Examinando por Autor "Kazmi, Khawar"
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- PublicaciónAcceso abiertoAvailability and affordability of medicines and cardiovascular outcomes in 21 high-income, middle-income and low-income countries(BMJ Journals, 2020-11-05) Chow, Clara Kayei; Nguyen, Ngoc; Marschner, Simone; Diaz, Rafael; Rahman, Omar; Avezum, Alvaro; Lear, Scott A.; Teo, Koon; Yeates, Karen; Lanas, Fernando; Li, Wei; Hu, Bo; Lopez-Jaramillo, Patricio; Gupta, Rajeev; Kumar, Rajesh; Mony, Prem; Bahonar, Ahmad; Yusoff, Khalid; Khatib, Rasha; Kazmi, Khawar; Dans, Antonio; Zatonska, Katarzyna; Alhabib, Khalid F.; Kruger, Iolanthe Marike; Rosengren, Annika; Yusufali, Afzalhussein; Chifamba, Jephat; Rangarajan, Sumathy; McKee, Martin; Yusuf, Salim; MasiraObjectives We aimed to examine the relationship between access to medicine for cardiovascular disease (CVD) and major adverse cardiovascular events (MACEs) among people at high risk of CVD in high-income countries (HICs), upper and lower middle-income countries (UMICs, LMICs) and low-income countries (LICs) participating in the Prospective Urban Rural Epidemiology (PURE) study. Methods We defined high CVD risk as the presence of any of the following: hypertension, coronary artery disease, stroke, smoker, diabetes or age >55 years. Availability and affordability of blood pressure lowering drugs, antiplatelets and statins were obtained from pharmacies. Participants were categorised: group 1—all three drug types were available and affordable, group 2—all three drugs were available but not affordable and group 3—all three drugs were not available. We used multivariable Cox proportional hazard models with nested clustering at country and community levels, adjusting for comorbidities, sociodemographic and economic factors. Results Of 163 466 participants, there were 93 200 with high CVD risk from 21 countries (mean age 54.7,49% female). Of these, 44.9% were from group 1, 29.4% from group 2 and 25.7% from group 3. Compared with participants from group 1, the risk of MACEs was higher among participants in group 2 (HR 1.19, 95% CI 1.07 to 1.31), and among participants from group 3 (HR 1.25, 95% CI 1.08 to 1.50). Conclusion Lower availability and affordability of essential CVD medicines were associated with higher risk of MACEs and mortality. Improving access to CVD medicines should be a key part of the strategy to lower CVD globally.
- PublicaciónAcceso abiertoGlobal variations in the prevalence, treatment, and impact of atrial fibrillation in a multi-national cohort of 153 152 middle-aged individuals(Oxford Academic, 2021-06-05) Joseph, Philip; Healey, Jeffrey S.; Raina, Parminder; Connolly, Stuart J.; Ibrahim, Quazi; Gupta, Rajeev; Avezum, Alvaro; Dans, Antonio; Lopez-Jaramillo, Patricio; Yeates, Karen; Teo, Koon; Douma, Reuben; Bahonar, Ahmad; Chifamba, Jephat; Lanas, Fernando; Dagenais, Gilles R.; Lear, Scott; Kumar, Rajesh; Kengne, Andre P.; Keskinler, Mirac; Mohan, Viswanathan; Mony, Prem; Alhabib, Khalid F.; Huisman, Hugo; Iype, Thomas; Zatonska, Katarzyna; Ismail, Rosnah; Kazmi, Khawar; Rosengren, Annika; Rahman, Omar; Yusufali, Afzalhussein; Wei, Li; Orlandini, Andres; Islam, Shofiqul; Rangarajan, Sumathy; Yusuf, Salim; The PURE Investigators; MasiraAims To compare the prevalence of electrocardiogram (ECG)-documented atrial fibrillation (or flutter) (AF) across eight regions of the world, and to examine antithrombotic use and clinical outcomes. Methods and results Baseline ECGs were collected in 153 152 middle-aged participants (ages 35–70 years) to document AF in two community-based studies, spanning 20 countries. Medication use and clinical outcome data (mean follow-up of 7.4 years) were available in one cohort. Cross-sectional analyses were performed to document the prevalence of AF and medication use, and associations between AF and clinical events were examined prospectively. Mean age of participants was 52.1 years, and 57.7% were female. Age and sex-standardized prevalence of AF varied 12-fold between regions; with the highest in North America, Europe, China, and Southeast Asia (270–360 cases per 100 000 persons); and lowest in the Middle East, Africa, and South Asia (30–60 cases per 100 000 persons) (P < 0.001). Compared with low-income countries (LICs), AF prevalence was 7-fold higher in middle-income countries (MICs) and 11-fold higher in high-income countries (HICs) (P < 0.001). Differences in AF prevalence remained significant after adjusting for traditional AF risk factors. In LICs/MICs, 24% of participants with AF and a CHADS2 score ≥1 received antithrombotic therapy, compared with 85% in HICs. AF was associated with an increased risk of stroke [hazard ratio (HR) 2.29; 95% confidence interval (CI) 1.49–3.52] and death (HR 2.97; 95% CI 2.25–3.93); with similar rates in different countries grouped by income level. Conclusions Large variations in AF prevalence occur in different regions and countries grouped by income level, but this is only partially explained by traditional AF risk factors. Antithrombotic therapy is infrequently used in poorer countries despite the high risk of stroke associated with AF.
- PublicaciónAcceso abiertoHousehold and personal air pollution exposure measurements from 120 communities in eight countries(The Lancet Planetary Health, 2020-10-01) Shupler, Matthew; Hystad, Perry; Birch, Aaron; Miller-Lionberg, Daniel; Jeronimo, Matthew; Arku, Raphael E.; Chu, Yen Li; Mushtaha, Maha; Heenan, Laura; Rangarajan, Sumathy; Seron, Pamela; Lanas, Fernando; Cazor, Fairuz; Lopez-Jaramillo, Patricio; Camacho López, Paul Anthony; Perez, Maritza; Yeates, Karen; West, Nicola; Ncube, Tatenda; Ncube, Brian; Chifamba, Jephat; Yusuf, Rita; Khan, Afreen; Hu, Bo; Liu, Xiaoyun; Wei, Li; Tse, Lap Ah; Mohan, Deepa; Kumar, Parthiban; Gupta, Rajeev; Mohan, Indu; Jayachitra, K. G.; Mony, Prem K.; Rammohan, Kamala; Nair, Sanjeev; Lakshmi, P. V. M.; Sagar, Vivek; Khawaja, Rehman; Iqbal, Romaina; Kazmi, Khawar; Yusuf, Salim; Brauer, Michael; thePURE-AIR study; EverestBackground Approximately 2·8 billion people are exposed to household air pollution from cooking with polluting fuels. Few monitoring studies have systematically measured health-damaging air pollutant (ie, fine particulate matter [PM2·5] and black carbon) concentrations from a wide range of cooking fuels across diverse populations. This multinational study aimed to assess the magnitude of kitchen concentrations and personal exposures to PM2·5 and black carbon in rural communities with a wide range of cooking environments. Methods As part of the Prospective Urban and Rural Epidemiological (PURE) cohort, the PURE-AIR study was done in 120 rural communities in eight countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Data were collected from 2541 households and from 998 individuals (442 men and 556 women). Gravimetric (or filter-based) 48 h kitchen and personal PM2·5 measurements were collected. Light absorbance (10− ⁵m− ¹) of the PM2·5 filters, a proxy for black carbon concentrations, was calculated via an image-based reflectance method. Surveys of household characteristics and cooking patterns were collected before and after the 48 h monitoring period. Findings Monitoring of household air pollution for the PURE-AIR study was done from June, 2017, to September, 2019. A mean PM2·5 kitchen concentration gradient emerged across primary cooking fuels: gas (45 μg/m³ [95% CI 43–48]), electricity (53 μg/m³ [47–60]), coal (68 μg/m³ [61–77]), charcoal (92 μg/m³ [58–146]), agricultural or crop waste (106 μg/m³ [91–125]), wood (109 μg/m³ [102–118]), animal dung (224 μg/m³ [197–254]), and shrubs or grass (276 μg/m³ [223–342]). Among households cooking primarily with wood, average PM2·5 concentrations varied ten-fold (range: 40–380 μg/m³). Fuel stacking was prevalent (981 [39%] of 2541 households); using wood as a primary cooking fuel with clean secondary cooking fuels (eg, gas) was associated with 50% lower PM2·5 and black carbon concentrations than using only wood as a primary cooking fuel. Similar average PM2·5 personal exposures between women (67 μg/m³ [95% CI 62–72]) and men (62 [58–67]) were observed. Nearly equivalent average personal exposure to kitchen exposure ratios were observed for PM2·5 (0·79 [95% 0·71–0·88] for men and 0·82 [0·74–0·91] for women) and black carbon (0·64 [0·45–0·92] for men and 0·68 [0·46–1·02] for women). Interpretation Using clean primary fuels substantially lowers kitchen PM2·5 concentrations. Importantly, average kitchen and personal PM2·5 measurements for all primary fuel types exceeded WHO’s Interim Target-1 (35 μg/m³ annual average), highlighting the need for comprehensive pollution mitigation strategies.
- PublicaciónAcceso abiertoMultinational prediction of household and personal exposure to fine particulate matter (PM2.5) in the PURE cohort study(Elsevier, 2022-01-15) Shupler, Matthew; Hystad, Perry; Birch, Aaron; Li Chu, Yen; Jeronimo, Matthew; Miller-Lionberg, Daniel; Gustafson, Paul; Rangarajan, Sumathy; Mustaha, Maha; Heenan, Laura; Seron, Pamela; Lanas, Fernando; Cazor, Fairuz; Oliveros, Maria Jose; Lopez-Jaramillo, Patricio; Camacho López, Paul Anthony; Otero, Johanna; Perez, Maritza; Yeates, Karen; West, Nicola; Ncube, Tatenda; Ncube, Brian; Chifamba, Jephat; Yusuf, Rita; Khan, Afreen; Liu, Zhiguang; Wu, Shutong; Wei, Li; Tse, Lap Ah; Mohan, Deepa; Kuma, Parthiban; Gupta, Rajeev; Mohan, Indu; Jayachitra, K.G.; Mony, Prem; Rammohan, Kamala; Nair, Sanjeev; Lakshmi, P.V.M.; Sagar, Vivek; Khawaja, Rehman; Iqbal, Romaina; Kazmi, Khawar; Yusuf, Salim; Brauer, Michael; PURE-AIR study investigators; MasiraAbstract Introduction Use of polluting cooking fuels generates household air pollution (HAP) containing health-damaging levels of fine particulate matter (PM2.5). Many global epidemiological studies rely on categorical HAP exposure indicators, which are poor surrogates of measured PM2.5 levels. To quantitatively characterize HAP levels on a large scale, a multinational measurement campaign was leveraged to develop household and personal PM2.5 exposure models. Methods The Prospective Urban and Rural Epidemiology (PURE)-AIR study included 48-hour monitoring of PM2.5 kitchen concentrations (n = 2,365) and male and/or female PM2.5 exposure monitoring (n = 910) in a subset of households in Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania and Zimbabwe. PURE-AIR measurements were combined with survey data on cooking environment characteristics in hierarchical Bayesian log-linear regression models. Model performance was evaluated using leave-one-out cross validation. Predictive models were applied to survey data from the larger PURE cohort (22,480 households; 33,554 individuals) to quantitatively estimate PM2.5 exposures. Results The final models explained half (R2 = 54%) of the variation in kitchen PM2.5 measurements (root mean square error (RMSE) (log scale):2.22) and personal measurements (R2 = 48%; RMSE (log scale):2.08). Primary cooking fuel type, heating fuel type, country and season were highly predictive of PM2.5 kitchen concentrations. Average national PM2.5 kitchen concentrations varied nearly 3-fold among households primarily cooking with gas (20 μg/m3 (Chile); 55 μg/m3 (China)) and 12-fold among households primarily cooking with wood (36 μg/m3 (Chile)); 427 μg/m3 (Pakistan)). Average PM2.5 kitchen concentration, heating fuel type, season and secondhand smoke exposure were significant predictors of personal exposures. Modeled average PM2.5 female exposures were lower than male exposures in upper-middle/high-income countries (India, China, Colombia, Chile). Conclusion Using survey data to estimate PM2.5 exposures on a multinational scale can cost-effectively scale up quantitative HAP measurements for disease burden assessments. The modeled PM2.5 exposures can be used in future epidemiological studies and inform policies targeting HAP reduction.
- PublicaciónAcceso abiertoPersonal and household PM2.5 and black carbon exposure measures and respiratory symptoms in 8 low- and middle-income countries(2022-09-01) Wang, Ying; Shupler, Matthew; Birch, Aaron; Li-Chu, Yen; Jeronimo, Matthew; Rangarajan, Sumathy; Mustaha, Maha; Heenan, Laura; Seron, Pamela; Saavedra, Nicolas; Oliveros, Maria Jose; Lopez-Jaramillo, Patricio; Camacho-Lopez, Paul Antony; Otero, Johnna; Perez-Mayorga, Maritza; Yeates, Karen; West, Nicola; Ncube, Tatenda; Ncube, Brian; Chifamba, Jephat; Yusuf, Rita; Khan, Afreen; Liu, Zhiguang; Cheng, Xiaoru; Wei, Li; Tse, L.A.; Mohan, Deepa; Kumar, Parthiban; Gupta, Rajeev; Mohan, Indu; Jayachitra, K.G.; Mony, Prem K.; Rammohan, Kamala; Nair, Sanjeev; Lakshmi, P.V.M.; Sagar, Vivek; Khawaja, Rehman; Iqbal, Romaina; Kazmi, Khawar; Yusuf, Salim; Brauer, Michael; Hystad, Perry; PURE-AIR study investigators; MasiraBackground Household air pollution (HAP) from cooking with solid fuels has been associated with adverse respiratory effects, but most studies use surveys of fuel use to define HAP exposure, rather than on actual air pollution exposure measurements. Objective To examine associations between household and personal fine particulate matter (PM2.5) and black carbon (BC) measures and respiratory symptoms. Methods As part of the Prospective Urban and Rural Epidemiology Air Pollution study, we analyzed 48-h household and personal PM2.5 and BC measurements for 870 individuals using different cooking fuels from 62 communities in 8 countries (Bangladesh, Chile, China, Colombia, India, Pakistan, Tanzania, and Zimbabwe). Self-reported respiratory symptoms were collected after monitoring. Associations between PM2.5 and BC exposures and respiratory symptoms were examined using logistic regression models, controlling for individual, household, and community covariates. Results The median (interquartile range) of household and personal PM2.5 was 73.5 (119.1) and 65.3 (91.5) μg/m3, and for household and personal BC was 3.4 (8.3) and 2.5 (4.9) x10−5 m−1, respectively. We observed associations between household PM2.5 and wheeze (OR: 1.25; 95%CI: 1.07, 1.46), cough (OR: 1.22; 95%CI: 1.06, 1.39), and sputum (OR: 1.26; 95%CI: 1.10, 1.44), as well as exposure to household BC and wheeze (OR: 1.20; 95%CI: 1.03, 1.39) and sputum (OR: 1.20; 95%CI: 1.05, 1.36), per IQR increase. We observed associations between personal PM2.5 and wheeze (OR: 1.23; 95%CI: 1.00, 1.50) and sputum (OR: 1.19; 95%CI: 1.00, 1.41). For household PM2.5 and BC, associations were generally stronger for females compared to males. Models using an indicator variable of solid versus clean fuels resulted in larger OR estimates with less precision. Conclusions We used measurements of household and personal air pollution for individuals using different cooking fuels and documented strong associations with respiratory symptoms.
- PublicaciónRestringidoPrevalence, awareness, treatment, and control of hypertension in rural and urban communities in high-, middle-, and low-income countries(2013-09-04) Chow, Clara K.; Teo, Koon; Rangarajan, Sumathy; Islam, Shofiqul; Gupta, Rajeev; Avezum, Alvaro; Bahonar, Ahmad; Chifamba, Jephat; Dagenais, Gilles; Diaz, Rafael; Kazmi, Khawar; Lanas, Fernando; Wei, Li; Lopez-Jaramillo, Patricio; Fanghong, Lu; Ismail, Noorhassim; Puoane, Thandi; Rosengren, Annika; Szuba, Andrzej; Temizhan, Ahmet; Wielgosz, Andy; Yusuf, Rita; Yusufali, Afzalhussein; McKee, Martin; Liu, Lisheng; Mony, Prem; Yusuf, Salim; The PURE (Prospective Urban Rural Epidemiology) Study investigatorsImportance Hypertension is the most important preventable cause of morbidity and mortality globally, yet there are relatively few data collected using standardized methods. Objective To examine hypertension prevalence, awareness, treatment, and control in participants at baseline in the Prospective Urban Rural Epidemiology (PURE) study. Design, Setting, and Participants A cross-sectional study of 153 996 adults (complete data for this analysis on 142 042) aged 35 to 70 years, recruited between January 2003 and December 2009. Participants were from 628 communities in 3 high-income countries (HIC), 10 upper–middle-income and low–middle-income countries (UMIC and LMIC), and 4 low-income countries (LIC). Main Outcomes and Measures Hypertension was defined as individuals with self-reported treated hypertension or with an average of 2 blood pressure measurements of at least 140/90 mm Hg using an automated digital device. Awareness was based on self-reports, treatment was based on the regular use of blood pressure–lowering medications, and control was defined as individuals with blood pressure lower than 140/90 mm Hg. Results Among the 142 042 participants, 57 840 (40.8%; 95% CI, 40.5%-41.0%) had hypertension and 26 877 (46.5%; 95% CI, 46.1%-46.9%) were aware of the diagnosis. Of those who were aware of the diagnosis, the majority (23 510 [87.5%; 95% CI, 87.1%-87.9%] of those who were aware) were receiving pharmacological treatments, but only a minority of those receiving treatment were controlled (7634 [32.5%; 95% CI, 31.9%-33.1%]). Overall, 30.8%, 95% CI, 30.2%-31.4% of treated patients were taking 2 or more types of blood pressure–lowering medications. The percentages aware (49.0% [95% CI, 47.8%-50.3%] in HICs, 52.5% [95% CI, 51.8%-53.2%] in UMICs, 43.6% [95% CI, 42.9%-44.2%] in LMICs, and 40.8% [95% CI, 39.9%-41.8%] in LICs) and treated (46.7% [95% CI, 45.5%-47.9%] in HICs, 48.3%, [95% CI, 47.6%-49.1%] in UMICs, 36.9%, [95% CI, 36.3%-37.6%] in LMICs, and 31.7% [95% CI, 30.8%-32.6%] in LICs) were lower in LICs compared with all other countries for awareness (P <.001) and treatment (P <.001). Awareness, treatment, and control of hypertension were higher in urban communities compared with rural ones in LICs (urban vs rural, P <.001) and LMICs (urban vs rural, P <.001), but similar for other countries. Low education was associated with lower rates of awareness, treatment, and control in LICs, but not in other countries. Conclusions and Relevance Among a multinational study population, 46.5% of participants with hypertension were aware of the diagnosis, with blood pressure control among 32.5% of those being treated. These findings suggest substantial room for improvement in hypertension diagnosis and treatment. High blood pressure is the leading cause of cardiovascular disease (CVD) and deaths globally. It is associated with at least 7.6 million deaths per year worldwide (13.5% of all deaths), making it the leading risk factor for CVD.1 The majority of CVD occurs in low-, low–middle-, and upper–middle-income countries (LIC, LMIC, and UMIC).1,2 The importance of blood pressure as a modifiable risk factor for CVD is well-recognized and many effective and inexpensive blood pressure–lowering treatments are available. Therefore, hypertension control and prevention of subsequent morbidity and mortality clearly should be achievable. Information on hypertension prevalence, awareness, treatment, and control in multiple countries and different types of communities is necessary to provide a baseline for monitoring and also to inform the development of new strategies for improving hypertension control. A number of initiatives from the World Health Organization (WHO) have documented prevalence of hypertension and some have recorded treatment rates.3-5 The largest systematic analysis of health surveys from 199 countries for individuals aged 25 years and older was conducted in 2008 and reported the prevalence and mean of hypertension.6 However, most studies were limited to few countries and were conducted at least 2 decades ago, few reported awareness, and none reported on variations between urban vs rural settings, economic status and other variables, rates of blood pressure control, or the types of treatments used. Such information is key to developing strategies for better detection and control of hypertension globally. The overall Prospective Urban Rural Epidemiology (PURE) study is a prospective, standardized collaborative study7,8 in which we report a cross-sectional analysis of baseline data to assess the prevalence, awareness, treatment, and control of hypertension by the economic status of countries and by sex, age group, location (urban vs rural), and education of the participants.
- PublicaciónAcceso abiertoThe Anti-Coronavirus Therapies (ACT) Trials: Design, Baseline Characteristics, and Challenges(2022-06-05) Eikelboom, John; Rangarajan, Sumathy; Jolly, Sanjit S.; Belley-Cote, Emilie P.; Whitlock, Richard; Beresh, Heather; Lewis, Gayle; Xu, Lizhen; Chan, Noel; Bangdiwala, Shrikant; Diaz, Rafael; Orlandini, Andres; Hassany, Mohamed; Tarhuni, Wadea M.; Yusufali, A.M.; Sharma, Sanjib Kumar; Kontsevaya, Anna; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Dans, Antonio L.; Wasserman, Sean; Felix, Camilo; Kazmi, Khawar; Pais, Prem; Xavier, Denis; Lopes, Renato D.; Berwanger, Otavio; Nkeshimana, Menelas; Harper, William; Loeb, Mark; Choudhri, Shurjeel; Farkouh, Michael E.; Bosch, Jackie; Anand, Sonia S.; Yusuf, Salim; MasiraBackground: Effective treatments for COVID-19 are urgently needed, but conducting randomized trials during the pandemic has been challenging.Methods: The Anti-Coronavirus Therapy (ACT) trials are parallel factorial international trials that aimed to enroll 3500 outpatients and 2500 inpatients with symptomatic COVID-19. The outpatient trial is evaluating colchicine vs usual care, and aspirin vs usual care. The primary outcome for the colchicine randomization is hospitalization or death, and for the aspirin randomization, it is major thrombosis, hospitalization, or death. The inpatient trial is evaluating colchicine vs usual care, and the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily vs usual care. The primary outcome for the colchicine randomization is need for high-flow oxygen, need for mechanical ventilation, or death, and for the rivaroxaban plus aspirin randomization, it is major thrombotic events, need for high-flow oxygen, need for mechanical ventilation, or death. Results: At the completion of enrollment on February 10, 2022, the outpatient trial had enrolled 3917 patients, and the inpatient trial had enrolled 2611 patients. Challenges encountered included lack of preliminary data about the interventions under evaluation, uncertainties related to the expected event rates, delays in regulatory and ethics approvals, and in obtaining study interventions, as well as the changing pattern of the COVID-19 pandemic. Conclusions: The ACT trials will determine the efficacy of antiinflammatory therapy with colchicine, and antithrombotic therapy with aspirin given alone or in combination with rivaroxaban, across the spectrum of mild, moderate, and severe COVID-19. Lessons learned from the conduct of these trials will inform planning of future trials.
- PublicaciónAcceso abiertoVariations in common diseases, hospital admissions, and deaths in middle-aged adults in 21 countries from five continents (PURE)(Elsevier Inc., 2019-09-03) Dagenais, Gilles R.; Leong, Darryl P.; Rangarajan, Sumathy; Lanas, Fernando; Lopez-Jaramillo, Patricio; Gupta, Rajeev; Diaz, Rafael; Avezum, Alvaro; Alhabib, Khalid F.; Temizhan, Ahmet; Ismail, Noorhassim; Chifamba, Jephat; Yeates, Karen; Khatib, Rasha; Rahman, Omar; Zatonska, Katarzyna; Kazmi, Khawar; Wei, Li; Zhu, Jun; Rosengren, Annika; Vijayakumar, K.; Kaur, Manmeet; Mohan, Viswanathan; Yusufali, AfzalHussein; Kelishadi, Roya; Teo, Koon K.; Joseph, Philip; Yusuf, Salim; Elsevier; EverestBackground To our knowledge, no previous study has prospectively documented the incidence of common diseases and related mortality in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) with standardised approaches. Such information is key to developing global and context-specific health strategies. In our analysis of the Prospective Urban Rural Epidemiology (PURE) study, we aimed to evaluate differences in the incidence of common diseases, related hospital admissions, and related mortality in a large contemporary cohort of adults from 21 HICs, MICs, and LICs across five continents by use of standardised approaches. Methods The PURE study is a prospective, population-based cohort study of individuals aged 35–70 years who have been enrolled from 21 countries across five continents. The key outcomes were the incidence of fatal and non-fatal cardiovascular diseases, cancers, injuries, respiratory diseases, and hospital admissions, and we calculated the age-standardised and sex-standardised incidence of these events per 1000 person-years. Findings This analysis assesses the incidence of events in 162 534 participants who were enrolled in the first two phases of the PURE core study, between Jan 6, 2005, and Dec 4, 2016, and who were assessed for a median of 9·5 years (IQR 8·5–10·9). During follow-up, 11 307 (7·0%) participants died, 9329 (5·7%) participants had cardiovascular disease, 5151 (3·2%) participants had a cancer, 4386 (2·7%) participants had injuries requiring hospital admission, 2911 (1·8%) participants had pneumonia, and 1830 (1·1%) participants had chronic obstructive pulmonary disease (COPD). Cardiovascular disease occurred more often in LICs (7·1 cases per 1000 person-years) and in MICs (6·8 cases per 1000 person-years) than in HICs (4·3 cases per 1000 person-years). However, incident cancers, injuries, COPD, and pneumonia were most common in HICs and least common in LICs. Overall mortality rates in LICs (13·3 deaths per 1000 person-years) were double those in MICs (6·9 deaths per 1000 person-years) and four times higher than in HICs (3·4 deaths per 1000 person-years). This pattern of the highest mortality in LICs and the lowest in HICs was observed for all causes of death except cancer, where mortality was similar across country income levels. Cardiovascular disease was the most common cause of deaths overall (40%) but accounted for only 23% of deaths in HICs (vs 41% in MICs and 43% in LICs), despite more cardiovascular disease risk factors (as judged by INTERHEART risk scores) in HICs and the fewest such risk factors in LICs. The ratio of deaths from cardiovascular disease to those from cancer was 0·4 in HICs, 1·3 in MICs, and 3·0 in LICs, and four upper-MICs (Argentina, Chile, Turkey, and Poland) showed ratios similar to the HICs. Rates of first hospital admission and cardiovascular disease medication use were lowest in LICs and highest in HICs. Interpretation Among adults aged 35–70 years, cardiovascular disease is the major cause of mortality globally. However, in HICs and some upper-MICs, deaths from cancer are now more common than those from cardiovascular disease, indicating a transition in the predominant causes of deaths in middle-age. As cardiovascular disease decreases in many countries, mortality from cancer will probably become the leading cause of death. The high mortality in poorer countries is not related to risk factors, but it might be related to poorer access to health care. Funding Full funding sources are listed at the end of the paper (see Acknowledgments).