| 1. |
- Naghavi, Mohsen, et al.
(författare)
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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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Ingår i: The Lancet. - 1474-547X .- 0140-6736. ; 385:9963, s. 117-171
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Tidskriftsartikel (refereegranskat)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. |
- Forouzanfar, Mohammad H, et al.
(författare)
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Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013 : a systematic analysis for the Global Burden of Disease Study 2013.
- 2015
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Ingår i: The Lancet. - 0140-6736 .- 1474-547X. ; 386:10010, s. 2287-2323
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.FUNDING: Bill & Melinda Gates Foundation.
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| 3. |
- Strauch, Stefanie, et al.
(författare)
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Objectively Assessed Physical Activity in the Oldest Old Persons With Coronary Artery Disease
- 2019
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Ingår i: Journal of Geriatric Physical Therapy. - : LIPPINCOTT WILLIAMS & WILKINS. - 1539-8412 .- 2152-0895. ; 42:4, s. E69-E76
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: Accelerometer threshold values to detect physical activity intensity in the oldest old persons with coronary artery disease (CAD) are lacking as well as knowledge about their free-living physical activity behavior. The purpose of this study was 2-fold. (1) To assess the sensitivity and specificity of 3 existing intensity threshold values for Acti-Graph accelerometers for the oldest old persons with CAD. (2) To assess free-living physical activity, applying the threshold values with the highest sensitivity and specificity for assessing at least moderate intensity, among these persons. Methods: In a cross-sectional design, a total of 24 persons with CAD, mean age 87.5 (3.7) years, participated in the study at a university hospital in Sweden. To assess the sensitivity and specificity of the existing threshold values, the participants walked at different speeds wearing the accelerometer at a pace corresponding to individualized perceived exertion at light, moderate, and high intensity according to the Borg Rating of Perceived Exertion Scale. For the free-living physical activity assessment, the persons wore the accelerometer for 7 consecutive days. The percentage agreement for light-, moderate-, and high-intensity threshold values, as well as receiver operating characteristic curves, was used to identify the sensitivity and specificity of the existing threshold values for moderate intensity. Results and Discussion: The threshold values for at least moderate intensity at 1041 counts per minute according to Copeland had the highest sensitivity (0.739) and specificity (0.609) to identify at least moderate intensity for the ActiGraph GT3X+ accelerometer. In a free-living setting, the oldest old persons with CAD spent 11 of 13.5 (81%) waking hours in a sedentary position and, of the 2.5 hours of being active, 19 minutes (2%) were at least at moderate intensity. Nine of 24 persons (38%) reached 20 minutes of moderate- to vigorous-intensity physical activity 3 days a week, according to guidelines for exercise-based cardiac rehabilitation. Conclusions: The existing threshold values according to Copeland had the highest sensitivity and specificity to identify at least moderate intensity and are valid for use in the oldest old persons with CAD. Using accelerometry as an objective measurement for physical activity can help further improve our understanding of free-living physical activity behavior and to assess relationships between free-living physical activity and health outcomes among the oldest old persons with CAD.
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| 4. |
- Adams, Marc A., et al.
(författare)
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Patterns of neighborhood environment attributes related to physical activity across 11 countries : a latent class analysis
- 2013
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Ingår i: International Journal of Behavioral Nutrition and Physical Activity. - : Springer Science and Business Media LLC. - 1479-5868. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Neighborhood environment studies of physical activity (PA) have been mainly single-country focused. The International Prevalence Study (IPS) presented a rare opportunity to examine neighborhood features across countries. The purpose of this analysis was to: 1) detect international neighborhood typologies based on participants' response patterns to an environment survey and 2) to estimate associations between neighborhood environment patterns and PA. Methods: A Latent Class Analysis (LCA) was conducted on pooled IPS adults (N=11,541) aged 18 to 64 years old (mean=37.5 +/- 12.8 yrs; 55.6% women) from 11 countries including Belgium, Brazil, Canada, Colombia, Hong Kong, Japan, Lithuania, New Zealand, Norway, Sweden, and the U. S. This subset used the Physical Activity Neighborhood Environment Survey (PANES) that briefly assessed 7 attributes within 10-15 minutes walk of participants' residences, including residential density, access to shops/services, recreational facilities, public transit facilities, presence of sidewalks and bike paths, and personal safety. LCA derived meaningful subgroups from participants' response patterns to PANES items, and participants were assigned to neighborhood types. The validated short-form International Physical Activity Questionnaire (IPAQ) measured likelihood of meeting the 150 minutes/week PA guideline. To validate derived classes, meeting the guideline either by walking or total PA was regressed on neighborhood types using a weighted generalized linear regression model, adjusting for gender, age and country. Results: A 5-subgroup solution fitted the dataset and was interpretable. Neighborhood types were labeled, "Overall Activity Supportive (52% of sample)", "High Walkable and Unsafe with Few Recreation Facilities (16%)", "Safe with Active Transport Facilities (12%)", "Transit and Shops Dense with Few Amenities (15%)", and "Safe but Activity Unsupportive (5%)". Country representation differed by type (e. g., U. S. disproportionally represented "Safe but Activity Unsupportive"). Compared to the Safe but Activity Unsupportive, two types showed greater odds of meeting PA guideline for walking outcome (High Walkable and Unsafe with Few Recreation Facilities, OR=2.26 (95% CI 1.18-4.31); Overall Activity Supportive, OR=1.90 (95% CI 1.13-3.21). Significant but smaller odds ratios were also found for total PA. Conclusions: Meaningful neighborhood patterns generalized across countries and explained practical differences in PA. These observational results support WHO/UN recommendations for programs and policies targeted to improve features of the neighborhood environment for PA.
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| 5. |
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| 6. |
- Moren, Carina, et al.
(författare)
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The Effects of Physical Activity on Prescription in Persons With Transient Ischemic Attack : A Randomized Controlled Study
- 2016
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Ingår i: Journal of neurologic physical therapy. - 1557-0576 .- 1557-0584. ; 40:3, s. 176-183
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: Transient ischemic attack (TIA) is a strong predictor of stroke, and physical inactivity is one risk factor for TIA/stroke. Physical activity on Prescription (PaP) can increase physical activity, but the effect of PaP after TIA has not been described. Our goal was to objectively measure the effect of PaP on physical activity and physical capacity, as well as self-rated health at 3 and 6 months after TIA. Methods: The primary outcome was moderate to vigorous intensities of physical activity objectively assessed by accelerometry. Secondary outcomes were steps per day assessed by accelerometry, physical capacity assessed by the 6-minute walk test, and self-rated health assessed by EQ-5D VAS. Results: Eighty-eight individuals with TIA were randomized to an intervention group (n = 44) that received conventional treatment and PaP or to a control group (n = 44) that received conventional treatment alone. There was a 30% dropout among the participants at 6 months. No significant differences between groups were found in physical activity at 3 and 6 months. At 6 months, participants in the intervention group were significantly more likely to have improved their physical capacity than the control group. There was no significant difference between groups in self-rated health. Discussion and Conclusions: PaP did not increase physical activity after TIA; however, there was an increase in physical capacity. The nonsignificant results for physical activity may be the result of a relatively high baseline physical activity level. The results may also indicate that prior studies suggesting that PaP increases physical activity overestimated effects because of the self-reported nature of the previous outcomes.
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| 7. |
- Orsini, Nicola, et al.
(författare)
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Validity of self-reported total physical activity questionnaire among older women
- 2008
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Ingår i: European Journal of Epidemiology. - : SPRINGER. - 0393-2990 .- 1573-7284. ; 23:10, s. 661-667
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Tidskriftsartikel (refereegranskat)abstract
- Aim of this study was to assess the validity of a short self-administered physical activity questionnaire, intended to measure past year total daily physical activity, by comparison with activity records and accelerometers. Over a 1-year period, data from a questionnaire, 7-day activity records and accelerometers were obtained from a subset of 116 women between the ages of 56 and 75 years from the population-based Swedish Mammography Cohort. We estimated concordance correlations as measure of validity, deattenuated for intraindividual variation in the reference method. Deattenuated concordance correlations comparing total daily activity measured by the questionnaire with the accelerometers and the records were 0.38 (95% CI: 0.22-0.54) and 0.64 (95% CI: 0.45-0.83), respectively. Validity of leisure-time activity (walking/bicycling and exercise) and inactivity (watching TV/reading) estimates comparing the records with the questionnaire were 0.42 (95% CI: 0.22-0.62) and 0.52 (95% CI: 0.36-0.69), respectively. These data indicate that the average past year total physical activity, leisure-time activity and inactivity can be estimated with a reasonable validity using our short self-administered questionnaire.
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| 8. |
- Strauch, S., et al.
(författare)
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Objectively Assessed Physical Activity in the Oldest Old Persons With Coronary Artery Disease
- 2019
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Ingår i: Journal of Geriatric Physical Therapy. - : Ovid Technologies (Wolters Kluwer Health). - 1539-8412. ; 42:4, s. E69-E76
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose: Accelerometer threshold values to detect physical activity intensity in the oldest old persons with coronary artery disease (CAD) are lacking as well as knowledge about their free-living physical activity behavior. The purpose of this study was 2-fold. (1) To assess the sensitivity and specificity of 3 existing intensity threshold values for Acti-Graph accelerometers for the oldest old persons with CAD. (2) To assess free-living physical activity, applying the threshold values with the highest sensitivity and specificity for assessing at least moderate intensity, among these persons. Methods: In a cross-sectional design, a total of 24 persons with CAD, mean age 87.5 (3.7) years, participated in the study at a university hospital in Sweden. To assess the sensitivity and specificity of the existing threshold values, the participants walked at different speeds wearing the accelerometer at a pace corresponding to individualized perceived exertion at light, moderate, and high intensity according to the Borg Rating of Perceived Exertion Scale. For the free-living physical activity assessment, the persons wore the accelerometer for 7 consecutive days. The percentage agreement for light-, moderate-, and high-intensity threshold values, as well as receiver operating characteristic curves, was used to identify the sensitivity and specificity of the existing threshold values for moderate intensity. Results and Discussion: The threshold values for at least moderate intensity at 1041 counts per minute according to Copeland had the highest sensitivity (0.739) and specificity (0.609) to identify at least moderate intensity for the ActiGraph GT3X+ accelerometer. In a free-living setting, the oldest old persons with CAD spent 11 of 13.5 (81%) waking hours in a sedentary position and, of the 2.5 hours of being active, 19 minutes (2%) were at least at moderate intensity. Nine of 24 persons (38%) reached 20 minutes of moderate- to vigorous-intensity physical activity 3 days a week, according to guidelines for exercise-based cardiac rehabilitation. Conclusions: The existing threshold values according to Copeland had the highest sensitivity and specificity to identify at least moderate intensity and are valid for use in the oldest old persons with CAD. Using accelerometry as an objective measurement for physical activity can help further improve our understanding of free-living physical activity behavior and to assess relationships between free-living physical activity and health outcomes among the oldest old persons with CAD.
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