Methods annex: Premature Adult Mortality and NCDs

Transcription

1 Bollyky TJ, Templin T, Andridge C, Dieleman JL. Understanding the relationships between noncommunicable diseases, unhealthy lifestyles, and country wealth. Health Aff (Millwood). 2015;34(9). APPENDIX Running header: Methods annex: Premature Adult Mortality and NCDs Version: August 10, 2015

2 METHODS ANNEX 1.0 Data Sources 1.1 Descriptive Statistics 1.2 Specification 1.3 Sensitivity 1.4 Estimation 2

3 Statistical analysis Part 1.0: DATA SOURCES GDP per capita was constructed using the method described in James et al. 1 It is measured in 2005 PPP. Additionally, we used Global Burden of Disease Study (GBD) 2013 data, which estimates the agesex specific mortality and risk factor attribution for 240 causes in 188 countries between 1990 and The GBD 2013 cause of death data used as inputs all obtainable vital registration, sample registration, verbal autopsy, burial site/mortuary, cancer registry, police report, census, household survey, and maternal mortality surveillance survey data. We focused on allncd adult mortality and adult mortality from 73 specific NCD groups, including ischemic heart disease, lung and bronchial cancers, and stroke. 2 The GBD 2013 risk factor data used all obtainable household and health examination records; satellite imagery and physical sensors; trade, sales, and consumption data; ainistrative data; and censuses. After correcting for representativeness and selection bias, as well as cross walking between different definitions, GBD 2013 obtained exposure estimates by risk, age, sex, year, and country. We utilized seven risk factor exposures: household air pollution, physical inactivity, sodium intake, binge drinking, ambient particulate matter, obesity prevalence, and smoking prevalence. 3 Table Definitions of risk factors included in the statistical analysis Modifiable Behavioral Risks Definition Tobacco use Agestandardized prevalence Binge drinking Agestandardized prevalence of heavy episodic drinking in adults above 15 years of age Insufficient physical activity Agestandardized prevalence of inactivity, defined as less than 600 MET minutes per week Sodium intake Grams per day of urinary sodium Metabolic and Physiologic Risks Definition Obesity Agestandardized prevalence Ambient air particulate matter Micrograms per cubic meter in PM 2.5 Household air pollution Proportion of households using solid fuels for cooking 3

4 Part 1.1: DESCRIPTIVE STATISTICS Descriptive statistics of GDP per capita, risk factors, and NCD mortality are summarized in Table 1.1.1, and correlations are shown in Table A total of 188 countries tracked in the GBD 2013 study are included in the analysis. The panel spans , although includes only 1990, 1995, 2000, 2005, 2010, and 2013 as risk factor exposure and mortality data were only available for those years. Table Descriptive statistics of variables included in the statistical analysis Variable Mean Standard Deviation Minimum Maximum GDP per capita 10,834 12, ,704 HAP 41.5% 37.1% 0.0% 99.7% Physical Inactivity 23.5% 12.2% 4.9% 67.1% Sodium Binge Drinking 5.1% 4.5% 0.0% 26.3% Ambient PM Obesity 16.8% 10.1% 1.1% 60.1% Smoking 19.0% 9.2% 3.3% 50.2% NCD mortality 9.4% 3.8% 2.6% 24.0% Table Correlation matrix of variables included in the statistical analysis GDP per capita HAP Inactive Sodium Binge Drinking Ambient PM Obesity Smoking NCD mortality GDP per capita 1 HAP Inactivity Sodium Binge Drinking Ambient PM Obesity Smoking NCD mortality

5 Part 1.2: SPECIFICATION We estimated a system of structural equations of the following form: For allncd adult mortality (45q15) and NCD cause group specific 45q15: ln 45q15!" = β!! ln GDPpc!" + β!"! ln EachRisk!"# + α!! + τ!! + ε!!" ln (EachRisk)!"# = β!!! ln (GDPpc)!" + α!!" + τ!!" + ε!!"# Risks = Household Air Pollution, Physical Inactivity, Sodium Intake, Binge Drinking, Ambient PM, Obesity, Smoking i = each of 188 countries t = each of six years r = each of seven risks The eight equations (adult NCD mortality and seven risk factor equations) were estimated simultaneously via maximum likelihood, with unstructured covariance. All variables were natural log transformed, so the coefficients are elasticities. To avoid dropping observations with observed values of 0, we employed a lognormal offset of 0.5% of the variable s median for only variables with a minimum value of zero. Country and year indicators were included in all equations. The eight equations were estimated once for allncd adult mortality and then 73 additional times, once for each GBD NCD cause level III causespecific adult mortality. For comparison purposes, the series of equations was also estimated for several communicable diareses. The direct effect of economic growth on adult mortality is β!!. The total effect of economic growth on adult! mortality is β!! +!!! β!"! β!!!. 5

6 Part 1.3: SENSITIVITY The consequences of some risk factors included in this analysis take time to fully manifest in mortality rates. Thus, we conduct a sensitivity analysis including temporal lags in our regression to model how historical changes in risk factors might affect current changes in adultmortality. The results of the temporal lag analysis are reported below. We include contemporaneous risk factor levels in equation (1); we included risks at their 2010 values in equation (2); we included risks at their 2005 values in equation (3). The total effect of GDP per capita on NCD mortality is always a statistically significant negative effect. Table (1) (2) (3) VARIABLES NCD Mortality NCD Mortality NCD Mortality GDP per capita *** *** *** Obesity *** *** Smoking *** *** HAP ** Inactivity Sodium Intake Binge Drinking *** * Ambient PM *** *** *** Lags None Observations

7 Part 1.4: ESTIMATION The estimated total and direct effects for all NCD groups and Type I/Type II Communicable causes are shown in Table Regression output for all NCD groups and Type I/Type II Communicable causes are available in the following pages. One star designates significance at the 10% level. Two stars designate significance at the 5% level. Three stars designate significance at the 1% level. Four stars designate significance at the 0.1% level. 7

8 Table 1.4.1: Regression output for NCD mortality, other Type I & II diseases, and their association to country wealth Cause Total Effect: Wealth on Mortality Direct Effect: Wealth on Mortality Noncommunicable diseases 0.99 **** 1.19 **** Schizophrenia 3.51 **** 3.99 **** Peptic ulcer disease 3.11 **** 3.33 **** Appendicitis 2.88 **** 3.18 **** Gynecological diseases 2.79 **** 2.29 **** Inguinal, femoral, or other abdominal hernia 2.63 **** 2.70 **** Other cardiovascular and circulatory diseases 2.31 **** 2.23 **** Rheumatic heart disease 2.14 **** 2.46 **** Gastritis and duodenitis 2.02 **** 2.01 **** Other digestive diseases 2.02 **** 1.95 **** Alcohol use disorders 1.97 **** 2.46 **** Gall bladder and bile duct disease 1.94 **** 2.21 **** Asthma 1.89 **** 2.42 **** Noninfective inflammatory bowel disease 1.88 **** 1.90 **** Acute glomerulonephritis 1.79 **** 1.61 **** Urinary diseases and male infertility 1.77 **** 2.24 **** Hodgkin's disease 1.72 **** 1.94 **** Hypertensive heart disease 1.58 **** 1.83 **** Nonmelanoma skin cancer 1.51 **** 1.63 **** Vascular disorders of intestine 1.37 **** 1.52 **** Paralytic ileus and intestinal obstruction without hernia 1.35 **** 1.46 **** Chronic kidney diseases 1.33 **** 1.52 **** Diabetes mellitus 1.31 **** 1.65 **** Epilepsy 1.29 **** 1.45 **** Rheumatoid arthritis 1.28 **** 1.56 **** Cerebrovascular disease 1.23 **** 1.56 **** Stomach cancer 1.20 **** 1.45 **** Chronic obstructive pulmonary disease 1.20 **** 1.29 **** Hemoglobinopathies and hemolytic anemias 1.09 **** 1.30 **** Bladder cancer 1.07 **** 1.18 **** Pneumoconiosis 1.07 **** 1.15 **** Ischemic heart disease 1.07 **** 1.55 **** Endocrine, metabolic, blood, and immune disorders 0.93 ** 1.22 *** Cervical cancer 0.91 **** 0.99 **** 8

9 Cause Total Effect: Wealth on Mortality Direct Effect: Wealth on Mortality Nasopharynx cancer 0.89 *** 1.01 **** Other neoplasms 0.88 **** 1.11 **** Uterine cancer 0.87 **** 0.85 **** Endocarditis 0.71 **** 0.76 **** Cirrhosis of the liver secondary to hepatitis B 0.69 ** 0.77 ** Malignant melanoma of skin 0.60 *** 0.57 *** Larynx cancer 0.54 ** 0.97 **** Testicular cancer ** Other cirrhosis of the liver Skin and subcutaneous diseases Cardiomyopathy and myocarditis ** Congenital anomalies *** Cirrhosis of the liver secondary to hepatitis C Cirrhosis of the liver secondary to alcohol use Thyroid cancer Mesothelioma Aortic aneurysm * Esophageal cancer Leukemia ** NonHodgkin lymphoma Gallbladder and biliary tract cancer Other chronic respiratory diseases Cancer of other part of pharynx and oropharynx Mouth cancer Pancreatitis Kidney and other urinary organ cancers Breast cancer Trachea, bronchus, and lung cancers Colon and rectum cancers Multiple myeloma 0.27 * 0.23 Multiple sclerosis 0.38 * 0.23 Brain and nervous system cancers Ovarian cancer 0.50 * 0.39 Interstitial lung disease and pulmonary sarcoidosis 0.51 * 0.46 * Other neurological disorders 0.54 ** 0.48 ** Pancreatic cancer 0.68 * 0.58 * 9

10 Cause Total Effect: Wealth on Mortality Direct Effect: Wealth on Mortality Prostate cancer 0.70 **** 0.71 **** Other musculoskeletal disorders 0.99 ** 0.95 ** Liver cancer 1.79 *** 1.61 *** Drug use disorders 2.00 **** 1.95 **** Type I/Type II Communicable diseases Diarrheal diseases 5.92 **** 4.94 **** Upper respiratory infections 4.98 **** 5.27 **** Irondeficiency anemia 3.92 **** 4.02 **** Tuberculosis 3.81 **** 3.96 **** Proteinenergy malnutrition 2.90 **** 2.90 **** Meningitis 2.79 **** 3.10 **** Lower respiratory infections 1.62 **** 1.74 **** Dengue * HIV/AIDS

11 ln_smoking_prev ln_hap_prop ln_prop_inactive_d ln_sodium ln_binge ln_pollution_outdoor ln ncd_ m _pm *** (0.0384) ln_smoking_prev 0.175*** (0.0319) 4.44e08 ln_hap_prop * (0.0150) ln_prop_inactive ln_sodium ln_binge *** _d m 0.126*** ln_gdppc * *** *** 0.119*** (0.0939) (0.105) (0.0161) (0.0223) 1.73e08 (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0150) year_ *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) ( ) 1.52e e year_ *** *** 0.176*** *** *** *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0113) e e year_ *** 0.107*** 0.261*** *** *** *** *** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0133) e e09 0 year_ *** 0.147*** 0.346*** *** *** *** 0.137*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0155) e e10 0 year_ *** 0.149*** 0.400*** *** *** *** 0.165*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0165) e06 0 Constant 0.139*** *** 0.209*** *** *** *** *** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) ( ) e e

12 ln_smoking_prev_d ln_hap_prop_d ln_prop_inactive_d ln_sodium ln_binge 25_d m m m m _d m ln_cirrhosis_alcohol_d m (0.0896) ln_smoking_prev 0.271*** (0.0745) ln_hap_prop (0.0350) ln_prop_inactive (0.219) ln_sodium 0.475* ln_binge _d m ln_gdppc * *** *** (0.244) (0.0376) (0.0520) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0350) year_ *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0228) 1.52e e year_ *** *** 0.176*** *** *** *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0263) e e year_ *** 0.107*** 0.261*** *** *** *** 0.141*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0311) e e e06 year_ *** 0.147*** 0.346*** *** *** *** 0.282*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0361) e e10 0 year_ *** 0.149*** 0.400*** *** *** *** 0.340*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0384) e06 0 Constant 0.139*** *** 0.209*** *** *** *** 0.141*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0228) e e e

13 ln_smoking_prev ln_hap_prop ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_cirrhosis_hepb 0.258*** (0.0843) ln_smoking_prev (0.0701) ln_hap_prop 0.150*** (0.0329) 5.01e06 ln_prop_inactive (0.206) ln_sodium (0.230) ln_binge (0.0354) ln_gdppc * *** *** ** (0.0489) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0329) ** year_ *** *** *** * *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0214) 1.52e e ** year_ *** *** 0.176*** *** * *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0248) e e ** year_ *** 0.107*** 0.261*** *** * *** *** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0293) e e ** year_ *** 0.147*** 0.346*** *** * *** 0.143*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0340) e e e ** year_ *** 0.149*** 0.400*** *** * *** 0.213*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0362) e e09 Constant 0.139*** *** 0.209*** *** ** * *** *** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0215) e e

14 ln_smoking_prev ln_hap_prop ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_cirrhosis_hepc (0.0992) ln_smoking_prev 0.158* (0.0826) ln_hap_prop 0.117*** (0.0388) ln_prop_inactive ln_sodium ln_binge ln_gdppc * *** *** (0.243) (0.271) (0.0417) (0.0576) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0388) ** year_ *** *** *** * *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0253) 1.52e e ** year_ *** *** 0.176*** *** * *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0292) e e ** year_ *** 0.107*** 0.261*** *** * *** ** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0345) e e ** year_ *** 0.147*** 0.346*** *** * *** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0400) e e ** year_ *** 0.149*** 0.400*** *** * *** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0426) e Constant 0.139*** *** 0.209*** *** ** * *** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0253) e e

15 ln_smoking_prev ln_hap_prop ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_cirrhosis_othe r (0.0782) ln_smoking_prev 0.233*** (0.0650) ln_hap_prop * (0.0305) ln_prop_inactive (0.191) ln_sodium (0.213) ln_binge (0.0328) ln_gdppc * *** *** (0.0454) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0305) year_ *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0199) 1.52e e year_ *** *** 0.176*** *** *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0230) e e year_ *** 0.107*** 0.261*** *** *** *** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0271) e e year_ *** 0.147*** 0.346*** *** *** *** *** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0315) e e year_ *** 0.149*** 0.400*** *** *** *** 0.126*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0335) e Constant 0.139*** *** 0.209*** *** *** *** ** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0199) e e

16 ln_smoking_prev ln_hap_prop_ ln_prop_inactive_ ln_sodium_ ln_binge_ 2 5 _ ln_ckd_d m (0.0895) ln_smoking_prev (0.0745) ln_hap_prop 0.159*** (0.0350) 5.58e06 ln_prop_inactive 0.365* (0.219) ln_sodium (0.244) ln_binge *** (0.0376) (0.0520) ln_gdppc * *** *** *** (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0350) e ** year_ *** *** *** *** *** * ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0228) 1.52e e year_ *** *** 0.176*** *** *** *** 0.172*** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0263) e e e11 year_ *** 0.107*** 0.261*** *** *** *** 0.198*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0311) e e e10 year_ *** 0.147*** 0.346*** *** *** *** 0.208*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0361) e e e09 year_ *** 0.149*** 0.400*** *** *** *** 0.192*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0384) e e07 Constant 0.139*** *** 0.209*** *** *** *** 0.141*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0228) e e e10 16

17 _ ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 2 5 ln_cong_d m (0.0446) ln_smoking_prev 0.140*** (0.0371) ln_hap_prop ** * (0.0174) ln_prop_inactive (0.109) ln_sodium (0.122) ln_binge ** * *** (0.0187) (0.0259) ln_gdppc * *** *** ** * (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0174) ** year_ *** *** *** *** *** * ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0114) 1.52e e ** year_ *** *** 0.176*** *** *** *** * ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0131) e e e ** year_ *** 0.107*** 0.261*** *** *** *** * ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0155) e e e ** year_ *** 0.147*** 0.346*** *** *** *** * ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0180) e e ** year_ *** 0.149*** 0.400*** *** *** *** * ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0192) e Constant 0.139*** *** 0.209*** *** *** *** ** * ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0114) e e e05 17

18 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_cvd_aortic 0.218*** ln_smoking_prev 0.336*** ln_hap_prop ln_prop_inactive 0.351** ln_sodium ln_binge ** *** ln_gdppc * *** *** * (0.0585) (0.0487) 0 (0.0229) (0.143) (0.160) (0.0246) (0.0340) 2.75e07 (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0228) year_ *** *** *** *** *** * ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0149) 1.52e e year_ *** *** 0.176*** *** *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0172) e e year_ *** 0.107*** 0.261*** *** *** *** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0203) e e year_ *** 0.147*** 0.346*** *** *** *** *** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0236) e e year_ *** 0.149*** 0.400*** *** *** *** *** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0251) e Constant 0.139*** *** 0.209*** *** *** *** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0149) e e

19 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_cvd_cmp_ 0.211*** ln_smoking_prev 0.418*** ln_hap_prop ** ln_prop_inactive ln_sodium 0.621*** ln_binge 0.116*** *** ln_gdppc * *** *** ** (0.0715) (0.0595) 0 (0.0279) (0.175) (0.195) (0.0300) (0.0415) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0279) year_ *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0182) 1.52e e year_ *** *** 0.176*** *** *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0210) e e year_ *** 0.107*** 0.261*** *** *** *** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0248) e e year_ *** 0.147*** 0.346*** *** *** *** ** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0288) e e year_ *** 0.149*** 0.400*** *** *** *** *** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0307) e Constant 0.139*** *** 0.209*** *** *** *** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0182) e e

20 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_cvd_endo_ * (0.0496) ln_smoking_prev 0.129*** (0.0413) ln_hap_prop (0.0194) ln_prop_inactive 0.356*** (0.121) ln_sodium ln_binge ln_gdppc * *** *** *** (0.135) (0.0208) (0.0288) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0194) e05 year_ *** *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0126) 1.52e e e06 year_ *** *** 0.176*** *** *** *** 0.119*** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0146) e e year_ *** 0.107*** 0.261*** *** *** *** 0.174*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0172) e e09 0 year_ *** 0.147*** 0.346*** *** *** *** 0.227*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0200) e e10 0 year_ *** 0.149*** 0.400*** *** *** *** 0.256*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0213) e06 0 Constant 0.139*** *** 0.209*** *** *** *** 0.140*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0127) e e

21 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 2 5 ln_cvd_htn_ 0.287*** ln_smoking_prev 0.207*** ln_hap_prop 0.123*** ln_prop_inactive ln_sodium 0.409** ln_binge ** ** ln_gdppc * *** *** 0.183*** (0.0739) (0.0615) (0.0289) 2.20e05 (0.181) (0.202) (0.0310) (0.0429) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0289) e10 year_ *** *** *** *** *** ** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0188) 1.52e e year_ *** *** 0.176*** *** *** *** ** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0217) e e year_ *** 0.107*** 0.261*** *** *** *** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0257) e e year_ *** 0.147*** 0.346*** *** *** *** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0298) e e year_ *** 0.149*** 0.400*** *** *** *** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0317) e Constant 0.139*** *** 0.209*** *** *** *** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0188) e e

22 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 2 5 ln_cvd_ihd_ 0.402*** (0.0644) 4.28e10 ln_smoking_prev 0.436*** (0.0536) 0 ln_hap_prop 0.101*** (0.0252) 5.56e05 ln_prop_inactive 0.362** ln_sodium ln_binge 0.107*** 7.18e *** ln_gdppc * *** *** 0.155*** (0.157) (0.176) (0.0270) (0.0374) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0251) e10 year_ *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0164) 1.52e e year_ *** *** 0.176*** *** *** *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0189) e e year_ *** 0.107*** 0.261*** *** *** *** 0.141*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0224) e e e10 year_ *** 0.147*** 0.346*** *** *** *** 0.202*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0260) e e10 0 year_ *** 0.149*** 0.400*** *** *** *** 0.234*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0276) e06 0 Constant 0.139*** *** 0.209*** *** *** *** 0.111*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0164) e e

23 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_cvd_other_ 0.198** (0.0948) ln_smoking_prev 0.315*** (0.0788) 6.31e05 ln_hap_prop (0.0370) ln_prop_inactive (0.232) ln_sodium (0.259) ln_binge (0.0398) * ln_gdppc * *** *** 0.223*** (0.0550) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0370) e09 year_ *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0241) 1.52e e year_ *** *** 0.176*** *** *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0278) e e year_ *** 0.107*** 0.261*** *** *** *** * ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0329) e e year_ *** 0.147*** 0.346*** *** *** *** 0.132*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0382) e e year_ *** 0.149*** 0.400*** *** *** *** 0.164*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0407) e e05 Constant 0.139*** *** 0.209*** *** *** *** *** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0242) e e

24 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 2 5 ln_cvd_rhd_ ln_smoking_prev ln_hap_prop 0.143*** ln_prop_inactive ln_sodium ln_binge * *** ln_gdppc * *** *** 0.246*** (0.0768) (0.0639) (0.0300) 1.99e06 (0.188) (0.210) (0.0322) (0.0446) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0300) year_ *** *** *** *** *** 0.166*** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0195) 1.52e e year_ *** *** 0.176*** *** *** *** 0.321*** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0226) e e year_ *** 0.107*** 0.261*** *** *** *** 0.494*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0267) e e09 0 year_ *** 0.147*** 0.346*** *** *** *** 0.645*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0310) e e10 0 year_ *** 0.149*** 0.400*** *** *** *** 0.709*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0330) e06 0 Constant 0.139*** *** 0.209*** *** *** *** 0.389*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0196) e e

25 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_cvd_stroke 0.381*** (0.0588) 9.41e11 ln_smoking_prev 0.349*** (0.0489) 0 ln_hap_prop *** (0.0230) 6.03e05 ln_prop_inactive 0.249* ln_sodium ln_binge *** *** ln_gdppc * *** *** 0.156*** (0.144) (0.160) (0.0247) (0.0341) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0230) year_ *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0150) 1.52e e year_ *** *** 0.176*** *** *** *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0173) e e e06 year_ *** 0.107*** 0.261*** *** *** *** 0.175*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0204) e e09 0 year_ *** 0.147*** 0.346*** *** *** *** 0.261*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0237) e e10 0 year_ *** 0.149*** 0.400*** *** *** *** 0.309*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0252) e06 0 Constant 0.139*** *** 0.209*** *** *** *** 0.141*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0150) e e

26 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_diabetes_ 0.213*** (0.0675) ln_smoking_prev 0.161*** (0.0561) ln_hap_prop *** (0.0264) ln_prop_inactive ln_sodium ln_binge *** *** ln_gdppc * *** *** 0.165*** (0.165) (0.184) (0.0283) (0.0392) 1.42e10 (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0264) e10 year_ *** *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0172) 1.52e e e06 year_ *** *** 0.176*** *** *** *** 0.109*** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0198) e e e08 year_ *** 0.107*** 0.261*** *** *** *** *** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0234) e e e05 year_ *** 0.147*** 0.346*** *** *** *** * ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0272) e e year_ *** 0.149*** 0.400*** *** *** *** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0290) e Constant 0.139*** *** 0.209*** *** *** *** *** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0172) e e

27 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_diarrhea_ (0.118) ln_smoking_prev 0.588*** (0.0984) 2.34e09 ln_hap_prop (0.0462) ln_prop_inactive 0.556* (0.289) ln_sodium (0.323) ln_binge 0.222*** (0.0496) e *** ln_gdppc * *** *** 0.494*** (0.0687) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0462) year_ *** *** *** *** *** 0.128*** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0301) 1.52e e e05 year_ *** *** 0.176*** *** *** *** 0.277*** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0347) e e year_ *** 0.107*** 0.261*** *** *** *** 0.424*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0411) e e09 0 year_ *** 0.147*** 0.346*** *** *** *** 0.583*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0477) e e10 0 year_ *** 0.149*** 0.400*** *** *** *** 0.630*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0508) e06 0 Constant 0.139*** *** 0.209*** *** *** *** 0.340*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0302) e e

28 ln_smoking_pre ln_hap_prop ln_prop_inactiv ln_sodium ln_binge_ ln_pollution_outdoor_p v e m25 ln_digest_appendicit is 0.493*** (0.0772) 1.72e10 ln_smoking_prev 0.143** (0.0642) ln_hap_prop *** (0.0302) ln_prop_inactive 0.541*** (0.189) ln_sodium 0.386* ln_binge *** ln_pollution_outdoor_p m * ln_gdppc * *** *** 0.318*** (0.211) (0.0324) (0.0448) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0302) ** year_ *** *** *** * *** 0.133*** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0197) 1.52e e ** year_ *** *** 0.176*** *** * *** 0.300*** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0227) e e ** year_ *** 0.107*** 0.261*** *** * *** 0.466*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0268) e e ** year_ *** 0.147*** 0.346*** *** * *** 0.638*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0311) e e ** year_ *** 0.149*** 0.400*** *** * *** 0.733*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0331) e06 0 Constant 0.139*** *** 0.209*** *** ** * *** 0.378*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0197) e e

29 ln_smoking_prev ln_hap_prop ln_prop_inactive ln_sodium_ ln_binge_d m 25 ln_digest_bile 0.483*** (0.0796) 1.32e09 ln_smoking_prev 0.157** (0.0662) ln_hap_prop * (0.0311) ln_prop_inactive 0.592*** (0.195) ln_sodium ln_binge ** ** ln_gdppc * *** *** 0.221*** (0.217) (0.0334) (0.0462) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0311) year_ *** *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0202) 1.52e e year_ *** *** 0.176*** *** *** *** 0.156*** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0234) e e year_ *** 0.107*** 0.261*** *** *** *** 0.234*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0276) e e09 0 year_ *** 0.147*** 0.346*** *** *** *** 0.305*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0321) e e10 0 year_ *** 0.149*** 0.400*** *** *** *** 0.354*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0341) e06 0 Constant 0.139*** *** 0.209*** *** *** *** 0.187*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0203) e e

30 ln_smoking_pre ln_hap_prop ln_prop_inactive ln_sodium_ ln_binge_ v 25 ln_digest_gastrititi s 0.192** (0.0752) ln_smoking_prev 0.261*** (0.0626) 3.10e05 ln_hap_prop 0.117*** (0.0294) 6.60e05 ln_prop_inactive 0.397** (0.184) ln_sodium 0.419** (0.205) ln_binge (0.0316) *** ln_gdppc * *** *** 0.201*** (0.0437) 9.39e07 (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0294) ** year_ *** *** *** * *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0191) 1.52e e e ** year_ *** *** 0.176*** *** * *** 0.158*** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0221) e e ** year_ *** 0.107*** 0.261*** *** * *** 0.229*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0261) e e ** year_ *** 0.147*** 0.346*** *** * *** 0.300*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0303) e e ** year_ *** 0.149*** 0.400*** *** * *** 0.350*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0323) e06 0 Constant 0.139*** *** 0.209*** *** ** * *** 0.185*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0192) e e

31 ln_smoking_prev ln_hap_prop ln_prop_inactive ln_sodium_ ln_binge_d m 25 ln_digest_hernia 0.486*** (0.0830) 4.61e09 ln_smoking_prev (0.0690) ln_hap_prop 0.173*** (0.0324) 9.08e08 ln_prop_inactive 0.474** (0.203) ln_sodium 0.422* (0.226) ln_binge (0.0348) ** ln_gdppc * *** *** 0.270*** (0.0482) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0324) year_ *** *** *** *** *** 0.158*** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0211) 1.52e e year_ *** *** 0.176*** *** *** *** 0.380*** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0244) e e year_ *** 0.107*** 0.261*** *** *** *** 0.609*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0288) e e09 0 year_ *** 0.147*** 0.346*** *** *** *** 0.829*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0334) e e10 0 year_ *** 0.149*** 0.400*** *** *** *** 0.925*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0356) e06 0 Constant 0.139*** *** 0.209*** *** *** *** 0.483*** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0212) e e

32 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_d m 25 ln_digest_ibd (0.0809) ln_smoking_prev 0.250*** (0.0673) ln_hap_prop (0.0316) ln_prop_inactive 0.516*** (0.198) ln_sodium (0.221) ln_binge (0.0339) *** (0.0470) ln_gdppc * *** *** 0.190*** (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0316) e09 year_ *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0206) 1.52e e year_ *** *** 0.176*** *** *** *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0238) e e year_ *** 0.107*** 0.261*** *** *** *** 0.116*** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0281) e e e05 year_ *** 0.147*** 0.346*** *** *** *** 0.179*** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0326) e e e08 year_ *** 0.149*** 0.400*** *** *** *** 0.221*** ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0347) e e10 Constant 0.139*** *** 0.209*** *** *** *** *** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0206) e e e06 32

33 ln_smoking_prev ln_hap_prop_ ln_prop_inactive ln_sodium_ ln_binge_ 25 ln_digest_ileus (0.0908) ln_smoking_prev (0.0755) ln_hap_prop 0.161*** (0.0355) 5.78e06 ln_prop_inactive (0.222) ln_sodium 0.549** (0.248) ln_binge * ln_gdppc * *** *** 0.146*** (0.0381) (0.0527) (0.0117) (0.0137) (0.0294) ( ) ( ) (0.0269) (0.0199) (0.0355) e05 year_ *** *** *** *** *** ( ) ( ) (0.0192) ( ) ( ) (0.0176) (0.0130) (0.0231) 1.52e e year_ *** *** 0.176*** *** *** *** ( ) ( ) (0.0194) ( ) ( ) (0.0177) (0.0131) (0.0267) e e year_ *** 0.107*** 0.261*** *** *** *** ( ) ( ) (0.0203) ( ) ( ) (0.0186) (0.0137) (0.0315) e e year_ *** 0.147*** 0.346*** *** *** *** ( ) (0.0101) (0.0217) ( ) ( ) (0.0198) (0.0147) (0.0366) e e year_ *** 0.149*** 0.400*** *** *** *** * ( ) (0.0105) (0.0226) ( ) ( ) (0.0207) (0.0153) (0.0390) e Constant 0.139*** *** 0.209*** *** *** *** ( ) ( ) (0.0145) ( ) ( ) (0.0133) ( ) (0.0232) e e