The global burden of cardiovascular disease attributable to diet low in fiber among people aged 60 years and older, 1990-2019: an age-period-cohort analysis of the global burden of disease study.

OBJECTIVES: This study aimed to quantify the global cardiovascular disease (CVD) burden attributable to diet low in fiber among adults aged 60 years and older using data from the Global Burden of Disease (GBD) Study 2019. METHODS: We extracted data on CVD mortality, disability-adjusted life-years (DALYs), and risk-factor exposures from the GBD 2019 study for people aged 60 and older. Age-period-cohort models were used to estimate the overall annual percentage change in mortality and DALY rate (net drift, % per year), mortality and DALY rate for each age group from 1990 to 2019 (local drift, % per year), longitudinal age-specific rate corrected for period bias (age effect), and mortality and Daly rate for each age group from 1990 to 2019 (local drift, % per year). And period/cohort relative risk (period/cohort effect). RESULTS: From 1990 to 2019, global age-standardized cardiovascular disease (CVD) mortality rates attributable to low dietary fiber intake decreased by 2.37% per year, while disability-adjusted life years (DALYs) fell by 2.48% annually. Decreases were observed across all sociodemographic index regions, with fastest declines in high and high-middle SDI areas. CVD mortality and DALY rates attributable to low fiber increased exponentially with age, peaking at 85-89 years, and were higher in men than women. Regarding period effects, mortality and DALY rates declined since 2000, reaching nadirs in 2015-2019. For birth cohort patterns, risks attributable to low fiber intake peaked among early 1900s births and subsequently fell, with more pronounced reductions over time in women. CONCLUSIONS: Low dietary fiber intake is a leading contributor to the global cardiovascular disease burden, accounting for substantial mortality and disability specifically among older adults over recent decades.

The temporal trend of tuberculosis burden in an aging population in China: a secondary data analysis from the GBD 2019.

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

Disease burden and attributable risk factors of lip and oral cavity cancer in China from 1990 to 2021 and its prediction to 2031.

Aims: This study addresses the essential need for updated information on the burden of lip and oral cavity cancer (LOC) in China for informed healthcare planning. We aim to estimate the temporal trends and the attributable burdens of selected risk factors of LOC in China (1990-2021), and to predict the possible trends (2022-2031). Subject and methods: Analysis was conducted using data from the Global Burden of Disease study (GBD) 2021, encompassing six key metrics: incidence, mortality, prevalence, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). Absolute number and age-standardized rates, alongside 95% uncertainty intervals, were computed. Forecasting of disease burden from 2022 to 2031 was performed using an autoregressive integrated moving average (ARIMA) model. Results: Over the observed period (1990-2021), there were notable increases in the number of deaths (142.2%), incidence (283.7%), prevalence (438.0%), DALYs (109.2%), YLDs (341.2%), and YLLs (105.1%). Age-standardized rates demonstrated notable changes, showing decreases and increases of -5.8, 57.3, 143.7, -8.9%, 85.8%, and - 10.7% in the respective metrics. The substantial majority of LOC burden was observed among individuals aged 40-79 years, and LOC may exhibit a higher burden among males in China. From 2022 to 2031, the age-standardized rate of incidence, prevalence, and YLDs of LOC showed upward trends; while mortality, DALYs, and YLLs showed downward trends, and their estimated values were predicted to change to 2.72, 10.47, 1.11, 1.10, 28.52, and 27.43 per 100,000 in 2031, respectively. Notably, tobacco and high alcohol use emerged as predominant risk factors contributing to the burden of LOC. Conclusion: Between 1990 and 2021, the disability burden from LOC in China increased, while the death burden decreased, and projections suggest these trends will persist over the next decade. A significant portion of this disease burden to modifiable risk factors, specifically tobacco use and excessive alcohol consumption, predominantly affecting males and individuals aged 40-79 years. Attention to these areas is essential for implementing targeted interventions and reducing the impact of LOC in China.

The global burden of maternal disorders attributable to iron deficiency related sub-disorders in 204 countries and territories: an analysis for the Global Burden of Disease study.

Background: Pregnancy-related anemia presents a significant health concern for approximately 500 million women of reproductive age worldwide. To better prevent maternal disorders, it is essential to understand the impact of iron deficiency across different maternal disorders, regions, age groups, and subcategories. Methods: Based on the comprehensive maternal disorders data sourced from the 2019 Global Burden of Disease study, an investigation was carried out focusing on Disability-Adjusted Life Years (DALYs) associated with iron deficiency spanning the period from 1990 to 2019. In addition, Estimated Annual Percentage Changes (EAPCs) were computed for the duration of the study. Results: Our study indicates decreasing mortality rates and years of life lost due to maternal conditions related to iron deficiency, such as maternal hemorrhage, miscarriage, abortion, hypertensive disorders, and infections. However, mortality rates and years of life lost due to indirect and late maternal deaths, as well as deaths aggravated by HIV/AIDS, have increased in high socio-demographic index (SDI) regions, especially in North America. Moreover, the proportion of maternal deaths aggravated by HIV/AIDS due to iron deficiency is rising globally, especially in Southern Sub-Saharan Africa, Oceania, and Georgia. In addition, in the Maldives, the age-standardized DALYs for maternal disorders attributable to iron deficiency exhibited a notable decreasing trend, encompassing a range of conditions. Furthermore, there was a significant decrease in Disability-Adjusted Life Years rate for miscarriages and preterm births among women aged 15-49, with hypertensive disorders posing the highest burden among women aged 15-39. Conclusion: The burden of maternal disorders caused by iron deficiency is decreasing in most regions and subtypes, except for deaths aggravated by HIV/AIDS. By thoroughly understanding the details of how iron deficiency impacts the health of pregnant women, health policymakers, healthcare professionals, and researchers can more effectively pinpoint and address the root causes of inequalities in maternal health.

Global Burden of Inflammatory Bowel Disease Among Children and Adolescents: A Comprehensive Analysis (1990-2019).

Objective: We summarize the global, regional, and national burden of inflammatory bowel disease (IBD) in children and adolescents from 1990 to 2019. Methods: Based on the Global Burden of Disease Study 2019, the data of IBD in children and adolescents were analyzed by sex, age, year, and location. Joinpoint analysis was applied to assess the temporal trend of the disease burden. Results: From 1990 to 2019, the incidence of IBD in children and adolescents increased by 22.8%, from 20,897.42 to 25,658.55 cases, especially in high SDI region. During the same period, the DALY numbers decreased by 53.5%, from 243,081.06 to 113,119.86, with all SDI regions experiencing a clear drop in DALYs except high SDI regions. In 2019, early-onset IBD incidence and DALY numbers were reported at 2,053.52 (95% UI: 1,575.62 to 2,677.49) and 73,797.46 (95% UI: 43,655.86 to 105,998.63), respectively. Conclusion: Early-onset IBD in children and adolescents remains a significant global health concern. The disease burden has not improved in developed countries over the past 30 years, highlighting the need for targeted interventions.

Further analysis of tuberculosis in eight high-burden countries based on the Global Burden of Disease Study 2021 data.

BACKGROUNDS: Most significant findings from the Global Tuberculosis (TB) Report 2023 indicate that India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and the Democratic Republic of the Congo (DRC) collectively contribute to approximately two-thirds of global TB cases. This study aims to provide crucial data-driven insights and references to improve TB control measures through a comprehensive analysis of these eight high-burden countries. METHODS: The eight high-burden TB countries analyzed in this study include India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh, and the DRC. Age-standardized incidence rates (ASIR) of TB were derived from the Global Burden of Diseases Study 2021 data. Temporal trends were analyzed using Joinpoint regression. An age-period-cohort model was applied to examine the risk ratios (RR) of TB across diverse age groups, periods, and birth cohorts. A Bayesian age-period-cohort framework was employed to predict the ASIR of TB by 2030. RESULTS: The study found that the Philippines (average annual percentage change = 3.1%, P < 0.001) exhibited an upward trend from 1990 to 2021. In India, the Philippines, Pakistan, and Bangladesh, the RR of TB incidence exceeded 1 after individuals reached 25 years old. Notably, the RR has shown a consistent upward trend since 2001, peaking during the period of 2017-2021 with an estimated RR of 1.5 (P < 0.001) in the Philippines. Similarly, the highest RR was observed during the period of 2017-2021 reaching 1.1 (P < 0.001) in the DRC. In the Philippines, the markedly increasing RR values for TB have been observed among individuals born after 1997-2001. Projections suggest that the ASIR of TB is expected to follow a continued upward trajectory, with an estimated rate of 392.9 per 100,000 by 2030 in the Philippines; India and Indonesia are projected to achieve less than 20.0% of the target set by the World Health Organization (WHO). CONCLUSIONS: Among the eight high-burden countries, the Philippines, India and Indonesia are diverging from the goals set by the WHO, and the risk of TB in the Philippines and the DRC shows a trend toward affecting younger populations, which suggests that the management strategies for TB patients need to be further strengthened.

Global burden of benign prostatic hyperplasia in males aged 60-90 years from 1990 to 2019: results from the global burden of disease study 2019.

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

Trends and disparities of disease burden in infections among pregnant women in 131 low-income and middle-income countries, 1990-2019.

Background: In low- and middle-income countries (LMICs) and territories, maternal infections impose a non-negligible disease burden. We aimed to analyse the secular trends, age distribution, and associated factors of maternal sepsis and other maternal infections (MSMI) across 131 LMICs from 1990 to 2019. Methods: We collected yearly data of incidences, deaths, and disability adjusted life years (DALYs) on MSMI in 131 LMICs from 1990 to 2019 from the Global Burden of Disease 2019 (GBD 2019). The sociodemographic index (SDI) and universal health coverage effective coverage index (UHCI) were also acquired. Relative percent change and estimated annual percentage change (EAPC) were used to assess the secular trends. Correlation analyses were also employed to explore the associations between the burden of MSMI with SDI and UHCI. Results: Between 1990 and 2019, the age-standardised incident rates (ASIRs), age-standardised maternal mortality ratios (ASMMRs) and age-standardised DALYs rates of low-income countries (LICs) were much higher than that of lower-middle-income countries (LMCs) and upper-middle income countries (UMCs), although they all continued to decline. At least six of 131 LMICs had ASMMR greater than 70.00 per 100 000 live births in 2019. The incidences of MSMI increased first till 20-24 years and then decreased with age both in 1990 and 2019, while the ASMMRs were higher in the youngest and the oldest age group. With the growth of SDI and UHCI in 2109, the decreasing trend of ASIR, ASMMR, and age-standardised DALYs rates slowed down. Conclusions: Although the progress has been made in reducing the burden of MSMI in 131 LMICs, the disease burden in LICs far exceeded that of LMCs and UMCs. Socio-economic status and universal health coverage were both associated with the MSMI burden, and further research is needed to explore the underlying factors contributing to these disparities and to identify effective strategies for reducing the burden of MSMI.

Global forecasting of chronic kidney disease mortality rates and numbers with the generalized additive model.

BACKGROUND: Chronic kidney disease (CKD) is an important public health problem worldwide; therefore, forecasting CKD mortality rates and death numbers globally is vital for planning CKD prevention programs. This study aimed to characterize the temporal trends in CKD mortality at the international level from 1990 to 2019 and predict CKD mortality rates and numbers until 2030. METHODS: Data were obtained from the Global Burden of Disease 2019 Study. A joinpoint regression model was used to estimate the average annual percentage change in CKD mortality rates and numbers. Finally, we used a generalized additive model to predict CKD mortality through 2030. RESULTS: The number of CKD-related deaths worldwide increased from 591.80 thousand in 1990 to 1425.67 thousand in 2019. The CKD age-adjusted mortality rate increased from 15.95 per 100,000 people to 18.35 per 100,000 people during the same period. Between 2020 and 2030, the number of CKD deaths is forecasted to increase further to 1812.85 thousand by 2030. The CKD age-adjusted mortality rate is expected to decrease slightly to 17.76 per 100,000 people (95% credible interval (CrI): 13.84 to 21.68). Globally, it is predicted that in the next decade, the CKD mortality rate will decrease in men, women, all subgroups of disease etiology except glomerulonephritis, people younger than 40 years old, and all groupings of countries based on the sociodemographic index (SDI) except high-middle-SDI countries. CONCLUSIONS: The CKD mortality rate is predicted to decrease in the next decade. However, more attention should be given to people with glomerulonephritis, people over 40 years old, and people in high- to middle-income countries because the mortality rate due to CKD in these subgroups is expected to increase until 2030.

Disease burden of AIDS in last 30-year period and its predicted level in next 25-years based on the global burden disease 2019.

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

The disease burden of bladder cancer and its attributable risk factors in five Eastern Asian countries, 1990-2019: a population-based comparative study.

BACKGROUNDS: The study aimed to estimate bladder cancer burden and its attributable risk factors in China, Japan, South Korea, North Korea and Mongolia from 1990 to 2019, to discuss the potential causes of the disparities. METHODS: Data were obtained from the Global Burden of Disease Study 2019. The annual percent change (APC) and average annual percent change (AAPC) were calculated by Joinpoint analysis, and the independent age, period and cohort effects were estimated by age-period-cohort analysis. RESULTS: In 2019, the highest incidence (7.70 per 100,000) and prevalence (51.09 per 100,000) rates of bladder cancer were in Japan, while the highest mortality (2.31 per 100,000) and DALY rates (41.88 per 100,000) were in South Korea and China, respectively. From 1990 to 2019, the age-standardized incidence and prevalence rates increased in China, Japan and South Korea (AAPC > 0) and decreased in Mongolia (AAPC < 0), while mortality and DALY rates decreased in all five countries (AAPC < 0). Age effects showed increasing trends for incidence, mortality and DALY rates, while the prevalence rates increased first and then decreased in older groups. The cohort effects showed downward trends from 1914-1918 to 2004-2008. Smoking was the greatest contributor and males had the higher burden than females. CONCLUSION: Bladder cancer was still a major public health problem in East Asia. Male and older population suffered from higher risk, and smoking played an important role. It is recommended that more efficient preventions and interventions should be operated among high-risk populations, thereby reduce bladder cancer burden in East Asia.

Global Burden of Atopic Dermatitis: Examining Disease Prevalence Across Pediatric and Adult Populations World-Wide.

Atopic Dermatitis (AD) is a common, pruritic inflammatory skin disease associated with marked disease burden and substantial health care costs. AD does not discriminate between populations; prevalence estimates vary widely with most studies focusing on general or pediatric populations and a limited number of studies in adult populations solely. The costs of treating AD are staggering. Studies that examine differences in prevalence may be difficult to compare due to differences in study designs. However, understanding the prevalence of AD across populations is critical if we are to improve the lives of patients and caregivers living with this disease.

A global analysis of the burden of ischemic heart disease attributable to diet low in fiber between 1990 and 2019.

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

Inequalities in disease burden and care quality of chronic obstructive pulmonary disease, 1990-2021: Findings from the Global Burden of Disease Study 2021.

Background: Chronic obstructive pulmonary disease (COPD) is one of the primary causes of significant morbidity and mortality worldwide. This study aimed to explore the cross-country inequalities by age, sex, and region in COPD's burden and care quality from 1990 to 2021. Methods: We obtained data from the Global Burden of Disease 2021. Using age-standardised disability-adjusted life years rate (ASDR) per 100 000 population and quality of care index (QCI), we quantified the COPD burden and care quality, respectively. Applying the principal component analysis method, we calculated QCI scores, ranging from 0 to 100, where higher values indicate better care quality. We quantified temporal trends from 1990 to 2021 for ASDR and QCI by estimated annual percentage change (EAPC). Finally, we assessed the absolute and relative disparities in ASDR and QCI across countries using the slope index of inequality (SII) and concentration index. Results: Between 1990 and 2021, there was a notable decline in ASDR of COPD globally (1990 = 1492.64; 2021 = 940.66; EAPC = -1.71), accompanied by an increase in QCI (1990 = 58.42; 2021 = 73.86; EAPC = 0.89). Regions with middle sociodemographic index (SDI) consistently demonstrated the highest ASDR and the lowest QCI in 1990 (ASDR = 2332.91; QCI = 31.70), whereas by 2021, low-middle SDI regions exhibited similar trends (ASDR = 1707.90; QCI = 57.50). In 2021, the highest ASDR was among individuals aged 95 years and above (16251.22), while the lowest QCI was among people aged 70-74 years (72.18). Papua New Guinea recorded the highest ASDR and the lowest QCI in 2021 (ASDR = 3004.36; QCI = 19.18). Compared to 1990, where the SII for ASDR was -612.44 and for QCI was 21.78, with concentration indices of -0.14 for ASDR and 0.11 for QCI, the absolute values of both SII and concentration index were smaller in 2021, with ASDR's SII at -555.90, QCI's at 16.72, ASDR's concentration index at -0.13, and QCI's at 0.04. Conclusions: The global burden of COPD decreases and care quality increases over time, with notable variations across ages, sexes and SDI regions. Countries with lower SDI had disproportionately higher burden and poorer care quality for COPD.

Estimating the Proportion of Overdiagnosis among Prostate, Breast, and Thyroid Cancers in China: Findings from the Global Burden of Disease 2019.

The incidence of prostate, breast, and thyroid cancers has increased in China over the past few decades. Whether and how much these increases can be attributed to overdiagnosis are less understood. This study aimed to estimate the proportion of overdiagnosis among these three cancers in China during 2004-2019. The age-specific cancer incidence, cancer mortality, and all-cause mortality in China were extracted from the Global Burden of Diseases 2019. The lifetime risk of developing and that of dying from each cancer were calculated using the life table method. The proportion of overdiagnosis of a cancer was estimated as the difference between the lifetime risk of developing the cancer and that of suffering from the cancer (including death, metastasis, and symptoms caused by the cancer), further divided by the lifetime risk of developing the cancer. The highest possible values of these parameters were adopted in the estimation so as to obtain the lower bounds of the proportions of overdiagnosis. Sensitivity analyses assuming different lag periods between the diagnosis of a cancer and death from the cancer were performed. The results showed that the lifetime risk of developing prostate, breast, and thyroid cancer increased dramatically from 2004 to 2019 in China, while the increase in the lifetime risk of dying from these cancers was less pronounced. The proportions of overdiagnosis among prostate, breast, and thyroid cancers were estimated to be 7.88%, 18.99%, and 24.92%, respectively, in 2004, and increased to 18.20%, 26.25%, and 29.24%, respectively, in 2019. The increasing trends were statistically significant for all three cancers (all p < 0.001). In sensitivity analyses, the proportions of overdiagnosis decreased, but upward trends over time remained for all three cancers. In conclusion, the overdiagnosis of prostate, breast, and thyroid cancers in China increased from 2004 to 2019, with the highest proportion seen in thyroid cancer and the most rapid increase seen in prostate cancer. Multifaceted efforts by policy makers, guideline developers, and clinicians are needed to tackle this problem.

Global burden of lung cancer in women of childbearing age attributable to ambient particulate matter pollution: 1990-2021.

BACKGROUND: This study aimed to evaluate the global burden of lung cancer due to ambient particulate matter (PM) pollution in women of childbearing age from 1990 to 2021. METHODS: This was a secondary analysis utilizing data from the Global Burden of Disease (GBD) 2021, with a focus on the temporal trends of the lung cancer burden attributable to ambient PM2.5 among women of childbearing age. RESULTS: In 2021, the global mortality and disability-adjusted life years (DALYs) number of lung cancer burden attributable to ambient PM2.5 among women of childbearing age were approximately 5205 and 247,211, respectively. The rate of lung cancer attributable to ambient PM2.5 among women of childbearing age increased between 1990 and 2021, with the age-standardized mortality rate (ASMR) increasing from 0.22 (95% uncertainty interval [UI]; 0.13 to 0.33) to 0.25 (95% UI; 0.14 to 0.37; average annual percent change [AAPC] = 0.40) and the age-standardized DALYs rate (ASDR) increasing from 10.39 (95% UI; 5.96 to 15.72) to 12.06 (95% UI; 6.83 to 17.51; AAPC = 0.41). The middle sociodemographic index (SDI) region, East Asia, and China had the heaviest burden, while the high SDI region showed the highest decrease. ASMR and ASDR exhibited an inverted U-shaped relationship with the SDI. CONCLUSIONS: From 1990 to 2021, the lung cancer burden attributable to ambient PM2.5 among women of childbearing age exhibited an increasing trend. Furthermore, increasing attention should be paid to the middle SDI region, East Asia, and China, as ambient PM pollution remains a critical target for intervention.

Tracking multidrug resistant tuberculosis: a 30-year analysis of global, regional, and national trends.

Objectives: To provide valuable insights for targeted interventions and resource allocation, our analysis delved into the multifaceted burden, trends, risks, and projections of multi drug resistant tuberculosis (MDR-TB). Methods: This research employed data from the Global Burden of Disease (GBD) 2019 dataset, which used a comparative risk assessment to quantify the disease burden resulting from risk factors. Initially, this database was utilized to extract details concerning the disability-adjusted life years (DALYs), mortality, incidence, and the number of individuals afflicted by MDR-TB. Subsequently, regression analyses were conducted using the Joinpoint program to figure average annual percent change (AAPC) to ascertain the trend. Thirdly, the age-period-cohort model (APCM) was adopted to analyze evolutions in incidence and mortality. Finally, utilizing the Nordpred model within R software, we projected the incidence and mortality of MDR-TB from 2020 to 2030. Results: MDR-TB remained a pressing global health concern in regions with lower socio-demographic indexes (SDI), where the AAPC in DALYs topped 7% from 1990 to 2019. In 2019, the cumulative DALYs attributed to MDR-TB tallied up to 4.2 million, with India, the Russian Federation, and China bearing the brunt. Notably, the incidence rates have shown a steadfast presence over the past decade, and a troubling forecast predicts an uptick in these areas from 2020 to 2030. Additionally, the risk of contracting MDR-TB grew with advancing age, manifesting most acutely among men aged 40+ in lower SDI regions. Strikingly, alcohol consumption had been identified as a significant contributor, surpassing the impacts of smoking and high fasting plasma glucose, leading to 0.7 million DALYs in 2019. Conclusions: A robust strategy is needed to end tuberculosis (TB) by 2030, especially in lower SDI areas.

[Disease burden and economic burden of breast cancer in females in China: a synthesis analysis].

Objective: To understand the current and integrated disease burden and economic burden caused by breast cancer in females in China. Methods: Based on six updated data sources, including the series of Chinese Cancer Registry Annual Report, China Death Cause Surveillance Datasets, China Health Statistical Yearbook, GLOBOCAN, Cancer Incidence in Five Continents, Global Burden of Disease Study (GBD), the information about incidence, mortality and disability adjusted life years (DALY) of breast cancer were extracted for the analysis on the current incidence and time trend of breast cancer and predicted disease burden of breast cancer in females in China. Software Joinpoint was used for time trend analysis. The data of economic burden were systematically updated and analyzed by literature review. Results: 1) GLOBOCAN 2022 estimated that the age-standardized incidence rate (ASIR) age-standardized mortality rate (ASMR) and one- year prevalence rate of breast cancer in females were 33.0/100 000, 6.1/100 000 and 40.1/100 000, respectively, in China in 2022. According to Chinese Cancer Registry Annual Report, the ASIR and ASMR were 28.4/100 000 and 5.8/100 000, respectively, in 2018. The China Death Cause Surveillance Datasets showed that the ASMR was 4.5/100 000 in 2021, and the urban to rural area mortality ratio was 1.2∶1. GBD reported that the DALYs of breast cancer were 2.921 million in China in 2021, accounting for 14.4% of the global total. 2) Chinese Cancer Registry Annual Report data showed that the ASIR and ASMR of breast cancer decreased by 2.1% and 11.4%, respectively, in China from 2009 to 2018, while increased by 43.9% and 8.2% in rural area, respectively. The Joinpoint analysis showed that the average annual percentage change (AAPC) of ASIR and ASMR in China were -0.2% (P>0.05) and -1.6% (P<0.05). The AAPC of ASIR and ASMR in rural area were 3.9% (P<0.05) and 0.6% (P>0.05), and -0.3% (P>0.05) and -1.2% (P<0.05) in urban area, respectively. China Health Statistical Yearbook data showed that the urban ASMR decreased by 12.3% from 2014 to 2021 with AAPC of -2.6% (P<0.05). 3) The GLOBOCAN 2022 predicted that, the breast cancer case count and death count in China would be 387 776 and 111 133 by 2050, an increase of 8.6% and 48.2%, respectively, compared with 2022, the increases would be more obvious in people over 65 years old, an increase of 80.8% and 124.9%, respectively. 4) Thirteen individual- based studies reported that the median medical expenditure per patient (M=21 000 to 39 000 Yuan) and length of hospital stay (M=11.0 to 30.5 days) for breast cancer treatment decreased from 2010 to 2019, while the average medical expenditure per visit (M=9 000 to 23 000 Yuan) showed an upward trend. There was only one national-level analysis, which showed that the treatment cost of breast cancer was 25.24 billion Yuan in China in 2018, accounting for 6.4% of the total cancer treatment cost. Conclusions: According to the above updated multi-source data, the incidence and mortality of female breast cancer in China were stable in the past ten years, but the increasing trend in rural area should be noted. The direct medical expenditure of breast cancer treatment per case might decrease, but the population-level economic burden would remain heavy due to population aging.