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Álvarez-Fernández C, Vaquero-Abellán M, Ruíz-Gandara Á, Romero-Saldaña M, Álvarez-López C. [Cardiovascular risk factors in the population at risk of poverty and social exclusión]. Aten Primaria 2017; 49:140-149. [PMID: 27423244 PMCID: PMC6876063 DOI: 10.1016/j.aprim.2016.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/04/2022] Open
Abstract
GOALS Detect if there are differences in prevalence, distribution of cardiovascular risk factors and risk according to REGICOR and SCORE's function; between people belonging to different occupational classes and population at risk of social exclusion. DESIGN Cross-sectional. SITE: Occupational health unit of the City Hall of Córdoba. PARTICIPANTS Sample availability of 628 people, excluding 59 by age or incomplete data. The group of municipal workers was obtained randomly while all contracted exclusion risk was taken. INTERVENTION No preventive, diagnostic or therapeutic actions that modify the course of the previous situation of workers were applied. MAIN MEASUREMENTS Smoke, glucose, lipids, blood pressure and BMI as main variables. T-student were used for comparison of means and percentages for Chi2. Statistical significance attached to an alpha error <5% and confidence interval with a 95% security. Receiver operator curves (ROC) were employed to find out what explanatory variables predict group membership of workers at risk of exclusion. RESULTS Smoking (95% CI: -.224;-.443), hypercholesterolemia (95% CI: -.127;-.320), obesity (95% CI: -.005;-0.214), diabetes (95% CI: -.060;-.211) and cardiovascular risk were higher in men at risk of exclusion. In women there were differences in the same variables except smoking (P=.053). CONCLUSIONS The existence of inequalities in prevalence of cardiovascular risk factors is checked. In a context of social crisis, health promotion and primary prevention programs directing to the most vulnerable, they are needed to mit.
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Affiliation(s)
| | - Manuel Vaquero-Abellán
- Dirección General de Prevención y Protección Ambiental, Universidad de Córdoba, Córdoba, España
| | | | | | - Carlos Álvarez-López
- Distrito Sanitario Guadalquivir (Córdoba), Servicio Andaluz de Salud, Córdoba, España
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Cirera L, Huerta JM, Chirlaque MD, Molina-Montes E, Altzibar JM, Ardanaz E, Gavrila D, Colorado-Yohar S, Barricarte A, Arriola L, Quirós JR, Sánchez-Cantalejo E, Sánchez MJ, Agudo A, Navarro C. Life-course social position, obesity and diabetes risk in the EPIC-Spain Cohort. Eur J Public Health 2015; 26:439-45. [PMID: 26635012 DOI: 10.1093/eurpub/ckv218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The literature has consistently shown that extreme social-economic groups predicted type 2 diabetes mellitus (T2D), rather than summarising the social gradient throughout all society stratification. Body mass index (BMI) was established as the principal mediator, with little support for other anthropometries. Our aim was to investigate an individual life-course social position (LiSoP) gradient and its mediators with T2D risk in the EPIC-Spain cohort. METHODS 36 296 participants (62% women), mostly aged 30-65 years, and free of T2D at baseline (1992-1996) were followed up for a mean of 12.1 years. A combined score of paternal occupation in childhood and own adult education assessed individual life-course social risk accumulation. Hazard ratios of T2D were estimated using Cox regression, stratifying by centre and age, and adjusting for different explanatory models, including anthropometric indices; dietary history; smoking and physical activity lifestyles; and clinical information. RESULTS Final models evidenced significant risks in excess of 63% for middle and 90% for lower classes of LiSoP in men; and of 104 and 126%, respectively, in women. Concurrently, LiSoP presented significant social gradients for T2D risk (P < 0.01) in both sexes. Waist circumference (WC) accounted for most of the risk excess in women, and BMI and WC in men. CONCLUSIONS LiSoP gradient was related to T2D risk in Spanish men and women. WC mostly explained the relationship in both genders, together with BMI in men, yet LiSoP retained an independent effect in final models.
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Affiliation(s)
- Lluís Cirera
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - José María Huerta
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Department of Health and Social Sciences, University of Murcia, Murcia, Spain
| | - Esther Molina-Montes
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Jone Miren Altzibar
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Donostia-San Sebastián, Spain
| | - Eva Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Public Health Institute of Navarra, Pamplona, Spain
| | - Diana Gavrila
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Sandra Colorado-Yohar
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain Research Group on Demography and Health, National Faculty of Public Health, University of Antioquia, Medellín, Colombia
| | - Aurelio Barricarte
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Public Health Institute of Navarra, Pamplona, Spain
| | - Larraitz Arriola
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Public Health Division of Gipuzkoa, Instituto BIO-Donostia, Basque Government, Donostia-San Sebastián, Spain
| | | | - Emilio Sánchez-Cantalejo
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - María José Sánchez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Escuela Andaluza de Salud Pública. Instituto de Investigación Biosanitaria ibs.GRANADA. Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Antonio Agudo
- Unit of Nutrition, Environment and Cancer, Cancer Epidemiology Research Programme, Catalan Institute of Oncology, l'Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Navarro
- Department of Epidemiology, Murcia Regional Health Council, IMIB - Arrixaca, Murcia, Spain CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain Department of Health and Social Sciences, University of Murcia, Murcia, Spain
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Pabayo R, Kawachi I, Gilman SE. US State-level income inequality and risks of heart attack and coronary risk behaviors: longitudinal findings. Int J Public Health 2015; 60:573-88. [PMID: 25981210 PMCID: PMC4517572 DOI: 10.1007/s00038-015-0678-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 03/25/2015] [Accepted: 03/26/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To examine prospectively the association between US state income inequality and incidence of heart attack. METHODS We used data from the National Epidemiologic Survey on Alcohol and Related Conditions (n = 34,445). Respondents completed interviews at baseline (2001-2002) and follow-up (2004-2005). Weighted multilevel modeling was used to determine if US state-level income inequality (measured by the Gini coefficient) at baseline was a predictor of heart attack during follow-up, controlling for individual-level and state-level covariates. RESULTS In comparison to residents of US states in the lowest quartile of income inequality, those living in the second [Adjusted Odds Ratio (AOR) = 1.71, 95 % CI 1.16-2.53)], third (AOR = 1.81, 95 % CI 1.28-2.57), and fourth (AOR = 2.04, 95 % CI 1.26-3.29) quartiles were more likely to have a heart attack. Similar findings were obtained when we excluded those who had a heart attack prior to baseline. CONCLUSIONS This study is one of the first to empirically show the longitudinal relationship between income inequality and coronary heart disease. Living in a state with higher income inequality increases the risk for heart attack among US adults.
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Affiliation(s)
- Roman Pabayo
- Department of Community Health Sciences, University of Nevada, Reno, Lombardi Building, 203, MS 0274, 1664 North Virginia Street, Reno, NV, 89557, USA,
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Roma coronary heart disease patients have more medical risk factors and greater severity of coronary heart disease than non-Roma. Int J Public Health 2013; 58:409-15. [PMID: 23543308 DOI: 10.1007/s00038-013-0462-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 03/09/2013] [Accepted: 03/20/2013] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Coronary heart disease (CHD) is the most common cause of mortality and morbidity world-wide. Evidence on ethnic differences between the Roma and non-Roma regarding medical risk factors is scarce. The aim of this study was to assess differences in medical risk factors and the severity of CHD in Roma compared with non-Roma CHD patients, adjusted for gender, age and education. METHODS Six hundred seventy four patients were included in this cross-sectional study (132 Roma, 542 non-Roma). Data on medical risk factors, symptoms, medication and severity of CHD were obtained from medical records. After matching Roma and non-Roma according to education, linear and logistic regression analyses with adjustments for gender and age were used. RESULTS Compared with non-Roma, Roma patients had significantly more risk factors and more severe types of CHD. They were treated less frequently with statins and beta-blockers, were more frequently left on pharmacotherapy and surgically revascularised. These differences remained after controlling for education, gender and age. CONCLUSIONS Roma CHD patients have a worse risk profile at entry of care and seem to be undertreated compared with non-Roma CHD patients.
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Abstract
The present study aimed at evaluating coronary risk factors in women with definite coronary artery disease. This prospective study was conducted on 250 women with primary diagnosis of acute myocardial infarction or unstable angina. The patients were selected randomly using interview and registering the related risk factors. The primary diagnosis included 11.5% of myocardial infarction and 88.5% of unstable angina. All patients had risk factors. Diabetes was seen in 38.5%, hypertension in 78%, smoking in 27%, cholesterol > 150 mg in 98%, consumption of oral contraceptive in 57%, family history in 28% and limited physical activity in 2.6% of the patients. Body mass index of 59.6% of the patients was equal to or more than 27 kg m(-2). Also, 66.7% of the patients were post menopausal and history of premature hysterectomy was seen in 9.6% of the patients. There were 3 or more risk factors of coronary artery disease in most patients. Considering the known risk factors in women, dyslipidemia, premature menopause, hypertension, oral contraceptives, diabetes and smoking were regarded as the most common ones.
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