Health care expenses impact on the disability-adjusted life years in non-communicable diseases in the European Union.

Background: Non-communicable diseases are a global health problem. The metric Disability-Adjusted Life Years was developed to measure its impact on health systems. This metric makes it possible to understand a disease's burden, towards defining healthcare policies. This research analysed the effect of healthcare expenditures in the evolution of disability-adjusted life years for non-communicable diseases in the European Union between 2000 and 2019. Methods: Data were collected for all 27 European Union countries from Global Burden of Disease 2019, Global Health Expenditure, and EUROSTAT databases. Econometric panel data models were used to assess the impact of healthcare expenses on the disability-adjusted life years. Only models with a coefficient of determination equal to or higher than 10% were analysed. Results: There was a decrease in the non-communicable diseases with the highest disability-adjusted life years: cardiovascular diseases (-2,952 years/105 inhabitants) and neoplasms (-618 years/105 inhabitants). Health expenditure significantly decreased disability-adjusted life years for all analysed diseases (p < 0.01) unless for musculoskeletal disorders. Private health expenditure did not show a significant effect on neurological and musculoskeletal disorders (p > 0.05) whereas public health expenditure did not significantly influence skin and subcutaneous diseases (p > 0.05). Conclusion: Health expenditure have proved to be effective in the reduction of several diseases. However, some categories such as musculoskeletal and mental disorders must be a priority for health policies in the future since, despite their low mortality, they can present high morbidity and disability.

Assessing the relationship between multimorbidity, NCD configurations, frailty phenotypes, and mortality risk in older adults.

BACKGROUND: Older adults are increasingly susceptible to prolonged illness, multiple chronic diseases, and disabilities, which can lead to the coexistence of multimorbidity and frailty. Multimorbidity may result in various noncommunicable disease (NCD) patterns or configurations that could be associated with frailty and death. Mortality risk may vary depending on the presence of specific chronic diseases configurations or frailty. METHODS: The aim was to examine the impact of NCD configurations on mortality risk among older adults with distinct frailty phenotypes. The population was analyzed from the Costa Rican Longevity and Healthy Aging Study Cohort (CRELES). A total of 2,662 adults aged 60 or older were included and followed for 5 years. Exploratory factor analysis and various clustering techniques were utilized to identify NCD configurations. The frequency of NCD accumulation was also assessed for a multimorbidity definition. Frailty phenotypes were set according to Fried et al. criteria. Kaplan‒Meier survival analyses, mortality rates, and Cox proportional hazards models were estimated. RESULTS: Four different types of patterns were identified: 'Neuro-psychiatric', 'Metabolic', 'Cardiovascular', and 'Mixt' configurations. These configurations showed a higher mortality risk than the mere accumulation of NCDs [Cardiovascular HR:1.65 (1.07-2.57); 'Mixt' HR:1.49 (1.00-2.22); ≥3 NCDs HR:1.31 (1.09-1.58)]. Frailty exhibited a high and constant mortality risk, irrespective of the presence of any NCD configuration or multimorbidity definition. However, HRs decreased and lost statistical significance when phenotypes were considered in the Cox models [frailty + 'Cardiovascular' HR:1.56 (1.00-2.42); frailty + 'Mixt':1.42 (0.95-2.11); and frailty + ≥ 3 NCDs HR:1.23 (1.02-1.49)]. CONCLUSIONS: Frailty accompanying multimorbidity emerges as a more crucial indicator of mortality risk than multimorbidity alone. Therefore, studying NCD configurations is worthwhile as they may offer improved risk profiles for mortality as alternatives to straightforward counts.

Efecto de la igualdad de género en la mortalidad por enfermedades no transmisibles / Effect of gender equality on mortality from non-communicable diseases

Objetivo: Relacionar las desigualdades de género con la probabilidad de mortalidad por enfermedades no transmisibles (ENT) en los países del mundo desde 2000 hasta 2019, para detectar el progreso de la Meta 3.4 del Objetivo de Desarrollo Sostenible 3, de reducir en un tercio las ENT entre los 30 y los 70 años para 2030. Método: Estudio ecológico exploratorio sobre la asociación entre la probabilidad de fallecimiento por ENT y el índice de desigualdad de género (IDG) en el mundo en 2000, 2015 y 2019. Estimación mediante regresión logística del riesgo de no estar en proceso de cumplir la Meta 3.4 en 2019 según desigualdad de género. Resultados: La probabilidad media de fallecimiento por ENT descendió progresivamente en todos los países. Medianas 2000/2015/2019: mujeres 20,20/16,58/16; hombres 26,59/22,45/21,88; total 23,14/20,10/19,23. El riesgo de no estar logrando la meta en 2019 es mayor en los países con menor IDG que en los países con mayor IDG (OR: 2,13; IC95%: 1,14-3,99; p = 0,018), siendo el riesgo mayor en las mujeres (OR: 2,64; IC95%: 1,40-5,06; p = 0,003) que en los hombres (OR: 2,12; IC95%: 1,44-3,98; p = 0,017). Conclusiones: El riesgo de fallecimiento por ENT descendió en ambos sexos en todos los países del mundo desde el año 2000, pero el progreso es lento y, a mayor desigualdad de género en los países, mayor riesgo de no estar logrando el descenso necesitado para cumplir con el acuerdo de reducir un tercio la mortalidad por ENT en 2030, siendo este riesgo mayor en las mujeres que en los hombres.(AU)

Objective: Relate gender inequalities with the probability of mortality from non-communicable diseases (NCD), in the countries of the world from the year 2000 to 2019, to detect the progress of Target 3.4 of the Sustainable Development Goal 3, to reduce NCD by one third between the ages of 30 and 70 by 2030. Method: Exploratory ecological study on the association between the probability of death from NCD and the gender inequality index (GII) at the global level in 2000, 2015 and 2019. Logistic regression estimation of the risk of not being on track to meet Target 3.4 by 2019 by gender inequality. Results: The mean probability of death from NCD decreased progressively in all countries. Median 2000/2015/2019: women 20.20/16.58/16; men 26.59/22.45/21.88; total 23.14/20.10/19.23. The risk of not achieving the goal in 2019 is greater in countries with a lower GII than in countries with a higher GII (OR: 2.13; 95% CI: 1.14–3.99; p = 0.018), being the higher risk in women (OR: 2.64; 95% CI: 1.40–5.06; p = 0.003) than in men (OR: 2.12; 95% CI: 1.44–3.98; p = 0.017). Conclusions: The risk of deaths from NCD has decreased in both sexes in all countries of the world since the year 2000; but progress is slow, so the greater gender inequality in the countries, there is a greater risk of not achieving the reduction needed to comply with the agreement to reduce mortality from NCD by one third in 2030; this risk being greater in women than in men.(AU)

Mortalidade prematura por doenças crônicas não-transmissíveis / Premature mortality from non-communicable chronic diseases

As Doenças Crônicas Não Transmissíveis (DCNTs) têm origem não infecciosa e são compostas pelas doenças respiratórias crônicas (DRC), neoplasias malignas ou cânceres (CA), diabetes mellitus (DM) e doenças do aprelho respiratório (DAC). Em todo o mundo, essas doenças são responsáveis por 63% das mortes, correspondendo a 36 milhões de óbitos anualmente e dentre essas, 15 milhôes ocorrem prematuramente em indivíduos com menos de 70 anos de idade. Diante desse cenário, e na perspectiva de enfrentamento das DCNTs, foi instituído em 2011 o Plano de Ações Estratégicas (2011-2022) com meta a reduzir, anualmente, 2% da taxa de mortalidade prematura. Sendo assim, essa revisão traz uma análise dos indicadores estratégicos, comparando dados que comprovem se as metas foram alcançadas e as tendências futuras das DCNTs que compõe o indicador Taxa de mortalidade prematura

Chronic Noncommunicable Diseases (NCDs) have a non-infectious origin and are composed of chronic respiratory diseases (CKD), malignant neoplasms or cancers (CA), diabetes mellitus (DM) and diseases of the respiratory system (CAD). Worldwide, these diseases are responsible for 63% of deaths, corresponding to 36 million deaths annually and of these, 15 million occur prematurely in individuals under 70 years of age. Given this scenario, and with a view to tackling NCDs, the Strategic Action Plan (2011-2022) was established in 2011 with the goal of reducing the premature mortality rate by 2% annually. Therefore, this review provides an analysis of strategic indicators, comparing data that prove whether the goals were achieved and future trends in NCDs that make up the indicator Premature mortality rate

Causes of death among people who used illicit opioids in England, 2001-18: a matched cohort study.

BACKGROUND: In many countries, the average age of people who use illicit opioids, such as heroin, is increasing. This has been suggested to be a reason for increasing numbers of opioid-related deaths seen in surveillance data. We aimed to describe causes of death among people who use illicit opioids in England, how causes of death have changed over time, and how they change with age. METHODS: In this matched cohort study, we studied patients in the Clinical Practice Research Datalink with recorded illicit opioid use (defined as aged 18-64 years, with prescriptions or clinical observations that indicate use of illicit opioids) in England between Jan 1, 2001, and Oct 30, 2018. We also included a comparison group, matched (1:3) for age, sex, and general practice with no records of illicit opioid use before cohort entry. Dates and causes of death were obtained from the UK Office for National Statistics. The cohort exit date was the earliest of date of death or Oct 30, 2018. We described rates of death and calculated cause-specific standardised mortality ratios. We used Poisson regression to estimate associations between age, calendar year, and cause-specific death. FINDINGS: We collected data for 106 789 participants with a history of illicit opioid use, with a median follow-up of 8·7 years (IQR 4·3-13·5), and 320 367 matched controls with a median follow-up of 9·5 years (5·0-14·4). 13 209 (12·4%) of 106 789 participants in the exposed cohort had died, with a standardised mortality ratio of 7·72 (95% CI 7·47-7·97). The most common causes of death were drug poisoning (4375 [33·1%] of 13 209), liver disease (1272 [9·6%]), chronic obstructive pulmonary disease (COPD; 681 [5·2%]), and suicide (645 [4·9%]). Participants with a history of illicit opioid use had higher mortality rates than the comparison group for all causes of death analysed, with highest standardised mortality ratios being seen for viral hepatitis (103·5 [95% CI 61·7-242·6]), HIV (16·7 [9·5-34·9]), and COPD (14·8 [12·6-17·6]). In the exposed cohort, at age 20 years, the rate of fatal drug poisonings was 271 (95% CI 230-313) per 100 000 person-years, accounting for 59·9% of deaths at this age, whereas the mortality rate due to non-communicable diseases was 31 (16-45) per 100 000 person-years, accounting for 6·8% of deaths at this age. Deaths due to non-communicable diseases increased more rapidly with age (1155 [95% CI 880-1431] deaths per 100 000 person-years at age 50 years; accounting for 52·0% of deaths at this age) than did deaths due to drug poisoning (507 (95% CI 452-562) per 100 000 person-years at age 50 years; accounting for 22·8% of deaths at this age). Mirroring national surveillance data, the rate of fatal drug poisonings in the exposed cohort increased from 345 (95% CI 299-391) deaths per 100 000 person-years in 2010-12 to 534 (468-600) per 100 000 person-years in 2016-18; an increase of 55%, a trend that was not explained by ageing of participants. INTERPRETATION: People who use illicit opioids have excess risk of death across all major causes of death we analysed. Our findings suggest that population ageing is unlikely to explain the increasing number of fatal drug poisonings seen in surveillance data, but is associated with many more deaths due to non-communicable diseases. FUNDING: National Institute for Health Research.

Changes in Emergency Department Visits, Diagnostic Groups, and 28-Day Mortality Associated With the COVID-19 Pandemic: A Territory-Wide, Retrospective, Cohort Study.

STUDY OBJECTIVE: We aimed to evaluate and characterize the scale and relationships of emergency department (ED) visits and excess mortality associated with the early phase of the COVID-19 pandemic in the territory of Hong Kong. METHODS: We conducted a territory-wide, retrospective cohort study to compare ED visits and the related impact of the COVID-19 pandemic on mortality. All ED visits at 18 public acute hospitals in Hong Kong between January 1 and August 31 of 2019 (n=1,426,259) and 2020 (n=1,035,562) were included. The primary outcome was all-cause mortality in the 28 days following an ED visit. The secondary outcomes were weekly number of ED visits and diagnosis-specific mortality. RESULTS: ED visits decreased by 27.4%, from 1,426,259 in 2019 to 1,035,562 in 2020. Overall period mortality increased from 28,686 (2.0%) in 2019 to 29,737 (2.9%) in 2020. The adjusted odds ratio for 28-day, all-cause mortality in the pandemic period of 2020 relative to 2019 was 1.26 (95% confidence interval 1.24 to 1.28). Both sexes, age more than 45 years, all triage categories, all social classes, all ED visit periods, epilepsy (odds ratio 1.58, 95% confidence interval 1.20 to 2.07), lower respiratory tract infection, and airway disease had higher adjusted ORs for all-cause mortality. CONCLUSION: A significant reduction in ED visits in the first 8 months of the COVID-19 pandemic was associated with an increase in deaths certified in the ED. The government must make provisions to encourage patients with alarming symptoms, mental health conditions, and comorbidities to seek timely emergency care, regardless of the pandemic.

Valuing burden of premature mortality attributable to air pollution in major million-plus non-attainment cities of India.

Accelerating growth due to industrialization and urbanization has improved the Indian economy but simultaneously has deteriorated human health, environment, and ecosystem. In the present study, the associated health risk mortality (age > 25) and welfare loss for the year 2017 due to excess PM2.5 concentration in ambient air for 31 major million-plus non-attainment cities (NACs) in India is assessed. The cities for the assessment are prioritised based on population and are classified as 'X' (> 5 million population) and 'Y' (1-5 million population) class cities. Ground-level PM2.5 concentration retrieved from air quality monitoring stations for the NACs ranged from 33 to 194 µg/m3. Total PM2.5 attributable premature mortality cases estimated using global exposure mortality model was 80,447 [95% CI 70,094-89,581]. Ischemic health disease was the leading cause of death accounting for 47% of total mortality, followed by chronic obstructive pulmonary disease (COPD-17%), stroke (14.7%), lower respiratory infection (LRI-9.9%) and lung cancer (LC-1.9%). 9.3% of total mortality is due to other non-communicable diseases (NCD-others). 7.3-18.4% of total premature mortality for the NACs is attributed to excess PM2.5 exposure. The total economic loss of 90,185.6 [95% CI 88,016.4-92,411] million US$ (as of 2017) was assessed due to PM2.5 mortality using the value of statistical life approach. The highest mortality (economic burden) share of 61.3% (72.7%) and 30.1% (42.7%) was reported for 'X' class cities and North India zone respectively. Compared to the base year 2017, an improvement of 1.01% and 0.7% is observed in premature mortality and economic loss respectively for the year 2024 as a result of policy intervention through National Clean Air Action Programme. The improvement among 31 NACs was found inconsistent, which may be due to a uniform targeted policy, which neglects other socio-economic factors such as population, the standard of living, etc. The study highlights the need for these parameters to be incorporated in the action plans to bring in a tailored solution for each NACs for better applicability and improved results of the programme facilitating solutions for the complex problem of air pollution in India.

Factores de riesgo cardiovascular para infarto agudo de miocardio en San Cristóbal / Cardiovascular Risk Factors for Acute Myocardial Infarction in San Cristóbal Municipality

Introducción: Las enfermedades no trasmisibles constituyen las primeras causas de muerte en Cuba. Dentro de estas, las enfermedades del corazón son un problema de salud a escala mundial Objetivo: Identificar los principales factores de riesgo cardiovascular para infarto agudo de miocardio en la población entre 40 a 60 años. Métodos: Se realizó una investigación descriptiva de tipo observacional, de corte transversal en el Consultorio Médico de Familia número 35, del Consejo Popular Ciro Redondo; Policlínico Camilo Cienfuegosˮ, San Cristóbal, Artemisa. El universo de estudio estuvo conformado por 145 pacientes con edades entre 40 y 60 años, residentes de la comunidad rural. La muestra la conformaron aquellos que cumplieron los criterios de inclusión y las variables seleccionadas para el estudio se recogieron de la historia clínica individual y familiar, en entrevista directa realizada al paciente para dar salida a los objetivos proyectados. Los datos obtenidos se llevaron a tablas de contingencia y fueron evaluados mediante tasas y razones de valoración porcentual acorde a la asociación las variables. Resultados: Predominó el grupo de edad de 50 a 60 años y, muy discretamente, el sexo masculino y el color de piel blanca. El riesgo cardiovascular bajo se comportó de igual manera en ambos sexos. El comportamiento de los factores de riesgos modificables estuvo a favor de los malos hábitos alimentarios, existió vínculo entre la intensidad del riesgo cardiovascular y la prevalencia del infarto del miocardio(AU)

Introduction: Noncommunicable diseases are the leading causes of death in Cuba. Among these, heart disease is a global health concern Objective: To identify the main cardiovascular risk factors for acute myocardial infarction in the population between aged 40-60 years. Methods: A descriptive, observational and cross-sectional research was carried out in the family medical office # 35 from Ciro Redondo neighborhood, belonging to Camilo Cienfuegos Polyclinic, San Cristóbal Municipality, Artemisa Province. The study universe was made up of 145 patients aged 40-60 years, residents of the rural community. The sample was made up of those who fulfilled the inclusion criteria, while the variables selected for the study were collected from the individual and family medical records, during direct patient interview, in order to fulfill the projected objectives. The obtained data were emptied into contingency tables and assessed through rates, ratios and percentages, according to the association of the variables. Results: The 50-60 age group predominated in the sample, with a slight predominance of males and patients of white skin. Low cardiovascular risk behaved in the same way in both sexes. The behavior of modifiable risk factors was consistent with poor eating habits. There was a link between the intensity of cardiovascular risk and the prevalence of myocardial infarction(AU)

Estratificación del riesgo de muerte por enfermedades no transmisibles asociado a la contaminación ambiental en Cuba / Stratification of the emergence risk of non communicable diseases associated with the environmental contamination in Cuba

Introducción: Las enfermedades no transmisibles representan un importante problema sanitario a nivel mundial, sobre todo para los países en vías de desarrollo. Objetivo: Identificar la variación de la mortalidad por cáncer de mama, de pulmón y de próstata y su posible asociación con la contaminación ambiental. Métodos: Se realizó un estudio ecológico a nivel nacional, desde 2000 hasta 2010, tomando como unidad de análisis el municipio. Las enfermedades seleccionadas fueron los tumores malignos, en específico los de mama, de próstata y de pulmón, y se calcularon las tasas de mortalidad acumuladas y tipificadas relacionadas con estos durante este período. Asimismo, se empleó el Sistema de Información Geográfica para confeccionar los mapas de estratificación de riesgo tomando como referencia la tasa nacional y se escogieron las principales fuentes fijas contaminantes de tipo industrial para el análisis de la contaminación atmosférica. Resultados: Fueron elaborados los mapas de estratificación de riesgo de morir por cada una de las enfermedades seleccionadas y se obtuvo el mapa de las principales fuentes fijas contaminantes de tipo industrial; de igual modo, se realizaron otros mapas integrales para explorar la posible asociación entre dichas entidades clínicas y la contaminación ambiental. Conclusiones: El análisis integral de la estratificación del riesgo epidemiológico y ambiental reflejó que los municipios más afectados fueron Mariel, Nuevitas y Moa, así como Matanzas, Cienfuegos, Camagüey y Santiago de Cuba. En Ciudad de La Habana sobresalieron los municipios de Habana Vieja, Regla, Cotorro, San Miguel del Padrón, Arroyo Naranjo, Marianao y Centro Habana.

Introduction: The non communicable diseases represent an important sanitary problem at world level, mainly for the developing countries. Objective: To identify the variation of mortality due to lung, breast and prostate cancer and their possible association with the environmental contamination. Methods: An ecological study at national level was carried out, from 2000 to 2010, taking as analysis unit the municipality. The selected diseases were malignant tumors, specifically those of breast, prostate and lung, and the accumulated typified mortality rates related with these were calculated during this period. Also, the System of Geographical Information was used to make the risk stratification maps, taking as reference the national rate and the main fixed pollutants sources of industrial type were chosen for the analysis of the atmospheric contamination. Results: Maps stratification risk of dying were elaborated for each of the selected diseases and the map of the main fixed pollutants sources of industrial type was obtained; in the same way, other comprehensive maps were elaborated to explore the possible association between these clinical entities and the environmental contamination. Conclusions: The comprehensive analysis of the stratification of the epidemiological and environmental risk reflected that the most affected municipalities were Mariel, Nuevitas and Moa, as well as Matanzas, Cienfuegos, Camagüey and Santiago de Cuba. In Havana the municipalities of Old Havana, Cotorro, San Miguel del Padrón, Arroyo Naranjo, Marianao and Centro Habana stood out.

Global and Regional Patterns in Noncommunicable Diseases and Dietary Factors across National Income Levels.

BACKGROUND: Noncommunicable diseases (NCDs) are the leading global cause of death and share common risk factors. Little quantitative data are available on the patterns of each NCDs death and dietary factors by national income level and region. We aimed to identify the trend of NCDs deaths and dietary factors with other health-related behaviors across national income levels and geographical regions. METHODS: Three databases were collected, including the World Health Organization, Food and Agriculture Organization, and World Bank in 2014. These were analyzed to describe the trend for NCDs deaths and dietary factors with health-related behaviors across national income levels (high income, upper-middle income, lower-middle income, and low income) from 151 countries using variance-weighted least-squares linear regression. RESULTS: Lower-middle-income and low-income countries in Africa and Asia had higher death rates of NCDs. More than 30% of the population had raised blood pressure with higher carbohydrate intake and lower protein and fat intake compared to high-income European countries in 2014. High-income countries had the highest prevalence of raised total cholesterol, overweight, and obesity, the highest total energy, fat, and protein intake, and the highest supplies of animal fat, stimulants, sugar and sweetener, vegetable oil, and milk, as well as insufficient activity with an increasing trend (p for trend < 0.001). CONCLUSION: There were differences in NCDs risk factors and dietary factors by national income and region. Accordingly, measures should be taken to suit the situation in each country. Our findings have significance for health workers and health policies preventing and controlling the rise of NCDs.

Long term exposure to low level air pollution and mortality in eight European cohorts within the ELAPSE project: pooled analysis.

OBJECTIVE: To investigate the associations between air pollution and mortality, focusing on associations below current European Union, United States, and World Health Organization standards and guidelines. DESIGN: Pooled analysis of eight cohorts. SETTING: Multicentre project Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE) in six European countries. PARTICIPANTS: 325 367 adults from the general population recruited mostly in the 1990s or 2000s with detailed lifestyle data. Stratified Cox proportional hazard models were used to analyse the associations between air pollution and mortality. Western Europe-wide land use regression models were used to characterise residential air pollution concentrations of ambient fine particulate matter (PM2.5), nitrogen dioxide, ozone, and black carbon. MAIN OUTCOME MEASURES: Deaths due to natural causes and cause specific mortality. RESULTS: Of 325 367 adults followed-up for an average of 19.5 years, 47 131 deaths were observed. Higher exposure to PM2.5, nitrogen dioxide, and black carbon was associated with significantly increased risk of almost all outcomes. An increase of 5 µg/m3 in PM2.5 was associated with 13% (95% confidence interval 10.6% to 15.5%) increase in natural deaths; the corresponding figure for a 10 µg/m3 increase in nitrogen dioxide was 8.6% (7% to 10.2%). Associations with PM2.5, nitrogen dioxide, and black carbon remained significant at low concentrations. For participants with exposures below the US standard of 12 µg/m3 an increase of 5 µg/m3 in PM2.5 was associated with 29.6% (14% to 47.4%) increase in natural deaths. CONCLUSIONS: Our study contributes to the evidence that outdoor air pollution is associated with mortality even at low pollution levels below the current European and North American standards and WHO guideline values. These findings are therefore an important contribution to the debate about revision of air quality limits, guidelines, and standards, and future assessments by the Global Burden of Disease.

Institutional mortality rate and cause of death at health facilities in Ghana between 2014 and 2018.

BACKGROUND: The epidemiological transition, touted as occurring in Ghana, requires research that tracks the changing patterns of diseases in order to capture the trend and improve healthcare delivery. This study examines national trends in mortality rate and cause of death at health facilities in Ghana between 2014 and 2018. METHODS: Institutional mortality data and cause of death from 2014-2018 were sourced from the Ghana Health Service's District Health Information Management System. The latter collates healthcare service data routinely from government and non-governmental health institutions in Ghana yearly. The institutional mortality rate was estimated using guidelines from the Ghana Health Service. Percent change in mortality was examined for 2014 and 2018. In addition, cause of death data were available for 2017 and 2018. The World Health Organisation's 11th International Classification for Diseases (ICD-11) was used to group the cause of death. RESULTS: Institutional mortality decreased by 7% nationally over the study period. However, four out of ten regions (Greater Accra, Volta, Upper East, and Upper West) recorded increases in institutional mortality. The Upper East (17%) and Volta regions (13%) recorded the highest increase. Chronic non-communicable diseases (NCDs) were the leading cause of death in 2017 (25%) and 2018 (20%). This was followed by certain infectious and parasitic diseases (15% for both years) and respiratory infections (10% in 2017 and 13% in 2018). Among the NCDs, hypertension was the leading cause of death with 2,243 and 2,472 cases in 2017 and 2018. Other (non-ischemic) heart diseases and diabetes were the second and third leading NCDs. Septicaemia, tuberculosis and pneumonia were the predominant infectious diseases. Regional variations existed in the cause of death. NCDs showed more urban-region bias while infectious diseases presented more rural-region bias. CONCLUSIONS: This study examined national trends in mortality rate and cause of death at health facilities in Ghana. Ghana recorded a decrease in institutional mortality throughout the study. NCDs and infections were the leading causes of death, giving a double-burden of diseases. There is a need to enhance efforts towards healthcare and health promotion programmes for NCDs and infectious diseases at facility and community levels as outlined in the 2020 National Health Policy of Ghana.

Noncommunicable diseases, climate change and iniquities: What COVID-19 has taught us about syndemic.

BACKGROUND: COVID-19 is generating clinical challenges, lifestyle changes, economic consequences. The pandemic imposes to familiarize with concepts as prevention, vulnerability and resilience. METHODS: We analysed and reviewed the most relevant papers in the MEDLINE database on syndemic, noncommunicable diseases, pandemic, climate changes, pollution, resilience, vulnerability, health costs, COVID-19. RESULTS: We discuss that comprehensive strategies must face multifactorial consequences since the pandemic becomes syndemic due to interactions with noncommunicable diseases, climate changes and iniquities. The lockdown experience, on the other hand, demonstrates that it is rapidly possible to reverse epidemiologic trends and to reduce pollution. The worst outcome is evident in eight highly industrialized nations, where 12% of the world population experienced about one-third of all COVID-19-deaths worldwide. Thus, a great economic power has not been fully protective, and a change of policy is obviously needed to avoid irreversible consequences. CONCLUSIONS: We are accumulating unhealthy populations living in unhealthy environments and generating unhealthy offspring. The winning policy should tackle structural inequities through a syndemic approach, to protect vulnerable populations from present and future harms.

Mortalidad prematura según causas seleccionadas en el Policlínico 5 de septiembre / Premature Mortality due to Selected Causes in 5 de Septiembre Municipality

Introducción: El conocimiento de las tendencias de mortalidad prematura en una población puede contribuir a realizar acciones que disminuyan los años de vida potencial perdidos por distintas causas. Objetivo: determinar la tendencia de mortalidad prematura por enfermedad de arterias, arteriolas y vasos, enfermedad cerebrovascular, infarto agudo del miocardio, diabetes mellitus, enfermedad pulmonar obstructiva crónica y cáncer de mama, próstata, bucal, colon y cérvix en el policlínico 5 de septiembre de Consolación del Sur. Métodos: Se realizó un estudio descriptivo retrospectivo del total de fallecidos prematuramente n = 313 por las causas seleccionadas, para ello se analizaron, a través de estadística descriptiva, los datos del Registro de Mortalidad de la Dirección Provincial de Salud Pública de Pinar del Río. Resultados: Existió correspondencia entre el incremento de la edad y el aumento de los fallecidos, los más afectados fueron el grupo etario 60-69 años, el sexo masculino y el color blanco de piel. Solo las enfermedades de arterias, arteriolas y vasos, la EPOC y la diabetes mellitus mostraron tendencia al ascenso. El mayor riesgo de morir prematuramente correspondió a los Grupos Básicos de Trabajo 2 y 4, y las causas de mayor tasa fueron la enfermedad cerebrovascular, infarto agudo de miocardio y EPOC. La población estudiada perdió 9,86 años de vida como promedio y el cáncer de cérvix fue la enfermedad que más aportó años de vida potencial perdidos. Conclusiones: Se apreció tendencia a la disminución de mortalidad prematura general por las enfermedades estudiadas(AU)

Introduction: Knowledge about tendencies of premature mortality in a population can contribute to carrying out actions that reduce the number of years of potential life lost due to different causes. Objective: To determine the tendency of premature mortality due to disease of the arteries, arterioles and vessels, cerebrovascular disease, acute myocardial infarction, diabetes mellitus, chronic obstructive pulmonary disease (COPD), as well as breast, prostate, oral, colon and cervical cancer in 5 de Septiembre Polyclinic of Consolación del Sur Municipality. Methods: A retrospective and descriptive study was carried out with the total number of prematurely deceased (n=313) for the selected causes. For this purpose, the data from the Mortality Registry of the Provincial Directorate of Public Health of Pinar del Río were analyzed through descriptive statistics. Results: There was a correspondence between increase in age and increase in deaths; the most affected were those in age group 60-69 years, as well as the male sex and white skin color. Only diseases of the arteries, arterioles and vessels, COPD and diabetes mellitus showed an upward tendency. The highest risk for dying prematurely corresponded to the basic work groups 2 and 4, while the causes with the highest rate were cerebrovascular disease, acute myocardial infarction and COPD. The study population lost 9.86 years of life on average and cervical cancer was the disease that accounted for the highest amount of lost years of potential life. Conclusions: There was a tendency towards a decrease in general premature mortality due to the diseases studied(AU)

Burden of disease among the world's poorest billion people: An expert-informed secondary analysis of Global Burden of Disease estimates.

BACKGROUND: The health of populations living in extreme poverty has been a long-standing focus of global development efforts, and continues to be a priority during the Sustainable Development Goal era. However, there has not been a systematic attempt to quantify the magnitude and causes of the burden in this specific population for almost two decades. We estimated disease rates by cause for the world's poorest billion and compared these rates to those in high-income populations. METHODS: We defined the population in extreme poverty using a multidimensional poverty index. We used national-level disease burden estimates from the 2017 Global Burden of Disease Study and adjusted these to account for within-country variation in rates. To adjust for within-country variation, we looked to the relationship between rates of extreme poverty and disease rates across countries. In our main modeling approach, we used these relationships when there was consistency with expert opinion from a survey we conducted of disease experts regarding the associations between household poverty and the incidence and fatality of conditions. Otherwise, no within-country variation was assumed. We compared results across multiple approaches for estimating the burden in the poorest billion, including aggregating national-level burden from the countries with the highest poverty rates. We examined the composition of the estimated disease burden among the poorest billion and made comparisons with estimates for high-income countries. RESULTS: The composition of disease burden among the poorest billion, as measured by disability-adjusted life years (DALYs), was 65% communicable, maternal, neonatal, and nutritional (CMNN) diseases, 29% non-communicable diseases (NCDs), and 6% injuries. Age-standardized DALY rates from NCDs were 44% higher in the poorest billion (23,583 DALYs per 100,000) compared to high-income regions (16,344 DALYs per 100,000). Age-standardized DALY rates were 2,147% higher for CMNN conditions (32,334 DALYs per 100,000) and 86% higher for injuries (4,182 DALYs per 100,000) in the poorest billion, compared to high-income regions. CONCLUSION: The disease burden among the poorest people globally compared to that in high income countries is highly influenced by demographics as well as large disparities in burden from many conditions. The comparisons show that the largest disparities remain in communicable, maternal, neonatal, and nutritional diseases, though NCDs and injuries are an important part of the "unfinished agenda" of poor health among those living in extreme poverty.

Impact of Mediterranean Diet on Chronic Non-Communicable Diseases and Longevity.

The average life expectancy of the world population has increased remarkably in the past 150 years and it is still increasing. A long life is a dream of humans since the beginning of time but also a dream is to live it in good physical and mental condition. Nutrition research has focused on recent decades more on food combination patterns than on individual foods/nutrients due to the possible synergistic/antagonistic effects of the components in a dietary model. Various dietary patterns have been associated with health benefits, but the largest body of evidence in the literature is attributable to the traditional dietary habits and lifestyle followed by populations from the Mediterranean region. After the Seven Countries Study, many prospective observational studies and trials in diverse populations reinforced the beneficial effects associated with a higher adherence to the Mediterranean diet in reference to the prevention/management of age-associated non-communicable diseases, such as cardiovascular and metabolic diseases, neurodegenerative diseases, cancer, depression, respiratory diseases, and fragility fractures. In addition, the Mediterranean diet is ecologically sustainable. Therefore, this immaterial world heritage constitutes a healthy way of eating and living respecting the environment.

Non-communicable diseases deaths attributable to high body mass index in Chile.

We estimated the proportion and number of deaths from non-communicable diseases (NCD) attributable to high body mass index (BMI) in Chile in 2018. We used data from 5927 adults from a 2016-2017 Chilean National Health Survey to describe the distribution of BMI. We obtained the number of deaths from NCD from the Ministry of Health. Relative risks (RR) and 95% confidence intervals per 5 units higher BMI for cardiovascular disease, cancer, and respiratory disease were retrieved from the Global BMI Mortality Collaboration meta-analyses. The prevalences of overweight and obesity were 38.9% and 39.1%, respectively. We estimated that reducing population-wide BMI to a theoretical minimum risk exposure level (mean BMI: 22.0 kg/m2; standard deviation: 1) could prevent approximately 21,977 deaths per year (95%CI 13,981-29,928). These deaths represented about 31.6% of major NCD deaths (20.1-43.1) and 20.4% of all deaths (12.9-27.7) that occurred in 2018. Most of these preventable deaths were from cardiovascular diseases (11,474 deaths; 95% CI 7302-15,621), followed by cancer (5597 deaths; 95% CI 3560-7622) and respiratory disease (4906 deaths; 95% CI 3119-6684). A substantial burden of NCD deaths was attributable to high BMI in Chile. Policies and population-wide interventions are needed to reduce the burden of NCD due to high BMI in Chile.

The 'freedom' to pollute? An ecological analysis of neoliberal capitalist ideology, climate culpability, lifestyle factors, and population health risk in 124 countries.

OBJECTIVES: This ecological study examined the relationship between neoliberal capitalist ideology (hereafter, neoliberal ideology) and non-communicable diseases (NCD) mortality in 124 countries, focusing on the degree to which climate culpability and physical inactivity are implicated in explaining that relationship. METHODS: The economic freedom of the world index of the Fraser Institute (representing neoliberal ideology), CO2 emissions (metric tons/capita) from the World Bank (representing climate culpability), and the World Health Organization's age-adjusted physical inactivity and NCD mortality data were used. Covariates included gross domestic product (GDP)/capita, the country-level prevalence of obesity (n = 123), tobacco smoking (n = 111), and alcohol consumption (n = 61). RESULTS: Neoliberal ideology was associated with NCD mortality after controlling for GDP/capita, physical inactivity, and obesity, and this association was most pronounced in less culpable countries. The association between neoliberal ideology and NCD mortality remained statistically significant even after further controlling for tobacco smoking and alcohol consumption. Neoliberal ideology was associated with NCD mortality, after controlling for GDP, climate culpability, and tobacco smoking, regardless of physical inactivity. When alcohol consumption was introduced, physical inactivity moderated the association between neoliberal ideology and NCD mortality. CONCLUSION: Neoliberal ideology was consistently associated with NCD mortality. Also, NCD mortality appears to be most severe in countries that are less culpable for global climate change. Our findings offer preliminary evidence-based support for a shift in thinking toward the fundamental determinants of health and calls for an upstream shift in climate change mitigation interventions to improve population health through the creation of equitable global political and economic systems.

RéSUMé: OBJECTIFS: Notre étude écologique porte sur le lien entre l'idéologie capitaliste néolibérale (ci-après dénommée « idéologie néolibérale ¼) et la mortalité due aux maladies non transmissibles (MNT) dans 124 pays, et en particulier sur la mesure dans laquelle la culpabilité climatique et la sédentarité peuvent expliquer ce lien. MéTHODE: Nous avons utilisé l'indice de liberté économique dans le monde de l'Institut Fraser (pour représenter l'idéologie néolibérale), les émissions de CO2 (en tonnes métriques par habitant) selon la Banque mondiale (pour représenter la culpabilité climatique) et les données sur la sédentarité et la mortalité due aux MNT de l'Organisation mondiale de la santé, rajustées selon l'âge. Nos covariables ont été le produit intérieur brut (PIB) par habitant et, par pays, la prévalence de l'obésité (n = 123), du tabagisme (n = 111) et de la consommation d'alcool (n = 61). RéSULTATS: L'idéologie néolibérale était associée à la mortalité due aux MNT après prise en compte du PIB par habitant, de la sédentarité et de l'obésité, et cette association était la plus prononcée dans les pays les moins coupables. L'association entre l'idéologie néolibérale et la mortalité due aux MNT est demeurée significative même après l'apport d'ajustements pour tenir compte des effets de tabagisme et de la consommation d'alcool. L'idéologie néolibérale était associée à la mortalité due aux MNT après prise en compte du PIB, de la culpabilité climatique et du tabagisme, quels que soient les niveaux de sédentarité. Quand la consommation d'alcool était introduite, la sédentarité réduisait l'association entre l'idéologie néolibérale et la mortalité due aux MNT. CONCLUSION: L'idéologie néolibérale était uniformément associée à la mortalité due aux MNT. Par ailleurs, la mortalité due aux MNT semble être la plus grave dans les pays les moins coupables à l'égard du changement climatique mondial. Nos constatations présentent des preuves préliminaires à l'appui d'une évolution de la pensée sur les déterminants fondamentaux de la santé et appellent à intervenir en amont pour atténuer le changement climatique, en vue d'améliorer la santé des populations par la création de systèmes politiques et économiques mondiaux équitables.

Preventable deaths among youth in South Africa: Measuring life expectancy in the absence of non-communicable diseases and its implications for the healthcare system.

BACKGROUND: Non-communicable diseases (NCDs) cause premature mortality among youth. Associated with lifestyle and behavioural choices, these diseases and deaths can and should be prevented among young people. This article presents data showing the gains in life expectancy among youth in the absence of NCD causes of death. OBJECTIVES: To estimate the levels of NCD mortality among youth (15 - 24 years of age) in South Africa (SA) and show the current and projected additional years of life gained with the elimination of heart disease, cancer and diabetes. METHODS: This was a cross-sectional study using 20 years of death notification forms from SA (1997 - 2016). The data were nationally representative and the sample was 62 395 youth deaths (age 15 - 24 years) from the selected NCDs. Cause-specific mortality rates, expressed as percentages, were estimated by age group and sex. Cause-deleted life-table techniques were used to estimate current and projected life expectancy (ex) and life expectancy in the absence of specific NCDs (e-ix). RESULTS: Death rates from NCDs are increasing over time among youth. Total death rates from cancer increased from 1.09% in 1997 - 2001 to 1.51% in 2012 - 2016. Female death rates from heart disease are almost double those for males. The number of additional years of life gained with elimination of these causes ranges from 2.2 to 10.3. Projected life expectancies show that males could gain as much as 1 additional year and females 1.06 years by 2035. CONCLUSIONS: Urgent action needs to be taken to prevent further mortality from non-communicable causes among youth. The results of this study are important to the SA healthcare system and to public health practitioners whose aim is to reduce the strain on public resources and reduce mortality among youth. Future studies should estimate the extent of NCD mortality in households and communities with the aim of developing macro-level interventions.