The changing landscape of small cell lung cancer.

BACKGROUND: Small-cell lung cancer (SCLC) is characterized by rapid proliferation and early dissemination. The objective of this study was to examine the demographic trends and outcomes in SCLC. METHODS: The authors queried the National Cancer Institute's Surveillance, Epidemiology, and End Results database to assess the trends in incidence, demographics, staging, and survival for SCLC from 1975 to 2019. Trends were determined using joinpoint analysis according to the year of diagnosis. RESULTS: Among the 530,198 patients with lung cancer, there were 73,362 (13.8%) with SCLC. The incidence per 100,000 population peaked at 15.3 in 1986 followed by a decline to 6.5 in 2019. The percentage of SCLC among all lung tumors increased from 13.3% in 1975 to a peak of 17.5% in 1986, declining to 11.1% by 2019. There was an increased median age at diagnosis from 63 to 69 years and an increased percentage of women from 31.4% to 51.2%. The percentage of stage IV increased from 58.6% in 1988 to 70.8% in 2010, without further increase. The most common sites of metastasis at diagnosis were mediastinal lymph nodes (75.3%) liver (31.6%), bone (23.7%), and brain (16.4%). The 1-year and 5-year overall survival rate increased from 23% and 3.6%, respectively, in 1975-1979 to 30.8% and 6.8%, respectively, in 2010-2019. CONCLUSIONS: The incidence of SCLC peaked in 1988 followed by a gradual decline. Other notable changes include increased median age at diagnosis, the percentage of women, and the percentage of stage IV at diagnosis. The improvement in 5-year overall survival has been statistically significant but clinically modest.

Identification of regional and sex differences in asthma mortality trends in Spanish Autonomous Communities (1980-2022).

OBJECTIVE: Despite global declines in asthma mortality, regional variations and sex disparities persist. This study investigates asthma mortality trends in Spanish Autonomous Communities (ACs) from 1980 to 2022, analyzing data by sex. METHODS: Data on asthma deaths and population were obtained from the National Institute of Statistics for the study period. Age-standardized mortality rates (ASMRs) were calculated, and joinpoint regression models were applied to identify trends. RESULTS: Overall, 44,728 asthma deaths occurred, with a steeper decline observed in men (-3.5% per year) compared to women (-0.7% per year). The female-to-male mortality ratio climbed from 0.7 in 1980 to 5.4 in 2016. Both sexes exhibited a significant decrease in ASMRs, with a more substantial decline in males (-6.3%).While all ACs showed a significant decrease in male ASMRs, female trends varied, with significant decreases in 13 ACs and stable trends elsewhere. Joinpoint analysis revealed diverse regional patterns for both sexes, with some ACs experiencing steady declines and others exhibiting periods of slower decline or even stabilization. CONCLUSION: This study identified concerning regional and sex disparities in Spanish ACs' asthma mortality (1980-2022). While male rates declined significantly across all regions, female rates showed variation, with even increases in some ACs. Targeted interventions addressing these disparities and their underlying causes (healthcare access, management practices, etc.) are crucial.

Dynamic trends of ischemic heart disease mortality attributable to high low-density lipoprotein cholesterol: a joinpoint analysis and age-period-cohort analysis with predictions.

AIMS: The purpose of this study was to analyze the dynamic trends of ischemic heart disease (IHD) mortality attributable to high low-density lipoprotein cholesterol (LDL-C). METHODS: Data on IHD mortality attributable to high LDL-C from 1990 to 2021 were extracted from the global disease burden database. Joinpoint software was used to estimate the average annual percentage change (AAPC) in the age-standardized mortality rate (ASMR). An age‒period‒cohort model was used to analyze the impacts of age, period, and cohort on these changes. The Bayesian framework was used to predict IHD mortality attributable to high LDL-C from 2022 to 2040. RESULTS: The overall ASMR of IHD attributable to high LDL-C decreased from 50. 479 per 100,000 people in 1990 to 32.286 per 100,000 people in 2021, and ASMR of IHD attributable to high LDL-C was higher in males than in females. The longitudinal age curves of the overall IHD mortality attributable to high LDL-C showed a monotonic upward trend, especially after 65 years of age. The period and cohort effect relative risk (RR) values of overall IHD mortality attributable to high LDL-C showed a downward trend. The overall ASMR of IHD attributable to high LDL-C is predicted to show a downward trend, and male IHD mortality attributable to high LDL-C is expected to be higher than that of females. CONCLUSION: This study revealed a sustained decrease in IHD mortality attributable to high LDL-C over three decades, with a continued decline expected. Despite this, gender disparities persist, with males experiencing higher mortality rates and elderly individuals remaining a vulnerable group.

Exploring the trend of age-standardized mortality rates from cardiovascular disease in Malaysia: a joinpoint analysis (2010-2021).

INTRODUCTION: Cardiovascular disease (CVD) is a major health concern worldwide, particularly in low- and middle-income countries. The COVID-19 pandemic that emerged in late 2019 may have had an impact on the trend of CVD mortality. This study aimed to investigate the trend and changes in CVD mortality rates in Malaysia, using age-standardized mortality rates (ASMR) from 2010 to 2021. METHODS: The Malaysian population and mortality data from 2010 to 2021 were obtained from the Department of Statistics Malaysia (DOSM). ASMRs from CVD per 100,000 population were calculated based on the World Health Organization (2000-2025) standard population using the direct method. The ASMRs were computed based on sex, age groups (including premature mortality age, 30-69 years), and CVD types. The annual percent change (APC) and average annual percent change (AAPC) of the ASMR with corresponding 95% confidence intervals (95% CI) were estimated from joinpoint regression model using the Joinpoint Regression Program, Version 4.9.1.0. RESULTS: Throughout the study period (2010-2021), ASMRs for CVD exhibited an increase from 93.1 to 147.0 per 100,000, with an AAPC of 3.6% (95% CI: 2.1 to 5.2). The substantial increase was observed between 2015 and 2018 (APC 12.6%, 95% CI: 5.4%, 20.3%), with significant changes in both sexes, and age groups 50-69, 70 years and over, and 30-69 (premature mortality age). Notably, the ASMR trend remained consistently high in the premature mortality age group across other age groups, with males experiencing higher rates than females. No significant changes were detected before or after the COVID-19 pandemic (between 2019 and 2021), except for females who died from IHD (10.3% increase) and those aged 0-4 (25.2% decrease). CONCLUSION: Overall, our analysis highlights the persistently high burden of CVD mortality in Malaysia, particularly among the premature mortality age group. These findings underscore the importance of continued efforts to address CVD risk factors and implement effective prevention and management strategies. Further research is needed to fully understand the impact of the COVID-19 pandemic on CVD mortality rates and to inform targeted interventions to reduce the burden of CVD in Malaysia.

Trends in chronic childhood undernutrition in Bangladesh for small domains.

Chronic childhood undernutrition, known as stunting, is an important population health problem with short- and long-term adverse outcomes. Bangladesh has made strides to reduce chronic childhood undernutrition, yet progress is falling short of the 2030 Sustainable Development Goals targets. This study estimates trends in age-specific chronic childhood undernutrition in Bangladesh's 64 districts during 1997-2018, using underlying direct estimates extracted from seven Demographic and Health Surveys in the development of small area time-series models. These models combine cross-sectional, temporal, and spatial data to predict in all districts in both survey and non-survey years. Nationally, there has been a steep decline in stunting from about three in five to one in three children. However, our results highlight significant inequalities in chronic undernutrition, with several districts experiencing less pronounced declines. These differences are more nuanced at the district-by-age level, with only districts in more socio-economically advantaged areas of Bangladesh consistently reporting declines in stunting across all age groups.

The burden of knee osteoarthritis worldwide, regionally, and nationally from 1990 to 2019, along with an analysis of cross-national inequalities.

OBJECTIVE: To describe the disease burden of knee osteoarthritis (KOA) globally, regionally, and in 204 countries by age, sex, and sociodemographic index (SDI) from 1990 to 2019, and to explore cross-national inequalities across SDI. METHODS: The Global Burden of Disease (GBD) 2019 database collected data on KOA worldwide from 1990 to 2019, including prevalence, incidence, years lived with disability (YLDs). The average annual percentage change (AAPC) was used to measure temporal trends. In addition, the inequality slope index and the health concentration index were calculated to quantify the unequal distribution of the burden of KOA across 204 countries worldwide. RESULTS: In 2019, the global age-standardized prevalence rate increased by 7.5% compared with 1990, and the age-standardized incidence rate increased by about 6.2%; The age-standardized YLDs rate increased by about 7.8%. In addition to the Republic of Korea and the United States of America, the disease burden of KOA has increased year by year in other countries around the world. The incidence of KOA was highest at ages 50-59, while the prevalence and rates of YLDs were highest at ages 75-84. The burden of KOA was higher in women than in men. Cross-country inequality suggests that the inequality in the burden of KOA between high SDI and low SDI countries becomes greater, and that countries with high SDI bear a disproportionately high burden. CONCLUSION: The global KOA burden has risen steadily between 1990 and 2019, and cross-national inequality gaps remain large. Targeted measures must therefore be taken to address this inequality and the increasing global KOA disease burden.

Pancreatic Cancer and its Attributable Risk Factors in East Asia, Now and Future.

BACKGROUND: The disease burden of pancreatic cancer in East Asia is at a high level, but the epidemiological characteristics of pancreatic cancer in the region have not been systematically studied. METHOD: Joinpoint analysis was used to identify average annual percentage change (AAPC) and annual percentage change (APC) in mortality. Age-period-cohort models were used to analyze age-period cohort effects across countries. Bayesian age-period-cohort (BAPC) analysis was used to project the burden of disease for 2020-2030. RESULTS: Pancreatic cancer mortality in males in Japan (2012-2019, APC = -0.97) and Korea (2012-2019, APC = -0.91) has shown a decreasing trend since 2012 (P < .05). However, China (2016-2019, APC = 3.21), Mongolia (2015-2.019, APC = 2.37), and North Korea (2012-2019, APC = 0.47) showed a significant increase in pancreatic cancer in both genders (P < .05). Risk factors for pancreatic cancer in East Asia remained largely stable between 2010 and 2019. Mortality of pancreatic cancer due to smoking began to decline in areas with high socio-demographic index (SDI), and mortality of pancreatic cancer due to high body mass index and high fasting plasma glucose increased with SDI. The age-standardized mortality for pancreatic cancer in Chinese males is expected to exceed that of Japan and South Korea by 2030, but the disease burden of pancreatic cancer in Japan and South Korea remains at extremely high levels. CONCLUSION: Economically developed countries are beginning to show a decreasing trend in the burden of pancreatic cancer disease, and developing countries are experiencing a rapid increase in the age-standardized death rate (ASDR) of pancreatic cancer.

The Incidence Trend of Papillary Thyroid Carcinoma in the United States During 2003-2017.

BACKGROUND: The rapid increase in the detection rate of thyroid cancer over the past few decades has caused some unexpected economic burdens. However, that of papillary thyroid carcinoma (PTC) seems to have had the opposite trend, which is worthy of further comprehensive exploration. METHODS: The Surveillance, Epidemiology, and End Results 18 database was used to identify patients with PTC diagnosed during 2003-2017. The incidence trends were analyzed using joinpoint analysis and an age-period-cohort model. RESULTS: The overall PTC incidence rate increased from 9.9 to 16.1 per 100 000 between 2003 and 2017. The joinpoint analysis indicated that the incidence growth rate began to slow down in 2009 (annual percentage change [APC] = 3.1%, 95% confidence interval [CI] = 1.9%-4.4%). After reaching its peak in 2015, it began to decrease by 2.8% (95% CI = -4.6% to -1.0%) per year. The stratified analysis indicated that the incidence patterns of different sexes, age groups, races, and tumor stages and sizes had similar downward trends, including for the localized (APC = -4.5%, 95% CI = -7% to -1.9%) and distant (APC = -1.3%, 95% CI = -2.7% to -.1%) stages, and larger tumors (APC = -4%, 95% CI = -12% to 4.7%). The age-period-cohort model indicated a significant period effect on PTC, which gradually weakened after 2008-2012. The cohort effect indicates that the risk of late birth cohorts is gradually stabilizing and lower than that of early birth cohorts. CONCLUSION: The analysis results of the recent downward trend and period effect for the incidence of each subgroup further support the important role of correcting overdiagnosis in reducing the prevalence of PTC. Future research needs to analyze more-recent data to verify these downward trends.

International trends in ovarian cancer incidence from 1973 to 2012.

PURPOSE: Ovarian cancer is the 7th leading cancer diagnosis and the 8th leading cause of cancer death in women worldwide. We conducted this study to investigate the incidence of ovarian cancer internationally. METHODS: The trends in ovarian cancer incidence were analyzed through the latest data of CI5 over the 40-year period from 21 populations in 4 continents using Joinpoint analysis, ASRs and proportions of different histological subtypes in those populations were also analyzed using volume XI of CI5. RESULTS: ASRs of ovarian cancer were from 7.0 to 11.6 per 100,000 in non-Asia populations during 2008-2012. In Asia, the ASR in Israel (Jews) were the highest, up to 8.1 per 100,000 in the same period. The international trends from 1973 to 2012 showed that ASRs of ovarian cancer were decreasing in 8 of 21 selected populations, whereas ASRs in Slovakia, Spain (Navarra) and China (Shanghai) were increasing. Meanwhile, there are certain differences in the main pathological classification patterns within different regions. In Asia, China (Hong Kong) and Japan both have a higher ASRs and proportions for clear cell and endometrioid carcinomas, while Japan has the highest ASRs and proportions for mucinous carcinomas. CONCLUSION: Although the reasons for those trends were not entirely clear, environmental, reproductive and genetic factors were likely to have led to these patterns. Meanwhile, more attention and further study should be given to the etiological factors of histology-specific ovarian cancer.

Disease-Specific Mortality and Prevalence Trends in Korea, 2002-2015.

BACKGROUND: Evaluation of mortality and prevalence trends is important for health planning and priority decision-making in health policy. This study was performed to examine disease-specific mortality and prevalence trends for diseases in Korea from 2002 to 2015. METHODS: In this study, 206 mutually exclusive diseases and injuries were classified into 21 cause clusters, which were divided into three cause groups: 1) communicable, maternal, neonatal, and nutritional conditions; 2) non-communicable diseases (NCDs); and 3) injuries. Cause specific trends for age-standardized mortality and prevalence rates were analyzed by the joinpoint regression method. RESULTS: Between 2002 and 2015, the age-standardized mortality declined to about 177 per 100,000 population, while the age-standardized prevalence rate increased to approximately 68,065 per 100,000 population. Among the 21 cause clusters, most of the disease mortality rates showed decreasing trends. However, neurological disorders, self-harm, and interpersonal violence included periods during which the mortality rates increased in 2002-2015. In addition, the trends for prevalence rates of human immunodeficiency virus infection and acquired immune deficiency syndrome, tuberculosis, transport injuries, and self-harm, and interpersonal violence differed from the overall prevalence rates. The annual percent change in prevalence rates for transport injuries increased during 2004-2007, and then decreased. The self-harm and interpersonal violence prevalence rates decreased from 2004 to 2014. CONCLUSION: Between 2002 and 2015, overall decreasing trends in the mortality rate and increasing trends in the prevalence rate were observed for all causes in Korea. Especially, NCDs represented an important part of the increasing trends in Korea. For clusters of diseases with unusual trends, proper management must be considered.

Trajectories of College Alcohol Involvement and Their Associations with Later Alcohol Use Disorder Symptoms.

Little is known about what differentiates individuals whose drinking patterns escalate into problematic use following the transition out of college compared to those who learn to drink in a way that is consistent with independent adult roles. Patterns of alcohol use and problems during college may pre-sage progression toward problem drinking in adulthood. The present study sought to examine such patterns in an effort to delineate those at greatest risk. Research has not yet elucidated whether, when, and how these groups diverge. Our results indicate that students who report AUD symptoms one year following graduation reported greater alcohol involvement from the first semester and escalated their involvement with alcohol at a more rapid pace. We observed marked and measurable differences in drinking patterns between those who go on to exhibit AUD symptoms following college and those who do not. A close inspection of these differences reveals that relatively small absolute differences in alcohol consumption add up to large differences in alcohol-related consequences. Thus, markers of longer-term risk are present early in college, and greater escalation of drinking across college is an indicator that intervention is needed. Brief Motivational Interventions could help students to anticipate some of the challenges ahead as they transition from the college environment, as well as the potential deleterious effects of immoderate alcohol use on making a successful transition into adult roles. In addition to the beginning of college, our findings also point to critical periods during which screening and brief intervention may be optimally timed.

Trends of mortality from Alzheimer's disease in the European Union, 1994-2013.

BACKGROUND AND PURPOSE: In many countries, Alzheimer's disease (AD) has gradually become a common disease in elderly populations. The aim of this study was to analyse trends of mortality caused by AD in the 28 member countries in the European Union (EU) over the last two decades. METHODS: We extracted data for AD deaths for the period 1994-2013 in the EU from the Eurostat and World Health Organization database. Age-standardized mortality rates per 100 000 were computed. Joinpoint regression was used to analyse the trends and compute the annual percent change in the EU as a whole and by country. Analyses by gender and by European regions were conducted. RESULTS: Mortality from AD has risen in the EU throughout the study period. Most of the countries showed upward trends, with the sharpest increases in Slovakia, Lithuania and Romania. We recorded statistically significant increases of 4.7% and 6.0% in mortality rates in men and women, respectively, in the whole EU. Several countries showed changing trends during the study period. According to the regional analysis, northern and eastern countries showed the steepest increases, whereas in the latter years mortality has declined in western countries. CONCLUSIONS: Our findings provide evidence that AD mortality has increased in the EU, especially in eastern and northern European countries and in the female population. Our results could be a reference for the development of primary prevention policies.

Gender disparities in mortality from infectious diseases in Serbia, 1991-2014: a time of civil wars and global crisis.

Infectious diseases remain one of the leading causes of death worldwide. The aim of this descriptive epidemiological study was to analyse the trends in mortality from infectious diseases in Serbia (excluding the Autonomous Province of Kosovo & Metohia) from 1991 to 2014 using joinpoint regression analysis. The mortality rates from infectious diseases were found to have increased markedly from 1991 to 1994 (+12·4% per year), followed by a significant decline from 1994 to 2009 (-4·6% per year) and then another increase from 2009 to 2014 (+4·3% per year). Throughout the study period, mortality rates were consistently higher in men than in women. Although a substantial decline was observed for young people of both sexes, no consistent pattern was evident for the middle-aged nor the elderly. Since 1991, septicaemia has emerged as a leading cause of infectious disease mortality, particularly in older men. The Yugoslav civil wars in the 1990s and the global financial crisis in 2008 corresponded with changes in the trends in mortality from infectious diseases in Serbia, with the elderly showing particular vulnerability during those time periods. Data presented in this study might be useful to improve control of infectious diseases in Serbia.

Long-term trends of suicide by choice of method in Norway: a joinpoint regression analysis of data from 1969 to 2012.

BACKGROUND: Suicide mortality and the rates by specific methods in a population may change over time in response to concurrent changes in relevant factors in society. This study aimed to identify significant changing points in method-specific suicide mortality from 1969 to 2012 in Norway. METHOD: Data on suicide mortality by specific methods and by sex and age were retrieved from the Norwegian Cause-of-Death Register. Long-term trends in age-standardized rates of suicide mortality were analyzed by using joinpoint regression analysis. RESULTS: The most frequently used suicide method in the total population was hanging, followed by poisoning and firearms. Men chose suicide by firearms more often than women, whereas poisoning and drowning were more frequently used by women. The joinpoint analysis revealed that the overall trend of suicide mortality significantly changed twice along the period of 1969 to 2012 for both sexes. The male age-standardized suicide rate increased by 3.1% per year until 1989, and decreased by 1.2% per year between 1994 and 2012. Among females the long-term suicide rate increased by 4.0% per year until 1988, decreased by 5.5% through 1995, and then stabilized. Both sexes experienced an upward trend for suicide by hanging during the 44-year observation period, with a particularly significant increase in 15-24 year old males. The most distinct change among men was seen for firearms after 1988 with a significant decrease through 2012 of around 5% per year. For women, significant reductions since 1985-88 were observed for suicide by drowning and poisoning. CONCLUSIONS: The present study demonstrates different time trends for different suicide methods with significant reductions in suicide by firearms, drowning and poisoning after the peak in the suicide rate in the late 1980s. Suicide by means of hanging continuously increased, but did not fully compensate for the reduced use of other methods. This lends some support for the effectiveness of method-specific suicide preventive measures, such as restrictions to the access to firearms, which had been implemented in Norway during the relevant time period.

Trends in standardized mortality rates for select groups of cardiovascular diseases in Slovakia between 1980 and 2010.

OBJECTIVES: Reducing mortality due to cardiovascular diseases especially in people less than 65 years is one of the main targets of WHO preventive programs. This work aimed to analyse recent trends in cardiovascular mortality rates in Slovakia. STUDY DESIGN: A descriptive study was implemented with a Joinpoint analysis. METHODS: Analysis was of annual all circulatory, acute myocardial infarction mortality, and cerebrovascular disease mortality rates, between 1980 and 2010 for Slovakia. Data were stratified by sex and 10-year age group (age 25-85 years). The annual percentage change (APC) and significant changes in the trend were identified using joinpoint Poisson regression. RESULTS: The standardized mortality rate for all cardiovascular diseases declined in Slovakia between 1980 and 2010 by 25.7% and 30.5% for men and women, respectively. Joinpoint analysis of all cardiovascular disease mortality rates demonstrated statistically significant changes in trends of APC decline for both genders. For men, acceleration in the rate of decline between 2001 and 2010 was observed APC -2.2 (95% CI = -3.5, -1.2) following a slowing of the rate of decline between 1980 and 2001, when the APC reached -0.5 (95% CI = -0.8, -0.3). For women the trend was similar. Between 2003 and 2010 acceleration in the decline was demonstrated APC -2.8 (95% CI = -4.3, -1.4). CONCLUSION: The results of our analysis demonstrate the need to constantly address issues of cardiovascular diseases, as mortality rates in Slovakia are among the highest within the European Union countries in the long term.

Trends and regional inequalities in mortality from stroke in the context of health care reform in Lithuania.

BACKGROUND AND OBJECTIVE: The objective of the study was to analyze mortality from stroke in Lithuania the context of health care reform with particular interest in urban/rural and regional inequalities. Based on the analysis of trends in mortality, and to detection of break-points over two decades of socioeconomic transition, it focused on the challenges in stroke care provision. MATERIALS AND METHODS: The analysis covered the entire country. Information on deaths from 1991 to 2012 was gathered from death certificates held by the Lithuanian Department of Statistics. The joinpoint analysis was used to identify the best-fitting points, wherever a statistically significant change in mortality occurred. Age-standardized mortality rates were calculated for 60 municipalities of Lithuania. RESULTS: The positive break-points in mortality from stroke were registered in 2007 for females and 2008 for males, when the increasing trends reversed to the declining. More positive changes occurred in urban areas, where stroke mortality is lower compare to rural since 1996. Considerable inequalities were disclosed among administrative regions of Lithuania: ratio between the highest and the lowest rates in different municipalities reached 4.88 for males and 3.35 for females. CONCLUSIONS: There are good reasons to expect the favorable stroke mortality trends observed will follow the same direction in the future. Stroke centers are growing up in their competence while networking is also under the development. The new strategies in stroke care should result not only in the declining mortality rates and numbers of severely handicapped stroke patients, but also in diminishing regional and urban/rural inequalities.

Thyroid cancer mortality and incidence: a global overview.

In most areas of the world, thyroid cancer incidence has been appreciably increasing over the last few decades, whereas mortality has steadily declined. We updated global trends in thyroid cancer mortality and incidence using official mortality data from the World Health Organization (1970-2012) and incidence data from the Cancer Incidence in Five Continents (1960-2007). Male mortality declined in all the major countries considered, with annual percent changes around -2/-3% over the last decades. Only in the United States mortality declined up to the mid 1980s and increased thereafter. Similarly, in women mortality declined in most countries considered, with APCs around -2/-5% over the last decades, with the exception of the UK, the United States and Australia, where mortality has been declining up to the late 1980s/late 1990s to level off (or increase) thereafter. In 2008-2012, most countries had mortality rates (age-standardized, world population) between 0.20 and 0.40/100,000 men and 0.20 and 0.60/100,000 women, the highest rates being in Latvia, Hungary, the Republic of Moldova and Israel (over 0.40/100,000) for men and in Ecuador, Colombia and Israel (over 0.60/100,000) for women. In most countries, a steady increase in the incidence of thyroid cancer (mainly papillary carcinomas) was observed in both sexes. The declines in thyroid cancer mortality reflect both variations in risk factor exposure and changes in the diagnosis and treatment of the disease, while the increases in the incidence are likely due to the increase in the detection of this neoplasm over the last few decades.

Incidence of marginal zone lymphoma in the United States, 2001-2009 with a focus on primary anatomic site.

The aetiology of marginal zone lymphoma (MZL) is purported to differ by anatomic site. While this is supported by clinical series of single MZL sites, no population-based study has comprehensively assessed incidence patterns across sites. To gain insight into disease aetiology, we assessed MZL incidence by site using data from 18 U.S. Surveillance, Epidemiology and End Results (SEER) Program population-based registries. We calculated age-adjusted incidence rates (IRs) by sex, race, and calendar year. During 2001-2009, 4,081 (IR = 5·7/1,000,000 person-years) and 8,821 (IR = 12·3) individuals were diagnosed with nodal MZL and extranodal MZL, respectively. The most common extranodal sites were stomach (IR = 3·8), spleen (IR = 1·6), eye/adnexa (IR = 1·4), and lung, skin, and salivary glands (IRs = 0·9-1·0). We observed distinct age-specific patterns by MZL site, with IRs increasing steeply at younger ages and less prominently after mid-life at several sites, except skin. Gender and racial/ethnic disparities were also apparent across sites. Between 2001-2005 and 2006-2009, MZL IRs decreased significantly for gastric (-15%) and soft tissue (-28%) sites, whereas IRs increased significantly for lung (18%), skin (43%), and kidney/renal pelvis (116%). In combination, our findings support the contention that MZL is characterized by aetiological heterogeneity across sites and susceptibility is probably influenced by intrinsic characteristics and environmental exposures.

Myelodysplastic syndromes mortality in Spain: a comprehensive age-period-cohort and joinpoint analysis.

OBJECTIVE: The present study aims to assess the mortality trends in myelodysplastic syndromes (MDS) in Spain from 1980 to 2021. METHODS: Deaths and mid-year population data were collected from the National Institute of Statistics. We estimated age-standardised mortality rates (ASMRs) per 100,000 person-years for all ages and ages 35-64. Joinpoint regression identified significant changes in mortality trends. The independent effects of age, period and birth cohort on MDS mortality were also examined. RESULTS: MDS-related deaths gradually increased from 36 in 1980 to 1118 in 2021, with an overall increase of 6.6% in age-standardised mortality rates (ASMRs) for both men and women. Joinpoint analysis identified four periods for both men and women: 1980-1987 (stable rates), 1987-1990 (sharp increase), 1990-1999 (slower increase) and 1999-2021 (stable rates). ASMRs (35-64 years) increased by 2.5% over the study period, with a turning point identified in 1996 when rates decreased. Mortality from MDS increases with age and is higher in men. The cohort's relative risk increased until the mid-1950s and then stabilised, whilst the period relative risk increased between 1982 and 1996 and then stabilised. CONCLUSION: The results of this study indicate a progressive increase in MDS-related deaths in Spain between 1980 and 2021. Notably, this increase was more pronounced in men than in women. Analysis of birth cohort trends revealed shifts in MDS risk, characterised by an increase until the mid-twentieth century, followed by a stabilisation. Using joinpoint analysis, four distinct periods were identified, shedding light on the changing patterns of mortality over time. These findings help to shape future research directions and inform public health strategies. They also provide optimism for advances in MDS treatment and potential reductions in mortality.

Global, regional, and national burden of pancreatitis in older adults, 1990-2019: A systematic analysis for the global burden of disease study 2019.

Background: To describe the past, present and future burden of pancreatitis in older adults, and to explore cross-national inequalities across socio-demographic index (SDI). Methods: Data on pancreatitis in older adults, including mortality and disability-adjusted life years (DALYs) rates, were collected from the Global Burden of Disease (GBD) 2019 study. Temporal trends were measured using joinpoint analyses and predicted using a Bayesian age-period-cohort model. Additionally, the unequal distribution of the burden of pancreatitis in older adults was quantified. Results: From 1990 to 2019, the number of deaths and DALYs due to pancreatitis in older adults has been increasing annually. However, in most regions of the world, age-standardized death rates (ASDR) and age-standardized DALYs rates have been declining. The burden of pancreatitis in older adults was highest in low SDI region, primarily affecting the population aged 65-74, with a greater burden on males than females. Furthermore, from 1990 to 2019, absolute and relative cross-national inequalities in pancreatitis among older adults have remained largely unchanged. It is projected that in the next 11 years, the number of deaths in older adults due to pancreatitis will continue to increase, but the ASDR is expected to decline. Conclusion: Over the past 30 years, the ASDR and age-standardized DALYs rate of pancreatitis in older adults have shown a decline globally, but the absolute burden continues to increase. Cross-national health inequalities persist. Therefore, it is necessary to develop targeted intervention measures and enhance awareness among this vulnerable population regarding the risk factors associated with pancreatitis.