Non-fatal Health Outcomes Research Articles

Cost-benefit analysis: just a step in the HIA process

Abstract The economic analysis within Health Impact Assessments (HIA) is a critical component in informing public policy decisions by assessing the financial implications of health outcomes associated with the different intervention options. Health metrics play a role defining the cost-effectiveness and societal value associated with the interventions. These metrics, quantifying the health impacts, include quality-adjusted life years (QALYs), years of life lost (YLLs) or disability-adjusted life years (DALYs). On another level, such metrics need to be translated into cost-effectiveness and societal value in which other methods play a role, such as the value of statistical life (VSL) or the value of a life year (VOLY). While VSL quantifies the value individuals place on reducing mortality risk, VOLY evaluates the value attributed to extending life expectancy. On another hand, uncertainties related to economic valuation pose challenges to the accuracy and reliability of cost estimates within HIA. These come from several factors, including data quality, methodological differences across studies, and subjective judgments involved in valuing health states. In fact, estimating the economic value of a prevented death involves multifaceted considerations and important assumptions. Additionally, assigning monetary values to non-fatal health outcomes, such as disability or reduced quality of life, involves subjective assessments and value judgments. By selecting appropriate metrics, considering diverse data sources, and addressing methodological steps and uncertainties, HIA practitioners can improve the utility of economic assessments, facilitating evidence-based decision-making in public health policy and resource allocation. This work was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020).

8702 Age-Sex Differences in Global Burden of Ischemic Heart Disease Attributable to High LDL in the Last 3 Decades:Global, Regional, National Variations, Age Dynamics, and Implications for Global Health

Abstract Disclosure: V. Adedara: None. K. Maddineni: None. A. Dekhne: None. M. Chinthapalli: None. G. Potluri: None. A. Parisapogu: None. K. Markandu: None. H. Desai: None. Background: Ischemic Heart Disease (IHD) stands as the foremost cause of mortality globally, contributing to 9.6 million deaths. Elevated levels of low-density lipoprotein cholesterol (LDL-C) consistently feature among the risk factors associated with IHD. Methods: Employing the Global Burden of Disease framework, we computed mortality and DALYs linked to IHD attributable to LDL-C, stratified by age-sex, year, and covering 204 countries and territories during the period from 1990 to 2019. Non-fatal health outcomes were estimated using DISMOD MR 2.1, Bayesian meta-regression tool for epidemiological modelling. Results were expressed in absolute counts and age-standardized rates (ASR) per 100,000 person-years. Results: The total number of deaths attributed to IHD due to elevated LDL-C increased from 2.5 million (95% Uncertainty Interval: 2-3.1 million) in 1990 to 3.7 million (95% UI: 2.8-4.8 million) in 2019. Concurrently, DALYs increased from 60.4 million (95% UI: 50.4-70.7 million) in 1990 to 84.9 million (95% UI: 69.5-101.3 million) in 2019. In terms of ASR, the annual percentage change (APC) in death rates decreased by 36%, and DALY rates decreased by 32% from 1990 to 2019. Regionally, East Asia exhibited the highest increase in APC in death counts by 191%, followed by Commonwealth Low-Income countries at 164%, and Oceania at 160% during the same period. Conversely, the Commonwealth High-Income region experienced the highest decrease at 41%. Males displayed higher APC in death (48% vs. 44%) and DALYs (42% vs. 38%) compared to females over the last three decades. In terms of ASR, males observed a higher decrease compared to females. In 2019, the age group 80-84 years had the highest number of deaths at 534,079 (264,177-813,898), while DALYs were most pronounced in the 55-59 year age group, reaching 10.6 million (8.9-12.3 million). Conclusion: IHD remains a significant global health challenge, with high LDL-C levels being a crucial modifiable risk factor. Age-sex disparities in the burden of IHD are evident, driven by variations in LDL-C metabolism, hormonal changes, and lifestyle factors. Recognizing and addressing these disparities is essential for developing effective prevention and treatment strategies tailored to different populations and age groups. Presentation: 6/2/2024

Abstract P100: Global Burden of Atrial Fibrillation and Atrial Flutter and Its Trend From 1990-2019 in G20 Countries: Results From the GBD 2019

Background: Atrial Fibrillation and Atrial Flutter (Afib) ranks 6th in mortality and 7th in disability amongst all cardiovascular disease the G20 nations. Method: We employed 2019 Global Burden of Disease methodology. Afib and Flutter, non-fatal health outcomes, such as incidence and prevalence, were estimated using the Bayesian meta-regression tool (DisMod MR 2.1). Fatal health outcomes were assessed using the Cause of Death Ensemble Model (CODEm), considering factors like age, gender, year, and location throughout the G20 from 1990 to 2019. Results: From 1990 to 2019, prevalence rose from 23.2 million (95%UI: 17.6-29.7) to 48.9 million (37.5-61.6). The annual percentage change (APC) in incidence surged by 102% (1.8-3.8 million), DALYs by 119% (3-6 million), and deaths by 168% (93,864-251,272). Despite these increases, the age-standardized rate per 100,000 person-years declined over the past three decades. In 2019, the U.S. reported the highest age-standardized incidence rate at 109.52 (88.97-131.92) per 100,000, while Sweden had the top mortality rate of 8.63 (4-10.32) per 100,000. The age group 65-69 had the peak incidence count of 700,768 (362,032-1,158,177). Meanwhile, the highest death count was in the 85-89 age bracket with 59,325 (48,618-70,077), and the most DALYs were in the 80-84 age group with 1,083,488 (882,995-1,323,533) in 2019. Males consistently faced a higher burden than females over this period. Conclusion: AFib and AF accounted for 1.88% deaths amongst all cardiovascular casualties in 2019. Clinicians in the G20 countries must prioritize early detection and intervention for Afib and flutter, especially in males and the elderly, given its escalating prevalence and its ranking as a major cause of death and disability. Public health strategies in the G20 nations should focus on targeted awareness and interventions to combat the rising burden of atrial fibrillation, with countries like the United States and Sweden requiring heightened attention due to their notably high incidence and mortality rates.

Abstract P211: Burden and Temporal Trend of Peripheral Artery Disease in the United States and Its Attributable Risk Factors From 1990-2019: An Insights From the Global Burden of Disease Study 2019

Background: Peripheral Artery Disease (PAD) ranks as the 10th primary cause of mortality and the 11th for disability among all cardiovascular diseases in the U.S. Method: We employed the Global Burden of Disease 2019 framework. PAD non-fatal health outcomes were analyzed using the DisMod MR 2.1 (Bayesian meta-regression tool) and determined fatal health outcome with the cause of death ensemble model (CODEm), segmented by age, gender, year, and location from 1990-2019 across the U.S. Results: The annual percentage change (APC) revealed a 26% (9.9-12.4 million) increase in overall prevalence and incidence, a significant 152% (5,757-14,527) rise in deaths, and a 98% (119,253-236,031) uptick in DALYs during 1990-2019. Notably, while the age-standardized incidence rate dipped by 28% (267-193), death and DALY rates climbed by 33% (1.7-2.27) and 11% (36-39) respectively. Delaware witnessed the highest APC in deaths 118% (2.33-5.08) per 100,000, trailed by Colorado with a 58% (35-55) rise in DALYs. Individuals under 70 experienced a 118% (1052-2294) surge in APC for deaths and a 28% (458,357-588,135) increase in incidence. In absolute numbers, males bore a heavier PAD burden, yet females exhibited elevated age-standardized rates from 1990-2019. Conclusion: The study underscores a concerning rise in PAD in the U.S. from 1990-2019, accounted for 1.52% deaths of all cardiovascular related casualties in 2019. Delaware and Colorado have notably high increases in PAD-related outcomes. From both a clinical and public health perspective, addressing high fasting plasma glucose and sodium-rich diets is crucial, as they stand as leading risk factors in PAD's burgeoning prevalence.

Health outcomes after myocardial infarction: A population study of 56 million people in England.

The occurrence of a range of health outcomes following myocardial infarction (MI) is unknown. Therefore, this study aimed to determine the long-term risk of major health outcomes following MI and generate sociodemographic stratified risk charts in order to inform care recommendations in the post-MI period and underpin shared decision making. This nationwide cohort study includes all individuals aged ≥18 years admitted to one of 229 National Health Service (NHS) Trusts in England between 1 January 2008 and 31 January 2017 (final follow-up 27 March 2017). We analysed 11 non-fatal health outcomes (subsequent MI and first hospitalisation for heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes mellitus, dementia, depression, and cancer) and all-cause mortality. Of the 55,619,430 population of England, 34,116,257 individuals contributing to 145,912,852 hospitalisations were included (mean age 41.7 years (standard deviation [SD 26.1]); n = 14,747,198 (44.2%) male). There were 433,361 individuals with MI (mean age 67.4 years [SD 14.4)]; n = 283,742 (65.5%) male). Following MI, all-cause mortality was the most frequent event (adjusted cumulative incidence at 9 years 37.8% (95% confidence interval [CI] [37.6,37.9]), followed by heart failure (29.6%; 95% CI [29.4,29.7]), renal failure (27.2%; 95% CI [27.0,27.4]), atrial fibrillation (22.3%; 95% CI [22.2,22.5]), severe bleeding (19.0%; 95% CI [18.8,19.1]), diabetes (17.0%; 95% CI [16.9,17.1]), cancer (13.5%; 95% CI [13.3,13.6]), cerebrovascular disease (12.5%; 95% CI [12.4,12.7]), depression (8.9%; 95% CI [8.7,9.0]), dementia (7.8%; 95% CI [7.7,7.9]), subsequent MI (7.1%; 95% CI [7.0,7.2]), and peripheral arterial disease (6.5%; 95% CI [6.4,6.6]). Compared with a risk-set matched population of 2,001,310 individuals, first hospitalisation of all non-fatal health outcomes were increased after MI, except for dementia (adjusted hazard ratio [aHR] 1.01; 95% CI [0.99,1.02];p = 0.468) and cancer (aHR 0.56; 95% CI [0.56,0.57];p < 0.001). The study includes data from secondary care only-as such diagnoses made outside of secondary care may have been missed leading to the potential underestimation of the total burden of disease following MI. In this study, up to a third of patients with MI developed heart failure or renal failure, 7% had another MI, and 38% died within 9 years (compared with 35% deaths among matched individuals). The incidence of all health outcomes, except dementia and cancer, was higher than expected during the normal life course without MI following adjustment for age, sex, year, and socioeconomic deprivation. Efforts targeted to prevent or limit the accrual of chronic, multisystem disease states following MI are needed and should be guided by the demographic-specific risk charts derived in this study.

Global Burden and Trends of Multiple Myeloma in High-Income North America Countries between 1990-2019, with Projections of Deaths to 2040: A Benchmarking Analysis for the Global Burden of Disease Study 2019

Background: Multiple myeloma (MM), a malignant neoplasm originating from plasma cells, imposes a considerable health burden in high-income North America (HINA). It ranks as the 14th leading cause of cancer-related deaths and disability in HINA countries. This study aims to assess the epidemiological aspects of MM, including its incidence, prevalence, mortality rates, and non-fatal health outcomes across HINA countries over the last three decades (1990-2019) with projections of deaths up to 2040. Methods: Using the Global Burden of Disease methodology, we evaluated MM prevalence, incidence, mortality, and disability-adjusted life years (DALYs) based on age group, sex, and year across HINA from 1990 to 2019, utilizing standardized approaches and statistical modeling. We employed a regression framework to forecast MM deaths through 2040, and the results were presented in absolute counts and age-standardized rates (per 100,000 person-years). Results: The absolute prevalence of MM increased from 42,637 (95% uncertainty interval (UI): 35,449-44,970) in 1990 to 101,994 (95% UI: 86,889-127,309) in 2019. Similarly, deaths increased from 11,200 (95% UI: 9,435-11,633) to 19,941 (95% UI: 18,012-22,919) during 1990-2019, and DALYs increased from 235,334 (95% UI: 194,820-244,361) in 1990 to 388,955 (95% UI: 360,494-478,317) in 2019. The age-standardized incidence rate (ASIR) increased from 4.32 (95% UI: 3.62-4.5) to 4.8 (95% UI: 4.12-5.87) cases per 100,000 persons from 1990-2019. However, the annual percentage of change (APC) in age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDALR) decreased by 1% and 8%, respectively, from 1990-2019. Among HINA countries, Canada observed the highest APC increase in total deaths (111%), followed by Greenland (110%) and the United States (75%) during 1990-2019. In terms of age groups, the 70-74 age group observed the highest number of incidences (5,257), deaths (3,336), and DALYs (67,310) in 2019. The 80+ age group exhibited the highest APC in total deaths, incidence, and DALYs from 1990-2019. Furthermore, males experienced a higher burden compared to females over the last three decades. The projected number of MM deaths in HINA is expected to reach 28,904 (95% UI: 22,690-37,300) by 2040. Conclusion: This study reveals the secular trend of MM burden in HINA, indicating a significant increase in MM cases and its impact on public health. MM accounted for 2.295% of deaths among all cancer-related deaths in HINA in 2019. The burden of MM has been on the rise in general from 1990 to 2019 and is predicted to continue increasing over the next two decades. Notably, there is a noticeable disparity in MM burden, with higher prevalence in males compared to females. Age and cohort effects appear to play a significant role, with elevated risk observed among elderly individuals and those from earlier-born cohorts. Nonetheless, continuous surveillance, data collection, and research efforts are crucial to monitor evolving epidemiological trends and inform evidence-based policies aimed at mitigating the impact of multiple myeloma on individuals and society in the region.

Health outcomes after myocardial infarction: a population study of 56 million people in England

Abstract Background Information about the health outcomes of people with myocardial infarction (MI) is required to determine individual health needs, enable earlier detection and treatment of new onset disease, and inform health service planning. Although estimating 10 year cardiovascular disease risk is an established part of primary prevention, this is not the case for MI where comprehensive evidence for the long term impact of MI on subsequent major health outcomes is lacking. Such information is critical not only for the development of guideline recommendations, but also to underpin shared decision making. Methods This nationwide cohort study includes 34,116,257 adults in England, contributing 145,912,852 hospitalisations between 1st January 2008 and 31st January 2017 (final follow-up 27th March 2017). The absolute risk of 11 non-fatal health outcomes following MI (subsequent MI and new hospitalisations of heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes, dementia, depression, cancer) and all-cause mortality was calculated via standardised cumulative incidence functions (CIFs) over nine years of follow-up. CIFs were estimated from flexible parametric survival models adjusted for age, sex, year, deprivation and competing risk of death. Risk-set matching by age, sex, and year of hospitalisation determined the relative risk of incident health outcomes compared with non-MI cases. Findings: There were 433,361 individuals with MI (mean age 67·4 years (SD 14·4); n=286,728 (65·3%) male). Following MI, all-cause mortality was the most frequent event (CIF 37·8%, 95% CI 37·6─37·9%), followed by heart failure (29·6%; 29·4─29·7%), renal failure (27·2%; 27·0─27·4%), atrial fibrillation (22·3%; 22·2─22·5%), severe bleeding (19·0%; 18·8-19·1%), diabetes (17·0%; 16·9─17·1%), cancer (13·5%; 13·3─13·6%), cerebrovascular disease (12·5%; 12·4─12·7%), depression (8·9%; 8·7─9·0%), dementia (7·8%; 7·7─7·9%), subsequent MI (7·1%; 7·0─7·2%), and peripheral arterial disease (6·5%; 6·4─6·6%). Compared with 2,001,301 matched controls, first hospitalisation of all non-fatal health outcomes were increased after MI, except for dementia (HR 1·01; 0·99─1·02) and cancer (HR 0·56; 0·56─0·57). Interpretation: Up to a third of patients with MI develop heart failure or renal failure, 7% have another MI and four in ten die within ten years. The incidence of heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes, and depression, but not dementia or cancer, was higher than expected during the normal life course without MI. Improved post-MI preventative strategies, encompassing enhanced surveillance and detection, are required to tackle the high incidences of heart failure, atrial fibrillation, cerebrovascular disease, and renal failure observed in this population.

Using individual-level stratification as an approach to integrating social inequalities into the burden of disease

Abstract Substantial social inequalities in almost all non-fatal and fatal health outcomes are one of the most consistent and universal epidemiological findings. Therefore, monitoring social inequalities in health is considered a key priority for researchers and policy makers. The Global Burden of Disease Injuries, and Risk Factors Study (GBD) is the most comprehensive worldwide observational epidemiological synthesis of data to date. However, currently, the GBD Study does not include the potential to stratify associated metrics, such as the disability-adjusted life years metric, by different socioeconomic factors, such as education or income level. Although The GBD Study does include the Socio-Demographic Index, this measure is only useful when comparing between, and not within, countries or regions. We conducted a Cox regression analysis using a national longitudinal prospective cohort study design and registry-based data linked at the individual-level. We stratified on educational groups and investigated cause-specific mortality rates over a 30-year period, adjusting for age, sex and 5-year age cohorts. We also calculate years of life lost (YLLs) stratified by educational groups, standardised by age, and presented for specific years - to investigate trends over time. We discuss the benefits and limitations of this “individual-level” stratification approach as one possible solution to the integration of social inequalities into the GBD study or when using a burden of disease framework approach more generally.

Association of fatal and non-fatal adverse health outcomes with urinary peptides reflecting collagen I turnover

Abstract Background Imbalance of collagen I (COL1) turnover, featured by increased synthesis and decreased degradation of collagen fibers, is a hallmark of fibrosis in the heart and blood vessels that associates with poor cardiovascular outcomes. Such as imbalance of COL1 turnover could be reflected in urine and serve as fingerprint for future adverse outcomes in general population, and high risk subjects. Purpose We hypothesize that imbalance of proteomic signatures of urinary peptides (UPs) reflecting COL1 turnover relate to adverse health outcomes in participants from a general population Methods We randomly recruited 776 participants (51.2% women; 50.5 years) from the Flemish Study on Environment, Genes and Health Outcomes cohort and measured UPs proteome by capillary electrophoresis coupled with mass spectrometry. Our analyses focused on 148 peptides of COL1 alpha-1 (COL1A1) chain that retained ≥70% signal in the whole sample. The primary endpoint included fatal and nonfatal cardiovascular endpoints. Secondary endpoints consisted of total mortality, fatal and nonfatal cardiac, coronary, and heart failure endpoints. Multivariate Cox proportional models, partial least squares analysis (PLS), log-likelihood test, and receiver operating characteristics (ROC) curve were applied. Results Over a median follow up of 12.4 years, 110 primary endpoints occurred, 61 participants died, 81, 41 and 24 experienced cardiac, coronary, and heart failure endpoints; respectively. In PLS analyses, upregulation of UPs signatures closer to C- and N-terminal locations of the COL1A1 chain whereas downregulation of mid-region UPs were associated with lower risk of adverse health outcomes. This pattern was inverted in subjects with cardiovascular disease, as upregulation of terminal and downregulation of mid region UPs increased risk. Adding UPs to a basic model including sex, age and usual cardiovascular risk factors significantly improved model performance between 2.54% to 4.93% (P≤0.001) for prediction of adverse health outcomes. In ROC plots, adding UPs to the basic model increased the area under the curve up to 4.00% (P&amp;lt;0.012). Conclusions UPs reflecting COL1 turnover predicted adverse health outcomes. The inverted up- and down regulations of UPs in between participants with and without previous cardiovascular diseases might be explained by a shift in the UPs signatures of COL1 fragments linked to distinct fibrotic processes. Urinary proteomic might have clinical importance in documenting the extent of collagen accumulation that relates to adverse health outcomes. In patients at high cardiovascular risk, modification of collagen I fibers turnover might be a potential treatment target Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The European Union the European Research Council and the European Research Area Net for Cardiovascular Diseases.

Intimate Partner Violence among Pregnant Women and Associated Factors in Negelle Borena Town Guji Zone, South Oromia

Background: Intimate partner violence is an important public health and human rights issue. Intimate partner violence during pregnancy has been found to be associated with fatal and non-fatal adverse health outcomes for the pregnant woman and her baby. The aim of this study is to determine the magnitude of intimate partner violence among pregnant mothers and associated factors.

Appraisal of Intimate Partner Violence and associated factors among Pregnant Women in Nagele, East Borena, Oromia Regional State, Ethiopia,

Background: Intimate partner violence, especially during pregnancy is an important public health and human rights issue associated with fatal and non-fatal adverse health outcomes for the pregnant woman and her baby. The paucity of data, seeming urgency, and significance of this topic warrants the attention of all stakeholders of health and relationship matters Objective: This study aims to determine the magnitude of intimate partner violence among pregnant mothers and associated factors Since there is inadequate data and intimate partner violence is common in this study area, we needed to study this topic. Materials and Methods: A facility-based cross-sectional study was carried out from Oct 15/2020 –Dec 15/2020. Face-to-face interviews were conducted using a pre-tested structured questionnaire. The collected data were entered into Epi Info version 7.2.1.0 and then exported into the statistical package for social science version 20 for analysis. Descriptive statistics were conducted. Bivariate analysis was done to select candidate variables for multivariate analysis. Finally, variables that had significant associations with intimate violence during pregnancy were identified based on p-value&lt;0.05 and AOR with a 95% CI. Result: About 44.3% (95% CI 44.2-44.4) of pregnant women had faced at least one form of intimate partner violence during the current pregnancy. Psychological violence (29.1%), sexual violence (24.4%), and physical violence (23.9%) were the forms of violence the respondents encountered. Respondents who were primary educated (AOR 2.99, 95%CI 1.23–7.25), secondary educated (AOR 2.36, 1.047-5.34), respondents in the age group of 26-34years (AOR 0.20 95%CI 0.065–0.64), and age group of &gt;=35years (AOR 0.26, 95%CI 0.09-0.77). Respondents with a history of miscarriage, abortion and/ stillbirth (AOR 0.5,95%CI 0.32-0.78), respondents who accepted their partner had the right to beat them(AOR 1.83, 95% CI 1.82-2.82), respondents whose partners were in the age group of 40-49 years(AOR 2.22,95%CI 1.10-4.47), tertiary educated (AOR 0.38, 95%CI 0.20-0.71), had a history of fighting with other men (AOR 1.77 95%CI 1.14- 2.75) were factors significantly associated with IPV during pregnancy. Conclusion: The prevalence of intimate violence in the Negele Borena town selected public health facility is among the highest. Policymakers need to consider screening for IPV in the antenatal care service as one component. It is also better to include IPV screening as one component of the community health extension package Keywords: Intimate partner violence, pregnancy, Negele Borena, Oromia,

Disability-adjusted life years associated with population ageing in China, 1990-2017

BackgroundThe Chinese population has aged significantly in the last few decades. Comprehensive health losses including both fatal and non-fatal health outcomes associated with ageing in China have not been detailed.MethodsBased on freely accessible disability adjusted life years (DALYs) estimated by the Global Burden of Diseases (GBD) 2017, we adopted a robust decomposition method that ascribes changes in DALYs in any given country across two time points to changes resulting from three sources: population size, age structure, and age-specific DALYs rate per 100,000 population. Using the method, we calculated DALYs associated with population ageing in China from 1990 to 2017 and examined the counteraction between the effects of DALYs rate change and population ageing. This method extends previous work through attributing the change in DALYs to the three sources.ResultsPopulation ageing was associated with 92.8 million DALYs between 1990 and 2017 in China, of which 65.8% (61.1 million) were years of life lost (YLLs). Males had comparatively more DALYs associated with population ageing than females in the study period. The five leading causes of DALYs associated with population ageing between 1990 and 2017 were stroke (23.6 million), chronic obstructive pulmonary disease (COPD) (18.3 million), ischemic heart disease (13.0 million), tracheal, bronchus, and lung cancer (6.1 million) and liver cancer (5.0 million). Between 1990 and 2017, changes in DALYs associated with age-specific DALY rate reductions far exceeded those related to population ageing (− 196.2 million versus 92.8 million); 57.5% (− 112.8 million) of DALYs were caused by decreases in rates attributed to 84 modifiable risk factors.ConclusionPopulation ageing was associated with growing health loss in China from 1990 to 2017. Despite the recent progress in alleviating health loss associated with population ageing, the government should encourage scientific research on effective and affordable prevention and control strategies and should consider investment in resources to implement strategies nationwide to address the future challenge of population ageing.

Caring for Mothers: A Narrative Review on Interpersonal Violence and Peripartum Mental Health.

Interpersonal violence in the perinatal period is frequent and should be considered a prominent health issue due to the risk of escalation of violence and the significant impact on mothers’ parenting after childbirth. Domestic violence during pregnancy can be associated with fatal and non-fatal adverse health outcomes due to the direct trauma to a pregnant woman’s body and to the effect of stress on fetal growth and development. Emotional violence is a risk factor for prenatal and/or postpartum depression. Recent studies focusing on abusive situations during peripartum and possible preventive strategies were identified in PubMed/Medline, Scopus, Embase, and ScienceDirect. All of the available literature was retrospectively reviewed with a special attention to peer-reviewed publications from the last ten years. Results of the present narrative review suggest that perinatal health care professionals (general practitioners, gynecologists, obstetricians, psychologists, psychiatrists) should promptly detect interpersonal violence during and after pregnancy and provide health care for pregnant women. It seems pivotal to guarantee psychological care for abused women before, during, and after pregnancy in order to prevent the risk of depressive symptoms, other mental or physical sequelae, and mother-to-infant bonding failure. There is an urgent need for multifaceted interventions: programs should focus on several risk factors and should design tailored care pathways fitted to the specific needs of women and finalized to support them across the lifespan.

Zoonotic infectious diseases as ecosystem disservices: a retrospective data review

BackgroundEcosystem disservices are ecosystem-generated functions and processes that result in negative effects on human wellbeing. To effectively manage Earth, we need to not only understand the ecological responses of species and habitats to global change, but also those of pathogens. Zoonotic infectious diseases (ZIDs) are a particularly important disservice as they can affect vulnerable populations and are major developmental barriers. Despite the increasing evidence linking the emergence of ZIDs to anthropogenic and environmental changes, we still know only little about the generality of these patterns amongst ecosystem-associated diseases. This issue is compounded by the frequent neglect of such diseases in global assessments of disease impacts. Here, we aimed to identify the most relevant ecosystem-linked zoonoses, evaluate their effects and burden on human health, and assess existing evidence of potential distributional or ecological responses to global change. MethodsWe collated a comprehensive database on priority ZIDs that have been linked to the world's ecosystems in the Global Infectious Diseases and Epidemiology Network. For each ZID, we sought to assess the current knowledge regarding overall global health effects (measured by the availability of annual case, mortality, and burden data), current capacity to medically treat or prevent the ZID (based on vaccine and treatment availability) and susceptibility or response to global change. To identify effects of global change, we systematically searched peer-reviewed publications from Web of Science using each ZID name and any synonyms and causative agents, in combination with a selection of ecological and anthropological change terms (relating to climate change, agriculture, urbanisation, forest fragmentation, and livestock keeping). Our search was restricted to empirical and review articles published between Jan 1, 1970, and May 1, 2018, in the English language. We extracted and classified responses into three distinct categories regarding changes in ZID distribution, changes in epidemiology or ecology (eg, association with a new habitat or vector), and changes in temporal occurrence (annual cases or outbreaks). For each impact, causative changes were listed and included in the analysis. FindingsNearly every ZID we identified (40 [95·2%] of 42) was associated with epidemiological or health burden changes in response to ecological change. Climate change, agricultural practices, and urbanisation were most frequently implicated. Notably, single ecological or anthropogenic factors were rarely suggested (three [7·1%] of 42 ZIDs), with multifactorial changes implicated in the remaining ZIDs. Only four (9·5%) ZIDs had effective or highly effective treatments available (in terms of those without substantial limitations or side-effects and percentage of patients recovered when undergoing the treatment; 60–90% being effective and >90% being highly effective) and 17 (40·5%) had only supportive therapy indicated. InterpretationWe found effects of ecological change to be almost ubiquitous among ecosystem-linked zoonoses. Further quantification of the global burden of ecosystem-associated ZIDs, paticularly those with sporadic outbreaks and non-fatal health outcomes, is urgently needed to prepare for potential increased burdens or future outbreaks. Overall the present results can be used to identify shortlists of currently understudied ZIDs that pose potential future global health threats, which could be controlled with appropriate ecosystem management. FundingNatural Environment Research Council.

Long-Term Association of Air Pollution and Hospital Admissions Among Medicare Participants Using a Doubly Robust Additive Model.

Background:Studies examining the nonfatal health outcomes of exposure to air pollution have been limited by the number of pollutants studied and focus on short-term exposures.Methods:We examined the relationship between long-term exposure to fine particulate matter with an aerodynamic diameter <2.5 micrometers (PM2.5), NO2, and tropospheric ozone and hospital admissions for 4 cardiovascular and respiratory outcomes (myocardial infarction, ischemic stroke, atrial fibrillation and flutter, and pneumonia) among the Medicare population of the United States. We used a doubly robust method for our statistical analysis, which relies on both inverse probability weighting and adjustment in the outcome model to account for confounding. The results from this regression are on an additive scale. We further looked at this relationship at lower pollutant concentrations, which are consistent with typical exposure levels in the United States, and among potentially susceptible subgroups.Results:Long-term exposure to fine PM2.5 was associated with an increased risk of all outcomes with the highest effect seen for stroke with a 0.0091% (95% CI, 0.0086–0.0097) increase in the risk of stroke for each 1-µg/m3 increase in annual levels. This translated to 2536 (95% CI, 2383–2691) cases of hospital admissions with ischemic stroke per year, which can be attributed to each 1-unit increase in fine particulate matter levels among the study population. NO2 was associated with an increase in the risk of admission with stroke by 0.00059% (95% CI, 0.00039–0.00075) and atrial fibrillation by 0.00129% (95% CI, 0.00114–0.00148) per ppb and tropospheric ozone was associated with an increase in the risk of admission with pneumonia by 0.00413% (95% CI, 0.00376–0.00447) per parts per billion. At lower concentrations, all pollutants were consistently associated with an increased risk for all our studied outcomes.Conclusions:Long-term exposure to air pollutants poses a significant risk to cardiovascular and respiratory health among the elderly population in the United States, with the greatest increase in the association per unit of exposure occurring at lower concentrations.

Health impact analysis of PM2.5 from wildfire smoke in Canada (2013–2015, 2017–2018)

Smoke from wildfires contains many air pollutants of concern and epidemiological studies have identified associations between exposure to wildfire smoke PM2.5 and mortality and respiratory morbidity, and a possible association with cardiovascular morbidity. For this study, a retrospective analysis of air quality modelling was performed to quantify the exposure to wildfire-PM2.5 across the Canadian population. The model included wildfire emissions from across North America for a 5-month period from May to September (i.e. wildfire season), between 2013 and 2015 and 2017–2018. Large variations in wildfire-PM2.5 were noted year-to-year, geospatially, and within fire season. The model results were then used to estimate the national population health impacts attributable to wildfire-PM2.5 and the associated economic valuation. The analysis estimated annual premature mortalities ranging from 54–240 premature mortalities attributable to short-term exposure and 570–2500 premature mortalities attributable to long-term exposure, as well as many non-fatal cardiorespiratory health outcomes. The economic valuation of the population health impacts was estimated per year at $410M–$1.8B for acute health impacts and $4.3B–$19B for chronic health impacts for the study period. The health impacts were greatest in the provinces with populations in close proximity to wildfire activity, though health impacts were also noted across many provinces indicating the long-range transport of wildfire-PM2.5. Understanding the population health impacts of wildfire smoke is important as climate change is anticipated to increase wildfire activity in Canada and abroad.

Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017

Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies. To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories. This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018. Being under the age of 20 years between 1990 and 2017. Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability. Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile. Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years.

The burden of disease in Greece, health loss, risk factors, and health financing, 2000–16: an analysis of the Global Burden of Disease Study 2016

SummaryBackgroundFollowing the economic crisis in Greece in 2010, the country's ongoing austerity measures include a substantial contraction of health-care expenditure, with reports of subsequent negative health consequences. A comprehensive evaluation of mortality and morbidity is required to understand the current challenges of public health in Greece.MethodsWe used the results of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 to describe the patterns of death and disability among those living in Greece from 2000 to 2010 (pre-austerity) and 2010 to 2016 (post-austerity), and compared trends in health outcomes and health expenditure to those in Cyprus and western Europe. We estimated all-cause mortality from vital registration data, and we calculated cause-specific deaths and years of life lost. Age-standardised mortality rates were compared using the annualised rate of change (ARC). Mortality risk factors were assessed using a comparative risk assessment framework for 84 risk factors and clusters to calculative summary exposure values and population attributable fraction statistics. We assessed the association between trends in total, government, out-of-pocket, and prepaid public health expenditure and all-cause mortality with a segmented correlation analysis.FindingsAll-age mortality in Greece increased from 944·5 (95% uncertainty interval [UI] 923·1–964·5) deaths per 100 000 in 2000 to 997·8 (975·4–1018) in 2010 and 1174·9 (1107·4–1243·2) in 2016, with a higher ARC after 2010 and the introduction of austerity (2·72% [1·65 to 3·74] for 2010–16) than before (0·55% [0·24 to 0·85] for 2000–10) or in western Europe during the same period (0·86% [0·54 to 1·17]). Age-standardised reduction in ARC approximately halved from 2000–10 (−1·61 [95% UI −1·91 to −1·30]) to 2010–16 (−0·87% [–2·03 to 0·20]), with post-2010 ARC similar to that in Cyprus (−0·86% [–1·4 to −0·36]) and lower than in western Europe (−1·14% [–1·48 to −0·81]). Mortality changes in Greece coincided with a rapid decrease in government health expenditure, but also with aggregate population ageing from 2010 to 2016 that was faster than observed in Cyprus. Causes of death that increased were largely those that are responsive to health care. Comparable temporal and age patterns were noted for non-fatal health outcomes, with a somewhat faster rise in years lived with disability since 2010 in Greece compared with Cyprus and western Europe. Risk factor exposures, especially high body-mass index, smoking, and alcohol use, explained much of the mortality increase in Greek adults aged 15–49 years, but only explained a minority of that in adults older than 70 years.InterpretationThe findings of increases in total deaths and accelerated population ageing call for specific focus from health policy makers to ensure the health-care system is equipped to meet the needs of the people in Greece.FundingBill & Melinda Gates Foundation.

Global burden of mental disorders among children aged 5\u201314\xa0years

BackgroundThe global burden of disease (GBD) study provides information about fatal and non-fatal health outcomes around the world.MethodsThe objective of this work is to describe the burden of mental disorders among children aged 5–14 years in each of the six regions of the World Health Organisation. Data come from the GBD 2015 study. Outcomes: disability-adjusted life-years (DALYs) are the main indicator of GBD studies and are built from years of life lost (YLLs) and years of life lived with disability (YLDs).ResultsMental disorders are among the leading causes of YLDs and of DALYs in Europe and the Americas. Because of the importance of infectious diseases, mental disorders appear marginal in Africa for YLLs although they play an important role in YLDs there. Because the epidemiological transition that has taken place in Europe and the Americas (i.e., a switch from acute and infectious conditions to chronic and mental health issues) is likely to happen sooner or later across the entire planet, mental health problems in youth are likely to become one of the main public health challenges of the twenty-first century.ConclusionThese results should improve health care if policy-makers use them to develop health policies to meet the real needs of populations (especially children) today.

The Burden of Cardiovascular Diseases Among US States, 1990-2016

Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes. Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017. Residing in the United States. Cardiovascular disease disability-adjusted life-years (DALYs). Between 1990 and 2016, age-standardized CVD DALYs for all states decreased. Several states had large rises in their relative rank ordering for total CVD DALYs among states, including Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa. The rate of decline varied widely across states, and CVD burden increased for a small number of states in the most recent years. Cardiovascular disease DALYs remained twice as large among men compared with women. Ischemic heart disease was the leading cause of CVD DALYs in all states, but the second most common varied by state. Trends were driven by 12 groups of risk factors, with the largest attributable CVD burden due to dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity. Increases in risk-deleted CVD DALY rates between 2006 and 2016 in 16 states suggest additional unmeasured risks beyond these traditional factors. Large disparities in total burden of CVD persist between US states despite marked improvements in CVD burden. Differences in CVD burden are largely attributable to modifiable risk exposures.