Moghaddam, Sahar Saeedi

BACKGROUND: Despite the substantial burden of IHD in North Africa and Middle East (NAME) region, temporal trends of the burden of IHD were not systematically evaluated in this region and its countries previously. Methods: We reported deaths, premature mortality, YLLs, YLDs, and DALYs of IHD in NAME region and its 21 countries during 1990-2019 using the results of the Global Burden of Disease Study 2019. Premature IHD mortality was defined as IHD death in males <55 and females <65 years of age. Results: IHD accounted for 0.8 million deaths and 18 million DALYs in NAME in 2019. From 1990-2019, the age-standardized death rate of IHD significantly decreased by 29% (-37 to -22) and reached 219 (194 to 247) per 100,000 in NAME in 2019 (Fig A) compared with the global estimates of -31% (-35 to -27) and 118 (108 to 126), respectively. From 1990-2019, the age-standardized DALY rate of IHD significantly decreased by 33% (95% CI: -41 to -25) and reached 4159 (3651 to 4752) per 100,000 population in NAME in 2019 (Fig B) compared with the global estimates of -29% (-33 to -24) and 2243 (2099 to 2385), respectively. The reduction in age-standardized DALY was mostly derived from the reduction in YLL (-34%) rather than YLD (-4%) compared with worldwide estimates of -29% and -6%. While the decreasing pattern in the age-standardized DALY and death rate of IHD was consistently observed across all 21 NAME countries, it was not statistically significant for Egypt, Libya, Saudi Arabia, Syria, Tunisia, and Yemen (Fig C, D). In 2019, 27% of IHD deaths in females and 18% of IHD deaths in males were premature in NAME, which was higher than the worldwide estimates of 17% and 15%, respectively. Turkey, Iran, and Lebanon showed the greatest reduction in IHD premature mortality during 1990-2019. CONCLUSIONS: Despite the improvements, IHD still remains the leading cause of lost death and DALYs in NAME. People are more likely to die prematurely due to IHD with more pronounced sex disparities in NAME compared with the global average.

Background The North Africa and Middle East (NAME) region has one of the highest burdens of ischemic heart disease (IHD) worldwide. This study reports the contemporary epidemiology of IHD in NAME. Methods and Results We estimated the incidence, prevalence, deaths, years of life lost, years lived with disability, disability‐adjusted life years (DALYs), and premature mortality of IHD, and its attributable risk factors in NAME from 1990 to 2019 using the results of the GBD (Global Burden of Disease study 2019). In 2019, 0.8 million lives and 18.0 million DALYs were lost due to IHD in NAME. From 1990 to 2019, the age‐standardized DALY rate of IHD significantly decreased by 33.3%, mostly due to the reduction of years of life lost rather than years lived with disability. In 2019, the proportion of premature death attributable to IHD was higher in NAME compared with global measures: 26.8% versus 16.9% for women and 18.4% versus 14.8% for men, respectively. The age‐standardized DALY rate of IHD attributed to metabolic risks, behavioral risks, and environmental/occupational risks significantly decreased by 28.7%, 37.8%, and 36.4%, respectively. Dietary risk factors, high systolic blood pressure, and high low‐density lipoprotein cholesterol were the top 3 risks contributing to the IHD burden in most countries of NAME in 2019. Conclusions In 2019, IHD was the leading cause of death and lost DALYs in NAME, where premature death due to IHD was greater than the global average. Despite the great reduction in the age‐standardized DALYs of IHD in NAME from 1990 to 2019, this region still had the second‐highest burden of IHD in 2019 globally.

Background Particulate matter (PM) pollution is a significant risk factor for cardiovascular diseases, causing substantial disease burden and deaths worldwide. This study aimed to investigate the global burden of cardiovascular diseases attributed to PM from 1990 to 2019. Methods and Results We used the GBD (Global Burden of Disease) study 2019 to investigate disability‐adjusted life‐years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and deaths attributed to PM as well as its subgroups. It was shown that all burden measures' age‐standardized rates for PM were in the same decreasing trend, with the highest decline recorded for deaths (−36.7%). However, the all‐age DALYs increased by 31%, reaching 8.9 million in 2019, to which YLLs contributed the most (8.2 million [95% uncertainty interval, 7.3 million–9.2 million]). Men had higher deaths, DALYs, and YLLs despite lower years lived with disability in 2019 compared with women. There was an 8.1% increase in the age‐standardized rate of DALYs for ambient PM; however, household air pollution from solid fuels decreased by 65.4% in the assessed period. Although higher in men, the low and high sociodemographic index regions had the highest and lowest attributed YLLs/YLDs ratio for PM pollution in 2019, respectively. Conclusions Although the total age‐standardized rate of DALYs for PM‐attributed cardiovascular diseases diminished from 1990 to 2019, the global burden of PM on cardiovascular diseases has increased. The differences between men and women and between regions have clinical and policy implications in global health planning toward more exact funding and resource allocation, in addition to addressing inequity in health care access.

AbstractBackgroundThyroid cancer (TC) is the most prevalent malignancy of the endocrine system. Over the past decades, TC incidence rates have been increasing. TC quality of care (QOC) has yet to be well understood. We aimed to assess the quality of TC care and its disparities.MethodsWe retrieved primary epidemiologic indices from the Global Burden of Disease (GBD) 1990–2017 database. We calculated four secondary indices of mortality to incidence ratio, disability‐adjusted life years (DALYs) to prevalence ratio, prevalence to incidence ratio, and years of life lost (YLLs) to years lived with disability (YLD) ratio and summarized them by the principal component analysis (PCA) to produce one unique index presented as the quality of care index (QCI) ranged between 0 and 100, to compare different scales. The gender disparity ratio (GDR), defined as the QCI for females divided by QCI for males, was applied to show gender inequity.ResultsIn 2017, there were 255,489 new TC incident cases (95% uncertainty interval [UI]: 245,709–272,470) globally, which resulted in 41,235 deaths (39,911–44,139). The estimated global QCI was 84.39. The highest QCI was observed in the European region (93.84), with Italy having the highest score (99.77). Conversely, the lowest QCI was seen in the African region (55.09), where the Central African Republic scored the lowest (13.64). The highest and lowest socio‐demographic index (SDI) regions scored 97.27 and 53.85, respectively. Globally, gender disparity was higher after the age of 40 years and in favor of better care in women.ConclusionTC QOC is better among those countries of higher socioeconomic status, possibly due to better healthcare access and early detection in these regions. Overall, the quality of TC care was higher in women and younger adults. Countries could adopt the introduced index of QOC to investigate the quality of provided care for different diseases and conditions.