The burden of chronic kidney disease in Asia, 1990-2019: Examination of estimates from global burden of disease 2019 study.

BACKGROUND: Chronic kidney disease (CKD) is a global public health issue, with Asia accounting for one of the highest CKD prevalence worldwide. This study examines the burden of CKD in Asian continent in the last three decades. DATA AND METHODS: The estimates of age, sex and year wise burden of CKD for 49 countries in Asia for 1990 to 2019 were procured from the Global Burden of Disease 2019 study. FINDINGS: In 2019, there were 9.8 million [9.0-10.6 million] new cases and 763 024 [696 050-823 829] deaths due to CKD in Asia. Between 1990 and 2019, CKD prevalence doubled from 202.4 million [186.5-219.1 million] to 431.2 [400.3-462.0 million]. Although age-standardized incidence rate (ASIR) of CKD increased from 170.6 [156.7-186.2] in 1990 to 206.3 [190.4-223.4] per 100 000 person-years in 2019, the age-standardized mortality rate (ASMR) witnessed a modest reduction from 18.4/100 000 [17.0-20.1] to 17.3/100 000 [15.7-18.7]. In 2019, the ASIR spanned from 141.9/100 000 [126.2-159.2] in Tajikistan to 561.4/100 000 [524.6-598.6] in Saudi Arabia, and ASMR varied from 8.9/100 000 [7.2-9.8] in Japan to Saudi Arabia (52.9 [42.8-63.1]). Between 1990 and 2019, absolute count of CKD incident cases, deaths, prevalent cases and disability-adjusted life years (DALYs) increased 100% or more in 48/49, 32/49, 43/49 and 23/49 countries, respectively. INTERPRETATION: CKD is widespread in the Asian region, with an alarming burden in resource-constrained countries. Strategies such as promoting awareness, screening among high-risk individuals, provision of cost-effective therapies, and increased healthcare coverage could help deal with the CKD epidemic in Asia.

A Review of Patient Satisfaction and Experience with Telemedicine: A Virtual Solution During and Beyond COVID-19 Pandemic.

Introduction: This article reviews the studies examining patients' perspective toward telemedicine and their preference for virtual health care services. Methods: An electronic literature search using PubMed was conducted to identify relevant research studies published between December 2019 and August 2020. Twenty-five studies were selected out of 1,041 studies based on inclusion and exclusion criteria, which highlight patients' satisfaction and experience with the use of telemedicine during the pandemic. Results: The findings based upon 48,144 surveyed patients and 146 providers in 12 different countries revealed high satisfaction with virtual encounters across a spectrum of diseases. Telemedicine was found satisfactory on various outcome measures, such as addressing patients' concerns, communication with health care providers, usefulness, and reliability. Most common advantages were time saved due to lesser traveling and waiting time, better accessibility, convenience, and cost efficiency. Age and sex did not significantly impact the satisfaction levels. Physicians and patients both showed a strong preference for continued usage and agreed upon telemedicine's potential to complement the regular health care services even after the pandemic. Technical challenges (reported in 10 studies) and lack of physical examination (reported in 13 studies) were the main limitations encountered in virtual visits. Conclusions: Long-term sustainability of telemedicine for all socioeconomic classes requires closer scrutiny of issues such as technology, training, reimbursement, data privacy, legal guidelines, and framework. Telemedicine must be adopted as a proactive strategy and scaled-up even beyond emergency usage due to its immense potential in complementing conventional health care services, such as diagnosis, treatment, follow-up, surveillance, and infection control.

A comprehensive examination of the economic impact of out-of-pocket health expenditures in India.

More than 50% of health expenditure is financed through out-of-pocket payments in India, imposing a colossal financial burden on households. Amidst the rising incidence of non-communicable diseases, injuries, and an unfinished agenda of infectious diseases, this study examines comprehensively the economic impact of out-of-pocket health expenditure (OOPE) across 17 disease categories in India. Data from the latest round of the National Sample Survey (2017-18), titled 'Household Social Consumption: Health', were employed. Outcomes, namely, catastrophic health expenditure (CHE), poverty headcount ratio, distressed financing, foregone care, and loss of household earnings, were estimated. Results showed that 49% of households that sought hospitalization and/or outpatient care experienced CHE and 15% of households fell below the poverty line due to OOPE. Notably, outpatient care was more burdensome (CHE: 47.8% and impoverishment: 15.0%) than hospitalization (CHE: 43.1% and impoverishment: 10.7%). Nearly 16% of households used distressed sources to finance hospitalization-related OOPE. Cancer, genitourinary disorders, psychiatric and neurological disorders, obstetric conditions, and injuries imposed a substantial economic burden on households. OOPE and associated financial burden were higher among households where members sought care in private healthcare facilities compared with those treated in public facilities across most disease categories. The high burden of OOPE necessitates the need to increase health insurance uptake and consider outpatient services under the purview of health insurance. Concerted efforts to strengthen the public health sector, improved regulation of private healthcare providers, and prioritizing health promotion and disease prevention strategies are crucial to augment financial risk protection.

Financial burden of seeking diabetes mellitus care in India: Evidence from a Nationally Representative Sample Survey.

Background: Diabetes mellitus (DM) is a major public health concern in India, and entails a severe burden in terms of disability, death, and economic cost. This study examined the out-of-pocket health expenditure (OOPE) and financial burden associated with DM care in India. Methods: The study used data from the latest round of the National Sample Survey on health, which covered 555,115 individuals from 113,823 households in India. In the present study, data of 1216 individuals who sought inpatient treatment and 6527 individuals who sought outpatient care for DM were analysed. Results: In India, 10.04 per 1000 persons reported having DM during the last 15 days before the survey date, varying from 6.94/1000 in rural areas to 17.45/1000 in urban areas. Nearly 38% of Indian households with diabetic members experienced catastrophic health expenditure (at the 10% threshold) and approximately 10% of DM-affected households were pushed below the poverty line because of OOPE, irrespective of the type of care sought. 48.5% of households used distressed sources to finance the inpatient costs of DM. Medicines constituted one of the largest proportion of total health expenditure, regardless of the type of care sought or type of healthcare facility visited. The average monthly OOPE was over 4.5-fold and 2.5-fold higher for households who sought inpatient and outpatient care, respectively, from private health facilities, compared with those treated at public facilities. Notably, the financial burden was more severe for households residing in rural areas, those in lower economic quintiles, those belonging to marginalised social groups, and those using private health facilities. Conclusion: The burden of DM and its associated financial ramifications necessitate policy measures, such as prioritising health promotion and disease prevention strategies, strengthening public healthcare facilities, improved regulation of private healthcare providers, and bringing outpatient services under the purview of health insurance, to manage the diabetes epidemic and mitigate its financial impact.

Type-2 Diabetes Mellitus (T2DM): Spatial-temporal Patterns of Incidence, Mortality and Attributable Risk Factors from 1990 to 2019 among 21 World Regions.

PURPOSE: Type-2 diabetes Mellitus (T2DM) is one of the leading causes of death and disability worldwide. This study examines temporal patterns of the global, regional, and national burden of T2DM in the last three decades. DATA AND METHODS: The estimates of age, sex and location-wise incident cases, deaths, prevalent cases, and disability-adjusted-life-years (DALYs) and risk factors for 21 regions and 204 countries are retrieved from the Global Burden of Disease 2019 study from 1990 to 2019. Socio-demographic index (SDI) is used as the indicator of the development status of countries, and quadratic regression is employed to examine the relationship between country-level age-standardized rates and SDI. RESULTS: Globally, incident cases of T2DM more than doubled from 8.4 million[95% uncertainty interval, 7.8-9.1 million] in 1990 to 21.7 million[20.0-23.5 million] in 2019, and deaths more than doubled from 606,407[573,069-637,508] to 1.5 million[1.4-1.6 million] between 1990 and 2019. Global T2DM prevalence increased from 148.4 million[135.5-162.6 million] in 1990 to 437.9 million[402.0-477.0 million] in 2019. In 2019, global age-standardized prevalence rate stood at 5282.8/100,000[4853.6-5752.1], varying from 2174.5/100,000[1924.3-2470.5] in Mongolia to 19876.8/100,000[18211.1-21795.3] in American Samoa. SDI exhibited inverted-U shaped relationship with country-level age-standardised rates. Globally, high body-mass-index (51.9%), ambient particulate matter pollution (13.6%), smoking (9.9%) and secondhand smoke (8.7%) were the major contributing risk factors towards T2DM DALYs in 2019. CONCLUSION: With ubiquitously rising prevalent cases globally, particularly in low and middle-income countries and regions, T2DM requires immediate attention and targeted policy response worldwide centered on lifestyle interventions (e.g., physical activity, smoking, diet, and obesity), air pollution control and cost-effective timely treatment.

Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020.

Objective: Cancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries. Methods: The estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles. Results: In Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 - 1.3 million] and 711,429 [611,604 - 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa. Conclusion: High cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.

Review of COVID-19 epidemiology and public health response in Europe in 2020.

OBJECTIVE: This study focuses on the epidemiology of COVID-19 in Europe and investigates public health response in severely hit countries. METHODS: European Centre for Disease Prevention and Control, Oxford COVID-19 Government Response Tracker and Health System Response Monitor were referred. The relationship between stringency index and COVID-19 cases, and between speed of stringency implementation and growth of cases was examined using linear regression. RESULTS: The case-fatality ratio (CFR) of Europe (2.35%) was higher than the global CFR (2.2%). United Kingdom, Russia, France, Italy, Spain, and Germany together, accounted for 61.15% of cases and 65.62% of deaths in Europe. Significant relationship was observed between growth of COVID-19 cases and late substantive stringency imposed by countries. Population aged 65 and above (r = 0.9037, p < 0.01) and male population (r = 0.8701, p < 0.01) were significantly and positively correlated with COVID-19 deaths. The public health system of even big European countries encountered roadblocks, such as shortages of healthcare resources and deferral of non-COVID-19 treatments while dealing with the unprecedented pandemic. CONCLUSION: Even big and richest European countries delayed the implementation of non-pharmaceutical interventions which led to rapid virus transmission. The pandemic has posed a reminder to make the public health system more resilient, as epidemics and pandemics of this nature will continue to threaten in future as well.

COVID-19: A Comprehensive Review of Epidemiology and Public Health System Response in Nordic Region.

This paper investigates the epidemiology and public health response of novel coronavirus infection (COVID-19) in the Nordic region. The data on cases and deaths due to COVID-19 were drawn from the European Centre for Disease Prevention and Control. The data on age- and sex-wise cases, deaths and intensive care unit (ICU) admissions, and public health interventions in the Nordic region through November 10, 2020, were obtained from respective countries' health ministries. Sweden accounted for 60.59% of cases (162 240 of 267 768 cases) and 81% of deaths (6057 of 7477 cases) in the Nordic region. The incidence rate for the Nordic region was 989.59 per 100 000, varying from 327.30 per 100 000 in Finland to 1616.51 per 100 000 in Sweden, and the mortality rate for the region was 27.63 per 100 000, ranging from 5.3 per 100 000 in Norway to 60.35 per 100 000 in Sweden. The case-fatality ratio of the Nordic region was 2.79%. Females were more susceptible to COVID-19 infection than males (52.30% vs 47.66%), while males had a greater proportion of deaths (54.7%) and ICU need (71.99%) than females. It is imperative to continue with social distancing, mandatory masks, testing, prohibition of mass gatherings, isolation of confirmed cases, and preventing the importation of cases from other countries to avoid the further resurgence of cases.