Overview of trends in cardiovascular and diabetes risk factors in Fiji

The global, regional and national burden of type 2 diabetes mellitus in the past, present and future: a systematic analysis of the Global Burden of Disease Study 2019

Aim

To report the global, regional, and national burden of type 2 diabetes mellitus (T2DM) in 2019, assess its trends in the past, and forecast its trends in the future.

Methods

The main data source was the Global Burden of Disease 2019 database. We assessed the changes in T2DM burden from 1990 to 2019 with joinpoint regression analysis. Age-period-cohort analysis was used to forecast the T2DM incidence and mortality rate from 2020 to 2034.

Results

The burden of T2DM has increased from 1990 to 2019 generally. The low-middle socio-demographic index (SDI) region had the highest increase in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), and age-standardized disability-adjusted life years (ASDR) due to T2DM. Nationally, the increase in ASIR (r=0.151, p=0.046) and the decrease in ASMR (r=0.355, p<0.001) were positively correlated with SDIs. In 2019, the global ASIR, ASPR, ASMR, ASDR due to T2DM were 259.9 (95% UI 240.3-281.4), 5282.9 (95% UI 4853.6-5752.1), 18.5 (95% UI 17.2-19.7), and 801.5 (95% UI 55477000-79005200) per 100,000 population, respectively. Additionally, the ASIR (r=0.153, p=0.030) and ASPR (r=0.159, p=0.024) of T2DM were positively correlated with SDIs, while ASMR (r=-0.226, p=0.001) and ASDR (r=-0.171, p=0.015) due to T2DM were negatively correlated with SDIs. The ASIR was estimated to increase to 284.42, and ASMR was estimated to increase to 19.1 from 2030 to 2034, per 100,000 population.

Conclusion

Globally, the burden of T2DM has increased in the past and was forecast to continue increasing. Greater investment in T2DM prevention is needed.

Understanding Sociocultural Influences on Physical Activity in Relation to Overweight and Obesity in a Rural Indigenous Community of Fiji Islands

INTRODUCTION

Given health disparities and increased rates of obesity and non-communicable diseases seen in Indigenous populations worldwide and the evidence connecting sociocultural knowledge with physical activity, health, and wellbeing, this research was undertaken to understand the social and cultural components contributing to obesity in the Indigenous Fijian rural areas.

METHODS

This research is a community-based participatory research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data was analysed using descriptive thematic analysis.

RESULTS

Four major themes emerged associated with sociocultural, economic, political, and physical environmental factors. Males emphasised sports and working on farmlands as preferred types of physical activity, while females focused on family activities and daily activities and support for females' separate playgrounds. There was a focus on previous health promotion programs that did not incorporate the cultural values, cultural competence beliefs, and traditional ways of the rural Indigenous Fijian community.

CONCLUSION

The healthcare providers and policymakers need to recognise the iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. These findings should inform future research and community-based health programs to address the physical activity levels of the rural Indigenous community and may be relevant to other Indigenous peoples.

Associations between sociodemographic factors, health spending, disease burden, and life expectancy of older adults (70 + years old) in 22 countries in the Western Pacific Region, 1995-2019: estimates from the Global Burden of Disease (GBD) Study 2019

The needs of the aging populations are putting increasing burden on healthcare particularly in the Western Pacific Region (WPR), which is the home of aging economies such as Hong Kong and Japan alongside rapid increases in older people in low- and middle-income countries (LMICs). However, little is known about the associations between sociodemographic factors, disease burden, and life expectancy in WPR. The current study conducted secondary analysis on the Global Burden of Disease (GBD) estimates of populations aged 70 years and older in WPR countries between 1995 and 2019. Correlation tests, linear mixed regressions and generalized additive mixture models were run to examine the associations of interest. Unsupervised machine learning was conducted to segment the data automatically, at cluster analysis. The sociodemographic development index was found an important factor to the disease burden in terms of Years Lived with Disability (YLD) rate and mortality rate among older adults. YLD rate and mortality rate of non-communicable diseases (NCDs) attributable to different risk groups were significant contributors to higher expectation of Lost Healthy Years (LHE) and shorter life expectancy respectively in the context of rising YLD rate, particularly in LMICs. Three clusters of countries with similar characteristics were identified. NCDs were the most significant contributors to shorter life expectancy within which the time living in poor health did not improve. Better management of NCDs in aging populations should be emphasized in all countries. The country clusters may help in a more regional strategic planning.

Incidence, Morbidity and years Lived With Disability due to Type 2 Diabetes Mellitus in 204 Countries and Territories: Trends From 1990 to 2019

BACKGROUND

We aimed to examine the descriptive epidemiology and trends in the burden of type 2 diabetes mellitus (T2DM).

METHODS

Data were extracted from the Global Burden of Disease 2019 dataset. Estimated annual percentage changes (EAPCs) were calculated to assess the trends in incidence rate, mortality and disability-adjusted life-years (DALYs) associated with T2DM. Measures were stratified by sex, region, country, age and social development index (SDI) value.

RESULTS

The global age-standardized incidence rate of T2DM increased from 1990 to 2019, with an EAPC of 1.25 (95% CI, 1.19 to 1.31). In 2019, the highest age-standardized incidence rate of T2DM was observed in high-SDI regions, and the largest increase in this rate from 1990 to 2019 was also in high-SDI regions (EAPC, 1.74;95% CI, 1.57 to 1.90). At the regional level, Central Asia (EAPC, 2.53;95% CI, 2.45 to 2.61) had the largest increase in the age-standardized incidence rate of T2DM from 1990 to 2019. At the national level, Luxembourg (EAPC, 4.51;95% CI, 4.37 to 4.65) and Uzbekistan (EAPC, 3.63; 95% CI, 3.44 to 3.82) had the largest increases in the age-standardized incidence rate of T2DM from 1990 to 2019. The global age-standardized death and DALY rates increased from 1990 to 2019, with EAPCs of 0.26 (95% CI, 0.16 to 0.37) and 0.81 (95% CI, 0.77 to 0.85), respectively. The age-standardized death and DALY rates showed the largest increases in Central Asia, South Asia and Southern Sub-Saharan Africa.

CONCLUSIONS

Globally, the age-standardized incidence, death and DALY rates increased from 1990 to 2019. Central Asia, South Asia and Southern Sub-Saharan Africa were found to have the greatest burden of T2DM. Future strategies should focus on these high-risk regions and other high-risk populations.

A Multicentre Study Comparing Cerebrovascular Disease Profiles in Pacific Islander and Caucasian Populations Presenting with Stroke and Transient Ischaemic Attack

INTRODUCTION

In a multicentre study, we contrasted cerebrovascular disease profiles in Pacific Island (PI)-born patients (Indigenous Polynesian [IP] or Indo-Fijian [IF]) presenting with transient ischaemic attack (TIA), ischaemic stroke (IS) or intracerebral haemorrhage (ICH) with those of Caucasians (CSs).

METHODS

Using a retrospective case-control design, we compared PI-born patients with age- and gender-matched CS controls. Consecutive patients were admitted to 3 centres in South Western Sydney (July 2013-June 2020). Demographic and clinical data studied included vascular risk factors, stroke subtypes, and imaging characteristics.

RESULTS

There were 340 CS, 183 (27%) IP, and 157 (23%) IF patients; mean age 65 years; and 302 (44.4%) female. Of these, 587 and patients presented with TIA/IS and 93 (13.6%) had ICH. Both IP and IF patients were significantly more likely to present >24 h from symptom onset (odds ratios [ORs] vs. CS 1.87 and 2.23). IP patients more commonly had body mass indexes >30 (OR 1.94). Current smoking and excess alcohol intake were higher in CS. Hypertension, diabetes, and chronic kidney disease were significantly higher in both IP and IF groups in comparison to CS. IP patients had higher rates of AF and those with known AF were more commonly undertreated than both IF and CS patients (OR 2.24, p = 0.007). ICH was more common in IP patients (OR 2.32, p = 0.005), while more IF patients had intracranial arterial disease (OR 5.10, p < 0.001).

DISCUSSION/CONCLUSION

Distinct cerebrovascular disease profiles are identifiable in PI-born patients who present with TIA or stroke symptoms in Australia. These may be used in the future to direct targeted approaches to stroke prevention and care in culturally and linguistically diverse populations.

Trends in mortality and life expectancy in Fiji over 20 years

BACKGROUND

Fiji, a Pacific Island nation of 884,887 (2017 census), has experienced a prolonged epidemiological transition. This study examines trends in mortality and life expectancy (LE) in Fiji by sex and ethnicity over 1996-2017, with comparisons to published estimates.

METHODS

Trends in infant mortality rates (IMR), under-5 mortality (U5M), adult mortality (probability of dying), LE (at birth) and directly age-standardised death rates (DASRs) by sex and ethnicity, are calculated (with 95% confidence limits) using unit death records from the Fiji Ministry of Health and Medical Services. The LE gap between populations, or within populations over time, is examined using decomposition by age. Period trends are assessed for statistical significance using linear regression.

RESULTS

Over 1996-98 to 2014-17: IMR and U5M for i-Taukei and Fijians of Indian descent declined; U5M decline for i-Taukei (24.6 to 20.1/1000 live births) was significant (p = 0.016). Mortality (15-59 years) for i-Taukei males was unchanged at 27% but declined for Indians 33 to 30% (p = 0.101). Mortality for i-Taukei females increased 22 to 24% (p = 0.011) but declined for Indians 20 to 18% (p = 0.240). DASRs 1996-2017 were lower for i-Taukei (9.3 to 8.2/1000 population) than Indian males (10.6 to 9.8/1000). DASRs declined for i-Taukei (both sexes, p < 0.05), and for Indians (both sexes, p > 0.05). Over 22 years, LE at birth increased by 1 year or less (p = 0.030 in male i-Taukei). In 2014-17, LE (years) for males was: i-Taukei 64.9, Indians 63.5; and females: i-Taukei 67.0 and Indians 68.2. Mortality changes in most 5-year age groups increased or decreased the LE gap less than 10 weeks over 22 years. Compared to international agency reports, 2014-17 empirical LE estimates (males 64.7, females 67.8) were lower, as was IMR.

CONCLUSIONS

Based on empirical data, LE in Fiji has minimally improved over 1996-2017, and is lower than some international agencies report. Adult mortality was higher in Indian than i-Taukei men, and higher in i-Taukei than Indian women. Exclusion of stillbirths resulted in IMRs lower than previously reported. Differing mortality trends in subgroups highlight the need to collect census and health data by ethnicity and sex, to monitor health outcomes and inform resource allocation.

Urban-Rural Compliance Variability to COVID-19 Restrictions of Indigenous Fijian (iTaukei) Funerals in Fiji

Research on coronavirus disease 2019 (COVID-19) has focused primarily on impacts in Western societies despite emerging evidence of increased vulnerability among indigenous peoples such as Pacific Islanders. Using Facebook public posts, this research assessed compliance to COVID-19 restrictions such as social gatherings (SG) and social distancing (SD) in non-COVID-19, indigenous Fijian (iTaukei) funerals in Fiji. Results showed 95% of the 20 funerals exceeding SG limits with greater, and highly variable crowd sizes in rural than urban communities. Additionally, 75% of the 20 funerals did not adhere to the 2-m SD requirement of which 80% were in rural areas. Higher SG and SD compliance in urban funerals could be partially explained by the presence of a recognized authority who enforced crowd size limits, and the heterogeneous urban community who were more likely to flag breaches than their collectivistic, homogeneous, close-knit, rural counterparts. Ultimately, health authorities need to utilize a social lens that incorporates etic and emic differences in culture to ensure maximum compliance.

Awareness of diabetes risk factors among Bisha Residents Southwestern Saudi Arabia

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