Abstract
Background
The substantial decline in cardiovascular-disease (CVD) mortality in high-income countries has underpinned their increasing longevity over the past half-century. However, recent ...evidence suggests this long-term decline may have stagnated, and even reversed in younger populations. We assess recent CVD-mortality trends in high-income populations and discuss the findings in relation to trends in risk factors.
Methods
We used vital statistics since 2000 for 23 high-income countries published in the World Health Organization Mortality Database. Age-standardized CVD death rates by sex for all ages, and at ages 35–74 years, were calculated and smoothed using LOWESS regression. Findings were contrasted with the Global Burden of Disease (GBD) Study.
Results
The rate of decline in CVD mortality has slowed considerably in most countries in recent years for both males and females, particularly at ages 35–74 years. Based on the latest year of data, the decline in the CVD-mortality rate at ages 35–74 years was <2% (about half the annual average since 2000) for at least one sex in more than half the countries. In North America (US males and females, Canada females), the CVD-mortality rate even increased in the most recent year. The GBD Study estimates, after correcting for misdiagnoses, suggest an even more alarming reversal, with CVD death rates rising in seven countries for at least one sex in 2017. The rate of decline and initial level of CVD mortality appear largely unrelated.
Conclusions
A significant slowdown in CVD-mortality decline is now apparent across high-income countries with diverse epidemiological environments. High and increasing obesity levels, limited potential future gains from further reducing already low smoking prevalence, especially in English-speaking countries, and persistent inequalities in mortality risk pose significant challenges for public policy to promote better cardiovascular health.
BackgroundDespite compelling evidence on the health hazards of tobacco products accumulated over the past 70 years, smoking remains a leading cause of death worldwide. Policy action to control ...smoking requires timely, comprehensive, and comparable evidence on smoking levels within and across countries. This study provides a recent assessment of that evidence based on the methods used in the Global Burden of Disease (GBD) Study.MethodsWe estimated annual prevalence of, and mortality attributable to smoking any form of tobacco from 1970 to 2020 and 1990–2020, respectively, using the methods and data sources (including 3431 surveys and studies) from the GBD collaboration. We modelled annual prevalence of current and former smoking, distributions of cigarette-equivalents per smoker per day, pack-years for current smoking, years since cessation for former smokers and estimated population-attributable fractions due to smoking.ResultsGlobally, adult smoking prevalence in 2020 was 32.6% (32.2% to 33.1%) and 6.5% (6.3% to 6.7%) among men and women, respectively. 1.18 (0.94 to 1.47) billion people regularly smoke tobacco, causing 7.0 (2.0 to 11.2) million deaths in 2020. Smoking prevalence has declined by 27.2% (26.0% to 28.3%) for men since 1990, and by 37.9% (35.3% to 40.1%) for women. Declines have been largest in the higher sociodemographic countries, falling by more than 40% in some high-income countries, and also in several Latin American countries, notably Brazil, where prevalence has fallen by 70% since 1990. Smoking prevalence for women has declined substantially in some countries, including Nepal, the Netherlands and Denmark, and remains low throughout Asia and Africa. Conversely, there has been little decline in smoking in most low- and middle-income countries (LMICs) with over half of all men continuing to smoke in large populations in Asia (China, Indonesia), as well as the Pacific Islands.ImplicationsWhile global smoking prevalence has fallen, smoking is still common and causes a significant health burden worldwide. The unequal pace of declines across the globe is shifting the epidemic progressively to LMICs. Smoking is likely to remain a leading cause of preventable death throughout this century unless smoking cessation efforts can significantly and rapidly reduce the number of smokers, particularly in Asia.FundingXD and EG received funding through grant projects from Bloomberg Philanthropies (funding no. 66-9468) and the Bill & Melinda Gates Foundation (funding no. 63-3452).
Global Burden of Disease and Risk Factors Lopez, Alan D; Mathers, Colin D; Ezzati, Majid ...
The World Bank eBooks,
2006, 04-02-2006, 2006-02-04, 20060101
eBook, Book
Odprti dostop
This volume is a single up-to-date source on the entire global epidemiology of diseases, injuries and risk factors with a comprehensive statement of methods and a complete presentation of results. It ...includes refined methods to assess data, ensure epidemiological consistency, and summarize the disease burden. Global Burden of Disease and Risk Factors examines the comparative importance of diseases, injuries, and risk factors; it incorporates a range of new data sources to develop consistent estimates of incidence, prevalence, severity and duration, and mortality for 136 major diseases and injuries. Drawing from more than 8,500 data sources that include epidemiological studies, disease registers, and notifications systems, Global Burden of Disease and Risk Factors incorporates information from more than 10,000 datasets relating to population health and mortality, representing one of the largest syntheses of global information on population health to date.
Many national and subnational governments need to routinely measure the completeness of death registration for monitoring and statistical purposes. Existing methods, such as death distribution and ...capture-recapture methods, have a number of limitations such as inaccuracy and complexity that prevent widespread application. This paper presents a novel empirical method to estimate completeness of death registration at the national and subnational level.
Random-effects models to predict the logit of death registration completeness were developed from 2,451 country-years in 110 countries from 1970-2015 using the Global Burden of Disease 2015 database. Predictors include the registered crude death rate, under-five mortality rate, population age structure and under-five death registration completeness. Models were developed separately for males, females and both sexes.
All variables are highly significant and reliably predict completeness of registration across a wide range of registered crude death rates (R-squared 0.85). Mean error is highest at medium levels of observed completeness. The models show quite close agreement between predicted and observed completeness for populations outside the dataset. There is high concordance with the Hybrid death distribution method in Brazilian states. Uncertainty in the under-five mortality rate, assessed using the dataset and in Colombian departmentos, has minimal impact on national level predicted completeness, but a larger effect at the subnational level.
The method demonstrates sufficient flexibility to predict a wide range of completeness levels at a given registered crude death rate. The method can be applied utilising data readily available at the subnational level, and can be used to assess completeness of deaths reported from health facilities, censuses and surveys. Its utility is diminished where the adult mortality rate is unusually high for a given under-five mortality rate. The method overcomes the considerable limitations of existing methods and has considerable potential for widespread application by national and subnational governments.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary Background Healthy life expectancy (HALE) summarises mortality and non-fatal outcomes in a single measure of average population health. It has been used to compare health between countries, ...or to measure changes over time. These comparisons can inform policy questions that depend on how morbidity changes as mortality decreases. We characterise current HALE and changes over the past two decades in 187 countries. Methods Using inputs from the Global Burden of Disease Study (GBD) 2010, we assessed HALE for 1990 and 2010. We calculated HALE with life table methods, incorporating estimates of average health over each age interval. Inputs from GBD 2010 included age-specific information for mortality rates and prevalence of 1160 sequelae, and disability weights associated with 220 distinct health states relating to these sequelae. We computed estimates of average overall health for each age group, adjusting for comorbidity with a Monte Carlo simulation method to capture how multiple morbidities can combine in an individual. We incorporated these estimates in the life table by the Sullivan method to produce HALE estimates for each population defined by sex, country, and year. We estimated the contributions of changes in child mortality, adult mortality, and disability to overall change in population health between 1990 and 2010. Findings In 2010, global male HALE at birth was 59·0 years (uncertainty interval 57·3–60·6) and global female HALE at birth was 63·2 years (61·4–65·0). HALE increased more slowly than did life expectancy over the past 20 years, with each 1-year increase in life expectancy at birth associated with a 10-month increase in HALE. Across countries in 2010, male HALE at birth ranged from 27·8 years (17·2–36·5) in Haiti, to 70·6 years (68·6–72·2) in Japan. Female HALE at birth ranged from 37·1 years (26·8–43·8) in Haiti, to 75·5 years (73·3–77·3) in Japan. Between 1990 and 2010, male HALE increased by 5 years or more in 48 countries compared with 43 countries for female HALE, while male HALE decreased in 22 countries and 11 for female HALE. Between countries and over time, life expectancy was strongly and positively related to number of years lost to disability. This relation was consistent between sexes, in cross-sectional and longitudinal analysis, and when assessed at birth, or at age 50 years. Changes in disability had small effects on changes in HALE compared with changes in mortality. Interpretation HALE differs substantially between countries. As life expectancy has increased, the number of healthy years lost to disability has also increased in most countries, consistent with the expansion of morbidity hypothesis, which has implications for health planning and health-care expenditure. Compared with substantial progress in reduction of mortality over the past two decades, relatively little progress has been made in reduction of the overall effect of non-fatal disease and injury on population health. HALE is an attractive indicator for monitoring health post-2015. Funding The Bill & Melinda Gates Foundation
Summary Background China has undergone rapid demographic and epidemiological changes in the past few decades, including striking declines in fertility and child mortality and increases in life ...expectancy at birth. Popular discontent with the health system has led to major reforms. To help inform these reforms, we did a comprehensive assessment of disease burden in China, how it changed between 1990 and 2010, and how China's health burden compares with other nations. Methods We used results of the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for 1990 and 2010 for China and 18 other countries in the G20 to assess rates and trends in mortality, causes of death, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE). We present results for 231 diseases and injuries and for 67 risk factors or clusters of risk factors relevant to China. We assessed relative performance of China against G20 countries (significantly better, worse, or indistinguishable from the G20 mean) with age-standardised rates and 95% uncertainty intervals. Findings The leading causes of death in China in 2010 were stroke (1·7 million deaths, 95% UI 1·5–1·8 million), ischaemic heart disease (948 700 deaths, 774 500–1 024 600), and chronic obstructive pulmonary disease (934 000 deaths, 846 600–1 032 300). Age-standardised YLLs in China were lower in 2010 than all emerging economies in the G20, and only slightly higher than noted in the USA. China had the lowest age-standardised YLD rate in the G20 in 2010. China also ranked tenth (95% UI eighth to tenth) for HALE and 12th (11th to 13th) for life expectancy. YLLs from neonatal causes, infectious diseases, and injuries in children declined substantially between 1990 and 2010. Mental and behavioural disorders, substance use disorders, and musculoskeletal disorders were responsible for almost half of all YLDs. The fraction of DALYs from YLDs rose from 28·1% (95% UI 24·2–32·5) in 1990 to 39·4% (34·9–43·8) in 2010. Leading causes of DALYs in 2010 were cardiovascular diseases (stroke and ischaemic heart disease), cancers (lung and liver cancer), low back pain, and depression. Dietary risk factors, high blood pressure, and tobacco exposure are the risk factors that constituted the largest number of attributable DALYs in China. Ambient air pollution ranked fourth (third to fifth; the second highest in the G20) and household air pollution ranked fifth (fourth to sixth; the third highest in the G20) in terms of the age-standardised DALY rate in 2010. Interpretation The rapid rise of non-communicable diseases driven by urbanisation, rising incomes, and ageing poses major challenges for China's health system, as does a shift to chronic disability. Reduction of population exposures from poor diet, high blood pressure, tobacco use, cholesterol, and fasting blood glucose are public policy priorities for China, as are the control of ambient and household air pollution. These changes will require an integrated government response to improve primary care and undertake required multisectoral action to tackle key risks. Analyses of disease burden provide a useful framework to guide policy responses to the changing disease spectrum in China. Funding Bill & Melinda Gates Foundation.
In recent years, there have been adverse trends in premature cardiovascular disease (CVD) mortality rates (35-74 years) in the USA and Australia. Following long-term declines, rates in the USA are ...now increasing while falls in Australia have slowed rapidly. These two countries also have the highest adult obesity prevalence of high-income countries. This study investigates the role of overweight and obesity in their recent CVD mortality trends by using multiple cause of death (MCOD) data-direct individual-level evidence from death certificates-and linking the findings to cohort lifetime obesity prevalence.
We identified overweight- and obesity-related mortality as any CVD reported on the death certificate (CVD MCOD) with one or more of diabetes, chronic kidney disease, obesity, lipidemias or hypertensive heart disease (DKOLH-CVD), causes strongly associated with overweight and obesity. DKOLH-CVD comprises 50% of US and 40% of Australian CVD MCOD mortality. Trends in premature age-standardized death rates were compared between DKOLH-CVD and other CVD MCOD deaths (non-DKOLH-CVD). Deaths from 2000 to 2017 in the USA and 2006-2016 in Australia were analyzed. Trends in in age-specific DKOLH-CVD death rates were related to cohort relative lifetime obesity prevalence.
Each country's DKOLH-CVD mortality rate rose by 3% per annum in the most recent year, but previous declines had reversed more rapidly in Australia. Non-DKOLH-CVD mortality in the USA increased in 2017 after declining strongly in the early 2000s, but in Australia it has continued declining in stark contrast to DKOLH-CVD. There were larger increases in DKOLH-CVD mortality rates at successively younger ages, strongly related with higher relative lifetime obesity prevalence in younger cohorts.
The increase in DKOLH-CVD mortality in each country suggests that overweight and obesity has likely been a key driver of the recent slowdown or reversal of CVD mortality decline in both countries. The larger recent increases in DKOLH-CVD mortality and higher lifetime obesity prevalence in younger age groups are very concerning and are likely to adversely impact CVD mortality trends and hence life expectancy in future. MCOD data is a valuable but underutilized source of data to track important mortality trends.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Over the years, in response to vigorous scientific critique,22 philosophical debate,23 and innovation from authors involved in the study, the GBD Study has continued to grow in scope, relevance, ...participation, and scale, to the point that it is now arguably the de facto source for global health accounting. In this Viewpoint, we trace the evolution of ten key dimensions of the GBD Study, which, in our view as the two founders of the GBD, have had an important role in increasing the utility, relevance, and integration of the GBD findings in national and global health policy debates, and highlight what we see as some of the principal challenges for the future.
Summary Background Breast and cervical cancer are important causes of mortality in women aged ≥15 years. We undertook annual age-specific assessments of breast and cervical cancer in 187 countries. ...Methods We systematically collected cancer registry data on mortality and incidence, vital registration, and verbal autopsy data for the period 1980–2010. We modelled the mortality-to-incidence (MI) ratio using a hierarchical model. Vital registration and verbal autopsy were supplemented with incidence multiplied by the MI ratio to yield a comprehensive database of mortality rates. We used Gaussian process regression to develop estimates of mortality with uncertainty by age, sex, country, and year. We used out-of-sample predictive validity to select the final model. Estimates of incidence with uncertainty were also generated with mortality and MI ratios. Findings Global breast cancer incidence increased from 641 000 (95% uncertainty intervals 610 000–750 000) cases in 1980 to 1 643 000 (1 421 000–1 782 000) cases in 2010, an annual rate of increase of 3·1%. Global cervical cancer incidence increased from 378 000 (256 000–489 000) cases per year in 1980 to 454 000 (318 000–620 000) cases per year in 2010—a 0·6% annual rate of increase. Breast cancer killed 425 000 (359 000–453 000) women in 2010, of whom 68 000 (62 000–74 000) were aged 15–49 years in developing countries. Cervical cancer death rates have been decreasing but the disease still killed 200 000 (139 000–276 000) women in 2010, of whom 46 000 (33 000–64 000) were aged 15–49 years in developing countries. We recorded pronounced variation in the trend in breast cancer mortality across regions and countries. Interpretation More policy attention is needed to strengthen established health-system responses to reduce breast and cervical cancer, especially in developing countries. Funding Susan G Komen for the Cure and the Bill & Melinda Gates Foundation.
PDF
