COVID-19 mortality trends before and after the national vaccination program in Iran: A joinpoint regression analysis

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

Cancer mortality in Serbia, 1991-2015: an age-period-cohort and joinpoint regression analysis

Background:As the result of dramatic political changes,civil wars,and a long-term refugee crisis from the end of the last to beginning of this century,the population of Serbia has experienced significant health problems.The aim of this study was to assess cancer mortality trends in Serbia.Methods:This nationwide study was carried out to analyze cancer mortality in Serbia during 1991-2015 using offi-cial data.The age-standardized mortality rates(per 100,000)were calculated by direct standardization,using the world standard population by Segi.The average annual percent change(AAPC)and corresponding 95%confidence interval(CI)were computed using joinpoint regression analysis.Age-period-cohort analysis was performed to address the possible underlying reasons for the observed temporal trends.Results:Over the 25-year study period,there were 466,075 cancer deaths(266,043 males and 200,032 females)in Serbia.Overall cancer mortality increased between 1991 and 2009 in both males(by+0.9%per year)and females(by+0.8%per year)and has been decreasing since then,by−0.9%annually in both sexes.For almost all major cancers except stomach cancer,cancer mortality in Serbia demonstrated upward trends during the study period.The largest increases were noted in lung cancer among females(AAPC=+3.7,95%CI 3.5-3.9)and prostate cancer in males(AAPC=+1.9,95%CI 1.4-2.3).Conclusions:After two decades of increase,cancer mortality rates are finally declining in Serbia.Despite this,these rates place Serbia among the countries with the highest cancer mortality in the world.

Changes in Notified Incidence of Pulmonary Tuberculosis in China,2005–2020

Objective To evaluate the trend of notified incidence of pulmonary tuberculosis(PTB)in China at different periods by population and region and to explore the effect of TB prevention and control in recent years.Methods Using pooled data on TB cases reported by the TB Information Management Reporting System(TBIMS)from 2005 to 2020,we calculated the annual percentage change(APC)using the Joinpoint regression model.Results From 2005 to 2020,a total of 16.2 million cases of PTB were reported in China,with an average notified incidence of 75.5 per 100,000 population.The age standardization rate(ASR)continued to decline from 116.9(/100,000)in 2005 to 47.6(/100,000)in 2020,with an average annual decrease of5.6%[APC=-5.6,95%confidence interval(CI):-7.0 to-4.2].The smallest decline occurred in2011–2018(APC=-3.4,95%CI:-4.6 to-2.3)and the largest decrease in 2018–2020(APC=-9.2,95%CI:-16.4 to-1.3).From 2005 to 2020,the ASR in males(159.8 per 100,000 in 2005,72.0 per 100,000 in2020)was higher than that in females(62.2 per 100,000 in 2005,32.3 per 100,000 in 2020),with an average annual decline of 6.0%for male and 4.9%for female.The average notified incidence was the highest among older adults(65 years and over)(182.3/100,000),with an average annual decline of6.4%;children(0–14 years)were the lowest(4.8/100,000),with an average annual decline of 7.3%,but a significant increase of 3.3%between 2014 and 2020(APC=3.3,95%CI:1.4 to 5.2);middle-aged(35–64years)decreased by 5.8%;and youth(15–34 years)decreased by an average annual rate of 4.2%.The average ASR in rural areas(81.3/100,000)is higher than that in urban areas(76.1/100,000).The average annual decline in rural areas was 4.5%and 6.3%in urban areas.South China had the highest average ASR(103.2/100,000),with an average annual decline of 5.9%,while North China had the lowest(56.5/100,000),with an average annual decline of 5.9%.The average ASR in the southwest was 95.3(/100,000),with the smallest annual decline(APC=-4.5,95%CI:-5.5 to-3.5);the average ASR in the Northwest China was 100.1(/100,000),with the largest annual decline(APC=-6.4,95%CI:-10.0 to-2.7);Central,Northeastern,and Eastern China declined by an average of 5.2%,6.2%,and 6.1%per year,respectively.Conclusions From 2005 to 2020,the notified incidence of PTB in China continued to decline,falling by55%.For high-risk groups such as males,older adults,high-burden areas in South,Southwest,and Northwest China,and rural regions,proactive screening should be strengthened to provide timely and effective anti-TB treatment and patient management services for confirmed cases.There is also a necessity to be vigilant about the upward trend of children in recent years,the specific reasons for which need to be further studied.

Effect of Age and Sex on Stroke Mortality of Young and Middle-aged Adults in China,2002–2019,and Predictions to 2030

Objective This study aimed to examine the trends in stroke mortality among young and middle-aged adults in China.Methods Data were obtained from the China national vital registration system.Significant changes in mortality were assessed by Joinpoint regression.Age-period-cohort analysis was used to explain the reasons for the changes.Future mortality and counts were predicted by the Bayesian age-period-cohort model.Results Between 2002 and 2019,a total of 6,253,951 stroke mortality in young and middle-aged adults were recorded.The age-adjusted mortality rates(AAMRs)of women showed a downward trend.The annual percent changes(APC)were-3.5%(-5.2%,-1.7%)for urban women and-2.8%(-3.7%,-1.9%)for rural women.By contrast,the AAMRs per 100,000 for rural men aged 25–44 years continued to rise from 9.40 to 15.46.The AAMRS for urban men aged 25–44 years and urban and rural men aged 45–64years did not change significantly.Between 2020 and 2030,the projected stroke deaths are 1,423,584 in men and 401,712 in women.Conclusion Significant sex and age disparities in the trends of stroke mortality among young and middle-aged adults were identified in China.Targeted health policy measures are needed to address the burden of stroke in the young generation,especially for rural men,with a focus on the prevention and management of high risk factors.

2006-2019年广东省人群狂犬病发病与暴露流行特征及变化趋势

目的 分析广东省人群狂犬病发病与暴露流行特征及其变化趋势,为广东省防控狂犬病提供决策依据。方法 应用描述性流行病学方法分析2006―2019年广东省狂犬病病例及暴露人群特征;采用Joinpoint回归模型分析狂犬病发病和暴露特征变化趋势。结果 广东省2006―2019年狂犬病年均发病率为0.17/10万,年发病率呈下降趋势,平均年度变化百分比(average annual percentage change, AAPC)为-26.15%(95%CI:-31.81%~-20.02%)。狂犬病年均暴露率为687.72/10万;年暴露率呈上升趋势(AAPC=5.21%, 95%CI:3.55%~6.90%),与年发病率存在负相关性(r=-0.947,P<0.001)。不同地区、性别和年龄组发病率呈不同程度的下降趋势,AAPC介于-22.95%和-49.19%,而暴露率呈不同程度的上升趋势,AAPC介于2.92%和7.93%。致伤动物以家犬居多(57.58%)。从伤口分级来看,以Ⅱ级暴露居多(61.26%),构成比呈上升趋势(P=0.006)。Ⅱ级和Ⅲ级暴露者年均暴露后伤口处理率为99.20%,呈下降趋势(AAPC=-0.58%, 95%CI:-0.78%~-0.38%);Ⅲ级暴露者年均被动免疫制剂接种率为23.78%,呈稳定趋势(AAPC=-0.36%, 95%CI:-2.78%~2.13%)。结论 广东省狂犬病发病率2006―2019年呈下降趋势,目前处于低发态势。狂犬病暴露后犬伤门诊就诊率呈上升趋势,但Ⅲ级暴露者狂犬病被动免疫制剂接种率维持在低水平,需有针对性加大狂犬病宣传力度。

Trends in disease burden of hepatitis B infection in Jiangsu Province,China,1990-2021

Background:The incidence of hepatitis B virus(HBV)has decreased year by year in China after the expansion of vaccination,but there is still a high disease burden in Jiangsu Province of China.Methods:The year-by-year incidence data of HBV in Jiangsu Province from 1990 to 2021 were collected.The incidence rates of males and females age groups were clustered by systematic clustering,and the incidence rates of each age group were analyzed and studied by using Joinpoint regression model and age-period-cohort effect model(APC).Results:Joinpoint regression model and APC model showed a general decrease in HBV prevalence in both males and females.In addition,the results of the APC model showed that the age,period,and cohort effects of patients all affected the incidence of HBV,and the incidence was higher in males than in females.The incidence is highest in the population between the ages of 15 and 30 years(mean:21.76/100,000),especially in males(mean:31.53/100,000)than in females(mean:11.67/100,000).Another high-risk group is those over 60 years of age(mean:21.40/100,000),especially males(mean:31.17/100,000)than females(mean:11.63/100,000).The period effect of the APC model suggests that HBV vaccination is effective in reducing the incidence of HBV in the population.Conclusions:The incidence of HBV in Jiangsu Province showed a gradual downward trend,but the disease burden in males was higher than that in females.The incidence is higher and increasing rapidly in the population between the ages of 15 and 30 years and people over 60 years of age.More targeted prevention and control measures should be imple-mented for males and the elderly.