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Trends and Predictors of Syphilis Prevalence in the General Population: Global Pooled Analyses of 1103 Prevalence Measures Including 136 Million Syphilis Tests.

ABSTRACT: Background:This study assessed levels, trends, and associations of observed syphilis prevalence in the general adult population using global pooled analyses. Methods:A standardized database of syphilis prevalence was compiled by pooling systematically gathered data. Random-effects meta-analyses and meta-regressions were conducted using data from the period 1990-2016 to estimate pooled measures and assess predictors and trends. Countries were classified by World Health Organization region. Sensitivity analyses were conducted. Results:The database included 1103 prevalence measures from 136 million syphilis tests across 154 countries (85% from women in antenatal care). Global pooled mean prevalence (weighted by region population size) was 1.11% (95% confidence interval [CI], .99-1.22). Prevalence predictors were region, diagnostic assay, sample size, and calendar year interacting with region. Compared to the African Region, the adjusted odds ratio (AOR) was 0.42 (95% CI, .33-.54) for the Region of the Americas, 0.13 (95% CI, .09-.19) for the Eastern Mediterranean Region, 0.05 (95% CI, .03-.07) for the European Region, 0.21 (95% CI, .16-.28) for the South-East Asia Region, and 0.41 (95% CI, .32-.53) for the Western Pacific Region. Treponema pallidum hemagglutination assay (TPHA) only or rapid plasma reagin (RPR) only, compared with dual RPR/TPHA diagnosis, produced higher prevalence (AOR >1.26), as did smaller sample-size studies (<500 persons) (AOR >2.16). Prevalence declined in all regions; the annual AORs ranged from 0.84 (95% CI, .79-.90) in the Eastern Mediterranean to 0.97 (95% CI, .97-1.01) in the Western Pacific. The pooled mean male-to-female prevalence ratio was 1.00 (95% CI, .89-1.13). Sensitivity analyses confirmed robustness of results. Conclusions:Syphilis prevalence has declined globally over the past 3 decades. Large differences in prevalence persist among regions, with the African Region consistently the most affected.

SUBMITTER: Smolak A

PROVIDER: S-EPMC5888928 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundOne of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes.MethodsWe pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence-defined as fasting plasma glucose of 7.0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs-in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.FindingsWe used data from 751 studies including 4,372,000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4.3% (95% credible interval 2.4-7.0) in 1980 to 9.0% (7.2-11.1) in 2014 in men, and from 5.0% (2.9-7.9) to 7.9% (6.4-9.7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28.5% due to the rise in prevalence, 39.7% due to population growth and ageing, and 31.8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target.InterpretationSince 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries.FundingWellcome Trust.

Project description:BackgroundPhysical activity has many health benefits for young people. In 2018, WHO launched More Active People for a Healthier World, a new global action on physical activity, including new targets of a 15% relative reduction of global prevalence of insufficient physical activity by 2030 among adolescents and adults. We describe current prevalence and trends of insufficient physical activity among school-going adolescents aged 11-17 years by country, region, and globally.MethodsWe did a pooled analysis of cross-sectional survey data that were collected through random sampling with a sample size of at least 100 individuals, were representative of a national or defined subnational population, and reported prevalence of of insufficient physical activity by sex in adolescents. Prevalence had to be reported for at least three of the years of age within the 10-19-year age range. We estimated the prevalence of insufficient physical activity in school-going adolescents aged 11-17 years (combined and by sex) for individual countries, for four World Bank income groups, nine regions, and globally for the years 2001-16. To derive a standard definition of insufficient physical activity and to adjust for urban-only survey coverage, we used regression models. We estimated time trends using multilevel mixed-effects modelling.FindingsWe used data from 298 school-based surveys from 146 countries, territories, and areas including 1·6 million students aged 11-17 years. Globally, in 2016, 81·0% (95% uncertainty interval 77·8-87·7) of students aged 11-17 years were insufficiently physically active (77·6% [76·1-80·4] of boys and 84·7% [83·0-88·2] of girls). Although prevalence of insufficient physical activity significantly decreased between 2001 and 2016 for boys (from 80·1% [78·3-81·6] in 2001), there was no significant change for girls (from 85·1% [83·1-88·0] in 2001). There was no clear pattern according to country income group: insufficient activity prevalence in 2016 was 84·9% (82·6-88·2) in low-income countries, 79·3% (77·2-87·5) in lower-middle-income countries, 83·9% (79·5-89·2) in upper-middle-income countries, and 79·4% (74·0-86·2) in high-income countries. The region with the highest prevalence of insufficient activity in 2016 was high-income Asia Pacific for both boys (89·0%, 62·8-92·2) and girls (95·6%, 73·7-97·9). The regions with the lowest prevalence were high-income western countries for boys (72·1%, 71·1-73·6), and south Asia for girls (77·5%, 72·8-89·3). In 2016, 27 countries had a prevalence of insufficient activity of 90% or more for girls, whereas this was the case for two countries for boys.InterpretationThe majority of adolescents do not meet current physical activity guidelines. Urgent scaling up of implementation of known effective policies and programmes is needed to increase activity in adolescents. Investment and leadership at all levels to intervene on the multiple causes and inequities that might perpetuate the low participation in physical activity and sex differences, as well as engagement of youth themselves, will be vital to strengthen the opportunities for physical activity in all communities. Such action will improve the health of this and future young generations and support achieving the 2030 Sustainable Development Goals.FundingWHO.

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Trends and Predictors of Syphilis Prevalence in the General Population: Global Pooled Analyses of 1103 Prevalence Measures Including 136 Million Syphilis Tests.

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