PONE-D-24-29086Global burden of subarachnoid hemorrhage among adolescents and young adults aged 15–39 years: A trend analysis study from 1990 to 2021PLOS ONE

Dear Dr. Ji,

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Muhammad Fawad, PhD

Academic Editor

PLOS ONE

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This work was financially supported by the Basic Research Plan of Shanxi Province in 2021, grant number 202103021224386, awarded to Dr. Hongming Ji. The funding body played no role in the study design, data collection, data analysis, decision to publish, or preparation of the manuscript. For more information about the funding source, please visit the official website at https://kjt.shanxi.gov.cn/.

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7. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

Authors should provide more insights into the specific socio-economic or healthcare factors that might help clarify why Middle-SDI regions experience a higher burden than Low-SDI regions?

Did the authors consider the impact of gender-specific healthcare access and health-seeking behaviors when explaining the observed disparities between men and women?

The figures in the manuscript are blurry and difficult to interpret. Please improve the resolution of these figures or consider redrawing them to ensure a clear presentation and easy understanding for readers.

[Note: HTML markup is below. Please do not edit.]

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: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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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: Yes

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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: Yes

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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: Strengths: The study has a clear and specific objective: analyzing the global burden of subarachnoid hemorrhage (SAH) among adolescents and young adults (AYAs) aged 15–39 years over a 31-year period, focusing on spatial and temporal trends. This provides a targeted approach, which is beneficial for creating specialized public health strategies.

Opportunities for Improvement: The objective could be enhanced by mentioning the geographical scope and the importance of the study in the context of global health explicitly. Additionally, the rationale for selecting the age group 15-39 years should be briefly explained to highlight its significance.

Methods

Strengths:

The study utilizes data from the Global Burden of Disease Study 2021, which is a comprehensive and widely recognized source.

Segmenting the data by age groups and socio-demographic index (SDI) quintiles allows for a detailed analysis of different populations.

The use of statistical methods such as Joinpoint regression and decomposition analysis adds robustness to the analysis of temporal trends and epidemiological changes.

Opportunities for Improvement:

The methods section could benefit from a more detailed explanation of the statistical techniques used, particularly Joinpoint regression and decomposition analysis, to aid readers who may not be familiar with these methods.

Including a brief discussion on data limitations, such as potential biases or gaps in the GBD 2021 data, would provide a more balanced view of the study's methodology.

Results

Strengths:

The results are presented with clear numerical data, showing both absolute numbers and age-standardized rates, which enhances the comprehensiveness of the analysis.

Highlighting the decrease in mortality and DALYs alongside the increase in incidence and prevalence provides a nuanced understanding of the burden of SAH among AYAs.

The regional analysis adds valuable insights into where the burden is most substantial, which is crucial for targeted interventions.

Opportunities for Improvement:

The results section could be improved by including visual aids such as graphs or charts to illustrate trends more effectively.

Providing a more in-depth analysis of why certain trends occurred, especially the increase in incidence and prevalence in recent years, would add depth to the findings.

Discussion and Conclusion

Strengths:

The discussion appropriately emphasizes the need for targeted public health interventions in low and low-middle SDI regions.

The conclusion ties the findings to practical recommendations, such as improving healthcare resources and preventive strategies, making the study's implications clear and actionable.

Opportunities for Improvement:

The discussion could benefit from a comparison with other studies or existing literature to place the findings within a broader context.

Expanding on potential future research directions or unanswered questions that arose from the study would provide a pathway for further investigation and enhance the overall impact of the research.

Overall Assessment

The study provides a comprehensive analysis of the global burden of subarachnoid hemorrhage among adolescents and young adults, with clear strengths in data utilization, statistical analysis, and practical recommendations. However, there are opportunities to improve the clarity and depth of the methodology, results, and discussion sections. Enhancing these aspects would strengthen the study's contribution to public health knowledge and policy formulation.

Reviewer #2: I appreciate the opportunity to critically review the manuscript PONE-D-24-29086, in which the authors analyze the burden of SAH among adolescents and young adults using the most recent GBD data (2021). The manuscript is clear, and the methodology is robust. I present a series of minor comments for the authors' consideration.

Comment 1: Lines 370-371: The authors indicate that they found the burden of SAH to be higher in men. While this is true, the current wording makes it appear that this is a unique finding of the study, which is not correct. There is extensive published evidence indicating that the burden of cardiovascular diseases is generally lower among women. I suggest briefly mentioning this.

Comment 2: Published evidence (DOI: 10.1016/j.jacc.2023.11.007) suggests that metabolic risk factors (i.e., high systolic blood pressure) and dietary factors have a significant attributable fraction in SAH, and in general (as expected) this was higher in older age groups. Although the authors did not aim to analyze risk factors, it would be interesting if they briefly discussed the impact these risk factors might have on this particular age group, composed of young individuals.

Comment 3: Figures 1-3 were illegible. I would appreciate it if they could be presented clearly should I have the pleasure of being considered as a reviewer for the revised version of the document.

Comment 4: The GBD 2021 Forecasting Collaborators Group conducted analyses up to the year 2050. Is there any particular methodological reason for conducting the analysis up to the year 2040? I suggest specifying this in the Discussion section.

Reviewer #3: This is a manuscript with interesting title that written well.

There are only some minor mistakes in some lines (including 197, 262, …) that can be corrected.

Also the quality of figures are very low that need to improve.

I suggest that in the decomposition analysis, the clustering analysis was performed and the characteristics of clusters across on the SDI categories, region, … was assessed.

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Reviewer #1: No

Reviewer #2: Yes: Efrén Murillo-Zamora

Reviewer #3: Yes: Farzane Ahmadi

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PONE-D-24-29086R1Global burden of subarachnoid hemorrhage among adolescents and young adults aged 15–39 years: A trend analysis study from 1990 to 2021PLOS ONE

Dear Dr. Ji,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Nov 28 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Muhammad Fawad, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

The authors' response effectively addresses both the reviewer's and my comments; however, some concerns from the reviewer still remain, and these should be clarified.

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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

Reviewer #3: (No Response)

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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

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: 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

Reviewer #3: Yes

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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: The article presents interesting results of great importance for public health. The authors have made the necessary changes. The article can be accepted for publication.

Reviewer #2: I thank the group of authors for considering the observations and suggestions I previously provided. I congratulate them on their interesting manuscript. It was a pleasure to critically review it.

Reviewer #3: Unfortunately, there is no correction for the clustering analysis in the manuscript.

The aim of the clustering analysis is to detect homogenous subgroups of countries without considering the SDI categories.

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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.

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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: Yes: Jonas Wolf

Reviewer #2: Yes: Efrén Murillo-Zamora

Reviewer #3: Yes: Farzane Ahmadi

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While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Global burden of subarachnoid hemorrhage among adolescents and young adults aged 15–39 years: A trend analysis study from 1990 to 2021

PONE-D-24-29086R2

Dear Dr. Ji,

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,

Muhammad Fawad, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The authors have thoroughly addressed the comments and provided clear, well-supported responses to each concern.

Reviewers' comments: