Premature Mortality Research Articles

Mortality among individuals with substance use disorder—does violent criminal behavior have an impact?

IntroductionUnderstanding violent criminality and its impact on health and eventually the risk of premature mortality is important for efficient future interventions. This study aimed to explore the effect violent criminality had on premature mortality (i.e., death before the age of 65) among individuals with substance use disorders (SUDs).MethodsThe cohort was created by identifying all Swedish patients diagnosed with SUD between the first of January 2013 and 31st of December 2014. The individuals were split into three age categories.ResultsThere were significant differences in standard mortality rates (SMR) in the cohort compared to the general Swedish population across the three age categories. We found differences between the SMRs for individuals convicted of violent and nonviolent crimes in the two younger age categories [age 15–29: violent crime (42.4) vs. non-violent crime (36.6), age 30–44: violent crime (28.0) vs. non-violent crime (23.0)]. A Cox regression analysis showed that each conviction of a violent crime increased the hazard ratio (HR) of premature mortality significantly [age 15–29; HR = 1.10 (95% CI: 1.04–1.17), age 30–44; HR =1.06 (95% CI: 1.03–1.09)]. After correcting for non-violent crimes, the increased risk only remained for the youngest group [HR = 1.06 (95% CI: 1.00–1.13)].DiscussionThis study suggests that criminal behavior constitutes a proxy for the risk behaviors that increase the risk of premature mortality among young individuals with SUD even after controlling for confounders. Longitudinal studies, examining time-dependent risks and protective influences, are needed to explain the different pathways and processes leading to the amplified premature mortality in the groups.

HIV-TB Coinfection: A Systemic Review and Meta-analysis Insights

HIV and Tuberculosis (TB) are the leading global causes of death among patients with infectious diseases. They contribute significantly to morbidity around the world because of their impact on shared immune defense mechanisms. Tuberculosis is an infection that exploits the vulnerability of compromised immune systems. Opportunistic infections are illnesses that are more frequent or severe in individuals with compromised immune systems. HIV weakens the immune system, making people more susceptible to tuberculosis. When someone is infected with both HIV and tuberculosis, this is known as HIV/TB coinfection. HIV and tuberculosis represent the primary infectious disease challenges in countries with limited resources. In affected individuals, the interaction between Mycobacterium tuberculosis and HIV exacerbates the effects of each other, hastening the decline of immune function and leading to premature mortality if left untreated. Individuals with HIV are more likely than those without HIV to develop active tuberculosis as a result of untreated latent tuberculosis. Antiretroviral therapy (ART) is the use of HIV medications to protect the immune system and prevent the progression of HIV to acquired immunodeficiency syndrome (AIDS). In people with HIV and latent tuberculosis, combined treatment with HIV and TB medications reduces the likelihood of latent tuberculosis progressing to active tuberculosis. The purpose of this research is to understand better the pathogenesis and pathways of HIV/TB co-infection, as well as to investigate drug-drug interactions in multi-drug therapies.

No Way Out? Cognitive Rigidity and Depressive Symptoms Associated with Suicidal Thoughts and Behaviors in Autistic Youth.

Research has found increased premature mortality among autistic individuals, with suicide being one of the most common causes of premature death in autistic youth. This study aimed to fill literature gaps related to suicidal thoughts and behaviors (STB) in autistic youth by exploring the clinical predictors of suicidal ideation (SI) and suicidal and/or self-injurious behavior (SSIB) in 404 autistic youth from a clinic database. Consistent with prior literature, STB were elevated in autistic youth compared to general population rates. Self-reported suicidal ideation and behaviors were increased in autistic youth assigned female at birth. Caregivers reported greater SI in older autistic youth as compared to younger youth. Logistic regression analyses showed that elevated depressive symptoms and greater cognitive rigidity significantly increased the likelihood of SI in autistic youth. Results have important implications for understanding factors that increase the risk for suicidal ideation and behaviors in autistic youth and informing the development of responsive interventions.

Cost-effectiveness of the Healthy Options group psychosocial intervention for perinatal women living with HIV and depression in Tanzania

Healthy Options is a psychosocial support group intervention facilitated by community-based health workers (CBHWs) to reduce symptoms of depression in perinatal women living with HIV in Tanzania. The objective of this study was to determine incremental cost-effectiveness of Healthy Options intervention in comparison to enhanced usual care for depression (EUDC) intervention. This study is a cost-effectiveness analysis of Healthy Options intervention. The primary outcome for the Healthy Options intervention was level of depressive symptoms. We estimated disability adjusted life years (DALYs) by considering life years lived with disability and years of life lost due to premature mortality resulting from depression. This study applied ingredients approach to cost all resources used in the intervention. We estimated total cost, unit cost, and incremental cost-effectiveness ratio (ICER) from a health care provider perspective. We used 3-year time horizon, univariate sensitivity analysis, and adjusted costs to 2017 value. Healthy Options intervention demonstrated effectiveness in reducing depressive symptoms among pregnant women with HIV in Tanzania. Total cost of Healthy Options was $319,729. Cost per woman treated was $883. ICER at 6 weeks postpartum is $89,699 per mean decrease in depression score and $310,030 per mean decrease in depression score at 9 months. ICER per DALY averted is $24,754 at 6 months and $4,169 at 9 months. Benefits of Healthy Options are sustained through 9 months postpartum. Healthy Options is nevertheless not cost-effective because ICER is above cost-effectiveness threshold. However, since mental health care is scarce in Tanzania, working with CBHWs is likely to offer effective intervention for maternal depression among women with HIV and it can be a less costly alternative to formal mental health professionals.

"Jumping on the Blood Pressure Bandwagon": Nurse, GP, and Patient Perspectives of a General Practice Nurse-Led Hypertension Management Intervention.

To explore the perceptions and experiences of general practice nurses, general practitioners, and patients who participated in a nurse-led intervention to improve blood pressure control. Given the impact of hypertension on rates of premature death and disability, it is important that interventions be evaluated to reduce blood pressure. A key component of such evaluation is understanding the experiences of participants and clinicians. Understanding these experiences can provide insight into acceptability and feasibility that informs future research and implementation. Qualitative descriptive study within a mixed methods project. Semi-structured interviews were conducted post-intervention with six patients, five nurses, and three general practitioners. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. The COREQ checklist guided reporting. Three themes around the need for change, navigating change, and sustaining change were revealed. In highlighting the need for change, participants recognized that it was time to actively work toward improved blood pressure control. In navigating change, general practice nurses were perceived as ideally placed to communicate risks around uncontrolled blood pressure and support lifestyle change. The final theme, sustaining change revealed the feasibility of the intervention in practice, however, clinician participants identified that appropriate funding is required to ensure sustainability. Nurse-led intervention to improve blood pressure control in general practice is feasible in practice and acceptable to patients. This highlights an opportunity for nurses to play a more proactive role in hypertension management within general practice. To ensure sustainability, however, issues such as funding, teamwork, and collaboration need to be addressed. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12618000169246.

An Honest Reckoning With the Amygdala and Mental Illness.

Anxiety disorders are a leading source of human misery, morbidity, and premature mortality. Existing treatments are far from curative for many, underscoring the need to clarify the underlying neural mechanisms. Although many brain regions contribute, the amygdala has received the most intense scientific attention. Over the past several decades, this scrutiny has yielded a detailed understanding of amygdala function, but it has failed to produce new clinical assays, biomarkers, or cures. Rising to this urgent public health challenge demands an honest reckoning with the functional-neuroanatomical complexity of the amygdala and a shift from theories anchored on "the amygdala" to models centered on specific amygdala nuclei and cell types. This review begins by examining evidence from studies of rodents, monkeys, and humans for the "canonical model," the idea that the amygdala plays a central role in fear- and anxiety-related states, traits, and disorders. Next, the authors selectively highlight work indicating that the canonical model, while true, is overly simplistic and fails to adequately capture the actual state of the evidentiary record, the breadth of amygdala-associated functions and illnesses, or the complexity of the amygdala's functional architecture. The authors describe the implications of these facts for basic and clinical neuroimaging research. The review concludes with some general recommendations for grappling with the complexity of the amygdala and accelerating efforts to understand and more effectively treat amygdala-related psychopathology.

Safety and efficacy of mitapivat in sickle cell disease (RISE UP): results from the phase 2 portion of a global, double-blind, randomised, placebo-controlled trial

Sickle cell disease, a debilitating, inherited haemolytic anaemia with premature morbidity and mortality, affects millions globally. Mitapivat, a first-in-class, oral, allosteric activator of pyruvate kinase, improves red blood cell survival by increasing ATP and diminishes sickling by decreasing 2,3-diphosphoglycerate. We aimed to evaluate the efficacy and safety of mitapivat in patients with sickle cell disease. We report results from the phase 2, 12-week, double-blind period of RISE UP, a global, phase 2/3, double-blind, randomised, placebo-controlled trial. The phase 2 part of the study was conducted at 32 clinical study sites across 13 countries. Patients aged 16 years or older with a confirmed diagnosis of sickle cell disease (any genotype), baseline haemoglobin of 5·5-10·5 g/dL (inclusive), and two to ten sickle cell pain crises within 12 months before providing informed consent, were randomly assigned 1:1:1 to receive oral mitapivat 50 mg, 100 mg, or placebo twice daily, in this portion of the study which is now complete. Randomisation was performed using a permuted-block method and concealed with an interactive response system; patients, investigators, and individuals assessing outcomes were masked to treatment assignment. Primary efficacy and safety endpoints were haemoglobin response (≥1·0 g/dL increase from baseline in average haemoglobin concentration from week 10 through week 12), and type, severity, and relationship to study drug of adverse and serious adverse events. Efficacy and safety endpoints were evaluated in the full analysis set (all randomly assigned patients) and safety analysis set (all patients who received at least one dose of study drug), respectively. This study is registered with ClinicalTrials.gov as part of an ongoing phase 2/3 study (NCT05031780). Between Jan 19, 2022, and April 25, 2023, 79 patients were randomly assigned (51 [65%] female, 28 [35%] male; 46 [58%] Black or African American, 26 [33%] White, five [6%] multiracial, two [3%] Asian); 26 received mitapivat 50 mg, 26 received mitapivat 100 mg, and 27 received placebo, twice daily. Both treatment groups showed a statistically significant haemoglobin response rate versus placebo (12 [46%] of 26 patients in the mitapivat 50 mg group and 13 [50%] of 26 patients in the mitapivat 100 mg group, versus one [4%] of 27 patients in the placebo group; two-sided p=0·0003 and p=0·0001, respectively). Mitapivat was generally well tolerated. Serious adverse events were reported in two (8%) of 26 patients in the mitapivat 50 mg group, four (15%) of 26 patients in the mitapivat 100 mg group, and three (11%) of 27 patients in the placebo group; grade 3 or worse adverse events occurred in three (12%), five (19%), and two (7%) patients, respectively. No serious or grade 3 or worse adverse events were considered treatment related and there were no treatment-related deaths. The most common grade 3 or worse adverse events were infections and infestations, and included one patient in the placebo group with an infected skin ulcer, one patient in the mitapivat 50 mg group with meningitis and one with pelvic inflammatory disease, and one patient each with malaria, pneumonia, and tonsillitis in the mitapivat 100 mg group. Mitapivat, through its dual effect of increasing ATP and decreasing 2,3-diphosphoglycerate, could provide clinical benefit to patients with sickle cell disease. These results support continued evaluation of mitapivat in the phase 3 portion of the study. Agios Pharmaceuticals.

Préhypertension artérielle et hypertension artérielle : analyse comparative des facteurs sociodémographiques et comportementaux dans une population ivoirienne

IntroductionHypertension is one of the preventable causes of premature morbidity and mortality worldwide. The term "prehypertension", defined as systolic blood pressure (BP) between 120 and 139 mmHg and/or diastolic BP between 80 and 89 mmHg, was introduced in 2003 and concerns around 25% to 50% of adults worldwide. The objective of this work was to describe some sociodemographic and behavioral factors associated with prehypertension compared to hypertension in a black population. MethodA cross-sectional survey was conducted in the commune of Anyama, located about 10 km from the city of Abidjan (Côte d'Ivoire). Sociodemographic and behavioral data were collected. Body mass index and abdominal obesity were defined. BP was measured and was categorized into two modalities: prehypertension and hypertension. Data were entered with Epi data® software and analyzed with R studio® software. The existence of associations was determined using Pearson's Chi-square test at the 0.05 significance level. Univariate and multivariate logistic regression was performed. ResultsFive hundred and seven (507) people were recruited with a mean age of 35.9 ± 12.8 years, among whom 266 had prehypertension (52.5%) and 140 had hypertension (27.6%). Age, wealth index, sedentary lifestyle, obesity, and abdominal obesity were associated with blood pressure. Prehypertension was very high in younger subjects compared to older subjects with a gradually decreasing odds ratio as individuals aged (p=0.001). The determinants of prehypertension compared to hypertension were age less than 44 years; absence of sedentary lifestyle; and absence of obesity. ConclusionSome sociodemographic and behavioral factors were favorable for prehypertension compared to hypertension.

Risk of mortality and complications in people with depressive disorder and diabetes mellitus: A 20-year population-based propensity score-matched cohort study

People with depression have increased premature mortality and elevated prevalence of diabetes-mellitus compared to general population. However, risk of mortality and diabetes-related complications among patients with depression and co-occurring diabetes is under-studied. This population-based propensity score-matched (1:10) cohort study identified 12,175 patients with pre-existing depression and incident-diabetes (depression-diabetes group) and 117,958 patients with incident-diabetes only (diabetes-only group) between 2002 and 2021 in Hong-Kong, using territory-wide medical-record database of public-healthcare services, to investigate whether depression increased the risk of overall mortality, complications and post-complication mortality in people with diabetes. Associations of depression with all-cause mortality, complication and post-complication all-cause mortality rates were examined by Cox proportional-hazards model. Complications were assessed by Diabetes-Complications-Severity-Index (DCSI). Associations of complications, in terms of DCSI scores (complication burden), specific types and two-way combinations of complications (complication patterns) with all-cause mortality rate in depression were also examined. Our results showed that depression-diabetes group exhibited increased all-cause mortality risk (adjusted hazards-ratio: 1.06 [95 %CI: 1.02–1.10]) relative to diabetes-only group, particularly among men and older age group, with significantly higher rate of experiencing neuropathy (1.44 [1.27–1.62]) and metabolic complications (1.30 [1.09–1.56]) and lower likelihood of peripheral-vascular complications, retinopathy and nephropathy, albeit comparable macrovascular and microvascular complication rates. The mortality-rate-ratio for patients with depression and diabetes was significantly higher than patients with diabetes-only at a low level of complication burden. In conclusion, depression patients with co-occurring diabetes are at increased risk of excess mortality. Further research is warranted to improve diabetes-related outcomes and reduce mortality gap in this vulnerable population.

Prevalence of non-compliance to prescribed antihypertensive medication among hypertensive middle-aged adults at a tertiary care hospital, Faisalabad, Pakistan: a descriptive cross-sectional study.

ABSTRACT BACKGROUND & OBJECTIVE: Uncontrolled hypertension due to non-compliance with prescribed treatment is one of the main reasons for premature illness and mortality in Pakistan. There is a lack of data on the prevalence of non-compliance with prescribed antihypertensive therapy among hypertensive middle-aged adults in Pakistan. To determine the overall prevalence of non-compliance with prescribed antihypertensive medication among middle-aged hypertensive patients at a tertiary care hospital in Faisalabad, Pakistan. METHODOLOGY: A Descriptive cross-sectional study was conducted over six months from December 2023 to May 2024. All hypertensive patients aged between 40 and 59 years who are conveniently available are included in this study. Data were directly collected from participants by using a structured questionnaire Hill-Bone Medication Adherence Scale. Informed consent was obtained, and participants were briefed on the research topic. The researcher explained the questionnaire in Urdu, which was completed in their presence, ensuring confidentiality to respect participants' ethical rights. RESULTS: A non-compliance score below 25 suggests a low non-compliance rate of 1.56%. Scores between 25-35 indicate moderate non-compliance at 8.31%. Scores of 35-45 show substantial non-compliance with a rate of 62.86%. Severe non-compliance, with scores above 45, results in a high rate of 27.27%. CONCLUSION: The study reveals varying compliance levels among hypertensive patients, highlighting minimal to severe non-compliance, necessitating targeted interventions to reduce non-compliance rates.

Evaluation of the Influence of Quality of Life on Work Performance in the Population with Diabetes Mellitus

To evaluate the influence of quality of life on work performance in Type II Diabetes Mellitus, determining the main factors and dimensions that make up the study variables. This research has a quantitative approach and a correlational scope through an instrument designed to estimate the quality of life and work performance. 387 surveys were obtained as a result of Cronbach’s alpha of 0.88, and the results of the exploratory factor analysis showed an adequacy of KMO of 0.869. For the Bartlett sphericity test, a significant value p < 0.001 was obtained. This confirms that the 8 dimensions indicate that the instrument adequately evaluates the construct in the population studied. Little is known about the influence of quality of life on work performance in diabetes mellitus; in this research, it was found that there is a statistically significant relationship between the variable quality of life and work performance in a population with Type II Diabetes Mellitus, the better the quality of life, the greater the work performance. An interest in employees with diabetes mellitus (DM) should be shown in companies by making the subject’s own well-being part of goal 3, “Health and well-being,” and target 3.4 of reducing premature mortality from this type of disease by one-third, which aims to ensure a healthy life and promote well-being for all at all ages, through prevention and treatment and promoting mental health as one of the company’s sustainable development goals, carry out an annual survey to evaluate the quality of life and work performance and in this way the organization can carry out programs to detect early employees diagnosed and not diagnosed with DM. This research provides data and information that has been little studied on the influence on the variables of quality of life and work performance in Type II Diabetes Mellitus, given that this disease is the second leading cause of death in the country.

Impact of inappropriate empirical antibiotic therapy on in-hospital mortality: a retrospective multicentre cohort study of patients with bloodstream infections in Chile, 2018–2022

IntroductionEmpirical antibiotic therapy is essential for treating bloodstream infections (BSI), yet there is limited evidence from resource-limited settings. We quantified the association of inappropriate empirical antibiotic therapy (IEAT) with in-hospital...

Regional and seasonal drivers of metals and PAHs concentrations in road dust and their health implications in the Czech Republic

While car exhaust emissions in the EU are clearly decreasing, the future of non-exhaust emissions looks more pessimistic. The relative importance of the latter is thus expected to increase in terms of air quality and human health. The aim of the study was to assess regional and seasonal differences in the chemical composition of road dust across the Czech Republic and the health impact of its resuspension, with special respect to polycyclic aromatic hydrocarbons and metals. The road dust samples across all regions and seasons were collected. Based on subsequent laboratory and statistical processing, the spatiotemporal distribution of elements and PAHs was evaluated. Next, the contribution of road dust resuspension to air concentrations was estimated and related health impacts were assessed. A significant regional and seasonal variations in PAHs and metals were discovered. Air quality, leading to atmospheric deposition, was the most important factor contributing to these variations. In contrast, road traffic intensity played only a minor role in influencing the concentrations of metals and PAHs in road dust. Exposure to the PM10 fraction of road dust led to an increase in premature mortality, postneonatal infant mortality, and the prevalence, occurrence, and incidence of bronchitis by several percent. It also significantly raises the annual rate of emergency respiratory hospitalizations and the number of days per year using bronchodilators. Exposure to PAHs and heavy metals in road dust causes cancer incidence on the order of a few cases per 10 million people. Air quality protection measures that lead to a decrease in atmospheric deposition rates are required for the effective reduction of health risks associated with particle resuspension by traffic.

Retrofitting Coal Power Units with Biomass and Coal Cofiring Intensifies Air Pollution and Health Risks.

Retrofitting coal power units with biomass and coal cofiring technology provides a promising pathway toward low-carbon transition. However, such a retrofitting approach may also pose potential environmental and health risks, even aggravating regional disparities. Here, we propose a comprehensive framework to evaluate the associated risks of Biomass and Coal Cofiring Retrofit (BCCR) in China. We find that air pollutants such as SO2, PM2.5, and NOx will increase by an average of 27.9, 38.04, and 42.79% respectively compared to the scenario with no BCCR. The national-wide PM2.5 concentration-related premature mortalities in scenarios with BCCR are projected to increase by 23.53% on average in 2030. Moreover, the Highest-20% of provinces with higher health risks (also health vulnerable groups such as the elderly and children concentrated area) are 19 times greater than that in the Lowest-20% group. Results suggest that implementing a Targeted Pollution Control strategy for areas with higher health risks would be an economical and effective way to reduce the total pollutants emissions and mitigate the regional disparities in health risks. Our research proposes stringent pollution control measures on biomass and coal cofiring retrofit in advance in regions with the utmost necessity to facilitate a fair transition toward clean energy.

Addressing Tobacco Use Disorder in Individuals With Mental Health Disorders: The Critical Role of Nurses.

Individuals with mental health disorders tend to smoke more frequently and intensely than the general population; however, smoking cessation efforts are still often neglected in mental health care. This position paper advocates for creating a more prominent role for mental health nurses in assisting individuals with severe psychiatric disorders to quit smoking. Given their extensive patient contact and holistic care approach, mental health nurses are uniquely positioned to lead smoking cessation initiatives. Consequently, there is an urgent need for increased awareness, mandatory professional training and policy support to empower nurses in this critical role. Strengthening the involvement of mental health nurses in smoking cessation programs could lead to reduced premature mortality and improved overall health for individuals with severe mental illnesses.

Metabolic Syndromeayurvedic View and Management

Metabolic syndrome is multifactorial disease frequently associated with cluster of pathology including obesity hypertriglyceridemia, impaired glucose tolerance and insulin resistance; collectively referred to as the metabolic syndrome. There has been heightened awareness of metabolic syndrome and subsequent increase in the clinical attention directed towards prevention due to its strong association with premature morbidity and mortality. In particular there is predisposed concept that the individual has greater risk for developing type 2 Diabetes and cardiovascular disease. Ayurveda is a science intended from employing the measures of healthy life in which there is no direct reference of metabolic syndrome. Therefore, metabolic syndrome can be included under the broad umbrella of santarpanjanya vikaras. which a can put forward to a better management strategy by assessing the metabolic syndrome on the basis of santarpanjanya vikaras.

The Premature Mortality of Sabinos or Montezuma Bald Cypress (Taxodium mucronatum Ten.) in the State of Durango, Mexico

The juniper (Taxodium mucronatum Ten. of the Cupressaceae family) is a long-lived species that forms gallery forests. Dozens of dead junipers > 100 years old have been identified in the San Pedro Mezquital watershed in Durango, Mexico. This work determines the causes of death of these specimens. The work was carried out in the field and in the laboratory, where in the former the surface of the damaged trees was identified, together with the changes observed in the watercourses. In the latter, sabino seedlings were transported to the work center and exposed for 7 days in containers with gravel to five types of wastewater generated in the region. With the above, the conditions experienced by the adult trees in the field were studied, as well as the sensitivity of the young specimens to the types of water quality, and the differences were validated with ANOVA tests. Five sites with dead junipers were found, ranging in size from 0.5 to 4 ha, with ages between 200 and 400 years. It was found that during the dry season, water is diverted to irrigated areas, leaving some areas without water for several months. The shoots survived in most of the water qualities, except the one with high salinity (3.34 mS/cm). It is concluded that the lack of water in the rivers had a stronger influence than the water quality and is the probable cause of the death of the sabino.

Risk and Determinants of Non-communicable Diseases Among Adolescents in Public and Private Secondary Schools in Port Harcourt, Rivers State, Nigeria

<i>Background</i>: Non-communicable diseases (NCDs) are the leading causes of poor health and premature mortality worldwide. Although NCDs are majorly prevalent in middle to late adulthood, most lifestyle habits are started during adolescence a significant period of development. This research evaluated the risk and determinants of non-communicable diseases among adolescents in public and private secondary schools in Port Harcourt, Rivers State. <i>Methods</i>: The study used a comparative cross-sectional design to collect research data from 640 adolescents. Participants were selected through a multi-stage sampling technique and data was analysed with IBM Statistical Product for the Service Solution version 29. <i>Results</i>: Private and public school respondents report on NCDs (asthma, diabetes and high blood pressure) was 3.4% and 2.5% respectively. NCDs behavioural and metabolic risk factors were prevalent among both private and public school adolescents. Private school students exhibited higher prevalence of physical activity (75% vs. 61.6%), soft drink consumption (96.3% vs. 92.5%), alcohol consumption (45.6% vs. 36.9%), overweight (17.3% vs. 7.5%), obesity (5.9% vs. 1.6%), prehypertension (12.8% vs. 5%) and hypertension (6.6% vs. 1.6%). Conversely, public school students had higher prevalence of daily fruit intake (19.4% vs. 8.8%) and tobacco use (7.5% vs. 2.2%). Socioeconomic status, behavioural risk factors and metabolic risk factors were statistically significant (p<0.05). <i>Conclusion</i>: This study identified NCDs risk factors among adolescents that can lead to development of NCDs in adulthood, hence there is need for preventive measures that are targeted and data-driven to ensure adolescents adopt healthy lifestyles.

Constructing causal pathways for premature cardiovascular disease mortality using directed acyclic graphs with integrating evidence synthesis and expert knowledge

Cardiovascular disease (CVD) is a major global cause of premature mortality. While multiple studies propose CVD mortality prediction models based on regression frameworks, incorporating causal understanding through causal inference approaches can enhance accuracy. This paper demonstrates a methodology combining evidence synthesis and expert knowledge to construct a causal model for premature CVD mortality using Directed Acyclic Graphs (DAGs). The process involves three phases: (1) initial DAG development based on the Evidence Synthesis for Constructing Directed Acyclic Graphs (ESC-DAGs) framework, (2) validation and consensus-building with 12 experts using the Fuzzy Delphi method (FDM), and (3) application to data analysis using population-based survey data linked with death records. Expert input refined the initial DAG model, achieving consensus on 45 causal paths. The revised model guided selection of confounding variables for adjustment. For example, to estimate the total effect of diabetes on premature CVD mortality, the suggested adjustment set included age, dietary pattern, genetic/family history, sex hormones, and physical activity. Testing different DAG models showed agreement between expert ratings and data accuracy from regression models. This systematic approach contributes to DAG methodology, offering a transparent process for constructing causal pathways for premature CVD mortality.

Economic costs attributable to modifiable risk factors: an analysis of 24 million urban residents in China

BackgroundEstimating the economic burden of modifiable risk factors is crucial for allocating scarce healthcare resources to improve population health. We quantified the economic burden attributable to modifiable risk factors in an urban area of China.MethodsOur Shanghai Municipal Health Commission dataset covered 2.2 million inpatient admissions for adults (age ≥ 20) in public and private hospitals in 2015 (1,327,187 admissions) and 2020 (837,482 admissions). We used a prevalence-based cost-of-illness approach by applying population attributable fraction (PAF) estimates for each modifiable risk factor from the Global Burden of Diseases Study (GBD) to estimate attributable costs. We adopted a societal perspective for cost estimates, comprising direct healthcare costs and productivity losses from absenteeism and premature mortality. Future costs were discounted at 3% and adjusted to 2020 prices.ResultsIn 2020, the total societal cost attributable to modifiable risk factors in Shanghai was US$7.9 billion (95% uncertainty interval [UI]: 4.6–12.4b), mostly from productivity losses (67.9%). Two health conditions constituted most of the attributable societal cost: cancer (51.6% [30.2–60.2]) and cardiovascular disease (31.2% [24.6–50.7]). Three modifiable risk factors accounted for half of the total attributable societal cost: tobacco (23.7% [16.4–30.5]), alcohol (13.3% [8.2–19.7]), and dietary risks (12.2% [7.5–17.7]). The economic burden varied by age and sex; most of the societal costs were from males (77.7%), primarily driven by their tobacco and alcohol use. The largest contributor to societal costs was alcohol for age 20–44, and tobacco for age 45 + . Despite the COVID-19 pandemic, the pattern of major modifiable risk factors remained stable from 2015 to 2020 albeit with notable increases in attributable healthcare costs from cancers and productivity losses from cardiovascular diseases.ConclusionsThe substantial economic burden of diseases attributable to modifiable risk factors necessitates targeted policy interventions. Priority areas are reducing tobacco and alcohol consumption and improving dietary habits that together constitute half of the total attributable costs. Tailored interventions targeting specific age and sex groups are crucial; namely tobacco in middle-aged/older males and alcohol in younger males.