Background Diabetes mellitus complicated by renal failure (DM-RF) is an emerging driver of premature death in China. Objective To quantify 19-year mortality trends attributable to DM-RF in Pudong New Area of Shanghai and to project the burden to 2035. Methods Using population-based vital-registration data covering 3.30 million residents (2005–2023), we calculated crude mortality, world-standardized age-standardized mortality rates (ASMRW), years-of-life-lost (YLL) rates and average YLL (AYLL). Decomposition analysis identified key drivers; Bayesian age–period–cohort models forecast rates for 2024–2035. Results Over the study period, 3,699 DM-RF deaths were documented. ASMRW more than tripled, rising from 1.29 to 4.15 per 100,000 (average annual percentage change 6.89%). Males consistently experienced higher mortality than females, with ASMRW of 5.44 vs 2.94 per 100,000 in 2023. The YLL rate increased by 8.64% annually, whereas AYLL declined modestly (− 0.62%; all P < 0.001). Epidemiological factors explained 311% of the 376 excess deaths, with males accounting for 521%. Bayesian projections estimated that ASMRW will reach 6.06 (95% CI: 3.77–8.35) per 100,000 by 2035. Conclusion DM-RF mortality is escalating rapidly in Pudong New Area of Shanghai, propelled by deteriorating glycaemic control and population aging. Sex-specific, age-targeted and community-integrated prevention strategies are urgently needed if Shanghai is to meet Sustainable Development Goal 3.4.

This study aims to compare the disease burden of low bone mineral density (LBMD) between China and global populations from 1990 to 2021 and quantify the associations of sex, age, and socio-demographic index with disability-adjusted life years (DALYs). A secondary analysis of LBMD was conducted using comprehensive data from the Global Burden of Disease Study 2021. The absolute number of DALYs and DALYs rates were determined for 1990 and 2021. Joinpoint regression analysis was employed to assess trends in the age-standardized DALYs rate from 1990 to 2021 and over the most recent decade (2012-2021), using the average annual percentage change. Additionally, China's future trends over the next 20 years were projected based on this analysis. In 2021, LBMD accounted for 17.31 million global DALYs and 3.47 million (95% UI: 2.78-4.24) in China. Despite a decline in China's age-standardized rate (from 195 to 175 per 1,00,000; average annual percentage change = -0.29%; 95% CI: -0.32 to -0.25), the absolute DALYs more than doubled. The most pronounced increase occurred in adults aged ≥80 years, with older women exhibiting rates 22.5% higher than men. Projections indicate a rise in China's rate from 175 to 210 per 1,00,000 by 2050, starting in approximately 2040. Women, older adults, and populations in low-middle and middle socio-demographic index regions are high-risk groups that require prioritized attention. These findings highlight the need for age-stratified screening protocols and context-specific resource allocation in low-middle SDI regions.

Patients with Alzheimer's disease (AD) frequently experience inflammatory insults; however, the mechanisms by which microglia respond to these challenges remain unclear. Although AD microglia have been proposed to be primed for exaggerated inflammatory responses, single-cell evidence remains limited. To investigate microglial responses to inflammation in AD, we challenged AD mouse models with intraperitoneal lipopolysaccharide (LPS) and used single-cell RNA sequencing to characterize microglial states, along with in vivo immunostaining and in vitro models to define their features and underlying mechanisms. We found that, in response to an inflammatory challenge, microglia adopted a low-inflammatory state accompanied by elevated expression of mitochondrial respiratory chain genes. This state was associated with the phagocytosis of dystrophic neurites and was recapitulated in vitro using an efferocytosis-based model, with apolipoprotein E implicated in its underlying mechanism. In summary, we identified a distinct microglial state that provides new insights into the dynamic role of microglia in AD.

Abstract Background Breast cancer (BC) has become the most common malignancy worldwide. Our aim was to assess the global diversity of disability due to breast cancer in 204 countries and territories. Methods Using data from the Global Burden of Disease (GBD) 2021 study the diversity of disability due to breast cancer was estimated for 204 countries and territories, and breast cancer incidence, prevalence, mortality, and Years Lived with Disability (YLDs) were further assessed. Absolute number, rate, and age standardized rate with 95% uncertainty intervals (UIs) were used to compare the difference. Data analysis was further stratified by the socio-demographic index (SDI) of the regions, average annual percentage changes (AAPC) and trends were analyzed by the Joinpoint regression procedure. Results From 1990 to 2021, the global disability-adjusted life years (DALYs) caused by breast cancer showed a trend of first decrease and then increase in 204 countries, especially during the epidemic period of Corona Virus Disease 2019 (COVID-19) from 2019 to 2021, with 63% of countries experiencing an increase in DALYs for three consecutive years, mainly in Africa. During this period, there was a significant increase trend in DALYs caused by breast cancer in low - and middle-income countries, with Turkey having the highest growth rate. High-income countries showed declines, with Denmark, Luxembourg and the United Kingdom experiencing declines of more than 50%. For males, the highest incidence, prevalence, mortality, and DALYs are mainly concentrated in the Eastern Sub-Saharan Africa region. For females, high incidence and prevalence are found in economically developed regions such as Europe and North America, while the highest mortality and DALYs are primarily concentrated in the Oceania region. The DALYs of breast cancer patients in the 15–49 years age group are highest in low-middle SDI countries, approximately 180.86 per 100,000 (95% UI:161.08, 201.32). For the 50–74 years age group, the highest DALYs are found in low SDI countries, about 754.47 per 100,000 (95% UI: ). In the ≥ 75 years age group, the highest DALYs are observed in high SDI countries, approximately 1166.46 per 100,000 (95% UI:952.49, 1296.24). Overall, DALYs showed a slight global increase from 2012 to 2021 but a decrease over the 30-year span from 1990 to 2021. Conclusions From 1990 to 2021, DALYs due to breast cancer worldwide decreased first and then increased, especially during the COVID-19 pandemic. There is a significant increase in breast cancer DALYs in low - and middle-income countries, while there is a downward trend in high-income countries. In addition, there is a complex relationship between breast cancer indicators and socio-demographic index (SDI) in different countries and regions, indicating the importance of considering multiple factors when analyzing cancer epidemiology and the need to tailor cancer prevention and treatment approaches based on local context and social characteristics.

Background: Despite progress in tuberculosis (TB) control in the Western Pacific Region, the equitable distribution of these reductions remains unclear. We evaluated long-term trends in socioeconomic inequalities in TB from 1990 to 2023. Methods: Using data from the Global Burden of Disease Study 2023, we calculated the slope index of inequality (SII) and concentration index to measure absolute and relative inequalities, respectively. Temporal trends of these indices were analyzed using Joinpoint regression, stratified by region, disease burden, age, and drug-resistance status. Findings: Regional absolute inequality decreased, but relative inequality worsened. Stratification revealed a masking effect: while the regional aggregate indicated worsening relative inequality driven by China, excluding China uncovered simultaneous absolute and relative improvements for the overall burden in the rest of the region. Conversely, high-burden countries experienced a "Lost 16 Years" (1990–2006) of stagnation. A demographic paradox was evident: contrary to the trend in older adults, children suffered the most severe deterioration in relative inequality. Most alarmingly, for multidrug-resistant TB (MDR-TB), excluding China revealed a fourfold widening of the absolute inequality gap in the remaining region. Interpretation: Aggregate success conceals widening disparities. The demographic paradox and the silent crisis of expanding absolute inequality in MDR-TB outside China highlight structural failures. Achieving the End TB Strategy requires shifting from broad coverage to precision equity interventions targeting these vulnerable groups.

Objective To explore the characteristics and correlation between perivascular spaces(PVS)and diffusion tensor image analysis along perivascular spaces(DTI-ALPS)index in patients with amnestic mild cognitive impairment(aMCI).Methods A retrospective study was conducted on a total of 118 participants,including cognitive normal(CN)healthy controls and aMCI patients,recruited from the Department of Neurology,Zhongshan Hospital,Fudan University from September 2020 to September 2022.All participants underwent structural magnetic resonance imaging(MRI)and diffusion tensor imaging(DTI).An automatic segmentation algorithm was used to quantify PVS metrics in the brain,and DTI-ALPS index was calculated based on DTI.Differences in DTI-ALPS index and PVS metrics between the CN and aMCI groups were compared.Multivariate logistic regression was used to identify independent factors influencing aMCI.Correlation analysis was performed to assess relationships among DTI-ALPS index,PVS metrics,and cognitive scores.Results A total of 80 CN healthy controls and 38 aMCI patients were included.The DTI-ALPS index was significantly lower in the aMCI group compared with the CN group(1.28±0.18 vs 1.37±0.21,P=0.018),while differences in PVS metrics between groups were not statistically significant.Multivariate logistic regression analysis indicated that DTI-ALPS index was an independent factor affecting aMCI(OR=0.097,95%CI 0.011-0.833,P=0.033).Correlation analysis revealed a positive relationship between DTI-ALPS index and MMSE score(r=0.210,P=0.023)as well as PVS length in the centrum semiovale(r=0.216,P=0.019).Conclusions The DTI-ALPS index may serve as an imaging biomarker for identifying early cognitive impairment,and patients with aMCI exhibit abnormal DTI-ALPS indices,suggesting that brain glymphatic system dysfunction may occur prior to morphological changes.

OBJECTIVE:We assessed long-term and recent trends, age and geographic disparities, and future prostate cancer (PC) burden in China, the Western Pacific Region (WPR), individual WPR locations, and globally from 1990 to 2021, with projections through 2035. METHODS:We analyzed Global Burden of Disease Study 2021 estimates of incidence, mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life years (DALYs) for China, WPR locations, sociodemographic index strata, and globally. Absolute numbers and age-standardized rates were examined separately. Joinpoint regression estimated average annual percent changes (AAPCs) for 1990-2021 and 2012-2021. Bayesian age-period-cohort models projected incidence and deaths for 2022-2035; projected YLLs and YLDs were combined to estimate DALYs. RESULTS:In 2021, the WPR had an estimated 192,632 incident cases (95% UI, 159,855-227,328) and 69,365 deaths (95% UI, 56,577-83,449). During 1990-2021, age-standardized incidence and prevalence increased (AAPC, 1.64% and 2.40%), whereas mortality and the age-standardized DALY rate (ASDLR) were stable (0.00% and 0.02%). ASDLR declined in high-SDI and high-middle-SDI locations but increased in lower SDI locations, and burden rose steeply with age. During 2012-2021, age-standardized incidence and mortality declined (AAPC, -0.28%; 95% CI, -0.56% to -0.06%; p = 0.014; and -0.58%; 95% CI, -0.76% to -0.40%; p < 0.001), but country-level trends were heterogeneous. From 2022 to 2035, posterior mean ASDLR increased modestly in China and the WPR and declined globally; projected mean absolute DALYs increased in all three settings, with widening uncertainty. CONCLUSION:Absolute PC burden increased substantially in the WPR, whereas age-standardized patterns varied across measures, periods, age groups, SDI strata, and countries. Recent regional declines did not indicate uniform improvement, and projected increases in absolute DALYs suggest continuing growth in service needs. Locally adapted prevention, risk-appropriate early detection, diagnosis, and treatment planning are required.

Pulmonary embolism (PE)-related deaths are rising amid population aging, yet comprehensive burden data remain scarce. We quantified all-cause PE mortality in Shanghai Pudong (2005-2021) and projected trends to 2035. Epidemiological transition theory and burden-of-disease metrics (YLL, ASMRW) framed the analysis; Joinpoint, ARIMA, and decomposition methods traced temporal and demographic drivers. Longitudinal population-based study using ICD-10-coded death records; calculated CMR, ASMRW, and YLL; modeled future burden and aging impact. Of 1,144 PE-related deaths, the top underlying causes were coronary heart disease (13.02%), PE (11.98%), and chronic lower respiratory disease (10.2%). ASMRW = 0.89/10(5); CMR = 2.37/10(5); YLL rate = 22.88/10(5). Population aging raised CMR by 30.72% annually (95% confidence interval (CI) 23.5-38.4%). By 2035, CMR, ASMRW, and YLL rates are expected to rise 3.89, 2.94, and 2.17% per year, respectively (all p < 0.001). Aging and comorbidities are fueling a sustained surge in PE mortality. Tailored prevention and early intervention strategies are urgently needed to mitigate this growing public health burden.

Importance Nasopharyngeal cancer (NPC) is a strikingly age-specific and region-specific malignancy whose disproportionate and changing burden among younger people in the Western Pacific Region (WPR) has yet to be comprehensively quantified.Objective This study aimed to evaluate the burden and trends of NPC in individuals under 55 years in the WPR from 1990 to 2021 and project future trends up to 2035.Design Population-based study.Population Individuals under 55 years in the WPR, as part of the Global Burden of Disease Study 2021, spanning from 1990 to 2021.Main Outcome Measures Age-standardized rates of incidence, mortality, prevalence, disability-adjusted life years (DALYs), and average annual percentage change (AAPC) of nasopharyngeal cancer among people younger than 55 analyzed by regions and countries in the WPR from 1990 to 2021.Results Between 1990 and 2021, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDLR) of NPC in individuals under 55 years in the WPR significantly decreased (all P < .001), whereas the age-standardized prevalence rate (ASPR) increased (P < .001). The NPC burden increased with age, peaking in the 50 to 54 age group, and was higher in males. Singapore exhibited the highest age-standardized incidence rate (ASIR) but low ASMR and ASDLR and China showed a decline in the ASIR and the ASMR, though the ASPR increased (all P < .001). Aging and population growth contributed to the rising NPC burden in the region. From 2022 to 2035, the ASIR is projected to rise to 2.85 per 100,000 [AAPC 95% CI = 2.04% (1.97%, 2.09%), P < .001], and the ASPR is expected to increase to 18.54 per 100,000 [AAPC 95% CI = 2.36% (2.24%, 2.44%), P < .001].Conclusion The growing NPC burden among young populations in the WPR underscores the need for countries to adopt effective prevention strategies based on the experiences of peers with similar demographic profiles.

BackgroundMultiple primary carcinomas (MPC) represent a clinically significant yet underexplored phenomenon, where patients develop more than one distinct primary malignancy. While prior studies have examined MPC within specific cancer types, comprehensive real-world patterns of primary malignancies and their subsequent primary malignancies remain limited. Moreover, the survival outcomes associated with these MPC patterns, particularly in relation to demographic and clinical characteristics, are not well characterized. ObjectiveThis study aimed to establish the patterns and combinations of MPC across a wide range of cancers and to assess whether the mortality status of patients with MPCs varies according to their demographic characteristics and disease status. MethodsWe conducted a retrospective analysis of 1560 patients with MPC in Shanghai, China, from 2002 to 2015. Data were extracted from the Shanghai Cancer Registry, with follow-up until December 2017. Cause of death was ascertained through linkage with the Shanghai Vital Registration System. The distribution of the frequency and proportion of primary carcinoma (PC) combinations were depicted, and a life table was used to calculate the 1- to 5-year survival rates. Cox regression analysis was performed to analyze the survival risk factors of the first and second PCs. ResultsAmong the 1560 patients (809/1560, 51.86% male and 751/1560, 48.14% female), the most frequent first PCs were colorectal, breast, and stomach cancers, while the most frequent second PCs were lung, colorectal, and stomach cancers. The most common combinations included colorectal and lung, colorectal and stomach, and colorectal and prostate. Survival rates were lowest for first PCs of skin (5 years=46.95%) and lung (5 years=41.54%) cancers, and for second PCs of pancreatic (5 year=9.13%) and liver (5 years=14.19%) cancers. A latency period of 12 months between PC diagnoses was associated with significantly higher cancer-specific mortality for both the first primary cancer (hazard ratio [HR] 3.539, 95% CI 2.822-4.438; P<.001) and the second primary cancer (HR 1.369, 95% CI 1.103-1.699; P=.004). Older age (>65 years) and advanced tumor stage (III+IV) were also significant independent risk factors for poor survival in both first PC (age: HR 2.049, 95% CI 1.689-2.485; P<.001; stage: HR 1.496, 95% CI 1.315-1.703; P<.001) and second PC (age: HR 1.575, 95% CI 1.242-1.996; P<.001; stage: HR 3.933, 95% CI 3.182-4.861; P<.001) analyses. ConclusionsThis study provides a comprehensive, real-world map of MPC patterns and highlights important findings: high-risk cancer combinations and key factors associated with poorer survival, including a short interdiagnosis interval (12 months), advanced age, and advanced tumor stage. Comprehensive prevention and control strategies for MPC should be developed, and clinicians should be aware of the risks of MPC in vulnerable populations during the early diagnosis stage.

ObjectiveTo analyze the changes in the disease burden of ischemic heart disease (IHD) attributable to high body mass index (hBMI) among Chinese residents from 1990 to 2021, to predict its future trends from 2022 to 2035, so as to provide data support for the development of targeted public health policies.MethodsUsing data from the global burden of disease study 2021 (GBD 2021), stratified analyses of age-and gender-specific mortality rates and disability-adjusted life years (DALYs) for IHD attributable to hBMI among Chinese residents from 1990 to 2021 were conducted. The average annual percentage change (AAPC) and its 95% confidence intervals (CI) for both mortality rates and DALY were calculated using Joinpoint regression models to analyze trends in the disease burden of IHD attributable to hBMI in China, globally, and across regions with different socio-demographic index (SDI) levels from 1990 to 2021. Age-standardized mortality rates and age-standardized DALY rates were computed based on the GBD world population standard. Additionally, the Bayesian age-period-cohort (BAPC) model was used to predict the standardized mortality rates and standardized DALYs rates for IHD attributable to hBMI in China from 2022 to 2035.ResultsBetween 1990 and 2021, the age-standardized mortality rate for IHD attributable to hBMI among Chinese residents increased from 3.34/100 000 to 8.24 /100 000, representing a growth of 146.71%, while the age-standardized DALY rate rose from 79.21/100 000 to 175.05/100 000, with an increase of 120.99%. Age-and gender-specific stratified analyses revealed that the disease burden among individuals aged ≥75 years was higher than that of other age groups, with a greater increase in disease burden observed in males compared to females. Trend analyses indicated that, from 1990 to 2021, the overall age-standardized mortality rate for IHD attributable to hBMI in China rose annually (AAPC=3.41%, 95%CI: 3.02%‒3.80%), whereas the global age-standardized mortality rate declined annually (AAPC=-0.73%, 95% CI: -0.82%‒ -0.65%), and the age-standardized mortality rate in high-middle SDI regions decreased annually (AAPC=-1.05%, 95%CI: -1.36%‒ -0.74%). Concurrently, the overall age-standardized DALY rate in China increased annually (AAPC=2.97%, 95%CI :2.67%‒3.28%), while the global age-standardized DALY rate declined annually (AAPC=-0.47%, 95%CI: -0.56%‒ -0.39%), and the age-standardized DALY rate in high-middle SDI regions decreased annually (AAPC=-1.13%, 95%CI:-1.51%‒ -0.76%). Predictive results indicated that, from 2022 to 2035, both the age-standardized mortality rate (AAPC=2.31%, 95%CI: 2.11%‒2.51%) and age-standardized DALY rate (AAPC= 2.16%, 95%CI: 1.96%‒2.37%) for IHD attributable to hBMI among residents of China are expected to increase annually.ConclusionThe disease burden of IHD attributable to hBMI among Chinese residents continues to increase. It is essential to address the challenges posed by population aging and the large population base. Appropriate body weight management measures should be implemented at both the macro-policy making and individual health management levels to reduce the disease burden associated with hBMI and achieve the high-quality development of population health.

BACKGROUND:To analyze the prevalence of overweight, obesity, and central obesity among 248,147 professional women in Shanghai from 2010 to 2024 and predict their trends up to 2035, providing a data support for the local implementation of the Weight Management Annual Plan. METHODS:We collated physical examination data from 248,147 female participants aged 20-59 years who underwent examinations at the Shanghai Health and Medical Center between 2010 and 2024. Overweight and obesity were determined based on body mass index (BMI), while central obesity was diagnosed using waist circumference (WC), waist-hip ratio (WHR), and waist-height ratio (WHtR) as reference values. The JoinPoint regression model was employed to calculate the average annual percent change (AAPC) and its 95% confidence interval (CI). The Bayesian age-period-cohort (BAPC) model was used to predict the development trends of these indicators from 2025 to 2035. RESULTS:Among the 248,147 female examinees, the prevalence of overweight was 22.58% (56,027 cases), obesity was 5.34% (13,257 cases), and central obesity was 27.16% (67,387 cases). From 2010 to 2024, the prevalence of overweight (AAPC = 0.79; 95%CI: 0.06 to 1.54; P < 0.05)) and obesity (AAPC = 4.63%; 95%CI: 4.05 to 5.37; P < 0.05) increased annually; the prevalence of central obesity peaked at 29.94% in 2013 and exhibited a fluctuating trend (AAPC = -2.02; 95%CI: -15.38 to 1.83; P > 0.05). Comparative analysis among age subgroups revealed a highly significant upward trend in the rates of overweight, obesity, and central obesity with increasing age (all P < 0.05). The forecast results indicated that the prevalence of obesity would increase by 2.69% annually, reaching 9.14%(95% CI: 7.12 to 11.16; P < 0.05) by 2035. CONCLUSION:Professional women should strengthen weight management, with employers facilitating health education, providing preferential medical insurance policies, improving the monitoring system, and implementing targeted interventions to control the obesity trend.

OBJECTIVES:To assess global, regional, and national burdens and trends of age-related macular degeneration (AMD) from 1990 to 2021. METHODS:Data from the Global Burden of disease Study 2021(GBD 2021) were used. The primary measurement were prevalent cases, years lived with disability (YLDs), age-standardised prevalence rate (ASPR) and age-standardised YLDs rate (ASYR), categorized by age and sociodemographic index (SDI). Trend analysis was measured by calculating average annual percentage change (AAPC) of ASPR and ASYR. RESULTS:Globally, the prevalent AMD cases increased to 8,057,520.459 (95% uncertainty interval [UI], 6,705,283.83 to 9,823,237.34) in 2021, with associated YLDs rising to 577,984.5004 (95% UI, 401,188.20 to 797,657.63). AMD burdens varied across regions and countries, as well as level of SDI development. China, India, and the United States of America (USA) were the top three countries with AMD cases. Caribbean regions have significant lower ASPR and ASYR of AMD. The AMD burden peaked between ages 65-69. Females had a significantly higher burden of AMD compared to males. From 1990 to 2021, the global ASPR and ASYR showed downward trend (AAPC = -0.15, 95% confidence interval [CI], -0.19 to -0.12, P < 0.001; AAPC = -0.69, 95% CI, -0.71 to -0.67, P < 0.001) respectively. The USA is the only developed country showed decreasing AAPCs of ASPR and ASYR from 1990 to 2021 but increasing AAPCs of ASPR and ASYR from 2012 to 2021. CONCLUSIONS:AMD burdens increased over 30 years, varying by age, sex, and SDI, guiding global strategies and public health interventions.

IMPORTANCE Nontraumatic subarachnoid hemorrhage (SAH) represents the third most common stroke type with unique etiologies, risk factors, diagnostics, and treatments. Nevertheless, epidemiological studies often cluster SAH with other stroke types leaving its distinct burden estimates obscure. OBJECTIVE To estimate the worldwide burden of SAH. DESIGN, SETTING, AND PARTICIPANTS Based on the repeated cross-sectional Global Burden of Disease (GBD) 2021 study, the global burden of SAH in 1990 to 2021 was estimated. Moreover, the SAH burden was compared with other diseases, and its associations with 14 individual risk factors were investigated with available data in the GBD 2021 study. The GBD study included the burden estimates of nontraumatic SAH among all ages in 204 countries and territories between 1990 and 2021. EXPOSURES SAH and 14 modifiable risk factors. MAIN OUTCOMES AND MEASURES Absolute numbers and age-standardized rates with 95% uncertainty intervals (UIs) of SAH incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) as well as risk factor-specific population attributable fractions (PAFs). RESULTS In 2021, the global age-standardized SAH incidence was 8.3 (95% UI, 7.3-9.5), prevalence was 92.2 (95% UI, 84.1-100.6), mortality was 4.2 (95% UI, 3.7-4.8), and DALY rate was 125.2 (95% UI, 110.5-142.6) per 100000 people. The highest burden estimates were found in Latin America, the Caribbean, Oceania, and high-income Asia Pacific. Although the absolute number of SAH cases increased, especially in regions with a low sociodemographic index, all age-standardized burden rates decreased between 1990 and 2021: the incidence by 28.8% (95% UI, 25.7%-31.6%), prevalence by 16.1% (95% UI, 14.8%-17.7%), mortality by 56.1% (95% UI, 40.7%-64.3%), and DALY rate by 54.6% (95% UI, 42.8%-61.9%). Of 300 diseases, SAH ranked as the 36th most common cause of death and 59th most common cause of DALY in the world. Of all worldwide SAH-related DALYs, 71.6% (95% UI, 63.8%-78.6%) were associated with the 14 modeled risk factors of which high systolic blood pressure (population attributable fraction [PAF]=51.6%; 95% UI, 38.0%-62.6%) and smoking (PAF=14.4%; 95% UI, 12.4%-16.5%) had the highest attribution. CONCLUSIONS AND RELEVANCE Although the global age-standardized burden rates of SAH more than halved over the last 3 decades, SAH remained one of the most common cardiovascular and neurological causes of death and disabilities in the world, with increasing absolute case numbers. These findings suggest evidence for the potential health benefits of proactive public health planning and resource allocation toward the prevention of SAH.

BACKGROUND:Young Chronic Obstructive Pulmonary Disease (COPD) was first introduced in 2022. Large-scale population-based studies on young COPD are limited. METHODS:Using Global Burden of Disease (GBD) 2021, the incidence, mortality, prevalence, and disability-adjusted life-years (DALYs) were estimated by sex, age group, and Socio-demographic Index (SDI). Time-trend changes were estimated. The future burden was predicted using a Bayesian age-period-cohort analysis model. RESULTS:The number of incidence, prevalence and DALYs increased by 54.02 %, 51.64 % and 8.12 %; while the mortality decreased by 12.86 % from 1990 to 2021. The age-standardized rate (ASR) of incidence, mortality, prevalence and DALYs decreased from 77.91/105 to 69.5/105, 3.83/105 to 1.89/105,978.94/105 to 897.71/105 and 258.71/105 to 163.18/105. The ASR of incidence, mortality, prevalence, and DALYs were observed with a downward trend,-0.37 (-0.37 to -0.36, P < 0.001), -2.28(-2.32 to -2.23, P < 0.001), -0.28 (-0.28 to -0.27, P < 0.001) and -1.50 (-1.52 to -1.47, P < 0.001). With increasing age, the mortality and DALYs were higher in males compared than in females. As the SDI increases, the burden of disease decreases globally. By 2035, the estimated AAPC of ASR of incidence, prevalence, mortality and DALYs will be -0.11 (P < 0.001), -0.10 (P < 0.001), -0.57 (P < 0.001) and -0.20 (P < 0.001). CONCLUSION:Promoting lung function testing among children and adolescents, and early screening and intervention for high-risk populations will be crucial public health goals. Although we found a decreasing burden, we cannot take it lightly, due to the limitations of model predictions and insufficient disease screening.

BackgroundCataracts, the leading cause of blindness globally, significantly impair vision and quality of life, particularly among the elderly. Despite advancements in cataract surgery, challenges in accessibility and economic disparities hinder the reduction of cataract burden, especially in low-income regions. This study examines the global prevalence and years lived with disability (YLDs) due to cataracts from 1990 to 2021, providing insights to inform public health strategies.MethodsUtilizing data from the Global Burden of Disease (GBD) Study 2021, we analysed cataract prevalence and YLDs across 204 countries and territories. The estimates were stratified by age, sex, region, and Socio-Demographic Index (SDI) and compared across different time periods. Age-standardized rates (ASRs) and average annual percentage changes (AAPCs) were calculated to evaluate trends.ResultsFrom 1990 to 2021, the global YLDs due to cataracts increased from 3.42 million to 6.55 million, a 91.8% rise. Most countries exhibited an increase in YLDs, with notable surges in low-SDI regions like Sub-Saharan Africa and South Asia. The AAPC for age-standardized prevalence rate (ASPR) was slightly positive globally, while the age-standardized YLD rate (ASYR) showed a decreasing trend, indicating improved cataract management. High-SDI regions experienced minor ASPR increases but significant ASYR reductions, reflecting effective interventions. Conversely, low-SDI regions saw declines in both ASPR and ASYR, though disparities persisted.ConclusionThe burden of cataracts remains substantial, with significant increases in YLDs driven by aging populations and improved diagnostic capabilities. Effective management strategies have reduced ASYRs, particularly in high-SDI regions. Addressing cataract burden in low-SDI regions requires enhanced healthcare access, targeted public health interventions, and global support. These findings underscore the need for continued investment in cataract prevention and treatment to mitigate the global impact.

BACKGROUND The burden of mental disorders (MD) in the Western Pacific Region (WPR) remains a critical public health concern, with substantial variations across demographics and countries. AIM To analyze the burden of MD in the WPR from 1990 to 2021, along with associated risk factors, to reveal changing trends and emerging challenges. METHODS We used data from the Global Burden of Disease 2021, analyzing prevalence, incidence, and disability-adjusted life years (DALYs) of MD from 1990 to 2021. Statistical methods included age-standardisation and uncertainty analysis to address variations in population structure and data completeness. RESULTS Between 1990 and 2021, the prevalence of MD rose from 174.40 million cases [95% uncertainty interval (UI): 160.17-189.84] to 234.90 million cases (95%UI: 219.04-252.50), with corresponding DALYs increasing from 22.8 million (95%UI: 17.22-28.79) to 32.07 million (95%UI: 24.50-40.68). During this period, the burden of MD shifted towards older age groups. Depressive and anxiety disorders were predominant, with females showing higher DALYs for depressive and anxiety disorders, and males more affected by conduct disorders, attention-deficit hyperactivity disorder, and autism spectrum disorders. Australia, New Zealand, and Malaysia reported the highest burdens, whereas Vietnam, China, and Brunei Darussalam reported the lowest. Additionally, childhood sexual abuse and bullying, and intimate partner violence emerged as significant risk factors. CONCLUSION This study highlights the significant burden of MD in the WPR, with variations by age, gender, and nation. The coronavirus disease 2019 pandemic has exacerbated the situation, emphasizing the need for a coordinated response.

Purpose:To determine the prevalence of overweight/obesity and their major complications, and to map comorbidity relationships by means of large-scale, real-world data. Patients and Methods:This cross-sectional study included individuals undergoing routine health examinations from January 2021 to April 2024. Clinical and demographic data were systematically collected. Obesity-related complications were diagnosed using standardized criteria. Descriptive statistics assessed prevalence; correlation and network analyses characterized comorbidity relationships. Results:A total of 233,004 participants (57.5% male; mean age 43.51 ± 13.28 years) were enrolled. Among these, 41.1% were overweight and 6.1% had obesity. The most prevalent complications were dyslipidemia (30.9%), fatty liver disease (26.4%), and hyperuricemia (20.0%). Over 60% of participants had at least one obesity-related comorbidity. Network analysis indicated a central disease cluster comprising overweight/obesity, fatty liver disease, hypertension, diabetes, and carotid plaque, with diabetes playing a key role linking metabolic abnormalities to cardiovascular risks. Conclusion:Overweight prevalence was high in this large-scale examined population and frequently coexisted with multiple metabolic and cardiovascular conditions. Network analysis highlighted diabetes as a central condition, supporting early targeted interventions for overweight individuals to reduce obesity-related chronic disease burden.

Objectives Stroke is a major global health issue with rising incidence in China. Current estimates often focus on specific deaths, underestimating their impact. This study aimed to quantify and predict the all-cause and cause-specific burden of stroke using real-world data.Design Population-based study.Participants and setting Residents in Shanghai Pudong, which covers an area of 1210.41 km² (467.34 mi²) and has a population of 3.17 million, spanning from 2005 to 2021.Outcomes Stroke-related deaths in Pudong (2005–2021) were analysed by gender, age and subtype. Metrics included crude mortality rates (CMR), age-standardised mortality rates (ASMRW) and years of life lost (YLL). The Joinpoint Regression Programme determined average annual per cent change (AAPC), while the decomposition method assessed ageing’s impact. The AutoRegressive Integrated Moving-Average (ARIMA) model projected trends from 2022 to 2035.Results Among the 92 779 stroke-related deaths, the top three causes were stroke, heart disease and diabetes mellitus. From 2005 to 2021, the CMR for stroke-related deaths (AAPC=1.65%), stroke-specific deaths (AAPC=0.60%) and YLL rates (AAPC=0.36%) increased significantly (all p<0.05), and the ASMRW of both stroke-related and stroke-specific deaths showed significant decreases among males, females and the total population (all p<0.05). The proportion of stroke-related or specific deaths in individuals aged 60–69 and ≥80 years also increased significantly (all p<0.001). Ageing contributed to a 36.95% and 35.54% increase in CMR for stroke-related and stroke-specific deaths, respectively (all p<0.001). Projections indicate that from 2022 to 2035, the CMR for stroke-specific deaths will rise at an AAPC of 0.24%, reaching 141.96 per 100 000 by 2035 (p=0.008), while the CMR for stroke-related deaths will increase at an AAPC of 0.69%, reaching 235.44 per 100 000 by 2035 (p<0.001).Conclusion Stroke’s real-world burden is substantial, with ageing exacerbating mortality. Urgent action is needed to manage risk factors and prevent stroke.

To assess all-cause Parkinson's disease (PD)-related and PD-specific mortality trends and years of life lost (YLL) in Shanghai Pudong (3.17 million population) from 2005–2021, and project future burdens through 2035. Using population-level mortality data including 4,218 PD-related deaths among 362,558 total deaths, we calculated crude mortality rates (CMR), age-standardized mortality rates (ASMRW), and YLL. Temporal trends were analyzed by the average annual percent change (AAPC) via Joinpoint regression, demographic impacts via decomposition methods, and future projections via ARIMA models. PD-related CMR and ASMRW were 8.74/100,000 and 2.76/100,000, respectively, with 31,904.41 YLL. PD-specific mortality rates (CMR: 3.76/100,000; ASMRW: 1.25/100,000) accounted for 14,532.50 YLL. Individuals aged ≥ 80 years exhibited highest mortality burden (CMR: 112.29/100,000). Cerebrovascular disease (18.94