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Marklund M, Aminde LN, Wanjau MN, Ale BM, Ojo AE, Okoro CE, Adegboye A, Huang L, Veerman JL, Wu JH, Huffman MD, Ojji DB. Estimated health benefits, costs and cost-effectiveness of eliminating industrial trans -fatty acids in Nigeria: cost-effectiveness analysis. BMJ Glob Health 2024; 9:e014294. [PMID: 38631705 PMCID: PMC11029410 DOI: 10.1136/bmjgh-2023-014294] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Nigeria is committed to reducing industrial trans-fatty acids (iTFA) from the food supply, but the potential health gains, costs and cost-effectiveness are unknown. METHODS The effect on ischaemic heart disease (IHD) burden, costs and cost-effectiveness of a mandatory iTFA limit (≤2% of all fats) for foods in Nigeria were estimated using Markov cohort models. Data on demographics, IHD epidemiology and trans-fatty acid intake were derived from the 2019 Global Burden of Disease Study. Avoided IHD events and deaths; health-adjusted life years (HALYs) gained; and healthcare, policy implementation and net costs were estimated over 10 years and the population's lifetime. Incremental cost-effectiveness ratios using net costs and HALYs gained (both discounted at 3%) were used to assess cost-effectiveness. RESULTS Over the first 10 years, a mandatory iTFA limit (assumed to eliminate iTFA intake) was estimated to prevent 9996 (95% uncertainty interval: 8870 to 11 118) IHD deaths and 66 569 (58 862 to 74 083) IHD events, and to save US$90 million (78 to 102) in healthcare costs. The corresponding lifetime estimates were 259 934 (228 736 to 290 191), 479 308 (95% UI 420 472 to 538 177) and 518 (450 to 587). Policy implementation costs were estimated at US$17 million (11 to 23) over the first 10 years, and US$26 million USD (19 to 33) over the population's lifetime. The intervention was estimated to be cost-saving, and findings were robust across several deterministic sensitivity analyses. CONCLUSION Our findings support mandating a limit of iTFAs as a cost-saving strategy to reduce the IHD burden in Nigeria.
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Affiliation(s)
- Matti Marklund
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Food Policy, The George Institute for Global Health, Newtown, New South Wales, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Leopold N Aminde
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Mary Njeri Wanjau
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Boni M Ale
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Holo Healthcare, Nairobi, Kenya
| | - Adedayo E Ojo
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Department of Epidemiology and Global Health, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Abimbola Adegboye
- National Agency for Food and Drug Administration and Control, Abuja, Federal Capital Territory, Nigeria
| | - Liping Huang
- Food Policy, The George Institute for Global Health, Newtown, New South Wales, Australia
| | - J Lennert Veerman
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Jason Hy Wu
- Food Policy, The George Institute for Global Health, Newtown, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark D Huffman
- Food Policy, The George Institute for Global Health, Newtown, New South Wales, Australia
- Washington University in St Louis, St Louis, St Louis, USA
| | - Dike B Ojji
- Cardiovascular Research Unit, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Federal Capital Territory, Nigeria
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Marklund M, Aminde LN, Wanjau MN, Huang L, Awuor C, Steele L, Cobb LK, Veerman JL, Wu JH. Estimated health benefits, costs and cost-effectiveness of eliminating dietary industrial trans fatty acids in Kenya: cost-effectiveness analysis. BMJ Glob Health 2023; 8:e012692. [PMID: 37848268 PMCID: PMC10583044 DOI: 10.1136/bmjgh-2023-012692] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/31/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES To model the potential health gains and cost-effectiveness of a mandatory limit of industrial trans fatty acids (iTFA) in Kenyan foods. DESIGN Multiple cohort proportional multistate life table model, incorporating existing data from the Global Burden of Disease study, pooled analyses of observational studies and peer-reviewed evidence of healthcare and policy implementation costs. SETTING Kenya. PARTICIPANTS Adults aged ≥20 years at baseline (n=50 million). INTERVENTION A mandatory iTFA limit (≤2% of all fats) in the Kenyan food supply compared with a base case scenario of maintaining current trans fat intake. MAIN OUTCOME MEASURES Averted ischaemic heart disease (IHD) events and deaths, health-adjusted life years; healthcare costs; policy implementation costs; net costs; and incremental cost-effectiveness ratio. RESULTS Over the first 10 years, the intervention was estimated to prevent ~1900 (95% uncertainty interval (UI): 1714; 2148) IHD deaths and ~17 000 (95% UI: 15 475; 19 551) IHD events, and to save ~US$50 million (95% UI: 44; 56). The corresponding estimates over the lifespan of the model population were ~49 000 (95% UI: 43 775; 55 326) IHD deaths prevented, ~113 000 (95% UI: 100 104; 127 969) IHD events prevented and some ~US$300 million (256; 331) saved. Policy implementation costs were estimated as ~US$9 million over the first 10 years and ~US$20 million over the population lifetime. The intervention was estimated to be cost saving regardless of the time horizon. Findings were robust across multiple sensitivity analyses. CONCLUSIONS Findings support policy action for a mandatory iTFA limit as a cost-saving strategy to avert IHD events and deaths in Kenya.
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Affiliation(s)
- Matti Marklund
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Leopold N Aminde
- Public Health and Economics Modelling Group, School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Mary Njeri Wanjau
- Public Health and Economics Modelling Group, School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Liping Huang
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Celine Awuor
- International Institute for Legislative Affairs, Nairobi, Kenya
| | | | | | - J Lennert Veerman
- Public Health and Economics Modelling Group, School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Jason Hy Wu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
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Wanjau MN, Kivuti-Bitok LW, Aminde LN, Veerman JL. The health and economic impact and cost effectiveness of interventions for the prevention and control of overweight and obesity in Kenya: a stakeholder engaged modelling study. Cost Eff Resour Alloc 2023; 21:69. [PMID: 37735408 PMCID: PMC10512507 DOI: 10.1186/s12962-023-00467-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/15/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND The global increase in mean body mass index has resulted in a substantial increase of non-communicable diseases (NCDs), including in many low- and middle-income countries such as Kenya. This paper assesses four interventions for the prevention and control of overweight and obesity in Kenya to determine their potential health and economic impact and cost effectiveness. METHODS We reviewed the literature to identify evidence of effect, determine the intervention costs, disease costs and total healthcare costs. We used a proportional multistate life table model to quantify the potential impacts on health conditions and healthcare costs, modelling the 2019 Kenya population over their remaining lifetime. Considering a health system perspective, two interventions were assessed for cost-effectiveness. In addition, we used the Human Capital Approach to estimate productivity gains. RESULTS Over the lifetime of the 2019 population, impacts were estimated at 203,266 health-adjusted life years (HALYs) (95% uncertainty interval [UI] 163,752 - 249,621) for a 20% tax on sugar-sweetened beverages, 151,718 HALYs (95% UI 55,257 - 250,412) for mandatory kilojoule menu labelling, 3.7 million HALYs (95% UI 2,661,365-4,789,915) for a change in consumption levels related to supermarket food purchase patterns and 13.1 million HALYs (95% UI 11,404,317 - 15,152,341) for a change in national consumption back to the 1975 average levels of energy intake. This translates to 4, 3, 73 and 261 HALYs per 1,000 persons. Lifetime healthcare cost savings were approximately United States Dollar (USD) 0.14 billion (USD 3 per capita), USD 0.08 billion (USD 2 per capita), USD 1.9 billion (USD 38 per capita) and USD 6.2 billion (USD 124 per capita), respectively. Lifetime productivity gains were approximately USD 1.8 billion, USD 1.2 billion, USD 28 billion and USD 92 billion. Both the 20% tax on sugar sweetened beverages and the mandatory kilojoule menu labelling were assessed for cost effectiveness and found dominant (health promoting and cost-saving). CONCLUSION All interventions evaluated yielded substantive health gains and economic benefits and should be considered for implementation in Kenya.
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Affiliation(s)
- Mary Njeri Wanjau
- School of Medicine & Dentistry, Griffith University, Gold Coast campus, Parklands Drive, Southport, Queensland, QLD 4222 Australia
- School of Nursing Sciences, University of Nairobi, P.O. Box 19676-00200, Nairobi, Kenya
| | - Lucy W. Kivuti-Bitok
- School of Medicine & Dentistry, Griffith University, Gold Coast campus, Parklands Drive, Southport, Queensland, QLD 4222 Australia
| | - Leopold N. Aminde
- School of Medicine & Dentistry, Griffith University, Gold Coast campus, Parklands Drive, Southport, Queensland, QLD 4222 Australia
- Non-communicable Disease Unit, Clinical Research Education Networking & Consultancy, Douala, Cameroon
| | - J. Lennert Veerman
- School of Medicine & Dentistry, Griffith University, Gold Coast campus, Parklands Drive, Southport, Queensland, QLD 4222 Australia
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Wanjau MN, Möller H, Haigh F, Milat A, Hayek R, Lucas P, Veerman JL. The Potential Impact of Physical Activity on the Burden of Osteoarthritis and Low Back Pain in Australia: A Systematic Review of Reviews and Life Table Analysis. J Phys Act Health 2023:1-12. [PMID: 37268300 DOI: 10.1123/jpah.2022-0541] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 04/13/2023] [Accepted: 04/16/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The objectives were (1) to establish the strength of the association between incident cases of osteoarthritis (OA) and low back pain (LBP), and physical activity (PA) and to assess the likelihood of the associations being causal; and (2) to quantify the impact of PA on the burden of OA and LBP in Australia. METHODS We conducted a systematic literature review in EMBASE and PubMed databases from January 01, 2000, to April 28, 2020. We used the Bradford Hill viewpoints to assess causality. We used a proportional multistate life table model to estimate the impact of changes in the PA levels on OA and LBP burdens for the 2019 Australian population (aged ≥ 20 y) over their remaining lifetime. RESULTS We found that both OA and LBP are possibly causally related to physical inactivity. Assuming causality, our model projected that if the 2025 World Health Organization global target for PA was met, the burden in 25 years' time could be reduced by 70,000 prevalent cases of OA and over 11,000 cases of LBP. Over the lifetime of the current adult population of Australia, the gains could add up to approximately 672,814 health-adjusted life years (HALYs) for OA (ie, 27 HALYs per 1000 persons) and 114,042 HALYs for LBP (ie, 5 HALYs per 1000 persons). The HALY gains would be 1.4 times bigger if the 2030 World Health Organization global target for PA was achieved and 11 times bigger if all Australians adhered to the Australian PA guidelines. CONCLUSION This study provides empirical support for the adoption of PA in strategies for the prevention of OA and back pain.
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Affiliation(s)
- Mary Njeri Wanjau
- Public Health & Economics Modelling Group, School of Medicine and Dentistry, Griffith University, Gold Coast, QLD,Australia
| | - Holger Möller
- School of Population Health, University of New South Wales, Sydney, NSW,Australia
| | - Fiona Haigh
- Health Equity Research and Development Unit (HERDU), University of New South Wales, Sydney, NSW,Australia
| | - Andrew Milat
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW,Australia
- School of Public Health, University of Sydney, Sydney, NSW,Australia
| | - Rema Hayek
- Health Infrastructure, NSW Health, Sydney, NSW,Australia
| | - Peta Lucas
- Centre for Population Health, NSW Ministry of Health, Sydney, NSW,Australia
| | - J Lennert Veerman
- Public Health & Economics Modelling Group, School of Medicine and Dentistry, Griffith University, Gold Coast, QLD,Australia
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Wanjau MN, Möller H, Haigh F, Milat A, Hayek R, Lucas P, Veerman JL. Physical Activity and Depression and Anxiety Disorders: A Systematic Review of Reviews and Assessment of Causality. AJPM Focus 2023; 2:100074. [PMID: 37790636 PMCID: PMC10546525 DOI: 10.1016/j.focus.2023.100074] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Globally, depressive and anxiety disorders are the leading contributors to mental ill health. Physical activity reduces symptoms of depression and anxiety and has been proposed as an adjunct treatment therapy for depression and anxiety. Prospective studies suggest that physical activity may reduce the incidence of depression and anxiety. We conducted a systematic review of reviews with the aim to provide a comprehensive overview of available epidemiologic evidence on the strength of the association between physical activity and incident cases of depression and anxiety and to assess the likelihood of these associations being causal. Methods We searched Embase and PubMed databases for systematic reviews published between January 1, 2000 and March 19, 2020 that reported findings on the strength of association between physical activity and incidence of depression and anxiety. We updated this search to October 15, 2022. Two reviewers independently assessed the methodologic quality of the included reviews using the Assessment of Multiple Systematic Reviews rating scale. We carried out a narrative synthesis of the evidence. We used the Bradford Hill criteria to assess the likelihood of associations being causal. Results The initial search yielded 770 articles, of which 4 remained for data extraction. Two of the included reviews were scored as high quality, and 2 were scored as low quality. From the 2 included reviews that reported pooled estimates, people with high physical activity levels were found to have a decreased risk of incident depression (adjusted RR=0.83, 95% CI=0.76, 0.90) and reduced odds of developing anxiety (adjusted OR=0.74,95% CI=0.62, 0.88) when compared with those with low physical activity levels. We assessed physical activity to be probably causally related to both depression and anxiety. Discussion Our evidence is drawn from systematic reviews of observational data. Further high-quality studies, such as randomized control trials, would help to strengthen the evidence base of the associations between physical activity and depression and anxiety. Nonetheless, our findings provide empirical support for the consideration of physical activity in strategies for the prevention of mental ill health.
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Affiliation(s)
- Mary Njeri Wanjau
- Public Health & Economics Modelling Group, School of Medicine and Dentistry, Griffith University, Southport, Australia
| | - Holger Möller
- School of Population Health, University of New South Wales Sydney, Kensington, Australia
- The George Institute for Global Health, Newtown, New South Wales, Australia
| | - Fiona Haigh
- Health Equity Research and Development Unit (HERDU), University of New South Wales Sydney, Kensington, Australia
| | - Andrew Milat
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia
- School of Public Health, University of Sydney, Sidney, Australia
| | - Rema Hayek
- Health Infrastructure, NSW Health, Sydney, Australia
| | - Peta Lucas
- Centre for Population Health, NSW Ministry of Health, Sydney, Australia
| | - J. Lennert Veerman
- Public Health & Economics Modelling Group, School of Medicine and Dentistry, Griffith University, Southport, Australia
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Wanjau MN, Möller H, Haigh F, Milat A, Hayek R, Lucas P, Veerman JL. Physical Activity and Depression and Anxiety Disorders in Australia: A Lifetable Analysis. AJPM Focus 2023; 2:100030. [PMID: 37790639 PMCID: PMC10546584 DOI: 10.1016/j.focus.2022.100030] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Mental disorders, in particular, depressive and anxiety disorders, are a leading cause of disability in Australia and globally. Physical activity may reduce the incidence of anxiety and depression, and this supports the inclusion of physical activity in strategies for the prevention of mental ill health. Policy makers need to know the potential impact and cost savings of such strategies. We aimed to quantify the impact of changes in physical activity on the burden of anxiety and depression and healthcare costs in Australia. Methods We used a proportional multistate lifetable model to estimate the impact of changes in physical activity levels on anxiety and depression burdens for the 2019 Australian population (numbering 24.6 million) over their remaining lifetime. The changes in physical activity were modeled through 3 counterfactual scenarios informed by policy targets: attainment of the Australian Physical Activity Guidelines and achievement of the WHO Global Action Plan on Physical Activity targets of a 10% relative reduction in the prevalence of insufficient physical activity by 2025 and a 15% relative reduction by 2030. Results If all Australians adhered to the recommended minimum physical activity levels, in 25 years' time, the burden of anxiety could be reduced by up to 6.4% (95% uncertainty intervals=2.5, 10.6), and that of depression could be reduced by 4.4% (95% uncertainty intervals=2.3, 6.5). Over the lifetime of the 2019 Australian population, the gains could add up to 640,592 health-adjusted life years for anxiety (26 health-adjusted life years per 1,000 persons), 523,717 health-adjusted life years for depression (21 health-adjusted life years per 1,000 persons), and healthcare cost savings of 5.4 billion Australian dollars for anxiety (220 Australian dollars per capita) and 5.8 billion for depression (237 Australian dollars per capita). Conclusions Adherence to the Australian physical activity guidelines and achievement of the 2025 and 2030 global physical activity targets could lead to a substantial reduction of the burden of anxiety and depression. This study provides empirical support for the inclusion of physical activity in strategies for the prevention of mental ill health. Future studies should also assess the size and distribution of the benefits for different socioeconomic and ethnic groups.
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Affiliation(s)
- Mary Njeri Wanjau
- Public Health & Economics Modelling Group, School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Holger Möller
- Medicine & Health, School of Population Health, University of New South Wales, Sydney, Australia
| | - Fiona Haigh
- Health Equity Research and Development Unit (HERDU), University of New South Wales, Sydney, Australia
| | - Andrew Milat
- Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, Australia
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, Australia
| | - Rema Hayek
- Health Infrastructure, NSW Health, Sydney, Australia
| | - Peta Lucas
- Centre for Population Health, NSW Ministry of Health, Sydney, Australia
| | - J. Lennert Veerman
- Public Health & Economics Modelling Group, School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
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Marklund M, Aminde LN, Wanjau MN, Ale BM, Ojo AE, Okoro CE, Adegboye AO, Veerman JL, Wu JHY, Huffman MD, Ojji DB. Abstract P223: Estimated Health Benefits, Costs, and Cost-Effectiveness of Eliminating Industrial Trans-Fatty Acids in Nigeria. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p223] [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] [Indexed: 03/18/2023]
Abstract
Objectives:
To estimate the potential health gains, costs, and cost-effectiveness of a mandatory limit on industrial trans fatty acids (iTFA) in the Nigerian food supply.
Methods:
We used Markov cohort models to estimate the effect on ischemic heart disease (IHD) burden, costs, and cost-effectiveness of a mandatory iTFA-limit (≤2% of all fats) for foods in Nigeria. Data on demographics, IHD epidemiology, and trans-fatty acid intake were derived from the 2019 Global Burden of Disease Study. We calculated the IHD burden attributable to iTFA by comparing the current trans-fatty acid intake to counterfactual settings with complete elimination of iTFA intake. Policy implementation costs (including government costs for legislation and monitoring, and industry costs for product reformulation), avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and healthcare costs saved were estimated over 10 years and lifetime of the Nigerian population. Incremental cost-effectiveness ratios using net costs (i.e., implementation costs minus healthcare cost savings) and HALYs gained (both discounted at 3%) were used to assess cost-effectiveness.
Results:
Over the first 10 years, elimination of iTFA intake was estimated to prevent 9,996 (95% uncertainty interval: 8,870; 11,118): IHD deaths and 66,569 (58,862; 74,083) IHD events, and to save 90 million USD (78; 102) in total healthcare costs. The corresponding estimates over the lifetime were 259,934 (228,736; 290,191), 479,308 (95% UI: 420,472; 538,177), and ~518 (450; 587). Policy implementation costs (government plus industry) were estimated as 18 million USD (12; 25) over the first 10 years, and 27 million USD (20; 35) over the population lifetime. The intervention was estimated to be cost-saving. Findings were robust across several deterministic sensitivity analyses (Figure).
Conclusions:
Our findings support legislating a mandatory limit of iTFAs as a cost-saving strategy to avert substantial numbers of IHD events and deaths in Nigeria.
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Affiliation(s)
- Matti Marklund
- The George Institute for Global Health, Univ of New South Wales, Newtown, Australia
| | | | | | - Boni M Ale
- Univ of Abuja, Gwagwalada, Abuja, Nigeria
| | | | | | - Abimbola O Adegboye
- National Agency for Food and Drug Administration and Control (NAFDAC), Abuja, Nigeria
| | | | - Jason HY Wu
- The George Institute for Global Health, Univ of New South Wales, Newtown, Australia
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Aminde LN, Wanjau MN, Cobiac LJ, Veerman JL. Estimated Impact of Achieving the Australian National Sodium Reduction Targets on Blood Pressure, Chronic Kidney Disease Burden and Healthcare Costs: A Modelling Study. Nutrients 2023; 15:nu15020318. [PMID: 36678188 PMCID: PMC9865653 DOI: 10.3390/nu15020318] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 12/30/2022] [Accepted: 01/04/2023] [Indexed: 01/10/2023] Open
Abstract
Excess sodium intake raises blood pressure which increases the risk of chronic kidney disease (CKD). We aimed to estimate the impact of reduced sodium intake on future CKD burden in Australia. A multi-cohort proportional multistate lifetable model was developed to estimate the potential impact on CKD burden and health expenditure if the Australian Suggested Dietary Target (SDT) and the National Preventive Health Strategy 2021-2030 (NPHS) sodium target were achieved. Outcomes were projected to 2030 and over the lifetime of adults alive in 2019. Achieving the SDT and NPHS targets could lower population mean systolic blood pressure by 2.1 mmHg and 1.7 mmHg, respectively. Compared to normal routines, attaining the SDT and NPHS target by 2030 could prevent 59,220 (95% UI, 53,140-65,500) and 49,890 (44,377-55,569) incident CKD events, respectively, while postponing 568 (479-652) and 511 (426-590) CKD deaths, respectively. Over the lifetime, this generated 199,488 health-adjusted life years (HALYs) and AUD 644 million in CKD healthcare savings for the SDT and 170,425 HALYs and AUD 514 million for the NPHS. CKD due to hypertension and CKD due to other/unspecified causes were the principal contributors to the HALY gains. Lowering sodium consumption in Australia could deliver substantial CKD health and economic benefits.
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Aminde LN, Cobiac LJ, Phung D, Phung HN, Veerman JL. Avoidable burden of stomach cancer and potential gains in healthy life years from gradual reductions in salt consumption in Vietnam, 2019-2030: a modelling study. Public Health Nutr 2022; 26:1-12. [PMID: 35983611 PMCID: PMC9989714 DOI: 10.1017/s136898002200177x] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 06/29/2022] [Accepted: 08/05/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Excess salt consumption is causally linked with stomach cancer, and salt intake among adults in Vietnam is about twice the recommended levels. The aim of this study was to quantify the future burden of stomach cancer that could be avoided from population-wide salt reduction in Vietnam. DESIGN A dynamic simulation model was developed to quantify the impacts of achieving the 2018 National Vietnam Health Program (8 g/d by 2025 and 7 g/d by 2030) and the WHO (5 g/d) salt reduction policy targets. Data on salt consumption were obtained from the Vietnam 2015 WHO STEPS survey. Health outcomes were estimated over 6-year (2019-2025), 11-year (2019-2030) and lifetime horizons. We conducted one-way and probabilistic sensitivity analyses. SETTING Vietnam. PARTICIPANTS All adults aged ≥ 25 years (61 million people, 48·4 % men) alive in 2019. RESULTS Achieving the 2025 and 2030 national salt targets could result in 3400 and 7200 fewer incident cases of stomach cancer, respectively, and avert 1900 and 4800 stomach cancer deaths, respectively. Achieving the WHO target by 2030 could prevent 8400 incident cases and 5900 deaths from stomach cancer. Over the lifespan, this translated to 344 660 (8 g/d), 411 060 (7 g/d) and 493 633 (5 g/d) health-adjusted life years gained, respectively. CONCLUSIONS A sizeable burden of stomach cancer could be avoided, with gains in healthy life years if national and WHO salt targets were attained. Our findings provide impetus for policy makers in Vietnam and Asia to intensify salt reduction strategies to combat stomach cancer and mitigate pressure on the health systems.
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Affiliation(s)
- Leopold Ndemnge Aminde
- School of Medicine and Dentistry, Griffith University, Ian O’Connor Building (G40), Gold Coast Campus, 1 Parklands Drive, Gold Coast, QLD4215, Australia
| | - Linda J Cobiac
- School of Medicine and Dentistry, Griffith University, Ian O’Connor Building (G40), Gold Coast Campus, 1 Parklands Drive, Gold Coast, QLD4215, Australia
| | - Dung Phung
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Hai N Phung
- School of Medicine and Dentistry, Griffith University, Ian O’Connor Building (G40), Gold Coast Campus, 1 Parklands Drive, Gold Coast, QLD4215, Australia
| | - J Lennert Veerman
- School of Medicine and Dentistry, Griffith University, Ian O’Connor Building (G40), Gold Coast Campus, 1 Parklands Drive, Gold Coast, QLD4215, Australia
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Wanjau MN, Aminde LN, Veerman JL. The avoidable disease burden associated with overweight and obesity in Kenya: A modelling study. EClinicalMedicine 2022; 50:101522. [PMID: 35799846 PMCID: PMC9253160 DOI: 10.1016/j.eclinm.2022.101522] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/28/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Globally, there is a rising burden of non-communicable diseases related to high body mass index (BMI). Estimation of the magnitude of the avoidable disease burden related to high BMI in Kenya could inform priority setting in health. METHODS Using a proportional multistate life table model, we estimated the impact of the elimination of exposure to high BMI (>22·5 kg/m2) on health adjusted life years, health adjusted life expectancy, and burden of 27 obesity-related diseases. Participants were the 2019 Kenyan population modelled over their remaining lifetime. FINDINGS Elimination of high BMI could save approximately 83·5 million health-adjusted life years and increase the health-adjusted life expectancy by 2·3 (95% UI 2·0-2·8) years for females and 1·0 (95% UI 0·8-1·1) years for males. Over the first 25 years, over 7·4 million new cases of BMI-related diseases could be avoided and approximately half a million BMI related deaths postponed. The cumulative number of new cases of type 2 diabetes could reduce by approximately 1·6 million, cardiovascular diseases by over 1·3 million, chronic kidney disease by 850,473 and cancer would reduce by 55,624 estimated cases. In 2044, an estimated 867,664 prevalent cases of musculoskeletal disease would be prevented. INTERPRETATION The magnitude of avoidable high BMI-related disease burden in Kenya underscores the need to prioritise the control and prevention of overweight and obesity globally, especially in low- and middle-income settings, where obesity rates are rising rapidly. Reducing population BMI is challenging, but sustained and well-enforced system-wide approaches could be a great starting point. FUNDING Mary Njeri Wanjau is supported by the Griffith University International Postgraduate Research Scholarship (GUIPRS) and Griffith University Postgraduate Research Scholarship (GUPRS).
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Affiliation(s)
- Mary Njeri Wanjau
- University of Nairobi, School of Nursing Sciences, Nairobi, Kenya
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Corresponding author at: Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Gold Coast campus, Parklands Drive, Southport, Queensland 4222, Australia.
| | - Leopold Ndemnge Aminde
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Non-communicable Disease Unit, Clinical Research Education, Networking & Consultancy, Douala, Cameroon
| | - J. Lennert Veerman
- Public Health & Economics Modelling Group, School of Medicine & Dentistry, Griffith University, Gold Coast, Queensland, Australia
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Miller V, Reedy J, Cudhea F, Zhang J, Shi P, Erndt-Marino J, Coates J, Micha R, Webb P, Mozaffarian D, Abbott P, Abdollahi M, Abedi P, Abumweis S, Adair L, Al Nsour M, Al-Daghri N, Al-Hamad N, Al-Hooti S, Al-Zenki S, Alam I, Ali JH, Alissa E, Anderson S, Anzid K, Arambepola C, Arici M, Arsenault J, Asciak R, Barbieri HE, Barengo N, Barquera S, Bas M, Becker W, Beer-Borst S, Bergman P, Biró L, Boindala S, Bovet P, Bradshaw D, Bukhary NBI, Bundhamcharoen K, Caballero M, Calleja N, Cao X, Capanzana M, Carmikle J, Castetbon K, Castro M, Cerdena C, Chang HY, Charlton K, Chen Y, Chen MF, Chiplonkar S, Cho Y, Chuah KA, Costanzo S, Cowan M, Damasceno A, Dastgiri S, De Henauw S, DeRidder K, Ding E, Dommarco R, Don R, Duante C, Duleva V, Duran Aguero S, Ekbote V, El Ati J, El Hamdouchi A, El-kour T, Eldridge A, Elmadfa I, Esteghamati A, Etemad Z, Fadzil F, Farzadfar F, Fernandez A, Fernando D, Fisberg R, Forsyth S, Gamboa-Delgado E, Garriguet D, Gaspoz JM, Gauci D, Geleijnse M, Ginnela B, Grosso G, Guessous I, Gulliford M, Gunnarsdottir I, Hadden W, Hadziomeragic A, Haerpfer C, Hakeem R, Haque A, Hashemian M, Hemalatha R, Henjum S, Hinkov H, Hjdaud Z, Hoffman D, Hopping B, Houshiar-rad A, Hsieh YT, Hung SY, Huybrechts I, Hwalla NC, Ibrahim HM, Ikeda N, Illescas-Zarate D, Inoue M, Janakiram C, Jayawardena R, Jeewon R, Jitnarin N, Johansson L, Jonsdottir O, Jundishapur A, Kally O, Kandiah M, Karupaiah T, Keinan-Boker L, Kelishadi R, Khadilkar A, Kim CI, Koksal E, Konig J, Korkalo L, Koster J, Kovalskys I, Krishnan A, Kruger H, Kuriyan-Raj R, Kweon S, Lachat C, Lai Y, Lanerolle P, Laxmaiah A, Leclercq C, Lee MS, Lee HJ, Lemming EW, Li Y, Lindström J, Ling A, Liputo NIL, Lopez-Jaramillo P, Luke A, Lukito W, Lupotto E, Ma Y, Mahdy ZA, Malekzadeh R, Manan W, Marchioni D, Marques LL, Marques-Vidal P, Martin-Prevel, Y, Mathee A, Matsumura Y, Mazumdar P, Memon A, Mensink G, Meyer A, Mirmiran P, Mirzaei M, Misra P, Misra A, Mitchell C, Mohamed HJBJ, Mohammadi-Nasrabadi F, Mohammadifard N, Moy FM, Musaiger A, Mwaniki E, Myhre J, Nagalla B, Naska A, Ng SA, Ng SW, Ngoan LTN, Noshad S, Ochoa A, Ocke M, Odenkirk J, Oh K, Oleas M, Olivares S, Orfanos P, Ortiz-Ulloa J, Otero J, Ovaskainen ML, Pakseresht M, Palacios C, Palmer P, Pan WH, Panagiotakos D, Parajuli R, Park M, Pekcan G, Petrova S, Piaseu N, Pitsavos C, Polasa K, Posada L, Pourfarzi F, Preston AM, Rached I, Rahbar AR, Rehm C, Richter A, Riley L, Salanave B, Sánchez-Romero LM, Sarrafzadegan N, Sawada N, Sekiyama M, Selamat R, Shamsuddin K, Shariff ZM, Sharma S, Sibai AM, Sinkko H, Sioen I, Sisa I, Skeaff S, Steingrimsdottir L, Strand T, Suarez-Ortegon MF, Swaminathan S, Swan G, Sygnowska E, Szabo M, Szponar L, Tan-Khouw I, Tapanainen H, Tayyem R, Tedla B, Tedstone A, Templeton R, Termote C, Thanopoulou A, Thorgeirsdottir H, Thorsdottir I, Trichopoulos D, Trichopoulou A, Tsugane S, Turrini A, van Oosterhout C, Vartiainen E, Veerman JL, Virtanen S, Vollenweider P, Vossenaar M, Waidyatilaka I, Waskiewicz A, Waterham E, Wieler L, Wondwossen T, Wu S, Yaakub R, Yap M, Yusof S, Zaghloul S, Zajkás G, Zapata M, Zarina K, Zohoori FV. Global, regional, and national consumption of animal-source foods between 1990 and 2018: findings from the Global Dietary Database. The Lancet Planetary Health 2022; 6:e243-e256. [PMID: 35278390 PMCID: PMC8926870 DOI: 10.1016/s2542-5196(21)00352-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/25/2021] [Accepted: 12/08/2021] [Indexed: 02/05/2023]
Abstract
Background Methods Findings Interpretation Funding
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Wanjau MN, Kivuti-Bitok LW, Aminde LN, Veerman JL. Stakeholder-engaged research: strategies for the prevention and control of overweight and obesity in Kenya. BMC Public Health 2021; 21:1622. [PMID: 34488690 PMCID: PMC8420014 DOI: 10.1186/s12889-021-11649-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background This study was done as part of a larger study that aims to identify the most impactful and cost-effective strategies for the prevention and control of overweight and obesity in Kenya. Our objective was to involve stakeholders in the identification of the strategies that would be included in our larger study. The results from the stakeholder engagement are analyzed and reported in this paper. Design This was a qualitative study. A one-day stakeholder workshop that followed a deliberative dialogue process was conducted. Participants A sample of stakeholders who participate in the national level policymaking process for health in Kenya. Outcome measure Strategies for the prevention and control of overweight and obesity in Kenya. Results Out of the twenty-three stakeholders who confirmed attendance, fifteen participants attended the one-day workshop. The stakeholders identified a total of 24 strategies for the prevention and control of overweight and obesity in Kenya. From the ranking process carried out the top six strategies identified were: a research-based strategy for the identification of the nutritional value of indigenous foods, implementation of health promotion strategies that focus on the creation of healthy environments, physical activity behavior such as gym attendance, jogging, walking, and running at the individual level, implementation of school curricula on nutrition and health promotion, integration of physical education into the new Competency-Based Education policy, and policies that increase use of public transport. Conclusion The stakeholders identified and ranked strategies for the prevention and control of overweight and obesity in Kenya. This informs future overweight and obesity prevention research and policy in Kenya and similar settings. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11649-0.
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Affiliation(s)
- Mary Njeri Wanjau
- University of Nairobi, School of Nursing Sciences, Nairobi, Kenya. .,Griffith University, School of Medicine, Gold Coast, Queensland, Australia.
| | | | - Leopold N Aminde
- Griffith University, School of Medicine, Gold Coast, Queensland, Australia.,Non-communicable Disease Unit, Clinical Research Education, Networking & Consultancy, Douala, Cameroon
| | - J Lennert Veerman
- Griffith University, School of Medicine, Gold Coast, Queensland, Australia
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Aminde LN, Phung HN, Phung D, Cobiac LJ, Veerman JL. Dietary Salt Reduction, Prevalence of Hypertension and Avoidable Burden of Stroke in Vietnam: Modelling the Health and Economic Impacts. Front Public Health 2021; 9:682975. [PMID: 34150712 PMCID: PMC8213032 DOI: 10.3389/fpubh.2021.682975] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Dietary salt reduction has been recommended as a cost-effective population-wide strategy to prevent cardiovascular disease. The health and economic impact of salt consumption on the future burden of stroke in Vietnam is not known. Objective: To estimate the avoidable incidence of and deaths from stroke, as well as the healthy life years and healthcare costs that could be gained from reducing salt consumption in Vietnam. Methods: This was a macrosimulation health and economic impact assessment study. Data on blood pressure, salt consumption and stroke epidemiology were obtained from the Vietnam 2015 STEPS survey and the Global Burden of Disease study. A proportional multi-cohort multistate lifetable Markov model was used to estimate the impact of achieving the Vietnam national salt targets of 8 g/day by 2025 and 7 g/day by 2030, and to the 5 g/day WHO recommendation by 2030. Probabilistic sensitivity analysis was conducted to quantify the uncertainty in our projections. Results: If the 8 g/day, 7 g/day, and 5 g/day targets were achieved, the prevalence of hypertension could reduce by 1.2% (95% uncertainty interval [UI]: 0.5 to 2.3), 2.0% (95% UI: 0.8 to 3.6), and 3.5% (95% UI: 1.5 to 6.3), respectively. This would translate, respectively, to over 80,000, 180,000, and 257,000 incident strokes and over 18,000, 55,000, and 73,000 stroke deaths averted. By 2025, over 56,554 stroke-related health-adjusted life years (HALYs) could be gained while saving over US$ 42.6 million in stroke healthcare costs. By 2030, about 206,030 HALYs (for 7 g/day target) and 262,170 HALYs (for 5 g/day target) could be gained while saving over US$ 88.1 million and US$ 122.3 million in stroke healthcare costs respectively. Conclusion: Achieving the national salt reduction targets could result in substantial population health and economic benefits. Estimated gains were larger if the WHO salt targets were attained and if changes can be sustained over the longer term. Future work should consider the equity impacts of specific salt reduction programs.
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Affiliation(s)
| | - Hai N Phung
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Dung Phung
- School of Medicine, Griffith University, Gold Coast, QLD, Australia
| | - Linda J Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Mohamed Nor N, Bui Kher Thinng W, Veerman JL, Ibrahim NS, Mohamad FZ, Ibrahim S. PRICE ELASTICITY OF DEMAND AND THE IMPACT OF TAXING SUGAR-SWEETENED BEVERAGES IN MALAYSIA. MJPHM 2021. [DOI: 10.37268/mjphm/vol.21/no.1/art.794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Malaysian government implemented an excise tax of MYR 0.40 per L on sugar-sweetened beverages in July 2019. Excise tax is imposed on sweetened drinks containing more than 5 g of sugar per 100 ml, flavoured Ultra High Temperature milk-based drinks, and fruit juices with more than 7 g and 12 g of sugar per 100 ml, respectively. We analysed the impact of excise tax on the consumption of SSBs by developing a demand model for SSBs to estimate the elasticity of demand using a two-way fixed-effect model. The tax increased the price of 1 L SSBs by 8.33%, and we estimated it to decrease the consumption of SSBs by 9.25%. The estimated own-price elasticity of demand for SSBs was −1.11 (95% CI: −1.97 to −0.25). Price of SSB is a determinant for SSB demand, but income or the price of milk are not. The estimated excise revenue calculated was MYR 357.61 million. However, industry responses via product reformulation and pass-through rates could reduce revenue and enhance or reduce health impacts.
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Aminde LN, Dzudie A, Mapoure YN, Tantchou JC, Veerman JL. Estimation and determinants of direct medical costs of ischaemic heart disease, stroke and hypertensive heart disease: evidence from two major hospitals in Cameroon. BMC Health Serv Res 2021; 21:140. [PMID: 33579273 PMCID: PMC7881453 DOI: 10.1186/s12913-021-06146-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 02/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the largest contributor to the non-communicable diseases (NCD) burden in Cameroon, but data on its economic burden is lacking. Methods A prevalence-based cost-of-illness study was conducted from a healthcare provider perspective and enrolled patients with ischaemic heart disease (IHD), ischaemic stroke, haemorrhagic stroke and hypertensive heart disease (HHD) from two major hospitals between 2013 and 2017. Determinants of cost were explored using multivariate generalized linear models. Results Overall, data from 850 patients: IHD (n = 92, 10.8%), ischaemic stroke (n = 317, 37.3%), haemorrhagic stroke (n = 193, 22.7%) and HHD (n = 248, 29.2%) were analysed. The total cost for these CVDs was XAF 676,694,000 (~US$ 1,224,918). The average annual direct medical costs of care per patient were XAF 1,395,200 (US$ 2400) for IHD, XAF 932,700 (US$ 1600) for ischaemic stroke, XAF 815,400 (US$ 1400) for haemorrhagic stroke, and XAF 384,300 (US$ 700) for HHD. In the fully adjusted models, apart from history of CVD event (β = − 0.429; 95% confidence interval − 0.705, − 0.153) that predicted lower costs in patients with IHD, having of diabetes mellitus predicted higher costs in patients with IHD (β = 0.435; 0.098, 0.772), ischaemic stroke (β = 0.188; 0.052, 0.324) and HHD (β = 0.229; 0.080, 0.378). Conclusions This study reveals substantial economic burden due to CVD in Cameroon. Diabetes mellitus was a consistent driver of elevated costs across the CVDs. There is urgent need to invest in cost-effective primary prevention strategies in order to reduce the incidence of CVD and consequent economic burden on a health system already laden with the impact of communicable diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06146-4.
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Affiliation(s)
- Leopold Ndemnge Aminde
- School of Medicine, Griffith University, Gold Coast, Australia. .,Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon.
| | - Anastase Dzudie
- Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon.,Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine, University of Yaounde 1, Yaounde, Cameroon
| | - Yacouba N Mapoure
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon.,Faculty of Medicine & Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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Aminde LN, Cobiac L, Veerman JL. Cost-effectiveness analysis of population salt reduction interventions to prevent cardiovascular disease in Cameroon: mathematical modelling study. BMJ Open 2020; 10:e041346. [PMID: 33234652 PMCID: PMC7689085 DOI: 10.1136/bmjopen-2020-041346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/05/2020] [Revised: 09/15/2020] [Accepted: 10/18/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Reducing dietary sodium (salt) intake has been proposed as a population-wide strategy to reduce blood pressure and cardiovascular disease (CVD). The cost-effectiveness of such strategies has hitherto not been investigated in Cameroon. METHODS A multicohort multistate life table Markov model was used to evaluate the cost-effectiveness of three population salt reduction strategies: mass media campaign, school-based salt education programme and low-sodium salt substitute. A healthcare system perspective was considered and adults alive in 2016 were simulated over the life course. Outcomes were changes in disease incidence, mortality, health-adjusted life years (HALYs), healthcare costs and incremental cost-effectiveness ratios (ICERs) over the lifetime. Probabilistic sensitivity analysis was used to quantify uncertainty. RESULTS Over the life span of the cohort of adults alive in Cameroon in 2016, substantial numbers of new CVD events could be prevented, with over 10 000, 79 000 and 84 000 CVD deaths that could be averted from mass media, school education programme and salt substitute interventions, respectively. Population health gains over the lifetime were 46 700 HALYs, 348 800 HALYs and 368 400 HALYs for the mass media, school education programme and salt substitute interventions, respectively. ICERs showed that all interventions were dominant, with probabilities of being cost-saving of 84% for the school education programme, 89% for the mass media campaign and 99% for the low sodium salt substitute. Results were largely robust in sensitivity analysis. CONCLUSION All the salt reduction strategies evaluated were highly cost-effective with very high probabilities of being cost-saving. Salt reduction in Cameroon has the potential to save many lives and offers good value for money.
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Affiliation(s)
| | - Linda Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - J Lennert Veerman
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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Marklund M, Zheng M, Veerman JL, Wu JHY. Estimated health benefits, costs, and cost-effectiveness of eliminating industrial trans-fatty acids in Australia: A modelling study. PLoS Med 2020; 17:e1003407. [PMID: 33137090 PMCID: PMC7605626 DOI: 10.1371/journal.pmed.1003407] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 10/26/2019] [Accepted: 09/29/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND trans-fatty acids (TFAs) are a well-known risk factor of ischemic heart disease (IHD). In Australia, the highest TFA intake is concentrated to the most socioeconomically disadvantaged groups. Elimination of industrial TFA (iTFA) from the Australian food supply could result in reduced IHD mortality and morbidity while improving health equity. However, such legislation could lead to additional costs for both government and food industry. Thus, we assessed the potential cost-effectiveness, health gains, and effects on health equality of an iTFA ban from the Australian food supply. METHODS AND FINDINGS Markov cohort models were used to estimate the impact on IHD burden and health equity, as well as the cost-effectiveness of a national ban of iTFA in Australia. Intake of TFA was assessed using the 2011-2012 Australian National Nutrition and Physical Activity Survey. The IHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting where consumption was lowered to a theoretical minimum distribution with a mean of 0.5% energy per day (corresponding to TFA intake only from nonindustrial sources, e.g., dairy foods). Policy costs, avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and changes in IHD-related healthcare costs saved were estimated over 10 years and lifetime of the adult Australian population. Cost-effectiveness was assessed by calculation of incremental cost-effectiveness ratios (ICERs) using net policy cost and HALYs gained. Health benefits and healthcare cost changes were also assessed in subgroups based on socioeconomic status, defined by Socio-Economic Indexes for Areas (SEIFA) quintile, and remoteness. Compared to a base case of no ban and current TFA intakes, elimination of iTFA was estimated to prevent 2,294 (95% uncertainty interval [UI]: 1,765; 2,851) IHD deaths and 9,931 (95% UI: 8,429; 11,532) IHD events over the first 10 years. The greatest health benefits were accrued to the most socioeconomically disadvantaged quintiles and among Australians living outside of major cities. The intervention was estimated to be cost saving (net cost <0 AUD) or cost-effective (i.e., ICER < AUD 169,361/HALY) regardless of the time horizon, with ICERs of 1,073 (95% UI: dominant; 3,503) and 1,956 (95% UI: 1,010; 2,750) AUD/HALY over 10 years and lifetime, respectively. Findings were robust across several sensitivity analyses. Key limitations of the study include the lack of recent data of TFA intake and the small sample sizes used to estimate intakes in subgroups. As with all simulation models, our study does not prove that a ban of iTFA will prevent IHD, rather, it provides the best quantitative estimates and corresponding uncertainty of a potential effect in the absence of stronger direct evidence. CONCLUSIONS Our model estimates that a ban of iTFAs could avert substantial numbers of IHD events and deaths in Australia and would likely be a highly cost-effective strategy to reduce social-economic and urban-rural inequalities in health. These findings suggest that elimination of iTFA can cost-effectively improve health and health equality even in countries with low iTFA intake.
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Affiliation(s)
- Matti Marklund
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Australia
| | | | - Jason H. Y. Wu
- The George Institute for Global Health and the Faculty of Medicine, University of New South Wales, Sydney, Australia
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Marklund M, Zheng M, Veerman JL, Wu JHY. Estimated Health Benefits, Costs, and Cost-Effectiveness of Eliminating Industrial Trans-Fatty acids in Australia. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa064_010] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
To assess the potential cost-effectiveness, health gains, and effects on health equality of eliminating industrial trans-fatty acids (TFAs) from the Australian food supply.
Methods
Markov cohort models were used to estimate the cost-effectiveness and policy impact on (ischemic heart disease) IHD burden and health equity of a national ban of industrial TFAs in Australia. Intake of TFA was assessed using the 2011–2012 Australian National Nutrition and Physical Activity Survey. The IHD burden attributable to TFA was calculated by comparing the current level of TFA intake to a counterfactual setting (0.5% energy per day from TFA; corresponding to TFA intake only from non-industrial sources, e.g., dairy foods). Policy costs, avoided IHD events and deaths, health-adjusted life years (HALYs) gained, and IHD-related healthcare costs saved were estimated over 10 years and lifetime of the adult Australian population. Cost-effectiveness was assessed by calculation of incremental cost-effectiveness ratios (ICER) using net policy cost and HALYs gained. Health benefits and health care cost changes were also assessed in subgroups based on socioeconomic status and remoteness.
Results
Elimination of industrial TFA was estimated to prevent 2,294 (95% uncertainty interval [UI]: 1,765; 2,851) IHD deaths and 9,931 (95% UI: 8,429; 11,532) IHD events over the first 10 years. The greatest health benefits were accrued to the most socioeconomically disadvantaged quintiles and among Australians living outside of major cities. The intervention was estimated to be cost-saving or cost-effective (i.e., ICER < 169,361 AUD/HALY) regardless of the time horizon, with ICERs of 1,073 (95% UI: dominant; 3,503) and 1,956 (95% UI: 1,010; 2,750) AUD/HALY over 10 years and life time, respectively. The TFA ban was estimated to be cost-saving or highly cost-effective in sensitivity analyses altering assumptions of post-intervention TFA intake, abundance of TFA-containing products, or discount rate.
Conclusions
A ban of industrial TFAs could avert substantial numbers of IHD events and deaths in Australia and will likely be a highly cost-effective strategy to reduce social-economic and urban-rural inequalities in health.
Funding Sources
National Health and Medical Research Council; and UNSW.
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Affiliation(s)
- Matti Marklund
- Friedman School of Nutrition Science and Policy, Tufts University; The George Institute for Global Health, UNSW
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Schofield D, Zeppel MJB, Tanton R, Veerman JL, Kelly SJ, Passey ME, Shrestha RN. Intellectual disability and autism: socioeconomic impacts of informal caring, projected to 2030. Br J Psychiatry 2019; 215:654-660. [PMID: 31524109 DOI: 10.1192/bjp.2019.204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/24/2022]
Abstract
BACKGROUND Intellectual disability and autism spectrum disorder (ASD) influence the interactions of a person with their environment and generate economic and socioeconomic costs for the person, their family and society. AIMS To estimate costs of lost workforce participation due to informal caring for people with intellectual disability or autism spectrum disorders by estimating lost income to individuals, lost taxation payments to federal government and increased welfare payments. METHOD We used a microsimulation model based on the Australian Bureau of Statistics' Surveys of Disability, Ageing and Carers (population surveys of people aged 15-64), and projected costs of caring from 2015 in 5-year intervals to 2030. RESULTS The model estimated that informal carers of people with intellectual disability and/or ASD in Australia had aggregated lost income of AU$310 million, lost taxation of AU$100 million and increased welfare payments of AU$204 million in 2015. These are projected to increase to AU$432 million, AU$129 million and AU$254 million for income, taxation, and welfare respectively by 2030. The income gap of carers for people with intellectual disability and/or ASD is estimated to increase by 2030, meaning more financial stress for carers. CONCLUSIONS Informal carers of people with intellectual disability and/or ASD experience significant loss of income, leading to increased welfare payments and reduced taxation revenue for governments; these are all projected to increase. Strategic policies supporting informal carers wishing to return to work could improve the financial and psychological impact of having a family member with intellectual disability and/or ASD. DECLARATION OF INTEREST None.
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Affiliation(s)
- Deborah Schofield
- Professor of Health Economics, Centre for Economic Impacts of Genomic Medicine, Department of Economics, Faculty of Business and Economics, Macquarie University, Australia
| | - Melanie J B Zeppel
- Senior Research Fellow, Centre for Economic Impacts of Genomic Medicine, Department of Economics, Faculty of Business and Economics, Macquarie University, Australia
| | - Robert Tanton
- Professor, National Centre for Social and Economic Modelling, University of Canberra, Australia
| | | | - Simon J Kelly
- Professor, National Centre for Social and Economic Modelling, University of Canberra, Australia
| | - Megan E Passey
- Associate Professor, University Centre for Rural Health, University of Sydney, Australia
| | - Rupendra N Shrestha
- Senior Research Fellow, Centre for Economic Impacts of Genomic Medicine, Department of Economics, Faculty of Business and Economics, Macquarie University, Australia
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Zahir SF, Griffin A, Veerman JL, Magliano DJ, Shaw JE, Cao KAL, Mehdi AM. Exploring the association between BMI and mortality in Australian women and men with and without diabetes: the AusDiab study. Diabetologia 2019; 62:754-758. [PMID: 30809715 PMCID: PMC6450848 DOI: 10.1007/s00125-019-4830-4] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 01/22/2019] [Indexed: 01/04/2023]
Abstract
AIMS/HYPOTHESIS There is conflicting evidence about the obesity paradox-the counterintuitive survival advantage of obesity among certain subpopulations of individuals with chronic conditions. It is believed that results supporting the obesity paradox are due to methodological flaws, such as collider bias. The aim of this study was to examine the association between obesity and mortality in Australian men and women. In addition, we explored whether obesity would appear to be protective if the analysis was restricted to a subpopulation with disease, and to discuss the potential role of collider bias in producing such a result. METHODS The examined cohort included 10,575 Australian adults (4844 men and 5731 women) aged 25-91 years who were recruited for the AusDiab baseline survey in 1999 and followed-up through 2014. The main predictor variable was BMI categorised as normal weight (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2) and obese (≥30 kg/m2), and the outcome of interest was all-cause mortality. Hazard ratios were estimated from Cox proportional hazards regression models in the entire cohort and then in subpopulations with and without diabetes. RESULTS A total of 1477 deaths occurred during 145,384 person-years (median 14.6 years) of follow-up. Mortality was higher in obese than in normal-weight individuals for the full population (HR 1.18; 95% CI 1.05, 1.32). When an interaction between diabetes status and BMI category was added to the model, there was no evidence of an interaction between BMI and diabetes status (p = 0.92). When participants with and without diabetes were analysed separately, there was no evidence of an association between obesity and mortality in those with diabetes (HR 0.91; 95% CI 0.62, 1.33). CONCLUSIONS/INTERPRETATION In the entire AusDiab cohort, we found a significantly higher mortality among obese participants as compared with their normal-weight counterparts. We found no difference in the obesity-mortality association between individuals with and without diabetes.
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Affiliation(s)
- Syeda F Zahir
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Level 6, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
| | | | | | | | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Kim-Anh Lê Cao
- Melbourne Integrative Genomics, School of Mathematics and Statistics, University of Melbourne, Melbourne, VIC, Australia
| | - Ahmed M Mehdi
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, Level 6, Translational Research Institute, 37 Kent Street, Woolloongabba, QLD, 4102, Australia.
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21
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Zapata-Diomedi B, Boulangé C, Giles-Corti B, Phelan K, Washington S, Veerman JL, Gunn LD. Physical activity-related health and economic benefits of building walkable neighbourhoods: a modelled comparison between brownfield and greenfield developments. Int J Behav Nutr Phys Act 2019; 16:11. [PMID: 30782142 PMCID: PMC6381620 DOI: 10.1186/s12966-019-0775-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/22/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND A consensus is emerging in the literature that urban form can impact health by either facilitating or deterring physical activity (PA). However, there is a lack of evidence measuring population health and the economic benefits relating to alternative urban forms. We examined the issue of housing people within two distinct types of urban development forms: a medium-density brownfield development in an established area with existing amenities (e.g. daily living destinations, transit), and a low-density suburban greenfield development. We predicted the health and economic benefits of a brownfield development compared with a greenfield development through their influence on PA. METHODS We combined a new Walkability Planning Support System (Walkability PSS) with a quantitative health impact assessment model. We used the Walkability PSS to estimate the probability of residents' transport walking, based on their exposure to urban form in the brownfield and greenfield developments. We developed the underlying algorithms of the Walkability PSS using multi-level multivariate logistic regression analysis based on self-reported data for transport walking from the Victorian Integrated Survey of Transport and Activity 2009-10 and objectively measured urban form in the developments. We derived the difference in transport walking minutes per week based on the probability of transport walking in each of the developments and the average transport walking time per week among those who reported any transport walking. We then used the well-established method of the proportional multi-cohort multi-state life table model to translate the difference in transport walking minutes per week into health and economic benefits. RESULTS If adult residents living in the greenfield neighbourhood were instead exposed to the urban development form observed in a brownfield neighbourhood, the incidence and mortality of physical inactivity-related chronic diseases would decrease. Over the life course of the exposed population (21,000), we estimated 1600 health-adjusted life years gained and economic benefits of A$94 million. DISCUSSION Our findings indicate that planning policies that create walkable neighbourhoods with access to shops, services and public transport will lead to substantial health and economic benefits associated with reduced incidence of physical inactivity related diseases and premature death.
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Affiliation(s)
- Belén Zapata-Diomedi
- School of Medicine, Griffith University Gold Coast, Building 40, level 8, room 8.38, Gold Coast, QLD, 4222, Australia.
| | - Claire Boulangé
- RMIT University, Healthy Liveable Cities Group, Centre for Urban Research, Melbourne, Victoria, Australia
| | - Billie Giles-Corti
- RMIT University, Healthy Liveable Cities Group, Centre for Urban Research, Melbourne, Victoria, Australia
| | - Kath Phelan
- Infrastructure Victoria, Melbourne, Victoria, Australia
| | - Simon Washington
- School of Civil Engineering, the University of Queensland, Brisbane, Queensland, Australia
| | - J Lennert Veerman
- School of Medicine, Griffith University Gold Coast, Building 40, level 8, room 8.38, Gold Coast, QLD, 4222, Australia.,Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Cancer Research Division, Cancer Council NSW, Woolloomooloo, New South Wales, Australia
| | - Lucy Dubrelle Gunn
- RMIT University, Healthy Liveable Cities Group, Centre for Urban Research, Melbourne, Victoria, Australia
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Aminde LN, Cobiac LJ, Veerman JL. Potential impact of a modest reduction in salt intake on blood pressure, cardiovascular disease burden and premature mortality: a modelling study. Open Heart 2019; 6:e000943. [PMID: 30997132 PMCID: PMC6443119 DOI: 10.1136/openhrt-2018-000943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/16/2018] [Accepted: 12/20/2018] [Indexed: 01/04/2023] Open
Abstract
Objective To assess the potential impact of reduction in salt intake on the burden of cardiovascular disease (CVD) and premature mortality in Cameroon. Methods Using a multicohort proportional multistate life table model with Markov process, we modelled the impact of WHO's recommended 30% relative reduction in population-wide sodium intake on the CVD burden for Cameroonian adults alive in 2016. Deterministic and probabilistic sensitivity analyses were conducted and used to quantify uncertainty. Results Over the lifetime, incidence is predicted to decrease by 5.2% (95% uncertainty interval (UI) 4.6 to 5.7) for ischaemic heart disease (IHD), 6.6% (95% UI 5.9 to 7.4) for haemorrhagic strokes, 4.8% (95% UI 4.2 to 5.4) for ischaemic strokes and 12.9% (95% UI 12.4 to 13.5) for hypertensive heart disease (HHD). Mortality over the lifetime is projected to reduce by 5.1% (95% UI 4.5 to 5.6) for IHD, by 6.9% (95% UI 6.1 to 7.7) for haemorrhagic stroke, by 4.5% (95% UI 4.0 to 5.1) for ischaemic stroke and by 13.3% (95% UI 12.9 to 13.7) for HHD. About 776 400 (95% UI 712 600 to 841 200) health-adjusted life years could be gained, and life expectancy might increase by 0.23 years and 0.20 years for men and women, respectively. A projected 16.8% change (reduction) between 2016 and 2030 in probability of premature mortality due to CVD would occur if population salt reduction recommended by WHO is attained. Conclusion Achieving the 30% reduction in sodium intake recommended by WHO could considerably decrease the burden of CVD. Targeting blood pressure via decreasing population salt intake could translate in significant reductions in premature CVD mortality in Cameroon by 2030.
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Affiliation(s)
- Leopold Ndemnge Aminde
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Non-communicable Diseases Unit, Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon
| | - Linda J Cobiac
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - J Lennert Veerman
- Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, Griffith University, Gold Coast, Queensland, Australia
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23
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Bourke EJ, Veerman JL. The potential impact of taxing sugar drinks on health inequality in Indonesia. BMJ Glob Health 2018; 3:e000923. [PMID: 30555724 PMCID: PMC6267297 DOI: 10.1136/bmjgh-2018-000923] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/06/2018] [Accepted: 10/14/2018] [Indexed: 11/17/2022] Open
Abstract
Background Evidence suggests reducing consumption of sugar-sweetened beverages is important to reducing weight gain and chronic disease risk. Indonesia’s large population is a growing market for sugar-sweetened beverages. Taxation to reduce consumption is of interest, but considered fiscally regressive. Little is known about differential effects between income groups in low-income countries. Methods This modelling study uses a proportional multistate life table to model reduced daily energy intake following a $0.30 per litre tax on sugar-sweetened beverages and subsequent shifts in Body Mass Index (BMI) distribution for income groups in Indonesia. Energy balance equations calculate reduced BMI. Reduced incidence of type 2 diabetes mellitus, ischaemic heart disease and stroke is determined from the relative risk of the BMI shift and subsequent health-adjusted life years gained calculated. Results The tax’s effect was greater for higher income quintiles than lower. Energy intake reduced most in higher income quintiles. Cases of overweight and obesity for women decreased by approximately 15 000 in the lowest income quintile, but 417 000 for the highest. For men, this was 12 000 and 415 000. Over 25 years, 63 000 cases of diabetes were averted in the lowest quintile and 1 487 000 in the highest. Similar magnitudes were observed for stroke and ischaemic heart disease. Tax paid over 25 years was $0.5 billion for the lowest income quintile and $15.1 billion for the highest. Conclusion Sugar-sweetened beverage taxation can help to reduce the number of overweight and obese, and prevent over a million cases of diabetes in Indonesia. Higher income groups would benefit more than lower income groups. The tax would raise $920 million in the first year and $27.3 billion over 25 years.
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Affiliation(s)
- Emily Jane Bourke
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - J Lennert Veerman
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,School of Medicine, Griffith University - Gold Coast Campus, Southport, Queensland, Australia
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24
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Aminde LN, Takah NF, Zapata-Diomedi B, Veerman JL. Primary and secondary prevention interventions for cardiovascular disease in low-income and middle-income countries: a systematic review of economic evaluations. Cost Eff Resour Alloc 2018; 16:22. [PMID: 29983644 PMCID: PMC6003072 DOI: 10.1186/s12962-018-0108-9] [Citation(s) in RCA: 29] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 06/09/2018] [Indexed: 12/12/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low- and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study. Methods In this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC. Several medical (PubMed, EMBASE, SCOPUS, Web of Science) and economic (EconLit, NHS EED) databases and grey literature were searched. Screening of studies and data extraction was done independently by two reviewers. Drummond’s checklist and the National Institute for Health and Care Excellence quality rating scale were used in the quality appraisal for all studies used to inform this evidence synthesis. Results From a pool of 4059 records, 94 full texts were read and 50 studies, which met our inclusion criteria, were retained for our narrative synthesis. Most of the studies were from middle-income countries and predominantly of high quality. The majority were modelled evaluations, and there was significant heterogeneity in methods. Primary prevention studies dominated secondary prevention. Most of the economic evaluations were performed for pharmacological interventions focusing on blood pressure, cholesterol lowering and antiplatelet aggregants. The greatest majority were cost-effective. Compared to individual-based interventions, population-based interventions were few and mostly targeted reduction in sodium intake and tobacco control strategies. These were very cost-effective with many being cost-saving. Conclusions This evidence synthesis provides a contemporary update on interventions that offer good value for money in LMICs. Population-based interventions especially those targeting reduction in salt intake and tobacco control are very cost-effective in LMICs with potential to generate economic gains that can be reinvested to improve health and/or other sectors. While this evidence is relevant for policy across these regions, decision makers should additionally take into account other multi-sectoral perspectives, including considerations in budget impact, fairness, affordability and implementation while setting priorities for resource allocation. Electronic supplementary material The online version of this article (10.1186/s12962-018-0108-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Leopold Ndemnge Aminde
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia.,Non-communicable Diseases Unit, Clinical Research Education, Network & Consultancy, Douala, Cameroon
| | | | - Belen Zapata-Diomedi
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia
| | - J Lennert Veerman
- 1Faculty of Medicine, School of Public Health, The University of Queensland, Brisbane, QLD 4006 Australia.,4School of Medicine, Griffith University, Gold Coast, QLD 4222 Australia.,5Cancer Research Division, Cancer Council NSW, Woolloomooloo, NSW 2011 Australia
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25
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Sia AD, Williams LJ, Pasco JA, Jacka FN, Brennan-Olsen SL, Veerman JL. The Population Mean Mood Predicts The Prevalence of Depression in an Australian Context. Aust N Z J Psychiatry 2018; 52:461-472. [PMID: 29143531 DOI: 10.1177/0004867417740207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 12/29/2022]
Abstract
BACKGROUND The mean population mood has been demonstrated to strongly correlate with the prevalence of depression in European populations. Mean population mood has, therefore, been proposed as both a metric to measure the impact of population-level interventions to prevent depression and a target for public health policy. AIM To demonstrate the relationship between mean population mood and the prevalence of depression using Australian data in order to broaden the applicability of this finding to the Australian population. METHODS We used data from the Geelong Osteoporosis Study to assess the relationship between population mean mood and depression. Participants reported mood symptoms via questionnaire (the Hospital Anxiety and Depression Scale or General Health Questionnaire-12). Depression was diagnosed by semi-structured clinical interview ( Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Non-patient Edition). Stratification by age and socio-economic status was used to create subpopulation groups. Socio-economic status was measured using Index of Relative Socio-economic Advantage and Disadvantage quintiles, an area-based measure based on Australian census data and published by the Australian Bureau of Statistics. The mean subpopulation questionnaire scores and subpopulation prevalence of depression were then analysed using regression and predictive models. RESULTS Mean subpopulation questionnaire scores correlated well with the prevalence of depression across socio-economic status groups in women but not age groups. Questionnaire scores tended to underestimate the prevalence of depression in the young and overestimate it in the elderly. CONCLUSION The mean population mood was demonstrated to correlate with the population prevalence of depression in Australia for women, but not for men. Due to the issues of questionnaire validity and sample size in the oldest age groups, the age analysis is unlikely to be a representative of population characteristics. Further work to identify population determinants of mean mood could potentially create policy targets to reduce the prevalence of depression.
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Affiliation(s)
- Aaron D Sia
- 1 Department of Medicine, Queen Elizabeth II Jubilee Hospital, Brisbane, QLD, Australia
| | | | - Julie A Pasco
- 2 Deakin University, Geelong, VIC, Australia.,3 Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, VIC, Australia
| | - Felice N Jacka
- 2 Deakin University, Geelong, VIC, Australia.,4 Centre for Adolescent Health, Murdoch Children's Research Institute, VIC, Australia.,5 Black Dog Institute, NSW, Australia
| | - Sharon L Brennan-Olsen
- 2 Deakin University, Geelong, VIC, Australia.,3 Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, VIC, Australia.,6 Australian Institute for Musculoskeletal Science (AIMSS), St Albans, VIC, Australia
| | - J Lennert Veerman
- 7 Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia.,8 School of Public Health, University of Queensland, Brisbane, QLD, Australia
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Zapata-Diomedi B, Gunn L, Giles-Corti B, Shiell A, Lennert Veerman J. A method for the inclusion of physical activity-related health benefits in cost-benefit analysis of built environment initiatives. Prev Med 2018; 106:224-230. [PMID: 29126917 DOI: 10.1016/j.ypmed.2017.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 07/14/2017] [Revised: 10/30/2017] [Accepted: 11/02/2017] [Indexed: 12/27/2022]
Abstract
The built environment has a significant influence on population levels of physical activity (PA) and therefore health. However, PA-related health benefits are seldom considered in transport and urban planning (i.e. built environment interventions) cost-benefit analysis. Cost-benefit analysis implies that the benefits of any initiative are valued in monetary terms to make them commensurable with costs. This leads to the need for monetised values of the health benefits of PA. The aim of this study was to explore a method for the incorporation of monetised PA-related health benefits in cost-benefit analysis of built environment interventions. Firstly, we estimated the change in population level of PA attributable to a change in the built environment due to the intervention. Then, changes in population levels of PA were translated into monetary values. For the first step we used estimates from the literature for the association of built environment features with physical activity outcomes. For the second step we used the multi-cohort proportional multi-state life table model to predict changes in health-adjusted life years and health care costs as a function of changes in PA. Finally, we monetised health-adjusted life years using the value of a statistical life year. Future research could adapt these methods to assess the health and economic impacts of specific urban development scenarios by working in collaboration with urban planners.
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Affiliation(s)
- Belen Zapata-Diomedi
- The University of Queensland, School of Public Health, Herston Road, Herston, 4006, Brisbane, Queensland, Australia.
| | - Lucy Gunn
- RMIT University, Healthy Liveable Cities Group, Centre for Urban Research, Melbourne, 3000, Victoria, Australia
| | - Billie Giles-Corti
- RMIT University, Healthy Liveable Cities Group, Centre for Urban Research, Melbourne, 3000, Victoria, Australia
| | - Alan Shiell
- La Trobe University, Department of Public Health, Plenty Road, Bundoora, 3083, Victoria, Australia
| | - J Lennert Veerman
- The University of Queensland, School of Public Health, Herston Road, Herston, 4006, Brisbane, Queensland, Australia; Cancer Council NSW, Woolloomooloo, 2011, Sydney, NSW, Australia; Sydney Medical School, Sydney, 2006, NSW, Australia
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Zapata-Diomedi B, Knibbs LD, Ware RS, Heesch KC, Tainio M, Woodcock J, Veerman JL. A shift from motorised travel to active transport: What are the potential health gains for an Australian city? PLoS One 2017; 12:e0184799. [PMID: 29020093 PMCID: PMC5636090 DOI: 10.1371/journal.pone.0184799] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 03/24/2017] [Accepted: 08/31/2017] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION An alarmingly high proportion of the Australian adult population does not meet national physical activity guidelines (57%). This is concerning because physical inactivity is a risk factor for several chronic diseases. In recent years, an increasing emphasis has been placed on the potential for transport and urban planning to contribute to increased physical activity via greater uptake of active transport (walking, cycling and public transport). In this study, we aimed to estimate the potential health gains and savings in health care costs of an Australian city achieving its stated travel targets for the use of active transport. METHODS Additional active transport time was estimated for the hypothetical scenario of Brisbane (1.1 million population 2013) in Australia achieving specified travel targets. A multi-state life table model was used to estimate the number of health-adjusted life years, life-years, changes in the burden of diseases and injuries, and the health care costs associated with changes in physical activity, fine particle (<2.5 μm; PM2.5) exposure, and road trauma attributable to a shift from motorised travel to active transport. Sensitivity analyses were conducted to test alternative modelling assumptions. RESULTS Over the life course of the Brisbane adult population in 2013 (860,000 persons), 33,000 health-adjusted life years could be gained if the travel targets were achieved by 2026. This was mainly due to lower risks of physical inactivity-related diseases, with life course reductions in prevalence and mortality risk in the range of 1.5%-6.0%. Prevalence and mortality of respiratory diseases increased slightly (≥0.27%) due to increased exposure of larger numbers of cyclists and pedestrians to fine particles. The burden of road trauma increased by 30% for mortality and 7% for years lived with disability. We calculated substantial net savings ($AU183 million, 2013 values) in health care costs. CONCLUSION In cities, such as Brisbane, where over 80% of trips are made by private cars, shifts towards walking, cycling and public transport would cause substantial net health benefits and savings in health care costs. However, for such shifts to occur, investments are needed to ensure safe and convenient travel.
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Affiliation(s)
- Belen Zapata-Diomedi
- The University of Queensland, School of Public Health, Brisbane, Queensland, Australia
- * E-mail:
| | - Luke D. Knibbs
- The University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - Robert S. Ware
- The University of Queensland, School of Public Health, Brisbane, Queensland, Australia
- Griffith University, Menzies Health Institute Queensland, Brisbane, Queensland, Australia
| | - Kristiann C. Heesch
- Queensland University of Technology, Institute of Health & Biomedical Innovation and the School of Public Health and Social Work, Brisbane, Queensland, Australia
| | - Marko Tainio
- MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridgeshire, Cambridge, United Kingdom
- Systems Research Institute, Polish Academy of Sciences, Mazovia, Warsaw, Poland
| | - James Woodcock
- MRC Epidemiology Unit & UKCRC Centre for Diet and Activity Research (CEDAR), University of Cambridge School of Clinical Medicine, Cambridgeshire, Cambridge, United Kingdom
| | - J. Lennert Veerman
- The University of Queensland, School of Public Health, Brisbane, Queensland, Australia
- Cancer Council NSW, Sydney, New South Wales, Australia
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Allen J, Rey-Conde T, North JB, Kruger P, Babidge WJ, Wysocki AP, Ware RS, Veerman JL, Maddern GJ. Processes of care in surgical patients who died with hospital-acquired infections in Australian hospitals. J Hosp Infect 2017; 99:17-23. [PMID: 28890286 DOI: 10.1016/j.jhin.2017.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/01/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infection may complicate surgical patients' hospital admission. The effect of hospital-acquired infections (HAIs) on processes of care among surgical patients who died is unknown. AIM To investigate the effect of HAIs on processes of care in surgical patients who died in hospital. METHODS Surgeon-recorded infection data extracted from a national Australian surgical mortality audit (2012-2016) were grouped into HAIs and no infection. The audit included all-age surgical patients, who died in hospital. Not all patients had surgery. Excluded from analysis were patients with community-acquired infection and those with missing timing of infection. Multivariate logistic regression was used to determine the adjusted effects of HAIs on the processes of care in these patients. Costs associated with HAIs were estimated. FINDINGS One-fifth of surgical patients who died did so with an HAI (2242 out of 11,681; 19.2%). HAI patients had increased processes of care compared to those who died without infection: postoperative complications [51.0% vs 30.3%; adjusted odds ratio (aOR): 2.20; 95% confidence interval (CI): 1.98-2.45; P < 0.001]; unplanned reoperations (22.6% vs 10.9%; aOR: 2.38; 95% CI: 2.09-2.71; P < 0.001) and unplanned intensive care unit admission (29.3% vs 14.8%; aOR: 2.18; 95% CI: 1.94-2.45; P < 0.001). HAI patients had longer hospital admissions and greater hospital costs than those without infection. CONCLUSION HAIs were associated with increased processes of care and costs in surgical patients who died; these outcomes need to be investigated in surgical patients who survive.
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Affiliation(s)
- J Allen
- Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, East Brisbane, Queensland, Australia; University of Queensland, School of Public Health, Herston, Brisbane, Queensland, Australia.
| | - T Rey-Conde
- Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, East Brisbane, Queensland, Australia
| | - J B North
- Queensland Audit of Surgical Mortality, Royal Australasian College of Surgeons, East Brisbane, Queensland, Australia
| | - P Kruger
- Intensive Care Unit, Princess Alexandra Hospital, Brisbane, Woolloongabba, Queensland, Australia; University of Queensland, School of Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - W J Babidge
- Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia
| | - A P Wysocki
- Department of Surgery, Logan Hospital, Yatala, Queensland, Australia
| | - R S Ware
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - J L Veerman
- University of Queensland, School of Public Health, Herston, Brisbane, Queensland, Australia; Cancer Council NSW, Kings Cross Sydney, New South Wales, Australia
| | - G J Maddern
- Australian and New Zealand Audit of Surgical Mortality, Royal Australasian College of Surgeons, North Adelaide, South Australia, Australia; Discipline of Surgery, University of Adelaide and The Queen Elizabeth Hospital, Woodville, Adelaide, South Australia, Australia
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Aminde LN, Takah N, Ngwasiri C, Noubiap JJ, Tindong M, Dzudie A, Veerman JL. Population awareness of cardiovascular disease and its risk factors in Buea, Cameroon. BMC Public Health 2017; 17:545. [PMID: 28583117 PMCID: PMC5460458 DOI: 10.1186/s12889-017-4477-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 05/30/2017] [Indexed: 12/30/2022] Open
Abstract
Background Adequate awareness of cardiovascular diseases (CVD) and their risk factors may help reduce the population’s exposure to modifiable risk factors and thereby contribute to prevention and control strategies. There is limited data on knowledge among the general population in sub-Saharan Africa regarding CVD and risk factors. We aimed to assess the population awareness (and associated factors) of CVD types and risk factors in Buea, Cameroon. Methods This was a community-based cross-sectional study conducted in 2016 among randomly selected adults (>18 years). Data on socio-demographic characteristics, knowledge about CVD types, their risk factors and warning signs for CVD events (stroke and heart attack) were acquired using a self-administered questionnaire. Logistic regression analysis was used to investigate factors associated with moderate-to-good knowledge. Results Of the 1162 participants (61.7% women, mean age 32 years), 52.5% had overall poor knowledge (mean score 12.1 on total of 25) on CVD with only about a quarter correctly identifying types of CVD. Overall, 36, 63 and 45% were unaware of CVD risk factors, warning signs of heart attack and stroke respectively. In multivariable analysis; high level of education (aOR = 2.26 (1.69–3.02), p < 0.0001), high monthly income (aOR = 1.64 (1.07–2.51), p = 0.023), having a family history of CVD (aOR = 1.59 (1.21–2.09), p = 0.001) and being a former smoker (aOR = 1.11 (1.02–1.95), p = 0.043) were associated with moderate-to-good knowledge. Conclusions There exists a significant gap in population awareness about CVDs in Cameroon and this is similar to previous reports. Cost-effective community health education interventions taking into account socioeconomic status may be beneficial in this setting.
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Affiliation(s)
- Leopold Ndemnge Aminde
- School of Public Health, Faculty of Medicine, The University of Queensland, QLD, Brisbane, 4006, Australia. .,Non-communicable diseases Unit, Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon.
| | - Noah Takah
- Non-communicable diseases Unit, Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon.,London School of Hygiene and Tropical Medicine, London, UK
| | - Calypse Ngwasiri
- Non-communicable diseases Unit, Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon.,Department of Internal Medicine, Faculty of Health Sciences, University of Buea and Douala General Hospital, Douala, Cameroon
| | - Jean Jacques Noubiap
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Maxime Tindong
- Non-communicable diseases Unit, Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon.,Universite Libres de Bruxelles, Brussels, Belgium
| | - Anastase Dzudie
- Non-communicable diseases Unit, Clinical Research Education, Networking and Consultancy (CRENC), Douala, Cameroon.,Department of Internal Medicine, Faculty of Health Sciences, University of Buea and Douala General Hospital, Douala, Cameroon.,NIH Millennium Fogarty Chronic Disease Leadership Program and Soweto Research Group, Department of Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - J Lennert Veerman
- School of Public Health, Faculty of Medicine, The University of Queensland, QLD, Brisbane, 4006, Australia.,Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia
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Zapata-Diomedi B, Herrera AMM, Veerman JL. Corrigendum to "The effects of built environment attributes on physical activity-related health and health care costs outcomes in Australia" [Health Place 42 (2016) 19-29]. Health Place 2017; 54:253-256. [PMID: 28473180 DOI: 10.1016/j.healthplace.2017.04.004] [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] [Indexed: 11/29/2022]
Affiliation(s)
- Belen Zapata-Diomedi
- The University of Queensland, School of Public Health, Herston, Queensland 4006, Australia.
| | | | - J Lennert Veerman
- The University of Queensland, School of Public Health, Herston, Queensland 4006, Australia
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Nomaguchi T, Cunich M, Zapata-Diomedi B, Veerman JL. The impact on productivity of a hypothetical tax on sugar-sweetened beverages. Health Policy 2017; 121:715-725. [PMID: 28420538 DOI: 10.1016/j.healthpol.2017.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 03/27/2017] [Accepted: 04/01/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To quantify the potential impact of an additional 20% tax on sugar-sweetened beverages (SSBs) on productivity in Australia. METHODS We used a multi-state lifetable Markov model to examine the potential impact of an additional 20% tax on SSBs on total lifetime productivity in the paid and unpaid sectors of the economy. The study population consisted of Australians aged 20 years or older in 2010, whose health and other relevant outcomes were modelled over their remaining lifetime. RESULTS The SSBs tax was estimated to reduce the number of people with obesity by 1.96% of the entire population (437,000 fewer persons with obesity), and reduce the number of employees with obesity by 317,000 persons. These effects translated into productivity gains in the paid sector of AU$751 million for the working-age population (95% confidence interval: AU$565 million to AU$954 million), using the human capital approach. In the unpaid sector, the potential productivity gains amounted to AU$1172 million (AU$929 million to AU$1435 million) using the replacement cost method. These productivity benefits are in addition to the health benefits of 35,000 life years gained and a reduction in healthcare costs of AU$425 million. CONCLUSIONS An additional 20% tax on SSBs not only improves health outcomes and reduces healthcare costs, but provides productivity gains in both the paid and unpaid sectors of the economy.
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Affiliation(s)
- Takeshi Nomaguchi
- Faculty of Business, Economics and Law, The University of Queensland, Brisbane, Queensland 4072, Australia.
| | - Michelle Cunich
- Faculty of Pharmacy, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales 2006, Australia
| | - Belen Zapata-Diomedi
- School of Public Health, The University of Queensland, Brisbane, Queensland 4006, Australia
| | - J Lennert Veerman
- Cancer Council NSW, 2011, Australia; School of Public Health, The University of Queensland, Brisbane, Queensland 4006, Australia
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Brown V, Moodie M, Mantilla Herrera AM, Veerman JL, Carter R. Active transport and obesity prevention - A transportation sector obesity impact scoping review and assessment for Melbourne, Australia. Prev Med 2017; 96:49-66. [PMID: 28011134 DOI: 10.1016/j.ypmed.2016.12.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 07/19/2016] [Revised: 12/05/2016] [Accepted: 12/15/2016] [Indexed: 01/17/2023]
Abstract
Given the alarming prevalence of obesity worldwide and the need for interventions to halt the growing epidemic, more evidence on the role and impact of transport interventions for obesity prevention is required. This study conducts a scoping review of the current evidence of association between modes of transport (motor vehicle, walking, cycling and public transport) and obesity-related outcomes. Eleven reviews and thirty-three primary studies exploring associations between transport behaviours and obesity were identified. Cohort simulation Markov modelling was used to estimate the effects of body mass index (BMI) change on health outcomes and health care costs of diseases causally related to obesity in the Melbourne, Australia population. Results suggest that evidence for an obesity effect of transport behaviours is inconclusive (29% of published studies reported expected associations, 33% mixed associations), and any potential BMI effect is likely to be relatively small. Hypothetical scenario analyses suggest that active transport interventions may contribute small but significant obesity-related health benefits across populations (approximately 65 health adjusted life years gained per year). Therefore active transport interventions that are low cost and targeted to those most amenable to modal switch are the most likely to be effective and cost-effective from an obesity prevention perspective. The uncertain but potentially significant opportunity for health benefits warrants the collection of more and better quality evidence to fully understand the potential relationships between transport behaviours and obesity. Such evidence would contribute to the obesity prevention dialogue and inform policy across the transportation, health and environmental sectors.
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Affiliation(s)
- V Brown
- Centre for Research Excellence in Obesity Policy and Food Systems, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia; Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria 3220, Australia.
| | - M Moodie
- Centre for Research Excellence in Obesity Policy and Food Systems, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia; Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria 3220, Australia
| | - A M Mantilla Herrera
- Centre for Research Excellence in Obesity Policy and Food Systems, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - J L Veerman
- Centre for Research Excellence in Obesity Policy and Food Systems, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia; School of Public Health, The University of Queensland, Brisbane, Australia
| | - R Carter
- Centre for Research Excellence in Obesity Policy and Food Systems, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria 3220, Australia; Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Victoria 3220, Australia
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Aminde LN, Atem JA, Kengne AP, Dzudie A, Veerman JL. Body mass index-measured adiposity and population attributability of associated factors: a population-based study from Buea, Cameroon. BMC Obes 2017; 4:1. [PMID: 28078091 PMCID: PMC5219758 DOI: 10.1186/s40608-016-0139-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 12/19/2016] [Indexed: 12/21/2022]
Abstract
Background Obesity is currently a global health challenge driven by a mix of behavioural, environmental and genetic factors. Up to date population-based disease burden estimates are needed to guide successful prevention and control efforts in African countries. We investigated the prevalence and population attributable fractions of overweight and obesity in Buea, the Southwest region of Cameroon. Methods Data are from a community-based cross-sectional study involving randomly selected adults conducted in 2016. Body mass index (BMI) was categorized according to the WHO classification. Multivariable logistic regressions were used to investigate factors independently associated with obesity. Corresponding population attributable fractions were estimated. Results Among the 1,139 participants, age-standardized prevalence (95% CI) of overweight and obesity were; 36.5 (33.7–39.3) and 11.1 (9.3–12.9) percent respectively. Mean BMI was 25.3 ± 4.3 kg/m2; women were heavier than men (25.8 vs. 24.4 kg/m2; p <0.0001). Factors associated with obesity were; female gender [odds ratio 3.20 (95% CI: 1.93–5.59)], age > 31 years [3.21 (1.86–5.28)] and being married [2.10 (1.60–3.51)]. At the population level; older age, being married, low level of education, high monthly income and physical inactivity accounted respectively for 11.9%, 21.8%, 11.6%, 6.4% and 8.7% of overweight and obesity among the women, while older age and being married explained 9.2% and 28.3% of overweight and obesity in men. Conclusion The prevalence of overweight and obesity in this semi-urban Cameroonian population is high, affecting over a third of individuals. Community-based interventions to control weight would need to take into account gender specificities and socio-economic status.
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Affiliation(s)
- Leopold Ndemnge Aminde
- The University of Queensland, School of Public Health, Herston, QLD 4006 Australia ; Non-communicable Diseases Unit, Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon
| | - Jeannine A Atem
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Andre Pascal Kengne
- Non-communicable Diseases Unit, Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon ; South African Medical Research Council and University of Cape Town, Cape Town, South Africa
| | - Anastase Dzudie
- Non-communicable Diseases Unit, Clinical Research Education, Networking & Consultancy (CRENC), Douala, Cameroon ; Faculty of Health Sciences, University of Buea, Buea, Cameroon ; Department of Medicine, Douala General Hospital and Faculty of Medicine & Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon
| | - J Lennert Veerman
- The University of Queensland, School of Public Health, Herston, QLD 4006 Australia
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Reeves MM, Terranova CO, Erickson JM, Job JR, Brookes DSK, McCarthy N, Hickman IJ, Lawler SP, Fjeldsoe BS, Healy GN, Winkler EAH, Janda M, Veerman JL, Ware RS, Prins JB, Vos T, Demark-Wahnefried W, Eakin EG. Living well after breast cancer randomized controlled trial protocol: evaluating a telephone-delivered weight loss intervention versus usual care in women following treatment for breast cancer. BMC Cancer 2016; 16:830. [PMID: 27793125 PMCID: PMC5086071 DOI: 10.1186/s12885-016-2858-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/19/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Obesity, physical inactivity and poor diet quality have been associated with increased risk of breast cancer-specific and all-cause mortality as well as treatment-related side-effects in breast cancer survivors. Weight loss intervention trials in breast cancer survivors have shown that weight loss is safe and achievable; however, few studies have examined the benefits of such interventions on a broad range of outcomes and few have examined factors important to translation (e.g. feasible delivery method for scaling up, assessment of sustained changes, cost-effectiveness). The Living Well after Breast Cancer randomized controlled trial aims to evaluate a 12-month telephone-delivered weight loss intervention (versus usual care) on weight change and a range of secondary outcomes including cost-effectiveness. METHODS/DESIGN Women (18-75 years; body mass index 25-45 kg/m2) diagnosed with stage I-III breast cancer in the previous 2 years are recruited from public and private hospitals and through the state-based cancer registry (target n = 156). Following baseline assessment, participants are randomized 1:1 to either a 12-month telephone-delivered weight loss intervention (targeting diet and physical activity) or usual care. Data are collected at baseline, 6-months (mid-intervention), 12-months (end-of-intervention) and 18-months (maintenance). The primary outcome is change in weight at 12-months. Secondary outcomes are changes in body composition, bone mineral density, cardio-metabolic and cancer-related biomarkers, metabolic health and chronic disease risk, physical function, patient-reported outcomes (quality of life, fatigue, menopausal symptoms, body image, fear of cancer recurrence) and behaviors (dietary intake, physical activity, sitting time). Data collected at 18-months will be used to assess whether outcomes achieved at end-of-intervention are sustained six months after intervention completion. Cost-effectiveness will be assessed, as will mediators and moderators of intervention effects. DISCUSSION This trial will provide evidence needed to inform the wide-scale provision of weight loss, physical activity and dietary interventions as part of routine survivorship care for breast cancer survivors. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry (ANZCTR) - ACTRN12612000997853 (Registered 18 September 2012).
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Affiliation(s)
- Marina M. Reeves
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Jane M. Erickson
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Jennifer R. Job
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Denise S. K. Brookes
- School of Public Health, The University of Queensland, Brisbane, Australia
- School of Medicine, Children’s Nutrition Research Centre, The University of Queensland, Brisbane, Australia
| | - Nicole McCarthy
- Icon Cancer Care, Wesley Medical Centre, Brisbane, Australia
| | - Ingrid J. Hickman
- Department of Nutrition & Dietetics, Princess Alexandra Hospital, Brisbane, Australia
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Sheleigh P. Lawler
- School of Public Health, The University of Queensland, Brisbane, Australia
| | | | - Genevieve N. Healy
- School of Public Health, The University of Queensland, Brisbane, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- School of Physiotherapy, Curtin University, Perth, Australia
| | | | - Monika Janda
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - J. Lennert Veerman
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Robert S. Ware
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Johannes B. Prins
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | | | - Elizabeth G. Eakin
- School of Public Health, The University of Queensland, Brisbane, Australia
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Lim SS, Allen K, Bhutta ZA, Dandona L, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Hay SI, Holmberg M, Kinfu Y, Kutz MJ, Larson HJ, Liang X, Lopez AD, Lozano R, McNellan CR, Mokdad AH, Mooney MD, Naghavi M, Olsen HE, Pigott DM, Salomon JA, Vos T, Wang H, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abraham B, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NME, Abyu GY, Achoki T, Adebiyi AO, Adedeji IA, Afanvi KA, Afshin A, Agarwal A, Agrawal A, Kiadaliri AA, Ahmadieh H, Ahmed KY, Akanda AS, Akinyemi RO, Akinyemiju TF, Akseer N, Al-Aly Z, Alam K, Alam U, Alasfoor D, AlBuhairan FS, Aldhahri SF, Aldridge RW, Alemu ZA, Ali R, Alkerwi A, Alkhateeb MAB, Alla F, Allebeck P, Allen C, Al-Raddadi R, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Amini H, Ammar W, Amrock SM, Andersen HH, Anderson BO, Anderson GM, Antonio CAT, Anwari P, Ärnlöv J, Artaman A, Asayesh H, Asghar RJ, Atique S, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Barac A, Barber R, Barker-Collo SL, Bärnighausen T, Barrero LH, Barrientos-Gutierrez T, Basu S, Bayou TA, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Béjot Y, Bell ML, Bello AK, Bennett DA, Bensenor IM, Benzian H, Berhane A, Bernabé E, Bernal OA, Betsu BD, Beyene AS, Bhala N, Bhatt S, Biadgilign S, Bienhoff KA, Bikbov B, Binagwaho A, Bisanzio D, Bjertness E, Blore J, Bourne RRA, Brainin M, Brauer M, Brazinova A, Breitborde NJK, Broday DM, Brugha TS, Buchbinder R, Butt ZA, Cahill LE, Campos-Nonato IR, Campuzano JC, Carabin H, Cárdenas R, Carrero JJ, Carter A, Casey D, Caso V, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Cavalleri F, Cecílio P, Chang HY, Chang JC, Charlson FJ, Che X, Chen AZ, Chiang PPC, Chibalabala M, Chisumpa VH, Choi JYJ, Chowdhury R, Christensen H, Ciobanu LG, Cirillo M, Coates MM, Coggeshall M, Cohen AJ, Cooke GS, Cooper C, Cooper LT, Cowie BC, Crump JA, Damtew SA, Dandona R, Dargan PI, Neves JD, Davis AC, Davletov K, de Castro EF, De Leo D, Degenhardt L, Del Gobbo LC, Deribe K, Derrett S, Des Jarlais DC, Deshpande A, deVeber GA, Dey S, Dharmaratne SD, Dhillon PK, Ding EL, Dorsey ER, Doyle KE, Driscoll TR, Duan L, Dubey M, Duncan BB, Ebrahimi H, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Felicio MM, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Ferrari AJ, Fischer F, Fitchett JRA, Fitzmaurice C, Foigt N, Foreman K, Fowkes FGR, Franca EB, Franklin RC, Fraser M, Friedman J, Frostad J, Fürst T, Gabbe B, Garcia-Basteiro AL, Gebre T, Gebrehiwot TT, Gebremedhin AT, Gebru AA, Gessner BD, Gillum RF, Ginawi IAM, Giref AZ, Giroud M, Gishu MD, Giussani G, Godwin W, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Graetz N, Greenwell KF, Griswold M, Gugnani H, Guo Y, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Gyawali B, Haagsma JA, Haakenstad A, Hafezi-Nejad N, Haile D, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hammami M, Hankey GJ, Harb HL, Haro JM, Hassanvand MS, Havmoeller R, Heredia-Pi IB, Hoek HW, Horino M, Horita N, Hosgood HD, Hoy DG, Htet AS, Hu G, Huang H, Iburg KM, Idrisov BT, Inoue M, Islami F, Jacobs TA, Jacobsen KH, Jahanmehr N, Jakovljevic MB, James P, Jansen HAFM, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jee SH, Jeemon P, Jha V, Jiang Y, Jibat T, Jin Y, Jonas JB, Kabir Z, Kalkonde Y, Kamal R, Kan H, Kandel A, Karch A, Karema CK, Karimkhani C, Karunapema P, Kasaeian A, Kassebaum NJ, Kaul A, Kawakami N, Kayibanda JF, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khan G, Khang YH, Khoja TAM, Khosravi A, Khubchandani J, Kieling C, Kim CI, Kim D, Kim S, Kim YJ, Kimokoti RW, Kissoon N, Kivipelto M, Knibbs LD, Kokubo Y, Kolte D, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko M, Krueger H, Defo BK, Kuchenbecker RS, Kuipers EJ, Kulikoff XR, Kulkarni VS, Kumar GA, Kwan GF, Kyu HH, Lal A, Lal DK, Lalloo R, Lam H, Lan Q, Langan SM, Larsson A, Laryea DO, Latif AA, Leasher JL, Leigh J, Leinsalu M, Leung J, Leung R, Levi M, Li Y, Li Y, Lind M, Linn S, Lipshultz SE, Liu PY, Liu S, Liu Y, Lloyd BK, Lo LT, Logroscino G, Lotufo PA, Lucas RM, Lunevicius R, El Razek MMA, Magis-Rodriguez C, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Malta DC, Mapoma CC, Margolis DJ, Martin RV, Martinez-Raga J, Masiye F, Mason-Jones AJ, Massano J, Matzopoulos R, Mayosi BM, McGrath JJ, McKee M, Meaney PA, Mehari A, Mekonnen AB, Melaku YA, Memiah P, Memish ZA, Mendoza W, Mensink GBM, Meretoja A, Meretoja TJ, Mesfin YM, Mhimbira FA, Micha R, Miller TR, Mills EJ, Mirarefin M, Misganaw A, Mitchell PB, Mock CN, Mohammadi A, Mohammed S, Monasta L, de la Cruz Monis J, Hernandez JCM, Montico M, Moradi-Lakeh M, Morawska L, Mori R, Mueller UO, Murdoch ME, Murimira B, Murray J, Murthy GVS, Murthy S, Musa KI, Nachega JB, Nagel G, Naidoo KS, Naldi L, Nangia V, Neal B, Nejjari C, Newton CR, Newton JN, Ngalesoni FN, Nguhiu P, Nguyen G, Le Nguyen Q, Nisar MI, Pete PMN, Nolte S, Nomura M, Norheim OF, Norrving B, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olivares PR, Olusanya BO, Olusanya JO, Opio JN, Oren E, Ortiz A, Osborne RH, Ota E, Owolabi MO, PA M, Park EK, Park HY, Parry CD, Parsaeian M, Patel T, Patel V, Caicedo AJP, Patil ST, Patten SB, Patton GC, Paudel D, Pedro JM, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Pinho C, Pishgar F, Polinder S, Poulton RG, Pourmalek F, Qorbani M, Rabiee RHS, Radfar A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai RK, Rajsic S, Raju M, Ram U, Rana SM, Ranabhat CL, Ranganathan K, Rao PC, Refaat AH, Reitsma MB, Remuzzi G, Resnikoff S, Ribeiro AL, Blancas MJR, Roba HS, Roberts B, Rodriguez A, Rojas-Rueda D, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy A, Roy N, Sackey BB, Sagar R, Saleh MM, Sanabria JR, Santos JV, Santomauro DF, Santos IS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Sawyer SM, Schmidhuber J, Schmidt MI, Schneider IJC, Schutte AE, Schwebel DC, Seedat S, Sepanlou SG, Servan-Mori EE, Shackelford K, Shaheen A, Shaikh MA, Levy TS, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth KN, Shey M, Shi P, Shibuya K, Shigematsu M, Shin MJ, Shiri R, Shishani K, Shiue I, Sigfusdottir ID, Silpakit N, Silva DAS, Silverberg JI, Simard EP, Sindi S, Singh A, Singh GM, Singh JA, Singh OP, Singh PK, Skirbekk V, Sligar A, Soneji S, Søreide K, Sorensen RJD, Soriano JB, Soshnikov S, Sposato LA, Sreeramareddy CT, Stahl HC, Stanaway JD, Stathopoulou V, Steckling N, Steel N, Stein DJ, Steiner C, Stöckl H, Stranges S, Strong M, Sun J, Sunguya BF, Sur P, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Tabb KM, Talongwa RT, Tarawneh MR, Tavakkoli M, Taye B, Taylor HR, Tedla BA, Tefera W, Tegegne TK, Tekle DY, Shifa GT, Terkawi AS, Tessema GA, Thakur JS, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tran BX, Truelsen T, Dimbuene ZT, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Donkelaar A, Varakin YY, Vasankari T, Vasconcelos AMN, Veerman JL, Venketasubramanian N, Verma RK, Violante FS, Vlassov VV, Volkow P, Vollset SE, Wagner GR, Wallin MT, Wang L, Wanga V, Watkins DA, Weichenthal S, Weiderpass E, Weintraub RG, Weiss DJ, Werdecker A, Westerman R, Whiteford HA, Wilkinson JD, Wiysonge CS, Wolfe CDA, Wolfe I, Won S, Woolf AD, Workie SB, Wubshet M, Xu G, Yadav AK, Yakob B, Yalew AZ, Yan LL, Yano Y, Yaseri M, Ye P, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, El Sayed Zaki M, Zambrana-Torrelio C, Zapata T, Zegeye EA, Zhao Y, Zhou M, Zodpey S, Zonies D, Murray CJL. Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis from the Global Burden of Disease Study 2015. Lancet 2016; 388:1813-1850. [PMID: 27665228 PMCID: PMC5055583 DOI: 10.1016/s0140-6736(16)31467-2] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [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: 07/30/2016] [Revised: 08/13/2016] [Accepted: 08/16/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). METHODS We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between the Socio-demographic Index (SDI, a summary measure based on average income per person, educational attainment, and total fertility rate) and each of the health-related SDG indicators and indices. FINDINGS In 2015, the median health-related SDG index was 59·3 (95% uncertainty interval 56·8-61·8) and varied widely by country, ranging from 85·5 (84·2-86·5) in Iceland to 20·4 (15·4-24·9) in Central African Republic. SDI was a good predictor of the health-related SDG index (r2=0·88) and the MDG index (r2=0·92), whereas the non-MDG index had a weaker relation with SDI (r2=0·79). Between 2000 and 2015, the health-related SDG index improved by a median of 7·9 (IQR 5·0-10·4), and gains on the MDG index (a median change of 10·0 [6·7-13·1]) exceeded that of the non-MDG index (a median change of 5·5 [2·1-8·9]). Since 2000, pronounced progress occurred for indicators such as met need with modern contraception, under-5 mortality, and neonatal mortality, as well as the indicator for universal health coverage tracer interventions. Moderate improvements were found for indicators such as HIV and tuberculosis incidence, minimal changes for hepatitis B incidence took place, and childhood overweight considerably worsened. INTERPRETATION GBD provides an independent, comparable avenue for monitoring progress towards the health-related SDGs. Our analysis not only highlights the importance of income, education, and fertility as drivers of health improvement but also emphasises that investments in these areas alone will not be sufficient. Although considerable progress on the health-related MDG indicators has been made, these gains will need to be sustained and, in many cases, accelerated to achieve the ambitious SDG targets. The minimal improvement in or worsening of health-related indicators beyond the MDGs highlight the need for additional resources to effectively address the expanded scope of the health-related SDGs. FUNDING Bill & Melinda Gates Foundation.
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Forouzanfar MH, Afshin A, Alexander LT, Anderson HR, Bhutta ZA, Biryukov S, Brauer M, Burnett R, Cercy K, Charlson FJ, Cohen AJ, Dandona L, Estep K, Ferrari AJ, Frostad JJ, Fullman N, Gething PW, Godwin WW, Griswold M, Hay SI, Kinfu Y, Kyu HH, Larson HJ, Liang X, Lim SS, Liu PY, Lopez AD, Lozano R, Marczak L, Mensah GA, Mokdad AH, Moradi-Lakeh M, Naghavi M, Neal B, Reitsma MB, Roth GA, Salomon JA, Sur PJ, Vos T, Wagner JA, Wang H, Zhao Y, Zhou M, Aasvang GM, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abdulle AM, Abera SF, Abraham B, Abu-Raddad LJ, Abyu GY, Adebiyi AO, Adedeji IA, Ademi Z, Adou AK, Adsuar JC, Agardh EE, Agarwal A, Agrawal A, Kiadaliri AA, Ajala ON, Akinyemiju TF, Al-Aly Z, Alam K, Alam NKM, Aldhahri SF, Aldridge RW, Alemu ZA, Ali R, Alkerwi A, Alla F, Allebeck P, Alsharif U, Altirkawi KA, Martin EA, Alvis-Guzman N, Amare AT, Amberbir A, Amegah AK, Amini H, Ammar W, Amrock SM, Andersen HH, Anderson BO, Antonio CAT, Anwari P, Ärnlöv J, Artaman A, Asayesh H, Asghar RJ, Assadi R, Atique S, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Bahit MC, Balakrishnan K, Barac A, Barber RM, Barker-Collo SL, Bärnighausen T, Barquera S, Barregard L, Barrero LH, Basu S, Batis C, Bazargan-Hejazi S, Beardsley J, Bedi N, Beghi E, Bell B, Bell ML, Bello AK, Bennett DA, Bensenor IM, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhansali A, Bhatt S, Biadgilign S, Bikbov B, Bisanzio D, Bjertness E, Blore JD, Borschmann R, Boufous S, Bourne RRA, Brainin M, Brazinova A, Breitborde NJK, Brenner H, Broday DM, Brugha TS, Brunekreef B, Butt ZA, Cahill LE, Calabria B, Campos-Nonato IR, Cárdenas R, Carpenter DO, Carrero JJ, Casey DC, Castañeda-Orjuela CA, Rivas JC, Castro RE, Catalá-López F, Chang JC, Chiang PPC, Chibalabala M, Chimed-Ochir O, Chisumpa VH, Chitheer AA, Choi JYJ, Christensen H, Christopher DJ, Ciobanu LG, Coates MM, Colquhoun SM, Manzano AGC, Cooper LT, Cooperrider K, Cornaby L, Cortinovis M, Crump JA, Cuevas-Nasu L, Damasceno A, Dandona R, Darby SC, Dargan PI, das Neves J, Davis AC, Davletov K, de Castro EF, De la Cruz-Góngora V, De Leo D, Degenhardt L, Del Gobbo LC, del Pozo-Cruz B, Dellavalle RP, Deribew A, Jarlais DCD, Dharmaratne SD, Dhillon PK, Diaz-Torné C, Dicker D, Ding EL, Dorsey ER, Doyle KE, Driscoll TR, Duan L, Dubey M, Duncan BB, Elyazar I, Endries AY, Ermakov SP, Erskine HE, Eshrati B, Esteghamati A, Fahimi S, Faraon EJA, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Fereshtehnejad SM, Fernandes JG, Fischer F, Fitchett JRA, Fleming T, Foigt N, Foreman K, Fowkes FGR, Franklin RC, Fürst T, Futran ND, Gakidou E, Garcia-Basteiro AL, Gebrehiwot TT, Gebremedhin AT, Geleijnse JM, Gessner BD, Giref AZ, Giroud M, Gishu MD, Giussani G, Goenka S, Gomez-Cabrera MC, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Gugnani HC, Guillemin F, Guo Y, Gupta R, Gupta R, Gutiérrez RA, Haagsma JA, Hafezi-Nejad N, Haile D, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Hassanvand MS, Hassen TA, Havmoeller R, Heredia-Pi IB, Hernández-Llanes NF, Heydarpour P, Hoek HW, Hoffman HJ, Horino M, Horita N, Hosgood HD, Hoy DG, Hsairi M, Htet AS, Hu G, Huang JJ, Husseini A, Hutchings SJ, Huybrechts I, Iburg KM, Idrisov BT, Ileanu BV, Inoue M, Jacobs TA, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Jansen HAFM, Jassal SK, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jee SH, Jeemon P, Jha V, Jiang Y, Jibat T, Jin Y, Johnson CO, Jonas JB, Kabir Z, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimkhani C, Kasaeian A, Kaul A, Kawakami N, Kazi DS, Keiyoro PN, Kemmer L, Kemp AH, Kengne AP, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khan G, Khang YH, Khatibzadeh S, Khera S, Khoja TAM, Khubchandani J, Kieling C, Kim CI, Kim D, Kimokoti RW, Kissoon N, Kivipelto M, Knibbs LD, Kokubo Y, Kopec JA, Koul PA, Koyanagi A, Kravchenko M, Kromhout H, Krueger H, Ku T, Defo BK, Kuchenbecker RS, Bicer BK, Kuipers EJ, Kumar GA, Kwan GF, Lal DK, Lalloo R, Lallukka T, Lan Q, Larsson A, Latif AA, Lawrynowicz AEB, Leasher JL, Leigh J, Leung J, Levi M, Li X, Li Y, Liang J, Liu S, Lloyd BK, Logroscino G, Lotufo PA, Lunevicius R, MacIntyre M, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Malta DC, Manamo WAA, Mapoma CC, Marcenes W, Martin RV, Martinez-Raga J, Masiye F, Matsushita K, Matzopoulos R, Mayosi BM, McGrath JJ, McKee M, Meaney PA, Medina C, Mehari A, Mejia-Rodriguez F, Mekonnen AB, Melaku YA, Memish ZA, Mendoza W, Mensink GBM, Meretoja A, Meretoja TJ, Mesfin YM, Mhimbira FA, Millear A, Miller TR, Mills EJ, Mirarefin M, Misganaw A, Mock CN, Mohammadi A, Mohammed S, Mola GLD, Monasta L, Hernandez JCM, Montico M, Morawska L, Mori R, Mozaffarian D, Mueller UO, Mullany E, Mumford JE, Murthy GVS, Nachega JB, Naheed A, Nangia V, Nassiri N, Newton JN, Ng M, Nguyen QL, Nisar MI, Pete PMN, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Obermeyer CM, Ogbo FA, Oh IH, Oladimeji O, Olivares PR, Olsen H, Olusanya BO, Olusanya JO, Opio JN, Oren E, Orozco R, Ortiz A, Ota E, PA M, Pana A, Park EK, Parry CD, Parsaeian M, Patel T, Caicedo AJP, Patil ST, Patten SB, Patton GC, Pearce N, Pereira DM, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Plass D, Polinder S, Pond CD, Pope CA, Pope D, Popova S, Poulton RG, Pourmalek F, Prasad NM, Qorbani M, Rabiee RHS, Radfar A, Rafay A, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai RK, Rajsic S, Raju M, Ram U, Rana SM, Ranganathan K, Rao P, García CAR, Refaat AH, Rehm CD, Rehm J, Reinig N, Remuzzi G, Resnikoff S, Ribeiro AL, Rivera JA, Roba HS, Rodriguez A, Rodriguez-Ramirez S, Rojas-Rueda D, Roman Y, Ronfani L, Roshandel G, Rothenbacher D, Roy A, Saleh MM, Sanabria JR, Sanchez-Riera L, Sanchez-Niño MD, Sánchez-Pimienta TG, Sandar L, Santomauro DF, Santos IS, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schmidhuber J, Schmidt MI, Schneider IJC, Schöttker B, Schutte AE, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Servan-Mori EE, Shaddick G, Shaheen A, Shahraz S, Shaikh MA, Levy TS, Sharma R, She J, Sheikhbahaei S, Shen J, Sheth KN, Shi P, Shibuya K, Shigematsu M, Shin MJ, Shiri R, Shishani K, Shiue I, Shrime MG, Sigfusdottir ID, Silva DAS, Silveira DGA, Silverberg JI, Simard EP, Sindi S, Singh A, Singh JA, Singh PK, Slepak EL, Soljak M, Soneji S, Sorensen RJD, Sposato LA, Sreeramareddy CT, Stathopoulou V, Steckling N, Steel N, Stein DJ, Stein MB, Stöckl H, Stranges S, Stroumpoulis K, Sunguya BF, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Takahashi K, Talongwa RT, Tandon N, Tanne D, Tavakkoli M, Taye BW, Taylor HR, Tedla BA, Tefera WM, Tegegne TK, Tekle DY, Terkawi AS, Thakur JS, Thomas BA, Thomas ML, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tillmann T, Tobe-Gai R, Tobollik M, Topor-Madry R, Topouzis F, Towbin JA, Tran BX, Dimbuene ZT, Tsilimparis N, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Donkelaar A, van Os J, Varakin YY, Vasankari T, Veerman JL, Venketasubramanian N, Violante FS, Vollset SE, Wagner GR, Waller SG, Wang JL, Wang L, Wang Y, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, Whiteford HA, Wijeratne T, Wiysonge CS, Wolfe CDA, Won S, Woolf AD, Wubshet M, Xavier D, Xu G, Yadav AK, Yakob B, Yalew AZ, Yano Y, Yaseri M, Ye P, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zhu J, Zipkin B, Zodpey S, Zuhlke LJ, Murray CJL. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1659-1724. [PMID: 27733284 PMCID: PMC5388856 DOI: 10.1016/s0140-6736(16)31679-8] [Citation(s) in RCA: 2646] [Impact Index Per Article: 330.8] [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: 07/25/2016] [Revised: 08/13/2016] [Accepted: 08/19/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. METHODS We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defined criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors-the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted cause-specific DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). FINDINGS Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6-58·8) of global deaths and 41·2% (39·8-42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient deficiencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading five risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. INTERPRETATION Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden. FUNDING Bill & Melinda Gates Foundation.
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Veerman JL, Zapata-Diomedi B, Gunn L, McCormack GR, Cobiac LJ, Mantilla Herrera AM, Giles-Corti B, Shiell A. Cost-effectiveness of investing in sidewalks as a means of increasing physical activity: a RESIDE modelling study. BMJ Open 2016; 6:e011617. [PMID: 27650762 PMCID: PMC5051510 DOI: 10.1136/bmjopen-2016-011617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 11/16/2022] Open
Abstract
BACKGROUND Studies consistently find that supportive neighbourhood built environments increase physical activity by encouraging walking and cycling. However, evidence on the cost-effectiveness of investing in built environment interventions as a means of promoting physical activity is lacking. In this study, we assess the cost-effectiveness of increasing sidewalk availability as one means of encouraging walking. METHODS Using data from the RESIDE study in Perth, Australia, we modelled the cost impact and change in health-adjusted life years (HALYs) of installing additional sidewalks in established neighbourhoods. Estimates of the relationship between sidewalk availability and walking were taken from a previous study. Multistate life table models were used to estimate HALYs associated with changes in walking frequency and duration. Sensitivity analyses were used to explore the impact of variations in population density, discount rates, sidewalk costs and the inclusion of unrelated healthcare costs in added life years. RESULTS Installing and maintaining an additional 10 km of sidewalk in an average neighbourhood with 19 000 adult residents was estimated to cost A$4.2 million over 30 years and gain 24 HALYs over the lifetime of an average neighbourhood adult resident population. The incremental cost-effectiveness ratio was A$176 000/HALY. However, sensitivity results indicated that increasing population densities improves cost-effectiveness. CONCLUSIONS In low-density cities such as in Australia, installing sidewalks in established neighbourhoods as a single intervention is unlikely to cost-effectively improve health. Sidewalks must be considered alongside other complementary elements of walkability, such as density, land use mix and street connectivity. Population density is particularly important because at higher densities, more residents are exposed and this improves the cost-effectiveness. Health gain is one of many benefits of enhancing neighbourhood walkability and future studies might consider a more comprehensive assessment of its social value (eg, social cohesion, safety and air quality).
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Affiliation(s)
- J Lennert Veerman
- The University of Queensland, School of Public Health, Herston, Queensland, Australia
| | - Belen Zapata-Diomedi
- The University of Queensland, School of Public Health, Herston, Queensland, Australia
| | - Lucy Gunn
- McCaughey Centre, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
- Centre for Excellence in Intervention Prevention Science, Carlton South, Victoria, Australia
| | - Gavin R McCormack
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Linda J Cobiac
- The University of Queensland, School of Public Health, Herston, Queensland, Australia
- Nuffield Department of Population Health, The British Heart Foundation Centre on Population Approaches for Non-Communicable Disease Prevention, University of Oxford, Oxford, UK
| | | | - Billie Giles-Corti
- McCaughey Centre, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Alan Shiell
- Centre for Excellence in Intervention Prevention Science, Carlton South, Victoria, Australia
- Department of Public Health, The Australian Prevention Partnership Centre, La Trobe University, Melbourne, Victoria, Australia
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Kyu HH, Bachman VF, Alexander LT, Mumford JE, Afshin A, Estep K, Veerman JL, Delwiche K, Iannarone ML, Moyer ML, Cercy K, Vos T, Murray CJL, Forouzanfar MH. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ 2016; 354:i3857. [PMID: 27510511 PMCID: PMC4979358 DOI: 10.1136/bmj.i3857] [Citation(s) in RCA: 619] [Impact Index Per Article: 77.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To quantify the dose-response associations between total physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events. DESIGN Systematic review and Bayesian dose-response meta-analysis. DATA SOURCES PubMed and Embase from 1980 to 27 February 2016, and references from relevant systematic reviews. Data from the Study on Global AGEing and Adult Health conducted in China, Ghana, India, Mexico, Russia, and South Africa from 2007 to 2010 and the US National Health and Nutrition Examination Surveys from 1999 to 2011 were used to map domain specific physical activity (reported in included studies) to total activity. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Prospective cohort studies examining the associations between physical activity (any domain) and at least one of the five diseases studied. RESULTS 174 articles were identified: 35 for breast cancer, 19 for colon cancer, 55 for diabetes, 43 for ischemic heart disease, and 26 for ischemic stroke (some articles included multiple outcomes). Although higher levels of total physical activity were significantly associated with lower risk for all outcomes, major gains occurred at lower levels of activity (up to 3000-4000 metabolic equivalent (MET) minutes/week). For example, individuals with a total activity level of 600 MET minutes/week (the minimum recommended level) had a 2% lower risk of diabetes compared with those reporting no physical activity. An increase from 600 to 3600 MET minutes/week reduced the risk by an additional 19%. The same amount of increase yielded much smaller returns at higher levels of activity: an increase of total activity from 9000 to 12 000 MET minutes/week reduced the risk of diabetes by only 0.6%. Compared with insufficiently active individuals (total activity <600 MET minutes/week), the risk reduction for those in the highly active category (≥8000 MET minutes/week) was 14% (relative risk 0.863, 95% uncertainty interval 0.829 to 0.900) for breast cancer; 21% (0.789, 0.735 to 0.850) for colon cancer; 28% (0.722, 0.678 to 0.768) for diabetes; 25% (0.754, 0.704 to 0.809) for ischemic heart disease; and 26% (0.736, 0.659 to 0.811) for ischemic stroke. CONCLUSIONS People who achieve total physical activity levels several times higher than the current recommended minimum level have a significant reduction in the risk of the five diseases studied. More studies with detailed quantification of total physical activity will help to find more precise relative risk estimates for different levels of activity.
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Affiliation(s)
- Hmwe H Kyu
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | | | - Lily T Alexander
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - John Everett Mumford
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - Kara Estep
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - J Lennert Veerman
- School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD 4006, Australia
| | - Kristen Delwiche
- Geisel School of Medicine, Dartmouth College, Hanover, NH 03755-1404, USA
| | - Marissa L Iannarone
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - Madeline L Moyer
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - Kelly Cercy
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - Christopher J L Murray
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
| | - Mohammad H Forouzanfar
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Avenue, Suite 600, Seattle, WA 98121, USA
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Zapata-Diomedi B, Veerman JL. The association between built environment features and physical activity in the Australian context: a synthesis of the literature. BMC Public Health 2016; 16:484. [PMID: 27277114 PMCID: PMC4898384 DOI: 10.1186/s12889-016-3154-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [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] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 05/27/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is growing evidence indicating that the built environment is a determinant of physical activity. However, despite the well-established health benefits of physical activity this is rarely considered in urban planning. We summarised recent Australian evidence for the association built environment-physical activity among adults. This summary aims to inform policy makers who advocate for the consideration of health in urban planning. METHODS A combination of built environment and physical activity terms were used to systematically identify relevant peer reviewed and grey literature. RESULTS A total of 23 studies were included, providing 139 tests of associations between specific built environment features and physical activity. Of the total, 84 relationships using objective measures of built environment attributes were evaluated, whereas 55 relationships using self-reported measures were evaluated. Our results indicate that walkable neighbourhoods with a wide range of local destinations to go to, as well as a diverse use of land, encourage physical activity among their residents. CONCLUSIONS This research provides a summary of recent Australian evidence on built environments that are most favourable for physical activity. Features of walkability and availability of destinations within walking distance should be accounted for in the development or redevelopment of urban areas. Our findings emphasise the importance of urban planning for health via its impact on population levels of physical activity.
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Affiliation(s)
- Belen Zapata-Diomedi
- The University of Queensland, School of Public Health, Herston, QLD, 4006, Australia.
- Centre for Research Excellence in Healthy, Liveable Communities, c/- McCaughey VicHealth Community Wellbeing Unit, Melbourne School of Population and Global Health, Melbourne University, Bouverie Street, Parkville, VIC, 3010, Australia.
| | - J Lennert Veerman
- The University of Queensland, School of Public Health, Herston, QLD, 4006, Australia
- Centre for Research Excellence in Healthy, Liveable Communities, c/- McCaughey VicHealth Community Wellbeing Unit, Melbourne School of Population and Global Health, Melbourne University, Bouverie Street, Parkville, VIC, 3010, Australia
- Centre for Research Excellence in Obesity Policy and Food Systems, c/- School of Health and Social Development, Deakin University, Burwood Highway, Burwood, VIC, 3125, Australia
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Abstract
Replacing saturated fat with polyunsaturated fat might not prolong life
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Affiliation(s)
- J Lennert Veerman
- University of Queensland, School of Public Health, Herston, Qld 4006, Australia
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Zapata-Diomedi B, Barendregt JJ, Veerman JL. Population attributable fraction: names, types and issues with incorrect interpretation of relative risks. Br J Sports Med 2016; 52:212-213. [PMID: 26964147 DOI: 10.1136/bjsports-2015-095531] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 11/04/2022]
Affiliation(s)
- Belen Zapata-Diomedi
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Jan J Barendregt
- Epigear International, Sunrise Beach, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - J Lennert Veerman
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Manyema M, Veerman JL, Chola L, Tugendhaft A, Labadarios D, Hofman K. Decreasing the Burden of Type 2 Diabetes in South Africa: The Impact of Taxing Sugar-Sweetened Beverages. PLoS One 2015; 10:e0143050. [PMID: 26575644 PMCID: PMC4648571 DOI: 10.1371/journal.pone.0143050] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 10/31/2015] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Type 2 diabetes poses an increasing public health burden in South Africa (SA) with obesity as the main driver of the epidemic. Consumption of sugar sweetened beverages (SSBs) is linked to weight gain and reducing SSB consumption may significantly impact the prevalence of obesity and related diseases. We estimated the effect of a 20% SSB tax on the burden of diabetes in SA. METHODS AND FINDINGS We constructed a life table-based model in Microsoft Excel (2010). Consumption data from the 2012 SA National Health and Nutrition Examination Survey, previously published own- and cross-price elasticities of SSBs and energy balance equations were used to estimate changes in daily energy intake and its projected impact on BMI arising from increased SSB prices. Diabetes relative risk and prevalent years lived with disability estimates from the Global Burden of Disease Study and modelled disease epidemiology estimates from a previous study were used to estimate the effect of the BMI changes on diabetes burden. Diabetes cost estimates were obtained from the South African Council for Medical Schemes. Over 20 years, a 20% SSB tax could reduce diabetes incident cases by 106 000 in women (95% uncertainty interval (UI) 70 000-142 000) and by 54 000 in men (95% UI: 33 000-80 000); and prevalence in all adults by 4.0% (95% UI: 2.7%-5.3%). Cumulatively over twenty years, approximately 21 000 (95% UI: 14 000-29 000) adult T2DM-related deaths, 374 000 DALYs attributed to T2DM (95% UI: 299 000-463 000) and over ZAR10 billion T2DM healthcare costs (95% UI: ZAR6.8-14.0 billion) equivalent to USD860 million (95% UI: USD570 million-USD1.2 billion) may be averted. CONCLUSION Fiscal policy on SSBs has the potential to mitigate the diabetes epidemic in South Africa and contribute to the National Department of Health goals stated in the National NCD strategic plan.
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Affiliation(s)
- Mercy Manyema
- PRICELESS SA- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J. Lennert Veerman
- School of Public Health, University of Queensland, Brisbane, QLD, Australia
| | - Lumbwe Chola
- PRICELESS SA- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Aviva Tugendhaft
- PRICELESS SA- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Demetre Labadarios
- Population Health, Health Systems and Innovation (PHHSI), Human Sciences Research Council, Capetown, South Africa
| | - Karen Hofman
- PRICELESS SA- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Affiliation(s)
- J Lennert Veerman
- University of Queensland, School of Public Health, Brisbane, QLD 4006, Australia
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Veerman JL, Shrestha RN, Mihalopoulos C, Passey ME, Kelly SJ, Tanton R, Callander EJ, Schofield DJ. Depression prevention, labour force participation and income of older working aged Australians: A microsimulation economic analysis. Aust N Z J Psychiatry 2015; 49:430-6. [PMID: 25425743 DOI: 10.1177/0004867414561528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Depression has economic consequences not only for the health system, but also for individuals and society. This study aims to quantify the potential economic impact of five-yearly screening for sub-syndromal depression in general practice among Australians aged 45-64 years, followed by a group-based psychological intervention to prevent progression to depression. METHOD We used an epidemiological simulation model to estimate reductions in prevalence of depression, and a microsimulation model, Health&WealthMOD2030, to estimate the impact on labour force participation, personal income, savings, taxation revenue and welfare expenditure. RESULTS Group therapy is estimated to prevent around 5,200 prevalent cases of depression (2.2%) and add about 520 people to the labour force. Private incomes are projected to increase by $19 million per year, tax revenues by $2.4 million, and transfer payments are reduced by $2.6 million. CONCLUSION Group-based psychological intervention to prevent depression could result in considerable economic benefits in addition to its clinical effects.
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Affiliation(s)
| | | | | | - Megan E Passey
- University Centre for Rural Health - North Coast, School of Public Health, University of Sydney, Lismore, Australia
| | - Simon J Kelly
- National Centre for Social and Economic Modelling, University of Canberra, Bruce, Australia
| | - Robert Tanton
- National Centre for Social and Economic Modelling, University of Canberra, Bruce, Australia
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Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NME, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DFJ, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SEAH, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KMV, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJC, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJL, Gakidou E. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384:766-81. [PMID: 24880830 PMCID: PMC4624264 DOI: 10.1016/s0140-6736(14)60460-8] [Citation(s) in RCA: 7556] [Impact Index Per Article: 755.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. METHODS We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). FINDINGS Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. INTERPRETATION Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Marie Ng
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Tom Fleming
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Blake Thomson
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Erin C Mullany
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Stan Biryukov
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Semaw Ferede Abera
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Jerry P Abraham
- University of Texas School of Medicine, San Antonio, TX, USA
| | - Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeti University, Ramallah, West Bank, Occupied Palestinian Territory
| | - Tom Achoki
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Ministry of Health, Gaborone, Botswana
| | - Fadia S AlBuhairan
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | | | | | - Simon Barquera
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | | | - Jed Blore
- University of Melbourne, Melbourne, VIC, Australia
| | | | | | | | | | | | | | | | | | - Lalit Dandona
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Public Health Foundation of India, New Delhi, India
| | | | | | | | - Eric L Ding
- Harvard School of Public Health, Boston, MA USA
| | - Adnan M Durrani
- National Institutes of Health, Bethesda and Montgomery, MD, USA
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand
| | - Abraham Flaxman
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Atsushi Goto
- Department of Diabetes Research, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | - Nima Hafezi-Nejad
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | | | | | | | - Lucia Hernandez
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | - Nayu Ikeda
- National Institute of Health and Nutrition, Tokyo, Japan
| | | | | | - Simerjot K Jassal
- VA San Diego, University of California San Diego, San Diego, CA, USA
| | - Sun Ha Jee
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | | | | | | | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Daniel Kim
- Northeastern University, Boston, MA, USA
| | | | - Jonas M Kinge
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Soewarta Kosen
- Center for Community Empowerment, Health Policy & Informatics, NIHRD, Jakarta, Indonesia
| | - Gene Kwan
- Boston Medical Center, Boston, MA, USA
| | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | - Mall Leinsalu
- The National Institute for Health Development, Tallinn, Estonia
| | - Yichong Li
- National Center for Chronic and Non-communicable Disease Control and Prevention, Beijing, China
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiwei Liu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | | | | | - Yuan Lu
- Harvard School of Public Health, Boston, MA USA
| | - Jixiang Ma
- Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, Bethesda and Montgomery, MD, USA
| | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Aliya Naheed
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | | | | | | | | | | | - Samuel O Oti
- African Population and Health Research Center, Nairobi, Kenya
| | - Andrea Pedroza
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | | | - Hyeyoung Seo
- Department of Public Health, Graduate School, Seoul, Korea
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Rahman Shiri
- Finnish institute of Occupational Health, Helsinki, Finland
| | - Ivy Shiue
- Heriot-Watt University, Edinburgh, Scotland, UK
| | | | | | | | | | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Martin Tobias
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Bach X Tran
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Stein Emil Vollset
- The Norwegian Institute of Public Health, Oslo, Norway; University of Bergen, Bergen, Norway
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - XiaoRong Wang
- Shandong University affiliated Jinan Central Hospital, Jinan, China
| | | | - Andrea Werdecker
- Institute of Medical Sociology and Social Medicine, Marburg, Hessen, Germany
| | | | | | | | - Jihyun Yoon
- Department of Preventive Medicine, Seoul, Korea
| | | | - Yong Zhao
- Chongqing Medical University, Chongqing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Beijing, China
| | - Shankuan Zhu
- Zhejiang University School of Public Health, Hangzhou, China
| | - Alan D Lopez
- University of Melbourne, Melbourne, VIC, Australia
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Coffeng LE, Stolk WA, Zouré HGM, Veerman JL, Agblewonu KB, Murdoch ME, Noma M, Fobi G, Richardus JH, Bundy DAP, Habbema D, de Vlas SJ, Amazigo UV. African programme for onchocerciasis control 1995-2015: updated health impact estimates based on new disability weights. PLoS Negl Trop Dis 2014; 8:e2759. [PMID: 24901642 PMCID: PMC4046979 DOI: 10.1371/journal.pntd.0002759] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Luc E. Coffeng
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Wilma A. Stolk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - J. Lennert Veerman
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- School of Population Health, The University of Queensland, Herston, Australia
| | | | - Michele E. Murdoch
- Department of Dermatology, Watford General Hospital, Watford, United Kingdom
| | - Mounkaila Noma
- African Programme for Onchocerciasis Control, Ouagadougou, Burkina Faso
| | - Grace Fobi
- African Programme for Onchocerciasis Control, Ouagadougou, Burkina Faso
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Donald A. P. Bundy
- Human Development Network, The World Bank, Washington, D.C., United States of America
| | - Dik Habbema
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sake J. de Vlas
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NME, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DFJ, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SEAH, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KMV, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJC, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang X, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJL, Gakidou E. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014. [PMID: 24880830 DOI: 10.1016/s0140-6736(14)60460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND In 2010, overweight and obesity were estimated to cause 3·4 million deaths, 3·9% of years of life lost, and 3·8% of disability-adjusted life-years (DALYs) worldwide. The rise in obesity has led to widespread calls for regular monitoring of changes in overweight and obesity prevalence in all populations. Comparable, up-to-date information about levels and trends is essential to quantify population health effects and to prompt decision makers to prioritise action. We estimate the global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013. METHODS We systematically identified surveys, reports, and published studies (n=1769) that included data for height and weight, both through physical measurements and self-reports. We used mixed effects linear regression to correct for bias in self-reports. We obtained data for prevalence of obesity and overweight by age, sex, country, and year (n=19,244) with a spatiotemporal Gaussian process regression model to estimate prevalence with 95% uncertainty intervals (UIs). FINDINGS Worldwide, the proportion of adults with a body-mass index (BMI) of 25 kg/m(2) or greater increased between 1980 and 2013 from 28·8% (95% UI 28·4-29·3) to 36·9% (36·3-37·4) in men, and from 29·8% (29·3-30·2) to 38·0% (37·5-38·5) in women. Prevalence has increased substantially in children and adolescents in developed countries; 23·8% (22·9-24·7) of boys and 22·6% (21·7-23·6) of girls were overweight or obese in 2013. The prevalence of overweight and obesity has also increased in children and adolescents in developing countries, from 8·1% (7·7-8·6) to 12·9% (12·3-13·5) in 2013 for boys and from 8·4% (8·1-8·8) to 13·4% (13·0-13·9) in girls. In adults, estimated prevalence of obesity exceeded 50% in men in Tonga and in women in Kuwait, Kiribati, Federated States of Micronesia, Libya, Qatar, Tonga, and Samoa. Since 2006, the increase in adult obesity in developed countries has slowed down. INTERPRETATION Because of the established health risks and substantial increases in prevalence, obesity has become a major global health challenge. Not only is obesity increasing, but no national success stories have been reported in the past 33 years. Urgent global action and leadership is needed to help countries to more effectively intervene. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Marie Ng
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Tom Fleming
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Blake Thomson
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Nicholas Graetz
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Erin C Mullany
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Stan Biryukov
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Semaw Ferede Abera
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Jerry P Abraham
- University of Texas School of Medicine, San Antonio, TX, USA
| | - Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeti University, Ramallah, West Bank, Occupied Palestinian Territory
| | - Tom Achoki
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Ministry of Health, Gaborone, Botswana
| | - Fadia S AlBuhairan
- King Abdulaziz Medical City, King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | | | | | - Simon Barquera
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | | | - Jed Blore
- University of Melbourne, Melbourne, VIC, Australia
| | | | | | | | | | | | | | | | | | - Lalit Dandona
- Institute for Health Metrics and Evaluation, Seattle, WA, USA; Public Health Foundation of India, New Delhi, India
| | | | | | | | - Eric L Ding
- Harvard School of Public Health, Boston, MA USA
| | - Adnan M Durrani
- National Institutes of Health, Bethesda and Montgomery, MD, USA
| | - Alireza Esteghamati
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Farzadfar
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand
| | - Abraham Flaxman
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Atsushi Goto
- Department of Diabetes Research, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | - Nima Hafezi-Nejad
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | | | | | | | - Lucia Hernandez
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | - Nayu Ikeda
- National Institute of Health and Nutrition, Tokyo, Japan
| | | | | | - Simerjot K Jassal
- VA San Diego, University of California San Diego, San Diego, CA, USA
| | - Sun Ha Jee
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | | | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | | | | | | | - Young-Ho Khang
- Institute of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Daniel Kim
- Northeastern University, Boston, MA, USA
| | | | - Jonas M Kinge
- The Norwegian Institute of Public Health, Oslo, Norway
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Soewarta Kosen
- Center for Community Empowerment, Health Policy & Informatics, NIHRD, Jakarta, Indonesia
| | - Gene Kwan
- Boston Medical Center, Boston, MA, USA
| | - Taavi Lai
- Fourth View Consulting, Tallinn, Estonia
| | - Mall Leinsalu
- The National Institute for Health Development, Tallinn, Estonia
| | - Yichong Li
- National Center for Chronic and Non-communicable Disease Control and Prevention, Beijing, China
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiwei Liu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | | | | | - Yuan Lu
- Harvard School of Public Health, Boston, MA USA
| | - Jixiang Ma
- Chinese Center for Disease Control and Prevention, Beijing, China
| | | | - George A Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, Bethesda and Montgomery, MD, USA
| | | | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Aliya Naheed
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | | | | | | | | | | | - Samuel O Oti
- African Population and Health Research Center, Nairobi, Kenya
| | - Andrea Pedroza
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | | | | | | | - Hyeyoung Seo
- Department of Public Health, Graduate School, Seoul, Korea
| | - Sadaf G Sepanlou
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Rahman Shiri
- Finnish institute of Occupational Health, Helsinki, Finland
| | - Ivy Shiue
- Heriot-Watt University, Edinburgh, Scotland, UK
| | | | | | | | | | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Martin Tobias
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | - Bach X Tran
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Stein Emil Vollset
- The Norwegian Institute of Public Health, Oslo, Norway; University of Bergen, Bergen, Norway
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, WA, USA
| | | | - XiaoRong Wang
- Shandong University affiliated Jinan Central Hospital, Jinan, China
| | | | - Andrea Werdecker
- Institute of Medical Sociology and Social Medicine, Marburg, Hessen, Germany
| | | | | | | | - Jihyun Yoon
- Department of Preventive Medicine, Seoul, Korea
| | | | - Yong Zhao
- Chongqing Medical University, Chongqing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Beijing, China
| | - Shankuan Zhu
- Zhejiang University School of Public Health, Hangzhou, China
| | - Alan D Lopez
- University of Melbourne, Melbourne, VIC, Australia
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Blondell SJ, Hammersley-Mather R, Veerman JL. Does physical activity prevent cognitive decline and dementia?: A systematic review and meta-analysis of longitudinal studies. BMC Public Health 2014; 14:510. [PMID: 24885250 PMCID: PMC4064273 DOI: 10.1186/1471-2458-14-510] [Citation(s) in RCA: 478] [Impact Index Per Article: 47.8] [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] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 05/08/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND By 2050, it has been estimated that approximately one-fifth of the population will be made up of older adults (aged ≥60 years). Old age often comes with cognitive decline and dementia. Physical activity may prevent cognitive decline and dementia. METHODS We reviewed and synthesised prospective studies into physical activity and cognitive decline, and physical activity and dementia, published until January 2014. Forty-seven cohorts, derived from two previous systematic reviews and an updated database search, were used in the meta-analyses. Included participants were aged ≥40 years, in good health and/or randomly selected from the community. Studies were assessed for methodological quality. RESULTS Twenty-one cohorts on physical activity and cognitive decline and twenty-six cohorts on physical activity and dementia were included. Meta-analysis, using the quality-effects model, suggests that participants with higher levels of physical activity, when compared to those with lower levels, are at reduced risk of cognitive decline, RR 0.65, 95% CI 0.55-0.76, and dementia, RR 0.86, 95% CI 0.76-0.97. Sensitivity analyses revealed a more conservative estimate of the impact of physical activity on cognitive decline and dementia for high quality studies, studies reporting effect sizes as ORs, greater number of adjustments (≥10), and longer follow-up time (≥10 years). When one heavily weighted study was excluded, physical activity was associated with an 18% reduction in the risk of dementia (RR 0.82; 0.73-0.91). CONCLUSIONS Longitudinal observational studies show an association between higher levels of physical activity and a reduced risk of cognitive decline and dementia. A case can be made for a causal interpretation. Future research should use objective measures of physical activity, adjust for the full range of confounders and have adequate follow-up length. Ideally, randomised controlled trials will be conducted. Regardless of any effect on cognition, physical activity should be encouraged, as it has been shown to be beneficial on numerous levels.
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Affiliation(s)
- Sarah J Blondell
- The University of Queensland, School of Population Health, 4006 Herston, Queensland, Australia
| | - Rachel Hammersley-Mather
- Counselling and Health at Student Services, University of Southern Queensland, 4350 Toowoomba, Queensland, Australia
| | - J Lennert Veerman
- The University of Queensland, School of Population Health, 4006 Herston, Queensland, Australia
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Stephens SK, Cobiac LJ, Veerman JL. Improving diet and physical activity to reduce population prevalence of overweight and obesity: an overview of current evidence. Prev Med 2014; 62:167-78. [PMID: 24534460 DOI: 10.1016/j.ypmed.2014.02.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [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: 08/06/2013] [Revised: 01/27/2014] [Accepted: 02/05/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of this study is to provide an overview of interventions to reduce or prevent overweight or obesity and improve diet or physical activity. METHODS A review of meta-analyses and/or systematic reviews of these interventions in any setting or age group were conducted. Narrative systematic reviews were included for intervention categories with limited meta-analyses available. Summary measures including weighted mean difference, standardised mean difference, and I-squared, were examined. RESULTS A total of 60 meta-analyses and 23 systematic reviews met the inclusion criteria. Dietary interventions and multi-component interventions targeting overweight and obesity appeared to have the greatest effects, particularly in comparison with workplace or technology or internet-based interventions. Pharmaceutical and surgical interventions produced favourable results for specific population sub-groups (i.e. morbidly obese). Population-wide strategies such as policy interventions have not been widely analysed. The effectiveness of the interventions to assist in maintaining behaviour or weight change remains unclear. CONCLUSIONS Various individually targeted interventions were shown to reduce body weight, although effect sizes were typically modest, and the durability of effects has been questioned. New approaches to evaluating population-based interventions, such as taxes and regulation, are recommended. Future research modelling the long-term effects of interventions across the lifespan would also be beneficial.
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Affiliation(s)
- Samantha K Stephens
- The University of Queensland, School of Population Health, Brisbane, Queensland, Australia.
| | - Linda J Cobiac
- The University of Queensland, School of Population Health, Brisbane, Queensland, Australia.
| | - J Lennert Veerman
- The University of Queensland, School of Population Health, Brisbane, Queensland, Australia.
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50
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Veerman JL, Cobiac LJ. Removing the GST exemption for fresh fruits and vegetables could cost lives. Med J Aust 2013; 199:534-5. [PMID: 24138373 DOI: 10.5694/mja13.11064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 09/18/2013] [Indexed: 11/17/2022]
Affiliation(s)
- J Lennert Veerman
- School of Population Health, University of Queensland, Brisbane, QLD, Australia.
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