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.

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.

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.

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.

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.

Health-related quality-of-life and health-utility reporting in critical care

Mortality is a well-established patient-important outcome in critical care studies.In contrast,morbidity is less uniformly reported(given the myriad of critical care illnesses and complications of each)but may have a common end-impact on a patient’s functional capacity and health-related quality-of-life(HRQoL).Survival with a poor quality-of-life may not be acceptable depending on individual patient values and preferences.Hence,as mortality decreases within critical care,it becomes increasingly important to measure intensive care unit(ICU)survivor HRQoL.HRQoL measurements with a preference-based scoring algorithm can be converted into health utilities on a scale anchored at 0(representing death)and 1(representing full health).They can be combined with survival to calculate quality-adjusted life-years(QALY),which are one of the most widely used methods of combining morbidity and mortality into a composite outcome.Although QALYs have been use for health-technology assessment decision-making,an emerging and novel role would be to inform clinical decision-making for patients,families and healthcare providers about what expected HRQoL may be during and after ICU care.Critical care randomized control trials(RCTs)have not routinely measured or reported HRQoL(until more recently),likely due to incapacity of some patients to participate in patient-reported outcome measures.Further differences in HRQoL measurement tools can lead to non-comparable values.To this end,we propose the validation of a gold-standard HRQoL tool in critical care,specifically the EQ-5D-5L.Both combined health-utility and mortality(disaggregated)and QALYs(aggregated)can be reported,with disaggregation allowing for determination of which components are the main drivers of the QALY outcome.Increased use of HRQoL,health-utility,and QALYs in critical care RCTs has the potential to:(1)Increase the likelihood of finding important effects if they exist;(2)improve research efficiency;and(3)help inform optimal management of critically ill patients allowing for decision-making about their HRQoL,in additional to traditional health-technology assessments.

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.

Disease burden of biliary tract cancer in 204 countries and territories,1990–2021:A comprehensive demographic analysis of the Global Burden of Disease Study 2021

Background:Biliary tract carcinomas(BTCs)are relatively rare but lethal primary malignant tumors derived from the biliary tract system.The burden of BTCs varies according to sex,age,region,and country,but limited attention has been paid to the burden of BTCs.We sought to explore the up-to-date data from the Global Burden of Disease Study(GBD)and expand findings by accessing the demographic features of BTC disease burden.Methods:Using the latest data from the GBD 2021,we evaluated and analyzed the distributions and patterns of BTC disease burden in various age groups,sexes,regions,and countries.Results:The number of incident cases,deaths,and disability-adjusted life-years(DALYs)tended to increase and peaked at 216,770(95%uncertainty interval[UI]:181,890-245,240),171,960(95%UI:142,350-194,240),and 3,732,100(95%UI:3,102,900-4,317,000)person-years,respectively,in 2021.However,the average global age-standardized rates(ASRs)of incident cases,deaths,and DALYs shrunk by−11.46%(95%UI:−21.91 to 3.35%),−24.09%(95%UI:−33.19 to 16.88%),and−26.25%(95%UI:−35.53 to 18.36%),respectively,from 1990 to 2021.Meanwhile,the male/female ratio(male per 100 female)of incidence,deaths,and DALYs changed from 76.40,75.41,and 74.72 to 86.89,79.11,and 82.29,respectively.In 2021,the highest number of incident cases,deaths,and DALYs occurred in East Asia.The top three highest incidences,deaths,and DALYs were observed in China,India,and Japan,and the highest ASRs were observed in Chile in 2021.Analysis of the Human Development Index along with disease burden estimates of BTCs also suggests that the burden of the disease is related to the level of comprehensive development of the society.Conclusion:This study provided a comprehensive comparison of differences in the burden of disease across populations and over time,and further presented evidence concerning the formulation of prevention and control policies and etiologic studies for BTCs and proposed logical hypotheses to investigate.

Global,regional,and national burden of hypertensive heart disease among older adults in 204 countries and territories between 1990 and 2019:a trend analysis

Background:Hypertensive heart disease(HHD)poses a public health challenge,but data on its burden and trends among older adults are scarce.This study aimed to identify trends in the burden of HHD among older adults between 1990 and 2019 at the global,regional,and national levels.Methods:Using the Global Burden of Diseases study 2019 data,we assessed HHD prevalence,death,and disability-adjusted life-year(DALY)rates for individuals aged 60-89 years at the global,regional,and national levels and estimated their average annual percentage changes(AAPCs)between 1990 and 2019 using joinpoint regression analysis.Results:In 2019,there were 14.35 million HHD prevalent cases,0.85 million deaths,and 14.56 million DALYs in older adults.Between 1990 and 2019,the prevalence of HHD increased globally{AAPC,0.38(95%confidence interval[CI],0.36,0.41)}with decreases observed in mortality(AAPC,-0.83[95%CI,-0.99,-0.66])and the DALY rate(AAPC,-1.03[95%CI,-1.19,-0.87]).This overall global trend pattern was essentially maintained for sex,age group,and sociodemographic index(SDI)quintile except for non-significant changes in the prevalence of HHD in those aged 70-74 years and in the middle SDI quintile.Notably,males had a higher HHD prevalence rate.However,HHD-related mortality and the DALY rate were higher in females.The middle SDI quintile experienced the largest decreases in mortality and the DALY rate,with a non-significant decline in prevalence between 1990 and 2019.There were significant discrepancies in the HHD burden and its trends across regions and countries.Conclusions:In the past three decades,there has been an overall increasing trend in the prevalence of HHD among older adults worldwide despite decreasing trends in mortality and the DALY rate.Better management of hypertension,and prevention and control of HHD are needed in older adults.

First line nucleos(t)ide analog monotherapy is more cost-effective than combination strategies in hepatitis B e antigen-positive chronic hepatitis B patients in China

Background:Nucleos(t)ide analog(NA)in combination with peginterferon(PegIFN)therapy in patients with hepatitis B e antigen(HBeAg)-positive chronic hepatitis B(CHB)shows better effectiveness than NA monotherapy in hepatitis B surface antigen loss,termed"functional cure,"based on previous published studies.However,it is not known which strategy is more cost-effective on functional cure.The aim of this study was to analyze the cost-effectiveness of first-line monotherapies and combination strategies in HBeAg-positive CHB patients in China from a social perspective.Methods:A Markov model was developed with functional cure and other five states including CHB,compensated cirrhosis,decompensated cirrhosis,hepatocellular carcinoma,and death to assess the cost-effectiveness of seven representative treatment strategies.Entecavir(ETV)monotherapy and tenofovir disoproxil fumarate(TDF)monotherapy served as comparators,respectively.Results:In the two base-case analysis,compared with ETV,ETV generated the highest costs with$44,210 and the highest quality-adjusted life-years(QALYs)with 16.78 years.Compared with TDF,treating CHB patients with ETV and NA-PegIFN strategies increased costs by$7639 and$6129,respectively,gaining incremental QALYs by 2.20 years and 1.66 years,respectively.The incremental cost-effectiveness ratios were$3472/QALY and$3692/QALY,respectively,which were less than one-time gross domestic product per capita.One-way sensitivity analysis and probabilistic sensitivity analyses showed the robustness of the results.Conclusion:Among seven treatment strategies,first-line NA monotherapy may be more cost-effective than combination strategies in HBeAg-positive CHB patients in China.