Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Direct and Indirect Costs Attributable to Alcohol Consumption in Germany

Aim: To estimate the direct and indirect costs of morbidity and mortality attributable to alcohol consumption in Germany from a societal perspective in 2002. Methods: Using the concept of attributable risks and the prevalence-based approach, age- and gender-specific alcohol-attributable fractions for morbidity and mortality were calculated for alcoholic disorder, neoplasms, endocrinological, nervous, circulatory, digestive, skin and perinatal disorders, and injuries and poisonings. The literature provided data on alcohol consumption in Germany by age, gender and dose amount, and relative risks. Direct costs were calculated based on routine resource utilisation and expenditure statistics. Indirect costs were calculated based on the human capital approach using a discount rate of 5%. Results: Alcohol consumption accounted for 5.5% of all deaths and 970_000 years of potential life lost. Total costs were _24_398 million, amounting to 1.16% of Germany's GDP, or _296 per person. Direct medical and non-medical costs were _8441 million. Indirect costs were _15_957 million (69% mortality and 31% morbidity costs). In contrast, protective health effects of alcohol consumption saved _4839 million. Conclusions: The magnitude of alcohol-attributable morbidity and mortality and associated costs demands more preventive efforts.Alcohol-use, Cost-of-illness

Costs of Inflammatory Bowel Disease in Germany

Introduction: Inflammatory bowel disease (IBD) is a chronic condition that afflicts young adults in their economically productive years. The goal of this study was to determine the costs of IBD in Germany from a societal perspective, using cost diaries. Methods: Members of the German Crohn's Disease and Ulcerative Colitis Association who had IBD were recruited by post, and those who agreed to participate documented their IBD-associated costs prospectively in a diary over 4 weeks. They documented their use of healthcare facilities, medications, sick leave and out-of-pocket expenditures, as well as general demographic information, the status and history of their IBD, and long-term disability. Item costs were calculated according to national sources. Cost data were calculated using non-parametric bootstrapping and presented as mean costs (year 2004) over 4 weeks. Results: The cost diaries were returned by 483 subjects (Crohn's disease: n_=_241, ulcerative colitis: n_=_242) with a mean age of 42 years and an average disease duration of 13 years (SD_+-_8.09). The cost diaries were regarded as `easy to complete' by 89% of participants. The mean 4-week costs per subject were _1425 (95% CI 1201, 1689) for Crohn's disease and _1015 (95% CI 832, 1258) for ulcerative colitis. Of the total costs for Crohn's disease, 64% were due to indirect costs such as early retirement or sick leave and 32% were due to direct medical costs. In contrast, of the total costs for ulcerative colitis, 41% were due to direct medical costs and 54% to indirect costs. Conclusions: This is the first comprehensive cost study for Crohn's disease and ulcerative colitis in Germany. The most important economic factors that influenced the cost profiles of both diseases were the long-term productivity losses due to an ongoing inability to work and the cost of medications. Results indicate significant cost differences between Crohn's disease and ulcerative colitis. This data provides initial cost estimates that can be analysed further with respect to cost determinants and disease-specific costs in the future.Cost-of-illness, Crohn's-disease, Inflammatory-bowel-disease, Ulcerative-colitis

Cost Effectiveness of Adding Folinic Acid to Fluorouracil Plus Levamisole as Adjuvant Chemotherapy in Patients with Colon Cancer in Germany

Objective: To assess the cost effectiveness of the addition of folinic acid to fluorouracil plus levamisole in patients with colon cancer from the perspective of the German Social Health Insurance. Study Design and Methods: Patients with International Union Against Cancer (Union International Contre Cancer; UICC) II/T4 or UICC III colon cancer enrolled in an open-label randomised clinical trial in Germany (Forschungsgruppe Onkologie Gastrointestinaler Tumoren-1 [FOGT-1]) received either fluorouracil plus levamisole (A, standard) or fluorouracil plus levamisole and folinic acid (B) for 12 months as adjuvant chemotherapy after curative intended surgery. Outcome measures for economic evaluation were disease-free life-years gained (df-LYG) and overall life-years gained (LYG) derived from the respective Kaplan-Meier survival curves. Direct medical costs from the perspective of the German Social Health Insurance were estimated retrospectively (2000 values) and incremental cost-effectiveness ratios (ICERs) were calculated. A Markov model was used to project the trial results beyond 5 years for the patients Results: Adding folinic acid to the fluorouracil/levamisole regimen results in an increase in time to progression and survival in patients with locally advanced colon cancer. Within the trial period of 5 years ICERs (B versus A) were Conclusions: Results of this cost-effectiveness analysis suggest that the addition of folinic acid offers clinical benefits at additional costs which are likely to be acceptable for decision makers in the long term. Cost-effectiveness ratios calculated within the clinical trial period were just aboveAntineoplastics, Colorectal-cancer, Cost-effectiveness, Fluorouracil, Folinic-acid, Levamisole, Pharmacoeconomics

Validation of the FIMA Questionnaire for Health-Related Resource Use Against Medical Claims Data: The Role Played by Length of Recall Period

Seidl H, Hein L, Scholz S, et al. Validierung des FIMA-Fragebogens zur Inanspruchnahme von Versorgungsleistungen anhand von Routinedaten der Krankenversicherung: Welchen Einfluss hat der Erinnerungszeitraum? Gesundheitswesen . 2019.Ziel Das Ziel der Studie ist die Validierung des Fragebogens zur Inanspruchnahme Medizinischer und nicht-medizinischer Versorgungsleistungen im Alter (FIMA). Methodik Die Selbstangaben von 1552 Teilnehmern wurden mit den Routinedaten der Krankenversicherung abgeglichen. Als Güteparameter wurden Intraklassenkorrelation (ICC), Sensitivität, Spezifität und Kappa-Koeffizienten nach Cohen bestimmt. Der Einfluss von soziodemografischen und gesundheitlichen Faktoren, des Erinnerungszeitraums (3, 6 oder 12 Monate) sowie der Häufigkeit der Inanspruchnahme wurde anhand logistischer Regressionen untersucht. Ergebnisse Die durchschnittlich 74 Jahre alten Teilnehmer stuften den FIMA größtenteils (95%) als einfach auszufüllen ein. Die Anzahl der Arztkontakte wurde je nach Erinnerungszeitraum zwischen 9 bis 28% unterschätzt, der ICC war für jeden Zeitraum mittelmäßig (ICC: 0,46, 0,48, 0,55). Die Anzahl physiotherapeutischer Kontakte wurde insgesamt sehr gut erinnert (ICC>0,75). Bei den Rehabilitations- und Krankenhaustagen gab es Unterschiede zwischen den Erinnerungszeiträumen (3/6/12 Monate): Rehabilitation: ICC=0,88/0,51/0,87; Krankenhaustage: ICC=0,69/0,88/0,66. Die Selbstangaben für die Leistungen aus der Pflegeversicherung zeigten durchgehend sehr hohe Kappa-Koeffizienten (>0,90) während die Hilfsmittel über alle Zeiträume eine schlechte Übereinstimmung (Kappa0,40) zeigten. In der ambulanten (Arzt, Physiotherapeut) und der stationären Versorgung (Rehabilitation, Krankenhaus) sank die Chance der Übereinstimmung pro zusätzlichem Kontakt signifikant. Darüber hinaus führte ein besserer Gesundheitszustand zu einer exakteren Erinnerung an Physiotherapeutenkontakte. Schlussfolgerung Der FIMA weist in weiten Teilen eine gute Reliabilität auf. Er ist sehr gut verständlich und ein valides Instrument, um Kosten der Gesundheitsversorgung in der älteren Bevölkerung zu ermitteln.AIM TO VALIDATE: the questionnaire on health-related resource use in an elderly population (FIMA).; METHODS: Self-reported health care use of 1,552 participants was validated against medical claims data. Reliability was measured by intraclass correlation coefficient (ICC), sensitivity, specificity, and Cohen's Kappa. Linear regression models were used to investigate the association between validity and individual characteristics, health state, recall period (3, 6, or 12 months), or frequency of resource use.; RESULTS: On average, participants were 74 years old; 95% rated the questionnaire as easy. The number of physician contacts was underestimated depending on recall period by 9 to 28% and the ICC was moderate (3/6/12 months, ICC 0.46/0.48/0.55), whereas contacts with physiotherapists were remembered quite well (ICC>0.75). Remembering the number of days in rehabilitation and hospital differed by recall periods (3/6/12 months); rehabilitation ICC=0.88/0.51/0.87; hospital ICC=0.69/0.88/0.66. Very good reliability of self-reported long-term care insurance benefits was found for all recall periods (Kappa>0.90) while agreement in self-reported medical aid was poor (Kappa0.40). The chance of agreement between self-reports and claims data significantly decreased with the number of contacts. Individuals with better health had a significantly higher chance of reporting contacts with physiotherapists accurately.; CONCLUSION: The FIMA largely demonstrated good reliability. The FIMA is a coherent and valid instrument to collect health-related resource use in health economic studies in an elderly population. © Georg Thieme Verlag KG Stuttgart · New York

Complex coevolution of depression and health-related quality of life in old age

Purpose To investigate the coevolution of depression and health-related quality of life (HRQoL) in old age. Methods In a representative survey of the German general population aged 75 years and older, the course of HRQoL and depression was observed over 4.5 years (3 waves). HRQoL was assessed by the Visual Analogue Scale (EQ VAS) of the EQ-5D instrument, while the Geriatric Depression Scale was used to measure depression. A panel vector autoregressive model was used to account for the complex coevolution of depression and HRQoL. Unobserved heterogeneity was taken into account by taking the first differences. Results We revealed a robust negative association between an initial change in HRQoL and a subsequent change in depression score, with substantial sex differences: In women there was a robust association, while in men the significance of this association depended on the model specification. Surprisingly, in the total sample and in both sexes, no robust association between an initial increase in depression and a subsequent change in HRQoL was found. Conclusions Findings indicate that the direction of evolution from HRQoL to depression deserves more attention. Furthermore, treatment of depression in late life should aim at improving HRQoL in which remission of depressive symptoms is necessary but not sufficient

Depression, non-fatal stroke and all-cause mortality in old age: A prospective cohort study of primary care patients

AbstractBackgroundDepression is a risk factor for stroke and mortality but whether this also holds into old age is uncertain. We therefore studied the association of depression with the risk for non-fatal stroke and all-cause mortality in very old age.MethodsA representative sample of 3085 primary care patients aged ≥75 years were serially assessed during a 6-year follow-up. The relation between depression (Geriatric Depression Scale >6, n=261) and relevant covariates including vascular risk factors and disease, functional and mild cognitive impairment and ApoE genotype on primary care givers information of incident stroke (n=209) and mortality (n=647) were assessed by Cox regression and by competing risk regressions.ResultsDepression was not independently associated with incident stroke in fully adjusted models that treated death as the competing event (subdistribution hazard ratio=0.80, 95% confidence interval=0.47 to 1.36). The risk associated with depression was similar for men and women, and for age groups 75–79, 80–84 and ≥85 years. In contrast, depression increased all-cause mortality rates, even after adjusting for a range of confounders (hazard ratio=1.31, 95% confidence interval=1.03 to 1.67).LimitationsWe have no information on past depressive episodes and cause of death.ConclusionsIn contrast to reports in younger populations, depression does not appear to increase stroke risk among the old and very old, but continuous to be a risk factor for all-cause mortality