National, regional, and global estimates of anaemia by severity in women and children for 2000-19: a pooled analysis of population-representative data.

BACKGROUND: Anaemia causes health and economic harms. The prevalence of anaemia in women aged 15-49 years, by pregnancy status, is indicator 2.2.3 of the UN Sustainable Development Goals, and the aim of halving the anaemia prevalence in women of reproductive age by 2030 is an extension of the 2025 global nutrition targets endorsed by the World Health Assembly (WHA). We aimed to estimate the prevalence of anaemia by severity for children aged 6-59 months, non-pregnant women aged 15-49 years, and pregnant women aged 15-49 years in 197 countries and territories and globally for the period 2000-19. METHODS: For this pooled analysis of population-representative data, we collated 489 data sources on haemoglobin distribution in children and women from 133 countries, including 4·5 million haemoglobin measurements. Our data sources comprised health examination, nutrition, and household surveys, accessed as anonymised individual records or as summary statistics such as mean haemoglobin and anaemia prevalence. We used a Bayesian hierarchical mixture model to estimate haemoglobin distributions in each population and country-year. This model allowed for coherent estimation of mean haemoglobin and prevalence of anaemia by severity. FINDINGS: Globally, in 2019, 40% (95% uncertainty interval [UI] 36-44) of children aged 6-59 months were anaemic, compared to 48% (45-51) in 2000. Globally, the prevalence of anaemia in non-pregnant women aged 15-49 years changed little between 2000 and 2019, from 31% (95% UI 28-34) to 30% (27-33), while in pregnant women aged 15-49 years it decreased from 41% (39-43) to 36% (34-39). In 2019, the prevalence of anaemia in children aged 6-59 months exceeded 70% in 11 countries and exceeded 50% in all women aged 15-49 years in ten countries. Globally in all populations and in most countries and regions, the prevalence of mild anaemia changed little, while moderate and severe anaemia declined in most populations and geographical locations, indicating a shift towards mild anaemia. INTERPRETATION: Globally, regionally, and in nearly all countries, progress on anaemia in women aged 15-49 years is insufficient to meet the WHA global nutrition target to halve anaemia prevalence by 2030, and the prevalence of anaemia in children also remains high. A better understanding of the context-specific causes of anaemia and quality implementation of effective multisectoral actions to address these causes are needed. FUNDING: USAID, US Centers for Disease Control and Prevention, and Bill & Melinda Gates Foundation.

Life expectancy and risk of death in 6791 communities in England from 2002 to 2019: high-resolution spatiotemporal analysis of civil registration data.

BACKGROUND: High-resolution data for how mortality and longevity have changed in England, UK are scarce. We aimed to estimate trends from 2002 to 2019 in life expectancy and probabilities of death at different ages for all 6791 middle-layer super output areas (MSOAs) in England. METHODS: We performed a high-resolution spatiotemporal analysis of civil registration data from the UK Small Area Health Statistics Unit research database using de-identified data for all deaths in England from 2002 to 2019, with information on age, sex, and MSOA of residence, and population counts by age, sex, and MSOA. We used a Bayesian hierarchical model to obtain estimates of age-specific death rates by sharing information across age groups, MSOAs, and years. We used life table methods to calculate life expectancy at birth and probabilities of death in different ages by sex and MSOA. FINDINGS: In 2002-06 and 2006-10, all but a few (0-1%) MSOAs had a life expectancy increase for female and male sexes. In 2010-14, female life expectancy decreased in 351 (5·2%) of 6791 MSOAs. By 2014-19, the number of MSOAs with declining life expectancy was 1270 (18·7%) for women and 784 (11·5%) for men. The life expectancy increase from 2002 to 2019 was smaller in MSOAs where life expectancy had been lower in 2002 (mostly northern urban MSOAs), and larger in MSOAs where life expectancy had been higher in 2002 (mostly MSOAs in and around London). As a result of these trends, the gap between the first and 99th percentiles of MSOA life expectancy for women increased from 10·7 years (95% credible interval 10·4-10·9) in 2002 to reach 14·2 years (13·9-14·5) in 2019, and for men increased from 11·5 years (11·3-11·7) in 2002 to 13·6 years (13·4-13·9) in 2019. INTERPRETATION: In the decade before the COVID-19 pandemic, life expectancy declined in increasing numbers of communities in England. To ensure that this trend does not continue or worsen, there is a need for pro-equity economic and social policies, and greater investment in public health and health care throughout the entire country. FUNDING: Wellcome Trust, Imperial College London, Medical Research Council, Health Data Research UK, and National Institutes of Health Research.

Statistically-Estimated Tree Composition for the Northeastern United States at Euro-American Settlement.

We present a gridded 8 km-resolution data product of the estimated composition of tree taxa at the time of Euro-American settlement of the northeastern United States and the statistical methodology used to produce the product from trees recorded by land surveyors. Composition is defined as the proportion of stems larger than approximately 20 cm diameter at breast height for 22 tree taxa, generally at the genus level. The data come from settlement-era public survey records that are transcribed and then aggregated spatially, giving count data. The domain is divided into two regions, eastern (Maine to Ohio) and midwestern (Indiana to Minnesota). Public Land Survey point data in the midwestern region (ca. 0.8-km resolution) are aggregated to a regular 8 km grid, while data in the eastern region, from Town Proprietor Surveys, are aggregated at the township level in irregularly-shaped local administrative units. The product is based on a Bayesian statistical model fit to the count data that estimates composition on the 8 km grid across the entire domain. The statistical model is designed to handle data from both the regular grid and the irregularly-shaped townships and allows us to estimate composition at locations with no data and to smooth over noise caused by limited counts in locations with data. Critically, the model also allows us to quantify uncertainty in our composition estimates, making the product suitable for applications employing data assimilation. We expect this data product to be useful for understanding the state of vegetation in the northeastern United States prior to large-scale Euro-American settlement. In addition to specific regional questions, the data product can also serve as a baseline against which to investigate how forests and ecosystems change after intensive settlement. The data product is being made available at the NIS data portal as version 1.0.

The global cardiovascular risk transition: associations of four metabolic risk factors with national income, urbanization, and Western diet in 1980 and 2008.

BACKGROUND: It is commonly assumed that cardiovascular disease risk factors are associated with affluence and Westernization. We investigated the associations of body mass index (BMI), fasting plasma glucose, systolic blood pressure, and serum total cholesterol with national income, Western diet, and, for BMI, urbanization in 1980 and 2008. METHODS AND RESULTS: Country-level risk factor estimates for 199 countries between 1980 and 2008 were from a previous systematic analysis of population-based data. We analyzed the associations between risk factors and per capita national income, a measure of Western diet, and, for BMI, the percentage of the population living in urban areas. In 1980, there was a positive association between national income and population mean BMI, systolic blood pressure, and total cholesterol. By 2008, the slope of the association between national income and systolic blood pressure became negative for women and zero for men. Total cholesterol was associated with national income and Western diet in both 1980 and 2008. In 1980, BMI rose with national income and then flattened at ≈Int$7000; by 2008, the relationship resembled an inverted U for women, peaking at middle-income levels. BMI had a positive relationship with the percentage of urban population in both 1980 and 2008. Fasting plasma glucose had weaker associations with these country macro characteristics, but it was positively associated with BMI. CONCLUSIONS: The changing associations of metabolic risk factors with macroeconomic variables indicate that there will be a global pandemic of hyperglycemia and diabetes mellitus, together with high blood pressure in low-income countries, unless effective lifestyle and pharmacological interventions are implemented.

Assessment and statistical modeling of the relationship between remotely sensed aerosol optical depth and PM2.5 in the eastern United States.

Research in scientific, public health, and policy disciplines relating to the environment increasingly makes use of high-dimensional remote sensing and the output of numerical models in conjunction with traditional observations. Given the public health and resultant public policy implications of the potential health effects of particulate matter (PM*) air pollution, specifically fine PM with an aerodynamic diameter < or = 2.5 pm (PM2.5), there has been substantial recent interest in the use of remote-sensing information, in particular aerosol optical depth (AOD) retrieved from satellites, to help characterize variability in ground-level PM2.5 concentrations in space and time. While the United States and some other developed countries have extensive PM monitoring networks, gaps in data across space and time necessarily occur; the hope is that remote sensing can help fill these gaps. In this report, we are particularly interested in using remote-sensing data to inform estimates of spatial patterns in ambient PM2.5 concentrations at monthly and longer time scales for use in epidemiologic analyses. However, we also analyzed daily data to better disentangle spatial and temporal relationships. For AOD to be helpful, it needs to add information beyond that available from the monitoring network. For analyses of chronic health effects, it needs to add information about the concentrations of long-term average PM2.5; therefore, filling the spatial gaps is key. Much recent evidence has shown that AOD is correlated with PM2.5 in the eastern United States, but the use of AOD in exposure analysis for epidemiologic work has been rare, in part because discrepancies necessarily exist between satellite-retrieved estimates of AOD, which is an atmospheric-column average, and ground-level PM2.5. In this report, we summarize the results of a number of empirical analyses and of the development of statistical models for the use of proxy information, in particular satellite AOD, in predicting PM2.5 concentrations in the eastern United States. We analyzed the spatiotemporal structure of the relationship between PM2.5 and AOD, first using simple correlations both before and after calibration based on meteorology, as well as large-scale spatial and temporal calibration to account for discrepancies between AOD and PM2.5. We then used both raw and calibrated AOD retrievals in statistical models to predict PM2.5 concentrations, accounting for AOD in two ways: primarily as a separate data source contributing a second likelihood to a Bayesian statistical model, as well as a data source on which we could directly regress. Previous consideration of satellite AOD has largely focused on the National Aeronautics and Space Administration (NASA) moderate resolution imaging spectroradiometer (MODIS) and multiangle imaging spectroradiometer (MISR) instruments. One contribution of our work is more extensive consideration of AOD derived from the Geostationary Operational Environmental Satellite East Aerosol/Smoke Product (GOES GASP) AOD and its relationship with PM2.5. In addition to empirically assessing the spatiotemporal relationship between GASP AOD and PM2.5, we considered new statistical techniques to screen anomalous GOES reflectance measurements and account for background surface reflectance. In our statistical work, we developed a new model structure that allowed for more flexible modeling of the proxy discrepancy than previous statistical efforts have had, with a computationally efficient implementation. We also suggested a diagnostic for assessing the scales of the spatial relationship between the proxy and the spatial process of interest (e.g., PM2.5). In brief, we had little success in improving predictions in our eastern-United States domain for use in epidemiologic applications. We found positive correlations of AOD with PM2.5 over time, but less correlation for long-term averages over space, unless we used calibration that adjusted for large-scale discrepancy between AOD and PM2.5 (see sections 3, 4, and 5). Statistical models that combined AOD, PM2.5 observations, and land-use and meteorologic variables were highly predictive of PM2.5 observations held out of the modeling, but AOD added little information beyond that provided by the other sources (see sections 5 and 6). When we used PM2.5 data estimates from the Community Multiscale Air Quality model (CMAQ) as the proxy instead of using AOD, we similarly found little improvement in predicting held-out observations of PM2.5, but when we regressed on CMAQ PM2.5 estimates, the predictions improved moderately in some cases. These results appeared to be caused in part by the fact that large-scale spatial patterns in PM2.5 could be predicted well by smoothing the monitor values, while small-scale spatial patterns in AOD appeared to weakly reflect the variation in PM2.5 inferred from the observations. Using a statistical model that allowed for potential proxy discrepancy at both large and small spatial scales was an important component of our modeling. In particular, when our models did not include a component to account for small-scale discrepancy, predictive performance decreased substantially. Even long-term averages of MISR AOD, considered the best, albeit most sparse, of the AOD products, were only weakly correlated with measured PM2.5 (see section 4). This might have been partly related to the fact that our analysis did not account for spatial variation in the vertical profile of the aerosol. Furthermore, we found evidence that some of the correlation between raw AOD and PM2.5 might have been a function of surface brightness related to land use, rather than having been driven by the detection of aerosol in the AOD retrieval algorithms (see sections 4 and 7). Difficulties in estimating the background surface reflectance in the retrieval algorithms likely explain this finding. With regard to GOES, we found moderate correlations of GASP AOD and PM2.5. The higher correlations of monthly and yearly averages after calibration reflected primarily the improved large-scale correlation, a necessary result of the calibration procedure (see section 3). While the results of this study's GOES reflectance screening and surface reflection correction appeared sensible, correlations of our proposed reflectance-based proxy with PM2.5 were no better than GASP AOD correlations with PM2.5 (see section 7). We had difficulty improving spatial prediction of monthly and yearly average PM2.5 using AOD in the eastern United States, which we attribute to the spatial discrepancy between AOD and measured PM2.5, particularly at smaller scales. This points to the importance of paying attention to the discrepancy structure of proxy information, both from remote-sensing and deterministic models. In particular, important statistical challenges arise in accounting for the discrepancy, given the difficulty in the face of sparse observations of distinguishing the discrepancy from the component of the proxy that is informative about the process of interest. Associations between adverse health outcomes and large-scale variation in PM2.5 (e.g., across regions) may be confounded by unmeasured spatial variation in factors such as diet. Therefore, one important goal was to use AOD to improve predictions of PM2.5 for use in epidemiologic analyses at small-to-moderate spatial scales (within urban areas and within regions). In addition, large-scale PM2.5 variation is well estimated from the monitoring data, at least in the United States. We found little evidence that current AOD products are helpful for improving prediction at small-to-moderate scales in the eastern United States and believe more evidence for the reliability of AOD as a proxy at such scales is needed before making use of AOD for PM2.5 prediction in epidemiologic contexts. While our results relied in part on relatively complicated statistical models, which may be sensitive to modeling assumptions, our exploratory correlation analyses (see sections 3 and 5) and relatively simple regression-style modeling of MISR AOD (see section 4) were consistent with the more complicated modeling results. When assessing the usefulness of AOD in the context of studying chronic health effects, we believe efforts need to focus on disentangling the temporal from the spatial correlations of AOD and PM2.5 and on understanding the spatial scale of correlation and of the discrepancy structure. While our results are discouraging, it is important to note that we attempted to make use of smaller-scale spatial variation in AOD to distinguish spatial variations of relatively small magnitude in long-term concentrations of ambient PM2.5. Our efforts pushed the limits of current technology in a spatial domain with relatively low PM2.5 levels and limited spatial variability. AOD may hold more promise in areas with higher aerosol levels, as the AOD signal would be stronger there relative to the background surface reflectance. Furthermore, for developing countries with high aerosol levels, it is difficult to build statistical models based on PM2.5 measurements and land-use covariates, so AOD may add more incremental information in those contexts. More generally, researchers in remote sensing are involved in ongoing efforts to improve AOD products and develop new approaches to using AOD, such as calibration with model-estimated vertical profiles and the use of speciation information in MISR AOD; these efforts warrant continued investigation of the usefulness of remotely sensed AOD for public health research.

Particulate air pollution and socioeconomic position in rural and urban areas of the Northeastern United States.

OBJECTIVES: Although differential exposure by socioeconomic position (SEP) to hazardous waste and lead is well demonstrated, there is less evidence for particulate air pollution (PM), which is associated with risk of death and illness. This study determined the relationship of ambient PM and SEP across several spatial scales. METHODS: Geographic information system-based, spatio-temporal models were used to predict PM in the Northeastern United States. Predicted concentrations were related to census tract SEP and racial composition using generalized additive models. RESULTS: Lower SEP was associated with small, significant increases in PM. Annual PM(10) decreased between 0.09 and 0.93 micrograms per cubic meter and PM(2.5) between 0.02 and 0.94 micrograms per cubic meter for interquartile range increases in income. Decrements in PM with SEP increased with spatial scale, indicating that between-city spatial gradients were greater than within-city differences. The PM-SEP relation in urban tracts was not substantially modified by racial composition. CONCLUSIONS: Lower compared with higher SEP populations were exposed to higher ambient PM in the Northeastern United States. Given the small percentage change in annual PM(2.5) and PM(10), SEP was not likely a major source of confounding in epidemiological studies of PM, especially those conducted within a single urban/metropolitan area.