Intravitreal bevacizumab(IVB) injection, is a humanized monoclonal antibody that has been in use for the treatment of retinal diseases, very cheaply, especially for developing countries like Nepal. This is a retrospective study designed to evaluate the indications and outcomes of IVB at Hetauda Community Eye Hospital from 2019 to 2022. In this study, among 247 patients including 260 eyes with a follow-up rate of 221 patients involving 234 eyes, the mean patient age was 64.4 years, with male predominance of 56.1%. Thus, IVB was used principally in the treatment of diabetic retinopathy, neovascular age-related macular degeneration(nAMD), and branch retinal vein occlusion(BRVO). The results indicated significant improvements in central macular thickness and visual acuity with respect to diabetic retinopathy, nAMD, and BRVO. The study thus puts forth the effectiveness of IVB in improving visual outcomes and reducing central macular thickness(CMT) in a resource-constrained setting; hence, its use should be implemented as a viable treatment option within such an environment.
{"title":"Indications and Outcomes of Intravitreal Bevacizumab Injection in a Community Eye Hospital, Nepal","authors":"Sunil Thakali, Mohini Shrestha, Aleena Gauchan, Hom Bahadur Gurung, Manish Poudel","doi":"10.1101/2024.07.31.24311307","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311307","url":null,"abstract":"Intravitreal bevacizumab(IVB) injection, is a humanized monoclonal antibody that has been in use for the treatment of retinal diseases, very cheaply, especially for developing countries like Nepal. This is a retrospective study designed to evaluate the indications and outcomes of IVB at Hetauda Community Eye Hospital from 2019 to 2022. In this study, among 247 patients including 260 eyes with a follow-up rate of 221 patients involving 234 eyes, the mean patient age was 64.4 years, with male predominance of 56.1%. Thus, IVB was used principally in the treatment of diabetic retinopathy, neovascular age-related macular degeneration(nAMD), and branch retinal vein occlusion(BRVO). The results indicated significant improvements in central macular thickness and visual acuity with respect to diabetic retinopathy, nAMD, and BRVO. The study thus puts forth the effectiveness of IVB in improving visual outcomes and reducing central macular thickness(CMT) in a resource-constrained setting; hence, its use should be implemented as a viable treatment option within such an environment.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1101/2024.07.31.24310913
Esther Nyadzua Katama, Katherine E Gallagher, Anoop Shah, James D Nokes, David A McAllister
Background Randomized clinical trials provide the highest standard of evidence about vaccine efficacy. Modelling exercises such as in evidence synthesis and health economic models where efficacy estimates are combined with other data to obtain effectiveness and cost-effectiveness estimates help inform policy decisions. The main challenge with such sensitivity analyses is in deciding on which assumptions to model. Purpose To identify plausible ranges for differential vaccine efficacy across high- and low-income settings. Data Sources and Study Selection MEDLINE, EMBASE, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO- ICTRP) were searched for multi-site randomized clinical trials of bacterial and viral vaccines. Articles were restricted to those where at least one trial had included a low- or lower-middle-income setting, published in English, and conducted in humans. Methods A Bayesian random-effects meta-analysis was used to estimate the difference in vaccine efficacy in high- (high or upper middle) and low- (low or lower middle) income settings. A single hierarchical model that included all trials was used so that the degree to which estimates of vaccine efficacy against different diseases influenced one another was estimated from the observed data. Results Across 65 eligible trials (37 high-income, 21 low-income, and 7 both) covering 7 pathogens, only one trial reported efficacy estimates stratified by setting. Trials were similar in terms of design across settings. There was evidence of heterogeneity by vaccine target, typhoid vaccine demonstrated higher vaccine efficacy in low-income settings than in high-income settings but for all other vaccines, the point estimates indicated efficacy was lower in low-income settings; however, all credible intervals crossed the null. Conclusions The percentage of trials in low-income settings poorly reflects the burden of disease experienced in low-income settings. While there is evidence of lower vaccine efficacy in low-income settings relative to high-income settings, the credible intervals were very wide. Vaccine efficacy trials should report treatment effects stratified by settings. Keywords Bayesian analysis, illustrative evidence synthesis, vaccine efficacy, policy.
{"title":"IDENTIFYING PLAUSIBLE RANGES FOR DIFFERENTIAL VACCINE EFFICACY ACROSS HIGH- AND LOW-INCOME SETTINGS: A SYSTEMATIC REVIEW, DESCRIPTIVE META-ANALYSIS, AND ILLUSTRATIVE EVIDENCE ANALYSIS","authors":"Esther Nyadzua Katama, Katherine E Gallagher, Anoop Shah, James D Nokes, David A McAllister","doi":"10.1101/2024.07.31.24310913","DOIUrl":"https://doi.org/10.1101/2024.07.31.24310913","url":null,"abstract":"Background\u0000Randomized clinical trials provide the highest standard of evidence about vaccine efficacy. Modelling exercises such as in evidence synthesis and health economic models where efficacy estimates are combined with other data to obtain effectiveness and cost-effectiveness estimates help inform policy decisions. The main challenge with such sensitivity analyses is in deciding on which assumptions to model. Purpose\u0000To identify plausible ranges for differential vaccine efficacy across high- and low-income settings.\u0000Data Sources and Study Selection\u0000MEDLINE, EMBASE, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO- ICTRP) were searched for multi-site randomized clinical trials of bacterial and viral vaccines. Articles were restricted to those where at least one trial had included a low- or lower-middle-income setting, published in English, and conducted in humans. Methods\u0000A Bayesian random-effects meta-analysis was used to estimate the difference in vaccine efficacy in high- (high or upper middle) and low- (low or lower middle) income settings. A single hierarchical model that included all trials was used so that the degree to which estimates of vaccine efficacy against different diseases influenced one another was estimated from the observed data. Results\u0000Across 65 eligible trials (37 high-income, 21 low-income, and 7 both) covering 7 pathogens, only one trial reported efficacy estimates stratified by setting. Trials were similar in terms of design across settings. There was evidence of heterogeneity by vaccine target, typhoid vaccine demonstrated higher vaccine efficacy in low-income settings than in high-income settings but for all other vaccines, the point estimates indicated efficacy was lower in low-income settings; however, all credible intervals crossed the null. Conclusions\u0000The percentage of trials in low-income settings poorly reflects the burden of disease experienced in low-income settings. While there is evidence of lower vaccine efficacy in low-income settings relative to high-income settings, the credible intervals were very wide. Vaccine efficacy trials should report treatment effects stratified by settings. Keywords\u0000Bayesian analysis, illustrative evidence synthesis, vaccine efficacy, policy.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: This systematic review and meta-analysis aims to compare the effectiveness and efficacy of pyriproxyfen, chlorfenapyr, and piperonyl butoxide long-lasting insecticidal nets (LLINs) with pyrethroid-only LLINs for malaria control in Africa, as pyrethroid resistance threatens the effectiveness of these nets in controlling malaria. Method: The protocol was registered in PROSPERO (CRD42024499800). The extracted data from eligible studies were pooled using the random effects model and expressed as a risk ratio (RR) with a 95% confidence interval (CI) by using Excel and STATA 17. Result: A study involving 21,916 households from 11 randomized controlled trials found using chlorfenapyr and piperonyl butoxide LLINs post-intervention for 6 months to 36 months significantly reduced the risk of malaria infection compared to pyrethroid-only nets. The chlorfenapyr treatment group had a 10% reduction in malaria infection risk, with a pooled overall prevalence of 25.96 per 100 children in the chlorfenapyr group and 32.38 per 100 children in the piperonyl butoxide group compared to 41.60 per 100 children in the control Pyrethroid-only group. This meta-analysis determined entomological outcomes effectiveness and efficacy showed they effectively reduced vector density per household per night and mean inoculation rates, with a 23% reduction in chlorfenapyr, a 7% reduction in pyrethroid-only treatments, and a 12% reduction in piperonyl butoxide treatments groups. Conclusion: This study found that chlorfenapyr and piperonyl butoxide treatments significantly reduced malaria infection risk in children in African countries. The review emphasizes the effectiveness of malaria control measures in preventing infection, anaemia, vector density, and inoculation rates. The study found that chlorfenapyr (CFP) long-lasting insecticidal nets (LLINs) are highly effective and superiorly efficacious in reducing malaria infection, case incidence, and anemia among children, as well as reducing mean indoor vector density, mean entomological inoculation rate, and sporozoite rate compared to pyriproxyfen (PPF) long-lasting insecticidal nets (LLINs) in Africa. The study found that chlorfenapyr (CFP) and piperonyl butoxide (PBO) long-lasting insecticidal nets (LLINs) are highly effective and efficacious in reducing malaria infection, case incidence, and anaemia among children, as well as reducing indoor vector density, inoculation rate, and sporozoite rate in Africa as compared to pyrethroid-only LLINs. The evidence generated found that piperonyl butoxide (PBO) long-lasting insecticidal nets effectively and efficaciously reduce indoor vector density, entomological inoculation rate, and sporozoite rate of malaria parasites compared to Pyriproxyfen (PPF) LLINs, but no significant difference was found in malaria infection reduction among children who use piperonyl butoxide (PBO) versus Pyriproxyfen (PPF) long-lasting insecticidal nets in Africa. The study found that chlorfenapyr (CF
{"title":"Effectiveness and efficacy of long-lasting insecticidal nets for malaria control in Africa: Systematic review and meta-analysis of randomized controlled trials","authors":"Dereje Bayissa Demissie, Getahun Fetensa Hirko, Tilahun Desta, Firew Tiruneh Tiyare","doi":"10.1101/2024.07.31.24311306","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311306","url":null,"abstract":"Background: This systematic review and meta-analysis aims to compare the effectiveness and efficacy of pyriproxyfen, chlorfenapyr, and piperonyl butoxide long-lasting insecticidal nets (LLINs) with pyrethroid-only LLINs for malaria control in Africa, as pyrethroid resistance threatens the effectiveness of these nets in controlling malaria.\u0000Method: The protocol was registered in PROSPERO (CRD42024499800). The extracted data from eligible studies were pooled using the random effects model and expressed as a risk ratio (RR) with a 95% confidence interval (CI) by using Excel and STATA 17. Result: A study involving 21,916 households from 11 randomized controlled trials found using chlorfenapyr and piperonyl butoxide LLINs post-intervention for 6 months to 36 months significantly reduced the risk of malaria infection compared to pyrethroid-only nets. The chlorfenapyr treatment group had a 10% reduction in malaria infection risk, with a pooled overall prevalence of 25.96 per 100 children in the chlorfenapyr group and 32.38 per 100 children in the piperonyl butoxide group compared to 41.60 per 100 children in the control Pyrethroid-only group. This meta-analysis determined entomological outcomes effectiveness and efficacy showed they effectively reduced vector density per household per night and mean inoculation rates, with a 23% reduction in chlorfenapyr, a 7% reduction in pyrethroid-only treatments, and a 12% reduction in piperonyl butoxide treatments groups. Conclusion: This study found that chlorfenapyr and piperonyl butoxide treatments significantly reduced malaria infection risk in children in African countries. The review emphasizes the effectiveness of malaria control measures in preventing infection, anaemia, vector density, and inoculation rates. The study found that chlorfenapyr (CFP) long-lasting insecticidal nets (LLINs) are highly effective and superiorly efficacious in reducing malaria infection, case incidence, and anemia among children, as well as reducing mean indoor vector density, mean entomological inoculation rate, and sporozoite rate compared to pyriproxyfen (PPF) long-lasting insecticidal nets (LLINs) in Africa. The study found that chlorfenapyr (CFP) and piperonyl butoxide (PBO) long-lasting insecticidal nets (LLINs) are highly effective and efficacious in reducing malaria infection, case incidence, and anaemia among children, as well as reducing indoor vector density, inoculation rate, and sporozoite rate in Africa as compared to pyrethroid-only LLINs. The evidence generated found that piperonyl butoxide (PBO) long-lasting insecticidal nets effectively and efficaciously reduce indoor vector density, entomological inoculation rate, and sporozoite rate of malaria parasites compared to Pyriproxyfen (PPF) LLINs, but no significant difference was found in malaria infection reduction among children who use piperonyl butoxide (PBO) versus Pyriproxyfen (PPF) long-lasting insecticidal nets in Africa.\u0000The study found that chlorfenapyr (CF","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"74 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1101/2024.07.31.24311289
Nicholas Metheny, Gabriel John Dusing, Beverley M. Essue, Patricia O'Campo
This study investigated the impact of non-physical intimate partner violence (IPV), including emotional and verbal abuse, and coercive/controlling behaviors, on Ontario Health Insurance Plan costs, the universal healthcare provider in the province of Ontario, Canada. Women exposed to non-physical IPV alone had 17% higher healthcare costs over 10 years compared to those not exposed, translating to CA$686 million in additional annual costs, challenging the perception that non-physical IPV is less harmful than physical forms. We argue for prevention of non-physical IPV and improved screening in healthcare settings is vital to mitigate its long-term impacts on individuals and healthcare systems.
{"title":"Non-physical Intimate Partner Violence and Long-term Public Healthcare Costs in a Representative Sample of Canadian Women","authors":"Nicholas Metheny, Gabriel John Dusing, Beverley M. Essue, Patricia O'Campo","doi":"10.1101/2024.07.31.24311289","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311289","url":null,"abstract":"This study investigated the impact of non-physical intimate partner violence (IPV), including emotional and verbal abuse, and coercive/controlling behaviors, on Ontario Health Insurance Plan costs, the universal healthcare provider in the province of Ontario, Canada. Women exposed to non-physical IPV alone had 17% higher healthcare costs over 10 years compared to those not exposed, translating to CA$686 million in additional annual costs, challenging the perception that non-physical IPV is less harmful than physical forms. We argue for prevention of non-physical IPV and improved screening in healthcare settings is vital to mitigate its long-term impacts on individuals and healthcare systems.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"113 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1101/2024.07.30.24311252
Lalaine Sevillano, Adrian M Bacong, Dale Maglalang
BACKGROUND: The Asian American (AA) population is the fastest-growing major racial or ethnic group in the U.S. Typically treated as a monolith in research, disaggregated data show disproportionate cardiovascular disease (CVD) burden among certain AA ethnic groups. This analysis aimed to identify which factors explain variance in cardiovascular health among AA ethnic groups. METHODS: We analyzed pooled 2010-2018 National Health Interview Survey cross-sectional data from Chinese, Asian Indian, Filipino, and Other Asian adults in the U.S. Coronary heart disease, heart attack, and stroke were the CVD outcomes of interest. Covariates included sociodemographic characteristics, CVD-related health behaviors (e.g., smoking tobacco, physical inactivity), and health conditions (e.g., diabetes, hypertension). The distribution of self-reported CVD outcomes and covariates were examined among the full AA sample and disaggregated ethnic groups. Variance explained by sociodemographic, health behaviors, and health conditions were calculated based on the adjusted R-squared from a series of five models for each CVD health outcome. RESULTS: Of the 10,353 AAs in the sample, 53% identified as female and 86% between the ages of 18-64 years old. Compared to the aggregate AA sample and the other ethnic groups, Filipinos had a higher burden of any CVD outcome (5.9%), particularly for coronary heart disease (4.0%) and heart attack (2.5%).The combination of all predictors explained at most 13% of variance, with sociodemographic characteristics accounting for at least half of the variance explained among all participants. Health behaviors explained a greater amount of additional variance for all CVD outcomes among Asian Indians, including an additional 3.1% for stroke. Inversely, existing health conditions were significant predictors of CVD for all AA ethnic groups compared to Asian Indians. CONCLUSIONS: There is heterogeneity in CVD outcomes and related risk factors in AA ethnic groups, emphasizing the need for culturally-tailored prevention and intervention strategies.
背景：亚裔美国人（AA）人口是美国增长最快的主要种族或族裔群体。在研究中，亚裔美国人通常被视为一个整体，但分类数据显示，某些亚裔美国人族裔群体的心血管疾病（CVD）负担过重。本分析旨在确定哪些因素可以解释 AA 族群心血管健康的差异。方法：我们分析了汇总的 2010-2018 年美国国家健康访谈调查横断面数据，这些数据来自美国的华裔、亚裔印度人、菲律宾人和其他亚裔成年人。协变量包括社会人口特征、与心血管疾病相关的健康行为（如吸烟、缺乏运动）和健康状况（如糖尿病、高血压）。在全部 AA 样本和细分的种族群体中，对自我报告的心血管疾病结果和协变量的分布进行了研究。结果：在 10353 个 AA 样本中，53% 为女性，86% 年龄在 18-64 岁之间。与所有 AA 样本和其他种族群体相比，菲律宾人的心血管疾病负担较高（5.9%），尤其是冠心病（4.0%）和心脏病发作（2.5%）。在亚裔印度人中，健康行为对所有心血管疾病结果的额外方差解释量更大，其中对中风的额外解释量为 3.1%。相反，与亚裔印第安人相比，所有 AA 族群的现有健康状况都是心血管疾病的重要预测因素。结论：亚裔美国人的心血管疾病结果和相关风险因素存在异质性，因此需要制定符合其文化特点的预防和干预策略。
{"title":"Explaining the Variance in Cardiovascular Health Indicators among Asian Americans: A Comparison of Demographic, Socioeconomic, and Ethnicity","authors":"Lalaine Sevillano, Adrian M Bacong, Dale Maglalang","doi":"10.1101/2024.07.30.24311252","DOIUrl":"https://doi.org/10.1101/2024.07.30.24311252","url":null,"abstract":"BACKGROUND: The Asian American (AA) population is the fastest-growing major racial or ethnic group in the U.S. Typically treated as a monolith in research, disaggregated data show disproportionate cardiovascular disease (CVD) burden among certain AA ethnic groups. This analysis aimed to identify which factors explain variance in cardiovascular health among AA ethnic groups. METHODS: We analyzed pooled 2010-2018 National Health Interview Survey cross-sectional data from Chinese, Asian Indian, Filipino, and Other Asian adults in the U.S. Coronary heart disease, heart attack, and stroke were the CVD outcomes of interest. Covariates included sociodemographic characteristics, CVD-related health behaviors (e.g., smoking tobacco, physical inactivity), and health conditions (e.g., diabetes, hypertension). The distribution of self-reported CVD outcomes and covariates were examined among the full AA sample and disaggregated ethnic groups. Variance explained by sociodemographic, health behaviors, and health conditions were calculated based on the adjusted R-squared from a series of five models for each CVD health outcome.\u0000RESULTS: Of the 10,353 AAs in the sample, 53% identified as female and 86% between the ages of 18-64 years old. Compared to the aggregate AA sample and the other ethnic groups, Filipinos had a higher burden of any CVD outcome (5.9%), particularly for coronary heart disease (4.0%) and heart attack (2.5%).The combination of all predictors explained at most 13% of variance, with sociodemographic characteristics accounting for at least half of the variance explained among all participants. Health behaviors explained a greater amount of additional variance for all CVD outcomes among Asian Indians, including an additional 3.1% for stroke. Inversely, existing health conditions were significant predictors of CVD for all AA ethnic groups compared to Asian Indians. CONCLUSIONS: There is heterogeneity in CVD outcomes and related risk factors in AA ethnic groups, emphasizing the need for culturally-tailored prevention and intervention strategies.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1101/2024.07.30.24311251
Belinda Hernandez, Adam Dyer, Cathal McCrory, Louise Newman, Ciarán Finucane, Rose Anne Kenny
Background: An integrated haemodynamic response during standing may serve as an integrative marker of neuro-cardiovascular function. Individual components of both heart rate (HR) and blood pressure (BP) responses to active stand (AS) have been linked with cardiovascular disease (CVD) and mortality. We assessed longitudinal associations between entire HR/BP response curves during AS, incident CVD and mortality over 12 years. Methods: Beat-to-beat measurements of dynamic HR/BP responses to AS were conducted in 4,336 individuals (61.5±8.2 years; 53.7% female). Functional Principal Components Analysis was applied to HR/BP response curves and their association with CVD and mortality assessed. We hypothesised that integrating BP/HR information from the entire haemodynamic response curve may uncover novel associations with both CVD and mortality. Results: Higher systolic BP (SBP) before AS and blunted recovery of SBP during AS was associated with all-cause mortality over 12-years (Hazard Ratio [HR]: 1.14; 1.04, 1.26; p=0.007). Higher baseline/peak HR and lower HR from 30 seconds post stand onwards were associated with lower mortality due to circulatory causes (HR: 0.78; 0.64, 0.95; p = 0.013). Higher HR throughout AS was associated with mortality from other causes (HR: 1.48; 1.22, 1.80; p<0.001). Findings persisted on robust covariate adjustment. Conclusions: We observed distinct relationships between HR/BP responses to AS and 12-year incident CVD and mortality. Integrating the entire haemodynamic response may reveal more nuanced relationships between HR/BP responses to AS, CVD and mortality - serving as an integrative marker of neuro-cardiovascular health in midlife and beyond.
{"title":"Which Components of the Haemodynamic Response to Active Stand Predict Cardiovascular Disease and Mortality? Data From The Irish Longitudinal Study on Ageing","authors":"Belinda Hernandez, Adam Dyer, Cathal McCrory, Louise Newman, Ciarán Finucane, Rose Anne Kenny","doi":"10.1101/2024.07.30.24311251","DOIUrl":"https://doi.org/10.1101/2024.07.30.24311251","url":null,"abstract":"Background: An integrated haemodynamic response during standing may serve as an integrative marker of neuro-cardiovascular function. Individual components of both heart rate (HR) and blood pressure (BP) responses to active stand (AS) have been linked with cardiovascular disease (CVD) and mortality. We assessed longitudinal associations between entire HR/BP response curves during AS, incident CVD and mortality over 12 years. Methods: Beat-to-beat measurements of dynamic HR/BP responses to AS were conducted in 4,336 individuals (61.5±8.2 years; 53.7% female). Functional Principal Components Analysis was applied to HR/BP response curves and their association with CVD and mortality assessed. We hypothesised that integrating BP/HR information from the entire haemodynamic response curve may uncover novel associations with both CVD and mortality. Results: Higher systolic BP (SBP) before AS and blunted recovery of SBP during AS was associated with all-cause mortality over 12-years (Hazard Ratio [HR]: 1.14; 1.04, 1.26; p=0.007). Higher baseline/peak HR and lower HR from 30 seconds post stand onwards were associated with lower mortality due to circulatory causes (HR: 0.78; 0.64, 0.95; p = 0.013). Higher HR throughout AS was associated with mortality from other causes (HR: 1.48; 1.22, 1.80; p<0.001). Findings persisted on robust covariate adjustment. Conclusions: We observed distinct relationships between HR/BP responses to AS and 12-year incident CVD and mortality. Integrating the entire haemodynamic response may reveal more nuanced relationships between HR/BP responses to AS, CVD and mortality - serving as an integrative marker of neuro-cardiovascular health in midlife and beyond.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01DOI: 10.1101/2024.07.31.24311298
Rahima Yasin, Zahra Padhani, Mushtaque Mirani, Muhammad Khan Jamali, Mahwish Memon, Sana Khatoon, Riya Rai, Areeba Rahman, Anushka Attaullahjan, Jai K. Das
Background: This paper comprehensively investigates various aspects of dietary behaviors relating to the usage of wheat flour and sociocultural preferences embedded within rural communities and aims to bridge health gaps resulting from zinc deficiency by introducing zinc bio-fortified and fortified flour in Pakistan. Method: A household and a market study was conducted in Ghotki and Tando Muhammad Khan districts in Sindh, Pakistan. Various stakeholders involved in the wheat-flour industry including farmers, seed suppliers, owners of atta-chakkis and flour mills, grocers and flour merchants, bakers and hoteliers, consumers, and agronomists were interviewed to gauge their knowledge of bio-fortified and fortified wheat-flour. Results: Wheat-flour is a staple food item in Pakistan, however, agricultural output in Pakistan varies across all provinces. Factors that hinder agricultural productivity include a shortfall of essential resources such as irrigation water, superior quality seeds and fertilizers, and machinery. Farmers use primitive methods of farming as they do not have access to modern technologies, information, or training. Wheat flour market vendors and consumers lack awareness of bio-fortified and fortified wheat flour products and believe the only way to create a customer-base is by ensuring that fortified wheat products are available to all and competitively priced compared to traditional options. Additionally, participants misconstrue the process of fermentation and perceive it as unhealthy. The lack of financial resources and awareness restricts adequate promotion of nutrient-rich food products amongst stakeholders involved in the wheat flour industry. Mass awareness campaigns, education and government incentives could bridge the gaps present and encourage wider adoption of bio-fortified and fortified wheat flour. Conclusion: Policy makers and communities can draw on the recommendations made in this paper to introduce and promote zinc bio-fortified and fortified flour in settings where zinc deficiency is prevalent.
背景：本文全面调查了与使用小麦粉有关的饮食行为的各个方面以及农村社区的社会文化偏好，旨在通过在巴基斯坦引入生物强化锌和强化面粉来弥补锌缺乏造成的健康差距：方法：在巴基斯坦信德省的 Ghotki 和 Tando Muhammad Khan 地区开展了一项家庭和市场研究。对参与小麦粉行业的各利益相关方，包括农民、种子供应商、atta-chakkis 和面粉厂业主、杂货店和面粉商、面包师和酒店经营者、消费者以及农学家进行了访谈，以了解他们对生物强化和强化小麦粉的认识：小麦粉是巴基斯坦的主食，但巴基斯坦各省的农业产量各不相同。阻碍农业生产力的因素包括灌溉用水、优质种子和化肥以及机械等基本资源短缺。由于无法获得现代技术、信息或培训，农民使用原始的耕作方法。小麦粉市场销售商和消费者缺乏对生物强化和强化小麦粉产品的认识，他们认为创造客户群的唯一途径是确保强化小麦产品面向所有人，并且价格与传统产品相比具有竞争力。此外，参与者对发酵过程存在误解，认为它不健康。由于缺乏资金和意识，小麦粉行业的利益相关者无法充分推广营养丰富的食品。大众宣传活动、教育和政府激励措施可以弥补现有差距，鼓励更广泛地采用生物强化和强化小麦粉。结论：政策制定者和社区可借鉴本文提出的建议，在锌缺乏症普遍存在的环境中引入并推广锌生物强化面粉。
{"title":"Biofortification and Fortification of Wheat Flour: Qualitative analysis for implementation and acceptance","authors":"Rahima Yasin, Zahra Padhani, Mushtaque Mirani, Muhammad Khan Jamali, Mahwish Memon, Sana Khatoon, Riya Rai, Areeba Rahman, Anushka Attaullahjan, Jai K. Das","doi":"10.1101/2024.07.31.24311298","DOIUrl":"https://doi.org/10.1101/2024.07.31.24311298","url":null,"abstract":"Background: This paper comprehensively investigates various aspects of dietary behaviors relating to the usage of wheat flour and sociocultural preferences embedded within rural communities and aims to bridge health gaps resulting from zinc deficiency by introducing zinc bio-fortified and fortified flour in Pakistan.\u0000Method: A household and a market study was conducted in Ghotki and Tando Muhammad Khan districts in Sindh, Pakistan. Various stakeholders involved in the wheat-flour industry including farmers, seed suppliers, owners of atta-chakkis and flour mills, grocers and flour merchants, bakers and hoteliers, consumers, and agronomists were interviewed to gauge their knowledge of bio-fortified and fortified wheat-flour.\u0000Results: Wheat-flour is a staple food item in Pakistan, however, agricultural output in Pakistan varies across all provinces. Factors that hinder agricultural productivity include a shortfall of essential resources such as irrigation water, superior quality seeds and fertilizers, and machinery. Farmers use primitive methods of farming as they do not have access to modern technologies, information, or training. Wheat flour market vendors and consumers lack awareness of bio-fortified and fortified wheat flour products and believe the only way to create a customer-base is by ensuring that fortified wheat products are available to all and competitively priced compared to traditional options. Additionally, participants misconstrue the process of fermentation and perceive it as unhealthy. The lack of financial resources and awareness restricts adequate promotion of nutrient-rich food products amongst stakeholders involved in the wheat flour industry. Mass awareness campaigns, education and government incentives could bridge the gaps present and encourage wider adoption of bio-fortified and fortified wheat flour. Conclusion: Policy makers and communities can draw on the recommendations made in this paper to introduce and promote zinc bio-fortified and fortified flour in settings where zinc deficiency is prevalent.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"88 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1101/2024.07.29.24311179
Diandra N Denier-Fields, Ronald E Gangnon, Leonardo A Rivera-Rivera, Tobey J Betthauser, Barbara B Bendlin, Sterling C Johnson, Corinne D Engelman
INTRODUCTION: Lifestyle factors have been studied for dementia risk, but few have comprehensively assessed both Alzheimer's disease (AD) and cerebrovascular disease (CBVD) pathologies. Our research aims to determine the relationships between lifestyle and various dementia pathologies, challenging conventional research paradigms. METHODS: Analyzing 1231 Wisconsin Registry for Alzheimer's Prevention (WRAP) study participants, we focused on Life Simple Seven (LS7) score calculations from questionnaire data and clinical vitals. We assessed brain health indicators including CBVD, AD, and cognition. RESULTS: Higher LS7 scores were associated with better CBVD outcomes, including lower percent white matter hyperintensities and higher cerebral blood flow, and higher Preclinical Alzheimer's Composite 3 and Delayed Recall scores. No significant associations were observed between LS7 scores and AD markers of amyloid and tau accumulation. DISCUSSION: This study provides evidence that the beneficial effects of LS7 on cognition are primarily mediated through cerebrovascular pathways rather than direct influences on AD pathology.
简介：人们已经对痴呆症风险的生活方式因素进行了研究，但很少有人同时对阿尔茨海默病（AD）和脑血管疾病（CBVD）病理进行全面评估。我们的研究旨在确定生活方式与各种痴呆症病理之间的关系，挑战传统的研究范式。方法：我们对 1231 名威斯康星州阿尔茨海默氏症预防登记（WRAP）研究参与者进行了分析，重点是根据问卷数据和临床生命体征计算生活简易七项（LS7）得分。结果：较高的 LS7 分数与较好的 CBVD 结果相关，包括较低的白质高密度百分比和较高的脑血流量，以及较高的临床前阿尔茨海默氏症综合 3 和延迟回忆分数。在 LS7 评分与淀粉样蛋白和 tau 累积的 AD 标志物之间未观察到明显的关联。讨论：本研究提供的证据表明，LS7对认知能力的有益影响主要是通过脑血管途径介导的，而不是直接影响阿尔茨海默病的病理变化。
{"title":"Evaluating Life Simple Seven's influence on brain health outcomes: The intersection of lifestyle and dementia","authors":"Diandra N Denier-Fields, Ronald E Gangnon, Leonardo A Rivera-Rivera, Tobey J Betthauser, Barbara B Bendlin, Sterling C Johnson, Corinne D Engelman","doi":"10.1101/2024.07.29.24311179","DOIUrl":"https://doi.org/10.1101/2024.07.29.24311179","url":null,"abstract":"INTRODUCTION: Lifestyle factors have been studied for dementia risk, but few have comprehensively assessed both Alzheimer's disease (AD) and cerebrovascular disease (CBVD) pathologies. Our research aims to determine the relationships between lifestyle and various dementia pathologies, challenging conventional research paradigms.\u0000METHODS: Analyzing 1231 Wisconsin Registry for Alzheimer's Prevention (WRAP) study participants, we focused on Life Simple Seven (LS7) score calculations from questionnaire data and clinical vitals. We assessed brain health indicators including CBVD, AD, and cognition.\u0000RESULTS: Higher LS7 scores were associated with better CBVD outcomes, including lower percent white matter hyperintensities and higher cerebral blood flow, and higher Preclinical Alzheimer's Composite 3 and Delayed Recall scores. No significant associations were observed between LS7 scores and AD markers of amyloid and tau accumulation. DISCUSSION: This study provides evidence that the beneficial effects of LS7 on cognition are primarily mediated through cerebrovascular pathways rather than direct influences on AD pathology.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-31DOI: 10.1101/2024.07.29.24311197
Lauren Pearson, Matthew J Page, Robyn Gerhard, Nyssa Clarke, Meghan Winters, Adrian Bauman, Laolu Arogundade, Ben Beck
Objective: To assess the efficacy of interventions aimed at increasing walking and cycling. Design: Systematic review with meta–analysis Study selection: The electronic databases MEDLINE, PsycINFO and Web of Science were searched from inception on 22nd May 2023. Eligible study designs included randomised and non–randomised studies of interventions with specific study design features that enabled estimation of causality. No restrictions on type of outcome measurement, publication date or population age were applied. Data extraction and synthesis: Two reviewers independently extracted data and conducted quality assessment with Joanna Briggs Quality Assessment tools. Studies were categorised by intervention types described within the Behaviour Change Wheel. Where possible, random–effects meta–analyses were used to synthesise results within intervention types. Main outcome measures: The main outcome of interest was modal shift to active modes (walking and cycling). Other outcomes of interest included cycling and walking duration, frequency and counts, active transport duration and frequency, and moderate to vigorous physical activity duration (MVPA). Results: 106 studies that assessed the impact of an intervention on walking, cycling or active transport overall were included. Findings demonstrate that physical environmental restructure interventions, such as protected bike lanes and traffic calming infrastructure, were effective in increasing cycling duration (OR = 1.70, 95% CI 1.20– 2.22; 2 studies). Other intervention types, including individually tailored behavioural programmes, and provision of e-bikes were also effective for increasing cycling frequency (OR = 1.33, 95% CI 1.23– 1.43; 1 study) and duration (OR = 1.13, 95% CI 1.02–1.22, 1 study). An intensive education programme intervention demonstrated a positive impact on walking duration (OR = 1.96, 95% CI 1.68 – 2.21; 1 study). An individually tailored behavioural programme (OR = 1.23, 95% CI 1.08 – 1.40; 3 studies) and community walking programme (OR = 1.15, 95% CI 1.14 – 1.17; 1 study) also increased the odds of increased walking duration. This body of research would benefit from more rigour in study design to limit lower quality evidence with the potential for bias. Conclusions: This review provides evidence for investment in high–quality active transportation infrastructure, such as protected bike lanes, to improve cycling and active transport participation overall. It also provides evidence for investment in other non–infrastructure interventions. Further research to understand which combinations of intervention types are most effective for modal shift are needed. Active transport research needs to include more robust trials and evaluations with consistent outcome measures to improve quality of evidence and provide evidence on which interventions (or combinations of interventions) are most effective. Study registration: PROSPERO CRD42023445982
目的评估旨在增加步行和骑自行车出行的干预措施的效果。设计：系统回顾与荟萃分析研究选择：从 2023 年 5 月 22 日开始对 MEDLINE、PsycINFO 和 Web of Science 等电子数据库进行检索。符合条件的研究设计包括随机和非随机干预研究，这些研究设计具有特定的特点，能够对因果关系进行估计。数据提取与综合：两名审稿人独立提取数据，并使用乔安娜-布里格斯质量评估工具进行质量评估。研究按照 "行为改变轮 "中描述的干预类型进行分类。在可能的情况下，使用随机效应荟萃分析来综合干预类型的结果。主要结果测量：主要结果是向积极模式（步行和骑自行车）的转变。其他相关结果包括骑自行车和步行的持续时间、频率和次数，积极交通的持续时间和频率，以及中度到剧烈运动的持续时间（MVPA）。研究结果共纳入了 106 项评估干预措施对步行、骑自行车或主动交通总体影响的研究。研究结果表明，物理环境结构调整干预措施，如受保护的自行车道和交通疏导基础设施，能有效延长骑自行车的时间（OR = 1.70，95% CI 1.20- 2.22；2 项研究）。其他类型的干预措施，包括为个人量身定制的行为方案和提供电动自行车，也能有效增加骑车频率（OR = 1.33，95% CI 1.23-1.43；1 项研究）和持续时间（OR = 1.13，95% CI 1.02-1.22，1 项研究）。强化教育计划干预对步行持续时间有积极影响（OR = 1.96，95% CI 1.68 - 2.21；1 项研究）。个人定制的行为计划（OR = 1.23，95% CI 1.08 - 1.40；3 项研究）和社区步行计划（OR = 1.15，95% CI 1.14 - 1.17；1 项研究）也增加了步行时间延长的几率。如果能在研究设计方面更加严格，以限制可能存在偏差的低质量证据，那么这些研究将从中受益。结论：本综述为投资高质量的主动交通基础设施提供了证据，如受保护的自行车道，以提高自行车运动和主动交通参与的整体水平。它还提供了投资其他非基础设施干预措施的证据。需要开展进一步研究，以了解哪些干预类型的组合对模式转换最为有效。积极交通研究需要包括更有力的试验和评估，并采用一致的结果衡量标准，以提高证据质量，并为哪些干预措施（或干预措施组合）最有效提供证据。研究注册：PROPERCO CRD42023445982
{"title":"Effectiveness of interventions for modal shift to walking and bike riding: a systematic review with meta-analysis","authors":"Lauren Pearson, Matthew J Page, Robyn Gerhard, Nyssa Clarke, Meghan Winters, Adrian Bauman, Laolu Arogundade, Ben Beck","doi":"10.1101/2024.07.29.24311197","DOIUrl":"https://doi.org/10.1101/2024.07.29.24311197","url":null,"abstract":"Objective: To assess the efficacy of interventions aimed at increasing walking and cycling. Design: Systematic review with meta–analysis\u0000Study selection: The electronic databases MEDLINE, PsycINFO and Web of Science were searched from inception on 22nd May 2023. Eligible study designs included randomised and non–randomised studies of interventions with specific study design features that enabled estimation of causality. No restrictions on type of outcome measurement, publication date or population age were applied.\u0000Data extraction and synthesis: Two reviewers independently extracted data and conducted quality assessment with Joanna Briggs Quality Assessment tools. Studies were categorised by intervention types described within the Behaviour Change Wheel. Where possible, random–effects meta–analyses were used to synthesise results within intervention types. Main outcome measures: The main outcome of interest was modal shift to active modes (walking and cycling). Other outcomes of interest included cycling and walking duration, frequency and counts, active transport duration and frequency, and moderate to vigorous physical activity duration (MVPA). Results: 106 studies that assessed the impact of an intervention on walking, cycling or active transport overall were included. Findings demonstrate that physical environmental restructure interventions, such as protected bike lanes and traffic calming infrastructure, were effective in increasing cycling duration (OR = 1.70, 95% CI 1.20– 2.22; 2 studies). Other intervention types, including individually tailored behavioural programmes, and provision of e-bikes were also effective for increasing cycling frequency (OR = 1.33, 95% CI 1.23– 1.43; 1 study) and duration (OR = 1.13, 95% CI 1.02–1.22, 1 study). An intensive education programme intervention demonstrated a positive impact on walking duration (OR = 1.96, 95% CI 1.68 – 2.21; 1 study). An individually tailored behavioural programme (OR = 1.23, 95% CI 1.08 – 1.40; 3 studies) and community walking programme (OR = 1.15, 95% CI 1.14 – 1.17; 1 study) also increased the odds of increased walking duration. This body of research would benefit from more rigour in study design to limit lower quality evidence with the potential for bias. Conclusions: This review provides evidence for investment in high–quality active transportation infrastructure, such as protected bike lanes, to improve cycling and active transport participation overall. It also provides evidence for investment in other non–infrastructure interventions. Further research to understand which combinations of intervention types are most effective for modal shift are needed. Active transport research needs to include more robust trials and evaluations with consistent outcome measures to improve quality of evidence and provide evidence on which interventions (or combinations of interventions) are most effective. Study registration: PROSPERO CRD42023445982","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"1412 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141867827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-27DOI: 10.1101/2024.07.26.24311071
Jacob Bor, Rafeya V Raquib, David Himmelstein, Steffie Woolhandler, Andrew C Stokes
Importance: The US has higher mortality rates than other wealthy nations. Objective: To determine causes of death responsible for excess mortality in the US compared to other wealthy nations and how the causes involved in this survival gap have changed over time. Design: Repeat cross-sectional study, 1999 to 2020. Setting: United States and 12 other wealthy nations. Participants: All residents. Exposures: Residing in the US versus other wealthy nations. Main outcome and measures: Excess US mortality in each year due to specific causes of death using data from the World Health Organization Mortality Database. Differences between the US and other wealthy nations were quantified for each cause of death as: (1) the number of excess US deaths (i.e., deaths that would have been averted if US death rates equaled the average rates of other wealthy nations); (2) years of life lost (YLL) resulting from excess US deaths; and (3) the ratio of observed deaths to expected deaths if US mortality rates equaled the average of other wealthy nations. Results: 10,856,851 excess US deaths occurred between 1999 and 2020. In 2019, prior to the COVID-19 pandemic, there were 637,682 excess US deaths, with leading causes including circulatory diseases (41% of total), mental and nervous system disorders (25%), diabetes, renal, and metabolic diseases (15%), drug poisonings, alcohol-related deaths, and suicide (13%), respiratory disease (12%), and transportation accidents (5%). Over two decades, excess US deaths due to drug poisonings, alcohol and suicide increased from -5,937 in 1999 to 109,015 in 2020. In 2019, deaths from drug poisonings were 6.7 times higher in the US than in peer countries. Circulatory mortality accounted for the largest absolute number of excess US deaths in nearly every year. In 2020, one in 5 excess US deaths were attributed to COVID-19. Conclusions and Relevance: The US had substantially higher death rates than other wealthy nations between 1999 and 2020, despite having similar access to advanced medical technology. Many of these excess US deaths could likely be avoided by adopting health and social policies that have benefited peer countries.
{"title":"Causes of excess deaths in the US relative to other wealthy nations, 1999-2020: a population autopsy","authors":"Jacob Bor, Rafeya V Raquib, David Himmelstein, Steffie Woolhandler, Andrew C Stokes","doi":"10.1101/2024.07.26.24311071","DOIUrl":"https://doi.org/10.1101/2024.07.26.24311071","url":null,"abstract":"Importance: The US has higher mortality rates than other wealthy nations. Objective: To determine causes of death responsible for excess mortality in the US compared to other wealthy nations and how the causes involved in this survival gap have changed over time. Design: Repeat cross-sectional study, 1999 to 2020. Setting: United States and 12 other wealthy nations.\u0000Participants: All residents.\u0000Exposures: Residing in the US versus other wealthy nations.\u0000Main outcome and measures: Excess US mortality in each year due to specific causes of death using data from the World Health Organization Mortality Database. Differences between the US and other wealthy nations were quantified for each cause of death as: (1) the number of excess US deaths (i.e., deaths that would have been averted if US death rates equaled the average rates of other wealthy nations); (2) years of life lost (YLL) resulting from excess US deaths; and (3) the ratio of observed deaths to expected deaths if US mortality rates equaled the average of other wealthy nations. Results: 10,856,851 excess US deaths occurred between 1999 and 2020. In 2019, prior to the COVID-19 pandemic, there were 637,682 excess US deaths, with leading causes including circulatory diseases (41% of total), mental and nervous system disorders (25%), diabetes, renal, and metabolic diseases (15%), drug poisonings, alcohol-related deaths, and suicide (13%), respiratory disease (12%), and transportation accidents (5%). Over two decades, excess US deaths due to drug poisonings, alcohol and suicide increased from -5,937 in 1999 to 109,015 in 2020. In 2019, deaths from drug poisonings were 6.7 times higher in the US than in peer countries. Circulatory mortality accounted for the largest absolute number of excess US deaths in nearly every year. In 2020, one in 5 excess US deaths were attributed to COVID-19.\u0000Conclusions and Relevance: The US had substantially higher death rates than other wealthy nations between 1999 and 2020, despite having similar access to advanced medical technology. Many of these excess US deaths could likely be avoided by adopting health and social policies that have benefited peer countries.","PeriodicalId":501276,"journal":{"name":"medRxiv - Public and Global Health","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141776547","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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