Showing papers by "Goodarz Danaei published in 2013"

The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors

Abstract: Importance Understanding the major health problems in the United States and how they are changing over time is critical for informing national health policy. Objectives To measure the burden of diseases, injuries, and leading risk factors in the United States from 1990 to 2010 and to compare these measurements with those of the 34 countries in the Organisation for Economic Co-operation and Development (OECD) countries. Design We used the systematic analysis of descriptive epidemiology of 291 diseases and injuries, 1160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors from 1990 to 2010 for 187 countries developed for the Global Burden of Disease 2010 Study to describe the health status of the United States and to compare US health outcomes with those of 34 OECD countries. Years of life lost due to premature mortality (YLLs) were computed by multiplying the number of deaths at each age by a reference life expectancy at that age. Years lived with disability (YLDs) were calculated by multiplying prevalence (based on systematic reviews) by the disability weight (based on population-based surveys) for each sequela; disability in this study refers to any short- or long-term loss of health. Disability-adjusted life-years (DALYs) were estimated as the sum of YLDs and YLLs. Deaths and DALYs related to risk factors were based on systematic reviews and meta-analyses of exposure data and relative risks for risk-outcome pairs. Healthy life expectancy (HALE) was used to summarize overall population health, accounting for both length of life and levels of ill health experienced at different ages. Results US life expectancy for both sexes combined increased from 75.2 years in 1990 to 78.2 years in 2010; during the same period, HALE increased from 65.8 years to 68.1 years. The diseases and injuries with the largest number of YLLs in 2010 were ischemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, and road injury. Age-standardized YLL rates increased for Alzheimer disease, drug use disorders, chronic kidney disease, kidney cancer, and falls. The diseases with the largest number of YLDs in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain, and anxiety disorders. As the US population has aged, YLDs have comprised a larger share of DALYs than have YLLs. The leading risk factors related to DALYs were dietary risks, tobacco smoking, high body mass index, high blood pressure, high fasting plasma glucose, physical inactivity, and alcohol use. Among 34 OECD countries between 1990 and 2010, the US rank for the age-standardized death rate changed from 18th to 27th, for the age-standardized YLL rate from 23rd to 28th, for the age-standardized YLD rate from 5th to 6th, for life expectancy at birth from 20th to 27th, and for HALE from 14th to 26th. Conclusions and Relevance From 1990 to 2010, the United States made substantial progress in improving health. Life expectancy at birth and HALE increased, all-cause death rates at all ages decreased, and age-specific rates of years lived with disability remained stable. However, morbidity and chronic disability now account for nearly half of the US health burden, and improvements in population health in the United States have not kept pace with advances in population health in other wealthy nations.

Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide

Abstract: Objectives: To estimate global, regional (21 regions) and national (187 countries) sodium intakes in adults in 1990 and 2010. Design: Bayesian hierarchical modelling using all identifiable primary sources. Data sources and eligibility: We searched and obtained published and unpublished data from 142 surveys of 24 h urinary sodium and 103 of dietary sodium conducted between 1980 and 2010 across 66 countries. Dietary estimates were converted to urine equivalents based on 79 pairs of dual measurements. Modelling methods: Bayesian hierarchical modelling used survey data and their characteristics to estimate mean sodium intake, by sex, 5 years age group and associated uncertainty for persons aged 20+ in 187 countries in 1990 and 2010. Country-level covariates were national income/person and composition of food supplies. Main outcome measures: Mean sodium intake (g/day) as estimable by 24 h urine collections, without adjustment for non-urinary losses. Results: In 2010, global mean sodium intake was 3.95 g/day (95% uncertainty interval: 3.89 to 4.01). This was nearly twice the WHO recommended limit of 2 g/day and equivalent to 10.06 (9.88–10.21) g/day of salt. Intake in men was ∼10% higher than in women; differences by age were small. Intakes were highest in East Asia, Central Asia and Eastern Europe (mean >4.2 g/day) and in Central Europe and Middle East/

The Age-Specific Quantitative Effects of Metabolic Risk Factors on Cardiovascular Diseases and Diabetes: A Pooled Analysis

Abstract: Background The effects of systolic blood pressure (SBP), serum total cholesterol (TC), fasting plasma glucose (FPG), and body mass index (BMI) on the risk of cardiovascular diseases (CVD) have been established in epidemiological studies, but consistent estimates of effect sizes by age and sex are not available. Methods We reviewed large cohort pooling projects, evaluating effects of baseline or usual exposure to metabolic risks on ischemic heart disease (IHD), hypertensive heart disease (HHD), stroke, diabetes, and, as relevant selected other CVDs, after adjusting for important confounders. We pooled all data to estimate relative risks (RRs) for each risk factor and examined effect modification by age or other factors, using random effects models. Results Across all risk factors, an average of 123 cohorts provided data on 1.4 million individuals and 52,000 CVD events. Each metabolic risk factor was robustly related to CVD. At the baseline age of 55–64 years, the RR for 10 mmHg higher SBP was largest for HHD (2.16; 95% CI 2.09–2.24), followed by effects on both stroke subtypes (1.66; 1.39–1.98 for hemorrhagic stroke and 1.63; 1.57–1.69 for ischemic stroke). In the same age group, RRs for 1 mmol/L higher TC were 1.44 (1.29–1.61) for IHD and 1.20 (1.15–1.25) for ischemic stroke. The RRs for 5 kg/m2 higher BMI for ages 55–64 ranged from 2.32 (2.04–2.63) for diabetes, to 1.44 (1.40–1.48) for IHD. For 1 mmol/L higher FPG, RRs in this age group were 1.18 (1.08–1.29) for IHD and 1.14 (1.01–1.29) for total stroke. For all risk factors, proportional effects declined with age, were generally consistent by sex, and differed by region in only a few age groups for certain risk factor-disease pairs. Conclusion Our results provide robust, comparable and precise estimates of the effects of major metabolic risk factors on CVD and diabetes by age group.

Associations of Suboptimal Growth with All-Cause and Cause-Specific Mortality in Children under Five Years: A Pooled Analysis of Ten Prospective Studies

Abstract: Background Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies.

The Global Cardiovascular Risk Transition Associations of Four Metabolic Risk Factors with National Income, Urbanization, and Western Diet in 1980 and 2008

Abstract: Background—It is commonly assumed that cardiovascular disease risk factors are associated with affluence and Westernization. We investigated the associations of body mass index (BMI), fasting plasma glucose, systolic blood pressure, and serum total cholesterol with national income, Western diet, and, for BMI, urbanization in 1980 and 2008. Methods and Results—Country-level risk factor estimates for 199 countries between 1980 and 2008 were from a previous systematic analysis of population-based data. We analyzed the associations between risk factors and per capita national income, a measure of Western diet, and, for BMI, the percentage of the population living in urban areas. In 1980, there was a positive association between national income and population mean BMI, systolic blood pressure, and total cholesterol. By 2008, the slope of the association between national income and systolic blood pressure became negative for women and zero for men. Total cholesterol was associated with national income and Weste...

Observational data for comparative effectiveness research: An emulation of randomised trials of statins and primary prevention of coronary heart disease

Abstract: This article reviews methods for comparative effectiveness research using observational data. The basic idea is using an observational study to emulate a hypothetical randomised trial by comparing initiators versus non-initiators of treatment. After adjustment for measured baseline confounders, one can then conduct the observational analogue of an intention-to-treat analysis. We also explain two approaches to conduct the analogues of per-protocol and as-treated analyses after further adjusting for measured time-varying confounding and selection bias using inverse-probability weighting. As an example, we implemented these methods to estimate the effect of statins for primary prevention of coronary heart disease (CHD) using data from electronic medical records in the UK. Despite strong confounding by indication, our approach detected a potential benefit of statin therapy. The analogue of the intention-to-treat hazard ratio (HR) of CHD was 0.89 (0.73, 1.09) for statin initiators versus non-initiators. The HR of CHD was 0.84 (0.54, 1.30) in the per-protocol analysis and 0.79 (0.41, 1.41) in the as-treated analysis for 2 years of use versus no use. In contrast, a conventional comparison of current users versus never users of statin therapy resulted in a HR of 1.31 (1.04, 1.66). We provide a flexible and annotated SAS program to implement the proposed analyses.

The contributions of risk factor trends to cardiometabolic mortality decline in 26 industrialized countries

Abstract: BACKGROUND: Cardiovascular disease mortality has declined and diabetes mortality has increased in high-income countries. We estimated the potential role of trends in population body mass index, systolic blood pressure, serum total cholesterol and smoking in cardiometabolic mortality decline in 26 industrialized countries. METHODS: Mortality data were from national vital statistics. Body mass index, systolic blood pressure and serum total cholesterol were from a systematic analysis of population-based data. We estimated the associations between change in cardiometabolic mortality and changes in risk factors, adjusted for change in per-capita gross domestic product. We calculated the potential contribution of risk factor trends to mortality decline. RESULTS: Between 1980 and 2009, age-standardized cardiometabolic mortality declined in all 26 countries, with the annual decline between 60% of decline among men and women in Finland and Switzerland, men in New Zealand and France, and women in Italy; their benefits were smallest in Mexican, Portuguese, and Japanese men and Mexican women. Risk factor trends may have slowed down mortality decline in Chilean men and women and had virtually no effect in Argentinean women. The contributions of risk factors to mortality decline seemed substantially larger among men than among women in the USA, Canada and The Netherlands. CONCLUSIONS: Industrialized countries have varied widely in the extent of risk factor prevention, and its likely benefits for cardiometabolic mortality.

Statins and Risk of Diabetes: An analysis of electronic medical records to evaluate possible bias due to differential survival

Abstract: OBJECTIVE Two meta-analyses of randomized trials of statins found increased risk of type 2 diabetes. One possible explanation is bias due to differential survival when patients who are at higher risk of diabetes survive longer under statin treatment. RESEARCH DESIGN AND METHODS We used electronic medical records from 500 general practices in the U.K. and included data from 285,864 men and women aged 50–84 years from January 2000 to December 2010. We emulated the design and analysis of a hypothetical randomized trial of statins, estimated the observational analog of the intention-to-treat effect, and adjusted for differential survival bias using inverse-probability weighting. RESULTS During 1.2 million person-years of follow-up, there were 13,455 cases of type 2 diabetes and 8,932 deaths. Statin initiation was associated with increased risk of type 2 diabetes. The hazard ratio (95% CI) of diabetes was 1.45 (1.39–1.50) before adjusting for potential confounders and 1.14 (1.10–1.19) after adjustment. Adjusting for differential survival did not change the estimates. Initiating atorvastatin and simvastatin was associated with increased risk of type 2 diabetes. CONCLUSIONS In this sample of the general population, statin therapy was associated with 14% increased risk of type 2 diabetes. Differential survival did not explain this increased risk.

Hypothetical midlife interventions in women and risk of type 2 diabetes.

Abstract: Background: Randomized trials have examined short-term effects of lifestyle interventions for diabetes prevention only among high-risk individuals. Prospective studies have examined the associations between lifestyle factors and diabetes in healthy populations but have not characterized the intervention. We estimated the long-term effects of hypothetical lifestyle interventions on diabetes in a prospective study of healthy women, using the parametric g-formula. Methods: Using data from the Nurses’ Health Study, we followed 76,402 women from 1984 to 2008. We estimated the risk of type 2 diabetes under eight hypothetical interventions: quitting smoking, losing weight by 5% every 2 years if overweight/obese, exercising at least 30 minutes a day, eating less than three servings a week of red meat, eating at least two servings a day of whole grain, drinking two or more cups of coffee a day, drinking five or more grams of alcohol a day, and drinking less than one serving of soda a week. Results: The 24-year risk of diabetes was 9.6% under no intervention and 4.3% when all interventions were imposed (55% lower risk [95% confidence interval = 47 to 63%]). The most effective interventions were weight loss (24% lower risk), physical activity (19%), and moderate alcohol use (19%). Overweight/obese women would benefit the most, with 10.8 percentage point reduction in 24-year risk of diabetes. The validity of these estimates relies on the absence of unmeasured confounding, measurement error, and model misspecification. Conclusion: A combination of dietary and nondietary lifestyle modifications, begun in midlife or later in relatively healthy women, could have prevented at least half of the cases of type 2 diabetes in this cohort of U.S. women.

Do mass media campaigns improve physical activity? a systematic review and meta-analysis

Abstract: Background Mass media campaigns are frequently used to influence the health behaviors of various populations. There are currently no quantitative meta-analyses of the effect of mass media campaigns on physical activity in adults.

The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from

Abstract: Background: Child stunting, wasting, and underweight have been individually associated with increased mortality. However, there has not been an analysis of the mortality risk associated with multiple anthropometric deficits. Objective: The objective was to quantify the association between combinations of stunting, wasting, and underweight and mortality among children ,5 y of age. Design: We analyzed data from 10 cohort studies or randomized trials in low- and middle-income countries in Africa, Asia, and Latin America with 53,767 participants and 1306 deaths. Height-for-age, weightfor-height, and weight-for-age were calculated using the 2006 WHO growth standards, and children were classified into 7 mutually exclusive combinations: no deficits; stunted only; wasted only; underweight only; stunted and underweight but not wasted; wasted and underweight but not stunted; and stunted, wasted, and underweight (deficit defined as ,2 2 z scores). We calculated studyspecific mortality HRs using Cox proportional hazards models and used a random-effects model to pool HRs across studies. Results: The risk of all-cause mortality was elevated among children with 1, 2, and 3 anthropometric deficits. In comparison with children with no deficits, the mortality HRs were 3.4 (95% CI: 2.6, 4.3) among children who were stunted and underweight, but not wasted; 4.7 (95% CI: 3.1, 7.1) in those who were wasted and underweight, but not stunted, and 12.3 (95% CI: 7.7, 19.6) in those who were stunted, wasted, and underweight. Conclusion: Children with multiple deficits are at a heightened risk of mortality and may benefit most from nutrition and other child survival interventions. Am J Clin Nutr doi: 10.3945/ajcn.112.047639.

An analysis of electronic medical records to evaluate possible bias due to differential survival

Abstract: RESULTSdDuring 1.2 million person-years of follow-up, there were 13,455 cases of type 2 diabetes and 8,932 deaths. Statin initiation was associated with increased risk of type 2 diabetes. The hazard ratio (95% CI) of diabetes was 1.45 (1.39–1.50) before adjusting for potential confounders and 1.14 (1.10–1.19) after adjustment. Adjusting for differential survival did not change the estimates. Initiating atorvastatin and simvastatin was associated with increased risk of type 2 diabetes. CONCLUSIONSdIn this sample of the general population, statin therapy was associated with 14% increased risk of type 2 diabetes. Differential survival did not explain this increased risk. Diabetes Care 36:1236–1240, 2013

Response to Letter Regarding Article, “The Global Cardiovascular Risk Transition: Associations of Four Metabolic Risk Factors With Macroeconomic Variables in 1980 and 2008”

Abstract: Drs Schooling and Leung provide a number of hypotheses on why cardiometabolic diseases and risks may still be conditions of affluence. Our study1 on the associations of 4 cardiometabolic risks with macroeconomic variables provides a bird’s eye view of global risk-factor distributions and inequalities at snapshots in time, including how these distributions have changed over nearly 3 decades. As emphasized in our study, these cross-sectional associations should not be interpreted as the causal influences of macroeconomic variables on cardiometabolic risk factors in specific countries. For example, although high-income countries on average had lower …

Abstract 028: The Global Impact of Sodium Consumption on Cardiovascular Mortality: A Global, Regional, and National Comparative Risk Assessment

Abstract: Background. Although sodium (Na) intake increases blood pressure (BP) and is thought to be high in many nations, the global impact of excess Na on BP related CVD is unknown. Methods. As part of the 2010 Global Burden of Diseases study, we established a comprehensive compilation of data on Na intake by age, sex, country, and time. From 2007 to 2012, we identified and extracted data from direct contacts on 247 national and subnational surveys worldwide, including 143 of 24-hour urine Na and 104 of estimated dietary Na, in sum representing 66 countries and 74.1% of the world population. We evaluated and adjusted for comparability, assessment methods, and representativeness, and imputed missing values using a Bayesian hierarchical model. We quantified BP effects of Na, including interaction by age, hypertension, and race, in a new meta-analysis of 107 RCTs. Effects of systolic BP on CVD were quantified from large prospective cohorts. Country, age, sex, and cause-specific deaths were obtained from WHO. Impacts of current Na intakes were quantified using comparative risk assessment, vs. a potential optimal intake of 1000 mg/d (2.5 g/d salt), by age, sex, and country. Findings. In 2010, mean global Na intake was 4.0 g/d, with regional means ranging from 2.2 to 5.6 g/d. 1.38M (95% CI 0.9, 1.5M) CVD deaths were attributable to excess Na in 2010, 45% due to CHD, 46% to stroke, and 9% other CVD. 55% of these deaths were in men; 45% in women. >80% of deaths were in low and mid-income countries. Among the top 30 most populous nations, highest mortality due to Na was seen in Ukraine (1163 deaths per million adult population), Russia (1006), and China (505); highest proportional mortality in Thailand (18.5% of all CVD deaths attributable to excess Na), China (17.6%), and Korea (17.4%) (Figure). Findings by age and sex will be shown. Conclusions. These findings provide the most robust evidence to-date on the global and country-specific impact of excess Na on CVD, directly informing priorities for prevention efforts and policies to reduce global deaths.