Regional years of life lost,years lived with disability,and disability-adjusted life-years for severe mental disorders in Guangdong Province,China:a real-world longitudinal study

Background:To understand the magnitude and spatial-temporal distribution of the regional burden attributable to severe mental disorders is of great essential and high policy relevance.The study aimed to address the burden of severe mental disorders by evaluating the years of life lost,years lived with disability,and disability-adjusted life-years(DALYs)in Guangdong,China.Methods:We undertook a longitudinal study based on a multicenter database established by the Health Commission of Guangdong,involving a total of 21 prefectures and four economic regions in the Guangdong province.A total of 520,731 medical records from patients with severe mental disorders were collected for 2010-2020.Data were analyzed via an integrated evaluation framework by synthesizing prevalence estimates,epidemiological adjustment as well as comorbidity assessment to develop internally consistent estimates of DALY.DALY changes during 2010-2020 were decomposed by population growth and aging and further grouped by Socio-demographic Index(SDI).DALYs were projected to 2030 by the weighted median annualized rate of change in 2010-2020.Results:In 2010-2020,the average DALYs for severe mental disorders reached 798,474(95%uncertainty interval[UI]:536,280-1,270,465)person-years(52.2%for males,and 47.8%for females).Severe mental disorders led to a great amount of disease burden,especially in Guangzhou,Shenzhen,and Foshan cities.Schizophrenia and mental retardation with mental disorders were the two leading sources of the burden ascribed to severe mental disorders.Population growth and aging could be accountable for the increasing burden of severe mental disorders.Economic regions with higher SDI carried a greater burden but had lower annualized rates of change in DALYs.The overall burden of severe mental disorders is projected to rise modestly over the next decade.Conclusions:The findings urge prioritization of initiatives focused on public mental health,prevention strategies,health resources reallocation,and active involvement of authorities to effectively address the anticipated needs.

Disability-adjusted life years and the trends of the burden of colorectal cancer:a population-based study in Shanghai,China during 2002 to 2016

Background:Colorectal cancer(CRC)still ranks the top in morbidity and mortality of cancers worldwide,posing a huge threat and burden to the society.We aimed to determine the age-standardized incidence,mortality,and disability-adjusted life years(DALYs)of CRC and explore potential changes in the temporal trends of the CRC burden in Shanghai during 2002 to 2016.Methods:The cancer statistics and demographics were obtained from the Cancer Registry and the Statistics Bureau of Pudong New Area,respectively.Data from 2002 to 2016 were included and analyzed retrospectively.DALYs were calculated using DisMod and the age-standardized rates(ASRs)were obtained according to Segi world standard population.Joinpoint regression was used to measure the trends in CRC incidence and to estimate the annual percent change.Results:The increasing trend of CRC ASR incidence halted after 2014,coinciding with the introduction of the Shanghai CRC screening program.The ASRs of mortality and DALYs increased,at 0.42%(P<0.05)and 4.07%(P<0.001)per year,respectively,which were mainly driven by men and individuals aged above the CRC screening program target.Conclusions:The disease burden of CRC in Shanghai remains serious,especially among men,and individuals aged>74 years.The benefits of the screening program have been partially proven by the ASRs of CRC incidence,providing important insights into better and wider application of screening programs.

Analysis of the Global Burden of Disease study highlights the trends in death and disability-adjusted life years of leukemia from 1990 to 2017

Background:The patterns of leukemia burden have dramatically changed in recent years.This study aimed to estimate the global trends of leukemiarelated death and disability-adjusted life-years(DALYs)from 1990 to 2017.Methods:The data was acquired from the latest version of the Global Burden of Disease(GBD)study.Estimated annual percentage changes(EAPCs)were calculated to estimate the trend of age-standardized rate(ASR)of death and DALYs due to leukemia and its main subtypes from 1990 to 2017.Results:Globally,the numbers of death and DALYs due to leukemia were 347.58×10^(3)(95%uncertainty interval[UI]=317.26×10^(3)-364.88×10^(3))and 11975.35×10^(3)(95%UI=10749.15×10^(3)-12793.58×10^(3))in 2017,with a 31.22% and 0.03% increase in absolute numbers from 1990 to 2017,respectively.Both of their ASR showed decreasing trends from 1990 to 2017 with the EAPCs being−1.04(95%confidence interval[CI]=(−1.10-−0.99)and−1.52(95%CI=−1.59-−1.44),respectively.Globally,the most pronounced decreasing trend of death and DALYs occurred in chronic myeloid leukemia with EAPCs of−2.76(95%CI=−2.88-−2.64)and−2.84(95%CI=−2.97-−2.70),respectively,while the trend increased in acute myeloid leukemia.The death and DALYs of leukemia decreased in most areas and countries with high socio-demographic index(SDI)including Bahrain,Finland,and Australia.Conclusions:The disease burden of death and DALYs due to leukemia decreased globally,and for most regions and countries from 1990 to 2017.However,the leukemia burden is still a substantial challenge globally and required adequate and affordable medical resources to improve the survival and quality of life of leukemia patients.

Burden of road traffic accidents in Nepal by calculating disability-adjusted life years

Objective:To calculate the burden of road traffic accidents in Kathmandu Valley and then extrapolate this to the national level.Methods:A prospective study was performed to compute the burden of road traffic accidents by quantification of disability-adjusted life years(DALYs)using the Global Burden of Disease Study method on the basis of 1-year data from nine hospitals in Nepal and the Department of Foren-sic Medicine and cross-checked with the Nepal Traffic Directorate.Multiple methods were applied to the extrapolated population metrics of the burden of road traffic accidents in Nepal.Results:The total number of years of life lived in disability,years of life lost,and DALYs in Nepal were 38,848±194,119,935±1464,and 158,783±1658(95% confidence interval)re-spectively.The number of years lost because of morbidity and death was similar in Kathmandu Valley.Most(75%)of the DALYs resulted from years of life lost in Nepal.Males accounted for 73% of DALYs.Almost half(44%)of the DALYs were contributed by the group aged 15-29 years.Conclusion:This study is the first to calculate the burden of road traffic accidents in Nepal using Nepal’s own data.Nepal needs to develop and enhance its own system to identify significant public health issues so as to set national priorities for prevention of road traffic accidents.

Burden of mental disorders and risk factors in the Western Pacific region from 1990 to 2021

BACKGROUND The burden of mental disorders(MD)in the Western Pacific Region(WPR)re-mains a critical public health concern,with substantial variations across demogra-phics and countries.AIM To analyze the burden of MD in the WPR from 1990 to 2021,along with associated risk factors,to reveal changing trends and emerging challenges.METHODS We used data from the Global Burden of Disease 2021,analyzing prevalence,incidence,and disability-adjusted life years(DALYs)of MD from 1990 to 2021.Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness.RESULTS Between 1990 and 2021,the prevalence of MD rose from 174.40 million cases[95%uncertainty interval(UI):160.17-189.84]to 234.90 million cases(95%UI:219.04-252.50),with corresponding DALYs increasing from 22.8 million(95%UI:17.22-28.79)to 32.07 million(95%UI:24.50-40.68).During this period,the burden of MD shifted towards older age groups.Depressive and anxiety disorders were predominant,with females showing higher DALYs for depressive and anxiety disorders,and males more affected by conduct disorders,attention-deficit hyperactivity disorder,and autism spectrum disorders.Australia,New Zealand,and Malaysia reported the highest burdens,whereas Vietnam,China,and Brunei Darussalam reported the lowest.Additionally,childhood sexual abuse and bullying,and intimate partner violence emerged as significant risk factors.CONCLUSION This study highlights the significant burden of MD in the WPR,with variations by age,gender,and nation.The coronavirus disease 2019 pandemic has exacerbated the situation,emphasizing the need for a coordinated response.

Esophageal cancer global burden profiles, trends, and contributors

Objective:This study aimed to provide a comprehensive overview of the global burden of esophageal cancer(EC)and determine the temporal trends and factors influencing changes in the global burden.Methods:The latest incidence and mortality data for EC worldwide were obtained from GLOBALCAN 2022.The mortality and disability-adjusted life years(DALYs)rates for EC from 1990±2019 were sourced from the 2019 Global Burden of Diseases.Trends in EC mortality and DALYs attributable to 11 risk factors or clusters of risk were analyzed using the joinpoint regression model.The trends in age-related EC burden were assessed using a decomposition approach.Results:An estimated 511,054 new cases of EC were diagnosed in 2022 with 445,391 deaths worldwide.Approximately 75%of cases and deaths occurred in Asia.Nearly 50%of global EC deaths and DALYs were attributed to tobacco use in men in 2019,while 20%were attributed to high body mass index(BMI)in women.From 1990±2019,EC deaths and DALYs attributable to almost all risk factors had declining trends,while EC deaths and DALYs attributed to high BMI in men had upward trends.The age-related EC burden exhibited an upward trend driven by population growth and aging,which contributed to 307.4 thousand deaths and 7.2 million DALYs due to EC.Conclusions:The EC burden remains substantial worldwide.Effective tobacco and obesity control measures are critical for addressing the risk-attributable burden of EC.Population growth and aging pose challenges for EC prevention and control efforts.

Burden of gastrointestinal cancers among working-age population over past thirty years in China

BACKGROUND Although gastrointestinal(GI)cancers have been becoming a great public health concern in China,there is currently a lack of comprehensive literature on the overall burden and changing trends of GI cancers in the working-age population.AIM To assess the burden of GI cancers and to examine the overall,age-and genderspecific trends among the working-age population in China from 1990 to 2019.METHODS Data were extracted from the Global Burden of Disease Study 2019.The burden of GI cancers was indicated by incidence,mortality,disability-adjusted life-years(DALYs),age-standardized incidence rate(ASIR),age-standardized mortality rate,and age-standardized DALYs rate.Trends in the burden of GI cancers from 1990 to 2019 were examined using annual percent change and average annual percent change with Joinpoint regression models.RESULTS For overall GI cancers,a declining trend was observed in the ASIR,age-standardized mortality rate,and agestandardized DALYs rate,with reductions of 0.74%,2.23%,and 2.22%,respectively,from 1999 to 2019 in the Chinese working-age population.However,an increasing trend was observed in the ASIR for overall GI cancers from 2016-2019.The number of either incident cases,mortality cases,and DALYs was higher for colon/rectum cancer and liver cancer in younger participants but lower for esophageal,gallbladder,biliary tract,pancreatic,and stomach cancer among older subjects.Moreover,sex disparity in the GI cancers burden was also examined over 30 years.CONCLUSION The total burden of GI cancers remained heavy among the working-age population in China,although declining trends were observed from 1999 to 2019.Disparities in the GI cancers burden existed between sexes,age groups,and cancer types.Population-based precision prevention strategies are needed to tackle GI cancers among working-age individuals,considering the age,sex,and cancer type disparities in China.

Colorectal cancer’s burden attributable to a diet high in processed meat in the Belt and Road Initiative countries

BACKGROUND Colorectal cancer(CRC)plays a significant role in morbidity,mortality,and economic cost in the Belt and Road Initiative(“B and R”)countries.In addition,these countries have a substantial consumption of processed meat.However,the burden and trend of CRC in relation to the consumption of a diet high in processed meat(DHPM-CRC)in these“B and R”countries remain unknown.AIM To analyze the burden and trend of DHPM-CRC in the“B and R”countries from 1990 to 2019.METHODS We used the 2019 Global Burden of Disease Study to collate information regarding the burden of DHPM-CRC.Numbers and age-standardized rates(ASRs)of deaths along with the disability-adjusted life years(DALYs)were determined among the“B and R”countries in 1990 and 2019.Using joinpoint regression analysis,the average annual percent change(AAPC)was used to analyze the temporal trends of age-standardized DALYs rate(ASDALR)from 1990 to 2019 and in the final decade(2010–2019).RESULTS We found geographical differences in the burden of DHPM-CRC among“B and R”countries,with the three highest-ranking countries being the Russian Federation,China,and Ukraine in 1990,and China,the Russian Federation,and Poland in 2019.The burden of DHPM-CRC generally increased in most member countries from 1990 to 2019(all P<0.05).The absolute number of deaths and DALYs in DHPM-CRC were 3151.15[95%uncertainty interval(UI)665.74-5696.64]and 83249.31(95%UI 15628.64-151956.31)in China in 2019.However,the number of deaths(2627.57-2528.51)and DALYs(65867.39-55378.65)for DHPM-CRC in the Russian Federation has declined.The fastest increase in ASDALR for DHPM-CRC was observed in Vietnam,Southeast Asia,with an AAPC value of 3.90%[95%confidence interval(CI):3.63%-4.16%],whereas the fastest decline was observed in Kyrgyzstan,Central Asia,with an AAPC value of-2.05%(95%CI:-2.37%to-1.73%).A substantial upward trend in ASR of mortality,years lived with disability,years of life lost,and DALYs from DHPM-CRC changes in 1990-2019 and the final decade(2010-2019)for most Maritime Silk Route members in East Asia,South Asia,Southeast Asia,North Africa,and the Middle East,as well as Central Europe,while those of the most Land Silk Route members in Central Asia and Eastern Europe have decreased markedly(all P<0.05).The ASDALR for DHPM-CRC increased more in males than in females(all P<0.05).For those aged 50-74 years,the ASDALR for DHPM-CRC in 40 members exhibited an increasing trend,except for 20 members,including 7 members in Central Asia,Maldives,and 12 high or high-middle social development index(SDI)members in other regions(all P<0.05).CONCLUSION The burden of DHPM-CRC varies substantially across“B and R”countries and threatens public health.Relevant evidence-based policies and interventions tailored to the different trends of countries in SDIs or Silk Routes should be adopted to reduce the future burden of CRC in“B and R”countries via extensive collaboration.

Nowcasting and forecasting global aging and cancer burden:analysis of data from the GLOBOCAN and Global Burden of Disease Study

Objective:To analyze the impact of global population aging on cancer epidemiology,with a focus on the incidence and mortality rates among individuals aged 60 years and above.Methods:We utilized open-source data,retrieving population age estimates from the United Nations Population Division website.The GLOBOCAN 2020 database provided estimates for cancer cases and deaths in 2020 and 2040,while the Global Burden of Disease 2019 database supplied estimates of new cancer cases worldwide from 2000 to 2019.Inclusion criteria considered individuals aged 60 years and over,focusing on the top five deadliest cancers.The cohort-component method was employed for population prediction,with age-specific incidence and mortality rates estimated for 2020 used to forecast the cancer burden.Results:In 2021,the global population aged over 60 years accounted for 13.7%,with Europe/North America and Australia/New Zealand having the highest proportions.The older population is predicted to reach 19.2%by 2040.In 2020,of the 19.3 million new cancer cases worldwide,64%occurred in individuals aged 60 and above,contributing to 71.3%of cancer-related deaths.The five most common cancer sites were the lung,colorectum,prostate,breast,and stomach.Cancer incidence and deaths are projected to rise significantly among older indi-viduals,reaching 20.7 million new cases and 12.7 million deaths by 2040.Older age,tobacco use,dietary factors,alcohol consumption,and high body mass index(BMI)were identified as major risk factors for various cancers in this demographic.Conclusions:This study reveals a significant rise in cancer incidence and mortality among the elderly due to global population aging.The urgency for targeted interventions in cancer prevention,screening,and treatment for older individuals is emphasized.Despite acknowledged limitations,these findings contribute valuable insights to inform strategies for managing cancer in the elderly amidst evolving demographic trends.

Epidemiological trends of urinary tract infections,urolithiasis and benign prostatic hyperplasia in 203 countries and territories from 1990 to 2019

Background:Urinary tract infections(UTI),urolithiasis,and benign prostatic hyperplasia(BPH)are three of the most common nonmalignant conditions in urology.However,there is still a lack of comprehensive and updated epidemiological data.This study aimed to investigate the disease burden of UTI,urolithiasis,and BPH in 203 countries and territories from 1990 to 2019.Methods:Data were extracted from the Global Burden of Disease 2019,including incident cases,deaths,disabilityadjusted life-years(DALYs)and corresponding age-standardized rate(ASR)from 1990 to 2019.Estimated annual percentage changes(EAPC)were calculated to evaluate the trends of ASR.The associations between disease burden and social development degrees were analyzed using a sociodemographic index(SDI).Results:Compared with 1990,the incident cases of UTI,urolithiasis,and BPH increased by 60.40%,48.57%,and 105.70%in 2019,respectively.The age-standardized incidence rate(ASIR)of UTI increased(EAPC=0.08),while urolithiasis(EAPC=–0.83)and BPH(EAPC=–0.03)decreased from 1990 to 2019.In 2019,the age-standardized mortality rate(ASMR)of UTI and urolithiasis were 3.13/100,000 and 0.17/100,000,respectively.BPH had the largest increase(110.56%)in DALYs in the past three decades,followed by UTI(68.89%)and urolithiasis(16.95%).The burden of UTI was mainly concentrated in South Asia and Tropical Latin America,while the burden of urolithiasis and BPH was recorded in Asia and Eastern Europe.Moreover,the ASIR and SDI of urolithiasis in high-SDI regions from 1990to 2019 were negatively correlated,while the opposite trend was seen in low-SDI regions.In 2019,the ASIR of UTI in females was 3.59 times that of males,while the ASIR of urolithiasis in males was 1.96 times higher than that in females.The incidence was highest in the 30–34,55–59,and 65–69 age groups among the UTI,urolithiasis,and BPH groups,respectively.Conclusions:Over the past three decades,the disease burden has increased for UTI but decreased for urolithiasis and BPH.The allocation of medical resources should be based more on the epidemiological characteristics and geographical distribution of diseases.

Temporal Trend in Lung Cancer Burden Attributed to Ambient Fine Particulate Matter in Guangzhou, China

Objective To estimate the lung cancer burden that may be attributable to ambient fine particulate matter （PM2.5） pollution in Guangzhou city in China from 2005 to 2013. Methods The data regarding PM2.5 exposure were obtained from the ＆#39;Ambient air pollution exposure estimation for the Global Burden of Disease 2013＇ dataset at 0.1° ×0.1° spatial resolution. Disability-adjusted life years （DALYs） were estimated based on the information of mortality and incidence of lung cancer. Comparative risk analysis and integrated exposure-response function were used to estimate attributed disease burden. Results The population-weighted average concentration of PM2.5 was increased by 34.6% between 1990 and 2013, from 38.37 μg/m3 to 51.31 μg/m^3. The lung cancer DALYs in both men and women were increased by 36.2% from 2005 to 2013. The PM2.5 attributed lung cancer DALYs increased from 12105.0 （8181.0 for males and 3924.0 for females） in 2005 to 16489.3 （11291.7 for males and 5197.6 for females） in 2013. An average of 23.1% lung cancer burden was attributable to PM2.5 pollution in 2013. Conclusion PM2.5 has caused serious but under-appreciated public health burden in Guangzhou and the trend deteriorates. Effective strategies are needed to tackle this major public health problem.

Methodology for the Assessment of Burden of Smear-positive Pulmonary TB and Its Infectivity

Objective The study investigated the burden of smear-positive pulmonary TB and itsinfectivity using DALY(disability-adjusted life year) as an indicator. Methods An assumedcohort of 2 000 cases was set up based on the age-specific incidence of 794 newly registeredsmear-positive cases in Beijing in 1994. Prognostic trees and model diagrams of infectivityunder natural history and DOTS(directly observed treatment, short-course) strategy wereestablished according to the epidemiological evidence. Results The results showed that 29. 6%of DALYs would be neglected if the burden caused by the infectivity was not considered.Conclusion DOTS strategy may reduce 97.3% of the number of potential cases infected,92.9% of DALYs related to TB-patients themselves, and 99.9% of DALYs caused by TB’sinfectivity as well.

A review of healthy aging in China,2000-2019

In 2021,China became an aged society when the share of its elderly population(age 65 years and above)exceeded 14%.In China,as in other upper‐middle‐income and high‐income countries,life expectancy gains are increasingly concentrated at older ages with below‐average health and economic activity.Governments worldwide are hence actively pursuing healthy and productive aging.Healthy aging by some measures is taking place.Similar with other upper‐middle‐income countries,China's young old in their 60s are healthier than the same age group two decades ago.The picture is more complex for the older age group(70 years and above).Although there is a substantial decline in leading disease burdens such as stroke and chronic obstructive pulmonary disease,diseases such as Alzheimer's and other dementia are on the rise.To meet the challenge of a rapidly aging population,China's healthy aging agenda should improve its multipronged approach that seeks to promote healthy lifestyles,enhance the healthcare system,create agefriendly communities,and tackle socioeconomic and health disparities.

Global,regional,and national burden of kidney,bladder,and prostate cancers and their attributable risk factors,1990–2019

Background:The burden of kidney,bladder,and prostate cancers has changed in recent decades.This study aims to investigate the global and regional burden of,and attributable risk factors for genitourinary cancers during the past 30 years.Methods:We extracted data of kidney,bladder,and prostate cancers from the Global Burden of Disease 2019 database,including incidence,mortality,disability-adjusted life-years(DALYs),and attributable risk factors from 1990 to 2019.Estimated annual percentage changes(EAPC)were calculated to assess the changes in age-standardized incidence rate,age-standardized mortality rate(ASMR),and age-standardized DALYs rate(ASDR).The associations between cancers burden and socio-demographic index(SDI)were also analyzed.Results:Compared with 1990,the global incident cases in 2019 were higher by 154.78%,123.34%,and 169.11%for kidney,bladder,and prostate cancers,respectively.During the 30-year study period,there was a downward trend in ASMR and ASDR for bladder cancer(EAPC=–0.68 and–0.83,respectively)and prostate cancer(EAPC=–0.75 and–0.71,respectively),but an upward trend for kidney cancer(EAPC=0.35 and 0.12,respectively).Regions and countries with higher SDI had higher incidence,mortality,and DALYs for all three types of cancers.The burden of bladder and prostate cancers was mainly distributed among older men,whereas the burden of kidney cancer increased among middle-aged men.Smoking related mortality and DALYs decreased,but high body mass index(BMI)and high fasting plasma glucose(FPG)related mortality and DALYs increased among kidney,bladder,and prostate cancers during the study period.Conclusions:Kidney,bladder,and prostate cancers remain major global public health challenges,but with distinct trend for different disease entity across different regions and socioeconomic status.More proactive intervention strategies,at both the administrative and academic levels,based on the dynamic changes,are needed.

Global burden of cirrhosis and other chronic liver diseases due to nonalcoholic fatty liver disease,1990-2019

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)has become the leading cause of cirrhosis and other chronic liver diseases(COCLDs).AIM To conduct a comprehensive and comparable updated analysis of the global,regional,and national burden of COCLDs due to NAFLD in 204 countries and territories from 1990 and 2019 by age,sex,and sociodemographic index.METHODS Data on COCLDs due to NAFLD were collected from the Global Burden of Diseases,Injuries,and Risk Factors Study 2019.Numbers and age-standardized prevalence,death,and disability-adjusted life years(DALYs)were estimated through a systematic analysis of modelled data from the Global Burden of Diseases,Injuries,and Risk Factors Study 2019.The estimated annual percentage change was used to determine the burden trend.RESULTS In 2019,the global age-standardized prevalence rate of COCLDs due to NAFLD was 15022.90 per 100000 population[95%uncertainty interval(UI):13493.19-16764.24],which increased by 24.51%(22.63%to 26.08%)from 1990,with an estimated annual percentage change of 0.78(95%confidence interval:0.74-0.82).In the same year,however,the age-standardized death rate and age-standardized DALYs per 100000 population were 1.66(95%UI:1.20-2.17)and 43.69(95%UI:31.28-58.38),respectively.North Africa and the Middle East had the highest prevalence rates of COCLDs due to NAFLD.The death rate increased with age up to the 95+age group for both sexes.Males had higher numbers of prevalence,death rate,and DALYs than females across all age groups before the 65-69 age group.The sociodemographic index was negatively correlated with the age-standardized DALYs.CONCLUSION Globally,the age-standardized prevalence rate has increased during the past three decades.However,the agestandardized death rate and age-standardized DALYs decreased.There is geographical variation in the burden of COCLDs due to NAFLD.It is strongly recommended to improve the data quality of COCLDs due to NAFLD across all countries and regions to facilitate better monitoring of the burden of COCLDs due to NAFLD.

Economic Evaluation of Mobile Mental Health Units in Greece: The Case of Cyclades Islands

Background: In Greece, the provision of mental health services is limited to people residing in rural and remote areas. The operation of Mobile Mental Health Units (MMHUs) has been introduced in the Cyclades islands. It is an innovative policy intervention that has been shown to be effective and efficient internationally. Objective: The aim was to evaluate the operation of MMHUs in the Cyclades islands based on real-world evidence (RWE), from a societal perspective. Methods: A cost-effectiveness analysis was performed where outcomes and costs were elaborated and classified based on two comparators, 1) with MMHUs’ operation and 2) without MMHUs’ operation. Clinical primary outcomes were based on RWE data and were elaborated for the Disability-Adjusted Life Years (DALYs) values calculation, for a 12 months’ time horizon. Data descriptive statistics were performed with SPSS Statistics 22.0. Direct medical, non-medical and indirect costs were incorporated. Unit costs and monetary values were extracted from published data. Sensitivity analysis was undertaken to test the robustness of the results. Results: The operation of MMHUs in the Cyclades islands led to an incremental cost of €12,250.78 per DALY averted. A substantial higher increase is observed in the direct non-medical costs of the non-MMHUs’ operation where patients had to pay approximately €2,602 per capita annually for their transportation and accommodation due to hospitalization and outpatient care. Informal care expenses are 3 fold increasing in the non-MMHUs’ operation arm. Both direct non-medical and informal care costs correspond to high out of pocket payments totally covered by the patients. The sensitivity analyses demonstrated that the decision does not change when we varied the unit costs by ±10%. Conclusions: The operation of MMHUs appears to be a cost-effective option for treating patients with mental disorders in remote areas and islands in Greece. MMHUs appear to overcome the existing NHS structural inefficiencies by minimizing public expenditures and patients’ income losses by preventing and improving their mental health status.

Epidemiological and Disease Burden Profiles of Leukemias and Malignant Lymphomas: Overview and Trends in the Republic of Moldova and Worldwide

Introduction: Hematological malignancies (HM) are relatively frequent nosological entities within the structure of morbidity by malignant tumors, exhibiting a severe evolution, restrained prognosis and negative socio-economic impact in the advanced stages and phases. Objective: The objective of the study was to identify the epidemiological patterns, and to evaluate the epidemiological trends and disease burden issues of HM in the Republic of Moldova and worldwide. Materials and Methods: The following research methods were used: epidemiological, descriptive statistics, clinico-analytic. The diagnosis was proved in all cases by histopathological, cytological, cytogenetic, molecular and immunophenotyping examinations. The qualitative type researches were performed and enriched by the narrative synthesis of the data. From the specialized international bibliographic sources and official statistics concerning HM. The narrative review of the reference sources was fulfilled in the form of a synthesis. Results: The number of newly diagnosed and followed-up patients with HM at the Institute of Oncology in 2016, 2017, 2018, 2019, 2020 and 2021 amounted respectively to 725, 802, 613, 628, 536 and 528, the incidence (new cases per 100,000 population) being 17.6, 19.5, 14.9, 17.7, 15.1 and 20.3. In 2021 HM constituted 6.2% of all newly-diagnosed cases with malignant tumors in the Republic of Moldova. In the same year Hodgkin lymphoma was diagnosed in 10.04% of cases, non-Hodgkin’s lymphomas—in 31.63%, multiple myeloma and plasma cells neoplasms—in 7.77%, lymphoid leukemias—in 17.42%, myeloid leukemias—in 12.31%, monocytic leukemias—in 0.95%, and other leukemias—in 16.29%. In 2019 the male rate was 51.5%, and the female rate—48.5%. Within 2 years males were 266 (50.4%), females—262 (49.6%). The age of 50 - 79 years prevailed in both genders (males—65%, females—72.5%). The children constituted 4.0% of the newly diagnosed cases, 4.8% of those under the follow-up at the end of the year 2019 and 6.4% of the newly diagnosed cases in 2021. The disease span from the onset to diagnosis ranged between 1 - 24 months and constituted on average 5.63 months, without a significant difference as compared to 2019 (5.76 months). The incidence of HM in Western countries is 14 - 19 new cases per 100,000 population (4% of all cases with malignant tumors). The incidence of non-Hodgkin’s lymphomas increased by 45% between 2006 and 2016, from 319,078 to 461,000 cases. Between 2006 and 2016, the incidence of leukemias increased by 26%, from 37,000,000 to 467,000 cases. Conclusions: The epidemiological study revealed slightly lower morbidity by HM in the Republic of Moldova as compared to the West European countries mainly due to the migration of a workable population. The patients with malignant lymphomas, male gender and age categories of 50 - 79 years proved to be commonly registered epidemiological patterns. The narrative analysis of the literature revealed that patients with HM may experience a considerable disease burden with a negative impact on their employment status, working productivity and annual household income.

Burden of biliary tract carcinoma in China(1990–2021):Findings from the 2021 Global Burden of Disease Study

Biliary tract carcinoma(BTC)is a group of malignant tumors that originate in the digestive system and occurs with a high incidence in China.Few consistent and comparable assessments of BTC disease burden have been conducted at national or subnational levels,and little is known about the demographic,temporal,and geographic patterns of epidemiological characteristics and disease burden of BTC in China.The incidence,mortality,disability-adjusted life-years(DALYs),years of life lost(YLLs)due to premature death and years lived with disability(YLDs)of BTC were comprehensively examined by age,sex,and calendar year in the Chinese population,using the methodological framework and analytical strategies used for the 2021 Global Burden of Disease study.All-age incidence increased from 17,077 to 51,720between 1990 and 2021,and the age-standardized incidence rate rose by 13.62%;all-age deaths increased from 17,251 to 37,833,but the age-standardized mortality rate fell by nearly one-fifth.The DALYs rose by 89.57%while the age-standardized DALY rate fell by 23.24%.Variations of the tendencies in BTC burden were found between sexes and age groups.Data for each provincial region indicate that coastal eastern provincial regions have higher incidence and YLD levels,whereas northern provincial regions have higher mortality,DALY,and YLL levels.The proportions of DALYs attributable to high body mass index(BMI)illustrate the growing attribution obesity has made,and high BMI usually puts more burden on northern provincial regions.These results provide evidence to support precise,targeted,and customed public health strategies aimed at enhancing biliary tract health among the Chinese population.

Cancer incidence,mortality,and burden in China:a time-trend analysis and comparison with the United States and United Kingdom based on the global epidemiological data released in 2020

Background:Cancer is one of the leading causes of death and a main economic burden in China.Investigating the differences in cancer patterns and control strategies between China and developed countries could provide reference for policy planning and contribute to improving cancer control measures.In this study,we reviewed the rates and trends of cancer incidence and mortality and disability-adjusted life year(DALY)burden in China,and compared them with those in the United States(US)and the United Kingdom(UK).Methods:Cancer incidence,mortality,and DALY data for China,US and UK were obtained fromtheGLOBOCAN2020 online database,Global Burden of Disease(GBD)2019 study,and Cancer Incidence in Five Continents plus database(CI5 plus).Trends of cancer incidence and mortality in China,US,and UK were analyzed using Joinpoint regression models to calculate annual percent changes(APCs)and identify the best-fitting joinpoints.Results:An estimated 4,568,754 newly diagnosed cancer cases and 3,002,899 cancer deaths occurred in China in 2020.Additionally,cancers resulted in 67,340,309 DALYs in China.Compared to the US and UK,China had lower cancer incidence but higher cancer mortality andDALY rates.Furthermore,the cancer spectrum of China was changing,with a rapid increase incidence and burden of lung,breast,colorectal,and prostate cancer in addition to a high incidence and heavy burden of liver,stomach,esophageal,and cervical cancer.Conclusions:The cancer spectrum of China is changing from a developing country to a developed country.Population aging and increase of unhealthy lifestyles would continue to increase the cancer burden of China.Therefore,the Chinese authorities should adjust the national cancer control program with reference to the practices of cancer control which have been well-established in the developed countries,and taking consideration of the diversity of cancer types by of different regions in China at the same time.

Projected burden of stroke in China through 2050

Background:Stroke is the leading cause of death in China,and predicting the stroke burden could provide essential information guiding the setting of medium-and long-term health policies and priorities.The study aimed to project trends associated with stroke burden in China through 2050,not only in terms of incidence and mortality but also for prevalence and disability-adjusted life years(DALYs).Methods:Data on stroke rates in incidence,prevalence,deaths,and DALYs in China between 1990 and 2019 were obtained from a recent Global Burden of Disease study.Demographic-specific trends in rates over time were estimated using three models:the loglinear model,the Lee-Carter model,and a functional time series model.The mean absolute percentage error and the root mean squared error were used for model selection.Projections up to 2050 were estimated using the best fitting model.United Nations population data were used to project the absolute numbers through 2050.Results:From 2019 to 2050,the crude rates for all measures of the stroke burden are projected to increase continuously among both men and women.We project that compared with those in 2019,the incidence,prevalence,deaths,and DALYs because of stroke in China in 2050 will increase by 55.58%,119.16%,72.15%,and 20.04%,respectively;the corresponding increases in number were 2.19,34.27,1.58,and 9.21 million.The age-standardized rate is projected to substantially decline for incidence(8.94%),death(40.37%),and DALYs(43.47%),but the age-standardized prevalence rate is predicted to increase by 10.82%.By 2050,the burden of stroke among the population aged≥65 years will increase significantly:by 104.70%for incidence,by 218.48%for prevalence,by 100.00%for death,and by 58.93%for DALYs.Conclusions:With the aging population in China increasing over the next three decades,the burden of stroke will be markedly increased.Continuous efforts are needed to improve stroke health care and secondary prevention,especially for older adults.