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Abstract Background The prevalence of low-, moderate-, and high-risk obesity has been increasing globally. Our aim was to estimate the societal burden of these three obesity classes in the Austrian population by taking a societal–annual perspective and an individual–life-cycle perspective. Secondly, we sought to identify the respective cost drivers and the effects on life expectancy. Methods We used population-weighted survey data on the distribution of body mass index (BMI) and data on relative risks regarding 83 diseases. Using fractional polynomial regressions, we estimated relative risks per BMI unit for about 30 cost-intensive diseases up to BMI values of 50. The approach for the cost analysis was based on the use of population-attributable fractions applied to direct medical and indirect cost data. Macro-disease-specific data regarding cost factors came from cost-of-illness statistics and administrative sources. Results About 8.2% of deaths and 4.6% of health expenditure are attributable to obesity in Austria in 2019, causing 0.61% of GDP loss. A third of annual direct and indirect costs came from class 2 and class 3 obesity. From an individual perspective, life-cycle costs of class 2 and class 3 obesity were 1.9 and 3.6 times the costs of class 1 obesity, respectively. At the age of 45, people with high-risk obesity are about to lose approximately 4.9 life years and 9.7 quality-adjusted life years. Conclusions We have extended the method of population-attributable fractions, allowing us to estimate differences in the life-cycle direct medical and indirect costs between low-, moderate-, and high-risk obesity. We found that the lifetime costs of obesity are strikingly different between obesity classes, which has been veiled in the societal—annual perspective. Our findings provide a foundation for evaluating public health interventions aimed at combating obesity in order to mitigate the escalating individual and societal burden resulting from obesity prevalence and complications in the future.

Background: The prevalence of low-, moderate-, and high-risk obesity has been increasing globally. Our aim was to estimate the societal burden of these three obesity classes in the Austrian population by taking a societal–annual perspective and an individual–life-cycle perspective. Secondly, we sought to identify the respective cost drivers and the effects on life expectancy. Methods: We used population-weighted survey data on the distribution of body mass index (BMI) and data on relative risks regarding 83 diseases. Using fractional polynomial regressions, we estimated relative risks per BMI unit for about 30 cost-intensive diseases up to BMI values of 50. The approach for the cost analysis was based on the use of population-attributable fractions applied to direct medical and indirect cost data. Macro-disease-specific data regarding cost factors came from cost-of-illness statistics and administrative sources. Results: About 8.2% of deaths and 4.6% of health expenditure are attributable to obesity in Austria in 2019, causing 0.61% of GDP loss. A third of annual direct and indirect costs came from class 2 and class 3 obesity. From an individual perspective, life-cycle costs of class 2 and class 3 obesity were 1.9 and 3.6 times the costs of class 1 obesity, respectively. At the age of 45, people with high-risk obesity are about to lose approximately 4.9 life years and 9.7 quality-adjusted life years. Conclusions: We have extended the method of population-attributable fractions, allowing us to estimate differences in the life-cycle direct medical and indirect costs between low-, moderate-, and high-risk obesity. We found that the lifetime costs of obesity are strikingly different between obesity classes, which has been veiled in the societal—annual perspective. Our findings provide a foundation for evaluating public health interventions aimed at combating obesity in order to mitigate the escalating individual and societal burden resulting from obesity prevalence and complications in the future. [ABSTRACT FROM AUTHOR]

Introduction: Twelve modifiable risk factors (RFs) account for 40% of dementia cases worldwide. However, limited data exist on such factors in middle- and low-income countries. We aimed to estimate the population-attributable fractions (PAFs) for the 12 RFs in Argentina, assessing changes over a decade and exploring socioeconomic and sex influences. Methods: We conducted cross-sectional analyses of the 12 RFs from Argentinian surveys conducted in 2009, 2015, and 2018, including 96,321 people. We calculated PAFs and stratified estimates based on sex and income. Results: We estimated an overall PAF of 59.6% (95% CI = 58.9–60.3%). The largest PAFs were hypertension = 9.3% (8.7–9.9%), physical inactivity = 7.4% (6.8–8.2%), and obesity = 7.4% (6.8–7.9%). Men were more impacted by excessive alcohol, while women by isolation and smoking. Lower income linked to higher PAFs in education, hypertension, and obesity. Discussion: Argentina has a higher PAF for dementia than the world population, with distinct RF distribution. PAF varied by sex and economic status, advocating tailored prevention strategies. [ABSTRACT FROM AUTHOR]

Background The persistence of tuberculosis today and its global disparity send a powerful message that effective tuberculosis control must respond to its regional epidemiology. Active case finding through contact investigation is a standard protocol used for tuberculosis control, but its effectiveness has not been established, especially in endemic areas. Methods To quantify the potential effectiveness of contact investigation in Kampala, Uganda, we used a cross-sectional design to evaluate the social networks of 123 tuberculosis index cases and 124 controls without tuberculosis. Results Tuberculous infection was present in 515 of 989 tuberculosis case contacts (52.1%) and 396 of 1026 control contacts (38.6%; adjusted prevalence ratio, 1.4; 95% CI, 1.3–1.6). The proportion of infected participants with known exposure within the social network of the tuberculosis case was 35%. The population-attributable fraction was 11.1% for any known exposure, with 7.3% attributable to household exposure and 3.4% attributable to extrahousehold exposure. Conclusions This low population-attributable fraction indicates that contact tracing in the social networks of index cases will have only a modest effect in reducing tuberculous infection in a community. New approaches to community-level active case finding are needed. [ABSTRACT FROM AUTHOR]

The population‐attributable fraction (PAF) is commonly interpreted as the proportion of events that can be ascribed to a certain exposure in a certain population. Its estimation is sensitive to common forms of time‐dependent bias in the face of a time‐dependent exposure. Predominant estimation approaches based on multistate modeling fail to fully eliminate such bias and, as a result, do not permit a causal interpretation, even in the absence of confounding. While recently proposed multistate modeling approaches can successfully eliminate residual time‐dependent bias, and moreover succeed to adjust for time‐dependent confounding by means of inverse probability of censoring weighting, inadequate application, and misinterpretation prevails in the medical literature. In this paper, we therefore revisit recent work on previously proposed PAF estimands and estimators in settings with time‐dependent exposures and competing events and extend this work in several ways. First, we critically revisit the interpretation and applied terminology of these estimands. Second, we further formalize the assumptions under which a causally interpretable PAF estimand can be identified and provide analogous weighting‐based representations of the identifying functionals of other proposed estimands. This representation aims to enhance the applied statistician's understanding of different sources of bias that may arise when the aim is to obtain a valid estimate of a causally interpretable PAF. To illustrate and compare these representations, we present a real‐life application to observational data from the Ghent University Hospital ICUs to estimate the fraction of ICU deaths attributable to hospital‐acquired infections. [ABSTRACT FROM AUTHOR]

Background: Despite the huge burden of hip osteoarthritis (OA) and the lack of effective treatment, research into the primary prevention of hip OA is in its infancy. Purpose: We sought to evaluate risk factors for incident clinical and incident radiographic hip OA among middle-aged and older adults, to evaluate the importance of risk factors from a preventive perspective, and to estimate the percentage of new cases attributable to these risk factors. Methods: We retrospectively reviewed data from the Rotterdam study, an open-population cohort study of individuals aged 55 years or older. Data including baseline age, sex, body mass index, smoking status, education level, diagnosis of diabetes, C-reactive protein (CRP), cam morphology, acetabular dysplasia, radiographic thumb OA, radiographic hip OA, and hip pain were assessed for their association with incident clinical hip OA and incident radiographic hip OA separately, after 11 years of follow-up. The population-attributable fractions (PAFs) of statistically significant modifiable risk factors were calculated, as well. Results: New onset of clinical hip OA was seen in 19.9% (544 of 2729) and incident radiographic hip OA in 9.9% (329 of 3309). Female sex, education level below average (PAF 21.4%), and radiographic hip OA (PAF 3.4%) were statistically significantly associated with incident clinical hip OA. Female sex, age, overweight (PAF 20.0%), cam morphology (PAF 7.9%), acetabular dysplasia (PAF 3.6%), and radiographic thumb OA (PAF 4.7%) were statistically significantly associated with radiographic hip OA. Conclusions: Our retrospective analysis suggests that, from a primary prevention perspective, the most important modifiable risk factors among middle-aged and older individuals may be low educational level for incident clinical hip OA and overweight for incident radiographic hip OA. Further study is warranted. [ABSTRACT FROM AUTHOR]

Background: This 3.6-year prospective study examined combined impacts of physical activity, dietary variety, and social interaction on incident disability and estimated population-attributable fraction for disability reduction in older adults. Methods: Participants were 7,822 initially non-disabled residents (3,966 men and 3,856 women) aged 65–84 years of Ota City, Tokyo, Japan. Sufficiency of moderate-to-vigorous-intensity physical activity (MVPA) ≥150 min/week, dietary variety score (DVS) ≥3 (median), and social interaction (face-to-face and/or non-face-to-face) ≥1 time/week was assessed using self-administered questionnaires. Disability incidence was prospectively identified using the long-term care insurance system’s nationally unified database. Results: During a follow-up of 3.6 years, 1,046 (13.4%) individuals had disabilities. Independent multivariate-hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA, DVS, and social interaction sufficiency for incident disability were 0.68 (95% CI, 0.59–0.78), 0.87 (95% CI, 0.77–0.99), and 0.90 (95% CI, 0.79–1.03), respectively. Incident disability HRs gradually reduced with increased frequency of satisfying these behaviors (any one: HR 0.82; 95% CI, 0.65–1.03; any two: HR 0.65; 95% CI, 0.52–0.82; and all three behaviors: HR 0.54; 95% CI, 0.43–0.69), in an inverse dose-response manner (P < 0.001 for trend). Population-attributable fraction for disability reduction in satisfying any one, any two, and all three behaviors were 4.0% (95% CI, −0.2 to 7.9%), 9.6% (95% CI, 4.8–14.1%), and 16.0% (95% CI, 8.7–22.8%), respectively. Conclusion: Combining physical activity, dietary variety, and social interaction substantially enhances the impacts on preventing disability among older adults, with evidence of an inverse dose-response manner. Improving insufficient behavior elements through individual habits and preexisting social group activities may be effective in preventing disability in the community.

Identifying modifiable risk factors that contribute to cancer is essential in setting up preventive strategies. Therefore, this study aimed to estimate the number and proportion of cancer cases and deaths attributable to five behavior‐related risk factors—tobacco smoking, second‐hand smoking, alcohol consumption, high body mass index and insufficient physical activity in Vietnam in 2020. Population attributable fractions were calculated for relationships of risk factors and cancer types based on sufficient evidence according to IARC or strong evidence according to WCRF/AICR. Relative risks were retrieved from meta‐analyses where possible. Prevalence of risk factors was obtained from the most current available nationally representative population surveys in Vietnam. Cancer cases and deaths were obtained from GLOBOCAN 2020. An estimated 40.5% of all cancer cases in men (39 924 cases) and 7.8% in women (6542 cases) were attributable to these risk factors. The proportions of cancer deaths attributable to these risk factors were 44.0% in men (32 807 cases) and 8.9% in women (4235 cases). Tobacco smoking was the leading cause of cancer cases and deaths in men, followed by alcohol consumption and high BMI. In women, high BMI accounted for the highest proportion of cancer cases and second‐hand smoking accounted for the highest proportion of cancer deaths. Lung and upper aerodigestive tract cancer cases and deaths could have been reduced at least by half if these risk factors had been eliminated. To reduce cancer incidence and mortality, preventive actions focusing on tobacco control are likely to have the most significant impact, especially in men. [ABSTRACT FROM AUTHOR]

Aims: Children are an important group harmed by others' alcohol consumption. This study (1) compared the risk of occurrence of child maltreatment among children exposed versus not exposed to parents with an alcohol‐attributable hospitalization or service use for mental health/addiction and (2) conducted sensitivity analyses to estimate the cases of child maltreatment that could be attributable to alcohol under two different conditions in New Zealand. Design: A cohort study conducted among children 0−17 years and their parents (years 2000–2017) using the Statistics New Zealand Integrated Data Infrastructure. The New Zealand Health Survey 2017 was also used. Setting: New Zealand. Participants: 58 359 children aged 0–17 years and their parents. Measurements: Survival analysis based on a Bayesian piecewise exponential model was used to estimate the risk of time to first substantiated child maltreatment event (identified from social service, hospital, mortality and police data) related to exposure to parents with an alcohol‐attributable hospitalization or who used a mental health/addiction service (versus no exposure). Potential confounders were included for parents and children. The sensitivity analyses (i) estimated an alcohol‐attributable admissions/service use fraction for maltreatment in 2017 and (ii) calculated a population‐attributable fraction using the relative risk from the cohort and prevalence of hazardous drinking (AUDIT 8+) among parents in 2017. Findings There was a 65.1% [1.65; 95% confidence interval (CI) = 1.46−1.86] increased risk of child maltreatment if a child was exposed to parents who had an alcohol‐attributable hospitalized or mental health/addictions service use. The sensitivity analyses estimated that in 2017 14.6% (CI = 14.0−15.3%) and 11.4% (95% CI = 8.4−14.3%) of the documented cases of child maltreatment in New Zealand could be attributable to parents with severe or hazardous consumption. Conclusions: In New Zealand, exposure to parents with an alcohol‐attributable hospitalization or service use is a risk factor for substantiated child maltreatment. [ABSTRACT FROM AUTHOR]

BackgroundWe aimed to investigate the incidence of dementia by age and year as well as the population-attributable fractions (PAFs) for known dementia risk factors in Republic of Korea.MethodsA 12-year, nationwide, population-based, retrospective cohort study was conducted. We used customized health information from the National Health Insurance Service (NHIS) data from 2002 to 2017. We analyzed age- and sex-adjusted incidence rates and PAF of dementia for each risk factor such as depression, diabetes, hemorrhagic stroke, ischemic stroke, hypertension, osteoporosis and physical inactivity using Levin’s formula.ResultsOf the 794,448 subjects in the dementia-free cohort, 49,524 (6.2%) developed dementia. Dementia incidence showed annual growth from 1.56 per 1,000 person-years in 2006 to 6.94 per 1,000 person-years in 2017. Of all dementia cases, 34,544 subjects (69.8%) were female and 2,479 subjects (5.0%) were early onset dementia. AD dementia accounted for 66.5% of the total dementia incidence. Considering relative risk and prevalence, physical inactivity attributed the greatest to dementia (PAF, 8.1%), followed by diabetes (PAF, 4.2%), and hypertension (PAF, 2.9%). Altogether, the significant risk factors increased the risk of dementia by 18.0% (overall PAF).ConclusionWe provided the incidence of dementia and PAFs for dementia risk factors in Republic of Korea using a 12-year, nationwide cohort. Encouraging lifestyle modifications and more aggressive control of risk factors may effectively prevent dementia.

In 2020, over 34 000 cases of Kaposi sarcoma (KS) were estimated globally, all attributable to KS herpesvirus (KSHV). Prior to the HIV epidemic, KS already existed in KSHV endemic regions, notably in sub‐Saharan Africa (SSA). The HIV epidemic has vastly increased the KS burden. We developed a methodology to provide global estimates of KS burden according to HIV status. A systematic review identified studies reporting HIV prevalence in consecutive KS series. Pooled estimates of HIV prevalence, by country or UN subregion, were used to calculate population‐attributable fraction (PAF) and these were applied to IARC's GLOBOCAN 2020 to estimate burden and incidence of HIV‐attributable and non‐HIV‐attributable KS. We identified 55 eligible studies, reporting HIV prevalence ranging from ≤5% to ≥95%. Approximately 80% of KS in SSA was estimated attributable to HIV, vs ~50% in the rest of the world. By applying PAFs to national GLOBOCAN estimates, an estimated 19 560 KS cases attributable to HIV were diagnosed in SSA in 2020 (~80% of the worldwide burden), vs 5064 cases of non‐HIV‐attributable KS (~60% of the worldwide burden). Incidence of HIV‐attributable KS was highest in Southern Africa (6.0 cases per 100 000) and Eastern Africa (3.4), which were also the world regions with highest incidence of non‐HIV‐attributable KS (0.4 and 1.0 cases per 100 000, respectively). This first systematic effort to produce a global picture of KS burden stratified by HIV status highlights the continuing important burden of HIV‐attributable KS in SSA, even in the era of combined antiretroviral therapy. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: Little is known concerning the cancer burden attributable to physical inactivity by state. Our objective was to calculate the proportion of incident cancer cases attributable to physical inactivity among adults age >=30 yr in 2013-2016 in all 50 states and District of Columbia. Methods : State-level, self-reported physical activity data from the Behavioral Risk Factor Surveillance System were adjusted by sex, age, and race/ethnicity using national-level, self-reported physical activity data from the National Health and Nutrition Examination Survey. Age-, sex-, and state-specific cancer incidence data were obtained from the US Cancer Statistics database. Sex-, age-, and state-specific adjusted prevalence estimates for eight physical activity categories and cancer-specific relative risks for the same categories from a large-scale pooled analysis were used to calculate population-attributable fractions (PAF) by state for stomach, kidney, esophageal (adenocarcinoma), colon, bladder, breast, and endometrial cancers. Results : When optimal physical activity was defined >=5 h[middle dot]wk-1 of moderate-intensity activity, equivalent to >=15 MET[middle dot]h[middle dot]wk-1, 3.0% (95% confidence interval (CI), 2.9%-3.0%) of all incident cancer cases (excluding nonmelanoma skin cancers) were attributable to physical inactivity, accounting for an average of 46,356 attributable cases per year. The PAF ranged from 2.3% (95% CI, 2.2%-2.5%) in Utah to 3.7% (95% CI, 3.4%-3.9%) in Kentucky. By cancer site, the PAF ranged from 3.9% (95% CI, 3.6%-4.2%) for urinary bladder to 16.9% (95% CI, 16.1%-17.7%) for stomach. Conclusions : Our results indicate that promoting physical activity through broad implementation of interventions could prevent many cancer cases. Over 46,000 cancer cases annually could be potentially avoided if the American population met the recommended 5 h[middle dot]wk-1 of moderate-intensity (or 15 (MET)-h[middle dot]wk-1) physical activity. [ABSTRACT FROM AUTHOR]

HIV substantially worsens human papillomavirus (HPV) carcinogenicity and contributes to an important population excess of cervical cancer, particularly in sub‐Saharan Africa (SSA). We estimated HIV‐ and age‐stratified cervical cancer burden at a country, regional and global level in 2020. Proportions of cervical cancer (a) diagnosed in women living with HIV (WLHIV), and (b) attributable to HIV, were calculated using age‐specific estimates of HIV prevalence (UNAIDS) and relative risk. These proportions were validated against empirical data and applied to age‐specific cervical cancer incidence (GLOBOCAN 2020). HIV was most important in SSA, where 24.9% of cervical cancers were diagnosed in WLHIV, and 20.4% were attributable to HIV (vs 1.3% and 1.1%, respectively, in the rest of the world). In all world regions, contribution of HIV to cervical cancer was far higher in younger women (as seen also in empirical series). For example, in Southern Africa, where more than half of cervical cancers were diagnosed in WLHIV, the HIV‐attributable fraction decreased from 86% in women ≤34 years to only 12% in women ≥55 years. The absolute burden of HIV‐attributable cervical cancer (approximately 28 000 cases globally) also shifted toward younger women: in Southern Africa, 63% of 5341 HIV‐attributable cervical cancer occurred in women <45 years old, compared to only 17% of 6901 non‐HIV‐attributable cervical cancer. Improved quantification of cervical cancer burden by age and HIV status can inform cervical cancer prevention efforts in SSA, including prediction of the impact of WLHIV‐targeted vs general population approaches to cervical screening, and impact of HIV prevention. What's new? The cancer‐causing potential of human papillomavirus (HPV) is amplified in patients infected with HIV. This is a particular consideration in sub‐Saharan Africa. Here, the authors developed an age‐specific method to determine the global burden of cervical cancer cases attributable to HIV. They found that around 20% of cervical cancer cases in sub‐Saharan Africa were attributable to HIV. Most of these occurred in women under age 45. These data can inform design of cervical cancer prevention programs, particularly in settings hit by a double burden of HPV and HIV. [ABSTRACT FROM AUTHOR]

Vitamin D deficiency is associated with an increased risk of falls and fractures. Assuming this association is causal, we aimed to identify the number and proportion of hospitalisations for falls and hip fractures attributable to vitamin D deficiency (25 hydroxy D (25(OH)D) <50 nmol/l) in Australians aged ≥65 years. We used 25(OH)D data from the 2011/12 Australian Health Survey and relative risks from published meta-analyses to calculate population-attributable fractions for falls and hip fracture. We applied these to data published by the Australian Institute of Health and Welfare to calculate the number of events each year attributable to vitamin D deficiency. In men and women combined, 8·3 % of hospitalisations for falls (7991 events) and almost 8 % of hospitalisations for hip fractures (1315 events) were attributable to vitamin D deficiency. These findings suggest that, even in a sunny country such as Australia, vitamin D deficiency contributes to a considerable number of hospitalisations as a consequence of falls and for treatment of hip fracture in older Australians; in countries where the prevalence of vitamin D deficiency is higher, the impact will be even greater. It is important to mitigate vitamin D deficiency, but whether this should occur through supplementation or increased sun exposure needs consideration of the benefits, harms, practicalities and costs of both approaches. [ABSTRACT FROM AUTHOR]

Background Pakistan's explosive human immunodeficiency virus (HIV) epidemic among people who inject drugs (PWID) varies widely across cities. We evaluated possible drivers for these variations. Methods Multivariable regression analyses were undertaken using data from 5 national surveys among PWID (n = 18 467; 2005–2017) to determine risk factors associated with variations in city-level HIV prevalence. A dynamic HIV model was used to estimate the population-attributable fraction (PAF; proportion of HIV infections prevented over 10 years when that risk factor is removed) of these risk factors to HIV transmission and impact on HIV incidence of reducing their prevalence. Results Regression analyses suggested that city-level HIV prevalence is strongly associated with the prevalence of using professional injectors at last injection, heroin use in last month, and injecting ≥4 times per day. Through calibrating a model to these associations, we estimate that the 10-year PAFs of using professional injectors, heroin use, and frequent injecting are 45.3% (95% uncertainty interval [UI], 4.3%–79.7%), 45.9% (95% UI, 8.1%–78.4%), and 22.2% (95% UI, 2.0%–58.4%), respectively. Reducing to lowest city-level prevalences of using professional injectors (2.8%; median 89.9% reduction), heroin use (0.9%; median 91.2% reduction), and frequent injecting (0.1%; median 91.8% reduction) in 2020 reduces overall HIV incidence by 52.7% (95% UI, 6.1%–82.0%), 53.0% (95% UI, 11.3%–80.2%), and 28.1% (95% UI, 2.7%–66.6%), respectively, over 10 years. Conclusions Interventions should focus on these risk factors to control Pakistan's explosive HIV epidemic among PWID, including a concomitant expansion of high-coverage needle/syringe provision, opioid substitution therapy, and antiretroviral therapy. [ABSTRACT FROM AUTHOR]

Background: Biological and epidemiological evidence suggest that herpes simplex virus type 2 (HSV-2) elevates HIV acquisition and transmission risks. We improved previous estimates of the contribution of HSV-2 to HIV infections by using a dynamic transmission model. Setting: World Health Organization regions. Methods: We developed a mathematical model of HSV-2/HIV transmission among 15- to 49-year-old heterosexual, non-druginjecting populations, calibrated using region-specific demographic and HSV-2/HIV epidemiological data. We derived global and regional estimates of the contribution of HSV-2 to HIV infection over 10 years [the transmission population-attributable fraction (tPAF)] under 3 additive scenarios, assuming: (1) HSV-2 increases only HIV acquisition risk (conservative); (2) HSV-2 also increases HIV transmission risk (liberal); and (3) HIV or antiretroviral therapy (ART) also modifies HSV-2 transmission risk, and HSV-2 decreases ART effect on HIV transmission risk (fully liberal). Results: Under the conservative scenario, the predicted tPAF was 37.3% (95% uncertainty interval: 33.4%-43.2%), and an estimated 5.6 (4.5-7.0) million incident heterosexual HIV infections were due to HSV-2 globally over 2009-2018. The contribution of HSV-2 to HIV infections was largest for the African region [tPAF = 42.6% (38.0%-51.2%)] and lowest for the European region [tPAF = 11.2% (7.9%-13.8%)]. The tPAF was higher among female sex workers, their clients, and older populations, reflecting their higher HSV-2 prevalence. The tPAF was approximately 50% and 1.3- to 2.4-fold higher for the liberal or fully liberal scenario than the conservative scenario across regions. Conclusion: HSV-2 may have contributed to at least 37% of incident HIV infections in the past decade worldwide, and even more in Africa, and may continue to do so despite increased ART access unless future improved HSV-2 control measures, such as vaccines, become available. [ABSTRACT FROM AUTHOR]

Background Antiretroviral therapy (ART) has reduced mortality among people living with human immunodeficiency virus (HIV), but cancer remains an important cause of death. We characterized cancer-attributable mortality in the HIV population during 2001–2015. Methods We used data from population-based HIV and cancer registries in the United States (US). Cox proportional hazards regression models were used to estimate adjusted hazard ratios (HRs) associating cancer diagnoses with overall mortality, we could perhaps cut these words to accommodate the word limit. However readers will probably want to know what statistical adjustments were made to the model. Population-attributable fractions (PAFs) were calculated using these HRs and the proportion of deaths preceded by cancer. Cancer-specific PAFs and cancer-attributable mortality rates were calculated for demographic subgroups, AIDS-defining cancers (Kaposi sarcoma [KS], non-Hodgkin lymphoma [NHL], cervical cancer), and non–AIDS-defining cancers. Results Cancer-attributable mortality was 386.9 per 100 000 person-years, with 9.2% and 5.0% of deaths attributed to non–AIDS-defining and AIDS-defining cancers, respectively. Leading cancer-attributable deaths were from NHL (3.5%), lung cancer (2.4%), KS (1.3%), liver cancer (1.1%), and anal cancer (0.6%). Overall, cancer-attributable mortality declined from 484.0 per 100 000 person-years during 2001–2005 to 313.6 per 100 000 person-years during 2011–2015, while the PAF increased from 12.6% to 17.1%; the PAF for non–AIDS-defining cancers increased from 7.2% to 11.8% during 2011–2015. Cancer-attributable mortality was highest among those aged ≥60 years (952.2 per 100 000 person-years), with 19.0% of deaths attributed to non–AIDS-defining cancers. Conclusions Although cancer-attributable mortality has declined over time, it remains high and represents a growing fraction of deaths in the US HIV population. Mortality from non–AIDS-defining cancers may rise as the HIV population ages. ART access, early cancer detection, and improved cancer treatment are priorities for reducing cancer-attributable mortality. [ABSTRACT FROM AUTHOR]

Few prospective studies have examined the association between social disconnection and late-life suicide. Therefore, we conducted a large-scale prospective study of older adults in Japan to examine differences in suicide mortality according to specific aspects of social disconnectedness. We conducted a nationwide baseline survey of functionally independent older adults (age ≥65 years) from 12 municipalities in Japan from 2010 to 2011. We followed the participants (n = 46,144) for cause of death through December 2017 using vital statistics. Social disconnection was assessed based on the indicators of eating alone, a lack of instrumental/emotional support, no participation in community activities, and no contact with friends. We adopted Cox regression models with multiple imputation for missing values and calculated the population-attributable fraction (PAF). A total of 55 suicide deaths were recorded during an average follow-up of 7 years. Older adults with social disconnection had a marginally increased risk of suicide. The hazard ratio for eating alone vs. eating together was 2.81 (95% confidence interval [CI]: 1.47–5.37). The direction of these associations and point estimations did not largely change after controlling for depressive symptoms, an evident risk factor for suicidal behavior. The PAF indicated that eating alone was attributable to around 1800 (29%) of the suicide deaths among older adults annually in Japan. Avoidance of not only depressive symptoms, but also social disconnection including eating alone, is useful in suicide prevention among older adults. [Display omitted] • 46,144 Japanese older adults were tracked for 7 years, with 55 recorded suicides. • Social disconnection relates to suicide in older adults marginally. • Eating alone was especially associated with a higher suicide mortality risk. • Around 30% of suicide deaths might be associated with eating alone. • Social disconnection may help identify potential targets for interventions. [ABSTRACT FROM AUTHOR]

BACKGROUND Our aim was to assess how the population-attributable fraction (PAF) for premature mortality due to cardiovascular disease (CVD) associated with hypertension changes if blood pressure (BP) thresholds for hypertension were lowered from systolic/diastolic BP ≥140/90 mm Hg to ≥130/80 mm Hg, as defined using the 2017 American College of Cardiology/American Heart Association blood pressure guideline. METHODS Analyses were conducted using a database of participants who underwent a national health checkup examination started in 2008 in Japan (n = 510,238; mean age, 59.6 ± 8.1 years; 42% men). Each participant was categorized as having normal or elevated BP, or stage 1 or 2 hypertension according to the guideline. Data on premature mortality due to CVD occurring before age 70 years were available through March 2015. RESULTS Over a median follow-up of 3.4 years, 739 deaths from CVD occurred. After multivariable adjustment, hazard ratios for premature CVD mortality for elevated BP, stage 1 hypertension, and stage 2 hypertension vs. normal BP were 1.02 (95% confidence interval, 0.72, 1.44), 1.33 (1.02, 1.75), and 2.41 (1.90, 3.05), respectively. The PAF associated with stage 1 and 2 hypertension was 4.4% and 39.4%, respectively. CONCLUSIONS In the current nationwide study of Japanese adults, stage 1 and 2 hypertension were associated with an increased risk for premature CVD mortality. The PAF for premature CVD mortality associated with hypertension increased by 4.4% if BP thresholds for hypertension were lowered from systolic/diastolic BP ≥140/90 to ≥130/80 mm Hg. [ABSTRACT FROM AUTHOR]

Objective: The International Agency for Research on Cancer has classified 13 infectious agents as carcinogenic or probably carcinogenic to humans. We aimed to estimate the percentage (ie, population-attributable fraction) and number of incident cancer cases in Texas in 2015 that were attributable to oncogenic infections, overall and by race/ethnicity. Methods: We calculated population-attributable fractions for cancers attributable to human papillomavirus (HPV), Helicobacter pylori, hepatitis C virus (HCV), hepatitis B virus (HBV), and human herpesvirus 8 (HHV-8) infections using prevalence estimates from National Health and Nutrition Examination Survey laboratory data and relative risks associated with infection from previous epidemiological studies. The Texas Cancer Registry provided cancer incidence data. Results: We estimated that 3603 excess cancer cases, or 3.5% of all cancers diagnosed in 2015, among adults aged ≥25 in Texas were attributable to oncogenic infections. Hispanic adults had the highest proportion of cancer cases attributable to infections (5.6%), followed by non-Hispanic Black (5.4%) and non-Hispanic White (2.3%) adults. HPV infection caused the highest proportion of all cancer cases (1.8%) compared with other oncogenic infections (HCV, 0.8%; H pylori, 0.5%; HBV, 0.3%; HHV-8, 0.1%). Hispanic adults had the highest proportions of all cancers caused by HPV infection (2.6%) and H pylori (1.1%), and non-Hispanic Black adults had the highest proportions of all cancers caused by HCV infection (1.7%), HBV infection (0.7%), and HHV-8 (0.3%). Conclusion: Preventable oncogenic infections contribute to cancer incidence in Texas and may affect racial/ethnic minority groups disproportionately. Infection control and prevention should be stressed as an important component of cancer prevention. [ABSTRACT FROM AUTHOR]

Abstract The 2011 EFSA opinion on Campylobacter was updated using more recent scientific data. The relative risk reduction in EU human campylobacteriosis attributable to broiler meat was estimated for on‐farm control options using Population Attributable Fractions (PAF) for interventions that reduce Campylobacter flock prevalence, updating the modelling approach for interventions that reduce caecal concentrations and reviewing scientific literature. According to the PAF analyses calculated for six control options, the mean relative risk reductions that could be achieved by adoption of each of these six control options individually are estimated to be substantial but the width of the confidence intervals of all control options indicates a high degree of uncertainty in the specific risk reduction potentials. The updated model resulted in lower estimates of impact than the model used in the previous opinion. A 3‐log10 reduction in broiler caecal concentrations was estimated to reduce the relative EU risk of human campylobacteriosis attributable to broiler meat by 58% compared to an estimate larger than 90% in the previous opinion. Expert Knowledge Elicitation was used to rank control options, for weighting and integrating different evidence streams and assess uncertainties. Medians of the relative risk reductions of selected control options had largely overlapping probability intervals, so the rank order was uncertain: vaccination 27% (90% probability interval (PI) 4–74%); feed and water additives 24% (90% PI 4–60%); discontinued thinning 18% (90% PI 5–65%); employing few and well‐trained staff 16% (90% PI 5–45%); avoiding drinkers that allow standing water 15% (90% PI 4–53%); addition of disinfectants to drinking water 14% (90% PI 3–36%); hygienic anterooms 12% (90% PI 3–50%); designated tools per broiler house 7% (90% PI 1–18%). It is not possible to quantify the effects of combined control activities because the evidence‐derived estimates are inter‐dependent and there is a high level of uncertainty associated with each.

Background: Human papillomavirus (HPV) is associated with a substantial percentage of cervical cancer, and a significant percentage of anal, penile, vaginal, vulvar, oral cavity, oropharyngeal, and laryngeal cancers. Understanding the burden and trends of HPV-attributable cancers is crucial to HPV prevention strategies. In the current study, the authors estimated the latest burden and trends of HPV-attributable cancers in China.Methods: Data from the following sources were used. The number of new cancer cases and cancer deaths in China were estimated based on the China Cancer Registry Annual Report. The population-attributable fraction was estimated using pooled high-risk HPV prevalence and biomarker-positive rates, which were calculated using random effects meta-analyses. Cancer burden estimates were stratified by anatomic site, sex, and age.Results: In 2015, a total of 110,650 new cancer cases and 36,714 cancer deaths attributable to HPV infection were estimated to have occurred in China, of which cervical cancer accounted for 85.6% and 78.1%, respectively. The age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of HPV-attributable cancers were 5.63 and 1.81 per 100,000 person-years, respectively. The ASIR and ASMR both varied by anatomic site, with the highest rates noted for cervical cancer at 4.83 and 1.42 per 100,000 person-years, respectively. Between 2005 and 2015, the ASIR and ASMR demonstrated significant upward trends for all HPV-attributable cancers combined.Conclusions: Between 2005 and 2015, cervical cancer accounted for the vast majority of HPV-attributable cancers and its incidence and mortality increased rapidly in China. The comprehensive prevention of cervical cancer remains the most important target in the prevention of HPV-attributable cancers. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine risk factors for progression to hemodynamically significant tricuspid regurgitation (TR) and the population burden attributable to these risk factors. Few data are available with regard to risk factors associated with the development of hemodynamically significant functional TR. A total of 1,552 subjects were studied beginning with an index echocardiogram demonstrating trivial or mild TR. Risk factors for progression to moderate or severe TR were determined by using logistic regression and classification trees. Population attributable fractions were calculated for each risk factor. During a median follow-up time of 38 (interquartile range [IQR]: 26 to 63) months, 292 patients (18.8%) developed moderate/severe TR. Independent predictors of TR progression were age, female sex, heart failure, pacemaker electrode, atrial fibrillation (AF), and indicators of left heart disease, including left atrial (LA) enlargement, elevated pulmonary artery pressure (PAP), and left-sided valvular disease. Classification and regression tree analysis demonstrated that the strongest predictors of TR progression were PAP of ≥36 mm Hg, LA enlargement, age ≥60 years, and AF. In the absence of these 4 risk factors, progression to moderate or severe TR occurred in ∼3% of patients. Age (28.4%) and PAP (20.5%) carried the highest population-attributable fractions for TR progression. In patients with TR progression, there was a marked concomitant increase of incident cases of elevated PAP (40%); mitral and aortic valve intervention (12%); reductions in left ventricular ejection fraction (19%), and new AF (32%) (all p < 0.01). TR progression is determined mainly by markers of increased left-sided filling pressures (PAP and LA enlargement), AF, and age. At the population level, age and PAP are the most important contributors to the burden of significant TR. TR progression entails a marked parallel increase in the severity of left-sided heart disease. [ABSTRACT FROM AUTHOR]

Alcohol consumption, especially at levels above 3 drinks/day, causes eight different types of cancer. We aimed to estimate the percentage and number of incident cancer cases diagnosed in Texas in 2015 that were attributable to alcohol consumption. We further examined for differences in these estimates across major population racial/ethnic subgroups. We calculated population-attributable fractions for cancers attributable to alcohol consumption using prevalence estimates of alcohol consumption from the Texas Behavioral Risk Factor Surveillance System and relative risks associated with alcohol consumption from the third World Cancer Research Fund/American Institute for Cancer Research expert report. Cancer incidence data were retrieved from the Texas Cancer Registry. We estimated 2.9% of all cancers or 2974 excess cancer cases diagnosed in 2015 in Texans aged ≥25 years were attributable to alcohol consumption. Non-Hispanic Blacks (2.2%) had the lowest proportion of alcohol-attributable cancers. Despite Hispanics having the highest percent of non-consumption of alcohol (65.3%, compared with 45.5% of non-Hispanic Whites), Hispanics had a slightly higher proportion of alcohol-attributable cancers than non-Hispanic Whites (3.0% and 2.7%, respectively). Alcohol consumption is an important target for intervention by public health programs aimed toward addressing cancer prevention. Differences in alcohol-attributable cancer burden among racial/ethnic subgroups should be acknowledged to provide appropriately tailored prevention recommendations. [ABSTRACT FROM AUTHOR]

The 2011 EFSA opinion on Campylobacter was updated using more recent scientific data. The relative risk reduction in EU human campylobacteriosis attributable to broiler meat was estimated for on‐farm control options using Population Attributable Fractions (PAF) for interventions that reduce Campylobacter flock prevalence, updating the modelling approach for interventions that reduce caecal concentrations and reviewing scientific literature. According to the PAF analyses calculated for six control options, the mean relative risk reductions that could be achieved by adoption of each of these six control options individually are estimated to be substantial but the width of the confidence intervals of all control options indicates a high degree of uncertainty in the specific risk reduction potentials. The updated model resulted in lower estimates of impact than the model used in the previous opinion. A 3‐log10 reduction in broiler caecal concentrations was estimated to reduce the relative EU risk of human campylobacteriosis attributable to broiler meat by 58% compared to an estimate larger than 90% in the previous opinion. Expert Knowledge Elicitation was used to rank control options, for weighting and integrating different evidence streams and assess uncertainties. Medians of the relative risk reductions of selected control options had largely overlapping probability intervals, so the rank order was uncertain: vaccination 27% (90% probability interval (PI) 4–74%); feed and water additives 24% (90% PI 4–60%); discontinued thinning 18% (90% PI 5–65%); employing few and well‐trained staff 16% (90% PI 5–45%); avoiding drinkers that allow standing water 15% (90% PI 4–53%); addition of disinfectants to drinking water 14% (90% PI 3–36%); hygienic anterooms 12% (90% PI 3–50%); designated tools per broiler house 7% (90% PI 1–18%). It is not possible to quantify the effects of combined control activities because the evidence‐derived estimates are inter‐dependent and there is a high level of uncertainty associated with each. [ABSTRACT FROM AUTHOR]

Cancer is a major contributing cause of morbidity and mortality in the Eastern Mediterranean region. The aim of the current study was to estimate the cancer burden attributable to major lifestyle and environmental risk factors. We used age‐, sex‐ and site‐specific incidence estimates for 2012 from IARC's GLOBOCAN, and assessed the following risk factors: smoking, alcohol, high body mass index, insufficient physical activity, diet, suboptimal breastfeeding, infections and air pollution. The prevalence of exposure to these risk factors came from different sources including peer‐reviewed international literature, the World Health Organization, noncommunicable disease Risk Factor Collaboration, and the Food and Agriculture Organization. Sex‐specific population‐attributable fraction was estimated in the 22 countries of the Eastern Mediterranean region based on the prevalence of the selected risk factors and the relative risks obtained from meta‐analyses. We estimated that approximately 33% (or 165,000 cases) of all new cancer cases in adults aged 30 years and older in 2012 were attributable to all selected risk factors combined. Infections and smoking accounted for more than half of the total attributable cases among men, while insufficient physical activity and exposure to infections accounted for more than two‐thirds of the total attributable cases among women. A reduction in exposure to major lifestyle and environmental risk factors could prevent a substantial number of cancer cases in the Eastern Mediterranean. Population‐based programs preventing infections and smoking (particularly among men) and promoting physical activity (particularly among women) in the population are needed to effectively decrease the regional cancer burden. What's new? How many cancers could be prevented by lifestyle changes? These authors set out to quantify the fraction of the cancer burden attributable to 8 major lifestyle factors in the Eastern Mediterranean region, which includes 22 countries. The risk factors they analyzed included smoking, alcohol, infections, and high BMI. Fully one third of new cancer cases among adults, they found, could be prevented by reducing exposure to risk factors. They conclude that public health programs to promote physical activity, reduce smoking, and prevent infections, would significantly reduce cancer mortality in this region. [ABSTRACT FROM AUTHOR]

In this study, we quantified the spatiotemporal burden of mortality attributable to ambient fine particulate matter (PM2.5, which is defined as a mass of particles with an aerodynamic dry diameter of ≤ 2.5 μm) in Taiwan during 2008–2015. Hourly concentrations of PM2.5 were obtained from the Taiwan Air Quality Monitoring Network. According to geographical and climatic characteristics, the Taiwan Environmental Protection Administration has divided Taiwan into seven air quality regions (AQRs): the North (four districts), Chu-Miao (two districts), Central (three districts), Yun-Chia-Nan (three districts), Kao-Ping (two districts), Yilan (one district), and Hua-Tung (two districts) regions. Demographic information and mortality data were acquired from the Department of Household Registration and National Death Registry of Taiwan, respectively. The World Health Organization's (WHO) AirQ+ software was used to estimate the mortality attributable to exposure to PM2.5 for specific causes of deaths, specifically from ischemic heart disease (IHD), cerebrovascular disease (stroke), lung cancer (LC), and chronic obstructive pulmonary disease (COPD). The results indicated that nationally, the annual mean concentration of PM2.5 decreased from 2008 (30.75 μg m−3) to 2015 (20.07 μg m−3). Moreover, the population-attributable fraction (PAF) of cause-specific mortality due to PM2.5 exposure for IHD, stroke, LC, and COPD decreased from 21.72%, 30.31%, 15.97%, and 13.04%, respectively, in 2008 to 17.40%, 18.18%, 10.77%, and 9.09%, respectively, in 2015. Geographic variation was observed in the PM2.5 concentration and PAF. High PM2.5 levels and PAF of mortality due to PM2.5 were observed in southwestern and central Taiwan. Moreover, cardiovascular and cerebrovascular disease (IHD and stroke) accounted for the majority of the premature deaths related to PM2.5. Stroke was the largest contributor in PM2.5-related premature mortality; however, IHD instead of stroke became the largest contributor in the Yilan AQR in 2010, 2012, and 2014–2015 and in the Hua-Tung AQR in 2012–2015 with relatively low PM2.5 levels (less than 19 μg m−3). In Taiwan, ambient PM2.5 contributed substantially to the burden of disease. Our results could aid authorities in determining the effectiveness of current air pollution control strategies and plans. [ABSTRACT FROM AUTHOR]

BackgroundHypoalbuminaemia is a marker of malnutrition-inflammation complex syndrome (MICS) and a strong predictor of cardiovascular (CV) death in maintenance haemodialysis (MHD) patients. However, serum albumin may change over time. Hence, its time-varying associations with outcome may be different.MethodsAssociations between 3-month averaged serum albumin levels, measured in a single laboratory using bromocresol green, and CV mortality were studied longitudinally in a 2-year cohort of 58,058 MHD patients. Mortality predictability of fixed baseline and trimonthly-varying serum albumin concentrations were compared.ResultsHazard ratios (HRs) of CV death strictly increased across decrements of baseline serum albumin, whereas the HR for time-varying serum albumin decrements below 3.8 g/dl did not differ. A drop in serum albumin in the first 6 months was associated with increasing all-cause and CV death risks in the subsequent 18 months, while a rise in serum albumin was a predictor of better survival independent of baseline serum albumin. The multivariate adjusted population-attributable fraction of death due to baseline serum albumin 3.8 g/dl might reduce the number of MHD deaths in the USA by approximately 10,000 annually. Nutritional interventions examining benefits of increasing serum albumin in MHD patients are urgently needed.

Abstract Background This study aimed to estimate potential reductions in case incidence of colorectal cancer attributable to the modifiable risk factors such as alcohol consumption, overweight and physical inactivity amongst the Malaysian population. Methods Gender specific population-attributable fractions (PAFs) for colorectal cancer in Malaysia were estimated for the three selected risk factors (physical inactivity, overweight, and alcohol consumptions). Exposure prevalence were sourced from a large-scale national representative survey. Risk estimates of the relationship between the exposure of interest and colorectal cancer were obtained from published meta-analyses. The overall PAF was then estimated, using the 2013 national cancer incidence data from the Malaysian Cancer Registry. Results Overall, the mean incidence rate for colorectal cancer in Malaysia from 2008 to 2013 was 21.3 per 100,000 population, with the mean age of 61.6 years (±12.7) and the majority were men (56.6%). Amongst 369 colorectal cancer cases in 2013, 40 cases (20 men, 20 women), 10 cases (9 men, 1 woman) or 20 cases (16 men,4 women) would be prevented, if they had done physical exercises, could reduce their body weight to normal level or avoided alcohol consumption, assuming that these factors are causally related to colorectal cancer. It was estimated that 66 (17.8%;66/369) colorectal cancer cases (42 men, 24 women) who had all these three risk factors for the last 10 years would have been prevented, if they could control these three risk factors through effective preventive measures. Conclusions Findings suggest that approximately 18% of colorectal cancer cases in Malaysia would be prevented through appropriate preventive measures such as doing regular physical exercises, reducing their body weight to normal level and avoiding alcohol consumption, if these factors are causally related to colorectal cancer. Scaling-up nationwide public health campaigns tailored to increase physical activity, controlling body weight within normal limits and avoid alcohol intake are recommended. Future studies with other site-specific cancers and additional risk factors are needed.

Abstract Background The extended illness-death model is a useful tool to study the risks and consequences of hospital-acquired infections (HAIs). The statistical quantities of interest are the transition-specific hazard rates and the transition probabilities as well as attributable mortality (AM) and the population-attributable fraction (PAF). In the most general case calculation of these expressions is mathematically complex. Methods When assuming time-constant hazards calculation of the quantities of interest is facilitated. In this situation the transition probabilities can be expressed in closed mathematical forms. The estimators for AM and PAF can be easily derived from these forms. Results In this paper, we show how to explicitly calculate all the transition probabilities of an extended-illness model with constant hazards. Using a parametric model to estimate the time-constant transition specific hazard rates of a data example, the transition probabilities, AM and PAF can be directly calculated. With a publicly available data example, we show how the approach provides first insights into principle time-dynamics and data structure. Conclusion Assuming constant hazards facilitates the understanding of multi-state processes. Even in a non-constant hazards setting, the approach is a helpful first step for a comprehensive investigation of complex data.

Abstract Background The global impact of alcohol consumption on deaths due to cardiomyopathy (CM) has not been quantified to date, even though CM contains a subcategory for alcoholic CM with an effect of heavy drinking over time as the postulated underlying causal mechanism. In this feasibility study, a model to estimate the alcohol-attributable fraction (AAF) of CM deaths based on alcohol exposure measures is proposed. Methods A two-step model was developed based on aggregate-level data from 95 countries, including the most populous (data from 2013 or last available year). First, the crude mortality rate of alcoholic CM per 1,000,000 adults was predicted using a negative binomial regression based on prevalence of alcohol use disorders (AUD) and adult alcohol per capita consumption (APC) (n = 52 countries). Second, the proportion of alcoholic CM among all CM deaths (i.e., AAF) was predicted using a fractional response probit regression with alcoholic CM crude mortality rate (from Step 1), AUD prevalence, APC per drinker, and Global Burden of Disease region as predictions. Additional models repeated these steps by sex and for the wider Global Burden of Disease study definition of CM. Results There were strong correlations (>0.9) between the crude mortality rate of alcoholic CM and the AAFs, supporting the modeling strategy. In the first step, the population-weighted mean crude mortality rate was estimated at 8.4 alcoholic CM deaths per 1,000,000 (95% CI: 7.4–9.3). In the second step, the global AAFs were estimated at 6.9% (95% CI: 5.4–8.4%). Sex-specific figures suggested a lower AAF among females (2.9%, 95% CI: 2.3–3.4%) as compared to males (8.9%, 95% CI: 7.0–10.7%). Larger deviations between observed and predicted AAFs were found in Eastern Europe and Central Asia. Conclusions The model proposed promises to fill the gap to include AAFs for CM into comparative risk assessments in the future. These predictions likely will be underestimates because of the stigma involved in all fully alcohol-attributable conditions and subsequent problems in coding of alcoholic CM deaths.

Background High sodium intake elevates blood pressure and thereby raises cardiovascular diseases (CVDs). Sodium intake is high in northern China, including Shandong province where the SMASH (Shandong‐Ministry of Health Action on Sodium and Hypertension) is currently underway. Methods and Results Blood pressure values and sodium intake measurements using 24‐hour urinary excretion were collected from the 2011 SMASH baseline survey, which was conducted in 20 counties/districts using a multistage stratified cluster random sampling method. We derived cause‐specific mortality from the Shandong Death Registration System (SDRS) during the same year and used population‐attributable fraction to estimate annual CVDs deaths attributable to high sodium intake (mediated through elevated systolic blood pressure) and CVD deaths averted by achieving different sodium‐reduction targets. Overall, 16 100 (95% uncertainty intervals, 11 000–22 600) CVD deaths among adults aged 25 to 69 years, including 5600 (4000–6500) for ischemic heart disease and 9000 (6700–11 600) for stroke, were attributable to higher sodium intake (2000 mg/day or 5.0 g/day of salt as a reference) in Shandong in 2011, accounting for 19.9% (13.7–25.0%) of total CVD deaths. The benefit of CVD deaths from sodium reduction is considerable with 8800 (6400–13 600), 6700 (4900–11 600), and 8500 (6000–10 800) averted, respectively, if sodium intake was reduced from the 2011 baseline to 3500 mg/day, 4000 mg/day, or reduced by 30%. Conclusions Nearly 20% of CVD deaths among adults aged 25 to 69 years could be attributable to the systolic blood pressure–raising effect of high sodium intake in Shandong in 2011. Potential benefits from population reduction of sodium intake are considerable.

Although medical ionizing radiation (IR) has clear clinical benefits, it is an established carcinogen. Our study estimates the number of new cancer cases in France in 2015 attributable to IR exposure from medical procedures. Exposures from external (X‐rays, CT scans, interventional radiology) and internal (nuclear medicine) sources were considered. We used 2007 national frequencies of diagnostic examinations by sex and age to estimate the lifetime organ dose exposure adjusted for changes in the use of such procedures over time. The Biological Effects of Ionizing Radiation VII risk models were used to estimate the corresponding excess cancer risk, assuming an average latency period of 10 years. Additionally, we used cancer incidence data from the French Cancer Registries Network. Of the 346,000 estimated new cancer cases in adults in France in 2015, 2300 cases (940 among men and 1360 among women) were attributable to diagnostic IR, representing 0.7% of all new cancer cases (0.5% for men and 0.9% for women). The leading cancers attributable to medical IR were female breast (n = 560 cases), lung (n = 500 cases) and colon (n = 290 cases) cancers. Compared to other risk factors, the contribution of medical IR to the cancer burden is small, and the benefits largely outweigh its harms. However, some of these IR‐associated cancer cases may be preventable through dose optimization of and enhanced justification for diagnostic examinations. What's new? Radiation exposure from medical diagnostic procedures accounted for about 0.7% of cases in 2015, according to a French study. The chief culprit was external radiation, like X‐rays or CT scans, and the biggest increases occurred in leukemia and bladder cancer. They considered the frequency of diagnostic procedures, combined with the Biological Effects of Ionizing Radiation VII risk model, to estimate the resulting excess cancer risk from these procedures. While the authors acknowledge that the benefits of medical radiation exposure outweigh the risks, they point out that careful consideration of dosages and justifications for the procedures could prevent some cancers. [ABSTRACT FROM AUTHOR]

The prevalence of excess body weight and the associated cancer burden have been rising over the past several decades globally. Between 1975 and 2016, the prevalence of excess body weight in adults-defined as a body mass index (BMI) ≥ 25 kg/m2 -increased from nearly 21% in men and 24% in women to approximately 40% in both sexes. Notably, the prevalence of obesity (BMI ≥ 30 kg/m2 ) quadrupled in men, from 3% to 12%, and more than doubled in women, from 7% to 16%. This change, combined with population growth, resulted in a more than 6-fold increase in the number of obese adults, from 100 to 671 million. The largest absolute increase in obesity occurred among men and boys in high-income Western countries and among women and girls in Central Asia, the Middle East, and North Africa. The simultaneous rise in excess body weight in almost all countries is thought to be driven largely by changes in the global food system, which promotes energy-dense, nutrient-poor foods, alongside reduced opportunities for physical activity. In 2012, excess body weight accounted for approximately 3.9% of all cancers (544,300 cases) with proportion varying from less than 1% in low-income countries to 7% or 8% in some high-income Western countries and in Middle Eastern and Northern African countries. The attributable burden by sex was higher for women (368,500 cases) than for men (175,800 cases). Given the pandemic proportion of excess body weight in high-income countries and the increasing prevalence in low- and middle-income countries, the global cancer burden attributable to this condition is likely to increase in the future. There is emerging consensus on opportunities for obesity control through the multisectoral coordinated implementation of core policy actions to promote an environment conducive to a healthy diet and active living. The rapid increase in both the prevalence of excess body weight and the associated cancer burden highlights the need for a rejuvenated focus on identifying, implementing, and evaluating interventions to prevent and control excess body weight. [ABSTRACT FROM AUTHOR]

Background: To investigate the relative contributions of prenatal complications, perinatal characteristics, neonatal morbidities and socio-economic conditions on the occurrence of motor, sensory, cognitive, language and psychological disorders in a large longitudinal preterm infant population during the first 7 years after birth.Methods: The study population comprised 4122 infants born at <35 weeks of gestation who were followed for an average of 74.0 months after birth. Developmental disorders, including motor, sensory, cognitive, language and psychological, were assessed at each follow-up visit from 18 months to 7 years of age. The investigated determinants included prenatal complications (prolonged rupture of membranes >24 hours, intrauterine growth restriction, preterm labour and maternal hypertension), perinatal characteristics (gender, multiple pregnancies, gestational age, birth weight, APGAR score and intubation or ventilation in the delivery room), neonatal complications (low weight gain during hospitalization, respiratory assistance, severe neurological anomalies, nosocomial infections) and socio-economic characteristics (socio-economic level, parental separation, urbanicity). Based on hazard ratios determined using a propensity score matching approach, population-attributable fractions (PAF) were calculated for each of the four types of determinants and for each developmental disorder.Results: The percentages of motor, sensory, cognitive, language and psychological disorders were 17.0, 13.4, 29.1, 25.9 and 26.1%, respectively. The PAF for the perinatal characteristics were the highest and they were similar for the different developmental disorders considered (around 60%). For the neonatal and socio-economic determinants, the PAF varied according to the disorder, with contributions of up to 17% for motor and 27% for language disorders, respectively. Finally, prenatal complications had the lowest contributions (between 6 and 13%).Conclusions: This study illustrates the heterogeneity of risk factors on the risk of developmental disorder in preterm infants. These results suggest the importance of considering both medical and psycho-social follow-ups of preterm infants and their families. [ABSTRACT FROM AUTHOR]

Background Obesity could be considered as the main consequence of unhealthy nutrition, responsible for many pathological alterations in human. Obese patients usually need more health care services. The aim of the study was to estimate the financial expenditures of health care provisions in Hungary, related to obesity and diabetes, as its main pathological consequence. Methods Data of the Hungarian National Health Insurance Fund (NHIF) were collected for 2013, regarding finances of secondary care, hospital services, reimbursement for medications and healing aids of diabetic patients together with selected morbidities linked to obesity, based on the codes of the International Classification of Diseases (ICD) and calculated their population prevalence on the population-attributable fraction (PAF). Results Financial data regarding diabetes care resulted in a 40,311 Million HUF (129 Million EUR) national fund expenses, beside a 7,173 Million HUF (23 Million EUR) contribution from patients. Estimated total health care expenditures related to obesity were 58,986 Million HUF (188 Million EUR) and the financial contribution of patients was calculated as 25,316 Million HUF (81 Million EUR). These data represent a 5.2 % and 9.3 % of the whole national health services, 16 % and 30 % of the whole drug-reimbursement budgets, respectively. Conclusions Although expenditures for some obesity related pathologies analyzed in this paper represent 0.28 % of the national GDP, considering other morbidities and other patient's expenses, the real ratio could be between 0.5-1 %. The increasing number of overweight and obese persons requires more focus in public health, higher awareness in the society and more governmental support. [ABSTRACT FROM AUTHOR]

Abstract Background Alcohol consumption is an important and preventable cause of cancer. The aim of this study was to quantify the proportion of the cancer burden in the Nordic countries linked to alcohol and estimate the potential for cancer prevention by changes in alcohol consumption. Methods Using the Prevent macro-simulation model, the number of cancer cases in the Nordic countries over a 30-year period (2016–2045) was modelled for six sites, under different scenarios of changing alcohol consumption, and compared to the projected number of cases if constant alcohol consumption prevailed. The studied sites were colorectal, post-menopausal breast, oral cavity and pharynx, liver, larynx as well as oesophageal squamous cell carcinoma. The alcohol consumption was based on the categories of non-drinkers/occasional drinkers, light drinkers (<=12.5 g alcohol per day), moderate drinkers (>12.5 and ≤ 50 g/day) and heavy drinkers (>50 g/day). Results About 83,000 cancer cases could be avoided in the Nordic countries in a 30-year period if alcohol consumption was entirely eliminated, which is 5.5% of the expected number of cases for the six alcohol-related cancer types. With a 50% reduction in the proportion with moderate alcohol consumption by year 2025, 21,500 cancer cases could be avoided. The number of avoidable cases was highest for post-menopausal breast and colorectal cancer, but the percentage was highest for oesophageal squamous cell carcinoma. Conclusion The results from this study can be used to understand the potential impact and significance of primary prevention programmes targeted towards reducing the alcohol consumption in the Nordic countries. Highlights • Eliminating alcohol consumption in the Nordic countries could avoid 83,000 cancers in 30 years. • This corresponds to 5.5% of the expected cancers for the six cancer sites causally linked to alcohol. • The number of avoidable cases was highest for breast and colorectal cancer. • Oesophageal squamous cell carcinoma showed the largest percentage of avoidable cancers. [ABSTRACT FROM AUTHOR]

Background: Smoking is a major modifiable risk factor for premature mortality. Estimating the smoking-attributable burden is important for public health policy. Typically, prevalence- or smoking impact ratio (SIR)-based methods are used to derive estimates, but there is controversy over which method is more appropriate for country-specific estimates. We compared smoking-attributable fractions (SAFs) of deaths estimated by these two methods. Methods: To estimate SAFs in 2012, we used several different prevalence-based approaches using no lag and 10- and 20-year lags. For the SIR-based method, we obtained lung cancer mortality rates from the Korean Cancer Prevention Study (KCPS) and from the United States-based Cancer Prevention Study-II (CPS-II). The relative risks for the diseases associated with smoking were also obtained from these cohort studies. Results: For males, SAFs obtained using KCPS-derived SIRs were similar to those obtained using prevalence-based methods. For females, SAFs obtained using KCPS-derived SIRs were markedly greater than all prevalence-based SAFs. Differences in prevalence-based SAFs by time-lag period were minimal among males, but SAFs obtained using longer-lagged prevalence periods were significantly larger among females. SAFs obtained using CPS-II-based SIRs were lower than KCPS-based SAFs by >15 percentage points for most diseases, with the exceptions of lung cancer and chronic obstructive pulmonary disease. Conclusions: SAFs obtained using prevalence- and SIR-based methods were similar for males. However, neither prevalence-based nor SIR-based methods resulted in precise SAFs among females. The characteristics of the study population should be carefully considered when choosing a method to estimate SAF.

Contemporary information on the fraction of cancers that potentially could be prevented is useful for priority setting in cancer prevention and control. Herein, the authors estimate the proportion and number of invasive cancer cases and deaths, overall (excluding nonmelanoma skin cancers) and for 26 cancer types, in adults aged 30 years and older in the United States in 2014, that were attributable to major, potentially modifiable exposures (cigarette smoking; secondhand smoke; excess body weight; alcohol intake; consumption of red and processed meat; low consumption of fruits/vegetables, dietary fiber, and dietary calcium; physical inactivity; ultraviolet radiation; and 6 cancer-associated infections). The numbers of cancer cases were obtained from the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute; the numbers of deaths were obtained from the CDC; risk factor prevalence estimates were obtained from nationally representative surveys; and associated relative risks of cancer were obtained from published, large-scale pooled analyses or meta-analyses. In the United States in 2014, an estimated 42.0% of all incident cancers (659,640 of 1570,975 cancers, excluding nonmelanoma skin cancers) and 45.1% of cancer deaths (265,150 of 587,521 deaths) were attributable to evaluated risk factors. Cigarette smoking accounted for the highest proportion of cancer cases (19.0%; 298,970 cases) and deaths (28.8%; 169,180 deaths), followed by excess body weight (7.8% and 6.5%, respectively) and alcohol intake (5.6% and 4.0%, respectively). Lung cancer had the highest number of cancers (184,970 cases) and deaths (132,960 deaths) attributable to evaluated risk factors, followed by colorectal cancer (76,910 cases and 28,290 deaths). These results, however, may underestimate the overall proportion of cancers attributable to modifiable factors, because the impact of all established risk factors could not be quantified, and many likely modifiable risk factors are not yet firmly established as causal. Nevertheless, these findings underscore the vast potential for reducing cancer morbidity and mortality through broad and equitable implementation of known preventive measures. CA Cancer J Clin 2018;68:31-54. © 2017 American Cancer Society. [ABSTRACT FROM AUTHOR]

Examine the risk for site-specific incident cancer across representative transport, rescue, and security industries. This Danish nationwide register-based study included all 302,789 workers from transport, rescue and security industries in 2001-2015 and 2,230,877 individuals aged 18-64 years from a total sample of the economically active population for comparison. We used Cox models to estimate the hazard ratios (HRs) of incident cancers. We categorized site-specific cancers by using population-attributable fraction (PAF) estimates from the previous literature. During an average follow-up of 13.4 years, 22,116 incident cancer cases were recorded in these industries. Compared with the reference population, the age-adjusted cancer incidence with a high PAF was higher among men in seafaring (HR 1.28; 95% CI 1.14-1.43), and land transport (HR 1.32; 95% CI: 1.26-1.37), and among women in seafaring (HR 1.26; 95% CI: 1.01-1.57), land transport (HR 1.21; 95% CI: 1.12-1.32), aviation (HR 1.22; 95% CI: 1.05-1.41), and police force (HR 1.21; 95% CI: 1.04-1.40). Overall, tobacco and physical inactivity were the most significant risk factors of cancer. Regardless of considerable disparities in incident cancer attributable to modifiable risk factors across industries, the total incident cancer rate was elevated in all industries in both sexes. • The total incident cancer rate was elevated in all included industries, both in men and women. • High PAF cancer incidence was elevated in both sexes in sea and land transport and in women in aviation and police force. • Tobacco and physical inactivity were the most significant risk factors of cancer. • More attention is needed to the management of cancer risk factors related to health behaviors and work environment. • This applies especially to individuals who work in transport industries. [ABSTRACT FROM AUTHOR]

Background: The extended illness-death model is a useful tool to study the risks and consequences of hospital-acquired infections (HAIs). The statistical quantities of interest are the transition-specific hazard rates and the transition probabilities as well as attributable mortality (AM) and the population-attributable fraction (PAF). In the most general case calculation of these expressions is mathematically complex.Methods: When assuming time-constant hazards calculation of the quantities of interest is facilitated. In this situation the transition probabilities can be expressed in closed mathematical forms. The estimators for AM and PAF can be easily derived from these forms.Results: In this paper, we show how to explicitly calculate all the transition probabilities of an extended-illness model with constant hazards. Using a parametric model to estimate the time-constant transition specific hazard rates of a data example, the transition probabilities, AM and PAF can be directly calculated. With a publicly available data example, we show how the approach provides first insights into principle time-dynamics and data structure.Conclusion: Assuming constant hazards facilitates the understanding of multi-state processes. Even in a non-constant hazards setting, the approach is a helpful first step for a comprehensive investigation of complex data. [ABSTRACT FROM AUTHOR]

Background: The global impact of alcohol consumption on deaths due to cardiomyopathy (CM) has not been quantified to date, even though CM contains a subcategory for alcoholic CM with an effect of heavy drinking over time as the postulated underlying causal mechanism. In this feasibility study, a model to estimate the alcohol-attributable fraction (AAF) of CM deaths based on alcohol exposure measures is proposed. Methods: A two-step model was developed based on aggregate-level data from 95 countries, including the most populous (data from 2013 or last available year). First, the crude mortality rate of alcoholic CM per 1,000,000 adults was predicted using a negative binomial regression based on prevalence of alcohol use disorders (AUD) and adult alcohol per capita consumption (APC) (n = 52 countries). Second, the proportion of alcoholic CM among all CM deaths (i.e., AAF) was predicted using a fractional response probit regression with alcoholic CM crude mortality rate (from Step 1), AUD prevalence, APC per drinker, and Global Burden of Disease region as predictions. Additional models repeated these steps by sex and for the wider Global Burden of Disease study definition of CM. Results: There were strong correlations (>0.9) between the crude mortality rate of alcoholic CM and the AAFs, supporting the modeling strategy. In the first step, the population-weighted mean crude mortality rate was estimated at 8.4 alcoholic CM deaths per 1,000,000 (95% CI: 7.4-9.3). In the second step, the global AAFs were estimated at 6.9% (95% CI: 5.4-8.4%). Sex-specific figures suggested a lower AAF among females (2.9%, 95% CI: 2.3-3.4%) as compared to males (8.9%, 95% CI: 7.0-10.7%). Larger deviations between observed and predicted AAFs were found in Eastern Europe and Central Asia. Conclusions: The model proposed promises to fill the gap to include AAFs for CM into comparative risk assessments in the future. These predictions likely will be underestimates because of the stigma involved in all fully alcohol-attributable conditions and subsequent problems in coding of alcoholic CM deaths. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the incidence of dementia by age and year as well as the population-attributable fractions (PAFs) for known dementia risk factors in Republic of Korea., Methods: A 12-year, nationwide, population-based, retrospective cohort study was conducted. We used customized health information from the National Health Insurance Service (NHIS) data from 2002 to 2017. We analyzed age- and sex-adjusted incidence rates and PAF of dementia for each risk factor such as depression, diabetes, hemorrhagic stroke, ischemic stroke, hypertension, osteoporosis and physical inactivity using Levin's formula., Results: Of the 794,448 subjects in the dementia-free cohort, 49,524 (6.2%) developed dementia. Dementia incidence showed annual growth from 1.56 per 1,000 person-years in 2006 to 6.94 per 1,000 person-years in 2017. Of all dementia cases, 34,544 subjects (69.8%) were female and 2,479 subjects (5.0%) were early onset dementia. AD dementia accounted for 66.5% of the total dementia incidence. Considering relative risk and prevalence, physical inactivity attributed the greatest to dementia (PAF, 8.1%), followed by diabetes (PAF, 4.2%), and hypertension (PAF, 2.9%). Altogether, the significant risk factors increased the risk of dementia by 18.0% (overall PAF)., Conclusion: We provided the incidence of dementia and PAFs for dementia risk factors in Republic of Korea using a 12-year, nationwide cohort. Encouraging lifestyle modifications and more aggressive control of risk factors may effectively prevent dementia., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hwangbo, Lee, Han, Chun, Jang, Seo, Na, Won, Kim and Lim.)

Background: This 3.6-year prospective study examined combined impacts of physical activity, dietary variety, and social interaction on incident disability and estimated population-attributable fraction for disability reduction in older adults., Methods: Participants were 7,822 initially non-disabled residents (3,966 men and 3,856 women) aged 65-84 years of Ota City, Tokyo, Japan. Sufficiency of moderate-to-vigorous-intensity physical activity (MVPA) ≥150 min/week, dietary variety score (DVS) ≥3 (median), and social interaction (face-to-face and/or non-face-to-face) ≥1 time/week was assessed using self-administered questionnaires. Disability incidence was prospectively identified using the long-term care insurance system's nationally unified database., Results: During a follow-up of 3.6 years, 1,046 (13.4%) individuals had disabilities. Independent multivariate-hazard ratios (HRs) and 95% confidence intervals (CIs) of MVPA, DVS, and social interaction sufficiency for incident disability were 0.68 (95% CI, 0.59-0.78), 0.87 (95% CI, 0.77-0.99), and 0.90 (95% CI, 0.79-1.03), respectively. Incident disability HRs gradually reduced with increased frequency of satisfying these behaviors (any one: HR 0.82; 95% CI, 0.65-1.03; any two: HR 0.65; 95% CI, 0.52-0.82; and all three behaviors: HR 0.54; 95% CI, 0.43-0.69), in an inverse dose-response manner (P < 0.001 for trend). Population-attributable fraction for disability reduction in satisfying any one, any two, and all three behaviors were 4.0% (95% CI, -0.2 to 7.9%), 9.6% (95% CI, 4.8-14.1%), and 16.0% (95% CI, 8.7-22.8%), respectively., Conclusion: Combining physical activity, dietary variety, and social interaction substantially enhances the impacts on preventing disability among older adults, with evidence of an inverse dose-response manner. Improving insufficient behavior elements through individual habits and preexisting social group activities may be effective in preventing disability in the community.

Objective: To explore the possibility that the mortality risk of mild cognitive impairment (MCI) as diagnosed using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria (DSM-5-MCI) will be higher than using Petersen's criteria (P-MCI) and to report the population-attributable fraction (PAF) of mortality due to MCI.Methods: A representative community sample of 4,803 individuals aged 55 or more years was interviewed and then followed for 17 years. Standardized instruments were used in the assessment, including the Geriatric Mental State-AGECAT, and research psychiatrists diagnosed P-MCI and DSM-5-MCI cases following operationalized criteria. Mortality information was obtained from the official population registry. Kaplan-Meier age-adjusted survival curves were built for the MCI diagnostic groups, and Cox proportional hazards regression models were used to calculate the hazard ratio of death in participants with MCI relative to those without. We also estimated the PAF of mortality due to specific MCI diagnostic groups.Results: Compared with noncases, the mortality rate ratio was approximately double in DSM-5-MCI individuals (2.3) than in P-MCI individuals (1.2). In the multivariate statistical analysis, a significant association between each diagnostic category and mortality was observed but was only maintained in the final model in DSM-5-MCI cases (hazard ratio: 1.24). The PAF of mortality due to MCI was approximately 1% in both MCI categories.Conclusion: The mortality risk in comparison with noncases was higher in DSM-5-MCI than in P-MCI. The PAF of mortality in DSM-5-MCI individuals was ~ 1% over a 17-year period. [ABSTRACT FROM AUTHOR]

Using long-term follow-up cohort data from the Korean Genome Epidemiology Study, we assessed the dietary risk factors for incident hypertension (HTN). In total, 6792 subjects (3300 males and 3492 females) aged 40–69 years were included in the study. Physician-diagnosed HTN self-reported by the participants was used as the outcome. Daily intake of 20 food groups was assessed while using a dish-based semi-quantitative food-frequency questionnaire. After controlling for known risk factors, the food groups that were most closely associated with HTN were identified by forward stepwise selection while using the Cox proportional hazards model. The median follow-up period was 11.5 years (interquartile range, 6.0–11.7 years) and the incidence of HTN was 20 per 1000 person-years. Older age, obesity, lower education level, high alcohol intake, and having at least one parent with HTN were associated with the risk for HTN. In addition, a high intake of salted seafood and a low intake of eggs and meat were independently associated with the incidence of HTN after controlling for the known risk factors. Those in the top quartile of salted seafood intake had a 28% greater risk for incident HTN than those in the bottom quartile. The population-attributable fraction of three dietary factors accounted for 29.0% of the incidence of HTN. A high intake of salted seafood and a low intake of eggs and meat were associated with a greater risk for HTN.

Introduction: Infections by certain viruses, bacteria, and parasites have been identified as risk factors for some cancers. In Nigeria, like many other developing countries, infections remain a leading cause of morbidity and mortality. While there are data on the incidence of different cancers in Nigeria, there has been no study of cancers attributable to infections. This study was carried out to determine the burden of cancers attributable to infections using data from two population-based cancer registries (PBCRs) in Nigeria. Methods: We obtained data on cancers associated with EBV, human papillomavirus (HPV), hepatitis B and C, HIV, HHV8, Helicobacter pylori, and Schistosoma spp. from the databases of Abuja and Enugu cancer registries in Nigeria. We used population-attributable fraction for infections-associated cancers in developing countries that are based on prevalence data and relative risk estimates from previous studies. results: The PBCRs reported 4,336 incident cancer cases [age standardized incidence rate (ASR) 113.9 per 100,000] from 2012 to 2014, of which 1,627 (37.5%) were in males and 2,709 (62.5%) were in females. Some 1,030 (23.8%) of these cancers were associated with infections (ASR 44.4 per 100,000), while 951 (22.0%) were attributable to infections (ASR 41.6 per 100,000). Cancers of the cervix (n = 392, ASR 28.3 per 100,000) and liver (n = 145, ASR 3.4 per 100,000); and non-Hodgkin's lymphoma (n = 110, ASR 2.5 per 100,000) were the commonest infections-associated cancers overall. The commonest infectious agents associated with cancers in this population were HPV, EBV, hepatitis B and C, HIV, and HHV8. conclusion: Our results suggest that 23.8% of incident cancer cases in this population were associated with infections, while 22.0% were attributable to infections. The infections attributable cancers are potentially preventable with strategies, such as vaccination, risk factor modification, or anti-infective treatment. [ABSTRACT FROM AUTHOR]

Background: Anemia is a leading cause of maternal deaths and adverse pregnancy outcomes in developing countries. Objectives: We conducted a systematic review and meta-analysis to estimate the pooled prevalence of anemia, the association between maternal anemia and pregnancy outcomes, and the population-attributable fraction (PAF) of these outcomes that are due to anemia in low- and middle-income countries. Design: PubMed, EMBASE, CINAHL, and the British Nursing Index were searched from inception to May 2015 to identify cohort studies of the association between maternal anemia and pregnancy outcomes. The anemic group was defined as having hemoglobin concentrations <10 or <11 g/dL or hematocrit values <33% or <34% depending on the study. A metaregression and stratified analysis were performed to assess the effects of study and participant characteristics on adverse pregnancy risk. The pooled prevalence of anemia in pregnant women by region and country-income category was calculated with the use of a random-effects meta-analysis. Results: Of 8182 articles reviewed, 29 studies were included in the systematic review, and 26 studies were included in the meta-analysis. Overall, 42.7% (95% CI: 37.0%, 48.4%) of women experienced anemia during pregnancy in low- and middle-income countries. There were significantly higher risks of low birth weight (RR: 1.31; 95% CI: 1.13, 1.51), preterm birth (RR: 1.63; 95% CI: 1.33, 2.01), perinatal mortality (RR: 1.51; 95% CI: 1.30, 1.76), and neonatal mortality (RR: 2.72; 95% CI: 1.19, 6.25) in pregnant women with anemia. South Asian, African, and low-income countries had a higher pooled anemia prevalence than did other Asian and upper-middle-income countries. Overall, in low- and middle-income countries, 12% of low birth weight, 19% of preterm births, and 18% of perinatal mortality were attributable to maternal anemia. The proportion of adverse pregnancy outcomes attributable to anemia was higher in low-income countries and in the South Asian region. Conclusion: Maternal anemia remains a significant health problem in low- and middle-income countries. [ABSTRACT FROM AUTHOR]