Contribution of chronic conditions to the disability burden across smoking categories in middle-aged adults, Belgium

Introduction : Smoking is considered the single most important preventable cause of morbidity and mortality worldwide, contributing to increased incidence and severity of disabling conditions. The aim of this study was to assess the contribution of chronic conditions to the disability burden across smoking categories in middle-aged adults in Belgium. Methods : Data from 10,224 individuals aged 40 to 60 years who participated in the 1997, 2001, 2004, or 2008 Health Interview Surveys in Belgium were used. Smoking status was defined as never, former (cessation >= 2 years), former (cessation = 20 cigarettes/day). To attribute disability to chronic conditions, binomial additive hazards models were fitted separately for each smoking category adjusted for gender, except for former (cessation <2 years) and occasional light smokers due to the small sample size. Results : An increasing trend in the disability prevalence was observed across smoking categories in men (never = 4.8%, former (cessation >= 2 years) = 5.8%, daily light = 7.8%, daily heavy = 10.7%) and women (never = 7.6%, former (cessation >= 2 years) = 8.0%, daily light = 10.2%, daily heavy = 12.0%). Musculoskeletal conditions showed a substantial contribution to the disability burden in men and women across all smoking categories. Other important contributors were depression and cardiovascular diseases in never smokers; depression, chronic respiratory diseases, and diabetes in former smokers (cessation >= 2 years); chronic respiratory diseases, cancer, and cardiovascular diseases in daily light smokers; cardiovascular diseases and chronic respiratory diseases in men and depression and diabetes in women daily heavy smokers. Conclusions : Beyond the well-known effect of smoking on mortality, our findings showed an increasing trend of the disability prevalence and different contributors to the disability burden across smoking categories. This information can be useful from a public health perspective to define strategies to reduce disability in Belgium

Substituting polyunsaturated fat for saturated fat: A health impact assessment of a fat tax in seven European countries

There is evidence that replacing saturated fat (SFA) with polyunsaturated fat (PUFA) lowers ischemic heart disease (IHD). In order to improve the population’s diet, the World Health Organization has called for the taxation of foods that are high in SFA. We aimed to assess the potential health gains of a European fat tax by applying the SFA intake reduction that has been observed under the Danish fat tax to six other European countries. For each country, we created a fat tax scenario with a decreased SFA intake and a corresponding increase in PUFA. We compared this fat tax scenario to a reference scenario with no change in SFA intake, and to a guideline scenario with a population-wide SFA intake in line with dietary recommendations. We used DYNAMO-HIA to dynamically project the policy-attributable IHD cases of these three scenarios 10 years into the future. A fat tax would reduce prevalent IHD cases by a minimum of 500 and 300 among males and females in Denmark, respectively, up to a maximum of 5,600 and 4,000 among males and females in the UK. Thereby, the prevented IHD cases under a fat tax scenario would correspond to between 11.0% (in females in the Netherlands) and 29.5% (in females in Italy) of the prevented IHD cases under a guideline scenario, which represents the maximum preventable disease burden. Henceforth, our quantification of beneficial health impacts makes the case for the policy debate on fat taxes

Smoking and inequalities in mortality in 11 European countries : a birth cohort analysis

Altres ajuts: Netspar (Network for Studies on Pensions, Aging and Retirement).Purpose: To study the trends of smoking-attributable mortality among the low and high educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality. Results: In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low- and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions: Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality

addhaz: Contribution of Chronic Diseases to the Disability Burden Using R

status: publishe

Impact of Chronic Conditions and Multimorbidity on the Disability Burden in the Older Population in Belgium

International audienceBACKGROUND:The increase in longevity along with a high prevalence of chronic conditions contribute to increased disability burden. Despite the high occurrence of multimorbidity observed in advanced ages, most studies are restricted to the investigation of individual diseases. In this study, we assessed the impact of chronic conditions and multimorbidity on the disability burden in the older population in Belgium.METHODS:Data from 9,482 participants in the 2001, 2004, or 2008 Belgian Health Interview Surveys aged 55 years or older were analyzed. Disability was defined based on the Global Activity Limitation Indicator (GALI). To attribute disability to single chronic conditions and disease pairs, a multiple additive hazard model was fitted.RESULTS:Musculoskeletal conditions (45.3%), chronic respiratory diseases (11.2%), and cardiovascular diseases (10.2%) diseases were the most frequent conditions. Cardiovascular diseases, the co-occurrence of chronic respiratory diseases and depression, neurological diseases, cancer, and the combination of diabetes and cardiovascular diseases were the top five disabling conditions. The disability prevalence in the older population in Belgium was 35.6% (confidence interval =35.0; 36.2%). The most important contributors to the disability burden were musculoskeletal, cardiovascular, and chronic respiratory diseases.CONCLUSIONS:The present findings provide a deeper understanding of the role of chronic conditions and multimorbidity on the disability burden in the older population in Belgium. Although the disease pairs showed a low contribution to the disability burden, their occurrence presented a high impact on disability. Prevention strategies to tackle disability should target the main contributors to the disability burden and the most disabling conditions/disease pairs, especially in the clinical practice

Disability rates and relative contribution of chronic conditions and background to the prevalence of disability.

<p><b>Health Interview Survey, Belgium, 1997, 2001, 2004, and 2008.</b> The relative contribution of chronic conditions and background sum to 100%. Background: represents the diseases and conditions not included in the analysis; Respiratory: chronic respiratory diseases (asthma, chronic bronchitis, and chronic pulmonary diseases); Cardiovascular: cardiovascular diseases (ischaemic heart diseases and stroke); Musculoskeletal: musculoskeletal conditions (low back pain, osteoarthritis, rheumatoid arthritis, and osteoporosis). Former: former smokers who reported smoking cessation two years or more prior to the interview; Light: <20 cigarettes/day; Heavy: ≥20 cigarettes/day. The bars represent the bootstrap percentile confidence intervals.</p

Prevalence of chronic conditions by gender and smoking categories.

<p><b>Health Interview Survey, Belgium, 1997, 2001, 2004, and 2008.</b> Respiratory: chronic respiratory diseases (asthma, chronic bronchitis, and chronic pulmonary diseases); Musculoskeletal: musculoskeletal conditions (low back pain, osteoarthritis, rheumatoid arthritis, and osteoporosis); Cardiovascular: cardiovascular diseases (ischaemic heart diseases and stroke). Former (2y+): former smokers who reported smoking cessation two years or more prior to the interview; Former (<2y): former smokers who reported smoking cessation less than two years prior to the interview; Light: <20 cigarettes/day; Heavy: ≥20 cigarettes/day. The bars represent the bootstrap percentile confidence intervals.</p

Characteristics of the study population.

<p>Health Interview Survey, Belgium, 1997, 2001, 2004, and 2008.</p