Reduction In Premature Deaths Research Articles

European air quality in view of the WHO 2021 guideline levels: Effect of emission reductions on air pollution exposure

Although anthropogenic emissions have decreased during the last 2 decades, air pollution is still problematic in Europe. This study analyzes the air quality in Europe using simulations by EURopean Air pollution Dispersion—Inverse Model for the year 2016 with updated emissions in view of the annual guideline levels for particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) released in 2021 by the World Health Organization (WHO). Three different emission scenarios are applied, including a scenario for the committed emission reductions from the European Union (EU), a scenario including additional reductions to specifically mitigate PM2.5, and a scenario in which all anthropogenic emissions are eliminated. Model results show that in Europe, the concentrations of PM2.5 and NO2 exceed the annual WHO guideline levels by up to a factor of 5.6 and 5.2, respectively, in the main polluted regions and by up to a factor of 2 for O3 in Southern Europe. High concentrations of PM2.5 and O3 are homogeneously distributed across Europe with 99% and 100% of the European population exposed to concentrations above the WHO guideline levels, respectively. NO2 concentrations above the annual WHO guideline level are primarily found in populated areas, affecting 323 million inhabitants in 2016. Although the emission scenario designed to mitigate PM2.5 shows a decrease of the highest annual mean concentrations of PM2.5 from 28 µgm−3 to 12 µgm−3, 527 million European inhabitants remain affected by PM2.5 annual mean concentrations above the WHO guideline level. Seasonal mean O3 concentrations after eliminating all anthropogenic emissions (between 60 and 82 µgm−3) are found to be above the WHO guideline level for the entire European continent. The mortality attributable to air pollution is reduced by 47% in the emission scenario for committed emissions by the EU. In the more aggressive scenario designed to mitigate PM2.5, the mortality is reduced by 72%. The study reveals that the emission scenarios and, therefore, the reduction in premature deaths are subject to sectoral emission reductions between 41% and 79%.

Analysis of human health effects under ozone exposure in the oasis area of Hetao Plain.

This article, based on OMI data products, utilizes spatial distribution, ozone-sensitive control areas, Pearson correlation methods, and the Ben-MAP model to study the changes in ozone column concentration from 2018 to 2022, along with the influencing factors and the health of populations exposed to ozone. The findings suggest a spatial variation in the ozone column concentration within the study area, with an increasing trend observed from west to east and from south to north. Over time, the ozone column concentration exhibits an initial increase followed by a subsequent decrease, with the peak concentration observed in 2019 at 37.45 DU and the nadir recorded in 2022 at 33.10 DU. The monthly mean distribution exhibits an inverted V-shaped pattern during the warm season from April to September, with a peak in July (46.71 DU) and a trough in April (35.29 DU). The Hetao Plain Oasis area is primarily a NOx control area in sensitive control areas. The concentrations of O3 and precursor HCHO exhibited significant positive correlations with vegetation index and air temperature, while showing significant negative correlations with wind speed and air pressure. The precursor NO2, in contrast, exhibited a significant negative correlation with both the vegetation index and relative humidity. Based on the ground-based monitoring sites and analysis of human health benefits, the study area witnessed 1944.45 deaths attributed to warm season O3 exposure in 2018, with a subsequent reduction in premature deaths by 149.7, 588.2, and 231.75 for the years 2019 to 2021 respectively when compared to the baseline year. In 2021, the observed decrease in warm-season O3 concentration within that region compared to 2018 resulted in a significant reduction, leading to the prevention of 126 premature deaths.

Reductions in premature deaths from heat and particulate matter air pollution in South Asia, China, and the United States under decarbonization

Following a sustainable development pathway designed to keep warming below 2 °C will benefit human health. We quantify premature deaths attributable to fine particulate matter (PM2.5) air pollution and heat exposures for China, South Asia, and the United States using projections from multiple climate models under high- and low-emission scenarios. Projected changes in premature deaths are typically dominated by population aging, primarily reflecting increased longevity leading to greater sensitivity to environmental risks. Changes in PM2.5 exposure typically have small impacts on premature deaths under a high-emission scenario but provide substantial benefits under a low-emission scenario. PM2.5-attributable deaths increase in South Asia throughout the century under both scenarios but shift to decreases by late century in China, and US values decrease throughout the century. In contrast, heat exposure increases under both scenarios and combines with population aging to drive projected increases in deaths in all countries. Despite population aging, combined PM2.5- and heat-related deaths decrease under the low-emission scenario by ~2.4 million per year by midcentury and ~2.9 million by century's end, with ~3% and ~21% of these reductions from heat, respectively. Intermodel variations in exposure projections generally lead to uncertainties of <40% except for US and China heat impacts. Health benefits of low emissions are larger from reduced heat exposure than improved air quality by the late 2090s in the United States. In contrast, in South and East Asia, the PM2.5-related benefits are largest throughout the century, and their valuation exceeds the cost of decarbonization, especially in China, over the next 30 y.

Economic Growth Facilitates Household Fuel Use Transition to Reduce PM2.5-Related Deaths in China.

Exposure to ambient and indoor particle matter (PM2.5) leads to millions of premature deaths in China. In recent years, indoor air pollution and premature deaths associated with polluting fuel cooking demonstrate an abrupt decline. However, the driving forces behind the mortality change are still unclear due to the uncertainty in household fuel use prediction. Here, we propose an integrated approach to estimate the fuel use fractions and PM2.5-related deaths from outdoor and indoor sources during 2000-2020 across China. Our model estimated 1.67 and 1.21 million premature deaths attributable to PM2.5 exposure in 2000 and 2020, respectively. We find that the residential energy transition is associated with a substantial reduction in premature deaths from indoor sources, with 100,000 (95% CI: 76,000-122,000) for urban and 265,000 (228,000-300,000) for rural populations during 2000-2020. Economic growth is the dominant driver of fuel use transition and avoids 21% related deaths (357,000, 315,000-402,000) from polluting fuel cooking since 2000, which offsets the adverse impact of ambient emissions contributed by economic growth. Our findings give an insight into the coupled impact of socioeconomic factors in reshaping health burden in exposure pathways.

Avoidable diet-related deaths and cost-of-illness with culturally optimized modifications in diet: The case of Brazil.

Dietary risk factors have an important impact on premature deaths and disabilities due to non-communicable diseases. In this study, we perform diet optimization to design different dietary scenarios taking into account food prices and preferences and evaluate the number of deaths that would be prevented as well as the economic burden and costs from the health system that would be saved in Brazil. We used dietary intake and food prices data from the nationwide Household Budget Survey (HBS) and the National Dietary Survey (NDS) 2017-2018. Linear programming models were performed to design five scenarios which different sets of key diet modifications at the least deviation from the baseline consumption. Comparative risk assessment models were used to estimate the health impacts of optimized dietary changes on mortality and the economic impacts on morbidity (hospitalizations) and premature deaths. The optimized diets were, on average, more expensive than the baseline diets, varying from Int$ (international dollar) 0.02/day to 0.52/day/adult. The number of deaths prevented or postponed varied from 12,750 (10,178-15,225) to 57,341 (48,573-66,298) according to the different scenarios. The diet modifications would save from 50 to 219 million in hospitalizations and from 239 to 804 million yearly in productivity losses with the reduction of premature deaths. A substantial number of deaths and costs due to hospitalization and productivity losses would be avoidable even with small changes in diets. However, even the cheapest intervention might be prohibitive for deprived families, yet subsidies and social policies could contribute to improving diets.

One health the future of rural health?

One health the future of rural health?

Observed and predicted premature mortality in Australia due to non-communicable diseases: a population-based study examining progress towards the WHO 25X25 goal

BackgroundThe World Health Organization’s (WHO) 25X25 goal aims for a 25% relative reduction in premature death due to four non-communicable diseases (NCD4)—cancer, cardiovascular disease, chronic respiratory diseases and diabetes—by 2025 compared to 2010. This study aimed to quantify the premature mortality in the Australian population due to NCD4, quantify the variation in mortality rates by age and sex, predict the premature mortality due to NCD4 in 2025 and evaluate the progress towards the WHO 25X25 goal.MethodsA population-based study using cause-specific mortality data of all deaths which occurred in Australia from 2010 to 2016 and registered up to 2017, for adults aged 30–69 years, was conducted. Age-specific and age-standardised mortality rates (ASMR) and probability of death for NCD4 were calculated for each year. ASMRs in 2016 were calculated for men and women. Deaths and the probability of death in 2025 were predicted using Poisson regression based on data from 2006 to 2016. To assess the progress against the WHO 25X25 goal, the relative reduction in the probability of death from NCD4 conditions in 2025 compared to 2010 was calculated.ResultsASMRs for NCD4 decreased from 2010 to 2016, except for diabetes which increased on average by 2.5% per year. Across sociodemographic factors, ASMRs were highest in males and increased with age. The projected probability of premature death in 2025 was 7.36%, equivalent to a relative reduction of 25.16% compared to 2010 levels.ConclusionsPremature mortality due to cancer, cardiovascular disease, respiratory diseases and diabetes declined in Australia from 2010 to 2016. This trend is consistent across age groups and by sex, and higher mortality rates were observed in males and at older ages. Nationally, if the current trends continue, we estimate that Australia will achieve a 25.16% relative reduction in premature deaths due to NCD4 in 2025 compared to 2010, signifying substantial progress towards the WHO 25X25 goal. Concerted efforts will need to continue to meet the 25X25 goal, especially in the context of the COVID-19 pandemic.

Synergistic Health Benefits of Household Stove Upgrading and Energy Switching in Rural China.

Rural residential energy switching from solid fuels to electricity and natural gas has resulted in substantial health benefits in China. Here, we quantitatively estimated the environmental and health benefits of stove upgrading, energy switching, and the interaction of stove upgrading and energy switching in rural mainland China during the period of 1980-2014. Driven by government intervention, technical progress, and socioeconomic development, domestic stoves have been upgraded from a domination of open-fire and traditional stoves to energy-saving, clean stoves, and gas range/electric stoves. Furthermore, stove upgrading significantly contributed to the overall reductions in PM2.5 emissions (25%), ambient and indoor PM2.5 concentrations (49 and 28%), population exposure (31%), and premature deaths (37%) attributable to residential emissions. The interaction between stove upgrading and energy switching resulted in an additional 15% reduction in premature deaths. The influences of the residential sector and the beneficial effects of stove upgrading and energy switching are magnified along the causal path from emissions to health impacts. The overall benefit of the transition in residential energy would be substantially underestimated without considering stove upgrading.

The Health-Oriented Transportation Model: Estimating the health benefits of active transportation

IntroductionOverdependence on gasoline-powered personal automobiles in industrialized urban settings has resulted in transportation behaviour that is detrimental to public health. Risk not only stems from an increase in air pollution, but also, and more significantly for wealthy nations, from a reduction in physical activity. Tools and models that demonstrate the magnitude of the health benefits of physical activity are needed to inform policies addressing the epidemic of physical inactivity and to help promote environmentally sustainable cities. MethodsThe Health-Oriented Transportation (HOT) model is a transparent and easily accessible tool that allows users to assess the current and potential health benefits of active transportation (walking or cycling) using data from a one-day travel survey. As a case-study, we apply the HOT model to the population of London, England, using the London Travel Demand Survey. ResultsWe estimate that in the 2016 adult population of London, 1,618 and 2,720 deaths were averted in the inner and outer boroughs, respectively, due to transportation-related physical activity; an additional 364 and 946 deaths are potentially averted if the proportion of the adult population that walked or cycled at least weekly from 80% and 73% to 100% in the inner and outer boroughs, respectively. A 50% increase in walking/cycling mode share among active travellers would result in a 2.5% reduction in premature deaths in the adult population of London. ConclusionsEstimating the potentially large health benefits arising from active transportation in an urban setting can provide key public health information for urban planners and local officials, informing investments in infrastructure and critical public health programs.

Global, regional and national disability-adjusted life years due to HIV from 1990 to 2019: findings from the Global Burden of Disease Study 2019.

Increasing life expectancy and decreasing mortality in patients with HIV infection are well documented. However, details of how many of the years of healthy life are damaged by HIV infection vs. good health have not been understood. We conducted this study to provide a comprehensive assessment of the levels and trends of the global burden, as measured by disability-adjusted life years (DALYs), of HIV infection. Data on HIV-related DALY were obtained from the Global Burden of Disease Study 2019. The absolute numbers and age-standardised rates of DALYs due to HIV were reported between 1990 and 2019. Estimated annual percentage changes in age-standardised rates by sex, region and nation were calculated to quantify the temporal trends in HIV burden. Global HIV infection caused 47.63 million DALYs in 2019, presenting a 1.28-fold increase from 1990 to 2019. In 2019, years of life lost contributed to most of the total DALYs, but the increases in HIV-related years lived with disability have outpaced increases in years of life lost. The age-standardised rates of HIV-related DALYs in 2019 decreased as the sociodemographic indexes increased. The highest age-standardised rates were observed in sub-Saharan Africa, and the greatest increments over time were detected in Oceania. Globally, HIV continues to cause enormous healthy life loss. The first and foremost strategy for controlling the HIV burden is still the reduction of premature deaths, and much effort needs to be exerted to mitigate the harm of comorbidities.

Sustainable Development Goal 3.4: Regional disparities in cancer premature mortality in Brazil

Abstract Background The Sustainable Development Goal 3.4 has a target of 1/3 reduction in premature mortality (30-69 years) from chronic noncommunicable diseases. Although cancer is a chronic disease, it comprises more than 100 different conditions, with different risk factors and prognosis. This study aimed to calculate current and predicted premature mortality by 2030 for Brazil and regions, compare with SDG 3.4 target and identify regional progress and future needs. Methods Mortality data were extracted from the National Mortality Information System of Brazil (SIM) and subsequently corrected for ill-defined causes. Crude and age-standardized mortality rates per 100,000 inhabitants were calculated. NordPred package by software R was used to calculate predictions up to 2030 and compared with the goal of 1/3 reduction of premature deaths. Results Comparison of observed (2011-2015) and predicted (2016-2030) mortality rates show a 12.0% reduction in the likelihood of death among men and 4.6% among women nationally. Although predicted rates for 2026-2030 are lower than those observed in 2011-2015 predicted number of deaths increases by 75,341 for men and 90,513 for women. Lung cancer mortality rates are predicted to decrease more among men than women, while colorectal cancer mortality will increase for both sexes, in all regions (except in the Southeast). Conclusions The profile of premature cancer mortality is diverse in Brazil. Nationally, only male lung cancer will be close to reaching SDG 3.4 target, endorsing government's long-term efforts to reduce tobacco consumption. The increase in colorectal cancer mortality reflects the epidemiological transition. Despite progress in cervical cancer control, it will continue to be a major challenge. Our results provide a baseline for public policies for both prevention and access to treatment to reduce premature mortality in Brazil. Differences in mortality patterns highlight the need to adapt cancer prevention policies regionally. Key messages Cancer premature mortality decrease in Brazil is expected to occur, but far from the SDG 3.4 target – including preventable cancers as cervical cancer. An increase is expected to occur in colorectal premature cancer mortality rates and strategies to face it need to be developed regionally.

Echocardiography Screening for Latent Rheumatic Heart Disease: What Can We Do in Indonesia?

Rheumatic heart disease (RHD), a sequela of acute rheumatic fever (ARF), is a preventable disease but remains a significant health problem, especially in developing countries. It causes disability, poor quality of life, early mortality, and national economic burden. The World Heart Federation (WHF) aimed to achieve a 25% reduction in premature deaths from ARF and RHD among individuals aged <25 years by 2025. Primordial and primary prophylaxis of RHD is aimed to prevent the occurrence of ARF, while the goal of secondary and tertiary prophylaxis is to limit the progression and reduce the consequences of RHD. Early recognition of RHD is important for early prophylaxis strategies to inhibit any progression to advanced stages. In 2012, WHF introduced the latest echocardiographic criteria to recognize the early stage of RHD. This includes the evaluation of pathological regurgitation jet and morphological features of RHD based on 2D, color, and spectral Doppler criteria. In remote areas, portable echocardiography is preferable for RHD screening. Previous portable devices were only capable of producing 2D and color images. Hence, a simplified echocardiographic criterion without spectral Doppler evaluation is needed in selected areas. Indonesia is a developing country, an archipelago with a population of over 250 million. Currently, there are no data on ARF incidence and RHD prevalence nationwide. The only data available are the number of patients in advanced stages who came to referral centers for further management. The screening program has to be introduced in Indonesia as part of national RHD prophylaxis.

Improving Information to Enable Effective Tobacco Control Intervention and Measure Progress Over Time: The Cambodia Country Experience.

Tobacco is a leading cause of noncommunicable diseases (NCDs) which kill about 41 million people each year. Of these, 15 million die prematurely between the ages of 30 and 69 years, most of which occur in low- and middle-income countries (LMICs). The adoption of the Sustainable Development Goals and their targets under the 2030 Agenda for Sustainable Development provides a new impetus for countries to accelerate tobacco control efforts as they specifically call for strengthening implementation of the World Health Organization (WHO) Framework Convention on Tobacco Control and striving to achieve a one-third reduction in premature deaths from NCDs. While NCD prevention and control is a priority in the national strategic plans and policies for health in most countries in the Western Pacific Region, few have formally adopted a national target for reducing tobacco use. Article 20 of the WHO FCTC calls on all countries to improve tobacco surveillance to enable monitoring and evaluation of tobacco control efforts. The increase in timely and standardized comparable data presents new opportunities to set scientifically valid and achievable national indicators and targets for development and implementation of strong tobacco control measures. Cambodia is yet to establish national targets and full implementation of legislative measures. However, with strong tobacco surveillance mechanism in place, it can provide the country experience for a LMIC that has developed its own capacity to conduct periodic monitoring and surveillance of tobacco use and for using national data to advocate successfully for stronger tobacco control policies.

Disparities in cancer premature mortality in Brazil: Predictions up to 2030 and sustainable development goals.

e13614 Background: Premature mortality affects the economy directly due to the loss of productivity of individuals who decease, thus ceasing to contribute economically to the country. The 1/3 reduction in premature mortality (30-69 years) from chronic noncommunicable diseases is goal 3.4 of the UN Sustainable Development Goals (SDG). Although cancer is a chronic disease, it comprises more than 100 different conditions, with different risk factors and prognosis. This study aimed to calculate current and predicted premature mortality by 2030 for Brazil and regions, compare with SDG 3.4 target and identify regional progress and future needs. Methods: Mortality data were extracted from the National Mortality Information System of Brazil (SIM) and subsequently corrected for ill-defined causes. Crude and age-standardized mortality rates per 100,000 inhabitants were calculated. NordPred package by software R was used to calculate predictions up to 2030 and compared with the goal of 1/3 reduction of premature deaths. Results: Comparison of observed (2011-2015) and predicted (2016-2030) mortality rates show a 12.0% reduction in the likelihood of death among men and 4.6% among women nationally. Although predicted rates for 2026-2030 are lower than those observed in 2011-2015 predicted number of deaths increases by 75,341 for men and 90,513 for women. Lung cancer mortality rates are predicted to decrease more among men than women, while colorectal cancer mortality will increase for both sexes. Conclusions: The profile of cancer premature mortality is diverse in Brazil. Nationally, only male lung cancer will be close to reaching SDG 3.4 target, endorsing government’s long term efforts to reduce tobacco consumption. Colorectal cancer mortality increases in most regions, reflecting the epidemiological transition. Despite progress in cervical cancer control, it will continue to be a major challenge, especially in the North and Northeast. Our results provide a baseline for public policies for both prevention and access to treatment to reduce premature mortality in Brazil. Differences in cancer patterns show the need to plan and to adapt regionally for each reality.

American Indian and Non-Hispanic White Midlife Mortality Is Associated With Medicaid Spending: An Oklahoma Ecological Study (1999-2016).

Objective: A one third reduction of premature deaths from non-communicable diseases by 2030 is a target of the United Nations Sustainable Development Goal for Health. Unlike in other developed nations, premature mortality in the United States (US) is increasing. The state of Oklahoma suffers some of the greatest rates in the US of both all-cause mortality and overdose deaths. Medicaid opioids are associated with overdose death at the patient level, but the impact of this exposure on population all-cause mortality is unknown. The objective of this study was to look for an association between Medicaid spending, as proxy measure for Medicaid opioid exposure, and all-cause mortality rates in the 45–54-year-old American Indian/Alaska Native (AI/AN45-54) and non-Hispanic white (NHW45-54) populations.Methods: All-cause mortality rates were collected from the US Centers for Disease Control & Prevention Wonder Detailed Mortality database. Annual per capita (APC) Medicaid spending, and APC Medicare opioid claims, smoking, obesity, and poverty data were also collected from existing databases. County-level multiple linear regression (MLR) analyses were performed. American Indian mortality misclassification at death is known to be common, and sparse populations are present in certain counties; therefore, the two populations were examined as a combined population (AI/NHW45-54), with results being compared to NHW45-54 alone.Results: State-level simple linear regressions of AI/NHW45-54 mortality and APC Medicaid spending show strong, linear correlations: females, coefficient 0.168, (R2 0.956; P < 0.0001; CI95 0.15, 0.19); and males, coefficient 0.139 (R2 0.746; P < 0.0001; CI95 0.10, 0.18). County-level regression models reveal that AI/NHW45-54 mortality is strongly associated with APC Medicaid spending, adjusting for Medicare opioid claims, smoking, obesity, and poverty. In females: [R2 0.545; (F)P < 0.0001; Medicaid spending coefficient 0.137; P < 0.004; 95% CI 0.05, 0.23]. In males: [R2 0.719; (F)P < 0.0001; Medicaid spending coefficient 0.330; P < 0.001; 95% CI 0.21, 0.45].Conclusions: In Oklahoma, per capita Medicaid spending is a very strong risk factor for all-cause mortality in the combined AI/NHW45-54 population, after controlling for Medicare opioid claims, smoking, obesity, and poverty.

Health Benefit Evaluation for Air Pollution Prevention and Control Action Plan in China

To quantitatively assess the health benefits brought by the implementation of the Action Plan of Air Pollution Prevention and Control, we firstly analyzed the spatial and temporal changes of PM2.5 population-weighted concentrations over China from 2013 to 2017. The BenMAP model was used to analyze the differences in premature death between the PM2.5 baseline scenario in 2013 and the control scenario in 2017 in 338 prefecture-level cities nationwide, so as to quantitatively analyze the number of premature deaths in 31 provinces. The results show that compared with other provinces, the largest reduction in premature deaths due to the significant decrease of PM2.5 concentration occurred in the Beijing-Tianjin-Hebei region and its surrounding regions, and the environmental health benefits from air quality have been greatly improved. The results show that from 2013 to 2017 the population weighted PM2.5 concentration was decreasing year by year due to the significant decrease in PM2.5 concentration; Beijing, Tianjin, Hebei, and the surrounding areas witnessed the largest reduction in premature deaths. In 2017, the number of avoided premature deaths in 280 prefecture-level cities nationwide increased, but declined in 58 cities. Taking the target value of the first phase of the WHO transition period (an annual average PM2.5 concentration of 35 μg·m-3) as the control scenario, it is estimated that the number of premature deaths in 2013 was approximately 101293, and in 2017 was approximately 41080. The implementation of the Action Plan helped to avoid approximately 60213 premature deaths. According to the method of 'willingness to pay', the monetary benefits are estimated to be approximately 54.97 billion yuan.

Rapid improvement of PM2.5 pollution and associated health benefits in China during 2013–2017

Exposure to fine particulate matter (PM2.5) is known to harm public health. In China, after implementation of aggressive emissions control measures under the Action Plan of Air Pollution Prevention and Control (2013–2017), air quality has significantly improved. In this work, we investigated changes in PM2.5 exposure and the associated health impacts in China for the period 2013–2017. We used an optimal estimator of PM2.5 combining in-situ observations, satellite measurements, and simulations from a chemical transport model to derive the spatial and temporal variations in PM2.5 exposure, and then used well-developed exposure-response functions to estimate the premature deaths attributable to PM2.5 exposure. We found that national population-weighed annual mean PM2.5 concentrations decreased from 67.4 µg m−3 in 2013 to 45.5 µg m−3 in 2017 (32% reduction). This rapid decrease in PM2.5 pollution led to a 14% reduction in premature deaths due to long-term exposure. We estimated that, during 2013–2017, the premature deaths attributable to long-term PM2.5 exposure decreased from 1.2 million (95% CI: 1.0, 1.3; fraction of total mortality: 13%) in 2013 to 1.0 million (95% CI: 0.9, 1.2; 10%) in 2017. Despite the rapid decrease in annual mean PM2.5 concentrations, health benefits associated with reduced long-term exposure were limited, because for many cities, the PM2.5 levels remain at the portion where the exposure-response function is less steeper than that at the low-concentration end. We also found that the deaths associated with acute exposure decreased by 61% during 2013–2017 due to rapid reduction in the number of heavily polluted days. Our results confirm that clean air policies in China have mitigated the air pollution crisis; however, continuous emissions reduction efforts are required to protect citizens from air pollution.

Health burdens of ambient PM2.5 pollution across Chinese cities during 2006–2015

With frequent severe haze and smog episodes in Chinese cities, an increasing number of studies have focused on estimating the impact of fine particulate matter (PM2.5) on public health. However, the current use of national and provincial demographic data might mask regional differences and lead to inaccurate estimations of pollution-related health impacts across cities. We applied the Global Burden of Disease methodology to develop a dataset of premature deaths attributed to ambient PM2.5 in 129 Chinese cities in 2006, 2010 and 2015, based on the information of baseline mortality rates and population densities at the city level. Our results suggested that ambient PM2.5 pollution led to 631,230 (95% confidence interval: 281,460–873,800) premature deaths in those cities in 2015, which was similar to that in 2010, but 42.8% higher than that in 2006. The reduction of premature deaths was not as obvious as the improvement in air quality in recent years, primarily owing to the aging Chinese population. For large and medium/small cities, the effects of PM2.5 abatement on alleviating public health burdens were lower than those for megalopolises and metropolises; however, such large and medium/small cities are at risk of increasing future PM2.5 pollution levels due to rapid development. Significant differences in PM2.5-induced premature deaths indicated the need for specific policies to mitigate the health burden of air pollution in different types of Chinese cities.

An update of the profile of older adults with dementia in Europe: findings from SHARE

Background: The increase in longevity due to the reduction of premature deaths has led to an increase of the number of people with dementia. The objective of the present work was to analyze the profile of the European population with dementia aged more than 50.Methods: The sample of individuals aged 51 or more years was taken from a European database within the last wave of the SHARE Project (Wave 6, March 2017). Participants with and without a diagnosis of dementia were compared in terms of socio-demographic, general health, mental health, behavioural risks, education and employment, by age group. Categorical variables were compared using chi-square test, quantitative variables were compared with the independent sample t-test.Results: From 45,340 subjects (40% males) 897 (2%) had dementia. The findings corroborate recent evidence stating that individuals with dementia have a lower physical and mental health as well as a lower quality of life than people without dementia. It was also verified that people with dementia: (i) had a lower employment rate; (ii) showed lower levels of formal education; (iii) less were living a married life; (iv) exhibited a moderate pattern of behavioural risks, but had higher levels of physical inactivity; (v) had more chronic diseases and (iv) higher intake of more than 5 drugs per day. The unfavourable health and well-being status of dementia subjects was found in all age groups.Conclusions: An update of the profile of older Europeans with dementia was performed with data from 18 countries. The findings of co-morbidity, high rates of intake of more than 5 drugs daily and low levels of well-being irrespective of age should be considered in the assessment and management of dementia in the European population.

Modelling impacts of food industry co-regulation on noncommunicable disease mortality, Portugal

ObjectiveTo model the reduction in premature deaths attributed to noncommunicable diseases if targets for reformulation of processed food agreed between the Portuguese health ministry and the food industry were met.MethodsThe 2015 co-regulation agreement sets voluntary targets for reducing sugar, salt and trans-fatty acids in a range of products by 2021. We obtained government data on dietary intake in 2015–2016 and on population structure and deaths from four major noncommunicable diseases over 1990–2016. We used the Preventable Risk Integrated ModEl tool to estimate the deaths averted if reformulation targets were met in full. We projected future trends in noncommunicable disease deaths using regression modelling and assessed whether Portugal was on track to reduce baseline premature deaths from noncommunicable diseases in the year 2010 by 25% by 2025, and by 30% before 2030.FindingsIf reformulation targets were met, we projected reductions in intake in 2015–2016 for salt from 7.6 g/day to 7.1 g/day; in total energy from 1911 kcal/day to 1897 kcal/day due to reduced sugar intake; and in total fat (% total energy) from 30.4% to 30.3% due to reduced trans-fat intake. This consumption profile would result in 248 fewer premature noncommunicable disease deaths (95% CI: 178 to 318) in 2016. We projected that full implementation of the industry agreement would reduce the risk of premature death from 11.0% in 2016 to 10.7% by 2021.ConclusionThe co-regulation agreement could save lives and reduce the risk of premature death in Portugal. Nevertheless, the projected impact on mortality was insufficient to meet international targets.