Pulmonary embolism (PE) remains a major contributor to the global disease burden. However, disparities in international trends of PE-related mortality have not been comprehensively examined across geographic, economic, and healthcare system parameters. We employed multifaceted stratification to analyse long-term trends in PE-related mortality. This epidemiological analysis used registration data from the World Health Organization Mortality Database. PE-related mortality was defined with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes for acute PE (I26) and any forms of venous thromboembolism (I80, I822, I828, I829, O882, O222, O223, O229, O870, O871, and O879). Countries were deemed eligible for inclusion in the analysis if they provided mortality data for 5-year age intervals up to ≥85 years, from 2001 to 2023 (last update, February 2025). Countries with incomplete age- and sex-stratified demographic data were excluded. We used locally weighted regression (LOESS) to show global trends in crude and age-standardised mortality rates. Subgroup analyses by geographic region and income level were also performed. Additionally, joinpoint regression analysis was performed to estimate the average annual per cent change (AAPC) in the age-standardised mortality trends for each country during 2010–2023. Data from 73 countries, encompassing 1,550,883 participants [57.8% (896,393) of whom were female], were eligible for the LOESS analysis, while those from 75 countries, including 915,518 participants (56.9% (520,587) of whom were female) were valid for the joinpoint analysis. The LOESS estimates of global age-standardised PE-related mortality rate (per 100,000) decreased from 3.49 (95% confidence interval [CI], 3.20–3.79) in 2001 to 2.42 (95% CI, 2.04–2.80) in 2023. The age-standardised mortality rates considerably reduced in European regions, such as Western Europe, from 5.24 (95% CI, 4.75–5.74) to 2.25 (95% CI, 1.62–2.87) in 2023; however, in Africa, they remained high from 4.23 (95% CI, 3.82–4.64) in 2001 to 3.90 (95% CI, 2.81–5.00) in 2023. High-income countries showed a continuous downward trend, from 3.68 (95% CI, 3.28–4.08) in 2001 to 2.20 (95% CI, 1.68–2.71) in 2023, whereas lower-to middle-income countries showed a rising trend, from 0.92 (95% CI, 0.04–1.81) in 2001 to 4.82 (95% CI, 3.12–6.52) in 2023. Higher increases in the age-standardised mortality rates were predominantly observed in lower-middle-income countries. Globally, the PE-related mortality rate has declined over the last two decades, except in countries with certain geographical and economic conditions. Despite the potential limitation of misclassification and underreporting, our efforts corroborated that greater efforts are needed to reduce PE-related mortality, especially for populations in susceptible regions and lower-middle-income countries. A multi-layered approach will increase awareness of the disease and facilitate the development of healthcare policies that enhance its clinical management. The Japan Society for the Promotion of Science, the 10.13039/100014475 Pfizer Health Research Foundation , and the Ohyama Health Foundation Inc.

Background & Aims: Biliary tract cancers (BTCs), including intrahepatic cholangiocarcinoma (iCCA), extrahepatic cholangiocarcinoma (eCCA), gallbladder cancer (GBC), and ampullary cancer, exhibit poor prognosis. This study examined temporal trends in mortality due to BTCs and their major subtypes at international, regional, and national levels. Approach & Results: This observational study used the World Health Organization mortality database. Locally weighted regression (LOESS) was used to produce a smoothed curve of long-term international and regional BTC and major subtype-related mortality rates in 2000–2022 based on available data from countries. Trends in age-standardised mortality rates (ASRs) during 2013–2022 for individual countries were examined using joinpoint regression analysis. Internationally, LOESS-smoothed ASRs per 100,000 population due to BTCs were 2.8 (95% confidence interval: 2.5–3.1) in 2000, and 2.7 (2.3–3.1) in 2022. LOESS-smoothed BTC-related ASRs were the highest in the Western Pacific region at 4.2 (1.8–6.6) in 2022, compared with those in the European and American regions at 2.6 (2.3–2.9) and 2.2 (1.8–2.6), respectively. Among major subtypes, LOESS-smoothed ASRs due to iCCA increased by 120.0%, those due to GBC decreased by 45.5%, and those due to eCCA remained stable between 2000 and 2022. Disparities in BTC and major subtype-related ASR trends were observed between countries during 2013–2022, with iCCA-associated ASRs showing increasing trends in many countries. Conclusions: Although internationally estimated BTC-associated ASRs showed a stable trend over the last two decades, a large increase in estimated iCCA-associated ASRs necessitates developing effective screening for high-risk individuals and disease management strategies. Export

Globally, the numbers of head and neck cancer (HNC) cases and related deaths have recently increased. In Japan, few studies have examined crude or age-adjusted HNC mortality rates. Therefore, this study aimed to determine the trends in crude and age-adjusted mortality rates for HNC per million individuals in Japan from 1999 to 2019. Data on HNC-associated deaths were extracted from the national death certificate database using the International Classification of Diseases, Tenth Revision (n = 156,742). HNC mortality trends were analysed using joinpoint regression models to estimate annual percentage change (APC) and average APC (AAPC). Among men, no significant change was observed in the age-adjusted death rate trend from 1999 to 2014; however, a marked decrease was observed from 2014 to 2019. No changing point was observed in women. Age-adjusted mortality rates continuously decreased over the 21-year period, with an AAPC of −0.7% in men and −0.6% in women. In conclusion, the overall trend in age-adjusted rates of HNC-associated deaths decreased, particularly among men, in the past 5 years. These results will contribute to the formulation of medical policies to develop targeted screening and prevention programmes for HNC in Japan and determine the direction of treatment strategies.

Background/Objectives: Five musculoskeletal disorders (MSDs), including gout, low back pain, neck pain, osteoarthritis, and rheumatoid arthritis represent a growing public health burden; however, evidence from the Association of Southeast Asian Nations (ASEAN) remains limited. This study aimed to assess the burden of these five MSDs across ten ASEAN countries. Methods: Using data from the Global Burden of Disease Study 2023, we estimated the burden using prevalence and disability-adjusted life years (DALYs). National trends from 1990 to 2023 were assessed using average annual percent change (AAPC). Results: From 1990 to 2023, the absolute numbers of prevalent cases and absolute numbers of DALYs increased, with low back pain and osteoarthritis accounting for large shares across the ten countries. Country-level patterns differed between absolute numbers and age-standardised rates of the five MSDs. In 2023, age-specific absolute numbers of prevalent cases and absolute numbers of DALYs increased with age before declining in older age groups, with peak ages varying across the five MSDs. Across the five MSDs, age-standardised prevalence rates were generally higher among females, while gout showed higher rates among males. Age-standardised prevalence rates showed generally modest positive AAPCs for osteoarthritis, rheumatoid arthritis, and gout, whereas low back pain and neck pain showed decreasing trends in most countries. Conclusions: The increasing burden in absolute numbers of the five MSDs across the ten ASEAN countries, together with persistent sex disparities, differences in age-specific patterns, variations in age-standardised trends, and considerable country-level heterogeneity, highlights the need for continued attention to the burden of the five MSDs in the region.