Search

Summary Background Non-communicable diseases (NCDs) cause a large burden of disease globally. Some infectious diseases cause an increased risk of developing specific NCDs. Although the NCD burden from some infectious causes has been quantified, in this study, we aimed to more comprehensively quantify the global burden of NCDs from infectious causes. Methods In this modelling study, we identified NCDs with established infectious risk factors and infectious diseases with long-term non-communicable sequelae, and did narrative reviews between April 11, 2018, and June 10, 2020, to obtain relative risks (RRs) or population attributable fractions (PAFs) from studies quantifying the contribution of infectious causes to NCDs. To determine infection-attributable burden for the year 2017, we applied estimates of PAFs to estimates of disease burden from the Global Burden of Disease Study (GBD) 2017 for pairs of infectious causes and NCDs, or used estimates of attributable burden directly from GBD 2017. Morbidity and mortality burden from these conditions was summarised with age-standardised rates of disability-adjusted life-years (DALYs), for geographical regions as defined by the GBD. Estimates of NCD burden attributable to infectious causes were compared with attributable burden for the groups of risk factors with the highest PAFs from GBD 2017. Findings Globally, we quantified 130 million DALYs from NCDs attributable to infection, comprising 8·4% of all NCD DALYs. The infection–NCD pairs with the largest burden were gastric cancer due to H pylori (14·6 million DALYs), cirrhosis and other chronic liver diseases due to hepatitis B virus (12·2 million) and hepatitis C virus (10·4 million), liver cancer due to hepatitis B virus (9·4 million), rheumatic heart disease due to streptococcal infection (9·4 million), and cervical cancer due to HPV (8·0 million). Age-standardised rates of infection-attributable NCD burden were highest in Oceania (3564 DALYs per 100 000 of the population) and central sub-Saharan Africa (2988 DALYs per 100 000) followed by the other sub-Saharan African regions, and lowest in Australia and New Zealand (803 DALYs per 100 000) followed by other high-income regions. In sub-Saharan Africa, the proportion of crude NCD burden attributable to infectious causes was 11·7%, which was higher than the proportion of burden attributable to each of several common risk factors of NCDs (tobacco, alcohol use, high systolic blood pressure, dietary risks, high fasting plasma glucose, air pollution, and high LDL cholesterol). In other broad regions, infectious causes ranked between fifth and eighth in terms of crude attributable proportions among the nine risks compared. The age-standardised attributable proportion for infectious risks remained highest in sub-Saharan Africa of the broad regions, but age-standardisation caused infectious risks to fall below dietary risks, high systolic blood pressure, and fasting plasma glucose in ranked attributable proportions within the region. Interpretation Infectious conditions cause substantial NCD burden with clear regional variation, and estimates of this burden are likely to increase as evidence that can be used for quantification expands. To comprehensively avert NCD burden, particularly in low-income and middle-income countries, the availability, coverage, and quality of cost-effective interventions for key infectious conditions need to be strengthened. Efforts to promote universal health coverage must address infectious risks leading to NCDs, particularly in populations with high rates of these infectious conditions, to reduce existing regional disparities in rates of NCD burden. Funding Leona M and Harry B Helmsley Charitable Trust.

Emergence of new disease remains a critical parameter in human health and society. Advances in artificial intelligence (AI) allow for rapid processing and analysis of massive and complex data. In this forum article, the recent applications across disease prediction and drug development in relation to the COVID-19 pandemic are reviewed.

Background In the Global Burden of Disease Study 2013 (GBD 2013), knowledge about health and its determinants has been integrated into a comparable framework to inform health policy. Outputs of this analysis are relevant to current policy questions in England and elsewhere, particularly on health inequalities. We use GBD 2013 data on mortality and causes of death, and disease and injury incidence and prevalence to analyse the burden of disease and injury in England as a whole, in English regions, and within each English region by deprivation quintile. We also assess disease and injury burden in England attributable to potentially preventable risk factors. England and the English regions are compared with the remaining constituent countries of the UK and with comparable countries in the European Union (EU) and beyond. Methods We extracted data from the GBD 2013 to compare mortality, causes of death, years of life lost (YLLs), years lived with a disability (YLDs), and disability-adjusted life-years (DALYs) in England, the UK, and 18 other countries (the first 15 EU members [apart from the UK] and Australia, Canada, Norway, and the USA [EU15+]). We extended elements of the analysis to English regions, and subregional areas defined by deprivation quintile (deprivation areas). We used data split by the nine English regions (corresponding to the European boundaries of the Nomenclature for Territorial Statistics level 1 [NUTS 1] regions), and by quintile groups within each English region according to deprivation, thereby making 45 regional deprivation areas. Deprivation quintiles were defined by area of residence ranked at national level by Index of Multiple Deprivation score, 2010. Burden due to various risk factors is described for England using new GBD methodology to estimate independent and overlapping attributable risk for five tiers of behavioural, metabolic, and environmental risk factors. We present results for 306 causes and 2337 sequelae, and 79 risks or risk clusters. Findings Between 1990 and 2013, life expectancy from birth in England increased by 5·4 years (95% uncertainty interval 5·0-5·8) from 75·9 years (75·9-76·0) to 81·3 years (80·9-81·7); gains were greater for men than for women. Rates of age-standardised YLLs reduced by 41·1% (38·3-43·6), whereas DALYs were reduced by 23·8% (20·9-27·1), and YLDs by 1·4% (0·1-2·8). For these measures, England ranked better than the UK and the EU15+ means. Between 1990 and 2013, the range in life expectancy among 45 regional deprivation areas remained 8·2 years for men and decreased from 7·2 years in 1990 to 6·9 years in 2013 for women. In 2013, the leading cause of YLLs was ischaemic heart disease, and the leading cause of DALYs was low back and neck pain. Known risk factors accounted for 39·6% (37·7-41·7) of DALYs; leading behavioural risk factors were suboptimal diet (10·8% [9·1-12·7]) and tobacco (10·7% [9·4-12·0]). Interpretation Health in England is improving although substantial opportunities exist for further reductions in the burden of preventable disease. The gap in mortality rates between men and women has reduced, but marked health inequalities between the least deprived and most deprived areas remain. Declines in mortality have not been matched by similar declines in morbidity, resulting in people living longer with diseases. Health policies must therefore address the causes of ill health as well as those of premature mortality. Systematic action locally and nationally is needed to reduce risk exposures, support healthy behaviours, alleviate the severity of chronic disabling disorders, and mitigate the effects of socioeconomic deprivation. Funding Bill & Melinda Gates Foundation and Public Health England. © 2015 Newton et al. Open Access article distributed under the terms of CC BY. Export Date: 21 December 2015 CODEN: LANCA Correspondence Address: Newton, J.N.; Public Health England, Wellington HouseUnited Kingdom; email: john.newton@phe.gov.uk References: Murray C.J.L., Richards M.A., Newton J.N., UK health performance: Findings of the Global Burden of Disease Study 2010 (2013) Lancet, 381, pp. 997-1020; Greer S.L., Devolution and divergence in UK health policies (2008) BMJ, 337, p. a2616; England N.H.S., (2014) Five Year Forward View, , http://www.england.nhs.uk/ourwork/futurenhs/, (accessed Aug 24, 2015); Naghavi M., Wang H., Lozano R., Global, regional and national levels of age-specific mortality and 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013 (2015) Lancet, 385, pp. 117-171; Global, regional, and national incidence, prevalence, and years lived with disabilities for 301 acute and chronic diseases and injuries for 188 countries, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013 (2015) Lancet, 386, pp. 743-800; Global, regional, and national comparative risk assessment of 76 behavioural, environmental, 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) Lancet, , http://dx.doi.org/10.1016/S0140-6736(15)00128-2, published online Sept 11; Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: Quantifying the epidemiological transition (2015) Lancet, , http://dx.doi.org/10.1016/S0140-6736(15)61340-X, published online Aug 27; Vos T., Flaxman A.D., Naghavi M., Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010 (2012) Lancet, 380, pp. 2163-2196; Murray C.J.L., Ezzati M., Flaxman A.D., GBD 2010: Design, definitions, and metrics (2012) Lancet, 380, pp. 2063-2066; Statistical Bulletin. Super Output Area Population Estimates, mid-2011 (Census Based), , http://www.ons.gov.uk/ons/dcp171778_302853.pdf, (accessed Aug 24, 2015); McLennan D., Barnes H., Noble M., Davies J., Garratt E., (2011) The English Indices of Deprivation 2010. Technical Report, , https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/6320/1870718.pdf, Department for Communities and Local Government London (accessed Aug 24, 2015); Adams J., White M., Removing the health domain from the Index of Multiple Deprivation 2004 - Effect on measured inequalities in census measure of health (2006) J Public Health (Oxf), 28, pp. 379-383; Wang H., Dwyer-Lindgren L., Lofgren K.T., Age-specific and sex-specific mortality in 187 countries, 1970-2010: A systematic analysis for the Global Burden of Disease Study 2010 (2012) Lancet, 380, pp. 2071-2094; Murray C.J.L., Rajaratnam J.K., Marcus J., Laakso T., Lopez A.D., What can we conclude from death registration? Improved methods for evaluating completeness (2010) PLoS Med, 7, p. e1000262; Naghavi M., Makela S., Foreman K., O'Brien J., Pourmalek F., Lozano R., Algorithms for enhancing public health utility of national causes-of-death data (2010) Popul Health Metr, 8, p. 9; Lozano R., Naghavi M., Foreman K., Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the Global Burden of Disease Study 2010 (2012) Lancet, 380, pp. 2095-2128; Ahern R.M., Lozano R., Naghavi M., Foreman K., Gakidou E., Murray C.J., Improving the public health utility of global cardiovascular mortality data: The rise of ischemic heart disease (2011) Popul Health Metr, 9, p. 8; Foreman K.J., Lozano R., Lopez A.D., Murray C.J., Modeling causes of death: An integrated approach using CODEm (2012) Popul Health Metr, 10, p. 1; (2014) Statistical Bulletin. Suicides in the United Kingdom, 2012 Registrations, , http://www.ons.gov.uk/ons/dcp171778_351100.pdf, (accessed Aug 24, 2015); (2014) Health Survey for England - 2013, , http://www.hscic.gov.uk/catalogue/PUB16076, (accessed Feb 26, 2015); Matthews F.E., Arthur A., Barnes L.E., A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: Results of the Cognitive Function and Ageing Study i and II (2013) Lancet, 382, pp. 1405-1412; Salomon J.A., Haagsma J.A., Acj D., Disability weights for the Global Burden of Disease 2013 Study Lancet Glob Health, , (in press); Haagsma J.A., De Noordhout C.M., Polinder S., Assessing disability weights based on the responses of 30 660 people from four European countries (2015) Popul Health Metr, 13, p. 10; Preston S., Heuveline P., Guillot M., (2000) Demography: Measuring and Modeling Population Processes, , 1st edn. Wiley-Blackwell Malden, MA; Beltrán-Sánchez H., Preston S.H., Canudas-Romo V., An integrated approach to cause-of-death analysis: Cause-deleted life tables and decompositions of life expectancy (2008) Demogr Res, 19, pp. 1323-1350; Salomon J.A., Wang H., Freeman M.K., Healthy life expectancy for 187 countries, 1990-2010: A systematic analysis for the Global Burden Disease Study 2010 (2012) Lancet, 380, pp. 2144-2162; Murray C.J.L., Vos T., Lozano R., Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: A systematic analysis for the Global Burden of Disease Study 2010 (2012) Lancet, 380, pp. 2197-2223; Gelman A., Analysis of variance - Why it is more important than ever (2005) Ann Stat, 33, pp. 1-53; (2010) Deaths from Alzheimer's Disease, Dementia and Senility in England, , http://www.endoflifecare-intelligence.org.uk/resources/publications/deaths_from_alzheimers, (accessed Aug 24, 2015); (2012) Mortality in the United Kingdom, 2010, , http://www.ons.gov.uk/ons/dcp171780_251270.pdf, (accessed Aug 24, 2015); (2014) Statistical Bulletin. National Life Tables, United Kingdom, 2011-2013, , http://www.ons.gov.uk/ons/rel/lifetables/national-life-tables/2011-2013/stb-uk-2011-2013.html, (accessed Aug 24, 2015); Green M., (2013) Death in England and Wales: Using A Classificatory Approach for Researching Mortality. PhD Thesis, , University of Sheffield; Green M.A., Vickers D., Dorling D., A neighbourhood level mortality classification of England and Wales, 2006-2009 (2014) Health Place, 30, pp. 196-204; Rasulo D., Bajekal M., Yar M., Inequalities in health expectancies in England and Wales - Small area analysis from the 2001 census (2007) Health Stat Q, 34, pp. 35-45; Statistical Bulletin. Experimental Statistics. Inequality in Disability-free Life Expectancy by Area Deprivation: England, 2003-06 and 2007-10, , http://www.ons.gov.uk/ons/dcp171778_319481.pdf, (accessed Aug 24, 2015); Bennett J.E., Li G., Foreman K., The future of life expectancy and life expectancy inequalities in England and Wales: Bayesian spatiotemporal forecasting (2015) Lancet, 386, pp. 163-170; Rienzo C., (2012) Migrants in the UK Labour Market: An Overview, , http://storage0.dms.mpinteractiv.ro/media/1/186/3927/10538667/2/briefing-migrants-the-uk-labour-market-0.pdf, (accessed Aug 24, 2015); Bongaart J., Trends in causes of death in low-mortality countries: Implications for mortality projections (2014) Popul Dev Rev, 40, pp. 189-212; Williams R., Aspinall R., Bellis M., Addressing liver disease in the UK: A blueprint for attaining excellence in health care and reducing premature mortality from lifestyle issues of excess consumption of alcohol, obesity, and viral hepatitis (2014) Lancet, 384, pp. 1953-1997; Prince M., Bryce R., Albanese E., Wimo A., Ribeiro W., Ferri C.P., The global prevalence of dementia: A systematic review and metaanalysis (2013) Alzheimers Dement, 9, pp. 63-75; Holland D., Desikan R.S., Dale A.M., McEvoy L.K., Rates of decline in Alzheimer disease decrease with age (2012) PLoS One, 7, p. e42325; Rocca W.A., Petersen R.C., Knopman D.S., Trends in the incidence and prevalence of Alzheimer's disease, dementia, and cognitive impairment in the United States (2011) Alzheimers Dement, 7, pp. 80-93; Hoy D.G., Smith E., Cross M., Reflecting on the global burden of musculoskeletal conditions: Lessons learnt from the Global Burden of Disease 2010 Study and the next steps forward (2014) Ann Rheum Dis, 74, pp. 4-7; Kessler D., Bennewith O., Lewis G., Sharp D., Detection of depression and anxiety in primary care: Follow up study (2002) BMJ, 325, pp. 1016-1017; Davidson J.R., Feltner D.E., Dugar A., Management of generalized anxiety disorder in primary care: Identifying the challenges and unmet needs (2010) Prim Care Companion J Clin Psychiatry, 12. , pii PCC.09r00772; Buszewicz M.J., Chew-Graham C., Improving the detection and management of anxiety disorders in primary care (2011) Br J Gen Pract, 61, pp. 489-490; Van Zoonen K., Buntrock C., Ebert D.D., Preventing the onset of major depressive disorder: A meta-analytic review of psychological interventions (2014) Int J Epidemiol, 43, pp. 318-329; (2014) Report 1. Care Processes and Treatment Targets, , http://www.hscic.gov.uk/catalogue/PUB14970, (accessed Aug 28, 2015); Bajekal M., Scholes S., Love H., Analysing recent socioeconomic trends in coronary heart disease mortality in England, 2000-2007: A population modelling study (2012) PLoS Med, 9, p. e1001237; He F.J., Brinsden H.C., MacGregor G.A., Salt reduction in the United Kingdom: A successful experiment in public health (2014) J Hum Hypertens, 28, pp. 345-352; Fleming K.M., Aithal G.P., Solaymani-Dodaran M., Card T.R., West J., Incidence and prevalence of cirrhosis in the United Kingdom, 1992-2001: A general population-based study (2008) J Hepatol, 49, pp. 732-738; Ratib S., West J., Crooks C.J., Fleming K.M., Diagnosis of liver cirrhosis in England, a cohort study, 1998-2009: A comparison with cancer (2014) Am J Gastroenterol, 109, pp. 190-198; Taylor-Robinson S.D., Foster G.R., Arora S., Hargreaves S., Thomas H.C., Increase in primary liver cancer in the UK, 1979-94 (1997) Lancet, 350, pp. 1142-1143; Bosch F.X., Ribes J., Díaz M., Cléries R., Primary liver cancer: Worldwide incidence and trends (2004) Gastroenterology, 127, pp. S5-16; Leon D.A., McCambridge J., Liver cirrhosis mortality rates in Britain from 1950 to 2002: An analysis of routine data (2006) Lancet, 367, pp. 52-56; Link B.G., Phelan J., Social conditions as fundamental causes of disease (1995) J Heal Soc Behav, pp. 80-94; Ritchie K., Carrière I., Ritchie C.W., Berr C., Artero S., Ancelin M.-L., Designing prevention programmes to reduce incidence of dementia: Prospective cohort study of modifiable risk factors (2010) BMJ, 341, p. c3885; Lee Y., Back J.H., Kim J., Systematic review of health behavioral risks and cognitive health in older adults (2010) Int Psychogeriatr, 22, pp. 174-187; Engelhart M.J., Geerlings M.I., Ruitenberg A., Dietary intake of antioxidants and risk of Alzheimer disease (2002) JAMA, 287, pp. 3223-3229; Haan M.N., Wallace R., Can dementia be prevented? Brain aging in a population-based context (2004) Annu Rev Public Health, 25, pp. 1-24; Dai Q., Borenstein A.R., Wu Y., Jackson J.C., Larson E.B., Fruit and vegetable juices and Alzheimer's disease: The Kame Project (2006) Am J Med, 119, pp. 751-759; Smith A.D., Yaffe K., Dementia (including Alzheimer's disease) can be prevented: Statement supported by international experts (2014) J Alzheimers Dis, 38, pp. 699-703; (2015) Suicides in the United Kingdom, 2013 Registrations, , http://www.ons.gov.uk/ons/dcp171778_395145.pdf, (accessed Aug 24, 2015); Butterfield R., Henderson J., Scott R., (2009) Public Health and Prevention, Expenditure in England. Health England Report No. 4, , Department of Health London