Review for 10.1186/s12876-025-03842-x (2025)

Title: Global Burden of Gallbladder and Biliary Diseases (1990-2021) with Healthcare
Workforce Analysis and Projections to 2035
Version: 3 Date: 11 Mar 2025
Reviewer:  Amira A. A. Othman
Reviewer's report:
First of all
I want to congratulate the authors on their work. In this study, Dai et al. examine the global
burden of gallbladder and biliary tract diseases from 1990 to 2021 and predict trends up to 2035.
The goal is to analyze temporal and spatial patterns of incidence, prevalence, disability-adjusted
life years (DALYs), and mortality. The research highlights geographic and demographic
variations, emphasizing the influence of aging and health inequalities. The findings aim to guide
targeted prevention and intervention strategies, particularly in high-burden regions.
The authors handled the reviewer comments satisfactorily, nevertheless, there is an observation
for which sufficient justification must be obtained.
In general:
1. The English writing level is shallow, and it is necessary to seek help from an English language
specialist to correct spelling and grammatical errors in the entire text.
In Title:
2. The title must be more concise. I suggest “Global Burden of Gallbladder and Biliary Diseases
(1990-2021) with Projections to 2035".
In the Abstract section
3. The background subsection:
- It should be the shortest part of the abstract. It should briefly outline the following information:
What is already known about the subject related to the paper in question? What is not known
about the subject and, hence, what the study intended to examine (or what the paper seeks to
present). Please reconstruct it properly.
- Add key numeric results. Example: Instead of "incidence decreased slightly," specify the
percentage decline.
- Mention whether the expected increase in disease burden is mainly due to aging, lifestyle
changes, or other factors.
- Make the conclusion stronger. Instead of "emphasizing the importance of prevention," suggest
specific actions.
In the Introduction section:
4. The introduction repeats points about the global disease burden multiple times.
5. Clarify knowledge gaps: Instead of just stating that prior research is limited, specify what is
missing (e.g., lack of long-term projections).
6. The transition from general disease burden to the study’s objectives could be smoother.
In the Methods section:
7. The explanation of DALYs and SDI comes later in the text. Introduce these terms earlier.
8. Explain why these methods were chosen. For example, why use the Bayesian Age-Period-
Cohort (BAPC) model instead of other forecasting methods?
9.  The study covers multiple diseases (gallstones, cholangitis, etc.). Was any condition
excluded?
In the Results section:
10. Avoid excessive detail in the text. Many numbers are already in tables. Summarize the key
points instead.
11. Some figures are mentioned before they are fully explained.
12. What were the patients' complaints?
13. Instead of listing statistics, discuss why high-SDI regions have a higher burden.
In the Discussion section:
14. The discussion section is one of the final parts of a research paper, in which an author
describes, analyzes, and interprets their findings. They explain the significance of those results
and tie everything back to the research question(s). In this manuscript, there is confusion
between what should be written in the introduction and discussion sections. Please reconstruct
the discussion section.
- Instead of just stating that the disease burden is increasing, discuss why this is happening
(aging, diet, healthcare access, etc.).
- How should policymakers respond? Suggest specific interventions, such as screening programs
or dietary guidelines.
- Are the findings consistent with previous research? If there are differences, explain why.
In the conclusion section:
15. The conclusion should restate your main points and provide closure. Please recontruct.
- Instead of just restating results, suggest how this research can influence public health policies.
- void vague phrases. Example: "Interventions should be developed" # What kind of
interventions? Who should implement them?
- Briefly acknowledge any study weaknesses.