COPD burden trends in China and G20 countries from GBD 2023 and Mendelian randomization

Type 2 diabetes in BRICS countries from 1990 to 2023: burden, trends and complementary Mendelian randomization evidence

Demographic time bomb in COPD (1990–2050)

Chronic obstructive pulmonary disease (COPD) is a leading global cause of morbidity and mortality, characterized by irreversible airflow limitation and progressive symptoms. Despite declining age-standardized rates (ASRs), absolute burdens are rising due to population aging and growth, particularly in low- and middle-Sociodemographic Index (SDI) regions. This study provides the first comprehensive analysis of COPD epidemiology from 1990 to 2021 using Global Burden of Disease 2021 data, integrating multimodel projections to 2050 and risk factor attribution across SDI quintiles. The study extracted COPD incidence, prevalence, mortality, and disability-adjusted life years (DALYs) from the Global Burden of Disease 2021 study (204 countries, 1990–2021). Trends were analyzed via Joinpoint regression, average annual percentage change, age-period-cohort models, and decomposition analysis (population growth/aging/epidemiological shifts). Risk factor burdens (smoking, ambient PM2.5, and household air pollution) were quantified using population attributable fractions. Bayesian age-period-cohort models projected the age-standardized incidence rate, age-standardized mortality rate, and age-standardized DALY rate to 2050. Globally, the age-standardized incidence rate, age-standardized mortality rate, and DALY rate declined (average annual percentage change: −0.05%, −1.49%, and −1.48%, respectively), while absolute cases, deaths, and DALYs increased (213.4 million cases and 1.69 million deaths in 2021). Low-/middle-SDI regions exhibited 2- to 3-fold higher ASRs than high-SDI areas. An inverted V-shaped relationship emerged between SDI and COPD burden, peaking at an SDI of 0.4 to 0.6. Smoking (38%–55% of DALYs), ambient PM2.5 (15%–25%), and household air pollution (0%–55%) dominated risk factors, with marked SDI-based heterogeneity. Projections indicate stable/declining ASRs globally to 2050, but rising absolute burdens in low-SDI nations. COPD remains a critical public health challenge, with shifting burdens from mortality to high prevalence. Targeted interventions in low-SDI regions – clean energy adoption, community spirometry screening, and culturally tailored tobacco control – are imperative to meet the United Nations 2030 noncommunicable disease mortality targets.

Burden dynamics of pulmonary arterial hypertension in China and the G20 aggregate: a comparative analysis based on the global burden of disease study 2023

Abstract Background Pulmonary arterial hypertension (PAH) causes substantial premature mortality and disability. Updated evidence comparing long-term PAH burden in China with the Group of Twenty (G20) aggregate remains limited. We assessed changes from 1990 to 2023 and projected future trends. Methods PAH estimates for China and the G20 aggregate were extracted from the Global Burden of Disease Study 2023. Outcomes included incidence, prevalence, deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs), expressed as absolute counts and age-standardized rates. Temporal trends were assessed using Joinpoint regression. Sex-specific and age-specific patterns and demographic decomposition were examined. Autoregressive integrated moving average (ARIMA) models projected overall burden through 2050. Bayesian age-period-cohort (BAPC) models projected sex-specific patterns through 2038. Results From 1990 to 2023, incident and prevalent cases and YLDs increased in both settings, whereas deaths, DALYs, and YLLs declined. In China, prevalent cases increased by 63.5%, from 17,020.87 to 27,834.41, while the age-standardized death rate decreased by 74.3%, from 0.29 to 0.08 per 100,000 population. Similar declines in mortality-related age-standardized indicators occurred in the G20 aggregate. Females generally had higher age-standardized prevalence and YLD rates than males, although sex differences in mortality-related outcomes varied by setting. Absolute burden shifted toward older age groups. Population growth and aging contributed to increases in absolute burden, whereas epidemiological change generally acted in the opposite direction. Projections suggested continued declines in age-standardized mortality-related burden through 2050, alongside increases in incident and prevalent case numbers. Conclusion Mortality-related PAH burden declined in China and the G20 aggregate, while absolute case numbers increased. Population growth and aging contributed to this divergence, underscoring the need for continued surveillance and long-term health-service planning.

Ischemic Heart Disease in G20 Countries: Forecasted Burden and Regional Disparities Based on GBD 2023 Estimates.

BACKGROUND Ischemic heart disease (IHD) remains the leading cause of mortality and disability in the G20, yet member states exhibit heterogeneous epidemiological transitions. Comparative assessments with long-term projections are essential to inform cardiovascular strategies. AIMS To comprehensively evaluate the temporal trends, regional disparities, risk factors, and future projections of ischemic heart disease burden across G20 countries using GBD 2023 estimates. METHODS Using Global Burden of Disease (GBD) 2023 estimates, we quantified IHD incidence, mortality, and disability-adjusted life years (DALYs) across G20 members from 1990 to 2023. Temporal patterns were evaluated using estimated annual percentage change (EAPC) and Joinpoint regression. Modifiable risks were assessed using population attributable fractions. ARIMA and Bayesian age-period-cohort (BAPC) models projected IHD burden through 2050. Determinants of DALYs were examined using XGBoost with SHAP interpretability. RESULTS In 2023, the G20 reported 8.52 million IHD cases and 5.81 million deaths. Age-standardized incidence (ASIR) and mortality (ASMR) declined overall (EAPC -1.61 and -1.49), although incidence increased in women aged 15-49 years, and mortality rebounded modestly after prior declines. The absolute burden was largest in India and China, while Russia had the highest ASIR, ASMR, and age-standardized DALY rates. High systolic blood pressure was the dominant modifiable risk, while particulate matter and lead exposure emerged as prominent environmental contributors. Projections indicate continued ASIR declines overall, though Japan is projected to experience a peak again around 2032. Age was the strongest determinant of DALYs, with a consistent male disadvantage. CONCLUSIONS The G20 has achieved substantial but uneven reductions in IHD burden, with early signs of reversal, demographic pressures, and expanding environmental risks. Targeted, stage-specific cardiovascular strategies will be required to sustain progress and reduce disparities through mid-century.

The burden of cardiovascular diseases in Asia from 1990 to 2023: an analysis for the Global Burden of Disease Study study 2023

Cardiovascular diseases (CVDs) remain the leading cause of mortality and disability worldwide. Asia bears a disproportionate share of this burden, with substantial heterogeneity across subregions. Using data from the Global Burden of Disease 2023 study, we assessed the burden of CVDs in Asia and its subregions from 1990 to 2023, including prevalence, deaths, and disability-adjusted life years (DALYs), stratified by age and sex. Temporal trends were evaluated using Joinpoint regression, and decomposition analysis was performed to quantify the contributions of population growth, aging, and epidemiological changes. Population attributable fractions (PAFs) of level 2 risk factors and rankings of the most detailed risk exposures were assessed across subregions. Estimates for prevalence, deaths, DALYs, and PAFs with corresponding 95% uncertainty intervals (UI) were derived. From 1990 to 2023, age-standardized mortality rates (ASMR) and DALY rates (ASDR) declined across all Asian subregions, whereas age-standardized prevalence rates (ASPR) remained stable or increased in several regions. Joinpoint regression analysis revealed transient increases in ASMR and ASDR during specific periods in certain subregions. In 2023, East Asia had the largest absolute burden (140.5 million cases [95% UI: 130.7 to 152.8]; 4.7 million deaths [4.1 to 5.2]), while South Asia recorded the highest DALYs (102.3 million [90.6 to 113.5]). Central Asia exhibited the highest age-standardized rates (ASMR: 400.7 [374.0 to 418.6]; ASDR: 8,111.4 [7,734.2 to 8,421.9] per 100,000), whereas high-income Asia Pacific had the lowest. Despite the declines in age-standardized rates, absolute CVD deaths increased in all subregions, with decomposition analysis showing this rise was primarily driven by population aging and population growth. Ischemic heart disease and stroke accounted for over 86% of deaths and DALYs in most subregions, with ischemic heart disease predominating in Central Asia and stroke contributing disproportionately in Southeast Asia. South Asia showed a notable burden of rheumatic heart disease, along with elevated early-life DALYs primarily driven by stroke and cardiomyopathy/myocarditis. Metabolic risk factors dominated across regions, with high systolic blood pressure and high low-density lipoprotein cholesterol as the leading contributors. Although age-standardized CVD mortality and DALYs have declined across Asia, the overall burden remains substantial and heterogeneous. Region-specific strategies targeting dominant risk factors are essential to effectively reduce CVD burden across diverse Asian populations.

Temporal trends and decomposition analysis of cardiovascular disease burden in China and worldwide from 1990 to 2021, with projections to 2036

Cardiovascular disease (CVD) is a major public health concern, and its burden and trends require further clarification. This study aimed to compare the CVD burden between China and the global population and provide projections. Data on CVD metrics from the Global Burden of Disease (GBD) 2021. The Joinpoint regression model was applied to analyze long-term trends in age-standardized incidence (ASIR), prevalence (ASPR), mortality (ASMR), and age-standardized disability-adjusted life year (ASDR) rates. Decomposition analysis quantified drivers of change, and autoregressive integrated moving average models projected future trends. From 1990 to 2021, ASMR and ASDR showed significant downward trends in China and globally. However, the ASIR for CVD in China increased from 783.897 to 811.813 per 100,000, while globally it declined from 878.787 to 787.04 per 100,000, with average annual percent change of 0.105% (95% CI: 0.067%, 0.144%) and –0.353% (95% CI: –0.404%, –0.301%), respectively. The upward trend of ASPR in China exceeded the global level. The crude rates of CVD metrics were low among individuals younger than 40 years and then increased with advancing age; sex differences were also observed. Decomposition analysis highlighted population aging as an important driver of increased CVD incidence in China (total population: 41.88%, male: 24.17%, female: 47.81%). Projections suggested that ASIR in China and globally will continue to rise to 825.94 and 807.96 per 100,000, respectively, by 2036, whereas ASMR and ASDR will continue to decline. This study revealed a complex CVD epidemiological landscape in China and globally, with increasing ASPR alongside declining ASMR and ASDR. The ASIR of CVD in China remains significant and is projected to continue increasing.