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Fayne RA, Borda LJ, Egger AN, Tomic-Canic M. The Potential Impact of Social Genomics on Wound Healing. Adv Wound Care (New Rochelle) 2020; 9:325-331. [PMID: 32286204 DOI: 10.1089/wound.2019.1095] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Significance: Human skin wounds carry an immense epidemiologic and financial burden, and their impact will continue to grow with an aging population and rising incidence of comorbid conditions known to affect wound healing. To comprehensively address this growing clinical issue, physicians should also be aware of how conditions of the human social environment may affect wound healing. Here we provide a review of the emerging field of social genomics and its potential impact on the wound healing. Recent Advances: Multiple studies using human and animal models have correlated social influences and their contributing effects to acute and chronic stress with delays in wound healing. Furthermore, observations between nongenetic factors such as nutrition, socioeconomic, and educational status have also shown to have a direct or indirect impact on clinical outcomes of wound healing. Critical Issues: Nutrition, financial burden, socioeconomic and education status, and acute and chronic stress are variables that have either direct (epigenetic) or indirect impact on wound healing and patients' quality of life. Wound care is costly and remains a challenge placing economic burden on patients. Furthermore, poor clinical outcomes and complications including loss of mobility and disability may lead to job loss, further contributing to socioeconomic related stress. Thus, the economic burden and inadequate wound healing are intertwined, making each other worse. Future Directions: Although some evidence regarding the specific changes in genetic pathways imparted by conditions of the social environment exists, further studies are warranted to identify potential mechanisms, interventions, and prevention approaches.
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Affiliation(s)
- Rachel A. Fayne
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Luis J. Borda
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Andjela N. Egger
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Marjana Tomic-Canic
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
- Wound Healing and Regenerative Medicine Research Program, Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, Florida
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102
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Seiglie JA, Marcus ME, Ebert C, Prodromidis N, Geldsetzer P, Theilmann M, Agoudavi K, Andall-Brereton G, Aryal KK, Bicaba BW, Bovet P, Brian G, Dorobantu M, Gathecha G, Gurung MS, Guwatudde D, Msaidié M, Houehanou C, Houinato D, Jorgensen JMA, Kagaruki GB, Karki KB, Labadarios D, Martins JS, Mayige MT, Wong-McClure R, Mwangi JK, Mwalim O, Norov B, Quesnel-Crooks S, Silver BK, Sturua L, Tsabedze L, Wesseh CS, Stokes A, Atun R, Davies JI, Vollmer S, Bärnighausen TW, Jaacks LM, Meigs JB, Wexler DJ, Manne-Goehler J. Diabetes Prevalence and Its Relationship With Education, Wealth, and BMI in 29 Low- and Middle-Income Countries. Diabetes Care 2020; 43:767-775. [PMID: 32051243 PMCID: PMC7085810 DOI: 10.2337/dc19-1782] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/13/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is a rapidly growing health problem in low- and middle-income countries (LMICs), but empirical data on its prevalence and relationship to socioeconomic status are scarce. We estimated diabetes prevalence and the subset with undiagnosed diabetes in 29 LMICs and evaluated the relationship of education, household wealth, and BMI with diabetes risk. RESEARCH DESIGN AND METHODS We pooled individual-level data from 29 nationally representative surveys conducted between 2008 and 2016, totaling 588,574 participants aged ≥25 years. Diabetes prevalence and the subset with undiagnosed diabetes was calculated overall and by country, World Bank income group (WBIG), and geographic region. Multivariable Poisson regression models were used to estimate relative risk (RR). RESULTS Overall, prevalence of diabetes in 29 LMICs was 7.5% (95% CI 7.1-8.0) and of undiagnosed diabetes 4.9% (4.6-5.3). Diabetes prevalence increased with increasing WBIG: countries with low-income economies (LICs) 6.7% (5.5-8.1), lower-middle-income economies (LMIs) 7.1% (6.6-7.6), and upper-middle-income economies (UMIs) 8.2% (7.5-9.0). Compared with no formal education, greater educational attainment was associated with an increased risk of diabetes across WBIGs, after adjusting for BMI (LICs RR 1.47 [95% CI 1.22-1.78], LMIs 1.14 [1.06-1.23], and UMIs 1.28 [1.02-1.61]). CONCLUSIONS Among 29 LMICs, diabetes prevalence was substantial and increased with increasing WBIG. In contrast to the association seen in high-income countries, diabetes risk was highest among those with greater educational attainment, independent of BMI. LMICs included in this analysis may be at an advanced stage in the nutrition transition but with no reversal in the socioeconomic gradient of diabetes risk.
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Affiliation(s)
- Jacqueline A Seiglie
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Maja-Emilia Marcus
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Cara Ebert
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Nikolaos Prodromidis
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, CA
| | | | | | - Glennis Andall-Brereton
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | | | | | - Pascal Bovet
- Ministry of Health, Victoria, Republic of Seychelles
- University Center for Primary Care and Public Health, Lausanne, Switzerland
| | - Garry Brian
- The Fred Hollows Foundation NZ, Auckland, New Zealand
| | - Maria Dorobantu
- Cardiology Department, Emergency Hospital of Bucharest, Bucharest, Romania
| | - Gladwell Gathecha
- Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Mohamed Msaidié
- Comoros Ministry of Health, Solidarity, Social Cohesion and Gender, Moroni, Comoros
| | - Corine Houehanou
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Dismand Houinato
- Laboratory of Epidemiology of Chronic and Neurological Diseases, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | | | | | - Khem B Karki
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Demetre Labadarios
- Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Joao S Martins
- Faculty of Medicine and Health Sciences, National University of East Timor, Dili, Timor-Leste
| | - Mary T Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Roy Wong-McClure
- Epidemiology Office and Surveillance, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Joseph Kibachio Mwangi
- Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
- Faculté de médecine, Université de Genève, Geneva, Switzerland
| | - Omar Mwalim
- Zanzibar Ministry of Health, Mnazi Mmoja, Zanzibar
| | - Bolormaa Norov
- National Center for Public Health, Ulaanbaatar, Mongolia
| | - Sarah Quesnel-Crooks
- Non-Communicable Diseases, Caribbean Public Health Agency, Port of Spain, Trinidad and Tobago
| | | | - Lela Sturua
- Non-Communicable Disease Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | | | - Andrew Stokes
- Center for Global Health and Development, Boston University, Boston, MA
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
- Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
- Institute of Applied Health Research, University of Birmingham, Birmingham, U.K
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Till W Bärnighausen
- Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
- Africa Health Research Institute, Somkhele, South Africa
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
- Public Health Foundation of India, New Delhi, India
| | - James B Meigs
- Department of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Deborah J Wexler
- Diabetes Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Jennifer Manne-Goehler
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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103
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Lomia N, Berdzuli N, Pestvenidze E, Sturua L, Sharashidze N, Kereselidze M, Topuridze M, Antelava T, Stray-Pedersen B, Stray-Pedersen A. Socio-Demographic Determinants of Mortality from Chronic Noncommunicable Diseases in Women of Reproductive Age in the Republic of Georgia: Evidence from the National Reproductive Age Mortality Study (2014). Int J Womens Health 2020; 12:89-105. [PMID: 32161506 PMCID: PMC7051896 DOI: 10.2147/ijwh.s235755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/27/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Worldwide, noncommunicable diseases (NCDs) are the leading cause of premature death of women, taking the highest toll in developing countries. This study aimed to identify key socio-demographic determinants of NCD mortality in reproductive-aged women (15-49 years) in Georgia. Materials and Methods The study employed the verbal autopsy data from the second National Reproductive Age Mortality Survey 2014. Univariate and multivariate logistic regression models were fitted to explore the association between each risk factor and NCD mortality, measured by crude and adjusted odds ratio (AOR) with respective 95% confidence intervals (95% CI). Results In the final sample of 843 women, 586 (69.5%) deaths were attributed to NCDs, the majority of which occurred outside a hospital (72.7%) and among women aged 45-49 years (46.8%), ethnic Georgians (85.2%), urban residents (60.1%), those being married (60.6%), unemployed (75.1%) or having secondary and higher education (69.5%), but with nearly equal distribution across the wealth quintiles. After multivariate adjustment, the odds of dying from NCDs were significantly higher in women aged 45-49 years (AOR=17.69, 95% CI= 9.35 to 33.50), those being least educated (AOR=1.55, 95% CI= 1.01 to 2.37) and unemployed (AOR=1.47, 95% CI= 1.01 to 2.14) compared, respectively, to their youngest (15-24 years), more educated and employed counterparts. Strikingly, the adjusted odds were significantly lower in "other" ethnic minorities (AOR=0.29, 95% CI= 0.14 to 0.61) relative to ethnic Georgians. Contrariwise, there were no significant associations between NCD mortality and women's marital or wealth status, place of residence (rural/urban) or place of death. Conclusion Age, ethnicity, education, and employment were found to be strong independent predictors of young women's NCD mortality in Georgia. Further research on root causes of inequalities in mortality across the socioeconomic spectrum is warranted to inform equity- and life course-based multisectoral, integrated policy responses that would be conducive to enhancing women's survival during and beyond reproduction.
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Affiliation(s)
- Nino Lomia
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nino Berdzuli
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ekaterine Pestvenidze
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lela Sturua
- Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Nino Sharashidze
- Department of Clinical and Research Skills, Faculty of Medicine, Iv. Javakhishvili Tbilisi State University, Tbilisi, Georgia
| | - Maia Kereselidze
- Department of Medical Statistics, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Marina Topuridze
- Health Promotion Division, Department of Noncommunicable Diseases, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | | | - Babill Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Obstetrics and Gynecology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Arne Stray-Pedersen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
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104
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Fantin R, Santamaría‐Ulloa C, Barboza‐Solís C. Socioeconomic inequalities in cancer mortality: Is Costa Rica an exception to the rule? Int J Cancer 2020; 147:1286-1293. [DOI: 10.1002/ijc.32883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/16/2019] [Accepted: 01/08/2020] [Indexed: 12/20/2022]
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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105
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Murphy A, Palafox B, Walli-Attaei M, Powell-Jackson T, Rangarajan S, Alhabib KF, Avezum AJ, Calik KBT, Chifamba J, Choudhury T, Dagenais G, Dans AL, Gupta R, Iqbal R, Kaur M, Kelishadi R, Khatib R, Kruger IM, Kutty VR, Lear SA, Li W, Lopez-Jaramillo P, Mohan V, Mony PK, Orlandini A, Rosengren A, Rosnah I, Seron P, Teo K, Tse LA, Tsolekile L, Wang Y, Wielgosz A, Yan R, Yeates KE, Yusoff K, Zatonska K, Hanson K, Yusuf S, McKee M. The household economic burden of non-communicable diseases in 18 countries. BMJ Glob Health 2020; 5:e002040. [PMID: 32133191 PMCID: PMC7042605 DOI: 10.1136/bmjgh-2019-002040] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/07/2020] [Accepted: 01/09/2020] [Indexed: 11/29/2022] Open
Abstract
Background Non-communicable diseases (NCDs) are the leading cause of death globally. In 2014, the United Nations committed to reducing premature mortality from NCDs, including by reducing the burden of healthcare costs. Since 2014, the Prospective Urban and Rural Epidemiology (PURE) Study has been collecting health expenditure data from households with NCDs in 18 countries. Methods Using data from the PURE Study, we estimated risk of catastrophic health spending and impoverishment among households with at least one person with NCDs (cardiovascular disease, diabetes, kidney disease, cancer and respiratory diseases; n=17 435), with hypertension only (a leading risk factor for NCDs; n=11 831) or with neither (n=22 654) by country income group: high-income countries (Canada and Sweden), upper middle income countries (UMICs: Brazil, Chile, Malaysia, Poland, South Africa and Turkey), lower middle income countries (LMICs: the Philippines, Colombia, India, Iran and the Occupied Palestinian Territory) and low-income countries (LICs: Bangladesh, Pakistan, Zimbabwe and Tanzania) and China. Results The prevalence of catastrophic spending and impoverishment is highest among households with NCDs in LMICs and China. After adjusting for covariates that might drive health expenditure, the absolute risk of catastrophic spending is higher in households with NCDs compared with no NCDs in LMICs (risk difference=1.71%; 95% CI 0.75 to 2.67), UMICs (0.82%; 95% CI 0.37 to 1.27) and China (7.52%; 95% CI 5.88 to 9.16). A similar pattern is observed in UMICs and China for impoverishment. A high proportion of those with NCDs in LICs, especially women (38.7% compared with 12.6% in men), reported not taking medication due to costs. Conclusions Our findings show that financial protection from healthcare costs for people with NCDs is inadequate, particularly in LMICs and China. While the burden of NCD care may appear greatest in LMICs and China, the burden in LICs may be masked by care foregone due to costs. The high proportion of women reporting foregone care due to cost may in part explain gender inequality in treatment of NCDs.
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Affiliation(s)
- Adrianna Murphy
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Benjamin Palafox
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Marjan Walli-Attaei
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Timothy Powell-Jackson
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Sumathy Rangarajan
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Jephat Chifamba
- Department of Physiology, University of Zimbabwe, Harare, Zimbabwe
| | | | - Gilles Dagenais
- Institut universitaire de cardiologie et de pneumologie de Québec, Quebec City, Ontario, Canada
| | - Antonio L Dans
- Department of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Rajeev Gupta
- Eternal Heart Care Centre and Research Institute, Jaipur, India
| | - Romaina Iqbal
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Manmeet Kaur
- School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Roya Kelishadi
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, the Islamic Republic of Iran
| | - Rasha Khatib
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Iolanthe Marike Kruger
- Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa
| | | | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, University Teknologi MARA, Beijing, China
| | | | - Viswanathan Mohan
- Dr. Mohan's Diabetes Specialities Centre & Madras Diabetes Research Foundation, Chennai, India
| | - Prem K Mony
- St John's Medical College and Research Institute, Bangalore, India
| | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University, Gothenburg, Sweden
| | - Ismail Rosnah
- Community Health Department, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Pamela Seron
- Facultad de Medicina, Universidad de La Frontera, Temucu, Chile
| | - Koon Teo
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Lap Ah Tse
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Lungiswa Tsolekile
- School of Public Health, University of the Western Cape, Bellville, Western Cape, South Africa
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Andreas Wielgosz
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ruohua Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Karen E Yeates
- Department of Medicine, Queen's University, Kingston, New Hampshire, Canada
| | - Khalid Yusoff
- UiTM, Selayang, Selangor and UCSI University, Cheras, Kuala Lumpur, Malaysia
| | - Katarzyna Zatonska
- Department of Social Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Kara Hanson
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada
| | - Martin McKee
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
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106
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Rippin HL, Hutchinson J, Jewell J, Breda JJ, Cade JE. Assessing diet in European populations using national dietary surveys. Proc Nutr Soc 2020; 79:1-11. [PMID: 31969200 DOI: 10.1017/s0029665119001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The WHO encourages countries to conduct national dietary surveys (NDS) to inform preventative policies targeting malnutrition and noncommunicable diseases. Previous reviews have found inadequate nutrient intakes and survey provision across Europe. This research is the first to provide an updated review of NDS provision within the whole WHO European Region, across the lifecourse, with reference to disadvantaged groups, obesity and nutrients of concern. Over a third of WHO European countries, mainly Central and Eastern European countries (CEEC), had no identifiable NDS. Where countries reported nutrient intakes, poor WHO recommended nutrient intake attainment was Europe-wide across the lifecourse, particularly in CEEC. Lower educated individuals had poorer diet quality. However, heterogeneity in age group sampled, dietary assessment method, nutrient composition database and under-reporting hindered inter-country comparisons. Average population trans fatty acid intakes below WHO recommended limits may hide inequalities in disadvantaged groups; legislative bans may help alleviate this. There were few associations between NDS-derived consumed food portion size (FPS) and BMI. However, consumed FPS was greater than on-pack serving-size in the majority of foods studied. This review illustrates how NDS can generate information on diet, nutrient intakes and the food environment. However, to enable valid inter-country comparisons, countries should be encouraged to conduct and report harmonised NDS, particularly in the age groups sampled, dietary assessment methodology, nutrient range, underpinning food composition database and treatment of under-reporters. This will aid effective, coordinated policy development that can have a real impact on dietary improvement, on a population and subgroup level, throughout Europe.
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Affiliation(s)
- Holly L Rippin
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, LeedsLS2 9JT, UK
| | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, LeedsLS2 9JT, UK
| | - Jo Jewell
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, UN City, Marmorvej 51, 21000Copenhagen, Denmark
| | - Joao J Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, UN City, Marmorvej 51, 21000Copenhagen, Denmark
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, LeedsLS2 9JT, UK
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107
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Medina-Urrutia AX, Martínez-Sánchez FD, Posadas-Romero C, Jorge-Galarza E, Martínez-Alvarado MDR, González-Salazar MDC, Osorio-Alonso H, Juárez-Rojas JG. Metabolic control achievement in a population with premature coronary artery disease: results of the genetics of atherosclerotic disease study. Ther Adv Endocrinol Metab 2020; 11:2042018820943374. [PMID: 32782778 PMCID: PMC7385835 DOI: 10.1177/2042018820943374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 06/29/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND AIMS To the best of our knowledge, no studies have investigated the metabolic control of patients with premature coronary artery disease (CAD). The present study analyzes the metabolic control, defined as the simultaneous target in blood pressure, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol and hemoglobin A1c, as well as the factors associated with its achievement in patients with premature CAD. METHODS The study included 1206 patients with CAD diagnosed before the age of 55 and 65 years in men and women, respectively. Sociodemographic, clinical and biochemical data were collected to know the prevalence of cardiovascular risk factors, including individual components of metabolic control plus smoking cessation and body mass index (BMI) <25 kg/m2. Non-strict and strict targets were used to evaluate metabolic control. RESULTS Participants were 54 ± 8 years old, 19.7% were women and had a median CAD evolution of 2.4 years. Non-strict and strict metabolic control was achieved by 18.4% and 6.2% of patients, respectively. Moreover, 79.8% and 67.6% met a composite of three or more cardiovascular risk factor goals using both criteria. BMI <25 kg/m2 was independently associated with 1.734 (95% confidence interval: 1.207-2.492) and 2.541 (95% confidence interval: 1.608-4.014) higher probabilities to meet non-strict or strict metabolic control. CONCLUSION Our results show that 18.4% and 6.2% of subjects with premature CAD achieved non-strict and strict metabolic control, respectively. BMI <25 kg/m2 was found to be associated with the achievement of metabolic control. Multidisciplinary strategies including healthy lifestyle changes and pharmacological therapies could decrease the socioeconomic and clinical impact of premature CAD.
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Affiliation(s)
- Aida X Medina-Urrutia
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
| | - Froylan D Martínez-Sánchez
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
| | - Carlos Posadas-Romero
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
| | - Esteban Jorge-Galarza
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
| | | | | | - Horacio Osorio-Alonso
- Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología Ignacio Chávez, Tlalpan, Mexico City, Mexico
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108
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Grosbois JM, Heluain-Robiquet J, Machuron F, Terce G, Chenivesse C, Wallaert B, Le Rouzic O. Influence Of Socioeconomic Deprivation On Short- And Long-Term Outcomes Of Home-Based Pulmonary Rehabilitation In Patients With Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2019; 14:2441-2449. [PMID: 31802862 PMCID: PMC6827503 DOI: 10.2147/copd.s224348] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/13/2019] [Indexed: 11/23/2022] Open
Abstract
Background Pulmonary rehabilitation (PR) improves exercise tolerance and quality of life in patients with chronic obstructive pulmonary disease (COPD), regardless of disease severity. Socioeconomic deprivation has been linked to the incidence of COPD; however, little is known about its impact on PR outcomes. Methods In this retrospective observational study, 459 COPD patients were enrolled and dichotomized into socially deprived (n=276) and non-socially deprived (n=183) groups based on a cut-off of 30.17 in the EPICES questionnaire (Evaluation of Deprivation and Inequalities in Health Centers), which evaluates socioeconomic disadvantage. The PR program consisted of once-weekly home sessions for 8 weeks, and consisted of an individualized plan of retraining exercises, physical activities, therapeutic education, and psychosocial and motivational support. Exercise tolerance, anxiety and depression, and quality of life were assessed using the 6 min stepper test (6MST), Hospital Anxiety and Depression Scale (HADS), and Visual Simplified Respiratory Questionnaire (VSRQ). Assessments were made before the PR program (baseline) and then at 2 (T2), 8 (T8), and 14 (T14) months after baseline. Results Compared with the non-socially deprived group, socially deprived patients were younger, more frequently women, active smokers, and living alone, and belonged to lower socioprofessional categories. At baseline, 6MST, VSRQ, and HADS measures were lower for the socially deprived than the non-socially deprived group. At T2, T8, and T14, there were no significant between-group differences in any outcome, and the percentage of patients showing clinically important improvements was the same in both groups. Conclusion Home-based PR is effective for COPD patients in the short and long term, regardless of socioeconomic status.
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Affiliation(s)
- Jean-Marie Grosbois
- FormAction Santé, Pérenchies F-59840, France.,CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France
| | - Justine Heluain-Robiquet
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France
| | - François Machuron
- CHU Lille, Department of Biostatistics, University Lille, EA 2694 - Santé Publique: Epidémiologie Et Qualité Des Soins, Lille F-59000, France
| | - Gaelle Terce
- CH Béthune, Service de Pneumologie et Réhabilitation Respiratoire, Béthune F-62400, France
| | - Cécile Chenivesse
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France.,University Lille, Lille F-59000, France.,Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, France
| | - Benoit Wallaert
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France.,University Lille, Lille F-59000, France.,Inserm, CNRS, Institut Pasteur de Lille, U1019 - UMR 8204 - CIIL - Center for Infection and Immunity of Lille, Lille F-59000, France
| | - Olivier Le Rouzic
- CHU Lille, Service de Pneumologie et Immuno-Allergologie, Centre de Référence Constitutif des Maladies Pulmonaires Rares, Department of Heart and Lung Diseases, Lille F-59000, France.,University Lille, Lille F-59000, France
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Bernal RTI, Felisbino-Mendes MS, de Carvalho QH, Pell J, Dundas R, Leyland A, Barreto ML, Malta DC. Indicators of chronic noncommunicable diseases in women of reproductive age that are beneficiaries and non-beneficiaries of Bolsa Família. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22Suppl 02:E190012.SUPL.2. [PMID: 31596383 PMCID: PMC6892639 DOI: 10.1590/1980-549720190012.supl.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 03/12/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of noncommunicable disease (NCD) indicators, including laboratory tests, in the population of Brazilian women of reproductive age, according to whether or not they receive the Bolsa Família (BF) benefit. METHODS A total of 3,131 women aged 18 to 49 years old who participated in the National Health Survey (Pesquisa Nacional de Saúde ) laboratory examination sub-sample were considered. We compared indicators among women of reproductive age (18 to 49 years old) who reported receiving BF or not, and calculated prevalence and confidence intervals, using Pearson's χ2. RESULTS Women of reproductive age who were beneficiaries of BF had worse health outcomes, such as a greater occurrence of being overweight (33.5%) and obese (26.9%) (p < 0.001), having hypertension (13.4% versus 4.4%, p < 0.001), used more tobacco (11.2% versus 8.2%, p = 0.029), and perceived their health as worse (6.2% versus 2.4%, p < 0.001). CONCLUSION Several NCD indicators were worse among women of childbearing age who were beneficiaries of BF. It should be emphasized that this is not a causal relationship, with BF being a marker of inequalities among women. The benefit has been directed to the population with greater health needs, and seeks to reduce inequities.
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Affiliation(s)
- Regina Tomie Ivata Bernal
- Graduate Program, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | | | - Jill Pell
- Institute of Health and Wellbeing, University of Glasgow - Glasgow, Scotland
| | - Ruth Dundas
- Medical Research Council/Chief Scientific Office (MRC/CSO) Social and Public Health Sciences Unit, University of Glasgow – Glasgow, Scotland
| | - Alastair Leyland
- Medical Research Council/Chief Scientific Office (MRC/CSO) Social and Public Health Sciences Unit, University of Glasgow – Glasgow, Scotland
| | - Mauricio Lima Barreto
- Center for the Integration of Health Knowledge and Data, Gonçalo Moniz Institute, Oswaldo Cruz Foundation - Salvador (BA), Brazil
| | - Deborah Carvalho Malta
- Graduate Program, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
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Blom DJ, Santos RD, Daclin V, Mercier F, Ruiz AJ, Danchin N. The challenge of multiple cardiovascular risk factor control outside Western Europe: Findings from the International ChoLesterol management Practice Study. Eur J Prev Cardiol 2019; 27:1403-1411. [PMID: 31533447 PMCID: PMC7457454 DOI: 10.1177/2047487319871735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Comprehensive control of multiple cardiovascular risk factors reduces cardiovascular risk but is difficult to achieve. Design A multinational, cross-sectional, observational study. Methods The International ChoLesterol management Practice Study (ICLPS) investigated achievement of European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline low-density lipoprotein cholesterol (LDL-C) targets in patients receiving lipid-modifying therapy in countries outside Western Europe. We examined the rate of, and association between, control of multiple risk factors in ICLPS participants with dyslipidaemia, diabetes and hypertension (N = 2377). Results Mean (standard deviation) age of patients was 61.4 (10.4) years; 51.3% were male. Type 2 diabetes was the most common form of diabetes (prevalence, 96.9%). The prevalence of metabolic syndrome was 67.8%, obesity 40.4%, atherosclerotic disease 39.6% and coronary artery disease 33.5%. All patients were at high (38.2%) or very high (61.8%) cardiovascular risk according to ESC/EAS guidelines. Body mass index (BMI) was <25 kg/m2 in 20.3% of patients, 62.8% had never smoked and 25.2% were former smokers. Overall, 12.2% achieved simultaneous control of LDL-C, diabetes and blood pressure. Risk factor control was similar across all participating countries. The proportion of patients achieving individual guideline-specified treatment targets was 43.9% for LDL-C, 55.5% for blood pressure and 39.3% for diabetes. Multiple correspondence analysis indicated that control of LDL-C, control of blood pressure, control of diabetes, BMI and smoking were associated. Conclusion Comprehensive control of multiple cardiovascular risk factors in high-risk patients is suboptimal worldwide. Failure to control one risk factor is associated with poor control of other risk factors.
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Affiliation(s)
- Dirk J Blom
- University of Cape Town, Cape Town, South Africa
| | - Raul D Santos
- Heart Institute (InCor), University of Sao Paulo Medical School Hospital and Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | | | | | | | - Nicolas Danchin
- Cardiology, European Hospital Georges-Pompidou, Paris, France
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The interaction between district-level development and individual-level socioeconomic gradients of cardiovascular disease risk factors in India: A cross-sectional study of 2.4 million adults. Soc Sci Med 2019; 239:112514. [PMID: 31541939 DOI: 10.1016/j.socscimed.2019.112514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/07/2019] [Accepted: 08/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Diabetes, hypertension, and obesity tend to be positively associated with socio-economic status in low- and middle-income countries (LMICs). It has been hypothesized that these positive socio-economic gradients will reverse as LMICs continue to undergo economic development. We use population-based cross-sectional data in India to examine how a district's economic development is associated with socio-economic differences in cardiovascular disease (CVD) risk factor prevalence between individuals. METHODS We separately analyzed two nationally representative household survey datasets - the NFHS-4 and the DLHS-4/AHS - that are representative at the district level in India. Diabetes was defined based on a capillary blood glucose measurement, hypertension on blood pressure measurements, obesity on measurements of height and weight, and current smoking on self-report. Five different measures of a district's economic development were used. We analyzed the data using district-level regressions (plotting the coefficient comparing high to low socio-economic status against district-level economic development) and multilevel modeling. RESULTS 757,655 and 1,618,844 adults participated in the NFHS-4 and DLHS-4/AHS, respectively. Higher education and household wealth were associated with a higher probability of having diabetes, hypertension, and obesity, and a lower probability of being a current smoker. For diabetes, hypertension, and obesity, we found that a higher economic development of a district was associated with a less positive (or even negative) association between the CVD risk factor and education. For smoking, the association with education tended to become less negative as districts had a higher level of economic development. In general, these associations did not show clear trends when household wealth quintile was used as the measure of socio-economic status instead of education. CONCLUSIONS While this study provides some evidence for the "reversal hypothesis", large-scale longitudinal studies are needed to determine whether LMICs should expect a likely reversal of current positive socioeconomic gradients in diabetes, hypertension, and obesity as their countries continue to develop economically.
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Feng L, Naheed A, de Silva HA, Jehan I, Raqib R, Islam MT, Luke N, Kasturiratne A, Farazdaq H, Senan S, Jafar TH. Regional Variation in Comorbid Prediabetes and Diabetes and Associated Factors among Hypertensive Individuals in Rural Bangladesh, Pakistan, and Sri Lanka. J Obes 2019; 2019:4914158. [PMID: 31183214 PMCID: PMC6515018 DOI: 10.1155/2019/4914158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/16/2019] [Indexed: 11/17/2022] Open
Abstract
We aimed to explore the cross-country variation in the prevalence of comorbid prediabetes or diabetes and determine the sociodemographic, lifestyle, and clinical factors, especially body mass index (BMI) and waist circumference, associated with comorbid diabetes in individuals with hypertension in rural South Asia. We analyzed cross-sectional data of 2426 hypertensive individuals of ≥40 years from 30 randomly selected rural communities in Bangladesh, Pakistan, and Sri Lanka. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL without use of antidiabetic treatment and diabetes as FPG ≥126 mg/dL or use of antidiabetic medication. The prevalence (95% CI) of prediabetes or diabetes (53.5% (51.5%, 55.5%)) and diabetes (27.7% (25.9%, 29.5%)) was high in the overall hypertensive study population in rural communities in 3 countries. Rural communities in Sri Lanka had the highest crude prevalence of prediabetes or diabetes and diabetes (73.1% and 39.3%) with hypertension, followed by those in Bangladesh (47.4% and 23.1%) and Pakistan (39.2% and 20.5%). The factors independently associated with comorbid diabetes and hypertension were residing in rural communities in Sri Lanka, higher education, international wealth index, waist circumference, pulse pressure, triglyceride, and lower high-density lipoprotein. The association of diabetes with waist circumference was stronger than with BMI in hypertensive individuals. Prediabetes or diabetes are alarmingly common among adults with hypertension and vary among countries in rural South Asia. The high prevalence of comorbid diabetes in Sri Lanka among hypertensives is not fully explained by conventional risk factors and needs further etiological research. Urgent public health efforts are needed to integrate diabetes control within hypertension management programs in rural South Asia, including screening waist circumference.
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Affiliation(s)
- Liang Feng
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Aliya Naheed
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh
| | - H. Asita de Silva
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Imtiaz Jehan
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
| | - Rubhana Raqib
- Immunobiology, Nutrition and Toxicology Laboratory, Infectious Diseases Division, icddr, b, Dhaka, Bangladesh
| | - Md Tauhidul Islam
- Initiative for Non-Communicable Diseases, Health Systems and Population Studies Division, icddr, b, Dhaka, Bangladesh
| | - Nathasha Luke
- Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Anuradhani Kasturiratne
- Department of Public Health, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Hamida Farazdaq
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Sahar Senan
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke Global Health Institute, Duke University, Durham, NC, USA
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Bernal RTI, Felisbino-Mendes MS, de Carvalho QH, Pell J, Dundas R, Leyland A, Barreto ML, Malta DC. Indicators of chronic noncommunicable diseases in women of reproductive age that are beneficiaries and non-beneficiaries of Bolsa Família. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019. [PMID: 31596383 PMCID: PMC6892639 DOI: 10.1590/1980-549720190012.supl.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of noncommunicable disease (NCD) indicators, including laboratory tests, in the population of Brazilian women of reproductive age, according to whether or not they receive the Bolsa Família (BF) benefit. METHODS A total of 3,131 women aged 18 to 49 years old who participated in the National Health Survey (Pesquisa Nacional de Saúde ) laboratory examination sub-sample were considered. We compared indicators among women of reproductive age (18 to 49 years old) who reported receiving BF or not, and calculated prevalence and confidence intervals, using Pearson's χ2. RESULTS Women of reproductive age who were beneficiaries of BF had worse health outcomes, such as a greater occurrence of being overweight (33.5%) and obese (26.9%) (p < 0.001), having hypertension (13.4% versus 4.4%, p < 0.001), used more tobacco (11.2% versus 8.2%, p = 0.029), and perceived their health as worse (6.2% versus 2.4%, p < 0.001). CONCLUSION Several NCD indicators were worse among women of childbearing age who were beneficiaries of BF. It should be emphasized that this is not a causal relationship, with BF being a marker of inequalities among women. The benefit has been directed to the population with greater health needs, and seeks to reduce inequities.
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Affiliation(s)
- Regina Tomie Ivata Bernal
- Graduate Program, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
| | | | | | - Jill Pell
- Institute of Health and Wellbeing, University of Glasgow - Glasgow, Scotland
| | - Ruth Dundas
- Medical Research Council/Chief Scientific Office (MRC/CSO) Social and Public Health Sciences Unit, University of Glasgow – Glasgow, Scotland
| | - Alastair Leyland
- Medical Research Council/Chief Scientific Office (MRC/CSO) Social and Public Health Sciences Unit, University of Glasgow – Glasgow, Scotland
| | - Mauricio Lima Barreto
- Center for the Integration of Health Knowledge and Data, Gonçalo Moniz Institute, Oswaldo Cruz Foundation - Salvador (BA), Brazil
| | - Deborah Carvalho Malta
- Graduate Program, School of Nursing, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil
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