Is Public Health Declining?

The State Of Western Health As Evidence Against Mutational Load

Navigation:

Introduction & Summary
Narrative Review:
—[Congenital Heart Disease]
—[Homosexuality]
—[Left Handedness]
—[Autoimmune Disorders (Cœliac, Crohn’s, & Inflammatory Bowel Diseases, etc)]
—[Hypothyroidism]
—[Lupus]
—[COPD & Chronic Respiratory Diseases]
—[Parkinsonism, Alzheimer’s Disease, & Dementia]
—[Multiple Sclerosis]
—[Sleep Apnea]
—[Cancers]
—[Impulse Control]
—[Blood Pressure, Diabetes, Cardiovascular Health, & Obesity]
—[Bipolar Disorder]
—[Depression]
—[Autism]
—[Neuromuscular Disease]
—[Peripheral Artery Disease]
—[Sarcoidosis]
—[Dry-Eye Disease]
—[Chronic Fatigue Syndrome]
—[Fibromyalgia & Chronic Widespread Pain]
—[Periodontal Health]
—[Leprosy]
—[Arthritis, Renal Disease, & Miscellaneous Age-Associated Diseases]
—[Symptomatic Kidney Stone Disease]
The Global Burden Of Disease Dataset:
—[Main Categories]
—[All Categories]
—[Mental Disorders]
—[Neurological Disorders]
—[Congenital Birth Defects]
—[Neoplasms (i.e. Cancers)]
—[Cardiovascular Diseases]
—[Chronic Respiratory Diseases]
—[Digestive Diseases]
—[Diabetes & Kidney Diseases]
—[Skin & Subcutaneous Diseases]
—[Musculoskeletal Disorders]
—[Other Non-Communicable Diseases]
—[Communicable, Maternal, Neonatal, & Nutritional Diseases]
References

Introduction & Summary:

Recently on twitter I saw somebody post the following (unsourced) graph [1]:

It got about the reaction I was expecting [2]:

 In principle, one could remark that “what’s asserted without evidence can be dismissed without evidence”, but this is an argument that’s been pursued before with a greater degree of rigor, albeit for a different set of outcomes [3]:

 In practice then, dismissing these claims without evidence is more akin to denying the rarity of pedophilia:

 For any given aspect of declining health, one can always produce no end of speculation as to possible environmental reasons that it might be happening. However, if declines are happening everywhere, then this requires that causes be posited which are of greater ætiological generality. This is the strength of an explanation which attributes declines to mutation (i.e. generalized declines in genetic quality within the population). Randomly-generated sequences of DNA generally do not code for anything. Most possible strings of DNA would produce nothing but a useless pile of goo. As such, mutation should be understood as genetic entropy. As the story goes, since industrialization and modern medicine have eliminated infant mortality, this is to be understood as a partial abolition of the Malthusian selection pressures which were once a check against this genetic entropy, and so one might expect generalized declines in genetic health as a result.

 Alternatively, if other causes of similar ætiological generality can be shown to be explanatory, or if the premise of general declines in health are false to begin with, then one need not worry so much. I propose two alternative explanations possessing the same ætiological generality:

1.  As fertility has collapsed and life expectancy has increased, the population pyramids of industrialized nations have come to look like this [4, figure 2.A]:

   

    Given that the elderly tend to be less generally healthy than the young, one should expect declines across the board simply due to aging populations. It is entirely possible for overall disease prevalence to rise even as age-standardized disease prevalence declines.

2.  There is a difference between disease prevalence and disease incidence. Western health systems are generally becoming better with time, and the consequence of this is that as the mortality rate of a disease declines, the people afflicted by it can become a larger percentage of the population even as the yearly rate of new cases declines. Ideally, we should want to verify systemic rises in age-standardized disease incidence.

 In addition to these factors, there’s also the problem of there being hundreds of ailments somebody can be afflicted with, meaning that there’s a need to try to study a large, unbiased selection of them, and to rely upon a comprehensive selection of the evidence that exists on any one of them. Generally speaking, rather than limiting ourselves to any one country, we also care about any region of the world that happens to be inhabited by people of Nordic or Western-European ancestry.

To accomplish all of these goals, I take two approaches:

1.  First, on google scholar, I search the following along with a couple of analogous searches up to about page 10 or so, or just when I got tired:

   (disease OR anemia OR disorder OR pathology) AND "incidence" AND ("over time" OR trends OR "trends in" OR "trend in" OR "time-series" OR "time series" OR "increase in") AND (developed OR industrialized OR OECD OR Europe OR "United States" OR "North America")

    If a particular ailment kept coming up and drowning out other results, I’d modify searches to exclude it and mark it as something to look into individually (i.e. I’d repeat the search again but replacing “(disease OR anemia OR disorder OR pathology)” with whatever excluded ailment). In addition to manually-excluded ailments, I’d also pay individual attention to every disorder on the meme graph, every disorder from Bronski’s list, and a couple of miscellaneous conditions I’d happened to think of which had evidence readily available.
    If I could only find information on prevalence, then if it was stable or declining, I considered this prima-facie evidence against an increase in age-standardized incidence. The same goes for age-standardized prevalence and for raw incidence, whatever the most rigorous available standard happened to be. If increases were evident for age-standardized incidence, this was considered prima-facie support for a mutational-load view. There weren’t many of these however, and when they occurred, I took the liberty to see if some other explanation could be confirmed, whether this be changes in measurement, an environmental origin of the rise, etc.  In summary, there are very few ailments seeing a rise in age-standardized incidence which could possibly be consistent with a mutational-load explanation, and the stability or decline in everything else contradicts the view that a mutational-load explanation is advantaged by its ætiological generality.

2.  Second, I use the 1990-2019 Global Burden of Disease Study [5], which tabulates yearly data for the 337 leading ‘causes of death’ across 188 nations. Specifically, I look at changes from 1990 to 2019 in age-standardized incidence rates for 261 relevant ailments (i.e. excluding things like physical injuries) for which there is data within 7 nations of interest: The United States of America, Great Britain, France, Germany, Luxembourg, Spain, and Portugal.
    The United States is the country with the highest White population, Portugal is the Western-European country with the most-dysgenic fertility [6], Luxembourg has Europe’s highest per-capita GDP and lowest infant mortality rate [7] (excluding Monoco, a city state having a below-100k population which causes problems for calculating per-100k incidence rates), Germany is the most industrialized country in Europe, accounting for 26% of European production capacity [8], France was the first country in the world to undergo the fertility transition [9, figure 1], England was the first nation in the world to industrialize [10, ch.12-13], and Spain is the Western-European country with the lowest fertility rate [11].
    Broadly, I find that outcomes are evenly split between age-standardized incidence rates rising and declining, even for the categories of highest theoretical relevance (these being mental disorders, neurological disorders, congenital birth defects, and neoplasms i.e. cancers). The headline results are as follows:

   

    In addition to the analyses presented here, some day I’d also like to also factor analyze the between-nations variation in all ailments to see what the different dimensions of health are, and to come up with a dimension of general (especially ‘innate’) health before employing latent growth modelling to see if the changes can be predicted by national-level differences in dysgenics and in infant mortality, controlling for national IQ and per-capita GDP. As it stands however, the analyses I present today took long enough, and I’ll only do a part 2 if this initial post generates enough paid subscriptions to justify the required time investment.

Narrative Review

Congenital Heart Disease:

 The global prevalence of congenital heart disease has increased from 0.6 per 1000 in 1930 to 9.1 per 1000 after 1995, which is important because CHD accounts for nearly one-third of all major congenital anomalies [12]. This cannot be blamed on third-world fertility as it has also increased within china, from 0.201% in 1980-1984 to 4.905% in 2015-2019 [13]. One might suspect that it's a rise in prevalence rather than incidence though, as mortality for the condition has decreased by 31% between 1987 and 2005 [14], but this is implausible since it's birth prevalence being measured. While the example of congenital heart disease is probably one of the best things that a mutational-load account has going for it, the trend has stagnated from 1990-2017 [15]; in central europe, western europe, north america, and australia, the percent change in prevalence at birth over this time period was -0.4%, +18.2%, -0.3%, and +0.5% respectively. For low, low-middle, middle, high-middle, and high SDI countries, the percent changes over this time period was -0.6%, -1.6%, -2.4%, -1.9%, and 0.6% respectively [15].

Homosexuality:

 The rise in homosexuality is real and not completely attributable to rises in tolerance, albeit it's mostly a rise in bisexuality, one stronger among women then men, as one might predict if, instead of tastes changing, increasing proportions of the 'sexually fluid' merely began expressing their diverse tastes [16].

Left Handedness:

 A k=262 meta-analysis found no significant correlation between publication year and percent left handed [17].

Autoimmune Disorders:

(Cœliac Disease, Crohn’s Disease, Inflammatory Bowel Disease, etc)

 Autoimmune disorders within industrialized nations are (mostly) increasing, but we have strong evidence that the rise is environmental in origin. First let’s take note of the evidence for rising incidence:

• [18] A systemic review of studies from 1985 to 2015 found rheumatic, endocrinological, gastrointestinal, and neurological autoimmune diseases to have annual increases of 7.1%, 6.3%, 6.2%, and 3.7% respectively.

• [19] An N = 22,009,375 UK cohort study found a significant change in the proportion of people with at least one autoimmune disorder (IRR = 1.04), with the growth being especially large for Cœliac disease (IRR = 2.19), Sjogren's syndrome (IRR = 2.09), and Graves' disease (IRR = 2.07), although Pernicious Anaemia (IRR = 0.79) and Hashimoto's thyroiditis (IRR = 0.81) showed decreased incidence.

• [20] As the meme graph claims, this meta-analysis finds that the age-standardized incidence Cœliac disease has unambiguously increased more than 10-fold since 1980.

• [21] This systemic review from 1985-2018 found an increase in the incidence of pædiatric-onset inflammatory bowel disease.

• [22] Interestingly enough, this meta-analysis found no increase in the incidence of Crohn's disease (i.e. one of the major types of IBD).

• [23] This representative UK study found a decrease in the incidence of dermatitis herpetiformis from 1990 to 2011.

• [24] In 20-29 year old women within industrialized nations, this paper found an increase in incidence of pelvic inflammatory disease between 1960 and 1980 on the order of a factor of 1.6-1.9.

 Now how do we know that the rise is environmental in origin? Well, studies of immigrant groups moving to different nations find that autoimmunity changes to reflect that of host populations [21, p.2742; & 25, p.912], and this works both for high-autoimmunity groups moving to low-autoimmunity areas (e.g. Pakistanis moving to the UK) and for low-autoimmunity groups moving to high-autoimmunity areas (e.g. Englishmen moving to Australia). Looks like magic dirt theory isn’t so silly in this case. Moreover, we have a good idea of the mechanism. The primary defect shared by people with autoimmune diseases is a dysfunction of TJ (intestinal tight junction) regulation, and there's a strong case that various additives within industrially processed foods induce intestinal permeability, with consumption of these additives having steeply risen over time [26]. Animal experimentation studies feeding mice the same ingredients also find such diets to result in autoimmune diseases [27, p.7], although interestingly, not in bacteria-free conditions, thereby suggesting that microbiome disruptions are the mechanism by which these ingredients cause TJ defects. Do the animal studies generalize? Well, we have two meta-analyses of experiments finding that autoimmune disease remission can be induced either by administering priobiotics and synbiotics [28], or by transplanting fæcal matter from healthy people to patients with autoimmune disorders [29].

Hypothyroidism:

 A meta-analysis found that between 1969 and 2020, the incidence of congenital hypothyroidism at birth increased in Europe from 2.32 per 10,000 to 3.73 per 10,000, and in high-income countries from 2.37 per 10,000 to 3.59 per 10,000; increases also were not attributable to changes in screening [33]. Hypothyroidism is another autoimmune disorder however. One might suspect that like other autoimmune disorders, the increase in incidence of congenital hypothyroidism might be due to increased consumption of additives in processed foods. Indeed, when cases due to dyshormonogenesis are excluded, immigrant groups moving to foreign countries adopt the disease rates of their new environments [34]. However, a nationwide, multicenter French analysis found not only that there was an increase in the incidence of congenital hypothyroidism which wasn't attributable to diognistic changes, but the increase was exclusive to cases of dyshormonogenesis (i.e. cases attributable to inborn errors in the eutopic glands responsible for thyroid hormone synthesis rather than cases attributable to problems in embryonic development) [35]. Indeed, other studies have found that cases due to dyshormonogenesis have risen to account for 30% of cases of hypothyroidism, as opposed to the prior proportion of 15% [36, p.5].

 Hypothyroidism is probably the single most appealing case for an ML account of health declines. A review of twin studies found liability for thyroid disease to have a heritability of ~75% [37]. Another study found that patients with congenital hypothyroidism had a high frequency of mutations within candidate genes for dyshormonogenesis [38]. Contrary to most autoimmune disorders, the emergence of hypothyroidism is probably genetic in origin. However, even if something is increasing for genetic reasons, this does not necessarily imply that it is increasing due to mutation.

 One alternative explanation to offer is immigration. In New Zealand, the incidence of congenital hypothyroidism has been increasing, but this is exclusively due to Asians and Pacific Islanders becoming larger proportions of the population; race-specific rates remained constant [39]. In the United States as well, it’s also arguably true that the growth in congenital hypothyroidism is entirely driven by Hispanic immigration [40]. At the national level, no ethnic group had any change with p<0.01, and arguably, with a multiple testing correction, Whites wouldn't even be p<0.05 either [40, table 2]:

When all states are put together, this restricts the range of time for which data is available, but within-state analyses of Texas and Massachusetts give further reason to doubt any increase among Whites. Massachusetts is one of the Whitest (>90%) and highest-latitude states in the union, and correcting for birth weight (a primary risk factor for congenital hypothyroidism at birth, with cases of this ætiology being imperative to ignore since they naturally cure themselves with age), the incidence trends in Massachusetts look like this [40, figure 9]:

In Texas, the incidence rate for non-Hispanic White boys increased while the incidence rate for non-Hispanic White girls decreased, such that the overall trend was a significant decrease [40, p.S44]. There was a significant within-Mestizo increase, but A) Mestizos aren’t a group we care about; and B) Mestizo immigrants to the United States have been increasing in Amerindian ancestry since the 1940s [41].

 Immigration explanations however work less well for locations like France [35], Québec [42], Ireland [43], and other areas of Europe with known increases [44]. Still, the fact that genetic increases in hypothyroidism aren't omnipresent within wealthy western European populations is a problem for a Mutational-Load account of decline. Why the differences? Well, there's another way that genetic propensities can change without mutational pressure: selection. A recent meta-analysis found pediatric patients with hypothyroidism to score 10.48 IQ points lower than controls [45]. Of course, with more-educated women having children later in life, dysgenic selection for intelligence is pervasive throughout the world [6]. If selection against hypothyroidism is a consequence of selection for intelligence, one might also expect selection against intelligence to result in rises in hypothyroidism. Are the European rises in hypothyroidism also happening in the countries with less-dysgenic fertility? Finland is the 5th-least dysgenic nation on the planet [6], and as it turns out, large, representative cohort studies in Finland have found the incidence of hypothyroidism to be the same in 2017 as in 1994 [46].

Lupus:

 A systemic review of studies on the incidence of lupus [50] found that incidence decreased in the UK from 1999 to 2012 (this is in spite of prevalence in the UK increasing over the same time period), decreased in the USA from 1980 to 2005, increased in denmark from 1980 to 1994, increased in greece from 1982 to 2001, and increased in the USA from 1950 to 1992. Lupus is also an autoimmune disorder, so we'd expect similar rises for the same environmental reasons we see rises in the other autoimmune diseases.

COPD & Chronic Respiratory Diseases:

 Due to a decrease in the mortality of the disease, this Québec cohort study found that Chronic Obstructive Pulmonary Disease (COPD) has decreased in age-standardized incidence from 2001-2011 despite increasing in age-standardized prevalence over the same time period [30]. When prevalence isn’t standardized to a constrant age distribution across time periods, the prevalence increase is also substantially inflated [31]. Another study using the global burden disease also aligns with my analysis, finding that despite increasing prevalence, trends in most chronic respiratory diseases are not cause for concern within high-SDI countries [32, fig.4]:

Parkinsonism, Alzheimer’s Disease, & Dementia:

 The incidence of Dementia has been decreasing while the incidence of Alzheimer’s Disease has remained steady in the West, although the incidence of Alzheimer’s has been increasing in non-Western countries [47 & 48]. As for Parkinsonism, incidence among Americans has increased, but only for men [49].

Multiple Sclerosis:

 The numbers in my analysis of the GBD study are a complete nonsense due to what has to be a coding error (incidence rates above 500k per 100k). By contrast, in this systemic review [51], when looking at representative samples with consistent measures of multiple sclerosis, there was no evident pattern of MS incidence increasing; of these 3/9 studies finding an increase, two were Canadian and thus redundant, and the third was in Taiwan, a country of non-interest. Even these Canadian results might plausibly be attributed to the country's aging population, as in the Canadian study with measures of pædiatric-onset multiple sclerosis which were consistent across time, no change in incidence was evident.

Sleep Apnea:

 The rise in sleep apnea is real. I couldn't find any other evidence to go on, but in the US, age-specific incidence rates in the military increased between 2005 and 2014 [52].

Cancers:

 There are many different types of cancer, and as is evident from my analysis of the Global Burden of Disease dataset, whether or not incidence rates are increasing depends on the type of cancer. I didn’t bother to check too many of these, but a few types we might consider of particular interest to mutational-load theory are those which affect the reproductive systems of men and women; these seem to be declining:

• [53] Between 1970 and 2015, industrialized nations have seen no obvious pervasive increases in the age-standardized incidence of ovarian cancer.

• [54 & 55] Penile cancer incidence in the USA decreased from 1973-2002 [54] before stagnating from 2000-2014 [55].

• [56] This paper found that the incidence of colorectal cancer in the United States decreased from 54.5 in 2000 to 38.6 per 100,000 in 2014.

• [57] This paper found that from 1976 to 2005, the age-adjusted incidence of proximal colon, distal colon, and rectal cancers per 100,000 population in the US decreased from 22.5, 18.8, and 19.2 to 21.1, 11.7, and 13.6, respectively.

• [58] This CDC report found age-adjusted melanoma incidence in the US to have doubled from 1982 to 2011.

• [59] This GBD study paper found large age-standardized increases in the incidence of primary liver cancer from 1990 to 2016 which were particularly large within high-SDI countries [59, fig 1.b & fig 1.c]:

  

• [60, table 1] Lip and oral cavity cancer incidence has increased all over the world except for high-SDI countries where it has decreased. Nasopharnygeal cancer incidence has decreased everywhere, and other pharyngeal cancer incidence has increased everywhere.

The United States is the nation where we have the most comprehensive cancer data, and since 1975, the “Annual Report to the Nation on the Status of Cancer” has documented a sustained decline in the overall age-standardized cancer incidence [100].

Impulse Control:

 It may surprise many to learn that impulse control among children has been increasing over the past 50 years [61]. This arguably also seems to be reflected in many aspects of youth behavior. Traditionally, it’s been understood that there’s a relationship between age and crime, with younger people committing more offenses; recently however, the age-crime curve has been weakening [62]. Young people are also drinking and smoking less these days [63 & 64] and having less casual sex [65 & 66].

Blood Pressure, Diabetes, Cardiovascular Health, & Obesity:

 Diabetes has been rising around the world. A systemic review [81] found that age-specific incidence rates of type-2 diabetes had been increasing throughout the industrialized world until around 2000, after which incidence started decreasing everywhere except for Denmark and Germany. The GBD dataset by contrast found widespread persistent increases.

 A meta-analysis of RCTs finds that cardiovascular health is improved by drugs which lower blood pressure, with effects not moderated by type of drug [67]. High blood pressure is also a primary risk factor for diabetes [87], and there is strong evidence that obesity is causal for higher blood pressure [88 & 89]. The obese have 7.19 times the relative risk of developing diabetes [90], and the association remains even among people with normal metabolic health [91].

 How have each of these things been changing over time? BMI increased persistently in Great Britain and in the United States between 1930 and 2000 [92] before stagnating in the United states from 2003 to 2012 [93]. Obesity in Sweden also increased between 1960 and 2010 [94], and a meta-analysis found that childhood obesity increased in Europe between 1999 and 2016 [95]. As we might expect from this, diabetes has been rising around the world. A systemic review [81] found that age-specific incidence rates of type-2 diabetes had been increasing throughout the industrialized world until around 2000, after which incidence started decreasing everywhere except for Denmark and Germany; the GBD dataset by contrast found widespread persistent increases. How about blood pressure and cardiovascular health? As it turns out, another meta-analysis finds that if anything, blood pressure among children has been decreasing despite the increase in obesity [68]. Another US study tracking trends in cardiovascular health metrics among adults found that although BMI and blood glucose had increased between 1988 and 2010 while physical activity decreased over the same period, blood pressure and cholesterol levels had decreased concurrently [98]. As for cardiovascular diseases, in the Global Burden of Desease dataset, age-standardized incidences of cardiovascular diseases were also down across the board between 1990 and 2019, and the other evidence I’ve been able to find on this question [96 & 97] is consistent with the GBD results.

 So, it would seem that some decline in health is apparent in terms of obesity and in terms of diabetes, but not in terms of blood pressure or cardiovascular diseases. Suppose we were to just ignore the latter two. Should increased obesity be expected to lead to a rise in left-wing views? The best paper I know of found that controlling for poverty, spatial autocorrelation (!), racial demographics (!), and educational attainment, US counties with more obesity were more likely to vote for Romney in 2012 [99].

Bipolar Disorder:

 Contrary to my results from the GBD dataset, this meta-analysis found no change in the age-standardized prevalence of bipolar disorder between 1990 and 2013 [69]. This may not be too unexpected given how small the increase in the BDP datset was to begin with.

Depression:

 A 2018 meta-analysis found that the 1964-2015 increase in anxiety, depression, and neuroticism is exclusive only to the united states and did not occur in Europe [70]. This is consistent with the results from my analysis of the GBD dataset. This European stability is pervasive across many countries. One WHO-dataset analysis finds the following for age-standardized suicide mortality [71, fig.1]:

The longest-running suicide dataset we have comes from England and Wales, where the trend in age-standardized suicide mortality is as follows [72, figure 1]:

Autism:

 Autism diagnoses are rising, but this is due to changes in measurement [73].

Neuromuscular Disease:

 From 2003-2014 in Canada, neuromuscular disease incidence remained stable among children and decreased by 3% among adults [74].

Peripheral Artery Disease:

 Peripheral Artery Disease incidence in the UK has decreased from 2000 to 2014 [75].

Sarcoidosis:

 A representative US sample found an increase in the prevalence of sarcoidosis in the US, which cannot plausibly be attributed to age since the trend was constant across the age distribution [76, fig.3]. The GBD-dataset results also show increases in incidence.

Dry-Eye Disease:

 From 2003 through 2015, Americans have seen age-specific increases in the incidence of dry eye disease [77].

Chronic Fatigue Syndrome:

 I didn’t find any studies analyzing incidence (or even prevalence) by cohort and the GBD dataset didn’t have any information either. I found a meta-analysis [78] however that gives CFS incidence rates by publication year but does not analyze trends over time. I checked myself, and when weighing observations by squared reciprocal standard errors, there is an insignificant negative correlation of r = -0.006831783 between publication date and incidence rate.

Fibromyalgia & Chronic Widespread Pain:

 Fibromyalgia is a disorder characterized by chronic widespread musculoskeletal pain. I didn’t find any studies analyzing trends in fibromyalgia, and it isn’t in the GBD database either, but I did find a meta-analysis [79] of the prevalence of chronic widespread pain which gives prevalence rates by publication year without analyzing trends over time. Weighing by squared reciprocal standard errors, there was a correlation of r = -0.7444931 between publication year and prevalence rate.

Periodontal Health:

 In Sweden, the proportion of periodontally-healthy individuals increased from 8% in 1974 to 44% in 2003 [80].

Leprosy:

 A CDC report [82] found the incidence of leprosy in the United States to be stable between 1994 and 2011, and found and that immigrant groups converge over time to the native rate.

Non-Alcoholic Fatty Liver Disease:

A meta-analysis [83] found no evident increase in the prevalence of Non-Alcoholic Fatty Liver Disease over time.

Arthritis, Renal Disease, & Miscellaneous Age-Associated Diseases:

While trying to find information on trends in the incidence in Arthritis and in Renal Disease, I came across a paper [84] using Medicare data in the National Long Term Care Survey to look at age-specific changes in a wide variety of age-related diseases. The results section speaks for itself:

Increases of incidence rates were dramatic for renal disease [the average annual percent change (APC) is 8.56%, 95% CI = 7.62, 9.50%], goiter (APC = 6.67%, 95% CI = 5, 90, 7, 44%), melanoma (APC = 6.15%, 95% CI = 4.31, 8.02%) and Alzheimer’s disease (APC = 3.96%, 95% CI = 2.67, 5.26%), and less prominent for diabetes and lung cancer. Decreases of incidence rates were remarkable for angina pectoris (APC = −6.17%, 95% CI = −6.96, −5.38%); chronic obstructive pulmonary disease (APC = −5.14%, 95% CI = −6.78,−3.47%), and ulcer (APC = −5.82%, 95% CI = −6.77, −4.86%) and less dramatic for carcinomas of colon and prostate, stroke, hip fracture and asthma. Incidence rates of female breast carcinoma, myocardial infarction, Parkinson’s disease and rheumatoid arthritis were almost stable.

Another paper on secular trends in the incidence of Rheumatoid Arthritis found that it did not change from 1995 to 2014 in California [85].

Symptomatic Kidney Stone Disease:

Symptomatic kindey stone disease incidence has not increased in iceland, although asymptomatic case detection has increased due to improved imaging [86].

The Global Burden Of Disease Dataset:

Cells show 2019 incidence rates subtracted from 1990 incidence rates (i.e. red cells indicate declining incidence over time):

Main Categories:

All Categories:

Mental Disorders:

Neurological Disorders:

Congenital Birth Defects:

Neoplasms (i.e. Cancers):

Cardiovascular Diseases:

Chronic Respiratory Diseases:

Digestive Diseases:

Diabetes & Kidney Diseases:

Skin & Subcutaneous Diseases:

Musculoskeletal Disorders:

Other Non-Communicable Diseases:

Communicable, Maternal, Neonatal, & Nutritional Diseases:

References

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2. https://twitter.com/cerflerg/status/1785290900437942749

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10. Clark, G. (2007). A Farewell To Alms. Princeton University Press. Retrieved from https://not-equal.org/content/pdf/misc/Clark2007.pdf

11. McEvoy, O. (2023). Total fertility rate in Europe 2023, by country. Statista. Retrieved from https://www.statista.com/statistics/612074/fertility-rates-in-european-countries/

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