The six global nutrition targets (GNTs) related to low birthweight, exclusive breastfeeding, child growth (ie, wasting, stunting, and overweight), and anaemia among females of reproductive age were chosen by the World Health Assembly in 2012 as key indicators of maternal and child health, but there has yet to be a comprehensive report on progress for the period 2012 to 2021. We aimed to evaluate levels, trends, and observed-to-expected progress in prevalence and attributable burden from 2012 to 2021, with prevalence projections to 2050, in 204 countries and territories.

The prevalence and attributable burden of each target indicator were estimated by age group, sex, and year in 204 countries and territories from 2012 to 2021 in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, the most comprehensive assessment of causes of death, disability, and risk factors to date. Country-specific relative performance to date was evaluated with a Bayesian meta-regression model that compares prevalence to expected values based on Socio-demographic Index (SDI), a composite indicator of societal development status. Target progress was forecasted from 2021 up to 2050 by modelling past trends with meta-regression using a combination of key quantities and then extrapolating future projections of those quantities.

In 2021, a few countries had already met some of the GNTs: five for exclusive breastfeeding, four for stunting, 96 for child wasting, and three for child overweight, and none met the target for low birthweight or anaemia in females of reproductive age. Since 2012, the annualised rates of change (ARC) in the prevalence of child overweight increased in 201 countries and territories and ARC in the prevalence of anaemia in females of reproductive age decreased considerably in 26 countries. Between 2012 and 2021, SDI was strongly associated with indicator prevalence, apart from exclusive breastfeeding (|r-|=0·46-0·86). Many countries in sub-Saharan Africa had a decrease in the prevalence of multiple indicators that was more rapid than expected on the basis of SDI (the differences between observed and expected ARCs for child stunting and wasting were -0·5% and -1·3%, respectively). The ARC in the attributable burden of low birthweight, child stunting, and child wasting decreased faster than the ARC of the prevalence for each in most low-income and middle-income countries. In 2030, we project that 94 countries will meet one of the six targets, 21 countries will meet two targets, and 89 countries will not meet any targets. We project that seven countries will meet the target for exclusive breastfeeding, 28 for child stunting, and 101 for child wasting, and no countries will meet the targets for low birthweight, child overweight, and anaemia. In 2050, we project that seven additional countries will meet the target for exclusive breastfeeding, five for low birthweight, 96 for child stunting, nine for child wasting, and one for child overweight, and no countries are projected to meet the anaemia target.

Based on current levels and past trends, few GNTs will be met by 2030. Major reductions in attributable burden for exclusive breastfeeding and anthropometric indicators should be recognised as huge scientific and policy successes, but the comparative lack of progress in reducing the prevalence of each, along with stagnant anaemia in women of reproductive age and widespread increases in child overweight, suggests a tenuous status quo. Continued investment in preventive and treatment efforts for acute childhood illness is crucial to prevent backsliding. Parallel development of effective treatments, along with commitment to multisectoral, long-term policies to address the determinants and causes of suboptimal nutrition, are sorely needed to gain ground.

Bill & Melinda Gates Foundation.

In this Series paper, we propose a comprehensive, 10-year cancer control strategy for Jordan, as outlined by a group of Jordanian medical experts in cancer care and medical education. The strategy is designed to create a robust, patient-centred, resilient health-care system in which comprehensive universal cancer care is prioritised. We include an assessment of the current state, gaps, and challenges for cancer care in Jordan, and recommend corrective actions to address them. The proposed framework discusses cancer care in Jordan, including public awareness and education, prevention, screening, equitable access to quality care, post-care monitoring, survivorship, and palliative care. In addition to workforce training, research, and supportive services, this framework emphasises the need to adopt evidence-based practices, innovative interventions, and adherence to oncological principles relevant to Jordan, including standardising oncology practices. This strategy calls for creating a consensus-based framework to evaluate and monitor implementation, ensuring the effectiveness and continuity of the system in a cost-effective and applicable manner, with use of a Common Sense Oncology approach.

High low-density lipoprotein cholesterol are a significant risk factor for ischemic stroke. This study aims to analyze the burden of disease and temporal trends of ischemic stroke attributable to high LDL-C (IS-hLDL-C) in China, thereby providing a scientific basis for the development of effective prevention and intervention strategies. This study extracted the age-standardized mortality rates (ASMRs) and age-standardized disability-adjusted life years rates (ASDRs) of IS-hLDL-C from the global burden of disease (GBD) 2021. Stratified analysis was performed by gender and age groups. Joinpoint regression models were used to calculate average annual percentage changes (AAPC) to assess trends in IS-hLDL-C burden between 1990 and 2021. Age-period-cohort (APC) model to estimate the independent effects of age, period, and cohort on IS-hLDL-C burden. In 2021, the total number of IS-hLDL-C deaths in China was 300,052 (95% UI 92,515-527,456), and disability-adjusted life years (DALYs) was 6,850,565 (95% UI 2,313,203 - 11,418,167). From 1990 to 2021, ASMRs changed from 18.23 (95% CI 5.52-33.43) to 15.93 (95% CI 4.83-28.08), and the AAPC was -0.47 (95% CI -0.83 to -0.10). The ASDRs decreased from 385.65 (95% CI 129.83 to 647.51) in 1990 to 335.59 (95% CI 112.75 to 566.25) in 2021, with an AAPC of -0.49 (95% CI -0.83 to -0.10). Sex-stratified analysis showed that male had greater ASMRs and ASDRs than female. Age-stratified analysis showed that the burden was greatest among the elderly. In the age-period-cohort analysis, the age effect of IS-hLDL-C showed a continuous increasing trend during the study period. The period effect generally showed a positive trend during the study period. From 1990 to 2021, while the ASMRs and ASDRs related to IS-hLDL-C have decreased in China, the absolute numbers of deaths and DALYs remain substantial. The burden of IS-hLDL-C disease is disproportionately higher among male and the elderly. Given large population and the ongoing trend of population aging, it is essential to consider various lipid-lowering strategies in the future to allocate healthcare resources effectively and reduce the disease burden associated with IS-hLDL-C.

Spatiotemporal disparities exist in the disease burden of non-communicable diseases (NCDs) attributable to kidney dysfunction, which has been poorly assessed. The present study aimed to evaluate the spatiotemporal trends of the global burden of NCDs attributable to kidney dysfunction and to predict future trends.

Data on NCDs attributable to kidney dysfunction, quantified using deaths and disability-adjusted life-years (DALYs), were extracted from the Global Burden of Diseases Injuries, and Risk Factors (GBD) Study in 2019. Estimated annual percentage change (EAPC) of age-standardized rate (ASR) was calculated with linear regression to assess the changing trend. Pearson's correlation analysis was used to determine the association between ASR and sociodemographic index (SDI) for 21 GBD regions. A Bayesian age-period-cohort (BAPC) model was used to predict future trends up to 2040.

Between 1990 and 2019, the absolute number of deaths and DALYs from NCDs attributable to kidney dysfunction increased globally. The death cases increased from 1,571,720 (95% uncertainty interval [UI]: 1,344,420-1,805,598) in 1990 to 3,161,552 (95% UI: 2,723,363-3,623,814) in 2019 for both sexes combined. Both the ASR of death and DALYs increased in Andean Latin America, the Caribbean, Central Latin America, Southeast Asia, Oceania, and Southern Sub-Saharan Africa. In contrast, the age-standardized metrics decreased in the high-income Asia Pacific region. The relationship between SDI and ASR of death and DALYs was negatively correlated. The BAPC model indicated that there would be approximately 5,806,780 death cases and 119,013,659 DALY cases in 2040 that could be attributed to kidney dysfunction. Age-standardized death of cardiovascular diseases (CVDs) and CKD attributable to kidney dysfunction were predicted to decrease and increase from 2020 to 2040, respectively.

NCDs attributable to kidney dysfunction remain a major public health concern worldwide. Efforts are required to attenuate the death and disability burden, particularly in low and low-to-middle SDI regions.

Alcohol significantly contributes to pancreatitis, causing high global mortality and health burden. This study examines trends in alcohol-attributable pancreatitis (AAP) from 1990 to 2021 using Global Burden of Disease (GBD) 2021 data, focusing on demographic, temporal, and regional variations to inform policymaking.

AAP-related deaths and disability-adjusted life years (DALYs) were analyzed across 204 countries from 1990 to 2021, stratified by Sociodemographic Index (SDI), gender, and age groups. An age-period-cohort model assessed age-standardized DALY rates (ASDR), and decomposition analysis quantified impacts of population growth, aging, and epidemiological changes.

AAP-related DALYs rose from 401,700 in 1990 to 699,300 in 2021, though ASDR and ASMR showed declines globally. Burden increased notably in low and lower-middle SDI regions, especially among those under 40, while high SDI regions achieved better control. Males faced a disproportionately high burden due to alcohol consumption patterns, although some regions saw rising female burdens. Low-SDI areas suffered from limited healthcare, increasing alcohol use, and weak policies, with younger populations contributing significantly to rising burdens. Projections estimate 1.146 million DALYs annually by 2050, with males comprising over 90%. A GBD-AAP visualization platform was developed to present burden data and trends.

AAP exhibits significant regional and gender disparities. Targeted measures, including alcohol regulation, resource allocation, and public health education, are critical in low-SDI regions and among young males to mitigate AAP burden. The GBD-AAP platform offers valuable tool for targeted interventions.

Pressure ulcer (PU) is a type of chronic ulcer, placing a high burden not only on patients' families but also on national healthcare systems globally. To determine the level, trends, and burden of PU worldwide and to provide an essential foundation for building targeted public policies on PUs at the national, regional, and global levels, data on PU were obtained from the Global Burden of Disease (GBD) 2019 Study. The incidence, disability-adjusted life years (DALYs), and deaths of PUs in 204 countries and regions from 1990 to 2019 were calculated and stratified by sex, age, geographical location, and sociodemographic index (SDI). The estimated annual percentage change (EAPC) of incidence, DALYs, and deaths was calculated to evaluate the temporal trends. A total of 3,170,796 new cases (95% uncertainty interval (UI), 3,499,729-2,875,433 cases) of PU were identified globally in 2019, more than 55% of which were among male individuals, and most of the new cases were concentrated in those 75-90 years of age. The burden of PU measured in DALYs was 481 423 (95% UI, 583 429-374 334) in 2019, 73% and 27% of which could be attributed to years of life lost (YLLs) and years lived with disability (YLDs), respectively. The burden increased gradually from 1990 to 2019 (from 267 846 [360 562-211 024] to 481 423 [95% UI, 583 429-374 334]). A total of 24 389 deaths were attributed to PU (95% UI, 31 260.82-17 299). The EAPC of incidence, DALYs, and deaths were negative in most regions, the age-standardized rate (ASR) of incidence, DALYs, and deaths were considered to be decreasing in most of the regions, and the EAPCs were negatively correlated with the SDI levels, universal health coverage (UHC), and gross domestic product (GDP), which shows that the ASRs of PU decreased as the economy developed and countries' healthcare system performances improved.

The consumption of sugar-sweetened beverages (SSBs) is recognized as a significant risk factor for chronic non-communicable diseases (NCDs). Accurate estimates of the burden of SSBs are crucial for preventing, controlling, and treating associated diseases to achieve the Third United Nations Sustainable Development Goal of reducing premature mortality from NCDs by one-third by 2030. In this study, we aim to systematically assess the regional patterns and trends in the burden of SSBs in the North Africa and the Middle East (NAME) region. By analyzing regional differences, the study identifies specific areas where SSBs consumption has a more significant impact on public health.

The study data were retrieved from the Global Burden of Disease (GBD) study 2021. This study analyzed the impact of SSBs on mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 21 countries in the NAME region from 1990 to 2021. Our analysis considered various factors, including sex, age, region, and socio-demographic index.

In 2021, DALYs attributable to SSBs there were 315,312 (95% uncertainty interval, 140,854 to 503,347) in absolute terms reflecting 518.3% (424.9 to 642.2) increase over three decades. From 1990 to 2021, the age-standardized rate of DALYs attributable to SSBs increased by 118.5%, from 27.9 (11.4 to 43.9) to 61.0 (27.6 to 97.0) per 100,000 population. Qatar (246.7 [113.1 to 404.5]), Saudi Arabia (201.2 [87.1 to 314.2]), and Bahrain (180.1 [78.4 to 295.8]) had the highest age-standardized rate of DALYs. The highest attributable DALYs and mortality from SSBs consumption were due to diabetes mellitus in all countries in 1990 and 2021. In 2021, Qatar (224.7 [104.9 to 365.5]), Bahrain (167.0 [74.8 to 274.8]), and Saudi Arabia (153.1 [75.3 to 230.4]) had the three highest age-standardized rates of DALYs from diabetes mellitus attributed to SSBs.

NAME witnessed a substantial increase in the burden attributable to SSBs. Alarmingly, exposure to SSBs has principally contributed to the increased burden of diabetes mellitus and chronic kidney disease. Among the region's countries, exposure and attributable burden trends vary considerably. It is imperative that governments and health authorities within the NAME region work together to combat SSBs' detrimental effects. Local, socioeconomic, and educational factors need to be considered when developing prevention and treatment strategies at the individual, community, and national levels.

The online version contains supplementary material available at 10.1007/s40200-025-01578-9.

Stroke is a significant health burden in Vietnam, with substantial impacts on mortality, morbidity, and healthcare resources. An up-to-date report on stroke epidemiology and associated risk factors in Vietnam was missing.

We analyzed the data published in the Global Burden of Disease (GBD) 2019, in combination with the first-time analysis of the Registry of Stroke Care Quality Improvement (RES-Q) initiative in Vietnam from 2017 to 2023.

Comparative analysis globally revealed that Vietnam had one of the highest stroke incidence and prevalence rates in Southeast Asia and ranked 4th in stroke mortality among 11 neighbouring countries. In the RES-Q dataset, 95,696 patients (77 %) were ischemic stroke, 23,203 (18 %) were intracerebral haemorrhage, and 2816 (2 %) were subarachnoid haemorrhage. In GBD 2019, stroke was the leading cause of death among cardiovascular diseases in Vietnam, accounting for 135,999 fatalities. The incidence of stroke was 222 (95 % UIs 206-242) per 100,000 population, with a prevalence of 1541 (1430-1679) per 100,000. Results align with the report from the RES-Q dataset in two megacities of Vietnam: Hanoi (incidence rate of 168.9, prevalence rate of 1182.2) and Ho Chi Minh City (incidence rate of 207.1, prevalence rate of 1221.8). Key risk factors for stroke mortality are high systolic blood pressure (79,000 deaths), unhealthy dietary (43,000 deaths), high fasting plasma glucose (35,000 deaths), and air pollution (33,000 deaths). Incidence is lower in rural Vietnam, but availability and quality of care are higher in megacities.

The results promote a further understanding of stroke and risk factors for the Vietnamese population and suggest prevention and treatment strategies for the Vietnamese government, including facility and capacity improvement and applications of advanced technologies.

Oral HIV pre-exposure prophylaxis (PrEP) can effectively reduce HIV incidence. A 2020-21 demonstration project assessed the feasibility and health outcomes of offering oral PrEP to men who have sex with men (MSM) in Cotonou, Benin. We evaluated the epidemiological impact and cost-effectiveness of this project and the potential scale-up of oral HIV PrEP for MSM in Cotonou.

We calibrated an HIV transmission-dynamic model structured by age and risk within a Bayesian framework to MSM-specific HIV prevalence and treatment data, parameterised with project behavioural and cost (including PrEP drug, implementation, and HIV care costs) data. We estimated the impact and cost-effectiveness of the 2020-21 Cotonou demonstration project (PrEP coverage, 5-10% of all MSM who are not living with HIV in Grand Cotonou; and adherence, 13-21% taking at least four of seven required doses [ie, at least four doses per week for daily users and at least four of seven expected doses given reported sexual activity for on-demand users]) and of its potential scale-up over 5 years (from 2022 to 2027), reaching 30% coverage of MSM in Grand Cotonou and with demonstration project adherence levels. We additionally modelled ideal PrEP adherence (100% taking at least four of seven required doses). We estimated the percentage of cumulative new HIV infections averted among participating MSM over 1 year and among all MSM in Grand Cotonou and their female partners over 20 years, and cost-effectiveness as cost per disability-adjusted life-year (DALY) averted over 20 years. Costs and DALYs were discounted 3% annually.

We found that the demonstration project averted an estimated 21·5% (95% uncertainty interval 16·6 to 26·2) of HIV infections among participants over 1 year. With ideal adherence, cases that would be averted increased to 95·2% (90·8 to 98·8). A 5-year PrEP scale-up could avert 3·2% (1·6 to 4·8) of HIV infections among all MSM and female partners over 20 years, at US$388 (36 to 2792) per DALY averted. With ideal adherence, this decreased to -$28 (-126 to 589) per DALY averted.

Low adherence to PrEP restricted the impact of the demonstration project. At 30% coverage among MSM by 2027, PrEP scale-up would be cost-effective at a $1225 threshold with 86·6% probability, and it could be more cost-effective if high adherence could be reached without substantially increasing costs.

Canadian Institutes of Health Research and US National Institutes of Health.

For the French translation of the abstract see Supplementary Materials section.

Neuroblastoma and other peripheral nerve cell tumors (NB-PNT) are the most common extracranial solid tumors in children. This study aimed to describe the global burden of NB-PNT across different age groups and genders, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs) in various countries and regions. Additionally, we analyzed changes in the disease burden over the past three decades and predicted future trends up to 2036.

Using open data from the Global Burden of Disease (GBD) database (1990-2021), we provided a dynamic description of the disease burden of NB-PNT patients across different age and gender groups on a global scale. Joinpoint analysis was used to calculate the average annual percentage change (AAPC) to quantify trends in the burden of NB-PNT. Meanwhile, the Bayesian Age-Period-Cohort (BAPC) model was applied to predict the changes in disease burden up to 2036.

From 1990 to 2021, the global burden of NB-PNT increased significantly, with global prevalence rising from 41,456 to 56,326 cases. Gender and age disparities were evident, with male patients and patients aged 6-11 months exhibiting higher disease burden. Regional variations were observed, with higher disease burdens in regions with a higher sociodemographic index (SDI), although low-SDI regions showed a consistent upward trend. Overall, the prevalence of NB-PNT increased year by year (overall AAPC = 0.64% [0.56 - 0.72%]), with a slight decline in age-standardized mortality rates observed in 2019 (APC2019 - 2021 = -2.02%). Projections indicate a slight decline in both incidence and mortality rates by 2036, with a more pronounced reduction in females.

A higher burden of NB-PNT was evident among male patients and infants. The disease burden in low-SDI regions has increased in recent years, while a decline was observed in high-SDI regions. Over the past 30 years, the burden rose overall, although a decline in incidence was observed in 2019. Projections indicate a slight decrease in global incidence and mortality rates through 2036.

Chronic kidney disease (CKD) poses a significant global health challenge; however, its burden on pediatric populations remains underexplored. This study assesses the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of pediatric CKD attributable to type 1 diabetes mellitus, type 2 diabetes mellitus, hypertension, glomerulonephritis, and congenital anomalies of the kidney and urinary tract from 1990 to 2021.

Data were extracted from the Global Burden of Disease (GBD) 2021 database. CKD burden was stratified by etiology, age, sex, sociodemographic index (SDI), and geography. Average annual percentage changes (AAPCs) in incidence, prevalence, mortality, and DALYs were calculated.

Globally, CKD-related mortality and DALYs decreased for type 1 diabetes mellitus (-2.176% AAPC), type 2 diabetes mellitus (-1.556%), glomerulonephritis (-0.854%), hypertension (-0.800%), and congenital anomalies of the kidney and urinary tract (-2.143%). The incidence of hypertension incidence increased (+1.299%). Boys experienced higher incidence and prevalence rates for all etiologies, while girls had more significant reductions in mortality and DALYs. High-SDI regions showed the steepest declines in CKD burden, while low-SDI regions experienced limited reductions and increasing hypertension prevalence.

Pediatric CKD burden reflects disparities by etiology, geography, and SDI. Interventions to improve early diagnosis, healthcare access, and targeted management strategies, particularly in low-SDI regions, are essential. Addressing obesity and improving treatment for glomerulonephritis are priorities. Standardized diagnostic criteria and broader global efforts are needed to mitigate the burden of pediatric CKD.

Approximately 3%-6% of infants were born with congenital birth defects worldwide every year, which ranked as the third leading cause of deaths among the population under 20 years of age in 2021.

By adopting the methodology from Global Burden of Disease Study 2021, we systematically analysed the burden and temporal trend of congenital birth defects at the global and regional levels. Correlations between these metrics and Healthcare Access and Quality (HAQ) Index were investigated by the Spearman correlation analyses.

In 2021, there were 7.2 million cases of congenital birth defects and 0.53 million associated deaths. The highest incidence rates were observed in Central Asia, Central Sub-Saharan Africa and Western Sub-Saharan Africa, while the highest mortality rates were reported in Oceania, Western Sub-Saharan Africa and the Caribbean. Congenital heart anomalies remained the leading cause of deaths and disability-adjusted life years (DALYs). The proportion of years lived with disability (YLD) in total DALY increased significantly from 1990 to 2021, indicating a shift from fatal to non-fatal burden. The global age-standardised mortality rate markedly declined from 1990 to 2021, while the YLD rate remained relatively stable. Negative correlations were observed between the incidence, mortality, years of life lost (YLL) and DALY rates of congenital birth defects and HAQ Index of 204 countries and territories, whereas positive correlations were found for prevalence and YLD.

Although remarkable progress has been made in reducing the global burden of congenital birth defects, it remains a major health issue in low sociodemographic index regions lacking equitable access to healthcare facilities. The shift from fatal to non-fatal burden underscores specific medical conditions for the increasing number of adult patients with congenital birth defects to promote postoperative rehabilitation and prevent complications.

Cancer registration in mainland China traditionally focuses on household-registered residents (HRR) and does not include the migrant population among permanent residents (PR), leading to significant selection bias. Estimating incidence among permanent residents provides a less biased and more representative measure of the true incidence. We developed a Bayesian Integrated Nested Laplace Approximation with Stochastic Partial Differential Equation model, incorporating inter-provincial migrant population weights to estimate uterine corpus cancer incidence among permanent residents. The findings revealed a substantial interprovincial migrant population of 67,509,881 individuals, with Shanghai and Beijing showing relatively high difference proportions of 39.6% and 37.0%, respectively. Nationally, the differences in estimated uterine corpus cancer incidence between female PR and HRR were marginal, ranging from 0.2/100,000 in Qinghai to - 0.4/100,000 in Shanghai. The analysis estimated that the provinces with the largest differences between incident cases among female PR and HRR were Henan (- 899 cases, 15.7%) and Guangdong (630 cases, 13.7%). This research holds significant implications for countries relying on HRR-based cancer registration system, particularly those contending with substantial migrant populations. The estimated differences in uterine corpus cancer incidence between PR and HRR provide crucial data support for optimizing prevention strategies and enabling precise allocation of regional healthcare resources.

Female diseases pose significant challenges in South Asia and Sub-Saharan Africa, particularly among adolescent girls and young women, who often receive insufficient attention.

To report patterns and trends of female diseases among adolescent girls and young females aged 10-24 years in South Asia and Sub-Saharan Africa from 1990 to 2021.

We used data from the Global Burden of Disease Study 2021 for 51 countries in South Asia and Sub-Saharan Africa between 1990 and 2021. Joinpoint Regression was used to calculate annual average percentage changes and 95 % confidence intervals to quantify temporal trends.

In 2021, South Asia and Sub-Saharan Africa had high mortality rates of maternal disorders of 6.04 (95 % uncertainty intervals 5.02, 7.39) and 17.69 (14.37, 21.78) per 100,000 population, respectively. The mortality rates for female cancers were approximately 0.98 in both regions, and the incidence rates for gynecological diseases were 16472.83 and 14480.99, per 100,000 population, respectively. From 1990 to 2021, there was an increasing trend in the number of maternal disorder deaths in Sub-Saharan Africa, as well as in all metric rates for most female cancers in both regions, and disability-adjusted life years, prevalence, and incidence rates for gynecological diseases in South Asia. Several female diseases varied across countries and were increasingly affecting younger adolescents aged 10-14 years in both regions. Although countries with lower Socio-demographic Index had a heavier burden of female diseases, no significant association was observed between the Universal Health Coverage effective coverage index and death rates for female cancers or gynecological diseases.

The burden of female diseases remains high among young females in South Asia and Sub-Saharan Africa, with younger adolescents being particularly affected. This underscores the urgent need for targeted interventions and increased investment in healthcare infrastructure to reduce the burden of female diseases in these regions.

Malignant neoplasm of bone and articular cartilage (MNBAC) represents one of the most prevalent malignant tumours among adolescents. Assessing its disease burden trends is critical for formulating prevention strategies. This study aims to evaluate the temporal trends of MNBAC burden in China, project future trajectories over the next 15 years, and compare these patterns with global benchmarks.

Data on incidence, prevalence, deaths, and disability-adjusted life years (DALYs) were extracted from the Global Burden of Disease (GBD) database 2021. Joinpoint regression analysed temporal trends, while decomposition analysis was used to investigate the impact of aging, population growth, and epidemiological factors on the deaths and DALYs rates of MNBAC. Additionally, we conducted BPAC model to project future trends to 2036. Spearman correlation assessed associations between the burden of MNBAC and the socio-demographic Index (SDI).

In 2021, China's age-standardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), age-standardised mortality rate (ASMR) and age-standardised DALYs rate (ASDR) for MNBAC were 1.42, 9.16, 0.93, and 29.52 per 100,000 population, respectively. Compared to 1990, these metrics increased by 118.46%, 125.62%, 60.34%, and 46.43%. Age-specific analyses revealed a bimodal burden pattern globally, peaking in adolescent and elderly populations. Joinpoint regression identified fluctuating trends in China (initial declining, subsequent rise, and then in decline), contrasting with global pattern. Decomposition analysis indicated that the increasing MNBAC burden in China was primarily driven by population aging and epidemiological changes, whereas globally, population growth played a more significant role. Projections indicated modest declines in MNBAC burden for China and globally by 2036. Spearman correlation analysis showed that the ASIR and ASPR of MNBAC in China and globally were significantly positively correlated with SDI (P < 0.05), and the ASMR and ASDR of MNBAC were also positively correlated with SDI, but not significantly.

This analysis underscores the substantial burden of MNBAC in China, surpassing global trends. While projections suggest gradual declines, the persistent high disability burden in youth and elderly populations necessitates strengthened screening protocols and prevention strategies. These findings provide critical epidemiological evidence for optimizing MNBAC management policies.

Nonmelanoma skin cancer (NMSC), accounts for approximately 90% of skin cancers. Global incidence is rising, with projections showing a significant increase in cases and disability-adjusted life years (DALYs). However, research on NMSC in the Middle East and North Africa (MENA) region is limited. This study aims to assess the epidemiology and burden of NMSC in the MENA region from 1990 to 2021, by sex, age, and socio-demographic index (SDI). The analysis used data from the Global Burden of Disease 2021 on age-standardized rates and cases of incidence, prevalence, deaths, and DALYs. Estimation of NMSCs death was performed by the Cause of Death Ensemble model, while DisMod-MR 2.1 was used for non-fatal outcomes. Counts and rates were presented with 95% uncertainty intervals. In 2021, the MENA region reported an age-standardized incidence rate of 6.7 per 100,000 population for NMSC, a 14% decrease from 1990. However, the age-standardized death rate increased by 10.5% to 0.3, and the DALY rate increased by 8.2% to 4.9 per 100,000. Among the countries, Turkey had the highest age-standardized DALY rate of 13.5 and the Syrian Arab Republic had the lowest with 0.1 per 100,000. Most cases of the disease were observed in older age groups, especially men aged 65-69 and women aged 60-64. Men had higher incidence, mortality, and DALYs than women in all age groups. From 1990 to 2021, the burden of NMSC increased with increasing SDI. There is variations in the NMSC burden in the MENA region. Interdisciplinary education, policy changes, and healthcare improvements are essential to reduce the burden and incidence of NMSCs in the coming years, particularly in the elderly and high SDI countries.

Accumulation of senescent cells is an increasingly recognized factor in the development and progression of cardiovascular (CV) disease (CVD). Senescent cells of different types display a pro-inflammatory and matrix remodelling molecular programme, known as the 'senescence-associated secretory phenotype' (SASP), which has roots in (epi)genetic changes. Multiple therapeutic options (senolytics, anti-SASP senomorphics, and epigenetic reprogramming) that delete or ameliorate cellular senescence have recently emerged. Some drugs routinely used in the clinics also have anti-senescence effects. However, multiple challenges hinder the application of novel anti-senescence therapeutics in the clinical setting. Understanding the biology of cellular senescence, advantages and pitfalls of anti-senescence treatments, and patients who can profit from these interventions is necessary to introduce this novel therapeutic modality into the clinics. We provide a guide through the molecular machinery of senescent cells, systematize anti-senescence treatments, and propose a pathway towards senescence-adapted clinical trial design to aid future efforts.

Introduction: Longevity is increasingly recognized as the result of modifiable lifestyle, environmental, and social factors rather than genetics alone. While global interest in healthy aging is growing, public awareness of these determinants remains understudied in the Middle East. This study aimed to assess public awareness and perceptions of longevity-related factors among adults in Saudi Arabia. Methods: A cross-sectional online survey was conducted between November 2024 and January 2025 targeting residents of Saudi Arabia aged 18 and above. A researcher-validated questionnaire explored awareness across various domains, including lifestyle, environment, genetics, sleep, and religious beliefs. Perceptions were assessed using a series of items measuring beliefs about the influence of lifestyle, environmental, technological, and cultural factors on health and longevity. Descriptive and inferential statistics were used to analyze responses from 395 participants. Results: The sample included 395 participants, with 67.8% females and more than half (51.4%) aged 18-25 years. The participants exhibited high awareness of key lifestyle factors; greater than 88% acknowledged the role of sleep, and more than 90% recognized the importance of exercise and nutrition. However, fewer were aware of environmental (72.2%) or social determinants, and nearly half believed that genetic factors exert a primary influence on longevity. Higher awareness was significantly associated with behaviors like regular exercise (p = 0.004), dietary supplement use (p = 0.002), and recognition of the importance of sleep (p < 0.001). Younger adults showed higher awareness than older adults, while there were no significant differences in regards to gender, education, and income. Support for incorporating religious themes into health campaigns was also linked to greater awareness. Insurance status and chronic illness were not associated with awareness levels. Conclusions: While awareness of lifestyle-related longevity factors is strong, gaps remain in understanding broader influences such as environmental and social determinants. Culturally grounded public health strategies that integrate religious framing and emphasize actionable, evidence-based behaviors may enhance community engagement and support healthy aging across Saudi Arabia.

Alzheimer disease (AD) is a growing global health issue, with incidence varying by gender, age, and region. Understanding these trends is essential for developing effective prevention strategies as the population ages. Unlike previous Global Burden of Disease (GBD) studies that primarily focussed on prevalence and mortality, we offer a novel perspective by examining historical incidence trends and projecting future patterns of AD and other dementias using advanced analytical approaches.

We used data from 204 countries and 21 global regions from the GBD 2021 database. We applied the age-period-cohort (APC) model to analyse historical incidence trends, and the Bayesian APC (BAPC) model to forecast future incidence from 2022-36. These models help reveal changes related to age, period, and birth cohort and enable forecasting of future trends - analytical perspectives not provided in the original GBD data sets or their supplementary documents.

Between 1992-2021, global AD cases increased from 4.078 million to 9.837 million, while the global age-standardised incidence rate (ASIR) remained relatively stable, rising slightly from 117.7 to 119.8 per 100 000. ASIR increased significantly in high-middle and middle-sociodemographic index regions, but declined in the low-sociodemographic index regions. Women consistently exhibited higher incidence rates than men across all regions. Projections indicate that 2036 global AD cases will reach 19.117 million, with an ASIR of 418.92 per 100 000.

While global ASIR has remained stable, the number of AD cases continues to rise due to population ageing, particularly in middle- and high-income regions. Low-income regions face additional challenges due to limited health care resources. Gender disparities and unequal access to health care contribute to the variations in disease burden. These findings emphasise the need to prioritise early diagnosis and implement targeted interventions to reduce future disease burdens and address global health care inequalities.

Ageing is influenced by a complex interplay of genetic, environmental, and lifestyle factors, with increasing evidence highlighting the exposome as a key determinant of healthspan. This review explores the impact of environmental exposures, focusing in particular on pollution, endocrine disruptors, and climate change on the development of age-related diseases such as cardiovascular diseases (CVDs), cancer, and metabolic disorders. Additionally, it examines protective factors that contribute to healthy ageing. A comprehensive literature review was conducted using PubMed, Scopus, and Google Scholar, focusing on studies published between 2000 and 2025. Findings indicate that chronic exposure to pollutants accelerates cellular ageing through mechanisms such as oxidative stress, inflammation, and epigenetic dysregulation. In contrast, longevity hotspots-Blue Zones, Cilento and the mountain villages of Sicily (Sicani and Madonie Mountains)-illustrate how traditional dietary patterns, strong social structures, and reduced environmental toxicity contribute to exceptional health and longevity. Mechanistically, exposome-driven alterations in immune-inflammatory pathways and epigenetic regulation play a central role in modulating ageing trajectories. Understanding these interactions is essential for developing targeted strategies to mitigate harmful exposures and enhance protective factors. This review underscores the urgent need for integrative public health policies that address the environmental determinants of ageing, ultimately promoting a longer and healthier lifespan.

Atrial fibrillation/flutter (AF/AFL) remains a significant global public health issue, with its development influenced by metabolic, behavioral, and environmental risk factors However, comprehensive analyses of temporal and geographic variations in AF/AFL burden attributed to risk factors remain lacking.

This study reveals the geographic and temporal distribution of the burden of AF/AFL attributable to specific risk factors at global, regional, and national levels from 1990 to 2021, providing a scientific basis for developing targeted prevention and control policies.

We extracted data on AF/AFL risk-attributable deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) from the Global Burden of Disease (GBD) database for the years 1990 to 2021. The burden of AF/AFL caused by metabolic, behavioral, and environmental risk factors stratified by age, sex, region, and country. Long-term trends in the AF/AFL burden associated with specific risk factors were assessed using the average annual percentage change (AAPC).

Over the past 32 years, high body mass index has been the primary contributor to the rising AF/AFL burden, with AAPCs of ASMR and ASDR at 1.66 (95% CI: 1.63-1.68) and 1.68 (95% CI: 1.67-1.70), respectively. The most significant increase occurred in males aged 30-34. The burden related to high sodium diets and lead exposure is also rising, particularly in females aged 65-69. Smoking showed the greatest decrease, with AAPCs of ASMR and ASDR at -0.66 (95% CI: -0.68 to -0.65) and -0.72 (95% CI: -0.72 to -0.71), most significantly in women aged 30-34. High systolic blood pressure decreased overall, but increased in individuals aged 34-49. East Asia saw the largest increase in burden from high body mass index, with AAPCs of ASMR at 8.28 (95% CI: 8.18-8.37) and ASDR at 8.22 (95% CI: 8.18-8.26). In 2021, China had the highest AF/AFL deaths and DALYs attributed to high systolic blood pressure, high sodium diets, smoking, and lead exposure.

From 1990 to 2021, high body mass index became the primary driver of the rising global AF/AFL burden, particularly affecting East Asia and young and middle-aged adults. In contrast, the burden associated with smoking showed the greatest decline. In 2021, China had the highest AF/AFL burden due to various risk factors. Given the regional variations and characteristics of high-risk populations, policymakers should develop targeted yet comprehensive prevention strategies. These measures should include promoting healthy dietary habits, strengthening global surveillance systems, and fostering data-sharing collaborations to mitigate this growing epidemic.

Self-harm has become a major public health problem globally. Data on the burden of self-harm in this study were taken from the GBD 2021. This study aimed to quantify historical trends (1990-2021) in the global burden of self-harm across genders, age groups, and regions, and project future changes (2022-2050) through Bayesian forecasting models.

Based on the seven GBD super-regions, the burden of self-harm was analyzed by region, age, and gender from 1990 to 2021. Hierarchical statistical approach was used to predict trends in global and regional changes in the burden of self-harm, 2022-2050.

In 2021, the global DALYs and death counts from self-harm were 33.5 million (95% UI: 31.3-35.8) and 746.4 thousand (95% UI: 691.8-799.8). The region with the highest number of DALYs and deaths is South Asia and the highest age-standardized rates of DALYs and mortality were in central Europe, eastern Europe, and central Asia. Globally, the burden of self-harm was higher for males than for females. DALYs rates were highest among adolescents and young adults (20-29 years), whereas mortality rates showed a predominantly age-progressive pattern with the highest burden observed in middle-aged and older populations, albeit with a modest decline in the oldest age groups. Forecasting models showed a sustained decline in the global burden of self-harm from 2022-2050.

The results highlight the need for policymakers to allocate resources to high-burden regions (e.g., South Asia and Eastern Europe), to implement gender- and age-specific prevention programs, and to strengthen cross-sectoral collaboration to address the underlying social determinants of self-harm. The findings call for strengthened mental health services and targeted interventions to effectively respond to and reduce the devastating impact of self-harm on individuals and the global community.

Urinary tract infection (UTI) are an important health issue for women, and this study aimed to assess the different disease burdens in premenopausal and postmenopausal women.

In this cross-sectional study, secondary analysis was conducted using Global Burden of Disease (GBD) 2021 data to assess the burden of urinary tract infections in women. Our study applied a joinpoint regression model to assess temporal trends and factors, an age-period-cohort (APC) analysis to evaluate age, period, and cohort effects, and a health inequality analysis to examine regional disparities based on the socio-demographic index (SDI), along with a predictive model for future trend forecasting.

From 1990 to 2021, UTI incidence grew faster in premenopausal women (average annual percentage change [AAPC] 0.17 [95% CI 0.15-0.18]) than in postmenopausal women (AAPC 0.04 [95% CI 0.02-0.07]), while mortality increased more for postmenopausal women (AAPC 1.08 [95% CI 0.81-1.36]) than premenopausal women (AAPC 0.45 [95% CI 0.33-0.56]). The COVID-19 pandemic saw a surge in premenopausal UTI incidence (AAPC 0.64 [95% CI 0.62-0.66]). Age, period, and cohort analyses revealed an age-related risk increase in premenopausal women, especially in early birth cohorts. Global health inequalities escalated, with a heavier UTI burden in lower SDI countries. By 2044, projections predict 253.33 million cases in premenopausal and 164.72 million in postmenopausal women, with the biggest increases in the 30-34 and 50-54 age brackets.

The study underscores global UTI burden disparities between pre- and postmenopausal women, worsened by COVID-19, urging future policies to enhance healthcare access, antibiotic stewardship, and high-risk group targeting.

Older adults face substantial sex gaps in health. In many contexts, females live longer than males, but their time spent with disability is also higher. Our study assesses (i) the sex gap (female-male) in health through life expectancy and healthy life expectancy and (ii) the morbidity-mortality paradox among older adults aged 60 and above in India and its states.

We utilized data on age-specific death rates obtained from the Sample Registration System and age-specific disability prevalence from the Longitudinal Ageing Survey (LASI) in India. We estimated abridged life tables between age groups 60-64 to 85 + using Greville's method. We then combined the disability data obtained from LASI with the constructed life tables using Sullivan's method to estimate disability-free life expectancy (DFLE) and life expectancy with disability (DLE). Finally, we decomposed the sex gap in DFLE and DLE into mortality and disability components using a stepwise replacement decomposition method.

At the national level, life expectancy at age 60 for males were 17.4 years and for females 19.2 years, indicating a female mortality advantage of 1.8 years. At the state level, the sex gap ranged between 5.1 years in Jammu & Kashmir and -1.1 years in Jharkhand. The disability prevalence was higher among females compared to males at the national level and in all states. The decomposition result indicates that 98% of the mortality advantage of females at the national level was spent in disability. The disability disadvantage of females over their mortality advantage was highest in Uttar Pradesh; 93% of additional years of life were spent with disability. The disability disadvantage of females over their mortality advantage was lowest in Rajasthan where only 9% of additional years were spent in disability. Stepwise replacement decomposition of the sex gap in DFLE by age groups shows that as age increases, the contribution of mortality effects decreases, whereas disability effects increase.

We find evidence of a morbidity-mortality paradox in India nationally and sub-nationally. As the sex gap in health and its implications vary across the states of India, policies to address these inequities must also vary across the states.

The online version contains supplementary material available at 10.1186/s41118-025-00247-2.

The ageing global population and overall population growth have significantly increased the burden of cardiovascular diseases (CVDs). This study aims to examine global temporal trends in the incidence, disability-adjusted life years (DALYs), and mortality rates of both overall and type-specific CVDs among adults aged 55 and older from 1990 to 2021, with a focus on identifying changes over time, regional disparities, and the key risk factors contributing to this burden.

We analysed data from the Global Burden of Disease Study 2021, covering 204 countries and territories. Trends in age-standardized rates of incidence, DALY, and mortality for both overall and specific types of CVDs were assessed, alongside the impact of key risk factors. Between 1990 and 2021, global age-standardized incidence, DALY, and mortality rates showed a declining trend, with estimated annual percentage changes of -0.39, -1.30, and -1.11, respectively. However, due to overall population growth and ageing, the absolute number of CVD cases continued to rise. Regions with high-middle socio-demographic index (SDI) exhibited the highest incidence and mortality rates, while high SDI regions saw the greatest declines. Men had higher age-standardized rates of CVD incidence, DALY, and mortality compared with women. The burden increased with age, with the oldest age groups (80+ years) showing the highest rates. High systolic blood pressure was the leading modifiable risk factor, contributing to more than half of the CVD-related DALY globally. Other major risk factors included high LDL cholesterol, smoking, and ambient particulate matter pollution.

While age-standardized rates of CVD incidence, DALY, and mortality have declined over the past three decades, the total burden of CVDs continues to rise due to population ageing and growth. These findings highlight the need for targeted prevention strategies in regions with high CVD burden, particularly those with lower socioeconomic status.

Gallbladder and biliary tract cancer (GBTC) presents a worldwide health challenge with a poor prognosis. Previous studies indicated an escalating burden and potential health inequalities, necessitating an updated investigation.

This study utilized data from the Global Burden of Disease (GBD) study, covering 204 countries from 1990 to 2021. Joinpoint regression evaluated temporal trends in age-standardized incidence rates (ASIR) and age-standardized disability-adjusted life years rates (ASDR) for GBTC. The Bayesian age-period-cohort (BAPC) model projected disease burden up to 2050. Inequality analysis assessed disparities by genders across countries, and decomposition analysis determined the contributions of demographic and epidemiological factors.

From 1990 to 2021, the incident cases of GBTC increased from 107,797 to 216,768, while Disability-Adjusted Life Years (DALYs) rose from 2,326,089 years to 3,732,121. Joinpoint regression analysis revealed a global decrease in ASIR (AAPC = -0.39, 95% CI: -0.49 to -0.28) and ASDR (AAPC = -0.97, 95% CI: -1.07 to -0.88). Gender disparities were notable, with a polar reversal observed: females exhibited consistently higher ASDR levels across three decades, although both ASDR and ASIR showed continuous decreases. In contrast, males experienced a decreased ASDR but increased ASIR, with both metrics eventually surpassing those of females. The projection model also suggested diverging ASIR trends between genders. Cross-country inequality analysis revealed persistent disparities, where higher SDI countries continue to bear a greater burden, and global improvement in health equity for males remains insufficient. Decomposition analysis indicated that population growth and ageing were primary drivers of disease burden increase, whereas epidemiological changes contributed to a reduction, particularly in higher SDI quintiles.

Despite improvements, GBTC burden is still greater in high SDI regions compared to lower SDI areas, contrary to expectations. Unexpected polar reversal of gender differences warrants further attention.

High body mass index (BMI) and hypertension are quite prevalent in women of childbearing age (WCBA) and are also common risk factors for ischemic heart disease (IHD). However, there are few studies globally evaluating the burden of IHD of WCBA attribute to high BMI and hypertension.

The DALYs (Disability-adjusted life years), Deaths, YLDs (Year lived with disabilitys), YLLs (Year of life losts) of IHD in WCBA attributable to high BMI and hypertension were analyzed by age, sex, year, and geographical location and Socio-demographic Index (SDI). To assess the contribution of epidemiological changes, population growth, and population ageing, a decomposition analysis was used. Exponential Smoothing (ES) modeling and the Autoregressive Integrated Moving Average (ARIMA) model were used to predict the global ASDR (age-standardized DALYs rate), ASMR (age-standardized mortality rate) attributed to the 2 risk factors from 2022 to 2050. The cluster analysis was used to evaluate the changing pattern of burden across GBD regions.

In 2021, the number of global deaths attribution to high BMI was 9,865,138 (95% UI: 3,845,800-15,976,196), and the corresponding ASMR was 216.05 (95% UI: 84.26-349.49) per 100000 population. In various age groups, the largest increase occurred in 20-24 years group (EAPC = 1.26 (95% CI:1.13-1.39)). The number of DALYs of IHD in WCBA attribution to hypertension is 2,158,633 (95% UI:1,725,994-2,538,752) with a corresponding ASMR 46.05 (95% UI: 36.87-54.15) per 100,000 population. The number of DALYs of IHD in WCBA attribution to hypertension is 37,920,567 (95% UI: 30,389,745-44,641,339), and the corresponding ASDR is 817.79 (95% UI: 655.74-962.67) per 100000 population. The largest number of Deaths and DALYs of IHD in WCBA was found between 45-49 years. From 1990 to 2021, ASMR and ASDR attributable to high BMI and hypertension led to a sustained upward trend in Low and Low-medium SDI regions. In addition, the ASMR and ASDR for high BMI and hypertension are highest in the Low-middle SDI regions. Globally, from 1990 to 2021, the overall changes in ASMR and ASDR indicate a relatively stable trend in IHD in WCNA attribute to high BMI. Meanwhile, ASMR and ASDR showed an overall downward trend for hypertension. The number of DALYs, deaths, YLLs, and YLDs of IHD in WCBA attribution to high BMI and hypertension based on the ES and ASMIR models are all increasing from 2022 to 2050.

Over the past 30 years, the ASMR and ASDR of IHD in WCBA has continued to rise. Countries need to remain vigilant about the increasing burden of IHD in WCBA attribute to high BMI and hypertension. It requires proactive prevention strategies, strict control of risk factors, and increased medical coverage to alleviate the burden of IHD. Each region should develop more proactive and effective strategic measures.

Congenital heart anomalies (CHAs) remain a significant global health burden despite advances in diagnosis and management. Data on CHA burden in North Africa and the Middle East region are scarce. This study aimed to estimate CHA trends from 1990 to 2021.

Using the Global Burden of Disease Research 2021 database, we assessed CHA incidence, prevalence, mortality, and disability-adjusted life years (DALYs), stratified by age, sex, and sociodemographic index (SDI) at regional and national levels. Decomposition analysis was used to evaluate the impact of population growth on CHA incidence. In 2021, CHAs caused 35 272 deaths (95% uncertainty interval [UI], 28 067-43 670) and 3 181 543 DALYs (95% UI, 2 544 864-3 899 408) in the North Africa and the Middle East region. Incidence and prevalence increased by 13% (95% CI, 10-17) and 70% (95% CI, 67-74), respectively, whereas CHA-related deaths and DALYs declined by 63% (95% CI, 28-73). Infants <12 months of age accounted for 74.9% of deaths and DALYs, with half occurring within the first month. High-SDI countries had the lowest CHA-related DALYs, whereas middle-SDI countries showed the most substantial decline in mortality. Decomposition analysis highlighted that the actual CHA incidence is lower than expected despite population growth.

Although CHA incidence and prevalence increased, mortality and DALYs decreased, particularly in middle-SDI countries. The highest burden was among infants, with better outcomes in higher-SDI nations. More effective strategies are needed to reduce the preventable childhood deaths related to CHAs in the North Africa and the Middle East region.

As a newly emerging collaborative platform to boost regional growth and prosperity, the Belt and Road Initiative (BRI) has great potential to promote global health development. However, the overall health status of BRI countries remains unclear. We analyzed the health patterns and its geographical distribution in 149 BRI countries from 1990 to 2021.

Using the Global Burden of Disease 2021 (GBD 2021) online database, we examined time trends, country and income variations in death rate and disability-adjusted life years (DALY) rate, and compared the trends and projected 2030 values for ten key health-related Sustainable Development Goals (SDGs) indicators among the 149 BRI countries.

The number of deaths and DALYs of BRI countries represented 62.9-66.0% of global deaths and 64.8-66.8% of global DALYs between 1990 and 2021, and both the overall age-standardized death rate and DALY rate continued to be higher in BRI countries than in non-BRI countries throughout the time period studied. Great variations existed across the 149 BRI countries for both level of and changes in age-standardized death rate and DALY rate. The 2030 targets for six health-related SDGs indicators will not be reached in over 70% of BRI countries according to the previous changing speed trajectory.

Our findings demonstrate that BRI countries face a heavy burden of disease that varies across countries, although health outcomes have improved since 1990. Progress toward 2030 targets for six key health-related SDGs indicators in most BRI countries was slow. These findings support calls for more health collaborations, aid programs, and other health service to reduce health disparities across the BRI countries.

Asthma and atopic dermatitis are common allergic conditions that contribute to substantial health loss, economic burden, and pain across individuals of all ages worldwide. Therefore, as a component of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, we present updated estimates of the prevalence, disability-adjusted life-years (DALYs), incidence, and deaths due to asthma and atopic dermatitis and the burden attributable to modifiable risk factors, with forecasted prevalence up to 2050.

Asthma and atopic dermatitis prevalence, incidence, DALYs, and mortality, with corresponding 95% uncertainty intervals (UIs), were estimated for 204 countries and territories from 1990 to 2021. A systematic review identified data from 389 sources for asthma and 316 for atopic dermatitis, which were further pooled using the Bayesian meta-regression tool. We also described the age-standardised DALY rates of asthma attributable to four modifiable risk factors: high BMI, occupational asthmagens, smoking, and nitrogen dioxide pollution. Furthermore, as a secondary analysis, prevalence was forecasted to 2050 using the Socio-demographic Index (SDI), air pollution, and smoking as predictors for asthma and atopic dermatitis. To assess trends in the burden of asthma and atopic dermatitis before (2010-19) and during (2019-21) the COVID-19 pandemic, we compared their average annual percentage changes (AAPCs).

In 2021, there were an estimated 260 million (95% UI 227-298) individuals with asthma and 129 million (124-134) individuals with atopic dermatitis worldwide. Asthma cases declined from 287 million (250-331) in 1990 to 238 million (209-272) in 2005 but increased to 260 million in 2021. Atopic dermatitis cases consistently rose from 107 million (103-112) in 1990 to 129 million (124-134) in 2021. However, age-standardised prevalence rates decreased-by 40·0% (from 5568·3 per 100 000 to 3340·1 per 100 000) for asthma and 8·3% (from 1885·4 per 100 000 to 1728·5 per 100 000) for atopic dermatitis. In 2021, there were substantial variations in the burden of asthma and atopic dermatitis across different SDI groups, with the highest age-standardised DALY rate found in south Asia for asthma (465·0 [357·2-648·9] per 100 000) and the high-income super-region for atopic dermatitis (3552·5 [3407·2-3706·1] per 100 000). During the COVID-19 pandemic, the decline in asthma prevalence had stagnated (AAPC pre-pandemic -1·39% [-2·07 to -0·71] and during the pandemic 0·47% [-1·86 to 2·79]; p=0·020); however, there was no significant difference in atopic dermatitis prevalence in the same period (pre-pandemic -0·28% [-0·33 to -0·22] and during the pandemic -0·35% [-0·78 to 0·08]; p=0·20). Modifiable risk factors were responsible for 29·9% of the global asthma DALY burden; among them, high BMI was the greatest contributor (39·4 [19·6-60·2] per 100 000), followed by occupational asthmagens (20·8 [16·7-26·5] per 100 000) across all regions. The age-standardised DALY rate of asthma attributable to high BMI was highest in high-SDI settings, whereas the contribution of occupational asthmagens was highest in low-SDI settings. According to our forecasting models, we expect 275 million (224-330) asthma cases and 148 million (140-158) atopic dermatitis cases in 2050, with population growth driving this increase. However, age-standardised prevalence rates are expected to remain stable (-23·2% [-44·4 to 5·3] for asthma and -1·4% [-9·1 to 7·0] for atopic dermatitis) from 2021 to 2050.

Although the increases in the total number of asthma and atopic dermatitis cases will probably continue until 2050, age-standardised prevalence rates are expected to remain stable. A considerable portion of the global burden could be managed through efforts to address modifiable risk factors. Additionally, the contribution of risk factors to the burden substantially varied by SDI, which suggests the need for tailored initiatives for specific SDI settings. The growing number of individuals expected to be affected by asthma and atopic dermatitis in the future suggests that it is essential to improve our understanding of risk factors for asthma and atopic dermatitis and collect disease prevalence data that are globally generalisable.

Gates Foundation.

Despite proven clinical benefits, cardiac rehabilitation referral rates remained insufficient and low globally. Healthcare professionals' knowledge and attitudes of cardiac rehabilitation may affect their referral behaviors, yet their interrelationships are rarely studied in China. This study aims to examine the cardiac rehabilitation referral rate among Chinese healthcare professionals and explore the associations among knowledge, attitude, and practice (KAP) of cardiac rehabilitation referral.

From July to August 2021, a cross-sectional study was conducted among 321 healthcare professionals from 40 hospitals in Hunan Province of China. The participants completed an online questionnaire to assess their KAP of cardiac rehabilitation referral. Mediation analysis was conducted using logistic regression analysis, Sobel test and Bootstrap method.

About one-third of healthcare professionals never recommended cardiac rehabilitation to their patients. The correlation analysis showed that cardiac rehabilitation knowledge was positively correlated with cardiac rehabilitation referral attitude (r = 0.57, P < 0.001). There was a robust positive association between cardiac rehabilitation knowledge and cardiac rehabilitation referral practice, which was partially mediated by cardiac rehabilitation referral attitude, with the mediating effect accounting for 4.3 %.

The low cardiac rehabilitation referral rate among healthcare professionals indicates an urgent need to improve cardiac rehabilitation referral. Our mediation model suggests that enhancing cardiac rehabilitation knowledge and promoting positive attitudes through education and training may effectively promote cardiac rehabilitation referral. Furthermore, the findings underscore the necessity of establishing an organized cardiac rehabilitation system to facilitate structured cardiac rehabilitation implementation and improve patient outcomes.

The roles of polyunsaturated fatty acids (PUFAs) in preventing coronary artery disease (CAD) remain controversial. This study aimed to investigate the relationships between circulating PUFA percentages and CAD outcomes using observational and Mendelian randomization (MR) approaches.

We analyzed data from 203,373 UK Biobank participants without CAD at baseline. Four PUFA percentages (docosahexaenoic acid [DHA]%, omega-3%, linoleic acid [LA]%, and omega-6%) were examined in relation to incident CAD and CAD mortality. MR analyses included one-sample linear and nonlinear approaches, as well as two-sample univariable and multivariable methods. Observational and one-sample MR analyses were conducted overall and stratified by age and sex.

During a median follow-up of 13.2 years, 16,098 incident CAD cases and 1243 CAD deaths occurred. Observationally, all PUFA percentages were inversely associated with both CAD outcomes. In one-sample MR, genetically predicted DHA% was strongly associated with decreased risk of CAD mortality (hazard ratio [HR] 0.31, 95 % confidence interval [CI] 0.15-0.62, P = 9.71 × 10-4), with a pronounced effect in individuals aged ≥58 years (HR 0.20, 95 % CI 0.09-0.43, P = 4.75 × 10-5). Genetically predicted omega-6% was associated with a decreased risk of incident CAD (HR 0.84, 95 % CI 0.76-0.92, P = 1.26 × 10-4), with a significant effect in females but not in males. Two-sample MR confirmed these findings, suggesting partial mediation through lipid pathways. Nonlinear MR analyses validated these linear associations without threshold effects.

Observational and genetically predicted high DHA% protects against CAD mortality, particularly in older adults. Omega-6% and incident CAD exhibited sex-specific inverse associations. These findings underscore the importance of considering age and sex in PUFA-based strategies for CAD prevention.