Age, gender and socioeconomic patterns of awareness and usage of e-cigarettes across selected WHO region countries: evidence from the Global Adult Tobacco Survey.

OBJECTIVES: The study explores the awareness and e-cigarette use by demographic and socio-economic characteristics of selected 14 Global Adult Tobacco Survey (GATS) countries. DESIGN: Cross-sectional. SETTING: 14 countries. PARTICIPANTS: Surveyed population ≥15 years selected through multi-stage cluster sampling. PRIMARY AND SECONDARY OUTCOME MEASURES: We selected 14 countries from 6 different WHO regions where GATS was conducted in different years during 2011-2017. RESULTS: Awareness and usage of e-cigarette were highest in Greece and lowest in India. Females were less aware of e-cigarette across ages. The gender gap in awareness is wide in Greece post 50 years of age, while the gap is distinct in early ages in Kazakhstan and Qatar. The gender difference in use of e-cigarette was negligible in most of the countries except among the younger cohorts of Russia, Philippines Malaysia and Indonesia. Relatively higher prevalence of e-cigarette smoking among females in the older adult age was observed in some of the Asian countries like India. Multivariate analysis indicates that those who were younger, male, residing in urban areas, current tobacco smokers were more likely to use e-cigarette than their counterparts. Though prevalence of e-cigarette use increased with wealth and education, such pattern is not strong and consistent. Promotional advertisement plays important role in higher use of e-cigaratte. The predicted national prevalence of e-ciragette use was highest in Malaysia . CONCLUSIONS: E-cigarette use is more among urban adults, current smokers, males and in countries with promotional advertisement of e-cigarette. Area specific interventions are needed to understand the nature of e-cigarette use. Russia, Ukraine, Costa Rica and Mexico need better understanding to explore whether e-cigaratte use is an indulgence to new mode of addiction, as youth being highly likely to adopt this practice.

Spatial heterogeneity of internal migration in China: The role of economic, social and environmental characteristics.

The purpose of this paper is to explore the spatial heterogeneity of internal migration in China and to discuss the influence of economic, social and environmental characteristics on this demographic process. The overall results suggest that migration in China occurred from inland to coastal areas and from rural areas to urban areas. By stepwise regression, we identified that 9 out of 15 factors with potential influence on internal migration were retained, and the multicollinearity among them was reduced. In addition, we used the OLS and GWR regression analysis to discuss the global and local effects of relevant factors on internal migration. Economic scale (GDP), population concentration (population density) and demographic dividend (labour force proportion) were the three main driving forces of internal migration. In turn, internal migration further widened the gap of economic scale, population agglomeration and demographic dividend between counties and cities. Internal migration in southern coastal areas of China was most affected by economic aspects and demographic dividend. In the central China, the population was more concentrated in high-density cities, while in the eastern regions, areas with high level of education were conducive to immigration, thus forming talent reserve highlands. In the west, areas with highly educated level faced out-migration, which might cause brain drain and widen further the gap in talent reserves between the east and the west in China. From the perspective of location, the net immigration of the provincial capital was accompanied by the net immigration of the surrounding area, which was conducive to the formation of city clusters or urban sprawl. On the other side, the net immigration in prefecture-level cities often meant the net out-migration in surrounding areas. The correlation is particularly strong in eastern coastal provinces.

Spatial analysis of cardiovascular mortality and associated factors around the world.

BACKGROUND: Cardiovascular disease (CVD) is one of the most serious health issues and the leading cause of death worldwide in both developed and developing countries. The risk factors for CVD include demographic, socioeconomic, behavioral, environmental, and physiological factors. However, the spatial distribution of these risk factors, as well as CVD mortality, are not uniformly distributed across countries. Therefore, the goal of this study is to compare and evaluate some models commonly used in mortality and health studies to investigate whether the CVD mortality rates in the adult population (over 30 years of age) of a country are associated with the characteristics of surrounding countries from 2013 to 2017. METHODS: We present the spatial distribution of the age-standardized crude mortality rate from cardiovascular disease, as well as conduct an exploratory data analysis (EDA) to obtain a basic understanding of the behavior of the variables of interest. Then, we apply the ordinary least squares (OLS) to the country level dataset. As OLS does not take into account the spatial dependence of the data, we apply two spatial modelling techniques, that is, spatial lag and spatial error models. RESULTS: Our empirical findings show that the relationship between CVD and income, as well as other socioeconomic variables, are important. In addition, we highlight the importance of understanding how changes in individual behavior across different countries might affect future trends in CVD mortality, especially related to smoking and dietary behaviors. CONCLUSIONS: We argue that this study provides useful clues for policymakers establishing effective public health planning and measures for the prevention of deaths from cardiovascular disease. The reduction of CVD mortality can positively impact GDP growth because increasing life expectancy enables people to contribute to the economy of the country and its regions for longer.

Regional Distribution of Causes of Death for Small Areas in Brazil, 1998-2017.

Background: What is the spatial pattern of mortality by cause and sex in Brazil? Even considering the main causes of death, such as neoplasms, cardiovascular diseases, external causes, respiratory diseases, and infectious diseases, there are still important debate regarding the spatial pattern of mortality by causes in Brazil. Evidence shows that there is an overlap in transitional health states, due to the persistence of infectious diseases (e.g., dengue, cholera, malaria, etc.,) in parallel with the increase in chronic degenerative diseases. The main objective of this paper is to analyze the spatio-temporal evolution of three groups of causes of death in Brazil across small areas from 1998 to 2017, by sex. Methods: We use publicly available data from the System Data Mortality Information (SIM-DATASUS) from 1998 to 2017. We focus on this period due to the better quality of information, in addition to all deaths are registered following the Tenth Revision of the International Classification of Diseases (ICD-10). We estimate standardized mortality rates by sex and cause aggregated into three main groups. We use a ternary color scheme to maximize all the information in a three-dimensional array of compositional data. Results: We find improvements in mortality from chronic degenerative diseases; faster declines are observed in the Southern regions of the country; but the persistence of high levels of mortality due to infectious diseases remained in the northern parts of the country. We also find impressive differences in external causes of deaths between males and females and an increase in mortality from these causes in the interior part of the country. Conclusions: This study provides useful information for policy makers in establishing effective measures for the prevention of deaths and public health planning for deaths from external and non-communicable causes. We observed how the distribution of causes of death varies across regions and how the patterns of mortality also vary by gender.

Spatial pattern of COVID-19 deaths and infections in small areas of Brazil.

As of mid-August 2020, Brazil was the country with the second-highest number of cases and deaths by the COVID-19 pandemic, but with large regional and social differences. In this study, using data from the Brazilian Ministry of Health, we analyze the spatial patterns of infection and mortality from Covid-19 across small areas of Brazil. We apply spatial autoregressive Bayesian models and estimate the risks of infection and mortality, taking into account age, sex composition of the population and other variables that describe the health situation of the spatial units. We also perform a decomposition analysis to study how age composition impacts the differences in mortality and infection rates across regions. Our results indicate that death and infections are spatially distributed, forming clusters and hotspots, especially in the Northern Amazon, Northeast coast and Southeast of the country. The high mortality risk in the Southeast part of the country, where the major cities are located, can be explained by the high proportion of the elderly in the population. In the less developed areas of the North and Northeast, there are high rates of infection among young adults, people of lower socioeconomic status, and people without access to health care, resulting in more deaths.

Chronic respiratory disease mortality and its associated factors in selected Asian countries: evidence from panel error correction model.

BACKGROUND: Chronic Respiratory Diseases (CRDs) in Asian countries are a growing concern in terms of morbidity and mortality. However, a systematic understanding of the increasing age-adjusted mortality rate of chronic respiratory disease (CRD) and its associated factors is not readily available for many Asian countries. We aimed to determine country-level factors affecting CRD mortality using a panel error correction model. METHODS: Based on data from the Global Burden of Disease Study 2017, we estimated the trends and distribution of CRD mortality for selected Asian countries from 2010 to 2017. Furthermore, we evaluated the relationship between CRD mortality and Gross Domestic Product (GDP) per capita, average years of schooling, urbanization, and pollutant emission (PM2.5 concentration) using a fixed-effect model. We corrected the estimates for heteroscedasticity and autocorrelation through Prais-Winsten adjustment along with robust standard error. RESULTS: Between 2010 and 2017, approximately 21.4 million people died from chronic respiratory diseases in the countries studied. Age-standardized crude mortality rate from CRDs in the period had minimum and maximum values of 8.19 (Singapore in 2016) and 155.42 (North Korea in 2010) per 100,000 population, respectively. The coefficients corrected for autocorrelation and heteroskedasticity based on the final model of our study (Prais-Winsten), showed that all explanatory variables were statistically significant (p < 0.001). The model shows that the 1% increase in GDP per capita results in a 20% increase (0.203) in the CRD mortality rate and that a higher concentration of air pollution is also positively associated with the CRD deaths (0.00869). However, an extra year of schooling reduces the mortality rate by 4.79% (- 0.0479). Further, rate of urbanization is negatively associated with the CRD death rate (- 0.0252). CONCLUSIONS: Our results indicate that both socioeconomic and environmental factors impact CRD mortality rates. Mortality due to CRD increases with rising GDP per capita and decreases with the percentage of the total population residing in urban areas. Further, mortality increases with greater exposure to PM2.5. Also, higher years of schooling mitigate rising CRD mortality rates, showing that education can act as a safety net against CRD mortality. These results are an outcome of sequential adjustments in the final model specification to correct for heteroscedasticity and autocorrelation.

Association between Cardiovascular Mortality and Economic Development: A Spatio-Temporal Study for Prefectures in Japan.

In this paper, we use a bivariate choropleth map to investigate the relationship between mortality from cardiovascular disease (CVD) and gross domestic product (GDP) per capita, by sex, in Japanese prefectures from 1996 to 2015. The overall results show a decline in age-standardized CVD mortality rates in all prefectures, for both men and women, and suggest that GDP per capita has varied over the period. We also observed that the relationship between CVD mortality rates and GDP per capita at the prefecture level does not have an overall pattern of the same or inverse association, but is instead a heterogeneous relationship. We argue that this study provides useful clues to policy makers for establishing effective measures for public health planning and the prevention of deaths from CVD. As demonstrated by this study, mapping of the CVD burden in Japan helps to clarify regional differences in life expectancy and health status across regions and identify prefectures where more targeted policy attention may be needed.

Decomposition of mortality rates from cardiovascular disease in the adult population: a study for Brazilian micro-regions between 1996 and 2015 / Decomposição das taxas de mortalidade por doenças cardiovasculares na população adulta: um estudo para as microrregiões brasileiras entre 1996 e 2015 / Descomposición de las tasas de mortalidad por enfermedades cardiovasculares en la población adulta: un estudio para las microrregiones brasileñas entre 1996 y 2015

Cardiovascular disease (CVD) is one of the most serious health issues and the leading cause of death worldwide, causing 30% of deaths in Brazil alone in recent years. However, CVD mortality rates are not uniformly distributed across the country. Brazil is marked by important regional differences resulting from socioeconomic inequality and limited access to health services. Given the spatial distribution of causes and heterogeneity of deaths from cardiovascular disease in Brazil, both at macro and micro levels, the goal of this paper is to investigate how age composition effects and age-specific mortality rates are related to the observed difference in deaths from cardiovascular disease in the adult population (over 30 years of age), by sex, in Brazilian micro-regions from 1996 to 2015. The results suggest there has been a decrease in mortality rates resulting from cardiovascular disease, and that both the effects of age structure and level may have influenced the variation of these deaths in Brazil over the period analyzed. These findings indicate that the Brazilian epidemiological transition is not uniform across and within regions of the country.

As mortes por doenças cardiovasculares constituem um dos mais sérios problemas de saúde, pois representam a primeira causa de morte em todo o planeta, inclusive no Brasil (algo em torno de 30% nos últimos anos). Entretanto, a mortalidade devido a essa causa não se apresenta de maneira uniforme no território brasileiro, uma vez que o país ainda possui importantes disparidades regionais resultantes das desigualdades socioeconômicas e de acesso aos sistemas de saúde. Diante disso, o objetivo deste artigo é verificar como efeitos de idade e taxas podem explicar o diferencial observado de mortes por doenças cardiovasculares na população adulta, por sexo, nas microrregiões brasileiras, no período de 1996 a 2015. Para tanto, e após a correção dos sub-registro de óbitos, foi utilizada a técnica de decomposição. Os resultados sugerem que há uma diminuição nas taxas de mortes por doenças cardiovasculares e que tanto o efeito da estrutura etária como o do nível podem ter influenciado na variação destas mortes registradas no Brasil ao longo do período analisado. Estes achados indicam que a transição epidemiológica brasileira não é uniforme entre e mesmo dentro dos próprios estados e, consequentemente, o Brasil ainda tem um extenso percurso para caminhar.

El número de muertes por enfermedades cardiovasculares es uno de los más graves problemas de salud, ya que representan la principal causa de muerte en toda la Tierra, incluso en Brasil (alrededor del 30% en los últimos años). Sin embargo, la mortalidad por esta causa no se presenta de manera uniforme en el territorio brasilero, ya que el país todavía tiene importantes diferencias regionales que resultan de las desigualdades socioeconómicas y del acceso a los sistemas de salud. En este sentido, el propósito de este artículo es ver cómo los efectos de edad y tasas pueden explicar la diferencia que se observa entre muertes por enfermedades cardiovasculares en la población adulta por sexo en las microrregiones brasileñas en el período 1996-2015. Para ello, luego de la corrección del subregistro de muertes, se utilizó la técnica de descomposición. Los resultados sugieren una disminución en las tasas de muertes por enfermedades cardiovasculares, y que tanto el efecto de la estructura de edad como el nivel pueden haber influido en la variación de estas muertes registradas en Brasil durante el período de análisis. Estos hallazgos indican que la transición epidemiológica brasileña no es uniforme entre, e incluso dentro, de los propios estados y que, en consecuencia, Brasil aún tiene un largo camino por recorrer.