Health fortunes reversed for some

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Hi All, http://www.nytimes.com/2008/04/27/weekinreview/27sack.html?hphttp://tinyurl.com/3mfk8cThe paper is free full-text.Ezzati M, Friedman AB, Kulkarni SC, Murray CJ.The Reversal of Fortunes: Trends in County Mortality and Cross-County Mortality Disparities in the United States.PLoS Med. 2008 Apr 22;5(4):e66 [Epub ahead of print]PMID: 18433290 http://tinyurl.com/3l6bz5BackgroundMost analyses of risks to health focus on the total burden of their aggregate effects. The distribution of risk-factor-attributable disease burden, for example by age or exposure level, can inform the selection and targeting of specific interventions and programs, and increase cost-effectiveness.Methods and FindingsFor 26

selected risk factors, expert working groups conducted comprehensive reviews of data on risk-factor exposure and hazard for 14 epidemiological subregions of the world, by age and sex. Age-sex-subregion-population attributable fractions were estimated and applied to the mortality and burden of disease estimates from the World Health Organization Global Burden of Disease database. Where possible, exposure levels were assessed as continuous measures, or as multiple categories. The proportion of risk-factor-attributable burden in different population subgroups, defined by age, sex, and exposure level, was estimated. For major cardiovascular risk factors (blood pressure, cholesterol, tobacco use, fruit and vegetable intake, body mass index, and physical inactivity) 43%-61% of attributable disease burden occurred between the ages of 15 and 59 y, and 87% of alcohol-attributable burden occurred in this age group. Most of the disease burden for continuous risks occurred in those

with only moderately raised levels, not among those with levels above commonly used cut-points, such as those with hypertension or obesity. Of all disease burden attributable to being underweight during childhood, 55% occurred among children 1-3 standard deviations below the reference population median, and the remainder occurred among severely malnourished children, who were three or more standard deviations below median.ConclusionsMany major global risks are widely spread in a population, rather than restricted to a minority. Population-based strategies that seek to shift the whole distribution of risk factors often have the potential to produce substantial reductions in disease burden.-- Al Pater, alpater@...

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