Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Global, regional, and national progress towards the 2030 global nutrition targets and forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.

METHODS

The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.

FINDINGS

In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.

INTERPRETATION

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.

FUNDING

Bill & Melinda Gates Foundation.

Burden of cardiometabolic disease attributable to sugar sweetened beverages consumption in North Africa and the Middle East from 1990 to 2021

Objectives

The consumption of sugar-sweetened beverages (SSBs) is recognized as a significant risk factor for chronic non-communicable diseases (NCDs). Accurate estimates of the burden of SSBs are crucial for preventing, controlling, and treating associated diseases to achieve the Third United Nations Sustainable Development Goal of reducing premature mortality from NCDs by one-third by 2030. In this study, we aim to systematically assess the regional patterns and trends in the burden of SSBs in the North Africa and the Middle East (NAME) region. By analyzing regional differences, the study identifies specific areas where SSBs consumption has a more significant impact on public health.

Methods

The study data were retrieved from the Global Burden of Disease (GBD) study 2021. This study analyzed the impact of SSBs on mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 21 countries in the NAME region from 1990 to 2021. Our analysis considered various factors, including sex, age, region, and socio-demographic index.

Results

In 2021, DALYs attributable to SSBs there were 315,312 (95% uncertainty interval, 140,854 to 503,347) in absolute terms reflecting 518.3% (424.9 to 642.2) increase over three decades. From 1990 to 2021, the age-standardized rate of DALYs attributable to SSBs increased by 118.5%, from 27.9 (11.4 to 43.9) to 61.0 (27.6 to 97.0) per 100,000 population. Qatar (246.7 [113.1 to 404.5]), Saudi Arabia (201.2 [87.1 to 314.2]), and Bahrain (180.1 [78.4 to 295.8]) had the highest age-standardized rate of DALYs. The highest attributable DALYs and mortality from SSBs consumption were due to diabetes mellitus in all countries in 1990 and 2021. In 2021, Qatar (224.7 [104.9 to 365.5]), Bahrain (167.0 [74.8 to 274.8]), and Saudi Arabia (153.1 [75.3 to 230.4]) had the three highest age-standardized rates of DALYs from diabetes mellitus attributed to SSBs.

Conclusions

NAME witnessed a substantial increase in the burden attributable to SSBs. Alarmingly, exposure to SSBs has principally contributed to the increased burden of diabetes mellitus and chronic kidney disease. Among the region's countries, exposure and attributable burden trends vary considerably. It is imperative that governments and health authorities within the NAME region work together to combat SSBs' detrimental effects. Local, socioeconomic, and educational factors need to be considered when developing prevention and treatment strategies at the individual, community, and national levels.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01578-9.

Knowledge, attitude, and practice of cardiac rehabilitation referral among healthcare professionals in China: A mediation model

Objective

Despite proven clinical benefits, cardiac rehabilitation referral rates remained insufficient and low globally. Healthcare professionals' knowledge and attitudes of cardiac rehabilitation may affect their referral behaviors, yet their interrelationships are rarely studied in China. This study aims to examine the cardiac rehabilitation referral rate among Chinese healthcare professionals and explore the associations among knowledge, attitude, and practice (KAP) of cardiac rehabilitation referral.

Methods

From July to August 2021, a cross-sectional study was conducted among 321 healthcare professionals from 40 hospitals in Hunan Province of China. The participants completed an online questionnaire to assess their KAP of cardiac rehabilitation referral. Mediation analysis was conducted using logistic regression analysis, Sobel test and Bootstrap method.

Results

About one-third of healthcare professionals never recommended cardiac rehabilitation to their patients. The correlation analysis showed that cardiac rehabilitation knowledge was positively correlated with cardiac rehabilitation referral attitude (r = 0.57, P < 0.001). There was a robust positive association between cardiac rehabilitation knowledge and cardiac rehabilitation referral practice, which was partially mediated by cardiac rehabilitation referral attitude, with the mediating effect accounting for 4.3 %.

Conclusion

The low cardiac rehabilitation referral rate among healthcare professionals indicates an urgent need to improve cardiac rehabilitation referral. Our mediation model suggests that enhancing cardiac rehabilitation knowledge and promoting positive attitudes through education and training may effectively promote cardiac rehabilitation referral. Furthermore, the findings underscore the necessity of establishing an organized cardiac rehabilitation system to facilitate structured cardiac rehabilitation implementation and improve patient outcomes.

Circulating polyunsaturated fatty acids percentages and coronary artery disease incidence and mortality: Observational and Mendelian randomization analyses

BACKGROUND

The roles of polyunsaturated fatty acids (PUFAs) in preventing coronary artery disease (CAD) remain controversial. This study aimed to investigate the relationships between circulating PUFA percentages and CAD outcomes using observational and Mendelian randomization (MR) approaches.

METHODS

We analyzed data from 203,373 UK Biobank participants without CAD at baseline. Four PUFA percentages (docosahexaenoic acid [DHA]%, omega-3%, linoleic acid [LA]%, and omega-6%) were examined in relation to incident CAD and CAD mortality. MR analyses included one-sample linear and nonlinear approaches, as well as two-sample univariable and multivariable methods. Observational and one-sample MR analyses were conducted overall and stratified by age and sex.

RESULTS

During a median follow-up of 13.2 years, 16,098 incident CAD cases and 1243 CAD deaths occurred. Observationally, all PUFA percentages were inversely associated with both CAD outcomes. In one-sample MR, genetically predicted DHA% was strongly associated with decreased risk of CAD mortality (hazard ratio [HR] 0.31, 95 % confidence interval [CI] 0.15-0.62, P = 9.71 × 10-4), with a pronounced effect in individuals aged ≥58 years (HR 0.20, 95 % CI 0.09-0.43, P = 4.75 × 10-5). Genetically predicted omega-6% was associated with a decreased risk of incident CAD (HR 0.84, 95 % CI 0.76-0.92, P = 1.26 × 10-4), with a significant effect in females but not in males. Two-sample MR confirmed these findings, suggesting partial mediation through lipid pathways. Nonlinear MR analyses validated these linear associations without threshold effects.

CONCLUSIONS

Observational and genetically predicted high DHA% protects against CAD mortality, particularly in older adults. Omega-6% and incident CAD exhibited sex-specific inverse associations. These findings underscore the importance of considering age and sex in PUFA-based strategies for CAD prevention.

Burden of Congenital Heart Anomalies in North Africa and the Middle East, 1990 to 2021: A Systematic Analysis for the Global Burden of Disease Study 2021

BACKGROUND

Congenital heart anomalies (CHAs) remain a significant global health burden despite advances in diagnosis and management. Data on CHA burden in North Africa and the Middle East region are scarce. This study aimed to estimate CHA trends from 1990 to 2021.

METHODS AND RESULTS

Using the Global Burden of Disease Research 2021 database, we assessed CHA incidence, prevalence, mortality, and disability-adjusted life years (DALYs), stratified by age, sex, and sociodemographic index (SDI) at regional and national levels. Decomposition analysis was used to evaluate the impact of population growth on CHA incidence. In 2021, CHAs caused 35 272 deaths (95% uncertainty interval [UI], 28 067-43 670) and 3 181 543 DALYs (95% UI, 2 544 864-3 899 408) in the North Africa and the Middle East region. Incidence and prevalence increased by 13% (95% CI, 10-17) and 70% (95% CI, 67-74), respectively, whereas CHA-related deaths and DALYs declined by 63% (95% CI, 28-73). Infants <12 months of age accounted for 74.9% of deaths and DALYs, with half occurring within the first month. High-SDI countries had the lowest CHA-related DALYs, whereas middle-SDI countries showed the most substantial decline in mortality. Decomposition analysis highlighted that the actual CHA incidence is lower than expected despite population growth.

CONCLUSIONS

Although CHA incidence and prevalence increased, mortality and DALYs decreased, particularly in middle-SDI countries. The highest burden was among infants, with better outcomes in higher-SDI nations. More effective strategies are needed to reduce the preventable childhood deaths related to CHAs in the North Africa and the Middle East region.

Multivariate decomposition of gender differentials in cognitive impairment among older adults in India based on Longitudinal Ageing Study in India, 2017-2018

BACKGROUND

Increasing life expectancy and declining fertility rates have increased the ageing population around the world. The literature lacks a consensus regarding the risk of cognitive impairments by gender.

OBJECTIVE

Our study aims to examine the differences in cognition impairments between male and female older adults in India.

METHODOLOGY

We utilized data from the first wave of the Longitudinal Ageing Study in India (LASI) (2017-18), analyzing 31,464 older adults aged 60 years and above (15,098 males and 16,366 females). Cognitive impairment is measured using the Harmonized Cognitive Assessment Protocol (HCAP) which includes five broad domains (memory, orientation, arithmetic function, executive function, and object naming). A multivariate decomposition analysis was performed using STATA 17 software to identify covariates'contributions, which explain the group differences to average predictions.

FINDINGS

The prevalence of cognitive impairment was significantly higher among females (19.8%) than males (6.4%) (p < 0.001). Gender disparities were more pronounced among the oldest-old (41.5% vs. 15.9%), widowed individuals (24.6% vs. 9.8%), those with no education (25.1% vs. 11.8%), and individuals living alone (23.4% vs. 5.0%). Decomposition analysis revealed that 62% of the gender gap in cognitive impairment was attributable to differences in compositional factors, primarily education (42%), marital status (6%), working status (6%), difficulty in instrumental activities of daily living (3%), and physical activity (2%). The remaining 38% of the disparity was due to differences in how these factors impacted men and women.

CONCLUSION

The findings indicate that cognitive impairments are more pronounced among women. Gender-responsive interventions improving education access among the female gender would bring relevant and desired results.

Global burden and future trends of head and neck cancer: a deep learning-based analysis (1980-2030)

BACKGROUND

Head and neck cancer (HNC) becomes a vital global health burden. Accurate assessment of the disease burden plays an essential role in setting health priorities and guiding decision-making.

METHODS

This study explores data from the Global Burden of Disease (GBD) 2021 study, involving totally 204 countries during the period from 1980 to 2021. The analysis focuses on age-standardized incidence, mortality, and disability-adjusted life years (DALYs) for HNC. A Transformer-based model, HNCP-T, is used for the prediction of future trends from 2022 to 2030, quantified based on the estimated annual percentage change (EAPC).

RESULTS

The global age-standardized incidence rate (ASIR) for HNC has escalated between 1980 and 2021, with men bearing a higher burden than women. In addition, the burden rises with age and exhibits regional disparities, with the greatest impact on low-to-middle sociodemographic index (SDI) regions. Additionally, the model predicts a continued rise in ASIR (EAPC = 0.22), while the age-standardized death rate (ASDR) is shown to decrease more sharply for women (EAPC = -0.92) than men (EAPC = -0.54). The most rapid increase in ASIR is projected for low-to-middle SDI countries, while ASDR and DALY rates are found to decrease in different degrees across regions.

CONCLUSIONS

The current work offers a detailed analysis of the global burden of HNC based on the GBD 2021 dataset and demonstrates the accuracy of the HNCP-T model in predicting future trends. Significant regional and gender-based differences are found, with incidence rates rising, especially among women and in low-middle SDI regions. Furthermore, the results underscore the value of deep learning models in disease burden prediction, which can outperform traditional methods.

Global Trends in the Incidence, Prevalence and Disability-Adjusted Life Years of Leprosy from 1990 to 2019: An Age-Period-Cohort Analysis Using the Global Burden of Disease Study 2019

Background

Leprosy is a neglected tropical disease, with approximately 200,000 new cases reported worldwide every year. Although there are numerous studies on the epidemiology of leprosy, the age, period, and cohort effects remain poorly understood.

Objective

We present an overview of trends in leprosy incidence, prevalence and disability-adjusted life years worldwide from 1990 to 2019 and associations with age, period, and birth cohort. Data for analysis were obtained from the Global Burden of Disease Study 2019.

Methods

We described incident case, prevalent case, age-standardised incidence, prevalence and disability-adjusted life years rates of leprosy from 1990 to 2019. Subsequently, we calculated overall annual percentage changes, annual percentage changes, and the relative risks of period and cohort using an age-period-cohort model.

Results

From 1990 to 2019, the global age-standardized incidence rate of leprosy decreased from 1.48 per 100,000 to 0.65 per 100,000. Additionally, countries with low Socio-Demographic Index (SDI) demonstrated higher age-standardised incidence, prevalence and disability-adjusted life years rate. The age-standardised incidence, prevalence and disability-adjusted life years rate were significantly higher in males compared to females. Furthermore, the impact of age on leprosy increased with age, peaking at 25-35 years, with the highest prevalence rates observed in the 35-40 age group. Notably, the peak age of leprosy onset increases with SDI. Both the period and cohort effects on leprosy incidence and prevalence showed decreasing trend in middle SDI, low-middle SDI and low SDI countries in recent 30 years and birth cohort later than 1905. However, unfavorable period and cohort effects were noted in high SDI regions.

Conclusion

Leprosy incidence, prevalence and disability-adjusted life years have significantly decreased globally, but remain high in areas with lower SDI. Developing regions should increase public awareness of leprosy risk factors, develop effective control policies to better manage and prevent the disease.

Global, regional, and national burden of four major neurological diseases in women from 1990 to 2021

Background

The burden of neurological diseases in women is underestimated. This study aimed to estimate the pattern and trend of four major nervous system diseases in women.

Methods

Utilizing data from the GBD Study 2021 on the incidence and disability-adjusted life-years (DALYs) of Alzheimer's disease (AD) and other dementias, Parkinson's disease, multiple sclerosis, and idiopathic epilepsy in women from 1990 to 2021. We estimated trends by age and socio-demographic index (SDI), globally, regionally, and nationally, using Estimated annual percentage changes (EAPC), Spearman correlation analysis and projected future trends with the Bayesian age-period-cohort (BAPC) model.

Results

In 2021, an estimated 6191564.2, 572999.9, 1536118.7, and 39191.7 new cases of female AD and other dementias, Parkinson's disease, multiple sclerosis, and idiopathic epilepsy were reported globally, with a significant increase in age-standardized incidence rate (ASIR) from 1990 to 2021. Contrary, the age-standardized DALY rate (ASDR) decreased in idiopathic epilepsy and multiple sclerosis. AD and other dementias and Parkinson's disease were prevalent among women worldwide, followed by idiopathic epilepsy and multiple sclerosis, with regional and country disparities. There are also difference of patterns among age and SDI. The BAPC model projects that by 2050, the ASIR of the four major neurological disorders will continue to increase.

Conclusion

The burden of major neurological diseases in women is a serious global health challenge. Given the regional disparities and varying age patterns in incidence and DALYs, there is an urgent need for tailored prevention and healthcare approaches to mitigate the burden worldwide.

The burden of colorectal cancer attributable to diet low in whole grains from 1990 to 2021: a global, regional and national analysis

Background

Colorectal cancer (CRC) is a major global health issue, with rising incidence and mortality rates. Dietary factors, especially whole grains consumption, are critical in determining CRC risk. Understanding CRC deaths and disability-adjusted life years (DALYs) related to low whole grains diets is important for prevention. The purpose of the study is to investigate temporal and geographic trends in CRC deaths and DALYs attributable to diet low in whole grains at the global, regional, and national levels from 1990 to 2021.

Methods

The data on CRC burden attributable to diet low in whole grains from 1990 to 2021 were extracted from the Global Burden of Diseases (GBD) 2021 database. We described the CRC burden attributable to diet low in whole grains across various years, genders, age groups (5-year age groups from 25 to 94 years and 95+ years), different Socio-demographic Index (SDI) regions and countries. To illustrate the temporal trends in the burden of CRC, we calculated the estimated annual percentage change (EAPC) from 1990 to 2021.

Results

From 1990 to 2021, the global number of CRC deaths attributable to diet low in whole grains increased from 101,813 (95% UI: 42,588 to 151,170) to 186,257 (95% UI: 76,127 to 284,803), representing a 82.94% growth. Similarly, the number of DALYs increased from 2,540,867 (95% UI: 1,050,794 to 3,754,416) to 4,327,219 (95% UI: 1,754,865 to 6,578,232), representing a 70.30% growth. However, both the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) exhibited a decline, with an EAPC of -0.82 (95% CI: -0.85 to -0.78) and - 0.84 (95% CI: -0.87 to -0.81), respectively. The disease burden is heavier in high SDI and high-middle SDI regions. However, between 1990 and 2021, the only region where both ASMR and ASDR increased was low-middle SDI, while in all other regions, they showed a declining trend. In 2021, East Asia had the highest number of CRC deaths and DALYs attributable to diet low in whole grains at the regional level, followed by Western Europe and High-income North America. Additionally, the burden is greater among males and the elderly. Between 1990 and 2021, the number of CRC deaths attributable to diet low in whole grains rose by 102.13% among males and by 63.20% among females. Generally, both the global age-specific mortality rate and the DALYs rate tend to increase with age. SDI demonstrates a nonlinear "S"-shaped correlation with both ASMR and ASDR of CRC attributable to diet low in whole grains. In 2021, the EAPC in ASMR of CRC attributable to diet low in whole grains was negatively associated with SDI (R = -0.402, p < 0.001), reaching the highest EAPC at approximately SDI of 0.51 and the lowest at 0.85. Similarly, the correlation between EAPC in ASDR and SDI in 2021 exhibited a similar pattern.

Conclusion

Despite a decline in the ASMR and ASDR of CRC attributable to diet low in whole grains from 1990 to 2021 globally, the absolute number of cases continues to increase, with a particularly notable burden observed in High-middle and High SDI regions, as well as among males and the elderly population. It is imperative to intensify efforts in CRC prevention and health education, specifically targeting these high-risk groups to raise public awareness and consumption of whole grains. Furthermore, screening initiatives should be intensified among these demographics to address the elevated risk of CRC mortality due to insufficient whole grains consumption.

The burden of mental disorders and substance abuse in the Middle East and North Africa (MENA) region: findings from the Global Burden of Disease Study

BACKGROUND

Mental disorders pose significant morbidity and mortality risks globally. Despite this, research on mental health in the Middle East and North Africa (MENA) region is scarce, hindered by social stigmas and limited healthcare expenditure. This study, utilizing the Global Burden of Disease (GBD) database, aims to address this gap by examining the prevalence, incidence, and demographic patterns of mental disorders in MENA.

METHODS

This ecological study draws on the GBD data to assess the prevalence and burden of mental disorders and substance abuse across the MENA region from 1990 to 2019. Utilizing age-standardized rates of prevalence and Disability-Adjusted Life Years (DALYs), we examine the evolving burden of mental disorders, variations among MENA countries, and trends in associated risk factors by age and gender.

RESULTS

From 1990 to 2019, the MENA region witnessed varying trends in mental disorders. The age-standardized prevalence rate in 2019 was 14,938 per 100,000 individuals, experiencing a 2.1% decrease overall. However, all-age prevalence surged by 86.2%. Disorders like schizophrenia and depressive disorders exhibited substantial increases, contrasting with a 128.1% rise in substance use disorders. Temporal analysis revealed fluctuations in DALY trends, capturing the dynamic nature of mental health burdens over time. Risk factors, including bullying victimization and intimate partner violence, underwent shifts, reflecting changing contributors to mental health burden.

CONCLUSION(S)

Despite a decrease in age-standardized prevalence rates in 2019, the substantial all-age prevalence rise demands attention. Temporal analysis unraveled nuanced trends, emphasizing the complex interplay of sociocultural factors. The shifting prominence of risk factors underscores the dynamic nature of mental health burdens, necessitating region-specific interventions that address both prevalence patterns and contributing factors. Future research should delve into the specific sociocultural determinants influencing the observed trends, allowing for tailored interventions to mitigate the burden of mental health disorders in the MENA region.

Global burden of periodontal diseases among the working-age population from 1990-2021: results from the Global Burden of Disease Study 2021

BACKGROUND

Periodontal diseases among working-age individuals (15-69 years) represent a significant global health challenge, impacting oral health, quality of life, and economic productivity. Defined according to the 2021 Global Burden of Disease (GBD) framework, periodontal disease in this study encompasses symptoms such as halitosis, altered taste sensation, and occasional gingival bleeding that do not impair daily activities. Despite their prevalence, comprehensive analyses of the global burden of periodontal diseases specifically within this demographic remain limited.

METHODS

We analyzed data from the GBD 2021 study, examining periodontal disease burden among individuals aged 15-69 years across 204 countries and territories from 1990 to 2021. Age-standardized rates of prevalence, incidence, and disability-adjusted life years (DALYs) were calculated. We employed joinpoint regression analysis to assess temporal trends, decomposition analysis to examine contributing factors, and frontier analysis to evaluate the relationship between disease burden and sociodemographic development.

FINDINGS

In 2021, global periodontal disease cases reached 951.3 million (95% UI: 729.0-1,183.3 million), with an age-standardized prevalence rate (ASPR: 17,011.6 per 100,000 persons) and 80.3 million new cases (ASIR: 1,464.7 per 100,000). The burden accounted for 6.2 million DALYs globally (age-standardized DALY rate: 110.8 per 100,000). Asia demonstrated the highest age-standardized rates across all metrics, while Low-middle SDI regions showed the highest ASPR (20,920.5 per 100,000) and ASIR (1,627.9 per 100,000). At the national level, Sierra Leone, Gambia, and Cabo Verde had the highest disease burden. Males consistently showed higher prevalence rates than females, with peak rates observed in the 50-59 age group. Joinpoint regression analysis revealed an overall increasing trend from 1990 to 2021 (AAPC: 0.04, 95% UI: 0.01-0.06), with notable variations across different time periods. While some countries like Qatar, UAE, and Jordan experienced over 500% increase in prevalence since 1990, Pacific island nations like Tonga and Tokelau achieved reductions exceeding 70%. Decomposition analysis identified population growth (74.56%) and aging (23.00%) as primary drivers of increased disease burden.

INTERPRETATION

Our analysis reveals significant global disparities in periodontal disease burden among the working-age population, with concerning increases in many regions from 1990 to 2021. The disproportionate burden in Low-middle SDI regions and South Asia, coupled with the substantial impact of population growth and aging, highlights the urgent need for targeted interventions. While some countries have achieved remarkable reductions in disease burden, the dramatic increases in others underscore the importance of strengthening preventive oral healthcare systems and addressing socioeconomic determinants. These findings emphasize the need for country-specific strategies, particularly in regions with rising burden, and can inform evidence-based policy making to reduce the impact of periodontal diseases on the global workforce.

Global, regional, and national burden of household air pollution, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Despite a substantial reduction in the use of solid fuels for cooking worldwide, exposure to household air pollution (HAP) remains a leading global risk factor, contributing considerably to the burden of disease. We present a comprehensive analysis of spatial patterns and temporal trends in exposure and attributable disease from 1990 to 2021, featuring substantial methodological updates compared with previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study, including improved exposure estimations accounting for specific fuel types.

METHODS

We estimated HAP exposure and trends and attributable burden for cataract, chronic obstructive pulmonary disease, ischaemic heart disease, lower respiratory infections, tracheal cancer, bronchus cancer, lung cancer, stroke, type 2 diabetes, and causes mediated via adverse reproductive outcomes for 204 countries and territories from 1990 to 2021. We first estimated the mean fuel type-specific concentrations (in μg/m3) of fine particulate matter (PM2·5) pollution to which individuals using solid fuels for cooking were exposed, categorised by fuel type, location, year, age, and sex. Using a systematic review of the epidemiological literature and a newly developed meta-regression tool (meta-regression: Bayesian, regularised, trimmed), we derived disease-specific, non-parametric exposure-response curves to estimate relative risk as a function of PM2·5 concentration. We combined our exposure estimates and relative risks to estimate population attributable fractions and attributable burden for each cause by sex, age, location, and year.

FINDINGS

In 2021, 2·67 billion (95% uncertainty interval [UI] 2·63-2·71) people, 33·8% (95% UI 33·2-34·3) of the global population, were exposed to HAP from all sources at a mean concentration of 84·2 μg/m3. Although these figures show a notable reduction in the percentage of the global population exposed in 1990 (56·7%, 56·4-57·1), in absolute terms, there has been only a decline of 0·35 billion (10%) from the 3·02 billion people exposed to HAP in 1990. In 2021, 111 million (95% UI 75·1-164) global disability-adjusted life-years (DALYs) were attributable to HAP, accounting for 3·9% (95% UI 2·6-5·7) of all DALYs. The rate of global, HAP-attributable DALYs in 2021 was 1500·3 (95% UI 1028·4-2195·6) age-standardised DALYs per 100 000 population, a decline of 63·8% since 1990, when HAP-attributable DALYs comprised 4147·7 (3101·4-5104·6) age-standardised DALYs per 100 000 population. HAP-attributable burden remained highest in sub-Saharan Africa and south Asia, with 4044·1 (3103·4-5219·7) and 3213·5 (2165·4-4409·4) age-standardised DALYs per 100 000 population, respectively. The rate of HAP-attributable DALYs was higher for males (1530·5, 1023·4-2263·6) than for females (1318·5, 866·1-1977·2). Approximately one-third of the HAP-attributable burden (518·1, 410·1-641·7) was mediated via short gestation and low birthweight. Decomposition of trends and drivers behind changes in the HAP-attributable burden highlighted that declines in exposures were counteracted by population growth in most regions of the world, especially sub-Saharan Africa.

INTERPRETATION

Although the burden attributable to HAP has decreased considerably, HAP remains a substantial risk factor, especially in sub-Saharan Africa and south Asia. Our comprehensive estimates of HAP exposure and attributable burden offer a robust and reliable resource for health policy makers and practitioners to precisely target and tailor health interventions. Given the persistent and substantial impact of HAP in many regions and countries, it is imperative to accelerate efforts to transition under-resourced communities to cleaner household energy sources. Such initiatives are crucial for mitigating health risks and promoting sustainable development, ultimately improving the quality of life and health outcomes for millions of people.

FUNDING

Bill & Melinda Gates Foundation.

Global burden of diarrhea disease in the older adult and its attributable risk factors from 1990 to 2021: a comprehensive analysis from the global burden of disease study 2021

Introduction

Diarrhea disease among the older adult is an underappreciated global health issue despite its substantial burden. This study provides a comprehensive analysis of the epidemiological trends of diarrhea in individuals over 65 years, examining incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021.

Methods

Utilizing data from the Global Burden of Diseases (GBD) 2021, this cross-sectional study assesses the older adult population across 204 countries and territories. The analysis includes metrics such as incidence, prevalence, mortality, DALYs, and estimated annual percentage changes (EAPCs), stratified by region, country, age, sex, and Sociodemographic Index (SDI).

Results

A nearly 200% increase in incidence and prevalence was observed worldwide, with the highest rise in those over 95 years. Mortality and DALYs have declined, especially in the 65-69 age group. High SDI regions showed the largest increase in incidence rates and are the only areas with increasing mortality and DALYs trends. Unsafe water sources emerged as the primary risk factor for diarrhea-related deaths among the older adult.

Discussion

The burden of diarrhea in the older adult has significantly increased, particularly in high-income regions, warranting targeted interventions. The positive correlation between EAPC and the Human Development Index underscores the need for improved water safety to mitigate the disease burden. This study's findings are crucial for shaping public health strategies and informing policy decisions regarding the older adult population.

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 fracture of sternum and/or fracture of one or more ribs: a systematic analysis of incidence, YLDs with projections to 2030

Background

Sternal and/or rib fractures represent a growing global health challenge. Despite their significant clinical and public health implications, epidemiological studies on these injuries remain limited. Utilizing the Global Burden of Disease 2019 (GBD2019) database, this study evaluates the worldwide burden of sternal and/or rib fractures and projects trends through 2030 to inform policy development.

Methods

We analyzed global incidence, age-standardized incidence rate (ASIR), years lived with disability (YLDs), age-standardized YLD rate (ASYR) and estimated annual percentage change (EAPC) of sternal and/or rib fractures across geographic regions, nations, age-sex groups, and socio-demographic index (SDI) quintiles using GBD2019 data. The Bayesian age-period-cohort (BAPC) model was employed to forecast trends until 2030.

Results

In 2019, global incident cases of sternal/rib fractures reached 4.1 million (44% increase since 1990), with YLDs at 190,000 (62% rise since 1990). While ASIR and ASYR showed modest declines, the absolute burden remained substantial. East Asia and high-income North America both exhibited the highest incident cases and YLDs. Central Latin America and Western Saharan Africa demonstrated the steepest incidence growth, whereas the Caribbean experienced the most pronounced YLD increases. Nationally, China reported the highest absolute burden, while Greenland had the highest ASIR and ASYR. Males carried over 60% of the burden. Also, there was a negative correlation between EAPC and national SDI. Projections indicate that the global burden of disease will continue to rise by 2030.

Conclusion

The escalating burden of sternal/rib fractures demands targeted interventions. Prioritizing injury prevention in high-burden regions (e.g., East Asia), addressing male-dominated occupational/behavioral risks, and optimizing infrastructure such as medical transport in low-SDI settings are critical policy priorities. Sustained surveillance through standardized reporting systems is essential for monitoring progress.

Global, regional, and national burden of older adult atopic dermatitis in 204 countries and territories worldwide

Background

With the aging global population, older adult atopic dermatitis (AD) is emerging as an increasingly significant health challenge. This study aimed to evaluate the global burden of older adult AD from 1990 to 2021 and to project its change to 2050.

Methods

The estimates and 95% uncertainty intervals of prevalence, incidence, and disability-adjusted life-years (DALYs) attributable to AD among individuals aged over 60 years were extracted from the Global Burden of Diseases (GBD) Study 2021. We used joinpoint regression analysis, decomposition analysis, cross-country inequality analysis, frontier analysis and prediction model to epidemiological analysis.

Results

From 1990 to 2021, the global prevalence of older adult AD increased to 11,009,630 cases (95% UI: 9,915,829 to 12,170,941), even as ASRs declined, which were primarily driven by population growth. It was observed that females and 75-79 years old had higher incidence rates. SDI relative and frontier analysis exhibited that incidence, prevalence and DALYs rates were positively correlated with SDI levels, while SDI-related inequalities had a significant decrease. Predictions up to 2050 anticipated increasing older adult AD incidence, prevalence, and DALYs numbers, while only age-standardized disability-adjusted life-year rates (ASDRs) were expected to decline.

Conclusion

The burden of older adult AD varied by genders, age groups, regions, countries and climatic conditions. Although the ASRs had shown a decline over time, the burden of older adult AD remained significant, especially in regions with high SDI levels. In the future, the burden of older adult AD was projected to continue rising until 2050, thereby targeted interventions and public health strategies were needed to address this trend.

Trends in acute glomerulonephritis mortality among older adults from 1992 to 2021

This study reports trends in acute glomerulonephritis (AGN) mortality in older adults (aged 65-94 years) and its association with age, period, and birth cohort across 204 countries and territories over the past 30 years, using data from the Global Burden of Disease (GBD) 2021 Study. An age-period-cohort model was used to estimate the overall annual percentage change in AGN mortality (net drift), annual percentage change for individuals aged 65-94 years (local drift), and longitudinal age-specific rates adjusted for period bias and period/cohort relative risks from 1992 to 2021. In 2021, there were 6213 AGN-related deaths globally (95% UI: 4460-7961). Between 1992 and 2021, the net drift for AGN mortality in high socio-demographic index (SDI) countries was 3.15% per year (95% CI 2.62-3.69), compared to - 1.18% per year in low SDI countries (95% CI - 2.01 to - 0.33). High-middle SDI countries had a decline of - 1.49% per year (95% CI - 1.80 to - 1.18), middle SDI countries - 1.52% per year (95% CI - 1.75 to - 1.28), and low-middle SDI countries - 1.78% per year (95% CI - 2.37 to - 1.20). Globally, high SDI countries showed an upward trend in AGN mortality, while others showed a downward trend. Despite the declining mortality in many regions, 15 high SDI countries, 5 high-middle SDI countries, 4 middle SDI countries, 5 low-middle SDI countries, and 3 low SDI countries showed poor or worsening outcomes in the most recent period and birth cohort. These findings suggest that AGN mortality trends are not related to a country's economic development, highlighting the need for high SDI countries to invest more in AGN-related healthcare.

Three decades of population health changes in Japan, 1990-2021: a subnational analysis for the Global Burden of Disease Study 2021

BACKGROUND

Given Japan's rapidly ageing demographic structure, comprehensive and long-term evaluations of its national and subnational health progress are important to inform public health policy. This study aims to assess Japan's population health, using the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to analyse the country's evolving disease patterns.

METHODS

GBD 2021 used Japanese data from 1474 sources, covering 371 diseases, including COVID-19, and 88 risk factors. The analysis included estimates of life expectancy, mortality, and disability-adjusted life-years (DALYs). Estimates were generated using the standardised GBD methodology, which incorporates various data sources through statistical modelling, including the Cause Of Death Ensemble Model for mortality, Bayesian Meta-Regression Disease Model for non-fatal outcomes, and risk factor estimation frameworks to quantify attributable burdens. Life expectancy decomposition by cause of death and annualised rates of change of age-standardised mortality and DALYs were calculated for 1990-2005, 2005-15, and 2015-21.

FINDINGS

Between 1990 and 2021, life expectancy in Japan rose from 79·4 years (95% uncertainty interval 79·3-79·4) to 85·2 years (85·1-85·2), with prefecture-level disparities widening. Gains were primarily driven by reduced mortality from stroke (adding 1·5 years to life expectancy), ischaemic heart disease (1·0 years), and neoplasms, particularly stomach cancer (0·5 years), with variation across prefectures. Leading causes of death in 2021 were Alzheimer's disease and other dementias (135·3 deaths [39·5-312·3] per 100 000 population), stroke (114·9 [89·8-129·3] per 100 000), ischaemic heart disease (96·5 [77·7-106·7] per 100 000), and lung cancer (72·1 [61·8-77·5] per 100 000). Age-standardised mortality for major non-communicable diseases declined, but the pace of this decline has slowed. All-cause annualised rate of change in mortality rate decreased from -1·6% for 2005-15 to -1·1% for 2015-21. Age-standardised COVID-19 mortality rates were 0·8 deaths (0·7-0·9) per 100 000 population (accounting for 0·3% of all deaths) in 2020 and 3·0 (2·5-3·7) per 100 000 population in 2021 (1·0% of deaths). Age-standardised DALY rates for diabetes worsened, with annualised rate of change increasing from 0·1% for 2005-15 to 2·2% for 2015-21. This change parallels worsening trends in major risk factors, particularly high fasting plasma glucose (annualised rate of change of attributable DALYs -0·8% for 2005-15 and 0·8% for 2015-21) and high BMI (0·2% and 1·4%, respectively). Age-standardised DALYs attributable to other major risk factors continued to decrease, albeit slower.

INTERPRETATION

Japan's health gains over the past 30 years are now stalling, with rising regional disparities. The increasing burdens of Alzheimer's disease and other dementias and diabetes, alongside high fasting plasma glucose and high BMI, highlight areas needing focused attention and action.

FUNDING

Gates Foundation.

Global, regional and national burden and trends of disease attributable to high body mass index in adolescents and young adults from 1990 to 2021

BACKGROUND

The burden of high high body mass index (BMI) in adolescent and young adults (AYA) is largely unknown. Therefore, we aim to assess this burden.

METHODS

Data were extracted from GBD 2021. Age-standardized mortality, DALY rates (ASMR, ASDR) and estimated annual percentage change (EAPC) were used to describe the burden. Pearson's correlation coefficient was used to evaluate the correlation between the sociodemographic index (SDI) and ASMR/ASDR.

RESULTS

From 1990 to 2021, the death and DALY number attributable to high BMI in AYA had increased by 109 % and 141 % respectively. Low-middle SDI regions showed the most significant upward trend (EAPC = 1.37 for ASMR and 1.97 for ASDR). All diseases caused by high BMI showed a upward trend except for asthma and leukemia. ASMR of this burden was negatively correlated with the SDI (r = -0.13, p < 0.001), while the relationship between ASDR and SDI was opposite (r = 0.23, p < 0.001). The burden of osteoarthritis caused by high BMI (r = 0.68, p < 0.001), low back pain (r = 0.67, p < 0.001), gout (r = 0.62, p < 0.001) due to high BMI rose with SDI, which contributed to the severe DALY burden in high SDI regions.

CONCLUSIONS

The burden of high BMI is still rising in AYA. Targeted measures need to be taken in different regions.

Disease Burden, Temporal Trends, and Cross-Country Inequality Associated with Sociodemographic Indicators in Alzheimer's Disease and Other Dementias

INTRODUCTION

The purpose of this article is to describe the global burden and temporal trends of Alzheimer's disease and other dementias from 1990 to 2021 and explore cross-country inequality associated with sociodemographic development-related factors.

METHODS

The disability-adjusted life years of Alzheimer's disease and other dementias and sociodemographic index were extracted from the Global Burden of Disease 2021 study, and other sociodemographic development-related factors, including government expenditure on education (% of GDP), net national income per capita, health expenditure per capita, and fertility rate, were sourced from World Bank Data. Disability-adjusted life years of Alzheimer's disease and other dementias across 204 countries/territories and global age-sex distribution in 2021 were illustrated. The Joinpoint regression model was used to analyze the temporal trends of disease burden, and the slope index of inequality and concentration index were calculated to quantify cross-country inequalities. Analyses were conducted in 2024.

RESULTS

Significant disparities were observed in the numbers, rates, and age-standardized rates of disability-adjusted life years across 204 countries/territories. Females demonstrated higher disability-adjusted life year numbers (rates) for all age groups. Age-standardized disability-adjusted life year rate increased worldwide and was high in high-middle and middle sociodemographic index regions but increased faster in low (average annual percentage change=0.227%) and low-middle (average annual percentage change=0.244%) sociodemographic index regions. Cross-country inequality analyses indicated that disability-adjusted life years of Alzheimer's disease and other dementias were skewed and higher in countries with higher sociodemographic development, and the inequality increased with time except for education expenditure-related inequality.

CONCLUSIONS

The burden of Alzheimer's disease and other dementias has risen globally over the past 3 decades, accompanied by increasing cross-country inequalities, which disproportionately affects countries with high sociodemographic development. Boosting expenditure on education may narrow this inequality.

Acne and the cutaneous microbiome: A systematic review of mechanisms and implications for treatments

BACKGROUND

Acne vulgaris is a pervasive skin disease characterized by inflammation of sebaceous units surrounding hair follicles. It results from the complex interplay between skin physiology and the intricate cutaneous microbiome. Current acne treatments, while effective, have major limitations, prompting a shift towards microbiome-based therapeutic approaches.

OBJECTIVES

This study aims to determine the relationship between acne and the cutaneous microbiome, assess the effects of current treatments on the cutaneous microbiome, and explore the implications for developing new therapies.

METHODS

A systematic review was performed using PubMed and SCOPUS databases within the last 10 years. Methodological quality was assessed independently by two authors. The search retrieved 1830 records, of which 26 articles met the inclusion criteria. Meta-analysis of alpha diversity change was assessed using fixed and randomized effect models per therapeutic group.

RESULTS

Eight studies pertain to the role of the cutaneous microbiome in acne, identifying C. acnes, S. aureus and S. epidermidis as key contributors through overproliferation, commensalism, or dysbiosis. Eleven studies discuss current acne treatments, including doxycycline (1), topical benzoyl peroxide (BPO) (4), isotretinoin (2), sulfacetamide-sulfur (SSA) (2) and aminolevulinic acid-photodynamic therapy (ALA-PDT) (2), identified as modulating the cutaneous microbiome as a mechanism of efficacy in acne treatment. Seven studies discuss new treatments with topical probiotics, plant derivatives, and protein derivatives, which contribute to acne clearance via modulation of dysbiosis, inflammatory markers and diversity indexes. A meta-analysis of the effects of existing therapeutics on the cutaneous microbiome identified benzoyl peroxide as the only treatment to facilitate significant change in diversity.

CONCLUSIONS

Despite the heterogeneity of study types and microbiome classifications limiting the analysis, this review underscores the complexity of microbial involvement in acne pathogenesis. It delineates the effects of acne therapeutics on microbial diversity, abundance, and composition, emphasizing the necessity for personalized approaches in acne management based on microbiome modulation.

Bridging the gap: Time to integrate sex and gender differences into research and clinical practice for improved health outcomes

The integration of sex and gender in medical research and clinical practice is increasingly recognized as a cornerstone for achieving equitable health outcomes. Biological sex and gender influence the manifestation, progression, and treatment response in numerous diseases. Biological sex influences health and disease outcomes through genetic, hormonal, and physiological factors, while gender impacts them via identity, societal roles and behaviors. Historically, medical research has focused predominantly on the male body, leading to diagnostic and therapeutic gaps for women and gender-diverse populations. In particular, women remain underrepresented in clinical trials, leading to suboptimal treatment strategies and outcomes. In addition, in many conditions, such as cardiovascular, metabolic and neurological diseases, sex-specific variations in risk factors and disease presentation are prominent. The present review discusses the critical importance of distinguishing between sex and gender in preclinical and clinical research, and the necessity of incorporating these variables across all stages of research, from study design to analysis and reporting of preclinical studies and clinical trials. By incorporating sex and gender as distinct but interacting variables, we propose a framework to advance health equity and foster personalized, inclusive healthcare. This approach will promote the development of gender-sensitive clinical guidelines, enhance the accuracy of diagnostic tools, and ultimately contribute to improved health outcomes for all individuals, regardless of their sex or gender identity.

Test, track, treat using wearable sensors for management of Parkinson's disease: 12‑month prospective observational United Arab Emirates study using Parkinson's Kinetograph (EmPark-PKG Study)

Parkinson's disease (PD) is a progressive neurodegenerative disorder marked by both motor and non-motor symptoms that necessitate ongoing clinical evaluation and medication adjustments. Home-based wearable sensor monitoring offers a detailed and continuous record of patient symptoms, potentially enhancing disease management. The EmPark-PKG study aims to evaluate the effectiveness of the Parkinson's KinetoGraph (PKG), a wearable sensor device, in monitoring and tracking the progression of motor symptoms over 12 months in Emirati and non-Emirati PD patients. Fifty PD patients (32% Emirati, 68% non-Emirati) were assessed at baseline and a 12-month follow-up. Clinical evaluations included levodopa equivalent daily dosage (LEDD) and motor and non-motor assessments. Concurrently, the PKG provided metrics such as bradykinesia score (BKS) and dyskinesia score (DKS). Statistical analyses were conducted to determine changes from baseline to six months, differences between Emirati and non-Emirati groups, and correlations between PKG metrics and clinical assessments. Significant reductions in LEDD and improvements in both motor and non-motor scores were observed from baseline to six months (p < 0.05). PKG-guided medication adjustments were associated with enhanced motor and non-motor outcomes (p < 0.05). Specifically, non-Emirati patients exhibited a significant reduction in LEDD (Z = - 2.010, p = 0.044), whereas Emirati patients did not (Z = - 0.468, p = 0.640). Both groups showed significant improvements in motor scale scores and motor complication scores. Spearman correlation analysis revealed strong relationships between PKG metrics and subjective clinical assessments (p < 0.001). The EmPark-PKG study demonstrates the potential benefits of remote PKG monitoring for personalised motor symptom management in PD. PKG supports a stepped care paradigm by enabling bespoke medication titration based on objective data, facilitating tailored and effective patient care.

Tea consumption and cognitive health in Chinese older adults: A propensity score matching and weighting analysis

BACKGROUND

The association between tea consumption, especially different types, and cognitive function has not been adequately explored. This study aimed to investigate the associations of tea consumption, including status, frequency, and type, with cognitive function, considering selection bias.

METHODS

We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2018(N = 8498). Cognitive function was measured by Mini-Mental State Examination (MMSE). Logistic and linear regression were applied to assess the associations of tea consumption with cognitive impairment and cognitive scores, respectively. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to balance characteristic differences between groups.

RESULTS

The characteristics of tea consumption status, frequency and type were well balanced between groups after using PSM and IPTW. Drinking tea was associated with less cognitive impairment (ORadjusted:0.84, ORPSM:0.84, ORIPTW:0.87) and higher cognitive scores (Coefficientadjusted:0.29, CoefficientPSM:0.33, CoefficientIPTW:0.29). Regular tea drinkers may have better cognitive function than those who never or rarely consumed (Ptrend < 0.05 for both methods). Green tea drinkers had lower prevalence of cognitive impairment (ORadjusted:0.71, ORIPTW:0.75) and higher cognitive scores (Coefficientadjusted:0.45, CoefficientIPTW:0.54). Men, uneducated, and those with annual income>10,000 RMB were more likely to benefit from flower tea. Significant interactions of tea consumption with age, education and income were observed.

CONCLUSIONS

Tea consumption, especially regular and green tea consumption, was associated with less cognitive impairment and higher cognitive scores, even after PSM and IPTW adjustments. Flower teas may have potential protective effect that is worth further study. Age, education and income have synergistic effects with tea consumption on cognitive function.

Insights on Late-Stage COVID-19 Pandemic Recovery From a 21-Country Online Survey

Objectives

The widespread impact of the COVID-19 pandemic on health systems, economies, and societies globally requires comprehensive data to guide effective recovery efforts. Online surveys have become crucial for rapid and extensive data collection. The Pandemic Response Survey (PRS), utilizing the Facebook Active User Base (FAUB), assessed the pandemic's population-level impacts across 21 countries, gathering information on healthcare, vaccine confidence, trust, and economic and educational indicators.

Methods

Conducted from March to May 2023, the PRS, translated into 15 languages, used the FAUB for gender-stratified random sampling of adults 18 years and older. The survey collected responses from 621,000 individuals, achieving a completion rate of 43%. Non-response and inverse propensity score weights were applied to calibrate the data to known demographic totals, enhancing the survey's generalizability.

Results

The PRS findings reveal disparities in life satisfaction, food security, delayed healthcare, vaccine confidence, and trust across countries. Life satisfaction was reported as high by 70%-80% of respondents in Egypt, Nigeria, Colombia, and Mexico, while only 20%-30% of respondents in Indonesia, Turkiye, and Viet Nam reported the same. Approximately 50% of respondents in Nigeria, South Africa, and Colombia experienced food insecurity, in contrast to less than 10% in Italy, Japan, and Germany. In Germany, 44% of respondents expressed high vaccine confidence compared to 10.6% in South Africa. Over half of respondents in Indonesia (52.4%) reported that their child was up to date on routine immunisations.

Conclusion

The PRS demonstrates the effectiveness of online surveys in capturing actionable data during a global health crisis. The findings underscore the importance of targeted interventions and policy decisions to address the multifaceted challenges of pandemic recovery. Collaborative efforts in data collection and knowledge sharing between nations with shared profiles may foster more effective strategies.

Association of Dietary Live Microbe Intake With Mortality: Results From the National Health and Nutrition Examination Survey, 1999-2018

BACKGROUND

The association between dietary intake of live microbes and mortality remains unclear.

OBJECTIVE

This study aims to investigate the relationship between dietary live microbial intake and all-cause and cause-specific mortality among adults in the United States.

DESIGN

This is a cross-sectional study of adults aged 20 years or older who participated in the 1999-2018 National Health and Nutrition Examination Survey.

PARTICIPANTS AND SETTING

The study utilized data from adults aged 20 years and older with complete dietary and mortality data from the National Health and Nutrition Examination Survey from 1999 to 2018.

MAIN OUTCOME MEASURES

Deaths from any cause are defined as all-cause mortality. The International Statistical Classification of Diseases, 10th Revision, and the National Center for Health Statistics classifications of heart disease (054-064) and malignant neoplasms (019-043) were used to identify disease-specific causes of death.

STATISTICAL ANALYSES PERFORMED

Cox proportional hazard regression was utilized to examine the associations between the consumption of dietary live microbes and all-cause and cause-specific mortality. Restricted cubic spline regression modeling was used to assess potential linear associations between dietary live microorganism intake and mortality. In addition, stratified analyses and sensitivity analyses of the association of dietary live microorganism intake with all-cause and cardiovascular deaths were performed to validate the robustness of the results.

RESULTS

The study included 31 836 participants, of whom 4160 died, including 1109 cardiovascular deaths and 915 cancer deaths. The study found that consuming live microbes from the diet was linked to a lower rate of all-cause and cardiovascular mortality, respectively (hazard ratio 0.80, 95% CI 0.72 to 0.89; P < .001; hazard ratio 0.79, 95% CI 0.65 to 0.95; P = .014). However, there was no significant association observed between microbial intake and cancer mortality (hazard ratio 0.93, 95% CI 0.75 to 1.17; P = .545). Restricted cubic spline demonstrates a linear association between dietary live microorganism intake and all-cause and cardiovascular mortality (P < .001). Furthermore, sensitivity analyses indicated that a high intake of live dietary microorganisms was associated with a lower risk of all-cause mortality and cardiovascular mortality (P < .05).

CONCLUSIONS

The study found that consuming live microbes through diet was linked to a lower rate of all-cause and cardiovascular mortality but not cancer mortality.

The global, regional, and national burden of pediatric stone disease: 1990-2021 and projections for the next two decades

Background

Pediatric stone disease, once considered rare, has gained significant attention over the past decade owing to its rapidly increasing incidence. Despite this surge, a comprehensive evaluation of this burden is lacking.

Objectives

This study aimed to estimate the burden of pediatric stone disease, stratified by age and sex, at the global, regional, and national levels from 1990 to 2021.

Methods

Data on the global incidence, deaths, and disability-adjusted life years (DALYs) related to pediatric stone disease from 1990 to 2021 were collected. The estimated annual percentage change (EAPC) quantified the disease trends over this period. Additionally, the relationship between disease burden and factors such as age and sociodemographic index (SDI) levels was analyzed. A Bayesian Age-Period-Cohort (BAPC) model was employed to project the future burden from 2022 to 2041.

Results

In 2021, there were 3,289,663 cases of pediatric stone disease worldwide (95% UI: 1,724,296 to 5,384,797), resulting in 66 deaths (95% UI: 43 to 94) and 14,230 disabilities (95% UI: 9,264 to 21,569). Regionally, South Asia reported the highest incidence, mortality, and DALYs based on the Global Burden of Disease (GBD) classifications. Age-standardized morbidity (ASIR) and age-standardized mortality (ASDR) are highest in Eastern Europe, while age-standardized mortality (ASMR) is 0 in all regions of the world. At the country level, India recorded the highest incidence, mortality, and DALYs for pediatric stone disease in 2021. Armenia had the highest ASIR, while 28 countries, including Afghanistan, Armenia, and Brazil, reported the highest ASMR. Armenia and Kazakhstan recorded the highest ASDR. The disease burden was most pronounced among children aged 15-19 years, with boys being more affected than girls. These findings have significant global implications. Projections indicate that by 2041, the burden of pediatric stone disease will decline, although boys will continue to be more affected than girls.

Conclusion

From 1990 to 2021, the global burden of pediatric stone disease, adjusted for age, has decreased. However, regional variations persist, with some areas experiencing an increase in burden. This underscores the importance of ongoing monitoring to effectively reduce the overall impact of pediatric stone diseases.

Global, regional, and national burden of asthma and atopic dermatitis, 1990-2021, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021

BACKGROUND

Asthma and atopic dermatitis are common allergic conditions that contribute to substantial health loss, economic burden, and pain across individuals of all ages worldwide. Therefore, as a component of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we present updated estimates of the prevalence, disability-adjusted life-years (DALYs), incidence, and deaths due to asthma and atopic dermatitis and the burden attributable to modifiable risk factors, with forecasted prevalence up to 2050.

METHODS

Asthma and atopic dermatitis prevalence, incidence, DALYs, and mortality, with corresponding 95% uncertainty intervals (UIs), were estimated for 204 countries and territories from 1990 to 2021. A systematic review identified data from 389 sources for asthma and 316 for atopic dermatitis, which were further pooled using the Bayesian meta-regression tool. We also described the age-standardised DALY rates of asthma attributable to four modifiable risk factors: high BMI, occupational asthmagens, smoking, and nitrogen dioxide pollution. Furthermore, as a secondary analysis, prevalence was forecasted to 2050 using the Socio-demographic Index (SDI), air pollution, and smoking as predictors for asthma and atopic dermatitis. To assess trends in the burden of asthma and atopic dermatitis before (2010-19) and during (2019-21) the COVID-19 pandemic, we compared their average annual percentage changes (AAPCs).

FINDINGS

In 2021, there were an estimated 260 million (95% UI 227-298) individuals with asthma and 129 million (124-134) individuals with atopic dermatitis worldwide. Asthma cases declined from 287 million (250-331) in 1990 to 238 million (209-272) in 2005 but increased to 260 million in 2021. Atopic dermatitis cases consistently rose from 107 million (103-112) in 1990 to 129 million (124-134) in 2021. However, age-standardised prevalence rates decreased-by 40·0% (from 5568·3 per 100 000 to 3340·1 per 100 000) for asthma and 8·3% (from 1885·4 per 100 000 to 1728·5 per 100 000) for atopic dermatitis. In 2021, there were substantial variations in the burden of asthma and atopic dermatitis across different SDI groups, with the highest age-standardised DALY rate found in south Asia for asthma (465·0 [357·2-648·9] per 100 000) and the high-income super-region for atopic dermatitis (3552·5 [3407·2-3706·1] per 100 000). During the COVID-19 pandemic, the decline in asthma prevalence had stagnated (AAPC pre-pandemic -1·39% [-2·07 to -0·71] and during the pandemic 0·47% [-1·86 to 2·79]; p=0·020); however, there was no significant difference in atopic dermatitis prevalence in the same period (pre-pandemic -0·28% [-0·33 to -0·22] and during the pandemic -0·35% [-0·78 to 0·08]; p=0·20). Modifiable risk factors were responsible for 29·9% of the global asthma DALY burden; among them, high BMI was the greatest contributor (39·4 [19·6-60·2] per 100 000), followed by occupational asthmagens (20·8 [16·7-26·5] per 100 000) across all regions. The age-standardised DALY rate of asthma attributable to high BMI was highest in high-SDI settings, whereas the contribution of occupational asthmagens was highest in low-SDI settings. According to our forecasting models, we expect 275 million (224-330) asthma cases and 148 million (140-158) atopic dermatitis cases in 2050, with population growth driving this increase. However, age-standardised prevalence rates are expected to remain stable (-23·2% [-44·4 to 5·3] for asthma and -1·4% [-9·1 to 7·0] for atopic dermatitis) from 2021 to 2050.

INTERPRETATION

Although the increases in the total number of asthma and atopic dermatitis cases will probably continue until 2050, age-standardised prevalence rates are expected to remain stable. A considerable portion of the global burden could be managed through efforts to address modifiable risk factors. Additionally, the contribution of risk factors to the burden substantially varied by SDI, which suggests the need for tailored initiatives for specific SDI settings. The growing number of individuals expected to be affected by asthma and atopic dermatitis in the future suggests that it is essential to improve our understanding of risk factors for asthma and atopic dermatitis and collect disease prevalence data that are globally generalisable.

FUNDING

Gates Foundation.

Global, regional and national burden and quality of care index (QCI) of leukaemia and brain and central nervous system tumours in children and adolescents aged 0-19 years: a systematic analysis of the Global Burden of Disease Study 1990-2019

OBJECTIVES

This study aimed to evaluate the global, regional and national disparities in the quality of care for leukaemia and brain and central nervous system (CNS) tumours among children and adolescents aged 0-19 years. We also assessed temporal trends in the quality of care index (QCI) and explored associations with sociodemographic development levels, gender and age.

SETTING

The study used data from the Global Burden of Disease (GBD) 2019 database, covering 204 countries and territories. The analysis included global, regional and national levels of care, stratified by sociodemographic index (SDI), gender and age groups.

PARTICIPANTS

The study included children and adolescents aged 0-19 years diagnosed with leukaemia or CNS tumours. Data on incidence, prevalence, mortality and disability-adjusted life years (DALYs) were extracted from the GBD 2019 database.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was the QCI, constructed using principal component analysis from four secondary indicators: years of life lost to years lived with disability ratio, DALYs to prevalence ratio, mortality to incidence ratio and prevalence to incidence ratio. Secondary outcomes included temporal trends in QCI, gender disparity ratios (GDRs) and correlations between QCI and SDI levels.

RESULTS

In 2019, leukaemia and CNS tumours accounted for 132 194 deaths globally. The QCI for leukaemia was 74.71, while for CNS tumours, it was 56.59. From 1990 to 2019, the QCI for CNS tumours increased significantly (estimated annual percentage change (EAPC)=1.45, 95% CI: 1.41 to 1.50), whereas the QCI for leukaemia showed a declining trend in middle and low-middle SDI regions (EAPC=-0.13, 95% CI: -0.16 to -0.09). Western Europe had the highest QCI for leukaemia (94.50), while South Asia had the lowest (57.64). Boys had lower QCI scores than girls, and the gender disparity in CNS tumours widened over time (GDR increased from 1.147 in 1990 to 1.160 in 2019). QCI was positively correlated with SDI levels (leukaemia: r=0.591, p<0.001; CNS tumours: r=0.812, p<0.001).

CONCLUSIONS

This study highlights significant disparities in the quality of childhood cancer care across regions, development levels and genders. While global QCI for CNS tumours improved, leukaemia care quality declined in middle and low-middle SDI regions. Boys and populations in low SDI regions are particularly vulnerable to poor care. Policymakers should prioritise targeted interventions to address these disparities, improve access to quality care and reduce the global burden of childhood cancer.

Epidemiological and demographic drivers of alcohol-attributable pancreatitis from 1990 to 2021: Findings from the 2021 Global Burden of Disease study. To be published in: Alcohol

BACKGROUND

Alcohol significantly contributes to pancreatitis, causing high global mortality and health burden. This study examines trends in alcohol-attributable pancreatitis (AAP) from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data, focusing on demographic, temporal, and regional variations to inform policymaking.

METHODS

AAP-related deaths and disability-adjusted life years (DALYs) were analyzed across 204 countries from 1990 to 2021, stratified by Sociodemographic Index (SDI), gender, and age groups. An age-period-cohort model assessed age-standardized death rates (ASDR), and decomposition analysis quantified impacts of population growth, aging, and epidemiological changes.

RESULTS

AAP-related DALYs rose from 401,700 in 1990 to 699,300 in 2021, though ASDR and ASMR showed declines globally. Burden increased notably in low and lower-middle SDI regions, especially among those under 40, while high SDI regions achieved better control. Males faced a disproportionately high burden due to alcohol consumption patterns, although some regions saw rising female burdens. Low-SDI areas suffered from limited healthcare, increasing alcohol use, and weak policies, with younger populations contributing significantly to rising burdens. Projections estimate 1.146 million DALYs annually by 2050, with males comprising over 90%. A GBD-AAP visualization platform was developed to present burden data and trends.

CONCLUSIONS

AAP exhibits significant regional and gender disparities. Targeted measures, including alcohol regulation, resource allocation, and public health education, are critical in low-SDI regions and among young males to mitigate AAP burden. The GBD-AAP platform offers valuable tool for targeted interventions.

Edentulousness and the Likelihood of Becoming a Centenarian: Longitudinal Observational Study

Background

In recent decades, the global life expectancy has risen notably to approximately 73.5 years worldwide, coinciding with a rapid growth in the older adult population, which presents a significant public health challenge in promoting healthy aging and longevity.

Objective

This study aimed to prospectively investigate the link between edentulousness and the likelihood of reaching centenarian status among individuals aged 80 years and older.

Methods

Data from the Chinese Longitudinal Healthy Longevity Survey were analyzed. Logistic regression models were used to assess the relationship between edentulousness and the likelihood of becoming a centenarian. Demographic characteristics, lifestyle habits, and disease histories were adjusted as confounding factors. Several sensitivity analyses, including propensity score matching and 2-year lag analyses, were conducted to further assess the association between edentulousness and the likelihood of becoming a centenarian. The correlation between the number of natural teeth as a continuous variable and the likelihood of becoming a centenarian was evaluated as well.

Results

The study included 4239 participants aged 80-100 years. After adjusting for all covariates, the likelihood for becoming a centenarian increased in the nonedentulous group compared to the edentulous group (odds ratio [OR] 1.384, 95% CI 1.093-1.751). The relationship persisted after propensity score matching analysis (OR 1.272, 95% CI 1.037-1.561). The association remained statistically significant after excluding participants with a follow-up duration of less than 2 years (OR 1.522, 95% CI 1.083-2.140; P=.02). Furthermore, a significant positive association between the number of natural teeth and the likelihood of becoming a centenarian was found after adjusting for all covariates (OR 1.022, 95% CI 1.002-1.042; P=.03), which aligned with the main results of the study.

Conclusions

The findings revealed that the presence of natural teeth was linked to an increased probability of becoming a centenarian, underscoring the importance of maintaining oral health even in advanced age.

Comprehensive analysis of the ischemic stroke burden at global, regional, and national levels (1990-2021): trends, influencing factors, and future projections

Background and purpose

Estimating the global burden of ischemic strokes (IS) is crucial for enhancing prevention and control strategies.

Methods

We collected four epidemiological indicators-prevalence, incidence, deaths, and disability-adjusted life years (DALYs)-for ischemic stroke (IS) from the Global Burden of Disease (GBD) database, which covers the years 1990 to 2021. Our research analyzed the features of the IS burden and described the trends of these four indicators.

Results

The Joinpoint and age-period-cohort models reflected the changing trends in age-standardized indicators. Decomposition analysis examined the factors influencing each epidemiological indicator. The Bayesian Age-Period-Cohort (BAPC) model detailed changes in the number and rate of IS from 1990 to 2021 and projected trends through 2046. The Norpred model was used to verify the stability of the BAPC prediction results. The prevalence, incidence, deaths, and DALYs due to IS generally exhibited a downward trend. However, the predictions indicated that while the age-standardized incidence rate decreased from 1990 to 2015, this trend reversed between 2016 and 2021 and is expected to continue until 2046. This reversal is likely driven by factors such as population aging, given that age is a strongly correlated risk factor for IS. The IS burden was negatively associated with socio-demographic index (SDI) levels, with high systolic blood pressure identified as the largest risk factor for DALYs and deaths. The consistency between the BAPC and Norpred models enhances the reliability of these projections.

Conclusion

Over the past two decades, trends in prevalence, incidence, deaths, and DALYs have all declined. However, projections suggest that incidence will show an upward trend over the next two decades.

Global, regional and national time trends in incidence of adverse effects of medical treatment, 1990-2019: an age-period-cohort analysis from the Global Burden of Disease 2019 study

BACKGROUND

Current adverse effects of medical treatment (AEMT) incidence estimates rely on limited record reviews and underreporting surveillance systems. This study evaluated global and national longitudinal patterns in AEMT incidence from 1990 to 2019 using the Global Burden of Disease (GBD) framework.

METHODS

AEMT was defined as harm resulting from a procedure, treatment or other contact with the healthcare system. The overall crude incidence rate, age-standardised incidence rate and their changes over time were analysed to evaluate temporal trends. Data were stratified by sociodemographic index (SDI) quintiles, age groups and sex to address heterogeneity across and within nations. An age-period-cohort model framework was used to differentiate the contributions of age, period and cohort effects on AEMT incidence changes. The model estimated overall and age-specific annual percentage changes in incidence rates.

FINDINGS

Although the global population increased 44.6% from 1990 to 2019, AEMT incidents rose faster by 59.3%. The net drift in the global incidence rate was 0.631% per year. The proportion of all cases accounted for by older adults and the incidence rate among older adults increased globally. The high SDI region had much higher and increasing incidence rates versus declining rates in lower SDI regions. The age effects showed that in the high SDI region, the incidence rate is higher among older adults. Globally, the period effect showed a rising incidence of risk after 2002. Lower SDI regions exhibited a significant increase in incidence risk after 2012. Globally, the cohort effect showed a continually increasing incidence risk across sequential birth cohorts from 1900 to 1950.

CONCLUSION

As the global population ageing intensifies alongside the increasing quantity of healthcare services provided, measures need to be taken to address the continuously rising burden of AEMT among the older population.

Trends in pulmonary arterial hypertension: insights from Global Burden of Disease 1990-2021

OBJECTIVE

This study aimed to assess the global, regional and national burden of pulmonary arterial hypertension (PAH) from 1990 to 2021 using data from the Global Burden of Disease Study 2021. The focus was on evaluating trends in incidence, prevalence, mortality and disability-adjusted life-years (DALYs) associated with PAH and examining these trends by age, gender and sociodemographic index (SDI).

DESIGN

This is a systematic analysis leveraging data from the Global Burden of Disease Study 2021. The analysis focused on both crude and age-standardised rates to track temporal trends in PAH burden, with data stratified by region and SDI.

SETTING

The study used global, regiona, and national data from 204 countries and regions, spanning from 1990 to 2021.

PARTICIPANTS

The participants in this study include individuals diagnosed with PAH, with data representing populations globally, categorised by age, gender and SDI.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome measures included global, regional and national incidence, prevalence, mortality and DALYs related to PAH. Secondary outcomes consisted of age-standardised rates (age-standardised incidence rate (ASIR), age-standardised mortality rate (ASMR)) and trends over the study period. A key strength of this study is the detailed stratification by SDI, revealing how PAH burden varies across different socio-economic settings. This extended temporal analysis offers new insights into long-term trends, highlighting the rising burden in lower-SDI regions and significant regional disparities in disease management and outcomes.

RESULTS

From 1990 to 2021, global PAH cases showed substantial increases in both incidence (85.62%) and prevalence (81.46%), while age-standardised rates remained stable. Across SDI levels, high-SDI regions maintained stable ASIRs (0.37 per 100 000) with a slight decline (estimated average percentage change (EAPC) -0.06%), while low-SDI regions demonstrated the most significant reduction (EAPC -0.30%). Deaths increased by 48.36% globally, though the ASMR decreased from 0.35 to 0.27 per 100 000. The disease burden measured by DALYs decreased by 6.59%, with high-SDI regions showing better improvements in age-standardised DALY rates (-1.39% EAPC) compared with other SDI levels. Gender analysis revealed persistent female predominance (female-to-male ratio 1.62:1), particularly pronounced in populations over 50 years across all SDI quintiles.

CONCLUSIONS

While global age-standardised rates have declined, PAH remains a significant global health burden, particularly in low-SDI regions. These findings underscore the need for targeted prevention and intervention strategies, especially for high-risk populations, such as females and the elderly, to reduce the global health impact of PAH.

Global, regional, and national burden of myelodysplastic syndromes and myeloproliferative neoplasms, 1990-2021: an analysis from the global burden of disease study 2021

Objective

To analyze the trends and cross-country inequalities in the burden of Myelodysplastic syndromes (MDS) and myeloproliferative neoplasms (MPN) over the past 30 years and forecast potential changes through 2045.

Methods

Estimates and 95% uncertainty intervals (UIs) for incidence, deaths, and disability-adjusted life-years (DALYs) associated with MDS/MPN were obtained from the Global Burden of Diseases (GBD) 2021 database. We described the epidemiology of MDS/MPN at global, regional, and national levels, analyzed trends in the burden of MDS/MPN from 1990 to 2021 through overall, local, and multidimensional perspectives, decomposed the burden based on population size, age structure, and epidemiological changes, quantified cross-country inequalities in MDS/MPN burden using standard health equity methods recommended by the WHO, and predicted changes of MDS/MPN burden to 2045.

Results

The global incidence of MDS/MPN has shown a marked increase, escalating from 171,132 cases in 1990 to 341,017 cases in 2021. Additionally, the burden was found to be significantly greater in men compared to women. The overall global burden of MDS/MPN exhibited a consistent increase from 1990 to 2021, although the growth rate showed a noticeable slowdown between 2018 and 2021. Decomposition analysis identified population growth as a key factor influencing the variations in the burden of MDS/MPN. An inequality analysis across countries indicated that high Socio-demographic Index (SDI) countries bore a disproportionate share of the MDS/MPN burden, with significant SDI-related disparities remaining evident. Interestingly, while the incidence and deaths of MDS/MPN, along with the age-standardized rate (ASR) for DALYs, are projected to decline annually from 2020 to 2045, the absolute number of cases for these indicators is expected to continue rising. By 2045, the projected numbers are estimated to reach 457,320 cases for incidence, 82,047 cases for deaths, and 1,689,518 cases for DALYs.

Conclusions

As a major public health issue, the global burden of MDS/MPN showed an overall increasing trend from 1990 to 2021, which was primarily driven by population growth and aging. The largest share of the MDS/MPN burden was seen primarily in men, with older demographics. Countries with elevated SDI experienced a significantly higher burden of MDS/MPN. While the burden of MDS/MPN was most pronounced in high SDI quintile, the fastest growth was observed in the low-middle SDI quintile, especially in tropical Latin America. This study highlighted great challenges in the control and management of MDS/MPN, including both growing case number and distributive inequalities worldwide. These findings provide valuable insights for developing more effective public health policies and optimizing the allocation of medical resources.

Disparities in the incidence, mortality and disability-adjusted life years of 33 early-onset cancer groups globally, 2012-2021: a systematic analysis

BACKGROUND

The global cancer burden is rising, with early-onset cancers becoming more prevalent. We aimed to investigate the burden, trend and population disparity in 33 early-onset cancers from 2012 to 2021.

METHODS

Annual incidence, death, and disability-adjusted life years (DALY) numbers and rates for early-onset (15-49 years) cancer groups were calculated from Global Burden of Diseases (GBD) 2021 dataset, covering 2012-2021 across global, five SDI groupings, and 204 countries and territories. Estimated annual percentage change (EAPC) in the incidence, mortality and DALY rates was calculated to quantify temporal trends, while spearman correlation analysis was used to examine the correlation between rates, EAPC and SDI.

RESULTS

In 2021, there were 2.65 million new early-onset cancer cases excluding non-melanoma skin cancer (NMSC), resulting in 0.99 million deaths and 50.7 million DALYs. Breast, tracheal, bronchus and lung (TBL), cervical, colon and stomach cancers were the leading causes of DALYs. The DALY rate for early-onset cancer excluding NMSC changed from 65.7 million in 2012 to 67.0 million in 2021, with an estimated annual percentage change (EAPC) of -0.49%. While the DALY rate plateaued for females, it decreased by -0.95% for males. Ten of 33 cancer groups exhibited an EAPC > 0. The high SDI quintile had 1,100 DALYs per 100,000 caused by early-onset cancers excluding NMSC, with the highest declining trend in DALY and mortality rates, while the high-middle SDI quintile had the highest early-onset mortality rates. Rising trends in cancer incidence and mortality were especially notable among females in the middle, low-middle, and low SDI quintiles.

CONCLUSION

The global burden of early-onset cancer differs significantly by SDI quintile and gender. The increasing burden across multiple cancer groups poses a significant public health challenge. The rising burden of multiple cancer types is alarming, highlighting the need for increased policy support and targeted medical assistance to address the disparities in their impact.

Estimating the Burden of Common Mental Disorders Attributable to Lifestyle Factors: Protocol for the Global Burden of Disease Lifestyle and Mental Disorder (GLAD) Project

BACKGROUND

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) collects and calculates risk-outcome data for modifiable lifestyle exposures (eg, dietary intake) and physical health outcomes (eg, cancers). These estimates form a critical digital resource tool, the GBD VizHub data visualization tool, for governments and policy makers to guide local, regional, and global health decisions. Despite evidence showing the contributions of lifestyle exposures to common mental disorders (CMDs), such as depression and anxiety, GBD does not currently generate these lifestyle exposure-mental disorder outcome pairings. This gap is due to a lack of uniformly collected and analyzed data about these exposures as they relate to CMDs. Such data are required to quantify whether, and to what degree, the global burden of CMDs could be reduced by targeting lifestyle factors at regional and global levels. We have established the Global burden of disease Lifestyle And mental Disorder (GLAD) Taskforce to address this gap.

OBJECTIVE

This study aims to generate the necessary estimates to afford the inclusion of lifestyle exposures as risk factors for CMDs in the GBD study and the GBD digital visualization tools, initially focusing on the relationship between dietary intake and CMDs.

METHODS

The GLAD project is a multicenter, collaborative effort to integrate lifestyle exposures as risk factors for CMDs in the GBD study. To achieve this aim, global epidemiological studies will be recruited to conduct harmonized data analyses estimating the risk, odds, or hazards of lifestyle exposures with CMD outcomes. Initially, these models will focus on the relationship between dietary intake, as defined by the GBD, and anxiety and depression.

RESULTS

As of August 2024, 18 longitudinal cohort studies from 9 countries (Australia: n=4; Brazil: n=1; France: n=1; Italy: n=3; The Netherlands: n=3; New Zealand: n=1; South Africa: n=1; Spain: n=1; and United Kingdom: n=3) have agreed to participate in the GLAD project.

CONCLUSIONS

Our comprehensive, collaborative approach allows for the concurrent execution of a harmonized statistical analysis protocol across multiple, internationally renowned epidemiological cohorts. These results will be used to inform the GBD study and incorporate lifestyle risk factors for CMD in the GBD digital platform. Consequently, given the worldwide influence of the GBD study, findings from the GLAD project can offer valuable insights to policy makers worldwide around lifestyle-based mental health care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/65576.

Burden of unintentional drowning in China from 1990 to 2019 and exposure to water: findings from the Global Burden of Disease 2019 study

BACKGROUND

Drowning is an important contributor to the burden of deaths in China. Exposure to open water is a risk factor for drowning, but few studies quantify its impact on drowning. The purpose of this study was to provide an up-to-date analysis of unintentional drowning in China, including impact of exposure to open water.

METHODS

Chinese provincial data from the Global Burden of Disease Study 2019 were used to describe the burden of unintentional drowning in 33 provinces and changes from 1990 to 2019. Provincial outdoor open water resource data were used to explore the relationship between outdoor open water resources and drowning burden using K-median clustering analysis.

RESULTS

Between 1990 and 2019, the unintentional drowning incidence, mortality and disability adjusted life years (DALY) rates declined by 31.2%, 68.6% and 74.9%, respectively, with differences by age, sex and province. In 2019, the DALY rate for drowning was relatively higher in children under 20 year, the elderly over 80 years than other age groups and was relatively higher in men. There was no statistical difference in overall incidence rate by sex. Provincial differences in unintentional drowning burden show a positive relationship with the availability and size of outdoor open water.

CONCLUSIONS

As expected availability of water increases drowning risk. There is a need to address drowning environmental risk especially among children and the elderly. Localised water safety plans which consider drowning burden and environmental risk factors are needed in China to ensure a sustained decline of unintentional drowning.

The global, regional, and national patterns of change in the burden of chronic kidney disease from 1990 to 2021

BACKGROUND

Chronic kidney disease (CKD) is a major global public health problem with increasing prevalence and a huge health and economic burden. Diabetes mellitus and hypertension are major risk factors for CKD, and CKD is associated with cardiovascular disease and end-stage renal disease. Understanding the prevalence and burden of CKD is essential for the development of prevention and control strategies.

METHODS

Using data from the Global Burden of Disease Study (GBD) 2021 study, this study analyzed the incidence, prevalence, and disability-adjusted life years (DALYs) of CKD at global, regional, and national levels between 1990 and 2021. Decomposition analysis, health inequalities and frontier analysis were used to analyse the changes.

RESULTS

This study analyzed the global regional and national burden, trends, and disparities of CKD from 1990 to 2021 and found that the global burden of CKD had increased significantly, in line with trends in population ageing and population growth, and with significant variations between regions. There were 673.7 million people with CKD worldwide in 2021, accounting for 8.54% of the global population, a 92.0% increase from 1990. Despite a slight decline in age-standardized prevalence rate (ASPR), the absolute number of CKD cases increased. Central Asia had the highest prevalence of CKD, while Central Latin America had the highest rate of DALYs and incidence for CKD. In 2021, At the national level, China had the highest number of new CKD cases. The country with the highest ASPR and age-standardized DALYs rate (ASDR) of CKD was Mauritius. Globally, age-standardized incidence rate (ASIR) and ASDR were on the rise in almost all countries/regions, suggesting that the impact of CKD on global health is increasing. Population growth and ageing were major factors contributing to the increasing burden of CKD, especially in China and low Socio-demographic Index (SDI) regions. In addition, the cross-national study of health inequalities in CKD showed that, although there have been improvements in global health over time, health inequalities continue to exist. The frontier analysis revealed a considerable degree of heterogeneity in the effective differences across the spectrum of socio-demographic indices.

CONCLUSION

CKD is a global health problem, the burden of which varies between regions and countries. A multifaceted approach is necessary to prevent and control CKD, including population-level interventions targeting risk factors, improvements in the accessibility and quality of health care, and measures to address health inequalities.

Global and East Asia tracheal, bronchus, and lung cancer trend analysis from 1990 to 2021 and forecast trend from 2021 to 2035

Background and Aims

This study aimed to evaluate the trends in incidence, mortality, and disability-adjusted life years (DALYs) for trachea, bronchus, and lung (TBL) cancer globally and in East Asia from 1990 to 2021.

Methods

We analyzed TBL cancer data from the Global Burden of Disease (GBD) 2021 study, focusing on five East Asian countries. Socioeconomic contexts were examined using sociodemographic indices. Trends in disease metrics were analyzed using time-segmented link-point regression to determine the average annual percentage change (AAPC). A Bayesian Age-Period-Cohort (BAPC) model was applied to forecast the future disease burden from 2022 to 2030.

Results

Globally and in East Asia, significant increases were observed in the incidence, mortality, and DALYs related to TBL cancer from 1990 to 2021. China had the highest rates of incidence (934,704; 95% UI, 750,040 to 1,136,938), mortality (814,364; 95% UI, 652,636 to 987,795), and DALYs (18,920,203; 95% UI, 15,100,681 to 23,111,519), while Mongolia had the lowest. Ambient particulate matter pollution was identified as the main risk factor for TBL cancer mortality both globally and in most East Asian countries. Notably, global TBL cancer incidence spikes occurred during 1999-2012 and 2019-2021 (AAPC: 1.170 [95%, 1.115 to 1.225] and 1.658 [95%, 0.604 to 2.723], respectively). In Mongolia, TBL cancer incidence showed variable trends. The increases in global and East Asian DALY rates were attributed to population aging and growth, while epidemiological shifts have contributed to reduced rates. Except for Democratic People's Republic of Korea, DALY risk trends were generally declining across the other East Asian countries.

Conclusion

There has been a significant increase in the incidence and mortality rates of TBL cancer both globally and in East Asia from 1990 to 2021, with environmental particulate matter pollution potentially serving as a strongly correlated risk factor. There is an urgent need to enhance prevention, early detection, and treatment measures, particularly in high-risk regions.

A systematic analysis and prediction of the disease burden of ischemic heart disease caused by hyperglycemia

OBJECTIVE

This study aims to analyze the disease burden of ischemic heart disease (IHD) caused by hyperglycemia and its changing trend, and to construct a visualization platform for disease burden and forecast trends on the Shiny platform.

MATERIALS AND METHODS

Using data from the 2021 Global Burden of Disease Study, we analyzed deaths and disability-adjusted life years (DALYs) due to IHD triggered by hyperglycemia, with detailed analysis by region, gender, and age. The age-period-cohort model was used to assess the impact of age, cohort, and period on age-standardized disease rates across different Socio-Demographic Index (SDI) regions, and decomposition analysis was employed to disentangle the contributions of population, aging, and epidemiological changes.

RESULTS

In 2021, approximately 14-15% of IHD's DALYs and deaths were attributed to high fasting plasma glucose (HFPG), with a nonsignificant decrease in the annual average percentage change of DALYs. In middle, low-middle, and low SDI regions, the age-standardized mortality rates caused by HFPG are increasing, particularly among males. In high-middle and high SDI regions, the effects of aging and epidemiological changes surpass population growth, whereas in low SDI regions, population growth is the main factor. By 2050, the global Age-Standardized Mortality Rate of IHD attributed to HFPG is projected to reach 16.96. More data can be accessed by visiting the disease burden visualization platform.

CONCLUSION

Global HFPG-induced IHD health presents significant imbalances. In low SDI regions with larger populations and more unbalanced healthcare distribution, there is a need to strengthen the construction of medical levels.

Locally Delivered Hydrogel with Sustained Release of Flavonol Compound Kaempferol Mitigates Inflammatory Progression of Periodontitis and Enhances the Gut Microflora Composition in Rats

OBJECTIVE

This study aimed to investigate the effects of a sustained-release composite containing gelatin methacryloyl (Gel) and kaempferol (Ka, K) on experimental periodontitis symptoms in rats.

METHODS

Forty 6-week-old male rats were randomly assigned to four treatment groups in a specific pathogen-free (SPF) environment: Control group (C), periodontitis model group (M), Gel alone group (G), and Gel_Ka composite-treated group (G_K). Treatment effects on the periodontal status of bilateral maxillary second molars in each rat group were assessed by micro-CT imaging and histology. Immunohistochemistry staining was employed to examine the effects on expression levels of inflammatory factors IL-6 and MMP9 (associated with M1 macrophages) and of the anti-inflammatory factor CD206 (associated with M2 macrophages). Additionally, treatment effects on oral and intestinal microbial communities were analyzed through 16S rDNA sequencing.

RESULTS

Local injection treatment with the G_K composite hydrogel effectively suppressed alveolar bone resorption and reduced periodontal attachment loss and inflammation infiltration in rats with periodontitis. It reduced the expression of inflammatory factors MMP9 and IL-6 but increased the anti-inflammatory factor CD206, and it also increased the abundance of gut microbial communities producing short-chain fatty acids.

CONCLUSION

Local treatment with the sustained-release G_K hydrogel composite demonstrates a substantial antiperiodontitis effect in rats by locally attenuating inflammation and is associated with enhancing the microbial composition of intestinal flora, thus aiding in mitigating the inflammatory progression of experimental periodontitis.

Mortality trends and causes of death in a South African hospital complex pre- and during COVID-19

Background

Before coronavirus disease 2019 (COVID-19), global health was improving, with declining mortality trends. The pandemic disrupted this progress, increasing mortality in South Africa between April 2020 and March 2022. Pre-pandemic data establishes a baseline for assessing COVID-19's impact on all-cause mortality.

Objectives

This study examines changes in hospital-based mortality trends in a Gauteng hospital complex from April 2018 to March 2022, addressing the scarcity of such studies during the COVID-19 era.

Method

A retrospective review of 7815 deaths from April 2018 to March 2022 was conducted. Chi-squared tests were used to analyse deaths by age group and gender, with correlations reported.

Results

Mortality rates rose from 3.2% in 2018-2019, peaked at 5.1% in 2020-2021, and declined to 4.2% in 2021-2022. Patients aged 15 years-64 years had the highest death rates, with an increase among those over 65. Male deaths exceeded female deaths, with the smallest difference observed in 2020-2021. Leading causes of death included diseases of the circulatory and respiratory systems, neoplasms, digestive system diseases, and infectious and parasitic diseases.

Conclusion

The study highlights COVID-19's impact on mortality, showing variations by year, age, gender, and disease.

Contribution

Excess non-COVID-19 deaths likely stemmed from disrupted healthcare services. These findings underscore the need for ongoing monitoring of hospital mortality to identify pandemic-related service disruptions and guide interventions to strengthen healthcare services, improve access to care, and enhance referral systems during unexpected disasters.

Global burden of diseases attributable to childhood sexual abuse and bullying: findings from 1990 to 2019 and predictions to 2035

PURPOSE

Childhood sexual abuse (CSA) and bullying are serious public health concerns that influence child, adolescent, and adult health. This study aims to provide updated estimate of age- and sex- specific deaths and disability-adjusted life years (DALYs) associated with CSA and bullying from 1990 to 2019 at the global, regional, and national levels, and to forecast the global burden of disease attributed to it from 2020 to 2035.

METHODS

We used the data for the number of deaths, DALYs, age-standardized rate (per 100,000 population), percentage change, and population attributable fraction (PAF) from the Global Burden of Disease Study 2019 (GBD 2019) to assess the disease burden attributable to CSA and bullying. We further applied an autoregressive integrated moving average (ARIMA) model to predict the disease burden for the period 2020 to 2035.

RESULTS

In 2019, CSA and bullying accounted for 0.02% and 0.28% of global all-cause deaths and DALYs, respectively. The highest deaths rates were observed in men aged 45-49, and women aged 50-54. The highest DALYs rates were observed in men aged 20-24 and women aged 15-19. The highest age-standardized deaths and DALYs rates were observed in the Eastern Europe region (1.222 [95% UI 0.161, 3.013]) and in High-Income North America region (176.613 [95% UI 79.02, 312.064]) per 100,000 people respectively. El Salvador (1.523 [95% UI 0.209, 3.589]) and Greenland (298.014 [95% UI 138.745, 518.086]) per 100,000 people had the highest age-standardized- deaths and DALYs rates, respectively. The highest age-standardized rates of CSA and bullying related deaths and DALYs were observed in high-socio-demographic Index (SDI) quintile. The age-standardized deaths rate attributable to CSA and bullying is projected to decrease in both sexes between 2019 and 2035, whereas the age-standardized DALYs rate is projected to decrease in male and increase in female between 2019 and 2035.

CONCLUSIONS

CSA and bullying contributed to the global disease burden. Action is needed to develop effective policies. Our study provides policymakers with up-to-date and comprehensive information.

Communicating cancer treatment with pictogram-based timeline visualizations

OBJECTIVE

This study evaluated the legibility, comprehension, and clinical usability of visual timelines for communicating cancer treatment paths. We examined how these visual aids enhance participants' and patients' understanding of their treatment plans.

MATERIALS AND METHODS

The study included 2 online surveys and 1 in-person survey with hematology cancer patients. The online surveys involved 306 and 160 participants, respectively, while the clinical evaluation included 30 patients (11 re-surveyed) and 24 medical doctors. Participants were assessed on their ability to understand treatment paths provided with audio information alone or with visual aids. The study also evaluated the comprehensibility of key treatment terms and the ability of patients to recall their cancer treatment paths.

RESULTS

Visual representations effectively communicated treatment terms, with 7 out of 8 terms achieving over 85% transparency as pictograms, compared to 5 out of 8 for comics and 4 out of 8 for photos. Visual treatment timelines improved the proportion of correct responses, increased confidence, and were rated higher in information quality than audio-only information. In the clinical evaluation, patients showed good comprehension (mean proportion correct: 0.82) and recall (mean proportion correct: 0.71 after several weeks), and both patients and physicians found the visual aids helpful.

DISCUSSION

We discuss that visual timelines enhance patient comprehension and confidence in cancer communication. We also discuss limitations of the online surveys and clinical evaluation. The importance of accessible visual aids in patient consultations is emphasized, with potential benefits for diverse patient populations.

CONCLUSION

Visual aids in the form of treatment timelines improve the legibility and comprehension of cancer treatment paths. Both patients and physicians support integrating these tools into cancer treatment communication.

Updates in Arterial Ulcers

Arterial ulcers are a clinical symptom of a complex array of underlying comorbid factors, namely peripheral artery disease (PAD). Chronic limb-threatening ischemia is representative of end-stage PAD. Ulcers of other etiologies can carry an arterial component, mandating recognition of risk factors, a comprehensive history and physical examination, and appropriate diagnostic testing in lower extremity ulcers. The primary therapy for arterial ulcers is re-establishment of in-line arterial flow, achieved by endovascular therapy or open revascularization. Medical management is essential to slow disease progression, and topical therapies are crucial to promote rapid ulcer closure and reduce infection risk.

The Association of Oral Processing Factors and Nutrient Intake in Community-Dwelling Older Adults: A Systematic Review and Meta-Analysis

CONTEXT

Oral health and food oral-processing issues emerge with functional decline in the older adult population, potentially increasing the risk of malnutrition. Impairment of oral health is associated with poorer nutrition status; however, the relationship between oral factors and the intake of each nutrient remains poorly understood.

OBJECTIVE

The associations between different oral factors and nutrient intakes among community-dwelling older adults were investigated.

DATA SOURCES

A literature search from 5 databases (Web of Science, Scopus, Cochrane Library, Ovid [MEDLINE and Embase], and CINAHL) was completed on February 1, 2022. The search was limited to peer-reviewed articles published between the years 2012 and 2022.

DATA EXTRACTION

Six cross-sectional studies were included in the meta-analysis. Two authors independently completed the data extraction and summarized the study characteristics, factors adjusted for in the statistical analysis, the outcome, and summary statistics of the results.

DATA ANALYSIS

Meta-analyses showed evidence of a significant association between compromised oral factors (namely, denture status, chewing ability, and the number of teeth) with lower energy (weighted mean difference [WMD], -107 kcal d-1 (95% CI, -132 to -81), protein (WMD, -5.2 g d-1; 95% CI, -6.6 to -3.8), fat (WMD, -4.6 g d-1; 95% CI, -6.7 to -2.6), carbohydrate (WMD, -8.8 g d-1; 95% CI, -13.9 to -3.7), and vitamin C intakes (WMD, -12.9 mg d-1; 95% CI, -16.6 to -9.2) in older adults.

CONCLUSION

Oral health can be an indicator of compromised daily energy, protein, fat, carbohydrate, and vitamin C intakes in older adults. However, the small sample size of the studies included in this review and the heterogeneity among macronutrient studies should be considered. Because of the lack of studies covering all aspects of food oral processing (eg, salivary flow rate, tongue pressure), the associations between oral processing and nutrient intake were not thoroughly explored.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022308823.

Long-term oral fluoxetine leads to reduced male reproductive function in mice and gradual recovery after discontinuation

Fluoxetine, a widely used selective serotonin reuptake inhibitor (SSRI), is highly effective in treating psychiatric disorders such as depression. Recently, its potential negative impact on male reproductive function has recently raised concerns, but it remains unknown whether testicular damage from long-term fluoxetine exposure can recover after stopping the drug. In this study, male C57BL/6 mice were divided into control (saline) and treatment (fluoxetine, 20 mg/kg.d) groups, administered orally for 4 weeks. This duration and dosage have been proven to demonstrate significant antidepressant effects in mice. Fertility assessments and euthanasia was then performed at three time points: immediately after treatment cessation, 4 weeks post-discontinuation, and 8 weeks post-discontinuation (n = 8). Results found that following long-term fluoxetine administration, male mice exhibited significantly reduced mating and fertility indices, decreased sperm count and motility, and increased sperm deformities compared to the control group. Testicular histology showed immature germ cells within the seminiferous tubule lumens, along with significantly reduced seminiferous epithelial thickness, seminiferous tubule diameter, and Johnsen score. Ki67 (proliferation marker) expression decreased, while Caspase3 (apoptosis marker) increased. By 4 weeks post-discontinuation, Ki67 and Caspase3 levels in the fluoxetine-treated group returned to control levels, with partial recovery in other parameters. By 8 weeks, all measured parameters had largely normalized, indicating significant recovery in reproductive function. These findings provided novel insights into fluoxetine's reproductive toxicity and were crucial for assessing its clinical safety in drug evaluations.

Global burden of non-rheumatic valvular heart disease in older adults (60-89 years old), 1990-2019: Systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND

Understanding the global burden and risk factors of non-rheumatic valvular heart disease (NRVHD) in older adults is important for effective disease control. We wanted to analyze the prevalence, incidence, disability-adjusted life years (DALY) rate, mortality rate, and risk factors of NRVHD in older adults aged 60-89 years.

METHODS

Global Burden of Disease Study (GBD) 2019 was used as the data source. Age standardized incidence rate, prevalence, DALY rate, and mortality rate of NRVHD among older adults aged 60-89 years from 1990 to 2019. We analyzed different age groups, genders, regions, sociodemographic index (SDI) across 204 countries/territories. Proportional DALY and mortality attributable to risk factors were calculated.

RESULTS

Globally, age-standardized DALY rate (per 100,000 population) for NRVHD in older adults decreased significantly from 44.46 (95 % confidence interval 39.95 to 49.18) in 1990 to 35.94 (32.32 to 40.19) in 2019 with an average annual percent change (AAPC) of -0.19 % (-0.24 % to -0.14 %), and the mortality rate also decreased significantly from 2.48 (2.21 to 2.64) to 2.25 (1.89 to 2.47) with an AAPC of -0.09 % (-0.16 % to -0.03 %,). However, the age-standardized incidence rate (per 100,000 population) increased from 18.37 (17.41 to 19.35) in 1990 to 19.77(18.62 to 20.95) in 2019 with an AAPC of 0.08 % (0.05 % to 0.10 %), and the age-standardized prevalence rate significantly increased from 391.40 (372.71 to 411.20) to 399.50 (378.31 to 420.75) with an AAPC of 0.02 % (0.00 % to 0.05 %). At the regional level, the greatest burden of NRVHD was seen in parts of high-income North America. At the national level, the highest age standardized incidence rate, age standardized DALY rate, and age standardized mortality rate in 2019 were all from Niger, Philippines and Belarus, making it the region with the greatest burden of NRVHD. The age standardized incidence and DALY rate were higher in women 20.83 (19.68 to 22.02) than in men 18.64 (17.39 to 19.88) globally, while the mortality rate was similar in different genders. The differences between men and women in incidence, DALY and mortality were mainly found in age groups of 80-84 and 85-89 years. A significant negative association was found between estimated annual percentage change (EAPCs) and age standardized rate (q=-0.19, p = 0.00). A significant positive relation was detected between EAPCs and human development index (q = 0.17, p = 0.02). The main attributable risk factor for DALY was high body mass index in all regions by SDI.

CONCLUSION

There is a substantial global burden of NRVHD in older adults in 2019, which is varied by age, gender, SDI and region. NRVHD in older people should be paid attention to. Risk factors described here should provide more evidence and clues for disease prevention in the future.