Global, regional, and national incidence and mortality of congenital birth defects from 1990 to 2019.

The study aims to estimate the trends in incidence and mortality of congenital birth defects at global, regional, and national levels from 1990 to 2019. Annual incident cases, age-standardized incidence rates (ASIRs), deaths, and age-standardized mortality rates (ASMRs) of congenital birth defects during 1990-2019 were collected from Global Burden of Diseases Study 2019. We calculated percentage of relative changes and estimated annual percentage changes (EAPCs) to quantify temporal trends, and explored potential influence factors of EAPCs using Pearson correlation. Globally, total incident cases and deaths of congenital birth defects were 8.52 million and 0.55 million in 2019. Congenital heart anomalies were the major category of congenital birth defects worldwide in 2019. From 1990 to 2019, the ASIR remained stable (EAPC=0.01, 95% CI -0.03 to 0.05), whereas the ASMR decreased (EAPC=-1.79, 95% CI -1.84 to -1.74). The most pronounced increase in ASIR occurred in low-middle socio-demographic index (SDI) regions (EAPC=0.03, 95% CI 0.01 to 0.06). The number of deaths increased by 14.49% in low SDI regions and the ASMR increased in Southern Sub-Saharan Africa (EAPC=0.17, 95% CI 0.02 to 0.33). Negative correlations of EAPCs in ASIRs and ASMRs with SDI and universal health coverage index values in 2019 were detected at national levels.  Conclusions: Congenital birth defects are an important child health problem. There is urgent need to strengthen surveillance and detection of congenital birth defects, build and improve maternal and child healthcare capacity, and promote treatment and rehabilitation, especially in resource-limited countries. What is known: • Congenital birth defects were the fourth leading cause of death among children under 5 years in 2019, accounting for nearly 10% of deaths. What is new: • In this study using data from the Global Burden of Disease Study, global incident cases, deaths, and age-standardized mortality rate (ASMR) of congenital birth defects decreased, whereas age-standardized incidence rate (ASIR) remained stable from 1990 to 2019. • From 1990 to 2019, the most pronounced increase in ASIR occurred in Oceania, and the ASMR increased by an average of 0.17% per year in Southern Sub-Saharan Africa.

Global, regional, and national disease burden of autism spectrum disorder among children under 5 years from 1990 to 2019: An analysis for the Global Burden of Disease 2019 Study.

AIM: To estimate the trend in burden of autism spectrum disorder (ASD) at global, regional, and national levels from 1990 to 2019. METHODS: Annual incident cases, incidence rates, prevalent cases, prevalence rates, disability-adjusted life years (DALYs), and DALY rates of ASD among children under 5 years from 1990 to 2019 were collected from the Global Burden of Diseases Study 2019. The percentage of relative changes in cases and the estimated annual percentage changes (EAPCs) of rates were calculated to reflect the temporal trends of ASD burden. Pearson correlation analysis was used to explore the influential factors for EAPC. RESULTS: Globally, the incidence rate, prevalence rate, and DALY rate of ASD among children under 5 years were 91.09 per 100,000, 439.39 per 100,000, and 68.67 per 100,000 in 2019, respectively. From 1990-2019, the incidence rate decreased (EAPC = -0.09, 95% confidence interval [CI] -0.12 to -0.06), whereas the prevalence rate (EAPC=0.08, 95%CI 0.06-0.09) and DALY rate (EAPC=0.08, 95%CI 0.07-0.10) increased. The largest increases in prevalent cases (80.26%) and DALYs (81.24%) were found in low SDI regions, while High-income North America experienced the fastest increase in incidence rate, prevalence rate, and DALY rate. Moreover, the burden of ASD among male children under 5 years was approximately three times that among female children, despite the slight narrowing of gender disparity. The EAPC of incidence rate was positively correlated with SDI and UHCI in 2019 (P < 0.001). CONCLUSION: ASD is a noticeable child neurodevelopmental syndrome. More attention should be given to early screening, diagnosis, and intervention, particularly in resource-limited areas.

Trends of global and regional aetiologies, risk factors and mortality of lower respiratory infections from 1990 to 2019: An analysis for the Global Burden of Disease Study 2019.

BACKGROUND AND OBJECTIVE: Lower respiratory infections (LRIs) are a leading cause of death worldwide. We aimed to estimate the trends of global and regional aetiologies, risk factors and mortality of LRIs from 1990 to 2019. METHODS: From the Global Burden of Disease (GBD) Study 2019, we collected relevant data, including annual LRI deaths, mortality and deaths and mortality attributable to the four high-burden aetiologies and 14 risk factors during 1990-2019. To quantify the temporal trends, estimated annual percentage changes (EAPCs) were calculated by fitting linear regression model. RESULTS: Globally, the age-standardized mortality due to LRIs decreased by an average of 2.39% (95% CI 2.33%-2.45%) per year, from 66.67 deaths per 100,000 in 1990 to 35.72 deaths per 100,000 in 2019. Low Socio-demographic Index regions, South Asia and Sub-Saharan Africa had the heaviest burden of LRIs. The age-standardized mortality decreased in 18 GBD regions, whereas increased in Southern Latin America (EAPC = 1.20, 95% CI 1.03-1.37). LRIs led to considerable deaths among children under 5 years and adults older than 70 years. Streptococcus pneumoniae was the first leading aetiology, accounting for over 50% of LRI deaths. Household air pollution from solid fuels, child wasting and ambient particulate matter pollution were the three leading risk factors for LRI mortality in 2019. CONCLUSION: LRIs remain an important health problem globally, especially in some vulnerable areas and among children under 5 and adults over 70 years. Future researches focusing on the aetiologies and risk factors for LRIs are needed to provide targeted and updated prevention strategies.

The trends of mortality, aetiologies and risk factors of lower respiratory infections in China from 1990 to 2019: Findings from the Global Burden of Disease Study 2019.

BACKGROUND: Lower respiratory infections (LRIs) are an important public health problem in China. This study aimed to estimate the fatal burden of LRIs in China and trends from 1990 to 2019, thereby making targeted prevention strategies. METHODS: Annual deaths and mortality were collected from the GBD 2019. Estimated annual percentage changes (EAPCs) of age-standardized mortality were calculated to quantify the trends of LRI mortality. We also analyzed four aetiologies and 14 risk factors. RESULTS: In China, total deaths due to LRIs decreased from 543,901 (95 %UI 472,378-606,600) in 1990 to 185,264 (95 %UI 160,993-216,219) in 2019. From 1990-2019, the age-standardized mortality decreased by an average of 5.68 % (95 %CI 5.46 %-5.89 %) per year, whereas the reduction among adults older than 70 years (EAPC=-2.56,95 %CI -2.68 to -2.43) was slower than that among children under 5 years (EAPC=-10.11,95 %CI -10.46 to -9.76). Moreover, Streptococcus pneumoniae was the first leading aetiology of LRI mortality among all ages. Although LRI mortality attributable to child undernutrition decreased rapidly from 2000 to 2019, alcohol use (EAPC=-1.06,95 %CI -1.40 to -0.72), smoking (EAPC=-3.70,95 %CI -3.89 to -3.51), and ambient particulate matter pollution (EAPC=-4.00,95 %CI -4.28 to -3.73) remained serious risk factors. CONCLUSIONS: LRIs remain an important health problem in China particularly in children under 5 years and adults older than 70 years. Continuous efforts are needed to promote maternal and child health, control smoking and alcohol use, and improve ambient air quality. More researches focusing on LRIs are required to provide targeted and updated prevention strategies.