Publications
163 results found
Bernabe-Ortiz A, Carrillo-Larco RM, Safary E, et al., 2023, Use of continuous glucose monitors in low- and middle-income countries: A scoping review, DIABETIC MEDICINE, Vol: 40, ISSN: 0742-3071
Carrillo Larco R, 2023, Prevalence and incidence of stroke in Latin America and the Caribbean: a systematic review and meta-analysis, Scientific Reports, Vol: 13, Pages: 1-11, ISSN: 2045-2322
Stroke is a recurrent and well-known cardiovascular event and a leading cause of death worldwide. We identified reliable epidemiological evidence of stroke in Latin America and the Caribbean (LAC) and estimated the prevalence and incidence of stroke, overall and by sex, in that region. A systematic search in OVID (Medline, Embase and Global Health) and in the Latin America and Caribbean Health Sciences Literature (LILACS) until the end of 2020 was made for all cross-sectional or longitudinal studies estimating (or allowing the estimation of) the prevalence or incidence of stroke among individuals of the general population ≥ 18 years from LAC countries. No language restriction was applied. Studies were assessed for methodological quality and risk of bias. Pooled estimates were calculated using random effect meta-analysis as high heterogeneity was expected. A total of 31 papers for prevalence and 11 papers for incidence were included in the review for analysis. The overall pooled stroke prevalence was 32 (95% CI 26–38) per 1000 subjects and were similar among men (21; 95% CI 17–25) and women (20; 95% CI 16–23) per 1000 subjects. The overall pooled stroke incidence was 255 (95% CI 217–293) per 100 000 person-years, being higher in men (261; 95% CI 221–301) compared to women (217; 95% CI 184–250) per 100 000 person-years. Our results highlight the relevance of the prevalence and incidence of stroke in the LAC region. The estimates were similar in stroke prevalence by sex, but with higher incidence rates among males than females. Subgroup analyses highlight the need for standardized methodologies to obtain appropriate prevalence and incidence estimates at the population level in a region with a great burden of cardiovascular events.
Bernabe-Ortiz A, Carrillo Larco R, 2023, Second-hand smoke exposure in adolescents in Latin America and the Caribbean: a pooled analysis, The Lancet Regional Health. Americas, Vol: 20, Pages: 1-7, ISSN: 2667-193X
BackgroundSecond-hand smoke exposure is prevalent amongst adolescents, despite of being a preventable risk factor associated with unfavourable outcomes. The distribution of this risk factor varies by underlying determinants and public health officers need contemporary evidence to update policies. Using the most recent data available from adolescents in Latin America and the Caribbean (LAC), we described the prevalence of second-hand smoking.MethodsPooled analysis of Global School-based Student Health (GSHS) surveys conducted from 2010 to 2018 was conducted. Two indicators were analysed based on information from the 7 days prior to the survey: a) any exposure to second-hand smoking (0 vs ≥1 days of exposure); and b) daily exposure (<7 vs 7 days). Prevalence estimates were carried out accounting for the complex survey design, and reported overall, by country, by sex, and by subregion.FindingsGSHS surveys were administered in 18 countries, yielding a total of 95,805 subjects. Pooled age-standardised prevalence of second-hand smoking was 60.9% (95% CI: 59.9%–62.0%) with no substantial differences between boys and girls. The age-standardised prevalence of any second-hand smoking varied from 40.2% in Anguilla to 68.2% in Jamaica, and the highest prevalence was in the Southern Latin America subregion (65.9%). Pooled age-standardised prevalence of daily second-hand smoking was 15.1% (95% CI: 14.2%–16.1%), and was higher in girls than boys (16.5% vs 13.7%; p < 0.001). The age-standardised prevalence of daily second-hand smoking ranged between 4.8% in Peru to 28.7% in Jamaica, and the highest age-standardised prevalence was in Southern Latin America (19.7%).InterpretationThe prevalence of any second-hand smoking is high among adolescents in LAC, though estimates changed substantially by country. While policies and interventions to reduce/stop smoking are implemented, attention should also be paid to avoid second-hand smoke exposure.
Carrillo Larco R, 2023, Mean systolic blood pressure above the control threshold in people with treated uncontrolled hypertension: a pooled, cross-sectional analysis of 55 national health surveys, EClinicalMedicine, Vol: 57, Pages: 1-12, ISSN: 2589-5370
BackgroundThe hypertension care cascade has been characterized worldwide, yet it has not been quantified how far above the blood pressure control threshold people with uncontrolled treated hypertension are. We summarized the mean systolic blood pressure (SBP; mmHg) in people treated for hypertension but SBP not <130/80.MethodsWe did a cross-sectional analysis of 55 WHO STEPS Surveys (n = 10,658), comprising six world regions (Africa, Americas, Eastern Mediterranean, Europe, Southeast Asia and Western Pacific); we only included the most recent survey by country regardless of when it was conducted. Adults, men and women, aged between 25 and 69 years, with self-reported hypertension receiving antihypertensive medication and whose blood pressure was >130/80 mmHg were included. We quantified the mean SBP overall and by socio-demographic (sex, age, urban/rural location, education) and cardiometabolic (current smoking, self-reported diabetes) risk factors.FindingsThe lowest SBP was observed in Kuwait (146.6; 95% CI: 143.8–149.4 mmHg) and the highest in Libya (171.9; 95% CI: 167.8–176.0 mmHg). In 29 countries, the SBP was higher in men, and SBP tended to be higher in older groups except in six countries. In 17 countries, the SBP was higher in rural than in urban sites, for example in Turkmenistan the SBP was 162.3 (95% CI: 158.4–166.2) mmHg in rural versus 151.6 (95% CI: 148.7–154.4) mmHg in urban areas. In 25 countries, the SBP was higher in adults with no education, for example in Benin the SBP in people without formal education was 175.3 (95% CI: 168.8–181.9) mmHg versus 156.4 (95% CI: 148.8–164.0) mmHg in people with higher education.InterpretationStronger interventions to improve and secure access to effective management are needed in most countries and specific groups, to reach hypertension control in people with hypertension already receiving antihypertensive medication.FundingThe Wellcome Trust International Training Fellows
Bernabe-Ortiz A, Carrillo-Larco RM, Gilman RH, et al., 2023, Skeletal muscle mass and all-cause mortality: Findings from the CRONICAS cohort study, TROPICAL MEDICINE & INTERNATIONAL HEALTH, Vol: 28, Pages: 107-115, ISSN: 1360-2276
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Labán-Seminario LM, Carrillo-Larco RM, Bernabé-Ortiz A, 2022, Stroke-related length of hospitalization trends and in-hospital mortality in Peru, PeerJ, Vol: 10, ISSN: 2167-8359
BACKGROUND: Peru faces challenges to provide adequate care to stroke patients. Length of hospitalization and in-hospital mortality are two well-known indicators of stroke care. We aimed to describe the length of stay (LOS) of stroke in Peru, and to assess in-hospital mortality risk due to stroke, and subtypes. METHODS: This retrospective cohort study used hospitalization registries coding with ICD-10 from 2002 to 2017 (N = 98,605) provided by the Ministry of Health; in-hospital mortality was available for 2016-2017 (N = 6,566). Stroke cases aged ≥35 years were divided into subarachnoid hemorrhage (I60), intracerebral hemorrhage (I61), cerebral infarction (I63), and stroke not specified as hemorrhage or infarction (I64). Data included stroke LOS and in-hospital mortality; socio-demographic and clinical variables. We fitted a region- and hospital level-stratified Weibull proportional hazard model to assess the in-hospital mortality. RESULTS: The median LOS was 7 days (IQR: 4-13). Hemorrhagic strokes had median LOS longer than ischemic strokes and stroke not specified as hemorrhage or infarction (P = <0.001). The case fatality rate (CFR) of patients with stroke was 11.5% (95% CI [10-12%]). Subarachnoid hemorrhage (HR = 2.45; 95% CI [1.91-3.14]), intracerebral hemorrhage (HR = 1.95; 95% CI [1.55-2.46]), and stroke not specified as hemorrhage or infarction (HR = 1.45; 95% CI [1.16-1.81]) were associated with higher in-hospital mortality risk in comparison to ischemic strokes. DISCUSSION: Between 2002 and 2017, LOS due to stroke has not changed in Peru in stroke patients discharged alive. Hemorrhagic cases had the longest LOS and highest in-hospital mortality risk during 2016 and 2017. The findings of our study seem to be consistent with a previous study carried out in Peru and similar to that of HIC and LMIC, also there is an increased median LOS in stroke cases managed in specialized centers. Likewise, LOS seems to depend on the type of stroke, where ischemic stro
Carrillo Larco R, Guzman-Vilca WC, Castillo-Cara M, et al., 2022, Phenotypes of non-alcoholic fatty liver disease (NAFLD) and all-cause mortality: Unsupervised machine learning analysis of NHANES III, BMJ Open, Vol: 12, ISSN: 2044-6055
Objectives: Non-alcoholic fatty liver disease (NAFLD) is a non-communicable disease with a rising prevalence worldwide and with large burden for patients and health systems. To date, the presence of unique phenotypes in patients with NAFLD has not been studied, and their identification could inform precision medicine and public health with pragmatic implications in personalised management and care for patients with NAFLD.Design: Cross-sectional and prospective (up to 31 December 2019) analysis of National Health and Nutrition Examination Survey III (1988–1994).Primary and secondary outcomes measures: NAFLD diagnosis was based on liver ultrasound. The following predictors informed an unsupervised machine learning algorithm (k-means): body mass index, waist circumference, systolic blood pressure (SBP), plasma glucose, total cholesterol, triglycerides, liver enzymes alanine aminotransferase, aspartate aminotransferase and gamma glutamyl transferase. We summarised (means) and compared the predictors across clusters. We used Cox proportional hazard models to quantify the all-cause mortality risk associated with each cluster.Results: 1652 patients with NAFLD (mean age 47.2 years and 51.5% women) were grouped into 3 clusters: anthro-SBP-glucose (6.36%; highest levels of anthropometrics, SBP and glucose), lipid-liver (10.35%; highest levels of lipid and liver enzymes) and average (83.29%; predictors at average levels). Compared with the average phenotype, the anthro-SBP-glucose phenotype had higher all-cause mortality risk (aHR=2.88; 95% CI: 2.26 to 3.67); the lipid-liver phenotype was not associated with higher all-cause mortality risk (aHR=1.11; 95% CI: 0.86 to 1.42).Conclusions: There is heterogeneity in patients with NAFLD, whom can be divided into three phenotypes with different mortality risk. These phenotypes could guide specific interventions and management plans, thus advancing precision medicine and public health for patients with NAFLD.
Bernabe-Ortiz A, Quinteros-Reyes C, Carrillo-Larco RM, 2022, Double burden of malnutrition as a risk factor for overweight and obesity, Revista de Saude Publica, Vol: 56, Pages: 1-11, ISSN: 0034-8910
OBJECTIVE To assess the longitudinal effect of double burden of malnutrition (DBM) on the risk of developing child and adolescent overweight or obesity. METHODS Analysis of the Peruvian Young Lives Study, younger cohort: baseline (2002) and 4 follow-ups (2006–2007, 2009–2010, 2013–2014, and 2016–2017). Outcomes were the incidence of overweight and obesity as defined by the World Health Organization standards. The exposure comprised a variable with 4 categories: non-stunted child with a non-overweight mother (reference group), non-stunted child with an overweight mother, stunted child with a non-overweight mother, and stunted child with an overweight mother (i.e., DBM). Poisson regression models were built to assess the association of interest, and relative risks (RR) and 95%CI were reported. RESULTS Data from 2,034 children; 50.0% were girls and the mean age was 12.0 (3.6) months at baseline. Non-stunted children with an overweight mother had greater risk (RR = 1.64; 95%CI: 1.35–1.99) of developing overweight, compared with the risk for stunted children with a non-overweight mother (RR = 1.38; 95%CI: 1.10–1.72), and for those with DBM (RR = 1.28; 95%CI: 1.02–1.61). When compared with the reference group, obesity risk was greater among non-stunted children with an overweight mother (RR = 2.33; 95%CI: 1.68–3.22), greater among stunted children with a non-overweight mother (RR = 2.59; 95%CI: 1.75–3.84), and greater among those with DBM (RR = 2.14; 95%CI: 1.39–3.28). CONCLUSIONS DBM is a risk factor for childhood overweight and obesity in Peru. Dual-duty policies tackling both undernutrition in children and overweight in mothers are needed to reduce DBM and its future effects in Peru.
Guzman-Vilca WC, Quispe-Villegas G, Vascones Roman FF, et al., 2022, Agreement between the laboratory- and non-laboratory-based WHO cardiovascular risk charts: a cross-sectional analysis of a national health survey in Peru, BMJ Open, Vol: 12, ISSN: 2044-6055
Objective: To determine the agreement between the cardiovascular disease (CVD) risk predictions computed with the WHO non-laboratory-based model and laboratory-based model in a nationally representative sample of Peruvian adults.Design: Cross-sectional analysis of a national health survey.Methods: Absolute CVD risk was computed with the 2019 WHO laboratory-based and non-laboratory-based models. The risk predictions from both models were compared with Bland-Altman plots, Lin’s concordance coefficient correlation (LCCC), and kappa statistics, stratified by sex, age, body mass index categories, smoking and diabetes status.Results: 663 people aged 30–59 years were included in the analysis. Overall, there were no substantial differences between the mean CVD risk computed with the laboratory-based model 2.0% (95% CI 1.8% to 2.2%) and the non-laboratory-based model 2.0% (95% CI 1.8% to 2.1%). In the Bland-Altman plots, the limits of agreement were the widest among people with diabetes (−0.21; 4.37) compared with people without diabetes (−1.17; 0.95). The lowest agreement as per the LCCC was also seen in people with diabetes (0.74 (95% CI 0.63 to 0.82)), the same was observed with the kappa statistic (kappa=0.36). In general, agreement between the scores was appropriate in terms of clinical significance.Conclusions: The absolute cardiovascular predicted risk was similar between the laboratory-based and non-laboratory-based 2019 WHO cardiovascular risk models. Pending validation from longitudinal studies, the non-laboratory-based model (instead of the laboratory-based) could be used when assessing CVD risk in Peruvian population.
Bello-Chavolla OY, Antonio-Villa NE, Fermín-Martínez CA, et al., 2022, Diabetes-related excess mortality in Mexico: a comparative analysis of National Death Registries between 2017-2019 and 2020, Diabetes Care, Vol: 45, Pages: 2957-2966, ISSN: 0149-5992
OBJECTIVE: To estimate diabetes-related mortality in Mexico in 2020 compared with 2017-2019 after the onset of the coronavirus disease 2019 (COVID-19) pandemic. RESEARCH DESIGN AND METHODS: This retrospective, state-level study used national death registries of Mexican adults aged ≥20 years for the 2017-2020 period. Diabetes-related death was defined using ICD-10 codes listing diabetes as the primary cause of death, excluding certificates with COVID-19 as the primary cause of death. Spatial and negative binomial regression models were used to characterize the geographic distribution and sociodemographic and epidemiologic correlates of diabetes-related excess mortality, estimated as increases in diabetes-related mortality in 2020 compared with average 2017-2019 rates. RESULTS: We identified 148,437 diabetes-related deaths in 2020 (177 per 100,000 inhabitants) vs. an average of 101,496 deaths in 2017-2019 (125 per 100,000 inhabitants). In-hospital diabetes-related deaths decreased by 17.8% in 2020 versus 2017-2019, whereas out-of-hospital deaths increased by 89.4%. Most deaths were attributable to type 2 diabetes (130 per 100,000 inhabitants). Compared with 2018-2019 data, hyperglycemic hyperosmolar state and diabetic ketoacidosis were the two contributing causes with the highest increase in mortality (128% and 116% increase, respectively). Diabetes-related excess mortality clustered in southern Mexico and was highest in states with higher social lag, rates of COVID-19 hospitalization, and prevalence of HbA1c ≥7.5%. CONCLUSIONS: Diabetes-related deaths increased among Mexican adults by 41.6% in 2020 after the onset of the COVID-19 pandemic, occurred disproportionately outside the hospital, and were largely attributable to type 2 diabetes and hyperglycemic emergencies. Disruptions in diabetes care and strained hospital capacity may have contributed to diabetes-related excess mortality in Mexico during 2020.
Guzman-Wilca WC, Quispe-Villegas GA, Carrillo Larco R, 2022, Predicted heart age profile across 41 countries: A cross-sectional study of nationally representative surveys in six world regions, EClinicalMedicine, Vol: 52, Pages: 1-17, ISSN: 2589-5370
Background: Predicted heart age (PHA) can simplify communicating the absolute cardiovascular disease (CVD) risk. Few studies have characterized PHA across multiple populations, and none has described whether people with excess PHA are eligible for preventive treatment for CVD.Methods: Pooled analysis of 41 World Health Organization (WHO) STEPS surveys conducted in 41 countries in six world regions between 2013 and 2019. PHA was calculated as per the non-laboratory Framingham risk score in adults without history of CVD. We described the differences between chronological age and PHA, the distribution of PHA, and the proportion of people with excess PHA that were eligible for antihypertensive and lipid-lowering treatment following the WHO guidelines. Logistic regression models were fitted to assess sociodemographic and health-related variables associated with PHA excess.Results: 94,655 individuals aged 30-74 years were included. 36% of those aged 30-34 years had a PHA of 30-34 years; 9% of those aged 60-64 years had a PHA of 60-64 years. Countries in Africa had the lowest prevalence of very high PHA (i.e., PHA exceeding chronological age in ≥5 years) and countries in Western Pacific had the highest. ≥50% of the population with PHA excess (i.e., PHA exceeding chronological age in ≥1 year) was not eligible for antihypertensive nor lipid-lowering treatment. Abdominal obesity, high total cholesterol, smoking and having diabetes were associated with higher odds of having PHA excess, whereas higher education and employment were inversely associated with excess PHA. Interpretation: PHA is generally higher than chronological age in LMICs and there are regional disparities. Most people with excess PHA would not be eligible to receive preventive medication.
Zhang Y, Chen H, Carrillo-Larco RM, et al., 2022, Association of dietary patterns and food groups intake with multimorbidity: A prospective cohort study, Clinical Nutrition ESPEN, Vol: 51, Pages: 359-366, ISSN: 2405-4577
BackgroundAlthough diet has been extensively studied in relation to individual chronic conditions, studies linking diet with multiple chronic conditions (multimorbidity) remained scarce. We aimed to undertake a comprehensive analysis evaluating associations of overall dietary patterns and specific food groups with long-term risk of multimorbidity.MethodsThe study included 348,290 participants from UK Biobank who completed eligible food frequency questionnaires (FFQ) and were not diagnosed with any of the 38 chronic or mental health conditions of interest at baseline (2006–2010). Dietary patterns were identified using exploratory factor analysis. Cox regression models were used to estimate corresponding hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsThe median follow-up was 8.01 years, and 50,837 (14.60%) participants developed multimorbidity. Among the three identified dietary patterns, the Western Pattern was associated with an increased risk of multimorbidity (HRQ5 vs Q1 = 1.06, 95% CI: 1.03–1.09), while inverse associations were observed for moderate adherence to the White Meat Pattern (HRQ3 vs Q1 = 0.97, 95% CI: 0.94–0.99) and highest adherence to the Prudent Pattern (HRQ5 vs Q1 = 0.92, 95% CI: 0.90–0.95). For specific food groups, more frequent intakes of processed meat and poultry were associated with higher risks of multimorbidity, whereas higher intake frequency of fish and more intakes of fruits and cereal were associated with decreased risks.ConclusionDietary patterns and specific food groups are associated with the risk of multimorbidity. These findings suggest the importance of considering dietary interventions in the prevention and management of multimorbidity.
Carrillo Larco R, Castillo-Cara M, Hernadez Santa Cruz JF, 2022, Street images classification according to COVID-19 risk in Lima, Peru: a convolutional neural networks feasibility analysis, BMJ Open, Vol: 12, Pages: 1-8, ISSN: 2044-6055
Objectives: During the COVID-19 pandemic, convolutional neural networks (CNNs) have been used in clinical medicine (e.g., chest X-rays classification). Whether CNNs could inform the epidemiology of COVID-19 classifying street images according to COVID-19 risk is unknown, yet it could pinpoint high-risk places and relevant features of the built environment. In a feasibility study, we trained CNNs to classify the area surrounding bus stops (Lima, Peru) into moderate or extreme COVID-19 risk.Design: CNN analysis based on images from bus stops and the surrounding area. We used transfer learning and updated the output layer of five CNNs: NASNetLarge, InceptionResNetV2, Xception, ResNet152V2, and ResNet101V2. We chose the best performing CNN which was further tuned. We used GradCam to understand the classification process.Setting: Bus stops from Lima, Peru. We used five images per bus stop.Primary and secondary outcome measures: Bus stop images were classified according to COVID-19 risk into two labels: moderate or extreme.Results: NASNetLarge outperformed the other CNNs except in the recall metric for the moderate label and in the precision metric for the extreme label; the ResNet152V2 performed better in these two metrics (85% vs 76% and 63% vs 60%, respectively). The NASNetLarge was further tuned. The best recall (75%) and F1 score (65%) for the extreme label were reached with data augmentation techniques. Areas close to buildings or with people were often classified as extreme risk.Conclusions: This feasibility study showed that CNNs have the potential to classify street images according to levels of COVID-19 risk. In addition to applications in clinical medicine, CNNs and street images could advance the epidemiology of COVID-19 at the population level.
Bernabe-Ortiz A, Carrillo Larco RM, 2022, The burden of diabetes in the Americas, The Lancet Diabetes and Endocrinology, Vol: 10, Pages: 613-614, ISSN: 2213-8595
Bernabe-Ortiz A, Carrillo-Larco RM, 2022, Physical activity patterns among adolescents in Latin America and the Caribbean region., Journal of Physical Activity and Health, Vol: 19, Pages: 607-614, ISSN: 1543-3080
BACKGROUND: Physical activity implies different patterns, but many studies have focused on physical inactivity and sedentary behaviors. This study aimed to estimate the prevalence of different physical activity patterns among adolescents in Latin America and the Caribbean region. METHODS: Pooled analysis of the most updated data of the Global School-based Student Health surveys. Age-standardized prevalence of 4 outcomes was estimated using information from the last 7 days: physical inactivity (0 d of at least 60 min/d), insufficient physical activity (<5 d of at least 60 min/d), commuting physical activity (≥5 d of walking or biking to school), and sedentary behavior (≥3 h/d of sitting time). RESULTS: A total of 132,071 records (33 countries) were analyzed, mean age 14.6 years, 51.2% girls. Pooled age-standardized prevalence of physical inactivity was 22.3%, greater among girls (25.4%) than boys (19.1%); insufficient physical activity was present in 67.7%, greater in girls (73.6%) than boys (61.5%); commuting physical activity was seen in 43.7%, similar between girls (43.3%) and boys (44.1%); and sedentary behavior was present in 43.4%, greater among girls (45.4%) than boys (41.3%). CONCLUSIONS: In Latin America and the Caribbean region, almost two-thirds of adolescents are insufficiently physically active, ≥40% are sedentary, and ≥20% are physically inactive, and these behaviors are more frequent among girls than boys.
Wang D, Dai X, Mishra SR, et al., 2022, Association between socioeconomic status and health behaviour change before and after non-communicable disease diagnoses: a multicohort study, The Lancet Public Health, Vol: 7, Pages: e670-e682, ISSN: 2468-2667
BACKGROUND: Behavioural risk factors of non-communicable diseases (NCDs) are socially patterned. However, the direction and the extent to which socioeconomic status (SES) influences behaviour changes before and after the diagnosis of NCDs is not clearly understood. We aimed to investigate the influence of SES on behaviour changes (physical inactivity and smoking) before and after the diagnosis of major NCDs. METHODS: In this multicohort study, we pooled individual-level data from six prospective cohort studies across 17 countries. We included participants who were diagnosed with either diabetes, cardiovascular disease, chronic lung disease, or cancer after recruitment. Participants were surveyed every 2 years. Education and total household wealth were used to construct SES. We measured behaviour changes as whether or not participants continued or initiated physical inactivity or smoking after NCD diagnosis. We used multivariable logistic regression models to estimate odds ratios (ORs), prevalence ratios (PRs), and 95% CIs for the associations between SES and continuation or initiation of unfavourable behaviours. FINDINGS: We included 8107 individuals recruited between March, 2002, and January, 2016. Over the 4-year period before and after NCD diagnosis, 886 (60·4%) of 1466 individuals continued physical inactivity and 1018 (68·8%) of 1480 participants continued smoking; 1047 (15·8%) of 6641 participants with physical activity before diagnosis initiated physical inactivity after diagnosis and 132 (2·0%) of 6627 non-smokers before diagnosis initiated smoking after diagnosis. Compared with participants with high SES, those with low SES were more likely to continue physical inactivity (244 [70·3%] of 347 vs 23 [50.0%] of 46; PR 1·41 [95% CI 1·05-1·99]; OR 2·28 [1·18-4·41]), continue smoking (214 [75·4%] of 284 vs 39 [60·9%] of 64; PR 1·27 [1·03-1·59]; OR 2&mid
Quezada-Pinedo HG, Cajachagua-Torres KN, Guzman-Vilca WC, et al., 2022, Flat trend of high caesarean section rates in Peru: A pooled analysis of 3,376,062 births from the national birth registry, 2012 to 2020, The Lancet Regional Health - Americas, Vol: 12, Pages: 1-10, ISSN: 2667-193X
BackgroundNational and subnational C-section rates are seldom available in low- and middle-income countries to guide policies and interventions. We aimed to describe the C-section rates at the national and subnational levels in Peru (2012-2020).MethodsBased on the Peruvian national birth registry, we quantified C-section rates at the national, regional and province levels; also, by natural regions (Coast, Highlands, and Amazon). Using individual-level data from the mother, we stratified the C-section rates by educational level, healthcare insurance and provider. Ecologically, we studied the correlations between C-section rates and human development index (HDI), altitude above sea level, proportion of the population living in poverty and proportion of rural population.FindingsC-section rate in Peru decreased slightly from 2012 (39·7%) to 2020 (38·0%). A widening gap of C-section rates was observed through the study years among the Coast that showed higher rates and the other natural regions that showed lower rates. The rates in most of the 25 regions showed a flat trend, particularly in the last four years and some provinces showed a very low rate. The rates were highest in mothers with higher education and in users of private health insurance. Higher HDI, health facility located at lower altitude, lower poverty and urbanization were positively correlated with higher C-section rates.InterpretationC-section rates in Peru are above the international recommendations. Large differences by natural region, provinces and women socioeconomic status were found. Further efforts are needed to achieve the recommended C-section rates.FundingAcademy Ter Meulen grant of the Academy Medical Sciences Fund of the Royal Netherlands Academy of Arts & Sciences (KNAWWF/1327/TMB202116), Wellcome Trust (214185/Z/18/Z), Fogarty (D43TW011502).
Bernabe-Ortiz A, Borjas-Cavero DB, Paucar-Alfaro JD, et al., 2022, Multimorbidity Patterns among People with Type 2 Diabetes Mellitus: Findings from Lima, Peru, INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, Vol: 19
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Bernabé-Ortiz A, Carrillo-Larco RM, 2022, Prevalencia y tendencias de tabaquismo activo y pasivo en adolescentes peruanos, Revista Peruana de Medicina Experimental y Salud Pública, Vol: 39, Pages: 193-200, ISSN: 1726-4634
Objetivo. El objetivo del presente estudio fue evaluar las tendencias ocurridas en diferentes indicadores de tabaquismo en adolescentes peruanos. Asimismo, se evaluó las tendencias en dichos indicadores de acuerdo a sexo y en aquellos sin antecedente de tabaquismo previo. Materiales y métodos. El presente estudio usa la Encuesta Mundial sobre Tabaquismo en Jóvenes (Global Youth Tobacco Survey 2007, 2014, 2019). Tabaquismo activo se definió según el consumo de tabaco en los últimos 30 días. Tabaquismo pasivo se definió en función a exposición a tabaco dentro y fuera del hogar, tanto global como en forma diaria. Los análisis consideraron el diseño muestral. Resultados. Un total de 17 047 registros (9869 en el 2007, 3424 en el 2014, y 3754 en el 2019) fueron analizados; edad media 14 años y 49,9% mujeres. El 26,6% reportó antecedente de tabaquismo previo; dicha prevalencia cayó de 45,2% (2007), a 25,3% (2014), y a 19,4% (2019, p de tendencias < 0,001), mientras que el tabaquismo activo cayó de 17,1% (2007) a 8,7% (2014) y a 5,7% (2019). La prevalencia global de tabaquismo pasivo en el hogar cayó de 24,7%, a 12,9% y a 10,4% (p de tendencias <0,001), mientras que la prevalencia global de tabaquismo pasivo fuera del hogar se redujo de 46,3%, a 39,4%, y a 36,3% (p < 0,001) en ese lapso. La caída en los indicadores de tabaquismo se vio principalmente en mujeres que en varones. Conclusión. Se evidencia una reducción sostenida en los indicadores de tabaquismo en adolescentes peruanos. El tabaquismo pasivo fuera del hogar continúa siendo frecuente requiriendo el fortalecimiento de las actuales políticas de control de tabaco.
Carrillo Larco R, Bernabe-Ortiz A, 2022, Urbanization, altitude and cardiovascular risk, Global Heart, Vol: 17, ISSN: 2211-8179
Background:There is limited information regarding the variation of the cardiovascular (CV) risk, that combines multiple risk factors in one metric, according to urbanization and altitude.Objective:To assess and disentangle the potential association between urbanization and altitude with absolute CV risk using Peruvian nationally-representative surveys.Methods:Pooled analysis of Peruvian Demographic Health Surveys (from 2014 to 2020), including subjects aged between 40 and 74 years, was conducted. The outcome of interest was the 10-year predicted absolute CV risk based on the non-laboratory version of the World Health Organization (WHO) and split into <10% and ≥10%. The exposures were urbanization (rural or urban) and altitude (<500 meters above the sea level [m.a.s.l.], between 500 and 2,499 m.a.s.l, between 2,500 and 3,499 m.a.s.l., and ≥3,500 m.a.s.l.). Crude and adjusted Poisson regression models were built to assess the associations of interest, reporting prevalence ratios (PR) and 95% confidence intervals (95% CI).Results:Data of 80,409 subjects, mean age 54.3 (SD: 8.8) and 42,640 (54.4%) females were analyzed. Regarding urbanization, 30,722 (25.4%) subjects were from rural areas, and 60.6% lives at <500 m.a.s.l., whereas only 9.3% lives at ≥3500 m.a.s.l. The 10-year predicted absolute CV risk mean was 4.5% (SD: 3.1), and 7.8% had a CV risk ≥10%. In multivariable model, urbanization, mainly rurality (PR=0.89; 95%CI: 0.81–0.97) and altitude (PR=0.82; 95%CI: 0.75–0.90 for those living between 2,500–3,490 m.a.s.l. and PR=0.68; 95%CI: 0.60–0.76 for those living ≥3,500 m.a.s.l) were factors independently associated with CV risk. Urbanization was an effect modifier of the association between altitude and CV risk with a greater effect in urban settings.ConclusionUrbanization, specifically rurality, and high-altitude, mainly ≥2,500 m.a.s.l., were factors independently associated with lower predicted CV risk.
Cohorts Consortium of Latin America and the Caribbean CC-LAC, Carrillo Larco R, Stern D, et al., 2022, Derivation, internal validation, and recalibration of a cardiovascular risk score for Latin America and the Caribbean (Globorisk-LAC): a pooled analysis of cohort studies, The Lancet Regional Health Americas, Vol: 9, ISSN: 2667-193X
Background: Risk stratification is a cornerstone of cardiovascular disease (CVD) prevention and a main strategy proposed to achieve global goals of reducing premature CVD deaths. There are no cardiovascular risk scores based on data from Latin America and the Caribbean (LAC) and it is unknown how well risk scores based on European and North American cohorts represent true risk among LAC populations. Methods: We developed a CVD (including coronary heart disease and stroke) risk score for fatal/non-fatal events using pooled data from 9 prospective cohorts with 21,378 participants and 1,202 events. We developed laboratory-based (systolic blood pressure, total cholesterol, diabetes, and smoking), and office-based (body mass index replaced total cholesterol and diabetes) models. We used Cox proportional hazards and held back a subset of participants to internally validate our models by estimating Harrell’s C-statistic and calibration slopes. Findings: The C-statistic for the laboratory-based model was 72% (70%-74%), the calibration slope was 0.994 (0.934-1.055) among men and 0.852 (0.761-0.942) among women; for the office-based model the C-statistic was 71% (69%-72%) and the calibration slope was 1.028 (0.980-1.076) among men and 0.811 (0.663-0.958) among women. In the pooled sample, using a 20% risk threshold, the laboratory-based model had sensitivity of 21.9% and specificity of 94.2%. Lowering the threshold to 10% increased sensitivity to 52.3% and reduced specificity to 78.7%.Interpretation: The cardiovascular risk score herein developed had adequate discrimination and calibration. The Globorisk-LAC would be more appropriate for LAC than the current global or regional risk scores. This work provides a tool to strengthen risk-based cardiovascular prevention in LAC. Funding: Wellcome Trust (214185/Z/18/Z)
Nicolaou L, Steinberg A, Carrillo-Larco RM, et al., 2022, Living at high altitude and COVID-19 mortality in Peru, High Altitude Medicine and Biology, Vol: 23, Pages: 1-1, ISSN: 1527-0297
Background: Previous studies have reported a lower severity of COVID-19 infections at higher altitudes; however, this association may be confounded by various factors. We examined the association between living at altitude and COVID-19 mortality in Peru adjusting for population density, prevalence of comorbidities, indicators of socioeconomic status, and health care access. Methods: Utilizing administrative data across 196 provinces located at varying altitudes (sea level to 4,373 m), we conducted a two-stage analysis of COVID-19 deaths between March 19 and December 31, 2020, Peru's first wave. We first calculated cumulative daily mortality rate for each province and fit lognormal cumulative distribution functions to estimate total mortality rate, and start, peak, and duration of the first wave. We then regressed province-level total mortality rate, start, peak, and duration of the first wave as a function of altitude adjusted for confounders. Results: There were 93,528 recorded deaths from COVID-19 (mean age 66.5 years, 64.5% male) for a cumulative mortality of 272.5 per 100,000 population between March 19 and December 31, 2020. We did not find a consistent monotonic trend between living at higher altitudes and estimated total mortality rate for provinces at 500 - 1,000 m (-12.1 deaths per 100,000 population per 100 m, 95% familywise confidence interval -27.7 to 3.5) or > 1,000 m (-0.3, -2.7 to 2.0). We also did not find consistent monotonic trends for the start, peak, and duration of the first wave beyond the first 500 m. Conclusions: Our findings suggest that living at high altitude may not confer a lower risk of death from COVID-19.
Carrillo Larco R, 2022, Estimating the gap between demand and supply of medical appointments by physicians for hypertension care: A pooled analysis in 191 countries, BMJ Open, Vol: 12, ISSN: 2044-6055
Introduction: With a growing number of people with hypertension, the limited number ofphysicians could not provide treatment to all patients. We quantified the gap between medicalappointments available and needed for hypertension care, overall and in relation to hypertensiontreatment cascade metrics.Methods: Ecological descriptive analysis. We combined country-year-specific data onhypertension prevalence, awareness, treatment and control (from NCD-RisC) and number ofphysicians (from WHO). We estimated from 1 to 12 medical appointments per year forhypertensive patients. We assumed that physicians could see 25 patients per day, work 200 daysper year, and dedicate 10% of their time to hypertension care.Results: We studied 191 countries. Forty-one countries would not have enough physicians toprovide at least 1 medical appointment per year to all the population with hypertension; thesecountries were low/lower-middle income and in Sub-Saharan Africa or East Asia and Pacific.Regardless of the world region, ≥50% of countries would not have enough physicians to provide≥8 medical appointments to their population with hypertension. Countries where the demandexceeded the offer of medical appointments for hypertension care had worse hypertensiondiagnosis, treatment and control rates than countries where the demand did not exceed the offer.There were positive correlations between the physician density and hypertension diagnosis(r=0.70, p<0.001), treatment (r=0.70, p<0.001) and control (r=0.59, p<0.001).Conclusions: Where physicians are the only healthcare professionals allowed to prescribeantihypertensive medications, particularly in low- and middle-income countries, the healthcaresystem may struggle to deliver antihypertensive treatment to hypertensive patients.
Carrillo Larco R, 2022, Simplified hypertension screening methods across 60 countries: An observational study, PLoS Medicine, Vol: 19, Pages: 1-19, ISSN: 1549-1277
BackgroundSimplified blood pressure (BP) screening approaches have been proposed. However, evidence is limited to a few countries and has not documented the cardiovascular risk amongst missed hypertension cases, limiting the uptake of these simplified approaches. We quantified the proportion of missed, over-diagnosed, and consistently identified hypertension cases and the 10-year cardiovascular risk in these groups.Methods and findingsWe used 60 WHO STEPS surveys (cross-sectional and nationally representative; n = 145,174) conducted in 60 countries in 6 world regions between 2004 and 2019. Nine simplified approaches were compared against the standard (average of the last 2 of 3 BP measurements). The 10-year cardiovascular risk was computed with the 2019 World Health Organization Cardiovascular Risk Charts. We used t tests to compare the cardiovascular risk between the missed and over-diagnosed cases and the consistent hypertension cases. We used Poisson multilevel regressions to identify risk factors for missed cases (adjusted for age, sex, body mass index, and 10-year cardiovascular risk). Across all countries, compared to the standard approach, the simplified approach that missed the fewest cases was using the second BP reading if the first BP reading was 130–145/80–95 mm Hg (5.62%); using only the second BP reading missed 5.80%. The simplified approach with the smallest over-diagnosis proportion was using the second BP reading if the first BP measurement was ≥140/90 mm Hg (3.03%). In many countries, cardiovascular risk was not significantly different between the missed and consistent hypertension groups, yet the mean was slightly lower amongst missed cases. Cardiovascular risk was positively associated with missed hypertension depending on the simplified approach. The main limitation of the work is the cross-sectional design.ConclusionsSimplified BP screening approaches seem to have low misdiagnosis rates, and cardiovascular risk could be lower amo
Carrillo Larco R, 2022, A systematic review of diagnostic and prognostic models of chronic kidney disease in low- and middle- income countries, BMJ Open, Vol: 12, ISSN: 2044-6055
Objective: To summarize available chronic kidney disease (CKD) diagnostic and prognostic models in Low- and Middle-Income countries (LMIC) Method: Systematic review (PRISMA guidelines). We searched Medline, EMBASE, Global Health (these three through OVID), Scopus and Web of Science from inception to April 9th, 2021, April 17th, 2021 and April 18th, 2021, respectively . We first screened titles and abstracts, and then studied in detail the selected reports; both phases were conducted by two reviewers independently. We followed the CHARMS recommendations and used the PROBAST for risk of bias assessment. Results: The search retrieved 14,845 results, 11 reports were studied in detail and nine (n= 61,134) were included in the qualitative analysis. The proportion of women in the study population varied between 24.5%-76.6%, and the mean age ranged between 41.8-57.7 years. Prevalence of undiagnosed chronic kidney disease ranged between 1.1%-29.7%. Age, diabetes mellitus and sex were the most common predictors in the diagnostic and prognostic models. Outcome definition varied greatly, mostly consisting of urinary albumin-to-creatinine ratio and estimated glomerular filtration rate. The highest performance metric was the negative predictive value. All studies exhibited high risk of bias, and some had methodological limitations. Conclusion: There is no strong evidence to support the use of a CKD diagnostic or prognostic model throughout LMIC. The development, validation and implementation of risk scores must be a research and public health priority in LMIC to enhance CKD screening to improve timely diagnosis.
Bernabe-Ortiz A, Carrillo-Larco RM, Gilman RH, et al., 2022, High-sensitivity C-reactive protein and all-cause mortality in four diverse populations: The CRONICAS Cohort Study, ANNALS OF EPIDEMIOLOGY, Vol: 67, Pages: 13-18, ISSN: 1047-2797
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Carrillo Larco R, Guzman-Vilca WC, 2022, Mortality attributable to type 2 diabetes mellitus in Latin America and the Caribbean: a comparative risk assessment analysis, BMJ Open Diabetes Research and Care, Vol: 10, ISSN: 2052-4897
Introduction: We quantified the proportion and the absolute number of deaths attributable to type 2 diabetes mellitus (T2DM) in Latin America and the Caribbean (LAC) using an estimation approach.Research design and methods: We combined T2DM prevalence estimates from the NCD Risk Factor Collaboration, relative risks between T2DM and all-cause mortality from a meta-analysis of cohorts in LAC, and death rates from the Global Burden of Disease Study 2019. We estimated population attributable fractions (PAF) and computed the absolute number of attributable deaths in 1990 and 2019 by multiplying the PAFs by the total deaths in each country, year, sex, and five-year age group.Results: Between 1985 and 2014 in LAC, the proportion of all-cause mortality attributable to T2DM increased from 12.2% to 16.9% in men and from 14.5% to 19.3% in women. In 2019, the absolute number of deaths attributable to T2DM was 349,787 in men and 330,414 in women. The highest death rates (deaths per 100,000 people) in 2019 were in Saint Kitts and Nevis (325 inmen, 229 in women), Guyana (313 in men, 272 in women), and Haiti (269 in men, 265 in women).Conclusions: A substantial burden of all deaths is attributed to T2DM in LAC. To decrease the mortality attributable to T2DM in LAC, policies are needed to strengthen early diagnosis and management, along with the prevention of complications.
Guzman-Vilca WC, Yovera Juarez EA, Tarazona-Meza C, et al., 2022, Sugar-sweetened beverages consumption in adults: evidence from a National Health Survey in Peru, Nutrients, Vol: 14, ISSN: 2072-6643
High consumption of sugar-sweetened beverages (SSB) is associated with a high risk of non-communicable diseases. Evidence of SSB consumption is needed to inform SSB-related policies, especially in countries with a high consumption, such as Peru. Using data from Peru’s National Health Survey conducted in 2017–2018, the consumption of homemade and ready-to-drink SSB was estimated from a single 24 h dietary recall, accounting for socio-demographic and health-related variables. Regression models were fitted to assess which variables were linked to a high/low SSB consumption. There were 913 people and mean age was 37.7 years (95% confidence interval (CI): 36.9–38.6). Mean consumption (8 oz servings/day) of homemade SSB (1.2) doubled that of ready-to-drink SSB (0.5). The intake of homemade and ready-to-drink SSB was higher in men (1.3 and 0.7) than women (1.1 and 0.3). The intake of ready-to-drink SSB was higher in urban (0.6) compared to rural (0.2) populations. People aware of having diabetes had a lower consumption of both ready-to-drink (0.9 vs. 0.4) and homemade SSB (1.3 vs. 0.8) than those unaware of having diabetes. Male sex and living in urban locations were associated with higher ready-to-drink SSB intake. Older age was associated with a higher intake of homemade SSB. Amongst Peruvian adults, the consumption of SSB products (particularly homemade) remains high. Population-wide interventions should also aim to improve awareness of the nutritional components of homemade beverages.
Bernabe-Ortiz A, Carrillo Larco R, Gilman RH, et al., 2022, Leisure-time and transport-related physical activity and the risk of mortality: the CRONICAS Cohort Study, Journal of Physical Activity and Health, Vol: 19, Pages: 118-124, ISSN: 1543-3080
Background:The long-term health association of the leisure-time and transport-related physical activity domains of the International Physical Activity Questionnaire (IPAQ) have not been established in Latin American settings. We aimed to quantify the 7-year all-cause mortality risk associated with levels of leisure-time and transport-related physical activity.Methods:Ongoing prospective cohort study conducted in four sites in Peru. People ≥35 years were randomly selected from the general population in each study site. The exposures were leisure-time and transport-related physical activity (IPAQ) at baseline. The outcome was all-cause mortality based on information retrieved from national records. Cox regression and sensitivity analyses were conducted.Results:There were 3601 people (mean age 55.8 years, 51.5% women). Greater levels of physical activity were associated with lower risk of all-cause mortality, an observation confirmed in sensitivity analyses. Compared to those with low levels of physical activity, leisure-time(≥500 MET-min/week) and transport-related (500-1499 and ≥1500 MET-min/week) physical activity were associated with 70% (95% CI: 3%-90%), 43% (95% CI: 18%-61%), and 42% (95% CI: 8%-63%) lower all-cause mortality, respectively.Conclusions:Greater levels of leisure-time and transport-related physical activity were associated with a strong reduction in the risk of all-cause mortality across different geographical sites.
Ascencio EJ, Cieza-Gómez GD, Carrillo Larco R, et al., 2022, Timed up and go test predicts mortality in older adults in Peru: a population-base cohort study, BMC Geriatrics, Vol: 22, ISSN: 1471-2318
Background: While there is evidence about stablished risk factors (e.g., raised blood pressure) and higher mortality risk in older population, less has been explored about other functional parameters like the Timed Up and Go test and the Gait Speed in older people at low- and middle-income countries. We aimed to study these mobility tests as predictors of mortality in a population of older people in Peru.Methods: Population-based prospective cohort study (2013-2020). Random sampling of people aged 60+ years in a community of Lima, Peru. Geriatricians conducted all clinical evaluations and laboratory tests were conducted in the local hospital. Participants were sought in the national vital registration system, and we collated cause (ICD-10) and date of death. We conducted a nested forward multivariate Cox proportional hazard model to identify all potential predictors of all-cause, communicable and non-communicable diseases mortality. Results: At baseline, there were 501 people (mean age 70.6 and 62.8% were women), complete follow-up information was available from 427 people. Mean follow-up time was 46.5 months (SD=25.3). In multivariate models, the Timed Up and Go test was associated with higher risk of all-cause mortality (HR=1.05; 95% CI: 1.02-1.09). For cause-specific mortality, history of heart disease (HR=2.25; 95% CI: 1.07-4.76) and age in years (HR=1.05; 95% CI: 1.01-1.09) were predictors of non-communicable diseases mortality. Conclusions: In addition to established risk factors for mortality in older population, the Timed Up and Go test, a functional parameter, raised as a relevant predictor of all-cause mortality.
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