Background: Understanding based on up-to-date data on the burden of non-communicable diseases (NCDs) is limited, especially regarding how subtypes contribute to the overall NCD burden and the attributable risk factors across locations and subtypes. We aimed to report the global, regional, and national burden of NCDs, subtypes, and attributable risk factors in 2021, and trends from 1990 to 2021 by age, sex, and socio-demographic index (SDI). Materials and methods: We used data from the Global Burden of Disease Study 2021 to estimate the prevalence, deaths, and disability-adjusted life years (DALYs) for NCDs and subtypes, along with attributable risk factors. Estimates were presented with 95% uncertainty intervals (UI). Relationships between NCD DALYs and SDI across regions and countries were estimated using smoothing splines models. Results: In 2021, NCDs accounted for 7.3 trillion global cases, 43.8 million deaths, and 1.73 billion DALYs. Global age-standardized rates showed NCD prevalence at 91 034.0, deaths at 529.7, and DALYs at 20 783.0 per 100 000 population, with changes of −0.1%, −27.9%, and −19.4% from 1990, respectively. Subtypes with the highest age-standardized DALYs were cardiovascular disease (5056), neoplasms (2954), and other NCDs (1913 per 100 000 population), with diabetes and kidney diseases increasing by 25.6% since 1990. Regionally, Oceania had the highest age-standardized DALYs (28 782.0) in 2021, while Southern Sub-Saharan Africa saw the largest increase (+8.0%) since 1990. Nationally, Nauru reported the highest age-standardized DALYs (42 754.3), with Lesotho experiencing the largest increase since 1990 (+38.4%). Cardiovascular diseases had the highest age-standardized DALYs among subtypes across 16 of 21 regions and 159 of 204 countries. Key risk factors globally were high systolic blood pressure (contributing to 12.8% of age-standardized DALYs), dietary risks (10.0%), and tobacco usage (9.9%), with the most significant increase in high body-mass index (+57.8%). High systolic blood pressure was the biggest attributable risk factor for NCDs in 9 regions and 101 countries. Age-standardized data reveal higher NCD prevalence in women and greater mortality and DALYs in men, with DALYs spiking post-45 for both sexes. Men have higher DALYs attributed to most risk factors, excluding those from unsafe sex, intimate partner violence, low physical activity, and high body-mass index. Age-standardized DALYs of NCDs generally decline with the SDI spectrum. Dominant NCD risk factors follow gender-age and SDI-based trajectories. Conclusion: Despite declining age-standardized prevalence, death rates, and DALYs for NCDs, they remain a major health issue. Emphasis on managing cardiovascular diseases, cancers, diabetes, kidney diseases, and mental disorders is essential. The burden of NCDs is more severe in low-SDI countries and among males. Prevention efforts should prioritize blood pressure control, dietary improvements, and tobacco reduction, tailoring interventions according to gender-age-based and SDI-development-based trajectories of dominant risk factors.

Background: Previous research has documented mental health status among rural-to-urban migrant children (labeled as “migrant children” henceforth) and urban children. However, the findings remain unclear. In addition, far less attention has been paid to rural children’s psychological outcomes. The purpose of this study was to compare mental health status among migrant, urban and rural school-age children in Guangdong Province, China. Methods: This was a cross-sectional study involving 372 migrant, 254 urban and 268 rural children selected respectively from 3 private schools, 4 public schools and 2 village schools in Guangdong Province, China. Participants provided their socio-demographic information and completed the Strengths and Difficulties Questionnaire (SDQ) to assess mental health. One-way analyses of variance (ANOVAs) and Bonferroni post hoc test were used to evaluate SDQ scores differences. A multiple linear regression analysis was conducted to measure mental health differences among children after controlling for socio-demographics. Chi-square analyses were used to assess differences in the prevalence of mental health problems among children. Results: Bonferroni post hoc test showed that migrant and rural children reported significantly higher scores than urban peers in emotional symptoms, hyperactivity/inattention and total difficulties score (p < 0.01). In addition, migrant children reported a higher peer problems score compared to urban children (p < 0.001). In multiple linear regression analysis, rural and migrant children reported significantly a higher total difficulties score than urban children (p = 0.046 and 0.024, respectively). Additionally, female gender, having insurance, seldom communicating with parents, and higher monthly household income were negatively associated with a higher total difficulties score. Conversely, children’s father with secondary education was positively associated with a higher total difficulties score. The prevalence of mental health problems among rural, migrant and urban children were 26.5, 18.8 and 15.0% (χ² = 11.41, p = 0.003), respectively. Conclusions: Rural and migrant children reported poorer mental health than urban children. Female gender, having insurance, seldom communicating with parents, and higher monthly household income were associated with better mental health of children. However, children’s father with secondary education was associated with poorer mental health of children. Given the different effects of socio-demographics, further support might be provided accordingly to improve the mental health of school-age children.

Background and aims: Smoking is a risk factor for low back pain (LBP) and rheumatoid arthritis (RA). We aimed to estimate the global health and economic burden of LBP and RA attributable to smoking.Design: This was a cross‐sectional study.Setting: The study was conducted in 192 countries and territories.Cases: Prevalent cases of LBP and RA were used, extracted from the Global Burden of Diseases, Injuries and Risk Factors Study 2019 data repositories.Measurements: Smoking‐attributable health and economic burden was estimated with the population‐attributable fraction method. Smoking‐attributable prevalence of LBP and RA and health‐care costs were estimated for patients of all ages, whereas years lived with disability (YLDs) and productivity losses due to morbidity were estimated for patients aged 15–84 years. Uncertainty intervals (UIs) of the results were obtained by repeating the analysis with the lower and upper bounds of all input variables.Findings: Globally, smoking accounted for 84.5 million (UI = 56.7–120.2 million) prevalent cases of LBP, 1.8 million (UI = 0.5–3.4 million) prevalent cases of RA and 11.3 million (UI = 6.2–18.5 million) YLDs, which represented 1.5% of all‐cause YLDs in the working‐age population aged 15–84 years in 2019. Health‐care costs and productivity losses of smoking‐attributable LBP and RA cost the global economy purchasing‐power parity $326.0 billion (UI = $184.0–521.4 billion), representing 0.2% of the global gross domestic product. Specifically, smoking accounted for $65.8 billion (UI = $38.0–101.2 billion) in health‐care costs world‐wide, with more than half [$39.8 billion (UI = $23.1–61.3 billion), 60.6%] borne by the public sector. Smoking also contributed to $260.3 billion (UI = $146.0–420.3 billion) in productivity losses globally. Approximately 60.0% of the global YLDs were observed in middle‐income countries, whereas 84.4% of health‐care costs and 72.7% of productivity losses were borne by high‐income countries.Conclusions: Globally, in 2019, smoking accounted for more than 11.0 million years lived with disability and purchasing‐power parity $326.0 billion in economic losses due to low back pain and rheumatoid arthritis. Middle‐income countries suffered more morbidity, whereas high‐income countries experienced larger economic losses.

To examine non-restorative sleep and its impact on quality of life (QOL) in Chinese adolescents, this cross-sectional study included 2827 students aged 12–20 who were selected from 15 secondary schools in Hong Kong, China. Non-restorative sleep was assessed by a single item, rated on a 0–10 scale: “To what extent did you feel refreshed upon awakening over the past month?”. QOL was evaluated by the World Health Organization Quality of Life Measure—Abbreviated Version Hong Kong Chinese Version. Univariable and multivariable linear mixed-effects regressions were conducted to examine the influence of non-restorative sleep (NRS) on QOL. In the present sample, the mean overall QOL was 13.83, and the extent of feeling refreshed upon awakening was 4.75 on average. In multivariable linear mixed-effects regression, one unit feeling less refreshed upon awakening was associated with 0.37 units of poorer overall QOL after adjusting for age, gender, medical conditions, parental education and occupation, weekly hours of aerobic exercises, smoking and drinking habits. Additionally, adolescents with a significantly poorer overall QOL were more likely to be older, have medical problems, have parents with an educational level of primary school or below, have an unemployed father, engage in less weekly aerobic exercise, and be current smokers or former drinkers. Adolescents who experienced non-restorative sleep had a poorer QOL. Future studies are needed to alleviate non-restorative sleep to improve health outcomes in adolescents.

Objectives This study aimed to examine the psychometric properties of the traditional Chinese version of the Youth Attitude to Noise Scale (YANS) in a large representative sample. Design Cross-sectional study. Setting 15 secondary schools in Hong Kong, China. Participants 2842 adolescents aged 12–20 years participated in this study between April and July 2016. Methods The standard forward–backward validation procedures were followed to obtain the traditional Chinese version of the YANS. Prior to the formal investigation, the YANS was evaluated by cognitive debriefing. The sample was randomly divided into two halves for exploratory factor analyses (EFAs) and confirmatory factor analyses (CFAs), respectively. The number of factors was determined by comparison data approach using EFAs, and the factor structure was confirmed by CFAs using the one-factor, four-factor and bifactor models. The scale’s internal reliability, dimensionality and measurement invariance across gender and age groups were also examined. Results EFAs (n=1338) showed that four factors were extracted, and CFAs (n=1337) demonstrated the bifactor model fitted better to the sample than the other models. Additionally, the traditional Chinese version of the YANS showed high reliability (ω=0.84), a general factor, scale multidimensionality, and gender and age invariance. Conclusions The findings of the current study indicate that the traditional Chinese version of the YANS is a feasible instrument to assess attitude to noise in Chinese adolescents, regardless of their gender and age. Given the presence of a general factor, the YANS is not merely multidimensional, and whether to use the total or subscale scores is recommended to rely on research objectives.

Objective: This study aims to investigate the prevalence of non-specific low back pain (NLBP) over the past 12 months and to determine its associated factors among Chinese older people aged 60 years and over. Methods: A cross-sectional study on NLBP prevalence was conducted at seven communities between July 2024 and January 2025. Data on demographic characteristics, lifestyle, and labor-related factors were also collected. This study included those who had suffered from LBP over the past 12 months. The univariate and multivariate Poisson regression analyses were used to examine the factors for the prevalence of LBP. Results: Of the 286 participants, 129 (45.1%) were females and 174 (60.8%) were in the 60–74 year age group. Overall, the prevalence of NLBP in Chinese people aged 60 and above was 26.2% (95% CI: 21.1, 31.4). Females (adjusted prevalence ratio [aPR]: 6.09, 95% CI: 3.09, 12.00), participants aged 85 years and over (aPR: 1.86, 95% CI: 1.26, 2.73), participants with a body mass index (BMI) ranged from 25.0 and 29.9 kg/m ² (aPR: 2.23, 95% CI: 1.29, 3.85), being current smokers (aPR: 4.39, 95% CI: 1.99, 9.69), being former drinkers (aPR: 1.58, 95% CI: 1.04, 2.38), having daily sitting reaching 8 h or longer (aPR: 1.73, 95% CI: 1.26, 2.39), no weekly exercise (aPR: 2.36, 95% CI: 1.50, 3.73), and daily work involving bending (aPR: 2.66, 95% CI: 1.58, 4.48) were associated with NLBP. Conclusion: NLBP was common in Chinese people aged 60 years and above. Gender, age, BMI, smoking, alcohol drinking, daily sitting reaching 8 h or longer, weekly exercise, and daily work involving bending were associated with the prevalence of NLBP. This study calls for tailored interventions such as launching public health campaigns, organizing social and sporting events, encouraging ergonomic adaptations, and establishing surveillance systems to reduce the LBP burden among Chinese older people.