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Ross S, Armas Rojas N, Sawatzky J, Varona-Pérez P, Burrett JA, Calderón Martínez M, Lorenzo-Vázquez E, Bess Constantén S, Sherliker P, Morales Rigau JM, Hernández López OJ, Martínez Morales MÁ, Alonso Alomá I, Achiong Estupiñan F, Díaz González M, Rosquete Muñoz N, Cendra Asencio M, Emberson J, Peto R, Lewington S, Lacey B. Educational inequalities and premature mortality: the Cuba Prospective Study. Lancet Public Health 2022; 7:e923-e931. [PMID: 36334608 DOI: 10.1016/s2468-2667(22)00237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although socioeconomic status is a major determinant of premature mortality in many populations, the impact of social inequalities on premature mortality in Cuba, a country with universal education and health care, remains unclear. We aimed to assess the association between educational level and premature adult mortality in Cuba. METHODS The Cuba Prospective Study (a cohort study) enrolled 146 556 adults aged 30 years and older from the general population in five provinces from Jan 1, 1996, to Nov 24, 2002. Participants were followed up until Jan 1, 2017, for cause-specific mortality. Deaths were identified through linkage to the Cuban Public Health Ministry's national mortality records. Cox regression models yielded rate ratios (RRs) for the effect of educational level (a commonly used measure for social status) on mortality at ages 35-74 years, with assessment for the mediating effects of smoking, alcohol consumption, and BMI. FINDINGS A total of 127 273 participants aged 35-74 years were included in the analyses. There was a strong inverse association between educational level and premature mortality. Compared with a university education, men who did not complete primary education had an approximately 60% higher risk of premature mortality (RR 1·55, 95% CI 1·40-1·72), while the risk was approximately doubled in women (1·96, 1·81-2·13). Overall, 28% of premature deaths could be attributed to lower education levels. Excess mortality in women was primarily due to vascular disease, while vascular disease and cancer were equally important in men. 31% of the association with education in men and 18% in women could be explained by common modifiable risk factors, with smoking having the largest effect. INTERPRETATION This study highlights the value of understanding the determinants of health inequalities in different populations. Although many major determinants lie outside the health system in Cuba, this study has identified the diseases and risk factors that require targeted public health interventions, particularly smoking. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, CDC Foundation (with support from Amgen).
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Affiliation(s)
- Stephanie Ross
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Nurys Armas Rojas
- National Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
| | - Julia Sawatzky
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Patricia Varona-Pérez
- Institute of Hygiene, Epidemiology and Microbiology, Ministry of Public Health, Havana, Cuba
| | - Julie Ann Burrett
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Marcy Calderón Martínez
- Institute of Hygiene, Epidemiology and Microbiology, Ministry of Public Health, Havana, Cuba
| | | | - Sonia Bess Constantén
- Directorate of Medical Records and Health Statistics, Ministry of Public Health, Havana, Cuba
| | - Paul Sherliker
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK; MRC Population Health Research Unit, NDPH, University of Oxford, Oxford, UK
| | | | | | | | - Ismell Alonso Alomá
- Directorate of Medical Records and Health Statistics, Ministry of Public Health, Havana, Cuba
| | | | - Mayda Díaz González
- Municipal Center of Hygiene, Epidemiology and Microbiology, Colón, Matanzas, Cuba
| | | | | | - Jonathan Emberson
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK; MRC Population Health Research Unit, NDPH, University of Oxford, Oxford, UK
| | - Richard Peto
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Sarah Lewington
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK; MRC Population Health Research Unit, NDPH, University of Oxford, Oxford, UK.
| | - Ben Lacey
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
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Pourfarzi F, Moghadam TZ, Zandian H. Decomposition socio-economic inequality in cardiovascular disease prevalence in adult population: A cohort based cross-sectional study in north-west of Iran. J Prev Med Public Health 2022; 55:297-306. [PMID: 35678004 PMCID: PMC9201090 DOI: 10.3961/jpmph.22.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/29/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Farhad Pourfarzi
- Digestive Disease Research Center, Ardabil University of Medical Sciences, Ardabil,
Iran
| | - Telma Zahirian Moghadam
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil,
Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil,
Iran
- Department of Community Medicine, School of Medicine, Ardabil University of Medical Sciences, Ardabil,
Iran
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Kong F, Wang A, Su J, He J, Xie D, Xiong L, Sheng X, Liu Z. Accidental death during pregnancy and puerperium from 2009 to 2019 in Hunan, China: a cross-sectional study. BMJ Open 2021; 11:e047660. [PMID: 34593489 PMCID: PMC8487173 DOI: 10.1136/bmjopen-2020-047660] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Few studies have analysed accidental maternal deaths. This study analysed the basic situation and classification of maternal accidental deaths and compared the differences between urban and rural areas. DESIGN A cross-sectional study on accidental deaths during pregnancy and puerperium from 2009 to 2019 in Hunan Province. SETTING Hunan Province, with a population of 74 million, has an area of 210 000 km2 and 123 counties/districts. PARTICIPANTS A collection of 239 cases of accidental death during pregnancy and puerperium in Hunan Province from 2009 to 2019, including 181 cases of rural pregnancy and puerperium and 58 cases of urban pregnancy and puerperium. MAIN OUTCOME MEASURE Classification of accidental mortality of pregnant women. RESULTS A total of 239 accidental deaths occurred in Hunan Province, with an accidental mortality rate of 2.8 per 100 000 live births. The accidental mortality rate in rural areas (3.2 per 100 000 live births) was higher than in urban areas (2.0 per 100 000 live births). The proportion of accidental deaths among pregnancy-related deaths showed an upward trend. The main types of accidental deaths were suicide (1.0 per 100 000 live births), traffic accidents (0.8 per 100 000 live births), accidental poisoning/overdose and assault/homicide (0.2 per 100 000 live births), and other accidents (0.6 per 100 000 live births). Maternal accidental deaths were mainly concentrated in low-income families, in rural areas and in those with low level of education. 74.5% of accidental deaths occurred before childbirth. 49.2% of pregnant women gave birth by caesarean section. CONCLUSION In response to the different causes of accidental maternal death, public health programmes and policy interventions should pay special attention to maternal suicide and traffic injuries.
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Affiliation(s)
- Fanjuan Kong
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Aihua Wang
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Jinping Su
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Jian He
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Donghua Xie
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Lili Xiong
- Information Management Section, Hunan Province, Changsha, Hunan, China
| | - Xiaoqi Sheng
- Psychology Department, Hunan Province, Changsha, Hunan, China
| | - Zhiyu Liu
- Information Management Section, Hunan Province, Changsha, Hunan, China
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Sociodemographic patterns of urine sodium excretion and its association with hypertension in Chile: a cross-sectional analysis. Public Health Nutr 2019; 22:2012-2021. [PMID: 30761970 DOI: 10.1017/s1368980018003889] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of the study was to determine the main factors (sociodemographic, anthropometric, lifestyle and health status) associated with high Na excretion in a representative population of Chile. DESIGN Na excretion (g/d), a valid marker of Na intake, was determined by urine analysis and Tanaka's formulas. Blood pressure was measured by trained staff and derived from the mean of three readings recorded after 15 min rest. The associations of Na excretion with blood pressure and the primary correlates of high Na excretion were determined using logistic regression. SETTING Chileans aged ≥15 years.ParticipantsParticipants (n 2913) from the Chilean National Health Survey 2009-2010. RESULTS Individuals aged 25 years or over, those who were obese and those who had hypertension, diabetes or metabolic syndrome were more likely to have higher Na excretion. The odds for hypertension increased by 10·2 % per 0·4 g/d increment in Na excretion (OR=1·10; 95 % CI 1·06, 1·14; P < 0·0001). These findings were independent of major confounding factors. CONCLUSIONS Age, sex, adiposity, sitting behaviours and existing co-morbidities such as diabetes were associated with higher Na excretion levels in the Chilean population. These findings could help policy makers to implement public health strategies tailored towards individuals who are more likely to consume high levels of dietary salt.
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Gróf M, Vagašová T, Oltman M, Skladaný Ľ, Maličká L. Inequalities in Cancer Deaths by Age, Gender and Education. Cent Eur J Public Health 2018. [PMID: 29524371 DOI: 10.21101/cejph.a5055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The economy of each state provides a significant amount of money into the health care system with the aim of knowing the health status of its population in the context of socioeconomic characteristics for effective resource allocation. In recent years, there is a growing number of cancer deaths in Slovakia. Therefore, the structure of cancer deaths according to its primary determinants, such as age, sex and education with the aim of effective implementation of prevention programs in Slovakia was examined. METHODS Main source of data on deaths from 1996 to 2014 was provided by National Health Information Centre in Slovakia. However, data were available only from 2011. Standardized mortality rate per 100,000 inhabitants was estimated by the method of direct standardization using European standard population. The R project for statistical computing was used for calculation of statistically significant differences among various groups of mortality. RESULTS The results show that people with primary education die from cancer later than people with higher education. However, major differences related to both sex and age are present in people with university education. A different variety of cancers occur in childhood (neoplasm of brain), adolescents (neoplasm of bone), young adults (neoplasm of brain), or adults (lung cancer and breast cancer). Malignant neoplasm of brain was more prevalent at higher education levels, Malignant neoplasm of bladder and Malignant melanoma of skin were more prevalent at the university level of education. CONCLUSIONS The results can be useful for economists to define the health priorities in each country, make the financial decisions in economics, and thus contribute to better health, economic growth, as well as effective spending of health expenditures.
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Affiliation(s)
- Marek Gróf
- Faculty of Economics, Technical University of Košice, Košice, Slovak Republic
| | - Tatiana Vagašová
- Faculty of Economics, Technical University of Košice, Košice, Slovak Republic
| | - Marián Oltman
- Center for Gastroenterology and Hepatology Thalion, Bratislava, Slovak Republic
| | - Ľubomír Skladaný
- Department Internal Medicine II, Faculty of Medicine, Slovak Medical University in Bratislava, F. D. Roosevelt University Hospital, Banská Bystrica, Slovak Republic
| | - Lenka Maličká
- Faculty of Economics, Technical University of Košice, Košice, Slovak Republic
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Dai L, Song L, Li X, Yang Y, Zheng X, Wu Y, Li C, Zhao H, Wang Y, Wu S, Wang Y. Association of visit-to-visit blood pressure variability with the risk of all-cause mortality and cardiovascular events in general population. J Clin Hypertens (Greenwich) 2018; 20:280-288. [PMID: 29457332 PMCID: PMC8031234 DOI: 10.1111/jch.13192] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 11/27/2022]
Abstract
The association between blood pressure variability (BPV) and the risk of all-cause mortality and cardiovascular diseases (CVD) is not well understood. The Kailuan study is a prospective longitudinal cohort study on cerebrovascular events and cardiovascular factors. In this study, resting blood pressure was measured at baseline and every 2 years from 2006 to 2007. BPV is mainly defined as the coefficient of variation (CV). Hazard ratio (HR), with 95% confidence intervals (CI) was calculated using Cox regression model. Among 52 387 participants, we identified 1817 who ended up with all-cause death and 1198 with CVD. Each 4.68% increase in BPV was associated with a 13% increase in the risk of mortality (HR = 1.13, 95% CI = 1.09-1.18) and a 7% increase in CVD (HR = 1.07, 95% CI = 1.02-1.13), respectively. After adjustment of confounding factors, the HR of comparing participants in the highest versus lowest quartile of CV of systolic blood pressure (SBP) was 1.37 (1.19, 1.57) for all-cause death, 1.18 (1.01, 1.39) for CVD. Similar results were also observed when BPV was measured by different parameters. We concluded that visit-to-visit BPV was associated with all-cause death and cardiovascular and cerebrovascular events in Chinese general population.
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Affiliation(s)
- Liye Dai
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Lu Song
- Department of RespiratoryKailuan HospitalNorth China University of Science and TechnologyTangshanChina
| | - Xiaoli Li
- Department of General Practice MedicalKailuan General HospitalTangshanChina
| | - Yuling Yang
- Department of NeurologyKailuan General HospitalTangshanChina
| | - Xiaoming Zheng
- Department of CardiologyKailuan HospitalNorth China University of Science and TechnologyTangshanChina
| | - Yuntao Wu
- Department of CardiologyKailuan HospitalNorth China University of Science and TechnologyTangshanChina
| | - Chunhui Li
- Department of Internal MedcineMaternal and Child Health Hospital of TangshanTangshanChina
| | - Hualing Zhao
- Department of Intensive Care UnitKailuan Hospital, North China University of Science and TechnologyTangshanChina
| | - Yilong Wang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseaseBeijingChina
| | - Shouling Wu
- Department of CardiologyKailuan HospitalNorth China University of Science and TechnologyTangshanChina
| | - Yongjun Wang
- Department of NeurologyBeijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
- Center of StrokeBeijing Institute for Brain DisordersBeijingChina
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular DiseaseBeijingChina
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Kones R, Rumana U. Cardiometabolic diseases of civilization: history and maturation of an evolving global threat. An update and call to action. Ann Med 2017; 49:260-274. [PMID: 27936950 DOI: 10.1080/07853890.2016.1271957] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Despite striking extensions of lifespan, leading causes of death in most countries now constitute chronic, degenerative diseases which outpace the capacity of health systems. Cardiovascular disease is the most common cause of death in both developed and undeveloped countries. In America, nearly half of the adult population has at least one chronic disease, and polypharmacy is commonplace. Prevalence of ideal cardiovascular health has not meaningfully improved over the past two decades. The fall in cardiovascular deaths in Western countries, half due to a fall in risk factors and half due to improved treatments, have plateaued, and this reversal is due to the dual epidemics of obesity and diabetes type 2. High burdens of cardiovascular risk factors are also evident globally. Undeveloped nations bear the burdens of both infectious diseases and high childhood death rates. Unacceptable rates of morbidity and mortality arise from insufficient resources to improve sanitation, pure water, and hygiene, ultimately linked to poverty and disparities. Simultaneously, about 80% of cardiovascular deaths now occur in low- and middle-income nations. For these reasons, risk factors for noncommunicable diseases, including poverty, health illiteracy, and lack of adherence, must be targeted with unprecedented vigor worldwide. Key messages In developed and relatively wealthy countries, chronic "degenerative" diseases have attained crisis proportions that threaten to reverse health gains made within the past decades. Although poverty, disparities, and poor sanitation still cause unnecessary death and despair in developing nations, they are now also burdened with increasing cardiovascular mortality. Poor adherence and low levels of health literacy contribute to the high background levels of cardiovascular risk.
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Affiliation(s)
- Richard Kones
- a Cardiology Section , The Cardiometabolic Research Institute , Houston , TX , USA
| | - Umme Rumana
- a Cardiology Section , The Cardiometabolic Research Institute , Houston , TX , USA
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Viego V, Temporelli K. Socioeconomic Status and Self-Reported Chronic Diseases Among Argentina's Adult Population: Results Based on Multivariate Probability Models. J Public Health Res 2017; 6:883. [PMID: 28785549 PMCID: PMC5523004 DOI: 10.4081/jphr.2017.883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/03/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hypertension, diabetes and hypercholesterolemia are the most frequent and diagnosed chronic diseases in Argentina. They contribute largely to the burden of chronic disease and they are strongly influenced by a small number of risk factors. These risk factors are all modifiable at the population and individual level and offer major prospects for their prevention. We are interested in socioeconomic determinants of prevalence of those 3 specific diseases. DESIGN AND METHODS We estimate 3-equation probit model, combined with 3 separate probit estimations and a probit-based Heckman correction considering possible sample selection bias. Estimations were carried out using secondary self-reported data coming from the 2013 Risk Factor National Survey. RESULTS We find a negative association between socioeconomic status and prevalence of hypertension, cholesterolemia and diabetes; main increases concentrate in the transition from low to high SES in hypertension and diabetes. In cholesterol, the major effect takes place when individual crosses from low to middle SES and then vanishes. Anyway, in Argentina SES exhibit and independent effect on chronic diseases apart from those based on habits and body weight. CONCLUSIONS Public strategies to prevent chronic diseases must be specially targeted at women, poorest households and the least educated individuals in order to achieve efficacy. Also, as the probability of having a condition related to excessive blood pressure, high levels of cholesterol or glucose in the blood do not increase proportionally with age, so public campaigns promoting healthy diets, physical activity and medical checkups should be focused on young individuals to facilitate prophylaxis.
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Affiliation(s)
- Valentina Viego
- Instituto de Investigaciones Economica y Sociales del Sur, CONICET; Department of Economics, Universidad Nacional del Sur, Argentina
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Bonaccio M, Di Castelnuovo A, Costanzo S, Persichillo M, Donati MB, de Gaetano G, Iacoviello L. Interaction between education and income on the risk of all-cause mortality: prospective results from the MOLI-SANI study. Int J Public Health 2016; 61:765-76. [DOI: 10.1007/s00038-016-0822-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022] Open
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10
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Koch E, Chireau M, Pliego F, Stanford J, Haddad S, Calhoun B, Aracena P, Bravo M, Gatica S, Thorp J. Abortion legislation, maternal healthcare, fertility, female literacy, sanitation, violence against women and maternal deaths: a natural experiment in 32 Mexican states. BMJ Open 2015; 5:e006013. [PMID: 25712817 PMCID: PMC4342595 DOI: 10.1136/bmjopen-2014-006013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/28/2014] [Accepted: 12/02/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To test whether there is an association between abortion legislation and maternal mortality outcomes after controlling for other factors thought to influence maternal health. DESIGN Population-based natural experiment. SETTING AND DATA SOURCES Official maternal mortality data from 32 federal states of Mexico between 2002 and 2011. MAIN OUTCOMES Maternal mortality ratio (MMR), MMR with any abortive outcome (MMRAO) and induced abortion mortality ratio (iAMR). INDEPENDENT VARIABLES Abortion legislation grouped as less (n=18) or more permissive (n=14); constitutional amendment protecting the unborn (n=17); skilled attendance at birth; all-abortion hospitalisation ratio; low birth weight rate; contraceptive use; total fertility rates (TFR); clean water; sanitation; female literacy rate and intimate-partner violence. MAIN RESULTS Over the 10-year period, states with less permissive abortion legislation exhibited lower MMR (38.3 vs 49.6; p<0.001), MMRAO (2.7 vs 3.7; p<0.001) and iAMR (0.9 vs 1.7; p<0.001) than more permissive states. Multivariate regression models estimating effect sizes (β-coefficients) for mortality outcomes showed independent associations (p values between 0.001 and 0.055) with female literacy (β=-0.061 to -1.100), skilled attendance at birth (β=-0.032 to -0.427), low birth weight (β=0.149 to 2.166), all-abortion hospitalisation ratio (β=-0.566 to -0.962), clean water (β=-0.048 to -0.730), sanitation (β=-0.052 to -0.758) and intimate-partner violence (β=0.085 to 0.755). TFR showed an inverse association with MMR (β=-14.329) and MMRAO (β=-1.750) and a direct association with iAMR (β=1.383). Altogether, these factors accounted for (R(2)) 51-88% of the variance among states in overall mortality rates. No statistically independent effect was observed for abortion legislation, constitutional amendment or other covariates. CONCLUSIONS Although less permissive states exhibited consistently lower maternal mortality rates, this finding was not explained by abortion legislation itself. Rather, these differences were explained by other independent factors, which appeared to have a more favourable distribution in these states.
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Affiliation(s)
- Elard Koch
- Division of Epidemiology, MELISA Institute, Concepción, Chile
| | - Monique Chireau
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, USA
| | - Fernando Pliego
- Instituto de Investigaciones Sociales, Universidad Nacional Autónoma de México, Av Universidad 3000, Copilco Universidad, Ciudad de México, Mexico
| | - Joseph Stanford
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Sebastian Haddad
- Coordinación de Investigación, Facultad de Ciencias de la Salud, Universidad Anáhuac, Estado de México, Mexico
| | - Byron Calhoun
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, USA
| | - Paula Aracena
- Division of Epidemiology, MELISA Institute, Concepción, Chile
| | - Miguel Bravo
- Division of Epidemiology, MELISA Institute, Concepción, Chile
| | | | - John Thorp
- Department of Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, USA
- Center for Women's Health Research, University of North Carolina School of Medicine, Chapel Hill, USA
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11
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Wong MCS, Wang HHX, Leung MCM, Tsang CSH, Lo SV, Griffiths SM. The rising prevalence of self-reported hypertension among Chinese subjects: a population-based study from 121 895 household interviews. QJM 2015; 108:9-17. [PMID: 24939188 DOI: 10.1093/qjmed/hcu129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hypertension is one of the most important public health issues worldwide. AIM We assessed the prevalence rates of self-reported hypertension in Hong Kong between 2001 and 2008 and evaluated factors associated with its prevalence. DESIGN Serial cross-sectional surveys. METHODS Territory-wide Household surveys in the Hong Kong population in the years 2001, 2002, 2005 and 2008 were included. Population-adjusted prevalence of self-reported hypertension were compared across calendar years. The independent association of these variables with hypertension was evaluated by multivariate regression analysis with self-reported hypertension as a binary outcome. RESULTS There were 121 895 subjects interviewed, among which 103 367 were adults aged ≥15 years. The age- and gender-adjusted prevalence of self-reported hypertension in 2001, 2002, 2005 and 2008 among male adults was 4.73, 6.68, 7.96 and 9.82%, respectively, and among female adults, the prevalence was 6.13, 8.28, 10.00 and 11.58%, respectively. Advanced age (adjusted odds ratios [AOR]: 47.1, 95% CI 33.6-66.0 for the age group 40-65 years; AOR 256.2, 95% CI 182.4-360.0 for the age group 66-100 years; referent 0-39 years), female gender (AOR 0.81, 95% CI 0.74-0.88 for male) and a low median household income (AOR 1.56, 95% CI 1.31-1.85 for income ≤ US$1289; referent ≥ US$6444) were significantly associated with hypertension (all P < 0.001). CONCLUSIONS This is the first study to show differences between socioeconomic groups in this Chinese population with higher rates among women and the less affluent. Similarly, it is the first to show gender differences with higher rates among women.
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Affiliation(s)
- M C S Wong
- From the School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China and Food and Health Bureau, The Government of the Hong Kong Special Administrative Region, Hong Kong, China
| | - H H X Wang
- From the School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China and Food and Health Bureau, The Government of the Hong Kong Special Administrative Region, Hong Kong, China
| | - M C M Leung
- From the School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China and Food and Health Bureau, The Government of the Hong Kong Special Administrative Region, Hong Kong, China
| | - C S H Tsang
- From the School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China and Food and Health Bureau, The Government of the Hong Kong Special Administrative Region, Hong Kong, China
| | - S V Lo
- From the School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China and Food and Health Bureau, The Government of the Hong Kong Special Administrative Region, Hong Kong, China
| | - S M Griffiths
- From the School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China and Food and Health Bureau, The Government of the Hong Kong Special Administrative Region, Hong Kong, China
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12
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Koch E, Calhoun B, Aracena P, Gatica S, Bravo M. Women's education level, contraceptive use and maternal mortality estimates. Public Health 2014; 128:384-7. [PMID: 24661638 DOI: 10.1016/j.puhe.2014.01.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 12/24/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Affiliation(s)
- E Koch
- Division of Epidemiology, MELISA Institute, Concepción, Chile; Doctoral Program, Division of Epidemiology, School of Public Health, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - B Calhoun
- Department of Obstetrics and Gynecology, West Virginia University School of Medicine, USA
| | - P Aracena
- Division of Epidemiology, MELISA Institute, Concepción, Chile
| | - S Gatica
- Division of Epidemiology, MELISA Institute, Concepción, Chile
| | - M Bravo
- Division of Epidemiology, MELISA Institute, Concepción, Chile
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Zhao M, Konishi Y, Glewwe P. Does information on health status lead to a healthier lifestyle? Evidence from China on the effect of hypertension diagnosis on food consumption. JOURNAL OF HEALTH ECONOMICS 2013; 32:367-385. [PMID: 23334058 DOI: 10.1016/j.jhealeco.2012.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 11/21/2012] [Accepted: 11/22/2012] [Indexed: 06/01/2023]
Abstract
We examine the role of information in understanding the differential effects of income on the demand for health. In the health capital framework of Grossman (JPE, 1972), we derive the testable hypotheses that individuals adjust their diet in a healthier direction upon receiving negative health information, and that the effect is greater for richer individuals. Based on unique Chinese longitudinal data and a regression discontinuity design that exploits the exogenous cutoff of systolic blood pressure in the diagnosis of hypertension, we find that, upon receiving hypertension diagnosis, individuals reduce fat intake significantly, and richer individuals reduce more. Our results also indicate that among the rich, hypertension diagnosis is more effective for individuals with lower education.
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Affiliation(s)
- Meng Zhao
- Waseda Institute for Advanced Study, Waseda University, 1-6-1 Nishiwaseda, Shinjuku-ku, Tokyo 169-8050, Japan.
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[Cardiovascular risk of immigrants living in Spain according to origin and years of stay]. Aten Primaria 2012; 45:92-100. [PMID: 23164796 PMCID: PMC6985518 DOI: 10.1016/j.aprim.2012.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 10/03/2012] [Accepted: 10/04/2012] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To assess whether there are differences in the immigrant population in terms of the years since their arrival in Spain and their geographical area of origin. DESIGN A cross-sectional study was conducted in three immigrant groups. PARTICIPANTS The groups selected were: a group of Latin American immigrants (298), a group of North African immigrants (130) and a group from Eastern Europe (114). A control group of 100 from a Spanish population of similar age and sex was also included. METHODS Anthropometric variables were measured, including biochemical inflammatory markers, blood pressure and cardiovascular risk estimation according to the tables of the European Societies of Hypertension and Cardiology. RESULTS The cardiovascular risk of the three groups of immigrants is similar between them (added cardiovascular risk high or very high at 5.5% in Latin Americans, 4.3% in North Africans, and 1.6% in immigrants from eastern countries), but significantly lower than the Spanish control group (28%). After 8 years in Spain, cardiovascular risk increases in the three groups of immigrants, with those from North Africa and eastern countries being comparable to the Spanish group (added cardiovascular risk high or very high of 18.5% in North Africans, and 20% in group from eastern countries). This cardiovascular risk was higher than the other groups, including the Spanish control group (Latin American immigrants 48.7% vs 28% in Spanish group). CONCLUSIONS The cardiovascular risk of immigrants increases over the years in Spain, with this increase being higher if they come from Latin America. This increase becomes clinically significant after the 8 years of stay in Spain.
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Sandoval D, Bravo M, Koch E, Gatica S, Ahlers I, Henríquez O, Romero T. Overcoming barriers in the management of hypertension: the experience of the cardiovascular health program in chilean primary health care centers. Int J Hypertens 2012; 2012:405892. [PMID: 22701781 PMCID: PMC3373127 DOI: 10.1155/2012/405892] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2012] [Accepted: 02/07/2012] [Indexed: 12/03/2022] Open
Abstract
Objective. To assess the blood pressure control and cardiovascular risk factors (CVRFs) in a population of hypertensive patients with access to care under a government-financed program, the Cardiovascular Health Program (CHP). Design. A cross-sectional and multicenter study. Setting. 52 primary care centers, metropolitan area of Santiago, Chile. Participants. 1,194 patients were selected by a systematic random sampling from a universe of 316,654 hypertensive patients. Key Measurements. Demographic information, blood pressure (BP) measurements, and CVRF were extracted from medical records of patients followed for a 12-month period. Results. 59.7% of patients reached target BP <140/90 mmHg. More women were captured in the sampling (2.1 : 1), achieving better BP control than men. Diabetic patients (26.4%) had worse BP control than nondiabetics. Antihypertensive medications were used in 91.5%, with multidrug therapy more frequent in patients with higher BP and more difficult control. Conclusions. The success in improving the BP control to values <140/90 mmHg from 45.3% to 59.7% underscores the contribution of this program in the Chilean primary care cardiovascular preventive strategies. However, fewer hypertensive men than women were captured by this program, and it is of concern the underperforming of BP control observed in diabetics.
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Affiliation(s)
- Daniela Sandoval
- Department of Family Medicine & Primary Care, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile
| | - Miguel Bravo
- Institute of Molecular Epidemiology (MELISA), Faculty of Medicine, Universidad Católica de la Santísima Concepción, 4070129 Concepción, Chile
| | - Elard Koch
- Department of Family Medicine & Primary Care, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile
- Institute of Molecular Epidemiology (MELISA), Faculty of Medicine, Universidad Católica de la Santísima Concepción, 4070129 Concepción, Chile
| | - Sebastián Gatica
- Institute of Molecular Epidemiology (MELISA), Faculty of Medicine, Universidad Católica de la Santísima Concepción, 4070129 Concepción, Chile
| | - Ivonne Ahlers
- Department of Family Medicine & Primary Care, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile
| | - Oscar Henríquez
- Department of Family Medicine & Primary Care, Faculty of Medicine, University of Chile, 8380453 Santiago, Chile
| | - Tomás Romero
- School of Medicine, University of California, San Diego, CA 92093, USA
- Fundacion Araucaria Foundation, Coronado, CA 92118, USA
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Gitlin LN, Fuentes P. The Republic of Chile: an upper middle-income country at the crossroads of economic development and aging. THE GERONTOLOGIST 2012; 52:297-305. [PMID: 22534464 PMCID: PMC4047290 DOI: 10.1093/geront/gns054] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 03/16/2012] [Indexed: 10/28/2022] Open
Abstract
Chile is a developing country with a rapidly expanding economy and concomitant social and cultural changes. It is expected to become a developed country within 10 years. Chile is also characterized as being in an advanced demographic transition. Unique challenges are posed by the intersection of rapid economic development and an aging population, making Chile an intriguing case study for examining the impact of these societal-level trends on the aging experience. This paper highlights essential characteristics of this country for understanding its emerging aging society. It reveals that there is a fundamental lack of adequate and depthful epidemiologic and country-specific research from which to fully understand the aging experience and guide new policies in support of health and well-being.
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Affiliation(s)
- Laura N Gitlin
- Department of Health Systems and Outcomes, School of Nursing, Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD 21205, USA.
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Linetzky B, De Maio F, Ferrante D, Konfino J, Boissonnet C. Sex-stratified socio-economic gradients in physical inactivity, obesity, and diabetes: evidence of short-term changes in Argentina. Int J Public Health 2012; 58:277-84. [DOI: 10.1007/s00038-012-0371-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 05/02/2012] [Accepted: 05/03/2012] [Indexed: 11/30/2022] Open
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Koch E, Thorp J, Bravo M, Gatica S, Romero CX, Aguilera H, Ahlers I. Women's education level, maternal health facilities, abortion legislation and maternal deaths: a natural experiment in Chile from 1957 to 2007. PLoS One 2012; 7:e36613. [PMID: 22574194 PMCID: PMC3344918 DOI: 10.1371/journal.pone.0036613] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 04/10/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the main factors related to maternal mortality reduction in large time series available in Chile in context of the United Nations' Millennium Development Goals (MDGs). METHODS Time series of maternal mortality ratio (MMR) from official data (National Institute of Statistics, 1957-2007) along with parallel time series of education years, income per capita, fertility rate (TFR), birth order, clean water, sanitary sewer, and delivery by skilled attendants were analysed using autoregressive models (ARIMA). Historical changes on the mortality trend including the effect of different educational and maternal health policies implemented in 1965, and legislation that prohibited abortion in 1989 were assessed utilizing segmented regression techniques. RESULTS During the 50-year study period, the MMR decreased from 293.7 to 18.2/100,000 live births, a decrease of 93.8%. Women's education level modulated the effects of TFR, birth order, delivery by skilled attendants, clean water, and sanitary sewer access. In the fully adjusted model, for every additional year of maternal education there was a corresponding decrease in the MMR of 29.3/100,000 live births. A rapid phase of decline between 1965 and 1981 (-13.29/100,000 live births each year) and a slow phase between 1981 and 2007 (-1.59/100,000 live births each year) were identified. After abortion was prohibited, the MMR decreased from 41.3 to 12.7 per 100,000 live births (-69.2%). The slope of the MMR did not appear to be altered by the change in abortion law. CONCLUSION Increasing education level appears to favourably impact the downward trend in the MMR, modulating other key factors such as access and utilization of maternal health facilities, changes in women's reproductive behaviour and improvements of the sanitary system. Consequently, different MDGs can act synergistically to improve maternal health. The reduction in the MMR is not related to the legal status of abortion.
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Affiliation(s)
- Elard Koch
- Institute of Molecular Epidemiology (MELISA), Center of Embryonic Medicine and Maternal Health, Faculty of Medicine, Universidad Católica de la Santísima Concepción, Concepción, Chile.
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De Maio FG. Understanding chronic non-communicable diseases in Latin America: towards an equity-based research agenda. Global Health 2011; 7:36. [PMID: 21981767 PMCID: PMC3193810 DOI: 10.1186/1744-8603-7-36] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 10/07/2011] [Indexed: 11/10/2022] Open
Abstract
Although chronic non-communicable diseases are traditionally depicted as diseases of affluence, growing evidence suggests they strike along the fault lines of social inequality. The challenge of understanding how these conditions shape patterns of population health in Latin America requires an inter-disciplinary lens. This paper reviews the burden of chronic non-communicable diseases in the region and examines key myths surrounding their prevalence and distribution. It argues that a social justice approach rooted in the idea of health inequity needs to be at the core of research in this area, and concludes with discussion of a new approach to guide empirical research, the 'average/deprivation/inequality' framework.
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Affiliation(s)
- Fernando G De Maio
- Department of Sociology, DePaul University, 990 W, Fullerton Ave,, Suite 1100, Chicago, IL 60614, USA.
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Romero T, Romero CX. Stagnant in cardiovascular prevention: alarming trends and persistent socioeconomic obstacles. Rev Esp Cardiol 2011; 63:1340-8. [PMID: 21070729 DOI: 10.1016/s1885-5857(10)70258-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recently it has been suggested that the decline in cardiovascular mortality observed over the last 50 years may be coming to an end. This alarming trend, which has been noted mainly in younger adults from lower socioeconomic strata, may be linked to other changes, namely the increasing prevalence of modifiable risk factors, the most important of which is obesity. In contrast, our ability to predict cardiovascular risk continues to improve steadily, although it is unclear which will be its ability in designing more effective global preventive measures. Coronary heart disease appears to develop through multiple pathways, whose association with cardiovascular risk is mediated by complex processes involving numerous factors ranging from genetic predisposition to unfavorable socioeconomic circumstances. Although some attention has been paid to the latter, more effort has been put into controlling isolated risk factors. For example, numerous large studies have involved looking at the effect of single-drug therapies aimed at specific targets rather than examining more comprehensive approaches to managing multiple risk factors. In conclusion, an effective strategy for controlling modifiable risk factors in both individuals and populations must address this complex scenario and should consider significant socioeconomic factors such as education, income and the built environment. The unfavorable trend observed in cardiovascular health makes it essential that current preventive strategies are reassessed.
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Affiliation(s)
- Tomás Romero
- Departamento de Medicina, Facultad de Medicina, Universidad de California, San Diego, USA.
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Hajsheikholeslami F, Hatami M, Hadaegh F, Ghanbarian A, Azizi F. Association of educational status with cardiovascular disease: Teheran Lipid and Glucose Study. Int J Public Health 2010; 56:281-7. [PMID: 21152950 DOI: 10.1007/s00038-010-0225-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 10/17/2010] [Accepted: 11/15/2010] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the associations between educational level and cardiovascular disease (CVD) in an older Iranian population. METHODS To estimate the odds ratio (OR) of educational level in a cross-sectional study, logistic regression analysis was used on 1,788 men and 2,204 women (222 men and 204 women positive based on their CVD status) aged ≥ 45 years. RESULTS In men, educational levels of college degree and literacy level below diploma were inversely associated with CVD in the multivariate model [0.52 (0.28-0.94), 0.61 (0.40-0.92), respectively], but diploma level did not show any significant association with CVD, neither in the crude model nor in the multivariate model. In women, increase in educational level was inversely associated with risk of CVD in the crude model, but in the multivariate adjusted model, literacy level below diploma decreased risk of CVD by 39%, compared with illiteracy. CONCLUSION Our findings support those of developed countries that, along with other CVD risk factors, educational status has an inverse association with CVD among a representative Iranian population of older men and women.
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Affiliation(s)
- Farhad Hajsheikholeslami
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, PO Box 19395-4763, Yaman Street, Velenjak, Tehran, Iran.
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Romero T, Romero CX. Prevención cardiovascular estancada: tendencias alarmantes y barreras socioeconómicas persistentes. Rev Esp Cardiol 2010. [DOI: 10.1016/s0300-8932(10)70303-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Boneberger A, Radon K, Baer J, Kausel L, Kabesch M, Haider D, Schierl R, von Kries R, Calvo M. Asthma in changing environments--chances and challenges of international research collaborations between South America and Europe--study protocol and description of the data acquisition of a case-control-study. BMC Pulm Med 2010; 10:43. [PMID: 20718949 PMCID: PMC2930633 DOI: 10.1186/1471-2466-10-43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 08/18/2010] [Indexed: 12/11/2022] Open
Abstract
Background Asthma in children is an emerging public health problem in South America. So far, research in this part of the world is limited. This paper presents the methodology and description of the data acquisition of an asthma case-control study conducted in the Central South of Chile. Methods/Design A hospital-based case-control study about asthma (188 cases, 294 controls) in children (6-15 years) was carried out in Valdivia, Chile between November 2008 and December 2009. Data on asthma risk factors were collected by computer-assisted personal interview using validated questions from e.g. ISAAC phase II. Data on household dust exposure (endotoxin, allergen analyses), skin prick tests to most common allergens, stool examinations for parasitic infection, and blood samples (total IgE, genetics) were collected. Additionally, 492 randomly chosen blood donors were recruited in order to assess allele frequencies in the population of Valdivia. Discussion Overall 1,173 participants were contacted. Response was 82% among cases and 65% among controls. Atopic sensitization was high (78% among cases, 47% among controls). Cases had a statistically significantly (p < .0001) increased self-reported 12-month prevalence of symptoms of rhinitis (82% vs. 51%) and wheeze (68% vs. 16%). The study is well placed to address current hypotheses about asthma and its correlates in the South American context. Results of this study might help develop novel, innovative and individualized prevention strategies in countries in transition with respect to the South American context.
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Affiliation(s)
- Anja Boneberger
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Hospital of the Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336 Munich, Germany
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Early Life and Adult Socioeconomic Influences on Mortality Risk: Preliminary Report of a ‘Pauper Rich’ Paradox in a Chilean Adult Cohort. Ann Epidemiol 2010; 20:487-92. [DOI: 10.1016/j.annepidem.2010.03.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 02/09/2010] [Accepted: 03/02/2010] [Indexed: 11/20/2022]
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