https://www.um.edu.mt/library/oar/handle/123456789/755 2026-06-28T09:57:28Z 2026-06-28T09:57:28Z Soares Andrade, Carlos Alexandre Mahrouseh, Nour Kovács, Nóra Cuschieri, Sarah Chen-Xu, José Varga, Orsolya https://www.um.edu.mt/library/oar/handle/123456789/147711 2026-06-25T10:20:19Z 2026-01-01T00:00:00Z

Title: National and subnational analysis of self-reported diabetes mellitus and health inequalities in Europe Authors: Soares Andrade, Carlos Alexandre; Mahrouseh, Nour; Kovács, Nóra; Cuschieri, Sarah; Chen-Xu, José; Varga, Orsolya Abstract: Diabetes mellitus (DM) has been a major public health concern with increased epidemiologic and economic burden in Europe. We aimed to estimate self-reported national and subnational DM prevalence and inequalities in individuals aged 50 years and over in 13 European countries between 2010 and 2019. Microdata were extracted from waves 4 (2010/2011), 5 (2013), 6 (2015), 7 (2017/2018) and 8 (2019) of the Survey of Health, Ageing and Retirement in Europe (SHARE) database. The analysis was conducted at both national and subnational levels, comprising 13 European countries. Health inequalities were assessed using the gini coefficient (GC) and concentration index (CI). Socioeconomic risk factors were included in the inequality analysis (urbanization, income, and educational level) in addition to multilevel regression model. The prevalence of DM decreased from 11% in wave 4 to 10.6% in wave 8, with the lowest recorded in Switzerland at 5.9% in wave 5 and the highest observed in Czechia at 16.7% in wave 8. DM prevalence varied widely subnationally, ranging from 2.1% in wave 8 Zentralschweiz (Switzerland) to 28.5% in wave 8 in Střední Čechy in Czechia. The GC demonstrated an increase from 21.9% (95% CI 17.0, 24.5) in wave 4 to 22.5% (95% CI 19.4,25.2) in wave 8, with Switzerland exhibiting the highest coefficient in wave 8 [30.1% (95% CI 7.9, 41.7)]. The CIs for income and educational level at national level were consistently low and mostly negative. The education and income CI ranged from [− 0.0182 (95% CI – 0.0242, − 0.0122) to − 0.0010 (95% CI − 0.0021, − 0.0001)] and [− 0.0278 (95% CI − 0.0411, −0.0166) to − 0.0018 (95% CI – 0.0032, – 0.0005)] across waves 4 and 8, respectively. The CI for urbanization displayed both negative and positive values, but most were not statistically significant (p > 0.05). Inequalities exist in the self-reported prevalence of DM both nationally and subnationally, with elevated rates observed among individuals with lower educational and income levels. Addressing these significant health inequalities calls for the development of prevention programs and policies by the European countries and subnational regions, specifically tailored to prioritize and support vulnerable groups.

2026-01-01T00:00:00Z Sant, Desiree’ Cuschieri, Andrea Cuschieri, Sarah https://www.um.edu.mt/library/oar/handle/123456789/147709 2026-06-25T10:05:43Z 2026-01-01T00:00:00Z

Title: Are future doctors ready for the post-pandemic obesity surge? A mixed-methods pilot study Authors: Sant, Desiree’; Cuschieri, Andrea; Cuschieri, Sarah Abstract: Obesity is a global epidemic, posing intricate health dilemmas with wide-reaching ramifications. Despite its rising prevalence, obesity often receives inadequate attention in medical training, which is hypothesized to influence obesity management. The study aimed to evaluate medical students’ readiness in addressing obesity, which is especially relevant in a country with significant high obesity rates. A cross-sectional pilot study was carried out by disseminating a mixed-methods anonymous questionnaire among pre-clinical and clinical students studying at the University of Malta. Quantitative data was analyzed through descriptive and inferential statistical analysis, while qualitative responses were subject to thematic assessment. One hundred and eighty-nine students were recruited, and the majority expressed dissatisfaction with curricular education on obesity, especially clinical students who reported a perceived lack of essential theoretical and practical skills (82.65%, 95% CI [73.69–89.56]). Less pre-clinical students perceived receiving sufficient education on obesity and obesity management students (33.3% and 43.33%, respectively) compared to their clinical counterparts (67.68% and 53.54% respectively), which highlights a potential curriculum gap. Qualitative analysis revealed discontent with teaching methods and demonstrated the need for a more holistic approach to obesity education. This study highlights an urgent need to integrate holistic and comprehensive obesity education within the medical education curriculum that addresses both theoretical understanding and practical skills.

2026-01-01T00:00:00Z Wyper, Grant M. A. Cuschieri, Sarah Devleesschauwer, Brecht https://www.um.edu.mt/library/oar/handle/123456789/147706 2026-06-25T09:50:34Z 2026-01-01T00:00:00Z

Title: The plight of the Monaco microstate in the GBD 2023 study Authors: Wyper, Grant M. A.; Cuschieri, Sarah; Devleesschauwer, Brecht Abstract: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, although invaluable for global health metrics, presents concerning estimates of life expectancy at birth for Monaco. Monaco is a microstate typically synonymous with world-leading levels of life expectancy at birth, with official sources, such as statistics from the Monaco Government and UN reports, consistently placing Monaco's life expectancy among the highest globally. The most recent estimate from the Monegasque Demography Observatory for 2022–24 places life expectancy at birth at 87·0 years; however, GBD estimates are substantially lower, at 80·4 years in 2023. This sizable discrepancy demands immediate attention. [excerpt]

2026-01-01T00:00:00Z Cuschieri, Sarah Zhang, Nairong Grech, Elizabeth Grech, Stephan https://www.um.edu.mt/library/oar/handle/123456789/147704 2026-06-25T09:41:43Z 2026-01-01T00:00:00Z

Title: Comparing anthropometric measures and Lancet Commission definitions in relation to hypertension : population-level evidence from a small island with high metabolic burden Authors: Cuschieri, Sarah; Zhang, Nairong; Grech, Elizabeth; Grech, Stephan Abstract: Objectives: Obesity is a major public health challenge, yet its classification remains debated. This study applies the newly proposed Lancet Diabetes & Endocrinology Commission definitions of pre-clinical and clinical obesity within a population with high obesity prevalence. These are compared with traditional anthropometric measures body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR) to evaluate how different classification approaches identify individuals at elevated risk of obesity-related complications and their association with hypertension (HTN).; Study design:- This cross-sectional study utilized data from a nationally representative health examination survey conducted in Malta between 2014 and 16, weighted N = 3947.; Methods: Anthropometric, biochemical, and sociodemographic information was gathered, with hypertension (HTN) explored as an obesity-related complication. Logistic regression models examined the associations between obesity classifications and HTN adjusting for sex, age, education, and locality.; Results: Obesity prevalence differed by classification, with BMI-defined obesity at 34.08%, high WC at 34.81%, high WHtR at 39.17%, clinical obesity at 22.40%, and pre-clinical obesity at 18.19%, based on the modified Lancet Commission definitions. All adiposity measures were significantly associated with hypertension (HTN). BMI-defined obesity was associated with a 6-fold increase in HTN, and overweight with a 3-fold increase. Clinical obesity was associated with a 5-fold increase in HTN, while high-risk WC and high WHtR were associated with 3-fold and 2-fold increases, respectively; all associations remained significant after adjustment.; Conclusion: Anthropometric measures classify obesity inconsistently within the Maltese population, with BMI showing the strongest adjusted association with hypertension. However, interpretation of findings related to clinical obesity should consider the overlap between hypertension as both an outcome and a defining criterion. The Lancet Commission framework identified a smaller high-risk subgroup illustrating the need for clearer guidance and population-specific adaptation to population context, supporting the need for country-specific, sex- and age-sensitive obesity diagnostic criteria.

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