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Ojha U, Marshall DC, Salciccioli JD, Al-Khayatt BM, Hammond-Haley M, Goodall R, Borsky KL, Crowley CP, Shalhoub J, Hartley A. Temporal trend analysis of rheumatic heart disease burden in high-income countries between 1990 and 2019. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:108-120. [PMID: 36477873 PMCID: PMC10904725 DOI: 10.1093/ehjqcco/qcac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/29/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022]
Abstract
AIMS To assesses trends in rheumatic heart disease (RHD) burden in high-income, European Union 15+ (EU15+) countries between 1990 and 2019. METHODS AND RESULTS Cross-sectional analysis of the incidence and mortality of RHD was conducted using data from the Global Burden of Disease (GBD) Study database. Age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were extracted for EU15+ countries per sex for each of the years from 1990 to 2019, inclusive, and mortality-to-incidence indices (MII) were computed. Joinpoint regression analysis was used for the description of trends. Over 29 years, an overall declining trend in RHD incidence and mortality across EU 15+ nations were observed. There was significant variability in RHD incidence and mortality rates across high-income countries. However, both RHD incidence and mortality were higher among females compared with males across EU15+ countries over the observed period. The most recent incidence trend, starting predominantly after 2014, demonstrated a rise in RHD incidence in most countries for both sexes. The timing of this RHD resurgence corresponds temporally with an influx of migrants and refugees into Europe. The recent increasing RHD incidence rates ranged from +0.4% to +24.7% for males, and +0.6% to +11.4% for females. CONCLUSION More than half of EU15+ nations display a recent increase in RHD incidence rate across both sexes. Possible factors associated with this rise are discussed and include increase in global migration from nations with higher RHD prevalence, host nation factors such as migrants' housing conditions, healthcare access, and migrant health status on arrival.
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Affiliation(s)
- Utkarsh Ojha
- Royal Brompton & Harefield Hospitals, Heart and Lung Division, Hill End Rd, Harefield, Uxbridge, UB9 6JH, UK
- Chelsea and Westminster Hospital, Department of Medicine, London SW10 9NH, UK
| | - Dominic C Marshall
- Department of Respiratory, National Heart and Lung Institute, Guy Scadding Building, Cale Street, London, SW3 6LY, UK
| | - Justin D Salciccioli
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA
| | - Becker M Al-Khayatt
- Department of Cardiology, East Surrey Hospital, Surrey and Sussex NHS Trusts, UK
| | - Matthew Hammond-Haley
- Department of Cardiology, King's College Hospital, British Heart Foundation Centre of Research Excellence, London, WC2R 2LS, UK
| | - Richard Goodall
- St Andrews Centre for Plastic Surgery and Burns, Chelmsford, CM1 7ET, UK
| | - Kim L Borsky
- Department of Plastic Surgery, Stoke Mandeville Hospital, Mandeville Rd, Aylesbury, HP21 8AL, UK
| | - Conor P Crowley
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, 41 Burlington Mall Rd, Burlington, MA, USA
| | - Joseph Shalhoub
- Imperial College London and Imperial College Healthcare NHS Trust, Imperial Vascular Unit, Mary Stanford Wing, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - Adam Hartley
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, London, SW7 2BX, UK
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Whittaker H, Rothnie KJ, Quint JK. Cause-specific mortality in COPD subpopulations: a cohort study of 339 647 people in England. Thorax 2024; 79:202-208. [PMID: 37328279 DOI: 10.1136/thorax-2022-219320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 05/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Identifying correlates of cause-specific mortality in patients with chronic obstructive pulmonary disease (COPD) may aid the targeting of therapies to reduce mortality. We determined factors associated with causes of death in a primary care COPD population. METHODS Clinical Practice Research Datalink Aurum was linked to Hospital Episode Statistics and death certificate data. People with COPD alive between 1 January 2010 and 1 January 2020 were included. Patient characteristics were defined before the start of follow-up: (a) frequency and severity of exacerbations; (b) emphysema or chronic bronchitis; (c) Global Obstructive Lung Disease (GOLD) groups A-D; and (d) airflow limitation. We used Cox Proportional Hazards regression and competing risks to investigate the association between patient characteristics and risk of all-cause, COPD and cardiovascular (CV) mortality. RESULTS 339 647 people with COPD were included of which 97 882 died during follow-up (25.7% COPD related and 23.3% CV related). Airflow limitation, GOLD group, exacerbation frequency and severity, and COPD phenotype were associated with all-cause mortality. Exacerbations, both increased frequency and severity, were associated with COPD-related mortality (≥2 exacerbations vs none adjusted HR: 1.64, 1.57-1.71; 1 severe vs none adjusted HR: 2.17, 2.04-2.31, respectively). Patients in GOLD groups B-D had a higher risk of COPD and CV mortality compared with GOLD group A (GOLD group D vs group A, adjusted HR for COPD mortality: 4.57, 4.23-4.93 and adjusted HR for CV mortality: 1.53, 1.41-1.65). Increasing airflow limitation was also associated with both COPD and CV mortality (GOLD 4 vs 1, adjusted HR: 12.63, 11.82-13.51 and adjusted HR: 1.75, 1.60-1.91, respectively). CONCLUSION Poorer airflow limitation, worse functional status and exacerbations had substantial associations with risk of all-cause mortality. Differing results for CV and COPD-related mortality suggests interventions to prevent mortality may need to target particular characteristics or time points in the disease course.
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Affiliation(s)
- Hannah Whittaker
- School of Public Health and National Heart and Lung Institute, Imperial College London, London, UK
| | - Kieran J Rothnie
- Department of Epidemiology, Value Evidence and Outcomes, Global Medical R&D, GlaxoSmithKline Plc, Brentford, UK
| | - Jennifer K Quint
- School of Public Health and National Heart and Lung Institute, Imperial College London, London, UK
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Du M, Liu M, Liu J. U-shaped association between sleep duration and the risk of respiratory diseases mortality: a large prospective cohort study from UK Biobank. J Clin Sleep Med 2023; 19:1923-1932. [PMID: 37477156 PMCID: PMC10620653 DOI: 10.5664/jcsm.10732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/11/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
STUDY OBJECTIVES Our cohort study aimed to study the association between sleep duration and risk of mortality due to respiratory diseases. METHODS We included 498,200 participants from UK Biobank (2006-2021). We classified sleep duration as short sleep duration (< 7 hours), long sleep duration (> 9 hours for adults, > 8 hours for older adults), and midrange sleep duration (7-9 hours). We used the Cox proportional hazards model and restricted cubic spline analysis to explore the association between sleep duration and respiratory diseases mortality. RESULTS During a median follow-up of 12.49 years, 2,477 deaths due to respiratory diseases were recorded, of which 1,099 were deaths due to chronic lower respiratory diseases. Cox models with penalized splines showed U-shaped associations of sleep duration with mortality due to total respiratory diseases and chronic lower respiratory diseases. Compared with midrange sleep duration, short sleep duration was associated with 14% higher risk of total respiratory diseases mortality (hazard ratio = 1.14; 95% confidence interval: 1.04, 1.25), and long sleep duration was associated with 35% higher risk of total respiratory diseases mortality (hazard ratio = 1.35; 95% confidence interval: 1.19, 1.55), after adjustment of baseline characteristics, health status, and lifestyle habits. Similarly, the hazard ratios for chronic lower respiratory diseases mortality were 1.20 (95% confidence interval: 1.04, 1.38) and 1.44 (95% confidence interval: 1.19, 1.74), respectively. CONCLUSIONS There was a U-shaped association between sleep duration and respiratory diseases mortality. Appropriate sleep duration may improve the progress of respiratory diseases. CITATION Du M, Liu M, Liu J. U-shaped association between sleep duration and the risk of respiratory diseases mortality: a large prospective cohort study from UK Biobank. J Clin Sleep Med. 2023;19(11):1923-1932.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing, China
- Key Laboratory of Reproductive Health, National Health and Family Planning Commission of the People’s Republic of China, Beijing, China
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Nikolaou E, German EL, Howard A, Nabwera HM, Matope A, Robinson R, Shiham F, Liatsikos K, McNamara C, Kattera S, Carter K, Parry CM, Read JM, Allen SJ, Urban BC, Hawcutt DB, Hill H, Collins AM, Ferreira DM. Assessing the use of minimally invasive self-sampling at home for long-term monitoring of the microbiota within UK families. Sci Rep 2023; 13:18201. [PMID: 37875557 PMCID: PMC10598218 DOI: 10.1038/s41598-023-45574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/21/2023] [Indexed: 10/26/2023] Open
Abstract
Monitoring the presence of commensal and pathogenic respiratory microorganisms is of critical global importance. However, community-based surveillance is difficult because nasopharyngeal swabs are uncomfortable and painful for a wide age range of participants. We designed a methodology for minimally invasive self-sampling at home and assessed its use for longitudinal monitoring of the oral, nasal and hand microbiota of adults and children within families. Healthy families with two adults and up to three children, living in and near Liverpool, United Kingdom, self-collected saliva, nasal lining fluid using synthetic absorptive matrices and hand swabs at home every two weeks for six months. Questionnaires were used to collect demographic and epidemiological data and assess feasibility and acceptability. Participants were invited to take part in an exit interview. Thirty-three families completed the study. Sampling using our approach was acceptable to 25/33 (76%) families, as sampling was fast (76%), easy (76%) and painless (60%). Saliva and hand sampling was acceptable to all participants of any age, whereas nasal sampling was accepted mostly by adults and children older than 5 years. Multi-niche self-sampling at home can be used by adults and children for longitudinal surveillance of respiratory microorganisms, providing key data for design of future studies.
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Affiliation(s)
- E Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, 3050, Australia.
- Microbiology and Immunology Department, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia.
| | - E L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - H M Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - A Matope
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - R Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - F Shiham
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Liatsikos
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - C McNamara
- Alder Hey Children's Hospital, Liverpool, UK
| | - S Kattera
- Alder Hey Children's Hospital, Liverpool, UK
| | - K Carter
- Alder Hey Children's Hospital, Liverpool, UK
| | - C M Parry
- Alder Hey Children's Hospital, Liverpool, UK
| | - J M Read
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - S J Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - B C Urban
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, OX3 7LE, UK
| | - D B Hawcutt
- Alder Hey Children's Hospital, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - H Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, OX3 7LE, UK.
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Lenoir A, Whittaker H, Gayle A, Jarvis D, Quint JK. Mortality in non-exacerbating COPD: a longitudinal analysis of UK primary care data. Thorax 2023; 78:904-911. [PMID: 36423926 DOI: 10.1136/thorax-2022-218724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Non-exacerbating patients with chronic obstructive pulmonary disease (COPD) are a less studied phenotype. We investigated clinical characteristics, mortality rates and causes of death among non-exacerbating compared with exacerbating patients with COPD. METHODS We used data from the Clinical Practice Research Datalink, Hospital Episode Statistics and Office for National Statistics between 1 January 2004 and 31 December 2018. Ever smokers with a COPD diagnosis with minimum 3 years of baseline information were included. We compared overall using Cox regression and cause-specific mortality rates using competing risk analysis, adjusted for age, sex, deprivation, smoking status, body mass index, GOLD stage and comorbidities. Causes of death were identified using International Classification of Diseases-10 codes. RESULTS Among 67 516 patients, 17.3% did not exacerbate during the 3-year baseline period. Mean follow-up was 4 years. Non-exacerbators were more likely to be male (63.3% vs 52.4%, p<0.001) and less often had a history of asthma (33.9% vs 43.6%, p<0.001) or FEV1<50% predicted (23.7 vs 31.8%) compared with exacerbators. Adjusted HR for overall mortality in non-exacerbators compared with exacerbators was 0.62 (95% CI 0.56 to 0.70) in the first year of follow-up and 0.87 (95% CI 0.83 to 0.91) thereafter. Non-exacerbating patients with COPD died less of respiratory causes than exacerbators (29.2% vs 40.3%) and more of malignancies (29.4% vs 23.4%) and cardiovascular diseases (26.2% vs 22.9%). HRs for malignant and circulatory causes of death were increased after the first year of follow-up. DISCUSSION In this primary care cohort, non-exacerbators showed distinct clinical characteristics and lower mortality rates. Non-exacerbators were equally likely to die of respiratory, malignant or cardiovascular diseases.
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Affiliation(s)
- Alexandra Lenoir
- Department of Respiratory Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Gesundheitsamt Fürstenfeldbruck, Fürstenfeldbruck, Germany
| | - Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Alicia Gayle
- National Heart and Lung Institute, Imperial College London, London, UK
- Epidemiology Department, AstraZeneca, Cambridge, UK
| | - Debbie Jarvis
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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Schnier C, Chin RF. Mortality in children with epilepsy: Cohort study using the clinical practice research datalink. Seizure 2023; 109:77-82. [PMID: 37269743 DOI: 10.1016/j.seizure.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/05/2023] Open
Abstract
OBJECTIVE To estimate Mortality Rate (MR) in UK children with epilepsy (CWE) compared to children without epilepsy (CWOE), describe causes of death, determine Mortality Rate Ratios (MRRs) for cause-specific mortality, and to analyse the contribution of co-morbidities (respiratory disease, neoplasm, and congenital disorders) to mortality rate. METHOD Retrospective cohort study of children born between 1998 and 2017, using linked data from the Clinical Practice Research Datalink Gold (Set 18). Epilepsy diagnoses were identified using previously validated codes. Causes of death were defined as natural or non-natural. Epilepsy-related deaths in CWE were those where underlying or contributing cause of death was epilepsy, status epilepticus, seizures, ill-defined/unknown cause or sudden death. We used Cox proportional hazard analysis to investigate associations of epilepsy and mortality. RESULTS There were 1,191,304 children followed for 13,994,916 person-years (median: 12) if which 9665 (0.8%) had epilepsy. Amongst CWE, 3.4% died. MR of CWE was 4.1 (95%CI 3.7-4.6)/1,000 person-years. CWE had an increased adjusted all-cause mortality (MRR 50.9,95%CI 44.8-57.7) compared to CWOE. Amongst the 330 deaths in CWE, 323 (98%) were natural, 7 (2%) non-natural, 80 (24%) epilepsy-related. MRR of non-natural deaths was 2.09 (95%CI 0.92,4.74, p = 0.08). SIGNIFICANCE Amongst CWE, 3.4% died during the study period. All-cause mortality rate in CWE was 4/1,000 person-years representing a fifty-fold increased mortality risk, after taking into account sex and socioeconomic status, compared to similarly aged children who did not have epilepsy. Causes of death mostly were not seizure-related. Non-natural death in CWE was uncommon.
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Affiliation(s)
- Christian Schnier
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, Edinburgh
| | - Richard F Chin
- Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences, Edinburgh; Royal Hospital for Children and Young People, Edinburgh.
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Singh H, Rupal A, Al Omari O, Jani C, Ahmed A, Khaliqdina S, Walker A, Shalhoub J, Thomson C, Marshall DC, Salciccioli JD. Trends in pulmonary tuberculosis mortality between 1985 and 2018: an observational analysis. BMC Pulm Med 2023; 23:184. [PMID: 37237250 DOI: 10.1186/s12890-023-02458-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Pulmonary tuberculosis (TB) is a major source of global morbidity and mortality. Latent infection has enabled it to spread to a quarter of the world's population. The late 1980s and early 1990s saw an increase in the number of TB cases related to the HIV epidemic, and the spread of multidrug-resistant TB. Few studies have reported pulmonary TB mortality trends. Our study reports and compares trends in pulmonary TB mortality. METHODS We utilized the World Health Organization (WHO) mortality database from 1985 through 2018 to analyze TB mortality using the International Classification of Diseases-10 codes. Based on the availability and quality of data, we investigated 33 countries including two countries from the Americas; 28 countries from Europe; and 3 countries from the Western Pacific region. Mortality rates were dichotomized by sex. We computed age-standardized death rates per 100,000 population using the world standard population. Time trends were investigated using joinpoint regression analysis. RESULTS We observed a uniform decrease in mortality in all countries across the study period except the Republic of Moldova, which showed an increase in female mortality (+ 0.12 per 100,000 population). Among all countries, Lithuania had the greatest reduction in male mortality (-12) between 1993-2018, and Hungary had the greatest reduction in female mortality (-1.57) between 1985-2017. For males, Slovenia had the most rapid recent declining trend with an estimated annual percentage change (EAPC) of -47% (2003-2016), whereas Croatia showed the fastest increase (EAPC, + 25.0% [2015-2017]). For females, New Zealand had the most rapid declining trend (EAPC, -47.2% [1985-2015]), whereas Croatia showed a rapid increase (EAPC, + 24.9% [2014-2017]). CONCLUSIONS Pulmonary TB mortality is disproportionately higher among Central and Eastern European countries. This communicable disease cannot be eliminated from any one region without a global approach. Priority action areas include ensuring early diagnosis and successful treatment to the most vulnerable groups such as people of foreign origin from countries with a high burden of TB and incarcerated population. Incomplete reporting of TB-related epidemiological data to WHO excluded high-burden countries and limited our study to 33 countries only. Improvement in reporting is crucial to accurately identify changes in epidemiology, the effect of new treatments, and management approaches.
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Affiliation(s)
- Harpreet Singh
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
- Medical Data Research Collaborative, London, UK
| | - Arashdeep Rupal
- Medical Data Research Collaborative, London, UK
- Division of Pulmonary, Critical Care Medicine, University of South Florida, Tampa, FL, USA
| | - Omar Al Omari
- Medical Data Research Collaborative, London, UK
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chinmay Jani
- Medical Data Research Collaborative, London, UK
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alaaeldin Ahmed
- Medical Data Research Collaborative, London, UK
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Shoheera Khaliqdina
- Department of Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Alexander Walker
- Medical Data Research Collaborative, London, UK
- Division of Pulmonary, Critical Care & Sleep Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Joseph Shalhoub
- Medical Data Research Collaborative, London, UK
- Department of Surgery and Cancer, Imperial College of London, London, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Carey Thomson
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA
| | - Dominic C Marshall
- Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Beth Israel Lahey Health, Cambridge, MA, USA.
- National Heart and Lung Institute, Imperial College London, London, UK.
| | - Justin D Salciccioli
- Medical Data Research Collaborative, London, UK
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
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Du M, Zhu L, Liu M, Liu J. Mutual Associations of Healthy Behaviours and Socioeconomic Status with Respiratory Diseases Mortality: A Large Prospective Cohort Study. Nutrients 2023; 15:nu15081872. [PMID: 37111091 PMCID: PMC10142455 DOI: 10.3390/nu15081872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Little cohort evidence is available on the effect of healthy behaviours and socioeconomic status (SES) on respiratory disease mortality. We included 372,845 participants from a UK biobank (2006-2021). SES was derived by latent class analysis. A healthy behaviours index was constructed. Participants were categorized into nine groups on the basis of combinations of them. The Cox proportional hazards model was used. There were 1447 deaths from respiratory diseases during 12.47 median follow-up years. The hazard ratios (HRs, 95% CIs) for the low SES (vs. high SES) and the four or five healthy behaviours (vs. no or one healthy behaviour) were 4.48 (3.45, 5.82) and 0.44 (0.36, 0.55), respectively. Participants with both low SES and no or one healthy behaviour had a higher risk of respiratory disease mortality (aHR = 8.32; 95% CI: 4.23, 16.35) compared with those in both high SES and four or five healthy behaviours groups. The joint associations were stronger in men than in women, and in younger than older adults. Low SES and less healthy behaviours were both associated with an increased risk of respiratory disease mortality, which augmented when both presented together, especially for young man.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing 100191, China
| | - Lin Zhu
- Center for Primary Care and Outcomes Research, School of Medicine, Center for Health Policy, Freeman Spogli Institute for International Studies, Stanford University, 450 Jane Stanford Way, Stanford, CA 94305-2004, USA
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing 100191, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38, Xueyuan Road, Haidian District, Beijing 100191, China
- Institute for Global Health and Development, Peking University, No.5, Yiheyuan Road, Haidian District, Beijing 100871, China
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, No.38, Xueyuan Road, Haidian District, Beijing 100191, China
- Key Laboratory of Reproductive Health, National Health and Family Planning Commission of the People's Republic of China, No.38, Xueyuan Road, Haidian District, Beijing 100191, China
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9
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Zhao N, Wang S, Wang L, Shi Y, Jiang Y, Tseng TJ, Liu S, Chan TC, Zhang Z. Epidemiological features and trends in the mortality rates of 10 notifiable respiratory infectious diseases in China from 2004 to 2020: Based on national surveillance. Front Public Health 2023; 11:1102747. [PMID: 36875408 PMCID: PMC9982089 DOI: 10.3389/fpubh.2023.1102747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Abstract
Objectives The aim of this study is to describe, visualize, and compare the trends and epidemiological features of the mortality rates of 10 notifiable respiratory infectious diseases in China from 2004 to 2020. Setting Data were obtained from the database of the National Infectious Disease Surveillance System (NIDSS) and reports released by the National and local Health Commissions from 2004 to 2020. Spearman correlations and Joinpoint regression models were used to quantify the temporal trends of RIDs by calculating annual percentage changes (APCs) in the rates of mortality. Results The overall mortality rate of RIDs was stable across China from 2004 to 2020 (R = -0.38, P = 0.13), with an APC per year of -2.2% (95% CI: -4.6 to 0.3; P = 0.1000). However, the overall mortality rate of 10 RIDs in 2020 decreased by 31.80% (P = 0.006) compared to the previous 5 years before the COVID-19 pandemic. The highest mortality occurred in northwestern, western, and northern China. Tuberculosis was the leading cause of RID mortality, and mortality from tuberculosis was relatively stable throughout the 17 years (R = -0.36, P = 0.16), with an APC of -1.9% (95% CI -4.1 to 0.4, P = 0.1000). Seasonal influenza was the only disease for which mortality significantly increased (R = 0.73, P = 0.00089), with an APC of 29.70% (95% CI 16.60-44.40%; P = 0.0000). The highest yearly case fatality ratios (CFR) belong to avian influenza A H5N1 [687.5 per 1,000 (33/48)] and epidemic cerebrospinal meningitis [90.5748 per 1,000 (1,010/11,151)]. The age-specific CFR of 10 RIDs was highest among people over 85 years old [13.6551 per 1,000 (2,353/172,316)] and was lowest among children younger than 10 years, particularly in 5-year-old children [0.0552 per 1,000 (58/1,051,178)]. Conclusions The mortality rates of 10 RIDs were relatively stable from 2004 to 2020 with significant differences among Chinese provinces and age groups. There was an increased mortality trend for seasonal influenza and concerted efforts are needed to reduce the mortality rate of seasonal influenza in the future.
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Affiliation(s)
- Na Zhao
- School of Ecology and Environment, Anhui Normal University, Wuhu, Anhui, China.,Collaborative Innovation Center of Recovery and Reconstruction of Degraded Ecosystem in Wanjiang Basin Co-founded by Anhui Province and Ministry of Education, Anhui Normal University, Wuhu, China
| | - Supen Wang
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
| | - Lan Wang
- Department of Geriatrics, The First Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Yingying Shi
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
| | - Yixin Jiang
- College of Life Sciences, Anhui Normal University, Wuhu, Anhui, China
| | - Tzu-Jung Tseng
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Centre for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Zhiruo Zhang
- School of Public Health, Lanzhou University, Lanzhou, Gansu, China.,School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Trends of kidney cancer burden from 1990 to 2019 in European Union 15 + countries and World Health Organization regions. Sci Rep 2022; 12:22368. [PMID: 36572700 PMCID: PMC9792551 DOI: 10.1038/s41598-022-25485-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 11/30/2022] [Indexed: 12/28/2022] Open
Abstract
In recent decades, variability in the incidence and mortality of kidney cancer (KC) has been reported. This study aimed to compare trends in incidence, mortality, and disability-adjusted life years (DALY) of KC between the European Union (EU) 15 + countries and 6 World Health Organization (WHO) regions. The data of KC Age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs), and age-standardized DALYs were extracted from the Global Burden of Disease database. Joinpoint regression was employed to examine trends. From 1990 to 2019, the ASIR increased in most countries except for Luxembourg (males), the USA (females) and Austria and Sweden (both sexes). ASIR increased across all 6 WHO regions for both sexes except for females in Americas. The ASMR increased in 10/19 countries for males and 9/19 for females as well across most WHO regions. The mortality-to-incidence ratio (MIR) decreased in all countries and WHO regions. Trends in DALYs were variable across countries and WHO regions. While the incidence and mortality from KC rose in most EU15 + countries and WHO regions from 1990 to 2019, the universal drop in MIR suggests an overall improvement in KC outcomes. This is likely multifactorial, including earlier detection of KC and improved treatments.
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11
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Du M, Tao L, Liu M, Liu J. Mediation of Healthy Behaviour on the Association of Frailty with Respiratory Diseases Mortality among 0.4 Million Participants: A Prospective Cohort Study from UK Biobank. Nutrients 2022; 14:nu14235046. [PMID: 36501077 PMCID: PMC9736014 DOI: 10.3390/nu14235046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022] Open
Abstract
The mutual relationship between frailty and healthy behaviour and its effect on respiratory diseases mortality remains largely unknown; this study aims to supplement related analysis on it by using a large sample cohort study. We included 411,987 participants from the UK Biobank study (2006-2021), and measured participants' frailty phenotype and healthy behaviour index by using questionnaires and physical measurement. Mortality from respiratory diseases were obtained through linkage to registries. We used the cox proportional hazards model to explore the association of frailty with respiratory diseases mortality, and calculated the mediation proportion of the healthy behaviour. During a median follow-up of 12.48 years, and after adjustment for other covariates and healthy behaviour index, when compared with non-frail participants, being frail was associated with 2.68 times, 3.27 times, and 3.31 times higher risk of total respiratory diseases mortality, influenza and pneumonia mortality and chronic lower respiratory diseases mortality, respectively. The attenuated proportions mediated by healthy behaviour were 5.1% (95% CI: 4.4%, 5.9%), 3.0% (95% CI: 2.1%, 4.2%) and 6.0% (95% CI: 4.9%, 7.4%), respectively. Compared with non-frail individuals with four or five healthy behaviours, frail individuals with no or one healthy behaviour had higher risks of total respiratory diseases mortality (aHR = 4.59; 95% CI: 3.27, 6.45), influenza and pneumonia mortality (aHR = 4.55; 95% CI: 2.30, 9.03), as well as chronic lower respiratory diseases mortality (aHR = 12.70; 95% CI: 5.76, 27.96). Adherence to a healthy lifestyle therefore represents a potentially modifiable target for improving the harmful impact of frailty on reduced life expectancy as a result of respiratory diseases.
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Affiliation(s)
- Min Du
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
- Institute for Global Health and Development, Peking University, Beijing 100871, China
- Global Center for Infectious Disease and Policy Research & Global Health and Infectious Diseases Group, Peking University, Beijing 100191, China
- Key Laboratory of Reproductive Health, National Health and Family Planning Commission of the People’s Republic of China, Beijing 100191, China
- Correspondence: ; Tel.: +86-10-8-2801528-319
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12
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Jia H, Xu J, Ning L, Feng T, Cao P, Gao S, Shang P, Yu X. Ambient air pollution, temperature and hospital admissions due to respiratory diseases in a cold, industrial city. J Glob Health 2022; 12:04085. [PMID: 36243957 PMCID: PMC9569423 DOI: 10.7189/jogh.12.04085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The influences of air pollution exposure and temperature on respiratory diseases have become major global health concerns. This study investigated the relationship between ambient air pollutant concentrations and temperature in cold industrial cities that have the risk of hospitalization for respiratory diseases. Methods A time-series study was conducted in Changchun, China, from 2015 to 2019 to analyse the number of daily admissions for respiratory diseases, air pollutant concentrations, and meteorological factors. Time-series decomposition was applied to analyse the trend and characteristics of the number of admissions. Generalized additive models and distributed lag nonlinear models were constructed to explore the effects of air pollutant concentrations and temperature on the number of admissions. Results The number of daily admissions showed an increasing trend, and the seasonal fluctuation was obvious, with more daily admissions in winter and spring than in summer and autumn. There were positive and gradually decreasing lag effects of PM10, PM2.5, NO2, and CO concentrations on the number of admissions, whereas O3 showed a J-shaped trend. The results showed that within the 7-day lag period, 0.5°C was the temperature associated with the lowest relative risk of admission due to respiratory disease, and extremely low and high temperatures (<-18°C, >27°C, respectively) increased the risk of hospitalization for respiratory diseases by 8.3% and 12.1%, respectively. Conclusions From 2015 to 2019, respiratory diseases in Changchun showed an increasing trend with obvious seasonality. The increased concentrations of SO2, NO2, CO, PM2.5, O3 and PM10 lead to an increased risk of hospitalization for respiratory diseases, with a significant lag effect. Both extreme heat and cold could lead to increases in the risk of admission due to respiratory disease.
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Affiliation(s)
- Huanhuan Jia
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Jiaying Xu
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Liangwen Ning
- School of Public Administration, Jilin University, Changchun City, Jilin Province, China
| | - Tianyu Feng
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Peng Cao
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Shang Gao
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Panpan Shang
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Xihe Yu
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
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13
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Whittaker H, Van Ganse E, Dalon F, Nolin M, Marrant-Micallef C, Pison C, Ryan DP, Deslee G, Quint JK, Belhassen M. Differences in severe exacerbations rates and healthcare utilisation in COPD populations in the UK and France. BMJ Open Respir Res 2022; 9:9/1/e001150. [PMID: 35944943 PMCID: PMC9367183 DOI: 10.1136/bmjresp-2021-001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/31/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality in Europe; however, it is important to understand how clinical practice patterns differ between countries and how this might relate to disease outcomes, to identify ways of improving local disease management. We aimed to describe and compare the management of patients with COPD in the UK and France between 2008 and 2017. Methods We used data from the Clinical Practice Research Datalink GOLD and Hospital Episode Statistics in the UK and the Echantillon Généraliste des Bénéficiaire in France to identify patients with COPD each year between 2008 and 2017. We compared patient characteristics, all-cause mortality and COPD exacerbations each year between 2008 and 2017 for patients in the UK and France separately. Health care utilisation and COPD exacerbations in 2017 were compared between France and the UK using t-tests and χ2 tests. Results Patients with COPD were similar in gender and comorbidities in both countries. Incidence of COPD exacerbations remained stable in the UK and France between 2007 and 2017. In 2017, the proportion of all-cause and COPD-related hospitalisations was greater in the UK than in France (43.9% vs 32.8% and 8.3% vs 4.9%, respectively; p<0.001) as was the proportion of patients visiting accident and emergency (A&E) (39.8% vs 16.2%, respectively; p<0.001). In addition, the mean length of stay in hospital for COPD-related causes was shorter in the UK than in France (6.2 days (SD 8.4) vs 10.5 days (SD 9.1), respectively; p<0.001). Discussion Overall, UK patients were more likely to go to A&E, be hospitalised for COPD-related causes and stay in hospital for fewer days after being admitted for COPD-related reasons compared with patients in France, illustrating a difference in health-seeking behaviours and access to healthcare.
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Affiliation(s)
- Hannah Whittaker
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Eric Van Ganse
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France.,Respiratory Medicine, Hospital Croix-Rousse, Lyon, France
| | | | - Maeva Nolin
- PELyon, Pharmaco Epidemiologie Lyon, Lyon, France
| | | | - Christophe Pison
- Clinique de Pneumologie, Centre Hospitalier Universitaire de Grenoble, Service de Pneumologie, Grenoble, France
| | - Dermot P Ryan
- Allergy and Respiratory Research Group, Centre for Population Health Sciences: GP Section, University of Edinburgh, Edinburgh, UK
| | - Gaetan Deslee
- Department of Respiratory Medicine, INSERM UMRS 903, University Hospital of Reims, Reims, France
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, London, UK
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14
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Schuster-Bruce J, Jani C, Goodall R, Kim D, Hughes W, Salciccioli JD, Marshall D, Shalhoub J. A Comparison of the Burden of Thyroid Cancer Among the European Union 15+ Countries, 1990-2019: Estimates From the Global Burden of Disease Study. JAMA Otolaryngol Head Neck Surg 2022; 148:350-359. [PMID: 35266977 PMCID: PMC8914910 DOI: 10.1001/jamaoto.2021.4549] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/10/2022] [Indexed: 01/14/2023]
Abstract
Importance The global incidence of thyroid cancer has been increasing rapidly, and this increase has had an attendant burden on health systems. However, it is unclear how the burden of this disease differs among the pre-2004 countries of the European Union (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, and the UK), US, Australia, Canada, and Norway (EU15+). Objective To assess the trends in mortality, incidence, and disability-adjusted life-years (DALYs) associated with thyroid cancer between 1990 and 2019 in EU15+ nations. Data analysis was conducted from July 11 to October 11, 2021. Design, Setting, and Participants Observational cross-sectional analysis of the incidence of thyroid cancer was conducted using data obtained from the Global Burden of Disease Study database. Nineteen countries of the EU15+ were included. Exposures Thyroid cancer. Main Outcomes and Measures Age-standardized incidence rates (ASIRs), age-standardized mortality rates (ASMRs) and DALYs were extracted for individual EU15+ countries per sex for each of the years from 1990 to 2019, and mortality-to-incidence indexes were computed. Joinpoint regression analysis was used to describe the trends. Results Thirteen of 19 countries (68%) showed an average annual percentage change increase in ASIR across the study period (range, 0.2%-2.5%). Joinpoint regression analysis revealed largely plateauing ASIR trends in recent years across most EU15+ nations since 1990. Between 2011 and 2019, the estimated annual percentage change in the US was 0. Australia, Denmark, and the US were the only countries with increasing ASMR trends with positive average annual percentage changes: Australia, 0.6 (95% CI, 0.2-1.0); Denmark, 1.0 (95% CI, 0.8-1.3); and US, 0.4 (95% CI, 0.4-0.5); the remaining 16 countries showed negative trends (range, -0.2 to -2.1). Disability-adjusted life-years decreased in all EU15+ countries except Australia, Denmark, and the US. Conclusions and Relevance This cross-sectional analysis found that overall, the burden of thyroid cancer across EU15+ countries appears to be decreasing, evidenced by plateauing incidence rates and reductions in mortality and DALYs over the 30-year study period. However, the US and Australia appear to have increasing ASMR and DALY trends. Ongoing observation is required to monitor how changes in international clinical practice guidelines affect thyroid cancer DALYs and mortality.
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Affiliation(s)
- James Schuster-Bruce
- Department of Ear, Nose and Throat and Head & Neck Surgery, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Chinmay Jani
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts
| | - Richard Goodall
- Department of Plastic Surgery, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Dae Kim
- Department of Ear, Nose and Throat and Head & Neck Surgery, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - William Hughes
- St Andrews Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, United Kingdom
| | - Justin D. Salciccioli
- Department of Pulmonary and Critical Care, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dominic Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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15
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Respiratory-related death in individuals with incident asthma and COPD: a competing risk analysis. BMC Pulm Med 2022; 22:28. [PMID: 34998380 PMCID: PMC8742941 DOI: 10.1186/s12890-022-01823-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background Distinguishing between mortality attributed to respiratory causes and other causes among people with asthma, COPD, and asthma-COPD overlap (ACO) is important. This study used electronic health records in England to estimate excess risk of death from respiratory-related causes after accounting for other causes of death. Methods We used linked Clinical Practice Research Datalink (CPRD) primary care and Office for National Statistics mortality data to identify adults with asthma and COPD from 2005 to 2015. Causes of death were ascertained using death certificates. Hazard ratios (HR) and excess risk of death were estimated using Fine-Gray competing risk models and adjusting for age, sex, smoking status, body mass index and socioeconomic status. Results 65,021 people with asthma and 45,649 with COPD in the CPRD dataset were frequency matched 5:1 with people without the disease on age, sex and general practice. Only 14 in 100,000 people with asthma are predicted to experience a respiratory-related death up to 10 years post-diagnosis, whereas in COPD this is 98 in 100,000. Asthma is associated with an 0.01% excess incidence of respiratory related mortality whereas COPD is associated with an 0.07% excess. Among people with asthma-COPD overlap (N = 22,145) we observed an increased risk of respiratory-related death compared to those with asthma alone (HR = 1.30; 95% CI 1.21–1.40) but not COPD alone (HR = 0.89; 95% CI 0.83–0.94). Conclusions Asthma and COPD are associated with an increased risk of respiratory-related death after accounting for other causes; however, diagnosis of COPD carries a much higher probability. ACO is associated with a lower risk compared to COPD alone but higher risk compared to asthma alone. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01823-4.
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16
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Jani C, Salcicciol I, Rupal A, Al Omari O, Goodall R, Salciccioli JD, Marshall DC, Hanbury G, Singh H, Weissmann L, Shalhoub J. Trends in Breast Cancer Mortality Between 2001 and 2017: An Observational Study in the European Union and the United Kingdom. JCO Glob Oncol 2021; 7:1682-1693. [PMID: 34910553 PMCID: PMC8691519 DOI: 10.1200/go.21.00288] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/13/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Breast cancer is the most common cancer in women worldwide, representing 25.4% of the newly diagnosed cases in 2018. The past two decades have seen advancements in screening technologies, guidelines, and newer modalities of treatment. Our study reports and compares trends in breast cancer mortality in the European Union and the United Kingdom. MATERIALS AND METHODS We used the WHO Mortality Database. We extracted breast cancer mortality data from 2001 to 2017 on the basis of the International Classification of Diseases, 10th revision system. Crude mortality rates were dichotomized by sex and reported by year. We computed age-standardized death rates (ASDRs) per 100,000 population using the world standard population. Breast cancer mortality trends were compared using joinpoint regression analysis. RESULTS We analyzed data from 24 EU countries, including the United Kingdom. For women, breast cancer mortality was observed to be downtrending in all countries except Croatia, France, and Poland. For the most recent female data, the highest ASDR for breast cancer was identified in Croatia (19.29 per 100,000), and the lowest ASDR was noted in Spain (12.8 per 100,000). Denmark had the highest change in ASDR and the highest estimated annual percentage change of -3.2%. For men, breast cancer mortality decreased in 18 countries, with the largest relative reduction observed in Denmark with an estimated annual percentage change of -27.5%. For the most recent male data, the highest ASDR for breast cancer was identified in Latvia (0.54 per 100,000). CONCLUSION Breast cancer mortality rates have down trended in most EU countries between 2001 and 2017 for both men and women. Given the observational nature of this study, causality to the observed trends cannot be reliably ascribed. However, possible contributing factors should be considered and subject to further study.
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Affiliation(s)
- Chinmay Jani
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
- Harvard Medical School, Boston, MA
| | | | - Arashdeep Rupal
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Richard Goodall
- Department of Surgery and Cancer, Imperial College of London, London, United Kingdom
| | - Justin D. Salciccioli
- Harvard Medical School, Boston, MA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA
| | - Dominic C. Marshall
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Georgina Hanbury
- Department of Surgery and Cancer, Imperial College of London, London, United Kingdom
| | - Harpreet Singh
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Lisa Weissmann
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
- Harvard Medical School, Boston, MA
- Division of Hematology-Oncology, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
| | - Joseph Shalhoub
- Department of Surgery and Cancer, Imperial College of London, London, United Kingdom
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
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17
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Naser AY, Mansour MM, Alanazi AFR, Sabha O, Alwafi H, Jalal Z, Paudyal V, Dairi MS, Salawati EM, Alqahtan JS, Alaamri S, Mustafa Ali MK. Hospital admission trends due to respiratory diseases in England and Wales between 1999 and 2019: an ecologic study. BMC Pulm Med 2021; 21:356. [PMID: 34749696 PMCID: PMC8573565 DOI: 10.1186/s12890-021-01736-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying trends of hospital admissions for respiratory diseases is crucial for public health and research to guide future clinical improvements for better outcomes. This study aims to define the trends of respiratory disease-related hospital admissions (RRHA) in England and Wales between 1999 and 2019. METHODS An ecological study was conducted using hospital admission data taken from the Hospital Episode Statistics database in England and the Patient Episode Database for Wales. Hospital admissions data for respiratory diseases were extracted for the period between April 1999 and March 2019. The trend in hospital admissions was assessed using a Poisson model. RESULTS Hospital admission rate increased by 104.7% [from 1535.05 (95% CI 1531.71-1538.38) in 1999 to 3142.83 (95% CI 3138.39-3147.26) in 2019 per 100,000 persons, trend test, p < 0.01]. The most common causes were influenza and pneumonia, chronic lower respiratory diseases, other acute lower respiratory infections, which accounted for 26.6%, 26.4%, and 14.9%, respectively. The age group 75 years and above accounted for 34.1% of the total number of hospital admissions. Males contributed to 50.5% of the total number of hospital admissions. Hospital admission rate in females increased by 119.8% [from 1442.18 (95% CI 1437.66-1446.70) in 1999 to 3169.38 (95% CI 3163.11-3175.64) in 2019 per 100,000 persons, trend test, p < 0.001]. Hospital admission rate increased by 92.9% in males [from 1633.25 (95% CI 1628.32-1638.17) in 1999 to 3149.78 (95% CI 3143.46-3156.09) in 2019 per 100,000 persons, trend test, p < 0.001]. CONCLUSION During the study period, hospital admissions rate due to respiratory diseases increased sharply. The rates of hospital admissions were higher among males for the vast majority of respiratory diseases. Further observational studies are warranted to identify risk factors for these hospital admissions and to offer relevant interventions to mitigate the risk.
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Affiliation(s)
- Abdallah Y Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, 11622, Jordan.
| | - Munthir M Mansour
- Department of Internal Medicine, University of Arkansas for Medical Center, Little Rock, AR, 72205, USA
| | - Abeer F R Alanazi
- Department of Pharmaceutical and Biological Sciences, UCL School of Pharmacy, London, UK
| | - Omar Sabha
- Al Khalidi Hospital and Medical Center, Amman, 11183, Jordan
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al Qura University, Mecca, 21514, Saudi Arabia
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Vibhu Paudyal
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - Mohammad S Dairi
- Faculty of Medicine, Umm Al Qura University, Mecca, 21514, Saudi Arabia
| | - Emad M Salawati
- Family Medicine Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Jaber S Alqahtan
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Shalan Alaamri
- Faculty of Medicine, Jeddah University, Jeddah, 24231, Saudi Arabia
| | - Moaath K Mustafa Ali
- Greenebaum Comprehensive Cancer Center, University of Maryland, Baltimore, MD, 20742, USA
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18
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Jani C, Marshall DC, Singh H, Goodall R, Shalhoub J, Al Omari O, Salciccioli JD, Thomson CC. Lung cancer mortality in Europe and the USA between 2000 and 2017: an observational analysis. ERJ Open Res 2021; 7:00311-2021. [PMID: 34988220 PMCID: PMC8711085 DOI: 10.1183/23120541.00311-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/27/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The lung is the most common site for cancer and has the highest worldwide cancer-related mortality. Our study reports and compares trends in lung cancer mortality in the USA and 26 European countries. STUDY DESIGN AND METHODS Lung cancer mortality data were extracted for males and females for each of the years 2000-2017 from the World Health Organization (WHO) Mortality and the Centers for Disease Control and Prevention (CDC) WONDER databases. Lung cancer mortality trends were compared using Joinpoint regression analysis, and male-to-female mortality ratios were calculated. RESULTS Down-trending lung cancer mortality rates were observed in males in all countries except Cyprus and Portugal between 2000 and 2017. In females, increasing mortality rates were observed in 22 of the 27 countries analysed. Latvia had the highest estimated annual percentage change (EAPC) in male mortality (-9.6%) between 2013 and 2015. In the USA, EAPCs were -5.1% for males and -4.2% for females between 2014 and 2017. All countries had an overall decrease in the ratio of male-to-female lung cancer mortality. The most recent observation of median male-to-female mortality was 2.26 (IQR 1.92-4.05). The countries with the greatest current sex disparity in lung cancer mortality were Lithuania (5.51) and Latvia (5.00). CONCLUSION Between 2000 and 2017, lung cancer mortality rates were decreasing for males in Europe and the USA, whereas increasing lung cancer mortality rates were generally observed in females. There is a persistent but decreasing sex-mortality gap, with men having persistently greater lung cancer mortality but with rates decreasing faster than women.
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Affiliation(s)
- Chinmay Jani
- Dept of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Harpreet Singh
- Dept of Pulmonary and Critical Care, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Richard Goodall
- Dept of Surgery and Cancer, Imperial College of London, London, UK
| | - Joseph Shalhoub
- Dept of Surgery and Cancer, Imperial College of London, London, UK
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
| | - Omar Al Omari
- Dept of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Justin D. Salciccioli
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA, USA
- These authors contributed equally
| | - Carey C. Thomson
- Dept of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Division of Pulmonary and Critical Care, Mount Auburn Hospital, Cambridge, MA, USA
- These authors contributed equally
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19
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Baptista EA, Dey S, Pal S. Chronic respiratory disease mortality and its associated factors in selected Asian countries: evidence from panel error correction model. BMC Public Health 2021; 21:53. [PMID: 33407306 PMCID: PMC7788752 DOI: 10.1186/s12889-020-10042-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 12/09/2020] [Indexed: 12/24/2022] Open
Abstract
Background Chronic Respiratory Diseases (CRDs) in Asian countries are a growing concern in terms of morbidity and mortality. However, a systematic understanding of the increasing age-adjusted mortality rate of chronic respiratory disease (CRD) and its associated factors is not readily available for many Asian countries. We aimed to determine country-level factors affecting CRD mortality using a panel error correction model. Methods Based on data from the Global Burden of Disease Study 2017, we estimated the trends and distribution of CRD mortality for selected Asian countries from 2010 to 2017. Furthermore, we evaluated the relationship between CRD mortality and Gross Domestic Product (GDP) per capita, average years of schooling, urbanization, and pollutant emission (PM2.5 concentration) using a fixed-effect model. We corrected the estimates for heteroscedasticity and autocorrelation through Prais-Winsten adjustment along with robust standard error. Results Between 2010 and 2017, approximately 21.4 million people died from chronic respiratory diseases in the countries studied. Age-standardized crude mortality rate from CRDs in the period had minimum and maximum values of 8.19 (Singapore in 2016) and 155.42 (North Korea in 2010) per 100,000 population, respectively. The coefficients corrected for autocorrelation and heteroskedasticity based on the final model of our study (Prais-Winsten), showed that all explanatory variables were statistically significant (p < 0.001). The model shows that the 1% increase in GDP per capita results in a 20% increase (0.203) in the CRD mortality rate and that a higher concentration of air pollution is also positively associated with the CRD deaths (0.00869). However, an extra year of schooling reduces the mortality rate by 4.79% (− 0.0479). Further, rate of urbanization is negatively associated with the CRD death rate (− 0.0252). Conclusions Our results indicate that both socioeconomic and environmental factors impact CRD mortality rates. Mortality due to CRD increases with rising GDP per capita and decreases with the percentage of the total population residing in urban areas. Further, mortality increases with greater exposure to PM2.5. Also, higher years of schooling mitigate rising CRD mortality rates, showing that education can act as a safety net against CRD mortality. These results are an outcome of sequential adjustments in the final model specification to correct for heteroscedasticity and autocorrelation.
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Affiliation(s)
| | - Sudeshna Dey
- Karnataka Health Promotion Trust (KHPT), Bengaluru, Karnataka, 560044, India
| | - Soumya Pal
- Indian Institute of Management Bangalore (IIMB), Bengaluru, Karnataka, 560076, India
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20
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Al-Balah A, Goodall R, Salciccioli JD, Marshall DC, Shalhoub J. Mortality from abdominal aortic aneurysm: trends in European Union 15+ countries from 1990 to 2017. Br J Surg 2020; 107:1459-1467. [PMID: 32391589 DOI: 10.1002/bjs.11635] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/20/2020] [Accepted: 03/23/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND This observational study assessed trends in abdominal aortic aneurysm (AAA) death rates in European Union (EU) 15+ countries for the years 1990 to 2017. METHODS Age-standardized death rates (ASDRs) were extracted from the Global Burden of Disease Study Global Health Data Exchange. Trends were analysed using joinpoint regression analysis. RESULTS Between 1990 and 2017, ASDRs from AAA decreased in all 19 EU15+ countries for women, and in 18 of 19 countries for men. Increasing AAA mortality was observed only for men in Greece (+5·3 per cent). The largest relative decreases in ASDR between 1990 and 2017 were observed in Australia (men -65·6 per cent, women -50·4 per cent) and Canada (men -60·8 per cent, women -48·6 per cent). Over the 28-year interval, the smallest decreases in ASDR for women were noted in Greece (-2·3 per cent) and in Italy (-2·5 per cent). In 2017, the highest mortality rates were observed in the UK for both men and women (7·5 per 100 000 and 3·7 per 100 000 respectively). The lowest ASDR was observed in Portugal for men (2·8 per 100 000) and in Spain for women (1·0 per 100 000). ASDRs for AAA in 2017 were higher for men than women in all 19 EU15+ countries. The most recent trends demonstrated increasing AAA ASDRs in 14 of 19 countries for both sexes; the increases were relatively small compared with the improvements in the preceding years. CONCLUSION This observational study identified decreasing mortality from AAA across EU15+ countries since 1990. The most recent trends demonstrated relatively small increases in AAA mortality across the majority of EU15+ countries since 2012.
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Affiliation(s)
- A Al-Balah
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, and Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - R Goodall
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, and Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - J D Salciccioli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - D C Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - J Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, and Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
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21
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Maiolo V, Reid AM. Looking for an explanation for the excessive male mortality in England and Wales since the end of the 19th century. SSM Popul Health 2020; 11:100584. [PMID: 32346599 PMCID: PMC7178544 DOI: 10.1016/j.ssmph.2020.100584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 11/10/2022] Open
Abstract
Several papers have primarily considered a female disadvantage in mortality as something to explain, considering a male disadvantage to be a “natural condition”. Even if, due to biological reasons, shorter life expectancy among males has been demonstrated, other factors need to be involved to explain firstly the increasing, and then the decreasing, of the male relative disadvantage over the past century. The principal aim of this paper is to provide a clearer picture of the major age-class and cause-of-death contributions to male excess mortality in England and Wales from 1881 to 2011. Results indicate a clear shift in contributions to the male disadvantage from differences occurring during the first year of life to those occurring in ageing people, and from tuberculosis, respiratory diseases, external causes and perinatal and congenital conditions to neoplasms and circulatory diseases. In contrast, the narrowing of the gap since 1981 seems to be most closely related to the decrease in the male disadvantage in respiratory diseases and to the simultaneous increasing in the female disadvantage in old-age diseases. The most important novelty of this research relates to the method: instead of using ratios to investigate gender differences in health, we use decomposition methods. Excess male mortality increased from the 1880s until the 1970s, then declined. Until the 1930s infant mortality was a major part of higher male mortality. Cancer and circulatory disease dominated male excess mortality in the 20th century. Female disadvantage from dementia and senility contributes to the declining sex gap in mortality.
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Affiliation(s)
- Valeria Maiolo
- PhD Student at the Magna Græcia University of Catanzaro, Department of Legal, Historical, Economic and Social Science, Viale Europa, 88100, Catanzaro, Italy
| | - Alice M Reid
- Cambridge Group for the History of Population and Social Structure, Department of Geography, Sir William Hardy Building, Downing Place, Cambridge, CB2 3EN, UK
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22
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Huntley C, Hakkak F, Ward H. Palliative care for chronic respiratory disease: integrated care in outpatient settings. Br J Community Nurs 2020; 25:132-138. [PMID: 32160031 DOI: 10.12968/bjcn.2020.25.3.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Chronic respiratory diseases are progressive and often life-limiting illnesses. Patients experience debilitating and troubling symptoms that impact on their quality of life. Despite this, there is under-recognition of patients who may be entering the final year of their life and require palliative care services. The Royal Wolverhampton NHS Trust in partnership with Compton Care has established chronic respiratory disease multidisciplinary team meetings and a combined respiratory and palliative care outpatient clinic to address these issues. This article presents the impact of this service, now in to its fourth year, of delivering palliative care services to patients with chronic respiratory disease.
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Affiliation(s)
| | | | - Helen Ward
- Consultant Respiratory Physician, Royal Wolverhampton NHS Trust
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23
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Goodall R, Salciccioli JD, Davies AH, Marshall D, Shalhoub J. Trends in peripheral arterial disease incidence and mortality in EU15+ countries 1990-2017. Eur J Prev Cardiol 2020; 28:1201-1213. [PMID: 34551087 DOI: 10.1177/2047487319899626] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/17/2019] [Indexed: 01/22/2023]
Abstract
AIMS The aim was to assess trends in peripheral arterial disease (PAD) incidence and mortality rates in European Union(15+) countries between 1990 and 2017. METHODS AND RESULTS This observational study used data obtained from the 2017 Global Burden of Disease study. Age-standardised mortality and incidence rates from PAD were extracted from the Global Health Data Exchange for EU15+ countries for the years 1990-2017. Trends were analysed using Joinpoint regression analysis. Between 1990 and 2017, the incidence of PAD decreased in all 19 EU15+ countries for females, and in 18 of 19 countries for males. Increasing PAD incidence was observed only for males in the United States (+1.4%). In 2017, the highest incidence rates were observed in Denmark and the United States for males (213.6 and 202.3 per 100,000, respectively) and in the United States and Canada for females (194.8 and 171.1 per 100,000, respectively). There was a concomitant overall trend for increasing age-standardised mortality rates in all EU15+ countries for females, and in 16 of 19 EU15+ countries for males between 1990 and 2017. Italy (-25.1%), Portugal (-1.9%) and Sweden (-0.6%) were the only countries with reducing PAD mortality rates in males. The largest increases in mortality rates were observed in the United Kingdom (males +140.4%, females +158.0%) and the United States (males +125.7%, females +131.2%). CONCLUSIONS We identify shifting burden of PAD in EU15+ countries, with increasing mortality rates despite reducing incidence. Strong evidence supports goal-directed medical therapy in reducing PAD mortality - population-wide strategies to improve compliance to optimal goal-directed medical therapy are warranted.
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Affiliation(s)
- Richard Goodall
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, UK.,Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Justin D Salciccioli
- Department of Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA, USA
| | - Alun Huw Davies
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, UK.,Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Dominic Marshall
- Critical Care Research Group, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Joseph Shalhoub
- Academic Section of Vascular Surgery, Department of Surgery and Cancer, Imperial College London, UK.,Department of Vascular Surgery, Imperial College Healthcare NHS Trust, London, UK
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24
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Affiliation(s)
- Christopher M Barber
- Centre for Workplace Health, Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - David Fishwick
- Centre for Workplace Health, Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
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25
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Deep Breath. Br J Gen Pract 2019; 69:3. [DOI: 10.3399/bjgp19x700301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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