The Causes of Death and Their Influence in Life Expectancy of Children Aged 5-14 Years in Low- and Middle-Income Countries From 1990 to 2019.

Introduction: Although child and adolescent health is the core of the global health agenda, the cause of death and its expected contribution to life expectancy (LE) among those aged 5-14 are under-researched across countries, especially in low- and middle-income countries (LMICs). Methods: Death rates per 10 years age group including a 5-14-year-old group were calculated by the formula, which used the population and the number of deaths segmented by the cause of death and gender from the 2019 Global Burden of Disease (GBD) study. LE and cause-eliminated LE in 10-year intervals were calculated by using life tables. Results: In 2019, the global mortality rate for children and adolescents aged 5-14 years was 0.522 (0.476-0.575) per 1,000, and its LF was 71.377 years. In different-income regions, considerable heterogeneity remains in the ranking of cause of death aged 5-14 years. The top three causes of death in low-income countries (LICs) are enteric infections [0.141 (0.098-0.201) per 1,000], other infectious diseases [0.103 (0.073-0.148) per 1,000], and neglected tropical diseases and malaria [0.102 (0.054-0.172) per 1,000]. Eliminating these mortality rates can increase the life expectancy of the 5-14 age group by 0.085, 0.062, and 0.061 years, respectively. The top three causes of death in upper-middle income countries (upper MICs) are unintentional injuries [0.066 (0.061-0.072) per 1,000], neoplasm [0.046 (0.041-0.050) per 1,000], and transport injuries [0.045 (0.041-0.049) per 1,000]. Eliminating these mortality rates can increase the life expectancy of the 5-14 age group by 0.045, 0.031, and 0.030 years, respectively. Conclusion: The mortality rate for children and adolescents aged 5-14 years among LMICs remains high. Considerable heterogeneity was observed in the main causes of death among regions. According to the main causes of death at 5-14 years old in different regions and countries at different economic levels, governments should put their priority in tailoring their own strategies to decrease preventable mortality.

Burden of chronic kidney disease and its risk-attributable burden in 137 low-and middle-income countries, 1990-2019: results from the global burden of disease study 2019.

BACKGROUND: Chronic kidney disease (CKD) is a global public health concern, but its disease burden and risk-attributable burden in CKD has been poorly studied in low - and middle-income countries (LMICs). This study aimed to estimate CKD burden and risk-attributable burden in LMICs from 1990 to 2019. METHODS: Data were collected from the Global Burden of Disease (GBD) Study 2019, which measure CKD burden using the years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs) and calculate percentage contributions of risk factors to age-standardized CKD DALY using population attributable fraction (PAF) from 1990 to 2019. Trends of disease burden between 1990 and 2019 were evaluated using average annual percent change (AAPC). The 95% uncertainty interval (UI) were calculated and reported for YLDs, YLLs, DALYs and PAF. RESULTS: In 2019, LICs had the highest age-standardized DALY rate at 692.25 per 100,000 people (95%UI: 605.14 to 785.67), followed by Lower MICs (684.72% (95%UI: 623.56 to 746.12)), Upper MICs (447.55% (95%UI: 405.38 to 493.01)). The age-standardized YLL rate was much higher than the YLD rate in various income regions. From 1990 to 2019, the age-standardized DALY rate showed a 13.70% reduction in LICs (AAPC = -0.5, 95%UI: - 0.6 to - 0.5, P < 0.001), 3.72% increment in Lower MICs (AAPC = 0.2, 95%UI: 0.0 to 0.3, P < 0.05). Age-standardized YLD rate was higher in females than in males, whereas age-standardized rates of YLL and DALY of CKD were all higher in males than in females in globally and LMICs. Additionally, the YLD, YLL and DALY rates of CKD increased with age, which were higher in aged≥70 years in various income regions. In 2019, high systolic blood pressure, high fasting plasma glucose, and high body-mass index remained the major causes attributable age-standardized CKD DALY. From 1990 to 2019, there were upward trends in the PAF of age-standardized DALY contributions of high fasting plasma glucose, high systolic blood pressure, and high body-mass index in Global, LICs, Lower MICs and Upper MICs. The greatest increase in the PAF was high body-mass index, especially in Lower MICs (AAPC = 2.7, 95%UI: 2.7 to 2.8, P < 0.001). The PAF of age-standardized DALY for high systolic blood pressure increased the most in Upper MICs (AAPC = 0.6, 95%UI: 0.6 to 0.7, P < 0.001). CONCLUSIONS: CKD burden remains high in various income regions, especially in LICs and Lower MICs. More effective and targeted preventive policies and interventions aimed at mitigating preventable CKD burden and addressing risk factors are urgently needed, particularly in geographies with high or increasing burden.

Burden of alcohol use disorders in China and the regions with different income levels over the world.

BACKGROUND: Alcohol use disorders (AUD) has long been one of the most disability mental disorders and a major cause of health loss. METHODS: Based on open access data from the 2019 Global Burden of Disease (GBD 2019) study, we extracted data of years lived with disability (YLD), years of life lost (YLL) and disability-adjusted life years (DALY) to describe the changes of AUD burden over the period of 1990-2019 stratified by sex in globe, high-income countries (HICs), upper-middle income countries (UMCs), lower-middle income countries (LMCs), low-income countries (LICs) and China. We used Joinpoint regression model to fit the changing trend of years. And pairwise comparison was applied to test the coincidence parallelism and judge whether the difference of the trend among different regions is statistically significant. RESULTS: LMCs experienced the largest changes in the YLD rate of AUD from 1990 to 2019 (average annual percent change (AAPC) = -0.7, 95% confidence interval (CI) = -0.8, -0.7, P < 0.05), with China experienced a higher increase in 1990 to 1993 (annual percent change (APC) = 3.8, 95% CI = 3.2, 4.4, P < 0.05) than other regions, and the rate of decline in China from 1996 to 2002 (APC = -3.4, 95% CI = -3.6, -3.1, P < 0.05) was higher than that in other regions. UMCs experienced the largest changes in the YLL rate of AUD from 1990 to 2019 (AAPC = -1.1, 95% CI = -1.6, -0.6, P < 0.05), with a larger decline in 2004 to 2012 (APC = -6.2, 95% CI = -6.7, -5.7, P < 0.05) than other regions, and China experienced a larger increase in the rate of YLL from 1999 to 2004 (APC = 9.2, 95% CI = 8.5, 9.9, P < 0.05) than other regions. LMCs experienced the largest changes in the DALY rate of AUD from 1990 to 2019 (AAPC = -0.9, 95% CI = -1.0, -0.8, P < 0.05), with a larger decline in 2006 to 2010 (APC = -3.3, 95% CI = -3.6, -2.9, P < 0.05) than other regions, and UMCs showed a larger increase in the rate of DALY from 1990 to 1994 (APC = 4.5, 95% CI = 3.8, 5.1, P < 0.05) than other regions. CONCLUSIONS: Given the large variations in AUD burden of disease by income level, future strategies to prevent and reduce the burden should be developed and implemented based on country-specific development status.