| 1. |
- Naghavi, Mohsen, et al.
(author)
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Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
- 2015
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In: The Lancet. - 1474-547X .- 0140-6736. ; 385:9963, s. 117-171
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Journal article (peer-reviewed)abstract
- Background Up-to-date evidence on levels and trends for age-sex-specifi c all-cause and cause-specifi c mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specifi c all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specifi c causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute diff erences between countries decreased but relative diff erences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative diff erences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specifi c mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.
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| 2. |
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| 3. |
- de Graaff, Anne M., et al.
(author)
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Scalable psychological interventions for Syrian refugees in Europe and the Middle East : STRENGTHS study protocol for a prospective individual participant data meta-analysis
- 2022
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In: BMJ Open. - : BMJ. - 2044-6055. ; 12:4
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Journal article (peer-reviewed)abstract
- Introduction The World Health Organization's (WHO) scalable psychological interventions, such as Problem Management Plus (PM+) and Step-by-Step (SbS) are designed to be cost-effective non-specialist delivered interventions to reduce symptoms of common mental disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD). The STRENGTHS consortium aims to evaluate the effectiveness, cost-effectiveness and implementation of the individual format of PM+ and its group version (gPM+), as well as of the digital SbS intervention among Syrian refugees in seven countries in Europe and the Middle East. This is a study protocol for a prospective individual participant data (IPD) meta-analysis to evaluate (1) overall effectiveness and cost-effectiveness and (2) treatment moderators of PM+, gPM+ and SbS with Syrian refugees. Methods and analysis Five pilot randomised controlled trials (RCTs) and seven fully powered RCTs conducted within STRENGTHS will be combined into one IPD meta-analytic dataset. The RCTs include Syrian refugees of 18 years and above with elevated psychological distress (Kessler Psychological Distress Scale (K10>15)) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 (WHODAS 2.0>16)). Participants are randomised into the intervention or care as usual control group, and complete follow-up assessments at 1-week, 3-month and 12-month follow-up. Primary outcomes are symptoms of depression and anxiety (25-item Hopkins Symptom Checklist). Secondary outcomes include daily functioning (WHODAS 2.0), PTSD symptoms (PTSD Checklist for DSM-5) and self-identified problems (PSYCHLOPS). We will conduct a one-stage IPD meta-analysis using linear mixed models. Quality of evidence will be assessed using the GRADE approach, and the economic evaluation approach will be assessed using the CHEC-list. Ethics and dissemination Local ethical approval has been obtained for each RCT. This IPD meta-analysis does not require ethical approval. The results of this study will be published in international peer-reviewed journals.
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| 4. |
- Footman, Katharine, et al.
(author)
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Smoking cessation and desire to stop smoking in nine countries of the former soviet union
- 2013
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In: Nicotine & tobacco research. - : Oxford University Press (OUP). - 1462-2203 .- 1469-994X. ; 15:9, s. 1628-1633
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Journal article (peer-reviewed)abstract
- Introduction: Smoking rates and corresponding levels of premature mortality from smoking-related diseases in the former Soviet Union (fSU) are among the highest in the world. To reduce this health burden, greater focus on smoking cessation is needed, but little is currently known about rates and characteristics of cessation in the fSU. Methods: Nationally representative household survey data from a cross-sectional study of 18,000 respondents in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine were analyzed to describe patterns of desire and action taken to stop smoking, quit ratios (former ever-smokers as a percent of ever-smokers, without a specified recall period), and help used to stop smoking. Multivariate logistic regression was used to analyze characteristics associated with smoking cessation and desire to stop smoking. Results: Quit ratios varied from 10.5% in Azerbaijan to 37.6% in Belarus. About 67.2% of respondents expressed a desire to quit, and 64.9% had taken action and tried to stop. The use of help to quit was extremely low (12.6%). Characteristics associated with cessation included being female, over 60, with higher education, poorer health, lower alcohol dependency, higher knowledge of tobacco's health effects, and support for tobacco control. Characteristics associated with desire to stop smoking among current smokers included younger age, poorer health, greater knowledge of tobacco's health effects, and support for tobacco control. Conclusions: Quit ratios are low in the fSU but there is widespread desire to stop smoking. Stronger tobacco control and cessation support are urgently required to reduce smoking prevalence and associated premature mortality.
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| 5. |
- Murphy, Adrianna, et al.
(author)
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A country divided? : Regional variation in mortality in Ukraine
- 2013
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In: International Journal of Public Health. - : Springer Science and Business Media LLC. - 1661-8556 .- 1661-8564. ; 58:6, s. 837-844
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Journal article (peer-reviewed)abstract
- We set out to identify the contribution of various causes of death to regional differences in life expectancy in Ukraine. Mortality data by oblast (province) were obtained from the State Statistical Committee of Ukraine. The contribution of various causes of death to differences in life expectancy between East, West and South Ukraine was estimated using decomposition. In 2008, life expectancy for men in South (61.8 years) and East Ukraine (61.2 years) was lower than for men in West Ukraine (64.0 years). A similar pattern was observed among women. This was mostly due to deaths from infectious disease and external causes among young adults, and cardio- and cerebro-vascular deaths among older adults. Deaths from TB among young adults contribute most to differences in life expectancy. Deaths due to infectious disease, especially TB, play an important role in the gap in life expectancy between regions in Ukraine. These deaths are entirely preventable-further research is needed to identify what has 'protected' individuals in Western Ukraine from the burden of deaths experienced by their Southern and Eastern counterparts.
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| 6. |
- Murphy, Adrianna, et al.
(author)
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Social Factors Associated with Alcohol Consumption in the Former Soviet Union : A Systematic Review
- 2012
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In: Alcohol and Alcoholism. - : Oxford University Press (OUP). - 0735-0414 .- 1464-3502. ; 47:6, s. 711-718
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Journal article (peer-reviewed)abstract
- Aims: Alcohol consumption is a major cause of premature mortality in countries of the former Soviet Union (fSU). Despite the unique social profile of the region, we could find no published systematic review of studies of social factors and alcohol consumption in formerly Soviet countries. We aim to critically review the current evidence for social factors associated with alcohol consumption in the fSU and to identify key gaps in the literature. Methods: We searched MEDLINE, EMBASE and Global Health databases for cross-sectional, case-control, longitudinal or qualitative studies of demographic, socio-economic, psycho-social and contextual factors associated with alcohol consumption, in any language, published from 1991 until 16 December 2011. Additional studies were identified from the references of selected papers and expert consultation. Our review followed PRISMA guidelines for the reporting of systematic reviews. Results: Our search strategy resulted in 26 articles for review. Although there is strong evidence in the literature that males and smokers in the fSU are more likely to engage in hazardous alcohol consumption, findings regarding other social factors were mixed and there were almost no data on the association of contextual factors and alcohol consumption in this region. Conclusion: This review highlights the extremely limited amount of evidence for social factors associated with heavy alcohol consumption in the fSU. Given the unique social environment of countries of the fSU, future research should take these factors into account in order to effectively address the high levels of alcohol-related mortality in this region.
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| 7. |
- Murphy, Adrianna, et al.
(author)
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Using multi-level data to estimate the effect of an 'alcogenic' environment on hazardous alcohol consumption in the former Soviet Union.
- 2014
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In: Health and Place. - : Elsevier. - 1353-8292 .- 1873-2054. ; 27, s. 205-211
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Journal article (peer-reviewed)abstract
- PURPOSE: The purpose of this study was to assess whether alcohol-related community characteristics act collectively to influence individual-level alcohol consumption in the former Soviet Union (fSU).METHODS AND RESULTS: Using multi-level data from nine countries in the fSU we conducted a factor analysis of seven alcohol-related community characteristics. The association between any latent factors underlying these characteristics and two measures of hazardous alcohol consumption was then analysed using a population average regression modelling approach. Our factor analysis produced one factor with an eigenvalue >1 (EV=1.28), which explained 94% of the variance. This factor was statistically significantly associated with increased odds of CAGE problem drinking (OR=1.40 (1.08-1.82)). The estimated association with EHD was not statistically significant (OR=1.10 (0.85-1.44)).CONCLUSIONS: Our findings suggest that a high number of beer, wine and spirit advertisements and high alcohol outlet density may work together to create an 'alcogenic' environment that encourages hazardous alcohol consumption in the fSU.
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| 8. |
- Roberts, Bayard, et al.
(author)
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Changes in household access to water in countries of the former Soviet Union
- 2012
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In: Journal of Public Health. - : Oxford University Press (OUP). - 2198-1833 .- 1613-2238 .- 1741-3850 .- 1741-3842. ; 34:3, s. 352-359
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Journal article (peer-reviewed)abstract
- Background Evidence from the Early 2000s quantified limited coverage of household water supplies in countries of the former Soviet Union. The study objectives were to measure changes in access to piped household water in seven of these countries between 2001 and 2010 and examine how these varied by household economic status. Methods Cross-sectional household sample surveys were conducted in 2010 in Armenia, Belarus, Georgia, Kazakhstan, Moldova, Russia and Ukraine. Data on household piped water were compared with a related 2001 study and descriptive, regression and relative risk analyses applied. Results Increases in access to piped water in the home between 2001 and 2010 were recorded in urban and rural areas of all countries, except Kazakhstan. Access remains lower in rural areas. The relative risk of urban households not having piped water in 2010 compared with 2001 diminished by one-third for households with a bad/very bad economic situation [rate ratio (RR): 0.66] and by half for wealthier households (RR: 0.48). In rural areas, the declines were 15% for households with a bad/very bad economic situation (RR: 0.85) and 30% for wealthier households (RR: 0.69). Conclusions Despite encouraging increases in access to piped water, there remain significant gaps for rural and poorer households.
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| 9. |
- Roberts, Bayard, et al.
(author)
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Changes in Smoking Prevalence in 8 Countries of the Former Soviet Union Between 2001 and 2010
- 2012
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In: American Journal of Public Health. - 0090-0036 .- 1541-0048. ; 102:7, s. 1320-1328
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Journal article (peer-reviewed)abstract
- Objectives. We sought to present new data on smoking prevalence in 8 countries, analyze prevalence changes between 2001 and 2010, and examine trend variance by age, location, education level, and household economic status. Methods. We conducted cross-sectional household surveys in 2010 in Armenia, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine. We compared smoking prevalence with a related 2001 study for the different countries and population subgroups, and also calculated the adjusted prevalence rate ratios of smoking. Results. All-age 2010 smoking prevalence among men ranged from 39% (Moldova) to 59% (Armenia), and among women from 2% (Armenia) to 16% (Russia). There was a significantly lower smoking prevalence among men in 2010 compared with 2001 in Belarus, Kazakhstan, Kyrgyzstan, and Russia, but not for women in any country. For all countries combined, there was a significantly lower smoking prevalence in 2010 than in 2001 for men aged 18 to 39 years and men with a good or average economic situation. Conclusions. Smoking prevalence appears to have stabilized and may be declining in younger groups, but remains extremely high among men, especially those in lower socioeconomic groups. (Am J Public Health. 2012;102:1320-1328. doi:10.2105/AJPH.2011.300547)
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| 10. |
- Roberts, Bayard, et al.
(author)
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Irregular treatment of hypertension in the former Soviet Union
- 2012
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In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 66:6, s. 482-488
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Journal article (peer-reviewed)abstract
- Background The USSR failed to establish a modern pharmaceutical industry and lacked the capacity for reliable distribution of drugs. Patients were required to pay for outpatient drugs and the successor states have inherited this legacy, so that those requiring long-term treatment face considerable barriers in receiving it. It was hypothesised that citizens of former Soviet republics requiring treatment for hypertension may not be receiving regular treatment. Aims To describe the regularity of treatment among those diagnosed with hypertension and prescribed treatment in eight countries of the former Soviet Union, and explore which factors are associated with not taking medication regularly. Methods Using data from over 18 000 respondents from eight former Soviet countries, individuals who had been told that they had hypertension by a health professional and prescribed treatment were identified. By means of multivariate logistic analysis the characteristics of those taking treatment daily and less than daily were compared. Results Only 26% of those prescribed treatment took it daily. The probability of doing so varied among countries and was highest in Russia, Belarus and Georgia, and lowest in Armenia ( although Georgia's apparent advantage may reflect low rates of diagnosis). Women, older people, those living in urban areas, and nonsmokers and non-drinkers were more likely to take treatment daily. Conclusions A high proportion of those who have been identified by health professionals as requiring hypertension treatment are not taking it daily. These findings suggest that irregular hypertension treatment is a major problem in this region and will require an urgent response.
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