Shengfeng Wang

Background: Research on the association between sodium‑glucose cotransporter 2 inhibitors (SGLT-2i) and chronic lower respiratory diseases (CLRDs) in patients with type 2 diabetes (T2DM) remains limited. This study aimed to investigate this association and examine the potential modifying effects such as age, sex, and diabetes severity. Methods: Using the Shenzhen Public Health Data Platform, we conducted two independent target trial emulations with a new‑user active comparator design, comparing SGLT‑2i with glucagon‑like peptide‑1 receptor agonists (GLP-1RA) and dipeptidyl peptidase‑4 inhibitors (DPP‑4i), respectively. The primary outcome was incident CLRD; secondary outcomes included five subtypes—bronchitis, bronchiectasis, asthma, chronic obstructive pulmonary disease, and emphysema. Overlap-weighted Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Results: During a median follow-up of 1.76 years, 349 (7.95%) and 397 (9.04%) new CLRD cases occurred in SGLT-2i and GLP-1RA users, respectively. Compared with GLP-1RA, SGLT-2i use was associated with a lower CLRD incidence (HR 0.87, 95% CI 0.79–0.96), primarily driven by reduced risk of bronchitis (HR: 0.89; 95% CI: 0.79-1.00) and asthma (HR: 0.77; 95% CI: 0.58–1.01); no significant associations were found for other subtypes. Compared with DPP-4i, SGLT-2i use showed a trend toward lower CLRD risk (HR: 0.95; 95% CI: 0.91–0.99), with significant reductions for bronchitis (HR: 0.95; 95% CI: 0.91-1.00), bronchiectasis (HR: 0.86; 95% CI: 0.75-1.00), and asthma (HR: 0.87; 95% CI: 0.77–0.98). Subgroup analyses indicated significant interactions for bronchiectasis by sex ( P _interaction = 0.001). Conclusion: Compared with GLP-1 RA, SGLT-2i were associated with a significantly lower risk of CLRDs, driven predominantly by bronchitis; versus DPP-4i, the risk reduction was primarily observed for bronchitis, bronchiectasis, and asthma. The protective association between SGLT-2i use and bronchiectasis was more pronounced in females than in males relative to DPP-4i.

Urolithiasis is a common condition worldwide, marked by significant variations in lifetime risk across different regions, genders, and socioeconomic backgrounds. Understanding these disparities is crucial for developing effective public health strategies. This study aims to analyze these risks from 1990 to 2021 and project future trends in the incidence and mortality of urolithiasis. Data were obtained from the Global Burden of Disease (GBD) 2021 study, which provides comprehensive estimates on urolithiasis incidence, prevalence, and mortality across various demographics. Analyses were stratified by gender, age, Sociodemographic Index (SDI), and geographic regions, and included assessments of temporal trends and concentration indices (CIs). Additionally, AutoRegressive Integrated Moving Average (ARIMA) models were employed to project future trends regarding the lifetime risk of developing urolithiasis.The global lifetime risk of developing urolithiasis in 2021 was estimated at 62.95%, with the highest risks observed in Eastern Europe (89.20%), Southern Latin America (80.34%), and Central Asia (75.75%). Men exhibited a higher risk than women (70.40% vs. 50.34%). The global mortality risk from urolithiasis remained low at 0.03%, with the highest rates found in High-income Asia Pacific (0.07%) and Eastern Europe (0.06%). Notably, the lifetime risk of developing urolithiasis declined with advancing age, particularly after 40. ARIMA projections suggest a moderate increase in lifetime risk, potentially reaching nearly 70% by 2050, especially among females. Urolithiasis demonstrates significant global and regional disparities influenced by socioeconomic, environmental, and demographic factors. Comprehensive strategies that address these disparities will be essential for enhancing public health outcomes and reducing the incidence of urolithiasis worldwide.

Background: Alopecia areata (AA) represents a significant autoimmune disorder affecting hair follicles, with sex differences that have yet to reach scientific consensus. The regional and temporal, age-related, and socioeconomic dimensions of sex-based lifetime risk disparities remain inadequately characterized and require further investigation. Methods: (1) We estimated AA lifetime risk using the adjusted for multiple primaries method. We evaluated regional and temporal features of sex disparities through Average Annual Percentage Change analysis, with future projections to 2050 via ARIMA modeling. (2) Age-stratified sex disparity features were analyzed. (3) We evaluated AA risk associations with Socio-Demographic Index (SDI) variations through Spearman correlation analysis and concentration indices to quantify female-to-male relative risk. Results: (1) Global lifetime risk increased from 29.89% (95% CI, 29.83%-29.94%) to 31.66% (31.61%-31.71%) in females, and from 15.91% (15.86%-15.95%) to 16.93% (16.88%-16.97%) in males between 1990 and 2021. The female-to-male lifetime risk ratio remained stable, measuring 1.88 (1.87–1.89) in 1990 and 1.87 (1.86–1.88) in 2021. Future projections through 2050 indicate increasing lifetime risks reaching 34.44% (32.99%-35.89%) for females and 19.06% (17.50%-20.63%) for males, despite comparatively faster growth rates observed in the male population (9.83% vs. 7.01% for females). Both sexes exhibited similar regional distribution features. (2) Sex differences in age-specific risk features were notable: females exhibited a high lifetime risk window between ages 20–50 years, while males demonstrated a narrower window primarily between ages 20–30 years. Female lifetime risk consistently peaked in the 30–39 age group regardless of SDI level, whereas males displayed significant SDI-dependent variations, with peak lifetime risks occurring at ages 20–29 in high-SDI regions versus ages 30–39 in the other areas. Females showed a slower decline in residual risk with increasing age compared to males, resulting in progressively higher female-to-male risk ratios that were particularly pronounced in high-SDI regions, reaching 4.51 (3.42–5.95) in the 70–79 age cohort. (3) With increasing SDI levels (reflecting socioeconomic development), females exhibited more pronounced risk elevation than males. Females exhibited consistently lower concentration indices relative to males, maintaining stable trends, while male concentration indices have shown a declining trend in recent years. The female-to-male ratio of concentration indices has shown a consistent upward trend since reaching its lowest point of 0.62 (0.51–0.76) in 1993, rising to 0.75 (0.60–0.95) by 2021. High SDI regions persistently demonstrate the lowest female-to-male concentration indices. Conclusions: Our analysis reveals pronounced sex disparities in global AA lifetime risk: consistently higher risk in females across regions and time periods, prolonged age-related risk window with slower decline in females, and greater risk elevation in females with increasing SDI levels.

Background: The number of cancer survivors that develop kidney failure is increasing. However, there is a lack of evidence supporting clinicians offering kidney transplant or dialysis when facing a kidney failure patient with a previous cancer history. Methods: This retrospective observational cohort study was conducted using the Inner Mongolia Regional Health Information Platform. Patients who underwent kidney transplantation or dialysis with a preexisting cancer diagnosis between January 1, 2012 and December 31, 2021 were included. We used overall mortality as the primary outcome, and cancer-specific mortality as the secondary outcome. Results: A total of 170,414 patients diagnosed with cancer were identified, out of which 1762 patients started kidney replacement therapy (KRT) after the cancer diagnosis, 5.45% ( n = 96) accepted kidney transplants and 94.55% ( n = 1666) underwent dialysis. Females tended to be less likely to commence kidney transplantation (odds ratio [OR] = 0.381, 95% confidence interval [CI]: 0.237–0.602). During a median follow-up of 3.19 (interquantile range [IQR] = 1.37–5.13) years, 566 (32.12%) deaths were recorded. The overall mortality rate (18.75% vs. 32.89%, P = 0.006) was lower in the kidney transplant group than in the dialysis group. After adjusting for sex, age, ethnicity, KRT start year, residency economic level, insurance type, cancer type, and cancer stage, kidney transplantation was associated with decreased overall mortality (hazard ratio [HR] = 0.542, 95% CI: 0.338–0.871, P = 0.011) compared with dialysis. These results were consistent after propensity score matching. The difference in cancer-specific mortality (10.42% vs. 17.59%, P = 0.095) and annual medical costs ($10,016.37 vs. $10,977.18, P = 0.982) between transplant and dialysis were statistically insignificant. Conclusions: In patients with prior cancer diagnoses, kidney transplantation showed better overall survival, similar cancer-specific survival outcomes, and cost-effectiveness than dialysis. Our findings add survival and cost data for KRT and provide evidence for stakeholders to consider the KRT mode in patients with a history of cancer.

Background: Benign prostatic hyperplasia (BPH) is a prevalent condition among older men that significantly reduces quality of life. Despite its global impact, comprehensive estimates of lifetime risk remain limited. This study aims to quantify the lifetime risk of BPH at both global and regional levels using data from the Global Burden of Disease (GBD) 2021. Materials and methods: We estimated the lifetime risk of developing BPH in men aged over 40 using the “adjusted for multiple primaries (AMP)” method, derived from age-specific incidence rates provided by GBD. The analysis included data from 204 countries and regions covering the period from 1990 to 2021, stratified by age, region, and sociodemographic index (SDI). Results: In 2021, the global lifetime risk of BPH from age 40 to death was estimated at 27.29% (95% CI 27.26–27.31), with significant regional and socioeconomic inequalities. Eastern Europe exhibited the highest risk (37.57%), while Central Sub-Saharan Africa had the lowest (13.66%). When stratified by SDI, lifetime risk increased from 19.46% in low SDI regions to 31.51% in high-middle SDI regions but declined to 24.71% in high SDI settings. Across all regions, most cases were observed in individuals aged 50–70. Furthermore, between 1990 and 2021, the global lifetime risk of BPH showed a gradual increase. Projections indicate that this risk will remain stable over the next 30 years, with pronounced regional disparities expected to persist. Conclusions: This study offers a comprehensive assessment of the global lifetime risk of BPH, revealing significant regional variations and age-related trends. These findings underscore the need for targeted prevention and management strategies, particularly for high-risk regions and men aged 50–70, to reduce the global burden of BPH.

Urinary tract infections (UTI) and interstitial nephritis (IN) are significant global health concerns, leaving a heavy burden to the healthcare system. UTI is one of the most common infections worldwide and IN is characterized by acute and chronic renal damage. This study aims to quantify the lifetime risk of developing and dying from UTI and IN across 204 countries from 1990 to 2021, utilizing data from the Global Burden of Disease 2021. We employed advanced statistical models, including the adjusted for multiple primaries method, Joinpoint trend analysis, and Autoregressive Integrated Moving Average (ARIMA) models, to assess temporal trends and forecast future risks. Results revealed a global lifetime risk of developing UTI and IN at 93.70% in 2021, with higher risks in females (96.05%) compared to males (77.27%). The global lifetime risk of dying from UTI and IN at 0.50%. High Socio-demographic Index (SDI) regions exhibited higher developing risks, while low-SDI regions showed significant upward trends. Gender disparities were evident, with females consistently experiencing higher risks. The ARIMA model projected a persistent upward trend in UTI and IN risks over the next 3 decades, emphasizing the need for targeted public health interventions. These findings highlight the importance of addressing UTI and IN through improved healthcare infrastructure, early screening, and preventive measures, particularly in high-risk populations and regions.

Summary This study is the first to measure global burden of hip fracture in patients aged 55 years and older across 204 countries and territories from 1990 to 2019. Our study further proved that the global burden of hip fracture is still large. Hip fractures among males are perhaps underestimated, and older adults should be given more attention. Purpose Hip fracture is a tremendous universal public health challenge, but no updated comprehensive and comparable assessment of hip fracture incidence and burden exists for most of the world in older adults. Methods Using data from the Global Burden of Diseases (GBD) 2019, we estimated the number and rates of the incidence, prevalence, and years lived with disability (YLD) of hip fracture across 204 countries and territories in patients aged 55 years and older from 1990 to 2019. Results In 2019, the incidence, prevalence, and YLDs rates of hip fracture in patients aged 55 years and older were 681.35 (95% UI 508.36–892.27) per 100000 population, 1191.39 (95% UI 1083.80–1301.52) per 100000 population, and 130.78 (95% UI 92.26–175.30) per 100000 population. During the three decades, the incidence among people aged below 60 years showed a downward trend, whereas it showed a rapid upward trend among older adults. All the numbers and rates of hip fractures among females were higher than those among males and increased with age, with the highest number and rate in the highest age group. Notably, the male to female ratio of the incidence for people aged over 55 years increased from 0.577 in 1990 to 0.612 in 2019. Falls were the leading cause among both sexes and in all age groups. Conclusions The incidence and the number of hip fractures among patients aged 55 years and older increased over the past three decades, indicating that the global burden of hip fracture is still large. Hip fractures among males are perhaps underestimated, and older adults should be given more attention.

Background: Osteoporotic vertebral fractures cause pain and disability, which result in heavy socioeconomic burden. However, the incidence and cost of vertebral fractures in China are unknown. We aimed to assess the incidence and cost of clinically recognized vertebral fractures among people aged 50 years and older in China from 2013 to 2017. Materials and Methods: This population-based cohort study was conducted by using Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) data in China from 2013 to 2017, which covered more than 95% of the Chinese population in urban areas. Vertebral fractures were identified by the primary diagnosis (i.e., International Classification of Diseases code or text of diagnosis) in UEBMI and URBMI. The incidence and medical cost of these clinically recognized vertebral fractures in urban China were calculated. Results: A total of 271,981 vertebral fractures (186,428, 68.5% females and 85,553, 31.5% males) were identified, with a mean age of 70.26 years. The incidence of vertebral fractures among patients aged 50 years and over in China increased approximately 1.79-fold during the five years, from 85.21 per 100,000 person-years in 2013 to 152.13 per 100,000 person-years in 2017. Medical costs for vertebral fracture increased from US$92.74 million in 2013 to US$505.3 million in 2017. Annual costs per vertebral fracture case increased from US$3.54 thousand in 2013 to US$5.35 thousand in 2017. Conclusion: The dramatic increase in the incidence and cost of clinically recognized vertebral fracture among patients aged 50 and over in urban China implies that more attention should be given to the management of osteoporosis to prevent osteoporotic fractures.