Assessing the Impacts of Smoking and Obesity on Mortality and Morbidity in the United States

Assessing the Impacts of Smoking and Obesity on Mortality and Morbidity in the United States Bochen Cao Michel Guillot Smoking and obesity are two leading risk factors that account for the current US lags in advances in health and longevity compared to other wealthy nations. This dissertation consists of three independent studies of the impacts of smoking and obesity on population health outcomes among older adults in the United States. The first study estimates the effects of the recent smoking decline on future all-cause mortality, based on the association observed between cohort smoking pattern and cohort death rates from lung cancer. We find that change in smoking is expected to have a large effect on U.S. mortality. However, compared to men, women are expected to have smaller increase in future life expectancy, because of their lagged decline in smoking. The second study extends the first one and estimates the joint effects of smoking and obesity on both mortality and disability. A multistate lifetable approach is applied to estimate the transition rates between different health states, which are in turn projected up to 2040 using a modified Lee-Carter model that incorporates cohort histories of smoking and obesity. The results indicate men and women both are expected to experience compression of disability, with increasing proportions of their future gain in life expectancy likely to be disability free. Nevertheless, due to gender difference in smoking history and in response to obesity, men will likely to have an advantage over women in health improvement in the next three decades. The third study investigates the direct effects of both obesity and weight change on mortality. A dynamic causal model is applied to adjust for reverse causality that is attributable to illness-associated and smoking-associated weight loss in a time-dependent fashion, a problem that prior studies often fail to adequately handle. This study demonstrates that both the confounding by illness and by smoking lead to overestimates of the effects of being underweight and of weight loss, but underestimates the effect of being obese. Moreover, not only being underweight or severe obese, but also sharp weight fluctuations are associated with excess mortality risk

Suicide worldwide in 2019

More than 700 000 persons die by suicide every year globally. Suicide is the fourth leading cause of death among 15-29 year olds. The reduction of suicide rates in countries is an indicator in the UN SDGs, the WHO GPW13 and Mental Health Action Plan. Information material on data and statistics is necessary for advocacy and information purposes. This booklet provides this essential information in an accessible and digestible format. Target audiences are academics/researchers, development agencies, general public, health workers, journalists/media, nongovernmental organizations, policy-makers

Global Report on the epidemiology and burden on sepsis: current evidence, identifying gaps and future directions

Sepsis is a preventable, life-threatening condition marked by severe organ dysfunction. For 2017, it was estimated that it had affected 49 million individuals and was related to approximately 11 million potentially avoidable deaths worldwide. Sepsis mortality is often related to suboptimal quality of care, an inadequate health infrastructure, poor infection prevention measures in place, late diagnosis, and inappropriate clinical management. Antimicrobial resistance further complicates sepsis management across all settings, particularly in high-risk populations, such as neonates and patients in intensive care units (ICUs). While primary infections have remained the leading cause of sepsis and sepsis-related mortality over the last three decades, there has been a marked increase in the proportion of sepsis incidence and mortality linked to injuries and non-communicable diseases. Moreover, survivors of sepsis face serious long-term health consequences in the form of increased post-discharge mortality, physical and cognitive impairment, and mental health disorders. Unfortunately, high-quality epidemiological data on the burden of sepsis are limited by inconsistent and variable diagnostic criteria, few prospective studies, and suboptimal administrative data and hospital discharge coding

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021:a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed.FundingBill &amp; Melinda Gates Foundation.<br/

A call for standardised age-disaggregated health data.

The 2030 Sustainable Development Goals agenda calls for health data to be disaggregated by age. However, age groupings used to record and report health data vary greatly, hindering the harmonisation, comparability, and usefulness of these data, within and across countries. This variability has become especially evident during the COVID-19 pandemic, when there was an urgent need for rapid cross-country analyses of epidemiological patterns by age to direct public health action, but such analyses were limited by the lack of standard age categories. In this Personal View, we propose a recommended set of age groupings to address this issue. These groupings are informed by age-specific patterns of morbidity, mortality, and health risks, and by opportunities for prevention and disease intervention. We recommend age groupings of 5 years for all health data, except for those younger than 5 years, during which time there are rapid biological and physiological changes that justify a finer disaggregation. Although the focus of this Personal View is on the standardisation of the analysis and display of age groups, we also outline the challenges faced in collecting data on exact age, especially for health facilities and surveillance data. The proposed age disaggregation should facilitate targeted, age-specific policies and actions for health care and disease management

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Estimating the Effects of Obesity and Weight Change on Mortality Using a Dynamic Causal Model

<div><p>Background</p><p>A well-known challenge in estimating the mortality risks of obesity is reverse causality attributable to illness-associated and smoking-associated weight loss. Given that the likelihood of chronic and acute illnesses rises with age, reverse causality is most threatening to estimates derived from elderly populations.</p><p>Methods</p><p>I analyzed data from 12,523 respondents over 50 years old from a nationally representative longitudinal dataset, the Health and Retirement Study (HRS). The effects of both baseline body weight and time-varying weight change on mortality are estimated, adjusting for demographic and socio-economic variables, as well as time-varying confounders including illness and smoking. Body weight is measured by body mass index (BMI). In survival models for mortality, illness and smoking were lagged to minimize bias from reverse causality in estimates of the effect of weight change. Furthermore, because illness both causes and is caused by changes in BMI, I used a marginal structural model (MSM) rather than standard adjustment to control confounding by this and other time-dependent factors.</p><p>Results</p><p>Overall, relative to normal weight, underweight and Class II/III at baseline are associated with hazard ratios that are 2.07 (95% confidence interval (CI): 1.28–3.37) and 1.82 (1.54–2.16) respectively, whereas overweight and Class I obesity do not significantly lower or raise the mortality risks. Furthermore, relative to stable weight change, all types of weight change lead to significantly increased risk of mortality. Specifically, large weight loss results in a mortality risk that is nearly 3.86 (3.26–4.58) times of staying in the stable weight range and small weight loss is about 1.81 (1.55–2.11 ) times riskier. In contrast, large weight gain and small weight gain are associated with hazard ratios that are 1.98 (1.67–2.35) and 1.20 (1.02–1.41) respectively.</p><p>Conclusions</p><p>Being underweight or severe obese at baseline is associated with excess mortality risk, and weight change tend to raise mortality risk. Both the confounding by illness and by smoking lead to overestimates of the effects of being underweight at baseline and of weight loss, but underestimates the effect of being obese at baseline.</p></div

Baseline Characteristics by Weight Change Status through All Interviews.

<p>Notes:</p><p>Numbers are percentages unless otherwise noted. Standard deviations for continuous variables are in parentheses. Individuals can appear in multiple weight-change categories.</p><p>Baseline Characteristics by Weight Change Status through All Interviews.</p

Adjusted Effects of Baseline BMI and Weight Change Over Time on Mortality (Marginal Structural Models by Smoking Status).

<p>Notes:</p><p>Both models are built on Marginal Structural Model that includes covariates for SES and socio-demographic characteristics (gender, age at first interview, race/ethnicity, education, and household income), covariates</p><p>for health behaviors (physical activity), and covariates for health conditions (previous diagnosis of chronic</p><p>diseases and self-rated health conditions)</p><p>*<i>p</i> < .05.</p><p>**<i>p</i> < .01.</p><p>***<i>p</i> < .001.</p><p>Adjusted Effects of Baseline BMI and Weight Change Over Time on Mortality (Marginal Structural Models by Smoking Status).</p