Examinando por Autor "Li, Wei"
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- PublicaciónAcceso abiertoAssessing global risk factors for non-fatal injuries from road traffic accidents and falls in adults aged 35–70 years in 17 countries : A cross-sectional analysis of the prospective urban rural Epidemiological (PURE) study(2016) Raina, Parminder; Sohel, Nazmul; Oremus, Mark; Shannon, Harry; Mony, Prem; Kumar, Rajesh; Li, Wei; Wang, Yang; Wang, Xingyu; Yusoff, Khalid; Yusuf, Rita; Iqbal, Romaina; Szuba, Andrzej; Oguz, Aytekin; Rosengren, Annika; Kruger, Annamarie; Chifamba, Jephat; Mohammadifard, Noushin; Darwish, Ebtihal Ahmad; Dagenais, Gilles; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Seron, Pamela; Rangarajan, Sumathy; Teo, Koon; Yusuf, Salim; The PURE (Prospective Urban Rural Epidemiology) Study investigatorsObjectives To assess risk factors associated with non-fatal injuries (NFIs) from road traffic accidents (RTAs) or falls. Methods Our study included 151 609 participants from the Prospective Urban Rural Epidemiological study. Participants reported whether they experienced injuries within the past 12 months that limited normal activities. Additional questions elicited data on risk factors. We employed multivariable logistic regression to analyse data. Results Overall, 5979 participants (3.9% of 151 609) reported at least one NFI. Total number of NFIs was 6300: 1428 were caused by RTAs (22.7%), 1948 by falls (30.9%) and 2924 by other causes (46.4%). Married/common law status was associated with fewer falls, but not with RTA. Age 65–70 years was associated with fewer RTAs, but more falls; age 55–64 years was associated with more falls. Male versus female was associated with more RTAs and fewer falls. In lower-middle-income countries, rural residence was associated with more RTAs and falls; in low-income countries, rural residence was associated with fewer RTAs. Previous alcohol use was associated with more RTAs and falls; current alcohol use was associated with more falls. Education was not associated with either NFI type. Conclusions This study of persons aged 35–70 years found that some risk factors for NFI differ according to whether the injury is related to RTA or falls. Policymakers may use these differences to guide the design of prevention policies for RTA-related or fall-related NFI.
- PublicaciónAcceso abiertoThe association between ownership of common household devices and obesity and diabetes in high, middle and low income countries(2014-03-04) Lear, Scott A.; Teo, Koon; Gasevic, Danijela; Zhang, Xiaohe; Poirier, Paul P.; Rangarajan, Sumathy; Seron, Pamela; Kelishadi, Roya; Mohd Tamil, Azmi; Kruger, Annamarie; Iqbal, Romaina; Swidan, Hani; Gómez Arbeláez, Diego; Yusuf, Rita; Chifamba, Jephat; Kutty, V. Raman; Karsıdag, Kubilay; Kumar, Rajesh; Li, Wei; Szuba, Andrzej; Avezum, Alvaro; Diaz, Rafael; Anand, Sonia S.; Rosengren, Annika; Yusuf, Salim; The PURE (Prospective Urban Rural Epidemiology) Study investigatorsBackground: Household devices (e.g., television, car, computer) are common in high income countries, and their use has been linked to obesity and type 2 diabetes mellitus. We hypothesized that device ownership is associated with obesity and diabetes and that these effects are explained through reduced physical activity, increased sitting time and increased energy intake. Methods: We performed a cross-sectional analysis using data from the Prospective Urban Rural Epidemiology study involving 153 996 adults from high, upper-middle, lower-middle and low income countries. We used multilevel regression models to account for clustering at the community and country levels. Results: Ownership of a household device increased from low to high income countries (4% to 83% for all 3 devices) and was associated with decreased physical activity and increased sitting, dietary energy intake, body mass index and waist circumference. There was an increased odds of obesity and diabetes with the ownership of any 1 household device compared to no device ownership (obesity: odds ratio [OR] 1.43, 95% confidence interval [CI] 1.32–1.55; diabetes: OR 1.38, 95% CI 1.28–1.50). Ownership of a second device increased the odds further but ownership of a third device did not. Subsequent adjustment for lifestyle factors modestly attenuated these associations. Of the 3 devices, ownership of a television had the strongest association with obesity (OR 1.39, 95% CI 1.29–1.49) and diabetes (OR 1.33, 95% CI 1.23–1.44). When stratified by country income level, the odds of obesity and diabetes when owning all 3 devices was greatest in low income countries (obesity: OR 3.15, 95% CI 2.33-4.25; diabetes: OR 1.97, 95% CI 1.53–2.53) and decreased through country income levels such that we did not detect an association in high income countries. Interpretation: The ownership of household devices increased the likelihood of obesity and diabetes, and this was mediated in part by effects on physical activity, sitting time and dietary energy intake. With increasing ownership of household devices in developing countries, societal interventions are needed to mitigate their effects on poor health.
- PublicaciónAcceso abiertoAssociation of bedtime with mortality and major cardiovascular events: an analysis of 112,198 individuals from 21 countries in the PURE study(Elsevier, 2021-04-05) Wang, Chuangshi; Hu, Bo; Rangarajan, Sumathy; Bangdiwala, Shrikant I.; Lear, Scott A.; Mohan, Viswanathan; Gupta, Rajeev; Alhabib, Khalid F.; Soman, Biju; Abat, Marc Evans M.; Rosengren, Annika; Lanas, Fernando; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Diaz, Rafael; Yusoff, Khalid; Iqbal, Romaina; Chifamba, Jephat; Yeates, Karen; Zatońska, Katarzyna; Kruger, Iolanthe M.; Bahonar, Ahmad; Yusufali, AfzalHussein; Li, Wei; Yusuf, Salim; The Prospective Urban Rural Epidemiology (PURE) study investigators; MasiraObjectives This study aimed to examine the association of bedtime with mortality and major cardiovascular events. Methods Bedtime was recorded based on self-reported habitual time of going to bed in 112,198 participants from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Participants were prospectively followed for 9.2 years. We examined the association between bedtime and the composite outcome of all-cause mortality, non-fatal myocardial infarction, stroke and heart failure. Participants with a usual bedtime earlier than 10PM were categorized as ‘earlier’ sleepers and those who reported a bedtime after midnight as ‘later’ sleepers. Cox frailty models were applied with random intercepts to account for the clustering within centers. Results A total of 5633 deaths and 5346 major cardiovascular events were reported. A U-shaped association was observed between bedtime and the composite outcome. Using those going to bed between 10PM and midnight as the reference group, after adjustment for age and sex, both earlier and later sleepers had a higher risk of the composite outcome (HR of 1.29 [1.22, 1.35] and 1.11 [1.03, 1.20], respectively). In the fully adjusted model where demographic factors, lifestyle behaviors (including total sleep duration) and history of diseases were included, results were greatly attenuated, but the estimates indicated modestly higher risks in both earlier (HR of 1.09 [1.03–1.16]) and later sleepers (HR of 1.10 [1.02–1.20]). Conclusion Early (10 PM or earlier) or late (Midnight or later) bedtimes may be an indicator or risk factor of adverse health outcomes.
- PublicaciónAcceso abiertoAssociation of estimated sleep duration and naps with mortality and cardiovascular events(European Society of Cardiology, 2019-05-21) Wang, Chuangshi; Bangdiwala, Shrikant I.; Rangarajan, Sumathy; Lear, Scott A.; AlHabib, Khalid F.; Mohan, Viswanathan; Koon, Teo; Poirier, Paul; Tse, Lap Ah; Liu, Zhiguang; Rosengren, Annika; Kumar, Rajesh; Lopez-Jaramillo, Patricio; Yusoff, Khalid; Monsef, Nahed; Krishnapillai, Vijayakumar; Ismail, Noorhassim; Seron, Pamela; Dans, Antonio; Kruger, Lanthé; Yeates, Karen; Leach, Lloyd; Yusuf, Rita; Orlandini, Andres; Wolyniec, Maria; Bahonar, Ahmad; Mohan, Indu; Khatib, Rasha; Temizhan, Ahmet; Li, Wei; Yusuf, Salim; On behalf of the Prospective Urban Rural Epidemiology (PURE) study investigators; EverestAims To investigate the association of estimated total daily sleep duration and daytime nap duration with deaths and major cardiovascular events. Methods and results We estimated the durations of total daily sleep and daytime naps based on the amount of time in bed and self-reported napping time and examined the associations between them and the composite outcome of deaths and major cardiovascular events in 116 632 participants from seven regions. After a median follow-up of 7.8 years, we recorded 4381 deaths and 4365 major cardiovascular events. It showed both shorter (≤6 h/day) and longer (>8 h/day) estimated total sleep durations were associated with an increased risk of the composite outcome when adjusted for age and sex. After adjustment for demographic characteristics, lifestyle behaviours and health status, a J-shaped association was observed. Compared with sleeping 6–8 h/day, those who slept ≤6 h/day had a non-significant trend for increased risk of the composite outcome [hazard ratio (HR), 1.09; 95% confidence interval, 0.99–1.20]. As estimated sleep duration increased, we also noticed a significant trend for a greater risk of the composite outcome [HR of 1.05 (0.99–1.12), 1.17 (1.09–1.25), and 1.41 (1.30–1.53) for 8–9 h/day, 9–10 h/day, and >10 h/day, Ptrend < 0.0001, respectively]. The results were similar for each of all-cause mortality and major cardiovascular events. Daytime nap duration was associated with an increased risk of the composite events in those with over 6 h of nocturnal sleep duration, but not in shorter nocturnal sleepers (≤6 h). Conclusion Estimated total sleep duration of 6–8 h per day is associated with the lowest risk of deaths and major cardiovascular events. Daytime napping is associated with increased risks of major cardiovascular events and deaths in those with >6 h of nighttime sleep but not in those sleeping ≤6 h/night.
- PublicaciónAcceso abiertoAssociation of Sitting Time with Mortality and Cardiovascular Events in High-Income, Middle-Income, and Low-Income Countries(2022-06-15) Li, Sidong; Lear, Scott A.; Rangarajan, Sumathy; Hu, Bo; Yin, Lu; Bangdiwala, Shrikant I.; Alhabib, Khalid F.; Rosengren, Annika; Gupta, Rajeev; Mony, Prem K.; Wielgosz, Andreas; Rahman, Omar; Mazapuspavina, M. Y.; Avezum, Alvaro; Oguz, Aytekin; Yeates, Karen; Lanas, Fernando; Dans, Antonio; Evans, Marc; Abat, M.; Yusufali, Afzalhussein; Rafael, Diaz; Lopez-Jaramillo, Patricio; Leach, Lloyd; Lakshmi, P. V. M.; Iqbal, Romaina; Kelishadi, Roya; Chifamba, Jephat; Khatib, Rasha; Li, Wei; Yusuf, Salim; MasiraImportance High amounts of sitting time are associated with increased risks of cardiovascular disease (CVD) and mortality in high-income countries, but it is unknown whether risks also increase in low- and middle-income countries. Objective To investigate the association of sitting time with mortality and major CVD in countries at different economic levels using data from the Prospective Urban Rural Epidemiology study. Design, Setting, and Participants This population-based cohort study included participants aged 35 to 70 years recruited from January 1, 2003, and followed up until August 31, 2021, in 21 high-income, middle-income, and low-income countries with a median follow-up of 11.1 years. Exposures Daily sitting time measured using the International Physical Activity Questionnaire. Main Outcomes and Measures The composite of all-cause mortality and major CVD (defined as cardiovascular death, myocardial infarction, stroke, or heart failure). Results Of 105 677 participants, 61 925 (58.6%) were women, and the mean (SD) age was 50.4 (9.6) years. During a median follow-up of 11.1 (IQR, 8.6-12.2) years, 6233 deaths and 5696 major cardiovascular events (2349 myocardial infarctions, 2966 strokes, 671 heart failure, and 1792 cardiovascular deaths) were documented. Compared with the reference group (<4 hours per day of sitting), higher sitting time (≥8 hours per day) was associated with an increased risk of the composite outcome (hazard ratio [HR], 1.19; 95% CI, 1.11-1.28; Pfor trend < .001), all-cause mortality (HR, 1.20; 95% CI, 1.10-1.31; Pfor trend < .001), and major CVD (HR, 1.21; 95% CI, 1.10-1.34; Pfor trend < .001). When stratified by country income levels, the association of sitting time with the composite outcome was stronger in low-income and lower-middle–income countries (≥8 hours per day: HR, 1.29; 95% CI, 1.16-1.44) compared with high-income and upper-middle–income countries (HR, 1.08; 95% CI, 0.98-1.19; P for interaction = .02). Compared with those who reported sitting time less than 4 hours per day and high physical activity level, participants who sat for 8 or more hours per day experienced a 17% to 50% higher associated risk of the composite outcome across physical activity levels; and the risk was attenuated along with increased physical activity levels. Conclusions and Relevance High amounts of sitting time were associated with increased risk of all-cause mortality and CVD in economically diverse settings, especially in low-income and lower-middle–income countries. Reducing sedentary time along with increasing physical activity might be an important strategy for easing the global burden of premature deaths and CVD.
- PublicaciónAcceso abiertoAssociations of urinary sodium excretion with cardiovascular events in individuals with and without hypertension : A pooled analysis of data from four studies(2016-07-30) Mente, Andrew; O’Donnell, Martin J.; Rangarajan, Sumathy; Dagenais, Gilles; Lear, Scott A.; McQueen, Matthew J.; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Li, Wei; Lu, Yin; Yi, Sun; Rensheng, Lei; Iqbal, Romaina; Mony, Prem; Yusuf, Rita; Yusoff, Khalid; Szuba, Andrzej; Oguz, Aytekin; Rosengren, Annika; Bahonar, Ahmad; Yusufali, Afzalhussein; Schutte, Aletta Elisabeth; Chifamba, Jephat; Mann, Johannes F. E.; Anand, Sonia S.; Teo, Koon; Yusuf, Salim; The PURE, EPIDREAM, and ONTARGET/TRANSCEND InvestigatorsBackground: Several studies reported a U-shaped association between urinary sodium excretion and cardiovascular disease events and mortality. Whether these associations vary between those individuals with and without hypertension is uncertain. We aimed to explore whether the association between sodium intake and cardiovascular disease events and all-cause mortality is modified by hypertension status. Methods: In this pooled analysis, we studied 133118 individuals (63559 with hypertension and 69559 without hypertension), median age of 55 years (IQR 45–63), from 49 countries in four large prospective studies and estimated 24-h urinary sodium excretion (as group-level measure of intake). We related this to the composite outcome of death and major cardiovascular disease events over a median of 4·2 years (IQR 3·0–5·0) and blood pressure. Findings: Increased sodium intake was associated with greater increases in systolic blood pressure in individuals with hypertension (2·08 mm Hg change per g sodium increase) compared with individuals without hypertension (1·22 mm Hg change per g; pinteraction<0·0001). In those individuals with hypertension (6835 events), sodium excretion of 7 g/day or more (7060 [11%] of population with hypertension: hazard ratio [HR] 1·23 [95% CI 1·11–1·37]; p<0·0001) and less than 3 g/day (7006 [11%] of population with hypertension: 1·34 [1·23–1·47]; p<0·0001) were both associated with increased risk compared with sodium excretion of 4–5 g/day (reference 25% of the population with hypertension). In those individuals without hypertension (3021 events), compared with 4–5 g/day (18508 [27%] of the population without hypertension), higher sodium excretion was not associated with risk of the primary composite outcome (≥7 g/day in 6271 [9%] of the population without hypertension; HR 0·90 [95% CI 0·76–1·08]; p=0·2547), whereas an excretion of less than 3 g/day was associated with a significantly increased risk (7547 [11%] of the population without hypertension; HR 1·26 [95% CI 1·10–1·45]; p=0·0009). Interpretation: Compared with moderate sodium intake, high sodium intake is associated with an increased risk of cardiovascular events and death in hypertensive populations (no association in normotensive population), while the association of low sodium intake with increased risk of cardiovascular events and death is observed in those with or without hypertension. These data suggest that lowering sodium intake is best targeted at populations with hypertension who consume high sodium diets. Funding: Full funding sources listed at end of paper (see Acknowledgments).
- 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 abiertoCardiovascular risk and events in 17 low-, middle-, and high-income countries(2014-08-28) Yusuf, Salim; Rangarajan, Sumathy; Teo, Koon; Islam, Shofiqul; Li, Wei; Liu, Lisheng; Bo, Jian; Lou, Qinglin; Lu, Fanghong; Liu, Tianlu; Yu, Liu; Zhang, Shiying; Mony, Prem; Swaminathan, Sumathi; Mohan, Viswanathan; Gupta, Rajeev; Kumar, Rajesh; Vijayakumar, Krishnapillai; Lear, Scott A.; Anand, Sonia S.; Wielgosz, Andreas; Diaz, Rafael; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Lanas, Fernando; Yusoff, Khalid; Ismail, Noorhassim; Iqbal, Romaina; Rahman, Omar; Rosengren, Annika; Yusufali, Afzalhussein; Kelishadi, Roya; Kruger, Annamarie; Puoane, Thandi; Szuba, Andrzej; Chifamba, Jephat; Oguz, Aytekin; McQueen, Matthew J.; McKee, Martin; Dagenais, Gilles; The PURE (Prospective Urban Rural Epidemiology) Study investigatorsBACKGROUND More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. METHODS We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years. RESULTS The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 person-years vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were also lowest in high-income countries (6.5%, 15.9%, and 17.3% in high-, middle-, and low-income countries, respectively; P=0.01). Urban communities had a higher risk-factor burden than rural communities but lower rates of cardiovascular events (4.83 vs. 6.25 events per 1000 person-years, P<0.001) and case fatality rates (13.52% vs. 17.25%, P<0.001). The use of preventive medications and revascularization procedures was significantly more common in high-income countries than in middle- or low-income countries (P<0.001). CONCLUSIONS Although the risk-factor burden was lowest in low-income countries, the rates of major cardiovascular disease and death were substantially higher in low-income countries than in high-income countries. The high burden of risk factors in high-income countries may have been mitigated by better control of risk factors and more frequent use of proven pharmacologic therapies and revascularization. (Funded by the Population Health Research Institute and others.)
- PublicaciónAcceso abiertoContrasting associations between diabetes and cardiovascular mortality rates in low-, middle-, and high-income countries: Cohort study data from 143,567 individuals in 21 countries in the pure study(American Diabetes Association, 2020-10-15) Mohan Anjana, Ranjit; Mohan, Viswanathan; Rangarajan, Sumathy; Gerstein, Hertzel C.; Venkatesan, Ulagamadesan; Sheridan, Patrick; Dagenais, Gilles R.; Lear, Scott A.; Teo, Koon; Karsidag, Kubilay; Alhabib, Khalid F.; Yusoff, Khalid; Ismail, Noorhassim; Mony, Prem; Lopez-Jaramillo, Patricio; Chifamba, Jephat; Palileo-Villanueva, Lia M.; Iqbal, Romaina; Yusufali, Afzalhussein; Kruger, Iolanthe M.; Rosengren, Annika; Bahonar, Ahmad; Zatonska, Katarzyna; Yeates, Karen; Gupta, Rajeev; Li, Wei; Hu, Lihua; Rahman, M. Omar; Lakshmi, P.V.M.; Iype, Thomas; Avezum, Alvaro; Diaz, Rafael; Lanas, Fernando; Yusuf, Salim; MasiraOBJECTIVE We aimed to compare cardiovascular (CV) events, all-cause mortality, and CV mortality rates among adults with and without diabetes in countries with differing levels of income. RESEARCH DESIGN AND METHODS The Prospective Urban Rural Epidemiology (PURE) study enrolled 143,567 adults aged 35–70 years from 4 high-income countries (HIC), 12 middle-income countries (MIC), and 5 low-income countries (LIC). The mean follow-up was 9.0 6 3.0 years. RESULTS Among those with diabetes, CVD rates (LIC 10.3, MIC 9.2, HIC 8.3 per 1,000 personyears, P < 0.001), all-cause mortality (LIC 13.8, MIC 7.2, HIC 4.2 per 1,000 personyears, P < 0.001), and CV mortality (LIC 5.7, MIC 2.2, HIC 1.0 per 1,000 person-years, P < 0.001) were considerably higher in LIC compared with MIC and HIC. Within LIC, mortality was higher in those in the lowest tertile of wealth index (low 14.7%, middle 10.8%, and high 6.5%). In contrast to HIC and MIC, the increased CV mortality in those with diabetes in LIC remained unchanged even after adjustment for behavioral risk factors and treatments (hazard ratio [95% CI] 1.89 [1.58–2.27] to 1.78 [1.36–2.34]). CONCLUSIONS CVD rates, all-cause mortality, and CV mortality were markedly higher among those with diabetes in LIC compared with MIC and HIC with mortality risk remaining unchanged even after adjustment for risk factors and treatments. There is an urgent need to improve access to care to those with diabetes in LIC to reduce the excess mortality rates, particularly among those in the poorer strata of society.
- PublicaciónRestringidoEnvironmental Profile of a Community's Health (EPOCH) : An Ecometric Assessment of Measures of the Community Environment Based on Individual Perception(2012-09-04) Corsi, Daniel J.; Subramanian, S. V.; McKee, Martin; Li, Wei; Swaminathan, Sumathi; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Lear, Scott A.; Dagenais, Gilles; Rangarajan, Sumathy; Teo, Koon; Yusuf, Salim; Chow, Clara K.Background: Public health research has turned towards examining upstream, community-level determinants of cardiovascular disease risk factors. Objective measures of the environment, such as those derived from direct observation, and perception-based measures by residents have both been associated with health behaviours. However, current methods are generally limited to objective measures, often derived from administrative data, and few instruments have been evaluated for use in rural areas or in low-income countries. We evaluate the reliability of a quantitative tool designed to capture perceptions of community tobacco, nutrition, and social environments obtained from interviews with residents in communities in 5 countries. Methodology/ Principal Findings: Thirteen measures of the community environment were developed from responses to questionnaire items from 2,360 individuals residing in 84 urban and rural communities in 5 countries (China, India, Brazil, Colombia, and Canada) in the Environmental Profile of a Community’s Health (EPOCH) study. Reliability and other properties of the community-level measures were assessed using multilevel models. High reliability (.0.80) was demonstrated for all community-level measures at the mean number of survey respondents per community (n = 28 respondents). Questionnaire items included in each scale were found to represent a common latent factor at the community level in multilevel factor analysis models. Conclusions/ Significance: Reliable measures which represent aspects of communities potentially related to cardiovascular disease (CVD)/risk factors can be obtained using feasible sample sizes. The EPOCH instrument is suitable for use in different settings to explore upstream determinants of CVD/risk factors.
- PublicaciónRestringidoEnvironmental profile of a community's health (EPOCH) : An instrument to measure environmental determinants of cardiovascular health in five countries(2010-12-10) Chow, Clara K.; Lock, Karen; Madhavan, Manisha; Corsi, Daniel J.; Gilmore, Anna B.; Subramanian, S. V.; Li, Wei; Swaminathan, Sumathi; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Lear, Scott A.; Dagenais, Gilles; Teo, Koon; McKee, Martin; Yusuf, SalimBackground: The environment in which people live is known to be important in influencing diet, physical activity, smoking, psychosocial and other risk factors for cardiovascular (CV) disease. However no instrument exists that evaluates communities for these multiple environmental factors and is suitable for use across different communities, regions and countries. This report describes the design and reliability of an instrument to measure environmental determinants of CV risk factors. Method/Principal Findings: The Environmental Profile of Community Health (EPOCH) instrument comprises two parts: (I) an assessment of the physical environment, and (II) an interviewer-administered questionnaire to collect residents’ perceptions of their community. We examined the inter-rater reliability amongst 3 observers from each region of the direct observation component of the instrument (EPOCH I) in 93 rural and urban communities in 5 countries (Canada, Colombia, Brazil, China and India). Data collection using the EPOCH instrument was feasible in all communities. Reliability of the instrument was excellent (Intraclass Correlation Coefficient - ICC.0.75) for 24 of 38 items and fair to good (ICC 0.4–0.75) for 14 of 38 items. Conclusion: This report shows data collection with the EPOCH instrument is feasible and direct observation of community measures reliable. The EPOCH instrument will enable further research on environmental determinants of health for population studies from a broad range of settings.
- PublicaciónAcceso abiertoErratum. Corrigendum to Association of bedtime with mortality and major cardiovascular events. an analysis of 112,198 individuals from 21 countries in the PURE study(2022-02-05) Wang, Chuangshi; Hu, Bo; Rangarajan, Sumathy; Bangdiwala, Shrikant I.; Gulec, Sadi; Lear, Scott A.; Mohan, Viswanathan; Gupta, Rajeev; Alhabib, Khalid F.; Soman, Biju; Abat, Marc Evans M.; Rosengren, Annika; Lanas, Fernando; Avezum, Alvaro; Lopez-Jaramillo, Patricio; Diaz, Rafael; Yusoff, Khalid; Iqbal, Romaina; Chifamba, Jephat; Yeates, Karen; ZatonskaIolanthe, Katarzyna; Kruger, M.; Bahonar, Ahmad; Yusufali, AfzalHussein; Li, Wei; Yusuf, Salim; Prospective Urban Rural Epidemiology (PURE) study investigators; Masira
- PublicaciónRestringidoFruit, vegetable, and legume intake, and cardiovascular disease and deaths in 18 countries (PURE) : A prospective cohort study(2017-11-04) Lopez-Jaramillo, Patricio; Miller, Victoria; Mente, Andrew; Dehghan, Mahshid; Rangarajan, Sumathy; Zhang, Xiaohe; Swaminathan, Sumathi; Dagenais, Gilles; Gupta, Rajeev; Mohan, Viswanathan; Lear, Scott A.; Bangdiwala, Shrikant I.; Schutte, Aletta Elisabeth; Wentzel Viljoen, Edelweiss; Avezum, Alvaro; Altuntas, Yuksel; Yusoff, Khalid; Ismail, Noorhassim; Peer, Nasheeta; Chifamba, Jephat; Diaz, Rafael; Rahman, Omar; Mohammadifard, Noushin; Lanas, Fernando; Zatonska, Katarzyna; Wielgosz, Andreas; Yusufali, Afzalhussein; Iqbal, Romaina; Khatib, Rasha; Rosengren, Annika; Kutty, V. Raman; Li, Wei; Liu, Jiankang; Liu, Xiaoyun; Yin, Lu; Teo, Koon; Anand, Sonia S.; Yusuf, Salim; The Prospective Urban Rural Epidemiology (PURE) study investigatorsBackground The association between intake of fruits, vegetables, and legumes with cardiovascular disease and deaths has been investigated extensively in Europe, the USA, Japan, and China, but little or no data are available from the Middle East, South America, Africa, or south Asia. Methods We did a prospective cohort study (Prospective Urban Rural Epidemiology [PURE] in 135335 individuals aged 35 to 70 years without cardiovascular disease from 613 communities in 18 low-income, middle-income, and highincome countries in seven geographical regions: North America and Europe, South America, the Middle East, south Asia, China, southeast Asia, and Africa. We documented their diet using country-specific food frequency questionnaires at baseline. Standardised questionnaires were used to collect information about demographic factors, socioeconomic status (education, income, and employment), lifestyle (smoking, physical activity, and alcohol intake), health history and medication use, and family history of cardiovascular disease. The follow-up period varied based on the date when recruitment began at each site or country. The main clinical outcomes were major cardiovascular disease (defined as death from cardiovascular causes and non-fatal myocardial infarction, stroke, and heart failure), fatal and non-fatal myocardial infarction, fatal and non-fatal strokes, cardiovascular mortality, non-cardiovascular mortality, and total mortality. Cox frailty models with random effects were used to assess associations between fruit, vegetable, and legume consumption with risk of cardiovascular disease events and mortality. Findings Participants were enrolled into the study between Jan 1, 2003, and March 31, 2013. For the current analysis, we included all unrefuted outcome events in the PURE study database through March 31, 2017. Overall, combined mean fruit, vegetable and legume intake was 3·91 (SD 2·77) servings per day. During a median 7·4 years (5·5–9·3) of followup, 4784 major cardiovascular disease events, 1649 cardiovascular deaths, and 5796 total deaths were documented. Higher total fruit, vegetable, and legume intake was inversely associated with major cardiovascular disease, myocardial infarction, cardiovascular mortality, non-cardiovascular mortality, and total mortality in the models adjusted for age, sex, and centre (random effect). The estimates were substantially attenuated in the multivariable adjusted models for major cardiovascular disease (hazard ratio [HR] 0·90, 95% CI 0·74–1·10, ptrend=0·1301), myocardial infarction (0·99, 0·74–1·31; ptrend=0·2033), stroke (0·92, 0·67–1·25; ptrend=0·7092), cardiovascular mortality (0·73, 0·53–1·02; ptrend=0·0568), non-cardiovascular mortality (0·84, 0·68–1·04; ptrend =0·0038), and total mortality (0·81, 0·68–0·96; ptrend<0·0001). The HR for total mortality was lowest for three to four servings per day (0·78, 95% CI 0·69–0·88) compared with the reference group, with no further apparent decrease in HR with higher consumption. When examined separately, fruit intake was associated with lower risk of cardiovascular, non-cardiovascular, and total mortality, while legume intake was inversely associated with non-cardiovascular death and total mortality (in fully adjusted models). For vegetables, raw vegetable intake was strongly associated with a lower risk of total mortality, whereas cooked vegetable intake showed a modest benefit against mortality. Interpretation Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375–500 g/day). Funding Full funding sources listed at the end of the paper (see Acknowledgments).
- PublicaciónAcceso abiertoGlycemic index, glycemic load, and cardiovascular disease and mortality(The New England Journal of Medicine, 2021-04-08) Jenkins, David; Dehghan, Mahshid; Mente, Andrew; Bangdiwala, Shrikant I.; Rangarajan, Sumathy; Srichaikul, Kristie; Mohan, Viswanathan; Avezum, Alvaro; Díaz, Rafael; Rosengren, Annika; Lanas, Fernando; Lopez-Jaramillo, Patricio; Li, Wei; Oguz, Aytekin; Khatib, Rasha; Poirier, Paul; Mohammadifard, Noushin; Pepe, Andrea; Alhabib, Khalid F.; Chifamba, Jephat; Yusufali, Afzal Hussein; Iqbal, Romaina; Yeates, Karen; Yusoff, Khalid; Ismail, Noorhassim; Teo, Koon; Swaminathan, Sumathi; Liu, Xiaoyun; Zatońska, Katarzyna; Yusuf, Rita; Yusuf, Salim; The PURE Study Investigators; MasiraBACKGROUND Most data regarding the association between the glycemic index and cardiovascular disease come from high-income Western populations, with little information from non-Western countries with low or middle incomes. To fill this gap, data are needed from a large, geographically diverse population. METHODS This analysis includes 137,851 participants between the ages of 35 and 70 years living on five continents, with a median follow-up of 9.5 years. We used countryspecific food-frequency questionnaires to determine dietary intake and estimated the glycemic index and glycemic load on the basis of the consumption of seven categories of carbohydrate foods. We calculated hazard ratios using multivariable Cox frailty models. The primary outcome was a composite of a major cardiovascular event (cardiovascular death, nonfatal myocardial infarction, stroke, and heart failure) or death from any cause. RESULTS In the study population, 8780 deaths and 8252 major cardiovascular events occurred during the follow-up period. After performing extensive adjustments comparing the lowest and highest glycemic-index quintiles, we found that a diet with a high glycemic index was associated with an increased risk of a major cardiovascular event or death, both among participants with preexisting cardiovascular disease (hazard ratio, 1.51; 95% confidence interval [CI], 1.25 to 1.82) and among those without such disease (hazard ratio, 1.21; 95% CI, 1.11 to 1.34). Among the components of the primary outcome, a high glycemic index was also associated with an increased risk of death from cardiovascular causes. The results with respect to glycemic load were similar to the findings regarding the glycemic index among the participants with cardiovascular disease at baseline, but the association was not significant among those without preexisting cardiovascular disease. CONCLUSIONS In this study, a diet with a high glycemic index was associated with an increased risk of cardiovascular disease and death. (Funded by the Population Health Research Institute and others.)
- PublicaciónAcceso abiertoHousehold, community, sub-national and country-level predictors of primary cooking fuel switching in nine countries from the PURE study(IOP Publishing Ltd, 2019-07-29) Shupler, Matthew; Hystad, Perry; Gustafson, Paul; Rangarajan, Sumathy; Mushtaha, Maha; Jayachtria, K.G.; Mony, Prem K.; Mohan, Deepa; Kumar, Parthiban; Lakshmi, P.V.M.; Sagar, Vivek; Gupta, Rajeev; Mohan, Indu; Nair, Sanjeev; Prasad Varma, Ravi; Li, Wei; Hu, Bo; You, Kai; Ncube, Tatenda; Ncube, Brian; Chifamba, Jephat; West, Nicola; Yeates, Karen; Iqbal, Romaina; Khawaja, Rehman; Yusuf, Rita; Khan, Afreen; Seron, Pamela; Lanas, Fernando; Lopez-Jaramillo, Patricio; Camacho López, Paul Anthony; Puoane, Thandi; Yusuf, Salim; Brauer, Michael; The Prospective Urban Rural Epidemiology (PURE) study; EverestIntroduction. Switching from polluting (e.g. wood, crop waste, coal) to clean (e.g. gas, electricity) cooking fuels can reduce household air pollution exposures and climate-forcing emissions. While studies have evaluated specific interventions and assessed fuel-switching in repeated cross-sectional surveys, the role of different multilevel factors in household fuel switching, outside of interventions and across diverse community settings, is not well understood. Methods. We examined longitudinal survey data from 24 172 households in 177 rural communities across nine countries within the Prospective Urban and Rural Epidemiology study. We assessed household-level primary cooking fuel switching during a median of 10 years of follow up (∼2005–2015). We used hierarchical logistic regression models to examine the relative importance of household, community, sub-national and national-level factors contributing to primary fuel switching. Results. One-half of study households (12 369) reported changing their primary cooking fuels between baseline and follow up surveys. Of these, 61% (7582) switched from polluting (wood, dung, agricultural waste, charcoal, coal, kerosene) to clean (gas, electricity) fuels, 26% (3109) switched between different polluting fuels, 10% (1164) switched from clean to polluting fuels and 3% (522) switched between different clean fuels. Among the 17 830 households using polluting cooking fuels at baseline, household-level factors (e.g. larger household size, higher wealth, higher education level) were most strongly associated with switching from polluting to clean fuels in India; in all other countries, community-level factors (e.g. larger population density in 2010, larger increase in population density between 2005 and 2015) were the strongest predictors of polluting-to-clean fuel switching. Conclusions. The importance of community and sub-national factors relative to household characteristics in determining polluting-to-clean fuel switching varied dramatically across the nine countries examined. This highlights the potential importance of national and other contextual factors in shaping large-scale clean cooking transitions among rural communities in low- and middle-income countries.
- PublicaciónRestringidoA novel method to evaluate the community built environment using photographs - Environmental profile of a community health (Epoch) Photo neighbourhood evaluation tool(2014-11-04) Chow, Clara K.; Corsi, Daniel J.; Lock, Karen; Madhavan, Manisha; Mackie, Pam; Li, Wei; Yi, Sun; Wang, Yang; Swaminathan, Sumathi; Lopez-Jaramillo, Patricio; Gómez Arbeláez, Diego; Avezum, Alvaro; Lear, Scott A.; Dagenais, Gilles; Teo, Koon; McKee, Martin; Yusuf, SalimBackground: Previous research has shown that environments with features that encourage walking are associated with increased physical activity. Existing methods to assess the built environment using geographical information systems (GIS) data, direct audit or large surveys of the residents face constraints, such as data availability and comparability, when used to study communities in countries in diverse parts of the world. The aim of this study was to develop a method to evaluate features of the built environment of communities using a standard set of photos. In this report we describe the method of photo collection, photo analysis instrument development and inter-rater reliability of the instrument. Methods/Principal Findings: A minimum of 5 photos were taken per community in 86 communities in 5 countries according to a standard set of instructions from a designated central point of each community by researchers at each site. A standard pro forma derived from reviewing existing instruments to assess the built environment was developed and used to score the characteristics of each community. Photo sets from each community were assessed independently by three observers in the central research office according to the pro forma and the inter-rater reliability was compared by intra-class correlation (ICC). Overall 87% (53 of 60) items had an ICC of $0.70, 7% (4 of 60) had an ICC between 0.60 and 0.70 and 5% (3 of 60) items had an ICC #0.50. Conclusions/Significance: Analysis of photos using a standardized protocol as described in this study offers a means to obtain reliable and reproducible information on the built environment in communities in very diverse locations around the world. The collection of the photographic data required minimal training and the analysis demonstrated high reliability for the majority of items of interest.
- PublicaciónAcceso abiertoPrognostic value of grip strength : Findings from the Prospective Urban Rural Epidemiology (PURE) study(2015-07) Leong, Darryl P.; Teo, Koon; Rangarajan, Sumathy; Lopez-Jaramillo, Patricio; Avezum, Alvaro; Orlandini, Andres; Seron, Pamela; Ahmed, Suad H.; Rosengren, Annika; Kelishadi, Roya; Rahman, Omar; Swaminathan, Sumathi; Iqbal, Romaina; Gupta, Rajeev; Lear, Scott A.; Oguz, Aytekin; Yusoff, Khalid; Zatonska, Katarzyna; Chifamba, Jephat; Igumbor, Ehimario; Mohan, Viswanathan; Anjana, Ranjit Mohan; Gu, Hongqiu; Li, Wei; Yusuf, Salim; The PURE (Prospective Urban Rural Epidemiology) Study investigatorsBackground Reduced muscular strength, as measured by grip strength, has been associated with an increased risk of all-cause and cardiovascular mortality. Grip strength is appealing as a simple, quick, and inexpensive means of stratifying an individual's risk of cardiovascular death. However, the prognostic value of grip strength with respect to the number and range of populations and confounders is unknown. The aim of this study was to assess the independent prognostic importance of grip strength measurement in socioculturally and economically diverse countries. Methods The Prospective Urban-Rural Epidemiology (PURE) study is a large, longitudinal population study done in 17 countries of varying incomes and sociocultural settings. We enrolled an unbiased sample of households, which were eligible if at least one household member was aged 35–70 years and if household members intended to stay at that address for another 4 years. Participants were assessed for grip strength, measured using a Jamar dynamometer. During a median follow-up of 4·0 years (IQR 2·9–5·1), we assessed all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, myocardial infarction, stroke, diabetes, cancer, pneumonia, hospital admission for pneumonia or chronic obstructive pulmonary disease (COPD), hospital admission for any respiratory disease (including COPD, asthma, tuberculosis, and pneumonia), injury due to fall, and fracture. Study outcomes were adjudicated using source documents by a local investigator, and a subset were adjudicated centrally. Findings Between January, 2003, and December, 2009, a total of 142 861 participants were enrolled in the PURE study, of whom 139 691 with known vital status were included in the analysis. During a median follow-up of 4·0 years (IQR 2·9–5·1), 3379 (2%) of 139 691 participants died. After adjustment, the association between grip strength and each outcome, with the exceptions of cancer and hospital admission due to respiratory illness, was similar across country-income strata. Grip strength was inversely associated with all-cause mortality (hazard ratio per 5 kg reduction in grip strength 1·16, 95% CI 1·13–1·20; p<0·0001), cardiovascular mortality (1·17, 1·11–1·24; p<0·0001), non-cardiovascular mortality (1·17, 1·12–1·21; p<0·0001), myocardial infarction (1·07, 1·02–1·11; p=0·002), and stroke (1·09, 1·05–1·15; p<0·0001). Grip strength was a stronger predictor of all-cause and cardiovascular mortality than systolic blood pressure. We found no significant association between grip strength and incident diabetes, risk of hospital admission for pneumonia or COPD, injury from fall, or fracture. In high-income countries, the risk of cancer and grip strength were positively associated (0·916, 0·880–0·953; p<0·0001), but this association was not found in middle-income and low-income countries. Interpretation This study suggests that measurement of grip strength is a simple, inexpensive risk-stratifying method for all-cause death, cardiovascular death, and cardiovascular disease. Further research is needed to identify determinants of muscular strength and to test whether improvement in strength reduces mortality and cardiovascular disease. Funding Full funding sources listed at end of paper (see Acknowledgments).
- PublicaciónAcceso abiertoProspective Urban Rural Epidemiology (PURE) study : Baseline characteristics of the household sample and comparative analyses with national data in 17 countries(2013-10) Corsi, Daniel J.; Subramanian, S. V.; Chow, Clara K.; McKee, Martin; Chifamba, Jephat; Dagenais, Gilles; Diaz, Rafael; Iqbal, Romaina; Kelishadi, Roya; Kruger, Annamarie; Lanas, Fernando; Lopez-Jaramillo, Patricio; Mony, Prem; Mohan, Viswanathan; Avezum, Alvaro; Oguz, Aytekin; Rahman, M. Omar; Rosengren, Annika; Szuba, Andrej; Li, Wei; Yusoff, Khalid; Yusufali, Afzalhussein; Rangarajan, Sumathy; Teo, Koon; Yusuf, SalimBackground The PURE study was established to investigate associations between social, behavioural, genetic, and environmental factors and cardiovascular diseases in 17 countries. In this analysis we compare the age, sex, urban/rural, mortality, and educational profiles of the PURE participants to national statistics. Methods PURE employed a community-based sampling and recruitment strategy where urban and rural communities were selected within countries. Within communities, representative samples of adults aged 35 to 70 years and their household members (n = 424,921) were invited for participation. Results The PURE household population compared to national statistics had more women (sex ratio 95.1 men per 100 women vs 100.3) and was older (33.1 years vs 27.3), although age had a positive linear relationship between the two data sources (Pearson's r = 0.92). PURE was 59.3% urban compared to an average of 63.1% in participating countries. The distribution of education was less than 7% different for each category, although PURE households typically had higher levels of education. For example, 37.8% of PURE household members had completed secondary education compared to 31.3% in the national data. Age-adjusted annual mortality rates showed positive correlation for men (r = 0.91) and women (r = 0.92) but were lower in PURE compared to national statistics (7.9 per 1000 vs 8.7 for men; 6.7 vs 8.1 for women). Conclusions These findings indicate that modest differences exist between the PURE household population and national data for the indicators studied. These differences, however, are unlikely to have much influence on exposure-disease associations derived in PURE. Further, incidence estimates from PURE, stratified according to sex and/or urban/rural location will enable valid comparisons of the relative rates of various cardiovascular outcomes across countries.
- PublicaciónAcceso abiertoThe household economic burden of non-communicable diseases in 18 countries(BMJ Global Health, 2020-02-11) Murphy, Adrianna; Palafox, Benjamin; Walli-Attaei, Marjan; Powell-Jackson, Timothy; Rangarajan, Sumathy; Alhabib, Khalid F.; Avezum, Alvaro; Tumerdem Calik, Kevser Burcu; Chifamba, Jephat; Choudhury, Tarzia; Dagenais, Gilles; Dans, Antonio; Gupta, Rajeev; Iqbal, Romaina; Kaur, Manmeet; Kelishadi, Roya; Khatib, Rasha; Kruger, Iolanthe Marike; Raman Kutty, Vellappillil; Lear, Scott A.; Li, Wei; Lopez-Jaramillo, Patricio; Mohan, Viswanathan; Mony, Prem K.; Orlandin, Andres; Rosengren, Annika; Rosnah, Ismail; Seron, Pamela; Teo, Koon; Tse, Lap Ah; Tsolekile, Lungiswa; Wang, Yang; Wielgosz, Andreas; Yan, Ruohua; Yeates, Karen; Yusoff, Khalid; Zatonska, Katarzyna; Hanson, Kara; Yusuf, Salim; McKee, Martin; EverestAbstract Background Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. Methods Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. Results The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. Conclusions Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs.
- 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.