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

337 results found

Coleman NC, Burnett RT, Higbee JD, Lefler JS, Merrill RM, Ezzati M, Marshall JD, Kim S-Y, Bechle M, Robinson AL, Pope CAet 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

Journal article

Peto J, Alwan NA, Godfrey KM, Burgess RA, Hunter DJ, Riboli E, Romer Pet al., 2020, Universal weekly testing as the UK COVID-19 lockdown exit strategy, The Lancet, Vol: 395, Pages: 1420-1421, ISSN: 0140-6736

Journal article

Higbee JD, Lefler JS, Burnett RT, Ezzati M, Marshall JD, Kim S-Y, Bechle M, Robinson AL, Pope CAet 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.

Journal article

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

Journal article

Angell SY, McConnell M, Anderson CAM, Bibbins-Domingo K, Boyle DS, Capewell S, Ezzati M, de Ferranti S, Gaskin DJ, Goetzel RZ, Huffman MD, Jones M, Khan YM, Kim S, Kumanyika SK, McCray AT, Merritt RK, Milstein B, Mozaffarian D, Norris T, Roth GA, Sacco RL, Saucedo JF, Shay CM, Siedzik D, Saha S, Warner JJet 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

Journal article

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

Journal article

Taddei C, Jackson R, Zhou B, Bixby H, Danaei G, Di Cesare M, Kuulasmaa K, Hajifathalian K, Bentham J, Bennett JE, Aekplakorn W, Cifkova R, Dallongeville J, De Bacquer D, Giampaoli S, Gudnason V, Khang Y-H, Laatikainen T, Mann JI, Marques-Vidal P, Mensah GA, Müller-Nurasyid M, Ninomiya T, Petkeviciene J, Rodríguez-Artalejo F, Servais J, Söderberg S, Stavreski B, Wilsgaard T, Zdrojewski T, Zhao D, Stevens GA, Savin S, Cowan MJ, Riley LM, Ezzati Met 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.

Journal article

Kontis V, Cobb LK, Mathers CD, Frieden TR, Ezzati M, Danaei Get 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

Journal article

Bentham J, Singh GM, Danaei G, Green R, Lin JK, Stevens GA, Farzadfar F, Bennett JE, Di Cesare M, Dangour AD, Ezzati Met 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.

Journal article

Parks RM, Bennett JE, Tamura-Wicks H, Kontis V, Toumi R, Danaei G, Ezzati Met 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.

Journal article

Jaime Miranda J, Carrillo-Larco RM, Ferreccio C, Hambleton IR, Lotufo PA, Nieto-Martinez R, Zhou B, Bentham J, Bixby H, Hajifathalian K, Lu Y, Taddei C, Abarca-Gomez L, Acosta-Cazares B, Aguilar-Salinas CA, Andrade DS, Assuncao MCF, Barcelo A, Barros AJD, Barros MVG, Bata I, Batista RL, Benet M, Bernabe-Ortiz A, Bettiol H, Boggia JG, Boissonnet CP, Brewster LM, Cameron C, Candido APC, Cardoso VC, Chan Q, Christofaro DG, Confortin SC, Craig CL, d'Orsi E, Delisle H, de Oliveira PD, Dias-da-Costa JS, Diaz A, Donoso SP, Elliott P, Escobedo-de la Pena J, Ferguson TS, Fernandes RA, Ferrante D, Monterubio Flores E, Francis DK, Franco MDC, Fuchs FD, Fuchs SC, Goltzman D, Goncalves H, Gonzalez-Rivas JP, Bonet Gorbea M, Gregor RD, Guerrero R, Guimaraes AL, Gulliford MC, Gutierrez L, Hernandez Cadena L, Herrera VM, Hopman WM, Horimoto ARVR, Hormiga CM, Horta BL, Howitt C, Irazola VE, Magaly Jimenez-Acosta S, Joffres M, Kolsteren P, Landrove O, Li Y, Lilly CL, Fernanda Lima-Costa M, Louzada Strufaldi MW, Machado-Coelho GLL, Makdisse M, Margozzini P, Marques LP, Martorell R, Matijasevich A, Posso AJMD, McFarlane SR, McLean SB, Menezes AMB, Miquel JF, Mohanna S, Monterrubio EA, Moreira LB, Morejon A, Motta J, Neal WA, Nervi F, Noboa OA, Ochoa-Aviles AM, Anselmo Olinto MT, Oliveira IO, Ono LM, Ordunez P, Ortiz AP, Otero JA, Palloni A, Peixoto SV, Pereira AC, Perez CM, Reina DAR, Ribeiro R, Ritti-Dias RM, Rivera JA, Robitaille C, Rodriguez-Villamizar LA, Rojas-Martinez R, Roy JGR, Rubinstein A, Sandra Ruiz-Betancourt B, Salazar Martinez E, Sanchez-Abanto J, Santos IS, dos Santos RN, Scazufca M, Schargrodsky H, Silva AM, Santos Silva DA, Stein AD, Suarez-Medina R, Tarqui-Mamani CB, Tulloch-Reid MK, Ueda P, Ugel EE, Valdivia G, Varona P, Velasquez-Melendez G, Verstraeten R, Victora CG, Wanderley RS, Wang M-D, Wilks RJ, Wong-McClure RA, Younger-Coleman NO, Zuniga Cisneros J, Danaei G, Stevens GA, Riley LM, Ezzati M, Di Cesare Met 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·

Journal article

Carter E, Yan L, Fu Y, Robinson B, Kelly F, Elliott P, Wu Y, Zhao L, Ezzati M, Yang X, Chan Q, Baumgartner Jet 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.

Journal article

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

Journal article

Lefler JS, Higbee JD, Burnett RT, Ezzati M, Coleman NC, Mann DD, Marshall JD, Bechle M, Wang Y, Robinson AL, Pope CAet al., 2019, Air pollution and mortality in a large, representative US cohort: multiple-pollutant analyses, and spatial and temporal decompositions, ENVIRONMENTAL HEALTH, Vol: 18

Journal article

Carrillo Larco R, Di Cesare MC, Ezzati M, Zhou Bet 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.

Journal article

Sania A, Sudfeld CR, Danaei G, Fink G, McCoy DC, Zhu Z, Fawzi MCS, Akman M, Arifeen SE, Barros AJD, Bellinger D, Black MM, Bogale A, Braun JM, van den Broek N, Carrara V, Duazo P, Duggan C, Fernald LCH, Gladstone M, Hamadani J, Handal AJ, Harlow S, Hidrobo M, Kuzawa C, Kvestad I, Locks L, Manji K, Masanja H, Matijasevich A, McDonald C, McGready R, Rizvi A, Santos D, Santos L, Save D, Shapiro R, Stoecker B, Strand TA, Taneja S, Tellez-Rojo M-M, Tofail F, Yousafzai AK, Ezzati M, Fawzi Wet 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

Journal article

Di Angelantonio E, Kaptoge S, Pennells L, De Bacquer D, Cooney MT, Kavousi M, Stevens G, Riley L, Savin S, Altay S, Amouyel P, Assmann G, Bell S, Ben-Shlomo Y, Berkman L, Beulens JW, Bjorkelund C, Blaha MJ, Blazer DG, Bolton T, Bonita R, Brenner BH, Brunner EJ, Casiglia E, Chamnan P, Choi Y-H, Chowdhury R, Coady S, Crespo CJ, Cushman M, Dagenais GR, D'Agostino RB, Daimon M, Davidson KW, Engstrom G, Fang X, Ford I, Gallacher J, Gansevoort RT, Gaziano TA, Giampaoli S, Grandits G, Grimsgaard S, Grobbee DE, Gudnason V, Guo Q, Humphries S, Iso H, Jukema JW, Kauhanen J, Kengne AP, Khalili D, Khan T, Knuiman M, Koenig W, Kromhout D, Krumholz HM, Lam TH, Laughlin G, Ibanez AM, Moons KGM, Nietert PJ, Ninomiya T, Nordestgaard BG, O'Donnell C, Palmieri L, Patel A, Perel P, Price JF, Costa RBDPE, Ridker PM, Rodriguez B, Rosengren A, Roussel R, Sakurai M, Salomaa V, Sato S, Schottker B, Shara N, Shaw JE, Shin H-C, Simons LA, Sofianopoulou E, Sundstrom J, Tolonen H, Ueshima H, Volzke H, Wallace RB, Wareham NJ, Willeit P, Wood D, Wood A, Zhao D, Onuma O, Woodward M, Danaei G, Roth G, Mendis S, Graham I, Varghese C, Ezzati M, Jackson R, Danesh J, Di Angelantonio E, Nambi V, Matsushita K, Couper D, Diabetes A, Zimmet PZ, Barr ELM, Atkins R, Whincup PH, Study B, Kiechl S, Willeit J, Rungger G, Sofat R, Dale C, Casas JP, Ben-Shlomo Y, Tikhonoff V, Casiglia E, Hunt KJ, Sutherland SE, Nietert PJ, Psaty BM, Tracy R, Frikke-Schmidt R, Jensen GB, Schnohr P, Palmieri L, Donfrancesco C, Vanuzzo D, Panico S, Giampaoli S, Balkau B, Bonnet F, Fumeron F, Simons J, McLachlan S, Guralnik J, Khaw K-T, Brenner H, Zhang Y, Holleczek B, Cohort F, Salomaa V, Vartiainen E, Jousilahti P, Harald K, Massaro JJ, Pencina M, Ramachandran V, Susa S, Oizumi T, Kayama T, Rosengren A, Wilhelmsen L, Lissner L, Hange D, Mehlig K, Hata J, Yoshida D, Hirakawa Y, Rodriguez B, Rutters F, Elders PJM, Kyowa I, Kiyama M, Yamagishi K, Iso H, Tuomainen T-P, Virtanen J, Salonen JT, Meade TW, Nilsson PM, Melander O, de Boer Iet 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

Journal article

Clark SN, Schmidt AM, Carter EM, Schauer JJ, Yang X, Ezzati M, Daskalopoulou SS, Baumgartner Jet 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

Journal article

Kontis V, Cobb LK, Mathers CD, Frieden TR, Ezzati M, Danaei Get 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

Journal article

Zhou B, Danaei G, Stevens GA, Bixby H, Taddei C, Carrillo Larco R, Solomon B, Riley LM, Di Cesare M, Iurilli N, Rodriguez Martinez A, Zhu A, Hajifathalian K, Amuzu A, Banegas JR, Bennett JE, Cameron C, Cho Y, Clarke J, Craig CL, Cruz JJ, Gates L, Giampaoli S, Gregg EW, Hardy R, Hayes AJ, Ikeda N, Jackson RT, Jennings G, Joffres M, Khang Y-H, Koskinen S, Kuh D, Kujala UM, Laatikainen T, Lehtimaki T, Lopez-Garcia E, Lundqvist A, Maggi S, Magliano DJ, Mann JI, McLean RM, McLean SB, Miller JC, Morgan K, Neuhauser HK, Niiranen TJ, Noale M, Oh K, Palmieri L, Panza F, Parnell WR, Peltonen M, Raitakari O, Rodriguez-Artalejo F, Roy JGR, Salomaa V, Sarganas G, Servais J, Shaw JE, Shibuya K, Solfrizzi V, Stavreski B, Tan EJ, Turley ML, Vanuzzo D, Viikari-Juntura E, Weerasekera D, Ezzati Met 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

Journal article

Li S, Yang M, Carter E, Schauer JJ, Yang X, Ezzati M, Goldberg MS, Baumgartner Jet 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

Journal article

Arden Pope C, Lefler JS, Ezzati M, Higbee JD, Marshall JD, Kim SY, Bechle M, Gilliat KS, Vernon SE, Robinson AL, Burnett RTet 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

Journal article

Bennett J, Tamura-Wicks H, Parks R, Burnett RT, Pope III CA, Bechle MJ, Marshall JD, Goodarz D, Ezzati Met 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

Journal article

Wolfenden L, Ezzati M, Larijani B, Dietz Wet al., 2019, The challenge for global health systems in preventing and managing obesity, OBESITY REVIEWS, Vol: 20, Pages: 185-193, ISSN: 1467-7881

Journal article

Danaei G, Farzadfar F, Kelishadi R, Rashidian A, Rouhani OM, Ahmadnia S, Ahmadvand A, Arabi M, Ardalan A, Arhami M, Azizi MH, Bahadori M, Baumgartner J, Beheshtian A, Djalalinia S, Doshmangir L, Haghdoost AA, Haghshenas R, Hosseinpoor AR, Islami F, Kamangar F, Khalili D, Madani K, Masoumi-Asl H, Mazyaki A, Mirchi A, Moradi E, Nayernouri T, Niemeier D, Omidvari A-H, Peykari N, Pishgar F, Qorbani M, Rahimi K, Rahimi-Movaghar A, Tehrani FR, Rezaei N, Shahraz S, Takian A, Tootee A, Ezzati M, Jamshidi HR, Larijani B, Majdzadeh R, Malekzadeh Ret al., 2019, Iran in transition, Lancet, Vol: 393, Pages: 1984-2005, ISSN: 0140-6736

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.

Journal article

Bixby H, Bentham J, Zhou B, Di Cesare M, Paciorek CJ, Bennett JE, Taddei C, Stevens GA, Rodriguez-Martinez A, Carrillo-Larco RM, Khang Y-H, Soric M, Gregg E, Miranda JJ, Bhutta ZA, Savin S, Sophiea MK, Iurilli MLC, Solomon BD, Cowan MJ, Riley LM, Danaei G, Bovet P, Christa-Emandi A, Hambleton IR, Hayes AJ, Ikeda N, Kengne AP, Laxmaiah A, Li Y, McGarvey ST, Mostafa A, Neovius M, Starc G, Zainuddin AA, Ezzati Met al., 2019, Rising rural body-mass index is the main driver of the global obesity epidemic, Nature, Vol: 569, Pages: 260-264, ISSN: 0028-0836

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

Journal article

Suel E, Polak J, Bennett J, Ezzati Met al., 2019, Measuring social, environmental and health inequalities using deep learning and street imagery, Scientific Reports, Vol: 9, ISSN: 2045-2322

Cities are home to an increasing majority of the world’s population. Currently, it is difficult to track social, economic, environmental and health outcomes in cities with high spatial and temporal resolution, needed to evaluate policies regarding urban inequalities. We applied a deep learning approach to street images for measuring spatial distributions of income, education, unemployment, housing, living environment, health and crime. Our model predicts different outcomes directly from raw images without extracting intermediate user-defined features. To evaluate the performance of the approach, we first trained neural networks on a subset of images from London using ground truth data at high spatial resolution from official statistics. We then compared how trained networks separated the best-off from worst-off deciles for different outcomes in images not used in training. The best performance was achieved for quality of the living environment and mean income. Allocation was least successful for crime and self-reported health (but not objectively measured health). We also evaluated how networks trained in London predict outcomes three other major cities in the UK: Birmingham, Manchester, and Leeds. The transferability analysis showed that networks trained in London, fine-tuned with only 1% of images in other cities, achieved performances similar to ones from trained on data from target cities themselves. Our findings demonstrate that street imagery has the potential complement traditional survey-based and administrative data sources for high-resolution urban surveillance to measure inequalities and monitor the impacts of policies that aim to address them.

Journal article

Brehmer C, Lai A, Clark S, Shan M, Ni K, Ezzati M, Yang X, Baumgartner J, Schauer JJ, Carter Eet al., 2019, The oxidative potential of personal and household PM2.5 in a rural setting in southwestern China, Environmental Science and Technology, Vol: 53, Pages: 2788-2798, ISSN: 0013-936X

The chemical constituents of fine particulate matter (PM2.5) vary by source and capacity to participate in redox reactions in the body, which produce cytotoxic reactive oxygen species (ROS). Knowledge of the sources and components of PM2.5 may provide insight into the adverse health effects associated with the inhalation of PM2.5 mass. We collected 48 h household and personal PM2.5 exposure measurements in the summer months among 50 women/household pairs in a rural area of southwestern China where daily household biomass burning is common. PM2.5 mass was analyzed for ions, trace metals, black carbon, and water-soluble organic matter, as well as ROS-generating capability (oxidative potential) by one cellular and one acellular assay. Crustal enrichment factors and a principal component analysis identified the major sources of PM2.5 as dust, biomass burning, and secondary sulfate. Elements associated with the secondary sulfate source (As, Mo, Zn) had the strongest correlation with increased cellular oxidative potential (Spearman r: 0.74, 0.68, and 0.64). Chemical markers of biomass burning (water-soluble potassium and water-soluble organic matter) had negligible oxidative potential, suggesting that these assays may not be useful as health-relevant exposure metrics in populations that are exposed to high levels of smoke from household biomass burning.

Journal article

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

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

Journal article

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

Journal article

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