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Landovská P. Social Costs of Smoking in the Czech Republic. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2024:10.1007/s40258-024-00917-w. [PMID: 39342546 DOI: 10.1007/s40258-024-00917-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/29/2024] [Indexed: 10/01/2024]
Abstract
OBJECTIVES Smoking is an important risk factor leading to many diseases, which brings substantial healthcare costs as well as indirect costs due to decreased productivity. This article aims to quantify the social costs of smoking in the Czech Republic in 2019. METHODS The prevalence-based, cost-of-illness approach is used, which assesses the costs as the sum of direct (healthcare) costs and indirect costs (productivity losses due to mortality and morbidity). The costs of healthcare utilization and pharmacotherapy in direct costs, and the costs of absenteeism, presenteeism, and premature mortality in indirect costs, are included. RESULTS Total costs of smoking in the Czech Republic in 2019 are estimated as 2110.6 million EUR (0.94% of GDP). Direct costs amounted to 537.0 million EUR (2.9% of health expenditures in 2019) and indirect costs were 1573.6 million EUR, mainly driven by the costs of premature mortality (1062.5 million EUR). CONCLUSIONS Despite the declining trend in the prevalence of smoking in the Czech Republic, the associated costs are considerable. Investments into strategies to reduce smoking continue to be needed.
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Affiliation(s)
- Petra Landovská
- Faculty of Social Sciences, Institute of Economic Studies, Charles University, Opletalova 26, 110 00, Prague, Czech Republic.
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Gligorić D, Preradović Kulovac D, Micic L, Vulovic V. Economic cost of cigarette smoking in Bosnia and Herzegovina. Tob Control 2024; 33:s95-s100. [PMID: 36609492 DOI: 10.1136/tc-2022-057722] [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: 09/02/2022] [Accepted: 12/15/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cigarette use is one of the major risk factors for non-communicable diseases in Bosnia and Herzegovina, with 41.1% of adults being current smokers in 2019 and almost half of current smokers using more than 20 cigarettes per day. METHODS This study applies the prevalence-based, cost-of-illness approach to estimate the annual economic cost of smoking in Bosnia and Herzegovina in 2019. RESULTS The study estimates that cigarette use by adults in Bosnia and Herzegovina caused between 24.4% and 42.8% of all deaths in 2019 and a total economic cost of between €367.5 and €635.1 million (2.0%-3.5% of gross domestic product). The direct costs represent the largest share of the total cost (between 1.0% and 1.7% of gross domestic product). CONCLUSION Cigarette use imposes a significant health and economic burden in the society of Bosnia and Herzegovina. Various tobacco control measures can be implemented to prevent and reduce tobacco consumption and the negative health consequences of tobacco use. Numerous studies have shown taxes on tobacco products are very effective in reducing tobacco use, especially among certain demographic groups, such as youth and low-income individuals. Smoke-free laws have also shown benefits. Other policy measures that can be implemented include restrictions to advertising, limitations on who can purchase tobacco products, how and where they can be purchased, etc. In addition, governments could also implement various education programmes on the negative health consequences of smoking. The results of this study provide information that calls for prompt and strengthened implementation of tobacco control measures to reduce cigarette consumption in the country and improve the health outcomes and productivity of its inhabitants.
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Affiliation(s)
- Dragan Gligorić
- Faculty of Economics, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Dragana Preradović Kulovac
- Faculty of Economics, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
- Doctoral School of Business Informatics, Corvinus University of Budapest, Budapest, Hungary
| | - Ljubisa Micic
- Faculty of Economics, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Violeta Vulovic
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
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Le PH, Van Phan C, Truong DTT, Ho NM, Shuyna I, Le NT. Waterpipe tobacco smoking and risk of all-cause mortality: a prospective cohort study. Int J Epidemiol 2024; 53:dyad140. [PMID: 37843876 DOI: 10.1093/ije/dyad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Despite an increasing proportion of smokers who use non-cigarette products, the harmfulness of these is inconsistent. This study aimed to evaluate the impact of waterpipe tobacco (WTP) smoking on all-cause mortality. METHODS A prospective cohort study followed up on 35 646 participants from 2007 to 2019 in Northern Viet Nam. Data for each type of cigarette and WTP smoking were collected based on demographic lifestyle and semi-quantitative food frequency questionnaires. Smokers were categorized as current smokers and former smokers who were lifetime ever smokers but stopped smoking >6 months before the interview. Data on all-cause mortality (2449 deaths) were obtained from medical records at the state health facilities. The hazard ratios (HRs) and 95% CIs for mortality were estimated using a Cox proportional-hazards model. RESULTS Compared with non-smokers, ever smokers had a higher all-cause mortality risk (HR = 1.29, 95% CI = 1.16-1.43). Current WTP (HR = 1.37, 95% CI = 1.19-1.57), current cigarette (HR = 1.40, 95% CI = 1.22-1.60) and former WTP smokers (HR = 1.39, 95% CI = 1.10-1.76) showed an elevated risk of dying. The mortality risk was significantly elevated in dual smokers using WTP and cigarettes (HR = 1.55, 95% CI = 1.35-1.79) and exclusive WTP smokers (HR = 1.38, 95% CI = 1.21-1.57). Elevated risk was observed for the main targeted attractions of cancer, diabetes and heart diseases. Smoking cessation of >10 years decreased the risk of all-cause mortality (HR = 0.61, 95% CI = 0.44-0.85) and cancer (HR = 0.24, 95% CI = 0.11-0.52). CONCLUSIONS WTP smoking increases the risk of all-cause mortality. A unique programme to control exposure to WTP should be a high priority in Viet Nam and other countries.
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Affiliation(s)
- Phuoc Hong Le
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Can Van Phan
- Center for Population Health Sciences, Hanoi University of Public Health, Ha Noi City, Viet Nam
| | - Dung Thuy Thi Truong
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
- Graduate School of Public Health, International University of Health and Welfare, Narita City, Japan
| | - Nguyet Minh Ho
- Department of Non-Communicable Disease Control, Ho Chi Minh City Center for Disease Control, Ho Chi Minh City, Viet Nam
| | - Ikeda Shuyna
- The Canon Institute for Global Studies, Tokyo, Japan
- Department of Public Health, School of Medicine, International University of Health and Welfare, Japan
| | - Ngoan Tran Le
- Institute of Research and Development, Duy Tan University, Da Nang City, Viet Nam
- Department of Occupational Health, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Ha Noi, Viet Nam
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Xue L, Cai M, Liu Q, Ying X, Wu S. Trends and regional variations in chronic diseases and their risk factors in China: an observational study based on National Health Service Surveys. Int J Equity Health 2023; 22:120. [PMID: 37381035 DOI: 10.1186/s12939-023-01910-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 05/06/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Over the past 25 years, the spectrum of diseases in China has rapidly changed from infectious to non-communicable diseases (NCDs). This study aimed to identify the prevalence of chronic diseases over the past 25 years in China and estimate the trends and changes in risk factors related to NCDs. METHODS We conducted a descriptive analysis based on the National Health Service Survey (NHSS) from 1993 to 2018. The survey year (in parentheses) and its respective number of respondents were (1993) 215,163; (1998) 216,101; (2003) 193,689; (2008) 177,501; (2013) 273,688; and (2018) 256,304. In each survey, approximately half the participants were male. In addition, we estimated the trends in the prevalence and risk factors of NCDs from 1993 to 2018 and described their coefficient of variation in the provisions. RESULTS The prevalence of NCDs has risen rapidly, from 17.0% in 1993 to 34.3% 2018. Hypertension and diabetes were the two main NCDs accounting for 53.3% in 2018. Similarly, the prevalence of hypertension and diabetes have also increased rapidly, increasing 15.1 and 27.0 times respectively from 1993 to 2018. Moreover, from 1993 to 2018, the proportion of smoking decreased from 32.0% to 24.7%, and the proportion of drinking and physical activity increased from 18.4% and 8.0% to 27.6% and 49.9%, respectively. The proportion of obesity increased from 5.4% in 2013 to 9.5% in 2018. The prevalence of NCDs in rural areas (35.2%) in 2018 was slightly higher than that in urban areas (33.5%). Changes in the prevalence of NCDs in rural were larger than those in urban. However, from 2013 to 2018, the provincial gaps for these metrics narrowed, except for that of smoking (Coefficient of Variation from 0.14 to 0.16). CONCLUSIONS The prevalence of NCDs increased rapidly in China and was similar in urban and rural areas in 2018. Two key risk factors (drinking and obesity) increased in prevalence, while the other two (smoking and physical inactivity) decreased. These results indicate that China is facing considerable challenges in curbing chronic diseases to achieve the United Nations Sustainable Development Goals or the Healthy China 2030 goals. The government should take more active measures to change unhealthy lifestyles, improve efficiency in risk factor management, and pay more attention and allocate more health resources to rural areas.
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Affiliation(s)
- Long Xue
- Huashan Hospital, Fudan University, Shanghai, China
| | - Min Cai
- Center of Health Statistics and Information, National Health Commission, 1 Xizhimen Wai Nan Lu, Xicheng District, Beijing, China
| | - Qinqin Liu
- Center of Health Statistics and Information, National Health Commission, 1 Xizhimen Wai Nan Lu, Xicheng District, Beijing, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, 138 Medical College Road, Shanghai, China.
| | - Shiyong Wu
- Center of Health Statistics and Information, National Health Commission, 1 Xizhimen Wai Nan Lu, Xicheng District, Beijing, China.
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Wu YT, Niubo AS, Daskalopoulou C, Moreno-Agostino D, Stefler D, Bobak M, Oram S, Prince M, Prina M. Sex differences in mortality: results from a population-based study of 12 longitudinal cohorts. CMAJ 2021; 193:E361-E370. [PMID: 33722827 PMCID: PMC8096404 DOI: 10.1503/cmaj.200484] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Women generally have longer life expectancy than men but have higher levels of disability and morbidity. Few studies have identified factors that explain higher mortality in men. The aim of this study was to identify potential factors contributing to sex differences in mortality at older age and to investigate variation across countries. METHODS This study included participants age ≥ 50 yr from 28 countries in 12 cohort studies of the Ageing Trajectories of Health: Longitudinal Opportunities and Synergies (ATHLOS) consortium. Using a 2-step individual participant data meta-analysis framework, we applied Cox proportional hazards modelling to investigate the association between sex and mortality across different countries. We included socioeconomic (education, wealth), lifestyle (smoking, alcohol consumption), social (marital status, living alone) and health factors (cardiovascular disease, diabetes, mental disorders) as covariates or interaction terms with sex to test whether these factors contributed to the mortality gap between men and women. RESULTS The study included 179 044 individuals. Men had 60% higher mortality risk than women after adjustment for age (pooled hazard ratio [HR] 1.6; 95% confidence interval 1.5-1.7), yet the effect sizes varied across countries (I 2 = 71.5%, HR range 1.1-2.4). Only smoking and cardiovascular diseases substantially attenuated the effect size (by about 22%). INTERPRETATION Lifestyle and health factors may partially account for excess mortality in men compared with women, but residual variation remains unaccounted for. Variation in the effect sizes across countries may indicate contextual factors contributing to gender inequality in specific settings.
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Affiliation(s)
- Yu-Tzu Wu
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Albert Sanchez Niubo
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Christina Daskalopoulou
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Dario Moreno-Agostino
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Denes Stefler
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Martin Bobak
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Sian Oram
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Martin Prince
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
| | - Matthew Prina
- Department of Health Service and Population Research (Wu, Daskalopoulou, Moreno-Agostino, Oram, Prince, Prina), Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Population Health Sciences (Wu), Newcastle University, Newcastle upon Tyne, UK; Research, Innovation and Teaching Unit (Sanchez Niubo), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (Sanchez Niubo), Madrid, Spain; Department of Epidemiology and Public Health (Stefler, Bobak), University College London, London, UK
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Tinusz B, Szapáry LB, Paládi B, Papp A, Bogner B, Hegedűs I, Bellyei S, Vincze Á, Solt J, Micsik T, Dunás-Varga V, Pályu E, Vass T, Schnabel T, Farkas N, Hegyi P, Thrift AP, Erőss B. The Esophageal Adenocarcinoma Epidemic Has Reached Hungary: A Multicenter, Cross-Sectional Study. Front Oncol 2020; 10:541794. [PMID: 33425714 PMCID: PMC7786275 DOI: 10.3389/fonc.2020.541794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022] Open
Abstract
Background The epidemiology of esophageal cancer has changed dramatically over the past 4 decades in many Western populations. We aimed to understand the Hungarian epidemiologic trends of esophageal squamous cell cancer (SCC) and adenocarcinoma (AC). Methods We performed a cross-sectional study using data from esophageal cancer patients diagnosed between 1992 and 2018 at eight tertiary referral centers in four major cities of Hungary. We retrospectively identified cases in the electronic databases of each center and collected data on gender, age at diagnosis, year of diagnosis, specialty of the origin center, histological type, and localization of the tumor. Patients were grouped based on the two main histological types: AC or SCC. For statistical analysis, we used linear regression models, chi-square tests, and independent sample t tests. Results We extracted data on 3,283 patients with esophageal cancer. Of these, 2,632 were diagnosed with either of the two main histological types; 737 had AC and 1,895 SCC. There was no significant difference in the gender ratio of the patients between AC and SCC (80.1 vs 81.8% males, respectively; p = 0.261). The relative incidence of AC increased over the years (p < 0.001, b = 1.19 CI: 0.84–1.54). AC patients were older at diagnosis than SCC patients (64.37 ± 11.59 vs 60.30 ± 10.07 years, p < 0.001). The age of patients at the diagnosis of primary esophageal cancer increased over time (p < 0.001, R = 0.119). Conclusions The rapid increase in the relative incidence of AC and simultaneous decrease of the relative incidence of SCC suggest that this well-established Western phenomenon is also present in Hungary.
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Affiliation(s)
- Benedek Tinusz
- Medical School, Institute for Translational Medicine and Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - László Botond Szapáry
- Medical School, Institute for Translational Medicine and Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Bence Paládi
- Medical School, Institute for Translational Medicine and Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - András Papp
- Department of Surgery, University of Pécs, Pécs, Hungary
| | - Barna Bogner
- Department of Pathology, Medical School, University of Pécs, Pécs, Hungary
| | - Ivett Hegedűs
- Department of Pathology, Medical School, University of Pécs, Pécs, Hungary
| | - Szabolcs Bellyei
- Department of Oncotherapy, Medical School, University of Pécs, Pécs, Hungary
| | - Áron Vincze
- Department of Gastroenterology, 1st Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Jenő Solt
- Department of Gastroenterology, 1st Department of Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Tamás Micsik
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Veronika Dunás-Varga
- 1st Department of Internal Medicine, Szent György University Teaching Hospital of Fejér County, Székesfehérvár, Hungary
| | - Eszter Pályu
- 2nd Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Tamás Vass
- 1st Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Tamás Schnabel
- Department of Gastroenterology, Saint John's Hospital, Budapest, Hungary
| | - Nelli Farkas
- Medical School, Institute of Bioanalysis, University of Pécs, Pécs, Hungary
| | - Péter Hegyi
- Medical School, Institute for Translational Medicine and Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Aaron P Thrift
- Department of Medicine and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Bálint Erőss
- Medical School, Institute for Translational Medicine and Szentágothai Research Center, University of Pécs, Pécs, Hungary
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Zou Z, Cini K, Dong B, Ma Y, Ma J, Burgner DP, Patton GC. Time Trends in Cardiovascular Disease Mortality Across the BRICS. Circulation 2020; 141:790-799. [DOI: 10.1161/circulationaha.119.042864] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Brazil, Russia, India, China, and South Africa (BRICS) are emerging economies making up almost half the global population. We analyzed trends in cardiovascular disease (CVD) mortality across the BRICS and associations with age, period, and birth cohort.
Methods:
Mortality estimates were derived from the Global Burden of Disease Study 2017. We used age-period-cohort modeling to estimate cohort and period effects in CVD between 1992 and 2016. Period was defined as survey year, and period effects reflect population-wide exposure at a circumscribed point in time. Cohort effects are defined as differences in risks across birth cohort. Net drift (overall annual percentage change), local drift (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rate), and period (cohort) relative risks were calculated.
Results:
In 2016, there were 8.4 million CVD deaths across the BRICS. Between 1992 and 2016, the reduction in CVD age-standardized mortality rate in BRICS (−17%) was less than in North America (−39%). Eighty-eight percent of the increased number of all-cause deaths resulted from the increase in CVD deaths. The age-standardized mortality rate from stroke and hypertensive heart disease declined by approximately one-third across the BRICS, whereas ischemic heart disease increased slightly (2%). Brazil had the largest age-standardized mortality rate reductions across all CVD categories, with improvement both over time and in recent birth cohorts. South Africa was the only country where the CVD age-standardized mortality rate increased. Different age-related CVD mortality was seen in those ≥50 years of age in China, ≤40 years of age in Russia, 35 to 60 years of age in India, and ≥55 years of age in South Africa. Improving period and cohort risks for CVD mortality were generally found across countries, except for worsening period effects in India and greater risks for ischemic heart disease in Chinese cohorts born in the 1950s and 1960s.
Conclusions:
Except for Brazil, reductions of CVD mortality across the BRICS have been less than that in North America, such that China, India, and South Africa contribute an increasing proportion of global CVD deaths. Brazil’s example suggests that prevention policies can both reduce the risks for younger birth cohorts and shift the risks for all age groups over time.
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Affiliation(s)
- Zhiyong Zou
- Institute of Child and Adolescent Health, Peking University School of Public Health; National Health Commission Key Laboratory of Reproductive Health, Beijing, China (Z.Z., B.D., Y.M., J.M., G.C.P)
- National Health Commission Key Laboratory of Reproductive Health, Beijing, China (Z.Z., B.D., Y.M., J.M., G.C.P.)
| | - Karly Cini
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia (D.P.B., G.C.P.)
- Murdoch Children’s Research Institute (K.C., D.P.B., G.C.P.), Royal Children’s Hospital, Parkville, Victoria, Australia
- Centre for Adolescent Health (K.C., G.C.P.), Royal Children’s Hospital, Parkville, Victoria, Australia
| | - Bin Dong
- Institute of Child and Adolescent Health, Peking University School of Public Health; National Health Commission Key Laboratory of Reproductive Health, Beijing, China (Z.Z., B.D., Y.M., J.M., G.C.P)
- National Health Commission Key Laboratory of Reproductive Health, Beijing, China (Z.Z., B.D., Y.M., J.M., G.C.P.)
| | - Yinghua Ma
- Institute of Child and Adolescent Health, Peking University School of Public Health; National Health Commission Key Laboratory of Reproductive Health, Beijing, China (Z.Z., B.D., Y.M., J.M., G.C.P)
- National Health Commission Key Laboratory of Reproductive Health, Beijing, China (Z.Z., B.D., Y.M., J.M., G.C.P.)
| | - Jun Ma
- Institute of Child and Adolescent Health, Peking University School of Public Health; National Health Commission Key Laboratory of Reproductive Health, Beijing, China (Z.Z., B.D., Y.M., J.M., G.C.P)
- National Health Commission Key Laboratory of Reproductive Health, Beijing, China (Z.Z., B.D., Y.M., J.M., G.C.P.)
| | - David P. Burgner
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia (D.P.B., G.C.P.)
- Murdoch Children’s Research Institute (K.C., D.P.B., G.C.P.), Royal Children’s Hospital, Parkville, Victoria, Australia
- Department of General Medicine (D.P.B.), Royal Children’s Hospital, Parkville, Victoria, Australia
| | - George C. Patton
- Institute of Child and Adolescent Health, Peking University School of Public Health; National Health Commission Key Laboratory of Reproductive Health, Beijing, China (Z.Z., B.D., Y.M., J.M., G.C.P)
- National Health Commission Key Laboratory of Reproductive Health, Beijing, China (Z.Z., B.D., Y.M., J.M., G.C.P.)
- Department of Pediatrics, University of Melbourne, Parkville, Victoria, Australia (D.P.B., G.C.P.)
- Murdoch Children’s Research Institute (K.C., D.P.B., G.C.P.), Royal Children’s Hospital, Parkville, Victoria, Australia
- Centre for Adolescent Health (K.C., G.C.P.), Royal Children’s Hospital, Parkville, Victoria, Australia
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Ilic I, Grujicic Sipetic S, Radovanovic D, Ilic M. Cigarette Smoking and E-Cigarette Use by Pharmacy Students in Serbia. Behav Med 2020; 46:43-51. [PMID: 30615564 DOI: 10.1080/08964289.2018.1541863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 10/19/2018] [Accepted: 10/24/2018] [Indexed: 10/27/2022]
Abstract
The purpose of this study was to assess the use of e-cigarettes among pharmacy students. In 2016, we conducted a cross-sectional study among pharmacy students enrolled at the University of Kragujevac (Serbia). Overall, 47.0% of pharmacy students reported that they ever smoked cigarettes; 29.7% were former and 17.3% were current smokers. The overall prevalence of e-cigarette use was 9.9%. The final year pharmacy students significantly more frequently smoked tobacco cigarettes (p = .001) and used e-cigarettes (p = .009) compared to younger students. Also, alcohol use was positively related to ever smoking tobacco cigarettes (adjusted OR = 4.57, 95% CI = 2.80-7.43; p < .001) and to ever use of e-cigarettes (adjusted OR = 5.58, 95% CI = 1.58-19.71; p = .008). The pharmacy students who ever used e-cigarettes more frequently reported a history of self-funded study financing (adjusted OR = 14.68, 95% CI = 2.42-89.17; p = .004) and use of psychoactive substances (adjusted OR = 13.63, 95% CI = 2.52-73.69; p = .002). In pharmacy students, a higher overall grade was related to a significantly less frequent ever use of tobacco cigarettes (adjusted OR = 0.43, 95% CI = 0.22-0.84, p = .015). This paper highlights the need for a more effective tobacco control among pharmacy students in Serbia in order to reduce smoking prevalence.
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Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac
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A Novel Risk-based Approach Simulating Oncological Surveillance After Radical Nephroureterectomy in Patients with Upper Tract Urothelial Carcinoma. Eur Urol Oncol 2019; 3:756-763. [PMID: 31395480 DOI: 10.1016/j.euo.2019.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The current guideline lacks evidence for creating individualized surveillance strategies for upper tract urothelial carcinoma (UTUC) patients after radical nephroureterectomy (RNU). OBJECTIVE To create a novel risk model and to simulate individualized surveillance duration that dynamically illustrates the changing risk relationship of UTUC-related death and non-UTUC death, considering the impact of cigarette smoking. DESIGN, SETTING, AND PARTICIPANTS This multicenter cohort study comprised 714 pTa-T4N0M0 UTUC patients, with a median follow-up duration of 65mo. There were 279 (39.1%) nonsmokers, 260 (36.4%) current smokers, and 175 (24.5%) ex-smokers. INTERVENTION All patients underwent RNU. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The risks of UTUC death and non-UTUC death over time were estimated using parametric models for time to failure with Weibull distributions. Age-specific, stage-specific, and smoking status-specific surveillance durations were simulated based upon Weibull estimates. RESULTS AND LIMITATIONS The hazard rate (HR) of non-UTUC death gradually increased over time in all age groups regardless of the smoking status, whereas that of UTUC-related death decreased markedly according to the pathological T (pT) stage and was affected by the smoking status. Among current smokers, the baseline HR of UTUC-related death in pT3/4 was higher than that of pT ≤2 and remained high even 10yr after RNU. Among heavy smokers, the HR of UTUC-related death in all pT stages was highest at baseline and remained high after RNU, compared with nonsmokers, current smokers, or ex-smokers. We simulated specific time points when the risk of non-UTUC death was greater than that of UTUC-related death. Among patients ≥80yr of with pT3N0M0, the risk of non-UTUC death was greater than that of UTUC-related death 1yr after RNU in nonsmokers, but 7yr for heavy smokers. CONCLUSIONS Our result revealed that smokers bear a long-term risk burden of UTUC-related death more than the risk of non-UTUC death. For UTUC smokers, longer-term surveillance duration is recommended even in elderly stage. PATIENT SUMMARY In the present study, we evaluated the risk transition of upper tract urothelial carcinoma (UTUC)-related death and non-cancer-related death over time. We found that smoking weighed a huge impact upon UTUC-related death compared with death from other cause, and therefore, we created a more individualized surveillance duration model.
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The burden of disease in Russia from 1980 to 2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018; 392:1138-1146. [PMID: 30173906 PMCID: PMC6172188 DOI: 10.1016/s0140-6736(18)31485-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/16/2018] [Accepted: 06/25/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Over the past few decades, social and economic changes have had substantial effects on health and wellbeing in Russia. We aimed to use data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to evaluate trends in mortality, causes of death, years lived with disability (YLDs), years of life lost (YLLs), disability-adjusted life-years (DALYs), and associated risk factors in Russia from 1980 to 2016. METHODS We estimated all-cause mortality by use of a multistage modelling process that synthesised data from vital registration systems, surveys, and censuses. A composite measure of health loss due to both fatal and non-fatal disease burden (DALYs) was calculated as the sum of YLLs and YLDs for each age, sex, year, and location. Health progress was evaluated in comparison with patterns of change in similar countries by use of the Socio-demographic Index that was developed for GBD 2016. FINDINGS Following rapid decreases in life expectancy after the collapse of the Soviet Union, life expectancy at birth in Russia improved between 2006 and 2016. The all-cause mortality rate decreased by 16·6% (95% uncertainty interval 9·4-33·8) between 1980 and 2016. This overall decrease encompasses the cycles of sharp increases and plateaus in mortality that occurred before 2005. Child mortality decreased by 57·5% (53·5-61·1) between 2000 and 2016. However, compared with countries at similar Socio-demographic Index levels, rates of mortality and disability in Russia remain high and life expectancy is low. Russian men have a disproportionate burden of disease relative to women. In 2016, 59·2% (55·3-62·6) of mortality in men aged 15-49 years and 46·8% (44·5-49·5) of mortality in women were attributable to behavioural risk factors, including alcohol use, drug use, and smoking. INTERPRETATION Trends in mortality in Russia from 1980 to 2016 might be related to complicated patterns of behavioural risk factors associated with economic and social change, to shifts in disease burden, and to changes in the capacity of and access to health care. Ongoing mortality and disability from causes and risks amenable to health-care interventions and behaviour modifications present opportunities to continue to improve the wellbeing of Russian citizens. FUNDING Bill & Melinda Gates Foundation.
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Stefler D, Azarova A, Irdam D, Scheiring G, Murphy M, McKee M, King L, Bobak M. Smoking, alcohol and cancer mortality in Eastern European men: Findings from the PrivMort retrospective cohort study. Int J Cancer 2018; 143:1128-1133. [PMID: 29582432 DOI: 10.1002/ijc.31406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 01/29/2023]
Abstract
Eastern European men have among the highest cancer mortality rates globally. Prevalence of smoking and alcohol intake in this region is also high. The aim of our study was to calculate population attributable risk fraction (PARF) of cancer deaths from smoking and alcohol in Russia, Belarus and Hungary, and to examine the contribution of these lifestyle factors to differences in male cancer mortality in the three countries. Data were collected as part of the PrivMort retrospective cohort study. Randomly selected participants living in mid-size towns in Russia, Belarus and Hungary provided information on smoking habits, alcohol consumption, vital status and cause of death (if applicable) of male relatives (fathers, siblings and partners). PARF of cancer deaths (age 35-79) due to smoking, alcohol consumption and both combined was estimated between 2001 and 2013. Among 72,190 men, 4,702 died of cancer. Age standardized cancer mortality rates were similar to official data in all three countries. The estimated PARF (95% CI) associated with measures of smoking, alcohol consumption, both combined, and overall smoking or drinking were 25% (19-30), 2% (0-4), 29% (19-39), 43% (32-53) in Russia, 18% (8-28), 2% (-1 to 6), 28% (20-35), 38% (25-50) in Belarus and 17% (13-20), 1% (0-3), 25% (20-30), 35% (28-42) in Hungary, respectively. These results suggest that in Eastern Europe, at least one third of cancer deaths in males may have been attributable to smoking and/or alcohol consumption in recent years. Health policies targeting these lifestyle factors can have a major impact on population health.
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Affiliation(s)
- Denes Stefler
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Aytalina Azarova
- Department of Sociology, University of Cambridge, Cambridge, United Kingdom
| | - Darja Irdam
- Department of Sociology, University of Cambridge, Cambridge, United Kingdom
| | - Gabor Scheiring
- Department of Sociology, University of Cambridge, Cambridge, United Kingdom
| | - Michael Murphy
- Department of Social Policy, London School of Economics, London, United Kingdom
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Larry King
- Department of Sociology, University of Cambridge, Cambridge, United Kingdom.,Department of Economics, University of Massachusetts, Amherst, MA, United States
| | - Martin Bobak
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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