Review for 10.1186/s12876-025-03904-0 (2025)

Title: Global, Regional, and National Burden of Disease Analysis on Paralytic Ileus and
Intestinal Obstruction in Adults Aged 65 and Over from 1990 to 2021, with Projections for 2030:
A Global Burden of Disease Study 2021 Analysis
Version: 1 Date: 24 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While decomposition analysis is mentioned as a method to explore the contributions of
population growth, aging, and shifts in epidemiological patterns, the description could be
expanded to provide more details. Specifically, explaining how these factors will be quantified
and interpreted in the context of disease burden could add clarity for readers unfamiliar with
the method.
-The methods section mentions the use of multiple advanced statistical methods, which is
commendable. However, for a broader audience, it may be useful to provide a brief explanation
of why each method is chosen and how it complements the other techniques. For instance,
more context around the Bayesian Markov Chain Monte Carlo algorithm and how it reduces
uncertainty could be helpful for non-experts.
-The predictive analysis, especially the use of age-period-cohort models, is a complex and
powerful tool, but additional information on the assumptions and limitations of these models
could help readers understand the scope and potential uncertainties of the projections. Since
projections for 2030 are crucial for policy-making, explaining the potential impact of different
variables or future scenarios would add depth to the analysis.
-While SDI is considered about disease burden, it may also be useful to mention other potential
confounders (e.g., healthcare infrastructure, access to medical care, comorbidities in elderly
populations) that could affect the trends observed. A brief mention of these factors could improve
the comprehensiveness of the study’s framework.
-While the study aims to inform health policy, there could be a more explicit discussion about
how healthcare systems and policies might influence the disease burden of paralytic ileus
and intestinal obstruction. For instance, how might access to timely medical care, surgery, or
rehabilitation influence trends? Incorporating this into the introduction would further highlight
the study's relevance for policymakers.
-While population growth is identified as a major driver of the increased disease burden, it
would be helpful to further clarify how population aging (not just size) contributes to the rising
incidence and prevalence. As the population ages, specific age-related diseases become more
common. A more detailed explanation of how this factor specifically impacts the results could
strengthen the argument.
-Similarly, the relationship between SDI and disease burden could be further unpacked. The
study mentions that increasing SDI correlates with higher incidence rates, but it would be useful
to delve deeper into how SDI influences healthcare access, diagnostic capabilities, and the
prevalence of chronic conditions. This would provide a clearer understanding of how SDI both
facilitates and complicates disease management.
-While the study provides a good overview of regional differences, it could expand on the
specific barriers that lead to higher DALYs and mortality in low-SDI regions. For instance,
it would be beneficial to explore specific challenges in these regions (e.g., lack of trained
healthcare professionals, inadequate surgical facilities) and the steps needed to address these
disparities.
-The mention of healthcare system challenges in low- and middle-income countries is crucial,
but further details on how disparities in healthcare resources (e.g., access to surgery, and post-
operative care) are impacting disease outcomes would add more depth. Additionally, how local
initiatives or international aid could help alleviate these disparities might strengthen the policy
recommendations.
-While the discussion touches on various factors contributing to the disease burden, including
lifestyle and comorbidities, it could be improved by providing a deeper exploration of how these
factors interact. For instance, the discussion could address how diseases like obesity and cancer
affect the pathophysiology of intestinal obstruction in the elderly. These complex interactions
would add nuance to the explanation of the increasing disease burden in developed regions.