PONE-D-23-23346Explaining the Increase Mortality from Cardiovascular Disease in Indonesia: Unraveling the trends in the Influence of Metabolic and Behavioral Risk Factors (2000-2019)PLOS ONE

Dear Dr. Mahardhika,

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Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: No

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Authors used data from IHME and evaluated trends in cardiovascular mortality in Indonesia (from 2000 to 2019). The study is well-designed and can provide helpful information for policymakers and can enlighten further research. Although the study is well-written, some points need to be addressed:

1- Abbreviations should be defined in their first use.

2- Limitations of the study have not been mentioned. In the last paragraph of the discussion, mention all limitations of this study. For example, data is from one database (IHME) and limits its generalizability. Moreover, no subnational analysis was performed in this study.

3- The authors used and analyzed data from GBD IHME. They should clearly mention this in the title, abstract, and main text. Please revise comprehensively.

4- First paragraph of the discussion section should mention main findings of this study.

5- Define abbreviation in figures and tables in their captions.

Reviewer #2: In this study by Socha et al., the authors analyzed the incidence rate, deaths, and DALYs of cardiovascular diseases (CVDs) from 2000 to 2019. They also examined the association between various prevalent behavioral and metabolic risk factors (hypertension, hyperglycemia, obesity, dyslipidemia, and smoking) and CVDs, categorizing their results by gender.

Although this study is interesting, there are several concerns, and I have a few critical questions and comments:

The conclusion and methodology of the abstract are confusing and need revision to improve clarity.

In the first paragraph of the introduction, the authors present paradoxical sentences. Please clarify whether you are discussing the prevalence of CVDs or the rate of change in the incidence of CVDs among developing and developed countries.

There are several errors in the reference numbers. Please correct the references. Additionally, some sentences lack references, while others with references seem to be incorrect. Therefore, it is necessary to revise the references throughout the manuscript.

The last paragraph of the introduction does not align with the stated aim in the abstract. Please revise these sections. Are you discussing an increase or decline in the incidence of CVDs?

Use the complete form of abbreviations in their first usage and then only use the abbreviations afterwards. Avoid repeating the complete form throughout the text.

In Figure 1, between 2015 and 2019, the mortality rate and DALYs for CVDs showed a decrease, especially in mortality. Please mention this observation in your results and discussion.

It would be valuable if you could report and compare these results based on age groups in addition to gender.

The results were not adequately discussed. Please provide one or two paragraphs regarding the metabolic and behavioral changes during recent years and their impact on CVDs. Discuss your results based on previous knowledge and elaborate on the differences between males and females based on your findings. Furthermore, provide several studies similar to yours, discuss their results, and compare them to your findings.

Please explain the limitations of your study.

Finally, provide a summary of your conclusion and future prospects at the end of the discussion section.

There are several typographical, grammatical, and English usage errors throughout the manuscript. Please revise them.

Reviewer #3: Dear Authors

I would like to express my gratitude for being involved in reviewing this interesting manuscript. After scrutinizing it; there are some points to be considered;

# Title and abstract section

• Authors should indicate the study’s design with a commonly used term in the title or the abstract.

• I am wondering about the sentence written in the abstract: Over the past two decades, CVD burden has shifted from developing to developed countries, this is rather counterintuitive. The authors should reexamine the references.

• The conclusion was rather lengthy, and the authors should focus on the results of the analysis

# Introduction section

• In the # Introduction, the authors did not explore the knowledge gap in terms of the association between behavioral and CVD risk factor with CVD in Indonesia; there is no bridging between # Paragraph 4 and # Paragraph 5.

• I am wondering the way the authors write the references quoted, the authors should jot down in order.

# Cardiovascular Diseases Outcome section:

• The authors stated that mortality rate, DALY to CVD, ischemic heart disease, stroke by gender, province and year were considered as independent variables; I would suggest that those are not suitable with the objective of the study. The authors should consider it.

# Multivariate regression

• In #Multivariate regression section, the authors stated that CVD as an outcome variable, this contradicts with the previous statement

• The authors would be much better in compiling the manuscript following the IMRAD, and the #multivariate regression should be put under the heading of #Statistical analysis

# Conclusion, I am wondering the authors did not elaborate the conclusion of the study and the limitation.

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Reviewer #1: No

Reviewer #2: Yes: Malihe Rezaee

Reviewer #3: No

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Explaining the Increase of Incidence and Mortality from Cardiovascular Disease in Indonesia: A Global Burden of Disease Study Analysis (2000-2019)

PONE-D-23-23346R1

Dear Dr. Mahardhika,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Seyed Aria Nejadghaderi

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thanks for the revision. All comments have been addressed and the paper can be published in its current form.

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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