Global burden of HIV-negative multidrug-and extensively drug-resistant tuberculosis based on Global Burden of Disease Study 2021

Background:Tuberculosis(TB),caused by Mycobacterium tuberculosis,remains the second leading cause of death from a single infectious disease globally and poses a significant economic and clinical burden in the world in 2022.Of particular concern is the emergence of drug-resistant TB,accounting for 15%-20%of TB deaths.It is imperative to delve into the global trends of incidence and death rate for multidrug-resistant tuberculosis(MDRTB)and extensively drug-resistant tuberculosis(XDR-TB),drawing upon the comprehensive Global Burden of Disease(GBD)2021 drug-resistant tuberculosis dataset.Methods:From the GBD 2021,data on incidence,prevalence,disability-adjusted life years(DALYs),and death of MDR-TB and XDR-TB from 1990 to 2021 were collected.We calculated the estimated annual percentage changes in age standardized incidence rate(ASIR)and age-standardized death rate(ASDR),segmented by age,sex,and socio-demographic index(SDI).The impacts of various risk factors on MDR-TB and XDR-TB were also analyzed.Results:In 2021,there were an estimated 443,680(95%uncertainty interval[UI]:259,196-766,545)incident cases of MDR-TB,and an estimated 106,818(95%UI:41,612-211,854)death cases of MDR-TB,while there were an estimated 24,036(95%UI:17,144-34,587)incident cases of XDR-TB and 7,946(95%UI:3,326-14,859)death cases of XDR-TB.The incidence and death cases of MDR-TB were lowest in high SDI regions,whereas the incidence rates of XDR-TB in high-middle SDI regions were higher than those in middle SDI and high SDI regions.Conclusion:This study reported the disease burden of drug-resistant TB from 1990 to 2021.Until 2021,drugresistant TB is still a serious problem in low SDI countries,especially for high-risk age populations with highrisk factors.Controlling drug-resistant TB requires effective control strategies and healthcare systems.

Trends in epidemiological characteristics and etiologies of diarrheal disease in children under five:an ecological study based on Global Burden of Disease study 2021

Background:Diarrhea remains a significant health threat to children under five years of age.The study aims to systematically elucidate the global burden of diarrhea in children,providing scientific insights for effective prevention and control strategies.Methods:The data from the Global Burden of Disease(GBD)2021 study was analyzed to assess the trends in incidence,prevalence,mortality,and disability-adjusted life years(DALYs)of diarrhea in children under five years across the globe,21 geographical region,and 204 countries and territories,stratified by age group,sex,and socio-demographic index(SDI)levels.The trend of the disease burden for childhood diarrhea from 1990 to 2021 was described and estimated using the average annual percent change(AAPC),and a Bayesian age-period-cohort(BAPC)model was employed to predict the future burden of diarrhea in children.Results:From 1990 to 2021,there was a significant decline in the global burden of diarrhea among children under five years of age.The AAPC for incidence(-4092.18,95%confidence interval[CI]:-4224.60 to-3959.76),prevalence(-70.98,95%CI:-72.67 to-69.28),mortality(-6.89,95%CI:-6.95 to-6.83),and DALYs rate(-621.79,95%CI:-627.20 to-616.38)of diarrhea in children all showed a marked downward trend.Diarrheal incidence(r=-0.782,P<0.001),prevalence(r=-0.777,P<0.001),mortality(r=-0.908,P<0.001),and DALYs rate(r=-0.904,P<0.001)were negatively correlated with the SDI.Between 2022 and 2035,the global incidence,prevalence,and mortality rates of diarrhea in children under five years are projected to continue declining.The leading causes of diarrheal mortality in children include wasting,underweight,and non-exclusive breastfeeding.Rotavirus remains the predominant pathogen associated with diarrhea-related mortality rate and DALY rate.Conclusion:Although the global burden of diarrhea in children under five has steadily declined,it remains a significant health threat.Rotavirus is the leading pathogen,highlighting the importance of expanding rotavirus vaccination.Additionally,improving nutritional status,increasing exclusive breastfeeding rates,and enhancing access to sanitation and clean drinking water are crucial measures that,when widely implemented,can effectively reduce the health risks posed by diarrhea in children.

Global,regional,and national burden of upper respiratory infections,1990–2021:findings from the Global Burden of Disease study 2021

Background:Upper respiratory infections(URIs)are common infectious diseases worldwide.Accurate and timely assessment of the disease burden of URIs is crucial for governments to develop comprehensive prevention and control strategies,and to allocate and utilize healthcare resources more efficiently.Methods:For URIs in Global Burden of Disease(GBD)2021 database,age-standardized incidence rates(ASIR),age-standardized prevalence rates(ASPR),age-standardized mortality rates(ASMR),disability-adjusted life-years(DALYs),and case numbers for incidence,prevalence,deaths,and DALYs across the globe,five socio-demographic index(SDI)regions,21 geographical regions,and 204 countries and territories were provided and analyzed.Trends from 1990 to 2021 were described using the average annual percentage change(AAPC),and future URIs burden was projected with a Bayesian age-period-cohort(BAPC)model.Results:From 1990 to 2021,there was a significant decline in global ASIR(APCC=-289.86,95%confidence interval[CI]:-298.59 to-281.12),ASPR(AAPC=-4.04,95%CI:-4.16 to-3.92),ASMR(AAPC=-0.02,95%CI:-0.02 to-0.03)and age-standardized DALY rate(AAPC=-0.75,95%CI:-0.76 to-0.74).The ASIR,ASPR,ASMR,and age-standardized DALY rate were high in elderly for both males and females,and both genders.Similarly,the number of incident cases,prevalence cases,deaths,and DALY cases for URIs was highest in children under five years.The ASMR and age-standardized DALY rate exhibited a negative correlation with SDI across 204 countries and territories in 2021.The ASIR and ASPR for URIs will show an upward trend from 2022 to 2050,while ASMR and age-standardized DALY rate are expected to decline.Low birth weight for gestation remains the leading contributor to deaths related to URIs.

Global Burden of Disease, Injury and Risk Factor Study 2010: Its Policy Implications for China

Results of the Global Burden of Disease, Injury and Risk Factor Study 2010 （GBD 2010） were released on December 13, 2012 in London, a series of papers concerning the project have been published in the Lancet[1]. Research findings of the project have been reported in the United States, the United Kingdom, Indonesia, China[2] and Australia, and widely applied across the world. In addition, the GBD 2010 will see more countries report their project research findings and implement these findings in the near future. The GBD 2010 provides researchers, administrators and policymakers with new and critical sources for their research, teaching and policymaking.

Tuberculosis Control Priorities Defined by Using Cost-Effectiveness and Burden of Disease

Objective To define TB control priorities using cost-effectiveness and burden of disease.Methods An assumed cohort of 2 000 cases was set up based on age-specific incidence of 794 newly registered smear-positive cases in Beijing in1994.Prognostic trees and model diagrams of infectivity with natural history and DOTS intervention were constructed based on the epidemiological parameters.Results DOTS reduced 89.19% of YLL,78.90% of YLD,and 99.98% of infectivity BOD.One DALY could be saved with 45.70% Yuan by DOTS with 3% discount.Sensitivity analysis showed that discount had effect on CER.Weight of age was insensitive to CER.The higher the DOTS coured rate,the more the cost-effectiveness.Conclusions DOTS is a good cost-effectiveness TB control strategy.Cost-effectiveness and burden of disease can be used to define TB control priorities.

Reevaluating health metrics:Unraveling the limitations of disabilityadjusted life years as an indicator in disease burden assessment

In 1993,the World Bank released a global report on the efficacy of health promotion,introducing the disability-adjusted life years(DALY)as a novel indicator.The DALY,a composite metric incorporating temporal and qualitative data,is grounded in preferences regarding disability status.This review delineates the algorithm used to calculate the value of the proposed DALY synthetic indicator and elucidates key methodological challenges associated with its application.In contrast to the quality-adjusted life years approach,derived from multi-attribute utility theory,the DALY stands as an independent synthetic indicator that adopts the assumptions of the Time Trade Off utility technique to define Disability Weights.Claiming to rely on no mathematical or economic theory,DALY users appear to have exempted themselves from verifying whether this indicator meets the classical properties required of all indicators,notably content validity,reliability,specificity,and sensitivity.The DALY concept emerged primarily to facilitate comparisons of the health impacts of various diseases globally within the framework of the Global Burden of Disease initiative,leading to numerous publications in international literature.Despite widespread adoption,the DALY synthetic indicator has prompted significant methodological concerns since its inception,manifesting in inconsistent and non-reproducible results.Given the substantial diffusion of the DALY indicator and its critical role in health impact assessments,a reassessment is warranted.This reconsideration is imperative for enhancing the robustness and reliability of public health decisionmaking processes.

Global and regional trends in the incidence and mortality burden of endometrial cancer,1990–2019:Updated results from the Global Burden of Disease Study,2019

Background:The disease burdens for endometrial cancer(EC)vary across different countries and geographical regions and change every year.Herein,we reported the updated results of the Global Burden of Disease Study 2019 on EC with respect to age-standardized incidence and mortality from 1990 to 2019.Methods:The annual percentage change(APC)of incidence and mortality was evaluated using joinpoint regression analysis to examine the temporal trends during the same timeframe in terms of the global landscape,different sociodemographic indices(SDI),and geographic regions.The relationship between Human Development Index(HDI)and incidence and mortality was additionally explored.Results:The age-standardized incidence rates(ASIRs)revealed a significant average global elevation by 0.5%per year(95%confidence interval[CI],0.3–0.7;P<0.001).The age-standardized mortality rates(ASMRs),in contrast,fell by an average of 0.8%per year(95%CI,−1.0 to−0.7;P<0.001)worldwide.The ASIRs and ASMRs for EC varied across different SDIs and geographical regions.We noted four temporal trends and a significant reduction by 0.5%per year since 2010 in the ASIR,whereas we detected six consecutively decreasing temporal trends in ASMR during the entire period.Notably,the estimated APCs were significantly positively correlated with HDIs(ρ=0.22;95%CI,0.07–0.35;P=0.003)with regard to incident cases in 2019.Conclusions:Incidence rates for EC reflected a significant increase overall(although we observed a decline since 2010),and the death rates declined consecutively from 1990 to 2019.We posit that more precise strategies can be tailored and then implemented based on the distinct age-standardized incidence and mortality burden in different geographical areas.

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.

Epidemiological features and temporal trends of the co-infection between HIV and tuberculosis, 1990-2021: findings from the Global Burden of Disease Study 2021

Background The co-infection of human immunodeficiency virus(HIV)/acquired immune deficiency syndrome(AIDS)and tuberculosis(TB)poses a significant clinical challenge and is a major global public health issue.This study aims to elucidate the disease burden of HIV-TB co-infection in global,regions and countries,providing critical informa-tion for policy decisions to curb the HIV-TB epidemic.Methods The ecological time-series study used data from the Global Burden of Disease(GBD)Study 2021.The data encompass the numbers of incidence,prevalence,mortality,and disability-adjusted life year(DALY),as well as age-standardized incidence rate(ASIR),prevalence rate(ASPR),mortality rate(ASMR),and DALY rate for HIV-infected drug-susceptible tuberculosis(HIV-DS-TB),HIV-infected multidrug-resistant tuberculosis(HIV-MDR-TB),and HIV-infected extensively drug-resistant tuberculosis(HIV-XDR-TB)from 1990 to 2021.from 1990 to 2021.The estimated annual percentage change(EAPC)of rates,with 95%confidence intervals(C/s),was calculated.Results In 2021,the global ASIR for HIV-DS-TB was 11.59 per 100,000 population(95%UI:0.37-13.05 per 100,000 population),0.55 per 100,000 population(95%UI:0.38-0.81 per 100,000 population),for HIV-MDR-TB,and 0.02 per 100,000 population(95%UI:0.01-0.03 per 100,000 population)for HIV-XDR-TB.The EAPC for the ASIR of HIV-MDR-TB and HIV-XDR-TB from 1990 to 2021 were 4.71(95%CI:1.92-7.59)and 13.63(95%CI:9.44-18.01),respectively.The global ASMR for HIV-DS-TB was 2.22 per 100,000 population(95%UI:1.73-2.74 per 100,000 population),0.21 per 100,000 population(95%UI:0.09-0.39 per 100,000 population)for HIV-MDR-TB,and 0.01 per 100,000 population(95%UI:0.00-0.03 per 100,000 population)for HIV-XDR-TB in 2021.The EAPC for the ASMR of HIV-MDR-TB and HIV-XDR-TB from 1990 to 2021 were 4.78(95%CI:1.32-8.32)and 10.00(95%Cl:6.09-14.05),respectively.Conclusions The findings indicate that enhancing diagnostic and treatment strategies,strengthening healthcare infrastructure,increasing access to quality medical care,and improving public health education are essential to combat HIV-TB co-infection.

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.

Global, regional, and national burden of HIV-negative tuberculosis, 1990-2021: findings from the Global Burden of Disease Study 2021

Background Tuberculosis(TB)is a major infectious disease with significant public health implications.Its widespread transmission,prolonged treatment duration,notable side effects,and high mortality rate pose severe challenges.This study examines the epidemiological characteristics of TB globally and across major regions,providing a scientific basis for enhancing TB prevention and control measures worldwide.Methods The ecological study used data from the Global Burden of Disease(GBD)Study 2021.It assessed new incidence cases,deaths,disability-adjusted life years(DALYs),and trends in age-standardized incidence rates(ASIRs),mortality rates(ASMRs),and DALY rates for drug-susceptible tuberculosis(DS-TB),multidrug-resistant tuberculosis(MDR-TB),and extensively drug-resistant tuberculosis(XDR-TB)from 1990 to 2021.A Bayesian age-period-cohort model was applied to project ASIR and ASMR.Results In 2021,the global ASIR for all HIV-negative TB was 103.00 per 100,000 population 95%uncertainty interval(UI):92.21,114.91 per 100,000 populationl,declining by 0.40%(95%UI:-0.43,-0.38%)compared to 1990.The global ASMR was 13.96 per 100,000 population(95%UI:12.61,15.72 per 100,000 population),with a decline of 0.44%(95%UI:-0.61,-0.23%)since 1990.The global age-standardized DALY rate for HIV-negative TB was 580.26 per 100,000 population(95%UI:522.37,649.82 per 100,000 population),showing a decrease of 0.65%(95%UI:-0.69,-0.57 per 100,000 population)from 1990.The global ASIR of MDR-TB has not decreased since 2015,instead,it has shown a slow upward trend in recent years.The ASIR of XDR-TB has exhibited significant increase in the past 30 years.The projections indicate MDR-TB and XDR-TB are expected to see signifcant increases in both ASIR and ASMR from 2022 to 2035,highlighting the growing challenge of drug-resistant TB.Conclusions This study found that the ASIR of MDR-TB and XDR-TB has shown an upward trend in recent years.To reduce the TB burden,it is essential to enhance health infrastructure and increase funding in low-SDl regions.Developing highly efficient,accurate,and convenient diagnostic reagents,along with more effective therapeutic drugs,and improving public health education and community engagement,are crucial for curbing TB transmission.

Trends in mortality of liver disease due to hepatitis B in China from 1990 to 2019: findings from the Global Burden of Disease Study

Background::Hepatitis B is a viral infection that attacks the liver and can cause both potentially life-threatening acute and chronic liver disease.China has the world’s largest burden of hepatitis B and is considered to be a major contributor toward the goal of World Health Organization(WHO)of eliminating hepatitis B virus(HBV)as a global health threat by 2030.This study aimed to analyze data from the Global Burden of Diseases,Injuries,and Risk Factors Study(GBD)to determine the trends in mortality of liver disease due to hepatitis B in China between 1990 and 2019 and the gap with the WHO’s goal.Methods::Annual deaths and age-standardized mortality rates(ASMRs)of liver disease due to hepatitis B in China between 1990 and 2019 were collected from GBD 2019.We calculated the percentage changes in deaths and estimated annual percentage changes(EAPCs)of ASMRs of liver disease due to hepatitis B.Results::In China,deaths of total liver disease due to hepatitis B decreased by 29.13%from 229 thousand in 2016 to 162 thousand in 2019,and ASMR decreased by an average of 4.92%(95%confidence interval[CI]:4.45–5.39%)per year in this period.For the spectrum of liver disease due to hepatitis B,deaths decreased by 74.83%,34.71%,and 23.34%for acute hepatitis,cirrhosis and other chronic liver diseases,and liver cancer from 1990 to 2019,respectively,and ASMRs of acute hepatitis(EAPC=–7.63;95%CI:–8.25,–7.00),cirrhosis and other chronic liver diseases(EAPC=–4.15;95%CI:–4.66,–3.65),and liver cancer(EAPC=–5.17;95%CI:–6.00,–4.33)decreased between 1990 and 2019.The proportions of older adults aged≥70 years among all deaths of the spectrum of liver disease due to hepatitis B increased from 1990 to 2019.Deaths of liver cancer due to hepatitis B increased by 7.05%from 2015 to 2019.Conclusions::Although a favorable trend in the mortality of liver disease due to hepatitis B was observed between 1990 and 2019,China still faces challenges in achieving the WHO’s goal of eliminating HBV as a public threat by 2030.Therefore,efforts to increase the coverage of diagnosis and treatment of liver disease due to hepatitis B,especially of liver cancer due to hepatitis B,are warranted in China.

Changing profiles of cardiovascular disease and risk factors in China:a secondary analysis for the Global Burden of Disease Study 2019

Background:Understanding the changing profiles of cardiovascular disease(CVD)and modifiable risk factors is essential for CVD prevention and control.We aimed to report the comprehensive trends in CVD and risk factors in China from 1990 to 2019.Methods:Data on the incidence,death,and disability-adjusted life years(DALYs)of total CVD and its 11 subtypes for China were obtained from the Global Burden of Disease Study 2019.The CVD burden attributable to 12 risk factors was also retrieved.A secondary analysis was conducted to summarize the leading causes of CVD burden and attributable risk factors.Results:From 1990 to 2019,the number of CVD incidence,death,and DALYs considerably increased by 132.8%,89.1%,and 52.6%,respectively.Stroke,ischemic heart disease,and hypertensive heart disease accounted for over 95.0%of CVD deaths in 2019 and remained the top three causes during the past 30 years.Between 1990 and 2019,the age-standardized rate of stroke decreased significantly(percentage of decreased incidence:-9.3%;death:-39.8%;DALYs:-41.6%),while the rate of ischemic heart disease increased(percentage of increased incidence:11.5%;death:17.6%;DALYs:2.2%).High systolic blood pressure,unhealthy diet,tobacco,and air pollution continued to be the major contributors to CVD deaths and DALYs(attributing to over 70%of the CVD burden),and the high body mass index(BMI)-associated CVD burden had the largest increase between 1990 and 2019.Conclusions:The significant increases in the number of CVD incident cases,deaths,and DALYs suggest that the CVD burden is still a concern.Intensified strategies and policies are needed to maintain promising progress in stroke and to reduce the escalating burden of ischemic heart disease.The CVD burden attributable to risk factors has not yet made adequate achievements;even worse,high BMI has contributed to the increasing CVD burden.

Burden of epilepsy in China and its provinces,1990 to 2019:findings from the Global Burden of Disease Study 2019

Background: Epilepsy accounts for a significant portion of the global disease burden. However, little is known about the disease burden of epilepsy in China and its provinces. Methods: We assessed the burden of epilepsy in China and its provinces, municipalities, and autonomous regions from 1990 to 2019. Burden was measured as incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs), by age, sex, year, and province. We used the Socio-Demographic Index (SDI) to determine the association between the provincial development level and age-standardized DALY rates of epilepsy from 1990 to 2019. Results: In 2019, epilepsy caused 1367.51 thousand (95% uncertainty interval [UI]: 979.92–1837.61 thousand) DALYs, and the age-standardized DALY rate was 99.77 (95% UI: 71.33–133.52)/100,000. The age-standardized incidence and prevalence rates for epilepsy in China were 24.65/100,000 and 219.69/100,000, increased by 45.00% (95% UI: 8.03–98.74%) and 35.72% (95% UI: 0.47–86.19%) compared with that in 1990, respectively. From 1990 to 2019, the proportion of DALY caused by epilepsy in the age group under 25 years steadily decreased. The proportion of DALYs caused by epilepsy in people aged 50 years and over increased from 9.45% and 10.22% in 1990 to 29.01% and 32.72% for male and female individuals in 2019, respectively. The highest age-standardized mortality rates were seen in Tibet (4.26 [95% UI: 1.43–5.66]/100,000), Qinghai (1.80 [95% UI: 1.15–2.36]/100,000), and Yunnan (1.30 [95% UI: 0.88–1.62]/100,000), and the lowest mortality rates were in Guangdong (0.48 [95% UI: 0.39–0.64]/100,000), Zhejiang (0.56 [95% UI: 0.44–0.70]/100,000), and Shanghai (0.57 [95% UI: 0.41–0.73]/100,000). The age-standardized DALY rates across the country and in provinces, municipalities, and autonomous regions generally decreased as their SDI increased. Conclusions: The disease burden of epilepsy is still heavy in China, especially in the western provinces. The incidence and prevalence of epilepsy increased between 1990 and 2019, and the burden of epilepsy in the elderly increases gradually. This study provides evidence on epilepsy prevention and care of different regions in China.

Global and regional burdens of oral cancer from 1990 to 2017:Results from the global burden of disease study

Background:Data on the incidence,mortality,and other burden of oral cancer as well as their secular trends are necessary to provide policy-makers with the information needed to allocate resources appropriately.The purpose of this study was to use the Global Burden of Disease(GBD)2017 results to estimate the incidence,mortality,and disability-adjusted life years(DALYs)for oral cancer from 1990 to 2017.Methods:We collected detailed data on oral cancer from 1990 to 2017 from the GBD 2017.The global incidence,mortality,and DALYs attributable to oral cancer as well as the corresponding age-standardized rates(ASRs)were calculated.The estimated annual percentage changes in the ASRs of incidence(ASRI)and mortality(ASRM)and age-standardized DALYs of oral cancer were also calculated according to regions and countries to quantify the secular trends in these rates.Results:We tracked the incidence,mortality,and DALYs of oral cancer in 195 countries/territories over 28 years.Globally,the incidence,mortality,and DALYs of oral cancer increased by about 1.0-fold from 1990 to 2017.The ASRI of oral cancer showed a similar trend,increasing from 4.41 to 4.84 per 100,000 person-years during the study period.The ASRM remained approximately stable at about 2.4 per 100,000 from 1990 to 2017,as did the age-standardized DALYs,at about 64.0 per 100,000 person-years.ASRI was highest in Pakistan(27.03/100,000,95%CI=22.13-32.75/100,000),followed by Taiwan China,and lowest in Iraq(0.96/100,000,95%CI=0.86-1.06/100,000).ASRM was highest in Pakistan(16.85/100,000,95%CI=13.92-20.17/100,000)and lowest in Kuwait(0.51/100,000,95%CI=0.45-0.58/100,000).Conclusions:The ASRI of oral cancer has increased slightly worldwide,while the ASRM and age-standardized DALY have remained stable.However,these characteristics vary between countries,suggesting that current prevention strategies should be reoriented,and much more targeted and specific strategies should be established in some countries to forestall the increase in oral cancer.

Comparison of time trends in the incidence of primary liver cancer between China and the United States: an age-period-cohort analysis of the Global Burden of Disease 2019

Background::China and the United States(US)ranked first and third in terms of new liver cancer cases and deaths globally in 2020.Therefore,a comprehensive assessment of trends in the incidence of primary liver cancer with four major etiological factors between China and the US during the past 30 years with age-period-cohort(APC)analyses is warranted.Methods::Data were obtained from the Global Burden of Disease 2019,and period/cohort relative risks were estimated by APC modeling from 1990 to 2019.Results::In 2019,there were 211,000 new liver cancer cases in China and 28,000 in the US,accounting for 39.4%and 5.2%of global liver cancer cases,respectively.For China,the age-standardized incidence rate(ASIR)consecutively decreased before 2005 but increased slightly since then,whereas the ASIR continuously increased in the US.Among the four etiological factors of liver cancer,the fastest reduction in incidence was observed in hepatitis B virus-related liver cancer among Chinese women,and the fastest increase was in nonalcoholic steatosis hepatitis(NASH)-related liver cancer among American men.The greatest reduction in the incidence of liver cancer was observed at the age of 53 years in Chinese men(-5.2%/year)and 33 years in Chinese women(-6.6%/year),while it peaked at 58 years old in both American men and women(4.5%/year vs.2.8%/year).Furthermore,the period risks of alcohol-and NASH-related liver cancer among Chinese men have been elevated since 2013.Simultaneously,leveled-off period risks were observed in hepatitis C viral-related liver cancer in both American men and women.Conclusions::Currently,both viral and lifestyle factors have been and will continue to play an important role in the time trends of liver cancer in both countries.More tailored and efficient preventive strategies should be designed to target both viral and lifestyle factors to prevent and control liver cancer.

Burden of multiple myeloma in China:an analysis of the Global Burden of Disease,Injuries,and Risk Factors Study 2019

Background:There is limited data to comprehensively evaluate the epidemiological characteristics of multiple myeloma(MM)in China;therefore,this study determined the characteristics of the disease burden of MM at national and provincial levels in China.Methods:The burden of MM,including incidence,mortality,prevalence,and disability-adjusted life years(DALYs),with a 95%uncertainty interval(UI),was determined in China following the general analytical strategy used in the Global Burden of Disease,Injuries,and Risk Factors Study 2019.The trends in the burden of MM from 1990 to 2019 were also evaluated.Results:There were an estimated 347.45 thousand DALYs with an age-standardized DALY rate of 17.05(95%UI,12.31-20.77)per 100,000 in 2019.The estimated number of incident case and deaths of MM were 18,793 and 13,421,with age-standardized incidence and mortality rates of 0.93(95%UI,0.67-1.15)and 0.67(95%UI,0.50-0.82)per 100,000,respectively.The age-specific DALY rates per 100,000 increased to more than 10.00 in the 40 to 44 years age group reaching a peak(93.82)in the 70 to 74 years age group.Males had a higher burden than females,with approximately 1.5-to 2.0-fold sex difference in age-specific DALY rates in all age groups.From 1990 to 2019,the DALYs of MM increased 134%,from 148,479 in 1990 to 347,453 in 2019.Conclusion:The burden of MM has doubled over the last three decades,which highlights the need to establish effective disease prevention and control strategies at both the national and provincial levels.

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.

Trends in burden of multidrug-resistant tuberculosis in countries,regions,and worldwide from 1990 to 2017:results from the Global Burden of Disease study

Background:Antituberculosis-drug resistance is an important public health issue,and its epidemiological patterns has dramatically changed in recent decades.This study aimed to estimate the trends of multidrug-resistant tuberculosis(MDR-TB),which can be used to inform health strategies.Methods:Data were collected from the Global Burden of Disease study 2017.The estimated annual percentage changes(EAPCs)were calculated to assess the trends of MDR-TB burden at global,regional,and national level from 1990 to 2017 using the linear regression model.

Global trends and regional differences in non-transport unintentional injuries mortality among children and adolescents, 1990 to 2019: results from the Global Burden of Disease 2019 study

Background::Non-transport unintentional injuries(NTUIs)are major public concerns,especially among children and adolescents in low-and middle-income countries.With environmental and cognitive changes,a recent systematic description of global trends and regional differences concerning NTUIs is urgently needed for the global agenda of relevant policy-making and intervention target findings.Methods::We used mortality,population,and socio-demographic-index(SDI)data from Global Burden of Disease 2019 to analyze the trends of NTUIs mortality.We applied the slope index of inequality(SII)and relative index of inequality(RII)to measure the absolute and relative inequality between countries and territories.The concentration curve and concentration index(CI)were also used to measure the inequality.We conducted a sensitivity analysis to make our findings credible.Results::In 2019,there were 205,000 deaths due to NTUIs among children and adolescents aged 5 to 24 years,which decreased from 375,000 in 1990.In 2019,the age-standardized mortality rate(ASMR)was 8.13 per 100,000,ranging from the lowest in the Netherlands(0.90 per 100,000)to the highest in the Solomon Islands(29.34 per 100,000).The low-middle SDI group had the highest ASMR of NTUIs,while the low SDI group had the slowest decrease.After excluding the death caused by"exposure to forces of nature"and"other unintentional injuries",drowning accounted for the most deaths in almost every SDI group,gender,and age group,but the major causes of death varied in different subgroups.For example,animal contact was a major cause in low and low-middle SDI groups but less in high SDI groups,while high and high-middle SDI groups had a higher proportion of deaths for foreign body and poisonings.The SII showed a declining trend,but the RII and CI did not,which might indicate that inequality was persistent.Similar results were found in the sensitivity analysis.Conclusions::Despite the declining trend of the mortality rate and the narrowing gap between countries,there were still a large number of children and adolescents dying from NTUIs,and those experiencing social-economic disadvantages remained at high mortality.Embedding the prevention of NTUIs into sustainable development goals might contribute to the progress of reducing death and inequalities,which ensures that no one is left behind.