Jinxin Zheng

Background & Aims: Whether socioeconomic development yields comparable population-level gains across digestive cancers is unclear. We assessed development-associated separation between mortality and incidence across six digestive cancers, focusing on pancreatic cancer. Methods: Using country-level GLOBOCAN 2024 estimates linked to 2023 Human Development Index (HDI) values, we conducted an ecological cross-sectional analysis of colorectal, stomach, esophageal, liver, gallbladder, and pancreatic cancers. Generalized additive models estimated a decoupling index (DI) as the difference between HDI-associated gradients in log incidence and log mortality; larger values indicated more favorable mortality patterns relative to incidence. Inference and robustness were assessed using bootstrap, within-country contrasts, mixed-effects models, sensitivity analyses, and constant-rate projections to 2050. Results: The six cancers accounted for 5,016,360 cases and 3,316,747 deaths in 2024. Pooled models included 855 country-cancer observations from 169 countries. Pancreatic cancer had the highest global mortality-to-incidence ratio (MIR; 0.901) and the smallest DI per 0.10-unit higher HDI (0.043; 95% CI, 0.025-0.053), compared with 0.082-0.253 for the other cancers. The colorectal-pancreatic DI difference was 0.117 (95% CI, 0.090-0.140; P<.001). Pancreatic MIR was only 11.6% lower in very-high- than low-HDI countries; reductions for other sites ranged from 18.2% to 41.3%. With 2024 age-specific rates held constant, pancreatic cancer deaths were projected to increase by 88.2% by 2050, and the very-high-HDI mortality-to-incidence count ratio was only 0.2% lower than the low-HDI ratio. Conclusions: Development-associated mortality-incidence decoupling varied substantially across digestive cancers and was weakest for pancreatic cancer. Comparable population-level gains cannot be assumed without disease-specific advances in early detection, treatment, and specialist care.

Background: The Belt and Road Initiative (BRI) encompasses 151 countries across six continents, accounting for nearly two-thirds of the global population. However, a comprehensive, up-to-date assessment of the infectious disease burden in these countries towards the 2030 Sustainable Development Goals (SDGs)—has been lacking. We aimed to systematically evaluate the burden of infectious diseases in BRI countries from 1990 to 2023, to examine regional and national disparities, and to project attainment of SDG 3.3 targets.Methods: Using data from the Global Burden of Disease Study (GBD) 2023, we estimated incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for BRI countries from 1990 to 2023. We constructed the BRI synthetic region and six geographical subregions using a rigorous extract-then-aggregate approach. We calculated age-standardised rates (ASR), average annual percentage changes (AAPC), and projected 2030 ASIR for five priority diseases using two log-linear extrapolation models, benchmarking against the SDG 3.3 target of an 80% reduction from 2015 levels.Findings: In 2023, BRI countries accounted for 65·95% of global incident cases (17·05 billion), 71·95% of deaths (5·91 million), and 78·34% of DALYs (342·43 million). Between 1990 and 2023, age-standardised mortality rates (ASMR) declined by 52·15% (AAPC −2·36%, 95% CI −2·83 to −1·88) and DALY rates by 56·23% (AAPC −2·83%, −3·15 to −2·52), but absolute levels remained 13%–17% above global averages. Regional heterogeneity was substantial: Asia achieved the steepest declines (ASDR −72·23%), whereas Africa carried the highest burden (ASMR 298·12 per 100 000, 5·0 times that of Asia). Europe was the only region with synchronous increases in both incidence and mortality (ASIR +60·74%, ASMR +12·23%). A near-universal reversal in respiratory infection trends occurred around 2013, with 99·3% of countries switching from declining to rising rates in the post-2013 period. Strong inverse associations between the Socio-demographic Index and all burden metrics were observed, with the same infectious event translating into a 9–12 times greater likelihood of death or disability in low-SDI settings. Under current trajectories, none of the five priority diseases—HIV/AIDS, tuberculosis, malaria, measles, and acute hepatitis—will achieve the SDG 3.3 target by 2030; malaria is projected to increase by 10%–21% from 2015 levels.Interpretation: Despite substantial declines in mortality and disability over the past three decades, BRI countries continue to bear a disproportionate and growing share of the global infectious disease burden. The post-2013 surge in respiratory infections—driven by COVID-19—and the re-emergence of dengue and malaria in many countries have offset gains made against traditional infectious diseases. The widening disparities between regions and the projected failure to meet SDG 3.3 targets underscore the urgent need for strengthened health system investments, enhanced cross-border surveillance and joint prevention mechanisms, and tailored strategies that address the dual challenge of persistent inequities in low-resource settings and emerging threats in higher-income and ageing populations.

Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tick-borne zoonosis with a complex host–vector ecology involving wildlife, domestic animals, and ticks, yet the comparative burden of SFTS virus (SFTSV) across these ecological compartments remains incompletely defined.Methods: We conducted a systematic review and meta-analysis to quantify SFTSV infection in animal hosts and tick vectors. We searched major international and Chinese databases and included observational studies reporting serological and/or molecular evidence of SFTSV infection in wild animals, domestic animals, or ticks. Random-effects meta-analyses of proportions were performed separately for antibody and RNA outcomes.Findings: Of 881 extracted records, 789 records representing 126 unique studies were included in the quantitative synthesis. The pooled seroprevalence of SFTSV was 7.99% (95% CI 4.81–13.00) in wild animals and 24.22% (95% CI 20.83–27.97) in domestic animals, while pooled RNA positivity was 1.14% (95% CI 0.66–1.95) in wild animals and 5.90% (95% CI 3.72–9.25) in domestic animals. The pooled RNA detection rate in ticks was 3.70% (95% CI 2.72–5.02). Species-specific analyses showed particularly high seroprevalence in goats, sheep, and cattle, and comparatively high RNA positivity in goats, cats, cattle, and dogs. Among ticks, Haemaphysalis longicornis contributed the largest evidence base, whereas higher pooled estimates were observed in some less-studied tick taxa. Although between-study heterogeneity was substantial, sensitivity analyses showed that the main patterns were robust.Interpretation: These findings indicate that SFTSV circulation is distributed across a connected host–vector system but is not evenly shared across ecological compartments. Domestic animals appear to carry the strongest combined signals of exposure and active infection, supporting their value as practical sentinels at the animal–human interface, while wildlife and tick surveillance remain essential for clarifying reservoir complexity and vector-borne maintenance.

Substance use disorders (SUDs) are a major public health challenge, contributing substantially to morbidity, premature mortality, and socioeconomic loss. Updated, comparable epidemiological evidence is essential to guide targeted prevention, treatment, and harm-reduction strategies across heterogeneous health-system and policy contexts. Recent global analyses indicate that SUD burden remains high and unevenly distributed across regions and […]

Despite vaccination advances, childhood meningitis remains a major global threat, disproportionately affecting low- and middle-income countries (LMICs). This study analyzes its burden trends from 1990 to 2021, with a focus on LMICs. Using data from the Global Burden of Disease Study 2021, we estimated mortality and disability-adjusted life years (DALYs) for children aged 0–14 years across 117 countries and territories grouped by low, low-middle, and middle Sociodemographic Index (SDI). Temporal trends were assessed with estimated annual percentage change (EAPC). We examined correlations between SDI and disease burden and applied decomposition analysis to attribute deaths and DALYs changes to aging, population growth, and epidemiological shifts. Frontier analysis was used to evaluate health system efficiency relative to SDI. Between 1990 and 2021, childhood meningitis deaths decreased in LMICs. Nevertheless, these regions accounted for 98.5% of global deaths in 2021, with low-SDI regions alone responsible for 61.0%. Streptococcus pneumoniae and Neisseria meningitidis were the leading pathogens. The disease burden was strongly inversely correlated with SDI, highlighting the key role of socioeconomic development. Decomposition analysis showed that in low-SDI regions, epidemiological improvements contributed substantially to mortality reduction (+ 513.02%), but were largely offset by population growth (− 417.38%), yielding only a modest net reduction. Frontier analysis revealed major health system inefficiencies in certain low-SDI countries, such as South Sudan and Nigeria. Conclusion: The concentrated burden of childhood meningitis in LMICs calls for context-specific strategies. Health system inefficiencies and rapid population growth threaten to offset intervention gains. Precision public health approaches that combine targeted vaccination, health system strengthening, and socioeconomic development are essential to reduce inequities and achieve global control goals. What is Known: • Childhood meningitis remains a leading infectious cause of mortality and long-term disability globally, with the highest burden concentrated in low-income regions. • Significant progress has been made in vaccine development, leading to declines in mortality globally; yet implementation and coverage gaps persist in resource-limited settings. What is New: • Decomposition analysis quantifies for the first time how rapid population growth in low-SDI regions nearly cancels out the benefits of epidemiological improvements, whereas middle-SDI regions achieved reductions almost solely through epidemiological progress. • Frontier analysis identifies profound health system inefficiencies in specific low-SDI countries (e.g., South Sudan, Nigeria), where observed mortality and DALYs rates are higher than the optimum achievable given their SDI level.

Drug-resistant tuberculosis (TB) remains a major global health threat, reflecting disparities in healthcare capacity, access, and socioeconomic development. Previous research often lacks geographic breadth. This study provides a comprehensive assessment of the global, regional, and national burden of Multidrug-resistant TB without extensive drug resistance (MDR-TB) and extensively drug-resistant TB(XDR-TB) from in Global Burden of Disease Study (GBD) 2021 Study 1990 to 2021, with a focus on distributional inequities. The findings aim to guide resource prioritization, inform targeted interventions, and reduce the burden in high-risk populations. We systematically assessed the global, regional, and national burden of MDR-TB and XDR-TB, along with their change trends from 1990 to 2021, using data from the GBD 2021 database. The indicators included age-standardized incidence rate (ASIR), prevalence rate (ASPR), mortality rate (ASMR), and disability-adjusted life-years rate (ASDR). ASDR was analyzed in conjunction with the sociodemographic index (SDI) for a comprehensive assessment. Health inequalities were quantified using the slope index of inequality (SII) and concentration index (CCI). Frontier analysis estimated the achievable outcomes across different development levels, while decomposition analysis identified the key factors driving changes in disease burden. In 2021, the global ASIR of MDR-TB was 5.42 per 100,000 population [95% uncertainty interval(UI): 3.17, 9.34]), and the ASIR of XDR-TB was 0.29 per 100,000 population (95% UI: 0.21, 0.42). From 1990 to 2021, the ASIR of MDR-TB [AAPC = 0.14%, 95% confidence interval (CI): 0.13, 0.14] and XDR-TB (AAPC = 0.01%, 95% CI: 0.01, 0.02) both showed an increasing trend. The ASIR and ASMR of MDR-TB increased in low and low-middle SDI regions. Similarly, the ASIR and ASMR of XDR-TB increased in all five SDI regions. The ASIR of MDR-TB increased in 155 countries, with the largest increase observed in Somalia (AAPC = 1.79%, 95% CI: 1.67, 1.92). The ASIR of XDR-TB increased in all countries. From 1990 to 2021, both absolute and relative health inequalities in the ASDR of MDR-TB and XDR-TB have grown. In addition, the ASIR and incidence of MDR-TB and XDR-TB are negatively correlated with SDI. The burden of MDR-TB/XIDR-TB is projected to increase, with persistent disparities concentrated in low-SDI settings. Targeted public health strategies—including improved resource allocation, infrastructure development, and community health education—are essential to reduce inequities. Strengthening these efforts may enhance global TB control and advance progress toward health equity.

The period from childhood to early adulthood is critically susceptible to the onset of mental disorders (MDs), substance use disorders (SUDs), and self-harm, with significant implications for public health policy. Understanding these trends over time and across different regions is essential for effective intervention and resource allocation. This study utilizes data from GBD 2021, focusing on youths aged 10–24 years globally. Data span from 1990 to 2021, providing a longitudinal perspective on trends and are stratified by age groups, gender, geographic regions, and Socio-demographic Index (SDI). The results showed that in 2021, the global standardized prevalence of MDs among youths reached 14,778 per 100,000, marking a 6.8%(4.7–9.0) increase from 1990. Anxiety disorders and depressive disorders exhibited the highest prevalence. The prevalence of SUDs decreased by 20.3%(17.4–22.9) since 1990, while self-harm rates decreased by 35%(33.6–38.3). The highest burden was observed in the 20–24 age group, with notable gender disparities: females had higher rates of anxiety and depressive disorders, whereas males were more affected by SUDs and conduct disorders. Geographical and socio-economic variations were pronounced, with high SDI regions exhibiting the most significant prevalence of most MDs and SUDs. The study highlights a significant rise in the burden of MDs among global youth over three decades, exacerbated during the COVID-19 pandemic. It underscores the need for targeted mental health interventions and resource allocation to address the escalating mental health needs of young populations.