Reduction In Premature Mortality Research Articles

Prevention Considerations in Cardiovascular Diseases regarding the premature mortality reduction

Introduction. Cardiovascular diseases are recognized as worldwide (1) and national public health issue (2, 3). This is argued by having a leading position in the structure of general mortality and disability, the substantial loss of quality of life and the health system needs for increased costs. Prevention and control of cardiovascular disease has become one of the priority directions for global and national noncommunicable disease control strategies developed to reduce premature mortality (1, 5). The major cardiovascular diseases mortality was identified some aspects of premature mortality among the adult population in the Republic of Moldova. Overall decrease of mortality due to cardiovascular diseases among adults (-5.9%) has been accompanied by a relatively slower decrease in premature mortality (-2.4%) in the Republic of Moldova (6). Primary, secondary and tertiary prevention measures are essential in reducing the burden of cardiovascular disease and contribute to improving cardiovascular health at the population level. Nature is helping people to maintain their health through mechanisms much closer to them than pharmaceutical ones through the curative action of the various natural factors that form the climate of the respective territorial area. Material and method. There is a descriptive study based on statistical data of the World Health Organization and official vital statistics of the Republic of Moldova. Results and discussions. The climatic conditions of Moldova are favorable to cardiovascular prevention and rehabilitation. Moldova is located in the temperate continental climate influenced by the proximity of the Black Sea and the interference of warm-humid air from the Mediterranean. The annual air temperatures average in the country is 9,30C. In the Republic of Moldova the warm weather with a confortable temperature lasts 175 days and the relative humidity oscillates in the average from 66 to 87%. The country's thermal regime is the most important curative factor for treating chronic diseases and opportunity for the amplification of medical rehabilitation programs for patients with cardiovascular diseases. Application of methods based on the action of climatic factors in cardiovascular rehabilitation process contributes to its efficiency. Increasing the role of tertiary prevention is a good practice for the quality improvement of medical services for this category of patients. By making appropriate, timely and complex measures of primary, secondary and tertiary prevention cardiovascular disease can be substantially prevented. Conclusions. Strengthening cardiovascular prevention centered on a complex approach to all its primary, secondary, and tertiary components is an opportunity to reduce premature mortality in the population. Key words: Cardiovascular diseases, prevention, premature mortality,

Mortality impact of achieving WHO cervical cancer elimination targets: a comparative modelling analysis in 78 low-income and lower-middle-income countries

SummaryBackgroundWHO is developing a global strategy towards eliminating cervical cancer as a public health problem, which proposes an elimination threshold of four cases per 100 000 women and includes 2030 triple-intervention coverage targets for scale-up of human papillomavirus (HPV) vaccination to 90%, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. We assessed the impact of achieving the 90–70–90 triple-intervention targets on cervical cancer mortality and deaths averted over the next century. We also assessed the potential for the elimination initiative to support target 3.4 of the UN Sustainable Development Goals (SDGs)—a one-third reduction in premature mortality from non-communicable diseases by 2030.MethodsThe WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) involves three independent, dynamic models of HPV infection, cervical carcinogenesis, screening, and precancer and invasive cancer treatment. Reductions in age-standardised rates of cervical cancer mortality in 78 low-income and lower-middle-income countries (LMICs) were estimated for three core scenarios: girls-only vaccination at age 9 years with catch-up for girls aged 10–14 years; girls-only vaccination plus once-lifetime screening and cancer treatment scale-up; and girls-only vaccination plus twice-lifetime screening and cancer treatment scale-up. Vaccination was assumed to provide 100% lifetime protection against infections with HPV types 16, 18, 31, 33, 45, 52, and 58, and to scale up to 90% coverage in 2020. Cervical screening involved HPV testing at age 35 years, or at ages 35 years and 45 years, with scale-up to 45% coverage by 2023, 70% by 2030, and 90% by 2045, and we assumed that 50% of women with invasive cervical cancer would receive appropriate surgery, radiotherapy, and chemotherapy by 2023, which would increase to 90% by 2030. We summarised results using the median (range) of model predictions.FindingsIn 2020, the estimated cervical cancer mortality rate across all 78 LMICs was 13·2 (range 12·9–14·1) per 100 000 women. Compared to the status quo, by 2030, vaccination alone would have minimal impact on cervical cancer mortality, leading to a 0·1% (0·1–0·5) reduction, but additionally scaling up twice-lifetime screening and cancer treatment would reduce mortality by 34·2% (23·3–37·8), averting 300 000 (300 000–400 000) deaths by 2030 (with similar results for once-lifetime screening). By 2070, scaling up vaccination alone would reduce mortality by 61·7% (61·4–66·1), averting 4·8 million (4·1–4·8) deaths. By 2070, additionally scaling up screening and cancer treatment would reduce mortality by 88·9% (84·0–89·3), averting 13·3 million (13·1–13·6) deaths (with once-lifetime screening), or by 92·3% (88·4–93·0), averting 14·6 million (14·1–14·6) deaths (with twice-lifetime screening). By 2120, vaccination alone would reduce mortality by 89·5% (86·6–89·9), averting 45·8 million (44·7–46·4) deaths. By 2120, additionally scaling up screening and cancer treatment would reduce mortality by 97·9% (95·0–98·0), averting 60·8 million (60·2–61·2) deaths (with once-lifetime screening), or by 98·6% (96·5–98·6), averting 62·6 million (62·1–62·8) deaths (with twice-lifetime screening). With the WHO triple-intervention strategy, over the next 10 years, about half (48% [45–55]) of deaths averted would be in sub-Saharan Africa and almost a third (32% [29–34]) would be in South Asia; over the next 100 years, almost 90% of deaths averted would be in these regions. For premature deaths (age 30–69 years), the WHO triple-intervention strategy would result in rate reductions of 33·9% (24·4–37·9) by 2030, 96·2% (94·3–96·8) by 2070, and 98·6% (96·9–98·8) by 2120.InterpretationThese findings emphasise the importance of acting immediately on three fronts to scale up vaccination, screening, and treatment for pre-invasive and invasive cervical cancer. In the next 10 years, a one-third reduction in the rate of premature mortality from cervical cancer in LMICs is possible, contributing to the realisation of the 2030 UN SDGs. Over the next century, successful implementation of the WHO elimination strategy would reduce cervical cancer mortality by almost 99% and save more than 62 million women's lives.FundingWHO, UNDP, UN Population Fund, UNICEF–WHO–World Bank Special Program of Research, Development and Research Training in Human Reproduction, Germany Federal Ministry of Health, National Health and Medical Research Council Australia, Centre for Research Excellence in Cervical Cancer Control, Canadian Institute of Health Research, Compute Canada, and Fonds de recherche du Québec–Santé.

Резерви зростання зайнятості в Україні за рахунок зменшення рівня передчасної смертності

The relevance of the study is due to the fact that today in Ukraine, unlike many countries around the world, employment is declining, the population is declining, including working age, which negatively affects the labor market and socio-economic development. In addition, the urgency of the work is increasing in the context of the spread of the pandemic — COVID-19. The aim of the article is to study the reserves of employment growth in Ukraine by reducing the level of premature mortality of the working population in the age group 15—64 years from exogenous causes. The peculiarities of the development of the modern labor market are generalized, in particular, attention is focused on the situation related to employment, unemployment, wages and services provided by the State Employment Service for various categories of the population (displaced persons, youth, servicemen, etc.). The hypothesis of the study is to assess the potential reserves for employment growth due to the reduction of premature mortality among able-bodied citizens in the age group 15—64 years from exogenous causes, which will, in particular, ensure the implementation of public employment policy, especially to stimulate new workers. seats for the period up to 2022. The growth (decrease) of the population in some countries of the world and in Ukraine in 2019 compared to 2018 and the dynamics of premature mortality of able-bodied citizens of Ukraine in the age group 15—64 are analyzed. The potential number of employed people who left the labor market due to premature mortality is calculated. Hypothetical economic effects of reducing the rate of premature mortality for employed citizens from exogenous causes in the age group 15—64 years (according to 2019) are calculated. The calculation of potential economic effects from the reduction of premature mortality from intentional self-harm and accidental poisoning and exposure to alcohol by age groups was calculated. Employment growth reserves in Ukraine due to the reduction of premature mortality from exogenous causes in the age group of 15—64 years have been calculated.

Implementing a package of noncommunicable disease interventions in the Republic of Moldova: two-year follow-up data.

Noncommunicable diseases (NCDs) are a growing challenge in the Republic of Moldova. A previously reported pilot cluster randomized controlled trial aimed to determine the feasibility of implementing and evaluating essential interventions for NCDs (e.g. cardiovascular risk scoring, hypertension management, statin treatment, etc.) in primary health care in the Republic of Moldova, with a view toward national scale up. One-year follow-up data (previously published) demonstrated modest improvements in NCD risk factor identification and management could be achieved. Herein, we report the second-year follow-up data and conclude that sustainable improvements in NCD risk factor control (e.g. hypertension control) can be achieved in primary health care in low resource settings by adapting existing resources (e.g. WHO PEN) and conducting focused clinical training and support. If scaled to a national level, these improvements in risk factor control could significantly translate to reductions in premature mortality from NCDs.

Is the COVID-19 pandemic an opportunity to advance the global noncommunicable disease agenda?

More than 70% of the annual global deaths are due to noncommunicable diseases (NCDs), and 80% of these deaths occur in low- and middle-income countries. Most of these deaths are in people <70 years of age and can be prevented and controlled by addressing a set of modifiable risk factors, namely tobacco use, alcohol misuse, unhealthy diets, physical inactivity, and obesity. Recognizing the global burden of NCDs, the world's leaders adopted several policy instruments such as the NCD Global Action Plan, the Framework Convention on Tobacco Control, and the global monitoring framework on NCDs. In 2015, the UN General Assembly included reduction of premature mortality from NCDs by one-third by 2030 as target 3.4 of the Sustainable Development Goals (SDGs). Assessment of this target in 2018 found some progress with tobacco control, but the overall progress was inadequate. The global pandemic of coronavirus disease 2019 (COVID-19) has brought NCDs to the forefront. Preliminary data indicate that persons with NCDs are extremely susceptible to COVID-19 and its complications including death. Focus on controlling the pandemic has led to delays in the diagnosis, treatment, and management of NCDs. This pandemic has exposed the weaknesses of the health-care systems, exacerbated the inequalities within societies, and disproportionately affected the vulnerable groups. In the process of recovery and in future planning, governments and leaders need to take proactive actions toward the prevention and control of all avoidable deaths from NCDs if the SDG target 3.4 is to be achieved by 2030.

Costs and benefits of agricultural ammonia emission abatement options for compliance with European air quality regulations

BackgroundIn Europe, ammonia (NH3) emissions strongly contribute to fine particulate matter (PM2.5) pollution and associated premature human mortality. The National Emission Ceilings Directive 2016/2284/EU has set an obligation for all European Union countries to reduce the NH3 emissions by 6%, relative to 2005, by 2020. This study aims to assess the costs and benefits of four NH3 emission abatement options for the compliance of the agricultural sector with the commitments of the European air quality regulatory framework. A regional atmospheric model (WRF/Chem) was used to assess the effects of regulating NH3 emissions reductions on PM2.5 concentrations over Europe. Non-market valuation techniques (value of statistical life) were used to monetize the associated health outcomes.ResultsWe calculated that 16 out of the 28 EU member states exceeded their 2020 NH3 emission ceilings in 2016. The highest exceedances from the 2020 emission commitment level occurred in Latvia (15%), Germany (12%) and the UK (12%). Simulation of the required NH3 emission reduction by WRF/Chem showed that relatively large reductions in PM2.5 concentrations occur over central-western Europe and the UK. The largest health benefits (> 5% reduction in premature mortality) were found for Scandinavia. The economic benefit from avoided premature deaths over Europe amounts to 14,837 M€/year. The costs of four NH3 emission abatement options, where each would fully achieve the required emission reduction, range from 80 M€/year for low nitrogen feed to 3738 M€/year for low-emission animal housing, with covered manure storage (236 M€/year) and urea fertilizer application (253 M€/year), in between.ConclusionOur analysis indicates that the costs of compliance by the agricultural sector with the commitments of the European air quality regulations are much lower than the economic benefit. Thus, much more ambitious reduction commitments for NH3 emissions could be applied by the EU-28. The monetization of the health benefits of NH3 emission abatement policies and the assessment of the implementation costs can help policy-makers devise effective air pollution control programmes.

Cause and Age-specific premature mortality attributable to PM2.5 Exposure: An analysis for Million-Plus Indian cities

In India, a majority population is exposed to high levels of ambient PM2.5 resulting in adverse health outcomes. Epidemiological studies have associated diseases such as Ischemic Heart Disease (IHD), Cerebrovascular Disease (Stroke), Chronic Obstructive Pulmonary Disease (COPD), Lower Respiratory Infection (LRI), and Lung Cancer (LNC) to long-term PM2.5 exposure resulting in premature mortality. In the present work, the Integrated Exposure Response (IER) model is used to estimate such premature deaths for the year 2016 in 29 million-plus Indian cities. The city-specific registered deaths data along with information of percent share of cause-specific deaths in the total deaths and measured ambient PM2.5 concentrations are used to estimate cause-specific baseline mortality in a city. The premature mortality attributable to PM2.5 exposure is estimated from this baseline mortality. The premature mortality burden attributable to PM2.5 exposure in these cities is 114,700 (104,100–125,500) deaths from the five causes (IHD, Stroke, COPD, LRI, and LNC). IHD is the leading cause of death accounting for 58% of PM2.5 related premature deaths, followed by Stroke (22%), COPD (14%), LRI (4%), and LNC (2%) in these 29 cities. The estimated number of PM2.5 related deaths in productive age group (25 – 50 years) is quite low compared to older people, but the percentage share of these deaths in the cumulative cause-specific baseline deaths is higher for productive age group. Thus, the productive population is considerably at a higher risk of mortality due to PM2.5 exposure. There is approximately 18% and 70% reduction in premature mortality if these cities can attain National Ambient Air Quality Standards (NAAQS) (40 μg/m3) and the World Health Organization (WHO) guidelines (10 μg/m3) of annual PM2.5, respectively. The estimates of air pollution related mortality at the city level could assist in city-specific policy formulation for better air pollution control.

P6147Access to essential cardiovascular medicines in Kerala, the state with the highest cardiovascular disease burden in India

Abstract Introduction The 2030 Agenda for Sustainable Development has prioritized the reduction of premature mortality due to NCDs – including cardiovascular diseases (CVD) - by a third. To achieve this goal, countries must achieve 80% availability of affordable essential medicines. Essential medicines as identified by the World Health Organization are those that meet the priority healthcare needs of majority population. Globally, India has the second highest CVD burden with over 1.7 million deaths annually, with the highest CVD morbidity and mortality rate in Kerala. Purpose To evaluate the availability, prices and affordability of essential CVD medicines in Kerala state to facilitate implementation of informed public health policy. Methods Using WHO/HAI methodology, we obtained data on availability and prices for 25 essential CVD medicines in a representative sample of 7 public-sector hospitals (survey anchors) and 37 private retail pharmacies located near the survey anchors in four districts. Additionally, we obtained the data from 10 government-subsidized discount pharmacies. We report availability as percentage of surveyed facilities where a given medicine was found. Median prices ratios (MPRs) were calculated by comparing consumer prices to the MSH International Reference Prices (IRPs). Medicines were considered affordable if the monthly supply costs less than one-day's wage of the lowest paid government worker. Results In the public-sector facilities (hospital and discount pharmacies combined), the mean (SD) availability of the surveyed CVD medicines was 52% (35.3%) for generic and 35.3% (20.7%) for originator brand (OB) version. 28% of surveyed medicines (including amlodipine, clopidogrel, losartan, metformin) were available in over 80% pharmacies. 12% (captopril, streptokinase and glyceryl trinitrate) were not available in any of the facilities. In the private sector, mean (SD) availability of generic and OB versions was 64.4% (37.2%) and 43.7% (34.6%), respectively. MPR was 1.28 [range: 0.02 (insulin NPH) – 16.7 (simvastatin)] for both lowest-priced generics (LPG) and most-sold generics (MSG). The lowest paid government worker in Kerala would spend 0.06 - 3.48 days' wages for the monthly supply of essential CVD medicines in the private sector. In government-subsidized discount pharmacies, mean availability was 49.3%. The generic medicine prices were 74% lower than in the private sector. Conclusions Availability of essential CVD medications in both public and private sector pharmacies fall short of the 80% target. In the private-sector, many essential CVD medications seem unaffordable especially considering the polypharmacy among CVD patients. Introducing policies to improve medicine availability in government-subsidized discount pharmacies is crucial in tackling Kerala's ever-increasing CVD burden.

The analysis of the level and trends of potential years of life lost due to diabetes in Poland in the years 2002-2013

&lt;b&gt;Introduction:&lt;/b&gt; The industrial and socio-economic development is the direct cause of changes in major health threats in highly developed societies. Diabetes is a civilization disease and it depends on the impaired action of insulin. Together with its complications, it is a significant cause of deaths all over the world. &lt;br/&gt;&lt;b&gt;Purpose:&lt;/b&gt; To assess the level and trends of potential years of life lost (PYLL) due to diabetes in Poland in the years 2002-2013. For specific purposes, it is necessary to assess the PYLL level and the dynamics of PYLL rates due to diabetes and comparison with all causes of death. &lt;br/&gt;&lt;b&gt;Materials and Methods:&lt;/b&gt; The research material consists of data from generally available databases from the Polish Statistical Office. Potentially lost years of life were calculated using the method proposed by J-M Romeder. Premature deaths have been defined as deaths occurring before the age of 70. Trends in PYLL coefficients were generated by the computer program Joinpoint Regression Programme. &lt;br/&gt;&lt;b&gt;Results:&lt;/b&gt; The results of the conducted analysis unambiguously indicate the increase in the PYLL ratio due to diabetes was observed in both the general population and the male population. The higher rate of PYLL growth and its much higher level in the male population, compared to the female population, point out to the fact that men die much younger because of diabetes. The dynamics of the PYLL coefficient trends connected with all causes of death indicate the reduction of premature mortality.

PCV7 EFFECTIVENESS OF A CARDIOVASCULAR RISK MANAGEMENT PROGRAM IN THE REDUCTION OF PREMATURE MORTALITY ASSOCIATED TO CARDIOVASCULAR EVENTS IN THE CARIBBEAN REGION OF COLOMBIA

To establish the effectiveness of a cardiovascular risk management program [“De Todo Corazon (DTC)” program in Mutual SER-EPS] in the reduction of premature mortality associated to cardiovascular events (CVE) (male < 55 years, female < 60 years). The population eligible for the study were patients over 18 years of age affiliated to Mutual SER insurance company between June 2015 and June 2018 and residents of the Caribbean region of Colombia, enrolled or not to DTC program in which a cardiovascular event (CVE) occurred. The main outcomes considered were age of occurrence of cardiovascular events (AOCVE), age at death due to CVE (ADCVE) and years life lost (YLL). For the evaluation of the effectiveness, differences in AOCVO, ADCVO and the YPLL between the patients enrolled and non-enrolled in the DTC program were estimated using a Simple Linear Regression model. A total of 3.902 CVE occurred in the study period among both groups. The enrolled patients had an average of AOCVE of 4.96 years (95% CI 3.85-6.06) higher than in non-enrolled patients. The ADCVE average was 4.64 years (95% CI 1.47 - 7.81) higher in the enrolled patients compared with the non-enrolled patients. Patients enrolled in the DTC program had on average -3.54 (95% CI -5.62 - -1.46) YLL compared to the non-enrolled patients. The DTC program in Mutual SER-EPS was effective to delay the AOCVE, ADCVE and YPLL. DTC program is an effective strategy to reduce the incidence and premature mortality due to CVE in the Caribbean region of Colombia.

Premature deaths due to head and neck cancers in canada: A nationwide analysis from 1980 to 2010.

To examine if there has been a reduction in premature mortality due to head and neck cancers and their subtypes in the Canadian population between 1980 and 2010. Retrospective database review. Mortality data for head and neck cancers were obtained from the World Health Organization's mortality database. Years of life lost (YLL) was calculated according to Canadian life tables. A new measure, average lifespan shortened (ALSS), was calculated as a ratio of YLL over the expected lifespan. During the period of interest, decreases in age standardized rates of death adjusted to the World Standard Population were observed mainly among men. The adjusted YLL rates remained unchanged with respect to oral cancers in women, but slightly decreased for oral cancers in men and for laryngeal cancers in both sexes. Our new measure of ALSS showed that in 1980, patients with oral cancers lost an average of 20% of their lifespan, whereas in 2010, men and women still lost approximately 20% and 18%, respectively. Patients with laryngeal cancers lost 18% of their lifespan in both sexes in 1980 and 17% in 2010. The ALSS subanalysis showed that the largest gain of lifespan was observed for cancers of the hypopharynx in men and for cancers of the floor of mouth and nasopharynx in women. There appears to be modest improvements in premature mortality due to head and neck cancers in Canada over a 30-year period, with the exception of oral cancers in men. Changes in premature mortality varied slightly by cancer subtypes. NA Laryngoscope, 130:911-917, 2020.

Achieving the targets of sustainable development goals (2030 agenda) for congenital disorders in Asia: Bottlenecks and interventions.

The United Nations General Assembly adopted the 2030 Agenda for Sustainable Development in November 2015 which included a set of 17 measurable "sustainable development goals" (SDGs). The SDGs included targets to end preventable deaths of newborns and children under 5 years of age by 2030, universal health care coverage, reduction of premature mortality from noncommunicable diseases (NCDs) by 33% as well as support the development and research for medicines for both communicable and NCDs. Although some successes were achieved in combating communicable diseases and improved childhood mortality rates, health systems in Asia are generally characterized by lack of accurate epidemiological information on congenital disorders, lack of human and financial resources, and inadequate focus on public health strategies to ensure targeted interventions, low level knowledge on congenital disorders amongst the community and healthcare providers and the ethical dilemma of managing rare congenital disorders in an environment of low national health expenditures. These bottlenecks must be addressed systematically and interventions such as the use of innovative epidemiological tools to overcome lack of data, increased efforts to standardize rare disease nomenclature and classification and renewed interest in birth defects registries by countries in the region must be considered. Targeted curative and public health approaches currently used in thalassaemia and neural tube defects may be used for other congenital disorders in Asian countries. The implementation of congenital disorders-related research, prevention, care, and treatment delivery services must be integrated into existing health systems in order to be effective to achieve the targets of SDG2030.

Recomendaciones de actividad física: un mensaje para el profesional de la salud

Regular physical activity (PA) is associated with the prevention and treatment of most chronic diseases such as cardiovascular diseases, diabetes, obesity and some types of cancer, and the reduction of premature mortality. PA has important effects on mental and cognitive health, quality of sleep, cognitive performance, prevention of falls and fractures and on the improvement of functional capacity in the elderly. Therefore, PA should be part of the recommendations of any health professional. PA guidelines for health promotion recommend that every person at any age should perform at least 30 minutes of moderate PA a day for adults and 60 minutes for children and adolescents and must include muscle strength exercises at least two days a week. In addition to this the health professional should recommend the decrease of time in sedentary behaviors and move whenever possible. More minutes and more intensity of AF bring benefits at any age and in any clinical condition

Effect on longevity of one-third reduction in premature mortality from non-communicable diseases by 2030: a global analysis of the Sustainable Development Goal health target.

To curb the rising global burden of non-communicable diseases (NCDs), the UN Sustainable Development Goals (SDGs) include a target to reduce premature mortality from NCDs by a third by 2030. A quantitative assessment of the effect on longevity of meeting this target is one of the many important measures needed to advocate and inform national disease control policies. We did a global analysis to estimate improvements in average expected years lived between 30 and 70 years of age that would result from meeting the SDG target. We estimated age-specific mortality in 183 countries in 2015, for the four major NCDs (cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes) and all NCDs combined, using data from WHO Global Health Estimates. We then estimated the potential gains in average expected years lived between 30 and 70 years of age (LE[30-70)) by eliminating all or a third of premature mortality from specific causes of death in countries grouped by World Bank income groups. The feasibility of reducing mortality to the targeted level over 15 years was also assessed on the basis of historical mortality trends from 2000 to 2015. Reducing a third of premature mortality from NCDs over 15 years is feasible in high-income and upper-middle-income countries, but remains challenging in countries with lower income levels. National longevity will improve if this target is met, corresponding to an average gain in LE[30-70) of 0·64 years worldwide from reduced premature mortality for the four major NCDs and 0·80 years for all NCDs. According to major NCD type, the largest gains attributable to cardiovascular diseases would be in lower-middle-income countries (a gain of 0·45 years), whereas gains attributable to cancer would be in low-income countries (0·33 years). A one-third reduction in premature mortality from the major NCDs in 2015-30 would have substantial effects on longevity. High-level political commitments to effective and equitable national surveillance and prioritised prevention, early detection, and treatment programmes tailored to the major NCD types are needed urgently in lower-resourced settings if this SDG target is to be met by 2030. None.

Potential reductions in premature mortality attributable to PM2.5 by reducing indoor pollution: A model analysis for Beijing-Tianjin-Hebei of China

BackgroundChina has one of the highest PM2.5 (particulate matter with an aerodynamic diameter smaller than 2.5 μm) pollution levels in the world. It might still be long before air quality reaches the National Class II standard of 35 μg/m3. ObjectiveWe aim to estimate the potential reduction in premature mortality by reducing indoor PM2.5 levels in the Beijing-Tianjin-Hebei (BTH) region and compare it with reducing outdoor levels. MethodsWe combined PM2.5 transport model and the Global Burden of Disease (2016) methodology to estimate potential reductions in premature mortality attributable to PM2.5 by reducing indoor PM2.5 to National Class I standard of 15 μg/m3, and compared with reducing outdoor PM2.5 to Government 2020 Interim target of 64 μg/m3 or National Class II standard of 35 μg/m3. ResultsA total of 74,000 (95% confidence interval (CI): 43,000–111,000) premature deaths were attributable to PM2.5 exposure in 2013. Thirty percent, or 22,000 (95% CI: 17,000–32,000) deaths, would have been averted if indoor PM2.5 had reached the National Class I standard. The benefit is greater than that from reaching the Government 2020 Interim target for outdoor PM2.5 [22%, or 16,000 (95% CI: 12,000–23,000), deaths], although still smaller than that from reaching the National Class II standard [42%, or 31,000 (95% CI: 24,000–45,000), deaths]. ConclusionsReaching the National Class I level of indoor PM2.5 at current outdoor pollution levels could bring considerable health benefits, which are comparable to those from reaching the Government 2020 Interim target for outdoor PM2.5. Main findingsThe avertable premature deaths gained from cleaning indoor PM2.5 to National Class I standard level would be greater than reducing outdoor PM2.5 to Government 2020 Interim target.

Kilocalorie Expenditure and All-Cause Mortality in Older Male Veterans and Nonveterans.

The objective of this study was to determine the effect of self-reported leisure-time physical activity, converted to kilocalorie expenditure and expressed as average daily expenditure, on all-cause mortality among older males 65 years of age and older in the University of Alabama at Birmingham (UAB) Study of Aging (SOA). Mean age of participants was 75.4 years. Multivariable Cox proportional hazard models evaluated the predictors of overall survival. Kilocalorie expenditure (p = .01), Black race (p = .02), young age (p < .00), fewer depressive symptoms (p = .00), and absence of cognitive impairment (p < .00) were significant independent predictors of higher rates of survival. Low body mass index was a significant independent predictor of death (p = .03). Veteran status did not improve survival. Further study about kilocalorie expenditure and mortality could lead to reductions in premature mortality in community-dwelling older men in the Deep South.

Health and nutritional aspects of sustainable diet strategies and their association with environmental impacts: a global modelling analysis with country-level detail

SummaryBackgroundSustainable diets are intended to address the increasing health and environmental concerns related to food production and consumption. Although many candidates for sustainable diets have emerged, a consistent and joint environmental and health analysis of these diets has not been done at a regional level. Using an integrated health and environmental modelling framework for more than 150 countries, we examined three different approaches to sustainable diets motivated by environmental, food security, and public health objectives.MethodsIn this global modelling analysis, we combined analyses of nutrient levels, diet-related and weight-related chronic disease mortality, and environmental impacts for more than 150 countries in three sets of diet scenarios. The first set, based on environmental objectives, replaced 25–100% of animal-source foods with plant-based foods. The second set, based on food security objectives, reduced levels of underweight, overweight, and obesity by 25–100%. The third set, based on public health objectives, consisted of four energy-balanced dietary patterns: flexitarian, pescatarian, vegetarian, and vegan. In the nutrient analysis, we calculated nutrient intake and changes in adequacy based on international recommendations and a global dataset of nutrient content and supply. In the health analysis, we estimated changes in mortality using a comparative risk assessment with nine diet and weight-related risk factors. In the environmental analysis, we combined country-specific and food group-specific footprints for greenhouse gas emissions, cropland use, freshwater use, nitrogen application, and phosphorus application to analyse the relationship between the health and environmental impacts of dietary change.FindingsFollowing environmental objectives by replacing animal-source foods with plant-based ones was particularly effective in high-income countries for improving nutrient levels, lowering premature mortality (reduction of up to 12% [95% CI 10–13] with complete replacement), and reducing some environmental impacts, in particular greenhouse gas emissions (reductions of up to 84%). However, it also increased freshwater use (increases of up to 16%) and had little effectiveness in countries with low or moderate consumption of animal-source foods. Following food-security objectives by reducing underweight and overweight led to similar reductions in premature mortality (reduction of up to 10% [95% CI 9–11]), and moderately improved nutrient levels. However, it led to only small reductions in environmental impacts at the global level (all impacts changed by <15%), with reduced impacts in high-income and middle-income countries, and increased resource use in low-income countries. Following public health objectives by adopting energy-balanced, low-meat dietary patterns that are in line with available evidence on healthy eating led to an adequate nutrient supply for most nutrients, and large reductions in premature mortality (reduction of 19% [95% CI 18–20] for the flexitarian diet to 22% [18–24] for the vegan diet). It also markedly reduced environmental impacts globally (reducing greenhouse gas emissions by 54–87%, nitrogen application by 23–25%, phosphorus application by 18–21%, cropland use by 8–11%, and freshwater use by 2–11%) and in most regions, except for some environmental domains (cropland use, freshwater use, and phosphorus application) in low-income countries.InterpretationApproaches for sustainable diets are context specific and can result in concurrent reductions in environmental and health impacts globally and in most regions, particularly in high-income and middle-income countries, but they can also increase resource use in low-income countries when diets diversify. A public health strategy focused on improving energy balance and dietary changes towards predominantly plant-based diets that are in line with evidence on healthy eating is a suitable approach for sustainable diets. Updating national dietary guidelines to reflect the latest evidence on healthy eating can by itself be important for improving health and reducing environmental impacts and can complement broader and more explicit criteria of sustainability.FundingWellcome Trust, EAT, CGIAR, and British Heart Foundation.

The Impact of Public and Private Research on Premature Cancer Mortality and Hospitalization in the United States, 1999-2013

This article provides evidence about the impact that public and private research had on premature mortality and hospitalization due to cancer in the United States during the period 1999-2013. We estimate difference-in-differences models based on longitudinal, cancer-site-level data to determine whether the cancer sites about which more research-supported articles were published had larger subsequent reductions in premature mortality and hospitalization during the period 1999 to 2013, controlling for the change in the number of people diagnosed. Premature (before age 75 years) mortality is inversely related to the number of research-supported articles that had been published 9 to 15 years earlier, controlling for incidence and non-research publications. The number of hospital discharges attributed to cancer is also significantly inversely related to the number of research-supported articles previously published. Public and private research reduced the number of years of potential life lost before age 75 years due to cancer in 2013 by 566,000. JEL Classifications: I1, I18

Barriers to Global Action Plan for the Prevention and Control of Noncommunicable Diseases: Proposal Modifications to the Voluntary Targets

World Health Organization member states gathered to draft the Global Action Plan for the prevention and control of noncommunicable diseases (NCDs). A global overarching target of a 25% reduction of premature mortality (between ages 30 and 70) from the four major NCDs (cardiovascular diseases, cancer, diabetes or chronic respiratory diseases) by 2025 was adopted. The primary aim of this mini-review is to identify the main barriers for reaching this plan using pertinent available evidence. The secondary aim is to reexamine the data with the dual purposes of amplifying beneficial effects of the voluntary global targets, and expanding the population to which they apply. This paper has identified five interrelated barriers: I) extremely low prevalence of ideal cardiovascular health, II) Gaps in affordability of essential medications, III) Gaps in health systems, IV) Low adherence to medications and V) Gaps in voluntary global targets. Conclusions: Modifications in the voluntary global targets are being proposed to produce greater effectiveness and extend reach. To this end, more ambitious risk factor targets for a larger proportion of the population and major efforts to strengthen healthcare systems are urgently needed.

Prevention and Treatment of Non-Communicable Diseases to Achieve a Reduction of Premature Mortality (SDG 3.4): Meta-Narrative Review of Global Strategies

Prevention and Treatment of Non-Communicable Diseases to Achieve a Reduction of Premature Mortality (SDG 3.4): Meta-Narrative Review of Global Strategies