Review for 10.1186/s12876-025-03916-w (2025)

Title: Spatiotemporal Trends in Hernia Disease Burden and Health Workforce Correlations in
Aging Populations: A Global Analysis with Projections to 2050
Version: 0 Date: 08 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-Although the study uses global data, the analysis does not provide sufficient granularity at
the regional or national levels. Given that hernias have substantial regional variation, further
exploration of specific regions or countries could help in identifying localized risk factors,
healthcare gaps, or successful interventions. This would enhance the relevance of the study for
policy development at national or regional levels.
-While the study identifies trends and provides projections, there is a limited discussion on the
underlying biological or physiological mechanisms driving the increasing incidence of hernias
in older populations. Exploring these mechanisms more deeply could add value to the study by
informing public health strategies and improving prevention efforts.
-Although the use of multiple machine learning models enhances robustness, the assumptions
and limitations of each model could be discussed in more detail. For instance, each model has
specific strengths and weaknesses that may influence the results (e.g., Prophet’s handling of
seasonal variations). A more thorough discussion of why specific models were chosen and how
their limitations were addressed would strengthen the transparency of the methodology.
-The study acknowledges that healthcare accessibility and socioeconomic factors influence the
burden of hernias but does not delve deeply into variations in healthcare systems across different
countries. For example, the availability of surgical treatments, the quality of healthcare systems,
and the disparity in access to care might affect the incidence, prevalence, and outcomes of
hernias, which could be explored further.
-While the study utilizes various machine learning models for forecasting, projections over long
time periods (2022-2050) are inherently uncertain. The paper could benefit from more explicit
discussion regarding the uncertainties and limitations of projecting trends over such a long
period, especially given the rapidly changing demographics and potential future developments
in medical care.
-The study briefly mentions gender differences in the incidence of hernias, with men being
disproportionately affected, but it does not dive into a deeper analysis of the reasons behind
these gender disparities. Given the clear difference in incidence between genders, exploring
biological, behavioral, and healthcare-related factors contributing to these disparities could
provide more actionable insights.
-One limitation discussed is the variability in the GBD 2021 dataset. Since data quality and
completeness may differ across regions, especially in low-resource settings, there is a risk of bias
that could influence findings, particularly in regions with less robust healthcare data collection
systems.
-Although the study acknowledges aging and comorbidities as risk factors, it lacks a deeper
exploration of modifiable factors such as lifestyle behaviors, dietary patterns, and occupational
risks that might contribute to the hernia burden. Addressing these factors could refine the
predictions and offer targeted prevention strategies.
-The SDI is a useful composite indicator of development, but it oversimplifies socioeconomic
factors, omitting regional and localized variations within countries that may have more granular
impacts on health outcomes. Further disaggregation could improve understanding, especially in
high-income countries with significant within-country disparities.
-The study doesn’t incorporate potential advancements in healthcare technologies, such as
minimally invasive surgery or improvements in post-operative care. These innovations could
alter the trajectory of the disease burden in the future.
-The absence of sub-national analysis is a notable limitation, as regional differences within
countries may be significant. For example, healthcare access and outcomes may vary
considerably between urban and rural areas, which could skew national-level findings.