Round 1

Reviewer 1 Report

The research investigates the rising prevalence of asthma in Mexico over the past decade, noting a higher incidence in males compared to females. Despite declining mortality and DALY rates, a differential deceleration has been observed recently. The study underscores the necessity for targeted prevention and cost-effective management strategies, particularly in middle- and low-income countries, and emphasizes the significance of location-specific efforts to reduce asthma-related health loss in high-burden areas. It serves to enhance the readers' understanding of the field and offer valuable guidance for clinical practice. Nonetheless, certain aspects of the paper could be further refined.

1. The 95% uncertainty interval (UI) obtained from the CODEm is too large (for example, the 95% UI of estimated deaths in 1990 ranges from 3 to 3052), indicating high uncertainty. In such cases, the authors may consider some of the following steps to reduce the UI and enhance the accuracy of the estimates: increasing data sources to provide more information for the model; employing more complex or better-suited statistical models; and performing thorough cleaning and preprocessing of the existing data to eliminate noise that may contribute to larger UI. Alternatively, the authors could adopt other reliable approaches to reduce the UI.

2. Could a more in-depth analysis be conducted to examine the reasons for the change in the variation trend of fatal/nonfatal components, such as identifying the factors contributing to the recent increase in prevalence and incidence rates?

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

REVIEW REPORT

This paper evaluated of the asthma burden in Mexico based on the results from the Global Burden of Disease (GBD 2019) study conducted in 2019. The research includes various aspects such as asthma prevalence, incidence, mortality, disability-adjusted life years (DALYs), and rates per 100,000 people, considering different demographic factors such as sex and age. The data covers the period from 1990 to 2019.

1. Asthma affected approximately 3.35 million people in Mexico in 2019, with an uncertainty interval (UI) of 2.59-4.37 million.
2. In 2019, there were 606,000 new incident cases of asthma, with an uncertainty interval of 433,000-811,100.
3. Asthma caused 1,655 deaths in Mexico in 2019, with an uncertainty interval of 3-1,931.
4. The burden of asthma was slightly higher in females compared to males.
5. Asthma primarily affected age groups between 1 and 14 years.
6. From 1990 to 2010, the burden of asthma gradually decreased.
7. However, during the last decade (2010-2019), there was an increase in asthma prevalence by 8.2% and incidence by 11.3%.
8. Mortality and DALYs associated with asthma decreased by 23.3% and 1.6%, respectively, during the same period.
9. The burden of asthma displayed a heterogeneous pattern at the subnational level, indicating regional variations in the disease burden across different states of the country.

They conclude that asthma poses a significant health burden in Mexico, with variations across different demographic groups and regions. The findings highlight the need for targeted interventions, especially for early diagnosis and control of asthma, in order to reduce its burden and address health disparities, particularly in the early stages of life.

Potential flaws in this research

The presented study provides valuable insights into the burden of asthma in Mexico, it is important to consider the potential flaws and limitations outlined below.

1. Data limitations: The study relies on available data from the GBD 2019 study, which itself is older than 3 years and may have limitations. The accuracy and reliability of the findings depend on the quality and representativeness of the data sources used. If the data sources have biases or limitations, it may impact the accuracy of the estimates.

2. Uncertainty intervals: The reported estimates for asthma prevalence, incidence, and mortality are accompanied by uncertainty intervals, indicating the range within which the true values are likely to fall. The wide uncertainty intervals suggest a considerable degree of uncertainty in the estimates, which could affect the precision of the results and the conclusions drawn from them.

3. Lack of clear information on data collection methods

4. Lack of information on confounding factors: The text does not mention whether the study accounted for confounding factors that could influence asthma burden, such as socioeconomic status, environmental factors, access to healthcare, and comorbidities. These factors can significantly impact the prevalence, incidence, and mortality rates of asthma. Not controlling for confounding factors can limit the study's ability to attribute the observed changes solely to asthma and may affect the accuracy of the conclusions.

5. Limited timeframe for analysis: The study covers the period from 1990 to 2019, which provides insights into the trends over time. However, considering a longer timeframe could provide a more comprehensive understanding of the changes in asthma burden and help identify long-term patterns or shifts that may not be apparent in the analyzed period alone.

6. Lack of comparison with global data: While the study evaluates asthma burden within Mexico, it does not provide a comparison with global or regional data. Comparing the burden of asthma in Mexico to that in other countries or regions could help contextualize the findings and identify whether the observed burden is relatively high or low.

7. Potential inconsistencies in subnational data: The text mentions that the burden of asthma displayed a heterogeneous pattern at the subnational level. However, it does not provide specific details or explanations for the regional variations. Understanding the reasons behind the regional disparities in asthma burden could be valuable for developing targeted interventions and policies.

8. Limited discussion on interventions and implications: The text briefly mentions the need for targeted interventions, early diagnosis, and control of asthma to reduce its burden. However, it does not provide a comprehensive discussion on the specific interventions, strategies, or policies that could be implemented based on the findings. Additionally, the implications of the study's results on public health and healthcare planning are not extensively explored.

Suggestions to Authors

1. Add comparison with global data or regional data

2. Increase the time frame of the study

3. Outline the information on data collection methods

4. Try to add the latest data till 2023

5. Correct Potential inconsistencies in subnational data

6. Expand the discussion on interventions and implications suggested

 

The quality of the English language in the paragraph is generally good. The sentences are well-structured, and the vocabulary used is appropriate for the scientific topic being discussed. The paragraph effectively communicates the flaws and limitations of the study, highlighting the areas where further information or clarification is needed. The language is clear and concise, making it easy to understand the points being made. Overall, the paragraph demonstrates a strong command of English language skills in terms of grammar, sentence structure, and vocabulary.

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The author are appreciated for their revisions, which have notably enhanced the quality of the manuscript.

Reviewer 2 Report

The authors analyzed the Asthma burden in Mexico was assessed based on GBD 2019 data. They claim that nationally, it impacted 3.35 million people in 2019, with 606,000 new cases and 1,655 deaths, Prevalence rose 8.2%, affecting mainly females and those aged 1-14. Finally that despite declining mortality and DALYs since 1990, prevalence and incidence increased during 2010-2019. Subnational variations existed. They conclude that asthma's caused significant health loss and underscores disparities that necessitate targeted control, especially in early life.

Negative Points for this artcle:
1. Rising Prevalence: Asthma's prevalence increased by 8.2% during the last decade (2010-2019), indicating a growing health concern.
2. Higher Incidence: Incidence also rose by 11.3% during the same period, contributing to the increasing burden of asthma.
3. Subnational Disparities: The heterogeneous subnational pattern suggests unequal access to asthma management and care across regions.
4. Limited DALY Reduction: While mortality and DALYs decreased, the reduction in DALYs (1.6%) was relatively modest, indicating ongoing health impact.
5. Childhood Impact: Asthma mainly affected young age groups (1-14 years), highlighting potential long-term health effects on affected children.

Hence this article is not worth publication.