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

Ezzati M, 2017, Excess weight and multimorbidity: putting people's health experience in risk factor epidemiology, LANCET PUBLIC HEALTH, Vol: 2, Pages: E252-E253, ISSN: 2468-2667

Journal article

Ezzati M, Zhou B, Riley L, Stevens GA, Hajifathalian K, Danaei G, NCD Risk Factor Collaborationet al., Challenges of monitoring global diabetes prevalence, Lancet Diabetes and Endocrinology, ISSN: 2213-8595

Journal article

Asaria P, Elliott P, Douglass M, Obermeyer Z, Soljak M, Majeed A, Ezzati Met al., 2017, Acute myocardial infarction hospital admissions and deaths in England: a national follow-back and follow-forward record-linkage study, Lancet Public Health, Vol: 2, Pages: e191-e201, ISSN: 2468-2667

Background Little information is available on how primary and comorbid acute myocardial infarction contribute to the mortality burden of acute myocardial infarction, the share of these deaths that occur during or after a hospital admission, and the reasons for hospital admission of those who died from acute myocardial infarction. Our aim was to fill in these gaps in the knowledge about deaths and hospital admissions due to acute myocardial infarction. Methods We used individually linked national hospital admission and mortality data for England from 2006 to 2010 to identify all primary and comorbid diagnoses of acute myocardial infarction during hospital stay and their associated fatality rates (during or within 28 days of being in hospital). Data were obtained from the UK Small Area Health Statistics Unit and supplied by the Health and Social Care Information Centre (now NHS Digital) and the Office of National Statistics. We calculated event rates (reported as per 100 000 population for relevant age and sex groups) and case-fatality rate for primary acute myocardial infarction diagnosed during the first physician encounter or during subsequent encounters, and acute myocardial infarction diagnosed only as a comorbidity. We also calculated what proportion of deaths from acute myocardial infarction occurred in people who had been in hospital on or within the 28 days preceding death, and whether acute myocardial infarction was one of the recorded diagnoses in such admissions. Findings Acute myocardial infarction was diagnosed in the first physician encounter in 307 496 (69%) of 446 744 admissions with a diagnosis of acute myocardial infarction, in the second or later physician encounter in 52 374 (12%) admissions, and recorded only as a comorbidity in 86 874 (19%) admissions. Patients with comorbid diagnoses of acute myocardial infarction had two to three times the case-fatality rate of patients in whom acute myocardial infarction was a primary diagnosis. 135 950 death

Journal article

Ezzati M, Zhou B, Riley L, Stevens GA, Hajifathalian K, Danaei Get al., 2017, Challenges of monitoring global diabetes prevalence, LANCET DIABETES & ENDOCRINOLOGY, Vol: 5, Pages: 162-162, ISSN: 2213-8587

Journal article

Ezzati M, Zhou B, Riley L, Stevens GA, Hajifathalian K, Danaei G, NCD Risk Factor Collaborationet al., 2017, Challenges of monitoring global diabetes prevalence, Lancet Diabetes and Endocrinology, Vol: 5, Pages: 162-162, ISSN: 2213-8595

Journal article

Kontis V, Bennett JE, Mathers CD, Li G, Foreman K, Ezzati Met al., 2017, Projections of life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble, Lancet, Vol: 389, Pages: 1323-1335, ISSN: 1474-547X

Background: Projections of future mortality and life expectancy are needed to plan for health and social services and pensions. Our aim was to forecast national age-specific mortality and life expectancy using an approach that takes into account the uncertainty related to the choice of forecasting model.Methods: We developed an ensemble of 21 forecasting models, all of which probabilistically contributed towards the final projections. We applied this approach to forecast age-specific mortality to 2030 in 35 industrialised countries with high-quality vital statistics data. We used age-specific death rates to calculate life expectancy at birth and at age 65 years, and probability of dying before 70 years of age, with life-table models.Results: Life expectancy is projected to increase in all 35 countries with a probability of at least 65% for women and 85% for men. There is a 90% probability that life expectancy at birth among South Korean women in 2030 will be higher than 86.7 years, the same as the highest life expectancy in 2012, and a 57% probability that it will be higher than 90 years. Female life expectancy in South Korea is followed by those in France, Spain and Japan. For men, there is > 95% probability that life expectancy in South Korea, Australia and Switzerland will surpass 80 years in 2030, and 27% that it will surpass 85 years. The USA, Japan, Sweden, Greece, Macedonia and Serbia have some of the lowest projected life expectancy gains for both men and women. The female life expectancy advantage over men is likely to shrink by 2030 in every country except Mexico, where female life expectancy is predicted to increase more than male life expectancy, and in Chile, France, Greece, and Romania where the two sexes will see similar gains. More than half of the projected gains in life expectancy at birth in women will be due to enhanced longevity above 65 years of age. Conclusions: There is more than a 50% probability that by 2030, national female life expecta

Journal article

Ueda P, Woodward M, Lu Y, Hajifathalian K, Al-Wotayan R, Aguilar-Salinas CA, Ahmadvand A, Azizi F, Bentham J, Cifkova R, Di Cesare M, Eriksen L, Farzadfar F, Ferguson TS, Ikeda N, Khalili D, Khang YH, Lanska V, León-Muñoz L, Magliano DJ, Margozzini P, Msyamboza KP, Mutungi G, Oh K, Oum S, Rodríguez-Artalejo F, Rojas-Martinez R, Valdivia G, Wilks R, Shaw JE, Stevens GA, Tolstrup JS, Zhou B, Salomon JA, Ezzati M, Danaei Get al., 2017, Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries: a pooled analysis of prospective cohorts and health surveys., Lancet Diabetes and Endocrinology, Vol: 5, Pages: 196-213, ISSN: 2213-8595

BACKGROUND: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements, and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal CVD in adults aged 40-74 years. METHODS: Based on our previous laboratory-based prediction model (Globorisk), we used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included age, sex, smoking, blood pressure, diabetes, and total cholesterol; in the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with BMI. We recalibrated risk scores for each sex and age group in each country using country-specific mean risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys (using data from adults aged 40-64 years) to estimate the proportion of the population at different levels of CVD risk for ten countries from different world regions as examples of the information the risk scores provide; we applied a risk threshold for high risk of at least 10% for high-income countries (HICs) and at least 20% for low-income and middle-income countries (LMICs) on the basis of national and international guidelines for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores. FINDINGS: Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for

Journal article

Grey C, Jackson R, Schmidt M, Ezzati M, Asaria P, Exeter DJ, Kerr AJet al., 2017, One in four major ischaemic heart disease events are fatal and 60% are pre-hospital deaths: a national data-linkage study (ANZACS-QI 8), EUROPEAN HEART JOURNAL, Vol: 38, Pages: 172-180, ISSN: 0195-668X

Journal article

Ezzati M, Baumgartner JC, 2016, Household energy and health: where next for research and practice?, Lancet, Vol: 389, Pages: 130-132, ISSN: 0140-6736

Journal article

Yakoob MY, Micha R, Khatibzadeh S, Singh GM, Shi P, Ahsan H, Balakrishna N, Brahmam GNV, Chen Y, Afshin A, Fahimi S, Danaei G, Powles JW, Ezzati M, Mozaffarian Det al., 2016, Impact of Dietary and Metabolic Risk Factors on Cardiovascular and Diabetes Mortality in South Asia: Analysis From the 2010 Global Burden of Disease Study, AMERICAN JOURNAL OF PUBLIC HEALTH, Vol: 106, Pages: 2113-2125, ISSN: 0090-0036

Journal article

Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E, Sania A, Fawzi MCS, Ezzati M, Fawzi WWet al., 2016, Risk Factors for Childhood Stunting in 137 Developing Countries: A Comparative Risk Assessment Analysis at Global, Regional, and Country Levels, PLOS MEDICINE, Vol: 13, ISSN: 1549-1676

Journal article

Howie SR, Schellenberg J, Chimah O, Ideh RC, Ebruke BE, Oluwalana C, Mackenzie G, Jallow M, Njie M, Donkor S, Dionisio KL, Goldberg G, Fornace K, Bottomley C, Hill PC, Grant CC, Corrah T, Prentice AM, Ezzati M, Greenwood BM, Smith PG, Adegbola RA, Mulholland Ket al., 2016, Childhood pneumonia and crowding, bed-sharing and nutrition: a case-control study from The Gambia, International Journal of Tuberculosis and Lung Disease, Vol: 20, Pages: 1405-1415, ISSN: 1815-7920

SETTING: Greater Banjul and Upper River Regions, The Gambia. OBJECTIVE: To investigate tractable social, environmental and nutritional risk factors for childhood pneumonia. DESIGN: A case-control study examining the association of crowding, household air pollution (HAP) and nutritional factors with pneumonia was undertaken in children aged 2-59 months: 458 children with severe pneumonia, defined according to the modified WHO criteria, were compared with 322 children with non-severe pneumonia, and these groups were compared to 801 neighbourhood controls. Controls were matched by age, sex, area and season. RESULTS: Strong evidence was found of an association between bed-sharing with someone with a cough and severe pneumonia (adjusted OR [aOR] 5.1, 95%CI 3.2-8.2, P < 0.001) and non-severe pneumonia (aOR 7.3, 95%CI 4.1-13.1, P < 0.001), with 18% of severe cases estimated to be attributable to this risk factor. Malnutrition and pneumonia had clear evidence of association, which was strongest between severe malnutrition and severe pneumonia (aOR 8.7, 95%CI 4.2-17.8, P < 0.001). No association was found between pneumonia and individual carbon monoxide exposure as a measure of HAP. CONCLUSION: Bed-sharing with someone with a cough is an important risk factor for severe pneumonia, and potentially tractable to intervention, while malnutrition remains an important tractable determinant.

Journal article

Khatibzadeh S, Saheb Kashaf M, Micha R, Fahimi S, Shi P, Elmadfa I, Kalantarian S, Wirojratana P, Ezzati M, Powles J, Mozaffarian D, Global Burden of Diseases Nutrition, Chronic Diseases Expert Group NutriCodeet al., 2016, A global database of food and nutrient consumption., Bull World Health Organ, Vol: 94, Pages: 931-934

Journal article

Allen RT, Hales NM, Baccarelli A, Jerrett M, Ezzati M, Dockery DW, Pope CAet al., 2016, Countervailing effects of income, air pollution, smoking, and obesity on aging and life expectancy: population-based study of U.S. Counties, Environmental Health, Vol: 15, ISSN: 1832-3367

BackgroundIncome, air pollution, obesity, and smoking are primary factors associated with human health and longevity in population-based studies. These four factors may have countervailing impacts on longevity. This analysis investigates longevity trade-offs between air pollution and income, and explores how relative effects of income and air pollution on human longevity are potentially influenced by accounting for smoking and obesity.MethodsCounty-level data from 2,996 U.S. counties were analyzed in a cross-sectional analysis to investigate relationships between longevity and the four factors of interest: air pollution (mean 1999–2008 PM2.5), median income, smoking, and obesity. Two longevity measures were used: life expectancy (LE) and an exceptional aging (EA) index. Linear regression, generalized additive regression models, and bivariate thin-plate smoothing splines were used to estimate the benefits of living in counties with higher incomes or lower PM2.5. Models were estimated with and without controls for smoking, obesity, and other factors.ResultsModels which account for smoking and obesity result in substantially smaller estimates of the effects of income and pollution on longevity. Linear regression models without these two variables estimate that a $1,000 increase in median income (1 μg/m3 decrease in PM2.5) corresponds to a 27.39 (33.68) increase in EA and a 0.14 (0.12) increase in LE, whereas models that control for smoking and obesity estimate only a 12.32 (20.22) increase in EA and a 0.07 (0.05) increase in LE. Nonlinear models and thin-plate smoothing splines also illustrate that, at higher levels of income, the relative benefits of the income-pollution tradeoff changed—the benefit of higher incomes diminished relative to the benefit of lower air pollution exposure.ConclusionsHigher incomes and lower levels of air pollution both correspond with increased human longevity. Adjusting for smoking and obesity reduces estimates of the benefi

Journal article

Bentham J, Di Cesare M, Stevens GA, Zhou B, Bixby H, Cowan M, Fortunato L, Bennett J, Danaei G, Hajifathalian K, Lu Y, Riley LM, Laxmaiah A, Kontis V, Paciorek CJ, Riboli E, Ezzati M, Chan Q, Elliott P, Gunter M, Hihtaniemi IT, Murphy N, Norat T, Riboli E, Vineis P, NCD Risk Factor Collaboration NCD-RisCet al., 2016, A century of trends in adult human height, eLife, Vol: 5, ISSN: 2050-084X

Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.

Journal article

Engelgau MM, Peprah E, Sampson UK, Mishoe H, Benjamin IJ, Douglas PS, Hochman JS, Ridker PM, Brandes N, Checkley W, El-Saharty S, Ezzati M, Hennis A, Jiang L, Krumholz HM, Lamourelle G, Makani J, Narayan KM, Ohene-Frempong K, Straus SE, Stuckler D, Chambers DA, Belis D, Bennett GC, Boyington JE, Creazzo TL, de Jesus JM, Krishnamurti C, Lowden MR, Punturieri A, Shero ST, Young NS, Zou S, Mensah GAet al., 2016, Perspectives from NHLBI Global Health Think Tank Meeting for Late Stage (T4) Translation Research., Global Heart, ISSN: 2211-8179

Almost three-quarters (74%) of all the noncommunicable disease burden is found within low- and middle-income countries. In September 2014, the National Heart, Lung, and Blood Institute held a Global Health Think Tank meeting to obtain expert advice and recommendations for addressing compelling scientific questions for late stage (T4) research-research that studies implementation strategies for proven effective interventions-to inform and guide the National Heart, Lung, and Blood Institute's global health research and training efforts. Major themes emerged in two broad categories: 1) developing research capacity; and 2) efficiently defining compelling scientific questions within the local context. Compelling scientific questions included how to deliver inexpensive, scalable, and sustainable interventions using alternative health delivery models that leverage existing human capital, technologies and therapeutics, and entrepreneurial strategies. These broad themes provide perspectives that inform an overarching strategy needed to reduce the heart, lung, blood, and sleep disorders disease burden and global health disparities.

Journal article

Fink G, Peet E, Danaei G, Andrews K, McCoy DC, Sudfeld CR, Smith Fawzi MC, Ezzati M, Fawzi WWet al., 2016, Schooling and wage income losses due to early-childhood growth faltering in developing countries: national, regional, and global estimates., American Journal of Clinical Nutrition, Vol: 104, Pages: 104-112, ISSN: 1938-3207

BACKGROUND: The growth of >300 million children <5 y old was mildly, moderately, or severely stunted worldwide in 2010. However, national estimates of the human capital and financial losses due to growth faltering in early childhood are not available. OBJECTIVE: We quantified the economic cost of growth faltering in developing countries. DESIGN: We combined the most recent country-level estimates of linear growth delays from the Nutrition Impact Model Study with estimates of returns to education in developing countries to estimate the impact of early-life growth faltering on educational attainment and future incomes. Primary outcomes were total years of educational attainment lost as well as the net present value of future wage earnings lost per child and birth cohort due to growth faltering in 137 developing countries. Bootstrapped standard errors were computed to account for uncertainty in modeling inputs. RESULTS: Our estimates suggest that early-life growth faltering in developing countries caused a total loss of 69.4 million y of educational attainment (95% CI: 41.7 million, 92.6 million y) per birth cohort. Educational attainment losses were largest in South Asia (27.6 million y; 95% CI: 20.0 million, 35.8 million y) as well as in Eastern (10.3 million y; 95% CI: 7.2 million, 12.9 million y) and Western sub-Saharan Africa (8.8 million y; 95% CI: 6.4 million, 11.5 million y). Globally, growth faltering in developing countries caused a total economic cost of $176.8 billion (95% CI: $100.9 billion, $262.6 billion)/birth cohort at nominal exchange rates, and $616.5 billion (95% CI: $365.3 billion, $898.9 billion) at purchasing power parity-adjusted exchange rates. At the regional level, economic costs were largest in South Asia ($46.6 billion; 95% CI: $33.3 billion, $61.1 billion), followed by Latin America ($44.7 billion; 95% CI: $19.2 billion, $74.6 billion) and sub-Saharan Africa ($34.2 billion; 95% CI: $24.4 billion, $45.3 billion). CONCLUSIONS: Our resu

Journal article

Carter E, Archer-Nicholls S, Ni K, Lai AM, Niu H, Secrest MH, Sauer SM, Schauer JJ, Ezzati M, Wiedinmyer C, Yang X, Baumgartner Jet al., 2016, Seasonal and Diurnal Air Pollution from Residential Cooking and Space Heating in the Eastern Tibetan Plateau., Environmental Science & Technology, Vol: 50, Pages: 8353-8361, ISSN: 1520-5851

Residential combustion of solid fuel is a major source of air pollution. In regions where space heating and cooking occur at the same time and using the same stoves and fuels, evaluating air-pollution patterns for household-energy-use scenarios with and without heating is essential to energy intervention design and estimation of its population health impacts as well as the development of residential emission inventories and air-quality models. We measured continuous and 48 h integrated indoor PM2.5 concentrations over 221 and 203 household-days and outdoor PM2.5 concentrations on a subset of those days (in summer and winter, respectively) in 204 households in the eastern Tibetan Plateau that burned biomass in traditional stoves and open fires. Using continuous indoor PM2.5 concentrations, we estimated mean daily hours of combustion activity, which increased from 5.4 h per day (95% CI: 5.0, 5.8) in summer to 8.9 h per day (95% CI: 8.1, 9.7) in winter, and effective air-exchange rates, which decreased from 18 ± 9 h(-1) in summer to 15 ± 7 h(-1) in winter. Indoor geometric-mean 48 h PM2.5 concentrations were over two times higher in winter (252 μg/m(3); 95% CI: 215, 295) than in summer (101 μg/m(3); 95%: 91, 112), whereas outdoor PM2.5 levels had little seasonal variability.

Journal article

Stevens GA, Alkema L, Black RE, Boerma JT, Collins GS, Ezzati M, Grove JT, Hogan DR, Hogan MC, Horton R, Lawn JE, Marusic A, Mathers CD, Murray CJL, Rudan I, Salomon JA, Simpson PJ, Vos T, Welch Vet al., 2016, Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement, PLOS MEDICINE, Vol: 13, ISSN: 1549-1676

Journal article

Arku RE, Bennett JE, Castro MC, Agyeman-Duah K, Mintah SE, Ware JH, Nyarko P, Spengler JD, Agyei-Mensah S, Ezzati Met al., 2016, Geographical Inequalities and Social and Environmental Risk Factors for Under-Five Mortality in Ghana in 2000 and 2010: Bayesian Spatial Analysis of Census Data, PLOS Medicine, Vol: 13, ISSN: 1549-1277

BackgroundUnder-five mortality is declining in Ghana and many other countries. Very few studies have measured under-five mortality—and its social and environmental risk factors—at fine spatial resolutions, which is relevant for policy purposes. Our aim was to estimate under-five mortality and its social and environmental risk factors at the district level in Ghana.Methods and FindingsWe used 10% random samples of Ghana’s 2000 and 2010 National Population and Housing Censuses. We applied indirect demographic methods and a Bayesian spatial model to the information on total number of children ever born and children surviving to estimate under-five mortality (probability of dying by 5 y of age, 5q0) for each of Ghana’s 110 districts. We also used the census data to estimate the distributions of households or persons in each district in terms of fuel used for cooking, sanitation facility, drinking water source, and parental education. Median district 5q0 declined from 99 deaths per 1,000 live births in 2000 to 70 in 2010. The decline ranged from <5% in some northern districts, where 5q0 had been higher in 2000, to >40% in southern districts, where it had been lower in 2000, exacerbating existing inequalities. Primary education increased in men and women, and more households had access to improved water and sanitation and cleaner cooking fuels. Higher use of liquefied petroleum gas for cooking was associated with lower 5q0 in multivariate analysis.ConclusionsUnder-five mortality has declined in all of Ghana’s districts, but the cross-district inequality in mortality has increased. There is a need for additional data, including on healthcare, and additional environmental and socioeconomic measurements, to understand the reasons for the variations in mortality levels and trends.

Journal article

Lu Y, Ezzati M, Rimm EB, Hajifathalian K, Ueda P, Danaei Get al., 2016, Sick Populations and Sick Subpopulations: Reducing Disparities in Cardiovascular Disease Between Blacks and Whites in the United States., Circulation, ISSN: 0009-7322

BACKGROUND: -Cardiovascular disease (CVD) death rates are much higher in blacks than whites in the United States (US). It is unclear how CVD risk and events are distributed among blacks vs. whites and how interventions reduce racial disparities. METHODS: -We developed risk models for fatal and for fatal-and-nonfatal CVD using 8 cohorts in the US. We used 6,154 adults aged 50-69 years in the National Health and Nutrition Examination Survey 1999-2012 to estimate the distributions of risk and events in blacks and whites. We estimated the total as well as disparity impacts of a range of population-wide, targeted and risk-based interventions on 10-year CVD risks and event rates. RESULTS: -25% (95% confidence interval 22-28) of black men and 12% (10-14) of black women were at ≥ 6.67% risk of fatal CVD (almost equivalent to 20% risk of fatal or nonfatal CVD), compared with 10% (8-12) of white men and 3% (2-4) of white women. These high-risk individuals accounted for 55% (49-59) of CVD deaths among black men and 42% (35-46) in black women, compared with 30% (24-35) in white men and 18% (13-22) in white women. We estimated that an intervention that treated multiple risk factors in high-risk individuals could reduce black-white difference in CVD death rate from 1,659 to 1,244 per 100,000 in men and from 1,320 to 897 in women. Rates of fatal-and-nonfatal CVD were generally similar between black and white men. In women, a larger proportion of women were at ≥ 7.5% risk of CVD (30% versus 19% in whites) and an intervention that targeted multiple risk factors among this group was estimated to reduce black-white differences in CVD rates from 1,688 to 1,197 per 100,000. CONCLUSIONS: -A substantially larger proportion of blacks have a high risk of fatal CVD and bear a large share of CVD deaths. A risk-based intervention that reduces multiple risk factors could substantially reduce overall CVD rates and racial disparities in CVD death rates.

Journal article

Ni K, Carter E, Schauer JJ, Ezzati M, Zhang Y, Niu H, Lai AM, Shan M, Wang Y, Yang X, Baumgartner Jet al., 2016, Seasonal variation in outdoor, indoor, and personal air pollution exposures of women using wood stoves in the Tibetan Plateau: Baseline assessment for an energy intervention study., Environment International, ISSN: 1873-6750

Cooking and heating with coal and biomass is the main source of household air pollution in China and a leading contributor to disease burden. As part of a baseline assessment for a household energy intervention program, we enrolled 205 adult women cooking with biomass fuels in Sichuan, China and measured their 48-h personal exposure to fine particulate matter (PM2.5) and carbon monoxide (CO) in winter and summer. We also measured the indoor 48-h PM2.5 concentrations in their homes and conducted outdoor PM2.5 measurements during 101 (74) days in summer (winter). Indoor concentrations of CO and nitrogen oxides (NO, NO2) were measured over 48-h in a subset of ~80 homes. Women's geometric mean 48-h exposure to PM2.5 was 80μg/m(3) (95% CI: 74, 87) in summer and twice as high in winter (169μg/m(3) (95% CI: 150, 190), with similar seasonal trends for indoor PM2.5 concentrations (winter: 252μg/m(3); 95% CI: 215, 295; summer: 101μg/m(3); 95% CI: 91, 112). We found a moderately strong relationship between indoor PM2.5 and CO (r=0.60, 95% CI: 0.46, 0.72), and a weak correlation between personal PM2.5 and CO (r=0.41, 95% CI: -0.02, 0.71). NO2/NO ratios were higher in summer (range: 0.01 to 0.68) than in winter (range: 0 to 0.11), suggesting outdoor formation of NO2 via reaction of NO with ozone is a more important source of NO2 than biomass combustion indoors. The predictors of women's personal exposure to PM2.5 differed by season. In winter, our results show that primary heating with a low-polluting fuel (i.e., electric stove or wood-charcoal) and more frequent kitchen ventilation could reduce personal PM2.5 exposures. In summer, primary use of a gaseous fuel or electricity for cooking and reducing exposure to outdoor PM2.5 would likely have the greatest impacts on personal PM2.5 exposure.

Journal article

Kwan GF, Mayosi BM, Mocumbi AO, Miranda JJ, Ezzati M, Jain Y, Robles G, Benjamin EJ, Subramanian SV, Bukhman Get al., 2016, Endemic Cardiovascular Diseases of the Poorest Billion, Circulation, Vol: 133, Pages: 2561-2575, ISSN: 0009-7322

Journal article

Tzoulaki I, Elliott P, Kontis V, Ezzati Met al., 2016, Worldwide Exposures to Cardiovascular Risk Factors and Associated Health Effects: Current Knowledge and Data Gaps, Circulation, Vol: 133, Pages: 2314-2333, ISSN: 0009-7322

Information on exposure to, and health effects of, cardiovascular disease (CVD) risk factors is needed to develop effective strategies to prevent CVD events and deaths. Here, we provide an overview of the data and evidence on worldwide exposures to CVD risk factors and the associated health effects. Global comparative risk assessment studies have estimated that hundreds of thousands or millions of CVD deaths are attributable to established CVD risk factors (high blood pressure and serum cholesterol, smoking, and high blood glucose), high body mass index, harmful alcohol use, some dietary and environmental exposures, and physical inactivity. The established risk factors plus body mass index are collectively responsible for ≈9.7 million annual CVD deaths, with high blood pressure accounting for more CVD deaths than any other risk factor. Age-standardized CVD death rates attributable to established risk factors plus high body mass index are lowest in high-income countries, followed by Latin America and the Caribbean; they are highest in the region of central and eastern Europe and central Asia. However, estimates of the health effects of CVD risk factors are highly uncertain because there are insufficient population-based data on exposure to most CVD risk factors and because the magnitudes of their effects on CVDs in observational studies are likely to be biased. We identify directions for research and surveillance to better estimate the effects of CVD risk factors and policy options for reducing CVD burden by modifying preventable risk factors.

Journal article

McCoy DC, Peet ED, Ezzati M, Danaei G, Black MM, Sudfeld CR, Fawzi W, Fink Get al., 2016, Early Childhood Developmental Status in Low- and Middle-Income Countries: National, Regional, and Global Prevalence Estimates Using Predictive Modeling, PLOS Medicine, Vol: 13, ISSN: 1549-1277

BACKGROUND: The development of cognitive and socioemotional skills early in life influences later health and well-being. Existing estimates of unmet developmental potential in low- and middle-income countries (LMICs) are based on either measures of physical growth or proxy measures such as poverty. In this paper we aim to directly estimate the number of children in LMICs who would be reported by their caregivers to show low cognitive and/or socioemotional development. METHODS AND FINDINGS: The present paper uses Early Childhood Development Index (ECDI) data collected between 2005 and 2015 from 99,222 3- and 4-y-old children living in 35 LMICs as part of the Multiple Indicator Cluster Survey (MICS) and Demographic and Health Surveys (DHS) programs. First, we estimate the prevalence of low cognitive and/or socioemotional ECDI scores within our MICS/DHS sample. Next, we test a series of ordinary least squares regression models predicting low ECDI scores across our MICS/DHS sample countries based on country-level data from the Human Development Index (HDI) and the Nutrition Impact Model Study. We use cross-validation to select the model with the best predictive validity. We then apply this model to all LMICs to generate country-level estimates of the prevalence of low ECDI scores globally, as well as confidence intervals around these estimates. In the pooled MICS and DHS sample, 14.6% of children had low ECDI scores in the cognitive domain, 26.2% had low socioemotional scores, and 36.8% performed poorly in either or both domains. Country-level prevalence of low cognitive and/or socioemotional scores on the ECDI was best represented by a model using the HDI as a predictor. Applying this model to all LMICs, we estimate that 80.8 million children ages 3 and 4 y (95% CI 48.1 million, 113.6 million) in LMICs experienced low cognitive and/or socioemotional development in 2010, with the largest number of affected children in sub-Saharan Africa (29.4.1 million; 43.8% of childre

Journal article

Chai J, Fink G, Kaaya S, Danaei G, Fawzi W, Ezzati M, Lienert J, Fawzi MCSet al., 2016, Association between intimate partner violence and poor child growth: results from 42 demographic and health surveys, Bulletin of the World Health Organization, Vol: 94, Pages: 331-339, ISSN: 1564-0604

Journal article

Majeed F, Hansell A, Saxena S, Millett C, Ward H, Harris M, Hayhoe B, Car J, Easton G, Donnelly CA, Perneczky R, Jarvelin MR, Ezzati M, Rawaf S, Vineis P, Ferguson N, Riboli Eet al., 2016, How would a decision to leave the European Union affect medical research and health in the United Kingdom?, Journal of the Royal Society of Medicine, Vol: 109, Pages: 216-218, ISSN: 1758-1095

Journal article

Foreman KJ, Li G, Best N, Ezzati Met al., 2016, Small area forecasts of cause-specific mortality: application of a Bayesian hierarchical model to US vital registration data, Journal of the Royal Statistical Society: Series C, Vol: 66, Pages: 121-139, ISSN: 0035-9254

Mortality forecasts are typically limited in that they pertain only to national death rates, predict only all-cause mortality or do not capture and utilize the correlation between diseases. We present a novel Bayesian hierarchical model that jointly forecasts cause-specific death rates for geographic subunits. We examine its effectiveness by applying it to US vital statistics data for 1979–2011 and produce forecasts to 2024. Not only does the model generate coherent forecasts for mutually exclusive causes of death, but also it has lower out-of-sample error than alternative commonly used models for forecasting mortality.

Journal article

Foreman KJ, Naghavi M, Ezzati M, 2016, Improving the usefulness of US mortality data: new methods for reclassification of underlying cause of death, Population Health Metrics, Vol: 14, ISSN: 1478-7954

BackgroundMortality data are affected by miscertification of the medical cause of death deaths and changes to cause of death classification systems. We present both mappings of ICD9 and ICD10 to a unified list of causes, and a new statistical model for reducing the impact of misclassification of cause of death.MethodsWe propose a Bayesian mixed-effects multinomial logistic model that can be run on individual record level death certificates to reclassify “garbage-coded” deaths onto causes that are more meaningful for public health purposes. The model uses information on the contributing causes of death and demographic characteristics of each decedent to make informed predictions of the underlying cause of death. We apply our method to death certificate data in the US from 1979 to 2011, creating more directly comparable series of cause-specific mortality for 25 major causes of death.ResultsWe find that many death certificates coded to garbage codes contain other information that provides strong clues about the valid underlying cause of death. In particular, a plausible underlying cause often appears in the contributing causes of death, implying that it may be incorrect ordering of the causal chain and not missed cause assignment that leads to many garbage-coded deaths. We present an example that redistributes 48 % of heart failure deaths to other cardiovascular diseases, 25 % to ischemic heart disease, and 15 % to chronic respiratory diseases.ConclusionsOur methods take advantage of more detailed micro-level data than is typically considered in garbage code redistribution algorithms, making it a useful tool in circumstances in which detailed death certificate data needs to be aggregated for public health purposes. We find that this method gives different redistribution results than commonly used methods that only consider population-level proportions.

Journal article

Singh GM, Micha R, Khatibzadeh S, Lim S, Ezzati M, Mozaffarian Det al., 2016, Response to Letter Regarding Article, "Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010", Circulation, Vol: 133, ISSN: 0009-7322

Journal article

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