Evolution of Legislation and Crimes Based on Sexual Identity or Orientation in Spain: A Retrospective Observational Study (2011–2021)

Respect for different sexual options and orientations prevents the occurrence of hate crimes against lesbian, gay, bisexual, trans and intersex (LGTBI) persons for this reason. Our aim was to review the legislation that protects the rights of LGTBI people and to quantify the victimization rates of hate crimes based on sexual identity and orientation. A retrospective observational study was conducted across all regions of Spain from 2011–2021. The laws on LGTBI rights in each region were identified. Hate crime victimization data on sexual identity and orientation were collected in annual rates per 100,000 inhabitants, annual percentage change and average change during the study period to assess the trend. The regulatory development of laws against discrimination against LGTBI individuals is heterogeneous across regions. Overall, in Spain there is an upward trend in the number of hate crime victimizations motivated by sexual identity or orientation. The effectiveness of data collection, thanks to better training and awareness of police forces regarding hate crimes and the processes of data cleansing and consolidation contributes to a greater visibility of hate crimes against LGTBI people.

Trends in Premature Mortality From Acute Myocardial Infarction in the United States, 1999 to 2019

Background Evaluating premature (<65 years of age) mortality because of acute myocardial infarction (AMI) by demographic and regional characteristics may inform public health interventions. Methods and Results We used the Centers for Disease Control and Prevention’s WONDER (Wide‐Ranging Online Data for Epidemiologic Research) death certificate database to examine premature (<65 years of age) age‐adjusted AMI mortality rates per 100 000 and average annual percentage change from 1999 to 2019. Overall, the age‐adjusted AMI mortality rate was 13.4 (95% CI, 13.3–13.5). Middle‐aged adults, men, non‐Hispanic Black adults, and rural counties had higher mortality than young adults, women, NH White adults, and urban counties, respectively. Between 1999 and 2019, the age‐adjusted AMI mortality rate decreased at an average annual percentage change of −3.4 per year (95% CI, −3.6 to −3.3), with the average annual percentage change showing higher decline in age‐adjusted AMI mortality rates among large (−4.2 per year [95% CI, −4.4 to −4.0]), and medium/small metros (−3.3 per year [95% CI, −3.5 to −3.1]) than rural counties (−2.4 per year [95% CI, −2.8 to −1.9]). Age‐adjusted AMI mortality rates >90th percentile were distributed in the Southern states, and those with mortality <10th percentile were clustered in the Western and Northeastern states. After an initial decline between 1999 and 2011 (−4.3 per year [95% CI, −4.6 to −4.1]), the average annual percentage change showed deceleration in mortality since 2011 (−2.1 per year [95% CI, −2.4 to −1.8]). These trends were consistent across both sexes, all ethnicities and races, and urban/rural counties. Conclusions During the past 20 years, decline in premature AMI mortality has slowed down in the United States since 2011, with considerable heterogeneity across demographic groups, states, and urbanicity. Systemic efforts are mandated to address cardiovascular health disparities and outcomes among nonelderly adults.

10-Year Trend of Abdominal Magnetic Resonance Imaging Compared With Abdominal Computed Tomography Scans in Inflammatory Bowel Disease

Background Patients with inflammatory bowel disease (IBD) frequently undergo multiple computed tomography (CT) examinations. With the widespread availability of magnetic resonance imaging (MRI), it is unclear whether the use of CTs in IBD has declined. We aimed to analyze the trends of CT and MRI use in a large cohort of IBD patients in a 10-year period. Methods We retrospectively analyzed adults ≥18 years of age using a de-identified database, IBM Explorys. Patients with ≥1 CT of the abdomen (± pelvis) or MRI of the abdomen (± pelvis) at least 30 days after the diagnosis of Crohn’s disease (CD) or ulcerative colitis (UC) were included. We examined the factors associated with patients undergoing multiple CTs (≥5 CTs of the abdomen) and performed a trend analysis from 2010 to 2019. Results Among 176 110 CD and 143 460 UC patients, those with ≥1 CT of the abdomen annually increased from 2010 to 2019 with mean annual percentage change of +3.6% for CD and +4.9% for UC. Similarly, annual percentage change for patients with ≥1 MRI (CD: +15.6%; UC: +22.8%) showed a rising trend. There was a 3.8% increase in CD patients receiving ≥5 CTs of the abdomen annually compared with a 2.4% increase among UC patients in the 10-year period. Age ≥50 years, men, African Americans, public insurance payors, body mass index ≥30kg/m2, and smoking history were associated with ≥5 CTs. Conclusions There is a considerable increase in the number of CT scans performed in IBD patients. Further studies can explore factors influencing the use of CT and MRI of the abdomen in IBD patients.

Trends in Breast Cancer Mortality Between 2001 and 2017: An Observational Study in the European Union and the United Kingdom

PURPOSE Breast cancer is the most common cancer in women worldwide, representing 25.4% of the newly diagnosed cases in 2018. The past two decades have seen advancements in screening technologies, guidelines, and newer modalities of treatment. Our study reports and compares trends in breast cancer mortality in the European Union and the United Kingdom. MATERIALS AND METHODS We used the WHO Mortality Database. We extracted breast cancer mortality data from 2001 to 2017 on the basis of the International Classification of Diseases, 10th revision system. Crude mortality rates were dichotomized by sex and reported by year. We computed age-standardized death rates (ASDRs) per 100,000 population using the world standard population. Breast cancer mortality trends were compared using joinpoint regression analysis. RESULTS We analyzed data from 24 EU countries, including the United Kingdom. For women, breast cancer mortality was observed to be downtrending in all countries except Croatia, France, and Poland. For the most recent female data, the highest ASDR for breast cancer was identified in Croatia (19.29 per 100,000), and the lowest ASDR was noted in Spain (12.8 per 100,000). Denmark had the highest change in ASDR and the highest estimated annual percentage change of −3.2%. For men, breast cancer mortality decreased in 18 countries, with the largest relative reduction observed in Denmark with an estimated annual percentage change of −27.5%. For the most recent male data, the highest ASDR for breast cancer was identified in Latvia (0.54 per 100,000). CONCLUSION Breast cancer mortality rates have down trended in most EU countries between 2001 and 2017 for both men and women. Given the observational nature of this study, causality to the observed trends cannot be reliably ascribed. However, possible contributing factors should be considered and subject to further study.

The Global Burden of Sexually Transmitted Infections Estimated from 1990 to 2019

Background:To explore the burden of sexually transmitted infections at national, regional, and global levels from the 2019 Global Burden of Disease Study database. Methods: The number of cases and age-standardized rate of prevalence, incidence, and disability-adjusted life years were used for a descriptive study of sexually transmitted infections burden from 1990 to 2019, and secular trends were assessed by counting the estimated annual percentage change. Finding:The global prevalence of sexually transmitted infections in 2019 was 128.82 million. There were 58.15% new cases than in 1990. The disability-adjusted life year burden of sexually transmitted infections was lower among males than females and peaks among under 5 and 15- to 44-year-olds. In 2019, the global disability-adjusted life year loss was mostly attributed to years of life lost (88.23%), the higher the social development index developed, the more the number of years lived with disability contributed. In 21 regions, the age-standardized rates of disability-adjusted life year (per 100, 000 population) showed that the Caribbean remained on top. At a national level, a decreasing trend of the estimated annual percentage change of disability-adjusted life year rate had been observed. Syphilis was proved as a leading cause of heavy disease burden, which carried almost 85.9% of it. The age-standardized rates of disability-adjusted life year were in positive correlation with the human development index in 2019 and had a negative correlation with the estimated annual percentage change in 1990. Conclusion: A declining trend of sexually transmitted infections was observed globally; prevention of syphilis remained a crucial strategy in the course of reducing sexually transmitted infections burden. The findings from this research can help to establish appropriate health policy and reduce the disease burden further.

Bayesian Age-Period-Cohort Prediction of Mortality of Type 2 Diabetic Kidney Disease in China: A Modeling Study

BackgroundThe burden of type 2 diabetic kidney disease (DKD) continues to rise in China. We analyzed time trends in DKD mortality and associations with age, period, and birth cohort from 1990 to 2019, made projections up to 2030, and examined the drivers of deaths from DKD.Methods and FindingsThe number of DKD deaths in China from 1990 to 2019 was obtained from the GBD 2019. We used age-period-cohort modeling to estimate age, period, and cohort effects in DKD mortality between 1990 and 2019. We calculated net drift (overall annual percentage change), local drift (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rates), period, and cohort relative risks. We used Bayesian age-period-cohort analysis with integrated nested Laplace approximations to project future age-specific DKD death cases from 2020 to 2030. We used a validated decomposition algorithm to attribute changes in DKD deaths to population growth, population aging, and epidemiologic changes from 1990 to 2030. From 1990 to 2019, the age-standardized mortality rate of DKD in China was relatively stable, but the absolute number of DKD deaths showed a noticeable increasing trend. The overall annual percentage change (net drift) was -0.75% (95% confidence interval, CI: -0.93 to -0.57) for males and -1.90% (95% CI, -2.19 to -1.62) for females. The age-specific annual percentage changes (local drifts) were below zero in all age groups from 1990 to 2019 except for males aged above 65 to 69 years, and for females aged above 70 to 74 years. The risk of DKD deaths increased exponentially with age for both sexes after controlling for period deviations. The Bayesian age-period-cohort analysis projects that there would be 88,803 deaths from DKD in 2030, increased by 224.2% from 1990. Despite a decrease in age-specific DKD death rates, the reduction would be entirely offset by population aging.ConclusionsAlthough China has made progress in reducing DKD deaths, demographic changes have entirely offset the progress. The burden of DKD deaths is likely to continue increasing. Our findings suggest that large-scale screening is imperative for DKD control and prevention, particularly for high-risk groups.

Decreasing Trends in Road Traffic Mortality in Poland: A Twenty-Year Analysis

The aim of the study was to assess mortality trends due to road traffic accidents in Poland between 1999 and 2018. The study material was a database including 7,582,319 death certificates of all inhabitants of Poland who died in the analyzed period (104,652 people died of transport accidents). Crude deaths rates (CDR), standardized death rates (SDR) and joinpoint models were used. Annual percentage change (APC) for each segment of broken lines and average annual percentage change (AAPC) for the whole study period were calculated. CDR decreased from 19.7 per 100,000 population in 1999 to 9.6 per 100,000 population in 2018; APC was −4.1% (p < 0.05) while SDR decreased from 20.9 to 10.9 per 100,000; APC was −4.1% (p < 0.05). Large differences in traffic accident-related mortality were observed between men and women. An analysis by gender and age shows that the decline in the number of deaths due to traffic accidents has been slowed down in the oldest age group, 65+, in both males and females. There is a need for in-depth analyses aimed at introducing effective preventive solutions in the field of road traffic safety in Poland. Legal regulations should particularly refer to the most endangered groups of road users.

Trend of Sudden Unexpected Death in Epilepsy Incidence Rate in Rural West China

Objectives: To explore the trend of sudden unexpected death in epilepsy (SUDEP) incidence rate over time in rural west China.Methods: We scanned probable SUDEP patients from the epilepsy program between 2010 and 2019 in rural West China and performed a verbal autopsy for each eligible patient. We calculated the crude and sex-adjusted incidence rate of SUDEP per person-year over a calendar year and the year of follow-up. We calculated the incidence rate ratio with the Poisson model in STATA 12.0 and calculated the annual percentage change (APC) and average annual percentage change in Joinpoint Trend Analysis Software 4.8.0.1 to analyze the trend of SUDEP incidence rate.Results: In 2010–2019, 44 probable SUDEPs were identified from 10,128 patients with a total person-year of 31,347. The crude and sex-adjusted incidence rates of SUDEP were 1.40 and 1.45%0. Twenty-five (56.8%) of the 44 probable SUDEPs had no generalized tonic-clonic seizure 3 months before their death. The incidence of probable SUDEP decreased significantly in the calendar year [APC = −11.7, 95% confidence interval (CI): −21.7 to −0.3] and in time of follow-up (average annual percentage change = −21.2, 95% CI: −34.3 to −5.4). Comparing the first 5 years in follow-up with the subsequent 3 years, the incidence rate of SUDEP decreased significantly (estimated incidence rate ratio = 0.4, 95% CI: 0.2 to 0.8).Significance: SUDEP happened to 1.4 cases per thousand patient-years in convulsive epilepsy in rural west China between 2010 and 2019. The incidence rate of SUDEP presented a downward trend over the time of follow-up.

Trends in Colorectal Cancer Incidence Rates in Saudi Arabia (2001–2016) Using Saudi National Registry: Early- Versus Late-Onset Disease

Early-onset (&lt;50 years old) colorectal cancer (CRC) has been increasing worldwide and is associated with poor outcomes. Over 85% of the Saudi population are &lt;50 years old, which put them at heightened risk of early-onset CRC. No study assessed the trends in CRC incidence rates among the Saudis. The Joinpoint Regression software by the Surveillance, Epidemiology, and End Results (SEER) program was used to estimate the magnitude and direction of CRC incidence trends by age and gender. The annual percentage change (APC) and the average annual percentage change (AAPC) between 2001 and 2016 were computed. In a sensitivity analysis, we also assessed trends using various age groups. Between 2001 and 2016, the early-onset CRC incidence (per 105) increased from 1.32 (95% CI: 1.11, 1.54) to 2.02 (95% CI: 1.83, 2.22) with AAPC (2.6, 95% CI: -0.4, 5.7). At same period, the late-onset incidence increased from 3.54 (95% CI: 3.10, 3.97) to 9.14 (95% CI: 8.62, 9.66) with AAPC (6.1, 95% CI: 3.5, 8.8). Among early-onset CRC patients, age 40–49 has the highest rates and women in this age group has higher rate than men. Our national data showed a gradual increase in CRC incidence rates, which reflect the global concern of early-onset CRC. Further research is needed to understand the etiology of early-onset CRC. Primary health care providers must be alerted about the increasing rate of early-onset CRC. To reduce the future burden of the disease, initiating CRC screening before age 50 is warranted.

Trends in Cardiovascular Mortality Related to Atrial Fibrillation in the United States, 2011 to 2018

Background Prevalence of atrial fibrillation (AF) continues to increase and is associated with significant cardiovascular morbidity and mortality. To inform prevention strategies aimed at reducing the burden of AF, we sought to quantify trends in cardiovascular mortality related to AF in the United States. Methods and Results We performed serial cross‐sectional analyses of national death certificate data for cardiovascular mortality related to AF, whereby cardiovascular disease was listed as underlying cause of death and AF as multiple cause of death among adults aged 35 to 84 years using the Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research. We calculated age‐adjusted mortality rates per 100 000 population and examined trends over time, estimating average annual percentage change using the Joinpoint Regression Program. Subgroup analyses were performed by race‐sex and across 2 age groups (younger: 35–64 years; older: 65–84 years). A total of 276 373 cardiovascular deaths related to AF were identified in the United States between 2011 and 2018 in decedents aged 35 to 84 years. Age‐adjusted mortality rate increased from 18.0 (95% CI, 17.8–18.2) to 22.3 (95% CI, 22.0–22.4) per 100 000 population between 2011 and 2018. The increase in age‐adjusted mortality rate (average annual percentage change) between 2011 and 2018 was greater among younger decedents (7.4% per year [95% CI, 6.8%–8.0%]) compared with older decedents (3.0% per year [95% CI, 2.6%–3.4%]). Conclusions Cardiovascular deaths related to AF are increasing, especially among younger adults, and warrant greater attention to prevention earlier in the life course.