Teferi Mekonnen Yitayew

• Wolfova, K.; Strand, Bjørn Heine; Weiss, J.; Kearns, P. Brennan; Yitayew, Teferi Mekonnen & Stern, Y. [Show all 9 contributors for this article] (2026). Reproductive history and cognitive health among older Norwegian females and males: the population-based HUNT Study. Journal of Psychiatric Research. ISSN 0022-3956. 194, p. 187–187. doi: 10.1016/j.jpsychires.2026.01.001. Full text in Research Archive
• Yitayew, Teferi Mekonnen; Staniford, Leanne; Connell, Spencer; Das-Gupta, Zofia; DeSilva, Umanga & Saoud, Yasmine [Show all 38 contributors for this article] (2025). Development of a core patient-centred outcome set for adults living with obesity: a modified delphi-based international consensus. EClinicalMedicine. 87, p. 1–15. doi: 10.1016/j.eclinm.2025.103422. Full text in Research Archive Show summary

  Background Obesity is a chronic disease linked to over 200 health conditions, reduced quality of life, and increased mortality. Despite the availability of multimodal treatments, there is a lack of standardised, patient-centred outcome measures to effectively assess and improve clinical care. This project aimed to define a core set of standardised outcome measures for adults with obesity, incorporating both patient-reported and clinician-reported outcomes. Additional objectives included determining the optimal measurement frequency and identifying case-mix variables essential for risk adjustment. Methods The International Consortium for Health Outcomes Measurement (ICHOM) established the Obesity Working Group (OWG), composed of 29 international experts and individuals living with obesity. Members were selected based on their expertise in obesity care and research and represented 21 countries. The development process, conducted from May 2023 to July 2024, began with a kick-off meeting to define scope, followed by eight virtual meetings. A comprehensive literature review informed the identification of relevant clinical outcomes, patient-reported outcomes, treatment-related complications, and case-mix variables. A three-round Delphi process was used to reach consensus on key outcomes and follow-up intervals. Outcomes were included in the final set if at least 80% of OWG members rated them between 7 and 9 on a 9-point scale. Validation was conducted through surveys with 95 patients and 106 healthcare professionals from fields such as dietetics, obesity medicine, and general practice. Findings The OWG developed a standardised set of 20 outcome measures, comprising 17 core measures and 3 population-specific measures. These span domains including physical health, psychosocial well-being, health behaviours, body functioning, and adverse events. Specific measures were also developed for bariatric surgery and female reproductive health (both pregnant and non-pregnant individuals). Key case-mix factors and appropriate follow-up periods were defined to support global consistency in reporting. Interpretation Adoption of this standardised outcome set enables clinicians, patients, and stakeholders to identify care gaps, monitor outcomes, and evaluate the quality of obesity care against global benchmarks. Implementation can support the creation of a robust international data resource to guide research, inform clinical practice, and shape policy and guidelines for adult obesity treatment. Limitations include limited geographical diversity in validation surveys, the exclusion of internalised weight bias due to a lack of validated measurement tools, and limited applicability to individuals with obesity and multiple comorbidities. Funding Novo Nordisk, Eli Lilly, and Boehringer Ingelheim International GmbH.

• Ellingjord-Dale, Merete; Strand, Bjørn Heine; Skirbekk, Vegard Fykse; Bratsberg, Bernt Magne; Yitayew, Teferi Mekonnen & Zotcheva, Ekaterina [Show all 10 contributors for this article] (2025). Potentially modifiable risk factors for dementia in Norway (HUNT4 70+): a retrospective cohort study. The Lancet Healthy Longevity. 6(12), p. 100802–100802. doi: 10.1016/j.lanhl.2025.100802. Full text in Research Archive Show summary

  Background The 2024 Lancet Commission report on dementia identified 14 modifiable dementia risk factors. The Norwegian HUNT study uniquely includes data collection of all 14 risk factors in the same individuals throughout adulthood, as well as a study-specific dementia diagnosis. We aimed to evaluate the potential for dementia prevention associated with these 14 risk factors, along with three additional sociodemographic risk factors in this retrospective cohort. Methods This retrospective cohort study included data on participants with study-specific diagnosis from the HUNT4 70+ study (2017–19) and was linked with national administrative registries (1960–2018) and earlier HUNT surveys (1984–2008) with data on dementia risk factors at ages 35–92 years. Inverse probability weighting was applied to account for non-response. Logistic regression estimated dementia risk associated with exposure to less education in early adult life (age <45 years), hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol use in midlife (age 45–65 years), and social isolation, air pollution, and vision loss in late life (age >65 years). Midlife occupational physical activity and marital and employment status were added to the Lancet model. The potential for dementia prevention was assessed using population attributable fraction (PAF). Findings Between Sept 1, 2017, and Feb 28, 2019, 19 403 individuals were invited to participate and 9745 participants (1525 with dementia, 8220 without dementia) were included. 4445 (45·6%) of 9745 participants were male and 5300 (54·4%) were female. The total PAF for the 14 Lancet risk factors was 50·9% (95% CI 37·7–61·4). Including family-related and work-related risk factors increased the PAF to 54·9% (42·3–64·7; p<0·0001). When these factors were added for women, the total PAF increased from 48·0% (95% CI 29·4–61·7) to 52·2% (34·2–65·3; p=0·0090), whereas no significant change was observed in men (56·2% [95% CI 35·5–70·2] to 56·7 [95% CI 36·1–70·6]; p=0·71).

• Yitayew, Teferi Mekonnen; Kristjansson, Dana; Bratsberg, Bernt Magne; Kohler, Hans-Peter; Selbæk, Geir & Larsen, Frode Kibsgaard [Show all 12 contributors for this article] (2025). Changes in survival probabilities and mortality risks among population living with Down syndrome born 1967–2018: a Norwegian registry-based study. BMC Public Health. 25. doi: 10.1186/s12889-025-25326-z. Full text in Research Archive
• Breivik, Anne; Kopperud, Simen E.; Mulic, Aida Gacic; Stein, Linda; Yitayew, Teferi Mekonnen & Hadler-Olsen, Elin Synnøve [Show all 7 contributors for this article] (2025). Risk Indicators Associated with Root Caries and Oral Health-Related Quality of Life among Older Adults: The Tromsø7 Study. Caries Research. ISSN 0008-6568. p. 13–13. doi: 10.1159/000547745. Full text in Research Archive Show summary

  Introduction: This study aimed to investigate risk indicators associated with root caries in older adults aged 65 years and above in Norway. A secondary aim was to explore whether root caries was associated with oral health-related quality of life (OHRQoL). Methods: This cross-sectional study included 1,075 participants aged ≥65 from the population-based Tromsø Study (Tromsø7) conducted in Northern Norway in 2015–2016. All inhabitants aged 40 years and older in Tromsø municipality (32,591) were invited, of whom 21,083 participated. The participants underwent clinical and radiographic examinations and answered extensive questionnaires. Root caries was registered on four surfaces per tooth and graded D_3-5. For analysis, prevalence of root caries was dichotomised into (1) no (if the participants had no root caries) and (2) yes (if root caries was registered on at least one surface). Characteristics of the study population were described with percentages and frequencies for the categorical variables and mean and standard deviation (SD) for continuous variables for the whole cohort and stratified on presence of root caries and OHRQoL impact. The statistical significance of differences was assessed with the Pearson χ2 test and independent sample T test. Factors associated with root caries and OHRQoL were explored using logistic regression. The significance level was set to p < 0.05 for all analysis. Results: Men had higher odds of root caries than women (OR: 1.70, 95% CI [1.08, 2.70]) and those who were smokers had a higher odds of root caries than those who had never smoked (OR: 1.83, 95% CI [1.13, 2.94]). Participants with root caries had 1.67 times higher odds of having reduced OHRQoL than those without root caries (95% CI: 1.02, 2.72). Conclusion: This study found that being male and smoking were risk indicators of root caries. Additionally, root caries had a negative impact on OHRQoL. The results could be useful for oral health professionals to guide individual and targeted root caries preventive measures in older adults.

• Yitayew, Teferi Mekonnen; Skirbekk, Vegard Fykse; Håberg, Asta; Engdahl, Bo Lars; Zotcheva, Ekaterina & Jugessur, Astanand [Show all 18 contributors for this article] (2025). Mediators of educational differences in dementia risk later in life: evidence from the HUNT study. BMC Public Health. 25, p. 1–12. doi: 10.1186/s12889-025-22592-9. Full text in Research Archive Show summary

  Despite a well-known inverse association between education and dementia risk, the mediating mechanisms are not well understood. We explored how lifestyle and health risk factors across the life-course mediate the relationship between education and dementia among adults aged 70 + years. We included 7,655 participants with dementia diagnoses and education information, using a historical cohort design linking prospective exposure data across the life course from the HUNT4 70 + Study with registry data from Statistics Norway and earlier HUNT surveys. We conducted causal mediation analysis to assess the mediating roles of occupational characteristics, lifestyle factors (smoking, physical inactivity), and health risk factors (obesity, hypertension, diabetes, hearing impairment, cardiovascular diseases, LDL cholesterol, depression, anxiety) assessed during early, middle, and late adulthood in the relationship between education and dementia in later life. Participants with lower education were more likely to have dementia with odds ratios of 1.99, 1.88, 1.83 for the model’s accounting exposure to mediators during early, middle, and late adulthood, respectively. These associations were partially mediated by the joint effect of health and lifestyle risk factors from early through late adulthood (mediated 11.55–19.50%). Health risk factors from early to late adulthood jointly mediated 6.85–13.06% of the effect of low education on dementia risk later in life. Additionally, lifestyle factors during middle and late adulthood jointly mediated 4.11–4.96% of the total effect of low education on dementia risk later in life. Educational differences in dementia risk can partly mediated by lifestyle and health factors across the life course. These findings suggest potential targets to address varying dementia risks linked to education levels.

• Yitayew, Teferi Mekonnen; Gebremariam, Mekdes; Andersen, Lene Frost; Lien, Nanna; Brantsæter, Anne Lise & Coutinho, Sílvia [Show all 8 contributors for this article] (2025). The impact of hypothetical early life interventions on rapid weight gain during infancy and body mass index at 5 and 8 years in Norway: The Norwegian Mother, Father, and Child Cohort Study (MoBa). Pediatric Obesity. ISSN 2047-6302. 20(6). doi: 10.1111/ijpo.70008. Full text in Research Archive Show summary

  Objectives: This study examined the impact of hypothetical interventions on (i) early life factors (prenatal and early postnatal) on rapid weight gain during infancy, and (ii) early life factors and child energy balance-related behaviours (EBRB) on children's body mass index (BMI)-for-age at 5 and 8 years. Methods: Data from the Norwegian Mother, Father, and Child Cohort Study included participants aged 2 (n = 48 109), 5 (n = 18 810) and 8 (n = 10 830) years. Early life intervention variables were maternal smoking during pregnancy, maternal weight before and during pregnancy, exclusive/partial breastfeeding for 6 months, and introduction of complementary food at 6 months. Child EBRB intervention variables for the 5-year outcome included screen time, fruit and vegetable intake, and sugar-sweetened soft drink intake assessed at 3 years. For the 8-year outcome, interventions included screen time, presence of a television in the child's bedroom, sleep hours and breakfast intake assessed at 5 years. The parametric g-formula was used for analysis. Results and Conclusions: The average population-level difference in rapid weight gain during infancy at 2 years under the intervention targeting the prenatal, early postnatal factors and these factors combined with 95% confidence intervals were −0.012 (−0.017, −0.007), −0.009 (−0.012, −0.005) and −0.020 (−0.025, −0.015), respectively. The average population-level differences in children's BMI-for-age z-score for interventions targeting early life factors, child EBRB and these factors combined were −0.225 (−0.244, −0.207), 0.02 (−0.021, 0.024) and −0.223 (−0.249, −0.196), respectively among 5-year-olds and −0.265 (−0.295, −0.236), −0.020 (−0.029, −0.011) and −0.285 (−0.315, −0.256), respectively among 8-year-olds. Our results suggested joint interventions on early life factors may reduce childhood BMI-for-age z-scores.

• Mekonnen, Teferi; Skirbekk, Vegard; Zotcheva, Ekaterina; Engdahl, Bo; Bratsberg, Bernt & Jugessur, Astanand [Show all 19 contributors for this article] (2025). Number of children and dementia risk: a causal mediation analysis using data from the HUNT study linked with national registries in Norway. BMC Neurology. 25(1). doi: 10.1186/s12883-025-04044-4. Full text in Research Archive Show summary

  Background: Childlessness, as well as having a high number of children, has been reported to be associated with an elevated risk of dementia compared to having 2–3 children. The mechanisms underlying these relationships are not well understood and may be mediated by different midlife risk factors. We examined the mediating role of various factors on the relationship between the number of children and dementia risk. These factors include socioeconomic factors (e.g., occupational complexity), psychosocial (e.g.., social activities, loneliness, life satisfaction), lifestyle (e.g., smoking, physical inactivity, alcohol intake), and chronic diseases (e.g., obesity, diabetes, depression, hearing impairment and hypertension). Methods: Using a historic cohort design, we included 9,745 participants born between 1931–48, with a mean age of 78.2 (SD = 6.4) years at the time of cognitive testing in the HUNT4 70 + sub-study (2017–2019). Further measures were obtained through data linkage between information from Statistics Norway and the HUNT1(1984–86), and HUNT2 (1995–97) Surveys. Causal mediation analyses using an inverse odd weighting approach were conducted to decompose the total effect of the number of children (0, 1, or 4 + children vs. 2–3) on the risk of dementia at age 70 + years into direct and indirect effects with mediators assessed at a mean age of 50.7 (SD = 6.4) years. The analyses were adjusted for age, sex, marital status at age 25 years, educational status, and religion assessed during HUNT3 (2006–2008). Results: Overall, 15.7% were diagnosed with dementia. The proportions with dementia by the number of children were 22.3% among those with no children, 21.4% for those with one child, 13% for those with 2–3 children (specifically, 12.6% for those with 2 children and 13.4% for those with 3 children), and 19.9% for those with 4 + children. Compared to the reference group of individuals with 2–3 children, the dementia risk was higher among the groups with no children (relative risk (RR): 1.30, 95% confidence interval (CI) (1.12, 1.51)), those with one child (RR: 1.30, 95% CI (1.14, 1.47)) and those with 4 + children (RR: 1.12, 95% CI (1.01, 1.24)). The elevated risks of dementia were not mediated by the socioeconomic, psychosocial, lifestyle, or chronic diseases related factors that we tested. Sex-stratified analysis showed higher dementia risk for men without children and women with one or 4 + children compared to those with 2–3 children, with similar patterns across sexes. None of the mediators contributed to mediation in either group. None of the mediators appeared to contribute through mediation in either group. Conclusions: Our findings suggest that the number of children—specifically being childless, having one child, or having four or more children—may influence the risk of dementia. These relationships were not mediated by psychosocial, lifestyle, and socioeconomic factors, or markers of chronic diseases in adulthood considered in this study.

• Edwin, Trine Holt; Håberg, Asta; Zotcheva, Ekaterina; Bratsberg, Bernt Magne; Jugessur, Astanand & Engdahl, Bo Lars [Show all 16 contributors for this article] (2024). Trajectories of Occupational Cognitive Demands and Risk of Mild Cognitive Impairment and Dementia in Later Life The HUNT4 70+ Study. Neurology. ISSN 0028-3878. 102(9). doi: 10.1212/WNL.0000000000209353. Full text in Research Archive
• Yitayew, Teferi Mekonnen; Papadopoulou, Eleni Zoumpoulia; Lien, Nanna; Andersen, Lene Frost; Pinho, Maria Gabriela Matias & Havdal, Hanne Hennig [Show all 8 contributors for this article] (2023). Mediators of parental educational differences in the intake of carbonated sugar-sweetened soft drinks among adolescents, and the moderating role of neighbourhood income. Nutrition Journal. 22(1). doi: 10.1186/s12937-023-00872-7. Full text in Research Archive Show summary

  Background: Existing evidence suggests that the intake of sugar-sweetened beverages (SSB) among adolescents remains a public health concern and that socioeconomic differences in intake exist. Tackling these challenges requires identifying the factors associated with SSB intake and the mediators of socioeconomic differences in SSB intake among adolescents. Thus, this study aimed to explore (i) factors at different levels of the ecological model associated with the intake of carbonated soft drinks with added sugar (hereafter called soft drinks), (ii) mediators of the association between parental education and the intake of soft drinks(iii) whether neighbourhood income moderates the indirect effect of parental education on adolescents’ soft drink intake through potential mediators. Methods: Data from 826 7th graders in Oslo, Norway, who participated in the TACKLE cross-sectional study conducted in 2020 were used. The association between factors at the individual, interpersonal and neighbourhood food environment levels and the intake of soft drinks among adolescents was assessed, as well as the mediating roles of these factors for the differences in intake by parental education, using multiple logistic regression and mediation analysis, respectively. Moderated mediation analyses were used to explore whether an indirect effect of parental education on adolescents' soft drink intake through potential mediators varies across neighbourhood income areas. Results: Higher perceived accessibility of SSB at home, increased parental modelling for SSB intake, and increased frequency of food/drink purchased from the neighbourhood store were associated with a higher intake of soft drinks among adolescents and mediated the differences in intake by parental education. Neighbourhood food environment factors were neither statistically significantly associated with adolescents’ higher intake of soft drinks nor explained the differences in intake by parental education. Moderated mediation analysis showed that the mediating effect of perceived accessibility of SSB at home on the association between parental education and adolescent soft drink intake was stronger among those living in low neighbourhood income. Conclusions: Our study identified modifiable factors at the intrapersonal level (perceived accessibility of SSB at home and frequency of food/drink purchased from neighbourhood shops) and interpersonal levels (parental modelling for SSB intake) associated with a higher intake of soft drinks among adolescents and mediated the differences in the intake by parental education. The modifiable factors identified in this study could be targeted in public health initiatives among adolescents aimed at reducing the intake of soft drinks and the related differences by parental education.

• Zotcheva, Ekaterina; Bratsberg, Bernt Magne; Strand, Bjørn Heine; Jugessur, Astanand; Engdahl, Bo Lars & Bowen, Catherine [Show all 17 contributors for this article] (2023). Trajectories of occupational physical activity and risk of later-life mild cognitive impairment and dementia: the HUNT4 70+ study. The Lancet Regional Health - Europe. 34. doi: 10.1016/j.lanepe.2023.100721. Full text in Research Archive Show summary

  High levels of occupational physical activity (PA) have been linked to an increased risk of dementia. We assessed the association of trajectories of occupational PA at ages 33–65 with risk of dementia and mild cognitive impairment (MCI) at ages 70+. Methods We included 7005 participants (49.8% were women, 3488/7005) from the HUNT4 70+ Study. Group-based trajectory modelling was used to identify four trajectories of occupational PA based on national registry data from 1960 to 2014: stable low (30.9%, 2162/7005), increasing then decreasing (8.9%, 625/7005), stable intermediate (25.1%, 1755/7005), and stable high (35.2%, 2463/7005). Dementia and MCI were clinically assessed in 2017–2019. We performed adjusted multinomial regression to estimate relative risk ratios (RRR) with 95% confidence intervals (CI) for dementia and MCI. Findings 902 participants were diagnosed with dementia and 2407 were diagnosed with MCI. Absolute unadjusted risks for dementia and MCI were 8.8% (95% CI: 7.6–10.0) and 27.4% (25.5–29.3), respectively, for those with a stable low PA trajectory, 8.2% (6.0–10.4) and 33.3% (29.6–37.0) for those with increasing, then decreasing PA; while they were 16.0% (14.3–17.7) and 35% (32.8–37.2) for those with stable intermediate, and 15.4% (14.0–16.8) and 40.2% (38.3–42.1) for those with stable high PA trajectories. In the adjusted model, participants with a stable high trajectory had a higher risk of dementia (RRR 1.34, 1.04–1.73) and MCI (1.80, 1.54–2.11), whereas participants with a stable intermediate trajectory had a higher risk of MCI (1.36, 1.15–1.61) compared to the stable low trajectory. While not statistically significant, participants with increasing then decreasing occupational PA had a 24% lower risk of dementia and 18% higher risk of MCI than the stable low PA group. Interpretation Consistently working in an occupation with intermediate or high occupational PA was linked to an increased risk of cognitive impairment, indicating the importance of developing strategies for individuals in physically demanding occupations to prevent cognitive impairment.

• Ong, Kanyin Liane; Stafford, Lauryn K; McLaughlin, Susan A; Boyko, Edward J.; Vollset, Stein Emil & Smith, Amanda E. [Show all 50 contributors for this article] (2023). Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. ISSN 0140-6736. 402(10397), p. 203–234. doi: 10.1016/S0140-6736(23)01301-6. Full text in Research Archive Show summary

  Background Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. Methods Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. Findings In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. Interpretation Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.

• Clarsen, Benjamin Matthew; Nylenna, Magne; Klitkou, Søren Toksvig; Vollset, Stein Emil; Baravelli, Carl Michael & Bølling, Anette Kocbach [Show all 31 contributors for this article] (2022). Changes in life expectancy and disease burden in Norway, 1990–2019: an analysis of the Global Burden of Disease Study 2019. The Lancet Public Health. ISSN 2468-2667. 7(7), p. e593–e605. doi: 10.1016/S2468-2667(22)00092-5. Full text in Research Archive Show summary

  Background: Geographical differences in health outcomes are reported in many countries. Norway has led an active policy aiming for regional balance since the 1970s. Using data from the Global Burden of Disease Study (GBD) 2019, we examined regional differences in development and current state of health across Norwegian counties. Methods: Data for life expectancy, healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) in Norway and its 11 counties from 1990 to 2019 were extracted from GBD 2019. County-specific contributors to changes in life expectancy were compared. Inequality in disease burden was examined by use of the Gini coefficient. Findings: Life expectancy and HALE improved in all Norwegian counties from 1990 to 2019. Improvements in life expectancy and HALE were greatest in the two counties with the lowest values in 1990: Oslo, in which life expectancy and HALE increased from 71·9 years (95% uncertainty interval 71·4-72·4) and 63·0 years (60·5-65·4) in 1990 to 81·3 years (80·0-82·7) and 70·6 years (67·4-73·6) in 2019, respectively; and Troms og Finnmark, in which life expectancy and HALE increased from 71·9 years (71·5-72·4) and 63·5 years (60·9-65·6) in 1990 to 80·3 years (79·4-81·2) and 70·0 years (66·8-72·2) in 2019, respectively. Increased life expectancy was mainly due to reductions in cardiovascular disease, neoplasms, and respiratory infections. No significant differences between the national YLD or DALY rates and the corresponding age-standardised rates were reported in any of the counties in 2019; however, Troms og Finnmark had a higher age-standardised YLL rate than the national rate (8394 per 100 000 [95% UI 7801-8944] vs 7536 per 100 000 [7391-7691]). Low inequality between counties was shown for life expectancy, HALE, all level-1 causes of DALYs, and exposure to level-1 risk factors. Interpretation: Over the past 30 years, Norway has reduced inequality in disease burden between counties. However, inequalities still exist at a within-county level and along other sociodemographic gradients. Because of insufficient Norwegian primary data, there remains substantial uncertainty associated with regional estimates for non-fatal disease burden and exposure to risk factors.

• Yitayew, Teferi Mekonnen; Brantsæter, Anne Lise; Andersen, Lene Frost; Lien, Nanna; Arah, Onyebuchi A. & Gebremariam, Mekdes [Show all 7 contributors for this article] (2022). Mediators of differences by parental education in weight-related outcomes in childhood and adolescence in Norway. Scientific Reports. 12(1), p. 1–13. doi: 10.1038/s41598-022-09987-z. Full text in Research Archive Show summary

  Studies exploring mediators of socioeconomic inequalities in excess weight gain in early-life and subsequent overweight/obesity (OW/OB) among youth are limited. Thus, this study examined the mediating role of prenatal and early postnatal factors and child energy balance-related behaviours (EBRB) in the effects of parental education on (i) excess weight gain from birth to 2 years and (ii) OW/OB at 5, 8 and 14 years. The Norwegian Mother, Father and Child Cohort Study was used to include participants at the ages of 2 (n = 59,597), 5 (n = 27,134), 8 (n = 28,285) and 14 (n = 11,278) years. Causal mediation analyses using the inverse odds weighting approach were conducted. Children of low-educated parents had a higher conditional excess weight gain at 2 years compared to children of high-educated parents (total effect, RRTE = 1.06; 95% CI 1.01, 1.10). The joint mediation effects of the prenatal and early postnatal factors explained most of the total effect of low education on conditional excess weight gain at 2 years. Children of low-educated parents had a higher risk of OW/OB at 5, 8 and 14 years compared to children of high-educated parents. The mediators jointly explained 63.7%, 67% and 88.9% of the total effect of parental education on OW/OB among 5, 8 and 14 year-old-children, respectively. Of the total mediated effects at 5, 8 and 14 years, the prenatal and early postnatal mediators explained 59.2%, 61.7% and 73.7%, whereas the child EBRB explained 10.3%, 15.8.0%% and 34.8%. The mediators included were found to have a considerable mediating effect in the associations explored, in particular the prenatal and early postnatal factors. If truly causal, the findings could indicate potential targets for interventions to tackle socioeconomic inequalities in OW/OB from birth to adolescence.

• Yitayew, Teferi Mekonnen; Papadopoulou, Eleni Zoumpoulia; Arah, Onyebuchi A.; Brantsæter, Anne Lise; Lien, Nanna & Gebremariam, Mekdes Kebede (2021). Socioeconomic inequalities in children's weight, height and BMI trajectories in Norway. Scientific Reports. 11, p. 1–9. doi: 10.1038/s41598-021-84615-w. Full text in Research Archive Show summary

  Abstract Studies exploring when social inequalities in body mass index (BMI) and its composites emerge and how these evolve with age are limited. Thus, this study explored parental income and education related inequalities in children’s weight, height, weight velocity and body mass index among Norwegian children from 1 month to 8 years. The study population included 59,927 family/children pairs participating in the Norwegian Mother, Father, and Child Cohort Study. Growth was modelled using the Jenss–Bayley model and linear mixed effects analyses were conducted. Maternal and paternal educational differences in children’s weight and BMI trajectories emerged during infancy, continuing to age 8 years. Parental income-related inequalities in children’s weight were observed from the age of 1 month to 4 years for maternal and up to 1 year for paternal income-related differences but then disappeared. Parental income-related inequalities in child’s BMI were observed from 18 months to 8 years for maternal income, and from 9 months to 8 years for paternal income-related differences. These results suggest that social inequalities in children’s BMI present early in infancy and continue to 8 years of age. The inequalities sometimes differed by indicator of socioeconomic position used. Interventions to combat these inequalities early in life are, thus needed.

• Kinyoki, Damaris K.; Osgood-Zimmerman, Aaron E.; Bhattacharjee, Natalia V.; Schaeffer, Lauren E.; Lazzar-Atwood, Alice & Lu, Dan [Show all 50 contributors for this article] (2021). Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018. Nature Medicine. ISSN 1078-8956. 27, p. 1761–1782. doi: 10.1038/s41591-021-01498-0. Full text in Research Archive Show summary

  Anemia is a globally widespread condition in women and is associated with reduced economic productivity and increased mortality worldwide. Here we map annual 2000–2018 geospatial estimates of anemia prevalence in women of reproductive age (15–49 years) across 82 low- and middle-income countries (LMICs), stratify anemia by severity and aggregate results to policy-relevant administrative and national levels. Additionally, we provide subnational disparity analyses to provide a comprehensive overview of anemia prevalence inequalities within these countries and predict progress toward the World Health Organization’s Global Nutrition Target (WHO GNT) to reduce anemia by half by 2030. Our results demonstrate widespread moderate improvements in overall anemia prevalence but identify only three LMICs with a high probability of achieving the WHO GNT by 2030 at a national scale, and no LMIC is expected to achieve the target in all their subnational administrative units. Our maps show where large within-country disparities occur, as well as areas likely to fall short of the WHO GNT, offering precision public health tools so that adequate resource allocation and subsequent interventions can be targeted to the most vulnerable populations

• Deshpande, Aniruddha; Miller-Petrie, Molly K.; Lindstedt, Paulina A; Baumann, Mathew M; Johnson, Kimberly B & Blacker, Brigette F [Show all 50 contributors for this article] (2020). Mapping geographical inequalities in access to drinking water and sanitation facilities in low-income and middle-income countries, 2000–17. The Lancet Global Health. ISSN 2572-116X. 8(9), p. 1162–1185. doi: 10.1016/S2214-109X(20)30278-3. Full text in Research Archive Show summary

  Background: Universal access to safe drinking water and sanitation facilities is an essential human right, recognised in the Sustainable Development Goals as crucial for preventing disease and improving human wellbeing. Comprehensive, high-resolution estimates are important to inform progress towards achieving this goal. We aimed to produce highresolution geospatial estimates of access to drinking water and sanitation facilities. Methods: We used a Bayesian geostatistical model and data from 600 sources across more than 88 low-income and middle-income countries (LMICs) to estimate access to drinking water and sanitation facilities on continuous continent-wide surfaces from 2000 to 2017, and aggregated results to policy-relevant administrative units. We estimated mutually exclusive and collectively exhaustive subcategories of facilities for drinking water (piped water on or off premises, other improved facilities, unimproved, and surface water) and sanitation facilities (septic or sewer sanitation, other improved, unimproved, and open defecation) with use of ordinal regression. We also estimated the number of diarrhoeal deaths in children younger than 5 years attributed to unsafe facilities and estimated deaths that were averted by increased access to safe facilities in 2017, and analysed geographical inequality in access within LMICs. Findings: Across LMICs, access to both piped water and improved water overall increased between 2000 and 2017, with progress varying spatially. For piped water, the safest water facility type, access increased from 40·0% (95% uncertainty interval [UI] 39·4–40·7) to 50·3% (50·0–50·5), but was lowest in sub-Saharan Africa, where access to piped water was mostly concentrated in urban centres. Access to both sewer or septic sanitation and improved sanitation overall also increased across all LMICs during the study period. For sewer or septic sanitation, access was 46·3% (95% UI 46·1–46·5) in 2017, compared with 28·7% (28·5–29·0) in 2000. Although some units improved access to the safest drinking water or sanitation facilities since 2000, a large absolute number of people continued to not have access in several units with high access to such facilities (>80%) in 2017. More than 253 000 people did not have access to sewer or septic sanitation facilities in the city of Harare, Zimbabwe, despite 88·6% (95% UI 87·2–89·7) access overall. Many units were able to transition from the least safe facilities in 2000 to safe facilities by 2017; for units in which populations primarily practised open defecation in 2000, 686 (95% UI 664–711) of the 1830 (1797–1863) units transitioned to the use of improved sanitation. Geographical disparities in access to improved water across units decreased in 76·1% (95% UI 71·6–80·7) of countries from 2000 to 2017, and in 53·9% (50·6–59·6) of countries for access to improved sanitation, but remained evident subnationally in most countries in 2017. Interpretation: Our estimates, combined with geospatial trends in diarrhoeal burden, identify where efforts to increase access to safe drinking water and sanitation facilities are most needed. By highlighting areas with successful approaches or in need of targeted interventions, our estimates can enable precision public health to effectively progress towards universal access to safe water and sanitation.

• Lozano, Rafael; Fullman, Nancy; Mumford, John Everett; Knight, Megan; Barthelemy, Celine M. & Abbafati, Cristiana [Show all 51 contributors for this article] (2020). Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. The Lancet. ISSN 0140-6736. 396(10258), p. 1250–1284. doi: 10.1016/S0140-6736(20)30750-9. Full text in Research Archive Show summary

  Background Achieving universal health coverage (UHC) involves all people receiving the health services they need, of high quality, without experiencing financial hardship. Making progress towards UHC is a policy priority for both countries and global institutions, as highlighted by the agenda of the UN Sustainable Development Goals (SDGs) and WHO's Thirteenth General Programme of Work (GPW13). Measuring effective coverage at the health-system level is important for understanding whether health services are aligned with countries' health profiles and are of sufficient quality to produce health gains for populations of all ages. Methods Based on the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we assessed UHC effective coverage for 204 countries and territories from 1990 to 2019. Drawing from a measurement framework developed through WHO's GPW13 consultation, we mapped 23 effective coverage indicators to a matrix representing health service types (eg, promotion, prevention, and treatment) and five population-age groups spanning from reproductive and newborn to older adults (≥65 years). Effective coverage indicators were based on intervention coverage or outcome-based measures such as mortality-to-incidence ratios to approximate access to quality care; outcome-based measures were transformed to values on a scale of 0–100 based on the 2·5th and 97·5th percentile of location-year values. We constructed the UHC effective coverage index by weighting each effective coverage indicator relative to its associated potential health gains, as measured by disability-adjusted life-years for each location-year and population-age group. For three tests of validity (content, known-groups, and convergent), UHC effective coverage index performance was generally better than that of other UHC service coverage indices from WHO (ie, the current metric for SDG indicator 3.8.1 on UHC service coverage), the World Bank, and GBD 2017. We quantified frontiers of UHC effective coverage performance on the basis of pooled health spending per capita, representing UHC effective coverage index levels achieved in 2019 relative to country-level government health spending, prepaid private expenditures, and development assistance for health. To assess current trajectories towards the GPW13 UHC billion target—1 billion more people benefiting from UHC by 2023—we estimated additional population equivalents with UHC effective coverage from 2018 to 2023. Findings Globally, performance on the UHC effective coverage index improved from 45·8 (95% uncertainty interval 44·2–47·5) in 1990 to 60·3 (58·7–61·9) in 2019, yet country-level UHC effective coverage in 2019 still spanned from 95 or higher in Japan and Iceland to lower than 25 in Somalia and the Central African Republic. Since 2010, sub-Saharan Africa showed accelerated gains on the UHC effective coverage index (at an average increase of 2·6% [1·9–3·3] per year up to 2019); by contrast, most other GBD super-regions had slowed rates of progress in 2010–2019 relative to 1990–2010. Many countries showed lagging performance on effective coverage indicators for non-communicable diseases relative to those for communicable diseases and maternal and child health, despite non-communicable diseases accounting for a greater proportion of potential health gains in 2019, suggesting that many health systems are not keeping pace with the rising non-communicable disease burden and associated population health needs. In 2019, the UHC effective coverage index was associated with pooled health spending per capita (r=0·79), although countries across the development spectrum had much lower UHC effective coverage than is potentially achievable relative to their health spending. Under maximum efficiency of translating health spending into UHC effective coverage performance, countries would need to reach USD 1398 pooled health spending per capita (US$ adjusted for purchasing power parity) in order to achieve 80 on the UHC effective coverage index. From 2018 to 2023, an estimated 388·9 million (358·6–421·3) more population equivalents would have UHC effective coverage, falling well short of the GPW13 target of 1 billion more people benefiting from UHC during this time. Current projections point to an estimated 3·1 billion (3·0–3·2) population equivalents still lacking UHC effective coverage in 2023, with nearly a third (968·1 million [903·5–1040·3]) residing in south Asia. Interpretation The present study demonstrates the utility of measuring effective coverage and its role in supporting improved health outcomes for all people—the ultimate goal of UHC and its achievement. Global ambitions to accelerate progress on UHC service coverage are increasingly unlikely unless concerted action on non-communicable diseases occurs and countries can better translate health spending into improved performance. Focusing on effective coverage and accounting for the world's evolving health needs lays the groundwork for better understanding how close—or how far—all populations are in benefiting from UHC.

• Kinyoki, Damaris K.; Ross, Jennifer M.; Lazzar-Atwood, Alice; Munro, Sandra B.; Schaeffer, Lauren E. & Abbasalizad-Farhangi, Mahdieh [Show all 49 contributors for this article] (2020). Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017. Nature Medicine. ISSN 1078-8956. 26, p. 750–759. doi: 10.1038/s41591-020-0807-6. Full text in Research Archive Show summary

  A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic.

• Yitayew, Teferi Mekonnen; Havdal, Hanne Hennig; Lien, Nanna; O'Halloran, Siobhan Anne; Arah, Onyebuchi A. & Papadopoulou, Eleni Zoumpoulia [Show all 7 contributors for this article] (2020). Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review. Obesity Reviews. ISSN 1467-7881. 21(7), p. 1–17. doi: 10.1111/obr.13016. Full text in Research Archive Show summary

  Children and adolescents with a lower socioeconomic position have poorer dietary behaviours compared to their counterparts with a higher socioeconomic position. A better understanding of the mechanisms behind such socioeconomic inequalities is vital to identify targets for interventions aimed at tackling these inequalities. This systematic review aimed to summarize existing evidence regarding the mediators of socioeconomic differences in dietary behaviours among youth. A systematic literature search of MEDLINE, Embase, PsycINFO, and Web of Science databases yielded 20 eligible studies. The dietary behaviours included in the reviewed studies were the intake of fruit and vegetables, sugar‐sweetened beverages, unhealthy snacks/fast food and breakfast. The consistent mediators of the effects of socioeconomic position on dietary behaviours among youth were: self‐efficacy, food preferences and knowledge at the intrapersonal level; and availability and accessibility of food items at home, food rules and parental modelling at the interpersonal level. Few studies including mediators at the organisational, community or policy levels were found. Our review found several modifiable factors at the intrapersonal and interpersonal levels that could be targeted in interventions aimed at combating inequalities in dietary behaviours among youth. Rigorous studies exploring organisational, community and policy level mediators are warranted.

• Knudsen, Ann Kristin; Allebeck, Peter; Tollånes, Mette Christophersen; Skogen, Jens Christoffer; Iburg, Kim Moesgaard & McGrath, John J. [Show all 46 contributors for this article] (2019). Life expectancy and disease burden in the Nordic countries: results from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. The Lancet Public Health. ISSN 2468-2667. 4(12), p. e658–e669. doi: 10.1016/S2468-2667(19)30224-5. Full text in Research Archive Show summary

  Background: The Nordic countries have commonalities in gender equality, economy, welfare, and health care, but differ in culture and lifestyle, which might create country-wise health differences. This study compared life expectancy, disease burden, and risk factors in the Nordic region. Methods: Life expectancy in years and age-standardised rates of overall, cause-specific, and risk factor-specific estimates of disability-adjusted life-years (DALYs) were analysed in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. Data were extracted for Denmark, Finland, Iceland, Norway, and Sweden (ie, the Nordic countries), and Greenland, an autonomous area of Denmark. Estimates were compared with global, high-income region, and Nordic regional estimates, including Greenland. Findings: All Nordic countries exceeded the global life expectancy; in 2017, the highest life expectancy was in Iceland among females (85·9 years [95% uncertainty interval [UI] 85·5–86·4] vs 75·6 years [75·3–75·9] globally) and Sweden among males (80·8 years [80·2–81·4] vs 70·5 years [70·1–70·8] globally). Females (82·7 years [81·9–83·4]) and males (78·8 years [78·1–79·5]) in Denmark and males in Finland (78·6 years [77·8–79·2]) had lower life expectancy than in the other Nordic countries. The lowest life expectancy in the Nordic region was in Greenland (females 77·2 years [76·2–78·0], males 70·8 years [70·3–71·4]). Overall disease burden was lower in the Nordic countries than globally, with the lowest age-standardised DALY rates among Swedish males (18 555·7 DALYs [95% UI 15 968·6–21 426·8] per 100 000 population vs 35 834·3 DALYs [33 218·2–38 740·7] globally) and Icelandic females (16 074·1 DALYs [13 216·4–19 240·8] vs 29 934·6 DALYs [26 981·9–33 211·2] globally). Greenland had substantially higher DALY rates (26 666·6 DALYs [23 478·4–30 218·8] among females, 33 101·3 DALYs [30 182·3–36 218·6] among males) than the Nordic countries. Country variation was primarily due to differences in causes that largely contributed to DALYs through mortality, such as ischaemic heart disease. These causes dominated male disease burden, whereas non-fatal causes such as low back pain were important for female disease burden. Smoking and metabolic risk factors were high-ranking risk factors across all countries. DALYs attributable to alcohol use and smoking were particularly high among the Danes, as was alcohol use among Finnish males. Interpretation: Risk factor differences might drive differences in life expectancy and disease burden that merit attention also in high-income settings such as the Nordic countries. Special attention should be given to the high disease burden in Greenland.

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• Kinyoki, Damaris K.; Ross, Jennifer M.; Lazzar-Atwood, Alice; Munro, Sandra B.; Schaeffer, Lauren E. & Abbasalizad-Farhangi, Mahdieh [Show all 929 contributors for this article] (2020). Author Correction: Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017 (Nature Medicine, (2020), 26, 5, (750-759), 10.1038/s41591-020-0807-6). Nature Medicine. ISSN 1078-8956. 26(8), p. 1308–1308. doi: 10.1038/s41591-020-0972-7. Full text in Research Archive

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