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Kaur J, Rinkoo AV, Richardson S. Update on numbers of tobacco-attributable deaths by country in the South-East Asia region: implications for policy. Tob Control 2024:tc-2024-058599. [PMID: 38851291 DOI: 10.1136/tc-2024-058599] [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: 01/11/2024] [Accepted: 04/24/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The WHO South-East Asia Region is home to around 33% of adult tobacco users. To inform tobacco control policy and practice, we conducted a study using the latest available data to update mortality attributable to overall tobacco use, including smoked tobacco, smokeless tobacco (SLT) and secondhand smoke (SHS) exposure, in the 11 countries of the Region. METHODS We estimated smoking, SLT use and SHS exposure using the latest available surveys for each country during 2016-2021, and then estimated all-cause and lung cancer-attributable annual deaths for each using the population-attributable fraction method. Finally, we estimated the annual total tobacco-attributable deaths including all three exposures using the multiplicative aggregation method. RESULTS We estimated the occurrence of 4 087 920 all-cause deaths and 105 279 lung cancer deaths annually attributable to tobacco use among the 11 countries investigated. India accounted for 63.9% of all-cause tobacco-attributable deaths. CONCLUSIONS The high annual number of tobacco-attributable deaths in the Region highlights the need for accelerating progress in reducing tobacco use. Implementation of the WHO Framework Convention on Tobacco Control (FCTC) and MPOWER policy package needs prioritisation at the country level. Tobacco cessation services, supply-side measures and policies to counter tobacco industry interference should be strengthened. Further work is needed to monitor progress towards FCTC implementation and analyse the impacts of policies on tobacco-related outcomes, including attributable mortality and disease burden, to inform advocacy efforts.
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Affiliation(s)
- Jagdish Kaur
- Tobacco Free Initiative, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Arvind Vashishta Rinkoo
- Tobacco Free Initiative, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Yatsuya H, Yamagishi K, Li Y, Saito I, Kokubo Y, Muraki I, Inoue M, Tsugane S, Iso H, Sawada N. Risk and Population Attributable Fraction of Stroke Subtypes in Japan. J Epidemiol 2024; 34:211-217. [PMID: 37460296 PMCID: PMC10999523 DOI: 10.2188/jea.je20220364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/20/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Associations of major risk factors for stroke with total and each type of stroke, as well as subtypes of ischemic stroke, and their population attributable fractions had not been examined comprehensively. METHODS Participants of the Japan Public Health Center-based prospective (JPHC) Study Cohort II without histories of cardiovascular disease and cancer (n = 14,797) were followed from 1993 through 2012. Associations of current smoking, hypertension, diabetes, overweight (body mass index ≥25 kg/m2), non-high-density lipoprotein cholesterol (non-HDLC) categories, low HDLC (<40 mg/dL), urine protein, and history of arrhythmia were examined in a mutually-adjusted Cox regression model that included age and sex. Population attributable fractions (PAFs) were estimated using the hazard ratios and the prevalence of risk factors among cases. RESULTS Subjects with hypertension were 1.63 to 1.84 times more likely to develop any type of stroke. Diabetes, low HDLC, current smoking, overweight, urine protein, and arrhythmia were associated with risk of overall and ischemic stroke. Hypertension and urine protein were associated with risk of intracerebral hemorrhage, while current smoking, hypertension, and low non-HDLC were associated with subarachnoid hemorrhage. Hypertension alone accounted for more than a quarter of stroke incidence, followed by current smoking and diabetes. High non-HDLC, current smoking, low HDLC, and overweight contributed mostly to large-artery occlusive stroke. Arrhythmia explained 13.2% of embolic stroke. Combined PAFs of all the modifiable risk factors for total, ischemic, and large-artery occlusive strokes were 36.7%, 44.5%, and 61.5%, respectively. CONCLUSION Although there are differences according to subtypes, hypertension could be regarded as the most crucial target for preventing strokes in Japan.
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Affiliation(s)
- Hiroshi Yatsuya
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan
| | - Yuanying Li
- Department of Public Health and Health Systems, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, Oita, Japan
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Isao Muraki
- Public Health, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Manami Inoue
- Division of Prevention, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
| | - Shoichiro Tsugane
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
- International University of Health and Welfare Graduate School of Public Health, Tokyo, Japan
| | - Hiroyasu Iso
- The Institute for Global Health Policy, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, Tokyo, Japan
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Kerr GH, van Donkelaar A, Martin RV, Brauer M, Bukart K, Wozniak S, Goldberg DL, Anenberg SC. Increasing Racial and Ethnic Disparities in Ambient Air Pollution-Attributable Morbidity and Mortality in the United States. ENVIRONMENTAL HEALTH PERSPECTIVES 2024; 132:37002. [PMID: 38445892 PMCID: PMC10916678 DOI: 10.1289/ehp11900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/01/2023] [Accepted: 01/16/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Ambient nitrogen dioxide (NO 2 ) and fine particulate matter with aerodynamic diameter ≤ 2.5 μ m (PM 2.5 ) threaten public health in the US, and systemic racism has led to modern-day disparities in the distribution and associated health impacts of these pollutants. OBJECTIVES Many studies on environmental injustices related to ambient air pollution focus only on disparities in pollutant concentrations or provide only an assessment of pollution or health disparities at a snapshot in time. In this study, we compare injustices in NO 2 - and PM 2.5 -attributable health burdens, considering NO 2 -attributable health impacts across the entire US; document changing disparities in these health burdens over time (2010-2019); and evaluate how more stringent air quality standards would reduce disparities in health impacts associated with these pollutants. METHODS Through a health impact assessment, we quantified census tract-level variations in health outcomes attributable to NO 2 and PM 2.5 using health impact functions that combine demographic data from the US Census Bureau; two spatially resolved pollutant datasets, which fuse satellite data with physical and statistical models; and epidemiologically derived relative risk estimates and incidence rates from the Global Burden of Disease study. RESULTS Despite overall decreases in the public health damages associated with NO 2 and PM 2.5 , racial and ethnic relative disparities in NO 2 -attributable pediatric asthma and PM 2.5 -attributable premature mortality have widened in the US during the last decade. Racial relative disparities in PM 2.5 -attributable premature mortality and NO 2 -attributable pediatric asthma have increased by 16% and 19%, respectively, between 2010 and 2019. Similarly, ethnic relative disparities in PM 2.5 -attributable premature mortality have increased by 40% and NO 2 -attributable pediatric asthma by 10%. DISCUSSION Enacting and attaining more stringent air quality standards for both pollutants could preferentially benefit the most marginalized and minoritized communities by greatly reducing racial and ethnic relative disparities in pollution-attributable health burdens in the US. Our methods provide a semi-observational approach to track changes in disparities in air pollution and associated health burdens across the US. https://doi.org/10.1289/EHP11900.
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Affiliation(s)
- Gaige Hunter Kerr
- Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA
| | - Aaron van Donkelaar
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Randall V. Martin
- Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Michael Brauer
- Department of Health Metrics Sciences, Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katrin Bukart
- Department of Health Metrics Sciences, Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Sarah Wozniak
- Department of Health Metrics Sciences, Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA
| | - Daniel L. Goldberg
- Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA
| | - Susan C. Anenberg
- Department of Environmental and Occupational Health, The George Washington University, Washington, District of Columbia, USA
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Walter TG, Bricknell LK, Preston RG, Crawford EGC. Climate Change Adaptation Methods for Public Health Prevention in Australia: an Integrative Review. Curr Environ Health Rep 2024; 11:71-87. [PMID: 38221599 PMCID: PMC10907446 DOI: 10.1007/s40572-023-00422-7] [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] [Accepted: 11/15/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE OF REVIEW Climate change poses a serious threat to human health and well-being. Australia is not immune to the public health impacts and continues to be underprepared, putting the population health at risk. However, there is a dearth in knowledge about how the Australian public health system will address the impacts of climate change. RECENT FINDINGS This integrative review synthesises tools, frameworks, and guidance material suitable for climate change adaptation from a preventive public health perspective. The literature search was conducted in electronic databases MEDLINE, PubMed, CINAHL, and Web of Science. Of 4507 articles identified, 19 articles met the inclusion criteria that focused on operational methods in public health and excluded the clinical context and reactive disaster response approaches. This review revealed that Australia is ill-prepared to manage climate change adverse health impacts due to ineffective adaptation strategies. The review highlights that Australia urgently requires effective adaptation strategies such as undertaking a National Adaptation Plan process and an improved understanding in managing complex health risks. Taking this action will strengthen the public health system and build health resilience especially for vulnerable populations. These findings will help understand and develop of the necessary adaptive strategies in Australia.
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Affiliation(s)
- Tony G Walter
- School of Health, Medical and Applied Sciences, Central Queensland University, 554-700 Yaamba Road, Norman Gardens, 4701, Australia.
| | - Lisa K Bricknell
- School of Health, Medical and Applied Sciences, Central Queensland University, 554-700 Yaamba Road, Norman Gardens, 4701, Australia
| | - Robyn G Preston
- School of Health, Medical and Applied Sciences, Central Queensland University, 538 Flinders Street, Townsville, QLD, 4810, Australia
| | - Elise G C Crawford
- School of Health, Medical and Applied Sciences, Central Queensland University, 554-700 Yaamba Road, Norman Gardens, 4701, Australia
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Allain S, Naouri D, Deroyon T, Costemalle V, Hazo JB. Income and professional inequalities in chronic diseases: prevalence and incidence in France. Public Health 2024; 228:55-64. [PMID: 38306754 DOI: 10.1016/j.puhe.2023.12.022] [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: 08/21/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVES In France, almost nine of 10 deaths are caused by non-communicable diseases, and there is significant social inequality in mortality rates. However, it is not easy to collect robust data on the incidence and prevalence of such diseases according to socio-economic status. Based on data from the link between the primary longitudinal population sample and the national health data system, the aim of our study was to compute the standardised incidence and prevalence of seven major groups of chronic diseases according to socio-economic status. STUDY DESIGN Descriptive retrospective cohort study. METHODS This was a descriptive retrospective cohort study on a weighted representative sample of the French population, comprising 3.4 million individuals from data collected 2016-2017. Main chronic disease categories include diabetes, cancers, psychiatric disorders, liver and pancreatic diseases, neurological conditions, respiratory and cardiovascular diseases, calculated from the 2016-2017 period by combining health care consumption and diagnoses received during hospitalisations and/or associated with specific full healthcare coverage. Socio-economic status was measured by disposable income from the 2013-2014 tax returns and census-derived socioprofessional groups, and findings were standardised for age and sex. RESULTS For all disease categories except cancers, standardised incidence rates showed a gradient favouring the wealthiest, with a risk ratio between the first and tenth standard of living deciles ranging from 1.4 (cardiovascular diseases) to 2.8 (diabetes). Incidence of all disease categories, except cancers, was higher for all groups compared with executives and higher academic professions (risk ratios between workers and executives ranged from 2.0 to 1.3 in psychiatric and cardiovascular diseases, respectively). Conversely, cancer incidence rate followed a flat curve, reduced in the two poorest standard of living deciles, and there were no significant differences between socioprofessional groups. Standardised prevalence rates followed the same patterns, although risk ratios were highest for psychiatric diseases, varying according to sex and disease. CONCLUSIONS Deep social inequalities in incidence and prevalence of chronic diseases were observed in a large representative sample of the French population. The reverse social inequalities in cancer incidence and prevalence calls for more detailed research into cancer types and selection mechanisms, the data from which would allow the long-term monitoring of such disparities.
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Affiliation(s)
- Samuel Allain
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Diane Naouri
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Thomas Deroyon
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Vianney Costemalle
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France
| | - Jean-Baptiste Hazo
- Direction de la recherche, des études, de l'évaluation et des statistiques (DREES), French Ministry of Health and Solidarity, France.
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Chen-Xu J, Jakobsen LS, Pires SM, Viegas S. Burden of lung cancer and predicted costs of occupational exposure to hexavalent chromium in the EU - The impact of different occupational exposure limits. ENVIRONMENTAL RESEARCH 2023; 228:115797. [PMID: 37001847 DOI: 10.1016/j.envres.2023.115797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Exposure to hexavalent chromium [Cr(VI)] occurs widely in occupational settings across the EU and is associated with lung cancer. In 2025, the occupational exposure limit is set to change to 5 μg/m3. Current exposure limits are higher, with 10 μg/m3 as a general limit and 25 μg/m3 for the welding industry. We aimed to assess the current burden of lung cancer caused by occupational exposure to Cr(VI) and to evaluate the impact of the recently established EU regulation by analysing different occupational exposure limits. METHODS Data were extracted from the literature, the Global Burden of Disease 2019) study, and Eurostat. We estimated the cases of cancer attributable to workplace exposure to Cr(VI) by combining exposure-effect relationships with exposure data, and calculated related DALYs and health costs in scenarios with different occupational exposure limits. RESULTS With current EU regulations, 253 cases (95%UI 250.96-255.71) of lung cancer were estimated to be caused by Cr(VI) in 2019, resulting in 4684 DALYs (95%UI 4683.57-4704.08). In case the welding industry adopted 10 μg/m3, a decrease of 43 cases and 797 DALYs from current values is expected. The predicted application of a 5 μg/m3 limit would cause a decrease of 148 cases and 2746 DALYs. Current costs are estimated to amount to 12.47 million euros/year (95%UI 10.19-453.82), corresponding to 39.97 million euros (95%UI 22.75-70.10) when considering costs per DALY. The limits implemented in 2025 would lead to a decrease of 23.35 million euros when considering DALYs, with benefits of introducing a limit value occurring after many decades. Adopting a 1 μg/m3 limit would lower costs to 1.04 million euros (95%UI 0.85-37.67) and to 3.33 million euros for DALYs (95%UI 1.89-5.84). DISCUSSION Assessing different scenarios with different Cr(VI) occupational exposure limits allowed to understand the impact of EU regulatory actions. These findings make a strong case for adapting even stricter exposure limits to protect workers' health and avoid associated costs.
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Affiliation(s)
- José Chen-Xu
- NOVA National School of Public Health, Public Health Research Centre, NOVA University Lisbon, Lisbon, Portugal; Public Health Unit, Primary Healthcare Cluster Baixo Mondego, Coimbra, Portugal.
| | | | | | - Susana Viegas
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
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Gorasso V, Morgado JN, Charalampous P, Pires SM, Haagsma JA, Santos JV, Idavain J, Ngwa CH, Noguer I, Padron-Monedero A, Sarmiento R, Pinheiro V, Von der Lippe E, Jakobsen LS, Devleesschauwer B, Plass D. Burden of disease attributable to risk factors in European countries: a scoping literature review. Arch Public Health 2023; 81:116. [PMID: 37355706 DOI: 10.1186/s13690-023-01119-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/24/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVES Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature review to: (1) map the BoD assessments including risk factors performed across Europe; and (2) identify the methodological choices in comparative risk assessment (CRA) and risk assessment methods. METHODS We searched multiple literature databases, including grey literature websites and targeted public health agencies websites. RESULTS A total of 113 studies were included in the synthesis and further divided into independent BoD assessments (54 studies) and studies linked to the Global Burden of Disease (59 papers). Our results showed that the methods used to perform CRA varied substantially across independent European BoD studies. While there were some methodological choices that were more common than others, we did not observe patterns in terms of country, year or risk factor. Each methodological choice can affect the comparability of estimates between and within countries and/or risk factors, since they might significantly influence the quantification of the attributable burden. From our analysis we observed that the use of CRA was less common for some types of risk factors and outcomes. These included environmental and occupational risk factors, which are more likely to use bottom-up approaches for health outcomes where disease envelopes may not be available. CONCLUSIONS Our review also highlighted misreporting, the lack of uncertainty analysis and the under-investigation of causal relationships in BoD studies. Development and use of guidelines for performing and reporting BoD studies will help understand differences, avoid misinterpretations thus improving comparability among estimates. REGISTRATION The study protocol has been registered on PROSPERO, CRD42020177477 (available at: https://www.crd.york.ac.uk/PROSPERO/ ).
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Affiliation(s)
- Vanessa Gorasso
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Joana Nazaré Morgado
- Environmental Health and Nutrition Laboratory, University of Lisbon, Lisbon, Portugal
| | | | - Sara M Pires
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | | | - João Vasco Santos
- MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, University of Porto, Porto, Portugal
- CINTESIS, Centre for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, ACES Grande Porto V - Porto Ocidental, Porto, Portugal
| | - Jane Idavain
- Department of Health Statistics, National Institute for Health Development, Tallinn, Estonia
| | - Che Henry Ngwa
- School of Public Health and Community Medicine, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Isabel Noguer
- Carlos III Institute of Health, National School of Public Health, Madrid, Spain
| | | | - Rodrigo Sarmiento
- Carlos III Institute of Health, National School of Public Health, Madrid, Spain
- Medicine School, University of Applied and Environmental Sciences, Bogota, Colombia
| | - Vera Pinheiro
- CINTESIS, Centre for Health Technology and Services Research, Porto, Portugal
- Public Health Unit, Matosinhos Local Health Unit, Matosinhos, Portugal
| | - Elena Von der Lippe
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Lea Sletting Jakobsen
- Division for Diet, Disease Prevention and Toxicology, Technical University of Denmark, Lyngby, Denmark
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Dietrich Plass
- Department for Exposure Assessment and Environmental Health Indicators, German Environment Agency, Berlin, Germany
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Cox LA. Re-assessing human mortality risks attributed to PM2.5-mediated effects of agricultural ammonia. ENVIRONMENTAL RESEARCH 2023; 223:115311. [PMID: 36731597 DOI: 10.1016/j.envres.2023.115311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/13/2023] [Accepted: 01/13/2023] [Indexed: 06/18/2023]
Abstract
How can and should epidemiologists and risk assessors assemble and present evidence for causation of mortality or morbidities by identified agents such as fine particulate matter or other air pollutants? As a motivating example, some scientists have warned recently that ammonia from the production of meat significantly increases human mortality rates in exposed populations by increasing the ambient concentration of fine particulate matter (PM2.5) in air. We reexamine the support for such conclusions, including quantitative calculations that attribute deaths to PM2.5 air pollution by applying associational results such as relative risks, odds ratios, or slope coefficients from regression models to predict the effects on mortality or morbidity of reducing PM2.5 exposures. Taking an outside perspective from the field of causal artificial intelligence (CAI), we conclude that these attribution calculations are methodologically unsound. They produce unreliable conclusions because they ignore an essential distinction between differences in outcomes observed at different levels of exposure and changes in outcomes caused by changing exposure. We find that multiple studies that have examined associations between changes over time in particulate exposure and mortality risk instead of differences in exposures and corresponding mortality risks have found no clear evidence that observed changes in exposure help to predict or explain subsequent changes in mortality risks. We conclude that there is no sound theoretical or empirical reason to believe that reducing ammonia emissions from farms has reduced or would reduce human mortality risks. More generally, applying CAI principles and methods can potentially improve current widespread practices of unsound causal inferences and policy-relevant causal claims that are made without the benefit of formal causal analysis in air pollution health effects research and in other areas of applied epidemiology and public health risk assessment.
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Zhang B, Pu L, Zhao T, Wang L, Shu C, Xu S, Sun J, Zhang R, Han L. Global burden of cardiovascular disease from 1990 to 2019 attributable to dietary factors. J Nutr 2023:S0022-3166(23)35504-4. [PMID: 37003507 DOI: 10.1016/j.tjnut.2023.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/22/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND While dietary factors play a crucial role in the incidence of cardiovascular disease, the specific dietary risk factors vary across regions and require further investigation. OBJECTIVE The burden of cardiovascular disease (CVD) due to different dietary factors was analyzed by determining sex, age, and sociodemographic index (SDI) values for 204 countries and territories between 1990 and 2019. METHODS Data were extracted from the Global Burden of Disease (GBD) 2019 and analyzed to determine population attributable fractions (PAFs), mortality, and disability-adjusted life years (DALYs), and trends thereof, for CVDs attributable to dietary risk factors from 1990 to 2019. We used a generalized linear model with a Gaussian distribution to calculate the estimated annual percentage changes (EPACs) in CVD mortality and DALY rates attributable to dietary risk factors. We also used a comparative risk-assessment framework to estimate the CVD mortality and DALYs attributable to dietary risk factors. RESULTS Approximately 40% of CVD mortality and DALY rates were attributable to dietary risk factors, with high sodium intake, low whole-grain intake, and low legume intake being the greatest dietary risk factors globally. Moreover, high-SDI regions had the highest PAFs for CVD mortality and DALYs associated with high red and processed meat intake, middle-SDI regions had the highest PAFs with high sodium intake, and low-SDI regions had the highest PAFs with low fruit and vegetable intake. The highest PAFs for CVD mortality and DALYs were associated with low whole-grain intake in 13 and 9 regions, respectively. CONCLUSION Reducing sodium intake and increasing whole-grain and legume intake should be the top priority worldwide for improving regional diets and thereby decreasing CVD burdens. Other priorities should be set for different SDI-value regions, depending on the predominant dietary risk factors for CVDs in the respective regions.
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Affiliation(s)
- Bei Zhang
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.
| | - Liyuan Pu
- Hwa Mei Hospital, Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.
| | - Tian Zhao
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.
| | - Li Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou ,510000, PR China.
| | - Chang Shu
- Tianjin Cerebral Vascular and Neural Degenerative Disease Key Laboratory, Tianjin Neurosurgery Institute, Tianjin Huanhu Hospital, Tianjin, China.
| | - Shan Xu
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, Guangdong, 518054, China.
| | - Jing Sun
- School of Medicine, Griffith University, Gold Coast Campus, Gold Coast, Queensland Q4222, Australia.
| | - Ruijie Zhang
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China; Hwa Mei Hospital, Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.
| | - Liyuan Han
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China; Hwa Mei Hospital, Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China.
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