179 results found
Greenfield G, Blair M, Aylin P, et al., Frequent attendances at emergency departments in England, Emergency Medicine Journal, ISSN: 1472-0205
Haagsma JA, James SL, Castle CD, et al., 2020, Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017, Injury Prevention, ISSN: 1353-8047
BACKGROUND: The epidemiological transition of non-communicable diseases replacing infectious diseases as the main contributors to disease burden has been well documented in global health literature. Less focus, however, has been given to the relationship between sociodemographic changes and injury. The aim of this study was to examine the association between disability-adjusted life years (DALYs) from injury for 195 countries and territories at different levels along the development spectrum between 1990 and 2017 based on the Global Burden of Disease (GBD) 2017 estimates. METHODS: Injury mortality was estimated using the GBD mortality database, corrections for garbage coding and CODEm-the cause of death ensemble modelling tool. Morbidity estimation was based on surveys and inpatient and outpatient data sets for 30 cause-of-injury with 47 nature-of-injury categories each. The Socio-demographic Index (SDI) is a composite indicator that includes lagged income per capita, average educational attainment over age 15 years and total fertility rate. RESULTS: For many causes of injury, age-standardised DALY rates declined with increasing SDI, although road injury, interpersonal violence and self-harm did not follow this pattern. Particularly for self-harm opposing patterns were observed in regions with similar SDI levels. For road injuries, this effect was less pronounced. CONCLUSIONS: The overall global pattern is that of declining injury burden with increasing SDI. However, not all injuries follow this pattern, which suggests multiple underlying mechanisms influencing injury DALYs. There is a need for a detailed understanding of these patterns to help to inform national and global efforts to address injury-related health outcomes across the development spectrum.
Alatab S, Sepanlou SG, Ikuta K, et al., 2020, The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet Gastroenterology & Hepatology, Vol: 5, Pages: 17-30, ISSN: 2468-1253
BackgroundThe burden of inflammatory bowel disease (IBD) is rising globally, with substantial variation in levels and trends of disease in different countries and regions. Understanding these geographical differences is crucial for formulating effective strategies for preventing and treating IBD. We report the prevalence, mortality, and overall burden of IBD in 195 countries and territories between 1990 and 2017, based on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017.MethodsWe modelled mortality due to IBD using a standard Cause of Death Ensemble model including data mainly from vital registrations. To estimate the non-fatal burden, we used data presented in primary studies, hospital discharges, and claims data, and used DisMod-MR 2.1, a Bayesian meta-regression tool, to ensure consistency between measures. Mortality, prevalence, years of life lost (YLLs) due to premature death, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) were estimated. All of the estimates were reported as numbers and rates per 100 000 population, with 95% uncertainty intervals (UI).FindingsIn 2017, there were 6·8 million (95% UI 6·4–7·3) cases of IBD globally. The age-standardised prevalence rate increased from 79·5 (75·9–83·5) per 100 000 population in 1990 to 84·3 (79·2–89·9) per 100 000 population in 2017. The age-standardised death rate decreased from 0·61 (0·55–0·69) per 100 000 population in 1990 to 0·51 (0·42–0·54) per 100 000 population in 2017. At the GBD regional level, the highest age-standardised prevalence rate in 2017 occurred in high-income North America (422·0 [398·7–446·1] per 100 000) and the lowest age-standardised prevalence rates were observed in the Caribbean (6·7 [6·3–7·2] per 100 000 population). High Socio-demogra
Foley K, Venkatraman T, Ram B, et al., A protocol for developing a core outcomes set for evaluation of school-based physical activity interventions in primary schools, BMJ Open, ISSN: 2044-6055
Introduction: Primary school-based physical activity interventions, such as The Daily Mile initiative, have the potential to increase children’s physical activity levels over time, which is associated with a variety of health benefits. Comparing interventions or combining results of several studies of a single intervention is challenging because previous studies have examined different outcomes or used different measures that are not feasible or relevant for researchers in school settings. The development and implementation of a core outcome set (COS) for primary school-based physical activity interventions would ensure outcomes important to those involved in implementing and evaluating interventions are standardized.Methods and Analysis: Our aim is to identify a Core Outcomes Set for studies of school based physical activity interventions. We will achieve this by undertaking a four-stage process: (1) identify a list of outcomes assessed in studies through a systematic review of international literature; (2) establish domains from these outcomes to produce questionnaire items; (3) prioritize outcomes through a 2-stage Delphi survey with four key stakeholder groups (researchers, public health professionals, educators and parents) where stakeholders rate the importance of each outcome on a 9-point Likert scale ( consensus that the outcomes should be included in the COS will be determined as 70% or more of all stakeholders scoring the outcome 7 to 9 and 15% or less scoring 1 to 3); (4) achieve consensus on a final Core Outcomes Set in face-to-face meetings with a sample of stakeholders and primary school children. Ethics and Dissemination: We have received ethical approval from Imperial College London (ref: 19IC5428). The results of this study will be disseminated via conference presentations/public health meetings, peer-reviewed publications and through appropriate media channels. Registration details: This study has been prospectively registered with Core Out
Burstein R, Henry NJ, Collison ML, et al., 2019, Mapping 123 million neonatal, infant and child deaths between 2000 and 2017, Nature, Vol: 574, Pages: 353-358, ISSN: 0028-0836
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
Modi N, Ashby D, Battersby C, et al., 2019, Developing routinely recorded clinical data from electronic patient records as a national resource to improve neonatal health care: the Medicines for Neonates research programme, Programme Grants for Applied Research, Vol: 7, Pages: 1-396, ISSN: 2050-4322
BackgroundClinical data offer the potential to advance patient care. Neonatal specialised care is a high-cost NHS service received by approximately 80,000 newborn infants each year.Objectives(1) To develop the use of routinely recorded operational clinical data from electronic patient records (EPRs), secure national coverage, evaluate and improve the quality of clinical data, and develop their use as a national resource to improve neonatal health care and outcomes. To test the hypotheses that (2) clinical and research data are of comparable quality, (3) routine NHS clinical assessment at the age of 2 years reliably identifies children with neurodevelopmental impairment and (4) trial-based economic evaluations of neonatal interventions can be reliably conducted using clinical data. (5) To test methods to link NHS data sets and (6) to evaluate parent views of personal data in research.DesignSix inter-related workstreams; quarterly extractions of predefined data from neonatal EPRs; and approvals from the National Research Ethics Service, Health Research Authority Confidentiality Advisory Group, Caldicott Guardians and lead neonatal clinicians of participating NHS trusts.SettingNHS neonatal units.ParticipantsNeonatal clinical teams; parents of babies admitted to NHS neonatal units.InterventionsIn workstream 3, we employed the Bayley-III scales to evaluate neurodevelopmental status and the Quantitative Checklist of Autism in Toddlers (Q-CHAT) to evaluate social communication skills. In workstream 6, we recruited parents with previous experience of a child in neonatal care to assist in the design of a questionnaire directed at the parents of infants admitted to neonatal units.Data sourcesData were extracted from the EPR of admissions to NHS neonatal units.Main outcome measuresWe created a National Neonatal Research Database (NNRD) containing a defined extract from real-time, point-of-care, clinician-entered EPRs from all NHS neonatal units in England, Wales and Scotland (
Saxena S, Cecil E, Majeed A, et al., 2019, The impact of smoking and smoking-cessation on disease outcomes in Ulcerative Colitis: a nationwide population-based study, Alimentary Pharmacology and Therapeutics, Vol: 50, Pages: 556-567, ISSN: 0269-2813
BackgroundSmokers are less likely to develop Ulcerative Colitis (UC) but the impact of smoking and subsequentcessation on clinical outcomes in UC is unclear. Aim: To evaluate the effect of smoking status andsmoking cessation on disease outcomes.MethodsUsing a nationally representative clinical research database, we identified incident cases of UCduring 2005-2016. Patients were grouped as never-smokers, ex-smokers and smokers, based onsmoking status recorded in the two years preceding UC diagnosis. We defined subgroups ofpersistent smokers and smokers who quit within 2 years after diagnosis. We compared rates ofoverall corticosteroid use, corticosteroid-requiring flares, corticosteroid dependency, thiopurineuse, hospitalization and colectomy between these groups.ResultsWe identified 6754 patients with a new diagnosis of UC over the study period with data on smokingstatus, of whom 878 were smokers at diagnosis. Smokers had a similar risk of corticosteroidrequiring flares (OR 1.16, 95%CI 0.92-1.25), thiopurine use (HR 0.84, 95%CI 0.62-1.14),corticosteroid dependency (HR 0.85, 95%CI 0.60-1.11), hospitalization (HR 0.92, 95%CI 0.72-1.18),and colectomy (HR 0.78, 95%CI 0.50-1.21) in comparison with never-smokers.Rates of flares, thiopurine use, corticosteroid dependency, hospitalization and colectomy were notsignificantly different between persistent smokers and those who quit smoking after a diagnosis ofUC.ConclusionsSmokers and never-smokers with UC have similar outcomes with respect to flares, thiopurine use,corticosteroid dependency, hospitalization and colectomy. Smoking cessation was not associatedwith worse disease course. The risks associated with smoking outweigh any benefits. UC patientsshould be counselled against smoking.
Saxena S, Hakim A, Alexakis C, et al., Comparison of small intestinal contrast ultrasound with magnetic resonance enterography in paediatric Crohn’s disease, JGH Open, ISSN: 2397-9070
AimTo compare the diagnostic yield of small intestinal contrast ultrasonography (SICUS) with magnetic resonance enterography (MRE) in routine clinical practice in a cohort of paediatric patients investigated for Crohn’s disease (CD) attending a UK tertiary centre.Methods and resultsPatients with suspected or established CD who underwent SICUS were identified retrospectively. SICUS was compared to conventional trans-abdominal ultrasound (TUS), ileocolonoscopy (IC) and MRE. Accuracy and agreement of SICUS in detecting small bowel lesions and CD-related complications were assessed using kappa (κ) coefficient statistics. Ninety-three patients (median age 15 years, range 2–17, 49 male) underwent SICUS; 58 had suspected and 35 established CD. In suspected CD, sensitivity and specificity of SICUS in detecting CD small bowel lesions were 81.8% and 100% and for trans-abdominal ultrasound (TUS) 85.7% and 87.5%, respectively. In established CD, sensitivity and specificity of SICUS were 98.7% and 100% and TUS 80% and 100%, respectively. Agreement between SICUS and IC was substantial for the presence of lesions (κ=0.73) but fair with TUS (κ=0.31). Agreement between SICUS and IC was almost perfect for detecting strictures (κ=0.84) with a sensitivity of 100% and specificity of 97.6%. When comparing SICUS and TUS with MRE, agreement for the presence of lesions was substantial (κ=0.63) and moderate (κ=0.53) respectively. Agreement between SICUS and MRE was substantial for detecting strictures (κ=0.77) and dilatation (κ=0.68).ConclusionsSICUS offers a radiation-free alternative for assessing paediatric small bowel CD, with diagnostic accuracy that is comparable to MRE and IC, supporting its wider use in routine practice.
Hargreaves DS, Lemer C, Ewing C, et al., 2019, Measuring and improving the quality of NHS care for children and young people, Archives of Disease in Childhood, Vol: 104, Pages: 618-621, ISSN: 1468-2044
Children and young people (CYP) in the UK suffer worse health and well-being outcomes than their peers in comparable countries across a range of physical and mental health measures, including overall mortality and deaths from long-term conditions such as epilepsy, asthma and diabetes.1–6 While social determinants, in particular relatively high rates of child poverty, account for some of this mortality gap, there is growing evidence that many deaths could be prevented through more accessible and higher quality National Health Service (NHS) care.2 3In addition, evidence suggests that the NHS care typically results in worse patient experience for young people aged 16–24 than older adults,7 and that there is sometimes objectively lower quality care for CYP than for adults. The UK ranked fourth out of 30 countries in a recent comparison of the quality of adult diabetes care, whereas the quality and outcomes of diabetes for patients aged 0–24 years lag well behind that of comparable countries.8 9 In addition to moral, public health and economic arguments for improving care quality for CYP, the UK also has legal obligations under the United Nations Convention on the Rights of the Child to provide the best healthcare possible (article 24) and to involve CYP in decisions that affect them (article 12).10–12Validated and appropriate quality measures are necessary (but not sufficient) to improve care quality and health and well-being outcomes.13 CYP have historically been under-represented in many quality frameworks; for example, one 2015 study reported that 0/77 indicators in the Quality Outcomes Framework for primary care were applicable to CYP.14 Following the recommendations of the CYP Health Outcomes Forum,15 the number of indicators in the NHS Outcomes Framework has increased,16 and the perspectives of CYP using NHS services have been given greater weight in some settings.17 However, there has been limited response to many of the Forum’s reco
Saxena S, Skirrow H, Wincott T, et al., 2019, Preschool respiratory hospital admissions following infant bronchiolitis: a birth cohort study, Archives of Disease in Childhood, Vol: 104, Pages: 658-663, ISSN: 1468-2044
Background: Bronchiolitis causes significant infant morbidity worldwide from hospital admissions. However, studies quantifying the subsequent respiratory burden in children under 5 years are lacking.Objective: To estimate the risk of subsequent respiratory hospital admissions in children under 5 years in England following bronchiolitis admission in infancy.Design: Retrospective population-based birth cohort study.Setting: Public hospitals in England.Patients: We constructed a birth cohort of 613,377 infants born between 1.4.2007 and 31.3.2008, followed up until aged 5 years by linking Hospital Episode Statistics (HES) admissions data. Methods: We compared the risk of respiratory hospital admission due to asthma, wheezing and lower and upper respiratory tract infections(LRTI & URTI) in infants who had been admitted for bronchiolitis with those who had not, using Cox proportional hazard regression. We adjusted hazard ratios for known respiratory illness risk factors including living in deprived households, being born preterm or with a comorbid condition.Results: We identified 16,288/613,377 infants(2.7 %) with at least one admission for bronchiolitis. Of these, 21.7% had a further respiratory hospital admission by age 5 years compared with 8% without a previous bronchiolitis admission, (HR(adjusted),2.82, 95%CI 2.72-2.92). The association was greatest for asthma (HR(adjusted), 4.35, 95%CI 4.00-4.73) and wheezing admissions (HR(adjusted), 5.02, 95%CI 4.64-5.44) but were also significant for URTI and LRTI admissions. Conclusions: Hospital admission for bronchiolitis in infancy is associated with a 3-to-5-fold risk of subsequent respiratory hospital admissions from asthma, wheezing and respiratory infections. One in five infants with bronchiolitis hospital admissions will have a subsequent respiratory hospital admission by age 5 years.
Lau W, Bielicki J, Tersigni C, et al., 2019, All-cause pneumonia in children after the introduction of pneumococcal vaccines in the United Kingdom: a population-based study, Pharmacoepidemiology and Drug Safety, Vol: 28, Pages: 821-829, ISSN: 1053-8569
Methods: We carried out a population-based study to assess the trend of all-cause pneumonia in children aged <10 years between 2002 and 2012. Data were obtained from the IMS Disease Analyzer, a primary care database in UK. Three time-periods were defined to estimate monthly incidence: pre-PCV7 (January 2002–August 2006), post-PCV7 (September 2006–March 2010), and post-PCV13 (April 2010–December 2012). Interrupted time series analysis (ITS) was performed to assess any immediate change or gradual change in the monthly incidence of pneumonia between pre- and post-vaccination introduction. Results: A total of 4,228 children with at least one all-cause pneumonia episode were identified. The overall annual incidence rate of all-cause pneumonia declined by 37% from 3.8 episodes/1,000 person-years in 2002 to 2.4 episodes/1,000 person-years in 2012. Results of ITS analyses indicated that the incidence did not decline immediately after the introduction of PCV7 and PCV13. The incidence declined gradually in children aged <2 years (IRR=0.98; 95%CI=0.97-0.99) post-PCV7, and levelled off during post-PCV13 (IRR=1.00; 95%CI=0.99-1.02). No significant changes in incidence trend was observed in children aged 2-4 years (IRR=0.86; 95%CI=0.68-1.07) and 5-9 years (IRR=0.92; 95%CI=0.73-1.15) after PCV13 introduction. Conclusions: In the UK, the incidence of all-cause pneumonia in children <2 years declined after the introduction of PCV7 and levelled off in the first two years of introduction of PCV13. Continual monitoring is warranted to assess the population impact of PCV13 in preventing childhood pneumonia in the long-term.
Sharland E, Long P, Sharland M, et al., 2019, Early origins of oral penicillin dosing for children, Archives of Disease in Childhood, ISSN: 1468-2044
Sutaria S, Saxena S, 2019, How Can Family Physicians Contribute to Ending Childhood Obesity?, Fam Med, Vol: 51, Pages: 308-310
Blackwell J, Saxena S, Pollok RC, 2019, Changing trends in coding for depression among the UK inflammatory bowel disease population., Gut
Troeger CE, Blacker BF, Khalil IA, et al., 2019, Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the Global Burden of Disease Study 2017, LANCET RESPIRATORY MEDICINE, Vol: 7, Pages: 69-89, ISSN: 2213-2600
Sutaria S, Devakumar D, Yasuda SS, et al., 2018, Is obesity associated with depression in children? Systematic review and meta-analysis, Archives of Disease in Childhood, Vol: 104, Pages: 64-74, ISSN: 1468-2044
OBJECTIVES: To compare the odds of depression in obese and overweight children with that in normal-weight children in the community. DESIGN: Systematic review and random-effect meta-analysis of observational studies. DATA SOURCES: EMBASE, PubMed and PsychINFO electronic databases, published between January 2000 and January 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Cross-sectional or longitudinal observational studies that recruited children (aged <18 years) drawn from the community who had their weight status classified by body mass index, using age-adjusted and sex-adjusted reference charts or the International Obesity Task Force age-sex specific cut-offs, and concurrent or prospective odds of depression were measured. RESULTS: Twenty-two studies representing 143 603 children were included in the meta-analysis. Prevalence of depression among obese children was 10.4%. Compared with normal-weight children, odds of depression were 1.32 higher (95% CI 1.17 to 1.50) in obese children. Among obese female children, odds of depression were 1.44 (95% CI 1.20 to 1.72) higher compared with that of normal-weight female children. No association was found between overweight children and depression (OR 1.04, 95% CI 0.95 to 1.14) or among obese or overweight male subgroups and depression (OR 1.14, 95% CI 0.93 to 1.41% and 1.08, 95% CI 0.85 to 1.37, respectively). Subgroup analysis of cross-sectional and longitudinal studies separately revealed childhood obesity was associated with both concurrent (OR 1.26, 95% CI 1.09 to 1.45) and prospective odds (OR 1.51, 95% CI 1.21 to 1.88) of depression. CONCLUSION: We found strong evidence that obese female children have a significantly higher odds of depression compared with normal-weight female children, and this risk persists into adulthood. Clinicians should consider screening obese female children for symptoms of depression. BACKGROUND: Childhood mental illness is poorly recognised by
Blackwell J, Saxena S, Pollok RC, 2018, Role of thiopurines as disease-modifying agents in Crohn's disease, GUT, Vol: 67, Pages: 2229-+, ISSN: 0017-5749
Zunt JR, Kassebaum NJ, Blake N, et al., 2018, Global, regional, and national burden of meningitis, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016, Lancet Neurology, Vol: 17, Pages: 1061-1082, ISSN: 1474-4422
BackgroundAcute meningitis has a high case-fatality rate and survivors can have severe lifelong disability. We aimed to provide a comprehensive assessment of the levels and trends of global meningitis burden that could help to guide introduction, continuation, and ongoing development of vaccines and treatment programmes.MethodsThe Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2016 study estimated meningitis burden due to one of four types of cause: pneumococcal, meningococcal, Haemophilus influenzae type b, and a residual category of other causes. Cause-specific mortality estimates were generated via cause of death ensemble modelling of vital registration and verbal autopsy data that were subject to standardised data processing algorithms. Deaths were multiplied by the GBD standard life expectancy at age of death to estimate years of life lost, the mortality component of disability-adjusted life-years (DALYs). A systematic analysis of relevant publications and hospital and claims data was used to estimate meningitis incidence via a Bayesian meta-regression tool. Meningitis deaths and cases were split between causes with meta-regressions of aetiological proportions of mortality and incidence, respectively. Probabilities of long-term impairment by cause of meningitis were applied to survivors and used to estimate years of life lived with disability (YLDs). We assessed the relationship between burden metrics and Socio-demographic Index (SDI), a composite measure of development based on fertility, income, and education.FindingsGlobal meningitis deaths decreased by 21·0% from 1990 to 2016, from 403 012 (95% uncertainty interval [UI] 319 426–458 514) to 318 400 (265 218–408 705). Incident cases globally increased from 2·50 million (95% UI 2·19–2·91) in 1990 to 2·82 million (2·46–3·31) in 2016. Meningitis mortality and incidence were closely related to SDI. The highest mortality rates an
Roth GA, Abate D, Abate KH, et al., 2018, Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1736-1788, ISSN: 0140-6736
BackgroundGlobal development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017.MethodsThe causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries—Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised.FindingsAt the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest f
Kyu HH, Abate D, Abate KH, et al., 2018, Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1859-1922, ISSN: 0140-6736
BackgroundHow long one lives, how many years of life are spent in good and poor health, and how the population's state of health and leading causes of disability change over time all have implications for policy, planning, and provision of services. We comparatively assessed the patterns and trends of healthy life expectancy (HALE), which quantifies the number of years of life expected to be lived in good health, and the complementary measure of disability-adjusted life-years (DALYs), a composite measure of disease burden capturing both premature mortality and prevalence and severity of ill health, for 359 diseases and injuries for 195 countries and territories over the past 28 years.MethodsWe used data for age-specific mortality rates, years of life lost (YLLs) due to premature mortality, and years lived with disability (YLDs) from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to calculate HALE and DALYs from 1990 to 2017. We calculated HALE using age-specific mortality rates and YLDs per capita for each location, age, sex, and year. We calculated DALYs for 359 causes as the sum of YLLs and YLDs. We assessed how observed HALE and DALYs differed by country and sex from expected trends based on Socio-demographic Index (SDI). We also analysed HALE by decomposing years of life gained into years spent in good health and in poor health, between 1990 and 2017, and extra years lived by females compared with males.FindingsGlobally, from 1990 to 2017, life expectancy at birth increased by 7·4 years (95% uncertainty interval 7·1–7·8), from 65·6 years (65·3–65·8) in 1990 to 73·0 years (72·7–73·3) in 2017. The increase in years of life varied from 5·1 years (5·0–5·3) in high SDI countries to 12·0 years (11·3–12·8) in low SDI countries. Of the additional years of life expected at birth, 26·3% (20·1&ndash
James SL, Abate D, Abate KH, et al., 2018, Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1789-1858, ISSN: 0140-6736
BackgroundThe Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data.MethodsWe estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calcula
Murray CJL, Callender CSKH, Kulikoff XR, et al., 2018, Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1995-2051, ISSN: 0140-6736
BackgroundPopulation estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods.MethodsWe estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migrat
Lozano R, Fullman N, Abate D, et al., 2018, Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 2091-2138, ISSN: 0140-6736
BackgroundEfforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment.MethodsWe measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected fo
Dicker D, Nguyen G, Abate D, et al., 2018, Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet, Vol: 392, Pages: 1684-1735, ISSN: 0140-6736
BackgroundAssessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally.MethodsThe GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different compone
Saxena S, Alexakis C, Chhaya V, et al., 2018, Smoking status at diagnosis and subsequent smoking cessation: associations with cortic os use and intestinal resection in Crohn's disease, The American Journal of Gastroenterology, Vol: 113, Pages: 1689-1700, ISSN: 1572-0241
BackgroundThe impact of smoking at diagnosis and subsequent smoking cessation on clinical outcomes in Crohn’s disease (CD) has not been evaluated in a population-based cohort.MethodsUsing a nationally representative clinical research database, we identified incident cases of CD between 2005 and 2014. We compared the following outcomes: overall corticosteroid (CS) use; flares requiring CS; CS dependency and intestinal surgery between smokers and non-smokers at time of CD diagnosis. Differences in these outcomes were also compared between persistent smokers and smokers who quit within 2 years of diagnosis.ResultsWe identified 3553 patients with a new CD diagnosis over the study period of whom 1121 (32%) were smokers. Smokers at CD diagnosis had significantly higher CS-use (56 versus 47%, p < 0.0001), proportionally more CS flares (>1 CS flare/year: 9 versus 6%, p < 0.0001), and higher CS dependency (27 versus 21%, p < 0.0001) than non-smokers. Regression analysis identified smoking at diagnosis to be associated with a higher risk of intestinal surgery (HR 1.64, 95% CI 1.16–2.52). There was a significantly higher proportion of ‘quitters’ who remained steroid-free through follow-up in comparison to ‘persistent smokers’ (45.4 versus 37.5%, respectively, p = 0.02). ‘Quitters’ also had lower rates of CS dependency compared to ‘persistent smokers’ (24 versus 33%, p = 0.008).ConclusionsSmokers at CD diagnosis have higher CS-use, CS dependency and higher risk of intestinal surgery. Quitting smoking appears to have beneficial effects on disease related outcomes, including reducing CS dependency highlighting the importance of offering early smoking cessation support.
Cecil E, Bottle RA, Ma R, et al., 2018, Impact of preventive primary care on children’s unplanned hospital admissions; population-based birth cohort study of UK children 2000-2013, BMC Medicine, Vol: 16, ISSN: 1741-7015
BackgroundUniversal health coverage (UHC) aims to improve child health through preventive primary care and vaccine coverage. Yet, in many developed countries with UHC, unplanned and ambulatory care sensitive (ACS) hospital admissions in childhood continue to rise. We investigated the relation between preventive primary care and risk of unplanned and ACS admission in children in a high-income country with UHC.MethodsWe followed 319,780 children registered from birth with 363 English practices in Clinical Practice Research Datalink linked to Hospital Episodes Statistics, born between January 2000 and March 2013. We used Cox regression estimating adjusted hazard ratios (HR) to examine subsequent risk of unplanned and ACS hospital admissions in children who received preventive primary care (development checks and vaccinations), compared with those who did not.ResultsOverall, 98% of children had complete vaccinations and 87% had development checks. Unplanned admission rates were 259, 105 and 42 per 1000 child-years in infants (aged < 1 year), preschool (1–4 years) and primary school (5–9 years) children, respectively.Lack of preventive care was associated with more unplanned admissions. Infants with incomplete vaccination had increased risk for all unplanned admissions (HR 1.89, 1.79–2.00) and vaccine-preventable admissions (HR 4.41, 2.59–7.49). Infants lacking development checks had higher risk for unplanned admission (HR 4.63, 4.55–4.71). These associations persisted across childhood. Children who had higher consulting rates with primary care providers also had higher risk of unplanned admission (preschool children: HR 1.17, 1.17–1.17). One third of all unplanned admissions (62,154/183,530) were for ACS infectious illness. Children with chronic ACS conditions, asthma, diabetes or epilepsy had increased risk of unplanned admission (HR 1.90, 1.77–2.04, HR 11.43, 8.48–15.39, and HR 4.82, 3.93–5.91, respective
Hayhoe BWJ, BUTLER CC, MAJEED A, et al., 2018, Telling the truth about antibiotics: benefits, harms and moral duty in prescribing for children in primary care, Journal of Antimicrobial Chemotherapy, Vol: 73, Pages: 2298-2304, ISSN: 0305-7453
Antimicrobial resistance represents a growing threat to global health, yet antibiotics are frequently prescribed primary care for acute childhood illness, where there is evidence of very limited clinical effectiveness. Moral philosophy supports the need for doctors to consider wider society, including future patients, when treating present individuals, and it is clearly wrong to waste antibiotics in situations where they are largely clinically ineffective at the expense of future generations. Doctors should feel confident in applying principles of antibiotic stewardship when treating children in primary care, but they must explain these to parents. Provision of accurate, accessible information about the benefits and harms of antibiotics is key to an ethical approach to antimicrobial stewardship and to supporting shared decision making. Openness and honesty about drivers for antibiotic requests and prescribing may further allow parents to have their concerns heard and help clinicians to develop with them an understanding of shared goals.
Cecil E, Saxena S, Aylin P, 2018, Children and Young People's Contacts in Primary Care within 3 Days of an Admission to Hospital with Meningitis, Publisher: OXFORD UNIV PRESS, Pages: 7-8, ISSN: 1353-4505
Ahmad A, Laverty AA, Cowling TE, et al., 2018, Changing nationwide trends in endoscopic, medical and surgical admissions for Inflammatory Bowel Disease: 2003-2013, BMJ Open Gastroenterology, Vol: 5, ISSN: 2054-4774
Background and study aims In the last decade, there have been major advances in inflammatory bowel disease (IBD) management but their impact on hospital admissions requires evaluation. We aim to investigate nationwide trends in IBD surgical/medical elective and emergency admissions, including endoscopy and cytokine inhibitor infusions, between 2003 and 2013.Patients and methods We used Hospital Episode Statistics and population data from the UK Office for National Statistics.Results Age-sex standardised admission rates increased from 76.5 to 202.9/100 000 (p<0.001) and from 69.5 to 149.5/100 000 (p<0.001) for Crohn’s disease (CD) and ulcerative colitis (UC) between 2003–2004 and 2012–2013, respectively. Mean length of stay (days) fell significantly for elective (from 2.6 to 0.7 and from 2.0 to 0.7 for CD and UC, respectively) and emergency admissions (from 9.2 to 6.8 and from 10.8 to 7.6 for CD and UC, respectively). Elective lower gastrointestinal (GI) endoscopy rates decreased from 6.3% to 3.7% (p<0.001) and from 18.4% to 17.6% (p=0.002) for CD and UC, respectively. Elective major abdominal surgery rates decreased from 2.8% to 1.0% (p<0.001) and from 4.9 to 2.4 (p=0.010) for CD and UC, respectively, with emergency rates also decreasing significantly for CD. Between 2006-2007 and 2012-2013, elective admission rates for cytokine-inhibitor infusions increased from 11.1 to 57.2/100 000 and from 1.4 to 12.1/100 000 for CD and UC, respectively.Conclusions Rising IBD hospital admission rates in the past decade have been driven by an increase in the incidence and prevalence of IBD. Lower GI endoscopy and surgery rates have fallen, while cytokine inhibitor infusion rates have risen. There has been a concurrent shift from emergency care to shorter elective hospital stays. These trends indicate a move towards more elective medical management and may reflect improvements in disease control.
Viner RM, Kinra S, Nicholls D, et al., 2018, Burden of child and adolescent obesity on health services in England, Arch Dis Child, Vol: 103, Pages: 247-254, ISSN: 0003-9888
OBJECTIVE: To assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England. DESIGN: Pathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data. SETTING: Data on CYP aged 2-18 years from the Health Survey for England 2006 to 2013. MAIN OUTCOME MEASURES: Clinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI >/=99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function). RESULTS: 11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13-18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management. CONCLUSIONS: There is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden.
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