Publications
422 results found
Bahk J, Ezzati M, Khang Y-H, 2018, The life expectancy gap between North and South Korea from 1993 to 2008, European Journal of Public Health, Vol: 28, Pages: 830-835, ISSN: 1101-1262
Background: Comparative research on health outcomes in North and South Korea offers a unique opportunity to explore political and social determinants of health. We examined the age- and cause-specific contributions to the life expectancy (LE) gap between the two Koreas. Methods: We calculated the LE at birth in 1993 and 2008 among North and South Koreans, and cause-specific contributions to the LE discrepancy between the two Koreas in 2008. The cause-specific mortality data from South Korea were used as proxies for the cause-specific mortality data in North Korea in 2008. Results: The LE gap between the two Koreas was approximately 1 year in 1993, but grew to approximately 10 years in 2008. This discrepancy was attributable to increased gaps in mortality among children younger than 1 year and adults 55 years of age or older. The major causes of the increased LE gap were circulatory diseases, digestive diseases, infant mortality, external causes, cancers and infectious diseases. Conclusions: This study underscores the urgency of South Korean and international humanitarian aid programs to reduce the mortality rate of the North Korean people.
Bennett JE, Stevens GA, Mathers CD, et al., 2018, NCD Countdown 2030: worldwide trends in non-communicable disease mortality and progress towards Sustainable Development Goal target 3.4, Lancet, Vol: 392, Pages: 1072-1088, ISSN: 0140-6736
The third UN High-Level Meeting on Non-Communicable Diseases (NCDs) on Sept 27, 2018, will review national and global progress towards the prevention and control of NCDs, and provide an opportunity to renew, reinforce, and enhance commitments to reduce their burden. NCD Countdown 2030 is an independent collaboration to inform policies that aim to reduce the worldwide burden of NCDs, and to ensure accountability towards this aim. In 2016, an estimated 40·5 million (71%) of the 56·9 million worldwide deaths were from NCDs. Of these, an estimated 1·7 million (4% of NCD deaths) occurred in people younger than 30 years of age, 15·2 million (38%) in people aged between 30 years and 70 years, and 23·6 million (58%) in people aged 70 years and older. An estimated 32·2 million NCD deaths (80%) were due to cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes, and another 8·3 million (20%) were from other NCDs. Women in 164 (88%) and men in 165 (89%) of 186 countries and territories had a higher probability of dying before 70 years of age from an NCD than from communicable, maternal, perinatal, and nutritional conditions combined. Globally, the lowest risks of NCD mortality in 2016 were seen in high-income countries in Asia-Pacific, western Europe, and Australasia, and in Canada. The highest risks of dying from NCDs were observed in low-income and middle-income countries, especially in sub-Saharan Africa, and, for men, in central Asia and eastern Europe. Sustainable Development Goal (SDG) target 3.4—a one-third reduction, relative to 2015 levels, in the probability of dying between 30 years and 70 years of age from cancers, cardiovascular diseases, chronic respiratory diseases, and diabetes by 2030—will be achieved in 35 countries (19%) for women, and 30 (16%) for men, if these countries maintain or surpass their 2010–2016 rate of decline in NCD mortality. Most of these are high-income c
Baumgartner J, Carter E, Schauer JJ, et al., 2018, Household air pollution and measures of blood pressure, arterial stiffness and central haemodynamics, HEART, Vol: 104, Pages: 1515-1521, ISSN: 1355-6037
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- Citations: 30
Snider G, Carter E, Clark S, et al., 2018, Impacts of stove use patterns and outdoor air quality on household air pollution and cardiovascular mortality in southwestern China, Environment International, Vol: 117, Pages: 116-124, ISSN: 0160-4120
BACKGROUND: Decades of intervention programs that replaced traditional biomass stoves with cleaner-burning technologies have failed to meet the World Health Organization (WHO) interim indoor air quality target of 35-μg m-3 for PM2.5. Many attribute these results to continued use of biomass stoves and poor outdoor air quality, though the relative impacts of these factors have not been empirically quantified. METHODS: We measured 496 days of real-time stove use concurrently with outdoor and indoor air pollution (PM2.5) in 150 rural households in Sichuan, China. The impacts of stove use patterns and outdoor air quality on indoor PM2.5 were quantified. We also estimated the potential avoided cardiovascular mortality in southwestern China associated with transition from traditional to clean fuel stoves using established exposure-response relationships. RESULTS: Mean daily indoor PM2.5 was highest in homes using both wood and clean fuel stoves (122 μg m-3), followed by exclusive use of wood stoves (106 μg m-3) and clean fuel stoves (semi-gasifiers: 65 μg m-3; gas or electric: 55 μg m-3). Wood stoves emitted proportionally higher indoor PM2.5 during ignition, and longer stove use was not associated with higher indoor PM2.5. Only 24% of days with exclusive use of clean fuel stoves met the WHO indoor air quality target, though this fraction rose to 73% after subtracting the outdoor PM2.5 contribution. Reduced PM2.5 exposure through exclusive use of gas or electric stoves was estimated to prevent 48,000 yearly premature deaths in southwestern China, with greater reductions if local outdoor PM2.5 is also reduced. CONCLUSIONS: Clean stove and fuel interventions are not likely to reduce indoor PM2.5 to the WHO target unless their use is exclusive and outdoor air pollution is sufficiently low, but may still offer some cardiovascular benefits.
Apte JS, Brauer M, Cohen AJ, et al., 2018, Ambient PM2.5 Reduces Global and Regional Life Expectancy, ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS, Vol: 5, Pages: 546-551, ISSN: 2328-8930
Ezzati M, Pearson-Stuttard J, Bennett J, et al., 2018, Acting on non-communicable diseases in low- and middle-income tropical countries, Nature, Vol: 559, Pages: 507-516, ISSN: 0028-0836
The classical portrayal of poor health in tropical countries is one of infections and parasites, contrasting with wealthy western countries, where unhealthy diet and behaviours cause non-communicable diseases (NCDs) like heart disease and cancer. Using international mortality data, we show that most NCDs cause more deaths at any age in low- and middle-income tropical countries than in high-income western countries. Causes of NCDs in low- and middle-income countries include poor nutrition and living environment, infections, insufficient regulation of tobacco and alcohol, and under-resourced and inaccessible healthcare. We identify a comprehensive set of actions across health, social, economic and environmental sectors that can confront NCDs in low- and middle-income tropical countries and reduce global health inequalities.
Pearson-Stuttard J, Zhou B, Kontis V, et al., 2018, Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment, The Lancet Diabetes and Endocrinology, Vol: 6, Pages: E6-E15, ISSN: 2213-8595
BackgroundDiabetes and high body-mass index (BMI) are associated with increased risk of several cancers, and are increasing in prevalence in most countries. We estimated the cancer incidence attributable to diabetes and high BMI as individual risk factors and in combination, by country and sex.MethodsWe estimated population attributable fractions for 12 cancers by age and sex for 175 countries in 2012. We defined high BMI as a BMI greater than or equal to 25 kg/m2. We used comprehensive prevalence estimates of diabetes and BMI categories in 2002, assuming a 10-year lag between exposure to diabetes or high BMI and incidence of cancer, combined with relative risks from published estimates, to quantify contribution of diabetes and high BMI to site-specific cancers, individually and combined as independent risk factors and in a conservative scenario in which we assumed full overlap of risk of diabetes and high BMI. We then used GLOBOCAN cancer incidence data to estimate the number of cancer cases attributable to the two risk factors. We also estimated the number of cancer cases in 2012 that were attributable to increases in the prevalence of diabetes and high BMI from 1980 to 2002. All analyses were done at individual country level and grouped by region for reporting.FindingsWe estimated that 5·7% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors, corresponding to 804 100 new cases. 187 600 (24·5%) of 766 000 cases of liver cancer and 121 700 (38·4%) of 317 000 cases of endometrial cancer were attributable to these risk factors. In the conservative scenario, about 4·5% (629 000 new cases) of all incident cancers assessed were attributable to diabetes and high BMI combined. Individually, high BMI (544 300 cases) was responsible for almost twice as many cancer cases as diabetes (293 300 cases). 25·8% of diabetes-related cancers (equating to 75 600 new cases) and
Pearson-Stuttard J, Zhou B, Kontis V, et al., 2018, Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment, LANCET DIABETES & ENDOCRINOLOGY, Vol: 6, Pages: 95-104, ISSN: 2213-8587
Zhou B, Bentham J, Di Cesare M, et al., 2018, Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: a pooled analysis of 1,018 population-based measurement studies with 88.6 million participants, International Journal of Epidemiology, Vol: 47, Pages: 872-883i, ISSN: 1464-3685
BackgroundChange in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure.MethodsWe pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure.ResultsIn 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association.ConclusionsChange in mean bloo
Engelgau MM, Narayan KMV, Ezzati M, et al., 2018, Implementation Research to Address the United States Health Disadvantage Report of a National Heart, Lung, and Blood Institute Workshop, GLOBAL HEART, Vol: 13, Pages: 65-72, ISSN: 2211-8160
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- Citations: 6
Ezzati M, Di Cesare M, Bentham J, 2018, Determining the worldwide prevalence of obesity reply, LANCET, Vol: 391, Pages: 1774-1774, ISSN: 0140-6736
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- Citations: 5
Pope CA, Ezzati M, Cannon JB, et al., 2018, Mortality risk and PM2.5 air pollution in the USA: an analysis of a national prospective cohort, AIR QUALITY ATMOSPHERE AND HEALTH, Vol: 11, Pages: 245-252, ISSN: 1873-9318
Chwojnicki K, Ryglewicz D, Wojtyniak B, et al., 2018, Acute Ischemic Stroke Hospital Admissions, Treatment, and Outcomes in Poland in 2009-2013, FRONTIERS IN NEUROLOGY, Vol: 9, ISSN: 1664-2295
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- Citations: 13
Arku RE, Ezzati M, Baumgartner J, et al., 2018, Elevated blood pressure and household solid fuel use in premenopausal women: Analysis of 12 Demographic and Health Surveys (DHS) from 10 countries, ENVIRONMENTAL RESEARCH, Vol: 160, Pages: 499-505, ISSN: 0013-9351
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- Citations: 48
Pearson-Stuttard J, Zhou B, Kontis V, et al., 2017, Worldwide burden of cancer attributable to diabetes and high body-mass index: a comparative risk assessment, Lancet Diabetes and Endocrinology, Vol: 6, Pages: 95-104, ISSN: 2213-8595
BackgroundDiabetes and high body-mass index (BMI) are associated with increased risk of several cancers, and are increasing in prevalence in most countries. We estimated the cancer incidence attributable to diabetes and high BMI as individual risk factors and in combination, by country and sex.MethodsWe estimated population attributable fractions for 12 cancers by age and sex for 175 countries in 2012. We defined high BMI as a BMI greater than or equal to 25 kg/m2. We used comprehensive prevalence estimates of diabetes and BMI categories in 2002, assuming a 10-year lag between exposure to diabetes or high BMI and incidence of cancer, combined with relative risks from published estimates, to quantify contribution of diabetes and high BMI to site-specific cancers, individually and combined as independent risk factors and in a conservative scenario in which we assumed full overlap of risk of diabetes and high BMI. We then used GLOBOCAN cancer incidence data to estimate the number of cancer cases attributable to the two risk factors. We also estimated the number of cancer cases in 2012 that were attributable to increases in the prevalence of diabetes and high BMI from 1980 to 2002. All analyses were done at individual country level and grouped by region for reporting.FindingsWe estimated that 5·6% of all incident cancers in 2012 were attributable to the combined effects of diabetes and high BMI as independent risk factors, corresponding to 792 600 new cases. 187 600 (24·5%) of 766 000 cases of liver cancer and 121 700 (38·4%) of 317 000 cases of endometrial cancer were attributable to these risk factors. In the conservative scenario, about 4·5% (626 900 new cases) of all incident cancers assessed were attributable to diabetes and high BMI combined. Individually, high BMI (544 300 cases) was responsible for twice as many cancer cases as diabetes (280 100 cases). 26·1% of diabetes-related cancers (equating to 77 000 new cases) and 31&mid
NCD Risk Factor Collaboration NCD-RisC, 2017, Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults., Lancet, Vol: 390, Pages: 2627-2642, ISSN: 0140-6736
BACKGROUND: Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. METHODS: We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5-19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5-19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). FINDINGS: Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (-0·01 kg/m(2) per decade; 95% credible interval -0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m(2) per decade (0·69-1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m(2) per decade (0·64-1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m(2) per decade (-0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m(2) per decade (0·50-1·06, PP>0·9999) in Polynesia and Micronesia. Tre
Shan M, Carter E, Baumgartner J, et al., 2017, A user-centered, iterative engineering approach for advanced biomass cookstove design and development, Environmental Research Letters, Vol: 12, ISSN: 1748-9326
Lee ACC, Kozuki N, Cousens S, et al., 2017, Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21st standard: analysis of CHERG datasets, BMJ-BRITISH MEDICAL JOURNAL, Vol: 358, ISSN: 1756-1833
Islami F, Chen W, Yu XQ, et al., 2017, Cancer deaths and cases attributable to lifestyle factors and infections in China, 2013, Annals of Oncology, Vol: 28, Pages: 2567-2574, ISSN: 0923-7534
Clark S, Carter E, Shan M, et al., 2017, Adoption and use of a semi-gasifier cooking and water heating stove and fuel intervention in the Tibetan Plateau, China, Environmental Research Letters, Vol: 12, ISSN: 1748-9326
Improved cookstoves and fuels, such as advanced gasifier stoves, carry the promise of improving health outcomes, preserving local environments, and reducing climate-forcing air pollutants. However, low adoption and use of these stoves in many settings has limited their benefits. We aimed to improve the understanding of improved stove use by describing the patterns and predictors of adoption of a semi-gasifier stove and processed biomass fuel intervention in southwestern China. Of 113 intervention homes interviewed, 79% of homes tried the stove, and the majority of these (92%) continued using it 5–10 months later. One to five months after intervention, the average proportion of days that the semi-gasifier stove was in use was modest (40.4% [95% CI 34.3–46.6]), and further declined over 13 months. Homes that received the stove in the first batch used it more frequently (67.2% [95% CI 42.1−92.3] days in use) than homes that received it in the second batch (29.3% [95% CI 13.8−44.5] days in use), likely because of stove quality and user training. Household stove use was positively associated with reported cooking needs and negatively associated with age of the main cook, household socioeconomic status, and the availability of substitute cleaner-burning stoves. Our results show that even a carefully engineered, multi-purpose semi-gasifier stove and fuel intervention contributed modestly to overall household energy use in rural China.
Kenge AP, Bentham J, Zhou B, et al., 2017, Trends in obesity and diabetes across regions in Africa from 1980 to 2014: an analysis of pooled population-based studies., International Journal of Epidemiology, Vol: 46, Pages: 1421-1432, ISSN: 1464-3685
Background: The 2016 Dar Es Salaam Call to Action on Diabetes and other NCDs advocates national multi-sectoral NCD strategies and action plans based on available data and information from countries of sub-Saharan Africa and beyond. We estimated trends, from 1980 to 2014, in age-standardised mean body mass index (BMI) and diabetes prevalence in these countries in order to assess the co-progression and assist policy formulation.Methods: We pooled data from African and world-wide population-based studies which measured height, weight, and biomarkers to assess diabetes status in adults aged >18 years. A Bayesian hierarchical model was used to estimate trends, by sex, for 200 countries and territories including 53 countries across five African regions, (central, eastern, northern, southern and western) in mean BMI and diabetes prevalence (defined as either fasting plasma glucose of >7.0 mmol/L, history of diabetes diagnosis, or use of insulin or oral glucose control agents). ResultsAfrican data came from 245 population-based surveys (1.2 million participants) for BMI and 76 surveys (182 000 participants) for diabetes prevalence estimates. Countries with the highest number of data sources for BMI were South Africa (n=17), Nigeria (n=15) and Egypt (n=13); and for diabetes estimates, Tanzania (n=8), Tunisia (n=7), Cameroon, Egypt and South Africa (all n=6). The age-standardised mean BMI increased from 21.0 kg/m2 (95% credible interval: 20.3-21.7) to 23.0 kg/m2 (22.7-23.3) in men, and from 21.9 kg/m2 (21.3-22.5) to 24.9 kg/m2 (24.6-25.1) in women. The age-standardised prevalence of diabetes increased from 3.4% (1.5-6.3) to 8.5% (6.5-10.8) in men, and from 4.1% (2.0-7.5) to 8.9 % (6.9-11.2) in women. Estimates in northern and southern regions were mostly higher than the global average; those in central, eastern and western regions were lower than global averages. A positive association (correlation coefficient ≃0.9) was observed between mean BMI and diabetes prevalence
Ezzati M, 2017, Excess weight and multimorbidity: putting people's health experience in risk factor epidemiology, LANCET PUBLIC HEALTH, Vol: 2, Pages: E252-E253, ISSN: 2468-2667
Ezzati M, Zhou B, Riley L, et al., 2017, Challenges of monitoring global diabetes prevalence, Lancet Diabetes and Endocrinology, ISSN: 2213-8595
Asaria P, Elliott P, Douglass M, et al., 2017, Acute myocardial infarction hospital admissions and deaths in England: a national follow-back and follow-forward record-linkage study, Lancet Public Health, Vol: 2, Pages: e191-e201, ISSN: 2468-2667
Background Little information is available on how primary and comorbid acute myocardial infarction contribute to the mortality burden of acute myocardial infarction, the share of these deaths that occur during or after a hospital admission, and the reasons for hospital admission of those who died from acute myocardial infarction. Our aim was to fill in these gaps in the knowledge about deaths and hospital admissions due to acute myocardial infarction. Methods We used individually linked national hospital admission and mortality data for England from 2006 to 2010 to identify all primary and comorbid diagnoses of acute myocardial infarction during hospital stay and their associated fatality rates (during or within 28 days of being in hospital). Data were obtained from the UK Small Area Health Statistics Unit and supplied by the Health and Social Care Information Centre (now NHS Digital) and the Office of National Statistics. We calculated event rates (reported as per 100 000 population for relevant age and sex groups) and case-fatality rate for primary acute myocardial infarction diagnosed during the first physician encounter or during subsequent encounters, and acute myocardial infarction diagnosed only as a comorbidity. We also calculated what proportion of deaths from acute myocardial infarction occurred in people who had been in hospital on or within the 28 days preceding death, and whether acute myocardial infarction was one of the recorded diagnoses in such admissions. Findings Acute myocardial infarction was diagnosed in the first physician encounter in 307 496 (69%) of 446 744 admissions with a diagnosis of acute myocardial infarction, in the second or later physician encounter in 52 374 (12%) admissions, and recorded only as a comorbidity in 86 874 (19%) admissions. Patients with comorbid diagnoses of acute myocardial infarction had two to three times the case-fatality rate of patients in whom acute myocardial infarction was a primary diagnosis. 135 950 death
Ezzati M, Zhou B, Riley L, et al., 2017, Challenges of monitoring global diabetes prevalence, LANCET DIABETES & ENDOCRINOLOGY, Vol: 5, Pages: 162-162, ISSN: 2213-8587
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- Citations: 4
Ezzati M, Zhou B, Riley L, et al., 2017, Challenges of monitoring global diabetes prevalence, Lancet Diabetes and Endocrinology, Vol: 5, Pages: 162-162, ISSN: 2213-8595
Kontis V, Bennett JE, Mathers CD, et al., 2017, Projections of life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble, Lancet, Vol: 389, Pages: 1323-1335, ISSN: 1474-547X
Background: Projections of future mortality and life expectancy are needed to plan for health and social services and pensions. Our aim was to forecast national age-specific mortality and life expectancy using an approach that takes into account the uncertainty related to the choice of forecasting model.Methods: We developed an ensemble of 21 forecasting models, all of which probabilistically contributed towards the final projections. We applied this approach to forecast age-specific mortality to 2030 in 35 industrialised countries with high-quality vital statistics data. We used age-specific death rates to calculate life expectancy at birth and at age 65 years, and probability of dying before 70 years of age, with life-table models.Results: Life expectancy is projected to increase in all 35 countries with a probability of at least 65% for women and 85% for men. There is a 90% probability that life expectancy at birth among South Korean women in 2030 will be higher than 86.7 years, the same as the highest life expectancy in 2012, and a 57% probability that it will be higher than 90 years. Female life expectancy in South Korea is followed by those in France, Spain and Japan. For men, there is > 95% probability that life expectancy in South Korea, Australia and Switzerland will surpass 80 years in 2030, and 27% that it will surpass 85 years. The USA, Japan, Sweden, Greece, Macedonia and Serbia have some of the lowest projected life expectancy gains for both men and women. The female life expectancy advantage over men is likely to shrink by 2030 in every country except Mexico, where female life expectancy is predicted to increase more than male life expectancy, and in Chile, France, Greece, and Romania where the two sexes will see similar gains. More than half of the projected gains in life expectancy at birth in women will be due to enhanced longevity above 65 years of age. Conclusions: There is more than a 50% probability that by 2030, national female life expecta
Ueda P, Woodward M, Lu Y, et al., 2017, Laboratory-based and office-based risk scores and charts to predict 10-year risk of cardiovascular disease in 182 countries: a pooled analysis of prospective cohorts and health surveys., Lancet Diabetes and Endocrinology, Vol: 5, Pages: 196-213, ISSN: 2213-8595
BACKGROUND: Worldwide implementation of risk-based cardiovascular disease (CVD) prevention requires risk prediction tools that are contemporarily recalibrated for the target country and can be used where laboratory measurements are unavailable. We present two cardiovascular risk scores, with and without laboratory-based measurements, and the corresponding risk charts for 182 countries to predict 10-year risk of fatal and non-fatal CVD in adults aged 40-74 years. METHODS: Based on our previous laboratory-based prediction model (Globorisk), we used data from eight prospective studies to estimate coefficients of the risk equations using proportional hazard regressions. The laboratory-based risk score included age, sex, smoking, blood pressure, diabetes, and total cholesterol; in the non-laboratory (office-based) risk score, we replaced diabetes and total cholesterol with BMI. We recalibrated risk scores for each sex and age group in each country using country-specific mean risk factor levels and CVD rates. We used recalibrated risk scores and data from national surveys (using data from adults aged 40-64 years) to estimate the proportion of the population at different levels of CVD risk for ten countries from different world regions as examples of the information the risk scores provide; we applied a risk threshold for high risk of at least 10% for high-income countries (HICs) and at least 20% for low-income and middle-income countries (LMICs) on the basis of national and international guidelines for CVD prevention. We estimated the proportion of men and women who were similarly categorised as high risk or low risk by the two risk scores. FINDINGS: Predicted risks for the same risk factor profile were generally lower in HICs than in LMICs, with the highest risks in countries in central and southeast Asia and eastern Europe, including China and Russia. In HICs, the proportion of people aged 40-64 years at high risk of CVD ranged from 1% for South Korean women to 42% for
Grey C, Jackson R, Schmidt M, et al., 2017, One in four major ischaemic heart disease events are fatal and 60% are pre-hospital deaths: a national data-linkage study (ANZACS-QI 8), EUROPEAN HEART JOURNAL, Vol: 38, Pages: 172-180, ISSN: 0195-668X
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- Citations: 27
Stevens GA, Alkema L, Black RE, et al., 2016, Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement, LANCET, Vol: 388, Pages: E19-E23, ISSN: 0140-6736
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- Citations: 333
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