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      Time trends in the burden of autoimmune diseases across the BRICS: an age–period–cohort analysis for the GBD 2019

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          Abstract

          Background

          This study aims to evaluate the long-term trend of prevalence and DALY (disability-adjusted life-year) rate on the age, period and cohort (APC) of the BRICS (Brazil, Russia, India, China and South Africa) country for autoimmune diseases (rheumatoid arthritis (RA), inflammatory bowel disease (IBD), multiple sclerosis (MS) and psoriasis).

          Methods

          The data are sourced from the Global Burden of Disease Study 2019, and it uses the Joinpoint regression model to estimate the time trends of autoimmune diseases from 1990 to 2019. Additionally, it employs the Age-Period-Cohort (APC) model to estimate the age, period, and cohort effects from 1990 to 2019.

          Results

          For 1990 to 2019, the ASPR (age-standardised prevalence rate) of IBD increased significantly for China and South Africa, and decreased significantly for Brazil, India, Russian. The Russian ASPR of MS demonstrated a significantly decreasing trend (average annual percent change=−0.5%, 95% CI −0.6 to −0.5), with the most increased occurring in Brazil at 2009–2014. The cohort effect on DALY rates for Psoriasis displayed an ongoing decreasing trend from the 1929–1933 birth cohort to the 1999–2003 birth cohort. Specifically, the five countries relative risk values (RRs) of DALYs due to RA increased significantly by 7.98, 16.07, 5.98, 3.19, 9.13 times, from 20 to 24 age group to 65 to 69 age group.

          Conclusions

          The population of the BRICS countries accounts for more than 40% of the global population. And we found that the age effect of various autoimmune diseases is heavily influenced by population ageing.

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          Most cited references49

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          Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies.

          Siew C. Ng, Hai Yun Shi, Nima Hamidi … (2017)
          Inflammatory bowel disease is a global disease in the 21st century. We aimed to assess the changing incidence and prevalence of inflammatory bowel disease around the world.
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            The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

            Sudabeh Alatab, Sadaf Sepanlou, Kevin Ikuta … (2019)
            Summary Background The burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Methods We modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95% uncertainty intervals (UI). Findings In 2017, there were 6·8 million (95% UI 6·4–7·3) cases of IBD globally. The age-standardised prevalence rate increased from 79·5 (75·9–83·5) per 100 000 population in 1990 to 84·3 (79·2–89·9) per 100 000 population in 2017. The age-standardised death rate decreased from 0·61 (0·55–0·69) per 100 000 population in 1990 to 0·51 (0·42–0·54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422·0 [398·7–446·1] per 100 000) and the lowest age-standardised prevalence rates were observed in the Caribbean (6·7 [6·3–7·2] per 100 000 population). High Socio-demographic Index (SDI) locations had the highest age-standardised prevalence rate, while low SDI regions had the lowest age-standardised prevalence rate. At the national level, the USA had the highest age-standardised prevalence rate (464·5 [438·6–490·9] per 100 000 population), followed by the UK (449·6 [420·6–481·6] per 100 000). Vanuatu had the highest age-standardised death rate in 2017 (1·8 [0·8–3·2] per 100 000 population) and Singapore had the lowest (0·08 [0·06–0·14] per 100 000 population). The total YLDs attributed to IBD almost doubled over the study period, from 0·56 million (0·39–0·77) in 1990 to 1·02 million (0·71–1·38) in 2017. The age-standardised rate of DALYs decreased from 26·5 (21·0–33·0) per 100 000 population in 1990 to 23·2 (19·1–27·8) per 100 000 population in 2017. Interpretation The prevalence of IBD increased substantially in many regions from 1990 to 2017, which might pose a substantial social and economic burden on governments and health systems in the coming years. Our findings can be useful for policy makers developing strategies to tackle IBD, including the education of specialised personnel to address the burden of this complex disease. Funding Bill & Melinda Gates Foundation.
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              Estimating average annual per cent change in trend analysis

              Limin Clegg, Benjamin F Hankey, Ram C Tiwari … (2009)
              Trends in incidence or mortality rates over a specified time interval are usually described by the conventional annual per cent change (cAPC), under the assumption of a constant rate of change. When this assumption does not hold over the entire time interval, the trend may be characterized using the annual per cent changes from segmented analysis (sAPCs). This approach assumes that the change in rates is constant over each time partition defined by the transition points, but varies among different time partitions. Different groups (e.g. racial subgroups), however, may have different transition points and thus different time partitions over which they have constant rates of change, making comparison of sAPCs problematic across groups over a common time interval of interest (e.g. the past 10 years). We propose a new measure, the average annual per cent change (AAPC), which uses sAPCs to summarize and compare trends for a specific time period. The advantage of the proposed AAPC is that it takes into account the trend transitions, whereas cAPC does not and can lead to erroneous conclusions. In addition, when the trend is constant over the entire time interval of interest, the AAPC has the advantage of reducing to both cAPC and sAPC. Moreover, because the estimated AAPC is based on the segmented analysis over the entire data series, any selected subinterval within a single time partition will yield the same AAPC estimate—that is it will be equal to the estimated sAPC for that time partition. The cAPC, however, is re-estimated using data only from that selected subinterval; thus, its estimate may be sensitive to the subinterval selected. The AAPC estimation has been incorporated into the segmented regression (free) software Joinpoint, which is used by many registries throughout the world for characterizing trends in cancer rates. Copyright © 2009 John Wiley & Sons, Ltd.
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                Author and article information

                Journal
                Journal ID (nlm-ta): RMD Open
                Journal ID (iso-abbrev): RMD Open
                Journal ID (hwp): rmdopen
                Journal ID (publisher-id): rmdopen
                Title: RMD Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2056-5933
                Publication date Collection: 2023
                Publication date (Electronic): 6 December 2023
                Volume: 9
                Issue: 4
                Electronic Location Identifier: e003650
                Affiliations
                [1 ] departmentDepartment of Neonatology , Ringgold_117752Xiangtan Central Hospital , Xiangtan, Hunan, China
                [2 ] departmentDepartment of Epidemiology and Medical Statistics , Ringgold_12570Xiangya School of Public Health, Central South university , Changsha, China
                [3 ] departmentKey Laboratory of Molecular Epidemiology of Hunan Province , Ringgold_12568School of Medicine, Hunan Normal University , Changsha, Hunan, China
                Author notes
                [Correspondence to ] Dr Yiran Cui; cyr0806@ 123456csu.edu.cn ; Dr Xiao Gao; 18670321975@ 123456163.com
                Author information
                http://orcid.org/0000-0002-3655-0210
                Article
                Publisher ID: rmdopen-2023-003650
                DOI: 10.1136/rmdopen-2023-003650
                PMC ID: 10711932
                PubMed ID: 38056916
                SO-VID: a9a5109c-4181-4846-a309-b692ae05547d
                Copyright © © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 30 August 2023
                Date accepted : 05 November 2023
                Funding
                Funded by: This work was funded by the National Science Foundation of Hunan Province (2021JJ40367), the National Science Foundation of Hunan Provincial Health Commission (202212055647), the open project of Hunan Normal University School of Medicine (KF2021016).;
                Categories
                Subject: Autoimmunity
                Subject: 1506
                Series title: Original research
                Custom metadata
                special-feature unlocked

                Keywords: autoimmune diseases,joinpoint regression analysis,prevalence,age-period-cohort model,daly
                Data availability:
                Keywords: autoimmune diseases, joinpoint regression analysis, prevalence, age-period-cohort model, daly

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