Burden of Oral Cancer on the 10 Most Populous Countries from 1990 to 2019: Estimates from the Global Burden of Disease Study 2019

Background: Oral cancer (OC) is a common tumour that poses a threat to human health and imposes a heavy burden on countries. This study assessed the burden imposed by OC on the 10 most populous countries from 1990 to 2019 on the basis of gender, age and socio-demographic index. Methods: Data on incidence, mortality, disability-adjusted life years (DALY) and corresponding age-standardised rates (ASR) for OC in the 10 most populous countries from 1990 to 2019 were derived from the Global Burden of Disease Study 2019. Estimated annual percentage changes were calculated to assess the trends of morbidity, mortality and DALY. The indicator that served as a proxy for survival rate was the supplement of mortality-to-incidence ratio (SMIR) (1 − (M/I)). Results: The number of new cases, deaths and DALY have increased in all 10 countries in the past 30 years. Trends in age-standardised incidence rates (ASIR), age-standardised mortality rate (ASMR) and age-standardised DALY for OC in the 10 most populous countries varied. The SMIR increased in all countries, with most countries having an SMIR between 30% and 50%. In 2019, the United States had the highest SMIR at 76%, whereas Russia had the lowest at 21.7%. Incidence and mortality were close between male and female subjects in Japan, Indonesia, Mexico, India, Bangladesh and Pakistan. The incidence and mortality in male subjects in the United States, Russia, China and Brazil were two or more times those of female subjects. Gender difference was highest among patients aged 40–69 years. Conclusion: Trends and gender differences in ASIR, ASMR and age-standardised DALY for OC vary in the 10 most populous countries. Government cancer programs are often expensive to run, especially in countries with large populations. Policy makers need to take these differences into account when formulating policies.

Effectiveness and Safety of Electroacupuncture for Depression: a systematic review and meta-analysis

Review question / Objective: Is electroacupuncture a safe therapy for the treatment of depression? Is electroacupuncture effective for the treatment of depression, as compared with sham control, or conventional drugs？ Condition being studied: Depression is a mood disorder that causes sufferers to feel sadness, decreased interest, guilt, self-blame, loss of energy, and experience sleep disorders such as insomnia. People suffering from depression even feel they have no way out and have suicidal thoughts. In the United States, the prevalence of a major depressive disorder is 16.2%1-3. The 2010 Global Burden of Disease Study identified major depression as the second leading cause of disability worldwide and a leading cause of the burden of suicide and ischaemic heart disease. At present, depression patients are mainly treated with antidepressants, but the efficacy is extremely unstable. Studies have shown that acupuncture can help improve symptoms in patients with depression, but these clinical studies have not been systematically evaluated, and further confirmation is needed to confirm the efficacy of electroacupuncture in treating depression.

The burden of diarrhea, etiologies, and risk factors in India from 1990 to 2019: evidence from the global burden of disease study

Background This study aims to measure the burden of diarrhea in India and analyze the trend of mortality associated with it for the past 30 years. We also intend to find the prevailing etiology and risk factors associated with diarrheal mortality in India. Methods The study has used the latest round of Global Burden of Disease (GBD) study-2019. GBD data is available across age groups and gender-wise over the period from 1990 to 2019. The study has identified 13 etiologies for the cause of diarrhea deaths and 20 risk factors to analyze the burden of disease. Results Our study shows, childhood diarrhea has declined over the years significantly, yet contributes to a larger share of DALYs associated with the disease. Among all the death cases of Diarrhea, in 2019, the most prevalent disease-causing pathogen is found to be Campylobacter. But Adenovirus is the major contributor to childhood diarrheal deaths. Though the burden of diarrhea is declining over the period, still there is a need to progress the interventions to prevent and control diarrhea rapidly to avoid the huge number of deaths and disabilities experienced in India. Conclusions Consumption of safe and clean water, proper sanitation facility in every household, required nutrition intake by mother and child, safe breastfeeding and stool disposal practices and careful case management, rotavirus vaccination are some of the effective interventions to be implemented all over the country. Further, evidence-based policies should be made and implemented to sustain diarrhea prevention programs.

Time trends in type 2 diabetes mellitus incidence across the BRICS from 1990 to 2019: an age-period-cohort analysis

Background The incidence rate of type 2 diabetes mellitus (T2DM) is rapidly increasing in Brazil, Russia, India, China, and South Africa (BRICS). The present study analyzed trends in T2DM incidence rate across the BRICS and associations with age, period, and birth cohort. Methods The incidence rate was estimated by the data obtained from GBD 2019 (Global Burden of Disease Study 2019) and was analyzed with the age-period-cohort framework. Incidence rates of T2DM (1990–2019) were collected for each 5-year age group (from 25 to 29 to 85–89 age group) stratified by gender from the Global Burden of Disease 2019 Study. Results In 2019, the the incidence rate of T2DM was 280.2 per 100,000 across the BRICS. Between 1990 and 2019, the incidence rate of T2DM among the BRICS population increased by 83.3%. In each period, as age increases, the incidence rate of T2DM in China and Russia first increased and then decreased, while the incidence rate of T2DM in Brazil, India and South Africa first increased and then decreased slightly with age group. Deteriorating period and cohort risks for incidence rate of T2DM were generally found across the BRICS. Conclusions The number of diabetic patients in the BRICS countries has continued to increase and the growth rate has been stable in the past 30 years, which is dependent on age and some other environmental factors. Some possible factors influencing T2DM incidence are analyzed and hypotheses generated through the age and period effects.

The global burden and attributable risk factors of chronic lymphocytic leukemia in 204 countries and territories from 1990 to 2019: analysis based on the global burden of disease study 2019

Background Chronic lymphocytic leukemia (CLL) is the most prevalent subtype of leukemia in Western countries, causing a substantial health burden on patients and society. Comprehensive evaluation of the epidemiological characteristics of CLL is warranted, especially in the current context of global population aging. The main objective of this study is evaluating the disease burden of CLL at global, regional, and national levels from 1990 to 2019. As secondary objectives, we studied the influence of demographic factors and performed risk factor analysis. We hope this study could provide evidence for the evaluation of the effectiveness of previous prevention strategies and the formulation of future global health policies. Results Based on data of CLL between 1990 to 2019 from the Global Burden of Disease (GBD) study 2019, we depicted the age, gender, and regional structure of the CLL burden population and described the impact of social development on the disease burden of CLL. The distribution and changing trends of attributable risk factors were also investigated. The global burden of CLL has increased dramatically. A high incidence has been achieved in males and elder people. Countries and territories with high social-demographic index (SDI) tended to have higher global burden than low-SDI region. Of risk factors, high body mass index and smoking were the major contributors for CLL-related mortality and disability adjusted life-years (DALYs). Conclusion In summary, the global CLL burden continues to rise over the past 30 years. The relocation of medical resource should be considered on a global scale. Graphical Abstract

The global, regional, and national burden and trends of NAFLD in 204 countries and territories: an analysis from Global Burden of Disease 2019

Background Nonalcoholic fatty liver disease (NAFLD) poses a substantial socioeconomic burden and is becoming the fastest-growing driver of chronic liver disease, potentially accompanied by a poor prognosis. We aim to elucidate the global and regional epidemiologic changes in NAFLD during the past thirty years and explore the relevant causes. Methods Data on NAFLD incidence, prevalence, death, and disability-adjusted life-years (DALYs) were extracted from the Global Burden of Disease Study 2019. In addition, we also investigated the correlation between the NAFLD burden and the social development degree. Finally, the associations of the three common comorbidities with NAFLD were determined. Results Globally, the incidence and prevalence of NAFLD both increased drastically from 1990 to 2019, mainly affecting young adults. Meanwhile, the deaths and DALYs increased significantly as well, dominating the aged group. However, the overall age-standardized death rate (ASDR) and DALY rate presented decreasing trends. Moreover, the sociodemographic index (SDI) appeared to have obvious negative associations with the age-standardized prevalence rate (ASPR), ASDR and age-standardized DALYs, indicating a more serious NAFLD burden in less developed regions. Finally, we found that the incidence and prevalence of NAFLD were positively related to those of diabetes mellitus type 2 (DM2), stroke and ischaemic heart disease (IHD). Conclusions NAFLD is leading to increasingly serious health challenges worldwide. Comprehensive acquisition of the epidemiologic pattern for NAFLD and the identification of high-risk comorbidities may help policy-makers and clinical physicians develop cost-effective prevention and control strategies, especially in countries with a high NAFLD burden.

Associations between sociodemographic factors, health spending, disease burden, and life expectancy of older adults (70 + years old) in 22 countries in the Western Pacific Region, 1995–2019: estimates from the Global Burden of Disease (GBD) Study 2019

The needs of the aging populations are putting increasing burden on healthcare particularly in the Western Pacific Region (WPR), which is the home of aging economies such as Hong Kong and Japan alongside rapid increases in older people in low- and middle-income countries (LMICs). However, little is known about the associations between sociodemographic factors, disease burden, and life expectancy in WPR. The current study conducted secondary analysis on the Global Burden of Disease (GBD) estimates of populations aged 70 years and older in WPR countries between 1995 and 2019. Correlation tests, linear mixed regressions and generalized additive mixture models were run to examine the associations of interest. Unsupervised machine learning was conducted to segment the data automatically, at cluster analysis. The sociodemographic development index was found an important factor to the disease burden in terms of Years Lived with Disability (YLD) rate and mortality rate among older adults. YLD rate and mortality rate of non-communicable diseases (NCDs) attributable to different risk groups were significant contributors to higher expectation of Lost Healthy Years (LHE) and shorter life expectancy respectively in the context of rising YLD rate, particularly in LMICs. Three clusters of countries with similar characteristics were identified. NCDs were the most significant contributors to shorter life expectancy within which the time living in poor health did not improve. Better management of NCDs in aging populations should be emphasized in all countries. The country clusters may help in a more regional strategic planning.