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Background: Tunafasi is a community-based rehabilitation (CBR) programme for persons with disability, implemented by a local non-governmental organisation in Uvira, Democratic Republic of Congo, in partnership with government. To assess affordability and support discussions with the government about continued financing and implementation, Tunafasi representatives commissioned a cost-effectiveness study of the programme’s health component. Objectives: This study aimed to estimate the programme’s impacts, costs, cost per disability-adjusted life year (DALY) averted and affordability of the health component implemented from February 2019 to December 2021. Method: Health-related improvements were assessed for a sample of 511 persons with disability and converted to DALYs averted. Total expenditure during the period February 2019 to December 2021 was estimated from audited financial statements. The cost per DALY averted was estimated by dividing total programme expenditure by the sum of DALYs averted and compared against newly generated, country-specific thresholds to assess affordability. Results: The programme cost $55 729.00 to implement from February 2019 to December 2021 and averted 234 DALYs in 511 persons, at a cost per DALY averted of $224.00. This falls above the affordability threshold of $54.00 – $199.00. Conclusion: While the cost per DALY averted is higher than what thresholds consider affordable for Democratic Republic of Congo, improved engagement from CBR facilitators and greater possibilities for treatment in the post-pandemic era should improve results. Contribution: This new CBR implementation modality offers a possibly affordable solution to African governments struggling to operationalise disability commitments such as United Nations Convention on the Rights of Persons with Disabilities.

Abstract Background and Aims Multiple sclerosis (MS) is a crippling, chronic, gender‐related disease that causes burdens to individuals and society. China has a considerable and increasing population of MS. We aim to analyze the gender disparities in the burden of MS in China and predict the trends. Methods The study was conducted based on the Global Burden of Disease Study 2019. Data on incidence, prevalence, deaths, and disability‐adjusted life years (DALYs) of MS in China from 1990 to 2019 was descriptively analyzed by year, gender, and age group. The Nordpred package in R (version 4.2.2) was used for age‐period‐cohort analysis to predict the all‐ages numbers and age‐standardized rates of incidence, prevalence, deaths, and DALYs in China from 2020 to 2044. Results The number of prevalent cases of MS in 2019 reached 18,143.56 (95% uncertainty intervals [UI]: 13,997.71–22,658.60) in males and 24,427.11 (95% UI: 18,906.02–30,530.21) in females in China. The peak age of prevalence was shifted from 40–44 years in 1990 to 45–49 years in 2019 in females but remained unchanged in males. In contrast to the increased age‐standardized prevalence rate, the age‐standardized death rate (ASDR) and age‐standardized DALYs rate showed downward trends, which were more significant in females. Different from the global, Chinese males showed lower prevalence but higher deaths and DALYs than females for age‐standardized rates and numbers. In the next 25 years, the patient population will remain large and peak around 44,599.78 in 2025–2029. The ASDR, age‐standardized DALYs rate, and DALYs number were expected to decrease. The improvements in deaths and DALYs will be more significant in females. Conclusion Males with MS had a lower prevalence but higher deaths and DALYs than females in China. The ASDR and age‐standardized DALYs rate have reduced over the past 30 years and were expected to continue decreasing, especially in females. The burden of MS will remain notable in the next 25 years.

Abstract is missing (Short communication)

BackgroundDiarrheal diseases are major contributors to deaths. Data on global and country-specific levels and trends of diarrheal diseases resulting from unsafe water are essential for policymakers to allocate resources.AimsThis study aimed to describe the global, regional, and national spatiotemporal burden of diarrheal diseases resulting from unsafe water exposure.MethodsAccording to the Global Burden of Disease (GBD) 2019 dataset, deaths, disability-adjusted life years (DALYs) of diarrheal diseases, and their age-standardized rates (ASRs) were analyzed by age and sex in 204 countries and territories. Moreover, the average annual percentage change (AAPC) was estimated by a log-linear regression model to reflect the time trend. The association between ASR of diarrheal diseases due to unsafe water and socio-demographic index (SDI) levels was also analyzed.ResultsFrom 1990 to 2019, the number of deaths and DALYs of diarrheal diseases resulting from unsafe water decreased by 50 and 59%, respectively. Moreover, the ASR of deaths and DALYs also decreased during the study period, with AAPCs of −3.69 (95% CI [95% confidence interval]: −3.91 to −3.47) and − 3.66 (95% CI: −3.8 to −3.52), respectively. High diarrheal diseases resulting from unsafe water occurred mainly in low SDI regions and Africa. Males exhibited greater diarrheal deaths attributable to unsafe water than females, which was contrary to the condition in terms of DALYs. The age-specific burden of diarrheal deaths attributable to unsafe water is concentrated in children younger than 5 years. The AAPCs of the ASR of both deaths and DALYs showed a strong negative correlation with the SDI levels.ConclusionThe current study indicated that the global burden of unsafe water exposure-related diarrheal diseases decreased from 1990 to 2019 and varied significantly according to age, sex, and geographical location. Effective health promotion and health communication strategies and policies should be adopted to prevent and control diarrheal diseases resulting from unsafe water exposure.

Epilepsy is a profound disorder, accounting for roughly 1% of the global disease burden. It can result in premature death and significant disability. To comprehensively understand the current dynamics and trends of idiopathic epilepsy, a deep insight into its epidemiological attributes is vital. We evaluated the incidence, prevalence, mortality, and disability-adjusted life years associated with idiopathic epilepsy from 1990 to 2019 using data and methodologies from the Global Burden of Disease Study.In 2019, there were approximately 2,898,222 individuals diagnosed with idiopathic epilepsy. Intriguingly, from 1990 to 2019, the age-standardized incidence rate of idiopathic epilepsy was consistently lower in women compared to men. Over these three decades, global mortality connected to idiopathic epilepsy increased by 13.95%. However, within the same period, age-standardized death rates for idiopathic epilepsy decreased from 1.94 per 100,000 population to 1.46 per 100,000 population. Predictions indicate an increase in the incidence of idiopathic epilepsy across all age brackets through 2035, especially among the elderly aged 80 and above. Mortality rates are projected to climb for those aged 80 and above while remaining relatively unchanged in other age demographics. Idiopathic epilepsy continues to be a significant contributor to both disability and death. The findings of our study underscore the critical importance of incorporating idiopathic epilepsy management into modern healthcare frameworks. Such strategic inclusion can enhance public awareness of relevant risk factors and the range of available therapeutic interventions.

The majority of emerging infectious diseases are zoonoses, most of which are classified as “neglected”. By affecting both humans and animals, zoonoses pose a dual burden. The disability-adjusted life year (DALY) metric quantifies human health burden since it combines mortality and morbidity. This review aims to describe and analyze the current state of evidence on neglected zoonotic diseases (NZDs) burden and start a discussion on the current understanding of the global burden of NZDs.We identified 26 priority NZDs through consulting three international repositories for national prioritization exercises. A systematic review of global and national burden of disease (BoD) studies was conducted using pre-selected databases. Data on diseases, location and DALYs were extracted for each eligible study.A total of 1887 records were screened, resulting in 74 eligible studies. The highest number of BoD was found for non-typhoidal salmonellosis (23), whereas no estimates were found for West Nile, Marburg and Lassa fever. Geographically, the highest number of studies was performed in the Netherlands (11), China (5) and Iran (4). The number of BoD retrieved mismatched the perceived importance in national prioritization exercises. For example, anthrax was considered a priority NZD in 65 countries; however, only one national study estimating BoD was retrieved. By summing the available global estimates, the selected NZDs caused at least 21 million DALYs per year, a similar order of magnitude to (but less than) the burden due to foodborne disease (included in the Foodborne Disease Burden Epidemiology Reference Group).The global burden of disease landscape of NZDs remains scattered. There are several priority NZDs for which no burden estimates exist, and the number of BoD studies does not reflect national disease priorities. To have complete and consistent estimates of the global burden of NZDs, these diseases should be integrated in larger global burden of disease initiatives.

Abstract Background and Aims The approach to the burden of disease is a demographic, economic, and a health problem, which requires the design and application of specific measures of cost of the disease, such as disability‐adjusted life years (DALYs), to establish better public health policies in the pediatric population. The aim of this study is to approach the burden of disease in children with acute respiratory failure (ARF) through the calculation of DALYs. Methods This study was conducted in the framework of a prospective, multicenter cohort in Bogotá, Colombia. Inclusion criteria were all pediatric patients admitted to the emergency department, hospitalization, and intensive care unit with respiratory distress; eligible patients were all those who developed ARF between April 2020 and December 2021. They were followed‐up during hospitalization, at 30 and 60 days after admission. The Infant/Toddler Quality of Life Questionnaire and KIDSCREEN quality of life scales were applied for follow‐up according to the age group. The results were used to calculate DALYs Results Six hundred and eighty‐five eligible patients, 296 (43.08%) developed ARF, of these 22 (6.08%) patients died (mortality rate = 7.43%). The total DALYs was 277.164 years. For younger than 9 years, the DALYs were 302.64 years, while for older than 10 years were 40.49 years. Conclusion ARF is one of the main causes of preventable mortality in pediatrics, its progression to respiratory failure is a highly prevalent condition in pediatric age, a condition that has a great impact on mortality, morbidity, and disability in our patients.

Objective: To analyze the changing trend of the global burden of thyroid cancer (TC) and its associated risk factors using data from the Global Burden of Disease study 2019 (GBD 2019). Methods: This study utilized the GBD 2019 database to analyze the burden trend of TC in various regions and countries from 1990 to 2019, while also examining the age-period-cohort (APC) effect. Additionally, the study used Bayesian age-period-cohort (BAPC) and predictive models to forecast TC incidence up until 2030. Results: According to data from 2019, there were 233,846.64 (95 % UI 211,636.89–252,806.55) cases of TC worldwide. The burden of TC varies among regions and countries, with higher incidence rates observed in moderate and above SDI regions. Age and gender also play a role, with incidence rates peaking in the >95 age group for men and the 70–74 age group for women. Additionally, women have a higher incidence than men. The APC model revealed that the impact of age was most significant among individuals aged 95 years and older, while it was lowest among those aged 0–14 years. Additionally, the period effect showed a relatively low risk of morbidity with a Period RR 0 during 2005–2019. Furthermore, the cohort effect demonstrated that the relative risk of developing the disease was lower before 1950 and higher after 1950. Predicted values show an increasing trend in thyroid incidence over the next 30 years. Conclusions: The findings of this study highlight the continued significance of thyroid cancer as a global public health issue. It is crucial to develop targeted interventions that address the specific risk factors associated with thyroid cancer. Furthermore, health policies should be customized and adapted to the unique needs of different regions and populations.

Objectives: This study aimed to describe the temporal trends in age and gender burdens of rheumatic heart disease (RHD) in China from 1990 to 2019, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), and to compare them with the global burden of the disease. Methods: Using open data from the Global Burden of Disease (GBD) database from 1990 to 2019, this study analyzed the characteristics of RHD burden in China and worldwide, including changes in incidence, prevalence, mortality, and DALYs. Joinpoint was used to calculate the average annual percentage change (AAPC) and the corresponding 95% confidence interval (95% CI) to reflect the trends in the burden of RHD. A comprehensive comparative analysis of the differences in RHD burden between China and the rest of the world was conducted from multiple dimensions, including age, gender, and time periods. Results: From 1990 to 2019, the age-standardized incidence rate (ASIR) of RHD in China decreased from 29.62/100,000 to 23.95/100,000, while the global ASIR increased from 32.69/100,000 to 37.40/100,000. The age-standardized prevalence rate (ASPR) in China decreased from 446.15/100,000 to 390.24/100,000, while the global ASPR increased from 451.56/100,000 to 513.68/100,000. The age-standardized rates of mortality (ASMR) in China decreased from 18.11/100,000 to 4.04/100,000, while the global ASMR decreased from 8.94/100,000 to 3.85/100,000. The age-standardized DALY rate (ASDR) in China decreased from 431.45/100,000 to 93.73/100,000, while the global ASDR decreased from 283.30/100,000 to 132.88/100,000. The AAPC of ASIR, ASPR, ASMR, and ASDR in China was − 0.73%, -0.47%, -5.10%, and − 5.21%, respectively, while the AAPC of the global burden of RHD was 0.48%, 0.45%, -2.87%, and − 2.58%, respectively. The effects of age and gender on the burden of RHD were different. ASIR generally decreased with increasing age, while ASPR increased first and then decreased. ASMR and ASDR increased with increasing age. Women had higher incidence and mortality rates of RHD than men. Conclusion: From 1990 to 2019, the incidence, prevalence, mortality, and DALYs of RHD in China decreased, indicating a relative reduction in the burden of RHD in China. The burden of RHD is age-related, with a higher prevalence observed in the younger population, a peak incidence among young adults, and a higher mortality rate among the elderly population. Women are more susceptible to RHD and have a higher risk of mortality than men. Given China's large population and aging population, RHD remains a significant public health challenge in China. [ABSTRACT FROM AUTHOR]

Background: Communicable diseases contribute substantially to morbidity and death rates worldwide, particularly in low-and middle-income countries. Pacific Island countries face unique challenges in addressing these diseases due to their remote locations and limited resources. Understanding the burden and trends of these diseases in this region is crucial for developing effective public health interventions. Objective: This study aimed to analyze the burden and trends of communicable diseases in Pacific Island countries from 1990 to 2019. Methods: We utilized data from the 2019 Global Burden of Disease (GBD) study to analyze indicators including incidence, death, and disability-adjusted life years (DALYs). Excel 2016, R 4.2.1, and GraphPad Prism 9 were used to analyze and visualize the data. Joinpoint regression models were used for trend analysis, and the average annual percent change (AAPC) was calculated. Results: From 1990 to 2019, the standardized incidence rate of communicable diseases in Pacific Island countries showed an upward trend (AAPC = 0.198%, 95% CI = 0.0174 ~ 0.221), while the standardized death rate (AAPC = -1.098%, 95% CI = –1.34 ~ 0.86) and standardized DALY rate (AAPC = -1.008%, 95% CI = -1.187 ~ -0.828) showed downward trends. In 2019, the standardized incidence, death, and DALY rates of communicable diseases were higher among males than among females, but the standardized death and DALY rates among males decreased faster than those among females from 1990 to 2019. There were significant differences in the disease burden among different Pacific Island countries. The Solomon Islands had the highest standardized death rate (363.73/100,000), and Guam had the lowest (50.42/100,000). Papua New Guinea had the highest standardized DALY rate (16,041.14/100,000), and the Cook Islands had the lowest (2,740.13/100,000). In 2019, the main attributable risk factors for communicable disease deaths in Pacific Island countries were child and maternal malnutrition (28.32%), followed by unsafe water, sanitation, and handwashing (27.14%), air pollution (16.11%), and unsafe sex (14.96%). There were considerable geographical variations in risk factors. Conclusion: The burden of communicable diseases in Pacific Island countries remains high, despite improvements in mortality and disability-adjusted life-year rates over the past few decades. This study provides valuable insights into the burden and trends of communicable diseases in Pacific Island countries from 1990 to 2019. The findings reveal several important insights and highlight the need for targeted public health interventions in the region. [ABSTRACT FROM AUTHOR]

Governments have increasingly adopted laws restricting the activities of international non-governmental organizations INGOs within their borders. Such laws are often intended to curb the ability of critical INGOs to discover and communicate government failures and abuses to domestic and international audiences. They can also have the unintended effect of reducing the presence and activities of INGOs working on health issues, and depriving local health workers and organizations of access to resources, knowledge and other forms of support. This study assesses whether legislative restrictions on INGOs are associated with fewer health INGOs in a wide range of countries and with the ability of those countries to mitigate disability-adjusted life years lost because of twenty-one disease categories between 1993 and 2017. The findings indicate that restrictive legislation hampered efforts by civil society to lighten the global burden of disease and had adverse side effects on the health of citizens worldwide. [ABSTRACT FROM AUTHOR]

Objective: Recent meta-analyses demonstrate that small-quantity lipid-based nutrient supplements (SQ-LNS) for young children significantly reduce child mortality, stunting, wasting, anaemia and adverse developmental outcomes. Cost considerations should inform policy decisions. We developed a modelling framework to estimate the cost and cost-effectiveness of SQ-LNS and applied the framework in the context of rural Uganda. Design: We adapted costs from a costing study of micronutrient powder (MNP) in Uganda, and based effectiveness estimates on recent meta-analyses and Uganda-specific estimates of baseline mortality and the prevalence of stunting, wasting, anaemia and developmental disability. Setting: Rural Uganda. Participants: Not applicable. Results: Providing SQ-LNS daily to all children in rural Uganda (> 1 million) for 12 months (from 6 to 18 months of age) via the existing Village Health Team system would cost ∼$52 per child (2020 US dollars) or ∼$58·7 million annually. SQ-LNS could avert an average of > 242 000 disability-adjusted life years (DALYs) annually as a result of preventing 3689 deaths, > 160 000 cases of moderate or severe anaemia and ∼6000 cases of developmental disability. The estimated cost per DALY averted is $242. Conclusions: In this context, SQ-LNS may be more cost-effective than other options such as MNP or the provision of complementary food, although the total cost for a programme including all age-eligible children would be high. Strategies to reduce costs, such as targeting to the most vulnerable populations and the elimination of taxes on SQ-LNS, may enhance financial feasibility. [ABSTRACT FROM AUTHOR]

Background: In recent years, headache disorders have garnered significant attention as a pressing global health issue. This concern is especially pronounced in low- to middle-income countries and exhibits a notable increase in prevalence among adolescents and young adults. Such a surge in these disorders has invariably diminished the quality of life for affected individuals. Despite its global impact, comprehensive studies exploring the ramifications of headache disorders in the younger population remain scant. Our study endeavored to quantify the global prevalence of headache disorders in individuals between the ages of 15 and 39, over a three-decade span from 1990 to 2019. Methods: Our study, conducted from 1990 to 2019, evaluated the impact of headache disorders, specifically migraines and tension-type headaches (TTH), in 204 different countries and territories. This comprehensive assessment included a detailed analysis of incidence rates, prevalence, and disability-adjusted life-years (DALYs) across various demographics such as age, gender, year, geographical location, and Socio-demographic Index (SDI). Results: In 2019, there were an estimated 581,761,847.2 migraine cases globally (95% UI: 488,309,998.1 to 696,291,713.7), marking a 16% increase from 1990. Concurrently, TTH cases numbered at 964,808,567.1 (95% UI: 809,582,531.8 to 1,155,235,337.2), reflecting a 37% rise since 1990. South Asia reported the highest migraine prevalence with 154,490,169.8 cases (95% UI: 130,296,054.6 to 182,464,065.6). High SDI regions exhibited the most substantial migraine prevalence rates both in 1990 (22,429 per 100,000 population) and 2019 (22,606 per 100,000 population). Among the five SDI classifications, the middle SDI region recorded the highest tally of TTH cases in both 1990 (210,136,691.6 cases) and 2019 (287,577,250 cases). Over the past 30 years, East Asia experienced the most pronounced surge in the number of migraine cases. On the whole, there was a discernible positive correlation between the disease burden of migraine and TTH and the SDI. Conclusion: Migraine and TTH represent formidable challenges in global health. The intensity of their impact exhibits marked disparities across nations and is distinctly elevated among women, individuals within the 30–39 age bracket, and populations characterized by a high SDI. The results of our research emphasize the imperative of assimilating migraine and TTH management into contemporary healthcare paradigms. Such strategic integration holds the potential to amplify public cognizance regarding pertinent risk factors and the spectrum of therapeutic interventions at hand. [ABSTRACT FROM AUTHOR]

Background: There were limited studies on the quantification of the modifiable and nonmodifiable lung cancer burden over time in China. Furthermore, the potential effect of risk factor reduction for lung cancer on gains in life expectancy (LE) remains unknown. Methods: This study explored temporal trends in lung cancer deaths and disability‐adjusted life years (DALY) attributable to modifiable risk factors from 1990 to 2019, based on the 2019 Global Burden of Disease Study. The abridged period life table method was used to quantify the effect of risk factors on LE. The authors used the decomposition approach to estimate contributions of aging metrics to change in the lung cancer burden. Results: Nationally, the majority of lung cancer deaths and DALYs were attributable to behavioral and environmental risk clusters. Potential gains in life expectancy (PGLE) at birth would be 0.78 years for males and 0.35 years for females if the exposure to risk factors was mitigated to the theoretical minimum level. Tobacco use had the most robust impact on LE for both sexes (PGLE: 0.71 years for males and 0.19 years for females). From 1990 to 2019, risk‐attributable age‐standardized death and DALY rates of lung cancer showed an increasing trend in both sexes; adult population growth imposed 245.9 thousand deaths and 6.2 million DALYs for lung cancer. Conclusions: The modifiable risk‐attributable lung cancer burden remains high in China. Effective tobacco control is the critical step toward addressing the lung cancer burden. Adult population growth was the foremost driver of transition in the age‐related lung cancer burden. Plain Language Summary: We estimate the lung cancer burden attributable to modifiable and nonmodifiable contributors and the effect of risk factor reduction for lung cancer on the life expectancy in China.The findings suggest that the majority of lung cancer deaths and disability‐adjusted life years were attributable to behavioral risk clusters, and the risk‐attributable lung cancer burden increased nationally from 1990 to 2019.The average gains in life expectancy would be 0.78 years for males and 0.35 years for females if the exposure to risk factors for lung cancer was reduced to the theoretical minimum risk exposure level.Adult population growth was identified as the foremost driver of variation in the aging lung cancer burden. This study emphasizes the crucial role of context‐specific interventions and policies targeted to reducing modifiable risk exposure and tackling population aging to effectively mitigate the lung cancer burden and ultimately improve the life expectancy. [ABSTRACT FROM AUTHOR]

Alcohol use is a major risk factor for the burden of mortality and morbidity. Alcoholic cirrhosis (AC) and alcoholic liver cancer (ALC) are most important and severe liver disease outcomes caused by alcohol use. The objectives of the current study were to investigate the global prevalence and burden of disease in disability-adjusted life years (DALYs) for AC and ALC, based on data from the Global Burden of Disease (GBD). Incidence, prevalence, death, and DALYs for GBDs in different locations, years, sex, and age groups were estimated using DisMod-MR 2.1 and a generic Cause of Death Ensemble Modeling approach. The correlations between the age-standardized incidence rate or age-standardized death rate and gender, sociodemographic index (SDI), and alcohol usage were conducted by Generalized Linear Models. Globally, the changes of age-standardized rates of indicators were not much significant over the 30-year period. However, the changes varied widely across regions. Central Asia and East Europe contributed the highest age-standardized incidence, prevalence, death, and DALYs and increased sharply by past 30 years. Generalized Linear Models (GLMs) showed male gender as a risk factor of AC, with the relative risk of incidence of 1.521 and relative risk of death of 1.503. Globally, there were improvements in overall health with regard to GBDs over the 30 years. However, the prevention of AC and ALC should be promoted in middle and middle-high SDI regions, especially Central Asia and East Europe, whereas more medical resources should be provided to improve treatment levels in low SDI region. [ABSTRACT FROM AUTHOR]

Importance: Both the morbidity and mortality of prostate cancer are increasing worldwide. Updated evaluations of prostate cancer burden and its global, regional and national patterns are essential for formulating effective preventive strategies. Objective: To investigate prostate cancer incidence, mortality, and disability-adjusted life years (DALYs) between 1990 and 2019 to facilitate preventive measures and control planning. Methods: Annual incident cases, deaths, DALYs, age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and age-standardized DALYs rates (ASDRs) of prostate cancer between 1990 and 2019 were derived from the Global Burden of Diseases study 2019. Percentage changes in incident cases, deaths and DALYs and estimated annual percentage changes (EAPCs) in ASIRs, ASMRs and ASDRs were calculated to quantify temporal trends. Correlations between EAPCs and socio-demographic index (SDI) and universal health coverage index (UHCI) were evaluated by Pearson correlation analyses. Results: Globally, the number of incident cases, deaths, and DALYs of prostate cancer increased by 116.11%, 108.94%, and 98.25% from 1990 to 2019, respectively. The ASIR increased by an average of 0.26% (95% CI: 0.14%, 0.37%) per year between 1990 and 2019, while the ASMR and ASDR decreased by an average of – 0.75% (95% CI: – 0.84%, – 0.67%) and – 0.71% (95% CI: – 0.78%, – 0.63%) per year in this period, respectively. Epidemic trends in the burdens of prostate cancer were not uniform throughout different groups of SDI or geography. The burdens of prostate cancer varied across SDI regions, with an increasing trend in ASIR, ASMR, and ASDR in low and low-middle SDI regions between 1990 and 2019. A significant positive correlation between the EAPC in ASIR and UHCI was observed in countries with a UHCI < 70 (ρ = 0.37, p < 0.001). Interpretation: Prostate cancer remains a major global health burden due to the increase in incident cases, deaths, and DALYs in the past three decades. These increases are likely to continue as the population ages, which indicates a potential talent gap in the trained healthcare workforce. The diversity of prostate cancer development models implies the importance of specific local strategies tailored for each country's risk factor profile. Prevention, early detection and more effective treatment strategies for prostate cancer are essential. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a highly prevalent disease with distinct sex pattern. We aimed to estimate the sex specific incidence, prevalence, and disability-adjusted life (DALYs) years of osteoporosis between 1990 and 2019, with additional predictions from 2020 to 2034. Methods: We collected osteoporosis disease burden data from the Global Burden of Disease study covering the years 1990 through 2019 in 204 countries and territories. The data included information on the number of incident cases of osteoporosis, DALYs, age-standardized incidence rates (ASIR), age-standardized prevalence rates (ASPR) and age-standardized DALYs rates. Additionally, we performed an age-period-cohort analysis to forecast the burden of osteoporosis. Results: The global number of incidence cases of osteoporosis, in 2019, reached 41.5 million cases. From 1990 to 2019, the low-middle socio-demographic index (SDI) region had the highest estimated annual percentage change in the world. Compared to males, female's ASIR and ASPR were all about 1.5 times higher than males for the same years in the same SDI regions. The projected global total number of incidence cases for osteoporosis between 2030 and 2034 is estimated to reach 263.2 million (154.4 million for females and 108.8 for males). Additionally, the burden in terms of DALYs is predicted to be 128.7 million (with 78.4 million for females and 50.3 million for males). Conclusion: The global burden of osteoporosis is still increasing, mainly observed in high SDI countries. Females bear a burden 1.5 times higher than males in terms of incidence and DALYs. Steps should be taken to reduce the osteoporosis burden, especially in high SDI countries. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is one of the leading causes of disability worldwide. Differences in social backgrounds and lifestyles in various regions and countries may contribute to the discrepancies in the disease burden of LBP. Methods: Based on the GBD 2019, we collected and analyzed numbers and age-standardized rates (ASR) of LBP disability-adjusted life years (DALYs). Temporal trends in ASR were also analyzed using estimated annual percentage change (EAPC). The Age-period-cohort (APC) model was used to estimate age, period and cohort trends in DALYs of LBP. An autoregressive integrated moving average (ARIMA) model was used to forecast DALYs of LBP trends from 2020 to 2035. Results: The DALYs due to LBP increased from 1990 to 2019. The APC model showed that the risk of DALYs for global LBP increased with age and year and that the risk of DALYs was lower in the later-born cohort than in the earlier-born cohort. The main risk factors which GBD estimates were available for DALYs of LBP include smoking, occupational ergonomic factors and high BMI. It is expected that DALYs of LBP will continue to rise until 2035. Conclusion: From 1990 to 2019, the global disease burden of LBP remained high. It is necessary to pay attention to the influence of social factors and lifestyle on LBP. Focusing on the impact of social factors as well as lifestyle on the prognosis of LBP and targeting interventions may further reduce the disease burden of LBP. [ABSTRACT FROM AUTHOR]

Background: Asthma and atopic dermatitis (AD) are chronic allergic conditions, along with allergic rhinitis and food allergy and cause high morbidity and mortality both in children and adults. This study aims to evaluate the global, regional, national, and temporal trends of the burden of asthma and AD from 1990 to 2019 and analyze their associations with geographic, demographic, social, and clinical factors. Methods: Using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2019, we assessed the age‐standardized prevalence, incidence, mortality, and disability‐adjusted life years (DALYs) of both asthma and AD from 1990 to 2019, stratified by geographic region, age, sex, and socio‐demographic index (SDI). DALYs were calculated as the sum of years lived with disability and years of life lost to premature mortality. Additionally, the disease burden of asthma attributable to high body mass index, occupational asthmagens, and smoking was described. Results: In 2019, there were a total of 262 million [95% uncertainty interval (UI): 224–309 million] cases of asthma and 171 million [95% UI: 165–178 million] total cases of AD globally; age‐standardized prevalence rates were 3416 [95% UI: 2899–4066] and 2277 [95% UI: 2192–2369] per 100,000 population for asthma and AD, respectively, a 24.1% [95% UI: −27.2 to −20.8] decrease for asthma and a 4.3% [95% UI: 3.8–4.8] decrease for AD compared to baseline in 1990. Both asthma and AD had similar trends according to age, with age‐specific prevalence rates peaking at age 5–9 years and rising again in adulthood. The prevalence and incidence of asthma and AD were both higher for individuals with higher SDI; however, mortality and DALYs rates of individuals with asthma had a reverse trend, with higher mortality and DALYs rates in those in the lower SDI quintiles. Of the three risk factors, high body mass index contributed to the highest DALYs and deaths due to asthma, accounting for a total of 3.65 million [95% UI: 2.14–5.60 million] asthma DALYs and 75,377 [95% UI: 40,615–122,841] asthma deaths. Conclusions: Asthma and AD continue to cause significant morbidity worldwide, having increased in total prevalence and incidence cases worldwide, but having decreased in age‐standardized prevalence rates from 1990 to 2019. Although both are more frequent at younger ages and more prevalent in high‐SDI countries, each condition has distinct temporal and regional characteristics. Understanding the temporospatial trends in the disease burden of asthma and AD could guide future policies and interventions to better manage these diseases worldwide and achieve equity in prevention, diagnosis, and treatment. [ABSTRACT FROM AUTHOR]

To analyze the global and Chinese disease burden of hearing loss and its changing trends from 1990 to 2019, and to provide data support for the formulation of hearing loss prevention and control measures. Methods The prevalence, disability-adjusted life years (DALYs), and other disease burden indicators of hearing loss in the whole world and China, as well as related information such as age and gender, were extracted from the Global Burden of Disease database in 2019 (GBD 2019). The basic situation of hearing loss disease burden, the distribution of various indicators in age and gender, and the time trend of changes were analyzed. Results From 1990 to 2019, the number of people with hearing loss worldwide increased from 752 million to 1.457 billion, with an increase of 93.75%; during the same period, the number of people with hearing loss in China increased from 199 million to 407 million, with an increase of 104.52%. The increase in hearing loss cases in China was higher than the global level. The number of DALYs for hearing loss worldwide increased from 22.01 million person -years to 40.24 million person-years, with an increase of 82.83%, while the number of DALYs for hearing loss in China increased from 5.58 million person-years to 10.48 million person-years, with an increase of 87.84%. From 1990 to 2019, the age-standardized prevalence rate (ASPR) of hearing loss in the world and China showed an upward trend, with China's rising faster than the world; the age-standardized DALY rate ASDR) showed a downward trend, with China's falling faster than the world; with age increasing, the number of cases and DALYs for hearing loss showed a trend of an initial increase followed by a decrease; in 1990 and 2019, the ASPR of hearing loss for males in the world or China was higher than that for females (P < 0.001). The proportion of mild hearing loss cases accounted for more than 70% of all hearing loss cases, but DALYs caused by moderate or above hearing loss accounted for more than 60%. Conclusions The disease burden caused by hearing loss in the world and China is still heavy and has a further increasing trend. Government departments are required to take appropriate measures to prevent hearing loss in order to control the growth of the disease burden. [ABSTRACT FROM AUTHOR]

Abstract Introduction Low back pain (LBP), neck pain (NKP), osteoarthritis (OST) and rheumatoid arthritis (RHE) are among the musculoskeletal (MSK) disorders causing the greatest disability in terms of Years Lived with Disability. The current study aims to analyze the health and economic impact of these MSK disorders in Belgium, providing a summary of morbidity and mortality outcomes from 2013 to 2018, as well as direct and indirect costs from 2013 to 2017. Methods The health burden of LBP, NKP, OST and RHE in Belgium from 2013 to 2018 was summarized in terms of prevalence and disability-adjusted life years (DALY) using data from the Belgian health interview surveys (BHIS), the INTEGO database (Belgian registration network for general practitioners) and the Global Burden of Diseases study 2019. The economic burden included estimates of direct medical costs and indirect costs, measured by cost of work absenteeism. For this purpose, data of the respondents to the BHIS-2013 were linked with the national health insurance data (intermutualistic agency [IMA] database) 2013–2017. Results In 2018, 2.5 million Belgians were affected by at least one MSK disorder. OST represented the disorder with the highest number of cases for both men and women, followed by LBP. In the same year, MSK disorders contributed to a total of 180,746 DALYs for female and 116,063 DALYs for men. LBP appeared to be the largest contributor to the health burden of MSK. Having at least one MSK disorder costed on average 3 billion € in medical expenses and 2 billion € in indirect costs per year, with LBP being the most costly. Conclusion MSK disorders represent a major health and economic burden in Belgium. As their burden will probably continue to increase in the future, acting on the risk factors associated to these disorders is crucial to mitigate both the health and economic burden.

Abstract Objectives Myocarditis, a health-threatening heart disease, is attracting increasing attention. This systematic study was conducted to study the prevalence of disease through the trends of incidence, mortality, disability-adjusted life years (DALYs) over the last 30 years, which would be helpful for the policymakers to better the choices for reasonable decisions. Methods The global, regional, and national burdens of myocarditis from 1990–2019 were analyzed by using the 2019 Global Burden of Disease (GBD) database. This study on myocarditis produced new findings according to age, sex, and Social-Demographic Index (SDI) by investigating DALYs, age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and corresponding estimated annual percentage change (EAPC). Results The number of myocarditis incidence increased by 62.19%, from 780,410 cases in 1990 to 1,265,770 cases in 2019. The ASIR decreased by 4.42% (95%CI, from -0.26% to -0.21%) over the past 30 years. The number of deaths from myocarditis increased by 65.40% from 19,618 in 1990 to 324,490 in 2019, but the ASDR was relatively stable over the investigated period. ASDR increased in low-middle SDI regions (EAPC=0.48; 95%CI, 0.24 to 0.72) and decreased in low SDI regions (EAPC=-0.97; 95%CI, from -1.05 to -0.89). The age-standardized DALY rate decreased by 1.19% (95%CI, from -1.33% to -1.04%) per year. Conclusions Globally, the ASIR and DALY for myocarditis decreased and the ASDR was stable over the past 30 years. The risk of incidences and death cases increased with age. Measures should be taken to control the risk of myocarditis in high-burden regions. Medical supplies should be improved in the high-middle SDI regions and middle SDI regions to reduce the deaths from myocarditis in these regions.

Abstract Introduction Despite the significant burden of childhood and adolescent cancers, no specific studies recently discussed the burden of cancer in this group in the North Africa and the Middle East (NAME) region. Therefore, we aimed to study the burden of cancers in this group in this region. Materials and methods We retrieved the Global Burden of Disease (GBD) data for children and adolescent cancers (0–19 years old) in the NAME region from 1990 to 2019. 21 types of neoplasms were grouped as “neoplasms”, comprising 19 specific cancer groups as well as “other malignant neoplasms” and “other neoplasms”. Three significant parameters of incidence, deaths, and Disability-Adjusted Life Years (DALYs) were studied. The data are presented with 95% uncertainty intervals (UI), and reported rates per 100,000. Results In 2019, almost 6 million (95% UI: 4.166 M–8.405 M) new cases and 11,560(9770-13,578) deaths due to neoplasms occurred in the NAME region. Incidence was higher in females (3.4 M), while deaths (6226 of overall 11,560) and DALYs (501,118 of overall 933,885) were estimated as higher in males. Incidence rates did not significantly change since 1990, while deaths and DALYs rates declined significantly. After excluding “other malignant neoplasms” and “other neoplasms”, leukemia was responsible for the highest number of incidence and deaths (incidence: 10,629(8237-13,081), deaths: 4053(3135-5013), followed by brain and central nervous system cancers (incidence: 5897(4192-7134), deaths: 2446(1761-2960)), and non-Hodgkin lymphoma (incidence: 2741 (2237-3392), deaths: 790(645–962)). Incidence rates of neoplasms were similar for most countries, but countries varied more in terms of death rates. Afghanistan 8.9(6.5–11.9), Sudan 6.4(4.5–8.6), and the Syrian Arab Republic 5.6(4.3–8.3) had the highest overall death rates. Conclusion The NAME region is observing relatively constant incidence rates and a decreasing pattern in the deaths and DALYs. Despite this success, several countries are lagging behind in development. Different issues such as economic problems, armed conflicts and political instabilities, lack of equipment or experienced staff or poor distribution, stigmatization and disbelief in the healthcare systems account for unfavorable numbers in some countries. Such problems require urgent solutions as new sophisticated and personalized cares raise the alarm for even more inequalities between high and low-income countries.

Abstract Background The emergence of COVID-19 has resulted in health, socio-economic, and political crises. The overall health impact of this disease can be measured by disability-adjusted life years (DALYs) which is the sum of the life years lost due to disability (YLDs) and the years life lost due to premature death (YLLs). The overarching objective of this systematic review was to identify the health burdens of COVID-19 and summarise the literature that can aid health regulators to make evidence-based decisions on COVID-19 mitigation strategies. Methods This systematic review was conducted using the PRISMA 2020 guidelines. DALYs-based primary studies were collected from databases, manual searches, and included studies’ references. The primary studies published in English language, conducted since the emergence of COVID-19, and using DALYs or its subsets (years life lost due to disability and/or years life lost due to premature death) as health impact metrics, were the inclusion criteria. The combined disability and mortality health impact of COVID-19 was measured in DALYs. The risk of bias due to literature selection, identification, and reporting processes was assessed using the Joanna Bridges Institute critical appraisal tool for cross-sectional studies, and the certainty of evidence was assessed using the GRADE Pro tool. Result Of the 1459 identified studies, twelve of them were eligible for inclusion in the review. The years life lost due to COVID-19 related mortality was dominant over the years life lost due to COVID-19 related disability (disability times from the onset of COVID-19 to recovery, from diseases occurrence to mortality, and the long-term consequences of COVID-19) in all included studies. The long-term consequence disability time and the pre-death disability time were not assessed by most of the reviewed articles. Conclusion The impact of COVID-19 on both the length and quality of life has been substantial and has been causing considerable health crises worldwide. The health burden of COVID-19 was greater than other infectious diseases. Further studies focussing on issues examining increasing preparedness for future pandemics, public sensitization, and multi-sectorial integration are recommended.

Bule Shao,1,2,&ast; Mengjia Zhu,1,&ast; Kai Shen,1,2 Liang Luo,1,2 Ping Du,1,2 Jun Li,1,2 Jing Xu,3 Yanyong Deng,1,2 Ne Lin,1,2 Jiaguo Wu,1,2 Weiling Hu1,2,4 1Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 2Institute of Gastroenterology, Zhejiang University, Hangzhou, People’s Republic of China; 3Department of Pathology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China; 4Cancer Center, Zhejiang University, Hangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Jiaguo Wu; Weiling Hu, Email ddwjg@163.com; huweiling@zju.edu.cnBackground: Understanding the temporal trends in the epidemiology of colorectal cancer (CRC) and early-onset CRC (EOCRC) in China is essential for policymakers to develop appropriate strategies to reduce the CRC burden.Methods: The prevalence, incidence, mortality, years of life lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) of CRC were obtained from the Global Burden of Disease (GBD) Study 2019. The incidence and mortality of CRC over the next 25 years were predicted.Results: From 1990 to 2019, the prevalence, incidence, and mortality of total CRC and EOCRC significantly increased in males, with milder trends in females. In 2019, the number of people living with CRC (or EOCRC) in China was approximately 3.4 (0.59) million, which was over seven (five) times higher than that in 1990. The DALYs, YLDs, and YLLs moderately increased from 1990 to 2019 in both sexes. The age-standardized mortality rate (ASMR) for females has shown a stable trend in total CRC, and a downward trend in EOCRC since 2000. While the ASMR for males showed increasing trends in total CRC and EOCRC. In 2019, the highest incidence, prevalence, YLDs, YLLs, and DALYs were all observed in the 65 to 69 age group, while the highest mortality was in the 70 to 74. By 2044, the incidence and deaths of CRC are expected to reach 1310 thousand and 484 thousand, respectively. For EOCRC, the incidence will peak at about 101 thousand around 2034, and the mortality will continuously decrease to a nadir at about 18 thousand around 2044.Conclusion: Although the age-standardized incidence and mortality of total CRC and EOCRC in China will reach a plateau, the number of incident cases and deaths of CRC have been increasing in the last three decades and will continue to increase in the next 25 years.Graphical Abstract: Keywords: early-onset colorectal cancer, prevalence, incidence, mortality, disability-adjusted life years, age-period-cohort analysis

Background: Air pollution and a number of metabolic disorders have been reported to increase the risk of severe COVID-19 outcomes. This study explored the association between severe COVID-19 outcomes, metabolic disorders and environmental air pollutants, at regional level, across 38 countries. Methods: We conducted an ecological study using COVID-19 data related to countries of the Organization for Economic Cooperation and Development (OECD), with an estimated population of 1.4 billion. They were divided into 3 regions: 1. Europe & Middle east; 2. Americas (north, central & south America); 3. East-Asia & West Pacific. The outcome variables were: COVID-19 case-fatality rate (CFR) and disability-adjusted life years (DALYs) at regional level. Freely accessible datasets related to regional DALYs, demographics and other environmental pollutants were obtained from OECD, WHO and the World in Data websites. Generalized linear model (GLM) was performed to determine the regional determinants of COVID-19 CFR and DALYs using the aggregate epidemiologic data (Dec. 2019–Dec. 2021). Results: Overall cumulative deaths were 65,000 per million, for mean CFR and DALYs of 1.31 (1.2)% and 17.35 (2.3) years, respectively. Globally, GLM analysis with adjustment for elderly population rate, showed that COVID-19 CFR was positively associated with atmospheric PM2.5 level (beta = 0.64(0.0), 95%CI: 0.06–1.35; p < 0.05), diabetes prevalence (beta = 0.26(0.1), 95%CI: 0.12–0.41; p < 0.001). For COVID-19 DALYs, positive associations were observed with atmospheric NOx level (beta = 0.06(0.0), 95%CI: 0.02–0.82; p < 0.05) and diabetes prevalence (beta = 0.32(0.2), 95%CI: 0.04–0.69; p < 0.05). At regional level, adjusted GLM analysis showed that COVID-19 CFR was associated with atmospheric PM2.5 level in the Americas and East-Asia & Western Pacific region; it was associated with diabetes prevalence for countries of Europe & Middle east and East-Asia & Western Pacific region. Furthermore, COVID-19 DALYs were positively associated with atmospheric PM2.5 and diabetes prevalence for countries of the Americas only. Conclusion: These findings confirm that diabetes and air pollution increase the risk of disability and fatality due to COVID-19, with disparities in terms of their impact. They suggest that efficient preventive and management programs for diabetes and air pollution countermeasures would have curtailed severe COVID-19 outcome rates.

With advancements in medical technology, the structure of disease is shifting from acute illnesses to chronic conditions, such as Alzheimer’s disease (AD). Consequently, there is an escalating need for evaluations that discourse on the potential effects on healthy life years, as well as disease onset. We aimed to evaluate the associations with AD disability-adjusted life year (AD-DALY) rates and protein intake by sex and age group. For the analysis, we used representative values for males and females in their 60s and aged over 70, extracted from the public dataset of the Global Burden of Disease Study and the National Health and Nutrition Survey in Japan, covering the years 1990 to 2019. In order to evaluate the association between AD-DALY rates and protein intake, we analyzed correlations and stratified multiple regression models. Additionally, we simulated alterations in AD-DALY rates associated with changes in protein intake by utilizing stratified multiple regression models. AD-DALY rates and protein intake indicated significant negative correlations across all sex and age groups. In stratified multiple regression models, significant associations were found between higher protein intake and lower AD-DALY rates in females. In the simulation, when protein intake was increased to 1.5 g/kg/day, AD-DALY rates decreased by 5–9 percent compared with 2019. However, the association between intake of animal and plant protein and AD-DALY rates were found to vary based on sex and age group. The present study suggests the possibility to improve AD-DALY rates by increasing population average protein intake levels in a recommended range.

Objectives: We aimed to analyze the secular trends in mesothelioma burden, the effect of age, period, and birth cohort, and project the global burden over time. Material and methods: Based on the mesothelioma incidence, mortality, and Disability-Adjusted Life Years (DALYs) data from 1990 to 2019 in Global Burden of Diseases (GBD) database, the annual percentage change (APC) and average annual percent change (AAPC), calculated from joinpoint regression model, was used to describe the burden trends. An age-period-cohort model was utilized to disentangle age, period, and birth cohort effects on mesothelioma incidence and mortality trends. The mesothelioma burden was projected by the Bayesian age-period-cohort (BAPC) model. Results: Globally, there were the significant declines in age-standardized incidence rate (ASIR) (AAPC = −0.4, 95%CI: −0.6,−0.3, P

BackgroundThe aim of this study was to assess the global burden of disease from non-communicable chronic diseases (NCD) due to diet low in fruits from 1990 to 2019.MethodsBased on data from the Global Burden of Disease (GBD) 2019, the global burden of disease due to diet low in fruits was analyzed for each country or region, disaggregated by disease type, age, sex, and year. The number of deaths and disability-adjusted life years (DALYs), population attributable fraction (PAF), age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) were calculated, and the average annual percentage change (AAPC) was calculated to describe trends in ASMR and ASDR from 1990 to 2019.ResultsFrom 1990 to 2019, the number of deaths and DALYs due to diet low in fruits increased by 31.5 and 27.4%, respectively. Among the tertiary diseases, ischemic heart disease, stroke, and diabetes and kidney disease were the top three contributors to the global increase in deaths and DALYs. However, both ASMR and ASDR showed a decreasing trend. The fastest decline in ASMR and ASDR was in stroke, with AAPC of −2.13 (95% CI: −2.22, −2.05, p

ObjectivesTo assess the disease burden and changing trend of cardiomyopathy in children aged 0–14 years in China from 1990 to 2019.MethodsThis study was based on the Global Burden of Disease Study 2019; the age-specific prevalence rate, mortality rate and disability-adjusted life year (DALY) rate were used for analysis. Estimated annual percentage change (EAPC) in burden rate and its 95% confidence interval were calculated. The data of China were compared with the global average level.ResultsIn 2019, the numbers of prevalence, deaths, and DALYs of cardiomyopathy in children aged 0–14 years in China were 4,493 [95% uncertainty interval (UI): 2687 ~ 6,838], 434 (95%UI: 337 ~ 565) and 37,522 (95%UI: 29,321 ~ 48,891), with declining amplitudes of 16.32, 70.56, and 70.74%, compared with 1990, respectively. In 2019, the prevalence rate of cardiomyopathy in Chinese children aged 0–14 years was 2.00/100,000 (95%UI: 1.2/100,000 ~ 3.04/100,000), higher than 1990 [1.66/100,000 (95%UI:1.00/100,000 ~ 2.53/100,000)]; mortality rate was 0.19/100,000 (95%UI: 0.15/100,000 ~ 0.25/100,000), significantly lower than 1990 [0.46/100,000 (95%UI: 0.25/100,000 ~ 0.95/100,000)]; DALY rate was 16.69/100,000 (95%UI: 13.04/100,000 ~ 21.75/100,000), also significantly lower than 1990 [39.71/100,000 (95%UI: 22.06/100,000 ~ 82.8/100,000)]. All burden rates of cardiomyopathy in Chinese children aged 0–14 years old were all lower than the global averages of 2019; the burden rates of male children were higher than female children. In all calendar years from 1990 to 2019, the mortality and DALY rates of children younger than 1-year-old were significantly higher than in the other age groups of 0–14 years old. From 1990 to 2019, the prevalence rate of cardiomyopathy aged 0–14 years old gradually increased, with EAPC of 0.82 (95%CI: 0.71–0.93); mortality rate and DALY rate decreased [EAPC = −2.32 (95%CI: −2.59 to −2.05)].ConclusionFrom 1990 to 2019, the disease burden of cardiomyopathy in children of China aged 0–14 years was heterogeneous; the burden of male children was higher than females; and the burden of cardiomyopathy in children younger than 1 year old needs more attention.

Purpose: Uterine fibroids occur in 40%–60% of women and are symptomatic in 30% of the patients by causing abnormal uterine bleeding, pelvic pressure, pain, and infertility. The study aims to evaluate the long-term trend of uterine fibroids mortality and disability-adjusted life years (DALYs) in China and the relative risks of age, period, and birth cohort effects. Methods: The mortality and DALYs of uterine fibroids from 1990 to 2019 were derived from the Global Burden of Disease 2019. The annual percentage change and average annual percent change (AAPC) were assessed using the Joinpoint regression. The effects of age, period, and birth cohort on death and DALYs were analyzed by the Age–Period–Cohort framework. Results: The age-standardized rates were all on the ascending trend, with the greatest increase in the age-standardized mortality rate (AAPC, 1.53; 95%CI, 1.04–2.02). The net driftwas found to be 3.51% (95% CI, 2.25%–4.78%) per year formortality and 0.34% (95% CI, 0.14%–0.53%) per year for DALYs. Significant age, period, and birth cohort effects were found for mortality and DALYs (p < 0.001 for all). The mortality risk increased overall with age, but the DALYs risk increased first and then decreased with age. The period and birth cohort risks for mortality and DALYs showed different trends. Conclusion: These secular time trends and changes of mortality and DALYs reveal the socioeconomic alterations, reform of diagnosis and therapy, and changes in social lifestyles and behaviors. Uterine fibroids are still the most common benign gynecological tumors in women, and more epidemiological investigations and social health prevention and control should be applied. [ABSTRACT FROM AUTHOR]

Introduction: Coronary artery disease (CAD) is the foremost single cause of mortality and loss of disability-adjusted life years globally and a large percentage of this burden is found in low and middle income countries, with the treatment strategies based on revascularisation, based on studies that have shown that on revascularisation of viable myocardium there is an improvement of function over a period of time. Aim: To evaluate the utilization of myocardial perfusion imaging (MPI) for identifying viable myocardium and assessing the improvement. Material and methods: This prospective observational study was conducted in patients having CAD planned for coronary artery bypass grafting. The patients were evaluated using 2D ECHO and MPI preoperatively and postoperatively after 1 year. Results: Mean ejection fraction preoperatively was 40.6 ±9.72% and postoperatively it improved to 41.32 ±10.64% and ejection fraction was calculated using MPI and an average improvement from 35.98 ±12.72% to 45.51 ±12.61% (p ≤ 0.0001). Summed rest score was calculated and an improvement was noted from 24.28 ±8.47 to 18.02 ±8.75 (p ≤ 0.0001). Total perfusion deficit was calculated and was found to have reduced from 32.44 ±11.98 to 25.61 ±12.23 (p ≤ 0.0001). Conclusions: MPI was able to accurately assess the improvement, which correlated not only with the 2D echocardiography data but also with the clinical wellbeing of the patients. Being a non-invasive, quick procedure, it should be added to the arsenal of the cardiac surgeon for evaluation of patients with diffuse diseases, low ejection fractions, patients who might generally be considered inoperable. [ABSTRACT FROM AUTHOR]

Most illnesses and deaths in industry workers are associated with occupational diseases (ODs). In recent years, mining has grown rapidly into a major driver of the Mongolian economy. In this study, the organization-based registry data on OD incidence and mortality from the archival data of the 'Erdenet' Copper and Molybdenum Concentrator Plant in Mongolia were used. We estimated the ODs burden in disability-adjusted life years (DALYs) loss between 1999 and 2019. A total of 72,802 DALYs were lost over 20 years, of which 97.5% were due to years lived with disability and 2.5% for years of life lost. The disease burden was high in men, accounting for 76.8% of total DALY. In terms of age groups, among people aged 46–55, DALY accounted for the largest percentage of losses. We found that workplace dust, noise, ergonomics, and vibration were the main factors attributed to the DALYs during the past two decades. [ABSTRACT FROM AUTHOR]

Introduction: Autism spectrum disorders (ASD) encompass a range of neurodevelopmental disorders that affect the patient's communication and behavior. There are some reports about the increasing prevalence of ASD in recent decades, mostly due to the improvement in diagnosis and screening status. Few studies suggested a lower prevalence of ASD in North Africa and Middle East compared to more developed regions. The aim of this study is to provide a comprehensive outlook of ASD in the region. Methods: We used Global Burden of Disease (GBD) data from 1990 to 2019 in North Africa and Middle East, which is one of the seven super regions of the GBD categorization. In this study, we reported the epidemiologic indices, including prevalence, incidence, and years lived with disability (YLDs) for ASD in the 21 countries of the super region. We also compared these indices between the countries based on their sociodemographic index (SDI) which was calculated according to income per capita, mean education, and fertility rate. Results: Age‐standardized prevalence rate (ASPR) of ASD in the region is 304.4 (95% uncertainty interval 251.2–366.1) per 100,000 in 2019 with less than one percentage change since 1990. Age‐standardized YLDs and incidence rates were 46.4 (30.4–67.5) and 7.7 (6.3–9.3) per 100,000 in 2019. The ASPR was 2.9 times greater in males compared to females in 2019. The highest age‐standardized prevalence, incidence, and YLD rates among the countries were seen in Iran in 2019 (370.3, 9.3, and 56.4 per 100,000, respectively). High SDI countries had higher age‐standardized YLDs rates compared to the other countries of the region. Conclusion: In conclusion, the trends of age‐standardized epidemiologic indices remained approximately steady through the years 1990–2019 in the region. Though, there was a wide discrepancy between the countries of the region. The difference of YLDs among the countries of this region is related to the SDI of the countries. Monetary and public awareness status are the SDI factors that may affect the quality of life of ASD patients in the region. This study provides valuable information for governments and health systems to implement policies for maintaining the improving trend, achieving more timely diagnosis, and bettering the supportive actions in this region. [ABSTRACT FROM AUTHOR]

The purpose of this investigation is to estimate the global disease burden attributable to low physical activity (PA) in 204 countries and territories from 1990 to 2019 by age, sex, and Socio-Demographic Index (SDI). Detailed information on global deaths and disability-adjusted life years (DALYs) attributable to low PA were collected from the Global Burden of Disease Study 2019. The ideal exposure scenario of PA was defined as 3000-4500 metabolic equivalent minutes per week and low PA was considered to be less than this threshold. Age-standardization was used to improve the comparison of rates across locations or between time periods. In 2019, low PA seems to contribute to 0.83 million [95% uncertainty interval (UI) 0.43 to 1.47] deaths and 15.75 million (95% UI 8.52 to 28.62) DALYs globally, an increase of 83.9% (95% UI 69.3 to 105.7) and 82.9% (95% UI 65.5 to 112.1) since 1990, respectively. The age-standardized rates of low-PA-related deaths and DALYs per 100,000 people in 2019 were 11.1 (95% UI 5.7 to 19.5) and 198.4 (95% UI 108.2 to 360.3), respectively. Of all age-standardized DALYs globally in 2019, 0.6% (95% UI 0.3 to 1.1) may be attributable to low PA. The association between SDI and the proportion of age-standardized DALYs attributable to low PA suggests that regions with the highest SDI largely decreased their proportions of age-standardized DALYs attributable to low PA during 1990-2019, while other regions tended to have increased proportions in the same timeframe. In 2019, the rates of low-PA-related deaths and DALYs tended to rise with increasing age in both sexes, with no differences between males and females in the age-standardized rates. An insufficient accumulation of PA across the globe occurs together with a considerable public health burden. Health initiatives to promote PA within different age groups and countries are urgently needed. [ABSTRACT FROM AUTHOR]

Background: This study aims to provide a theoretical basis for the prevention of oral cancer by analyzing the epidemiological trends of oral cancer. Materials and Methods: The data on oral cancer from 1990 to 2019 were extracted from the Global Burden of Disease 2019 database. The incidence, mortality, disability‐adjusted life years (DALYs), and age‐standardized rate as well as attributable risk factors of oral cancer were used for the analysis. Estimated annual percentage change (EAPC) was calculated to describe the changes in age‐standardized incidence rate (ASIR), age‐standardized mortality rate (ASMR), and age‐standardized DALYs rate (ASDR). Results: The global ASIR of oral cancer showed an increasing trend from 1990 to 2019. ASIR in high SDI regions showed a decreasing trend during the studied period, with high SDI regions having the lowest ASMR in 2019. In 2019, the highest ASIR, ASMR, and ASDR were detected in South Asia. At the national level, Pakistan had the highest ASMR and ASDR in 2019. The increasing disease burden was observed in younger populations aged below 45 during the studied period. Smoking and alcohol use still exerted profound impacts on the oral cancer burden, with South Asia having the greatest increase in the percentage of deaths due to oral cancer attributable to chewing tobacco from 1990 to 2019. Conclusion: In conclusion, there is a large variability in the temporal and spatial burden of oral cancer, and it is essential for priority countries to take targeted intervention policies and measures to reduce the disease burden of oral cancer. In addition, the oral cancer burden caused by attributable risk factors should also receive close attention. [ABSTRACT FROM AUTHOR]

Background: No study to date has concomitantly reported the global burden of alopecia areata (AA) and its associated diseases. Methods: The crude and age‐standardized rates of prevalence (ASPR), incidence (ASIR) and years lived with disability (YLDs) of AA were extracted from the global burden of disease, injuries and risk factors study (GBD) database between 1990 and 2019 for 204 countries and territories. We stratified the analysis by global region, nation, sex, age and sociodemographic index (SDI) to dissect the epidemiology of AA and its associated diseases. Results: Alopecia areata was responsible for 0.024% of the total DALYs. Age‐standardized DALYs rate of AA was 7.51 [4.73–11.14] per 100,000. Overall ASPR, ASIR and age‐standardized YLDs rates were stable from 1990 to 2019 globally. All three rates were about two times higher in females compared to males and had a bimodal distribution with peaks at age 30–34 years and 60–64 years. AA burden was positively correlated with SDI (r =.375, p <.001) and was most prevalent in high‐income countries, especially North America. Countries with a high AA incidence were more likely to have high incidences of autoimmune diseases and low incidences of ischaemic heart disease and ischaemic stroke. Conclusions: The burden of AA was prominent in females, young adults, high sociodemographic countries and North Americans. The study corroborates sex‐ and region‐specific implications and public health measures for AA and its associated burdens. These epidemiological data on AA burden can guide future research efforts, prevention strategies and allocation of resources. [ABSTRACT FROM AUTHOR]

To estimate the burden of disease related to chronic pain in Ecuador. We used Global Burden of Disease (GBD) methods to estimated disability-adjusted life years (DALYs) related to chronic pain in Ecuador related to lumbar pain, osteoarthritis, post-herpetic neuralgia, diabetic neuropathy, cancer-related pain, and other musculoskeletal pain. We estimated the prevalent cases by sex and age group using literature data. We only estimated years lived with disability using disability weights obtained from the GBD, with the assumption that no premature death would be related to pain. We used a prevalence-based approach to estimate cases by sex and age group using literature, without discounting or age adjustment. We calculated total DALYs and DALYs/100,000 inhabitants. Our estimated yielded a total of 3,644,108 patients with chronic pain. They would produce 256,090 DALYs or 1,483 DALYs/100,000 inhabitants attributable to chronic pain. Low back pain, osteoarthritis and cancer-related pain were the drivers of DALY production. Chronic pain is an important source of burden of disease. It is comparable to other important causes such as headaches, stroke, diabetes and chronic obstructive pulmonary disease, among others. Low back pain, osteoarthritis and other musculoskeletal pain were the biggest contributors given their high prevalence. [ABSTRACT FROM AUTHOR]

Disability-adjusted life years (DALYs) capture the mortality and morbidity arising from a disease: they incorporate the years of life lost (YLLs) and the years of life lived with disability (YLD) due to a disease. The relative importance of YLLs and YLDs differs across diseases. The magnitudes of YLLs and YLDs depend on parameters such as the age of onset of disease, duration of disease, the case fatality ratio and disability weight. In this paper, we examine the mathematical computation of the DALY and its underlying components, YLDs and YLLs. We aim to demonstrate under which circumstances (e.g. sets of input parameters) disease-specific YLDs and YLLs become sizeable relative to one another using the parameters of a set of diseases in low-income country settings. Researchers could then focus on understanding the key inputs that drive the relative extents of YLDs and YLLs (e.g. determine whether a detailed estimation of disability weights is essential), while maintaining DALYs as their key outcome metric consistent with disease burden assessments. [ABSTRACT FROM AUTHOR]

Introduction: Stroke is one of the leading causes of morbidity and mortality worldwide accompanied by huge financial burden on an individual and society. Objective: The objective is to estimate the economic burden by calculating the costs (per capita Gross Domestic Product (GDP)) on stroke survivors in African and Asian countries. Materials and Methods: Published electronic articles from inception till August 2022 will be screened from five databases: MEDLINE (PubMed), Scopus, Embase, Science Direct, and Web of Science. Effect sizes in the form of risk ratios and risk differences will be calculated for estimating the burden per capita income of the country. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis 2020 Guidelines, titles and abstracts will be screened by two authors independently. Any disagreements will be resolved by the third author. Rayyan QCRI software will be used for the inclusion of articles and removing of duplicates. Quality assessment will be conducted by the National Institute of Health (NIH) tool for observational and cross-sectional studies whereas risk of bias will be assessed using the Cochrane's ROBINS-I tool for observational studies. RevMan 5.4 software will be used for plotting forest plots and further analysis. In case, heterogeneity is observed in the outcomes data, I2 statistics will be calculated to further the possibility of a meta-analysis. Publication bias will be assessed by plotting a funnel plot and “trim-and-fill method”. This systematic review will estimate the economic burden by collating data using socioeconomic indicators of stroke in African and Asian countries. The results will help policymakers in designing and allocation of resources in the two continents.

Background: Due to the staggering number of tobacco users in India, it is important to determine the exact mortality and morbidity rates due to tobacco use. This study aimed to estimate deaths, disability-adjusted life years (DALYs), and years of life lost (YLLs) attributable to cigarettes, bidis, and smokeless tobacco (SLT) in India. Methods: Data pooling and meta-analysis were done using case-control studies available on the three types of tobacco products. Health burden was estimated by applying the population attributable fraction (PAF) value to the total disease burden. Findings: A total of 33 studies were included. PAF was calculated for oral and lung cancer as well as ischemic heart disease (IHD) due to cigarettes, oral and lung cancer, IHD, and chronic obstructive pulmonary disease due to bidi, and oral and stomach cancer and IHD due to SLT. Cigarettes resulted in 8.4 million DALYs, 8.26 million YLLs, and 341 deaths; bidis led to 11.7 million DALYs, 10.7 million YLLs, and 478 thousand deaths, and SLTs accounted for 4.38 million DALYs, 4.3 million YLLs, and 171 thousand deaths annually. Conclusion: Evidence of measurable health burden and methodology for calculation for individual states was provided in the study. The generated evidence could be utilized for policy recommendations and revision of the existing taxation norms.

Abstract Background Experimental and epidemiological studies have indicated an association between diabetes exposure and an increased risk of liver cancer due to nonalcoholic steatohepatitis (NASH). However, to date, no systematic study has specifically investigated the burden of NASH-related liver cancer due to exposure to high fasting plasma glucose (HFPG) levels worldwide. Methods The number and rate of deaths and disability-adjusted life years (DALYs) from HFPG-induced NASH-related liver cancer were estimated based on the results of the 2019 Global Burden of Disease Study. The estimated annual percentage changes (EAPCs) for age-standardized death or DALYs rates were calculated using a generalized linear model with a Gaussian distribution to quantify the temporal trends in the global burden of NASH-related liver cancer attributable to HFPG. The strength and direction of the association between the sociodemographic index (SDI) and death or DALY rate were measured using Spearman’s rank-order correlation. Results Globally, approximately 7.59% of all DALY and 8.76% of all mortalities of NASH-related liver cancer in 2019 were due to HFPG. The age-standardized death and DALY rates of NASH-related liver cancer attributable to HFPG increased from 1990 to 2019. The corresponding EAPCs were 0.69 (95% UI 0.48–0.89), and 0.30 (95% UI 0.05–0.56), respectively. This increasing pattern was most obvious in the high- and low-SDI regions. The age-standardized mortality and DALYs rate of NASH-related liver cancer attributable to HFPG varies considerably worldwide, with the middle SDI region having the highest death and DALY rates in 2019 (DALY 0.96 [95% UI 0.23–2.18]; death 0.05 [95% UI 0.01–0.11]). Conclusion The burden of NASH-related liver cancer attributable to HFPG has increased over the past three decades, particularly in regions with high and low SDI.

Abstract Objectives This study aims to evaluate whether Somalia will reach Sustainable Development Goals 2 and 3 by 2030 and what the country requires to advance closer to these objectives. Setting: Somalia. Participants We carried out analyses of secondary data obtained from the following open-access databases: Global Burden of Disease 2019 study; United Nations (UN) Department of Economic and Social Affairs Population Division; World Bank World Development Indicators; United Nations Children’s Fund (UNICEF); UNICEF/World Health Organisation (WHO)/World Bank Joint Child Malnutrition Estimates; and UN Interagency Group for Child Mortality Estimation (UN IGME), disaggregated by sex. Primary outcome measures: stillbirth, neonatal, infant, under-five, maternal and child mortality; under-five malnutrition; life expectancy; health-adjusted life expectancy; age-standardised all-cause mortality; age-standardised cause-specific mortality for the leading causes of death; disability-adjusted life years. Secondary outcome measures: vitamin A coverage; stunting, overweight in children under 5; top risk factors contributing to cause-specific mortality. Results life expectancy in Somalia will increase to 65.42 years (95% UI 62.30–68.54) for females and 58.54 years (95% UI 54.89–62.19) for males in 2030. Stunting will continue to decline to 25.2% (90% UI 13.9–39.5%), and the under-five mortality rate will drop to 85.9 per 1000 live births (90% UI 22.0–228.1 per 1000 live births) for females and 96.4 per 1000 live births (90% UI 24.8–255.3 per 1000 live births) for males in 2030. This study’s analyses predict that the maternal mortality ratio in Somalia will decline to 696.42 deaths per 100,000 live births in 2030. Conclusions there has been progress towards SDG targets in Somalia since 1990. To achieve these, Somalia requires greater health improvements than observed between 1990 and 2019.

Objectives: Rabies is an acute lethal infectious disease caused by a lyssavirus infection. In 2018, the World Health Organization proposed a global strategic plan to end human rabies deaths by 2030. However, systematic studies on the global rabies disease burden and epidemiological trends are scarce. Methods: We extracted the disease burden and epidemiological data of rabies worldwide in the preceding 30 years from the Global Burden of Disease Study 2019 and performed a comprehensive analysis. Results: In 2019, the incident cases of rabies worldwide were 14,075.51 (95% uncertainty interval: 6124.33-21,618.11), and the number of deaths was 13,743.44 (95% uncertainty interval: 6019.13-17,938.53), both of which were lower than that in 1990. With the improvement of the sociodemographic index, the incident cases, the number of deaths, age-standardized incidence rate, age-standardized incidence death rate, and disability-adjusted life years of rabies all showed downward trends. Adolescents and adults aged

BackgroundAs traditional chemical and physical hazards as well as associated adverse health outcomes in workplace were wildly controlled in the past half century, the prevalence and disease burden of low back pain (LBP) have drawn more and more attention and become one of the important public health problems in the world. ObjectiveTo analyze the health loss and attributable disease burden of ergonomic risk factors for LBP in two major categories of occupations in China, aiming to provide evidence for formulating effective prevention and control policies of LBP in the workplace. MethodsBased on the methodological framework of the Global Burden of Disease Study (GBD), a meta-analysis was firstly applied to summarize relevant literature results and estimate the prevalence of LBP in two occupational groups (including technicians and associate professionals and machine operators and assemblers) by different age groups in China. Then important epidemiologic parameters (including disability weight, remission rate, and incidence) from GBD 2019 were used to estimate mean duration of disease and age at onset using DisMod II software, and to calculate health loss indexes in the selected occupational groups in China in 2013, such as years lived with disability (YLD) and disability-adjusted life year (DALY) of LBP and its attributable fractions by ergonomic risk factors, which were compared to the outcome of GBD 2013. ResultsAfter the adjustment by DisMod II, the prevalence rate of LBP was 13.00% in technicians and associate professionals (11.25% for males and 14.84% for females) and 14.80% in machine operators and assemblers (13.56% for males and 16.10% for females) in 2013, which increased with age. The DALY rate of LBP was 8.02‰ in technicians and associate professionals (7.68‰ for males and 8.33‰ for females) and 10.34‰ in machine operators and assemblers (10.30‰ for males and 10.44‰ for females), which also showed an overall increasing trend with age. In 2013, the population attributable fraction (PAF) of ergonomic risk factors to LBP was 11.42% in technicians and associate professionals and 29.17% in machine operators and assemblers. The DALY of LBP attributable to ergonomics risk factors was 4498 person-years (2108 person-years for males), with the highest DALY in the 45-49 year group (951 person-years), and the attributable DALY rate was 0.92‰ in technicians and associate professionals. The DALY of LBP attributable to ergonomics risk factors was 48529 person-years (33046 person-years for males), with the highest DALY in the 40-44 year group (10852 person-years), and the attributable DALY rate was 3.02‰ in machine operators and assemblers. Regarding LBP-associated DALY rate, in the 20 years of age and above group, both occupational groups (technicians and associate professionals: 8.06‰, machine operators and assemblers: 10.66‰) showed higher values than the general population (3.55‰). In the 20 years of age and above group, the DALY rates attributable to ergonomic risk factors with the order from high to low were machine operators and assemblers (3.11‰), general population (1.10‰) and technicians and associate professionals (0.92‰).ConclusionThe LBP-associated disease burden is heavier in the two Chinese occupational groups than in general population. Reducing the disease burden of LBP by interventions targeting ergonomic risk factors in machine operators and assemblers is more effective than that in technicians and associate professionals as the results of attributable burden of disease suggest.