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Kibria GMA, Meghani A, Ssemagabo C, Wosu A, Nareeba T, Gyezaho C, Galiwango E, Nanyonga JK, Pariyo GW, Kajungu D, Rutebemberwa E, Gibson DG. Geographical, sex, and socioeconomic differences in non-communicable disease indicators: A cross-sectional survey in Eastern Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003308. [PMID: 38865350 PMCID: PMC11168612 DOI: 10.1371/journal.pgph.0003308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/15/2024] [Indexed: 06/14/2024]
Abstract
The prevalence of non-communicable diseases (NCDs) is increasing in many low- and middle-income countries (LMICs). This study examined differences in the burden of NCDs and their risk factors according to geographic, sex, and sociodemographic characteristics in a rural and peri-urban community in Eastern Uganda. We compared the prevalence by sex, location, wealth, and education. Unadjusted and adjusted prevalence ratios (PR) were reported. Indicators related to tobacco use, alcohol use, salt consumption, fruit/vegetable consumption, physical activity, body weight, and blood pressure were assessed. Among 3220 people (53.3% males, mean age: 35.3 years), the prevalence of NCD burden differed by sex. Men had significantly higher tobacco (e.g., current smoking: 7.6% vs. 0.7%, adjusted PR (APR): 12.8, 95% CI: 7.4-22.3), alcohol use (e.g., current drinker: 11.1% vs. 4.6%, APR: 13.4, 95% CI: 7.9-22.7), and eat processed food high in salt (13.4% vs. 7.1, APR: 1.8, 95% CI: 1.8, 95% CI: 1.4-2.4) than women; however, the prevalence of overweight (23.1% vs 30.7%, APR: 0.7, 95% CI: 0.6-0.9) and obesity (4.1% vs 14.7%, APR: 0.3, 95% CI: 0.2-0.3) was lower among men than women. Comparing locations, peri-urban residents had a higher prevalence of current alcohol drinking, heavy episodic drinking, always/often adding salt while cooking, always eating processed foods high in salt, poor physical activity, obesity, prehypertension, and hypertension than rural residents (p<0.5). When comparing respondents by wealth and education, we found people who have higher wealth or education had a higher prevalence of always/often adding salt while cooking, poor physical activity, and obesity. Although the findings were inconsistent, we observed significant sociodemographic and socioeconomic differences in the burden of many NCDs, including differences in the distributions of behavioral risk factors. Considering the high burden of many risk factors, we recommend appropriate prevention programs and policies to reduce these risk factors' burden and future negative consequences.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ankita Meghani
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Charles Ssemagabo
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Adaeze Wosu
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Tryphena Nareeba
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Collins Gyezaho
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Edward Galiwango
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Judith Kaija Nanyonga
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - George W. Pariyo
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dan Kajungu
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Elizeus Rutebemberwa
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, Mulago Hill, Kampala, Uganda
| | - Dustin G. Gibson
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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González Fernández L, Firima E, Gupta R, Sematle MP, Khomolishoele M, Molulela M, Bane M, Meli R, Tlahali M, Lee T, Chammartin F, Gerber F, Lejone TI, Ayakaka I, Weisser M, Amstutz A, Labhardt ND. Prevalence and determinants of cardiovascular risk factors in Lesotho: a population-based survey. Int Health 2024; 16:313-324. [PMID: 37593886 PMCID: PMC11062187 DOI: 10.1093/inthealth/ihad058] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND There are no recent data on the prevalence of cardiovascular risk factors (CVDRFs) in Lesotho. This study aims to assess the prevalence of CVDRFs and their determinants. METHODS We conducted a household-based, cross-sectional survey among adults ≥18 y of age in 120 randomly sampled clusters in two districts. RESULTS Among 6061 participants, 52.2% were female and their median age was 39 y (interquartile range 27-58). The overall prevalence of overweight, diabetes, elevated blood pressure (BP) and tobacco use was 39.9%, 5.3%, 21.6% and 24.9%, respectively. Among participants, 34.6% had none, 45.2% had one and 20.2% had two or more CVDRFs. Women were more likely to have two or more CVDRFs (20.7% vs 12.3%). Overall, 7.5% of participants had elevated total cholesterol, 52.7% had low high-density lipoprotein cholesterol and 1.6% had elevated low-density lipoprotein cholesterol. Among younger participants (18-29 y), 16.1% reported tobacco use, 28.6% were overweight, 1.5% had diabetes and 3.5% had elevated BP. Household wealth positively correlated with the prevalence of elevated BP, overweight and diabetes, whereas tobacco use was higher among people in the lowest three wealth quintiles. CONCLUSIONS CVDRFs are highly prevalent in Lesotho across age and sex groups, underlining the importance of strengthening prevention and care programs in Lesotho and similar settings in southern Africa.
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Affiliation(s)
- Lucia González Fernández
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Basel, 4051, Switzerland
- University of Basel, Basel, Switzerland
- SolidarMed, Partnerships for Health, Luzern, Switzerland
| | - Emmanuel Firima
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Basel, 4051, Switzerland
- University of Basel, Basel, Switzerland
| | - Ravi Gupta
- SolidarMed, Partnerships for Health, Maseru, Lesotho
| | | | | | | | | | - Raphaela Meli
- SolidarMed, Partnerships for Health, Luzern, Switzerland
| | - Mosa Tlahali
- Mokhotlong District Health Management Team, Mokhotlong, Ministry of Health Lesotho
| | - Tristan Lee
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Basel, 4051, Switzerland
- University of Basel, Basel, Switzerland
| | - Frédérique Chammartin
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Felix Gerber
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Basel, 4051, Switzerland
- University of Basel, Basel, Switzerland
| | - Thabo Ishmael Lejone
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Irene Ayakaka
- SolidarMed, Partnerships for Health, Maseru, Lesotho
| | - Maja Weisser
- Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Basel, 4051, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Alain Amstutz
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Niklaus Daniel Labhardt
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Addo IY, Acquah E, Nyarko SH, Dickson KS, Boateng ENK, Ayebeng C. Exposure to pro-tobacco and anti-tobacco media messages and events and smoking behaviour among adolescents in Gambia. BMC Public Health 2024; 24:1041. [PMID: 38622588 PMCID: PMC11017583 DOI: 10.1186/s12889-024-18543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/07/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Despite the widespread prevalence of adolescent smoking in Gambia, a West African country, there is limited research exploring the relationships between exposure to pro-tobacco and anti-tobacco media messages and events and smoking behaviour among young people. This study investigates the interplay of these exposures and smoking behaviour among 11-17-year-old adolescents in Gambia. METHODS Secondary data analysis was conducted using the 2017 Gambia Global Youth and Tobacco Survey (GYTS), which included a total of 9,127 respondents. Descriptive and inferential analyses, including proportions, Pearson's chi-squared tests, and multivariable logistic regression models, were employed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI). RESULTS The final model revealed significant associations between exposure to anti-tobacco media messages and events and smoking behaviour. Adolescents exposed to anti-tobacco media messages had a 29% increased odds of smoking (aOR 1.29,CI = 1.08,1.53) compared to those unexposed, while exposure to anti-tobacco media events showed a 31% increased odds (aOR 1.31,CI = 1.09,1.59) compared to those unexposed. Exposure to pro-tobacco messages, such as witnessing tobacco use on TV (aOR 1.41, CI = 1.17,1.69) and owning objects with tobacco brand logos (aOR 1.49,CI = 1.19,1.86), was associated with higher odds of smoking. Covariates, including sex, age, and exposure to smoking behaviour by significant others, also demonstrated associations with smoking behaviour. Notably, male respondents showed significantly higher odds of smoking (aOR = 4.01,CI = 3.28,4.89) compared to females. Respondents aged 15 years and older had increased odds of smoking (aOR = 1.47,CI = 1.22,1.76) compared to those below 15 years old. Those whose fathers smoke displayed higher odds of smoking (aOR = 1.35, CI = 1.04,1.76) compared to individuals with non-smoking parents. Additionally, those whose closest friends smoke showed remarkably higher odds of smoking (aOR = 2.87,CI = 2.37, 3.48) compared to those without such influence. CONCLUSION This study underscores the significant impact of exposure to both anti-tobacco and pro-tobacco media messages and events on smoking behaviour among adolescents in Gambia. However, pro-tobacco messages had a greater influence on smoking prevalence than anti-tobacco messages and events. Understanding these associations is crucial for devising effective public health interventions aimed at reducing tobacco use in this population.
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Affiliation(s)
- Isaac Yeboah Addo
- Concord Clinical School, University of Sydney, Sydney, Australia
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia
| | - Evelyn Acquah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health, and Allied Sciences, Ho, Ghana
| | - Samuel H Nyarko
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas, USA
| | - Kwamena S Dickson
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer N K Boateng
- Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana
| | - Castro Ayebeng
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
- Department of Research and Advocacy, Challenging Heights, Winneba, Ghana.
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Al Kibria GM, Kagoro F, Pariyo G, Ali J, Hassan F, Kilambo JW, Petro I, Maniar V, Kaufman MR, Vecino-Ortiz A, Ahmed S, Masanja H, Gibson DG. A nationwide mobile phone survey for tobacco use in Tanzania: Sample quality and representativeness compared to a household survey. Prev Med Rep 2024; 38:102609. [PMID: 38375185 PMCID: PMC10874872 DOI: 10.1016/j.pmedr.2024.102609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/21/2024] Open
Abstract
We investigated the feasibility of an interactive voice response (IVR) survey in Tanzania and compared its prevalence estimates for tobacco use to the estimates of the 'Global Adult Tobacco Survey (GATS) 2018'. IVR participants were enrolled by random digit dialing. Quota sampling was employed to achieve the required sample sizes of age-sex strata: sex (male/female) and age (18-29-, 30-44-, 45-59-, and ≥60-year-olds). GATS was a nationally representative survey and used a multistage stratified cluster sampling design. The IVR sample's weights were generated using the inverse proportional weighting (IPW) method with a logit model and the standard age-sex distribution of Tanzania. The IVR and GATS had 2362 and 4555 participants, respectively. Compared to GATS, the unweighted IVR sample had a higher proportion of males (58.7 % vs. 43.2 %), educated people (secondary/above education: 43.3 % vs. 21.1 %), and urban residents (56.5 % vs. 40 %). The weighted prevalence (95 % confidence interval (CI)) of current smoking was 4.99 % (4.11-6.04), 5.22 % (4.36-6.24), and 7.36 % (6.51-8.31) among IVR (IPW), IVR (age-sex standard), and GATS samples, respectively; the weighted prevalence (95 % CI) of smokeless tobacco use was similar: 3.54 % (2.73-4.57), 3.58 % (2.80-4.56), and 2.43 % (1.98-2.98), respectively. Most differences in point estimates for tobacco indicators were small (<2%). Overall, the odds of tobacco smoking indicators were lower in IVR than in GATS; however, the odds of smokeless tobacco use were reversed. Although we found under-/over-estimation of the prevalence of tobacco use in IVR than GATS, the estimates were close. Further research is required to increase the representativeness of IVR.
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Affiliation(s)
- Gulam Muhammed Al Kibria
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Frank Kagoro
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Center for Optimising Antimalarial Therapy, University of Cape Town, Cape Town, South Africa
- The Global Health Network, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - George Pariyo
- Serum Africa Medical Research Institute, Kampala, Uganda
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
- Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, United States
| | | | | | - Irene Petro
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Vidhi Maniar
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Michelle R. Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Andres Vecino-Ortiz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | - Saifuddin Ahmed
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
| | | | - Dustin G. Gibson
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, United States
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Mlouki I, Majdoub M, Hariz E, Silini A, Mrabet HE, Rezg N, El Mhamdi S. Gender differences in adverse childhood experiences, resilience and internet addiction among Tunisian students: Exploring the mediation effect. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002556. [PMID: 38236830 PMCID: PMC10795992 DOI: 10.1371/journal.pgph.0002556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/16/2023] [Indexed: 01/22/2024]
Abstract
Adverse Childhood Experiences (ACEs) are a common public health issue with a variety of consequences, including behavioral addiction such as Internet Addiction (IA). Despite widespread recognition of this issue, the underlying mechanisms are not well studied in recent literature. Additionally, studies have indicated gender disparities in the prevalence and manifestation of ACEs and IA. The objective of this study was to investigate the mediating effect of resilience on the link between ACEs and IA among high-school students according to gender in Mahdia city (Tunisia). We conducted a cross-sectional survey for two months (January- February 2020), among 2520 schooled youth in Mahdia city (Tunisia). The Arabic-language edition of the World Health Organisation ACE questionnaire was used. The validated Arabic versions of the Adolescent Psychological Resilience Scale and the Internet Addiction Test were the screening tools for resilience and IA. Data were analyzed according to gender. The majority of youth (97.5%) were exposed to at least one ACE with the most prevalent being emotional neglect (83.2%). Exposure to extra-familial ACEs was also high reaching 86.9% with higher rates among boys for all types of social violence. Internet addiction was common among students (50%) with higher prevalence for boys (54.4% vs 47.7%for girls, p = 0.006). Resilience scores were86.43 ± 9.7 for girls vs 85.54 ± 9.79 for boys. The current study showed that resilience mediated the link between ACEs, especially intrafamilial violence, and internet addiction (%mediated = 15.1). According to gender, resilience had a significant mediating role on internet addiction for girls (%mediated = 17) and no significant role for boys. The mediating effect of resilience in the relationship between ACEs and cyberaddiction among schooled adolescents in the region of Mahdia (Tunisia) has been identified.
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Affiliation(s)
- Imen Mlouki
- Preventive and Community Medicine, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
- Research Laboratory “Epidemiology Applied to Maternal and Child Health” 12SP17, Monastir, Tunisia
| | - Mariem Majdoub
- Department of Preventive and Community Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Emna Hariz
- Department of Preventive and Community Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ahlem Silini
- Preventive and Community Medicine, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | | | - Nejla Rezg
- Department of Preventive and Community Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Sana El Mhamdi
- Preventive and Community Medicine, Faculty of Medicine of Monastir, University of Monastir, Monastir, Tunisia
- Department of Preventive and Community Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
- Research Laboratory “Epidemiology Applied to Maternal and Child Health” 12SP17, Monastir, Tunisia
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Keino BC, Carrel M. Spatial and temporal trends of overweight/obesity and tobacco use in East Africa: subnational insights into cardiovascular disease risk factors. Int J Health Geogr 2023; 22:20. [PMID: 37620831 PMCID: PMC10463724 DOI: 10.1186/s12942-023-00342-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is increasing in Sub-Saharan Africa (SSA). Overweight/obesity and tobacco use are modifiable CVD risk factors, however literature about the spatiotemporal dynamics of these risk factors in the region at subnational or local scales is lacking. We describe the spatiotemporal trends of overweight/obesity and tobacco use at subnational levels over a 13-year period (2003 to 2016) in five East African nations. METHODS Cross-sectional, nationally representative Demographic and Health Surveys (DHS) were used to explore the subnational spatiotemporal patterns of overweight/obesity and tobacco use in Burundi, Kenya, Rwanda, Tanzania, and Uganda, five East African Community (EAC) nations with unique cultural landscapes influencing CVD risk factors. Adaptive kernel density estimation and logistic regression were used to determine the spatial distribution and change over time of CVD risk factors on a subnational and subpopulation (rural/urban) scale. RESULTS Subnational analysis shows that regional and national level analysis masks important trends in CVD risk factor prevalence. Overweight/obesity and tobacco use trends were not similar: overweight/obesity prevalence increased across most nations included in the study and the inverse was true for tobacco use prevalence. Urban populations in each nation were more likely to be overweight/obese than rural populations, but the magnitude of difference varied widely between nations. Spatial analysis revealed that although the prevalence of overweight/obesity increased over time in both urban and rural populations, the rate of change differed between urban and rural areas. Rural populations were more likely to use tobacco than urban populations, though the likelihood of use varied substantially between nations. Additionally, spatial analysis showed that tobacco use was not evenly distributed across the landscape: tobacco use increased in and around major cities and urban centers but declined in rural areas. CONCLUSIONS We highlight the importance of de-homogenizing CVD risk factor research in SSA. Studies of national or regional prevalence trends mask important information about subpopulation and place-specific behavior and drivers of risk factor prevalence. Spatially explicit studies should be considered as a vital tool to understand local drivers of health, disease, and associated risk factor trends, especially in highly diverse yet low-resourced, marginalized, and often homogenized regions.
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Affiliation(s)
- Barbara Chebet Keino
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA.
| | - Margaret Carrel
- Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA
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Sheikh ZD, Branston JR, van der Zee K, Gilmore AB. How has the tobacco industry passed tax changes through to consumers in 12 sub-Saharan African countries? Tob Control 2023:tc-2023-058054. [PMID: 37567600 DOI: 10.1136/tc-2023-058054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/10/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION Tobacco taxation is only effective in reducing consumption when it is translated into higher prices. This study aims to investigate to what extent the tobacco industry (TI) passes tax increases over to consumers by increasing the retail price of cigarettes in 12 sub-Saharan African (SSA) countries. METHODS African Cigarette Prices Project and WHO's Global Tobacco Epidemic Reports data were used to calculate the rate of tax pass-through by decomposing the retail price of cigarettes into tax and net prices between 2016 and 2020. Percentage change in net price was used to identify industry pricing behaviour, in both packs and single-stick sales. TI pricing strategies were examined by country, producer type, producers, and cigarette price segment. RESULTS There were mixed TI strategies, with taxes primarily overshifted (Botswana, Madagascar, Tanzania, Zimbabwe), undershifted (Ethiopia, Lesotho, Mozambique, Namibia, South Africa, Zambia) or a mix of both (Malawi, Nigeria). The detail varied between countries, over time, and between the different brands/segments offered. Patterns for single-stick sales were broadly similar to that of packs but with some differences observed in particular countries/years. Pricing strategies for the various transnational tobacco companies and domestic producers were similar but the changes in net price for the latter were larger. The country tax level/type and the size of tax change did not seem to be an obvious influence. CONCLUSION This paper provides an overview of TI pricing strategies in response to tax increases in SSA. Governments must monitor how the TI responds to tax changes to ensure that tax increases are effective in impacting price.
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Affiliation(s)
| | | | - Kirsten van der Zee
- School of Economics, University of Cape Town, Rondebosch, Western Cape, South Africa
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Melariri H, Els T, Oyedele O, Suttle TK, Bermosky KT, De Freitas A, Murtaza A, Moosajee M, Melariri PE. Prevalence of locoregional recurrence and survival post-treatment of head and neck cancers in Africa: a systematic review and meta-analysis. EClinicalMedicine 2023; 59:101964. [PMID: 37125401 PMCID: PMC10139903 DOI: 10.1016/j.eclinm.2023.101964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/02/2023] Open
Abstract
Background Recurrent cancers of the head and neck are associated with poor survival outcome. Yet, their burden in Africa is not reliably known. We therefore aimed to estimate the prevalence of recurrence and the 5-year overall survival among patients treated for head and neck cancers (HNC) in Africa. Method In this systematic review and meta-analysis, we searched four electronic databases (Pubmed, CINAHL, MEDLINE, and Web of Science) and the grey literature for studies reporting the prevalence of HNC recurrence and 5-year overall survival post treatment, published between January 1, 2002, and December 31, 2022. We contacted corresponding authors of relevant studies. Searches were extended to reference lists of review articles and other relevant sources for potentially eligible studies. Each record was assessed for inclusion or exclusion by two independent reviewers. Records with individual-level data on recurrence and survival conducted in Africa were included while exclusion was based on the study design and availability of relevant data. Data were independently extracted by three reviewers from eligible studies, and summary estimates were sought. Our primary outcomes were recurrence and 5-year overall survival of patients who have been treated for HNC, and our secondary outcomes included risk factors, tumor site, squamous cell histology, clinical stage of tumor, and treatment options received. Only records selected for primary outcomes were assessed for secondary outcome data extraction. Random-effects meta-analysis was conducted for each outcome. Meta-regression models were used in addressing sample heterogeneity among the studies. Protocol for this study was registered with PROSPERO, CRD42022372307. Findings This systematic review and meta-analysis returned 3998 records, yielding 28 included studies after exclusion. Eighteen studies reported on the prevalence of HNC recurrence while 24 articles reported on the 5-year overall survival. Of the pooled total study population, 7199 (70.5%) of 10,218 patients were males while 2603 (25.5%) were females. We found that the prevalence of HNC recurrence was 15.4% (I2 = 96.2%; 95% CI: 9.5-22.3; n = 3214; k = 18), and the 5-year overall survival was 54.4% (I2 = 99.5%; 95% CI: 40.1-68.4; n = 9798; k = 24). We also found that the prevalence of smoking and alcohol consumption as risk factors for HNC were 42.6% (I2 = 98.8%; 95% CI: 25.2-61.0; n = 4374; k = 15) and 35.8% (I2 = 98.9%; 95% CI: 21.7-51.4; n = 4110; k = 11) respectively. The pooled current prevalence for advanced HNC (clinical stages III-IV) was 80.0% (I2 = 99.2%; 95% CI: 68.6-89.5; n = 7624; k = 18) compared to 12.2% (I2 = 96.4%; 95% CI: 6.2-19.8; n = 7624; k = 18) in early disease (clinical stages I-II). Interpretation The results showed significantly high prevalence of cancer recurrence, poor 5-year overall survival and very high prevalence of advanced cancers at time of diagnosis. This study provides robust evidence for strategies towards prompt diagnosis and appropriate management of HNC to improve patients' outcome in the African continent. Funding This study was not supported by any funding.
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Affiliation(s)
- Herbert Melariri
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
- Corresponding author. Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Buckingham Road, Mount Croix, Gqeberha, South Africa.
| | - Timothy Els
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
| | - Opeoluwa Oyedele
- Department of Computing, Mathematical, and Statistical Sciences, School of Science, University of Namibia, Windhoek, Namibia
- Department of Environmental Health, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Tessa K. Suttle
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
| | - Kim Theresa Bermosky
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
| | - Adelaide De Freitas
- Department of Radiation Oncology, Livingstone Tertiary Hospital, Gqeberha, South Africa
| | - Amir Murtaza
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
| | - Mohamed Moosajee
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, Gqeberha, South Africa
| | - Paula E. Melariri
- Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
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9
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Ogbodo SC, Onyekwum CA. Social determinants of health, religiosity, and tobacco use in sub-Saharan Africa: evidence from the global adult tobacco surveys in seven countries. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-01882-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
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10
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Keetile M, Ndlovu K, Setshegetso N, Yaya S, Serojane F. Prevalence and correlates of tobacco use in Botswana: evidence from the 2014 Botswana STEPwise survey. BMC Public Health 2023; 23:40. [PMID: 36609262 PMCID: PMC9817272 DOI: 10.1186/s12889-022-14879-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/16/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Tobacco use is one of the notable risk factors for non-communicable diseases globally. The objective of this study was to assess the prevalence of tobacco use and identify its correlates in the general population of Botswana aged 15 to 69 years. METHODS This study used a nationally representative WHO STEPwise Approach to Non-Communicable Disease Risk Factor Surveillance (STEPS) risk factors conducted in 2014 to explore the prevalence of tobacco use and its correlates in Botswana. Using IBM SPSS version 27, data on 4062 people aged 15 to 69 years who had been selected using multistage cluster sampling and had successfully completed the individual questionnaire were analysed. The prevalence of current tobacco smoking and smokeless tobacco use was determined using descriptive statistics while multivariable logistic regression was employed to assess correlates of current tobacco smoking and smokeless tobacco use. All comparisons were statistically significant at 5% significance level. RESULTS From a total sample of 4062 participants the prevalence of current tobacco smoking was estimated to be 12.9% while smokeless tobacco use was 3.2%. Adjusted results indicate that the odds of current tobacco smoking were eight times (AOR = 8.57, C.I = 6.28-11.7) higher among males compared to their female counterparts; six(AOR = 6.52, C.I 3.64-11.6) and three (AOR = 3.27, C.I. =2.07-5.15) times higher among respondents with no education and primary level education respectively, compared to their counterparts with tertiary or higher education; while for alcohol users the odds of current tobacco smoking were four times (AOR = 4.28, C.I = 2.93-6.24) higher than among non-alcohol users. The odds of smokeless tobacco use were significantly higher among women compared to men (AOR = 7.34, C.I = 4.01-13.4); individuals aged 50-59 (AOR = 1.15, C.I = 1.06-3.37) and 60-69 years (AOR = 1.23, C.I. =1.08-3.63) compared to 15-29 years; individuals with no education (AOR = 2.07, C.I = 1.03-4.02) and primary education (AOR = 1.05, C.I = 1.01-2.23) compared to individuals with tertiary education. However, the odds of smokeless tobacco use were significantly lower among individuals who consume alcohol (AOR = 0.48, C.I. = 0.29-0.80) compared to non-alcohol consumers. CONCLUSION Findings of this study indicate the need to strengthen existing national policies to reduce harmful use of tobacco among men, women, older adults, no or primary education level individuals and alcohol users.
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Affiliation(s)
- Mpho Keetile
- grid.7621.20000 0004 0635 5486Department of Population Studies, University of Botswana, Gaborone, Botswana ,grid.7621.20000 0004 0635 5486Department of Computer Science, University of Botswana, Gaborone, Botswana
| | - Kagiso Ndlovu
- grid.7621.20000 0004 0635 5486Department of Computer Science, University of Botswana, Gaborone, Botswana
| | - Naomi Setshegetso
- grid.7621.20000 0004 0635 5486Department of Economics, University of Botswana, Gaborone, Botswana
| | - Sanni Yaya
- grid.28046.380000 0001 2182 2255School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
| | - Fattimah Serojane
- Public Health Department, Institute of Health Sciences, Lobatse, Botswana
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11
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Theilmann M, Lemp JM, Winkler V, Manne-Goehler J, Marcus ME, Probst C, Lopez-Arboleda WA, Ebert C, Bommer C, Mathur M, Andall-Brereton G, Bahendeka SK, Bovet P, Farzadfar F, Ghasemi E, Mayige MT, Saeedi Moghaddam S, Mwangi KJ, Naderimagham S, Sturua L, Atun R, Davies JI, Bärnighausen T, Vollmer S, Geldsetzer P. Patterns of tobacco use in low and middle income countries by tobacco product and sociodemographic characteristics: nationally representative survey data from 82 countries. BMJ 2022; 378:e067582. [PMID: 36041745 PMCID: PMC10471941 DOI: 10.1136/bmj-2021-067582] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and frequency of use vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and frequency of use within countries. DESIGN Secondary analysis of nationally representative, cross-sectional, household survey data from 82 low and middle income countries collected between 1 January 2015 and 31 December 2020. SETTING Population based survey data. PARTICIPANTS 1 231 068 individuals aged 15 years and older. MAIN OUTCOME MEASURES Self-reported current smoking, current daily smoking, current smokeless tobacco use, current daily smokeless tobacco use, pack years, and current use and use frequencies of each tobacco product. Products were any type of cigarette, manufactured cigarette, hand rolled cigarette, water pipe, cigar, oral snuff, nasal snuff, chewing tobacco, and betel nut (with and without tobacco). RESULTS The smoking prevalence in the study sample was 16.5% (95% confidence interval 16.1% to 16.9%) and ranged from 1.1% (0.9% to 1.3%) in Ghana to 50.6% (45.2% to 56.1%) in Kiribati. The user prevalence of smokeless tobacco was 7.7% (7.5% to 8.0%) and prevalence was highest in Papua New Guinea (daily user prevalence of 65.4% (63.3% to 67.5%)). Although variation was wide between countries and by tobacco product, for many low and middle income countries, the highest prevalence and cigarette smoking frequency was reported in men, those with lower education, less household wealth, living in rural areas, and higher age. CONCLUSIONS Both smoked and smokeless tobacco use and frequency of use vary widely across tobacco products in low and middle income countries. This study can inform the design and targeting of efforts to reduce tobacco use in low and middle income countries and serve as a benchmark for monitoring progress towards national and international goals.
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Affiliation(s)
- Michaela Theilmann
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Julia M Lemp
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Volker Winkler
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maja E. Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Charlotte Probst
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Cara Ebert
- RWI — Leibniz Institute for Economic Research, Essen (Berlin Office), GermanyQuantitative Sciences Unit and Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Christian Bommer
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Maya Mathur
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- RWI — Leibniz Institute for Economic Research, Essen (Berlin Office), GermanyQuantitative Sciences Unit and Department of Pediatrics, Stanford University, Stanford, CA, USA
- Port of Spain, Trinidad and Tobago
- St Francis Hospital, Kampala, Uganda
- Ministry of Health, Victoria, Seychelles
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- National Institute for Medical Research, Dar es Salaam, Tanzania
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Africa Health Research Institute, Somkhele, South Africa
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | - Glennis Andall-Brereton
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- RWI — Leibniz Institute for Economic Research, Essen (Berlin Office), GermanyQuantitative Sciences Unit and Department of Pediatrics, Stanford University, Stanford, CA, USA
- Port of Spain, Trinidad and Tobago
- St Francis Hospital, Kampala, Uganda
- Ministry of Health, Victoria, Seychelles
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- National Institute for Medical Research, Dar es Salaam, Tanzania
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Africa Health Research Institute, Somkhele, South Africa
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | | | - Pascal Bovet
- Ministry of Health, Victoria, Seychelles
- University Center for Primary Care and Public Health (Unisanté), Lausanne, Switzerland
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mary T Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Sahar Saeedi Moghaddam
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Kibachio J Mwangi
- Division of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
- Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Shohreh Naderimagham
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
- Africa Health Research Institute, Somkhele, South Africa
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
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12
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A Contemporary Review of Epidemiology, Risk Factors, Etiology, and Outcomes of Premature Stroke. Curr Atheroscler Rep 2022; 24:939-948. [PMID: 36374365 PMCID: PMC9660017 DOI: 10.1007/s11883-022-01067-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE OF REVIEW Recent data identifies increases in young ischemic and hemorrhagic strokes. We provide a contemporary overview of current literature on stroke among young patients or premature stroke along with directions for future investigation. RECENT FINDINGS Strokes in the young are highly heterogenous and often cryptogenic. Sex distribution and risk factors shift from women among the youngest age groups (< 35) to men over the age of 45, with a coinciding rise in traditional vascular risk factors. Incidence is higher in minority and socioeconomically disadvantaged populations, and the impact of stroke among these communities may be exaggerated by disparities in symptom recognition and access to care. Special diagnostic work-up may be needed, and a lower threshold for diagnosis is warranted as potential misdiagnosis is a concern and may preclude necessary triage and management. Although "premature strokes" form a relatively small proportion of total incidence, they vary greatly across subgroups and present an outsized impact on quality of life and productivity.
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