Imperial College London

ProfessorMajidEzzati

Faculty of MedicineSchool of Public Health

Chair in Global Environmental Health
 
 
 
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Contact

 

+44 (0)20 7594 0767majid.ezzati Website

 
 
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Location

 

Norfolk PlaceSt Mary's Campus

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Summary

 

Publications

Publication Type
Year
to

339 results found

Jaacks LM, Vandevijvere S, Pan A, McGowan CJ, Wallace C, Imamura F, Mozaffarian D, Swinburn B, Ezzati Met al., 2019, The obesity transition: stages of the global epidemic, Lancet Diabetes and Endocrinology, Vol: 7, Pages: 231-240, ISSN: 2213-8595

The global prevalence of obesity has increased substantially over the past 40 years, from less than 1% in 1975, to 6–8% in 2016, among girls and boys, and from 3% to 11% among men and from 6% to 15% among women over the same time period. Our aim was to consolidate the evidence on the epidemiology of obesity into a conceptual model of the so-called obesity transition. We used illustrative examples from the 30 most populous countries, representing 77·5% of the world's population to propose a four stage model. Stage 1 of the obesity transition is characterised by a higher prevalence of obesity in women than in men, in those with higher socioeconomic status than in those with lower socioeconomic status, and in adults than in children. Many countries in south Asia and sub-Saharan Africa are presently in this stage. In countries in stage 2 of the transition, there has been a large increase in the prevalence among adults, a smaller increase among children, and a narrowing of the gap between sexes and in socioeconomic differences among women. Many Latin American and Middle Eastern countries are presently at this stage. High-income east Asian countries are also at this stage, albeit with a much lower prevalence of obesity. In stage 3 of the transition, the prevalence of obesity among those with lower socioeconomic status surpasses that of those with higher socioeconomic status, and plateaus in prevalence can be observed in women with high socioeconomic status and in children. Most European countries are presently at this stage. There are too few signs of countries entering into the proposed fourth stage of the transition, during which obesity prevalence declines, to establish demographic patterns. This conceptual model is intended to provide guidance to researchers and policy makers in identifying the current stage of the obesity transition in a population, anticipating subpopulations that will develop obesity in the future, and enacting proactive measures to at

Journal article

Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, Calvillo A, De Schutter O, Devarajan R, Ezzati M, Friel S, Goenka S, Hammond RA, Hastings G, Hawkes C, Herrero M, Hovmand PS, Howden M, Jaacks LM, Kapetanaki AB, Kasman M, Kuhnlein HV, Kumanyika SK, Larijani B, Lobstein T, Long MW, Matsudo VKR, Mills SDH, Morgan G, Morshed A, Nece PM, Pan A, Patterson DW, Sacks G, Shekar M, Simmons GL, Smit W, Tootee A, Vandevijvere S, Waterlander WE, Wolfenden L, Dietz WHet al., 2019, The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report, LANCET, Vol: 393, Pages: 791-846, ISSN: 0140-6736

Journal article

Smith Fawzi MC, Andrews KG, Fink G, Danaei G, McCoy DC, Sudfeld CR, Peet ED, Cho J, Liu Y, Finlay JE, Ezzati M, Kaaya SF, Fawzi WWet al., 2019, Lifetime economic impact of the burden of childhood stunting attributable to maternal psychosocial risk factors in 137 low/middle-income countries, BMJ Global Health, Vol: 4, ISSN: 2059-7908

Introduction: The first 1000 days of life is a period of great potential and vulnerability. In particular, physical growth of children can be affected by the lack of access to basic needs as well as psychosocial factors, such as maternal depression. The objectives of the present study are to: (1) quantify the burden of childhood stunting in low/middle-income countries attributable to psychosocial risk factors; and (2) estimate the related lifetime economic costs. Methods: A comparative risk assessment analysis was performed with data from 137 low/middle-income countries throughout Asia, Latin America and the Caribbean, North Africa and the Middle East, and sub-Saharan Africa. The proportion of stunting prevalence, defined as <-2 SDs from the median height for age according to the WHO Child Growth Standards, and the number of cases attributable to low maternal education, intimate partner violence (IPV), maternal depression and orphanhood were calculated. The joint effect of psychosocial risk factors on stunting was estimated. The economic impact, as reflected in the total future income losses per birth cohort, was examined. Results: Approximately 7.2 million cases of stunting in low/middle-income countries were attributable to psychosocial factors. The leading risk factor was maternal depression with 3.2 million cases attributable. Maternal depression also demonstrated the greatest economic cost at $14.5 billion, followed by low maternal education ($10.0 billion) and IPV ($8.5 billion). The joint cost of these risk factors was $29.3 billion per birth cohort. Conclusion: The cost of neglecting these psychosocial risk factors is significant. Improving access to formal secondary school education for girls may offset the risk of maternal depression, IPV and orphanhood. Focusing on maternal depression may play a key role in reducing the burden of stunting. Overall, addressing psychosocial factors among perinatal women can have a signi

Journal article

Lai AM, Carter E, Shan M, Ni K, Clark S, Ezzati M, Wiedinmyer C, Yang X, Baumgartner J, Schauer JJet al., 2019, Chemical composition and source apportionment of ambient, household, and personal exposures to PM2.5 in communities using biomass stoves in rural China, SCIENCE OF THE TOTAL ENVIRONMENT, Vol: 646, Pages: 309-319, ISSN: 0048-9697

Journal article

Bennett J, Pearson-Stuttard J, Kontis V, Capewell S, Wolfe I, Ezzati Met al., 2018, Contributions of diseases and injuries to widening life expectancy inequalities in England from 2001 to 2016: population-based analysis of vital registration data, The Lancet Public Health, Vol: 3, Pages: e586-e597, ISSN: 2468-2667

BackgroundLife expectancy inequalities in England have increased steadily since the 1980s. Our aim was to investigate how much deaths from different diseases and injuries and at different ages have contributed to this rise to inform policies that aim to reduce health inequalities.MethodsWe used vital registration data from the Office for National Statistics on population and deaths in England, by underlying cause of death, from 2001 to 2016, stratified by sex, 5-year age group, and decile of the Index of Multiple Deprivation (based on the ranked scores of Lower Super Output Areas in England in 2015). We grouped the 7·65 million deaths by their assigned International Classification of Diseases (10th revision) codes to create categories of public health and clinical relevance. We used a Bayesian hierarchical model to obtain robust estimates of cause-specific death rates by sex, age group, year, and deprivation decile. We calculated life expectancy at birth by decile of deprivation and year using life-table methods. We calculated the contributions of deaths from each disease and injury, in each 5-year age group, to the life expectancy gap between the most deprived and affluent deciles using Arriaga's method.FindingsThe life expectancy gap between the most affluent and most deprived deciles increased from 6·1 years (95% credible interval 5·9–6·2) in 2001 to 7·9 years (7·7–8·1) in 2016 in females and from 9·0 years (8·8–9·2) to 9·7 years (9·6–9·9) in males. Since 2011, the rise in female life expectancy has stalled in the third, fourth, and fifth most deprived deciles and has reversed in the two most deprived deciles, declining by 0·24 years (0·10–0·37) in the most deprived and 0·16 years (0·02–0·29) in the second-most deprived by 2016. Death rates from every disease and at every age were higher in depriv

Journal article

Pennells L, Kaptoge S, Wood A, Sweeting M, Zhao X, White I, Burgess S, Willeit P, Bolton T, Moons KGM, van der Schouw YT, Selmer R, Khaw K-T, Gudnason V, Assmann G, Amouyel P, Salomaa V, Kivimaki M, Nordestgaard BG, Blaha MJ, Kuller LH, Brenner H, Gillum RF, Meisinger C, Ford I, Knuiman MW, Rosengren A, Lawlor DA, Völzke H, Cooper C, Marín Ibañez A, Casiglia E, Kauhanen J, Cooper JA, Rodriguez B, Sundström J, Barrett-Connor E, Dankner R, Nietert PJ, Davidson KW, Wallace RB, Blazer DG, Björkelund C, Donfrancesco C, Krumholz HM, Nissinen A, Davis BR, Coady S, Whincup PH, Jørgensen T, Ducimetiere P, Trevisan M, Engström G, Crespo CJ, Meade TW, Visser M, Kromhout D, Kiechl S, Daimon M, Price JF, Gómez de la Cámara A, Wouter Jukema J, Lamarche B, Onat A, Simons LA, Kavousi M, Ben-Shlomo Y, Gallacher J, Dekker JM, Arima H, Shara N, Tipping RW, Roussel R, Brunner EJ, Koenig W, Sakurai M, Pavlovic J, Gansevoort RT, Nagel D, Goldbourt U, Barr ELM, Palmieri L, Njølstad I, Sato S, Monique Verschuren WM, Varghese CV, Graham I, Onuma O, Greenland P, Woodward M, Ezzati M, Psaty BM, Sattar N, Jackson R, Ridker PM, Cook NR, D'Agostino RB, Thompson SG, Danesh J, Di Angelantonio E, Emerging Risk Factors Collaborationet al., 2018, Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies, European Heart Journal, Vol: 40, Pages: 621-631, ISSN: 1522-9645

Aims: There is debate about the optimum algorithm for cardiovascular disease (CVD) risk estimation. We conducted head-to-head comparisons of four algorithms recommended by primary prevention guidelines, before and after 'recalibration', a method that adapts risk algorithms to take account of differences in the risk characteristics of the populations being studied. Methods and results: Using individual-participant data on 360 737 participants without CVD at baseline in 86 prospective studies from 22 countries, we compared the Framingham risk score (FRS), Systematic COronary Risk Evaluation (SCORE), pooled cohort equations (PCE), and Reynolds risk score (RRS). We calculated measures of risk discrimination and calibration, and modelled clinical implications of initiating statin therapy in people judged to be at 'high' 10 year CVD risk. Original risk algorithms were recalibrated using the risk factor profile and CVD incidence of target populations. The four algorithms had similar risk discrimination. Before recalibration, FRS, SCORE, and PCE over-predicted CVD risk on average by 10%, 52%, and 41%, respectively, whereas RRS under-predicted by 10%. Original versions of algorithms classified 29-39% of individuals aged ≥40 years as high risk. By contrast, recalibration reduced this proportion to 22-24% for every algorithm. We estimated that to prevent one CVD event, it would be necessary to initiate statin therapy in 44-51 such individuals using original algorithms, in contrast to 37-39 individuals with recalibrated algorithms. Conclusion: Before recalibration, the clinical performance of four widely used CVD risk algorithms varied substantially. By contrast, simple recalibration nearly equalized their performance and improved modelled targeting of preventive action to clinical need.

Journal article

Steel N, Ford JA, Newton JN, Davis ACJ, Vos T, Naghavi M, Glenn S, Hughes A, Dalton AM, Stockton D, Humphreys C, Dallat M, Schmidt J, Flowers J, Fox S, Abubakar I, Aldridge RW, Baker A, Brayne C, Brugha T, Capewell S, Car J, Cooper C, Ezzati M, Fitzpatrick J, Greaves F, Hay R, Hay S, Kee F, Larson HJ, Lyons RA, Majeed A, McKee M, Rawaf S, Rutter H, Saxena S, Sheikh A, Smeeth L, Viner RM, Vollset SE, Williams HC, Wolfe C, Woolf A, Murray CJLet al., 2018, Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016, The Lancet, Vol: 392, Pages: 1647-1661, ISSN: 0140-6736

BackgroundPrevious studies have reported national and regional Global Burden of Disease (GBD) estimates for the UK. Because of substantial variation in health within the UK, action to improve it requires comparable estimates of disease burden and risks at country and local levels. The slowdown in the rate of improvement in life expectancy requires further investigation. We use GBD 2016 data on mortality, causes of death, and disability to analyse the burden of disease in the countries of the UK and within local authorities in England by deprivation quintile.MethodsWe extracted data from the GBD 2016 to estimate years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), and attributable risks from 1990 to 2016 for England, Scotland, Wales, Northern Ireland, the UK, and 150 English Upper-Tier Local Authorities. We estimated the burden of disease by cause of death, condition, year, and sex. We analysed the association between burden of disease and socioeconomic deprivation using the Index of Multiple Deprivation. We present results for all 264 GBD causes of death combined and the leading 20 specific causes, and all 84 GBD risks or risk clusters combined and 17 specific risks or risk clusters.FindingsThe leading causes of age-adjusted YLLs in all UK countries in 2016 were ischaemic heart disease, lung cancers, cerebrovascular disease, and chronic obstructive pulmonary disease. Age-standardised rates of YLLs for all causes varied by two times between local areas in England according to levels of socioeconomic deprivation (from 14 274 per 100 000 population [95% uncertainty interval 12 791–15 875] in Blackpool to 6888 [6145–7739] in Wokingham). Some Upper-Tier Local Authorities, particularly those in London, did better than expected for their level of deprivation. Allowing for differences in age structure, more deprived Upper-Tier Local Authorities had higher attributable YLLs for most major risk factors in the GBD.

Journal article

Parks RM, Bennett J, Foreman K, Toumi R, Ezzati Met al., 2018, National and regional seasonal dynamics of all-cause and cause-specific mortality in the USA from 1980 to 2016, eLife, Vol: 7, ISSN: 2050-084X

In temperate climates, winter deaths exceed summer ones. However, there is limited information on the timing and the relative magnitudes of maximum and minimum mortality, by local climate, age group, sex and medical cause of death. We used geo-coded mortality data and wavelets to analyse the seasonality of mortality by age group and sex from 1980 to 2016 in the USA and its subnational climatic regions. Death rates in men and women ≥ 45 years peaked in December to February and were lowest in June to August, driven by cardiorespiratory diseases and injuries. In these ages, percent difference in death rates between peak and minimum months did not vary across climate regions, nor changed from 1980 to 2016. Under five years, seasonality of all-cause mortality largely disappeared after the 1990s. In adolescents and young adults, especially in males, death rates peaked in June/July and were lowest in December/January, driven by injury deaths.

Journal article

Ezzati M, Webster CJ, Doyle YG, Rashid S, Owusu G, Leung GMet al., 2018, Cities for global health, BMJ, Vol: 363, ISSN: 0959-8138

Journal article

Bahk J, Ezzati M, Khang Y-H, 2018, The life expectancy gap between North and South Korea from 1993 to 2008, European Journal of Public Health, Vol: 28, Pages: 830-835, ISSN: 1101-1262

Background: Comparative research on health outcomes in North and South Korea offers a unique opportunity to explore political and social determinants of health. We examined the age- and cause-specific contributions to the life expectancy (LE) gap between the two Koreas. Methods: We calculated the LE at birth in 1993 and 2008 among North and South Koreans, and cause-specific contributions to the LE discrepancy between the two Koreas in 2008. The cause-specific mortality data from South Korea were used as proxies for the cause-specific mortality data in North Korea in 2008. Results: The LE gap between the two Koreas was approximately 1 year in 1993, but grew to approximately 10 years in 2008. This discrepancy was attributable to increased gaps in mortality among children younger than 1 year and adults 55 years of age or older. The major causes of the increased LE gap were circulatory diseases, digestive diseases, infant mortality, external causes, cancers and infectious diseases. Conclusions: This study underscores the urgency of South Korean and international humanitarian aid programs to reduce the mortality rate of the North Korean people.

Journal article

Bennett JE, Stevens GA, Mathers CD, Bonita R, Rehm J, Kruk M, Riley L, Dain K, Kengne A, Chalkidou K, Beagley J, Kishore S, Chen W, Saxena S, Bettcher D, Grove J, Beaglehole R, Ezzati Met al., 2018, NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4, Lancet, Vol: 392, Pages: 1072-1088, ISSN: 0140-6736

The third UN High-Level Meeting on Non-Communicable Diseases (NCDs) on Sept 27, 2018, will review national and global progress towards the prevention and control of NCDs, and provide an opportunity to renew, reinforce, and enhance commitments to reduce their burden. NCD Countdown 2030 is an independent collaboration to inform policies that aim to reduce the worldwide burden of NCDs, and to ensure accountability towards this aim. In 2016, an estimated 40·5 million (71%) of the 56·9 million worldwide deaths were from NCDs. Of these, an estimated 1·7 million (4% of NCD deaths) occurred in people younger than 30 years of age, 15·2 million (38%) in people aged between 30 years and 70 years, and 23·6 million (58%) in people aged 70 years and older. An estimated 32·2 million NCD deaths (80%) were due to cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes, and another 8·3 million (20%) were from other NCDs. Women in 164 (88%) and men in 165 (89%) of 186 countries and territories had a higher probability of dying before 70 years of age from an NCD than from communicable, maternal, perinatal, and nutritional conditions combined. Globally, the lowest risks of NCD mortality in 2016 were seen in high-income countries in Asia-Pacific, western Europe, and Australasia, and in Canada. The highest risks of dying from NCDs were observed in low-income and middle-income countries, especially in sub-Saharan Africa, and, for men, in central Asia and eastern Europe. Sustainable Development Goal (SDG) target 3.4—a one-third reduction, relative to 2015 levels, in the probability of dying between 30 years and 70 years of age from cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes by 2030—will be achieved in 35 countries (19%) for women, and 30 (16%) for men, if these countries maintain or surpass their 2010–2016 rate of decline in NCD mortality. Most of these are high-income c

Journal article

Baumgartner J, Carter E, Schauer JJ, Ezzati M, Daskalopoulou SS, Valois M-F, Shan M, Yang Xet al., 2018, Household air pollution and measures of blood pressure, arterial stiffness and central haemodynamics, HEART, Vol: 104, Pages: 1515-1521, ISSN: 1355-6037

Journal article

Snider G, Carter E, Clark S, Tseng JTW, Yang X, Ezzati M, Schauer JJ, Wiedinmyer C, Baumgartner Jet al., 2018, Impacts of stove use patterns and outdoor air quality on household air pollution and cardiovascular mortality in southwestern China, Environment International, Vol: 117, Pages: 116-124, ISSN: 0160-4120

BACKGROUND: Decades of intervention programs that replaced traditional biomass stoves with cleaner-burning technologies have failed to meet the World Health Organization (WHO) interim indoor air quality target of 35-μg m-3 for PM2.5. Many attribute these results to continued use of biomass stoves and poor outdoor air quality, though the relative impacts of these factors have not been empirically quantified. METHODS: We measured 496 days of real-time stove use concurrently with outdoor and indoor air pollution (PM2.5) in 150 rural households in Sichuan, China. The impacts of stove use patterns and outdoor air quality on indoor PM2.5 were quantified. We also estimated the potential avoided cardiovascular mortality in southwestern China associated with transition from traditional to clean fuel stoves using established exposure-response relationships. RESULTS: Mean daily indoor PM2.5 was highest in homes using both wood and clean fuel stoves (122 μg m-3), followed by exclusive use of wood stoves (106 μg m-3) and clean fuel stoves (semi-gasifiers: 65 μg m-3; gas or electric: 55 μg m-3). Wood stoves emitted proportionally higher indoor PM2.5 during ignition, and longer stove use was not associated with higher indoor PM2.5. Only 24% of days with exclusive use of clean fuel stoves met the WHO indoor air quality target, though this fraction rose to 73% after subtracting the outdoor PM2.5 contribution. Reduced PM2.5 exposure through exclusive use of gas or electric stoves was estimated to prevent 48,000 yearly premature deaths in southwestern China, with greater reductions if local outdoor PM2.5 is also reduced. CONCLUSIONS: Clean stove and fuel interventions are not likely to reduce indoor PM2.5 to the WHO target unless their use is exclusive and outdoor air pollution is sufficiently low, but may still offer some cardiovascular benefits.

Journal article

Apte JS, Brauer M, Cohen AJ, Ezzati M, Pope CAet al., 2018, Ambient PM2.5 Reduces Global and Regional Life Expectancy, ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS, Vol: 5, Pages: 546-551, ISSN: 2328-8930

Journal article

Ezzati M, Pearson-Stuttard J, Bennett J, Mathers CDet al., 2018, Acting on non-communicable diseases in low- and middle-income tropical countries, Nature, Vol: 559, Pages: 507-516, ISSN: 0028-0836

The classical portrayal of poor health in tropical countries is one of infections and parasites, contrasting with wealthy western countries, where unhealthy diet and behaviours cause non-communicable diseases (NCDs) like heart disease and cancer. Using international mortality data, we show that most NCDs cause more deaths at any age in low- and middle-income tropical countries than in high-income western countries. Causes of NCDs in low- and middle-income countries include poor nutrition and living environment, infections, insufficient regulation of tobacco and alcohol, and under-resourced and inaccessible healthcare. We identify a comprehensive set of actions across health, social, economic and environmental sectors that can confront NCDs in low- and middle-income tropical countries and reduce global health inequalities.

Journal article

Engelgau MM, Narayan KMV, Ezzati M, Salicrup LA, Belis D, Aron LY, Beaglehole R, Beaudet A, Briss PA, Chambers DA, Devaux M, Fiscella K, Gottlieb M, Hakkinen U, Henderson R, Hennis AJ, Hochman JS, Jan S, Koroshetz WJ, Mackenbach JP, Marmot MG, Martikainen P, McClellan M, Meyers D, Parsons PE, Rehnberg C, Sanghavi D S S, Siega-Riz AM, Straus S, Woolf SH, Constant S, Creazzo TL, de Jesus JM, Gavini N, Lerner NB, Mishoe HO, Nelson C, Peprah E, Antonello, Sampson U, Tracy RL, Mensah GAet al., 2018, Implementation Research to Address the United States Health Disadvantage Report of a National Heart, Lung, and Blood Institute Workshop, GLOBAL HEART, Vol: 13, Pages: 65-72, ISSN: 2211-8160

Journal article

Pearson-Stuttard J, Zhou B, Kontis V, Bentham J, Gunter MJ, Ezzati Met al., 2018, Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment, LANCET DIABETES & ENDOCRINOLOGY, Vol: 6, Pages: E6-E15, ISSN: 2213-8587

Journal article

Pearson-Stuttard J, Zhou B, Kontis V, Bentham J, Gunter MJ, Ezzati Met al., 2018, Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment, LANCET DIABETES & ENDOCRINOLOGY, Vol: 6, Pages: 95-104, ISSN: 2213-8587

Journal article

Zhou B, Bentham J, Di Cesare M, Bixby HRH, Danaei G, Hajifathalian K, Taddei C, Carrillo-Larco R, Khatibzadeh S, Lugero C, Peykari N, Zhang WZ, Bennett J, Bilano V, Stevens G, Riley L, Cowan M, Chen Z, Hambleton I, Jackson RT, Kengne A-P, Khang Y-H, Laxmaiah A, Liu J, Malekzadeh R, Neuhauser H, Soric M, Starc G, Sundstrom J, Woodward M, Ezzati Met 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

Journal article

Ezzati M, Di Cesare M, Bentham J, 2018, Determining the worldwide prevalence of obesity reply, LANCET, Vol: 391, Pages: 1774-1774, ISSN: 0140-6736

Journal article

Pope CA, Ezzati M, Cannon JB, Allen RT, Jerrett M, Burnett RTet al., 2018, Mortality risk and PM2.5 air pollution in the USA: an analysis of a national prospective cohort, AIR QUALITY ATMOSPHERE AND HEALTH, Vol: 11, Pages: 245-252, ISSN: 1873-9318

Journal article

Chwojnicki K, Ryglewicz D, Wojtyniak B, Zagozdzon P, Czlonkowska A, Jedrzejczyk T, Karaszewski B, Kozera G, Gierlotka M, Ezzati M, Zdrojewski Tet al., 2018, Acute Ischemic Stroke Hospital Admissions, Treatment, and Outcomes in Poland in 2009-2013, FRONTIERS IN NEUROLOGY, Vol: 9, ISSN: 1664-2295

Journal article

Arku RE, Ezzati M, Baumgartner J, Fink G, Zhou B, Hystad P, Brauer Met al., 2018, Elevated blood pressure and household solid fuel use in premenopausal women: Analysis of 12 Demographic and Health Surveys (DHS) from 10 countries, ENVIRONMENTAL RESEARCH, Vol: 160, Pages: 499-505, ISSN: 0013-9351

Journal article

Pearson-Stuttard J, Zhou B, Kontis V, Bentham J, Gunter M, Ezzati Met al., 2017, Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment, Lancet Diabetes and Endocrinology, Vol: 6, Pages: 95-104, ISSN: 2213-8595

BackgroundDiabetes and high body-mass index (BMI) are associated with increased risk of several cancers, and are increasing in prevalence in most countries. We estimated the cancer incidence attributable to diabetes and high BMI as individual risk factors and in combination, by country and sex.MethodsWe estimated population attributable fractions for 12 cancers by age and sex for 175 countries in 2012. We defined high BMI as a BMI greater than or equal to 25 kg/m2. We used comprehensive prevalence estimates of diabetes and BMI categories in 2002, assuming a 10-year lag between exposure to diabetes or high BMI and incidence of cancer, combined with relative risks from published estimates, to quantify contribution of diabetes and high BMI to site-specific cancers, individually and combined as independent risk factors and in a conservative scenario in which we assumed full overlap of risk of diabetes and high BMI. We then used GLOBOCAN cancer incidence data to estimate the number of cancer cases attributable to the two risk factors. We also estimated the number of cancer cases in 2012 that were attributable to increases in the prevalence of diabetes and high BMI from 1980 to 2002. All analyses were done at individual country level and grouped by region for reporting.FindingsWe estimated that 5·6% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors, corresponding to 792 600 new cases. 187 600 (24·5%) of 766 000 cases of liver cancer and 121 700 (38·4%) of 317 000 cases of endometrial cancer were attributable to these risk factors. In the conservative scenario, about 4·5% (626 900 new cases) of all incident cancers assessed were attributable to diabetes and high BMI combined. Individually, high BMI (544 300 cases) was responsible for twice as many cancer cases as diabetes (280 100 cases). 26·1% of diabetes-related cancers (equating to 77 000 new cases) and 31&mid

Journal article

NCD Risk Factor Collaboration NCD-RisC, 2017, Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults., Lancet, Vol: 390, Pages: 2627-2642, ISSN: 0140-6736

BACKGROUND: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. METHODS: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). FINDINGS: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m(2) per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m(2) per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m(2) per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m(2) per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m(2) per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Tre

Journal article

Shan M, Carter E, Baumgartner J, Deng M, Clark S, Schauer JJ, Ezzati M, Li J, Fu Y, Yang Xet al., 2017, A user-centered, iterative engineering approach for advanced biomass cookstove design and development, Environmental Research Letters, Vol: 12, ISSN: 1748-9326

Journal article

Lee ACC, Kozuki N, Cousens S, Stevens GA, Blencowe H, Silveira MF, Sania A, Rosen HE, Schmiegelow C, Adair LS, Baqui AH, Barros FC, Bhutta ZA, Caulfield LE, Christian P, Clarke SE, Fawzi W, Gonzalez R, Humphrey J, Huybregts L, Kariuki S, Kolsteren P, Lusingu J, Manandhar D, Mongkolchati A, Mullany LC, Ndyomugyenyi R, Jyh KN, Roberfroid D, Saville N, Terlouw DJ, Tielsch JM, Victora CG, Velaphi SC, Watson-Jones D, Willey BA, Ezzati M, Lawn JE, Black RE, Katz Jet al., 2017, Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets, BMJ-BRITISH MEDICAL JOURNAL, Vol: 358, ISSN: 1756-1833

Journal article

Islami F, Chen W, Yu XQ, Lortet-Tieulent J, Zheng R, Flanders WD, Xia C, Thun MJ, Gapstur SM, Ezzati M, Jemal Aet al., 2017, Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013, Annals of Oncology, Vol: 28, Pages: 2567-2574, ISSN: 0923-7534

Journal article

Clark S, Carter E, Shan M, Ni K, Niu H, Tseng JTW, Pattanayak SK, Jeuland M, Schauer JJ, Ezzati M, Wiedinmyer C, Yang X, Baumgartner Jet al., 2017, Adoption and use of a semi-gasifier cooking and water heating stove and fuel intervention in the Tibetan Plateau, China, Environmental Research Letters, Vol: 12, ISSN: 1748-9326

Improved cookstoves and fuels, such as advanced gasifier stoves, carry the promise of improving health outcomes, preserving local environments, and reducing climate-forcing air pollutants. However, low adoption and use of these stoves in many settings has limited their benefits. We aimed to improve the understanding of improved stove use by describing the patterns and predictors of adoption of a semi-gasifier stove and processed biomass fuel intervention in southwestern China. Of 113 intervention homes interviewed, 79% of homes tried the stove, and the majority of these (92%) continued using it 5–10 months later. One to five months after intervention, the average proportion of days that the semi-gasifier stove was in use was modest (40.4% [95% CI 34.3–46.6]), and further declined over 13 months. Homes that received the stove in the first batch used it more frequently (67.2% [95% CI 42.1−92.3] days in use) than homes that received it in the second batch (29.3% [95% CI 13.8−44.5] days in use), likely because of stove quality and user training. Household stove use was positively associated with reported cooking needs and negatively associated with age of the main cook, household socioeconomic status, and the availability of substitute cleaner-burning stoves. Our results show that even a carefully engineered, multi-purpose semi-gasifier stove and fuel intervention contributed modestly to overall household energy use in rural China.

Journal article

Kenge AP, Bentham J, Zhou B, Bixby H, Taddei C, Chan Q, Elliott P, Ezzati M, Mbanya JCNet al., 2017, Trends in obesity and diabetes across regions in Africa from 1980 to 2014: an analysis of pooled population-based studies., International Journal of Epidemiology, Vol: 46, Pages: 1421-1432, ISSN: 1464-3685

Background: The 2016 Dar Es Salaam Call to Action on Diabetes and other NCDs advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. We estimated trends, from 1980 to 2014, in age-standardised mean body mass index (BMI) and diabetes prevalence in these countries in order to assess the co-progression and assist policy formulation.Methods: We pooled data from African and world-wide population-based studies which measured height, weight, and biomarkers to assess diabetes status in adults aged >18 years. A Bayesian hierarchical model was used to estimate trends, by sex, for 200 countries and territories including 53 countries across five African regions, (central, eastern, northern, southern and western) in mean BMI and diabetes prevalence (defined as either fasting plasma glucose of >7.0 mmol/L, history of diabetes diagnosis, or use of insulin or oral glucose control agents). ResultsAfrican data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. Countries with the highest number of data sources for BMI were South Africa (n=17), Nigeria (n=15) and Egypt (n=13); and for diabetes estimates, Tanzania (n=8), Tunisia (n=7), Cameroon, Egypt and South Africa (all n=6). The age-standardised mean BMI increased from 21.0 kg/m2 (95% credible interval: 20.3-21.7) to 23.0 kg/m2 (22.7-23.3) in men, and from 21.9 kg/m2 (21.3-22.5) to 24.9 kg/m2 (24.6-25.1) in women. The age-standardised prevalence of diabetes increased from 3.4% (1.5-6.3) to 8.5% (6.5-10.8) in men, and from 4.1% (2.0-7.5) to 8.9 % (6.9-11.2) in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association (correlation coefficient ≃0.9) was observed between mean BMI and diabetes prevalence

Journal article

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