Awareness on breast cancer among the women of reproductive age in Bangladesh

Hamilton EM, Rassam W, Yan Y, et al. Correlates of chronic hepatitis B virus infection in the general adult population of China: Systematic review and meta-analysis. Journal of Viral Hepatitis. 2023;Epub ahead of print. Publisher's Version Abstract

Abstract Chronic infection with hepatitis B virus (HBV) is a significant public health issue in China. Understanding factors associated with chronic HBV is important to enable targeted screening and education and to improve early diagnosis and prevention of disease progression. This systematic review and meta-analysis aimed to identify and describe correlates of chronic HBV among Chinese adults. Searches were conducted in MEDLINE, EMBASE and grey literature up to 25 June 2020. Eligible papers included observational studies in adults of the general population in China that reported factors associated with chronic HBV, measured by Hepatitis B surface antigen (HBsAg). Meta-analysis was performed using fixed-effect models of HBsAg prevalence among factors, and of adjusted odds ratios (ORs) for chronic HBV associated with each factor. Overall 39 articles were included, covering 22 factors, including a range of sociodemographic, behavioural and medical factors. In meta-analysis of eligible studies, a range of factors were significantly associated with higher HBsAg prevalence, including middle age, male sex, being married, rural residence, lower education, smoking, having a HBsAg positive household contact, family history of HBV, history of surgery or blood transfusion. The adjusted ORs varied, from 1.11 (95% CI 1.05–1.18) for smoking to 5.13 (95% CI 4.99–5.26) for having a HBsAg positive household contact. In Chinese adults, a range of factors are associated with chronic HBV infection, which may help inform targeted screening in the general population.

Bosworth ML, Ahmed T, Larsen T, et al. Ethnic differences in COVID-19 mortality in the second and third waves of the pandemic in England during the vaccine rollout: a retrospective, population-based cohort study. BMC Medicine. 2023;21 (1) :13. Publisher's Version Abstract

Abstract Background Ethnic minority groups in England have been disproportionately affected by the COVID-19 pandemic and have lower vaccination rates than the White British population. We examined whether ethnic differences in COVID-19 mortality in England have continued since the vaccine rollout and to what extent differences in vaccination rates contributed to excess COVID-19 mortality after accounting for other risk factors. Methods We conducted a retrospective, population-based cohort study of 28.8 million adults aged 30–100 years in England. Self-reported ethnicity was obtained from the 2011 Census. The outcome was death involving COVID-19 during the second (8 December 2020 to 12 June 2021) and third wave (13 June 2021 to 1 December 2021). We calculated hazard ratios (HRs) for death involving COVID-19, sequentially adjusting for age, residence type, geographical factors, sociodemographic characteristics, pre-pandemic health, and vaccination status. Results Age-adjusted HRs of death involving COVID-19 were elevated for most ethnic minority groups during both waves, particularly for groups with lowest vaccination rates (Bangladeshi, Pakistani, Black African, and Black Caribbean). HRs were attenuated after adjusting for geographical factors, sociodemographic characteristics, and pre-pandemic health. Further adjusting for vaccination status substantially reduced residual HRs for Black African, Black Caribbean, and Pakistani groups in the third wave. Fully adjusted HRs only remained elevated for the Bangladeshi group (men: 2.19 [95% CI 1.72–2.78]; women: 2.12 [1.58–2.86]) and Pakistani men (1.24 [1.06–1.46]). Conclusions Lower COVID-19 vaccination uptake in several ethnic minority groups may drive some of the differences in COVID-19 mortality compared to White British. Public health strategies to increase vaccination uptake in ethnic minority groups would help reduce inequalities in COVID-19 mortality, which have remained substantial since the start of the vaccination campaign.

Wright LF, Cheema K, Goldacre R, et al. Effects of the COVID-19 pandemic on secondary care for cardiovascular disease in the UK: an electronic health record analysis across three countries. European Heart Journal - Quality of Care and Clinical Outcomes. 2022. Publisher's Version Abstract

Although morbidity and mortality from COVID-19 have been widely reported, the indirect effects of the pandemic beyond 2020 on other major diseases and health service activity have not been well described.Analyses used national administrative electronic hospital records in England, Scotland, and Wales for 2016–21. Admissions and procedures during the pandemic (2020–21) related to six major cardiovascular conditions [acute coronary syndrome (ACS), heart failure (HF), stroke/transient ischaemic attack (TIA), peripheral arterial disease (PAD), aortic aneurysm (AA), and venous thromboembolism(VTE)] were compared with the annual average in the pre-pandemic period (2016–19). Differences were assessed by time period and urgency of care.In 2020, there were 31 064 (−6%) fewer hospital admissions [14 506 (−4%) fewer emergencies, 16 560 (−23%) fewer elective admissions] compared with 2016–19 for the six major cardiovascular diseases (CVDs) combined. The proportional reduction in admissions was similar in all three countries. Overall, hospital admissions returned to pre-pandemic levels in 2021. Elective admissions remained substantially below expected levels for almost all conditions in all three countries [−10 996 (−15%) fewer admissions]. However, these reductions were offset by higher than expected total emergency admissions [+25 878 (+6%) higher admissions], notably for HF and stroke in England, and for VTE in all three countries. Analyses for procedures showed similar temporal variations to admissions.The present study highlights increasing emergency cardiovascular admissions during the pandemic, in the context of a substantial and sustained reduction in elective admissions and procedures. This is likely to increase further the demands on cardiovascular services over the coming years.

Ahern AL, Breeze P, Fusco F, et al. Effectiveness and cost-effectiveness of referral to a commercial open group behavioural weight management programme in adults with overweight and obesity: 5-year follow-up of the WRAP randomised controlled trial. The Lancet Public Health. 2022;7 (10) :e866-e875. Publisher's Version Abstract

Summary Background There is evidence that commercially available behavioural weight management programmes can lead to short-term weight loss and reductions in glycaemia. Here, we aimed to provide the 5-year impact and cost-effectiveness of these interventions compared with a brief intervention. Methods WRAP was a non-blinded, parallel-group randomised controlled trial (RCT). We recruited from primary care practices in England and randomly assigned participants to one of three interventions (brief intervention, 12-week open-group behavioural programme [WW, formerly Weight Watchers], or a 52-week open-group WW behavioural programme) in an uneven (2:5:5) allocation. Participants were followed up 5 years after randomisation using data from measurement visits at primary care practices or a research centre, review of primary care electronic medical notes, and self-report questionnaires. The primary outcome was change in weight at 5 years follow-up, assessed using analysis of covariance. We also estimated cost-effectiveness of the intervention. This study is registered at Current Controlled Trials, ISRCTN64986150. Findings Between Oct 18, 2012, and Feb 10, 2014, we recruited 1269 eligible participants (two participants were randomly assigned but not eligible and therefore excluded) and 1040 (82%) consented to be approached about additional follow-up and to have their medical notes reviewed at 5 years. The primary outcome (weight) was ascertained for 871 (69%) of 1267 eligible participants. Mean duration of follow-up was 5·1 (SD 0·3) years. Mean weight change from baseline to 5 years was −0·46 (SD 8·31) kg in the brief intervention group, −1·95 (9·55) kg in the 12-week programme group, and −2·67 (9·81) kg in the 52-week programme. The adjusted difference in weight change was –1·76 (95% CI –3·68 to 0·17) kg between the 52-week programme and the brief intervention; –0·80 (–2·13 to 0·54) kg between the 52-week and the 12-week programme; and –0·96 (–2·90 to 0·97) kg between the 12-week programme and the brief intervention. During the trial, the 12-week programme incurred the lowest cost and produced the highest quality-adjusted life-years (QALY). Simulations beyond 5 years suggested that the 52-week programme would deliver the highest QALYs at the lowest cost and would be the most cost-effective. No participants reported adverse events related to the intervention. Interpretation Although the difference in weight change between groups was not statistically significant, some weight loss was maintained at 5 years after an open-group behavioural weight management programme. Health economic modelling suggests that this could have important implications to reduce the incidence of weight-related disease and these interventions might be cost-saving. Funding The UK National Institute for Health and Care Research Programme Grants for Applied Research and the Medical Research Council.

Islam N, Cole TJ, Ross JS, Feeney T, Loder E. Post-submission changes to prespecified statistical analysis plans. BMJ. 2022;378 :o2244. Publisher's Version

Bates SE, Thomas C, Islam N, et al. Using health economic modelling to inform the design and development of an intervention: estimating the justifiable cost of weight loss maintenance in the UK. BMC Public Health. 2022;22 (1) :290. Publisher's Version Abstract

Abstract Background There is a need to develop cost-effective weight loss maintenance interventions to prolong the positive impact of weight loss on health outcomes. Conducting pre-trial health economic modelling is recommended to inform the design and development of behavioural interventions. We aimed to use health economic modelling to estimate the maximum cost per-person (justifiable cost) of a cost-effective behavioural weight loss maintenance intervention, given an estimated intervention effect for individuals with: i) a Body Mass Index (BMI) of 28 kg/m 2 or above without diabetes and ii) a diagnosis of type 2 diabetes prescribed a single non-insulin diabetes medication. Methods The School for Public Health Research Diabetes prevention model was used to estimate the lifetime Quality-adjusted life year (QALY) gains, healthcare costs, and maximum justifiable cost associated with a weight loss maintenance intervention. Based on a meta-analysis, the estimated effect of a weight loss maintenance intervention following a 9 kg weight loss, was a regain of 1.33 kg and 4.38 kg in years one and two respectively compared to greater regain of 2.84 kg and 5.6 kg in the control group. Sensitivity analysis was conducted around the rate of regain, duration of effect and initial weight loss. Results The justifiable cost for a weight loss maintenance intervention at an ICER of £20,000 per QALY was £104.64 for an individual with a BMI of 28 or over and £88.14 for an individual with type 2 diabetes. Within sensitivity analysis, this varied from £36.42 to £203.77 for the former, and between £29.98 and £173.05 for the latter. Conclusions Researchers developing a weight loss maintenance intervention should consider these maximum justifiable cost estimates and the potential impact of the duration of effect and initial weight loss when designing intervention content and deciding target populations. Future research should consider using the methods demonstrated in this study to use health economic modelling to inform the design and budgetary decisions in the development of a behavioural interventions.

Matthews AA, Danaei G, Islam N, Kurth T. Target trial emulation: applying principles of randomised trials to observational studies. BMJ. 2022;378 :e071108. Publisher's Version

Thygesen JH, Tomlinson C, Hollings S, et al. COVID-19 trajectories among 57 million adults in England: a cohort study using electronic health records. The Lancet Digital Health. 2022;4 (7) :e542–e557. Publisher's Version

Bermingham C, Morgan J, Ayoubkhani D, et al. Estimating the effectiveness of first dose of COVID-19 vaccine against mortality in England: a quasi-experimental study. American Journal of Epidemiology. 2022 :kwac157. Publisher's Version

Yates T, Summerfield A, Razieh C, et al. A population-based cohort study of obesity, ethnicity and COVID-19 mortality in 12.6 million adults in England. Nature Communications. 2022;13 :624. Publisher's Version

Gillies CL, Rowlands AV, Razieh C, et al. Association between household size and COVID-19: A UK Biobank observational study. Journal of the Royal Society of Medicine. 2022;115 (4) :138-44. Publisher's Version

Islam N. “Excess deaths” is the best metric for tracking the pandemic. BMJ. 2022;376 :o285. Publisher's Version

Norris T, Razieh C, Zaccardi F, et al. Impact of cardiometabolic multimorbidity and ethnicity on cardiovascular/renal complications in patients with COVID-19. Heart. 2022;108 (15) :1200-1208. Publisher's Version

Rojas NAB, Lacey B, Simadibrata DM, et al. Alcohol consumption and cause-specific mortality in Cuba: prospective study of 120 623 adults. EClinicalMedicine. 2021;33 :100692. Publisher's Version

Chudasama YV, Zaccardi F, Gillies CL, et al. Patterns of Multimorbidity and Risk of Severe SARS-CoV-2 Infection: an observational study in the UK. BMC infectious diseases. 2021;21 :908. Publisher's Version

Nafilyan* V, Islam N*, Mathur R, et al. Ethnic differences in COVID-19 mortality during the first two waves of the Coronavirus Pandemic: a nationwide cohort study of 29 million adults in England. European Journal of Epidemiology. 2021;36 :605–617. Publisher's Version

Yates T, Zaccardi F, Islam N, et al. Obesity, Ethnicity, and Risk of Critical Care, Mechanical Ventilation, and Mortality in Patients Admitted to Hospital with COVID-19: Analysis of the ISARIC CCP-UK Cohort. Obesity. 2021;29 :1223–1230. Publisher's Version

Oguntade AS, Jin D, Islam N, et al. Body composition and risk of heart failure: protocol for a systematic review and meta-analysis. Open Heart. 2021;8 (1) :e001632.

Islam N, Lacey B, Shabnam S, et al. Social inequality and the syndemic of chronic disease and COVID-19: county-level analysis in the USA. J Epidemiol Community Health. 2021;75 (6) :496–500. Publisher's Version

Razieh C, Zaccardi F, Islam N, et al. Ethnic minorities and COVID-19: Examining whether excess risk is mediated through deprivation. European Journal of Public Health. 2021;31 (3) :630–4. Publisher's Version

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Nazrul Islam

MBBS, MSc, MPH, PhD

Awareness on breast cancer among the women of reproductive age in Bangladesh

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