Search Results (183)

Background/Objective: Spinal cord injury (SCI) is a life-altering condition representing a major cause of long-term disability and substantial health burden worldwide. In the Middle East, including Saudi Arabia, rapid urbanization and evolving injury patterns may have influenced SCI trends; however, national data remain limited. This study aimed to examine age-standardized trends in SCI incidence, prevalence, and years lived with disability (YLDs) in Saudi Arabia from 1990 to 2021, comparing transport-related and non-transport unintentional injuries, and describing age- and sex-specific SCI patterns in 2021. Methods: Using data from the Global Burden of Diseases (GBD) 2021 study, we conducted a population-based trend analysis for Saudi Arabia from 1990 to 2021, stratified by age, sex, and injury cause. Outcomes included age-standardized incidence, prevalence, and YLD rates per 100,000 population, along with percentage changes, average annual percentage changes, and rate ratios with 95% uncertainty intervals (UIs). Results: Between 1990 and 2021, age-standardized SCI showed a point estimate increase in incidence (25.0%; 95% UI: −28.3 to 116.8) and prevalence (24.3%; 95% UI: 0.8 to 53.4), while YLDs showed a modest rise (1.4%; 95% UI: −44.5 to 83.9). Males experienced greater increases in incidence (31.9%) and prevalence (32.3%) than females. Non-transport unintentional injuries surpassed transport-related causes, accounting for nearly 75% of SCI-related YLDs in 2021. The highest burden occurred among young adult males (highest incidence) and older adults (peak prevalence). Conclusions: The burden of SCI in Saudi Arabia has increased over the past three decades, with a shift toward non-transport unintentional injuries. Because wide uncertainty intervals limit definitive conclusions on trend direction, strengthening injury prevention, rehabilitation, and surveillance programs is crucial to mitigate this growing burden. Full article

Background: premature birth is a significant public health problem, especially in developing countries such as Brazil. Premature newborns require special care from birth, often requiring prolonged hospitalization and continuous monitoring by various specialists after discharge. Infant Mortality among children under five years of age in Brazil is alarming, with prematurity being the main cause of death in this age group. Objectives: we aim to analyze the prevalence and temporal trend of premature live births in the state of São Paulo, Brazil, in the period 2000–2023. Methods: this is an Ecological, Time-Series Study with secondary data on premature live births in the state of São Paulo, Brazil, from 2000 to 2023. The variables in this study are aggregated measures by year. The Annual Percentage Change and the Average Annual Percentage Change in the percentage of premature live births were estimated by Joinpoint regression. Results: the percentage of premature live births in the period 2000 to 2023 was 9.71%. The average annual percentage change showed an increase of 2.30% per year. In the 2010 to 2013 segment, there was an increase of 12.58% per year (p ≤ 0.05), with subsequent stability in the 2013 to 2016 segment (p ≥ 0.05). The largest annual increases occurred in the number of 4 to 6 prenatal consultations and cesarean sections, with an annual percentage change of 4.51% per year and 2.68% per year, respectively. In the birth weight category equal to or greater than 2500 g, there was an increase in premature live births of 2.50% per year. All categories of the variables sex, type of pregnancy, and type of delivery increased in the period 2000–2023 (p ≤ 0.05). Conclusions: given the increase in the prematurity rate in the period 2000–2023, a long-term growing trend is expected in the largest and most developed state in Brazil. Full article

Background/Introduction: Alzheimer’s disease (AD) is a progressive neurological disorder and one of the leading causes of death among older adults in the United States. It causes gradual cognitive decline, memory loss, and impaired functioning. Vulnerable populations—especially those living in rural and predominantly Black communities like the Mississippi Delta—are disproportionately affected. Despite high Alzheimer’s disease mortality rates in Mississippi, limited research has analyzed recent trends disaggregated by race, gender, and geography. This study evaluated trends in AD mortality in the Mississippi Delta between 2016 and 2022 to inform equitable public health responses. Methods: This trend study used age-adjusted mortality rates (AAMRs) for adults aged 65 and older to examine Alzheimer’s disease deaths. AAMRs allow for fair comparisons across groups by adjusting for differences in population age structures. Mortality data were obtained from the Mississippi Statistically Automated Health Resource System (MSTAHRS), a statewide health surveillance system managed by the Mississippi State Department of Health. Joinpoint regression analysis was used to identify statistically significant changes in mortality trends over time using Annual Percent Change (APC) and Average Annual Percent Change (AAPC), with 95% confidence intervals (CIs). AAPC denotes an average percentage change in mortality trends over a seven-year period. Joinpoint regression is an appropriate method for detecting points at which linear trends change significantly, especially in chronic disease mortality analysis. Results: From 2016 to 2022, Alzheimer’s disease mortality significantly increased among Black individuals (AAPC = 8.3%, 95% CI [2.6 to 16.0]; p < 0.05) and declined among White individuals (AAPC = −2.9%, 95% CI [−12.3 to 7.6] p < 0.05). Gender-specific analyses showed slight, non-significant increases among both males and females. County-level disparities were evident: counties such as Sharkey experienced increases exceeding 10%, while Humphreys counties showed declines. Racial disparities in AD mortality were more pronounced than gender differences. Conclusions: This study reveals widening racial and geographic disparities in Alzheimer’s disease mortality across the Mississippi Delta. The statistically significant increase among Black seniors highlights structural inequities in early diagnosis, access to culturally appropriate care, and chronic disease management. These findings support the need for targeted public health interventions, such as the expansion of rural memory clinics, culturally competent outreach, and Medicaid-supported long-term care. Strengthening surveillance systems like MSTAHRS is critical to tracking disparities and advancing equity in dementia-related mortality. Full article

Background: While tobacco smoke remains a leading modifiable risk factor for urologic cancers, comprehensive assessments in BRICS countries are scarce. We aimed to quantify the burden of kidney, prostate, and bladder cancers attributable to tobacco exposure from 1990 to 2021 in BRICS countries. Methods: We estimated tobacco-attributable deaths, disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for kidney, prostate, and bladder cancers in BRICS nations using data from the Global Burden of Disease Study 2021. The data were stratified by sex, age, and sociodemographic index (SDI) and analyzed for temporal trends using the estimated annual percentage change (EAPC). Forecasts until 2050 were produced using autoregressive integrated moving average (ARIMA) modeling. Results: In 2021, tobacco-related genitourinary cancers caused approximately 85,000 deaths and 1.8 million DALYs in BRICS countries. While age-standardized DALY rates declined in most countries, absolute burdens rose due to aging and population growth. Bladder cancer contributed the greatest burden, with notable sex disparities: males experienced significantly higher rates across all three cancers. Russia and South Africa had the highest age-standardized rates, while China and India bore the largest absolute burdens. YLLs dominated the total burden, but YLDs increased faster over time, indicating a growing need for survivorship care. Conclusion: Despite some progress in reducing age-standardized rates, tobacco-attributable urologic cancer burdens continue to rise in BRICS countries. Targeted tobacco control, early detection, and long-term survivorship care are essential to mitigate future impacts. Full article

Background/Objectives: Suicide is a critical public health issue that leads to premature mortality among young people and requires substantial public health interventions. Demonstrating the importance of developing effective suicide prevention programs through health indicators can be valuable. This study aims to examine the change in suicide rates and Years of Life Lost (YLL) in Türkiye over the 2013–2023 period—a country that displays characteristics of both developed and developing nations—and to reveal the productivity losses using the human capital approach. Methods: The data for this descriptive study were obtained from the Turkish Statistical Institute between 2012 and 2023. YLL was computed by determining the difference between the age at which an individual died by suicide and their expected age of death for both males and females. Years of Potential Life Lost (YPLL) was estimated using the same method as YLL for individuals aged 15–64 (working age). The time trend of suicide and YLL rates was calculated using Annual Percentage Change and the Average Annual Percent Change values, based on a Poisson-based Generalized Linear Model and the Joinpoint regression method. Using the human capital approach, the economic cost of the labor force lost due to suicide was estimated. Results: The YLL per death was 33.57 years for males, 47.73 years for females, and 37.06 years overall. The age group with the highest YLL percentage is 20–24 among males (23.55%) and 15–19 among females (33.06%). An increase of 7.8% was observed among males from 2018 to 2021. The mean changes in the overall time trend were found to be significant in male suicides. Among females, there was a 5.3% decrease until 2017, followed by a 4.5% increase from 2017 onwards. Combined, male and female suicide rates have significantly increased since 2017. The financial loss associated with suicide over a 12-year period totaled USD 10,775,943,197 with an annual loss of USD 897,995,266. The premature mortality cost per death was estimated at USD 278,400.84 for men and USD 186,625.16 for women, while the premature mortality cost per YLL was USD 8292.23 for men and USD 3910.36 for women. Conclusions: Changes in the temporal trend of suicide may be associated with societal events. The study reveals that premature deaths due to suicide in Türkiye are a multidimensional public health problem that significantly affects not only individuals but also the overall productivity and economic structure of society. Full article

Agricultural crop yield prediction is vital for ensuring global food security and optimizing resource management amid the increasing challenges posed by climate change and extreme weather variability. This study investigates the use of discrete-time, finite-state, time-homogeneous Markov chains to model crop failure and yield fluctuation probability. Maize yields in Hungary during 1921–1960 and 1980–2023 were analyzed. Yield distribution was assumed to depend only on the yield of the previous year. The Olympic average was computed for 5-year periods, excluding the highest and lowest values. Annual yield was divided by the value of the moving average and expressed as a percentage. According to our estimates, a higher degree of yield fluctuation is associated with an increased frequency of years with yields close to the long-term average. Considering the long-time trend during 1925–1960, the probability of having average maize yield, yield failure, and high yield would be 73.5%, 11.8%, and 14.7%, respectively. For the period of 1985–2023, the probability of failure was calculated to be at least 15% higher, while that of the high yield was found to be lower than for the first period. Taking the second period’s trend into account, the probabilities of average harvest, crop failure, and high harvest would be 66%, 21%, and 13%, respectively. Our findings confirm that the probability of yield variability can be modeled using the discrete-time Markov chain method, providing a new mathematical approach for crop yield prediction. Full article

Background/Objectives: Antimicrobial resistance (AMR) remains a major global threat, with the COVID-19 pandemic influencing its dynamics, although its overall impact remains uncertain. This study analyzed seven-year AMR trends, including the pandemic period, in a tertiary care hospital in Greece that served as a COVID-19 referral center. Methods: Multiresistant bacteria isolated from all biological specimens of hospitalized patients between January 2018 and December 2024 were recorded and classified as multidrug- (MDR), extensively drug- (XDR), or pandrug-resistant (PDR). Overall AMR was defined as the sum of these categories. Annual incidences of overall AMR, its categories, and predominant Gram-negative (A. baumannii, K. pneumoniae, P. aeruginosa) and Gram-positive [methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococcus (VRE)] pathogens were analyzed for the entire hospital and by sector (medical, intensive care unit [ICU], surgical). Bloodstream infection (BSI) AMR was also evaluated. Trend analysis was performed using Joinpoint regression. Results: Overall AMR exhibited a transient peak around 2021 across the hospital, except in the surgical sector. A significant rise in average annual percentage change (AAPC) occurred only in the medical sector (p < 0.001). PDR incidence increased hospital-wide (p < 0.001). K. pneumoniae, P. aeruginosa, MRSA, and VRE rose significantly in the medical sector, whereas ICU incidences remained largely stable despite the 2021 peak. A. baumannii showed no significant change. BSI-related AMR increased in the medical sector (p < 0.001) but not in the ICU (p = 0.2). Conclusions: Although overall AMR did not rise uniformly, PDR organisms increased hospital-wide. These findings support updating empiric therapy guidelines, reinforcing infection prevention measures, and translating surveillance data into targeted stewardship actions to enhance patient care. Full article

Introduction: While there is an increasing shift towards minimally invasive distal pancreatectomy (MIDP), little is known about how utilization of MIDP vs. open distal pancreatectomy (ODP) has evolved over time. We aimed to determine competing temporal trends in use and outcomes of MIDP (laparoscopic and robotic) over time and to determine if a threshold of effectiveness has been reached. Methods: Adults undergoing MIDP and ODP were identified from the National Cancer Database (2010–2021) and the National Surgical Quality Improvement Program database (2014–2022). Propensity score matching (PSM) was performed to address baseline differences between groups before comparing outcomes. Joinpoint regression analysis (JRA) was employed to assess adjusted trends in adoption and outcomes. We calculated Annual Percentage Change (APC) and Average Annual Percentage Change (AAPC) to quantify yearly adoption rates and their trends, respectively. Results: Among 21,966 patients in the NCDB cohort, 49.5% underwent MIDP, including 33.7% laparoscopic distal pancreatectomy (LDP) and 15.8% robotic distal pancreatectomy (RDP), while 50.5% underwent ODP. ODP declined from 74.1% of cases (2010) to 41.1% (2021), with an AAPC of −4.9%. MIDP increased significantly throughout the study from 25.9% of cases (2010) to 58.9% (2021), with an AAPC of 6.3%. Among MIDP subgroups, there was an initial increase in LDP until 2016, after which its rate of utilization stagnated with an AAPC of 0.7% (p > 0.05). In contrast, RDP demonstrated steady growth with an AAPC of about 15% (p < 0.05). A consistent and significant decline in clinically relevant postoperative pancreatic fistula rates occurred across all surgical approaches, with the most pronounced improvement observed in the robotic approach. MIDP approaches had significantly shorter hospital stays and lower mortality rates; however, RDP cases were associated with longer operative times compared to LDP and ODP. Conclusions: Over the past decade, the use of MIDP increased while ODP decreased. This increase was initially driven by greater use of LDP, which plateaued after 2016, and was further driven by the increased use of the robotic approach. Specifically, RDP demonstrated consistent growth, while LDP showed a decline around 2016. These findings highlight changing practice patterns, accompanied by improvements across all surgical approaches. This may provide insights for clinical training and resource allocation. Full article

Estimating the impacts of climate change on streamflow in the Xiaoxingkai Lake Basin is vital for ensuring sustainable water resource management and transboundary cooperation across the entire Xingkai Lake Basin, a transboundary lake system shared between China and Russia. In this study, 11 Global Climate Models (GCMs) from the Coupled Model Intercomparison Project Phase 6 (CMIP6) under two Shared Socioeconomic Pathways (SSP245 and SSP585) were used to drive the Soil and Water Assessment Tool Plus (SWAT+) model. Streamflow projections were made for two future periods: the 2040s (2021–2060) and the 2080s (2061–2100). To correct for systematic biases in the GCM outputs, we applied the Delta Change method, which significantly reduced root mean square error (RMSE) in both precipitation and temperature by 3–35%, thereby improving the accuracy of SWAT+ simulations. To better capture inter-model variability and enhance the robustness of streamflow projections, we used the Bayesian Model Averaging (BMA) technique to generate a weighted ensemble, which outperformed the simple arithmetic mean by reducing uncertainty across models. Our results indicated that under SSP245, greater increases were projected in annual streamflow as well as in wet and normal-flow seasons (e.g., streamflow in normal-flow season in the 2080s increased by 13.0% under SSP245, compared to 7.0% under SSP585). However, SSP585 produced a much larger relative amplification in the dry season, with percentage changes relative to the historical baseline reaching up to +171.7% in the 2080s, although the corresponding absolute increases remained limited due to the low baseline flow. These findings quantify climate-driven hydrological changes in a cool temperate lake basin by integrating climate projections, hydrological modeling, and ensemble techniques, and highlight their implications for understanding hydrological sustainability under future climate scenarios, providing a critical scientific foundation for developing adaptive, cross-border water management strategies, and for further studies on water resource resilience in transboundary basins. Full article

Australian scuba fatalities over 50 years were examined to determine temporal changes over two consecutive periods, 1972–1999 and 2000–2021. The Australasian Diving Safety Foundation database and National Coronial Information System were searched to identify scuba deaths from 1972 to 2021. Historical data, police and witness reports, and autopsies were recorded and comparisons made between the two periods. Of 430 total deaths, 236 occurred during 1972–1999 and 194 during 2000–2021, with average annual fatalities of 8.4 and 8.8, respectively. The proportion of males reduced (83% to 76%) and median ages rose (33 to 47 years) with a large rise in the percentage of casualties among people aged 45 years or older (24% to 57%). There were increases in certified divers (64% to 81%) and in the proportion of divers who were with a buddy at the time of their incident (17% to 27%), as well as a decrease in out-of-gas incidents (30% to 25%). A reduction in primary drowning (47% to 36%) was accompanied by more than a doubling of cardiac-related disabling conditions (12% to 26%). The substantial increase in casualties’ ages and of the proportions of casualties aged 45 or more and of females between the periods indicate the inclusion of a broader cohort of participants and ageing of longtime divers. The reduction in primary drowning was likely due to increased training and improvements in equipment, particularly BCDs and pressure gauges. The rise in cardiac-related deaths was due to an older and more obese cohort. Improved health education and surveillance and improved dive planning are essential to reduce such deaths. Full article

Mississippi has long been one of the most obese states in the U.S., with its obesity rates consistently exceeding the national average. The state’s severe obesity rate is also among the highest in the nation. This study utilized the 2011 to 2021 data from the Mississippi Behavioral Risk Factor Surveillance System (BRFSS) to conduct a comprehensive analysis of obesity and severe obesity trends in Mississippi by sex, age, and race and ethnicity. The data set included a BMI variable calculated by using self-reported height and weight, which the authors categorized into two obesity classification groups—obesity (BMI: 30.00 to 39.99) and severe obesity (BMI: 40.00 or greater)—and demographic characteristics such as sex, age, race and ethnicity. The data were analyzed using SAS 9.4 software to account for the complex design. Weighted prevalence estimates and associated standard errors (SEs) for obesity and severe obesity were calculated. Changes in the prevalence over time were assessed using logistic regression models. The prevalence estimates and SEs were exported to Joinpoint software to calculate the annual percentage change (APC) and associated 95% confidence intervals (CIs) and p-values for the trends. Our analysis of the data revealed a consistent increase in severe obesity, regardless of age, sex, or race. A concerning trend exists where individuals are moving from the obese category to the severely obese category, indicating a worsening trend in overall weight status. This is likely to accelerate the development of chronic disease and, hence, place additional strain on an economically disadvantaged state. Future research should explore the underlying drivers of this shift, including biological, behavioral, and socioeconomic factors, while also evaluating the effectiveness of existing obesity prevention and treatment programs. Full article

Background: Lower respiratory infections (LRIs) are the leading cause of the global disease burden, accounting for millions of deaths each year. Methods: Data on LRIs, including deaths, disability-adjusted life years (DALYs), and incidence, were obtained from the Global Burden of Disease Study 2021. Joinpoint regression was employed to assess temporal trends in the LRIs’ burden, while the age–period–cohort model was used to evaluate age, period, and cohort effects. Pearson’s correlation coefficients were calculated to examine the relationship between DALYs attributable to risk factors and the socio-demographic index (SDI). Results: Over recent decades, the average annual percentage change in age-standardized mortality rate, age-standardized DALYs rate, and age-standardized incidence rate of LRIs globally were −2.4%, −3.5%, and −1.3%, respectively. Notably, the LRIs’ burden dropped considerably from 2019 to 2021. The disease burden was higher among children under five and individuals over 60 compared to other age groups. In terms of gender, males had a higher burden. The age-standardized DALYs rate of LRIs was strongly and negatively correlated with SDI (r = −0.84; p < 0.05). Streptococcus pneumoniae remained the leading pathogen, followed by Staphylococcus aureus, and Klebsiella pneumoniae. Conclusions: In recent years, the global burden of LRIs has declined, but regional, gender, and age disparities persist. Targeted measures are needed to address high-risk populations and major risk factors. Full article

Background: Rheumatic heart disease (RHD) remains a major contributor to childhood cardiovascular morbidity and mortality globally, particularly in low-resource settings. This study offers a thorough evaluation of the global, regional, and national burden of RHD among children aged 0–14 years, from 1990 to 2021, utilizing data from the 2021 Global Burden of Disease (GBD) study. Methods: We analyzed age-standardized incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for RHD in 204 countries and territories. Novel methodological approaches included APC analysis to decompose temporal trends into age, period, and cohort effects, and inequality analysis to assess socioeconomic disparities. We calculated age-standardized rates and average annual percentage changes (AAPC) by sex, region, and socio-demographic index (SDI) level. Results: From 1990 to 2021, the global age-standardized death rate due to RHD in children declined by approximately 74%, from 1.24 to 0.32 per 100,000 (AAPC: −4.27%). Similarly, DALY rates dropped from 117.22 to 41.56 per 100,000 (AAPC: −3.30%). Despite this progress, the global age-standardized incidence rate increased modestly from 55.84 to 66.76 per 100,000 (AAPC: 0.58%), and prevalence rates also rose (AAPC: 0.53%). Females consistently experienced higher burden across all metrics. Inequality analysis demonstrated a concerning divergence: while mortality and DALY inequalities narrowed substantially (mortality slope index of inequality (SII) improved from −1.35 to −0.31), incidence and prevalence inequalities widened (incidence SII worsened from −112.60 to −131.90), indicating growing disparities in disease occurrence despite improved survival. Conclusions: While global mortality and DALYs from childhood rheumatic heart disease have declined substantially over the past three decades, a troubling paradox has emerged: rising incidence rates alongside widening socioeconomic inequalities in disease occurrence. This represents a critical public health challenge demanding targeted intervention strategies. The divergent trends in health outcomes, namely, improved survival rates but increased disease burden, reveal that while access to treatment has advanced, upstream prevention efforts remain critically inadequate among socioeconomically disadvantaged populations. Full article

Lower respiratory infections (LRIs) persist as a major global health threat. This study analyses the 1991–2021 trends in LRI mortality, deaths, and aetiologies across 204 countries using Global Burden of Disease 2021 data, aiming to evaluate the disease burden of LRIs and provide evidence-based guidance for prevention strategies. To quantify the temporal trends, the annual percentage change was estimated (EAPC) using linear regression modeling. Globally, the ASMR for LRI decreased by an average of 2.29% annually (95% CI: 2.16–2.42%). While ASMR decreased in 20 of the GBD regions, mortality rates in Southern Latin America increased (EAPC = 1.32, 95% CI: 0.98–1.67). The LRI burden remains the heaviest in low SDI regions and sub-Saharan Africa. LRIs continue to cause high mortality in children and the elderly. Mortality in children decreased rapidly, while mortality in the elderly declined more slowly. Streptococcus pneumoniae was the leading cause of LRI-related deaths, followed by Staphylococcus aureus and Klebsiella pneumoniae. LRIs remain a leading cause of global mortality, especially in low SDI regions, and among children and the elderly. Future research on LRIs and the development of effective prevention and control strategies are essential to reduce the disease burden of LRIs. Full article

Background: Ovarian cancer remains the deadliest and leading cause of gynecological cancer-associated mortality in the US. The aim of this study was to characterize the trends in the incidence of ovarian cancer between premenopausal and postmenopausal women to inform future targeted interventions. Methods: This population-based cross-sectional study analyzed data from the US Cancer Statistics (USCS) database, which covered the whole of the US population between 2001 and 2021. Joinpoint regression was used to compute the average annual percentage change (APC) with 95% confidence interval (CI) and age-standardized incidence rates per 1,000,000 population. Results: The results showed that the IR of ovarian cancer declined between 2001 and 2021. Postmenopausal women had greater decreases in the IR of ovarian cancer compared to premenopausal women who showed a small decline. When stratified by race/ethnicity, non-Hispanic American Indian/Alaska Native women aged 20–49 years experienced an increase in the IR of ovarian cancer (APC = 2.4; 95% CI 0.9 to 4.1) compared to other racial/ethnic groups which showed a decline. Joinpoint trend analyses identified one inflection point in localized ovarian cancer incidence trends among all three age groups: an initial decline from 2001 to 2011 among women 20–49 years old and 65+ years old, and from 2001 to 2012 among women 50–64 years old, followed by an upward trend thereafter to 2021. Similarly, there was one inflection point in the IR of ovarian cancer for the clear cell and endometrioid types among women aged 20–49 years old. Conclusions: The IR of ovarian cancer in the US declined significantly among postmenopausal compared to premenopausal women, for whom the IR of ovarian cancer decreased only slightly. Although encouraging, these findings show a need for continued efforts to improve early detection and prevention strategies to mitigate the burden of this deadly disease. Full article