Meta-analysis Of Population-based Studies Research Articles

A215 DEFINING THE MODERN GLOBAL INCIDENCE AND PREVALENCE OF EOSINOPHILIC ESOPHAGITIS IN POPULATION-BASED STUDIES

Abstract Background Eosinophilic esophagitis (EoE) is an immune-mediated condition that results in esophageal dysfunction. Previous research demonstrated a marked increase in both incidence and prevalence of EoE globally, associated with a concomitant increase in type 2 inflammatory diseases. A previous meta-analysis suggested that the pooled prevalence of EoE was 34.4 cases/100,000 population and the incidence was 6.6 cases/100,000 person-years, but this analysis included only studies conducted to 2018. Aims To assess the current global incidence and prevalence of EoE, through systematic review and meta-analysis of population-based studies. Methods Electronic databases (Medline and Embase) were searched to February 22, 2023. Abstracts were screened, and full texts were reviewed for inclusion in meta-analysis. Original population-based studies published after 2018 that reported the incidence or prevalence of EoE in adults or children were included. Meta-analysis of incidence and prevalence rates, reported per 100,000 person-years or per 100,000 population, respectively, were pooled using a random-effects model. Heterogeneity was quantified using the I2 statistic. Results A total of 1916 unique reports were identified, and abstracts were reviewed. 129 full texts were read, and 21 reports met inclusion criteria for population based, incidence and prevalence studies. The pooled global incidence of EoE was 8.43 cases per 100,000 person-years [95% CI: 6.52, 10.34] (I2=99%) (Figure 1). The incidence was similar in adult and pediatric subgroups. The pooled global prevalence of EoE was 68.0 cases per 100,000 population [95% CI: 37.5, 123.4] (I2=99%). Conclusions The incidence and prevalence of EoE in recent studies is higher than that previously published. The prevalence of EoE is anticipated to compound, given that this is a disease typically diagnosed in young patients without an associated increased risk of mortality. Funding Agencies None

The effects of organic food on human health: a systematic review and meta-analysis of population-based studies.

Although the nutritional composition of organic food has been thoroughly researched, there is a dearth of published data relating to its impact on human health. This systematic review aimed to examine the association between organic food intake and health effects, including changes in in vivo biomarkers, disease prevalence, and functional changes. PubMed, EMBASE, Web of Science, the Cochrane Library, and ClinicalTrials.gov were searched from inception through Nov 13, 2022. Both observational and interventional studies conducted in human populations were included, and association between level of organic food intake and each outcome was quantified as "no association," "inconsistent," "beneficial correlation/harmful correlation," or "insufficient". For outcomes with sufficient data reported by at least 3 studies, meta-analyses were conducted, using random-effects models to calculate standardized mean differences. Based on the included 23 observational and 27 interventional studies, the association between levels of organic food intake and (i) pesticide exposure biomarker was assessed as "beneficial correlation," (ii) toxic metals and carotenoids in the plasma was assessed as "no association," (iii) fatty acids in human milk was assessed as "insufficient," (iv) phenolics was assessed as "beneficial", and serum parameters and antioxidant status was assessed as "inconsistent". For diseases and functional changes, there was an overall "beneficial" association with organic food intake, and there were similar findings for obesity and body mass index. However, evidence for association of organic food intake with other single diseases was assessed as "insufficient" due to the limited number and extent of studies. Organic food intake was found to have a beneficial impact in terms of reducing pesticide exposure, and the general effect on disease and functional changes (body mass index, male sperm quality) was appreciable. More long-term studies are required, especially for single diseases. PROSPERO registration no. CRD42022350175.

S969 Risk of Surgery for Inflammatory Bowel Diseases Has Decreased Over Time: A Systematic Review and Meta-analysis of Population-Based Studies

S969 Risk of Surgery for Inflammatory Bowel Diseases Has Decreased Over Time: A Systematic Review and Meta-analysis of Population-Based Studies

Prevalence of food allergy in the Chinese population: A systematic review and meta-analysis of population-based studies.

Background: The prevalence of food allergy is increasing and varies among different populations. Study on the food allergy prevalence is very limited in China. Objective: To assess the prevalence of food allergy in the Chinese population by using systematic evaluation and meta-analysis. Methods: A literature search for population-based epidemiologic study on food allergy in China was conducted in several Chinese and English medical literature data bases. Pooled prevalence data and 95% confidence intervals were calculated to estimate the prevalence of food allergy in China. Subgroup analyses were performed to eliminate and explain the heterogeneity, and also to obtain the prevalence of pooled food allergy in different populations. Results: The overall food allergy prevalence ranged from 4.0% to 8.2%. Subgroup analysis showed a trend of overall increase of food allergy, which varied between 4.4% and 9.9%; The common allergic foods were determined to be mango, shrimp, egg, milk, and crab, with the prevalence of 1.9%, 1.5%, 1.4%, 1.3%, 1.3%, respectively; There is a lack of epidemiologic studies on food allergy in some regions and the overall prevalence of food allergy varied from region to region in China. Conclusion: This study revealed that the prevalence of food allergy in the Chinese population ranged from 4.0% to 8.2%; Food allergy prevalence varied by gender, age, and region. This study highlighted the need for collaborative studies of food allergy with the same rational methods to minimize potential bias caused by methods and techniques. Findings of this study may provide baseline data and scientific reference for improving policies on prevention and control of food allergy.

Primary headache disorders in Latin America and the Caribbean: A meta-analysis of population-based studies

In this manuscript, we aim to systematically estimate the pooled prevalence and incidence of primary headaches and its subtypes (migraine, tension-type headache, and chronic headaches) in Latin America and the Caribbean, describing its epidemiological profile and associated factors. We systematically searched PubMed/MEDLINE, Scopus, and LILACS (From conception to March 2021), for populational studies reporting the epidemiology of primary headaches and their associated factors in Latin America and the Caribbean. The data extraction was conducted independently. We performed random-effect model meta-analysis of prevalence (overall primary headaches and by subtypes) and associated factors, assessed potential sources of heterogeneity, the risk of bias, publication bias, and the evidence certainty (GRADE methodology). We included 32 populational studies (38 subpopulations, n = 63,813). The prevalence of primary headaches was 41.4% (95% CI 31.1-52.2%; n = 54,357), 15% for migraine (95% CI 12.0-18.3; n = 53,658 individuals), 20.6% for tension-type headache (95% CI 12.4-30.2; n = 25,840), and 6% for chronic headaches (95% CI 3.3-9.6; n = 21,720), with high between-study heterogeneity. No incidence data was found. Female sex, white ethnicity, high BMI, comorbid mental health disorders, and low-back pain were associated with higher prevalence of primary headaches. The prevalence was less in rural areas. In Latin America and the Caribbean, primary headaches are highly prevalent affecting young females disproportionally. The prevalence of chronic headaches is higher than in other systematic global and regional estimations. The presence of comorbidities as modifiable risk factors should encourage their integration as targets for community-based preventive and therapeutic interventions. CRD42018105116.

Risk of Cervical Cancer in Inflammatory Bowel Disease: A Meta-Analysis of Population-Based Studies.

There is increased risk of several malignancies in inflammatory bowel disease (IBD). However, evidence regarding risk of cervical cancer in IBD is conflicting. We aimed to investigate the risk of cervical cancer in IBD by undertaking a systematic review and meta-analysis of unselected, population-based studies. MEDLINE, EMBASE, and Cochrane Library were searched using Medical Subject Heading terms, and 2 reviewers independently screened results. Pooled hazard ratios (HRs) were calculated using random effects model meta-analysis for risk of cervical cancer in IBD. Subgroup meta-analysis was undertaken to assess risk of cervical cancer by IBD subtype (Crohn's disease and ulcerative colitis), treatment exposure, and grade of lesion. We screened 1,393 articles to identify 5 population-based studies, including 74,310 patients with IBD and 2,029,087 reference patients, across 5 different countries. Pooled random effects model meta-analysis of these studies did not show statistically significant increased risk for cervical cancer in IBD compared with reference populations (HR: 1.24; 95% confidence interval [CI]: 0.94-1.63). Meta-analysis by grade of lesion showed increased risk of low-grade cervical lesions (HR: 1.15; 95% CI: 1.04-1.28). Meta-analysis by disease subtype indicated no statistically significant increased risk in Crohn's disease (HR: 1.36; 95% CI: 0.83-2.23) or ulcerative colitis (HR: 0.95; 95% CI: 0.72-1.25) or in patients treated with antitumor necrosis factor (HR: 1.19; 95% CI: 0.64-2.21) or thiopurines (HR: 0.96; 95% CI: 0.60-1.50). This meta-analysis of high-quality, unselected population-based studies shows no statistically significant increased risk of cervical cancer in patients with IBD. There is, however, increased risk of low-grade cervical lesions compared with the general population.

Prevalence of overweight and obesity in Nigeria: Systematic review and meta-analysis of population-based studies.

In Nigeria, several studies have assessed the prevalence of overweight/obesity with different reports. The purpose of this study was to use a systematic review and meta-analysis to analyze these overweight and obesity reports from different locations in Nigeria over the last ten years. In addition, there was a dearth of systematic reviews and meta-analyses on the prevalence, trends, and demographic characteristics of overweight and obesity in the country. This was a systematic review and meta-analysis of cross-sectional population-based studies among adult Nigerians on the prevalence of overweight/ obesity (defined by body mass index) published from January 2010 to December 2020. Relevant abstracts were scrutinized and articles that included adults of all age groups and were not restricted to a particular group of people (e.g. university community) were selected. Each article was scrutinized by more than 2 authors before selection. The prevalence of overweight/obesity among all participants, among men and among women in Nigeria and its 6 geopolitical zones was determined. All analyses were performed using STATA version 14 (Stata Corp. College Station, Texas, USA). Thirty-three studies were selected and the number of participants was 37,205. The estimated prevalence of overweight and obesity was 27.6%, and 14.5% respectively. The prevalence of overweight among men and among women was 26.3% and 28.3% respectively and, the prevalence of obesity among men and women was 10.9% and 23.0% respectively. The prevalence of overweight in the 6 geopolitical zones was Southeast 29.3%, Southwest 29.3%, South-south 27.9%, Northwest 27.2%, North-central 25.3%, Northeast 20.0% and obesity South-south 24.7%, Southeast 15.7%, Southwest 13.9%, Northwest 10.4%, North-central 10.2%, Northeast 6.4%. Egger's tests showed no statistically significant publication bias among the studies that reported the overweight and obesity prevalence respectively (p = 0.225, P 0.350). The prevalence of overweight/obesity in Nigeria is high. The southern geopolitical zones had a higher prevalence of overweight/obesity.

MEdication Management in older people with Intellectual Disabilities (MEMID): a scoping review

Abstract Introduction Globally, around 1 in 100 adults have intellectual disabilities (ID) (synonymous with learning disability in the UK) (1) yet their needs in terms of healthcare in general and medication management in particular, are under-researched. People with ID have more comorbidities compared with those without ID and around one third of older people (≥ 50 years) with ID (OPwID) have two or more chronic conditions, putting them at risk of polypharmacy (use of multiple medicines) (2). Aim To undertake a scoping review to gather evidence on the barriers and facilitators in the medication management of OPwID from a multi-stakeholder (patient, carer and healthcare professional) perspective. Methods Standard scoping review methods were used. Electronic databases (Medline, PsycINFO) were searched from 2011-2021 using a range of search terms. Studies were included if they involved: OPwID without dementia (all types); healthcare professionals or caregivers caring for individuals with ID; problems related to medication use. The review was restricted to studies in the English language. The PRISMA-ScR checklist and reporting standards was used to conduct and report the review. Independent duplicate screening and data extraction was undertaken. The quality of studies was not formally assessed. A narrative synthesis was conducted to summarise the results and included barriers and facilitators associated with medicines management from patients’/carers’ and professionals’ perspectives. Results Eight studies were included, of which seven used qualitative methods. The majority of studies were undertaken in Europe ((the Netherlands (2), Norway (1), Belgium (1), UK (3)) and one was conducted in the US. Patients/carers reported several barriers/facilitators: The most cited barriers to medication management of OPwID from professionals’ perspective included: limited knowledge of, and training about, ID; nonadherence to guideline recommendation; and lack of coordination between different professionals in multidisciplinary teams. Conclusion/Discussion The review was restricted to two databases and the English language due to resource- and time-constraints. All the included studies were conducted in developed countries with different healthcare settings/practice. As such, the findings might not be generalisable to other less/under-developed countries or settings. There is limited empirical evidence regarding the medication management of OPwID, in particular, facilitators to medicines management from professionals’ perspective. OPwID are a highly vulnerable population for whom medications have an important role in managing their multiple morbidities. This review highlights an evidence gap regarding the medication management of these individuals. The results will be used to inform the development of personalised intervention(s) to improve the safe and effective use of medication in this population. References (1) Maulik PK, Mascarenhas MN, Mathers CD, Dua T, Saxena S. Prevalence of intellectual disability: a meta-analysis of population-based studies. Res Dev Disabil. 2011 Mar 1;32(2):419-36. (2) Hermans H, Evenhuis HM. Multimorbidity in older adults with intellectual disabilities. Res Dev Disabil. 2014;35(4):776–83.

A211 INCIDENCE OF PRIMARY SCLEROSING CHOLANGITIS: A META-ANALYSIS OF POPULATION-BASED STUDIES

BackgroundPrimary sclerosing cholangitis (PSC) is a chronic liver disease associated with significant morbidity, mortality and healthcare utilization. Understanding the incidence of PSC is important in defining the burden of disease and planning for allocation of healthcare resources.AimsTo conduct a systematic review and meta-analysis of population-based studies of the incidence of PSC and to assess temporal trends of incidence overtime.MethodsMedline and Embase (from inception to May 10, 2021) were systematically searched to identify studies via the following inclusion criteria: 1) original articles, 2) population-based study of defined geographic area, 3) reported the incidence of PSC or provided data to calculate the incidence of PSC. Studies that assessed specific populations (e.g., pediatric-only, IBD-only) or reported less than 1 year of data were excluded. s and full texts were reviewed for inclusion and data was extracted independently in duplicate by two individuals (JC, AM). Meta-analyses were performed to calculate overall and country-specific incidence rates (per 100,000 persons) with 95% confidence intervals (CI). Meta-regression calculated the Average Annual Percentage Change (AAPC) of PSC incidence rates overtime.ResultsThe initial search returned 3,958 abstracts. After duplicates were removed, abstracts (3,443) were screened, and full texts were reviewed (317), 17 studies met the criteria for inclusion and underwent data extraction. Meta-analysis included 6 studies with annual data contributing to the calculation of AAPC. Studies originated from 10 countries from North America, Europe, and Oceania; however, no population-based studies were published in Asia, Africa, or Latin America (Figure 1). Overall, the incidence rates of PSC was 0.82 per 100,000 (95% CI: 0.62, 1.02) (Figure 1). Incidence rates of PSC were significantly increasing overtime (AAPC: 4.56%; 95% CI: 0.45, 8.68).ConclusionsThe incidence of PSC is low at 0.82 per 100,000 but has been significantly increasing over time. Future studies on the incidence of PSC should be directed at Asia, Africa of Latin America to assess the global epidemiology of PSC. Figure 1: Pooled incidence rate estimates of PSC per 100,000 person-years at risk.Funding AgenciesNone

Worldwide magnitude of inguinal hernia: Systematic review and meta-analysis of population-based studies.

This review pooled the magnitude of inguinal hernia based on the available population-based studies conducted throughout the world. We have searched for population-based articles reporting the magnitude of inguinal hernia on PubMed/Medline, EMBASE, Cochrane library and Google Scholar. Random-effect meta-analysis was carried out to pool the magnitude of inguinal hernia and its proportion between male and female subjects. To determine the presence of between-study heterogeneity, I2 and Cochran's Q methods were employed. Publication bias was evaluated by the Egger test and visual examination of a funnel plot. All statistical tests were conducted by Stata version 16 software. Ten population-based studies with a total population of 51,304,093 were incorporated to pool the magnitude of inguinal hernia. The pooled prevalence of inguinal hernia was 7.7% (95% confidence interval: 6.06-9.34). Subgroup analysis showed that the highest pooled prevalence of inguinal hernia (12.72%) was observed in Asia, On the contrary, the lowest pooled prevalence emanated from America, 4.73%. The pooled prevalence of inguinal hernia in males is far higher than females. It was, respectively, 9.61% (95% confidence interval: 6.46-12.76) and 1.31% (95% confidence interval: 0.36-2.26) for males and females. The current meta-analysis revealed a higher burden of inguinal hernia. This finding glares the light that giving greater attention to inguinal hernia is required. It is recommended to identify the significant causes of inguinal hernia and design appropriate prevention as well as management strategies.

Myopic Open-angle Glaucoma Prevalence in Northeast Asia: A Systematic Review and Meta-analysis of Population-based Studies.

PurposeInvestigation of myopic open-angle glaucoma (OAG) prevalence in Northeast Asia by systematic review and meta-analysis.MethodsSystematic PubMed, Embase and Cochrane database searches for Northeast Asian population-based studies published up to 30 November 2020 and reporting on myopia and OAG diagnosis. By random-effect models, pooled OAG prevalence in a myopic population and pooled myopic OAG prevalence in a general population were generated, with 95% confidence intervals (CIs).ResultsThe meta-analysis encompassed five population-based studies in four countries (12,830 individuals, including 7,723 patients with myopia and 1,112 patients with OAG). In a myopic population, OAG prevalence was 4.10% (95% CI, 3.00–5.70; I2 = 93%); in a general population, myopic OAG prevalence was 1.10% (95% CI, 0.60–1.70; I2 = 94%). A visual examination of funnel plot symmetry raised a suspicion of publication bias. Notwithstanding, Begg and Mazumbar’s adjusted rank correlation test showed no such evidence (p = 0.6242).ConclusionsOur systematic review and meta-analysis returned an estimate of OAG prevalence in a myopic Northeast Asian population. Our findings will inform future glaucoma studies as well as public health guidelines for Northeast Asian populations.

Incidence and Prevalence of Thoracic Aortic Aneurysms: A Systematic Review and Meta-analysis of Population-Based Studies

Thoracic aortic aneurysms (TAA) may grow asymptomatically until they rupture, with a mortality over 90%. The true incidence and prevalence of this condition is uncertain and epidemiologic data is scarce, understudied and dispersed. Therefore, we aimed to conduct a systematic review and meta-analysis of the incidence and prevalence of TAAs in population-based studies. We searched MEDLINE, EMBASE and CENTRAL from inception to October 2020 for all population-based studies reporting on incidence and/or prevalence of TAAs. Data were pooled using a random effects model. The main outcome was the overall available worldwide incidence and prevalence of TAAs. The secondary outcomes were to evaluate the incidence of ruptured TAAs, differences in the location of these aneurysms (either ascending, arch or descending aorta) and differences in prevalence/incidence across different study designs. Twenty-two studies were included in the review and meta-analysis. The pooled incidence and prevalence of TAAs was 5.3 per 100,000 individuals/year (95% confidence interval [CI]: 3.0; 8.3) and 0.16% (95% CI: 0.12; 0.20), respectively. The pooled incidence of ruptured aneurysms was 1.6 per 100,000 individuals/year (95% CI: 1.3; 2.1). We found a significant difference of the prevalence in autopsy-only studies, which was 0.76% (95% CI: 0.47; 1.13) and the prevalence of TAAs dropped down to 0.07% (95% CI: 0.05;0.11) when these studies were excluded from the overall analysis. The current epidemiologic information provided serve as a base for future public-health decisions. The lack of well-design population-base studies and the limitations encountered serve as calling for future research in this field.

Long-term survival of children born with congenital anomalies: A systematic review and meta-analysis of population-based studies.

BackgroundFollowing a reduction in global child mortality due to communicable diseases, the relative contribution of congenital anomalies to child mortality is increasing. Although infant survival of children born with congenital anomalies has improved for many anomaly types in recent decades, there is less evidence on survival beyond infancy. We aimed to systematically review, summarise, and quantify the existing population-based data on long-term survival of individuals born with specific major congenital anomalies and examine the factors associated with survival.Methods and findingsSeven electronic databases (Medline, Embase, Scopus, PsycINFO, CINAHL, ProQuest Natural, and Biological Science Collections), reference lists, and citations of the included articles for studies published 1 January 1995 to 30 April 2020 were searched. Screening for eligibility, data extraction, and quality appraisal were performed in duplicate. We included original population-based studies that reported long-term survival (beyond 1 year of life) of children born with a major congenital anomaly with the follow-up starting from birth that were published in the English language as peer-reviewed papers. Studies on congenital heart defects (CHDs) were excluded because of a recent systematic review of population-based studies of CHD survival. Meta-analysis was performed to pool survival estimates, accounting for trends over time. Of 10,888 identified articles, 55 (n = 367,801 live births) met the inclusion criteria and were summarised narratively, 41 studies (n = 54,676) investigating eight congenital anomaly types (spina bifida [n = 7,422], encephalocele [n = 1,562], oesophageal atresia [n = 6,303], biliary atresia [n = 3,877], diaphragmatic hernia [n = 6,176], gastroschisis [n = 4,845], Down syndrome by presence of CHD [n = 22,317], and trisomy 18 [n = 2,174]) were included in the meta-analysis. These studies covered birth years from 1970 to 2015. Survival for children with spina bifida, oesophageal atresia, biliary atresia, diaphragmatic hernia, gastroschisis, and Down syndrome with an associated CHD has significantly improved over time, with the pooled odds ratios (ORs) of surviving per 10-year increase in birth year being OR = 1.34 (95% confidence interval [95% CI] 1.24–1.46), OR = 1.50 (95% CI 1.38–1.62), OR = 1.62 (95% CI 1.28–2.05), OR = 1.57 (95% CI 1.37–1.81), OR = 1.24 (95% CI 1.02–1.5), and OR = 1.99 (95% CI 1.67–2.37), respectively (p < 0.001 for all, except for gastroschisis [p = 0.029]). There was no observed improvement for children with encephalocele (OR = 0.98, 95% CI 0.95–1.01, p = 0.19) and children with biliary atresia surviving with native liver (OR = 0.96, 95% CI 0.88–1.03, p = 0.26). The presence of additional structural anomalies, low birth weight, and earlier year of birth were the most commonly reported predictors of reduced survival for any congenital anomaly type. The main limitation of the meta-analysis was the small number of studies and the small size of the cohorts, which limited the predictive capabilities of the models resulting in wide confidence intervals.ConclusionsThis systematic review and meta-analysis summarises estimates of long-term survival associated with major congenital anomalies. We report a significant improvement in survival of children with specific congenital anomalies over the last few decades and predict survival estimates up to 20 years of age for those born in 2020. This information is important for the planning and delivery of specialised medical, social, and education services and for counselling affected families. This trial was registered on the PROSPERO database (CRD42017074675).

A systematic review of population-based studies on lipid profiles in Latin America and the Caribbean.

We aimed to study time trends and levels of mean total cholesterol and lipid fractions, and dyslipidaemias prevalence in Latin America and the Caribbean (LAC). Systematic-review and meta-analysis of population-based studies in which lipid (total cholesterol [TC; 86 studies; 168,553 people], HDL-Cholesterol [HDL-C; 84 studies; 121,282 people], LDL-Cholesterol [LDL-C; 61 studies; 86,854 people], and triglycerides [TG; 84 studies; 121,009 people]) levels and prevalences were laboratory-based. We used Scopus, LILACS, Embase, Medline and Global Health; studies were from 1964 to 2016. Pooled means and prevalences were estimated for lipid biomarkers from ≥2005. The pooled means (mg/dl) were 193 for TC, 120 for LDL-C, 47 for HDL-C, and 139 for TG; no strong trends. The pooled prevalence estimates were 21% for high TC, 20% for high LDL-C, 48% for low HDL-C, and 21% for high TG; no strong trends. These results may help strengthen programs for dyslipidaemias prevention/management in LAC.

Sodium and Salt Consumption in Latin America and the Caribbean: A Systematic-Review and Meta-Analysis of Population-Based Studies and Surveys

Sodium/salt consumption is a risk factor for cardiovascular diseases. Although global targets to reduce salt intake have been established, current levels and trends of sodium consumption in Latin America and the Caribbean (LAC) are unknown. We conducted a systematic review and meta-analysis of population-based studies in which sodium consumption was analyzed based on urine samples (24 h samples or otherwise). The search was conducted in Medline, Embase, Global Health, Scopus and LILACS. From 2350 results, 53 were studied in detail, of which 15 reports were included, providing evidence for 18 studies. Most studies were from Brazil (7/18) and six collected 24 h urine samples. In the random effects meta-analysis, 12 studies (29,875 people) were analyzed since 2010. The pooled mean 24 h estimated sodium consumption was 4.13 g/day (10.49 g/day of salt). When only national surveys were analyzed, the pooled mean was 3.43 g/day (8.71 g/day of salt); when only community studies were analyzed the pooled mean was 4.39 g/day (11.15 g/day of salt). Studies had low risk of bias. The estimated 24 h sodium consumption is more than twice the World Health Organization recommendations since 2010. Regional organizations and governments should strengthen policies and interventions to measure and reduce sodium consumption in LAC.

Pregnancy-specific malarial immunity and risk of malaria in pregnancy and adverse birth outcomes: a systematic review

BackgroundIn endemic areas, pregnant women are highly susceptible to Plasmodium falciparum malaria characterized by the accumulation of parasitized red blood cells (pRBC) in the placenta. In subsequent pregnancies, women develop protective immunity to pregnancy-associated malaria and this has been hypothesized to be due to the acquisition of antibodies to the parasite variant surface antigen VAR2CSA. In this systematic review we provide the first synthesis of the association between antibodies to pregnancy-specific P. falciparum antigens and pregnancy and birth outcomes.MethodsWe conducted a systematic review and meta-analysis of population-based studies (published up to 07 June 2019) of pregnant women living in P. falciparum endemic areas that examined antibody responses to pregnancy-specific P. falciparum antigens and outcomes including placental malaria, low birthweight, preterm birth, peripheral parasitaemia, maternal anaemia, and severe malaria.ResultsWe searched 6 databases and identified 33 studies (30 from Africa) that met predetermined inclusion and quality criteria: 16 studies contributed estimates in a format enabling inclusion in meta-analysis and 17 were included in narrative form only. Estimates were mostly from cross-sectional data (10 studies) and were heterogeneous in terms of magnitude and direction of effect. Included studies varied in terms of antigens tested, methodology used to measure antibody responses, and epidemiological setting. Antibody responses to pregnancy-specific pRBC and VAR2CSA antigens, measured at delivery, were associated with placental malaria (9 studies) and may therefore represent markers of infection, rather than correlates of protection. Antibody responses to pregnancy-specific pRBC, but not recombinant VAR2CSA antigens, were associated with trends towards protection from low birthweight (5 studies).ConclusionsWhilst antibody responses to several antigens were positively associated with the presence of placental and peripheral infections, this review did not identify evidence that any specific antibody response is associated with protection from pregnancy-associated malaria across multiple populations. Further prospective cohort studies using standardized laboratory methods to examine responses to a broad range of antigens in different epidemiological settings and throughout the gestational period, will be necessary to identify and prioritize pregnancy-specific P. falciparum antigens to advance the development of vaccines and serosurveillance tools targeting pregnant women.

Blood pressure and burden of hypertension in Cameroon, a microcosm of Africa: a systematic review and meta-analysis of population-based studies.

To estimate national and geography-based variations in blood pressure and burden of hypertension in Cameroon, generally called 'miniature Africa'. PubMed, Medline, EMBASE, CINHAL, Web of Science, Popline, Scopus and BDSP were searched through November 2018, for hypertension studies among Cameroonians aged at least 18 years. Hypertension was measured as SBP at least 140 mmHg or DBP at least 90 mmHg. Random-effects meta-analysis was used. Twenty studies involving 46 491 participants met inclusion criteria. Overall hypertension prevalence was 30.9% [95% confidence interval (CI) 27.0-34.8]: 29.6% (24.1-35.1) and 32.1% (27.2-37.1) in 1994-2010 and 2011-2018, respectively. Of hypertensive participants, only 24.4% (18.9-30.0) - 31.6% (21.0-42.3) and 20.8% (14.0-27.7) in 1994-2010 and 2011-2018, respectively - were aware of their status, 15.1% (10.6-19.6) were taking antihypertensive medications and 8.8% (5.7-11.9) - 10.4% (7.5-13.3) and 8.3% (4.4-12.3) in 1994-2010 and 2011-2018, respectively - were controlled. Hypertension prevalence varied by sex: 34.3% (30.0-38.6) for men and 31.3% (26.5-36.1) for women; ethnicity: from 3.3% (0.4-6.2) among Pygmies to 56.6% (49.4-63.8) among Bamileke; urbanity: 25.4% (17.1-33.7) for rural and 31.4% (27.3-35.5) for urban dwellers; agroecological zone: from 35.1% (28.9-41.3) in Tropical highlands to 28% (20.1-35.9) in Guinea-Savannah; and subnational region: from 36.3% (27.8-44.9) in the West to 17.1% (9.9-44.2) in the South. Cameroon's hypertension prevalence is high and increasing whereas awareness, treatment and control are low and declining. Emerging patterns call urgently for effective campaigns to raise hypertension awareness alongside strategies for hypertension prevention and BP control.

Atopic eczema and major cardiovascular outcomes: A systematic review and meta-analysis of population-based studies

BackgroundAtopic eczema is a common inflammatory skin disease. Various inflammatory conditions have been linked to cardiovascular disease, a major cause of global mortality and morbidity.ObjectiveWe sought to systematically review and meta-analyze population-based studies assessing associations between atopic eczema and specific cardiovascular outcomes.MethodsMEDLINE, Embase, and Global Health were searched from inception to December 2017. We obtained pooled estimates using random-effects meta-analyses. We used a multivariate Bayesian meta-regression model to estimate the slope of effect of increasing atopic eczema severity on cardiovascular outcomes.ResultsNineteen relevant studies were included. The effects of atopic eczema reported in cross-sectional studies were heterogeneous, with no evidence for pooled associations with angina, myocardial infarction, heart failure, or stroke. In cohort studies atopic eczema was associated with increased risk of myocardial infarction (n = 4; relative risk [RR], 1.12; 95% CI, 1.00-1.25), stroke (n = 4; RR, 1.10; 95% CI, 1.03-1.17), ischemic stroke n = 4; RR, 1.17; 95% CI, 1.14-1.20), angina (n = 2; RR, 1.18; 95% CI, 1.13-1.24), and heart failure (n = 2; RR, 1.26; 95% CI, 1.05-1.51). Prediction intervals were wide for myocardial infarction and stroke.The risk of cardiovascular outcomes appeared to increase with increasing severity (mean RR increase between severity categories, 1.15; 95% credibility interval, 1.09-1.21; uncertainty interval, 1.04-1.28).ConclusionSignificant associations with cardiovascular outcomes were more common in cohort studies but with considerable between-study heterogeneity. Increasing atopic eczema severity was associated with increased risk of cardiovascular outcomes. Improved awareness among stakeholders regarding this small but significant association is warranted.

Is traumatic brain injury a risk factor for neurodegeneration? A meta-analysis of population-based studies

BackgroundTo determine the association of prior traumatic brain injury (TBI) with subsequent diagnosis of neurodegeneration disease.MethodsAll studies from 1980 to 2016 reporting TBI as a risk factor for diagnoses of interest were identified by searching PubMed, Embase, study references, and review articles. The data and study design were assessed by 2 investigators independently. A meta-analysis was performed by RevMan 5.3.ResultsThere were 18 studies comprising 3,263,207 patients. Meta-analysis revealed a significant association of prior TBI with subsequent dementia. The pooled odds ratio (OR) for TBI on development of dementia, FTD and TDP-43 associated disease were 1.93 (95% CI 1.47–2.55, p < 0.001), 4.44 (95% CI 3.86–5.10, p < 0.001), and 2.97 (95% CI 1.35–6.53, p < 0.001). However, analyses of individual diagnoses found no evidence that the risk of Alzheimer’s disease, and Parkinson’s disease in individuals with previous TBI compared to those without TBI.ConclusionsHistory of TBI is not associated with the development of subsequent neurodegeneration disease. Care must be taken in extrapolating from these results because no suitable criteria define post TBI neurodegenerative processes. Therefore, further research in this area is needed to confirm these questions and uncover the link between TBI and neurodegeneration disease.

Prevalence and risk factors of epiretinal membranes: a systematic review and meta-analysis of population-based studies

ObjectiveThis study was to aggregate the prevalence and risks of epiretinal membranes (ERMs) and determine the possible causes of the varied estimates.DesignSystematic review and meta-analysis.Data sourcesThe search strategy was designed...