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Biomedical subjects

Stephen Vander Hoorn

Publications and source records attributed to Stephen Vander Hoorn.

At least 19 recordsLinked to original sources
PubMed2006

Global and regional mortality from ischaemic heart disease and stroke attributable to higher-than-optimum blood glucose concentration: comparative risk assessment.

BACKGROUND: Cardiovascular mortality risk increases continuously with blood glucose, from concentrations well below conventional thresholds used to define diabetes. We aimed to quantify population-level effects of all higher-than-optimum concentrations of blood glucose on mortality from ischaemic heart disease and stroke worldwide. METHODS: We used population distribution of fasting plasma glucose to measure exposure to higher-than-optimum blood glucose. We collated exposure data in 52 countries from individual-level records in population health surveys, systematic reviews, and data provided by investigators. Relative risks for ischaemic heart disease and stroke mortality were from a meta-analysis of more than 200,000 participants in the Asia-Pacific region, with adjustment for other cardiovascular risk factors. RESULTS: In addition to 959,000 deaths directly assigned to diabetes, 1 490,000 deaths from ischaemic heart disease and 709,000 from stroke were attributable to high blood glucose, accounting for 21% and 13% of all deaths from these conditions. 1.8 million of these 2.2 million cardiovascular deaths (84%) were in low-and-middle-income countries (1,224,000 for ischaemic heart disease, 623,000 for stroke). 792,000 (53%) of deaths from ischaemic heart disease and 345,000 (49%) from stroke that were attributable to high blood glucose were in men. Largest numbers of deaths attributable to this risk factor from ischaemic heart disease were in low-and-middle-income countries of South Asia (548,000) and Europe and Central Asia (313,000), and from stroke in South Asia (215,000) and East Asia and Pacific (190,000). INTERPRETATION: Higher-than-optimum blood glucose is a leading cause of cardiovascular mortality in most world regions. Programmes for cardiovascular risk and diabetes management and control at the population level need to be more closely integrated.

Adult↗
PubMed2006

Ethnic disparities in nutrition-related mortality in New Zealand: 1997-2011.

AIMS: To estimate the mortality due to non-optimal levels of systolic blood pressure, total blood cholesterol, body mass index (BMI), and vegetable and fruit intake amongst Maori and non-Maori in New Zealand in 1997. In addition, to estimate the ethnic-specific burden of disease that could potentially be avoided in 2011 if exposure to these risk factors were reduced. METHODS: The study uses comparative risk assessment methodology, a systematic approach to estimating both attributable and avoidable burden of disease developed by the World Health Organization. RESULTS: About 47% of deaths among Maori and 39% of deaths among non-Maori were estimated to be due to the selected risk factors. Age-standardised mortality rates for attributable ischaemic heart disease burden were consistently higher in Maori for individual risk factors. Age standardised mortality attributable to BMI was relatively higher for Maori, especially diabetes mortality. Estimates of avoidable mortality suggest that the health gains for Maori would be relatively greater than for non-Maori across all risk factors, but particularly with improvements in BMI. CONCLUSIONS: Non-optimal levels of systolic blood pressure, cholesterol, BMI, and to a lesser extent vegetable and fruit intake are major modifiable causes of death in New Zealand. Small changes in risk factor levels could have a major impact on population health within a decade, with relatively greater health gains for Maori.

Age Distribution↗
PubMed2006

Blood pressure and the global burden of disease 2000. Part 1: estimates of blood pressure levels.

OBJECTIVE: To provide global estimates of blood pressure by age and sex for adults aged > or = 30 years, by WHO subregion. DESIGN AND METHODS: Data were obtained from studies identified in a literature review of population-based surveys. These were complemented by data from MONICA and INTERSALT studies. Estimates of the shape of the age-systolic blood pressure (SBP) association were made from survey data utilizing parametric and non-parametric analyses. A linear sex-specific association of SBP with age was demonstrated from 30 to 70 years in females and 20 to 70 years for males in each subregion. Mean age- and sex-specific estimates of SBP were estimated for each WHO subregion separately, based on study and country-weighted SBP data. RESULTS: Analyses were based on data from about 230 surveys and over 660 000 participants. Age-specific mean SBP values ranged from 114 to 164 mmHg for females, and 117-153 mmHg for males. Females typically had lower SBP levels than males in the 30-44-year age groups, but in all subregions, SBP levels rose more steeply with age for females than males. Therefore, SBP levels in those aged > or = 60 years tended to be higher in females. Subregions with consistently high mean SBP levels included parts of eastern Europe and Africa. Mean SBP levels were lowest in south-east Asia and parts of the western Pacific. CONCLUSIONS: These global estimates of blood pressure by age, sex and subregion show considerable variation in estimated levels. The lack of data in developing countries is substantial, and this is an important limitation given the role of blood pressure in increasing cardiovascular disease levels.

Adult↗
PubMed2006

Blood pressure and the global burden of disease 2000. Part II: estimates of attributable burden.

OBJECTIVES: To provide estimates of the global burden of disease attributable to non-optimal blood pressure by age and sex for adults aged > or = 30 years, by WHO subregion. METHODS: Estimates of attributable burden were made using population impact fractions, which used data on mean systolic blood pressure levels, disease burden [in deaths and/or disability-adjusted life years (DALYs)] and relative risk corrected for regression dilution bias. Estimates were made of burden attributable to a population distribution of blood pressure with a mean systolic blood pressure of greater than 115 mmHg. RESULTS: Globally, approximately two-thirds of stroke and one-half of ischaemic heart disease were attributable to non-optimal blood pressure. These proportions were highest in the more developed parts of the world. Worldwide, 7.1 million deaths (approximately 12.8% of the global total) and 64.3 million DALYs (4.4% of the global total) were estimated to be due to non-optimal blood pressure. Overall approximately, two-thirds of the attributable burden of disease occurred in the developing world, approximately two-thirds in the middle age groups (45-69 years) and approximately one-half occurred in those with systolic blood pressure levels between 130 and 150 mmHg. CONCLUSIONS: The burden of non-optimal blood pressure is almost double that of the only previous global estimates, which is largely explained by the correction for regression dilution adopted in these analyses. High blood pressure is a leading cause of global burden of disease, and most of it occurs in the developing world.

Blood Pressure↗
PubMed2006

Vegetable and fruit intake and mortality from chronic disease in New Zealand.

OBJECTIVE: To estimate mortality attributable to inadequate vegetable and fruit intake in New Zealand in 1997, and the burden of disease that could be avoided in 2011 if modest increases in vegetable and fruit intake were to occur. METHODS: Comparative risk assessment methodology was used to estimate both attributable and avoidable mortality due to inadequate vegetable and fruit consumption (< 600 g/day). Vegetables and fruit were defined as all fresh, frozen, canned, dried or juiced vegetables and fruit, except potatoes, nuts, seeds and pulses. Disease outcomes assessed were mortality from ischaemic heart disease, ischaemic stroke, and lung, oesophageal, stomach and colorectal cancers. RESULTS: In 1997, mean vegetable and fruit intake was 420 g/day in males and 404 g/day in females. Inadequate vegetable and fruit intake is estimated to have contributed to 1,559 deaths (6% of all deaths) in that year, including 1,171 from ischaemic heart disease, 179 from ischaemic stroke and 209 from cancer. Modest increases in vegetable and fruit intake (40 g/day above the historic trend) could prevent 334 deaths each year from 2011, mostly from ischaemic heart disease. CONCLUSIONS: Inadequate vegetable and fruit intake is an important cause of mortality in New Zealand. Small increases in vegetable and fruit intake could have a major impact on population health within a decade.

Adult↗
PubMed2006

Cardiovascular mortality attributable to high blood cholesterol in New Zealand.

OBJECTIVE: To estimate mortality attributable to higher-than-optimal blood cholesterol in New Zealand in 1997, and the mortality burden that could be potentially avoided in 2011 if modest reductions in mean population blood cholesterol concentrations were achieved. DESIGN: Comparative risk assessment methodology was used to estimate the attributable and avoidable mortality due to higher-than-optimal total blood cholesterol (> 3.8 mmol/L). Disease outcomes assessed were deaths from ischaemic heart disease (IHD) and ischaemic stroke. RESULTS: Overall, higher-than-optimal blood cholesterol contributed to 4,721 deaths in New Zealand in 1997 (17% of all deaths). This included 4,096 IHD deaths (64%) and 625 ischaemic stroke deaths (38%). Modest reductions in mean population blood cholesterol concentrations (e.g. 0.1 mmol/L) could potentially prevent 300 deaths (261 IHD and 39 ischaemic stroke) each year from 2011. CONCLUSIONS: Higher-than-optimal blood cholesterol concentrations are a leading cause of mortality in New Zealand. Modest reductions in blood cholesterol levels could have a major impact on population health within a decade.

Adolescent↗
PubMed2006

Relationship between retinal nerve fiber layer and visual field sensitivity as measured by optical coherence tomography in chiasmal compression.

PURPOSE: To investigate the spatial relationship between retinal nerve fiber layer (RNFL) thickness measured with optical coherence tomography (OCT) and visual field sensitivity (VFS) measured by standard automated perimetry (SAP) in chiasmal compression. METHODS: Twenty-six patients with chiasmal compression were enrolled. RNFL thickness was measured with the StratusOCT and VFS with SAP (Humphrey Field Analyzer; both from Carl Zeiss Meditec, Dublin, CA). Relationships between RNFL thickness (in clock hours, hemifields, and sectors) and VFS (zones were divided into hemifields, quadrants, and sectors based on a validated visual field map) expressed in a decibel scale and 1/lambert (L) were evaluated by linear and nonlinear regression. Coefficients of determination (R(2)) were calculated by using a multivariate model. RESULTS: Average RNFL thickness correlated strongly with pattern standard deviation (PSD; R = 0.622) and mean deviation (MD; R = 0.413). The four strongest correlations were between the 8 o'clock OCT position (temporal disc), with the temporal hemifield (R = -0.813), the superotemporal quadrant (R = -0.847), the inferotemporal quadrant (R = -0.855), and the field sector representing the papillomacular bundle (R = -0.809). Coefficients of determination improved significantly in all sectors when time since surgery was included in the regression model-most notably, average thickness and 1/L (R(2) = 0.35-0.49), the decibels (R(2) = 0.31-0.47), and the temporal sector (R(2) = 0.44-0.57). CONCLUSIONS: This is the first study to compare the structure-function correlation of RNFL measured by OCT with SAP in patients with chiasmal compression. RNFL is topographically related globally and sectorally to decreased SAP, with the temporal sectors showing the strongest correlations. The correlation between RNFL and VFS strengthens as the time from surgical intervention increases.

Adolescent↗
PubMed2006

Trends in national and state-level obesity in the USA after correction for self-report bias: analysis of health surveys.

OBJECTIVES: To quantify population-level bias in self-reported weight and height as a function of age, sex, and the mode of self-report, and to estimate unbiased trends in national and state level obesity in the USA. DESIGN: Statistical analysis of repeated cross-sectional health examination surveys (the National Health and Nutrition Examination Survey [NHANES]) and health surveys (the Behavioral Risk Factor Surveillance System [BRFSS]) in the USA. SETTING: The 50 states of the USA and the District of Columbia. RESULTS: In the USA, on average, women underreported their weight, but men did not. Young and middle-aged (<65 years) adult men over-reported their height more than women of the same age. In older age groups, over-reporting of height was similar in men and women. Population-level bias in self-reported weight was larger in telephone interviews (BRFSS) than in-person interviews (NHANES). Except in older adults, height was over-reported more often in telephone interviews than in-person interviews. Using corrected weight and height in the year 2000, Mississippi (30%) and Texas (31%) [corrected] had the highest prevalence of obesity for men; Texas (37%), Louisiana (37%), Mississippi (37%), District of Columbia (37%), Alabama (37%), and South Carolina (36%) for women. CONCLUSIONS: Population-level bias in self-reported weight and height is larger in telephone interviews than in-person interviews. Telephone interviews are a low-cost method for regular, nationally- and sub-nationally representative monitoring of obesity. It is possible to obtain corrected estimates of trends and geographical distributions of obesity from telephone interviews by using systematic analysis which measure weight and height from an independent sample of the same population.

Adult↗
PubMed2005

Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors.

INTRODUCTION: With respect to reducing mortality, advances in cancer treatment have not been as effective as those for other chronic diseases; effective screening methods are available for only a few cancers. Primary prevention through lifestyle and environmental interventions remains the main way to reduce the burden of cancers. In this report, we estimate mortality from 12 types of cancer attributable to nine risk factors in seven World Bank regions for 2001. METHODS: We analysed data from the Comparative Risk Assessment project and from new sources to assess exposure to risk factors and relative risk by age, sex, and region. We applied population attributable fractions for individual and multiple risk factors to site-specific cancer mortality from WHO. FINDINGS: Of the 7 million deaths from cancer worldwide in 2001, an estimated 2.43 million (35%) were attributable to nine potentially modifiable risk factors. Of these, 0.76 million deaths were in high-income countries and 1.67 million in low-and-middle-income nations. Among low-and-middle-income regions, Europe and Central Asia had the highest proportion (39%) of deaths from cancer attributable to the risk factors studied. 1.6 million of the deaths attributable to these risk factors were in men and 0.83 million in women. Smoking, alcohol use, and low fruit and vegetable intake were the leading risk factors for death from cancer worldwide and in low-and-middle-income countries. In high-income countries, smoking, alcohol use, and overweight and obesity were the most important causes of cancer. Sexual transmission of human papilloma virus is a leading risk factor for cervical cancer in women in low-and-middle-income countries. INTERPRETATION: Reduction of exposure to key behavioural and environmental risk factors would prevent a substantial proportion of deaths from cancer.

Adolescent↗
PubMed2005

The contribution of leading diseases and risk factors to excess losses of healthy life in Eastern Europe: burden of disease study.

BACKGROUND: The East/West gradient in health across Europe has been described often, but not using metrics as comprehensive and comparable as those of the Global Burden of Disease 2000 and Comparative Risk Assessment studies. METHODS: Comparisons are made across 3 epidemiological subregions of the WHO region for Europe--A (very low child and adult mortality), B (low child and low adult mortality) and C (low child and high adult mortality)--with populations in 2000 of 412, 218 and 243 millions respectively, and using the following measures: 1. Probabilities of death by sex and causal group across 7 age intervals; 2. Loss of healthy life (DALYs) to diseases and injuries per thousand population; 3. Loss of healthy life (DALYs) attributable to selected risk factors across 3 age ranges. RESULTS: Absolute differences in mortality are most marked in males and in younger adults, and for deaths from vascular diseases and from injuries. Dominant contributions to east-west differences come from the nutritional/physiological group of risk factors (blood pressure, cholesterol concentration, body mass index, low fruit and vegetable consumption and inactivity) contributing to vascular disease and from the legal drugs--tobacco and alcohol. CONCLUSION: The main requirements for reducing excess health losses in the east of Europe are: 1) favorable shifts in all amenable vascular risk factors (irrespective of their current levels) by population-wide and personal measures; 2) intensified tobacco control; 3) reduced alcohol consumption and injury control strategies (for example, for road traffic injuries). Cost effective strategies are broadly known but local institutional support for them needs strengthening.

Adolescent↗
PubMed2005

Cardiovascular medications in primary care: treatment gaps and targeting by absolute risk.

AIM: To measure the use of three major types of cardiovascular medications (antiplatelet, blood pressure lowering, and cholesterol lowering) in primary care, and their level of targeting to individuals at high absolute risk of a cardiovascular event. METHODS: Demographic, risk factor, and prescribing data from the Dunedin Royal New Zealand College of General Practitioners Research Unit database were analysed. The data set consisted of 25,384 individuals, men aged at least 45 years and women at least 55 years, who consulted a doctor in 2000 in a practice which supplied electronic clinical notes. People with congestive heart failure were excluded. Five-year risk of a cardiovascular event was estimated using a history of vascular disease or the Framingham risk equation, and correlated with prescribed medications. RESULTS: Cardiovascular risk could be estimated for only one-third of the study population due to missing risk factor information. Data were largely unavailable on antiplatelet agents and so lipid lowering and blood pressure lowering medications were used to assess the 'treatment gap'. This combination was prescribed to only 28% of those with documented cardiovascular disease. For the remainder without a history of disease and for whom 5-year absolute risk of cardiovascular disease could be estimated, prescription of combination therapy ranged from 8% in the lowest risk group (<5% 5-year risk) to 14-16% in the other risk categories. CONCLUSIONS: Among this primary care population, more than two-thirds of people with vascular disease were not receiving guideline-recommended medications and there was little evidence of targeting by absolute risk for those without disease. However limited conclusions can be made for the latter group because of lack of documented risk factor information. While these treatment gaps may be less now, for example due to increased access to statins, it is probable that substantial gaps remain.

Aged↗
PubMed2005

Rethinking the "diseases of affluence" paradigm: global patterns of nutritional risks in relation to economic development.

BACKGROUND: Cardiovascular diseases and their nutritional risk factors--including overweight and obesity, elevated blood pressure, and cholesterol--are among the leading causes of global mortality and morbidity, and have been predicted to rise with economic development. METHODS AND FINDINGS: We examined age-standardized mean population levels of body mass index (BMI), systolic blood pressure, and total cholesterol in relation to national income, food share of household expenditure, and urbanization in a cross-country analysis. Data were from a total of over 100 countries and were obtained from systematic reviews of published literature, and from national and international health agencies. BMI and cholesterol increased rapidly in relation to national income, then flattened, and eventually declined. BMI increased most rapidly until an income of about ID 5,000 (international dollars) and peaked at about ID 12,500 for females and ID 17,000 for males. Cholesterol's point of inflection and peak were at higher income levels than those of BMI (about ID 8,000 and ID 18,000, respectively). There was an inverse relationship between BMI/cholesterol and the food share of household expenditure, and a positive relationship with proportion of population in urban areas. Mean population blood pressure was not correlated or only weakly correlated with the economic factors considered, or with cholesterol and BMI. CONCLUSIONS: When considered together with evidence on shifts in income-risk relationships within developed countries, the results indicate that cardiovascular disease risks are expected to systematically shift to low-income and middle-income countries and, together with the persistent burden of infectious diseases, further increase global health inequalities. Preventing obesity should be a priority from early stages of economic development, accompanied by population-level and personal interventions for blood pressure and cholesterol.

Adult↗
PubMed2005

The burden of death, disease, and disability due to alcohol in New Zealand.

AIM: To estimate the burden of death, disease, and disability attributable to alcohol consumption in New Zealand. METHODS: We applied the World Health Organization's comparative risk assessment methodology at country level; separately for Maori and non-Maori where possible. We combined the best estimates of alcohol consumption in the populations, with best estimates of alcohol-disease relationships from the international and, where available, national epidemiological literature, to calculate the proportions of alcohol-related conditions attributable to alcohol. RESULTS: We estimated that 3.9% of deaths in New Zealand in 2000 were attributable to alcohol consumption (approximately 1037 deaths), and approximately 981 deaths were prevented by alcohol, resulting in a net loss of about 56 lives. As a consequence, 17,200 years of life were lost, but only 5,300 years of life gained; a net loss of almost 12,000 years of life. The burden was substantially higher for younger age groups, for men compared with women, and for Maori compared with non-Maori. Injury was the biggest contributing cause of death and years of life lost, while positive effects were largely due to reduced coronary disease mortality in elderly people. The impact of alcohol on these conditions depended on the pattern as well as volume of drinking. In a separate analysis that included estimates of morbidity, we calculated a net loss of 26,000 disability-adjusted life years (DALYs) due to alcohol in 2002, with 76% lost by men. Alcohol use disorders accounted for about half of all DALYs lost. CONCLUSIONS: Five main messages emerged from the analysis that can inform policy to reduce the health burden of alcohol: there are no health benefits of drinking alcohol before middle age; pattern of drinking is an important determinant of health effects; injuries are a major component of the alcohol burden; alcohol use disorders underlie many adverse effects; and the health impact of alcohol falls inequitably on Maori.

Adolescent↗
PubMed2005

Nutrition and the burden of disease in New Zealand: 1997-2011.

OBJECTIVE: To estimate the burden of disease due to selected nutrition-related risk factors (high total blood cholesterol, high systolic blood pressure, high body mass index (BMI) and inadequate vegetable and fruit intake) in 1997, as well as the burden that could potentially be avoided in 2011 if small, favourable changes in the current risk factor distribution were to occur. DESIGN: Data on risk factor levels, disease burden and risk associations were combined using comparative risk assessment methodology, a systematic approach to estimating both attributable and avoidable burden of disease. Disease outcomes assessed varied according to risk factor and included ischaemic heart disease, stroke, type 2 diabetes mellitus and selected cancers. SETTING: New Zealand. RESULTS: Approximately 4500 deaths (17% of all deaths) in 1997 were attributable to high cholesterol, 3500 (13%) to high blood pressure, 3000 (11%) to high BMI and 1500 (6%) to inadequate vegetable and fruit intake. Taking prevalence overlap into account, these risk factors were estimated jointly to contribute to approximately 11 000 (40%) deaths annually in New Zealand. Approximately 300 deaths due to each risk factor could potentially be avoided in 2011 if modest changes were made to each risk factor distribution. CONCLUSIONS: High cholesterol, blood pressure and BMI, as well as inadequate vegetable and fruit intake, are major modifiable causes of death in New Zealand. Small changes in the population distribution of these risk factors could have a major impact on population health within a decade.

Adult↗
PubMed2005

Mortality attributable to higher-than-optimal body mass index in New Zealand.

OBJECTIVES: To estimate the burden of mortality in New Zealand due to higher-than-optimal body mass index (BMI) in 1997, as well as mortality that could be avoided in 2011 with feasible changes in mean population BMI. SETTING: New Zealand. DESIGN: Comparative risk assessment methodology was used to estimate the attributable and avoidable mortality due to high BMI. Outcomes assessed were ischaemic heart disease (IHD), ischaemic stroke, type 2 diabetes mellitus, colorectal cancer and postmenopausal breast cancer. RESULTS: In 1997, 3154 deaths (11% of all deaths) in New Zealand were due to higher-than-optimal BMI (>21 kg m(-2)). This amounted to 83% of diabetes deaths, 24% of IHD deaths, 15% of ischaemic stroke deaths and 4% of all cancer deaths. If the projected increase in mean population BMI by 2011 was limited to 1.0 kg m(-2) rather than 1.3 kg m(-2), approximately 385 deaths could be prevented annually, mainly from diabetes. CONCLUSIONS: These results quantify the importance of higher-than-optimal BMI as a major modifiable cause of premature death in New Zealand. Intervention policies that would have only modest effects on slowing the rate of increase in mean population BMI by 2011 could still prevent hundreds of deaths annually.

Adolescent↗
PubMed2004

Distribution of major health risks: findings from the Global Burden of Disease study.

BACKGROUND: Most 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 FINDINGS: For 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. CONCLUSIONS: Many 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.

Adolescent↗