Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Summary

Background

Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050.

Methods

Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively.

Findings

In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%.

Interpretation

Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.

Funding

Bill & Melinda Gates Foundation.

Gap in life expectancy between rich and poor London areas has increased as house prices rise

Revealed: 

Researchers at Imperial College London studied life expectancy in thousands of areas alongside house prices

VIEW 5 COMMENTS [их больше]

Life expectancy was found to be highest in the central London districts 

The gap in life expectancy between the richest and poorest areas of London has increased as house prices rise in a study showing how polarised the capital has become.

Researchers at Imperial College London tracked changes in life expectancy in thousands of areas between 2002 and 2019 and analysed these alongside data on house prices from the Land Registry.

The study examined data from 4,835 of London’s “lower-layer super output” areas, which have an average of approximately 1,500 residents or 650 households. Researchers calculated the correlation between the change in housing prices and the sociodemographic characteristics of each area.

It found that large gains in life expectancy occurred where house prices were already high, or in areas where house prices grew the most.

The average life expectancy for women increased from 80.9 in 2002 to 85.4 in 2019. For men, this figure climbed from 76.1 to 81.6 in the same period.

But the study found that life expectancy inequality — defined as the difference between the highest and lowest percentiles of the areas — had increased substantially. The gap between richest and poorest was 19.1 years for women and 17.2 years for men in 2019. In 2002, these figures were 11.1 and 11.6 for women and men respectively.

Life expectancy was highest in the central London districts of Kensington and Chelsea, Westminster, City and Camden. Lower life expectancy was spread in areas throughout the capital, researchers said, but was more common in outer east and south-east London.

The researchers concluded: “Where prices were high at the turn of the century, life expectancy increased substantially independently of price change, and with little change in the resident population. In areas that started with lower prices life expectancy only increased proportional to price change, and was accompanied by a greater influx of new residents into the area.”

The study said that areas where house prices grew the most saw an influx of “new, more educated and better-off” working age residents during the period.

These areas also saw an “outflux of residents in retirement ages” as well as children, adolescents and young adults.

The study’s authors write that London’s economic growth has been “highly polarised” and, despite city-wide growth in income, nearly one half of the city’s population falls in the two bottom rankings of national income deprivation. The study is published today in The Lancet.

London house prices: have they risen or fallen in your borough?

Health and cancer risks associated with low levels of alcohol consumption

Benjamin O Anderson Nino Berdzuli Andre Ilbawi Dévora Kestel Hans P Kluge Rüdiger Krech
et al. Show all authors
https://doi.org/10.1016/S2468-2667(22)00317-6

The overall risks and harms resulting from alcohol consumption have been systematically assessed and are well documented. According to the latest WHO estimates, alcohol consumption contributed to 3 million deaths in 2016 globally and was responsible for 5·1% of the global burden of disease and injury. Alcohol consumption is associated with an increased risk of many health conditions and is the main and sufficient cause for several disorders, including alcohol dependence, liver cirrhosis, and several other non-communicable diseases and mental health conditions. Alcohol use is among the leading risk factors for premature mortality and disability because of its causal relationship with multiple health conditions, which also include non-intentional injuries and suicides. Younger people are disproportionately affected by alcohol compared with older people, and 13·5% of all deaths among those aged 20–39 years are attributed to alcohol. Disadvantaged and vulnerable populations have increased rates of alcohol-related death and hospitalisation.

Alcohol, as classified by the International Agency for Research on Cancer, is a toxic, psychoactive, and dependence-producing substance and a Group 1 carcinogen that is causally linked to seven types of cancer, including oesophagus, liver, colorectal, and breast cancers. Alcohol consumptions is associated with 740 000 new cancer cases each year globally.

In the EU, light to moderate alcohol consumption (<20 g of pure alcohol per day, which is equivalent to consumption of approximately <1·5 L of wine [12% alcohol by volume; ABV], <3·5 L of beer [5% ABV], or <450 mL of spirits [40% ABV] per week) was associated with almost 23 000 new cancer cases in 2017, accounting for 13·3% of all alcohol-attributable cancers and for 2·3% of all cases of the seven alcohol-related cancer types. Almost half of these cancers (approximately 11 000 cases) were female breast cancers. Also, more than a third of the cancer cases attributed to light to moderate drinking (approximately 8500 cases) were associated with a light drinking level (<10 g per day).

Increasing levels of alcohol use are associated with increasing levels of risk of illness and mortality, leading to the question of whether a safe level of alcohol consumption that is associated with zero risk of health consequences can be defined. To identify a safe level of alcohol consumption, scientific evidence is required to show the absence of increased risk of illness or injury associated with alcohol consumption at and below that level. Some, but not all, studies have suggested that light alcohol consumption could have a small protective effect, as measured by the risk of some cardiovascular diseases or type 2 diabetes. Some studies show the existen ce of such effects on certain types of cardiovascular diseases in middle-aged and older people. However, several reviews also found that the protective effects of moderate consumption disappear with heavy episodic drinking, which increases the risk of any cardiovascular diseases.

No studies have shown that the potential existence of a protective effect for cardiovascular diseases or type 2 diabetes also reduces the risk of cancer for an individual consumer. Evidence does not indicate the existence of a particular threshold at which the carcinogenic effects of alcohol start to manifest in the human body. As such, no safe amount of alcohol consumption for cancers and health can be established. Alcohol consumers should be objectively informed about the risks of cancer and other health conditions associated with alcohol consumption.

We declare no competing interests. All authors are staff members of WHO. The authors alone are responsible for the views expressed here and these do not necessarily represent the decisions or the stated policy of WHO.

Subacute parkinsonism

A 54-year-old woman attended our hospital with a 2-week history of rapidly worsening difficulty with her walking, tremor, a weak voice, and trouble swallowing.

The patient had a history of systemic lupus erythematosus (SLE) and antiphospholipid syndrome with positive anticardiolipin antibodies, which had been diagnosed more than 30 years earlier.

She had been treated with acenocoumarol, azathioprine, denosumab, and prednisolone.
On examination, the patient was distressed but her vital signs were normal. She had hypophonia, hypomimia, bilateral saccadic horizontal eye movements, and supranuclear upward gaze palsy. She had symmetrical brisk reflexes in all limbs with normal plantar reflexes; rigidity was found in both arms and legs with her right side affected more than her left. She had symmetrical bradykinesia in all limbs, and a resting and postural tremor bilaterally, that was more severe on her right side. The patient had a festinated gait and she needed support with walking; she had no arm swing, and episodically, experienced freezing (video).

T2 weighted MRI of the patient's brain showed hyperintense confluent lesions of the basal ganglia and thalami with multiple foci of restricted diffusion located in both supratentorial and infratentorial regions; bilateral peripheral microbleeds were seen on susceptibility weighted images (figure). The lesions showed no contrast enhancement and MRI of vessel walls showed no signs of vasculitis.

Systemic lupus erythematosus and catastrophic antiphospholipid syndrome

Transthoracic echocardiography findings were inconclusive—specifically, we were unable to rule out the presence of valvular vegetations. Weighing up the pros and cons of carrying out an invasive procedure and further therapeutic interventions, we decided against a transoesophageal echocardiogram.

Cerebrospinal fluid (CSF) analysis showed a normal leukocyte count of 2 cells per μL (normal <4) and protein concentration of 445 mg/L (normal range 215–720); a slightly elevated glucose concentration of 4·7 mmol/L (normal range 3·0–4·0), with a low glucose CSF to serum ratio of 0·45 (normal range 0·51–0·81); and a slightly elevated L-lactate concentration of 2·33 μmol/L (normal range 1·42–2·22). Identical oligoclonal IgG bands were present in the CSF and serum.
Repeated blood and CSF cultures remained negative. We considered the probable diagnosis to be a flare-up of the patient's SLE with striatal encephalitis and catastrophic antiphospholipid syndrome.

Despite early aggressive immunosuppressive therapy, which included corticosteroids, cyclophosphamide, plasmapheresis, rituximab, and intravenous immunoglobulin, and anticoagulant treatment with low-molecular-weight heparin, the patient developed multiorgan failure and died 2 months after admission.

At autopsy, a Libman-Sachs endocarditis of the aortic and mitral valves, with signs of recent and semi-recent ischaemia in multiple organs caused by microthrombi, including the brain, kidneys, coronary arteries, and lungs were seen; histopathological analysis of a specimen of the brain showed central nuclei with foci of ischaemic alterations with foamy macrophages (appendix). Additionally, sporadic perivascular lymphocytic infiltration of the basal ganglia was seen; however, as this may be secondary to the presence of thrombi, we were unable to conclusively diagnose either encephalitis or vasculitis. No abnormalities were seen in the substantia nigra. Therefore, the cause of death was multiorgan failure due to microthrombi resulting from Libman-Sachs endocarditis and catastrophic antiphospholipid syndrome. We assumed the extensive hyperintense lesions of the basal ganglia were related to an SLE-mediated striatal encephalitis, since they did not correspond to the brain regions showing multifocal ischaemia.
SLE and antiphospholipid syndrome both have very varied clinical presentations. Catastrophic antiphospholipid syndrome, while uncommon in SLE, is often fatal. Severe disease flares in SLE and catastrophic antiphospholipid syndrome require prompt, extensive treatment by a multidisciplinary team.

Contributors

We all provided care for the patient and contributed to writing and editing the manuscript. Written consent was obtained from the patient's husband.

• View related content for this article

по ссылке приложение и проч., но нало аккаунт на Ланцете

Subacute parkinsonism due to systemic lupus erythematosus and catastrophic antiphospholipid syndrome

Jasmijn A Hebbink, MD Edith Nobels-Janssen, MD Ivo Verhagen, MD Benno Kusters, PhD  Sjoert A H Pegge, MD Anil M Tuladhar, PhD

Published:December 03, 2022DOI:https://doi.org/10.1016/S0140-6736(22)01691-9

climate change

Изменение климата имеет все более серьезные последствия для здоровья людей во всем мире. К таким выводам пришли авторы ежегодного доклада "Обратный отсчет", опубликованного в медицинском журнале Lancet.

🔺Выяснилось, что от жары теперь умирают в полтора раза чаще, люди чаще заражаются инфекциями, которые разносят москиты, вроде малярии и лихорадки Денге.

🔺В 2020 году 4,7 млн человек умерли в результате загрязнения воздуха, говорится в докладе. Причем 1,3 млн смертей напрямую связаны с сжиганием ископаемого топлива.

🔺Одна из самых главных проблем - продовольственная безопасность. С острой нехваткой еды сейчас столкнулось уже на 100 млн человек больше, чем в период 1981-2010 годов.

🔺Площадь суши, затронутая сильной засухой, за последние полвека увеличилась почти на треть, что поставило сотни миллионов людей перед невозможностью вести сельское хозяйство и риском умереть от жажды.

🔺Перебои с поставками продуктов, вызванные вторжением России в Украину в феврале, наглядно продемонстрировали, насколько мир чувствителен к сбоям в пищевой логистике, и эта ситуация лишь усугубила последствия, вызванные климатическими изменениями.

Подробностi

Люди голодают, люди замерзают, люди умирают. У нас климатическая катастрофа, и вы боитесь только томатного супа или картофельного пюре на картине.

The Russian invasion of Ukraine and its public health consequences

By David A. Leon Dmitri Jdanov Christopher J. Gerry Pavel Grigoriev Domantas Jasilionis Martin McKee France Meslé Olga Penina Judyth Twigg Jacques Vallin Denny Vågerö

The unprovoked and unjustified Russian invasion of Ukraine on 24 February 2022 is already having terrible consequences for health. As we write, only seven days since Russian troops crossed the border, substantial numbers on both sides have died, many due to Russian attacks on civilian targets in violation of international law. [1]

This catastrophic turn of events comes hard on the heels of the two-year COVID-19 pandemic during which countries of Eastern Europe were among some of the worst affected. [2] All governments are struggling to replenish public finances, with health services facing great pressures, yet the invasion is resulting in substantial resources in Europe now being understandably diverted to bolster defences. [3]

The Ukrainian health system is facing exceptional pressure. Demand has vastly increased by the steeply growing number of casualties caused by the attacks on densely populated areas, alongside the ongoing needs of those with serious infectious and chronic conditions. However, its ability to meet these needs is being severely depleted by the reckless destruction of infrastructure, displacement of health workers and shortage of essential supplies, including oxygen.

The physical and mental health problems experienced by the anticipated millions of refugees and internally displaced persons will once again be substantial. [4] This is a major challenge that European countries appear to be responding to, although it is a sad reality that those most in need will be the least likely to make the arduous and sometimes dangerous journey to find safety outside of Ukraine. The long-term scars of physical injury and psychological trauma suffered by millions in Ukraine will be felt long after this war is past.

The impact of these events will also be felt in the months to come by the people of Russia and Belarus following imposition of unprecedented economic sanctions. Their health systems will face severe shortages, including modern therapies, many of which come from Western countries. Beyond this, the social, economic and political stresses will worsen the living conditions of many, and may potentially trigger substantially increased mortality similar to that seen following the collapse of the Soviet Union.

We have spent decades collaborating with colleagues in Eastern Europe and the former Soviet Union to understand why population health in these countries has historically lagged behind the West and what can be done to close the gap. This has been motivated by a desire to improve the health and welfare of ordinary people and not to protect, burnish or advance the reputations of governments or political leaders.

Along with much of the world we call for an end to the fighting and for Russian forces to withdraw immediately before causing further death and injury. However, the invasion of Ukraine raises particular questions for all scientists who have worked collaboratively in the region. We need to support, morally and practically, our Ukrainian colleagues who face threats to their lives. We welcome the decision of the European Union to offer sanctuary to all Ukrainians. For Ukrainian researchers and academics who leave their country we also need a special international programme that provides them with a supportive professional environment.

We note how several thousand scientists in Russia have signed a letter opposing the invasion, despite the risks this entails to their careers and possibly their liberty. [6] Those who are in danger due to their political views or speak out against the war should be supported by their international colleagues. More generally, we believe that contacts between individual researchers should be maintained and work continued to the extent that it is possible, and support the decision by Elsevier that its journals should not simply reject a scientific paper because it is from Russian researchers. [5] However, for now, institutional links between universities and research institutes in Russia and other countries, enshrined in formal agreements, should be suspended.

Finally, this war is not just about Ukraine and Russia. The threat of Russian expansion, with massive consequences for global security and sustainable development, coincides with other crises facing humanity including climate change and the prospect of future pandemics. The world should be coming together to tackle these existential global issues rather than being forced to respond to this disastrous war and the humanitarian crisis it is already creating.

Author contribution

The initial text was written by DAL and DJ with crucial input from other colleagues. Extensive suggestions and changes were made by all other authors over the course of a series of revisions all of whom contributed equally. All authors approved the final version prior to submission.

Declaration of interests

Authors do not have anything to declare.

References

1. ICRC. Practice relating to rule 6. Civilians’ loss of protection from attack. n.d. https://ihl-databases.icrc.org/customary-ihl/eng/docindex/v2_rul_rule6. Accessed 1st March 2022. View in Article Google Scholar 
2. Islam N. Jdanov D.A. Shkolnikov V.M. et al. Effects of covid-19 pandemic on life expectancy and premature mortality in 2020: time series analysis in 37 countries.BMJ. 2021; 375e066768 View in Article Google Scholar
3. Deutsche Welle. Germany commits €100 billion to defense spending. 2022. https://www.dw.com/en/germany-commits-100-billion-to-defense-spending/a-60933724. Accessed 27th February 2022. View in Article Google Scholar
4. Roberts B. Makhashvili N. Javakhishvili J. et al. Mental health care utilisation among internally displaced persons in Ukraine: results from a nation-wide survey.Epidemiol Psychiatr Sci. 2019; 28: 100-111 View in Article Google Scholar
5. Hassink L. Handling submissions that include Russian researchers. Elsevier author update 1st March 2022 2022. View in Article Google Scholar
6. An open letter from Russian scientists and science journalists against the war with Ukraine. 2022. https://www.eureporter.co/world/russia/2022/02/24/an-open-letter-from-russian-scientists-and-science-journalists-against-the-war-with-ukraine/. Accessed 27th February 2022.

What is wrong with global health?

Всё Open Access, как грицо: enjoy

At the beginning of 2021, The Lancet Global Health invited readers, particularly those who are not regular contributors to our pages, to share their expertise and experiences with us in the form of Correspondence, Viewpoints, and Comments on the theme: What is wrong with global health? This page presents a collection of all published responses.

Why and for whom are we decolonising global health?
The Lancet Global HealthVol. 9No. 10e1359–e1360Published: October, 2021
Ong’era F Mogaka
Jenell Stewart
Elizabeth Bukusi

Thinking outside the modern capitalist logic: health-care systems based in other world views
The Lancet Global HealthVol. 9No. 10e1355–e1356Published: October, 2021
Erika Arteaga-Cruz
Juan Cuvi

Transcending global health dogma: an Indigenous perspective
The Lancet Global HealthVol. 9No. 10e1357–e1358Published: October, 2021
Kirti Ranchod
Danilo Silva Guimarães

Says who? Northern ventriloquism, or epistemic disobedience in global health scholarship
The Lancet Global HealthVol. 9No. 9e1332–e1335Published: September, 2021
Thirusha Naidu

Voices in the wilderness: how exclusionist article processing charge policies of academic journals underscore what is wrong with global health
The Lancet Global HealthVol. 9No. 9e1205–e1207Published: September, 2021
Bassey Edem
Esin Nkereuwem
Oghenebrume Wariri

Epistemic injustice in academic global health
The Lancet Global HealthVol. 9No. 10e1465–e1470Published: August 9, 2021
Himani Bhakuni
Seye Abimbola

Systemic racism in global health: a personal reflection
The Lancet Global HealthVol. 9No. 8e1051–e1052Published: August, 2021
Bolajoko O Olusanya

Challenges for breaking down the old colonial order in global health research: the role of research funding
The Lancet Global HealthVol. 9No. 8e1057Published: August, 2021
Larissa Fortunato Araújo
Flávia B Pilecco
Francisco Gustavo Silveira Correia
Marcelo José Monteiro Ferreira

Reform of research funding processes could pave the way for progress in global health
The Lancet Global HealthVol. 9No. 8e1053–e1054Published: August, 2021
Gloria Ashuntantang
Valerie Luyckx
Saraladevi Naicker
Sridhar Venkatapuram

My experience in global health
The Lancet Global HealthVol. 9No. 8e1058Published: August, 2021
Girija Sankar

Coming to terms with COVID-19 personally and professionally in Bangladesh
The Lancet Global HealthVol. 9No. 10e1471–e1473Published: July 16, 2021
Senjuti Saha

Global health in low-income and middle-income countries: a framework for action
The Lancet Global HealthVol. 9No. 7e899–e900Published: July, 2021
Isaac Olufadewa
Miracle Adesina
Toluwase Ayorinde

Evidence-based medicine in low-income and middle-income countries
The Lancet Global HealthVol. 9No. 7e903–e904Published: July, 2021
Sudeep Adhikari

A call for reforms in global health publications
The Lancet Global HealthVol. 9No. 7e901–e902Published: July, 2021
Dhananjaya Sharma

The words we choose matter: recognising the importance of language in decolonising global health
The Lancet Global HealthVol. 9No. 7e897–e898Published: July, 2021
Franziska Hommes
Helena Brazal Monzó
Rashida Abbas Ferrand
Meggan Harris
Lioba A Hirsch
Emilie Koum Besson
John Manton
Toyin Togun
Robindra Basu Roy

all we need is

истерика, конечно, плохой помощник, если вообще
справедливо не только про СПИД

June 5, 2021 marks 40 years since the first description of cases of what came to be known as AIDS. Since then, remarkable progress has been made in understanding the disease and its treatment. The HIV response globally has not always been smooth but has become a model for community engagement.

The Lancet journals have been committed to supporting HIV research and communities affected since the early days and we mark this anniversary with a collection of content, old and new, from across the Lancet family.

Women's and Children's Health

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2020 has been a year like no other

In January 2020, a novel virus with pandemic potential was identified. Scientists mobilized like never before. With the help of our authors, peer reviewers, and readers, we have published the best available evidence to inform policy and clinical care, with the shared aim of protecting and improving lives around the world

The Lancet is an expanding family of journals covering all specialties. Our collective most read content in 2020 has mostly been on COVID-19. It has dominated all aspects of everyone’s lives, and rightly so. The pandemic is still ongoing. With over 1•5 million lives already tragically lost, health care disrupted, the education of over one billion children put on pause, and economic hardship faced by millions of people, the shadow of the pandemic will be long-lasting. COVID-19 will be one of many challenges we face in 2021, but we hope that by continuing to publish the best science, advocating for science to make a difference alongside our authors and partners, and proclaiming the right to health, to make a lasting contribution not just to science, but global society. 

шведский опыт от туда же — там есть ссылка на шведскую статистику

DALY

МОСКВА, 17 окт — РИА Новости. 

Исследование "Глобальное бремя болезней" показало в России самую низкую продолжительность здоровой жизни в Европе, сообщает журнал The Lancet.

В ходе исследования высчитывался показатель DALY (Disability-adjusted life year), обозначающий годы жизни, утраченные из-за потери здоровья или инвалидности. Чем он выше, тем больше хронических болезней у населения страны.
В последние десять лет в России этот показатель ежегодно снижался в среднем на 2%.

Однако, несмотря на этот прогресс, наша страна заняла последнее место в Европе по ожидаемой продолжительности здоровой жизни. В прошлом году этот показатель составил 63,7 года. Лидером стала Исландия с результатом 71,9 года.

Участвовавшие в исследовании российские ученые связывают слабый результат страны с высокими рисками неинфекционных болезней, вызываемых курением, употреблением алкоголя, неправильным питанием и низкой физической активностью.

Offline: The crisis of political language

George Orwell, in his 1945 essay Politics and the English Language, wrote that “to think clearly is a necessary first step towards political regeneration”. The Moscow press briefing held last week on the Russian COVID-19 vaccine quickly turned into a platform for national rivalry. The research, led by scientists at the N F Gamaleya National Research Centre for Epidemiology and Microbiology, found encouraging evidence of an immune response using their prime boost strategy of a two-component, human recombinant adenovirus vector-based vaccine. The study was small, non-randomised, uncontrolled, and did not include those most at risk of severe disease. The Russian team recognise these limitations and are proceeding with large randomised trials. The first results were released by Russian President Vladimir Putin on Aug 13. “I know that it works quite effectively”, he said, “forms strong immunity, and I repeat, it has passed all the needed checks”. At last week's event, more big claims were made. The “poorly researched approaches” by “western” nations were criticised, and one speaker challenged western governments to respond to these alleged concerns—“would you please show your citizens” evidence about the safety of western vaccine candidates given the “poorly developed platforms” you are using, he said. “It doesn't make any sense to use poorly researched approaches”, he argued. His view was that a human adenovirus vector was safer than a chimpanzee adenovirus vector (the basis for the Oxford COVID-19 vaccine, for example). A press conference to present the results of a scientific study became the venue for renewed Cold War conflict. 

Russia isn't the only country to use COVID-19 as a tool to fight perceived adversaries. US President Donald Trump routinely refers to SARS-CoV-2 as the “China virus”. He is seeking to amplify the American public's fear of China to wound his opponent in the current presidential campaign. In Latrobe, PA, on Sept 3, President Trump suggested that, “Joe Biden wants to surrender your jobs to China”. The message is clear—China is America's enemy, it is the cause of a pandemic that has destroyed the US economy, and the policies of the Democrat candidate will only strengthen America's chief international competitor. There is not one shred of evidence to support these claims. The twisting of language in public discussion of the pandemic is now standard fare. “Thanks to the efforts of Operation Warp Speed”, said President Trump in Wilmington, NC, on Sept 2, “we remain on track to deliver a vaccine very rapidly, in record time”. He has suggested a vaccine might be available by the end of October—an important claim given that the US election will take place on Nov 3. Yet there is no possibility that a COVID-19 vaccine will be ready for public use before the US election. Orwell's reflection that language is used “with intent to deceive” in “the sordid processes of international politics” could not be more apposite.

Richard Horton
DOI:https://doi.org/10.1016/S0140-6736(20)31904-8

the letter to The Lancet

подписать можно до полуночи сегодня по Гринвичу

sub-Saharan Africa might exceed its projected population size

Why sub-Saharan Africa might exceed its projected population size by 2100

Alex Ezeh, Frances Kissling, Peter Singer
Open Access Published:July 14, 2020 DOI: https://doi.org/10.1016/S0140-6736(20)31522-1

как кажется, медики точно не понимают (им простительно, ибо они этого в школе не проходят, а надо бы), что такое population projection, но и часть демографов тоже

Christopher Murray and colleagues [ссылка на сопсно прогноз Мурэя и кампании] at the Institute for Health Metrics and Evaluation (IHME) report their new models of future global, regional, and national population scenarios as a function of fertility, migration, and mortality rates for 195 countries and territories from 2017 to 2100.

придётся читать оргинал, а не хотелось

с аналогичной критикой "Почему всем собирать коубнику в Южной Корее" уже выступал Д. Коулмен, тогда была идея "substition migration", теперь SDG

Regional population structures at a glance

ссылка

Political casualties of the COVID-19 pandemic

After implementing to varying degrees of success non-pharmaceutical interventions to control the COVID-19 outbreak, countries around the world are now lifting restrictions, many seemingly without heed of epidemic curves, reproductive number estimates, or regional differences in these. Economic pressures are driving these decisions, with the detrimental effects of an economic crisis anticipated to outweigh the damage caused by the virus. There is some justification for this concern: the World Bank estimates that at least 71 million people will be pushed into extreme poverty, itself a public health issue, as a result of the pandemic. Thus, for some countries it seems lifting lockdown restrictions is not a choice but a necessity. All countries, however, should endeavor to lift restrictions in a way that considers scientific evidence. Any increase in cases and deaths resulting from relaxing restrictions too quickly will likely diminish public trust at a time when public confidence in decision-makers is already low.

In the UK, which as of June 10 ranks fourth in the world in the number of COVID-19 cases and second in the number of deaths, public approval of the Conservative Government's handling of the COVID-19 outbreak has declined steadily during the lockdown. According to a YouGov survey, only 41% of people in the UK on May 29 said they thought the government was handling the issue of COVID-19 very or somewhat well, compared with a high of 72% on March 27. Loss of confidence in the UK Government results in part from confusing and inconsistent messaging at the government's daily media briefings, a lack of transparency around the scientific evidence and who exactly is informing policy, neglect of care homes as cases and deaths in hospitals rose, and refusal to acknowledge the dearth of personal protective equipment available to health-care workers. Prime Minister Boris Johnson's continued support of his chief advisor Dominic Cummings after Cummings broke lockdown rules was perhaps the final nail in the coffin of public trust. Unsurprisingly, hypocrisy and an attitude of “one rule for us, another for them” does not win public favor.

Elsewhere, public confidence in-country leadership is similarly declining. Unpopular internationally and domestically before the outbreak, support for Brazil's President Jair Bolsonaro has since taken a further nosedive because of his failure to acknowledge the seriousness of the pandemic and his open flouting of lockdown rules while thousands of Brazilians die from COVID-19. Bolsonaro's actions have sown confusion and dissent among the Brazilian population, made worse by the government's decision on June 5 to cease publishing cumulative totals of COVID-19 cases and deaths and to remove months of data from the public domain. After public outrage, accusations of censorship, and a ruling by a Supreme Court judge, these data were quickly reinstated, but the damage had already been done.

In the USA, President Donald Trump has made clear from the beginning of the outbreak that the US economy is his priority, and with encouragement from the president, many states had entirely lifted lockdown restrictions by the end of May. Lifting these measures occurred despite infections still increasing in some states and the country's ranking as worst affected in the world. The human toll of the pandemic in the USA, combined with disastrous press briefings, Trump's decision to terminate the USA's relationship with WHO, and his aggressive response to Black Lives Matter demonstrations, has led Trump's popularity to slump.

Public distrust of authorities has detrimental effects on the control of infectious diseases. Not only does it permit conspiracy theories to take hold, but it also fosters vaccine hesitancy. It is not clear when a COVID-19 vaccine will be ready to deploy, but its success will to a great extent be determined by people's acceptance of immunization. Vaccine hesitancy has been on the rise, and evidence from a survey in France suggests the situation is no different for COVID-19. 26% of respondents to the survey said they would not use a vaccine if one became available, with differences in acceptance related to the candidate who respondents voted for in the first round of the 2017 presidential election. This finding demonstrates the integral role of politicians in the acceptance of public health interventions. Public mistrust in leadership could also undermine the public's compliance with, and so the success of, responses to the second wave of infections.

Governments and political leaders around the world might become casualties of COVID-19. How they have responded to the outbreak and listened to and communicated with their citizens will be important in deciding their fates in future elections. Public trust must be earnt, and COVID-19 has made clear who is and is not worthy of that trust.

View related content for this article

The Lancet Infectious Diseases
Published: June 11, 2020 DOI

Salient lessons from Russia's COVID-19 outbreak

THE LANCET
Published: June 06, 2020 DOI:https://doi.org/10.1016/S0140-6736(20)31280-0

29-01-2020 Совещание о мерах по борьбе с распространением

коронавируса в России. Слева направо: Анна Юрьевна Попова,

Татьяна Алексеевна Голикова, Владимир Владимирович Путин,

Михаил Альбертович Мурашко.

Alexander Myasnikov, Russia's COVID-19 information chief, said in mid-April that it would be “impossible” for Russians to get the virus, estimating the probability of extensive spread in Russia at “0·0%”. This hubris has been sorely exposed. As of June 2, Russia has 423 186 cases, the third most in the world, while relatively few deaths from COVID-19 (5031) have been recorded. The rapid spread of the epidemic in Russia has highlighted the strengths and weaknesses of the health system, and presents the traditionally strong Russian leadership with a new challenge.

There were some grounds for optimism. The 2615-mile Chinese–Russian border was shut early, on Jan 30; population density in the country is low; and the public health system in Russia has long experience in the control of infectious diseases such as plague. Although many countries have cut back capacity over the past few decades, Russia has retained an extensive, albeit outdated, public health system. Testing capacity in Russia, for example, is vast, and was scaled up quickly. In Russia, more than 10 million tests have been done so far and more than 200 laboratories are providing same-day test results.

This large testing programme at least partly explains the high number of cases. Although many countries have very large numbers of cases, health officials publicly admit that the official number is still a sizeable underestimation. As for deaths, many explanations have been put forward for the relatively low mortality rate—from questions over how cause of death is attributed, to the presence of widespread testing—but data on excess deaths and all-cause mortality are needed to give the best insight into the true toll of the epidemic in Russia.

Nevertheless, like in many other countries, there have been conspicuous shortages of personal protective equipment (PPE) throughout the care system. According to one report, Russian health workers are 16 times more likely to die from COVID-19 than their counterparts in other countries, accounting for an estimated 7% of all COVID-19 deaths in Russia. Russian health workers report having been discouraged from highlighting PPE shortages. There have also been problems with ventilators, a situation emblematic of Russia's vast but creaking health system. Before the epidemic, Russia had 27 ventilators per 100 000 citizens, far more than the 18·8 per 100 000 in the USA. However, many of these ventilators were old and doctors have complained about their quality.

There are also regional variations to contend with. Quality of health care differs greatly across Russia's many regions, which have varying levels of preparation and equipment. A doctor speaking to the BBCcalled the kit available to doctors in Dagestan “primitive”, and the region has capacity for fewer than 1000 tests a day among a population of more than 3 million. According to a local health minister, 40 health workers have died of COVID-19 in Dagestan, which is more than the official total of all COVID-19 fatalities for the region.

Regionalisation and delegation have led to a problem with overall public health messaging, a consistent feature of countries struggling to manage their COVID-19 outbreaks. On May 11, President Vladimir Putin called an end to Russia's “non-working period”, first declared on March 30. As part of these measures, wages were paid by companies for furloughed workers, rather than the state, but the removal of these measures meant companies could refuse to pay workers who did not return to work. The return to work for Russians clashed with the message from deputy prime minister, Tatiana Golikova, who subsequently explained that only 11 of Russia's 85 regions were in the position to loosen restrictions at all. Although regions have been in charge of their own lockdown measures, the message from the central powers has been the need to return to work and restart the economy.

Among all of this, public trust in Putin appears to be eroding, with his approval rating tumbling in recent weeks. There is a sense that by leaving the difficult decisions about public health to the regions he will absent himself from blame for the toll of the pandemic in Russia. The USA, Brazil, and to an extent the UK, have seen how local government and the public often have to use their own best judgment when they do not receive direct, consistent messaging from the top. There are many unique factors at play in the Russian epidemic, but a lack of clear political leadership has become a common hallmark of countries that have suffered the most.

covid reproductive number

estimated basic reproductive number

Risk of spread outside Wuhan

(A) Cumulative number of confirmed cases of 2019 novel coronavirus as of Jan 28, 2020, in Wuhan, in mainland China (including Wuhan), and outside mainland China. (B) Major routes of outbound air and train travel originating from Wuhan during chunyun, 2019. Darker and thicker edges represent greater numbers of passengers. International outbound air travel (yellow) constituted 13·5% of all outbound air travel, and the top 40 domestic (red) outbound air routes constituted 81·3%. Islands in the South China Sea are not shown.

A 5-point strategy for improved connection with relatives of critically ill patients with COVID-19

1. Stimulate family visits by restricting them to the closest relative who is asymptomatic and able to apply optimal personal protective measures.
2. Standardized written information for relatives. This letter is sent to the relatives but also discussed during the first remote call between the health-care professionals and the family.
3. Schedule routine telephone calls with the relatives to maintain continuity of communication. The calls could be made by a medical student, a non-ICU physician, another health-care professional, or a volunteer. In addition to these calls, family members are invited to call the physician and bedside nurse once a day to receive basic information. More detailed information is to be provided during a face-to-face meeting when the relative visits the patient. For conscious patients, smartphones and digital tablets can allow video calls or virtual ICU visits.
4. Stay in touch by encouraging the family to find ways to improve the link with the relative (web-based remote family conferences, diaries, drawings, text messages, and media groups).
5. Switch to a different approach in end-of-life situations to avoid depriving family members of the opportunity to say goodbye to a relative. For example, family conferences should be organized, remotely if needed, to meet family needs and prepare for the bereavement. The relative should be allowed to stay in the room as much as possible. However, the safety of the relative is a primary concern, and the health-care professionals must provide the relative with training in the use of personal protective equipment.

The Lancet

Centring sexual and reproductive health and justice in the global COVID-19 response

Global responses to the coronavirus disease 2019 (COVID-19) pandemic are converging with pervasive, existing sexual and reproductive health and justice inequities to disproportionately impact the health, wellbeing, and economic stability of women, girls, and vulnerable populations. People whose human rights are least protected are likely to experience unique difficulties from COVID-19. Women, girls, and marginalized groups are likely to carry a heavier burden of what will be the devastating downstream economic and social consequences of this pandemic. A sexual and reproductive health and justice framework—one that centers human rights, acknowledges intersecting injustices, recognizes power structures, and unites across identities—is essential for monitoring and addressing the inequitable gender, health, and social effects of COVID-19.

The complex interplay between biological and behavioral risk factors needs to be recognized during the COVID-19 pandemic. It is not yet known whether the higher COVID-19 case fatality rates reported in men compared with women in China, South Korea, and Italy to date are attributed to sex-specific biological susceptibility, variations in pre-existing comorbidities, behavioral risk factors, or some combination of these factors. In terms of behavioral risk factors, women's risk of contracting COVID-19 may be higher than men's risk as women are front-line providers, comprising 70% of the global health and social care workforce, and they do three times as much unpaid care work at home as men.

Moreover, pregnant women could be at risk of pregnancy-related complications during the COVID-19 pandemic. Severe acute respiratory syndrome and Middle East respiratory syndrome were associated with increased risk of pregnancy-related morbidity and mortality, but data on COVID-19 are scarce. In China, among nine women in their third trimester with COVID-19, clinical outcomes were similar to non-pregnant adults. Yet another study of 33 neonates born to mothers with COVID-19 identified intrauterine vertical transmission of COVID-19 in three neonates. However, studies to date have been based on third-trimester cases and viral infections during pregnancy are typically most severe during the first 20 weeks of gestation.

Disruption of services and diversion of resources away from essential sexual and reproductive health care because of prioritizing the COVID-19 response is expected to increase risks of maternal and child morbidity and mortality. Globally, there are anticipated shortages of contraception. Sexual and reproductive health providers and clinics, which are the primary care providers and a safety net for women of reproductive age, youth, those uninsured for health care, and people on low incomes in many countries including in the USA, may also be deemed non-essential and diverted to respond to COVID-19. Past humanitarian crises have shown that reduced access to family planning, abortion, antenatal, HIV, gender-based violence, and mental health care services results in increased rates and sequelae from unintended pregnancies, unsafe abortions, sexually transmitted infections (STIs), pregnancy complications, miscarriage, post-traumatic stress disorder, depression, suicide, intimate partner violence, and maternal and infant mortality. Additionally, systemic racism, discrimination, and stigma are likely to further compound logistical barriers to accessing sexual and reproductive health care for women and marginalized groups.

Restrictive global policies that target vulnerable populations will exacerbate sexual and reproductive health and justice inequities. The US administration's Protecting Life in Global Health Assistance (PLGHA) policy is of grave concern. The PLGHA expanded the Global Gag Rule (the Mexico City policy), which blocks US global health assistance to foreign non-governmental organizations that provide, counsel, refer, or advocate for abortion services. Three crucial impacts of the PLGHA include decreased stakeholder coordination and chilling of sexual and reproductive health and rights discussions; reduced access to family planning, with increases in unintended pregnancy and induced abortion; and negative outcomes beyond sexual and reproductive health, including weakened health systems functioning. Migration policies of deterrence, including closures at US and European borders, force women to live in informal settlements or conditions of poverty for long periods of time, often without basic sanitation and hygiene or access to health care during antenatal and postnatal periods.

Only when public health responses to COVID-19 leverage intersectional, human-rights centered frameworks, transdisciplinary science-driven theories and methods, and community-driven approaches, will they sufficiently prevent complex health and social adversities for women, girls, and vulnerable populations. The way forwards will not be easy. Even rigorous implementation of science-driven approaches might not match the pace of COVID-19 threats in the face of reduced human capacity, shortages of drugs and supplies, and increased demands on already strained sexual and reproductive health services.

For clinical services and programs, additional resources must be directed to, not diverted from, the sexual and reproductive health workforce so that effective, evidence-based approaches are deployed. Previous humanitarian crises have shown the crucial role of contraception and medication abortion for the prevention of unintended pregnancy and maternal mortality. Resources also need to ensure access to skilled health workers for deliveries and emergency obstetric care. Telemedicine can be used to provide access to services for medication abortion, contraception, and expedited partner therapy for STI prevention, as well as trauma-informed care for managing gender-based violence, post-traumatic stress disorder, depression, and suicide.

Sex-disaggregated mortality and morbidity surveillance data should be a priority in COVID-19 research. Plans must prioritize protections for participants but account for gender perspectives, lived experiences, and outcomes in research design, intervention, evaluation, interpretation, and dissemination. Immediate research priorities focused on identifying the pathophysiology of the disease and the development of vaccines and therapeutics should give explicit attention to sex differences in viral transmission and disease progression, biological, social, and environmental risks by gender, and safety of vaccines and drugs for pregnant and lactating women.

All these efforts must be community-driven. Recognition of inequitable power structures, distribution of resources, and a collaborative approach dictate the way forward. Advocates must continue to fight the exploitation of the COVID-19 crisis to further an agenda that restricts access to essential sexual and reproductive health services, particularly abortion, and targets immigrants and adolescents.

A sexual and reproductive health and justice policy agenda must be at the heart of the COVID-19 response. The response must ensure that universal health coverage includes pregnant women, adolescents, and marginalized groups and must designate sexual and reproductive health, family planning, and community health centers as essential health providers, reallocating resources accordingly. Policymakers should scale up telemedicine for needed, evidence-based care for women and girls, including sexual and reproductive health care. Finally, the response must eliminate legal and policy restrictions to sexual and reproductive health service provision and reverse the PLGHA and Global Gag Rule [из-за этого стока букаф] to ensure comprehensive sexual and reproductive health care for women and girls around the world.

Есть и плохие новости:

The relationship between chronic diseases and number of sexual partners: an exploratory analysis