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.

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.

Physical activity and cancer risk:a dose-response analysis for the Global Burden of Disease Study 2019

Objective Adopting a healthy lifestyle,including regular physical activity,is widely believed to decrease cancer risk.This study aimed to quantitatively establish the dose-response relationships between total physical activity and the risk of breast,colon,lung,gastric,and liver cancers.Methods A systematic review and dose-response analysis were conducted using PubMed and Embase from January 1,1980 to March 20,2023.Prospective cohort studies that examined the association between physical activity and the risks of any of the 5 outcomes were included.The search was confined to publications in the English language with a specific focus on human studies.Physical activity is standardized by using the data from US National Health and Nutrition Examination Surveys(NHANES)and the Global Burden of Disease 2019 database.Results A total of 98 studies,involving a combined population of 16,418,361 individuals,were included in the analysis.Among the included studies,57 focused on breast cancer,17 on lung cancer,23 on colon cancer,5 on gastric cancer,and 7 on liver cancer.Overall,elevated levels of physical activity exhibited an inverse correlation with the risk of cancer.The dose-response curve for lung cancer exhibited a non-linear pattern,with the greatest benefit risk reduction observed at 13,200 MET-minutes/week of physical activity,resulting in a 14.7%reduction in risk(relative risk 0.853,uncertainty interval 0.798 to 0.912)compared to the inactive population.In contrast,the dose-response curves for colon,gastric,breast,and liver cancers showed linear associations,indicating that heightened levels of total physical activity were consistently associated with reduced cancer risks.However,the increase in physical activity yielded a smaller risk reduction for colon and gastric cancers compared to breast and liver cancers.Compared to individuals with insufficient activity(total activity level<600 MET-minutes/week),individuals with high levels of activity(≥8,000 MET-minutes/week)experienced a 10.3%(0.897,0.860 to 0.934)risk reduction for breast cancer;5.9%(0.941,0.884 to 1.001)for lung cancer;7.1%(0.929,0.909 to 0.949)for colon cancer;5.1%(0.949,0.908 to 0.992)for gastric cancer;17.1%(0.829,0.760 to 0.903)for liver cancer.Conclusions This study demonstrated a significant inverse relationship between total physical activity and the risk of breast,gastric,liver,colon,and lung cancers.

Global burden of inflammatory bowel disease 1990-2019:A systematic examination of the disease burden and twenty-year forecast

BACKGROUND Inflammatory bowel disease(IBD)is an idiopathic intestinal disease with various levels and trends in different countries and regions.Understanding the current burden and trends of IBD in various geographical locations is essential to establish effective strategies for prevention and treatment.We report the average annual percentage change(AAPC)and estimated annual percentage change(EAPC)in age-standardized rates(ASR)of IBD in different regions based on the Global Burden of Disease(GBD)study from 1990-2019,and the relationships between IBD and the human development index(HDI)and socio-demographic index(SDI).The prevalence trends of IBD were predicted by gender from 2019-2039.AIM To comprehensively investigate IBD data,providing further insights into the management of this chronic disease.METHODS We collected the information on the incidence of IBD from the GBD study from 1990-2019 to calculate the AAPC and EAPC in ASR of IBD in different regions.The relationships between IBD,HDI,and SDI were analyzed.The Nordpred and Bayesian age-period-cohort models were used to predict the prevalence trends of IBD by gender from 2019-2039,and the reliability of the results was validated.RESULTS North America consistently had the highest IBD ASR,while Oceania consistently had the lowest.East Asia had the fastest average annual growth in ASR(2.54%),whereas Central Europe had the fastest decline(1.38%).Countries with a low age-standardized incidence rates in 1990 showed faster growth in IBD while there was no significant correlation in 2019.Additionally,IBD increased faster in countries with a low age-standardized death rates in 1990,whereas the opposite was true in 2019.Analysis of SDI and IBD ASR showed that countries with a high SDI generally had a higher IBD ASR.Finally,the projections showed a declining trend in the incidence of IBD from 2019-2039,but a gradual increase in the number of cases.CONCLUSION As the global population increases and ages,early monitoring and prevention of IBD is important to reduce the disease burden,especially in countries with a high incidence of IBD.

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.

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.

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.

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.

Neglected tropical diseases and global burden of disease in China

Recently,the mortality of 240 causes in China including a subnational analysis during 1990-2013 was published in The Lancet.This comprehensive analysis will undoubtedly impact policymaking regarding public health in China.However,it is unfavourable in some degree to neglected tropical diseases,which is the subject of this Letter to the Editor.Policymakers,especially those in less developed provinces of China,should fully consider the burden of neglected tropical diseases,which will benefit the control and final elimination of these diseases in the country.

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.

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.

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.

The burden of disease on HIV-infected orphaned and non-orphaned children accessing primary health facilities in a rural district with poor resources in South Africa: a cross-sectional survey of primary caregivers of HIV-infected children aged 5–18 years

Background:Provider-initiated HIV testing and counseling(PITC)is offered as part of the normal standard of care to increase access to treatment for HIV-infected children.In practice,HIV diagnosis occurs in late childhood following recurrent and chronic infections.We investigated primary caregivers’reported reasons for seeking HIV testing for children aged 5–18 years,determined the orphan status of the children,and compared the clinical profile and disease burden of orphans and non-orphans.Methods:This was a cross-sectional survey of primary caregivers of HIV-infected children accessing antiretroviral treatment(ART)from two community hospitals and 34 primary healthcare facilities in a rural district in Mpumalanga province,South Africa.Results:The sample consisted of 406 primary caregivers:319(78.6%)brought the child to the health facility for HIV testing because of chronic and recurrent infections.Almost half(n=183,45.1%)of the children were maternal orphans,128(31.5%)were paternal orphans,and 73(39.9%)were double orphans.A univariate analysis showed that maternal orphans were significantly more likely to be older(OR=2.57,p=0.000,CI:1.71–3.84),diagnosed late(OR=2.48,p=0.009,CI:1.26–4.88),and to start ART later(OR=2.5,p=0.007,CI:1.28–4.89)than non-orphans.There was a high burden of infection among the children prior to HIV diagnosis;274(69.4%)presented with multiple infections.Multiple logistic regression showed that ART start age(aOR=1.19,p=0.000,CI:1.10–1.29)and time on ART(aOR=2.30,p=0.000,CI:1.45–3.64)were significantly associated with orphanhood status.Half(n=203,(50.2%)of the children were admitted to hospital prior to start of ART,and hospitalization was associated with multiple infections(OR=1.27,p=0.004,CI:1.07–1.51).Conclusions:The study found late presentation with undiagnosed perinatal HIV infection and high prevalence of orphanhood among the children.The health of maternal orphans was more compromised than non-orphans.Routine PICT should be strengthened to increase community awareness about undiagnosed HIV among older children and to encourage primary caregivers to accept HIV testing for children.

The Association of Socioeconomic Status with the Burden of Cataract-related Blindness and the Effect of Ultraviolet Radiation Exposure: An Ecological Study

Objective To assess the association of socioeconomic status with the burden of cataract blindness in terms of year lived with disability(YLD) rates and to determine whether ultraviolet radiation(UVR) levels modify the effect of socioeconomic status on this health burden.Methods National and subnational age-standardized YLD rates associated with cataract-related blindness were derived from the Global Burden of Disease(GBD) study 2017. The human development index(HDI) from the Human Development Report was used as a measure of socioeconomic status.Estimated ground-level UVR exposure was obtained from the Ozone Monitoring Instrument(OMI)dataset of the National Aeronautics and Space Administration(NASA).Results Across 185 countries, socioeconomic status was inversely associated with the burden of cataract blindness. Countries with a very high HDI had an 84% lower age-standardized YLD rate [95%confidence interval(CI): 60%–93%, P < 0.001] than countries with a low HDI;for high-HDI countries, the proportion was 76%(95% CI: 53%–88%, P < 0.001), and for medium-HDI countries, the proportion was48%(95% CI: 15%–68%, P = 0.010;P for trend < 0.001). The interaction analysis showed that UVR exposure played an interactive role in the association between socioeconomic status and cataract blindness burden(P value for interaction = 0.047).Conclusion Long-term high-UVR exposure amplifies the association of poor socioeconomic status with the burden of cataract-related blindness. The findings emphasize the need for strengthening UVR exposure protection interventions in developing countries with high-UVR exposure.

Estimation of lung cancer burden in Australia,the Philippines,and Singapore:an evaluation of disability adjusted life years

Objective: Lung cancer is one of the leading cancers and major causes of cancer mortality worldwide. The economic burden associated with the high mortality of lung cancer is high, which accounts for nearly $180 billion on a global scale in 2008. This paper aims to understand the economic burden of lung cancer in terms of disability adjusted life years(DALY) in Australia, the Philippines, and Singapore.Methods: The years of life lost(YLL) and years lost due to disability(YLD) were calculated using the formula developed by Murray and Lopez in 1996 as part of a comprehensive assessment of mortality and disability for diseases, injuries and risk factors in 1990 and projected to 2020. The same formula is represented in the Global Burden of Disease template provided by the World Health Organization. Appropriate assumptions were made when data were unavailable and projections were performed using regression analysis to obtain data for 2015.Results: The total DALYs due to lung cancer in Australia, the Philippines, and Singapore were 91,695, 38,584, and 12,435,respectively, and the corresponding DALY rates per a population of 1,000 were 4.0, 0.4, and 2.2, respectively, with a discount rate of 3%. When researchers calculated DALYs without the discount rate, the burden of disease increased substantially; the DALYs were 117,438 in Australia, 50,977 in the Philippines, and 16,379 in Singapore. Overall, YLL or premature death accounted for more than 95% of DALYs in these countries.Conclusions: Strategies for prevention, early diagnosis, and prompt treatment must be devised for diseases where the major burden is due to mortality.

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.

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.

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.

Global trends in hepatitis C-related hepatocellular carcinoma mortality:A public database analysis(1999-2019)

BACKGROUND Hepatitis C is the leading cause of chronic liver disease worldwide and it significantly contributes to the burden of hepatocellular carcinoma(HCC).However,there are marked variations in the incidence and mortality rates of HCC across different geographical regions.With the advent of new widely available treatment modalities,such as direct-acting antivirals,it is becoming increasingly imperative to understand the temporal and geographical trends in HCC mortality associated with Hepatitis C.Furthermore,gender disparities in HCC mortality related to Hepatitis C are a crucial,yet underexplored aspect that adds to the disease's global impact.While some studies shed light on gender-specific trends,there is a lack of comprehensive data on global and regional mortality rates,particularly those highlighting gender disparities.This gap in knowledge hinders the development of targeted interventions and resource allocation strategies.DISCUSSION The results of our study show an overall decline in the mortality rates of patients with hepatitis C-related HCC over the last two decades.Notably,females exhibited a remarkable decrease in mortality compared to males.Regionally,East Asia and the Pacific displayed a significant decline in mortality,while Europe and Central Asia witnessed an upward trend.Latin America and the Caribbean also experienced an increase in mortality rates.However,no significant difference was observed in the Middle East and North Africa.North America exhibited a notable upward trend.South Asia and Sub-Saharan Africa significantly declined throughout the study period.This raises the hope of identifying areas for implementing more targeted resources.Despite some progress,multiple challenges remain in meeting the WHO 2030 goal of eliminating viral hepatitis[24].