Pub Date : 2021-10-11DOI: 10.1186/s12963-021-00266-z
Thaddäus Tönnies, Jens Baumert, Christin Heidemann, Elena von der Lippe, Ralph Brinks, Annika Hoyer
Background: Type 2 diabetes (T2D) causes substantial disease burden and is projected to affect an increasing number of people in coming decades. This study provides projected estimates of life years free of type 2 diabetes (T2D) and years of life lost ([Formula: see text]) associated with T2D for Germany in the years 2015 and 2040.
Methods: Based on an illness-death model and the associated mathematical relation between prevalence, incidence and mortality, we projected the prevalence of diagnosed T2D using currently available data on the incidence rate of diagnosed T2D and mortality rates of people with and without diagnosed T2D. Projection of prevalence was achieved by integration of a partial differential equation, which governs the illness-death model. These projected parameters were used as input values to calculate life years free of T2D and [Formula: see text] associated with T2D for the German population aged 40 to 100 years in the years 2015 and 2040, while accounting for different assumptions on future trends in T2D incidence and mortality.
Results: Assuming a constant incidence rate, women and men at age 40 years in 2015 will live approximately 38 years and 33 years free of T2D, respectively. Up to the year 2040, these numbers are projected to increase by 1.0 years and 1.3 years. Assuming a decrease in T2D-associated excess mortality of 2% per year, women and men aged 40 years with T2D in 2015 will be expected to lose 1.6 and 2.7 years of life, respectively, compared to a same aged person without T2D. In 2040, these numbers would reduce by approximately 0.9 years and 1.6 years. This translates to 10.8 million and 6.4 million [Formula: see text] in the German population aged 40-100 years with prevalent T2D in 2015 and 2040, respectively.
Conclusions: Given expected trends in mortality and no increase in T2D incidence, the burden due to premature mortality associated with T2D will decrease on the individual as well as on the population level. In addition, the expected lifetime without T2D is likely to increase. However, these trends strongly depend on future improvements of excess mortality associated with T2D and future incidence of T2D, which should motivate increased efforts of primary and tertiary prevention.
{"title":"Diabetes free life expectancy and years of life lost associated with type 2 diabetes: projected trends in Germany between 2015 and 2040.","authors":"Thaddäus Tönnies, Jens Baumert, Christin Heidemann, Elena von der Lippe, Ralph Brinks, Annika Hoyer","doi":"10.1186/s12963-021-00266-z","DOIUrl":"10.1186/s12963-021-00266-z","url":null,"abstract":"<p><strong>Background: </strong>Type 2 diabetes (T2D) causes substantial disease burden and is projected to affect an increasing number of people in coming decades. This study provides projected estimates of life years free of type 2 diabetes (T2D) and years of life lost ([Formula: see text]) associated with T2D for Germany in the years 2015 and 2040.</p><p><strong>Methods: </strong>Based on an illness-death model and the associated mathematical relation between prevalence, incidence and mortality, we projected the prevalence of diagnosed T2D using currently available data on the incidence rate of diagnosed T2D and mortality rates of people with and without diagnosed T2D. Projection of prevalence was achieved by integration of a partial differential equation, which governs the illness-death model. These projected parameters were used as input values to calculate life years free of T2D and [Formula: see text] associated with T2D for the German population aged 40 to 100 years in the years 2015 and 2040, while accounting for different assumptions on future trends in T2D incidence and mortality.</p><p><strong>Results: </strong>Assuming a constant incidence rate, women and men at age 40 years in 2015 will live approximately 38 years and 33 years free of T2D, respectively. Up to the year 2040, these numbers are projected to increase by 1.0 years and 1.3 years. Assuming a decrease in T2D-associated excess mortality of 2% per year, women and men aged 40 years with T2D in 2015 will be expected to lose 1.6 and 2.7 years of life, respectively, compared to a same aged person without T2D. In 2040, these numbers would reduce by approximately 0.9 years and 1.6 years. This translates to 10.8 million and 6.4 million [Formula: see text] in the German population aged 40-100 years with prevalent T2D in 2015 and 2040, respectively.</p><p><strong>Conclusions: </strong>Given expected trends in mortality and no increase in T2D incidence, the burden due to premature mortality associated with T2D will decrease on the individual as well as on the population level. In addition, the expected lifetime without T2D is likely to increase. However, these trends strongly depend on future improvements of excess mortality associated with T2D and future incidence of T2D, which should motivate increased efforts of primary and tertiary prevention.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2021-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8507142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39506695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-10DOI: 10.1186/s12963-021-00268-x
Gary Ka-Ki Chung, Francisco Tsz Tsun Lai, Eng-Kiong Yeoh, Roger Yat-Nork Chung
Background: Gender differences in the trend of educational inequality in diabetes have been widely observed in the Western populations, indicating the increasing importance of educational attainment as a social determinant of diabetes among women. Nonetheless, relevant evidence is scarce in developed Asian settings for comparisons. This study examined the gender-specific trends of educational inequality in diagnosed diabetes in Hong Kong between 1999 and 2014.
Methods: A series of eight territory-wide population-representative samples of 97,481 community-dwelling Hong Kong Chinese adults aged 45 or above were surveyed between 1999 and 2014. Regression-based Relative Index of Inequality (RII) and age-standardized Slope Index of Inequality (SII) were adopted to examine the extent and trend of gender-specific educational inequality in self-reported physician-diagnosed diabetes.
Results: Age-standardized prevalence of diabetes increased in both genders over time, with a steeper surge among men. In addition, educational inequalities in diabetes, in both relative and absolute terms, significantly widened among women over the study period (annual RII change = 1.04; 95% CI = 1.02-1.07, annual SII change = 0.36%; 95% CI = 0.16-0.56%), with the peak in 2011 (RII = 2.44; 95% CI = 1.83-3.24, SII = 9.21%; 95% CI = 6.47-11.96%). However, no significant widening inequality was found among men. Further adjustment for household income level did not attenuate the observed educational inequality.
Conclusions: Despite a greater increase in diabetes prevalence among men, disparity in diabetes substantially widened across education levels among women in the past decade in Hong Kong. The gender perspective should be taken into considerations for policy making to alleviate the prevalence surge and rising educational inequality in diabetes.
背景:在西方人群中,糖尿病教育不平等趋势的性别差异已经被广泛观察到,这表明教育程度作为女性糖尿病的社会决定因素越来越重要。然而,在亚洲发达国家,相关的比较证据很少。本研究调查了1999年至2014年间香港糖尿病患者受教育程度不平等的性别趋势。方法:在1999年至2014年期间,对97,481名45岁或以上的香港华人社区居民进行了一系列具有全港人口代表性的调查。采用基于回归的相对不平等指数(RII)和年龄标准化的不平等斜率指数(SII)来检验自述医师诊断糖尿病中性别教育不平等的程度和趋势。结果:随着时间的推移,年龄标准化的糖尿病患病率在两性中都有所增加,其中男性的激增幅度更大。此外,在研究期间,糖尿病的教育不平等,无论是相对的还是绝对的,都在女性中显著扩大(年度RII变化= 1.04;95% CI = 1.02-1.07, SII年变化= 0.36%;95% CI = 0.16-0.56%),峰值出现在2011年(RII = 2.44;95% ci = 1.83 ~ 3.24, sii = 9.21%;95% ci = 6.47-11.96%)。然而,在男性中没有发现明显的不平等扩大。进一步调整家庭收入水平并没有减弱观察到的教育不平等。结论:在过去十年中,尽管香港男性糖尿病患病率增加较多,但女性在糖尿病患病率上的差异在教育水平上明显扩大。在制定政策时应考虑到性别观点,以缓解糖尿病患病率激增和教育不平等的加剧。
{"title":"Gender-specific trends of educational inequality in diagnosed diabetes from 1999 to 2014 in Hong Kong: a serial cross-sectional study of 97,481 community-dwelling Chinese adults.","authors":"Gary Ka-Ki Chung, Francisco Tsz Tsun Lai, Eng-Kiong Yeoh, Roger Yat-Nork Chung","doi":"10.1186/s12963-021-00268-x","DOIUrl":"https://doi.org/10.1186/s12963-021-00268-x","url":null,"abstract":"<p><strong>Background: </strong>Gender differences in the trend of educational inequality in diabetes have been widely observed in the Western populations, indicating the increasing importance of educational attainment as a social determinant of diabetes among women. Nonetheless, relevant evidence is scarce in developed Asian settings for comparisons. This study examined the gender-specific trends of educational inequality in diagnosed diabetes in Hong Kong between 1999 and 2014.</p><p><strong>Methods: </strong>A series of eight territory-wide population-representative samples of 97,481 community-dwelling Hong Kong Chinese adults aged 45 or above were surveyed between 1999 and 2014. Regression-based Relative Index of Inequality (RII) and age-standardized Slope Index of Inequality (SII) were adopted to examine the extent and trend of gender-specific educational inequality in self-reported physician-diagnosed diabetes.</p><p><strong>Results: </strong>Age-standardized prevalence of diabetes increased in both genders over time, with a steeper surge among men. In addition, educational inequalities in diabetes, in both relative and absolute terms, significantly widened among women over the study period (annual RII change = 1.04; 95% CI = 1.02-1.07, annual SII change = 0.36%; 95% CI = 0.16-0.56%), with the peak in 2011 (RII = 2.44; 95% CI = 1.83-3.24, SII = 9.21%; 95% CI = 6.47-11.96%). However, no significant widening inequality was found among men. Further adjustment for household income level did not attenuate the observed educational inequality.</p><p><strong>Conclusions: </strong>Despite a greater increase in diabetes prevalence among men, disparity in diabetes substantially widened across education levels among women in the past decade in Hong Kong. The gender perspective should be taken into considerations for policy making to alleviate the prevalence surge and rising educational inequality in diabetes.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2021-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39501501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-02DOI: 10.1186/s12963-021-00269-w
Shih-Yung Su, Long-Teng Lee, Wen-Chung Lee
Background: Globally, the morbidity and mortality rates for chronic liver disease and cirrhosis are increasing. The National Viral Hepatitis Therapy Program in Taiwan was implemented in 2003, but evidence regarding the program's effect on the trends of mortality for chronic liver disease and cirrhosis is limited.
Methods: We analyzed mortality rates for chronic liver disease and cirrhosis in Taiwan for the period from 1981 to 2015. An autoregressive age-period-cohort model was used to estimate age, period, and cohort effects.
Results: Age-adjusted mortality rates for chronic liver disease and cirrhosis all displayed a flat but variable trend from 1981 to 2004 and a decreasing trend thereafter for both sexes. The age-period-cohort model revealed differential age gradients between the two sexes; mortality rates in the oldest age group (90-94 years) were 12 and 66 times higher than those in the youngest age group (30-34 years) for men and women, respectively. The period effects indicated that mortality rates declined after 2004 in both sexes. Mortality rates decreased in men but increased in women in the 1891-1940 birth cohorts and increased in both sexes in the birth cohorts from 1950 onward.
Conclusions: The National Viral Hepatitis Therapy Program in Taiwan may have contributed to the decrease in mortality rates for chronic liver disease and cirrhosis in adulthood.
{"title":"Mortality trends in chronic liver disease and cirrhosis from 1981 to 2015 in Taiwan.","authors":"Shih-Yung Su, Long-Teng Lee, Wen-Chung Lee","doi":"10.1186/s12963-021-00269-w","DOIUrl":"https://doi.org/10.1186/s12963-021-00269-w","url":null,"abstract":"<p><strong>Background: </strong>Globally, the morbidity and mortality rates for chronic liver disease and cirrhosis are increasing. The National Viral Hepatitis Therapy Program in Taiwan was implemented in 2003, but evidence regarding the program's effect on the trends of mortality for chronic liver disease and cirrhosis is limited.</p><p><strong>Methods: </strong>We analyzed mortality rates for chronic liver disease and cirrhosis in Taiwan for the period from 1981 to 2015. An autoregressive age-period-cohort model was used to estimate age, period, and cohort effects.</p><p><strong>Results: </strong>Age-adjusted mortality rates for chronic liver disease and cirrhosis all displayed a flat but variable trend from 1981 to 2004 and a decreasing trend thereafter for both sexes. The age-period-cohort model revealed differential age gradients between the two sexes; mortality rates in the oldest age group (90-94 years) were 12 and 66 times higher than those in the youngest age group (30-34 years) for men and women, respectively. The period effects indicated that mortality rates declined after 2004 in both sexes. Mortality rates decreased in men but increased in women in the 1891-1940 birth cohorts and increased in both sexes in the birth cohorts from 1950 onward.</p><p><strong>Conclusions: </strong>The National Viral Hepatitis Therapy Program in Taiwan may have contributed to the decrease in mortality rates for chronic liver disease and cirrhosis in adulthood.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2021-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8487474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39479185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-22DOI: 10.1186/s12963-021-00265-0
Estifanos Baye, Firehiwot Workneh Abate, Michelle Eglovitch, Fisseha Shiferie, Ingrid E Olson, Tigest Shifraw, Workagegnehu Tarekegn Kidane, Kalkidan Yibeltal, Sitota Tsegaye, Mulatu Melese Derebe, Sheila Isanaka, Blair J Wylie, Rose L Molina, Grace J Chan, Amare Worku, Luke C Mullany, Alemayehu Worku, Yemane Berhane, Anne C C Lee
Background: Low birthweight (LBW) (< 2500 g) is a significant determinant of infant morbidity and mortality worldwide. In low-income settings, the quality of birthweight data suffers from measurement and recording errors, inconsistent data reporting systems, and missing data from non-facility births. This paper describes birthweight data quality and the prevalence of LBW before and after implementation of a birthweight quality improvement (QI) initiative in Amhara region, Ethiopia.
Methods: A comparative pre-post study was performed in selected rural health facilities located in West Gojjam and South Gondar zones. At baseline, a retrospective review of delivery records from February to May 2018 was performed in 14 health centers to collect birthweight data. A birthweight QI initiative was introduced in August 2019, which included provision of high-quality digital infant weight scales (precision 5 g), routine calibration, training in birth weighing and data recording, and routine field supervision. After the QI implementation, birthweight data were prospectively collected from late August to early September 2019, and December 2019 to June 2020. Data quality, as measured by heaping (weights at exact multiples of 500 g) and rounding to the nearest 100 g, and the prevalence of LBW were calculated before and after QI implementation.
Results: We retrospectively reviewed 1383 delivery records before the QI implementation and prospectively measured 1371 newborn weights after QI implementation. Heaping was most frequently observed at 3000 g and declined from 26% pre-initiative to 6.7% post-initiative. Heaping at 2500 g decreased from 5.4% pre-QI to 2.2% post-QI. The percentage of rounding to the nearest 100 g was reduced from 100% pre-initiative to 36.5% post-initiative. Before the QI initiative, the prevalence of recognized LBW was 2.2% (95% confidence interval [CI]: 1.5-3.1) and after the QI initiative increased to 11.7% (95% CI: 10.1-13.5).
Conclusions: A QI intervention can improve the quality of birthweight measurements, and data measurement quality may substantially affect estimates of LBW prevalence.
{"title":"Effect of birthweight measurement quality improvement on low birthweight prevalence in rural Ethiopia.","authors":"Estifanos Baye, Firehiwot Workneh Abate, Michelle Eglovitch, Fisseha Shiferie, Ingrid E Olson, Tigest Shifraw, Workagegnehu Tarekegn Kidane, Kalkidan Yibeltal, Sitota Tsegaye, Mulatu Melese Derebe, Sheila Isanaka, Blair J Wylie, Rose L Molina, Grace J Chan, Amare Worku, Luke C Mullany, Alemayehu Worku, Yemane Berhane, Anne C C Lee","doi":"10.1186/s12963-021-00265-0","DOIUrl":"10.1186/s12963-021-00265-0","url":null,"abstract":"<p><strong>Background: </strong>Low birthweight (LBW) (< 2500 g) is a significant determinant of infant morbidity and mortality worldwide. In low-income settings, the quality of birthweight data suffers from measurement and recording errors, inconsistent data reporting systems, and missing data from non-facility births. This paper describes birthweight data quality and the prevalence of LBW before and after implementation of a birthweight quality improvement (QI) initiative in Amhara region, Ethiopia.</p><p><strong>Methods: </strong>A comparative pre-post study was performed in selected rural health facilities located in West Gojjam and South Gondar zones. At baseline, a retrospective review of delivery records from February to May 2018 was performed in 14 health centers to collect birthweight data. A birthweight QI initiative was introduced in August 2019, which included provision of high-quality digital infant weight scales (precision 5 g), routine calibration, training in birth weighing and data recording, and routine field supervision. After the QI implementation, birthweight data were prospectively collected from late August to early September 2019, and December 2019 to June 2020. Data quality, as measured by heaping (weights at exact multiples of 500 g) and rounding to the nearest 100 g, and the prevalence of LBW were calculated before and after QI implementation.</p><p><strong>Results: </strong>We retrospectively reviewed 1383 delivery records before the QI implementation and prospectively measured 1371 newborn weights after QI implementation. Heaping was most frequently observed at 3000 g and declined from 26% pre-initiative to 6.7% post-initiative. Heaping at 2500 g decreased from 5.4% pre-QI to 2.2% post-QI. The percentage of rounding to the nearest 100 g was reduced from 100% pre-initiative to 36.5% post-initiative. Before the QI initiative, the prevalence of recognized LBW was 2.2% (95% confidence interval [CI]: 1.5-3.1) and after the QI initiative increased to 11.7% (95% CI: 10.1-13.5).</p><p><strong>Conclusions: </strong>A QI intervention can improve the quality of birthweight measurements, and data measurement quality may substantially affect estimates of LBW prevalence.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2021-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8459538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39439438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-26DOI: 10.1186/s12963-021-00264-1
László Németh, Domantas Jasilionis, Henrik Brønnum-Hansen, Dmitri A Jdanov
Background: The lack of classification by educational attainment in death and population exposure data at older ages is an important constraint for studying changes and patterns of mortality disparities by education in Denmark and Sweden. The missing educational distribution of population also restricts analyses aiming at estimating contributions of compositional change to the improvements in national longevity. This study proposes a transparent approach to solve the two methodological issues allowing to obtain robust education-specific mortality estimates and population weights.
Methods: Using nonparametric approach, we redistribute the unknown cases and extrapolate the mortality curves of these sub-populations with the help of population-level data on an aggregate level from the Human Mortality Database.
Results: We present reconstructed and harmonized education-specific abridged and complete life tables for Sweden and Denmark covering 5-year-long periods from 1991-1995 to 2011-2015. The newly estimated life tables are in good agreement with the national life tables and show plausible age- and education-specific patterns. The observed changes in life expectancy by education suggest about the widening longevity gap between the highest and lowest educated for males and females in both countries.
Conclusions: The proposed simple and transparent method can be applied in similar country-specific cases showing large proportions of missing education or other socio-economic characteristics at older ages.
{"title":"Method for reconstructing mortality by educational groups.","authors":"László Németh, Domantas Jasilionis, Henrik Brønnum-Hansen, Dmitri A Jdanov","doi":"10.1186/s12963-021-00264-1","DOIUrl":"https://doi.org/10.1186/s12963-021-00264-1","url":null,"abstract":"<p><strong>Background: </strong>The lack of classification by educational attainment in death and population exposure data at older ages is an important constraint for studying changes and patterns of mortality disparities by education in Denmark and Sweden. The missing educational distribution of population also restricts analyses aiming at estimating contributions of compositional change to the improvements in national longevity. This study proposes a transparent approach to solve the two methodological issues allowing to obtain robust education-specific mortality estimates and population weights.</p><p><strong>Methods: </strong>Using nonparametric approach, we redistribute the unknown cases and extrapolate the mortality curves of these sub-populations with the help of population-level data on an aggregate level from the Human Mortality Database.</p><p><strong>Results: </strong>We present reconstructed and harmonized education-specific abridged and complete life tables for Sweden and Denmark covering 5-year-long periods from 1991-1995 to 2011-2015. The newly estimated life tables are in good agreement with the national life tables and show plausible age- and education-specific patterns. The observed changes in life expectancy by education suggest about the widening longevity gap between the highest and lowest educated for males and females in both countries.</p><p><strong>Conclusions: </strong>The proposed simple and transparent method can be applied in similar country-specific cases showing large proportions of missing education or other socio-economic characteristics at older ages.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8393442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39355119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-12DOI: 10.1186/s12963-021-00263-2
Carine Øien-Ødegaard, Lars Johan Hauge, Anne Reneflot
Background: The presence and quality of social ties can influence suicide risk. In adulthood, the most common provider of such ties is one's partner. As such, the link between marital status and suicide is well-documented, with lower suicide risk among married. However, the association between marital status and educational level suggest that marriage is becoming a privilege of the better educated. The relationship between educational attainment and suicide is somewhat ambiguous, although several studies argue that there is higher suicide risk among the less educated. This means that unmarried with low education may concurrently experience several risk factors for suicide. However, in many cases, these associations apply to men only, making it unclear whether they also refer to women. We aim to investigate the association between marital status, educational attainment, and suicide risk, and whether these associations differ across sexes.
Methods: Our data consist of Norwegian residents aged 35-54, between 1975 and 2014. Using personal identification-numbers, we linked information from various registers, and applied event history analysis to estimate suicide risk, and predicted probabilities for comparisons across sexes.
Results: Overall, associations across sexes are quite similar, thus contradicting several previous studies. Married men and women have lower suicide risk than unmarried, and divorced and separated have significant higher odds of suicide than never married, regardless of sex. Low educational attainment inflates the risk for both sexes, but high educational attainment is only associated with lower risk among men. Being a parent is associated with lower suicide risk for both sexes.
Conclusions: Higher suicide risk among the divorced and separated points to suicide risk being associated with ceasing of social ties. This is the case for both sexes, and especially those with low educational attainment, which both healthcare professionals and people in general should be aware of in order to promote suicide prevention.
{"title":"Marital status, educational attainment, and suicide risk: a Norwegian register-based population study.","authors":"Carine Øien-Ødegaard, Lars Johan Hauge, Anne Reneflot","doi":"10.1186/s12963-021-00263-2","DOIUrl":"https://doi.org/10.1186/s12963-021-00263-2","url":null,"abstract":"<p><strong>Background: </strong>The presence and quality of social ties can influence suicide risk. In adulthood, the most common provider of such ties is one's partner. As such, the link between marital status and suicide is well-documented, with lower suicide risk among married. However, the association between marital status and educational level suggest that marriage is becoming a privilege of the better educated. The relationship between educational attainment and suicide is somewhat ambiguous, although several studies argue that there is higher suicide risk among the less educated. This means that unmarried with low education may concurrently experience several risk factors for suicide. However, in many cases, these associations apply to men only, making it unclear whether they also refer to women. We aim to investigate the association between marital status, educational attainment, and suicide risk, and whether these associations differ across sexes.</p><p><strong>Methods: </strong>Our data consist of Norwegian residents aged 35-54, between 1975 and 2014. Using personal identification-numbers, we linked information from various registers, and applied event history analysis to estimate suicide risk, and predicted probabilities for comparisons across sexes.</p><p><strong>Results: </strong>Overall, associations across sexes are quite similar, thus contradicting several previous studies. Married men and women have lower suicide risk than unmarried, and divorced and separated have significant higher odds of suicide than never married, regardless of sex. Low educational attainment inflates the risk for both sexes, but high educational attainment is only associated with lower risk among men. Being a parent is associated with lower suicide risk for both sexes.</p><p><strong>Conclusions: </strong>Higher suicide risk among the divorced and separated points to suicide risk being associated with ceasing of social ties. This is the case for both sexes, and especially those with low educational attainment, which both healthcare professionals and people in general should be aware of in order to promote suicide prevention.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2021-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s12963-021-00263-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39173039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-28DOI: 10.1186/s12963-021-00258-z
Andres I Vecino-Ortiz, Madhuram Nagarajan, Kenneth Roger Katumba, Shamima Akhter, Raymond Tweheyo, Dustin G Gibson, Joseph Ali, Elizeus Rutebemberwa, Iqbal Ansary Khan, Alain Labrique, George W Pariyo
Background: This is the first study to examine the costs of conducting a mobile phone survey (MPS) through interactive voice response (IVR) to collect information on risk factors for noncommunicable diseases (NCD) in three low- and middle-income countries (LMIC); Bangladesh, Colombia, and Uganda.
Methods: This is a micro-costing study conducted from the perspective of the payer/funder with a 1-year horizon. The study evaluates the fixed costs and variable costs of implementing one nationally representative MPS for NCD risk factors of the adult population. In this costing study, we estimated the sample size of calls required to achieve a population-representative survey and associated incentives. Cost inputs were obtained from direct economic costs incurred by a central study team, from country-specific collaborators, and from platform developers who participated in the deployment of these MPS during 2017. Costs were reported in US dollars (USD). A sensitivity analysis was conducted assessing different scenarios of pricing and incentive strategies. Also, costs were calculated for a survey deployed targeting only adults younger than 45 years.
Results: We estimated the fixed costs ranging between $47,000 USD and $74,000 USD. Variable costs were found to be between $32,000 USD and $129,000 USD per nationally representative survey. The main cost driver was the number of calls required to meet the sample size, and its variability largely depends on the extent of mobile phone coverage and access in the country. Therefore, a larger number of calls were estimated to survey specific harder-to-reach sub-populations.
Conclusion: Mobile phone surveys have the potential to be a relatively less expensive and timely method of collecting survey information than face-to-face surveys, allowing decision-makers to deploy survey-based monitoring or evaluation programs more frequently than it would be possible having only face-to-face contact. The main driver of variable costs is survey time, and most of the variability across countries is attributable to the sampling differences associated to reaching out to population subgroups with low mobile phone ownership or access.
{"title":"A cost study for mobile phone health surveys using interactive voice response for assessing risk factors of noncommunicable diseases.","authors":"Andres I Vecino-Ortiz, Madhuram Nagarajan, Kenneth Roger Katumba, Shamima Akhter, Raymond Tweheyo, Dustin G Gibson, Joseph Ali, Elizeus Rutebemberwa, Iqbal Ansary Khan, Alain Labrique, George W Pariyo","doi":"10.1186/s12963-021-00258-z","DOIUrl":"https://doi.org/10.1186/s12963-021-00258-z","url":null,"abstract":"<p><strong>Background: </strong>This is the first study to examine the costs of conducting a mobile phone survey (MPS) through interactive voice response (IVR) to collect information on risk factors for noncommunicable diseases (NCD) in three low- and middle-income countries (LMIC); Bangladesh, Colombia, and Uganda.</p><p><strong>Methods: </strong>This is a micro-costing study conducted from the perspective of the payer/funder with a 1-year horizon. The study evaluates the fixed costs and variable costs of implementing one nationally representative MPS for NCD risk factors of the adult population. In this costing study, we estimated the sample size of calls required to achieve a population-representative survey and associated incentives. Cost inputs were obtained from direct economic costs incurred by a central study team, from country-specific collaborators, and from platform developers who participated in the deployment of these MPS during 2017. Costs were reported in US dollars (USD). A sensitivity analysis was conducted assessing different scenarios of pricing and incentive strategies. Also, costs were calculated for a survey deployed targeting only adults younger than 45 years.</p><p><strong>Results: </strong>We estimated the fixed costs ranging between $47,000 USD and $74,000 USD. Variable costs were found to be between $32,000 USD and $129,000 USD per nationally representative survey. The main cost driver was the number of calls required to meet the sample size, and its variability largely depends on the extent of mobile phone coverage and access in the country. Therefore, a larger number of calls were estimated to survey specific harder-to-reach sub-populations.</p><p><strong>Conclusion: </strong>Mobile phone surveys have the potential to be a relatively less expensive and timely method of collecting survey information than face-to-face surveys, allowing decision-makers to deploy survey-based monitoring or evaluation programs more frequently than it would be possible having only face-to-face contact. The main driver of variable costs is survey time, and most of the variability across countries is attributable to the sampling differences associated to reaching out to population subgroups with low mobile phone ownership or access.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2021-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s12963-021-00258-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39115009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-14DOI: 10.1186/s12963-021-00252-5
Emily K Johnson, Dillon Sylte, Sandra S Chaves, You Li, Cedric Mahe, Harish Nair, John Paget, Tayma van Pomeren, Ting Shi, Cecile Viboud, Spencer L James
Background: Influenza and respiratory syncytial virus (RSV) contribute significantly to the burden of acute lower respiratory infection (ALRI) inpatient care, but heterogeneous coding practices and availability of inpatient data make it difficult to estimate global hospital utilization for either disease based on coded diagnoses alone.
Methods: This study estimates rates of influenza and RSV hospitalization by calculating the proportion of ALRI due to influenza and RSV and applying this proportion to inpatient admissions with ALRI coded as primary diagnosis. Proportions of ALRI attributed to influenza and RSV were extracted from a meta-analysis of 360 total sources describing inpatient hospital admissions which were input to a Bayesian mixed effects model over age with random effects over location. Results of this model were applied to inpatient admission datasets for 44 countries to produce rates of hospital utilization for influenza and RSV respectively, and rates were compared to raw coded admissions for each disease.
Results: For most age groups, these methods estimated a higher national admission rate than the rate of directly coded influenza or RSV admissions in the same inpatient sources. In many inpatient sources, International Classification of Disease (ICD) coding detail was insufficient to estimate RSV burden directly. The influenza inpatient burden estimates in older adults appear to be substantially underestimated using this method on primary diagnoses alone. Application of the mixed effects model reduced heterogeneity between countries in influenza and RSV which was biased by coding practices and between-country variation.
Conclusions: This new method presents the opportunity of estimating hospital utilization rates for influenza and RSV using a wide range of clinical databases. Estimates generally seem promising for influenza and RSV associated hospitalization, but influenza estimates from primary diagnosis seem highly underestimated among older adults. Considerable heterogeneity remains between countries in ALRI coding (i.e., primary vs non-primary cause), and in the age profile of proportion positive for influenza and RSV across studies. While this analysis is interesting because of its wide data utilization and applicability in locations without laboratory-confirmed admission data, understanding the sources of variability and data quality will be essential in future applications of these methods.
{"title":"Hospital utilization rates for influenza and RSV: a novel approach and critical assessment.","authors":"Emily K Johnson, Dillon Sylte, Sandra S Chaves, You Li, Cedric Mahe, Harish Nair, John Paget, Tayma van Pomeren, Ting Shi, Cecile Viboud, Spencer L James","doi":"10.1186/s12963-021-00252-5","DOIUrl":"10.1186/s12963-021-00252-5","url":null,"abstract":"<p><strong>Background: </strong>Influenza and respiratory syncytial virus (RSV) contribute significantly to the burden of acute lower respiratory infection (ALRI) inpatient care, but heterogeneous coding practices and availability of inpatient data make it difficult to estimate global hospital utilization for either disease based on coded diagnoses alone.</p><p><strong>Methods: </strong>This study estimates rates of influenza and RSV hospitalization by calculating the proportion of ALRI due to influenza and RSV and applying this proportion to inpatient admissions with ALRI coded as primary diagnosis. Proportions of ALRI attributed to influenza and RSV were extracted from a meta-analysis of 360 total sources describing inpatient hospital admissions which were input to a Bayesian mixed effects model over age with random effects over location. Results of this model were applied to inpatient admission datasets for 44 countries to produce rates of hospital utilization for influenza and RSV respectively, and rates were compared to raw coded admissions for each disease.</p><p><strong>Results: </strong>For most age groups, these methods estimated a higher national admission rate than the rate of directly coded influenza or RSV admissions in the same inpatient sources. In many inpatient sources, International Classification of Disease (ICD) coding detail was insufficient to estimate RSV burden directly. The influenza inpatient burden estimates in older adults appear to be substantially underestimated using this method on primary diagnoses alone. Application of the mixed effects model reduced heterogeneity between countries in influenza and RSV which was biased by coding practices and between-country variation.</p><p><strong>Conclusions: </strong>This new method presents the opportunity of estimating hospital utilization rates for influenza and RSV using a wide range of clinical databases. Estimates generally seem promising for influenza and RSV associated hospitalization, but influenza estimates from primary diagnosis seem highly underestimated among older adults. Considerable heterogeneity remains between countries in ALRI coding (i.e., primary vs non-primary cause), and in the age profile of proportion positive for influenza and RSV across studies. While this analysis is interesting because of its wide data utilization and applicability in locations without laboratory-confirmed admission data, understanding the sources of variability and data quality will be essential in future applications of these methods.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2021-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s12963-021-00252-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39232648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-10DOI: 10.1186/s12963-021-00257-0
Henry Dyson, Raf Van Gestel, Eddy van Doorslaer
Background: Since the Global Burden of Disease study (GBD) has become more comprehensive, data for hundreds of causes of disease burden, measured using Disability Adjusted Life Years (DALYs), have become increasingly available for almost every part of the world. However, undergoing any systematic comparative analysis of the trends can be challenging given the quantity of data that must be presented.
Methods: We use the GBD data to describe trends in cause-specific DALY rates for eight regions. We quantify the extent to which the importance of 'major' DALY causes changes relative to 'minor' DALY causes over time by decomposing changes in the Gini coefficient into 'proportionality' and 'reranking' indices.
Results: The fall in regional DALY rates since 1990 has been accompanied by generally positive proportionality indices and reranking indices of negligible magnitude. However, the rate at which DALY rates have been falling has slowed and, at the same time, proportionality indices have tended towards zero. These findings are clearest where the focus is exclusively upon non-communicable diseases. Notably, large and positive proportionality indices are recorded for sub-Saharan Africa over the last decade.
Conclusion: The positive proportionality indices show that disease burden has become less concentrated around the leading causes over time, and this trend has become less prominent as the DALY rate decline has slowed. The recent decline in disease burden in sub-Saharan Africa is disproportionally driven by improvements in DALY rates for HIV/AIDS, as well as for malaria, diarrheal diseases, and lower respiratory infections.
{"title":"The relative importance and stability of disease burden causes over time: summarizing regional trends on disease burden for 290 causes over 28 years.","authors":"Henry Dyson, Raf Van Gestel, Eddy van Doorslaer","doi":"10.1186/s12963-021-00257-0","DOIUrl":"https://doi.org/10.1186/s12963-021-00257-0","url":null,"abstract":"<p><strong>Background: </strong>Since the Global Burden of Disease study (GBD) has become more comprehensive, data for hundreds of causes of disease burden, measured using Disability Adjusted Life Years (DALYs), have become increasingly available for almost every part of the world. However, undergoing any systematic comparative analysis of the trends can be challenging given the quantity of data that must be presented.</p><p><strong>Methods: </strong>We use the GBD data to describe trends in cause-specific DALY rates for eight regions. We quantify the extent to which the importance of 'major' DALY causes changes relative to 'minor' DALY causes over time by decomposing changes in the Gini coefficient into 'proportionality' and 'reranking' indices.</p><p><strong>Results: </strong>The fall in regional DALY rates since 1990 has been accompanied by generally positive proportionality indices and reranking indices of negligible magnitude. However, the rate at which DALY rates have been falling has slowed and, at the same time, proportionality indices have tended towards zero. These findings are clearest where the focus is exclusively upon non-communicable diseases. Notably, large and positive proportionality indices are recorded for sub-Saharan Africa over the last decade.</p><p><strong>Conclusion: </strong>The positive proportionality indices show that disease burden has become less concentrated around the leading causes over time, and this trend has become less prominent as the DALY rate decline has slowed. The recent decline in disease burden in sub-Saharan Africa is disproportionally driven by improvements in DALY rates for HIV/AIDS, as well as for malaria, diarrheal diseases, and lower respiratory infections.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2021-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39080408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-07DOI: 10.1186/s12963-021-00261-4
Huan Jiang, Shannon Lange, Alexander Tran, Sameer Imtiaz, Jürgen Rehm
Background: It remains unclear whether alcohol use disorders (AUDs) can be characterized by specific levels of average daily alcohol consumption. The aim of the current study was to model the distributions of average daily alcohol consumption among those who consume alcohol and those with alcohol dependence, the most severe AUD, using various clustering techniques.
Methods: Data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used in the current analyses. Clustering algorithms were applied in order to group a set of data points that represent the average daily amount of alcohol consumed. Gaussian Mixture Models (GMMs) were then used to estimate the likelihood of a data point belonging to one of the mixture distributions. Individuals were assigned to the clusters which had the highest posterior probabilities from the GMMs, and their treatment utilization rate was examined for each of the clusters.
Results: Modeling alcohol consumption via clustering techniques was feasible. The clusters identified did not point to alcohol dependence as a separate cluster characterized by a higher level of alcohol consumption. Among both females and males with alcohol dependence, daily alcohol consumption was relatively low.
Conclusions: Overall, we found little evidence for clusters of people with the same drinking distribution, which could be characterized as clinically relevant for people with alcohol use disorders as currently defined.
{"title":"Determining the sex-specific distributions of average daily alcohol consumption using cluster analysis: is there a separate distribution for people with alcohol dependence?","authors":"Huan Jiang, Shannon Lange, Alexander Tran, Sameer Imtiaz, Jürgen Rehm","doi":"10.1186/s12963-021-00261-4","DOIUrl":"10.1186/s12963-021-00261-4","url":null,"abstract":"<p><strong>Background: </strong>It remains unclear whether alcohol use disorders (AUDs) can be characterized by specific levels of average daily alcohol consumption. The aim of the current study was to model the distributions of average daily alcohol consumption among those who consume alcohol and those with alcohol dependence, the most severe AUD, using various clustering techniques.</p><p><strong>Methods: </strong>Data from Wave 1 and Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions were used in the current analyses. Clustering algorithms were applied in order to group a set of data points that represent the average daily amount of alcohol consumed. Gaussian Mixture Models (GMMs) were then used to estimate the likelihood of a data point belonging to one of the mixture distributions. Individuals were assigned to the clusters which had the highest posterior probabilities from the GMMs, and their treatment utilization rate was examined for each of the clusters.</p><p><strong>Results: </strong>Modeling alcohol consumption via clustering techniques was feasible. The clusters identified did not point to alcohol dependence as a separate cluster characterized by a higher level of alcohol consumption. Among both females and males with alcohol dependence, daily alcohol consumption was relatively low.</p><p><strong>Conclusions: </strong>Overall, we found little evidence for clusters of people with the same drinking distribution, which could be characterized as clinically relevant for people with alcohol use disorders as currently defined.</p>","PeriodicalId":51476,"journal":{"name":"Population Health Metrics","volume":null,"pages":null},"PeriodicalIF":3.3,"publicationDate":"2021-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s12963-021-00261-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39072381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}