Non-communicable Diseases Deaths Research Articles

Diagnosis and Treatment of Hypertension Among People Aged 45 Years and Over in India: A Sub-national Analysis of the Variation in Performance of Indian States.

Introduction: Cardiovascular disease (CVD) is the single largest contributor to non-communicable disease (NCD) deaths, with hypertension contributing to a significant proportion of these deaths. This study aims to provide estimates of the prevalence, awareness, treatment and control of hypertension at sub-national levels in India and identifies well and under-performing states with respect to the diagnosis and treatment of hypertension.Methods: The study utilises data from the Longitudinal Study of Ageing in India (LASI), a nationally representative survey of more than 72,000 individuals. Age-sex adjusted prevalence rates of self-reported hypertension was calculated using the direct standardisation method. Multivariable logistic regression was performed to assess the association of self-reported hypertension with the various individual co-morbidity, lifestyle, and household factors. Self-reported prevalence was compared with an objective measure of hypertension for each state, and funnel plots were constructed to assess the performance of states.Results: Our findings suggest that the overall prevalence of age-sex adjusted self-reported hypertension was 25.8% in India with significant variation among states. Results based on logistic regression confirm that those individuals who are elderly, obese, belong to a higher socio-economic group and have associated co-morbidities are at increased odds of reporting hypertension. Overall, 4 out of 10 adults over 45 years of age in India are not aware of their hypertensive condition, and of those who are aware, 73% are currently taking medication, and only 10% of these have their hypertension under control. Based on the performance, states were classified into high and low performing categories. States with an increased proportion of population below the poverty line had significantly lower performance with respect to the diagnosis of hypertension, whereas states with higher literacy rates and greater availability of specialist doctors at community health centres (CHCs) had significantly better performance with respect to treatment-seeking behaviour.Conclusion: The findings of this study and its policy implications are discussed. Based on state performance, strategies are proposed in terms selective targeting vs. population-based strategies. High impact states and sub-groups are identified where intense efforts are needed to tackle the growing menace of hypertension in India.

The behavioral risk factors of non-communicable diseases in the Russian Federation

Abstract Background Behavioral risk factors are one of the significant problems in Public health around the world. The authors of the current research are involved in The Global Burden of Diseases, Injuries, and Risk Factors Study, which provides a graded and complete estimation of risk factor exposure, relative risk, and attributable burden. Methods Relative risks we assessed as a function of exposure based on issued systematic reviews for the GBD 2019 study and meta-regression. The exposure levels for each year, age, gender, location included in the survey we calculated based on all available data sources using Gaussian Spatio-temporal regression, DisMod-MR 2.1, Bayesian meta-regression method. Results Behavioral risk factors determine a loss of 42.2% DALYs (56% in males and 28.5% in females) from all non-communicable diseases (NCD) in the Russian Federation. It causes 49% of all NCD-related deaths (62% in males and 37% in females). The main burden came from cardiovascular diseases (CVD). Behavioral risk factors affect 60% of DALYs (71.5% in males and 47.6% in females) burden and determine 54% of all NCD deaths (67% in males and 44.5% in females). In second place are neoplasms determined by behavioral risk factors on 39% of DALYs (51.6% in males and 23.6% in females) and 38% of deaths (53% in males and 22% in females). Conclusions Behavioral risk factors are one of Russia's most critical public health challenges; they affect about half of the loss of health of the population from non-communicable diseases. The appropriate policies for preventing non-communicable diseases that include consideration of behavioral risk factors, it is possible to achieve excellent results in preventing premature mortality and loss of public health. We have a great potential to reduce health losses from NCD in Russia. Key messages The behavioral risk factors determine almost half of all NCD-related deaths in the Russian Federation. Males in Russia are more susceptible to behavioral risk factors than females.

The impact of the COVID-19 pandemic on paediatric glioma patients in low, middle, and high-income countries: a multicentre, international, observational cohort study

AimsPaediatric cancer is a leading cause of non-communicable disease deaths for children worldwide, with more than 90% of deaths occurring in low-and-middle-income countries (LMICs). The COVID-19 pandemic may have exacerbated disparities in paediatric cancer outcomes between LMICs and HICs. The World Health Organization (WHO) Global Initiative for Childhood Cancer has identified gliomas as a common cancer that can act as a benchmark for assessing global paediatric cancer care. This study aims to ascertain the short and medium-term outcome across 17 countries during the COVID-19 pandemic by determining 30- and 90-day all-cause mortality rates for paediatric glioma patients who underwent treatment.MethodA multicentre, international, mixed- (retrospective and prospective), collaborative cohort study in 17 countries. Patients were recruited between March 12th 2020 and July 12th 2020.Results129 patients were recruited with the majority being histologically diagnosed as low-grade gliomas (n = 86/118, 72.9%). Seven children had a change to their planned chemotherapy treatment because of the COVID-19 pandemic. Similarly, seven children and eleven children had a change to their planned radiotherapy treatment and surgical treatment respectively because of the COVID-19 pandemic. Five patients died within the 30-day follow-up period, with all five patients being in LMICs. A sixth child, also in a LMIC, died within the 90-day follow-up period. This significant difference in mortality between LMICs and HICs was present when controlling for confounding for factors such as grade, ASA status, sex, weight, and age. ConclusionThere has been relatively minimal change to the treatment of paediatric gliomas worldwide compared to their initial planned care. There was a significant difference in mortality for childhood gliomas between LMICS and high-income countries during the COVID-19 pandemic. There needs to be a concerted effort to improve equity in health outcomes globally.

Global and Regional Patterns in Noncommunicable Diseases and Dietary Factors across National Income Levels.

Background: Noncommunicable diseases (NCDs) are the leading global cause of death and share common risk factors. Little quantitative data are available on the patterns of each NCDs death and dietary factors by national income level and region. We aimed to identify the trend of NCDs deaths and dietary factors with other health-related behaviors across national income levels and geographical regions. Methods: Three databases were collected, including the World Health Organization, Food and Agriculture Organization, and World Bank in 2014. These were analyzed to describe the trend for NCDs deaths and dietary factors with health-related behaviors across national income levels (high income, upper-middle income, lower-middle income, and low income) from 151 countries using variance-weighted least-squares linear regression. Results: Lower-middle-income and low-income countries in Africa and Asia had higher death rates of NCDs. More than 30% of the population had raised blood pressure with higher carbohydrate intake and lower protein and fat intake compared to high-income European countries in 2014. High-income countries had the highest prevalence of raised total cholesterol, overweight, and obesity, the highest total energy, fat, and protein intake, and the highest supplies of animal fat, stimulants, sugar and sweetener, vegetable oil, and milk, as well as insufficient activity with an increasing trend (p for trend < 0.001). Conclusion: There were differences in NCDs risk factors and dietary factors by national income and region. Accordingly, measures should be taken to suit the situation in each country. Our findings have significance for health workers and health policies preventing and controlling the rise of NCDs.

Non-communicable diseases deaths attributable to high body mass index in Chile

We estimated the proportion and number of deaths from non-communicable diseases (NCD) attributable to high body mass index (BMI) in Chile in 2018. We used data from 5927 adults from a 2016–2017 Chilean National Health Survey to describe the distribution of BMI. We obtained the number of deaths from NCD from the Ministry of Health. Relative risks (RR) and 95% confidence intervals per 5 units higher BMI for cardiovascular disease, cancer, and respiratory disease were retrieved from the Global BMI Mortality Collaboration meta-analyses. The prevalences of overweight and obesity were 38.9% and 39.1%, respectively. We estimated that reducing population-wide BMI to a theoretical minimum risk exposure level (mean BMI: 22.0 kg/m2; standard deviation: 1) could prevent approximately 21,977 deaths per year (95%CI 13,981–29,928). These deaths represented about 31.6% of major NCD deaths (20.1–43.1) and 20.4% of all deaths (12.9–27.7) that occurred in 2018. Most of these preventable deaths were from cardiovascular diseases (11,474 deaths; 95% CI 7302–15,621), followed by cancer (5597 deaths; 95% CI 3560–7622) and respiratory disease (4906 deaths; 95% CI 3119–6684). A substantial burden of NCD deaths was attributable to high BMI in Chile. Policies and population-wide interventions are needed to reduce the burden of NCD due to high BMI in Chile.

Prevalence of Hypertension and its Various Determinants among the Factory Workers in City of Rajasthan, India

Introduction: In modern world Non-communicable diseases (NCDs) is the major killer causes almost 44million deaths each year, equivalent to 72% of all deaths globally. Cardio-vascular diseases account formost NCD deaths or 17.81 million people annually. Factory workers has been exposed to the most stressfuloccupations in the world, so these workers are more susceptible to coronary heart disease. Materials andMethods: A cross-sectional study was carried out during Jan 2021– March 2021 among 456 Factory workersposted in Udaipur city of Rajasthan selected randomly. The investigator made two measurements of bloodpressure. Data were collected using predesigned, pretested, semi-structured interview schedule, and analyzedusing the Statistical Package for the Social Sciences version 20.0. Results: Among 456 participants, 142(31.1%) participants were found to be hypertensive. Age of study participants, duration of service, rank, andeducation are significantly associated with the prevalence of hypertension (HTN) among Factory workers.Conclusion: HTN in Factory workers has emerged as an important public health problem. Knowledge ofimportant risk factors for HTN may give tracks for better prevention in this population. Therefore, it is veryimportant to make screening strategy to diagnose HTN among Factory workers and devise a comprehensivestrategy for the management of HTN.

Risk Factors of Non-communicable Diseases and its Effective Surveillance with STEPwise Approach

Non-communicable diseases (NCDs) are responsible for almost 70% of all deaths worldwide. Almost 75% of all NCD deaths, and 82% of the 16 million people that died prematurely, or before reaching 70 years aged, occur in low and middle-income countries. The epidemic of NCDs including heart condition, stroke, cancer, diabetes, and chronic lung disease poses devastating health consequences for people, and threatens to overburden the health systems. In finances starved countries, the costs associated with NCDs make the management of these diseases a major development concern for the 21st century.[1]

Health impacts of changes in travel patterns in Greater Accra Metropolitan Area, Ghana

BackgroundHealth impact assessments of alternative travel patterns are urgently needed to inform transport and urban planning in African cities, but none exists so far. ObjectiveTo quantify the health impacts of changes in travel patterns in the Greater Accra Metropolitan Area, Ghana. MethodsWe estimated changes to population exposures to physical activity, air pollution, and road traffic fatality risk and consequent health burden (deaths and years of life lost prematurely – YLL) in response to changes in transportation patterns. Five scenarios were defined in collaboration with international and local partners and stakeholders to reflect potential local policy actions. ResultsSwapping bus and walking trips for car trips can lead to more than 400 extra deaths and 20,500 YLL per year than travel patterns observed in 2009. If part of the rise in motorisation is from motorcycles, we estimated an additional nearly 370 deaths and over 18,500 YLL per year. Mitigating the rise in motorisation by swapping long trips by car or taxi to bus trips is the most beneficial for health, averting more than 600 premature deaths and over 31,500 YLL per year. Without significant improvements in road safety, reduction of short motorised trips in favour of cycling and walking had no significant net health benefits as non-communicable diseases deaths and YLL benefits were offset by increases in road traffic deaths. In all scenarios, road traffic fatalities were the largest contributor to changes in deaths and YLL. ConclusionsRising motorisation, particularly from motorcycles, can cause significant increase in health burden in the Greater Accra Metropolitan Area. Mitigating rising motorisation by improving public transport would benefit population health. Tackling road injury risk to ensure safe walking and cycling is a top priority. In the short term, this will save lives from injury. Longer term it will help halt the likely fall in physical activity.

Impact of the COVID-19 pandemic on paediatric patients with cancer in low-income, middle-income and high-income countries: protocol for a multicentre, international, observational cohort study

IntroductionChildhood cancers are a leading cause of non-communicable disease deaths for children around the world. The COVID-19 pandemic may have impacted on global children’s cancer services, which can have consequences...

Advancing tobacco control research in Ghana: findings from a meeting with key stakeholders

Prevalence of non-communicable diseases (NCDs) is growing globally, with the greatest increase in NCD deaths expected to occur in sub-Saharan Africa (SSA) over the next five to 15 years. Tobacco use is implicated in all leading NCDs, and is one of the biggest global public health threats. Despite the projected increase in tobacco-related NCD deaths in low- and Middle-income countries (LMICs), research on tobacco control policy and implementation in SSA and more specifically, Ghana, is a low priority. To address these challenges, the School of Public Health (KNUST, Ghana) with support from the Tobacco Control Capacity Program (TCCP) funded by the Global Challenges Research Fund (GCRF) organized a 1-day stakeholder’s meeting to discuss the advancement of tobacco control research in Ghana. The aim was to propose the way forward for strengthening applied research that can inform the development of health policies and programs focused on tobacco control. Participants were drawn from academia, research and health institutions, civil society and non-governmental organisations. In this meeting overview, we present the key themes that emerged from the meeting and some strategies for advancing tobacco control research in Ghana and beyond. Directions for future research agenda include building institutional research capacity, strengthening stakeholder and public engagement on tobacco control, need for more local and comprehensive data and research, improve sustainable funding of comprehensive programs on tobacco control in Ghana and social and behavior change communication on tobacco use.

Understanding cardiovascular disease in day-to-day living for African people: a qualitative metasynthesis

BackgroundGlobally, cardiovascular disease (CVD) accounts for 45% of all chronic non-communicable disease deaths and 31% of all deaths. CVD has remained the primary cause of death in the world for the past fifteen years. Compared to other continents, CVD and its risk factors are highly prevalent in Africa, but the continent also displays a low-level of knowledge and awareness of CVD, and poor perception of its risk factors. Little research has been done on the connection between the daily lived experiences of African people and the high prevalence and poor perception of CVD and its risk factors on the African continent. The aim of this study is to provide an in-depth understanding of the daily, lived experiences of African people and the connections between these experiences and the prevention, control, and management of CVD and its risk factors.MethodsA systematic search was performed in PubMed, CINAHL, EMBASE, Psych INFO, and Web of Science databases to identify published English qualitative studies of CVD and its risk factors. Qualitative metasynthesis included structured techniques of data immersion and quality appraisal, thematic synthesis, and reciprocal translation.ResultsSeven studies met the inclusion criteria. Four major themes were identified from the metasynthesis: 1) understanding and beliefs about CVD; 2) perceived causes/risk factors for CVD; 3) understanding and belief about obesity; 4) perceived treatment options for CVD. The metasynthesis identified a consistent disconnect among African people between seeing CVD as a deadly and chronic disease and their perceptions of the minimal signs and symptoms of the disease in the early stages. This was further compounded by the gap between traditional healers and health care professionals.ConclusionsPerceptions of CVD, its risk factors, and treatments were influenced by religious and cultural factors. Given the minimal signs and symptoms experienced in the early stages of the disease, there was a consistent disconnect among African people between seeing CVD as a deadly and chronic illness. Further investigations of the religious and cultural influences and educational programs related to these areas of disconnect are needed to improve the knowledge, attitudes, and beliefs of African people.

P9 A study to investigate the impact of the COVID-19 pandemic on paediatric cancer patients: an international, multicentre, observational cohort study (COVIDPaedsCancer)

IntroductionChildhood cancers are a leading cause of non-communicable disease deaths for paediatric patients around the world. The COVID-19 pandemic may have impacted on global children’s cancer services, which can have consequences for childhood cancer outcomes. The Global Health Research Group on Children’s Non-Communicable Diseases (Global Children’s NCDs) is currently undertaking the first international study to determine the variation in paediatric cancer management during the COVID-19 pandemic, and the short to medium term impacts on childhood cancer outcomes.Methods and analysisThis is a multicentre, international, cohort study that will use routinely collected hospital data in a de-identified and anonymised form. Patients will be recruited consecutively into the study, with a 12 -month follow-up period. Patients will be included if they are below the age of 18 years and undergoing anti-cancer treatment for the following cancers: Acute lymphoblastic leukaemia, Burkitt’s Lymphoma, Hodgkin's lymphoma, Wilms Tumour, Sarcoma, Retinoblastoma, Gliomas, Medulloblastomas and Neuroblastomas. Patients must be newly presented or be undergoing active anti-cancer treatment from the 12th March 2020 to the 12th December 2020. The primary objective of the study is to determine 30- and 90-day all-cause mortality rates. This study will examine the factors that influenced these outcomes. Chi-squared analysis will be used to compare mortality between low and middle-income countries and high-income countries. Multilevel, multivariate logistic regression analysis will be undertaken to identify patient-level and hospital-level factors affecting outcomes with adjustment for confounding factors.Ethics and disseminationAt the host centre, this study was deemed to be exempt from ethical committee approval due to the use of anonymised registry data. At other centres, participating collaborators have gained local approvals in accordance with their institutional ethical regulations. Collaborators will be encouraged to present the results locally, nationally, and internationally. The results will be submitted for publication in a peer reviewed journal.

Use of mHealth technology for modification of behavioural risk factors of noncommunicable diseases in primary health care settings

Noncommunicable diseases (NCDs) kill 41 million people each year, of which more than three-quarters occur in low- and middle-income countries. Four groups of diseases, namely cardiovascular diseases, cancers, respiratory diseases, and diabetes, account for over 80% of all premature NCD deaths, and four common modifiable behaviors, namely tobacco use, physical inactivity, unhealthy diet, and the harmful use of alcohol, increase the risk of NCDs. The use of mHealth interventions for Behavior Change Communication has been shown to be effective in modifying the behavioral risk factors, through various studies. The present study proposes to conduct a systematic review and meta-analysis to assess the effectiveness and feasibility of the use of mHealth in improving diet and increasing physical activity, which are two of the major behavioral risk factors of NCDs. Research reported on this, from countries in the South-East Asian Region, during the past 20 years, will be included in this review.

An assessment of non-communicable disease mortality among adults in Eastern Uganda, 2010-2016.

There is a dearth of studies assessing non-communicable disease (NCD) mortality within population-based settings in Uganda. We assessed mortality due to major NCDs among persons ≥ 30 years in Eastern Uganda from 2010 to 2016. The study was carried out at the Iganga-Mayuge health and demographic surveillance site in the Iganga and Mayuge districts of Eastern Uganda. Information on cause of death was obtained through verbal autopsies using a structured questionnaire to conduct face-face interviews with carers or close relatives of the deceased. Physicians assigned likely cause of death using ICD-10 codes. Age-adjusted mortality rates were calculated using direct method, with the average population across the seven years of the study (2010 to 2016) as the standard. Age categories of 30-40, 41-50, 51-60, 61-70, and ≥ 71 years were used for standardization. A total of 1,210 deaths among persons ≥ 30 years old were reported from 2010 to 2016 (50.7% among women). Approximately 53% of all deaths were due to non-communicable diseases, 31.8% due to communicable diseases, 8.2% due to injuries, and 7% due to maternal-related deaths or undetermined causes. Cardiovascular diseases accounted for the largest proportion of NCD deaths in each year, and women had substantially higher cardiovascular disease mortality rates compared to men. Conversely, women had lower diabetes mortality rates than men for five of the seven years examined. Non-communicable diseases are major causes of death among adults in Iganga and Mayuge; and cardiovascular diseases and diabetes are leading causes of NCD deaths. Efforts are needed to tackle NCD risk factors and provide NCD care to reduce associated burden and premature mortality.

Temporal trend of probability of premature death caused by four major non-communicable diseases in Anhui province, 2014 to 2018, and the potential of achieving healthy goals

Objective: To investigate the current status and temporal trend of probability of premature death, caused by four major non-communicable diseases (NCDs) in Anhui province, from 2014 to 2018, and to explore the possibility of achieving the goal of "Healthy China 2030". Methods: Data of death were collected from the "Information System for Death Cause Register and Management". The mortality, standardized mortality, premature mortality rate and annual percentage change (APC) were calculated. Based on the reduction target of "Healthy China 2030"(-30%) and "Healthy Anhui 2030"(-25%) for premature death probability of four major NCDs, the possibility of achieving the target was evaluated. Results: From 2014 to 2018, the proportion of four major NCDs deaths to total deaths increased from 82.76% to 84.77%, showing an upward trend(APC=0.50%). The standardized mortality rate of four major NCDs in the population aged 30-69 years was decreasing annually (APC=-1.78%). The premature death probability of four major NCDs decreased from 15.53% to 14.43% with a downward trend. The decline rate of men (APC=-1.80%) was slightly lower than that of women (APC=-2.00%). The decline rate of urban (APC=-1.57%) and rural (APC=-1.99%), Northern Anhui (APC=-2.32%) and Central Anhui (APC=-1.81%) areas were all showed a downward trend. The premature death probability in the same year was higher in men, rural areas and northern Anhui areas. The decrease of chronic respiratory diseases was the greatest (APC=-9.19%), followed by cancer (APC=-1.77%), but increased in diabetes for men (APC=-2.90%). According to the average growth rate of premature death probability from 2014 to 2018, it was predicted that the goal of healthy Anhui would be achieved by 2030. However, to achieve the goal of healthy China, the rate of decline needs to be increased by 26.40% on the existing basis. Comparing to the proportion, the descent speed needs to be increased between different genders, urban and rural areas and regions. Conclusions: The premature death probability of four major NCDs in Anhui province has a continuous downward trend. Men, rural residents and residents in northern Anhui province are the key population. We should carry out intervention against the main risk factors of NCDs, reduce the premature mortality rate of NCDs, and strive to achieve the goal of "Healthy China 2030".

Abstract PS7-09: Achievability of 2030 sustainable development goals in breast cancer control

Abstract Background The United Nations Sustainable Development Goals (SDGs) target a one-third reduction in non-communicable disease (NCD) mortality between the years 2015 and 2030. Cancer accounts for 22% of NCD deaths, and breast cancer is the leading global cause of female cancer mortality, despite its high survivability. Therefore, reducing female breast cancer mortality is critical to any nation’s achievement of this goal. However, sex-based disparities in healthcare are evident in lower-resource settings, and lack of infrastructure for breast cancer control leads to greater underdiagnosis in low- and lower middle-income countries (LICs &amp; LMICs). Mortality may be a biased indicator due to the impact of differing incidence rates. Therefore, the mortality-to-incidence ratio (MIR) was examined as a practical indicator of breast cancer control. We projected mortality and MIR for women with breast cancer in 195 countries to quantify progress in breast cancer control and assess the feasibility of achieving the 2030 NCD mortality target of the SDGs. Methods We used data on incidence and mortality rates for female breast cancer reported by The Global Burden of Disease Study 2017 for the years between 2000-2017. For each country, we projected mortality rate and MIR for female breast cancer by national income level from 2018-2030 using generalized linear mixed-effects models. We stratified our results by country’s Gross National Income per Capita (GNI/capita) and income group as defined by the World Bank. Findings Between 2017 and 2030, global breast cancer mortality is projected to increase by 12.4% from 19.02 (95% confidence interval [CI]: 17.36-20.64) to 21.38 ( 95% prediction interval [PI]: 19.03-23.93), while MIR is projected to decrease by 10.3% from 0.404 (95% CI: 0.385-0.425) to 0.362 (95% PI: 0.342-0.383). In 2017, MIR was 2.22 times higher in low-income countries (LICs) and 1.71 times higher in lower-middle income countries (LMICs) than in high income countries (HICs). Although MIR is projected to decrease between 2017 and 2030 across all income groups (15.9% in HICs, 10.61% in UMICs, 3.66% in LMICs, 10.2% in LICs), 2030 MIR is projected to be 2.37 times higher in LICs and 1.96 times higher in LMICs when compared to HICs. Interpretation Use of mortality to measure progress towards SDGs can be misleading in the context of breast cancer control. Simultaneously increasing mortality and incidence may still imply improvement, if mortality is increasing at a slower rate than incidence. Therefore, MIR is a better indicator of progress in breast cancer control. The decreasing global breast cancer MIR from 2015 to 2030, despite increasing mortality, indicates that global progress is being made in breast cancer. Despite globally decreasing MIR, the disparity between HICs and LICs may increase between now and 2030 in the absence of significant resource-stratified policy reform. Citation Format: Gizem Sultan Nemutlu, Ethan Thayumanavan, Barri Blauvelt, Jagpreet Chhatwal. Achievability of 2030 sustainable development goals in breast cancer control [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-09.

Mortality Among Young Adults Born Preterm and Early Term in 4 Nordic Nations

Adverse long-term outcomes in individuals born before full gestation are not confined to individuals born at extreme gestational ages. Little is known regarding mortality patterns among individuals born in the weeks close to ideal gestation, and the exact causes are not well understood; both of these are crucial for public health, with the potential for modification of risk. To examine the risk of all-cause and noncommunicable diseases (NCD) deaths among young adults born preterm and early term. This multinational population-based cohort study used nationwide birth cohorts from Norway, Sweden, Denmark, and Finland for individuals born between 1967 and 2002. Individuals identified at birth who had not died or emigrated were followed up for mortality from age 15 years to 2017. Analyses were performed from June 2019 to May 2020. Categories of gestational age (ie, moderate preterm birth and earlier [23-33 weeks], late preterm [34-36 weeks], early term [37-38 weeks], full term [39-41 weeks] and post term [42-44 weeks]). All-cause mortality and cause-specific mortality from NCD, defined as cancer, diabetes, chronic lung disease, and cardiovascular disease (CVD). A total of 6 263 286 individuals were followed up for mortality from age 15 years. Overall, 339 403 (5.4%) were born preterm, and 3 049 100 (48.7%) were women. Compared with full-term birth, the adjusted hazard ratios (aHRs) for all-cause mortality were 1.44 (95% CI, 1.34-1.55) for moderate preterm birth and earlier; 1.23 (95% CI, 1.18-1.29) for late preterm birth; and 1.12 (95% CI, 1.09-1.15) for early-term birth. The association between gestational age and all-cause mortality were stronger in women than in men (P for interaction = .03). Preterm birth was associated with 2-fold increased risks of death from CVD (aHR, 1.89; 95% CI, 1.45-2.47), diabetes (aHR, 1.98; 95% CI, 1.44-2.73), and chronic lung disease (aHR, 2.28; 95% CI, 1.36-3.82). The main associations were replicated across countries and could not be explained by familial or individual confounding factors. The findings of this study strengthen the evidence of increased risk of death from NCDs in young adults born preterm. Importantly, the increased death risk was found across gestational ages up to the ideal term date and includes the much larger group with early-term birth. Excess mortality associated with shorter gestational age was most pronounced for CVDs, chronic lung disease, and diabetes.

Estimating the impact of achieving Turkey's non-communicable disease policy targets: A macro-simulation modelling study.

SummaryBackgroundThe Burden of non-communicable disease (NCDs) has continued to rise globally, particularly in low- and middle-income countries. In Turkey, NCDs account for 89% of all deaths, with nearly one in five deaths occurring before age 70. This study investigates the number of NCD deaths that could be prevented if Turkey met national and international targets for major modifiable NCD risk factors.MethodsPreventable deaths were estimated using the World Health Organization (WHO) ‘Preventable Risk Integrated ModEl’ (PRIME), by combining: 1) Baseline exposure data for risk factors, referenced from national surveillance and cohort studies; 2) Aetiological associations from published meta-analyses; and 3) Demographic and mortality statistics obtained from the Turkish Statistical Institute (TurkStat). Confidence intervals were estimated using Monte Carlo simulations.FindingsIf Turkey met its NCD risk factor targets for reducing tobacco and salt consumption by 30%, and physical inactivity by 10% in 2017, an estimated 19,859 deaths (95%CI: 12,802 to 26,609) could have been prevented. Approximately two thirds of these preventable deaths were in men, and one in three were in adults below 75 years. A 30% relative reduction in the consumption of alcohol, tobacco, and salt, as well as physical inactivity, would prevent 180 (107 to 259); 4,786 (3,679 to 5,836); 13,112 (5,819 to 19,952); and 7,124 (5,053 to 9,212) deaths, respectively.InterpretationAmong major modifiable NCD risk factors, population-level reductions in salt intake and physical inactivity present the greatest opportunity for reducing NCD mortality in Turkey. These findings can help Turkey prioritise interventions to meet the Sustainable Development Goal target of reducing NCD mortality by one third, by 2030.

PCN174 Achievability of the 2030 United Nations Sustainable Development Goals in Breast Cancer Control

Sustainable Development Goals (SDGs) target a one-third reduction in non-communicable disease (NCD) mortality between 2015-2030. Cancer accounts for 22% of NCD deaths, and breast cancer is the leading cause of female cancer mortality. Therefore, reducing female breast cancer mortality is critical. We projected health outcomes for women with breast cancer in 195 countries to quantify progress towards the 2030 target of the SDGs. We used data on incidence and mortality rates for female breast cancer reported by The Global Burden of Disease Study 2017 between 2000–2017. We projected mortality rate and MIR by national income level, as defined by the World Bank, for 2018-2030 using generalized linear mixed-effects models. Between 2017 and 2030, global breast cancer mortality is projected to increase by 12.4% from 19.02 (95% confidence interval [CI]: 17.36–20.64) to 21.38 (95% prediction interval [PI]: 19.03–23.93), while MIR is projected to decrease by 10.3% from 0.404 (95% CI: 0.385–0.425) to 0.362 (95% PI: 0.342–0.383). In 2017, MIR was 2.22 times higher in low-income countries (LICs) and 1.71 times higher in lower middle-income countries (LMICs) than in high-income countries (HICs). Although MIR is projected to decrease by 2030 across all income groups (15.9% in HICs, 10.61% in upper middle-income countries, 3.66% in LMICs, 10.2% in LICs), 2030 MIR is projected to be 2.37 and 1.96 times higher in LICs and LMICs, respectively, than MIR in HICs. MIR is a better indicator than mortality to measure progress towards SDGs for breast cancer control. The decreasing global breast cancer MIR from 2015 to 2030, despite increasing mortality, indicates that global progress is being made in breast cancer. However, disparities across income levels will remain notable in the absence of significant resource-stratified policy reform.

Non Communicable Diseases: Challenge Ahead

Non-communicable diseases (NCDs) are of long duration and generally of slow progress. The four main groups of NCDs are Cardio-vascular diseases, Cancers, Chronic Respiratory diseases and Diabetes. The NCDs kill 38 million people worldwide annually (63% of global deaths). Almost three quarters of the NCD deaths (28 million) occur in the low and middle income countries. Sixteen million deaths due to NCDs are premature, occurring before the age of 70 years; and 82% of these premature deaths occur in the low and middle income countries. These four groups of diseases account for 82% of all NCD deaths: cardiovascular diseases 17.5 million, cancers 8.2 million, chronic respiratory diseases 4 million and diabetes 1.5 million. In India, 60% of all deaths are attributable to NCDs, making them the leading cause of death- ahead of injuries and communicable, maternal, prenatal, and nutritional conditions. The NCDs account for about 40% of all hospital stays and roughly 35% of all recorded outpatient visits in India. The globalization of unhealthy life styles, which are recognized as the modifiable risk factors, like tobacco use, physical inactivity, harmful use of alcohol and unhealthy diets are the key factors that increase the risk of dying from the NCDs. The unhealthy behaviours lead to four key metabolic/ physiological changes (called the intermediate risk factors of NCDs) i.e. raised blood pressure, overweight/ obesity, raised blood glucose and dyslipidaemia that increase the risk of NCDs. The underlying determinants of NCDs mainly exist in non-health sectors, such as agriculture, urban development, education and trade. In terms of attributable deaths, the leading metabolic risk factor globally is elevated blood pressure (to which 18% of global deaths are attributed), followed by overweight and obesity and raised blood glucose. Tobacco accounts for around 6 million deaths every year and is projected to increase to 8 million by 2030. About 3.2 million deaths annually can be attributed to insufficient physical activity. In 2010, 1.7 million annual deaths from cardio vascular causes have been attributed to excess salt intake. More than 3.3 million annual deaths are attributed to harmful drinking of alcohol.