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Introduction In the past several decades, declining incidences of nasopharyngeal carcinoma (NPC) have been observed in Chinese populations in Hong Kong, Taiwan, Los Angeles, and Singapore. A previous study indicated that the incidence of NPC in Sihui County, South China remained stable until 2002, but whether age, diagnosis period, and birth cohort affect the incidence of NPC remains unknown. Methods Age‐standardized rates (ASRs) of NPC incidence based on the world standard population were examined in both males and females in Sihui County from 1987 to 2011. Joinpoint regression analysis was conducted to quantify the changes in incidence trends. A Poisson regression age‐period‐cohort model was used to assess the effects of age, diagnosis period, and birth cohort on the risk of NPC. Results The ASRs of NPC incidence during the study period were 30.29/100,000 for males and 13.09/100,000 for females. The incidence of NPC remained stable at a non‐significant average annual percent change of 0.2% for males and −1.6% for females throughout the entire period. A significantly increased estimated annual percent change of 6.8% (95% confidence interval, 0.1%–14.0%) was observed from 2003 to 2009 for males. The relative risk of NPC increased with advancing age up to 50–59 and decreased at ages >60 years. The period effect curves on NPC were nearly flat for males and females. The birth cohort effect curve for males showed an increase from the 1922 cohort to the 1957 cohort and a decrease thereafter. In females, there was an undulating increase in the relative risk from the 1922 cohort to the 1972 cohort. Conclusions The incidence trends for NPC remained generally stable in Sihui from 1987 to 2011, with an increase from 2003 to 2009. The relative risks of NPC increased in younger females.

Breast cancer is one of the rapidly increasing cancers among women and a significant cause of cancer-related morbidity and mortality worldwide. Therefore, the current study was designed to examine and compare trends of breast cancer incidence (BCI) during the observed period (1990-2015) in specific age groups and investigate age-specific, time period, and birth cohort-related effects on BCI in China, India, Pakistan, and Thailand. Data related to BCI were retrieved from the Institute for Health Metrics and Evaluation. Age-period-cohort model joint with intrinsic estimator algorithm was used to estimate the effect of age, period, and birth cohort on BCI. BCI rates were analyzed among different age groups ranging from 20 to 84 years in specified periods. Overall, results showed an increasing trend of BCI among four Asian countries during the study period especially in age groups 50 to 84 years. Higher incidence rates were observed in 2015 in the age group 70-74, 65-69, 50-54, and 60-64 in Pakistan, China, India, and Thailand, respectively. Age period cohort analysis revealed significantly raised effect of age and period and declined effect of the cohort on incidence rates. The current study reported increased BCI with time in selected four Asian countries. Overall, BCI remained high in Pakistan as compared to China, India, and Thailand. Although proper registries are not available in most of the developing Asian countries, the current study highlighted the increased incidence and may play an essential role in registries development or spreading awareness against this disease. Therefore, maintaining proper records to build registries at the national level along with advancements in breast cancer screening and treatment are highly recommended to deal with the increasing burden of this disease.

Background Maternal hemorrhage (MH) remains a leading cause of maternal morbidity and mortality worldwide. Understanding global trends and future projections is essential for informing effective health strategies. Methods This study drew on data from the Global Burden of Disease (GBD) 2021 study and applied hierarchical cluster analysis, the age-period-cohort (APC) model, and the Bayesian age-period-cohort (BAPC) model to assess MH incidence, age-standardized incidence rates (ASIRs), and net drift from 1992 to 2021, as well as to forecast trends through 2036. Results From 1992 to 2021, the global annual incidence of MH modestly increased from 13,847,163 to 13,914,838 cases. Despite this, the ASIR decreased from 948.07 to 722.16 per 100,000 people, with a net drift of -0.83 (95% uncertainty intervals (UIs): -1.03 to -0.64), indicating a reduction in risk, especially in low and low-middle socio-demographic index (SDI) regions. Persistent challenges remain in certain Sub-Saharan Africa countries, Eastern Europe, and East Asia. Saudi Arabia has made significant progress in managing and preventing MH. According to APC model analyses, women aged 20–29 are at the highest risk, although improvements have been observed since 2002, with decreasing risks in subsequent generations. BAPC model projections suggest that by 2036, the number of global MH cases will reduce to 10,287,971, with an expected ASIR of 479.83 per 100,000 people (95% UI: 479.82 to 479.83). Conclusions Although global MH burden has decreased, substantial disparities persist across regions and age groups. Targeted public health efforts are needed, particularly in Europe, East Asia, parts of Sub-Saharan Africa, and among women aged 20–29, to further mitigate the impact of MH.

Background Exposure to air pollution contributes to cardiovascular disease-related deaths and morbidity, including stroke. However, few studies have examined the global stroke burden linked to air pollution. This study aimed to evaluate the global stroke morbidity and mortality associated with air pollution from 1990 to 2021. Method With the Global Burden of Disease Study (GBD) 2021, the numbers, and age-standardized rates (ASRs) of deaths and disability-adjusted life years (DALYs) for air pollution-related stroke were reported globally. Further subgroup analyses were conducted by age, sex, region and country, and stroke subtypes. A linear regression model explored global temporal trends and a cluster analysis examined temporal trends across GBD regions. To predict trends until 2040, the age-period-cohort (APC) model and the Bayesian age-period-cohort (BAPC) model were applied. Results In 2021, there were 1,989,686 (95% uncertainty interval [95% UI], 1,530,479-2,493,238) deaths and 44,962,167 (95% UI, 35,020,339 − 55,467,024) DALYs due to air pollution-related stroke. The ASRs increased with age, peaking generally over 85 years. Males, the Central African region, and Guinea-Bissau showed higher stroke burdens Intracerebral hemorrhage was the most lethal subtype, with an ASR of 11.69 (95% UI 8.94–14.69) for deaths and 276.93 (95% UI 212.21-344.36) for DALYs. From 1990 to 2021, the crude number of deaths and DALYs increased by 13.4% and 6.3%, respectively, for the global stroke burden but showed a declining trend when age-standardized. Most GBD regions in Asia and Africa experienced an increasing stroke burden linked to air pollution, while Europe and America showed a decreasing trend. Predictions indicated a gradual reduction in ASRs, with higher rates in males from 2020 to 2040. Conclusions The global stroke burden associated with air pollution remained significant despite a decreasing trend until 2021. Although future predictions suggested a reduction, the crude counts for stroke burden remained substantial, with significant regional disparities. This warranted the implementation of public health policies and ongoing efforts.

For more than a century, researchers from a wide range of disciplines have sought to estimate the unique contributions of age, period, and cohort (APC) effects on a variety of outcomes. A key obstacle to these efforts is the linear dependence among the three time scales. Various methods have been proposed to address this issue, but they have suffered from either ad hoc assumptions or extreme sensitivity to small differences in model specification. After briefly reviewing past work, we outline a new approach for identifying temporal effects in population-level data. Fundamental to our framework is the recognition that it is only the slopes of an APC model that are unidentified, not the nonlinearities or particular combinations of the linear effects. One can thus use constraints implied by the data along with explicit theoretical claims to bound one or more of the APC effects. Bounds on these parameters may be nearly as informative as point estimates, even with relatively weak assumptions. To demonstrate the usefulness of our approach, we examine temporal effects in prostate cancer incidence and homicide rates. We conclude with a discussion of guidelines for further research on APC effects.

Background Inflammatory bowel disease (IBD) is a chronic and relapsing gastrointestinal disorder whose global disease burden continues to rise, making it a significant public health issue. In recent years, rapid socioeconomic development in East Asia has led to notable changes in lifestyle and dietary patterns, accompanied by dynamic shifts in the epidemiological characteristics of IBD. However, there remains a lack of systematic comparison and analysis of the long-term disease burden and evolutionary trends of IBD across five East Asian countries and regions: China, Japan, South Korea, North Korea, and Mongolia. Based on data from The Global Burden of Disease Study 2021 (GBD 2021), this study aims to comprehensively describe the trends in incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of IBD in The region from 1990 to 2021, thereby providing a basis for differentiated prevention and control strategies. Methods Descriptive analysis, Joinpoint regression, and age–period–cohort (APC) modeling were employed to examine epidemiological patterns and trends. Results Significant variations in IBD burden were observed across the region. China and South Korea experienced the most rapid increases in incidence and prevalence, exhibiting a profile of “high morbidity and low disability.” Japan demonstrated a stabilizing disease burden alongside a continuing decline in standardized mortality rates, reflecting its advanced healthcare system. North Korea and Mongolia currently have a relatively low overall burden; however, a notable rise in incidence among young Mongolians suggests an emerging risk of early-onset IBD. APC analysis further indicated complex influences from environmental factors, healthcare resource allocation, and lifestyle changes such as Westernized diets. The study proposes tailored prevention strategies: high-SDI countries should optimize geriatric care systems, medium-SDI countries should enhance preventive interventions for adolescents, and low-SDI countries should prioritize the establishment of primary screening networks. Conclusion These findings provide a scientific basis for differentiated IBD prevention and control in East Asia and contribute to a deeper understanding of the epidemiological transition of chronic diseases.

This study examines long-term trends in mortality from HIV infection and tuberculosis in Russia. We use age-specific mortality data for men and women from the Russian Fertility and Mortality Database (RusFMD/RosBRiS) of the NES Center for Demographic Research for the period 1989–2022. Based on these data, cohort mortality rates were calculated, and an age–period–cohort (APC) model was constructed. The results show a steady decline in the cohort effect on tuberculosis mortality in both sexes starting with cohorts born in the late 1970s. In contrast, for HIV infection the cohort effect indicates higher mortality risks among women compared to men, while the period effect remains similar for both sexes. The reduction in HIV mortality observed after 2017 does not reflect improved cohort characteristics among younger generations, but rather the influence of situational factors, primarily expanded access to antiretroviral therapy. These findings suggest that the HIV epidemic has moved beyond its initial high-risk birth cohorts of 1975–1985 and now poses a significant threat to younger cohorts, particularly women.

Background: Atrial fibrillation and atrial flutter (AF/AFL) disease is a common arrhythmia that poses a significant health risk to the older population. With an aging population worldwide, the incidence and mortality rates of AF/AFL show notable gender differences, presenting a challenge to public health systems. This study focused on the AF/AFL disease burden trends in high-income European Union 15+ (EU15+) countries. Methods: Data were sourced from the Global Burden of Disease Study (GBD 2021), using age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) by gender for each year from 1990 to 2021 in EU15+ countries; the mortality-incidence index (MII) was calculated. Analyses were conducted using Joinpoint regression software and age–period–cohort (APC) models to evaluate trends in morbidity, annual changes in morbidity (net drift), annual percentage changes in age-specific morbidity (local drift), and period- and cohort-relative risks by gender, allowing the impact of age, period, and cohort effects on morbidity trends to be assessed. Results: The study found a declining trend in AF/AFL ASIRs and ASMRs in most EU15+ countries, though significant differences were observed between countries. Male ASIRs and ASMRs were generally higher than those of females, though older women often had higher incidence and mortality rates than men. Furthermore, advances in treatment methods, such as updated anticoagulation therapy, radiofrequency ablation, and novel rhythm control drugs, have impacted the changes in disease burden. Conclusions: Although the AF/AFL disease burden has declined in more than half of the high-income EU15+ countries, there are significant differences in trend changes between countries. This decline may be due to advances in treatment, such as newer anticoagulation therapies, radiofrequency ablation techniques, and the use of novel cardioverter drugs. Trend changes with unique characteristics may be related to the healthcare system of each country, socioeconomic factors, and the promotion of health education. This study also identified gender differences, with older women at greater risk of developing AF/AFL, implying that the older female population faces the need for enhanced risk assessment and management.

Background In Italy, the area of Casale Monferrato in the Piedmont Region has experienced a high burden of malignant mesothelioma (MM) due to environmental contamination from Eternit, the country’s largest asbestos-cement plant, which operated from 1907 to 1986. The severity of the health impact led to the area’s designation as a Site of National Interest (SIN) for environmental and health concerns. Despite the 1992 asbestos ban, the MM epidemic persists, driven by the disease’s long latency. Using data from the Piedmont Malignant Mesothelioma Registry (RMM), we describe MM trends in Casale Monferrato’s SIN from 1990 to 2021 and project future incidence through 2042 using Age-Period-Cohort (APC) models. Methods Incidence rates (1990–2021) were estimated as smooth functions of age and calendar time using APC models with restricted cubic splines. Projections through 2042 were made using three approaches: (1) spline-unrestricted, (2) spline-restricted, and (3) constraint-based approach. Performance was evaluated by predicting 2010–2021 rates using data up to 2010 and comparing predicted to observed cases. Sensitivity to the number and position of spline knots was assessed. Results Between 1990 and 2021, 1,282 pleural MM cases (731 men, 551 women) aged 35–96 were recorded in the Casale Monferrato SIN. Occupational exposure was reported in 61% of men and 21% of women. Non-occupational exposures, including environmental and familial exposures, were common in women (58%) than in men (22%). Incidence increased with age up to 85–90 years, and with birth cohort up to 1945 (154 and 105 per 100,000 in men and women, respectively), then declined. Rates increased over time by period until the mid-2010s and began to decrease thereafter. All approaches projected a slow but steady decline, with case numbers by 2035 returning to early 1990s levels. By 2042, incidence is estimated at 31 per 100,000 in men (8 cases) and 34 per 100,000 in women (9 cases). Conclusions The three approaches yielded consistent results, predicting extinction of the MM epidemic curve around mid-century. However, the health burden will persist over the next two decades, highlighting the need for sustained environmental health surveillance.

PurposeCitation is an important measure of quality, and it plays a vital role in evaluating scientific research. However, citation advantage varies from discipline to discipline, subject to subject and topic to topic. This study aims to compare the citation advantage of open access and toll access articles from four subfields of computer science.Design/methodology/approachThis research studies the articles published by two prestigious publishers: Springer and Elsevier in the author-pays charges model from 2011 to 2015. For experimentation, four sub-domains of computer science are selected including (a) artificial intelligence, (b) human–computer interaction, (c) computer vision and graphics, and (d) software engineering. The open-access and toll-based citation advantage is studied and analyzed at the micro level within the computer science domain by performing independent sample t-tests.FindingsThe results of the study highlight that open access articles have a higher citation advantage as compared to toll access articles across years and sub-domains. Further, an increase in open access articles has been observed from 2011 to 2015. The findings of the study show that the citation advantage of open access articles varies among different sub-domains of a subject. The study contributed to the body of knowledge by validating the positive movement toward open access articles in the field of computer science and its sub-domains. Further, this work added the success of the author-pays charges model in terms of citation advantage to the literature of open access.Originality/valueTo the best of the authors’ knowledge, this is the first study to examine the citation advantage of the author-pays charges model at a subject level (computer science) along with four sub-domains of computer science.