Simon Capewell

Background The association between higher consumption of ultra-processed foods (UPF) and adverse health outcomes, including obesity, is increasingly evident. England has one of the highest UPF intakes worldwide. UPF consumption may be influenced by exposures to poor local nutrition environments. However, diet data are rarely available at local or regional levels. Local data would support approaches to improve these environments more equitably. We therefore aimed to create small area estimates of UPF consumption for England and Wales using local and individual-level data.Methods Using spatial microsimulation (SMS), we combined individual-level survey data (National Dietary and Nutritional Survey 2008–2018, n=15,655) and spatial data from the 2021 Census to create a unique estimate of all-population UFP consumption for all 7264 middle-layer output areas (MSOA) in England and Wales. SMS …

BackgroundWe aimed to estimate the future burden of coronary heart disease (CHD) and stroke mortalities by sex and all 47 prefectures of Japan until 2040 while accounting for effects of age, period, and cohort and integrating them to be at the national level to account for regional differences among prefectures.MethodsWe estimated future CHD and stroke mortality projections, developing Bayesian age-period-cohort (BAPC) models in population and the number of CHD and stroke by age, sex, and all 47 prefectures observed from 1995 to 2019; then applying these to official future population estimates until 2040. The present participants were all men and women aged over 30 years and were residents of Japan.FindingsIn the BAPC models, the predicted number of national-level cardiovascular deaths from 2020 to 2040 would decrease (39,600 [95% credible interval: 32,200–47,900] to 36,200 [21,500–58,900 …

ImportancePreterm birth is a leading cause of preventable neonatal morbidity and mortality. Preterm birth rates at the national level may mask important geographic variation in rates and trends at the county level.ObjectiveTo estimate age-standardized preterm birth rates by US county from 2007 to 2019.Design, Setting, and ParticipantsThis serial cross-sectional study used data from the National Center for Health Statistics composed of all live births in the US between 2007 and 2019. Data analyses were performed between March 22, 2022, and September 29, 2022.Main Outcomes and MeasuresAge-standardized preterm birth (<37 weeks’ gestation) and secondarily early preterm birth (<34 weeks’ gestation) rates by county and year calculated with a validated small area estimation model (hierarchical bayesian spatiotemporal model) and percent change in preterm birth rates using log-linear regression models …

Background: Excessive salt consumption is an important risk factor for cardiovascular diseases (CVD), especially through increased blood pressure. In Brazil, the average salt intake is almost twice the international recommendations, and the current population-level salt reduction policies include only voluntary maximum salt targets for packaged foods and communication strategies. This study aims to quantify the potential health and economic impact of additional salt reduction strategies in Brazil from 2019 to 2038.Methods: We used a previously validated microsimulation of a close-to-reality synthetic population (IMPACT NCD-BR) to estimate CVD events (cases and deaths) prevented or postponed and the corresponding cost savings from 2019 to 2038, stratified by age and sex. The policy scenarios that were modelled include 1) regulatory front-of-pack labelling warnings for excessive salt in foods, 2) universal use of 10% potassium table salt, and 3) voluntary and regulatory limits (targets) for maximum salt content in packaged foods. Model inputs were informed by nationally representative health and food consumption surveys and high-quality meta-analyses. Cost analysis incorporated the costs of CVD treatment to the National Health System and informal care costs.Findings: The study found that from 2019 to 2038, the continuation of the current voluntary targets could prevent or postpone some 268,000 CVD case-years (95% UI: 90,000 to 584,000) and 5,000 CVD deaths (95% UI: 1,000 to 12,000). Mandatory front-of-pack labelling warnings could prevent or postpone approximately 406,000 CVD case-years (95% UI: 130,000 to 872,000) and …

Background Understand factors that influence food choice and explore public perceptions of the need for government policies to improve diets in the UK, particularly food pricing interventions. Methods A qualitative study design was used with semi-structured interviews. The study was carried out in Greater Manchester, England. In all, 15 participants from a diverse range of backgrounds were recruited. Results Food price, lack of time, availability, and food knowledge and culture were key factors that led some study participants towards unhealthy food choices. The UK’s individual, willpower-focused approach to tackling obesity was deemed ineffective and many participants supported further government intervention. Product reformulation was supported as a less intrusive and less regressive way of improving diets than taxation. There was also support for …

BackgroundSmoking still generates a huge, costly, and inequitable burden of disease. The UK tobacco-free generation target to reduce smoking prevalence to below 5% by 2030 will be missed if current trends continue. We aimed to determine whether additional policies could speed progress towards meeting the tobacco-free generation target.MethodsWe developed, calibrated, and validated a microsimulation model, IMPACTHINT simulating English adults aged 30–89 years from 2023 to 2072. The model included a detailed smoking history and quantified policy health outcomes including smoking prevalence and smoking-related diseases, economics, and equity. We simulated five scenarios: (1) baseline trends; (2) increasing the minimum age of access to tobacco to 21 years (MinAge21); (3) a 30% increase in tobacco duty (TaxUP); (4) improved smoking cessation services (ServicesUP); and (5) a combination of …

BackgroundPolicy simulation models (PSMs) have been used extensively to shape health policies before real-world implementation and evaluate post-implementation impact. This systematic review aimed to examine best practices, identify common pitfalls in tobacco control PSMs and propose a modelling quality assessment framework.MethodsWe searched five databases to identify eligible publications from July 2013 to August 2019. We additionally included papers from Feirman et al for studies before July 2013. Tobacco control PSMs that project tobacco use and tobacco-related outcomes from smoking policies were included. We extracted model inputs, structure and outputs data for models used in two or more included papers. Using our proposed quality assessment framework, we scored these models on population representativeness, policy effectiveness evidence, simulated smoking histories, included …

Background Adverse pregnancy outcomes (APOs) (hypertensive disorders of pregnancy [HDP], preterm delivery [PTD], or low birth weight [LBW]) are associated adverse maternal and offspring cardiovascular outcomes. Therefore, we sought to describe nationwide temporal trends in the burden of each APO (HDP, PTD, LBW) from 2007 to 2019 to inform strategies to optimize maternal and offspring health outcomes. Methods and Results We performed a serial cross‐sectional analysis of APO subtypes (HDP, PTD, LBW) from 2007 to 2019. We included maternal data from all live births that occurred in the United States using the National Center for Health Statistics Natality Files. We quantified age‐standardized and age‐specific rates of APOs per 1000 live births and their respective mean annual percentage change. All analyses were stratified by self‐report of maternal race and ethnicity. Among 51 685 525 live …

Background The association between higher consumption of industrially ultra-processed foods (UPF) and adverse health outcomes, including obesity, is increasingly evident. Furthermore, health outcomes such as obesity show pronounced social gradients in the UK. As a high-income country, we might expect higher UPF consumption in the lowest socio-economic position (SEP). However, the evidence for UK social gradients in UPF intake is scarce. We therefore evaluated the association between UPF intakes and measurements of SEP.Methods We used data from the UK National Diet and Nutrition Survey (2008–18), with dietary intakes based on four-day food diaries. To quantify UPF consumption, we classified the extent of industrial food processing for each food and beverage using the NOVA classification, then calculated UPF intake in grams, and percentage of daily energy. As markers of SEP, we used …

Poor diet generates a larger burden of non-communicable disease than tobacco, alcohol and physical inactivity combined. However, the industries producing energy-dense, ultra-processed products (UPPs) and sugar-sweetened beverages (SSBs) energetically defend their profitable products and employ much the same denial tactics used previously by the tobacco industry. They thus aim to promote weak or ineffective policies (such as voluntary reformulation or public–private partnerships), while denouncing, delaying and diluting effective policies (notably regulation, taxation, reformulation and marketing restrictions). However, the UPP industries now face increasing public and political pressure to accept progressive regulation and taxation, or risk triggering reputational damage and more stringent measures. Previous successes in tobacco control offer valuable lessons for predicting and overcoming UPP industry …

Background Salt consumption is a major risk factor for high blood pressure and thus cardiovascular diseases (CVD), yet most countries in the world consume excessive salt. In Brazil, salt reduction policies currently include only voluntary sodium targets and communication strategies. This study aims to quantify the potential health and economic impact of additional salt reduction strategies in Brazil from 2019 to 2038. Methods We used a previously validated microsimulation approach of a close-to-reality synthetic population (IMPACT NCD BR Model) to estimate CVD cases and deaths prevented or postponed by reducing sodium intake and disease treatment cost savings from 2019 to 2038. We quantified uncertainities as 95% Uncertainty Intervals (95% UIs). We compared 1) regulatory front of pack labelling warnings for excessive salt content in foods 2) universal use of 10% potassium table salt, and 3) regulatory …

BackgroundSmoking prevalence has declined considerably in recent decades. However, it still accounts for approximately 17% of deaths and over 450,000 hospital admissions annually in England. In addition, inequalities in smoking persist. Recognising the need for stricter tobacco policies, an All-Party Parliament Group recently recommended increasing the Minimum Age to Legal Access tobacco to 21 (MALA21) in England. Enforced in the United States, this policy has seen a 30% reduction of smoking prevalence in the 18–21 year age group since 2019. In this research, we quantified the potential health, economic and equity impact of the tobacco MALA21 policy on the English population.MethodsWe modelled two scenarios over a 50-year time horizon: a) Baseline (maintaining current policy levels and trends); and b) Enforcement of tobacco MALA21.

Introduction: Incidence of hypertensive disorders of pregnancy (HDP) has increased concurrently with maternal age at first birth. To better understand the contributions of age, delivery year (period), and maternal birth year (birth cohort) to HDP rates, we performed an age-period-cohort analysis. Methods: We included data from the National Center for Health Statistics for nulliparous individuals without pre-pregnancy hypertension who were 15-44 years with singleton live births from 1995-2019. We defined HDP as gestational hypertension, preeclampsia or eclampsia. We determined age effects by calculating HDP incidence adjusted separately for period and cohort in each 5-year age group. Period and cohort effects were quantified as rate ratios (RR) comparing age-adjusted HDP incidence to the median period (2005-2009) and cohort (1980-1984), respectively. Age, period, and cohort effects were summarized as …

The government's long awaited food strategy for England was finally published on 13 June 2022. 1 Immediately pronounced “feeble,” 2 it was also condemned for largely ignoring the expert recommendations of the independent review commissioned by government ministers. 3 4 It does not seem to be a strategy, offering neither ambition nor concrete proposals. The focus on personal responsibility is naive, foolishly ignoring far more powerful population-wide policy measures. 5 Likewise the blatant failures to tackle climate sustainability, 4 equity, and child health. 1Crucially, this policy paper also ducks the sugar and salt reformulation levy, a powerful public health measure that has long been recommended by the wider scientific community. Fiscal policies targeting salt, fats, and sugar have been proved to be particularly effective, decreasing consumption of unhealthful foods 6 and thus saving thousands of lives. 4 6 …

Denmark has experienced a remarkable reduction in CVD mortality over recent decades. The scale of the health contribution from the Danish regulation on industrially produced trans fatty acid (ITFA) has therefore long been of interest. Thus the objective was to determine health and equity benefits of the Danish regulation on ITFA content in Danish food, by quantifying the relative contributions of changes in ITFA intake, other risk factors and treatments on coronary heart disease (CHD) mortality decline from 1991 to 2007 in Denmark, stratified by socioeconomic group. To evaluate the effects of the ITFA ban (Danish Order no. 160 of March 2003) the Danish IMPACTSEC model was extended to quantify reductions in CHD deaths attributable to changes in ITFA (%E) intake between 1991–2007. Population counts were obtained from the Danish Central Office of Civil Registration, financial income from Statistics Denmark and ITFA intake from Dan-MONICA III (1991) and DANSDA (2005–2008). Participants were adults aged 25–84 years living in Denmark in 1991 and 2007, stratified by socioeconomic quintiles. The main outcome measure was CHD deaths prevented or postponed (DPP). Mean energy intake from ITFA was decimated between 1991 and 2007, falling from 1.1%E to 0.1%E in men and from 1·0%E to 0·1%E in women. Approximately 1,191 (95% CI 989–1,409) fewer CHD deaths were attributable to the ITFA reduction, representing some 11% of the overall 11,100 mortality fall observed in the period. The greatest attributable mortality falls were seen in the most deprived quintiles. Adding ITFA data to the original IMPACTsec model improved …

Background There is uncertainty around the health impact and economic costs of the recent slowing of the historical decline in cardiovascular disease (CVD) incidence and the future impact on dementia and disability. Methods Previously validated IMPACT Better Ageing Markov model for England and Wales, integrating English Longitudinal Study of Ageing (ELSA) data for 17,906 ELSA participants followed from 1998 to 2012, linked to NHS Hospital Episode Statistics. Counterfactual design comparing two scenarios: Scenario 1. CVD Plateau—age-specific CVD incidence remains at 2011 levels, thus continuing recent trends. Scenario 2. CVD Fall—age-specific CVD incidence goes on declining, following longer-term trends. The main outcome measures were age-related healthcare costs, social care costs, opportunity costs of informal care, and quality adjusted life years (valued at £60,000 per QALY). Findings The total 10 year cumulative incremental net monetary cost associated with a persistent plateauing of CVD would be approximately £54 billion (95% uncertainty interval £14.3-£96.2 billion), made up of some £13 billion (£8.8-£16.7 billion) healthcare costs, £1.5 billion (-£0.9-£4.0 billion) social care costs, £8 billion (£3.4-£12.8 billion) informal care and £32 billion (£0.3-£67.6 billion) value of lost QALYs. Interpretation After previous, dramatic falls, CVD incidence has recently plateaued. That slowdown could substantially increase health and social care costs over the next ten years. Healthcare costs are likely to increase more than social care costs in absolute terms, but social care costs will increase more in relative terms. Given the links …

Background Statins are universally recommended for the primary prevention of cardiovascular diseases (CVD). However, studies suggest that statins also increase the incidence of type 2 diabetes mellitus (T2DM), which increases the risk of CVD in the long run. Empirical studies usually have short observation periods that may underestimate the consequences of living with diabetes. This modelling study aimed to quantify the 20-year impact of statins on CVD primary prevention adjusted for the T2DM harms.Methods We used the IMPACTNCD validated dynamic stochastic microsimulation to simulate four scenarios: 1) the base-case scenario with statin utilisation informed by the Health Survey for England; 2) in the cohort eligible for primary prevention of CVD in 2020, simulants without known T2DM aged 40–49 are prescribed Atorvastatin 20mg daily; 3) for the remaining two scenarios we changed the age to start …

Co-producing the specifications of the workHORSE model-Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users-NCBI Bookshelf

Policy simulation models (PSMs) have been used extensively, both to shape health policies before real-world implementation and to evaluate post-implementation impact. However, an accepted quality assessment framework for simulation models is lacking. This systematic review aimed to develop a novel quality assessment framework for tobacco control PSMs. We searched five databases to identify peer-reviewed tobacco control PSMs that projected tobacco-use and tobacco-related outcomes from smoking policy scenarios. We extracted information on modelling inputs, structure and outputs. Using our proposed quality assessment framework, we scored models on nine dimensions: representativeness of population, policy effectiveness evidence, simulated smoking histories, simulated smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. We then …

Research objectivesThe overall purpose was to answer the question: what is the likely acceptability of a trial to determine the clinical effectiveness of standing frames? To do this, we undertook two surveys as well as focus groups and in-depth interviews to assess the feasibility and potential design of a trial (or trials) of standing frame use for young people with CP.Aims and objectivesAim 1. To determine current standing frame use in UK practice for the postural management of young people with CP aged 1–18 years with severe movement impairment (GMFCS IV and V).