COVID-19 Pandemic and Burden of Non-Communicable Diseases: An Ecological Study on Data of 185 Countries

M Reza Azarpazhooh¹, Negar Morovatdar², Abolfazl Avan³, Thanh G Phan⁴, Afshin A Divani⁵, Nawaf Yassi⁶, Saverio Stranges⁷, Brian Silver⁸, José Biller⁹, Masoud Tokazebani Belasi¹⁰, Sepideh Kazemi Neya¹⁰, Bita Khorram¹¹, Asher Frydman¹², Yongchai Nilanont¹³, Elisa Onorati¹⁴, Mario Di Napoli¹⁵

Affiliations

¹ Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
² Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
³ Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
⁴ Department of Neurology Monash Health, Clinical Trials, Imaging and Informatics division of Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.
⁵ Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
⁶ Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
⁷ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry Western University, London, ON, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
⁸ Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
⁹ Department of Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
¹⁰ Research centre for Prevention of cardiovascular disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
¹¹ Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada.
¹² Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada.
¹³ Siriraj Stroke Center, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁴ Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy.
¹⁵ Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy. Electronic address: mariodinapoli@katamail.com.

PMID: 32807484
PMCID: PMC7315949
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105089

Multicenter Study

COVID-19 Pandemic and Burden of Non-Communicable Diseases: An Ecological Study on Data of 185 Countries

M Reza Azarpazhooh et al. J Stroke Cerebrovasc Dis. 2020 Sep.

. 2020 Sep;29(9):105089.

doi: 10.1016/j.jstrokecerebrovasdis.2020.105089. Epub 2020 Jun 25.

Authors

Affiliations

¹ Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada; Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
² Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
³ Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
⁴ Department of Neurology Monash Health, Clinical Trials, Imaging and Informatics division of Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia.
⁵ Department of Neurology, School of Medicine, University of New Mexico, Albuquerque, NM, USA.
⁶ Departments of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, Australia; Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia.
⁷ Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry Western University, London, ON, Canada; Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg.
⁸ Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
⁹ Department of Neurology, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
¹⁰ Research centre for Prevention of cardiovascular disease, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran.
¹¹ Dalla Lana School of Public Health, University of Toronto; Toronto, ON, Canada.
¹² Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Ontario, Canada.
¹³ Siriraj Stroke Center, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
¹⁴ Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy.
¹⁵ Department of Neurology and Stroke Unit, San Camillo de' Lellis General District Hospital, Rieti, Italy; Neurological Section, Neuro-epidemiology Unit, SMDN-Centre for Cardiovascular Medicine and Cerebrovascular Disease Prevention, Sulmona, L'Aquila, Italy. Electronic address: mariodinapoli@katamail.com.

PMID: 32807484
PMCID: PMC7315949
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105089

Abstract

Background: The interaction between coronavirus disease 2019 (COVID-19) and non-communicable diseases may increase the global burden of disease. We assessed the association of COVID-19 with ageing and non-communicable diseases.

Methods: We extracted data regarding non-communicable disease, particularly cardiovascular disease, deaths, disability-adjusted life years (DALYs), and healthy life expectancy (HALE) from the Global Burden of Disease Study (GBD) 2017. We obtained data of confirmed COVID-19 cases, deaths, and tests from the Our World in Data database as of May 28, 2020. Potential confounders of pandemic outcomes analyzed include institutional lockdown delay, hemispheric geographical location, and number of tourists. We compared all countries according to GBD classification and World Bank income level. We assessed the correlation between independent variables associated with COVID-19 caseload and mortality using Spearman's rank correlation and adjusted mixed model analysis.

Findings: High-income had the highest, and the Southeast Asia, East Asia, and Oceania region had the least cases per million population (3050.60 vs. 63.86). Sub-saharan region has reported the lowest number of COVID-19 mortality (1.9). Median delay to lockdown initiation varied from one day following the first case in Latin America and Caribbean region, to 34 days in Southeast Asia, East Asia, and Oceania. Globally, non-communicable disease DALYs were correlated with COVID-19 cases (r = 0.32, p<0.001) and deaths (r = 0.37, p<0.001). HALE correlated with COVID-19 cases (r = 0.63, p<0.001) and deaths (r = 0.61, p<0.001). HALE was independently associated with COVID-19 case rate and the number of tourists was associated with COVID-19 mortality in the adjusted model.

Interpretation: Preventive measures against COVID-19 should protect the public from the dual burden of communicable and non-communicable diseases, particularly in the elderly. In addition to active COVID-19 surveillance, policymakers should utilize this evidence as a guide for prevention and coordination of health services. This model is timely, as many countries have begun to reduce social isolation.

Keywords: Coronavirus; Correlation; Incidence; Mortality; Prevention; Stroke.

PubMed Disclaimer

Figures

Fig 1 — **Fig. 1**
COVID-19 pandemic: A comparison of (A) confirmed cases, (B) deaths, (C) tests, and (D) positive test rates as of May 28, 2020 according to the seven GBD super regions.

Fig 2 — **Fig. 2**
Global burden of (A and B) non-communicable diseases and (C and D) cardiovascular diseases: Results from the GBD 2017 study.

See this image and copyright information in PMC

Comment in

The interplay between COVID 19 and non-communicable diseases.
Chaturvedi S, Gorelick P. Chaturvedi S, et al. J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105104. doi: 10.1016/j.jstrokecerebrovasdis.2020.105104. Epub 2020 Jul 1. J Stroke Cerebrovasc Dis. 2020. PMID: 32653107 Free PMC article. No abstract available.

References

1. Monaco A, Palmer K, Marengoni A, Maggi S, Hassan TA, Donde S. Integrated care for the management of ageing-related non-communicable diseases: current gaps and future directions. Aging Clin Exp Res. 2020 doi: 10.1007/s40520-020-01533-z. published online April 10. - DOI - PMC - PubMed
1. Cheng ZJ, Shan J. 2019 Novel coronavirus: where we are and what we know. Infection. 2020;48:155–163. - PMC - PubMed
1. He F, Deng Y, Li W. Coronavirus disease 2019: What we know? J Med Virol. 2020 doi: 10.1002/jmv.25766. published online March 14. - DOI - PMC - PubMed
1. WHO. WHO Director-general's opening remarks at the media briefing on COVID-19 - 11 March 2020. 2020; published online March 11. https://www.who.int/dg/speeches/detail/who-director-general-s-opening-re... (accessed April 23, 2020).
1. WHO. WHO/Europe | Past pandemics. 2020. http://www.euro.who.int/en/health-topics/communicable-diseases/influenza...(accessed April 24, 2020).

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

COVID-19 Pandemic and Burden of Non-Communicable Diseases: An Ecological Study on Data of 185 Countries

Affiliations

COVID-19 Pandemic and Burden of Non-Communicable Diseases: An Ecological Study on Data of 185 Countries

Authors

Affiliations

Abstract

Figures

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical