Publications
404 results found
Alli AS, Clark SN, Wang J, et al., 2023, High-resolution patterns and inequalities in ambient fine particle mass (PM2.5) and black carbon (BC) in the Greater Accra Metropolis, Ghana., Science of the Total Environment, Vol: 875, Pages: 1-11, ISSN: 0048-9697
Growing cities in sub-Saharan Africa (SSA) experience high levels of ambient air pollution. However, sparse long-term city-wide air pollution exposure data limits policy mitigation efforts and assessment of the health and climate effects in growing cities. In the first study of its kind in West Africa, we developed high resolution spatiotemporal land use regression (LUR) models to map fine particulate matter (PM2.5) and black carbon (BC) concentrations in the Greater Accra Metropolitan Area (GAMA), one of the fastest sprawling metropolises in SSA. We conducted a one-year measurement campaign covering 146 sites and combined these data with geospatial and meteorological predictors to develop separate Harmattan and non-Harmattan season PM2.5 and BC models at 100 m resolution. The final models were selected with a forward stepwise procedure and performance was evaluated with 10-fold cross-validation. Model predictions were overlayed with the most recent census data to estimate the population distribution of exposure and socioeconomic inequalities in exposure at the census enumeration area level. The fixed effects components of the models explained 48-69 % and 63-71 % of the variance in PM2.5 and BC concentrations, respectively. Spatial variables related to road traffic and vegetation variables explained the most variability in the non-Harmattan models, while temporal variables were dominant in the Harmattan models. The entire GAMA population is exposed to PM2.5 levels above the World Health Organization guideline, including even the Interim Target 3 (15 μg/m3), with the highest exposures in poorer neighborhoods. The models can be used to support air pollution mitigation policies, health, and climate impact assessments. The measurement and modelling approach used in this study can be adapted to other African cities to bridge the air pollution data gap in the region.
Suel E, Muller E, Bennett J, et al., 2023, Do poverty and wealth look the same the world over? A comparative study of 12 cities from five high-income countries using street images, EPJ Data Science, ISSN: 2193-1127
Bennett J, Rashid T, Zolfaghari A, et al., 2023, Changes in life expectancy and house prices in London from 2002 to 2019: Hyper-resolution spatiotemporal analysis of death registration and real estate data, The Lancet Regional Health Europe, Vol: 27, Pages: 1-13, ISSN: 2666-7762
Background:London has outperformed smaller towns and rural areas in terms of life expectancy increase. Our aim was to investigate life expectancy change at very-small-area level, and its relationship with house prices and their change.Methods:We performed a hyper-resolution spatiotemporal analysis from 2002 to 2019 for 4835 London Lower-layer Super Output Areas (LSOAs). We used population and death counts in a Bayesian hierarchical model to estimate age- and sex-specific death rates for each LSOA, converted to life expectancy at birth using life table methods. We used data from the Land Registry via the real estate website Rightmove (www.rightmove.co.uk), with information on property size, type and land tenure in a hierarchical model to estimate house prices at LSOA level. We used linear regressions to summarise how much life expectancy changed in relation to the combination of house prices in 2002 and their change from 2002 to 2019. We calculated the correlation between change in price and change in sociodemographic characteristics of the resident population of LSOAs and population turnover.Findings:In 134 (2.8%) of London's LSOAs for women and 32 (0.7%) for men, life expectancy may have declined from 2002 to 2019, with a posterior probability of a decline >80% in 41 (0.8%, women) and 14 (0.3%, men) LSOAs. The life expectancy increase in other LSOAs ranged from <2 years in 537 (11.1%) LSOAs for women and 214 (4.4%) for men to >10 years in 220 (4.6%) for women and 211 (4.4%) for men. The 2.5th-97.5th-percentile life expectancy difference across LSOAs increased from 11.1 (10.7–11.5) years in 2002 to 19.1 (18.4–19.7) years for women in 2019, and from 11.6 (11.3–12.0) years to 17.2 (16.7–17.8) years for men. In the 20% (men) and 30% (women) of LSOAs where house prices had been lowest in 2002, mainly in east and outer west London, life expectancy increased only in proportion to the rise in house prices. In contrast, in the 30% (men) and
Zhang M, Shi Y, Zhou B, et al., 2023, Prevalence, awareness, treatment, and control of hypertension in China, 2004-18: findings from six rounds of a national survey, BMJ: British Medical Journal, Vol: 380, ISSN: 0959-535X
Objective: To assess the recent trends in prevalence and management of hypertension in China, nationally and by population subgroups.Design: Six rounds of a national survey, China.Setting China Chronic Disease and Risk Factors Surveillance, 2004-18.Participants: 642 523 community dwelling adults aged 18-69 years (30 501 in 2004, 47 353 in 2007, 90 491 in 2010, 156 836 in 2013, 162 293 in 2015, and 155 049 in 2018).Main outcome measures: Hypertension was defined as a blood pressure of ≥140/90 mm Hg or taking antihypertensive drugs. The main outcome measures were hypertension prevalence and proportion of people with hypertension who were aware of their hypertension, who were treated for hypertension, and whose blood pressure was controlled below 140/90 mm Hg.Results: The standardised prevalence of hypertension in adults aged 18-69 years in China increased from 20.8% (95% confidence interval 19.0% to 22.5%) in 2004 to 29.6% (27.8% to 31.3%) in 2010, then decreased to 24.7% (23.2% to 26.1%) in 2018. During 2010-18, the absolute annual decline in prevalence of hypertension among women was more than twice that among men (−0.83 percentage points (95% confidence interval −1.13 to −0.52) v −0.40 percentage points (−0.73 to −0.07)). Despite modest improvements in the awareness, treatment, and control of hypertension since 2004, rates remained low in 2018, at 38.3% (36.3% to 40.4%), 34.6% (32.6% to 36.7%), and 12.0% (10.6% to 13.4%). Of 274 million (95% confidence interval 238 to 311 million) adults aged 18-69 years with hypertension in 2018, control was inadequate in an estimated 240 million (215 to 264 million). Across all surveys, women with low educational attainment had higher prevalence of hypertension than those with higher education, but the finding was mixed for men. The gap in hypertension control between urban and rural areas persisted, despite larger improvements in diagnosis an
Kanagasabai T, Carter E, Yan L, et al., 2022, Cross-sectional study of household solid fuel use and renal function in older adults in China, Environmental Research, Vol: 219, Pages: 1-11, ISSN: 0013-9351
BackgroundEmerging evidence links outdoor air pollution and declined renal function but the relationship between household air pollution and renal function is not well understood.MethodsUsing cross-sectional data from the multi-provincial INTERMAP-China Prospective Study, we collected blood samples and questionnaire information on stove use and socio-demographic factors. We calculated estimated glomerular filtration rate (eGFR) from serum creatinine to assess renal function. Participants with eGFR <60 mL/min per 1.73 m2 were defined as having chronic kidney disease (CKD) in this analysis. Generalized estimating equations were used to estimate the association of household fuel with renal function and prevalent CKD in models adjusting for confounders.ResultsAmong the 646 enrolled adults (40-79y; 56% female), one-third exclusively used clean fuel (gas and electric) cookstoves and 11% of northern China participants (n = 49 of 434) used only clean fuel heaters, whereas the rest used solid fuel. In multivariable models, use of solid fuel cookstoves was associated with 0.17 ml/min/1.73 m2 (95% CI: −0.30, 0.64) higher eGFR and 19% (0.86, 1.64) higher prevalence of CKD than exclusive clean fuel use. Greater intensity of solid fuel use was associated with 0.25 ml/min/1.73 m2 (−0.71, 0.21) lower eGFR per 5 stove-use years, though the confidence intervals included the null, while greater current intensity of indoor solid fuel use was associated with 1.02 (1.00, 1.04) higher prevalent CKD per 100 stove-use days per year. Larger associations between current solid fuel use and intensity of use with lower eGFR and prevalent CKD were observed among participants in southern China, those with hypertension or diabetes (eGFR only), and females (CKD only), through these groups had small sample sizes and some confidence intervals included the null.ConclusionWe found inconsistent evidence associating household solid fuel use and renal function in this cross-sectional study o
Paalanen L, Levalahti E, Maki P, et al., 2022, Association of socioeconomic position and childhood obesity in Finland: a registry-based study, BMJ Open, Vol: 12, Pages: 1-9, ISSN: 2044-6055
Objective To identify what dimensions of socioeconomic position (SEP) are most closely associated with childhood obesity in Finland, leveraging population-wide data among the whole child population aged 2–17 years in Finland.Design Registry-based study.Setting Data from several administrative registries linked on individual level covering the whole of Finland were used. Data on height and weight measurements in 2018 were obtained from the Register of Primary Health Care visits and data on sociodemographic and socioeconomic indicators (2014–2018) from Statistics Finland.Participants Children aged 2–17 years with valid height and weight measurements performed at the child health clinic or school healthcare in 2018 (final n=194 423).Main outcome measures Obesity was defined according to WHO Growth Reference curves. Sociodemographic and socioeconomic indicators were linked on individual level for adults (both parents) who lived in the same household (42 predictors). Boosted regression model was used to analyse the contribution of SEP to obesity.Results From socioeconomic indicators, annual household income (12.6%) and mother and father’s educational level (12.6% and 8.1%, respectively) had the highest relative influence on obesity risk. The relative influence of a child’s sex was 7.7%.Conclusions The parents’ SEP was inversely associated with obesity among the offspring. A remarkable number of objective SEP indicators were analysed with parents’ education and household income finally being the indicators most strongly associated with obesity among children. In future research, more attention should be paid to reliable and objective ways of measuring educational status and income rather than on developing new SEP indicators. Administrative registries with information on both healthcare and socioeconomic indicators can in future provide better opportunities to assess the influence of SEP on various health risks.
Nathvani R, Clark S, Muller E, et al., 2022, Characterisation of urban environment and activity across space and time using street images and deep learning in Accra, Scientific Reports, Vol: 12, ISSN: 2045-2322
The urban environment influences human health, safety and wellbeing. Cities in Africa are growing faster than other regions but have limited data to guide urban planning and policies. Our aim was to use smart sensing and analytics to characterise the spatial patterns and temporal dynamics of features of the urban environment relevant for health, liveability, safety and sustainability. We collected a novel dataset of 2.1 million time-lapsed day and night images at 145 representative locations throughout the Metropolis of Accra, Ghana. We manually labelled a subset of 1,250 images for 20 contextually relevant objects and used transfer learning with data augmentation to retrain a convolutional neural network to detect them in the remaining images. We identified 23.5 million instances of these objects including 9.66 million instances of persons (41% of all objects), followed by cars (4.19 million, 18%), umbrellas (3.00 million, 13%), and informally operated minibuses known as tro tros (2.94 million, 13%). People, large vehicles and market-related objects were most common in the commercial core and densely populated informal neighbourhoods, while refuse and animals were most observed in the peripheries. The daily variability of objects was smallest in densely populated settlements and largest in the commercial centre. Our novel data and methodology shows that smart sensing and analytics can inform planning and policy decisions for making cities more liveable, equitable, sustainable and healthy.
Clark S, Alli AS, Ezzati M, et al., 2022, Spatial modelling and inequalities of environmental noise in Accra, Ghana, Environmental Research, Vol: 214, ISSN: 0013-9351
Noise pollution is a growing environmental health concern in rapidly urbanizing sub-Saharan African (SSA) cities. However, limited city-wide data constitutes a major barrier to investigating health impacts as well as implementing environmental policy in this growing population. As such, in this first of its kind study in West Africa, we measured, modelled and predicted environmental noise across the Greater Accra Metropolitan Area (GAMA) in Ghana, and evaluated inequalities in exposures by socioeconomic factors. Specifically, we measured environmental noise at 146 locations with weekly (n = 136 locations) and yearlong monitoring (n = 10 locations). We combined these data with geospatial and meteorological predictor variables to develop high-resolution land use regression (LUR) models to predict annual average noise levels (LAeq24hr, Lden, Lday, Lnight). The final LUR models were selected with a forward stepwise procedure and performance was evaluated with cross-validation. We spatially joined model predictions with national census data to estimate population levels of, and potential socioeconomic inequalities in, noise levels at the census enumeration-area level. Variables representing road-traffic and vegetation explained the most variation in noise levels at each site. Predicted day-evening-night (Lden) noise levels were highest in the city-center (Accra Metropolis) (median: 64.0 dBA) and near major roads (median: 68.5 dBA). In the Accra Metropolis, almost the entire population lived in areas where predicted Lden and night-time noise (Lnight) surpassed World Health Organization guidelines for road-traffic noise (Lden <53; and Lnight <45). The poorest areas in Accra also had significantly higher median Lden and Lnight compared with the wealthiest ones, with a difference of ∼5 dBA. The models can support environmental epidemiological studies, burden of disease assessments, and policies and interventions that address underlying causes of noise exposure ineq
Asaria P, Bennett J, Elliott P, et al., 2022, Contributions of event rates, pre-hospital deaths and hospital case fatality to variations in myocardial infarction mortality in 326 districts in England: spatial analysis of linked hospitalisation and mortality data, The Lancet Public Health, Vol: 7, Pages: e813-e824, ISSN: 2468-2667
Background: Myocardial infarction (MI) mortality varies substantially within high-income countries. There is limited guidance on what interventions – primary and secondary prevention and/or improving care pathways and quality – can reduce and equalise MI mortality. Our aimwas to understand the contribution of incidence (event rate), pre-hospital deaths and hospital case-fatality, to how MI mortality varies within England.Methods: We used linked data on hospitalisation and deaths from 2015-2018 with geographical identifiers to estimate MI death and event rates, pre-hospital deaths and hospital case fatality for men and women aged 45 years and older in 326 districts in England. Data were analysed in a Bayesian spatial model that accounted for similarities and differences inspatial patterns of fatal and non-fatal MI. Results: The 99th to 1st percentile ratio of age-standardised MI death rate was 2.63 (95% credible interval 2.45-2.83) in women and 2.56 (2.37-2.76) in men across districts, with death rate highest in north of England. The main contributor to this variation was MI event rate, with a 99th to 1st percentile ratio of 2.55 (2.39-2.72) (women) and 2.17 (2.08-2.27) (men) across districts. Pre-hospital mortality was greater than hospital case fatality in every district. Prehospital mortality had a 99th to 1st percentile ratio 1.60 (1.50-1.70) in women and 1.75 (1.66-1.86) in men across districts and made a greater contribution to case-fatality variation thanhospital case fatality which had a 99th to 1st percentile ratio of 1.39 (1.29-1.49) (women) and1.49 (1.39-1.60) (men). The contribution of case fatality to variation in deaths across districtswas largest in middle ages. Pre-hospital mortality was slightly higher in men than women inmost districts and age groups, whereas hospital case fatality was higher in women in virtuallyall districts at ages up to and including 65-74 years; after this age, it became similar betweenthe sexes.3Interpretation: Mos
Lelijveld N, Benedict RK, Wrottesley S, et al., 2022, Towards standardised and valid anthropometric indicators of nutritional status in middle childhood and adolescence, LANCET CHILD & ADOLESCENT HEALTH, Vol: 6, Pages: 738-746, ISSN: 2352-4642
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Tetteh JD, Templeton M, Cavanaugh A, et al., 2022, Spatial heterogeneity in drinking water sources in the Greater Accra Metropolitan Area (GAMA), Ghana, Population and Environment, Vol: 44, Pages: 46-76, ISSN: 0199-0039
Universal access to safe drinking water is essential to population health and wellbeing, as recognized in the Sustainable Development Goals (SDG). To develop targeted policies which improve urban access to improved water and ensure equity, there is the need to understand the spatial heterogeneity in drinking water sources and the factors underlying these patterns. Using the Shannon Entropy Index and the Index of Concentration at the Extremes at the enumeration area level, we analyzed census data to examine the spatial heterogeneity in drinking water sources and neighborhood income in the Greater Accra Metropolitan Area (GAMA), the largest urban agglomeration in Ghana. GAMA has been a laboratory for studying urban growth, economic security, and other concomitant socio-environmental and demographic issues in the recent past. The current study adds to this literature by telling a different story about the spatial heterogeneity of GAMA’s water landscape at the enumeration area level. The findings of the study reveal considerable geographical heterogeneity and inequality in drinking water sources not evidenced in previous studies. We conclude that heterogeneity is neither good nor bad in GAMA judging by the dominance of both piped water sources and sachet water (machine-sealed 500ml plastic bag of drinking water). The lessons from this study can be used to inform the planning of appropriate localized solutions targeted at providing piped water sources in neighborhoods lacking these services and to monitor progress in achieving universal access to improved drinking water as recognized in the SDG 6 and improving population health and wellbeing
Suel E, Sorek-Hamer M, Moise I, et al., 2022, What you see is what you breathe? Estimating air pollution spatial variation using street level imagery, Remote Sensing, Vol: 14, ISSN: 2072-4292
High spatial resolution information on urban air pollution levels is unavailable in many areas globally, partially due to high input data needs of existing estimation approaches. Here we introduce a computer vision method to estimate annual means for air pollution levels from street level images. We used annual mean estimates of NO2 and PM2.5 concentrations from locally calibrated models as labels from London, New York, and Vancouver to allow for compilation of a sufficiently large dataset (~250k images for each city). Our experimental setup is designed to quantify intra and intercity transferability of image-based model estimates. Performances were high and comparable to traditional land-use regression (LUR) and dispersion models when training and testing on images from the same city (R2 values between 0.51 and 0.95 when validated on data from ground monitoring stations). Like LUR models, transferability of models between cities in different geographies is more difficult. Specifically, transferability between the three cities i.e., London, New York, and Vancouver, which have similar pollution source profiles were moderately successful (R2 values between zero and 0.67). Comparatively, performances when transferring models trained on these cities with very different source profiles i.e., Accra in Ghana and Hong Kong were lower (R2 between zero and 0.21) suggesting the need for local calibration with local calibration using additional measurement data from cities that share similar source profiles.
Moulds S, Chan ACH, Tetteh JD, et al., 2022, Sachet water in Ghana: a spatiotemporal analysis of the recent upward trend in consumption and its relationship with changing household characteristics, 2010-2017, PLoS One, Vol: 17, Pages: 1-22, ISSN: 1932-6203
The consumption of packaged water in Ghana has grown significantly in recent years. By 2017, “sachet water” – machine-sealed 500ml plastic bags of drinking water – was consumed by 33% of Ghanaian households. Reliance on sachet water has previously been associated with the urban poor, yet recent evidence suggests a customer base which crosses socioeconomic lines. Here, we conduct a repeated cross-sectional analysis of three nationally representative datasets to examine the changing demography of sachet water consumers between 2010 and 2017. Our results show that over the course of the study period sachet water has become a ubiquitous source of drinking water in Ghana, with relatively wealthy households notably increasing their consumption. In 2017, the majority of sachet water drinking households had access to another improved water source. The current rate and form of urbanisation, inadequate water governance, and an emphasis on cost recovery pose significant challenges for the expansion of the piped water supply network, leading us to conclude that sachet water will likely continue to be a prominent source of drinking water in Ghana for the foreseeable future. The main challenge for policymakers is to ensure that the growing sachet water market enhances rather than undermines Ghana’s efforts towards achieving universal and equitable access to clean drinking water and sanitation.
Ikeda N, Nakaya T, Bennett J, et al., 2022, Trends and disparities in adult body mass index across the 47 prefectures of Japan, 1975-2018: a bayesian spatiotemporal analysis of national household surveys, Frontiers in Public Health, Vol: 10, Pages: 1-9, ISSN: 2296-2565
Background: Among high-income countries, Japan has a low prevalence of obesity, but little is understood about subnational trends and variations in body mass index (BMI), largely owing to the lack of data from representative samples of prefectures. We aimed to examine long-term trends and distributions of adult BMI at the prefecture level in Japan from the late 1970s using a spatiotemporal model.Methods: We obtained cross-sectional data for 233,988 men and 261,086 women aged 20–79 years from the 44 annual National Health and Nutrition Surveys (NHNS) conducted during 1975–2018. We applied a Bayesian spatiotemporal model to estimate the annual time series of age-standardized and age-specific mean BMI by 20-year age group and sex for each of the 47 prefectures. We assessed socioeconomic inequalities in BMI across prefectures using the concentration index, according to population density.Results: In men, the age-standardized prefectural mean BMI ranged from 21.7 kg/m2 (95% credible interval, 21.6–21.9) to 23.1 kg/m2 (22.9–23.4) in 1975 and from 23.5 kg/m2 (23.3–23.7) to 24.8 kg/m2 (24.6–25.1) in 2018. In women, the age-standardized prefectural mean BMI ranged from 22.0 kg/m2 (21.9–22.2) to 23.4 kg/m2 (23.2–23.6) in 1975 and from 21.7 kg/m2 (21.6–22.0) to 23.5 kg/m2 (23.2–23.8) in 2018. Mean BMI was highest in the southernmost prefecture for most of the study period, followed by northeast prefectures. The increase in mean BMI was largest in southwest prefectures, which caught up with northeast prefectures over time. The concentration index was negative, indicating higher BMI in less-populated prefectures. Absolute values of the concentration index were greater in women than in men and increased over time.Conclusions: There were variations in adult mean BMI across prefectures, and geographic distributions changed over time. Further national and local efforts are needed to address the rising trend in mean BMI, par
Stevens GA, Paciorek CJ, Flores-Urrutia MC, et al., 2022, National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data, The Lancet Global Health, Vol: 10, Pages: e627-e639, ISSN: 2214-109X
BACKGROUND: Anaemia causes health and economic harms. The prevalence of anaemia in women aged 15-49 years, by pregnancy status, is indicator 2.2.3 of the UN Sustainable Development Goals, and the aim of halving the anaemia prevalence in women of reproductive age by 2030 is an extension of the 2025 global nutrition targets endorsed by the World Health Assembly (WHA). We aimed to estimate the prevalence of anaemia by severity for children aged 6-59 months, non-pregnant women aged 15-49 years, and pregnant women aged 15-49 years in 197 countries and territories and globally for the period 2000-19. METHODS: For this pooled analysis of population-representative data, we collated 489 data sources on haemoglobin distribution in children and women from 133 countries, including 4·5 million haemoglobin measurements. Our data sources comprised health examination, nutrition, and household surveys, accessed as anonymised individual records or as summary statistics such as mean haemoglobin and anaemia prevalence. We used a Bayesian hierarchical mixture model to estimate haemoglobin distributions in each population and country-year. This model allowed for coherent estimation of mean haemoglobin and prevalence of anaemia by severity. FINDINGS: Globally, in 2019, 40% (95% uncertainty interval [UI] 36-44) of children aged 6-59 months were anaemic, compared to 48% (45-51) in 2000. Globally, the prevalence of anaemia in non-pregnant women aged 15-49 years changed little between 2000 and 2019, from 31% (95% UI 28-34) to 30% (27-33), while in pregnant women aged 15-49 years it decreased from 41% (39-43) to 36% (34-39). In 2019, the prevalence of anaemia in children aged 6-59 months exceeded 70% in 11 countries and exceeded 50% in all women aged 15-49 years in ten countries. Globally in all populations and in most countries and regions, the prevalence of mild anaemia changed little, while moderate and severe anaemia declined in most populations and geographical locations, indicatin
Cohorts Consortium of Latin America and the Caribbean CC-LAC, Carrillo Larco R, Stern D, et al., 2022, Derivation, internal validation, and recalibration of a cardiovascular risk score for Latin America and the Caribbean (Globorisk-LAC): a pooled analysis of cohort studies, The Lancet Regional Health Americas, Vol: 9, ISSN: 2667-193X
Background: Risk stratification is a cornerstone of cardiovascular disease (CVD) prevention and a main strategy proposed to achieve global goals of reducing premature CVD deaths. There are no cardiovascular risk scores based on data from Latin America and the Caribbean (LAC) and it is unknown how well risk scores based on European and North American cohorts represent true risk among LAC populations. Methods: We developed a CVD (including coronary heart disease and stroke) risk score for fatal/non-fatal events using pooled data from 9 prospective cohorts with 21,378 participants and 1,202 events. We developed laboratory-based (systolic blood pressure, total cholesterol, diabetes, and smoking), and office-based (body mass index replaced total cholesterol and diabetes) models. We used Cox proportional hazards and held back a subset of participants to internally validate our models by estimating Harrell’s C-statistic and calibration slopes. Findings: The C-statistic for the laboratory-based model was 72% (70%-74%), the calibration slope was 0.994 (0.934-1.055) among men and 0.852 (0.761-0.942) among women; for the office-based model the C-statistic was 71% (69%-72%) and the calibration slope was 1.028 (0.980-1.076) among men and 0.811 (0.663-0.958) among women. In the pooled sample, using a 20% risk threshold, the laboratory-based model had sensitivity of 21.9% and specificity of 94.2%. Lowering the threshold to 10% increased sensitivity to 52.3% and reduced specificity to 78.7%.Interpretation: The cardiovascular risk score herein developed had adequate discrimination and calibration. The Globorisk-LAC would be more appropriate for LAC than the current global or regional risk scores. This work provides a tool to strengthen risk-based cardiovascular prevention in LAC. Funding: Wellcome Trust (214185/Z/18/Z)
Black RE, Liu L, Hartwig FP, et al., 2022, Health and development from preconception to 20 years of age and human capital, LANCET, Vol: 399, Pages: 1730-1740, ISSN: 0140-6736
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- Citations: 13
Sorek-Hamer M, Von Pohle M, Sahasrabhojanee A, et al., 2022, A deep learning approach for meter-scale air quality estimation in urban environments using very high-spatial-resolution satellite imagery, Atmosphere, Vol: 13, Pages: 1-16, ISSN: 2073-4433
High-spatial-resolution air quality (AQ) mapping is important for identifying pollution sources to facilitate local action. Some of the most populated cities in the world are not equipped with the infrastructure required to monitor AQ levels on the ground and must rely on other sources, such as satellite derived estimates, to monitor AQ. Current satellite-data-based models provide AQ mapping on a kilometer scale at best. In this study, we focus on producing hundred-meter-scale AQ maps for urban environments in developed cities. We examined the feasibility of an image-based object-detection analysis approach using very high-spatial-resolution (2.5 m) commercial satellite imagery. We fed the satellite imagery to a deep neural network (DNN) to learn the association between visual urban features and air pollutants. The developed model, which solely uses satellite imagery, was tested and evaluated using both ground monitoring observations and land-use regression modeled PM2.5 and NO2 concentrations over London, Vancouver (BC), Los Angeles, and New York City. The results demonstrate a low error with a total RMSE < 2 µg/m3 and highlight the contribution of specific urban features, such as green areas and roads, to continuous hundred-meter-scale AQ estimations. This approach offers promise for scaling to global applications in developed and developing urban environments. Further analysis on domain transferability will enable application of a parsimonious model based merely on satellite images to create hundred-meter-scale AQ maps in developing cities, where current and historical ground data are limited.
Lim S, Bassey E, Bos B, et al., 2022, Comparing human exposure to fine particulate matter in low and high-income countries: A systematic review of studies measuring personal PM2.5 exposure, SCIENCE OF THE TOTAL ENVIRONMENT, Vol: 833, ISSN: 0048-9697
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- Citations: 5
Tseng T-WJ, Carter E, Yan L, et al., 2022, Household air pollution from solid fuel use as a dose-dependent risk factor for cognitive impairment in northern China, Scientific Reports, Vol: 12, ISSN: 2045-2322
The relationship between exposure to household air pollution (HAP) from solid fuel use and cognition remains poorly understood. Among 401 older adults in peri-urban northern China enrolled in the INTERMAP-China Prospective Study, we estimated the associations between exposure to HAP and z-standardized domain-specific and overall cognitive scores from the Montreal Cognitive Assessment. Interquartile range increases in exposures to fine particulate matter (53.2-µg/m3) and black carbon (0.9-µg/m3) were linearly associated with lower overall cognition [- 0.13 (95% confidence interval: - 0.22, - 0.04) and - 0.10 (- 0.19, - 0.01), respectively]. Using solid fuel indoors and greater intensity of its use were also associated with lower overall cognition (range of point estimates: - 0.13 to - 0.03), though confidence intervals included zero. Among individual cognitive domains, attention had the largest associations with most exposure measures. Our findings indicate that exposure to HAP may be a dose-dependent risk factor for cognitive impairment. As exposure to HAP remains pervasive in China and worldwide, reducing exposure through the promotion of less-polluting stoves and fuels may be a population-wide intervention strategy to lessen the burden of cognitive impairment.
NCD Countdown 2030 collaborators, Ezzati M, Chalkidou K, et al., 2022, NCD Countdown 2030: Efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target in low- and middle-income countries, The Lancet, Vol: 399, Pages: 1266-1278, ISSN: 0140-6736
As of 2019, most countries were off track to achieve the Sustainable Development Goal 3.4 target (SDG 3.4), which calls for a one-third reduction in premature mortality from noncommunicable diseases (NCDs) between 2015 and 2030. In this Health Policy paper, we synthesise a range of evidence related to interventions that can reduce premature mortality from the major NCDs over the next decade and are feasible to implement in countries at all levels of income. Our recommendations are intended as generic guidance to help countries get back on track for SDG 3.4; country-level applications would require additional analyses and consideration of the local context. Protecting current investments and scaling up these interventions is especially crucial in the context of COVID-19-related health system disruptions. We illustrate how cost-effectiveness data and other information can be used to define locally tailored packages of interventions to accelerate rates of decline in NCD mortality across 123 low- and middle-income countries. Under realistic implementation constraints, the majority of countries could achieve the NCD target, or at least get very close to it, using some combination of these interventions; the greatest gains would be for cardiovascular disease mortality. Implementing the most efficient package of interventions in each world region would require, on average, an additional US$18 billion annually over 2023-2030; this investment could avert 39 million deaths and generate an average net economic benefit of US$2.7 trillion, or US$390 per capita. While specific clinical intervention pathways would vary across countries and regions, policies to reduce behavioural risks like tobacco smoking, harmful use of alcohol, and excess sodium intake would be relevant in nearly every country, accounting for nearly two-thirds of the health gains of any locally-tailored NCD package. By 2030, ministries of health would need to be devoting about 20% of their budgets to high-priori
Parks RM, Benavides J, Anderson GB, et al., 2022, Association of Tropical Cyclones With County-Level Mortality in the US, JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, Vol: 327, Pages: 946-955, ISSN: 0098-7484
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- Citations: 5
Kontis V, Bennett JE, Parks RM, et al., 2022, Lessons learned and lessons missed: impact of the coronavirus disease 2019 (COVID-19) pandemic on all-cause mortality in 40 industrialised countries and US states prior to mass vaccination [version 2; peer review: 2 approved], Wellcome Open Research, Vol: 6, ISSN: 2398-502X
Background: Industrialised countries had varied responses to the COVID-19 pandemic, which may lead to different death tolls from COVID-19 and other diseases. Methods: We applied an ensemble of 16 Bayesian probabilistic models to vital statistics data to estimate the number of weekly deaths if the pandemic had not occurred for 40 industrialised countries and US states from mid-February 2020 through mid-February 2021. We subtracted these estimates from the actual number of deaths to calculate the impacts of the pandemic on all-cause mortality. Results: Over this year, there were 1,410,300 (95% credible interval 1,267,600-1,579,200) excess deaths in these countries, equivalent to a 15% (14-17) increase, and 141 (127-158) additional deaths per 100,000 people. In Iceland, Australia and New Zealand, mortality was lower than would be expected in the absence of the pandemic, while South Korea and Norway experienced no detectable change. The USA, Czechia, Slovakia and Poland experienced >20% higher mortality. Within the USA, Hawaii experienced no detectable change in mortality and Maine a 5% increase, contrasting with New Jersey, Arizona, Mississippi, Texas, California, Louisiana and New York which experienced >25% higher mortality. Mid-February to the end of May 2020 accounted for over half of excess deaths in Scotland, Spain, England and Wales, Canada, Sweden, Belgium, the Netherlands and Cyprus, whereas mid-September 2020 to mid-February 2021 accounted for >90% of excess deaths in Bulgaria, Croatia, Czechia, Hungary, Latvia, Montenegro, Poland, Slovakia and Slovenia. In USA, excess deaths in the northeast were driven mainly by the first wave, in southern and southwestern states by the summer wave, and in the northern plains by the post-September period. Conclusions: Prior to widespread vaccine-acquired immunity, minimising the overall death toll of the pandemic requires policies and non-pharmaceutical interventions that delay and reduce infections, effective trea
Kanagasabai T, Xie W, Yan L, et al., 2022, Household air pollution and blood pressure, vascular damage and sub-clinical indicators of cardiovascular disease in older Chinese adults, American Journal of Hypertension, Vol: 35, Pages: 121-131, ISSN: 0895-7061
BackgroundLimited data suggest that household air pollution from cooking and heating with solid fuel (i.e., coal and biomass) stoves may contribute to the development of hypertension and vascular damage.MethodsUsing mixed-effects regression models, we investigated the associations of household air pollution with blood pressure (BP) and vascular function in 753 adults (ages 40-79y) from three diverse provinces in China. We conducted repeated measures of participants’ household fuel use, personal exposure to fine particulate air pollution (PM2.5), BP, brachial-femoral pulse wave velocity (bfPWV), and augmentation index. Ultrasound images of the carotid arteries were obtained to assess intima-media thickness (CIMT) and plaques. Covariate information on socio-demographics, health behaviors, 24-h urinary sodium, and blood lipids was also obtained.ResultsAverage estimated yearly personal exposure to PM2.5 was 97.5 μg/m 3 (SD: 79.2; range: 3.5-1241), and 65% of participants cooked with solid fuel. In multivariable models, current solid fuel use was associated with higher systolic (2.4 mmHg, 95%CI: -0.4, 4.9) and diastolic BP (1.4 mmHg, 95%CI: -0.1, 3.0) and greater total area of plaques (1.7 mm 2, 95%CI: -6.5, 9.8) compared with exclusive use of electricity or gas stoves. A 1-ln(µg/m 3) increase in PM2.5 exposure was associated with higher systolic (1.5 mmHg, 95%CI: 0.2, 2.7) and diastolic BP (1.0 mmHg, 95%CI: 0.4, 1.7) and with greater CIMT (0.02 mm, 95%CI: 0.00, 0.04) and total area of plaques (4.7 mm 2, 95%CI: -2.0, 11.5). We did not find associations with arterial stiffness, except for a lower bfPWV (-1.5 m/s, 95%CI: -3.0, -0.0) among users of solid fuel heaters.ConclusionsThese findings add to limited evidence that household air pollution is associated with higher BP and with greater CIMT and total plaque area.
Baumgartner J, Rodriguez J, Berkhout F, et al., 2022, Synthesizing the links between secure housing tenure and health for more equitable cities, Wellcome Open Research, Vol: 7, Pages: 18-18
<ns4:p>Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.</ns4:p>
Bixby H, Bennett J, Bawah AA, et al., 2022, Quantifying within-city inequalities in child mortality across neighbourhoods in Accra, Ghana: a Bayesian spatial analysis, BMJ Open, Vol: 12, ISSN: 2044-6055
Objective Countries in sub-Saharan Africa suffer the highest rates of child mortality worldwide. Urban areas tend to have lower mortality than rural areas, but these comparisons likely mask large within-city inequalities. We aimed to estimate rates of under-five mortality (U5M) at the neighbourhood level for Ghana’s Greater Accra Metropolitan Area (GAMA) and measure the extent of intraurban inequalities.Methods We accessed data on >700 000 women aged 25–49 years living in GAMA using the most recent Ghana census (2010). We summarised counts of child births and deaths by five-year age group of women and neighbourhood (n=406) and applied indirect demographic methods to convert the summaries to yearly probabilities of death before age five years. We fitted a Bayesian spatiotemporal model to the neighbourhood U5M probabilities to obtain estimates for the year 2010 and examined their correlations with indicators of neighbourhood living and socioeconomic conditions.Results U5M varied almost five-fold across neighbourhoods in GAMA in 2010, ranging from 28 (95% credible interval (CrI) 8 to 63) to 138 (95% CrI 111 to 167) deaths per 1000 live births. U5M was highest in neighbourhoods of the central urban core and industrial areas, with an average of 95 deaths per 1000 live births across these neighbourhoods. Peri-urban neighbourhoods performed better, on average, but rates varied more across neighbourhoods compared with neighbourhoods in the central urban areas. U5M was negatively correlated with multiple indicators of improved living and socioeconomic conditions among peri-urban neighbourhoods. Among urban neighbourhoods, correlations with these factors were weaker or, in some cases, reversed, including with median household consumption and women’s schooling.Conclusion Reducing child mortality in high-burden urban neighbourhoods in GAMA, where a substantial portion of the urban population resides, should be prioritised as part of continued
Pearson-Stuttard J, Cheng Y, Bennett J, et al., 2022, Trends in leading causes of hospitalisation among adults with diabetes in England from 2003 to 2018: an epidemiological analysis of linked primary care records, The Lancet Diabetes and Endocrinology, Vol: 10, Pages: 46-57, ISSN: 2213-8595
BackgroundDiabetes mellitus (DM) leads to a wide range of established vascular and metabolic complications which has resulted in specific prevention programmes being implemented across high-income countries. DM has been associated with increased risk of a broader set of conditions including cancers, liver disease and common infections. We aimed to examine the trends in a broad set of cause-specific hospitalisations in individuals with DM in England from 2003-2018.MethodsWe identified 309,874 individuals with DM in the Clinical Practice Research Datalink, a well described primary care database, linked to Hospital Episode Statistics inpatient data from 2003-2018. We generated a mixed prevalence and incident DM study population through serial cross sections and follow-up over time. We used a discretised Poisson regression model to estimate annual cause-specific hospitalisation rates in men and women with DM across 17 cause groupings. We generated a 1:1 age and sex matched non-DM population to compare findings. FindingsHospitalisation rates were higher for all causes in persons with DM compared to those without throughout the study period. DM itself and Ischaemic Heart Disease (IHD) were the leading causes of excess hospitalisation in 2003, but by 2018, respiratory conditions, cancers and IHD were the most common causes of excess hospitalisation across men and women. Hospitalisation rates declined in almost all traditional DM complication groupings (IHD, stroke, DM, amputations) whilst generally increasing across broader conditions (cancers, infections, respiratory conditions). These differing trends resulted in a diversification in the cause of hospitalisation, such that the traditional DM complications accounted for more than 50% of hospitalisations in 2003, but only approximately 30% in 2018. In contrast, the portion of hospitalisations that broader conditions accounted for increased including respiratory infections being attributable for 12% of hospitalisations in 2
Carrillo-Larco RM, Stern D, Hambleton IR, et al., 2021, Impact of common cardio-metabolic risk factors on fatal and non-fatal cardiovascular disease in Latin America and the Caribbean: an individual-level pooled analysis of 31 cohort studies, The Lancet Regional Health - Americas, Vol: 4, Pages: 1-12, ISSN: 2667-193X
BackgroundEstimates of the burden of cardio-metabolic risk factors in Latin America and the Caribbean (LAC) rely on relative risks (RRs) from non-LAC countries. Whether these RRs apply to LAC remains unknown.MethodsWe pooled LAC cohorts. We estimated RRs per unit of exposure to body mass index (BMI), systolic blood pressure (SBP), fasting plasma glucose (FPG), total cholesterol (TC) and non-HDL cholesterol on fatal (31 cohorts, n=168,287) and non-fatal (13 cohorts, n=27,554) cardiovascular diseases, adjusting for regression dilution bias. We used these RRs and national data on mean risk factor levels to estimate the number of cardiovascular deaths attributable to non-optimal levels of each risk factor.ResultsOur RRs for SBP, FPG and TC were like those observed in cohorts conducted in high-income countries; however, for BMI, our RRs were consistently smaller in people below 75 years of age. Across risk factors, we observed smaller RRs among older ages. Non-optimal SBP was responsible for the largest number of attributable cardiovascular deaths ranging from 38 per 100,000 women and 54 men in Peru, to 261 (Dominica, women) and 282 (Guyana, men). For non-HDL cholesterol, the lowest attributable rate was for women in Peru (21) and men in Guatemala (25), and the largest in men (158) and women (142) from Guyana.InterpretationRRs for BMI from studies conducted in high-income countries may overestimate disease burden metrics in LAC; conversely, RRs for SBP, FPG and TC from LAC cohorts are similar to those estimated from cohorts in high-income countries.FundingWellcome Trust (214185/Z/18/Z)
Ni MY, Canudas-Romo V, Shi J, et al., 2021, Understanding longevity in Hong Kong: a comparative study with long-living, high-income countries, LANCET PUBLIC HEALTH, Vol: 6, Pages: E919-E931, ISSN: 2468-2667
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Lai A, Lee M, Carter E, et al., 2021, A chemical investigation of household solid fuel use and outdoor air pollution contributions to personal PM2.5 exposures, Environmental Science and Technology (Washington), Vol: 55, Pages: 15969-15979, ISSN: 0013-936X
In communities with household solid fuel use, transitioning to clean stoves/fuels often results in only moderate reductions in fine particulate matter (PM2.5) exposures; the chemical composition of those exposures may help explain why. We collected personal exposure (men and women) and outdoor PM2.5 samples in villages in three Chinese provinces (Shanxi, Beijing, and Guangxi) and measured chemical components, including water-soluble organic carbon (WSOC), ions, elements, and organic tracers. Source contributions from chemical mass balance modeling (biomass burning, coal combustion, vehicles, dust, and secondary inorganic aerosol) were similar between outdoor and personal PM2.5 samples. Principal component analysis of organic and inorganic components identified analogous sources, including a regional ambient source. Chemical components of PM2.5 exposures did not differ significantly by gender. Participants using coal had higher personal/outdoor (P/O) ratios of coal combustion tracers (picene, sulfate, As, and Pb) than those not using coal, but no such trend was observed for biomass burning tracers (levoglucosan, K+, WSOC). Picene and most levoglucosan P/O ratios exceeded 1 even among participants not using coal and biomass, respectively, indicating substantial indirect exposure to solid fuel emissions from other homes. Contributions of community-level emissions to exposures suggest that meaningful exposure reductions will likely require extensive fuel use changes within communities.
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