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Landeiro F, Harris C, Groves D, O'Neill S, Jandu KS, Tacconi EMC, Field S, Patel N, Göpfert A, Hagson H, Leal J, Luengo-Fernández R. The economic burden of cancer, coronary heart disease, dementia, and stroke in England in 2018, with projection to 2050: an evaluation of two cohort studies. THE LANCET. HEALTHY LONGEVITY 2024; 5:e514-e523. [PMID: 39068947 DOI: 10.1016/s2666-7568(24)00108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Cancer, coronary heart disease, dementia, and stroke are major contributors to morbidity and mortality in England. We aimed to assess the economic burden (including health-care, social care, and informal care costs, as well as productivity losses) of these four conditions in England in 2018, and forecast this cost to 2050 using population projections. METHODS We used individual patient-level data from the Clinical Practice Research Datalink (CPRD) Aurum, which contains primary care electronic health records of patients from 738 general practices in England, to calculate health-care and residential and nursing home resource use, and data from the English Longitudinal Study on Ageing (ELSA) to calculate informal and formal care costs. From CPRD Aurum, we included patients registered on Jan 1, 2018, in a CPRD general practice with Hospital Episode Statistics (HES)-linked records, omitting all children younger than 1 year. From ELSA, we included data collected from wave 9 (2018-19). Aggregate English resource use data on morbidity, mortality, and health-care, social care, and informal care were obtained and apportioned, using multivariable regression analyses, to cancer, coronary heart disease, dementia, and stroke. FINDINGS We included 4 161 558 patients from CPRD Aurum with HES-linked data (mean age 41 years [SD 23], with 2 079 679 [50·0%] men and 2 081 879 [50·0%] women) and 8736 patients in ELSA (68 years [11], with 4882 [55·9 %] men and 3854 [44·1%] women). In 2018, the total cost was £18·9 billion (95% CI 18·4-19·4) for cancer, £12·7 billion (12·3-13·0) for coronary heart disease, £11·7 billion (9·6-12·7) for dementia, and £8·6 billion (8·2-9·0) for stroke. Using 2050 English population projections, we estimated that costs would rise by 40% (39-41) for cancer, 54% (53-55) for coronary heart disease, 100% (97-102) for dementia, and 85% (84-86) for stroke, for a total of £26·5 billion (25·7-27·3), £19·6 billion (18·9-20·2), £23·5 billion (19·3-25·3), and £16·0 billion (15·3-16·6), respectively. INTERPRETATION This study provides contemporary estimates of the wide-ranging impact of the most important chronic conditions on all aspects of the economy in England. The data will help to inform evidence-based polices to reduce the impact of chronic disease, promoting care access, better health outcomes, and economic sustainability. FUNDING Alzheimer's Research UK.
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Affiliation(s)
- Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Callum Harris
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - David Groves
- Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | - Samantha Field
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nileema Patel
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anya Göpfert
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Hannes Hagson
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - José Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ramón Luengo-Fernández
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Wu Y, Liu Y, Liu Y, Chen Y, Lobanov-Rostovsky S, Zhang Y, Liu Y, Brunner EJ, French E, Liao J. Projections of Socioeconomic Costs for Individuals with Dementia in China 2020-2050: Modeling Study. J Alzheimers Dis 2024; 101:1321-1331. [PMID: 39302371 DOI: 10.3233/jad-240583] [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] [Indexed: 09/22/2024]
Abstract
Background Previous estimates on future socioeconomic costs of dementia in China are inconsistent, and the main drivers of these costs are unclear. Objective This study projected future socioeconomic costs (healthcare, formal social care, and informal care costs) and value of quality adjusted life years (QALYs) lost to dementia in China and assessed drivers of socioeconomic costs. Methods Based on our prior projection on dementia cases to 2050 by a Markov model, we forecasted future socioeconomic costs and the value of QALYs from a societal perspective, utilizing the China Health and Retirement Longitudinal Study and the Chinese Longitudinal Healthy Longevity Survey. In our main analysis, dementia incidence increased by 2.9% annually, while sensitivity analyses considered a flat or 1.0% annual decrease in the temporal trend of dementia incidence. Furthermore, we decomposed socioeconomic costs changes (2018 US$) into population growth, population aging, dementia prevalence and average socioeconomic costs per case. Results The annual socioeconomic costs and value of QALYs lost to dementia will reach $1,233 billion and $702 billion by 2050. If dementia incidence stays constant or decreases by 1.0% annually, the costs and QALYs would respectively decrease by 34% or 43% in 2050. Informal care is currently, and projected to remain, the largest share of socioeconomic costs. Population aging and rising dementia prevalence will mainly drive the growth in socioeconomic costs through 2050. Conclusions Dementia casts an increasingly large economic burden on Chinese society, mainly driven by fast aging population and growing dementia prevalence.
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Affiliation(s)
- Yanjuan Wu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yixuan Liu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yuyang Liu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
- Shenzhen Health Development Research and Data Management Center, Shenzhen, P.R. China
| | - Yuntao Chen
- Department of Epidemiology & Public Health, University College London, London, UK
| | | | - Yuting Zhang
- Faculty of Economics, University of Cambridge, Cambridge, UK
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, P.R. China
| | - Eric J Brunner
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Eric French
- Faculty of Economics, University of Cambridge, Cambridge, UK
| | - Jing Liao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health and Institute of State Governance, Sun Yat-sen University, Guangzhou, P.R. China
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Fu Y, Yu G, Maulana N, Thomson K. Interventions to tackle health inequalities in cardiovascular risks for socioeconomically disadvantaged populations: a rapid review. Br Med Bull 2023; 148:22-41. [PMID: 37724711 PMCID: PMC10724464 DOI: 10.1093/bmb/ldad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) has shown significant health inequalities for people with low socioeconomic status associated with more risk factors. This review was to synthesize interventions that targeted CVD risks and outcomes among socioeconomically disadvantaged populations and to understand the impact associated with these interventions. SOURCES OF DATA Cochrane CENTRAL, MEDLINE, Embase, PsycINFO and CINAHL were searched for records published in the last decade using a systematic search strategy, complemented by screening the reference lists and citation indexes. Nineteen studies were included and a narrative synthesis with the effect direction plot was undertaken in which studies, interventions, participants and outcomes were examined according to the intervention type focusing on behaviours, lifestyle, education, medication and monitoring. AREAS OF AGREEMENT No universal definition of disadvantaged socioeconomic status was used with common factors relating to racial/ethnic minorities, low income and low or no health insurance. Mixed effects of interventions were reported on clinical outcomes including weight, body mass index, blood pressure, glycated haemoglobin and cholesterol. AREAS OF CONTROVERSY Inconsistent effect was reported due to a large variety of settings, participants and intervention components although they are considered necessary to address the complex health needs of socioeconomically disadvantaged populations. GROWING POINTS There is inadequate evidence to determine whether any of the intervention types are effective in optimising lipids management for socioeconomically disadvantaged populations. AREAS TIMELY FOR DEVELOPING RESEARCH Research is needed with mixed evidence using real world evaluation and lived experience combined with health economic evaluation, on both mental and physical health outcomes.
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Affiliation(s)
- Yu Fu
- Department of Primary Care & Mental Health, Institute of Population Health, University of Liverpool, 1-3 Brownlow Street, Liverpool, L69 3GL, UK
| | - Ge Yu
- King’s Health Economics, Health Services and Population Research, Department of Psychiatry, Psychology & Neuroscience, King’s College London, David Goldberg Centre 18 De Crespigny Park, London, SE5 8AF, UK
| | - Naswa Maulana
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
| | - Katie Thomson
- Population Health Sciences Institute, Faculty of Medical Sciences Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne NE2 4AX, UK
- National Institute for Health Research Applied Research Collaboration, North East and North Cumbria, Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust St Nicholas Hospital Gosforth, Newcastle Upon Tyne NE3 3XT, UK
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Chen Y, Bandosz P, Stoye G, Liu Y, Wu Y, Lobanov-Rostovsky S, French E, Kivimaki M, Livingston G, Liao J, Brunner EJ. Dementia incidence trend in England and Wales, 2002-19, and projection for dementia burden to 2040: analysis of data from the English Longitudinal Study of Ageing. Lancet Public Health 2023; 8:e859-e867. [PMID: 37898518 PMCID: PMC10958989 DOI: 10.1016/s2468-2667(23)00214-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Dementia incidence declined in many high-income countries in the 2000s, but evidence on the post-2010 trend is scarce. We aimed to analyse the temporal trend in England and Wales between 2002 and 2019, considering bias and non-linearity. METHODS Population-based panel data representing adults aged 50 years and older from the English Longitudinal Study of Ageing were linked to the mortality register across wave 1 (2002-03) to wave 9 (2018-19) (90 073 person observations). Standard criteria based on cognitive and functional impairment were used to ascertain incident dementia. Crude incidence rates were determined in seven overlapping initially dementia-free subcohorts each followed up for 4 years (ie, 2002-06, 2004-08, 2006-10, 2008-12, 2010-14, 2012-16, and 2014-18). We examined the temporal trend of dementia incidence according to age, sex, and educational attainment. We estimated the trend of dementia incidence adjusted by age and sex with Cox proportional hazards and multistate models. Restricted cubic splines allowed for potential non-linearity in the time trend. A Markov model was used to project future dementia burden considering the estimated incidence trend. FINDINGS Incidence rate standardised by age and sex declined from 2002 to 2010 (from 10·7 to 8·6 per 1000 person-years), then increased from 2010 to 2019 (from 8·6 to 11·3 per 1000 person-years). Adjusting for age and sex, and accounting for missing dementia cases due to death, estimated dementia incidence declined by 28·8% from 2002 to 2008 (incidence rate ratio 0·71, 95% CI 0·58-0·88), and increased by 25·2% from 2008 to 2016 (1·25, 1·03-1·54). The group with lower educational attainment had a smaller decline in dementia incidence from 2002 to 2008 and a greater increase after 2008. If the upward incidence trend continued, there would be 1·7 million (1·62-1·75) dementia cases in England and Wales by 2040, 70% more than previously forecast. INTERPRETATION Dementia incidence might no longer be declining in England and Wales. If the upward trend since 2008 continues, along with population ageing, the burden on health and social care will be large. FUNDING UK Economic and Social Research Council.
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Affiliation(s)
- Yuntao Chen
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Piotr Bandosz
- Division of Prevention Medicine & Education, Medical University of Gdansk, Gdansk, Poland
| | | | - Yuyang Liu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yanjuan Wu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | | | - Eric French
- Faculty of Economics, University of Cambridge, Cambridge, UK
| | - Mika Kivimaki
- Division of Psychiatry, University College London, London, UK
| | - Gill Livingston
- Division of Psychiatry, University College London, London, UK
| | - Jing Liao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
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Zaki HA, Bashir I, Mahdy A, Abdurabu M, Khallafalla H, Fayed M, Elsayed WAE, Abdelrahim MG, Basharat K, Salloum W, Shaban E. Exploring Clinical Trajectories and the Continuum of Care for Patients With Acute Coronary Syndrome in the United Kingdom: A Thorough Cross-Sectional Analysis. Cureus 2023; 15:e49391. [PMID: 38146552 PMCID: PMC10749670 DOI: 10.7759/cureus.49391] [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] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
The United Kingdom (UK) has a sustainable healthcare system. Nonetheless, the burden of acute coronary syndrome (ACS) is still a significant challenge. A scarcity of literature primarily focuses on the continuum of care for ACS patients in the UK. Moreover, limited research studies highlight the clinical trajectories of ACS patients across the UK. Therefore, the current study was designed to explore clinical trajectories and the continuum of care for patients with ACS in the UK. Secondary data was obtained from the Myocardial Ischaemia National Audit Project (MINAP) database. The latest data available in the MINAP database was used. As our objective was to explore clinical trajectories and the continuum of care for patients, we retrieved data regarding the care received by ACS patients admitted to hospitals across the UK. The data of 85574 ACS patients was retrieved. A large number (n=47035) of patients were estimated to be eligible for the angiogram; however, an angiogram was performed for 87.15% (n=40995) of eligible patients. Angioplasty within 72 hours of admission was required for most (n=26313) ACS patients. Nonetheless, angioplasty within 72 hours of admission was performed for 59.7% (n=15703) of the eligible patients. There was a significant difference (P<0.05) between different regions of the UK and the percentage of patients for whom angioplasty was performed within 72 hours of admission. Primary percutaneous coronary intervention (PCI) was performed for 23923 ACS patients, of which the door-to-balloon interval for 17590 (73.5%) patients was ≤60 minutes while the door-to-balloon interval for 3086 (12.9%) patients was ≤90 minutes. Out of the total 85574 ACS patients, 65959 (77.08%) patients were discharged on appropriate medications, while 19615 (22.92%) were transferred to another hospital or died there. A total of 75361 were eligible to be referred to cardiac rehabilitation settings. Nonetheless, 64518 (85.61%) were referred to cardiac rehabilitation. About 85000 patients were reported in the UK (England, Northern Ireland, Wales). Optimal care was provided to most patients in the UK. However, some patients received sub-optimal care, highlighting the disparity in the healthcare system. There is a need to explore further the factors that might be responsible for the sub-optimal care to the patients.
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Affiliation(s)
- Hany A Zaki
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Israr Bashir
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Ahmed Mahdy
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | - Mohamed Fayed
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | | | - Wathek Salloum
- Emergency Medicine, Hamad Medical Corporation, Doha, QAT
| | - Eman Shaban
- Cardiology, Al Jufairi Diagnosis and Treatment, Doha, QAT
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Chen Y, Araghi M, Bandosz P, Shipley MJ, Ahmadi-Abhari S, Lobanov-Rostovsky S, Venkatraman T, Kivimaki M, O'Flaherty M, Brunner EJ. Impact of hypertension prevalence trend on mortality and burdens of dementia and disability in England and Wales to 2060: a simulation modelling study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e470-e477. [PMID: 37573867 PMCID: PMC11108803 DOI: 10.1016/s2666-7568(23)00129-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/29/2023] [Accepted: 06/29/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Previous estimates of the impact of public health interventions targeting hypertension usually focus on one health outcome. This study aims to consider the effects of change in future hypertension prevalence on mortality, dementia, and disability simultaneously. METHODS We modelled three plausible scenarios based on observed trends of hypertension prevalence from 2003 to 2017 in England: observed trends continue (baseline scenario); 2017 prevalence remains unchanged; and 2017 prevalence decreases by 50% by 2060. We used a probabilistic Markov model to integrate calendar trends in incidence of cardiovascular disease, dementia, disability, and mortality to forecast their future occurrence in the population of England and Wales. Assuming the hypertension prevalence trend modifies health transition probabilities, we compared mortality outcomes and the burden of dementia and disability to 2060 for the scenarios. FINDINGS If the decline in hypertension prevalence stops, there would be a slight increase in the number of additional deaths to 2060 (22·9 [95% uncertainty interval 19·0-26·6] more deaths per 100 000 population), although the burdens of disability and dementia in absolute terms would change little. Alternatively, if the downward hypertension prevalence trend accelerates (with prevalence falling by 50% between 2017 and 2060), there would be a modest additional reduction in deaths (57·0 [50·4-63·5] fewer deaths per 100 000 population), a small increase in dementia burden (9·0 [5·1-13·2] more cases per 100 000 population), no significant effect on disability burden, and an 8% gain in healthy life expectancy at age 65 years from 2020 to 2060 (5·3 years vs 4·9 years) compared with the baseline scenario. INTERPRETATION The major future impact of alternative hypertension prevention strategies appears to be on future life expectancy. The salutary effect of lower population blood pressure distribution on incidence of dementia and disability might not offset expansion of the susceptible population due to reduced mortality. FUNDING British Heart Foundation and UK Economic and Social Research Council.
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Affiliation(s)
- Yuntao Chen
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Marzieh Araghi
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK; Division of Prevention Medicine & Education, Medical University of Gdansk, Gdansk, Poland
| | - Martin J Shipley
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Sara Ahmadi-Abhari
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | | | - Tishya Venkatraman
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Eric J Brunner
- Department of Epidemiology and Public Health, University College London, London, UK
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Affiliation(s)
| | - Francesca Colombo
- Organisation for Economic Co-operation and Development, Paris, France
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