Publications
163 results found
Carrillo-Larco R, Castillo-Cara M, 2020, Using country-level variables to classify countries according to the number of confirmed COVID-19 cases: An unsupervised machine learning approach
<h4>Background: </h4> The COVID-19 pandemic has attracted the attention of researchers and clinicians whom have provided evidence about risk factors and clinical outcomes. Research on the COVID-19 pandemic benefiting from open-access data and machine learning algorithms is still scarce yet can produce relevant and pragmatic information. With country-level pre-COVID-19-pandemic variables, we aimed to cluster countries in groups with shared profiles of the COVID-19 pandemic. <h4>Methods: </h4>: Unsupervised machine learning algorithms (k-means) were used to define data-driven clusters of countries; the algorithm was informed by disease prevalence estimates, metrics of air pollution, socio-economic status and health system coverage. Using the one-way ANOVA test, we compared the clusters in terms of number of confirmed COVID-19 cases, number of deaths, case fatality rate and order in which the country reported the first case. <h4>Results: </h4>: The model to define the clusters was developed with 155 countries. The model with three principal component analysis parameters and five or six clusters showed the best ability to group countries in relevant sets. There was strong evidence that the model with five or six clusters could stratify countries according to the number of confirmed COVID-19 cases (p<0.001). However, the model could not stratify countries in terms of number of deaths or case fatality rate. <h4>Conclusions: </h4> A simple data-driven approach using available global information before the COVID-19 pandemic, seemed able to classify countries in terms of the number of confirmed COVID-19 cases. The model was not able to stratify countries based on COVID-19 mortality data.
Carrillo-Larco RM, Altez-Fernandez C, Ugarte-Gil C, 2019, Is diabetes associated with malaria and malaria severity? A systematic review of observational studies [version 3; peer review: 2 approved], Wellcome Open Research, Vol: 4, Pages: 1-19, ISSN: 2398-502X
Background: We conducted a systematic review to study the association between diabetes as a risk factor for malaria. Methods: The search was conducted in Embase, Global Health, MEDLINE, Scopus and Web of Science. Titles and abstracts were screened, full-text studied and information extracted for qualitative synthesis. Risk of bias was assessed with ROBINS-I criteria. The exposure was diabetes and the outcome malaria or malaria severity. Results: Of 1992 results, three studies were included (n=7,226). Two studies found strong associations: people with diabetes had higher odds of malaria (adjusted odds ratio (aOR): 1.46 (95% CI: 1.06-2.03)) and severe malaria (aOR: 2.98 (95% CI: 1.25-7.09)). One study did not find conclusive evidence: aOR for severe malaria was 0.95 (95% CI: 0.71-1.28). Risk of bias was high in all the studies. Conclusions: Although the available evidence on the association between diabetes and malaria is limited, the results may suggest there is a non-trivial positive relationship between these conditions.
Jiwani SS, Carrillo-Larco RM, Hernández-Vásquez A, et al., 2019, The shift of obesity burden by socioeconomic status between 1998 and 2017 in Latin America and the Caribbean: a cross-sectional series study, The Lancet Global Health, Vol: 7, Pages: e1644-e1654, ISSN: 2214-109X
BackgroundThe burden of obesity differs by socioeconomic status. We aimed to characterise the prevalence of obesity among adult men and women in Latin America and the Caribbean by socioeconomic measures and the shifting obesity burden over time.MethodsWe did a cross-sectional series analysis of obesity prevalence by socioeconomic status by use of national health surveys done between 1998 and 2017 in 13 countries in Latin America and the Caribbean. We generated equiplots to display inequalities in, the primary outcome, obesity by wealth, education, and residence area. We measured obesity gaps as the difference in percentage points between the highest and lowest obesity prevalence within each socioeconomic measure, and described trends as well as changing patterns of the obesity burden over time.Findings479 809 adult men and women were included in the analysis. Obesity prevalence across countries has increased over time, with distinct patterns emerging by wealth and education indices. In the most recent available surveys, obesity was most prevalent among women in Mexico in 2016, and the least prevalent among women in Haiti in 2016. The largest gap between the highest and lowest obesity estimates by wealth was observed in Honduras among women (21·6 percentage point gap), and in Peru among men (22·4 percentage point gap), compared with a 3·7 percentage point gap among women in Brazil and 3·3 percentage points among men in Argentina. Urban residents consistently had a larger burden than their rural counterparts in most countries, with obesity gaps ranging from 0·1 percentage points among women in Paraguay to 15·8 percentage points among men in Peru. The trend analysis done in five countries suggests a shifting of the obesity burden across socioeconomic groups and different patterns by gender. Obesity gaps by education in Mexico have reduced over time among women, but increased among men, whereas the gap has increased among women
Carrillo Larco R, Aparcana-Granda DJ, R Mejia J, et al., 2019, Risk scores for type 2 diabetes mellitus in Latin America: A systematic review of population-based studies, Diabetic Medicine, Vol: 36, Pages: 1573-1584, ISSN: 0742-3071
Aims: Weaimed tosummarize the evidence ondiabetes risk scores forLatin American populations.Methods:A systematic review was conducted (CRD42019122306)looking for diagnostic and prognostic models for type 2 diabetes mellitusamong randomlyselected adults in Latin Americacountries. Five databases(LILACS, Scopus, Medline, Embase and Global Health) weresearched. Type 2 diabetes mellituswasdefined using at least one blood bio-markerandthe reports needed to include information on the development and/or validation of a multivariableregressionmodel. Risk of bias was assessed withthe PROBAST guidelines.Results:Out of the1,500 reports identified, 11 were studied in detailandfivewere included in the qualitative analysis. Two reports were from Mexico, two from Peru, and one from Brazil. The number of diabetes casesvaried from 48 to 207 in the derivations models, whereas these numbers ranged between 29 and582 in the validation models. The most common predictors were age, waist circumference and family history of diabetes, and only one study used oral glucose tolerance test as the outcome. The discrimination performance across studies was around 70% (range: 66% -72%) as per the area under the receiving-operator curve, thehighestmetric was always the negative prediction value. Sensitivity was always higher than specificity. Conclusion:There is no evidence to support the use of one risk scorethroughout Latin America. The development, validation and implementation of risk scores should be a research and public health priorityin Latin America to improve type 2 diabetes mellitusscreening and prevention.
Carrillo Larco R, Albitres-Flores L, Barengo NC, et al., 2019, The association between serum lipids and risk of premature mortality in Latin America: A systematic review of population-based prospective cohort studies, PeerJ, Vol: 7, ISSN: 2167-8359
Objective: To synthetize the scientific evidence on the association between serum lipids and premature mortality in Latin America (LA). Methods: Five data bases were searched from inception without language restrictions: Embase, Medline, Global Health, Scopus and LILACS. Population-based studies following random sampling methods were identified. The exposure variable was lipid biomarkers (e.g., total, LDL- or HDL- cholesterol). The outcome was all-cause and cause-specific mortality. The risk of bias was assessed following the Newcastle-Ottawa criteria. Results were summarized qualitatively. Results: The initial search resulted in 264 abstracts, five (N=27,903) were included for the synthesis. Three papers reported on the same study from Puerto Rico (baseline in 1965), one was from Brazil (1996) and one from Peru (2007). All reports analysed different exposure variables and used different risk estimates (relative risks, hazard ratios or odds ratios). None of the reviewed reports showed strong association between individual lipid biomarkers and all-cause or cardiovascular mortality. Conclusion: The available evidence is outdated, inconsistently reported on several lipid biomarker definitions and used different methods to study the long-term mortality risk. These findings strongly support the need to better ascertain the mortality risk associated with lipid biomarkers in LA.
Carrillo-Larco R, Altez-Fernandez C, Ugarte-Gil C, 2019, Is diabetes associated with malaria and malaria severity? A systematic review of observational studies [version 1; peer review: 2 approved with reservations], Wellcome Open Research, Vol: 4, Pages: 1-17, ISSN: 2398-502X
Background: We conducted a systematic review to study the association between diabetes as a risk factor for malaria. Methods: The search was conducted in Embase, Global Health, MEDLINE, Scopus and Web of Science. Titles and abstracts were screened, full-text studied and information extracted for qualitative synthesis. Risk of bias was assessed with ROBINS-I criteria. The exposure was diabetes and the outcome malaria or malaria severity. Results: Of 1992 results, three studies were included (n=7,226). Two studies found strong associations: people with diabetes had higher odds of malaria (adjusted odds ratio (aOR): 1.46 (95% CI: 1.06-2.03)) and severe malaria (aOR: 2.98 (95% CI: 1.25-7.09)). One study did not find conclusive evidence: aOR for severe malaria was 0.95 (95% CI: 0.71-1.28). Risk of bias was high in all the studies. Conclusions: Although the available evidence on the association between diabetes and malaria is limited, the results may suggest there is a non-trivial positive relationship between these conditions.
Zafra-Tanaka JH, Carrillo-Larco RM, Bernabe-Ortiz A, et al., 2019, Training opportunities for noncommunicable diseases research in Latin America: A scoping review., Revista Panamericana de Salud Pública, Vol: 43, Pages: 1-9, ISSN: 0030-0632
Objective: To identify gaps in postgraduate training and options for building capacity in noncommunicable disease (NCDs) research in Latin America. Methods: This was a scoping review of postgraduate opportunities in NCDs at top universities in Latin America and of training grants awarded by international funding bodies. Three global university rankings were considered-the QS Ranking, the Shanghai Ranking, and the Times Ranking. Latin American universities appearing in at least two of these were selected. University websites were searched for current graduate programs in biostatistics, epidemiology, global health, health economics, and public health. Information was extracted, summarized, and evaluated to identify any programs focused on NCDs. In addition, seven international funding bodies' websites were searched for training grants. Results: In all, 33 universities offering 72 postgraduate programs met the inclusion criteria. One of these programs was exclusively devoted to NCD, and 12 offered NCDs as a dissertation research topic. Only two training grants were awarded to a Latin American institution for NCD capacity building. There are few NCD research training programs in Latin America and only one program exclusively focused on NCDs. Conclusion: There seem to be few NCD-specific research training programs in Latin America. Leveraging existing programs and expanding those with a focus on NCDs could help enhance NCD research capacity in the region. These initiatives should be supported by international funding agencies through more funding opportunities.
Carrillo-Larco RM, Acevedo-Rodriguez JG, Altez-Fernandez C, et al., 2019, Is there an association between cutaneous leishmaniasis and skin cancer? A systematic review, Wellcome Open Research, Vol: 4, ISSN: 2398-502X
Background: Cutaneous leishmaniasis is a prevalent communicable disease in low- and middle-income countries, where non-communicable diseases like skin cancer are on the rise. However, the study of multi-morbidity or co-morbidity between communicable and non-communicable diseases is limited, and even null for some tropical or neglected diseases. Nevertheless, looking at these conditions together instead of as isolated entities in places where these illnesses exist, could show new prevention and treatment paths. We aimed to summarize and critically appraise the epidemiological evidence on the association between cutaneous leishmaniasis and skin cancer. Methods: Following the PRISMA guidelines, we conducted a systematic review using five search engines (Embase, Medline, Global Health, Scopus and Web of Science). We sought observational studies in which the outcome was skin cancer whilst the exposure was cutaneous leishmaniasis; these conditions should have had laboratory or pathology confirmation. Results: No epidemiological investigations have studied the association between cutaneous leishmaniasis and skin cancer. Most of the evidence about the association of interest is still based on case reports and other clinical observations rather than strong epidemiological observational studies. Conclusions: Research is much needed to verify the repeatedly clinical observation that cutaneous leishmaniasis may be a risk factor for skin cancer. This evidence could inform and guide early diagnosis or prevention of skin cancer in survivors of cutaneous leishmaniasis or where cutaneous leishmaniasis is still highly prevalent. Registration: PROSPERO ID CRD42018111230; registered on 16/10/18.
Carrillo Larco R, Miranda JJ, Gilman RH, et al., 2019, Urbanization and altitude are associated with low kidney function in Peru, High Altitude Medicine and Biology, Vol: 20, Pages: 133-140, ISSN: 1527-0297
Background: Kidney health needs to be studied in low- and middle-income countries with populations living at high altitude and undergoing urbanization. We studied whether greater level of urbanization was associated with worse kidney function; and higher hemoglobin was associated with worse kidney function at high altitude. Methods: Cross-sectional analysis of population-based studies in Peru including five sites at different altitude above the sea level and urbanization level (in decreasing order of urbanization): Lima (sea level), Arequipa (2,335m), urban Puno (3,825m), Tumbes (sea level), and rural Puno (3,825m). The exposures were urbanization and altitude as per study site, and hemoglobin (g/dL). The outcome was the estimated glomerular filtration rate (eGFR). Results: 4,208 people were studied: mean age was 57.4 (SD: 12.4) and 51.9% were women. In comparison to rural Puno, eGFR was similar in Lima; in comparison to rural Puno, Arequipa, urban Puno and Tumbes had worse eGFR, for example in Arequipa β= -8.07 (95% CI: -10.90; -5.24). Intermediate (β= -8.60; 95% CI: -10.55; -6.66) and high (β= -11.21; 95% CI: -14.19; -8.24) altitude were negatively correlated with eGFR when only urban places were analyzed. At high altitude, there was a trend for a negative association between hemoglobin and eGFR: β= -1.09 (95% CI: -2.22; 0.04). Conclusions: Apparently, higher altitude and level of urbanization, except for one highly-urbanized site, were associated with worse kidney function. Our findings suggest that some of the adverse impact of high altitude on kidney function has been balanced by the lower risk conferred by rural environments.
Carrillo Larco R, Altez-Fernandez C, Acevedo-Rodriguez JG, et al., 2019, Leptospirosis as a risk factor for chronic kidney diseases: A systematic review of observational studies, PLoS Neglected Tropical Diseases, Vol: 13, ISSN: 1935-2727
BackgroundLeptospirosis is a worldwide prevalent zoonosis and chronic kidney disease (CKD) is a leading global disease burden. Because of pathophysiological changes in the kidney, it has been suggested that these conditions may be associated. However, the extent of this interaction has not been synthetized. We aimed to systematically review and critically appraise the evidence on the association between leptospirosis and CKD.Methodology/Principal findingsObservational studies with a control group were selected. Leptospirosis, confirmed with laboratory methods, and CKD also based on a laboratory assessment, were the exposures and outcomes of interest. The search was conducted in EMBASE, MEDLINE, Global Health, Scopus and Web of Science. Studies selected for qualitative synthesis were assessed for risk of bias following the Newcastle-Ottawa Scale. 5,981 reports were screened, and 2 (n = 3,534) were included for qualitative synthesis. The studies were conducted in Taiwan and Nicaragua; these reported cross-sectional and longitudinal estimates. In the general population, the mean estimated glomerular filtration rate (eGFR) was lower (p<0.001) in people testing positive for antileptospira antibodies (eGFR = 98.3) than in negative controls (eGFR = 100.8). Among sugarcane applicants with high creatinine, those who were seropositive had lower eGFR (mean difference: -10.08). In a prospective analysis, people with high antileptospira antibodies titer at baseline and follow-up, had worse eGFR (p<0.05).ConclusionAlthough the available evidence suggests there may be a positive association between leptospirosis and CKD, whereby leptospirosis could be a risk factor for CKD, it is still premature to draw conclusions. There is an urgent need for research on this association.
Bixby H, Bentham J, Zhou B, et al., 2019, Rising rural body-mass index is the main driver of the global obesity epidemic, Nature, Vol: 569, Pages: 260-264, ISSN: 0028-0836
Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.
Carrillo-Larco RM, Barengo NC, Albitres-Flores L, et al., 2019, The risk of mortality among people with type 2 diabetes mellitus in Latin America: A systematic review and meta-analysis of population-based cohort studies, Diabetes/Metabolism Research and Reviews, Vol: 35, ISSN: 1520-7560
Type 2 Diabetes mellitus (T2DM) is associated with a high mortality risk, though the magnitude of this association remains unknown in Latin America (LA). We aimed to assess the strength of the association between T2DM and all-cause and cause-specific mortality in population-based cohort studies in LA. Systematic review and meta-analysis. The inclusion criteria were: i) men and women ≥18 years-old with T2DM; ii) study outcomes all-cause and/or cause-specific mortality; and iii) using people without T2DM as comparison group. Five databases (Scopus, Medline, Embase, Global Health and LILACS) were searched. Risk of bias was evaluated with the Robins-I criteria. Initially there were 979 identified studies, of which seventeen were selected for qualitative synthesis; 14 were included in the meta-analysis (N=416,821). Self-reported T2DM showed a pooled relative risk (RR) of 2.49 for all-causes mortality (I-squared [I2 ]=85.7%, p<0.001; 95% confidence interval [CI] 1.96-3.15). T2DM based on a composite definition was associated with a 2.26-fold higher all-cause mortality (I2 =93.9%, p<0.001; 95% CI: 1.36-3.74). The pooled risk estimates were similar between men and women, though higher at younger ages. The pooled RR for cardiovascular mortality was 2.76 (I2 = 59.2%; p<0.061; 95% CI: 1.99-3.82), and for renal mortality 15.85 (I2 = 0.00%; p<0.645; 95% CI: 9.82-25.57). Using available population-based cohort studies this work has identified and estimated the strength of the association between T2DM and mortality in LA. The higher mortality risk compared with high-income countries deserves close attention from health policies makers and clinicians to improve diabetes care and control hence preventing complications and delaying death.
Carrillo-Larco RM, Bernabé-Ortiz A, 2019, Diabetes mellitus tipo 2 en Peru: una revision sistematica sobre la prevalencia e incidencia en población general [Type 2 diabetes mellitus in peru: a systematic review of prevalence and incidence in the general population], Revista Peruana de Medicina Experimental y Salud Publica, Vol: 36, Pages: 26-36, ISSN: 1726-4634
Objetives. To identify prevalence and incidence studies of type 2 diabetes mellitus in the general adult population in Peru. MATERIALS AND METHODS: Observational studies involving randomly selected individuals from the general population were evaluated. The definition of diabetes had to include at least one laboratory parameter (e.g. baseline glucose). LILACS, SciELO, Scopus, Medline, Embasem and Global Health were reviewed without restriction. Risk of bias was assessed using the Newcastle-Ottawa scale. RESULTS: The search identified 909 results; additionally, an article from another source was added. After evaluating the results, 20 articles representing nine studies were selected (n=16 585). One of the studies was national in scope and another semi-national (ENINBSC, 2004-05 and PERUDIAB, 2010-12). The first study reported a prevalence of 5.1% in subjects ≥35 years, while the second reported 7.0% in subjects ≥25 years. Other studies focused on populations in one or more cities in the country, or on selected population groups, such as the PERU MIGRANT study (2007-08) which reported the prevalence of diabetes in subjects in rural areas (0.8%), in rural-urban migrants (2.8%), and in urban areas (6.3%). Three studies followed up prospectively, one of them being PERUDIAB: a cumulative incidence of 19.5 new cases per 1,000 people per year. The risk of bias was low in all studies. CONCLUSIONS: Population studies indicate that the prevalence of diabetes has increased and that there are approximately two new cases per 100 people per year. Evidence is still scarce in the jungle and in rural populations.
Carrillo Larco R, Altez-Fernandez C, Pacheco-Barrios N, et al., 2019, Cardiovascular disease prognostic models in Latin America and the Caribbean: a systematic review, Global Heart, Vol: 14, Pages: 81-93, ISSN: 2211-8179
Cardiovascular diseases are the leading cause of deathand disability, both globallyand in Latin America and the Caribbean (LAC).1,2 These trends can be improved through different strategies, modifying the distribution ofrisk factorsin the populationas a whole, i.e., a population-based prevention approach (e.g., sugar taxes), and through an overall risk-based preventionapproach.3,4 It has been argued that the latteris cost effective andmaximizesresources allocation (e.g., treatment) to those who most need them with minimal harm.5,6 However,risk-based prevention needs accurate prognostictools to identify the target population. There is some evidence that available cardiovascular risk prediction equations do not perform well in LAC,7 where cardiovascular key risk factorssuch as diabetesseem to have different strength of association with cardiovascular events.8 Therefore, it becomes necessary to identify which available equationshave undergone local scrutinyand whether new localtoolshave been developed. Even though there have been efforts to summarisecardiovascular prognosticmodels,9,10 they did not include studies written in Spanish or search engines with large LAC influence, hence reporting no results from LAC.10 Therefore, whether available cardiovascularprognostic modelshave been tested or a new model has been derived in LAC, remainslargely unknown.Consequently, we conducted a systematic review to summarise and critically appraise studies evaluating or generating prognosticmodels for cardiovascular outcomes conducted in LAC. In so doing,we provide a comprehensive list of available prognostic models, their strengths and limitations, as well as recommendations and identification of research gapsto be addressed toimprove cardiovascular prevention in LAC.
Najera H, Nandy S, Carrillo-Larco RM, et al., 2019, Within-country migration and obesity dynamics: analysis of 94,783 women from the Peruvian demographic and health surveys, BMC Public Health, Vol: 19, ISSN: 1471-2458
BackgroundRural-to-urban migration is associated with increased obesity, yet it remains unknown whether this association exist, and to what extent, with other types of internal migration.MethodsWe conducted a secondary analysis of the Peruvian Demographic and Health Surveys (2005 to 2012) on data collected from women aged 15–49 years. Participants were classified as rural stayers, urban stayers, rural-to-urban migrants, intra-rural migrants, intra-urban migrants, and urban-to-rural migrants. Marginal effects from a logit regression model were used to assess the probabilities of being and becoming obese given both the length of time in current place of residence and women’s migration status.ResultsAnalysis of cross-sectional survey data generated between 2005 and 2012. Data from 94,783 participants was analyzed. Intra-urban migrants and rural-to-urban migrants had the highest rates of obesity (21% in 2012). A steady increase in obesity is observed across all migration statuses. Relative to rural non-migrants, participants exposed to urban environments had greater odds, two- to three-fold higher, of obesity. The intra-rural migrant group also shows higher odds relative to rural stayers (42% higher obesity odds). The length of exposure to urban settings shows a steady effect over time.ConclusionBoth exposure to urban environments and migration are associated with higher odds of obesity. Expanding the characterization of within-country migration dynamics provides a better insight into the relationship between duration of exposure to urban settings and obesity.
Ugarte-Gil C, Carrillo-Larco RM, Kirwan DE, 2019, Latent tuberculosis infection and non-infectious co-morbidities: Diabetes mellitus type 2, chronic kidney disease and rheumatoid arthritis, International Journal of Infectious Diseases, Vol: 80, Pages: 29-31, ISSN: 1201-9712
The prevalence of non-communicable diseases is increasing worldwide, which coincides with the persistence of infectious diseases including tuberculosis. These can synergistically affect individual and population health. Three non-communicable diseases that are relevant because of their associated morbidity, mortality and disability are type 2 diabetes mellitus, chronic kidney disease and rheumatoid arthritis. There is some evidence that patients with these conditions are at increased risk of acquiring latent tuberculosis infection (LTBI) and of this progressing to active disease. Unfortunately, evidence on accurate testing and effective prophylactic treatment in these populations is lacking. This review discusses current evidence and recommendations for management of LTBI in these patients.
Mercado-Gonzales SI, Carpio-Rodríguez AN, Carrillo-Larco RM, et al., 2019, Sleep duration and risk of obesity by sex: nine-year follow-up of the young lives study in Peru, Childhood Obesity, Vol: 15, ISSN: 2153-2168
BACKGROUND: We aimed to evaluate if there is association between hours of sleep and the risk of obesity among children and whether this association differs by sex. METHODS: A secondary data analysis, using information of the Young Lives study, was conducted. The outcome was obesity, based on the BMI for age z-score; the exposure was child's sleep duration (reported by parents) categorized using the National Sleep Foundation guidelines, and as a numerical variable. Baseline and three follow-ups information were used to evaluate association, reporting relative risks (RRs), and 95% confidence intervals (CIs), as well as coefficients and 95% CI. RESULTS: Data from 1949 children, baseline mean age 4.3 (standard deviation: 0.3) and 962 (49.5%) females, were analyzed. Short sleep duration was present in 26.0% (95% CI: 24.0-28.0) at baseline. After 9.6 years of follow-up, the incidence of obesity was 0.83 (95% CI: 0.70-0.98) per 100 person-years at risk. In multivariable model (n = 1579), there was no association between short sleep duration and obesity in the whole sample (p = 0.13); but the risk of obesity was lower among girls (n = 816; RR = 0.45; 95% CI: 0.21-0.96; p = 0.03) compared with boys (n = 763; RR = 1.43; 95% CI: 0.95-2.14; p = 0.09). On the contrary, each additional hour of sleep was associated with an increase of boy's BMI mean (0.05; 95% CI: 0.02-0.08; p < 0.001), but not among girls (-0.02; 95% CI: -0.05 to 0.01; p = 0.11). CONCLUSIONS: Our results evidenced a lower risk of obesity due to short sleep duration in girls, but not in boys. Each additional hour of sleep was associated with an increase of BMI in boys, but not in girls. Strategies are needed to guarantee adequate sleep duration in Peruvian children.
Carrillo-Larco RM, Jaime Miranda J, Gilman RH, et al., 2018, The HOMA-IR performance to identify new diabetes cases by degree of urbanization and altitude in Peru: The CRONICAS Cohort Study, Journal of Diabetes Research, Vol: 2018, ISSN: 2314-6745
Aims. Prognostic thresholds to identify new type 2 diabetes mellitus (T2DM) cases using the HOMA-IR have not been defined. We studied the HOMA-IR performance to identify incident T2DM cases and to assess if the thresholds varied according to urbanization and altitude in Peru. Methods. Longitudinal analysis. The outcome was incident T2DM cases: self-report diagnosis and fasting glucose. The exposure was the HOMA-IR. Receiver operating characteristic (ROC) curves were plotted, and the area under the ROC curve (AUC) was estimated with 95% confidence intervals (95% CIs). Results are presented overall and stratified by study site (Lima, Tumbes, urban Puno, and rural Puno), rurality (urban, semiurban, and rural), and altitude (low and high). Results. A total of 3120 participants (mean age: 55.6 years, 51.2% females) contributed data to this analysis. The median baseline HOMA-IR was 1.7 (IQR 1.0–2.9), with median values ranging from 1.1 in rural Puno to 2.0 in Lima and Tumbes (). Overall for incident T2DM, the AUC was 0.69 (95% CI: 0.64–0.74) with an empirical threshold of 2.8 yielding a positive likelihood ratio of 2.30 and a negative one of 0.61; the positive and negative predictive values were 14.6% and 95.7%, respectively. The empirical thresholds varied within the variables of interest, for example, from 0.9 in urban Puno to 2.9 in Lima. Conclusions. Using the HOMA-IR to identify incident T2DM cases seems to yield moderate accuracy. The HOMA-IR could help improve identifying people at high risk of T2DM.
Carrillo-Larco RM, Bernabé-Ortiz A, 2018, [Mortality from chronic kidney disease in Peru: national trends 2003-2015], Revista Peruana de Medicina Experimental y Salud Publica, Vol: 35, Pages: 409-415, ISSN: 1726-4634
OBJECTIVES.: To describe the mortality trend due to chronic kidney disease (CKD) in Peru in the period 2003-2015. MATERIALS AND METHODS.: Analysis of secondary data and ecological design. National mortality registries based on death certificates were analyzed. ERC was defined as CIE code 10: N18 in the basic cause. Absolute and relative frequencies of death by ERC are described. To estimate the proportion of deaths by CKD in each region of Peru, a generalized mixed linear model was used. The outcome variable was the proportion of deaths, the independent variables were each region of the country and the year. RESULTS.: The analysis included 1,086,778 deaths, of which 25,091 (2.0 % age- and sex-adjusted) were by CKD. During the study period, the average age at death increased by 2.6 years (p<0.001); in addition, the proportion of age- and sex-adjusted CKD deaths was always higher in women. In the observation period, the region with the highest mortality from CKD was Puno (4.1%), and with the lowest mortality was Amazonas (1.1%). Those regions that showed a significantly greater increase than the others were Tacna, La Libertad, Tumbes, Apurímac, Cusco, Ica, Moquegua, Ayacucho, Huancavelica and Puno. CONCLUSIONS.: In the 2003-2015 period, mortality from CKD in Peru has increased; this trend is observed in several regions of the country. Preventive measures, early identification, and access to treatment must be implemented to control this trend.
Carrillo-Larco RM, Bernabe-Ortiz A, 2018, A divergence between underlying and final causes of death in selected conditions: an analysis of death registries in Peru, PeerJ, Vol: 6, ISSN: 2167-8359
BackgroundThe underlying cause of death is used to study country and global mortality trends and profiles. The final cause of death could also inform the ultimately cause of death in individuals with underlying conditions. Whether there is a pattern between the underlying and final cause of death has not been explored using national death registries. We studied what final causes of death were most common among selected underlying causes using national death registries in Peru, 2015.MethodsUnderlying and final causes of death were classified according to their ICD-10 codes. Underlying causes included chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), hypertension (HTN), diabetes, and selected cancers (cervix, breast, stomach, prostate, and lung). Final causes were categorized as: communicable, cardiovascular, and cancers. Descriptive statistics were used.ResultsA total of 77,065 death registries were analyzed; cases had a mean age of 69.4 (SD: 19.3) years at death and were mostly men (53.9%). When the underlying cause was HTN, the most frequent final cause was cardiovascular diseases (82.3%). For all the other underlying causes, the most frequent final cause was communicable diseases: COPD (86.4%), CKD (79.3%), cancer (76.5%), and diabetes (68.3%).ConclusionsIn four selected underlying causes of death there was a divergence with respect to the final cause, suggesting there was a shift from non-communicable to communicable causes. Although efforts should be deployed to prevent underlying non-communicable diseases, potential communicable complications should not be neglected.
Carrillo-Larco RM, Jiwani SS, Diez-Canseco F, et al., 2018, Implementation tells us more beyond pooled estimates: Secondary analysis of a multicountry mHealth trial to reduce blood pressure, JMIR mHealth and uHealth, Vol: 6, ISSN: 2291-5222
Background: The uptake of an intervention aimed at improving health-related lifestyles may be influenced by the participant’s stage of readiness to change behaviors.Objective: We conducted secondary analysis of the Grupo de Investigación en Salud Móvil en América Latina (GISMAL) trial according to levels of uptake of intervention (dose-response) to explore outcomes by country, in order to verify the consistency of the trial’s pooled results, and by each participant’s stage of readiness to change a given lifestyle at baseline. The rationale for this secondary analysis is motivated by the original design of the GISMAL study that was independently powered for the primary outcome—blood pressure—for each country.Methods: We conducted a secondary analysis of a mobile health (mHealth) multicountry trial conducted in Argentina, Guatemala, and Peru. The intervention consisted of monthly motivational phone calls by a trained nutritionist and weekly tailored text messages (short message service), over a 12-month period, aimed to enact change on 4 health-related behaviors: salt added to foods when cooking, consumption of high-fat and high-sugar foods, consumption of fruits or vegetables, and practice of physical activity. Results were stratified by country and by participants’ stage of readiness to change (precontemplation or contemplation; preparation or action; or maintenance) at baseline. Exposure (intervention uptake) was the level of intervention (<50%, 50%-74%, and ≥75%) received by the participant in terms of phone calls. Linear regressions were performed to model the outcomes of interest, presented as standardized mean values of the following: blood pressure, body weight, body mass index, waist circumference, physical activity, and the 4 health-related behaviors.Results: For each outcome of interest, considering the intervention uptake, the magnitude and direction of the intervention effect differed by count
Carrillo-Larco RM, Luza-Dueñas AC, Urdániga-Hung M, et al., 2018, Diagnosis of erectile dysfunction can be used to improve screening for Type 2 diabetes mellitus., Diabetic Medicine, Vol: 35, Pages: 1538-1543, ISSN: 0742-3071
AIMS: To assess the diagnostic accuracy of four undiagnosed Type 2 diabetes mellitus risk scores accounting for erectile dysfunction status. METHODS: This was a population-based cross-sectional study. Type 2 diabetes was defined according to a oral glucose tolerance test and self-reported physician diagnosis. Erectile dysfunction was defined according to the answer to the question, 'Have you had difficulties obtaining an erection in the last 6 months?' (yes/no). The risk scores used were the FINDRISC, LA-FINDRISC, American Diabetes Association score and the Peruvian Risk Score. A Poisson regression model was fitted to assess the association between Type 2 diabetes and erectile dysfunction. The area under the receiver-operating characteristic curve was estimated overall and by erectile dysfunction status. RESULTS: A total of 799 men with a mean (sd) age of 48.6 (10.7) years were included in the study. The overall prevalence of Type 2 diabetes was 9.3%. Compared with healthy men, men with Type 2 diabetes had 2.71 (95% CI 1.57-4.66) higher chances of having erectile dysfunction. Having excluded men aware of Type 2 diabetes status (N=38), the area under the receiver-operating characteristic curve of three of the risk scores (not the American Diabetes Association score) improved among those who had erectile dysfunction in comparison with those who did not; for example, the area under the receiver-operating characteristic curve of the LA-FINDRISC score was 89.6 (95% CI 78.7-99.9) in men with erectile dysfunction and 76.5 (95% CI 68.5-84.4) overall. CONCLUSIONS: In a population-based study, erectile dysfunction was more common in men with Type 2 diabetes than in the otherwise healthy men. Screening for erectile dysfunction before screening for Type 2 diabetes seems to improve the accuracy of well-known risk scores for undiagnosed Type 2 diabetes.
Carrillo-Larco RM, Moscoso-Porras M, Taype-Rondan A, et al., 2018, The use of unmanned aerial vehicles for health purposes: a systematic review of experimental studies, GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS, Vol: 3, ISSN: 2054-4200
BackgroundUnmanned aircraft vehicles (UAVs) have had a rapid escalation in manageability and affordability, which can be exploited in healthcare. We conducted a systematic review examining the use of drones for health-related purposes.MethodsA search was conducted in Medline, Embase, Global Health, Scopus, CINAHL and SciELO. Experimental studies were selected if the population included human subjects, the intervention was the use of UAVs and there was a health-related outcome.ResultsOf 500 results, five met inclusion criteria during an initial search. An updated search yielded four additional studies. Nine studies, all in high-income countries, were included for systematic syntheses: four studies addressed out-of-hospital cardiac arrest emergencies, three assessed drones for identification of people after accidents, one used drones to transport blood samples and one used drones to improve surgical procedures in war zones.ConclusionsResearch on the use of drones in healthcare is limited to simulation scenarios, and this review did not retrieve any studies from low- and middle-income countries.
Zhou B, Bentham J, Di Cesare M, et al., 2018, Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1,018 population-based measurement studies with 88.6 million participants, International Journal of Epidemiology, Vol: 47, Pages: 872-883i, ISSN: 1464-3685
BackgroundChange in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure.MethodsWe pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure.ResultsIn 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association.ConclusionsChange in mean bloo
Alviso-Orellana C, Estrada-Tejada D, Carrillo-Larco RM, et al., 2018, Sweetened beverages, snacks and overweight: findings from the Young Lives cohort study in Peru, Public Health Nutrition, Vol: 21, Pages: 1627-1633, ISSN: 1368-9800
OBJECTIVE: To determine the association between consumption of snacks and sweetened beverages and risk of overweight among children. DESIGN: Secondary analysis of the Young Lives cohort study in Peru. SETTING: Twenty sentinel sites from a total of 1818 districts available in Peru. SUBJECTS: Children in the younger cohort of the Young Lives study in Peru, specifically those included in the third (2009) and the fourth (2013) rounds. RESULTS: A total of 1813 children were evaluated at baseline; 49·2 % girls and mean age 8·0 (sd 0·3) years. At baseline, 3·3 (95 % CI 2·5, 4·2) % reported daily sweetened beverage consumption, while this proportion was 3·9 (95 % CI 3·1, 4·9) % for snacks. Baseline prevalence of overweight was 22·0 (95 % CI 20·1, 23·9) %. Only 1414 children were followed for 4·0 (sd 0·1) years, with an overweight incidence of 3·6 (95 % CI 3·1, 4·1) per 100 person-years. In multivariable analysis, children who consumed sweetened beverages and snacks daily had an average weight increase of 2·29 (95 % CI 0·62, 3·96) and 2·04 (95 % CI 0·48, 3·60) kg more, respectively, than those who never consumed these products, in approximately 4 years of follow-up. Moreover, there was evidence of an association between daily consumption of sweetened beverages and risk of overweight (relative risk=2·12; 95 % CI 1·05, 4·28). CONCLUSIONS: Daily consumption of sweetened beverages and snacks was associated with increased weight gain v. never consuming these products; and in the case of sweetened beverages, with higher risk of developing overweight.
Carrillo-Larco RM, Bernabé-Ortiz A, Sal Y Rosas VG, et al., 2018, Parental body mass index and blood pressure are associated with higher body mass index and blood pressure in their adult offspring: a cross-sectional study in a resource-limited setting in northern Peru, Tropical Medicine and International Health, Vol: 23, Pages: 533-540, ISSN: 1360-2276
OBJECTIVES: High body mass index (BMI) and blood pressure (BP) are major contributors to the high burden of non-communicable diseases in adulthood. Individual high-risk and population approaches for prevention require newer strategies to target these risk factors and focusing on the family to introduce prevention initiatives appears as a promising scenario. Characterisation of the relationship between BMI and BP among the adult members of a given family merits evaluation. We conducted a secondary analysis of an implementation study in Tumbes, Peru, benefiting from data derived from families with at least one adult offspring. METHODS: The exposures of interest were the BMI, systolic BP (SBP) and diastolic BP (DBP) of the mother and father. The outcomes were the BMI, SBP and DBP of the offspring. Mixed-effects linear regression models were conducted. RESULTS: The mean age of the offspring, mothers and fathers was 29 (SD: 9.5), 54 (SD: 11.8) and 59 (SD: 11.6) years, respectively. Father's BMI was associated with a quarter-point increase in offspring BMI, regardless of the sex of the offspring. Mother's BMI had a similar effect on the BMI of her sons, but had no significant effect on her daughters'. Mother's SBP was associated with almost one-tenth of mmHg increase in the SBP of the adult offspring. There was no evidence of an association for DBP. CONCLUSIONS: In families with adult members, the higher the parents' BMI and SBP, the higher their adult offspring's levels will be.
Ruiz-Alejos A, Carrillo-Larco RM, Miranda JJ, et al., 2018, Addressing the impact of urban exposure on the incidence of type 2 diabetes mellitus: The PERU MIGRANT Study, Scientific Reports, Vol: 8, Pages: 5512-5512, ISSN: 2045-2322
The aim of this study was to estimate the incidence of T2DM in three population groups: rural, rural-to-urban migrants and urban dwellers. Data from the PERU MIGRANT Study was analysed. The baseline assessment was conducted in 2007-2008 using a single-stage random sample and further follow-up was undertaken in 2015-16. T2DM was defined based on fasting glucose and self-reported diagnosis. Poisson regression models and robust variance to account for cluster effects were used for reporting risk ratios (RR) and 95%CI. At baseline, T2DM prevalence was 8% in urban, 3.6% in rural-to-urban migrants and 1.5% in rural dwellers. After 7.7 (SD: 1.1) years, 6,076 person-years of follow-up, 61 new cases were identified. The incidence rates in the urban, migrant and rural groups were 1.6, 0.9 and 0.5 per 100 person-years, respectively. Relative to rural dwellers, a 4.3-fold higher risk (95%CI: 1.6-11.9) for developing T2DM was found in urban dwellers and 2.7-fold higher (95%CI: 1.1-6.8) in migrants with ≥30 years of urban exposure. Migration and urban exposure were found as significant risk factors for developing T2DM. Within-country migration is a sociodemographic phenomenon occurring worldwide; thus, it is necessary to disentangle the effect of urban exposure on non-healthy habits and T2DM development.
Carrillo-Larco RM, Miranda JJ, Gilman RH, et al., 2018, Trajectories of body mass index and waist circumference in four Peruvian settings at different level of urbanisation: the CRONICAS Cohort Study, Journal of Epidemiology and Community Health, Vol: 72, Pages: 397-403, ISSN: 0143-005X
BACKGROUND: Studies have reported the incidence/risk of becoming obese, but few have described the trajectories of body mass index (BMI) and waist circumference (WC) over time, especially in low/middle-income countries. We assessed the trajectories of BMI and WC according to sex in four sites in Peru. METHODS: Data from the population-based CRONICAS Cohort Study were analysed. We fitted a population-averaged model by using generalised estimating equations. The outcomes of interest, with three data points over time, were BMI and WC. The exposure variable was the factorial interaction between time and study site. RESULTS: At baseline mean age was 55.7 years (SD: 12.7) and 51.6% were women. Mean follow-up time was 2.5 years (SD: 0.4). Over time and across sites, BMI and WC increased linearly. The less urbanised sites showed a faster increase than more urbanised sites, and this was also observed after sex stratification. Overall, the fastest increase was found for WC compared with BMI. Compared with Lima, the fastest increase in WC was in rural Puno (coefficient=0.73, P<0.001), followed by urban Puno (coefficient=0.59, P=0.001) and Tumbes (coefficient=0.22, P=0.088). CONCLUSIONS: There was a linear increase in BMI and WC across study sites, with the greatest increase in less urbanised areas. The ongoing urbanisation process, common to Peru and other low/middle-income countries, is accompanied by different trajectories of increasing obesity-related markers.
Carrillo-Larco RM, Saavedra-Garcia L, Miranda JJ, et al., 2018, Sodium and potassium consumption in a semi-urban area in Peru: evaluation of a population-based 24-Hour urine collection, Nutrients, Vol: 10, ISSN: 2072-6643
Despite the negative effects of high sodium and low potassium consumption on cardiovascular health, their consumption has not been quantified in sites undergoing urbanization. We aimed to determine the sodium and potassium consumption in a semi-urban area in Peru with a cross-sectional study. 24-h urine samples were collected. The outcomes were mean consumption of sodium and potassium, as well as adherence to their consumption recommendation: <2 g/day and ≥3.51 g/day, respectively. Bivariate analyses were conducted to identify socio-economic and clinical variables associated with the consumption recommendations of 602 participants, complete urine samples were found in 409: mean age of participants was 45.7 (standard deviation (SD): 16.2) years and 56% were women. The mean sodium and potassium consumption was 4.4 (SD: 2.1) and 2.0 (SD: 1.2) g/day. The sodium and potassium recommendation was met by 7.1% and 13.7% of the study sample; none of the participants met both recommendations. People not adherent to the sodium recommendation had higher diastolic (73.1 mmHg vs. 68.2 mmHg,p= 0.015) and systolic (113.1 mmHg vs. 106.3 mmHg,p= 0.047) blood pressure than those who comply with the recommendation. Public health actions ought to be implemented in areas undergoing urbanization to improve sodium and potassium consumption at the population level.
Miranda JJ, Weinhouse C, Carrillo-Larco RM, et al., 2018, Capitalizing on natural experiments in low- to middle-income countries to explore epigenetic contributions to disease risk in migrant populations., Global Health, Epidemiology and Genomics, Vol: 1, ISSN: 2054-4200
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