Assessment of Wet Season Precipitation in the Central United States by the Regional Climate Simulation of the WRFG Member in NARCCAP and Its Relationship with Large-Scale Circulation Biases

Assessment of past-climate simulations of regional climate models(RCMs)is important for understanding the reliability of RCMs when used to project future regional climate.Here,we assess the performance and discuss possible causes of biases in a WRF-based RCM with a grid spacing of 50 km,named WRFG,from the North American Regional Climate Change Assessment Program(NARCCAP)in simulating wet season precipitation over the Central United States for a period when observational data are available.The RCM reproduces key features of the precipitation distribution characteristics during late spring to early summer,although it tends to underestimate the magnitude of precipitation.This dry bias is partially due to the model’s lack of skill in simulating nocturnal precipitation related to the lack of eastward propagating convective systems in the simulation.Inaccuracy in reproducing large-scale circulation and environmental conditions is another contributing factor.The too weak simulated pressure gradient between the Rocky Mountains and the Gulf of Mexico results in weaker southerly winds in between,leading to a reduction of warm moist air transport from the Gulf to the Central Great Plains.The simulated low-level horizontal convergence fields are less favorable for upward motion than in the NARR and hence,for the development of moist convection as well.Therefore,a careful examination of an RCM’s deficiencies and the identification of the source of errors are important when using the RCM to project precipitation changes in future climate scenarios.

Geologic characteristics,exploration and production progress of shale oil and gas in the United States:An overview

We present a systematic summary of the geological characteristics,exploration and development history and current state of shale oil and gas in the United States.The hydrocarbon-rich shales in the major shale basins of the United States are mainly developed in six geological periods:Middle Ordovician,Middle-Late Devonian,Early Carboniferous(Middle-Late Mississippi),Early Permian,Late Jurassic,and Late Cretaceous(Cenomanian-Turonian).Depositional environments for these shales include intra-cratonic basins,foreland basins,and passive continental margins.Paleozoic hydrocarbon-rich shales are mainly developed in six basins,including the Appalachian Basin(Utica and Marcellus shales),Anadarko Basin(Woodford Shale),Williston Basin(Bakken Shale),Arkoma Basin(Fayetteville Shale),Fort Worth Basin(Barnett Shale),and the Wolfcamp and Leonardian Spraberry/Bone Springs shale plays of the Permian Basin.The Mesozoic hydrocarbon-rich shales are mainly developed on the margins of the Gulf of Mexico Basin(Haynesville and Eagle Ford)or in various Rocky Mountain basins(Niobrara Formation,mainly in the Denver and Powder River basins).The detailed analysis of shale plays reveals that the shales are different in facies and mineral components,and"shale reservoirs"are often not shale at all.The United States is abundant in shale oil and gas,with the in-place resources exceeding 0.246×10^(12)t and 290×10^(12)m^(3),respectively.Before the emergence of horizontal well hydraulic fracturing technology to kick off the"shale revolution",the United States had experienced two decades of exploration and production practices,as well as theory and technology development.In 2007-2023,shale oil and gas production in the United States increased from approximately 11.2×10^(4)tons of oil equivalent per day(toe/d)to over 300.0×10^(4)toe/d.In 2017,the shale oil and gas production exceeded the conventional oil and gas production in the country.In 2023,the contribution from shale plays to the total U.S.oil and gas production remained above 60%.The development of shale oil and gas has largely been driven by improvements in drilling and completion technologies,with much of the recent effort focused on“cube development”or“co-development”.Other efforts to improve productivity and efficiency include refracturing,enhanced oil recovery,and drilling of“U-shaped”wells.Given the significant resources base and continued technological improvements,shale oil and gas production will continue to contribute significant volumes to total U.S.hydrocarbon production.

Characteristics of patients with Wilson disease in the United States: An insurance claims database study

BACKGROUND Wilson disease(WD)is a progressive,potentially fatal degenerative disease affecting the liver and central nervous system.Given its low prevalence,collecting data on large cohorts of patients with WD is challenging.Comprehensive insur-ance claims databases provide powerful tools to collect retrospective data on large numbers of patients with rare diseases.AIM To describe patients with WD in the United States,their treatment and clinical outcome,using a large insurance claims database.METHODS This retrospective,longitudinal study was performed in the Clarivate Real-World Data Product database.All patients with≥2 claims associated with an Interna-tional Classification of Diseases 10(ICD-10)diagnostic code for WD(E83.01)between 2016 and 2021 were included and followed until death or study end.Patients were divided into two groups by whether or not they were documented to have received a specific treatment for WD.Clinical manifestations,hospital-isations,liver transplantation and death were documented.RESULTS Overall,5376 patients with an ICD-10 diagnostic code for WD were identified.The mean age at inclusion was 41.2 years and 52.0%were men.A specific WD treatment was documented for 885 patients(15.1%),although the number of patients taking zinc salts may be underestimated due to over the counter purchase.At inclusion,the mean age of patients with a documented treatment was 36.6±17.8 years vs 42.2±19.6 years in those without a documented treatment.During follow-up,273 patients(5.1%)died.Compared with the American general population,the standardised mortality ratio was 2.19.The proportion of patients with a documented WD-specific treatment who died during follow-up was 4.0%and the mean age at death 52.7 years.CONCLUSION Patients treated for WD in the United States had an excess early mortality compared with the American population.These findings indicate that there is a significant unmet need for effective treatment for WD in the United States.

Travel-Limiting Disabilities in the United States: Why Accessibility Matters?

This study evaluates the distribution of travel-limiting disabilities across genders and geographic locations in the United States. This study aims to describe and compare the socioeconomic and demographic variables of the people with and without travel-limiting disabilities across geographic locations and gender. The study further evaluates the trip purpose and impact of Covid-19 fourth wave pandemic on the use of public transit and travel to physical workplace for the people with and without travel-limiting disabilities across gender and geographic locations. The study uses the 2022 weighted National Household Travel Survey dataset and employs descriptive statistics. Results reaffirm the findings from previous literature that there are more people with travel-limiting disabilities in urban areas and among women. Over 50 percent of people aged 65 and above have a form of travel-limiting disabilities. The most trip for people with travel-limiting disabilities is made for shopping and medical purposes. Across all categories, rural areas, urban areas, male and female for the people without travel-limiting disabilities, COVID-19 fourth wave did not change the pattern of trips made to physical workplace as pre-COVID-19 era. This pattern is also observable for the people with travel-limiting disabilities in rural and urban areas. Females with travel-limiting disabilities reported making less trips to physical workplaces while male reported doing the same as before COVID-19 era. The study concludes that the quantification of travel-limiting disabilities across geographic location and gender is vital in disability study and could drive policy implementation for improved accessibility for the vulnerable population.

The Enforcement of Occupational Safety and Health Requirements in Public and Private Sectors in the Emirate of Abu Dhabi, the United Arab Emirates

Research Problem: In Abu Dhabi, limited implementation of OSH Regulations contributes to the general unawareness among employees and workers about occupational hazards and safety measures, resulting in slow responsiveness toward enforcement measures and a lack of self-regulatory approaches within companies. Purpose: The purpose of this study is to examine the implementation methods practised in Abu Dhabi with those in developed countries with established OSH regulatory bodies. Methodology: Qualitative and quantitative research methods were employed to gather primary research data. Workers from various industries in Abu Dhabi were sampled on purpose and asked to respond to questionnaires and interviews on OSH protocol awareness and implementation, and circumstances of workplace incidence. Results: The findings of this study showed that the enforcement of OSH requirements in UAE positively correlated to a reduction in the rate of work-related injury and improved business performance. The quantitative research data showed that the energy sector had the highest score (15) while the tourism sector had the lowest score (5.3) in occupational health systems and improvements in business efficiency and productivity. Implications: The outcomes of this study shed light on the importance of implementing OSH Guidelines for companies to empower their safety managers to fully enforce OSH requirements in their organisations. In conclusion, effective OSH enforcement requires cooperation between general workers and OSH managers and facilitation from business owners.

Maternal Mortality Rates among Im/Migrant Populations in the United States

Introduction: Maternal mortality rates have more than doubled in the U.S over the last two decades, making it one of the few places in the world where maternal mortality is increasing. Differences in maternal mortality among certain races and ethnicities are known but few studies examine maternal mortality among immigrants. Since immigrants represent 13.7% of the U.S. population, it is essential to examine immigrant subsets to understand maternal mortality among this vulnerable population. Methods: A literature search identified 318 articles on maternal mortality and immigrants, with 12 articles from the U.S. The keywords included maternal mortality, United States, migrants, asylum seekers, immigrants, and disparities. Maternal mortality statistics were obtained from the World Health Organization and Center for Disease Control. Results: Studies analyzed in this review found an overall lower maternal mortality rate among immigrant women compared to U.S.-born women, except for Hispanic immigrant women. Black women had the highest maternal mortality rate, regardless of immigration status. Conclusion: Although the literature points to lower maternal mortality among immigrants, the data is still somewhat mixed, making it challenging to draw comprehensive conclusions. Additional research examining maternal mortality among Im/migrants in the U.S. is needed to guide future training among healthcare professionals and policymakers.

Coping with the Impact of Climate Change: A Dive into Precision Agriculture in the United States

With the continued increase in the number of people that are food insecure globally, which could be increasing because of the ongoing Ukraine-Russia war, leading to reduction in international agribusinesses, coupled with drastic climate change exacerbating the problem of food insecurity, there is a constant need to come up with innovative approaches to solve this global issue. In this article, we articulated how precision agriculture can be a tool for ensuring food security in the United States. This study aims to reiterate the significance of precision agriculture in solving global food insecurity.

Evolution and impacts of the United States’Arctic strategy and China’s responses

On 7 October,2022,the Biden administration released an updated version of the National Strategy for the Arctic Region based on new developments in the Arctic region and global affairs.This strategy emphasizes traditional security issues in the Arctic,attaches great importance to climate governance in the region,and advocates for restoring American leadership through international cooperation.In view of the strong influence of the United States(U.S.)in the Arctic region,the changes of the U.S.Arctic strategy will inevitably have an impact on China’s scientific researchrights,economic interests,and governance rights in the Arctic region.To respond to the new situation brought about by the changes in the U.S.Arctic strategy,China should take the initiative to maintain positive relationships with all Arctic countries,and continue its active participation in Arctic affairs.

Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the United States

BACKGROUND Early in the coronavirus disease 2019(COVID-19)pandemic,there was a significant impact on routine medical care in the United States,including in fields of transplantation and oncology.AIM To analyze the impact and outcomes of early COVID-19 pandemic on liver transplantation(LT)for hepatocellular carcinoma(HCC)in the United States.METHODS WHO declared COVID-19 as a pandemic on March 11,2020.We retrospectively analyzed data from the United Network for Organ Sharing(UNOS)database regarding adult LT with confirmed HCC on explant in 2019 and 2020.We defined pre-COVID period from March 11 to September 11,2019,and early-COVID period as from March 11 to September 11,2020.RESULTS Overall,23.5%fewer LT for HCC were performed during the COVID period(518 vs 675,P<0.05).This decrease was most pronounced in the months of March-April 2020 with a rebound in numbers seen from May-July 2020.Among LT recipients for HCC,concurrent diagnosis of non-alcoholic steatohepatitis significantly increased(23 vs 16%)and alcoholic liver disease(ALD)significantly decreased(18 vs 22%)during the COVID period.Recipient age,gender,BMI,and MELD score were statistically similar between two groups,while waiting list time decreased during the COVID period(279 days vs 300 days,P=0.041).Among pathological characteristics of HCC,vascular invasion was more prominent during COVID period(P<0.01),while other features were the same.While the donor age and other characteristics remained same,the distance between donor and recipient hospitals was significantly increased(P<0.01)and donor risk index was significantly higher(1.68 vs 1.59,P<0.01)during COVID period.Among outcomes,90-day overall and graft survival were the same,but 180-day overall and graft were significantly inferior during COVID period(94.7 vs 97.0%,P=0.048).On multivariable Coxhazard regression analysis,COVID period emerged as a significant risk factor of post-transplant mortality(Hazard ratio 1.85;95%CI:1.28-2.68,P=0.001).CONCLUSION During COVID period,there was a significant decrease in LTs performed for HCC.While early postoperative outcomes of LT for HCC were same,the overall and graft survival of LTs for HCC after 180 days were significantly inferior.

Epidemiology of shoulder dislocations presenting to United States emergency departments:An updated ten-year study

BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.

Unveiling transplantation research productivity of United States: A bibliometric analysis

BACKGROUND The United States has witnessed significant advancements in the field of organ transplantation over the course of the last five decades,as demonstrated by a notable increase in the quantity of academic research.The presence of a highly dynamic research environment necessitates continuous evaluations to maintain the integrity and progress of the field.AIM To evaluate the total output and thematic emphasis of transplant research conducted in the United States.METHODS On January 10,2023,we conducted a bibliometric search of United States research output in transplantation journals from the Web of Science database's Science Citation Index Expanded.We excluded editorials,meeting abstracts,and other non-article types.We analyzed annual trends,authors,institutions,articles,keywords,and countries collaborating with the United States,using VOSviewer 1.6.18 to create figures and tables.RESULTS The United States published 25956 papers(3078 reviews and 22878 articles)representing 37.7%of the world's scientific output.Canada emerged as the top collaborator with the United States,co-authoring 1263 articles.Leading institutions in United States transplantation research were the University of Pittsburgh(1749 articles),Mayo Clinic(1605 articles),Harvard Medical School(1549 articles),and Johns Hopkins University(1280 articles).The top three keywords with over 2000 occurrences were"recipients,""survival,"and"outcomes,"indicating a focus on graft and recipient outcome markers by United States researchers.CONCLUSION Our findings demonstrate the United States leadership in organ transplantation research,contributing significantly to the global scientific output in this field.However,opportunities exist for fostering expansive partnerships,particularly with developing countries.This study provides valuable insights into the transplantation research landscape in the United States,emphasizing the importance of ongoing evaluations to maintain and propel advancements in this critical medical discipline.The results may facilitate future collaborations,knowledge exchange,and the pursuit of innovative solutions in the realm of organ transplantation.

Information Management in Disaster and Humanitarian Response: A Case in United Nations Office for the Coordination of Humanitarian Affairs

To guarantee a unified response to disasters, humanitarian organizations work together via the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). Although the OCHA has made great strides to improve its information management and increase the availability of accurate, real-time data for disaster and humanitarian response teams, significant gaps persist. There are inefficiencies in the emergency management of data at every stage of its lifecycle: collection, processing, analysis, distribution, storage, and retrieval. Disaster risk reduction and disaster risk management are the two main tenets of the United Nations’ worldwide plan for disaster management. Information systems are crucial because of the crucial roles they play in capturing, processing, and transmitting data. The management of information is seldom discussed in published works. The goal of this study is to employ qualitative research methods to provide insight by facilitating an expanded comprehension of relevant contexts, phenomena, and individual experiences. Humanitarian workers and OCHA staffers will take part in the research. The study subjects will be chosen using a random selection procedure. Online surveys with both closed- and open-ended questions will be used to compile the data. UN OCHA offers a structure for the handling of information via which all humanitarian actors may contribute to the overall response. This research will enable the UN Office for OCHA better gather, process, analyze, disseminate, store, and retrieve data in the event of a catastrophe or humanitarian crisis.

Strategic Planning for Drug Regulatory Science in the United States and Its Enlightenments to China

Objective To study the strategic planning of drug regulatory science,the effectiveness and role of policy implementation in the United States so as to gain insights and make suggestions for further improving the strategic planning of drug regulatory science in China.Methods Literature research method and comparative research method were used to compare and analyze the strategic planning of regulatory science in China and the United States.Results and Conclusion Drawing on the US experience,China should set goals based on mission and vision and identify problems,knowledge gaps,and key areas,then concrete measures can be taken to advance regulatory science.

Design and Operation of Municipal Rain and Sewage United Pumping Station

In the process of designing a municipal rainwater and sewage pumping station,it is necessary to accurately grasp the design points,reasonably determine the scale of the rainwater and sewage pumping station,scientifically select the location and layout,and select materials reasonably.After completing the process design of the municipal rainwater and sewage pumping station and putting it into operation,in order to ensure the normal and stable operation of the pumping station,it is necessary to focus on strengthening the operation and management of diving equipment,cleaning equipment,and electromechanical equipment.The author analyzes the key points and specific design path of the process design of municipal rainwater and sewage pumping stations,and puts forward effective strategies for operation management,hoping to contribute to the scientific design and stable operation of municipal rainwater and sewage pumping stations.

Comparison of the Evolution of Genetically Modified Food Safety Policies between the United States and the European Union

With the research on and development of Genetically Modified Food （GMF）, people＇s attitude toward GMF may fall into two divergent categories, typical- ly represented by the United States（US） and the European Union（EU）, respectively. The former follows a ＂sound science principle＂ and firmly objects to the precautionary principle, namely a permissive policy of positive support of and voluntary labelling on GMF; while the latter adopts a cautiously precautionary principle, requiring mandatory labelling and traceability. From the standpoint of regulatory principles, together with corresponding supervisory measures and relevant provisions, this paper compared the execution of directives and provisions on GMF from the initial policies enacted by the US and EU to current situation combined with the track and analysis of latest polic ies issued.

A Comparative Study of the Value Orientations of Foreign Language Education Policies in China and the United States in the 21st Century

Since the 21 st century, both Chinese Mainland and the United States have formulated foreign language education policiesbased on their national needs. This paper makes a comparative study of the value orientations of foreign language education poli-cies in Chinese Mainland and the United States in the 21 st century and finds that both China and the United States have regardedtheir national interests as the essential value orientation of their foreign language education policies. To be specific,the core valueorientation of foreign language education policies in China is to enhance its cultural soft power.In contrast,the core value orienta-tion of foreign language education policies in the United States is to safeguard its national security. Through the comparison of thedifferent value orientations of foreign language education policies of the two countries, the paper provides some reference for the for-eign language education policy-making in Chinese Mainland.

Impact of diabetes mellitus on risk of cardiovascular disease and all-cause mortality: Evidence on health outcomes and antidiabetic treatment in United States adults

AIMTo examine the epidemic of diabetes mellitus (DM) and its impact on mortality from all-cause and cardiovascular disease (CVD), and to test the effect of antidiabetic therapy on the mortality in United States adults. METHODS The analysis included a randomized population sample of 272149 subjects ages ≥ 18 years who participated in the National Health Interview Surveys (NHIS) in2000-2009. Chronic conditions (hypertension, DM and CVD) were classified by participants’ self-reports of physician diagnosis. NHIS-Mortality Linked Files, and NHIS-Medical Expenditure Panel Survey Linkage Fileson prescribed medicines for patients with DM were used to test the research questions. χ 2, Poisson and Cox’s regression models were applied in data analysis.RESULTS Of all participants, 22305 (8.2%) had DM. The prevalence of DM significantly increased from 2000 to 2009 in all age groups (P < 0.001). Within an average 7.39 (SD= 3) years of follow-up, male DM patients had 1.56 times higher risk of death from all-cause (HR = 1.56, 95%CI:1.49-1.64), 1.72 times higher from heart disease [1.72 (1.53-1.93)], 1.48 times higher from cerebrovascular disease [1.48 (1.18-1.85)], and 1.67 times higher from CVD [1.67 (1.51-1.86)] than subjects without DM,respectively. Similar results were observed in females. In males, 10% of DM patients did not use any antidiabetic medications, 38.1% used antidiabetic monotherapy, and 51.9% used ≥ 2 antidiabetic medications. These corresponding values were 10.3%, 40.4% and 49.4% in females. A significant protective effect of metformin monotherapy or combination therapy (except for insulin) on all-cause mortality and a protective but non-significant effect on CVD mortality were observed. CONCLUSION This is the first study using data from multiple linkage files to confirm a significant increased prevalence of DM in the last decade in the United States. Patients with DM have significantly higher risk of death from all-cause and CVD than those without DM. Antidiabetic mediations,specifically for metformin use, show a protective effect against all-cause and CVD mortalities.

The 2 ℃ Global Temperature Target and the Evolution of the Long-TermGoal of Addressing Climate Change-From the United Nations FrameworkConvention on Climate Change to the Paris Agreement

The Paris Agreement proposed to keep the increase in global average temperature to well below 2 ℃ abovepre-industrial levels and to pursue efforts to limit the temperature increase to 1.5 ℃ above pre-industriallevels. It was thus the first international treaty to endow the 2 ℃ global temperature target with legal effect.The qualitative expression of the ultimate objective in Article 2 of the United Nations Framework Conventionon Climate Change （UNFCCC） has now evolved into the numerical temperature rise target in Article 2 of theParis Agreement. Starting with the Second Assessment Report （SAR） of the Intergovernmental Panel on Cli-mate Change （IPCC）, an important task for subsequent assessments has been to provide scientific informa-tion to help determine the quantified long-term goal for UNFCCC negotiation. However, due to involvementin the value judgment within the scope of non-scientific assessment, the IPCC has never scientifically af-firmed the unacceptable extent of global temperature rise. The setting of the long-term goal for addressingclimate change has been a long process, and the 2 ℃ global temperature target is the political consensuson the basis of scientific assessment. This article analyzes the evolution of the long-term global goal foraddressing climate change and its impact on scientific assessment, negotiation processes, and global low-carbon development, from aspects of the origin of the target, the series of assessments carried out by the 1PCCfocusing on Article 2 of the UNFCCC, and the promotion of the global temperature goal at the political level.

Pretreatment of Crude Oil by Ultrasonic-electric United Desalting and Dewatering

A technology of ultrasonic-electric united desalting and dewatering of crude oil is studied. The ultrasonic setup is designed to form a standing-wave field, which is more efficient for agglomeration of water particles. The desalting and dewatering results of the ultrasonic-electric united process are compared with those of the electric process. For high salt-contenting crude oil （40-70 mg·L ^-1）, the salt content is still above 10.0 mg·L^-1 after crude oil has been treated by two-stage electric desalting process in refinery, which cannot meet the need of refinery. Ultrasonic-electric united process is a novel technology for treating the high salt-contenting oil. On the optimal operating conditions of the ultrasonic-electric united process, the salt content of crude oil can be reduced from 67 5 mg·L^-1 to 3.97 mg·L ^-1 by one-stage ultrasonic-electric united process, and the water content falls below 0.3% （by volume）. The results show that the ultrasonic-electric united process is more effective than the electric process in high salt-contenting oil desalting. This technology should be useful in the refinery process.

Prevalence of anal fistula in the United Kingdom

BACKGROUND Anal fistula is a pathological connection between the anal canal and perianal skin, which most commonly develops from an infected anal crypt. While the majority of anal fistulas are idiopathic, they are also associated with Crohn’s disease (CD) and other inflammatory conditions. The prevalence of anal fistula is estimated to be 1-2 per 10000 patients, but population-based studies on anal fistula epidemiology are limited and outdated. AIM To assess the prevalence of anal fistula and relevant comorbidities, with and without CD in the United Kingdom and Europe. METHODS A retrospective population-representative observational cohort study was performed in The Health Improvement Network (THIN), a United Kingdom primary care database. Mid-year point prevalence of anal fistula was calculated on the first of July for each year between 2014 and 2017. Estimates were calculated for anal fistula overall and by CD status and standardized to the United Kingdom and European population. Prevalence of relevant comorbidities including lymphogranuloma venereum, hidradenitis suppurativa, anal presentation of sexually transmitted diseases, diabetes mellitus, and radiation in the pelvic area was reported. RESULTS The United Kingdom-standardized overall point prevalence of anal fistula was 1.80 (95%CI: 1.65-1.94) per 10000 patients in 2017, while the Europe standardized estimate was 1.83 (95%CI: 1.68-1.98) per 10000 patients. Both these standardized point prevalence estimates ranged from 1.89 to 2.36 between 2014-2016. The United Kingdom-standardized point prevalence of anal fistula without CD was 1.35 (95%CI: 1.23-1.48) per 10000 patients, while the Europe-standardized estimate was 1.39 (95%CI: 1.26-1.52) per 10000 patients. In contrast, the standardized point prevalence estimate of anal fistula with CD was lower for both United Kingdom and Europe (0.44;95%CI United Kingdom: 0.37-0.52, 95%CI Europe: 0.37-0.51) per 10000 patients in 2017. In 2017, 19% of anal fistula patients without CD and 13% of anal fistula patients with CD had at least one relevant comorbidity. These results show that anal fistulas are infrequent in the general population. 24.5% of prevalent anal fistulas are associated with CD, but other potentially etiological comorbidities are rare. CONCLUSION This real-world evidence study estimated the United Kingdom-standardized prevalence of anal fistula was 1.80 per 10000 patients in 2017. Approximately 25% of cases may be associated with CD, while other comorbidities are rare.