Causes of death among children aged 5-14 years in the WHO European Region: a systematic analysis for the Global Burden of Disease Study 2016.

BACKGROUND: The mortality burden in children aged 5-14 years in the WHO European Region has not been comprehensively studied. We assessed the distribution and trends of the main causes of death among children aged 5-9 years and 10-14 years from 1990 to 2016, for 51 countries in the WHO European Region. METHODS: We used data from vital registration systems, cancer registries, and police records from 1980 to 2016 to estimate cause-specific mortality using the Cause of Death Ensemble model. FINDINGS: For children aged 5-9 years, all-cause mortality rates (per 100 000 population) were estimated to be 46·3 (95% uncertainty interval [UI] 45·1-47·5) in 1990 and 19·5 (18·1-20·9) in 2016, reflecting a 58·0% (54·7-61·1) decline. For children aged 10-14 years, all-cause mortality rates (per 100 000 population) were 37·9 (37·3-38·6) in 1990 and 20·1 (18·8-21·3) in 2016, reflecting a 47·1% (43·8-50·4) decline. In 2016, we estimated 10 740 deaths (95% UI 9970-11 542) in children aged 5-9 years and 10 279 deaths (9652-10 897) in those aged 10-14 years in the WHO European Region. Injuries (road injuries, drowning, and other injuries) caused 4163 deaths (3820-4540; 38·7% of total deaths) in children aged 5-9 years and 4468 deaths (4162-4812; 43·5% of total) in those aged 10-14 years in 2016. Neoplasms caused 2161 deaths (1872-2406; 20·1% of total deaths) in children aged 5-9 years and 1943 deaths (1749-2101; 18·9% of total deaths) in those aged 10-14 years in 2016. Notable differences existed in cause-specific mortality rates between the European subregions, from a two-times difference for leukaemia to a 20-times difference for lower respiratory infections between the Commonwealth of Independent States (CIS) and EU15 (the 15 member states that had joined the European Union before May, 2004). INTERPRETATION: Marked progress has been made in reducing the mortality burden in children aged 5-14 years over the past 26 years in the WHO European Region. More deaths could be prevented, especially in CIS countries, through intervention and prevention efforts focusing on the leading causes of death, which are road injuries, drowning, and lower respiratory infections. The findings of our study could be used as a baseline to assess the effect of implementation of programmes and policies on child mortality burden. FUNDING: WHO and Bill & Melinda Gates Foundation.

Systematic review of foodborne burden of disease studies: quality assessment of data and methodology.

Burden of disease (BoD) studies aim to identify the public health impact of different health problems and risk factors. To assess BoD, detailed knowledge is needed on epidemiology, disability and mortality in the population under study. This is particularly challenging for foodborne disease, because of the multitude of causative agents and their health effects. The purpose of this study is to systematically review the methodology of foodborne BoD studies. Three key questions were addressed: 1) which data sources and approaches were used to assess mortality, morbidity and disability?, 2) which methodological choices were made to calculate Disability Adjusted Life Years (DALY), and 3) were uncertainty analyses performed and if so, how? Studies (1990-June 2012) in international peer-reviewed journals and grey literature were identified with main inclusion criteria being that the study assessed disability adjusted life years related to foodborne disease. Twenty-four studies met our inclusion criteria. To assess incidence or prevalence of foodborne disease in the population, four approaches could be distinguished, each using a different data source as a starting point, namely 1) laboratory-confirmed cases, 2) cohort or cross-sectional data, 3) syndrome surveillance data and 4) exposure data. Considerable variation existed in BoD methodology (e.g. disability weights, discounting, age-weighting). Almost all studies analyzed the effect of uncertainty as a result of possible imprecision in the parameter values. Awareness of epidemiological and methodological rigor between foodborne BoD studies using the DALY approach is a critical priority for advancing burden of disease studies. Harmonization of methodology that is used and of modeling techniques and high quality data can enlarge the detection of real variation in DALY outcomes between pathogens, between populations or over time. This harmonization can be achieved by identifying substantial data gaps and uncertainty and establish which sequelae of foodborne disease agents should be included in BoD calculations.

Early life factors and type 2 diabetes in south India: Do the associations change with age?

BACKGROUND: Studies since the early 1990s have shown that birth size can be a predictor of the development of Type 2 diabetes mellitus (T2DM). In the present study, we evaluated changes in the strength of associations between T2DM and birth size and maternal weight with age. METHODS: In 1993-1994 (t0), 509 men and women (mean age 46 years) who had been born in Holdsworth Memorial Hospital were screened for diabetes, with increased diabetes risk identified in those who were shorter at birth and those born to heavier mothers. Ten years later (t10), the screening was repeated in 266 subjects who were non-diabetic at t0 (70% of survivors). RESULTS: At t10, 56 new cases of diabetes were found. The incidence of diabetes decreased with increasing birth length (odds ratio (OR) = 0.90, 95% confidence interval (CI) 0.84-0.97/cm birth length; P = 0.006) after adjustment for sex, age, socioeconomic status, family history, and current body mass index. Overall, there were no significant differences in OR for the association between birth length and diabetes at t0 compared with t10, but limiting analysis to subjects with normal glucose tolerance at t0 resulted in a stronger association at t10 (OR = 0.71, 95% CI 0.58-0.87) than at t0 (OR = 0.95, 95% CI 0.86-1.05; P = 0.015 for the difference). There was a positive correlation between maternal weight and incident disease at t0 (OR = 1.08, 95% CI 1.03-1.14; P = 0.001), but not at t10 (OR = 0.98/kg, 95% CI 0.92-1.05; P = 0.6; P = 0.02 for the difference). CONCLUSIONS: Short birth length remains a risk factor for diabetes. Changes in the effects of birth length and maternal weight on diabetes risk with age may indicate different causal pathways. These findings require replication in studies with more accurate dating of the onset of diabetes.

The global mortality of infectious and parasitic diseases in children.

Although considerable advances in the reduction of global child morbidity and mortality have been made since 1970, when more than 17 million children died, the burden of child mortality is still intolerably high today. An estimated 10.5 million younger than the age of 5 years died in the year 2002 from largely preventable diseases, such as those having infectious, parasitic, and perinatal causes. The reductions in rates of mortality observed did not take place uniformly across time and regions of the world, but the success stories in developing countries demonstrate clearly that low mortality levels are achievable in those settings. If the whole world came to share the current child mortality experience of Northern European countries, more than 10 million deaths of children could be prevented each year. This work aims to answer the questions concerning where and why so many of the world's children still succumb to largely preventable causes.

The global burden of measles in the year 2000--a model that uses country-specific indicators.

The estimation of the global burden of measles is challenging in the absence of reliable and comparable surveillance systems worldwide. A static model is described that enables estimation of measles morbidity, mortality, and disability for the year 2000 on the basis of country-specific information (i.e., demographic profile, vaccine coverage, and estimates of case-fatality ratios). This approach estimated a global incidence of 39.9 million measles cases, 777,000 deaths, and 28 million disability-adjusted life years. The World Health Organization regions of Africa and Southeast Asia had 70% of incident cases and 84% of measles-related deaths; 11 countries alone (Afghanistan, Burkina Faso, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Niger, Nigeria, Pakistan, Somalia, Uganda) account for 66% of deaths. This approach quantifies the measles burden by considering country-specific indicators, which can be updated, permitting an assessment of country, regional, and global changes in the burden associated with measles infection.

Cortisol and the metabolic syndrome in South Asians.

OBJECTIVE: The cardiovascular risk factors which comprise the metabolic syndrome are associated with increased hypothalamic-pituitary-adrenal axis (HPAA) activity in some Caucasian populations. South Asians have high rates of cardiovascular disease and its risk factors. We have investigated the relationships between HPAA activity, adiposity and the metabolic syndrome in a South Asian population. DESIGN: Cross-sectional cohort study. PARTICIPANTS: A total of 509 men and women born at the Holdsworth Memorial Hospital, Mysore, South India between 1934 and 1954 and still living in the area. MEASUREMENTS: Fasting 09.00 h cortisol and corticosteroid-binding globulin. The cohort had previously been investigated for features of the metabolic syndrome. RESULTS: At 09.00 h, cortisol concentration was strongly associated with systolic and diastolic blood pressure (r = 0.25 and r = 0.24, respectively; P < 0.001), fasting glucose concentration (r = 0.26; P < 0.001), insulin resistance (r = 0.20; P < 0.001) and fasting triglyceride concentration (r = 0.17; P < 0.001). In general, higher cortisol concentrations added to the effect of adiposity in increasing cardiovascular risk factors, but there was evidence of an interaction between cortisol and adiposity in determining fasting glucose concentration (P = 0.045) and insulin resistance (P = 0.006). CONCLUSIONS: Associations between 09.00 h cortisol concentration and cardiovascular risk factors in this South Asian cohort were stronger than those previously shown in Caucasian populations, despite similar mean cortisol concentrations, and were amplified by adiposity. This suggests that increased glucocorticoid action may contribute to ethnic differences in the prevalence of the metabolic syndrome, particularly among men and women with a higher body mass index.

Left ventricular mass and arterial compliance: relation to coronary heart disease and its risk factors in South Indian adults.

BACKGROUND: Rates of coronary heart disease (CHD) in India are rising, and are now similar to those in Western countries. The prevalence of conventional CHD risk factors such as hypercholesterolaemia, hypertension, smoking and obesity, tend to be lower in Indian than Western populations, and fail to explain these high rates of disease. Increased left ventricular (LV) mass and decreased arterial compliance predict a higher risk of CHD in Western populations, but there are no published data from India. We have measured LV mass and arterial compliance, and examined their relation to CHD and other known risk factors, in men and women living in Mysore, South India. METHODS: We examined 435 men and women born in Mysore during 1934-1953. LV mass was measured by echocardiography and arterial compliance (derived from pulse wave velocity, PWV) was measured by a non-invasive optical method in three arterial segments. RESULTS: The mean LV mass was 149 g (S.D. 37) in men and 125 g (S.D. 32) in women. The mean PWV was 4.14 m/s in the aorto-radial, 3.28 m/s in the aorto-femoral and 13.59 m/s in the femoro-popliteal-posterior tibial segments. LV mass and PWV were positively correlated with each other and with systolic and diastolic blood pressures, non-insulin dependant diabetes mellitus, fasting plasma glucose, insulin, proinsulin concentrations and serum triglyceride concentrations (p<0.05 for all), independently of age, sex and body size. In addition, LV mass correlated negatively with fasting serum HDL-cholesterol (p=0.02). Higher LV mass was associated with an increased risk of CHD (p=0.05). CONCLUSIONS: The mean LV mass in this Indian population is low compared with Western populations, though as in the West, increased LV mass is associated with an increased risk of CHD. Greater LV mass and reduced arterial compliance are associated with higher levels of many known CHD risk factors especially with those which form the Insulin Resistance Syndrome.