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Naghavi M, Ong KL, Aali A, Ababneh HS, Abate YH, Abbafati C, Abbasgholizadeh R, Abbasian M, Abbasi-Kangevari M, Abbastabar H, Abd ElHafeez S, Abdelmasseh M, Abd-Elsalam S, Abdelwahab A, Abdollahi M, Abdollahifar MA, Abdoun M, Abdulah DM, Abdullahi A, Abebe M, Abebe SS, Abedi A, Abegaz KH, Abhilash ES, Abidi H, Abiodun O, Aboagye RG, Abolhassani H, Abolmaali M, Abouzid M, Aboye GB, Abreu LG, Abrha WA, Abtahi D, Abu Rumeileh S, Abualruz H, Abubakar B, Abu-Gharbieh E, Abu-Rmeileh NME, Aburuz S, Abu-Zaid A, Accrombessi MMK, Adal TG, Adamu AA, Addo IY, Addolorato G, Adebiyi AO, Adekanmbi V, Adepoju AV, Adetunji CO, Adetunji JB, Adeyeoluwa TE, Adeyinka DA, Adeyomoye OI, Admass BAA, Adnani QES, Adra S, Afolabi AA, Afzal MS, Afzal S, Agampodi SB, Agasthi P, Aggarwal M, Aghamiri S, Agide FD, Agodi A, Agrawal A, Agyemang-Duah W, Ahinkorah BO, Ahmad A, Ahmad D, Ahmad F, Ahmad MM, Ahmad S, Ahmad S, Ahmad T, Ahmadi K, Ahmadzade AM, Ahmed A, Ahmed A, Ahmed H, Ahmed LA, Ahmed MS, Ahmed MS, Ahmed MB, 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K, Deng X, Denova-Gutiérrez E, Deravi N, Dereje N, Dervenis N, Dervišević E, Des Jarlais DC, Desai HD, Desai R, Devanbu VGC, Dewan SMR, Dhali A, Dhama K, Dhimal M, Dhingra S, Dhulipala VR, Dias da Silva D, Diaz D, Diaz MJ, Dima A, Ding DD, Ding H, Dinis-Oliveira RJ, Dirac MA, Djalalinia S, Do THP, do Prado CB, Doaei S, Dodangeh M, Dodangeh M, Dohare S, Dokova KG, Dolecek C, Dominguez RMV, Dong W, Dongarwar D, D'Oria M, Dorostkar F, Dorsey ER, dos Santos WM, Doshi R, Doshmangir L, Dowou RK, Driscoll TR, Dsouza HL, Dsouza V, Du M, Dube J, Duncan BB, Duraes AR, Duraisamy S, Durojaiye OC, Dwyer-Lindgren L, Dzianach PA, Dziedzic AM, E'mar AR, Eboreime E, Ebrahimi A, Echieh CP, Edinur HA, Edvardsson D, Edvardsson K, Efendi D, Efendi F, Effendi DE, Eikemo TA, Eini E, Ekholuenetale M, Ekundayo TC, El Sayed I, Elbarazi I, Elema TB, Elemam NM, Elgar FJ, Elgendy IY, ElGohary GMT, Elhabashy HR, Elhadi M, El-Huneidi W, Elilo LT, Elmeligy OAA, Elmonem MA, Elshaer M, Elsohaby I, Emeto TI, Engelbert 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Ghahramani S, Ghailan KY, Ghasemi MR, Ghasempour Dabaghi G, Ghasemzadeh A, Ghashghaee A, Ghassemi F, Ghazy RM, Ghimire A, Ghoba S, Gholamalizadeh M, Gholamian A, Gholamrezanezhad A, Gholizadeh N, Ghorbani M, Ghorbani Vajargah P, Ghoshal AG, Gill PS, Gill TK, Gillum RF, Ginindza TG, Girmay A, Glasbey JC, Gnedovskaya EV, Göbölös L, Godinho MA, Goel A, Golchin A, Goldust M, Golechha M, Goleij P, Gomes NGM, Gona PN, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Goulart BNG, Goyal A, Grada A, Graham SM, Grivna M, Grosso G, Guan SY, Guarducci G, Gubari MIM, Gudeta MD, Guha A, Guicciardi S, Guimarães RA, Gulati S, Gunawardane DA, Gunturu S, Guo C, Gupta AK, Gupta B, Gupta MK, Gupta M, Gupta RD, Gupta R, Gupta S, Gupta VB, Gupta VK, Gupta VK, Gurmessa L, Gutiérrez RA, Habibzadeh F, Habibzadeh P, Haddadi R, Hadei M, Hadi NR, Haep N, Hafezi-Nejad N, Hailu A, Haj-Mirzaian A, Halboub ES, Hall BJ, Haller S, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hamilton EB, Han C, Han Q, Hanif A, Hanifi N, 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A, Lai DTC, Lal DK, Lalloo R, Lallukka T, Lam H, Lám J, Landrum KR, Lanfranchi F, Lang JJ, Langguth B, Lansingh VC, Laplante-Lévesque A, Larijani B, Larsson AO, Lasrado S, Lassi ZS, Latief K, Latifinaibin K, Lauriola P, Le NHH, Le TTT, Le TDT, Ledda C, Ledesma JR, Lee M, Lee PH, Lee SW, Lee SWH, Lee WC, Lee YH, LeGrand KE, Leigh J, Leong E, Lerango TL, Li MC, Li W, Li X, Li Y, Li Z, Ligade VS, Likaka ATM, Lim LL, Lim SS, Lindstrom M, Linehan C, Liu C, Liu G, Liu J, Liu R, Liu S, Liu X, Liu X, Llanaj E, Loftus MJ, López-Bueno R, Lopukhov PD, Loreche AM, Lorkowski S, Lotufo PA, Lozano R, Lubinda J, Lucchetti G, Lugo A, Lunevicius R, Ma ZF, Maass KL, Machairas N, Machoy M, Madadizadeh F, Madsen C, Madureira-Carvalho ÁM, Maghazachi AA, Maharaj SB, Mahjoub S, Mahmoud MA, Mahmoudi A, Mahmoudi E, Mahmoudi R, Majeed A, Makhdoom IF, Malakan Rad E, Maled V, Malekzadeh R, Malhotra AK, Malhotra K, Malik AA, Malik I, Malta DC, Mamun AA, Mansouri P, Mansournia MA, Mantovani LG, Maqsood S, Marasini 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Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00367-2. [PMID: 38582094 DOI: 10.1016/s0140-6736(24)00367-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation.
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N, Zakzuk J, Zamagni G, Zaman BA, Zaman SB, Zamora N, Zand R, Zandi M, Zandieh GGZ, Zanghì A, Zare I, Zastrozhin MS, Zeariya MGM, Zeng Y, Zhai C, Zhang C, Zhang H, Zhang H, Zhang Y, Zhang Z, Zhang Z, Zhao H, Zhao Y, Zhao Y, Zheng P, Zhong C, Zhou J, Zhu B, Zhu Z, Ziaeefar P, Zielińska M, Zou Z, Zumla A, Zweck E, Zyoud SH, Lim SS, Murray CJL. Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. Lancet 2024:S0140-6736(24)00476-8. [PMID: 38484753 DOI: 10.1016/s0140-6736(24)00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/08/2023] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Neeraj Bhala
- Nottingham Digestive Diseases Centre, Translational Medical Sciences, NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham School of Medicine, Queens Medical Centre, Nottingham, NG7 2UH, UK
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Bhala N, Mellinger J, Asrani SK, Shah VH. Tackling the burden of preventable liver disease in the USA. Lancet Gastroenterol Hepatol 2024; 9:9-10. [PMID: 37956688 DOI: 10.1016/s2468-1253(23)00361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023]
Affiliation(s)
- Neeraj Bhala
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA; Queens Medical Centre, University of Nottingham, Nottingham, UK; Queen Elizabeth Hospital Birmingham, University Hospital Birmingham, Birmingham, UK.
| | - Jessica Mellinger
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sumeet K Asrani
- Baylor University Medical Center, Baylor Scott and White Health, Dallas, TX, USA
| | - Vijay H Shah
- Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA
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5
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Bhala N, Subhani M, Aithal GP. Liver disease admissions in the UK are increasing, urgently needing local and national solutions. Lancet Gastroenterol Hepatol 2023; 8:1071. [PMID: 37951234 DOI: 10.1016/s2468-1253(23)00334-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/13/2023]
Affiliation(s)
- Neeraj Bhala
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, Queens Medical Centre, Nottingham NG7 2UH, UK.
| | - Mohsan Subhani
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, Queens Medical Centre, Nottingham NG7 2UH, UK
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK; Nottingham Digestive Diseases Centre, Translational Medical Sciences, School of Medicine, Queens Medical Centre, Nottingham NG7 2UH, UK
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6
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Ahmed R, Abuelgasim E, Ashraf M, Bould J, Crouch J, Foulkes S, Wu SK, Leonard D, Sewell C, Troth T, Sarwar A, Sanghera A, Alame R, Cooney R, Bhala N. Intravenous cyclizine: expression of concerns on the gastroenterology ward round post-Christmas and the bigger picture at a university hospital. Clin Med (Lond) 2023; 23 Suppl 6:95. [PMID: 38614765 DOI: 10.7861/clinmed.23-6-s95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Rachel Cooney
- University Hospitals Birmingham and University of Birmingham
| | - Neeraj Bhala
- University Hospitals Birmingham and University of Birmingham
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7
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Thorlu-Bangura Z, Poole L, Sood H, Khan N, Stevenson F, Khunti K, Gill P, Sajid M, Hanif W, Bhala N, Modha S, Patel K, Blandford A, Banerjee A, Ramasawmy M. Correction to: Digital health, cardiometabolic disease and ethnicity: an analysis of United Kingdom government policies from 2010 to 2022. J Public Health Policy 2023:10.1057/s41271-023-00415-8. [PMID: 37165204 DOI: 10.1057/s41271-023-00415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
| | - Lydia Poole
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, Surrey, UK
| | | | - Nushrat Khan
- Institute of Health Informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
| | - Fiona Stevenson
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Madiha Sajid
- Patient and Public Involvement Representative, DISC Study, London, UK
| | - Wasim Hanif
- Department of Diabetes, University Hospital Birmingham, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Edgbaston, Birmingham, UK
| | - Shivali Modha
- Patient and Public Involvement Representative, DISC Study, London, UK
| | - Kiran Patel
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Amitava Banerjee
- Institute of Health Informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
| | - Mel Ramasawmy
- Institute of Health Informatics, UCL, 222 Euston Road, London, NW1 2DA, UK.
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8
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Thorlu-Bangura Z, Poole L, Sood H, Khan N, Stevenson F, Khunti K, Gill P, Sajid M, Hanif W, Bhala N, Modha S, Patel K, Blandford A, Banerjee A, Ramasawmy M. Digital health, cardiometabolic disease and ethnicity: an analysis of United Kingdom government policies from 2010 to 2022. J Public Health Policy 2023:10.1057/s41271-023-00410-z. [PMID: 37085565 PMCID: PMC10120476 DOI: 10.1057/s41271-023-00410-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2023] [Indexed: 04/23/2023]
Abstract
Recent health policies in the United Kingdom (UK) and internationally have focussed on digitisation of healthcare. We examined UK policies for evidence of government action addressing health inequalities and digital health, using cardiometabolic disease as an exemplar. Using a systematic search methodology, we identified 87 relevant policy documents published between 2010 and 2022. We found increasing emphasis on digital health, including for prevention, diagnosis and management of cardiometabolic disease. Several policies also focused on tackling health inequalities and improving digital access. The COVID-19 pandemic amplified inequalities. No policies addressed ethnic inequalities in digital health for cardiometabolic disease, despite high prevalence in minority ethnic communities. Our findings suggest that creating opportunities for digital inclusion and reduce longer-term health inequalities, will require future policies to focus on: the heterogeneity of ethnic groups; cross-sectoral disadvantages which contribute to disease burden and digital accessibility; and disease-specific interventions which lend themselves to culturally tailored solutions.
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Affiliation(s)
| | - Lydia Poole
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, Surrey, UK
| | | | - Nushrat Khan
- Institute of Health Informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
| | - Fiona Stevenson
- Department of Primary Care and Population Health, University College London, London, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Madiha Sajid
- Patient and Public Involvement Representative, DISC Study, London, UK
| | - Wasim Hanif
- Department of Diabetes, University Hospital Birmingham, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHSFT, Edgbaston, Birmingham, UK
| | - Shivali Modha
- Patient and Public Involvement Representative, DISC Study, London, UK
| | - Kiran Patel
- Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | | | - Amitava Banerjee
- Institute of Health Informatics, UCL, 222 Euston Road, London, NW1 2DA, UK
| | - Mel Ramasawmy
- Institute of Health Informatics, UCL, 222 Euston Road, London, NW1 2DA, UK.
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9
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Bhala N, Ferguson JW, Rajoriya N, Newsome PN. Using global burden of hepatocellular cancer and liver cirrhosis as a driver to tackle preventable mortality and morbidity nationally and regionally. Hepatology 2023; 77:1078-1080. [PMID: 36626619 DOI: 10.1097/hep.0000000000000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/28/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Neeraj Bhala
- Gastroenterology and Liver Units, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, National Institute of Health Research Biomedical Research Centre and Centre for Liver and Gastroenterology Research, University of Birmingham, Birmingham, UK
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10
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Verma AM, Bhala N. Ethnicity, diversity, and inclusion in UK gastroenterology. Lancet Gastroenterol Hepatol 2023; 8:207-209. [PMID: 36773610 DOI: 10.1016/s2468-1253(22)00425-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 02/13/2023]
Affiliation(s)
- Ajay M Verma
- Department of Digestive Diseases, Kettering General Hospital, Kettering NN16 8UZ, UK.
| | - Neeraj Bhala
- Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham, UK
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11
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Saifuddin A, Kent AJ, Mehta SJ, Hicks LC, Gonzalez HA, Segal JP, Brookes MJ, Subramanian S, Bhala N, Conley TE, Patel KV, Lamb CA, Walker GJ, Kennedy NA, Sebastian S. Treatment adaptations and outcomes of patients experiencing inflammatory bowel disease flares during the early COVID-19 pandemic: the PREPARE-IBD multicentre cohort study. Aliment Pharmacol Ther 2022; 56:1460-1474. [PMID: 36196569 PMCID: PMC9874879 DOI: 10.1111/apt.17223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/06/2022] [Accepted: 09/05/2022] [Indexed: 01/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic offered a unique opportunity to understand inflammatory bowel disease (IBD) management during unexpected disruption. This could help to guide practice overall. AIMS To compare prescribing behaviour for IBD flares and outcomes during the early pandemic with pre-pandemic findings METHODS: We performed an observational cohort study comprising patients who contacted IBD teams for symptomatic flares between March and June 2020 in 60 National Health Service trusts in the United Kingdom. Data were compared with a pre-pandemic cohort after propensity-matching for age and physician global assessment of disease activity. RESULTS We included 1864 patients in each of the pandemic and pre-pandemic cohorts. The principal findings were reduced systemic corticosteroid prescription during the pandemic in Crohn's disease (prednisolone: pandemic 26.5% vs. 37.1%; p < 0.001) and ulcerative colitis (UC) (prednisolone: pandemic 33.5% vs. 40.7%, p < 0.001), with increases in poorly bioavailable oral corticosteroids in Crohn's (pandemic 15.6% vs. 6.8%; p < 0.001) and UC (pandemic 11.8% vs. 5.2%; p < 0.001). Ustekinumab (Crohn's and UC) and vedolizumab (UC) treatment also significantly increased. Three-month steroid-free remission in each period was similar in Crohn's (pandemic 28.4% vs. 32.1%; p = 0.17) and UC (pandemic 36.4% vs. 40.2%; p = 0.095). Patients experiencing a flare and suspected COVID-19 were more likely to have moderately-to-severely active disease at 3 months than those with a flare alone. CONCLUSIONS Despite treatment adaptations during the pandemic, steroid-free outcomes were comparable with pre-pandemic levels, although concurrent flare and suspected COVID-19 caused worse outcomes. These findings have implications for IBD management during future pandemics and for standard practice.
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Affiliation(s)
| | - Alexandra J. Kent
- Department of GastroenterologyKing's College Hospital NHS Foundation TrustLondonUK
| | | | - Lucy C. Hicks
- Department of GastroenterologyImperial College Healthcare NHS TrustLondonUK
| | - Haidee A. Gonzalez
- Department of Inflammatory Bowel DiseaseHull University Teaching Hospitals NHS TrustHullUK,Department of GastroenterologyUniversity of HullHullUK
| | - Jonathan P. Segal
- Department of GastroenterologyImperial College Healthcare NHS TrustLondonUK
| | - Matthew J. Brookes
- Department of GastroenterologyRoyal Wolverhampton NHS TrustWolverhamptonUK,Faculty of Science and EngineeringUniversity of WolverhamptonWolverhamptonUK
| | - Sreedhar Subramanian
- Department of GastroenterologyRoyal Liverpool and Broadgreen University Hospitals NHS TrustLiverpoolUK,Department of GastroenterologyUniversity of LiverpoolLiverpoolUK
| | - Neeraj Bhala
- Department of Gastrointestinal MedicineQueen Elizabeth Hospital Birmingham NHS Foundation TrustBirminghamUK,Institute of Applied Health Research, Institute of Translational MedicineUniversity of BirminghamBirminghamUK
| | - Thomas E. Conley
- Department of GastroenterologyRoyal Liverpool and Broadgreen University Hospitals NHS TrustLiverpoolUK
| | - Kamal V. Patel
- Department of GastroenterologySt George's University Hospitals NHS Foundation TrustLondonUK
| | | | - Christopher A. Lamb
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK,Department of GastroenterologyNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Gareth J. Walker
- Department of GastroenterologyTorbay and South Devon NHS Foundation TrustTorquayUK
| | - Nicholas A. Kennedy
- Department of Inflammatory Bowel DiseaseRoyal Devon and Exeter NHS Foundation TrustExeterUK,Exeter Inflammatory Bowel Disease and Pharmacogenetics Research GroupUniversity of ExeterExeterUK
| | - Shaji Sebastian
- Department of Inflammatory Bowel DiseaseHull University Teaching Hospitals NHS TrustHullUK,Department of GastroenterologyUniversity of HullHullUK
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12
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Umar N, King D, Chandan JS, Bhala N, Nirantharakumar K, Adderley N, Zemedikun DT, Harvey P, Trudgill N. The association between inflammatory bowel disease and mental ill health: a retrospective cohort study using data from UK primary care. Aliment Pharmacol Ther 2022; 56:814-822. [PMID: 35770611 DOI: 10.1111/apt.17110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/18/2022] [Accepted: 06/14/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Patients with active inflammatory bowel disease (IBD) and mental illnesses experience worse IBD outcomes. AIM To describe the incidence of mental illnesses, including deliberate self-harm, in IBD patients. METHODS A population-based retrospective cohort study using IQVIA medical research data of a primary care database covering the whole UK, between January 1995 and January 2021. IBD patients of all ages were matched 4:1 by demographics and primary care practice to unexposed controls. Following exclusion of patients with mental ill health at study entry, adjusted hazard ratios (HR) of developing depression, anxiety, deliberate self-harm, severe mental illness and insomnia were calculated using a Cox proportional hazards model. RESULTS We included 48,799 incident IBD patients: 28,352 with ulcerative colitis and 20,447 with Crohn's disease. Incidence rate ratios of mental illness were higher in IBD patients than controls (all p < 0.001): deliberate self-harm 1.31 (95% CI 1.16-1.47), anxiety 1.17 (1.11-1.24), depression 1.36 (1.31-1.42) and insomnia 1.62 (1.54-1.69). Patients with Crohn's disease were more likely to develop deliberate self-harm HR 1.51 (95% CI 1.28-1.78), anxiety 1.38 (1.16-1.65), depression 1.36 (1.26-1.47) and insomnia 1.74 (1.62-1.86). Patients with IBD are at increased risk of deliberate self-harm (HR 1.20 [1.07-1.35]). The incidence rate ratios of mental illnesses were particularly high during the first year following IBD diagnosis: anxiety 1.28 (1.13-1.46), depression 1.62 (1.48-1.77) and insomnia 1.99 (1.78-2.21). CONCLUSION Deliberate self-harm, depression, anxiety and insomnia were more frequent among patients with IBD. IBD is independently associated with an increased risk of deliberate self-harm.
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Affiliation(s)
- Nosheen Umar
- Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Dominic King
- Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Nicola Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Dawit T Zemedikun
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Nigel Trudgill
- Sandwell and West Birmingham NHS Trust, West Bromwich, UK
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13
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Tran KB, Lang JJ, Compton K, Xu R, Acheson AR, Henrikson HJ, Kocarnik JM, Penberthy L, Aali A, Abbas Q, Abbasi B, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abbastabar H, Abdelmasseh M, Abd-Elsalam S, Abdelwahab AA, Abdoli G, Abdulkadir HA, Abedi A, Abegaz KH, Abidi H, Aboagye RG, Abolhassani H, Absalan A, Abtew YD, Abubaker Ali H, Abu-Gharbieh E, Achappa B, Acuna JM, Addison D, Addo IY, Adegboye OA, Adesina MA, Adnan M, Adnani QES, Advani SM, Afrin S, Afzal MS, Aggarwal M, Ahinkorah BO, Ahmad AR, Ahmad R, Ahmad S, Ahmad S, Ahmadi S, Ahmed H, Ahmed LA, Ahmed MB, Ahmed Rashid T, Aiman W, Ajami M, Akalu GT, Akbarzadeh-Khiavi M, Aklilu A, Akonde M, Akunna CJ, Al Hamad H, Alahdab F, Alanezi FM, Alanzi TM, Alessy SA, Algammal AM, Al-Hanawi MK, Alhassan RK, Ali BA, Ali L, Ali SS, Alimohamadi Y, Alipour V, Aljunid SM, Alkhayyat M, Al-Maweri SAA, Almustanyir S, Alonso N, Alqalyoobi S, Al-Raddadi RM, Al-Rifai RHH, Al-Sabah SK, Al-Tammemi AB, Altawalah H, Alvis-Guzman N, Amare F, Ameyaw EK, Aminian Dehkordi JJ, Amirzade-Iranaq MH, Amu H, Amusa GA, Ancuceanu R, Anderson JA, Animut YA, Anoushiravani A, Anoushirvani AA, Ansari-Moghaddam A, Ansha MG, Antony B, Antwi MH, Anwar SL, Anwer R, Anyasodor AE, Arabloo J, Arab-Zozani M, Aremu O, Argaw AM, Ariffin H, Aripov T, Arshad M, Artaman A, Arulappan J, Aruleba RT, Aryannejad A, Asaad M, Asemahagn MA, Asemi Z, Asghari-Jafarabadi M, Ashraf T, Assadi R, Athar M, Athari SS, Atout MMW, Attia S, Aujayeb A, Ausloos M, Avila-Burgos L, Awedew AF, Awoke MA, Awoke T, Ayala Quintanilla BP, Ayana TM, Ayen SS, Azadi D, Azadnajafabad S, Azami-Aghdash S, Azanaw MM, Azangou-Khyavy M, Azari Jafari A, Azizi H, Azzam AYY, Babajani A, Badar M, Badiye AD, Baghcheghi N, Bagheri N, Bagherieh S, Bahadory S, Baig AA, Baker JL, Bakhtiari A, Bakshi RK, Banach M, Banerjee I, Bardhan M, Barone-Adesi F, Barra F, Barrow A, Bashir NZ, Bashiri A, Basu S, Batiha AMM, Begum A, Bekele AB, Belay AS, Belete MA, Belgaumi UI, Bell AW, Belo L, Benzian H, Berhie AY, Bermudez ANC, Bernabe E, Bhagavathula AS, Bhala N, Bhandari BB, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bhojaraja VS, Bhuyan SS, Bibi S, Bilchut AH, Bintoro BS, Biondi A, Birega MGB, Birhan HE, Bjørge T, Blyuss O, Bodicha BBA, Bolla SR, Boloor A, Bosetti C, Braithwaite D, Brauer M, Brenner H, Briko AN, Briko NI, Buchanan CM, Bulamu NB, Bustamante-Teixeira MT, Butt MH, Butt NS, Butt ZA, Caetano dos Santos FL, Cámera LA, Cao C, Cao Y, Carreras G, Carvalho M, Cembranel F, Cerin E, Chakraborty PA, Charalampous P, Chattu VK, Chimed-Ochir O, Chirinos-Caceres JL, Cho DY, Cho WCS, Christopher DJ, Chu DT, Chukwu IS, Cohen AJ, Conde J, Cortés S, Costa VM, Cruz-Martins N, Culbreth GT, Dadras O, Dagnaw FT, Dahlawi SMA, Dai X, Dandona L, Dandona R, Daneshpajouhnejad P, Danielewicz A, Dao ATM, Darvishi Cheshmeh Soltani R, Darwesh AM, Das S, Davitoiu DV, Davtalab Esmaeili E, De la Hoz FP, Debela SA, Dehghan A, Demisse B, Demisse FW, Denova-Gutiérrez E, Derakhshani A, Derbew Molla M, Dereje D, Deribe KS, Desai R, Desalegn MD, Dessalegn FN, Dessalegni SAA, Dessie G, Desta AA, Dewan SMR, Dharmaratne SD, Dhimal M, Dianatinasab M, Diao N, Diaz D, Digesa LE, Dixit SG, Doaei S, Doan LP, Doku PN, Dongarwar D, dos Santos WM, Driscoll TR, Dsouza HL, Durojaiye OC, Edalati S, Eghbalian F, Ehsani-Chimeh E, Eini E, Ekholuenetale M, Ekundayo TC, Ekwueme DU, El Tantawi M, Elbahnasawy MA, Elbarazi I, Elghazaly H, Elhadi M, El-Huneidi W, Emamian MH, Engelbert Bain L, Enyew DB, Erkhembayar R, Eshetu T, Eshrati B, Eskandarieh S, Espinosa-Montero J, Etaee F, Etemadimanesh A, Eyayu T, Ezeonwumelu IJ, Ezzikouri S, Fagbamigbe AF, Fahimi S, Fakhradiyev IR, Faraon EJA, Fares J, Farmany A, Farooque U, Farrokhpour H, Fasanmi AO, Fatehizadeh A, Fatima W, Fattahi H, Fekadu G, Feleke BE, Ferrari AA, Ferrero S, Ferro Desideri L, Filip I, Fischer F, Foroumadi R, Foroutan M, Fukumoto T, Gaal PA, Gad MM, Gadanya MA, Gaipov A, Galehdar N, Gallus S, Garg T, Gaspar Fonseca M, Gebremariam YH, Gebremeskel TG, Gebremichael MA, Geda YF, Gela YY, Gemeda BNB, Getachew M, Getachew ME, Ghaffari K, Ghafourifard M, Ghamari SH, Ghasemi Nour M, Ghassemi F, Ghimire A, Ghith N, Gholamalizadeh M, Gholizadeh Navashenaq J, Ghozy S, Gilani SA, Gill PS, Ginindza TG, Gizaw ATT, Glasbey JC, Godos J, Goel A, Golechha M, Goleij P, Golinelli D, Golitaleb M, Gorini G, Goulart BNG, Grosso G, Guadie HA, Gubari MIM, Gudayu TW, Guerra MR, Gunawardane DA, Gupta B, Gupta S, Gupta VB, Gupta VK, Gurara MK, Guta A, Habibzadeh P, Haddadi Avval A, Hafezi-Nejad N, Hajj Ali A, Haj-Mirzaian A, Halboub ES, Halimi A, Halwani R, Hamadeh RR, Hameed S, Hamidi S, Hanif A, Hariri S, Harlianto NI, Haro JM, Hartono RK, Hasaballah AI, Hasan SMM, Hasani H, Hashemi SM, Hassan AM, Hassanipour S, Hayat K, Heidari G, Heidari M, Heidarymeybodi Z, Herrera-Serna BY, Herteliu C, Hezam K, Hiraike Y, Hlongwa MM, Holla R, Holm M, Horita N, Hoseini M, Hossain MM, Hossain MBH, Hosseini MS, Hosseinzadeh A, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Huang J, Hugo FN, Humayun A, Hussain S, Hussein NR, Hwang BF, Ibitoye SE, Iftikhar PM, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Immurana M, Innos K, Iranpour P, Irham LM, Islam MS, Islam RM, Islami F, Ismail NE, Isola G, Iwagami M, J LM, Jaiswal A, Jakovljevic M, Jalili M, Jalilian S, Jamshidi E, Jang SI, Jani CT, Javaheri T, Jayarajah UU, Jayaram S, Jazayeri SB, Jebai R, Jemal B, Jeong W, Jha RP, Jindal HA, John-Akinola YO, Jonas JB, Joo T, Joseph N, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kacimi SEO, Kadashetti V, Kahe F, Kakodkar PV, Kalankesh LR, Kalankesh LR, Kalhor R, Kamal VK, Kamangar F, Kamath A, Kanchan T, Kandaswamy E, Kandel H, Kang H, Kanno GG, Kapoor N, Kar SS, Karanth SD, Karaye IM, Karch A, Karimi A, Kassa BG, Katoto PDMC, Kauppila JH, Kaur H, Kebede AG, Keikavoosi-Arani L, Kejela GG, Kemp Bohan PM, Keramati M, Keykhaei M, Khajuria H, Khan A, Khan AAK, Khan EA, Khan G, Khan MN, Khan MAB, Khanali J, Khatab K, Khatatbeh MM, Khatib MN, Khayamzadeh M, Khayat Kashani HR, Khazeei Tabari MA, Khezeli M, Khodadost M, Kim MS, Kim YJ, Kisa A, Kisa S, Klugar M, Klugarová J, Kolahi AA, Kolkhir P, Kompani F, Koul PA, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Krishnamoorthy Y, Kucuk Bicer B, Kugbey N, Kulimbet M, Kumar A, Kumar GA, Kumar N, Kurmi OP, Kuttikkattu A, La Vecchia C, Lahiri A, Lal DK, Lám J, Lan Q, Landires I, Larijani B, Lasrado S, Lau J, Lauriola P, Ledda C, Lee SW, Lee SWH, Lee WC, Lee YY, Lee YH, Legesse SM, Leigh J, Leong E, Li MC, Lim SS, Liu G, Liu J, Lo CH, Lohiya A, Lopukhov PD, Lorenzovici L, Lotfi M, Loureiro JA, Lunevicius R, Madadizadeh F, Mafi AR, Magdeldin S, Mahjoub S, Mahmoodpoor A, Mahmoudi M, Mahmoudimanesh M, Mahumud RA, Majeed A, Majidpoor J, Makki A, Makris KC, Malakan Rad E, Malekpour MR, Malekzadeh R, Malik AA, Mallhi TH, Mallya SD, Mamun MA, Manda AL, Mansour-Ghanaei F, Mansouri B, Mansournia MA, Mantovani LG, Martini S, Martorell M, Masoudi S, Masoumi SZ, Matei CN, Mathews E, Mathur MR, Mathur V, McKee M, Meena JK, Mehmood K, Mehrabi Nasab E, Mehrotra R, Melese A, Mendoza W, Menezes RG, Mengesha SID, Mensah LG, Mentis AFA, Mera-Mamián AYM, Meretoja TJ, Merid MW, Mersha AG, Meselu BT, Meshkat M, Mestrovic T, Miao Jonasson J, Miazgowski T, Michalek IM, Mijena GFW, Miller TR, Mir SA, Mirinezhad SK, Mirmoeeni S, Mirza-Aghazadeh-Attari M, Mirzaei H, Mirzaei HR, Misganaw AS, Misra S, Mohammad KA, Mohammadi E, Mohammadi M, Mohammadian-Hafshejani A, Mohammadpourhodki R, Mohammed A, Mohammed S, Mohan S, Mohseni M, Moka N, Mokdad AH, Molassiotis A, Molokhia M, Momenzadeh K, Momtazmanesh S, Monasta L, Mons U, Montasir AA, Montazeri F, Montero A, Moosavi MA, Moradi A, Moradi Y, Moradi Sarabi M, Moraga P, Morawska L, Morrison SD, Morze J, Mosapour A, Mostafavi E, Mousavi SM, Mousavi Isfahani H, Mousavi Khaneghah A, Mpundu-Kaambwa C, Mubarik S, Mulita F, Munblit D, Munro SB, Murillo-Zamora E, Musa J, Nabhan AF, Nagarajan AJ, Nagaraju SP, Nagel G, Naghipour M, Naimzada MD, Nair TS, Naqvi AA, Narasimha Swamy S, Narayana AI, Nassereldine H, Natto ZS, Nayak BP, Ndejjo R, Nduaguba SO, Negash WW, Nejadghaderi SA, Nejati K, Neupane Kandel S, Nguyen HVN, Niazi RK, Noor NM, Noori M, Noroozi N, Nouraei H, Nowroozi A, Nuñez-Samudio V, Nzoputam CI, Nzoputam OJ, Oancea B, Odukoya OO, Oghenetega OB, Ogunsakin RE, Oguntade AS, Oh IH, Okati-Aliabad H, Okekunle AP, Olagunju AT, Olagunju TO, Olakunde BO, Olufadewa II, Omer E, Omonisi AEE, Ong S, Onwujekwe OE, Orru H, Otstavnov SS, Oulhaj A, Oumer B, Owopetu OF, Oyinloye BE, P A M, Padron-Monedero A, Padubidri JR, Pakbin B, Pakshir K, Pakzad R, Palicz T, Pana A, Pandey A, Pandey A, Pant S, Pardhan S, Park EC, Park EK, Park S, Patel J, Pati S, Paudel R, Paudel U, Paun M, Pazoki Toroudi H, Peng M, Pereira J, Pereira RB, Perna S, Perumalsamy N, Pestell RG, Pezzani R, Piccinelli C, Pillay JD, Piracha ZZ, Pischon T, Postma MJ, Pourabhari Langroudi A, Pourshams A, Pourtaheri N, Prashant A, Qadir MMF, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Radhakrishnan RA, Radhakrishnan V, Raeisi M, Rafiee A, Rafiei A, Raheem N, Rahim F, Rahman MO, Rahman M, Rahman MA, Rahmani AM, Rahmani S, Rahmanian V, Rajai N, Rajesh A, Ram P, Ramezanzadeh K, Rana J, Ranabhat K, Ranasinghe P, Rao CR, Rao SJ, Rashedi S, Rashidi A, Rashidi M, Rashidi MM, Ratan ZA, Rawaf DL, Rawaf S, Rawal L, Rawassizadeh R, Razeghinia MS, Rehman AU, Rehman IU, Reitsma MB, Renzaho AMN, Rezaei M, Rezaei N, Rezaei N, Rezaei N, Rezaei S, Rezaeian M, Rezapour A, Riad A, Rikhtegar R, Rios-Blancas M, Roberts TJ, Rohloff P, Romero-Rodríguez E, Roshandel G, Rwegerera GM, S M, Saber-Ayad MM, Saberzadeh-Ardestani B, Sabour S, Saddik B, Sadeghi E, Saeb MR, Saeed U, Safaei M, Safary A, Sahebazzamani M, Sahebkar A, Sahoo H, Sajid MR, Salari H, Salehi S, Salem MR, Salimzadeh H, Samodra YL, Samy AM, Sanabria J, Sankararaman S, Sanmarchi F, Santric-Milicevic MM, Saqib MAN, Sarveazad A, Sarvi F, Sathian B, Satpathy M, Sayegh N, Schneider IJC, Schwarzinger M, Šekerija M, Senthilkumaran S, Sepanlou SG, Seylani A, Seyoum K, Sha F, Shafaat O, Shah PA, Shahabi S, Shahid I, Shahrbaf MA, Shahsavari HR, Shaikh MA, Shaka MF, Shaker E, Shannawaz M, Sharew MMS, Sharifi A, Sharifi-Rad J, Sharma P, Shashamo BB, Sheikh A, Sheikh M, Sheikhbahaei S, Sheikhi RA, Sheikhy A, Shepherd PR, Shetty A, Shetty JK, Shetty RS, Shibuya K, Shirkoohi R, Shirzad-Aski H, Shivakumar KM, Shivalli S, Shivarov V, Shobeiri P, Shokri Varniab Z, Shorofi SA, Shrestha S, Sibhat MM, Siddappa Malleshappa SK, Sidemo NB, Silva DAS, Silva LMLR, Silva Julian G, Silvestris N, Simegn W, Singh AD, Singh A, Singh G, Singh H, Singh JA, Singh JK, Singh P, Singh S, Sinha DN, Sinke AH, Siraj MS, Sitas F, Siwal SS, Skryabin VY, Skryabina AA, Socea B, Soeberg MJ, Sofi-Mahmudi A, Solomon Y, Soltani-Zangbar MS, Song S, Song Y, Sorensen RJD, Soshnikov S, Sotoudeh H, Sowe A, Sufiyan MB, Suk R, Suleman M, Suliankatchi Abdulkader R, Sultana S, Sur D, Szócska M, Tabaeian SP, Tabarés-Seisdedos R, Tabatabaei SM, Tabuchi T, Tadbiri H, Taheri E, Taheri M, Taheri Soodejani M, Takahashi K, Talaat IM, Tampa M, Tan KK, Tat NY, Tat VY, Tavakoli A, Tavakoli A, Tehrani-Banihashemi A, Tekalegn Y, Tesfay FH, Thapar R, Thavamani A, Thoguluva Chandrasekar V, Thomas N, Thomas NK, Ticoalu JHV, Tiyuri A, Tollosa DN, Topor-Madry R, Touvier M, Tovani-Palone MR, Traini E, Tran MTN, Tripathy JP, Ukke GG, Ullah I, Ullah S, Ullah S, Unnikrishnan B, Vacante M, Vaezi M, Valadan Tahbaz S, Valdez PR, Vardavas C, Varthya SB, Vaziri S, Velazquez DZ, Veroux M, Villeneuve PJ, Violante FS, Vladimirov SK, Vlassov V, Vo B, Vu LG, Wadood AW, Waheed Y, Walde MT, Wamai RG, Wang C, Wang F, Wang N, Wang Y, Ward P, Waris A, Westerman R, Wickramasinghe ND, Woldemariam M, Woldu B, Xiao H, Xu S, Xu X, Yadav L, Yahyazadeh Jabbari SH, Yang L, Yazdanpanah F, Yeshaw Y, Yismaw Y, Yonemoto N, Younis MZ, Yousefi Z, Yousefian F, Yu C, Yu Y, Yunusa I, Zahir M, Zaki N, Zaman BA, Zangiabadian M, Zare F, Zare I, Zareshahrabadi Z, Zarrintan A, Zastrozhin MS, Zeineddine MA, Zhang D, Zhang J, Zhang Y, Zhang ZJ, Zhou L, Zodpey S, Zoladl M, Vos T, Hay SI, Force LM, Murray CJL. The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2022; 400:563-591. [PMID: 35988567 PMCID: PMC9395583 DOI: 10.1016/s0140-6736(22)01438-6] [Citation(s) in RCA: 189] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/13/2022] [Accepted: 07/28/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]). INTERPRETATION The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. FUNDING Bill & Melinda Gates Foundation.
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Bryazka D, Reitsma MB, Griswold MG, Abate KH, Abbafati C, Abbasi-Kangevari M, Abbasi-Kangevari Z, Abdoli A, Abdollahi M, Abdullah AYM, Abhilash ES, Abu-Gharbieh E, Acuna JM, Addolorato G, Adebayo OM, Adekanmbi V, Adhikari K, Adhikari S, Adnani QES, Afzal S, Agegnehu WY, Aggarwal M, Ahinkorah BO, Ahmad AR, Ahmad S, Ahmad T, Ahmadi A, Ahmadi S, Ahmed H, Ahmed Rashid T, Akunna CJ, Al Hamad H, Alam MZ, Alem DT, Alene KA, Alimohamadi Y, Alizadeh A, Allel K, Alonso J, Alvand S, Alvis-Guzman N, Amare F, Ameyaw EK, Amiri S, Ancuceanu R, Anderson JA, Andrei CL, Andrei T, Arabloo J, Arshad M, Artamonov AA, Aryan Z, Asaad M, Asemahagn MA, Astell-Burt T, Athari SS, Atnafu DD, Atorkey P, Atreya A, Ausloos F, Ausloos M, Ayano G, Ayanore MAA, Ayinde OO, Ayuso-Mateos JL, Azadnajafabad S, Azanaw MM, Azangou-Khyavy M, Azari Jafari A, Azzam AY, Badiye AD, Bagheri N, Bagherieh S, Bairwa M, Bakkannavar SM, Bakshi RK, Balchut/Bilchut AH, Bärnighausen TW, Barra F, Barrow A, Baskaran P, Belo L, Bennett DA, Benseñor IM, Bhagavathula AS, Bhala N, Bhalla A, Bhardwaj N, Bhardwaj P, Bhaskar S, Bhattacharyya K, Bhojaraja VS, Bintoro BS, Blokhina EAE, Bodicha BBA, Boloor A, Bosetti C, Braithwaite D, Brenner H, Briko NI, Brunoni AR, Butt ZA, Cao C, Cao Y, Cárdenas R, Carvalho AF, Carvalho M, Castaldelli-Maia JM, Castelpietra G, Castro-de-Araujo LFS, Cattaruzza MS, Chakraborty PA, Charan J, Chattu VK, Chaurasia A, Cherbuin N, Chu DT, Chudal N, Chung SC, Churko C, Ciobanu LG, Cirillo M, Claro RM, Costanzo S, Cowden RG, Criqui MH, Cruz-Martins N, Culbreth GT, Dachew BA, Dadras O, Dai X, Damiani G, Dandona L, Dandona R, Daniel BD, Danielewicz A, Darega Gela J, Davletov K, de Araujo JAP, de Sá-Junior AR, Debela SA, Dehghan A, Demetriades AK, Derbew Molla M, Desai R, Desta AA, Dias da Silva D, Diaz D, Digesa LE, Diress M, Dodangeh M, Dongarwar D, Dorostkar F, Dsouza HL, Duko B, Duncan BB, Edvardsson K, Ekholuenetale M, Elgar FJ, Elhadi M, Elmonem MA, Endries AY, Eskandarieh S, Etemadimanesh A, Fagbamigbe AF, Fakhradiyev IR, Farahmand F, Farinha CSES, Faro A, Farzadfar F, Fatehizadeh A, Fauk NK, Feigin VL, Feldman R, Feng X, Fentaw Z, Ferrero S, Ferro Desideri L, Filip I, Fischer F, Francis JM, Franklin RC, Gaal PA, Gad MM, Gallus S, Galvano F, Ganesan B, Garg T, Gebrehiwot MGD, Gebremeskel TG, Gebremichael MA, Gemechu TR, Getacher L, Getachew ME, Getachew Obsa A, Getie A, Ghaderi A, Ghafourifard M, Ghajar A, Ghamari SH, Ghandour LA, Ghasemi Nour M, Ghashghaee A, Ghozy S, Glozah FN, Glushkova EV, Godos J, Goel A, Goharinezhad S, Golechha M, Goleij P, Golitaleb M, Greaves F, Grivna M, Grosso G, Gudayu TW, Gupta B, Gupta R, Gupta S, Gupta VB, Gupta VK, Hafezi-Nejad N, Haj-Mirzaian A, Hall BJ, Halwani R, Handiso TB, Hankey GJ, Hariri S, Haro JM, Hasaballah AI, Hassanian-Moghaddam H, Hay SI, Hayat K, Heidari G, Heidari M, Hendrie D, Herteliu C, Heyi DZ, Hezam K, Hlongwa MM, Holla R, Hossain MM, Hossain S, Hosseini SK, hosseinzadeh M, Hostiuc M, Hostiuc S, Hu G, Huang J, Hussain S, Ibitoye SE, Ilic IM, Ilic MD, Immurana M, Irham LM, Islam MM, Islam RM, Islam SMS, Iso H, Itumalla R, Iwagami M, Jabbarinejad R, Jacob L, Jakovljevic M, Jamalpoor Z, Jamshidi E, Jayapal SK, Jayarajah UU, Jayawardena R, Jebai R, Jeddi SA, Jema AT, Jha RP, Jindal HA, Jonas JB, Joo T, Joseph N, Joukar F, Jozwiak JJ, Jürisson M, Kabir A, Kabthymer RH, Kamble BD, Kandel H, Kanno GG, Kapoor N, Karaye IM, Karimi SE, Kassa BG, Kaur RJ, Kayode GA, Keykhaei M, Khajuria H, Khalilov R, Khan IA, Khan MAB, Kim H, Kim J, Kim MS, Kimokoti RW, Kivimäki M, Klymchuk V, Knudsen AKS, Kolahi AA, Korshunov VA, Koyanagi A, Krishan K, Krishnamoorthy Y, Kumar GA, Kumar N, Kumar N, Lacey B, Lallukka T, Lasrado S, Lau J, Lee SW, Lee WC, Lee YH, Lim LL, Lim SS, Lobo SW, Lopukhov PD, Lorkowski S, Lozano R, Lucchetti G, Madadizadeh F, Madureira-Carvalho ÁM, Mahjoub S, Mahmoodpoor A, Mahumud RA, Makki A, Malekpour MR, Manjunatha N, Mansouri B, Mansournia MA, Martinez-Raga J, Martinez-Villa FA, Matzopoulos R, Maulik PK, Mayeli M, McGrath JJ, Meena JK, Mehrabi Nasab E, Menezes RG, Mensink GBM, Mentis AFA, Meretoja A, Merga BT, Mestrovic T, Miao Jonasson J, Miazgowski B, Micheletti Gomide Nogueira de Sá AC, Miller TR, Mini GK, Mirica A, Mirijello A, Mirmoeeni S, Mirrakhimov EM, Misra S, Moazen B, Mobarakabadi M, Moccia M, Mohammad Y, Mohammadi E, Mohammadian-Hafshejani A, Mohammed TA, Moka N, Mokdad AH, Momtazmanesh S, Moradi Y, Mostafavi E, Mubarik S, Mullany EC, Mulugeta BT, Murillo-Zamora E, Murray CJL, Mwita JC, Naghavi M, Naimzada MD, Nangia V, Nayak BP, Negoi I, Negoi RI, Nejadghaderi SA, Nepal S, Neupane SPP, Neupane Kandel S, Nigatu YT, Nowroozi A, Nuruzzaman KM, Nzoputam CI, Obamiro KO, Ogbo FA, Oguntade AS, Okati-Aliabad H, Olakunde BO, Oliveira GMM, Omar Bali A, Omer E, Ortega-Altamirano DV, Otoiu A, Otstavnov SS, Oumer B, P A M, Padron-Monedero A, Palladino R, Pana A, Panda-Jonas S, Pandey A, Pandey A, Pardhan S, Parekh T, Park EK, Parry CDH, Pashazadeh Kan F, Patel J, Pati S, Patton GC, Paudel U, Pawar S, Peden AE, Petcu IR, Phillips MR, Pinheiro M, Plotnikov E, Pradhan PMS, Prashant A, Quan J, Radfar A, Rafiei A, Raghav PR, Rahimi-Movaghar V, Rahman A, Rahman MM, Rahman M, Rahmani AM, Rahmani S, Ranabhat CL, Ranasinghe P, Rao CR, Rasali DP, Rashidi MM, Ratan ZA, Rawaf DL, Rawaf S, Rawal L, Renzaho AMN, Rezaei N, Rezaei S, Rezaeian M, Riahi SM, Romero-Rodríguez E, Roth GA, Rwegerera GM, Saddik B, Sadeghi E, Sadeghian R, Saeed U, Saeedi F, Sagar R, Sahebkar A, Sahoo H, Sahraian MA, Saif-Ur-Rahman KM, Salahi S, Salimzadeh H, Samy AM, Sanmarchi F, Santric-Milicevic MM, Sarikhani Y, Sathian B, Saya GK, Sayyah M, Schmidt MI, Schutte AE, Schwarzinger M, Schwebel DC, Seidu AA, Senthil Kumar N, SeyedAlinaghi S, Seylani A, Sha F, Shahin S, Shahraki-Sanavi F, Shahrokhi S, Shaikh MA, Shaker E, Shakhmardanov MZ, Shams-Beyranvand M, Sheikhbahaei S, Sheikhi RA, Shetty A, Shetty JK, Shiferaw DS, Shigematsu M, Shiri R, Shirkoohi R, Shivakumar KM, Shivarov V, Shobeiri P, Shrestha R, Sidemo NB, Sigfusdottir ID, Silva DAS, Silva NTD, Singh JA, Singh S, Skryabin VY, Skryabina AA, Sleet DA, Solmi M, SOLOMON YONATAN, Song S, Song Y, Sorensen RJD, Soshnikov S, Soyiri IN, Stein DJ, Subba SH, Szócska M, Tabarés-Seisdedos R, Tabuchi T, Taheri M, Tan KK, Tareke M, Tarkang EE, Temesgen G, Temesgen WA, Temsah MH, Thankappan KR, Thapar R, Thomas NK, Tiruneh C, Todorovic J, Torrado M, Touvier M, Tovani-Palone MR, Tran MTN, Trias-Llimós S, Tripathy JP, Vakilian A, Valizadeh R, Varmaghani M, Varthya SB, Vasankari TJ, Vos T, Wagaye B, Waheed Y, Walde MT, Wang C, Wang Y, Wang YP, Westerman R, Wickramasinghe ND, Wubetu AD, Xu S, Yamagishi K, Yang L, Yesera GEE, Yigit A, Yiğit V, Yimaw AEAE, Yon DK, Yonemoto N, Yu C, Zadey S, Zahir M, Zare I, Zastrozhin MS, Zastrozhina A, Zhang ZJ, Zhong C, Zmaili M, Zuniga YMH, Gakidou E. Population-level risks of alcohol consumption by amount, geography, age, sex, and year: a systematic analysis for the Global Burden of Disease Study 2020. Lancet 2022; 400:185-235. [PMID: 35843246 PMCID: PMC9289789 DOI: 10.1016/s0140-6736(22)00847-9] [Citation(s) in RCA: 122] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 04/11/2022] [Accepted: 04/26/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. METHODS For this analysis, we constructed burden-weighted dose-response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15-95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. FINDINGS The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15-39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0-0) and 0·603 (0·400-1·00) standard drinks per day, and the NDE varied between 0·002 (0-0) and 1·75 (0·698-4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0-0·403) to 1·87 (0·500-3·30) standard drinks per day and an NDE that ranged between 0·193 (0-0·900) and 6·94 (3·40-8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3-65·4) were aged 15-39 years and 76·9% (73·0-81·3) were male. INTERPRETATION There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol. FUNDING Bill & Melinda Gates Foundation.
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Sharma R, Abbasi-Kangevari M, Abd-Rabu R, Abidi H, Abu-Gharbieh E, Acuna JM, Adhikari S, Advani SM, Afzal MS, Aghaie Meybodi M, Ahinkorah BO, Ahmad S, Ahmadi A, Ahmadi S, Ahmed H, Ahmed LA, Ahmed MB, Al Hamad H, Alahdab F, Alanezi FM, Alanzi TM, Alhalaiqa FAN, Alimohamadi Y, Alipour V, Aljunid SM, Alkhayyat M, Almustanyir S, Al-Raddadi RM, Alvand S, Alvis-Guzman N, Amini S, Ancuceanu R, Anoushiravani A, Anoushirvani AA, Ansari-Moghaddam A, Arabloo J, Aryannejad A, Asghari Jafarabadi M, Athari SS, Ausloos F, Ausloos M, Awedew AF, Awoke MA, Ayana TM, Azadnajafabad S, Azami H, Azangou-Khyavy M, Azari Jafari A, Badiye AD, Bagherieh S, Bahadory S, Baig AA, Baker JL, Banach M, Barrow A, Berhie AY, Besharat S, Bhagat DS, Bhagavathula AS, Bhala N, Bhattacharyya K, Bhojaraja VS, Bibi S, Bijani A, Biondi A, Bjørge T, Bodicha BBA, Braithwaite D, Brenner H, Calina D, Cao C, Cao Y, Carreras G, Carvalho F, Cerin E, Chakinala RC, Cho WCS, Chu DT, Conde J, Costa VM, Cruz-Martins N, Dadras O, Dai X, Dandona L, Dandona R, Danielewicz A, Demeke FM, Demissie GD, Desai R, Dhamnetiya D, Dianatinasab M, Diaz D, Didehdar M, Doaei S, Doan LP, Dodangeh M, Eghbalian F, Ejeta DD, Ekholuenetale M, Ekundayo TC, El Sayed I, Elhadi M, Enyew DB, Eyayu T, Ezzeddini R, Fakhradiyev IR, Farooque U, Farrokhpour H, Farzadfar F, Fatehizadeh A, Fattahi H, Fattahi N, Fereidoonnezhad M, Fernandes E, Fetensa G, Filip I, Fischer F, Foroutan M, Gaal PA, Gad MM, Gallus S, Garg T, Getachew T, Ghamari SH, Ghashghaee A, Ghith N, Gholamalizadeh M, Gholizadeh Navashenaq J, Gizaw AT, Glasbey JC, Golechha M, Goleij P, Gonfa KB, Gorini G, Guha A, Gupta S, Gupta VB, Gupta VK, Haddadi R, Hafezi-Nejad N, Haj-Mirzaian A, Halwani R, Haque S, Hariri S, Hasaballah AI, Hassanipour S, Hay SI, Herteliu C, Holla R, Hosseini MS, Hosseinzadeh M, Hostiuc M, Househ M, Huang J, Humayun A, Iavicoli I, Ilesanmi OS, Ilic IM, Ilic MD, Islami F, Iwagami M, Jahani MA, Jakovljevic M, Javaheri T, Jayawardena R, Jebai R, Jha RP, Joo T, Joseph N, Joukar F, Jozwiak JJ, Kabir A, Kalhor R, Kamath A, Kapoor N, Karaye IM, Karimi A, Kauppila JH, Kazemi A, Keykhaei M, Khader YS, Khajuria H, Khalilov R, Khanali J, Khayamzadeh M, Khodadost M, Kim H, Kim MS, Kisa A, Kisa S, Kolahi AA, Koohestani HR, Kopec JA, Koteeswaran R, Koyanagi A, Krishnamoorthy Y, Kumar GA, Kumar M, Kumar V, La Vecchia C, Lami FH, Landires I, Ledda C, Lee SW, Lee WC, Lee YY, Leong E, Li B, Lim SS, Lobo SW, Loureiro JA, Lunevicius R, Madadizadeh F, Mahmoodpoor A, Majeed A, Malekpour MR, Malekzadeh R, Malik AA, Mansour-Ghanaei F, Mantovani LG, Martorell M, Masoudi S, Mathur P, Meena JK, Mehrabi Nasab E, Mendoza W, Mentis AFA, Mestrovic T, Miao Jonasson J, Miazgowski B, Miazgowski T, Mijena GFW, Mirmoeeni S, Mirza-Aghazadeh-Attari M, Mirzaei H, Misra S, Mohammad KA, Mohammadi E, Mohammadi S, Mohammadi SM, Mohammadian-Hafshejani A, Mohammed S, Mohammed TA, Moka N, Mokdad AH, Mokhtari Z, Molokhia M, Momtazmanesh S, Monasta L, Moradi G, Moradzadeh R, Moraga P, Morgado-da-Costa J, Mubarik S, Mulita F, Naghavi M, Naimzada MD, Nam HS, Natto ZS, Nayak BP, Nazari J, Nazemalhosseini-Mojarad E, Negoi I, Nguyen CT, Nguyen SH, Noor NM, Noori M, Noori SMA, Nuñez-Samudio V, Nzoputam CI, Oancea B, Odukoya OO, Oguntade AS, Okati-Aliabad H, Olagunju AT, Olagunju TO, Ong S, Ostroff SM, Padron-Monedero A, Pakzad R, Pana A, Pandey A, Pashazadeh Kan F, Patel UK, Paudel U, Pereira RB, Perumalsamy N, Pestell RG, Piracha ZZ, Pollok RCG, Pourshams A, Pourtaheri N, Prashant A, Rabiee M, Rabiee N, Radfar A, Rafiei S, Rahman M, Rahmani AM, Rahmanian V, Rajai N, Rajesh A, Ramezani-Doroh V, Ramezanzadeh K, Ranabhat K, Rashedi S, Rashidi A, Rashidi M, Rashidi MM, Rastegar M, Rawaf DL, Rawaf S, Rawassizadeh R, Razeghinia MS, Renzaho AMN, Rezaei N, Rezaei N, Rezaei S, Rezaeian M, Rezazadeh-Khadem S, Roshandel G, Saber-Ayad MM, Saberzadeh-Ardestani B, Saddik B, Sadeghi H, Saeed U, Sahebazzamani M, Sahebkar A, Salek Farrokhi A, Salimi A, Salimzadeh H, Samadi P, Samaei M, Samy AM, Sanabria J, Santric-Milicevic MM, Saqib MAN, Sarveazad A, Sathian B, Satpathy M, Schneider IJC, Šekerija M, Sepanlou SG, Seylani A, Sha F, Shafiee SM, Shaghaghi Z, Shahabi S, Shaker E, Sharifian M, Sharifi-Rad J, Sheikhbahaei S, Shetty JK, Shirkoohi R, Shobeiri P, Siddappa Malleshappa SK, Silva DAS, Silva Julian G, Singh AD, Singh JA, Siraj MS, Sivandzadeh GR, Skryabin VY, Skryabina AA, Socea B, Solmi M, Soltani-Zangbar MS, Song S, Szerencsés V, Szócska M, Tabarés-Seisdedos R, Tabibian E, Taheri M, TaheriAbkenar Y, Taherkhani A, Talaat IM, Tan KK, Tbakhi A, Tesfaye B, Tiyuri A, Tollosa DN, Touvier M, Tran BX, Tusa BS, Ullah I, Ullah S, Vacante M, Valadan Tahbaz S, Veroux M, Vo B, Vos T, Wang C, Westerman R, Woldemariam M, Yahyazadeh Jabbari SH, Yang L, Yazdanpanah F, Yu C, Yuce D, Yunusa I, Zadnik V, Zahir M, Zare I, Zhang ZJ, Zoladl M. Global, regional, and national burden of colorectal cancer and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Gastroenterol Hepatol 2022; 7:627-647. [PMID: 35397795 PMCID: PMC9192760 DOI: 10.1016/s2468-1253(22)00044-9] [Citation(s) in RCA: 148] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 01/30/2022] [Accepted: 02/04/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Colorectal cancer is the third leading cause of cancer deaths worldwide. Given the recent increasing trends in colorectal cancer incidence globally, up-to-date information on the colorectal cancer burden could guide screening, early detection, and treatment strategies, and help effectively allocate resources. We examined the temporal patterns of the global, regional, and national burden of colorectal cancer and its risk factors in 204 countries and territories across the past three decades. METHODS Estimates of incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer were generated as a part of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 by age, sex, and geographical location for the period 1990-2019. Mortality estimates were produced using the cause of death ensemble model. We also calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. FINDINGS Globally, between 1990 and 2019, colorectal cancer incident cases more than doubled, from 842 098 (95% uncertainty interval [UI] 810 408-868 574) to 2·17 million (2·00-2·34), and deaths increased from 518 126 (493 682-537 877) to 1·09 million (1·02-1·15). The global age-standardised incidence rate increased from 22·2 (95% UI 21·3-23·0) per 100 000 to 26·7 (24·6-28·9) per 100 000, whereas the age-standardised mortality rate decreased from 14·3 (13·5-14·9) per 100 000 to 13·7 (12·6-14·5) per 100 000 and the age-standardised DALY rate decreased from 308·5 (294·7-320·7) per 100 000 to 295·5 (275·2-313·0) per 100 000 from 1990 through 2019. Taiwan (province of China; 62·0 [48·9-80·0] per 100 000), Monaco (60·7 [48·5-73·6] per 100 000), and Andorra (56·6 [42·8-71·9] per 100 000) had the highest age-standardised incidence rates, while Greenland (31·4 [26·0-37·1] per 100 000), Brunei (30·3 [26·6-34·1] per 100 000), and Hungary (28·6 [23·6-34·0] per 100 000) had the highest age-standardised mortality rates. From 1990 through 2019, a substantial rise in incidence rates was observed in younger adults (age <50 years), particularly in high Socio-demographic Index (SDI) countries. Globally, a diet low in milk (15·6%), smoking (13·3%), a diet low in calcium (12·9%), and alcohol use (9·9%) were the main contributors to colorectal cancer DALYs in 2019. INTERPRETATION The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions. FUNDING Bill & Melinda Gates Foundation.
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Bhala N, Hart A, Watts D, Lewis S, Ghosh S, Hansell C, Ahmad T, Van Haaren S, Sensky T. Disease activity, burden and suffering in patients with ulcerative colitis in the UK cohort recruited into the global ICONIC study. Frontline Gastroenterol 2022; 14:25-31. [PMID: 36561781 PMCID: PMC9763636 DOI: 10.1136/flgastro-2022-102104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The Understanding the Impact of Ulcerative Colitis and Its Associated Disease Burden on Patients (ICONIC) was a 2-year, global, prospective, observational study assessing disease burden in adults recently diagnosed (≤36 months) with ulcerative colitis (UC) receiving routine outpatient care, irrespective of disease severity or treatment. A subanalysis was conducted to understand the UK perspective. DESIGN/METHOD All eligible consenting patients enrolled in ICONIC from the UK were included in the subanalysis of patient-reported and physician-reported outcomes at baseline and year 2 (Y2). RESULTS Sixty-three UK patients were included (mean age 43.4 years, 58.7% female). At baseline and Y2, the mean (±SD) Simple Clinical Colitis Activity Index (SCCAI) scores were 3.6 (±3.3) and 1.5 (±1.5); Patient Modified Simple Clinical Colitis Activity Index (P-SSCAI) were 4.9 (±4.0) and 2.6 (±2.6), respectively. Physician-reported Pictorial Representation of Illness and Self Measure (PRISM) median scores (assessing inverse of suffering) were 3.5 (IQR 2.0-6.8) at baseline and 5.5 (IQR 3.6-6.9) at Y2; patient-reported PRISM scores were 4.7 (IQR 2.6-6.9) and 5.4 (IQR 3.2-8.0), respectively. At baseline, SCCAI and P-SCCAI were strongly correlated (r=0.86, p<0.0001), and patient-reported and physician-reported PRISM scores moderately correlated (r=0.67, p<0.0001). At Y2, moderate correlations were observed (SCCAI vs P-SCCAI: r=0.72, p<0.0001; patient-reported vs physician- reported PRISM: r=0.60, p<0.0001). Rating Form of IBD Patient Concerns scores indicated patients' greatest concerns were with energy level, having an ostomy bag and effects of medication (baseline scores >3.0). CONCLUSIONS These findings demonstrated the multifaceted burden of disease in patients recently diagnosed with UC in the UK. Agreement between patients and physicians on disease activity/severity varied according to the instrument used.
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Affiliation(s)
- Neeraj Bhala
- Institute of Applied Health Research, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Ailsa Hart
- IBD Unit, St Mark's Hospital, Harrow, London, UK
| | - David Watts
- Department of Gastroenterology, NHS Forth Valley, Stirling, UK
| | - Stephen Lewis
- Department of Gastroenterology, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Subrata Ghosh
- College of Medicine and Health, APC Microbiome Ireland, University College Cork, Cork, Ireland
| | - Chris Hansell
- Medical Affairs Department, AbbVie Ltd, Maidenhead, UK
| | - Tariq Ahmad
- Exeter IBD Group, Royal Devon and Exeter Hospital, Exeter, UK,Exeter IBD Group, University of Exeter, Exeter, UK
| | | | - Tom Sensky
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK
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Ramasawmy M, Poole L, Thorlu-Bangura Z, Chauhan A, Murali M, Jagpal P, Bijral M, Prashar J, G-Medhin A, Murray E, Stevenson F, Blandford A, Potts HWW, Khunti K, Hanif W, Gill P, Sajid M, Patel K, Sood H, Bhala N, Modha S, Mistry M, Patel V, Ali SN, Ala A, Banerjee A. Frameworks for implementation, uptake and use of digital health interventions in ethnic minority populations: a scoping review using cardiometabolic disease as a case study. (Preprint). JMIR Cardio 2022; 6:e37360. [PMID: 35969455 PMCID: PMC9412726 DOI: 10.2196/37360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Digital health interventions have become increasingly common across health care, both before and during the COVID-19 pandemic. Health inequalities, particularly with respect to ethnicity, may not be considered in frameworks that address the implementation of digital health interventions. We considered frameworks to include any models, theories, or taxonomies that describe or predict implementation, uptake, and use of digital health interventions. Objective We aimed to assess how health inequalities are addressed in frameworks relevant to the implementation, uptake, and use of digital health interventions; health and ethnic inequalities; and interventions for cardiometabolic disease. Methods SCOPUS, PubMed, EMBASE, Google Scholar, and gray literature were searched to identify papers on frameworks relevant to the implementation, uptake, and use of digital health interventions; ethnically or culturally diverse populations and health inequalities; and interventions for cardiometabolic disease. We assessed the extent to which frameworks address health inequalities, specifically ethnic inequalities; explored how they were addressed; and developed recommendations for good practice. Results Of 58 relevant papers, 22 (38%) included frameworks that referred to health inequalities. Inequalities were conceptualized as society-level, system-level, intervention-level, and individual. Only 5 frameworks considered all levels. Three frameworks considered how digital health interventions might interact with or exacerbate existing health inequalities, and 3 considered the process of health technology implementation, uptake, and use and suggested opportunities to improve equity in digital health. When ethnicity was considered, it was often within the broader concepts of social determinants of health. Only 3 frameworks explicitly addressed ethnicity: one focused on culturally tailoring digital health interventions, and 2 were applied to management of cardiometabolic disease. Conclusions Existing frameworks evaluate implementation, uptake, and use of digital health interventions, but to consider factors related to ethnicity, it is necessary to look across frameworks. We have developed a visual guide of the key constructs across the 4 potential levels of action for digital health inequalities, which can be used to support future research and inform digital health policies.
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Affiliation(s)
- Mel Ramasawmy
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Lydia Poole
- Institute of Health Informatics, University College London, London, United Kingdom
| | | | - Aneesha Chauhan
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Mayur Murali
- Division of Anaesthetics, Pain Medicine, and Intensive Care, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Parbir Jagpal
- School of Pharmacy, University of Birmingham, Birmingham, United Kingdom
| | - Mehar Bijral
- University College London Medical School, University College London, London, United Kingdom
| | - Jai Prashar
- University College London Medical School, University College London, London, United Kingdom
| | - Abigail G-Medhin
- Department of Population Health Sciences, King's College London, London, United Kingdom
| | - Elizabeth Murray
- eHealth Unit, Research Department of Primary Care and Population Health, University College London Medical School, London, United Kingdom
| | - Fiona Stevenson
- eHealth Unit, Research Department of Primary Care and Population Health, University College London Medical School, London, United Kingdom
| | - Ann Blandford
- University College London Interaction Centre, University College London, London, United Kingdom
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, United Kingdom
| | - Wasim Hanif
- Department of Diabetes and Institute of Translational Medicine, University Hospital Birmingham, Birmingham, United Kingdom
| | - Paramjit Gill
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Madiha Sajid
- Patient and Public Involvement Representative, DISC Study (UK), United Kingdom
| | - Kiran Patel
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Harpreet Sood
- Health Education England, London, United Kingdom
- Hurley Group Practice, London, United Kingdom
| | - Neeraj Bhala
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Shivali Modha
- Patient and Public Involvement Representative, DISC Study (UK), United Kingdom
| | - Manoj Mistry
- Patient and Public Involvement Representative, DISC Study (UK), United Kingdom
| | - Vinod Patel
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Sarah N Ali
- Department of Diabetes and Endocrinology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Aftab Ala
- Department of Access and Medicine, Royal Surrey NHS Foundation Trust, Guildford, United Kingdom
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
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Sebastian S, Patel KV, Segal JP, Subramanian S, Conley TE, Gonzalez HA, Kent AJ, Saifuddin A, Hicks L, Mehta S, Bhala N, Brookes MJ, Lamb CA, Kennedy NA, Walker GJ. Ambulatory care management of 69 patients with acute severe ulcerative colitis in comparison to 695 inpatients: insights from a multicentre UK cohort study. BMJ Open Gastroenterol 2022; 9:bmjgast-2021-000763. [PMID: 35101886 PMCID: PMC8804638 DOI: 10.1136/bmjgast-2021-000763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/08/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction Acute severe ulcerative colitis (ASUC) traditionally requires inpatient hospital management for intravenous therapies and/or colectomy. Ambulatory ASUC care has not yet been evaluated in large cohorts. Aims We used data from PROTECT, a UK multicentre observational COVID-19 inflammatory bowel disease study, to report the extent, safety and effectiveness of ASUC ambulatory pathways. Methods Adults (≥18 years old) meeting Truelove and Witts criteria between 1 January 2019–1 June 2019 and 1 March 2020–30 June 2020 were recruited to PROTECT. We used demographic, disease phenotype, treatment outcomes and 3-month follow-up data. Primary outcome was rate of colectomy during the index ASUC episode. Secondary outcomes included corticosteroid response, time to and rate of rescue or primary induction therapy, response to rescue or primary induction therapy, time to colectomy, mortality, duration of inpatient treatment and hospital readmission and colectomy within 3 months of index flare. We compared outcomes in three cohorts: (1) patients treated entirely in inpatient setting; ambulatory patients subdivided into; (2) patients managed as ambulatory from diagnosis and (3) patients hospitalised and subsequently discharged to ambulatory care for continued intravenous steroids. Results 37% (22/60) participating hospitals used ambulatory pathways. Of 764 eligible patients, 695 (91%) patients received entirely inpatient care, 15 (2%) patients were managed as ambulatory from diagnosis and 54 (7%) patients were discharged to ambulatory pathways. Aside from younger age in patients treated as ambulatory from diagnosis, no significant differences in disease or patient phenotype were observed. The rate of colectomy (15.0% (104/695) vs 13.3% (2/15) vs 13.0% (7/54), respectively, p=0.96) and secondary outcomes were similar among all three cohorts. Stool culture and flexible sigmoidoscopy were less frequently performed in ambulatory cohorts. Forty per cent of patients treated as ambulatory from diagnosis required subsequent hospital admission. Conclusions In a post hoc analysis of one of the largest ASUC cohorts collected to date, we report an emerging UK ambulatory practice which challenges treatment paradigms. However, our analysis remains underpowered to detect key outcome measures and further studies exploring clinical and cost-effectiveness as well as patient and physician acceptability are needed. Trial registration number NCT04411784.
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Affiliation(s)
- Shaji Sebastian
- IBD Unit, Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Hull York Medical School, Hull, UK
| | - Kamal V Patel
- Department of Gastroenterology, St George's University Hospitals NHS Trust, London, UK
| | | | - Sreedhar Subramanian
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
- Univeristy of Liverpool, Liverpool, UK
| | - Thomas Edward Conley
- Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Haidee Aleman Gonzalez
- IBD Unit, Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Alexandra J Kent
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Lucy Hicks
- Gastroenterology, Imperial College Healthcare NHS Trust, London, UK
| | - Shameer Mehta
- Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Neeraj Bhala
- Gastroenterology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Applied Health Research, University Of Birmingham, Birmingham, UK
| | - Matthew J Brookes
- Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
- University of Wolverhampton, Wolverhampton, UK
| | - Christopher A Lamb
- Newcastle University, Newcastle upon Tyne, UK
- Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Nicholas A Kennedy
- Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
- IBD Pharmacogenetics, University of Exeter, Exeter, UK
| | - Gareth J Walker
- Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, UK
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Chapman R, Haroon S, Simms-Williams N, Bhala N, Miah F, Nirantharakumar K, Ferguson J. Socioeconomic deprivation, age and language are barriers to accessing personal health records: a cross-sectional study of a large hospital-based personal health record system. BMJ Open 2022; 12:e054655. [PMID: 35058264 PMCID: PMC8783813 DOI: 10.1136/bmjopen-2021-054655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To investigate barriers to accessing a hospital-based personal health record (PHR) system. DESIGN Retrospective cross-sectional study. SETTING This study was conducted in a large secondary and tertiary acute care trust in Birmingham, UK. PARTICIPANTS Data were collected from 28 637 patients who attended liver medicine, diabetes, renal medicine or endocrinology specialist outpatient clinics from 1 June 2017 to 31 May 2018. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was sign up to and activation of the PHR. The secondary outcomes were the use of the PHR, defined as the number of logons and frequency of access of specific PHR functions. RESULTS 8070 patients (28.2%) were signed up to the PHR and 4286 patients (53.1% of those signed up) went on to activate their PHR account. Patients aged 75 years and older were significantly less likely to be signed up (adjusted OR, aOR 0.40, 95% CI 0.36 to 0.44) or to activate (aOR 0.39, 0.32 to 0.47) their PHR than patients aged 35-54. Patients who did not need an interpreter were more likely to be signed up (aOR 1.63, 95% CI 1.33 to 1.99) and to activate (aOR 3.16, 95% CI 1.96 to 5.09) their PHR. Patients living in the least deprived areas were more than twice as likely to be signed up (aOR 2.31, 95% CI 2.04 to 2.63), and were three times more likely to activate their PHR (aOR 2.99, 95% CI 2.40 to 3.71), than those in the most deprived. CONCLUSION Socioeconomic deprivation, older age and non-English language were significant barriers to accessing a hospital-based PHR. Strategies are needed to account for these factors to ensure that PHRs do not widen health inequalities.
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Affiliation(s)
- Rachel Chapman
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
| | - Shamil Haroon
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
| | | | - Neeraj Bhala
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
- Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Foyzal Miah
- Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - James Ferguson
- Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- National Institute for Health Research, Birmingham, UK
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Snook J, Bhala N, Beales ILP, Cannings D, Kightley C, Logan RP, Pritchard DM, Sidhu R, Surgenor S, Thomas W, Verma AM, Goddard AF. British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults. Gut 2021; 70:2030-2051. [PMID: 34497146 PMCID: PMC8515119 DOI: 10.1136/gutjnl-2021-325210] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/26/2021] [Indexed: 12/12/2022]
Abstract
Iron deficiency anaemia (IDA) is a major cause of morbidity and burden of disease worldwide. It can generally be diagnosed by blood testing and remedied by iron replacement therapy (IRT) using the oral or intravenous route. The many causes of iron deficiency include poor dietary intake and malabsorption of dietary iron, as well as a number of significant gastrointestinal (GI) pathologies. Because blood is iron-rich it can result from chronic blood loss, and this is a common mechanism underlying the development of IDA-for example, as a consequence of menstrual or GI blood loss.Approximately a third of men and postmenopausal women presenting with IDA have an underlying pathological abnormality, most commonly in the GI tract. Therefore optimal management of IDA requires IRT in combination with appropriate investigation to establish the underlying cause. Unexplained IDA in all at-risk individuals is an accepted indication for fast-track secondary care referral in the UK because GI malignancies can present in this way, often in the absence of specific symptoms. Bidirectional GI endoscopy is the standard diagnostic approach to examination of the upper and lower GI tract, though radiological scanning is an alternative in some situations for assessing the large bowel. In recurrent or refractory IDA, wireless capsule endoscopy plays an important role in assessment of the small bowel.IDA may present in primary care or across a range of specialties in secondary care, and because of this and the insidious nature of the condition it has not always been optimally managed despite the considerable burden of disease- with investigation sometimes being inappropriate, incorrectly timed or incomplete, and the role of IRT for symptom relief neglected. It is therefore important that contemporary guidelines for the management of IDA are available to all clinicians. This document is a revision of previous British Society of Gastroenterology guidelines, updated in the light of subsequent evidence and developments.
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Affiliation(s)
- Jonathon Snook
- Gastroenterology, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Neeraj Bhala
- Gastroenterology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ian L P Beales
- Gastroenterology, University of East Anglia, Norwich, UK
| | - David Cannings
- Gastroenterology, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Chris Kightley
- Digestive Diseases, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | | | - D Mark Pritchard
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool and Department of Gastroenterology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Reena Sidhu
- Gastroenterology, Royal Hallamshire Hospital, Sheffield, UK
| | - Sue Surgenor
- Gastroenterology, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Wayne Thomas
- Haematology, Plymouth Hospitals NHS Foundation Trust, Plymouth, Plymouth, UK
| | - Ajay M Verma
- Digestive Diseases, Kettering General Hospital NHS Foundation Trust, Kettering, UK
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Kendrick PJ, Reitsma MB, Abbasi-Kangevari M, Abdoli A, Abdollahi M, Abedi A, Abhilash ES, Aboyans V, Adebayo OM, Advani SM, Ahinkorah BO, Ahmad S, Ahmadi K, Ahmed H, Aji B, Akalu Y, Akunna CJ, Alahdab F, Al-Aly Z, Alanezi FM, Alanzi TM, Alhabib KF, Ali T, Alif SM, Alipour V, Aljunid SM, Alomari MA, Amin TT, Amini S, Amu H, Ancuceanu R, Anderson JA, Andrei CL, Andrei T, Ansari-Moghaddam A, Antony B, Anvari D, Arabloo J, Arian ND, Arora M, Artanti KD, Asmare WN, Atnafu DD, Ausloos M, Awan AT, Ayano G, Aynalem GL, Azari S, B DB, Badiye AD, Baig AA, Banach M, Banerjee SK, Barker-Collo SL, Bärnighausen TW, Barqawi HJ, Basu S, Bayati M, Bazargan-Hejazi S, Bekuma TT, Bennett DA, Bensenor IM, Benzian H, Benziger CP, Berman AE, Bhagavathula AS, Bhala N, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bibi S, Bijani A, Biondi A, Braithwaite D, Brenner H, Brunoni AR, Burkart K, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Car J, Carreras G, Castaldelli-Maia JM, Cattaruzza MSS, Chang JC, Chaturvedi P, Chen S, Chido-Amajuoyi OG, Chu DT, Chung SC, Ciobanu LG, Costa VM, Couto RAS, Dagnew B, Dai X, Damasceno AAM, Damiani G, Dandona L, Dandona R, Daneshpajouhnejad P, Darega Gela J, Derbew Molla M, Desta AA, Dharmaratne SD, Dhimal M, Eagan AW, Ebrahimi Kalan M, Edvardsson K, Effiong A, El Tantawi M, Elbarazi I, Esmaeilnejad S, Fadhil I, Faraon EJA, Farwati M, Farzadfar F, Fazlzadeh M, Feigin VL, Feldman R, Filip I, Filippidis F, Fischer F, Flor LS, Foigt NA, Folayan MO, Foroutan M, Gad MM, Gallus S, Geberemariyam BS, Gebregiorgis BG, Getacher L, Getachew Obsa A, Ghafourifard M, Ghanei Gheshlagh R, Ghashghaee A, Ghith N, Gil GF, Gill PS, Ginawi IA, Goharinezhad S, Golechha M, Gopalani SV, Gorini G, Grivna M, Guha A, Guimarães RA, Guo Y, Gupta RD, Gupta R, Gupta T, Gupta V, Hafezi-Nejad N, Haider MR, Hamadeh RR, Hankey GJ, Hargono A, Hay SI, Heidari G, Herteliu C, Hezam K, Hird TR, Holla R, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hsiao T, Huang J, Ibeneme CU, Ibitoye SE, Ilic IM, Ilic MD, Inbaraj LR, Irvani SSN, Islam JY, Islam RM, Islam SMS, Islami F, Iso H, Itumalla R, Jaafari J, Jain V, Jakovljevic M, Jang SI, Jayaram S, Jeemon P, Jha RP, Jonas JB, Jürisson M, Kabir A, Kabir Z, Kalankesh LR, Kanchan T, Kandel H, Kapoor N, Karch A, Karimi SE, Kebede KM, Kelkay B, Kennedy RD, Khader YS, Khan EA, Khayamzadeh M, Kim GR, Kimokoti RW, Kivimäki M, Kosen S, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Kugbey N, Kumar GA, Kumar N, Kurmi OP, Kusuma D, Lacey B, Landires I, Lasrado S, Lauriola P, Lee DW, Lee YH, Leung J, Li S, Lin H, Liu W, Lugo A, Madhava Kunjathur S, Majeed A, Maleki A, Malekzadeh R, Malta DC, Mamun AA, Manjunatha N, Mansouri B, Mansournia MA, Martini S, Mathur MR, Mathur P, Mazidi M, McKee M, Medina-Solís CE, Mehata S, Mendoza W, Menezes RG, Miazgowski B, Michalek IM, Miller TR, Mini GK, Mirica A, Mirrakhimov EM, Mirzaei H, Misra S, Mohammad Y, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Molokhia M, Monasta L, Moni MA, Moradzadeh R, Morrison SD, Mossie TB, Mubarik S, Mullany EC, Murray CJL, Nagaraju SP, Naghavi M, Naik N, Nalini M, Nangia V, Naqvi AA, Narasimha Swamy S, Naveed M, Nazari J, Nduaguba SO, Negoi RI, Neupane Kandel S, Nguyen HLT, Nigatu YT, Nixon MR, Nnaji CA, Noubiap JJ, Nowak C, Nuñez-Samudio V, Ogbo FA, Oguntade AS, Oh IH, Olagunju AT, Owolabi MO, P A M, Pakshir K, Pana A, Panagiotakos D, Panda-Jonas S, Pandey A, Parekh U, Park EC, Park EK, Pashazadeh Kan F, Pathak M, Pawar S, Pestell RG, Pham HQ, Pinheiro M, Pokhrel KN, Pourshams A, Prashant A, Radfar A, Rahimi-Movaghar V, Rahman MHU, Rahman MA, Rahmani AM, Ram P, Rana J, Ranabhat CL, Rathi P, Rawaf DL, Rawaf S, Rawassizadeh R, Renzaho AMN, Rezapour A, Riaz MA, Roever L, Ronfani L, Roshandel G, Roy A, Roy B, Saddik B, Sahebkar A, Salehi S, Salimzadeh H, Samy AM, Sanabria J, Santric-Milicevic MM, Sao Jose BP, Sathian B, Sawhney M, Saya GK, Schwendicke F, Seidu AA, Senthil Kumar N, Sepanlou SG, Shafaat O, Shah SM, Shaikh MA, Shannawaz M, Sharafi K, Sheikh A, Sheikhbahaei S, Shigematsu M, Shiri R, Shishani K, Shivakumar KM, Shivalli S, Shrestha R, Siabani S, Sidemo NB, Sigfusdottir ID, Sigurvinsdottir R, Silva JP, Singh A, Singh JA, Singh V, Sinha DN, Skryabin VY, Skryabina AA, Soroush A, Soyiri IN, Sreeramareddy CT, Stein DJ, Steiropoulos P, Stortecky S, Straif K, Suliankatchi Abdulkader R, Sulo G, Sundström J, Tabuchi T, Tadesse EG, Tamiru AT, Tareke M, Tareque MI, Tarigan IU, Thakur B, Thankappan KR, Thapar R, Tolani MA, Tovani-Palone MR, Tran BX, Tripathy JP, Tsegaye GW, Tymeson HD, Ullah S, Unim B, Updike RL, Uthman OA, Vacante M, Vardavas C, Venketasubramanian N, Verma M, Vidale S, Vo B, Vu GT, Waheed Y, Wang Y, Welding K, Werdecker A, Whisnant JL, Wickramasinghe ND, Wubishet BL, Yamagishi K, Yano Y, Yazdi-Feyzabadi V, Yeshaw Y, Yimmer MZ, Yonemoto N, Yousefi Z, Yu C, Yunusa I, Yusefzadeh H, Zaman MS, Zamani M, Zamanian M, Zastrozhin MS, Zastrozhina A, Zhang J, Zhang ZJ, Zhong C, Zuniga YMH, Gakidou E. Spatial, temporal, and demographic patterns in prevalence of chewing tobacco use in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Public Health 2021; 6:e482-e499. [PMID: 34051920 PMCID: PMC8251505 DOI: 10.1016/s2468-2667(21)00065-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chewing tobacco and other types of smokeless tobacco use have had less attention from the global health community than smoked tobacco use. However, the practice is popular in many parts of the world and has been linked to several adverse health outcomes. Understanding trends in prevalence with age, over time, and by location and sex is important for policy setting and in relation to monitoring and assessing commitment to the WHO Framework Convention on Tobacco Control. METHODS We estimated prevalence of chewing tobacco use as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 using a modelling strategy that used information on multiple types of smokeless tobacco products. We generated a time series of prevalence of chewing tobacco use among individuals aged 15 years and older from 1990 to 2019 in 204 countries and territories, including age-sex specific estimates. We also compared these trends to those of smoked tobacco over the same time period. FINDINGS In 2019, 273·9 million (95% uncertainty interval 258·5 to 290·9) people aged 15 years and older used chewing tobacco, and the global age-standardised prevalence of chewing tobacco use was 4·72% (4·46 to 5·01). 228·2 million (213·6 to 244·7; 83·29% [82·15 to 84·42]) chewing tobacco users lived in the south Asia region. Prevalence among young people aged 15-19 years was over 10% in seven locations in 2019. Although global age-standardised prevalence of smoking tobacco use decreased significantly between 1990 and 2019 (annualised rate of change: -1·21% [-1·26 to -1·16]), similar progress was not observed for chewing tobacco (0·46% [0·13 to 0·79]). Among the 12 highest prevalence countries (Bangladesh, Bhutan, Cambodia, India, Madagascar, Marshall Islands, Myanmar, Nepal, Pakistan, Palau, Sri Lanka, and Yemen), only Yemen had a significant decrease in the prevalence of chewing tobacco use, which was among males between 1990 and 2019 (-0·94% [-1·72 to -0·14]), compared with nine of 12 countries that had significant decreases in the prevalence of smoking tobacco. Among females, none of these 12 countries had significant decreases in prevalence of chewing tobacco use, whereas seven of 12 countries had a significant decrease in the prevalence of tobacco smoking use for the period. INTERPRETATION Chewing tobacco remains a substantial public health problem in several regions of the world, and predominantly in south Asia. We found little change in the prevalence of chewing tobacco use between 1990 and 2019, and that control efforts have had much larger effects on the prevalence of smoking tobacco use than on chewing tobacco use in some countries. Mitigating the health effects of chewing tobacco requires stronger regulations and policies that specifically target use of chewing tobacco, especially in countries with high prevalence. FUNDING Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.
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Lamb CA, Sebastian S, Kent AJ, Segal JP, Gonzalez HA, Brookes MJ, Mehta SJ, Subramanian S, Bhala N, Hicks LC, Conley TE, Patel KV, Walker GJ, Kennedy NA. Letter: risk of severe COVID-19 outcomes associated with inflammatory bowel disease medications-reassuring insights from the United Kingdom PREPARE-IBD multicentre cohort study. Aliment Pharmacol Ther 2021; 53:1236-1240. [PMID: 33961708 PMCID: PMC8207069 DOI: 10.1111/apt.16349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
LINKED CONTENT This article is linked to Taxonera et al paper. To view this article, visit https://doi.org/10.1111/apt.15804
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Williams R, Alessi C, Alexander G, Allison M, Aspinall R, Batterham RL, Bhala N, Day N, Dhawan A, Drummond C, Ferguson J, Foster G, Gilmore I, Goldacre R, Gordon H, Henn C, Kelly D, MacGilchrist A, McCorry R, McDougall N, Mirza Z, Moriarty K, Newsome P, Pinder R, Roberts S, Rutter H, Ryder S, Samyn M, Severi K, Sheron N, Thorburn D, Verne J, Williams J, Yeoman A. New dimensions for hospital services and early detection of disease: a Review from the Lancet Commission into liver disease in the UK. Lancet 2021; 397:1770-1780. [PMID: 33714360 PMCID: PMC9188483 DOI: 10.1016/s0140-6736(20)32396-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/29/2020] [Accepted: 11/03/2020] [Indexed: 12/26/2022]
Abstract
This Review, in addressing the unacceptably high mortality of patients with liver disease admitted to acute hospitals, reinforces the need for integrated clinical services. The masterplan described is based on regional, geographically sited liver centres, each linked to four to six surrounding district general hospitals-a pattern of care similar to that successfully introduced for stroke services. The plan includes the establishment of a lead and deputy lead clinician in each acute hospital, preferably a hepatologist or gastroenterologist with a special interest in liver disease, who will have prime responsibility for organising the care of admitted patients with liver disease on a 24/7 basis. Essential for the plan is greater access to intensive care units and high-dependency units, in line with the reconfiguration of emergency care due to the COVID-19 pandemic. This Review strongly recommends full implementation of alcohol care teams in hospitals and improved working links with acute medical services. We also endorse recommendations from paediatric liver services to improve overall survival figures by diagnosing biliary atresia earlier based on stool colour charts and better caring for patients with impaired cognitive ability and developmental mental health problems. Pilot studies of earlier diagnosis have shown encouraging progress, with 5-6% of previously undiagnosed cases of severe fibrosis or cirrhosis identified through use of a portable FibroScan in primary care. Similar approaches to the detection of early asymptomatic disease are described in accounts from the devolved nations, and the potential of digital technology in improving the value of clinical consultation and screening programmes in primary care is highlighted. The striking contribution of comorbidities, particularly obesity and diabetes (with excess alcohol consumption known to be a major factor in obesity), to mortality in COVID-19 reinforces the need for fiscal and other long delayed regulatory measures to reduce the prevalence of obesity. These measures include the food sugar levy and the introduction of the minimum unit price policy to reduce alcohol consumption. Improving public health, this Review emphasises, will not only mitigate the severity of further waves of COVID-19, but is crucial to reducing the unacceptable burden from liver disease in the UK.
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Affiliation(s)
- Roger Williams
- Institute of Hepatology, Foundation for Liver Research, London, UK
| | | | - Graeme Alexander
- UCL Institute for Liver & Digestive Health, Royal Free Hospital, London, UK
| | - Michael Allison
- Liver Unit, Department of Medicine, Cambridge Biomedical Research Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Richard Aspinall
- Department of Gastroenterology & Hepatology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rachel L Batterham
- National Institute of Health Research, UCLH Biomedical Research Centre, London, UK
| | - Neeraj Bhala
- NIHR Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Gastrointestinal and Liver Services, Queen Elizabeth Hospital Birmingham at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Natalie Day
- Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Anil Dhawan
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital NHS Foundation Trust, London, UK
| | - Colin Drummond
- Institute of Psychiatry, Psychology & Neuroscience, King's College London and South London and Maudsley NHS Foundation Trust, London, UK
| | - James Ferguson
- NIHR Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Graham Foster
- Bart's Liver Centre, Queen Mary University of London, London, UK
| | - Ian Gilmore
- Liverpool Centre for Alcohol Research, University of Liverpool, Liverpool, UK; Alcohol Health Alliance, London, UK.
| | - Raphael Goldacre
- Unit of Health Care Epidemiology, Big Data Institute, Nuffield Department of Population Health, NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Harriet Gordon
- Gastroenterology Department, Hampshire Hospitals Foundation Trust, Winchester, UK
| | | | - Deirdre Kelly
- Liver Unit, Birmingham Women's and Children's Hospital and University of Birmingham, Birmingham, UK
| | | | | | | | - Zulfiquar Mirza
- Emergency Department, West Middlesex University Hospital, London, UK
| | | | - Philip Newsome
- NIHR Birmingham Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Richard Pinder
- School of Public Health, Imperial College of Science & Technology, London, UK
| | | | - Harry Rutter
- Department of Social and Policy Sciences, University of Bath, Bath, UK
| | - Stephen Ryder
- NIHR Biomedical Research Centre at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Marianne Samyn
- Paediatric Liver, GI and Nutrition Centre, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Nick Sheron
- Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Douglas Thorburn
- UCL Institute for Liver & Digestive Health, Royal Free Hospital, London, UK; Sheila Sherlock Liver Centre, Royal Free Hospital, London, UK
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Chandan JS, Zemedikun DT, Thayakaran R, Byne N, Dhalla S, Acosta-Mena D, Gokhale KM, Thomas T, Sainsbury C, Subramanian A, Cooper J, Anand A, Okoth KO, Wang J, Adderley NJ, Taverner T, Denniston AK, Lord J, Thomas GN, Buckley CD, Raza K, Bhala N, Nirantharakumar K, Haroon S. Nonsteroidal Antiinflammatory Drugs and Susceptibility to COVID-19. Arthritis Rheumatol 2021; 73:731-739. [PMID: 33185016 PMCID: PMC8252419 DOI: 10.1002/art.41593] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 11/10/2020] [Indexed: 01/03/2023]
Abstract
Objective To identify whether active use of nonsteroidal antiinflammatory drugs (NSAIDs) increases susceptibility to developing suspected or confirmed coronavirus disease 2019 (COVID‐19) compared to the use of other common analgesics. Methods We performed a propensity score–matched cohort study with active comparators, using a large UK primary care data set. The cohort consisted of adult patients age ≥18 years with osteoarthritis (OA) who were followed up from January 30 to July 31, 2020. Patients prescribed an NSAID (excluding topical preparations) were compared to those prescribed either co‐codamol (paracetamol and codeine) or co‐dydramol (paracetamol and dihydrocodeine). A total of 13,202 patients prescribed NSAIDs were identified, compared to 12,457 patients prescribed the comparator drugs. The primary outcome measure was the documentation of suspected or confirmed COVID‐19, and the secondary outcome measure was all‐cause mortality. Results During follow‐up, the incidence rates of suspected/confirmed COVID‐19 were 15.4 and 19.9 per 1,000 person‐years in the NSAID‐exposed group and comparator group, respectively. Adjusted hazard ratios for suspected or confirmed COVID‐19 among the unmatched and propensity score–matched OA cohorts, using data from clinical consultations in primary care settings, were 0.82 (95% confidence interval [95% CI] 0.62–1.10) and 0.79 (95% CI 0.57–1.11), respectively, and adjusted hazard ratios for the risk of all‐cause mortality were 0.97 (95% CI 0.75–1.27) and 0.85 (95% CI 0.61–1.20), respectively. There was no effect modification by age or sex. Conclusion No increase in the risk of suspected or confirmed COVID‐19 or mortality was observed among patients with OA in a primary care setting who were prescribed NSAIDs as compared to those who received comparator drugs. These results are reassuring and suggest that in the absence of acute illness, NSAIDs can be safely prescribed during the ongoing pandemic.
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Affiliation(s)
- Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK, and Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Rasiah Thayakaran
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | | | | | - Krishna M Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tom Thomas
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | | | | | - Jennifer Cooper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Astha Anand
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kelvin O Okoth
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jingya Wang
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Thomas Taverner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Institute of Inflammation and Ageing, University of Birmingham, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Janet Lord
- Institute of Inflammation and Ageing, University of Birmingham, MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christopher D Buckley
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK, and Institute of Inflammation and Ageing, MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Karim Raza
- Institute of Inflammation and Ageing, MRC Versus Arthritis Centre for Musculoskeletal Ageing Research, Sandwell and West Birmingham NHS Hospitals Trust, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, University of Birmingham, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Krishnarajah Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Health Data Research UK Midlands, Birmingham, UK
| | - Shamil Haroon
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Vos T, Lim SS, Abbafati C, Abbas KM, Abbasi M, Abbasifard M, Abbasi-Kangevari M, Abbastabar H, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abolhassani H, Aboyans V, Abrams EM, Abreu LG, Abrigo MRM, Abu-Raddad LJ, Abushouk AI, Acebedo A, Ackerman IN, Adabi M, Adamu AA, Adebayo OM, Adekanmbi V, Adelson JD, Adetokunboh OO, Adham D, Afshari M, Afshin A, Agardh EE, Agarwal G, Agesa KM, Aghaali M, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi A, Ahmadi M, Ahmadieh H, Ahmadpour E, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Al-Aly Z, Alam K, Alam N, Alam S, Alam T, Alanzi TM, Albertson SB, Alcalde-Rabanal JE, Alema NM, Ali M, Ali S, Alicandro G, Alijanzadeh M, Alinia C, Alipour V, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Alonso J, Al-Raddadi RM, Altirkawi KA, Alvis-Guzman N, Alvis-Zakzuk NJ, Amini S, Amini-Rarani M, Aminorroaya A, Amiri F, Amit AML, Amugsi DA, Amul GGH, Anderlini D, Andrei CL, Andrei T, Anjomshoa M, Ansari F, Ansari I, Ansari-Moghaddam A, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Arabloo J, Arab-Zozani M, Aravkin AY, Ariani F, Ärnlöv J, Aryal KK, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Asghari B, Ashbaugh C, Atnafu DD, Atre SR, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Aynalem YA, Azari S, Azarian G, Azene ZN, Babaee E, Badawi A, Bagherzadeh M, Bakhshaei MH, Bakhtiari A, Balakrishnan S, Balalla S, Balassyano S, Banach M, Banik PC, Bannick MS, Bante AB, Baraki AG, Barboza MA, Barker-Collo SL, Barthelemy CM, Barua L, Barzegar A, Basu S, Baune BT, Bayati M, Bazmandegan G, Bedi N, Beghi E, Béjot Y, Bello AK, Bender RG, Bennett DA, Bennitt FB, Bensenor IM, Benziger CP, Berhe K, Bernabe E, Bertolacci GJ, Bhageerathy R, Bhala N, Bhandari D, Bhardwaj P, Bhattacharyya K, Bhutta ZA, Bibi S, Biehl MH, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisanzio D, Bisignano C, Biswas RK, Bohlouli S, Bohluli M, Bolla SRR, Boloor A, Boon-Dooley AS, Borges G, Borzì AM, Bourne R, Brady OJ, Brauer M, Brayne C, Breitborde NJK, Brenner H, Briant PS, Briggs AM, Briko NI, Britton GB, Bryazka D, Buchbinder R, Bumgarner BR, Busse R, Butt ZA, Caetano dos Santos FL, Cámera LLAA, Campos-Nonato IR, Car J, Cárdenas R, Carreras G, Carrero JJ, Carvalho F, Castaldelli-Maia JM, Castañeda-Orjuela CA, Castelpietra G, Castle CD, Castro F, Catalá-López F, Causey K, Cederroth CR, Cercy KM, Cerin E, Chandan JS, Chang AR, Charlson FJ, Chattu VK, Chaturvedi S, Chimed-Ochir O, Chin KL, Cho DY, Christensen H, Chu DT, Chung MT, Cicuttini FM, Ciobanu LG, Cirillo M, Collins EL, Compton K, Conti S, Cortesi PA, Costa VM, Cousin E, Cowden RG, Cowie BC, Cromwell EA, Cross DH, Crowe CS, Cruz JA, Cunningham M, Dahlawi SMA, Damiani G, Dandona L, Dandona R, Darwesh AM, Daryani A, Das JK, Das Gupta R, das Neves J, Dávila-Cervantes CA, Davletov K, De Leo D, Dean FE, DeCleene NK, Deen A, Degenhardt L, Dellavalle RP, Demeke FM, Demsie DG, Denova-Gutiérrez E, Dereje ND, Dervenis N, Desai R, Desalew A, Dessie GA, Dharmaratne SD, Dhungana GP, Dianatinasab M, Diaz D, Dibaji Forooshani ZS, Dingels ZV, Dirac MA, Djalalinia S, Do HT, Dokova K, Dorostkar F, Doshi CP, Doshmangir L, Douiri A, Doxey MC, Driscoll TR, Dunachie SJ, Duncan BB, Duraes AR, Eagan AW, Ebrahimi Kalan M, Edvardsson D, Ehrlich JR, El Nahas N, El Sayed I, El Tantawi M, Elbarazi I, Elgendy IY, Elhabashy HR, El-Jaafary SI, Elyazar IRF, Emamian MH, Emmons-Bell S, Erskine HE, Eshrati B, Eskandarieh S, Esmaeilnejad S, Esmaeilzadeh F, Esteghamati A, Estep K, Etemadi A, Etisso AE, Farahmand M, Faraj A, Fareed M, Faridnia R, Farinha CSES, Farioli A, Faro A, Faruque M, Farzadfar F, Fattahi N, Fazlzadeh M, Feigin VL, Feldman R, Fereshtehnejad SM, Fernandes E, Ferrari AJ, Ferreira ML, Filip I, Fischer F, Fisher JL, Fitzgerald R, Flohr C, Flor LS, Foigt NA, Folayan MO, Force LM, Fornari C, Foroutan M, Fox JT, Freitas M, Fu W, Fukumoto T, Furtado JM, Gad MM, Gakidou E, Galles NC, Gallus S, Gamkrelidze A, Garcia-Basteiro AL, Gardner WM, Geberemariyam BS, Gebrehiwot AM, Gebremedhin KB, Gebreslassie AAAA, Gershberg Hayoon A, Gething PW, Ghadimi M, Ghadiri K, Ghafourifard M, Ghajar A, Ghamari F, Ghashghaee A, Ghiasvand H, Ghith N, Gholamian A, Gilani SA, Gill PS, Gitimoghaddam M, Giussani G, Goli S, Gomez RS, Gopalani SV, Gorini G, Gorman TM, Gottlich HC, Goudarzi H, Goulart AC, Goulart BNG, Grada A, Grivna M, Grosso G, Gubari MIM, Gugnani HC, Guimaraes ALS, Guimarães RA, Guled RA, Guo G, Guo Y, Gupta R, Haagsma JA, Haddock B, Hafezi-Nejad N, Hafiz A, Hagins H, Haile LM, Hall BJ, Halvaei I, Hamadeh RR, Hamagharib Abdullah K, Hamilton EB, Han C, Han H, Hankey GJ, Haro JM, Harvey JD, Hasaballah AI, Hasanzadeh A, Hashemian M, Hassanipour S, Hassankhani H, Havmoeller RJ, Hay RJ, Hay SI, Hayat K, Heidari B, Heidari G, Heidari-Soureshjani R, Hendrie D, Henrikson HJ, Henry NJ, Herteliu C, Heydarpour F, Hird TR, Hoek HW, Hole MK, Holla R, Hoogar P, Hosgood HD, Hosseinzadeh M, Hostiuc M, Hostiuc S, Househ M, Hoy DG, Hsairi M, Hsieh VCR, Hu G, Huda TM, Hugo FN, Huynh CK, Hwang BF, Iannucci VC, Ibitoye SE, Ikuta KS, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Ippolito H, Irvani SSN, Islam MM, Islam M, Islam SMS, Islami F, Iso H, Ivers RQ, Iwu CCD, Iyamu IO, Jaafari J, Jacobsen KH, Jadidi-Niaragh F, Jafari H, Jafarinia M, Jahagirdar D, Jahani MA, Jahanmehr N, Jakovljevic M, Jalali A, Jalilian F, James SL, Janjani H, Janodia MD, Jayatilleke AU, Jeemon P, Jenabi E, Jha RP, Jha V, Ji JS, Jia P, John O, John-Akinola YO, Johnson CO, Johnson SC, Jonas JB, Joo T, Joshi A, Jozwiak JJ, Jürisson M, Kabir A, Kabir Z, Kalani H, Kalani R, Kalankesh LR, Kalhor R, Kamiab Z, Kanchan T, Karami Matin B, Karch A, Karim MA, Karimi SE, Kassa GM, Kassebaum NJ, Katikireddi SV, Kawakami N, Kayode GA, Keddie SH, Keller C, Kereselidze M, Khafaie MA, Khalid N, Khan M, Khatab K, Khater MM, Khatib MN, Khayamzadeh M, Khodayari MT, Khundkar R, Kianipour N, Kieling C, Kim D, Kim YE, Kim YJ, Kimokoti RW, Kisa A, Kisa S, Kissimova-Skarbek K, Kivimäki M, Kneib CJ, 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Zandian H, Zangeneh A, Zastrozhin MS, Zewdie KA, Zhang Y, Zhang ZJ, Zhao JT, Zhao Y, Zheng P, Zhou M, Ziapour A, Zimsen SRM, Naghavi M, Murray CJL. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1204-1222. [PMID: 33069326 PMCID: PMC7567026 DOI: 10.1016/s0140-6736(20)30925-9] [Citation(s) in RCA: 6299] [Impact Index Per Article: 1574.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/27/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. METHODS GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. FINDINGS Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990-2010 time period, with the greatest annualised rate of decline occurring in the 0-9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10-24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10-24 years were also in the top ten in the 25-49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50-74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. INTERPRETATION As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and development investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. FUNDING Bill & Melinda Gates Foundation.
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Murray CJL, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, Abd-Allah F, Abdelalim A, Abdollahi M, Abdollahpour I, Abegaz KH, Abolhassani H, Aboyans V, Abreu LG, Abrigo MRM, Abualhasan A, Abu-Raddad LJ, Abushouk AI, Adabi M, Adekanmbi V, Adeoye AM, Adetokunboh OO, Adham D, Advani SM, Agarwal G, Aghamir SMK, Agrawal A, Ahmad T, Ahmadi K, Ahmadi M, Ahmadieh H, Ahmed MB, Akalu TY, Akinyemi RO, Akinyemiju T, Akombi B, Akunna CJ, Alahdab F, Al-Aly Z, Alam K, Alam S, Alam T, Alanezi FM, Alanzi TM, Alemu BW, Alhabib KF, Ali M, Ali S, Alicandro G, Alinia C, Alipour V, Alizade H, Aljunid SM, Alla F, Allebeck P, Almasi-Hashiani A, Al-Mekhlafi HM, Alonso J, Altirkawi KA, Amini-Rarani M, Amiri F, Amugsi DA, Ancuceanu R, Anderlini D, Anderson JA, Andrei CL, Andrei T, Angus C, Anjomshoa M, Ansari F, Ansari-Moghaddam A, Antonazzo IC, Antonio CAT, Antony CM, Antriyandarti E, Anvari D, Anwer R, Appiah SCY, Arabloo J, Arab-Zozani M, Ariani F, Armoon B, Ärnlöv J, Arzani A, Asadi-Aliabadi M, Asadi-Pooya AA, Ashbaugh C, Assmus M, Atafar Z, Atnafu DD, Atout MMW, Ausloos F, Ausloos M, Ayala Quintanilla BP, Ayano G, Ayanore MA, Azari S, Azarian G, Azene ZN, Badawi A, Badiye AD, Bahrami MA, Bakhshaei MH, Bakhtiari A, Bakkannavar SM, Baldasseroni A, Ball K, Ballew SH, Balzi D, Banach M, Banerjee SK, Bante AB, Baraki AG, Barker-Collo SL, Bärnighausen TW, Barrero LH, Barthelemy CM, Barua L, Basu S, Baune BT, Bayati M, Becker JS, Bedi N, Beghi E, Béjot Y, Bell ML, Bennitt FB, Bensenor IM, Berhe K, Berman AE, Bhagavathula AS, Bhageerathy R, Bhala N, Bhandari D, Bhattacharyya K, Bhutta ZA, Bijani A, Bikbov B, Bin Sayeed MS, Biondi A, Birihane BM, Bisignano C, Biswas RK, Bitew H, Bohlouli S, Bohluli M, Boon-Dooley AS, Borges G, Borzì AM, Borzouei S, Bosetti C, Boufous S, Braithwaite D, Breitborde NJK, Breitner S, Brenner H, Briant PS, Briko AN, Briko NI, Britton GB, Bryazka D, Bumgarner BR, Burkart K, Burnett RT, Burugina Nagaraja S, Butt ZA, Caetano dos Santos FL, Cahill LE, 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Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1223-1249. [PMID: 33069327 PMCID: PMC7566194 DOI: 10.1016/s0140-6736(20)30752-2] [Citation(s) in RCA: 3166] [Impact Index Per Article: 791.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Rigorous analysis of levels and trends in exposure to leading risk factors and quantification of their effect on human health are important to identify where public health is making progress and in which cases current efforts are inadequate. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 provides a standardised and comprehensive assessment of the magnitude of risk factor exposure, relative risk, and attributable burden of disease. METHODS GBD 2019 estimated attributable mortality, years of life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs) for 87 risk factors and combinations of risk factors, at the global level, regionally, and for 204 countries and territories. GBD uses a hierarchical list of risk factors so that specific risk factors (eg, sodium intake), and related aggregates (eg, diet quality), are both evaluated. This method has six analytical steps. (1) We included 560 risk-outcome pairs that met criteria for convincing or probable evidence on the basis of research studies. 12 risk-outcome pairs included in GBD 2017 no longer met inclusion criteria and 47 risk-outcome pairs for risks already included in GBD 2017 were added based on new evidence. (2) Relative risks were estimated as a function of exposure based on published systematic reviews, 81 systematic reviews done for GBD 2019, and meta-regression. (3) Levels of exposure in each age-sex-location-year included in the study were estimated based on all available data sources using spatiotemporal Gaussian process regression, DisMod-MR 2.1, a Bayesian meta-regression method, or alternative methods. (4) We determined, from published trials or cohort studies, the level of exposure associated with minimum risk, called the theoretical minimum risk exposure level. (5) Attributable deaths, YLLs, YLDs, and DALYs were computed by multiplying population attributable fractions (PAFs) by the relevant outcome quantity for each age-sex-location-year. (6) PAFs and attributable burden for combinations of risk factors were estimated taking into account mediation of different risk factors through other risk factors. Across all six analytical steps, 30 652 distinct data sources were used in the analysis. Uncertainty in each step of the analysis was propagated into the final estimates of attributable burden. Exposure levels for dichotomous, polytomous, and continuous risk factors were summarised with use of the summary exposure value to facilitate comparisons over time, across location, and across risks. Because the entire time series from 1990 to 2019 has been re-estimated with use of consistent data and methods, these results supersede previously published GBD estimates of attributable burden. FINDINGS The largest declines in risk exposure from 2010 to 2019 were among a set of risks that are strongly linked to social and economic development, including household air pollution; unsafe water, sanitation, and handwashing; and child growth failure. Global declines also occurred for tobacco smoking and lead exposure. The largest increases in risk exposure were for ambient particulate matter pollution, drug use, high fasting plasma glucose, and high body-mass index. In 2019, the leading Level 2 risk factor globally for attributable deaths was high systolic blood pressure, which accounted for 10·8 million (95% uncertainty interval [UI] 9·51-12·1) deaths (19·2% [16·9-21·3] of all deaths in 2019), followed by tobacco (smoked, second-hand, and chewing), which accounted for 8·71 million (8·12-9·31) deaths (15·4% [14·6-16·2] of all deaths in 2019). The leading Level 2 risk factor for attributable DALYs globally in 2019 was child and maternal malnutrition, which largely affects health in the youngest age groups and accounted for 295 million (253-350) DALYs (11·6% [10·3-13·1] of all global DALYs that year). The risk factor burden varied considerably in 2019 between age groups and locations. Among children aged 0-9 years, the three leading detailed risk factors for attributable DALYs were all related to malnutrition. Iron deficiency was the leading risk factor for those aged 10-24 years, alcohol use for those aged 25-49 years, and high systolic blood pressure for those aged 50-74 years and 75 years and older. INTERPRETATION Overall, the record for reducing exposure to harmful risks over the past three decades is poor. Success with reducing smoking and lead exposure through regulatory policy might point the way for a stronger role for public policy on other risks in addition to continued efforts to provide information on risk factor harm to the general public. FUNDING Bill & Melinda Gates Foundation.
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Mohammed H, Mohammed S, Mohebi F, Mohseni Bandpei MA, Mokari A, Mokdad AH, Momen NC, Monasta L, Mooney MD, Moradi G, Moradi M, Moradi-Joo M, Moradi-Lakeh M, Moradzadeh R, Moraga P, Moreno Velásquez I, Morgado-da-Costa J, Morrison SD, Mosser JF, Mouodi S, Mousavi SM, Mousavi Khaneghah A, Mueller UO, Musa KI, Muthupandian S, Nabavizadeh B, Naderi M, Nagarajan AJ, Naghavi M, Naghshtabrizi B, Naik G, Najafi F, Nangia V, Nansseu JR, Ndwandwe DE, Negoi I, Negoi RI, Ngunjiri JW, Nguyen HLT, Nguyen TH, Nigatu YT, Nikbakhsh R, Nikpoor AR, Nixon MR, Nnaji CA, Nomura S, Noubiap JJ, Nouraei Motlagh S, Nowak C, Oţoiu A, Odell CM, Oh IH, Oladnabi M, Olagunju AT, Olusanya BO, Olusanya JO, Omar Bali A, Ong KL, Onwujekwe OE, Ortiz A, Otstavnov N, Otstavnov SS, Øverland S, Owolabi MO, P A M, Padubidri JR, Pakshir K, Palladino R, Pana A, Panda-Jonas S, Park J, Pasupula DK, Patel JR, Patel SK, Patton GC, Paulson KR, Pazoki Toroudi H, Pease SA, Peden AE, Pepito VCF, Peprah EK, Pereira A, Pereira DM, Perico N, Pigott DM, Pilgrim T, Pilz TM, Piradov MA, Pirsaheb M, Pokhrel KN, Postma MJ, Pourjafar H, Pourmalek F, Pourshams A, Poznańska A, Prada SI, Prakash S, Preotescu L, Quazi Syed Z, Rabiee M, Rabiee N, Radfar A, Rafiei A, Raggi A, Rahman MA, Rajabpour-Sanati A, Ram P, Ranabhat CL, Rao SJ, Rasella D, Rashedi V, Rastogi P, Rathi P, Rawal L, Remuzzi G, Renjith V, Renzaho AMN, Resnikoff S, Rezaei N, Rezai MS, Rezapour A, Rickard J, Roever L, Ronfani L, Roshandel G, Rostamian M, Rubagotti E, Rwegerera GM, Sabour S, Saddik B, Sadeghi E, Sadeghi M, Saeedi Moghaddam S, Safari Y, Safi S, Safiri S, Sagar R, Sahebkar A, Sahraian MA, Sajadi SM, Salahshoor MR, Salama JS, Salamati P, Salem MRR, Salimi Y, Salomon JA, Salz I, Samad Z, Samy AM, Sanabria J, Santric-Milicevic MM, Saraswathy SYI, Sartorius B, Sarveazad A, Sathian B, Sathish T, Sattin D, Saylan M, Schaeffer LE, Schiavolin S, Schwebel DC, Schwendicke F, Sekerija M, Senbeta AM, Senthilkumaran S, Sepanlou SG, Serván-Mori E, Shabani M, Shahabi S, Shahbaz M, Shaheen AA, Shaikh MA, Shalash AS, Shams-Beyranvand M, Shamsi M, Shamsizadeh M, Shannawaz M, Sharafi K, Sharafi Z, Sharara F, Sharma R, Shaw DH, Sheikh A, Shin JI, Shiri R, Shrime MG, Shuval K, Siabani S, Sigfusdottir ID, Sigurvinsdottir R, Silva DAS, Simonetti B, Simpson KE, Singh JA, Skiadaresi E, Skryabin VY, Soheili A, Sokhan A, Sorensen RJD, Soriano JB, Sorrie MB, Soyiri IN, Spurlock EE, Sreeramareddy CT, Stockfelt L, Stokes MA, Stubbs JL, Sudaryanto A, Sufiyan MB, Suliankatchi Abdulkader R, Sykes BL, Tabarés-Seisdedos R, Tabb KM, Tadakamadla SK, Taherkhani A, Tang M, Taveira N, Taylor HJ, Teagle WL, Tehrani-Banihashemi A, Teklehaimanot BF, Tessema ZT, Thankappan KR, Thomas N, Thrift AG, Titova MV, Tohidinik HR, Tonelli M, Topor-Madry R, Topouzis F, Tovani-Palone MRR, Traini E, Tran BX, Travillian R, Trias-Llimós S, Truelsen TC, Tudor Car L, Unnikrishnan B, Upadhyay E, Vacante M, Vakilian A, Valdez PR, Valli A, Vardavas C, Vasankari TJ, Vasconcelos AMN, Vasseghian Y, Veisani Y, Venketasubramanian N, Vidale S, Violante FS, Vlassov V, Vollset SE, Vos T, Vujcic IS, Vukovic A, Vukovic R, Waheed Y, Wallin MT, Walters MK, Wang H, Wang YP, Watson S, Wei J, Weiss J, Weldesamuel GT, Werdecker A, Westerman R, Whiteford HA, Wiangkham T, Wiens KE, Wijeratne T, Wiysonge CS, Wojtyniak B, Wolfe CDA, Wondmieneh AB, Wool EE, Wu AM, Wu J, Xu G, Yamada T, Yamagishi K, Yano Y, Yaya S, Yazdi-Feyzabadi V, Yearwood JA, Yeheyis TY, Yilgwan CS, Yip P, Yonemoto N, Yoon SJ, Yoosefi Lebni J, York HW, Younis MZ, Younker TP, Yousefi Z, Yousefinezhadi T, Yousuf AY, Yusefzadeh H, Zahirian Moghadam T, Zakzuk J, Zaman SB, Zamani M, Zamanian M, Zandian H, Zhang ZJ, Zheng P, Zhou M, Ziapour A, Murray CJL. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396:1160-1203. [PMID: 33069325 PMCID: PMC7566045 DOI: 10.1016/s0140-6736(20)30977-6] [Citation(s) in RCA: 701] [Impact Index Per Article: 175.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 03/10/2020] [Accepted: 04/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. METHODS 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10-14 and 50-54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. FINDINGS The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66-2·79) in 2000 to 2·31 (2·17-2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5-137·8) in 2000 to a peak of 139·6 million (133·0-146·9) in 2016. Global livebirths then declined to 135·3 million (127·2-144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4-27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8-67·6) in 2000 to 73·5 years (72·8-74·3) in 2019. The total number of deaths increased from 50·7 million (49·5-51·9) in 2000 to 56·5 million (53·7-59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1-10·3) in 2000 to 5·0 million (4·3-6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0-6·3) in 2000 to 7·7 billion (7·5-8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1-60·8) in 2000 to 63·5 years (60·8-66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. INTERPRETATION Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Benjamin Disney
- University Hospital of Coventry and Warwickshire, Coventry, United Kingdom
| | - Ajay Verma
- Kettering General Hospital, Kettering, United Kingdom
| | - Neeraj Bhala
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Vusirikala A, Thomas T, Bhala N, Tahrani AA, Thomas GN, Nirantharakumar K. Impact of obesity and metabolic health status in the development of non-alcoholic fatty liver disease (NAFLD): A United Kingdom population-based cohort study using the health improvement network (THIN). BMC Endocr Disord 2020; 20:96. [PMID: 32605642 PMCID: PMC7325099 DOI: 10.1186/s12902-020-00582-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND With the obesity epidemic reaching crisis levels, there has been attention around those who may be resilient to the effects of obesity, termed metabolically healthy obesity (MHO), who initially present without associated metabolic abnormalities. Few longitudinal studies have explored the relationship between MHO and non-alcoholic fatty liver disease (NAFLD), which we address using over 4 million primary care patient records. METHODS A retrospective population-based longitudinal cohort was conducted using The Health Improvement Network (THIN) database incorporating adults with no history of NAFLD or alcohol excess at baseline. Individuals were classified according to BMI category and metabolic abnormalities (diabetes, hypertension and dyslipidaemia). Diagnosis of NAFLD during follow-up was the primary outcome measure. NAFLD was identified by Read codes. RESULTS During a median follow-up period of 4.7 years, 12,867 (0.3%) incident cases of NAFLD were recorded in the cohort of 4,121,049 individuals. Compared to individuals with normal weight and no metabolic abnormalities, equivalent individuals who were overweight, or obese were at significantly greater risk of incident NAFLD (Adjusted HR 3.32 (95%CI 2.98-3.49), and 6.92 (6.40-7.48, respectively). Metabolic risk factors further increased risk, including in those with normal weight and 1 (2.27, 1.97-2.61) or = < 2 (2.39, 1.99-2.87) metabolic abnormalities. CONCLUSIONS MHO individuals are at greater risk of developing NAFLD compared to those with normal weight. This finding supports that the MHO phenotype is a temporary state, and weight must be considered a risk factor even before other risk factors develop. Being normal weight with metabolic abnormalities was also associated with risk of NAFLD.
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Affiliation(s)
- A Vusirikala
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - T Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Translational Gastroenterology Unit, University of Oxford, Oxford, UK
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - N Bhala
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - A A Tahrani
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Department of Diabetes and Endocrinology, University Hospitals Birmingham, Birmingham, UK
- Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK
| | - G N Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - K Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
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Kennedy NA, Hansen R, Younge L, Mawdsley J, Beattie RM, Din S, Lamb CA, Smith PJ, Selinger C, Limdi J, Iqbal TH, Lobo A, Cooney R, Brain O, Gaya DR, Murray C, Pollok R, Kent A, Raine T, Bhala N, Lindsay JO, Irving PM, Lees CW, Sebastian S. Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID-19 pandemic. Frontline Gastroenterol 2020; 11:343-350. [PMID: 32874484 PMCID: PMC7335699 DOI: 10.1136/flgastro-2020-101520] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/29/2020] [Accepted: 05/30/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To determine the challenges in diagnosis, monitoring, support provision in the management of inflammatory bowel disease (IBD) patients and explore the adaptations of IBD services. METHODS Internet-based survey by invitation of IBD services across the UK from 8 to 14 April 2020. RESULTS Respondents from 125 IBD services completed the survey. The number of whole-time equivalent gastroenterologists and IBD nurses providing elective outpatient care decreased significantly between baseline (median 4, IQR 4-7.5 and median 3, IQR 2-4) to the point of survey (median 2, IQR 1-4.8 and median 2, IQR 1-3) in the 6-week period following the onset of the COVID-19 pandemic (p<0.001 for both comparisons). Almost all (94%; 112/119) services reported an increase in IBD helpline activity. Face-to-face clinics were substituted for telephone consultation by 86% and video consultation by 11% of services. A variation in the provision of laboratory faecal calprotectin testing was noted with 27% of services reporting no access to faecal calprotectin, and a further 32% reduced access. There was also significant curtailment of IBD-specific endoscopy and elective surgery. CONCLUSIONS IBD services in the UK have implemented several adaptive strategies in order to continue to provide safe and high-quality care for patients. National Health Service organisations will need to consider the impact of these changes in current service delivery models and staffing levels when planning exit strategies for post-pandemic IBD care. Careful planning to manage the increased workload and to maintain IBD services is essential to ensure patient safety.
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Affiliation(s)
- Nicholas A Kennedy
- Gastroenterology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Richard Hansen
- Paediatric Gastroenterology, Royal Hospital for Children, Glasgow, UK
| | - Lisa Younge
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | - Joel Mawdsley
- Department of Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - R Mark Beattie
- Department of Gastroenterology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shahida Din
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
| | - Christopher A Lamb
- Department of Gastroenterology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Philip J Smith
- Department of Gastroenterology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | | | - Jimmy Limdi
- Section of IBD, Division of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Tariq H Iqbal
- Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Alan Lobo
- Academic Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel Cooney
- Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Oliver Brain
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Daniel R Gaya
- Gastroenterology, Glasgow Royal Infirmary, Glasgow, UK
| | - Charles Murray
- Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | - Richard Pollok
- Gastroenterology, St George's University Hospitals NHS Foundation Trust, London, UK
- Department of Gastroenterology, St George's University of London, London, UK
| | - Alexandra Kent
- Gastroenterology, King's College Hospital NHS Foundation Trust, London, UK
| | - Tim Raine
- Gastroenterology, Addenbrooke's Hospital, Cambridge, UK
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - James O Lindsay
- Department of Gastroenterology, Barts Health NHS Trust, London, UK
| | - Peter M Irving
- Department of Gastroenterology, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Charlie W Lees
- Department of Gastroenterology, Western General Hospital, Edinburgh, UK
| | - Shaji Sebastian
- IBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK
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Arasaradnam RP, Bhala N, Evans C, Greenaway J, Logan R, Penman I, Seward E, Singh B, Smith S, Stephenson JA, Waugh N. Faecal immunochemical testing in the COVID-19 era: balancing risk and costs. Lancet Gastroenterol Hepatol 2020; 5:717-719. [PMID: 32526209 PMCID: PMC7279754 DOI: 10.1016/s2468-1253(20)30185-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Ramesh P Arasaradnam
- Department of Gastroenterology, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK; Warwick Medical School, University of Warwick, Warwick, UK.
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospital Birmingham Foundation Trust, Birmingham, UK
| | - Charles Evans
- Department of Colorectal Surgery, University Hospital Coventry and Warwickshire, Coventry CV2 2DX, UK
| | - John Greenaway
- Department of Gastroenterology, South Tees NHS Trust, Teesside, UK
| | - Robert Logan
- Department of Gastroenterology, Kings College Hospital, London, UK
| | - Ian Penman
- Department of Gastroenterology, Royal Edinburgh Hospital, Edinburgh, UK
| | - Edward Seward
- Department of Gastroenterology, University College London, London, UK
| | - Baljit Singh
- Department of Colorectal Surgery, University Hospital Leicester NHS Trust, Leicester, UK
| | - Steve Smith
- Midlands and North West NHS England Bowel Cancer Screening Programme Hub, Rugby, UK
| | - James A Stephenson
- Department of Radiology, University Hospital Leicester NHS Trust, Leicester, UK
| | - Norman Waugh
- Warwick Medical School, University of Warwick, Warwick, UK
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32
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Affiliation(s)
- Neeraj Bhala
- Queen Elizabeth Hospital Birmingham and Institute of Applied Health Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, UK.
| | - Gwenetta Curry
- Usher Institute, The University of Edinburgh, Edinburgh, UK; Department of Gender and Race Studies, College of Arts and Sciences, University of Alabama, Tuscaloosa, AL, USA
| | - Adrian R Martineau
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Charles Agyemang
- Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Raj Bhopal
- Usher Institute, The University of Edinburgh, Edinburgh, UK
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Affiliation(s)
- Jonathan P Segal
- Department of Gastroenterology, St Mary's Hospital, London W2 1NY, UK.
| | - Mohammed Nabil Quraishi
- University of Birmingham Microbiome Treatment Centre and Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Neeraj Bhala
- University of Birmingham Microbiome Treatment Centre and Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Matthew James Brookes
- Department of Gastroenterology, Royal Wolverhampton NHS trust, Wolverhampton, UK; University of Wolverhampton, Wolverhampton, UK
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Thomas T, Chandan JS, Verma AM, Cockwell P, Vaux E, Bhala N. COVID-19 guidance in chronic diseases: a need to reach across the borders of the traditional medical specialities. Frontline Gastroenterol 2020; 11:332-333. [PMID: 32577196 PMCID: PMC7246097 DOI: 10.1136/flgastro-2020-101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/30/2020] [Indexed: 02/04/2023] Open
Affiliation(s)
- Tom Thomas
- Translational Gastroenterology Unit, John Radcliffe Hospital and Kennedy Institute, University of Oxford, Oxford, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ajay Mark Verma
- Department of Digestive Diseases, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Paul Cockwell
- Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Emma Vaux
- Royal College of Physicians, London, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK,Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Taylor RS, Taylor RJ, Bayliss S, Hagström H, Nasr P, Schattenberg JM, Ishigami M, Toyoda H, Wai-Sun Wong V, Peleg N, Shlomai A, Sebastiani G, Seko Y, Bhala N, Younossi ZM, Anstee QM, McPherson S, Newsome PN. Association Between Fibrosis Stage and Outcomes of Patients With Nonalcoholic Fatty Liver Disease: A Systematic Review and Meta-Analysis. Gastroenterology 2020; 158:1611-1625.e12. [PMID: 32027911 DOI: 10.1053/j.gastro.2020.01.043] [Citation(s) in RCA: 537] [Impact Index Per Article: 134.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/19/2020] [Accepted: 01/22/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS Biopsy-confirmed liver fibrosis is a prognostic factor for patients with nonalcoholic fatty liver disease (NAFLD). We performed a systematic review to quantify the prognostic value of fibrosis stage in patients with NAFLD and the subgroup of patients with nonalcoholic steatohepatitis (NASH) and to assess the evidence that change in fibrosis stage is a surrogate endpoint. METHODS We searched the MEDLINE, Embase, Cochrane Library, and trial registry databases through August 2018 for prospective or retrospective cohort studies of liver-related clinical events and outcomes in adults with NAFLD or NASH. We collected data on mortality (all cause and liver related) and morbidity (cirrhosis, liver cancer, and all liver-related events) by stage of fibrosis, determined by biopsy, for patients with NAFLD or NASH. Using fibrosis stage 0 as a reference population, we calculated fibrosis stage-specific relative risk (RR) and 95% confidence interval (CI) values for mortality and morbidities. We performed fixed-effect and random-effect model meta-analyses. Metaregression was used to examine associations among study design (prospective vs retrospective cohort), overall risk of bias (medium or high), and mean duration of follow-up (in years). RESULTS Our meta-analysis included 13 studies, comprising 4428 patients with NAFLD; 2875 of these were reported to have NASH. Compared with no fibrosis (stage 0), unadjusted risk increased with increasing stage of fibrosis (stage 0 vs 4): all-cause mortality RR, 3.42 (95% CI, 2.63-4.46); liver-related mortality RR, 11.13 (95% CI, 4.15-29.84); liver transplant RR, 5.42 (95% CI, 1.05-27.89); and liver-related events RR, 12.78 (95% CI, 6.85-23.85). The magnitude of RR did not differ significantly after adjustment for confounders, including age or sex in the subgroup of NAFLD patients with NASH. Three studies examined the effects of increasing fibrosis on quality of life had inconsistent findings. CONCLUSIONS In a systematic review and meta-analysis, we found biopsy-confirmed fibrosis to be associated with risk of mortality and liver-related morbidity in patients with NAFLD, with and without adjustment for confounding factors and in patients with reported NASH. Further studies are needed to assess the association between fibrosis stage and patient quality of life and establish that change in liver fibrosis stage is a valid endpoint for use in clinical trials.
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Affiliation(s)
- Rod S Taylor
- Institute of Health and Well Being, University of Glasgow, United Kingdom.
| | | | - Sue Bayliss
- Institute of Applied Health Research, University of Birmingham, United Kingdom
| | - Hannes Hagström
- Unit of Hepatology, Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Patrik Nasr
- Department of Gastroenterology and Hepatology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jorn M Schattenberg
- University Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidenori Toyoda
- Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Vincent Wai-Sun Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Noam Peleg
- Department of Gastroenterology and Hepatology, Rabin Medical Center, Beilinson Hospital, Petach-Tikva Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Medicine D, Rabin Medical Center, Beilinson hospital, Petach-Tikva
| | - Amir Shlomai
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Giada Sebastiani
- Department of Medicine, McGill University Health Centre, Montréal, Quebec, Canada
| | - Yuya Seko
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Neeraj Bhala
- Institute of Applied Health Research, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, United Kingdom
| | - Zobair M Younossi
- Department of Medicine, Inova Fairfax Hospital, Falls Church, Virginia
| | - Quentin M Anstee
- Institute of Clinical and Translational Research, Faculty of Medical Sciences, Newcastle University, Newcastle-upon-Tyne, United Kingdom; Newcastle National Institute of Health Research Biomedical Research Centre and Liver Transplant Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, United Kingdom
| | - Stuart McPherson
- Liver Transplant Unit, The Newcastle upon Tyne Hospitals NHS Foundation Trust; Institute of Clinical and Translational Research, Newcastle University, Newcastle-upon-Tyne, United Kingdom; Newcastle National Institute of Health Research Biomedical Research Centre, Newcastle-upon-Tyne, United Kingdom
| | - Philip N Newsome
- National Institute for Health Research Biomedical Research Centre at University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, United Kingdom; Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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King D, Reulen RC, Thomas T, Chandan JS, Thayakaran R, Subramanian A, Gokhale K, Bhala N, Nirantharakumar K, Adderley NJ, Trudgill N. Changing patterns in the epidemiology and outcomes of inflammatory bowel disease in the United Kingdom: 2000-2018. Aliment Pharmacol Ther 2020; 51:922-934. [PMID: 32237083 DOI: 10.1111/apt.15701] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 12/01/2019] [Accepted: 03/09/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data regarding incidence, prevalence and long-term outcomes of inflammatory bowel diseases in the UK are limited or outdated. AIMS To investigate incidence and prevalence of Crohn's disease and ulcerative colitis and risk of colorectal cancer and all-cause mortality in these diseases. METHODS Inflammatory bowel disease cases between 2000 and 2018 were identified from a national primary care database. Inflammatory bowel disease prevalence was forecast until 2025. The association between inflammatory bowel disease and colorectal cancer and all-cause mortality was investigated using age/sex-matched retrospective cohort studies. Hazard ratios were adjusted for age, sex, deprivation, comorbidity, smoking status and body mass index. RESULTS Ulcerative colitis prevalence increased from 390 to 570 per 100 000 population from 2000 to 2017. Prevalence of Crohn's disease increased from 220 to 400 per 100 000. In 2017 male Crohn's disease prevalence was 0.35% (95% confidence interval 0.34-0.36); female prevalence was 0.44% (0.43-0.45). Prevalence of inflammatory bowel disease is predicted to be 1.1% by 2025. Incidence of ulcerative colitis and Crohn's disease was 23.2 (22.8-23.6) and 14.3 (14.0-14.7) per 100 000 person-years respectively. Subjects with ulcerative colitis were more likely to develop colorectal cancer than controls (adjusted Hazard Ratio 1.40 [1.23-1.59]). Colorectal cancer rates remained stable in inflammatory bowel diseases over time. Ulcerative colitis and Crohn's disease were associated with increased risk of all-cause mortality (1.17 [1.14-1.21] and 1.42 [1.36-1.48] respectively). CONCLUSIONS The UK prevalence of inflammatory bowel disease is greater than previous reports suggest and we predict an 11% increase in prevalence by the year 2025. Mortality risk in inflammatory bowel disease and colorectal cancer risk in ulcerative colitis are increased compared to matched controls.
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Affiliation(s)
- Dominic King
- Sandwell & West Birmingham Hospitals NHS Trust, West Bromwich, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Raoul C Reulen
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tom Thomas
- Translational Gastroenterology Unit, Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Rasiah Thayakaran
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Krishna Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nigel Trudgill
- Sandwell & West Birmingham Hospitals NHS Trust, West Bromwich, UK
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Chakravorty I, Daga S, Dave S, Chakravorty S, Bhala N, Menon G, Mehta R, Bamrah JS. An Online Survey of Healthcare Professionals in the COVID-19 Pandemic in the UK:. ACTA ACUST UNITED AC 2020. [DOI: 10.38192/13.2.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
To explore the emerging concerns of COVID-19 related issues amongst health care workers, members of a range of healthcare organisations, governmental agencies, and the media, and online self-administered survey of healthcare workers was undertaken by the British Association of Physicians of Indian Origin in April 2020.
Results
The respondents were predominantly hospital doctors (67%), aged between 40-60 years (72%) and from Black, Asian, and Minority Ethnicity (BAME) backgrounds in the UK (86%). Thirty percent of respondents had one or more vulnerable comorbidities. Over 78% reported either lack of, or inappropriate Personal Protective Equipment (PPE) for their role and 68% of respondents felt that they were unable to comply with or that it was impractical to adhere to social distancing at work (including commuting). At the time of the survey, 18.5% of respondents reported having a confirmed or suspected diagnosis of COVID-19. In multivariate analysis, the BAME community emerged as an independent risk factor (OR 1.45) for COVID-19 when adjusted for confounding factors.
Conclusions
These results add to the emerging concerns expressed internationally on the observation that BAME ethnicity appears to have a higher risk of developing COVID-19. This is the first study that adjusted work-related factors (inability to maintain social distancing and inadequate PPE) and comorbidities. Our work supports the imperative for designing and conducting urgent larger studies to understand this risk and plan appropriate mitigation of the risks to health care workers
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Affiliation(s)
| | - Sunil Daga
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | | | | | - Ramesh Mehta
- British Association of Physicians of Indian Origin, UK
| | - JS Bamrah
- Central Manchester Mental Health Partnership Trust, UK
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Verma AM, Bhala N, Chilton A, Disney BR. Concerns regarding the recommendations of the British Society of Gastroenterology's lower GI bleeding guidelines. Gut 2020; 69:792. [PMID: 30996044 DOI: 10.1136/gutjnl-2019-318582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 04/01/2019] [Accepted: 04/06/2019] [Indexed: 12/08/2022]
Affiliation(s)
- Ajay M Verma
- Department of Digestive Diseases, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Neeraj Bhala
- Gastroenterology and Liver Units, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Andrew Chilton
- Department of Digestive Diseases, Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | - Benjamin R Disney
- Gastroenterology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Sepanlou SG, Safiri S, Bisignano C, Ikuta KS, Merat S, Saberifiroozi M, Poustchi H, Tsoi D, Colombara DV, Abdoli A, Adedoyin RA, Afarideh M, Agrawal S, Ahmad S, Ahmadian E, Ahmadpour E, Akinyemiju T, Akunna CJ, Alipour V, Almasi-Hashiani A, Almulhim AM, Al-Raddadi RM, Alvis-Guzman N, Anber NH, Angus C, Anoushiravani A, Arabloo J, Araya EM, Asmelash D, Ataeinia B, Ataro Z, Atout MMW, Ausloos F, Awasthi A, Badawi A, Banach M, Bejarano Ramirez DF, Bhagavathula AS, Bhala N, Bhattacharyya K, Biondi A, Bolla SR, Boloor A, Borzì AM, Butt ZA, Cámera LLAA, Campos-Nonato IR, Carvalho F, Chu DT, Chung SC, Cortesi PA, Costa VM, Cowie BC, Daryani A, de Courten B, Demoz GT, Desai R, Dharmaratne SD, Djalalinia S, Do HT, Dorostkar F, Drake TM, Dubey M, Duncan BB, Effiong A, Eftekhari A, Elsharkawy A, Etemadi A, Farahmand M, Farzadfar F, Fernandes E, Filip I, Fischer F, Gebremedhin KBB, Geta B, Gilani SA, Gill PS, Gutirrez RA, Haile MT, Haj-Mirzaian A, Hamid SS, Hasankhani M, Hasanzadeh A, Hashemian M, Hassen HY, Hay SI, Hayat K, Heidari B, Henok A, Hoang CL, Hostiuc M, Hostiuc S, Hsieh VCR, Igumbor EU, Ilesanmi OS, Irvani SSN, Jafari Balalami N, James SL, Jeemon P, Jha RP, Jonas JB, Jozwiak JJ, Kabir A, Kasaeian A, Kassaye HG, Kefale AT, Khalilov R, Khan MA, Khan EA, Khater A, Kim YJ, Koyanagi A, La Vecchia C, Lim LL, Lopez AD, Lorkowski S, Lotufo PA, Lozano R, Magdy Abd El Razek M, Mai HT, Manafi N, Manafi A, Mansournia MA, Mantovani LG, Mazzaglia G, Mehta D, Mendoza W, Menezes RG, Mengesha MM, Meretoja TJ, Mestrovic T, Miazgowski B, Miller TR, Mirrakhimov EM, Mithra P, Moazen B, Moghadaszadeh M, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Montero-Zamora PA, Moradi G, Naimzada MD, Nayak V, Negoi I, Nguyen TH, Ofori-Asenso R, Oh IH, Olagunju TO, Padubidri JR, Pakshir K, Pana A, Pathak M, Pourshams A, Rabiee N, Radfar A, Rafiei A, Ramezanzadeh K, Rana SMM, Rawaf S, Rawaf DL, Reiner RC, Roever L, Room R, Roshandel G, Safari S, Samy AM, Sanabria J, Sartorius B, Schmidt MI, Senthilkumaran S, Shaikh MA, Sharif M, Sharifi A, Shigematsu M, Singh JA, Soheili A, Suleria HAR, Teklehaimanot BF, Tesfay BE, Vacante M, Vahedian-Azimi A, Valdez PR, Vasankari TJ, Vu GT, Waheed Y, Weldegwergs KG, Werdecker A, Westerman R, Wondafrash DZ, Wondmieneh AB, Yeshitila YG, Yonemoto N, Yu C, Zaidi Z, Zarghi A, Zelber-Sagi S, Zewdie KA, Zhang ZJ, Zhao XJ, Naghavi M, Malekzadeh R. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol 2020; 5:245-266. [PMID: 31981519 PMCID: PMC7026710 DOI: 10.1016/s2468-1253(19)30349-8] [Citation(s) in RCA: 705] [Impact Index Per Article: 176.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cirrhosis and other chronic liver diseases (collectively referred to as cirrhosis in this paper) are a major cause of morbidity and mortality globally, although the burden and underlying causes differ across locations and demographic groups. We report on results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 on the burden of cirrhosis and its trends since 1990, by cause, sex, and age, for 195 countries and territories. METHODS We used data from vital registrations, vital registration samples, and verbal autopsies to estimate mortality. We modelled prevalence of total, compensated, and decompensated cirrhosis on the basis of hospital and claims data. Disability-adjusted life-years (DALYs) were calculated as the sum of years of life lost due to premature death and years lived with disability. Estimates are presented as numbers and age-standardised or age-specific rates per 100 000 population, with 95% uncertainty intervals (UIs). All estimates are presented for five causes of cirrhosis: hepatitis B, hepatitis C, alcohol-related liver disease, non-alcoholic steatohepatitis (NASH), and other causes. We compared mortality, prevalence, and DALY estimates with those expected according to the Socio-demographic Index (SDI) as a proxy for the development status of regions and countries. FINDINGS In 2017, cirrhosis caused more than 1·32 million (95% UI 1·27-1·45) deaths (440 000 [416 000-518 000; 33·3%] in females and 883 000 [838 000-967 000; 66·7%] in males) globally, compared with less than 899 000 (829 000-948 000) deaths in 1990. Deaths due to cirrhosis constituted 2·4% (2·3-2·6) of total deaths globally in 2017 compared with 1·9% (1·8-2·0) in 1990. Despite an increase in the number of deaths, the age-standardised death rate decreased from 21·0 (19·2-22·3) per 100 000 population in 1990 to 16·5 (15·8-18·1) per 100 000 population in 2017. Sub-Saharan Africa had the highest age-standardised death rate among GBD super-regions for all years of the study period (32·2 [25·8-38·6] deaths per 100 000 population in 2017), and the high-income super-region had the lowest (10·1 [9·8-10·5] deaths per 100 000 population in 2017). The age-standardised death rate decreased or remained constant from 1990 to 2017 in all GBD regions except eastern Europe and central Asia, where the age-standardised death rate increased, primarily due to increases in alcohol-related liver disease prevalence. At the national level, the age-standardised death rate of cirrhosis was lowest in Singapore in 2017 (3·7 [3·3-4·0] per 100 000 in 2017) and highest in Egypt in all years since 1990 (103·3 [64·4-133·4] per 100 000 in 2017). There were 10·6 million (10·3-10·9) prevalent cases of decompensated cirrhosis and 112 million (107-119) prevalent cases of compensated cirrhosis globally in 2017. There was a significant increase in age-standardised prevalence rate of decompensated cirrhosis between 1990 and 2017. Cirrhosis caused by NASH had a steady age-standardised death rate throughout the study period, whereas the other four causes showed declines in age-standardised death rate. The age-standardised prevalence of compensated and decompensated cirrhosis due to NASH increased more than for any other cause of cirrhosis (by 33·2% for compensated cirrhosis and 54·8% for decompensated cirrhosis) over the study period. From 1990 to 2017, the number of prevalent cases more than doubled for compensated cirrhosis due to NASH and more than tripled for decompensated cirrhosis due to NASH. In 2017, age-standardised death and DALY rates were lower among countries and territories with higher SDI. INTERPRETATION Cirrhosis imposes a substantial health burden on many countries and this burden has increased at the global level since 1990, partly due to population growth and ageing. Although the age-standardised death and DALY rates of cirrhosis decreased from 1990 to 2017, numbers of deaths and DALYs and the proportion of all global deaths due to cirrhosis increased. Despite the availability of effective interventions for the prevention and treatment of hepatitis B and C, they were still the main causes of cirrhosis burden worldwide, particularly in low-income countries. The impact of hepatitis B and C is expected to be attenuated and overtaken by that of NASH in the near future. Cost-effective interventions are required to continue the prevention and treatment of viral hepatitis, and to achieve early diagnosis and prevention of cirrhosis due to alcohol-related liver disease and NASH. FUNDING Bill & Melinda Gates Foundation.
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Bhopal A, Wium C, Reisæter AV, Bhala N, Kumar B. Organ donation for migrants and ethnic minorities. Tidsskr Nor Laegeforen 2019; 139:19-0406. [PMID: 31556540 DOI: 10.4045/tidsskr.19.0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Thomas T, Chandan JS, Li VSW, Lai CY, Tang W, Bhala N, Kaplan GG, Ng SC, Ghosh S. Global smoking trends in inflammatory bowel disease: A systematic review of inception cohorts. PLoS One 2019; 14:e0221961. [PMID: 31545811 PMCID: PMC6756556 DOI: 10.1371/journal.pone.0221961] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/18/2019] [Indexed: 12/18/2022] Open
Abstract
Background and aims The effect of smoking on the risk of developing inflammatory bowel diseases (IBD) may be heterogeneous across ethnicity and geography. Although trends in smoking for the general population are well described, it is unknown whether these can be extrapolated to the IBD cohort. Smoking prevalence trends specific to the global IBD cohort over time have not been previously reported. This is a systematic review of smoking prevalence specific to the IBD cohort across geography. Methods A systematic literature search was conducted on Medline and Embase from January 1st 1946 to April 5th 2018 to identify population-based studies assessing the prevalence of smoking at diagnosis in inception cohorts of Crohn’s disease(CD) or ulcerative colitis(UC). Studies that did not report smoking data from time of diagnosis or the year of IBD diagnosis were excluded. Prevalence of smoking in IBD was stratified by geography and across time. Results We identified 56 studies that were eligible for inclusion. Smoking prevalence data at diagnosis of CD and UC was collected from twenty and twenty-five countries respectively. Never-smokers in the newly diagnosed CD population in the West has increased over the last two decades, especially in the United Kingdom and Sweden; +26.6% and +11.2% respectively. Never-smokers at CD diagnosis in newly industrialised nations have decreased over the 1990s and 2000s; China (-19.36%). Never-smokers at UC diagnosis also decreased in China; -15.4%. The former-smoker population at UC diagnosis in China is expanding; 11%(1990–2006) to 34%(2011–2013). Conclusion There has been a reduction in the prevalence of smoking in the IBD cohort in the West. This is not consistent globally. Although, smoking prevalence has decreased in the general population of newly industrialised nations, this remains an important risk factor with longer term outcomes awaiting translation in both UC and CD.
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Affiliation(s)
- Tom Thomas
- Translational Gastroenterology Unit, University of Oxford, Oxford, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Venice Sze Wai Li
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk Yin Lai
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Whitney Tang
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Neeraj Bhala
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Gilaad G. Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Siew C. Ng
- Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Hong Kong, China
| | - Subrata Ghosh
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- NIHR Biomedical Research Centre Birmingham, Institute of Translational Medicine, University of Birmingham, Birmingham, United Kingdom
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Mullish BH, Quraishi MN, Segal JP, McCune VL, Baxter M, Marsden GL, Moore D, Colville A, Bhala N, Iqbal TH, Settle C, Kontkowski G, Hart AL, Hawkey PM, Williams HR, Goldenberg SD. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology (BSG) and Healthcare Infection Society (HIS) guidelines. J Hosp Infect 2019; 100 Suppl 1:S1-S31. [PMID: 30173851 DOI: 10.1016/j.jhin.2018.07.037] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 07/23/2018] [Indexed: 02/08/2023]
Affiliation(s)
- Benjamin H Mullish
- Division of Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Departments of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington, London, UK
| | - Mohammed Nabil Quraishi
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan P Segal
- Division of Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Inflammatory Bowel Disease Unit, St Mark's Hospital, Harrow, London, UK
| | - Victoria L McCune
- Public Health England, Public Health Laboratory Birmingham, Birmingham, UK; Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Melissa Baxter
- Department of Microbiology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | | | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Alaric Colville
- Department of Microbiology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Neeraj Bhala
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Applied Health Research, University of Birmingham, Birmingham, UK; Institute of Translational Medicine, University of Birmingham, Edgbaston, Birmingham, UK
| | - Tariq H Iqbal
- Department of Gastroenterology, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Translational Medicine, University of Birmingham, Edgbaston, Birmingham, UK
| | - Christopher Settle
- Department of Microbiology, City Hospitals Sunderland NHS Foundation Trust, Sunderland, UK
| | | | - Ailsa L Hart
- Division of Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Inflammatory Bowel Disease Unit, St Mark's Hospital, Harrow, London, UK
| | - Peter M Hawkey
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - Horace Rt Williams
- Division of Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK; Departments of Gastroenterology and Hepatology, St Mary's Hospital, Imperial College Healthcare NHS Trust, Paddington, London, UK
| | - Simon D Goldenberg
- Centre for Clinical Infection and Diagnostics Research, King's College London, London, UK; Department of Microbiology, Guy's and St Thomas' NHS Foundation Trust, London UK.
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Siau K, Chapman W, Sharma N, Tripathi D, Iqbal T, Bhala N. Management of acute upper gastrointestinal bleeding: an update for the general physician. J R Coll Physicians Edinb 2019; 47:218-230. [PMID: 29465096 DOI: 10.4997/jrcpe.2017.303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute upper gastrointestinal bleed (AUGIB) is one of the most common medical emergencies in the UK, with roughly one presentation every 6 min. Despite advances in therapeutics and endoscopy provision, mortality following AUGIB over the last two decades has remained high, with over 9,000 deaths annually in the UK; consequently, several national bodies have published UK-relevant guidelines. Despite this, the 2015 UK National Confidential Enquiry into Patient Outcome and Death in AUGIB highlighted variations in practice, raised concerns regarding suboptimal patient care and released a series of recommendations. This review paper incorporates the latest available evidence and UK-relevant guidelines to summarise the optimal pre-endoscopic, endoscopic, and post-endoscopic approach to and management of non-variceal and variceal AUGIB that will be of practical value to both general physicians and gastroenterologists.
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Affiliation(s)
- K Siau
- N Bhala, Department of Gastroenterology, University Hospital, Birmingham, Mindelsohn Way, Birmingham B15 2TH, UK.
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Harvey PR, Thomas T, Chandan JS, Bhala N, Nirantharakumar K, Trudgill NJ. Outcomes following feeding gastrostomy (FG) insertion in patients with learning disability: a retrospective cohort study using the health improvement network (THIN) database. BMJ Open 2019; 9:e026714. [PMID: 31221879 PMCID: PMC6588980 DOI: 10.1136/bmjopen-2018-026714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To measure the rates of lower respiratory tract infection (LRTI) and mortality following feeding gastrostomy (FG) placement in patients with learning disability (LD). Following this to compare these rates between those having LRTI prior to FG placement and those with no recent LRTI. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS The study population included patients with LD undergoing FG placement in the 'The Health Improvement Network' database. Patients with LRTI in the year prior (LYP) to their FG placement were compared with patients without a history of LRTI in the year prior (non-LYP) to FG placement. FG placement and LD were identified using Read codes previously developed by an expert panel. MAIN OUTCOME MEASURES Incidence rate ratio (IRR) of developing LRTI and mortality following FG, comparing patients with LRTI in the year prior to FG placement to patients without a history of LRTI. RESULTS 214 patients with LD had a FG inserted including 743.4 person years follow-up. 53.7% were males and the median age was 27.6 (IQR 19.6 to 38.6) years. 27.1% were in the LYP patients. 18.7% had a LRTI in the year following FG, with an estimated incidence rate of 254 per 1000-person years. Over the study period the incidence rate of LRTI in LYP patients was 369 per 1000-person years, in non-LYP patients this was 91 per 1000-person years (adjusted IRR 4.21 (95% CI 2.68 to 6.63) p<0.001). 27.1% of patients died during study follow-up. Incidence rate of death was 80 and 45 per 1000-person year for LYP and non-LYP patients, respectively (adjusted IRR 1.80 (1.00 to 3.23) p=0.05). CONCLUSION In LD patients, no clinically meaningful reduction in LRTI incidence was observed following FG placement. Mortality and LRTI were higher in patients with at least one LRTI in the year preceding FG placement, compared with those without a preceding LRTI.
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Affiliation(s)
- Philip R Harvey
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
| | - Tom Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham, UK
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Kotecha D, Mak J, Sharma N, Boulton R, Disney B, Bhala N, Verma A. A multicentre review of acute upper gastrointestinal bleeding; a raised urea:creatinine ratio aids diagnosis. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-3s-s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kotecha D, Mak J, Sharma N, Boulton R, Disney B, Bhala N, Verma A. A multicentre review of acute upper gastrointestinal bleeding; a raised urea:creatinine ratio aids diagnosis. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-3-s3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Harvey PR, Thomas T, Chandan JS, Mytton J, Coupland B, Bhala N, Evison F, Patel P, Nirantharakumar K, Trudgill NJ. Incidence, morbidity and mortality of patients with achalasia in England: findings from a study of nationwide hospital and primary care data. Gut 2019; 68:790-795. [PMID: 29925629 DOI: 10.1136/gutjnl-2018-316089] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/04/2018] [Accepted: 05/12/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Achalasia is an uncommon condition characterised by failed lower oesophageal sphincter relaxation. Data regarding its incidence, prevalence, disease associations and long-term outcomes are very limited. METHODS Hospital Episode Statistics (HES) include demographic and diagnostic data for all English hospital attendances. The Health Improvement Network (THIN) includes the primary care records of 4.5 million UK subjects, representative of national demographics. Both were searched for incident cases between 2006 and 2016 and THIN for prevalent cases. Subjects with achalasia in THIN were compared with age, sex, deprivation tand smoking status matched controls for important comorbidities and mortality. RESULTS There were 10 509 and 711 new achalasia diagnoses identified in HES and THIN, respectively. The mean incidence per 100 000 people in HES was 1.99 (95% CI 1.87 to 2.11) and 1.53 (1.42 to 1.64) per 100 000 person-years in THIN. The prevalence in THIN was 27.1 (25.4 to 28.9) per 100 000 population. Incidence rate ratios (IRRs) were significantly higher in subjects with achalasia (n=2369) compared with controls (n=3865) for: oesophageal cancer (IRR 5.22 (95% CI: 1.88 to 14.45), p<0.001), aspiration pneumonia (13.38 (1.66 to 107.79), p=0.015), lower respiratory tract infection (1.33 (1.05 to 1.70), p=0.02) and mortality (1.33 (1.17 to 1.51), p<0.001). The median time from achalasia diagnosis to oesophageal cancer diagnosis was 15.5 (IQR 20.4) years. CONCLUSION The incidence of achalasia is 1.99 per 100 000 population in secondary care data and 1.53 per 100 000 person-years in primary care data. Subjects with achalasia have an increased incidence of oesophageal cancer, aspiration pneumonia, lower respiratory tract infections and higher mortality. Clinicians treating patients with achalasia should be made aware of these associated morbidities and its increased mortality.
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Affiliation(s)
- Philip R Harvey
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tom Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht S Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jemma Mytton
- Department of Health Informatics, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ben Coupland
- Department of Health Informatics, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Felicity Evison
- Department of Health Informatics, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Prashant Patel
- Department of Health Informatics, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Thomas T, Chandan JS, Harvey PR, Bhala N, Ghosh S, Nirantharakumar K, Trudgill NJ. The Risk of Inflammatory Bowel Disease in Subjects Presenting With Perianal Abscess: Findings From the THIN Database. J Crohns Colitis 2019; 13:600-606. [PMID: 30544202 DOI: 10.1093/ecco-jcc/jjy210] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Perianal abscess [PA] is associated with inflammatory bowel disease [IBD]. The incidence of IBD after a diagnosis of PA and potential predictors of a future diagnosis of IBD are unknown. METHODS The Health Improvement Network [THIN] is a primary care database representative of the UK population. Incident cases of PA were identified between 1995 and 2017. Subjects with PA were matched to controls within the same general practice. The primary outcome was a subsequent diagnosis of Crohn's Disease [CD] or ulcerative colitis [UC]. A Cox regression model was used to assess potential predictors of a new diagnosis of CD or UC following PA. RESULTS The risk of CD was higher in the PA cohort compared with controls; adjusted hazard ratio [HR] 7.51 (95% confidence interval [CI] 4.86-11.62), p < 0.0001. The risk of UC was also higher in the PA cohort compared with controls; adjusted HR 2.03 [1.38-2.99], p < 0.0001. Anaemia in men (HR 2.82 [1.34-5.92], p = 0.002), and use of antidiarrhoeal medications (HR 2.70 [1.71-4.25], p < 0.0001) were associated with an increased risk of CD following PA. Anaemia in men (HR 2.58 [1.09-6.07], p = 0.03), diarrhoea (HR 2.18 [1.23-3.85], p = 0.007), and use of anti-diarrhoeal medication (HR 2.27 [1.19-4.30], p = 0.012) were associated with an increased risk of UC following PA. CONCLUSION Subjects with PA are at an increased risk of subsequent diagnosis of CD and UC. Clinicians should strongly consider investigation for IBD in young patients presenting with diarrhoea and anaemia [in males] following PA. Future research should discern appropriate screening strategies for this high-risk cohort.
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Affiliation(s)
- Tom Thomas
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Joht S Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Philip R Harvey
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Neeraj Bhala
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Subrata Ghosh
- NIHR Birmingham Biomedical Research Centre , University Hospitals Birmingham NHS Foundation Trust and University of Birmingham
| | | | - Nigel J Trudgill
- Department of Gastroenterology, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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Shivaji UN, Sharratt CL, Thomas T, Smith SCL, Iacucci M, Moran GW, Ghosh S, Bhala N. Review article: managing the adverse events caused by anti-TNF therapy in inflammatory bowel disease. Aliment Pharmacol Ther 2019; 49:664-680. [PMID: 30735257 DOI: 10.1111/apt.15097] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/12/2018] [Accepted: 11/23/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Biological therapy is currently widely used to treat IBD. Infliximab, adalimumab and golimumab are currently licensed anti-TNF therapies. Biosimilar anti-TNF monoclonal antibodies are increasingly used. Anti-TNF therapies are widely used and their adverse effects are well characterised, and may cause significant morbidity and mortality in a small proportion of exposed patients. Gastroenterologists need to understand the mechanisms for these effects, recognise these swiftly and manage such events appropriately. AIM To cover the range of potential adverse reactions as a result of biologic therapy and specifically management of these events. METHODS A Medline and Pubmed search was undertaken. Search terms included were "anti-TNF," "infliximab" or "adalimumab" or "golimumab" combined with the keywords "ulcerative colitis" or "Crohn's disease" or "inflammatory bowel disease" and then narrowed to articles containing the keywords "complications," "side effects" or "adverse events" or "safety profile." International guidelines were also reviewed where relevant. RESULTS Adverse events discussed in this review include infusion reactions, blood disorders and infections (including bacterial, viral, fungal and opportunistic infections) as well as autoimmune, dermatological disorders, cardiac and neurological conditions. Malignancies including solid organ, haematological and those linked to viral disease are discussed. CONCLUSIONS Anti-TNF therapy has wide-ranging effects on the immune system resulting in a spectrum of potential adverse events in a small proportion of patients. Research advances are improving the understanding, recognition and management of these adverse events.
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Affiliation(s)
- Uday N Shivaji
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Caroline L Sharratt
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK.,Nottingham Digestive Diseases Centre, Nottingham University Hospitals, Nottingham, UK
| | - Tom Thomas
- Department of Gastroenterology, University Hospitals Birmingham, Birmingham, UK
| | | | - Marietta Iacucci
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Institute of Translational Medicine, Edgbaston, UK
| | - Gordon W Moran
- National Institute for Health Research (NIHR), Nottingham Biomedical Research Centre, Nottingham, UK.,Nottingham Digestive Diseases Centre, Nottingham University Hospitals, Nottingham, UK
| | - Subrata Ghosh
- National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK.,Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Institute of Translational Medicine, Edgbaston, UK
| | - Neeraj Bhala
- Department of Gastroenterology, University Hospitals Birmingham, Birmingham, UK.,University of Birmingham, Birmingham, UK
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Abstract
This article outlines latest evidence-based care for patients with acute upper gastrointestinal (GI) bleeding. It aims to help gastroenterology and general medical ward nurses plan nursing interventions and understand the diagnostic treatment options available. Acute upper GI bleeding can present as variceal or non-variceal bleeding and has a high death rate. Endoscopy is used for diagnosis and to provide therapy, prior to which the patient should be adequately resuscitated and assessed. Various therapies can be initiated at endoscopy, depending on the source of bleeding. If bleeding continues in spite of these therapies, further interventions such as the Sengstaken tube, oesophageal stents, radiological or surgical treatments may be required. After endoscopy, it is important to have a plan for ongoing treatment. Patients may require acid suppression treatment or eradication of Helicobacter pylori as part of their treatment plan. They may in additional require correction of their haemoglobin levels and follow-up endoscopy. It is essential that nurses caring for such patients are aware of the current UK guidance and help patients to adhere to agreed treatment plans.
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Affiliation(s)
- Warren Chapman
- Advanced Clinical Practitioner (Endoscopist), Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham
| | - Keith Siau
- Endoscopy Research Fellow, Dudley Group Hospitals NHS Foundation Trust, Dudley
| | - Fiona Thomas
- Endoscopy Senior Sister, Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham
| | - Selvajothi Ernest
- Advanced Clinical Practitioner (Endoscopist), Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham
| | - Shriya Begum
- Endoscopy Sister, Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham
| | - Tariq Iqbal
- Consultant Gastroenterologist, Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham
| | - Neeraj Bhala
- Consultant Gastroenterologist, Department of Gastroenterology, Queen Elizabeth Hospital, Birmingham
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