Review for 10.1186/s12876-025-03592-w (2025)

Title: Age-period-cohort analysis of gallbladder and biliary diseases epidemiological trends
from 1990 to 2021 and forecasts for 2035: a systematic analysis from the Global Burden of
Disease Study 2021
Version: 0 Date: 04 Dec 2024
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the introduction addresses the global prevalence and incidence of Gallbladder and related
diseases (GABD), it would be advantageous to briefly acknowledge that GABD encompasses
several conditions, such as gallstones, cholecystitis, and cholangitis, which are clinically relevant
for understanding the overall disease burden.
-Although the introduction references variations in prevalence across different countries, it
could enhance clarity by providing specific examples of regional disparities or risk factors
that contribute to these differences. For instance, discussing lifestyle choices, dietary habits,
and genetic predispositions—such as increased rates within certain ethnic groups—would
contextualize the epidemiology on a global scale.
-While the Age-Period-Cohort (APC) model is well-articulated, a more succinct description
of the analytical steps involved would be beneficial. Clarification regarding how data are
categorized into age groups, periods, and cohorts would render the process more transparent for
individuals outside the specialty. Furthermore, including a brief example of how these various
influences (age, period, cohort) affect the outcomes would enhance comprehension.
-The study categorizes countries into Socio-Demographic Index (SDI) groups (ranging from low
to high). However, it would be prudent to elucidate how these SDI categories relate to healthcare
resources and infrastructure. This clarification would help explain the rationale behind grouping
countries according to SDI and its potential impact on the incidence and mortality rates of
GABD.
-What specific public health measures should be prioritized in regions exhibiting a high burden
of GABD, particularly among middle-aged females and the elderly? How can healthcare systems
be fortified to address this growing burden? Establishing a more explicit connection between
research findings and actionable public health recommendations would significantly enhance
the study's impact.
-The discussion acknowledges the heightened burden of GABD among females; however,
further exploration of the biological mechanisms underlying these differences would be
valuable. For instance, it would be beneficial to expand upon the influences of genetic factors
and hormones, such as estrogen, thereby providing a more comprehensive explanation.
-To what extent do changes in global dietary patterns, particularly the increase in ultra-processed
food consumption, correlate with the rising incidence of GABD in high SDI countries? A
detailed examination of the effects of globalization and urbanization on trends related to GABD
would strengthen this section of the discussion.
-Additionally, how can policies that promote active lifestyles be effectively integrated into
national health strategies to reduce GABD incidence? It is also important to explore how specific
risk factors, such as elevated cholesterol levels, bile composition, and inflammation, contribute
to the development of these conditions.