An economic evaluation of eptinezumab for the preventive treatment of migraine in the UK, with consideration for natural history and work productivity.

BACKGROUND: Migraine is a highly prevalent neurological disease with a substantial societal burden due to lost productivity. From a societal perspective, we assessed the cost-effectiveness of eptinezumab for the preventive treatment of migraine. METHODS: An individual patient simulation of discrete competing events was developed to evaluate eptinezumab cost-effectiveness compared to best supportive care for adults in the United Kingdom with ≥ 4 migraine days per month and prior failure of ≥ 3 preventive migraine treatments. Individuals with sampled baseline characteristics were created to represent this population, which comprised dedicated episodic and chronic migraine subpopulations. Clinical efficacy, utility, and work productivity inputs were based on results from the DELIVER randomised controlled trial (NCT04418765). Timing of natural history events and treatment holidays-informed by the literature-were simulated to unmask any natural improvement of the disease unrelated to treatment. The primary outcomes were monthly migraine days, migraine-associated costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio, and net monetary benefit, each evaluated over a 5-year time horizon from 2020. Secondary analyses explored a lifetime horizon and an alternative treatment stopping rule. RESULTS: Treatment with eptinezumab resulted in an average of 0.231 QALYs gained at a saving of £4,894 over 5 years, making eptinezumab dominant over best supportive care (i.e., better health outcomes and less costly). This result was confirmed by the probabilistic analysis and all alternative assumption scenarios under the same societal perspective. Univariate testing of inputs showed net monetary benefit was most sensitive to the number of days of productivity loss, and monthly salary. CONCLUSIONS: This economic evaluation shows that from a societal perspective, eptinezumab is a cost-effective treatment in patients with ≥ 4 migraine days per month and for whom ≥ 3 other preventive migraine treatments have failed. TRIAL REGISTRATION: N/A.

Structural equation modeling for identifying the drivers of health-related quality of life improvement experienced by patients with migraine receiving eptinezumab.

BACKGROUND: As new migraine therapies emerge, it is crucial for measures to capture the complexities of health-related quality of life (HRQoL) improvement beyond improvements in monthly migraine day (MMD) reduction. Investigations into the correlations between MMD reduction, symptom management, and HRQoL are lacking, particularly those that focus on improvements in canonical symptoms and improvement in patient-identified most-bothersome symptoms (PI-MBS), in patients treated with eptinezumab. This exploratory analysis identified efficacy measures mediating the effect of eptinezumab on HRQoL improvements in patients with migraine. METHODS: Data from the DELIVER study of patients with 2-4 prior preventive migraine treatment failures (NCT04418765) were inputted to two structural equation models describing sources of HRQoL improvement via Migraine-Specific Quality-of-Life Questionnaire (MSQ) scores. A single latent variable was defined to represent HRQoL and describe the sources of HRQoL in DELIVER. One model included all migraine symptoms while the second model included the PI-MBS as the only migraine symptom. Mediating variables capturing different aspects of efficacy included MMDs, other canonical symptoms, and PI-MBS. RESULTS: In the first model, reductions in MMDs and other canonical symptoms accounted for 35% (standardized effect size [SES] - 0.11) and 25% (SES - 0.08) of HRQoL improvement, respectively, with 41% (SES - 0.13) of improvement comprising "direct treatment effect," i.e., unexplained by mediators. In the second model, substantial HRQoL improvement with eptinezumab (86%; SES - 0.26) is due to MMD reduction (17%; SES - 0.05) and change in PI-MBS (69%; SES - 0.21). CONCLUSIONS: Improvements in HRQoL experienced by patients treated with eptinezumab can be substantially explained by its effect on migraine frequency and PI-MBS. Therefore, in addition to MMD reduction, healthcare providers should discuss PI-MBS improvements, since this may impact HRQoL. Health technology policymakers should consider implications of these findings in economic evaluation, as they point to alternative measurement of quality-adjusted life years to capture fully treatment benefits in cost-utility analyses. TRIAL REGISTRATION: ClinicalTrials.gov (Identifier: NCT04418765 ; EudraCT (Identifier: 2019-004497-25; URL: https://www.clinicaltrialsregister.eu/ctr-search/search?query=2019-004497-25 ).

Preventing type 2 diabetes mellitus in Qatar by reducing obesity, smoking, and physical inactivity: mathematical modeling analyses.

BACKGROUND: The aim of this study was to estimate the impact of reducing the prevalence of obesity, smoking, and physical inactivity, and introducing physical activity as an explicit intervention, on the burden of type 2 diabetes mellitus (T2DM), using Qatar as an example. METHODS: A population-level mathematical model was adapted and expanded. The model was stratified by sex, age group, risk factor status, T2DM status, and intervention status, and parameterized by nationally representative data. Modeled interventions were introduced in 2016, reached targeted level by 2031, and then maintained up to 2050. Diverse intervention scenarios were assessed and compared with a counter-factual no intervention baseline scenario. RESULTS: T2DM prevalence increased from 16.7% in 2016 to 24.0% in 2050 in the baseline scenario. By 2050, through halting the rise or reducing obesity prevalence by 10-50%, T2DM prevalence was reduced by 7.8-33.7%, incidence by 8.4-38.9%, and related deaths by 2.1-13.2%. For smoking, through halting the rise or reducing smoking prevalence by 10-50%, T2DM prevalence was reduced by 0.5-2.8%, incidence by 0.5-3.2%, and related deaths by 0.1-0.7%. For physical inactivity, through halting the rise or reducing physical inactivity prevalence by 10-50%, T2DM prevalence was reduced by 0.5-6.9%, incidence by 0.5-7.9%, and related deaths by 0.2-2.8%. Introduction of physical activity with varying intensity at 25% coverage reduced T2DM prevalence by 3.3-9.2%, incidence by 4.2-11.5%, and related deaths by 1.9-5.2%. CONCLUSIONS: Major reductions in T2DM incidence could be accomplished by reducing obesity, while modest reductions could be accomplished by reducing smoking and physical inactivity, or by introducing physical activity as an intervention.

Estimation of hepatitis C virus infections resulting from vertical transmission in Egypt.

UNLABELLED: Despite having the highest hepatitis C virus (HCV) prevalence in the world, the ongoing level of HCV incidence in Egypt and its drivers are poorly understood. Whereas HCV mother-to-child infection is a well-established transmission route, there are no estimates of HCV infections resulting from vertical transmission for any country, including Egypt. The aim of this study was to estimate the absolute number of new HCV infections resulting from vertical transmission in Egypt. We developed a conceptual framework of HCV vertical transmission, expressed in terms of a mathematical model and based on maternal HCV antibody and viremia. The mathematical model estimated the number of HCV vertical infections nationally and for six subnational areas. Applying two vertical transmission risk estimates to the 2008 Egyptian birth cohort, we estimated that between 3,080 and 5,167 HCV infections resulted from vertical transmission among children born in 2008. HCV vertical transmission may account for half of incident cases in the <5-year age group. Disproportionately higher proportions of vertical infections were estimated in Lower Rural and Upper Rural subnational areas. This geographical clustering was a result of higher-area-level HCV prevalence among women and higher fertility rates. CONCLUSION: Vertical transmission is one of the primary HCV infection routes among children<5 years in Egypt. The absolute number of vertical transmissions and the young age at infection highlight a public health concern. These findings also emphasize the need to quantify the relative contributions of other transmission routes to HCV incidence in Egypt.

HCV prevalence can predict HIV epidemic potential among people who inject drugs: mathematical modeling analysis.

BACKGROUND: Hepatitis C virus (HCV) and HIV are both transmitted through percutaneous exposures among people who inject drugs (PWID). Ecological analyses on global epidemiological data have identified a positive association between HCV and HIV prevalence among PWID. Our objective was to demonstrate how HCV prevalence can be used to predict HIV epidemic potential among PWID. METHODS: Two population-level models were constructed to simulate the evolution of HCV and HIV epidemics among PWID. The models described HCV and HIV parenteral transmission, and were solved both deterministically and stochastically. RESULTS: The modeling results provided a good fit to the epidemiological data describing the ecological HCV and HIV association among PWID. HCV was estimated to be eight times more transmissible per shared injection than HIV. A threshold HCV prevalence of 29.0% (95% uncertainty interval (UI): 20.7-39.8) and 46.5% (95% UI: 37.6-56.6) were identified for a sustainable HIV epidemic (HIV prevalence >1%) and concentrated HIV epidemic (HIV prevalence >5%), respectively. The association between HCV and HIV was further described with six dynamical regimes depicting the overlapping epidemiology of the two infections, and was quantified using defined and estimated measures of association. Modeling predictions across a wide range of HCV prevalence indicated overall acceptable precision in predicting HIV prevalence at endemic equilibrium. Modeling predictions were found to be robust with respect to stochasticity and behavioral and biological parameter uncertainty. In an illustrative application of the methodology, the modeling predictions of endemic HIV prevalence in Iran agreed with the scale and time course of the HIV epidemic in this country. CONCLUSIONS: Our results show that HCV prevalence can be used as a proxy biomarker of HIV epidemic potential among PWID, and that the scale and evolution of HIV epidemic expansion can be predicted with sufficient precision to inform HIV policy, programming, and resource allocation.

Impact of mitigating obesity, smoking, and physical inactivity on type 2 diabetes mellitus burden in Oman: insights from mathematical modeling.

INTRODUCTION: To estimate the impact of reducing obesity, smoking, and physical inactivity (PIA) prevalence, and of introducing physical activity (PA) as an explicit intervention, on the prevalence, incidence, and mortality of type 2 diabetes mellitus (T2DM) in Oman. RESEARCH DESIGN AND METHODS: A deterministic population-level mathematical model was employed to investigate the impact of different scenarios for reducing T2DM risk factors on T2DM epidemiology. The model was stratified by sex, age group, risk factor status, T2DM status, and intervention status and parameterized with nationally representative data. Intervention scenarios were calculated and compared with a baseline (no-intervention) scenario for changes in T2DM prevalence, incidence, and mortality among adult Omanis between 2020 and 2050. RESULTS: In the no-intervention scenario, T2DM prevalence increased from 15.2% in 2020 to 23.8% in 2050. Achieving the goals of halting the rise of obesity, reducing smoking by 30%, and reducing PIA by 10% as outlined in the WHO's Global Action Plan for Non-communicable Diseases (implemented between 2020 and 2030 and then maintained between 2031 and 2050) would reduce T2DM prevalence by 32.2%, cumulative incidence by 31.3%, and related deaths by 19.3% by 2050. Halting the rise of or reducing obesity prevalence by 10%-50% would reduce T2DM prevalence by 33.0%-51.3%, cumulative incidence by 31.9%-53.0%, and related deaths by 19.5%-35.6%. Reducing smoking or PIA prevalence by 10%-50% would lead to smaller reductions of less than 5% in T2DM prevalence, cumulative incidence, and related deaths. Introducing PA with varying intensities at a 25% coverage would reduce T2DM prevalence by 4.9%-14.1%, cumulative incidence by 4.8%-13.8%, and related deaths by 3.4%-9.6% by 2050. CONCLUSIONS: Intervention-for-prevention efforts targeting obesity reduction and introducing PA could result in major reductions in the T2DM burden. Prioritizing such interventions could alleviate the burden of T2DM in Oman and other countries with similarly high T2DM and obesity burdens.

Impact of price reductions, subsidies, or financial incentives on healthy food purchases and consumption: a systematic review and meta-analysis.

Poor diets are a global concern and are linked with various adverse health outcomes. Healthier foods such as fruit and vegetables are often more expensive than unhealthy options. This study aimed to assess the effect of price reductions for healthy food (including fruit and vegetables) on diet. We performed a systematic review and meta-analysis on studies that looked at the effects of financial incentives on healthy food. Main outcomes were change in purchase and consumption of foods following a targeted price reduction. We searched electronic databases (MEDLINE, EconLit, Embase, Cinahl, Cochrane Library, and Web of Science), citations, and used reference screening to identify relevant studies from Jan 1, 2013, to Dec 20, 2021, without language restrictions. We stratified results by population targeted (low-income populations vs general population), the food group that the reduction was applied to (fruit and vegetables, or other healthier foods), and study design. Percentage price reduction was standardised to assess the effect in meta-analyses. Study quality was assessed using the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. 34 studies were eligible; 15 took place in supermarkets and eight took place in workplace canteens in high-income countries, and 21 were targeted at socioeconomically disadvantaged communities. Pooled analyses of 14 studies showed a price reduction of 20% resulted in increases in fruit and vegetable purchases by 16·62% (95% CI 12·32 to 20·91). Few studies had maintained the price reduction for over 6 months. In conclusion, price reductions can lead to increases in purchases of fruit and vegetables, potentially sufficient to generate health benefits, if sustained.

Mapping HIV clustering: a strategy for identifying populations at high risk of HIV infection in sub-Saharan Africa.

BACKGROUND: The geographical structure of an epidemic is ultimately a consequence of the drivers of the epidemic and the population susceptible to the infection. The 'know your epidemic' concept recognizes this geographical feature as a key element for identifying populations at higher risk of HIV infection where prevention interventions should be targeted. In an effort to clarify specific drivers of HIV transmission and identify priority populations for HIV prevention interventions, we conducted a comprehensive mapping of the spatial distribution of HIV infection across sub-Saharan Africa (SSA). METHODS: The main source of data for our study was the Demographic and Health Survey conducted in 20 countries from SSA. We identified and compared spatial clusters with high and low numbers of HIV infections in each country using Kulldorff spatial scan test. The test locates areas with higher and lower numbers of HIV infections than expected under spatial randomness. For each identified cluster, a likelihood ratio test was computed. A P-value was determined through Monte Carlo simulations to evaluate the statistical significance of each cluster. RESULTS: Our results suggest stark geographic variations in HIV transmission patterns within and across countries of SSA. About 14% of the population in SSA is located in areas of intense HIV epidemics. Meanwhile, another 16% of the population is located in areas of low HIV prevalence, where some behavioral or biological protective factors appear to have slowed HIV transmission. CONCLUSIONS: Our study provides direct evidence for strong geographic clustering of HIV infection across SSA. This striking pattern of heterogeneity at the micro-geographical scale might reflect the fact that most HIV epidemics in the general population in SSA are not far from their epidemic threshold. Our findings identify priority geographic areas for HIV programming, and support the need for spatially targeted interventions in order to maximize the impact on the epidemic in SSA.

Estimating treatment effects on health utility scores for patients living with migraine: a post hoc analysis of the DELIVER trial.

BACKGROUND: This post hoc analysis aimed to estimate eptinezumab's therapeutic effect on health utilities and determined to which extent monthly migraine days (MMDs) explain changes in health utilities. RESEARCH DESIGN/METHODS: DELIVER, a randomized, double-blind, placebo-controlled phase 3b trial (NCT04418765), investigated eptinezumab efficacy and safety in patients with 2-4 prior migraine treatment failures. Regression analysis explored the relationship between utility scores and MMDs, with eptinezumab treatment as a covariate along with MMDs to identify any MMD-independent effect on utilities. Path analysis quantified eptinezumab's impact as mediated through MMD reduction. RESULTS: The base case model showed that each reduction in MMD was associated with a mean utility score increase (0.0189; 95% CI: 0.0180, 0.0198; P < 0.001). Mean utility score was generally higher for eptinezumab versus placebo, justifying addition of treatment effect to the base case model. Patients administered eptinezumab had on average 0.0562 (95% CI: 0.0382, 0.0742; P < 0.001) higher utility versus placebo when controlling for number of MMDs. From path analysis, MMD reduction resulting from eptinezumab treatment accounted for 53% additional utility gain observed in patients. CONCLUSIONS: Changes in MMDs alone inadequately captured migraine's impact on patient utility, as there was also a positive eptinezumab-driven, treatment-specific impact on utility score. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov (CT.gov identifier: NCT04418765).

Epidemiological impact of public health interventions against diabetes in Qatar: mathematical modeling analyses.

Aims: To predict the epidemiological impact of specific, and primarily structural public health interventions that address lifestyle, dietary, and commuting behaviors of Qataris as well as subsidies and legislation to reduce type 2 diabetes mellitus (T2DM) burden among Qataris. Methods: A deterministic population-based mathematical model was used to investigate the impact of public health interventions on the epidemiology of T2DM among Qataris aged 20-79 years, which is the age range typically used by the International Diabetes Federation for adults. The study evaluated the impact of interventions up to 2050, a three-decade time horizon, to allow for the long-term effects of different types of interventions to materialize. The impact of each intervention was evaluated by comparing the predicted T2DM incidence and prevalence with the intervention to a counterfactual scenario without intervention. The model was parameterized using representative data and stratified by sex, age, T2DM risk factors, T2DM status, and intervention status. Results: All intervention scenarios had an appreciable impact on reducing T2DM incidence and prevalence. A lifestyle management intervention approach, specifically applied to those who are categorized as obese and ≥35 years old, averted 9.5% of new T2DM cases by 2050. An active commuting intervention approach, specifically increasing cycling and walking, averted 8.5% of new T2DM cases by 2050. Enhancing consumption of healthy diets including fruits and vegetables, specifically a workplace intervention involving dietary modifications and an educational intervention, averted 23.2% of new T2DM cases by 2050. A subsidy and legislative intervention approach, implementing subsidies on fruits and vegetables and taxation on sugar-sweetened beverages, averted 7.4% of new T2DM cases by 2050. A least to most optimistic combination of interventions averted 22.8-46.9% of new T2DM cases by 2050, respectively. Conclusions: Implementing a combination of individual-level and structural public health interventions is critical to prevent T2DM onset and to slow the growing T2DM epidemic in Qatar.

Impact of diabetes mellitus on tuberculosis epidemiology in Indonesia: A mathematical modeling analysis.

We investigated and forecasted the impact of diabetes mellitus (DM) on tuberculosis (TB) epidemiology in Indonesia between 2020 and 2050. A recently-developed age-structured TB-DM dynamic mathematical model was utilized to assess the impact of DM on TB epidemiology. Model parameters were informed by systematic reviews and meta-analyses. Sensitivity and uncertainty analyses were conducted to assess robustness of predictions. The proportion of TB incident cases attributed to DM increased from 18.8% (95% uncertainty interval (UI): 12.6%-24.3%) in 2020, to 20.9% (95% UI: 14.7%-27.1%) in 2030, and 25.8% (95% UI: 17.7%-32.2%) in 2050. The proportion of TB-related deaths attributed to DM increased from 24.3% (95% UI: 18.7%-29.1%) in 2020, to 27.7% (95% UI: 22.4%-32.4%) in 2030, and 34.3% (95% UI: 27.6%-38.0%) in 2050. Most of the impact of DM on TB transmission has risen because of faster progression to TB disease, increased risk of reinfection, and increased infectiousness, with higher bacterial loads. Sensitivity and uncertainty analyses affirmed the predictions. TB-DM synergy is projected to increase in Indonesia over the next three decades with DM becoming a major driver of TB incidence and deaths. Joint TB-DM management and programs could offer significant reductions in TB incidence and mortality, making post-2015 End TB targets more feasible.

Impact of trends and gender disparity in obesity on future type 2 diabetes in Turkey: a mathematical modelling analysis.

BACKGROUND: Using a previously developed and validated mathematical model, we predicted future prevalence of type 2 diabetes mellitus (T2DM) and major modifiable risk factors (obesity, physical inactivity and smoking) stratified by age and sex in Turkey up to the year 2050. METHODS: Our deterministic compartmental model fitted nationally representative demographic and risk factor data simultaneously for Turkish adults (aged 20-79) between 1997 and 2017, then estimated future trends. Our novel approach explored the impact of future obesity trends on these projections, specifically modelling (1) a gradual fall in obesity in women after the year 2020 until it equalled the age-specific levels seen in men and (2) cessation of the rise in obesity after 2020. RESULTS: T2DM prevalence is projected to rise from an estimated 14.0% (95% uncertainty interval (UI) 12.8% to 16.0%) in 2020 to 18.4% (95% UI 16.9% to 20.9%) by 2050; 19.7% in women and 17.2% in men by 2050; reflecting high levels of obesity (39.7% for women and 22.0% for men in 2050). Overall, T2DM prevalence could be reduced by about 4% if obesity stopped rising after 2020 or by 12% (22% in women) if obesity prevalence among women could be lowered to equal that of men. The higher age-specific obesity prevalence among women resulted in 2 076 040 additional women developing T2DM by the year 2050. CONCLUSION: T2DM is common in Turkey and will remain so. Interventions and policies targeting the high burden of obesity (and low physical activity levels), particularly in women, could significantly impact future disease burdens.

Type 2 diabetes epidemic and key risk factors in Qatar: a mathematical modeling analysis.

INTRODUCTION: We aimed to characterize and forecast type 2 diabetes mellitus (T2DM) disease burden between 2021 and 2050 in Qatar where 89% of the population comprises expatriates from over 150 countries. RESEARCH DESIGN AND METHODS: An age-structured mathematical model was used to forecast T2DM burden and the impact of key risk factors (obesity, smoking, and physical inactivity). The model was parametrized using data from T2DM natural history studies, Qatar's 2012 STEPwise survey, the Global Health Observatory, and the International Diabetes Federation Diabetes Atlas, among other data sources. RESULTS: Between 2021 and 2050, T2DM prevalence increased from 7.0% to 14.0%, the number of people living with T2DM increased from 170 057 to 596 862, and the annual number of new T2DM cases increased from 25 007 to 45 155 among those 20-79 years of age living in Qatar. Obesity prevalence increased from 8.2% to 12.5%, smoking declined from 28.3% to 26.9%, and physical inactivity increased from 23.1% to 26.8%. The proportion of incident T2DM cases attributed to obesity increased from 21.9% to 29.9%, while the contribution of smoking and physical inactivity decreased from 7.1% to 6.0% and from 7.3% to 7.2%, respectively. The results showed substantial variability across various nationality groups residing in Qatar-for example, in Qataris and Egyptians, the T2DM burden was mainly due to obesity, while in other nationality groups, it appeared to be multifactorial. CONCLUSIONS: T2DM prevalence and incidence in Qatar were forecasted to increase sharply by 2050, highlighting the rapidly growing need of healthcare resources to address the disease burden. T2DM epidemiology varied between nationality groups, stressing the need for prevention and treatment intervention strategies tailored to each nationality.

Spatial epidemiology of diabetes: Methods and insights.

Diabetes mellitus (DM) is a growing epidemic with global proportions. It is estimated that in 2019, 463 million adults aged 20-79 years were living with DM. The latest evidence shows that DM continues to be a significant global health challenge and is likely to continue to grow substantially in the next decades, which would have major implications for healthcare expenditures, particularly in developing countries. Hence, new conceptual and methodological approaches to tackle the epidemic are long overdue. Spatial epidemiology has been a successful approach to control infectious disease epidemics like malaria and human immunodeficiency virus. The implementation of this approach has been expanded to include the study of non-communicable diseases like cancer and cardiovascular diseases. In this review, we discussed the implementation and use of spatial epidemiology and Geographic Information Systems to the study of DM. We reviewed several spatial methods used to understand the spatial structure of the disease and identify the potential geographical drivers of the spatial distribution of DM. Finally, we discussed the use of spatial epidemiology on the design and implementation of geographically targeted prevention and treatment interventions against DM.

Implementation of a Vaccination Program Based on Epidemic Geospatial Attributes: COVID-19 Pandemic in Ohio as a Case Study and Proof of Concept.

Geospatial vaccine uptake is a critical factor in designing strategies that maximize the population-level impact of a vaccination program. This study uses an innovative spatiotemporal model to assess the impact of vaccination distribution strategies based on disease geospatial attributes and population-level risk assessment. For proof of concept, we adapted a spatially explicit COVID-19 model to investigate a hypothetical geospatial targeting of COVID-19 vaccine rollout in Ohio, United States, at the early phase of COVID-19 pandemic. The population-level deterministic compartmental model, incorporating spatial-geographic components at the county level, was formulated using a set of differential equations stratifying the population according to vaccination status and disease epidemiological characteristics. Three different hypothetical scenarios focusing on geographical subpopulation targeting (areas with high versus low infection intensity) were investigated. Our results suggest that a vaccine program that distributes vaccines equally across the entire state effectively averts infections and hospitalizations (2954 and 165 cases, respectively). However, in a context with equitable vaccine allocation, the number of COVID-19 cases in high infection intensity areas will remain high; the cumulative number of cases remained >30,000 cases. A vaccine program that initially targets high infection intensity areas has the most significant impact in reducing new COVID-19 cases and infection-related hospitalizations (3756 and 213 infections, respectively). Our approach demonstrates the importance of factoring geospatial attributes to the design and implementation of vaccination programs in a context with limited resources during the early stage of the vaccine rollout.

A systematic review of interventions to promote physical activity in six Gulf countries.

Physical activity (PA) levels are low in Gulf Cooperation Council countries (GCC; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, United Arab Emirates). We carried out a systematic review (PROSPERO registration number 131817) to assess the effect of interventions to increase PA levels in this region. We also assessed their effects on anthropometry and cardiovascular risk. A systematic search of six databases (Medline, EMBASE, SPORTDiscus, CINAHL, Cochrane, Web of Science) was performed to identify randomized and non-randomized intervention studies performed in adults and children published between January 1985 and November 2020. We included studies published in English or Arabic, and included PA interventions regardless of setting, delivery, and duration. The primary outcomes were changes in PA duration and intensity. Secondary outcomes included anthropometric measures (e.g., weight, body mass index) and cardiovascular risk profiles (e.g., lipid measures, blood glucose). Two independent reviewers screened studies in accordance with pre-determined criteria, extracted data, assessed risk of bias (Cochrane Risk of Bias 2 and Newcastle Ottawa Scale) and undertook a narrative synthesis. From 13,026 records identified, 14 studies were included. Nine studies focussed exclusively on changing PA behaviour, resulting in statistically significant increases in step count ranging from an additional 757 steps/day (95% confidence interval [CI] 0-1,513) to 3,853 steps/day (95% CI 3,703-4,002). Five identified studies were multi-component lifestyle interventions, targeting people at higher risk (due to obesity or type 2 diabetes). Evidence for increases in PA from multi-component studies was limited, although improvements were seen in outcomes e.g. body weight and blood lipid levels. In conclusion, relatively few studies have focussed on changing PA behaviour, despite the urgent need in the GCC. Limited evidence suggested that pedometer-based programmes encouraging step counting and walking were effective in promoting PA, at least in the short term. Policies to roll out such interventions should be implemented and evaluated.

Analytic Characterization of the Herpes Simplex Virus Type 2 Epidemic in the United States, 1950-2050.

BACKGROUND: We analytically characterized the past, present, and future levels and trends of the national herpes simplex virus type 2 (HSV-2) epidemic in the United States. METHODS: A population-level mathematical model was constructed to describe HSV-2 transmission dynamics and was fitted to the data series of the National Health and Nutrition Examination Survey. RESULTS: Over 1950-2050, antibody prevalence (seroprevalence) increased rapidly from 1960, peaking at 19.9% in 1983 in those aged 15-49 years, before reversing course to decline to 13.2% by 2020 and 8.5% by 2050. Incidence rate peaked in 1971 at 11.9 per 1000 person-years, before declining by 59% by 2020 and 70% by 2050. Annual number of new infections peaked at 1 033 000 in 1978, before declining to 667 000 by 2020 and 600 000 by 2050. Women were disproportionately affected, averaging 75% higher seroprevalence, 95% higher incidence rate, and 71% higher annual number of infections. In 2020, 78% of infections were acquired by those 15-34 years of age. CONCLUSIONS: The epidemic has undergone a major transition over a century, with the greatest impact in those 15-34 years of age. In addition to 47 million prevalent infections in 2020, high incidence will persist over the next 3 decades, adding >600 000 new infections every year.

Forecasting the type 2 diabetes mellitus epidemic and the role of key risk factors in Oman up to 2050: Mathematical modeling analyses.

AIMS/INTRODUCTION: To investigate and forecast type 2 diabetes mellitus epidemic, its related risk factors and cost in Oman by 2050. MATERIALS AND METHODS: An age-structured mathematical model was used to characterize type 2 diabetes mellitus epidemiology and trends in Oman between 1990 and 2050. The model was parametrized using current and quality data, including six nationally representative population-based epidemiological surveys for type 2 diabetes mellitus and its key risk factors. RESULTS: The projected type 2 diabetes mellitus prevalence increased from 15.2% in 2020 to 23.8% in 2050. The prevalence increased from 16.8 and 13.8% in 2020 among women and men to 26.3 and 21.4% in 2050, respectively. In 2020, 190,489 Omanis were living with type 2 diabetes mellitus compared with 570,227 in 2050. The incidence rate per 1,000 person-years changed from 8.3 in 2020 to 12.1 in 2050. Type 2 diabetes mellitus' share of Oman's national health expenditure grew by 36% between 2020 and 2050 (from 21.2 to 28.8%). Obesity explained 56.7% of type 2 diabetes mellitus cases in 2020 and 71.4% in 2050, physical inactivity explained 4.3% in 2020 and 2.7% in 2050, whereas smoking accounted for <1% of type 2 diabetes mellitus cases throughout 2020-2050. Sensitivity and uncertainty analyses affirmed these predictions. CONCLUSIONS: The type 2 diabetes mellitus epidemic in Oman is expected to increase significantly over the next three decades, consuming nearly one-third of the national health expenditure. The type 2 diabetes mellitus burden is heavily influenced by obesity. Interventions targeting this single risk factor should be a national priority to reduce and control the burden of type 2 diabetes mellitus in Oman.

A diabetes risk score for Qatar utilizing a novel mathematical modeling approach to identify individuals at high risk for diabetes.

We developed a diabetes risk score using a novel analytical approach and tested its diagnostic performance to detect individuals at high risk of diabetes, by applying it to the Qatari population. A representative random sample of 5,000 Qataris selected at different time points was simulated using a diabetes mathematical model. Logistic regression was used to derive the score using age, sex, obesity, smoking, and physical inactivity as predictive variables. Performance diagnostics, validity, and potential yields of a diabetes testing program were evaluated. In 2020, the area under the curve (AUC) was 0.79 and sensitivity and specificity were 79.0% and 66.8%, respectively. Positive and negative predictive values (PPV and NPV) were 36.1% and 93.0%, with 42.0% of Qataris being at high diabetes risk. In 2030, projected AUC was 0.78 and sensitivity and specificity were 77.5% and 65.8%. PPV and NPV were 36.8% and 92.0%, with 43.0% of Qataris being at high diabetes risk. In 2050, AUC was 0.76 and sensitivity and specificity were 74.4% and 64.5%. PPV and NPV were 40.4% and 88.7%, with 45.0% of Qataris being at high diabetes risk. This model-based score demonstrated comparable performance to a data-derived score. The derived self-complete risk score provides an effective tool for initial diabetes screening, and for targeted lifestyle counselling and prevention programs.

Characterizing epidemiology of prediabetes, diabetes, and hypertension in Qataris: A cross-sectional study.

OBJECTIVES: To characterize the epidemiologic profiles of prediabetes mellitus (preDM), diabetes mellitus (DM), and hypertension (HTN) in Qataris using the nationally representative 2012 Qatar STEPwise Survey. METHODS: A secondary data analysis of a cross-sectional survey that included 2,497 Qatari nationals aged 18-64 years. Descriptive and analytical statistical analyses were conducted. RESULTS: Prevalence of preDM, DM, and HTN in Qataris aged 18-64 years was 11.9% (95% confidence interval [CI] 9.6%-14.7%), 10.4% (95% CI 8.4%-12.9%), and 32.9% (95% CI 30.4%-35.6%), respectively. Age was the common factor associated with the three conditions. Adjusted analyses showed that unhealthy diet (adjusted odds ratio (aOR) = 1.84, 95% CI 1.01-3.36) was significantly associated with preDM; that physical inactivity (aOR = 1.66, 95% CI 1.12-2.46), central obesity (aOR = 2.08, 95% CI 1.02-4.26), and HTN (aOR = 2.18, 95% CI 1.40-3.38) were significantly associated with DM; and that DM (aOR = 2.07, 95% CI 1.34-3.22) was significantly associated with HTN. Population attributable fraction of preDM associated with unhealthy diet was 7.7%; of DM associated with physical inactivity, central obesity, and HTN, respectively, was 14.9%, 39.8%, and 17.5%; and of HTN associated with DM was 3.0%. CONCLUSIONS: One in five Qataris is living with either preDM or DM, and one in three is living with HTN, conditions that were found to be primarily driven by lifestyle factors. Prevention, control, and management of these conditions should be a national priority to reduce their disease burden and associated disease sequelae.