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Sharing data on Europe's preventable deaths
Editorial
Lth Nhs Trust/Science Photo Library
Towards a better understanding of type 1 diabetes
See World Report page 2280 See Perspectives page 2283 See Series pages 2331 and 2340
For NCD Risk Factor Collaboration report see Lancet 2016; 397: 1513–30
According to the NCD Risk Factor Collaboration, an estimated 422 million people worldwide were living with diabetes in 2014—four fold more than 35 years ago. Type 2 diabetes represents the majority of the epidemic (85–95%), and as a consequence type 1 diabetes has too often been overlooked. Today’s Lancet features a clinical Series on type 1 diabetes—an autoimmune disease in which insulin-producing β cells of the pancreas are destroyed. The precise aetiology and pathogenesis of type 1 diabetes remain a subject for research. The two Series papers discuss in depth recent developments in genetic risk factors and environmental risk factors, respectively. In the first paper, Flemming Pociot and Åke Lernmark review the advances from research in children followed up from birth, and genetic studies, which have reframed understanding from a classic association with genetic factors to genetic determinants that can trigger β-cell autoimmunity and contribute to subsequent progression to clinical onset. Beyond the HLA region, which can contribute up to 50% of the risk, more than
50 susceptibility loci that might affect the likelihood of developing type 1 diabetes have now been identified. The disease is complex. It is also heterogeneous. Such heterogeneity might be explained by a combination of an individual‘s genetics and exposure to various environmental factors at different life stages. A wide range of environmental risk factors that have been suggested to trigger islet autoimmunity in genetically predisposed people and promote progression to type 1 diabetes is reviewed in the second paper by Marian Rewers and Johnny Ludvigsson. Although there is no dearth of factors that could be involved, good evidence is scarce. The factors with the strongest evidence include enteroviral infections, older maternal age, rapid weight gain in early life, and β-cell stress. The challenge in coming years will be to decipher type 1 diabetes complexities and move towards precision medicine approaches. Research networks such as TrialNet featured in Research Focus, will be key to providing the strong evidence crucially needed to prevent and improve the prognosis of type 1 diabetes. The Lancet
dapd
Sharing data on Europe’s preventable deaths
For the Eurostat report see http://ec.europa.eu/eurostat/ statistics-explained/index.php/ Amenable_and_preventable_ deaths_statistics
2264
An insight into health systems and wider public health performance of the 28 member states of the European Union (EU) was provided on May 24 with the latest report from Eurostat, the EU’s statistical office. Of the 1·7 million deaths that occurred in 2013 before age 75 years, around a third (577 500) could have been avoided through better care within country health systems, so-called amenable deaths. Adding in estimates of preventable deaths via potential public health interventions, the total number of preventable deaths was estimated to be around 1·2 million. Unsurprisingly for such a diverse region, the report is characterised by wide between-country variations. Preventable deaths are lowest in France (23·8%) and Denmark (27·1%), and highest in Romania (49·4%) and Latvia (48·5%). Heart attack and stroke account for half of amenable deaths and dominate male mortality, as do breast cancer and accidental injuries among women. The report is long on statistics, yet short on analysis, with a brief mention of how the data could be used as
a potential warning signal or proxy indicator for overall health system or public health performance. How useful is this report, given the age of the data? In the absence of a pan-European public health agency, it is the responsibility of EU member states to use these data to inform health-system and public health planning. Limited though the Eurostat report is, it should be a reminder, especially in the UK with its EU referendum barely 3 weeks away, of the value of Europe as a natural laboratory, allowing each country to benchmark itself against others. EU membership means the best performing nations (such as France and Denmark), should serve as an example to under performing countries (such as the UK and Italy), to help provide future models for the newer and less mature health systems in eastern Europe. Through continued EU membership, countries can not just share data, but strive to improve the health of their nation, and collectively and rightly, the European region as a whole. The Lancet www.thelancet.com Vol 387 June 4, 2016
Lth Nhs Trust/Science Photo Library
Towards a better understanding of type 1 diabetes
See World Report page 2280 See Perspectives page 2283 See Series pages 2331 and 2340
For NCD Risk Factor Collaboration report see Lancet 2016; 397: 1513–30
According to the NCD Risk Factor Collaboration, an estimated 422 million people worldwide were living with diabetes in 2014—four fold more than 35 years ago. Type 2 diabetes represents the majority of the epidemic (85–95%), and as a consequence type 1 diabetes has too often been overlooked. Today’s Lancet features a clinical Series on type 1 diabetes—an autoimmune disease in which insulin-producing β cells of the pancreas are destroyed. The precise aetiology and pathogenesis of type 1 diabetes remain a subject for research. The two Series papers discuss in depth recent developments in genetic risk factors and environmental risk factors, respectively. In the first paper, Flemming Pociot and Åke Lernmark review the advances from research in children followed up from birth, and genetic studies, which have reframed understanding from a classic association with genetic factors to genetic determinants that can trigger β-cell autoimmunity and contribute to subsequent progression to clinical onset. Beyond the HLA region, which can contribute up to 50% of the risk, more than
50 susceptibility loci that might affect the likelihood of developing type 1 diabetes have now been identified. The disease is complex. It is also heterogeneous. Such heterogeneity might be explained by a combination of an individual‘s genetics and exposure to various environmental factors at different life stages. A wide range of environmental risk factors that have been suggested to trigger islet autoimmunity in genetically predisposed people and promote progression to type 1 diabetes is reviewed in the second paper by Marian Rewers and Johnny Ludvigsson. Although there is no dearth of factors that could be involved, good evidence is scarce. The factors with the strongest evidence include enteroviral infections, older maternal age, rapid weight gain in early life, and β-cell stress. The challenge in coming years will be to decipher type 1 diabetes complexities and move towards precision medicine approaches. Research networks such as TrialNet featured in Research Focus, will be key to providing the strong evidence crucially needed to prevent and improve the prognosis of type 1 diabetes. The Lancet
dapd
Sharing data on Europe’s preventable deaths
For the Eurostat report see http://ec.europa.eu/eurostat/ statistics-explained/index.php/ Amenable_and_preventable_ deaths_statistics
2264
An insight into health systems and wider public health performance of the 28 member states of the European Union (EU) was provided on May 24 with the latest report from Eurostat, the EU’s statistical office. Of the 1·7 million deaths that occurred in 2013 before age 75 years, around a third (577 500) could have been avoided through better care within country health systems, so-called amenable deaths. Adding in estimates of preventable deaths via potential public health interventions, the total number of preventable deaths was estimated to be around 1·2 million. Unsurprisingly for such a diverse region, the report is characterised by wide between-country variations. Preventable deaths are lowest in France (23·8%) and Denmark (27·1%), and highest in Romania (49·4%) and Latvia (48·5%). Heart attack and stroke account for half of amenable deaths and dominate male mortality, as do breast cancer and accidental injuries among women. The report is long on statistics, yet short on analysis, with a brief mention of how the data could be used as
a potential warning signal or proxy indicator for overall health system or public health performance. How useful is this report, given the age of the data? In the absence of a pan-European public health agency, it is the responsibility of EU member states to use these data to inform health-system and public health planning. Limited though the Eurostat report is, it should be a reminder, especially in the UK with its EU referendum barely 3 weeks away, of the value of Europe as a natural laboratory, allowing each country to benchmark itself against others. EU membership means the best performing nations (such as France and Denmark), should serve as an example to under performing countries (such as the UK and Italy), to help provide future models for the newer and less mature health systems in eastern Europe. Through continued EU membership, countries can not just share data, but strive to improve the health of their nation, and collectively and rightly, the European region as a whole. The Lancet www.thelancet.com Vol 387 June 4, 2016