Healthy Life Years Research Articles

The Perceived Health Status from Young Adults to Elderly: Results of the MEHM Questionnaire within the CUORE Project Survey 2008-2012.

Improving healthy life years requires an effective understanding and management of the process of healthy ageing. Assessing the perceived health status and its determinants is a relevant step in this process. This study explored the potentialities of the Minimum European Health Module (MEHM) to cope with this critical issue. Investigation was conducted on 4798 Italian residents (49.7% women, aged 35–79 years), participating in the CUORE Project Health Examination Survey 2008–2012. The three MEHM questions—perceived health status, chronic morbidity and activity limitations—were examined also in association with living context, seasonality, marital status and level of education. A higher prevalence of health status negative perception was associated with older age (9% and 24% respectively in men and women aged 35–44 years; 46% and 61% respectively in men and women aged 75–79 years). In women, this negative perception was higher than in men in any age group, and reached 50% in the 65–69 age group, 10 years earlier than in men. For both sexes, the level of education had a strong impact on this negative perception (odds ratio 2.32 and 2.72 in men and women respectively), while “living alone” played a greater impact in women than in men. MEHM activity limitations subscale was as much as 30% higher for questionnaires answered during the hottest months. This study identified potential predictors of perceived health status in adults aged 35–79 years, which can be used to target interventions aimed at improving self-perceived health status.

Cost-Effectiveness of Operating on Traumatic Spinal Injuries in Low-Middle Income Countries: A Preliminary Report From a Major East African Referral Center.

Study Design:Retrospective cost-effectiveness analysis.Objectives:While the incidence of traumatic spine injury (TSI) is high in low-middle income countries (LMICs), surgery is rarely possible due to cost-prohibitive implants. The objective of this study was to conduct a preliminary cost-effectiveness analysis of operative treatment of TSI patients in a LMIC setting.Methods:At a tertiary hospital in Tanzania from September 2016 to May 2019, a retrospective analysis was conducted to estimate the cost-effectiveness of operative versus nonoperative treatment of TSI. Operative treatment included decompression/stabilization. Nonoperative treatment meant 3 months of bed rest. Direct costs included imaging, operating fees, surgical implants, and length of stay. Four patient scenarios were chosen to represent the heterogeneity of spine trauma: Quadriplegic, paraplegic, neurologic improvement, and neurologically intact. Disability-adjusted-life-years (DALYs) and incremental-cost-effectiveness ratios were calculated to determine the cost per unit benefit of operative versus nonoperative treatment. Cost/DALY averted was the primary outcome (i.e., the amount of money required to avoid losing 1 year of healthy life).Results:A total of 270 TSI patients were included (125 operative; 145 nonoperative). Operative treatment averaged $731/patient. Nonoperative care averaged $212/patient. Comparing operative versus nonoperative treatment, the incremental cost/DALY averted for each patient outcome was: quadriplegic ($112-$158/DALY averted), paraplegic ($47-$67/DALY averted), neurologic improvement ($50-$71/DALY averted), neurologically intact ($41-$58/DALY averted). Sensitivity analysis confirmed these findings without major differences.Conclusions:This preliminary cost-effectiveness analysis suggests that the upfront costs of spine trauma surgery may be offset by a reduction in disability. LMIC governments should consider conducting more spine trauma cost-effectiveness analyses and including spine trauma surgery in universal health care.

EU and UK targets for healthy life expectancy – are they achievable?

In 2008, the EU Innovation Partnership on Active and Healthy Ageing (EIP-AHA) set a target of an increase of two healthy life years by 2020. More recently, in 2018, the UK Government set a target to “ensure people can enjoy at least 5 extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest”. This paper reviews the progress the EU member states have made towards meeting this target, and what the UK can learn from their experiences. I conclude that, although the EU target is likely to be reached, the gap in healthy life years between the member states has increased. Past trends in and projections of disability-free life expectancy in England suggest that it will be diffcult to achieve an increase of five healthy and independent years of life by 2035.

Antibacterial Efficacy of Commonly Available Alcohol-Based Hand Sanitizers on Escherichia Coli

Background: The WHO estimates that approximately 600 million people fall ill after consumption of contaminated food and over 420 000 die every year, resulting in loss of 33 million healthy life years. Hand hygiene is considered by the WHO to be the most effective preventive measure for infectious diseases including food borne diseases.Methods: A laboratory-based study involving convenient sampling of common brands alcohol-based hand sanitizers (ABHS) from retail community pharmacies and local supermarkets was conducted in Ilala District, Dar es salaam, Tanzania. The study was conducted, between December 2018 to January 2019. A modified protocol of The European Norm (EN) 1500 was used for in vivo testing of sampled ABHs. Efficacy was evaluated using standard strain of Escherichia coli. A total of 26 healthy volunteers were used for hand sanitization. The percentage of bioburden/microbial reduction was assessed at baseline and after treatment, and the log reduction factor calculated.Results: A total of 10 gel ABHS were purchased and assayed for antibacterial efficacy. Majority (70%) of ABHS were imported products and contained ethanol as the sole active ingredient. About 60% of them did not correctly indicate the label disclosure information on concentration of active ingredients. Only one product was efficacious against E. coli with log reduction of 3.75; while majority (70%) of the samples had poor bacterial efficacy with log reduction ranging from 0.140 -0.664.Conclusions: Most of ABHS gel products available in the Dar es Salaam market were not efficacious as per FDA and EN 1500 guidelines. Post market surveillance is recommended of the circulating ABH to safe guard consumers.
 Keywords: Hand sanitizers, efficacy, E. coli, EN 1500.

Smoke-Free Air Interventions in Seven Latin American Countries: Health and Financial Impact to Inform Evidence-Based Policy Implementation

Disease burden due to tobacco smoking in Latin America remains very high. The objective of this study was to evaluate the potential impact of implementing smoke-free air interventions on health and cost outcomes in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, using a mathematical model. We built a probabilistic Monte Carlo microsimulation model, considering natural history, direct health system costs, and quality of life impairment associated with main tobacco-related diseases. We followed individuals in hypothetical cohorts and calculated health outcomes on an annual basis to obtain aggregated 10-year population health outcomes (deaths and events) and costs. To populate the model, we completed an overview and systematic review of the literature. Also, we calibrated the model comparing the predicted disease-specific mortality rates with those coming from local national statistics. With current policies, for the next 10 years, a total of 137 121 deaths and 917 210 events could be averted, adding 3.84 million years of healthy life and saving USD 9.2 billion in these seven countries. If countries fully implemented smoke-free air strategies, it would be possible to avert nearly 180 000 premature deaths and 1.2 million events, adding 5 million healthy years of life and saving USD 13.1 billion in direct healthcare. Implementing the smoke-free air strategy would substantially reduce deaths, diseases, and health care costs attributed to smoking. Latin American countries should not delay the full implementation of this strategy. Tobacco smoking is the single most preventable and premature mortality cause in the world. The Framework Convention on Tobacco Control, supported by the World Health Organization, introduced a package of evidence-based measures for tobacco control. This study adds quality evidence on the potential health effects and savings of implementing smoke-free air policies in countries representing almost 80% of the Latin America and the Caribbean population.

Evolution of External Health Costs of Electricity Generation in the Baltic States.

Implementation of strict policies for mitigating climate change has a direct impact on public health as far as the external health costs of electricity generation can be reduced, thanks to the reduction of emission of typical pollutants by switching to cleaner low carbon fuels and achieving energy efficiency improvements. Renewables have lower external health costs due to the lower life cycle emission of typical air pollutants linked to electricity generation, such as SO2, NOx, particulate matter, NH3, or NMVOC (Non-methane volatile organic compounds), which all appear to have serious negative effects on human health. Our case study performed in the Baltic States analyzed the dynamics of external health costs in parallel with the dynamics of the main health indicators in these countries: life expectancy at birth, mortality rates, healthy life years, self-perceived health, and illness indicators. We employed the data for external health costs retrieved from the CASES database, as well as the health statistics data compiled from the EUROSTAT database. The time range of the study was 2010–2018 due to the availability of consistent health indicators for the EU Member States. Our results show that the decrease of external health costs had a positive impact on the increase of the self-perceived good health and reduction of long-standing illness as well as the decrease of infant death rate. Our conclusions might be useful for other countries as well as for understanding the additional benefits of climate change mitigation policies and tracking their positive health impacts. The cooperation initiatives on clean energy and climate change mitigation between countries like One Belt One Road initiative by the Chinese government can also yield additional benefits linked to the public health improvements.

Targeted client communication via mobile devices for improving maternal, neonatal, and child health.

Targeted client communication via mobile devices for improving maternal, neonatal, and child health.

Estimating Health Adjusted Age at Death (HAAD).

At any point in time, a person's lifetime health is the number of healthy life years they are expected to experience during their lifetime. In this article we propose an equity-relevant health metric, Health Adjusted Age at Death (HAAD), that facilitates comparison of lifetime health for individuals at the onset of different medical conditions, and allows for the assessment of which patient groups are worse off. A method for estimating HAAD is presented, and we use this method to rank four conditions in six countries according to several criteria of "worse off" as a proof of concept. For individuals with specific conditions HAAD consists of two components: past health (before disease onset) and future expected health (after disease onset). Four conditions (acute myeloid leukemia (AML), acute lymphoid leukemia (ALL), schizophrenia, and epilepsy) are analysed in six countries (Ethiopia, Haiti, China, Mexico, United States and Japan). Data from 2017 for all countries and for all diseases were obtained from the Global Burden of Disease Study database. In order to assess who are the worse off, we focus on four measures: the proportion of affected individuals who are expected to have HAAD<20 (T20), the 25th and 75th percentiles of HAAD for affected individuals (Q1 and Q3, respectively), and the average HAAD (aHAAD) across all affected individuals. Even in settings where aHAAD is similar for two conditions, other measures may vary. One example is AML (aHAAD = 59.3, T20 = 2.0%, Q3-Q1 = 14.8) and ALL (58.4, T20 = 4.6%, Q3-Q1 = 21.8) in the US. Many illnesses, such as epilepsy, are associated with more lifetime health in high-income settings (Q1 in Japan = 59.2) than in low-income settings (Q1 in Ethiopia = 26.3). Using HAAD we may estimate the distribution of lifetime health of all individuals in a population, and this distribution can be incorporated as an equity consideration in setting priorities for health interventions.

Tackling global challenges in pediatric rheumatology.

To highlight the current challenges in diagnosis and clinical care of pediatric rheumatic disease and barriers to research and education of pediatric rheumatologists worldwide. Recent studies and reports demonstrate a paucity of studies on epidemiology, outcomes, and management guidelines from many regions of the world. There have been noteworthy efforts to bridge the gap in under resourced areas. An analysis of the global burden of rheumatic disease has demonstrated that while understudied, musculoskeletal diseases are prevalent and increasingly contribute to loss of years of healthy life. In juvenile idiopathic arthritis, two milestone publications in global pediatric rheumatology have recently been published. An international study evaluated the epidemiology, treatment, and outcomes of juvenile idiopathic arthritis and demonstrated global diversity in both clinical manifestations and outcomes. Notably, the first guidelines for managing pediatric rheumatic disease in a less resourced setting have been published for juvenile idiopathic arthritis. This document offers the first publication targeted to address challenges faced by pediatric rheumatology caregivers in low-resourced settings. These documents serve as exemplars for international collaboration in pediatric rheumatology and can be used as models for other pediatric rheumatic disease research. Other efforts are making progress in various arenas towards increasing access to care, education, and training in pediatric rheumatology. The global burden of rheumatic disease in the pediatric population is poorly understood but unrecognized disease greatly impacts the overall morbidity and mortality in this population. More studies in lesser resourced regions are needed to prioritize access to pediatric rheumatology care and prioritize a further increase in research capacity and education moving forward.

Związek między stanem zdrowia a wydatkami na zdrowie w krajach Europy, w oparciu o analizę danych złożonych

The type of health system in each country and the resources devoted to it determine its outcomes. Relationships between ratios of expenditure to Gross Domestic Product (GDP) classified by provider and indicators reflecting health outcomes in 2015 are examined for 30 countries by means of a compositional data analysis and a regression analysis. The countries in the sample are the European Union (EU-28) countries plus Iceland and Norway. The outcome indicators used are life expectancy at birth (LE); healthy life years in absolute value at birth for females (HLYf) and for males (HLYm); and death rate due to chronic diseases (DR) (response variables). The results indicate that the higher the ratio of expenditure on retailers and other providers of medical goods in relation to other types of expenditure in the composition, the higher the DR indicator and the lower the LE indicator. The ratio of expenditure on residential long-term care facilities in the composition seems to have had a positive effect on both HLY indicators. The effect of expenditure ratios on providers of healthcare system administration and financing is not straightforward.

Sınıf Öğretmenlerinin Sağlık Okuryazarlık Düzeylerini Belirleme, Bilgi, Tutum, Davranış Değişikliği ve Eğitim İhtiyacını Saptama Çalışması

Nowadays, individuals are expected to be able to recognize their own diseases, manage their chronic diseases, and make decisions that they think are good for them during the prevention and treatment process. The effectiveness, effectiveness and quality of health services also depend on the decisions of individuals receiving health care on their own health. Health Literacy; It is extremely important in terms of increasing the year and quality of healthy life in health services and eliminating health inequalities. Method: The population of this research, which was planned descriptively and cross- sectionally, was analyzed using TSOY-32 Health Literacy Scale by classroom teachers working in Sancaktepe district of Istanbul to 306 classroom teachers determined by randomization method between 15.05.2019 15.06.2019. There were 255 valid survey returns. Results: 35% of the participants had Problem-Limited Health Literacy, 17% had poor Health Literacy, 27% had Adequate, 21% had Excellent Health Literacy. 52.2% were in the 22-34 age range, 69.8% were married, 71.4% were women, 93.7% were bachelor’s degree; 11.4% have chronic disease. Discussion: Behavioral changes that may occur with the development of Health Literacy should be gained to people at an early age. Primary school age is an important opportunity for this. In this respect, class teachers are the ones who play the most important role. As a result of this study, it was found that the health literacy levels of classroom teachers were limited and problematic. Efforts should be made to increase the health literacy levels of classroom teachers.

The burden attributable to substance use in the Russian Federation

Aim. Assessment of the health consequences of substance use in the form of lost years of healthy life in the world in comparison with Russia. An additional task was to determine the economic losses from alcohol, tobacco and drugs in the Russian Federation.&#x0D; Methods. We used indicators of mortality, morbidity, prevalence, and years of life lost, taking into account the DALY disability from tobacco, alcohol, opiates, cannabis, and other drugs (ICD10: I42.6, K70.03, Z72.0, F10-19). Indicators of harmful health effects from PS were presented from 1990 to 2017. Variables were standardized by age and sex. An economic assessment of the impact of tobacco, alcohol, and drugs denominated in rubles was applied.&#x0D; Results. Total economic losses from psychoactive substances, expressed in rubles, amounted to from 887.4 billion to 8.5 trillion rubles in Russia in 2017. The greatest harmful effects on health from psychoactive substances in Russia and the world are caused by tobacco, with alcohol in the second place. The damage from smoking in Russia in years of lost life including disability DALY amounted to 8.6 million in 2017 Alcohol consumption and its consequences in Russia caused 1.85 million DALYs of harm to health, alcoholic cirrhosis and other liver diseases-643 thousand DALYs.&#x0D; Conclusion. Alcohol and nicotine cause maximum harm to the health and economy of Russia, and in conditions of limited resources, the main efforts should be directed at preventing the consequences of alcoholism and tobacco smoking.

Uremic Sarcopenia: Clinical Evidence and Basic Experimental Approach.

Sustained physical activity extends healthy life years while a lower activity due to sarcopenia can reduce them. Sarcopenia is defined as a decrease in skeletal muscle mass and strength due not only to aging, but also from a variety of debilitating chronic illnesses such as cancer and heart failure. Patients with chronic kidney disease (CKD), who tend to be cachexic and in frail health, may develop uremic sarcopenia or uremic myopathy due to an imbalance between muscle protein synthesis and catabolism. Here, we review clinical evidence indicating reduced physical activity as renal function deteriorates and explore evidence-supported therapeutic options focusing on nutrition and physical training. In addition, although sarcopenia is a clinical concept and difficult to recapitulate in basic research, several in vivo approaches have been attempted, such as rodent subtotal nephrectomy representing both renal dysfunction and muscle weakness. This review highlights molecular mechanisms and promising interventions for uremic sarcopenia that were revealed through basic research. Extensive study is still needed to cast light on the many aspects of locomotive organ impairments in CKD and explore the ways that diet and exercise therapies can improve both outcomes and quality of life at every level.

Health and Economic Impact of Health Warnings and Plain Tobacco Packaging in Seven Latin American Countries: Results of a Simulation Model.

The burden of disease attributable to tobacco use in Latin America is very high. Our objective was to evaluate the 10-year potential impact of current legislation related to cigarette packaging and warnings and expected effects of moving to a higher level of strategies implementing cigarette plain packaging on health and cost outcomes in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru, using a microsimulation model. We used a probabilistic state-transition microsimulation model, considering natural history, costs, and quality of life losses associated with main tobacco-related diseases. We followed up individuals in hypothetical cohorts and calculated health outcomes annually to obtain aggregated long-term population health outcomes and costs. We performed a literature review to estimate effects and analyzed studies and information from ministries, relevant organizations, and national surveys. We calibrated the model comparing the predicted disease-specific mortality rates with local statistics. Current graphic warnings already in place in each country could avert, during 10 years, 69 369 deaths and 638 295 disease events, adding 1.2 million years of healthy life and saving USD 5.3 billion in the seven countries. If these countries implemented plain packaging strategies, additional 155 857 premature deaths and 4 133 858 events could be averted, adding 4.1 million healthy years of life and saving USD 13.6 billion in direct health care expenses of diseases attributable to smoking. Latin American countries should not delay the implementation of this strategy that will alleviate part of the enormous health and financial burden that tobacco poses on their economies and health care systems. Tobacco smoking is the single most preventable and premature mortality cause in the world. The Framework Convention on Tobacco Control, supported by the World Health Organization, introduced a package of evidence-based measures for tobacco control. This study adds evidence on the potential health effects and savings of implementing cigarette plain packaging in countries representing almost 80% of the Latin American population; findings are valuable resources for policy makers in the region.

Mind the gaps: age and cause specific mortality and life expectancy in the older population of South Korea and Japan

BackgroundRecent life expectancy gains in high-income Asia-pacific countries have been largely the result of postponement of death from non-communicable diseases in old age, causing rapid demographic ageing. This study compared and quantified age- and cause-specific contributions to changes in old-age life expectancy in two high-income Asia-pacific countries with ageing populations, South Korea and Japan.MethodsThis study used Pollard’s actuarial method of decomposing life expectancy to compare age- and cause-specific contributions to changes in old-age life expectancy between South Korea and Japan during 1997 and 2017.ResultsSouth Korea experienced rapid population ageing, and the gaps in life expectancy at 60 years old between South Korea and Japan were reduced by 2.47 years during 1997 and 2017. Decomposition analysis showed that mortality reductions from non-communicable diseases in South Korea were the leading causes of death contributing to the decreased gaps in old-age life expectancy between the two countries. More specifically, mortality reductions from cardiovascular diseases (stroke, ischaemic and hypertensive heart disease) and cancers (stomach, liver, lung, pancreatic cancers) in South Korea contributed to the decreased gap by 1.34 and 0.41 years, respectively. However, increased mortality from Alzheimer and dementia, lower respiratory tract disease, self-harm and falls in South Korea widened the gaps by 0.41 years.ConclusionsAge- and cause- specific contributions to changes in old-age life expectancy can differ between high-income Asia-pacific countries. Although the gaps in old-age life expectancy between high-income Asia-pacific countries are primarily attributed to mortality changes in non-communicable diseases, these countries should also identify potential emerging threats of communicable diseases and injuries along with demographic ageing in pursuit of healthy life years in old age.

Multidimensional Analysis of the Relationship between Sustainable Living Conditions and Long and Good Health in the European Union Countries

Purpose: The main goal of the study is to determine the relationship between two multidimensional phenomena, i.e., sustainable living conditions of households and the long and good health of the populations of the European Union countries. In particular, the analysis focused on showing the differences between EU(28) countries in terms of the research indicators used, the diagnosis of the relationships between them, creating synthetic measures for the investigated phenomena, as well as creating rankings and groups of countries with similar characteristics. Design/Approach/Methodology: The issues were evaluated using 23 indicators. The empirical data consisted of information from the European Statistical Office. The analysis covered 28 European Union countries. The study was carried out between 2010 and 2018. The empirical data was subjected to statistical analysis using STATISICA and Microsoft Excel software. Findings: The analyses showed that sustainable living conditions of households in the EU(28) countries affect the number of healthy life years of their populations. In countries that are relatively more often affected by financial issues and limited living conditions, have low income and are at risk of poverty, are exposed to noise and air pollution, their populations are healthy for shorter periods of time, less often perceive their health as good or very good. Practical Implications: The results are compared with other possible forms of relationships, sustainable living conditions of households with long and good health of the population. Originality/Value: The study included some detailed calculations involving selected living conditions of households in EU(28) countries and showed how they affect the life expectancy and health.

Underwater noise impairs social communication during aggressive and reproductive encounters

Human-generated noise pollution is of global concern, as designated by the World Health Organization ( WHO, 2011 , Burden of disease from environmental noise: Quantification of healthy life years lost in Europe. https://www.who.int/quantifying_ehimpacts/publications/e94888/en/). Increases in shipping, sonar use, pile driving, and more have all contributed to a rise in ambient underwater sound levels. Unfortunately, continuous low-intensity sounds, like shipping noise, are pervasive in shallow-shore environments where many social species live and correspond to the frequency ranges at which many fishes produce and detect acoustic stimuli. Noise has the potential to alter the sender's production of the signal, mask the signal itself (if acoustic), or change the receiver's physiology. We hypothesized that continuous tonal noise would impair social interactions and communication. To test this, we used highly social African cichlid fish, Astatotilapia burtoni, to examine inter- and intrasexual interactions that occurred in a control or noisy environment (pure tones of 100–2000 Hz). During reproductive interactions, we found that males changed the location of their courtship behaviours. Instead of producing courtship quivers (and associated sounds) immediately next to gravid females, males produced these behaviours inside their spawning shelter. This change in location decreases the likelihood of the female detecting it. Also detrimental to acoustic communication, we found that noise-exposed gravid females had lower hearing sensitivity at 100–200 Hz, a major component of male courtship sounds. In addition, males changed their visual displays during male–male territorial interactions such that they spent more time with their eyebar displayed, suggesting an increase in visual signalling. Together, these data indicate that noise may impact all three components of social communication: signal production, signal reception and the signal itself, and highlights a possible cross-modal impact of noise on visual signalling. Subtle changes to social behaviours and communication, rather than dramatic effects such as injury or mortality, are important to evaluating sublethal impacts of noise on reproductive success and species survival.

Costs and outcomes of "intermediate" vs "minimal" care for youth-onset type 1 diabetes in six countries.

Data are needed to demonstrate that providing an "intermediate" level of type 1 diabetes (T1D) care is cost-effective compared to "minimal" care in less-resourced countries. We studied these care scenarios in six countries. We modeled the complications/costs/mortality/healthy life years (HLYs) associated with "intermediate" care including two blood glucose tests/day (mean HbA1c 9.0% [75 mmol/mol]) in three lower-gross domestic product (GDP) countries (Mali, Tanzania, Pakistan), or three tests/day (mean HbA1c 8.5% [69 mmol/mol]) in three higher-GDP countries (Bolivia, Sri Lanka, Azerbaijan); and compared findings to "minimal" care (mean HbA1c 12.5% [113 mmol/mol]). A discrete time Markov illness-death model with age and calendar-year-dependent transition probabilities was developed, with inputs of 30 years of complications and Standardized Mortality Rate data from the youth cohort in the Pittsburgh Epidemiology of Diabetes Complications Study, background mortality, and costs determined from international and local prices. Cumulative 30 years incidences of complications were much lower for "intermediate care" than "minimal care", for example, for renal failure incidence was 68.1% (HbA1c 12.5%) compared to 3.9% (9%) and 2.4% (8.5%). For Mali, Tanzania, Pakistan, Bolivia, Sri Lanka, and Azerbaijan, 30 years survival was 50.1%/52.7%/76.7%/72.5%/82.8%/89.2% for "intermediate" and 8.5%/10.1%/39.4%/25.8%/45.5%/62.1% for "minimal" care, respectively. The cost of a HLY gained as a % GDP/capita was 141.1%/110.0%/52.3%/41.8%/17.0%/15.6%, respectively. Marked reductions in complications rates and mortality are achievable with "intermediate" T1D care achieving mean clinic HbA1c of 8.5% to 9% (69-75 mmol/mol). This is also "very cost-effective" in four of six countries according to the WHO "Fair Choices" approach which costs HLYs gained against GDP/capita.

Abstract P102: Potential U.S. Population Impact Of Low Cardiovascular Health In Terms Of Preventable Loss Of Life-span And Health-span

Introduction: Individuals who maintain optimal cardiovascular health (CVH) live a longer, healthier life without cardiovascular disease (CVD). In order to quantify the population burden of sub-optimal CVH, we estimated potential loss of health- and life-span in a nationally representative sample of middle-aged US black and white adults. Methods: We first calculated individual-level composite CVH scores (range 0-14 points), including all 7 AHA-defined CVH metrics (smoking, diet, physical activity, body mass index, blood pressure, glucose, and cholesterol) using data from middle-aged participants (40-49 years) from 3 population-based cohorts. We categorized participants into low (0-6), moderate (7-9), and high (10-14) CVH and used Irwin’s restricted means to estimate years lived free of and with CVD. Next, we determined the contemporary prevalence of low, moderate, and high CVH in middle-aged black and white adults (40-59 years) pooled from 3 NHANES survey cycles (2011-2016). Finally, we generated estimates of CVD-free and overall years of life lost in moderate and low CVH compared to high CVH subgroups, weighted to the US population accounting for the NHANES complex survey design. Results: Of 12,906 participants in the pooled cohort, 23% were black and 56% women. Low and moderate CVH were associated with 4.41±0.02 and 1.86±0.01 fewer healthy years lived without CVD and 2.43±0.02 and 1.09±0.01 fewer overall years of life, respectively. This resulted in a greater proportion of life lived with CVD across all race-sex groups (FIGURE). When weighted to the US population, we estimate that approximately 230.8 (203.5, 258.0) and 97.1 (95% CI 85.6, 108.6) million healthy life years will be lost due to low and moderate CVH, respectively, in middle-aged adults. Conclusions: The projected loss of healthy CVD-free years and total life years due to low and moderate CVH is substantial. Maintenance of optimal CVH into mid-life may represent a significant opportunity to extend healthspan and mitigate disparities in the US population.

Overview of the burden of chronic kidney disease in Mexico: secondary data analysis based on the Global Burden of Disease Study 2017

ObjectiveTo describe the evolution of the burden of chronic kidney disease (CKD) in Mexico by states, sex and subtypes from 1990 to 2017.DesignSecondary data analysis based on the Global Burden...