Non-communicable Disease Mortality Research Articles

Social determinants of adult mortality from non-communicable diseases in northern Ethiopia, 2009-2015: Evidence from health and demographic surveillance site.

IntroductionIn developing countries, mortality and disability from non-communicable diseases (NCDs) is rising considerably. The effect of social determinants of NCDs-attributed mortality, from the context of developing countries, is poorly understood. This study examines the burden and socio-economic determinants of adult mortality attributed to NCDs in eastern Tigray, Ethiopia.MethodsWe followed 45,982 adults implementing a community based dynamic cohort design recording mortality events from September 2009 to April 2015. A physician review based Verbal autopsy was used to identify the most probable causes of death. Multivariable Cox proportional hazards regression was performed to identify social determinants of NCD mortality.ResultsAcross the 193,758.7 person-years, we recorded 1,091 adult deaths. Compared to communicable diseases, NCDs accounted for a slightly higher proportion of adult deaths; 33% vs 34.5% respectively. The incidence density rate (IDR) of NCD attributed mortality was 194.1 deaths (IDR = 194.1; 95% CI = 175.4, 214.7) per 100,000 person-years. One hundred fifty-seven (41.8%), 68 (18.1%) and 34 (9%) of the 376 NCD deaths were due to cardiovascular disease, cancer and renal failure, respectively. In the multivariable analysis, age per 5-year increase (HR = 1.35; 95% CI: 1.30, 1.41), and extended family and non-family household members (HR = 2.86; 95% CI: 2.05, 3.98) compared to household heads were associated with a significantly increased hazard of NCD mortality. Although the difference was not statistically significant, compared to poor adults, those who were wealthy had a 15% (HR = 0.85; 95% CI: 0.65, 1.11) lower hazard of mortality from NCDs. On the other hand, literate adults (HR = 0.35; 95% CI: 0.13, 0.9) had a significantly decreased hazard of NCD attributed mortality compared to those adults who were unable to read and write. The effect of literacy was modified by age and its effect reduced by 18% for every 5-year increase of age among literate adults.ConclusionIn summary, the study indicates that double mortality burden from both NCDs and communicable diseases was evident in northern rural Ethiopia. Public health intervention measures that prioritise disadvantaged NCD patients such as those who are unable to read and write, the elders, the extended family and non-family household co-residents could significantly reduce NCD mortality among the adult population.

Knowledge and awareness of and perception towards cardiovascular disease risk in sub-Saharan Africa: A systematic review.

IntroductionCardiovascular diseases (CVDs) are the most common cause of non-communicable disease mortality in sub-Saharan African (SSA) countries. Gaps in knowledge of CVD conditions and their risk factors are important barriers in effective prevention and treatment. Yet, evidence on the awareness and knowledge level of CVD and associated risk factors among populations of SSA is scarce. This review aimed to synthesize available evidence of the level of knowledge of and perceptions towards CVDs and risk factors in the SSA region.MethodsFive databases were searched for publications up to December 2016. Narrative synthesis was conducted for knowledge level of CVDs, knowledge of risk factors and clinical signs, factors influencing knowledge of CVDs and source of health information on CVDs. The review was registered with Prospero (CRD42016049165).ResultsOf 2212 titles and abstracts screened, 45 full-text papers were retrieved and reviewed and 20 were included: eighteen quantitative and two qualitative studies. Levels of knowledge and awareness for CVD and risk factors were generally low, coupled with poor perception. Most studies reported less than half of their study participants having good knowledge of CVDs and/or risk factors. Proportion of participants who were unable to identify a single risk factor and clinical symptom for CVDs ranged from 1.8% in a study among hospital staff in Nigeria to a high of 73% in a population-based survey in Uganda and 7% among University staff in Nigeria to 75.1% in a general population in Uganda respectively. High educational attainment and place of residence had a significant influence on the levels of knowledge for CVDs among SSA populations.ConclusionLow knowledge of CVDs, risk factors and clinical symptoms is strongly associated with the low levels of educational attainment and rural residency in the region. These findings provide useful information for implementers of interventions targeted at the prevention and control of CVDs, and encourages them to incorporate health promotion and awareness campaigns in order to enhance knowledge and awareness of CVDs in the region.

Estimation of the impact of risk factors control on non-communicable diseases mortality, life expectancy and the labor force lost in China in 2030

Objective: To estimate the impact of risk factors control on non-communicable diseases (NCDs) mortality, life expectancy and the numbers of labor force lost in China in 2030. Methods: We used the results of China from Global Burden of Disease Study 2013, according to the correlation between death of NCDs and exposure of risk factors and the comparative risk assessment theory, to calculate population attributable fraction (PAF) and disaggregate deaths of NCDs into parts attributable and un-attributable. We used proportional change model to project risk factors exposure and un-attributable deaths of NCDs in 2030, then to get deaths of NCDs in 2030. Simulated scenarios according to the goals of global main NCDs risk factors control proposed by WHO were constructed to calculate the impact of risk factors control on NCDs death, life expectancy and the numbers of labor force lost. Results: If the risk factors exposure changed according to the trend of 1990 to 2013, compared to the numbers (8.499 million) and mortality rate (613.5/100 000) of NCDs in 2013, the death number (12.161 million) and mortality rate (859.2/100 000) would increase by 43.1% and 40.0% respectively in 2030, among which, ischemic stroke (increasing by 103.3% for death number and 98.8% for mortality rate) and ischemic heart disease (increasing by 85.0% for death number and 81.0% for mortality rate) would increase most quickly. If the risk factors get the goals in 2030, the NCDs deaths would reduce 2 631 thousands. If only one risk factor gets the goal, blood pressure (1 484 thousands NCDs deaths reduction), smoking (717 thousands reduction) and BMI (274 thousands reduction) would be the most important factors affecting NCDs death. Blood pressure control would have greater impact on ischemic heart disease (662 thousands reduction) and hemorrhagic stroke (449 thousands reduction). Smoking control would have the greatest effect on lung cancer (251 thousands reduction) and chronic obstructive pulmonary disease (201 thousands reduction). BMI control would have the greatest impact on ischemic heart disease (86 thousands reduction) and hypertensive heart disease (45 thousands reduction). If the risk factors exposure changed according to the trend of 1990 to 2013, in 2030, the life expectancy of Chinese population would reach to 79.0 years old, compared to 2013, increasing by 3.3 years old, the labor force at the age of 15-64 years old would loss 1.932 million. If the risk factors get the goals in 2030, life expectancy would increase to 81.7 years old and the number of labor force lost would decrease to 1.467 million. Blood pressure, smoking and BMI control would have much greater impact on life expectancy (4.9, 4.0 and 3.8 years old respectively) and labor force lost (630 thousands, 496 thousands and 440 thousands respectively). Conclusion: Risk factors control would play an important role in reducing NCD death, improving life expectancy of residents and reducing loss of labor force. Among them, the control of blood pressure raising, smoking and BMI raising would have a greater contribution to the improvement of population health status.

DIFFERENCES IN WALKABILITY INFLUENCE RESIDENTS’ HYPERTENSION IN TAIWAN: AN ANALYSIS OF OPEN GOVERNMENT DATA

The non-communicable disease is a serious problem in the world. Prevention emphasized modifiable behavioral and environmental features. Walkable neighborhood increases the level of physical activity and decreases the risk and the mortality of non-communicable diseases. Therefore, the purposes of this study were to understand the walkability and the distribution of the rate of outpatients with hypertension in each administrative region in Taiwan, and to analyze whether the difference of walkability could affect the rate of outpatients with hypertension. All data were retrieved from open government data in Taiwan and analyzed by ANOVA and National Geographic Information System. According to the standard deviation of walkability index, the regions were divided into four levels. The result demonstrated there was a significant difference in the rate of outpatients with hypertension among different regions. The regions with the highest walkability presented the lowest rate of outpatients with hypertension, which was significantly less than the third and the lowest one. In conclusion, the walkability is an important risk factor for hypertension. The walkable neighborhood should be considered of urban planning and sport and health related policies, in order to promote resident’s well-beings in advance. To cite this document: Hsin-Yen Yen and Saeedeh Ching Li, DIFFERENCES IN WALKABILITY INFLUENCE RESIDENTS’ HYPERTENSION IN TAIWAN: AN ANALYSIS OF OPEN GOVERNMENT DATA, International Journal of Electronic Commerce Studies, Vol.8, No.2, pp.97-107, 2017. Permanent link to this document: http://dx.doi.org/10.7903/ijecs.1516

The implantation of the Surveillance System for Non-communicable Diseases in Brazil, 2003 to 2015: successes and challenges.

To describe the implantation of the Surveillance System for Noncommunicable Diseases (NCDs) in the Unified Health System (Sistema Único de Saúde) and the challenges in maintaining it. A literature review was carried out the information contained in federal government directives between 2003 and 2015 was consulted. A comprehensive risk and protection factor surveillance system was implemented. It is capable of producing information and providing evidence to monitor changes in the health behavior of the population. Among the advances cited are the organization of epidemiological surveys, such as the Surveillance System for Risk Factors and Protection for NCD (Sistema de Vigilância de Fatores de Risco e Proteção para DCNT - Vigitel), the National School Health Survey (Pesquisa Nacional de Saúde do Escolar - PeNSE), and the National Health Survey (Pesquisa Nacional de Saude) from 2013, which enabled the most extensive health diagnosis of the Brazilian population. In 2011, the NCD National Plan 2011-2022 established targets for reducing risk factors and NCD mortality. The information gathered from the NCD surveillance system can support the implementation of sectoral and intersectorial strategies, which will result in the implementation of the Brazilian Strategic Action Plan for the prevention and control of NCDs, as well as the monitoring and evaluation of their results periodically. Finally, it can be a very important tool to help Brazil achieve the goals proposed by the 2030 Agenda for Sustainable Development and the Global Plan to Tackling NCDs.

PHP12 - Adult Risk Factors of Noncommunicable Disease Outcomes

Global mortality for noncommunicable diseases (NCDs) remains high and is increasing. The impact of major NCDs on developed European countries is disquieting. A risk predictor analysis of NCD outcome indicators is key to fight increasing global mortality and aid global monitoring. With this motivation, this study aimed to address the risk factors of NCD outcomes. Data from the World Health Organization (WHO) were used to assess NCD country profiles in 194 countries for the year 2014. The proportional mortality (percentage of total deaths) from NCDs was used as a predictor variable, and tobacco consumption, alcohol consumption per capita, raised blood pressure, and obesity variables were used as covariates. A random forest plot was used to examine NCD-related mortality risk factors while performing a Classification and Regression Tree (CART) algorithm. Classification accuracy, specificity, sensitivity, and area under the receiver operating characteristic curve (AUC) were used as performance measures. A decision tree graph was used to visualize the risk predictors of NCD mortality. The CART algorithm showed classification accuracy, sensitivity, and specificity at values of 0.7425, 0.7889, and 0.7019, respectively. The AUC was 0.8285. Study results highlight that alcohol consumption per capita, in liters of pure alcohol, was the best predictor of NCD mortality. Raised blood pressure and obesity were also predictors of NCDs. The study results offer several insights for health policy makers in the fight against increasing global NCD mortality. Evidence-based strategies – helping adults change their drinking behaviors, promoting compliance with alcoholism treatment, limiting access to cheap alcohol, and encouraging networking and the exchange of experiences among countries – are essential to combat detrimental alcohol consumption. It is crucial that all stakeholders work together to develop holistic and sustainable policies that are opposed to alcohol consumption and NCD mortality.

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

BackgroundHazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.MethodsA consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.ResultsScreening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.ConclusionsThe implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

The NCDs Cooperative: a call to action

Over the past 20 years, decision makers have largely stood impotent as non-communicable diseases (NCDs) have exploded around the world. Without a dramatic change in strategy, this resounding collective failure will persist. As I travelled the globe as one of three nominees for the Director-General of WHO, I met with 191 country delegations, including heads of state, foreign ministers, and health ministers. The good news on NCDs is that policy makers have both an awareness of the problem and an appetite for change. Unfortunately, this is not paralleled with action. 1 Horton R Offline: NCDs—why are we failing?. Lancet. 2017; 390: 346 Summary Full Text Full Text PDF PubMed Scopus (35) Google Scholar We must understand why not. Port-of-Spain Declaration for global NCD preventionAs global health researchers who work on non-communicable diseases (NCDs) and global health diplomacy, we were delighted to see the prioritisation of and emphasis on a global commitment to tackle the epidemic of NCDs in the Comment1 by Sania Nishtar (Oct 21, p 1820). Nishtar suggests excellent strategies, such as a multi stakeholder structure to serve as a holistic platform, to enable transparency and accountability to negotiate policy space for NCDs. Nishtar also highlights that none of the more than 80 disease-specific partnerships that have been created holistically address NCDs, and that this requires a multisectoral, partnership-based solution. Full-Text PDF Universal health coverage is needed to deliver NCD controlPresident Vázquez and Tedros Ghebreyesus (Sept 23, p 1473)1 rightly highlight the urgent global need for fiscal, trade, environmental, and political actions against non-communicable diseases (NCDs). Sania Nishtar suggests that scope exists for a new NCD agency because such diseases “have exploded around the world”.2 However, hyperbole around NCDs is unhelpful. Premature NCD mortality (ie, mortality in individuals aged 30–69 years) is estimated to be decreasing across all sociodemographic quintiles (figure). Full-Text PDF

Tobacco Cessation in India

Tobacco use is the most common cause of non-communicable disease related morbidity and mortality worldwide despite being preventable. Almost fifty percent or more than seven million tobacco users get killed each year and about 13 percent of them are non-smokers being exposed to second hand smoke (1). According to the recent National family health survey (NFHS-4) study for the year 2015-16, there were 38.9% men who use any kind of tobacco in urban while 48% in rural areas of India. On the other hand, 4.4% of women in urban and 8.1% in rural use any kind of tobacco. Prevalence of tobacco use in the ages of 13-15 among boys was 19% and girls 8.3 % according to global youth tobacco survey of 2009. The tobacco dependence was considered as disease by the international classification of diseases (ICD 10). Proportion of tobacco related cancers in comparison to all other cancers were reported to be as high as 25% in men and 18% in women (2).

The impact of income inequality and national wealth on child and adolescent mortality in low and middle-income countries

BackgroundIncome inequality and national wealth are strong determinants for health, but few studies have systematically investigated their influence on mortality across the early life-course, particularly outside the high-income world.MethodsWe performed cross-sectional regression analyses of the relationship between income inequality (national Gini coefficient) and national wealth (Gross Domestic Product (GDP) averaged over previous decade), and all-cause and grouped cause national mortality rate amongst infants, 1–4, 5–9, 10–14, 15–19 and 20–24 year olds in low and middle-income countries (LMIC) in 2012. Gini models were adjusted for GDP.ResultsData were available for 103 (79%) countries. Gini was positively associated with increased all-cause and communicable disease mortality in both sexes across all age groups, after adjusting for national wealth. Gini was only positively associated with increased injury mortality amongst infants and 20–24 year olds, and increased non-communicable disease mortality amongst 20–24 year old females. The strength of these associations tended to increase during adolescence.Increasing GDP was negatively associated with all-cause, communicable and non-communicable disease mortality in males and females across all age groups. GDP was also associated with decreased injury mortality in all age groups except 15–19 year old females, and 15–24 year old males. GDP became a weaker predictor of mortality during adolescence.ConclusionPolicies to reduce income inequality, rather than prioritising economic growth at all costs, may be needed to improve adolescent mortality in low and middle-income countries, a key development priority.

Profile of Cardiorespiratory Fitness, Flexibility and Fat Percentage of Junior High School Students in Jatinangor

Background: Obesity and physical inactivity is a major risk factor for non-communicable disease and global mortality in adolescent. Lack of physical activity will lead the condition into poor physical fitness, measured by cardio respiratory fitness (maximum oxygen volume, VO2 max), and other components such as flexibility. The study aimed to describe VO2 max, flexibility and fat percentage among junior high school students in Jatinangor. Methods: The study was a descriptive observational study using descriptive analysis. VO2 max was assessed using Astrand Ryhming step test, flexibility was measured using flexometer sit and reach test, and fat percentage was determined using bioelectrical impedance analysis scale. The subjects were junior high school students who were study in 1st, 2nd and 3rd grade in Jatinangor Junior High School based on stratification sampling method. It was conducted from September–October 2013. Results: Total subjects were 110 students consisted of male (n=52) and female (n=58). The VO2 max were in good and above category, 57.69% of male (50.37 ± 9.80 ml/kg/min), and 60.34% of female (37.66±7.03 ml/kg/min). The flexibility for both males and females were within excellent category (67.31%, 26.56 ±7.14 cm and 67.24%, 27.29±6.64 cm respectively). The fat percentage in females were within healthy category (67.24%, 25.28 ± 6.85 %), meanwhile male were within underfat category (48.08%, 11.66 ± 5.83 %). Conclusions: The majority of VO2 max, and flexibility both in male and female were good. The fat percentages were good in female students, while in male students were under normal range. DOI: 10.15850/amj.v4n2.1085

Socioeconomic Determinants of Sodium Intake in Adult Populations of High-Income Countries: A Systematic Review and Meta-Analysis

Background. A poorer quality diet among individuals with low socioeconomic status (SES) may partly explain the higher burden of noncommunicable disease among disadvantaged populations. Because there is a link between sodium intake and noncommunicable diseases, we systematically reviewed the current evidence on the social patterning of sodium intake. Objectives. To conduct a systematic review and a meta-analysis of the evidence on the association between SES and sodium intake in healthy adult populations of high-income countries. Search Methods. We followed the PRISMA-Equity guidelines in conducting a literature search that ended June 3, 2016, via MEDLINE, Embase, and SciELO. We imposed no publication date limits. Selection Criteria. We considered only peer-reviewed articles meeting the following inclusion criteria: (1) reported a measure of sodium intake disaggregated by at least 1 measure of SES (education, income, occupation, or any other socioeconomic indicator); (2) were written in English, Spanish, Portuguese, French, or Italian; and (3) were conducted in a high-income country as defined by the World Bank (i.e., per capita national gross income was higher than $12 746). We also excluded articles that exclusively sampled low-SES individuals, pregnant women, children, adolescents, elderly participants, or diseased patients or that reported results from a trial or intervention. Data Collection and Analysis. As summary measures, we extracted (1) the direction (positive, negative, or neutral) and the magnitude of the association between each SES indicator and sodium intake, and (2) the estimated sodium intake according to SES level. When possible and if previously unreported, we calculated the magnitude of the relative difference in sodium intake between high- and low-SES groups for each article, applying this formula: ([value for high-SES group – value for low-SES group]/[value for high-SES group]) × 100. We considered an association significant if reported as such, and we set an arbitrary 10% relative difference as clinically relevant and significant. We conducted a meta-analysis of the relative difference in sodium intake between high- and low-SES groups. We included articles in the meta-analysis if they reported urine-based sodium estimates and provided the total participant numbers in the low- and high-SES groups, the estimated sodium intake means for each group (in mg/day or convertible units), and the SDs (or transformable measures). We chose a random-effects model to account for both within-study and between-study variance. Main Results. Fifty-one articles covering 19 high-income countries met our inclusion criteria. Of these, 22 used urine-based methods to assess sodium intake, and 30 used dietary surveys. These articles assessed 171 associations between SES and sodium intake. Among urine-based estimates, 67% were negative (higher sodium intake in people of low SES), 3% positive, and 30% neutral. Among diet-based estimates, 41% were negative, 21% positive, and 38% neutral. The random-effects model indicated a 14% relative difference between low- and high-SES groups (95% confidence interval [CI] = –18, –9), corresponding to a global 503 milligrams per day (95% CI = 461, 545) of higher sodium intake among people of low SES. Conclusions. People of low SES consume more sodium than do people of high SES, confirming the current evidence on socioeconomic disparities in diet, which may influence the disproportionate noncommunicable disease burden among disadvantaged socioeconomic groups. Public Health Implications. It is necessary to focus on disadvantaged populations to achieve an equitable reduction in sodium intake to a population mean of 2 grams per day as part of the World Health Organization’s target to achieve a 25% relative reduction in noncommunicable disease mortality by 2025.

Socioeconomic Determinants of Sodium Intake in Adult Populations of High-Income Countries: A Systematic Review and Meta-Analysis.

A poorer quality diet among individuals with low socioeconomic status (SES) may partly explain the higher burden of noncommunicable disease among disadvantaged populations. Because there is a link between sodium intake and noncommunicable diseases, we systematically reviewed the current evidence on the social patterning of sodium intake. To conduct a systematic review and a meta-analysis of the evidence on the association between SES and sodium intake in healthy adult populations of high-income countries. We followed the PRISMA-Equity guidelines in conducting a literature search that ended June 3, 2016, via MEDLINE, Embase, and SciELO. We imposed no publication date limits. We considered only peer-reviewed articles meeting the following inclusion criteria: (1) reported a measure of sodium intake disaggregated by at least 1 measure of SES (education, income, occupation, or any other socioeconomic indicator); (2) were written in English, Spanish, Portuguese, French, or Italian; and (3) were conducted in a high-income country as defined by the World Bank (i.e., per capita national gross income was higher than $12 746). We also excluded articles that exclusively sampled low-SES individuals, pregnant women, children, adolescents, elderly participants, or diseased patients or that reported results from a trial or intervention. As summary measures, we extracted (1) the direction (positive, negative, or neutral) and the magnitude of the association between each SES indicator and sodium intake, and (2) the estimated sodium intake according to SES level. When possible and if previously unreported, we calculated the magnitude of the relative difference in sodium intake between high- and low-SES groups for each article, applying this formula: ([value for high-SES group - value for low-SES group]/[value for high-SES group]) × 100. We considered an association significant if reported as such, and we set an arbitrary 10% relative difference as clinically relevant and significant. We conducted a meta-analysis of the relative difference in sodium intake between high- and low-SES groups. We included articles in the meta-analysis if they reported urine-based sodium estimates and provided the total participant numbers in the low- and high-SES groups, the estimated sodium intake means for each group (in mg/day or convertible units), and the SDs (or transformable measures). We chose a random-effects model to account for both within-study and between-study variance. Fifty-one articles covering 19 high-income countries met our inclusion criteria. Of these, 22 used urine-based methods to assess sodium intake, and 30 used dietary surveys. These articles assessed 171 associations between SES and sodium intake. Among urine-based estimates, 67% were negative (higher sodium intake in people of low SES), 3% positive, and 30% neutral. Among diet-based estimates, 41% were negative, 21% positive, and 38% neutral. The random-effects model indicated a 14% relative difference between low- and high-SES groups (95% confidence interval [CI] = -18, -9), corresponding to a global 503 milligrams per day (95% CI = 461, 545) of higher sodium intake among people of low SES. People of low SES consume more sodium than do people of high SES, confirming the current evidence on socioeconomic disparities in diet, which may influence the disproportionate noncommunicable disease burden among disadvantaged socioeconomic groups. Public Health Implications. It is necessary to focus on disadvantaged populations to achieve an equitable reduction in sodium intake to a population mean of 2 grams per day as part of the World Health Organization's target to achieve a 25% relative reduction in noncommunicable disease mortality by 2025.

Socioeconomic status and non-communicable disease behavioural risk factors in low-income and lower-middle-income countries: a systematic review.

SummaryBackgroundNon-communicable diseases are the leading global cause of death and disproportionately afflict those living in low-income and lower-middle-income countries (LLMICs). The association between socioeconomic status and non-communicable disease behavioural risk factors is well established in high-income countries, but it is not clear how behavioural risk factors are distributed within LLMICs. We aimed to systematically review evidence on the association between socioeconomic status and harmful use of alcohol, tobacco use, unhealthy diets, and physical inactivity within LLMICs.MethodsWe searched 13 electronic databases, including Embase and MEDLINE, grey literature, and reference lists for primary research published between Jan 1, 1990, and June 30, 2015. We included studies from LLMICs presenting data on multiple measures of socioeconomic status and tobacco use, alcohol use, diet, and physical activity. No age or language restrictions were applied. We excluded studies that did not allow comparison between more or less advantaged groups. We used a piloted version of the Cochrane Effective Practice and Organisation of Care Group data collection checklist to extract relevant data at the household and individual level from the included full text studies including study type, methods, outcomes, and results. Due to high heterogeneity, we used a narrative approach for data synthesis. We used descriptive statistics to assess whether the prevalence of each risk factor varied significantly between members of different socioeconomic groups. The study protocol is registered with PROSPERO, number CRD42015026604.FindingsAfter reviewing 4242 records, 75 studies met our inclusion criteria, representing 2 135 314 individuals older than 10 years from 39 LLMICs. Low socioeconomic groups were found to have a significantly higher prevalence of tobacco and alcohol use than did high socioeconomic groups. These groups also consumed less fruit, vegetables, fish, and fibre than those of high socioeconomic status. High socioeconomic groups were found to be less physically active and consume more fats, salt, and processed food than individuals of low socioeconomic status. While the included studies presented clear patterns for tobacco use and physical activity, heterogeneity between dietary outcome measures and a paucity of evidence around harmful alcohol use limit the certainty of these findings.InterpretationDespite significant heterogeneity in exposure and outcome measures, clear evidence shows that the burden of behavioural risk factors is affected by socioeconomic position within LLMICs. Governments seeking to meet Sustainable Development Goal (SDG) 3.4—reducing premature non-communicable disease mortality by a third by 2030—should leverage their development budgets to address the poverty-health nexus in these settings. Our findings also have significance for health workers serving these populations and policy makers tasked with preventing and controlling the rise of non-communicable diseases.FundingWHO.

Mortality and risk factors for non-communicable diseases in Russia: Specific features, trends, and prognosis

In the Russian Federation, the increase in all-cause and cardiovascular disease mortality began in the 1960s and lasted almost continuously until 2003. In our country, the characteristics of mortality are its substantially higher rates among men and a large regional variability, which is associated with economic, climatic, and geographic factors. Urbanization coupled with dietary changes and the higher prevalence of hypertension is the most likely initial impetus to the rise in mortality rates. The subsequent increase in mortality can be explained by the higher prevalence of behavioral and biological risk factors, alcoholism, and, since the 1990s, by heavy and protracted socioeconomic upheavals and lifestyle changes. The mortality decline since 2006 has been linked to the strengthening of the health system and to the reduction in the prevalence of smoking among men and hypertension in women. The slowing down of the pace of mortality decline may be due to the increase in the prevalence of hypertension and obesity among men. The modelling data show that by 2025, reductions in smoking prevalence rates by 23% among men and by 12% among women and increases in the efficiency of hypertension treatment by 17.2% in men and by 11.2% in women will reduce cardiovascular mortality rates by 15%.

CARDIOVASCULAR AND OTHER NON-COMMUNICABLE DISEASES IN THE COUNTRIES OF THE NORTHERN DIMENSION PARTNERSHIP IN PUBLIC HEALTH AND SOCIAL WELL-BEING: PRIORITIES AND BETTER PREVENTION APPROACHES

The issues on prevention of non-communicable diseases (NCD) with the goal of premature mortality decrease and, respectively, of people lives saving, is being discussed actively in the countries of Northern Dimension Partnership in Public Health and Social Well-being (NDPHS). Comparative analysis of NCD in the NDP countries showed serious, approximately 3 times, differences in the parameters of premature mortality from NCD within the countries, and direct relationship of premature mortality from NCD with smoking prevalence in men, as with alcohol consumption in both sexes. Negative correlation is found in premature NCD mortality indices and amount of money spent on public health per person per year; such difference is as high as 10-15 times among the countries. The discussion of priorities and effective methods of NCD prevention by the members of NDPHS is significant for experience exchange and facilitates implementation of three strategies on NCD prevention and their promotion in all political and strategic events in the countries.

Probability of premature mortality caused by non-communicable diseases in Beijing, 2010-2015

Objective: To understand the probability of premature mortality caused by non-communicable diseases (NCD) in Beijing from 2010 to 2015. Methods: The data of deaths from Beijing vital registration system were used to analyze age-standardized NCD mortality rates, proportion of NCD deaths in age group <70 years and premature NCD mortality. Results: NCD deaths accounted for 90% of the total deaths in Beijing. Age-standardized NCD death rate decreased from 332.43/100 000 in 2010 to 280.02/100 000 in 2015. Meanwhile, the probability of deaths from four NCDs between in age group 30-70 years (premature NCD mortality) decreased from 12.81% to 11.11% in Beijing. The premature mortality of four NCDs in men was 14.63%, and compared with 2015 baseline, it would decrease by 16.4% to reach 2025 goal (12.23%), and the probability of premature mortality four NCDs in women was 7.54%, and compared with 2015 baseline, it would decrease by 6.8% to reach the 2025 goal (7.03%). People living in suburb areas had a higher probability of premature NCD mortality (13.67%) than those living in urban areas (9.72%) in Beijing in 2015. Conclusions: The premature NCD mortality was much higher in men than in women in Beijing. More attention should be paid to the control of risk factors for NCD premature deaths, especially in men and in suburb residents, to reach the 25×25 goal.

The spatial pattern of premature mortality in Hong Kong: How does it relate to public housing?

Research into understanding the relationship between access to housing, health and wellbeing in cities has yielded mixed evidence to date and has been limited to case studies from Western countries. Many studies appear to highlight the negative effects of public housing in influencing the health of its residents. Current trends in the urban housing markets in cities of advanced Asian economies and debates surrounding the role of government in providing housing underscore the need for more focused research into housing and health. In this paper, we investigate Hong Kong as an example of a thriving Asian city by exploring and comparing the intra-urban geographies of premature mortality and public housing provision in the city. Using a fully Bayesian spatial structural model, we estimate associations between public housing provision and different types of premature mortality. We find significant geographic variations in premature mortality within Hong Kong during the five-year period 2005–2009, with positive associations between the residents of public housing and premature mortality risk. But the associations attenuate or are even reversed for premature mortality of injuries and non-communicable diseases after controlling for local deprivation, housing instability, access to local amenities and other neighbourhood characteristics. The results indicate that public housing may have a protective effect on community health, which contradicts the findings of similar studies carried out in Western cities. We suggest reasons why the association between public housing and health differs in Hong Kong and discuss the implications for housing policy in Hong Kong and other Asian cities.

Engaging young people in the prevention of noncommunicable diseases.

Noncommunicable diseases (NCDs) are one of the biggest public health challenges of the 21st century.1 The social and economic impact of NCDs are threatening progress towards sustainable development. NCDs are the leading causes of death,2 causing 16 million premature deaths annually.3 Four main groups of noncommunicable diseases – cardiovascular diseases, cancers, chronic respiratory diseases and diabetes – account for 82% of all NCD attributable deaths.3 By 2025, the global economic cost from these four groups of diseases is predicted to surpass 51 trillion United States dollars.4 Despite a common assumption that NCDs are “diseases of affluence” only affecting people in wealthy nations, NCDs disproportionately affect people in low- and middle-income countries. The probability of dying prematurely from NCD in a low- and middle-income country is four times higher than that in high-income countries.3 It is important for young people to understand NCDs and their risk factors. Two-thirds of premature deaths in adults are associated with childhood conditions5 or behaviours initiated in youth: over 150 million young people smoke;5 81% of adolescents don’t get enough physical activity;6 11.7% of adolescents partake in heavy episodic drinking7 and 41 million children under 5 years old are overweight or obese.8 Entrenched behaviours and unhealthy environments ensure that NCDs will continue to affect future generations. Many young people today have unprecedented access to information and the capacity to act on that information in shaping their own lives, and determining their own health status.9 Young people can contribute in several ways to prevent NCDs. By using new media, young voices can provide a novel perspective on NCD prevention and control by sharing targeted messages on key risk factors and interventions. Young people can engage with different communities and share information about NCDs. Young people can lead programmes to promote healthy behaviour, such as community exercise classes, or healthy eating programmes. We can contribute to education and awareness initiatives, to inform the public and decision-makers about health problems and solutions. Young medical and allied health students also have a unique opportunity to get involved. Students on clinical rotations can promote effective disease prevention measures such as tobacco cessation. Young people can also advocate for policies and practices that aim to improve NCD prevention and care. In 2011, more than 190 countries agreed on global mechanisms to reduce the avoidable NCD burden including a Global action plan for the prevention and control of NCDs 2013–2020.10 So far this commitment has yielded insufficient resources and political action to reach the target of 25% reduction in premature NCD mortality by 2025. It is our responsibility to hold our governments accountable for their commitments to the 2011 political declaration on NCDs. We suggest that all institutions working on NCDs evaluate how they gather and act on the perspectives of young people. NCD prevention should be included in the agenda of international youth groups and integrated in all medical, nursing and allied health curriculums. To reduce the impact of NCDs, the next generation needs to be involved in recognizing and changing the conditions that favour these diseases.

Chronic diseases in the Western world: Increasing incidence or increasing overdiagnosis?

This issue of the SAMJ carries an important paper for South Africa (SA), outlining the trends in non-communicable disease (NCD) mortality in this country over the 13 years 1997 - 2010. In this largely resource-poor country, nearly 40% of deaths during this period were due to NCDs, and of these nearly 15% were regarded as premature deaths - i.e. before the age of 45. Another 21% were deaths between the ages of 45 and 59. This is a worrying trend in a country where we still have significant child mortality. However, commentators in the developed world are concerned, for different reasons, about an explosion of chronic disease. In a recent article in the BMJ, McGrail et al. question whether this increase in chronic disease truly reflects worse health. They cite a recent paper from the Global Burden of Disease Study suggesting that only 4% of the world's population is free of disease - in other words, health is an anomaly. Chronic diseases are the conditions that contribute to this alarming 'lack of health', and multimorbidity - described as the 'most common chronic condition' - affects at least half of the population aged over 65.