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Quezada-Pinedo HG, Ahanchi NS, Cajachagua-Torres KN, Obeso-Manrique JA, Huicho L, Gräni C, Muka T. A comprehensive analysis of cardiovascular mortality trends in Peru from 2017 to 2022: Insights from 183,386 deaths of the national death registry. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 35:100335. [PMID: 38511183 PMCID: PMC10946053 DOI: 10.1016/j.ahjo.2023.100335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/06/2023] [Accepted: 10/16/2023] [Indexed: 03/22/2024]
Abstract
Background/objectives Cardiovascular diseases are the leading cause of global mortality. Systematic studies on cardiovascular-related mortality at national and subnational levels in Peru are lacking. We aimed to describe the trends in cardiovascular-related mortality between 2017 and 2022 in Peru at national and subnational levels and by socioeconomic indicators. Subjects/methods We used data from the Peruvian death registry 2017-2022. Using ICD-10 codes, mortality was categorized into: hypertensive-, coronary-, and cerebrovascular- related deaths. We estimated age-standardized cardiovascular-related mortality rates by sex at national and regional levels, and by natural regions (Coast, Highlands, Amazon). We estimated the change in mortality rates between 2017-2019 and 2020-2022 and explored factors that contributed to such a change. We explored ecological relationships between mortality rates and socioeconomic indicators. Findings Overall 183,386 cardiovascular-related deaths were identified. Coronary-related deaths (37.2 %) were followed by hypertensive-related (25.1 %) and cerebrovascular-related deaths (22.6 %). Peru showed a marked increasing trend in cardiovascular-related mortality in 2020-2022 (77.8 %). The increase clustered in the Coast and Highlands, with the highest change observed in Lima (132.1 %). Mortality was highest in subjects with lower education and subjects with public health insurance. Gini coefficient was associated with lower mortality rates while unemployment was associated with higher mortality rates. Interpretation There was a notable rise in cardiovascular-related mortality in Peru, particularly during the Covid-19 pandemic with a slight decrease in 2022. Gaining a comprehensive understanding of the factors that contribute to the increase in cardiovascular deaths in Peru will facilitate the development of precise interventions at both the national and regional levels.
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Affiliation(s)
- Hugo G. Quezada-Pinedo
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Noushin Sadat Ahanchi
- Institute of Social and Preventive Medicine (ISPM), Graduate School of Health Sciences, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
- Department of Internal Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Kim N. Cajachagua-Torres
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Pediatrics, New York University Grossman of Medicine, New York, USA
| | - Jordan A. Obeso-Manrique
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luis Huicho
- Centro de Investigación en Salud Materna e Infantil and Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina “Alberto Hurtado”, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Christoph Gräni
- Institute of Social and Preventive Medicine (ISPM), Graduate School of Health Sciences, University of Bern, Bern, Switzerland
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Le C, Liu L, Li GH, Zhao Y, Wu X, Rabkin Golden A. Trends in prevalence and clustering of modifiable cardiovascular disease risk factors across socioeconomic spectra in rural southwest China: a cross-sectional study. BMJ Open 2023; 13:e071152. [PMID: 37105696 PMCID: PMC10151950 DOI: 10.1136/bmjopen-2022-071152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES This study aimed to determine the changing prevalence of clustering of cardiovascular disease (CVD) risk factors across socioeconomic spectra in rural southwest China. DESIGN Data were collected from two waves of cross-sectional health interviews and examinations among individuals aged ≥35 years in rural China. Anthropometric measurements, blood pressure and fasting blood sugar levels were recorded for each participant. SETTING This study was conducted in rural Yunnan Province of China. PARTICIPANTS 8187 individuals in 2011 and 7572 in 2021 consented to participate in this study. RESULTS From 2011 to 2021, prevalence increased of hypertension (26.1% vs 41.6%), diabetes mellitus (5.9% vs 9.8%), obesity (5.9% vs 12.0%) and central obesity (50.0% vs 58.3%) (p<0.01), while prevalence decreased of current smoking (35.2% vs 29.6%), secondhand smoke exposure (42.6% vs 27.4%) and current drinking (26.6% vs 29.6%) (p<0.01). This decade also saw an increase in the prevalence of participants with clustering of ≥2 (61.8% vs 63.0%) and ≥3 CVD risk factors (28.4% vs 32.2%) (p<0.05). These increasing rates were also observed among subgroups categorised by sex, ethnicity, education level, income level and those ≥45 years of age (p<0.05). In both 2011 and 2021, male participants and participants with a lower education level had higher prevalence of clustering of ≥2 and ≥3 CVD risk factors than their counterparts (p<0.01). Ethnic minority participants and participants with higher annual income had higher prevalence of clustering of CVD risk factors in 2011 but presented opposite associations in 2021 (p<0.01). CONCLUSION The prevalence of clustering of CVD risk factors increased substantially across all socioeconomic spectra in rural southwest China from 2011 to 2021. Future efforts to implement comprehensive lifestyle interventions to promote the prevention and control of CVD should in particular focus on men, those of Han ethnicity and those with low socioeconomic status.
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Affiliation(s)
- Cai Le
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Lan Liu
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Guo-Hui Li
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Yi Zhao
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
| | - Xia Wu
- School of Public Health, Kunming Medical University, Kunming, Yunnan, China
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Brindley C, Van Ourti T, Capuno J, Kraft A, Kudymowa J, O'Donnell O. Risk factor contributions to socioeconomic inequality in cardiovascular risk in the Philippines: a cross-sectional study of nationally representative survey data. BMC Public Health 2023; 23:689. [PMID: 37046247 PMCID: PMC10092926 DOI: 10.1186/s12889-023-15517-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/24/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Primary prevention of cardiovascular diseases (CVD) increasingly relies on monitoring global CVD risk scores. Lack of evidence on socioeconomic inequality in these scores and the contributions that specific risk factors make to this inequality impedes effective targeting of CVD prevention. We aimed to address this evidence gap by measuring and decomposing socioeconomic inequality in CVD risk in the Philippines. METHODS We used data on 8462 individuals aged 40-74 years from the Philippines National Nutrition Survey and the laboratory-based Globorisk equation to predict 10-year risk of a CVD event from sex, age, systolic blood pressure, total cholesterol, high blood glucose, and smoking. We used a household wealth index to proxy socioeconomic status and measured socioeconomic inequality with a concentration index that we decomposed into contributions of the risk factors used to predict CVD risk. We measured socioeconomic inequalities in these risk factors and decomposed them into contributions of more distal risk factors: body mass index, fat share of energy intake, low physical activity, and drinking alcohol. We stratified by sex. RESULTS Wealthier individuals, particularly males, had greater exposure to all risk factors, with the exception of smoking, and had higher CVD risks. Total cholesterol and high blood glucose accounted for 58% and 34%, respectively, of the socioeconomic inequality in CVD risk among males. For females, the respective estimates were 63% and 69%. Systolic blood pressure accounted for 26% of the higher CVD risk of wealthier males but did not contribute to inequality among females. If smoking prevalence had not been higher among poorer individuals, then the inequality in CVD risk would have been 35% higher for males and 75% higher for females. Among distal risk factors, body mass index and fat intake contributed most to inequalities in total cholesterol, high blood sugar, and, for males, systolic blood pressure. CONCLUSIONS Wealthier Filipinos have higher predicted CVD risks and greater exposure to all risk factors, except smoking. There is need for a nuanced approach to CVD prevention that targets anti-smoking programmes on the poorer population while targeting diet and exercise interventions on the wealthier.
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Affiliation(s)
- Callum Brindley
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands.
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - Tom Van Ourti
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Tinbergen Institute, Amsterdam, the Netherlands
| | - Joseph Capuno
- School of Economics, University of the Philippines Diliman, Diliman, The Philippines
| | - Aleli Kraft
- School of Economics, University of the Philippines Diliman, Diliman, The Philippines
| | - Jenny Kudymowa
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Rethink Priorities, Frankfurt, Germany
| | - Owen O'Donnell
- Erasmus School of Health Policy and Management, Erasmus University, 1738, Rotterdam, 3000 DR, The Netherlands
- Erasmus Centre for Health Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Tinbergen Institute, Amsterdam, the Netherlands
- Faculty of Economics and Business, University of Lausanne, Lausanne, Switzerland
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Cerpa-Arana SK, Rimarachín-Palacios LM, Bernabé-Ortiz A. Association between socioeconomic level and cardiovascular risk in the Peruvian population. Rev Saude Publica 2022; 56:91. [PMID: 36287488 PMCID: PMC9586518 DOI: 10.11606/s1518-8787.2022056004132] [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: 08/10/2021] [Accepted: 11/22/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the association between socioeconomic level and the presence of obesity, hypertension and type 2 diabetes mellitus in the Peruvian population. METHODS Secondary analysis of data from the National Demographic and Family Health Survey ( Encuesta Nacional Demográfica y de Salud Familiar , Endes) from 2018 to 2020. The outcomes were obesity, hypertension, and type 2 diabetes mellitus. The exposure variables were two indicators of socioeconomic status: educational level (< 7 years, 7–11 years, and 12+ years) and wealth index (in tertiles). Models were created using Poisson regression, reporting prevalence ratios (PR) and 95% confidence intervals (95%CI). RESULTS Data from 98,846 subjects were analyzed. Mean age: 45.3 (SD: 16.0) years, and 55.5% were women. The prevalence of obesity was 26.0% (95%CI: 25.4–26.6); of hypertension, 24.9% (95%CI: 24.3–25.5); and of type 2 diabetes mellitus, 4.8% (95%CI: 4.5–5.1). In multivariate model, and compared with those with a low wealth index, those with a high wealth index had a higher prevalence of obesity (PR = 1.49; 95%CI: 1.38–1.62), hypertension (PR = 1.09; 95%CI: 1.02–1.17) and type 2 diabetes mellitus (PR = 1.72; 95%CI: 1.29–2.29). On the other hand, higher educational level was only associated with a reduction in the prevalence of obesity (PR = 0.89; 95%CI: 0.84–0.95). CONCLUSIONS There is a differential association between the wealth index, educational level and markers of noncommunicable diseases. There is evidence of a positive association between wealth index and obesity, hypertension and type 2 diabetes mellitus, whereas educational level was only negatively associated with obesity.
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Affiliation(s)
- Stefany Katherine Cerpa-Arana
- Universidad Científica del SurFacultad de Ciencias de la SaludLimaPerú Universidad Científica del Sur . Facultad de Ciencias de la Salud . Lima , Lima, Perú
| | - Lourdes Magaly Rimarachín-Palacios
- Universidad Científica del SurFacultad de Ciencias de la SaludLimaPerú Universidad Científica del Sur . Facultad de Ciencias de la Salud . Lima , Lima, Perú
| | - Antonio Bernabé-Ortiz
- Universidad Científica del SurFacultad de Ciencias de la SaludLimaPerú Universidad Científica del Sur . Facultad de Ciencias de la Salud . Lima , Lima, Perú ,Universidad Peruana Cayetano HerediaCentro de Excelencia en Enfermedades CrónicasLimaPerú Universidad Peruana Cayetano Heredia . Centro de Excelencia en Enfermedades Crónicas . Lima , Lima, Perú
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Soleimani H, Ghasemi E, Saeedi Moghaddam S, Azadnajafabad S, Rezaei N, Masinaei M, Naderimagham S, Rezaei N, Malekpour MR, Keykhaei M, Gorgani F, Kazemi A, Tahmasebi S, Makhdoom R, Farzadfar F. Assessing the effect of socioeconomic factors on prevalence of dyslipidemia among iranian adult population; district level analysis from 2016 STEPS national study using small area estimation. J Diabetes Metab Disord 2022; 21:647-655. [PMID: 35673466 PMCID: PMC9167271 DOI: 10.1007/s40200-022-01027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/03/2022] [Indexed: 11/28/2022]
Abstract
Background Atherosclerotic Cardiovascular Disease (CVD) is the leading cause of death globally and dyslipidemia plays a critical role in the development of this condition. This study aimed to analyze the potential impact of socioeconomic factors on the prevalence of dyslipidemia at district level in Iran. Understanding these factors is important for development of future risk factor control programs. Methods We used the nationwide Iran STEPwise approach to risk factor Surveillance (STEPS) 2016 survey as a representative dataset on the Non-Communicable Diseases (NCDs) risk factors in Iran. To obtain a district level dyslipidemia estimates, we utilized the small area estimation method with a Bayesian spatial hierarchical multilevel regression and multilevel mixed models. The principal component analysis was applied to derive household wealth index. For evaluation of education, successful years of schooling was calculated at district level. Urbanization ratio was defined as the proportion of residents in the urban area to the urban and rural areas for each district. Results The highest difference was found for hypercholesterolemia coverage with 9.11 times difference among the lowest and highest prevalence across the country's district for males. Men with lower income, lower urbanization, and lower education levels had lower values of high-density lipoprotein (HDL) cholesterol, and higher level of hypercholesterolemia, and hypertriglyceridemia (P-value < 0.001). Triglyceride levels were directly correlated with all analyzed socioeconomic factors in both females and males (P-value < 0.001). Conclusion We demonstrated that there is an inverse relationship between socioeconomic levels and dyslipidemia indices as populations with higher socioeconomic levels consistently had higher mean dyslipidemia levels. Our findings provide an excellent fundamental framework for healthcare administrators and policymakers to set goals and pursue effective preventive strategies. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01027-x.
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Affiliation(s)
- Hamidreza Soleimani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Masinaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Naderimagham
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Keykhaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Feinberg Cardiovascular Research Institute, Feinberg School of Medicine, Northwestern University, IL 60611, Chicago, USA
| | - Fateme Gorgani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ameneh Kazemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Saba Tahmasebi
- Faculty of Medicine, Tehran Medical Branch, Islamic Azad University, Tehran, Iran
| | - Rashed Makhdoom
- Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Moyo G, Montenegro-Montenegro E, Stickley Z, Egal A, Oldewage-Theron W. A Structural Equation Modelling Approach to Examine the Relationship between Socioeconomic Status, Diet Quality and Dyslipidaemia in South African Children and Adolescents, 6-18 Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312825. [PMID: 34886551 PMCID: PMC8657719 DOI: 10.3390/ijerph182312825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/19/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022]
Abstract
This study utilised a structural equation model to examine the relationship between diet quality, socioeconomic status, and cardiovascular disease (CVD) risk in South African learners. Confirmatory factor analysis was used to test the indirect effects model for diet, socioeconomic status, diet quality and cardiovascular risk using pre-existing cross-sectional data. The structural equation model was fit using Lavaan version 0.6-5 in R version 3.6.1. Data were analysed from 178 children and adolescents, aged 6-18 years, from five rural schools in Cofimvaba, South Africa. Latent variables were created for dietary quality, dyslipidaemia and the socioeconomic status of participants. A negative association was observed between socioeconomic status and dyslipidaemia in school-aged children (p = 0.029).
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Affiliation(s)
- Gugulethu Moyo
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, 1301 Akron Ave, Lubbock, TX 79409, USA;
- Correspondence:
| | | | - Zachary Stickley
- Institute for Measurement, Methodology, Analysis & Policy, Texas Tech University, Lubbock, TX 79409, USA;
| | - Abdulkadir Egal
- Centre of Food and Nutrition Security, Somali National University, Mogadishu, Somalia;
| | - Wilna Oldewage-Theron
- Department of Nutritional Sciences, College of Human Sciences, Texas Tech University, 1301 Akron Ave, Lubbock, TX 79409, USA;
- Department of Sustainable Food Systems and Development, University of the Free State, Bloemfontein 9300, South Africa
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Su Y, Du S, Yang M, Wu J, Lu H, Wang X. Socioeconomic Determinants of Diet Quality on Overweight and Obesity in Adults Aged 40-59 Years in Inner Mongolia: A Cross-Sectional Study. Int J Public Health 2021; 66:1604107. [PMID: 34819829 PMCID: PMC8607545 DOI: 10.3389/ijph.2021.1604107] [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: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study investigated the relationship of socioeconomic status (SES), diet quality and overweight and obesity in adults aged 40-59 years in Inner Mongolia. Methods: This cross-sectional study was based on the survey of Chronic Disease and Nutrition Monitoring in Adults in Inner Mongolia in 2015. Diet quality was evaluated by the Alternate Mediterranean Diet score (aMeds). SES was measured by household annual income. Generalized estimating equations and path analysis were performed to determine the association of SES, diet quality and overweight and obesity. Results: Among participants, 63.0% had overweight and obesity. In high SES group, 66.4% had overweight and obesity. Higher SES was associated with a higher risk of overweight and obesity (OR = 1.352, 95%CI: 1.020-1.793). And higher aMeds was associated with a lower risk of overweight and obesity (OR = 0.597, 95%CI: 0.419-0.851). There was a positive correlation between SES and the intake of red and processed meat (r = 0.132, p < 0.05). Higher intake of red and processed meat was associated with lower diet quality (β = -0.34). And lower diet quality was associated with a higher risk of overweight and obesity (β = -0.10). Conclusion: In Inner Mongolia, during the period of economic transition, people aged 40-59 years in high SES had poor diet quality, which was related to a higher risk of overweight and obesity.
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Affiliation(s)
- Yuenan Su
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Sha Du
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Min Yang
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
| | - Jing Wu
- National Center for Chronic and Non-Communicable Diseases Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haiwen Lu
- Affiliated Hospital, Inner Mongolia Medical University, Hohhot, China
| | - Xuemei Wang
- School of Public Health, Inner Mongolia Medical University, Hohhot, China
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Chambergo-Michilot D, Rebatta-Acuña A, Delgado-Flores CJ, Toro-Huamanchumo CJ. Socioeconomic determinants of hypertension and prehypertension in Peru: Evidence from the Peruvian Demographic and Health Survey. PLoS One 2021; 16:e0245730. [PMID: 33497389 PMCID: PMC7837486 DOI: 10.1371/journal.pone.0245730] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Peru is a Latin American country with a significant burden of hypertension that presents worrying rates of disparities in socioeconomic determinants. However, there is a lack of studies exploring the association between those determinants, hypertension and prehypertension in Peruvian population. Objective We aimed to assess the association betwgeen socioeconomic determinants, hypertension and prehypertension using a nationally representative survey of Peruvians. Methods We performed a cross-sectional analysis of the Peruvian Demographic and Health Survey (2018), which is a two-staged regional-level representative survey. We used data from 33,336 people aged 15 and older. The dependent variable was blood pressure classification (normal, prehypertension and hypertension) following the Seventh Report of the Joint National Committee (JNC-7) on hypertension management. Independent variables were socioeconomic: age, sex, marital status, wealth index, health insurance, education, region and area of residence. Due to the nature of the dependent variable (more than two categories), we opted to use the multinomial regression model, adjusting the effect of the multistage sample using the svy command. We tested interactions with the adjusted Wald test. Results The prevalence of prehypertension and hypertension was 33.68% and 19.77%, respectively. Awareness was higher in urban than in rural areas (9.61% vs. 8.31%, p = 0.008). Factors associated with a higher prevalence ratio of both prehypertension and hypertension were age (ratios rose with each age group), male sex (prehypertension aRPR 5.15, 95%CI 4.63–5.73; hypertension aRPR 3.85, 95% CI 3.37–4.40) and abdominal obesity (prehypertension aRPR 2.11, 95%CI 1.92–2.31; hypertension aRPR 3.04, 95% CI 2.69–3.43). Factors with a lower prevalence ratio of both diseases were secondary education (prehypertension aRPR 0.76, 95%CI 0.60–0.95; hypertension aRPR 0.75, 95% CI 0.58–0.97), higher education (prehypertension aRPR 0.78, 95%CI 0.61–0.99; hypertension aRPR 0.62, 95% CI 0.46–0.82), being married/cohabiting (prehypertension aRPR 0.87, 95%CI 0.79–0.95; hypertension aRPR 0.77, 95% CI 0.68–0.87), richest wealth index (only prehypertension aRPR 0.76, 95%CI 0.63–0.92) and living in cities different to Lima (rest of the Coastline, Highlands and Jungle). Having health insurance (only hypertension aRPR 1.26, 95%CI 1.03–1.53) and current drinking (only prehypertension aRPR 1.15, 95%CI 1.01–1.32) became significant factors in rural areas. Conclusions We evidenced socioeconomic disparities among people with hypertension and prehypertension. Better health policies on reducing the burden of risk factors are needed, besides, policy decision makers should focus on hypertension preventive strategies in Peru.
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Affiliation(s)
| | - Alexis Rebatta-Acuña
- Sociedad Científica de Estudiantes de Medicina de Ica, Universidad Nacional San Luis Gonzaga, Ica, Peru
| | | | - Carlos J. Toro-Huamanchumo
- Universidad Católica Los Ángeles de Chimbote, Instituto de Investigación, Chimbote, Peru
- Clínica Avendaño, Unidad de Investigación Multidisciplinaria, Lima, Peru
- * E-mail:
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Hernández-Vásquez A, Chacón-Torrico H, Vargas-Fernández R, Bendezu-Quispe G, Santero M. Metrics of Ideal Cardiovascular Health are Unequally Distributed between Peruvian Men and Women: Analysis of a National Population-Based Survey in 2017. Int J Prev Med 2020; 11:190. [PMID: 33815714 PMCID: PMC8000168 DOI: 10.4103/ijpvm.ijpvm_326_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/21/2019] [Indexed: 11/08/2022] Open
Abstract
Background: To determine socioeconomic inequalities in cardiovascular health (CVH) metrics among Peruvian adults as well as differences according to sex. Methods: An observational, cross-sectional study was conducted in 26,175 individuals aged 18–65 years using the 2017 Peruvian Demographic and Health Survey. According to the American Heart Association, 5 CVH metrics which comprised three ideal health behaviors (diet, non smoking, ideal body mass index [BMI]), and two ideal health factors (ideal blood pressure and no history of diabetes) were evaluated. The concentration curves (CC) methodology was used to analyze whether CVH metrics vary between socioeconomic status and sex. The concentration index (CI) was used to quantify socioeconomic-related inequality in health variables. Results: Overall, the mean age was 36.5 years (SD = 11.9) and 51.2% were women. Only 2.4% had 5 ideal CVH metrics (women 3.7%, men 1.0%) with a CI very close to the equality line (0.0135). (0.0135; higher in women [0.0262], compared to men [0,0002]). A greater prevalence of ideal CHV metrics (3 or more) was found in women (P < 0.001). Ideal health factors were more prevalent (52.1%) than ideal health behaviors (13.8%). Regarding inequality measures, CCs for most CVH metrics had a higher concentration in the lowest wealth population, except for ideal diet, which was more frequent among higher levels of wealth. An ideal BMI was the CVH metric with the lowest CI (overall: −0.0817; men: −0.2699). Conclusions: Peruvian women presented a higher prevalence of ideal CVH metrics and fewer inequalities. Ideal CVH metrics tend to be concentrated in the wealthiest women. Low- and middle-income countries should consider socioeconomic inequalities in cardiovascular disease prevention programs.
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Affiliation(s)
- Akram Hernández-Vásquez
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Lima, Peru
| | | | | | - Guido Bendezu-Quispe
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Lima, Peru
| | - Marilina Santero
- Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto de Efectividad Clínica y Sanitaria, Buenos Aires, Argentina
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Iwundu C, Pang D, Pappas Y. Childhood Maternal School Leaving Age (Level of Education) and Risk Markers of Metabolic Syndrome in Mid-Adulthood: Results from the 1958 British Birth Cohort. Diabetes Metab Syndr Obes 2020; 13:3761-3771. [PMID: 33116725 PMCID: PMC7573814 DOI: 10.2147/dmso.s263332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/01/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The aim of this study is to investigate the relationship between childhood maternal level of education (CMLE) and changes in anthropometric and laboratory risk markers of metabolic syndrome (MetS) in mid-adulthood using results from the 1958 British Birth Cohort Study. DESIGN Cohort study. PARTICIPANTS A total of 9376 study samples consisting of subjects that participated in the biomedical survey of the national child development study (NCDS) carried out between 2002 and 2004 were used for the analysis. MAIN OUTCOME MEASURES Five risk markers of MetS: (i) HDL-cholesterol (ii) triglyceride (iii) blood pressure (BP) including systolic (SBP) and diastolic (DBP) (iv) waist circumference (WC) and (v) glycated haemoglobin (HbA1c). METHODS The NCDS or the 1958 British birth cohort data deposited in the UK data service by the centre for longitudinal studies were used for analyses. Ordinary least squares regression was used to determine unit changes in the outcome variables given CMLE. RESULTS The estimates for unadjusted regression analysis of individual risk markers indicated a significant relationship between CMLE and alterations in the five risk markers of MetS (HDL-cholesterol, triglyceride, WC, HbA1c, and BP) in midlife. After adjustment for birth and lifestyle characteristics/health behaviours, the relationship between CMLE and the risk markers was attenuated for HDL-cholesterol, triglycerides, and HbA1c but remained significant for WC 0.70 (95% confidence interval (CI) 0.065-1.30, p<0.001) and SBP 1.48 (95% CI 0.48-2.47 p<0.001). CONCLUSION There was a positive association between lower CMLE and the risk of MetS using the NCDS data. Lifestyle characteristics may be influential determinants of MetS risk in mid-adulthood.
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Affiliation(s)
- Chukwuma Iwundu
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Dong Pang
- Institute for Health Research, University of Bedfordshire, Luton, UK
| | - Yannis Pappas
- Institute for Health Research, University of Bedfordshire, Luton, UK
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Mirmiran P, Bakhshi B, Hosseinpour-Niazi S, Sarbazi N, Hejazi J, Azizi F. Does the association between patterns of fruit and vegetables and metabolic syndrome incidence vary according to lifestyle factors and socioeconomic status? Nutr Metab Cardiovasc Dis 2020; 30:1322-1336. [PMID: 32513582 DOI: 10.1016/j.numecd.2020.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS The aim of this study is to investigate the association between the identified patterns of fruits and vegetables and metabolic syndrome (MetS) incidence, and to investigate whether lifestyle factors and socioeconomic status modify the effect of the patterns on MetS risk. METHODS AND RESULTS We prospectively studied 1915 participants of the Tehran Lipid and Glucose Study, who were aged 19-74 years and followed up for dietary assessment using a validated, semi-quantitative food frequency questionnaire. After adjustment for confounding factors, total vegetable intake was inversely related to the risk of MetS. Total fruit and total fruit and vegetable were not associated with MetS risk. We identified four major patterns of fruits and vegetables by factor analysis: "fresh fruit pattern", "vegetable pattern", "dried fruit and cruciferous vegetable pattern", and "potatoes and fruit juice pattern". "Vegetable pattern" was negatively associated with MetS risk, and "potatoes and fruit juice pattern" increased the risk of MetS. Among participants with weight gain <7% during follow-up, all four identified patterns reduced MetS risk. When stratified by smoking, "vegetable pattern" and "dried Fruit and cruciferous vegetable pattern" lowered MetS risk among non-smokers. Stratification based on education resulted in MetS risk reduction across tertiles of "fresh fruit pattern" and "vegetable pattern". First and second tertiles of "dried fruit and cruciferous vegetable pattern" lowered MetS risk among educated participants, compared to the reference. CONCLUSIONS The reduction in MetS risk caused by fruits and vegetables intake depends on the modifying effect of lifestyle and socioeconomic factors.
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Affiliation(s)
- Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahar Bakhshi
- Nutrition and Endocrine Research center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Somayeh Hosseinpour-Niazi
- Nutrition and Endocrine Research center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Narges Sarbazi
- Nutrition and Endocrine Research center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jalal Hejazi
- Department of Nutrition, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Hessel P, Rodríguez-Lesmes P, Torres D. Socio-economic inequalities in high blood pressure and additional risk factors for cardiovascular disease among older individuals in Colombia: Results from a nationally representative study. PLoS One 2020; 15:e0234326. [PMID: 32516351 PMCID: PMC7282633 DOI: 10.1371/journal.pone.0234326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 05/24/2020] [Indexed: 12/19/2022] Open
Abstract
Background Studies in high-income countries have documented a consistent gradient between socio-economic status (SES) and high blood pressure (HBP), a key risk factor for cardiovascular disease (CVD). However, evidence from Latin American countries (LA) remains comparatively scarce and inconclusive. Data Data for 3,984 individuals came from a nationally representative survey of individuals aged 60 years or above in Colombia (Encuesta de Salud, Bienestar y Envejecimiento) (SABE) conducted in 2015. SES was measured by educational achievement and household assets. CVD risk factors included objectively measured HBP and body mass index (BMI), as well as behaviors (smoking, alcohol consumption, fruit and vegetables intake, and physical activity). Methods Bivariate methods and multivariate regression models were used to assess associations between SES with HBP as well as additional risk factors for CVD. Results Individuals with lower SES have significantly higher risk of suffering from HBP. Compared to those with no formal education, individuals with secondary or post-secondary education have a 37% lower risk of HBP (odds ratio [OR] = 0.63, P-value<0.001). Being in the highest asset quartile (most affluent) is associated with a 44% lower risk (OR = 56, P-value = 0.001) of HBP compared to those in the lowest asset quartile (most deprived). Individuals with lower SES are more likely to smoke, not engage in regular physical activity and not regularly consume fruits or vegetables. In contrast, individuals with higher SES are more likely to consume alcohol and, those with more assets, more likely to be obese. Conclusions Among older Colombians there exists a marked SES gradient in HBP as well as several additional risk factors for CVD. The results highlight the importance of a public health approach towards HBP and additional CVD risk factors that takes into account the specific conditions of older individuals, especially among disadvantaged groups.
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Affiliation(s)
- Philipp Hessel
- University of the Andes, Alberto Lleras Camargo School of Government, Bogotá, Colombia
- * E-mail:
| | | | - David Torres
- University of the Andes, Alberto Lleras Camargo School of Government, Bogotá, Colombia
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Kephart JL, Fandiño-Del-Rio M, Koehler K, Bernabe-Ortiz A, Miranda JJ, Gilman RH, Checkley W. Indoor air pollution concentrations and cardiometabolic health across four diverse settings in Peru: a cross-sectional study. Environ Health 2020; 19:59. [PMID: 32493322 PMCID: PMC7268316 DOI: 10.1186/s12940-020-00612-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 05/21/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND Indoor air pollution is an important risk factor for health in low- and middle-income countries. METHODS We measured indoor fine particulate matter (PM2.5) and carbon monoxide (CO) concentrations in 617 houses across four settings with varying urbanisation, altitude, and biomass cookstove use in Peru, between 2010 and 2016. We assessed the associations between indoor pollutant concentrations and blood pressure (BP), exhaled carbon monoxide (eCO), C-reactive protein (CRP), and haemoglobin A1c (HbA1c) using multivariable linear regression among all participants and stratifying by use of biomass cookstoves. RESULTS We found high concentrations of indoor PM2.5 across all four settings (geometric mean ± geometric standard deviation of PM2.5 daily average in μg/m3): Lima 41.1 ± 1.3, Tumbes 35.8 ± 1.4, urban Puno 14.1 ± 1.7, and rural Puno 58.8 ± 3.1. High indoor CO concentrations were common in rural households (geometric mean ± geometric standard deviation of CO daily average in ppm): rural Puno 4.9 ± 4.3. Higher indoor PM2.5 was associated with having a higher systolic BP (1.51 mmHg per interquartile range (IQR) increase, 95% CI 0.16 to 2.86), a higher diastolic BP (1.39 mmHg higher DBP per IQR increase, 95% CI 0.52 to 2.25), and a higher eCO (2.05 ppm higher per IQR increase, 95% CI 0.52 to 3.57). When stratifying by biomass cookstove use, our results were consistent with effect measure modification in the association between PM2.5 and eCO: among biomass users eCO was 0.20 ppm higher per IQR increase in PM2.5 (95% CI - 2.05 to 2.46), and among non-biomass users eCO was 5.00 ppm higher per IQR increase in PM2.5 (95% CI 1.58 to 8.41). We did not find associations between indoor air concentrations and CRP or HbA1c outcomes. CONCLUSIONS Excessive indoor concentrations of PM2.5 are widespread in homes across varying levels of urbanisation, altitude, and biomass cookstove use in Peru and are associated with worse BP and higher eCO.
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Affiliation(s)
- Josiah L. Kephart
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD USA
- Present Address: Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA USA
| | - Magdalena Fandiño-Del-Rio
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD USA
| | - Kirsten Koehler
- Department of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H. Gilman
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
| | - William Checkley
- Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD USA
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1830 E. Monument St Room 555, Baltimore, MD 21287 USA
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Mamani Ortiz Y, Gustafsson PE, San Sebastián Chasco M, Armaza Céspedes AX, Luizaga López JM, Illanes Velarde DE, Mosquera Méndez PA. Underpinnings of entangled ethnical and gender inequalities in obesity in Cochabamba-Bolivia: an intersectional approach. Int J Equity Health 2019; 18:153. [PMID: 31615512 PMCID: PMC6794886 DOI: 10.1186/s12939-019-1062-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 09/30/2019] [Indexed: 01/20/2023] Open
Abstract
Background Social inequalities in obesity have been observed not only by gender but also between ethnic groups. Evidence on combined dimensions of inequality in health, and specifically including indigenous populations, is however scarce, and presents a particularly daunting challenge for successful prevention and control of obesity in Bolivia, as well as worldwide. Objective The aims of this study were i) to examine intersectional inequalities in obesity and ii) to identify the factors underlying the observed intersectional inequalities. Methods An intersectional approach study was employed, using the information collected in a cross-sectional community-based survey. The sample consisted of youth and adults with permanent residence in Cochabamba department (N = 5758), selected through a multistage sampling technique. An adapted version of the WHO-STEPS survey was used to collect information about Abdominal obesity and risk factors associated. Four intersectional positions were constructed from gender (woman vs. men) and ethnic group (indigenous vs. mestizo). Joint and excess intersectional disparities in obesity were estimated as absolute prevalence differences between binary groups, using binomial regression models. The Oaxaca-Blinder decomposition was applied to estimate the contributions of explanatory factors underlying the observed intersectional disparities, using Oaxaca command in Stata software v15.1. Results The prevalence of abdominal obesity had a higher prevalence in mestizos (men 35.01% and women 30.71%) as compared to indigenous (men 25.38% and women 27.75%). The joint disparity was estimated at 7.26 percentage points higher prevalence in the doubly advantaged mestizo men than in the doubly disadvantaged indigenous women. The gender referent disparity showed that mestizo-women had a higher prevalence than indigenous-women. The ethnic referent disparity showed that mestizo-men had a higher prevalence than indigenous men. The behavioural risk factors were the most important to explain the observed inequalities, while differences in socioeconomic and demographic factors played a less important role. Conclusion Our study illustrates that abdominal obesity is not distributed according to expected patterns of structural disadvantage in the intersectional space of ethnicity and gender in Bolivia. In the Cochabamba case, a high social advantage was related to higher rates of abdominal obesity, as well as the behavioural risk factors associated with them.
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Affiliation(s)
- Yercin Mamani Ortiz
- Biomedical and Social Research Institute, Faculty of Medicine, San Simon University, Cochabamba, Bolivia. .,Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Ada Ximena Armaza Céspedes
- Biomedical and Social Research Institute, Faculty of Medicine, San Simon University, Cochabamba, Bolivia
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Prevalence, awareness, treatment and control of hypertension in rural and urban communities in Latin American countries. J Hypertens 2019; 37:1813-1821. [DOI: 10.1097/hjh.0000000000002108] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Differences in magnitude and rates of change in BMI distributions by socioeconomic and geographic factors in Mexico, Colombia, and Peru, 2005–2010. Eur J Clin Nutr 2019; 74:472-480. [DOI: 10.1038/s41430-019-0479-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 07/12/2019] [Indexed: 01/06/2023]
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Redondo-Bravo L, Fernández-Alvira JM, Górriz J, Mendiguren JM, Sanz J, Fernández-Friera L, García-Ruiz JM, Fernández-Ortiz A, Ibáñez B, Bueno H, Fuster V. Does Socioeconomic Status Influence the Risk of Subclinical Atherosclerosis? J Am Coll Cardiol 2019; 74:526-535. [DOI: 10.1016/j.jacc.2019.05.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/24/2019] [Accepted: 05/03/2019] [Indexed: 12/11/2022]
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Prevalence and Predictors of Obesity and Overweight among Adults Visiting Primary Care Settings in the Southwestern Region, Saudi Arabia. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8073057. [PMID: 30949511 PMCID: PMC6425323 DOI: 10.1155/2019/8073057] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 02/03/2019] [Accepted: 02/19/2019] [Indexed: 12/14/2022]
Abstract
Introduction Obesity is becoming the most common health problem of the 21st century, as it will contribute significantly to the high prevalence of cardiovascular disease in developing countries. The main objective of our study was to estimate the prevalence of obesity and overweight among adults attending primary health care settings, southwestern region of the Kingdom of Saudi Arabia. Methods The studied population was composed of adults visiting primary health care centres in the southwestern region of Saudi Arabia. A cross-sectional study was carried out on a representative sample of 1681 adult patients. Obesity and overweight were defined according to the WHO standards. Statistical analysis was conducted using the statistical package SPSS 17.0. Logistic regression analysis was used to identify independent predictors of obesity and overweight in the studied population. Results Data on body mass index (BMI) measurement was recorded for 1649 out of 1681 participants (98.1%). The overall mean weight was 74.1 ± 15.81 kg; and that for men was 77.69 ± 16.14 kg vs. 69.37 ± 14.02 kg for women with significant statistical difference of p < 0.001. The overall prevalence of overweight and obesity was, respectively, 38.3% and 27.6%. Smoking was not significantly associated with obesity, whereas hypertension was significantly associated with obesity. The risk of overweight or obesity significantly increased from the highest to the lowest monthly income; it passed from 1.67 CI 95% = [1.24-2.25] within the category 5000-7000 SAR to 2.23 CI 95% = [1.71-2.90] within the category less than 5000 SAR. Conclusion Our study showed high prevalence of overweight and obesity which should be considered as a public health concern to be followed by specific interventions at the community level with multidisciplinary activities starting from childhood as a primordial prevention program.
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Abstract
Background: Evidence from the developed world associates higher prevalence of hypertension with lower socioeconomic status (SES). However, patterns of association are not as clear in Africa and other developing countries, with varying levels of socioeconomic development and epidemiological transition. Using wealth and education as indicators, we investigated association between SES and hypertension among older adult women in Sudan and examined whether urbanicity mediates the relationship. Methods: The sample included women aged 50 years and over participating in the nationally representative population-based second Sudan Health Household Survey (SHHS) conducted in 2010. Principal components analysis was used to assign each household with a wealth score based on assets owned. The score was categorized into quintiles from lowest (poorest) to highest (richest). Findings: The sample included a total of 5218 women, median and mean age 55 and 59 years, respectively, with the majority not have any schooling (81.6%). The overall prevalence of reported hypertension was found to be 10.5%. After adjustment for age, marital status, work status and urban/rural location, better wealth and higher education were independently and positively associated with hypertension prevalence rates. However, when stratified by urbanicity, the relationship between wealth and hypertension lost its significance for women in urban areas but maintained it in rural areas, increasing significantly and consistently with each increase in quintile index (adjusted odds ratio, aOR1 = 1.95 95% CI = 1.08–3.52; aOR2 = 5.25, 95% CI = 3.01–9.15; aOR3 = 8.27, 95% CI = 4.78–14.3; and aOR4 = and 11.4, 95% CI = 6.45–20.0; respectively). By contrast, education played a greater role in increasing the odds of hypertension among women in urban locations but not in rural locations (aOR = 2.14, 95% CI = 1.25–7.90 vs. aOR = 0.79, 95% CI = 0.27–2.30, respectively). Conclusions: Our findings of a socioeconomic gradient in the prevalence of hypertension among women, mediated by urbanization, call for targeted interventions from early stages of economic development in Sudan and similar settings of transitioning countries.
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Ogunsina K, Dibaba DT, Akinyemiju T. Association between life-course socio-economic status and prevalence of cardio-metabolic risk ractors in five middle-income countries. J Glob Health 2018; 8:020405. [PMID: 30023052 PMCID: PMC6036943 DOI: 10.7189/jogh.08.020405] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The burden of non-communicable diseases has increased rapidly in low- and middle-income countries. Past studies have reported an association between socioeconomic status (SES) and cardio-metabolic risk factors, but most have focused on upper income countries. The purpose of this study is to examine the association between SES over the life-course and the burden of cardio-metabolic risk factors in middle-income countries. METHODS A total of 38 297 adults from China, Mexico, India, South Africa and Russia were included in this cross-sectional study. Life-course SES was defined based on maternal and participant education, and data on blood pressure, body mass index (BMI), self-reported diabetes and hypertension were obtained by trained interviewers. Descriptive, age standardized and multivariable adjusted analyses were conducted using survey weighted statistical procedures in SAS 9.4 (SAS Institute, Cary, NC, USA). RESULTS Although 14% of men and 12% of women had current hypertension based on blood pressure measurements, only 2% of men and 4% of women were aware of their hypertensive status. Men with stable high life-course SES had higher odds of being overweight/obese (odds ratio OR = 2.01, 95% confidence interval (CI) = 1.30-3.10), diabetic (OR = 4.82, 95% CI = 2.07-11.2) and hypertensive based on self-report (OR = 3.42, 95% CI = 1.85-6.32) compared to men of low life-course SES. Among women, the odds of being overweight/obese were significantly higher among women with high life-course SES (OR = 1.50, 95% CI = 1.08-2.08). CONCLUSIONS Higher life-course SES for both men and women was associated with increased odds of overweight/ obesity, and additionally diabetes and hypertension for men in middle income countries.
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Affiliation(s)
- Kemi Ogunsina
- Department of Epidemiology, University of Miami, Miami, Florida, USA
| | - Daniel T Dibaba
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky,USA
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
| | - Tomi Akinyemiju
- Department of Epidemiology, University of Kentucky, Lexington, Kentucky,USA
- Markey Cancer Center, University of Kentucky, Lexington, Kentucky, USA
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Mou L, Norby FL, Chen LY, O'Neal WT, Lewis TT, Loehr LR, Soliman EZ, Alonso A. Lifetime Risk of Atrial Fibrillation by Race and Socioeconomic Status: ARIC Study (Atherosclerosis Risk in Communities). Circ Arrhythm Electrophysiol 2018; 11:e006350. [PMID: 30002066 PMCID: PMC6053683 DOI: 10.1161/circep.118.006350] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/08/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Limited information exists on the lifetime risk of atrial fibrillation (AF) in African Americans and by socioeconomic status. METHODS We studied 15 343 participants without AF at baseline from the ARIC (Atherosclerosis Risk in Communities) cohort recruited in 1987 to 1989 from 4 communities in the United States when they were 45 to 64 years of age. Participants have been followed through 2014. Incidence rates of AF were calculated dividing the number of new cases by person-years of follow-up. Lifetime risk of AF was estimated by a modified Kaplan-Meier method considering death as a competing risk. Participants' family income and education were obtained at baseline. RESULTS We identified 2760 AF cases during a mean follow-up of 21 years. Lifetime risk of AF was 36% (95% confidence interval, 32%-38%) in white men, 30% (95% confidence interval, 26%-32%) in white women, 21% (95% confidence interval, 13%-24%) in African American men, and 22% (95% confidence interval, 16%-25%) in African American women. Regardless of race and sex, incidence rates of AF decreased from the lowest to the highest categories of income and education. In contrast, lifetime risk of AF increased in individuals with higher income and education in most sex-race groups. Cumulative incidence of AF was lower in those with higher income and education compared with their low socioeconomic status counterparts through earlier life but was reversed after age 80. CONCLUSIONS Lifetime risk of AF in the ARIC cohort was ≈1 in 3 among whites and 1 in 5 among African Americans. Socioeconomic status was inversely associated with cumulative incidence of AF before the last decades of life.
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Affiliation(s)
- Liping Mou
- School of Public Health, Georgia State University, Atlanta (L.M.)
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis (F.L.N.)
| | - Lin Y Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis (L.Y.C.)
| | - Wesley T O'Neal
- Division of Cardiology, Department of Medicine, School of Medicine (W.T.O.)
| | - Tené T Lewis
- Department of Epidemiology, Rollins School of Public Health (T.T.L., A.A.)
| | - Laura R Loehr
- Emory University, Atlanta, GA. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (L.R.L.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Wake Forest Medical School, Winston-Salem, NC (E.Z.S.)
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health (T.T.L., A.A.)
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Abstract
PURPOSE OF REVIEW The aim of this paper is to summarize the recent and relevant evidence linking socioeconomic status (SES) to cardiovascular disease (CVD) and cardiovascular risk factors (CVRFs). RECENT FINDINGS In high-income countries (HICs), the evidence continues to expand, with meta-analyses of large longitudinal cohort studies consistently confirming the inverse association between SES and several CVD and CVRFs. The evidence remains limited in low-income and middle-income countries (LMICs), where most of the evidence originates from cross-sectional studies of varying quality and external validity; the available evidence indicates that the association between SES and CVD and CVRFs depends on the socioeconomic development context and the stage in the demographic, epidemiological, and nutrition transition of the population. The recent evidence confirms that SES is strongly inversely associated with CVD and CVRFs in HICs. However, there remains a need for more research to better understand the way socioeconomic circumstances become embodied in early life and throughout the life course to affect cardiovascular risk in adult and later life. In LMICs, the evidence remains scarce; thus, there is an urgent need for large longitudinal studies to disaggregate CVD and CVRFs by socioeconomic indicators, particularly as these countries already suffer the greatest burden of CVD.
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Affiliation(s)
- Carlos de Mestral
- Division of Chronic Diseases, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Biopôle 2 - Route de la Corniche 10, 1010, Lausanne, Switzerland
| | - Silvia Stringhini
- Division of Chronic Diseases, Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Biopôle 2 - Route de la Corniche 10, 1010, Lausanne, Switzerland.
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Puolakka E, Pahkala K, Laitinen TT, Magnussen CG, Hutri-Kähönen N, Kähönen M, Lehtimäki T, Tossavainen P, Jokinen E, Sabin MA, Laitinen T, Elovainio M, Pulkki-Råback L, Viikari JSA, Raitakari OT, Juonala M. Childhood Socioeconomic Status and Arterial Stiffness in Adulthood: The Cardiovascular Risk in Young Finns Study. Hypertension 2017; 70:729-735. [PMID: 28808067 DOI: 10.1161/hypertensionaha.117.09718] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 05/28/2017] [Accepted: 07/24/2017] [Indexed: 12/27/2022]
Abstract
Increasing evidence supports the importance of socioeconomic factors in the development of atherosclerotic cardiovascular disease. However, the association of childhood socioeconomic status (SES) with arterial stiffness in adulthood has not been reported. Our aim was to determine whether higher childhood family-level SES is associated with lower arterial stiffness in adulthood. The analyses were performed using data gathered within the longitudinal Young Finns Study. The sample comprised 2566 participants who had data concerning family SES at ages 3 to 18 years in 1980 and arterial pulse wave velocity and carotid artery distensibility measured 21 or 27 years later in adulthood. Higher family SES in childhood was associated with lower arterial stiffness in adulthood; carotid artery distensibility being higher (β value±SE, 0.029±0.0089%/10 mm Hg; P=0.001) and pulse wave velocity lower (β value±SE, -0.062±0.022 m/s; P=0.006) among those with higher family SES in a multivariable analysis adjusted with age, sex, and conventional childhood cardiometabolic risk factors. The association remained significant after further adjustment for participant's SES in adulthood (β value±SE, 0.026±0.010%/10 mm Hg; P=0.01 for carotid artery distensibility and β value±SE, -0.048±0.023 m/s; P=0.04 for pulse wave velocity) but attenuated after adjustment for adulthood cardiometabolic risk factors (β value±SE, 0.015±0.008%/10 mm Hg; P=0.08 for carotid artery distensibility and β value±SE, -0.019±0.02 m/s; P=0.38 for pulse wave velocity). In conclusion, we observed an association between higher family SES in childhood and lower arterial stiffness in adulthood. Our findings suggest that special attention could be paid to children from low SES families to prevent cardiometabolic diseases primordially.
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Affiliation(s)
- Elina Puolakka
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.).
| | - Katja Pahkala
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Tomi T Laitinen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Costan G Magnussen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Nina Hutri-Kähönen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Mika Kähönen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Terho Lehtimäki
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Päivi Tossavainen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Eero Jokinen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Matthew A Sabin
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Tomi Laitinen
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Marko Elovainio
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Laura Pulkki-Råback
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Jorma S A Viikari
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Olli T Raitakari
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
| | - Markus Juonala
- From the Research Centre of Applied and Preventive Cardiovascular Medicine (E.P., K.P., T.T.L., C.G.M., O.T.R., M.J.), Department of Physical Activity and Health, Sports and Exercise Medicine Unit, Paavo Nurmi Centre (K.P., T.T.L.), and Department of Medicine (J.S.A.V., M.J.), University of Turku, Finland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (C.G.M.); Department of Pediatrics (N.H.-K.) and Department of Clinical Physiology (M.K.), Tampere University Hospital and University of Tampere, Finland; Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center-Tampere, Faculty of Medicine and Life Sciences, University of Tampere, Finland (T. Lehtimäki); Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, Oulu University Hospital and University of Oulu, Finland (P.T.); Department of Pediatric Cardiology, Hospital for Children and Adolescents (E.J.), Unit of Personality, Work, and Health, Institute of Behavioural Sciences (M.E., L.P.-R.), and Helsinki Collegium for Advanced Studies, University of Helsinki, Finland (L.P.-R.); Murdoch Childrens Research Institute, Royal Children's Hospital, Australia (M.A.S.); Department of Pediatrics, University of Melbourne, Victoria, Australia (M.A.S.); Department of Clinical Physiology and Nuclear Medicine, Kuopio University Hospital and University of Eastern Finland (T. Laitinen); Division of Medicine, Turku University Hospital, Finland (J.S.A.V., M.J.); and Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Finland (O.T.R.)
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Training and Capacity Building in LMIC for Research in Heart and Lung Diseases: The NHLBI-UnitedHealth Global Health Centers of Excellence Program. Glob Heart 2017; 11:17-25. [PMID: 27102019 DOI: 10.1016/j.gheart.2016.01.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 12/17/2022] Open
Abstract
Stemming the tide of noncommunicable diseases (NCDs) worldwide requires a multipronged approach. Although much attention has been paid to disease control measures, there is relatively little consideration of the importance of training the next generation of health-related researchers to play their important role in this global epidemic. The lack of support for early stage investigators in low- and middle-income countries interested in the global NCD field has resulted in inadequate funding opportunities for research, insufficient training in advanced research methodology and data analysis, lack of mentorship in manuscript and grant writing, and meager institutional support for developing, submitting, and administering research applications and awards. To address this unmet need, The National Heart, Lung, and Blood Institute-UnitedHealth Collaborating Centers of Excellence initiative created a Training Subcommittee that coordinated and developed an intensive, mentored health-related research experience for a number of early stage investigators from the 11 Centers of Excellence around the world. We describe the challenges faced by early stage investigators in low- and middle-income countries, the organization and scope of the Training Subcommittee, training activities, early outcomes of the early stage investigators (foreign and domestic) and training materials that have been developed by this program that are available to the public. By investing in the careers of individuals in a supportive global NCD network, we demonstrate the impact that an investment in training individuals from low- and middle-income countries can have on the preferred future of or current efforts to combat NCDs.
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25
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Gender differences in the relationships between psychosocial factors and hypertension. Maturitas 2016; 93:58-64. [PMID: 27338977 DOI: 10.1016/j.maturitas.2016.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 05/25/2016] [Accepted: 06/01/2016] [Indexed: 12/19/2022]
Abstract
Gender differences in the epidemiology, pathophysiology, clinical manifestations and outcomes of cardiovascular disease are well established but there is still a lack of awareness of this both in the general population and among healthcare providers. In addition to the traditionally recognized cardiovascular risk factors, more recently psychosocial risk factors such as stress, mood disorders, low socioeconomic status and sleep disorders have been linked to cardiovascular diseases and hypertension. Psychosocial factors may have different cardiovascular consequences in men and women; thus further efforts are required to explore pathophysiological mechanisms, to obtain gender-specific data from clinical trials and to translate this knowledge into everyday clinical practice.
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What Defines a Valuable Investment in Global Health Research? Glob Heart 2016; 11:1-3. [DOI: 10.1016/j.gheart.2015.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022] Open
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