Shrikant Pawar

BACKGROUND: The WHO Global Oral Health Action Plan has set an overarching global target of achieving a 10% reduction in the prevalence of oral conditions by 2030. Robust and up-to-date information on the global burden of oral conditions is paramount to monitor progress towards this target. The aim of this systematic data analysis was to produce global, WHO region, and country-level estimates of the prevalence of, and disability-adjusted life-years (DALYs) attributed to, untreated caries, severe periodontitis, edentulism, other oral disorders, lip and oral cavity cancer, and orofacial clefts from 1990 to 2021. METHODS: This report is based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. Input data were extracted from epidemiological surveys, population-based registries, and vital statistics. Data were modelled with DisMod-MR 2.1, a Bayesian meta-regression modelling tool, to ensure consistency between prevalence, incidence, remission, and mortality estimates for oral conditions. DALYs were estimated as the aggregation of the years of life lost (YLLs) due to premature mortality and years lived with disability (YLDs). YLDs were calculated by multiplying prevalence estimates, the severity of the oral condition's sequelae (disability weight) and duration of the sequelae. Although all oral conditions lead to YLDs, only lip and oral cavity cancer and orofacial clefts lead to YLLs as well. 95% uncertainty intervals (UIs) were generated for every metric with the 25th and 975th ordered 1000 draw values of the posterior distribution. FINDINGS: The combined global age-standardised prevalence of the main oral conditions (untreated caries, severe periodontitis, edentulism, and other oral disorders) was 45 900 (95% UI 42 300 to 49 800) per 100 000 population in 2021, with 3·69 billion (3·40 to 4·00) people affected globally. Untreated dental caries of permanent teeth and severe periodontitis were the most common oral conditions, with a global age-standardised prevalence of 27 500 (24 000 to 32 000) per 100 000 population and 12 500 (10 500 to 14 500) per 100 000 population, respectively. Edentulism, severe periodontitis, and lip and oral cavity cancer caused the highest burden as demonstrated by their counts of DALYs and age-standardised DALY rates. Existing trends for 1990-2021 reveal relatively small changes (upward or downward) in prevalence and burden. Increasing counts of prevalent cases and DALYs were noted for all oral conditions but untreated caries of deciduous teeth (no percentage change in prevalence or DALYs) and orofacial clefts (-68·3% [-79·3 to -46·5] decrease in DALYs). There were decreases in both age-standardised prevalence and DALY rate for untreated caries of permanent teeth and edentulism, no change in both for untreated caries of deciduous teeth and severe periodontitis, an increase in the prevalence but no change in the DALY rate for lip and oral cavity cancer, and no change in the prevalence but a decrease in the DALY rate for orofacial clefts. By WHO region, the African and Eastern Mediterranean regions showed the largest increases in prevalent cases and DALYs for most oral conditions, while the European region showed the smallest increases or no change. The European region was the only region with decreasing age-standardised prevalence of untreated caries in both deciduous (-9·88%; -12·6 to -6·71) and permanent teeth (-5·94% (-8·38 to -3·62). The prevalence and DALY rate of severe periodontitis decreased in the African region, while the prevalence and DALY rate of edentulism decreased in the African region, South-East Asia region, and Western Pacific region. Furthermore, DALY rates of lip and oral cavity cancer decreased in the European region and the region of the Americas, while DALY rates of orofacial clefts decreased in all regions. INTERPRETATION: The minor changes in the burden of oral conditions over the past 30 years demonstrate that past and current efforts to control oral conditions have not been successful and that different approaches are needed. Many countries now face the double challenge of controlling the occurrence of new cases of oral conditions and addressing the huge unmet need for oral health care. FUNDING: Bill & Melinda Gates Foundation.

BACKGROUND: Benign prostatic hyperplasia is a common urological disease affecting older men worldwide, but comprehensive data about the global, regional, and national burden of benign prostatic hyperplasia and its trends over time are scarce. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated global trends in, and prevalence of, benign prostatic hyperplasia and disability-adjusted life-years (DALYs) due to benign prostatic hyperplasia, in 21 regions and 204 countries and territories from 2000 to 2019. METHODS: This study was conducted with GBD 2019 analytical and modelling strategies. Primary prevalence data came from claims from three countries and from hospital inpatient encounters from 45 locations. A Bayesian meta-regression modelling tool, DisMod-MR version 2.1, was used to estimate the age-specific, location-specific, and year-specific prevalence of benign prostatic hyperplasia. Age-standardised prevalence was calculated by the direct method using the GBD reference population. Years lived with disability (YLDs) due to benign prostatic hyperplasia were estimated by multiplying the disability weight by the symptomatic proportion of the prevalence of benign prostatic hyperplasia. Because we did not estimate years of life lost associated with benign prostatic hyperplasia, disability-adjusted life-years (DALYs) equalled YLDs. The final estimates were compared across Socio-demographic Index (SDI) quintiles. The 95% uncertainty intervals (UIs) were estimated as the 25th and 975th of 1000 ordered draws from a bootstrap distribution. FINDINGS: Globally, there were 94·0 million (95% UI 73·2 to 118) prevalent cases of benign prostatic hyperplasia in 2019, compared with 51·1 million (43·1 to 69·3) cases in 2000. The age-standardised prevalence of benign prostatic hyperplasia was 2480 (1940 to 3090) per 100 000 people. Although the global number of prevalent cases increased by 70·5% (68·6 to 72·7) between 2000 and 2019, the global age-standardised prevalence remained stable (-0·770% [-1·56 to 0·0912]). The age-standardised prevalence in 2019 ranged from 6480 (5130 to 8080) per 100 000 in eastern Europe to 987 (732 to 1320) per 100 000 in north Africa and the Middle East. All five SDI quintiles observed an increase in the absolute DALY burden between 2000 and 2019. The most rapid increases in the absolute DALY burden were seen in the middle SDI quintile (94·7% [91·8 to 97·6]), the low-middle SDI quintile (77·3% [74·1 to 81·2]), and the low SDI quintile (77·7% [72·9 to 83·2]). Between 2000 and 2019, age-standardised DALY rates changed less, but the three lower SDI quintiles (low, low-middle, and middle) saw small increases, and the two higher SDI quintiles (high and high-middle SDI) saw small decreases. INTERPRETATION: The absolute burden of benign prostatic hyperplasia is rising at an alarming rate in most of the world, particularly in low-income and middle-income countries that are currently undergoing rapid demographic and epidemiological changes. As more people are living longer worldwide, the absolute burden of benign prostatic hyperplasia is expected to continue to rise in the coming years, highlighting the importance of monitoring and planning for future health system strain. FUNDING: Bill & Melinda Gates Foundation. TRANSLATION: For the Amharic translation of the abstract see Supplementary Materials section.

BACKGROUND: Gout is an inflammatory arthritis manifesting as acute episodes of severe joint pain and swelling, which can progress to chronic tophaceous or chronic erosive gout, or both. Here, we present the most up-to-date global, regional, and national estimates for prevalence and years lived with disability (YLDs) due to gout by sex, age, and location from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021, as well as forecasted prevalence to 2050. METHODS: Gout prevalence and YLDs from 1990 to 2020 were estimated by drawing on population-based data from 35 countries and claims data from the USA and Taiwan (province of China). Nested Bayesian meta-regression models were used to estimate prevalence and YLDs due to gout by age, sex, and location. Prevalence was forecast to 2050 with a mixed-effects model. FINDINGS: In 2020, 55·8 million (95% uncertainty interval 44·4-69·8) people globally had gout, with an age-standardised prevalence of 659·3 (525·4-822·3) per 100 000, an increase of 22·5% (20·9-24·2) since 1990. Globally, the prevalence of gout in 2020 was 3·26 (3·11-3·39) times higher in males than in females and increased with age. The total number of prevalent cases of gout is estimated to reach 95·8 million (81·1-116) in 2050, with population growth being the largest contributor to this increase and only a very small contribution from the forecasted change in gout prevalence. Age-standardised gout prevalence in 2050 is forecast to be 667 (531-830) per 100 000 population. The global age-standardised YLD rate of gout was 20·5 (14·4-28·2) per 100 000 population in 2020. High BMI accounted for 34·3% (27·7-40·6) of YLDs due to gout and kidney dysfunction accounted for 11·8% (9·3-14·2). INTERPRETATION: Our forecasting model estimates that the number of individuals with gout will increase by more than 70% from 2020 to 2050, primarily due to population growth and ageing. With the association between gout disability and high BMI, dietary and lifestyle modifications focusing on bodyweight reduction are needed at the population level to reduce the burden of gout along with access to interventions to prevent and control flares. Despite the rigour of the standardised GBD methodology and modelling, in many countries, particularly low-income and middle-income countries, estimates are based on modelled rather than primary data and are also lacking severity and disability estimates. We strongly encourage the collection of these data to be included in future GBD iterations. FUNDING: Bill & Melinda Gates Foundation and the Global Alliance for Musculoskeletal Health.

Background: Antimicrobial resistance (AMR) is an urgent global health challenge and a critical threat to modern health care. Quantifying its burden in the WHO Region of the Americas has been elusive-despite the region's long history of resistance surveillance. This study provides comprehensive estimates of AMR burden in the Americas to assess this growing health threat. Methods: We estimated deaths and disability-adjusted life-years (DALYs) attributable to and associated with AMR for 23 bacterial pathogens and 88 pathogen-drug combinations for countries in the WHO Region of the Americas in 2019. We obtained data from mortality registries, surveillance systems, hospital systems, systematic literature reviews, and other sources, and applied predictive statistical modelling to produce estimates of AMR burden for all countries in the Americas. Five broad components were the backbone of our approach: the number of deaths where infection had a role, the proportion of infectious deaths attributable to a given infectious syndrome, the proportion of infectious syndrome deaths attributable to a given pathogen, the percentage of pathogens resistant to an antibiotic class, and the excess risk of mortality (or duration of an infection) associated with this resistance. We then used these components to estimate the disease burden by applying two counterfactual scenarios: deaths attributable to AMR (compared to an alternative scenario where resistant infections are replaced with susceptible ones), and deaths associated with AMR (compared to an alternative scenario where resistant infections would not occur at all). We generated 95% uncertainty intervals (UIs) for final estimates as the 25th and 975th ordered values across 1000 posterior draws, and models were cross-validated for out-of-sample predictive validity. Findings: was the leading pathogen-drug combination in 15 countries for deaths associated with AMR. Interpretation: Given the burden across different countries, infectious syndromes, and pathogen-drug combinations, AMR represents a substantial health threat in the Americas. Countries with low access to antibiotics and basic health-care services often face the largest age-standardised mortality rates associated with and attributable to AMR in the region, implicating specific policy interventions. Evidence from this study can guide mitigation efforts that are tailored to the needs of each country in the region while informing decisions regarding funding and resource allocation. Multisectoral and joint cooperative efforts among countries will be a key to success in tackling AMR in the Americas. Funding: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care using UK aid funding managed by the Fleming Fund.