NCD Mortality Research Articles

Effect of PM2.5 on burden of mortality from non-communicable diseases in northern Thailand.

Particulate pollution, especially PM2.5from biomass burning, affects public and human health in northern Thailand during the dry season. Therefore, PM2.5exposure increases non-communicable disease incidence and mortality. This study examined the relationship between PM2.5and NCD mortality, including heart disease, hypertension, chronic lung disease, stroke, and diabetes, in northern Thailand during 2017-2021. The analysis utilized accurate PM2.5data from the MERRA2 reanalysis, along with ground-based PM2.5measurements from the Pollution Control Department and mortality data from the Division of Non-Communicable Disease, Thailand. The cross-correlation and spearman coefficient were utilized for the time-lag, and direction of the relationship between PM2.5and mortality from NCDs, respectively. The Hazard Quotient (HQ) was used to quantify the health risk of PM2.5to people in northern Thailand. High PM2.5 risk was observed in March, with peak PM2.5concentration reaching 100 µg/m3, with maximum HQ values of 1.78±0.13 to 4.25±0.35 and 1.45±0.11 to 3.46±0.29 for males and females, respectively. Hypertension significantly correlated with PM2.5levels, followed by chronic lung disease and diabetes. The cross-correlation analysis showed a strong relationship between hypertansion mortality and PM2.5at a two-year time lag in Chiang Mai (0.73) (CI [-0.43-0.98], p-value of 0.0270) and a modest relationship with chronic lung disease at Lampang (0.33) (a four-year time lag). The results from spearman correlation analysis showed that PM2.5concentrations were associated with diabetes mortality in Chiang Mai, with a coefficient of 0.9 (CI [0.09-0.99], p-value of 0.03704). Lampang and Phayao had significant associations between PM2.5 and heart disease, with coefficients of 0.97 (CI [0.66-0.99], p-value of 0.0048) and 0.90 (CI [0.09-0.99], p-value of 0.0374), respectively, whereas Phrae had a high coefficient of 0.99 on stroke.

Exploring the Relationship Between Lifestyle Factors, Cholesterol Levels, and Non-Communicable Diseases Risk: A Cross-sectional Survey of Middle-aged Adults in Edo State, Nigeria

NCDs are a global health issue, especially in low-income and lower-middle-income countries. LLMICs lack a clear grasp of the link between socioeconomic position and behavioural risk factors for NCDs, unlike high-income nations. A cross-sectional survey of middle-aged adults in Edo State, Nigeria, examined how lifestyle factors like alcohol and tobacco use, poor diets, and physical inactivity affect socioeconomic position. A comprehensive search of 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists found primary research published between January 1, 1990, and June 30, 2015. Numerous socioeconomic and lifestyle studies from LLMICs were included. Data extraction focused on household and individual-level data, study types, methodology, outcomes, and results utilising the Cochrane Effective Practice and Organisation of Care Group data collecting checklist. Due to study design and outcome measure diversity, narrative synthesis was used. Of 4,242 records reviewed, 75 studies satisfied inclusion criteria, including 2,135,314 people aged 10 and older from 39 LLMICs. The results showed that lower socioeconomic groups used smoke and alcohol more, while higher socioeconomic groups ate more fats, salt, and processed foods. Contrary to predictions, higher socioeconomic groups reported less physical activity. To accomplish Sustainable Development Goal 3.4, which aims to reduce early NCD mortality by one-third by 2030, socioeconomic inequities must be targeted. These policymakers and health practitioners must prioritise poverty-health nexus solutions to reduce NCD burdens.

The comparative analysis of health care systems

Within the framework of the national development goal of the Russian Federation "preservation of population, health and well-being of people" the target indicator "the increase of life expectancy up to 78 years" is to be achieved by 2030. The achievement of this value is also directly affected by functioning of of health care system. In 2015, the United Nations, within the framework of the Sustainable Development Goals for the period up to 2030, formulated the task that implies ensuring of universal health services coverage "including financial risk security, access to qualitative essential medical and sanitary services and access to safe, effective, qualitative and inexpensive essential medications and vaccines for all". In the course of the study, methodology was developed that permitted to calculate values of performance indicators of main health care systems (financial support and infrastructure development) and to conduct comprehensive comparative analysis with values of particular public health indicators. The study results confirmed possibility of such comparisons. The stable direct relationship between such indicators as "current health expenditure (CHE) per capita", "current health expenditure (CHE) as percentage of gross domestic product (GDP)", "UHC Service Coverage Index", "life expectancy" was revealed. The inverse dependency between such indicators as "out-of-pocket expenditure as percentage of current health expenditure (CHE)" and "UHC Service Coverage Index" as well as between "UHC Service Coverage Index" and "total NCD mortality rate" and "probability of premature dying from non-infectious diseases" was determined.

Ölümler sürdürülebilir kalkınma hedeflerini nasıl etkiliyor?

Aims: The aim of this study was to reveal the relationship between the sustainable development indicators index score and mortality, including maternal deaths, deaths under the age of five (u5mortality) traffic deaths, and death of non-communicable disease (NCD mortality).
 Methods: Panel data method was used in the analyses, mortality rates independent variables belonging to 11 OECD countries with regular data between 2000-2020; sustainable development indicators index score was considered as the dependent variable. 
 Results: According to the results of the least squares analysis, a 1% increase in maternal mortality reduced the sustainable development index score by 0.021%; a 1% increase in under five years mortality reduced the sustainable development index score by 0.037%; a 1% increase in NCD mortality reduced the sustainable development index score by 0.044%; a 1% increase in trafficmortality reduced the sustainable development index score by 0.016% (p

Patient-reported measures for integrated care assessment: interprofessional collaboration, self-care and outcomes.

Chronicity is spreading and rapidly becoming a urgent issue also for the complexity of care. 32.2 million of NCD deaths (80%) are due to chronic diseases (1). Every country has been developing strategies to guarantee assistance to chronic patients while ensuring the sustainability of the system. Interprofessional collaboration is among the features to improve the assistance for chronic patients and to reach coordination, appropriateness, and continuity along the care pathways (2,3). Data collection on this topic is still scarce, especially from the point of view of patients themselves. Patient Reported Outcome and Experience Measures (PROMs and PREMs) collected in an integrated way can help in understanding the relationship of experience and outcome along the patient care pathway, thus providing a complete vision of the quality and integration of care from the patient perspective (4).
 This work aims at reporting some preliminary results about the impact of interprofessional collaboration on the health outcomes and self-care capacity of chronic heart failure (CHF) patients. 
 Data from the Observatory on PROMs and PREMs of the Tuscany Region in Italy will be used to explore the hypothesis that interprofessional collaboration can lead to better self-care and outcome scores as reported by patients. The selected sample replied to four questionnaires: one at discharge by the hospital, a first follow-up after 30 days; a second follow-up after 7 months; a final follow-up after 12 months (5). Average scores and deltas for the KCCQ-12 and the SCHFI scales will be used to detect potential differences between patients’ self-care, health status and quality of care according to the reported level of integration between the general practitioner and the specialist.
 132 responses were valid to be analysed. At baseline, 23% of patients declared that their GP and their specialist were in contact to take care of the care pathway, 15% declared they did not know. Differences between scores are not significant for the KCCQ-12 on health status and quality of life. A weak difference emerged for the Self-care Maintenance about daily lifestyle adherence. 
 Further research should be conducted on this topic to understand if these results are linked to a scarce knowledge of patients with respect to the joint work of GPs and specialists or if the interprofessional collaboration is not sufficient to guarantee an improvement of outcomes, at least for CHF patients. Indeed, the same analyses could be repeated on other two chronic populations (e.g. diabetic and IBD patients) which are providing their data that will be available next year.
 
 1.2018. “NCD Countdown 2030: Worldwide Trends in NCD Mortality and Progress towards Sustainable Development Goal Target 3.4.” Lancet 
 2.Pascucci2021. “Impact of Interprofessional Collaboration on Chronic Disease Management.” Health Policy 
 3.Davidson2022. “What Do Patients Experience? Interprofessional Collaborative Practice for Chronic Conditions in Primary Care” BMC Primary Care
 4.Pennucci“Can the Jointly Collection of PROMs and PREMs Improve Integrated Care?” IJIC
 5.Pennucci“Piloting a Web-Based Systematic Collection and Reporting of PROMs/PREMs in Chronic Heart Failure.” BMJ Open

Disparities of obesity and non-communicable disease burden between the Tibetan Plateau and developed megacities in China.

Non-communicable diseases (NCDs) including risk factors, e.g., obesity, are the major causes of preventable deaths in China, yet NCD disparities in China remain under-studied. This study aimed to compare the determinants and burden of NCDs within four selected provinces in mainland China: the least developed Qinghai-Tibet Plateau group (PG, Tibetan Autonomous Region [TAR] and Qinghai Province) and most developed megacity group (MCG, Shanghai, and Beijing). Studies, reports, and other official sources with comparable data for NCD burden and related determinants for the four provinces were searched. Geographic, demographic, socioeconomic, and dietary characteristics and selected health indicators (e.g., life expectancy) were extracted from the China Statistical Yearbook and China Health Statistics Yearbook. Data on NCD burdens were extracted from the National Chronic Disease and Risk Factor Surveillance Study and other nationally representative studies. The overall NCD mortality rates and prevalence of metabolic risk factors including obesity, hypertension, and diabetes in mainland China have increased in the past 20 years, and this trend is expected to continue. The PG had the highest level of standardized mortality rates (SMRs) on NCDs (711.6-896.1/100,000, 6th/6-level); the MCG had the lowest (290.6-389.6/100,000, 1st/6-level) in mainland China. The gaps in SMRs were particularly high with regard to chronic respiratory diseases (PG 6th/6-level, MCG 1st/6-level) and cardiovascular diseases (6th/6 and 4th/6 in TAR and Qinghai; 1st/6-level and 2nd/6-level in Shanghai and Beijing). In contrast, the prevalence rates of obesity, hypertension, and diabetes were generally higher or comparable in MCG compared to PG. Diabetes prevalence was particularly high in MCG (5th/5-level, 13.36-14.35%) and low in PG (1st/5-level, 6.20-10.39%). However, awareness, treatment, and control of hypertension were poor in PG. Additionally, PG had much lower and severely inadequate intakes of vegetables, fruits, and dairy products, with additional indicators of lower socioeconomic status (education, income, etc.,) compared with MCG. Evidence showed large disparities in NCD burden in China's provinces. Socioeconomic disparity and dietary determinants are probably the reasons. Integrated policies and actions are needed.

Evaluating the role of salt intake in achieving WHO NCD targets in the Eurasian Economic Union: A PRIME modeling study.

The World Health Organization has set clear global targets in reducing non-communicable disease mortality by 2030 in its sustainable development goals. This study models the number of deaths that could be averted if Eurasian Economic Union (EEU) member states met the target of reducing their population's current mean salt intake by 30% to achieve mortality reduction targets. Using the WHO Preventable Risk Integrated ModEl (PRIME), we modelled the mortality impact of reducing salt consumption by 30%, as well as according to WHO recommended levels (5 g/person/day), for the five member states of the EEU. PRIME models the number of averted deaths from reducing salt intake by applying established risk ratios to a given population. The baseline demographic and mortality data that are required to generate these estimates were obtained from the relevant government statistical bodies, and salt intake data were referenced from surveillance studies. Uncertainty intervals were generated using Monte Carlo simulation. If salt consumption was reduced by 30%, we estimate that there would have been 94,150 (95%UI: 47,329 to 137,131) fewer deaths due to cardiovascular disease in the EEU in the baseline year, with males and the elderly being more affected. If the WHO-recommended maximum salt intake of 5 g/day was achieved, a total of 193,155 (95%UI: 98,548 to 272,536) deaths would have been prevented. These findings underline the importance of incorporating effective policy changes to meet targets in reducing NCD mortality by one-third by 2030.

Social determinants of health inequity in Iran: a narrative review.

COVID-19 burden the health system by influencing several aspects of social determinants of health (SDH). We review SDH inequity in Iran with notice on COVID-19 pandemic and sanctions. The Databases such as MEDLINE, Scopus, and Google Scholar were searched. The SDH components were extracted regarding the effect of COVID-19 and sanctions. Global burden of disease was used to evaluate the impact of sanctions on mortality in Iran. The literacy rate improved over the last decades but, there is still inequality between provinces. Age and regional inequity exists, regarding NCD mortality. Food insecurity varies in different regions between 20% and 60%.Providing care for a growing aging population, with a large burden of NCDs and disabilities will be the major issue in the next decade. The decrease slop of mortality rate due to NCDs, have become smoother since impose of sanctions, while, cancer mortality have changed upwards. COVID-19, and sanctions negatively impacts lower socioeconomically vulnerable groups due to preexisting conditions which wider the existing inequity in SDH are adding a heavy burden of inequity in Iran. Iran, similar to large numbers of countries, face inequity at regional level in different SDH related issues. The COVID-19 pandemic showed that economic status and health are aligned. Sanctions superimposed on the COVID-19 pandemic cause harm to millions of innocent people. One of the main goals of health authorities is to reduce SDH inequity in order to achieve the goal of "health for all". To tackle these inequities, prompt action is needed.

Trends in Non-Communicable Disease Mortality at the Bono Regional Hospital, Sunyani-Ghana

Cardiovascular disorders (such as heart attacks and strokes), cancer, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma), and diabetes are the most common non-communicable diseases in the world. Projecting mortality patterns can offer policymakers and planners with useful information. This study employed a retrospective approach which involved taking secondary data from events that have already occurred and making inferences and projections about the future. A trend line was used to forecast the death rate. The cause specific mortality rates of the four main NCDs (cancer, cardiovascular diseases, chronic respiratory diseases and diabetes) were extracted from DHIMs (District Health Information Management System). The information gathered was entered into Microsoft Excel 2016. The mortality rates were then categorized into their respective groups and a time- series graph was used to graphically present the trend of NCD mortality from 2013 to 2021. The projection for the upcoming years was done by fitting a ‘trend line’ into the time series graph that was already generated. The findings showed that cancer had a mortality rate of 0 for the seven-year period, CVDs had a mortality rate of 3.4% for the same period, CRDs had a mortality rate of 1.4% and diabetes had a mortality rate of 0.8% for the same period. The findings further showed that males had higher mortality rates than females for most years during the seven-year period. The mortality rates for three categories of non-communicable diseases will continue to increase (CVDs: 3.4% to 3.7%, CRDs: 1.4% in 2013 to 1.9% in 2020, diabetes 0.8% in 2013 to 1.2% in 2025). At Bono regional Hospital, by 2025, mortality rates from non-communicable diseases are expected to rise. This could be due to the fact that the country is still developing, and as a result, people are picking up unhealthy habits from the developed countries.

Estimated Impacts of Alcohol Control Policies on NCD Premature Deaths in Thailand.

Background: This study aimed to assess the impacts of achieving a 10% alcohol reduction target and different alcohol policy interventions on NCD premature deaths during 2010–2025 in Thailand. Methods: The researchers estimated the impacts on three main NCDs: cancers, cardiovascular diseases, and diabetes. These represent two ideal scenarios, which are the target reduction and five intervention scenarios. These intervention scenarios comprise taxation with 50% price increases, a total ban on advertisements, availability restriction by shortening sales times, early psychological intervention, and combined interventions. Consumption data and mortality trends were obtained from available national data. Relative risks and intervention effects were derived from the literature. Results: Achieving a 10% reduction target would lead to 3903–7997 avoidable NCD deaths. Taxation was the most effective intervention, with the highest number of avoidable NCD deaths, followed by early psychological intervention, availability restriction, and an advertisement ban. A combination of these four interventions would reduce 13,286 NCD deaths among men and 4994 NCD deaths among women, accounting for 46.8% of the NCD mortality target. Conclusion: This study suggests using Thailand as an example for low- and middle-income countries to enhance implementation and enforcement of the recommended effective alcohol policies for achieving the global targets.

Trends in obesity-related cancer burden in Czechia.

Obesity is amajor lifestyle risk factor that contributes greatly to the burden of disease, including cancer. Overweight and obesity have shown association with several types of cancer. As Czechia is one of the most overweight countries in Europe, and has high cancer mortality, this study aims to investigate the country's long-term burden of obesity-related cancer. Using the Czech National Cancer Register and the NCD Risk Factor Collaboration (NCD-RisC), standardized incidence and mortality rates were calculated for 12types of cancer related to obesity for the years 1985-2018. Population attributable fractions (PAF) were calculated. Finally, the standardized attributable rates were calculated from the standardized incidence and mortality rates and the PAFs. Approximately 11.0% of selected cancer cases in the male population and 12.3% in the female population were attributable to overweight and obesity in 2018. Since the beginning of the millennium, obesity attributable cancer mortality has dropped, while incidence has remained constant. The incidence throughout the whole period was almost twice as high (18.7cases per 100,000 population in 2018) in women than in men (10.9cases per 100,000 population in 2018). Obesity-related cancer mortality in Czechia has declined in the last two decades, but the incidence has remained constant. Given the increasing prevalence of overweight and obesity in western countries, this issue needs to be prioritized in future healthcare and policy making.

Correlation of Climate Change Indicators with Health and Environmental Data in the Philippines

Introduction. The Lancet Countdown used Global Burden of Disease (GBD) data to track mortality from diseases influenced by climate change. The Philippines is one of the most vulnerable nations to climate change.
 Objective. This study aimed to provide summative data on climate change and health-environmental factors based on several large databases. It looked into the correlation of climate change to selected health variables and correlated environmental factors to health chosen variables in the Philippines.
 Methods. The database was assembled through a compilation of different secondary data. Climate change variables were acquired from the Global Burden of Disease (GBD 2017) Study on Health-related Sustainable Development Goals Indicators from 1990 to 2030. The data for the Philippines were obtained. These indicators include air pollution mortality, disaster mortality, household air pollution, malaria incidence, mean PM2.5, non-communicable disease mortality, neglected tropical diseases mortality, unimproved sanitation, and unsafe water. The resulting database was analyzed using exploratory data analysis techniques with descriptive statistics and line graphs to analyze trends over the years. Then Pearson correlation analysis was done to explore the linear relationship between health indicators, climate indicators, and environmental indicators.
 Results. The study results showed that the trend in the Philippines for air pollution mortality, household air pollution, malaria incidence, and neglected tropical diseases mortality is in a downward direction. However, non-communicable disease mortality was constantly increasing from 41.99 in 1990 to 55.00 in 2016. Meanwhile, the mean temperature is significantly negatively correlated to household air pollution, malaria incidence, and neglected tropical diseases and significantly correlated with non-communicable diseases. Also, NOAA adjusted sea level is significantly positively correlated with air pollution mortality, malaria incidence, disaster mortality, and non-communicable diseases. It is negatively correlated with malaria incidence and neglected tropical diseases prevalence. Global mean CO2 is significantly negatively correlated with household air pollution, malaria incidence, and neglected tropical diseases prevalence. On the other hand, it was significantly and positively correlated with air pollution mortality and non-communicable diseases mortality. Household air pollution health risk was significantly positively correlated to mean PM2.5 levels in the Philippines. Unimproved sanitation was positively correlated with household air pollution, malaria incidence, and neglected tropical disease prevalence.
 Conclusion. As recordings of heat index increased, there was a correlation with NCD, Malaria, Disaster, and NTD infection mortality. With the evidence of the correlation of increasing temperature and pollution to health, the urgency to focus on addressing these problems was present in this study. Further research may help in policymaking to target drivers of pollution which affect extreme climate changes.

Association between COVID-19 morbidity, mortality, and gross domestic product, overweight/ obesity, non-communicable diseases, vaccination rate: A cross-sectional study

BackgroundThe spread of COVID-19 depends on a lot of social and economic factors. The aim: to study the influence of country’s gross domestic product, population prevalence of overweight/ obesity, NCD mortality, and vaccination on COVID-19 morbidity and mortality rates. MethodsA cross-sectional study with two phases: correlation-regression interrelations in 1) all world countries; 2) all world non-island countries. The study includes the following data from 218 world countries: COVID-19 morbidity/mortality rates, GDP per capita, the prevalence of overweight/ obesity, NCD mortality among adults (both sexes), people fully vaccinated against COVID-19. ResultsAn average percentage of the prevalence of overweight among adults in world countries by 2019 was 47.31 ± 15.99%, obesity 18.34 ± 9.64%, while the prevalence by 2016 were 39% and 13%, respectively. Overweight and obesity among adults during three years grew by 21.2% and 40.8%, respectively.Data from the world countries provide significant correlations (p < 0.0001) between COVID-19 morbidity, and: GDP (r = 0.517), overweight (r = 0.54), obesity (r = 0.528), NCD mortality (r = 0.537); COVID-19 mortality, and: GDP (r = 0.344), overweight (r = 0.514), obesity (r = 0.489), NCD mortality (r = 0.611); GDP, and: overweight (r = 0.507), obesity (r = 0.523), NCD mortality (r = 0.35), fully vaccinated people (r = 0.754). An increase in fully vaccinated people, from 3% to 30% of world population, decreases new confirmed COVID-19 cases, although the dependence was not significant (p = 0.07).Data from non-island world countries provides more highly significant correlations (p < 0.0001) between COVID-19 morbidity, and: GDP (r = 0.616), overweight (r = 0.581), obesity (r = 0.583); COVID-19 mortality, and: GDP (r = 0.43), overweight (r = 0.556), obesity (r = 0.539); GDP, and: overweight (r = 0.601), obesity (r = 0.633). The differences of correlation coefficients between data of 176 world countries and data of 143 world non-island countries were not significant (Z-scores<1.29; p > 0.05). ConclusionThe study provides evidence of a significant impact of overweight/obesity prevalence on the increase in COVID-19 morbidity/mortality. Countries with higher GDP have a high overweight/obesity prevalence and possibility to get vaccinated.

The Association between GDP and non-communicable disease mortality in the WHO European Region

Abstract Background The WHO Europe Region consists of 53 countries, each of which has differences in mortality from cardiovascular (CVD), neurological, and chronic respiratory diseases. Such diverse metrics result from political, social, and economic events that have influenced the health performance of each European sub-region. From a public health perspective, an updated analysis of such metrics is required for policymakers and health system organisations to improve the overall population health outcomes. Methods This study utilised data between 1990-2017 from the Global Burden of Disease study 2017 to explore the association between GDP and NCD mortality in Western, Central, and Eastern Europe and Central Asia. The mortality data was already stratified by age and sex, and a fixed effected regression analysis was run to observe associations between both variables using STATA. Data completeness was 80-100% for GDP and 100% for mortality across the European region. The final results were reported as a rate per 100,000, with confidence intervals. The rate changes were calculated using an equation from the GBD. Results The most significant decrease per 100,000 of the population across all three NCDs as GDP increased was in Central Asia and Eastern Europe among both sexes. For every 1000 unit increase in GDP, we expect -12.13 [-13.60, -10.66] and -14.49 [-16.89, -12.29] less deaths in CVD in females and males per 100,000 of population, respectively. Western Europe had the lowest decrease per 100,000 of the population, as with every 1000 unit increase in GDP, we expect -2.42 [-2.59, -2.25] and -4.09 [-4.33, -3.84] fewer deaths in CVD in females and males, respectively. Conclusions The overall differential rate of mortality from the three NCDs is decreasing across all regions. However, there is a large disparity between the sexes. Males have a higher mortality rate across CVD and chronic respiratory diseases, whilst neurological disorders were highest among females. Key messages This study’s analysis has added to existing knowledge on chronic health patterns in the WHO European region. Governments in Eastern Europe and Central Asia should introduce health policies targeting unhealthy consumption of alcohol, smoking and diets, as seen in Western Europe.

NCD behavioral risk factors and mortality among older adults in Brazil.

Literature shows that the most studied concurrent risk factors for mortality in elderly individuals are smoking, inadequate diet, alcohol consumption and physical inactivity. The combination of such habits can increase from 3 to 11 times the chance of death. To measure the association between concurrence of behavioral risk factors (BRF) for non-communicable diseases (NCD's) and mortality up to three years among the elderly. Cohort study started in 2014 named "COMO VAI?" with community-dwelling aged ≥60 years in Pelotas, Rio Grande do Sul, Brazil. We investigated the deaths from all causes occurred until April 2017. The exposure was defined by the presence of physical inactivity, low-quality diet, alcohol consumption and smoking that composed a score ranging from 0 (none) to 4 (all). Cox proportional hazard regression models were used to evaluate the association between BRF concurrence and mortality. In 2014, 1451 elderly people were interviewed, 145 deaths were identified (10%) by April 2017. Higher risk of death was observed for the combinations of physical inactivity+smoking and low-quality diet+physical inactivity. The simultaneous presence of three or more BRF was associated with a nearly six-fold higher risk of death. Higher mortality during a 3-year period was observed among those with at least three BRF for NCD's.

Diversity of epidemiological transition in the Pacific: Findings from the application of verbal autopsy in Papua New Guinea and the Solomon Islands

BackgroundCause of death data are essential for rational health planning yet are not routinely available in Papua New Guinea (PNG) and Solomon Islands. Indirect estimation of cause of death patterns suggests these populations are epidemiologically similar, but such assessments are not based on direct evidence. MethodsVerbal autopsy (VA) interviews were conducted at three sites in PNG and nationwide in Solomon Islands. Training courses were also facilitated to improve data from medical certificates of cause of death (MCCODs) in both countries. Data were categorised into broad groups of endemic and emerging conditions to aid assessment of the epidemiological transition. FindingsBetween 2017 and 2020, VAs were collected for 1,814 adult deaths in PNG and 819 adult deaths in Solomon Islands. MCCODs were analysed for 662 deaths in PNG and 1,408 deaths in Solomon Islands. The VA data suggest lower NCD mortality (48.8% versus 70.3%); higher infectious mortality (27.0% versus 18.3%) and higher injury mortality (24.5% versus 11.4%) in PNG compared to Solomon Islands. Higher infectious mortality in PNG was evident for both endemic and emerging infections. Higher NCD mortality in Solomon Islands reflected much higher emerging NCDs (43.6% vs 21.4% in PNG). A similar pattern was evident from the MCCOD data. InterpretationThe cause of death patterns suggested by VA and MCCOD indicate that PNG is earlier in its epidemiological transition than Solomon Islands, with relatively higher infectious mortality and lower NCD mortality. Injury mortality was also particularly high in PNG.This study was funded by Bloomberg Philanthropies.

Obesity, SDGs and ROOTS: a Framework for Impact.

Purpose of ReviewThis paper demonstrates how addressing obesity is vital to achieving several of the Sustainable Development Goals and targets, especially target 3.4 on reducing premature mortality from non-communicable diseases.Recent FindingsRecent research by the UN notes that countries are not on schedule to achieve the SDGs. It is noted that obesity, neglected in earlier development goals and overlooked by global health funders and policymakers, is playing a role in major health and development issues. As such, the ROOTS framework developed by the World Obesity Federation offers a roadmap towards attaining several of the goals and targets.SummaryBy making these connections, this paper shows that obesity is a relevant and essential component of the global development agenda and must be prioritised to successfully achieve targets related to NCD mortality.

Understanding non-communicable diseases: combining health surveillance with local knowledge to improve rural primary health care in South Africa

ABSTRACT Background: NCDs are non-infectious, long-term conditions that account for 40 million deaths per annum. 87% of premature NCD mortality occurs in low- and middle-income countries. Objective: The aims were:develop methods to provide integrated biosocial accounts of NCD mortality; and explore the practical utility of extended mortality data for the primary health care system. Methods: We drew on data from research programmes in the study area. Data were analysed in three steps: [a]analysis of levels, causes and circumstances of NCD mortality [n = 4,166] from routine census updates including Verbal Autopsy and of qualitative data on lived experiences of NCDs in rural villages from participatory research; [b] identifying areas of convergence and divergence between the analyses; and [c]exploration of the practical relevance of the data drawing on engagements with health systems stakeholders. Results: NCDs constituted a significant proportion of mortality in this setting [36%]. VA data revealed multiple barriers to access in end-of-life care. Many deaths were attributed to problems with resources and health systems [21%;19% respectively]. The qualitative research provided rich complementary detail on the processes through which risk originates, accumulates and is expressed in access to end-of-life care, related to chronic poverty and perceptions of poor quality care in clinics. The exploration of practical relevance revealed chronic under-funding for NCD services, and an acute need for robust, timely data on the NCD burden. Conclusions: VA data allowed a significant burden of NCD mortality to be quantified and revealed barriers to access at and around the time of death. Qualitative research contextualised these barriers, providing explanations of how and why they exist and persist. Health systems analysis revealed shortages of resources allocated to NCDs and a need for robust research to provide locally relevant evidence to organise and deliver care. Pragmatic interdisciplinary and mixed method analysis provides relevant renditions of complex problems to inform more effective responses.

Modelling and prediction of global non-communicable diseases

BackgroundNon-communicable diseases (NCDs) are the main health and development challenge facing humankind all over the world. They are inextricably linked to socio-economic development. Deaths caused by NCDs should be different in different socio-economic development stages. The stratified heterogeneity of NCD deaths is currently not fully explored.MethodsCountries were classified according to their socio-economic types and development stages, which were illustrated as a tree-like structure called Geotree. NCD deaths were linked to the countries and so were attached to the Geotree, which was modelled by a multilevel model (MLM) approach. Accordingly, the levels of NCD death indexes were predicted for 2030.ResultsThrough the Geotree structure constructed in the study, it can be seen that the NCD death index has obvious stratified heterogeneity; that is, the NCD death index shows different trends in different country types and socio-economic development stages. In the first-level branches (country type), as national income increases, NCD mortality rate decreases and the proportion of NCD deaths to total deaths increases. In the secondary-level trunks (socio-economic development stage), as a country’s development stage rises, the NCD mortality rate decreases and the proportion of NCD deaths to total deaths increases. In addition, combined with the hierarchical nature of the evolution tree model, the MLM was used to predict the global NCD death index for 2030. The result was that by 2030, the global average age-standardized NCD mortality rate would be 510.54 (per 100,000 population) and the global average mortality for NCD deaths of the total number of deaths would be 75.26%.ConclusionsThis study found that there is a significant association between socio-economic factors and NCD death indicators in the tree-like structure. In the Geotree, countries on the same branch or trunk can learn from countries with higher development stages to formulate more effective NCD response policies and find the right prevention and treatment path.

Impact of India’s National Tobacco Control Programme on bidi and cigarette consumption: a difference-in-differences analysis

BackgroundDespite the importance of decreasing tobacco use to achieve mortality reduction targets of the Sustainable Development Goals in low-income and middle-income countries (LMICs), evaluations of tobacco control programmes in these...