scholarly journals Attributable is Preventable: Corrected and revised estimates of population attributable fraction of TB related to undernutrition in 30 high TB burden countries

2021 ◽  
Author(s):  
Anurag Bhargava ◽  
Madhavi Bhargava ◽  
Andrea Beneditti ◽  
Anura Kurpad
Keyword(s):  
Risk Factors ◽  
Population Attributable Fraction ◽  
Attributable Fraction ◽  
Energy Availability ◽  
Asian Countries ◽  
High Burden ◽  
Population Attributable Fractions ◽  
Attributable Fractions ◽  
Per Capita ◽  
Corrected Estimate

AbstractIntroductionThe Global TB Report 2020 estimated the population attributable fractions (PAF) for the major risk factors of TB. Undernourishment emerged as the leading risk factor accounting for 19% of the cases. The WHO however used the terms undernourishment and undernutrition interchangeably in its computation of PAF. Undernourishment is an indirect model derived estimate of decreased per capita energy availability, while undernutrition is defined by direct anthropometric measurements of nutritional status.MethodsWe re-estimated the PAF of undernutrition (instead of undernourishment) in 30 high TB burden countries, using the prevalence of undernutrition (age standardized estimate of BMI < 18.5 kg/m2 in adults for both sexes), and the relative risk (RR) of 3.2. Further, we revised PAF estimates of undernutrition with an RR of 4.49, in light of recent evidence.FindingsTwenty four percent of TB in high burden countries is attributable to undernutrition. The PAF of undernutrition was highest in Asian countries, unlike the PAF of undernourishment that was highest in Africa. The corrected estimate led up to 65% increase in number of cases attributable to undernutrition in Asian countries. More than one-third to nearly half of TB cases in India could be attributable to undernutrition.InterpretationEstimation of the PAF of TB related to undernutrition is methodologically valid and operationally relevant, rather than PAF related to undernourishment. Addressing undernutrition, the leading driver of TB in high TB burden countries (especially Asia) could enable achievement of END TB milestones of TB incidence for 2025.

scholarly journals Proportion of Orofacial Clefts Attributable to Recognized Risk Factors

2018 ◽  
Vol 56 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Janhavi R. Raut ◽  
Regina M. Simeone ◽  
Sarah C. Tinker ◽  
Mark A. Canfield ◽  
R. Sue Day ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cleft Palate ◽  
Cleft Lip ◽  
Population Attributable Fraction ◽  
Attributable Fraction ◽  
Individual Risk ◽  
Orofacial Clefts ◽  
Maternal Risk ◽  
Population Attributable Fractions ◽  
Attributable Fractions

Objective: Estimate the population attributable fraction (PAF) for a set of recognized risk factors for orofacial clefts. Design: We used data from the National Birth Defects Prevention Study. For recognized risk factors for which data were available, we estimated crude population attributable fractions (cPAFs) to account for potential confounding, average-adjusted population attributable fractions (aaPAFs). We assessed 11 modifiable and 3 nonmodifiable parental/maternal risk factors. The aaPAF for individual risk factors and the total aaPAF for the set of risk factors were calculated using a method described by Eide and Geffler. Setting: Population-based case–control study in 10 US states. Participants: Two thousand seven hundred seventy-nine cases with isolated cleft lip with or without cleft palate (CL±P), 1310 cases with isolated cleft palate (CP), and 11 692 controls with estimated dates of delivery between October 1, 1997, and December 31, 2011. Main Outcome Measures: Crude population attributable fraction and aaPAF. Results: The proportion of CL±P and CP cases attributable to the full set of examined risk factors was 50% and 43%, respectively. The modifiable factor with the largest aaPAF was smoking during the month before pregnancy or the first month of pregnancy (4.0% for CL±P and 3.4% for CP). Among nonmodifiable factors, the factor with the largest aaPAF for CL±P was male sex (27%) and for CP it was female sex (16%). Conclusions: Our results may inform research and prevention efforts. A large proportion of orofacial cleft risk is attributable to nonmodifiable factors; it is important to better understand the mechanisms involved for these factors.

scholarly journals Workshop: Population attributable fraction: methodologies, utilization and translations into public health messages

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Public Health ◽  
Best Practices ◽  
Population Attributable Fraction ◽  
Prevention Programs ◽  
Attributable Fraction ◽  
Health Messages ◽  
Population Attributable Fractions ◽  
Attributable Fractions ◽  
Public Health Messages ◽  
Common Application

Abstract The aim of this session is to give an overview of the methodology, applications, and translations of studies where population attributable fraction is estimated. This session will go through the methodologies of basic population attributable fractions and also further utilization of its method beyond common application today. It will therefore go through best practices and also show case how such estimates can support assessment of prevention programs and also setting up public health messages.

scholarly journals Pathway-specific population attributable fractions

2020 ◽  
Author(s):  
Maurice O’Connell ◽  
John Ferguson
Keyword(s):  
Risk Factors ◽  
Disease Burden ◽  
Alcohol Intake ◽  
Population Attributable Fraction ◽  
Disease Prevalence ◽  
Population Attributable Fractions ◽  
Attributable Fractions ◽  
Excessive Alcohol ◽  
Relative Change ◽  
Control Study

AbstractA population attributable fraction (PAF) represents the relative change in disease prevalence that one might expect if a particular exposure was absent from the population. Often, one might be interested in what percentage of this effect acts through particular pathways. For instance, the effect of excessive alcohol intake on stroke risk may be mediated by blood pressure, body mass index and several other intermediate risk factors. In this situation, attributable fractions for each mediating pathway of interest can be defined as the relative change in disease prevalence from disabling the effect of the exposure through that mediating pathway.This quantity is related to, but distinct from the recently proposed metrics of direct and indirect PAF by Sjölander. In particular, while differing pathway-specific PAF will each usually be less than total PAF, they may sum over differing mediating pathways to more than total PAF, whereas direct and indirect PAF must sum to total PAF. Here, we present definitions, identifiability conditions and estimation approaches for pathway-specific attributable fractions. We illustrate results, and comparisons to indirect PAF using INTERSTROKE, a case-control study designed to quantify disease burden attributable to a number of known causal risk factors.

scholarly journals Trends in the prevalence of airflow limitation in a general Japanese population: two serial cross-sectional surveys from the Hisayama Study

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e023673
Author(s):  
Hiroaki Ogata ◽  
Yoichiro Hirakawa ◽  
Koichiro Matsumoto ◽  
Jun Hata ◽  
Daigo Yoshida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Population Attributable Fraction ◽  
Airway Disease ◽  
Population Based ◽  
Forced Expiratory Volume ◽  
Airflow Limitation ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Population Attributable Fractions ◽  
Attributable Fractions

ObjectivesChronic obstructive airway disease, which is characterised by airflow limitation, is a major burden on public health. Reductions in environmental pollution in the atmosphere and workplace and a decline in the prevalence of smoking over recent decades may have affected the prevalence of airflow limitation in Japan. The present epidemiological study aimed to evaluate trends in the prevalence of airflow limitation and in the influence of risk factors on airflow limitation in a Japanese community.DesignTwo serial cross-sectional surveys.SettingData from the Hisayama Study, a population-based prospective study that has been longitudinally conducted since 1961.ParticipantsA total of 1842 and 3033 residents aged ≥40 years with proper spirometric measurements participated in the 1967 and 2012 surveys, respectively.Main outcome measuresAirflow limitation was defined as forced expiratory volume in 1 s/forced vital capacity <70% by spirometry. For each survey, the age-adjusted prevalence of airflow limitation was evaluated by sex. ORs and population attributable fractions of risk factors on the presence of airflow limitation were compared between surveys.ResultsThe age-standardised prevalence of airflow limitation decreased from 1967 to 2012 in both sexes (from 26.3% to 16.1% in men and from 19.8% to 10.5% in women). Smoking was significantly associated with higher likelihood of airflow limitation in both surveys, although the magnitude of its influence was greater in 2012 than in 1967 (the multivariable-adjusted OR was 1.63 (95% CI 1.19 to 2.24) in 1967 and 2.26 (95% CI 1.72 to 2.99) in 2012; p=0.007 for heterogeneity). Accordingly, the population attributable fraction of smoking on airflow limitation was 33.5% in 2012, which was 1.5-fold higher than that in 1967 (21.1%).ConclusionsThe prevalence of airflow limitation was decreased over 45 years in Japan, but the influence of smoking on airflow limitation increased with time.

scholarly journals Population attributable fraction for continuously distributed exposures

2020 ◽  
Author(s):  
John Ferguson ◽  
Fabrizio Maturo ◽  
Salim Yusuf ◽  
Martin O’Donnell
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Population Attributable Fraction ◽  
Continuous Exposure ◽  
Minimum Risk ◽  
Population Attributable Fractions ◽  
Graphical Comparison ◽  
Attributable Fractions ◽  
Potential Outcomes Framework ◽  
Prior Risk

AbstractWhen estimating population attributable fractions (PAF), it is common to partition a naturally continuous exposure into a categorical risk factor. While prior risk factor categorization can help estimation and interpretation, it can result in underestimation of the disease burden attributable to the exposure as well as biased comparisons across different exposures and risk factors. Here, we propose sensible PAF estimands for continuous exposures under a potential outcomes framework. In contrast to previous approaches, we incorporate estimation of the minimum risk exposure value (MREV) into our procedures. While for exposures such as tobacco usage, a sensible value of the MREV is known, often it is unknown and needs to be estimated. Second, in the setting that the MREV value is an extreme-value of the exposure lying in the distributional tail, we argue that the natural estimator of PAF may be both statistically biased and highly volatile; instead, we consider a family of modified PAFs which include the natural estimate of PAF as a limit. A graphical comparison of this set of modified PAF for differing risk factors may be a better way to rank risk factors as intervention targets, compared to the standard PAF calculation. Finally, we analyse the bias that may ensue from prior risk factor categorization, examining whether categorization is ever a good idea, and suggest interpretations of categorized-estimands within a causal inference setting.

Preventable Risk Factors for Dementia: Population Attributable Fractions in a Brazilian Population-Based Study

2021 ◽  
Author(s):  
Wyllians Vendramini Borelli ◽  
Vanessa Bielefeldt Leotti ◽  
Matheus Zschornack Strelow ◽  
Márcia Lorena Fagundes Chaves ◽  
Raphael Machado Castilhos
Keyword(s):  
Risk Factors ◽  
Population Based ◽  
Brazilian Population ◽  
Population Based Study ◽  
Population Attributable Fractions ◽  
Attributable Fractions

scholarly journals Regional variations in the economic burden attributable to excess weight, physical inactivity and tobacco smoking across British Columbia

2016 ◽  
Vol 36 (4) ◽  
pp. 76-86 ◽  
Author(s):  
H. Krueger ◽  
J.M. Koot ◽  
D.P. Rasali ◽  
S. E. Gustin ◽  
M. Pennock
Keyword(s):  
Risk Factors ◽  
British Columbia ◽  
Tobacco Smoking ◽  
Economic Burden ◽  
Physical Inactivity ◽  
Excess Weight ◽  
Prevalence Rates ◽  
Population Attributable Fractions ◽  
Attributable Fractions ◽  
Social Environmental

Introduction Prevalence rates of excess weight, tobacco smoking and physical inactivity vary substantially by geographical region within British Columbia (B.C.). The purpose of this study is to determine the potential reduction in economic burden in B.C. if all regions in the province achieved prevalence rates of these three risk factors equivalent to those of the region with the lowest rates. Methods We used a previously developed approach based on population-attributable fractions to estimate the economic burden associated with the various risk factors. Sexspecific relative risk and age/sex-specific prevalence data was used in the modelling. Results The annual economic burden attributable to the three risk factors in B.C. was about $5.6 billion in 2013, with a higher proportion of this total attributable to excess weight ($2.6 billion) than to tobacco smoking ($2.0 billion). While B.C. has lower prevalence rates of the risk factors than any other Canadian province, there is significant variation within the province. If each region in the province were to achieve the best prevalence rates for the three risk factors, then $1.4 billion (24% of the $5.6 billion) in economic burden could be avoided annually. Conclusion There are notable disparities in the prevalence of each risk factor across health regions within B.C., which were mirrored in each region’s attributable economic burden. A variety of social, environmental and economic factors likely drive some of this geographical variation and these underlying factors should be considered when developing prevention programs.

scholarly journals Cardiovascular Health and Stroke in Older British Men

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3286-3294
Author(s):  
Ayesha Ahmed ◽  
Snehal M. Pinto Pereira ◽  
Lucy Lennon ◽  
Olia Papacosta ◽  
Peter Whincup ◽  
...  
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Cardiovascular Health ◽  
Population Attributable Fraction ◽  
Cox Models ◽  
Population Attributable Fractions ◽  
Hazard Ratios ◽  
Attributable Fractions ◽  
Time Point

Background and Purpose: Research exploring the utility of cardiovascular health (CVH) and its Life’s Simple 7 (LS7) components (body mass index, blood pressure [BP], glucose, cholesterol, physical activity, smoking, and diet) for prevention of stroke in older adults is limited. In the British Regional Heart Study, we explored (1) prospective associations of LS7 metrics and composite CVH scores with, and their impact on, stroke in middle and older age; and (2) if change in CVH was associated with subsequent stroke. Methods: Men without cardiovascular disease were followed from baseline recruitment (1978–1980), and again from re-examination 20 years later, for stroke over a median period of 20 years and 16 years, respectively. LS7 were measured at each time point except baseline diet. Cox models estimated hazard ratios (95% CI) of stroke for (1) ideal and intermediate versus poor levels of LS7; (2) composite CVH scores; and (3) 4 CVH trajectory groups (low-low, low-high, high-low, high-high) derived by dichotomising CVH scores from each time point across the median value. Population attributable fractions measured impact of LS7. Results: At baseline (n=7274, mean age 50 years), healthier levels of BP, physical activity, and smoking were associated with reduced stroke risk. At 20-year follow-up (n=3798, mean age 69 years) only BP displayed an association. Hazard ratios for intermediate and ideal (versus poor) levels of BP 0.65 (0.52–0.81) and 0.40 (0.24–0.65) at baseline; and 0.84 (0.67–1.05) and 0.57 (0.36–0.90) at 20-year follow-up. With reference to low-low trajectory, the low-high trajectory was associated with 40% reduced risk, hazard ratio 0.60 (0.44–0.83). Associations of CVH scores weakened, and population attributable fractions of LS7 reduced, from middle to old age; population attributable fraction of nonideal BP from 53% to 39%. Conclusions: Except for BP, CVH is weakly associated with stroke at older ages. Prevention strategies for older adults should prioritize BP control but also enhance focus beyond traditional risk factors.

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