Healthy Life Years Research Articles

Priorities in tackling non-communicable diseases in children and adolescents in China

China was one of the top ten fast-track countries towards achieving the UN Millennium Development Goals 4 and 5 by 2015, and has since made substantial progress in child and adolescent health. 1 Qiao J Wang Y Li X et al. A Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China. Lancet. 2021; 397: 2497-2536 Summary Full Text Full Text PDF PubMed Google Scholar Over the past decades, the country has undergone an epidemiological transition towards non-communicable diseases (NCDs). The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has estimated that disability-adjusted life-years (DALYs) caused by NCDs among children and adolescents aged 0–19 years in China exceeded 13 million in 2019, accounting for 50·30% of all-cause DALYs among children and adolescents aged 0–19 years in China. This loss of healthy life-years necessitates a more effective and equitable approach that is responsive to the country's increasing NCD burden. To address this enormous challenge, prevention and timely diagnosis of, and early intervention for, NCDs should be a prominent focus of paediatric health services in China. Given the long-term burden of NCDs, such a focus is crucial in achieving progress towards the UN Sustainable Development Goals (SDGs), WHO's Global Strategy for Women's, Children's and Adolescents' Health (2016–2030), and Healthy China 2030. 2 WHOThe Global Strategy for Women's, Children's and Adolescents' Health (2016–2030): survive, thrive, transform. https://www.everywomaneverychild.org/global-strategy/#Date: September, 2015 Date accessed: August 26, 2020 Google Scholar , 3 The State Council of the People's Republic of ChinaHealthy China 2030. http://www.gov.cn/zhengce/2016-10/25/content_5124174.htmDate: October, 2016 Date accessed: November 13, 2022 Google Scholar

Investigating factors associated with the prevalence of IHD among uncontrolled diabetic patients

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Monash University Malaysia Background Ischaemic Heart Disease (IHD) is the leading cause of death in Malaysia (1), and there is an increasing trend in mortality due to IHD from 15.2% in 2019 to 17.2% in 2020 (2). IHD is one of the NCDs, estimated to have an RM100.79 billion burden of disease cost (health burden resulting from disability and loss of healthy life years), equivalent to 7% of GDP (3). Diabetes mellitus (DM) is known to be one of the risk factors for IHD. Purpose This study aimed to investigate the risk factors associated with the prevalence of IHD in uncontrolled diabetic patients. Besides, these characteristics were also compared among the duration of uncontrolled DM (<10 years vs. ≥10 years) Materials and Methods A single-center, cross-sectional study was conducted in a cardio referral center using Electronic Medical Record from 1 January 2020 to 31 December 2020. Adult patients aged ≥ 18 years old with uncontrolled type 2 diabetes mellitus (defined as HbA1c ≥7%) had their medical records examined for IHD upon first contact with the Diabetes Mellitus Therapy Adherence Clinic (DMTAC) pharmacist. Results A total of 495 participants with uncontrolled diabetes were included in the final analysis. The mean age and HbA1c in the overall cohort were 52.2 (10.9) years and 10.5%, respectively, with 59.4% (n=294) of them having <10 years of underlying diabetes. The majority were obese (64.8%) and had underlying hypertension (78.4%) and hyperlipidemia (78.4%). The prevalence of ischemic heart disease (IHD) among the overall cohort was 19.0% (n=94). Patients with longer underlying diabetes (≥10 years) were significantly older [mean age 56.8 (8.4) vs. 49.0 (11.4), p=<0.001], drinks alcohol [12.0% vs. 6.0%; p=0.022], had underlying hypertension [86.6 vs. 72.8; p=<0.001] and more comorbidities [mean 1.7 (0.55) vs. 1.5 (0.65); p=<0.001] compared to those with <10 years respectively. Independent predictors of IHD events were age 40-49 [OR 5.1 (95% CI 1.1-23.3); p=0.038], 50-59 [OR 5.36 (1.2-23.7); p=0.027] and ≥60 [OR 7.1 (1.6-32.3); p=0.011], alcohol use [OR 2.4 (1.1-5.1); p=0.023], ≥10 years of uncontrolled diabetes [OR 2.0 (1.2-3.3); P=0.007], and underlying hypertension [OR 2.6 (1.2-5.8); p=0.016]. Conclusion IHD has an indirect impact on social and economic development due to the high burden of the disease cost. In our study, older age, alcohol use, prolonged uncontrolled diabetes, and underlying hypertension seem to be associated with the prevalence of IHD complications. With the understanding of the recent outlook on diabetes, health education for the targeted population may negate this complication.

Lottery incentives for smoking cessation at the workplace: design and protocol of the smoke-free lottery - a cluster randomized trial

BackgroundSmoking is the leading behavioral risk factor for the loss of healthy life years. Many smokers want to quit, but have trouble doing so. Financial incentives in workplace settings have shown promising results in supporting smokers and their design influences their impact. Lotteries that leverage behavioral economic insights might improve the effectiveness of workplace cessation support.Methods and designWe examine in a cluster randomized trial if a workplace cessation group training paired with lottery deadlines will increase continuous abstinence rates over and above the cessation training alone. Organizations are randomized to either the control arm or lottery arm. The lotteries capitalize regret aversion by always informing winners at the deadline, but withholding prizes if they smoked. In the lottery-arm, winners are drawn out of all participants within a training group, regardless of their smoking status. In weeks 1-13 there are weekly lotteries. Winners are informed about their prize (€50), but can only claim it if they did not smoke that week, validated biochemically. After 26 weeks, there is a long-term lottery where the winners are informed about their prize (vacation voucher worth €400), but can only claim it if they were abstinent between weeks 13 and 26. The primary outcome is continuous abstinence 52 weeks after the quit date.DiscussionThere is a quest for incentives to support smoking cessation that are considered fair, affordable and effective across different socioeconomic groups. Previous use of behavioral economics in the design of lotteries have shown promising results in changing health behavior. This cluster randomized trial aims to demonstrate if these lotteries are also effective for supporting smoking cessation. Therefore the study design and protocol are described in detail in this paper. Findings might contribute to the application and development of effective cessation support at the workplace.Trial registrationNetherlands Trial Register Identifier: NL8463. Date of registration: 17-03-2020.

Secondary prevention of osteoporotic fractures in the Republic of Belarus: DALY-analysis and cost-effectiveness

Objective. To calculate the number of lost (including healthy) years of life in patients aged 50 years and older with proximal femur fractures (PF) in the Republic of Belarus based on primary incidence data and evaluate the cost-effectiveness of the therapeutic model for the secondary prevention of osteoporotic fractures.Materials and methods. A comprehensive assessment of health losses was carried out using DALY analysis based on our own epidemiological data on the primary incidence of PF and is presented in years of life lost to due to premature mortality and the years lived with a disability. The alendronic acid (AA) prescription after a primary PF fracture was proposed for secondary prevention of PF fractures. The cost-effectiveness was calculated based on the cost of one saved (including healthy) year in relation to the national GDP per capita.Results. In the Republic of Belarus taking into account sex and age structure of the population it is expected to have a total of 2867 PF fractures in men (558 atal cases during the first year) and 7921 (2382 fatal cases) in women per year. The total number of lost (including healthy) years of life due to osteoporotic PF fractures was 8719.0 in men and 8169.9 in women. The administration of AA after PF fracture will save 1806.11 years of healthy life. The cost of one saved (incl. healthy) year was 1044.2 BYN/year for men (6.5% of GDP per capita) and 1720.1 BYN/year for women (10.8% of GDP per capita).Conclusion. Prescription of antiresorptive therapy in the form of alendronic acid to men and women aged 50 years and older after a osteoporotic PF fracture for prevention of recurrent osteoporotic fractures is highly cost-effective and can be considered when assessing the threshold of intervention in treating patients with osteoporosis in the Republic of Belarus.

Burden of Cancer in the Working Age Population in the Context of Economic Inequalities in the European Union

The aim of the presented research is to assess the degree of burdening the EU economies with the effects of cancer in the context of the limitations diagnosed of the labor market potential in the Member States. Particular attention was paid to the problem of existing inequalities in the level of burdening national economies with the effects of premature mortality due to cancer observed in the relationship between the "old" and the "new" EU. The extent to which EU economies were burdened by the long-term effects of cancer was measured by the number of prematurely lost years of healthy life for people of working age. The hypothesis of a persistently high level of inequality was verified on the basis of an analysis of the convergence process in the group of EU-27 countries in the years 1990-2019. The results obtained indicate that the level of health limitations caused by cancer is strongly differentiated in the EU-27 group. The inequalities observed concern, in particular, the relationship between the "old" and "new" Europe and indicate a high burden of health consequences for the inhabitants of Central and Eastern Europe. The analysis of catching up process by the countries with the least favorable situation (the highest level of cancer burden), carried out in the EU-27 group, did not show a real effect of reducing disproportions in the level of the parameters analyzed.

Clinico-epidemiological Profile of Geriatric Patients Presenting With Heart Failure: A Hospital Based Study.

Introduction: Heart Failure (HF) is a chronic complex clinical condition that results from any structural or functional (systolic or diastolic) impairment of ventricular filling or ejection of blood. It has currently increased in prevalence with 64.34 million cases, accounting for 9.91 million years of healthy life lost due to disability (YLDs). Aim: This research was conducted to study the clinico-epidemiological profile of heart failure in geriatric patients. Materials & Methodology: The present hospital based study was conducted for a period of 18 months, among all patients above 60yrs of age presented to OPD or admitted in medicine department, NIMS, as a case of Heart failure. Follow up was done till the study end points. Results: Total of 100 patients were included in the study, who fulfilled the inclusion criteria. The median age of patients was found to be71.77±0.72 years, among which 58.6% are male. There was significant association of Heart failure with ejection fraction & Systolic HTN. Conclusion: We concluded that age, BMI, Heart Rate, economic status and serum creatinine are significant factor in predicting the incidence of heart failure in the geriatric patients.

Clinico-epidemiological Profile of Geriatric Patients Presenting With Heart Failure: A Hospital Based Study.

Introduction: Heart Failure (HF) is a chronic complex clinical condition that results from any structural or functional (systolic or diastolic) impairment of ventricular filling or ejection of blood. It has currently increased in prevalence with 64.34 million cases, accounting for 9.91 million years of healthy life lost due to disability (YLDs). Aim: This research was conducted to study the clinico-epidemiological profile of heart failure in geriatric patients. Materials & Methodology: The present hospital based study was conducted for a period of 18 months, among all patients above 60yrs of age presented to OPD or admitted in medicine department, NIMS, as a case of Heart failure. Follow up was done till the study end points. Results: Total of 100 patients were included in the study, who fulfilled the inclusion criteria. The median age of patients was found to be71.77±0.72 years, among which 58.6% are male. There was significant association of Heart failure with ejection fraction & Systolic HTN. Conclusion: We concluded that age, BMI, Heart Rate, economic status and serum creatinine are significant factor in predicting the incidence of heart failure in the geriatric patients.

Clinico-epidemiological Profile of Geriatric Patients Presenting With Heart Failure: A Hospital Based Study.

Introduction: Heart Failure (HF) is a chronic complex clinical condition that results from any structural or functional (systolic or diastolic) impairment of ventricular filling or ejection of blood. It has currently increased in prevalence with 64.34 million cases, accounting for 9.91 million years of healthy life lost due to disability (YLDs). Aim: This research was conducted to study the clinico-epidemiological profile of heart failure in geriatric patients. Materials & Methodology: The present hospital based study was conducted for a period of 18 months, among all patients above 60yrs of age presented to OPD or admitted in medicine department, NIMS, as a case of Heart failure. Follow up was done till the study end points. Results: Total of 100 patients were included in the study, who fulfilled the inclusion criteria. The median age of patients was found to be71.77±0.72 years, among which 58.6% are male. There was significant association of Heart failure with ejection fraction & Systolic HTN. Conclusion: We concluded that age, BMI, Heart Rate, economic status and serum creatinine are significant factor in predicting the incidence of heart failure in the geriatric patients.

Comparing the Performance of a Survival Models In a Computerized Dataset

Every patient demonstrates the loss of one year of healthy life. In addition, 7.6% of global DALYs are assigned to the neoplasms. The three leading cancers in both sexes worldwide were lung cancer (13% of the total), breast cancer (11.9%), and colorectal cancer (9.7%); the most common types of cancer in men, respectively, are lung cancer (16.8%), prostate cancer (14.8%) and colorectal cancer (10.1%) while in women they are ordered as breast cancer (25.1%), colorectal cancer (9.2%) and lung cancer (8.8%). The research aimed to compare the performance of Weibull, Log-logistics, and Gompertz survival models on oncological data. The research methodology involved the collection of data cases on oncological study analyzed using descriptive statistics, parametric survival models were also used in the analysis. The result shows the maximum likelihood estimates of dataset 1 with 3 with a different model fit, all the information criteria and log-likelihood of the models indicate that Gompertz model has the smallest value in all the information criteria, indicating that Gompertz model is the best-fitted model to Remission Times of Bladder Cancer patient’s data. The research concludes that a parametric that can best be used to model cancer data known as Gompertz model is the best-used model in the research. The research will enable other researchers such as medical personnel to model or know the best model for cancer-related cases.

School-based socio-emotional learning programs to prevent depression, anxiety and suicide among adolescents: a global cost-effectiveness analysis.

Preventing the occurrence of depression/anxiety and suicide during adolescence can lead to substantive health gains over the course of an individual person's life. This study set out to identify the expected population-level costs and health impacts of implementing universal and indicated school-based socio-emotional learning (SEL) programs in different country contexts. A Markov model was developed to examine the effectiveness of delivering universal and indicated school-based SEL programs to prevent the onset of depression/anxiety and suicide deaths among adolescents. Intervention health impacts were measured in healthy life years gained (HLYGs) over a 100-year time horizon. Country-specific intervention costs were calculated and denominated in 2017 international dollars (2017 I$) under a health systems perspective. Cost-effectiveness findings were subsequently expressed in terms of I$ per HLYG. Analyses were conducted on a group of 20 countries from different regions and income levels, with final results aggregated and presented by country income group - that is, low and lower middle income countries (LLMICs) and upper middle and high-income countries (UMHICs). Uncertainty and sensitivity analyses were conducted to test model assumptions. Implementation costs ranged from an annual per capita investment of I$0.10 in LLMICs to I$0.16 in UMHICs for the universal SEL program and I$0.06 in LLMICs to I$0.09 in UMHICs for the indicated SEL program. The universal SEL program generated 100 HLYGs per 1 million population compared to 5 for the indicated SEL program in LLMICs. The cost per HLYG was I$958 in LLMICS and I$2,006 in UMHICs for the universal SEL program and I$11,123 in LLMICs and I$18,473 in UMHICs for the indicated SEL program. Cost-effectiveness findings were highly sensitive to variations around input parameter values involving the intervention effect sizes and the disability weight used to estimate HLYGs. The results of this analysis suggest that universal and indicated SEL programs require a low level of investment (in the range of I$0.05 to I$0.20 per head of population) but that universal SEL programs produce significantly greater health benefits at a population level and therefore better value for money (e.g., less than I$1,000 per HLYG in LLMICs). Despite producing fewer population-level health benefits, the implementation of indicated SEL programs may be justified as a means of reducing population inequalities that affect high-risk populations who would benefit from a more tailored intervention approach.

The cost-effectiveness of improved brief interventions for tobacco cessation in Thailand.

This study estimated the cost-effectiveness of four strategies enhancing the quality and accessibility of Brief Intervention (BI) service for smoking cessation in Thailand during 2022-2030: (1) current-BI (status quo), (2) the effective-training standard-BI, (3) the current-BI plus the village health volunteers (VHV) mobilization, and (4) the effective-training BI plus VHV mobilization. By interviewing five public health officers, nine healthcare professionals aiding these services, and fifteen BI service experts, we explored the status quo situation of the Thai smoking cessation service system, including main activities, their quantity assumptions, and activities' unit prices needed to operate the current cessation service system. Then, we modeled additional activities needed to implement the other three simulated scenarios. We estimated the costs and impacts of implementing these strategies over a nine-year operating horizon (2022-2030), covering 3 years of service system preparation and 6 years of full implementation. The modeled costs of these four strategies included intervention and program costs. The study focused on current smokers age 15 years or older. The assessed impact parameters encompassed smoking prevalence, deaths averted, and healthy life-years gained. An Incremental Cost-Effectiveness Analysis compared the four simulated strategies was employed. Data analysis was performed using the One Health Tool software, which the World Health Organization developed. The findings of this investigation reveal that all three intervention strategies exhibited cost-effectiveness compared to the prevailing status quo. Among these strategies, Strategy 2, enhancing BI service quality, emerged as the most efficient and efficacious option. Therefore, the expansion of quality services should be synergistically aligned with augmented training, service delivery optimization, and managerial enhancements. This approach is particularly poised to enhance accessibility to and the efficacy of smoking cessation interventions across Thailand.

Red flags for secondary headaches: challenges in clinical practice

Introduction The World Health Organization (WHO) ranks migraine as one of the top 20 causes of impaired healthy life years per year worldwide. Migraine alone is responsible for about 400,000 lost workdays per year per one million inhabitants in developed countries. Headache is probably among the five most important causes of disability worldwide. Method This literature review was carried out by searching the Pubmed, Lilacs and Scopus databases, using the following Health Science Descriptors (DeCS) of the Virtual Health Library and in particular the current data collected by the WHO or health entities in the various countries: "secondary headaches" AND "red flags" AND "review". Articles published in Portuguese and English were selected. The eligibility criteria defined for the inclusion of articles were studies that addressed the chosen theme. Results The use of "Red Flags" in clinical practice is of considerable relevance. The combination of "Red Flags", anamnesis, physical examination, laboratory, and imaging examination accentuate the probability of predicting the etiology that may underlie the onset of a secondary headache. However, despite this widely useful screening tool, there are still gaps in the prognosis. Conclusion Much remains unclear as there is a lack of prospective epidemiological studies. In addition, some "Red Flags" such as pattern change are poorly elucidated. Large-scale studies are needed due to the low incidence of many secondary causes. New patients with headache should be screened using the SNNOOP10 list to increase the likelihood of detecting a secondary cause.

A SIMPLIFIED APPROACH FOR CLASSIFYING PHYSICAL RESILIENCE AMONG OLDER ADULTS: THE HEALTH ABC STUDY

Abstract Physical resilience is an emerging concept within the context of aging and geriatric medicine, and we previously developed and validated one such measure based on the mismatch between persons’ frailty level and comorbidity burden. We sought to develop a simplified version for classifying physical resilience. We also examined the agreement between the simplified version and the original approach and evaluated its predictive validity. We included 2,457 older adults from the Health, Aging, and Body Composition Study. We constructed a simplified version for quantifying physical resilience based on the comorbidity burden and level of frailty (score: 0-10). Participants were grouped by the number of diseases and classified into three groups—adapters, expected agers, and premature frailers—based on the mean and SD of frailty score (less than, within, or above one standard deviation of the mean). The Cohen’s kappa between the novel resilience classification and the original approach was 0.70, and the percentage of absolute agreement was 85.4%. We observed a steep increase in years of healthy and able life from premature frailers to adapters in the simplified resilience classifications. We developed a simplified version for quantifying physical resilience in a cohort of initially well-functioning older Black and White adults. The agreement between the simplified version and the original approach is high. Adapters had a longer healthy lifespan than expected agers and premature frailers. This user-friendly measure could help assess patients’ physical resilience in clinical settings.

Association of Parental Cardiovascular Health With Disability-Adjusted Life Years in the Offspring: Results From the Framingham Heart Study.

Disability-adjusted life years (DALYs) are used to evaluate the relative burden of diseases in populations to help set prevention or treatment priorities. The impact of parental cardiovascular health (CVH) on healthy life years lost from cardiovascular disease (CVD) in adult offspring is unknown. We compared parent-offspring CVD DALYs trends over the life course and examined the association of parental CVH with offspring CVD DALYs. Using data from the Framingham Heart Study, 4814 offspring-mother-father trios were matched for age at selected baseline exams. CVH score was computed from the number of CVH metrics attained at recommended levels: poor (0-2), intermediate (3-4), and ideal (5-7). CVD DALYs were defined as the sum of years of life lost and years lived with CVD. Age-sex-standardized life expectancy and disability weights were derived from the actuarial life tables and Global Burden of Disease study, respectively. Multivariable-adjusted linear regression was used to investigate the association of parental CVH with offspring CVD DALYs. Over an equal 47-year follow-up, parents lost nearly twice the number of CVD DALYs compared to their offspring (23 234 versus 12 217). However, age-adjusted CVD DALYs were higher at younger ages and similar along the life course for parents and offspring. One-unit increase in parental CVH was associated with 5 healthy life months saved in offspring. Offspring of mothers with ideal versus poor CVH had 3 healthy life years saved (β=-3.0 DALYs [95% CI, -5.6 to -0.3]). No statistically significant association was found between paternal CVH categories and offspring CVD DALYs. Higher maternal and paternal CVH were associated with increased healthy life years in offspring; however, the association was strongest between mothers and offspring. Investment in CVH promotion along the life course has the potential to reduce the burden of CVD in the current and future generation of adults.

Food Accessibility in the Suburbs of the Metropolitan City of Antwerp (Belgium): A Factor of Concern in Local Public Health and Active and Healthy Aging.

Population aging and declining birth rates are key demographic trends of the 21st century. While the overall life expectancy and healthy life years increase, the quality of life and functional capacity worsens due to non-communicable diseases strongly related to aging. Therefore, aging citizens are often vulnerable to food insecurity. The aim of this paper is to provide insights into the physical accessibility of fresh food and possible alternatives within the setting of an aging society in Antwerp (Belgium), a metropolitan city at the heart of the EU Reference Site 'Three Rivers Food Delta'. We demonstrate that a large number of the Antwerp suburban areas in which 15 to 25% of current inhabitants are already over 65 years old are confronted with problematic physical accessibility of food due to long walking distances to the nearest food shop. E-commerce has the potential to provide better access to fresh food. This is especially relevant for people with specific needs, such as health-related diets, dysphagia, and/or limited mobility. However, e-commerce introduces new inequalities, as those who would benefit the most from digital accessibility currently use it least. Hence, the organization of fresh food access requires a more thoughtful organization of the 'last mile' and possible alternatives to home delivery. This makes food accessibility an urgent factor of concern in public health and healthy aging in the Antwerp suburban areas.

Cross-sectional estimates of population health from the Survey of Health and Retirement in Europe (SHARE) are biased due to health-related sample attrition

Cross-sectional data from the Survey of Health, Ageing and Retirement in Europe (SHARE) are a common source of information in comparative studies of population health in Europe. In the largest part, these data are based on longitudinal samples, which are subject to health-specific attrition. This implies that estimates of population health based on cross-sectional SHARE datasets are biased as the data are selected on the outcome variable of interest.We examine whether cross-sectional datasets are selected based on health status. We compare estimates of the prevalence of full health, healthy life years at age 50 (HLY), and rankings of 18 European countries by HLY based on the observed, cross-sectional SHARE wave 7 datasets and full samples. The full samples consist of SHARE observed and attrited respondents, whose health trajectories are imputed by microsimulation. Health status is operationalized across the global index of limitations in activities of daily living (GALI). HLY stands for life expectancy free of activity limitations.Cross-sectional datasets are selected based on health status, as health limitations increase the odds of attrition from the panel in older age groups and reduce them in younger ones. In older age groups, the prevalence of full health is higher in the observed cross-sectional data than in the full sample in most countries. In most countries, HLY is overestimated based on the cross-sectional data, and in some countries, the opposite effect is observed. While, due to the small sample sizes of national surveys, the confidence intervals are large, the direction of the effect is persistent across countries. We also observe shifts in the ranking of countries according to HLYs of the observed data versus the HLYs of the full sample.We conclude that estimates on population health based on cross-sectional datasets from longitudinal, attrited SHARE samples are over-optimistic.

Healthspan versus lifespan: new medicines to close the gap.

On 27 and 28 June 2022, the UK SPINE network ( www.kespine.org.uk ) held an in-person conference focusing on how new medicines could contribute to improving healthspan (healthy life years). The event facilitated knowledge exchange within the broader geroscience community by bringing together researchers and stakeholders from multiple sectors, including industry, academia, entrepreneurs, small-to-medium-sized enterprises, regulators, patients and carers, investors and policy makers.

Ecological and socioeconomic factors associated with the human burden of environmentally mediated pathogens: a global analysis

Billions of people living in poverty are at risk of environmentally mediated infectious diseases-that is, pathogens with environmental reservoirs that affect disease persistence and control and where environmental control of pathogens can reduce human risk. The complex ecology of these diseases creates a global health problem not easily solved with medical treatment alone. We quantified the current global disease burden caused by environmentally mediated infectious diseases and used a structural equation model to explore environmental and socioeconomic factors associated with the human burden of environmentally mediated pathogens across all countries. We found that around 80% (455 of 560) of WHO-tracked pathogen species known to infect humans are environmentally mediated, causing about 40% (129 488 of 359 341 disability-adjusted life years) of contemporary infectious disease burden (global loss of 130 million years of healthy life annually). The majority of this environmentally mediated disease burden occurs in tropical countries, and the poorest countries carry the highest burdens across all latitudes. We found weak associations between disease burden and biodiversity or agricultural land use at the global scale. In contrast, the proportion of people with rural poor livelihoods in a country was a strong proximate indicator of environmentally mediated infectious disease burden. Political stability and wealth were associated with improved sanitation, better health care, and lower proportions of rural poverty, indirectly resulting in lower burdens of environmentally mediated infections. Rarely, environmentally mediated pathogens can evolve into global pandemics (eg, HIV, COVID-19) affecting even the wealthiest communities. The high and uneven burden of environmentally mediated infections highlights the need for innovative social and ecological interventions to complement biomedical advances in the pursuit of global health and sustainability goals. Bill & Melinda Gates Foundation, National Institutes of Health, National Science Foundation, Alfred P. Sloan Foundation, National Institute for Mathematical and Biological Synthesis, Stanford University, and the US Defense Advanced Research Projects Agency.

Genetics of healthy life years.

Genetics of healthy life years.

Redistribution down under—dealing with ill-defined deaths in the Australian Burden of Disease Study

Abstract Burden of disease analyses measure the healthy years of life lost due to living with and dying prematurely from disease and injury. It is now the global standard for comparable policy-relevant evidence on the impact of disease, injuries, and risks on a population. The Australian Burden of Disease Study (ABDS), undertaken by the Australian Institute of Health and Welfare, uses Australian-specific data and methods (based on the Global Burden of Disease Study, adjusted to suit the Australian context) to quantify disease burden for Australia. Despite the high quality of deaths registration data in Australia, in burden of disease analyses not all coded causes of death are considered appropriate or valid to estimate years of life lost (YLL). Therefore, these ‘ill-defined deaths’ are redistributed to one or more diseases on the ABDS disease list according to a more probable underlying cause of death. In the latest ABDS, almost 1 in 10 deaths in 2018 was an ill-defined death. Most of these were redistributed to other diseases using one of three methods developed for the Study: 1) direct evidence on more plausible causes of death from data linkage studies or other sources 2) redistribution algorithms based on the distribution of underlying causes of death where the ill-defined cause was recorded as an associated cause of death 3) reassignment of deaths across a specified range of target diseases according to patterns of causes of death observed in the mortality data for the ABDS disease list. Expert advice was also received on the redistribution of deaths from septicaemia and deaths coded to ICD-10 code X59 Exposure to unspecified factor. Overall, 8.5% of the years of life lost for Australia in 2018 came from ill-defined deaths. These deaths generally followed age-specific all-cause mortality patterns. It is important to consider methods and target diseases when redistributing ill-defined deaths to appropriately quantify their contribution to disease-specific burden.