Global Epidemiology最新文献

{"title":"Improving the integration of epidemiological data into human health risk assessment: What risk assessors told us they want","authors":"Carl V. Phillips ,&nbsp;Igor Burstyn ,&nbsp;David J. Miller ,&nbsp;Ali K. Hamade ,&nbsp;Raghavendhran Avanasi ,&nbsp;Denali Boon ,&nbsp;Saumitra V. Rege ,&nbsp;Sandrine E. Déglin","doi":"10.1016/j.gloepi.2024.100167","DOIUrl":"10.1016/j.gloepi.2024.100167","url":null,"abstract":"<div><div>One of the practical contributions of epidemiology studies is to inform risk assessment and management to protect public health. However, there is a perception among some that environmental and occupational epidemiology is falling short of satisfying the needs of risk assessors. The specific reasons for this are not clearly understood. To help identify the points of dissatisfaction and possible areas for mutual learning, we conducted a survey of risk assessors, seeking their opinions of epidemiology research. We present a few quantitative measures and a thematic analysis of responses to open-ended questions. Survey results suggest that some risk assessors (with some adamant exceptions) believe that epidemiology has great potential to contribute to risk assessment but can be deficient in many ways. For example, respondents identified the lack of full disclosure of methods, deficiencies in exposure assessment, the absence of comprehensive uncertainty analyses, and the failure to investigate or explore thresholds of effects as some of the common shortcomings. These could be straightforward to address. Respondents also brought up a wide collection of more complicated and subtle concerns that could lead to further improvement of useful results. We identify areas where mutually-educating interdisciplinary dialogue seems particularly promising. Epidemiology research is expensive, and risk management decisions even more so; therefore, it is desirable for the risk assessment and epidemiologic communities to work toward making epidemiologic research more useful for informing decisions.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mockery that confounds better treatment of confounding in epidemiology: The change in estimate fallacy","authors":"Igor Burstyn","doi":"10.1016/j.gloepi.2024.100166","DOIUrl":"10.1016/j.gloepi.2024.100166","url":null,"abstract":"<div><div>Confounding is one of the most infamous bugbears of epidemiology, used by some to dismiss the field's utility outright. The subject has received considerable attention from epidemiologists and the field boasts a remarkable arsenal for addressing the issue. However, it appears that there are still misconceptions about how to identify variables that cause confounding (a lack of exchangeability) in epidemiologic practice. In this commentary, I examine whether analysis of the properties of change-in-estimate method for identification of confounding, exemplified by two highly cited papers, has been appropriately cited in published reports and whether it was utilized to improve epidemiologic practice. I conclude that the myth that a change-in-estimate criterion of 10 % is legitimate for identifying confounding persists in epidemiological practice, despite having been discredited by several independent research groups decades ago. Speculations on possible solutions to this problem are offered, but my work's main contribution is identification of a problem of how methodological advances in epidemiology may be misapplied. There currently do not exist any universal criteria for identification of confounding! “Citation without representation” or biased presentation of conclusions of methodological research may be pervasive.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142424326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored guidance to apply the Estimand framework to Trials within Cohorts (TwiCs) studies","authors":"R. Gal ,&nbsp;R. Kessels ,&nbsp;K. Luijken ,&nbsp;L.A. Daamen ,&nbsp;D.R. Mink van der Molen ,&nbsp;S.A.M. Gernaat ,&nbsp;A.M. May ,&nbsp;H.M. Verkooijen ,&nbsp;P.M. van de Ven","doi":"10.1016/j.gloepi.2024.100163","DOIUrl":"10.1016/j.gloepi.2024.100163","url":null,"abstract":"<div><div><strong>Objective</strong>: The estimand framework offers a structured approach to define the treatment effect to be estimated in a clinical study. Defining the estimand upfront helps formulating the research question and informs study design, data collection and statistical analysis methods. Since the Trials within Cohorts (TwiCs) design has unique characteristics, the objective of this study is to describe considerations and provide guidance for formulating estimands for TwiCs studies.</div><div><strong>Methods</strong>: The key attributes of an estimand are the target population, treatments that are compared, the endpoint, intercurrent events and their handling, and the population-level summary measure. The estimand framework was applied retrospectively to two TwiCs studies: the SPONGE and UMBRELLA Fit trial. The aim is to demonstrate how the estimand framework can be implemented in TwiCs studies, thereby focusing on considerations relevant for defining the estimand. Three estimands were defined for both studies. For the SPONGE trial, estimators were derived.</div><div><strong>Results</strong>: Intercurrent events considered to occur exclusively or more frequently in TwiCs studies compared to conventional randomized trials included intervention refusal after randomization, misalignment of timing of routine cohort measurements and the intervention period, and participants in the control arm initiating treatments similar to the studied intervention. Considerations for handling refusal after randomization related to decisions on whether the target population should include all eligible participants or the subpopulation that would accept (or undergo) the intervention when offered. Considerations for handling treatment initiation in the control arm and misalignments of timing related to decisions on whether such events should be considered part of treatment policy or whether interest is in a hypothetical scenario where such events do not occur.</div><div><strong>Conclusion</strong>: The TwiCs study design has unique features that pose specific considerations when formulating an estimand. The examples in this study can provide guidance in the definition of estimands in future TwiCs studies.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100163"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A note on handling conditional missing values","authors":"Mohammad Ali Mansournia ,&nbsp;Maryam Nazemipour ,&nbsp;Mahyar Etminan","doi":"10.1016/j.gloepi.2024.100164","DOIUrl":"10.1016/j.gloepi.2024.100164","url":null,"abstract":"<div><div>In medical research, some variables are conditionally defined on some levels of another variable, leading to conditional missing data. Imputation of this type of structural missing data is needed given inefficiency of listwise deletion inherent in regression modeling. Using some examples, we illustrate handling of conditional missing values using simple imputation procedures in etiologic and prediction research.</div></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100164"},"PeriodicalIF":0.0,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142319449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the timeliness of birth registration in Fiji through a financial incentive","authors":"Christine Linhart ,&nbsp;Neel Singh ,&nbsp;Meli Nadakuca ,&nbsp;Varanisese Saumaka ,&nbsp;Carlie Congdon ,&nbsp;Sharita Serrao ,&nbsp;Richard Taylor ,&nbsp;Stephen Morrell","doi":"10.1016/j.gloepi.2024.100162","DOIUrl":"10.1016/j.gloepi.2024.100162","url":null,"abstract":"<div><h3>Background</h3><p>Fiji is a Pacific Island nation with the predominant ethnic groups indigenous Fijians (iTaukei) (62 %) and Fijians of Indian descent (31 %). This study reports on the effect of a Parental Assistance Payment Program (PAPP) tied to on-time birth registration, available in Fiji from August 2018 to July 2020.</p></div><div><h3>Methods</h3><p>Unit record birth registration data (<em>n</em> = 117,829) for children born during 2016–22 were used to calculate mean birth-to-registration intervals and the likelihood of on-time birth registration (within 365 days) before the PAPP (January 2016–July 2018) compared to during the PAPP (August 2018–July 2020), by population disaggregations (sex, ethnicity, age, marital status).</p></div><div><h3>Results</h3><p>During the PAPP, mean birth-to-registration intervals declined sharply by 81 %, from 665 days (95 %CI: 658–671) to 124 days (121–127). The largest declines were among i-Taukei children (803 to 139 days, 83 %) compared to non-iTaukei (283 to 76 days, 73 %); mothers aged 10–19 years (880 to 134 days, 85 %) compared to ≥20 years (653 to 123 days, 81 %); and single mothers (983 to 145 days, 85 %) compared to married mothers (570 to 115 days, 80 %). On-time birth registration increased from 57 % to 93 %, and the adjusted hazard ratio showed children born during the PAPP were 2.3 times more likely (95 %CI: 2.2–2.4) to have their birth registered on-time compared to children born before the PAPP. When the PAPP was discontinued in August 2020, the birth-to-registration interval increased sharply in all population groups.</p></div><div><h3>Conclusions</h3><p>During the two-year period the PAPP was available, it was highly effective at improving the timeliness of birth registration, particularly among iTaukei children, young mothers, and single mothers. After the PAPP was discontinued, the timeliness of birth registration deteriorated sharply. Longer post-PAPP follow-up time (≠5 years) is required to determine whether the timeliness of birth registration has deteriorated to levels similar to those during the pre-PAPP period.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100162"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000282/pdfft?md5=1171905bb3ebcdc81969c7a95b876f4b&pid=1-s2.0-S2590113324000282-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142229625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting adolescent psychopathology from early life factors: A machine learning tutorial","authors":"Faizaan Siddique ,&nbsp;Brian K. Lee","doi":"10.1016/j.gloepi.2024.100161","DOIUrl":"10.1016/j.gloepi.2024.100161","url":null,"abstract":"<div><h3>Objective</h3><p>The successful implementation and interpretation of machine learning (ML) models in epidemiological studies can be challenging without an extensive programming background. We provide a didactic example of machine learning for risk prediction in this study by determining whether early life factors could be useful for predicting adolescent psychopathology.</p></div><div><h3>Methods</h3><p>In total, 9643 adolescents ages 9–10 from the Adolescent Brain and Cognitive Development (ABCD) Study were included in ML analysis to predict high Child Behavior Checklist (CBCL) scores (i.e., t-scores ≥ 60). ML models were constructed using a series of predictor combinations (prenatal, family history, sociodemographic) across 5 different algorithms. We assessed ML performance through sensitivity, specificity, F1-score, and area under the curve (AUC) metrics.</p></div><div><h3>Results</h3><p>A total of 1267 adolescents (13.1 %) were found to have high CBCL scores. <strong>The best performing algorithms were elastic net and gradient boosted trees. The best performing elastic net models included prenatal and family history factors (Sensitivity 0.654, Specificity 0.713; AUC 0.742, F1-score 0.401) and prenatal, family, history, and sociodemographic factors (Sensitivity 0.668, Specificity 0.704; AUC 0.745, F1-score 0.402).</strong> Across all 5 ML algorithms, family history factors (e.g., either parent had nervous breakdowns, trouble holding jobs/fights/police encounters, and counseling for mental issues) and sociodemographic covariates (e.g., maternal age, child's sex, caregiver income and caregiver education) tended to be better predictors of adolescent psychopathology. The most important prenatal predictors were unplanned pregnancy, birth complications, and pregnancy complications.</p></div><div><h3>Conclusion</h3><p>Our results suggest that inclusion of prenatal, family history, and sociodemographic factors in ML models can generate moderately accurate predictions of adolescent psychopathology. Issues associated with model overfitting, hyperparameter tuning, and system seed setting should be considered throughout model training, testing, and validation. Future early risk predictions models may improve with the inclusion of additional relevant covariates.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000270/pdfft?md5=dee32756e9126cdf20786c2d3fd846a7&pid=1-s2.0-S2590113324000270-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142122258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging unverified assumptions in causal claims: Do gas stoves increase risk of pediatric asthma?","authors":"Louis Anthony Cox, Jr.","doi":"10.1016/j.gloepi.2024.100160","DOIUrl":"10.1016/j.gloepi.2024.100160","url":null,"abstract":"<div><p>The use of unverified models for risk estimates and policy recommendations can be highly misleading, as their predictions may not reflect real-world health impacts. For example, a recent article states that NO₂ from gas stoves “likely causes ∼50,000 cases of current pediatric asthma from long-term NO₂ exposure alone” annually in the United States. This explicitly causal claim, which is contrary to several methodology and review articles published in this journal, among others, reflects both (a) An unverified modeling assumption that pediatric asthma burden is approximately proportional to NO₂; and (b) An unverified causal assumption that the assumed proportionality between exposure and response is causal. The article is devoid of any causal analysis showing that these assumptions are likely to be true. It does not show that reducing NO₂ exposure from gas stoves would reduce pediatric asthma risk. Its key references report no significant associations – let alone causation – between NO₂ and pediatric asthma. Thus, the underlying data suggests that the number of pediatric asthma cases caused by gas stoves in the United States is indistinguishable from zero. This highlights the need to rigorously validate modeling assumptions and causal claims in public health risk assessments to ensure scientifically sound foundations for policy decisions.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100160"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000269/pdfft?md5=6eb2ea0e253f4813c3fa87272c37c4f8&pid=1-s2.0-S2590113324000269-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142099240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and prevalence of autoimmune diseases in China: A systematic review and meta-analysis of epidemiological studies","authors":"Olaa Mohamed-Ahmed ,&nbsp;Lianhan Shang ,&nbsp;Lin Wang ,&nbsp;Zhengming Chen ,&nbsp;Christiana Kartsonaki ,&nbsp;Fiona Bragg","doi":"10.1016/j.gloepi.2024.100158","DOIUrl":"10.1016/j.gloepi.2024.100158","url":null,"abstract":"<div><h3>Background</h3><p>Autoimmune diseases account for a substantial burden of disease in high-income countries, including Europe and North America. However, their epidemiology remains under-researched in other regions. We examined the incidence and prevalence of eight autoimmune diseases in the adult Chinese population through a systematic review of epidemiological studies.</p></div><div><h3>Methods</h3><p>We searched OvidSP MEDLINE and Google Scholar from 1995 to 2023 (inclusive) for articles on the incidence or prevalence of autoimmune thyroiditis (AT), Graves' disease (GD), type 1 diabetes mellitus (T1D), multiple sclerosis (MS), Crohn's disease (CD), ulcerative colitis (UC), rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We included studies from mainland China, Taiwan, Hong Kong or Macau. The study is registered with PROSPERO (CRD42021225842).</p></div><div><h3>Findings</h3><p>We retrieved 2278 records, of which 62 studies (161 estimates) were included in the systematic review, and 42 studies (101 estimates) were included in the meta-analysis. Pooled fixed-effects estimates for incidence of CD, UC, MS, T1D and SLE were 0.22 (95% CI 0.21–0.23), 1.13 (1.10–1.17), 0.28 (0.26–0.30), 2.20 (1.70–2.84) and 4.87 (4.21–5.64) per 100,000 persons, respectively. For RA, one study estimate was included, with an incidence of 15.8 per 100,000 persons. Fixed-effects estimates for the prevalence of CD, UC, MS, SLE, RA, GD and AT were 3.73 (95% CI 3.68–3.78), 16.11 (15.93–16.29), 4.08 (3.95–4.21), 93.44 (92.27–94.63), 104 (103–106), 450 (422–481) and 2322 (2057-2620), respectively, per 100,000 persons. Across all conditions, women were almost twice as likely as men to be diagnosed with an autoimmune disease.</p></div><div><h3>Interpretation</h3><p>There is marked variation in the frequency of autoimmune diseases among Chinese adults. We estimate that 2.7–3.0% (&gt;31 million people) of the adult Chinese population have one or more autoimmune diseases, comparable to Western populations, with the majority of the burden from autoimmune thyroid diseases and rheumatoid arthritis.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000245/pdfft?md5=dd7fc6654de767b54fc46e46f35aa386&pid=1-s2.0-S2590113324000245-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142136515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the COVID-19 impact on cancer surgery in Ireland using three national data sources","authors":"Mengyang Zhang ,&nbsp;Caitriona Kelly ,&nbsp;Triona McCarthy ,&nbsp;Paula Tierney ,&nbsp;Aline Brennan ,&nbsp;Louise Burke ,&nbsp;Caitriona McGrath ,&nbsp;Maeve Mullooly ,&nbsp;Deirdre Murray ,&nbsp;Kathleen Bennett","doi":"10.1016/j.gloepi.2024.100159","DOIUrl":"10.1016/j.gloepi.2024.100159","url":null,"abstract":"<div><h3>Background</h3><p>The healthcare system in Ireland was profoundly affected by COVID-19. This study aimed to explore the impact of the pandemic on cancer surgery in Ireland, from 2019 to 2022 using three national health data sources.</p></div><div><h3>Methods</h3><p>A repeated cross-sectional study design was used and included: (i) cancer resections from the National Histopathology Quality Improvement (NHQI) Programmes; (ii) cancer surgery from the National Cancer Registry Ireland (NCRI), and (iii) cancer surgery from Hospital Inpatient Enquiry (HIPE) System. Cancer surgery was presented by invasive/in situ and invasive only cancers (NCRI &amp; HIPE), and by four main cancer types (breast, lung, colorectal &amp; melanoma for NCRI &amp; HIPE data only).</p></div><div><h3>Results</h3><p>The annual number of cancer resections (NHQI) declined by 4.4% in 2020 but increased by 4% in 2021 compared with 2019. NCRI data indicated invasive/in-situ cancer surgery for the four main cancer types declined by 14% in 2020 and 5.1% in 2021, and by 12.3% and 7.3% for invasive cancer only, compared to 2019. Within HIPE for the same tumour types, invasive/in situ cancer surgery declined by 21.9% in 2020 and 9.9% in 2021 and by 20.8% and 9.6% for invasive cancer only. NHQI and HIPE data indicated an increase in the number of cancer surgeries performed in 2022.</p></div><div><h3>Conclusions</h3><p>Cancer surgery declined in the initial pandemic waves suggests mitigation measures for cancer surgery, including utilising private hospitals for public patients, reduced the adverse impact on cancer surgery.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000257/pdfft?md5=6892aaa5bedebdcb942896b8ea9b6f27&pid=1-s2.0-S2590113324000257-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141985454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adult mortality from non-communicable diseases in Fiji's major ethnic groups 2013–17","authors":"Catherine Dearie ,&nbsp;Christine Linhart ,&nbsp;Carah Figueroa ,&nbsp;Varanisese Saumaka ,&nbsp;Timothy Dobbins ,&nbsp;Stephen Morrell ,&nbsp;Richard Taylor","doi":"10.1016/j.gloepi.2024.100157","DOIUrl":"10.1016/j.gloepi.2024.100157","url":null,"abstract":"<div><h3>Background</h3><p>Sustainable Development Goal 3.4.1 (SDG3.4.1) targets a one-third reduction in non-communicable disease (NCD) mortality in ages 30–69-years by 2030 (relative to 2015). Directing interventions to achieve this aim requires reliable estimates of underlying cause of death (UCoD). This may be problematic when both cardiovascular diseases (CVD) and diabetes are present due to a lack of consistency in certification of such deaths. We estimate empirically 2013–17 NCD mortality in Fiji, by sex and ethnicity, from CVD, diabetes, cancer, and chronic lower respiratory diseases (CRD), and aggregated as NCD4.</p></div><div><h3>Methods</h3><p>UCoD was determined from Medical Certificates of Cause-of-Death (MCCD) from the Fiji Ministry of Health after pre-processing of mortality data where diabetes and/or hypertension were present in order to generate internationally comparable UCoD. If no potentially fatal complications from diabetes or hypertension accompanied these causes in Part I (direct cause) of the MCCD, these conditions were re-assigned to Part II (contributory cause). The probability of a 30-year-old dying before reaching age 70-years (PoD_30–70), by cause, was calculated.</p></div><div><h3>Findings</h3><p>The PoD_30–70 from NCD4 over 2013–17 differed by sex and ethnicity: in women, it was 36% (95%CI 35–37%) in i-Taukei and 27% (26–28%) in Fijians of Indian descent (FID); in men, it was 41% (40–42%) in both i-Taukei and FID.</p><p>PoD_30–70 from CVD, diabetes, cancer and CRD in women was: 18%, 10%, 13% and 1·0% in i-Taukei; 13%, 10%, 5·6% and 1·1% in FID; in men was: 28%, 8.4%, 7·6% and 2·2% in i-Taukei; 31%, 8.3%, 3.5% and 3·1% in FID.</p></div><div><h3>Interpretation</h3><p>To achieve SDG3.4.1 goals in Fiji by 2030, effective population wide and ethnic-specific interventions targeting multiple NCDs are required to reduce PoD_30–70 from NCD4: from 36% to 24% in i-Taukei, and 27% to 18% in FID women; and from 41% to 27% in i-Taukei and FID men.</p></div><div><h3>Funding</h3><p>Not applicable.</p></div>","PeriodicalId":36311,"journal":{"name":"Global Epidemiology","volume":"8 ","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590113324000233/pdfft?md5=5980565eda00806f852fca412646efc6&pid=1-s2.0-S2590113324000233-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}