20 results found
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
Kontis V, Bennett JE, Parks RM, et al., 2021, Lessons learned and lessons missed: impact of the coronavirus disease 2019 (COVID-19) pandemic on all-cause mortality in 40 industrialised countries prior to mass vaccination, Wellcome Open Research, Vol: 6, Pages: 279-279
<ns4:p><ns4:bold>Background:</ns4:bold> Industrialised countries had varied responses to the coronavirus disease 2019 (COVID-19) pandemic, and how they adapted to new situations and knowledge since it began. These differences in preparedness and policy may lead to different death tolls from COVID-19 as well as other diseases.<ns4:bold> </ns4:bold></ns4:p><ns4:p> <ns4:bold>Methods: </ns4:bold>We applied an ensemble of 16 Bayesian probabilistic models to vital statistics data to estimate the impacts of the pandemic on weekly all-cause mortality for 40 industrialised countries from mid-February 2020 through mid-February 2021, before a large segment of the population was vaccinated in these countries.</ns4:p><ns4:p> <ns4:bold>Results:</ns4:bold> Over the entire year, an estimated 1,410,300 (95% credible interval 1,267,600-1,579,200) more people died in these countries than would have been expected had the pandemic not happened. This is equivalent to 141 (127-158) additional deaths per 100,000 people and a 15% (14-17) increase in deaths in all these countries combined. In Iceland, Australia and New Zealand, mortality was lower than would be expected if the pandemic had not occurred, while South Korea and Norway experienced no detectable change in mortality. In contrast, the USA, Czechia, Slovakia and Poland experienced at least 20% higher mortality. There was substantial heterogeneity across countries in the dynamics of excess mortality. The first wave of the pandemic, from 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. At the other extreme, the period between mid-September 2020 and mid-February 2021 accounted for over 90% of excess deaths in Bulgaria, Croatia, Czechia, Hungary, Latvia, Montenegro, Poland, Slovakia and Slovenia.<ns4:bold> </ns4:bold></ns4:p&g
Kontis V, Bennett JE, Rashid T, et al., 2021, Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries (vol 26, pg 1919, 2020), NATURE MEDICINE, Vol: 27, Pages: 562-562, ISSN: 1078-8956
NCD Countdown 030 collaborators, Bennett JE, Kontis V, et al., 2020, NCD countdown 2030: pathways to achieving sustainable development goal target 3.4, The Lancet, Vol: 396, Pages: 918-934, ISSN: 0140-6736
The Sustainable Development Goal (SDG) target 3.4 is to reduce premature mortality from non-communicable diseases (NCDs) by a third by 2030 relative to 2015 levels, and to promote mental health and wellbeing. We used data on cause-specific mortality to characterise the risk and trends in NCD mortality in each country and evaluate combinations of reductions in NCD causes of death that can achieve SDG target 3.4. Among NCDs, ischaemic heart disease is responsible for the highest risk of premature death in more than half of all countries for women, and more than three-quarters for men. However, stroke, other cardiovascular diseases, and some cancers are associated with a similar risk, and in many countries, a higher risk of premature death than ischaemic heart disease. Although premature mortality from NCDs is declining in most countries, for most the pace of change is too slow to achieve SDG target 3.4. To investigate the options available to each country for achieving SDG target 3.4, we considered different scenarios, each representing a combination of fast (annual rate achieved by the tenth best performing percentile of all countries) and average (median of all countries) declines in risk of premature death from NCDs. Pathways analysis shows that every country has options for achieving SDG target 3.4. No country could achieve the target by addressing a single disease. In at least half the countries, achieving the target requires improvements in the rate of decline in at least five causes for women and in at least seven causes for men to the same rate achieved by the tenth best performing percentile of all countries. Tobacco and alcohol control and effective health-system interventions—including hypertension and diabetes treatment; primary and secondary cardiovascular disease prevention in high-risk individuals; low-dose inhaled corticosteroids and bronchodilators for asthma and chronic obstructive pulmonary disease; treatment of acute cardiovascular diseases
Kontis V, Cobb LK, Mathers CD, et al., 2020, Response by Kontis et al to Letter Regarding Article, "Three Public Health Interventions Could Save 94 Million Lives in 25 Years: Global Impact Assessment Analysis", CIRCULATION, Vol: 141, Pages: E5-E5, ISSN: 0009-7322
Parks RM, Bennett JE, Tamura-Wicks H, et al., 2020, Anomalously warm temperatures are associated with increased injury deaths, Nature Medicine, Vol: 26, Pages: 65-70, ISSN: 1078-8956
Temperatures which deviate from long-term local norm affect human health, and are projected to become more frequent as the global climate changes.1 There is limited data on how such anomalies affect deaths from injuries. Here, we used data on mortality and temperature over 38 years (1980-2017) in the contiguous USA and formulated a Bayesian spatio-temporal model to quantify how anomalous temperatures, defined as deviations of monthly temperature from the local average monthly temperature over the entire analysis period, affect deaths from unintentional (transport, falls and drownings) and intentional (assault and suicide) injuries, by age group and sex. We found that a 1.5°C anomalously warm year, as envisioned under the Paris Climate Agreement,2 would be associated with an estimated 1,601 (95% credible interval 1,430-37 1,776) additional injury deaths. 84% of these additional deaths would occur in males, mostly in adolescent to middle ages. These deaths would comprise of increases in deaths 39 from drownings, transport, assault and suicide, offset partly by a decline in deaths from falls in older ages. The findings demonstrate the need for targeted interventions against injuries during periods of anomalously high temperatures, especially as these episodes are likely to increase with global climate change.
Kontis V, Cobb LK, Mathers CD, et al., 2019, Three public health interventions could save 94 Million lives in 25 Years -global impact assessment analysis, Circulation, Vol: 140, Pages: 715-725, ISSN: 0009-7322
Background:Preventable noncommunicable diseases, mostly cardiovascular diseases, are responsible for 38 million deaths annually. A few well-documented interventions have the potential to prevent many of these deaths, but a large proportion of the population in need does not have access to these interventions. We quantified the global mortality impact of 3 high-impact and feasible interventions: scaling up treatment of high blood pressure to 70%, reducing sodium intake by 30%, and eliminating the intake of artificial trans fatty acids.Methods:We used global data on mean blood pressure levels and sodium and trans fat intake by country, age, and sex from a pooled analysis of population health surveys, and regional estimates of current coverage of antihypertensive medications, and cause-specific mortality rates in each country, as well, with projections from 2015 to 2040. We used the most recent meta-analyses of epidemiological studies to derive relative risk reductions for each intervention. We estimated the proportional effect of each intervention on reducing mortality from related causes by using a generalized version of the population-attributable fraction. The effect of antihypertensive medications and lowering sodium intake were modeled through their impact on blood pressure and as immediate increase/reduction to the proposed targets.Results:The combined effect of the 3 interventions delayed 94.3 million (95% uncertainty interval, 85.7–102.7) deaths during 25 years. Increasing coverage of antihypertensive medications to 70% alone would delay 39.4 million deaths (35.9–43.0), whereas reducing sodium intake by 30% would delay another 40.0 million deaths (35.1–44.6) and eliminating trans fat would delay an additional 14.8 million (14.7–15.0). The estimated impact of trans fat elimination was largest in South Asia. Sub-Saharan Africa had the largest proportion of premature delayed deaths out of all delayed deaths.Conclusions:Three effective inte
Watkins D, Hale J, Hutchinson B, et al., 2019, Investing in non-communicable disease risk factor control among adolescents worldwide: a modelling study, BMJ GLOBAL HEALTH, Vol: 4, ISSN: 2059-7908
Bennett J, Pearson-Stuttard J, Kontis V, et al., 2018, Contributions of diseases and injuries to widening life expectancy inequalities in England from 2001 to 2016: population-based analysis of vital registration data, The Lancet Public Health, Vol: 3, Pages: e586-e597, ISSN: 2468-2667
BackgroundLife expectancy inequalities in England have increased steadily since the 1980s. Our aim was to investigate how much deaths from different diseases and injuries and at different ages have contributed to this rise to inform policies that aim to reduce health inequalities.MethodsWe used vital registration data from the Office for National Statistics on population and deaths in England, by underlying cause of death, from 2001 to 2016, stratified by sex, 5-year age group, and decile of the Index of Multiple Deprivation (based on the ranked scores of Lower Super Output Areas in England in 2015). We grouped the 7·65 million deaths by their assigned International Classification of Diseases (10th revision) codes to create categories of public health and clinical relevance. We used a Bayesian hierarchical model to obtain robust estimates of cause-specific death rates by sex, age group, year, and deprivation decile. We calculated life expectancy at birth by decile of deprivation and year using life-table methods. We calculated the contributions of deaths from each disease and injury, in each 5-year age group, to the life expectancy gap between the most deprived and affluent deciles using Arriaga's method.FindingsThe life expectancy gap between the most affluent and most deprived deciles increased from 6·1 years (95% credible interval 5·9–6·2) in 2001 to 7·9 years (7·7–8·1) in 2016 in females and from 9·0 years (8·8–9·2) to 9·7 years (9·6–9·9) in males. Since 2011, the rise in female life expectancy has stalled in the third, fourth, and fifth most deprived deciles and has reversed in the two most deprived deciles, declining by 0·24 years (0·10–0·37) in the most deprived and 0·16 years (0·02–0·29) in the second-most deprived by 2016. Death rates from every disease and at every age were higher in depriv
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
Kontis V, Ottobre M, Zegarlinski B, 2017, Long- and short-time behaviour of hypocoercive-type operators in infinite dimensions: an analytic approach, Infinite Dimensional Analysis, Quantum Probability and Related Topics, Vol: 30, ISSN: 0219-0257
In this paper we provide a range of examples to illustrate the general theory developed in Ref. 19, where we studied smoothing and ergodicity for infinite dimensional Markovian systems with hypocoercive type generator. We also introduce and study new models, where the framework of Ref. 19 cannot be applied as is but can be adapted to obtain improved results, by exploiting the specific structure of the generator at hand. Among such examples, we examine a system of infinitely many interacting heat baths.
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
Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3–19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8–144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.
Tzoulaki I, Elliott P, Kontis V, et al., 2016, Worldwide Exposures to Cardiovascular Risk Factors and Associated Health Effects: Current Knowledge and Data Gaps, Circulation, Vol: 133, Pages: 2314-2333, ISSN: 0009-7322
Information on exposure to, and health effects of, cardiovascular disease (CVD) risk factors is needed to develop effective strategies to prevent CVD events and deaths. Here, we provide an overview of the data and evidence on worldwide exposures to CVD risk factors and the associated health effects. Global comparative risk assessment studies have estimated that hundreds of thousands or millions of CVD deaths are attributable to established CVD risk factors (high blood pressure and serum cholesterol, smoking, and high blood glucose), high body mass index, harmful alcohol use, some dietary and environmental exposures, and physical inactivity. The established risk factors plus body mass index are collectively responsible for ≈9.7 million annual CVD deaths, with high blood pressure accounting for more CVD deaths than any other risk factor. Age-standardized CVD death rates attributable to established risk factors plus high body mass index are lowest in high-income countries, followed by Latin America and the Caribbean; they are highest in the region of central and eastern Europe and central Asia. However, estimates of the health effects of CVD risk factors are highly uncertain because there are insufficient population-based data on exposure to most CVD risk factors and because the magnitudes of their effects on CVDs in observational studies are likely to be biased. We identify directions for research and surveillance to better estimate the effects of CVD risk factors and policy options for reducing CVD burden by modifying preventable risk factors.
V Kontis, MOttobre, Zegarlinski B, 2016, Markov semigroups with hypocoercive-type generator in infinite dimensions: Ergodicity and smoothing, Journal of Functional Analysis, Vol: 270, Pages: 3173-3223, ISSN: 0022-1236
We start by considering finite dimensional Markovian dynamics in Rm generated by operators of hypocoercive type and for such models we obtain short and long time pointwise estimates for all the derivatives, of any order and in any direction, along the semigroup. We then look at infinite dimensional models (in (Rm)Zd) produced by the interaction of infinitely many finite dimensional dissipative dynamics of the type indicated above. For these infinite dimensional models we study finite speed of propagation of information, well-posedness of the semigroup, time behaviour of the derivatives and strong ergodicity problem.
Kontis V, Mathers CD, Bonita R, et al., 2015, Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study, Lancet Global Health, Vol: 3, Pages: e746-e757, ISSN: 2214-109X
BackgroundCountries have agreed to reduce premature mortality from the four main non-communicable diseases (NCDs) by 25% from 2010 levels by 2025 (referred to as the 25 × 25 target). Countries also agreed on a set of global voluntary targets for selected NCD risk factors. Previous analyses have shown that achieving the risk factor targets can contribute substantially towards meeting the 25 × 25 mortality target at the global level. We estimated the contribution of achieving six of the globally agreed risk factor targets towards meeting the 25 × 25 mortality target by region.MethodsWe estimated the effect of achieving the targets for six risk factors (tobacco and alcohol use, salt intake, obesity, and raised blood pressure and glucose) on NCD mortality between 2010 and 2025. Our methods accounted for multicausality of NCDs and for the fact that, when risk factor exposure increases or decreases, the harmful or beneficial effects on NCDs accumulate gradually. We used data for risk factor and mortality trends from systematic analyses of available country data. Relative risks for the effects of individual and multiple risks, and for change in risk after decreases or increases in exposure, were from reanalyses and meta-analyses of epidemiological studies.FindingsThe probability of dying between the ages 30 years and 70 years from the four main NCDs in 2010 ranged from 19% in the region of the Americas to 29% in southeast Asia for men, and from 13% in Europe to 21% in southeast Asia for women. If current trends continue, the probability of dying prematurely from the four main NCDs is projected to increase in the African region but decrease in the other five regions. If the risk factor targets are achieved, the 25 × 25 target will be surpassed in Europe in both men and women, and will be achieved in women (and almost achieved in men) in the western Pacific; the regions of the Americas, the eastern Mediterranean, and southeast Asia will approach the t
Bennett JE, Li G, Foreman K, et al., 2015, The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting, Lancet, Vol: 386, Pages: 163-170, ISSN: 0140-6736
Background: To plan for pensions and health and social services, future mortality and life expectancy need to be forecast. Consistent forecasts for all subnational units within a country are very rare. Our aim was to forecast mortality and life expectancy for England and Wales' districts.Methods: We developed Bayesian spatiotemporal models for forecasting of age-specific mortality and life expectancy at a local, small-area level. The models included components that accounted for mortality in relation to age, birth cohort, time, and space. We used geocoded mortality and population data between 1981 and 2012 from the Office for National Statistics together with the model with the smallest error to forecast age-specific death rates and life expectancy to 2030 for 375 of England and Wales' 376 districts. We measured model performance by withholding recent data and comparing forecasts with this withheld data.Findings: Life expectancy at birth in England and Wales was 79·5 years (95% credible interval 79·5–79·6) for men and 83·3 years (83·3–83·4) for women in 2012. District life expectancies ranged between 75·2 years (74·9–75·6) and 83·4 years (82·1–84·8) for men and between 80·2 years (79·8–80·5) and 87·3 years (86·0–88·8) for women. Between 1981 and 2012, life expectancy increased by 8·2 years for men and 6·0 years for women, closing the female–male gap from 6·0 to 3·8 years. National life expectancy in 2030 is expected to reach 85·7 (84·2–87·4) years for men and 87·6 (86·7–88·9) years for women, further reducing the female advantage to 1·9 years. Life expectancy will reach or surpass 81·4 years for men and reach or surpass 84·5 years for women in every district by 2030. Longevity inequality across distr
Kontis V, Mathers CD, Rehm J, et al., 2014, Contribution of six risk factors to achieving the 25×25 non-communicable disease mortality reduction target: a modelling study, The Lancet, Vol: 384, Pages: 427-437, ISSN: 0140-6736
BackgroundCountries have agreed to reduce premature mortality (defined as the probability of dying between the ages of 30 years and 70 years) from four main non-communicable diseases (NCDs)—cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes—by 25% from 2010 levels by 2025 (referred to as 25×25 target). Targets for selected NCD risk factors have also been agreed on. We estimated the contribution of achieving six risk factor targets towards meeting the 25×25 mortality target.MethodsWe estimated the impact of achieving the targets for six risk factors (tobacco and alcohol use, salt intake, obesity, and raised blood pressure and glucose) on NCD mortality between 2010 and 2025. Our methods accounted for multi-causality of NCDs and for the fact that when risk factor exposure increases or decreases, the harmful or beneficial effects on NCDs accumulate gradually. We used data for risk factor and mortality trends from systematic analyses of available country data. Relative risks for the effects of individual and multiple risks, and for change in risk after decreases or increases in exposure, were from re-analyses and meta-analyses of epidemiological studies.FindingsIf risk factor targets are achieved, the probability of dying from the four main NCDs between the ages of 30 years and 70 years will decrease by 22% in men and by 19% in women between 2010 and 2025, compared with a decrease of 11% in men and 10% in women under the so-called business-as-usual trends (ie, projections based on current trends with no additional action). Achieving the risk factor targets will delay or prevent more than 37 million deaths (16 million in people aged 30–69 years and 21 million in people aged 70 years or older) from the main NCDs over these 15 years compared with a situation of rising or stagnating risk factor trends. Most of the benefits of achieving the risk factor targets, including 31 million of the delayed or prevented deaths, wil
Inglis J, Kontis V, Zegarlinski B, 2011, From U-bounds to isoperimetry with applications to H-type groups, Journal of Functional Analysis (2011), Vol: 260, Pages: 76-116
Dragoni F, Kontis V, Zegarlinski B, 2011, Ergodicity of Markov Semigroups with Hörmander Type Generators in Infinite Dimensions, Potential Analysis: an international journal devoted to the interactions between potential theory, p
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