342 results found
Kontis V, Bennett JE, Rashid T, et al., 2020, Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries, NATURE MEDICINE, ISSN: 1078-8956
Bukhman G, Mocumbi AO, Atun R, et al., 2020, The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion., Lancet, Vol: 396, Pages: 991-1044
Coleman NC, Burnett RT, Ezzati M, et al., 2020, Fine Particulate Matter Exposure and Cancer Incidence: Analysis of SEER Cancer Registry Data from 1992-2016., Environ Health Perspect, Vol: 128
BACKGROUND: Previous research has identified an association between fine particulate matter ( PM 2.5 ) air pollution and lung cancer. Most of the evidence for this association, however, is based on research using lung cancer mortality, not incidence. Research that examines potential associations between PM 2.5 and incidence of non-lung cancers is limited. OBJECTIVES: The primary purpose of this study was to evaluate the association between the incidence of cancer and exposure to PM 2.5 using >
Chatzidiakou L, Krause A, Han Y, et al., 2020, Using low-cost sensor technologies and advanced computational methods to improve dose estimations in health panel studies: results of the AIRLESS project, JOURNAL OF EXPOSURE SCIENCE AND ENVIRONMENTAL EPIDEMIOLOGY, ISSN: 1559-0631
Coleman NC, Burnett RT, Higbee JD, et al., 2020, Cancer mortality risk, fine particulate air pollution, and smoking in a large, representative cohort of US adults, CANCER CAUSES & CONTROL, Vol: 31, Pages: 767-776, ISSN: 0957-5243
NCD Risk Factor Collaboration NCD-RisC, 2020, Repositioning of the global epicentre of non-optimal cholesterol, Nature, Vol: 582, Pages: 73-77, ISSN: 0028-0836
High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol-which is a marker of cardiovascular risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and per
Peto J, Alwan NA, Godfrey KM, et al., 2020, Universal weekly testing as the UK COVID-19 lockdown exit strategy, The Lancet, Vol: 395, Pages: 1420-1421, ISSN: 0140-6736
Higbee JD, Lefler JS, Burnett RT, et al., 2020, Estimating long-term pollution exposure effects through inverse probability weighting methods with Cox proportional hazards models., Environ Epidemiol, Vol: 4
Background: Fine particulate matter (PM2.5) is associated with negative health outcomes in both the short and long term. However, the cohort studies that have produced many of the estimates of long-term exposure associations may fail to account for selection bias in pollution exposure as well as covariate imbalance in the study population; therefore, causal modeling techniques may be beneficial. Methods: Twenty-nine years of data from the National Health Interview Survey (NHIS) was compiled and linked to modeled annual average outdoor PM2.5 concentration and restricted-use mortality data. A series of Cox proportional hazards models, adjusted using inverse probability weights, yielded causal risk estimates of long-term exposure to ambient PM2.5 on all-cause and cardiopulmonary mortality. Results: Covariate-adjusted estimated relative risks per 10 μg/m3 increase in PM2.5 exposure were estimated to be 1.117 (1.083, 1.152) for all-cause mortality and 1.232 (1.174, 1.292) for cardiopulmonary mortality. Inverse probability weighted Cox models provide relatively consistent and robust estimates similar to those in the unweighted baseline multivariate Cox model, though they have marginally lower point estimates and higher standard errors. Conclusions: These results provide evidence that long-term exposure to PM2.5 contributes to increased mortality risk in US adults and that the estimated effects are generally robust to modeling choices. The size and robustness of estimated associations highlight the importance of clean air as a matter of public health. Estimated confounding due to measured covariates appears minimal in the NHIS cohort, and various distributional assumptions have little bearing on the magnitude or standard errors of estimated causal associations.
Carrillo Larco R, Gregg EW, Ezzati M, Cohort profile: The Cohorts Consortium of Latin America and the Caribbean (CC-LAC), International Journal of Epidemiology, ISSN: 0300-5771
Angell SY, McConnell M, Anderson CAM, et al., 2020, The American Heart Association 2030 Impact Goal: A Presidential Advisory From the American Heart Association, CIRCULATION, Vol: 141, Pages: E120-E138, ISSN: 0009-7322
Baumgartner J, Brauer M, Ezzati M, 2020, The role of cities in reducing the cardiovascular impacts of environmental pollution in low- and middle-income countries, BMC MEDICINE, Vol: 18, ISSN: 1741-7015
Taddei C, Jackson R, Zhou B, et al., 2020, National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: an analysis of trends in Asian and Western countries, International Journal of Epidemiology, Vol: 49, Pages: 173-192, ISSN: 1464-3685
Background: Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease (CHD), multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio in Asian and Western countries.Methods: We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol, and mean total-to-HDL cholesterol ratio by country, sex and age group.Results: Since ~1980, mean TC increased in Asian countries. In Japan and South Korea, TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, ~0.4 mmol/Lper decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as ~0.7 per decade in Swiss men (equivalent to ~26% decline in CHD risk per decade). The ratio increased in China. Conclusions: HDL cholesterol has risen and total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only weak correlation to changes in TC or non-HDL cholesterol.
Kontis V, Cobb LK, Mathers CD, et al., 2020, Response by Kontis et al to Letter Regarding Article, "Three Public Health Interventions Could Save 94 Million Lives in 25 Years: Global Impact Assessment Analysis", CIRCULATION, Vol: 141, Pages: E5-E5, ISSN: 0009-7322
Parks RM, Bennett JE, Tamura-Wicks H, et al., 2020, Anomalously warm temperatures are associated with increased injury deaths, Nature Medicine, Vol: 26, Pages: 65-70, ISSN: 1078-8956
Temperatures which deviate from long-term local norm affect human health, and are projected to become more frequent as the global climate changes.1 There is limited data on how such anomalies affect deaths from injuries. Here, we used data on mortality and temperature over 38 years (1980-2017) in the contiguous USA and formulated a Bayesian spatio-temporal model to quantify how anomalous temperatures, defined as deviations of monthly temperature from the local average monthly temperature over the entire analysis period, affect deaths from unintentional (transport, falls and drownings) and intentional (assault and suicide) injuries, by age group and sex. We found that a 1.5°C anomalously warm year, as envisioned under the Paris Climate Agreement,2 would be associated with an estimated 1,601 (95% credible interval 1,430-37 1,776) additional injury deaths. 84% of these additional deaths would occur in males, mostly in adolescent to middle ages. These deaths would comprise of increases in deaths 39 from drownings, transport, assault and suicide, offset partly by a decline in deaths from falls in older ages. The findings demonstrate the need for targeted interventions against injuries during periods of anomalously high temperatures, especially as these episodes are likely to increase with global climate change.
Bentham J, Singh GM, Danaei G, et al., 2020, Multidimensional characterization of global food supply from 1961 to 2013, Nature Food, Vol: 1, Pages: 70-75, ISSN: 2662-1355
Food systems are increasingly globalized and interdependent and diets around the world are changing. Characterising national food supplies and how they have changed can inform food policies that ensure national food security, support access to healthy diets and enhance environmental sustainability. Here, we analysed data for 171 countries on availability of 18 food groups from the United Nations Food and Agriculture Organization to identify and track 40 multi-dimensional food supply patterns from 1961 to 2013. Four predominant food group combinations were identified that explained almost 90% of cross-country variance in food supply: animal source and sugar; vegetable; starchy root and fruit; and seafood and oilcrops. South Korea, China and Taiwan experienced the largest changes in food supply over the past five decades, with animal source foods and sugar, vegetables, and seafood and oilcrops all becoming more abundant components of food supply. In contrast, in many Western countries, the supply of animal source foods and sugar declined. Meanwhile, there was remarkably little change in food supply in countries in the sub-Saharan Africa region. These changes have led to a partial global convergence in national supply of animal source foods and sugar, and a divergence in vegetables, and seafood and oilcrops. Our analysis has generated a novel characterisation of food supply that highlights the interdependence of multiple food types in national food systems. A better understanding of how these patterns have evolved and will continue to change is needed to support the delivery of healthy and sustainable food system policies.
Jaime Miranda J, Carrillo-Larco RM, Ferreccio C, et al., 2020, Trends in cardiometabolic risk factors in the Americas between 1980 and 2014: a pooled analysis of population-based surveys, The Lancet Global Health, Vol: 8, Pages: E123-E133, ISSN: 2214-109X
BackgroundDescribing the prevalence and trends of cardiometabolic risk factors that are associated with non-communicable diseases (NCDs) is crucial for monitoring progress, planning prevention, and providing evidence to support policy efforts. We aimed to analyse the transition in body-mass index (BMI), obesity, blood pressure, raised blood pressure, and diabetes in the Americas, between 1980 and 2014.MethodsWe did a pooled analysis of population-based studies with data on anthropometric measurements, biomarkers for diabetes, and blood pressure from adults aged 18 years or older. A Bayesian model was used to estimate trends in BMI, raised blood pressure (systolic blood pressure ≥140 mm Hg or diastolic blood pressure ≥90 mm Hg), and diabetes (fasting plasma glucose ≥7·0 mmol/L, history of diabetes, or diabetes treatment) from 1980 to 2014, in 37 countries and six subregions of the Americas.Findings389 population-based surveys from the Americas were available. Comparing prevalence estimates from 2014 with those of 1980, in the non-English speaking Caribbean subregion, the prevalence of obesity increased from 3·9% (95% CI 2·2–6·3) in 1980, to 18·6% (14·3–23·3) in 2014, in men; and from 12·2% (8·2–17·0) in 1980, to 30·5% (25·7–35·5) in 2014, in women. The English-speaking Caribbean subregion had the largest increase in the prevalence of diabetes, from 5·2% (2·1–10·4) in men and 6·4% (2·6–10·4) in women in 1980, to 11·1% (6·4–17·3) in men and 13·6% (8·2–21·0) in women in 2014). Conversely, the prevalence of raised blood pressure has decreased in all subregions; the largest decrease was found in North America from 27·6% (22·3–33·2) in men and 19·9% (15·8–24·4) in women in 1980, to 15·
Carter E, Yan L, Fu Y, et al., 2020, Household transitions to clean energy in a multi-provincial cohort study in China, Nature Sustainability, Vol: 3, Pages: 42-50, ISSN: 2398-9629
Household solid fuel (biomass, coal) burning contributes to climate change and is a leading health risk factor. How and why households stop using solid fuel stoves after adopting clean fuels has not been studied. We assessed trends in the uptake, use, and suspension of household stoves and fuels in a multi-provincial cohort study of 753 Chinese adults and evaluated determinants of clean fuel uptake and solid fuel suspension. Over one-third (35%) and one-fifth (17%) of participants suspended use of solid fuel for cooking and heating, respectively, during the past 20 years. Determinants of solid fuel suspension (younger age, widowed) and of earlier suspension (younger age, higher education, and poor self-reported health status) differed from the determinants of clean fuel uptake (younger age, higher income, smaller households, and retired) and of earlier adoption (higher income). Clean fuel adoption and solid fuel suspension warrant joint consideration as indicators of household energy transition. Household energy research and planning efforts that more closely examine solid fuel suspension may accelerate household energy transitions that benefit climate and human health.
Pearson-Stuttard J, Ezzati M, Gregg E, 2019, Multimorbidity—a defining challenge for health systems, Lancet Public Health, Vol: 4, Pages: e599-e600, ISSN: 2468-2667
Lefler JS, Higbee JD, Burnett RT, et al., 2019, Air pollution and mortality in a large, representative US cohort: multiple-pollutant analyses, and spatial and temporal decompositions, ENVIRONMENTAL HEALTH, Vol: 18
Carrillo Larco R, Di Cesare MC, Ezzati M, et al., Transitions of cardio-metabolic risk factors in the Americas between 1980 and 2014, The Lancet Global Health, ISSN: 2214-109X
Background: Describing the levels and trends of cardio-metabolic risk factors associated with non-communicable diseases (NCDs) is vital for monitoring progress, planning prevention and provide evidence to support policy efforts. We aimed to analyse the transition in body-mass index (BMI), obesity, blood pressure, raised blood pressure (RBP) and diabetes in the Americas, 1980-2014.Methods: Pooled analysis of population-based studies with data on anthropometric measurements, biomarkers for diabetes, and blood pressure from adults aged 18+ years. A Bayesian model was used to estimate trends in BMI, RBP (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) and diabetes(fasting plasma glucose ≥7.0 mmol/l, history of diabetes, or diabetes treatment) from 1980 to 2014 in 37 countries and 6 sub-regions of the Americas.Findings: 389 population-based surveys from the Americas were available. Comparing the 2014 with the 1980 prevalence estimates, the obesity ratio was the largest in the non-English-speaking Caribbean sub-region (4.71 in men and 2.50 in women) showing that the prevalence in 2014 for men is almost five times larger than it was in 1980. The English-speaking Caribbean sub-region had the largest ratio regarding diabetes (2.14 in men and 2.13 in women). Conversely, the ratio for RBP signals that the frequency of this condition has diminished across the region; the largest decrease was found in North America (0.56 in men and 0.54 in women). Interpretation: Despite the generally high prevalence of cardio-metabolic risk factors across the Americas region, estimates also show a high level of heterogeneity in the transition between countries.
Sania A, Sudfeld CR, Danaei G, et al., 2019, Early life risk factors of motor, cognitive and language development: a pooled analysis of studies from low/middle-income countries, BMJ OPEN, Vol: 9, ISSN: 2044-6055
Di Angelantonio E, Kaptoge S, Pennells L, et al., 2019, World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions, LANCET GLOBAL HEALTH, Vol: 7, Pages: E1332-E1345, ISSN: 2214-109X
Clark SN, Schmidt AM, Carter EM, et al., 2019, Longitudinal evaluation of a household energy package on blood pressure, central hemodynamics, and arterial stiffness in China, Environmental Research, Vol: 177, Pages: 1-11, ISSN: 0013-9351
BackgroundCardiovascular diseases are the leading contributors to disease burden in China and globally, and household air pollution exposure is associated with risk of cardiovascular disease.ObjectivesWe evaluated whether subclinical cardiovascular outcomes in adult Chinese women would improve after distribution of an energy package comprised of a semi-gasifier cookstove, water heater, chimney, and supply of processed biomass fuel.MethodsWe enrolled 204 households (n = 205 women) from 12 villages into a controlled before- and after-intervention study on cardiovascular health and air pollution in Sichuan Province. The intervention was distributed to 124 households during a government-sponsored rural energy demonstration program. The remaining 80 households received the package 18 months later at the end of the study, forming a comparison group. One woman from each household had their blood pressure (BP), central hemodynamics, and arterial stiffness measured along with exposures to air pollution and demographic and household characteristics, on up to five visits. We used a difference-in-differences mixed-effects regression approach with Bayesian inference to assess the impact of the energy package on sub-clinical cardiovascular outcomes.ResultsWomen who did not receive the energy package had greater mean decreases in brachial systolic (−4.1 mmHg, 95% credible interval (95%CIe) −7.3, −0.9) and diastolic BP (−2.0 mmHg, 95%CIe −3.6, −0.5) compared with women who received the package (systolic: −2.7, 95%CIe −5.0, −0.4; diastolic: −0.3, 95%CIe −1.4, 0.8) resulting in slightly positive but not statistically significant difference-in-differences effect estimates of 1.3 mmHg (95%CIe −2.5, 5.2) and 1.7 mmHg (95%CIe −0.3, 3.6), respectively. Similar trends were found for central BP, central pulse pressure, and arterial stiffness. Air pollution exposures decreased on average for both treatment groups
Kontis V, Cobb LK, Mathers CD, et al., 2019, Three public health interventions could save 94 Million lives in 25 Years -global impact assessment analysis, Circulation, Vol: 140, Pages: 715-725, ISSN: 0009-7322
Background:Preventable noncommunicable diseases, mostly cardiovascular diseases, are responsible for 38 million deaths annually. A few well-documented interventions have the potential to prevent many of these deaths, but a large proportion of the population in need does not have access to these interventions. We quantified the global mortality impact of 3 high-impact and feasible interventions: scaling up treatment of high blood pressure to 70%, reducing sodium intake by 30%, and eliminating the intake of artificial trans fatty acids.Methods:We used global data on mean blood pressure levels and sodium and trans fat intake by country, age, and sex from a pooled analysis of population health surveys, and regional estimates of current coverage of antihypertensive medications, and cause-specific mortality rates in each country, as well, with projections from 2015 to 2040. We used the most recent meta-analyses of epidemiological studies to derive relative risk reductions for each intervention. We estimated the proportional effect of each intervention on reducing mortality from related causes by using a generalized version of the population-attributable fraction. The effect of antihypertensive medications and lowering sodium intake were modeled through their impact on blood pressure and as immediate increase/reduction to the proposed targets.Results:The combined effect of the 3 interventions delayed 94.3 million (95% uncertainty interval, 85.7–102.7) deaths during 25 years. Increasing coverage of antihypertensive medications to 70% alone would delay 39.4 million deaths (35.9–43.0), whereas reducing sodium intake by 30% would delay another 40.0 million deaths (35.1–44.6) and eliminating trans fat would delay an additional 14.8 million (14.7–15.0). The estimated impact of trans fat elimination was largest in South Asia. Sub-Saharan Africa had the largest proportion of premature delayed deaths out of all delayed deaths.Conclusions:Three effective inte
Zhou B, Danaei G, Stevens GA, et al., 2019, Long-term and recent trends in hypertension awareness, treatment, and control in 12 high-income countries: an analysis of 123 nationally representative surveys, Lancet, Vol: 394, Pages: 639-651, ISSN: 0140-6736
Background: Antihypertensive medicines are effective in reducing adverse cardiovascular events. Our aim was to compare hypertension awareness, treatment and control, and how they have changed over time, in high-income countries. Methods: We used data on 526,336 participants aged 40-79 years in 123 national health examination surveys from 1976 to 2017 in twelve high-income countries: Australia, Canada, Finland, Germany, Ireland, Italy, Japan, New Zealand, South Korea, Spain, the UK, and the USA. We calculated the percent of participants with hypertension – defined as systolic blood pressure ≥140mmHg or diastolic blood pressure ≥90mmHg or being on pharmacological treatment for hypertension – who were aware of their condition, who were treated, and whose hypertension was controlled (i.e. lower than 140/90 mmHg). Findings: Canada, South Korea, Australia and the UK have the lowest prevalence of hypertension, and Finland the highest. In the 1980s and early 1990s, treatment rates were at most 40% and control rates were below 25% in most countries and age-sex groups. Over time, hypertension awareness and treatment increased and control rate improved in all twelve countries, with South Korea and Germany experiencing the largest improvements. Most of the increase occurred in the 1990s and early-mid 2000s, having plateaued since in most countries.Canada, Germany, South Korea and the USA have the highest rates of awareness, treatment and control, while Finland, Ireland, Japan and Spain the lowest. Even in the best performing countries, treatment coverage was at most 80% and control rates were below 70%. Interpretation: Hypertension awareness, treatment and control have improved substantially in high-income countries since the 1980s and 1990s. However, control rates have plateaued in the past decade, at levels lower than those in high-quality hypertension
Li S, Yang M, Carter E, et al., 2019, Exposure-Response Associations of Household Air Pollution and Buccal Cell Telomere Length in Women Using Biomass Stoves., Environ Health Perspect, Vol: 127, Pages: 87004-87004
BACKGROUND: Telomere shortening is associated with early mortality and chronic disease. Recent studies indicate that environmental exposures, including urban and traffic-related air pollution, may shorten telomeres. Associations between exposure to household air pollution from solid fuel stoves and telomere length have not been evaluated. METHODS: Among 137 rural Chinese women using biomass stoves ([Formula: see text] of age), we measured 48-h personal exposures to fine particulate matter [PM [Formula: see text] in aerodynamic diameter ([Formula: see text])] and black carbon and collected oral DNA on up to three occasions over a period of 2.5 y. Relative telomere length (RTL) was quantified using a modified real-time polymerase chain reaction protocol. Mixed effects regression models were used to investigate the exposure-response associations between household air pollution and RTL, adjusting for key sociodemographic, behavioral, and environmental covariates. RESULTS: Women's daily exposures to air pollution ranged from [Formula: see text] for [Formula: see text] ([Formula: see text]) and [Formula: see text] for black carbon ([Formula: see text]). Natural cubic spline models indicated a mostly linear association between increased exposure to air pollution and shorter RTL, except at very high concentrations where there were few observations. We thus modeled the linear associations with all observations, excluding the highest 3% and 5% of exposures. In covariate-adjusted models, an interquartile range (IQR) increase in exposure to black carbon ([Formula: see text]) was associated with shorter RTL [all observations: [Formula: see text] (95% CI: [Formula: see text], [Formula: see text]); excluding highest 5% exposures: [Formula: see text] (95% CI: [Formula: see text], [Formula: see text])]. Further adjustment for outdoor temperature brought the estimates closer to zero [all observations: [Formula: see text] (95% CI: [Formula: see text], 0.06); excluding highest 5% expos
Arden Pope C, Lefler JS, Ezzati M, et al., 2019, Mortality risk and fine particulate air pollution in a large, representative cohort of U.S. adults, Environmental Health Perspectives, Vol: 127, Pages: 077007-1-077007-9, ISSN: 0091-6765
Background: Evidence indicates that air pollution contributes to cardiopulmonary mortality. There is ongoing debate regarding the size and shape of the pollution-mortality exposure-response relationship. There are also growing appeals for estimates of pollution-mortality relationships that use public data and are based on large, representative study cohorts.Objectives: Evaluate fine particulate matter air pollution (PM2.5) and mortality using a large cohort that is representative of the U.S. population and is based on public data. Additional objectives include exploring model sensitivity, evaluating relative effects across selected subgroups, and assessing the shape of the PM2.5-mortality relationship.Methods: National Health Interview Surveys (1986-2014), with mortality linkage through 2015, were used to create a cohort of 1,599,329 U.S. adults and a sub-cohort with information on smoking and BMI of 635,539 adults. Data were linked with modeled ambient PM2.5 at census tracts. Cox Proportional Hazards models estimated PM2.5-mortality hazard ratios for all-cause and specific causes of death controlling for individual risk factors and regional and urban versus rural differences. Sensitivity and subgroup analyses were conducted and the shape of the PM2.5-mortality relationship was explored.Results: Estimated mortality hazard ratios, per 10 µg/m3 long-term exposure to PM2.5, were 1.12 (95% CI=1.08–1.15) for all-cause mortality, 1.23 (1.17–1.29) for cardiopulmonary mortality, and 1.12 (1.00 – 1.26) for lung cancer mortality. In general, PM2.5-mortality associations were consistently positive for all-cause and cardiopulmonary across key modeling choices and across sub-groups of sex, age, race-ethnicity, income, education levels, and geographic regions.Discussion: This large, nationwide, representative cohort of U.S. adults provides robust evidence that long-term PM2.5 exposure contributes to cardiopulmonary mortality risk. The ubiquito
Bennett J, Tamura-Wicks H, Parks R, et al., 2019, Particulate matter air pollution and national and county life expectancy loss in the USA: a spatiotemporal analysis, PLoS Medicine, Vol: 16, ISSN: 1549-1277
Background Exposure to fine particulate matter pollution (PM2.5) is hazardous to health. Our aim was to directly estimate the health and longevity impacts of current PM2.5 concentrations, and the benefits of reductions from 1999 to 2015, nationally and at county level, for the entire contemporary population of the contiguous United States. Methods and findings We used vital registration and population data with information on sex, age, cause of death and county of residence. We used four Bayesian spatio-temporal models, with different adjustments for other determinants of mortality, to directly estimate mortality and life expectancy loss due to current PM2.5 pollution, and the benefits of reductions since 1999, nationally and by county. The covariates included in the adjusted models were per capita income; percentage of population whose family income is below the poverty threshold, who are of Black or African American race, who have graduated from high-school, who live in urban areas, and who are unemployed; cumulative smoking; and mean temperature and relative humidity. In the main model, which adjusted for these covariates and for unobserved county characteristics through the use of county random intercepts, PM2.5 pollution in excess of the lowest observed concentration (2.8 µg/m3) was responsible for an estimated 15,612 deaths (95% credible interval 13,248-17,945) in females and in 14,757 deaths (12,617-16,919) for males. These deaths would lower national life expectancy by an estimated 0.15 years (0.13-0.17) for women and 0.13 years (0.11-0.15) for men. The life expectancy loss due to PM2.5 was largest around Los Angeles and in some southern states, such as Arkansas, Oklahoma or Alabama. At any PM2.5 concentration, life expectancy loss was, on average, larger in counties with lower income than in wealthier counties. Reductions in PM2.5 since 1999 have lowered mortality in all but 14 counties where PM2.5 increased slightly. The main limitation of our study
Wolfenden L, Ezzati M, Larijani B, et al., 2019, The challenge for global health systems in preventing and managing obesity, OBESITY REVIEWS, Vol: 20, Pages: 185-193, ISSN: 1467-7881
Being the second-largest country in the Middle East, Iran has a long history of civilisation during which several dynasties have been overthrown and established and health-related structures have been reorganised. Iran has had the replacement of traditional practices with modern medical treatments, emergence of multiple pioneer scientists and physicians with great contributions to the advancement of science, environmental and ecological changes in addition to large-scale natural disasters, epidemics of multiple communicable diseases, and the shift towards non-communicable diseases in recent decades. Given the lessons learnt from political instabilities in the past centuries and the approaches undertaken to overcome health challenges at the time, Iran has emerged as it is today. Iran is now a country with a population exceeding 80 million, mainly inhabiting urban regions, and has an increasing burden of non-communicable diseases, including cardiovascular diseases, hypertension, diabetes, malignancies, mental disorders, substance abuse, and road injuries.
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