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6th February 2024
There will be more than 327,600 premature deaths across Europe if there is a delay in fully aligning the EU’s Ambient Air Quality Directive (AAQD) with World Health Organization (WHO) Air Quality Guidelines (AQG) 2021, according to a new report.
Writing in the International Journal of Public Health, doctors and experts from European Respiratory Society (ERS) and other health groups called for immediate action on European air pollution to ensure alignment with the AQG by 2030.
They warned that not doing so will result in poorer health for millions of people and widen the health inequality gap between western and eastern Europe.
Research from Europe indicates a strong link between air pollution and millions of new cases of asthma, COPD, acute respiratory infections, lung cancer and other serious illnesses each year.
The report stated: ‘This is a historic opportunity towards clean air in Europe for all that could prevent hundreds of thousands of premature deaths and millions of new cases of non-communicable diseases every year, as well as improve health of all European citizens.
‘Full alignment with WHO AQG would enhance children health in Europe by improving lung function and reducing asthma and respiratory infections burden. Achieving the WHO AQG would also reduce healthcare costs, social, environmental and health inequalities, boost economic growth, and help mitigate the adverse effects of climate change.’
This urgent call for action against air pollution comes as trilogue discussions between the EU Commission, Parliament and Council continue, with a deal to be reached soon regarding revisions to the EU’s AAQD.
The current proposals, the report said, leave out full alignment with WHO AQGs and allow delays in achieving air pollution limit values up to the 2040 for countries whose gross domestic product per capita is below EU average.
The report highlighted that ‘using poverty as an excuse to fail to act is the opposite of what countries in Europe need’.
It concludes: ‘We strongly urge the EU environment ministers to put European health and environmental justice at the core of their political aspirations.
‘This is a unique public health opportunity for EU Member States to follow the scientific evidence and listen to the concerns of citizens.’
Commenting on the report, Professor Zorana J. Andersen, ERS Environment and Health Committee chair, said: ‘Allowing additional delays in reaching new EU air quality standards, differentiated based on GDP, is completely unacceptable to the ERS community. A delay would widen existing inequalities in air pollution levels and health burden between east and west.
‘Children and adults in eastern European countries have already been breathing the most polluted air in Europe and suffering from related lung diseases for far too long. We need fair, ambitious new EU air quality legislation that values the health of all Europeans equally.
‘A new Air Quality Directive must provide clear vision and support to speed up, and not delay, much needed air pollution reductions in eastern Europe, in order to improve health and wellbeing, and achieve clean air for all in Europe, as soon as possible.’
In September 2023, the ERS issued a consensus statement on climate change and respiratory health, including guidance on how global warming can be addressed in clinical practice.
And in November 2023, the WHO published a new operational framework for building climate-resilient, low-carbon and sustainable health systems and address climate-related health risks to safeguard health.
29th January 2024
People with obsessive-compulsive disorder (OCD) have an increased risk of death than those who are not affected by it, Swedish research suggests.
An analysis of more than 61,000 people with OCD and 10 times as many unaffected people from the general population found an increased risk of death associated with both natural and unnatural causes.
As part of the research, the team also compared patient records from a group of 34,000 people with OCD with almost 48,000 unaffected siblings over an eight-year period where they found similar increased risks to the general population.
Writing in the BMJ, the researchers said previous studies had focused on unnatural causes of death including suicide.
Their research suggested that after taking into account potentially influential factors such as birth year, sex, county, migrant status, education and family income, people with OCD had an 82% increased risk of death from any cause.
The excess risk of death was 31% higher for natural causes and three times higher for unnatural causes of death, they reported.
Among the natural causes of death, people with OCD had increased risks of death due to respiratory system diseases (73%), mental and behavioural disorders (58%), diseases of the genitourinary system (55%), endocrine, nutritional, and metabolic diseases (47%), diseases of the circulatory system (33%), nervous system (21%), and digestive system (20%), the analysis showed.
For unnatural causes, suicide was by far the biggest factor with an almost five-fold increased risk of death followed by accidents with a 92% increased risk.
Overall, the risk was similar for both men and women with OCD, although women did have a higher risk of dying due to unnatural causes. That could be explained by their lower baseline risk in the general population, the researchers explained.
But people with OCD had a 10% lower risk of death due to tumours, they noted.
‘Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD.
‘Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD,’ they concluded.
They added that ‘significant efforts’ should also be made to promote early detection and improve access to specialist treatment for people with OCD.
‘People with psychiatric disorders are known to be less likely to seek help for health related problems and to attend medical check-ups, and they are also less likely to receive health interventions and prescriptions for non-psychiatric drugs, potentially leading to delays in the detection and treatment of diseases,’ they noted.
A version of this article was originally published by our sister publication Pulse.
12th January 2024
Paediatric cholesterol tests and the adoption of an ‘adolescent cholesterol passport’ could help prevent up to one-fifth of premature heart disease, a new study has revealed.
Published in the journal Atherosclerosis, the research shows that elevated levels of cholesterol and dyslipidaemia in children and adolescents increases the risk of heart issues such as subclinical atherosclerosis in their mid-20s and premature death by their mid-40s.
Scientists from the Universities of Exeter, Bristol and Eastern Finland found that earlier cholesterol checks, such as universal paediatric lipid screening, could reduce the number of adults suffering from preventable heart disease.
Using data from the University of Bristol’s ’Children of the 90’s’ cohort, also known as the Avon Longitudinal Study of Parents and Children, the researchers analysed data from 1,595 adolescents at the age of 17 and followed up with each participant for seven years. Cholesterol levels and evidence of heart damage were assessed at the start and throughout the follow-up period.
The scientists found an 18-20% increased risk of premature heart damage in adolescents with increased low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and higher overall cholesterol levels.
An increase in triglycerides was also found to be associated with up to a three-fold increase in the risk of premature heart damage within seven years.
The study‘s lead author Dr Andrew Agbaje, paediatric clinical epidemiologist at the University of Eastern Finland and honorary research fellow at the University of Exeter, said: ‘Health guidelines generally recommend a cholesterol check by the age of 40 years. However, we are seeing the first evidence of the catastrophic effects of elevated cholesterol levels on the heart more than two decades earlier.
‘Waiting until age 40 years might result in one in five of the adult population developing preventable heart problems which are very expensive to treat.’
Elevated cholesterol levels were seen in both adolescents of a healthy weight and those considered overweight or obese.
The findings also revealed that while these increased levels were responsible for around a third of the direct damage to the heart, increased fat mass and blood pressure indirectly contributed to around 40% of heart damage.
The researchers showed that genetics and sedentary time could explain the remaining 30% of damage.
Dr Agbaje added: ‘Recently we discovered that increased sedentary time from childhood contributed 70% of the increase in cholesterol level before mid-20s and that engaging in light physical activity can completely reverse elevated cholesterol and dyslipidaemia.
‘Taken together, these findings suggest that being sedentary is at the root of health problems and childhood and adolescent sedentariness is a one-way ticket for cardiovascular diseases and death.’
The researchers state that public health experts, paediatricians, parents and health policymakers should encourage early cholesterol checks, especially in the teenage years, to reduce the risk of dyslipidaemia and to enable early preventive treatment.
And the adoption of an ‘adolescent cholesterol passport’ to help track any increases in cholesterol levels could help to initiate a timely preventive treatment in the young population.
A version of this article was originally published by our sister publication Nursing in Practice.
9th January 2024
Health inequalities saw more than one million people living in 90% of areas in England living shorter lives than they should have between 2011 and the start of the Covid-19 pandemic – equivalent to the whole population of Birmingham, or that of Edinburgh and Glasgow combined, new research has found.
According to research led by University College London’s Institute of Health Equity (IHE), the period from 2011 to 2019 saw more than a million people dying earlier than they otherwise would have done had they experienced the death rates seen in the least deprived decile of areas.
Of these excess deaths, 148,000 were additional to what might have been expected based on levels in the two years prior to 2011, the report – titled ’Health Inequalities, Lives Cut Short’ – said.
And in 2020, the level of excess deaths rose by an additional 28,000 compared to those over the previous five years.
To contextualise the UK’s downwards health trend, the IHE analysed European Union data and compared healthy life years (HLY) – the number of years a person is expected to continue to live in a healthy condition, and also called disability-free life expectancy – in the UK to other European Union countries.
In 2014, both males and females in the UK had a higher average number of healthy years lived (HYL) than those in the EU. However, by 2017, HLY in the UK had stagnated for men, and fallen for women.
In the same period, HLY increased by more than two years in the EU. Consequently, 10 EU countries had higher HLY than the UK for males, and 14 had higher HLY than the UK for females.
UCL IHE Director, Professor Sir Michael Marmot, said: ’If you needed a case study example of what not to do to reduce health inequalities, the UK provides it. The only other developed country doing worse is the USA, where life expectancy is falling.
’Our country has become poor and unhealthy, where a few rich, healthy people live. People care about their health, but it is deteriorating, with their lives shortening, through no fault of their own. Political leaders can choose to prioritise everyone’s health, or not. Currently they are not.’
Referring to this ’dismal state of affairs’, he is calling on political party leaders and MPs to prioritise health equity and wellbeing.
’Important as is the NHS – publicly funded and free at the point of use – action is needed on the social determinants of health: the conditions in which people are born, grow, live, work and age. These social conditions are the main cases of health inequalities,’ he said.
Ahead of the general election, the IHE is also proposing the appointment of an independent health equity commissioner and the establishment of a new cabinet-level health equity and wellbeing cross-departmental committee.
In 2020, Sir Michael’s ’Build Back Fairer: The Covid-19 Marmot Review’ document highlighted how pre-pandemic social and economic conditions contributed to the unequal Covid-19 death toll.
The UK cabinet office cited the report as ‘the most comprehensive early assessment of how Covid-19 exacerbated existing health inequalities’ when he was named in the 2023 King’s New Year Honours.
Last January, Sir Michael criticised the UK Government’s short-term policies being announced and rolled out, stating that they damage the service overall, and warning health leaders to be ‘aware of short-term fixes that might undermine a longer term agenda’ for the service.
17th March 2023
A childhood lower respiratory tract infection (LRTI) nearly doubles the risk of a premature adult respiratory-related death according to the findings of a life-spanning cohort study by UK researchers.
Chronic respiratory diseases are a leading cause of death and disability worldwide and in 2017, represented the third largest cause of mortality. Moreover, adverse factors affecting lung development during foetal life as well as in early childhood, decrease the attainment of maximal lung function and accelerate function decline in adulthood. Although researchers have speculated for some time that there is a direct casual link between acute lower respiratory infection in early childhood and conditions such as chronic bronchitis in adult life, an absence of longitudinal data, makes it difficult to provide greater clarity on the relationship between childhood respiratory infections and possible early deaths from a respiratory cause.
In the current study, researchers prospectively collected data from a nationally representative cohort of all single births among married women during 1 week in March, 1946, across England, Scotland and Wales with a review to evaluating the association between the presence of a LRTI during early childhood (age < 2 years) and death from respiratory disease from age 26 through 73 years.
Childhood LRTI and premature respiratory-related death
Researchers included a total of 3,589 participants, aged 26 years (51% male) and who were included in the analysis from 1972 onwards and followed-up for a median of 47.9 years.
After adjusting for several factors including adult smoking, among these 3,589 participants, 25% had an LRTI during early childhood, which nearly doubled their risk of premature death from a respiratory-related disease by age 73 (Hazard Ratio, HR = 1.93, 95% CI 1.10 – 3.37, p = 0.021). Furthermore, in subgroup analysis, there was no evidence that an early childhood LRTI increased the risk of circulatory, cancer, external, other-cause, or all-cause mortality.
The researchers also calculated that the population attributable risk of premature adult death from respiratory disease due to early childhood LRTI was 20·4% and which corresponded to an estimated 179, 188 excess and premature adult deaths across England and Wales between 1972 and 2019.
The authors concluded that a LRTI during early childhood was associated with almost a two times increased risk of premature adult death from respiratory disease and that it accounted for a fifth of all these deaths.
Citation
Allinson JP et al. Early childhood lower respiratory tract infection and premature adult death from respiratory disease in Great Britain: a national birth cohort study. Lancet 2023
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