World mortality 1950-2000: divergence replaces convergence from the late 1980s.

OBJECTIVE: We sought to investigate to what extent worldwide improvements in mortality over the past 50 years have been accompanied by convergence in the mortality experience of the world's population. METHODS: We have adopted a novel approach to the objective measurement of global mortality convergence. The global mortality distribution at a point in time is quantified using a dispersion measure of mortality (DMM). Trends in the DMM indicate global mortality convergence and divergence. The analysis uses United Nations data for 1950-2000 for all 152 countries with populations of at least 1 million in 2000 (99.7% of the world's population in 2000). FINDINGS: The DMM for life expectancy at birth declined until the late 1980s but has since increased, signalling a shift from global convergence to divergence in life expectancy at birth. In contrast, the DMM for infant mortality indicates continued convergence since 1950. CONCLUSION: The switch in the late 1980s from the global convergence of life expectancy at birth to divergence indicates that progress in reducing mortality differences between many populations is now more than offset by the scale of reversals in adult mortality in others. Global progress needs to be judged on whether mortality convergence can be re-established and indeed accelerated

Socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in India: analysis of nationally-representative survey data.

BACKGROUND: Hypertension is a major contributing factor to the current epidemic of cardiovascular disease in India. Small studies suggest high, and increasing, prevalence especially in urban areas, with poor detection and management, but national data has been lacking. The aim of the current study was to use nationally-representative survey data to examine socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in Indian adults. METHODS: Using data on self-reported diagnosis and treatment, and blood pressure measurement, collected from 12,198 respondents aged 18+ in the 2007 WHO Study on Global Ageing and Adult Health in India, factors associated with prevalence, diagnosis and treatment of hypertension were investigated. RESULTS: 22% men and 26% women had hypertension; prevalence increased steeply with body mass index (<18.5 kg/m(2): 18% men, 21% women; 25-29.9 kg/m(2): 35% men, 35% women), was higher in the least poor vs. poorest (men: odds ratio (95%CI) 1.82 (1.20 to 2.76); women: 1.40 (1.08 to 1.81)), urban vs. rural men (1.64 (1.19 to 2.25)), and men recently vs. never using alcohol (1.96 (1.40 to 2.76)). Over half the hypertension in women, and 70% in men, was undetected with particularly poor detection rates in young urban men, and in poorer households. Two-thirds of men and women with detected hypertension were treated. Two-thirds of women treated had their hypertension controlled, irrespective of urban/rural setting or wealth. Adequate blood pressure control was sub-optimal in urban men. CONCLUSION: Hypertension is very common in India, even among underweight adults and those of lower socioeconomic position. Improved detection is needed to reduce the burden of disease attributable to hypertension. Levels of treatment and control are relatively good, particularly in women, although urban men require more careful attention

Low birth weight persists in South Asian babies born in England and Wales regardless of maternal country of birth. Slow pace of acculturation, physiological constraint or both? Analysis of routine data.

BACKGROUND: The mean birth weight of offspring of Bangladeshi, Indian and Pakistani women tends to be among the lowest of any ethnic groups regardless of country of residence. However, it is unclear whether the mean birth weight of South Asian offspring born in England and Wales is higher among those whose mothers were themselves born in England and Wales compared to those whose mothers were born in the Indian sub-continent. METHODS: We used cross-sectional data from a unique linkage of routine records for the whole of England and Wales (2005-2006, n=861 654) to estimate mean birth weights of the live singleton offspring of Bangladeshi, Indian, Pakistani or White British ethnicity according to whether maternal place of birth was England and Wales or the Indian sub-continent. RESULTS: Offspring of women born in the Indian sub-continent were slightly heavier at birth than offspring of South Asian women born in England and Wales even after adjustment for gestational age, maternal age and parity (Bangladeshi 28 g, 95% CI 10 to 46; Indian 31 g, 95% CI 20 to 42; Pakistani 21 g, 95% CI 12 to 29). CONCLUSIONS: There is no indication that the mean birth weight of South Asian offspring of women born in England and Wales is higher than the mean birth weight of those whose mothers were born in the Indian sub-continent. This suggests a shared physiological tendency for down-regulation of fetal growth transmissible across generations. Within the UK, there is unlikely to be any appreciable increase in mean birth weight of South Asian babies over the next few decades

Birthweight and gestational age by ethnic group, England and Wales 2005: introducing new data on births.

Low birthweight babies and babies born preterm are at increased risk of morbidity and mortality in the first year of life, as well as in the longer-term. Since information on ethnic group is not recorded at birth registration in England and Wales, it has not been possible to produce routine statistics on birthweight or gestational age by ethnic group. A new system, introduced in 2002, for allocating NHS numbers at birth (NN4B) provided the opportunity to obtain ethnic group information. The NN4B record includes information on the ethnic group of the baby classified according to the 2001 Census categories. This paper presents the first analyses of ethnic differences in birthweight and gestational age at birth for England and Wales as a whole. Utilising NN4B records linked with birth registration records for all births occurring in England and Wales in 2005, birthweight and gestational age distributions, including the percentages low birthweight and preterm, are compared between ethnic groups. The paper also examines how parental socio-demographic circumstances vary by ethnic group

Comparing health inequalities across time and place--rate ratios and rate differences lead to different conclusions: analysis of cross-sectional data from 22 countries 1991-2001.

BACKGROUND: Socio-economic inequalities in health within countries are a key public health issue. It is important that we can effectively make international comparisons of the level of inequalities and assess trends over time. We investigate how the results of such comparisons can differ depending on whether inequality is quantified using the rate ratio or rate difference. METHODS: We examine levels and trends in inequality in under-five mortality using data from 22 low/lower-middle income countries [Africa (11), Latin America/Caribbean (5), Asia (6)], each with two Demographic and Health Surveys between 1991 and 2001. Within-country inequalities are quantified using the rate ratio and rate difference. RESULTS: Ranking countries by their level of inequality at one point in time differed, sometimes substantially, according to whether the rate ratio or difference was used (Spearman's rank correlation = 0.49). Similarly, ranking countries according to the magnitude and direction of change in inequality over time depended on the measure used. Importantly from a policy perspective, in five countries the direction of change was in the opposite direction (increase vs decline in inequality) when using the ratio compared with the difference measure. CONCLUSIONS: The results of comparisons of the magnitude of health inequalities between countries and over time depend upon whether the rate ratio or rate difference is used. When statements are made comparing the size of inequalities it should be made completely clear whether these are measured on an absolute or relative scale. If the substantive conclusions differ according to the measure used this should be clearly stated. In this situation emphasis should only be given to results based on one summary measure if this can be clearly and explicitly justified in the context

Prevalence, diagnosis, treatment and control of hypertension by wealth quintile and sex.

<p>percentages are weighted; n refers to number in unweighted sample.</p><p>subgroups are not mutually exclusive.</p