Contribution Of Modifiable Risk Factors Research Articles

Modifiable risk factors mediating the impact of educational inequality on heart failure: A Mendelian randomization study

BackgroundHeart failure (HF) is a rapidly growing global disease burden with high mortality rates. We aimed to utilize mendelian randomization (MR) analyses to investigate the association between educational attainment (EA) and HF, and to evaluate the contribution of modifiable risk factors as mediators. MethodsWe applied a two-sample MR approach based on the largest genome-wide association studies (GWAS) to investigate the causal relationship between EA and HF. Data collection was conducted in July 2023. We then conducted mediation analyses to explore whether body mass index (BMI), blood pressure, and type 2 diabetes mellitus (T2DM) mediate the effect of EA on HF, and utilized multivariable MR to estimate the proportion of mediation attributed to these factors. ResultsGenetically predicted 3.4 years of additional education was associated with a decrease in the risk of HF (OR 0.76 for each 3.4 years of schooling; 95% CI 0.72, 0.81). BMI, T2DM, systolic blood pressure, and diastolic blood pressure mediated 40.82% (95% CI: 28.86%, 52.77%), 18.00% (95% CI: 12.10%, 23.90%), 11.60% (95% CI: 7.63%, 15.56%), and 7.80% (95% CI: 4.63%, 10.96%) of the EA-HF association, respectively. All risk factors combined were estimated to mediate 63.81% (95% CI: 45.91%, 81.71%) of the effect of EA on HF. ConclusionHigher EA has a protective effect against the risk of HF, and potential mechanisms may include regulation of BMI, blood pressure, and blood glucose. Further research is needed to understand whether interventions targeting these factors could influence the association between EA and HF risk.

Role of cardiovascular health factors in mediating social inequalities in the incidence of dementia in the UK: two prospective, population-based cohort studies

The contribution of modifiable risk factors to social inequalities in dementia, observed in longitudinal studies, remains unclear. We aimed to quantify the role of cardiovascular health factors, assessed using Life's Essential 8 (LE8) score, in mediating social inequalities in incidence of dementia and, for comparison, in incidence of stroke, coronary heart disease, and mortality. In this prospective, population-based cohort study, we collected data from the UK Whitehall II Study and UK Biobank databases. Participants were included if data were available on SEP, outcomes and LE8 (smoking, physical activity, diet, body mass index, blood pressure, fasting blood glucose, lipid levels, sleep duration). The primary outcome was incident dementia and secondary outcomes were stroke, coronary heart disease, and mortality. Outcomes were derived from electronic healthcare records. Socioeconomic position (SEP) was measured by occupation in Whitehall II and education in UK Biobank. Counterfactual mediation analysis was used to quantify the extent to which LE8 score explained the associations of SEP with all outcomes. Analyses involved Cox regression, accelerated failure time models, and linear regression; and were adjusted for age, sex, and ethnicity. Between 10.09.1985 and 29.03.1988, a total of 9688 participants (mean age±SD 44.9±6.0; 67% men) from the Whitehall II study, and between 19.12.2006 and 01.10.2010, 278,215 participants (mean age±SD 56.0±8.1; 47% men) from the UK Biobank were included. There were 606 and 4649 incident dementia cases over a median (interquartile range) follow-up of 31.7 (31.1-32.7) and 13.5 (12.7-14.1) years respectively in Whitehall II and UK Biobank. In Whitehall II, the hazard ratio was 1.85 [95% CI 1.42, 2.32] for the total effect of SEP on dementia and 1.20 [1.12, 1.28] for the indirect effect via the LE8, the proportion mediated being 36%. In UK Biobank, the total effect of SEP on dementia was 1.65 [1.54, 1.78]; the indirect effect was 1.11 [1.09, 1.12], and the proportion mediated was 24%. The proportions mediated for stroke, coronary heart disease, and mortality were higher, ranging between 34% and 63% in Whitehall II and between 36% and 50% in UK Biobank. In two well-characterised cohort studies, up to one third of the social inequalities in incidence of dementia was attributable to cardiovascular health factors. Promotion of cardiovascular health in midlife may contribute to reducing social inequalities in risk of dementia, in addition to cardiovascular diseases and all-cause mortality. This study used adult measures of SEP, further research is warranted using lifecourse measures of SEP. NIH (RF1AG062553).

ALCOHOLIC LIVER DISEASE: ISSUES OF ETIOLOGY AND THE IMPACT OF RISK FACTORS (LITERATURE REVIEW)

Alcohol consumption is one of the main causes leading to chronic liver disease. Alcoholic liver disease is a set of cascading events, consisting first of alcoholic hepatic steatosis and then mainly through alcoholic steatohepatitis, leading to cirrhosis and hepatocellular carcinoma. This review considers chronic alcohol intoxication as the main factor in the development of liver disease. Modern data on the prevalence of forms of alcoholic liver damage in Russia and in the world are presented. The role of the consumed dose of ethanol, the nature of the alcoholic beverage, as well as the pattern of alcohol consumption in the formation of liver damage is assessed, predisposing factors are presented. The leading risk factors for alcoholic liver damage are: female gender, hereditary predisposition (ethnicity), trophological status (underweight or obesity), taking certain hepatotoxic drugs, the amount and duration of alcohol consumption and the type of alcohol consumed, smoking. The presence of concomitant viral hepatitis, environmental toxico-ecological influence and prenatal intoxication also predispose to alcoholic liver damage. The article provides a detailed assessment of the role of the presented risk factors in the development of alcoholic liver damage. However, it is not possible to identify the dominant risk factor for alcoholic liver damage, since the development of liver pathology directly depends not only on the amount of alcohol consumed, but also on the individual combination of predisposing factors. Understanding the etiology of the disease and the contribution of modifiable risk factors to its development will allow the development of effective strategies aimed at reducing the incidence and mortality from liver diseases.

Does the contribution of modifiable risk factors on oral health inequities differ by experience of negative life events among Indigenous Australian adults?

Although the prevalence of poor self-rated oral health and experience of negative life events among Indigenous adults is high, the contribution of modifiable risk factors is unknown. We aimed to estimate the contribution of modifiable risk factors in poor self-rated oral health among Indigenous Australian adults with high and low experience of negative life events using decomposition analysis. The study utilised a cross-sectional design, with data from a large convenience study of Indigenous adults in South Australia. Participants were stratified based on a median split of negative life events in the last 12 months. The outcome was the proportion of fair/poor self-rated oral health (SROH). Independent variables included experience of racism, sex, age, geographic location, car ownership, and time since last dental visit. Of the 1011 participants, the proportion with fair poor self-rated oral health was 33.5% (95% CI 30.5 to 36.4) and the proportion who had experienced 3+ negative life events in the past 12 months was 47.3% (95% CI 43.7 to 50.9). More than half the contribution in fair/poor self-rated oral health among Indigenous adults with a higher magnitude of negative life events was from experience of racism (55.3%, p<0.001), followed by residential location (19.9%), sex (9.7%) and car ownership (9.8%). The contributions of modifiable risk factors in poor self-rated oral health among Indigenous adults with different exposures to negative life events differed substantially. Targets to reduce racism will decrease oral health inequities for both groups, however Indigenous adults who have experienced substantial negative life events require additional focus on provision of culturally safe dental care.

The contribution of modifiable risk factors to socioeconomic inequities in cardiovascular disease morbidity and mortality: A nationally representative population-based cohort study

This study examined the individual and joint effects of modifiable risk factors mediating the associations between socioeconomic position (SEP) and morbidity and mortality from cardiovascular diseases (CVD) in a nationally representative sample of adults in Canada.Participants in the Canadian Community Health Survey (n = 289,800) were followed longitudinally for CVD morbidity and mortality using administrative health and mortality data. SEP was measured as a latent variable consisting of household income and individual educational attainment. Mediators included smoking, physical inactivity, obesity, diabetes and hypertension. The primary outcome was CVD morbidity and mortality, defined as the first fatal/nonfatal CVD event during follow-up (median 6.2 years). Generalized structural equation modeling tested the mediating effects of modifiable risk factors in associations between SEP and CVD in the total population and stratified by sex.Lower SEP was associated with 2.5 times increased odds of CVD morbidity and mortality (OR: 2.52, 95% CI: 2.28, 2.76). Modifiable risk factors mediated 74% of associations between SEP and CVD morbidity and mortality in the total population and were more important mediators of associations in females (83%) than males (62%). Smoking mediated these associations independently and jointly with other mediators. The mediating effects of physical inactivity were through joint mediating effects with obesity, diabetes or hypertension. There were additional joint mediating effects of obesity through diabetes or hypertension in females.Findings point to modifiable risk factors as important targets for interventions along with interventions that target structural determinants of health to reduce socioeconomic inequities in CVD.

Contribution of modifiable dementia risk factors to cognitive performance and subjective cognition in middle‐aged adults

AbstractBackgroundCharacterization of the contribution of modifiable risk factors (MRF) to dementia generally consider MRFs individually, despite strong evidence that MRFs co‐occur. In a large group of middle‐aged adults, the prevalence and co‐occurrence of MRFs for dementia was determined, spanning five broad domains (mood, lifestyle behaviours (e.g., physical inactivity), cardiovascular health, cognitive/social engagement, and sleep). We then investigated relationships between MRFs, both individually and combined, to cognitive performance and subjective cognition.MethodMiddle‐aged adults (n = 1610), most (70%) with a family history of dementia, enrolled in the Healthy Brain Project, completed an extensive set of questionnaires about their physical and psychological health and lifestyle. Participants also completed the Cogstate Brief Battery (CBB), and the Cognitive Function Instrument (CFI), a measure of subjective cognition. Participants were classified according to the number of domains (mood, lifestyle behaviours, cardiovascular health, cognitive/social engagement, and sleep, ranging from 0‐5) in which they reported at least one MRF. Age, sex, education and ethnicity were adjusted for in analyses.ResultMost participants (65%) reported at least one MRF in two or more domains (Fig 1A). Compared to participants reporting no MRFs, participants who reported at least one MRF in 3‐5 domains showed worse memory performance and reported greater subjective cognitive concerns, with magnitudes of differences moderate to large (d = 0.30‐0.93; Fig 1B). Participants who reported at least one MRF in five domains also showed worse attention than those reporting no MRFs (d = 0.58). When individual MRFs were considered simultaneously, MRFs in the mood (e.g., anxiety symptomatology) and cognitive/social engagement domains (e.g., leisure activities) were associated with worse attention and memory performance. Individual MRFs reflecting mood and sleep symptomatology were associated with greater subjective cognitive concerns.ConclusionIn middle‐aged community dwelling adults, multidomain MRFs for dementia are highly prevalent and co‐occur, and are associated with poorer cognitive outcomes. This suggests that the presence of multiple MRFs as early as midlife may have negative neurological outcomes, however, this will need to be explored in future neuroimaging studies. These findings indicate that multidomain lifestyle prevention trials in middle‐aged adults may be useful to delay or prevent future cognitive impairment or dementia.

Overview.

South Africa (SA) faces multiple health challenges. Quantifying the contribution of modifiable risk factors can be used to identify and prioritise areas of concern for population health and opportunities for health promotion and disease prevention interventions. To estimate the attributable burden of 18 modifiable risk factors for 2000, 2006 and 2012. Comparative risk assessment (CRA), a standardised and systematic approach, was used to estimate the attributable burden of 18 risk factors. Risk exposure estimates were sourced from local data, and meta-regressions were used to model the parameters, depending on the availability of data. Risk-outcome pairs meeting the criteria for convincing or probable evidence were assessed using relative risks against a theoretical minimum risk exposure level to calculate either a potential impact fraction or population attributable fraction (PAF). Relative risks were sourced from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study as well as published cohort and intervention studies. Attributable burden was calculated for each risk factor for 2000, 2006 and 2012 by applying the PAF to estimates of deaths and years of life lost from the Second South African National Burden of Disease Study (SANBD2). Uncertainty analyses were performed using Monte Carlo simulation, and age-standardised rates were calculated using the World Health Organization standard population. Unsafe sex was the leading risk factor across all years, accounting for one in four DALYs (26.6%) of the estimated 20.6 million DALYs in 2012. The top five leading risk factors for males and females remained the same between 2000 and 2012. For males, the leading risks were (in order of descending rank): unsafe sex; alcohol consumption; interpersonal violence; tobacco smoking; and high systolic blood pressure; while for females the leading risks were unsafe sex; interpersonal violence; high systolic blood pressure; high body mass index; and high fasting plasma glucose. Since 2000, the attributable age-standardised death rates decreased for most risk factors. The largest decrease was for household air pollution (-41.8%). However, there was a notable increase in the age-standardised death rate for high fasting plasma glucose (44.1%), followed by ambient air pollution (7%). This study reflects the continued dominance of unsafe sex and interpersonal violence during the study period, as well as the combined effects of poverty and underdevelopment with the emergence of cardiometabolic-related risk factors and ambient air pollution as key modifiable risk factors in SA. Despite reductions in the attributable burden of many risk factors, the study reveals significant scope for health promotion and disease prevention initiatives and provides an important tool for policy makers to influence policy and programme interventions in the country.

Preventable Cancer in Israel.

Background: The cancer burden in Israel is substantial. Recently calculated population attributable fractions (PAFs) for modifiable cancer risk factors in the US and the UK have indicated much room for prevention. Our aim was to estimate PAFs for selected modifiable cancer risk factors in Israel. Methods: Exposure data on selected modifiable risk factors were based on national health surveys conducted in 2013–2015. Data on invasive cancer incidence in 2015 were retrieved from the Israel National Cancer Registry (INCR). Relative risks (RRs) for specific cancer sites were retrieved from the scientific literature. PAFs were calculated for selected modifiable risk factors using an approximate formula. Results: In 2015, 21% of all invasive cancer cases in Israel were attributed to smoking, 9% to excess body weight, and 1.5% to alcohol intake. Moreover, 32% of all invasive cancer cases were attributed to all modifiable risk factors (combined) included in our study. Conclusions: Quantifying the contribution of modifiable risk factors to the incidence of certain cancer types in Israel offers an opportunity for primary prevention and enables informed decision-making with respect to the prioritization of interventions.

Improving the global reporting of multiple myeloma: a focus on low-income and middle-income countries

The findings reported by Junjie Huang and colleagues,1 published in The Lancet Haematology, elaborate on the recent trends in the epidemiology of multiple myeloma through several global cancer registries, emphasising the contribution of modifiable risk factors, namely overweight and physical inactivity, towards the development of multiple myeloma. The age-standardised multiple myeloma incidence was 1·78 (95% UI 1·69–1·87) per 100 000 people globally and mortality was 1·14 (95% UI 1·07–1·21) per 100 000 people globally in 2020.

Contribution of modifiable risk factors on the burden of diabetes among women in reproductive age-group in India: a population based cross-sectional study.

The diabetes burden is rapidly accelerating in India, particularly since the 2000s. We explore the burden and contribution of modifiable risk factors in diabetes among reproductive women across geographic regions of India. The study uses data from the National Family Health Survey in India 2015-2016, Census of India 2011, and World Population Prospects 2015. We computed Population Attributable Fractions and the number of total and estimated avoidable diabetic cases across regions. The prevalence of diabetic cases in India were 24.4 per 1000 women, varying across geographic regions. Diabetes affected around 8.2 million women (15-49years) in India. Overweight (PAF = 19.5%) and obesity (PAF = 18.3%) contributed to the diabetes burden; if mitigated optimally, these can reduce diabetic cases by 2.8 million in India. Controlling diabetes should be region specific for maximum impact. Extending chronic disease screening during maternal and child health consultations might help decelerate the growing menace of diabetes in the country.

The Contribution of Modifiable Risk Factors to Socioeconomic Inequities in Cardiovascular Disease Morbidity and Mortality: A Nationally Representative Population-Based Cohort Study

The Contribution of Modifiable Risk Factors to Socioeconomic Inequities in Cardiovascular Disease Morbidity and Mortality: A Nationally Representative Population-Based Cohort Study

The burden of stroke and modifiable risk factors in Ethiopia: A systemic review and meta-analysis.

The burden and contribution of modifiable risk factors of stroke in Ethiopia are unclear. Knowledge about this burden and modifying risk factors is pivotal for establishing stroke prevention strategies. In recent decades, the issue of lifestyle and behavioral modification is a key to improve the quality of life. The modifiable risk factors are an importance as intervention strategies aimed at reducing these factors can subsequently reduce the risk of stroke. So far, many primary studies were conducted to estimate the burden of stroke and modifiable risk factors in Ethiopia. However, the lack of a nationwide study that determines the overall pooled estimation of burden and modifiable risk factors of stroke is a research gap. To conduct this systemic review and meta-analysis, we are following the PRISMA checklist. Three authors searched and extracted the data from the CINAHL (EBSCO), MEDLINE (via Ovid), PubMed, EMcare, African Journals Online (AJOL), and Google scholar. The quality of the primary study was assessed using the Newcastle-Ottawa Scale (NOS) by two independent reviewers. The primary studies with low and moderate risk of bias were included in the final analysis. The authors presented the pooled estimated burden of stroke and its modifiable risk factors. The registered protocol number in PROSPERO was CRD42020221906. In this study, the pooled burden of hemorrhagic and ischemic stroke were 46.42% (95%CI: 41.82-51.53; I2 = 91.6%) and 51.40% (95%CI: 46.97-55.82; I2 = 85.5%) respectively. The overall magnitude of modifiable risk factor of hypertension, alcohol consumption and dyslipidemia among stroke patients were 49% (95%CI: 43.59, 54.41), 24.96% (95CI%:15.01, 34.90), and 20.99% (95%CI: 11.10, 30.88), respectively. The least proportion of stroke recovery was in the Oromia region (67.38 (95%CI: 41.60-93.17; I2 = 98.1%). Farther more, the proportion of stroke recovery was decreased after 2017 (70.50 (56.80-84.20). In our study, more than 90% of stroke patients had one or more modifiable risk factors. All identified modifiable stroke risk factors are major public health issues in Ethiopia. Therefore, strategy is designed for stroke prevention to decrease stroke burden through targeted modification of a single risk factor, or a cluster of multiple risk factors, used on a population, community, or individual level.

Modifiable Risk Factors Mediate Associations Between Socioeconomic Position and Cardiovascular Disease Morbidity and Mortality

Abstract Objectives Morbidity and mortality from cardiovascular diseases (CVDs) are higher among individuals with a lower, compared to those with a higher socioeconomic position (SEP). However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to examine whether and to what extent modifiable risk factors mediate associations between SEP and CVD morbidity and mortality in a nationally representative sample of Canadian adults. Methods We used a population-based prospective observational cohort design whereby participants who completed the Canadian Community Health Survey (2000–2011; n = 289,800) were followed longitudinally for CVD morbidity and mortality using administrative health and mortality data in the Discharge Abstract Database and the Canadian Mortality Database until 31 March 2013. Participants were included if they were at least 35 years of age and did not self-report CVD at the time of survey administration. The exposure of interest was SEP, which was measured as a latent variable consisting of annual household income and educational attainment. Potential mediators included smoking, physical inactivity, obesity, diabetes, and hypertension. The primary outcome of interest was CVD morbidity and mortality, which was defined as the first fatal or nonfatal CVD event that occurred during follow-up (6.2 years). Generalized structural equation modeling was used to test the mediating effects of modifiable risk factors in associations between SEP and CVD morbidity and mortality. Results SEP was associated with CVD morbidity and mortality. Modifiable risk factors mediated 80% of associations between SEP and CVD morbidity and mortality. Smoking was the most important mediator of these associations. Obesity mediated associations between SEP and CVD individually and jointly with diabetes or hypertension. Conclusions These findings point to modifiable risk factors as potential targets for interventions to reduce inequities in CVD morbidity and mortality. Knowledge of pathways linking SEP with CVD is essential to inform targeted interventions to reduce socioeconomic inequities in CVD morbidity and mortality. Funding Sources This study was funded by a Libin Cardiovascular Research Institute of Alberta Innovation Seed Grant and the Petro-Canada Young Innovator Award in Community Health.

Quantifying the contribution of modifiable risk factors to socio-economic inequities in cancer morbidity and mortality: a nationally representative population-based cohort study.

Compared with those with a higher socio-economic position (SEP), individuals with a lower SEP have higher cancer morbidity and mortality. However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and cancer morbidity and mortality. This study used a prospective observational cohort design. We combined eight cycles of the Canadian Community Health Survey (2000/2001-2011) as baseline data to identify a cohort of adults (≥35 years) without cancer at the time of survey administration (n = 309800). The cohort was linked to the Discharge Abstract Database and the Canadian Mortality Database for cancer morbidity and mortality ascertainment. Individuals were followed from the date they completed the Canadian Community Health Survey until 31 March 2013. Dates of individual first hospitalizations for cancer and deaths due to cancer were captured during this time period. SEP was operationalized using a latent variable combining measures of education and household income. Self-reported modifiable risk factors, including smoking, excess alcohol consumption, low fruit-and-vegetable intake, physical inactivity and obesity, were considered as potential mediators. Generalized structural equation modelling was used to estimate the mediating effects of modifiable risk factors in associations between low SEP and cancer morbidity and mortality in the total population and stratified by sex. Modifiable risk factors together explained 45.6% of associations between low SEP and overall cancer morbidity and mortality. Smoking was the most important mediator in the total population and for males, accounting for 15.5% and 40.2% of the total effect, respectively. For females, obesity was the most important mediator. Modifiable risk factors are important mediators of socio-economic inequities in cancer morbidity and mortality. Nevertheless, more than half of the variance in these associations remained unexplained. Midstream interventions that target modifiable risk factors may help to alleviate inequities in cancer risk in the short term. However, ultimately, upstream interventions that target structural determinants of health are needed to reduce overall socio-economic inequities in cancer morbidity and mortality.

Risk factors for ischemic stroke in Bulgaria

Background. Stroke is a multifactorial disease with various clinical presentations ruled out by modifiable and non-modifiable risk factors (RF). Multiple vascular and behavioural factors lead to an increased risk of ischemic stroke, as they can differ in various countries. Understanding those factors may result in the implementation of strategies for screening, prevention, and reducing the overall risk of stroke. There is a lack of contemporary information regarding the RF for ischemic stroke (IS) in Bulgaria. Objective. We aimed to determine the major potential RF for ischemic stroke in the Bulgarian population. Material and methods. A prospective hospital-based case-control study was conducted between July 1, 2019, and June 30, 2020, at a tertiary care referral center for neurological disorders. We included cases with first-ever and recurrent stroke and stroke-free controls. Association between RF and IS was expressed in odds ratio (OR) through a 95% confidence interval (CI). Statistical significance was defined as a p-value of 0.05 or less. Results. Overall 150 cases and 100 stroke-free participants were included. All risk factors were more prevalent in the case-group, except for dyslipidemia which had an inverse association with IS risk. The most significant RF for IS consisted of hypertension (OR, 28.78; 95% CI, 6.67 – 124.15) heart failure (OR, 15.25; 95% CI, 6.29-36.97), atrial fibrillation (OR, 11.29; 95% CI, 3.92-32.51), ischemic heart disease (OR, 5.83; 95% CI, 2.81-12.12), diabetes mellitus (OR, 2.65; 95% CI, 1.28-5.49), daily alcohol abuse with concentrate (OR, 9.39; 95% CI, 1.21-73.00) and current smoking (OR, 1.82; 95% CI, 1.00-3.32). Conclusions. The results of this study confirm the significant contribution of modifiable RF, both behavioral and related to medical conditions. Early detection and management of the major stroke RF may result in lower stroke incidence. Therefore, implementations of strategies for screening and prevention are needed to reduce the overall risk of stroke.

High population-attributable fractions of traditional risk factors for non-AIDS-defining diseases among people living with HIV in China: a cohort study

ABSTRACT Morbidity and mortality of non-AIDS-defining diseases (NADs) have become the increasing burden of people living with HIV (PLWH) with long-term antiretroviral therapy (ART). We aimed to quantify the contribution of modifiable risk factors to NADs. We included PLWHs starting ART at the Third People’s Hospital of Shenzhen (China) from Jan 1, 2010 to Dec 31, 2017. We defined NAD outcomes of interest as cardiovascular disease (CVD), end-stage liver disease (ESLD), advanced renal disease (ARD), and non-AIDS-defining cancers (NADCs). We estimated incidence of outcomes and population-attributable fractions (PAFs) of modifiable traditional and HIV-related risk factors for each outcome. Overall, 8,301 participants (median age at study entry, 31 years) contributed 33,146 person-years of follow-up (PYFU). Incidence of CVD (362/100,000 PYFU) was the highest among outcomes, followed by that of ARD (270/100,000 PYFU), ESLD (213/100,000 PYFU), and NADC (152/100,000 PYFU). Totally, 34.14% of CVD was attributable to smoking, 7.98% to hypertension, and 6.44% to diabetes. For ESLD, 24.57% and 25.04% of it could be avoided if chronic hepatitis B and C virus infection, respectively, did not present. The leading PAFs for ARD were declined estimated glomerular filtration rate (eGFR) (39.68%) and low CD4 count (39.61%), followed by diabetes (10.19%). PAFs of hypertension, diabetes, and smoking for CVD, and declined eGFR and diabetes for ARD increased with age. The contribution of traditional risk factors for these NADs far outweighed the HIV-related risk factors. Individual-level interventions and population-level policy-making is needed to focus on these factors to prevent NADs in long-term management of HIV infection.

Machine learning to determine relative contribution of modifiable and non-modifiable risk factors of major eye diseases

AimsTo use machine learning (ML) to determine the relative contributions of modifiable and non-modifiable clinical, metabolic, genetic, lifestyle and socioeconomic factors on the risk of major eye diseases.MethodsWe conducted analyses...

Contribution of Modifiable Risk Factors on the Burden of Diabetes Among Women in Reproductive Age-Group in India: A Population Based Cross-Sectional Study

With the ongoing epidemiological transition, the burden of diabetes is rapidly accelerating in India, particularly in the past two decades. The study explores the burden of diabetes and the contribution of modifiable risk factors in the occurrence of diabetes among reproductive women (age group 15-49 years) across geographic regions of India. The study utilizes data from the National Family Health Survey in India 2015-16, Census of India 2011, and World Population Prospects 2015. Population Attributable Fraction was computed and the number of total and avoidable diabetic cases were estimated across regions. The prevalence of diabetic cases in India was 24.4 per 1000 women and it largely varies across geographic regions. Diabetes was found to affect around 8.2 million women in the reproductive age-group, out of which Southern region (accounted for 3.3 million diabetic cases), followed by Central (1.6 million), and Eastern region (1.3 million). Overweight, Obesity and Hypertension were important contributors to the diabetes burden, which if mitigated optimally can reduce diabetic cases by 1.6 million, 1.5 million, and 1.3 million, respectively. Inclusion of diabetes screening along with Maternal and Child Health services could help in monitoring and effective management of diabetes burden among women. An optimal level of monitoring regarding the cascades in diabetes care needs to be ensured by Government keeping women in a central place.

Race and Sex-Specific Population Attributable Fractions for Incident Heart Failure: Lifetime Risk Pooling Project

Objective Despite race- and sex-specific differences in risk of heart failure (HF), there are limited data comparing the contribution of major modifiable risk factors to the population burden of HF in each race-sex group. In addition, studies have not used a competing risk framework to account for death in the absence of HF, to provide a more accurate risk estimate for each risk factor. We determined the contribution of modifiable risk factors, specifically hypertension, diabetes, obesity, current smoking, and hyperlipidemia, to the population burden of HF, as measured by population attributable fraction (PAF), stratified by race and sex. Methods A pooled cohort was created using harmonized data from six longitudinal US-based cohorts (Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Heart Study starting from 1970, Framingham Offspring Study, and the Multi-Ethnic Study of Atherosclerosis). Baseline measurements of the risk factors were used to determine prevalence. Relative risk of incident HF for each risk factor was determined using a piecewise constant hazards model adjusted for age, education, other modifiable risk factors, and the competing risk of non-HF death. PAF for HF was then calculated for each risk factor in each race-sex group. Results Hypertension had the highest adjusted PAF in black men (28.3%, 95% CI 18.7, 36.7%) and black women (25.8%, 95% CI 16.3, 34.2%). In contrast, obesity had the highest adjusted PAF in white men (21.0%, 95% CI 14.6, 27.0%) and white women (17.9%, 95% CI 12.8, 22.6%). Diabetes disproportionately contributed to HF in black women (PAF 16.4%, 95% CI 12.7, 19.9%). Current smoking made a modest contribution and hyperlipidemia contributed minimally to HF risk. The cumulative PAF for all risk factors was highest in black women (51.9%, 95% CI 39.3, 61.8%) and lowest in white women (39.3%, 95% CI 33.9, 44.4%). Conclusions Our findings extend insights into the contribution of modifiable risk factors to population HF burden by using a competing risk model and providing race and sex-specific contemporary PAF estimates (Figure 1). Our results highlight the growing impact of hypertension and diabetes on HF burden, especially in black women. These results can guide public health policies aimed at reducing the population burden of HF. Despite race- and sex-specific differences in risk of heart failure (HF), there are limited data comparing the contribution of major modifiable risk factors to the population burden of HF in each race-sex group. In addition, studies have not used a competing risk framework to account for death in the absence of HF, to provide a more accurate risk estimate for each risk factor. We determined the contribution of modifiable risk factors, specifically hypertension, diabetes, obesity, current smoking, and hyperlipidemia, to the population burden of HF, as measured by population attributable fraction (PAF), stratified by race and sex. A pooled cohort was created using harmonized data from six longitudinal US-based cohorts (Atherosclerosis Risk in Communities Study, Coronary Artery Risk Development in Young Adults Study, Cardiovascular Health Study, Framingham Heart Study starting from 1970, Framingham Offspring Study, and the Multi-Ethnic Study of Atherosclerosis). Baseline measurements of the risk factors were used to determine prevalence. Relative risk of incident HF for each risk factor was determined using a piecewise constant hazards model adjusted for age, education, other modifiable risk factors, and the competing risk of non-HF death. PAF for HF was then calculated for each risk factor in each race-sex group. Hypertension had the highest adjusted PAF in black men (28.3%, 95% CI 18.7, 36.7%) and black women (25.8%, 95% CI 16.3, 34.2%). In contrast, obesity had the highest adjusted PAF in white men (21.0%, 95% CI 14.6, 27.0%) and white women (17.9%, 95% CI 12.8, 22.6%). Diabetes disproportionately contributed to HF in black women (PAF 16.4%, 95% CI 12.7, 19.9%). Current smoking made a modest contribution and hyperlipidemia contributed minimally to HF risk. The cumulative PAF for all risk factors was highest in black women (51.9%, 95% CI 39.3, 61.8%) and lowest in white women (39.3%, 95% CI 33.9, 44.4%). Our findings extend insights into the contribution of modifiable risk factors to population HF burden by using a competing risk model and providing race and sex-specific contemporary PAF estimates (Figure 1). Our results highlight the growing impact of hypertension and diabetes on HF burden, especially in black women. These results can guide public health policies aimed at reducing the population burden of HF.

Attributable Causes of Cancer in Vietnam.

PURPOSEVietnam is undergoing rapid socio-economic transition with an increasing cancer burden. The contribution of modifiable risk factors to cancers in Vietnam has not been studied. Therefore, we sought to evaluate the attributable causes of cancer in Vietnam.METHODSWe reviewed the data on burden of cancer in Vietnam from 2 cancer registries in Hanoi and Ho Chi Minh City between 1995 and 2012. Next, we calculated the fractions of cancers occurring in 2018 attributable to established modifiable risk factors whose impact could be quantified. Data on exposure prevalence were obtained for the period from 2000 to 2010 from national sources wherever possible.RESULTSCancer incidence in Vietnam has decreased slightly in both sexes. Cancer related to infectious agents decreased sharply, whereas cancer related to nutrition and metabolism has increased. In 2018, established carcinogens included in the analysis explained 47.0% of cancer burden in Vietnam. Chronic infections accounted for 29.1% of cancers (34.7% in men and 22.1% in women), tobacco smoking for 13.5% (23.9% in men and 0.8% in women), and alcohol drinking for 10.3%. Passive smoking was responsible for 8.8% of cancers in women. Other risk factors, including overweight or obesity, nulliparity, and low vegetable and fruit intake, accounted for < 1% of all cancers each.CONCLUSIONCancer incidence is slowly decreasing in Vietnam, and the causes of more than half of cancers remain unexplained. This result underlines the need for further epidemiologic and fundamental research. Our findings confirm the notion that controlling oncogenic infections and decreasing tobacco smoking are the most effective approaches to reduce the burden of cancer in Vietnam, but other risk factors, including alcohol drinking and diet, should not be neglected.