted risk stratification methods may improve treatment decision-making and cardiovascular outcomes.

Evaluating the causal effect of using glucagon-like peptide-1 receptor agonists on the risk of autoimmune diseases

OBJECTIVE

To investigate the causal association of using glucagon-like peptide-1 receptor (GLP1R) agonists with autoimmune diseases.

METHODS

The available cis-eQTLs for drugs target genes (GLP1R) were used as genetic variants for exposure to GLP1R agonists. Type 2 diabetes was used as positive control. Mendelian randomizations (MR) were performed to explore the association of genetically-proxied GLP1R agonists with 11 autoimmune diseases from large-scale consortia. Replicating the findings in the FinnGen study and then pooled with meta-analysis. Finally, we performed MR analysis to examine whether GLP1R agonists affect 731 immune cell phenotypes to clarify the potential mechanism.

RESULTS

We observed supportive evidence to support the association of GLP1R agonists with reduced the risk of hypothyroidism (OR [95 %] = 0.89 [0.82-0.95], P < 0.001), but increased risk of ulcerative colitis (OR [95 %] = 1.48 [1.27-1.71], P < 0.001), type 1 diabetes (OR [95 %] = 1.34 [1.21-1.50], P < 0.001), systemic lupus erythematosus (OR [95 %] = 1.61 [1.29-2.02], P < 0.001) and sarcoidosis (OR [95 %] = 1.38 [1.08-1.75], P = 0.008). There was no supporting evidence to verify the association of GLP1R expression with asthma, Crohn's disease, multiple sclerosis and myasthenia gravis (P > 0.05). In addition, we found that GLP1R agonists was positively associated with 221 immune cell phenotypes (P < 0.05, OR > 1), and negatively associated with 317 immune cell phenotypes (P < 0.05, OR < 1).

CONCLUSION

GLP1R agonists are causally associated with various autoimmune diseases potentially through the modulation of 731 immune cell phenotypes.

Trends and cross-country inequality in the incidence of GI cancers among the working-age population from 1990 to 2021: a Global Burden of Disease 2021 analysis

BACKGROUND

GI cancers pose an increasing global health burden, with their impact on the working-age population (WAP) aged 15-64 years remaining largely unexplored despite the crucial role of this group in societal and economic well-being.

OBJECTIVE

To assess trends and cross-country inequality in the global burden of six GI cancers from 1990 to 2021 among individuals in the WAP.

DESIGN

The 2021 Global Burden of Disease study dataset was used to obtain estimates of GI cancer incidence and 95% uncertainty intervals, including the number of cases, crude incidence rate and age-standardised incidence rate (ASIR). WAP GI cancer epidemiology was assessed at the national, regional and global levels, evaluating trends from 1990 to 2021 from overall, local and Sociodemographic Index (SDI) perspectives and using standard health equity methods to quantify cross-country inequality.

RESULTS

Colorectal cancer exhibited the greatest burden of GI cancer among the WAP in 2021. From 1990 to 2021, the number of GI cancer cases rose by 51.9%, although the ASIR declined by 23.4%. These rates exhibit geographic variation, with the most cases and the highest ASIR in China and Mongolia, respectively. Incidence was disproportionately concentrated in higher SDI countries, and worsening inequality was evident over time.

CONCLUSIONS

While the ASIR of GI cancer is trending downwards among the WAP, high incidence rates, regional variability and an unequal burden of disease emphasise the need for flexible, targeted medical interventions to support policymaking and medical resource allocation.

Global, regional, and national temporal trends in metabolism-related ischemic stroke mortality and disability from 1990 to 2021

BACKGROUND

Stroke ranks as the second leading cause of mortality and the third leading cause of disability worldwide. Nonetheless, the evolving burden of ischemic stroke attributable to various metabolic risk factors remains inadequately elucidated. A thorough grasp of these trends is crucial for a nuanced comprehension of stroke epidemiology and the formulation of effective preventive and interventional measures.

METHOD

Based on the Global Burden of Disease, Injury, and Risk Factors Study 2021 (GBD), we analyzed national temporal trends in the burden of metabolism-associated ischemic stroke in 204 countries and territories globally from 1990-2021, as measured by the average annual percentage change (AAPC), using join-point regression models. The burden of disease was assessed using age-standardized (ASR) mortality rates and disability-adjusted life years (DALY) per 100 000 population. Cross-country inequalities in ischemic stroke burden were quantified using standard health equity methods and changes in ischemic stroke burden were projected to 2045.

RESULTS

Globally, the ASR for ischemic stroke mortality linked to overall dietary metabolic risk declined by an average of 1.6% annually, while the ASR for disability-adjusted life years saw an average annual decrease of 1.3%. High systolic blood pressure remained a primary contributor to metabolism-related ischemic stroke, accounting for 57.9% of deaths and 58.0% of disability in 2021. Disparities associated with the sociodemographic index (SDI) diminished, with the gap in DALYs between countries with the highest and lowest SDIs narrowing from 592.2 (95% CI: 440.2-744.4) to 480.4 (95% CI: 309.7-651.2) in 2021. Projections indicate a continued decline in overall metabolism-related ischemic stroke deaths, mortality rates, and ASRs through 2045, although an increase in DALYs and ASRs is anticipated within the male population.

CONCLUSION

The global burden of metabolic risk-associated ischemic stroke has generally been decreasing from 2019 to 2021. This study highlights significant challenges in controlling and managing metabolic risk-associated ischemic stroke, including an increase in the number of cases in certain countries and regions, as well as an uneven distribution worldwide. These findings may provide valuable insights for the development of improved public health policies and the rational allocation of healthcare resources.

Cross-country inequalities in disease burden and care quality of chronic kidney disease due to type 2 diabetes mellitus, 1990-2021: Findings from the global burden of disease study 2021

AIM

To explore the trend of burden and care quality of chronic kidney disease due to type 2 diabetes mellitus (CKD-T2DM) and their cross-country inequalities from 1990 to 2021.

MATERIALS AND METHODS

Data were from the Global Burden of Disease 2021 study. Disease burden and care quality were quantified using the disability-adjusted life years rate and the quality-of-care index (QCI). Trend analyses of the age-standardized disability-adjusted life years rate (ASDR) and age-standardized QCI from 1990 to 2021 were conducted using the estimated annual percentage change. The associations of disease burden and care quality with the socio-demographic index (SDI) were explored. Cross-country inequalities in disease burden and care quality were assessed using the slope index of inequality (SII) and concentration index.

RESULTS

From 1990 to 2021, the global ASDR for CKD-T2DM increased, while the age-standardized QCI slightly decreased, with an estimated annual percentage change of 0.81 [95% confidence interval (CI): 0.75, 0.87] and -0.08 (95% CI: -0.09, -0.07). The ASDR escalated with increasing SDI, reaching a peak at mid-level SDI, followed by a decrease. The age-standardized QCI was higher with increasing SDI. Globally, ASDR concentrated on countries/territories with a lower SDI. The SII of ASDR was -96.64 (95% CI: -136.94, -56.35) in 1990 and -118.15 (95% CI: -166.36, -69.94) in 2021,  with a concentration index of -0.1298 (95% CI: -0.1904, -0.0692) in 1990 and -0.1104 (95% CI: -0.1819, -0.0389) in 2021. In 1990 and 2021, countries/territories at higher SDI levels exhibited increased age-standardized QCI, indicated by an SII of 15.09 (95% CI: 10.74, 19.45) and 15.75 (95% CI: 10.92, 20.59), and a concentration index of 0.0393 (95% CI: 0.0283, 0.0503) and 0.0400 (95% CI: 0.0264, 0.0536).

CONCLUSIONS

Our study highlights considerable disparities in the burden and care quality of CKD-T2DM. Regions experiencing an increasing burden and a declining care quality simultaneously underscore the need for further research and tailored health interventions.

Human Papillomavirus Infection and Autoimmune Diseases: A Two-Sample Bidirectional Mendelian Randomization Study

BACKGROUND

Although earlier observational studies have revealed a connection between human papillomavirus (HPV) infection and several autoimmune diseases, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), the exact causative mechanism underlying this association is still unknown.

METHODS

This two-sample bidirectional MR study was conducted based on publicly released data from genome-wide association studies (GWAS). Our results were mainly derived from the inverse variance weighted (IVW) model, with the remaining three models also being calculated. The MR Steiger test was used to examine the correctness of our causal direction. Sensitivity analysis was performed using Mendelian randomized pleiotropy residual sum and outlier (MR-PRESSO), MR-Egger regression.

RESULTS

The IVW results showed that there was a positive causal association between HPV16 E7 protein and SLE (odds ratio (OR) = 1.075, 95% confidence interval (CI), 1.003-1.151, FDR-p = 0.04), however, there was a negative causal association between HPV18 E7 protein and SLE (OR = 0.884, 95% CI, 0.804-0.972, FDR-p = 0.02). No causal associations of HPV16 E7 protein and HPV18 E7 protein with RA, IBD was observed including its subtypes Ulcerative colitis (UC) and Crohn's disease (CD). Sensitivity analysis showed that there was no significant heterogeneity (p > 0.05) or genetic pleiotropy (p > 0.05).

CONCLUSION

Our two-sample bidirectional Mendelian randomization study identifies a causal association between HPV infection and SLE, but no causal association between HPV infection and RA and IBD.

A novel metric of autoimmune disease burden and its estimated incidence across different stages in life cycle of women

AIM

To produce a unique metric 'autoimmune disease (ADs)' based on various single autoimmune disorder and estimate its case number and age-standardized rate of incidence for each stage in life cycle of women from 1990 to 2019, and to further explore their temporal trends at global, regional, and national levels.

METHODS

A comprehensive classification for life cycle of women was proposed. The estimates and 95 % uncertainty intervals (UIs) for case number and rate of incidence for rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, psoriasis, and type 1 diabetes mellitus in all age groups (< 1, 1-4, 5-9, 10-14, 15-19, 20-24, 25-29, ……,80-84, 85-89, 90-94, 95+) were extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. 'ADs' was defined by combining these five disorders. Age standardization by direct method was utilized to estimate the age-standardized rate (ASR) of incidence of 'ADs' for each stage in life cycle of women. Joinpoint regression analysis was adopted to investigate temporal trends of ASR from 1990 to 2019 by calculating annual percentage change (APC) and average APC (AAPC). Associations of incidence in 2019 and change in incidence from 1990 to 2019, with Socio-demographic Index (SDI) were also explored.

RESULTS

In 2019, global ASR of incidence of 'ADs' in childhood, adolescence, adulthood, senility, women of childbearing age, perimenopause, menopause, and sex mature adults at the best reproductive age were 45.46 (95 % CI: 36.40 to 55.09), 59.97(95 % CI:46.62 to 75.30), 104.45 (95 % CI: 84.55 to 127.79), 129.58 (95 % CI: 105.18 to 157.68), 89.51 (95 % CI: 71.94 to 110.35), 130.92 (95 % CI: 106.98 to 158.16), 132.94 (95 % CI: 108.76 to 160.90) and 85.78 (95 % CI: 68.72 to 106.37), respectively. Regionally, although ASR in eight life stages differed from distinct geographical areas, the top three highest ASR all occurred in Western Europe, Australasia, and High-income North America. From 1990 to 2019, global ASR in childhood (AAPC: -0.39, [95 % CI: -0.4 to -0.38], p < 0.001), adolescence (AAPC: -0.4, [95 % CI: -0.41 to -0.4], p < 0.001), adulthood (AAPC: -0.53, [95 % CI: -0.55 to -0.51], p < 0.001), senility (AAPC: -0.4, [95 % CI: -0.41 to -0.38], p < 0.001), women of childbearing age (AAPC: -0.53, [95 % CI: -0.55 to -0.5], p < 0.001), perimenopause (AAPC: -0.56, [95 % CI: -0.59 to -0.52], p < 0.001), menopause (AAPC: -0.56, [95 % CI: -0.59 to -0.53], p < 0.001), and sex mature adults at the best reproductive age (AAPC: -0.5, [95 % CI: -0.51 to -0.49], p < 0.001) all significantly decreased. Nationally, ASR and its temporal trends in eight life stages varied significantly across 204 countries and territories. Additionally, incidence in 2019 and change in incidence from 1990 to 2019 were positively correlated with SDI across nations.

CONCLUSIONS

Significant heterogeneities in incidence of autoimmune diseases across nations, with higher sociodemographic development level presenting higher burden, suggest that flexible health policy and targeted resource allocation tailored to sociodemographic status are crucial for each country.

Global trends in the burden of rheumatoid arthritis by sociodemographic index: a joinpoint and age-period-cohort analysis based on the Global Burden of Disease Study 2019

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.

Global burden and cross-country inequalities in diseases associated with high body mass index from 1990 to 2019: Result from the Global Burden of Disease Study 2019

BACKGROUND

High body mass index (BMI) has gradually become an increased risk factor for the global burden of diseases (GBD). As the disease burden and the number of elders globally increase, it is crucial for policymakers to realise the associations between high BMI and disease burden worldwide in a timely manner and to develop effective interventions for different countries and ages.

METHODS

We used the GBD 2019 database to analyse the deaths and disability-adjusted life-years (DALYs) in the disease burden associated with high BMI and indicated the health inequality at the global, regional, and national levels. We applied the slope index of inequality and concentration index, two standard metrics of absolute and relative gradient inequality recommended by the World Health Organization (WHO), to quantify the distributive inequalities in the burden of diseases associated with high BMI. These rates were reported per 100 000 population as crude incidence rates, death rates, and DALYs rates. All the estimates were generated with a 95% uncertainty interval (UIs).

RESULTS

Globally, we revealed that an estimated age-standardised mortality rate associated with high BMI is 6.26 million (95% UIs = 3.99, 8.91). The age-standardised DALYs rate is 19.32 million (95% UIs = 12.77, 26.40), and the global population attributable fraction was 9% (95% UIs = 5, 12) in 2019. The largest number of high-BMI-related deaths in women mainly concentrated in the age group of 65-79 years, whereas the largest number in men was in the age group of 60-69 years. The age-standardised DALYs rate of diseases associated with high BMI was larger in the high-middle and middle socio-demographic index (SDI) (population attributable fraction (PAF) = 11 and PAF = 9) regions than those with high SDI (PAF = 1) and low SDI (PAF = 5) regions.

CONCLUSIONS

In this study, our results showed that the disease burden of global deaths and DALYs associated with high BMI has substantially increased between 1990-2019. Furthermore, we demonstrated that countries with higher SDI development levels shoulders higher burden of diseases associated with high BMI. Future policies to prevent and reduce the burden should be developed and implemented based on country-specific development status.

Global, Regional, and National Burden of Intracerebral Hemorrhage in Young Adults From 1990 to 2021: A Population-Based Study

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.

Global, regional, and national burden of bladder cancer, 1990-2019: an age-period-cohort analysis based on the Global Burden of Disease 2019 study

OBJECTIVES

Bladder cancer is a common malignancy worldwide, with substantial morbidity and mortality. This study aimed to assess the global, regional, and national burden of bladder cancer from 1990 to 2019 using data from the Global Burden of Disease (GBD) 2019 study and to analyze the trends using an age-period-cohort (APC) model.

STUDY DESIGN

In this cross-sectional study, secondary analyses were conducted to assess the burden of bladder cancer using data from GBD 2019.

METHODS

Bladder cancer prevalence, incidence, mortality, disability-adjusted life years (DALYs), and their age-standardized rates (ASRs) were obtained from the GBD 2019 study. The estimated annual percentage changes (EAPCs) were calculated to quantify the trends in ASRs. An APC analysis was performed to distinguish the effects of age, period, and cohort on the observed temporal trends.

RESULTS

The global prevalence of bladder cancer increased substantially from 1990 to 2019, reaching 2,869,046.4 cases (95% UI: 2,614,200.3-3,114,474.4) in 2019. The age-standardized prevalence rate rose from 20.9 per 100,000 population in 1990 to 37.1 per 100,000 population in 2019, with an EAPC of 1.97 (95% CI: 1.93-2.01). The global burden of bladder cancer, as measured by DALYs, increased from 48.0 per 100,000 population in 1990 to 56.8 per 100,000 population in 2019, with an EAPC of 0.47 (95% CI: 0.4-0.53), demonstrating the growing impact of this disease on population health.

CONCLUSIONS

This study demonstrates a significant increase in prevalence, incidence, mortality, and DALYs, with substantial variations across sociodemographic index (SDI) quintiles and GBD regions. The findings emphasize the need for concerted efforts at the global, regional, and national levels to reduce the burden of bladder cancer through primary prevention, early detection, and improved access to treatment services.

Two-sample Mendelian Randomization to evaluate the causal relationship between inflammatory arthritis and female-specific cancers

BACKGROUND

There is evidence that inflammatory arthritis in the form of ankylosing spondylitis (AS), psoriatic arthritis (PsA), and rheumatoid arthritis are both positively and negatively associated with certain female-specific cancers. However, the study results are very heterogeneous.

METHODS

Based on up to 375,814 European women, we performed an iterative two-sample Mendelian randomization to assess causal effects of the occurrence of the inflammatory arthritis on the risk of female-specific cancer in form of breast, endometrial, and ovarian cancer sites as well as their subtypes. Evidence was strengthened by using similar exposures for plausibility or by replication with a subsequent meta-analysis. P-values were Bonferroni adjusted.

RESULTS

Genetic liability to AS was associated with ovarian cancer (OR = 1.03; 95% CI: [1.01; 1.04]; [Formula: see text]=0.029) and liability to PsA with breast cancer (OR = 1.02; CI: [1.01; 1.04]; [Formula: see text]=0.002). Subgroup analyses revealed that the high-grade serous ovarian cancer (OR = 1.04; CI: [1.02; 1.06]; [Formula: see text]=0.015) and the ER- breast cancer (OR = 1.04; CI: [1.01; 1.07]; [Formula: see text]=0.118) appeared to drive the observed associations, respectively. No further associations were found between the remaining inflammatory arthritis phenotypes and female-specific cancers.

CONCLUSIONS

This study suggests that AS is a risk factor for ovarian cancer, while PsA is linked to an increased breast cancer risk. These results are important for physicians caring women with inflammatory arthritis to advise their patients on cancer screening and preventive measures.

Identification of potential novel targets for treating inflammatory bowel disease using Mendelian randomization analysis

BACKGROUND

Inflammatory bowel disease (IBD) is a complex autoimmune disorder, although some medications are available for its treatment. However, the long-term efficacy of these drugs remains unsatisfactory. Therefore, there is a need to develop novel drug targets for IBD treatment.

METHODS

We conducted two-sample Mendelian randomization (MR) analysis using Genome-Wide Association Study (GWAS) data to assess the causal relationships between plasma proteins and IBD and its subtypes. Subsequently, the presence of shared genetic variants between the identified plasma proteins and traits was explored using Bayesian co-localization. Phenome-wide MR was used to evaluate evaluated adverse effects, and drug target databases were examined for therapeutic potential.

RESULTS

Using the Bonferroni correction (P < 3.56e-05), 17 protein-IBD pairs were identified. Notably, the genetic associations of IBD shared a common variant locus (PP.H4 > 0.7) with five proteins (MST1, IL12B, HGFAC, FCGR2A, and IL18R1). As a subtype of IBD, ulcerative colitis shares common variant loci with FCGR2A, IL12B, and MST1. In addition, we found that ANGPTL3, IL18R1, and MST1 share a common variant locus with Crohn's disease. Furthermore, phenome-wide MR analysis revealed that except for ANGPTL3, no other proteins showed potential adverse effects. In the drug database, identified plasma proteins such as FCGR2A and IL18R1 were found to be potential drug targets for the treatment of IBD and its subtypes.

CONCLUSION

Six proteins (FCGR2A, IL18R1, MST1, HGFAC, IL12B, and ANGPTL3) were identified as potential drug targets for the treatment of IBD and its subtypes.

The role of mitochondrial DNA copy number in autoimmune disease: a bidirectional two sample mendelian randomization study

Background

Mitochondrial DNA (mtDNA) plays an important role in autoimmune diseases (AD), yet the relationship between mitochondria and autoimmune disease is controversial. This study employed bidirectional Mendelian randomization (MR) to explore the causal relationship between mtDNA copy number and 13 ADs (including ankylosing spondylitis [AS], Crohn's disease [CD], juvenile rheumatoid arthritis [JRA], polymyalgia rheumatica [PMR], psoriasis [PSO], rheumatoid arthritis [RA], Sjogren's syndrome [SS], systemic lupus erythematosus [SLE], thyrotoxicosis, type 1 diabetes mellitus [T1DM], ulcerative colitis [UC], and vitiligo).

Methods

A two-sample MR analysis was performed to assess the causal relationship between mtDNA copy number and AD. Genome-wide association study (GWAS) for mtDNA copy number were obtained from the UK Biobank (UKBB), while those associated with AD were sourced from the FinnGen Biobank. Inverse variance weighting (IVW) was the primary analysis method, complemented by three sensitivity analyses (MR-Egger, weighted median, weighted mode) to validate the results.

Results

IVW MR analysis identified significant associations between mtDNA copy number and CD (OR=2.51, 95% CI 1.56-4.22, P<0.001), JRA (OR=1.87, 95% CI 1.17-7.65, P=0.022), RA (OR=1.71, 95%CI 1.18-2.47, P=0.004), thyrotoxicosis (OR=0.51, 95% CI0.27-0.96, P=0.038), and T1DM (OR=0.51, 95% CI 0.27-0.96, P=0.038). Sensitivity analyses indicated no horizontal pleiotropy.

Conclusions

Our study revealed a potential causal relationship between mtDNA copy number and ADs, indicating that these markers may be relevant in exploring new therapeutic approaches.

Global, regional, and national burden of preterm birth, 1990-2021: a systematic analysis from the global burden of disease study 2021

Background

Preterm birth and its complications are leading causes of mortality among children under five years of age. Given the increasing burden of preterm birth on neonatal mortality and long-term health outcomes worldwide, a comprehensive global analysis is essential to guide effective public health interventions and policies. This study aims to assess the burden of preterm birth at the global, regional, and national levels.

Methods

Using data from the Global Burden of Disease (GBD) 2021 database, this study analysed trends in age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and disability-adjusted life-years (DALYs) as primary outcomes for preterm birth from 1990 to 2021 at global, regional, and national levels. Data were assessed using joinpoint regression analysis, decomposition analysis, and the health inequality concentration index.

Findings

Globally, the incidence, mortality and DALYs due to preterm birth have shown a declining trend, but ASIR started to increase in 2016. Males were more commonly born preterm than females (12329075.82, 95% uncertainty interval [UI]: 12192632.55-12464605.4 vs. 9224694.94, 95% UI: 9113876.1-9330107.89). Changes in DALYs were primarily due to epidemiological change (111.97%) and population (-21.59%). Low Socio-demographic Index (SDI) regions increased in annual incidence cases (43.1%, 95% UI: 40.17-46.09), while high SDI regions decreased in annual incidence cases (-9.6%, 95% UI: -11.45 to -7.79). The highest annual mortality and DALYs respectively occurred in sub-Saharan Africa (295490.66, 95% UI: 241762.78-353624.41) and South Asia (32760273.93, 95% UI: 27295547.76-39070225.69). Western sub-Saharan Africa showed the largest increase in annual incidence (98.95%, 95% UI: 94.77 to 103.09), and Australasia had the lowest annual mortality (287.18, 95% UI: 244.26-339.42) and DALYs (61081.4, 95% UI: 50897.33-73069.96). Western sub-Saharan Africa also had the highest ASMR (21.57, 95% confidence interval [CI]: 17.9-25.89). The highest ASIR (543.78, 95% CI: 535.11-553.21) and age-standardized DALYs (2064.65, 95% CI: 1717.27-2473.36) both occurred in South Asia, while the lowest ASIR and age-standardized DALYs were seen in East Asia (147.31, 95% CI: 144.22-150.85) and High-income Asia Pacific (143.32, 95% CI: 117.9-167.25). India, Nigeria, and Pakistan ranked highest globally in terms of annual incidence cases, mortality, and DALYs, while the lowest annual incidence, mortality and DALYs respectively occurred in Tokelau (2.34, 95% UI: 2.12-2.56), San Marino (0.04, 95% UI: 0.02-0.07) and Tokelau (17.22, 95% UI: 11.11-24.95).

Interpretation

While the global burden of preterm birth has decreased, significant disparities persist, especially in low SDI regions. There is a need for more refined policies and preventive measures to effectively address preterm birth.

Funding

No funds, grants, or other support was received.

Temporal trends in cross-country inequalities of stroke and subtypes burden from 1990 to 2021: a secondary analysis of the global burden of disease study 2021

Background

Stroke remains a significant global health challenge, with persistent disparities in burden across different countries and regions. This study aimed to assess the temporal trends in cross-country inequalities of stroke and its subtypes burden from 1990 to 2021.

Methods

We conducted a secondary analysis of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The age-standardised disability-adjusted life years (DALYs) rate (ASDR) was used to assess the burden of stroke and its subtypes (ischemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage) across 21 GBD regions and 204 countries. The slope index of inequality (SII) and the concentration index were calculated to quantify the absolute and relative cross-country inequalities in the burden of stroke and its subtypes, with negative values indicating a higher burden in lower socio-demographic index (SDI) countries, and positive values indicating a higher burden in higher SDI countries. Estimated annual percentage change (EAPC) was used to illustrate temporal trends at global and regional levels from 1990 to 2021. The inequality changing patterns from 1990 to 2021 were classified as worsening, improving, and shifting to higher burdens among higher or lower SDI countries.

Findings

From 1990 to 2021, the ASDR of total stroke decreased from 3078.95 (95% uncertainty interval [UI]: 2893.58, 3237.34) to 1886.20 (95% UI: 1738.99, 2017.90) per 100,000 population globally. While both absolute and relative inequalities increased, with a disproportionately higher burden shouldered by countries with lower SDI. The SII of total stroke exhibited a worsening inequality among lower SDI countries, increasing by 286.97 units from -2329.47 (95% confidence interval [CI]: -2857.50, -1801.43) in 1990 to -2616.44 (95% CI: -2987.33, -2245.56) in 2021. Similarly, the concentration index of total stroke increased by 0.03 from -0.0819 (95% CI: -0.1143, -0.0495) in 1990 to -0.1119 (95% CI: -0.1478, -0.0759) in 2021. The changing patterns from 1990 to 2021 were diverse across regions, yet most regions exhibited a worsening inequality among lower SDI countries in both SII and concentration index. Southern Sub-Saharan Africa showed the largest worsening inequality in SII (EAPC: -2.15, 95% CI: -2.71, -1.57) while Central Europe showed the largest worsening inequality in concentration index (EAPC: -0.51, 95% CI: -0.58, -0.44). In 2021, the highest negative SII was observed in Oceania and the highest negative concentration index was in the Caribbean. In terms of subtypes, ischemic stroke reported a worsening inequality among lower SDI countries in SII (EAPC: -2.13, 95% CI: -2.20, -2.05) while intracerebral haemorrhage showed an improving inequality in SII (EAPC: 0.44, 95% CI: 0.40, 0.47). SII in subarachnoid haemorrhage (EAPC: -0.18, 95% CI: -0.19, -0.17) and concentration index in ischemic stroke (EAPC: -0.25, 95% CI: -0.27, -0.23) presented a shift to higher burden among lower SDI countries from 1990 to 2021.

Interpretation

Although the burden of stroke and its subtypes decreased from 1990 to 2021, inequalities have persisted and even widened in some regions. Timely and effective prevention and management strategies for stroke and its subtypes are needed in specific areas to reduce the stroke burden and achieve equity in health outcomes.

Funding

None.

Global burden of musculoskeletal disorders in children and adolescents from 1990 to 2021: a joint point regression and decomposition analysis

The study aimed to investigate the pattern and trend of Musculoskeletal (MSK) disorders in people aged 5-19 years from 1990 to 2021. The data was sourced from the Global Burden of Disease study 2021. The Age-standardized DALYs rates (ASDR), age-standardized mortality rate (ASMR), age-standardized prevalence rate (ASPR), and age-standardized incidence rate (ASIR) and their corresponding average annual percent change (AAPC) for MSK disorders were evaluated by sex, region, and sociodemographic index (SDI) quintiles. Globally, the ASPR of MSK disorders among children and adolescents increased per 100,000 population from 3048.66 (95% confidence interval [CI]: 2336.68-3887.02) in 1990 to 3105.46 (95% CI: 2421.09-3904.95) in 2021 (AAPC 0.06 [95% CI: 0.05-0.07]). In 2021, individuals aged 15-19 experienced the highest burden compared to those aged 5-9 and 10-14. In 2021, high SDI countries had the highest ASIR, ASPR, ASDR of MSK disorders. The AAPC of ASPR in high SDI countries showed a stark contrast to that in low SDI countries for the same period (AAPC 0.48 vs. AAPC -0.03). From 1990 to 2021, in low SDI and low-middle SDI countries, the increase in DALYs was primarily due to population growth. However, in middle SDI, high-middle, and high SDI countries, the increases were mainly due to epidemiological changes. Globally, patients aged 10-14 experienced better care compared to those in the 5-9 and 15-19 age groups. Specific preventive health measures are needed for females and adolescents aged 15-19 in high SDI countries.

Global burden, trends, and cross-country inequalities of urinary tract infections in adolescents and young adults, 1990 to 2019

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.

C/EBPδ Mediates Immunity to Renal Autoinflammatory Disorders in a Stage-specific Manner

Kidney disease represents a major medical and economic burden for which improved treatments are urgently needed. Emerging data have implicated Th17 cells and IL-17 signaling in the underlying pathogenesis of autoantibody-induced glomerulonephritis (AGN). However, the downstream transduction pathways mediated by IL-17 in autoimmunity are not well defined. In this article, we show that CCAAT/enhancer-binding protein (C/EBP) δ is elevated in kidney biopsies from multiple manifestations of human AGN. C/EBPδ is similarly upregulated in a mouse model of anti-glomerular basement membrane protein-mediated kidney disease, and Cebpd-/- mice were fully refractory to disease. Although C/EBPδ is expressed in a variety of cell types, C/EBPδ was required only in the radioresistant compartment to drive GN pathology. C/EBPδ induced expression of several IL-17-induced kidney injury markers and cytokines implicated in disease, including Il6 and Lcn2. Because mouse AGN models do not progress to fibrosis, we employed a nephrotoxic injury model using aristolochic acid I to assess the contribution of the IL-17-C/EBPδ pathway to renal fibrotic events. Surprisingly, deficiency of either C/EBPδ or the IL-17 receptor caused kidney fibrosis to be enhanced. Thus, C/EBPδ and IL-17 play divergent and apparently stage-specific roles in the pathogenesis of kidney disease.

Global, regional, and national burden of inflammatory bowel disease, 1990-2021: Insights from the global burden of disease 2021

PURPOSE

The prevalence of inflammatory bowel disease (IBD) is on the rise worldwide. We utilizes data from the Global Burden of Diseases (GBD) 2021 to analyze the national-level burden of IBD, trends in disease incidence, and epidemiological characteristics.

METHODS

Detailed information on IBD was gathered from 204 countries and territories spanning 1990 to 2021, sourced from the GBD 2021. Calculations were performed for incidence rates, mortality rates, disease-adjusted life years (DALYs), and estimated annual percentage changes (EAPCs). These trends were analyzed based on region, nationality, age, gender, and World Bank income level stratifications.

RESULTS

The global age-standardised incident rate (ASIR) of IBD increased from 4.22 per 100000 in 1990 to 4.45 per 100000 in 2021. However, the age-standardised mortality rate (ASMR) decreased from 0.60 per 100000 in 1990 to 0.52 per 100000 in 2021. Similarly, the age-standardised DALYs rate decreased from 21.55 per 100000 in 1990 to 18.07 per 100000 in 2021. Gender comparisons showed negligible differences in disease burden. The greatest increase in IBD-associated ASIR and ASMR occurred in World Bank upper-middle income region (EAPCs, 1.25) and World Bank high-income region (EAPCs, 1.00), respectively. Regionally, East Asia experienced the largest increase in ASIR (EAPCs, 2.89). Among 204 countries, China had the greatest increases in ASIR (EAPCs, 2.93), Netherlands had the highest ASMR in 2021 (2.21 per 100000).

CONCLUSIONS

Global incidence rate of IBD have been increasing from 1990 to 2021, while the DALYs and mortality have been decreasing. The escalating incident rates in select Asian regions deserves further attention.

Telitacicept: A novel horizon in targeting autoimmunity and rheumatic diseases

BLyS and APRIL have the capability to bind to B cells within the body, allowing these cells to evade elimination when they should naturally be removed. While BLyS primarily plays a role in B cell development and maturation, APRIL is linked to B cell activation and the secretion of antibodies. Thus, in theory, inhibiting BLyS or APRIL could diminish the population of aberrant B cells that contribute to SLE and reduce disease activity in patients. Telitacicept functions by binding to and neutralizing the activities of both BLyS and APRIL, thus hindering the maturation and survival of plasma cells and fully developed B cells. The design of telitacicept is distinctive; it is not a monoclonal antibody but a TACI-Fc fusion protein generated through recombinant DNA technology. This fusion involves merging gene segments of the TACI protein, which can target BLyS/APRIL simultaneously, with the Fc gene segment of the human IgG protein. The TACI-Fc fusion protein exhibits the combined characteristics of both proteins. Currently utilized for autoimmune disease treatment, telitacicept is undergoing clinical investigations globally to assess its efficacy in managing various autoimmune conditions. This review consolidates information on the mechanistic actions, dosing regimens, pharmacokinetics, efficacy, and safety profile of telitacicept-a dual-targeted biological agent. It integrates findings from prior experiments and pharmacokinetic analyses in the treatment of RA and SLE, striving to offer a comprehensive overview of telitacicept's research advancements.

The global burden, trends and cross-country inequalities of female breast and gynaecologic cancers: A population based study

OBJECTIVE

To analyse the global burden, trends and cross-country inequalities of female breast and gynaecologic cancers (FeBGCs).

DESIGN

Population-Based Study.

SETTING

Data sourced from the Global Burden of Disease Study 2019.

POPULATION

Individuals diagnosed with FeBGCs.

METHODS

Age-standardised mortality rates (ASMRs), age-standardised Disability-Adjusted Life Years (DALYs) rates (ASDRs) and their 95% uncertainty interval (UI) described the burden. Estimated annual percentage changes (EAPCs) and their confidence interval (CI) of age-standardised rates (ASRs) illustrated trends. Social inequalities were quantified using the Slope Index of Inequality (SII) and Concentration Index.

MAIN OUTCOME MEASURES

The main outcome measures were the burden of FeBGCs and the trends in its inequalities over time.

RESULTS

In 2019, the ASDRs per 100 000 females were as follows: breast cancer: 473.83 (95% UI: 437.30-510.51), cervical cancer: 210.64 (95% UI: 177.67-234.85), ovarian cancer: 124.68 (95% UI: 109.13-138.67) and uterine cancer: 210.64 (95% UI: 177.67-234.85). The trends per year from 1990 to 2019 were expressed as EAPCs of ASDRs and these: for Breast cancer: -0.51 (95% CI: -0.57 to -0.45); Cervical cancer: -0.95 (95% CI: -0.99 to -0.89); Ovarian cancer: -0.08 (95% CI: -0.12 to -0.04); and Uterine cancer: -0.84 (95% CI: -0.93 to -0.75). In the Social Inequalities Analysis (1990-2019) the SII changed from 689.26 to 607.08 for Breast, from -226.66 to -239.92 for cervical, from 222.45 to 228.83 for ovarian and from 74.61 to 103.58 for uterine cancer. The concentration index values ranged from 0.2 to 0.4.

CONCLUSIONS

The burden of FeBGCs worldwide showed a downward trend from 1990 to 2019. Countries or regions with higher Socio-demographic Index (SDI) bear a higher DALYs burden of breast, ovarian and uterine cancers, while those with lower SDI bear a heavier burden of cervical cancer. These inequalities increased over time.

Advances in research on immunocyte iron metabolism, ferroptosis, and their regulatory roles in autoimmune and autoinflammatory diseases

Autoimmune diseases commonly affect various systems, but their etiology and pathogenesis remain unclear. Currently, increasing research has highlighted the role of ferroptosis in immune regulation, with immune cells being a crucial component of the body's immune system. This review provides an overview and discusses the relationship between ferroptosis, programmed cell death in immune cells, and autoimmune diseases. Additionally, it summarizes the role of various key targets of ferroptosis, such as GPX4 and TFR, in immune cell immune responses. Furthermore, the release of multiple molecules, including damage-associated molecular patterns (DAMPs), following cell death by ferroptosis, is examined, as these molecules further influence the differentiation and function of immune cells, thereby affecting the occurrence and progression of autoimmune diseases. Moreover, immune cells secrete immune factors or their metabolites, which also impact the occurrence of ferroptosis in target organs and tissues involved in autoimmune diseases. Iron chelators, chloroquine and its derivatives, antioxidants, chloroquine derivatives, and calreticulin have been demonstrated to be effective in animal studies for certain autoimmune diseases, exerting anti-inflammatory and immunomodulatory effects. Finally, a brief summary and future perspectives on the research of autoimmune diseases are provided, aiming to guide disease treatment strategies.

Identification of lipid-modifying drug targets for autoimmune diseases: insights from drug target mendelian randomization

BACKGROUNDS

A growing body of evidence has highlighted the interactions of lipids metabolism and immune regulation. Nevertheless, there is still a lack of evidence regarding the causality between lipids and autoimmune diseases (ADs), as well as their possibility as drug targets for ADs.

OBJECTIVES

This study was conducted to comprehensively understand the casual associations between lipid traits and ADs, and evaluate the therapeutic possibility of lipid-lowering drug targets on ADs.

METHODS

Genetic variants for lipid traits and variants encoding targets of various lipid-lowering drugs were derived from Global Lipid Genetics Consortium (GLGC) and verified in Drug Bank. Summary data of ADs were obtained from MRC Integrative Epidemiology Unit (MER-IEU) database and FinnGen consortium, respectively. The causal inferences between lipid traits/genetic agents of lipid-lowering targets and ADs were evaluated by Mendelian randomization (MR), summary data-based MR (SMR), and multivariable MR (MVMR) analyses. Enrichment analysis and protein interaction network were employed to reveal the functional characteristics and biological relevance of potential therapeutic lipid-lowering targets.

RESULTS

There was no evidence of causal effects regarding 5 lipid traits and 9 lipid-lowering drug targets on ADs. Genetically proxied 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) inhibition was associated with a reduced risk of rheumatoid arthritis (RA) in both discovery (OR [odds ratio] = 0.45, 95%CI: 0.32, 0.63, P = 6.79 × 10- 06) and replicate datasets (OR = 0.37, 95%CI: 0.23, 0.61, P = 7.81 × 10- 05). SMR analyses supported that genetically proxied HMGCR inhibition had causal effects on RA in whole blood (OR = 0.48, 95%CI: 0.29, 0.82, P = 6.86 × 10- 03) and skeletal muscle sites (OR = 0.75, 95%CI: 0.56, 0.99, P = 4.48 × 10- 02). After controlling for blood pressure, body mass index (BMI), smoking and drinking alchohol, HMGCR suppression showed a direct causal effect on a lower risk of RA (OR = 0.33, 95%CI: 0.40, 0.96, P = 0.042).

CONCLUSIONS

Our study reveals causal links of genetically proxied HMGCR inhibition (lipid-lowering drug targets) and HMGCR expression inhibition with a decreased risk of RA, suggesting that HMGCR may serve as candidate drug targets for the treatment and prevention of RA.