Abstract P336: Predicting Future Trends in Disability Individuals With Cardiovascular Disease: A Modelling Study to 2030

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Maria Guzman Castillo ◽  
Sara Ahmadi-Abhari ◽  
Piotr Bandosz ◽  
Martin Shipley ◽  
Andrew Steptoe ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Transition Probabilities ◽  
The Elderly ◽  
Effective Prevention ◽  
England And Wales ◽  
Incidence And Mortality ◽  
Health And Social Care ◽  
The Us ◽  
Disability Prevalence ◽  
The Impact

Background: Most industrialised countries have experienced remarkable reductions in mortality from cardiovascular disease (CVD) and other chronic diseases since the 1970s. Yet CVD and dementia together account for half of all disability in the elderly in the US, UK and beyond. However recent trends in CVD morbidity and disability prevalence in the US and UK offer some encouragement: concerns regarding a potential increase in the burden of these diseases do not appear to be materialising. Meanwhile, clinicians and service planners urgently need reliable forecasts of the burden of CVD and disability. Previous studies have not modelled the complex interactions of CVD, dementia and disability over time. In this study, we therefore set out to forecast trends in CVD related disability in England and Wales up to 2030. Methods: As part of the IMPACT-Better Ageing Model study, we developed and validated a probabilistic Markov model. This model tracked health transitions in the England and Wales population (60 million) through ten states characterised by the presence or absence of CVD, dementia, disability and death from 2015 to 2030. Disease occurrence and age/sex/year specific transition probabilities were derived from the English Longitudinal Study of Ageing (ELSA). We estimated future CVD and disability prevalence. As observed in ELSA, we assumed continuing parallel downward trends in CVD incidence and mortality and a 2.7% annual decline in dementia incidence. Uncertainty was estimated using Monte Carlo simulation. Findings: By 2030, approximately 2,100,000 individuals (2,000,000-2,200,000 95% Uncertainty Intervals) will live with CVD in England and Wales (a 35% decrease from 2015). Standardised CVD mortality rates will plummet by 75%. However, approximately 910,000 (882,000- 946,000 95% UI) of these CVD patients will live with disabilities (a 19% decrease from 2015). Approximately 185,000 (178,000- 192,000 UI) CVD patients will additionally be living with dementia. Despite the rapid decreases in CVD and disability burden, the standardised prevalence of disability among CVD individuals will therefore increase from 35.2% to 39.6%. Interpretation: Our model predicts a 35% reduction in the total burden of CVD in England and Wales by 2030. However, over one third of the individuals with CVD will also be living with poor functional levels. That will represent a substantial burden for our already hard-pressed health and social care services. Our results suggest that recent efforts on CVD prevention might not be enough, thus emphasizing the need for more effective prevention of all non-communicable diseases and dementia as the major causes of disability. Policies focussing on the shared NCD risk factors of poor diet, tobacco, alcohol and inactivity could substantially reduce the burden of these dread diseases and greatly benefit the future functional level of senior citizens in the UK, USA and elsewhere.

Abstract 17309: Scope and Determinants of Nonfinancial Barriers to Healthcare Access in Individuals With Atherosclerotic Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Isaac Acquah ◽  
Javier Valero-Elizondo ◽  
Miguel Cainzos Achirica ◽  
Rahul Singh ◽  
Karan Shah ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Logistic Regression ◽  
Low Income ◽  
Barriers To Care ◽  
Multinomial Logistic Regression ◽  
The Elderly ◽  
Atherosclerotic Cardiovascular Disease ◽  
The Us ◽  
Barriers To Healthcare ◽  
Relative Prevalence

Introduction: Barriers to healthcare - financial and nonfinancial - may result in unmet health needs and adverse outcomes. Despite this, the nonfinancial barriers to care among adults with atherosclerotic cardiovascular disease (ASCVD) is poorly defined in the US. We aimed to explore the scope and determinants of nonfinancial barriers to care among individuals with ASCVD. Methods: We analyzed data from the 2013-17 National Health Interview Survey (NHIS). We included adults with self-reported ASCVD (heart attack, angina, and/or stroke). Nine key variables in the NHIS that represent nonfinancial barriers to healthcare were assessed as absent/present, and participants were classified as having 0-1, 2, or ≥3 barriers. Multinomial logistic regression (using 0-1 nonfinancial barriers as reference) was used to evaluate the relationship between various sociodemographic factors, and an increasing number of nonfinancial barriers. Results: Of all the 15,758 adults with ASCVD (8.1% annually in the US; representing 19.6 million), 23.4% reported having at least one nonfinancial barrier to care while 4.9% reported 3 nonfinancial barriers. In a multivariable multinomial logistic regression, after stratifying by age, individuals from low-income families had an almost 2-fold relative prevalence of 3 nonfinancial barriers ( Figure) . In the elderly, however, lack of insurance was the strongest predictor (relative prevalence ratio of 6.51 [95% confidence interval; 2.25, 18.87]) of having ≥3 barriers. Conclusion: Among adults with ASCVD, the relative prevalence of ≥3 nonfinancial barriers was low (4.9%) with low-income being the only modifiable predictor of reporting ≥3 nonfinancial barriers and lack of insurance being the strongest predictor in the elderly. Addressing financial barriers to healthcare may help alleviate these nonfinancial barriers.

Abstract P165: Future Burden of Morbidity and Disability in England and Wales: A Modelling Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Maria Guzman Castillo ◽  
Sara Ahmadi-Abhari ◽  
Piotr Bandosz ◽  
Martin Shipley ◽  
Simon Capewell ◽  
...  
Keyword(s):  
Life Expectancy ◽  
Similar Degree ◽  
Health States ◽  
England And Wales ◽  
Incidence Trends ◽  
Dementia Incidence ◽  
Incidence And Mortality ◽  
The Future ◽  
Future Burden ◽  
Disability Prevalence

Background: Cardiovascular disease (CVD) and dementia have profound impacts on the morbidity and disability burden in older people. Uncertainty remains regarding the future incidence of these conditions. We forecast future levels of morbidity and disability in England and Wales up to 2040 under two scenarios regarding CVD and dementia future trends. Methods: We developed a probabilistic Markov model (IMPACT-BAM) which follows the transitions of the England and Wales population into health states characterised by the presence or absence of CVD, dementia and disability to 2040. Data sources include national health registers (ONS) and cohort studies (HSE, Whitehall II and ELSA). Modelled CVD and Non-CVD mortality and prevalence trends for disability and morbidity were used to estimate trends in life expectancy (LE), morbidity-free life expectancy (MFLE) and disability-free life expectancy (DFLE). We assumed that CVD incidence and mortality will continue their current trends and modelled two scenarios: Scenario A assumes constant dementia incidence, a common assumption when projecting future burden of dementia; Scenario B assumes 2% annual decline in dementia incidence, as suggested in UK population-based cohorts. Results: In 2011, LE at age 65 was 18.4 years for men and 21.0 years for women. In Scenario A, LE at 65 in 2040 will increase to 26.7 and 24.8 years in men and women. DFLE at 65 will increase (by 5.5 years in men and 2.8 years in women, to 21.7 and 20.7 years respectively). MFLE at 65 will increase slightly (by 1.5 years in men and 1.4 in women, to 10.7 and 13.2 years respectively). Disability prevalence would increase by 3.1% to 14.4% ( 1,081,483 of 7,510,299) in men and decrease slightly (by 0.6% to 14% (1,214,754 of 8,676,813)) in women. In Scenario B, LE at 65 in 2040 will increase to a similar degree as in Scenario A, but DFLE and MFLE will increase faster (DFLE: by 7.5 years in men and 4.6 in women, to 23.7 and 22.5 years respectively; MFLE: by 4.5 years for both genders to 13.8 years in men and 16.3 in women). Disability prevalence will slightly increase (by 0.8% to 12.1% (908,746 of 7,510,299)) in men and decrease by 3.0% to 11.4% (989,157 of 8,676,813) in women. Conclusions: The future disability burden crucially depends on assumptions about future dementia incidence trends. If the dementia incidence continues unchanged, the duration of morbidity and disability will be prolonged. However, if dementia incidence decreases (as suggested in the UK and mirroring CVD declines) we could live more years in good health, with morbidity compressed into a shorter period before death.

scholarly journals 211 - Changes to post-diagnostic dementia support in England and Wales during the COVID-19 pandemic

2021 ◽  
Vol 33 (S1) ◽  
pp. 13-13
Author(s):  
Alison Wheatley ◽  
Marie Poole ◽  
Louise Robinson
Keyword(s):  
Social Care ◽  
Third Sector ◽  
Full Time ◽  
England And Wales ◽  
Team Meetings ◽  
Use Of Technology ◽  
People With Dementia ◽  
Health And Social Care ◽  
The Impact ◽  
Diagnostic Support

Background:The COVID-19 pandemic precipitated widespread change across health and social care in England and Wales. A series of lockdowns and UK Government guidance designed to reduce the spread of COVID-19 which emphasised social distancing and increased use of personal protective equipment led to changes such as increased use of remote consultation technologies and the closure of services deemed non-essential. This included many services for people with dementia and their families, such as day centres and dementia cafes.Objective:To explore the changes made to services during the pandemic and the impact of these changes on the delivery of good post-diagnostic dementia support.Method:Professionals who had previously been recruited to the ongoing PriDem qualitative study were approached for follow up interview. Eighteen interviews with a total of 21 professionals working in health, social care and the third sector were conducted using telephone or video conferencing.Interviews were audio recorded, transcribed and checked prior to thematic analysis.Results:Key themes emerging from preliminary analysis of the data include: uncertainty about the future and the need to adapt quickly to shifting guidance; changing job roles and ways of working; the emotional and physical impact of the pandemic on staff working with people with dementia and their families; and the impact of changes made (e.g. increased PPE, remote working) on the ability to deliver post-diagnostic support. However, there were also some unintended positive outcomes of the changes. These included the ability to include family members living at a distance in remote consultations, allowing for more robust history-taking, as well as the uptake of technology to facilitate cross-sector and multidisciplinary working between professionals.Conclusion:Delivering post-diagnostic dementia support during COVID-19 was challenging and forced dementia services to make adaptations. Participants expected that some of these changes would be incorporated into post-pandemic work, for example increased use of technology for multidisciplinary team meetings or blended approaches to patient-facing services involving both virtual and face to face work as appropriate. However, most participants agreed that it was not appropriate nor desirable to provide fully remote post-diagnostic support on a full time basis.

scholarly journals The Impact of Non-optimum Ambient Temperature on Years of Life Lost: A Multi-county Observational Study in Hunan, China

2020 ◽  
Vol 17 (8) ◽  
pp. 2699
Author(s):  
Ling-Shuang Lv ◽  
Dong-Hui Jin ◽  
Wen-Jun Ma ◽  
Tao Liu ◽  
Yi-Qing Xu ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Ambient Temperature ◽  
Respiratory Disease ◽  
Age Groups ◽  
The Elderly ◽  
Cold Temperature ◽  
Years Of Life Lost ◽  
Distributed Lag ◽  
Preventative Measures ◽  
The Impact

The ambient temperature–health relationship is of growing interest as the climate changes. Previous studies have examined the association between ambient temperature and mortality or morbidity, however, there is little literature available on the ambient temperature effects on year of life lost (YLL). Thus, we aimed to quantify the YLL attributable to non-optimum ambient temperature. We obtained data from 1 January 2013 to 31 December 2017 of 70 counties in Hunan, China. In order to combine the effects of each county, we used YLL rate as a health outcome indicator. The YLL rate was equal to the total YLL divided by the population of each county, and multiplied by 100,000. We estimated the associations between ambient temperature and YLL with a distributed lag non-linear model (DNLM) in a single county, and then pooled them in a multivariate meta-regression. The daily mean YLL rates were 22.62 y/(p·100,000), 10.14 y/(p·100,000) and 2.33 y/(p·100,000) within the study period for non-accidental, cardiovascular, and respiratory disease death. Ambient temperature was responsible for advancing a substantial fraction of YLL, with attributable fractions of 10.73% (4.36–17.09%) and 16.44% (9.09–23.79%) for non-accidental and cardiovascular disease death, respectively. However, the ambient temperature effect was not significantly for respiratory disease death, corresponding to 5.47% (−2.65–13.60%). Most of the YLL burden was caused by a cold temperature than the optimum temperature, with an overall estimate of 10.27% (4.52–16.03%) and 15.94% (8.82–23.05%) for non-accidental and cardiovascular disease death, respectively. Cold and heat temperature-related YLLs were higher in the elderly and females than the young and males. Extreme cold temperature had an effect on all age groups in different kinds of disease-caused death. This study highlights that general preventative measures could be important for moderate temperatures, whereas quick and effective measures should be provided for extreme temperatures.

scholarly journals Sex Differences in Stroke

2012 ◽  
Vol 32 (12) ◽  
pp. 2100-2107 ◽  
Author(s):  
Roy AM Haast ◽  
Deborah R Gustafson ◽  
Amanda J Kiliaan
Keyword(s):  
Sex Differences ◽  
Sex Hormones ◽  
Premenopausal Women ◽  
Epidemiologic Studies ◽  
Stroke Onset ◽  
Effective Prevention ◽  
Sex Steroid Hormone ◽  
Incidence And Mortality ◽  
Primary Focus ◽  
The Impact

Sex differences in stroke are observed across epidemiologic studies, pathophysiology, treatments, and outcomes. These sex differences have profound implications for effective prevention and treatment and are the focus of this review. Epidemiologic studies reveal a clear age-by-sex interaction in stroke prevalence, incidence, and mortality. While premenopausal women experience fewer strokes than men of comparable age, stroke rates increase among postmenopausal women compared with age-matched men. This postmenopausal phenomenon, in combination with living longer, are reasons for women being older at stroke onset and suffering more severe strokes. Thus, a primary focus of stroke prevention has been based on sex steroid hormone-dependent mechanisms. Sex hormones affect different (patho)physiologic functions of the cerebral circulation. Clarifying the impact of sex hormones on cerebral vasculature using suitable animal models is essential to elucidate male–female differences in stroke pathophysiology and development of sex-specific treatments. Much remains to be learned about sex differences in stroke as anatomic and genetic factors may also contribute, revealing its multifactorial nature. In addition, the aftermath of stroke appears to be more adverse in women than in men, again based on older age at stroke onset, longer prehospital delays, and potentially, differences in treatment.

scholarly journals Long-term exposure to PM2.5 and cardiovascular disease incidence and mortality in an Eastern Mediterranean country: findings based on a 15-year cohort study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Soheila Jalali ◽  
Mojgan Karbakhsh ◽  
Mehdi Momeni ◽  
Marzieh Taheri ◽  
Saeid Amini ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Ambient Air ◽  
Ambient Air Pollution ◽  
Individual Risk ◽  
Mediterranean Country ◽  
Incidence And Mortality ◽  
The Impact

Abstract Background Evidence concerning the impact of long-term exposure to fine Particulate Matter ≤2.5 μm (PM2.5) on Cardio-Vascular Diseases (CVDs) for those people subject to ambient air pollution in developing countries remains relatively scant. This study assessed the relationship of 15-year PM2.5 exposure with cardiovascular incidence and mortality rate in Isfahan province, Iran. Methods The cohort comprised 3081 participants over 35 years old who were free of CVDs. They were selected through multi-stage cluster sampling in Isfahan, Iran. PM2.5 exposure was determined separately for each individual via satellite-based spatiotemporal estimates according to their residential addresses. In this context, CVD is defined as either fatal and non-fatal Acute Myocardial Infarctions (AMI) or stroke and sudden cardiac death. The incidence risk for CVD and the ensuing mortality was calculated based on the average PM2.5 exposure within a study period of 15 years using the Cox proportional hazards frailty model upon adjusting individual risk factors. The mean annual rate of PM2.5 and the follow-up data of each residential area were combined. Results Mean three-year PM2·5 exposure for the cohort was measured at 45.28 μg/m3, ranging from 20.01 to 69.80 μg/m3. The median time period for conducting necessary follow-ups was 12.3 years for the whole population. Notably, 105 cardiovascular and 241 all-cause deaths occurred among 393,786 person-months (27 and 61 per 100,000 person-months, respectively). In well-adjusted models, 10 μg/m3 increase in PM2.5 corresponded to a 3% increase in the incidence rate of CVDs [0.95 CI = 1.016, 1.036] (in case of p = 0.000001 per 10 μg/m3 increase in PM2.5, the Hazard Ratio (HR) for AMI and Ischemic Heart Disease (IHD) was 1.031 [0.95 CI = 1.005, 1.057] and 1.028 [0.95 CI = 1.017, 1.039]), respectively. No consistent association was observed between PM2.5 concentration and fatal CVD (fatal AMI, fatal stroke, SCD (Sudden Cardiac Death)) and all-cause mortality. Conclusions Results from analyses suggest that the effect of PM2.5 on cardiovascular disease occurrence was stronger in the case of older people, smokers, and those with high blood pressure and diabetes. The final results revealed that long-term exposure to ambient PM2.5 with high concentrations positively correlated with IHD incidence and its major subtypes, except for mortality. The outcome accentuates the need for better air quality in many countries.

scholarly journals 1491Impact of COVID19 on years of life lost with and without disability across 18 European-countries

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Sara Ahmadi-Abhari ◽  
Piotr Bandosz ◽  
Mika Kivimaki ◽  
Lefkos Middleton
Keyword(s):  
Cardiovascular Disease ◽  
Life Expectancy ◽  
Mortality Rates ◽  
European Countries ◽  
Accurate Estimation ◽  
Years Of Life Lost ◽  
Incidence And Mortality ◽  
The Impact ◽  
Prevalence Of Dementia ◽  
Incidence Of Dementia

Abstract Background To accurately assess the impact of COVID19 on life-expectancy, years of life lost, and prevalence of dementia and disability, a model integrating calendar-trends in cardiovascular-disease, dementia, disability and mortality is required. We estimated these impacts in Austria, Belgium, Czech-Republic, Denmark, Estonia, France, Germany, Greece, Hungary, Italy, The Netherlands, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland, and the UK. Methods Data to inform the ten-state Monte-Carlo Markov-model for the 18 European countries were derived from official-statistics for population-numbers and mortality-rates (age&sex-specific) and from Survey for Health, Ageing and Retirement in Europe for prevalence-estimates and transition-probabilities. Impact of COVID19 was measured comparing the estimates derived from incorporating expected mortality rates assuming calendar-trends in mortality and incidence of dementia, disability, and cardiovascular-disease continue those of the past two-decades, and those incorporating excess COVID19 mortality. Results Assuming COVID-19 vaccination and termination of the pandemic will be accomplished by the end of 2021, the pandemic will have resulted in a loss of 9.3M (95% Uncertainty-Interval 1.3M-29.8M) person-years of life, including 7.1M person-years of dementia-free life and 5.2M person-years of disability-free life among the 289M population (as of 2019) above age-35. The effects on prevalence of dementia, disability and life-expectancy will be presented. Conclusions The impact of the pandemic on disability-free person-years of life lost are devastating, marking a need for more rapid actions to halt the spread of epidemics. Key messages Accurate estimation of future prevalence of dementia and disability to quantify the impact of the pandemic on years of life lost needs to simultaneously account for the declining trends in incidence of dementia and the decline in cardiovascular disease incidence and mortality resulting in increased life-expectancy and a larger pool susceptible to dementia and disability. The COVID19 pandemic is estimated to result in 9.3million person-years of life lost in 18 European countries including a loss of 7.1M person-years of dementia-free life and 5.2M person-years of disability-free life.

scholarly journals Preventing the Risk of Hospitalization for Respiratory Complications of Influenza among the Elderly: Is There a Better Influenza Vaccination Strategy? A Retrospective Population Study

Vaccines ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 344
Author(s):  
Silvia Cocchio ◽  
Tolinda Gallo ◽  
Stefania Del Zotto ◽  
Elena Clagnan ◽  
Andrea Iob ◽  
...  
Keyword(s):  
Influenza Vaccination ◽  
Vaccination Strategy ◽  
The Elderly ◽  
Protective Role ◽  
The Body ◽  
Health Concern ◽  
Respiratory Complications ◽  
Effective Prevention ◽  
Vaccination Strategies ◽  
The Impact

Influenza and its complications are an important public health concern, and vaccination remains the most effective prevention measure. However, the efficacy of vaccination depends on several variables, including the type of strategy adopted. The goal of this study was to assess the impact of different influenza vaccination strategies in preventing hospitalizations for influenza and its related respiratory complications. A retrospective cohort study was conducted on data routinely collected by the health services for six consecutive influenza seasons, considering the population aged 65 years or more at the time of their vaccination and living in northeastern Italy. Our analysis concerns 987,266 individuals vaccinated against influenza during the study period. The sample was a mean 78.0 ± 7.7 years old, and 5681 individuals (0.58%) were hospitalized for potentially influenza-related reasons. The hospitalization rate tended to increase over the years, not-significantly peaking in the 2016–2017 flu season (0.8%). Our main findings revealed that hospitalizations related to seasonal respiratory diseases were reduced as the use of the enhanced vaccine increased (R2 = 0.5234; p < 0.001). Multivariate analysis confirmed the significantly greater protective role of the enhanced vaccine over the conventional vaccination strategy, with adjusted Odds Ratio (adj OR) = 0.62 (95% CI: 0.59–0.66). A prior flu vaccination also had a protective role (adj OR: 0.752 (95% CI: 0.70–0.81)). Age, male sex, and H3N2 mismatch were directly associated with a higher risk of hospitalization for pneumonia. In the second part of our analysis, comparing MF59-adjuvanted trivalent inactivated vaccine (MF59-TIV) with conventional vaccines, we considered 479,397 individuals, of which 3176 (0.66%) were admitted to a hospital. The results show that using the former vaccine reduced the risk of hospitalization by 33% (adj OR: 0.67 (95% CI: 0.59–0.75)). This study contributes to the body of evidence of a greater efficacy of enhanced vaccines, and MF59-adjuvanted TIV in particular, over conventional vaccination strategies in the elderly.

Abstract P180: Impact of Intensive Systolic Blood Pressure Treatment on Cardiovascular Disease and Mortality in the US Population

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Joshua D Bundy ◽  
Changwei Li ◽  
Jiang He
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Systolic Blood Pressure ◽  
Incidence Rates ◽  
Intensive Treatment ◽  
Baseline Risk ◽  
Mortality Data ◽  
The Us ◽  
The Impact

Introduction: Hypertension is the most important risk factor for cardiovascular disease (CVD), the leading cause of morbidity and mortality among US adults. Clinical trials suggest that intensive systolic blood pressure (BP) management significantly reduces risk of CVD and mortality in patients at high risk for CVD. However, the impact of intensive BP lowering in the US population is uncertain. Hypothesis: More intensive treatment of systolic BP provides great benefits in the reduction of CVD and total deaths in the US population aged ≥40 years. Methods: We pooled follow-up data in 31,851 individuals from four US cohort studies (ARIC, CHS, Framingham Heart Study, and MESA) to estimate annual incidence rates of major CVD (combined stroke, coronary heart disease, and heart failure) by sex, race (white and non-white), and age groups (40-49, 50-59, 60-69, and ≥70 years). We retrieved mortality data from annual death statistics reported by the CDC. We combined nationally-representative survey data from three NHANES cycles (2009-2010, 2011-2012, 2013-2014) to estimate the proportions of US adults aged ≥40 years in each of 10 systolic BP categories (range <120 to ≥160 mm Hg). A Bayesian network meta-analysis of antihypertensive clinical trials was used to estimate relative risks for CVD and mortality comparing each of the 10 systolic BP categories, after adjusting for baseline risk in included trials. Using these data sources, we calculated the population attributable fractions and number of events (and deaths) that could be reduced by treating systolic BP ≥140 mmHg to more intensive systolic BP targets in the US population. Results: Treating systolic BP to 120-124 mm Hg showed the largest reduction in number of CVD events and total deaths compared to higher targets (Table). Conclusions: In conclusion, intensive treatment of systolic BP could prevent a large number of CVD events and total deaths in the US population.

scholarly journals Ubiquitous digital technologies and spatial structure; an update

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0248982
Author(s):  
Emmanouil Tranos ◽  
Yannis M. Ioannides
Keyword(s):  
Information And Communication Technologies ◽  
Digital Technologies ◽  
City Size ◽  
Urban Systems ◽  
Estimation Methods ◽  
Urban Structure ◽  
Spatial Structures ◽  
England And Wales ◽  
The Us ◽  
The Impact

This paper examines the impact of widespread adoption of information and communication technologies (ICT) on urban structure worldwide. Has it offset agglomeration benefits and led to more dispersed spatial structures, or has it strengthened urban externalities and thus resulted in more concentrated spatial structures? Theoretical and empirical studies on this question have produced contradictory findings. The present study recognizes that assumptions made earlier about the evolution of technological capabilities do not necessarily hold today. As cutting-edge digital technologies have matured considerably, a fresh look at this question is called for. The paper addresses this issue by means of several data sets using instrumental variable methods. One is the UN data on Urban Settlements with more than 300, 000 inhabitants. Estimation methods with these data show that increased adoption of ICT has resulted in national urban systems that are less uniform in terms of city sizes and are characterized by higher population concentrations in larger cities, when concentration is proxied the Pareto (Zipf) coefficient for national city size distributions. Two, is disaggregated data for the urban systems of the US, defined as Micropolitan and Metropolitan Areas, and for the UK, defined as Built-up Areas in England and Wales, respectively. These data allow for the impacts to be studied for cities smaller than those included in the cross-country data. Increased internet usage improved a city’s ranking in the US urban system. Similarly, increased download speed improves a built-up area’s ranking in England and Wales.

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