Smoking-attributable burden of musculoskeletal disorders, 1990–2021, with exploratory projections to 2050: A secondary dataset analysis of the Global Burden of Disease Study 2021

Global, regional, and national burden of low-back pain attributable to smoking from 1990 to 2021: An age-period-cohort and joinpoint analysis of the Global Burden of Disease Study 2021

INTRODUCTION Low-back pain (LBP) is the leading cause of disability worldwide. Although smoking is a well-established, modifiable risk factor that accelerates intervertebral disc degeneration, comprehensive spatiotemporal analyses of its attributable burden remain scarce. This study assessed the global burden of smoking-attributable LBP from 1990 to 2021, elucidating the underlying temporal dynamics and socioeconomic inequalities. METHODS Data were extracted from the Global Burden of Disease (GBD) study 2021. We evaluated absolute disability-adjusted life years (DALYs), age-standardized DALYs rate (ASDR), and estimated annual percentage change (EAPC) across 204 countries and territories. To disentangle temporal trends, age-period-cohort and joinpoint regression models were applied. The spatial-temporal relationship between the burden and the sociodemographic index (SDI) was also examined. RESULTS Globally, the absolute number of DALYs for smoking-attributable LBP increased by 29.6% to 8.67 million in 2021, primarily driven by population growth and aging. Conversely, the global ASDR decreased significantly by 35.8% to 99.95. Males bore a substantially higher burden than females, with biological risk peaking at 60–69 years (inverted U-shape). The ASDR trajectory exhibited a distinct inverted U-shaped relationship with SDI; while high-income nations experienced rapid declines (e.g. Denmark, EAPC= -2.29), the burden surged in specific developing regions (e.g. Afghanistan, EAPC=2.37). Joinpoint analysis revealed an accelerated global decline from 2016 to 2021 (annual percent change, APC= -1.70). Age-period-cohort modeling confirmed continuous monotonic reductions in both period and cohort relative risks, highlighting a profound ‘generational dividend’. CONCLUSIONS Despite continuous improvements in age-standardized rates driven by recent global tobacco control policies and younger birth cohorts, the absolute burden of smoking-attributable LBP continues to grow. Progress is alarmingly unequal, heavily favoring high-income countries while intensifying in developing nations. Global health strategies must prioritize equitable implementation of tobacco control in lower income regions and integrate cessation programs into occupational health initiatives and strengthening of targeted tobacco control policies, particularly in low- and middle-income regions.

Global, regional, and national prevalence of second-hand smoke and attributable disease burden in 204 countries and territories, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023.

BACKGROUND Second-hand smoke (SHS) exposure remains a major source of morbidity and mortality among non-smokers. This study presents the first dedicated Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) publication to systematically quantify SHS prevalence and evaluate its effect as a global risk factor across a broader range of outcomes. METHODS Using the GBD 2023 comparative risk assessment framework, we estimated SHS exposure prevalence and attributable disease burden across 204 countries and territories from 1990 to 2023, stratified by age and sex. Exposure estimates were derived by synthesising population-based surveys and household composition data through spatiotemporal Gaussian process regression. Relative risks for nine health outcomes, now including asthma, were estimated using the Burden of Proof methodology, and applied to calculate attributable deaths and disability-adjusted life-years (DALYs). FINDINGS In 2023, an estimated 2·71 billion (95% UI 2·44-3·02) people worldwide were exposed to SHS, including 767 million (687-858) children aged 0-14 years. Age-standardised prevalence was highest in southeast Asia, east Asia, and Oceania (48·4% [44·0-53·4]), with female individuals in some countries experiencing nearly 1·8 times the exposure prevalence of male individuals. Despite a 22·2% (10·6-32·4) decline in global age-standardised prevalence since 1990, this progress has not been sufficient to reduce the absolute number of exposed individuals, which has remained stable globally and has risen sharply in sub-Saharan Africa (98·5% [62·0-144·4] increase) and North Africa and the Middle East (72·1% [47·8-101·8] increase). In 2023, SHS exposure accounted for 1·66 million (1·33-2·07) deaths and 44·8 million (35·8-54·3) DALYs globally. Ischaemic heart disease was the leading contributor to SHS-attributable DALYs (12·0 million [9·31-15·2]) overall, while lower respiratory infections predominated among children (5·16 million [3·48-7·12]). INTERPRETATION We estimated that SHS remains a substantial driver of global health loss, particularly through cardiovascular and paediatric respiratory diseases. Persistent geographical disparities and growing absolute numbers of exposed individuals in several regions underscore the urgent need for accelerated implementation and enforcement of comprehensive tobacco control measures, particularly to protect women and children in both public and domestic environments. FUNDING Bloomberg Philanthropies and the Gates Foundation.

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.

Global burden of osteoarthritis attributable to high body mass index (1990-2021): rising trends with marked sex-age disparities and prediction to 2050.

Global Burden and Forecasting of Musculoskeletal Disability Attributable to High BMI, 1990–2040: A GBD 2021 and Mendelian Randomization Study

Background Osteoarthritis (OA), low back pain (LBP), and gout contribute substantially to global disability. Although high body mass index (BMI) is an important modifiable risk factor for these conditions, its attributable burden, temporal patterns, and genetically supported associations have not been comprehensively evaluated at the global level. Methods Using Global Burden of Disease (GBD) 2021 data, we analyzed age-standardized years lived with disability (YLD) rates attributable primarily to high BMI, with kidney dysfunction additionally assessed for gout across sex, age, region, and SDI levels. Joinpoint regression assessed temporal trends. Two-sample Mendelian randomization (MR) evaluated the association between genetically predicted BMI and OA, LBP, and gout. Forecasts to 2040 were generated using a Bayesian age–period–cohort model. Results From 1990 to 2021, global musculoskeletal disability attributable predominantly to high BMI increased across all three disorders, with kidney dysfunction additionally contributing to gout. Women bore a consistently higher absolute burden, whereas men showed a faster temporal increase (AAPC 1.21% vs 1.05%). The burden was highest in high-SDI regions but increased fastest in low- to middle-SDI settings. For each 1-SD increase in genetically predicted BMI, the ORs were 1.99 (95% CI, 1.79–2.21) for OA, 1.67 (95% CI, 1.37–2.03) for gout, and 1.31 (95% CI, 1.19–1.45) for LBP. Sensitivity analyses showed heterogeneity but no directional pleiotropy. Model-based projections indicated that global YLDs attributable to these selected risks (high BMI, with kidney dysfunction additionally contributing to gout) would increase from 14.10 million in 2022 to 23.88 million by 2040, representing an increase of approximately 69%, with age-standardized rates rising from 158.45 to 200.73 per 100,000. Conclusion High BMI was a major contributor to the growing global MSK burden, with Mendelian randomization findings supporting an adverse association with OA, gout, and LBP. These findings support the integration of weight management into MSK prevention and management strategies to reduce future disability.

Global, regional, and national burden of colorectal cancer attributable to modifiable risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background Colorectal cancer (CRC) represents a major global health burden, with modifiable risk factors including high body-mass index, insufficient physical activity, tobacco use, and dietary risks contributing substantially to its incidence and mortality. However, comprehensive spatiotemporal analyses of this burden, particularly within Brazil, Russia, India, China, and South Africa (BRICS) countries, remain limited. This study aimed to assess the global, regional, and national burden of CRC attributable to these four modifiable risk factors from 1990 to 2021 using Global Burden of Disease Study 2021 data. Methods Data from 204 countries and territories were analyzed to estimate attributable CRC burden, stratified by sex, age, region, and country. Temporal trends were assessed, projections to 2050 were generated using autoregressive integrated moving average and exponential smoothing models, and health inequalities across Socio-demographic index (SDI) levels were evaluated using the Slope Index of Inequality and Concentration Index. Results In 2021, males in BRICS countries exhibited higher attributable CRC burden. Age-standardized rates decreased in high-SDI regions but increased in low-SDI regions. Between 1990 and 2021, absolute attributable CRC cases increased across all BRICS countries, although age-standardized trends varied. Projections indicated continued increases in absolute case numbers in BRICS countries by 2050. Global burden remained concentrated in low-SDI regions, with modest reductions in absolute inequalities but persistent relative inequalities. Conclusions Substantial disparities in CRC burden attributable to modifiable risk factors exist across sociodemographic contexts. Targeted, equity-oriented public health strategies are essential to mitigate the projected burden increase, particularly within BRICS countries, by 2050.