Zubair Kabir

Introduction: Increasing use of e-cigarettes and forms of non-combustible nicotine consumption, especially among children and young people who do not smoke, is an emerging challenge for traditional services oriented to stop smoking care. However, as services struggle to manage these newer...

Background: Non-suicidal self-injury (NSSI) is a prevalent and clinically significant behaviour, particularly among adolescents and young adults, and is strongly associated with suicidal behaviour. However, existing reviews have often combined heterogeneous outcomes, including suicidal ideation, plans, attempts, and death, limiting the identification of clinically meaningful pathways. Objective: This protocol describes a systematic review that aims to synthesise evidence on the temporally ordered relationship between NSSI and subsequent suicide attempts or death, and to examine whether characteristics of NSSI are associated with increased risk or severity of later suicidal behaviour. Methods: This protocol is reported in accordance with PRISMA-P 2015 and registered with the Open Science Framework (OSF; https://doi.org/10.17605/OSF.IO/EA4M6 ). A comprehensive search will be conducted in MEDLINE, Embase, PsycINFO, CINAHL, and Web of Science. Eligible studies will include prospective and retrospective observational studies demonstrating temporal ordering between NSSI and subsequent suicide attempts or death. Studies focusing solely on suicidal ideation will be excluded. Data extraction and risk-of-bias assessment will be conducted independently by two reviewers using Joanna Briggs Institute tools. Due to anticipated heterogeneity, findings will be synthesised using a structured narrative approach. Conclusion: This review will provide a focused synthesis of evidence on the relationship between NSSI and subsequent suicidal outcomes, addressing gaps related to temporality, outcome specificity, and severity. The findings are expected to inform clinical formulation, safety planning, and future research on suicide prevention by improving understanding of factors associated with subsequent suicidal behaviour.

Accurate comparable prevalence proportions are required to better understand the epidemiology of frailty. Estimates in many countries are missing or incomparable. The Global Burden of Disease Frailty Index (GBD-FI) applies the deficit accumulation model to generate frailty scores from items available in the Global Burden of Disease study. To externally validate the GBD-FI. Data were obtained from the Survey of Health Ageing and Retirement in Europe (SHARE). A 20-item modified GBD-FI was compared with established frailty measures: a 70-item frailty index (FI-70), the Clinical Frailty Scale (CFS), Frailty Phenotype (FP) and SHARE-FI. Area under receiver operating characteristic curves (AUC) were fitted to examine diagnostic accuracy for frailty and predictive validity for 2-year mortality. In total, 31,624 participants aged ≥50 years from 15 countries were included. Frailty prevalence was 22% using the GBD-FI (ranging from 8% in Switzerland to 41% in Poland). The GBD-FI had good to excellent diagnostic accuracy for frailty, irrespective of approach; the AUC ranged from 0.86 (95% confidence interval: 0.85–0.87) measuring frailty using the CFS to 0.94 (0.93–0.94) with the FI-70. The GBD-FI had similar accuracy for 2-year mortality (AUC 0.71, 0.69–0.74) compared with the CFS (0.73; P = 0.186), FP (0.73; P = 0.392) and SHARE-FI (0.70; P = 0.255) but lower than the FI-70 (0.76; P < 0.001). The GBD-FI demonstrated concurrent and predictive validity, suggesting it is a valid measure of frailty. It has the potential to be an efficient, replicable and consistent approach to comparing frailty between countries and regions across time using GBD data.

Background: Life expectancy (LE) is an important population health metric over the life course. LE has increased significantly, over the past two centuries but has showed signs of slowing recently in Europe, the United Kingdom, and the United States. Several drivers have been suggested to be causing the slowdown, including slowing improvements in cardiovascular mortality. We set out to investigate trends in LE across Europe from 1990-2019, and how deaths from different causes have contributed to annual average change in LE across two time periods: 2007-2009 to 2012-2014 and 2012-2014 to 2017-2019. Methods: Data were obtained from the Global Burden of Disease (GBD) Study 2019, which are in public domain. The GBD Study is a comprehensive global epidemiologic data resource employing standardized methodology for comparability. Joinpoint regression analysis was utilised to identify trends. The Arriaga decomposition method was applied to produce estimates of the contribution of different age groups and underlying causes of death to changes in LE at birth for the two periods. Results: Overall, LE in Europe was 72.6 years in 1990- increasing to 78.3 years in 2019, with significant variations within EU countries. However, LE showed a slower pace from 2012 onwards in Europe- much slower in Western Europe, and more pronounced among females. LE in females fell from an annual increase of 0.38% between 2003-2012 to 0.16% between 2012-2019, and LE in males showed a similar pattern (from 0.66% between 2004-2012 to 0.26% between 2012-1019). Overall, improvements in mortality from almost all causes of death slowed, with LE contributions from improvements in ischemic heart disease (IHD) reduced by half. Conclusions: LE is slowing down in Europe, especially in the Western region. Females and the elderly are facing the brunt of the slowdown. Slowing improvements in IHD mortality are the primary driver of the LE slowdown. Key messages: • Life expectancy has overall improved in Europe but has slowed down from 2012 onwards- more pronounced among females and in Western Europe. • The decomposition analyses showed that improvements in mortality from all causes of death slowed, life expectancy contributions from improvements in ischemic heart disease (IHD) reduced by half.

Background Alcohol use is the seventh leading risk factor for death and disability globally, resulting in close to 2.8 million yearly deaths in 2016. The Global Burden of Disease (GBD) Study is a global enterprise, informing and developing policies through comprehensive systematic analysis of comparable data using standardised methodology. GBD estimations have become more robust for recent iterations, with new methodological improvements. The Nordic population is unique in cultural similarities, as well as having strong social and welfare programs. Alcohol is a societal issue, with a complex association with health. Therefore, any underlying notable differences across these Nordic nations will provide additional insights into population level exposure to alcohol harms, thereby informing country-specific alcohol control policies. Methods We set out to estimate the burden of alcohol related fatal and non-fatal health outcomes in six Nordic countries (Greenland, Denmark, Finland, Sweden, Iceland, and Norway) for 2019, using the most recently available GBD Compare data. Disability-Adjusted-Life -Years (DALYs) and total deaths attributable to alcohol were estimated using the GBD comparative risk assessment framework. Improvements to GBD methodology related to alcohol estimation process, such as access to more recent data and accounting for compositional bias, and factoring in abstention, tourism-related and unrecorded information in statistical modelling. 95% Uncertainty Intervals (UI) are provided. Results In 2019, Greenland had the highest DALYs per 100,000 (2931; 95% UI: 2074–3904) followed by Denmark (1927; 95% UI: 1678–2199); Finland (1840; 95% UI: 1578–2149); Sweden (1292; 95% UI: 1069–1549); Iceland (892; 95% UI: 722–1088); Norway (887; 95% UI: 733–1081). Total estimated deaths attributable to alcohol use were: 40 (Greenland); 3532 (Denmark); 2634 (Finland); 4340 (Sweden); 71 (Iceland); 1263 (Norway). Gender variations were also noted. Conclusion Despite strong cultural, social and welfare ties, the Nordic countries showed notable differences in the burden of alcohol-related mortality and morbidity in recent years. This can be in part attributed to changing alcohol control policies across these nations resulting in different consumption patterns. Denmark, Greenland, Sweden and Finland showed relatively high burden compared to Norway and Iceland.

Objectives: Burden of Disease frameworks facilitate estimation of the health impact of diseases to be translated into a single measure, such as the Disability-Adjusted-Life-Year (DALY).Methods: DALYs were calculated as the sum of Years of Life Lost (YLL) and Years Lived with Disability (YLD) directly associated with COVID-19 in the Republic of Ireland (RoI) from 01 March 2020, to 28 February 2021. Life expectancy is based on the Global Burden of Disease (GBD) Study life tables for 2019.Results: There were 220,273 confirmed cases with a total of 4,500 deaths as a direct result of COVID-19. DALYs were estimated to be 51,622.8 (95% Uncertainty Intervals [UI] 50,721.7, 52,435.8). Overall, YLL contributed to 98.5% of the DALYs. Of total symptomatic cases, 6.5% required hospitalisation and of those hospitalised 10.8% required intensive care unit treatment. COVID-19 was likely to be the second highest cause of death over our study’s duration.Conclusion: Estimating the burden of a disease at national level is useful for comparing its impact with other diseases in the population and across populations. This work sets out to standardise a COVID-19 BoD methodology framework for the RoI and comparable nations in the EU.