Caesarean section births nearly doubled since 2000

A study published in The Lancet by Boerma et al found that the rates of caesarean section (CS) births nearly doubled between 2000 and 2015 – from 12 to 21 percent worldwide.

The paper was based on data from 169 countries that includes 98% of the world's births.  The authors estimated that 29·7 million or 21% births occurred with CS in 2015, which was almost double the number of births by CS in 2000 16 million or 12·% births. C-section use in 2015 was up to ten times more frequent in the Latin America and Caribbean region, where it was used in 44% of births, than in the west and central Africa region, where it was used in 4% of births. 

C-section births varied from 0·6% in South Sudan to 58% in the Dominican Republic. Markedly high CS use was used even among low obstetric risk births, especially among more educated women in Brazil and China; and CS use was 1·6 times more frequent in private than in public facilities.

The researchers report that CS is unavailable to women in poor countries while often over-used in richer ones. The authors found that in 15 countries in North America, Western Europe and Latin America and the Caribbean more than 40 percent of all babies born are delivered by C-section. 

C-section use in excess of the 10-15% which is considered optimal is concerning because the procedure is associated with sort-term and long-term effects without offering any significant maternal benefits.

Rates of unvaccinated children have quadrupled since 2001

The Centers for Disease Control and Prevention (CDC) reports that a small but increasing number of children in the United States are not getting some or all of their recommended vaccinations with 1.3 percent of children born in 2015 having not received any vaccinations, up from 0.3 percent in 2001. 

Though the number remains small it is something that CDC is concerned about.  CDC data show children in rural areas and those without insurance had significantly higher rates of not being vaccinated.  The CDC estimates that 100,000 young children have not had a vaccination against any of the 14 diseases for which vaccines are recommended. 

Although 70 percent of the children have been vaccinated the new estimate of 1.3 percent of the children born in 2015 were completely unvaccinated is very concerning because young children are especially vulnerable to complications from vaccine-preventable diseases, some of which can be fatal.

Screening for Cervical Cancer

The U.S. Preventive Services Task Force issued new guidelines that were published in JAMA regarding cervical cancer screening, suggesting that women can get a test that looks for the human papilloma virus.

The task force recommends that screening should begin for women age 21-29 with a Pap test every three years, which they may continue from age 30 to 65, or they can get screened every five years with a test that looks for the high-risk types of HPV that cause cervical cancer or get both tests every five years.

The USPSTF guidelines say that women over 30 can safely wait five years between cervical cancer screenings thus reducing false alarms that lead to invasive follow-up tests and unnecessary treatment.

The new guidelines “are based on a now-solid body of evidence showing that almost all cases of cervical cancer are caused by the human papilloma virus.

Sleeping more than eight hours increases risk of death from heart disease and/or stroke.

In a study by Kwok et al published in the Journal of the American Heart Associationthe researchers found that sleeping more than eight hours a night may increase the risk of death from heart disease or stroke, while sleeping fewer than seven hours did not affect one’s likelihood of death.

The authors searched MEDLINE and EMBASE databases and identified seventy‐four studies that included 3,340,684 participants.  In those studies 242,240 deaths were reported among 2,564,029 participants. Self‐reported duration of sleep of more than 8 hours was associated with a moderate increased risk of all‐cause mortality, with risk ratio, 1.14 (1.05–1.25) for 9 hours, risk ratio, 1.30 (1.19–1.42) for 10 hours, and risk ratio, 1.47 (1.33–1.64) for 11 hours. No significant difference was identified for periods of self‐reported sleep of less than 7 hours, whereas similar patterns were observed for stroke and cardiovascular disease mortality. Subjective poor sleep quality was associated with coronary heart disease (risk ratio, 1.44; 95% confidence interval, 1.09–1.90), but no difference in mortality and other outcomes.

The authors concluded that divergence from the recommended 7 to 8 hours of sleep is associated with a higher risk of mortality and cardiovascular events. 

Moderate alcohol consumption increases the risk of cardiovascular events and death.

A study by Wood et al published in Lancet suggests that the risks of drinking vis-à-vis cardiovascular events and death are significant.

The authors analyzed data from 599 912 current drinkers without previous cardiovascular disease.  They characterized dose–response associations per 100 gram per week of alcohol across 83 prospective studies, adjusting for age, sex, smoking, and diabetes.

They recorded 40 310 deaths and 39 018 incident cardiovascular disease events among the 599 912 drinkers in high-income countries that were included in their study. For all-cause mortality, they recorded a positive and curvilinear association with the level of alcohol consumption, with the minimum mortality risk at or below 100 g per week. Alcohol consumption was roughly linearly associated with a higher risk of stroke, coronary disease excluding myocardial infarction, fatal hypertensive disease and fatal aortic aneurysm. By contrast, increased alcohol consumption was log-linearly associated with a lower risk of myocardial infarction. In comparison to those who reported drinking >0–≤100 g per week, those who reported drinking >100–≤200 g per week, >200–≤350 g per week, or >350 g per week had lower life expectancy at age 40 years of approximately 6 months, 1–2 years, or 4–5 years, respectively.

The threshold for lowest risk of all-cause mortality was about 100 gram per week or one drink per day. The study concludes that there are no overall health benefits from moderate drinking which according to current guidelines is 196g per week or two drinks per day.  

An egg a day reduces cardiovascular and stroke risk

Qin et al in a study publish by British Medical Journal examined survey data from individuals that were followed for nine years and found that compared to people who never ate eggs, individuals who ate an average of 0.76 eggs per day were at less risk to develop cardiovascular diseases (CVD) and less likely to die from ischemic heart disease (IHD), major coronary events, hemorrhagic and ischemic strokes.

Among 461 213 participants free of prior cancer, CVD and diabetes, a total of 83 977 CVD incident cases and 9985 CVD deaths were documented, as well as 5103 major coronary events (MCE).

 Among the participants 13.1% reported daily consumption (usual amount 0.76 egg/day) and 9.1% reported never or very rare consumption (usual amount 0.29 egg/day). Compared with non-consumers, daily egg consumption was associated with 11 percent lower risk of developing CVD disease and cut the risk of stroke by 26 percent while also decreasing the risk of dying from CVD conditions to 18 percent compared to non-consumers.  Daily consumers also had a 28% lower risk of hemorrhagic stroke death compared to non-consumers.

The researchers concluded that a moderate level of egg consumption (up to <1 egg/day) was significantly associated with lower risk of CVD and largely independent of other risk factors.

Dairy Consumption does not Increase Risk of Cardiovascular Attacks

Research published in the European Journal of Epidemiology suggests that consumption of dairy products does not increase the risk of cardiovascular events or death. 

The investigators analyzed results from 29 medical studies carried out over the last 35 years, using information based on almost 938,465 participants and 93,158 cases of mortality, 28,419 cases cardiovascular heart disease (CHD) and 25,416 cardiovascular disease (CVD) cases. No associations were found for total (high-fat/low-fat) dairy, and milk with the health outcomes of mortality, CHD or CVD. Inverse associations were found between totally fermented dairy such as sour milk products, cheese or yogurt; per 20 g/day with mortality and CVD risk. Further analyses of individual fermented dairy of cheese and yogurt showed cheese to have a 2% lower risk of CVD per 10 g/day, but not yogurt. 

In conclusion data from prospective cohort studies demonstrated that consumption of dairy products – even high-fat ones demonstrated neutral associations between dairy products and cardiovascular events as well as all-cause mortality.

Dog Ownership Decreases Risk of Dying from Cardiovascular Disease

Mubanga et al in a paper published in Scientific Reports suggest that having a dog could be linked to lower risk of dying from cardiovascular disease.

The investigators analyzed health records of 3.4 million people in Sweden. The data indicated that people who owned a dog were less likely to have cardiovascular disease or die from any cause during the 12 years covered by their research.

In single- and multiple-person households, dog ownership (13.1%) was associated with lower risk of deathwith the protective effect being more prominent for people living alone, who have been found to have a higher risk for early death than those who live with other people.  Ownership of hunting breed dogs was associated with lowest risk of CVD.

The protective effects may be due to dog owners are more physically active or due to increased well being and social contacts or effects of the dog on the bacterial microbiome of the owner.

In conclusion, dog ownership appears to be associated with lower risk of CVD in single-person households but also lower mortality in the population at large.

Coffee drinking provides more benefits than harm

An article published in The BMJ reviewed 201 meta-analyses of observational research and 17 meta-analyses of interventional research and found that coffee consumption was more often associated with benefits than harm.

The researchers found that drinking three cups of coffee a day was associated with the greatest benefit in terms of cardiovascular disease, coronary heart disease, and stroke, when compared with not drinking coffee. Consumption at this level was associated with a 19% lower risk of mortality from cardiovascular disease, a 16% lower risk of mortality from coronary heart disease, and a 30% lower risk of stroke mortality.

Increasing consumption to more than three cups a day was not associated with harm, but the beneficial effects were less pronounced. Women seemed to benefit more from greater coffee consumption than men in terms of reduced risk of coronary heart disease and cardiovascular disease mortality, but less so in stroke mortality.

Review of the studies showed that coffee drinkers had lower incidence of cancer. High consumption of coffee was associated with a lower risk of prostate cancer, endometrial cancer, melanoma, oral cancer, leukemia, non-melanoma skin cancer, and liver cancer.

Coffee consumption also seemed to have a beneficial effect on gastrointestinal system. Coffee drinkers had a 29% lower risk of non-alcoholic fatty liver, a 27% lower risk of liver fibrosis, and a 39% lower risk of liver cirrhosis.

The picture was mixed for consumption of coffee in pregnancy. High versus low consumption was associated with a higher risk of low birth weight and pregnancy loss.  No significant association, however, was found between any category of coffee consumption and third trimester preterm birth, neural tube defects, and congenital malformations of the oral cleft or cardiovascular system.

High versus low consumption of coffee was also associated with an increased risk of fracture in women but a decreased risk in men.

In conclusion moderate coffee consumption seems safe, and it can be incorporated as part of a healthy lifestyle by most of the adults.

Cancer Death Rate Has Declined in the US

In 2018, 1,735,350 new cancer cases and 609,640 cancer deaths are projected by the American Cancer Society (ACS) to occur in the United States.

Over the past decade (2005-2014), the cancer incidence rate was stable in women and declined by approximately 2% annually in men, while the cancer death rate (2006-2015) declined by about 1.5% annually in both men and women.

This decrease means that more than 2.3 million people have not died of cancer since 1991, which would otherwise have if the cancer rates had remained unchanged.

One of the biggest reasons behind this decline is the reduction in smoking.  Although lung cancer remains a leading cause of cancer death, death rates have dropped by 45% among men from 1990 to 2015 and by 19% among women from 2002 to 2015.

In the mid-1990s, the American Cancer Society Board of Directors made as a goal to cut the U.S. cancer mortality rate in half by the year 2015.  Though the goal of a 50% reduction has not been achieved the cancer death rate has been reduced and hopefully this trend will continue.