Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. Methods We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. Findings In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. Interpretation The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively. Funding The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38)

Frequency of cesarean deliveries in Cartagena, Colombia, 2006 - 2015

Objectives Describir el comportamiento de los partos en la Clínica Maternidad Rafael Calvo de Cartagena (CMRC), Colombia desde 2006 a 2015. Methods Se utilizaron los registros de la CMRC, hospital que atiende la mayor proporción de partos en Cartagena. También se usaron microdatos del Departamento Administrativo Nacional de Estadística (DANE), que contienen estadísticas vitales (nacimientos y muertes) en Colombia. Los análisis se hicieron para el periodo 2006 a 2015. Se tomaron en cuenta para el análisis las variables de nivel educativo de la madre, control prenatal y edad gestacional. Results Desde el año 2006 hasta el 2015, se atendieron en la ciudad de Cartagena 43,193 partos en adolescentes de 10 a 19 años, de ellos, 3 de cada 4 fueron atendidos en la CMRC, además se atendieron 163,779 partos en pacientes de 20 años o más, de estos la tercera parte se atendieron en la Institución. De todos los partos atendidos en la CMRC, la mitad fueron vaginales y la otra mitad fueron cesáreas. La incidencia promedio de Cesáreas en adolescentes fue del 47.5%, un 55% de estas operaciones se presentaron en la adolescencia-temprana (10 – 14 años). En promedio, el 70% de las madres tuvo un parto controlado (más de 4 controles prenatales), en donde la mitad fueron cesáreas, además, 6 de cada 10 pacientes que no tuvieron un parto controlado tuvieron un parto vaginal. Igualmente se encontró que las madres que tuvieron un menor nivel educativo presentaron mayor incidencia de partos vaginales. Lo mismo ocurrió cuando la edad gestacional fue inferior a 42 semanas. Conclusions En Cartagena, la operación cesárea es cada vez más frecuente como alternativa de atención de parto a medida que las madres tienen un mayor nivel educativo y tienen un embarazo controlado.Objectives Describe the performance of deliveries at the Rafael Calvo Maternity Clinic in Cartagena (CMRC), Colombia from 2006 to 2015. Methods We used the registers of the CMRC, the hospital that attends the highest proportion of births in Cartagena. Microdata from the National Administrative Department of Statistics (DANE) were also used, which contain vital statistics (births and deaths) in Colombia. The analyzes were made for the period 2006 to 2015. The variables of the mother's educational level, prenatal control and gestational age were taken into account for the analysis. Results From 2006 to 2015, were attended in the city of Cartagena 43.193 births in adolescents from 10 to 19 years, of them, 3 out of 4 were treated at the CMRC, in addition 163,779 births were attended in patients of 20 years or more , of these the third part was attended in the Institution. Of all the deliveries attended in the CMRC, half were vaginal and the other half were cesarean. The average incidence of Cesarean sections in adolescents was 47.5%, 55% of these operations occurred in adolescence-early (10-14 years). On average, 70% of the mothers had a controlled delivery (more than 4 prenatal check-ups), where half were cesareans, and 6 out of 10 patients who did not have a controlled birth had a vaginal delivery. It was also found that mothers who had a lower educational level had a higher incidence of vaginal births. The same happened when the gestational age was less than 42 weeks. Conclusions In Cartagena, cesarean section surgery is increasingly used as an alternative to delivery care as mothers have a higher educational level and have a controlled pregnancy

Bajo peso al nacer en recién nacidos y factores maternos y neonatales asociados en un hospital ginecológico-obstétrico colombiano

Objectives To determine the prevalence of Low Birth Weight (LBW) in newborns treated at the Rafael Calvo Maternity Clinic (CMRC) during 2016 and their possible maternal and neonatal factors associated. Methods Cross-sectional retrospective observational study with a population of 7,217 pregnant women who had a live birth in the CMRC. The prevalence of total and term (≥37 gestation weeks "GW") LBW were estimated from the weight of the newborn. Risk factors associated with LBW were estimated through a logistic regression model. Modeled variables were weight, maternal age, prenatal control, mother´s education level, area of residence and multiplicity of pregnancy. Statistical significance was defined in 5% and 10%. Results The prevalence of total and term LBW in the CMRC were 11.6% (838 cases out of 7,217) and 4.2% (259 out of 6,203) respectively. The risk of LBW is 16.6% (p=0.061) and 37.0% (p=0.044) lower in mothers between 20 and 34 years and 35 years or more respectively, than in mothers under 20. A child born at term represents a lower risk (β = 0.03, p=0.000) of LBW than a pre-term (<37GW). Mothers with controlled pregnancy (4 or more prenatal visits) have a lower risk (β =18.6%, p=0.042) to have a baby with LBW than mothers who are not controlled. Expecting two or more children in the same pregnancy increases the risk (β=3.3, p=0.000) of LBW compared to expecting a single child. Living in urban areas decreases the risk of LBW by 21% (p = 0.057) compared to living in rural areas. Conclusions We found significant low birth weight in newborns in the CMRC. The prevalence of total LBW (11.6%) was above figures for Colombia (9.0%) and Cartagena (8.9%) in 2015. Controlling the risk factors associated to LBW could be favorable for its reduction.Los objetivos Determinar la prevalencia de bajo peso al nacer (LBW) en recién nacidos tratados en la Clínica de maternidad Rafael Calvo (CMRC) durante 2016 y sus posibles factores maternos y neonatales asociados. Los metodos Estudio observacional retrospectivo transversal con una población de 7,217 mujeres embarazadas que tuvieron un nacimiento vivo en el CMRC. La prevalencia de LBW total y a término (≥37 semanas de gestación "GW") se estimó a partir del peso del recién nacido. Los factores de riesgo asociados con el BPN se estimaron a través de un modelo de regresión logística. Las variables modeladas fueron peso, edad materna, control prenatal, nivel de educación de la madre, área de residencia y multiplicidad del embarazo. La significación estadística se definió en 5% y 10%. Resultados La prevalencia de LBW total y a término en el CMRC fue de 11.6% (838 casos de 7,217) y 4.2% (259 de 6,203) respectivamente. El riesgo de LBW es 16.6% (p = 0.061) y 37.0% (p = 0.044) más bajo en madres entre 20 y 34 años y 35 años o más respectivamente, que en madres menores de 20 años. Un niño nacido a término representa un riesgo menor (β = 0.03, p = 0.000) de LBW que un término previo (<37GW). Las madres con embarazo controlado (4 o más visitas prenatales) tienen un riesgo menor (β = 18.6%, p = 0.042) para tener un bebé con LBW que las madres que no están controladas. Esperar a dos o más hijos en el mismo embarazo aumenta el riesgo (β = 3.3, p = 0.000) de LBW en comparación con la expectativa de un solo hijo. Vivir en áreas urbanas disminuye el riesgo de BPN en un 21% (p = 0.057) en comparación con vivir en áreas rurales. Conclusiones Encontramos un peso bajo al nacer significativo en recién nacidos en el CMRC. La prevalencia del LBW total (11.6%) estuvo por encima de las cifras de Colombia (9.0%) y Cartagena (8.9%) en 2015. El control de los factores de riesgo asociados a LBW podría ser favorable para su reducción

Frecuencia de histerectomías en una población afiliada a una aseguradora de salud pública en Colombia; 2012 - 2016

Objectives To describe the frequency of hysterectomies of women affiliated to a public health insurance company in Colombia, segmented by five-year groups over a period of five years. Methods A retrospective dynamic cohort from a subsidized and public health insurance company was followed between 2012-2016. An average of 2,034 annual hysterectomies were performed on an average population of 765,431 women. To calculate the incidence of hysterectomies, the number of events (hysterectomies) were taken from the procedures database performed by the insurer. Every procedure was identified through the unique procedure codes (CUPS) from Colombia. Risk of hysterectomies (number of hysterectomies / number of women) and hysterectomy rates (# of hysterectomies / 10,000 women-year) were calculated from the number of events identified and follow-up of the dynamic cohort. Results The cumulative incidence of hysterectomies was 0.002. The frequencies of hysterectomies on the population presented a normal distribution, where the highest number of hysterectomies performed during the five years was concentrated in women between 45-49 years (23.7%), followed by women between 40-44 (22.5% ). The hysterectomy rate for the age group of 45-49 was 98.9 per 10,000 women-year (95% CI 79.9-121.9) and for the 40-44 group was 91.5 per 10,000 women- year (95% CI: 75.5-102.1). The risk of hysterectomies in women aged 45-49 years was 1.009% (95% CI 0.84% -1.15%), while for the 40-44 group it was 0.93% (95% CI 0.82% -1.03%) during the period. Diagnoses that most generated these procedures were leiomyoma of the uterus without another specification (49.9%) and unspecified abnormal vaginal and uterine bleeding (11.6%). Conclusions Similar to other studies findings, hysterectomies were related mostly to leiomyomas diagnoses and were mostly concentrated in the group of 40 to 49 years.Los objetivos Describir la frecuencia de las histerectomías de mujeres afiliadas a una compañía pública de seguros de salud en Colombia, segmentadas por grupos de cinco años en un período de cinco años. Los metodos Entre 2012 y 2016, se realizó un seguimiento de una cohorte dinámica retrospectiva de una compañía de seguros de salud pública y subsidiada. Un promedio de 2,034 histerectomías anuales se realizaron en una población promedio de 765,431 mujeres. Para calcular la incidencia de histerectomías, el número de eventos (histerectomías) se tomó de la base de datos de procedimientos realizada por el asegurador. Cada procedimiento fue identificado a través de los códigos de procedimientos únicos (CUPS) de Colombia. El riesgo de histerectomías (número de histerectomías / número de mujeres) y tasas de histerectomía (número de histerectomías / 10,000 mujeres-año) se calcularon a partir del número de eventos identificados y el seguimiento de la cohorte dinámica. Resultados La incidencia acumulada de histerectomías fue de 0,002. Las frecuencias de histerectomías en la población presentaron una distribución normal, donde el mayor número de histerectomías realizadas durante los cinco años se concentró en mujeres entre 45-49 años (23.7%), seguido de mujeres entre 40-44 (22.5%). La tasa de histerectomía para el grupo de edad de 45-49 fue de 98.9 por 10,000 mujeres-año (95% CI 79.9-121.9) y para el grupo de 40-44 fue de 91.5 por 10,000 mujeres-año (95% CI: 75.5-102.1). El riesgo de histerectomías en mujeres de 45 a 49 años fue de 1.009% (IC 95%: 0.84% ​​-1.15%), mientras que para el grupo de 40-44 fue de 0.93% (IC 95% 0.82% -1.03%) durante el período. Los diagnósticos que más generaron estos procedimientos fueron leiomioma del útero sin otra especificación (49.9%) y sangrado vaginal y uterino anormal no especificado (11.6%). Conclusiones Al igual que en los hallazgos de otros estudios, las histerectomías se relacionaron principalmente con los diagnósticos de leiomiomas y se concentraron principalmente en el grupo de 40 a 49 años

Desnutrición y vacunación en niños: caso de zona de postconflicto en el caribe colombiano

Objectives To establish the association between malnutrition and vaccination and its socioeconomic determinants in children from a post-conflict zone. Methods a sample of 2,183 households with 2,682 children of 0-4 years was extracted from a survey of more than 15,000 persons. Indicators as weight-for-height, height-for-age and weight-for-age were calculated according to the World Health Organization standards. Vaccination status was checked by comparing the report of the vaccination card with the scheme of the Expanded Immunization Plan for the Pentavalent vaccine (Hepatitis B, Haemophilus Influenzae type B and Diphtheria - Whooping cough - Tetanus) for children 2-59 months and the scheme of BCG Tuberculosis and Hepatitis B for children <2 months. A logistic model with clusters per community was estimated to identify factors associated with malnutrition and vaccination. Results The prevalence of low weight, acute and chronic malnutrition was 2.4%, 5.5%, and 8.6% respectively. 96.3% of the children had their vaccines at the right age. Timely vaccination protects against global and acute malnutrition (OR: 0.244 and 0.357 p <0.001). Children with an incomplete vaccination scheme have a 4.6% probability of being underweight, and 12.1% of having acute malnutrition. The education of the mother (OR: 0.543 and 2.269 p <0.001), the socioeconomic level of the household (OR: and 0.811, and 2.631 p <0.001) and the dependency rate of the child under 5 years (OR: 1.22 and 0,546 p <0.001) are common determinants between acute malnutrition and child vaccination status, respectively. Conclusions This article provides evidence of timely vaccination at age as a protective factor for global and acute malnutrition. In addition, it shows the double effect of the socioeconomic conditions of households in the determination of vaccination and the nutritional status of children.Los objetivos Establecer la asociación entre la desnutrición y la vacunación y sus determinantes socioeconómicos en niños de una zona de postconflicto. Los metodos de una encuesta de más de 15,000 personas se extrajo una muestra de 2,183 hogares con 2,682 niños de 0 a 4 años. Los indicadores como peso para la altura, altura para la edad y peso para la edad se calcularon de acuerdo con los estándares de la Organización Mundial de la Salud. El estado de la vacunación se verificó comparando el informe de la tarjeta de vacunación con el esquema del Plan de inmunización ampliado para la vacuna pentavalente (hepatitis B, Haemophilus Influenzae tipo B y Difteria - tos ferina - tétanos) para niños de 2 a 59 meses y el esquema de BCG Tuberculosis y hepatitis B para niños <2 meses. Se estimó un modelo logístico con grupos por comunidad para identificar los factores asociados con la desnutrición y la vacunación. Resultados La prevalencia de desnutrición de bajo peso, aguda y crónica fue de 2.4%, 5.5% y 8.6% respectivamente. El 96,3% de los niños se vacunaron a la edad adecuada. La vacunación oportuna protege contra la desnutrición global y aguda (OR: 0.244 y 0.357 p <0.001). Los niños con un esquema de vacunación incompleto tienen un 4,6% de probabilidad de tener bajo peso y el 12,1% de tener desnutrición aguda. La educación de la madre (OR: 0.543 y 2.269 p <0.001), el nivel socioeconómico del hogar (OR: y 0.811, y 2.631 p <0.001) y la tasa de dependencia del niño menor de 5 años (OR: 1.22 y 0.546 p <0,001) son determinantes comunes entre la desnutrición aguda y el estado de vacunación infantil, respectivamente. Conclusiones Este artículo proporciona evidencia de la vacunación oportuna a la edad como factor protector para la desnutrición global y aguda. Además, muestra el doble efecto de las condiciones socioeconómicas de los hogares en la determinación de la vacunación y el estado nutricional de los niños

Situación nutricional en sub - 5 en "montes de maria", zona de postconflicto en colombia- 2017

Objectives To estimate the nutritional status in children under 5 in “Montes de María”, a post-conflict zone in Colombia- 2017. Methods Cross sectional observational study that use data from a survey of 15,230 households with subsidized health care insurance. From these, 2,682 children between 0-4 years with anthropometric information from 2,183 households were included. Based on the World Health Organization standards, weight and height information were used to calculate the Z-score indicator = weight-for-height (W/H), height-for-age (H/A) and weight-for-age (W/A). Z-score categories were defined as: well fed (±2), malnourished (<-2), severely malnourished (<-3). Prevalence of nutritional states were estimated and association among children characteristics, households and nutritional status were validated through Chi-X2 test. Results Prevalence of low weight, acute and chronic malnutrition was 2.4%, 5.5% and 8.6% respectively. Group of 0-1 years was the most prevalent in acute (6.7%) and chronic (9.6%) malnutrition. There were significant differences in prevalence between children ages (Pr<0.001) in all of three indicators, except in the prevalence of low weight for sex (Pr<0.05). Age of the head of household (Pr=0.027), education of the head of household (Pr=0.001), education of mother (Pr=0.001), number of people in household (Pr=0.001) were significantly associated with growth retardation of children. Conclusions In this study, acute malnutrition is higher than national level (0.9%), being children of <1 year those who presented higher malnutrition compared with the national level. Health policies related with early childhood in vulnerable population must be improved in order to reduce these figures.Los objetivos Para estimar el estado nutricional en niños menores de 5 años en “Montes de María”, una zona de posconflicto en Colombia- 2017. Los metodos Estudio observacional transversal que utiliza datos de una encuesta de 15,230 hogares con seguro de salud subsidiado. De estos, 2,682 niños entre 0 y 4 años con información antropométrica de 2,183 hogares fueron incluidos. Sobre la base de los estándares de la Organización Mundial de la Salud, la información de peso y talla se utilizó para calcular el indicador de puntuación Z = peso para la altura (W / H), altura para la edad (H / A) y peso para la edad ( WASHINGTON). Las categorías de puntuación Z se definieron como: bien alimentadas (± 2), desnutridas (<-2), gravemente desnutridas (<-3). Se estimó la prevalencia de estados nutricionales y se validó la asociación entre las características de los niños, los hogares y el estado nutricional mediante la prueba Chi-X2. Resultados La prevalencia de desnutrición de bajo peso, aguda y crónica fue de 2.4%, 5.5% y 8.6% respectivamente. El grupo de 0-1 años fue el más prevalente en desnutrición aguda (6.7%) y crónica (9.6%). Hubo diferencias significativas en la prevalencia entre las edades de los niños (Pr <0,001) en los tres indicadores, excepto en la prevalencia de bajo peso para el sexo (Pr <0,05). La edad del jefe de hogar (Pr = 0.027), la educación del jefe de hogar (Pr = 0.001), la educación de la madre (Pr = 0.001), el número de personas en el hogar (Pr = 0.001) se asoció significativamente con el retraso del crecimiento de niños. Conclusiones En este estudio, la desnutrición aguda es más alta que el nivel nacional (0,9%), siendo niños de <1 año los que presentaron mayor desnutrición en comparación con el nivel nacional. Las políticas de salud relacionadas con la primera infancia en la población vulnerable deben mejorarse para reducir estas cifras

Age-sex differences in the global burden of lower respiratory infections and risk factors, 1990-2019: results from the Global Burden of Disease Study 2019

Background The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across a groups by sex, for 204 countries and territories.Methods In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used dinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466-469, 470.0, 480-482.8, 483.0-483.9, 484.1-484.2, 484.6-484.7, and 487-489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4 B97.6, 109-115.8, J16 J16.9, J20-121.9, J91.0, P23.0 P23.4, and U04 U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23109 site-years of vital r *stration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian metaregression tool, to analyse age sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and daims and inpatient data. Additio y, we estimated age sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors.Findings Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240-275) LRI incident episodes in males and 232 million (217-248) in females. In the same year, LRIs accounted for 1.30 million (95% UI 1.18-1.42) male deaths and 1.20 million (1.07-1.33) female deaths. Age-standardised incidence and mortality rates were 1.17 times (95% UI 1.16-1.18) and 1.31 times (95% UI 1.23-1.41) greater in males than in fe es in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126.0% [95% UI 121.4-131.1]) and deaths (100.0% [83.4-115.9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest dedine was observed for LRI deaths in males younger than 5 years (-70.7% [-77.2 to 61.8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53.0% [95% UI 37.7-61.8] in males and 56.4% [40.7-65.1] in females), and more than a quarter of LRI deaths among those aged 5-14 years were attributable to household air pollution (PAF 26.0% [95% UI 16.6-35.5] for males and PAF 25.8% [16.3-35.4] for females). PAFs of male LRI deaths attributed to smoking were 20.4% (95% UI 15.4-25.2) in those aged 15-49 years, 305% (24.1-36. 9) in those aged 50-69 years, and 21.9% (16. 8-27. 3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21.1% (95% UI 14.5-27.9) in those aged 15-49 years and 18 " 2% (12.5-24.5) in those aged 50-69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11-7% (95% UI 8.2-15.8) of LRI deaths.Interpretation The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children you - than 5 years was dearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, induding promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities.Copyright 2022 The Author(s). Published by Elsevier Ltd