scholarly journals Trends in incidence and mortality of tuberculosis in India over past three decades: a joinpoint and age–period–cohort analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Deepak Dhamnetiya ◽  
Priyanka Patel ◽  
Ravi Prakash Jha ◽  
Neha Shri ◽  
Mayank Singh ◽  
...  

Abstract Background Tuberculosis, as a communicable disease, is an ongoing global epidemic that accounts for high burden of global mortality and morbidity. Globally, with an estimated 10 million new cases and around 1.4 million deaths, TB has emerged as one of the top 10 causes of morbidity and mortality in 2019. Worst hit 8 countries account for two thirds of the new TB cases in 2019, with India leading the count. Despite India's engagement in various TB control activities since its first recognition through the resolution passed in the All-India Sanitary Conference in 1912 and launch of first National Tuberculosis Control Programme in 1962, it has remained a major public health challenge to overcome. To accelerate progress towards the goal of ending TB by 2025, 5 years ahead of the global SDG target, it is imperative to outline the incidence and mortality trends of tuberculosis in India. This study aims to provide deep insights into the recent trends of TB incidence and mortality in India from 1990 to 2019. Methods This is an observational study based on the most recent data from the Global Burden of Disease (GBD) Study 2019. We extracted numbers, age-specific and age-standardized incidence and mortality rates of Tuberculosis for the period 1990–2019 from the Global Health Data Exchange. The average annual percent change (AAPC) along with 95% Confidence Interval (CI) in incidence and mortality were derived by joinpoint regression analysis; the net age, period, and cohort effects on the incidence and mortality rates were estimated by using Age–Period–Cohort model. Results During the study period, age-standardized incidence and mortality rates of TB in India declines from 390.22 to 223.01 and from 121.72 to 36.11 per 100,000 population respectively. The Joinpoint regression analysis showed a significant decreasing pattern in incidence rates in India between 1990 and 2019 for both male and female; but larger decline was observed in case of females (AAPC: − 2.21; 95% CI: − 2.29 to − 2.12; p < 0.001) as compared to males (AAPC: − 1.63; 95% CI: − 1.71 to − 1.54; p < 0.001). Similar pattern was observed for mortality where the declining trend was sharper for females (AAPC: − 4.35; 95% CI: − 5.12 to − 3.57; p < 0.001) as compared to males (AAPC: − 3.88; 95% CI: − 4.63 to − 3.11; p < 0.001). For age-specific rates, incidence and mortality rates of TB decreased for both male and female across all ages during this period. The age effect showed that both incidence and mortality significantly increased with advancing age; period effect showed that both incidence and mortality decreased with advancing time period; cohort effect on TB incidence and mortality also decreased from earlier birth cohorts to more recent birth cohorts. Conclusion Mortality and Incidence of TB decreased across all age groups for both male and female over the period 1990–2019. The incidence as well as mortality was higher among males as compared to females. The net age effect showed an unfavourable trend while the net period effect and cohort effect presented a favourable trend. Aging was likely to drive a continued increase in the mortality of TB. Though the incidence and mortality of tuberculosis significantly decreased from 1990 to 2019, the annual rate of reduction is not sufficient enough to achieve the aim of India’s National Strategic plan 2017–2025. Approximately six decades since the launch of the National Tuberculosis Control Programme, TB still remains a major public health problem in India. Government needs to strengthen four strategic pillars “Detect–Treat–Prevent–Build” (DTPB) in order to achieve TB free India as envisaged in the National Tuberculosis Elimination Programme (2020).

Author(s):  
Xiaoxue Liu ◽  
Chuanhua Yu ◽  
Yongbo Wang ◽  
Yongyi Bi ◽  
Yu Liu ◽  
...  

Background: The prevalence of diabetes mellitus is rapidly increasing in China, but the secular trends in incidence and mortality remain unknown. This study aims to examine time trends from 1990 to 2017 and the net age, period, and cohort effects on diabetes incidence and mortality. Methods: Incidence and mortality rates of diabetes (1990–2017) were collected for each 5-year age group (from 5–9 to 80–84 age group) stratified by gender from the Global Burden of Disease 2017 Study. The average annual percentage changes in incidence and mortality were analyzed by joinpoint regression analysis; the net age, period, and cohort effects on the incidence and mortality were estimated by age-period-cohort analysis. Results: The joinpoint regression analysis showed that age-standardized incidence significantly rose by 0.92% (95% CI: 0.6%, 1.3%) in men and 0.69% in women (95% CI: 0.3%, 1.0%) from 1990 to 2017; age-standardized mortality rates rose by 0.78% (95% CI: 0.6%, 1.0%) in men and decreased by 0.12% (95% CI: −0.4%, 0.1%) in women. For age-specific rates, incidence increased in most age groups, with exception of 30–34, 60–64, 65–69 and 70–74 age groups in men and 25–29, 30–34, 35–39 and 70–74 age groups in women; mortality in men decreased in the younger age groups (from 20–24 to 45–49 age group) while increased in the older age groups (from 50–54 to 80–84 age group), and mortality in women decreased for all age groups with exception of the age group 75–79 and 80–84. The age effect on incidence showed no obvious changes with advancing age while mortality significantly increased with advancing age; period effect showed that both incidence and mortality increased with advancing time period while the period trend on incidence began to decrease since 2007; cohort effect on incidence and mortality decreased from earlier birth cohorts to more recent birth cohorts while incidence showed no material changes from 1982–1986 to 2012–2016 birth cohort. Conclusions: Mortality decreased in younger age groups but increased in older age groups. Incidence increased in most age groups. The net age or period effect showed an unfavorable trend while the net cohort effect presented a favorable trend. Aging likely drives a continued increase in the mortality of diabetes. Timely population-level interventions aiming for obesity prevention, healthy diet and regular physical activity should be conducted, especially for men and earlier birth cohorts at high risk of diabetes.


1991 ◽  
Vol 25 (2) ◽  
pp. 181-190 ◽  
Author(s):  
Keren Skegg ◽  
Brian Cox

New Zealand suicide rates from 1957 to 1986 were analysed for age, period and cohort effects. Cumulative suicide rates were relatively stable but more complex patterns were revealed by detailed analysis. There was a steadily increasing rate in young men and a recent increase in elderly men. Reduced mortality rates in equivalent categories of accidental and “undetermined” deaths could have accounted for only a proportion of these increases. A cohort effect was noted in men, with increasing risks of suicide in the young for successive birth-cohorts born from 1947 onwards. In women a period effect was likely, with increasing rates for all age-groups between 1957–61 and 1962–66, followed by a decline recently among all except the youngest age-groups. These trends in women may have been largely due to changes in barbiturate prescribing. In both sexes poisoning declined as a method of suicide, while hanging and carbon monoxide poisoning increased. Firearm suicides also increased in men. The implications of these results for prevention are considered.


2021 ◽  
Author(s):  
Deepak Dhamnetiya ◽  
Priyanka Patel ◽  
Ravi Prakash Jha ◽  
Neha Shri ◽  
Mayank Singh ◽  
...  

Abstract BackgroundThe morbidity and mortality burden of tuberculosis has been a major public health challenge in India. Despite various commitments to end the global TB epidemic, India has the highest burden of TB and MDR-TB. To accelerate progress towards the goal of ending TB by 2025, it is imperative to outline the incidence and trend of tuberculosis in India. This study provides the trends in the burden of TB in India, along with age, period and cohort effect of TB. MethodsWe have extracted the TB incidence and mortality estimates from GBD database over the period 1990 to 2019. Joinpoint regression was used to determine the magnitude of time trends in incidence and mortality rates of Tuberculosis by calculating the average annual percent change (AAPC) and its 95% confidence interval (CI). We have analyzed the tuberculosis incidence and mortality trends in India to distinguish age, period and cohort effects by using age-period-cohort (APC) model.ResultsThere has been a decline in age standardized incidence rate in the period 1990-2019. Results from the APC table showed that the incidence and mortality due to tuberculosis in India decreased with the recent cohort. The period RRs of incidence had a downward trend in India in the period 1990-2019. Age standardized incidence and mortality rates of tuberculosis was found higher among males. The period RRs of incidence had a downward trend. Findings show that incidence and mortality were higher in older ages. The cohort effect on the incidence of tuberculosis was found higher among 1990-94 birth cohorts than in the later birth cohorts 2010-14. Wald test results demonstrated that the cohort and period RRs for both sexes and the net drift and local drifts for tuberculosis incidence and mortality were statistically significant.ConclusionHigher incidence and mortality in the older age groups is attributed to poor nutrition and socio-economic status. Improvement in India’s public health facility and strategic programs aimed at eliminating tuberculosis might be the reason behind declining RRs in India. The decline in the cohort RRs signifies the effective measures taken to reduce the burden of tuberculosis in the country.


2021 ◽  
Author(s):  
Yufeng Wang ◽  
Xueying Huang ◽  
Huan Ma ◽  
Suru Yue ◽  
Jie Liu ◽  
...  

Abstract Background Migraine is a common disorder of the nervous system in China, imposing heavy burdens on individuals and societies. Optimal healthcare planning requires understanding the magnitude and changing trend of migraine incidence in China. However, the secular trend of migraine incidence in China remains unclear. Methods Data were collected from the Global Burden of Disease Study 2019 in China from 1990 to 2019 to investigate changes in the incidence rate of migraine. The average annual percent change and relative risk were calculated using joinpoint regression and an age–period–cohort model, respectively. Results From 1990 to 2019, the age-standardized incidence rates of migraine in China increased by 0.26% (95% CI: 0.22 to 0.31) and 0.23% (95% CI: 0.19 to 0.28) per year in males and females, respectively. The age effect exerted the most significant impact on the incidence of migraine. The period effect showed a slightly decreasing trend in the incidence of migraine. In terms of the cohort effect, people born after the 1960s presented a higher risk of migraine as compared with the total cohort, with the occurrence risk of migraine increasing with birth cohorts. Conclusion Migraine incidence shows an overall increasing trend in China, with a significant gender difference. An intensive understanding of the risk characteristics and disease pattern of migraine could allow the early detection of persons with a high risk of developing migraine and promote the development of timely intervention measures to relieve this burden effectively.


2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Wilmer Tarupi ◽  
Esther de Vries ◽  
Patricia Cueva ◽  
José Yépez

Background. Despite the significant global decline in mortality and incidence, gastric cancer (GC) remains a very common cause of illness and death in the Latin American region. This article seeks to describe, in depth, the time trend of incidence and mortality of GC in the city of Quito, from 1985 to 2013. Methods. Using data from the Quito Cancer Registry, annual sex-specific age-standardized incidence and mortality rates were calculated. The analysis included all types of GC together, as well as by histological subtype. Joinpoint regression analysis was performed to estimate the annual percentage change (EAPC). To evaluate cohort and period effects, Age-Period-Cohort (APC) modeling was performed. Results. Over time, incidence rate decreased from 30.4 to 18.8 cases in men and from 20.1 to 12.9 cases in women. The mortality rate decreased from 17.5 to 14.4 deaths in men and from 14.2 to 10.9 deaths in women. The incidence trend was composed of a first period (1986-1999) of strong decline (EAPC Men= -2.6, 95% Confidence Interval [CI]: -4.2, -0.9; EAPC Women= -3.2, 95% CI: -4.6, -1.9), followed by a less important decrease in men (EAPC= -0.8, 95% CI:-2.5, 0.9) and a slight increase in women (EAPC= 0.7, 95% CI: -1.4; 2.8). Mortality rates were constantly decreasing in both men (EAPC= -0.5, 95% CI: -0.9, -0.1) and women (EAPC= -0.9, 95% CI: -1.7, -0.1) throughout the period of analysis. Conclusions. The declines in incidence and mortality rates are stagnating. It is important to take measures to further reduce the high burden of GC.


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