Epidemiological features of and changes in incidence of infectious diseases in China in the first decade after the SARS outbreak: an observational trend study.
ABSTRACT: BACKGROUND:The model of infectious disease prevention and control changed significantly in China after the outbreak in 2003 of severe acute respiratory syndrome (SARS), but trends and epidemiological features of infectious diseases are rarely studied. In this study, we aimed to assess specific incidence and mortality trends of 45 notifiable infectious diseases from 2004 to 2013 in China and to investigate the overall effectiveness of current prevention and control strategies. METHODS:Incidence and mortality data for 45 notifiable infectious diseases were extracted from a WChinese public health science data centre from 2004 to 2013, which covers 31 provinces in mainland China. We estimated the annual percentage change in incidence of each infectious disease using joinpoint regression. FINDINGS:Between January, 2004, and December, 2013, 54?984?661 cases of 45 infectious diseases were reported (average yearly incidence 417·98 per 100?000). The infectious diseases with the highest yearly incidence were hand, foot, and mouth disease (114·48 per 100?000), hepatitis B (81·57 per 100?000), and tuberculosis (80·33 per 100?000). 132?681 deaths were reported among the 54?984?661 cases (average yearly mortality 1·01 deaths per 100?000; average case fatality 2·4 per 1000). Overall yearly incidence of infectious disease was higher among males than females and was highest among children younger than 10 years. Overall yearly mortality was higher among males than females older than 20 years and highest among individuals older than 80 years. Average yearly incidence rose from 300·54 per 100?000 in 2004 to 483·63 per 100?000 in 2013 (annual percentage change 5·9%); hydatid disease (echinococcosis), hepatitis C, and syphilis showed the fastest growth. The overall increasing trend changed after 2009, and the annual percentage change in incidence of infectious disease in 2009-13 (2·3%) was significantly lower than in 2004-08 (6·2%). INTERPRETATION:Although the overall incidence of infectious diseases was increasing from 2004, the rate levelled off after 2009. Effective prevention and control strategies are needed for diseases with the highest incidence-including hand, foot, and mouth disease, hepatitis B, and tuberculosis-and those with the fastest rates of increase (including hydatid disease, hepatitis C, and syphilis). FUNDING:Chinese Ministry of Science and Technology, National Natural Science Foundation (China).
Project description:BACKGROUND:A re-emergence of scarlet fever has been noted in Hong Kong, South Korea, and England, UK, since 2008. China also had a sudden increase in the incidence of the disease in 2011. In this study, we aimed to assess the epidemiological changes before and after the upsurge. We also aimed to explore the reasons for the upsurge in disease in 2011, the epidemiological factors that contributed to it, and assess how these could be managed to prevent future epidemics. METHODS:In this observational study, we extracted the epidemiological data for all cases of scarlet fever between 2004 and 2016 in China from the Chinese Public Health Science Data Center, the official website of National Health Commission of the People's Republic of China, and the National Notifiable Infectious Disease Surveillance System. These data had been collected from 31 provinces and regions in China and included geographical, seasonal, and patient demographic information. We used descriptive statistical methods and joinpoint regression to examine the spatiotemporal patterns and annual percentage change in incidence of the upsurge of disease across China. FINDINGS:Between Jan 1, 2004, and Dec 31, 2016, 502?723 cases of scarlet fever, with ten fatalities, were reported in China, resulting in an annualised average incidence of 2·8807 per 100?000 people. The annual average incidence increased from 1·457 per 100?000 people in 2004 to 4·7638 per 100?000 people in 2011 (incidence rate ratio [IRR] 3·27, 95% CI 3·22-3·32; p<0·0001), peaking in 2015 (5·0092 per 100?000 people). The annual incidence after the 2011 upsurge of scarlet fever, between 2011 and 2016, was twice the average annual incidence reported between 2004 and 2010 (4·0125 vs 1·9105 per 100?000 people; IRR 2·07, 95% CI 2·06-2·09; p<0·0001). Most cases were distributed in the north, northeast, and northwest of the country. Semi-annual patterns were observed in May-June and November-December. The median age at onset of disease was 6 years, with the annual highest incidence observed in children aged 6 years (49·4675 per 100?000 people). The incidence among boys and men was 1·54 greater than that among girls and women before the upsurge, and 1·51 times greater after the upsurge (p<0·0001 for both). The median time from disease onset to reporting of the disease was shorter after the upsurge in disease than before (3 days vs 4 days; p=0·001). INTERPRETATION:To our knowledge, this is the largest epidemiological study of scarlet fever worldwide. The patterns of infection across the country were similar before and after the 2011 upsurge, but the incidence of disease was substantially higher after 2011. Prevention and control strategies being implemented in response to this threat include improving disease surveillance and emergency response systems. In particular, the school absenteeism and symptom monitoring and early-warning system will contribute to the early diagnosis and report of the scarlet fever. This approach will help combat scarlet fever and other childhood infectious diseases in China. FUNDING:National Key R&D Plan of China Science and key epidemiological disciplines of Zhejiang Provincial Health of China.
Project description:To outline which infectious diseases in the pre-covid-19 era persist in children and adolescents in China and to describe recent trends and variations by age, sex, season, and province. National surveillance studies, 2008-17. 31 provinces in mainland China. 4?959?790 Chinese students aged 6 to 22 years with a diagnosis of any of 44 notifiable infectious diseases. The diseases were categorised into seven groups: quarantinable; vaccine preventable; gastrointestinal and enteroviral; vectorborne; zoonotic; bacterial; and sexually transmitted and bloodborne. Diagnosis of, and deaths from, 44 notifiable infectious diseases. From 2008 to 2017, 44 notifiable infectious diseases were diagnosed in 4?959?790 participants (3?045?905 males, 1?913?885 females) and there were 2532 deaths (1663 males, 869 females). The leading causes of death among infectious diseases shifted from rabies and tuberculosis to HIV/AIDS, particularly in males. Mortality from infectious diseases decreased steadily from 0.21 per 100?000 population in 2008 to 0.07 per 100?000 in 2017. Quarantinable conditions with high mortality have effectively disappeared. The incidence of notifiable infectious diseases in children and adolescents decreased from 280 per 100?000 in 2008 to 162 per 100?000 in 2015, but rose again to 242 per 100?000 in 2017, largely related to mumps and seasonal influenza. Excluding mumps and influenza, the incidence of vaccine preventable diseases fell from 96 per 100?000 in 2008 to 7 per 100?000 in 2017. The incidence of gastrointestinal and enterovirus diseases remained constant, but typhoid, paratyphoid, and dysentery continued to decline. Vectorborne diseases all declined, with a particularly noticeable reduction in malaria. Zoonotic infections remained at low incidence, but there were still unpredictable outbreaks, such as pandemic A/H1N1 2009 influenza. Tuberculosis remained the most common bacterial infection, although cases of scarlet fever doubled between 2008 and 2017. Sexually transmitted diseases and bloodborne infections increased significantly, particularly from 2011 to 2017, among which HIV/AIDS increased fivefold, particularly in males. Difference was noticeable between regions, with children and adolescents in western China continuing to carry a disproportionate burden from infectious diseases. China's success in infectious disease control in the pre-covid-19 era was notable, with deaths due to infectious diseases in children and adolescents aged 6-22 years becoming rare. Many challenges remain around reducing regional inequalities, scaling-up of vaccination, prevention of further escalation of HIV/AIDS, renewed efforts for persisting diseases, and undertaking early and effective response to highly transmissible seasonal and unpredictable diseases such as that caused by the novel SARS-CoV-2 virus.
Project description:<label>Importance</label>Infectious diseases are mostly preventable but still pose a public health threat in the United States, where estimates of infectious diseases mortality are not available at the county level.<label>Objective</label>To estimate age-standardized mortality rates and trends by county from 1980 to 2014 from lower respiratory infections, diarrheal diseases, HIV/AIDS, meningitis, hepatitis, and tuberculosis.<label>Design and Setting</label>This study used deidentified death records from the National Center for Health Statistics (NCHS) and population counts from the US Census Bureau, NCHS, and the Human Mortality Database. Validated small-area estimation models were applied to these data to estimate county-level infectious disease mortality rates.<label>Exposures</label>County of residence.<label>Main Outcomes and Measures</label>Age-standardized mortality rates of lower respiratory infections, diarrheal diseases, HIV/AIDS, meningitis, hepatitis, and tuberculosis by county, year, and sex.<label>Results</label>Between 1980 and 2014, there were 4?081?546 deaths due to infectious diseases recorded in the United States. In 2014, a total of 113?650 (95% uncertainty interval [UI], 108?764-117?942) deaths or a rate of 34.10 (95% UI, 32.63-35.38) deaths per 100?000 persons were due to infectious diseases in the United States compared to a total of 72?220 (95% UI, 69?887-74?712) deaths or a rate of 41.95 (95% UI, 40.52-43.42) deaths per 100?000 persons in 1980, an overall decrease of 18.73% (95% UI, 14.95%-23.33%). Lower respiratory infections were the leading cause of infectious diseases mortality in 2014 accounting for 26.87 (95% UI, 25.79-28.05) deaths per 100?000 persons (78.80% of total infectious diseases deaths). There were substantial differences among counties in death rates from all infectious diseases. Lower respiratory infection had the largest absolute mortality inequality among counties (difference between the 10th and 90th percentile of the distribution, 24.5 deaths per 100?000 persons). However, HIV/AIDS had the highest relative mortality inequality between counties (10.0 as the ratio of mortality rate in the 90th and 10th percentile of the distribution). Mortality from meningitis and tuberculosis decreased over the study period in all US counties. However, diarrheal diseases were the only cause of infectious diseases mortality to increase from 2000 to 2014, reaching a rate of 2.41 (95% UI, 0.86-2.67) deaths per 100?000 persons, with many counties of high mortality extending from Missouri to the northeastern region of the United States.<label>Conclusions and Relevance</label>Between 1980 and 2014, there were declines in mortality from most categories of infectious diseases, with large differences among US counties. However, over this time there was an increase in mortality for diarrheal diseases.
Project description:Importance:Melanoma is one of the most common cancers worldwide, typically diagnosed in older adults. There is an increasing incidence in the younger population (age ?40 years) in America. In addition, approximately 1 in 5 cases of melanoma affect the head and neck. However, there are limited data on the incidence of head and neck melanoma in the pediatric, adolescent, and young adult population in North America (United States and Canada). Objective:To assess 20-year demographic and incidence changes associated with head and neck melanoma in the pediatric, adolescent, and young adult population in North America. Design, Setting, and Participants:A descriptive analysis of retrospective data on head and neck melanoma from the North American Association of Central Cancer Registries' Cancer in North America public use data set from 1995 to 2014 was conducted. The data set currently includes 93% of the United States and 64% of the Canadian populations. Eligible data were from 12?462 pediatric, adolescent, and young adult patients (aged 0-39 years) with a confirmed diagnosis of melanoma (International Classification of Diseases-Oncology 3 histologic types 8720-8790) in primary head and neck sites: skin of lip, not otherwise specified (C44.0); eyelid (C44.1); external ear (C44.2); skin of other/unspecified parts of face (C44.3); and skin of scalp and neck (C44.4). The study was conducted from January 26 to July 21, 2019. Main Outcomes and Measures:Log-linear regression was used to estimate annual percentage change in age-adjusted incidence rates (AAIRs) of head and neck melanoma. Results:Of the 12?462 patients with head and neck melanoma included in the study, 6810 were male (54.6%). The AAIR was 0.51 per 100?000 persons (95% CI, 0.50-0.52 per 100?000 persons). In North America, the incidence of head and neck melanoma increased by 51.1% from 1995 to 2014. The rate was higher in the United States (AAIR, 0.52; 95% CI, 0.51-0.53 per 100?000 person-years) than Canada (AAIR, 0.43; 95% CI, 0.40-0.45 per 100?000 persons). In the United States, the incidence increased 4.68% yearly from 1995 to 2000 and 1.15% yearly from 2000 to 2014. In Canada, the incidence increased 2.18% yearly from 1995 to 2014. Male sex (AAIR, 0.55; 95% CI, 0.54-0.57 per 100?000 persons), older age (AAIR, 0.79; 95% CI, 0.79-0.80 per 100?000 persons), and non-Hispanic white race/ethnicity (AAIR, 0.79; 95% CI, 0.77-0.80 per 100?000 persons) were associated with an increased incidence of head and neck melanoma. Conclusions and Relevance:The incidence of pediatric, adolescent, and young adult head and neck melanoma in North America appears to have increased by 51.1% in the past 2 decades, with males aged 15 to 39 years the main cohort associated with the increase.
Project description:OBJECTIVE:China's national hepatitis burden is high. This study aims to provide a detailed national-level description of the reported incidence of viral hepatitis in China during 2004-2016. DESIGN:Observational study. SETTING:Data were obtained from China's National Notifiable Disease Reporting System, and changing trends were estimated by joinpoint regression analysis. PARTICIPANTS:In this system, 16 927 233 reported viral hepatitis cases occurring during 2004-2016 were identified. PRIMARY OUTCOME MEASURE:Incidence rates per 100 000 person-years and changing trends were calculated. RESULTS:There were 16 927 233 new cases of viral hepatitis reported in China from 2004 to 2016. Hepatitis B (HBV) (n=13 543 137, 80.00%) and hepatitis C (HCV) (n=1 844 882, 10.90%) accounted for >90% of the cases. The overall annual percent change (APC) in reported cases of viral hepatitis and HBV were 0.3%(95% CI -2.0 to 0.8, p=0.6) and -0.2% (95% CI -1.6 to 1.2, p=0.8), respectively, showing a stable trend. HBV rates were highest in the 20-29 year old age group and lowest in younger individuals, likely resulting from the universal HBV vaccination. The reported incidence of HCV and hepatitis E (HEV) showed increasing trends; the APCs were 14.5% (95% CI 13.1 to 15.9, p<0.05) and 4.7% (95% CI 2.8 to 6.7, p<0.05), respectively. The hepatitis A (HAV) reporting incidence decreased, and the APC was -13.1% (95% CI -15.1 to -11.0, p<0.05). There were marked differences in the reporting of hepatitis among provinces. CONCLUSIONS:HBV continues to constitute the majority of viral hepatitis cases in China. Over the entire study period, the HBV reporting incidence was stable, the HCV and HEV incidence increased and the HAV incidence decreased. There were significant interprovincial disparities in the burden of viral hepatitis, with higher rates in economically less-developed areas. Vaccination is important for viral hepatitis prevention and control.
Project description:BACKGROUND:Skin diseases can have high morbidity that can be costly to society and individuals. To date, there has been no comprehensive assessment of the burden of skin disease in Canada. OBJECTIVES:To evaluate the burden of 18 skin and subcutaneous diseases from 1990 to 2017 in Canada using the Global Burden of Disease (GBD) data. METHODS:The 2017 GBD study measures health loss from 359 diseases and injuries in 195 countries; we evaluated trends in population health in Canada from 1990 to 2017 using incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Data are presented as rates (per 100 000), counts, or percent change with the uncertainty interval in brackets. RESULTS:From 1990 to 2017 for all skin diseases, DALY rates increased by 8% to 971 per 100 000 (674-1319), YLD rates increased by 8% to 897 per 100 000 (616-1235), YLL rates increased by 4% to 74 per 100 000 (53-89), and death rates increased by 18% to 5 per 100 000 (3-6). DALY rates for melanoma increased by 2% to 54 per 100 000 (39-68), for keratinocyte carcinoma by 14% to 17 per 100 000 (16-19), and for skin and subcutaneous disease by 8% to 900 per 100 000 (619-1233). The observed over expected ratios were higher for skin and subcutaneous disease (1.37) and keratinocyte carcinoma (1.17) and were lower for melanoma (0.73). CONCLUSIONS:The burden of skin disease has increased in Canada since 1990. These results can be used to guide health policy regarding skin disease in Canada.
Project description:OBJECTIVE:To evaluate the trends in disease burden and the epidemiological features of liver cancer in China while identifying potential strategies to lower the disease burden. DESIGN:Observational study based on the Global Burden of Diseases. PARTICIPANTS:Data were publicly available and de-identified and individuals were not involved. MEASUREMENT AND METHODS:To measure the liver cancer burden, we extracted data from the Global Health Data Exchange using the metrics of prevalence, incidence, mortality and disability-adjusted life years (DALYs). Joinpoint and negative binomial regressions were applied to identify trends and risk factors. RESULTS:From 1997 to 2016, the prevalence, incidence, mortality and DALYs of liver cancer in China were from 28.22/100 000 to 60.04/100 000, from 27.33/100 000 to 41.40/100 000, from 27.40/100 000 to 31.49/100 000 and from 10 311 308 to 11 539 102, respectively. The prevalence, incidence and mortality were increasing, with the average annual percent changes (AAPCs) of 4.0% (95% CI 3.9% to 4.2%), 2.1% (95% CI 2.0% to 2.2%) and 0.5% (95% CI 0.2% to 0.9%), respectively. Meanwhile, the rate of DALYs was stable with the AAPCs of -0.1% (95% CI -0.4% to 0.3%). The mortality-to-incidence ratio of liver cancer decreased from 1.00 in 1997 to 0.76 in 2016 (β=-0.014, p<0.0001). Males (OR: 2.98, 95% CI 2.68 to 3.30 for prevalence, OR: 2.45, 95% CI 2.21 to 2.71 for incidence) and the elderly individuals (OR: 1.57, 95% CI 1.55 to 1.59 for prevalence, OR: 1.58, 95% CI 1.56 to 1.60 for incidence) had a higher risk. Hepatitis B accounted for the highest proportion of liver cancer cases (55.11%) and deaths (54.13%). CONCLUSIONS:The disease burden of liver cancer continued to increase in China with viral factors as one of the leading causes. Strategies such as promoting hepatitis B vaccinations, blocking the transmission of hepatitis C and reducing alcohol consumption should be prioritised.
Project description:BACKGROUND:Infectious disease burden estimates provided by a composite health measure give a balanced view of the true impact of a disease on a population, allowing the relative impact of diseases that differ in severity and mortality to be monitored over time. This article presents the first national disease burden estimates for a comprehensive set of 32 infectious diseases in the Netherlands. METHODS AND FINDINGS:The average annual disease burden was computed for the period 2007-2011 for selected infectious diseases in the Netherlands using the disability-adjusted life years (DALY) measure. The pathogen- and incidence-based approach was adopted to quantify the burden due to both morbidity and premature mortality associated with all short and long-term consequences of infection. Natural history models, disease progression probabilities, disability weights, and other parameters were adapted from previous research. Annual incidence was obtained from statutory notification and other surveillance systems, which was corrected for under-ascertainment and under-reporting. The highest average annual disease burden was estimated for invasive pneumococcal disease (9444 DALYs/year; 95% uncertainty interval [UI]: 8911-9961) and influenza (8670 DALYs/year; 95% UI: 8468-8874), which represents 16% and 15% of the total burden of all 32 diseases, respectively. The remaining 30 diseases ranked by number of DALYs/year from high to low were: HIV infection, legionellosis, toxoplasmosis, chlamydia, campylobacteriosis, pertussis, tuberculosis, hepatitis C infection, Q fever, norovirus infection, salmonellosis, gonorrhoea, invasive meningococcal disease, hepatitis B infection, invasive Haemophilus influenzae infection, shigellosis, listeriosis, giardiasis, hepatitis A infection, infection with STEC O157, measles, cryptosporidiosis, syphilis, rabies, variant Creutzfeldt-Jakob disease, tetanus, mumps, rubella, diphtheria, and poliomyelitis. The very low burden for the latter five diseases can be attributed to the National Immunisation Programme. The average disease burden per individual varied from 0.2 (95% UI: 0.1-0.4) DALYs per 100 infections for giardiasis, to 5081 and 3581 (95% UI: 3540-3611) DALYs per 100 infections for rabies and variant Creutzfeldt-Jakob disease, respectively. CONCLUSIONS:For guiding and supporting public health policy decisions regarding the prioritisation of interventions and preventive measures, estimates of disease burden and the comparison of burden between diseases can be informative. Although the collection of disease-specific parameters and estimation of incidence is a process subject to continuous improvement, the current study established a baseline for assessing the impact of future public health initiatives.
Project description:BACKGROUND:Pharmaceutically derived cannabinoids are used for several indications, particularly pain management. The extent of their use from a population perspective is unknown; hence, the aim of this study was to evaluate trends in pharmaceutical cannabinoid use in Manitoba. METHODS:This was a retrospective population-based cross-sectional study using administrative data from the Manitoba Centre for Health Policy. Pharmaceutical cannabinoid users residing in Manitoba from Apr. 1, 2004, to Mar. 31, 2015 were identified. We assessed the annual prevalence and incidence of pharmaceutical cannabinoid use, and the sociodemographic characteristics and medical conditions of users. RESULTS:We identified 5181 people who received at least 1 prescription for a pharmaceutical cannabinoid over the study period, 5033 of whom received their first prescription after Apr. 1, 2004. Nabilone accounted for 73 650 (96.0%) of all prescriptions dispensed; dronabinol was discontinued during the study period. The annual prevalence rate of use increased by 527.2%, from 21.5 (95% confidence interval [CI] 21.4-21.6) users per 100 000 people in 2004/05 to 134.9 (95% CI 134.7-135.1) users per 100 000 people in 2014/15. The annual incidence rate increased by 413.3%, from 12.1 (95% CI 12.1-12.2) users per 100 000 person-years in 2004/05 to 62.2 (95% CI 62.1-62.4) users per 100 000 person-years in 2014/15. The highest use was among older adults aged 46-64 years, females and urban area residents. One-third of incident users (1775 [35.3%]) had a diagnosis of fibromyalgia in a 2-year period before their first cannabinoid prescription. General practitioners initiated almost half (2350 [46.7%]) of first prescriptions, and anesthesiologists/pain specialists initiated one-quarter (1299 [25.8%]). INTERPRETATION:The prevalence and incidence of pharmaceutical cannabinoid use increased over time. These findings provide insight into the use of cannabinoids before the introduction of recreational marijuana, which may affect this trend.
Project description:National-level data that characterize contemporary prostate cancer patients are limited. We used 2004-2005 data from the Surveillance, Epidemiology, and End Results Program to generate a contemporary profile of prostate cancer patients (N = 82 541) and compared patient characteristics of this 2004-2005 population with those of patients diagnosed in 1998-1989 and 1996-1997. Among newly diagnosed patients in 2004-2005, the majority (94%) had localized (ie, stage T1 or T2) prostate cancer and a median serum prostate-specific antigen (PSA) level of 6.7 ng/mL. Between 1988-1989 and 2004-2005, the average age at prostate cancer diagnosis decreased from 72.2 to 67.2 years, and the incidence rate of T3 or T4 cancer decreased from 52.7 per 100 000 to 7.9 per 100 000 among whites and from 90.9 per 100 000 to 13.3 per 100 000 among blacks. In 2004-2005, compared with whites, blacks were more likely to be diagnosed at a younger age (mean age: 64.7 vs 67.5 years, difference = 2.7 years, 95% confidence interval [CI] = 2.5 to 2.9 years, P < .001) and to have a higher PSA level at diagnosis (median PSA level: 7.4 vs 6.6 ng/mL, difference = 0.8 ng/mL, 95% CI = 0.6 to 1.0 ng/mL, P < .001). In conclusion, more men were diagnosed with prostate cancer at a younger age and earlier stage in 2004-2005 than in earlier years. The racial disparity in cancer stage at diagnosis has decreased statistically significantly over time.