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Background: This study aimed to understand the vision health status of adolescents in the Western Pacific Region (WPR) using Global Burden of Disease (GBD) data from 1990 to 2019. Methods: We conducted a comprehensive analysis of blindness and vision loss using GBD data from 1990 to 2019, analyzed trends in the prevalence and burden of blindness and vision loss over time using joinpoint regression, and analyzed their independent effects on blindness and vision loss in three dimensions using age-period-cohort (APC) modeling. Results: The prevalence of blindness and vision loss among adolescents in the WPR showed an increasing trend between 1990 and 2019 (AAPC: 0.56%) and a slight increase in YLD (AAPC: 0.11%). The joinpoint regression showed a decreasing trend after 2017 (AAPC: -2.45%). The prevalence and burden trended downward in most Western Pacific countries, with only China rising significantly (AAPC prevalence: 0.57%). Refractive disorders had the highest prevalence among the subgroups. The risk of blindness and vision loss in adolescents reduced with age but grew later in time and at later birth. In addition, prevalence and burden were generally higher in females than males. Conclusions: In the context of a declining global trend in the prevalence and burden of blindness and vision loss among adolescents, there is an increasing trend among adolescents in WPR, with the most pronounced rise in China. This finding has important implications for WPR, suggesting that more attention should be given to adolescent eye health in the region. [ABSTRACT FROM AUTHOR]

Background: Suicide is a serious public health problem that affects our entire country. The aim of this research was to study the variation in completed suicide rates between 2010 and 2022 in Spain and their relationship with the consumption of addictive substances. Methods: Completed suicide data from the Spanish Statistical Office (INE) were analyzed with a joinpoint regression model to determine time trends. The relationship between the variation in completed suicide rates with sociodemographic variables, including depression rates, obtained from the Spanish Statistical Office and variables related to the consumption of substances obtained from the survey on alcohol and other drugs in Spain (EDADES) of the Government Delegation for the National Plan on Drugs (DGPNSD) was also studied using an exploratory analysis and also performing a Generalized Additive Model. Results: The joinpoint regression model did reveal a point of significant change in the period studied for Spain showing a trend of increased suicide death rates for the studied period. The following variables correlated positively with the variation in completed suicide rates in the Generalized Additive Model: alcohol use in the past 12 months, alcohol use in the last 30 days, daily alcohol use in the last 30 days, binge drinking in the last 12 months, binge drinking in the last month, positive Alcohol Use Disorder Test for risky alcohol use, benzodiazepine use in the last 12 months, benzodiazepine use in the last month, daily benzodiazepine use in the last month, use of illegal substances in the last 12 months, use of illegal substances in the last month, mean age and depression rates. Conclusion: Applying preventive strategies on the risky consumption of alcohol, benzodiazepines and illegal substances would help reduce the rates of completed suicide in Spain. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies have reported that levels of rurality and deprivation are factors associated with suicide risk. Reports on the association between rurality, deprivation and suicide incidence during the COVID-19 pandemic are scarce. The study aims to investigate how suicide rates evolved in areas with different levels of rurality and deprivation among Japanese adults aged 20 years or older between 2009 and 2022. Methods: This study used population density in 2020 as an indicator of rurality and per capita prefectural income in 2019 as a proxy for deprivation in Japan's 47 prefectures. Joinpoint regression analysis was performed to analyze secular trends in suicide rates by rurality and deprivation. Results: Suicide rates for both men and women at different levels of rurality and deprivation remained roughly parallel during the research period. Suicide rates for men and women at all levels of rurality and deprivation were on a downward trend until around 2019, just before the onset of the pandemic. Following this, suicide rates in women showed a clear upward trend, while the trend in suicide rates for men also changed around 2019, with a slightly increasing or flat trend thereafter. Changes in suicide rates were greater among women and those aged 20–59 years. Conclusions: In Japan, time trends in suicide rates for both men and women have changed before and after the pandemic, but levels of rurality and deprivation across the 47 prefectures do not appear to have contributed much to these changes. [ABSTRACT FROM AUTHOR]

Objective: Uterine cancer (UC) is one of the prevalent malignancies in the female reproductive system. Estimating the burden trends of UC is crucial for developing effective prevention strategies at the national level. However, there has been no comprehensive analysis of the UC burden in China. We focused on the evaluation of the burden trends of UC in China over the past 32 years to provide a 15-year projection, comparing it with global levels. Methods: Data on incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were extracted from Global Burden of Disease (GBD) 2021 to describe the burden of UC in China. Joinpoint regression analysis was employed to describe the temporal trends of UC in China and globally over the past 32 years. A Bayesian age-period-cohort model was utilized to predict the trends of UC in the next 15 years. Spearman correlation analysis was used to compare the relationship between ASIR, ASPR, ASMR, ASDR, and SDI in UC in China and globally. Changes in ASMR and ASDR in UC caused by high BMI in China and globally from 1990 to 2021 were explored. Results: In 2021, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of UC in China were 6.65, 46.52, 1.24, and 37.86 (per 100,000 population) respectively. Compared to 1990, the ASMR and ASDR decreased by 48.63% and 48.15% respectively, while the ASIR and ASPR increased by 17.79% and 37.67% respectively. Globally, the burden of UC followed a similar trend in China, with increasing ASIR and ASPR, and decreasing ASMR and ASDR, although the magnitude of increase and decrease was smaller than in China. Joinpoint regression analysis results showed an overall upward trend in ASIR and ASPR for both China and global UC, while an overall downward trend was observed in ASMR and ASDR. Age-specific analysis revealed that during the period from 1990 to 2021, the age groups with the highest incidence, prevalence, mortality, and DALYs for UC in China generally occurred at earlier ages compared to the global pattern. It is projected that over the next 15 years, the burden of UC in China will continue to increase at a higher rate than the global level. Spearman correlation analysis showed that ASIR and ASPR of UC in China and the world were significantly positively correlated with SDI (p < 0.05), and ASMR and ASDR were significantly negatively correlated with SDI (p < 0.001). High BMI is a risk factor affecting the mortality rate and DALYs of UC in both China and globally, with the increase in ASMR and ASDR due to high BMI being greater in China than globally. Conclusion: The incidence and prevalence burden of UC among Chinese and global women have shown an increasing trend over the past 32 years, while the mortality and DALYs have decreased. The projected burden of UC in China is anticipated to continue rising at a higher rate than the global level over the next 15 years. Given the large population in China, the government needs to strengthen screening and prevention strategies to mitigate the burden of UC. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) has the highest disease burden among all skin diseases. However, reports on AD prevalence trends in China are limited. This study aimed to investigate the time trends of AD prevalence in China from 1990 to 2021 and to explore the age and sex differences. Methods: Data were obtained from the Global Burden of Disease Study, 2021. We analyzed the annual percentage change in the crude prevalence rate and age‐standardized prevalence rate (ASPR) of AD from 1990 to 2021 using the Joinpoint model. We predicted the future prevalence of AD from 2022 to 2030 using the Bayesian age–period–cohort model. Results: The total ASPR decreased slightly from 1990 (1357.93 per 100,000) to 2021 (1347.11 per 100,000). The ASPR of females (1457.64 per 100,000) was higher than that of males (1247.04 per 100,000) in 2021. The prevalence rate of AD was highest in the under 5 years old age group (3455.56 per 100,000) and the 5–9 years old age group (3360.31 per 100,000). By 2030, the predicted ASPR of AD will be 1394.36 (per 100,000) in males and 1603.69 in females (per 100,000). The predicted prevalence rate in the under 5 years old (3996.14 per 100,000 in males and 3990.68 per 100,000 in females) and 5–9 years old (3714.61 per 100,000 in males and 3963.96 per 100,000 in females) age groups will be higher than those in other age groups. Conclusion: Despite a slight decrease from 1990 to 2021, there has been an increasing trend since 2015 in the total AD burden. Given the increasing burden of AD on Chinese children and females, healthcare practitioners should enhance community education, improve disease management abilities of patients and caregivers, and reduce the burden and healthcare costs of AD. [ABSTRACT FROM AUTHOR]

In the United States, the lifetime prevalence of depression in the US population is 20.6 %. We aimed to understand the temporal trends in the prevalence of depression among adults in the United States during the period 2013–2022 as well as the effects of age, period, and cohort effects on the prevalence of depression. Data from 3,139,488 participants in the U.S. Behavioral Risk Factor Surveillance System (BRFSS) from 2013 to 2022 were used in this study. The joinpoint regression model was used to calculate annual percentage change (APC) and average annual percentage change (AAPC) to learn about the time trends in the prevalence of depression. Age-period-cohort models were used to estimate the effects of age, period, and birth cohort effects on the prevalence of depression. The prevalence of depression among adults in the United States showed an overall increasing trend from 2013 to 2022. The rate of increase was greater in males than females, with AAPC values of 1.44 % (95 % CI: 0.32–2.18), and 1.23 % (95 % CI: 0.32–2.25), respectively. Regarding the age effect, the risk of depression among adults in the United States generally showed an increasing and then decreasing trend with age. The risk of developing the condition reached its maximum at 50–54 years (RR = 1.28, 95 % CI = 1.26–1.30). Regarding the period effect, the risk of depression among US adults was higher during 2018–2022 than during 2013–2017. The overall cohort effect for depression prevalence was a higher risk for those born later, with a maximum RR of 1.51 (95 % CI: 1.47–1.54). The prevalence of adult depression in the United States is showing an increasing trend. Middle-aged people and those born later in life deserve more attention as high-risk groups. It is recommended that the condition burden of depression be reduced with the promotion of healthy lifestyles, the promotion of interpersonal communication, as well as enhanced mental health education and mental health literacy. • This study utilized the latest data collected by the BRFSS and was able to observe the latest trends in depression. • Moreover, the sample size of this study was large and covered a wide range of groups. • Additionally, this study has identified the high-risk groups for depression prevalence through an age-period-cohort model. [ABSTRACT FROM AUTHOR]

In the 20th century, influenza and pneumonia constituted the largest proportion of infectious disease deaths in the United States. Despite progress in management, US mortality trends for these diseases have not been thoroughly investigated. We aim to examine the patterns of influenza and pneumonia-related deaths among US residents. Crude death rates and age-adjusted mortality rates (AAMRs) per 100,000 individuals were calculated using influenza and pneumonia mortality data (International Classification of Diseases, 10th revision codes: J09-J18) from the CDC WONDER database. Annual percentage changes with a 95% confidence interval were determined using joinpoint regression analysis. Average annual percentage changes were computed as the weighted average of annual percentage changes. From 1999 to 2020, US influenza and pneumonia deaths totaled 1,257,088 (AAMR: 17.09), with a significantly decreasing AAMR (−2.94). Males had a higher AAMR (20.13) than females (15.02). Non-Hispanic American Indians had the highest AAMR (20.44), while Hispanics had the lowest AAMR (13.91). The Northeast had the highest AAMR (18.02). All other regions had similar AAMRs. Rural regions had a consistently higher AAMR (19.80) than urban regions (AAMR: 16.51). Tailoring interventions toward high-risk groups can enhance the effectiveness of preventive measures, vaccination, and health care access. [Display omitted] • In 20th century, influenza & pneumonia were leading causes of infectious death in US. • Past research has examined mortality trends of geographical racial disparities. • Over the study period, death rates from influenza and pneumonia declined in the US. • Males consistently exhibited higher mortality rates than females. • NH American Indians had the highest mortality rates, while Hispanics had the lowest. [ABSTRACT FROM AUTHOR]

Stroke is the second leading cause of death and disability in Latin America; however, few epidemiological studies have been conducted in South America. An observational study was conducted to analyze trends in stroke mortality in South American (SA) countries. Age-standardized mortality rates and proportional mortality due to stroke in the populations of SA countries between 1990 and 2019 were assessed by extracting data from the Global Burden of Disease 2019 study. Joinpoint regression models were employed to identify trends in the annual percentage change in mortality rates for each segment. Considering the data collected over the 30 years that were studied, the age-standardized stroke mortality trend decreased in Argentina (−1.6%), Uruguay (−0.6%), Brazil (−0.5%), Guyana (−0.5%), and Bolivia (−0.4%), while Venezuela (+1.6%) and Suriname (+1.0%) showed an increasing trend. The proportional stroke mortality trend decreased in Argentina (−1.7%), Paraguay (−0.9%), Uruguay (−0.7%), Guyana (−0.7%), Brazil (−0.5%), and Chile (−0.5%), whereas Bolivia (+1.0%), Suriname (+0.6%), and Peru (+0.4%) exhibited an increasing trend. The trends in stroke mortality between 1990 and 2019 demonstrated considerable variability. While most SA countries experienced significant decreases in stroke mortality trends, Venezuela and Suriname showed increases in age-standardized mortality rates, and Bolivia, Suriname, and Peru exhibited increases in proportional mortality rates. No decreasing stroke mortality trend was observed in the segment after the last joinpoint, highlighting the need for improvement in prevention and treatment. [ABSTRACT FROM AUTHOR]

Abstract Objective Uterine cancer (UC) is one of the prevalent malignancies in the female reproductive system. Estimating the burden trends of UC is crucial for developing effective prevention strategies at the national level. However, there has been no comprehensive analysis of the UC burden in China. We focused on the evaluation of the burden trends of UC in China over the past 32 years to provide a 15-year projection, comparing it with global levels. Methods Data on incidence, prevalence, mortality, and disability-adjusted life years (DALYs) were extracted from Global Burden of Disease (GBD) 2021 to describe the burden of UC in China. Joinpoint regression analysis was employed to describe the temporal trends of UC in China and globally over the past 32 years. A Bayesian age-period-cohort model was utilized to predict the trends of UC in the next 15 years. Spearman correlation analysis was used to compare the relationship between ASIR, ASPR, ASMR, ASDR, and SDI in UC in China and globally. Changes in ASMR and ASDR in UC caused by high BMI in China and globally from 1990 to 2021 were explored. Results In 2021, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) of UC in China were 6.65, 46.52, 1.24, and 37.86 (per 100,000 population) respectively. Compared to 1990, the ASMR and ASDR decreased by 48.63% and 48.15% respectively, while the ASIR and ASPR increased by 17.79% and 37.67% respectively. Globally, the burden of UC followed a similar trend in China, with increasing ASIR and ASPR, and decreasing ASMR and ASDR, although the magnitude of increase and decrease was smaller than in China. Joinpoint regression analysis results showed an overall upward trend in ASIR and ASPR for both China and global UC, while an overall downward trend was observed in ASMR and ASDR. Age-specific analysis revealed that during the period from 1990 to 2021, the age groups with the highest incidence, prevalence, mortality, and DALYs for UC in China generally occurred at earlier ages compared to the global pattern. It is projected that over the next 15 years, the burden of UC in China will continue to increase at a higher rate than the global level. Spearman correlation analysis showed that ASIR and ASPR of UC in China and the world were significantly positively correlated with SDI (p

Stroke is the second leading cause of death and disability in Latin America; however, few epidemiological studies have been conducted in South America. An observational study was conducted to analyze trends in stroke mortality in South American (SA) countries. Age-standardized mortality rates and proportional mortality due to stroke in the populations of SA countries between 1990 and 2019 were assessed by extracting data from the Global Burden of Disease 2019 study. Joinpoint regression models were employed to identify trends in the annual percentage change in mortality rates for each segment. Considering the data collected over the 30 years that were studied, the age-standardized stroke mortality trend decreased in Argentina (−1.6%), Uruguay (−0.6%), Brazil (−0.5%), Guyana (−0.5%), and Bolivia (−0.4%), while Venezuela (+1.6%) and Suriname (+1.0%) showed an increasing trend. The proportional stroke mortality trend decreased in Argentina (−1.7%), Paraguay (−0.9%), Uruguay (−0.7%), Guyana (−0.7%), Brazil (−0.5%), and Chile (−0.5%), whereas Bolivia (+1.0%), Suriname (+0.6%), and Peru (+0.4%) exhibited an increasing trend. The trends in stroke mortality between 1990 and 2019 demonstrated considerable variability. While most SA countries experienced significant decreases in stroke mortality trends, Venezuela and Suriname showed increases in age-standardized mortality rates, and Bolivia, Suriname, and Peru exhibited increases in proportional mortality rates. No decreasing stroke mortality trend was observed in the segment after the last joinpoint, highlighting the need for improvement in prevention and treatment.

Abstract Objective To evaluate the trend of alcohol use disorder (AUD) mortality as a percentage of all-cause mortality in Canada and the United States (US) between 2000 and 2019, by age group. Results Joinpoint regression showed that AUD mortality as a percentage of all-cause mortality significantly increased between 2000 and 2019 in both countries, and across all age groups (i.e., young adults (20–34 years), middle-aged adults (35–49 years), and older adults (50 + years)). The trend has been levelling off, and even reversing in some cases, in recent years. The average annual percentage change differed across countries and between age groups, with a greater increase among Canadian adults aged 35–49 years and among adults aged 50 + years in the US. Over the past two decades, AUD mortality as a percentage of all-cause mortality has been increasing among all adults in both Canada and the US.

Abstract Background Transport injuries (TI) remains one of leading causes of death in children in China. This study aimed to analyze the temporal trend of disease burden and associated risk factors of TI among children aged 0–14 years in China, utilizing data from 1990 to 2019. Methods We retrieved data of disease burden and risk factors of TI among children aged 0–14 year in China from 1990 to 2019 from the Global Burden of Disease (GBD) dataset. We estimated incidence rate, death rate, and disability adjusted life years (DALYs) rate with a 95% uncertainty interval (95% UI), stratified by age, sex, and all type-road users. Trends in disease burden with annual percentage changes (APC) and average annual percent change (AAPC) were performed by Joinpoint regression model. Results The incidence rate (AAPC = 1.18%, P

Abstract Chronic lower respiratory disease (CLRD) related mortality has decreased in the United States due to increasing awareness in the general population and advancing preventative efforts, diagnostic measures, and treatment. However, demographic and regional differences still persist throughout the United States. In this study, we analyzed the temporal trends of demographic and geographical differences in CLRD-related mortality. Data was extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Using this data, age-adjusted mortality rates per 100,000 people (AAMR), annual percentage change (APC), and average annual percentage changes with 95% confidence intervals (CIs) were assessed. The Joinpoint Regression Program was used to determine mortality trends between 1999 and 2020 based on demographic and regional groups. During this study period, there were 3,064,049 CLRD-related deaths, with most demographics and regional areas showing an overall decreasing trend. However, higher mortality rates were seen in the non-Hispanic White population and rural areas. Interestingly, mortality rates witnessed a decreasing trend for males throughout the study duration compared to females, who only began to show decreases in mortality during the latter half of the 2010s. Using these results, one can target efforts and build policies to improve CLRD-related mortality and reduce disparities in the coming decades.

Objective: To evaluate the trend of alcohol use disorder (AUD) mortality as a percentage of all-cause mortality in Canada and the United States (US) between 2000 and 2019, by age group. Results: Joinpoint regression showed that AUD mortality as a percentage of all-cause mortality significantly increased between 2000 and 2019 in both countries, and across all age groups (i.e., young adults (20–34 years), middle-aged adults (35–49 years), and older adults (50 + years)). The trend has been levelling off, and even reversing in some cases, in recent years. The average annual percentage change differed across countries and between age groups, with a greater increase among Canadian adults aged 35–49 years and among adults aged 50 + years in the US. Over the past two decades, AUD mortality as a percentage of all-cause mortality has been increasing among all adults in both Canada and the US. [ABSTRACT FROM AUTHOR]

Background: Transport injuries (TI) remains one of leading causes of death in children in China. This study aimed to analyze the temporal trend of disease burden and associated risk factors of TI among children aged 0–14 years in China, utilizing data from 1990 to 2019. Methods: We retrieved data of disease burden and risk factors of TI among children aged 0–14 year in China from 1990 to 2019 from the Global Burden of Disease (GBD) dataset. We estimated incidence rate, death rate, and disability adjusted life years (DALYs) rate with a 95% uncertainty interval (95% UI), stratified by age, sex, and all type-road users. Trends in disease burden with annual percentage changes (APC) and average annual percent change (AAPC) were performed by Joinpoint regression model. Results: The incidence rate (AAPC = 1.18%, P < 0.001) of TI among children aged 0–14 years showed an increasing trend, whereas mortality rate (AAPC = -3.87%, P < 0.001) and DALYs rate (AAPC = -3.83%, P < 0.001) decreased annually. Notably, boys experienced a higher increase in incidence (1.30%) compared to girls (1.06%), but a faster decrease in mortality and DALYs rate (-3.90% vs. -3.82%, -3.88% vs. -3.79%, respectively) (Pall < 0.001). Declines in death rates and DALYs rates were observed across all age groups (Pall < 0.001), while remained the highest among children aged 0–4 in 2019. Among different road-type users, cyclist road injuries were identified as the primary cause of TI (182.3 cases per 100,000) while pedestrians were the group with the highest mortality (2.9 cases per 100,000) and DALYs rate (243 cases per 100,000) in 2019. Besides, alcohol use was a significant risk factors for TI, while low temperature appeared to be a protective factor. Conclusion: Future efforts must prioritize raising awareness among children and their guardians to mitigate the disease burden of TI in children. It's critical to enhance preventive interventions for boys, children aged 0–4 and vulnerable road users such as pedestrians and cyclists in future. [ABSTRACT FROM AUTHOR]

Objective To analyze the epidemiological characteristics of injuries deaths among children and adolescents in Shaanxi Province from 2015 to 2022 and provide insight in formulating interventions to prevent accidental deaths among children and adolescents. Methods Analyze the distribution of gender, age groups, and cause of death in injury deaths among children and adolescents in Shaanxi Province from 2015 to 2022. χ² test was used to compare the mortality differences between genders, age groups and years. The Joinpoint regression method was used to analyze the trend of child and adolescent mortality. Average Annual Percent Change (AAPC) was used to describe trends. Results The average mortality of children and adolescents aged 5一19 in Shaanxi Province from 2015 to 2022 was 10. 86/100000, with a standardized mortality of 11. 01/100000, which accounted for 53. 86% of the total deaths among children and adolescents. The mortality of males is 2. 00 times higher than that of females (χ² = 76, 77, P < 0. 001). During the past 8 years, there was no change in injuries mortality among children and adolescents in Shaanxi Province AAPC (95% C/) -4. 21% (-11.06%-- -2.66%) (P > 0. 05). The top two causes of death in injuries among children and adolescents are road injuries and drowning, which accounted for 57.87% of the total deaths among children and adolescents. The average annual death rate of road traffic accidents in the general population and men in 2015--2019 was higher than that in 2020 - 2022 (P <0. 05). The average annual death rate from falls in the general population and women was lower in 2015--2019 than in 2020--2022 (P <0. 05). The mortality of injuries increased with age groups, with the highest in 15--19 age group (χ² = 21. 12, P < 0. 001). The road traffic accident and suicide death rates were the highest in the 15一19 age group (P <0.05). Conclusion The main causes of death in injuries among children and adolescents aged 5-19 in Shanxi Province from 2015 to 2022 are road injuries and drowning. The mortality in injuries is higher in male than female. Targeted prevention and control measures should be taken based on the characteristics of mortality in injuries among children and adolescents in Shaanxi Province. [ABSTRACT FROM AUTHOR]

Objective：To analyze the epidemic characteristics of public health emergencies of infectious disease in Jiangsu Province, and to provide scientific basis for prevention and control efforts. Methods：Joinpoint regression model was used to analyze the temporal trends, and space ⁃time permutation scan was employed for spatiotemporal cluster detection and exploration. Results：From 2004 to 2022, a total of 3 641 emergencies were reported, with 131 880 cases and 73 deaths. There were 1 868 emergencies involving 25 notifiable infectious diseases, including 76 Class A, 391 Class B, and 1 401 Class C diseases. Additionally, 1 773 emergencies of 8 other non⁃notifiable infectious diseases were involved. Joinpoint regression analysis revealed that the number of emergencies in Jiangsu Province showed an increasing trend [average APC (AAPC) = 16.28, P < 0.05)}. Class A showed a declining trend since 2006 (AAPC =-18.23, P < 0.05), while Class B, Class C, and others exhibited increasing trends (AAPC>0, P < 0.05). Emergencies in Southern of Jiangsu, Middle of jiangsu, and Northern of Jiangsu all showed increasing trend (AAPC>0, P < 0.05). In Southern of Jiangsu, the trend was characterized by 4 stages：rapid increase, slow increase, rapid increase, and decrease. In Middle of Jiangsu, Emergencies showed a monotonic increase. In Northern of Jiangsu, the trend was characterized by 4 stages：increase, slow decrease, rapid increase, and decrease. 2006, 2015, and 2018 were major turning points. 8 space - time clusters were detected, sequentially distributed in midde of Jiangsu + Southern of Jiangsu, Northern of Jiangsu, Southern of Jiangsu, and Southern of Jiangsu+Northern of Jiangsu. Conclusion：In Jiangsu Province, infectious disease emergencies showed increasing trends, with clusters in southern and northern regions and relatively scattered in middle region. Priority areas need to focus on monitoring and controlling key diseases such as chickenpox, influenza, and hand foot and mouth disease (HFMD). [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite a global decrease in HIV incidence, recent trends in Türkiye indicate a concerning rise, particularly among younger populations and women. This study investigates the local and regional dynamics influencing these trends using advanced epidemiological methodologies. Material and Methods: Utilizing Age–period–cohort analysis and joinpoint regression, we analysed HIV incidence and prevalence data from the Global Burden of Disease study for Türkiye. These methods allowed for a detailed examination of changes over time, identifying specific age groups and periods with significant shifts in incidence rates. Results: Key findings include a 13.03% increase in annual percentage change among males aged 15–19 and an 11.37% increase among females in the same age group. Additionally, the incidence rates among females have shown a significant rise after 2008. Conclusions: The rising HIV incidence in Türkiye reflects complex socio-economic, cultural, and biological factors, with significant increases among young people and women. Addressing these challenges requires targeted interventions, comprehensive educational programs, and inclusive healthcare services to align with global efforts and commitments. The study underscores the importance of incorporating young people in decision-making processes to effectively combat HIV in Türkiye. [ABSTRACT FROM AUTHOR]

Background: Stroke is the second leading cause of death and the leading cause of disability worldwide. However, how the prevalence of stroke varies across the world is uncertain. Aims: The aim of this study was to analyze temporal trends of prevalence for stroke, including ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) at the global, regional, and national levels. Methods: The age-standardized prevalence rates (ASPR) of stroke, IS, ICH, and SAH, along with their corresponding 95% uncertainty intervals (UI), were derived from data in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This provides estimates for the burden of 369 diseases and injuries globally in 2019, as well as their temporal trends over the past 30 years. Joinpoint regression analysis was used to analyze the 1990–2019 temporal trends by calculating the annual percentage change (APC) and average annual percentage change (AAPC), as well as their 95% confidence interval (CI). Results: In 2019, the global ASPR of stroke was 1240.263 per 100,000 population (95% UI: 1139.711 to 1352.987), with ASPRs generally lower in Europe compared to other regions. Over the period from 1990 to 2019, a significant global decrease in ASPR was observed for stroke (AAPC −0.200, 95% CI: −0.215 to −0.183), IS (AAPC −0.059%, 95% CI: −0.077 to −0.043), SAH (AAPC −0.476, 95% CI: −0.483 to −0.469), and ICH (AAPC −0.626, 95% CI: −0.642 to −0.611). The trends of ASPR of stroke, IS, SAH, and ICH varied significantly across 204 countries and territories. Conclusion: Our findings highlight significant global disparities in stroke prevalence, emphasizing the need for ongoing monitoring and intensified efforts in developing regions to reduce the global burden of stroke. [ABSTRACT FROM AUTHOR]

Objective To analyze the trends in pre-marital medical examinations (PME) and the detection of major diseases, as well as the spatial distribution patterns in Urumqi city from 2012 to 2022, to provide foundational data for disease prevention and promoting healthy births. Methods Based on the “Annual Report on Pre-marital Health” of Urumqi city from 2012 to 2022, descriptive analyses were conducted on the PME rate and the detection of major diseases. The Joinpoint regression analysis and spatial autocorrelation analysis were employed to explore the spatio-temporal distribution characteristics of PME levels. Results The average PME rate in Urumqi over 11 years was 61.79%. A turning point in PME rate occurred in 2015, showing a significant overall upward trend (AAPC=58.012, 95% CI: 34.388-85.790). The average detection rate of diseases during the 11-year period was 6.43%, with statistically significant differences in the detection rates of specified infectious diseases, internal medicine diseases, and reproductive system diseases across different years (P<0.001). Spatially, the PME levels in Urumqi city shifted from low-high aggregation to high-low aggregation. Hotspot areas shifted from Tianshan District in 2012 to Xinshi District in 2022, while cold spot areas shifted from Dabancheng District in 2017 to Tianshan District in 2022. Conclusion The PME rate in Urumqi has increased annually since 2012, but growth has slowed in recent years. The number of detected diseases has increased, with varied incidences between males and females. While overall spatial aggregation of PME levels is not significant, local areas exhibit diverse aggregation levels. Further efforts are needed to enhance pre-marital health services citywide, supporting early disease prevention and promoting healthy births. [ABSTRACT FROM AUTHOR]

Chronic lower respiratory disease (CLRD) related mortality has decreased in the United States due to increasing awareness in the general population and advancing preventative efforts, diagnostic measures, and treatment. However, demographic and regional differences still persist throughout the United States. In this study, we analyzed the temporal trends of demographic and geographical differences in CLRD-related mortality. Data was extracted from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database. Using this data, age-adjusted mortality rates per 100,000 people (AAMR), annual percentage change (APC), and average annual percentage changes with 95% confidence intervals (CIs) were assessed. The Joinpoint Regression Program was used to determine mortality trends between 1999 and 2020 based on demographic and regional groups. During this study period, there were 3,064,049 CLRD-related deaths, with most demographics and regional areas showing an overall decreasing trend. However, higher mortality rates were seen in the non-Hispanic White population and rural areas. Interestingly, mortality rates witnessed a decreasing trend for males throughout the study duration compared to females, who only began to show decreases in mortality during the latter half of the 2010s. Using these results, one can target efforts and build policies to improve CLRD-related mortality and reduce disparities in the coming decades. [ABSTRACT FROM AUTHOR]

BackgroundSuicide is a serious public health problem that affects our entire country. The aim of this research was to study the variation in completed suicide rates between 2010 and 2022 in Spain and their relationship with the consumption of addictive substances.MethodsCompleted suicide data from the Spanish Statistical Office (INE) were analyzed with a joinpoint regression model to determine time trends. The relationship between the variation in completed suicide rates with sociodemographic variables, including depression rates, obtained from the Spanish Statistical Office and variables related to the consumption of substances obtained from the survey on alcohol and other drugs in Spain (EDADES) of the Government Delegation for the National Plan on Drugs (DGPNSD) was also studied using an exploratory analysis and also performing a Generalized Additive Model.ResultsThe joinpoint regression model did reveal a point of significant change in the period studied for Spain showing a trend of increased suicide death rates for the studied period. The following variables correlated positively with the variation in completed suicide rates in the Generalized Additive Model: alcohol use in the past 12 months, alcohol use in the last 30 days, daily alcohol use in the last 30 days, binge drinking in the last 12 months, binge drinking in the last month, positive Alcohol Use Disorder Test for risky alcohol use, benzodiazepine use in the last 12 months, benzodiazepine use in the last month, daily benzodiazepine use in the last month, use of illegal substances in the last 12 months, use of illegal substances in the last month, mean age and depression rates.ConclusionApplying preventive strategies on the risky consumption of alcohol, benzodiazepines and illegal substances would help reduce the rates of completed suicide in Spain.

Abstract Background This study aimed to analyze the trends of Parkinson’s disease (PD) mortality rates among Chinese residents from 2004 to 2021, provide evidence for the formulation of PD prevention and control strategies to improve the quality of life among PD residents. Methods Demographic and sociological data such as gender, urban or rural residency and age were obtained from the National Cause of Death Surveillance Dataset from 2004 to 2021. We then analyzed the trends of PD mortality rates by Joinpoint regression. Results The PD mortality and standardized mortality rates in China showed an overall increasing trend during 2004–2021 (average annual percentage change [AAPC] = 7.14%, AAPCASMR=3.21%, P 85 years was the highest. Considering gender, female aged > 85 years had the fastest mortality trend (annual percentage change [APC] = 5.69%, P 85 years were risk factors for PD-related death and should be the primary focus for PD prevention.

Qilin Han,1,2 Yifan Li,3 Yao Liu,1 Xuehan Zhu,1 Qiqi An,4 Yameng Li,5 Tingting Wang,5 Yuzhen Zhang,1,2 Yingying Li,5 Weiwei Fang,1,2 Ningning Tao,1,&ast; Huaichen Li1,2,&ast; 1Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China; 2Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, Shandong, 250117, People’s Republic of China; 3Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Shandong First Medical University (Affiliated Hospital of Shandong Academy of Medical Sciences), Jinan, Shandong, 250031, People’s Republic of China; 4Department of Pulmonary and Critical Care Medicine, Xingyi People’s Hospital, Qianxinan, Guizhou, 561499, People’s Republic of China; 5Shandong University of Traditional Chinese Medicine, Jinan, Shandong, 250355, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Ningning Tao, Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China, Email 826794467@qq.com Huaichen Li, Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwuweiqi Road, Huaiyin District, Jinan, Shandong, 250021, People’s Republic of China, Email lihuaichen@163.comPurpose: To analyze the time trends in the notification rates of registered tuberculosis (TB) and bacteriologically confirmed TB in Shandong Province. And analyze the changes in TB treatment outcomes during 2005– 2021.Patients and Methods: The information of TB patients registered in the Shandong Information Center for Disease Control and Prevention (CDC) was collected during 2005– 2021. We calculated the notification rates of registered TB and bacteriologically confirmed TB. Moreover, we calculated the year-to-year change rate of TB in treatment outcomes before and after COVID-19. The time trends were analyzed using the joinpoint regression method and illustrated as the annual percentage change (APC) of notification rates.Results: A total of 236,898 cases of TB were diagnosed during 2005– 2021, of which 51.11% were bacteriologically confirmed cases. Since 2008, the notification rates of registered TB have declined. The notification rates of bacteriologically confirmed TB had been declining during 2005– 2016, then remained stable after 2016. In subgroup, the notification rates of both registered TB and bacteriologically confirmed TB were higher among men, rural residents, and people aged ≥ 60 years. Compared with clinically confirmed TB, bacteriologically confirmed TB has shown higher rates of poor outcomes since 2008 and higher case fatality rate since 2005. The rate of poor outcomes remained stable during 2008– 2019. However, after the COVID-19 outbreak, the rate of poor outcomes and case fatality rate of TB has risen significantly.Conclusion: After unremitting efforts to fight against TB, the notification rates of registered TB and bacteriologically confirmed TB declined in Shandong Province. The rate of poor outcomes remained stable during 2008– 2019, then rise significantly after the COVID-19 outbreak. In the context of the long-term existence of COVID-19, further efforts should be made in TB diagnosis and treatment among high-risk population, especially with regard to males, rural residents and older adults.Keywords: tuberculosis, joinpoint regression, time trends, COVID-19

Background Overweight, obesity, and central obesity have become significant public health issues globally, affecting the well-being of residents. Analyzing the prevalence trends of overweight, obesity, and central obesity among residents in Shanxi Province can provide valuable scientific insights for the prevention and control of related diseases. Objective To analyze the prevalence and trends of overweight, obesity, and central obesity among adults aged 20 and above in Shanxi Province between 2010 and 2018. Methods The survey data of adults aged 20 and above in Shanxi Province were collected during four rounds of the China Chronic Disease Surveillance project from August 2010 to November 2018 (in 2010, 2013, 2015, and 2018) to calculate the rates of overweight, obesity, and central obesity among adults aged 20 and above in different years, and analyze the prevalence trends of overweight, obesity and central obesity for different characteristics of the study subjects. Results From 2010 to 2018, the overall crude rates and age- and gender-standardized rates of overweight among adults aged 20 and above in Shanxi Province ranged from 37.7% to 40.1% and 36.1% to 39.6%, respectively, with no significant upward trend (Z=0.005, 2.413; P=0.942, 0.120). The overall standardized obesity rate, overall crude rate of central obesity and the standardized rate central of obesity increased from 17.2%, 53.8%, and 52.4% in 2010 to 20.0%, 61.6%, and 60.2% in 2018, respectively (Z=8.100, 10.994, 12.218; P0.05) ; the standardized overweight rate for males was higher than that for females (χ2=4.259, P0.05) ; the overall obesity rate, male obesity rate, and both male and female central obesity rates in the age group of 20-39 years old showed an upward trend during the 8-year period (P0.05). There was also no significant difference in the trends of these rates between different genders and regions (P>0.05) . Conclusion From 2010 to 2018, the overweight rate among residents aged 20 and above in Shanxi Province remained stable, while the overall trends for obesity and central obesity rates showed an increasing trend. The prevention and control of obesity and central obesity should focus on the population aged 20-39 years to slow down the growth rate. For residents aged 40 and above, as well as urban residents, targeted prevention strategies should be implemented, so as to control the prevalence of overweight, obesity, and central obesity.

Abstract Background In China, the rising prevalence of high Body Mass Index (BMI) is linked to increasing health issues, including Alzheimer’s disease (AD). This study analyzes mortality trends related to AD and other dementias associated with high BMI from 1990 to 2019, considering age, period, and birth cohort effects, and forecasts future trends. Methods We analyzed mortality data for AD and other dementias linked to high BMI in Chinese residents from the Global Burden of Disease 2019 database. Using Joinpoint regression, we examined age-standardized mortality rate (ASMR) trends and calculated annual and average annual percentage changes (APC and AAPC). Age-period-cohort models provided deeper insights, with Bayesian models used to project future ASMR trends to 2042. Results From 1990 to 2019, the ASMR for AD and other dementias associated with high BMI in China showed an overall increasing trend. Females had a lower increase rate than males, yet their overall levels remained higher. Specifically, the ASMR for males increased by an average of 2.70% per year, peaking between 2006 and 2010, while for females, it increased by an average of 2.29% per year, also peaking in the same period. Age-period-cohort analysis revealed increasing mortality relative risk with age and period, but a decrease with birth cohort. Projections suggest a continued rise in ASMR by 2042, with rates for males and females expected to be 2.48/100,000 and 2.94/100,000, respectively. Conclusion The increasing mortality trend from AD and other dementias associated with high BMI highlights the urgent need for policy interventions focused on overweight prevention, particularly vital for addressing the health challenges in China’s aging population.

Background: Tuberculosis (TB) is a major public health issue in South Asia and accounts for a large share of the global TB burden. Despite global efforts to curb TB incidence and mortality, progress in South Asia has been uneven, necessitating focused regional analysis to guide effective interventions. This study aims to analyse the trends in the TB burden in South Asia from 1990 to 2021 and project future TB incidence rates up to 2031. Methods: This study utilized data from the Global Burden of Disease (GBD) 2021 results to analyse trends in age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life years (DALYs) rates (ASDR) associated with TB in South Asia from 1990 to 2021. Joinpoint regression analysis was employed to identify significant trends, whereas ARIMA models were used to project future TB incidence rates up to 2031. Results: This study revealed significant declines in the ASIR, ASPR, ASDR, and ASMR related to TB in South Asia over the past three decades. Prominent reductions were found in Bangladesh and Bhutan, whereas India, Pakistan, and Nepal continue to bear the highest TB burdens. The ARIMA model projections indicate a continued decline in TB incidence across the region, although the extent of the decline varies by country, with less favourable trends observed in Nepal and Pakistan. The analysis also highlights tobacco use, high fasting plasma glucose, and high body mass index as significant risk factors contributing to the TB burden. Conclusions: Substantial progress has been made in reducing the TB burden in South Asia; however, sustained and intensified efforts are needed, particularly in countries with inconsistent progress. These findings emphasize the need for targeted interventions to meet the WHO End TB Strategy (WETS) targets by 2035. Continuous monitoring and adaptive strategies will be crucial in maintaining and accelerating progress toward TB elimination in South Asia.

Objective To analyze the time trend and potential influencing factors of hospitalization of children with mental disorders in Beijing. Methods The information on hospital admissions of children with mental disorders living in Beijing from 2014 to 2018 was collected. Joinpoint regression model and grey correlation analysis were used to explore the changing trend of hospital admissions and the correlation intensity of the influencing factors. Results From 2014 to 2018, the number of hospitalized children with mental disorders showed an upward trend with an average annual change rate of 19.33%. In the subgroup, the number of hospitalized children with mood disorders increased most rapidly (average annual percentage rate change (AAPC) = 34.39%), followed by female children (AAPC=31.97%). The results of grey correlation analysis showed that per capita disposable income (correlation degree 0.841) and per capita GDP (correlation degree 0.837) had the strongest correlation with the number of hospitalized children with mental disorders. Conclusion The number of hospitalized children with mental disorders increased significantly from 2014 to 2018, and the trend of hospitalization of children witli mental disorders with different characteristics and the correlation order of influencing factors were different We should focus on the strongly related factors of different children with mental disorders and strengthen the mental health education and prevention and control of children in Beijing so as to provide reference for the formulation of relevant policies. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to study the primary risk factors for the long-term trends of mortality rates in ischemic stroke (IS) in China. Methods: Using the Global Burden of Disease Study 2019 (GBD 2019) database, research was conducted on the 11 primary risk factors for the mortality rates of IS in China from 1990 to 2019. This study employed joinpoint regression software and the age-period-cohort method to evaluate the trends of mortality rates divided by age, period, and cohort over time. Results: From 1990 to 2019, the age-standardized mortality rate (ASMR) caused by a diet high in red meat and high body mass index in China showed an upward trend. ASMR increased first and then decreased due to smoking, diet high in sodium, particulate matter pollution, high fasting plasma glucose, and high systolic blood pressure. Low-density lipoprotein cholesterol (LDL-C), kidney dysfunction, low temperature, and lead exposure remained relatively stable during this period. In the 35–45 age group, the mortality rate of IS due to high LDL-C was up to about 60%, and smoking affected men more than women. Overall, high LDL-C, high systolic blood pressure, and particulate matter pollution were the most common risk factors in patients with IS. The risk of death rose with age. The period and cohort relative risks showed that metabolic risk factors had the greatest impact on the mortality of IS. Conclusion: Metabolic risk factors have become the primary risk factors for the ASMR of IS in China. Relevant authorities should pay attention to their long-term effects on IS. Effective public health policies and interventions should be implemented to reduce the burden of IS. [ABSTRACT FROM AUTHOR]

Background: This study aimed to analyze the trends of Parkinson’s disease (PD) mortality rates among Chinese residents from 2004 to 2021, provide evidence for the formulation of PD prevention and control strategies to improve the quality of life among PD residents. Methods: Demographic and sociological data such as gender, urban or rural residency and age were obtained from the National Cause of Death Surveillance Dataset from 2004 to 2021. We then analyzed the trends of PD mortality rates by Joinpoint regression. Results: The PD mortality and standardized mortality rates in China showed an overall increasing trend during 2004–2021 (average annual percentage change [AAPC] = 7.14%, AAPCASMR=3.21%, P < 0.001). The mortality and standardized mortality rate in male (AAPC = 7.65%, AAPCASMR=3.18%, P < 0.001) were higher than that of female (AAPC = 7.03%, AAPCASMR=3.09%, P < 0.001). The PD standardized mortality rates of urban (AAPC = 5.13%, AAPCASMR=1.76%, P < 0.001) and rural (AAPC = 8.40%, AAPCASMR=4.29%, P < 0.001) residents both increased gradually. In the age analysis, the mortality rate increased with age. And the mortality rates of those aged > 85 years was the highest. Considering gender, female aged > 85 years had the fastest mortality trend (annual percentage change [APC] = 5.69%, P < 0.001). Considering urban/rural, rural aged 80–84 years had the fastest mortality trend (APC = 6.68%, P < 0.001). Conclusions: The mortality rate of PD among Chinese residents increased from 2004 to 2021. Male sex, urban residence and age > 85 years were risk factors for PD-related death and should be the primary focus for PD prevention. [ABSTRACT FROM AUTHOR]

Objective Gastroschisis is a full-thickness congenital defect of the abdominal wall through which intestines and other organs may herniate. In a prior analysis, attempted vaginal delivery with fetal gastroschisis appeared to increase through 2013, although cesarean delivery remained common. The objective of this analysis was to update current trends in attempted vaginal birth among pregnancies complicated by gastroschisis. Study Design We performed an updated cross-sectional analysis of live births from 2014 and 2020 using data from the U.S. National Vital Statistics System and evaluated trends in attempted vaginal deliveries among births with gastroschisis. Trends were evaluated using joinpoint regression. We constructed logistic regression models to evaluate the association between demographic and clinical variables and attempted vaginal delivery in the setting of gastroschisis. Results Among 5,355 deliveries with gastroschisis meeting inclusion criteria, attempted vaginal delivery increased significantly from 68.9% to 75.1%, an average annual percent change of 1.7% (95% confidence interval [CI], 0.8–2.5). Among gastroschisis-complicated pregnancies, patients 35 to 39 years old (adjusted odds ratio [aOR], 0.53; 95% CI, 0.37–0.79) and Hispanic race/ethnicity (aOR, 0.69; 95% CI, 0.58–0.62) were at lower likelihood of attempted vaginal delivery in adjusted analyses. Conclusion These findings suggest that vaginal delivery continues to increase in the setting of gastroschisis. Further reduction of surgical delivery for this fetal defect may be possible. Key Points Vaginal deliveries increased among gastroschisis pregnancies. Hispanic patients were less likely to attempt vaginal delivery. Some gastroschisis pregnancies still deliver surgically. [ABSTRACT FROM AUTHOR]

Background: In China, the rising prevalence of high Body Mass Index (BMI) is linked to increasing health issues, including Alzheimer's disease (AD). This study analyzes mortality trends related to AD and other dementias associated with high BMI from 1990 to 2019, considering age, period, and birth cohort effects, and forecasts future trends. Methods: We analyzed mortality data for AD and other dementias linked to high BMI in Chinese residents from the Global Burden of Disease 2019 database. Using Joinpoint regression, we examined age-standardized mortality rate (ASMR) trends and calculated annual and average annual percentage changes (APC and AAPC). Age-period-cohort models provided deeper insights, with Bayesian models used to project future ASMR trends to 2042. Results: From 1990 to 2019, the ASMR for AD and other dementias associated with high BMI in China showed an overall increasing trend. Females had a lower increase rate than males, yet their overall levels remained higher. Specifically, the ASMR for males increased by an average of 2.70% per year, peaking between 2006 and 2010, while for females, it increased by an average of 2.29% per year, also peaking in the same period. Age-period-cohort analysis revealed increasing mortality relative risk with age and period, but a decrease with birth cohort. Projections suggest a continued rise in ASMR by 2042, with rates for males and females expected to be 2.48/100,000 and 2.94/100,000, respectively. Conclusion: The increasing mortality trend from AD and other dementias associated with high BMI highlights the urgent need for policy interventions focused on overweight prevention, particularly vital for addressing the health challenges in China's aging population. [ABSTRACT FROM AUTHOR]

Background and Objective: Occupational injuries are considered one of the most critical health, social, and economic risk factors in industrial and developing societies, such as Iran. The long-term trend of these injuries has not been investigated in Hamadan province. Therefore, the present study aimed to assess the trend of mortality and Disability Adjusted Life Years (DALYs) rates due to occupational injuries in Hamedan province from 1990 to 2021. Materials and Methods: In this cross-sectional descriptive study, the trend of changes in the mortality and DALYs due to occupational injuries in Hamedan province over 32 years was investigated using Joinpoint Regression software (version 5.1.0). Results: The DALYs (due to premature death and disability) from occupational injuries in Hamedan province decreased from 496.75 years per thousand population in 1990 to 229.98 years per thousand population in 2021 (the average annual percent changes (AAPC) was -2.40 and 95% confidence interval: -2.60 to -2.30). This decreasing trend in DALY caused by occupational injuries was also evident in men and women (the AAPC in men and women was -2.40% and -1.10%, respectively). Furthermore, the mortality rate due to injuries in both genders decreased from 7.55 cases per 100,000 population in 1990 to 3.46 cases per 100,000 population in 2021 (AAPC was -2.50% (95% CI: -- 2.60% to -2.40%). Conclusion: Consistent with other studies conducted in Iran and the world, the trend of mortality and DALYs due to occupational injuries in Hamedan province had a decreasing trend. [ABSTRACT FROM AUTHOR]

Background: In the Americas, deaths by diseases avoidable with vaccines are a significant contributor to child mortality. An essential means of reducing this is through broad vaccine coverage. The COVID-19 pandemic has posed a potential disruption to vaccine coverage due to its effects on the healthcare system. Objectives: this study aims to evaluate the impact of the COVID-19 pandemic on DTP3 vaccination coverage in the Americas, investigating trends from 2012 to 2022 to identify significant changes, regional disparities, and the overall effect of the pandemic on progress towards global immunization targets. Methods: This study used the coverage data for the third dose of the diphtheria, tetanus, and pertussis vaccine (DTP3) pulled from UNICEF databases spanning 2012 to 2022. We conducted a Joinpoint regression to identify points of significant trend changes. The annual percentage change (APC) and 95% confidence intervals (95% CIs) were calculated for America and its regions. We also used segmented regression analysis. Using the Chi-square test, we compared DTP3 vaccination coverage for each country between 2019 and 2022. Results: Overall, America saw a decrease in vaccine coverage during this period, with an APC of −1.4 (95% CI −1.8; −1.0). This trend varied across regions. In North America, the decrease was negligible (−0.1% APC). South America showed the steepest decrease, with an APC of −2.5%. Central America also declined, with an APC of −1.3%. Our findings suggest a concerning trend of declining DTP-vaccination rates in the Americas, exacerbated in certain regions, in the wake of the COVID-19 pandemic. The absolute decrease in vaccine coverage in the Americas was −4% between 2019 and 2022, with the most important drop being in Central America (−7%). However, six countries reported increased vaccination rates post-COVID-19, led by Brazil, with a 7% increase. Conversely, twenty-two countries registered a decline in DTP3 vaccine coverage, with the average decrease being −7.37%. This decline poses an important challenge to achieving the WHO's target of 90% coverage for the third dose of DTP by 2030, as evidenced by the reduction in the number of countries meeting this target from 2019 to 2022. Conclusions: The COVID-19 pandemic has impacted vaccine coverage in America, leading to a decrease, especially across Central America. [ABSTRACT FROM AUTHOR]

BackgroundThis study explored the epidemiological trends in pelvic fracture (PF) in China from 1992 to 2021, analyze their relationships with age–period–cohort (APC) factors, and predict the trends of PF from 2022 to 2046.MethodsIncidence and years lived with disabilities (YLDs) of PF among sexes in China from 1992 to 2021 were obtained through the 2021 Global Burden of Disease (GBD) database. Trends in the incidence and YLDs were described, and a joinpoint regression model was used. The APC model was used to explore the effects of age, period, and cohort on the incidence and YLDs. Nordpred forecasted the incidence and YLDs in China from 2022 to 2046.ResultsIn 2021, there were an estimated 0.63 million incidence cases and 0.33 million of YLDs, respectively. The number and age-standardized rate (ASR) of incidence and YLDs were both gradually increased. The average annual percent change (AAPC) in incidence and YLDs for men were 0.26% and −0.17%, respectively. For women, the AAPC values for incidence and YLDs were −0.03% and −0.57% (p 95 years for incidence and aged 90–94 years for YLDs. The period effect showed a totally increase in the risk across the general, male, and female populations. Cohort effects indicated a totally significant decline for both incidence and YLDs. The predicted incidence and YLDs of PF in China from 2022 to 2046 showed an initial rise, followed by a decline, with 2029 and 2034 being the turning point for incidence and YLDs, respectively.ConclusionThe characteristics of pelvic fracture incidence and YLDs in China are complex. Thus, primary prevention measures must be strengthened. Raising awareness about osteoporosis prevention, enhancing public health education, and promoting good dietary and hygiene habits are appropriate preventive measures for PF in China.

Background and Objective: Due to the growing trend of the cesarean section rate in Iran in the past years, the natural childbirth promotion program was implemented as one of the health system transformation plans in 2014. The present study aimed to assess the trend of changes in the percentage of cesarean deliveries following the implementation of this program in Hamadan province. Materials and Methods: This longitudinal study was conducted using secondary data to investigate the changes in the rate of cesarean delivery during 22 years. The data required for this study included deliveries from April 1998 to March 2019 by delivery type. The statistical analysis of this study was performed in joinpoint software (version 3.4) using the joining point regression method. Results: The percentage of cesarean deliveries in the whole province during the study period has constantly increased, from 32% in 2017 to 48% in 2019. The results of the joinpoint regression indicated an annual increase of 1.9% in the trend of cesarean section in Hamadan province. The trend has some joinpoints, none of which correspond to the timing of the implementation of the health evolution plan. Conclusion: Based on the obtained results, although the transformation plan has been able to reduce the increasing percentage of cesarean births, this amount of change was not sufficient to achieve the predetermined goals of the health transformation plan.

Introduction Despite that the smoking prevalence has considerably declined in Australia after successful public health strategies over many decades, smoking is still the leading cause of preventable diseases and death in Australia. These declines have not occurred consistently across all geographical–demographic domains. In order to provide an evidence base for monitoring the trend towards the goal of reducing smoking across all domains in Australia, this study aims to estimate trends of smoking prevalence for small domains cross-classified by seven age groups (18–24, 25–29, 30–39, 40–49, 50–59, 60–69, and ≥70 years), two genders, and eight states and territories over twenty years (2001–2021). Methods Direct estimates of smoking prevalence for the target small domains were calculated from the micro-data of the Australian National Health Surveys conducted in seven rounds during 2001–2021. The obtained direct estimates were then used as input for developing time-series models expressed in a hierarchical Bayesian structure as a form of small-area estimation. The developed models borrow cross-sectional, temporal, and spatial strength in such a way that they can interpolate smoking levels in the non-survey years for all detailed level small domains. Smoothed trends of smoking prevalence for higher aggregation levels are obtained by aggregation of the detailed level trend predictions. Results Model-based small area estimators provide consistent and reasonable smoothed trends at both detailed and higher aggregation levels. Results show that the national-level trend exhibits a steeper linear decline over the study period, from 24% in 2001 to 12% in 2021, with a considerable gender difference of around 5% over the period, with males reporting a higher prevalence. Improved model-based estimates at the state level and by age also show steady declines in trends except for the Northern Territory (still above 20%) and older age groups 60–69 and ≥70 years (declining trends remain stable after 2012). Conclusions The findings of the study identify the geographical–demographic groups that had poor improvement over the period 2001–2021, and are still behind the target of achieving lower smoking prevalence. These, in turn, will help health researchers and policymakers deliver targeted programs to the most vulnerable, enabling the nation to meet its health goals in a timely way.

Abstract Background Tuberculosis(TB) remains a pressing public health challenge, with multidrug-resistant tuberculosis (MDR-TB) emerging as a major threat. And healthcare authorities require reliable epidemiological evidence as a crucial reference to address this issue effectively. The aim was to offer a comprehensive epidemiological assessment of the global prevalence and burden of MDR-TB from 1990 to 2019. Methods Estimates and 95% uncertainty intervals (UIs) for the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized disability-adjusted life years rate (ASR of DALYs), and age-standardized death rate (ASDR) of MDR-TB were obtained from the Global Burden of Disease (GBD) 2019 database. The prevalence and burden of MDR-TB in 2019 were illustrated in the population and regional distribution. Temporal trends were analyzed by using Joinpoint regression analysis to calculate the annual percentage change (APC), average annual percentage change (AAPC) and its 95% confidence interval(CI). Results The estimates of the number of cases were 687,839(95% UIs: 365,512 to 1223,262), the ASPR were 8.26 per 100,000 (95%UIs: 4.61 to 15.20), the ASR of DALYs were 52.38 per 100,000 (95%UIs: 22.64 to 97.60) and the ASDR were 1.36 per 100,000 (95%UIs: 0.54 to 2.59) of MDR-TB at global in 2019. Substantial burden was observed in Africa and Southeast Asia. Males exhibited higher ASPR, ASR of DALYs, and ASDR than females across most age groups, with the burden of MDR-TB increasing with age. Additionally, significant increases were observed globally in the ASIR (AAPC = 5.8; 95%CI: 5.4 to 6.1; P

ObjectiveTo analyze the epidemiological distribution and temporal trends of liver cancer incidence among Luzhou residents from 2016‒2022， and to provide a theoretical basis for improving liver cancer prevention and treatment strategies in Luzhou.MethodsData on liver cancer incidence among Luzhou residents from 2016 to 2022 were collected， and the incidence rate， age-specific incidence rate， and annual percentage change （APC） were calculated. A Joinpoint regression model was used to fit a time series segment to the monthly number of new cases in each district and county of Luzhou to explore the trend of liver cancer incidence rate.ResultsThe incidence rate of liver cancer in Luzhou increased from 22.96/105 in 2016 to 32.31/105 in 2022. The incidence rate of liver cancer in men was higher than that in women in both 2016 and 2022， and the incidence rate of liver cancer in men increased from 34.83/105 in 2016 to 47.95/105 in 2022， with an APC of 3.3%； the incidence rate of liver cancer in women increased from 10.50/105 in 2016 to 15.95/105 in 2022， with an APC of 3.0%， and the differences in the change trends were not statistically significant （P>0.05）.The incidence of liver cancer was low in the age group of 0‒

Li-Ting Kao,1 Shian-Chin Ko,2 Ping-Jen Chen,3,4 Yu-Cih Wu,5 Kuang-Ming Liao,6 Yi-Shan Liang,1 Chung-Han Ho,5,7,8 Fu-Wen Liang9– 11 1Department of Respiratory Therapy, Chi Mei Medical Center, Tainan, Taiwan; 2Center for Palliative Care, Chi Mei Medical Center, Tainan, Taiwan; 3Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 4School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 5Department of Medical Research, Chi Mei Medical Center, Tainan City, Taiwan; 6Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, Taiwan; 7Department of Information Management, Southern Taiwan University of Science and Technology, Tainan City, Taiwan; 8Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; 9Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; 10Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; 11Center for Big Data Research, Kaohsiung Medical University, Kaohsiung, TaiwanCorrespondence: Chung-Han Ho, Department of Medical Research, Chi Mei Medical Center, No. 901, Zhonghua Road Yongkang District, Tainan City, 71004, Taiwan, Tel +886-6-281-2811, Email ho.c.hank@gmail.com Fu-Wen Liang, Department of Public Health, College of Health Sciences, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin District, Kaohsiung, 807, Taiwan, Tel +886-7-312-1101 Ext 2786, Fax +886-7-311-0811, Email fwliang@kmu.edu.twPurpose: Palliative care utilization among hospitalized patients with advanced chronic obstructive pulmonary disease (COPD) in Taiwan remains low despite its costs making it eligible for reimbursement since 2009. Few studies have examined the trends of palliative care utilization. We analyzed the annual rate, associated factors, and timing of the inpatient palliative care utilization by hospitalized patients with COPD.Patients and Methods: We conducted a cross-sectional observational study between 1 January 2007 and 31 December 2018. Population-based claims data were extracted from Taiwan’s National Health Insurance Research Database to identify patients aged ≧40 years with COPD five years before the first instance of inpatient palliative care utilization.Results: There were 24,502 patients with COPD receiving inpatient palliative care. Our results indicated that older age, concomitant chronic conditions—especially cancer—and severity of comorbidities were associated with a higher rate of palliative care utilization by hospitalized patients with chronic obstructive pulmonary disease. In our study, the proportion of hospitalized patients with COPD receiving inpatient palliative care and having a Charlson comorbidity index score of 1– 2 was lower than that of patients with cancer and a Charlson comorbidity index score ≧3 during the 12-year study-observation period. In addition, approximately 50% of hospitalized patients with COPD received palliative care within 18 months after their initial admission for COPD during the study period. However, individuals with a CCI score of 1– 2 exhibited a slower entry into palliative care, with nearly 50% initiating it within the first two years.Conclusion: Inpatient palliative care utilization by hospitalized patients with advanced COPD remains low due to various causes. Our findings highlight that palliative care may be considered by professional care providers as routine care and as a way to manage problematic symptoms during hospitalization.Keywords: cancer comorbidity, inpatient care, joinpoint regression, Taiwan’s health insurance database

Background: Tuberculosis(TB) remains a pressing public health challenge, with multidrug-resistant tuberculosis (MDR-TB) emerging as a major threat. And healthcare authorities require reliable epidemiological evidence as a crucial reference to address this issue effectively. The aim was to offer a comprehensive epidemiological assessment of the global prevalence and burden of MDR-TB from 1990 to 2019. Methods: Estimates and 95% uncertainty intervals (UIs) for the age-standardized prevalence rate (ASPR), age-standardized incidence rate (ASIR), age-standardized disability-adjusted life years rate (ASR of DALYs), and age-standardized death rate (ASDR) of MDR-TB were obtained from the Global Burden of Disease (GBD) 2019 database. The prevalence and burden of MDR-TB in 2019 were illustrated in the population and regional distribution. Temporal trends were analyzed by using Joinpoint regression analysis to calculate the annual percentage change (APC), average annual percentage change (AAPC) and its 95% confidence interval(CI). Results: The estimates of the number of cases were 687,839(95% UIs: 365,512 to 1223,262), the ASPR were 8.26 per 100,000 (95%UIs: 4.61 to 15.20), the ASR of DALYs were 52.38 per 100,000 (95%UIs: 22.64 to 97.60) and the ASDR were 1.36 per 100,000 (95%UIs: 0.54 to 2.59) of MDR-TB at global in 2019. Substantial burden was observed in Africa and Southeast Asia. Males exhibited higher ASPR, ASR of DALYs, and ASDR than females across most age groups, with the burden of MDR-TB increasing with age. Additionally, significant increases were observed globally in the ASIR (AAPC = 5.8; 95%CI: 5.4 to 6.1; P < 0.001), ASPR (AAPC = 5.9; 95%CI: 5.4 to 6.4; P < 0.001), ASR of DALYs (AAPC = 4.6; 95%CI: 4.2 to 5.0; P < 0.001) and ASDR (AAPC = 4.4; 95%CI: 4.0 to 4.8; P < 0.001) of MDR-TB from 1990 to 2019. Conclusions: This study underscored the persistent threat of drug-resistant tuberculosis to public health. It is imperative that countries and organizations worldwide take immediate and concerted action to implement measures aimed at significantly reducing the burden of TB. [ABSTRACT FROM AUTHOR]

INTRODUCTION Despite that the smoking prevalence has considerably declined in Australia after successful public health strategies over many decades, smoking is still the leading cause of preventable diseases and death in Australia. These declines have not occurred consistently across all geographical-demographic domains. In order to provide an evidence base for monitoring the trend towards the goal of reducing smoking across all domains in Australia, this study aims to estimate trends of smoking prevalence for small domains cross-classified by seven age groups (18-24, 25-29, 30-39, 40-49, 50-59, 60-69, and ≥70 years), two genders, and eight states and territories over twenty years (2001-2021). METHODS Direct estimates of smoking prevalence for the target small domains were calculated from the micro-data of the Australian National Health Surveys conducted in seven rounds during 2001-2021. The obtained direct estimates were then used as input for developing time-series models expressed in a hierarchical Bayesian structure as a form of small-area estimation. The developed models borrow cross-sectional, temporal, and spatial strength in such a way that they can interpolate smoking levels in the non-survey years for all detailed level small domains. Smoothed trends of smoking prevalence for higher aggregation levels are obtained by aggregation of the detailed level trend predictions. RESULTS Model-based small area estimators provide consistent and reasonable smoothed trends at both detailed and higher aggregation levels. Results show that the national-level trend exhibits a steeper linear decline over the study period, from 24% in 2001 to 12% in 2021, with a considerable gender difference of around 5% over the period, with males reporting a higher prevalence. Improved model-based estimates at the state level and by age also show steady declines in trends except for the Northern Territory (still above 20%) and older age groups 60-69 and ≥70 years (declining trends remain stable after 2012). CONCLUSIONS The findings of the study identify the geographical-demographic groups that had poor improvement over the period 2001-2021, and are still behind the target of achieving lower smoking prevalence. These, in turn, will help health researchers and policymakers deliver targeted programs to the most vulnerable, enabling the nation to meet its health goals in a timely way. [ABSTRACT FROM AUTHOR]

Adolescents and young adults are the driving force of social development, and the prevalence of acute viral hepatitis (AVH) in this population cannot be ignored. At present, there are few studies on the disease burden of AVH in this age group, and most studies focus on chronic liver disease. In this study, we identified global trends in the burden of AVH among adolescents and young adults (15–29) to help policymakers implement precise disease interventions. In this observational study of disease trends, we collected data exclusively from the Global Burden of Disease (GBD) 2019 study. This study examined the trends in the prevalence, incidence and mortality of AVH among adolescents and young adults in 21 regions of the world from 2009 to 2019. Age‐specific disease trends were analysed with a joinpoint regression model. The overall global disease burden of AVH declined. The prevalence rate per 100,000 people decreased from 316.13 in 2009 to 198.79 in 2019, the incidence rate decreased from 3245.52 in 2009 to 2091.93 in 2019, and the death rate decreased from 0.87 in 2009 to 0.43 in 2019. During the study period, the prevalence of hepatitis B virtues (HBV) in the young population decreased, but the downward trend of other types of hepatitis other than HBV was not obvious, especially HAV, which even showed an upward trend. Among adolescents and young adults aged 15–29 years, Western Saharan Africa had the highest prevalence of AVH in 2019. There were significant differences in mortality rates among different age groups; 20–24 was the age group with the highest mortality rate from 2009 to 2019, followed by the 15–19 and 25–29 age groups. Although the overall global AVH disease burden declined, some causes of AVH, such as HAV, showed an upward trend during the study period. In addition, the prevalence of AVH among adolescents and young adults in Asia and Africa was higher than that in other parts of the world and warrants more attention. Finally, more research should be conducted on mortality in the 20–24 age group. [ABSTRACT FROM AUTHOR]

Background Retinoblastoma is the most common intraocular malignant tumor occurring among children, with an incidence rate of 1/15 000. This study built a joinpoint regression model to assess the incidence trend of retinoblastoma from 2004 to 2015 and constructed a nomogram to predict the overall survival (OS) in children. Materials and Methods Patients less than 19 years diagnosed with retinoblastoma from 2004 to 2015 were selected from the SEER database. Joinpoint regression analysis (version 4.9.0.0) was performed to evaluate the trends in retinoblastoma incidence rates from 2004 to 2015. Cox Regression Analysis was applied to investigate prognostic risk factors that influence OS. Results Joinpoint regression revealed that retinoblastoma incidence exhibited no significant increase or decrease from 2004 to 2015. As per the multiple Cox regression, tumor size, laterality, and residence (rural-urban continuum code) were correlated with OS and were used to construct a nomogram. The nomogram exhibited a good C-index of 0.71 (95% CI, 0.63 to 0.79), and the calibration curve for survival probability demonstrated that the predictions corresponded well with actual observations. Conclusions and Relevance A prognostic nomogram integrating the risk factors for retinoblastoma was constructed to provide comparatively accurate individual survival predictions. If validated, this type of assessment could be used to guide therapy in patients with retinoblastoma. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe the disease burden and trends of musculoskeletal (MSK) disorders in Mexico from 1990 to 2019. Method: A cross-sectional study using systematic analysis from the Global Burden of Disease Study 2019 (GBD study 2019) was performed to analyze data on MSK disorders and estimate crude and age-standardized rates per 100,000 population concerning disease prevalence, incidence, mortality, disability-adjusted life-years (DALY), and years lived with disability (YLD). The average annual percentage change (AAPC) was calculated using the joinpoint regression. Results: In 2019, there were 4.8 million (95% UI 4.3, 5.4) new cases and 3,312 (95% UI 2201, 4,790) deaths attributable to MSK disorders. In 2019, MSK disorders ranked first, increasing from 1990 (second rank) for the YLD in Mexico. Subnational variations were identified, with the state of Oaxaca having the highest age-standardized incidence rate (ASIR) per 100,000 population in 2019. Joinpoint analysis revealed a significant increase in prevalence in Mexico from 1990 to 2019 (AAPC: 0.14%; 95%CI 0.09–0.19), incidence (AAPC: 0.05%; 95%CI 0.03–0.07), DALY (AAPC: 0.13%; 95%CI 0.04–0.22), and YLD (AAPC: 0.13%; 95%CI 0.02–0.24). Among the risk factors, occupational ergonomic factors and high body mass index (BMI) had the largest influence on MSK disorders. Conclusions: In Mexico, we observed an increase the national burden of MSK disorders from 1990 to 2019. Specific determinants, such as occupational ergonomic factors and high BMI, contribute to the MSK disorder burden. The burden of MSK disorders requires an improved and prompt assessment to plan valuable diagnostic and management approaches. Key Points • In Mexico, the burden of musculoskeletal (MSK) disorders increased from 1990 to 2019. • Specific risk factors, such as occupational ergonomic factors and high body mass index, contribute to the MSK disorder burden. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate mortality and years of life lost (YLL) due to suicide and homicide in children aged 10-19 years in southern Iran from 2004 to 2019. Study Design: A cross-sectional study. Methods: The data on all deaths due to suicide and homicide in Fars province were obtained from the population-based electronic death registration system (EDRS). Crude mortality rate and YLL were calculated. The joinpoint regression method was used to examine the trend. Results: During the study period, 563 cases of suicide and 218 cases of homicide in children aged 10-19 have occurred. The total number of YLL due to suicide was 9766 in men and 6261 in women. According to the joinpoint regression analysis, the trend of YLL due to suicide was increasing in males. In other words, the annual percent change (APC) was 4.8% (95% CI 0.4 to 9.5, P = 0.036). Additionally, there was a constant trend in females, and APC was 2.7% (95% CI -2.0 to 7.7, P = 0.241). The number of YLL due to homicide was 4890 in males and 1294 in females. The trend of YLL due to homicide was stable in males and females. In other words, APC was -1.6% (95% CI -5.6 to -2.6, P = 0.422) in males and -2.7% (95% CI -10.0 to 5.2, P = 0.467) in females. Conclusion: Based on the findings of this study, the trend of mortality rate and YLL due to suicide in men has been increasing and it has been stable in women. Moreover, the trend of mortality due to homicide was stable for both males and females. Therefore, it is necessary to take preventive actions. [ABSTRACT FROM AUTHOR]

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Introduction: Data on exercise in Taiwan mostly describe annual changes (i.e., rise and fall) in the percentage of people engaging in regular exercise, but whether the changes were evidenced and when the trend changed have not been analyzed using statistical models. This study investigated regular exercise trends and identify differences by sex, age, and county/city in Taiwan between 2007 and 2022 using joinpoint regression analysis. Methods: Data on the annual percentage of people engaging in regular exercise, overall and by sex, age group (13-17, 18-29, 30-39, 40-49, 50-59, 60- 64, 65-69 and ≥70 years), and county/city (2007-2022), were extracted from the Ministry of Education, Taiwan. Joinpoint regression models were used to identify the years in which regular exercise trends changed. Results: The overall percentage of people engaging in regular exercise increased between 2007 and 2013 and stopped increasing between 2013 and 2022. The percentages of regular exercise in males, people aged ≥18 years, and most counties/cities residents showed similar trends to that of the overall population; the corresponding percentages for females and young population aged 13-17 years continued to increase, with an attenuated level, until 2022. Conclusion: The overall enegagement in regular exercise did not continue to increase in Taiwan in the last decade, with differences in regular exercise trends between different sexes, age groups, and counties/cities. Further research is required to identify factors related to the recent changes in regular exercise trends in various demographic groups to inform relevant promotion strategies. [ABSTRACT FROM AUTHOR]

In order to find the exact strategies in the prevention of cardiovascular diseases (CVD), it is necessary to assess their risk factors systematically. Here, we used the Global Burden of Disease (GBD) to review the long-term trends and epidemiological characteristics among Chinese. We comprehensively analyzed the burden of CVD for the Chinese population using GBD 2019, including prevalence, incidence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Then, we analyzed trends over time, and predicted mortality and morbidity, using joinpoint regression, age-period-cohort (APC) model, and Bayesian APC approach. Finally, we analyzed the attributable burden of CVD. In 2019, the prevalence of CVD in China was 120 million, representing a 140.02% increase since 1990. The number of DALYs attributed to CVD increased by 52.56% compared to 1990. Joinpoint showed a fluctuating incidence downward, while mortality significantly declined. The APC fitting results indicated that recent generations have a higher prevalence than the past, and the prevalence has increased among individuals of the same age group. The BAPC predicted that CVD's prevalence and mortality in the Chinese would stabilize and decline between 2020 and 2030, with a significant decline among males. The main CVD-attributable burdens in 2019 were metabolic risks, especially high blood pressure. Given China's large and rapidly aging population, the burden of CVD is a major concern. Practical strategies to prevent and manage CVD are urgently needed to address this public health challenge. • CVD prevalence in China increased by 140% since 1990. • DALYs attributed to CVD rose 52.56% since 1990. • The overall incidence of CVD in China fluctuated downward. • More effective intervention strategies are needed for metabolic risk in managing CVD burden. [ABSTRACT FROM AUTHOR]

Objective: To investigate the trend of mortality by COVID-19 before and after the national vaccination program using joinpoint regression analysis from 19 February 2020 to 5 September 2022. Methods: In the present study, a joinpoint regression analysis of monthly collected data on confirmed deaths of COVID-19 in Iran from February 19, 2020 to September 5, 2022 was performed. Results: After national vaccination in Iran, the trend of new monthly deaths due to COVID-19 was decreasing. The percentage of monthly changes from the beginning of the pandemic to the 19th month was 6.62% (95% CI: 1.1, 12.4), which had an increasing trend. From the 19th month to the end of the 31st month, the mortality trend was decreasing, and the percentage of monthly changes was -20.05% (95% CI: -8.3, -30.3) (P=0.002). The average percentage of monthly changes was -5% with a 95% CI of (-10.5, 0.9). Conclusions: Along with other health measures, such as quarantine, wearing a mask, hand washing, social distancing, etc., national vaccination significantly reduces the mortality rate of COVID-19. [ABSTRACT FROM AUTHOR]