Non-communicable Disease Mortality Research Articles

Emerging trends in non-communicable disease mortality in South Africa, 1997 - 2010.

National trends in age-standardised death rates (ASDRs) for non-communicable diseases (NCDs) in South Africa (SA) were identified between 1997 and 2010. As part of the second National Burden of Disease Study, vital registration data were used after validity checks, proportional redistribution of missing age, sex and population group, demographic adjustments for registration incompleteness, and identification of misclassified AIDS deaths. Garbage codes were redistributed proportionally to specified codes by age, sex and population group. ASDRs were calculated using mid-year population estimates and the World Health Organization world standard. Of 594 071 deaths in 2010, 38.9% were due to NCDs (42.6% females). ASDRs were 287/100 000 for cardiovascular diseases (CVDs), 114/100 000 for cancers (malignant neoplasms), 58/100 000 for chronic respiratory conditions and 52/100 000 for diabetes mellitus. An overall annual decrease of 0.4% was observed resulting from declines in stroke, ischaemic heart disease, oesophageal and lung cancer, asthma and chronic respiratory disease, while increases were observed for diabetes, renal disease, endocrine and nutritional disorders, and breast and prostate cancers. Stroke was the leading NCD cause of death, accounting for 17.5% of total NCD deaths. Compared with those for whites, NCD mortality rates for other population groups were higher at 1.3 for black Africans, 1.4 for Indians and 1.4 for coloureds, but varied by condition. NCDs contribute to premature mortality in SA, threatening socioeconomic development. While NCD mortality rates have decreased slightly, it is necessary to strengthen prevention and healthcare provision and monitor emerging trends in cause-specific mortality to inform these strategies if the target of 2% annual decline is to be achieved.

Keeping Public Health Clean: Food Policy Barriers and Opportunities in the Era of the Industrial Epidemics.

Poor diet accounts for a larger burden of disability and death than tobacco, alcohol and physical inactivity combined.[1] The World Health Assembly has recognized this as a priority and has challenged member countries to reduce non-communicable disease (NCD) mortality by 25% by 2025 targeting their determinants.[2] Reaching these ambitious targets is possible, but it will require decisive action on diets and tobacco smoking if we want to make a difference.[1] Certainly diet can deliver these reductions rapidly, possibly in less than a decade, and particularly by reducing cardiovascular disease burden, still one of the most important cause of death globally. [3],[4]But the impact of these diseases can be substantially lowered. Several natural experiments have shown the dramatic changes in mortality can be observed after changes of risk factors at population level, many attributable to changes in food intake [5]

High Fasting Plasma Glucose Mortality Effect: A Comparative Risk Assessment in 25-64 Years Old Iranian Population.

Background:High fasting plasma glucose (FPG) is one of the main leading risk factors of ischemic heart disease (IHD), stroke, and chronic kidney diseases (CKDs). We estimated population attributable fraction (PAF) and attributed death of these fatal outcomes of high FPG at national and subnational levels in 25–64 years old Iranian adult.Methods:We used national and subnational data of the Non-Communicable Disease Surveillance Survey for exposure to risk factors in 2005 and 2011 among Iranian adults of 25–64 years old. For estimating the attributed death, using the death registration system data of Iran, we multiply the cause-specific PAFs by the number of outcome-specific deaths.Results:In Iran, high FPG was responsible for about 31% of attributed total deaths of IHD, stroke, and CKD in 2011. The related attributed deaths had increased from 2005 to 2011. In females, the PAFs for the effect of high FPG on IHD, stroke, and CKD were higher in 2011 than 2005 in all age groups. In males, this increase has occurred in over 45 years old. The highest PAFs of high FPG outcomes mostly related to central provinces of Iran. The central region of Iran had the highest and the southeast of the country had the lowest levels of attributed deaths.Conclusions:Considering the global 25 × 25 targets for noncommunicable disease mortality reduction, high FPG as a leading risk factor of fatal outcomes should be more targeted through the dietary, behavioral, and pharmacological interventions in Iran.

Simulating the impact on health of internalising the cost of carbon in food prices combined with a tax on sugar-sweetened beverages.

BackgroundRising greenhouse gas emissions (GHGEs) have implications for health and up to 30 % of emissions globally are thought to arise from agriculture. Synergies exist between diets low in GHGEs and health however some foods have the opposite relationship, such as sugar production being a relatively low source of GHGEs. In order to address this and to further characterise a healthy sustainable diet, we model the effect on UK non-communicable disease mortality and GHGEs of internalising the social cost of carbon into the price of food alongside a 20 % tax on sugar sweetened beverages (SSBs).MethodsDeveloping previously published work, we simulate four tax scenarios: (A) a GHGEs tax of £2.86/tonne of CO2 equivalents (tCO2e)/100 g product on all products with emissions greater than the mean across all food groups (0.36 kgCO2e/100 g); (B) scenario A but with subsidies on foods with emissions lower than 0.36 kgCO2e/100 g such that the effect is revenue neutral; (C) scenario A but with a 20 % sales tax on SSBs; (D) scenario B but with a 20 % sales tax on SSBs. An almost ideal demand system is used to estimate price elasticities and a comparative risk assessment model is used to estimate changes to non-communicable disease mortality.ResultsWe estimate that scenario A would lead to 300 deaths delayed or averted, 18,900 ktCO2e fewer GHGEs, and £3.0 billion tax revenue; scenario B, 90 deaths delayed or averted and 17,100 ktCO2e fewer GHGEs; scenario C, 1,200 deaths delayed or averted, 18,500 ktCO2e fewer GHGEs, and £3.4 billion revenue; and scenario D, 2,000 deaths delayed or averted and 16,500 ktCO2e fewer GHGEs. Deaths averted are mainly due to increased fibre and reduced fat consumption; a SSB tax reduces SSB and sugar consumption.ConclusionsIncorporating the social cost of carbon into the price of food has the potential to improve health, reduce GHGEs, and raise revenue. The simple addition of a tax on SSBs can mitigate negative health consequences arising from sugar being low in GHGEs. Further conflicts remain, including increased consumption of unhealthy foods such as cakes and nutrients such as salt.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2723-8) contains supplementary material, which is available to authorized users.

Translating global commitments on NCDs into national action: the role of civil society

The inclusion of non-communicable diseases (NCDs) in the UN Agenda 2030 for Sustainable Development, 1 UN General Assembly resolutionTransforming our world: the 2030 Agenda for Sustainable Development, Sept. A/69/L.85. United Nations, 2015 Google Scholar adopted in September, 2015, firmly establishes NCDs as an urgent global health and development priority. With the global prioritisation of NCDs and associated commitments, such as the WHO Global NCD Action Plan 2013–20, 2 WHOGlobal NCD Action Plan 2013–2020. World Health Organization, Geneva2013 Google Scholar in place, the responsibility for action has shifted to the national and regional level. However, progress at the national level has been insufficient and highly uneven, 3 UN Secretary General Progress Report on NCDs, December, 2A/68/650. World Health Organization, Geneva2013http://ncdalliance.org/sites/default/files/rfiles/SG%20progress%20report_January%202014.pdf Google Scholar to use the words of the UN Secretary-General Ban Ki-moon. According to the recent WHO NCD Progress Monitor, 4 WHONoncommunicable Diseases Progress Monitor 2015. World Health Organization, Geneva2015 Google Scholar only 33% of countries have a national NCD action plan or strategy, and only 31% have national NCD targets and indicators. The situation is even bleaker when it comes to resources for NCDs. 5 Dain K Sustainable financing: the Achilles heel of the non-communicable diseases response. Lancet Diabetes Endocrinol. 2015; (published online Oct 22.)http://dx.doi.org/10.1016/S2213-8587(15)00393-9 Google Scholar With only 10 years to achieve the global 25 by 25 NCD mortality reduction goal, what is missing to ensure significant progress over the coming years? The ageing of AfricaDemographically speaking, Africa is the world's youngest continent—as recently as 2011, an estimated 70% of the population was younger than 30 years. But Africa is now ageing faster than the global average, with the number of Africans aged 55 years or older predicted to increase from 64·5 million to 103 million by 2030, and to 212 million by 2050. And with an increasing aged population comes an increased burden of diabetes and other non-communicable diseases (NCDs). Full-Text PDF

Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study.

Countries have agreed to reduce premature mortality from the four main non-communicable diseases (NCDs) by 25% from 2010 levels by 2025 (referred to as the 25 × 25 target). Countries also agreed on a set of global voluntary targets for selected NCD risk factors. Previous analyses have shown that achieving the risk factor targets can contribute substantially towards meeting the 25 × 25 mortality target at the global level. We estimated the contribution of achieving six of the globally agreed risk factor targets towards meeting the 25 × 25 mortality target by region. We estimated the effect of achieving the targets for six risk factors (tobacco and alcohol use, salt intake, obesity, and raised blood pressure and glucose) on NCD mortality between 2010 and 2025. Our methods accounted for multicausality of NCDs and for the fact that, when risk factor exposure increases or decreases, the harmful or beneficial effects on NCDs accumulate gradually. We used data for risk factor and mortality trends from systematic analyses of available country data. Relative risks for the effects of individual and multiple risks, and for change in risk after decreases or increases in exposure, were from reanalyses and meta-analyses of epidemiological studies. The probability of dying between the ages 30 years and 70 years from the four main NCDs in 2010 ranged from 19% in the region of the Americas to 29% in southeast Asia for men, and from 13% in Europe to 21% in southeast Asia for women. If current trends continue, the probability of dying prematurely from the four main NCDs is projected to increase in the African region but decrease in the other five regions. If the risk factor targets are achieved, the 25 × 25 target will be surpassed in Europe in both men and women, and will be achieved in women (and almost achieved in men) in the western Pacific; the regions of the Americas, the eastern Mediterranean, and southeast Asia will approach the target; and the rising trend in Africa will be reversed. In most regions, a more ambitious approach to tobacco control (50% reduction relative to 2010 instead of the agreed 30%) will contribute the most to reducing premature NCD mortality among men, followed by addressing raised blood pressure and the agreed tobacco target. For women, the highest contributing risk factor towards the premature NCD mortality target will be raised blood pressure in every region except Europe and the Americas, where the ambitious (but not agreed) tobacco reduction would have the largest benefit. No WHO region will meet the 25 × 25 premature mortality target if current mortality trends continue. Achieving the agreed targets for the six risk factors will allow some regions to meet the 25 × 25 target and others to approach it. Meeting the 25 × 25 target in Africa needs other interventions, including those addressing infection-related cancers and cardiovascular disease. UK Medical Research Council.

Health reform and mortality in China: Multilevel time-series analysis of regional and socioeconomic inequities in a sample of 73 million

China’s 2009 expansion of universal health insurance has received global interest, but little empirical investigation. This epidemiological study was a first attempt to assess potential impacts on population health and health equity. Multilevel negative binomial regression was used to analyse all-cause and non-communicable disease (NCD) mortality between 2006 and 2012 from a representative sample including all 31 provinces. The age-standardised ratios (per 100,000) in 2006 were 860.4 and 732.9 for mortality from all-causes and NCDs respectively. These ratios decreased over time to 737.5 (all-causes) and 642.9 (NCD) by 2012. Modelling indicated these trajectories were curvilinear, dipping more rapidly from 2009 onwards. Compared to the east, all-cause mortality was higher in other regions (e.g. northwest RR: 1.34, 95% CI: 1.20, 1.48). Compared to more affluent urban areas, rate ratios for all-cause mortality were 1.23 (95% CI: 0.97, 1.54) in the least affluent urban areas, 1.22 (95% CI: 1.02, 1.46) in affluent rural areas and 1.64 (95% CI: 1.51, 1.79) in the least affluent rural areas. These health inequities were largely repeated for NCD mortality and did not vary spatiotemporally. Overall, universal health insurance in China may have accelerated reductions in all-cause and NCD mortality, but potential impacts on health inequity may take longer to manifest.

Socioeconomic inequalities in non-communicable diseases and their risk factors: an overview of systematic reviews.

BackgroundNon-communicable diseases (NCDs) are the largest cause of premature death worldwide. Socioeconomic inequalities contribute to a disparity in the burden of NCDs among disadvantaged and advantaged populations in low (LIC), middle (MIC), and high income countries (HIC). We conducted an overview of systematic reviews to systematically and objectively assess the available evidence on socioeconomic inequalities in relation to morbidity and mortality of NCDs and their risk factors.MethodsWe searched PubMed, The Cochrane Library, EMBASE, SCOPUS, Global Health, and Business Source Complete for relevant systematic reviews published between 2003 and December 2013. Two authors independently screened abstracts and full-text publications and determined the risk of bias of the included systematic reviews.ResultsWe screened 3302 abstracts, 173 full-text publications and ultimately included 22 systematic reviews. Most reviews had major methodological shortcomings; however, our synthesis showed that having low socioeconomic status (SES) and/or living in low and middle income countries (LMIC) increased the risk of developing cardiovascular diseases (CVD), lung and gastric cancer, type 2 diabetes, and chronic obstructive pulmonary disease (COPD). Furthermore, low SES increased the risk of mortality from lung cancer, COPD, and reduced breast cancer survival in HIC. Reviews included here indicated that lower SES is a risk factor for obesity in HIC, but this association varied by SES measure. Early case fatalities of stroke were lower and survival of retinoblastoma was higher in MIC compared to LIC.ConclusionsThe current evidence supports an association between socioeconomic inequalities and NCDs and risk factors for NCDs. However, this evidence is incomplete and limited by the fairly low methodological quality of the systematic reviews, including shortcomings in the study selection and quality assessment process.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2227-y) contains supplementary material, which is available to authorized users.

Trend of non-communicable disease mortality for three common conditions in the elderly population from 2002 to 2010: A population-based study in China

ObjectiveThere is a lack of data focusing on non-communicable disease (NCD) mortality in the Chinese elderly population over the past decade. MethodsUsing mortality data from the Chinese Health Statistics, we explored the crude and age-standardized mortality trend of three major NCDs in the Chinese population ≥65 years of age from 2002 to 2010, namely, malignant neoplasms, heart diseases, and cerebrovascular diseases. Subpopulations characterized as rural and urban residence, and by gender and age were examined separately. ResultsMortality increased with age and was higher among males than among females across the three NCDs, with the gender difference being most remarkable for malignant neoplasms and least for heart diseases mortality. Condition-specific crude mortalities increased between 2002 and 2010, overall and in all the pre-specified subpopulations. After age-standardization, rising trends were observed for people ≥65 years old, and condition-specific mortalities generally increased in rural regions and decreased in urban regions, especially for cerebrovascular diseases. ConclusionsThere were increasing trends for mortality due to malignant neoplasms, heart diseases, and cerebrovascular diseases in China between 2002 and 2010, which were largely driven by the population aging. Disparities existed by rural and urban residence, gender, and age.

Dietary patterns in relation to quality-adjusted life years in the EPIC-NL cohort

BackgroundDietary patterns have been associated with the incidence or mortality of individual non-communicable diseases, but their association with disease burden has received little attention. ObjectiveThe aim of our study was to relate dietary patterns to health expectancy using quality-adjusted life years (QALYs) as outcome parameter. MethodsData from the EPIC-NL study were used, a prospective cohort study of 33,066 healthy men and women aged 20–70 years at recruitment. A lifestyle questionnaire and a validated food frequency questionnaire were administered at study entry (1993–1997). Five dietary patterns were studied: three a priori patterns (the modified Mediterranean Diet Score (mMDS), the WHO-based Healthy Diet Indicator (HDI) and the Dutch Healthy Diet index (DHD-index)) and two a posteriori data–based patterns. QALYs were used as a summary health measure for healthy life expectancy, combining a person’s life expectancy with a weight reflecting loss of quality of life associated with having chronic diseases. ResultsThe mean QALYs of the participants were 74.9 (standard deviation 4.4). A higher mMDS and HDI were associated with a longer life in good health. Participants who had a high mMDS score (6–9) had 0.17 [95% CI, 0.05; 0.30] more QALYs than participants with a low score (0–3), equivalent to two months longer life in good health. Participants with a high HDI score also had more QALYs (0.15 [95% CI, 0.03; 0.27]) than participants with a low HDI score. ConclusionA Mediterranean-type diet and the Healthy Diet Indicator were associated with approximately 2months longer life in good health.

One-day Workshop Training Improves Physical Activity Prescription Knowledge in Latin American Physicians

Increases in non-communicable diseases morbidity and mortality have made it imperative for physicians (MD´s) to effectively prescribe physical activity (PA) as part of treatment plan. A one-day certification workshop was designed to improve MD´s PA knowledge and skills, as part of the Exercise is Medicine® (EIM) global health initiative (EIM-GHI). PURPOSE: To determine MD´s knowledge gain after a standardized one-day PA prescription workshop performed throughout Latin America (LA). METHODS: Pre/post-test analysis without a control group performed on 1497 MDs after an 8-hour PA prescription workshop delivered 68 times across 10 LA countries. It included a 6-hour theoretical and 2-hour hands-on sessions. A multiple-choice test based on the ACSM’s Guidelines was completed before and after. MD’s who scored ≥80% were certified. Knowledge improvement was determined using the class-average normalized gain (mean actual gain / maximum possible gain). T-tests with a 95% confidence level were conducted to compare and analyze differences between MD specialties. RESULTS: Of the 1497 MD’s, 61% were certified. Mean test scores improved from 63% to 79% after the workshop (p <0.001). The overall relative gain was 31% [CI: 29% to 34%]. The mean of the 68 workshops’ class-average normalized gain was 45% [CI: 41 to 47%], significantly above the 30% (p <0.001) minimum gain international standard for a curriculum to be considered effective. Results were consistent across countries. Specialties with the largest number of workshop participants were general practitioners (GP’s) (31%), internal medicine (16%), family medicine (8%), sports medicine (7%) and pediatrics (6%). Family medicine MD’s knowledge relative gain was significantly higher than that of general practitioners’ (37% vs 34%, p =0.03). Both Family and GP’s had significantly higher relative gain than internal medicine and pediatrics (27% and 28%; respectively, p <0.001). Sports medicine MD’s knowledge gain (17%) was significantly lower than the rest (p <0.001). CONCLUSIONS: This one-day workshop had a positive impact on the knowledge gain of MD’s. Specialties that benefited most were GP’s and family medicine, MD´s that are critical for NCD control. Short training and certification strategies in PA prescription are pivotal for implementing the EIM-GHI.

Achieving a 25% reduction in premature non-communicable disease mortality: the Swedish population as a cohort study.

BackgroundThe 2012 World Health Assembly set a target for Member States to reduce premature non-communicable disease (NCD) mortality by 25% over the period 2010 to 2025. This reflected concerns about increasing NCD mortality burdens among productive adults globally. This article first considers whether the WHO target of a 25% reduction in the unconditional probability of dying between ages of 30 and 70 from NCDs (cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases) has already taken place in Sweden during an equivalent 15-year period. Secondly, it assesses which population sub-groups have been more or less successful in contributing to overall changes in premature NCD mortality in Sweden.MethodsA retrospective dynamic cohort database was constructed from Swedish population registers in the Linnaeus database, covering the entire population in the age range 30 to 69 years for the period 1991 to 2006, which was used directly to measure reductions in premature NCD mortality using a life table method as specified by the WHO. Multivariate Poisson regression models were used to assess the contributions of individual background factors to decreases in premature NCD mortality.ResultsA total of 292,320 deaths occurred in the 30 to 69 year age group during the period 1991 to 2006, against 70,768,848 person-years registered. The crude all-cause mortality rate declined from 5.03 to 3.72 per 1,000 person-years, a 26% reduction. Within this, the unconditional probability of dying between the ages of 30 and 70 from NCD causes as defined by the WHO fell by 30.0%. Age was consistently the strongest determinant of NCD mortality. Background determinants of NCD mortality changed significantly over the four time periods 1991–1994, 1995–1998, 1999–2002, and 2003–2006.ConclusionsSweden, now at a late stage of epidemiological transition, has already exceeded the 25% premature NCD mortality reduction target during an earlier 15-year period. This should be encouraging news for countries currently implementing premature NCD mortality reduction programmes. Our findings suggest, however, that it may be difficult for Sweden and other late-transition countries to reach the current 25 × 25 target, particularly where substantial premature mortality reductions have already been achieved.

Review of 5 year mortality trend at federal medical center, Umuahia Nigeria using the global burden of disease classification

Background: There have been few systematic studies of the causes of death in Nigeria. However, the causes of death as well as the average age at death are important statistics in the public health policy formulation. The global burden of disease (GBD) classification is very useful in describing relative etiologies of mortality, as well as the epidemiologic transition. Objective: The aim of this study was to describe the causes of mortality in the Federal Medical Centre, Umuahia with respect to causes, gender, age at death, and duration of hospital stay using the GBD classification. Methods: We retrospectively reviewed records of mortalities seen between February 2003 and December 2008 at the Federal Medical Centre, Umuahia using the deaths register at our records department. Results: There were 3444 cases of mortality over the period, comprising 58.2% males and 41.4% females. Mean age at death was 40.92 ± 26.12 years communicable, maternal, neonatal, and nutritional disorders comprised 39.91%, noncommunicable diseases made up 48.76%, while Injuries comprised 11.33%. Conclusion: Public health attention should be sustained at reducing morbidity and mortality of noncommunicable diseases.

Obesity and public health in the Kingdom of Saudi Arabia.

Overweight and obesity are now a global epidemic, with more than one in five people qualifying as obese worldwide. These conditions are accompanied by excessive rates of non-communicable diseases (NCDs) related to overweight, like type 2 diabetes mellitus, hypertension, and cardiovascular diseases. Saudi Arabia, which has become increasingly westernized over the past few decades now has one of the highest prevalence rates of overweight and obesity, even in children. This puts the population at great risk for increased rates of NCD mortality. Competing cultures is partly to blame, as the combination of persisting traditional Saudi cultural practices, modern cultural changes, and economic prosperity has created an obesogenic environment that promotes unhealthy eating, sedentary lifestyles, and weight gain. Overweight and obesity are more prevalent in Saudi women than in Saudi men. Interventions targeting the environment are needed in order to promote greater health through healthy eating decisions and increased physical activity or exercise (especially for women).

Non-Communicable Disease Mortality and Risk Factors in Formal and Informal Neighborhoods, Ouagadougou, Burkina Faso: Evidence from a Health and Demographic Surveillance System.

The expected growth in NCDs in cities is one of the most important health challenges of the coming decades in Sub-Saharan countries. This paper aims to fill the gap in our understanding of socio-economic differentials in NCD mortality and risk in low and middle income neighborhoods in urban Africa. We use data collected in the Ouagadougou Health and Demographic Surveillance System. 409 deaths were recorded between 2009–2011 among 20,836 individuals aged 35 years and older; verbal autopsies and the InterVA program were used to determine the probable cause of death. A random survey asked in 2011 1,039 adults aged 35 and over about tobacco use, heavy alcohol consumption, lack of physical activity and measured their weight, height, and blood pressure. These data reveal a high level of premature mortality due to NCDs in all neighborhoods: NCD mortality increases substantially by age 50. NCD mortality is greater in formal neighborhoods, while adult communicable disease mortality remains high, especially in informal neighborhoods. There is a high prevalence of risk factors for NCDs in the studied neighborhoods, with over one-fourth of the adults being overweight and over one-fourth having hypertension. Better-off residents are more prone to physical inactivity and excessive weight, while vulnerable populations such as widows/divorced individuals and migrants suffer more from higher blood pressure. Females have a significantly lower risk of being smokers or heavy drinkers, while they are more likely to be physically inactive or overweight, especially when married. Muslim individuals are less likely to be smokers or heavy drinkers, but have a higher blood pressure. Everything else being constant, individuals living in formal neighborhoods are more often overweight. The data presented make clear the pressing need to develop effective programs to reduce NCD risk across all types of neighborhoods in African cities, and suggest several entry points for community-based prevention programs.

An International Perspective on Improving the Quality and Potential of Behavioral Clinical Trials

Healthy behaviors (e.g., eating a healthy diet, engaging in regular physical activity, smoking cessation) are associated with a reduction in the incidence and mortality of chronic non-communicable diseases (NCDs), including cardiovascular disease. There have been many examples of health behavior interventions leading to improvements in NCDs and their risk factors, such as hypertension. However, despite their potential benefits, the uptake of existing behavioral interventions has been limited. Among many barriers to implementation of behavioral treatments are concerns about methodological inadequacies. The current manuscript discusses recent advances in frameworks for the development of interventions, the reporting of trials and their protocols, and areas which need further work. The goal of this article is to increase awareness and encourage further debate about how best to promote high-quality behavioral intervention research.

Adult non-communicable disease mortality in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System sites

Background Mortality from non-communicable diseases (NCDs) is a major global issue, as other categories of mortality have diminished and life expectancy has increased. The World Health Organization's Member States have called for a 25% reduction in premature NCD mortality by 2025, which can only be achieved by substantial reductions in risk factors and improvements in the management of chronic conditions. A high burden of NCD mortality among much older people, who have survived other hazards, is inevitable. The INDEPTH Network collects detailed individual data within defined Health and Demographic Surveillance sites. By registering deaths and carrying out verbal autopsies to determine cause of death across many such sites, using standardised methods, the Network seeks to generate population-based mortality statistics that are not otherwise available. Objective To describe patterns of adult NCD mortality from INDEPTH Network sites across Africa and Asia, according to the WHO 2012 verbal autopsy (VA) cause categories, with separate consideration of premature (15–64 years) and older (65+ years) NCD mortality. Design All adult deaths at INDEPTH sites are routinely registered and followed up with VA interviews. For this study, VA archives were transformed into the WHO 2012 VA standard format and processed using the InterVA-4 model to assign cause of death. Routine surveillance data also provide person-time denominators for mortality rates. Results A total of 80,726 adult (over 15 years) deaths were documented over 7,423,497 person-years of observation. NCDs were attributed as the cause for 35.6% of these deaths. Slightly less than half of adult NCD deaths occurred in the 15–64 age group. Detailed results are presented by age and sex for leading causes of NCD mortality. Per-site rates of NCD mortality were significantly correlated with rates of HIV/AIDS-related mortality. Conclusions These findings present important evidence on the distribution of NCD mortality across a wide range of African and Asian settings. This comes against a background of global concern about the burden of NCD mortality, especially among adults aged under 70, and provides an important baseline for future work.

Trends in non-communicable disease mortality among adult residents in Nairobi's slums, 2003–2011: applying InterVA-4 to verbal autopsy data

Background About 80% of deaths from non-communicable diseases (NCDs) occur in developing countries such as Kenya. However, not much is known about the burden of NCDs in slums, which account for about 60% of the residences of the urban population in Kenya. This study examines trends in NCD mortality from two slum settings in Nairobi. Design We use verbal autopsy data on 1954 deaths among adults aged 35 years and older who were registered in the Nairobi Urban Health and Demographic Surveillance System between 2003 and 2011. InterVA-4, a computer-based program, was used to assign causes of death for each case. Results are presented as annualized cause-specific mortality rates (CSMRs) and cause-specific mortality fractions (CSMFs) by sex. Results The CSMRs for NCDs did not appear to change significantly over time for both males and females. Among males, cardiovascular diseases (CVDs) and neoplasms were the leading NCDs – contributing CSMFs of 8 and 5%, respectively, on average over time. Among females, CVDs contributed a CSMF of 14% on average over time, while neoplasms contributed 8%. Communicable diseases and related conditions remained the leading causes of death, contributing a CSMF of over 50% on average in males and females over time. Conclusions Our findings are consistent with the Global Burden of Disease 2010 study which shows that communicable diseases remain the dominant cause of death in Africa, although NCDs were still significant contributors to mortality. We recommend an integrated approach towards disease prevention that focuses on health systems strengthening in resource-limited settings such as slums.

Trends in Mortality for Non-Communicable Diseases in Mexican Border Municipalities

Trends in Mortality for Non-Communicable Diseases in Mexican Border MunicipalitiesAbstract Number:2827 Gabriel Anaya, Wael Al-Delaimy*, and Melissa Floca Gabriel Anaya University of California San Diego, United States, E-mail Address: [email protected] Search for more papers by this author , Wael Al-Delaimy* University of California San Diego, United States, E-mail Address: [email protected] Search for more papers by this author , and Melissa Floca University of California San Diego, United States, E-mail Address: [email protected] Search for more papers by this author AbstractIn recent decades, Mexico’s public health system has undergone important transformations. Simultaneously, the northern border area with the United States has seen significant expansion of urban areas. There is limited data on how such changes have impacted health at the municipal and state level in the border area, especially with regards to Non-Communicable Diseases. To increase our understanding of trends in Non-Communicable Diseases in the 37 municipalities and 6 Mexican States that touch the US border, we use a dataset of almost six million death certificates in Mexico spanning the time period from 1998 to 2011 and apply the WHO Global Burden of Disease (GBD) methodology to recode and reclassify cause of death based on ICD-10 codes. Standardized Mortality Rates (SMR) were age-adjusted to the population of Mexico. Municipalities where sub-grouped based on population size into: Urban (large) and Rural (small) municipalities. We used STATA v.12 and SPSS v.21 to manage and analyze the datasets and ArcGis to define the border and non-border municipalities. We found that that Non-Communicable Diseases are consistently the major causes of death across all municipalities, and several folds higher than common infectious diseases. Ischemic heart disease is the major cause of death in both rural and urban border areas but rural areas experienced much higher increase between 1999 (137.1/10-5) and 2011 (174.1/10-5) than urban SMR that was similar to rural SMR in 1999 but did not increase substantially. This trend was similarly observed in rural areas for cancer (66.6-100.2/10-5), diabetes (73.6-112.9/10-5), and chronic respiratory illnesses (33.6-45.1/10-5). Our data indicate a shift of the burden of diseases in northern Mexico to Non-Communicable Diseases, and there is a much higher increase in rural areas compared to larger urban cities. Addressing such shifts for the border area and the causes behind it will impact the overall health of the Mexican population.

Information–processing methods for mortality surveillance in the presence of varying levels of completeness and ill–defined codes of causes of death – the case of Brazil

The World Health Organization has developed proposals on how efforts to reduce non–communicable diseases (NCD) in low– and middle–income countries may be monitored over time. One of the proposed indicators is the unconditional probability of death between the ages of 30 and 70 from any of the four main groups of non–communicable diseases – cardiovascular disease, cancer, chronic respiratory disease, and diabetes. Our objective is to describe Information–processing methods developed to facilitate this monitoring of mortality over time for Brazil. We developed an IPython Notebook which incorporates mortality records, population sizes, estimates of sub notification, redistribution of ill–defined causes of death, international disease codes, and world standard population weights for five–year age group, gender, state, and year strata. The approach permits flexibility in the incorporation of different estimates of sub–notification and ill–defined causes of death. The main output is a “Basic Sheet”, where each line provides corrected deaths by disease categories and denominators for a given stratum. This sheet is then used to generate desired statistics. This collection of shareable computer code and data organizes the approach necessary for calculations, making the data available to interested parties for the remaining relatively simple calculations. The mortality statistic suggested by the World Health Organization is derived from this sheet. The approach developed is an additional step toward rapid and accurate reporting of Brazilian NCD mortality data. The code is available and may be adapted by others facing similar tasks.