Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

EFETIVIDADE DA INTERVENÇÃO EDUCACIONAL DIGICARE NA MELHORIA DAS HABILIDADES DE COACHING CLÍNICO DE ESTUDANTES DE ENFERMAGEM E MEDICINA NO VIETNAME E BANGLADESH: UM PRÉ- E PÓS-ESTUDO EXPLORATÓRIO

Coaching has become an important approach to support self-management of patients with non-communicable diseases (NCDs) in healthcare education. Studies conducted in European countries have emphasized the significance of formal coaching training in enhancing the competencies of healthcare students. However, in Southeast Asia, where NCDs pose a serious public health concern, there is a lack of such training opportunities. To address this issue, an exploratory pre and post study was conducted to evaluate the effectiveness of the DigiCare educational intervention in improving clinical coaching skills. Nursing and medical students from six universities in Vietnam and Bangladesh were invited to participate. The intervention included both theoretical and practical classes with interactive methods and home assignments, with a total duration of over 10 contact hours. Pre- and post-intervention assessments were conducted using the Self-Efficacy and Performance in Self-management Support instrument, which was translated and culturally adapted to both countries. Statistical analysis showed a significant improvement in students’ overall competence scores from before (M = 2.6, SD = .67) to after the intervention (M = 3.05, SD = .55), with a medium effect size (p < .001; d = .73). The DigiCare educational intervention appears to be a low-cost and meaningful addition to the curriculum of both nursing and medical universities across countries, with potential benefits in the development of students’ clinical coaching competencies.O coaching tornou-se uma abordagem importante para apoiar a autogestão de pacientes com doenças não transmissíveis (DNTs) na educação em saúde. Estudos realizados em países europeus têm enfatizado a importância do treinamento formal em coaching para aprimorar as competências dos estudantes de saúde. No entanto, no Sudeste Asiático, onde as DNTs representam uma séria preocupação de saúde pública, há uma falta de oportunidades de treinamento nesse sentido. Para abordar essa questão, foi conduzido um pré- e pós-estudo exploratório para avaliar a eficácia da intervenção educacional DigiCare na melhoria das habilidades de coaching clínico. Estudantes de enfermagem e medicina de seis universidades no Vietname e em Bangladesh foram convidados a participar. A intervenção incluiu aulas teóricas e práticas com métodos interativos e tarefas domiciliares, totalizando mais de 10 horas de contato. Avaliações pré e pós-intervenção foram conduzidas utilizando o instrumento de Autoeficácia e Desempenho no Suporte à Autogestão, que foi traduzido e adaptado culturalmente para ambos os países. Análises estatísticas mostraram uma melhoria significativa nas pontuações gerais de competência dos estudantes, de antes (M = 2,6, DP = 0,67) para depois da intervenção (M = 3,05, DP = 0,55), com um efeito médio (p < 0,001; d = 0,73). A intervenção educacional DigiCare parece ser uma adição de baixo custo e significativa para o currículo de universidades de enfermagem e medicina em diferentes países, com benefícios potenciais no desenvolvimento das competências clínicas de coaching dos estudantes

ADAPTAÇÃO CULTURAL E VALIDAÇÃO PSICOMÉTRICA DO QUESTIONÁRIO SELF EFFICIENCY AND PERFORMANCE IN SELF-MANAGEMENT SUPPORT (SEPSS) EM ESTUDANTES DE GRADUAÇÃO EM ENFERMAGEM E MEDICINA DE BANGLADESH

In an aging society, healthcare professionals and students face increasing demands to actively involve patients in the decision-making process regarding their health conditions and lifestyles. Self-management support is considered a best practice that aligns with the patient-centered care paradigm in Bangladesh. However, there is currently no instrument available to assess healthcare professionals’ competencies in this field, particularly during their early education and training period. The aim of this study was to translate the Self Efficiency and Performance in Self-management Support (SEPSS) instrument into Bangla and validate its psychometric properties in a sample of undergraduate healthcare students in Bangladeshi higher education institutions. A cross-sectional study was conducted to assess the reliability, validity, and cultural appropriateness of the Bangla version of SEPSS-36 among 486 nursing and medical students. Confirmatory factor analysis was carried out using the chi-square model fit index (CMIN), comparative fit index (CFI), and Root Mean Square Error of Approximation (RMSEA) as fit indices. The internal consistency was estimated by the Cronbach alpha coefficient. The results indicate that the CMIN (2.658) and RMSEA (.058) values suggest that the sample data and hypothetical model are an acceptable fit in the analysis, with satisfactory CFI values (.895). The reliability for all SEPSS dimensions was acceptable. The Bangla version of the SEPSS questionnaire is a valid and reliable instrument that can assist healthcare educators and researchers in determining students’ competencies within this domain.Numa sociedade envelhecida, os profissionais de saúde e os estudantes enfrentam exigências cada vez maiores para envolver ativamente os pacientes no processo de tomada de decisão em relação às suas condições de saúde e estilos de vida. O apoio à autogestão é considerado uma prática recomendada que está alinhada com o paradigma de cuidados centrados no paciente em Bangladesh. No entanto, atualmente não existe um instrumento disponível para avaliar as competências dos profissionais de saúde nesse campo, especialmente durante o período inicial de educação e formação. O objetivo deste estudo foi traduzir o instrumento Self Efficiency and Performance in Self-management Support (SEPSS) para o bengali e validar as suas propriedades psicométricas numa amostra de estudantes de saúde de graduação em instituições de ensino superior de Bangladesh. Foi realizado um estudo transversal para avaliar a confiabilidade, validade e adequação cultural da versão em bengali do SEPSS-36 entre 486 estudantes de enfermagem e medicina. A análise fatorial confirmatória foi conduzida utilizando o índice de ajustamento do modelo qui-quadrado (CMIN), o índice de ajustamento comparativo (CFI) e o erro quadrado médio de aproximação (RMSEA) como índices de ajustamento. A consistência interna foi estimada pelo coeficiente alfa de Cronbach. Os resultados indicam que os valores de CMIN (2,658) e RMSEA (0,058) sugerem que os dados da amostra e o modelo hipotético têm um ajustamento aceitável na análise, com valores de CFI satisfatórios (0,895). A confiabilidade de todas as dimensões do SEPSS foi aceitável. A versão em bengali do questionário SEPSS é um instrumento válido e fiável que pode ajudar os educadores e investigadores em saúde a determinar as competências dos estudantes nesta área

COMO É QUE OS ESTUDANTES DE ENFERMAGEM PERCEBEM A TECNOLOGIA EM SAÚDE? UM ESTUDO DE VALIDAÇÃO PSICOMÉTRICA DO USABILITY EVALUATION QUESTIONNAIRE NO VIETNAME

The rapid advancement of technology has transformed the role of nurses and nursing students in patient care, making it an integral component of healthcare delivery. The use of innovative technologies has become commonplace in healthcare settings, creating a high-tech environment that can enhance nursing care quality and patient experience. It is essential for nursing staff and students to be receptive to incorporating such tools into their practice to ensure safe and efficient use of various forms of healthcare technology. Objective: Given the absence of an existing tool in Vietnam to evaluate healthcare students’ technology acceptance, the aim of our research was to culturally adapt, translate, and validate the Usability Evaluation Questionnaire (UtEQ) among nursing students in Vietnam. Method: We conducted a methodological and cross-sectional study in two phases: translation of the UtEQ to Vietnamese (UtEQ-V) following six stages proposed by Beaton and collaborators, and assessment of its psychometric properties in a non-probability sample of 295 Vietnamese nursing students. Results: The UtEQ-V’s reliability was found to be above 0.8 for all factors (.88–.95), while confirmatory factor analysis showed adequate goodness-of-fit indicators. Conclusion: The UtEQ-V is a reliable and valid instrument that can support nursing educators and researchers to assess students’ technology acceptance during their clinical training.O rápido avanço da tecnologia transformou o papel das enfermeiras e dos estudantes de enfermagem nos cuidados aos pacientes, tornando-o um componente integral da prestação de cuidados de saúde. O uso de tecnologias inovadoras tornou-se comum nos contextos de saúde, criando um ambiente de alta tecnologia que pode melhorar a qualidade dos cuidados de enfermagem e a experiência do paciente. É essencial que a equipa de enfermagem e os estudantes estejam recetivos à incorporação de tais ferramentas na sua prática, a fim de garantir o uso seguro e eficiente de várias formas de tecnologia de saúde. Objetivo: Dada a inexistência de uma ferramenta existente no Vietname para avaliar a aceitação da tecnologia por parte dos estudantes de saúde, o objetivo da nossa investigação foi adaptar culturalmente, traduzir e validar o Questionário de Avaliação da Usabilidade (UtEQ) entre estudantes de enfermagem no Vietname. Método: Realizámos um estudo metodológico e transversal em duas fases: tradução do UtEQ para vietnamita (UtEQ-V) seguindo as seis etapas propostas por Beaton e colaboradores e avaliação das suas propriedades psicométricas numa amostra não probabilística de 295 estudantes de enfermagem vietnamitas. Resultados: A fiabilidade do UtEQ-V revelou-se superior a 0,8 para todos os fatores (.88–.95), enquanto a análise fatorial confirmatória apresentou indicadores adequados de ajustamento. Conclusão: O UtEQ-V é um instrumento fiável e válido que pode apoiar os educadores e os investigadores de enfermagem na avaliação da aceitação da tecnologia pelos estudantes durante o seu treino clínico

COMO É QUE OS ESTUDANTES DE MEDICINA E ENFERMAGEM VEEM A TECNOLOGIA DE SAÚDE? UM ESTUDO DE VALIDAÇÃO PSICOMÉTRICA DO QUESTIONÁRIO DE AVALIAÇÃO DE USABILIDADE EM BANGLADESH

The modernization of healthcare delivery is a reality in various international settings. To ensure efficient and safe use of the diverse forms of healthcare technology available, professionals and students must be receptive to incorporating such tools into their practice. Currently, there is no instrument in Bangladesh to assess healthcare students’ technology acceptance. Objective: To translate, culturally adapt, and validate the Usability Evaluation Questionnaire (UtEQ) among Bangladeshi healthcare students. Method: A cross-sectional study with a methodological approach was conducted in two phases. The first phase involved the translation of the UtEQ questionnaire to Bengali, following the six stages proposed by Beaton et al. In the second phase, the psychometric properties of the questionnaire were evaluated using a non-probability sample of 486 undergraduate healthcare students from three higher education institutions in Bangladesh. Confirmatory factor analysis was performed, and the Cronbach’s alpha coefficient was estimated to find out the internal consistency. Results: Internal consistency was found to be excellent for all scale dimensions, ranging from 0.88 to 0.92, while confirmatory factor analysis showed adequate goodness-of-fit indicators. Conclusion: The UtEQ-B provides a reliable and valid method for healthcare educators and researchers to assess technology acceptance among healthcare students during clinical training in Bangladesh.A modernização da prestação de cuidados de saúde é uma realidade em vários contextos internacionais. Para garantir a utilização eficiente e segura das diversas formas de tecnologia em saúde disponíveis, os profissionais e estudantes devem estar receptivos à incorporação dessas ferramentas na sua prática. Atualmente, não existe em Bangladesh um instrumento para avaliar a aceitação da tecnologia pelos estudantes de saúde. Objetivo: Traduzir, adaptar culturalmente e validar o Questionário de Avaliação da Usabilidade (UtEQ) entre estudantes de saúde de Bangladesh. Método: Foi realizado um estudo transversal com uma abordagem metodológica em duas fases. A primeira fase envolveu a tradução do questionário UtEQ para bengali, seguindo as seis etapas propostas por Beaton et al. Na segunda fase, foram avaliadas as propriedades psicométricas do questionário usando uma amostra não probabilística de 486 estudantes de graduação em saúde de três instituições de ensino superior em Bangladesh. Foi realizada uma análise fatorial confirmatória e estimou-se o coeficiente alfa de Cronbach para verificar a consistência interna. Resultados: Foi encontrada uma consistência interna excelente para todas as dimensões da escala, variando de 0,88 a 0,92, enquanto a análise fatorial confirmatória mostrou indicadores adequados de ajuste. Conclusão: O UtEQ-B fornece um método confiável e válido para educadores e pesquisadores em saúde avaliarem a aceitação da tecnologia entre estudantes de saúde durante o treinamento clínico em Bangladesh

Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Findings In 2019, 273 center dot 9 million (95% uncertainty interval 258 center dot 5 to 290 center dot 9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 center dot 72% (4 center dot 46 to 5 center dot 01). 228 center dot 2 million (213 center dot 6 to 244 center dot 7; 83 center dot 29% [82 center dot 15 to 84 center dot 42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global agestandardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 center dot 21% [-1 center dot 26 to -1 center dot 16]), similar progress was not observed for chewing tobacco (0 center dot 46% [0 center dot 13 to 0 center dot 79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 center dot 94% [-1 center dot 72 to -0 center dot 14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Summary Background Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. Methods We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. Findings In 2019, 273 & middot;9 million (95% uncertainty interval 258 & middot;5 to 290 & middot;9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4 & middot;72% (4 & middot;46 to 5 & middot;01). 228 & middot;2 million (213 & middot;6 to 244 & middot;7; 83 & middot;29% [82 & middot;15 to 84 & middot;42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1 & middot;21% [-1 & middot;26 to -1 & middot;16]), similar progress was not observed for chewing tobacco (0 & middot;46% [0 & middot;13 to 0 & middot;79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0 & middot;94% [-1 & middot;72 to -0 & middot;14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. Interpretation Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019 : a systematic analysis from the Global Burden of Disease Study 2019

Background Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. Methods We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. Findings Globally in 2019, 1.14 billion (95% uncertainty interval 1.13-1.16) individuals were current smokers, who consumed 7.41 trillion (7.11-7.74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27.5% [26. 5-28.5] reduction) and females (37.7% [35.4-39.9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0.99 billion (0.98-1.00) in 1990. Globally in 2019, smoking tobacco use accounted for 7.69 million (7.16-8.20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20.2% [19.3-21.1] of male deaths). 6.68 million [86.9%] of 7.69 million deaths attributable to smoking tobacco use were among current smokers. Interpretation In the absence of intervention, the annual toll of 7.69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a dear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe