Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: Contributions from risk factor changes and treatments

Publication date: 1 April 2016Source:International Journal of Cardiology, Volume 208 Author(s): Julia Critchley, Simon Capewell, Martin O’Flaherty, Niveen Abu-Rmeileh, Samer Rastam, Olfa Saidi, Kaan Sözmen, Azza Shoaibi, Abdullatif Husseini, Fouad Fouad, Nadia Ben Mansour, Wafa Aissi, Habiba Ben Romdhane, Belgin Unal, Piotr Bandosz, Kathleen Bennett, Mukesh Dherani, Radwan Al Ali, Wasim Maziak, Hale Arık, Gül Gerçeklioğlu, Deniz Utku Altun, Hatice Şimşek, Sinem Doganay, Yücel Demiral, Özgür Aslan, Nigel Unwin, Peter Phillimore, Nourredine Achour, Waffa Aissi, Riadh Allani, Chokra Arfa, Heidar Abu-Kteish, Niveen Abu-Rmeileh, Radwan Al Ali, Deniz Altun, Balsam Ahmad, Hale Arık, Özgür Aslan, Latifa Beltaifa, Nadia Ben Mansour, Kathleen Bennett, Habiba Ben Romdhane, Nabil Ben Salah, Marissa Collins, Julia Critchley, Simon Capewell, Mukesh Dherani, Yücel Demiral, Sinem Doganay, Madonna Elias, Gül Ergör, Ibtihal Fadhil, Fouad Fouad, Gül Gerçeklioğlu, Rula Ghandour, Sibel Göğen, Abdullatif Husseini, Samer Jaber, Sibel Kalaca, Rana Khatib, Rasha Khatib, Saer Koudsie, Bülent Kilic, Olfa Lassoued, Helen Mason, Wasim Maziak, Maher Abou Mayaleh, Nahed Mikki, Ghmaez Moukeh, Martin O. Flaherty, Peter Phillimore, Samer Rastam, Gojka Roglic, Olfa Saidi, Gül Saatli, Ilhan Satman, Azza Shoaibi, Hatice Şimşek, Nesrien Soulaiman, Kaan Sözmen, Faten Tlili, Belgin Unal, Nigel Unwin, Nazan Yardim, Shahaduz ZamanBackgroundMiddle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey.MethodsData on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995–97; 2006–09); integrated and analysed using the IMPACT model.ResultsRisk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1–2kg/m2 and diabetes prevalence increased by 40%–50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria.Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake.CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder.DiscussionCHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically.

Contrasting cardiovascular mortality trends in Eastern Mediterranean populations: Contributions from risk factor changes and treatments

Publication date: Available online 7 January 2016Source:International Journal of Cardiology Author(s): Julia Critchley, Simon Capewell, Martin O. Flaherty, Niveen Abu-Rmeileh, Samer Rastam, Olfa Saidi, Kaan Sözmen, Azza Shoaibi, Abdullatif Husseini, Fouad Fouad, Nadia Ben Mansour, Wafa Aissi, Habiba Ben Romdhane, Belgin Unal, Piotr Bandosz, Kathleen Bennett, Mukesh Dherani, Radwan Al Ali, Wasim Maziak, Hale Arık, Gül Gerçeklioğlu, Deniz Utku Altun, Hatice Şimşek, Sinem Doganay, Yücel Demiral, Özgür Aslan, Nigel Unwin, Peter Phillimore, Nourredine Achour, Waffa Aissi, Riadh Allani, Chokra Arfa, Heidar Abu-Kteish, Niveen Abu-Rmeileh, Radwan Al Ali, Deniz Altun, Balsam Ahmad, Hale Arık, Özgür Aslan, Latifa Beltaifa, Nadia Ben Mansour, Kathleen Bennett, Habiba Ben Romdhane, Nabil Ben Salah, Marissa Collins, Julia Critchley, Simon Capewell, Mukesh Dherani, Yücel Demiral, Sinem Doganay, Madonna Elias, Gül Ergör, Ibtihal Fadhil, Fouad Fouad, Gül Gerçeklioğlu, Rula Ghandour, Sibel Göğen, Abdullatif Husseini, Samer Jaber, Sibel Kalaca, Rana Khatib, Rasha Khatib, Saer Koudsie, Bülent Kilic, Olfa Lassoued, Helen Mason, Wasim Maziak, Maher Abou Mayaleh, Nahed Mikki, Ghmaez Moukeh, Martin O. Flaherty, Peter Phillimore, Samer Rastam, Gojka Roglic, Olfa Saidi, Gül Saatli, Ilhan Satman, Azza Shoaibi, Hatice Şimşek, Nesrien Soulaiman, Kaan Sözmen, Faten Tlili, Belgin Unal, Nigel Unwin, Nazan Yardim, Shahaduz ZamanBackgroundMiddle income countries are facing an epidemic of non-communicable diseases, especially coronary heart disease (CHD). We used a validated CHD mortality model (IMPACT) to explain recent trends in Tunisia, Syria, the occupied Palestinian territory (oPt) and Turkey.MethodsData on populations, mortality, patient numbers, treatments and risk factor trends from national and local surveys in each country were collated over two time points (1995–97; 2006–09); integrated and analysed using the IMPACT model.ResultsRisk factor trends: Smoking prevalence was high in men, persisting in Syria but decreasing in Tunisia, oPt and Turkey. BMI rose by 1–2kg/m2 and diabetes prevalence increased by 40%–50%. Mean systolic blood pressure and cholesterol levels increased in Tunisia and Syria.Mortality trends: Age-standardised CHD mortality rates rose by 20% in Tunisia and 62% in Syria. Much of this increase (79% and 72% respectively) was attributed to adverse trends in major risk factors, occurring despite some improvements in treatment uptake.CHD mortality rates fell by 17% in oPt and by 25% in Turkey, with risk factor changes accounting for around 46% and 30% of this reduction respectively. Increased uptake of community treatments (drug treatments for chronic angina, heart failure, hypertension and secondary prevention after a cardiac event) accounted for most of the remainder.DiscussionCHD death rates are rising in Tunisia and Syria, whilst oPt and Turkey demonstrate clear falls, reflecting improvements in major risk factors with contributions from medical treatments. However, smoking prevalence remains very high in men; obesity and diabetes levels are rising dramatically.

Paediatric pain-related conditions impact healthcare expenditures

Commentary on: Groenewald CB, Wright DR, Palermo TM. Health care expenditures associated with pediatric pain-related conditions in the USA. Pain 2015;156:951–7 . ContextPain-related conditions affect an estimated 15–25% of children. These conditions are twice as prevalent as asthma and attention deficit and hyperactivity disorder (ADHD), with a similar prevalence to obesity. Unlike the three other conditions which are known to impose a heavy economic burden on families and society, little is known about the economic impact of paediatric pain-related conditions. The objectives of this study, therefore, are twofold: (1) to assess the impact of paediatric pain-related conditions on national healthcare expenditures and (2) to compare incremental healthcare expenditures associated with paediatric pain-related conditions relative to asthma, ADHD and obesity in children. MethodsThis cross-sectional study linked two large, nationally representative databases: the 2007 National Health Interview Survey (NHIS) and 2008 Medical Expenditure Panel Survey (MEPS)….