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Zhu Y, Hu C, Lin L, Wang S, Lin H, Huo Y, Wan Q, Qin Y, Hu R, Shi L, Su Q, Yu X, Yan L, Qin G, Tang X, Chen G, Xu M, Xu Y, Wang T, Zhao Z, Gao Z, Wang G, Shen F, Luo Z, Chen L, Li Q, Ye Z, Zhang Y, Liu C, Wang Y, Wu S, Yang T, Deng H, Chen L, Zeng T, Zhao J, Mu Y, Wang W, Ning G, Bi Y, Chen Y, Lu J. Obesity mediates the opposite association of education and diabetes in Chinese men and women: Results from the REACTION study. J Diabetes 2022; 14:739-748. [PMID: 36217863 PMCID: PMC9705800 DOI: 10.1111/1753-0407.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/06/2022] [Accepted: 09/17/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Evidence regarding the impact of education on diabetes risk is scarce in developing countries. We aimed to explore the association between education and diabetes within a large population in China and to identify the possible mediators between them. METHODS Information on educational level and lifestyle factors was collected through questionnaires. Diabetes was diagnosed from self-report and biochemical measurements. A structural equation model was constructed to quantify the mediation effect of each mediator. RESULTS Compared with their least educated counterparts, men with college education had a higher risk of diabetes (odds ratio [OR] 1.19; 95% confidence interval [CI], 1.12-1.27), while college-educated women were less likely to have diabetes (OR 0.77; 95% CI, 0.73-0.82). Obesity was the strongest mediator in both genders (proportion of mediation: 11.6% in men and 23.9% in women), and its association with education was positive in men (β[SE] 0.0387 [0.0037]) and negative in women (β[SE] -0.0824 [0.0030]). Taken together, all behavioral factors explained 12.4% of the excess risk of diabetes in men and 33.3% in women. CONCLUSIONS In a general Chinese population, the association between education level and diabetes was positive in men but negative in women. Obesity was the major mediator underlying the education disparities of diabetes risk, with a stronger mediation effect among women.
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Affiliation(s)
- Yuanyue Zhu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Chunyan Hu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Lin Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hong Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yanan Huo
- Jiangxi Provincial People's Hospital Affiliated to Nanchang UniversityNanchangChina
| | - Qin Wan
- The Affiliated Hospital of Luzhou Medical CollegeLuzhouChina
| | - Yingfen Qin
- The First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Ruying Hu
- Zhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Lixin Shi
- Affiliated Hospital of Guiyang Medical UniversityGuiyangChina
| | - Qing Su
- Xinhua Hospital Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
| | - Xuefeng Yu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Li Yan
- Sun Yat‐sen Memorial Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Guijun Qin
- The First Affiliated Hospital of Zhengzhou UniversityZhengzhouChina
| | - Xulei Tang
- The First Hospital of Lanzhou UniversityLanzhouChina
| | - Gang Chen
- Fujian Provincial Hospital, Fujian Medical UniversityFuzhouChina
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zhengnan Gao
- Dalian Municipal Central Hospital Affiliated of Dalian Medical UniversityDalianChina
| | - Guixia Wang
- The First Hospital of Jilin UniversityChangchunChina
| | - Feixia Shen
- The First Affiliated Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Zuojie Luo
- The First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Li Chen
- Qilu Hospital of Shandong UniversityJinanChina
| | - Qiang Li
- The Second Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Zhen Ye
- Zhejiang Provincial Center for Disease Control and PreventionHangzhouChina
| | - Yinfei Zhang
- Central Hospital of Shanghai Jiading DistrictShanghaiChina
| | - Chao Liu
- Jiangsu Province Hospital on Integration of Chinese and Western MedicineNanjingChina
| | - Youmin Wang
- The First Affiliated Hospital of Anhui Medical UniversityHefeiChina
| | - Shengli Wu
- Karamay Municipal People's HospitalXinjiangChina
| | - Tao Yang
- The First Affiliated Hospital of Nanjing Medical UniversityNanjingChina
| | - Huacong Deng
- The First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Lulu Chen
- Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Tianshu Zeng
- Union HospitalTongji Medical College, Huazhong University of Science and TechnologyWuhanChina
| | - Jiajun Zhao
- Shandong Provincial Hospital affiliated to Shandong UniversityJinanChina
| | - Yiming Mu
- Chinese People's Liberation Army General HospitalBeijingChina
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Guang Ning
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
- Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Key Laboratory for Endocrine Tumors, State Key Laboratory of Medical Genomics, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Ichihara MY, Ferreira AJ, Teixeira CSS, Alves FJO, Rocha AS, Diógenes VHD, Ramos DO, Pinto EP, Flores-Ortiz R, Rameh L, da Costa LCC, Gonzaga MR, Lima EEC, Dundas R, Leyland A, Barreto ML. Mortality inequalities measured by socioeconomic indicators in Brazil: a scoping review. Rev Saude Publica 2022; 56:85. [PMID: 36228230 PMCID: PMC9529207 DOI: 10.11606/s1518-8787.2022056004178] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Summarize the literature on the relationship between composite socioeconomic indicators and mortality in different geographical areas of Brazil. METHODS This scoping review included articles published between January 1, 2000, and August 31, 2020, retrieved by means of a bibliographic search carried out in the Medline, Scopus, Web of Science, and Lilacs databases. Studies reporting on the association between composite socioeconomic indicators and all-cause, or specific cause of death in any age group in different geographical areas were selected. The review summarized the measures constructed, their associations with the outcomes, and potential study limitations. RESULTS Of the 77 full texts that met the inclusion criteria, the study reviewed 24. The area level of composite socioeconomic indicators analyzed comprised municipalities (n = 6), districts (n = 5), census tracts (n = 4), state (n = 2), country (n = 2), and other areas (n = 5). Six studies used composite socioeconomic indicators such as the Human Development Index, Gross Domestic Product, and the Gini Index; the remaining 18 papers created their own socioeconomic measures based on sociodemographic and health indicators. Socioeconomic status was inversely associated with higher rates of all-cause mortality, external cause mortality, suicide, homicide, fetal and infant mortality, respiratory and circulatory diseases, stroke, infectious and parasitic diseases, malnutrition, gastroenteritis, and oropharyngeal cancer. Higher mortality rates due to colorectal cancer, leukemia, a general group of neoplasms, traffic accident, and suicide, in turn, were observed in less deprived areas and/or those with more significant socioeconomic development. Underreporting of death and differences in mortality coverage in Brazilian areas were cited as the main limitation. CONCLUSIONS Studies analyzed mortality inequalities in different geographical areas by means of composite socioeconomic indicators, showing that the association directions vary according to the mortality outcome. But studies on all-cause mortality and at the census tract level remain scarce. The results may guide the development of new composite socioeconomic indicators for use in mortality inequality analysis.
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Affiliation(s)
- Maria Yury Ichihara
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
| | - Andrêa J.F. Ferreira
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Camila S. S. Teixeira
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Flávia Jôse O. Alves
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Aline Santos Rocha
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
- Universidade Federal da BahiaEscola de NutriçãoSalvadorBABrasil Universidade Federal da Bahia. Escola de Nutrição. Salvador, BA, Brasil
| | - Victor Hugo Dias Diógenes
- Universidade Federal do Rio Grande do NortePrograma de Pós-Graduação em DemografiaNatalRNBrasil Universidade Federal do Rio Grande do Norte. Programa de Pós-Graduação em Demografia. Natal, RN, Brasil
- Universidade Federal da ParaíbaDepartamento de Finanças e ContabilidadeJoão PessoaPBBrasilUniversidade Federal da Paraíba. Departamento de Finanças e Contabilidade. João Pessoa, PB, Brasil
| | - Dandara Oliveira Ramos
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
| | - Elzo Pereira Pinto
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
| | - Renzo Flores-Ortiz
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
| | - Leila Rameh
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
| | - Lilia Carolina C. da Costa
- Universidade Federal da BahiaInstituto de Matemática e EstatísticaSalvadorBABrasil Universidade Federal da Bahia. Instituto de Matemática e Estatística. Salvador, BA, Brasil
| | - Marcos Roberto Gonzaga
- Universidade Federal do Rio Grande do NortePrograma de Pós-Graduação em DemografiaNatalRNBrasil Universidade Federal do Rio Grande do Norte. Programa de Pós-Graduação em Demografia. Natal, RN, Brasil
| | - Everton E. C. Lima
- Universidade Estadual de CampinasDepartamento de DemografiaCampinasSPBrasilUniversidade Estadual de Campinas, Departamento de Demografia. Campinas, SP, Brasil
| | - Ruth Dundas
- Medical Research CouncilUniversity of GlasgowGlasgowScotlandMedical Research Council. University of Glasgow, Glasgow, Scotland
| | - Alastair Leyland
- Medical Research CouncilUniversity of GlasgowGlasgowScotlandMedical Research Council. University of Glasgow, Glasgow, Scotland
| | - Maurício L. Barreto
- Fundação Oswaldo CruzCentro de Integração de Dados e Conhecimentos para SaúdeSalvadorBABrasil Fundação Oswaldo Cruz. Centro de Integração de Dados e Conhecimentos para Saúde. Salvador, BA, Brasil
- Universidade Federal da BahiaInstituto de Saúde ColetivaSalvadorBABrasilUniversidade Federal da Bahia. Instituto de Saúde Coletiva. Salvador, BA, Brasil
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Hynicka LM, Piedrahita G, Barnabic C, Rambob I, Berman BM, D'Adamo CR. Interprofessional Culinary Medicine Training Enhanced Nutrition Knowledge, Nutrition Counseling Confidence, and Interprofessional Experience. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:811-820. [PMID: 35834608 DOI: 10.1089/jicm.2022.0573] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Introduction: Culinary medicine training combining evidence-based nutrition instruction with experiential cooking application has improved nutrition knowledge, skills, and attitudes in the professional and personal lives of medical students. However, interprofessional culinary training remains largely unstudied among professional students who will be involved in collaborative patient care. The goal of this study was to evaluate the feasibility and effectiveness of an elective interprofessional culinary medicine course for students in the medical, pharmacy, social work, nursing, law, and dentistry schools at the University of Maryland, Baltimore. Methods: The interprofessional culinary medicine course was offered in-person at the teaching kitchen of the Nova Institute for Health in 2020 and virtually in 2021 during the COVID pandemic. The training featured five workshops combining instruction in a variety of popular diets, cooking a meal inspired by the diet in focus, and group discussion. Paired t tests were utilized to evaluate changes in pre-/post-training nutrition and interprofessional experience outcomes. Linear regression models were constructed to compare outcomes between in-person and virtual delivery. Results: A total of 62 students participated in the culinary medicine training. Confidence in all nutrition knowledge, skills, and attitudes, as well as interprofessional experience outcomes, improved after the training (p < 0.05). Similar improvements were noted in most outcomes with in-person and virtual delivery in linear regression modeling. Discussion: Interprofessional culinary medicine training is feasible, and virtual delivery may help enhance replicability in other settings.
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Affiliation(s)
- Lauren M Hynicka
- Pharmacy Practice and Science Department, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | | | - Christine Barnabic
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Isabel Rambob
- Department of Neural and Pain Sciences, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Brian M Berman
- Nova Institute for Health, Baltimore, MD, USA
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Christopher R D'Adamo
- Nova Institute for Health, Baltimore, MD, USA
- Department of Family & Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Sharma SK, Nambiar D, Sankar H, Joseph J, Surendran S, Benny G. Decomposing socioeconomic inequality in blood pressure and blood glucose testing: evidence from four districts in Kerala, India. Int J Equity Health 2022; 21:128. [PMID: 36085070 PMCID: PMC9461212 DOI: 10.1186/s12939-022-01737-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/03/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Non-Communicable Diseases (NCDs) constitute a significant danger to the nation's public health system, both in terms of morbidity and mortality, as well as the financial burden they inflict. Kerala is undergoing an epidemiologic transition, which has significantly impacted the state's morbidity and mortality figures. For decades, the state has been putting in place myriad programs to reduce the burden of NCDs across population groups. Socioeconomic inequalities in NCD testing have been documented in India, although they are understudied in Kerala. The study aimed to estimate and characterize districtwise socioeconomic inequality in Blood Pressure (BP) and Blood Glucose (BG) testing. METHODS A cross-sectional household survey was conducted between July-October 2019 in Kasaragod, Alappuzha, Kollam and Thiruvananthapuram districts of Kerala, India. A total of 6383 participants aged 30 years and above were interviewed using multistage random sampling. Descriptive statistics were derived district-wise. We computed ratios, differences, equiplots, and Erreygers concentration indices for each district to measure socioeconomic inequality in BP and BG testing. Erreygers decomposition techniques were used to estimate the relative contribution of covariates to socioeconomic inequality. RESULTS There was a significant concentration of BP and BG testing favouring wealthier quintiles in Alappuzha, Kollam, and Thiruvananthapuram districts. The inequality in BP and BG testing was highest in Thiruvananthapuram (0.087 and 0.110), followed by Kollam (0.077 and 0.090), Alappuzha (0.083 and 0.073) and Kasaragod (0.026 and 0.056). Decomposition analysis revealed that wealth quintile and education contributed substantially to socioeconomic inequality in BP and BG testing in all four districts. It was also found that family history of NCDs significantly contributed to observed socioeconomic inequality in BP testing (29, 11, 16, and 27% in Kasaragod, Alappuzha, Kollam, and Thiruvananthapuram, respectively). Similarly, in BG testing, family history of NCDs substantially contributed to observed socioeconomic inequality, explaining 16-17% in Kasaragod, Alappuzha, Kollam, and Thiruvananthapuram respectively of the total inequality. CONCLUSION While the magnitude of socioeconomic inequality in NCD risk factor testing did not appear to be very high in four Kerala districts, although levels were statistically significant in three of them. Greater exploration is needed on how education and caste contribute to these inequalities and their relationship to NCD risk factors such as family history. From such analyses, we may be able to identify entry points to mitigate inequalities in testing access, as well as burden.
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Affiliation(s)
| | - Devaki Nambiar
- Health Systems and Equity, The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Hari Sankar
- The George Institute for Global Health, New Delhi, India
| | - Jaison Joseph
- The George Institute for Global Health, New Delhi, India
| | | | - Gloria Benny
- The George Institute for Global Health, New Delhi, India
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Dearing C, Handa RJ, Myers B. Sex differences in autonomic responses to stress: implications for cardiometabolic physiology. Am J Physiol Endocrinol Metab 2022; 323:E281-E289. [PMID: 35793480 PMCID: PMC9448273 DOI: 10.1152/ajpendo.00058.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/21/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022]
Abstract
Chronic stress is a significant risk factor for negative health outcomes. Furthermore, imbalance of autonomic nervous system control leads to dysregulation of physiological responses to stress and contributes to the pathogenesis of cardiometabolic and psychiatric disorders. However, research on autonomic stress responses has historically focused on males, despite evidence that females are disproportionality affected by stress-related disorders. Accordingly, this mini-review focuses on the influence of biological sex on autonomic responses to stress in humans and rodent models. The reviewed literature points to sex differences in the consequences of chronic stress, including cardiovascular and metabolic disease. We also explore basic rodent studies of sex-specific autonomic responses to stress with a focus on sex hormones and hypothalamic-pituitary-adrenal axis regulation of cardiovascular and metabolic physiology. Ultimately, emerging evidence of sex differences in autonomic-endocrine integration highlights the importance of sex-specific studies to understand and treat cardiometabolic dysfunction.
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Affiliation(s)
- Carley Dearing
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Robert J Handa
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Brent Myers
- Department of Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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Cardiovascular Mortality Risk in Patients with Bladder Cancer: A Population-Based Study. J Cardiovasc Dev Dis 2022; 9:jcdd9080255. [PMID: 36005419 PMCID: PMC9409417 DOI: 10.3390/jcdd9080255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The purpose of this study was to evaluate the risk of cardiovascular mortality (CVM) among patients with bladder cancer (BC). Methods and Materials: Data were collected from the Surveillance, Epidemiology, and End Results (SEER) database for patients who were diagnosed with BC by pathology between 2000 and 2016. The standardized mortality rate (SMR) was calculated based on reference data from the general population. Nelson–Aalen cumulative hazard curves were used to assess the risk of experiencing CVM in BC patients. Multivariate competing risk models were performed. Results: In total, data from 237,563 BC patients were obtained from the SEER database for further analysis, of which 21,822 patients experienced CVM; the overall SMR for CVM in BC patients was 1.16 (95% CI: 1.14–1.17). Age, race, sex, year of diagnosis, histologic type, summary stage, surgery, marital status, and college education level were independent predictors of CVM in patients with BC. Conclusions: Patients with BC have a significantly increased risk of experiencing CVM compared to the general population. Pre-identification of high-risk groups and cardiovascular protection interventions are important measures to effectively improve survival in this group of patients.
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Gupta MK, Mingwal M, Mantri N, Goel AD, Bhardwaj P, Singh K. Why The Knowledge of Indian School-Going Adolescents Regarding NCDs is Not Transforming into Lifestyle Changes? Niger Med J 2022; 63:326-335. [PMID: 38863467 PMCID: PMC11163254 DOI: 10.60787/nmj-63-4-129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Background There is a paucity of research to demonstrate the quantification of adolescents' risk behavior toward Non-Communicable Diseases (NCD) in India. This study aims to explain the knowledge of school-aged adolescents about NCD and whether their knowledge is truly translating into lifestyle changes and if not, what are the potential underlying factors responsible for that. Methodology A school-based cross-sectional study was conducted on adolescents in Jodhpur district, India, in grades 6 to 12. The data was gathered via a semi-structured questionnaire. The participant's weight and height were assessed using a digital weighing machine and a stadiometer, respectively. SPSS v.23 was used to analyze the data. Univariate (chi-square) and multivariate (logistic regression) analysis were used to quantify knowledge and risk factors, and inferences were derived. Results A total of 1010 students participated in the study. The mean scores of knowledge and risk behavior were 32.82±6.43 (out of 40) and 9.23+2.63 (out of 30), respectively. Adolescent risk behavior and knowledge were not found to be significantly related. Physical activity, spending fewer hours sitting, not skipping breakfast, and habit of fruit and vegetable consumption were significant factors for a healthy lifestyle among them. Conclusion Due to differences in underlying predictors, adolescents' understanding of NCDs did not translate into healthy lifestyle modifications. These findings highlight the importance of developing tailored interventions for adolescents that target identified risk domains.
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Affiliation(s)
- Manoj Kumar Gupta
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
- School of Public Health, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Mrinalini Mingwal
- School of Public Health, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Neha Mantri
- School of Public Health, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Akhil Dhanesh Goel
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Pankaj Bhardwaj
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
- School of Public Health, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Kuldeep Singh
- Department of Paediatrics, All India Institute of Medical Sciences (AIIMS) Jodhpur, India
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58
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Risk of developing type 2 diabetes according to FINDRISC and socioeconomic status. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-021-01493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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59
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Neves RG, Saes MDO, Duro SMS, Flores TR, Tomasi E. Inequalities in care for the people with diabetes in Brazil: A nationwide study, 2019. PLoS One 2022; 17:e0270027. [PMID: 35767515 PMCID: PMC9242508 DOI: 10.1371/journal.pone.0270027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
The purpose of this paper is to evaluate inequalities in care for people with diabetes in Brazil. This cross-sectional population-based study was carried out in 2019 and evaluated care provided by receiving advice, requesting laboratory tests, and performing examinations. We used the slope index of inequality and concentration index to assess inequalities according to educational level and Poisson regression to estimate prevalence ratios for each outcome in the education category. We assessed a total of 6317 people with diabetes, 41.8% had their eyes checked, and 36.1% had their feet examined in the previous year. Prevalence for both examinations was 2.45 times higher in those from the highest level of education compared to those from the lowest level. The largest absolute differences (in percentage points) between the lowest and highest education levels in care indicators were the following: request for glycated hemoglobin test (39.0), glucose curve test (31.4), and eyes checked in the previous year (29.7). There were notable inequalities in the prevalence ratios of care provided to people with diabetes in Brazil. Requests for glycated hemoglobin tests, glucose curve tests, eye and feet examinations should be emphasized, especially for people from lower educational levels.
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Affiliation(s)
| | | | | | - Thaynã Ramos Flores
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Elaine Tomasi
- Postgraduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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Consumption of oils and anthocyanins may positively modulate PPAR-γ expression in chronic non-communicable diseases: a systematic review. Nutr Res 2022; 105:66-76. [DOI: 10.1016/j.nutres.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022]
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Zhang J, Liu Z, Luo Y, Li X, Huang G, Chen H, Li A, Qin S. The Role of Flavonoids in the Osteogenic Differentiation of Mesenchymal Stem Cells. Front Pharmacol 2022; 13:849513. [PMID: 35462886 PMCID: PMC9019748 DOI: 10.3389/fphar.2022.849513] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/16/2022] [Indexed: 01/02/2023] Open
Abstract
Mesenchymal stem cells (MSCs) play an important role in developing bone tissue engineered constructs due to their osteogenic and chondrogenic differentiation potential. MSC-based tissue engineered constructs are generally considered a safe procedure, however, the long-term results obtained up to now are far from satisfactory. The main causes of these therapeutic limitations are inefficient homing, engraftment, and directional differentiation. Flavonoids are a secondary metabolite, widely existed in nature and have many biological activities. For a long time, researchers have confirmed the anti-osteoporosis effect of flavonoids through in vitro cell experiments, animal studies. In recent years the regulatory effects of flavonoids on mesenchymal stem cells (MSCs) differentiation have been received increasingly attention. Recent studies revealed flavonoids possess the ability to modulate self-renewal and differentiation potential of MSCs. In order to facilitate further research on MSCs osteogenic differentiation of flavonoids, we surveyed the literature published on the use of flavonoids in osteogenic differentiation of MSCs, and summarized their pharmacological activities as well as the underlying mechanisms, aimed to explore their promising therapeutic application in bone disorders and bone tissue engineered constructs.
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Affiliation(s)
- Jinli Zhang
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Zhihe Liu
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Yang Luo
- School of Physical Education, Southwest University, Guangzhou, China
| | - Xiaojian Li
- Department of Burn and Plastic Surgery, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Guowei Huang
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Huan Chen
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Aiguo Li
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
| | - Shengnan Qin
- Guangzhou Institute of Traumatic Surgery, Department of Orthopedics, Guangzhou Red Cross Hospital, Medical College, Jinan University, Guangzhou, China
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Were V, Foley L, Turner-Moss E, Mogo E, Wadende P, Musuva R, Obonyo C. Comparison of household socioeconomic status classification methods and effects on risk estimation: lessons from a natural experimental study, Kisumu, Western Kenya. Int J Equity Health 2022; 21:47. [PMID: 35397583 PMCID: PMC8994881 DOI: 10.1186/s12939-022-01652-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/16/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Low household socioeconomic status is associated with unhealthy behaviours including poor diet and adverse health outcomes. Different methods leading to variations in SES classification has the potential to generate spurious research findings or misinform policy. In low and middle-income countries, there are additional complexities in defining household SES, a need for fieldwork to be conducted efficiently, and a dearth of information on how classification could impact estimation of disease risk. Methods Using cross-sectional data from 200 households in Kisumu County, Western Kenya, we compared three approaches of classifying households into low, middle, or high SES: fieldworkers (FWs), Community Health Volunteers (CHVs), and a Multiple Correspondence Analysis econometric model (MCA). We estimated the sensitivity, specificity, inter-rater reliability and misclassification of the three methods using MCA as a comparator. We applied an unadjusted generalized linear model to determine prevalence ratios to assess the association of household SES status with a self-reported diagnosis of diabetes or hypertension for one household member. Results Compared with MCA, FWs successfully classified 21.7% (95%CI = 14.4%-31.4%) of low SES households, 32.8% (95%CI = 23.2–44.3) of middle SES households, and no high SES households. CHVs successfully classified 22.5% (95%CI = 14.5%-33.1%) of low SES households, 32.8% (95%CI = 23.2%-44.3%) of middle SES households, and no high SES households. The level of agreement in SES classification was similar between FWs and CHVs but poor compared to MCA, particularly for high SES. None of the three methods differed in estimating the risk of hypertension or diabetes. Conclusions FW and CHV assessments are community-driven methods for SES classification. Compared to MCA, these approaches appeared biased towards low or middle SES households and not sensitive to high household SES. The three methods did not differ in risk estimation for diabetes and hypertension. A mix of approaches and further evaluation to refine SES classification methodology is recommended. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-022-01652-1.
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Mengesha SD, Teklu KT, Weldetinsae A, Serte MG, Kenea MA, Dinssa DA, Woldegabriel MG, Alemayehu TA, Belay WM. Tobacco use prevalence and its determinate factor in Ethiopia- finding of the 2016 Ethiopian GATS. BMC Public Health 2022; 22:555. [PMID: 35313839 PMCID: PMC8935848 DOI: 10.1186/s12889-022-12893-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 02/28/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Tobacco, one of the risk factors for non-communicable diseases, kills 8 million people each year. Like other sub-Saharan countries, Ethiopia faces the potential challenge of a tobacco epidemic. However, there is no organized data on the prevalence of tobacco use in the country. Therefore, this study aims to determine adult tobacco use in Ethiopia. METHODS The study was conducted using the WHO and CDC GATS survey methods. Complex survey analysis was used to obtain prevalence and population estimates with 95% confidence intervals. Bivariate regression analyses were employed to examine factors related to tobacco use. RESULTS The overall tobacco use percentage was 5.0% [95% CI (3.5, 6.9)], of which 65.8% [95% CI (53.4, 76.3)] only smoked tobacco products; 22.5% [95% CI (15.7, 31.2)] used smokeless tobacco only; and 11.8% [95% CI (6.5, 20.4)] used both smoked and smokeless tobacco products. In 2016, more men adults (8.1%) used tobacco than women did (1.8%). Eight out of eleven states have a higher smoking rate than the national average (3.7%). Gender, employment, age, religion, and marital status are closely linked to current tobacco use (p-value< 0.05). Men adults who are employed, married, and mostly from Muslim society are more likely to use tobacco. CONCLUSION The prevalence of tobacco use is still low in Ethiopia. However, the percentage of female smokers is increasing, and regional governments such as Afar and Gambella have a relatively high prevalence. This calls for the full implementation of tobacco control laws following the WHO MPOWER packages. A tailored tobacco control intervention targeting women, younger age groups, and regions with a high proportion of tobacco use are recommended.
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Affiliation(s)
- Sisay Derso Mengesha
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Kirubel Tesfaye Teklu
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Abel Weldetinsae
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Melaku Gizaw Serte
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Moa Abate Kenea
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | - Daniel Abera Dinssa
- Ethiopian Public Health Institute, Gulelle Patriot Street, P.O.Box 1242, Addis Ababa, Ethiopia
| | | | | | - Wassihun Melaku Belay
- World Health organization- Country office for Ethiopia, UNECA Compound, Zambezi Building, Addis Ababa, Ethiopia
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Sasaki Y, Shobugawa Y, Nozaki I, Takagi D, Nagamine Y, Funato M, Chihara Y, Shirakura Y, Lwin KT, Zin PE, Bo TZ, Sone T, Win HH. Association between Happiness and Economic Status among Older Adults in Two Myanmar Regions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3216. [PMID: 35328904 PMCID: PMC8951419 DOI: 10.3390/ijerph19063216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 12/04/2022]
Abstract
Few studies have examined whether objective or subjective economic status (ES) has a greater association with the happiness of older adults, despite concerns regarding the growing economic cost of morbidity and their functional dependence in developing countries with aging populations. Thus, this study examined whether objective/subjective ES was associated with happiness in older adults in two Myanmar regions. A multistage random sampling procedure and face-to-face interviews were conducted in the urban and rural areas of Myanmar. The happiness of 1200 participants aged >60 years was evaluated using a single happiness score ranging from 0 (very unhappy) to 10 (very happy). The wealth index, used as an objective ES, was calculated from 17 household asset items, such as radio, washing machines, and television. Subjective ES was assessed by asking “Which of the following best describes your current financial situation in light of general economic conditions?” Responses ranged from “very difficult” to “very comfortable”. Both low objective and subjective ES were negatively associated with happiness, after adjusting for confounding variables and stratification by region (urban and rural areas). Although objective and subjective ES had similar associations with happiness in urban areas, subjective ES had a stronger association in rural areas.
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Affiliation(s)
- Yuri Sasaki
- Department of International Health and Collaboration, National Institute of Public Health, Wako City 351-0197, Japan
| | - Yugo Shobugawa
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510, Japan; (Y.S.); (Y.C.); (Y.S.)
| | - Ikuma Nozaki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan;
| | - Daisuke Takagi
- Department of Health and Social Behavior, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan;
| | - Yuiko Nagamine
- Department of Family Medicine, Tokyo Medical and Dental University, Tokyo 113-8510, Japan;
| | - Masafumi Funato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA;
| | - Yuki Chihara
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510, Japan; (Y.S.); (Y.C.); (Y.S.)
| | - Yuki Shirakura
- Graduate School of Medical and Dental Sciences, Niigata University, Niigata City 951-8510, Japan; (Y.S.); (Y.C.); (Y.S.)
| | - Kay Thi Lwin
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
| | - Poe Ei Zin
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
| | - Thae Zarchi Bo
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
| | - Tomofumi Sone
- National Institute of Public Health, Wako City 351-0197, Japan;
| | - Hla Hla Win
- Department of Preventive and Social Medicine, University of Medicine 1, Yangon 245, Myanmar; (K.T.L.); (P.E.Z.); (T.Z.B.); (H.H.W.)
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Hawkes S, Pantazis A, Purdie A, Gautam A, Kiwuwa-Muyingo S, Buse K, Tanaka S, Borkotoky K, Sharma S, Verma R. Sex-disaggregated data matters: tracking the impact of COVID-19 on the health of women and men. ECONOMIA POLITICA (BOLOGNA, ITALY) 2022; 39:55-73. [PMID: 35422585 PMCID: PMC8773398 DOI: 10.1007/s40888-021-00254-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 11/30/2021] [Indexed: 05/31/2023]
Abstract
Sex and gender matter to health outcomes, but despite repeated commitments to sex-disaggregate data in health policies and programmes, a persistent and substantial absence of such data remains especially in lower-income countries. This represents a missed opportunity for monitoring and identifying gender-responsive, evidence-informed solutions to address a key driver of the pandemic. In this paper we review the availability of national sex-disaggregated surveillance data on COVID-19 and examine trends on the testing-to-outcome pathway. We further analyse the availability of data according to the economic status of the country and investigate the determinants of sex differences, including the national gender inequality status (according to a global index) in each country. Results are drawn from 18 months of global data collection from over 200 countries. We find differences in COVID-19 prevention behaviours and illness outcomes by sex, with lower uptake of vaccination and testing plus an elevated risk of severe disease and death among men. Supporting and maintaining the collection, collation, interpretation and presentation of sex-disaggregated data requires commitment and resources at subnational, national and global levels, but provides an opportunity for identifying and taking gender-responsive action on health inequities. As a first step the global health community should recognise, value and support the importance of sex-disaggregated data for identifying and tackling an inequitable pandemic.
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Affiliation(s)
- Sarah Hawkes
- Institute for Global Health, UCL, and Global Health 50/50, 30 Guilford Street, London, WC1N 1EH UK
| | - Athena Pantazis
- Independent Consultant To Global Health 50/50, Maseru, Lesotho
| | - Anna Purdie
- Institute for Global Health, UCL, and Global Health 50/50, 30 Guilford Street, London, WC1N 1EH UK
| | - Abhishek Gautam
- International Center for Research On Women, C-59, South Extension Part -2, New Delhi , 110049 India
| | - Sylvia Kiwuwa-Muyingo
- African Population and Health Research Center, APHRC Campus, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Kent Buse
- Healthier Societies Programme, The George Institute for Global Health and Global Health 50/50, University of New South Wales, Global Health 50/50, Paris, France
| | - Sonja Tanaka
- Global Health 50/50, 16 A Rue Petit, Paris, France
| | - Kakoli Borkotoky
- International Center for Research On Women, C-59, South Extension Part -2, New Delhi , 110049 India
| | - Sneha Sharma
- International Center for Research On Women, C-59, South Extension Part -2, New Delhi , 110049 India
| | - Ravi Verma
- International Center for Research On Women, C-59, South Extension Part -2, New Delhi , 110049 India
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Gilbert RF, Cichowitz C, Bibangambah P, Kim JH, Hemphill LC, Yang IT, Sentongo RN, Kakuhikire B, Christiani DC, Tsai AC, Okello S, Siedner MJ, North CM. Lung function and atherosclerosis: a cross-sectional study of multimorbidity in rural Uganda. BMC Pulm Med 2022; 22:12. [PMID: 34983492 PMCID: PMC8728924 DOI: 10.1186/s12890-021-01792-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of global mortality. In high-income settings, the presence of cardiovascular disease among people with COPD increases mortality and complicates longitudinal disease management. An estimated 26 million people are living with COPD in sub-Saharan Africa, where risk factors for co-occurring pulmonary and cardiovascular disease may differ from high-income settings but remain uncharacterized. As non-communicable diseases have become the leading cause of death in sub-Saharan Africa, defining multimorbidity in this setting is critical to inform the required scale-up of existing healthcare infrastructure. METHODS We measured lung function and carotid intima media thickness (cIMT) among participants in the UGANDAC Study. Study participants were over 40 years old and equally divided into people living with HIV (PLWH) and an age- and sex-similar, HIV-uninfected control population. We fit multivariable linear regression models to characterize the relationship between lung function (forced expiratory volume in one second, FEV1) and pre-clinical atherosclerosis (cIMT), and evaluated for effect modification by age, sex, smoking history, HIV, and socioeconomic status. RESULTS Of 265 participants, median age was 52 years, 125 (47%) were women, and 140 (53%) were PLWH. Most participants who met criteria for COPD were PLWH (13/17, 76%). Median cIMT was 0.67 mm (IQR: 0.60 to 0.74), which did not differ by HIV serostatus. In models adjusted for age, sex, socioeconomic status, smoking, and HIV, lower FEV1 was associated with increased cIMT (β = 0.006 per 200 mL FEV1 decrease; 95% CI 0.002 to 0.011, p = 0.01). There was no evidence that age, sex, HIV serostatus, smoking, or socioeconomic status modified the relationship between FEV1 and cIMT. CONCLUSIONS Impaired lung function was associated with increased cIMT, a measure of pre-clinical atherosclerosis, among adults with and without HIV in rural Uganda. Future work should explore how co-occurring lung and cardiovascular disease might share risk factors and contribute to health outcomes in sub-Saharan Africa.
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Affiliation(s)
- Rebecca F Gilbert
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA
| | - Cody Cichowitz
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA
| | | | - June-Ho Kim
- Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Linda C Hemphill
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Harvard Medical School, Boston, MA, USA
| | | | - Ruth N Sentongo
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David C Christiani
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alexander C Tsai
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Harvard Medical School, Boston, MA, USA
| | - Samson Okello
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark J Siedner
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Harvard Medical School, Boston, MA, USA
| | - Crystal M North
- Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA, 02114, USA. .,Harvard Medical School, Boston, MA, USA.
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Oyando R, Barasa E, Ataguba JE. Socioeconomic Inequity in the Screening and Treatment of Hypertension in Kenya: Evidence From a National Survey. FRONTIERS IN HEALTH SERVICES 2022; 2:786098. [PMID: 36925851 PMCID: PMC10012826 DOI: 10.3389/frhs.2022.786098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/21/2022] [Indexed: 11/13/2022]
Abstract
Background Non-communicable diseases (NCDs) account for 50% of hospitalisations and 55% of inpatient deaths in Kenya. Hypertension is one of the major NCDs in Kenya. Equitable access and utilisation of screening and treatment interventions are critical for reducing the burden of hypertension. This study assessed horizontal equity (equal treatment for equal need) in the screening and treatment for hypertension. It also decomposed socioeconomic inequalities in care use in Kenya. Methods Cross-sectional data from the 2015 NCDs risk factors STEPwise survey, covering 4,500 adults aged 18-69 years were analysed. Socioeconomic inequality was assessed using concentration curves and concentration indices (CI), and inequity by the horizontal inequity (HI) index. A positive (negative) CI or HI value suggests a pro-rich (pro-poor) inequality or inequity. Socioeconomic inequality in screening and treatment for hypertension was decomposed into contributions of need [age, sex, and body mass index (BMI)] and non-need (wealth status, education, exposure to media, employment, and area of residence) factors using a standard decomposition method. Results The need for hypertension screening was higher among poorer than wealthier socioeconomic groups (CI = -0.077; p < 0.05). However, wealthier groups needed hypertension treatment more than poorer groups (CI = 0.293; p <0.001). Inequity in the use of hypertension screening (HI = 0.185; p < 0.001) and treatment (HI = 0.095; p < 0.001) were significantly pro-rich. Need factors such as sex and BMI were the largest contributors to inequalities in the use of screening services. By contrast, non-need factors like the area of residence, wealth, and employment status mainly contributed to inequalities in the utilisation of treatment services. Conclusion Among other things, the use of hypertension screening and treatment services in Kenya should be according to need to realise the Sustainable Development Goals for NCDs. Specifically, efforts to attain equity in healthcare use for hypertension services should be multi-sectoral and focused on crucial inequity drivers such as regional disparities in care use, poverty and educational attainment. Also, concerted awareness campaigns are needed to increase the uptake of screening services for hypertension.
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Affiliation(s)
- Robinson Oyando
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Health Economics Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya.,Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - John E Ataguba
- Health Economics Unit, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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Lima LJLD, Lopes MR, Botelho Filho CADL, Cecon RS. Avaliação do autocuidado com os pés entre pacientes portadores de diabetes melito. J Vasc Bras 2022; 21:e20210011. [PMID: 35251141 PMCID: PMC8862594 DOI: 10.1590/1677-5449.210011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background The diabetic foot is a complication of diabetes mellitus (DM) and is the most common cause of lower limb amputation. Objectives To assess foot self-care practices by sex and educational level in DM patients from the Northeast of Brazil, state of Bahia. Methods This was a quantitative, cross-sectional, observational, analytical study with 88 DM patients seen at routine consultations from February to March of 2020. Data were collected using questionnaires on socioeconomic data and self-care of feet (knowledge about the diabetic foot, habits related to care/inspection of feet, and visits to the Healthcare Center when changes to foot health are detected). Results 58% of the sample did not know the term “diabetic foot”, but a majority did perform minimum adequate foot care practices, such as inspecting feet (60.2%), moisturizing feet (65.9%), avoiding walking barefoot (81.8%), and trimming toenails (92%), although 90.9% did not wear footwear considered appropriate. There was a relationship between lower educational level and worse performance in questions relating to walking barefoot, moisturizing feet, trimming toenails, wearing appropriate footwear, and identifying mycoses (p < 0.05), but there was no association between performing self-care activities and sex. Conclusions Interviewed patients with DM did not perform all foot self-care activities and did not know what the term “diabetic foot” means. There was an association between lower educational level and reduced capacity to perform these activities, which suggests that health literacy is important to improve self-care of feet, contributing to reduce complications and foot amputations.
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Social Deprivation and Peripheral Artery Disease. Can J Cardiol 2021; 38:612-622. [PMID: 34971734 DOI: 10.1016/j.cjca.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/08/2021] [Accepted: 12/22/2021] [Indexed: 12/24/2022] Open
Abstract
The link between peripheral artery disease and socioeconomic status is complex. The objective of this narrative review is to explore this relationship in detail, including how social factors impact the development, management, and outcomes of peripheral artery disease. Although the current literature on this topic is limited, some patterns do emerge. Populations of low socioeconomic status appear to be at increased risk for the development of peripheral artery disease, due to factors such as increased prevalence of cardiovascular risk factors (i.e. cigarette smoking) and decreased access to care. However, variables that are more difficult to quantify, such as chronic stress and health literacy, also likely play a significant role. Among those who are living with peripheral artery disease, socioeconomic status can also affect disease management. Secondary prevention strategies, such as medication use, smoking cessation, and exercise therapy, are underutilized in socially deprived populations. This underutilization of evidence-based management leads to adverse outcomes in these groups, including increased rates of amputation and decreased post-operative survival. The recognition of the importance of social factors in prognosis is an important first step towards addressing this health disparity. Moving forward, interventions that help to identify those who are at high risk and help to improve access to care in populations of low socioeconomic status, will be critical to improving outcomes.
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Fiorini G, Franchi M, Corrao G, Tritto R, Fadelli S, Rigamonti AE, Sartorio A, Cella SG. Effects of SARS-CoV-2 pandemic on follow-up and pharmacological treatment of chronic diseases in undocumented migrants. BMJ Nutr Prev Health 2021; 4:365-373. [PMID: 35024545 PMCID: PMC8260286 DOI: 10.1136/bmjnph-2021-000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 05/28/2021] [Indexed: 11/17/2022] Open
Abstract
Background All over the world, the COVID-19 pandemic, not unlikely other epidemics, has hit harder people in low socioeconomic conditions. In Western countries, undocumented migrants are a growing component of this disadvantaged segment of the population. Their health conditions are frequently burdened by a number of chronic conditions, and they experience many difficulties in accessing public health services. Frequently, the only medical assistance they can get is provided by non-governmental organisations. Methods We studied the medical records (including pharmacological treatments) of all patients attending the outpatient clinics of Opera San Francesco (OSF; a big charity in Milano, Italy), in the first 5 months of 2020. These comprise the outbreak of the pandemic and the lockdown period. The 1914 patients (1814 undocumented migrants and 100 Italians) seen during the lockdown were compared with those seen in the same period of 2019 and with those seen in the preceding months of 2020. We especially focused on three chronic conditions: cardiovascular diseases, diabetes and psychiatric disorders. Results The number of consultations during the first 5 months of 2020 was much smaller than that of the same period of 2019. During the lockdown, we found 4048 consultations for 1914 patients, while they were 8051 in the same period of 2019 and 5681 in the first 2 months of 2020. The quantity of medicines dispensed by OSF showed a marked decrease in the period of the study and mainly during the lockdown. The decrease in consultations and dispensation of medicines was most evident for psychiatric patients and almost not existent for patients with diabetes. Female patients suffered a more pronounced reduction. Conclusions Western countries need strategies to better assist the very poor during epidemics. Differences among different groups of disadvantaged persons should be taken into account when designing recovery plans.
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Bordin D, Gonçalves D, Cabral LPA, Lima ML, Grden CRB. Factors associated to multimorbidity in inpatient elderly according to sociodemographic characteristics, lifestyle and use of services. ABCS HEALTH SCIENCES 2021. [DOI: 10.7322/abcshs.2020061.1508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Introduction: Aging is a physiological process associated to decreased functional capacity and the presence of diseases, especially chronic noncommunicable diseases. Objective: To analyze the prevalence and factors associated to the multimorbidity of elderly in a teaching hospital, according to sociodemographic characteristics, lifestyle and use of services in the health care network. Methods: Descriptive and inferential cross-sectional study, conducted with 144 hospitalized patients 60 years of age or more, from January to June 2018, in a university hospital in the state of Paraná. Data were collected 30 days after hospital discharge by telephone interview. The dependent variable was the occurrence of multimorbidity and the independent variables were: sociodemographic characteristics, lifestyle and use of hospital health services. Logistic regression analysis was performed. Results: It was found that 55% of the elderly had multimorbidity. The elderly who were more chances to have multimorbidity where there low education (OR=16.29; CI:2.75-96.42), non-white (OR=2.34; CI:1.00-5.50) hospitalized longer (4 to 7 days: OR=6.91; CI:2.40-19.96; more than 7 days: OR=3.03; CI:1.00-9.22), who scheduled to return to the hospital (OR=18.99; CI: 1.30-277.87), and that after discharge they needed help from someone to follow the medical recommendations (OR=3.16; CI:1.38-7.22). Conclusion: It was identified a high prevalence of multimorbidity, and important factors associated to multimorbidity in hospitalized elderly, with emphasis on education; color; hospitalization time; scheduling of return to hospital after discharge; need for help from someone (family member/caregiver), without post-discharge, to follow medical recommendations.
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Karpyn A, Pon J, Grajeda SB, Wang R, Merritt KE, Tracy T, May H, Sawyer-Morris G, Humphrey DL, Hunt A. Purchases, Consumption, and BMI of SNAP Farmers’ Market Shoppers. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1997860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Allison Karpyn
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Julia Pon
- Wholesome Wave, Berkeley, California, USA
| | - Sara Bernice Grajeda
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Rui Wang
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | | | - Tara Tracy
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Henry May
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Ginnie Sawyer-Morris
- Human Development & Family Sciences, The University of Delaware, Newark, Delaware, USA
| | - D. Layne Humphrey
- Center for Research in Education and Social Policy, University of Delaware, Newark, Delaware, USA
| | - Alan Hunt
- Wholesome Wave, Bridgeport, Connecticut, USA
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Kim HHS, Katelyn Kim HJ. Income inequality, emotional anxiety, and self-rated health in times of the coronavirus pandemic: Evidence from a cross-national survey. RESEARCH IN SOCIAL STRATIFICATION AND MOBILITY 2021; 75:100640. [PMID: 34385741 PMCID: PMC8339547 DOI: 10.1016/j.rssm.2021.100640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 05/07/2023]
Abstract
Using a unique cross-national dataset, we explore the interplay between household income, coronavirus-induced anxiety, national context, and self-rated health (SRH) across dozens of countries among more than 13,500 older adults. Based on multilevel models, we find that the emotional anxiety due to COVID-19 negatively predicts SRH, net of country random effects. And holding constant coronavirus-related stress and background controls at both individual and contextual (country) levels, higher income is positively associated with better subjective health. We also report cross-level interactions. The income-health gradient is stronger in countries with higher numbers of coronavirus-related deaths and, to lesser extent, infected cases. That is, health benefits of higher income are more pronounced in countries hit harder by the pandemic. Our study shows that globally income inequality exacerbates the unequal health consequences of COVID-19 for older segments of the population especially vulnerable to the disease.
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Affiliation(s)
- Harris Hyun-Soo Kim
- Department of Sociology, Ewha Womans University, 52 Ewhayeodae-gil Seodaemun-gu, Seoul, 03760, Republic of Korea
| | - Hyun-Jin Katelyn Kim
- Department of Sociology, Ewha Womans University, 52 Ewhayeodae-gil Seodaemun-gu, Seoul, 03760, Republic of Korea
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Garmany A, Yamada S, Terzic A. Longevity leap: mind the healthspan gap. NPJ Regen Med 2021; 6:57. [PMID: 34556664 PMCID: PMC8460831 DOI: 10.1038/s41536-021-00169-5] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/02/2021] [Indexed: 02/08/2023] Open
Abstract
Life expectancy has increased by three decades since the mid-twentieth century. Parallel healthspan expansion has however not followed, largely impeded by the pandemic of chronic diseases afflicting a growing older population. The lag in quality of life is a recognized challenge that calls for prioritization of disease-free longevity. Contemporary communal, clinical and research trends aspiring to extend the health horizon are here outlined in the context of an evolving epidemiology. A shared action integrating public and societal endeavors with emerging interventions that target age-related multimorbidity and frailty is needed. A multidimensional buildout of a curative perspective, boosted by modern anti-senescent and regenerative technology with augmented decision making, would require dedicated resources and cost-effective validation to responsibly bridge the healthspan-lifespan gap for a future of equitable global wellbeing.
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Affiliation(s)
- Armin Garmany
- Center for Regenerative Medicine, Marriott Family Comprehensive Cardiac Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Mayo Clinic Alix School of Medicine, Regenerative Sciences Track, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN, USA
| | - Satsuki Yamada
- Center for Regenerative Medicine, Marriott Family Comprehensive Cardiac Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andre Terzic
- Center for Regenerative Medicine, Marriott Family Comprehensive Cardiac Regenerative Medicine, Marriott Heart Disease Research Program, Van Cleve Cardiac Regenerative Medicine Program, Mayo Clinic, Rochester, MN, USA.
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA.
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA.
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Millán-Guerrero RO, Caballero-Hoyos R, Monárrez-Espino J. Poverty and survival from COVID-19 in Mexico. J Public Health (Oxf) 2021; 43:437-444. [PMID: 33367803 PMCID: PMC7798985 DOI: 10.1093/pubmed/fdaa228] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/05/2020] [Accepted: 11/11/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Recent evidence points to the relevance of poverty and inequality as factors affecting the spread and mortality of the COVID-19 pandemic in Latin America. This study aimed to determine whether COVID-19 patients living in Mexican municipalities with high levels of poverty have a lower survival compared with those living in municipalities with low levels. METHODS Retrospective cohort study. Secondary data was used to define the exposure (multidimensional poverty level) and outcome (survival time) among patients diagnosed with COVID-19 between 27 February and 1 July 2020. Crude and adjusted hazard ratios (HR) from Cox regression were computed. RESULTS Nearly 250 000 COVID-19 patients were included. Mortality was 12.3% reaching 59.3% in patients with ≥1 comorbidities. Multivariate survival analyses revealed that individuals living in municipalities with extreme poverty had 9% higher risk of dying at any given time proportionally to those living in municipalities classified as not poor (HR 1.09; 95% CI 1.06-1.12). The survival gap widened with the follow-up time up to the third to fourth weeks after diagnosis. CONCLUSION Evidence suggests that the poorest population groups have a lower survival from COVID-19. Thus, combating extreme poverty should be a central preventive strategy.
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Affiliation(s)
| | - Ramiro Caballero-Hoyos
- Clinical Epidemiology Research Unit, Mexican Institute of Social Security, Colima, Col, 28000, Mexico
| | - Joel Monárrez-Espino
- Health Sciences Division, University of Monterrey, Monterrey, N.L., 66238, Mexico
- Public Health Research Group, Claustro Universitario, Chihuahua, Chih., 31320, Mexico
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Alahmad B, AlMekhled D, Odeh A, Albloushi D, Gasana J. Disparities in excess deaths from the COVID-19 pandemic among migrant workers in Kuwait. BMC Public Health 2021; 21:1668. [PMID: 34521360 PMCID: PMC8438289 DOI: 10.1186/s12889-021-11693-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 08/29/2021] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The actual human cost of the pandemic cannot be viewed through the COVID-19 mortality rates alone, especially when the pandemic is widening the existing health disparities among different subpopulations within the same society. In Kuwait, migrant workers were already disproportionately impacted by COVID-19 and its unintended consequences. The totality of that effect on mortality is yet to be fully understood. OBJECTIVE To estimate excess deaths in the pandemic year of 2020 among the Kuwaiti and non-Kuwaiti migrant populations. METHODS We analyzed publicly available retrospective data in Kuwait on total annual mortality historically (from 2005 to 2019) and in 2020. We fitted a quasi-poisson generalized linear model adjusted for yearly trend and nationality to estimate the expected deaths in 2020 in the absence of the pandemic. We calculated excess deaths as the difference between observed and expected mortality for the year of the pandemic in both Kuwaitis and non-Kuwaitis. RESULTS In the absence of the pandemic, we expected the total mortality in Kuwait to be 6629 (95% CI: 6472 to 6789) deaths. However, the observed total mortality in 2020 was 9975 deaths; about 3346 (3186 to 3503) more deaths above the expected historical trend. Deaths among migrant workers would have been approximately 71.9% (67.8 to 76.0) lower in the absence of the pandemic. On the other hand, deaths among Kuwaitis would have been 32.4% (29.3 to 35.6) lower if the country had not been hit by the pandemic. CONCLUSION The burden of mortality brought on by the COVID-19 pandemic is substantially higher than what the official tally might suggest. Systematically disadvantaged migrant workers shouldered a larger burden of deaths in the pandemic year. Public health interventions must consider structural and societal determinants that give rise to the health disparities seen among migrant workers.
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Affiliation(s)
- Barrak Alahmad
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait.,Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Dawoud AlMekhled
- School of Biomedical Sciences, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Australia
| | - Ayah Odeh
- Department of Health Policy and Management, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait
| | - Dalia Albloushi
- Mubarak Al-Kabeer Hospital, Ministry of Health, Hawalli, Kuwait
| | - Janvier Gasana
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Kuwait City, Kuwait.
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Coates MM, Ezzati M, Robles Aguilar G, Kwan GF, Vigo D, Mocumbi AO, Becker AE, Makani J, Hyder AA, Jain Y, Stefan DC, Gupta N, Marx A, Bukhman G. Burden of disease among the world's poorest billion people: An expert-informed secondary analysis of Global Burden of Disease estimates. PLoS One 2021; 16:e0253073. [PMID: 34398896 PMCID: PMC8366975 DOI: 10.1371/journal.pone.0253073] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/27/2021] [Indexed: 12/12/2022] Open
Abstract
Background The health of populations living in extreme poverty has been a long-standing focus of global development efforts, and continues to be a priority during the Sustainable Development Goal era. However, there has not been a systematic attempt to quantify the magnitude and causes of the burden in this specific population for almost two decades. We estimated disease rates by cause for the world’s poorest billion and compared these rates to those in high-income populations. Methods We defined the population in extreme poverty using a multidimensional poverty index. We used national-level disease burden estimates from the 2017 Global Burden of Disease Study and adjusted these to account for within-country variation in rates. To adjust for within-country variation, we looked to the relationship between rates of extreme poverty and disease rates across countries. In our main modeling approach, we used these relationships when there was consistency with expert opinion from a survey we conducted of disease experts regarding the associations between household poverty and the incidence and fatality of conditions. Otherwise, no within-country variation was assumed. We compared results across multiple approaches for estimating the burden in the poorest billion, including aggregating national-level burden from the countries with the highest poverty rates. We examined the composition of the estimated disease burden among the poorest billion and made comparisons with estimates for high-income countries. Results The composition of disease burden among the poorest billion, as measured by disability-adjusted life years (DALYs), was 65% communicable, maternal, neonatal, and nutritional (CMNN) diseases, 29% non-communicable diseases (NCDs), and 6% injuries. Age-standardized DALY rates from NCDs were 44% higher in the poorest billion (23,583 DALYs per 100,000) compared to high-income regions (16,344 DALYs per 100,000). Age-standardized DALY rates were 2,147% higher for CMNN conditions (32,334 DALYs per 100,000) and 86% higher for injuries (4,182 DALYs per 100,000) in the poorest billion, compared to high-income regions. Conclusion The disease burden among the poorest people globally compared to that in high income countries is highly influenced by demographics as well as large disparities in burden from many conditions. The comparisons show that the largest disparities remain in communicable, maternal, neonatal, and nutritional diseases, though NCDs and injuries are an important part of the “unfinished agenda” of poor health among those living in extreme poverty.
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Affiliation(s)
- Matthew M. Coates
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, United Kingdom
| | | | - Gene F. Kwan
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
| | - Daniel Vigo
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ana O. Mocumbi
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Anne E. Becker
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Julie Makani
- Sickle Cell Programme, Muhimbili University of Health & Allied Sciences, Dar-es-Salaam, Tanzania
- Department of Haematology & Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Adnan A. Hyder
- George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Yogesh Jain
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
| | - D. Cristina Stefan
- African Medical Research and Innovation Institute, Cape Town, South Africa
- SingHealth Duke-NUS Global Health Institute (SDGHI), Duke-NUS Medical School, Singapore, Singapore
| | - Neil Gupta
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
| | - Andrew Marx
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gene Bukhman
- Program in Global Noncommunicable Diseases and Social Change, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Partners In Health, Boston, Massachusetts, United States of America
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- * E-mail:
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Needham BL, Straight B, Hilton CE, Olungah CO, Lin J. Family socioeconomic status and child telomere length among the Samburu of Kenya. Soc Sci Med 2021; 283:114182. [PMID: 34225037 DOI: 10.1016/j.socscimed.2021.114182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/27/2021] [Accepted: 06/25/2021] [Indexed: 01/08/2023]
Abstract
Previous research in high-income countries suggests that children from families with lower socioeconomic status (SES) tend to have shorter telomere length - a biomarker of stress and cell aging - than children from families with greater social and economic resources. However, little is known about predictors of child telomere length in low-income settings. Data for the current study are from a sample of 214 Samburu children aged 1-9 years. The Samburu are semi-nomadic pastoralists who live in the Rift Valley of north-central Kenya. Samburu livelihood is based primarily on livestock, and polygynous marriage is common. Drawing on prior ethnographic research, we measured 14 culturally relevant indicators of family SES, including mother's education, head of household's education, whether the child is currently attending school, household spending, mother's employment history, head of household's employment history, mother's perceived wealth, whether the child lives in a modern house, livestock holdings (total, cows, sheep/goats, and camels), mother's wife number, and whether the child lives in a polygynous household. Telomere length was measured in salivary DNA by the quantitative polymerase chain reaction (qPCR) method. Using latent class analysis, we identified four groups of children that are similar based on the 14 indicators of family SES: Lower SES; Middle SES, Traditional; Middle SES, Modern; and Higher SES. SES classes were not significantly associated with child telomere length. In models examining individual indicators of SES, we found that telomere length was 0.57 standard deviations greater for children who lived in families in the lowest quartile of total livestock holdings compared to those in the highest quartile (b = 0.57, p = 0.03). While additional research is needed to identify the mechanisms underlying this counterintuitive finding, the current study highlights the importance of cultural context in shaping the social gradient in health.
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Affiliation(s)
- Belinda L Needham
- Department of Epidemiology and Center for Social Epidemiology and Population Health, University of Michigan, USA.
| | - Bilinda Straight
- Department of Gender and Women's Studies, Western Michigan University, USA
| | - Charles E Hilton
- Department of Anthropology, University of North Carolina, Chapel Hill, USA
| | | | - Jue Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, USA
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Tumas N, Rodríguez López S, Bilal U, Ortigoza AF, Diez Roux AV. Urban social determinants of non-communicable diseases risk factors in Argentina. Health Place 2021; 77:102611. [PMID: 34210611 PMCID: PMC8714870 DOI: 10.1016/j.healthplace.2021.102611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/20/2022]
Abstract
We examined associations of individual-, neighborhood- and city-level education -as proxies of SES at different levels-, with diabetes, hypertension, obesity, smoking and binge drinking (non-communicable disease risk factors -NCD/RF) among Argentinian adults. We estimated mixed models based on 21,415 individuals from the 2013 National Survey of Risk Factors, living in 2,698 neighborhoods and 33 cities. Gradients by individual-level education differed by gender and NCD/RF, and some were modified by city education. In addition, we identified contextual effects of neighborhood and city education on some NCD/RF. Urban efforts to tackle NCD/RF in Argentina should be context- and gender-sensitive, and mainly focused on socially disadvantaged groups.
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Affiliation(s)
- Natalia Tumas
- Departament de Ciències Polítiques i Socials, Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Argentina.
| | - Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Argentina; Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Argentina.
| | - Usama Bilal
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
| | - Ana F Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
| | - Ana V Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, USA.
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Mendivil CO, Gutiérrez Romero SA, Peláez-Jaramillo MJ, Nieves-Barreto LD, Montaño-Rodríguez A, Betancourt-Villamizar E. Diabetes and associated dietary intake among urban adults: COPEN (Colombian Nutritional Profiles)-a cross-sectional study. BMJ Open 2021; 11:e042050. [PMID: 34140339 PMCID: PMC8212409 DOI: 10.1136/bmjopen-2020-042050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Diabetes is increasing rapidly in low-income and middle-income countries. We aimed to estimate the prevalence of diabetes, describe its correlates and its associated dietary intake in urban adults from Colombia. SETTING The Colombian Study of Nutritional Profiles was a population-based, cross-sectional, multi-stage probabilistic sampling survey designed to represent the five main Colombian cities. PARTICIPANTS Between June and November 2018, we studied 736 non-pregnant participants aged 18 or older. Diabetes was defined as a random plasma glucose ≥200 mg/dL, self-reported prior diagnosis of diabetes or use of any oral or injectable antidiabetic medication(s). Participants also fulfilled a detailed 157-item food-frequency questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of diabetes, dietary intake of key nutrients, achievement of dietary goals among individuals with diabetes. RESULTS The overall estimated prevalence of diabetes was 10.1%, with no difference by sex (9.6% in women, 10.8% in men, p=0.43). The association between diabetes and education level depended on sex, diabetes was more prevalent among more educated men and less educated women. Abdominal obesity was associated with a 65% increase in diabetes prevalence among men, and a 163% increase in women. Individuals with diabetes reported lower mean consumption of all nutrients, but after adjustment by sex, age, socioeconomic level (SEL) and body mass index, only their lower sodium consumption remained significant (p=0.013). The proportion of non-achievement of dietary intake goals among participants with diabetes was 94.4% for saturated fats, 86.7% for sodium, 84.4% for fibre and 80% for trans fats. In multivariate logistic regression models, age was the strongest independent correlate of diabetes. CONCLUSIONS Diabetes by self-report, random plasma glucose or medication use was highly prevalent among Colombian adults. There were large differences by abdominal obesity status, region of residence, SEL and educational level. The proportion of individuals with diabetes meeting dietary recommendations was alarmingly low.
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Affiliation(s)
- Carlos O Mendivil
- School of Medicine, Universidad de los Andes, Bogota, Colombia
- Endocrinology Section, Department of Internal Medicine, Fundacion Santa Fe de Bogota, Bogota, Colombia
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81
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Barboza Solís C, Reyes-Carmona J, Fantin R. Social inequality in incidence and mortality of malignant neoplasms of lip, oral cavity and pharynx: Is Costa Rica an international paradox? Community Dent Oral Epidemiol 2021; 50:243-250. [PMID: 34076287 DOI: 10.1111/cdoe.12658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Low socioeconomic position (SEP) has been associated with higher incidences and mortality of lip, oral cavity and pharynx (LOP) cancers in the vast majority of countries with available data. The origins of health inequalities in cancer are socioeconomic, although they vary by time and country. Evidence from Low-and Middle-income Countries (LMICs) remains scarce. This study aims to identify and describe socioeconomic inequalities in LOP cancers incidence and mortality in Costa Rica. The hypothesis tested is that people leaving in low-SEP districts in Costa Rica have greater incidence and mortality rates of lip, oral cavity and pharynx cancers. METHODS The 10th revision of the International Classification of Diseases (ICD-10) was used to define cancer sites. Data come from a national population-based Cancer Registry with 100% completeness to study incidence. Incidence rate included all new cases of LOP cancer diagnosed from January 1, 2011, and December 31, 2015, for a total of 2 798 517 individuals, 13 832 524 years of follow-up and 601 LOP cases. Mortality rate was extracted from the National Death Index, including 2 739 733 individuals, 23 950 240 person-years of follow-up and 586 LOP cancer deaths, from January 1, 2010, to December 31, 2018. The 2011 Census (with 94% of Costa Rican inhabitants) was used to characterize the urbanicity and wealth of 477 districts. Survival models were performed for both incidence and mortality, allowing to consider existing competitive risks. Cox models were used for incidence, and parametric survival models based on a Gompertz distribution for mortality. RESULTS The study found that people who lived in the most socioeconomically disadvantaged areas had lower probabilities of developing LOP cancers than people in the richest districts. The same pattern for mortality, however, was not significant. CONCLUSIONS The hypothesis that incidence and mortality of LOP cancers will show a positive social gradient was not confirmed in this study, contradicting the existing literature. This could be explained by the social distribution of risky health behaviours, more frequent in socially advantaged populations.
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Affiliation(s)
| | | | - Romain Fantin
- Centro Centroamericano de Población, Universidad de Costa Rica, San José, Costa Rica.,Escuela de Salud Pública, Facultad de Medicina, Universidad de Costa Rica, San José, Costa Rica.,Escuela de Medicina, Facultad de Medicina, Universidad de Costa Rica, San José, Costa Rica
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82
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Ortiz-Rodríguez MA, Aldaz-Rodríguez MV, González-Robledo LM, Villa A, Bouzas C, Pastor R, Tur JA. Association between the Use of Health Services, Cardiovascular Risk Factors and Metabolic Syndrome in Mexican Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5336. [PMID: 34067845 PMCID: PMC8156833 DOI: 10.3390/ijerph18105336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 11/16/2022]
Abstract
Background: The use of health services is a complex behavioral phenomenon affected by multiple factors (availability, distance, cost, quality, attitudes, cultural beliefs, socioeconomic characteristics, and individuals' self-perception of health). Mexico has a segmented health system, and the access to it depends on the labor insertion and the population's ability to pay. Objective: To assess association between use of health services and cardiovascular and metabolic syndrome risk factors among Mexican adults. Methods: Analytical cross-sectional nationally representative study carried out on Mexican adults (≥20-year-old adults of both sexes; n = 4595). Socioeconomic factors, geographic area, health care coverage, information about the use of health services, previous medical diagnoses of diabetes and hypertension, and smoking were assessed. Anthropometrics, triglyceride, total cholesterol, HDL-cholesterol, and glucose plasma levels were measured. Metabolic syndrome (MetS) and cardiovascular risk factors were assessed. Prevalences were expressed in terms of percentages, and significant differences were calculated using χ2 test. Univariate and multivariate analysis was performed to evaluate the association between the use of health services and cardiovascular risk factors and sociodemographic variables. Results: The probability of using health services is higher and more significant in subjects with obesity, diabetes (OR (95% CI): 1.73 (1.49-2.00; p < 0.001), hypertension (OR (95% CI): 1.29 (1.14-1.45; p < 0.001), hypertriglyceridemia (OR (95% CI): 1.30 (1.15-1.46; p < 0.001), and in those with hypercholesterolemia (OR (95% CI): 1.23 (1.03-1.39; p = 0.001). Conclusions: Among health service users, there is a positive significant association between the use of health services and the presence of metabolic syndrome, obesity, diabetes, hypertension, hypertriglyceridemia, and hypercholesterolemia.
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Affiliation(s)
- María Araceli Ortiz-Rodríguez
- Faculty of Nutrition, Autonomous University of the State of Morelos, Cuernavaca 62350, Mexico; (M.A.O.-R.); (L.M.G.-R.)
| | | | - Luz María González-Robledo
- Faculty of Nutrition, Autonomous University of the State of Morelos, Cuernavaca 62350, Mexico; (M.A.O.-R.); (L.M.G.-R.)
| | - Antonio Villa
- Faculty of Medicine, National Autonomous University of Mexico, México City 04360, Mexico; (M.V.A.-R.); (A.V.)
| | - Cristina Bouzas
- Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS & IDISBA, 07122 Palma de Mallorca, Spain; (C.B.); (R.P.)
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
- Faculty of Health Sciences, Catholic University of Avila, 05005 Avila, Spain
| | - Rosario Pastor
- Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS & IDISBA, 07122 Palma de Mallorca, Spain; (C.B.); (R.P.)
- Faculty of Health Sciences, Catholic University of Avila, 05005 Avila, Spain
| | - Josep A. Tur
- Research Group on Community Nutrition and Oxidative Stress, University of the Balearic Islands-IUNICS & IDISBA, 07122 Palma de Mallorca, Spain; (C.B.); (R.P.)
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN), Institute of Health Carlos III (ISCIII), 28029 Madrid, Spain
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83
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Dietary Intake and Chronic Disease Prevention. Nutrients 2021; 13:nu13041358. [PMID: 33921568 PMCID: PMC8072965 DOI: 10.3390/nu13041358] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/07/2021] [Indexed: 12/11/2022] Open
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84
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Laine JE, Baltar VT, Stringhini S, Gandini M, Chadeau-Hyam M, Kivimaki M, Severi G, Perduca V, Hodge AM, Dugué PA, Giles GG, Milne RL, Barros H, Sacerdote C, Krogh V, Panico S, Tumino R, Goldberg M, Zins M, Delpierre C, Vineis P. Reducing socio-economic inequalities in all-cause mortality: a counterfactual mediation approach. Int J Epidemiol 2021; 49:497-510. [PMID: 31855265 PMCID: PMC7266549 DOI: 10.1093/ije/dyz248] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/27/2019] [Indexed: 12/05/2022] Open
Abstract
Background Socio-economic inequalities in mortality are well established, yet the contribution of intermediate risk factors that may underlie these relationships remains unclear. We evaluated the role of multiple modifiable intermediate risk factors underlying socio-economic-associated mortality and quantified the potential impact of reducing early all-cause mortality by hypothetically altering socio-economic risk factors. Methods Data were from seven cohort studies participating in the LIFEPATH Consortium (total n = 179 090). Using both socio-economic position (SEP) (based on occupation) and education, we estimated the natural direct effect on all-cause mortality and the natural indirect effect via the joint mediating role of smoking, alcohol intake, dietary patterns, physical activity, body mass index, hypertension, diabetes and coronary artery disease. Hazard ratios (HRs) were estimated, using counterfactual natural effect models under different hypothetical actions of either lower or higher SEP or education. Results Lower SEP and education were associated with an increase in all-cause mortality within an average follow-up time of 17.5 years. Mortality was reduced via modelled hypothetical actions of increasing SEP or education. Through higher education, the HR was 0.85 [95% confidence interval (CI) 0.84, 0.86] for women and 0.71 (95% CI 0.70, 0.74) for men, compared with lower education. In addition, 34% and 38% of the effect was jointly mediated for women and men, respectively. The benefits from altering SEP were slightly more modest. Conclusions These observational findings support policies to reduce mortality both through improving socio-economic circumstances and increasing education, and by altering intermediaries, such as lifestyle behaviours and morbidities.
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Affiliation(s)
- Jessica E Laine
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Valéria T Baltar
- Department of Epidemiology and Biostatistics, Instituto de Saúde Coletiva, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Silvia Stringhini
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Martina Gandini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy
| | - Marc Chadeau-Hyam
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Mika Kivimaki
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Gianluca Severi
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP, UMR Inserm 1018) Facultés de Medicine, Université Paris-Saclay, Université Paris-Sud, Saint-Aubin, France
| | - Vittorio Perduca
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP, UMR Inserm 1018) Facultés de Medicine, Université Paris-Saclay, Université Paris-Sud, Saint-Aubin, France
| | - Allison M Hodge
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Pierre-Antoine Dugué
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Graham G Giles
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Roger L Milne
- Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia.,Precision Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Henrique Barros
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, AO Citta' della Salute e della Scienza-University of Turin and Center for Cancer Prevention, Turin, Italy
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Salvatore Panico
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Rosario Tumino
- Provincial Healthcare Company (ASP) Ragusa, Vittoria, Italy
| | - Marcel Goldberg
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Marie Zins
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France
| | - Cyrille Delpierre
- LEASP, UMR 1027, Inserm-Université Toulouse III Paul Sabatier, Toulouse, France
| | | | - Paolo Vineis
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
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85
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Gabrani J, Schindler C, Wyss K. Health Seeking Behavior Among Adults and Elderly With Chronic Health Condition(s) in Albania. Front Public Health 2021; 9:616014. [PMID: 33796494 PMCID: PMC8007873 DOI: 10.3389/fpubh.2021.616014] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
Aim: Assess the use of different health care service providers by adults (aged 18–59) and elderly (aged > =60) who suffer from non-communicable disease (NCD) and explore relationships between sociodemographic variables and care-seeking behaviors. Methods: A cross-sectional survey was conducted in the districts of Diber and Fier in December 2018, using random cluster sampling. Descriptive statistics were used to compare the care-seeking behaviors of adults and elderly people. We employed binary and multinomial logistic regression to assess factors associated with the type of health service provider used. Analyses were adjusted for clustering within districts of residence. Results: Out of 3,799 respondents, 1,116 (29.4%) suffered from an NCD. Of these, 95% sought to obtain care for their chronic condition through public healthcare providers. The elderly were more likely to use primary healthcare services (PHC) to initiate care when facing health problems (56%), compared to those aged 18–59 years (49%, p < 0,001). Over the last 8 weeks, 82% (914/1,116) of participants sought care. Binary and multinomial logistic regression analyses, adjusted for socio-demographic variables, showed that the elderly were more likely to choose PHC services (OR 1.56; 95% CI: 1.04; 2.35). Moreover, individuals who suffered from hypertension used PHC services more frequently than hospitals (OR 1.94; 95% CI: 1.32; 2.85). A positive association was found between living in an urban area and seeking care for NCDs at polyclinics (OR 10.1; 95% CI: 2.1; 50.1). There was no significant gender difference observed with regard to the type of provider consulted. Conclusion: Public facilities were reported as the main providers for initiating care and the main providers used in the 8 weeks prior to the interview. While a majority of elderly people visited a PHC to initiate treatment (and follow up) on their chronic conditions, a substantial proportion of adults (aged 18–59) initiated and sought regular NCD care at a hospital. Educating patients and caregivers on active participation in NCD prevention, management, and control through the PHC level should be a long-term effort, along with the establishment of well-structured referral mechanisms and integrated care systems.
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Affiliation(s)
- Jonila Gabrani
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
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86
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Tu R, Hou J, Liu X, Li R, Dong X, Pan M, Yin S, Hu K, Mao Z, Huo W, Chen G, Guo Y, Wang X, Li S, Wang C. Low socioeconomic status aggravated associations of exposure to mixture of air pollutants with obesity in rural Chinese adults: A cross-sectional study. ENVIRONMENTAL RESEARCH 2021; 194:110632. [PMID: 33345892 DOI: 10.1016/j.envres.2020.110632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 12/11/2020] [Accepted: 12/14/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Socio-economic status (SES) and air pollutants are thought to play an important role in human obesity. The evidence of interactive effect between SES and long-term exposure to mixture of air pollutants on obesity is limited, thus, this study is aimed to investigate their interactive effects on obesity among a rural Chinese population. METHODS A total of 38,817 individuals were selected from the Henan Rural Cohort Study. Structural equation modeling (SEM) was applied to construct the latent variables of low SES (educational level, marital status, family yearly income, and number of family members), air pollution (particulate matter with aerodynamics diameters ≤ 1.0 μm, ≤ 2.5 μm or ≤ 10 μm, and nitrogen dioxide) and obesity (body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio, body fat percentage and visceral fat index). Generalized linear regression models were used to assess associations between the constructed latent variables. Interaction plots were applied to describe interactive effect of air pollution and low SES on obesity and biological interaction indicators (the relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S)) were also calculated. RESULTS Increased latent variables of low SES and mixture of air pollution were associated with a higher odds of latent variable of obesity (odds ratios (OR) (95% confidence interval (CI)) were 1.055 (1.049, 1.060) and 1.050 (1.045, 1.055)). The association of the mixture of air pollutants on obesity was aggravated by increased values of the latent variable of low SES (P < 0.001). Furthermore, the values of RERI, AP and S were 0.073 (0.051, 0.094), 0.057 (0.040, 0.073) and 1.340 (1.214, 1.479), respectively, indicating an additive effect of estimated latent variable of low SES and air pollution on obesity. CONCLUSIONS These findings suggested that low SES aggravated the negative effect of mixture of air pollutants on obesity, implying that individuals with low SES may be more susceptible to exposure to high levels of mixture of air pollutants related to increased risk of prevalent obesity.
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Affiliation(s)
- Runqi Tu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Jian Hou
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Ruiying Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xiaokang Dong
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Mingming Pan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Shanshan Yin
- Department of health policy research, Henan Academy of Medical Sciences, Zhengzhou, China
| | - Kai Hu
- Department of health policy research, Henan Academy of Medical Sciences, Zhengzhou, China
| | - Zhenxing Mao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Wenqian Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Gongbo Chen
- Department of Global Health, School of Health Sciences, Wuhan University, Wuhan, China
| | - Yuming Guo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Xian Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, PR China.
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87
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Braverman-Bronstein A, Hessel P, González-Uribe C, Kroker MF, Diez-Canseco F, Langellier B, Lucumi DI, Rodríguez Osiac L, Trotta A, Diez Roux AV. Association of education level with diabetes prevalence in Latin American cities and its modification by city social environment. J Epidemiol Community Health 2021; 75:874-880. [PMID: 33542029 PMCID: PMC7611487 DOI: 10.1136/jech-2020-216116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/14/2021] [Accepted: 01/23/2021] [Indexed: 11/30/2022]
Abstract
Background Diabetes prevalence continues to increase in urban areas of low-income and middle-income countries (LMIC). Evidence from high-income countries suggests an inverse association between educational attainment and diabetes, but research in LMIC is limited. We investigated educational differences in diabetes prevalence across 232 Latin American (LA) cities, and the extent to which these inequities vary across countries/cities and are modified by city socioeconomic factors. Methods Using harmonised health survey and census data for 110 498 city dwellers from eight LA countries, we estimated the association between education and diabetes. We considered effect modification by city Social Environment Index (SEI) as a proxy for city-level development using multilevel models, considering heterogeneity by sex and country. Results In women, there was an inverse dose–response relationship between education and diabetes (OR: 0.80 per level increase in education, 95% CI 0.75 to 0.85), consistent across countries and not modified by SEI. In men, Argentina, Brazil, Colombia, Chile and Mexico showed an inverse association (pooled OR: 0.92; 95% CI 0.86 to 0.99). Peru, Panama and El Salvador showed a positive relationship (pooled OR 1.24; 95% CI 1.04 to 1.49). For men, these associations were further modified by city-SEI: in countries with an inverse association, it became stronger as city-SEI increased. In countries where the association was positive, it became weaker as city-SEI increased. Conclusion Social inequities in diabetes inequalities increase as cities develop. To achieve non-communicable disease-related sustainable development goals in LMIC, there is an urgent need to develop policies aimed at reducing these educational inequities.
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Affiliation(s)
| | - Philipp Hessel
- School of Government, Universidad de los Andes, Bogota, Colombia
| | | | - Maria F Kroker
- INCAP Research Center for the Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Francisco Diez-Canseco
- CRONICAS, Center of Excellence in Chronic Diseases, University Peruana Cayetano Heredia, Lima, Peru
| | - Brent Langellier
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Diego I Lucumi
- School of Government, Universidad de los Andes, Bogota, Colombia
| | | | - Andrés Trotta
- Institute of Collective Health, National University of Lanus, Buenos Aires, Argentina
| | - Ana V Diez Roux
- Urban Health Collaborative, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
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88
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Moazzeni SS, Toreyhi H, Asgari S, Azizi F, Tehrani FR, Hadaegh F. Number of parity/live birth(s) and cardiovascular disease among Iranian women and men: results of over 15 years of follow-up. BMC Pregnancy Childbirth 2021; 21:28. [PMID: 33413159 PMCID: PMC7792076 DOI: 10.1186/s12884-020-03499-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
Background Most previous studies conducted in non-Middle Eastern populations have suggested that an increase in the number of parity/live birth(s) leads to cardiovascular disease (CVD) development, although their findings were inconclusive on this issue for both sexes. Biologic and socioeconomic pathways were suggested to explain this association. We studied this issue among urban Iranian men and women. Methods In this population-based cohort study, which included 3929 women and 2571 men aged ≥30 years, data for the number of parity/live birth(s) were obtained by a standard questionnaire. Participants were then annually followed for CVD events. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the number of parity/live birth(s) and other traditional CVD risk factors. Results During more than 15 years of follow-up, 456 and 524 CVD events have occurred among women and men, respectively. Among women, a J-shaped association was found between the number of live births and incident CVD with the lowest risk for women with two live births. Among women in multivariable analyses, each unit increase in parity had a HR of 1.05 (CI: 1.01–1.10), and having ≥4 parity was associated with a HR of 1.86 (0.97–3.56, p-value = 0.061). Among men, in comparison with participants who had 1 child, multivariable HRs of having 2, 3, and ≥ 4 children were 1.97 (1.24–3.12), 2.08 (1.31–3.31), and 2.08 (1.30–3.34), respectively. Conclusion To the best of our knowledge, the current study is the first report on this issue in the Middle East and North Africa region, a region with a high burden of CVD. It can now be suggested that the number of parity/live birth(s) is linked to CVD among the Iranian population, with this issue being more prominent among men. Further research is needed to support our results and clarify the pathways between the number of parity/live birth(s) and CVD development among Iranian populations by considering potential risk factors, especially psycho-socio-economic risk factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03499-2.
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Affiliation(s)
- Seyyed Saeed Moazzeni
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Toreyhi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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89
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Tipayamongkholgul M, Kongtip P, Woskie S. Association between occupations and selected noncommunicable diseases: A matched case-control among Thai informal workers. J Occup Health 2021; 63:e12249. [PMID: 34263504 PMCID: PMC8279900 DOI: 10.1002/1348-9585.12249] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES We conducted a matched case-control study of informal workers to determine the association between occupational classification and selected types of noncommunicable diseases (NCDs). METHOD We extracted data of patients aged ≥18 years from the Thai National Health Security Office database (NHSO) during 2011-2014. Cases were patients who had a primary diagnosis of: diabetes mellitus (E10-E14), hypertension (I10-I15), ischemic heart disease (I20-I25) or stroke (I60-69), or thyroid gland disorder (E00-E07). Controls were patients who had a primary diagnosis of intestinal or parasitic infections (A00-A09 and B25-B99), and were randomly matched 1:1 with cases of the same age and residential area. The four-digit occupation codes recorded in the NHSO were grouped and recoded based on the submajor groups of International Standard Classification of Occupations (ISCO-08) as follows: agricultural workers, unskilled workers, service, and sales workers. Analysis was performed using multivariable conditional logistic regression. RESULTS Occupation and sex inequalities were present among all the selected NCDs. Higher risk for the four selected NCDs was found among unskilled workers. Stronger risk for cardiovascular disease was present among males, while females had a higher risk for metabolic disorders. CONCLUSIONS There is a need to understand what are the key factors that increase the risk for NCDs among informal sector workers. Health promotion campaigns are needed to raise awareness among economically and social disadvantaged informal workers about the risk for NCDs. This will require collaboration between public health and the workforce, and allocation of government budgets to address the needs of these workers.
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Affiliation(s)
| | - Pornpimol Kongtip
- Department of Occupational Health and SafetyFaculty of Public HealthMahidol UniversityBangkokThailand
| | - Susan Woskie
- Department of Public HealthZuckerberg College of Health SciencesUniversity of Massachusetts LowellBostonMAUSA
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90
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Current Pharmacological Treatment of Type 2 Diabetes Mellitus in Undocumented Migrants: Is It Appropriate for the Phenotype of the Disease? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218169. [PMID: 33167380 PMCID: PMC7663831 DOI: 10.3390/ijerph17218169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/22/2022]
Abstract
Type 2 diabetes is increasingly recognized as a spectrum of metabolic disorders sharing chronic hyperglycaemia. In Europe, the continually growing number of migrants from developing countries could affect diabetes phenotypes. We evaluated a population of 426 Italians and 412 undocumented migrants. Using 17 variables (with the exclusion of ethnic origin) we performed a multiple component analysis to detect potential clusters, independently from ethnicity. We also compared the two groups to evaluate potential ethnicity associated differences. We found five clusters of patients with different disease phenotypes. Comparing Italians with undocumented migrants, we noted that the first had more often cardiovascular risk factors and neurologic involvement, while the latter had a higher frequency of diabetic ulcers and renal involvement. Metformin was used in a comparable percentage of patients in all clusters, but other antidiabetic treatments showed some differences. Italians were more often on insulin, due to a larger use of long acting insulin, and received a larger number of oral antidiabetics in combination. Pharmacological treatment of comorbidities showed some differences too. We suggest that type 2 diabetes should be considered as a spectrum of diseases with different phenotypes also in heterogeneous populations, and that this is not due only to ethnic differences.
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91
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Wurdeman T, Menon G, Meara JG, Alkire BC. A country-level comparison of access to quality surgical and non-surgical healthcare from 1990-2016. PLoS One 2020; 15:e0241669. [PMID: 33141856 PMCID: PMC7608906 DOI: 10.1371/journal.pone.0241669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 10/19/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Healthcare Access and Quality (HAQ) index, developed by the Institute for Health Metrics and Evaluation, uses estimates of amenable mortality to quantify health system performance over time. While much is known about general health system performance globally, few studies have portrayed the performance of surgical systems. In order to quantify access to quality surgical care, evaluate changes over time, and link these changes to health care investments, surgical and non-surgical Health Access and Quality sub-indices were developed. DESIGN We categorized 32 amenable mortality causes as either surgical or non-surgical conditions. Using principal components analysis and scaled amenable mortality rates, we constructed a surgical and non-surgical Health Access and Quality sub-index. Using these sub-indices, relative improvement over time was compared. An expenditure model with country fixed effects was built to explore drivers of differences in relative improvement of sub-indices. RESULTS Compared to low-income countries, high-income countries have been 2.77 times more effective at improving surgical care (p < .05). Government expenditure on healthcare has a larger effect on improving surgical Health Access and Quality (p < 0.05) while development assistance for health has a larger effect on improving non-surgical Health Access and Quality (p < 0.05). CONCLUSIONS AND RELEVANCE Global health investment must prioritize strengthening health systems as opposed to the historically favored vertical programming. In order to achieve health equity in low-income countries, more focus should be placed on domestic financing of surgical systems. Health Access and Quality sub-indices can be used by countries to identify targets, monitor progress, and evaluate interventions aimed at improving access to quality surgical healthcare.
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Affiliation(s)
- Taylor Wurdeman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- Miller School of Medicine, University of Miami, Miami, FL, United States of America
| | - Gopal Menon
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- Columbia University Medical Center Department of Surgery, New York, NY, United States of America
| | - John G. Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, MA, United States of America
| | - Blake C. Alkire
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States of America
- Department of Otolaryngology, Massachusetts Eye and Ear Institute, Boston, MA, United States of America
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92
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Allen LN, Smith RW, Simmons-Jones F, Roberts N, Honney R, Currie J. Addressing social determinants of noncommunicable diseases in primary care: a systematic review. Bull World Health Organ 2020; 98:754-765B. [PMID: 33177772 PMCID: PMC7607469 DOI: 10.2471/blt.19.248278] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/16/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To explore how primary care organizations assess and subsequently act upon the social determinants of noncommunicable diseases in their local populations. METHODS For this systematic review we searched the online databases of PubMed®, MEDLINE®, Embase® and the Health Management Information Consortium from inception to 28 June 2019, along with hand-searching of references. Studies of any design that examined a primary care organization assessing social determinants of noncommunicable diseases were included. For quality assessment we used Cochrane's tool for assessing risk of bias in non-randomized studies of interventions. We used narrative data synthesis to appraise the extent to which the assessments gathered data on the domains of the World Health Organization social determinants of health framework. FINDINGS We identified 666 studies of which 17 were included in the review. All studies used descriptive study designs. Clinic-based and household surveys and interviews were more commonly used to assess local social determinants than population-level data. We found no examples of organizations that assessed sociopolitical drivers of noncommunicable diseases; all focused on sociodemographic factors or circumstances of daily living. Nevertheless, the resulting actions to address social determinants ranged from individual-level interventions to population-wide measures and introducing representation of primary care organizations on system-level policy and planning committees. CONCLUSION Our findings may help policy-makers to consider suitable approaches for assessing and addressing social determinants of health in their domestic context. More rigorous observational and experimental evidence is needed to ascertain whether measuring social determinants leads to interventions which mitigate unmet social needs and reduce health disparities.
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Affiliation(s)
- Luke N Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, England
| | - Robert W Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | | | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, England
| | - Rory Honney
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, England
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93
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Hawkes S, Buse K. COVID-19 and the gendered markets of people and products: explaining inequalities in infections and deaths. REVUE CANADIENNE D'ETUDES DU DEVELOPPEMENT = CANADIAN JOURNAL OF DEVELOPMENT STUDIES 2020; 42:37-54. [PMID: 35475122 PMCID: PMC7612661 DOI: 10.1080/02255189.2020.1824894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/02/2020] [Indexed: 06/01/2023]
Abstract
COVID-19 has exposed and exploited existing inequalities in gender to drive inequities in health outcomes. Evidence illustrates the relationship between occupation, ethnicity and gender to increase risk of infection in some places. Higher death rates are seen among people also suffering from non-communicable diseases - e.g. heart disease and lung disease driven by exposure to harmful patterns of exposure to corporate products (tobacco, alcohol, ultra-processed foods), corporate by-products (e.g. outdoor air pollution) or gendered corporate processes (e.g. gendered occupational risk). The paper argues that institutional gender blindness in the health system means that underlying gender inequalities have not been taken into consideration in policies and programmatic responses to COVID-19.
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Affiliation(s)
- Sarah Hawkes
- Institute for Global Health, University College London, London, UK
| | - Kent Buse
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
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94
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Foguet-Boreu Q, Ayerbe García-Morzon L. [Psychosocial stress, high blood pressure and cardiovascular risk]. HIPERTENSION Y RIESGO VASCULAR 2020; 38:83-90. [PMID: 33060048 DOI: 10.1016/j.hipert.2020.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 01/09/2023]
Abstract
Psychosocial stress can be the result of a wide variety of causes and circumstances. The experience of stress is often unique and experienced in a very personal way, although with common physiological responses. Predictably, it will increase in the modern world, which is subject to vertiginous social, cultural and technological changes. This review aims to determine the psychosocial factors that affect arterial hypertension (HT) and cardiovascular risk (CVR). Psychosocial stress more than doubles the risk of HT, the most related factors being post-traumatic stress disorder, anxiety and work stress. The factors that were most related to an increase in CVR were informal care, lower socioeconomic status, severe mental disorders, marital status, and post-traumatic stress disorder. Individual and collective psychosocial stress prevention strategies can be decisive in decreasing the prevalence of HT and CVR.
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Affiliation(s)
- Q Foguet-Boreu
- Servicio de Psiquiatría, Hospital Universitario de Vic, Vic, Barcelona, España; Facultad de Medicina, Universitat de Vic-Universitat Central de Catalunya (UVic-UCC), Vic, Barcelona, España.
| | - L Ayerbe García-Morzon
- Centre of Primary Care and Public Health, Queen Mary University of London, Londres, Reino Unido; Carnarvon Medical Centre, Southend-on-Sea, Reino Unido
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95
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Mela A, Rdzanek E, Poniatowski ŁA, Jaroszyński J, Furtak-Niczyporuk M, Gałązka-Sobotka M, Olejniczak D, Niewada M, Staniszewska A. Economic Costs of Cardiovascular Diseases in Poland Estimates for 2015-2017 Years. Front Pharmacol 2020; 11:1231. [PMID: 33013357 PMCID: PMC7506040 DOI: 10.3389/fphar.2020.01231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background Cardiovascular diseases are associated with growing public and private expenditure on healthcare regardless geographic region. Therefore, it is necessary to accurately estimate the overall societal costs-both direct and indirect expenses from the perspective of patients, caregivers and employers. Research Design The aim of this paper is to determine the direct and indirect costs related to cardiovascular diseases in Poland from 2015 to 2017. All costs are estimated based on data available in the public domain and obtained from the major Polish institutions. Indirect costs were calculated using a modified human capital approach. Results The financial burden of cardiovascular diseases in Poland is significant. This study revealed that total costs (direct and indirect) of cardiovascular diseases, for 2015-2017, range from 34.9 bn PLN (8.2 bn EUR) to over 40.9 bn PLN (9.6 bn EUR). Total direct cost and indirect costs were approximately 6.1 bn PLN (1.4 bn EUR) (16%) and 31.3 bn PLN (7.3 bn EUR) (84%), respectively. Conclusion Collectively, the estimated direct and indirect cost of cardiovascular diseases provide a useful input for economic impact assessments of public health programs and health technology analyses.
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Affiliation(s)
- Aneta Mela
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
| | - Elżbieta Rdzanek
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
| | - Łukasz A Poniatowski
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland.,Department of Neurosurgery, Maria Skłodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland
| | - Janusz Jaroszyński
- Chair of Administrative Procedure, Faculty of Law and Administration, Maria Curie-Skłodowska University of Lublin, Lublin, Poland
| | | | - Małgorzata Gałązka-Sobotka
- Department of Management and Marketing, Faculty of Economics and Management, Łazarski University, Warsaw, Poland.,Institute of Management in Health Care, Łazarski University, Warsaw, Poland
| | - Dominik Olejniczak
- Department of Public Health, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Niewada
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
| | - Anna Staniszewska
- Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, Warsaw, Poland
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96
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Bukhman G, Mocumbi AO, Atun R, Becker AE, Bhutta Z, Binagwaho A, Clinton C, Coates MM, Dain K, Ezzati M, Gottlieb G, Gupta I, Gupta N, Hyder AA, Jain Y, Kruk ME, Makani J, Marx A, Miranda JJ, Norheim OF, Nugent R, Roy N, Stefan C, Wallis L, Mayosi B. The Lancet NCDI Poverty Commission: bridging a gap in universal health coverage for the poorest billion. Lancet 2020; 396:991-1044. [PMID: 32941823 PMCID: PMC7489932 DOI: 10.1016/s0140-6736(20)31907-3] [Citation(s) in RCA: 155] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/29/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Gene Bukhman
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ana O Mocumbi
- Universidade Eduardo Mondlane, Maputo, Mozambique; Instituto Nacional de Saúde, Maputo, Mozambique
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Anne E Becker
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA
| | - Zulfiqar Bhutta
- Center for Global Child Health, Hospital for Sick Kids, Toronto, ON, Canada; Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Institute for Global Health & Development, Aga Khan University, South-Central Asia, East Africa, and UK
| | | | - Chelsea Clinton
- Clinton Foundation, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Matthew M Coates
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Gary Gottlieb
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Indrani Gupta
- Health Policy Research Unit, Institute of Economic Growth, Delhi, India
| | - Neil Gupta
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA; Partners In Health, Boston, MA, USA; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Adnan A Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yogesh Jain
- Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Julie Makani
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Andrew Marx
- Department of Global Health and Social Medicine, Harvard University, Boston, MA, USA; Program in Global NCDs and Social Change, Harvard University, Boston, MA, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Ole F Norheim
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA
| | - Nobhojit Roy
- WHO Collaborating Centre for Research on Surgical Care Delivery in LMICs, Department of Surgery, BARC Hospital, HBNI University, Government of India, Mumbai, India; Field Health Systems Laboratory, Bihar Technical Support Programme, CARE India, Madhubani, Bihar, India
| | - Cristina Stefan
- SingHealth Duke-NUS Global Health Institute (SDGHI), Duke-NUS Medical School, Singapore; African Medical Research and Innovation Institute, Cape Town, South Africa
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Bongani Mayosi
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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97
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Ioshimoto T, Shitara DI, do Prado GF, Pizzoni R, Sassi RH, de Gois AFT. Education is an important factor in end-of-life care: results from a survey of Brazilian physicians' attitudes and knowledge in end-of-life medicine. BMC MEDICAL EDUCATION 2020; 20:339. [PMID: 33008366 PMCID: PMC7531127 DOI: 10.1186/s12909-020-02253-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/23/2020] [Indexed: 06/08/2023]
Abstract
BACKGROUND According to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. As a reflection of the current scenario, little research about end-of-life care has been published so that studies addressing this subject in the Brazilian setting are crucial. METHODS A cross-sectional study study conducted with students applying for the medical residency of the Federal University of São Paulo were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in end-of-life care, prior end-of-life care experience, the 20-item Palliative Care Knowledge Test (PCKT) and a consent term. RESULTS Of the 3086 subjects applying for residency, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half of them (46,2%) reported having received no education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8% of correct answers), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric problems and 43,4% for gastrointestinal problems). Doctors that had already concluded a prior residency program and the ones that had prior experience with terminal patients performed better in the PCKT (p < 0,001). The high-performance group (more than 50% of correct answers) had received more training in end-of-life care, showed more interest in learning more about the subject, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p < 0,001). CONCLUSIONS Our study showed that Brazilian physicians lack not only the knowledge, but also training in end-of-life medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, for this group, training showed to be a key factor in overall in this area of knowledge. Therefore, Brazilian medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.
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Affiliation(s)
- Thais Ioshimoto
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Danielle Ioshimoto Shitara
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Gilmar Fernades do Prado
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Raymon Pizzoni
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil.
| | - Rafael Hennemann Sassi
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Aécio Flávio Teixeira de Gois
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
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98
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Social gradient in cancer incidence in Costa Rica: Findings from a national population-based cancer registry. Cancer Epidemiol 2020; 68:101789. [DOI: 10.1016/j.canep.2020.101789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/19/2022]
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99
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Paudel S, Tran T, Owen AJ, Smith BJ. The contribution of physical inactivity and socioeconomic factors to type 2 diabetes in Nepal: A structural equation modelling analysis. Nutr Metab Cardiovasc Dis 2020; 30:1758-1767. [PMID: 32636120 DOI: 10.1016/j.numecd.2020.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/02/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIM Type 2 diabetes mellitus (T2DM) is emerging as a significant public health challenge in Nepal. Behavioural, social and economic changes are likely to play a part in the rise of this chronic disease, as they are in many developing countries. A better understanding of the relationship between physical activity (PA), socioeconomic factors and T2DM can inform the design of prevention programs. This study aimed to identify the path relationships between PA, socioeconomic position, anthropometric and metabolic variables and T2DM. METHODS AND RESULTS This study analysed data from 1977 Nepalese adults aged 40-69 years from the cross-sectional WHO STEPS survey undertaken in 2013. The latent variable "PA" was created using the information on domains of PA while the latent variable "socioeconomic position" was created using the variables education, occupation and ethnicity. Participants' fasting blood glucose was used to determine their diabetes status. Structural equation modelling was conducted, and correlations and adjusted regression coefficients are reported. Individuals with higher education, in paid employment and from advantaged ethnic groups were more likely to have T2DM. Waist circumference, triglycerides and hypertension were found to have a statistically significant positive direct effect on T2DM. PA had indirect effects on T2DM, mediated by waist circumference. The indirect effects of socioeconomic position on T2DM were mediated by body mass index, waist circumference, triglycerides and total cholesterol. CONCLUSION Among Nepalese adults, higher socioeconomic position had a significant direct effect on T2DM, while both PA and higher socioeconomic position had significant indirect effects. Policies and programs to address T2DM in Nepal should address the factors contributing to unhealthy weight status, particularly among those of higher socioeconomic status.
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Affiliation(s)
- Susan Paudel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Thach Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice J Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ben J Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia
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100
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Buse K, Aftab W, Akhter S, Phuong LB, Chemli H, Dahal M, Feroz A, Hofiani S, Pradhan NA, Anwar I, Skhiri HA, El Ati J, Giang KB, Puri M, Noormal B, Rabbani F, Hawkes S. The state of diet-related NCD policies in Afghanistan, Bangladesh, Nepal, Pakistan, Tunisia and Vietnam: a comparative assessment that introduces a 'policy cube' approach. Health Policy Plan 2020; 35:503-521. [PMID: 32091080 PMCID: PMC7225567 DOI: 10.1093/heapol/czz175] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2019] [Indexed: 01/01/2023] Open
Abstract
We assessed the technical content of sugar, salt and trans-fats policies in six countries in relation to the World Health Organization 'Best Buys' guidelines for the prevention and control of non-communicable diseases (NCDs). National research teams identified policies and strategies related to promoting healthy diets and restricting unhealthy consumption, including national legislation, development plans and strategies and health sector-related policies and plans. We identified relevant text in relation to the issuing agency, overarching aims, goals, targets and timeframes, specific policy measures and actions, accountability systems, budgets, responsiveness to inequitable vulnerabilities across population groups (including gender) and human rights. We captured findings in a 'policy cube' incorporating three dimensions: policy comprehensiveness, political salience and effectiveness of means of implementation, and equity/rights. We compared diet-related NCD policies to human immunodeficiency virus policies in relation to rights, gender and health equity. All six countries have made high-level commitments to address NCDs, but dietary NCDs policies vary and tend to be underdeveloped in terms of the specificity of targets and means of achieving them. There is patchwork reference to internationally recognized, evidence-informed technical interventions and a tendency to focus on interventions that will encounter least resistance, e.g. behaviour change communication in contrast to addressing food reformulation, taxation, subsidies and promotion/marketing. Policies are frequently at the lower end of the authoritativeness spectrum and have few identified budgetary commitments or clear accountability mechanisms. Of concern is the limited recognition of equity and rights-based approaches. Healthy diet policies in these countries do not match the severity of the NCDs burden nor are they designed in such a way that government action will focus on the most critical dietary drivers and population groups at risk. We propose a series of recommendations to expand policy cubes in each of the countries by re-orienting diet-related policies so as to ensure healthy diets for all.
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Affiliation(s)
- Kent Buse
- UNAIDS, Avenue Appia 20, 1211 Genève, Switzerland
| | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sadika Akhter
- Health System and Population Studies Division, icddrb, GPO Box 128, Dhaka 1000, Bangladesh
| | - Linh Bui Phuong
- Center for Population Health Sciences, Hanoi University of Public Health, No. 1A, Duc Thang Street, Duc Thang Ward, Bac Tu Liem District, Hanoi City, Vietnam
| | - Haroun Chemli
- SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, Bab Saadoun, 1007, Tunis, Tunisia
| | - Minakshi Dahal
- Center for Research on Environment, Health and Population Activities (CREHPA), P.O.Box. 9626, Kusunti (near Yatayat office), Lalitpur, Nepal
| | - Anam Feroz
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sayad Hofiani
- Ministry of Public Health, Fifth Floor, Central Blood Bank Building, Cinema Pamir Area, Kabul, Afghanistan
| | - Nousheen Akber Pradhan
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Iqbal Anwar
- Health System and Population Studies Division, icddrb, GPO Box 128, Dhaka 1000, Bangladesh
| | - Hajer Aounallah Skhiri
- Faculty of Medicine of Tunis, University of Tunis El-Manar, Rue de la Faculte de Medecine, Tunis, Tunisia
- National Health Institute, Ministry of Health, 5/7 Rue El Khartoum, Diplomat, Bloc IV, 10ème étage, le Belvédère 1002 Tunis, Tunisia
| | - Jalila El Ati
- National Institute of Nutrition and Food Technology, SURVEN (Nutrition Surveillance and Epidemiology in Tunisia) Research Laboratory, 11 Rue Jebel Lakhdar, Bab Saadoun, 1007 Tunis, Tunisia
| | - Kim Bao Giang
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, No 1 Ton That Tung, Dong da District, Hanoi, Vietnam
| | - Mahesh Puri
- Center for Research on Environment, Health and Population Activities (CREHPA), P.O.Box. 9626, Kusunti (near Yatayat office), Lalitpur, Nepal
| | - Bashir Noormal
- Ministry of Public Health, Fifth Floor, Central Blood Bank Building, Cinema Pamir Area, Kabul, Afghanistan
| | - Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Stadium Road, P. O. Box 3500, Karachi 74800, Pakistan
| | - Sarah Hawkes
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH5, UK
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