Examinando por Autor "Kruger, Iolanthé M."
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- PublicaciónAcceso abiertoAssociation of Symptoms of Depression with Cardiovascular Disease and Mortality in Low-, Middle-, and High-Income Countries(American Medical Association, 2020-06-10) Rajan, Selina; McKee, Martin; Rangarajan, Sumathy; Bangdiwala, Shrikant; Rosengren, Annika; Gupta, Rajeev; Kutty, Vellappillil Raman; Wielgosz, Andreas; Lear, Scott; AlHabib, Khalid F.; Co, Homer U.; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Seron, Pamela; Oguz, Aytekin; Kruger, Iolanthé M.; Diaz, Rafael; Nafiza, Mat-Nasir; Chifamba, Jephat; Yeates, Karen; Kelishadi, Roya; Sharief, Wadeia Mohammed; Szuba, Andrzej; Khatib, Rasha; Rahman, Omar; Iqbal, Romaina; Bo, Hu; Yibing, Zhu; Wei, Li; Yusuf, Salim; The Prospective Urban Rural Epidemiology (PURE) Study Investigators; EverestIMPORTANCE Depression is associated with incidence of and premature death from cardiovascular disease (CVD) and cancer in high-income countries, but it is not known whether this is true in low- and middle-income countries and in urban areas, where most people with depression now live. OBJECTIVE To identify any associations between depressive symptoms and incident CVD and all-cause mortality in countries at different levels of economic development and in urban and rural areas. DESIGN, SETTING, AND PARTICIPANTS This multicenter, population-based cohort study was conducted between January 2005 and June 2019 (median follow-up, 9.3 years) and included 370 urban and 314 rural communities from 21 economically diverse countries on 5 continents. Eligible participants aged 35 to 70 years were enrolled. Analysis began February 2018 and ended September 2019. EXPOSURES Four or more self-reported depressive symptoms from the Short-Form Composite International Diagnostic Interview. MAIN OUTCOMES AND MEASURES Incident CVD, all-cause mortality, and a combined measure of either incident CVD or all-cause mortality. RESULTS Of 145 862 participants, 61 235 (58%) were male and the mean (SD) age was 50.05 (9.7) years. Of those, 15 983 (11%) reported 4 or more depressive symptoms at baseline. Depression was associated with incident CVD (hazard ratio [HR], 1.14; 95% CI, 1.05-1.24), all-cause mortality (HR, 1.17; 95% CI, 1.11-1.25), the combined CVD/mortality outcome (HR, 1.18; 95% CI, 1.11-1.24), myocardial infarction (HR, 1.23; 95% CI, 1.10-1.37), and noncardiovascular death (HR, 1.21; 95% CI, 1.13-1.31) in multivariable models. The risk of the combined outcome increased progressively with number of symptoms, being highest in those with 7 symptoms (HR, 1.24; 95% CI, 1.12-1.37) and lowest with 1 symptom (HR, 1.05; 95% CI, 0.92 -1.19; P for trend < .001). The associations between having 4 or more depressive symptoms and the combined outcome were similar in 7 different geographical regions and in countries at all economic levels but were stronger in urban (HR, 1.23; 95% CI, 1.13-1.34) compared with rural (HR, 1.10; 95% CI, 1.02-1.19) communities (P for interaction = .001) and in men (HR, 1.27; 95% CI, 1.13-1.38) compared with women (HR, 1.14; 95% CI, 1.06-1.23; P for interaction < .001). CONCLUSIONS AND RELEVANCE In this large, population-based cohort study, adults with depressive symptoms were associated with having increased risk of incident CVD and mortality in economically diverse settings, especially in urban areas. Improving understanding and awareness of these physical health risks should be prioritized as part of a comprehensive strategy to reduce the burden of noncommunicable diseases worldwide.
- PublicaciónAcceso abiertoTiming and Length of Nocturnal Sleep and Daytime Napping and Associations with Obesity Types in High-, Middle-, and Low-Income Countries(JAMA, 2021-06-30) Tse, Lap Ah; Wang, Chuangshi; Rangarajan, Sumathy; Liu, Zhiguang; Teo, Koon; Yusufali, Afzalhussein; Avezum, Alvaro; Wielgosz, Andreas; Rosengren, Annika; Kruger, Iolanthé M.; Chifamba, Jephat; Tumerdem Calik, Kevser Burcu; Tumerdem Calik, Kevser Burcu; Zatońska, Katarzyna; AlHabib, Khalid F.; Yusoff, Khalid; Kaur, Manmeet; Ismail, Noorhassim; Seron, Pamela; Lopez-Jaramillo, Patricio; Poirier, Paul; Gupta, Rajeev; Khatib, Rasha; Kelishadi, Roya; Lear, Scott A.; Choudhury, Tarzia; Mohan, Viswanathan; Li, Wei; Yusuf, Salim; MasiraImportance Obesity is a growing public health threat leading to serious health consequences. Late bedtime and sleep loss are common in modern society, but their associations with specific obesity types are not well characterized. Objective To assess whether sleep timing and napping behavior are associated with increased obesity, independent of nocturnal sleep length. Design, Setting, and Participants This large, multinational, population-based cross-sectional study used data of participants from 60 study centers in 26 countries with varying income levels as part of the Prospective Urban Rural Epidemiology study. Participants were aged 35 to 70 years and were mainly recruited during 2005 and 2009. Data analysis occurred from October 2020 through March 2021. Exposures Sleep timing (ie, bedtime and wake-up time), nocturnal sleep duration, daytime napping. Main Outcomes and Measures The primary outcomes were prevalence of obesity, specified as general obesity, defined as body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 or greater, and abdominal obesity, defined as waist circumference greater than 102 cm for men or greater than 88 cm for women. Multilevel logistic regression models with random effects for study centers were performed to calculate adjusted odds ratios (AORs) and 95% CIs. Results Overall, 136 652 participants (81 652 [59.8%] women; mean [SD] age, 51.0 [9.8] years) were included in analysis. A total of 27 195 participants (19.9%) had general obesity, and 37 024 participants (27.1%) had abdominal obesity. The mean (SD) nocturnal sleep duration was 7.8 (1.4) hours, and the median (interquartile range) midsleep time was 2:15 am (1:30 am-3:00 am). A total of 19 660 participants (14.4%) had late bedtime behavior (ie, midnight or later). Compared with bedtime between 8 pm and 10 pm, late bedtime was associated with general obesity (AOR, 1.20; 95% CI, 1.12-1.29) and abdominal obesity (AOR, 1.20; 95% CI, 1.12-1.28), particularly among participants who went to bed between 2 am and 6 am (general obesity: AOR, 1.35; 95% CI, 1.18-1.54; abdominal obesity: AOR, 1.38; 95% CI, 1.21-1.58). Short nocturnal sleep of less than 6 hours was associated with general obesity (eg, <5 hours: AOR, 1.27; 95% CI, 1.13-1.43), but longer napping was associated with higher abdominal obesity prevalence (eg, ≥1 hours: AOR, 1.39; 95% CI, 1.31-1.47). Neither going to bed during the day (ie, before 8pm) nor wake-up time was associated with obesity. Conclusions and Relevance This cross-sectional study found that late nocturnal bedtime and short nocturnal sleep were associated with increased risk of obesity prevalence, while longer daytime napping did not reduce the risk but was associated with higher risk of abdominal obesity. Strategic weight control programs should also encourage earlier bedtime and avoid short nocturnal sleep to mitigate obesity epidemic.
- PublicaciónAcceso abiertoVariations in risks from smoking between high-income, middle-income, and low-income countries. An analysis of data from 179 000 participants from 63 countries(The Lancet Global Health, 2022-02-24) Sathish, Thirunavukkarasu; Teo, Koon; Britz-McKibbin, Philip; Gill, Biban; Islam, Shofiqul; Pare, Guillaume; Rangarajan, Sumathy; Duong, MyLinh; Lanas, Fernando; Lopez-Jaramillo, Patricio; Mony, Prem; Pinnaka, Lakshmi; Raman Kutty, Vellappillil; Orlandini, Andres; Avezum, Alvaro; Wielgosz, Andreas; Poirier, Paul; Alhabib, Khalid F.; Temizhan, Ahmet; Chifamba, Jephat; Yeates, Karen; Kruger, Iolanthé M.; Khatib, Rasha; Yusuf, Rita; Rosengren, Annika; Zatonska, Katarzyna; Iqbal, Romaina; Lui, Weida; Lang, Xinyue; Li, Sidong; Hu, Bo; Dans, Antonio; Yusufali, Afzalhussein; Bahonar, Ahmad; O’Donnell, Martin J.; McKee, Martin; Yusuf, Salim; MasiraBackground Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11·3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study; 9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study; and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1·87, 95% CI 1·65–2·12) than in MICs (1·41, 1·34–1·49) and LICs (1·35, 1·25–1·46; interaction p<0·0001). Similar patterns were observed for each component of the composite outcome in PURE, myocardial infarction in INTERHEART, and stroke in INTERSTROKE. The median levels of tar, nicotine, and carbon monoxide displayed on the cigarette packs from PURE HICs were higher than those on the packs from MICs. In PURE, the proportion of never smokers reporting high second-hand smoke exposure (≥1 times/day) was 6·3% in HICs, 23·2% in MICs, and 14·0% in LICs. The adjusted geometric mean total nicotine equivalent was higher among current smokers in HICs (47·2 μM) than in MICs (31·1 μM) and LICs (25·2 μM; ANCOVA p<0·0001). By contrast, it was higher among never smokers in LICs (18·8 μM) and MICs (11·3 μM) than in HICs (5·0 μM; ANCOVA p=0·0001). Interpretation The variations in risks from smoking between country income groups are probably related to the higher exposure of tobacco-derived toxicants among smokers in HICs and higher rates of high second-hand smoke exposure among never smokers in MICs and LICs.
- PublicaciónAcceso abiertoVariations in risks from smoking between high-income, middle-income, and low-income countries: an analysis of data from 179 000 participants from 63 countries(2022-02-05) Sathish, Thirunavukkarasu; Teo, Koon K.; Britz-McKibbin, Philip; Gill, Biban; Islam, Shofiqul; Paré, Guillaume; Rangarajan, Sumathy; Duong, MyLinh; Lanas, Fernando; Lopez-Jaramillo, Patricio; Mony, Prem K.; Pinnaka, Lakshmi; Kutty, Vellappillil Raman; Orlandini, Andres; Avezum, Alvaro; Wielgosz, Andreas; Poirier, Paul; Alhabib, Khalid F.; Temizhan, Ahmet; Chifamba, Jephat; Yeates, Karen; Kruger, Iolanthé M.; Khatib, Rasha; Yusuf, Rita; Rosengren, Annika; Zatonska, Katarzyna; Iqbal, Romaina; Lui, Weida; Lang, Xinyue; Li, Sidong; Hu, Bo; Dans, Antonio L.; Yusufali, Afzal Hussein; Bahonar, Ahmad; O’Donnell, Martin J.; McKee, Martin; Yusuf, Salim; MasiraBackground Separate studies suggest that the risks from smoking might vary between high-income (HICs), middle-income (MICs), and low-income (LICs) countries, but this has not yet been systematically examined within a single study using standardised approaches. We examined the variations in risks from smoking across different country income groups and some of their potential reasons. Methods We analysed data from 134 909 participants from 21 countries followed up for a median of 11·3 years in the Prospective Urban Rural Epidemiology (PURE) cohort study; 9711 participants with myocardial infarction and 11 362 controls from 52 countries in the INTERHEART case-control study; and 11 580 participants with stroke and 11 331 controls from 32 countries in the INTERSTROKE case-control study. In PURE, all-cause mortality, major cardiovascular disease, cancers, respiratory diseases, and their composite were the primary outcomes for this analysis. Biochemical verification of urinary total nicotine equivalent was done in a substudy of 1000 participants in PURE. Findings In PURE, the adjusted hazard ratio (HR) for the composite outcome in current smokers (vs never smokers) was higher in HICs (HR 1·87, 95% CI 1·65–2·12) than in MICs (1·41, 1·34–1·49) and LICs (1·35, 1·25–1·46; interaction p<0·0001). Similar patterns were observed for each component of the composite outcome in PURE, myocardial infarction in INTERHEART, and stroke in INTERSTROKE. The median levels of tar, nicotine, and carbon monoxide displayed on the cigarette packs from PURE HICs were higher than those on the packs from MICs. In PURE, the proportion of never smokers reporting high second-hand smoke exposure (≥1 times/day) was 6·3% in HICs, 23·2% in MICs, and 14·0% in LICs. The adjusted geometric mean total nicotine equivalent was higher among current smokers in HICs (47·2 μM) than in MICs (31·1 μM) and LICs (25·2 μM; ANCOVA p<0·0001). By contrast, it was higher among never smokers in LICs (18·8 μM) and MICs (11·3 μM) than in HICs (5·0 μM; ANCOVA p=0·0001). Interpretation The variations in risks from smoking between country income groups are probably related to the higher exposure of tobacco-derived toxicants among smokers in HICs and higher rates of high second-hand smoke exposure among never smokers in MICs and LICs.
- PublicaciónAcceso abiertoVariations in the financial impact of the COVID-19 pandemic across 5 continents: A cross-sectional, individual level analysis(2022-02-05) Khetan, Aditya K.; Yusuf, Salim; Lopez-Jaramillo, Patricio; Szuba, Andrzej; Orlandini, Andres; Mat-Nasir, Nafiza; Oguz, Aytekin; Gupta, Rajeev; Avezum, Álvaro; Rosnah, Ismail; Poirier, Paul; Teo, Koon K.; Wielgosz, Andreas; Lear, Scott A.; Palileo-Villanueva, Lia M.; Serón, Pamela; Chifamba, Jephat; Rangarajan, Sumathy; Mushtaha, Maha; Mohan, Deepa; Yeates, Karen; McKee, Martin; Mony, Prem K.; Walli-Attaei, Marjan; Khansaheb, Hamda; Rosengren, Annika; Alhabib, Khalid F.; Kruger, Iolanthé M.; Paucar, María-José; Mirrakhimov, Erkin; Assembekov, Batyrbek; Leong, Darryl P.; MasiraBackground COVID-19 has caused profound socio-economic changes worldwide. However, internationally comparative data regarding the financial impact on individuals is sparse. Therefore, we conducted a survey of the financial impact of the pandemic on individuals, using an international cohort that has been well-characterized prior to the pandemic. Methods Between August 2020 and September 2021, we surveyed 24,506 community-dwelling participants from the Prospective Urban-Rural Epidemiology (PURE) study across high (HIC), upper middle (UMIC)-and lower middle (LMIC)-income countries. We collected information regarding the impact of the pandemic on their self-reported personal finances and sources of income. Findings Overall, 32.4% of participants had suffered an adverse financial impact, defined as job loss, inability to meet financial obligations or essential needs, or using savings to meet financial obligations. 8.4% of participants had lost a job (temporarily or permanently); 14.6% of participants were unable to meet financial obligations or essential needs at the time of the survey and 16.3% were using their savings to meet financial obligations. Participants with a post-secondary education were least likely to be adversely impacted (19.6%), compared with 33.4% of those with secondary education and 33.5% of those with pre-secondary education. Similarly, those in the highest wealth tertile were least likely to be financially impacted (26.7%), compared with 32.5% in the middle tertile and 30.4% in the bottom tertile participants. Compared with HICs, financial impact was greater in UMIC [odds ratio of 2.09 (1.88 −2.33)] and greatest in LMIC [odds ratio of 16.88 (14.69−19.39)]. HIC participants with the lowest educational attainment suffered less financial impact (15.1% of participants affected) than those with the highest education in UMIC (22.0% of participants affected). Similarly, participants with the lowest education in UMIC experienced less financial impact (28.3%) than those with the highest education in LMIC (45.9%). A similar gradient was seen across country income categories when compared by pre-pandemic wealth status. Interpretation The financial impact of the pandemic differs more between HIC, UMIC, and LMIC than between socio-economic categories within a country income level. The most disadvantaged socio-economic subgroups in HIC had a lower financial impact from the pandemic than the most advantaged subgroup in UMIC, with a similar disparity seen between UMIC and LMIC. Continued high levels of infection will exacerbate financial inequity between countries and hinder progress towards the sustainable development goals, emphasising the importance of effective measures to control COVID-19 and, especially, ensuring high vaccine coverage in all countries. Funding Funding for this study was provided by the Canadian Institutes of Health Research and the International Development Research Centre.