BACKGROUND: Liver cancer (LC) is frequently preceded by cirrhosis and poses a significant public health challenge in the United States (US). Recent decades have seen notable shifts in the epidemiological patterns of LC, yet national data guiding the optimal allocation of resources and preventive efforts remain limited. This study aims to investigate the current trends, risk factors, and outcomes of LC in the US.
METHODS: This study utilized the Global Burden of Disease (GBD) dataset to collect data on the annual incident cases, deaths, Disability-Adjusted Life Years (DALYs), age-standardized incidence rates (ASIR), age-standardized death rates, and age-standardized DALY rates of primary LC and its etiologies and risk factors, between 1990 and 2019. Percentage changes in incident cases, DALYs, and deaths and the estimated annual percentage change (EAPC) in ASIR and deaths rates of LC were calculated to conduct temporal analysis. Linear regression was applied for the calculation of EAPCs. Correlations of EAPC with socio-demographic index (SDI) were separately evaluated by Pearson correlation analyses.
RESULTS: We observed a marked increase in the ASIR of LC, increasing from 2.22 (95% CI: 2.15-2.27) per 100,000 people in 1990 to 5.23 (95% CI: 4.28-6.29) per 100,000 people in 2019, a percentage change of 135.4%. LC due to hepatitis C followed by alcohol use were the primary factors driving this increase. The ASIR and age-standardized death rates of LC showed a significant average annual increase of 3.0% (95% CI: 2.7-3.2) and 2.6% (95% CI: 2.5-2.8), respectively. There was a significant negative correlation between the SDI and the EAPC in ASIR (ρ = -0.40, p = 0.004) and age-standardized death rates (ρ = -0.46, p < 0.001). In 2019, drug and alcohol use, followed by elevated body mass index (BMI) were the primary risk factors for age-standardized DALY rates attributable to LC.
CONCLUSIONS: The increased burden of LC in the US highlights the need for interventions. This is particularly important given that LC is mostly influenced by modifiable risk factors, such as drug and alcohol use, and elevated BMI. Our findings highlight the urgent need for public health interventions targeting socio-economic, lifestyle, and modifiable risk factors to mitigate the escalating burden of LC.

Quantifying the impact of poor animal health outcomes on human health represents a complex challenge. Using the disability-adjusted life year (DALY) metric as an endpoint, this article discusses how animal health outcomes can impact humans through three key processes: directly through zoonotic disease, indirectly via changes in yields and their impacts on nutrition and wealth, and finally, through indirect features associated with the agricultural industry, such as pharmaceuticals and climate change. For each process, the current state of the art and feasibility of global DALY-associated estimates are discussed. Existing frameworks for zoonoses already consider some key pathogens; ensuring completeness in the pathogens considered and consistency in methodological decisions is an important next step. For diet, risk factor frameworks enable a calculation of attributable DALYs; however, significant economic methodological developments are needed to ensure that local production changes are appropriately mapped to both local and global changes in dietary habits. Concerning wealth-related impacts, much work needs to be done on method development. Industry-related impacts require a focus on key research topics, such as attribution studies for animal antimicrobial resistance contributing to human outcomes. For climate change, a critical next step is identifying to what extent associated industry emissions are amenable to change should animal health outcomes improve. Allocation of finite funds to improve animal health must also consider the downstream impact on humans. Leveraging DALYs enables comparisons with other human health-related decisions and would represent a transformative way of approaching animal health decision-making should the obstacles in this article be addressed and new methods be developed.
La quantification de l\'impact des problèmes de santé animale sur la santé humaine constitue un défi d\'une grande complexité. En se servant de l\'indicateur des années de vie ajustées sur l\'incapacité (DALY) comme critère d\'évaluation, les auteurs examinent trois processus essentiels illustrant l\'impact que la situation zoosanitaire peut avoir sur la santé humaine : impact direct résultant des maladies zoonotiques, impact indirect résultant des mauvaises performances des animaux et de leurs conséquences sur la nutrition et la création de richesses, et enfin, effets indirects résultant de facteurs en lien avec le secteur agricole, par exemple l\'utilisation de produits pharmaceutiques et le changement climatique. Pour chacun de ces processus, les auteurs font le point sur l\'état actuel des connaissances et sur l\'applicabilité des évaluations mondiales basées sur l\'indicateur DALY. Les cadres existants relatifs aux zoonoses recouvrent déjà certains agents pathogènes majeurs ; la prochaine étape importante consistera à assurer une couverture complète des agents pathogènes et à veiller à la cohérence des décisions méthodologiques. S\'agissant de l\'alimentation, les cadres basés sur l\'analyse des facteurs de risque permettent de calculer les DALY imputables à l\'alimentation ; toutefois, d\'importantes avancées méthodologiques sur les aspects économiques de cette corrélation seront nécessaires pour s\'assurer que tout changement intervenant localement en matière de production animale est correctement mis en correspondance avec les modifications des habitudes alimentaires dans ce même contexte local mais aussi à l\'échelle mondiale. S\'agissant des impacts liés à la création de richesses, il reste beaucoup à faire dans le domaine méthodologique. La détermination des impacts liés aux filières d\'élevage requiert des travaux axés sur des sujets précis, par exemple des études visant à déceler les sources de la résistance aux agents antimicrobiens qui contribuent à l\'apparition d\'antibiorésistances chez l\'être humain. Enfin, pour ce qui concerne le changement climatique, une étape cruciale consistera à déterminer dans quelle mesure les émissions associées à l\'élevage sont susceptibles de changer en cas d\'amélioration de la situation zoosanitaire. Dans un contexte de ressources limitées, l\'affectation de fonds à l\'amélioration de la santé animale doit également prendre en compte l\'impact en aval sur la santé humaine. L\'utilisation de l\'indicateur DALY permet des comparaisons avec d\'autres décisions de santé publique et représenterait une approche transformative de la prise de décision en santé animale, dès lors que les obstacles mentionnés dans cet article sont surmontés et que de nouvelles méthodes sont mises au point.
Cuantificar el impacto de una mala sanidad animal en la salud humana es un desafío complejo. Utilizando el parámetro de años de vida ajustados en función de la discapacidad (AVAD o DALY) como criterio de valoración, en este artículo se examina cómo la sanidad animal puede repercutir en los seres humanos a través de tres procesos clave: directamente, a través de las zoonosis; indirectamente, a través de cambios en los rendimientos y sus repercusiones en la nutrición y la riqueza; y, por último, a través de factores indirectos asociados a la industria agropecuaria, como los fármacos y el cambio climático. Para cada uno de estos procesos, se examinan el estado actual y la viabilidad de estimar AVAD a escala mundial. Los marcos existentes para la zoonosis ya tienen en cuenta algunos patógenos claves; garantizar la exhaustividad de los patógenos considerados y la coherencia en las decisiones metodológicas es un próximo paso importante. En lo que respecta a la alimentación, aunque los marcos de factores de riesgo permiten calcular los AVAD atribuibles, se necesitan importantes avances metodológicos en el ámbito económico para asegurar que los cambios en la producción local se correspondan adecuadamente con los cambios locales y mundiales en los hábitos alimentarios. En cuanto a las repercusiones en la riqueza, queda mucho trabajo por hacer en el desarrollo de métodos. Para abordar las repercusiones relacionadas con la industria, es necesario centrarse en temas clave de investigación, como los estudios de atribución relativos al impacto en la salud humana de la resistencia a los antimicrobianos en los animales. En lo que se refiere al cambio climático, un próximo paso crucial es determinar en qué medida las emisiones de la industria podrían cambiar, en función de la mejora de los resultados en materia de sanidad animal. Al asignar fondos limitados para la mejora de la sanidad animal también se deben tener en cuenta las repercusiones correspondientes en los seres humanos. Utilizar los AVAD permite hacer comparaciones con otras decisiones importantes relacionadas con la salud humana y representaría una forma transformadora de enfocar la toma de decisiones en materia de sanidad animal, en caso de que se aborden los obstáculos presentados en ese artículo y se desarrollen nuevos métodos.

Atrial fibrillation (AF)/atrial flutter (AFL) is the most common cardiac tachyarrhythmia, with an increasing trend in its burden in recent years. However, the burden of AF/AFL in Iran remains unclear. This study aimed to estimate the burden of AF/AFL and its attributable risk factors from 1990 to 2019 at national and subnational levels. Using the comparative risk assessment method of the Global Burden of Disease (GBD) Study 2019, we extracted data on AF/AFL incidence, prevalence, deaths, disability-adjusted life years (DALYs), and their age-standardized rates from 1990 to 2019 and analyzed them based on by age, sex, and socio-demographic index (SDI). The percentage contribution of AF/AFL major risk factors was calculated. Moreover, the AF/AFL burden in 2050 was projected using the United Nations world population prospect data. In 2019, there were 339.1 (259.4-433.7) thousand AF/AFL patients in Iran, with 30.2 (23.2-38.5) thousand new cases, 1.7 (1.5-2) thousand deaths and 48 (37.7-60.5) thousand DALYs. Females and 50-69-year-old patients recorded a higher burden for AF/AFL; however, the increasing trend was more pronounced in males and more than 85-year-old patients. High systolic blood pressure and elevated body mass index (BMI) were the predominant attributable risk factors for AF/AFL-related deaths and DALYs. It is estimated that in 2050, the number of AF/AFL patients will increase to 1.1 million people, the incidence of AF/AFL will increase to 91 thousand patients, and the number of AF/AFL-related deaths and DALYs will surge to 7.2 and 170.8 thousand, respectively. Despite advancements in prevention and treatment, AF/AFL remains a major public health problem in Iran. Given its largely preventable and treatable nature, more cost-effective strategies are required to target modifiable risk factors, especially within susceptible age and sex groups.

BACKGROUND: The burden of disease based on disability-adjusted life years (DALYs) is one of the internationally accepted metrics for assessing the impact of a disease or injury on population health. This study aimed to provide evidence of the burden of COVID-19 on health in Iran based on hospital-level data from the Iran Health Insurance Organization (IHIO), which covers almost half of the country\'s population.
METHODS: The data of all IHIO enrollees who were referred to hospitals across the country from the beginning of the COVID-19 pandemic (February 2020) to December 30, 2021, with assigned diagnosis codes of COVID-19, were extracted from the hospital information processing system. The DALYs due to COVID-19 were estimated using the standard approach of the World Health Organization and the European Burden of Disease Network guideline.
RESULTS: In the years 2020 and 2021, among a population of about 42 million people, 1,040,367 individuals were admitted to the hospital due to COVID-19 infection, of whom 73% were hospitalized (760,963 patients). The total estimated DALYs for these two years were 665,823 and 928,393, respectively (1,603 and 2,234 per 100,000 population). 99.7% of DALYs were attributed to years of life lost due to premature death (YLLs). The share of the disease burden in the age groups of under 20 years, 20-49 years, 50-80 years, and over 80 years was 6.6%, 26.4%, 58.4%, and 8.6%, respectively.
CONCLUSIONS: Based on the hospital-level data estimates, COVID-19 has had a significant burden on health in Iran. COVID-19 was identified as the fifth leading cause of disease burden in Iran during the study period, ranking after cardiovascular diseases, psychological disorders, neoplasms, and musculoskeletal disorders. Additionally, COVID-19 was the third major cause of death, following cardiovascular diseases and neoplasms. Policymaking and the implementation of comprehensive programs to enhance the response of the health system and society to outbreaks of emerging and re-emerging infectious diseases are of utmost importance.

UNASSIGNED: No studies have updated the epidemiologic changes in non-rheumatic degenerative mitral valve disease (DMVD) since 2019, thus this study utilized data from the Global Study of Diseases, Injuries, and Risk Factors 2019 (GBD2019) to assess the burden of DMVD in 204 countries and territories over the period 1990-2019, as well as changes in the prevalence, incidence, deaths and changes in disability-adjusted life years (DALYs).
UNASSIGNED: Using the results from the GBD2019, analyzing the incidence, prevalence, deaths, and DALYs rates, as well as their age-standardized rates (ASR). Based on the human development index (HDI), the socio-demographic index (SDI), age, and sex.
UNASSIGNED: In 2019, there were 24.229 million (95% uncertainty interval (UI) 23.081-25.419 million) existing cases of DMVD worldwide, with 1.064 million (95% UI 1.010-1.122 million) new cases and 0.034 million (95% UI 0.028-0.043 million) deaths, and 0.883 million (95% UI 0.754-1.092 million) disability-adjusted life years. The incidence, prevalence, deaths, and DALYs of DMVD and their ASR showed significant differences across sex, age groups, regions, and countries from 1990 to 2019. It is projected that by 2030, the incidence of DMVD in females will be 0.72 million with an ASR of 15.59 per 100,000 population, 0.51 million in males with an ASR of 11.75 per 100,000 population, and a total incidence of 1.23 million with an ASR of 14.03 per 100,000 population.
UNASSIGNED: DMVD remains a significant public health problem that cannot be ignored, despite a decreasing trend in the ASR of global incidence, prevalence, deaths and DALYs from 1990 to 2019. However, we note an adverse development trend in countries with low socio-demographic indexes and seriously aging societies, and sex inequality is particularly prominent. This indicates the need to reposition current prevention and treatment strategies, with some national health administrations developing corresponding strategies for preventing an increase in DMVD based on local health, education, economic conditions, sex differences, and age differences.

BACKGROUND: In this study we estimate the burden of esophageal cancer (EC) in China and globally from 1990 to 2021, with a forecast to 2035, using Global Burden of Disease (GBD) data. We also analyze the related risk factors to investigate burden trends.
METHODS: Mortality, disability-adjusted life years (DALYs), crude rates, and age-standardized rates of EC were analyzed in China and globally from 1990 to 2035, utilizing GBD open data as a secondary dataset analysis of GBD data. Temporal change trends of EC risk factors were analyzed from 1990 to 2021. Joinpoint regression determined average annual percentage change (AAPC) of age-standardized rates. Descriptive analysis compared mortality and DALYs by age groups. Bayesian age-period-cohort (BAPC) predicted age-standardized mortality and DALYs rates for the next 14 years.
RESULTS: The ASMR and ASDR fluctuations in EC were significant in China, showing an overall downward trend. Globally, although there was also a downward trend, the fluctuations were relatively mild. The number of deaths and DALYs related to EC in China and globally showed a significant upward trend. Age-specific burden trends in China for EC indicated that the age group with the peak number of EC deaths shifted to the 70-74 years age group in 2021, while DALYs peaked in the 65-69 years age group. The crude mortality rate (CMR) peaked consistently in 1990 and 2021, both within the 90-94 years age range, while the crude DALY rate (CDR) shifted to the 85-89 years age group. Overall, the burden of EC deaths and DALYs in the population aged <40 years was relatively low, increasing rapidly after the age of 40 years, reaching a peak and gradually declining, and reaching a lower level after the age of 85 years. The predictive results of the BAPC model indicated that over the next 14 years, both ASMR and ASDR for EC in China and globally would show a slight overall increase. The GBD 2021 study identified smoking, high alcohol use, chewing tobacco, and diet low in vegetables as the main risk factors affecting EC mortality rate and DALYs. Among these, smoking and alcohol use were the most significant risk factors, with a higher impact on EC in China compared to the global level. From 1990 to 2021, the overall changes in ASMR and ASDR indicate a decreasing trend in the impact of these four risk factors on EC mortality rate and DALYs.
CONCLUSIONS: The burden of EC is expected to steadily increase in China and globally until 2035, posing a significant challenge. Targeted prevention and control policies, such as calling on people to quit smoking and reduce alcohol use, may help curb this upward trend.

BACKGROUND: Female breast cancer stands as the prime type of cancer in the Kingdom of Saudi Arabia (KSA), with a high incidence and mortality rates. This study assessed the burden of female breast cancer in KSA by analyzing and forecasting its incidence, mortality, and disability-adjusted life years (DALYs).
METHODS: We retrieved data from the Global Burden of Disease (GBD) about female breast cancer from 1990 to 2021. Time-series analysis used the autoregressive integrated moving average (ARIMA) model to forecast female breast cancer statistics from 2022 to 2026.
RESULTS: From 1990 to 2021, KSA reported 77,513 cases of female breast cancer. The age groups with the highest number of cases are 45-49 years, followed by 40-44 years, 50-54 years, and 35-39 years. The analysis also showed fewer cases in the younger age groups, with the lowest number in the less than 20-year-old age group. From 1990 to 2021, KSA reported 19,440 deaths due to breast cancer, increasing from 201 cases in 1990 to 1,190 cases in 2021. The age-standardized incidence rate/100,000 of breast cancer increased from 15.4 (95% confidence interval (CI) 11.2-21.0) in 1990 to 46.0 (95%CI 34.5-61.5) in 2021. The forecasted incidence rate of female breast cancer will be 46.5 (95%CI 45.8-46.5) in 2022 and 49.6 (95%CI 46.8-52.3) in 2026. The age-standardized death rate per 100,000 Saudi women with breast cancer increased from 6.73 (95%CI 6.73-9.03) in 1990 to 9.77 (95%CI 7.63-13.00) in 2021. The forecasted female breast cancer death rate will slightly decrease to 9.67 (95%CI 9.49-9.84) in 2022 and to 9.26 (95%CI 8.37-10.15) in 2026. DALYs increased from 229.2 (95%CI 165.7-313.6) in 1990 to 346.1 (95%CI 253.9-467.2) in 2021. The forecasted DALYs of female breast cancer will slightly decrease to 343.3 (95%CI 337.2-349.5) in 2022 reaching 332.1 (95%CI 301.2-363.1) in 2026.
CONCLUSIONS: Female breast cancer is still a significant public health burden that challenges the health system in KSA, current policies and interventions should be fashioned to alleviate the disease morbidity and mortality and mitigate its future burden.

This paper presents a thorough evaluation of health outcomes linked to water-related challenges in Islamic nations across East Asia and Central Asia from 2020 to 2030. It has been examined carefully that the trajectory of deaths and disability-adjusted life years associated with unsafe water sources, lack of sanitation, and absence of handwashing facilities is showing a potential rise in negative health impacts due to water pollution. The direct health influences of water-related problems are thoughtful. The increase in deaths and DALYs due to poor water quality and sanitation leads to a higher occurrence of waterborne diseases such as cholera, diarrhea, and dysentery. These conditions not only cause instant health disasters but also subsidize to long-term health issues which include chronic gastrointestinal disorders and malnutrition that is particularly among susceptible populations like children and the elderly. Employing various predictive models including autoregressive integrated moving average, exponential smoothing, support vector machines, and neural networks. The study evaluates their predictive capabilities by using mean absolute percentage error. Support vector machines is found to be the most accurate in forecasting deaths and disability-adjusted life years which is outperforming autoregressive integrated moving average, exponential smoothing, and neural networks. This research aims to inform stakeholders by providing insights into effective strategies for improving water resource management and public health interventions in the targeted regions.

This study aimed to assess the current status and changing trends of the disease burden of stroke and its subtypes due to low dietary fiber intake in China from 1990 to 2019. In cases of stroke and its subtypes attributable to low dietary fiber, deaths, disability-adjusted life-years (DALYs), age-standardized mortality rates (ASMR), age-standardized DALYs rates (ASDR), and percentage change were used to assess disease burden. Data were obtained from the 2019 global burden of disease study. Trends were assessed using Joinpoint regression and age-period-cohort analysis. Between 1990 and 2019, there was a declining trend in stroke and its subtypes, ASDR and ASMR, as well as the corresponding number of deaths and DALYs, due to low dietary fiber intake in China. Subarachnoid hemorrhage (SH) showed the greatest decrease, followed by intracerebral hemorrhage (IH) and ischemic stroke (IS). Local drift curves showed a U-shaped distribution of stroke, IS, and IH DALYs across the whole group and sex-based groups. For mortality, the overall and male trends were similar to those for DALYs, whereas female stroke, IH, and IS showed an upward trend. The DALYs for stroke and IH showed a clear bimodal distribution, IS showed an increasing risk with age. For mortality, the SH subtype showed a decreasing trend, whereas other subtypes showed an increasing risk with age. Both the period and cohort rates of stroke DALYs and motality due to low dietary fiber have declined. Males had a higher risk of DALYs and mortality associated with low fiber levels. The burden of stroke and its subtypes associated with a low-fiber diet in China has been declining over the past 30 years, with different patterns of change for different stroke subtypes and a higher burden for males, highlighting the differential impact of fiber intake on stroke and its subtypes.

BACKGROUND: Migraine, a neurological disorder with a significant female predilection, is the leading cause of disability-adjusted life years (DALYs) in women of childbearing age (WCBA). There is currently a lack of comprehensive literature analysis on the overall global burden and changing trends of migraines in WCBA.
METHODS: This study extracted three main indicators, including prevalence, incidence, and DALYs, related to migraine in WCBA from the Global Burden of Disease(GBD) database from 1990 to 2021. Our study presented point estimates with 95% uncertainty intervals (UIs). It evaluated the changing trends in the burden of migraine in WCBA using the estimated annual percentage change (EAPC) and percentage change.
RESULTS: In 2021, the global prevalence, incidence, and DALYs cases of migraine among WCBA were 493.94 million, 33.33 million, and 18.25 million, respectively, with percentage changes of 48%, 43%, and 47% compared to 1990. Over the past 32 years, global prevalence rates and DALYs rates globally have increased, with an EAPC of 0.03 (95% UI: 0.02 to 0.05) and 0.04 (95% UI: 0.03 to 0.05), while incidence rates have decreased with an EAPC of -0.07 (95% UI: -0.08 to -0.05). Among the 5 Socio-Demographic Index (SDI) regions, in 2021, the middle SDI region recorded the highest cases of prevalence, incidence, and DALYs of migraine among WCBA, estimated at 157.1 million, 10.56 million, and 5.81 million, respectively, approximately one-third of the global total. In terms of age, in 2021, the global incidence cases for the age group 15-19 years were 5942.5 thousand, with an incidence rate per 100,000 population of 1957.02, the highest among all age groups. The total number of migraine cases and incidence rate among WCBA show an increasing trend with age, particularly in the 45-49 age group.
CONCLUSIONS: Overall, the burden of migraine among WCBA has significantly increased globally over the past 32 years, particularly within the middle SDI and the 45-49 age group. Research findings emphasize the importance of customized interventions aimed at addressing the issue of migraines in WCBA, thus contributing to the attainment of Sustainable Development Goal 3 set by the World Health Organization.