A perfect #storm in the #Caribbean requires a concerted #response (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

A perfect storm in the Caribbean requires a concerted response

Sandeep Maharaj, Terence Seemungal, Martin McKee

Published: September 17, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)31822-7

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The countries of the Caribbean are facing a perfect storm of events that pose a severe threat to the health of their people. 2018 was the third consecutive year of above average meteorological activity, with several countries, including Anguilla and the British Virgin Islands, devastated by major hurricanes. The effects of climate change mean the situation can only get worse.

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We declare no competing interests.

Keywords: Public Health; Hurricanes; Caribbean; Society; Poverty.

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#Variations in common #diseases, #hospital admissions, and #deaths in middle-aged #adults in 21 countries from five continents (#PURE): a prospective cohort study (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Variations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE): a prospective cohort study

Prof Gilles R Dagenais, MD †, Darryl P Leong, PhD †, Sumathy Rangarajan, MSc, Fernando Lanas, PhD, Prof Patricio Lopez-Jaramillo, PhD, Prof Rajeev Gupta, PhD, Rafael Diaz, MD, Prof Alvaro Avezum, PhD, Gustavo B F Oliveira, PhD, Prof Andreas Wielgosz, PhD, Shameena R Parambath, MBBS, Prem Mony, MD, Khalid F Alhabib, MBBS, Ahmet Temizhan, MD, Noorhassim Ismail, MD, Jephat Chifamba, DPhil, Karen Yeates, MD, Rasha Khatib, PhD, Prof Omar Rahman, MD, Katarzyna Zatonska, PhD, Khawar Kazmi, MD, Prof Li Wei, PhD, Prof Jun Zhu, MD, Prof Annika Rosengren, MD, Prof K Vijayakumar, MD, Manmeet Kaur, PhD, Prof Viswanathan Mohan, MD, AfzalHussein Yusufali, MD, Prof Roya Kelishadi, MD, Prof Koon K Teo, PhD, Philip Joseph, MD, Prof Salim Yusuf, DPhil

Published: September 03, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)32007-0

 

Summary

Background

To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches.

Methods

The PURE study is a prospective, population-based cohort study of individuals aged 35–70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the age-standardised and sex-standardised incidence of these events per 1000 person-years.

Findings

This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9·5 years (IQR 8·5–10·9). During follow-up, 11 307 (7·0%) participants died, 9329 (5·7%) participants had cardiovascular disease, 5151 (3·2%) participants had a cancer, 4386 (2·7%) participants had injuries requiring hospital admission, 2911 (1·8%) participants had pneumonia, and 1830 (1·1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7·1 cases per 1000 person-years) and in MICs (6·8 cases per 1000 person-years) than in HICs (4·3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13·3 deaths per 1000 person-years) were double those in MICs (6·9 deaths per 1000 person-years) and four times higher than in HICs (3·4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs ( vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0·4 in HICs, 1·3 in MICs, and 3·0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs.

Interpretation

Among adults aged 35–70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care.

Funding

Full funding sources are listed at the end of the paper (see Acknowledgments).

Keywords: Public Health; Worldwide.

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#Ambient #Particulate #Air #Pollution and Daily #Mortality in 652 Cities (N Engl J Med., abstract)

[Source: The New England Journal of Medicine, full page: (LINK). Abstract, edited.]

Ambient Particulate Air Pollution and Daily Mortality in 652 Cities

Cong Liu, M.S., Renjie Chen, Ph.D., Francesco Sera, Ph.D., Ana M. Vicedo-Cabrera, Ph.D., Yuming Guo, Ph.D., Shilu Tong, Ph.D., Micheline S.Z.S. Coelho, Ph.D., Paulo H.N. Saldiva, Ph.D., Eric Lavigne, Ph.D., Patricia Matus, Ph.D., Nicolas Valdes Ortega, M.Sc., Samuel Osorio Garcia, Ph.D., et al.

 

Abstract

BACKGROUND

The systematic evaluation of the results of time-series studies of air pollution is challenged by differences in model specification and publication bias.

METHODS

We evaluated the associations of inhalable particulate matter (PM) with an aerodynamic diameter of 10 μm or less (PM10) and fine PM with an aerodynamic diameter of 2.5 μm or less (PM2.5) with daily all-cause, cardiovascular, and respiratory mortality across multiple countries or regions. Daily data on mortality and air pollution were collected from 652 cities in 24 countries or regions. We used overdispersed generalized additive models with random-effects meta-analysis to investigate the associations. Two-pollutant models were fitted to test the robustness of the associations. Concentration–response curves from each city were pooled to allow global estimates to be derived.

RESULTS

On average, an increase of 10 μg per cubic meter in the 2-day moving average of PM10 concentration, which represents the average over the current and previous day, was associated with increases of 0.44% (95% confidence interval [CI], 0.39 to 0.50) in daily all-cause mortality, 0.36% (95% CI, 0.30 to 0.43) in daily cardiovascular mortality, and 0.47% (95% CI, 0.35 to 0.58) in daily respiratory mortality. The corresponding increases in daily mortality for the same change in PM2.5 concentration were 0.68% (95% CI, 0.59 to 0.77), 0.55% (95% CI, 0.45 to 0.66), and 0.74% (95% CI, 0.53 to 0.95). These associations remained significant after adjustment for gaseous pollutants. Associations were stronger in locations with lower annual mean PM concentrations and higher annual mean temperatures. The pooled concentration–response curves showed a consistent increase in daily mortality with increasing PM concentration, with steeper slopes at lower PM concentrations.

CONCLUSIONS

Our data show independent associations between short-term exposure to PM10 and PM2.5 and daily all-cause, cardiovascular, and respiratory mortality in more than 600 cities across the globe. These data reinforce the evidence of a link between mortality and PM concentration established in regional and local studies. (Funded by the National Natural Science Foundation of China and others.)

Keywords: Environmental pollution; Society.

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#Gambling #harm: a #global #problem requiring global solutions (Lancet, summary)

[Source: The Lancet, full page: (LINK). Summary, edited.]

Gambling harm: a global problem requiring global solutions

Gerda Reith, Heather Wardle, Ian Gilmore

Published: August 20, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)31991-9

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Addicted to Gambling, an episode of the BBC’s Panorama programme broadcast on Aug 12, 2019, highlighted the profound harms that can be associated with gambling and the impact these have on individuals, families, and society. According to data published in England, problem gamblers are much more likely to think about taking their lives and to attempt suicide than those who do not have a gambling problem. 1 Other publications have highlighted the importance of a public health approach to gambling 2,3 and research from different jurisdictions shows a similar picture. Swedish data suggested a 15-times increase in mortality among people with gambling disorder. 4 Research from Victoria, Australia, conservatively estimated that around 2% of deaths by suicide were related to gambling. 5

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Keywords: Society; Psychiatry; Public Health.

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#Emergency #Declarations for #PublicHealth Issues: Expanding Our #Definition of Emergency (J Law Med Ethics, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Law Med Ethics. 2019 Jun;47(2_suppl):95-99. doi: 10.1177/1073110519857328.

Emergency Declarations for Public Health Issues: Expanding Our Definition of Emergency.

Sunshine G1, Barrera N1, Corcoran AJ1, Penn M1.

Author information: 1 Gregory Sunshine, J.D., serves as a public health analyst with the Public Health Law Program in the Center for State, Tribal, Local, and Territorial Support at the Centers for Disease Control and Prevention (CDC). Gregory oversees research on topics such as disaster and public health emergency declarations, state Ebola monitoring and movement policies, isolation and quarantine, and medical countermeasures, and he has published on topics such as gubernatorial emergency authorities, Ebola and the law, and tribal emergency declarations. Gregory earned his J.D. with a certificate in health law from the University of Maryland School of Law in Baltimore, Maryland, and his bachelor of arts in political science from Dickinson College in Carlisle, Pennsylvania. Nancy Barrera, J.D., M.P.H., is a senior attorney with the California Department of Public Health, Office of Legal Services. Nancy has extensive experience in public health and has advised various public health programs, including tobacco control, chronic diseases, vital records, injury control, family health programs, health care quality, health equity, and civil rights. Currently, she advises the communicable diseases and emergency preparedness programs on important public health legal issues. Nancy earned her J.D. from the University of the Pacific, McGeorge School of Law in Sacramento, California, and her M.P.H. from San Jose State University, California. Aubrey Joy Corcoran, J.D., M.P.H., is the health unit chief in the Education and Health Section of Arizona’s Office of the Attorney General, where she practices public health law. Aubrey Joy’s practice includes litigation at the administrative, trial, and appellate levels in Arizona and federal courts. She earned her J.D. with a certificate in health law from the Sandra Day O’Connor College of Law at Arizona State University in Tempe, Arizona and her M.P.H. from the Rollins School of Public Health at Emory University in Atlanta, Georgia. Matthew Penn, J.D., M.L.I.S., is the director of the Public Health Law Program within CDC’s Center for State, Tribal, Local, and Territorial Support. In this role he provides critical legal expertise and leadership to advance public health practice through law. Matthew developed expertise in legal preparedness issues as lead counsel for South Carolina Department of Health and Environmental Control’s Office of Public Health Preparedness, the South Carolina Advisory Committee for the Emergency System for Advance Registration of Volunteer Health Professionals, and the South Carolina Pandemic Influenza Ethics Task Force. Mr. Penn earned his J.D. from the University of South Carolina School of Law and his M.L.I.S. from the University of South Carolina in Columbia.

 

Abstract

Emergency declarations are a vital legal authority that can activate funds, personnel, and material and change the legal landscape to aid in the response to a public health threat. Traditionally, declarations have been used against immediate and unforeseen threats such as hurricanes, tornadoes, wildfires, and pandemic influenza. Recently, however, states have used emergency declarations to address public health issues that have existed in communities for months and years and have risk factors such as poverty and substance misuse. Leaders in these states have chosen to use emergency powers that are normally reserved for sudden catastrophes to address these enduring public health issues. This article will explore emergency declarations as a legal mechanism for response; describe recent declarations to address hepatitis A and the opioid overdose epidemic; and seek to answer the question of whether it is appropriate to use emergency powers to address public health issues that are not traditionally the basis for an emergency declaration.

PMID: 31298138 DOI: 10.1177/1073110519857328

Keywords: USA; Public Health.

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#Insurance #Reimbursements for Routinely Recommended #Adult #Vaccines in the #Private Sector (Am J Prev Med., abstract)

[Source: American Journal of Preventive Medicine, full page: (LINK). Abstract, edited.]

Insurance Reimbursements for Routinely Recommended Adult Vaccines in the Private Sector

Yuping Tsai, PhD , Fangjun Zhou, PhD, Megan C. Lindley, MPH

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

DOI: https://doi.org/10.1016/j.amepre.2019.03.011 / Published online: June 25, 2019

 

Abstract

Introduction

Financial concerns are frequently cited by providers as a barrier to adult vaccination. This study assessed insurance reimbursements to providers for administering vaccines to adults in the private sector.

Methods

This study, conducted in 2018, used the 2016 MarketScan Commercial Claims and Encounters Database and included vaccination visits made by adults aged 19–64 years. Four routinely recommended vaccines targeted at adults were included: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap); tetanus and diphtheria toxoids (Td); zoster; and influenza. The mean reimbursements for vaccine purchase and administration were reported and examined by state, metropolitan statistical area, provider type, and insurance plan type. Using the private vaccine purchase price published by the Centers for Disease Control and Prevention (CDC), the study reported the proportion of vaccination visits receiving reimbursements above the CDC-published price.

Results

The mean vaccine administration reimbursement was $25.80 for the first dose and $14.71 for additional doses in the same visit. The mean vaccine purchase reimbursement was $44.15 for Tdap, $25.78 for Td, and $216.05 for the zoster vaccine; the unweighted mean for the four examined influenza vaccines was $17.25. Reimbursements varied widely by state. Vaccine reimbursements exceeded the CDC-published price for most visits where Tdap (71.4%), zoster (87.8%), and three of four influenza (61.5%–88.5%) vaccines were administered but only for 25.8% of visits where Td was given.

Conclusions

On average, reimbursements for administering vaccines to privately insured adults were adequate for most private practices. However, providers’ financial concerns may vary across geographic locations.

Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

Keywords: USA; Vaccines; Public Health.

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#Mortality, #morbidity, and #risk #factors in #China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017 (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Prof Maigeng Zhou, PhD *, Haidong Wang, PhD *, Xinying Zeng, MS, Peng Yin, PhD, Prof Jun Zhu, MD, Prof Wanqing Chen, PhD, Xiaohong Li, PhD, Prof Lijun Wang, MS, Prof Limin Wang, MS, Yunning Liu, MS, Jiangmei Liu, MS, Mei Zhang, PhD, Jinlei Qi, PhD, Prof Shicheng Yu, PhD, Ashkan Afshin, MD, Prof Emmanuela Gakidou, PhD, Scott Glenn, MSc, Varsha Sarah Krish, BA, Molly Katherine Miller-Petrie, MSc, W Cliff Mountjoy-Venning, BA, Erin C Mullany, BA, Sofia Boston Redford, MPH, Hongyan Liu, PhD, Prof Mohsen Naghavi, PhD, Prof Simon I Hay, DSc, Prof Linhong Wang, MD, Prof Christopher J L Murray, DPhil, Xiaofeng Liang, MD

Open Access / Published: June 24, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30427-1

 

Summary

Background

Public health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 to help inform decision making and monitor progress on health at the province level.

Methods

We used the methods in GBD 2017 to analyse health patterns in the 34 province-level administrative units in China from 1990 to 2017. We estimated all-cause and cause-specific mortality, years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life-years (DALYs), summary exposure values (SEVs), and attributable risk. We compared the observed results with expected values estimated based on the Socio-demographic Index (SDI).

Findings

Stroke and ischaemic heart disease were the leading causes of death and DALYs at the national level in China in 2017. Age-standardised DALYs per 100 000 population decreased by 33·1% (95% uncertainty interval [UI] 29·8 to 37·4) for stroke and increased by 4·6% (–3·3 to 10·7) for ischaemic heart disease from 1990 to 2017. Age-standardised stroke, ischaemic heart disease, lung cancer, chronic obstructive pulmonary disease, and liver cancer were the five leading causes of YLLs in 2017. Musculoskeletal disorders, mental health disorders, and sense organ diseases were the three leading causes of YLDs in 2017, and high systolic blood pressure, smoking, high-sodium diet, and ambient particulate matter pollution were among the leading four risk factors contributing to deaths and DALYs. All provinces had higher than expected DALYs per 100 000 population for liver cancer, with the observed to expected ratio ranging from 2·04 to 6·88. The all-cause age-standardised DALYs per 100 000 population were lower than expected in all provinces in 2017, and among the top 20 level 3 causes were lower than expected for ischaemic heart disease, Alzheimer’s disease, headache disorder, and low back pain. The largest percentage change at the national level in age-standardised SEVs among the top ten leading risk factors was in high body-mass index (185%, 95% UI 113·1 to 247·7]), followed by ambient particulate matter pollution (88·5%, 66·4 to 116·4).

Interpretation

China has made substantial progress in reducing the burden of many diseases and disabilities. Strategies targeting chronic diseases, particularly in the elderly, should be prioritised in the expanding Chinese health-care system.

Funding

China National Key Research and Development Program and Bill & Melinda Gates Foundation.

Keywords: China; Public Health; Society.

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