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Biomedical subjects

L Bonneux

Publications and source records attributed to L Bonneux.

53 records · Page 3Linked to original sources
PubMed1995

Variation in reported prevalences of hypertension in The Netherlands: the impact of methodological variables.

STUDY OBJECTIVE: To estimate the prevalence of hypertension in The Netherlands and to quantify the influence of methodological variables on the reported prevalences. DESIGN: A pooled analysis was performed based on reported age specific prevalences of hypertension. A logistic model was used to estimate the probability of hypertension. MAIN RESULTS: The age standardised prevalence of hypertension varies more than fivefold between studies carried out in The Netherlands. The probability of having hypertension was lower if blood pressure was measured at more than one point in time (Odds ratio 0.44 (OR) (95% confidence interval (95% CI) 0.38, 0.51) for men and 0.47 (0.41, 0.54) for women, and if the study was carried out more recently (OR 0.92 (0.91, 0.93) per year). The probability was higher if the study was carried out in a general practice (OR 1.14 (1.03, 1.27) for men and 1.52 (1.36, 1.69) for women). The inclusion of treated people as hypertensive yields contradictory results for men and women. CONCLUSIONS: The strong variation in prevalence is explained by methodology and by a period effect indicating a decrease of the prevalence of hypertension over time. Whether this decrease is true or caused by confounding due to unknown or unreported methodological variation over time is unknown. For future studies, a standardised method could reduce the influence of methodological variables and thereby the variation in reported prevalences.

Adult↗
PubMed1994

Current and future costs of cancer.

Cancer costs in the Netherlands amounted to 4.8% of health care costs in 1988. For five cancer types, and a sixth group covering all other malignancies, costs were broken down by age, sex and disease phase. They showed a remarkably similar pattern of medical consumption. Costs were linked to observed incidence, mortality and estimated prevalence, together allowing for prediction of future costs of cancer. In 2020, as a result of ageing, cancer costs will have increased much more rapidly than total health care costs, in particular for cancer of the lung and prostate. Colorectal cancer costs were predicted for epidemiological scenarios. Our model shows that an increase in future prevalence may bear quite different cost implications. If it is due to higher incidence, the costs will increase substantially. If due to survival improvement, the increase will be less prominent. Simply extrapolating costs based on future prevalence or mortality may produce serious errors.

Adult↗
PubMed1994

Health expectancy: an indicator for change? Technology Assessment Methods Project Team.

STUDY OBJECTIVE: Health expectancy is an increasingly used indicator of population health status. It collapses both mortality and morbidity into a single indicator, and is therefore preferred to the total life expectancy index for populations with low mortality but high morbidity rates. Three methods of calculation exist: the Sullivan, double decrement, and multi-state methods. This report aims to describe their relative advantages and limitations when used to monitor changes in population health status over time. DESIGN: The differences between the three methods are explained. Using a dynamic model of heart disease, the effect of the introduction of thrombolytic treatment on the survival of patients with acute myocardial infarction is calculated. The resulting changes in health expectancy are calculated according to the Sullivan and multi-state methods. MAIN RESULTS: As opposed to the double decrement and the multi-state methods, the Sullivan method produces spurious trends in health expectancy in response to the change in survival. CONCLUSIONS: Estimates of health expectancy in a dynamic situation can be very misleading when based on the Sullivan method, with its attractively moderate data requirements. The multi-state method, which requires longitudinal studies of population health status, is often indispensable.

Disease-Free Survival↗
PubMed1994

Estimating clinical morbidity due to ischemic heart disease and congestive heart failure: the future rise of heart failure.

OBJECTIVES: Many developed countries have seen declining mortality rates for heart disease, together with an alleged decline in incidence and a seemingly paradoxical increase in health care demands. This paper presents a model for forecasting the plausible evolution of heart disease morbidity. METHODS: The simulation model combines data from different sources. It generates acute coronary event and mortality rates from published data on incidences, recurrences, and lethalities of different heart disease conditions and interventions. Forecasts are based on plausible scenarios for declining incidence and increasing survival. RESULTS: Mortality is postponed more than incidence. Prevalence rates of morbidity will decrease among the young and middle-aged but increase among the elderly. As the milder disease states act as risk factors for the more severe states, effects will culminate in the most severe disease states with a disproportionate increase in older people. CONCLUSIONS: Increasing health care needs in the face of declining mortality rates are no contradiction, but reflect a tradeoff of mortality for morbidity. The aging of the population will accentuate this morbidity increase.

Female↗
PubMed1993

Stroke trends in an aging population. The Technology Assessment Methods Project Team.

BACKGROUND AND PURPOSE: Trends in stroke incidence and survival determine changes in stroke morbidity and mortality. This study examines the extent of the incidence decline and survival improvement in the Netherlands from 1979 to 1989. In addition, it projects future changes in stroke morbidity during the period 1985 to 2005, when the country's population will be aging. METHODS: A state-event transition model is used, which combines Dutch population projections and existing data on stroke epidemiology. Based on the clinical course of stroke, the model describes historical national age- and sex-specific hospital admission and mortality rates for stroke. It extrapolates observed trends and projects future changes in stroke morbidity rates. RESULTS: There is evidence of a continuing incidence decline. The most plausible rate of change is an annual decline of -1.9% (range, -1.7% to -2.1%) for men and -2.4% (range, -2.3% to -2.8%) for women. Projecting a constant mortality decline, the model shows a 35% decrease of the stroke incidence rate for a period of 20 years. Prevalence rates for major stroke will decline among the younger age groups but increase among the oldest because of increased survival in the latter. In absolute numbers this results in an 18% decrease of acute stroke episodes and an 11% increase of major stroke cases. CONCLUSIONS: The increase in survival cannot fully explain the observed mortality decline and, therefore, a concomitant incidence decline has to be assumed. Aging of the population partially outweighs the effect of an incidence decline on the total burden of stroke. Increase in cardiovascular survival leads to a further increase in major stroke prevalence among the oldest age groups.

Adult↗
PubMed1992

[The cost of illness].

This study is an essential prerequisite to gain more insight into the complex relationship between public health and the costs of medical care. It offers a first tentative but comprehensive description of the total direct costs generated by all diseases in the Dutch population. We classified estimated direct costs of illness (39.8 thousand million guilders) by type of care, sex, age and 48 diagnostic categories for 1988. In order to estimate the costs of health care in the year 2030, we linked this information with demographic development. We were able to allocate 75% of all costs to diseases. Ranking by major disease categories revealed that mental disorders account for the highest proportion of costs (20%), followed by diseases of the circulatory system (9%), and diseases of the digestive system (8%). Costs of medical care increased significantly with age and were presumably incurred for non fatal ailments. Health care costs for men and women were almost similar. In the year 2030 the costs of dementia and diseases of the circulatory system will increase most. A reliable estimate of the costs should also take epidemiological and economic considerations into account.

Age Factors↗
PubMed1989

Advanced immunodeficiency as a risk factor for heterosexual transmission of HIV.

To define the rate of HIV infection and associated risk factors among heterosexual partners of HIV-infected individuals, 80 partners and 77 index cases were examined for clinical, behavioural and virological variables. The study population included 61 male and 16 female index cases, of whom 40 were European and 37 African. Multiple sexual partners in central Africa was the risk factor for HIV infection in 83%. The overall infection rate among the contact cases was 45%, 53% among female partners and 13% among male partners (P less than 0.001). Variables significantly associated with HIV infection in the partners included advanced clinical stage (AIDS-related complex or AIDS), a low concentration of T4 lymphocytes and African nationality of the index case, young age of the partner, and more than 50 instances of sexual contact with the index cases. In a logistic regression analysis, a low concentration of T4 lymphocytes, clinical stage ARC/AIDS and African nationality of the index case but not number of sexual contacts, remained as independent risk factors for HIV transmission. Our data indicate that there is a significant biological heterogeneity in sexual transmission of HIV and that advanced clinical stage and severe T cell depletion of the index case are major determinants of infectivity.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Risk factors for infection with human immmunodeficiency virus among European expatriates in Africa.

The pattern of cases of AIDS in Belgium suggests that Europeans infected with human immunodeficiency virus (HIV) acquired the infection in Africa. The prevalence of infection was assessed in Belgian advisers and European expatriates and risk factors for infection defined in a case-control study of expatriate men. Fifteen (1.1%) of 1401 Belgian advisers working in Africa and 41 (0.9%) of 4564 European expatriates living in Africa, were positive for antibody to HIV in a voluntary screening programme in Belgium. Among subjects with antibody to HIV the ratio of men to women was 3:1. These subjects did not have a history of intravenous drug abuse or blood transfusion and only one was homosexual. In a case-control study of 33 expatriate men who had antibody to HIV and 119 controls the men with antibody reported significantly more female sexual partners, who were more commonly local; and significantly more sexual contact with prostitutes in Africa. They had a significantly higher prevalence of history of sexually transmitted disease and had received significantly more injections by unqualified staff in Africa during the previous five years. No specific sexual practices were associated with having antibody to HIV. After multivariate analysis sexual contact with local women (adjusted odds ratio 14.7; 95% confidence interval 2.81 to 76.9), sexual contact with prostitutes (adjusted odds ratio 10.8 (1.6 to 71.9), and injections by unqualified staff (adjusted odds ratio 13.5 (3.7 to 49.8) remained independent risk factors for infection. European expatriates in Africa were at increased risk from infection with HIV and were a means of introducing HIV into the heterosexual population in Europe. Transmission from women to men by vaginal intercourse seemed to be the most probable route of infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Protected carotid artery stenting (PCAS): a short medical technology assessment.

After a period of experimenting with angioplasty and stenting, carotid artery stenting under embolic protection (PCAS) is becoming a viable alternative for carotid endarterectomy (CEA). A standard literature review showed that, at January 2005, there was no evidence that PCAS is more effective than CEA. The high costs of stent and protection device makes PCAS then inferior to CEA. PCAS may be the sole possible option in patients with symptomatic carotid artery stenosis unfit for surgery, where the high risk of stroke overrides uncertainty about health effects and overrides cost-effectiveness. These are a few patients per year in Belgium. Several randomised controlled trials comparing PCAS and CEA are now recruiting patients. To have answers on key questions of cost-effectiveness, it is of paramount importance that these trials recruit and publish rapidly. The KCE (Belgian HealthCare Knowledge Center/Centre Fédéral d'Expertise des Soins de Santé/Federaal Kenniscentrum voor de Gezondheidszorg) therefore advises cooperation with these trials. Outside these trials and compassionate use in the few symptomatic patients unfit for CEA, the use of PCAS raises serious ethical questions.

Cardiovascular Surgical Procedures↗
PubMedDate not supplied

Burden of mortality and morbidity from dementia.

The purpose of this study was to estimate severity-specific mortality and to quantify the global health burden of dementia by assessing the time spent disabled with dementia and the life years lost due to dementia. We used mortality data from the Rotterdam study, a population-based prospective study in the 55+-year age range to calculate overall and severity-specific excess mortality for the demented. Lost life years were calculated by decomposing the (mixed) Dutch life table of 1990-1992 in two populations, the demented and the healthy, using prevalence and excess (all cause) mortality. Healthy life loss was calculated by a modified Sullivan technique, weighting for disease severity. Our results indicated that mortality was increased in the demented, in all age, sex, and severity groups. Mortality rate ratios were 2.1 (men) and 2.3 (women), with ranges of 1.7-3.4 (men) and 2.0-3.1 (women), depending on severity. Fifty-five-year-old men lose 1.2 life years due to morbidity and mortality and 0.7 life years due to mortality resulting from dementia. Women lose 3.1 and 1.9 life years, respectively. This population-based study provides evidence that mortality is increased in the demented at all stages, including minimal dementia. The quantified health impact on the general population is in the same order as that of lung cancer or stroke.

Aged↗