Zongkai Li

Maternal hemorrhage (MH) remains a leading preventable cause of maternal health, yet global disparities on its burden remain poorly quantified. Using the Global Burden of Disease 2021 data, we analyzed global, regional, and national trends in age-standardized maternal mortality ratio (ASR_MMR) attributed to MH from 1990 to 2021. We applied Joinpoint regression, age–period–cohort modeling, inequality indices and frontier analysis. This descriptive–analytical ecological study is based on modeled secondary data. Globally, the proportion of ASR_MMR attributed to MH declined from 33.31% in 1990 to 24.52% in 2021 (relative reduction: 24.24%). ASR_MMR attributed to MH consistently declined, with an estimated annual percentage change (EAPC) of −3.17 (95% UI: −3.42, −2.91). In 2021, Central and West Africa countries reported ASR_MMR attributed to MH exceeding 300 per 100,000 live births, while the Caribbean experienced a temporary increase. ASR_MMR attributed to MH was strongly inversely correlated with the socio-demographic index (SDI). Absolute inequality (slope index of inequality) narrowed by 49.4%, while relative inequality (concentration index) increased by approximately 27.5%. Countries with the largest negative deviations from the frontier included Somalia, the Central African Republic, Chad, Nigeria, and Afghanistan. While substantial global progress has been made, socioeconomic inequities continue to drive persistent disparities in MMR attributed to MH. Policies must not only address average reductions but also the widening relative gap between advantaged and disadvantaged populations.

A healthy lifestyle is related to metabolic syndrome (MetS), but the mechanism is not fully understood. This study aimed to examine the association of components of MetS with lifestyle in a Chinese population and potential mediation role of serum uric acid (SUA) in the association between lifestyle behaviors and risk of components of MetS. Data were derived from a baseline survey of the Shaanxi urban cohort in the Regional Ethnic Cohort Study in northwest China. The relationship between components of MetS, healthy lifestyle score (HLS), and SUA was investigated by logistic or linear regression. A counterfactual-based mediation analysis was performed to ascertain whether and to what extent SUA mediated the total effect of HLS on components of MetS. Compared to those with 1 or less low-risk lifestyle factors, participants with 4–5 factors had 43.6% lower risk of impaired glucose tolerance (OR = 0.564; 95%CI: 0.408~0.778), 60.8% reduction in risk of high blood pressure (OR = 0.392; 95%CI: 0.321~0.478), 69.4% reduction in risk of hypertriglyceridemia (OR = 0.306; 95%CI: 0.252~0.372), and 47.3% lower risk of low levels of HDL cholesterol (OR = 0.527; 95%CI: 0.434~0.641). SUA mediated 2.95% (95%CI: 1.81~6.16%) of the total effect of HLS on impaired glucose tolerance, 14.68% (95%CI: 12.04~18.85%) on high blood pressure, 17.29% (95%CI: 15.01~20.5%) on hypertriglyceridemia, and 12.83% (95%CI: 10.22~17.48%) on low levels of HDL cholesterol. Increased HLS tends to reduce risk of components of MetS partly by decreasing the SUA level, which could be an important mechanism by which lifestyle influences MetS.