Gains in life expectancy from decreasing cardiovascular disease and cancer mortality - an analysis of 28 European countries 1995-2019

Global, regional, and national burden of ischemic heart disease attributable to metabolic risks: a systematic analysis of Global Burden of Disease 2021

Background

Ischemic heart disease (IHD) represents the most significant disease burden among all cardiovascular diseases (CVDs). The increasing prevalence of metabolic risks in the 21st century has a profound impact on the disease burden associated with IHD. We analyzed the global, regional, and national burdens of IHD attributable to metabolic risks from 1990 to 2021.

Methods

The data were taken from Global Burden of Disease (GBD) study 2021. Deaths, disability-adjusted life years (DALYs), the average annual percent change (AAPC), age-standardized death rates per 100,000 persons (ASDR) and age-standardized rate per 100,000 persons (ASR) of DALYs ranging from 1990 to 2021, were extracted and stratified according to region, nationality, socio-demographic index (SDI), sex, and age. Additionally, the global future trends were predicted using Nordpred prediction model.

Results

Compared to 1990, in 2021, the number of death and DALYs from metabolic risk-attributed IHD increased globally by 67.35% and 59.91%, respectively; whereas ASDR and ASR of DALYs showed a decreasing trend and the most severe impact was observed in male and elderly populations. In addition, the burden of disease showed an inverted V-shaped relationship with SDI from 1990 to 2021. AAPC showed a significant increase in developing countries and a decrease in developed countries. We also analyzed the effects of different risk factors including metabolic risk factors on IHD in different SDI regions and genders. The prediction of future disease burden showed that the number of death and DALYs will keep rising, while ASDR and ASR of DALYs will maintain a certain downward trend.

Conclusions

The results of this study highlighted the need for screening and intervention for metabolic risk factors in specific regions and populations, this should call for increased collaboration between developing and developed countries to reduce the burden of disease and improve the prognosis of patients with IHD.

The effect of addressing the top 10 global causes of death on life expectancy in 2019: a global and regional analysis

BACKGROUND

The life expectancy (LE) index reflects health changes in society, highlighting trends in health quality and quantity. This study focused on analysing the impact of the top 10 causes of death on the global increase in LE in 2019.

METHODS

Data on the top 10 causes of death in 2019 were obtained from the Global Burden of Disease website and a period life table was used to assess how eliminating these causes would impact LE.

RESULTS

At the global level, eliminating deaths from ischaemic heart disease, stroke, chronic obstructive pulmonary disease, lower respiratory infections, neonatal conditions, lung cancers, Alzheimer's disease, diarrheal diseases, diabetes mellitus and kidney diseases resulted in an increase in LE at birth of 2.44, 1.64, 0.75, 0.80, 4.06, 0.48, 0.36, 0.52, 0.36 and 0.35 y, respectively.

CONCLUSIONS

The analysis reveals a gender gap in LE influenced by specific causes of death and regional differences. Therefore, public health policies should be customized for each area to target reductions in deaths that significantly improve LE.

Global trends and regional differences in mortality of cardiovascular disease and its impact on longevity, 1980-2021: Age-period-cohort analyses and life expectancy decomposition based on the Global Burden of Disease study 2021

OBJECTIVE

To investigate the temporal trend in cardiovascular disease (CVD) mortality and its impact on life expectancy (LE) gains across different Socio-demographic Index (SDI) regions.

METHODS

Cause-specific mortality estimates during 1980-2021 were obtained from the Global Burden of Disease 2021 study. An age-period-cohort (APC) analysis was adopted to estimate the net/local drifts and the age/period/cohort effects of CVD mortality. CVD-specific contributions to LE gains were estimated with Arriaga's method.

RESULTS

The global age-standardized mortality rate of CVD declined remarkably from 416.1 to 235.2 per 100,000 during 1980-2021, with slight increase in the proportion of CVD death to all-cause mortality. The net drift of CVD mortality was -1.25 % per year during 1980-2019, and we observed negative local drifts across all age groups, among which middle-aged individuals experienced more rapid declines in CVD mortality than their younger counterparts. Favorable period and cohort effects were generally noted, particularly in high SDI countries. Globally, CVD mortality improvements accounted for an increase of 2.28 years (38.89 %) in LE at 20 years during 1980-2019, with relative contributions increasing from 15.18 % in low SDI region (mostly intracerebral hemorrhage) to 64.66 % in high SDI countries (mostly ischemic heart disease). Notably, LE gaps between low and high SDI countries further widened over study period, and the corresponding proportion attributable to CVD increased remarkably.

CONCLUSION

Process in reducing CVD mortality contributed to longevity improvements over the past four decades globally, with expanded cardiovascular health disparities across various SDI regions. More attention should be paid to CVD epidemic in low SDI countries to mitigate regional inequalities.

Contributions of injury deaths to the changes in sex gaps in life expectancy and life disparity in the Nordic countries in the 21st century

OBJECTIVE

The objective of this study was to provide novel comparative insights on the contributions of injury deaths to the changes in sex gaps in life expectancy (SGLE) and sex gaps in life disparity (SGLD) across Nordic countries.

STUDY DESIGN

Retrospective demographic analysis of aggregated mortality data.

METHODS

To compute life expectancy (LE)/life disparity (LD), annual data on age- and sex-specific causes of death from the World Health Organization mortality database were used to construct abridged life tables for two periods: 2000-2002 and 2016-2018 (2014-2016 for Norway). The contributions of injury deaths to the changes in the SGLE and SGLD between these two periods were decomposed by age and cause using a continuous-change model.

RESULTS

Females' LE and LD advantages due to injury deaths narrowed by 0.16-0.44 (0.06-0.35) years for LE (LD) over time. While self-inflicted injuries consistently played a predominant role in contributing to the SGLE/SGLD in all countries in both periods, in all countries but Finland, transport accidents had the greatest contributions to the narrowing SGLE/SGLD. Widening SGLE due to self-inflicted injuries in Iceland and due to falls in Sweden were unique to these countries. Accounting for >20% of total contributions of injury deaths, the age group of 20-24 years had the greatest contributions to the narrowing SGLE/SGLD. Deaths due to falls in older ages and assault in younger ages generally contributed to the widening SGLE/SGLD.

CONCLUSIONS

Injury deaths, particularly transport accidents, contributed significantly to the narrowing SGLE and SGLD across Nordic countries, with cross-country variations in age- and cause-specific patterns. The results suggest the need for injury prevention policies targeting self-inflicted injuries in younger and falls in older males.

The contribution of avoidable mortality to life expectancy differences and lifespan disparities in the European Union: a population-based study

Background

Twenty years after the 2004 European Union (EU) enlargement, life expectancy differences between established (EMS) and new member states (NMS) remain large. Contributing to this gap are deaths that can be avoided through preventive services or adequate medical treatment. We estimate the impact of reducing avoidable mortality on life expectancy and lifespan disparities in the enlarged EU.

Methods

Using World Health Organization mortality database data, we analysed the potential of reducing avoidable mortality, as defined by Eurostat and the Organisation for Economic Cooperation and Development, to close the mortality gap between NMS and EMS. We decomposed the changes in life expectancy and lifespan disparity by age and cause using linear integral decomposition.

Findings

Averting all avoidable deaths across the EU from 2005 to 2019 would decrease the average life expectancy gap from 5.8 to 2.4 years in men and 3.3-2 years in women and eliminate the lifespan disparity gap. Had NMS achieved the average EMS avoidable mortality rates during the same period, the average life expectancy gap would have been reduced to 1.8 years in men and 1.6 years in women, and the lifespan disparities gap would have been reversed. Avoidable circulatory and injury-related deaths in middle and older age drove the observed mortality changes.

Interpretation

Our results suggest that the gap in life expectancy and lifespan disparity across the EU could be reduced by strengthening health systems and investing in averting circulatory and injury-related deaths in middle and older age in NMS.

Funding

None.

Urban-rural disparities in COVID-19 hospitalisations and mortality: A population-based study on national surveillance data from Germany and Italy

PURPOSE

Recent literature has highlighted the overlapping contribution of demographic characteristics and spatial factors to urban-rural disparities in SARS-CoV-2 transmission and outcomes. Yet the interplay between individual characteristics, hospitalisation, and spatial factors for urban-rural disparities in COVID-19 mortality have received limited attention.

METHODS

To fill this gap, we use national surveillance data collected by the European Centre for Disease Prevention and Control and we fit a generalized linear model to estimate the association between COVID-19 mortality and the individuals' age, sex, hospitalisation status, population density, share of the population over the age of 60, and pandemic wave across urban, intermediate and rural territories.

FINDINGS

We find that in what type of territory individuals live (urban-intermediate-rural) accounts for a significant difference in their probability of dying given SARS-COV-2 infection. Hospitalisation has a large and positive effect on the probability of dying given SARS-CoV-2 infection, but with a gradient across urban, intermediate and rural territories. For those living in rural areas, the risk of dying is lower than in urban areas but only if hospitalisation was not needed; while for those who were hospitalised in rural areas the risk of dying was higher than in urban areas.

CONCLUSIONS

Together with individuals' demographic characteristics (notably age), hospitalisation has the largest effect on urban-rural disparities in COVID-19 mortality net of other individual and regional characteristics, including population density and the share of the population over 60.

Global burden of 34 cancers among women in 2020 and projections to 2040: Population-based data from 185 countries/territories

Globally women face inequality in cancer outcomes; for example, smaller improvements in life expectancy due to decreased cancer-related deaths than men (0.5 vs 0.8 years, 1981-2010). However, comprehensive global evidence on the burden of cancer among women (including by reproductive age spectrum) as well as disparities by region, remains limited. This study aimed to address these evidence gaps by considering 34 cancer types in 2020 and their projections for 2040. The cancer burden among women in 2020 was estimated using population-based data from 185 countries/territories sourced from GLOBOCAN. Mortality to Incidence Ratios (MIR), a proxy for survival, were estimated by dividing the age-standardised mortality rates by the age-standardised incidence rates. Demographic projections were performed to 2040. In 2020, there were an estimated 9.3 million cancer cases and 4.4 million cancer deaths globally. Projections showed an increase to 13.3 million (↑44%) and 7.1 million (↑60%) in 2040, respectively, with larger proportional increases in low- and middle-income countries. MIR among women was higher (poorer survival) in rare cancers and with increasing age. Countries with low Human Development Indexes (HDIs) had higher MIRs (69%) than countries with very high HDIs (30%). There was inequality in cancer incidence and mortality worldwide among women in 2020, which will further widen by 2040. Implementing cancer prevention efforts and providing basic cancer treatments by expanding universal health coverage through a human rights approach, expanding early screening opportunities and strengthening medical infrastructure are key to improving and ensuring equity in cancer control and outcomes.

Strategies to decrease inequalities in cancer therapeutics, care and prevention: Proceedings on a conference organized by the Pontifical Academy of Sciences and the European Academy of Cancer Sciences, Vatican City, February 23-24, 2023

Analyses of inequalities related to prevention and cancer therapeutics/care show disparities between countries with different economic standing, and within countries with high Gross Domestic Product. The development of basic technological and biological research provides clinical and prevention opportunities that make their implementation into healthcare systems more complex, mainly due to the growth of Personalized/Precision Cancer Medicine (PCM). Initiatives like the USA-Cancer Moonshot and the EU-Mission on Cancer and Europe's Beating Cancer Plan are initiated to boost cancer prevention and therapeutics/care innovation and to mitigate present inequalities. The conference organized by the Pontifical Academy of Sciences in collaboration with the European Academy of Cancer Sciences discussed the inequality problem, dependent on the economic status of a country, the increasing demands for infrastructure supportive of innovative research and its implementation in healthcare and prevention programs. Establishing translational research defined as a coherent cancer research continuum is still a challenge. Research has to cover the entire continuum from basic to outcomes research for clinical and prevention modalities. Comprehensive Cancer Centres (CCCs) are of critical importance for integrating research innovations to preclinical and clinical research, as for ensuring state-of-the-art patient care within healthcare systems. International collaborative networks between CCCs are necessary to reach the critical mass of infrastructures and patients for PCM research, and for introducing prevention modalities and new treatments effectively. Outcomes and health economics research are required to assess the cost-effectiveness of new interventions, currently a missing element in the research portfolio. Data sharing and critical mass are essential for innovative research to develop PCM. Despite advances in cancer research, cancer incidence and prevalence is growing. Making cancer research infrastructures accessible for all patients, considering the increasing inequalities, requires science policy actions incentivizing research aimed at prevention and cancer therapeutics/care with an increased focus on patients' needs and cost-effective healthcare.

Myocardial ischemia/reperfusion: Translational pathophysiology of ischemic heart disease

Ischemic heart disease is the greatest health burden and most frequent cause of death worldwide. Myocardial ischemia/reperfusion is the pathophysiological substrate of ischemic heart disease. Improvements in prevention and treatment of ischemic heart disease have reduced mortality in developed countries over the last decades, but further progress is now stagnant, and morbidity and mortality from ischemic heart disease in developing countries are increasing. Significant problems remain to be resolved and require a better pathophysiological understanding. The present review attempts to briefly summarize the state of the art in myocardial ischemia/reperfusion research, with a view on both its coronary vascular and myocardial aspects, and to define the cutting edges where further mechanistic knowledge is needed to facilitate translation to clinical practice.

Competing risk analysis of cardiovascular death in breast cancer: evidence from the SEER database

BACKGROUND

Cardiovascular disease (CVD) is the leading cause of death for all non-cancer deaths among breast cancer (BC) patients. The aim of this study was to investigate the risk of cardiovascular mortality (CVM) in patients with BC.

METHODS

Patients diagnosed with primary BC between 2010 and 2018 were identified through the Surveillance, Epidemiology and End Results (SEER) database. The standardized mortality ratio (SMR) for CVD was calculated to compare the CVM of BC patients with that of the general population. Multivariate competing risk models were performed to identify predictors of CVM in BC patients.

RESULTS

Overall, 399,014 BC patients were included from the SEER database, of whom 7,023 (1.8%) suffered death from CVD. The significantly higher overall SMR of CVM was observed in BC patients [SMR =4.84, 95% confidence interval (CI): 4.72-4.95]. Multivariate competing risk regression analysis revealed that age, race, American Joint Committee on Cancer (AJCC) stage, year of diagnosis, estrogen receptor (ER) status, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, BC subtype, surgery, chemotherapy, radiation therapy, and median household income as independent predictors of CVM in BC patients.

CONCLUSIONS

Compared to the general population, BC patients have a higher risk of experiencing CVM during the follow-up period after diagnosis. Early detection and intervention of cardiovascular risk factors would improve overall survival (OS) of BC patients.