Alcohol as a risk factor for global burden of disease

AIM: To make quantitative estimates of the burden of disease attributable to alcohol in the year 2000 on a global basis. DESIGN: Secondary data analysis. MEASUREMENTS: Two dimensions of alcohol exposure were included: average volume of alcohol consumption and patterns of drinking. There were also two main outcome measures: mortality, i.e. the number of deaths, and disability-adjusted life years (DALYs), i.e. the number of years of life lost to premature mortality or to disability. All estimates were prepared separately by sex, age group and WHO region. FINDINGS: Alcohol causes a considerable disease burden: 3.2% of the global deaths and 4.0% of the global DALYs in the year 2000 could be attributed to this exposure. There were marked differences by sex and region for both outcomes. In addition, there were differences by disease category and type of outcome; in particular, unintentional injuries contributed most to alcohol-attributable mortality burden while neuropsychiatric diseases contributed most to alcohol-attributable disease burden. DISCUSSION/CONCLUSIONS: The underlying assumptions are discussed and reasons are given as to why the estimates should still be considered conservative despite the considerable burden attributable to alcohol globally.     

Alcohol consumption and non-communicable diseases: epidemiology and policy implications

Aims This paper summarizes the relationships between different patterns of alcohol consumption and various on non‐communicable disease (NCD) outcomes and estimates the percentage of NCD burden that is attributable to alcohol. Methods A narrative review, based on published meta‐analyses of alcohol consumption‐disease relations, together with an examination of the Comparative Risk Assessment estimates applied to the latest available revision of Global Burden of Disease study. Results Alcohol is causally linked (to varying degrees) to eight different cancers, with the risk increasing with the volume consumed. Similarly, alcohol use is related detrimentally to many cardiovascular outcomes, including hypertension, haemorrhagic stroke and atrial fibrillation. For other cardiovascular outcomes the relationship is more complex. Alcohol is furthermore linked to various forms of liver disease (particularly with fatty liver, alcoholic hepatitis and cirrhosis) and pancreatitis. For diabetes the relationship is also complex. Conservatively, of the global NCD‐related burden of deaths, net years of life lost (YLL) and net disability adjusted life years (DALYs), 3.4%, 5.0% and 2.4%, respectively, can be attributed to alcohol consumption, with the burden being particularly high for cancer and liver cirrhosis. This burden is especially pronounced in countries of the former Soviet Union. Conclusions There is a strong link between alcohol and non‐communicable diseases, particularly cancer, cardiovascular disease, liver disease, pancreatitis and diabetes, and these findings support calls by the World Health Organization to implement evidence‐based strategies to reduce harmful use of alcohol.     

Volume of alcohol consumption, patterns of drinking and burden of disease in the European region 2002

AIMS: To describe the volume of alcohol consumption and patterns of drinking in the World Health Organization (WHO) European regions in 2002 and to estimate quantitatively the burden of disease attributable to alcohol in that year. METHODS: Secondary data analysis. Exposure data were taken from the WHO Comparative Risk Assessment, outcome data from the WHO Measurement and Health Information department, and used to derive three outcome measures: deaths, years of life lost (YLL) and disability adjusted life years (DALY) for 2002. All calculations were conducted according to age, sex and region. RESULTS: Alcohol consumption in the WHO regions for Europe was high, with 12.1 litres pure alcohol per capita, on average more than 100% above the global consumption. Alcohol consumption caused a considerable disease burden: 6.1% of all the deaths, 12.3% of all YLL and 10.7% of all DALY in all European regions in 2002 could be attributed to this exposure. Intentional and unintentional injuries accounted for almost 50% of all alcohol-attributable deaths and almost 44% of alcohol-attributable disease burden. Young people and men were affected the most. Geographically, the most eastern region around Russia had the highest alcohol-attributable disease burden. CONCLUSIONS: Interventions should be implemented to reduce the high burden of alcohol-attributable disease in the European regions. Given the epidemiological structure of the burden, injury prevention, including but not restricted to the prevention of traffic injuries, and specific prevention for young people should play the most important role in a comprehensive plan to reduce alcohol-attributable burden.     

Global burden attributable to high sodium intake from 1990 to 2019

Background and aimsHigh sodium intake is associated with a higher risk of a wide range of diseases. We aimed to estimate the pattern and trend of the global disease burden associated with high sodium intake from 1990 to 2019.Methods and resultsWe obtained numbers and rates of death and disability-adjusted life year (DALY) attributable to high sodium intake by sex, socio-demographic index, and country from the Global Burden of Disease Study 2019. We calculated the estimated annual percentage change to evaluate the age-standardized rate (ASR) of the burden attributable to high sodium intake between 1990 and 2019. We further calculated the contribution of population growth, population aging, and age-specific rates of death and DALY to the net change in the total number of deaths and DALYs attributable to high sodium intake. From 1990 to 2019, global age-standardized rates of death and DALY attributable to high sodium intake substantially decreased for both sexes. However, there were significant increases in the total numbers of deaths and DALYs attributable to high sodium intake, which were driven by population growth and population aging. The attribution of population growth and population aging varied widely across countries, with a higher contribution of population growth in most developing countries and a higher contribution of population aging in countries with slow population growth.ConclusionsAlthough the global burden attributable to high sodium intake in terms of age-standardized rate declined from 1990 to 2019, the absolute burden increased significantly, which was driven by population growth and population aging.     

Global cardiovascular diseases burden attributable to high sodium intake from 1990 to 2019

Sodium intake shows a positive correlation with blood pressure, resulting in an increased risk for cardiovascular diseases (CVD). Salt reduction is a key step toward the WHO's goal of 25% reduction in mortality from non-communicable diseases (NCDs) by 2025. This study aims to assess the current condition and temporal changes of the global CVD burden due to high sodium intake (HSI). We extracted data from the Global Burden of Disease (GBD) study 2019. The numbers and age-standardized rates of mortality and disability-adjusted life-years (DALYs), stratified by location, sex, and socio-demographic Index (SDI), were used to assess the high sodium intake attributable CVD burden from 1990 to 2019. The relationship between the DALYs rates and related factors was evaluated by stepwise multiple linear regression analysis. Globally, in 2019, the deaths and DALYs of HSI-related CVD were 1.72 million and 40.54 million, respectively, increasing by 41.08% and 33.06% from 1990. Meanwhile, the corresponding mortality and DALYs rates dropped by 35.1% and 35.2%, respectively. The high-middle and middle SDI quintiles bore almost two-thirds of CVD burden caused by HSI. And the leading cause of HSI attributable CVD burden was ischemic heart disease. Universal health coverage (UHC) was associated with the DALYs rates after adjustment. From 1990 to 2019, the global CVD burden attributable to HSI has declined with spatiotemporal and sexual heterogeneity. However, it remains a major public health challenge because of the increasing absolute numbers. Improving UHC serves as an effective strategy to reduce the HSI-related CVD burden.     

Burden of disease from hypercholesterolemia in Portugal.

Cardiovascular diseases are the main cause of death in Portugal, in developed countries and indeed, worldwide. Hypercholesterolemia is a major risk factor for these diseases. What are the potential health gains to be obtained by reducing the prevalence of hypercholesterolemia in the Portuguese population? How are they to be estimated and quantified? Studies of the burden of disease aim to measure and evaluate the impact of a disease or group of diseases on overall levels of health. Although they do not strictly speaking constitute an economic evaluation, since no specific interventions are analyzed, burden of disease studies do provide an accurate picture of a specific health problem and its magnitude, as well as an indication of changes in health policy and in preventive or corrective measures that might lead to improvement. This paper reports the results of a study of the disease burden of hypercholesterolemia in Portugal, calibrated for data from the year 2000. In this study, the disease burden is estimated as the component attributable to hypercholesterolemia in DALYs (disability-adjusted life years). DALYs are a measure used by international organizations such as the World Health Organization and the World Bank.     

Global statistics on alcohol,tobacco and illicit drug use: 2017 status report

Aims

This review provides an up‐to‐date curated source of information on alcohol, tobacco and illicit drug use and their associated mortality and burden of disease. Limitations in the data are also discussed, including how these can be addressed in the future.

Methods

Online data sources were identified through expert review. Data were obtained mainly from the World Health Organization, United Nations Office on Drugs and Crime and Institute for Health Metrics and Evaluation.

Results

In 2015, the estimated prevalence among the adult population was 18.4% for heavy episodic alcohol use (in the past 30 days); 15.2% for daily tobacco smoking; and 3.8, 0.77, 0.37 and 0.35% for past‐year cannabis, amphetamine, opioid and cocaine use, respectively. European regions had the highest prevalence of heavy episodic alcohol use and daily tobacco use. The age‐standardized prevalence of alcohol dependence was 843.2 per 100 000 people; for cannabis, opioids, amphetamines and cocaine dependence it was 259.3, 220.4, 86.0 and 52.5 per 100 000 people, respectively. High‐income North America region had among the highest rates of cannabis, opioid and cocaine dependence. Attributable disability‐adjusted life‐years (DALYs) were highest for tobacco smoking (170.9 million DALYs), followed by alcohol (85.0 million) and illicit drugs (27.8 million). Substance‐attributable mortality rates were highest for tobacco smoking (110.7 deaths per 100 000 people), followed by alcohol and illicit drugs (33.0 and 6.9 deaths per 100 000 people, respectively). Attributable age‐standardized mortality rates and DALYs for alcohol and illicit drugs were highest in eastern Europe; attributable age‐standardized tobacco mortality rates and DALYs were highest in Oceania.

Conclusions

In 2015 alcohol use and tobacco smoking use between them cost the human population more than a quarter of a billion disability‐adjusted life years, with illicit drugs costing further tens of millions. Europeans suffered proportionately more, but in absolute terms the mortality rate was greatest in low‐ and middle‐income countries with large populations and where the quality of data was more limited. Better standardized and rigorous methods for data collection, collation and reporting are needed to assess more accurately the geographical and temporal trends in substance use and its disease burden.     

Burden of disease attributable to obesity and overweight in Korea

OBJECTIVE: To estimate the burden of disease attributable to overweight and obesity using disability-adjusted life-year (DALY) in Korea. RESEARCH METHODS: Firstly, overweight and obesity-related diseases and their relative risk (RR) were selected by the systematic review. Secondly, population-attributable fractions (PAFs) were computed by using the formula including RR and the prevalence of exposure (Pe) of overweight and obesity. Thirdly, DALYs of overweight and obesity-related diseases in Korea were estimated. Finally, the attributable burden (AB) of diseases due to overweight and obesity was calculated as the sum of the products from multiplying DALYs of overweight and obesity-related diseases by their PAFs. RESULTS: The disease burden attributable to overweight was 827.1 person years (PYs) overall, 732.6 for men, 922.9 for women per 100,000 persons. The disease burden attributable to obesity was 260.0 PYs overall, 144.2 for men, 377.3 for women. Diabetes attributable to overweight and obesity accounts for highest burden among other diseases in both genders. The disease burden attributable to overweight was 3.2 times higher than that attributable to obesity. CONCLUSION: Most proportion of disease burden attributable to high body mass index (BMI) occurred among those with only moderately raised levels such as overweight, not the extremes such as obesity. It suggests that population-based, public health intervention rather than high-risk group-focused strategies are more effective to reduce the burden of disease attributable to overweight and obesity in Korea.     

Evaluation of the burden of diabetes in Poland

Burden of diabetes in terms of economic costs and life years lost due to premature deaths and disability in Poland is analyzed. This study calculates direct costs of type 1 and type 2 diabetes in Poland in 1998 and burden of diabetes in terms of years of life lost using Disability Adjusted Life Years (DALYs) measure within the Polish Multicenter Study of Diabetes Epidemiology (1998-1999). There is a consequent need to evaluate the burden of diabetes for the society and to develop affordable and cost-effective preventing strategies. The burden of diabetes is examined in terms of resources used by diabetic patients and time lost due to premature deaths and disability caused by diabetes. The profile of "a standard patient" (type 1 and type 2 diabetes) resource utilization is created using patient survey in Krakow. This includes main elements of cost associated with prevention, diagnosis and treatment: ambulatory care (visits); hospital care (bed/days and dialysis sessions); pharmaceuticals (goods consumed) and diagnosis (tests). This study calculates direct costs to the health sector of type 1 and type 2 diabetes in Poland 1998. Burden of diabetes in Poland in terms of time lost in 1998 is expressed in Disability Adjusted Life Years (DALYs) unit of measurement. DALY is a combination of two dimensions: YLL--number of years lost due to premature mortality; YLD--loss of healthy years due to disability caused by diabetes (with and without complications). The incidence approach is applied for the YLD caused by diabetes type 1 calculations by gender and age groups (0-29 years). Incidence rates are obtained from the prospective data collection [1, 2]. Other data as average age of onset, average duration of the disease (with or without complications), severity (age specific disability weight for treated or untreated forms of diabetes--with or without complications) are obtained from the GBD study for the Formerly Socialist Economies of Europe [9]. Discounting and age weighting procedure is applied. The prevalence approach is applied for YLD caused by diabetes type 2 calculations for treated and untreated forms of diabetes (with and without complications) by gender and age groups (35 years and more). Prevalence data are obtained from the Polish Multicenter Study on Diabetes Epidemiology. Age specific disability weights for treated or untreated forms of diabetes (with or without complication) are obtained from the GBD study for the Formerly Socialist Economies. Discounting procedure is not applied (duration of the disease is assumed 1 year). Years of Life Lost are calculated using Polish mortality data and life expectancy at the time of death in 1998. Cost of diabetes study is particularly useful in indicating the magnitude of the costs involved, which tend to be much higher than perceived by the general public. In 1998 the average diabetes type 1 patient's costs were 6.4 times and diabetes type 2 patient's costs 3 times higher than average public direct health care costs. The total costs of diabetes in Poland 1998 accounted for 9.3% of total public health care expenditures. The cost of diabetic patient's estimation indicates the potential benefits of effective medical interventions. Not only mortality rates should be taken into consideration in the creation of health policy and financial planning. Disability of the population is also an important factor, particularly in diseases which do not lead to fatalities. In 1998 112,584 DALYs (46% for males and 54% for females) were lost in Poland due to premature deaths and disability caused by diabetes. 72% of the total was due to disability. Secondary prevention is very important especially for diabetes type 2 patients. 95% of total time lost due to disability is caused by diabetes type 2. National burden of disease evaluation is helpful to develop a justifiable basis for setting priorities in purchasing and investing at central and local levels especially in prevention.     

Measuring the global burden of disease and epidemiological transitions: 2002-2030

Any planning process for health development ought to be based on a thorough understanding of the health needs of the population. This should be sufficiently comprehensive to include the causes of premature death and of disability, as well as the major risk factors that underlie disease and injury. To be truly useful to inform health-policy debates, such an assessment is needed across a large number of diseases, injuries and risk factors, in order to guide prioritization. The results of the original Global Burden of Disease Study and, particularly, those of its 2000-2002 update provide a conceptual and methodological framework to quantify and compare the health of populations using a summary measure of both mortality and disability: the disability-adjusted life-year (DALY). Globally, it appears that about 56 million deaths occur each year, 10.5 million (almost all in poor countries) in children. Of the child deaths, about one-fifth result from perinatal causes such as birth asphyxia and birth trauma, and only slightly less from lower respiratory infections. Annually, diarrhoeal diseases kill over 1.5 million children, and malaria, measles and HIV/AIDS each claim between 500,000 and 800,000 children. HIV/AIDS is the fourth leading cause of death world-wide (2.9 million deaths) and the leading cause in Africa. The top three causes of death globally are ischaemic heart disease (7.2 million deaths), stroke (5.5 million) and lower respiratory diseases (3.9 million). Chronic obstructive lung diseases (COPD) cause almost as many deaths as HIV/AIDS (2.7 million). The leading causes of DALY, on the other hand, include causes that are common at young ages [perinatal conditions (7.1% of global DALY), lower respiratory infections (6.7%), and diarrhoeal diseases (4.7%)] as well as depression (4.1%). Ischaemic heart disease and stroke rank sixth and seventh, retrospectively, as causes of global disease burden, followed by road traffic accidents, malaria and tuberculosis. Projections to 2030 indicate that, although these major vascular diseases will remain leading causes of global disease burden, with HIV/AIDS the leading cause, diarrhoeal diseases and lower respiratory infections will be outranked by COPD, in part reflecting the projected increases in death and disability from tobacco use.     

Burden of Chronic Viral Hepatitis and Liver Cirrhosis in Brazil - the Brazilian Global Burden of Disease Study

Introduction and aimData on epidemiology of liver diseases in Brazil is scarce. This study aimed to estimate the burden of chronic viral hepatitis and liver cirrhosis in the country.Materials and MethodsThe indicator used was disability-adjusted life year (DALY), a sum of years of life lost due to premature mortality (YLL) and years lived with disability (YLD). Liver cirrhosis was analyzed in etiologic categories and cirrhosis of viral origin was considered part of the burden of chronic hepatitis.ResultsThere were 57,380 DALYs (30.3 per 100,000 inhabitants) attributable to chronic hepatitis B and cirrhosis due to hepatitis B, with 41,262 DALYs in men. Most burden was caused by YLL (47,015 or 24.8/100,000) rather than YLD (10,365 or 5.5/100,000). Chronic hepatitis C and cirrhosis due to hepatitis C were responsible for 207,747 DALYs (109.6/100,000), of which 137,922 were YLL (72.7/100,000) and 69,825 (36.8/100,000) were YLD, with a higher proportion of DALYs in men (73.9%). Cirrhosis due to alcohol or other causes had a total of 536,169 DALYs (1,4% of total DALYs in Brazil), with 418,272 YLL (341,140 in men) and 117,897 YLD (97,965 in men). Highest DALYs’ rates occurred at ages 60-69 in chronic hepatitis and at ages 45-59 in cirrhosis due to alcohol or other causes.ConclusionChronic viral hepatitis and liver cirrhosis are responsible for a significant burden in Brazil, affecting mainly men and individuals still in their productive years. Most burden is related to non-viral causes of cirrhosis, with a major contribution of alcohol.     

MORBIDITY AND MORTALITY DUE TO AIDS: A STUDY OF BURDEN OF DISEASE AT A MUNICIPAL LEVEL

Introduction:

The purpose of measuring the burden of disease involves aggregating morbidity and mortality components into a single indicator, the disability-adjusted life year (DALY), to measure how much and how people live and suffer the impact of a disease.

Objective:

To estimate the global burden of disease due to AIDS in a municipality of southern Brazil.

Methods:

An ecological study was conducted in 2009 to examine the incidence and AIDS-related deaths among the population residing in the city of Tubarao, Santa Catarina State, Brazil. Data from the Mortality Information System in the National Health System was used to calculate the years of life lost (YLL) due to premature mortality. The calculation was based on the difference between a standardized life expectancy and age at death, with a discount rate of 3% per year. Data from the Information System for Notifiable Diseases were used to calculate the years lived with disability (YLD). The DALY was estimated by the sum of YLL and YLD. Indicator rates were estimated per 100,000 inhabitants, distributed by age and gender.

Results:

A total of 131 records were examined, and a 572.5 DALYs were estimated, which generated a rate of 593.1 DALYs/100,000 inhabitants. The rate among men amounted to 780.7 DALYs/100,000, whereas among women the rate was 417.1 DALYs/100,000. The most affected age groups were 30-44 years for men and 60-69 years for women.

Conclusion:

The burden of disease due to AIDS in the city of Tubarao was relatively high when considering the global trend. The mortality component accounted for more than 90% of the burden of disease.     

1990年和2016年北京市心脑血管疾病负担及其变化

目的调查1990年和2016年北京市心脑血管疾病负担及其变化情况。方法利用2016年全球疾病负担研究数据,分析1990年和2016年北京市心脑血管疾病死亡情况和疾病负担。主要指标包括死亡人数、过早死亡损失寿命年(YLL)、伤残损失寿命年(YLD)和伤残调整寿命年(DALY),同时使用2000—2025年世界人口的平均人口作为标准人口,计算标化死亡率、DALY率、YLL率和YLD率。结果2016年,北京市居民心脑血管病标化死亡率为209.24/10万;心脑血管病DALY、YLL和YLD分别为87.56、73.36和14.20万人年,较1990年分别增加了58.05%、44.24%和213.47%;标化DALY率和标化YLL率分别为3552.24/10万和2988.01/10万,较1990年分别下降47.90%和52.43%,标化YLD率为564.23/10万,较1990年增加5.10%。2016年,脑血管疾病和缺血性心脏病的死亡数分别为1.76万例和2.37万例;DALY分别为39.63和39.36万人年,较1990年(DALY分别为33.02和16.27万人年)分别增加20.02%和141.92%。结论北京市心脑血管疾病负担重,其中以脑血管疾病和缺血性心脏病最为显著;脑血管疾病的伤残负担严重,缺血性心脏病的疾病负担成倍增长。     

Determining public health priorities for an ageing population: the value of a disability survey

In order to determine which diseases and health problems were most strongly associated with long-term disability among the Thai elderly and to determine their public health priority, a national cross-sectional multistage random sampling survey was conducted in 1997. Four thousand and forty-eight Thai older persons aged 60 years and over were recruited and interviewed by trained interviewers. Overall, 769 (19%) people reported having a long-term disability. Participants with long-term disability (LD) reported having between one and 21 long-term diseases or health problems. Eighteen of these problems were independently associated with LD in logistic regression analysis. Nearly half of the cases with LD (46.4%) suffered from two or more health problems. The odds of LD increased with the number of problems suffered. The problems contributing most to the population burden of disease as assessed by population attributable risk fractions were hemiparesis, arthritis, accidents (unintentional injuries), blindness and other eye diseases, kyphosis, weakness of limbs, deafness, and hypertension. This ranking of public health priority differs from conventional approaches using mortality statistics and disability adjusted life years (DALYs). In conclusion, national disability surveys provide a valuable means of assessing the population burden of disability and determining the underlying causes of disability. These methods provide a direct assessment of disability prevalence and disease priorities for rapidly ageing transitional countries where death certification may be incomplete or inaccurate.     

Estimating the burden of scleroderma disease in Spain

OBJECTIVE: Scleroderma (systemic sclerosis) is a rare disease that results in great suffering. We estimated the burden of disease posed by scleroderma and its relative importance in the health of the Spanish population. METHODS: We estimated scleroderma-based burden of disease following procedures developed for the Global Burden of Disease study to ensure comparability. RESULTS: Despite its low prevalence, scleroderma generated 1732 disability-adjusted life-years (DALY) in Spain in 2001, comprising 562 (32%) years of life lost and 1170 (68%) years lived with disability. Most scleroderma-related DALY (73%) occurred in the population aged 15-54 years. Estimated DALY accounted for 0.59% of other musculoskeletal disorder-related DALY in the European A subregion (countries with low mortality rate in both adults and children in the World Health Organization classification), a significant value in the overall burden of disease. CONCLUSION: The burden of scleroderma in Spain was high, with disability being the major contributing factor. Burden of disease is an important measure in rare diseases, and may be an important indicator to be considered as a health unit in developed countries.     

Os custos da insuficiência cardíaca em Portugal e a sua evolução previsível com o envelhecimento da população

Introduction and ObjectivesHeart failure (HF) is a growing public health problem. This study estimates the current and future costs of HF in mainland Portugal.MethodsCosts were estimated based on prevalence and from a societal perspective. The annual costs of HF included direct costs (resource consumption) and indirect costs (productivity losses). Estimates were mostly based on data from the Diagnosis‐Related Groups database, real‐world data from primary care, and the opinions of an expert panel. Costs were estimated for 2014 and, taking population aging into account, changes were forecast up to 2036.ResultsDirect costs in 2014 were €299 million (39% for hospitalizations, 24% for medicines, 17% for exams and tests, 16% for consultations, and the rest for other needs, including emergencies and long‐term care). Indirect costs were €106 million (16% for absenteeism and 84% for reduced employment). Between 2014 and 2036, due to demographic dynamics, total costs will increase from €405 to €503 million. Per capita costs are estimated to rise by 34%, which is higher than the increase in total costs (+24%), due to the expected reduction in the resident population.ConclusionsHF currently has a significant economic impact, representing around 2.6% of total public health expenditure, and this is expected to increase in the future. This should be taken into account by health policy makers, alerting them to the need for resource management in order to mitigate the impact of this disease.     

Costs of illness due to hypeercholesterolemia in Portugal.

Cardiovascular diseases are the main cause of death in Portugal, in developed countries and, indeed, worldwide. Hypercholesterolemia is a major risk factor for these diseases, including ischemic heart disease, cerebrovascular disease, and peripheral vascular disease. This paper reports the results of a study of the cost of illness associated with hypercholesterolemia and the costs directly attributable to hypercholesterolemia in Portugal, estimated from data for the year 2000. The results indicate that the cost of the health care provided to deal with illnesses associated with hypercholesterolemia was Euros 735.9 million (direct costs) and the costs of lost production due to disability of patients of working age was Euros 74.82 million (indirect costs). The costs attributable to hypercholesterolemia, those that would be avoided if hypercholesterolemia were completely eliminated, amount to Euros 358.84 million in direct costs and Euros 28.31 million in indirect costs. These results confirm that hypercholesterolemia is a source of major health costs. This means that hypercholesterolemia deserves special attention from those who formulate health policy and should be given priority in implementing such policies.     

Global disease burden of stroke attributable to high fasting plasma glucose in 204 countries and territories from 1990 to 2019: An analysis of the Global Burden of Disease Study

BackgroundHigh fasting plasma glucose (HFPG) is the leading risk factor contributing to the increase of stroke burden in the past three decades. However, the global distribution of stroke burden specifically attributable to HFPG was not studied in depth. Therefore, we analyzed the HFPG‐attributable burden in stroke and its subtypes in 204 countries and territories from 1990 to 2019.MethodsDetailed data on stroke burden attributable to HFPG were obtained from the Global Burden of Disease Study 2019. The numbers and age‐standardized rates of stroke disability‐adjusted life years (DALYs), deaths, years lived with disability, and years of life lost between 1990 and 2019 were estimated by age, sex, and region.ResultsIn 2019, the age‐standardized rate of DALYs (ASDR) of HFPG‐attributable stroke was 354.95 per 100 000 population, among which 49.0% was from ischemic stroke, 44.3% from intracerebral hemorrhage, and 6.6% from subarachnoid hemorrhage. The ASDRs of HFPG‐attributable stroke in lower sociodemographic index (SDI) regions surpassed those in higher SDI regions in the past three decades. Generally, the population aged over 50 years old accounted for 92% of stroke DALYs attributable to HFPG, and males are more susceptible to HFPG‐attributable stroke than females across their lifetime.ConclusionsSuccessful key population initiatives targeting HFPG may mitigate the stroke disease burden. Given the soaring population‐attributable fractions of HFPG for stroke burden worldwide, each country should assess its disease burden and determine targeted prevention and control strategies.     

Cardiovascular disease burden attributable to dietary risk factors from 1990 to 2019: A systematic analysis of the Global Burden of Disease study

Background and aimsDietary risks have always been a major risk factor for cardiovascular diseases (CVDs), especially in young people. This article aimed to provide an updated and comprehensive view of the spatial, temporal and sexual heterogeneity in diet-attributable CVD burdens from 1990 to 2019.Methods and resultsData on diet-attributable CVD burdens were extracted from the Global Burden of Disease (GBD) Study 2019. Numbers and age-standardized rates (ASRs) of deaths, disability-adjusted life years (DALYs) and corresponding estimated annual percentage change (EAPC) were determined. Globally, the number of diet-attributable CVD deaths and DALYs in 2019 were 6.9 million and 153.2 million, marking 43.8% and 34.3% increases since 1990, respectively. However, ASRs of death and DALYs have declined over time. The regions with the highest ASRs of diet-related CVD deaths and DALYs were in Central Asia, whereas the lowest ASRs of CVD deaths and DALYs were observed in the high-income Asia Pacific region. Globally, men suffered higher death and DALY burdens than women. Ischemic heart disease and stroke were the leading causes of CVD deaths and DALYs, globally. Regarding the specific diet group, diets low in whole grains, high in sodium, low in fruits, low in nuts and seeds, low in vegetables and low in seafood omega-3 fatty acids contributed to CVD deaths and DALYs the most. Dietary risks accounted for a higher proportion in people aged less than 65 years old.ConclusionsDiet-attributable CVDs threaten public health, particularly in low SDI countries and younger generations. As diet-related CVDs are nation-specific, the prioritization of public health interventions should be evidence-based.