Nishimura, Yoshito

Background and Aims: Biliary tract cancers (BTCs), including intrahepatic cholangiocarcinoma (iCCA), extrahepatic cholangiocarcinoma, gallbladder cancer, and ampullary cancer, exhibit poor prognosis. This study examined temporal trends in mortality due to BTCs and their major subtypes at international, regional, and national levels. Approach and Results: This observational study used the World Health Organization mortality database. Locally weighted regression (LOESS) was used to produce a smoothed curve of long-term international and regional BTC and major subtype-related mortality rates in 2000–2022 based on available data from countries. Trends in age-standardized mortality rates (ASRs) during 2013–2022 for individual countries were examined using joinpoint regression analysis. Internationally, LOESS-smoothed ASRs per 100,000 population due to BTCs were 2.8 (95% CI: 2.5–3.1) in 2000, and 2.7 (2.3–3.1) in 2022. LOESS-smoothed BTC-related ASRs were the highest in the Western Pacific region at 4.2 (1.8–6.6) in 2022, compared with those in the European and American regions at 2.6 (2.3–2.9) and 2.2 (1.8–2.6), respectively. Among major subtypes, LOESS-smoothed ASRs due to iCCA increased by 120.0%, those due to gallbladder cancer decreased by 45.5%, and those due to extrahepatic cholangiocarcinoma remained stable between 2000 and 2022. Disparities in BTC and major subtype-related ASR trends were observed between countries during 2013–2022, with iCCA-associated ASRs showing increasing trends in many countries. Conclusions: Although internationally estimated BTC-associated ASRs showed a stable trend over the last 2 decades, a large increase in estimated iCCA-associated ASRs necessitates developing effective screening for high-risk individuals and disease management strategies.

AbstractBackground and ObjectivesSubstance use disorders (SUD) are a major public health concern in the United States. This study examined racial/ethnic and state‐level disparities in SUD mortality in the United States from 2000 to 2019.MethodsAge‐standardized mortality rates for SUD were obtained for 5 racial/ethnic groups (White respondents, Black respondents, Latino, Asian‐Pacific Islander [API], American Indian/Alaska Native [AIAN]) by state and sex from 2000 to 2019. Joinpoint regression analysis was used to model temporal trends overall and by demographic factors.ResultsFrom 2000 to 2019, the overall mortality rate increased from 8.0 to 28.8 deaths per 100,000 population across all groups. AIANs had the highest mortality in 2019 (57.8 per 100,000), followed by Black respondents, White respondents, Latinos, and APIs. Significant increases occurred across all racial/ethnic groups, with the greatest average annual percentage change (AAPC2000–2019) among White respondents (6.7%; 95% confidence interval [CI]: 6.2%–7.3%), APIs (6.0%, 95% CI: 5.6%–6.2%), and AIANs (5.9%, 95% CI: 5.6%–6.2%). Mortality rates increased more rapidly for females than males among White respondents, AIANs, Black respondents, and Latinos. Substantial state‐level variation emerged, with the highest mortality rates in 2019 seen in West Virginia, the District of Columbia, Delaware, Ohio, and Pennsylvania.Discussion and ConclusionsRacial/ethnic and geographic disparities in SUD mortality have widened significantly from 2000 to 2019, highlighting priority areas for prevention efforts.Scientific SignificanceThis study provides detailed insights into long‐term trends in racial, ethnic, and geographic disparities in SUD mortality across the United States, informing targeted prevention and intervention strategies.

AbstractBackgroundAdverse effects of medical treatment (AEMT) pose significant risks to paediatric patients. However, the mortality trends associated with AEMT in this population have been unclear.ObjectiveWe aimed to clarify the trends in the incidence, disability‐adjusted life years (DALYs) and mortality rates of AEMT for children in the US from 2000 to 2019.MethodsData were retrieved from the Global Burden of Disease study 2019. We estimated age‐standardized incidence, DALYs and mortality rates of paediatric AEMT per 100,000 children in the US using a Bayesian meta‐regression model. We also analysed incidence, DALYs and mortality in different age groups, and employed Joinpoint regression models to assess the age‐ and sex‐specific trends.ResultsThe number of deaths due to AEMT in children, the number of cases, and DALYs were 105.1, 551,076 and 145,555 in 2019, decreased by 37.5%, 6% and 28% from those in 2000, respectively. Age‐standardized mortality rates decreased across all age groups, while the incidence increased across all age groups with an average annual percentage change (AAPC) of 2.2% in those children <1 year and 4.5% in 5–9 years of age. The increases in DALYs over time was higher in children aged 1–4 years (AAPC: 0.51, 95% CI: 0.47, 0.62) and 5–9 years (AAPC: 0.33, 95% CI: 0.15, 0.50), with the 1–4 year age group being the highest.ConclusionThe study reveals declining AEMT mortality but rising incidence and DALYs, emphasizing a disproportionate burden in <1, 1–4 and 5–9 years. To develop effective mitigation strategies, future research is warranted to identify the causes of increased AEMT in children, especially young males.