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  • Conference paper
    Chang K, Vamos E, Lee J, Palladino R, Millett C, Majeed Aet al., 2017,

    Socio-demographic inequalities in cardiovascular risk management and early detection of vascular conditions by the nhs health check: a difference-in-differences matching analysis

    , Publisher: BMJ Publishing Group, Pages: A3-A3, ISSN: 0143-005X
  • Journal article
    Laverty AA, Bottle R, Kim SH, Visani B, Majeed FA, Millett C, Vamos EPet al., 2017,

    Gender differences in hospital admissions for major cardiovascular events and procedures in people with and without diabetes in England: a nationwide study 2004 – 2014

    , Cardiovascular Diabetology, Vol: 16, ISSN: 1475-2840

    BackgroundSecondary prevention of cardiovascular disease (CVD) has improved immensely during the past decade but controversies persist on cardiovascular benefits among women with diabetes. We investigated 11-year trends in hospital admission rates for acute myocardial infarction (AMI), stroke, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) in people with and without diabetes by gender in England.MethodsWe identified all hospital admissions for cardiovascular disease causes among people aged 17 years and above between 2004 and 2014 in England. We calculated diabetes-specific and non-diabetes-specific rates for study outcomes by gender. To assess temporal changes, we fitted negative binomial regression models.ResultsDiabetes-related admission rates remained unchanged for AMI (incidence rate ratio (IRR) 0.99 [95% CI 0.98–1.01]), increased for stroke by 2% (1.02 [1.01–1.03]) and PCI by 3% (1.03 [1.01–1.04]) and declined for CABG by 3% (0.97 [0.96–0.98]) annually. Trends did not differ significantly by diabetes status. Women with diabetes had significantly lower rates of AMI (IRR 0.46 [95% CI 0.40–0.53]) and stroke (0.73 [0.63–0.84]) compared with men with diabetes. However, gender differences in admission rates for AMI attenuated in diabetes compared with the non-diabetic group. While diabetes tripled admission rates for AMI in men (IRR 3.15 [95% CI 2.72–3.64]), it increased it by over fourfold among women (4.27 [3.78–4.93]). Furthermore, while the presence of diabetes was associated with a threefold increased rates for PCI and fivefold increased rates for CABG (IRR 3.14 [2.83–3.48] and 5.01 [4.59–5.05], respectively) in men, among women diabetes was associated with a 4.4-fold increased admission rates for PCI and 6.2-fold increased rates for CABG (4.37 [3.93–4.85] and 6.24 [5.66–6.88], respectively). Proportional changes in rates were similar in men and women for

  • Journal article
    Carruthers J, Bottle R, Laverty AA, Khan SA, Millett C, Vamos EPet al., 2017,

    Nation-wide trends in non-alcoholic steatohepatitis (NASH) in patients with and without diabetes between 2004-05 and 2014-15 in England

    , Diabetes Research and Clinical Practice, Vol: 132, Pages: 102-107, ISSN: 1872-8227

    AimsThere are no national studies evaluating the epidemiology of non-alcoholic steatohepatitis (NASH) in England. NASH is becoming an increasingly important health issue given the inexorable rise in obesity and diabetes. We evaluated the rates of NASH in people with and without diabetes from 2004–2005 to 2014–2015.MethodsWe identified cases of biopsy-proven NASH in people with and without diabetes in England over an eleven-year period using Hospital Episode Statistics. We estimated incidence rates for each year. Negative binomial regression models were fitted to test trends.ResultsOver the study period, people without diabetes recorded a 3% reduction in admission rates per year (incidence rate ratio (IRR) (95% CI) 0.97 (0.96–0.98), p < 0.001), whilst there was an increase in admission rates in people with diabetes (IRR (95% CI) 1.01 (1.00–1.02), p = 0.04). In people with diabetes, this upward trend was driven by people over 65 years (IRR (95% CI) 1.03 (1.02–1.04), p < 0.001) and men (IRR (95% CI) 1.01 (1.0–1.02), p = 0.03). Inpatient mortality declined for people with diabetes by 2% per year after adjusting for age, sex and year (IRR (95% CI) 0.98 (0.95–0.99), p = 0.03). The 2% decline per year in inpatient mortality for people without diabetes did not achieve statistical significance after adjustment (IRR (95% CI) 0.98 (0.95–1.01), p = 0.175).ConclusionsThere was a decline in NASH-related hospital admissions amongst people without diabetes over eleven years, whilst rates increased in people with diabetes. These observations highlight the increasing burden of NASH.

  • Journal article
    Hone TV, Rasella D, Barreto ML, Majeed, Millett Cet al., 2017,

    Association between expansion of primary healthcare and racial inequalities in mortality amenable to primary care in Brazil: A national longitudinal analysis

    , Plos Medicine, Vol: 14, ISSN: 1549-1676

    BackgroundUniversal health coverage (UHC) can play an important role in achieving Sustainable Development Goal (SDG) 10, which addresses reducing inequalities, but little supporting evidence is available from low- and middle-income countries. Brazil’s Estratégia de Saúde da Família (ESF) (family health strategy) is a community-based primary healthcare (PHC) programme that has been expanding since the 1990s and is the main platform for delivering UHC in the country. We evaluated whether expansion of the ESF was associated with differential reductions in mortality amenable to PHC between racial groups.Methods and findingsMunicipality-level longitudinal fixed-effects panel regressions were used to examine associations between ESF coverage and mortality from ambulatory-care-sensitive conditions (ACSCs) in black/pardo (mixed race) and white individuals over the period 2000–2013. Models were adjusted for socio-economic development and wider health system variables. Over the period 2000–2013, there were 281,877 and 318,030 ACSC deaths (after age standardisation) in the black/pardo and white groups, respectively, in the 1,622 municipalities studied. Age-standardised ACSC mortality fell from 93.3 to 57.9 per 100,000 population in the black/pardo group and from 75.7 to 49.2 per 100,000 population in the white group. ESF expansion (from 0% to 100%) was associated with a 15.4% (rate ratio [RR]: 0.846; 95% CI: 0.796–0.899) reduction in ACSC mortality in the black/pardo group compared with a 6.8% (RR: 0.932; 95% CI: 0.892–0.974) reduction in the white group (coefficients significantly different, p = 0.012). These differential benefits were driven by greater reductions in mortality from infectious diseases, nutritional deficiencies and anaemia, diabetes, and cardiovascular disease in the black/pardo group. Although the analysis is ecological, sensitivity analyses suggest that over 30% of black/pardo deaths would have to be incorre

  • Journal article
    Hone T, Millett C, 2017,

    Brazilian Mortality Rates: The Authors Reply

    , HEALTH AFFAIRS, Vol: 36, Pages: 962-962, ISSN: 0278-2715
  • Journal article
    Filippidis FT, Gerovasili V, Millett C, Tountas Yet al., 2017,

    Medium-term impact of the economic crisis on mortality, health-related behaviours and access to healthcare in Greece

    , Scientific Reports, Vol: 7, ISSN: 2045-2322

    Previous studies on the health consequences of the crisis in Greece investigated short-term impacts on selected outcomes. This study examined the impact of the crisis on a key set of health indicators with longer follow up than previous studies. We conducted interrupted time series (ITS) analysis to compare trends in standardised mortality by cause before and during the crisis. We examined changes in fruit and vegetable consumption, smoking, physical activity, obesity, out-of-pocket payments and unmet needs for healthcare using national household data from the “Hellas Health” surveys. Standardised mortality rates for suicides (p < 0.001) and infant mortality (p = 0.003) increased during the crisis compared to pre-existing trends, while mortality from respiratory diseases (p = 0.053) and transport accidents (p = 0.067) decreased. The prevalence of smoking (42.6% to 36.5%; RR = 0.86) and sedentary lifestyle (43.4% to 29.0%; RR = 0.69) declined. The prevalence of unmet need for healthcare significantly increased from 10.0% to 21.9% (RR = 2.10) and the proportion of people paying out-of-pocket for healthcare from 34.4% to 58.7% (RR = 1.69) between 2010 and 2015. The impact of the economic crisis in Greece on health was more nuanced than previous reports suggest. Effective strategies to mitigate the adverse health impacts of economic crises need to be better understood and implemented.

  • Journal article
    Jawad M, Laverty AA, Millett C, 2017,

    Pokémon GO: are limited physical activity benefits undermined by McFlurries consumed?

    , BMJ, Vol: 356, ISSN: 0959-8138
  • Journal article
    Seferidi P, Millett C, Laverty AA, 2017,

    Sweetened beverage intake in association to energy and sugar consumption and cardiometabolic markers in children

    , Pediatric Obesity, Vol: 13, Pages: 1-9, ISSN: 2047-6310

    BackgroundArtificially sweetened beverages (ASBs) are promoted as healthy alternatives to sugar‐sweetened beverages (SSBs) in order to reduce sugar intake, but their effects on weight control and glycaemia have been debated. This study examines associations of SSBs and ASBs with energy and sugar intake and cardiometabolic measures.MethodsOne thousand six hundred eighty‐seven children aged 4–18 participated in the National Diet and Nutrition Survey Rolling Programme (2008/9–2011/12) in the UK. Linear regression was used to examine associations between SSBs and ASBs and energy and sugar, overall and from solid foods and beverages, and body mass index, waist‐to‐hip ratio and blood analytes. Fixed effects linear regression examined within‐person associations with energy and sugar.ResultsCompared with non‐consumption, SSB consumption was associated with higher sugar intake overall (6.1%; 4.2, 8.1) and ASB consumption with higher sugar intake from solid foods (1.7%; 0.5, 2.9) but not overall, mainly among boys. On SSB consumption days, energy and sugar intakes were higher (216 kcal; 163, 269 and 7.0%; 6.2, 7.8), and on ASB consumption days, sugar intake was lower (−1.0%; −1.8, −0.1) compared with those on non‐consumption days. SSB and ASB intakes were associated with higher levels of blood glucose (SSB: 0.30 mmol L−1; 0.11, 0.49 and ASB: 0.24 mmol L−1; 0.06, 0.43) and SSB intake with higher triglycerides (0.29 mmol L−1; 0.13, 0.46). No associations were found with other outcomes.ConclusionSugar‐sweetened beverage intake was associated with higher sugar intake and both SSBs and ASBs with a less healthy cardiometabolic profile. These findings add to evidence that health policy should discourage all sweetened beverage consumption.

  • Journal article
    Hone T, Lee JT, Majeed A, Conteh L, Millett C, Hone T, Lee JT, Majeed FA, Conteh L, Millett Cet al., 2017,

    Does charging different user fees for primary and secondary care affect first-contacts with primary healthcare? A systematic review.

    , Health Policy and Planning, Vol: 32, Pages: 723-731, ISSN: 1460-2237

    Policy-makers are increasingly considering charging users different fees between primary and secondary care (differential user charges) to encourage utilisation of primary health care in health systems with limited gate keeping. A systematic review was conducted to evaluate the impact of introducing differential user charges on service utilisation. We reviewed studies published in MEDLINE, EMBASE, the Cochrane library, EconLIT, HMIC, and WHO library databases from January 1990 until June 2015. We extracted data from the studies meeting defined eligibility criteria and assessed study quality using an established checklist. We synthesized evidence narratively. Eight studies from six countries met our eligibility criteria. The overall study quality was low, with diversity in populations, interventions, settings, and methods. Five studies examined the introduction of or increase in user charges for secondary care, with four showing decreased secondary care utilisation, and three showing increased primary care utilisation. One study identified an increase in primary care utilisation after primary care user charges were reduced. The introduction of a non-referral charge in secondary care was associated with lower primary care utilisation in one study. One study compared user charges across insurance plans, associating higher charges in secondary care with higher utilisation in both primary and secondary care. Overall, the impact of introducing differential user-charges on primary care utilisation remains uncertain. Further research is required to understand their impact as a demand side intervention, including implications for health system costs and on utilisation among low-income patients.

  • Journal article
    Lee JT, Lawson KD, Wan Y, Majeed A, Morris S, Soljak M, Millett Cet al., 2017,

    Are cardiovascular disease risk assessment and management programmes cost effective? A systematic review of the evidence

    , PREVENTIVE MEDICINE, Vol: 99, Pages: 49-57, ISSN: 0091-7435
  • Journal article
    Zahid R, Dogar O, Mansoor S, Khan A, Kanaan M, Jawad M, Ahluwalia JS, Siddiqi Ket al., 2017,

    The efficacy of varenicline in achieving abstinence among waterpipe tobacco smokers - study protocol for a randomized controlled trial

    , Trials, Vol: 18, ISSN: 1745-6215

    Background:Waterpipe tobacco smoking has increased among youth across the globe including in the US, and it continues as a common and traditional form of smoking tobacco in Pakistan. A range of behavioral and pharmacological therapies are available to support people in quitting cigarette smoking; however, little evidence exists for the efficacy of these therapies in achieving abstinence among waterpipe tobacco smokers. The objective of this study is to assess the efficacy of varenicline when added to behavioral support for waterpipe tobacco smoking cessation, by measuring biochemically validated continuous abstinence in waterpipe tobacco smokers.Methods/design:This is a two-arm, double-blind, placebo-controlled randomized trial conducted in four districts in Punjab, Pakistan. Study participants include adults using a waterpipe (with or without concomitant cigarette, bidi or other forms of tobacco smoking) on a daily basis for at least 6 months and who are willing to quit. We will individually randomize 510 participants to one of the two arms of the trial. Participants in the intervention arm will receive varenicline and behavioral support and those in the control arm will receive placebo and behavioral support. The primary outcome will be continuous abstinence for at least 6 months (week 25) which is biochemically verified by a carbon monoxide level of <10 ppm. Secondary outcomes will include biochemically verified 7-day point abstinence at 5, 12 and 25 weeks and any lapses and relapses between the different assessment points. Tertiary outcomes will include assessment of withdrawal symptoms using the Mood and Physical Symptoms Scale (MPSS), smoking dependency using the Lebanon Waterpipe Dependency Scale (LWDS-11) and monitoring adverse outcomes.Discussion:This is an efficacy trial and would require a subsequent effectiveness trial for a definitive evaluation of the intervention.

  • Journal article
    Borges MC, Louzada ML, de Sá TH, Laverty AA, Parra DC, Garzillo JM, Monteiro CA, Millett Cet al., 2017,

    Artificially sweetened beverages and the response to the global obesity crisis

    , Plos Medicine, Vol: 14, ISSN: 1549-1676

    In March 2015, the World Health Organization (WHO) published revised guidelines onsugar intake that call on national governments to institute policies to reduce sugarintake and increase the scope for regulation of sugar-sweetened beverages (SSBs).• In face of the growing threat of regulatory action on SSBs, transnational beverage companiesare responding in multiple ways, including investing in the formulation and salesof artificially sweetened beverages (ASBs), promoted as healthier alternatives to SSBs.• The absence of consistent evidence to support the role of ASBs in preventing weightgain and the lack of studies on other long-term effects on health strengthen the positionthat ASBs should not be promoted as part of a healthy diet.• The promotion of ASBs must be discussed in a broader context of the additional potentialimpacts on health and the environment. In addition, a more robust evidence base,free of conflicts of interest, is needed.

  • Journal article
    Hone T, Rasella D, Barreto M, Atun R, Majeed A, Millett Cet al., 2017,

    Large reductions In amenable mortality associated with Brazil's primary care expansion and strong health governance

    , Health Affairs, Vol: 36, Pages: 149-158, ISSN: 0278-2715

    Strong health governance is key to universal health coverage. However, the relationship between governance and health system performance is underexplored. We investigated whether expansion of the Brazilian Estratégia de Saúde da Família (ESF; family health strategy), a community-based primary care program, reduced amenable mortality (mortality avoidable with timely and effective health care) and whether this association varied by municipal health governance. Fixed-effects longitudinal regression models were used to identify the relationship between ESF coverage and amenable mortality rates in 1,622 municipalities in Brazil over the period 2000-12. Municipal health governance was measured using indicators from a public administration survey, and the resulting scores were used in interactions. Overall, increasing ESF coverage from 0 percent to 100 percent was associated with a reduction of 6.8 percent in rates of amenable mortality, compared with no increase in ESF coverage. The reductions were 11.0 percent for municipalities with the highest governance scores and 4.3 percent for those with the lowest scores. These findings suggest that strengthening local health governance may be vital for improving health services effectiveness and health outcomes in decentralized health systems.

  • Journal article
    Filippidis F, Gerovasili V, Man W, Quint JKet al., 2016,

    Trends in mortality from respiratory system diseases in Greece during the financial crisis

    , European Respiratory Journal, Vol: 48, Pages: 1487-1489, ISSN: 1399-3003
  • Journal article
    Hone T, Palladino R, Filippidis FT, 2016,

    Association of searching for health-related information online with self-rated health in the European Union.

    , Eur J Public Health, Vol: 26, Pages: 748-753

    BACKGROUND: The Internet is widely accessed for health information, but poor quality information may lead to health-worsening behaviours (e.g. non-compliance). Little is known about the health of individuals who use the Internet for health information. METHODS: Using the Flash Eurobarometer survey 404, European Union (EU) citizens aged ≥15 (n = 26 566) were asked about Internet utilisation for health information ('general' or 'disease-specific'), the sources used, self-rated health, and socioeconomic variables. Multivariable logistic regression was employed to assess the likelihood of bad self-rated health and accessing different health information sources (social networks, official website, online newspaper, dedicated websites, search engines). RESULTS: Those searching for general information were less likely to report bad health [odds ratios (OR) = 0.80; 95% confidence intervals (CI): 0.70-0.92], whilst those searching for disease-specific information were more likely (OR = 1.22; 95% CI: 1.07-1.38). Higher education and frequent doctor visits were associated with use of official websites and dedicated apps for health. Variation between EU member states in the proportion of people who had searched for general or disease-specific information online was high. CONCLUSIONS: Searching for general health information may be more conducive to better health, as it is easier to understand, and those accessing it may already be or looking to lead healthier lives. Disease-specific information may be harder to understand and assimilate into appropriate care worsening self-rated health. It may also be accessed if health services fail to meet individuals' needs, and health status is currently poor. Ensuring individuals' access to quality health services and health information will be key to addressing inequalities in health.

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