Findings from the Global Burden of Disease Study 2021

Unpacking the post-COVID association between unexpected births and excess deaths

OBJECTIVE

Global fertility has halved since its 1960s peak to be little above the replacement rate, and lower in many developed countries. In addition it has been suggested that excess deaths since the onset of the COVID pandemic may have influenced fertility. Given the economic and social interest in declining fertility, this study seeks an explanation.

METHODS

We developed a sample for 18 mid-large industrialized countries of 30 variables covering vital statistics and health, social and economic data, and determined excess deaths during 2020-2022 and unexpected births during 2022-2024. Analysis estimated the link between COVID excess deaths and subsequent unexpected births; and estimated links between excess deaths and unexpected births and national parameters.

RESULTS

Countries' average birth rate during 2022-2023 was 5-6% below that expected from their trend and mean prior to the spread of COVID-19 in 2020. Birth rates were higher than expected after 2022 in countries which had high excess deaths during 2020-2022. Regression against national parameters traced reductions in post-COVID births to countries' strong economic measures (low unemployment, high GDP per capita), indicators of women's high economic capacity (years at school, female workforce participation), and weak religiosity. Similar analysis identified higher excess deaths in less wealthy countries, and those with weaker social measures and women's opportunities, and poor pre-existing health outcomes (high infant mortality, low life expectancy, fewer physicians).

CONCLUSION

The association between unexpected births and excess deaths this decade is largely spurious because lower wealth and poor previous health outcomes drove excess deaths, while the opportunity cost of childbearing has accelerated declining births in wealthier countries post-COVID. Better understanding population effects of the pandemic is of broad social and economic interest given declining fertility rates; and change in trajectory of births could prove the pandemic's most serious socio-economic consequences.

Global, regional and national level burden of bulimia nervosa from 1990 to 2021 and their projections to 2030: analysis of the global burden of disease study

Background

Bulimia nervosa (BN) is increasingly recognized as a significant public health issue worldwide. This study aims to explore the effects of BN on global, regional, and national scales by analyzing data from the Global Burden of Disease (GBD) Study 2021.

Methods

We obtained the age-standardized rates (ASRs) of prevalence, incidence, and disability-adjusted life years rates (DALYs), along with their 95% uncertainty intervals (UIs) for BN from the GBD 2021 dataset, covering the period from 1990 to 2021. And estimated annual percentage changes (EAPCs) was used to represent the changing trend of BN burden. The Long-term trends of the burden of BN were quantified by Age-period-cohort (APC) analysis. Furthermore, an evaluation of inequality and a prospective prediction concerning the worldwide impact of BN is performed.

Results

From 1990 to 2021, the global burden of BN showed a continuous increase. In 2021, the highest burden of BN was observed in regions with a high socio-demographic index (SDI), particularly in Australasia (ASPR was 811.9 per 100,000 individuals; 95% UI: 629.68 to 1041.59). The most substantial increase in the burden of BN was observed in Asia. In the national level, Equatorial Guinea experienced the most significant increase in the burden of BN from 1990 to 2021 (EAPC of ASPR was 3.48; 2.86 to 4.11). In contrast, burden of BN in High-income North America recorded a substantial decrease from 1990 to 2021 (EAPC of ASPRs was − 0.26; -0.39 to -0.13). The growth rate of male BN burden was higher than that of female. The relative inequality of the BN burden decreased between 1990 and 2021. Further forecasts from the GBD indicated that the global burden of BN would continue to rise by 2030.

Conclusion

These results can help governments across the globe in developing suitable health and medical policies focused on the prevention and early intervention of BN. Moreover, the differences in BN burden should be analyzed based on region, nation, gender, and year when setting international health goals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40337-025-01289-9.

Analyses of prevalence, incidence, and disability-adjusted life years (DALYs) for bulimia nervosa (BN) revealed a sustained increase in BN’s global burden from the year of 1990 to 2021. Regionally and nationally, BN burden correlated positively with socioeconomic development levels, with Australia exhibiting the highest burden in 2021. The most pronounced growth occurred in East and South Asia, while high-income North America experienced a decline. Notably, although females bore a higher burden, males demonstrated faster growth rates in BN cases. Inequality analyses showed widening absolute disparities in BN burden between high- and low-income nations, whereas relative inequality decreased due to accelerated burden growth in lower-income regions. Projections indicate a continuing global rise in BN burden through 2030, underscoring the need for targeted interventions.

Readability of written information for patients across 30 years: A systematic review of systematic reviews

OBJECTIVE

This study conducted a systematic review of the systematic reviews of readability assessment studies to contribute to future readability research and practice by providing a comprehensive overview of information readability for patients.

METHODS

We searched multiple databases. We included systematic reviews of studies that quantitatively assessed the readability of health information.

RESULTS

This study included 24 systematic reviews, which assessed the readability of 29,424 materials across 438 studies from 1990 to 2022. All systematic reviews reported that the readability of most materials exceeded the recommended sixth to eight-grade reading level. The readability level did not improve between 2001 and 2022, when the included systematic reviews were published.

CONCLUSIONS

We found that the required reading level of information was too high for patients in all clinical areas included in this systematic review. We also identified gaps in readability assessment research in clinical areas and across media types and languages, which should be addressed by future studies.

PRACTICE IMPLICATIONS

Health professionals should use available guidelines to make existing patient information easy to read and to write easy-to-read patient information, thereby improving readability. Such efforts are needed regardless of the organizations these professionals work at.

Burdens and trends of age-related macular degeneration at global, regional, and national levels,1990-2021: findings from the 2021 global burden of disease study

OBJECTIVES

To assess global, regional, and national burdens and trends of age-related macular degeneration (AMD) from 1990 to 2021.

METHODS

Data from the Global Burden of disease Study 2021(GBD 2021) were used. The primary measurement were prevalent cases, years lived with disability (YLDs), age-standardised prevalence rate (ASPR) and age-standardised YLDs rate (ASYR), categorized by age and sociodemographic index (SDI). Trend analysis was measured by calculating average annual percentage change (AAPC) of ASPR and ASYR.

RESULTS

Globally, the prevalent AMD cases increased to 8,057,520.459 (95% uncertainty interval [UI], 6,705,283.83 to 9,823,237.34) in 2021, with associated YLDs rising to 577,984.5004 (95% UI, 401,188.20 to 797,657.63). AMD burdens varied across regions and countries, as well as level of SDI development. China, India, and the United States of America (USA) were the top three countries with AMD cases. Caribbean regions have significant lower ASPR and ASYR of AMD. The AMD burden peaked between ages 65-69. Females had a significantly higher burden of AMD compared to males. From 1990 to 2021, the global ASPR and ASYR showed downward trend (AAPC = -0.15, 95% confidence interval [CI], -0.19 to -0.12, P < 0.001; AAPC = -0.69, 95% CI, -0.71 to -0.67, P < 0.001) respectively. The USA is the only developed country showed decreasing AAPCs of ASPR and ASYR from 1990 to 2021 but increasing AAPCs of ASPR and ASYR from 2012 to 2021.

CONCLUSIONS

AMD burdens increased over 30 years, varying by age, sex, and SDI, guiding global strategies and public health interventions.

Trends in the incidence and burden of otitis media in children: a global analysis from 1990 to 2021

BACKGROUND

Otitis media (OM) is a prevalent and serious condition in childhood, but comprehensive global studies assessing its burden are lacking.

METHODS

Using data from the 2021 Global Burden of Disease (GBD) study, we analyzed OM incidence cases and disability-adjusted life years (DALYs) in children aged 0-14 from 1990 to 2021. Trends were analyzed across regions, age groups, sexes, and socio-demographic index (SDI) using estimated annual percentage changes (EAPC). Predictive models were used to forecast trends to 2050.

RESULTS

The global number of OM incidence cases in children increased from 256 million in 1990 to 297 million in 2021, a 15.97% rise. The age-standardized incidence rate (ASIR) showed a slight increase (EAPC: 0.12). Despite some variations across age, sex, and regions, the age-standardized DALY rate (ASDR) declined. ASIR and ASDR were highest in children aged < 1 year and gradually decreased with age. The largest burden was observed in low- and middle-low-SDI regions, although these regions showed the greatest declines in EAPC. Correlation analysis indicated that ASDR decreases as the SDI increases. By 2050, the number of global OM incidence cases in children is projected to reach 334 million, with most of the increase concentrated in low-SDI regions, while ASIR is expected to remain stable.

CONCLUSION

Although progress has been made in controlling OM in children over the past 30 years, the ASIR remains high. The sustained high burden and incidence of OM in low-SDI regions, and among young children, pose a significant challenge to children's health.

Gendered experience of people living with type 2 diabetes in rural and urban Mexico: an ethnographic study

OBJECTIVE

To analyse the gendered experience of women and men living with type 2 diabetes mellitus (T2D) related to diagnosis, treatment, and control in rural and urban contexts of Mexico.

METHODOLOGY

Qualitative ethnographic study. Thirty-six adults (21 women and 15 men) with a confirmed diagnosis of T2D for more than five years residing in urban and rural localities in Baja California and Morelos participated in this qualitative study between November 2022 and February 2023. A semi-structured interview guide was used to explore lifestyle changes, social and community networks, work and living conditions, experience with the disease, health services and associated economic burden. The analysis was guided by four conceptual domains of gender influence: identity, norms and roles, relationships and institutionalised gender.

RESULTS

Women were more likely to report difficulty in accepting the diagnosis of T2D and stress in coping with the disease and related lifestyle changes. Men were more likely to report impact of T2D on their job and role as household providers, and their inability to contribute to the care of other family members. Women were more likely to report leaving their jobs, taking on caregiving responsibilities for family members, experiencing difficulty in accessing healthcare, and prioritizing their health in comparison to men. Men reported receiving more support from their partners, faced fewer financial barriers to care access, and had more freedom to pay for their medications and seek treatment in private care. However, they were also less adherent to treatment and disease care measures.

CONCLUSIONS

Gender appears to substantially influence experience of living with T2D. Women were more likely to provide family support and less likely to receive it and reported greater financial barriers to care access in comparison to men. Men were more likely to experience stress in relation to their employment as primary providers for their family, and less likely to adhere to prescribed medical management of their condition. These findings should be considered in more targeted health policy interventions to promote greater gender equity in the care of those with T2D in Mexico.

The effects of Tai Chi on clinical outcomes and gait biomechanics in knee osteoarthritis patients: a pilot randomized controlled trial

Knee osteoarthritis (KOA) is a common degenerative joint disease that significantly reduces mobility and quality of life in elderly populations. Tai Chi, a low-impact mind-body exercise, has been suggested as a potential non-pharmacological intervention for managing KOA, but its biomechanical effects remain unclear. This study aimed to evaluate the effects of a 14-week Tai Chi program on clinical symptoms, lower limb biomechanics, and muscle activation patterns in elderly patients with KOA. A single-blinded randomized controlled trial was conducted, enrolling 24 participants aged 55-70 years with unilateral KOA. Participants were randomly assigned to a Tai Chi intervention group or a control group receiving health education only. Primary outcomes included joint range of motion, joint moments, and muscle activation, measured using a motion capture system and surface electromyography. Secondary outcomes, such as pain, stiffness, function (WOMAC), balance (BBS), and quality of life (SF-12), were also assessed pre- and post-intervention. The Tai Chi group demonstrated significant improvements in WOMAC pain (-1.58 ± 1.44 vs. 0.11 ± 0.78, p = 0.01), stiffness (-0.33 ± 0.78 vs. 0.56 ± 0.88, p = 0.02), and function scores (-2.58 ± 3.53 vs. 1.00 ± 2.78, p = 0.02) compared to the control group. Balance (BBS: 1.42 ± 1.88 vs. -0.89 ± 1.27, p = 0.01) and physical health (SF-12 PCS: 5.45 ± 6.76 vs. -1.05 ± 2.17, p = 0.01) were also enhanced. Biomechanically, Tai Chi reduced horizontal plane knee ROM (-3.03 ± 1.00°, p = 0.01) and maximum knee extension moments (affected side: -0.09 ± 0.04 N/kg, p = 0.04, Non-affected side: -0.11 ± 0.05 N/kg, p = 0.03). Tibialis anterior muscle activation increased significantly (5.66 ± 1.05%MVIC, p = 0.02), while other muscles showed non-significant trends. Tai Chi demonstrated significant clinical and biomechanical benefits for elderly KOA patients, suggesting its potential as a safe, accessible, and effective therapeutic intervention.

Bone SPECT/CT in the diagnosis and treatment decision making of axial pain

PURPOSE

To explore the usefulness of bone SPECT/CT for providing additional information to Magnetic Resonance Imaging (MRI) in patients with axial pain, and for guiding the site of spinal injections.

METHODS

We studied 194 patients with axial pain evaluated with SPECT/CT and MRI. Imaging abnormalities were classified according to location and diagnosis of pain generators. Patient outcomes after SPECT/CT guided spinal injection were evaluated during clinical follow-up. Descriptive analyses and kappa coefficient were performed for facet joint arthropathy detection and degenerative disc disease between imaging modalities.

RESULTS

MRI showed 44.3% more abnormalities than SPECT/CT (329 vs. 228). However, SPECT/CT detected 17% more patients with facet joint arthropathy compared to MRI (43.3% vs. 26.3% respectively). Imaging agreement for diagnosing degenerative disc disease was moderate (κ: 0.44; 95% CI, 0.32-0.56), but only fair for facet joint arthropathy (κ: 0.35; 95% CI, 0.28-0.42). The response to spinal injections guided by SPECT/CT imaging was assessed in 56 patients with facet joint arthropathy. Among these, 26 /56 had a history of previous spinal injections guided by physical examination. In this group, the response was effective or partially effective in 65.4% of patients and ineffective in 34.6%. After a second injection guided by SPECT/CT, the response rate increased to 88.4%, with only 11.6% remaining ineffective, resulting in an absolute benefit of 23.4%. In 30/56 patients with no prior history of spinal injections, the therapy was effective or partially effective in 93.3%, while 6.7% did not show any improvement in pain after SPECT/CT-guided spinal injections.

CONCLUSION

Bone SPECT/CT imaging complements MRI by providing valuable information to identify pain generators. In facet joint arthropathy, it improves the effectiveness of pain relief when used to guide spinal injections.

Exploring the burden of anorexia nervosa and bulimia nervosa in Mexico, 1990-2021

BACKGROUND

Eating disorders (ED) have been on the rise in both high-income and middle-income countries. The objective of this study is to analyze the burden of eating disorders (ED) due anorexia nervosa (AN) and bulimia nervosa (BN) in Mexico at the national and subnational levels between 1990 and 2021 and to measure the correlation between disability-adjusted life years (DALY) with the socio-demographic index (SDI) and with the healthcare access and quality index (HAQI) for both 1990 and 2021.

METHODS

This was a secondary analysis of the GBD 2021. The DALY number and age-standardized rate (ASR) were analyzed for 1990, 2005, 2019, and 2021. The data were disaggregated by sex, age groups, and subcauses (AN and BN) at national and subnational levels.

RESULTS

In Mexico, the ASR DALY due to ED increased by 50.2% and 49.6% between 1990 and 2021. In all states and for all years, women had higher ASR DALY due to ED than men. The ASR DALY was also higher for BN than for AN. A positive and significant correlation existed between ASR DALY due to ED and the SDI and HAQI.

CONCLUSIONS

ED due AN and BN represents a significant burden for individuals under 50 years old in Mexico. There are wide disparities between states and heterogeneous patterns by sex, age groups, and subcauses. Prioritizing this issue on the country's public policy agenda is crucial.

Temporal Trends in the Burden of Disease for Male Infertility from 1990 to 2021 in the BRICS

Background

Over the past three decades, male infertility has become a significant burden on global public health. As an international organization with nearly half of the world's population, BRICS plays a crucial role in global health. This study investigates the trend of male infertility burden in BRICS countries from 1990 to 2021, providing valuable information for prevention and treatment strategies.

Methods

Data on male infertility in BRICS countries were obtained from the Global Burden of Disease database. Joinpoint regression, decomposition analysis, and prediction models were applied to analyze the data and assess the disease burden trends.

Results

The global prevalence of male infertility has worsened significantly between 1990 and 2021, with projections indicating this trend will continue for the next 15 years. While this global trend is based on data from a range of countries, the results of this study specifically focus on the BRICS countries. In these countries, while China and the Russian Federation have had high prevalence rates, improvements were observed over the past 30 years. India and Brazil, though unable to control male infertility in this period, have managed to halt its worsening in recent years. South Africa experienced substantial fluctuations from 2001 to 2015, with further significant changes projected in the next 15 years.

Conclusion

This study provides valuable insights into the evolving burden of male infertility in BRICS countries. It underscores the importance of targeted prevention and treatment strategies for these countries based on national and global trends.

Global trends and burden of brain and central nervous system cancers in adolescents and young adults GBD 2021 study

Brain and central nervous system (CNS) cancers are a major cause of cancer-related mortality and morbidity among adolescents and young adults (AYAs) aged 15-39, presenting significant global health challenges despite advances in treatment. This study assesses the global burden and future trends of CNS cancers in AYAs using data from the Global Burden of Disease (GBD) 2021 database. Data on incidence, mortality, and disability-adjusted life years (DALYs) from 1990 to 2021 were analyzed for 204 countries and territories. Age-standardized rates for incidence (ASIR), mortality (ASMR), and DALYs (ASDR) were calculated, with temporal trends assessed using Joinpoint regression and future projections estimated using the Bayesian Age-Period-Cohort (BAPC) model. Disparities were evaluated using the Socio-Demographic Index (SDI), a composite measure of income, education, and fertility rates. In 2021, global CNS cancer incidence among AYAs was 57,645 cases, with a prevalence of 271,770. The ASIR was 1.92 per 100,000, the ASMR 0.95 per 100,000, and DALYs totaled 1,744,650. High-SDI regions reported higher ASIR but lower ASMR and ASDR. By 2040, case numbers are projected to rise, while age-standardized rates may stabilize or decline. This study highlights significant global disparities in CNS cancer burden, calling for investments in cancer registries, equitable healthcare access, and tailored prevention and treatment strategies.

Epidemiological trends and forecasts in stroke at global, regional and national levels

BACKGROUND

Stroke, characterized as ischemic or hemorrhagic, leads to severe morbidity, mortality, and recurrence. This research analyzed stroke epidemiological trends from 1990-2021.

METHODS

The Global Burden of Disease database provided stroke data including incidence, mortality, and disability-adjusted life-years (DALYs). Age-standardized rates (ASRs) and Estimated Annual Percent Changes (EAPC) measured incidence and mortality shifts. The sociodemographic index (SDI) was explored alongside stroke burden. Forecasting of stroke trends until 2035 utilized the Bayesian age-period-cohort (BAPC) model. The factors influencing the variability of stroke burden were subjected to decomposition analysis for a more in-depth examination. Additionally, frontier analysis was employed to visually illustrate the opportunities for alleviating burden in each nation or region, taking into account their respective stages of development.This study utilized the slope index of inequality (SII) and the concentration index, as defined by the World Health Organization (WHO), to assess absolute and relative inequalities in disease burden.

RESULTS

From 1990-2021, global stroke incidence increased by 15.03 %, with an overall decline in age-standardized incidence rate (ASIR). Lower in females than males, the incidence rise was larger in females. Stroke mortality declined by 2.60 % overall, with a rise in male mortality and decrease in female mortality. DALYs increased, with a 10.67 % decline by rate per 100,000 people. Eastern Europe, Central Asia, and East Asia experienced the highest incidence rates, with the greatest ASIR decline in the high-income Asia Pacific region. The decomposition analysis revealed a notable rise in Disability-Adjusted Life Years (DALYs) within the middle Socio-Demographic Index (SDI) quintile region, where factors such as aging and population growth were identified as primary contributing elements. Additionally, the frontier analysis indicated that nations or regions categorized within higher SDI quintiles are likely to exhibit greater potential for improvement. Projections for 2035 anticipate increased stroke cases alongside further ASIR and ASMR declines. Cross-country inequality analysis suggests that both absolute and relative health inequalities associated with the stroke burden have escalated during the period from 1990 to 2021.

CONCLUSION

Despite rising global stroke incidence and DALYs, decreases were seen in ASIR and ASMR since 1990. Incidence rates increased most quickly in females, with regional variation observable. High systolic blood pressure remained a key risk factor. Future efforts should target prevention and treatment to mitigate sex, age, and regional stroke disparities.

Global, regional, and national trends in peripheral arterial disease among older adults: findings from the global burden of disease study 2021

IMPORTANCE

Lower extremity peripheral arterial disease (PAD) is a significant health concern among older adults globally, affecting both mortality and quality of life.

OBJECTIVE

To evaluate the temporospatial trends and its risk factors in lower extremity PAD-related burden among adults aged 60 years and older from 1990 to 2021.

DESIGN, SETTING, AND PARTICIPANTS

This repeated cross-sectional study utilized data from the Global Burden of Disease Study 2021, encompassing 204 countries and territories. The study population included adults aged 60 years and older.

EXPOSURE

Lower extremity PAD among older adults from January 1990 to December 2021.

MAIN OUTCOMES AND MEASURES

Primary outcomes included age-standardized prevalence rates (ASPR), mortality rates (ASMR), disability-adjusted life-years (DALYs), and average annual percentage changes (AAPCs). Trends were analyzed by age, sex, and sociodemographic index (SDI). Joinpoint regression analysis was used to identify significant trend changes.

RESULTS

From 1990 to 2021, global trends showed decreases in lower extremity PAD-related prevalence, mortality, and DALYs. Significant geographical disparities were observed: high-SDI regions had the highest prevalence (11,171.66 per 100,000 in 2021) but showed declining trends (AAPC, -0.74; 95% CI, -0.80 to -0.68), while low-SDI regions had the lowest prevalence (4,842.40 per 100,000) but demonstrated increasing trends (AAPC, 0.22; 95% CI, 0.21 to 0.24). Regionally, although lower extremity PAD-related prevalence showed a decreasing trend in most regions from 1990 to 2021, there were still some regions with an increasing trend (North Africa and Middle East AAPC, 0.57; 95% CI, 0.55 to 0.59). Temporal analysis showed sex-specific divergent trends in recent years, with males exhibiting an upward trend since 2015 (APC, 0.15; 95% CI, 0.07 to 0.24), while females showed a slowed decline since 2014 (APC, -0.06; 95% CI, -0.12 to -0.01). Decomposition analysis identified population growth as the primary driver of PAD burden increase, with epidemiological changes showing contrasting effects across SDI regions. Among risk factors, high fasting glucose emerged as the leading contributor, while smoking's contribution decreased.

CONCLUSIONS AND RELEVANCE

This study revealed significant disparities in lower extremity PAD burden across different SDI levels and regions, with low-SDI countries facing an increasing burden. The contrasting trends between high- and low-SDI regions, coupled with varying risk factor patterns (particularly the rise in high fasting glucose and decline in smoking), suggest the need for targeted interventions in resource-limited settings to address this growing health challenge among older adults.

Long-term exposure to traffic-related air pollution is associated with impaired odor identification: Results from the population-based KORA FIT study in Augsburg, Germany

Ambient air pollution has been linked to neurodegenerative diseases. Nevertheless, the literature on the effects of air pollution on the olfactory system and early cognitive impairment is scarce. In this study, we investigated the association between long-term air pollution exposure and odor identification, which can serve as an early indicator of various neurodegenerative conditions. We used data collected in Augsburg, Germany in 2018-2019 for the population-based KORA FIT study of 3,059 participants born between 1945-1964. The Sniffin' Sticks 12-Item Test was used to assess each participant's odor identification. Air pollution concentrations at residential addresses were estimated using land use regression modeling. We dichotomized the odor identification score to normosmia (score ≥ 10) versus hyposmia (score < 7) or anosmia (score < 10) and applied logistic regression. The models were adjusted for age, sex, socioeconomic characteristics (education, income, socioeconomic status), lifestyle factors (physical activity, smoking, body mass index, alcohol consumption) and disease history (e.g., allergies). We observed increased odds of hyposmia or anosmia compared to normosmia per interquartile range increase in the concentrations of PNC, PM2.5, PM2.5abs, PMcoarse, PM10, NO2 and NOx [OR (95 % CI): 1.12 (1.02, 1.24), 1.10 (0.98, 1.25), 1.14 (1.00, 1.30), 1.20 (1.06, 1.35), 1.20 (1.06, 1.36), 1.20 (1.06, 1.37) and 1.13 (1.01, 1.27); respectively]. For O3, no clear effects were detected. Females and physically active people appeared to be more susceptible. No further significant indications of effect modification were found. The results were consistent across sensitivity analyses. This study provides robust evidence for an association between long-term exposure to traffic-related air pollution and poor odor identification, even in a region with relatively low air pollution levels. These findings suggest a potential link between prolonged air pollution exposure and early changes in the olfactory system and could be indicative of early signs of detrimental effects on the brain.

The global, regional, and national burden and trends of anxiety disorders among women of childbearing age from 1990 to 2021: Estimates from the global burden of disease study 2021

BACKGROUND

Anxiety disorders are prevalent, early-onset mental illnesses that have a major negative impact on society and the economy globally. Comprehensive research on the global prevalence and evolving patterns of anxiety disorders in women of childbearing age (WCBA) is lacking.

METHODS

We computed estimated annual percentage changes (EAPCs) to evaluate trends in the incidence and Disability-Adjusted Life Years (DALYs) rates of anxiety disorders using the three primary WCBA indicators for anxiety disorders: prevalence, incidence, and DALYs, which were taken from the Global Burden of Disease (GBD) database from 1990 to 2021.

RESULTS

The number of prevalent cases increased from 120.2 million in 1990 to 224.8 million in 2021. The number of new cases increased from 17.406 million in 1990 to 30.730 million in 2021. Anxiety disorders is more prevalent in women, particularly those of reproductive age (15-49 years). Over the past 32 years, the global changes of Age-standardized incidence rate (ASIR) and Age-standardized prevalence rate (ASPR) were relatively stable. The results of differential smoothing and ARR model fitting showed that the long term risks showed a fluctuating downward trend in the long run, but showed a significant abnormal increase after 2020.

CONCLUSION

The relative increase in the incidence of anxiety disorders and DALYs in the WCBA over 32 years remains high. Our results can help different countries or regions in the world to develop more reasonable prevention and control measures for anxiety disorders, so as to reduce the serious economic and social burden caused by the disease.

Maternal Abnormal Liver Function in Early Pregnancy and Spontaneous Pregnancy Loss: A Retrospective Cohort Study

BACKGROUND

Spontaneous pregnancy loss (SPL) precedes an increased risk of reduced fertility, while its etiology mechanism remains largely unknown. Liver dysfunction presenting in early pregnancy may represent a pre-existing undiagnosed liver condition affecting fetal development. Here, we investigated whether maternal abnormal liver function in early pregnancy contributed to the incidence of SPL.

METHODS

Data on pregnant women were leveraged from the Maternal Health Care Information System in Shanghai City from 2017 to 2021. Liver dysfunction status was defined as having any elevated liver function biomarker levels (LFBs) at the first antenatal visit. SPL cases were defined as fetal death occurring before 28 weeks gestation. Generalized linear models were used to estimate crude and adjusted risk ratios (RRs and aRRs, respectively) and 95% confidence intervals (CIs).

RESULTS

Among 10,175 leveraged pregnant women, 918 (9.0%) SPL cases were recorded. Maternal liver dysfunction in early pregnancy was associated with a 49% increased risk of SPL (RR 1.49; 95% CI, 1.22-1.84). This positive association persisted after adjustment for covariates (aRR 1.55; 95% CI, 1.26-1.92). Higher γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP) levels were also linked with increased risk of SPL in a linear fashion (aRRs per 1 standard deviation increase: 1.13; 95% CI, 1.08-1.17 and 1.13; 95% CI, 1.07-1.20, respectively). Similar magnitudes of associations were observed between normal weight and overweight pregnant women in subgroup analysis.

CONCLUSION

We provide new evidence that maternal abnormal liver function in early pregnancy, as well as GGT and ALP, predisposes to an increased risk of SPL.

The burden of viral skin diseases in the Middle East and North Africa region, 1990-2021

OBJECTIVE

To report the prevalence, incidence, and Years Lived with Disability (YLD) due to viral skin diseases (VSD) in the MENA region from 1990 to 2021, focusing on age, sex, and socio-demographic index (SDI) using GBD 2021 data.

METHODS

Data on the burden of VSD were sourced from the Global Burden of Disease (GBD) 2021 study, covering 21 countries in the MENA region. The results included the counts and age-standardised rates per 100,000 population, along with the associated 95 % uncertainty intervals (UIs).

RESULTS

In 2021, the MENA region exhibited an age-standardised prevalence rate of 1257.6 cases per 100,000 population for VSD and an incidence rate of 990.5 cases per 100,000. Prevalence rates peaked sharply in the 5-9 age group before declining with age for both sexes, indicating a higher burden in younger populations. A strong positive relationship existed between the YLD rate and SDI, suggesting an increased burden of VSD with higher SDIs.

CONCLUSION

This study highlights the increasing burden of viral skin diseases (VSD) in the MENA region, especially among younger populations, with males also experiencing a slightly higher burden than females. Given the influence of multiple factors, a comprehensive strategy focusing on data systems, healthcare delivery, and regional collaboration is vital. Addressing these areas will help mitigate VSD's impact and improve health outcomes.

The disease burden, risk factors and future predictions of Alzheimer's disease and other types of dementia in Asia from 1990 to 2021

BACKGROUND

There is a lack of analysis and prediction of the disease burden of Alzheimer's disease and other dementias (ADOD) in Asia.

OBJECTIVES

This study aims to explore the impact of ADOD on the Asian region during the period from 1990 to 2021.

DESIGN

Data on ADOD in Asia from 1990 to 2021 were collected from the Global Burden of Disease (GBD) Study 2021. We analyzed the number and age-standardized rates (ASRs) of incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of ADOD from 1990 to 2021. Joinpoint regression analysis was performed, and the average annual percent changes (AAPCs) were calculated to evaluate the trends during this period. Subsequently, an auto - regressive integrated moving average (ARIMA) prediction model analysis was conducted to assess the trends in the next 30 years, aiming to report the epidemiology and disease burden of ADOD in Asia.

RESULTS

According to the analysis of the GBD database in 2021, the deaths, DALYs, incidence, and prevalence of ADOD increased by 297.34 %, 249.54 %, 244.73 %, and 250.44 % in Asia from 1990 to 2021. The ASRs of incidence, prevalence, death, and DALYs in both males and females, which consistently increased over the study period, showed that the ASRs of all females were consistently higher than those of males in Asia from 1990 to 2021. During the period from 1990 to 2021, Qatar and the United Arab Emirates witnessed the greatest changes in the number of DALYs, incidence, and prevalence. Afghanistan and China had the highest age-standardized mortality rate (ASMR) in 2021. It is worth noting that high fasting blood glucose is the top risk factor for the onset of ADOD. Females are more susceptible to the risk factor of high body-mass index (BMI), while males are more likely to be affected by smoking. According to the analysis of the ARIMA prediction model, the disease burden of ADOD in Asia will continue to show an upward trend in the next 30 years.

CONCLUSIONS

We should pay attention to the issue of population aging, attach importance to the intervention measures targeting the risk factors of ADOD, and formulate action plans to address the rising incidence of ADOD.

Mechanism of Ligusticum wallichii-Borneol in the Treatment of Cerebral Ischemic Stroke in Rats Based On Network Pharmacology, Molecular Docking, and Experimental Verification

The pharmacodynamics, molecular biology, network pharmacology, and molecular docking mechanisms of the Ligusticum wallichii and borneol medication pair (CXBP) were investigated for ischemic stroke treatment. Effective chemical components and targets of CXBP were identified using TCMSP, ETCM, and SymMap databases, whereas ischemic stroke targets were sourced from OMIM, GeneCards, TTD, PubMed, Web of Science, CNKI, Wanfang Data, and VIP databases. Protein-protein interaction (PPI) networks were generated using the STRING database, and GO and KEGG enrichment analyses were conducted using Metascape. A "disease-pathway-target-component-drug" network was created in Cytoscape, and molecular docking was confirmed with PyMOL and AutoDock tools. Rat models of MCAO were established to evaluate neurological scores, triphenyltetrazolium chloride (TTC) staining, and Nissl staining. Key components were validated through enzyme-linked immunosorbent assay (ELISA), real-time polymerase chain reaction (PCR), and immunohistochemistry. Thirty-three active ingredients and 419 potential targets for CXBP, with key compounds including Z-6,8',7,3'-diligustilide, cedrene, (+)-alpha-funebrene, POL, dipterocarpol, oleanolic acid, 1-acetyl-beta-carboline, and erythrodiol. Critical targets included ESR1, PRKCA, and PTPN6. KEGG pathway analysis revealed 179 signaling pathways, primarily neuroactive ligand-receptor interactions, whereas GO enrichment analysis identified 2911 biological processes, 398 molecular activities, and 203 cellular components. The neurological function scores and TTC staining of the infarcted brain regions were significantly improved following CXBP intervention compared to the MCAO group. These findings were supported by Nissl staining, which demonstrated better preserved cellular morphology and a significantly higher number of Nissl vesicles in the CXBP group. ELISA analysis revealed substantial modulation in gene expression: levels of PRKCA, PTPN6, ESR1, and TNF-α changed significantly, whereas IL-1β, IL-6, and TNF-α were notably downregulated compared to the MCAO group. PCR results corroborated these findings, showing a significant decrease in PRKCA expression and marked downregulation of IL-1β, IL-6, and TNF-α, whereas ESR1 and PTPN6 levels increased significantly. Immunohistochemical analysis further confirmed these results, with the CXBP and nimodipine groups exhibiting higher ESR1 and PTPN6 expression and lower PRKCA expression compared to the MCAO group. To improve cerebral ischemia and reperfusion injury, CXBP improves ischemic stroke outcomes through key active ingredients (e.g., Z-6,8',7,3'-diligustilide, cedrene, and oleanolic acid) and targets ESR1, PRKCA, and PTPN6, modulating multiple signaling pathways to alleviate cerebral ischemia-reperfusion injury.

Global trends and disparities in gallbladder and biliary tract cancers: insights from the global burden of disease study 2021

BACKGROUND

Gallbladder and biliary tract cancers (GBC and BTC) are highly malignant, with poor prognoses and substantial regional variability in the disease burden. Although advances in medical science have improved outcomes in high-income regions, low- and middle-income regions continue to face rising incidence and mortality rates owing to delayed detection and treatment. Understanding the global trends and risk factors of GBC and BTC is essential for targeted interventions to reduce disease burden.

METHODS

A retrospective analysis of GBC and BTC was conducted using the 2021 Global Burden of Disease study. Data from 204 countries and territories between 1990 and 2021 were analyzed for incidence, mortality, and disability-adjusted life years stratified by age, sex, and sociodemographic index (SDI). Trends were quantified using age-standardized rates and estimated annual percentage changes.

RESULTS

In 2021, 216,768 new cases and 171,961 deaths were reported globally, with age-standardized incidence and mortality rates of 2.6 and 2.0 per 100,000, respectively. The high-income Asia-Pacific and Latin American regions exhibited the highest disease burdens. While global age-standardized rates declined estimated annual percentage changes for incidence: -0.44; mortality: -0.97), low-SDI regions experienced increases. High BMI emerged as the leading risk factor, contributing to 12% of the disability-adjusted life years. Projections indicate a stable incidence but rising mortality by 2036.

CONCLUSION

Although the global age-standardized rates of GBC and BTC are decreasing, disparities persist, with low-SDI regions experiencing increasing burdens. Targeted interventions addressing modifiable risk factors such as obesity, along with improved healthcare infrastructure and early detection, are critical for mitigating this global health challenge.

Effects of the Mediterranean diet on the secondary prevention of cardiovascular diseases: a systematic review of randomised controlled trials

This systematic review aimed to summarise the current knowledge regarding the effects of the Mediterranean diet (MD) on the secondary prevention of cardiovascular diseases (CVDs). A systematic search was done on Web of Sciences, PubMed, Scopus, and Google Scholar databases until January 2025. The majority of the included studies (15 of 16 RCTs) supported the role of MD following in the secondary prevention of CVDs. According to the RCT results, the patients in the MD group had lower cardiovascular deaths, non-fatal myocardial infarction, and other events. They also had healthier lipid profiles and blood fatty acids, higher flow-mediated dilation and endothelial progenitor cell levels, and lower endothelial progenitor cells compared to a low-fat diet. However, both MD and control (low-fat diet) groups promoted similar decreases in blood pressure and body mass index. The findings of this review suggested that adherence to the MD could be beneficial in the secondary prevention of CVD.

Rising Burden of Colon and Rectum Cancer in China: An Analysis of Trends, Gender Disparities, and Projections to 2030

BACKGROUND

Colon and rectum cancer (CRC) is a major health burden in China, with notable gender disparities. This study was designed to analyze trends in CRC incidence, prevalence, and mortality from 1990 to 2021 and to project future trends.

METHODS

Using data from the Global Burden of Disease (GBD) Study 2021, we examined CRC burden in China, including incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Joinpoint regression, Bayesian age-period-cohort (BAPC) models, and age-period-cohort (APC) analysis identified trends and projected incidence up to 2030.

RESULTS

In 2021, CRC incidence was 658,321 cases, disproportionately affecting males, with an age-standardized incidence rate of 42.24 per 100,000 in males and 21.87 per 100,000 in females. The CRC-related deaths reached 275,129, with higher mortality in males (18.95 per 100,000) than females (9.34 per 100,000). The DALYs totaled 6,848,390 and largely impacted males. Joinpoint analysis showed a persistent increase in incidence and prevalence, especially in younger cohorts, whereas mortality declined slightly but began rising again after 2015. The BAPC analysis projected further incidence growth, particularly in males, through 2030. The APC analysis revealed higher CRC risk among younger cohorts, suggesting increasing early-onset CRC linked to lifestyle risk factors, such as smoking, high alcohol consumption, and diets low in fiber and calcium, with a stronger effect on males.

CONCLUSIONS

The increase of CRC incidence and prevalence in China, particularly among males, underscores the need for targeted prevention and early detection. Future research should address gender disparities and modifiable lifestyle risks through public health interventions.

Global, regional, and national burden of fracture of vertebral column, 1990-2021: analysis of data from the global burden of disease study 2021

Background

Fractures of the vertebral column, encompassing various spinal injuries, represent a significant public health burden worldwide. These injuries can lead to long-term disability, reduced quality of life, and substantial healthcare costs.

Methods

We utilized comprehensive data sources from the Global Health Data Exchange (GHDx). The study employed the incidence, prevalence, and years lived with disability (YLDs) metric to quantify the burden. First, numbers and age-standardized rates (ASRs) of incidence, prevalence, and YLDs were assessed globally and by sub-types including sex, age, socio-demographic index (SDI) regions, Global Burden of Disease Study (GBD) regions, and countries in 2021. Furthermore, the temporal trend of the disease burden was explored by the linear regression model from 1990 to 2021. The cluster analysis was used to evaluate the changing pattern of related disease burden across GBD regions. Finally, the age-period-cohort (APC) model were used to predict the future disease burden in the next 25 years.

Results

Exposure to fracture of vertebral column contributed to 7,497,446 incidence, 5,371,438 prevalence, and 545,923 YLDs globally in 2021. The disease burden was higher in males than in females. And it was higher in older adults. High SDI regions were high-risk areas. From 1990 to 2021, the number of cases showed the increasing trend, and the ASRs showed the decreasing trend. The predicted results showed that the number of cases for both genders would still increase from 2022 to 2046.

Conclusion

Our findings highlight the substantial and growing global burden of vertebral column fractures, with significant variations across regions and countries. Targeted interventions to address modifiable risk factors, such as osteoporosis and falls, are essential to mitigate the burden.

Temporal trends in cross-country inequalities of early-onset pancreatic cancer: a comprehensive analysis for the global burden of disease study 2021

By 2040, pancreatic cancer is expected to become the second leading cause of cancer-related deaths in the U.S., with early-onset pancreatic cancer (EOPC) cases rising among adolescents and young adults. This study uses the global burden of disease (GBD) 2021 dataset to examine global, regional, and national EOPC trends and predicts the burden through 2050. The analysis covers EOPC burden from 1990 to 2021, focusing on age-standardized prevalence rate (ASPR), incidence rate (ASIR), mortality rate (ASMR), and disability-adjusted life years rate (ASDR). Annual percentage change (APC) and average annual percentage change (AAPC) were calculated via joinpoint regression. Clustering and frontier analysis based on the sociodemographic index (SDI) assessed the link between development levels and health outcomes. We used WHO-recommended health equity methods to quantify EOPC burden disparities and applied a Bayesian age-period-cohort (BAPC) model to project trends. In 2021, EOPC cases rose to 42,254, a 73% increase from 1990, while deaths reached 26,996, up 57%. Although ASIR, ASMR, and ASDR declined, ASPR rose (EAPC = 0.1). Central and Eastern Europe had the highest EOPC burden, with the fastest growth in Australasia (EAPC = 2.78) and Western Sub-Saharan Africa (EAPC = 2.25). Males had about double the burden of females, though female prevalence increased. The widening gap in health burden between low- and high-SDI regions is especially concerning. While EOPC currently affects high-SDI countries the most, there is a clear trend over time showing a gradual shift of EOPC burden towards low-SDI countries. By 2050, ASIR, ASPR, ASMR, and ASDR are projected to stabilize, with cases increasing until 2036, then decreasing. High-SDI countries bear a disproportionately high EOPC burden, with significant diagnostic and management challenges, particularly in Central and Eastern Europe. Rising global EOPC prevalence highlights the need to identify burden differences and risk factors across countries to develop targeted prevention and control strategies.

Age-period-cohort analysis of autism spectrum disorders-related prevalence and DALYs: based on the Global Burden Of Disease Study 2021

Background

The Sustainable Development Goals (SDGs) call for systematic monitoring to optimize child development outcomes. As a developmental disorder affecting children and adults, Autism Spectrum Disorder (ASD) not only impacts individual social functioning but also places a burden on families and society. A detailed analysis of the latest global burden data on ASD can assist stakeholders in formulating support policies and interventions, thereby helping to meet the health needs of ASD.

Methods

We used data from the Global Burden of Disease Study 2021 (GBD 2021), compiled by the Institute for Health Metrics and Evaluation (IHME). Data were obtained through the Global Health Data Exchange (GHDx) and covered 204 countries and territories from 1990 to 2019. Variables included ASD-related prevalence, mortality, disability-adjusted life years (DALYs), age-standardized rates, and the sociodemographic index (SDI).

Results

Exposure to autism spectrum disorders contributed to 61823540 prevalence and 11544038 DALYs globally in 2021. Males and younger adults were high-risk populations. Higher socio-demographic index (SDI) regions were high-risk areas. The disease burden varied considerably across the GBD regions and the countries. From 1990 to 2021, the number of cases increased. The predicted results showed that the disease burden for both genders would still increase from 2022 to 2046. Countries or regions with a higher SDI have greater burden improvement potential.

Conclusion

The global burden of ASD has shown a continuous upward trend, with some differences observed across gender, age groups, and SDI regions. In terms of gender, the burden of ASD among females may be underestimated. Regarding age groups, the aging process has highlighted the urgent need to address ASD in the elderly population. High-SDI regions should place greater emphasis on improving diagnostic methods and implementing precise interventions, while middle- and low-SDI regions should focus on raising public awareness and enhancing screening capabilities.

Global, regional, and national burden and trends of intracerebral hemorrhage among adolescents and young adults aged 15-39 years from 1990 to 2021: a comprehensive trend analysis based on the global burden of disease study 2021

Background

Intracerebral hemorrhage (ICH) poses a significant health challenge, notably affecting adolescents and young adults (AYAs) aged 15-39 years. Despite advancements in medical technology, the global burden of ICH remains substantial, influenced by lifestyle factors, socioeconomic conditions, and disparities in healthcare access. This study leverages data from the 2021 Global Burden of Disease (GBD) to conduct a comprehensive analysis of ICH trends and burdens at global, regional, and national levels, emphasizing the role of the Social Development Index (SDI).

Methods

We utilized data from the GBD 2021 to assess the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) associated with ICH from 1990 to 2021, covering 204 countries and regions. Age-standardized rates were calculated to ensure comparability. Temporal trends were evaluated using Joinpoint regression analysis, and future projections were made using a Bayesian Age-Period-Cohort model.

Results

In 2021, ~246,938 new cases of ICH were reported among the global AYAs population, reflecting a decline in age-standardized incidence rates from 11.85 per 100,000 in 1990 to 8.14 in 2021. Prevalence rates also decreased from 124.44 to 94.58 per 100,000. Mortality rates and DALYs exhibited similar downward trends. Significant regional disparities were observed, with high SDI regions experiencing lower ICH burdens than low SDI regions, highlighting the influence of socioeconomic factors and healthcare access.

Conclusion

While the global burden of ICH among AYAs has declined, significant disparities persist, particularly in regions with lower SDI. To further mitigate the impact of ICH, public health initiatives should focus on enhancing healthcare infrastructure, promoting health education, and addressing socioeconomic inequalities.

Global Disease Burden, Trends, and Inequalities of Brain and Central Nervous System Cancers, 1990-2021: A Population-Based Study with Projections to 2036

BACKGROUND

Brain and central nervous system (CNS) cancers pose a significant global health challenge, with marked regional variations. Updated evidence is essential to optimize resource allocation and inform targeted interventions.

METHODS

Data from the Global Burden of Disease 2021 were systematically analyzed, including incidence, mortality, and disability-adjusted life years (DALYs), along with their corresponding age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR). Temporal trends were evaluated using Joinpoint regression, health disparities were assessed with inequality metrics, and burden contributors were identified through decomposition analysis. Future trends were projected using Bayesian age-period-cohort models.

RESULTS

Over the past 30 years, CNS cancer incidence rose by 106.52%, DALYs by 49.59%, and mortality by 89.87%. High-Socio-Demographic Index (SDI) regions (e.g., Europe, North America, East Asia) reported the highest ASIR, with aging as the primary driver of increasing DALYs and mortality. In low-SDI regions (e.g., Africa, Latin America), population growth was the leading contributor to the rising burden. Although ASDRs and ASMRs have declined in high-SDI regions, significant increases have been detected among individuals aged 65 years and more. Low-SDI regions continue to bear a heavy disease burden, particularly among those aged more than 10 years. Disparities across SDI levels are projected to widen, especially in low-income areas. Nonetheless, advances in neuroscience suggest declines in ASIR, ASDR, and ASMR over the next 15 years.

CONCLUSIONS

The growing CNS cancer burden highlights the urgent need for targeted interventions. Enhancing healthcare access and bolstering prevention and treatment in underserved regions are critical priorities.

The Global, Regional, and National Patterns of Change in the Burden of Orofacial Clefts, 1990-2021: An Analysis of the Global Burden of Disease Study 2021 and Forward-Looking Forecast

OBJECTIVE

Orofacial clefts (OFCs) are the most common congenital craniofacial anomalies worldwide. However, data on the burden and trends of this disease remains limited.

METHODS

This study utilizes data from the 2021 Global Burden of Disease study to analyze the prevalence, incidence, and disability-adjusted life years from 1990 to 2021 at global, regional, and national levels, along with age-standardized rates and the average annual percentage change. In addition, the authors examine these global trends by age, gender, and Sociodemographic Index (SDI). Frontier analysis was employed to visually illustrate each country's or region's potential to reduce the burden based on its development level. Finally, the authors used the autoregressive integrated moving average model to forecast future trends in disease burden from 2022 to 2036.

RESULTS

The study shows that, despite a 24.79% decline in incidence from 1990 to 2021, the global number of OFC cases has increased by 3.96%. The incidence of OFCs varies significantly across regions, with the highest incidence in Central Asia. The OFC burden is negatively correlated with SDI, indicating that higher socio-economic development is associated with a lower disease burden. Gender differences show a slightly higher incidence in males, while age-specific data indicate that the highest burden occurs in the first year of life. This study also identifies countries with the greatest disease burden disparities, particularly in low-income regions such as Afghanistan and Cambodia. Projections indicate a continued decline in global OFC incidence and case numbers from 2022 to 2036.

CONCLUSION

The findings highlight the need for targeted interventions, especially in low-income and middle-income countries, to address inequalities in access to health care.

Global and regional trends in Clostridioides difficile infection: An analysis from 1990 to 2021

OBJECTIVES

The epidemiological situation of Clostridioides difficile infection (CDI) has dramatically changed over the past 30 years, but few studies have systematically analysed changes in the global epidemic landscape. This study aimed to delineate the global, regional, and national burden of CDI from 1990 to 2021.

METHODS

CDI data were derived from the Global Burden of Disease Study 2021. Joinpoint regression analysis assessed changes over time and calculated annual percentage change (APC) statistics. An age-period-cohort model was adopted to estimate net/local drifts as well as the age, period, and cohort effects of CDI mortality. The relationship between the sociodemographic index (SDI) and antibiotic use and disease burden was analysed.

RESULTS

The age-standardised death rate (ASDR) increased from 0.10 per 100,000 persons in 1990 to 0.19 per 100,000 persons in 2021, with an estimated annual percentage change of 2.76 (95% confidence interval [CI]: 2.18, 3.33). The ASDR of global CDI exhibited an upward trend from 1990 to 2021, with an AAPC of 2.26 (95% CI: 1.77, 2.76), but a downward trend from 2017 to 2021, with an APC of -2.04 (95% CI: -3.17, -0.90). Antibiotic use was significantly positively associated with CDI burden. The defined daily dose of all antibiotic use per 1000 inhabitants was positively correlated with ASDRs in high, high-middle, and low SDI regions (P< 0.001, P < 0.001, and P< 0.001, respectively).

CONCLUSIONS

The burden of CDI has increased globally from 1990 to 2021, revealing significant spatial disparities. Antibiotic use is positively associated with CDI mortality.

Psychometric evaluation of the problem areas in diabetes (PAID) scale among people with type 2 diabetes in Ethiopia: a tool validation study

OBJECTIVE

to assesses the psychometric properties of the Problem Area in Diabetes (PAID) scale for Ethiopian patients with type 2 diabetes.

RESULTS

The confirmatory factor analysis for the Ethiopian Problem Area in Diabetes (Eth-PAID) scales demonstrated good model fit to the one, two, three, and four factor structures. The one-factor model Eth-PAID-20 scale showed acceptable internal consistency (α = 0.82), but the "Diabetes distress" subscale of two, three, and four-factor structures partially satisfied the internal consistency (ranged α = 0.74-77). The Eth-PAID-20 scale correlated negatively with self-care efficacy (r = 0.131, P = 0.06) and positively with Fasting Blood Sugar (FBS) level (r = 0.02, P = 0.86), which implies poor convergent validity. Moreover, "lack of confidence," "food-related problem," and "support-related problem" subclasses of two, three, and four-factor models showed very weak convergent validity. Discriminative validity revealed that female patients (30.16 ± 13.11), t = - 2.73, p = 0.007, d = 0.4) and patients who lived alone (28.05 ± 12.98), t = 2.542, p = 0.021, d = 0.5) had significantly higher distress scores in Eth-PAID-20 as one factor model.

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.

Trends in the burden of chronic kidney disease related to high red meat intake from 1990 to 2021

OBJECTIVE

To systematically examine global trends and spatial distribution of the burden of chronic kidney disease associated with high red meat intake from 1990 to 2021 using data from the Global Burden of Disease 2021 study, providing scientific evidence for targeted prevention strategies.

METHODS

We assessed disease burden using age-standardized death rate and age-standardized disability-adjusted life year rate. Disease burden was analyzed by sex, age, region, and Socio-demographic Index level, while estimated annual percentage change was calculated to evaluate temporal trends.For the analysis of future trends in chronic kidney disease burden, we utilized both the Age-Period-Cohort model and the Bayesian Age-Period-Cohort model.

RESULTS

From 1990 to 2021, age-standardized death rate and disability-adjusted life year rates of chronic kidney disease linked to high red meat intake increased, with EAPCs of 1.33% and 1.07%, respectively. Males consistently exhibited a higher disease burden than females, with mortality peaking in the 85-89 age group. The age-standardized disability-adjusted life year rate in high-SDI groups (6.59 per 100,000) was significantly higher than in low-SDI groups (2.38 per 100,000). A temporary decline occurred between 2016 and 2018, and disease burden decreased among individuals over 95 years old between 2018 and 2021.

CONCLUSION

The chronic kidney disease burden associated with high red meat intake demonstrated significant demographic and regional disparities, characterized by an overall increasing trend with some period-specific exceptions. These findings suggest the need for targeted public health interventions, particularly dietary guidance for high-risk populations such as males and residents of high-SDI groups. Future research should focus on elucidating the underlying biological mechanisms and social determinants that drive these disparities.

Systematic analysis of the burden of ischemic stroke attributable to high LDL-C from 1990 to 2021

Background

Low-density lipoprotein cholesterol (LDL-C) is a public health concern linked to ischemic stroke. The study aimed to describe the epidemiological characteristics of ischemic stroke attributable to high LDL-C from 1990 to 2021.

Methods

In this study, we analyzed data from the Global Burden of Disease 2021 to present trends in ischemic stroke related to high LDL-C over the past 30 years. The relationship between disease burden and the Socio-Demographic Index (SDI) was examined. To assess international health disparities, we applied the Slope Index of Inequality (SII) and the Concentration Index (CI). Furthermore, we conducted a frontier analysis to identify areas for improvement and developmental gaps among nations, and employed the Bayesian Age-Period-Cohort (BAPC) model to forecast the disease burden for the next 15 years.

Results

In 2021, the incidence of ischemic stroke attributed to high LDL-C significantly increased compared to 1990, with a more pronounced growth rate in males. The burden mainly affects individuals aged 70 to 84. Analysis using the age-period-cohort model indicates that mortality rates and DALYs rise with age, while period and cohort effects exhibit a gradual decline. Across different SDI regions, trends generally follow a similar downward path, with a narrowing gap in disease burden among regions with varying SDI levels. However, the disease burden in high SDI countries remains significant, indicating potential for reduction. Predictions for the next 15 years suggest that while the global disease burden will decrease, there may be an increase among individuals under 55.

Conclusion

Compared to 1990, the overall age-standardized burden of ischemic stroke related to high LDL-C has been controlled. However, disparities persist across different SDI regions. We have observed an increasing burden among younger populations. Consequently, countries and regions must adopt new measures tailored to their SDI levels, with a specific emphasis on younger individuals. It is essential to develop prevention and treatment strategies aimed at high-risk groups.

Burden, trends, projections, and spatial patterns of lip and oral cavity cancer in Iran: a time-series analysis from 1990 to 2040

BACKGROUND

Lip and oral cavity cancer (LOCC) is a significant public health concern worldwide. This study investigated the long-term trends in the LOCC burden in Iran from 1990 to 2021.

METHODS

We analyzed LOCC burden in Iran from 1990 to 2021 using the Global Burden of Disease (GBD) 2021 dataset, focusing on age-standardized disability-adjusted life years (ASDR), mortality rates (ASMR), and incidence rates (ASIR) stratified by sex and province. Joinpoint regression analysis was used to identify temporal trends, and the annual percent change (APC) and average APC (AAPC) were calculated. Future projections up to 2040 were generated using a hybrid forecasting model (ARIMA, ETS, and neural networks). Spatial analysis detected hotspot and coldspot regions in 1990 and 2021.

RESULTS

We observed a significant increase in the LOCC burden across all three indicators (disability-adjusted life years [DALY], ASMR, and ASIR) from 1990 to 2021. Joinpoint analysis revealed significant temporal trends, with an overall upward trajectory in the AAPC for both sexes combined and separately. Specifically, the overall AAPC for the ASDR was 0.34% (95% confidence interval [CI]: 0.26,0.39) for both sexes, 0.40% (95% CI: 0.32,0.45) for females, and 0.35% (95% CI: 0.27,0.42) for males. For the ASMR, the overall AAPC was 0.41% (95% CI: 0.34,0.46), 0.54% (95% CI: 0.48,0.58) for females, and 0.36% (95% CI: 0.29,0.42) for males. Similarly, the overall AAPC for ASIR was 1.33% (95% CI: 1.24,1.40), 1.51% (95% CI: 1.43,1.59) for females, and 1.26% (95% CI: 1.17,1.33) for males. Geographic variations were evident, with most provinces exhibiting increasing ASDR and ASMR, while ASIR displayed a consistent upward trend across all provinces. Notably, females showed a slightly more pronounced increase in ASDR, ASMR, and ASIR compared to males. Projections indicate a declining trend in DALYs, a fluctuating but stable mortality rate, and a continuous rise in incidence by 2040. Spatial analysis indicated no significant spatial autocorrelation at the national level in both 1990 and 2021.

CONCLUSION

Our findings highlight a rising burden of LOCC in Iran, with future projections indicating a growing incidence rate. Targeted public health interventions addressing regional disparities and risk factors are crucial. Sex-specific and region-specific policies, along with early detection strategies, are essential to mitigate the disease burden.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSION

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

The effect of mild to moderate knee osteoarthritis on gait and three-dimensional biomechanical alterations

Background

Knee Osteoarthritis (KOA) is a prevalent chronic degenerative joint disease, particularly among the elderly, leading to pain, stiffness, and diminished functionality. The progression of KOA is often associated with significant changes in gait and biomechanics, yet detailed investigations of these changes-especially in early to moderate stages-remain limited. This study aims to conduct a comparative analysis of three-dimensional gait biomechanics in patients with mild to moderate KOA, in order to gain deeper insights into the early biomechanical changes associated with KOA.

Methods

A case-control study design was employed, consisting of three groups: Kellgren-Lawrence (K-L) grade I KOA patients, K-L grade II KOA patients, and healthy controls, with 15 participants in each group. Kinetic and kinematic data were collected using two force plates and a three-dimensional motion capture system. Gait parameters, joint range of motion (ROM), angular velocities, and joint moments were analyzed, with a significance level of p < 0.05.

Results

Grade II KOA patients showed prolonged gait cycles, wider step widths, and reduced swing phases on the affected side compared to grade I patients and controls. Grade I patients had reduced hip and knee ROM compared to controls. In the sagittal plane, grade II patients had more significant reductions in knee and ankle ROM. In the coronal plane, grade II patients had less hip and ankle ROM than grade I and controls. Horizontally, grade II patients had greater hip ROM but reduced knee ROM compared to grade I. Additionally, grade I patients showed smaller extension moments in the hip and knee than controls. Grade II patients had lower angular velocities and reduced extension and flexion moments in the hip and knee compared to controls.

Conclusion

KOA induces significant biomechanical alterations in gait, which become more pronounced with advancing disease severity. These changes highlight the importance of early detection and tailored rehabilitation strategies to improve mobility and prevent further joint degeneration. Understanding the biomechanical profile of KOA at different stages is essential for developing personalized therapeutic approaches aimed at enhancing patient quality of life and reducing the societal burden of KOA.

Evolving Landscape of Melanoma in Portugal, Spain, Italy, and Greece: Trends and Insights

OBJECTIVE

To study melanoma incidence trends from 1990 to 2021 in Southern European countries-Portugal, Spain, Italy, Greece-and explore regional and age-period-cohort (A-P-C) patterns.

METHODS

Data from the Global Burden of Disease Study 2021 were used to calculate age-standardized incidence rates (ASIRs). Joinpoint regression and age-period cohort (A-P-C) models were applied to identify trends and patterns.

RESULTS

A substantial increase in melanoma ASIRs was observed across all Southern European countries from 1990 to 2021. Joinpoint analysis revealed a potential turning point in the 2010s, with ASIRs stabilizing or declining in younger age groups across all countries. For instance, rates among younger women in Italy, Portugal, and Spain have shown signs of stabilization or decline, while Greek women experienced a continued but slower increase. Men exhibited a similar trend, except for Greece, where the increase rate persisted albeit at a slower pace. Gender differences were evident, with younger women generally facing higher risks vs men but exhibiting a slower rise in incidence with age. The A-P-C analysis confirmed a pronounced cohort effect, indicating a higher risk for melanoma among earlier birth cohorts. Among younger generations, there is evidence of stabilization or even a decline in incidence rates.

CONCLUSION

Melanoma rates are rising in Southern Europe, especially among men. While younger populations show promising declines, likely due to sun protection efforts, older generations continue to be affected. Addressing regional disparities and sustaining these positive trends requires ongoing efforts and comprehensive prevention strategies.

Impact of health intervention coverage on reducing maternal mortality in 126 low- and middle-income countries: a Lives Saved Tool modelling study

BACKGROUND

There is a continued and urgent need to address the stagnation of the global maternal mortality ratio (MMR), especially for low- and middle-income countries (LMICs). We aimed to assess the impact of scaling up health intervention coverage on reducing MMR under four scenarios for 126 LMICs.

METHODS

We conducted the modelling study to estimate MMR and additional maternal lives saved by intervention by 2030 for 126 LMICs using the Lives Saved Tool (LiST). We applied four scenarios to assess the impact of scaling up health intervention coverage with no scale-up (no change), a modest scale-up (increased by 2% per year), a substantial scale-up (increased by 5% per year), and universal coverage (coverage reached 95% by 2030). In sensitivity analysis, with the current trend, we assumed that coverage of each intervention remained unchanged from 2024, with MMR changing according to the annual percentage change (APC) of 2015-2020.

RESULTS

Among the 126 LMICs, 31.7% (40/126) countries showed an increase in MMR, and 38.1% (48/126) stalled on the reduction of MMR from 2015 to 2020. With a modest, substantial, or universal scale-up, the 2030 average MMR would be 172.1 (117.6-262.9), 139.8 (95.6-213.5) or 98.6 (67.8-149.7), not reaching the SDG Target 3.1. Additional maternal lives saved by scaling up the coverage of health interventions were mainly clustered in the African Region, the Southeast Asia Region, and the Eastern Mediterranean Region. Compared with other included interventions, uterotonics for postpartum hemorrhage, assisted vaginal delivery and cesarean delivery played more important roles in reducing maternal mortality.

CONCLUSIONS

The study findings highlighted that even under a substantial scale-up of intervention coverage or scaling up to universal coverage of interventions, it would be difficult for the 126 LMICs to achieve the SDG Target 3.1 on time. Optimizing the allocation of health resources, promoting health equality, taking more decisive national, regional and global actions are urgently needed for LMICs to reduce MMR and reach the SDG Target 3.1.

The global burden of osteoarthritis knee: a secondary data analysis of a population-based study

BACKGROUND

Osteoarthritis knee poses a substantial and pervasive global health challenge.

METHODS

The data was extracted from the Global Burden of Disease 2021 Study database. First, numbers and age-standardized rates (ASRs) of incidence, prevalence, and disability-adjusted life years (DALYs) of osteoarthritis knee were assessed globally and by sub-types in 2021. Subsequently, we employed a linear regression model to analyze the temporal trends from 1990 to 2021. To predict the future burden, we utilized the age-period-cohort model and the Bayesian age-period-cohort model. Furthermore, we conducted a sensitivity analysis using the Autoregressive Integrated Moving Average model and the Exponential Smoothing model.

RESULTS

In 2021, osteoarthritis knee accounted for 30.85 million incidence cases, 374.74 million prevalence cases, and 12.02 million DALYs cases globally, with ASRs of 353.67, 4294.27, and 137.59, respectively. Females and individuals over 50 years old were identified as high-risk populations, while higher socio-demographic index regions emerged as high-risk areas. From 1990 to 2021, incidence cases rose from 14.13 million to 30.85 million, prevalence cases from 159.80 million to 374.74 million, and DALYs cases from 5.15 million to 12.02 million, accompanied by increases in their respective ASRs. Projections using the APC model predict a continued increase in incidence, prevalence, and DALYs cases for both genders until 2046. Specifically, male incidence cases are projected to increase to 18.45 million and female incidence to 25.60 million. Similarly, male prevalence cases are projected to rise to 235.41 million and female prevalence to 365.97 million. Male DALYs cases are expected to increase to 7.52 million and female DALYs to 11.55 million. The BAPC models also indicate an upward trend in number of cases.

CONCLUSION

In conclusion, osteoarthritis knee represents a formidable threat to global public health, necessitating the development of proactive and tailored strategic interventions that account for global-specific contexts. Key Points • Females and individuals over 50 years old were identified as high-risk populations. • Higher socio-demographic index regions were identified as high-risk areas. • The disease burden attributable to osteoarthritis knee increased from 1990 to 2019. • The number of deaths and DALYs cases would still increase in the next 25 years.

Global, regional, and national disability-adjusted life years and prevalence of lymphatic filariasis from 1990 to 2021: A trend and health inequality analysis based on the global burden of disease study 2021

Lymphatic filariasis (LF) is a neglected tropical disease predominantly affecting marginalized populations in resource-limited settings. It can lead to long-term deformities, disabilities, and reduced economic productivity. This study examines differences in Disability-Adjusted Life Year (DALY) and prevalence of LF across countries and regions and predicts future trends. Trends were analyzed based on demographic factors and epidemiological changes, and cross-national health inequalities in LF were quantified. Using data from the Global Burden of Disease (GBD) 2021 database, this study evaluated trends in age-standardized LF DALY rates and prevalence from 1990 to 2021, employing estimated annual percentage change. The study also assessed the relative contributions of aging, population growth, and epidemiological changes in LF burden trends. To quantify absolute and relative cross-country inequalities, the Slope Index of Inequality (SII) and Concentration Index (CI) were applied. Additionally, Bayesian age-period-cohort models were used to predict LF case numbers and prevalence from 2022 to 2030. The findings indicated that, in 2021, LF burden varied by age, sex, and region, with the highest prevalence among individuals aged 15-49 years, males, and populations in low SDI regions. The global age-standardized prevalence and DALY rates of LF declined between 1990 and 2021, and predictions suggest this downward trend will continue through 2030. Potential changes adjusted by aging and population growth were the primary drivers of reductions in the number of LF cases and DALYs. Over the past few decades, the LF burden has concentrated in underdeveloped and disadvantaged regions. However, cross-national inequalities in LF are narrowing rapidly. These results emphasize the urgent need for sustained health interventions and public health policies to eliminate LF, particularly in low-income, high-risk regions such as Oceania. Targeted efforts are essential to improving the health and well-being of marginalized populations.

Global burden of injury due to low bone mineral density in adults aged 55 years and older, 1990 to 2021: A population-based study

OBJECTIVES

This study aimed to assess the global burden of injuries due to low bone mineral density (BMD) among adults aged 55 and above from 1990 to 2021, focusing on mortality and disability-adjusted life years (DALYs) and analyzing trends across sexes, age groups, and sociodemographic index (SDI) regions.

METHODS

Data from the Global Burden of Disease Study 2021, covering 204 countries and territories, were analyzed. Joinpoint regression quantified temporal changes in mortality and DALYs, calculating average annual percentage change (AAPC). Age-period-cohort modeling elucidated demographic influences, and decomposition analysis identified key contributors to mortality changes.

RESULTS

Globally, in 2021, the crude DALY rate for injuries due to low BMD was 900.32 (95 % UI: 742.64 to 1081.51) per 100,000, and the crude mortality rate was 27.04 (95 % UI: 22.49 to 30.75) per 100,000. The age-standardized mortality rate for injuries due to low BMD showed no significant change from 1990 to 2021 (AAPC 0.26 %, P = 0.071), but there was a significant increase in countries with a high SDI (AAPC 0.51 %, P = 0.001). The burden of disease in persons aged 80 years and older remained substantial, with a slight increase. Decomposition analysis identified population growth as the main driver of increasing mortality and DALYs.

CONCLUSION

Despite the reductions in DALY rates, the mortality has remained stable worldwide; however, has risen significantly in high SDI countries. The substantial and slightly increasing burden of disease in people aged 80 years and older underscores the need for targeted strategies for the prevention and management of low BMD to mitigate the future global impact of these injuries.

Burden of colon and rectum cancer attributable to processed meat consumption in China, 1990-2021

Background

Colon and rectum cancer (CRC) poses a significant public health challenge, and diets high in processed meat have been identified as key risk factors. This study aims to assess the burden of CRC attributable to processed meat consumption in China from 1990 to 2021, focusing on mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs).

Methods

Data were obtained from the Global Burden of Disease (GBD) study for CRC attributable to processed meat consumption in China from 1990 to 2021. The analysis included age-standardized rates for deaths, DALYs, YLDs, and YLLs, alongside age-period-cohort (APC) and decomposition analyses to examine temporal trends and contributing factors. Joinpoint regression was used to detect significant changes in trends.

Results

The burden of CRC attributable to processed meat consumption in China increased significantly between 1990 and 2021. In 2021, males exhibited higher mortality and DALY rates than females, particularly in older age groups. The age-standardized death rate rose from 0.23 to 0.32 per 100,000, and DALYs increased from 5.83 to 8.57 per 100,000. Joinpoint analysis revealed steep rises in DALYs and YLLs, especially during 2007-2011. APC analysis showed that older cohorts consistently exhibited higher death rates, while more recent cohorts displayed lower mortality. Decomposition analysis indicated that population growth and epidemiological changes drove the rise in mortality, with aging contributing to a reduction in deaths. These factors had a more pronounced impact on males.

Conclusion

The study highlights the growing burden of CRC linked to processed meat consumption in China over three decades, with significant gender differences and strong cohort effects. The findings call for targeted interventions to reduce processed meat consumption and mitigate CRC risk.

Sludge amended soil induced multidrug and heavy metal resistance in endophytic Exiguobacterium sp. E21L: genomics evidences

The emergence of multidrug-resistant bacteria in agro-environments poses serious risks to public health and ecological balance. In this study, Exiguobacterium sp. E21L, an endophytic strain, was isolated from carrot leaves cultivated in soil amended with sewage treatment plant-derived sludge. The strain exhibited resistance to clinically relevant antibiotics, including beta-lactams, fluoroquinolones, aminoglycosides, and macrolides, with a high Multi-Antibiotic Resistance Index of 0.88. Whole-genome sequencing revealed a genome of 3.06 Mb, encoding 3894 protein-coding genes, including antimicrobial resistance genes (ARGs) such as blaNDM, ermF, tetW, and sul1, along with heavy metal resistance genes (HMRGs) like czcD, copB, and nikA. Genomic islands carrying ARGs and stress-related genes suggested potential horizontal gene transfer. The strain demonstrated robust biofilm formation, high cell hydrophobicity (> 80%), and significant auto-aggregation (90% at 48 h), correlating with genes associated with motility, quorum sensing, and stress adaptation. Notably, phenotypic assays confirmed survival under simulated gastrointestinal conditions, emphasizing its resilience in host-associated environments. Comparative genomics positioned Exiguobacterium sp. E21L near Exiguobacterium chiriqhucha RW-2, with a core genome of 2716 conserved genes. Functional annotations revealed genes involved in xenobiotic degradation, multidrug efflux pumps, and ABC-type transporters, indicating versatile resistance mechanisms and metabolic capabilities. The presence of ARGs, HMRGs, and MGEs (mobile genetic elements) highlights the potential role of Exiguobacterium sp. E21L as a reservoir for resistance determinants in agricultural ecosystems. These findings emphasized the need for stringent regulations on sludge-based fertilizers and advanced sludge treatment strategies to mitigate AMR risks in agro-environments.

The global burden of childhood diarrheal diseases attributable to suboptimal breastfeeding from 1990 to 2021: an exploratory analysis of estimates from the global burden of disease study

BACKGROUND

Understanding the spatial and temporal patterns of the disease burden of childhood diarrhea attributable to suboptimal breastfeeding (including non-exclusive and discontinued breastfeeding) is crucial for global health policy and intervention strategies. This study aimed to comprehensively assess the global, regional, and national burden of childhood diarrheal diseases attributable to suboptimal breastfeeding in 204 countries and territories from 1990 to 2021.

METHODS

This study utilized data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 to estimate deaths, disability-adjusted life years (DALYs), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of childhood diarrheal diseases attributable to suboptimal breastfeeding. Suboptimal breastfeeding was assessed as a combination of non-exclusive breastfeeding and discontinued breastfeeding. And the average annual percentage change (AAPC) from 1990 to 2021 was calculated to determine long-term trends. Additionally, frontier analyses were conducted to evaluate the efficiency of different countries in reducing the disease burden relative to their socio-demographic index (SDI) levels.

RESULTS

By 2021, the global number of deaths and DALYs attributable to childhood diarrheal diseases due to suboptimal breastfeeding was 63,133 and 573,430, respectively. Between 1990 and 2021, the number of deaths and DALYs, as well as ASMR (AAPC: -5.40) and ASDR (AAPC: -5.38), declined by approximately 80%. However, significant disparities persist across regions. Low-SDI regions, particularly in Western Sub-Saharan Africa, continued to bear the highest disease burden. At the countries or territories level, Nigeria, India, and Chad recorded the highest number of deaths and DALYs, while Chad, South Sudan, and Lesotho exhibited the highest ASMR and ASDR values. Similar patterns were observed for non-exclusive and discontinued breastfeeding, with the greatest burden concentrated in resource-limited settings.

CONCLUSION

While the global burden of childhood diarrheal diseases attributable to suboptimal breastfeeding has significantly declined over the past three decades, the disease burden remains disproportionately high in less developed regions. These findings underscore the urgent need for targeted public health policies and interventions to promote exclusive and continued breastfeeding, especially in high-burden regions, to further reduce preventable childhood morbidity and mortality.

Effects of high-intensity interval training on physical morphology, cardiopulmonary function, and metabolic indicators in older adults: a systematic review and meta-analysis

Background

Despite the growing attention towards the efficacy of high-intensity interval training (HIIT) on older adult health, a consensus regarding the pleiotropic effects of HIIT in this population is yet to be reached. Previous studies have predominantly focused on specific outcomes or particular groups, lacking comprehensive analysis.

Objective

We aimed to conduct a systematic evaluation of the impact of HIIT on body composition, cardiopulmonary function, and metabolic parameters in older adults.

Methods

The databases searched included PubMed, Web of Science, Cochrane Library, Scopus, WanFang, and other relevant sources from the inception of the database until July 2023. Randomized controlled trials (RCTs) on the effects of HIIT on body shape, cardiopulmonary function, and metabolic parameters in the older adult were searched.

Results

A total of 87 RCTs meeting the criteria were included, involving 4,213 older adult people. Meta-analysis results showed that HIIT significantly improved body fat percentage (BF%) [MD: -1.63%, p = 0.005], maximal oxygen uptake (VO2max) [MD: 2.46 mL min-1 kg-1, p < 0.00001], maximal heart rate (HRmax) [MD: 2.83 beats min-1, p = 0.02], and high-density lipoprotein (HDL) levels [MD: 0.04 mmol L-1, p = 0.002]. However, for systolic blood pressure (SBP) [MD: 0.49 mmHg, p = 0.60], resting heart rate (HRrest) [MD: -0.95 BPM -1, p = 0.24], triglycerides (TG) [tendency for MD: -0.02 mmol L-1, p = 0.61], low-density lipoprotein (LDL) [MD: -0.04 mmol L-1, p = 0.27] had no significant effect. Sensitivity analysis found that HIIT significantly improved waist circumference (WC) [MD: -1.89 cm, p = 0.17], diastolic blood pressure (DBP) [MD: -0.63 mmHg, p = 0.23], respiratory exchange rate (RER) [MD: 0.01, p = 0.20], total cholesterol (TC) [MD: 0.10 mmol L-1, p = 0.14], and fasting plasma glucose (FPG) [MD:-0.20 mmol L-1, p = 0.08], but the results lacked robustness. There was no significant improvement in DBP [MD: -0.63 mmHg, p = 0.23] and body mass index (BMI) [MD: -0.36 kg m-2, p = 0.06].

Conclusions

HIIT has shown certain potential and advantages in improving the physical health of the older adult, especially in cardiopulmonary function. However, more high-quality studies are needed to confirm the effects of HIIT on the physical health of the older adult in the future. It also provides a reference for the clinical practice and family health management of HIIT in the older adult and the development of HIIT guidelines.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/myprospero, identifier CRD42023460252.

The national and provincial burden of transport injuries in Iran between 1990 and 2021

Transport injuries (TIs) are a major cause of mortality and morbidity worldwide, and Iran, with its rapid demographic transitions in recent decades, is no exception. This study aimed to assess the burden of TIs in Iran and its provinces from 1990 to 2021. Estimates from the Global Burden of Diseases (GBD) 2021 were used to report age-standardized rates (ASRs) for the prevalence, incidence, mortality, and disability-adjusted life years (DALYs) of TIs by sex, age group, injury type, province, and Socio-demographic Index (SDI). In 2021, Iran recorded 1.147 million (95% uncertainty interval (UI): 1.014 to 1.287 million) incident cases of TIs with an age-standardized incident rate of 1341.9 per 100,000 (95% UI: 1193.7 to 1495.1). Compared with 1990, its prevalence, incidence, death, and DALY rates decreased by - 52% (95% UI: - 54% to - 50%), - 52% (95% UI: - 55% to - 50%), - 62% (95% UI: - 65% to - 58%), and - 64% (95% UI: - 67% to - 61%), respectively. At the provincial level, Tehran (233.1; 95% UI: 191.3 to 304) had the lowest age-standardized DALY rate, while the highest DALY rate was for Sistan-Baluchistan (2155.3; 95% UI: 1866.2 to 2478.3). In addition, age-standardized DALY rates were mainly higher for males, the 20-24 age group, and provinces with a lower SDI. Despite a significant decrease in TIs in Iran since 1990, they still pose a significant burden, with notable disparities across provinces and demographic groups. Targeted prevention programs focusing on high-risk populations, such as young adults and lower-SDI provinces with lower SDI, are recommended.

The roles of neutrophils in cardiovascular diseases

The immune response plays a vital role in the development of cardiovascular diseases (CVDs). As a crucial component of the innate immune system, neutrophils are involved in the initial inflammatory response following cardiovascular injury, thereby inducing subsequent damage and promoting recovery. Neutrophils exert their functional effects in tissues through various mechanisms, including activation and the formation of neutrophil extracellular traps (NETs). Once activated, neutrophils are recruited to the site of injury, where they release inflammatory mediators and cytokines. This study discusses the main mechanisms associated with neutrophil activity and proposes potential new therapeutic targets. In this review, we systematically summarize the diverse phenotypes of neutrophils in disease regulatory mechanisms, different modes of cell death, and focus on the relevance of neutrophils to various CVDs, including atherosclerosis, acute coronary syndrome, myocardial ischemia/reperfusion injury, hypertension, atrial fibrillation, heart failure, and viral myocarditis. Finally, we also emphasize the preclinical/clinical translational significance of neutrophil-targeted strategies.

Accelerated global burden of depressive disorders during the COVID-19 pandemic from 2019 to 2021

A thorough and current analysis of the burden and evolving trends in depressive disorders during the COVID-19 pandemic from 2019 to 2021 remains unavailable. Employing the Global Burden of Disease (GBD) 2021 database, we evaluated the burden of depressive disorders at the global, regional, and national levels, stratifying the analysis by age, gender, and socio-demographic index (SDI). To examine trends in depressive disorders during the epidemic, we calculated the estimated annual percentage change (EAPC) in age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR), and age-standardized DALYs rates (ASDR) across all levels from 2019 to 2021. Furthermore, we performed a frontier analysis of depressive disorders across various countries, incorporating risk factor analyses at multiple levels. In 2021, the global incidence of depressive disorders stood at 357.43 million, while the prevalence was recorded at 332.41 million, accompanied by 56.33 million disability-adjusted life years (DALYs). Throughout the COVID-19 pandemic, there was a notable upward trend in ASIR (EAPC = 8.33 [-0.46 to 17.9]), ASPR (EAPC = 6.02 [0.28 to 12.09]), and ASDR (EAPC = 7.13 [-0.18 to 14.97]) for depressive disorders on a global scale. The burden of depressive disorders is most pronounced among females and individuals aged 60 to 64 within their respective subgroups. From 1990 to 2021, the burden of depressive disorders consistently remained highest in the low SDI region; however, it experienced the most significant increase in the high SDI region during the COVID-19 pandemic from 2019 to 2021. In 2021, the burden of depressive disorders was highest in central sub-Saharan Africa, Greenland, and Uganda, while the Andean region of Latin America, along with Bulgaria and Belarus, experienced the most significant increase in depressive disorders during the COVID-19 pandemic. Globally, bullying victimization, intimate partner violence, and childhood sexual abuse contributed to 6.47%, 4.91%, and 2.65% of the ASDR for depressive disorders, respectively. The global burden of depressive disorders has markedly increased during the COVID-19 pandemic, gradually shifting from low to high SDI regions, particularly in North America and Europe.

Pathways for India to Reduce Ambient Air Pollution Health Burden and Achieve the Sustainable Development Goal (SDG-3.4)

Sustainable Development Goal 3.4 (SDG-3.4) aims to reduce non-communicable disease (NCD) mortality by one-third by 2030, compared to 2015 levels. First, we examined whether the National Clean Air Program (NCAP) is sufficient to allow India to achieve this target. Subsequently, we integrated GAINS-simulated sector-specific PM2.5 concentrations across three pathways─business-as-usual (BAU), advanced control technology (ACT), and sustainable development scenario (SDS)─with the Global Burden of Disease framework to assess potential health benefits for 2030 at a subnational scale and evaluate the feasibility of accomplishing SDG-3.4. In 2015, ambient PM2.5 attributable premature deaths were 0.72 million (95& UIs: 0.53-0.89), and an aggregated 0.12 million (0.08-0.16) deaths could be prevented if the NCAP target is met by 2026. However, states could reduce 3.6-10.8% of targeted NCD mortality by 2030 with a lagged 40% reduction in PM2.5 levels relative to the baseline. PM2.5-attributable deaths would change to 0.79 million (0.57-1.1), 0.76 million (0.6-1.1), and 0.63 million (0.48-0.81) in 2030 under the BAU, ACT, and SDS pathways, respectively. Implementing stringent emission controls through policy and technological interventions, primarily focusing on household and energy sectors, would reduce NCD mortality by 5-13% across subregions. Simultaneously controlling other risk factors would accelerate India's journey toward achieving SDG-3.4.