Pascal Geldsetzer

• Harvard University

Importance Recent evidence from a quasi-experiment in Wales showed that herpes zoster (HZ) vaccination appears to prevent or delay dementia. Exploiting a similar quasi-experiment in Australia, this study investigated the effect of HZ vaccination on dementia occurrence in a different population and health system setting. Objective To determine the...

Background The relationship between education and cardiovascular health (CVH) metrics in low- and middle-income countries (LMICs) remains unclear. This study explores the associations between education and ideal cardiovascular health score (CVHS), as well as seven CVH metrics. Methods This cross-sectional study extracted data from the STEPwise app...

Providing quality healthcare is essential to reduce the future burden of cardiovascular disease. We assessed the quality of care for people with hypertension in Burkina Faso using the Institute of Medicine (IoM) Quality Domains of effectiveness, timeliness of access, patient-centredness and equitability of care. We performed an analysis of cross-se...

Neurotropic herpesviruses may be implicated in the development of dementia1, 2, 3, 4–5. Moreover, vaccines may have important off-target immunological effects6, 7, 8–9. Here we aim to determine the effect of live-attenuated herpes zoster vaccination on the occurrence of dementia diagnoses. To provide causal as opposed to correlational evidence, we...

Background Frequent hospital readmissions place a significant burden on patients, families, and society. Many high-income countries have implemented financial incentives to reduce readmissions. In China, readmission metrics have also been introduced as part of the performance evaluation for secondary hospitals. However, the understanding of hospita...

Background We have recently provided evidence from a quasi-randomized study in Wales that herpes zoster (HZ) vaccination reduced the incidence of new dementia diagnoses. This study used a similar quasi-randomization in Australia to determine the effect of HZ vaccination on new dementia diagnoses over 7.5 years.Figure 1:Eligibility for a free herpes...

Background Using a unique natural randomization, we have recently provided evidence from Welsh electronic health record data that herpes zoster (HZ) vaccination caused a reduction in new dementia diagnoses over a seven‐year period. This study aimed to determine whether eligibility for HZ vaccination also caused a reduction in deaths due to dementia...

The causal effect of hospital length of stay on crucial patient outcomes such as readmissions or mortality is underinvestigated and therefore unknown for the vast majority of the US population. Existing evidence stems from association studies that are unable to draw causal conclusions. This study leverages Medicare's two-midnight (2MN) and three-da...

Background : The advancement of generative artificial intelligence (AI) has shown great potential to enhance productivity in many cognitive tasks. However, concerns are raised that the use of generative AI may undermine human cognition due to over-reliance. Conversely, others argue that generative AI holds the promise to augment human cognition by...

Background The impact of cardiometabolic multimorbidity (CMM) on functional dependency (FD) is well established, but the temporal effect of FD on CMM and its mechanisms remain underexplored. Design A multicohort study pooled data from three international cohorts. Setting Data were sourced from the Health and Retirement Study (USA), the China Heal...

Constructed with used plastic bottles, the eco-cooler has been widely adopted in resource-poor communities in Bangladesh and other countries. We tested the eco-cooler under controlled conditions using a scientific wind tunnel in a climatic chamber. In our tests, we used seven eco-cooler designs in 27 climate conditions typical of Bangladesh (temper...

Background Frequent hospital readmissions place a significant burden on patients, families, and society. Many high-income countries have implemented financial incentives to reduce readmissions. In China, readmission metrics have also been introduced as part of the performance evaluation for secondary hospitals. However, the understanding of hospita...

The varicella zoster virus, a neurotropic herpesvirus, has been hypothesized to play a role in the pathophysiology of dementia, such as through neuroinflammatory processes or intracerebral vasculopathy. Using unique natural experiments, our group has previously found that live-attenuated herpes zoster (HZ) vaccination reduced the incidence of new d...

Introduction Hypertension is highly prevalent in India, but the proportion of patients achieving blood pressure control remains low. Efforts have been made to expand health insurance coverage nationwide with the aim of improving overall healthcare access. It is critical to understand the role of health insurance coverage in improving hypertension c...

Adolescent suicide is a major public health concern, particularly among adolescents who have endured Adverse Childhood Experiences (ACEs). Adolescents who have been exposed to multiple ACEs are as much as three times more likely to present with suicidality compared to the general adolescent population. Adolescents who have been exposed to multiple...

Background Understanding the chronic obstructive pulmonary disease (COPD) care cascade is crucial for identifying where and when to intervene to improve COPD outcomes. We aimed to determine the proportion of patients with COPD seeking care in China's health system who are lost at each stage of the COPD care cascade and how the patterns of loss vary...

Background There is a paucity of evidence regarding the definition of the quality of primary health care (PHC) in China. This study aims to evaluate the PHC quality for chronic diseases in rural areas based on a modified conceptual framework tailored to the context of rural China. Methods This comprehensive study, involving a patient survey, a pro...

Background The COVID-19 pandemic has caused a large mortality and morbidity burden globally. For individuals, a strong immune response is the most effective means to block SARS-CoV-2 infection. To inform clinical case management of COVID-19, development of improved vaccines, and public health policy, a better understanding of antibody response dyna...

Understanding public preferences concerning vaccination is critical to inform pandemic response strategies. To investigate Chinese adults’ preferences regarding COVID-19 vaccine attributes, we conducted a cross-sectional online survey in 12,000 Chinese adults in June-July, 2021. Participants were requested to answer a series of discrete choice ques...

Background Understanding willingness to undergo pulmonary function tests (PFTs) and the factors associated with poor uptake of PFTs is crucial for improving early detection and treatment of chronic obstructive pulmonary disease (COPD). This study aimed to understand willingness to undergo PFTs among high-risk populations and identify any barriers t...

There are large differences in premature mortality in the USA by race/ethnicity, education, rurality and social vulnerability index groups. Using existing concentration–response functions, published particulate matter (PM2.5) air pollution estimates, population estimates at the census tract level and county-level mortality data from the US National...

Importance Taking advantage of a natural experiment in Wales, our group has recently provided evidence that herpes zoster (HZ) vaccination appears to prevent or delay dementia. Exploiting a similar natural experiment in Australia, this present study investigated the effect of HZ vaccination on dementia occurrence in a different population and healt...

OBJECTIVE The relationship between depression, diabetes, and access to diabetes care is established in high-income countries (HICs) but not in middle-income countries (MICs), where contexts and health systems differ and may impact this relationship. In this study, we investigate access to diabetes care for individuals with and without depressive sy...

Background and Aims The effect of vaccinations against SARS-CoV-2 on risk of infection and subsequent adverse outcomes in patients with kidney dysfunction beyond end-stage kidney disease remains uncertain. Based on nationwide data from multiple health care registers, the study aims to evaluate vaccination effect on rates of SARS-CoV-2 infection and...

Premature deaths from NCDs disproportionately affect people in low-and middle-income countries. Since alcohol use is one of the most common causes of reversible hypertension, interventions targeting alcohol use may be a feasible and effective low-cost approach to synergistically reduce the prevalence of harmful drinking and high blood pressure. Thi...

Background China has the highest disease burden of chronic obstructive pulmonary disease (COPD) in the world; however, the diagnosis rate remains low. Screening for COPD in the population may improve early diagnosis and long-term health outcomes for patients with COPD. In this study, we aimed to evaluate the cost-effectiveness of population-based C...

Providing quality healthcare is essential to reduce the future burden of cardiovascular disease. We assessed the quality of hypertension care in Burkina Faso using the Institute of Medicine (IOM) Quality Domains of effectiveness, timeliness of access, patient-centredness and equitability of care. We performed an analysis of cross-sectional househol...

The prevalence of multiple age-related cardiovascular disease (CVD) risk factors is high among individuals living in low- and middle-income countries. We described receipt of healthcare services for and management of hypertension and diabetes among individuals living with these conditions using individual-level data from 55 nationally representativ...

Evidence on cardiovascular disease (CVD) risk factor prevalence among adults living below the World Bank’s international line for extreme poverty (those with income <$1.90 per day) globally is sparse. Here we pooled individual-level data from 105 nationally representative household surveys across 78 countries, representing 85% of people living in e...

Health agencies rely upon survey-based physical measures to estimate the prevalence of key global health indicators such as hypertension. Such measures are usually collected by non-healthcare worker personnel and are potentially subject to measurement error due to variations in interviewer technique and setting, termed “interviewer effects”. In the...

Background: In India, several state governments are implementing or considering home-based hypertension screening programs to improve population-wide diagnosis and blood pressure (BP) control rates. However, there is limited evidence on the effectiveness of home-based screening programs in India. Methods: Using six waves of population-representativ...

Background: To ensure resources invested into services are commensurate with benefit, economists utilise various methods to assess value of life. Understanding the performance of these methods in older populations is crucial, particularly in low-and-middle-income countries (LMICs), where the majority of older people will live by 2030. Value of Stat...

Improving hypertension control in low- and middle-income countries has uncertain implications across socioeconomic groups. In this study, we simulated improvements in the hypertension care cascade and evaluated the distributional benefits across wealth quintiles in 44 low- and middle-income countries using individual-level data from nationally repr...

Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008–2019. We describe the weighted incidence of non-...

Background There is growing recognition that infectious agents, particularly herpesviruses, could play a role in the development of some types of dementia. Method In Wales, eligibility for the herpes zoster vaccine (Zostavax) for shingles prevention was determined based on an individual’s exact date of birth. Those born before September‐2‐1933 wer...

Importance High-quality peer reviews are often thought to be essential to ensuring the integrity of the scientific publication process, but measuring peer review quality is challenging. Although imperfect, review word count could potentially serve as a simple, objective metric of review quality. Objective To determine the prevalence of very short...

Objective Clear criteria to individualize glycemic targets in patients with type II diabetes are lacking. In this post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes trial (ACCORD), we evaluate whether the kidney failure risk equation (KFRE) can identify patients for whom intensive glycemic control confers more benefit in pre...

Diabetes is a leading cause of morbidity, mortality and cost of illness1,2. Health behaviours, particularly those related to nutrition and physical activity, play a key role in the development of type 2 diabetes mellitus³. Whereas behaviour change programmes (also known as lifestyle interventions or similar) have been found efficacious in controlle...

Communicable diseases remain a leading cause of death and disability in low- and middle-income countries (LMICs). mHealth technologies carry considerable promise for managing these disorders within resource-poor settings, but many existing applications exclusively represent digital versions of existing guidelines or clinical calculators, communicat...

Background The global burden of diabetes is rising rapidly, yet there is little evidence on individual-level diabetes prevention activities undertaken by health systems in low-income and middle-income countries (LMICs). Here we describe the population at high risk of developing diabetes, estimate diabetes prevention activities, and explore sociodem...

Low uptake and high discontinuation remain major obstacles to realizing the potential of Pre-Exposure Prophylaxis (PrEP) in changing the trajectory of the HIV epidemic. We conducted a card sorting and ranking exercise with 155 local stakeholders to determine their views on the most important barriers and most promising interventions to achieving hi...

Cardiovascular disease risk factors (CVDRF), in particular diabetes and hypertension, are chronic conditions which carry a substantial disease burden in Low- and Middle-Income Countries. Unlike HIV, they were neglected in the Millenium Development Goals along with the health services required to manage them. To inform the level of health service re...

The Bacillus Calmette–Guérin (BCG) vaccine for tuberculosis (TB) is widely used globally. Many high-income countries discontinued nationwide vaccination policies starting in the 1980s as the TB prevalence decreased. However, there is continued scientific interest in whether the general childhood immunity boost conferred by the BCG vaccination impac...

Background: The United Kingdom (UK) has used date of birth-based eligibility rules for live-attenuated herpes zoster (HZ) vaccination that have led to large differences in HZ vaccination coverage between individuals who differed in their age by merely a few days. Using this unique natural randomization, we have recently provided evidence from Welsh...

Importance: Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. Objective:...

Importance: Diabetes is widespread and treatable, but little is known about the diabetes care continuum (diagnosis, treatment, and control) in India and how it varies at the national, state, and district levels. Objective: To estimate the adult population levels of diabetes diagnosis, treatment, and control in India at national, state, and distr...

Background High blood pressure is a major public health problem in low- and middle-income countries. Low-sodium salt substitute (LSSS) is a promising population-level blood pressure-lowering intervention requiring minimal behavioral change. The optimal method of delivering LSSS to individuals, however, is currently unknown. Community health workers...

Background Pre-Exposure Prophylaxis (PrEP) has demonstrated clinical efficacy in preventing HIV infection, yet its uptake remains low. This study, conducted in five PrEP implementing districts in Lesotho, examined factors motivating persons at risk of HIV infection to adopt or reject PrEP when offered freely. Methods In-depth interviews were under...

Objective: Clear criteria to individualize glycemic targets are lacking. In this post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes trial (ACCORD), we evaluate whether the kidney failure risk equation (KFRE) can identify patients who disproportionately benefit from intensive glycemic control on kidney microvascular outcomes....

There remains widespread doubt among clinicians that mere lifestyle advice and counseling provided in routine care can achieve improvements in health. We aimed to determine the health effects of the largest behavior change program for pre-diabetes globally (the English Diabetes Prevention Programme) when implemented at scale in routine care. We exp...

Vitamin A supplementation (VAS) can protect children from the adverse health consequences of vitamin A deficiency. To inform the geographically precise targeting of VAS programs and provide a benchmark for monitoring progress in reducing geographic disparities in coverage over time, we created high resolution maps (5km x 5km) of the proportion of p...

Background: High-quality peer reviews are often thought to be essential to ensuring the integrity of the scientific publication process but measuring peer review quality is challenging. Although imperfect, review word count could serve as a simple, objective metric of review quality. We aimed to examine the prevalence of very short reviews and how...

Background: Cardiovascular diseases (CVDs) are the leading cause of death in most low- and middle-income countries (LMICs). CVDs and their metabolic risk factors have historically been concentrated among urban residents with higher socioeconomic status (SES) in LMICs such as India. However, as India develops, it is unclear whether these socioecono...

Objective To determine which early‐stage variables best predicted the deterioration of coronavirus disease 2019 (COVID‐19) among community‐isolated people infected with severe acute respiratory syndrome coronavirus 2 and to test the performance of prediction using only inexpensive‐to‐measure variables. Methods Medical records of 3145 people isolat...

Health agencies rely upon survey-based physical measures to estimate the prevalence of key global health indicators such as hypertension. Such measures are usually collected by non-healthcare worker personnel and are potentially subject to measurement error due to variations in interviewer technique and setting, termed "interviewer effects". In the...

Background: Diabetes is a growing concern in South Asia but few nationally representative studies identify factors behind this rising disease burden. We studied the nationwide change in diabetes prevalence in Bangladesh, subpopulations disproportionately affected, and the contribution of rising unhealthy weight to the change in diabetes prevalence...

Background Diabetes and hypertension are increasingly important population health challenges in Eswatini. Prior to this project, healthcare for these conditions was primarily provided through physician-led teams at tertiary care facilities and accessed by only a small fraction of people living with diabetes or hypertension. This trial tests and eva...

Background Diabetes is a growing concern in South Asia but few nationally representative studies identify factors behind this rising disease burden. We studied the nationwide change in diabetes prevalence in Bangladesh, subpopulations disproportionately affected, and the contribution of rising unhealthy weight to the change in diabetes prevalence....

The Global Diabetes Compact is a WHO-driven initiative uniting stakeholders around goals of reducing diabetes risk and ensuring that people with diabetes have equitable access to comprehensive, affordable care and prevention. In this report we describe the development and scientific basis for key health metrics, coverage, and treatment targets acco...

IMPORTANCE Cancers are a leading cause of mortality, accounting for nearly 10 million annual deaths worldwide, or 1 in 6 deaths. Cancers also negatively affect countries' economic growth. However, the global economic cost of cancers and its worldwide distribution have yet to be studied. OBJECTIVE To estimate and project the economic cost of 29 can...

The Bacillus Calmette Guerin (BCG) vaccine for tuberculosis (TB) is widely used globally. Many high-income countries discontinued nationwide vaccination policies as the TB prevalence decreased. However, there is continued interest in whether the general childhood immunity boost conferred by the BCG vaccination impacts adult health and mortality in...

Importance Diabetes mellitus (DM) is widespread and treatable. Little is known about the diabetes care continuum (diagnosis, treatment, and control) in India, and whether it varies by socio-demographic characteristics and vary at the national, state, and district levels. Objective To estimate the diabetes care continuum among individuals aged 18-98...

Background: Asthma is an important contributor to the burden of non-communicable diseases in China. Understanding spatial, temporal, and demographic patterns in asthma mortality is relevant to the design and implementation of targeted interventions. Methods: This study collected information on asthma deaths occurring across 605 disease surveilla...

Background Cardiovascular diseases (CVDs) are the leading cause of mortality globally with almost a third of all annual deaths worldwide. Low- and middle-income countries (LMICs) are disproportionately highly affected covering 80% of these deaths. For CVD, hypertension (HTN) is the leading modifiable risk factor. The comparative impact of diagnosti...

Background Low uptake and high discontinuation rates remain major obstacles to realizing the potential of Pre-Exposure Prophylaxis (PrEP) in changing the trajectory of the HIV epidemic in sub-Saharan Africa. Evidence on how PrEP could be successfully delivered has thus far mainly focused on key target groups rather than the general adult population...

The provision of high-quality antenatal care (ANC) is important for preventing maternal and newborn mortality and morbidity, but only around half of pregnant women in Tanzania attended four or more ANC visits in 2019. Although there is emerging evidence on the benefit of community health worker (CHW) interventions on ANC uptake, few large-scale pra...

Communicable diseases remain a leading cause of death and disability in low- and middle-income countries (LMICs). mHealth technologies carry considerable promise for managing these disorders within resource-poor settings, but many existing applications simply represent digital versions of existing guidelines or clinical calculators, communication f...

Background Cardiovascular diseases (CVDs) are the leading cause of death in most low- and middle-income countries (LMICs). CVDs and their metabolic risk factors have historically been concentrated among urban residents with higher socioeconomic status (SES) in LMICs such as India. However, as India develops, it is unclear whether these socioeconomi...

Data resource basics The World Health Organization (WHO) and the Centres for Disease Control and Prevention (CDC) developed the Global School-based Student Health Survey (GSHS) in collaboration with United Nations Children’s Fund (UNICEF), United Nations Educational, Scientific and Cultural Organization (UNESCO) and Joint United Nations Programme o...

Background Historically, the international development community has often held the view that those living in extreme poverty (at less than $1.90/day) are likely to have a low prevalence of cardiovascular disease (CVD) risk factors due to calorie scarcity, a largely plant-based diet, and physical labor. Evidence on CVD risk factor prevalence among...

Studies on knowledge and attitudes about HIV pre-exposure prophylaxis (PrEP) have mostly focused on key populations in North America and Europe. To inform Lesotho’s national rollout of PrEP to the general population, this study aimed to characterize knowledge and attitudes about PrEP among policy makers, implementing partners, healthcare providers,...

Objective: To determine the proportion of adults with hypertension who reported: (i) having been previously diagnosed with hypertension; (ii) taking blood pressure-lowering medication; and (iii) having achieved hypertension control, in five health and demographic surveillance system sites across five countries in Asia. Methods: Data were collect...

Background Alcohol is a leading risk factor for over 200 conditions and an important contributor to socioeconomic health inequalities. However, little is known about the associations between individuals’ socioeconomic circumstances and alcohol consumption, especially heavy episodic drinking (HED; ≥5 drinks on one occasion) in low-income or middle-i...

Objectives To determine the prevalence and frequency of using any tobacco product and each of a detailed set of tobacco products, how tobacco use and use frequency vary across countries, world regions, and World Bank country income groups, and the socioeconomic and demographic gradients of tobacco use and use frequency within countries. Design Sec...

There is a dearth of evidence on the epidemiology of multimorbidity in low- and middle-income countries. This study aimed to determine the prevalence of multimorbidity in India and its variation among states and population groups. We analyzed data from a nationally representative household survey conducted in 2015–2016 among individuals aged 15 to...

This study aimed to determine levels of health insurance coverage in low- and middle-income countries and how coverage varies by people's sociodemographic characteristics. We conducted a population size-weighted, one-stage individual participant data meta-analysis of health insurance coverage, using a population-based sample of 2,035,401 participan...

Background Effective equity-focused health policy for hypertension in low- and middle-income countries (LMICs) requires an understanding of the condition’s current socioeconomic gradients and how these are likely to change in the future as countries develop economically. Objectives This cross-sectional study aimed to determine how hypertension pre...

Alcohol use is a major risk factor for noncommunicable diseases in Thailand, and one of its pathways is high blood pressure. Given that brief intervention can effectively reduce hazardous alcohol consumption, this study aimed to investigate how hypertensive patients with concomitant alcohol use are identified and treated in Thai primary care settin...

Managing hypertension is a highly dynamic process, yet current evidence on hypertension control in middle-income countries (MICs) is largely based on cross-sectional data. Using multiple waves of population-based cohort data from four MICs (China, Indonesia, Mexico, and South Africa), we undertook a longitudinal investigation into how individuals w...