Reduction In Premature Mortality Research Articles

Premature mortality trends in 183 countries by cancer type, sex, WHO region, and World Bank income level in 2000-19: a retrospective, cross-sectional, population-based study.

Cancer is a leading cause of mortality worldwide. By 2040, over 30 million new cancers are predicted, with the greatest cancer burden in low-income countries. In 2015, the UN passed the Sustainable Development Goal 3.4 (SDG 3.4) to tackle the rising burden of non-communicable diseases, which calls for a reduction by a third in premature mortality from non-communicable diseases, including cancer, by 2030. However, there is a paucity of data on premature mortality rates by cancer type. In this study, we examine annual rates of change for cancer-specific premature mortality and classify whether countries are on track to reach SDG 3.4 targets. This is a retrospective, cross-sectional, population-based study investigating premature mortality trends from 2000-19 using the WHO Global Health Estimates data. All cancers combined and thirteen individual cancers in 183 countries were examined by WHO region, World Bank income level, and sex. The risk of premature mortality was calculated for ages 30-69 years, independent of other competing causes of death, using standard life table methods. The primary objective was to compute average annual rate of change in premature mortality from 2000 to 2019. Secondary objectives assessed whether this annual rate of change would be sufficient to reach SDG 3.4. targets for premature mortality by 2030. This study was conducted using data retrieved for the years 2000-19. Premature mortality rates decreased in 138 (75%) of 183 countries across all World Bank income levels and WHO regions, however only eight (4%) countries are likely to meet the SDG 3.4 targets for all cancers combined. Cancers where early detection strategies exist, such as breast and colorectal cancer, have higher declining premature mortality rates in high-income countries (breast cancer 48 [89%] of 54 and colorectal cancer 45 [83%]) than in low-income countries (seven [24%] of 29 and four [14%]). Cancers with primary prevention programmes, such as cervical cancer, have more countries with declining premature mortality rates (high-income countries 50 [93%] of 54 and low-income countries 26 [90%] of 29). Sex-related disparities in premature mortality rates vary across WHO regions, World Bank income groups, and by cancer type. There is a greater reduction in premature mortality for all cancers combined and for individual cancer types in high-income countries compared with lower-middle-income and low-income countries. However, most countries will not reach the SDG 3.4 target. Cancers with early detection strategies in place, such as breast and colorectal cancers, are performing poorly in premature mortality compared with cancers with primary prevention measures, such as cervical cancer. Investments toward prevention, early detection, and treatment can potentially accelerate declines in premature mortality. WHO.

Economic impact of the use of patiromer in chronic kidney disease or heart failure for the treatment of chronic hyperkalemia in Spain

IntroductionChronic hyperkalemia has negative consequences in the medium and long term, and determines the suspension of nephro and cardioprotective drugs, such as renin–angiotensin–aldosterone system inhibitors (RAASi). There is an alternative to the suspension or dose reduction of these treatments: the administration of potassium chelators. The aim of this study is to estimate the economic impact of the use of patiromer in patients with chronic kidney disease (CKD) or heart failure (HF) and hyperkalemia in Spain. Materials and methodThe annual economic impact of the use of patiromer has been estimated from the perspective of the Spanish society. Two scenarios were compared: patients with CKD or HF and hyperkalemia treated with and without patiromer. The costs have been updated to 2020 euros, using the Health Consumer Price Index. Direct healthcare costs related to the use of resources (treatment with RAASi, CKD progression, cardiovascular events and hospitalization due to hyperkalemia), direct non-healthcare costs (informal care: costs derived from time dedicated by patient’s relatives), the indirect costs (productivity loss), as well as an intangible cost (due to premature mortality) were considered. A deterministic sensitivity analysis was performed to validate the robustness of the study results. ResultsThe mean annual cost per patient in the scenario without patiromer is €9,834.09 and €10,739.37 in CKD and HF, respectively. The use of patiromer would lead to cost savings of over 30% in both diseases. The greatest savings in CKD come from the delay in the progression of CKD. While in the case of HF, 80.1% of these savings come from premature mortality reduction. The sensitivity analyses carried out show the robustness of the results, obtaining savings in all cases. ConclusionsThe incorporation of patiromer allows better control of hyperkalemia and, as a consequence, maintain treatment with RAASi in patients with CKD or HF. This would generate a 32% of annual savings in Spain (€3,127 in CKD; €3,466 in HF). The results support the positive contribution of patiromer to health cost in patients with only CKD or in patients with only HF.

The global and regional air quality impacts of dietary change

Air pollution increases cardiovascular and respiratory-disease risk, and reduces cognitive and physical performance. Food production, especially of animal products, is a major source of methane and ammonia emissions which contribute to air pollution through the formation of particulate matter and ground-level ozone. Here we show that dietary changes towards more plant-based flexitarian, vegetarian, and vegan diets could lead to meaningful reductions in air pollution with health and economic benefits. Using systems models, we estimated reductions in premature mortality of 108,000-236,000 (3-6%) globally, including 20,000-44,000 (9-21%) in Europe, 14,000-21,000 (12-18%) in North America, and 49,000-121,000 (4-10%) in Eastern Asia. We also estimated greater productivity, increasing economic output by USD 0.6-1.3 trillion (0.5-1.1%). Our findings suggest that incentivising dietary changes towards more plant-based diets could be a valuable mitigation strategy for reducing ambient air pollution and the associated health and economic impacts, especially in regions with intensive agriculture and high population density.

Assessing progress of India in reduction of premature mortality due to four noncommunicable diseases towards achieving the WHO 25×25 goal and the sustainable development goals

AbstractThe World Health Organization (WHO) adopted a global noncommunicable disease monitoring framework in 2013 with a target of a 25% reduction in premature mortality from four noncommunicable diseases (NCDs) such as cancer, diabetes, cardiovascular disease (CVD) and chronic respiratory disease (CRD) by 2025 compared to 2010. The Sustainable Development Goals (SDGs) target to reduce premature deaths from the four major NCDs by one‐third from 2015 to 2030. The objective of this study was to estimate the trend and reduction in premature mortality in India due to 4 major NCDs combined and separately between 2001 and 2030 and compare its progress toward the WHO and SDG target achievement. The publicly available data from the census for population and the Sample Registration System (SRS) for cause of death by 5‐year‐age groups were extracted. Age standardized premature mortality rates, unconditional probability of dying and annual percent change (APC) were computed. The premature mortality for four major NCDs decreased by −13.9% from 2010 to 2025 and by −15.6% from 2015 to 2030. The percentage changes in premature mortality from 2010 to 2025 were −33.9%, −17.4%, −9.3%, and 6.9% for CRD, cancer, CVD and diabetes respectively. For 2015–2030, these changes were −21.7%, −11.5%, −15.4%, and −15.1%. A significant reduction trend was observed for CRD with an average APC of −5.2%. The current reduction trend in premature mortality indicates that either the 25% reduction by 2025 or a one‐third reduction by 2030 will require intensive implementation of policies and program for NCD reduction.

Does Democracy Matter for Lifespan Inequalities? Regime Type and Premature Mortality by Sex

Reductions in premature mortality are widely attributed to economic, educational, and medical factors. This study contributes to our understanding of the influence of political factors in preventing early death and gender inequalities in health outcomes. We analyze data from life tables of the World Health Organization, 2000–2015, to estimate the annual, sex-specific standard deviation of the age-at-death distribution across 162 countries. We apply dynamic panel model analyses to assess the association between political liberalization and inequalities in premature mortality. Our findings show reduced inequalities in premature mortality in liberal democracies, with men benefiting disproportionately. We theorize that liberal democracy may motivate governments to respond to citizens’ desires for policies that improve health and reduce risks. As democratic liberalization increases, premature mortality falls for men, which may be accounted for in part by reduced male mortality from injuries. Reductions in premature mortality for women appear to stem primarily from improvements in maternal mortality across regime types. Our findings support the idea that democratization may provide public health benefits, especially for male citizens.

Burden of non-communicable diseases and the achievement of the sustainable development goals in 2030 in Mercosur countries

ObjectivesThe aims of this article were to analyse the burden of NCDs and their RFs in the Mercosur countries between 1990 and 2019 and to project mortality trends for 2030. Study designEpidemiological study of time series. MethodsThe present study used data from the Global Burden of Disease study. The absolute number of deaths, mortality rates, disability-adjusted life years, years of life lost, years lived with disability and the burden of premature mortality by NCD attributable to the RFs were evaluated. Projections were made up to 2030. Age-standardised rates were used to draw comparisons by years and by countries. The analysis was conducted using the RStudio software. ResultsBetween 1990 and 2019, a decrease was found in the premature mortality rates caused by NCDs in all the countries, except for Paraguay, which remained stable. When analysing premature mortality rates due to NCDs up to 2030, it was predicted that none of the countries would achieve the sustainable development goal of a one-third reduction in premature mortality by NCDs. Regarding the impacts of the RFs for NCDs, smoking, dietary risks, high blood pressure (BP) and high body mass index (BMI) were the main risks attributable to premature deaths due to NCDs. ConclusionsThe results showed that mortality rates are declining in Mercosur countries; however, none of the countries are predicted to achieve the sustainable development goal of a one-third reduction in mortality due to NCDs by 2030. In addition to access to adequate treatment, progress is required in public regulation actions to reduce RFs, such as smoking, dietary risks, high BP and high BMI.

Benefits of Short-term Premature Mortality Reduction Attributed to PM2.5 Pollution: A Case Study in Long an Province, Vietnam.

PM2.5 pollution exposure is the leading cause of disease burden globally, especially in low- and middle-income countries, including Vietnam. Therefore, economic damage in this context must be quantified. Long An province in the Southern Key Economic (SKE) region was selected as a research area. This study aimed to evaluate PM2.5-related human health effects causing early deaths attributable to respiratory, cardiovascular, and circulatory diseases in all ages and genders. Health end-points and health impact estimation, economic loss model, groups of PM2.5 concentration data, data of exposed population, data of baseline premature mortality rate, and data of health impact functions were used. Hourly PM2.5 concentration data sets were generated specifically using the coupled Weather Research and Forecasting Model (WRF)/Community Multiscale Air Quality Modelling System (CMAQ) models. Daily PM2.5 pollution levels considered mainly in the dry season (from January to April 2018) resulted in 12.9 (95% CI -0.6; 18.7) all-cause premature deaths per 100,000 population, of which 7.8 (95% CI 1.1; 7.1), 1.5 (95% CI -0.2; 3.1), and 3.6 (95% CI -1.5; 8.5) were due to respiratory diseases (RDs; 60.54%), cardiovascular diseases (CVDs; 11.81%), and circulatory system diseases (CSDs; 27.65%) per 100,000 population, respectively. The total economic losses due to acute PM2.5 exposure-related premature mortality cases reached 62.0 (95% CI -2.7; 89.6) billion VND, equivalent to 8.3 (95% CI -0.4; 12.0) million USD. The study outcomes contributed remarkably to the generation and development of data sources for effectively managing ambient air quality in Long An.

Global burden of chronic respiratory diseases and risk factors, 1990-2019: an update from the Global Burden of Disease Study 2019.

Updated data on chronic respiratory diseases (CRDs) are vital in their prevention, control, and treatment in the path to achieving the third UN Sustainable Development Goals (SDGs), a one-third reduction in premature mortality from non-communicable diseases by 2030. We provided global, regional, and national estimates of the burden of CRDs and their attributable risks from 1990 to 2019. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we estimated mortality, years lived with disability, years of life lost, disability-adjusted life years (DALYs), prevalence, and incidence of CRDs, i.e. chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease and pulmonary sarcoidosis, and other CRDs, from 1990 to 2019 by sex, age, region, and Socio-demographic Index (SDI) in 204 countries and territories. Deaths and DALYs from CRDs attributable to each risk factor were estimated according to relative risks, risk exposure, and the theoretical minimum risk exposure level input. In 2019, CRDs were the third leading cause of death responsible for 4.0 million deaths (95% uncertainty interval 3.6-4.3) with a prevalence of 454.6 million cases (417.4-499.1) globally. While the total deaths and prevalence of CRDs have increased by 28.5% and 39.8%, the age-standardised rates have dropped by 41.7% and 16.9% from 1990 to 2019, respectively. COPD, with 212.3 million (200.4-225.1) prevalent cases, was the primary cause of deaths from CRDs, accounting for 3.3 million (2.9-3.6) deaths. With 262.4 million (224.1-309.5) prevalent cases, asthma had the highest prevalence among CRDs. The age-standardised rates of all burden measures of COPD, asthma, and pneumoconiosis have reduced globally from 1990 to 2019. Nevertheless, the age-standardised rates of incidence and prevalence of interstitial lung disease and pulmonary sarcoidosis have increased throughout this period. Low- and low-middle SDI countries had the highest age-standardised death and DALYs rates while the high SDI quintile had the highest prevalence rate of CRDs. The highest deaths and DALYs from CRDs were attributed to smoking globally, followed by air pollution and occupational risks. Non-optimal temperature and high body-mass index were additional risk factors for COPD and asthma, respectively. Albeit the age-standardised prevalence, death, and DALYs rates of CRDs have decreased, they still cause a substantial burden and deaths worldwide. The high death and DALYs rates in low and low-middle SDI countries highlights the urgent need for improved preventive, diagnostic, and therapeutic measures. Global strategies for tobacco control, enhancing air quality, reducing occupational hazards, and fostering clean cooking fuels are crucial steps in reducing the burden of CRDs, especially in low- and lower-middle income countries.

Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being

Context: The ‘Northern Dimension on Public Health and Social Well-being’ is a platform for dialogue and cooperation of countries around the Baltic Sea, established in 2003, guided by the Sustainable Development Goal 3 on Health and Social Well-being and the Strategy for the Baltic Sea Region of the European Union adopted in 2009. In this paper we determine the overall progress of the Russian Federation and its North West Federal Okrugin in particular, with regard to the reduction of mortality.
 Methods: For the purpose of inter-country comparison and progress over time we make use of age-standardised Potential Years of Life Lost (PYLL) applied to quantifiable strategic targets, the Sustainable Development Goal 3 on Health and Social Well-being and the European Union Strategy of the Baltic Sea Region. A gap analysis is performed to determine whether the target achievement is in delay or on track.
 Results: With reference to the baseline of 2009 – corresponding to the most relevant recent period 2009-2020 respectively 2009-2030 – the Russian Federation as a whole is on track achieving the two strategic targets in advance by 2.7 years. For the North West Federal Okrug around St. Petersburg and Kaliningrad bordering the Baltic Sea the target achievement is estimated to be 4.8 and 10.8 years in advance of the deadlines 2020 and 2030. In comparison to the Baltic Sea states the Russian Federation takes a middle position after Estonia, Latvia and Finland. The early target achievement is confirmed if the period 2003-2020 respectively 2003-2030 is considered.
 Conclusion: Although the region is progressing there may be a slowdown towards 2030. A careful analysis is required to determine to which degree the activities of the Partnership for Health and Social Well-being have contributed to the success and what should be proposed to increase the impact on premature mortality.

Can the sustainable development goals for cancer be met in Brazil? A population-based study.

A one-third reduction in premature mortality (30-69 years) from chronic noncommunicable diseases is goal 3.4 of the United Nations Sustainable Development Goals (UN SDG). The burden of NCDs is expected to continue to increase in low- and middle-income countries, including Brazil. The aim of this study was to assess geographical and temporal patterns in premature cancer mortality in Brazil between 2001 and 2015 and to predict this to 2030 in order to benchmark against the 3.4 SDG target. We used data on deaths from cancer in those aged 30-69, by age group, sex and cancer site, between 2001 and 2015 from the National Mortality Information System of Brazil (SIM). After correcting for ill-defined causes, crude and world age-standardised mortality rates per 100,000 inhabitants were calculated nationally and for the 5 regions. Predictions were calculated using NordPred, up to 2030. The difference in observed (2011-2015) and predicted (2026-2030) mortality was compared against the SDG 3.4 target. Between 2011-2015 and 2026-2030a 12.0% reduction in premature cancer age-standardised mortality rate among males and 4.6% reduction among females is predicted nationally. Across regions this varied from 2.8% among females in North region to 14.7% among males in South region. Lung cancer mortality rates are predicted to decrease among males but not among females nationally (men 28%, females 1.1% increase) and in all regions. Cervical cancer mortality rates are projected to remain very high in the North. Colorectal cancer mortality rates will increase for both sexes in all regions except the Southeast. Cancer premature mortality is expected to decrease in Brazil, but the extent of the decrease will be far from the SDG 3.4 target. Nationally, only male lung cancer will be close to reaching the SDG 3.4 target, reflecting the government's long-term efforts to reduce tobacco consumption. Projected colorectal cancer mortality increases likely reflect the epidemiological transition. This and, cervical cancer control will continue to be major challenges. These results will help inform strategic planning for cancer primary prevention, early detection and treatment programs; such initiatives should take cognizance of the regional differences highlighted here.

Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward.

In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs-hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing-whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a gradual decline. In a continent where health systems are traditionally geared toward addressing communicable diseases, several gaps exist to adequately meet the growing demand imposed by CVDs. Among these, high-quality research to inform interventions, underfunded health systems with high out-of-pocket costs, limited accessibility and affordability of essential medicines, CVD preventive services, and skill shortages. Overall, the African continent progress toward a third reduction in premature mortality come 2030 is lagging behind. More can be done in the arena of effective policy implementation for risk factor reduction and CVD prevention, increasing health financing and focusing on strengthening primary health care services for prevention and treatment of CVDs, whilst ensuring availability and affordability of quality medicines. Further, investing in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on interventions. This review summarizes the current CVD burden, important gaps in cardiovascular medicine in Africa, and further highlights priority areas where efforts could be intensified in the next decade with potential to improve the current rate of progress toward achieving a 33% reduction in CVD mortality.

New frontiers in risk assessments related to diets, health and the environment

Abstract Based on the sustainable development goals agenda, public health experts should approach the study of planetary diets, environment, and health with a holistic approach that includes both human and planetary health. Modelling studies help in estimating priorities while attaining differences across countries. Future scenarios vary according to priorities to be set. When aiming only at fulfilling food-security objectives, studies suggest that reductions in premature mortality have few environmental co-benefits. In contrast, modelling studies that include environmental goals indicate the potential for reducing environmental impacts while improving diet quality and overall health outcomes, especially in high-income countries. The scenarios indicate that focusing on dietary changes towards healthy and balanced dietary pattern seems an ideal strategy to improve both mortality risk and the environmental impact, although the magnitude of the effects may vary across countries. Weight and dietary risk factors have traditionally been considered separate categories. A new approach can be proposed for attributing weight-related risks to food intake at global, regional, and national levels. When comparing current consumption patterns to diets that for each country minimise diet and weight-related risks, a total of 5 million weight-related deaths in 2019 were attributed to the overconsumption of refined grains, dairy, red and processed meat, sugar, and eggs, and to the underconsumption of oils, and legumes, among others. A large share of deaths attributable to high intake of animal source foods and imbalanced grain intake occurred in countries with the higher high human development index, while more than a third due to imbalanced sugar and oil intake occurred in medium ones. Attributing weight-related risks to food intake can inform food-based interventions for reducing the burden of preventable deaths associated with imbalanced weight levels.

Long COVID and NCDs: the Elephant in the Room

Abstract Issue/problem COVID-19 has now emerged as a public health concern that not only disrupted healthcare services of people living with non-communicable diseases (NCDs) but likely also increase the burden of NCDs. Description of the problem Before the pandemic, SDG target 3.4, which calls for a reduction in premature mortality from NCDs by one third by 2030, was expected to be achieved by 17.5% of countries, and a further of 23% could achieve the target with a slight acceleration in decline. Currently, most countries are off track due to disruption of healthcare services for people with NCDs, overstretched health systems, and fewer resources than before the pandemic. In addition, only around one in four people who had COVID-19 reported feeling fully recovered within a year of being discharged from hospital. The adverse health effects from long COVID range from ‘invisible symptoms’ such as fatigue and difficulty concentrating, to neurological and neuropsychiatric symptoms, respiratory and cardiovascular problems, and metabolic disease. Results The COVID-19 pandemic has shown that siloed programmes are increasingly unfit, and the bidirectional relationships between communicable diseases and NCDs underscore the need to dismantle disease-specific silos, emphasising reforms and investments that improve a wide range of health outcomes. Cost-effective, feasible, and relevant interventions that target both physical and mental health impairments are urgently required. Lessons By 2030, ministries of health would need to contribute about 20% of their budgets to high-priority NCD interventions. Protecting current investments and scaling up cost-effective public health interventions is especially crucial in the context of long haul COVID and NCDs. Policy makers and planners will need concrete guidance for making progress on SDG target 3.4, often with overburdened health systems and scarcer resources.

Impacto económico del uso de patiromer en enfermedad renal crónica o insuficiencia cardíaca para el tratamiento de la hiperpotasemia crónica en España

IntroductionChronic hyperkalemia has negative consequences in the medium and long term, and determines the suspension of nephro and cardioprotective drugs, such as renin–angiotensin–aldosterone system inhibitors (RAASi). There is an alternative to the suspension or dose reduction of these treatments: the administration of potassium chelators. The aim of this study is to estimate the economic impact of the use of patiromer in patients with chronic kidney disease (CKD) or heart failure (HF) and hyperkalemia in Spain. Materials and methodThe annual economic impact of the use of patiromer has been estimated from the perspective of the Spanish society. Two scenarios were compared: patients with CKD or HF and hyperkalemia treated with and without patiromer. The costs have been updated to 2020 euros, using the Health Consumer Price Index. Direct healthcare costs related to the use of resources (treatment with RAASi, CKD progression, cardiovascular events and hospitalization due to hyperkalemia), direct non-healthcare costs (informal care: costs derived from time dedicated by patient's relatives), the indirect costs (productivity loss), as well as an intangible cost (due to premature mortality) were considered. A deterministic sensitivity analysis was performed to validate the robustness of the study results. ResultsThe mean annual cost per patient in the scenario without patiromer is €9834.09 and €10,739.37 in CKD and HF, respectively. The use of patiromer would lead to cost savings of over 30% in both diseases. The greatest savings in CKD come from the delay in the progression of CKD. While in the case of HF, 80.1% of these savings come from premature mortality reduction. The sensitivity analyses carried out show the robustness of the results, obtaining savings in all cases. ConclusionsThe incorporation of patiromer allows better control of hyperkalemia and, as a consequence, maintain treatment with RAASi in patients with CKD or HF. This would generate a 32% of annual savings in Spain (€3127 in CKD; €3466 in HF). The results support the positive contribution of patiromer to health cost in patients with only CKD or in patients with only HF.

The effect of temperature on physical activity: an aggregated timeseries analysis of smartphone users in five major Chinese cities

BackgroundPhysical activity is an important factor in premature mortality reduction, non-communicable disease prevention, and well-being protection. Climate change will alter temperatures globally, with impacts already found on mortality and morbidity. While uncomfortable temperature is often perceived as a barrier to physical activity, the actual impact of temperature on physical activity has been less well studied, particularly in China. This study examined the associations between temperature and objectively measured physical activity among adult populations in five major Chinese cities.MethodsAggregated anonymized step count data was obtained between December 2017-2018 for five major Chinese cities: Beijing, Shanghai, Chongqing, Shenzhen, and Hong Kong. The associations of temperature with daily aggregated mean step count were assessed using Generalized Additive Models (GAMs), adjusted for meteorological, air pollution, and time-related variables.ResultsSignificant decreases in step counts during periods of high temperatures were found for cold or temperate climate cities (Beijing, Shanghai, and Chongqing), with maximum physical activity occurring between 16 and 19.3 °C. High temperatures were associated with decreases of 800-1500 daily steps compared to optimal temperatures. For cities in subtropical climates (Shenzhen and Hong Kong), non-significant declines were found with high temperatures. Overall, females and the elderly demonstrated lower optimal temperatures for physical activity and larger decreases of step count in warmer temperatures.ConclusionsAs minor reductions in physical activity could consequentially affect health, an increased awareness of temperature’s impact on physical activity is necessary. City-wide adaptations and physical activity interventions should seek ways to sustain physical activity levels in the face of shifting temperatures from climate change.

Prevalence of hyperglycemia in masters athletes.

BackgroundAgeing is associated with decreased physical activity, obesity and subsequently an increased risk of developing type 2 diabetes mellitus (T2dm). Master athletes (MA) have initiated exercise or sport later in life or pursued a physically active lifestyle for an extended period. Subsequently, MAs have been proposed as a model of successful ageing as this active lifestyle is associated with health benefits including decreased health risk of chronic diseases and a reduction in premature mortality. Given long-term physical activity/exercise has previously been shown to be protective against hyperglycemia, a risk factor for T2dm, it is plausible that MA may have protective benefit against developing hyperglycemia. Therefore, the aim of this study was to investigate the prevalence of hyperglycemia via fasting plasma glucose (FPG) in MAs competing at the World Masters Games (WMG).MethodsThis cross-sectional, observational survey utilized an online survey using open-source web-based software was used to investigate MAs physiological and medical-related parameters. Over 28,000 MAs competed in the WMG, of which 8,072 MAs completed the survey. Of these MAs, a total of 486 (males 277, females 209; range 27 to 91 years, mean age 55.1 ± 10.2 years) attained recent pathology results which included FPG which was subsequently analyzed for this study. FPG and other outcome variables were compared between genders and to the Australian and United States general population.ResultsMean FPG for MAs was 5.03 mmol (±1.2, 95% CI [4.9–5.1] mmol) with majority (75.5%) of MAs reporting a normal (<5.5 mmol) FPG, followed by pre-diabetes (20.2%, >5.51 to <5.99 mmol) and abnormal (4.3%, >7.0 mmol). There was no significant difference (P = 0.333) in FPG between genders however, males had a slightly higher (+2.1%) FPG as compared to females (5.08 ± 1.2 mmol (95% CI [4.9–5.22] mmol) versus 4.98 ± 1.1 mmol (95% CI 4.8-5.1 mmol)). The majority of males (71.8%) and females (80.3%) were classified with a normal FPG. With regard to an abnormal FPG level, only 4.0% of males and 4.9% of females were classified abnormal which was suggestive of undiagnosed T2dm. With regard to age by decade, there was no significant difference (P = 0.06–1.00) between age groups and no relationship between the MAs’ age and FPG (r = .054, P = 0.24). As a group, MAs had a significantly lower FPG as compared to the Australian (−3.2%, P = 0.005) and United States general populations (−13.9%, P < 0.001).ConclusionsMost, however not all, MAs were found to have normal glycaemia, with only a small percentage indicating a risk of developing T2dm (i.e., impaired fasting glucose) and a smaller percentage identified with an abnormal FPG, suggestive of T2dm. These findings suggest MAs appear to be at low metabolic risk for developing T2dm based upon FPG and the physical activity/exercise they complete as MAs may indeed be protective against hyperglycemia whilst maintaining an active lifestyle.

Long-term exposure to residential greenness and neurodegenerative disease mortality among older adults: a 13-year follow-up cohort study

BackgroundLiving in greener areas is associated with slower cognitive decline and reduced dementia risk among older adults, but the evidence with neurodegenerative disease mortality is scarce. We studied the association between residential surrounding greenness and neurodegenerative disease mortality in older adults.MethodsWe used data from the 2001 Belgian census linked to mortality register data during 2001–2014. We included individuals aged 60 years or older and residing in the five largest Belgian urban areas at baseline (2001). Exposure to residential surrounding greenness was assessed using the 2006 Normalized Difference Vegetation Index (NDVI) within 500-m from residence. We considered all neurodegenerative diseases and four specific outcomes: Alzheimer’s disease, vascular dementia, unspecified dementia, and Parkinson’s disease. We fitted Cox proportional hazard models to obtain hazard ratios (HR) and 95% confidence intervals (CI) of the associations between one interquartile range (IQR) increment in surrounding greenness and neurodegenerative disease mortality outcomes, adjusted for census-based covariates. Furthermore, we evaluated the potential role of 2010 air pollution (PM2.5 and NO2) concentrations, and we explored effect modification by sociodemographic characteristics.ResultsFrom 1,134,502 individuals included at baseline, 6.1% died from neurodegenerative diseases during follow-up. After full adjustment, one IQR (0.22) increment of surrounding greenness was associated with a 4–5% reduction in premature mortality from all neurodegenerative diseases, Alzheimer’s disease, vascular and unspecified dementia [e.g., for Alzheimer’s disease mortality: HR 0.95 (95%CI: 0.93, 0.98)]. No association was found with Parkinson’s disease mortality. Main associations remained for all neurodegenerative disease mortality when accounting for air pollution, but not for the majority of specific mortality outcomes. Associations were strongest in the lower educated and residents from most deprived neighbourhoods.ConclusionsLiving near greener spaces may reduce the risk of neurodegenerative disease mortality among older adults, potentially independent from air pollution. Socioeconomically disadvantaged groups may experience the greatest beneficial effect.

Vehicular Traffic in Urban Areas: Health Burden and Influence of Sustainable Urban Planning and Mobility

Vehicular traffic is one of the major sources of air pollution in European cities. This work aims to understand which characteristics of the urban environment could influence mobility-related air pollution, quantify the health impacts of exposure to traffic-derived PM2.5 and NO2 concentrations, and assess the potential health benefits expected from traffic interventions. The health benefits modeled are intended to provide a set of comparable data to support decision-makers and encourage informed decision-making to design healthier cities. Targeting a large geographical coverage, 12 European cities from 9 countries were comparatively assessed in terms of mean daily traffic volume/area, the number of public transport stops/area, and the percentage of green and outdoor leisure areas, among other urban indicators. This was implemented using an open-source data mining tool, which was seen as a useful engine to identify potential strategies to improve air quality. The comparison of urban indicators in the selected cities evidenced two trends: (a) cities with the most heterogeneous distribution of public transport stops, as an indicator of poor accessibility, are also those with the lowest proportion of km dedicated to cycleways and footways, highlighting the need in these cities for more sustainable mobility management; and (b) the percentage of green and outdoor leisure areas may influence the share of journeys by bicycle, pointing out that promoting the perception of green routes is relevant to enhance the potential of active transport modes. Socioeconomic factors can be key determinants of the urban indicators and would need further consideration. For the health impact assessment (HIA), two baseline scenarios were evaluated and compared. One is based on mean annual traffic contributions to PM2.5 concentrations in each target city (ranging between 1.9 and 13 µg/m3), obtained from the literature, and the second is grounded on mean annual NO2 concentrations at all available traffic and urban background stations within each city (17.2–83.5 µg/m3), obtained from the European Environment Agency database. The intervention scenarios modeled were designed based on traffic mitigation strategies in the literature, and set to ranges of 6–50% in traffic-derived PM2.5 concentrations and of 4–12.5% in NO2 concentrations. These scenarios could result in only a 1.7% (0.6–4%) reduction in premature mortality due to exposure to traffic-derived PM2.5, and 1.0% (0.4–2%) due to exposure to NO2, as the mean for all the cities. This suggests that more ambitious pollution abatement strategies should be targeted.

Potential health benefits of eliminating traffic emissions in urban areas.

Traffic is one of the major contributors to PM2.5 in cities worldwide. Quantifying the role of traffic is an important step towards understanding the impact of transport policies on the possibilities to achieve cleaner air and accompanying health benefits. With the aim of estimating potential health benefits of eliminating traffic emissions, we carried out a meta-analysis using the World Health Organisation (WHO) database of source apportionment studies of PM2.5 concentrations. Specifically, we used a Bayesian meta-regression approach, modelling both overall and traffic-related (tailpipe and non-tailpipe) concentrations simultaneously. We obtained the distributions of expected PM2.5 concentrations (posterior densities) of different types for 117 cities worldwide. Using the non-linear Integrated Exposure Response (IER) function of PM2.5, we estimated percent reduction in different disease endpoints for a scenario with complete removal of traffic emissions. We found that eliminating traffic emissions results in achieving the WHO-recommended concentration of PM2.5 only for a handful of cities that already have low concentrations of pollution. The percentage reduction in premature mortality due to cardiovascular and respiratory diseases increases up to a point (30–40 ug/m3), and above this concentration, it flattens off. For diabetes-related mortality, the percentage reduction in mortality decreases with increasing concentrations—a trend that is opposite to other outcomes. For cities with high concentrations of pollution, the results highlight the need for multi-sectoral strategies to reduce pollution. The IER functions of PM2.5 result in diminishing returns of health benefits at high concentrations, and in case of diabetes, there are even negative returns. The results show the significant effect of the shape of IER functions on health benefits. Overall, despite the diminishing results, a significant burden of deaths can be prevented by policies that aim to reduce traffic emissions even at high concentrations of pollution.

Addressing the Impact of Noncommunicable Diseases and Injuries (NCDIs) in Ethiopia: Findings and Recommendations from the Ethiopia NCDI Commission.

Noncommunicable diseases and injuries (NCDIs) are the leading causes of premature mortality globally. Ethiopia is experiencing a rapid increase in NCDI burden. The Ethiopia NCDI Commission aimed to determine the burden of NCDIs, prioritize health sector interventions for NCDIs and estimate the cost and available fiscal-space for NCDI interventions. We retrieved data on NCDI disease burden and concomitant risk factors from the Global Burden of Disease (GBD) Study, complemented by systematic review of published literature from Ethiopia. Cost-effective interventions were identified through a structured priority-setting process and costed using the One Health tool. We conducted fiscal-space analysis to identify an affordable package of NCDI services in Ethiopia. We find that there is a large and diverse NCDI disease burden and their risk factors such as hypertension and diabetes (these conditions are NCDIs themselves and could be risk factors to other NCDIs), including less common but more severe NCDIs such as rheumatic heart disease and cancers in women. Mental, neurological, chronic respiratory and surgical conditions also contribute to a substantial proportion of NCDI disease burden in Ethiopia. Among an initial list of 235 interventions, the commission recommended 90 top-priority NCDI interventions (including essential surgery) for implementation. The additional annual cost for scaling up of these interventions was estimated at US$550m (about US$4.7 per capita). A targeted investment in cost-effective interventions could result in substantial reduction in premature mortality and may be within the projected fiscal space of Ethiopia. Innovative financing mechanisms, multi-sectoral governance, regional implementation, and an integrated service delivery approach mainly using primary health care are required to achieve these goals.