1
|
Khoury MJ, Engelgau M, Chambers DA, Mensah GA. Beyond Public Health Genomics: Can Big Data and Predictive Analytics Deliver Precision Public Health? Public Health Genomics 2019; 21:244-250. [PMID: 31315115 DOI: 10.1159/000501465] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/11/2019] [Indexed: 01/13/2023] Open
Abstract
The field of public health genomics has matured in the past two decades and is beginning to deliver genomic-based interventions for health and health care. In the past few years, the terms precision medicine and precision public health have been used to include information from multiple fields measuring biomarkers as well as environmental and other variables to provide tailored interventions. In the context of public health, "precision" implies delivering the right intervention to the right population at the right time, with the goal of improving health for all. In addition to genomics, precision public health can be driven by "big data" as identified by volume, variety, and variability in biomedical, sociodemographic, environmental, geographic, and other information. Most current big data applications in health are in elucidating pathobiology and tailored drug discovery. We explore how big data and predictive analytics can contribute to precision public health by improving public health surveillance and assessment, and efforts to promote uptake of evidence-based interventions, by including more extensive information related to place, person, and time. We use selected examples drawn from child health, cardiovascular disease, and cancer to illustrate the promises of precision public health, as well as current methodologic and analytic challenges to big data to fulfill these promises.
Collapse
Affiliation(s)
- Muin J Khoury
- Office of Public Health Genomics, Centers for Disease Control and Prevention, Atlanta, Georgia, USA,
| | - Michael Engelgau
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | - David A Chambers
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| |
Collapse
|
2
|
Jan S, Laba TL, Essue BM, Gheorghe A, Muhunthan J, Engelgau M, Mahal A, Griffiths U, McIntyre D, Meng Q, Nugent R, Atun R. Action to address the household economic burden of non-communicable diseases. Lancet 2018; 391:2047-2058. [PMID: 29627161 DOI: 10.1016/s0140-6736(18)30323-4] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [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] [Received: 10/30/2015] [Revised: 09/04/2017] [Accepted: 01/19/2018] [Indexed: 01/05/2023]
Abstract
The economic burden on households of non-communicable diseases (NCDs), including cardiovascular diseases, cancer, respiratory diseases, and diabetes, poses major challenges to global poverty alleviation efforts. For patients with NCDs, being uninsured is associated with 2-7-fold higher odds of catastrophic levels of out-of-pocket costs; however, the protection offered by health insurance is often incomplete. To enable coverage of the predictable and long-term costs of treatment, national programmes to extend financial protection should be based on schemes that entail compulsory enrolment or be financed through taxation. Priority should be given to eliminating financial barriers to the uptake of and adherence to interventions that are cost-effective and are designed to help the poor. In concert with programmes to strengthen national health systems and governance arrangements, comprehensive financial protection against the growing burden of NCDs is crucial in meeting the UN's Sustainable Development Goals.
Collapse
Affiliation(s)
- Stephen Jan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Tracey-Lea Laba
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Beverley M Essue
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adrian Gheorghe
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Janani Muhunthan
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Michael Engelgau
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ajay Mahal
- Nossal Institute for Global Health, University of Melbourne, VIC, Australia
| | - Ulla Griffiths
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Diane McIntyre
- Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, China
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard School of Public Health, Harvard University, Cambridge, MA, USA
| |
Collapse
|
3
|
Twigg HL, Crystal R, Currier J, Ridker P, Berliner N, Kiem HP, Rutherford G, Zou S, Glynn S, Wong R, Peprah E, Engelgau M, Creazzo T, Colombini-Hatch S, Caler E. Refining Current Scientific Priorities and Identifying New Scientific Gaps in HIV-Related Heart, Lung, Blood, and Sleep Research. AIDS Res Hum Retroviruses 2017; 33:889-897. [PMID: 28530113 DOI: 10.1089/aid.2017.0026] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The National Heart, Lung, and Blood Institute (NHLBI) AIDS Program's goal is to provide direction and support for research and training programs in areas of HIV-related heart, lung, blood, and sleep (HLBS) diseases. To better define NHLBI current HIV-related scientific priorities and with the goal of identifying new scientific priorities and gaps in HIV-related HLBS research, a wide group of investigators gathered for a scientific NHLBI HIV Working Group on December 14-15, 2015, in Bethesda, MD. The core objectives of the Working Group included discussions on: (1) HIV-related HLBS comorbidities in the antiretroviral era; (2) HIV cure; (3) HIV prevention; and (4) mechanisms to implement new scientific discoveries in an efficient and timely manner so as to have the most impact on people living with HIV. The 2015 Working Group represented an opportunity for the NHLBI to obtain expert advice on HIV/AIDS scientific priorities and approaches over the next decade.
Collapse
Affiliation(s)
- Homer L. Twigg
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University Medical Center, Indianapolis, Indiana
| | - Ronald Crystal
- Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
| | - Judith Currier
- Department of Medicine, University of California, Los Angeles, California
| | - Paul Ridker
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nancy Berliner
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Hans-Peter Kiem
- Department of Medicine, Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington
| | - George Rutherford
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Shimian Zou
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Simone Glynn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Renee Wong
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Emmanuel Peprah
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael Engelgau
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Tony Creazzo
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Sandra Colombini-Hatch
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Elisabet Caler
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
4
|
Li N, Yan LL, Niu W, Yao C, Feng X, Zhang J, Shi J, Zhang Y, Zhang R, Hao Z, Chu H, Zhang J, Li X, Pan J, Li Z, Sun J, Zhou B, Zhao Y, Yu Y, Engelgau M, Labarthe D, Ma J, MacMahon S, Elliott P, Wu Y, Neal B. The Effects of a Community-Based Sodium Reduction Program in Rural China - A Cluster-Randomized Trial. PLoS One 2016; 11:e0166620. [PMID: 27935977 PMCID: PMC5147834 DOI: 10.1371/journal.pone.0166620] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [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] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 10/29/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Average sodium intake and stroke mortality in northern China are both among the highest in the world. An effective, low-cost strategy to reduce sodium intake in this population is urgently needed. OBJECTIVE We sought to determine the effects of a community-based sodium reduction program on salt consumption in rural northern China. DESIGN This study was a cluster-randomized trial done over 18 months in 120 townships (one village from each township) from five provinces. Sixty control villages were compared to 60 intervention villages that were given access to a reduced-sodium, added-potassium salt substitute in conjunction with a community-based health education program focusing on sodium reduction. The primary outcome was the difference in 24-hour urinary sodium excretion between randomized groups. RESULTS Among 1,903 people with valid 24-hour urine collections, mean urinary sodium excretion in intervention compared with control villages was reduced by 5.5% (-14mmol/day, 95% confidence interval -26 to -1; p = 0.03), potassium excretion was increased by 16% (+7mmol/day, +4 to +10; p<0.001), and sodium to potassium ratio declined by 15% (-0.9, -1.2 to -0.5; p<0.001). Mean blood pressure differences were -1.1 mm Hg systolic (-3.3 to +1.1; p = 0.33) and -0.7 mm Hg diastolic (-2.2 to +0.8, p = 0.35) and the difference in the proportion with hypertension was -1.3% (-5.1 to 2.5, p = 0.56). CONCLUSION There were clear differences in population sodium and potassium intake between villages that were most likely a consequence of increased use of salt substitute. The absence of effects on blood pressure reflects the moderate changes in sodium and potassium intake achieved. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01259700.
Collapse
Affiliation(s)
- Nicole Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, the University of Sydney, Sydney, Australia
| | - Lijing L. Yan
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Wenyi Niu
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Chen Yao
- Peking University Clinical Research Institute, Beijing, China
| | | | - Jianxin Zhang
- Hebei Province Center for Disease Prevention and Control, Shijiazhuang, Hebei, China
| | - Jingpu Shi
- First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yuhong Zhang
- Ningxia Medical University, Yinchuan, Ningxia, China
| | | | - Zhixin Hao
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Hongling Chu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jing Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Jianhong Pan
- Peking University Clinical Research Institute, Beijing, China
| | - Zhifang Li
- Changzhi Medical College, Changzhi, Shanxi, China
| | - Jixin Sun
- Hebei Province Center for Disease Prevention and Control, Shijiazhuang, Hebei, China
| | - Bo Zhou
- First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Yi Zhao
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yan Yu
- Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Michael Engelgau
- United States Centers for Disease Control and Prevention, Beijing, China
| | - Darwin Labarthe
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Jixiang Ma
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Stephen MacMahon
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, the University of Sydney, Sydney, Australia
| | | | - Yangfeng Wu
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- School of Public Health, Peking University Health Science Center, Beijing, China
- Peking University Clinical Research Institute, Beijing, China
| | - Bruce Neal
- The George Institute for Global Health, Sydney, Australia
- Sydney Medical School, the University of Sydney, Sydney, Australia
- Imperial College London, United Kingdom
- Royal Prince Alfred Hospital, Sydney
| |
Collapse
|
5
|
Peprah E, Lopez-Class M, Shero S, John-Sowah J, Engelgau M. A Global Perspective on Using Implementation Research to Address Hypertension-Associated Target Organ Damage. Ethn Dis 2016; 26:395-8. [PMID: 27440980 DOI: 10.18865/ed.26.3.395] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Hypertension, a major risk factor for cardiovascular disease, imposes a significant public health burden and challenge to address it worldwide. Scaling up delivery of proven, effective interventions for hypertension could significantly advance the goal of reducing the global burden. Although significant progress has been made in many countries, some lament that large-scale initiatives focused on reducing blood pressure in global populations have not effectively addressed this challenge. Late-stage implementation research plays a critical role in determining effective and sustainable scale-up of these initiatives. In this article, we briefly discuss some of the global initiatives that have been funded by the National Heart, Lung, and Blood Institute of the US National Institutes of Health. Intervention delivery strategies in low resource settings must have demonstrated effectiveness and consideration for the social, cultural and physical context (eg, access, affordability, and availability of medications) in which a program is being delivered in order to be sustainable nationally and globally. Hence, the use of implementation research is central to determining sustainable delivery of evidence-based and tailored interventions focused on hypertension control. The sustained control of hypertension in global populations holds tremendous potential for reducing morbidity, premature mortality, and the adverse economic impact of cardiovascular disease in all regions.
Collapse
Affiliation(s)
- Emmanuel Peprah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda MD
| | - Maria Lopez-Class
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda MD
| | - Susan Shero
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda MD
| | - Joylene John-Sowah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda MD
| | - Michael Engelgau
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health (NIH), Bethesda MD
| |
Collapse
|
6
|
Lee ES, Vedanthan R, Jeemon P, Kamano JH, Kudesia P, Rajan V, Engelgau M, Moran AE. Quality Improvement for Cardiovascular Disease Care in Low- and Middle-Income Countries: A Systematic Review. PLoS One 2016; 11:e0157036. [PMID: 27299563 PMCID: PMC4907518 DOI: 10.1371/journal.pone.0157036] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/24/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The majority of global cardiovascular disease (CVD) burden falls on people living in low- and middle-income countries (LMICs). In order to reduce preventable CVD mortality and morbidity, LMIC health systems and health care providers need to improve the delivery and quality of CVD care. OBJECTIVES As part of the Disease Control Priorities Three (DCP3) Study efforts addressing quality improvement, we reviewed and summarized currently available evidence on interventions to improve quality of clinic-based CVD prevention and management in LMICs. METHODS We conducted a narrative review of published comparative clinical trials that evaluated efficacy or effectiveness of clinic-based CVD prevention and management quality improvement interventions in LMICs. Conditions selected a priori included hypertension, diabetes, hyperlipidemia, coronary artery disease, stroke, rheumatic heart disease, and congestive heart failure. MEDLINE and EMBASE electronic databases were systematically searched. Studies were categorized as occurring at the system or patient/provider level and as treating the acute or chronic phase of CVD. RESULTS From 847 articles identified in the electronic search, 49 met full inclusion criteria and were selected for review. Selected studies were performed in 19 different LMICs. There were 10 studies of system level quality improvement interventions, 38 studies of patient/provider interventions, and one study that fit both criteria. At the patient/provider level, regardless of the specific intervention, intensified, team-based care generally led to improved medication adherence and hypertension control. At the system level, studies provided evidence that introduction of universal health insurance coverage improved hypertension and diabetes control. Studies of system and patient/provider level acute coronary syndrome quality improvement interventions yielded inconclusive results. The duration of most studies was less than 12 months. CONCLUSIONS The results of this review suggest that CVD care quality improvement can be successfully implemented in LMICs. Most studies focused on chronic CVD conditions; more acute CVD care quality improvement studies are needed. Longer term interventions and follow-up will be needed in order to assess the sustainability of quality improvement efforts in LMICs.
Collapse
Affiliation(s)
- Edward S. Lee
- Department of Medicine, Division of Geriatric, Hospital, Palliative and General Internal Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, United States of America
| | - Rajesh Vedanthan
- Department of Medicine, Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Panniyammakal Jeemon
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Kerala, India
| | - Jemima H. Kamano
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Preeti Kudesia
- Health, Nutrition and Population Global Practice, The World Bank, Kathmandu, Nepal
| | | | - Michael Engelgau
- Center for Translation Research and Implementation Science, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Andrew E. Moran
- Department of Medicine, Division of General Medicine, Columbia University Medical Center, New York, New York, United States of America
| |
Collapse
|
7
|
Yan L, Bi Z, Tang J, Wang L, Yang Q, Guo X, Cogswell ME, Zhang X, Hong Y, Engelgau M, Zhang J, Elliott P, Angell SY, Ma J. Relationships Between Blood Pressure and 24-Hour Urinary Excretion of Sodium and Potassium by Body Mass Index Status in Chinese Adults. J Clin Hypertens (Greenwich) 2015; 17:916-25. [PMID: 26332433 PMCID: PMC8031527 DOI: 10.1111/jch.12658] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/08/2015] [Accepted: 06/10/2015] [Indexed: 11/26/2022]
Abstract
This study examined the impact of overweight/obesity on sodium, potassium, and blood pressure associations using the Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH) project baseline survey data. Twenty-four-hour urine samples were collected in 1948 Chinese adults aged 18 to 69 years. The observed associations of sodium, potassium, sodium-potassium ratio, and systolic blood pressure (SBP) were stronger in the overweight/obese population than among those of normal weight. Among overweight/obese respondents, each additional standard deviation (SD) higher of urinary sodium excretion (SD=85 mmol) and potassium excretion (SD=19 mmol) was associated with a 1.31 mm Hg (95% confidence interval, 0.37-2.26) and -1.43 mm Hg (95% confidence interval, -2.23 to -0.63) difference in SBP, and each higher unit in sodium-potassium ratio was associated with a 0.54 mm Hg (95% confidence interval, 0.34-0.75) increase in SBP. The association between sodium, potassium, sodium-potassium ratio, and prevalence of hypertension among overweight/obese patients was similar to that of SBP. Our study indicated that the relationships between BP and both urinary sodium and potassium might be modified by BMI status in Chinese adults.
Collapse
Affiliation(s)
- Liuxia Yan
- Department of Cardiovascular Disease Control and PreventionNational Center for Chronic and Noncommunicable Disease Control and PreventionBeijingChina
| | - Zhenqiang Bi
- Academy of Preventive MedicineShandong UniversityJinanChina
- Department of Chronic and Noncommunicable Disease Control and PreventionShandong Center for Disease Control and Prevention (CDC)JinanChina
| | - Junli Tang
- Academy of Preventive MedicineShandong UniversityJinanChina
- Department of Chronic and Noncommunicable Disease Control and PreventionShandong Center for Disease Control and Prevention (CDC)JinanChina
| | - Linhong Wang
- Department of Cardiovascular Disease Control and PreventionNational Center for Chronic and Noncommunicable Disease Control and PreventionBeijingChina
| | - Quanhe Yang
- Division for Heart Disease and Stroke PreventionCenters for Disease Control and PreventionAtlantaGA
| | - Xiaolei Guo
- Academy of Preventive MedicineShandong UniversityJinanChina
- Department of Chronic and Noncommunicable Disease Control and PreventionShandong Center for Disease Control and Prevention (CDC)JinanChina
| | - Mary E. Cogswell
- Division for Heart Disease and Stroke PreventionCenters for Disease Control and PreventionAtlantaGA
| | - Xiaofei Zhang
- Department of Clinical Epidemiology and BiostatisticsBeijing Tsinghua Changgung HospitalTsinghua UniversityBeijingChina
| | - Yuling Hong
- Division for Heart Disease and Stroke PreventionCenters for Disease Control and PreventionAtlantaGA
| | - Michael Engelgau
- Center for Global HealthCenters for Disease Control and PreventionAtlantaGA
- Present address:
National Institutes of HealthBethesdaMD
| | - Jiyu Zhang
- Academy of Preventive MedicineShandong UniversityJinanChina
- Department of Chronic and Noncommunicable Disease Control and PreventionShandong Center for Disease Control and Prevention (CDC)JinanChina
| | - Paul Elliott
- Department of Epidemiology and BiostatisticsMRC‐PHE Centre for Environment and HealthImperial College LondonLondonUK
| | - Sonia Y. Angell
- Center for Global HealthCenters for Disease Control and PreventionAtlantaGA
| | - Jixiang Ma
- Department of Cardiovascular Disease Control and PreventionNational Center for Chronic and Noncommunicable Disease Control and PreventionBeijingChina
| |
Collapse
|
8
|
Mensah GA, Engelgau M, Stoney C, Mishoe H, Kaufmann P, Freemer M, Fine L. News from NIH: a center for translation research and implementation science. Transl Behav Med 2015; 5:127-30. [PMID: 26029274 PMCID: PMC4444711 DOI: 10.1007/s13142-015-0310-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- George A. Mensah
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, One Rockledge Center, 6705 Rockledge Drive, Suite 6070, Bethesda, MD 20892 USA
| | - Michael Engelgau
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, One Rockledge Center, 6705 Rockledge Drive, Suite 6070, Bethesda, MD 20892 USA
| | - Catherine Stoney
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, One Rockledge Center, 6705 Rockledge Drive, Suite 6070, Bethesda, MD 20892 USA
| | - Helena Mishoe
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, One Rockledge Center, 6705 Rockledge Drive, Suite 6070, Bethesda, MD 20892 USA
| | - Peter Kaufmann
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, One Rockledge Center, 6705 Rockledge Drive, Suite 6070, Bethesda, MD 20892 USA
| | - Michelle Freemer
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, One Rockledge Center, 6705 Rockledge Drive, Suite 6070, Bethesda, MD 20892 USA
| | - Lawrence Fine
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, One Rockledge Center, 6705 Rockledge Drive, Suite 6070, Bethesda, MD 20892 USA
| | - For the Trans-NHLBI T4 Translation Research Work Groups
- Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, National Institutes of Health, One Rockledge Center, 6705 Rockledge Drive, Suite 6070, Bethesda, MD 20892 USA
| |
Collapse
|
9
|
Toscano CM, Zhuo X, Imai K, Duncan BB, Polanczyk CA, Zhang P, Engelgau M, Schmidt MI. Cost-effectiveness of a national population-based screening program for type 2 diabetes: the Brazil experience. Diabetol Metab Syndr 2015; 7:95. [PMID: 26523154 PMCID: PMC4628345 DOI: 10.1186/s13098-015-0090-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/15/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The cost-effectiveness of screening for type 2 diabetes mellitus (DM2) in developing countries remains unknown. The Brazilian government conducted a nationwide population screening program for type 2 diabetes mellitus (BNDSP) in which 22 million capillary glucose tests were performed in individuals aged 40 years and older. The objective of this study was to evaluate the life-time cost-effectiveness of a national population-based screening program for DM2 conducted in Brazil. METHODS We used a Markov-based cost-effectiveness model to simulate the long-term costs and benefits of screening for DM2, compared to no screening program. The analysis was conducted from a public health care system perspective. Sensitivity analyses were conducted to examine the robustness of results to key model parameters. RESULTS Brazilian National diabetes screening program will yield a large health benefit and higher costs. Compared with no screening, screen detection of undiagnosed diabetes resulted in US$ 31,147 per QALY gained. Results from sensitivity analyses found that screening targeted at hypertensive individuals would cost US$ 22,695/QALY. When benefits from early glycemic control on cardiovascular outcomes were considered, the cost per QALY gained would reduce significantly. CONCLUSIONS In the base case analysis, not considering the intangible benefit of transferring diabetes management to primary care nor the benefit of using statin to treat eligible diabetic patients, CE ratios were not cost-effective considering thresholds proposed by the World Health Organization. However, significant uncertainty was demonstrated in sensitivity analysis. Our results indicate that policy-makers should carefully balance the benefit and cost of the program while considering using a population-based approach to screen for diabetes.
Collapse
Affiliation(s)
- Cristiana M. Toscano
- />Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
- />Federal University of Goiás (UFG), Rua T-62, 595, Apto. 201, Goiânia, GO 74223-180 Brazil
| | - Xiaohui Zhuo
- />Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Kumiko Imai
- />Centers for Disease Control and Prevention, Atlanta, GA USA
- />UNICEF, New York City, New York USA
| | - Bruce B. Duncan
- />Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
| | | | - Ping Zhang
- />Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Michael Engelgau
- />Centers for Disease Control and Prevention, Atlanta, GA USA
- />National Institutes of Health, Bethesda, Maryland USA
| | | | | |
Collapse
|
10
|
Bi Z, Liang X, Xu A, Wang L, Shi X, Zhao W, Ma J, Guo X, Zhang X, Zhang J, Ren J, Yan L, Lu Z, Wang H, Tang J, Cai X, Dong J, Zhang J, Chu J, Engelgau M, Yang Q, Hong Y, Wang Y. Hypertension prevalence, awareness, treatment, and control and sodium intake in Shandong Province, China: baseline results from Shandong-Ministry of Health Action on Salt Reduction and Hypertension (SMASH), 2011. Prev Chronic Dis 2014; 11:E88. [PMID: 24854239 PMCID: PMC4032056 DOI: 10.5888/pcd11.130423] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [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] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION In China, population-based blood pressure levels and prevalence of hypertension are increasing. Meanwhile, sodium intake, a major risk factor for hypertension, is high. In 2011, to develop intervention priorities for a salt reduction and hypertension control project in Shandong Province (population 96 million), a cross-sectional survey was conducted to collect information on sodium intake and hypertension prevalence, awareness, treatment, and control. METHODS Complex, multistage sampling methods were used to select a provincial-representative adult sample. Blood pressure was measured and a survey conducted among all participants; condiments were weighed in the household, a 24-hour dietary recall was conducted, and urine was collected. Hypertension was determined by blood pressure measured on a single occasion and self-reported use of antihypertension medications. RESULTS Overall, 23.4% (95% confidence interval [CI], 20.9%-26.0%) of adults in Shandong were estimated to have hypertension. Among those classified as having hypertension, approximately one-third (34.5%) reported having hypertension, approximately one-fourth (27.5%) reported taking medications, and one-seventh (14.9%) had their blood pressure controlled (<140/<90 mm Hg). Estimated total average daily dietary sodium intake was 5,745 mg (95% CI, 5,428 mg-6,063 mg). Most dietary sodium (80.8%) came from salt and high-salt condiments added during cooking: a sodium intake of 4,640 mg (95% CI, 4,360 mg-4,920 mg). The average daily urinary sodium excretion was 5,398 mg (95% CI, 5,112 mg-5,683 mg). CONCLUSION Hypertension and excessive sodium intake in adults are major public health problems in Shandong Province, China.
Collapse
Affiliation(s)
- Zhenqiang Bi
- Academy of Preventive Medicine, Shandong University, Jinan, China, and Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xiaofeng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Aiqiang Xu
- Academy of Preventive Medicine, Shandong University, Jinan, China, and Shandong Center for Disease Control and Prevention, Jinan, China
| | - Linghong Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoming Shi
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wenhua Zhao
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jixiang Ma
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaolei Guo
- Academy of Preventive Medicine, Shandong University, Jinan, China, and Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xiaofei Zhang
- Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou, China
| | - Jiyu Zhang
- Academy of Preventive Medicine, Shandong University, Jinan, China, and Shandong Center for Disease Control and Prevention, Jinan, China
| | - Jie Ren
- Academy of Preventive Medicine, Shandong University, Jinan, China, and Shandong Center for Disease Control and Prevention, Jinan, China
| | - Liuxia Yan
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zilong Lu
- Academy of Preventive Medicine, Shandong University, Jinan, China, and Shandong Center for Disease Control and Prevention, Jinan, China
| | - Huicheng Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Junli Tang
- Academy of Preventive Medicine, Shandong University, Jinan, China, and Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xiaoning Cai
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jing Dong
- Academy of Preventive Medicine, Shandong University, Jinan, China, and Shandong Center for Disease Control and Prevention, Jinan, China
| | - Juan Zhang
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Chu
- Academy of Preventive Medicine, Shandong University, Jinan, China, and Shandong Center for Disease Control and Prevention, Jinan, China
| | | | - Quanhe Yang
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yuling Hong
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yu Wang
- Chinese Center for Disease Control and Prevention, 155 Changbai Rd, Changping District, Beijing, 102206, People's Republic of China. E-mail:
| |
Collapse
|
11
|
Affiliation(s)
- Anup Karan
- Public Health Foundation of India New Delhi India
- Nuffield Department of Population Health University of Oxford Oxford UK
| | | | - Ajay Mahal
- School of Public Health and Preventive Medicine Monash University Melbourne Vic. Australia
| |
Collapse
|
12
|
Ali MK, Rabadán-Diehl C, Flanigan J, Blanchard C, Narayan KMV, Engelgau M. Systems and capacity to address noncommunicable diseases in low- and middle-income countries. Sci Transl Med 2013; 5:181cm4. [PMID: 23596201 DOI: 10.1126/scitranslmed.3005121] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Noncommunicable diseases (NCDs) are increasingly getting attention from different forums, including media outlets, health agencies, and the public and private sectors. Progress is being made in addressing NCDs, though more slowly in low- and middle-income countries (LMICs) as compared with high-income settings. Here, we offer an analysis of the challenges faced in LMICs. We discuss realistic strategies to understand and develop capacity needs (workforce, finances, and infrastructure) and systems (institutions and processes) to sustainably optimize NCD prevention and care in LMICs.
Collapse
Affiliation(s)
- Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
| | | | | | | | | | | |
Collapse
|
13
|
He L, Zhai Y, Engelgau M, Li W, Qian H, Si X, Gao X, Sereny M, Liang J, Zhu X, Shi X. Association of children's eating behaviors with parental education, and teachers' health awareness, attitudes and behaviors: a national school-based survey in China. Eur J Public Health 2013; 24:880-7. [PMID: 24287031 DOI: 10.1093/eurpub/ckt177] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In China, childhood obesity is a growing health issue. Eating behaviors among children can be influenced by both the family and school environment. We examine the association between these environments and eating habits among children. METHODS A total of 11 270 fourth to sixth grade school children, 11 270 of their fathers or mothers, and 1348 teachers from 48 schools were sampled using a multistage cluster random sampling method. Questionnaires collected information on eating behaviors among children, non-communicable chronic disease (NCD)-related health knowledge and behaviors among teachers, and education levels among parents. Mixed effect logistic regression models were used to describe the key associations between eating behaviors among children and teacher and parental characteristics. RESULTS Health awareness, positive health attitudes, never-smoking and regular-exercise among teachers was positively associated with healthy eating behaviors among their students (having breakfast, vegetables and dairy products every day; P < 0.05), and negatively associated with the unhealthy behaviors (daily intake of fried foods and desserts and sugary beverages; P < 0.05). More than one parent having a high school level or above was positively related to healthy eating behaviors among their children (P < 0.05), but its associations with high-calorie eating habits were negative in urban and positive in rural areas (P < 0.05). CONCLUSIONS School-based interventions which target health-related awareness, attitude and behaviors among school teachers may help improve school-aged children's eating behaviors. Parental education levels may help guide efforts to target children at higher risk of unhealthy eating habits.
Collapse
Affiliation(s)
- Liu He
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yi Zhai
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | | | - Weirong Li
- 3 Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Hanzhu Qian
- 4 Vanderbilt Institute for Global Health, Vanderbilt University, Nashville, TN, USA
| | - Xiang Si
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xin Gao
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Melanie Sereny
- 5 Department of Sociology, Duke University, Durham, NC, USA
| | - Jing Liang
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xiaolei Zhu
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Xiaoming Shi
- 1 Division of Non-Communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| |
Collapse
|
14
|
Li N, Yan LL, Niu W, Labarthe D, Feng X, Shi J, Zhang J, Zhang R, Zhang Y, Chu H, Neiman A, Engelgau M, Elliott P, Wu Y, Neal B. A large-scale cluster randomized trial to determine the effects of community-based dietary sodium reduction--the China Rural Health Initiative Sodium Reduction Study. Am Heart J 2013; 166:815-22. [PMID: 24176436 DOI: 10.1016/j.ahj.2013.07.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [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] [Received: 12/16/2012] [Accepted: 07/01/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiovascular diseases are the leading cause of death and disability in China. High blood pressure caused by excess intake of dietary sodium is widespread and an effective sodium reduction program has potential to improve cardiovascular health. DESIGN This study is a large-scale, cluster-randomized, trial done in five Northern Chinese provinces. Two counties have been selected from each province and 12 townships in each county making a total of 120 clusters. Within each township one village has been selected for participation with 1:1 randomization stratified by county. The sodium reduction intervention comprises community health education and a food supply strategy based upon providing access to salt substitute. Subsidization of the price of salt substitute was done in 30 intervention villages selected at random. Control villages continued usual practices. The primary outcome for the study is dietary sodium intake level estimated from assays of 24-hour urine. TRIAL STATUS The trial recruited and randomized 120 townships in April 2011. The sodium reduction program was commenced in the 60 intervention villages between May and June of that year with outcome surveys scheduled for October to December 2012. Baseline data collection shows that randomisation achieved good balance across groups. DISCUSSION The establishment of the China Rural Health Initiative has enabled the launch of this large-scale trial designed to identify a novel, scalable strategy for reduction of dietary sodium and control of blood pressure. If proved effective, the intervention could plausibly be implemented at low cost in large parts of China and other countries worldwide.
Collapse
Affiliation(s)
- Nicole Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Abstract
We assessed the burden of cancer on households’ out-of-pocket health spending, non-medical consumption, workforce participation, and debt and asset sales using data from a nationally representative health and morbidity survey in India for 2004 of nearly 74 thousand households. Propensity scores were used to match households containing a member diagnosed with cancer (i.e. cancer-affected households) to households with similar socioeconomic and demographic characteristics (controls). Our estimates are based on data from 1,645 households chosen through matching. Cancer-affected households experienced higher levels of outpatient visits and hospital admissions and increased out-of-pocket health expenditures per member, relative to controls. Cancer-affected households spent between Indian Rupees (INR) 66 and INR 85 more per member on healthcare over a 15-day reference period, than controls and additional expenditures (per member) incurred on inpatient care by cancer-affected households annually is equivalent to 36% to 44% of annual household expenditures of matched controls. Members without cancer in cancer-affected households used less health-care and spent less on healthcare. Overall, adult workforce participation rates were lower by between 2.4 and 3.2 percentage points compared to controls; whereas workforce participation rates among adult members without cancer were higher than in control households. Cancer-affected households also had significantly higher rates of borrowing and asset sales for financing outpatient care that were 3.3% to 4.0% higher compared to control households; and even higher for inpatient care.
Collapse
Affiliation(s)
- Ajay Mahal
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anup Karan
- Public Health Foundation of India, New Delhi, India, and University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Victoria Y. Fan
- Center for Global Development, Washington, District of Columbia, United States of America
| | - Michael Engelgau
- South Asia Human Development Unit, The World Bank, Washington, District of Columbia, United States of America
| |
Collapse
|
16
|
Zhang J, Xu AQ, Ma JX, Shi XM, Guo XL, Engelgau M, Yan LX, Li Y, Li YC, Wang HC, Lu ZL, Zhang JY, Liang XF. Dietary sodium intake: knowledge, attitudes and practices in Shandong Province, China, 2011. PLoS One 2013; 8:e58973. [PMID: 23527061 PMCID: PMC3601121 DOI: 10.1371/journal.pone.0058973] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [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: 11/30/2012] [Accepted: 02/08/2013] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate the knowledge, attitudes and practices (KAP) for dietary sodium intake among adult residents of Shandong Province, China Methods In 2011, we conducted a cross sectional survey among a representative sample of 15,350 adults aged 18 to 69 years using a standardized questionnaire to assess their KAP for sodium. Variation in the KAPs by gender, and residence location were compared using the Chi-square tests. Predictors for the ‘intention to’ and ‘currently taking action to’ reduce sodium intake were determined by multivariate logistic regression with adjustment for confounding factors. Results KAPs for dietary sodium intake among urban residents was generally more favorable than among rural residents. Women were likely to have more favorable KAPs than men. About four fifth of subjects reported that they favored a low sodium diets. However, 31% reported that consumption of less sodium results in less physical strength. Overall, 70% indicated their intention to reduce sodium intake, although only 39 % reported that they had taken action to reduce sodium. Multiple logistic regression analyses indicated that favorable actions to dietary sodium reduction were more likely to occur among those who were aware of the link between sodium and hypertension, and less likely among those who had unfavorable attitudes towards dietary sodium reduction. Conclusion Increasing knowledge levels about the benefits of sodium reduction will be a key success factor for effective sodium reduction initiatives and is linked to favorable behavioral change. Emphasis should be placed on the rural area.
Collapse
Affiliation(s)
- Juan Zhang
- Division of Non-communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ai-qiang Xu
- Shandong Center for Disease Control and Prevention, Jinan, China
| | - Ji-xiang Ma
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao-ming Shi
- Division of Non-communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiao-lei Guo
- Institute of NCD Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Michael Engelgau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America,
| | - Liu-xia Yan
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Li
- Division of Non-communicable Disease Control and Community Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yi-chong Li
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hui-cheng Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zi-long Lu
- Institute of NCD Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Ji-yu Zhang
- Institute of NCD Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xiao-feng Liang
- Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
| |
Collapse
|
17
|
Engelgau M, Rosenhouse S, El-Saharty S, Mahal A. The economic effect of noncommunicable diseases on households and nations: a review of existing evidence. J Health Commun 2011; 16 Suppl 2:75-81. [PMID: 21916715 DOI: 10.1080/10810730.2011.601394] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In developing countries, the noncommunicable disease (NCD) and risk factor burdens are shifting toward the poor. Treating chronic diseases can be expensive. In developing countries where generally much health care costs are borne by patients themselves, for those who live in poverty or recently escaped severe poverty, when faced with large, lifelong out-of-pocket expenses, impoverishment persists or can reoccur. These patterns have implications for national economic growth and poverty-reduction efforts. NCDs can change spending patterns dramatically and result in significantly reducing non-medical-related spending on food and education. In India, about 40% of household expenditures for treating NCDs are financed by households with distress patterns (borrowing and sales of assets). NCD short- and long-term disability can lead to a decrease in working-age population participation in the labor force and reduce productivity and, in turn, reduce per capita gross domestic product growth. To fully capitalize on the demographic dividend (i.e., aging of the population resulting in less dependent children, not yet more dependent elderly, and greater national productivity), healthy aging is necessary, which, in turn, requires effectively tackling NCDs. Last, from an equity standpoint, the economic effect of NCDs, evident at the household level and at the country level, will disproportionately affect the poor and vulnerable populations in the developing world.
Collapse
Affiliation(s)
- Michael Engelgau
- South Asia Human Development Unit, World Bank, Washington, District of Columbia, USA.
| | | | | | | |
Collapse
|
18
|
Beaglehole R, Bonita R, Horton R, Adams C, Alleyne G, Asaria P, Baugh V, Bekedam H, Billo N, Casswell S, Cecchini M, Colagiuri R, Colagiuri S, Collins T, Ebrahim S, Engelgau M, Galea G, Gaziano T, Geneau R, Haines A, Hospedales J, Jha P, Keeling A, Leeder S, Lincoln P, McKee M, Mackay J, Magnusson R, Moodie R, Mwatsama M, Nishtar S, Norrving B, Patterson D, Piot P, Ralston J, Rani M, Reddy KS, Sassi F, Sheron N, Stuckler D, Suh I, Torode J, Varghese C, Watt J. Priority actions for the non-communicable disease crisis. Lancet 2011; 377:1438-47. [PMID: 21474174 DOI: 10.1016/s0140-6736(11)60393-0] [Citation(s) in RCA: 1021] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The UN High-Level Meeting on Non-Communicable Diseases (NCDs) in September, 2011, is an unprecedented opportunity to create a sustained global movement against premature death and preventable morbidity and disability from NCDs, mainly heart disease, stroke, cancer, diabetes, and chronic respiratory disease. The increasing global crisis in NCDs is a barrier to development goals including poverty reduction, health equity, economic stability, and human security. The Lancet NCD Action Group and the NCD Alliance propose five overarching priority actions for the response to the crisis--leadership, prevention, treatment, international cooperation, and monitoring and accountability--and the delivery of five priority interventions--tobacco control, salt reduction, improved diets and physical activity, reduction in hazardous alcohol intake, and essential drugs and technologies. The priority interventions were chosen for their health effects, cost-effectiveness, low costs of implementation, and political and financial feasibility. The most urgent and immediate priority is tobacco control. We propose as a goal for 2040, a world essentially free from tobacco where less than 5% of people use tobacco. Implementation of the priority interventions, at an estimated global commitment of about US$9 billion per year, will bring enormous benefits to social and economic development and to the health sector. If widely adopted, these interventions will achieve the global goal of reducing NCD death rates by 2% per year, averting tens of millions of premature deaths in this decade.
Collapse
|
19
|
Gregg EW, Gu Q, Williams D, de Rekeneire N, Cheng YJ, Geiss L, Engelgau M. Prevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and diabetes among U.S. adults aged 40 or older. Diabetes Res Clin Pract 2007; 77:485-8. [PMID: 17306411 DOI: 10.1016/j.diabres.2007.01.005] [Citation(s) in RCA: 69] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 01/08/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peripheral arterial disease (PAD) and peripheral neuropathy (PN) are serious complications of diabetes, but early detection and intervention may reduce this morbidity. The degree to which PAD and PN develop before diabetes diagnosis has not been established among a representative sample of U.S. adults. OBJECTIVE To compare the prevalence of lower extremity diseases (LEDs) among U.S. adults aged 40 or older with previously diagnosed diabetes, undiagnosed diabetes, impaired fasting glucose, and normal glucose levels. RESEARCH DESIGN AND METHODS We analyzed cross-sectional data of a nationally representative sample of 3607 U.S. adults from the 1999-2004 National Health and Nutrition Examination Surveys (NHANES). Subjects were divided into four groups on the basis of their fasting plasma glucose (FPG) levels and interview responses: normal glucose levels (FPG<100mg/dl), impaired fasting glucose (IFG; FPG 100-125 mg/dl), undiagnosed diabetes (FPG> or =126 and no self-reported diabetes), and diagnosed diabetes. PN was assessed by monofilament testing at three sites on each foot and defined as > or =1 insensate area. PAD was defined as an ankle-brachial blood pressure index <0.9. Any LED was defined as the presence of PAD or PN or a history of non-healing ulcer or amputation. RESULTS The prevalence of PN was lowest among persons with normal glucose (10.5%) and IFG (11.9%) and highest among those with undiagnosed (16.6%) and diagnosed diabetes (19.4%). PAD prevalence was also lowest among persons with normal glucose (3.9%), similar among those with IFG (5.4%), and significantly higher among those with undiagnosed (9.2%) and diagnosed diabetes (7.5%). Any LED was present in about 27% of persons with both undiagnosed diabetes and diagnosed diabetes. CONCLUSIONS LED prevalence was nearly as high among persons with previously undiagnosed diabetes as among those with diagnosed diabetes, but it was not appreciably higher among persons with impaired fasting glucose than among those with normal glucose levels. These results suggest that LED detection efforts should be focused on persons with diabetes, including those with undiagnosed diabetes.
Collapse
Affiliation(s)
- Edward W Gregg
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, Atlanta, GA 30341, USA.
| | | | | | | | | | | | | |
Collapse
|
20
|
Affiliation(s)
- Leonard Pogach
- HSR Center for Healthcare Knowledge Management, New Jersey Veterans Healthcare System, East Orange 07018, USA.
| | | | | |
Collapse
|
21
|
Affiliation(s)
- K M Venkat Narayan
- Hubert Department of Global Health, The Rollins School of Public Health, Emory University, Atlanta, Ga, USA
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Over the last few decades, numerous public health agencies and other private and public organizations have sought to prevent and delay the disabling complications of diabetes by increasing the use of preventive care practices and reducing risk factors for complications among people with diabetes. Now, federal diabetes surveillance activities are yielding encouraging reports that progress is being made in increasing the use of preventive care practices, reducing risk factors for complications, and preventing or delaying diabetes complications. However, although several gains have been noted, levels of preventive care practices remain suboptimal, risk factors for diabetes complications are too prevalent, and diabetes complications are too pervasive. Furthermore, with compelling evidence that the onset of diabetes can be prevented or delayed among adults at high risk, prevention of diabetes has become a major new challenge. Additional efforts are needed to address the growing problems of obesity and physical inactivity, to identify the most efficacious and cost-effective prevention strategies and interventions, and to implement surveillance activities that allow us to gauge our success. Although progress has been made against diabetes complications, the current epidemic of diabetes increases the urgency of primary prevention efforts.
Collapse
Affiliation(s)
- Linda Geiss
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Saydah SH, Geiss LS, Tierney E, Benjamin SM, Engelgau M, Brancati F. Review of the performance of methods to identify diabetes cases among vital statistics, administrative, and survey data. Ann Epidemiol 2004; 14:507-16. [PMID: 15301787 DOI: 10.1016/j.annepidem.2003.09.016] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2003] [Accepted: 09/29/2003] [Indexed: 11/22/2022]
Abstract
PURPOSE The ability to identify prevalent cases of diagnosed diabetes is crucial to monitoring preventative care practices and health outcomes among persons with diagnosed diabetes. METHODS We conducted a comprehensive literature review to assess and summarize the validity of various strategies for identifying individuals with diagnosed diabetes and to examine the factors influencing the validity of these strategies. RESULTS We found that studies using either administrative data or survey data were both adequately sensitive (i.e., identified the majority of cases of diagnosed diabetes) and highly specific (i.e., did not identify the individuals as having diabetes if they did not). In contrast, studies based on cause-of-death data from death certificates were not sensitive, failing to identify about 60% of decedents with diabetes and in most of these studies, researchers did not report specificity or positive predictive value. CONCLUSIONS Surveillance is critical for tracking trends in diabetes and targeting diabetes prevention efforts. Several approaches can provide valuable data, although each has limitations. By understanding the limitations of the data, investigators will be able to estimate diabetes prevalence and improve surveillance of diabetes in the population.
Collapse
Affiliation(s)
- Sharon H Saydah
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | | | | | | | | | | |
Collapse
|
24
|
Porterfield DS, Din R, Burroughs A, Burrus B, Petteway R, Treiber L, Lamb B, Engelgau M. Screening for diabetes in an African-American community: the Project DIRECT experience. J Natl Med Assoc 2004; 96:1325-31. [PMID: 15540883 PMCID: PMC2568551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
AIM To report the results of a community-based screening program associated with Project DIRECT, a multiyear diabetes mellitus prevention and control project targeting African-American residents of southeast Raleigh, NC. METHODS Between December 1996 and June 1999, 183 screening events took place in community settings. Screening was by capillary glucose concentration. Participants with a positive screen were referred for confirmatory testing and physician follow-up. MAIN RESULTS Risk factors for diabetes were prevalent, including ethnic minority race (88.2%), obesity (45.6%), and family history of diabetes (41.7%). In all, 197 personshad an elevated screening result; the prevalence of diabetes in the screened population that underwent follow-up testiing was 1.7%. Despite persistent tracking efforts, 28% of the persons with a high screening test received no final diagnosis CONCLUSIONS In this community-based screening program targeted to high-risk African Americans, risk factors for diabetes were common, but new cases of undiagnosed diabetes among participants were uncommon. Intensive follow-up for persons with high screening values is necessary but difficult to achieve. Our results support national recommendations against community-based screening; opportunistic screening for diabetes in clinical settings is likely a more effective use of resources.
Collapse
|
25
|
Gregg EW, Sorlie P, Paulose-Ram R, Gu Q, Eberhardt MS, Wolz M, Burt V, Curtin L, Engelgau M, Geiss L. Prevalence of lower-extremity disease in the US adult population >=40 years of age with and without diabetes: 1999-2000 national health and nutrition examination survey. Diabetes Care 2004; 27:1591-7. [PMID: 15220233 DOI: 10.2337/diacare.27.7.1591] [Citation(s) in RCA: 396] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although lower-extremity disease (LED), which includes lower-extremity peripheral arterial disease (PAD) and peripheral neuropathy (PN), is disabling and costly, no nationally representative estimates of its prevalence exist. The aim of this study was to examine the prevalence of lower-extremity PAD, PN, and overall LED in the overall U.S. population and among those with and without diagnosed diabetes. RESEARCH DESIGN AND METHODS The analysis consisted of data for 2873 men and women aged >or=40 years, including 419 with diagnosed diabetes, from the 1999-2000 National Health and Nutrition Examination Survey. The main outcome measures consisted of the prevalence of lower-extremity PAD (defined as ankle-brachial index <0.9), PN (defined as >or=1 insensate area based on monofilament testing), and of any LED (defined as either PAD, PN, or history of foot ulcer or lower-extremity amputations). RESULTS Of the U.S. population aged >or=40 years, 4.5% (95% CI 3.4-5.6) have lower-extremity PAD, 14.8% (12.8-16.8) have PN, and 18.7% (15.9-21.4) have any LED. Prevalence of PAD, PN, and overall LED increases steeply with age and is higher (P < 0.05) in non-Hispanic blacks and Mexican Americans than non-Hispanic whites. The prevalence of LEDs is approximately twice as high for individuals with diagnosed diabetes (PAD 9.5% [5.5-13.4]; PN 28.5% [22.0-35.1]; any LED 30.2% [22.1-38.3]) as the overall population. CONCLUSIONS LED is common in the U.S. and twice as high among individuals with diagnosed diabetes. These conditions disproportionately affect the elderly, non-Hispanic blacks, and Mexican Americans.
Collapse
Affiliation(s)
- Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Centers for Diseases Control and Prevention, Atlanta, GA 30341, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
Abstract
BACKGROUND No randomized, controlled trial of screening for diabetes has been conducted. In the absence of direct evidence, cost-effectiveness models may provide guidance about preferred screening strategies. OBJECTIVE To estimate the incremental cost-effectiveness of 2 diabetes screening strategies: screening targeted to people with hypertension and universal screening. DESIGN Markov model. DATA SOURCES United Kingdom Prospective Diabetes Study, Hypertension Optimal Treatment trial, and recent cost data. TARGET POPULATION General primary care population in the United States. TIME HORIZON Lifetime. PERSPECTIVE Health care system. INTERVENTIONS Diabetes screening targeted to people with hypertension and universal screening. OUTCOME MEASURES Cost per quality-adjusted life-year (QALY) gained. Costs (in 1997 U.S. dollars) and QALYs discounted at a 3% annual rate. RESULTS OF BASE-CASE ANALYSIS At all ages, incremental cost-effectiveness ratios were more favorable for screening targeted to people with hypertension than for universal screening. For example, at age 55 years, the cost per QALY for targeted screening compared with no screening was 34,375 dollars, whereas the cost per QALY for universal screening compared with targeted screening was 360,966 dollars. Screening was more cost-effective for ages 55 to 75 years than for younger ages. RESULTS OF SENSITIVITY ANALYSIS In single-way and probabilistic sensitivity analyses, findings were robust to therapy costs, screening costs, screening lead time, reduced effectiveness of intensive antihypertensive therapy, and increased relative risk reduction for stroke attributable to intensive hypertension control. LIMITATIONS We did not consider screening targeted to persons with dyslipidemia, and we used studies of people whose diabetes was detected clinically to estimate screening benefits. CONCLUSIONS Diabetes screening targeted to people with hypertension is more cost-effective than universal screening. The most cost-effective strategy is targeted screening at age 55 to 75 years.
Collapse
Affiliation(s)
- Thomas J Hoerger
- RTI International, Research Triangle Park, North Carolina 27709, USA.
| | | | | | | | | | | |
Collapse
|
27
|
Affiliation(s)
- Frank Vinicor
- Division of Diabetes Translation (K-10), Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | | | | |
Collapse
|
28
|
Earnshaw SR, Richter A, Sorensen SW, Hoerger TJ, Hicks KA, Engelgau M, Thompson T, Narayan KMV, Williamson DF, Gregg E, Zhang P. Optimal allocation of resources across four interventions for type 2 diabetes. Med Decis Making 2002; 22:S80-91. [PMID: 12369234 DOI: 10.1177/027298902237704] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Several interventions can be applied to prevent complications of type 2 diabetes. This article examines the optimal allocation of resources across 4 interventions to treat patients newly diagnosed with type 2 diabetes. The interventions are intensive glycemic control, intensified hypertension control, cholesterol reduction, and smoking cessation. METHODS A linear programming model was designed to select sets of interventions to maximize quality-adjusted life years (QALYs), subject to varied budget and equity constraints. RESULTS For no additional cost, approximately 211,000 QALYs can be gained over the lifetimes of all persons newly diagnosed with diabetes by implementing interventions rather than standard care. With increased availability of funds, additional health benefits can be gained but with diminishing marginal returns. The impact of equity constraints is extensive compared to the solution with the same intervention costs and no equity constraint. Under the conditions modeled, intensified hypertension control and smoking cessation interventions were provided most often, and intensive glycemic control and cholesterol reduction interventions were provided less often. CONCLUSIONS A resource allocation model identifies trade-offs involved when imposing budget and equity constraints on care for individuals with newly diagnosed diabetes.
Collapse
Affiliation(s)
- Stephanie R Earnshaw
- RTI Health Solutions, RTI, 3040 Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Jones CA, Francis ME, Eberhardt MS, Chavers B, Coresh J, Engelgau M, Kusek JW, Byrd-Holt D, Narayan KMV, Herman WH, Jones CP, Salive M, Agodoa LY. Microalbuminuria in the US population: third National Health and Nutrition Examination Survey. Am J Kidney Dis 2002; 39:445-59. [PMID: 11877563 DOI: 10.1053/ajkd.2002.31388] [Citation(s) in RCA: 315] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Microalbuminuria (MA) is associated with adverse health outcomes in diabetic and hypertensive adults. The prevalence and clinical significance of MA in nondiabetic populations is less clear. The purpose of this study was to generate national estimates of the prevalence of MA in the US population. Untimed urinary albumin concentrations (UACs) and creatinine concentrations were evaluated in a nationally representative sample of 22,244 participants aged 6 years and older. Persons with hematuria and menstruating or pregnant women were excluded from analysis. The percent prevalence of clinical proteinuria (UAC > or = 300 mg/L) was similar for males and females. However, the prevalence of MA (urinary albumin-creatinine ratio [ACR], 30 to 299 mg/g) was significantly lower in males (6.1%) compared with females (9.7%). MA prevalence was greater in children than young adults and increased continuously starting at 40 years of age. MA prevalence was greater in non-Hispanic blacks and Mexican Americans aged 40 to 79 years compared with similar-aged non-Hispanic whites. MA prevalence was 28.8% in persons with previously diagnosed diabetes, 16.0% in those with hypertension, and 5.1% in those without diabetes, hypertension, cardiovascular disease, or elevated serum creatinine levels. In adults aged 40+ years, after excluding persons with clinical proteinuria, albuminuria (defined as ACR > or = 30 mg/g) was independently associated with older age, non-Hispanic black and Mexican American ethnicity, diabetes, hypertension, and elevated serum creatinine concentration. MA is common, even among persons without diabetes or hypertension. Age, sex, race/ethnicity, and concomitant disease contribute to the variability of MA prevalence estimates.
Collapse
Affiliation(s)
- Camille A Jones
- Division of Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA, 02215, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|