The burden of type 2 diabetes in Australia during the period 1990-2019: Findings from the global burden of disease study

AIMS

To describe morbidity and mortality trends of type 2 diabetes in Australia, from 1990 to 2019, compared with similar sociodemographic index (SDI) countries.

METHODS

Australia-specific Global Burden of Diseases data were used to estimate age-standardised, age-specific, and sex-specific rates for prevalence, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life years (DALYs), and deaths due to type 2 diabetes between 1990 and 2019. Australian data were compared with 14 similar SDI countries.

RESULTS

Type 2 diabetes increased in Australia between 1990 and 2019. The age-standardised prevalence increased from 1,985 [95% Confidence Interval (CI): 1,786.7-2195.3] per 100,000 population, to 3,429 [95% CI 3,053.3-3,853.7]. Cases tripled, from 379,532 [342,465-419,475] to 1,307,261 [1,165,522-1,461,180]. The age-standardised death rates doubled, from 2,098 [1,953-2,203] per 100,000, to 4,122 [3,617-4,512]. DALYs doubled, from 70,348 [59,187-83,500] to 169,763 [129,792-216,150], with increases seen in YLDs and YLLs. Men displayed higher rates. Compared to similar SDI countries, Australia ranked 4th in terms of burden for type 2 diabetes.

CONCLUSIONS

The burden of type 2 diabetes in Australia has increased considerably over three decades. There is an urgent need to prioritise resource allocation for prevention programs, screening initiatives to facilitate early detection, and effective and accessible management strategies for the large proportion of the population impacted by type 2 diabetes.

Systems Thinking and Complexity Science Methods and the Policy Process in Non-communicable Disease Prevention: A Systematic Scoping Review

BACKGROUND

Given the complex determinants of non-communicable diseases (NCDs), and the dynamic policy landscape, researchers and policymakers are exploring the use of systems thinking and complexity science (STCS) in developing effective policies. The aim of this review is to systematically identify and analyse existing applications of STCS-informed methods in NCD prevention policy.

METHODS

Systematic scoping review: We searched academic databases (Medline, Scopus, Web of Science, EMBASE) for all publications indexed by 13 October 2020, screening titles, abstracts and full texts and extracting data according to published guidelines. We summarised key data from each study, mapping applications of methods informed by STCS to policy process domains. We conducted a thematic analysis to identify advantages, limitations, barriers and facilitators to using STCS.

RESULTS

4681 papers were screened and 112 papers were included in this review. The most common policy areas were tobacco control, obesity prevention and physical activity promotion. Methods applied included system dynamics modelling, agent-based modelling and concept mapping. Advantages included supporting evidence-informed decision-making; modelling complex systems and addressing multi-sectoral problems. Limitations included the abstraction of reality by STCS methods, despite aims of encompassing greater complexity. Challenges included resource-intensiveness; lack of stakeholder trust in models; and results that were too complex to be comprehensible to stakeholders. Ensuring stakeholder ownership and presenting findings in a user-friendly way facilitated STCS use.

CONCLUSION

This review maps the proliferating applications of STCS methods in NCD prevention policy. STCS methods have the potential to generate tailored and dynamic evidence, adding robustness to evidence-informed policymaking, but must be accessible to policy stakeholders and have strong stakeholder ownership to build consensus and change stakeholder perspectives. Evaluations of whether, and under what circumstances, STCS methods lead to more effective policies compared to conventional methods are lacking, and would enable more targeted and constructive use of these methods.

Mental Health and Prevention of Substance Use Programs in Iran: Component of the National Action Plan for Prevention and Control of Non-communicable Diseases

Background: Mental disorders have a high prevalence and significant burden among all health conditions across the world and in Iran. Therefore, some targets in the field of mental health and substance and alcohol use prevention have been included in the National Action Plan for Prevention and Control of Non-communicable Diseases and Related Risk Factors. Methods: Keeping in mind the key priorities, important strategies have been considered for attaining the main targets in this field. These strategies fall under four categories of governance, prevention and reduction of risk factors, health care, and surveillance, and monitoring and evaluation strategies. Conclusion: The success of mental health and substance and alcohol use prevention programs in Iran can be partly related to the evidence-based approach adopted and also to the commitment of high-rank officials of the Ministry of Health and Medical Education to the principal strategy of increasing access to the general population to basic mental health services, among all other non-communicable diseases.

Epidemiological Transition in the Economic Community of West African States (ECOWAS): Evidence from the Global Burden of Disease 1990-2017

INTRODUCTION

This study sought to explore the pattern of epidemiological transition in the Economic Community of West African States (ECOWAS).

METHODS

We extracted data from the global burden of disease study. Countries were grouped using the Sociodemographic Index (SDI). The DisMod-MR 2.1, a Bayesian meta-regression tool, was used as the main method of estimating variations in epidemiologic data sources and other parameters. Examples of these included model predictions, as well as 95% corresponding uncertainty intervals for all death, Years of Life Lost, Years Lived with Disability, and DisabilityAdjusted Life Years (DALYs).

RESULTS

The DALYs from Group 1 diseases were higher in all the countries in the region compared to those from non-communicable diseases (NCDs) and injuries, as well as total NCDs in 1990 and this was the same in the subregion in 2017, except in Cape Verde (with the highest SDI), where there were higher DALYs from NCDs/ injuries and the total NCDs than the Group 1 diseases. In 1990, deaths from Group 1 diseases were higher in all the countries in the region than those from the total NCDs except in Cape Verde, while in 2017, deaths from Group 1 diseases were higher than those from Total NCDs except in Cape Verde, the Gambia, Ghana, and Senegal.

CONCLUSION

The overall pattern is that of concurrent communicable disease and increasing NCD burden with increasing SDI. Detailed understanding of these patterns and contextual factors are needed to help inform national and regional policies to address the epidemiological transition in the ECOWAS.

Poor Physical Function as a Risk Factor for Non-Communicable Diseases in Indonesia: A Retrospective Cohort Study

BACKGROUND

it cannot be ascertained whether an individual with poor physical function is at an increased risk of Non-Communicable Diseases (NCDs), thus the aim of this study is to examine this potential relationship.

METHODS

in this study, a fixed retrospective cohort design has been conducted by using data from the Indonesia Family Life Survey (IFLS) in 2007 and 2014. A total of 6,863 respondents who were not diagnosed with NCD by medical personnel in 2007 were successfully traced. After being controlled for covariates, the association between NCD type and poor physical function was measured by using the Adjusted Risk Ratio (ARR) and Population Attributable Risk (PAR).

RESULTS

respondents with poor physical function were at a significantly increased of being diagnosed with stroke (ARR: 6.9, 95%CI: 4.3-10.9), diabetes (ARR: 3.1, 95%CI: 2.4-4.1), or heart disease (ARR: 3.2, 95%CI: 2.4-4.5). The PAR score of respondents with diabetes was 0.006, meaning 0.6% of diabetes cases are attributed to poor physical function and can therefore be prevented if people maintain good physical function.

CONCLUSION

poor physical function can be assessed to identify risk of diabetes, heart disease, and stroke. Healthcare personnel should provide education programs that inform patients on the importance of maintaining a healthy physical ability.

The SIPHER Consortium: Introducing the new UK hub for systems science in public health and health economic research

The conditions in which we are born, grow, live, work and age are key drivers of health and inequalities in life chances. To maximise health and wellbeing across the whole population, we need well-coordinated action across government sectors, in areas including economic, education, welfare, labour market and housing policy. Current research struggles to offer effective decision support on the cross-sector strategic alignment of policies, and to generate evidence that gives budget holders the confidence to change the way major investment decisions are made. This open letter introduces a new research initiative in this space. The SIPHER ( Systems Science in Public Health and Health Economics Research) Consortium brings together a multi-disciplinary group of scientists from across six universities, three government partners at local, regional and national level, and ten practice partner organisations. The Consortium’s vision is a shift from health policy to healthy public policy, where the wellbeing impacts of policies are a core consideration across government sectors. Researchers and policy makers will jointly tackle fundamental questions about: a) the complex causal relationships between upstream policies and wellbeing, economic and equality outcomes; b) the multi-sectoral appraisal of costs and benefits of alternative investment options; c) public values and preferences for different outcomes, and how necessary trade-offs can be negotiated; and d) creating the conditions for intelligence-led adaptive policy design that maximises progress against economic, social and health goals. Whilst our methods will be adaptable across policy topics and jurisdictions, we will initially focus on four policy areas: Inclusive Economic Growth, Adverse Childhood Experiences, Mental Wellbeing and Housing.

Contributions and Implications of the Tehran Lipid and Glucose Study

Tehran Lipid and Glucose Study (TLGS), an epidemiological study of non-communicable disease with 20 years follow up in a developing country in nutrition transition is a unique study in 15000 family based individuals, 3 - 75 years of age in a part of large city of Tehran. The success rate of recruitment for 20 years, intervention for lifestyle change, and thyroid, reproduction and cardiometabolic genetic studies derived from TLGS have paved suitable path towards precision medicine. In this review, baseline findings and changes of risk factors for the development of NCD including body weight, nutrition, physical activity, blood pressure, tobacco smoking, serum glucose and serum lipids as well as metabolic syndrome, chronic kidney disease, quality of life and biochemical findings in TLGS cohort have been summarized. The results of community based intervention for lifestyle change caused decreases in the prevalence of metabolic syndrome and the incidence of diabetes. It is concluded that TLGS has served as a model for other cohort studies in Iran and the region; it has helped to mobilize scientists in developing countries; it has established locally needed definitions of NCD variables; has served as a model for cohort studies in developing countries in nutrition transition with all socioeconomic constraints and has helped manpower education and development of local CVD risk scores for implementation of NCD management.

Outcomes of a Longitudinal Population-based Cohort Study and Pragmatic Community Trial: Findings from 20 Years of the Tehran Lipid and Glucose Study

CONTEXT

The Tehran lipid and glucose study (TLGS) is one of the oldest population-based longitudinal cohort studies, providing knowledge about the incidence and risk factors of some non-communicable diseases (NCDs) in West Asia which hitherto was relatively scarce. We reviewed the methods and results related to the outcome measurements of this study.

EVIDENCE ACQUISITION

We reviewed all the TLGS papers which reported the incidence of NCDs.

RESULTS

The TLGS was initiated in 1999 - 2001 on a population in district no. 13 of Tehran with the same age distribution of the overall Tehran population and with a middle socioeconomic status. Totally, 15005 individuals, aged ≥ 3 years, participated in the first examination; reexaminations were conducted in a triennial manner and 3550 individuals were added in the second examination. All participants were also followed up annually and asked about any medical event leading to hospitalization or death. A part of participants was assigned to an educational program for lifestyle modification. High incidence of cardiovascular disease (CVD), premature CVD, diabetes and hypertension (around 19, 6, 10 and 31 in men and 11, 5, 11 and 29 in women per 1000 person-year, respectively) besides the high incidence of pre-diabetes and pre-hypertension (around 46 and 76 in men and 37 and 49 in women per 1000 person-year, respectively) showed a worrying situation. Fortunately, the results of the community interventions were promising with around 20% reduction in the risk of metabolic syndrome up to six years.

CONCLUSIONS

These precise detections of different outcomes in the TLGS provided valuable evidences for prediction and prevention of NCDs in Iran with some novelties in the middle-income countries in the world. The Tehran thyroid study (TTS) and the Tehran cardiometabolic genetic study (TCGS), conducted in the framework of the TLGS, are among few studies aiming to determine the natural course of thyroid function and to identify patterns of genetic polymorphisms related to cardiometabolic outcomes, respectively.

A Systematic Review of Studies on Blood Pressure in Iranian Pediatric Population: First Report From the Middle East and North Africa

Context:

Blood pressure (BP) tracks from childhood to adulthood, and has ethnic variations. Therefore, it is important to assess the situation of pediatric BP in different populations. This study aims to systematically review the studies conducted on BP in Iranian children and adolescents.

Evidence Acquisition:

We conducted a systematic review on published and national data about pediatric BP in Iran, our search was conducted in Pub Med, Medline, ISI, and Scopus, as well as in national databases including Scientific Information database (SID), IranMedex and Irandoc from 1990 to 2014.

Results:

We found 1373 records in the primary search including 840 from international and 533 from national databases. After selection and quality assessment phases, data were extracted from 36 papers and four national data sources. Mean systolic BP (SBP) varied from 90.1 ± 14 mmHg (95% CI 89.25, 90.94) to 120.2 ± 12.3 (118.98, 121.41) mmHg, and for diastolic BP (DBP) from 50.7 ± 11.4 (50.01, 51.38) to 79.2 ± 12.3 (77.95, 80.44) mmHg. The frequency of elevated BP had large variation in sub-national studies with rates as low as 0.4% (0.009, 1.98) for high SBP and as high as 24.1% (20.8, 27.67) for high DBP. At national level, three surveys reported slightly raised rates of elevated BP from 2009 to 2012.

Conclusions:

The findings provide practical information on BP levels in Iranian pediatric population. Although differences exist on the findings of various studies, this review underscores the necessity of tracking BP from childhood, and implementing interventions for primordial prevention of hypertension.

mHealth in the Prevention and Control of Non-Communicable Diseases in India: Current Possibilities and the Way Forward

Mobile health technology has been used effectively for healthcare delivery in many developing countries. India is currently facing an epidemic of Non-Communicable Diseases (NCDs). With greater availability of cheaper phones in the market, the user base of mobile phones in India is increasing rapidly. The present review was thus conducted to explore the current possibilities and future scope of mobile health for NCD prevention and control in India. Literature search was conducted using MEDLINE, EMBASE, and Cochrane Library to collect information regarding mobile health interventions. Two authors extracted the data and included studies if at least the abstract was available. Information from key reports and government websites were also included. We examined information from domains such as need for mobile health in NCDs in India, and the advantages, scope and challenges of mobile health for healthcare delivery in India. Existing mobile health systems in India, current evidence of mobile health use in NCDs, and the recent mobile health related initiatives taken by Government of India were also assessed. Though we found some examples of current mobile phone usage in many health related programmes in India, data from mobile health research is scarce, particularly for NCDs. The current evidence base needs to be strengthened. There is also a need for identifying various opportunities in the recent initiatives taken by Government of India. It can be concluded that though mobile health has many advantages, there are numerous challenges which need to be addressed before scaling it up at the national level.