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Al Saleh A, Jamee A, Sulaiman K, Sobhy M, Gamra H, Alkindi F, Benkhedda S, Al-Motarreb A, Amin MI, Almahmeed W, Hammoudeh A, Skouri H, Farhan HA, Al Jarallah M, Fellat N, Panduranga P, Alnajm BK, Abdelhamid M, Refaat R, Amor H, Messaous S, Ahmed HS, Chibane A, AbdulMalek A, Alsagheer NK, Dada S, Mokhtar Z, Ali M, Ullah A, AlBackr H, Alhabib KF. Clinical features, socioeconomic status, management, short and long-term outcomes of patients with acute myocardial infarction: Phase I results of PEACE MENA registry. PLoS One 2024; 19:e0296056. [PMID: 38206951 PMCID: PMC10783754 DOI: 10.1371/journal.pone.0296056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The Program for the Evaluation and Management of Cardiac Events in the Middle East and North Africa (PEACE MENA) is a prospective registry program in Arabian countries that involves in patients with acute myocardial infarction (AMI) or acute heart failure (AHF). METHODS This prospective, multi-center, multi-country study is the first report of the baseline characteristics and outcomes of inpatients with AMI who were enrolled during the first 14-month recruitment phase. We report the clinical characteristics, socioeconomic, educational levels, and management, in-hospital, one month and one-year outcomes. RESULTS Between April 2019 and June 2020, 1377 patients with AMI were enrolled (79.1% males) from 16 Arabian countries. The mean age (± SD) was 58 ± 12 years. Almost half of the population had a net income < $500/month, and 40% had limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia; 53% had STEMI, and almost half (49.7%) underwent a primary percutaneous intervention (PCI) (lowest 4.5% and highest 100%). Thrombolytics were used by 36.2%. (Lowest 6.45% and highest (90.9%). No reperfusion occurred in 13.8% of patients (lowest was 0% and highest 72.7%).Primary PCI was performed less frequently in the lower income group vs. high income group (26.3% vs. 54.7%; P<0.001). Recurrent ischemia occurred more frequently in the low-income group (10.9% vs. 7%; P = 0.018). Re-admission occurred in 9% at 1 month and 30% at 1 year, whereas 1-month mortality was 0.7% and 1-year mortality 4.7%. CONCLUSION In the MENA region, patients with AMI present at a young age and have a high burden of cardiac risk factors. Most of the patients in the registry have a low income and low educational status. There is heterogeneity among key performance indicators of AMI management among various Arabian countries.
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Affiliation(s)
- Ayman Al Saleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Amal Jamee
- Nassar Medical Complex Hospital, Ministry of Health, Khan Younes, Gaza Strip, Palestine
- Al-Quds Hospital, Gaza, Palestine
| | | | - Mohamed Sobhy
- International Cardiac Center (ICC), Alexandria, Egypt
| | - Habib Gamra
- Research Laboratory LR, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Fahad Alkindi
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Salim Benkhedda
- Cardiology Department, Mustapha Hospital, COCRG Laboratory University Benyoucef Benkhedda, Algiers, Algeria
| | | | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirate
| | | | - Hadi Skouri
- Cardiology Division, Internal Medicine Department at American University of Beirut Medical Center, Beirut, Lebanon
| | - Hasan A. Farhan
- Iraqi Board for Medical Specializations, Scientific Council of Cardiology. Baghdad Heart Center, Medical City, Baghdad, Iraq
| | | | | | | | | | - Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Giza Governorate, Egypt
| | - Rafik Refaat
- International Cardiac Center (ICC), Alexandria, Egypt
| | - Hassen Amor
- Taher Sfar University Hospital, Mahdia, Tunisia
| | - Salma Messaous
- Research Laboratory LR, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | | | - Ahcene Chibane
- Internal Medicine and Cardiology Department, CHU Douéra, Algiers, University Saad Dahlab, Blida, Algeria
| | - Azzouz AbdulMalek
- Cardiology Department, Mustapha Hospital, COCRG Laboratory University Benyoucef Benkhedda, Algiers, Algeria
| | | | - Sobhi Dada
- Hammoud University Medical Center, Saida, Lebanon
| | - Zaki Mokhtar
- King Saud Hospital, Unizah, Qaseem, Saudi Arabia
| | | | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Hanan AlBackr
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
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Daran B, Levasseur P, Clément M. Updating the association between socioeconomic status and obesity in low-income and lower-middle-income sub-Saharan African countries: A literature review. Obes Rev 2023; 24:e13601. [PMID: 37415279 DOI: 10.1111/obr.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
Globally, the literature tends to emphasize negative associations between socioeconomic status (SES) and bodyweight in countries improving their economic development. However, little is known about the social distribution of obesity in sub-Saharan Africa (SSA) where economic growth has been highly heterogeneous the last decades. This paper reviews an exhaustive set of recent empirical studies examining its association in low-income and lower-middle-income countries in SSA. Although there is evidence of a positive association between SES and obesity in low-income countries, we found mixed associations in lower-middle-income countries, potentially providing evidence of a social reversal of the obesity burden.
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Affiliation(s)
- Bertille Daran
- PSAE, INRAE, AgroParisTech, Université Paris-Saclay, Palaiseau, France
| | - Pierre Levasseur
- SADAPT, INRAE, AgroParisTech, Université Paris-Saclay, Palaiseau, France
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Socioeconomic Inequalities in the Prevalence of Non-Communicable Diseases among Older Adults in India. Geriatrics (Basel) 2022; 7:geriatrics7060137. [PMID: 36547273 PMCID: PMC9778373 DOI: 10.3390/geriatrics7060137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/25/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
Understanding socioeconomic inequalities in non-communicable disease prevalence and preventive care usage can help design effective action plans for health equality programs among India's aging population. Hypertension (HTN) and diabetes mellitus (DM) are frequently used as model non-communicable diseases for research and policy purposes as these two are the most prevalent NCDs in India and are the leading causes of mortality. For this investigation, data on 31,464 older persons (aged 60 years and above) who took part in the Longitudinal Ageing Survey of India (LASI: 2017-2018) were analyzed. The concentration index was used to assess socioeconomic inequality whereas relative inequalities indices were used to compare HTN, DM, and preventive care usage between the different groups of individuals based on socioeconomic status. The study reveals that wealthy older adults in India had a higher frequency of HTN and DM than the poor elderly. Significant differences in the usage of preventive care, such as blood pressure/blood glucose monitoring, were found among people with HTN or DM. Furthermore, economic position, education, type of work, and residential status were identified as important factors for monitoring inequalities in access to preventive care for HTN and DM. Disparities in non-communicable diseases can be both a cause and an effect of inequality across social strata in India.
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Dong Y, Chen M, Sun B, Li Y, Gao D, Wen B, Song Y, Ma J. Trends in associations between socioeconomic development and urban-rural disparity with high blood pressure in Chinese children and adolescents over two decades. J Hum Hypertens 2022; 36:866-874. [PMID: 34354252 DOI: 10.1038/s41371-021-00592-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/26/2021] [Accepted: 07/29/2021] [Indexed: 11/09/2022]
Abstract
This study aimed to assess the association between the trend of urban-rural disparity in high blood pressure (HBP) in Chinese children and adolescents and socioeconomic development. Data on 1,054,602 students aged 7-18 years were obtained from five successive national surveys administered in 29 Chinese provinces in 1995, 2000, 2005, 2010, and 2014. HBP was defined as average measured systolic BP and/or diastolic BP equal to or more than 95th percentile. The socioeconomic indicators at the provincial-level included gross domestic product (GDP) per capita, the Engel coefficient, and urbanization rates. From 1995 to 2014, HBP prevalence in Chinese children and adolescents fluctuated between 6.9% and 9.2%. Rural areas had a higher prevalence of HBP than urban areas, with a diminishing trend in urban-rural disparity from 1995 to 2010 with a reduced OR from 1.45 (95% CI: 1.40-150) in 1995 to 1.09 (1.05-1.12) in 2010, whereas a widening gap in 2014 with OR of 1.23 (1.19-1.26)). A positive association existed between the improvement of socioeconomic indicators and the increase in HBP, which was demonstrated obviously by the Engel coefficient strata. The increases in the urbanization rates were accompanied by a greater increase of HBP in urban than in rural areas. The large urban-rural disparity suggests a priority of HBP control in rural children due to their current and future HBP and cardiovascular disease risks. Socioeconomic development could affect the urban-rural disparity in HBP risk, reflecting the importance of effective policy responses for preventing HBP by avoiding unhealthy lifestyles brought about by rapid economic development.
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Affiliation(s)
- Yanhui Dong
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Manman Chen
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Binbin Sun
- Institute of Population Research, Peking University/KU-APEC Health Science Academy, Beijing, China
| | - Yanhui Li
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Di Gao
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Bo Wen
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China
| | - Yi Song
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China.
| | - Jun Ma
- Institute of Child and Adolescent Health & School of Public Health, Peking University, Beijing, China.
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Lamb KE, Crawford D, Thornton LE, Shariful Islam SM, Maddison R, Ball K. Educational differences in diabetes and diabetes self-management behaviours in WHO SAGE countries. BMC Public Health 2021; 21:2108. [PMID: 34789208 PMCID: PMC8597224 DOI: 10.1186/s12889-021-12131-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Diabetes mellitus represents a substantial global health challenge, with prevalence rising in low- and middle-income countries (LMICs). Although diabetes is known to follow a socioeconomic gradient, patterns in LMICs are unclear. This study examined associations between education and diabetes, and diabetes self-management behaviours, in six LMICs. Methods Cross-sectional data for 31,780 participants from China, Ghana, India, Mexico, Russia, and South Africa from the World Health Organization Study on Global AGEing and adult health (SAGE) study were used. Participants aged ≥50 years completed face-to-face interviews between 2007 and 2010. Participants self-reported diabetes diagnosis, physical activity, sedentary time, fruit and vegetable consumption, any special diet/program for diabetes, whether they were taking insulin for diabetes and number of years of education. Height, weight, waist, and hip circumference were measured. Country-specific survey-weighted log-binomial regression models were fitted to examine associations between the number of years of education and self-reported diabetes diagnosis (primary analysis). In secondary analyses, among those with a self-reported diabetes diagnosis, generalised linear regression models were fitted to examine associations between education and i) physical activity, ii) sedentary time, iii) fruit and vegetable consumption, iv) special diet for diabetes, v) taking insulin, vi) BMI, vii) waist circumference and viii) hip circumference. Results There was strong evidence of an association between years of education and diabetes diagnosis in Ghana (RR = 1.09, 95% CI: 1.06–1.13) and India (RR = 1.09, 95% CI: 1.07–1.12) only. In India, greater years of education was associated with higher leisure physical activity, fruit and vegetable intake, rates following a special diet or taking insulin, but also higher mean BMI, waist and hip circumference. Relationships between education and self-management behaviours were rarely seen in the other countries. Conclusions Associations between education and diabetes, and behavioural self-management (India only) was more evident in the two least developed (Ghana and India) of the WHO SAGE countries, indicating increasing diabetes diagnosis with greater numbers of years of education. The lack of gradients elsewhere may reflect shifting risk from higher to lower educated populations. While there was some suggestion that self-management behaviours were greater with increased education in India, this was not observed in the other countries. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12131-7.
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Affiliation(s)
- Karen E Lamb
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia. .,Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia. .,Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.
| | - David Crawford
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Lukar E Thornton
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Sheikh M Shariful Islam
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Ralph Maddison
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Kylie Ball
- Deakin University, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Geelong, Australia.
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Prevalence and Socioeconomic Factors of Diabetes and High Blood Pressure Among Women in Kenya: A Cross-Sectional Study. J Epidemiol Glob Health 2021; 11:397-404. [PMID: 34734380 PMCID: PMC8664325 DOI: 10.1007/s44197-021-00004-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 07/22/2021] [Indexed: 01/06/2023] Open
Abstract
Background The emerging burden of high blood pressure (HBP) and diabetes in sub-Saharan Africa will create new challenges to health systems in African countries. There is a scarcity of studies that have reported associations of diabetes and HBP with socioeconomic factors on women within the population. We assessed the prevalence and socioeconomic factors of diabetes and high blood pressure among women in Kenya. Methods We analysed cross-sectional data from the 2014 Kenya Demographic and Health Survey. Subjects were women aged 15–49 years. Self-reported status of HBP and diabetes was used to measure the prevalences. The association between educational and wealth index with HBP and diabetes was assessed by multivariable binary logistic regression. Results The prevalences of self-reported HBP and diabetes were 9.4% and 1.3%, respectively. Women with secondary [aOR = 1.53; 95% CI = 1.15–2.02] and primary [aOR = 1.48; 95% CI = 1.15–1.92] levels of education were more likely to report having HBP, compared to those with no formal education. However, there was no significant association between educational level and self-reported diabetes. In terms of wealth quintile, we found that women with higher wealth quintile were more likely to report having HBP and diabetes compared to those with poorest wealth quintile. Specifically, the highest odds of self-reported HBP was found among women with richest wealth quintile compared to those with poorest wealth quintile [aOR = 2.22; 95% CI = 1.71–2.88]. Also, women with poorer wealth quintile were more likely to have self-reported diabetes compared to those with poorest wealth quintile [aOR = 1.89; 95% CI = 1.08–2.38]. Conclusion The prevalence of HBP and diabetes was low among women in Kenya. Household wealth status was associated with HBP and diabetes. No causation can be inferred from the data; hence, longitudinal studies focusing on health-related behaviour associated with NCDs are recommended. Proper dissemination of health information regarding the risk factors for HBP and diabetes may prove to be beneficial for NCD prevention programmes.
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Liu R, Mi B, Zhao Y, Li Q, Dang S, Yan H. Gender-specific association between carbohydrate consumption and blood pressure in Chinese adults. BMJ Nutr Prev Health 2021; 4:80-89. [PMID: 34308115 PMCID: PMC8258083 DOI: 10.1136/bmjnph-2020-000165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 01/30/2023] Open
Abstract
Background The association between dietary carbohydrate consumption and blood pressure (BP) is controversial. The present study aimed to evaluate the possible gender-specific association of carbohydrate across the whole BP distribution. Method Cross-sectional survey including 2241 rural adults was conducted in northwestern China in 2010. BP was measured by trained medical personnel. Dietary information was collected by semiquantitative Food-Frequency Questionnaire. Multivariate quantile regression model was used to estimate the association between total carbohydrates consumption and systolic BP (SBP) and diastolic BP (DBP) at different quantiles. Gender-specific β coefficient and its 95% CI was calculated. Results The average carbohydrate intake was 267.4 (SD 112.0) g/day in males and 204.9 (SD 90.7) g/day in females, with only 10.6% of males and 6.5% females consumed at least 65% of total energy from carbohydrates. And more than 80% carbohydrates were derived from refined grains. In females, increased total carbohydrates intake was associated with adverse SBP and DBP. An additional 50 g carbohydrates per day was positively associated with SBP at low and high quantiles (10th-20th and 60th-80th) and with DBP almost across whole distribution (30th-90th), after adjusting for age, fortune index, family history of hypertension, body mass index, physical activity level, alcohol intake and smoke, energy, two nutrient principal components, protein and sodium intake. Both relatively low and high carbohydrate intake were associated with increased SBP, with minimum level observed at 130-150 g carbohydrate intake per day from restricted cubic splines. However, no significant associations were observed in males. Conclusions Higher total carbohydrates consumption might have an adverse impact on both SBP and DBP in Chinese females but not males. Additionally, the positive association varies across distribution of BP quantiles. Further research is warranted to validate these findings and clarify the causality.
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Affiliation(s)
- Ruru Liu
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China.,Department of Disinfection, Xi'an Center for Disease Control and Prevention, Xi'an, Shaanxi Province, China
| | - Baibing Mi
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Yaling Zhao
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Qiang Li
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Shaonong Dang
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
| | - Hong Yan
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, China
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Global epidemiology, health burden and effective interventions for elevated blood pressure and hypertension. Nat Rev Cardiol 2021; 18:785-802. [PMID: 34050340 PMCID: PMC8162166 DOI: 10.1038/s41569-021-00559-8] [Citation(s) in RCA: 487] [Impact Index Per Article: 162.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 02/07/2023]
Abstract
High blood pressure is one of the most important risk factors for ischaemic heart disease, stroke, other cardiovascular diseases, chronic kidney disease and dementia. Mean blood pressure and the prevalence of raised blood pressure have declined substantially in high-income regions since at least the 1970s. By contrast, blood pressure has risen in East, South and Southeast Asia, Oceania and sub-Saharan Africa. Given these trends, the prevalence of hypertension is now higher in low-income and middle-income countries than in high-income countries. In 2015, an estimated 8.5 million deaths were attributable to systolic blood pressure >115 mmHg, 88% of which were in low-income and middle-income countries. Measures such as increasing the availability and affordability of fresh fruits and vegetables, lowering the sodium content of packaged and prepared food and staples such as bread, and improving the availability of dietary salt substitutes can help lower blood pressure in the entire population. The use and effectiveness of hypertension treatment vary substantially across countries. Factors influencing this variation include a country's financial resources, the extent of health insurance and health facilities, how frequently people interact with physicians and non-physician health personnel, whether a clear and widely adopted clinical guideline exists and the availability of medicines. Scaling up treatment coverage and improving its community effectiveness can substantially reduce the health burden of hypertension.
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Heikkilä K, Loftus IM, Waton S, Johal AS, Boyle JR, Cromwell DA. Association of neighbourhood deprivation with risks of major amputation and death following lower limb revascularisation. Atherosclerosis 2020; 306:11-14. [DOI: 10.1016/j.atherosclerosis.2020.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/31/2020] [Accepted: 06/17/2020] [Indexed: 01/18/2023]
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Lai S, Shen C, Yang X, Zhang X, Xu Y, Li Q, Gao J, Zhou Z. Socioeconomic inequalities in the prevalence of chronic diseases and preventive care among adults aged 45 and older in Shaanxi Province, China. BMC Public Health 2019; 19:1460. [PMID: 31694609 PMCID: PMC6833131 DOI: 10.1186/s12889-019-7835-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/23/2019] [Indexed: 11/14/2022] Open
Abstract
Background Monitoring inequalities in chronic disease prevalence and their preventive care can help build effective strategies to improve health equality. Using hypertension and diabetes as a model, this study measures and decomposes socioeconomic inequalities in their prevalence and preventive care among Chinese adults aged 45 years and older in Shaanxi Province, an underdeveloped western region of China. Methods Data of 27,728 respondents aged 45 years and older who participated in the fifth National Health Services Survey conducted in 2013 in Shaanxi Province were analyzed. The relative indexes of inequalities based on Poisson regressions were used to assess disparities in the prevalence of hypertension and diabetes and their preventive care between those with the lowest and the highest socioeconomic status, and the concentration index was used to measure the magnitude of the socioeconomic-related inequality across the entire socioeconomic spectrum. The contribution of each factor to the inequality was further estimated via the concentration index decomposition. Results Our results indicate a higher prevalence of hypertension and diabetes among the rich than the poor individuals aged 45 years and older in Shaanxi Province, China. Among individuals with hypertension or diabetes, significant inequalities favoring the rich were observed in the use of preventive care, i.e. in adequate use of medication and of blood pressure/blood glucose monitoring. Furthermore, economic status, educational level, employment status, and urban-rural areas were identified as the key socioeconomic indicators for monitoring the inequalities in the patient preventive care. Conclusions Our study suggests that the existence of clear inequities in the prevalence of chronic diseases and preventive care among adults aged 45 and older in Shaanxi Province, China. These inequalities in chronic diseases could be as much a cause as a consequence of socioeconomic inequalities.
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Affiliation(s)
- Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Xiaowei Yang
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Xiaolong Zhang
- Jinhe Center for Economic Research, Xi'an Jiaotong University, No. 28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Yongjian Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Qian Li
- the First Affiliated Hospital of Xi'an Jiaotong University, No.277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, P.O Box 86, No. 76 West Yanta Road, Xi'an, 710061, Shaanxi, China.
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The interaction between district-level development and individual-level socioeconomic gradients of cardiovascular disease risk factors in India: A cross-sectional study of 2.4 million adults. Soc Sci Med 2019; 239:112514. [PMID: 31541939 DOI: 10.1016/j.socscimed.2019.112514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/07/2019] [Accepted: 08/21/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Diabetes, hypertension, and obesity tend to be positively associated with socio-economic status in low- and middle-income countries (LMICs). It has been hypothesized that these positive socio-economic gradients will reverse as LMICs continue to undergo economic development. We use population-based cross-sectional data in India to examine how a district's economic development is associated with socio-economic differences in cardiovascular disease (CVD) risk factor prevalence between individuals. METHODS We separately analyzed two nationally representative household survey datasets - the NFHS-4 and the DLHS-4/AHS - that are representative at the district level in India. Diabetes was defined based on a capillary blood glucose measurement, hypertension on blood pressure measurements, obesity on measurements of height and weight, and current smoking on self-report. Five different measures of a district's economic development were used. We analyzed the data using district-level regressions (plotting the coefficient comparing high to low socio-economic status against district-level economic development) and multilevel modeling. RESULTS 757,655 and 1,618,844 adults participated in the NFHS-4 and DLHS-4/AHS, respectively. Higher education and household wealth were associated with a higher probability of having diabetes, hypertension, and obesity, and a lower probability of being a current smoker. For diabetes, hypertension, and obesity, we found that a higher economic development of a district was associated with a less positive (or even negative) association between the CVD risk factor and education. For smoking, the association with education tended to become less negative as districts had a higher level of economic development. In general, these associations did not show clear trends when household wealth quintile was used as the measure of socio-economic status instead of education. CONCLUSIONS While this study provides some evidence for the "reversal hypothesis", large-scale longitudinal studies are needed to determine whether LMICs should expect a likely reversal of current positive socioeconomic gradients in diabetes, hypertension, and obesity as their countries continue to develop economically.
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Pihl Lesnovska K, Münch A, Hjortswang H. Microscopic colitis: Struggling with an invisible, disabling disease. J Clin Nurs 2019; 28:3408-3415. [PMID: 31090966 PMCID: PMC7328780 DOI: 10.1111/jocn.14916] [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: 01/23/2019] [Revised: 03/20/2019] [Accepted: 05/02/2019] [Indexed: 12/22/2022]
Abstract
Background and aims Microscopic colitis causes chronic or recurrent nonbloody, watery diarrhoea, which is associated with urgency, faecal incontinence and abdominal pain. The patient's health‐related quality of life is often impaired. In microscopic colitis, health‐related quality of life has been studied using questionnaires originally constructed and validated for patients with inflammatory bowel disease. The aim of this study was to explore the impact of microscopic colitis on everyday life. Methods and results Inductive, qualitative, semi‐structured interviews were performed with 15 persons suffering from microscopic colitis. Content analysis was used to explore the impact of the condition on everyday life. The study followed the consolidated criteria for reporting qualitative research. The qualitative inductive content analysis generated one theme and five subthemes. The theme was “struggling with an invisible, disabling disease.” The five subthemes were as follows: physical experience of bowel function; associated symptoms affecting quality of life; impact of the disease on everyday life; disease‐related worry; and strategies for managing everyday life. Conclusions The semi‐structured interviews with persons suffering from microscopic colitis provided a wide spectrum of answers to the question of how everyday life is affected. Microscopic colitis can be a disabling life experience, and patients develop different strategies to adapt, cope and regain their previous performance level. Relevance to clinical practice There are new and interesting findings in our study that everyday life still remains affected even when patients are in remission. These findings have relevance in clinical practice and may create a better understanding of the patient's symptoms and situation.
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Affiliation(s)
- Katarina Pihl Lesnovska
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Andreas Münch
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Henrik Hjortswang
- Department of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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The contribution of health behaviors to socioeconomic inequalities in health: A systematic review. Prev Med 2018; 113:15-31. [PMID: 29752959 DOI: 10.1016/j.ypmed.2018.05.003] [Citation(s) in RCA: 199] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 12/22/2022]
Abstract
Unhealthy behaviors and their social patterning have been frequently proposed as factors mediating socioeconomic differences in health. However, a clear quantification of the contribution of health behaviors to the socioeconomic gradient in health is lacking. This study systematically reviews the role of health behaviors in explaining socioeconomic inequalities in health. Published studies were identified by a systematic review of PubMed, Embase and Web-of-Science. Four health behaviors were considered: smoking, alcohol consumption, physical activity and diet. We restricted health outcomes to cardiometabolic disorders and mortality. To allow comparison between studies, the contribution of health behaviors, or the part of the socioeconomic gradient in health that is explained by health behaviors, was recalculated in all studies according to the absolute scale difference method. We identified 114 articles on socioeconomic position, health behaviors and cardiometabolic disorders or mortality from electronic databases and articles reference lists. Lower socioeconomic position was associated with an increased risk of all-cause mortality and cardiometabolic disorders, this gradient was explained by health behaviors to varying degrees (minimum contribution -43%; maximum contribution 261%). Health behaviors explained a larger proportion of the SEP-health gradient in studies conducted in North America and Northern Europe, in studies examining all-cause mortality and cardiovascular disease, among men, in younger individuals, and in longitudinal studies, when compared to other settings. Of the four behaviors examined, smoking contributed the most to social inequalities in health, with a median contribution of 19%. Health behaviors contribute to the socioeconomic gradient in cardiometabolic disease and mortality, but this contribution varies according to population and study characteristics. Nevertheless, our results should encourage the implementation of interventions targeting health behaviors, as they may reduce socioeconomic inequalities in health and increase population health.
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Stringhini S, Bovet P. Socioeconomic status and risk factors for non-communicable diseases in low-income and lower-middle-income countries. LANCET GLOBAL HEALTH 2018; 5:e230-e231. [PMID: 28193380 DOI: 10.1016/s2214-109x(17)30054-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Route de la Corniche 10, 1010 Lausanne, Switzerland.
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15
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Stringhini S, Carmeli C, Jokela M, Avendaño M, McCrory C, d'Errico A, Bochud M, Barros H, Costa G, Chadeau-Hyam M, Delpierre C, Gandini M, Fraga S, Goldberg M, Giles GG, Lassale C, Kenny RA, Kelly-Irving M, Paccaud F, Layte R, Muennig P, Marmot MG, Ribeiro AI, Severi G, Steptoe A, Shipley MJ, Zins M, Mackenbach JP, Vineis P, Kivimäki M. Socioeconomic status, non-communicable disease risk factors, and walking speed in older adults: multi-cohort population based study. BMJ 2018; 360:k1046. [PMID: 29572376 PMCID: PMC5865179 DOI: 10.1136/bmj.k1046] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess the association of low socioeconomic status and risk factors for non-communicable diseases (diabetes, high alcohol intake, high blood pressure, obesity, physical inactivity, smoking) with loss of physical functioning at older ages. DESIGN Multi-cohort population based study. SETTING 37 cohort studies from 24 countries in Europe, the United States, Latin America, Africa, and Asia, 1990-2017. PARTICIPANTS 109 107 men and women aged 45-90 years. MAIN OUTCOME MEASURE Physical functioning assessed using the walking speed test, a valid index of overall functional capacity. Years of functioning lost was computed as a metric to quantify the difference in walking speed between those exposed and unexposed to low socioeconomic status and risk factors. RESULTS According to mixed model estimations, men aged 60 and of low socioeconomic status had the same walking speed as men aged 66.6 of high socioeconomic status (years of functioning lost 6.6 years, 95% confidence interval 5.0 to 9.4). The years of functioning lost for women were 4.6 (3.6 to 6.2). In men and women, respectively, 5.7 (4.4 to 8.1) and 5.4 (4.3 to 7.3) years of functioning were lost by age 60 due to insufficient physical activity, 5.1 (3.9 to 7.0) and 7.5 (6.1 to 9.5) due to obesity, 2.3 (1.6 to 3.4) and 3.0 (2.3 to 4.0) due to hypertension, 5.6 (4.2 to 8.0) and 6.3 (4.9 to 8.4) due to diabetes, and 3.0 (2.2 to 4.3) and 0.7 (0.1 to 1.5) due to tobacco use. In analyses restricted to high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was 8.0 (5.7 to 13.1) for men and 5.4 (4.0 to 8.0) for women, whereas in low and middle income countries it was 2.6 (0.2 to 6.8) for men and 2.7 (1.0 to 5.5) for women. Within high income countries, the number of years of functioning lost attributable to low socioeconomic status by age 60 was greater in the United States than in Europe. Physical functioning continued to decline as a function of unfavourable risk factors between ages 60 and 85. Years of functioning lost were greater than years of life lost due to low socioeconomic status and non-communicable disease risk factors. CONCLUSIONS The independent association between socioeconomic status and physical functioning in old age is comparable in strength and consistency with those for established non-communicable disease risk factors. The results of this study suggest that tackling all these risk factors might substantially increase life years spent in good physical functioning.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010 Switzerland
| | - Cristian Carmeli
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010 Switzerland
| | - Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mauricio Avendaño
- Department of Global Health and Social Medicine, King's College London, London, UK
- Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Cathal McCrory
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Angelo d'Errico
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy
| | - Murielle Bochud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010 Switzerland
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Giuseppe Costa
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy
| | - Marc Chadeau-Hyam
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Cyrille Delpierre
- INSERM, UMR1027, Toulouse, France, and Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Martina Gandini
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco (TO), Italy
| | - Silvia Fraga
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Marcel Goldberg
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France, and Paris Descartes University, Paris, France
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Camille Lassale
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin, Ireland
| | - Michelle Kelly-Irving
- INSERM, UMR1027, Toulouse, France, and Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Fred Paccaud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Biopôle 2-Route de la Corniche 10, 1010 Switzerland
| | - Richard Layte
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
| | - Peter Muennig
- Global Research Analytics for Population Health, Health Policy and Management, Columbia University, New York, NY, USA
| | - Michael G Marmot
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Ana Isabel Ribeiro
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Gianluca Severi
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
- CESP, Inserm U1018, Université Paris-Saclay, Villejuif, France
- Human Genetics Foundation (HuGeF), Turin, Italy
| | - Andrew Steptoe
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Martin J Shipley
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Marie Zins
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France, and Paris Descartes University, Paris, France
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Mika Kivimäki
- University College London, Department of Epidemiology and Public Health, London, UK
- Clinicum, Faculty of Medicine, University of Helsinki, Finland
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Chamik T, Viswanathan B, Gedeon J, Bovet P. Associations between psychological stress and smoking, drinking, obesity, and high blood pressure in an upper middle-income country in the African region. Stress Health 2018; 34:93-101. [PMID: 28586134 DOI: 10.1002/smi.2766] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 02/17/2017] [Accepted: 05/14/2017] [Indexed: 11/06/2022]
Abstract
The direction and magnitude of the associations between cardiovascular risk factors (CVRFs) and psychological stress continue to be debated, and no data are available from surveys in the African region. In this study, we examine the associations between CVRFs and psychological stress in the Seychelles, a rapidly developing small island state in the African region. A survey was conducted in 1,240 adults aged 25-64 years representative of the Seychelles. Participants were asked to rank psychological stress that they had experienced during the past 12 months in four domains: work, social life, financial situation, and environment around home. CVRFs (high blood pressure, tobacco use, alcohol drinking, and obesity) were assessed using standard procedures. Psychological stress was associated with age, sex, and socioeconomic status. Overall, there were only few consistent associations between psychological stress and CVRFs, adjusting for age, sex, and socioeconomic status. Social stress was associated with smoking, drinking, and obesity, and there were marginal associations between stress at work and drinking, and between financial stress, and smoking and drinking. Psychological stress was not associated with high blood pressure. These findings suggest that psychological stress should be considered in cardiovascular disease prevention and control strategies.
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Affiliation(s)
- Tanja Chamik
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Jude Gedeon
- Ministry of Health, Victoria, Republic of Seychelles
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, University Hospital of Lausanne, Lausanne, Switzerland
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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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18
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Trends in prevalence, awareness, treatment and control of high blood pressure in the Seychelles between 1989 and 2013. J Hypertens 2017; 35:1465-1473. [DOI: 10.1097/hjh.0000000000001358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Daoulah A, Elkhateeb OE, Nasseri SA, Al-Murayeh M, Al-Kaabi S, Lotfi A, Alama MN, Al-Faifi SM, Haddara M, Dixon CM, Alzahrani IS, Alghamdi AA, Ahmed W, Fathey A, Haq E, Alsheikh-Ali AA. Socioeconomic Factors and Severity of Coronary Artery Disease in Patients Undergoing Coronary Angiography: A Multicentre Study of Arabian Gulf States. Open Cardiovasc Med J 2017; 11:47-57. [PMID: 28553410 PMCID: PMC5427707 DOI: 10.2174/1874192401711010047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/27/2017] [Accepted: 03/16/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) is a leading cause of death worldwide. The association of socioeconomic status with CAD is supported by numerous epidemiological studies. Whether such factors also impact the number of diseased coronary vessels and its severity is not well established. MATERIALS AND METHODS We conducted a prospective multicentre, multi-ethnic, cross sectional observational study of consecutive patients undergoing coronary angiography (CAG) at 5 hospitals in the Kingdom of Saudi Arabia and the United Arab Emirates. Baseline demographics, socioeconomic, and clinical variables were collected for all patients. Significant CAD was defined as ≥70% luminal stenosis in a major epicardial vessel. Left main disease (LMD) was defined as ≥50% stenosis in the left main coronary artery. Multi-vessel disease (MVD) was defined as having >1 significant CAD. RESULTS Of 1,068 patients (age 59 ± 13, female 28%, diabetes 56%, hypertension 60%, history of CAD 43%), 792 (74%) were from urban and remainder (26%) from rural communities. Patients from rural centres were older (61 ± 12 vs 58 ± 13), and more likely to have a history of diabetes (63 vs 54%), hypertension (74 vs 55%), dyslipidaemia (78 vs 59%), CAD (50 vs 41%) and percutaneous coronary intervention (PCI) (27 vs 21%). The two groups differed significantly in terms of income level, employment status and indication for angiography. After adjusting for baseline differences, patients living in a rural area were more likely to have significant CAD (adjusted OR 2.40 [1.47, 3.97]), MVD (adjusted OR 1.76 [1.18, 2.63]) and LMD (adjusted OR 1.71 [1.04, 2.82]). Higher income was also associated with a higher risk for significant CAD (adjusted OR 6.97 [2.30, 21.09]) and MVD (adjusted OR 2.49 [1.11, 5.56]), while unemployment was associated with a higher risk of significant CAD (adjusted OR 2.21, [1.27, 3.85]). CONCLUSION Communal and socioeconomic factors are associated with higher odds of significant CAD and MVD in the group of patients referred for CAG. The underpinnings of these associations (e.g. pathophysiologic factors, access to care, and system-wide determinants of quality) require further study.
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Affiliation(s)
- Amin Daoulah
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Osama E Elkhateeb
- Cardiac Center, King Abdullah Medical City in Holy Capital Makkah, Kingdom of Saudi Arabia
| | - S Ali Nasseri
- Politecnico di Torino, Italy Armed Forces Hospital Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia
| | - Mushabab Al-Murayeh
- Cardiovascular Department, Armed Forces Hospital Southern Region, Khamis Mushayt, Kingdom of Saudi Arabia
| | - Salem Al-Kaabi
- Cardiology Department, Zayed Military Hospital, Abu Dhabi, UAE
| | - Amir Lotfi
- Division of Cardiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, Massachusetts
| | - Mohamed N Alama
- Cardiology unit, King Abdul Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Salem M Al-Faifi
- Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Mamdouh Haddara
- Anesthesia Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Ciaran M Dixon
- Emergency Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
| | - Ibrahim S Alzahrani
- College of medicine, King Abdul Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Abdullah A Alghamdi
- Anesthesia Department, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Waleed Ahmed
- Internal Medicine Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Adnan Fathey
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Ejazul Haq
- Section of Adult Cardiology, Cardiovascular Department, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE. Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, UAE
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Stringhini S, Carmeli C, Jokela M, Avendaño M, Muennig P, Guida F, Ricceri F, d'Errico A, Barros H, Bochud M, Chadeau-Hyam M, Clavel-Chapelon F, Costa G, Delpierre C, Fraga S, Goldberg M, Giles GG, Krogh V, Kelly-Irving M, Layte R, Lasserre AM, Marmot MG, Preisig M, Shipley MJ, Vollenweider P, Zins M, Kawachi I, Steptoe A, Mackenbach JP, Vineis P, Kivimäki M. Socioeconomic status and the 25 × 25 risk factors as determinants of premature mortality: a multicohort study and meta-analysis of 1·7 million men and women. Lancet 2017; 389:1229-1237. [PMID: 28159391 PMCID: PMC5368415 DOI: 10.1016/s0140-6736(16)32380-7] [Citation(s) in RCA: 737] [Impact Index Per Article: 105.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/05/2016] [Accepted: 11/01/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND In 2011, WHO member states signed up to the 25 × 25 initiative, a plan to cut mortality due to non-communicable diseases by 25% by 2025. However, socioeconomic factors influencing non-communicable diseases have not been included in the plan. In this study, we aimed to compare the contribution of socioeconomic status to mortality and years-of-life-lost with that of the 25 × 25 conventional risk factors. METHODS We did a multicohort study and meta-analysis with individual-level data from 48 independent prospective cohort studies with information about socioeconomic status, indexed by occupational position, 25 × 25 risk factors (high alcohol intake, physical inactivity, current smoking, hypertension, diabetes, and obesity), and mortality, for a total population of 1 751 479 (54% women) from seven high-income WHO member countries. We estimated the association of socioeconomic status and the 25 × 25 risk factors with all-cause mortality and cause-specific mortality by calculating minimally adjusted and mutually adjusted hazard ratios [HR] and 95% CIs. We also estimated the population attributable fraction and the years of life lost due to suboptimal risk factors. FINDINGS During 26·6 million person-years at risk (mean follow-up 13·3 years [SD 6·4 years]), 310 277 participants died. HR for the 25 × 25 risk factors and mortality varied between 1·04 (95% CI 0·98-1·11) for obesity in men and 2 ·17 (2·06-2·29) for current smoking in men. Participants with low socioeconomic status had greater mortality compared with those with high socioeconomic status (HR 1·42, 95% CI 1·38-1·45 for men; 1·34, 1·28-1·39 for women); this association remained significant in mutually adjusted models that included the 25 × 25 factors (HR 1·26, 1·21-1·32, men and women combined). The population attributable fraction was highest for smoking, followed by physical inactivity then socioeconomic status. Low socioeconomic status was associated with a 2·1-year reduction in life expectancy between ages 40 and 85 years, the corresponding years-of-life-lost were 0·5 years for high alcohol intake, 0·7 years for obesity, 3·9 years for diabetes, 1·6 years for hypertension, 2·4 years for physical inactivity, and 4·8 years for current smoking. INTERPRETATION Socioeconomic circumstances, in addition to the 25 × 25 factors, should be targeted by local and global health strategies and health risk surveillance to reduce mortality. FUNDING European Commission, Swiss State Secretariat for Education, Swiss National Science Foundation, the Medical Research Council, NordForsk, Portuguese Foundation for Science and Technology.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine and Departments of Psychiatry and Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland.
| | - Cristian Carmeli
- Institute of Social and Preventive Medicine and Departments of Psychiatry and Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Markus Jokela
- Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland
| | - Mauricio Avendaño
- Department of Global Health and Social Medicine, King's College London, London, UK; Harvard T H Chan School of Public Health, Boston MA, USA
| | - Peter Muennig
- Global Research Analytics for Population Health, Health Policy and Management, Columbia University, New York, NY, USA
| | - Florence Guida
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Fulvio Ricceri
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy
| | - Angelo d'Errico
- Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy
| | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal; Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal
| | - Murielle Bochud
- Institute of Social and Preventive Medicine and Departments of Psychiatry and Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Marc Chadeau-Hyam
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | | | - Giuseppe Costa
- Department of Biological and Clinical Sciences, Universtiy of Turin, Turin, Italy
| | - Cyrille Delpierre
- INSERM, UMR1027, Toulouse, France; Université Toulouse III Paul-Sabatier, UMR1027, Toulouse, France
| | - Silvia Fraga
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Marcel Goldberg
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France; Paris Descartes University, Paris, France
| | - Graham G Giles
- Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michelle Kelly-Irving
- INSERM, UMR1027, Toulouse, France; Université Toulouse III Paul-Sabatier, UMR1027, Toulouse, France
| | - Richard Layte
- Department of Sociology, Trinity College Dublin, Dublin, Ireland
| | - Aurélie M Lasserre
- Institute of Social and Preventive Medicine and Departments of Psychiatry and Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael G Marmot
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Martin Preisig
- Institute of Social and Preventive Medicine and Departments of Psychiatry and Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Martin J Shipley
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Peter Vollenweider
- Institute of Social and Preventive Medicine and Departments of Psychiatry and Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Marie Zins
- Population-based Epidemiological Cohorts Unit, INSERM UMS 11, Villejuif, France; Paris Descartes University, Paris, France
| | - Ichiro Kawachi
- Harvard T H Chan School of Public Health, Boston MA, USA
| | - Andrew Steptoe
- University College London, Department of Epidemiology and Public Health, London, UK
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Paolo Vineis
- MRC-PHE Centre for Environment and Health, School of Public Health, Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Mika Kivimäki
- University College London, Department of Epidemiology and Public Health, London, UK; Clinicum, Faculty of Medicine, University of Helsinki, Finland
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Trends in Determinants of Hypercholesterolemia among Chinese Adults between 2002 and 2012: Results from theNational Nutrition Survey. Nutrients 2017; 9:nu9030279. [PMID: 28294966 PMCID: PMC5372942 DOI: 10.3390/nu9030279] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/09/2017] [Accepted: 02/15/2017] [Indexed: 11/26/2022] Open
Abstract
Hypercholesterolemia is a known risk factor for cardiovascular diseases and affects a high proportion of the population. This study aimed to assess and compare the determinants of hypercholesterolemia among Chinese adults aged 18 years and above, from 2002 to 2012. The study used a stratified multistage cluster sampling method to select participants. Sociodemographic and lifestyle information was collected during face-to-face interviews. Dietary intake was calculated by 3-day, 24-h dietary records in combination with weighted edible oil and condiments. Hypercholesterolemia was defined as total cholesterol above 6.22 mmol/L (240 mg/dL) from fasting blood samples. The study included 47,701 (mean age 43.0 years) and 39,870 (mean age 51.0 years) participants in 2002 and 2010–2012 surveys respectively. The weighted prevalence of hypercholesterolemia increased from 1.6% (2.1% urban, 1.0% rural) in 2002 to 6.0% (6.4% urban, 5.1% rural) in 2012. The intake of plant-based food decreased but the intake of pork increased over the 10 years. A high intake of protein and pork, alcohol drinking and overweight/obesity were positively associated with hypercholesterolemia. Neither education nor fruit and vegetable intake were associated with hypercholesterolemia. In conclusion, the burden of hypercholesterolemia increased substantially between 2002 and 2012 in China. Unhealthy lifestyle factors and change in traditional dietary pattern were positively associated with hypercholesterolemia. Further research on the role of diet in the development and prevention of hypercholesterolemia is needed.
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Yan R, Li W, Yin L, Wang Y, Bo J. Cardiovascular Diseases and Risk-Factor Burden in Urban and Rural Communities in High-, Middle-, and Low-Income Regions of China: A Large Community-Based Epidemiological Study. J Am Heart Assoc 2017; 6:JAHA.116.004445. [PMID: 28167497 PMCID: PMC5523752 DOI: 10.1161/jaha.116.004445] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Most cardiovascular diseases occur in low‐ and middle‐income regions of the world, but the socioeconomic distribution within China remains unclear. Our study aims to investigate whether the prevalence of cardiovascular diseases differs among high‐, middle‐, and low‐income regions of China and to explore the reasons for the disparities. Methods and Results We enrolled 46 285 individuals from 115 urban and rural communities in 12 provinces across China between 2005 and 2009. We recorded their medical histories of cardiovascular diseases and calculated the INTERHEART Risk Score for the assessment of cardiovascular risk‐factor burden, with higher scores indicating greater burden. The mean INTERHEART Risk Score was higher in high‐ and middle‐income regions than in low‐income regions (9.47, 9.48, and 8.58, respectively, P<0.0001). By contrast, the prevalence of total cardiovascular disease (stroke, ischemic heart disease, and other heart diseases that led to hospitalization) was lower in high‐ and middle‐income regions than in low‐income regions (7.46%, 7.42%, and 8.36%, respectively, Ptrend=0.0064). In high‐ and middle‐income regions, urban communities have higher INTERHEART Risk Score and higher prevalent rate than rural communities. In low‐income regions, however, the prevalence of total cardiovascular disease was similar between urban and rural areas despite the significantly higher INTERHEART Risk Score for urban settings. Conclusions We detected an inverse trend between risk‐factor burden and cardiovascular disease prevalence in urban and rural communities in high‐, middle‐, and low‐income regions of China. Such asymmetry may be attributed to the interregional differences in residents’ awareness, quality of healthcare, and availability and affordability of medical services.
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Affiliation(s)
- Ruohua Yan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Yin
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Bo
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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23
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Backholer K, Peters SAE, Bots SH, Peeters A, Huxley RR, Woodward M. Sex differences in the relationship between socioeconomic status and cardiovascular disease: a systematic review and meta-analysis. J Epidemiol Community Health 2016; 71:550-557. [PMID: 27974445 DOI: 10.1136/jech-2016-207890] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 10/24/2016] [Accepted: 11/15/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Low socioeconomic status (SES) is a known risk factor for cardiovascular disease (CVD) but whether its effects are comparable in women and men is unknown. METHODS PubMed MEDLINE was systematically searched. Studies that reported sex-specific estimates, and associated variability, of the relative risk (RR) for coronary heart disease (CHD), stroke or CVD according to a marker of SES (education, occupation, income or area of residence), for women and men were included. RRs were combined with those derived from cohort studies using individual participant data. Data were pooled using random effects meta-analyses with inverse variance weighting. Estimates of the ratio of the RRs (RRR), comparing women with men, were computed. RESULTS Data from 116 cohorts, over 22 million individuals, and over 1 million CVD events, suggest that lower SES is associated with increased risk of CHD, stroke and CVD in women and men. For CHD, there was a significantly greater excess risk associated with lower educational attainment in women compared with men; comparing lowest with highest levels, the age-adjusted RRR was 1.24 (95% CI 1.09 to 1.41) and the multiple-adjusted RRR was 1.34 (1.09 to 1.63). For stroke, the age-adjusted RRR was 0.93 (0.72 to 1.18), and the multiple-adjusted was RRR 0.79 (0.53 to 1.19). Corresponding results for CVD were 1.18 (1.03 to 1.36), 1.23 (1.03 to 1.48), respectively. Similar results were observed for other markers of SES for all three outcomes. CONCLUSIONS Reduction of socioeconomic inequalities in CHD and CVD outcomes might require different approaches for men and women.
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Affiliation(s)
- Kathryn Backholer
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sanne A E Peters
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Sophie H Bots
- The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Anna Peeters
- School of Health and Social Development, Deakin University, Geelong, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rachel R Huxley
- School of Public Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, UK.,The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
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24
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Manne-Goehler J, Atun R, Stokes A, Goehler A, Houinato D, Houehanou C, Hambou MMS, Mbenza BL, Sobngwi E, Balde N, Mwangi JK, Gathecha G, Ngugi PW, Wesseh CS, Damasceno A, Lunet N, Bovet P, Labadarios D, Zuma K, Mayige M, Kagaruki G, Ramaiya K, Agoudavi K, Guwatudde D, Bahendeka SK, Mutungi G, Geldsetzer P, Levitt NS, Salomon JA, Yudkin JS, Vollmer S, Bärnighausen T. Diabetes diagnosis and care in sub-Saharan Africa: pooled analysis of individual data from 12 countries. Lancet Diabetes Endocrinol 2016; 4:903-912. [PMID: 27727123 DOI: 10.1016/s2213-8587(16)30181-4] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 07/01/2016] [Accepted: 07/04/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Despite widespread recognition that the burden of diabetes is rapidly growing in many countries in sub-Saharan Africa, nationally representative estimates of unmet need for diabetes diagnosis and care are in short supply for the region. We use national population-based survey data to quantify diabetes prevalence and met and unmet need for diabetes diagnosis and care in 12 countries in sub-Saharan Africa. We further estimate demographic and economic gradients of met need for diabetes diagnosis and care. METHODS We did a pooled analysis of individual-level data from nationally representative population-based surveys that met the following inclusion criteria: the data were collected during 2005-15; the data were made available at the individual level; a biomarker for diabetes was available in the dataset; and the dataset included information on use of core health services for diabetes diagnosis and care. We first quantified the population in need of diabetes diagnosis and care by estimating the prevalence of diabetes across the surveys; we also quantified the prevalence of overweight and obesity, as a major risk factor for diabetes and an indicator of need for diabetes screening. Second, we determined the level of met need for diabetes diagnosis, preventive counselling, and treatment in both the diabetic and the overweight and obese population. Finally, we did survey fixed-effects regressions to establish the demographic and economic gradients of met need for diabetes diagnosis, counselling, and treatment. FINDINGS We pooled data from 12 nationally representative population-based surveys in sub-Saharan Africa, representing 38 311 individuals with a biomarker measurement for diabetes. Across the surveys, the median prevalence of diabetes was 5% (range 2-14) and the median prevalence of overweight or obesity was 27% (range 16-68). We estimated seven measures of met need for diabetes-related care across the 12 surveys: (1) percentage of the overweight or obese population who received a blood glucose measurement (median 22% [IQR 11-37]); and percentage of the diabetic population who reported that they (2) had ever received a blood glucose measurement (median 36% [IQR 27-63]); (3) had ever been told that they had diabetes (median 27% [IQR 22-51]); (4) had ever been counselled to lose weight (median 15% [IQR 13-23]); (5) had ever been counselled to exercise (median 15% [IQR 11-30]); (6) were using oral diabetes drugs (median 25% [IQR 18-42]); and (7) were using insulin (median 11% [IQR 6-13]). Compared with those aged 15-39 years, the adjusted odds of met need for diabetes diagnosis (measures 1-3) were 2·22 to 3·53 (40-54 years) and 3·82 to 5·01 (≥55 years) times higher. The adjusted odds of met need for diabetes diagnosis also increased consistently with educational attainment and were between 3·07 and 4·56 higher for the group with 8 years or more of education than for the group with less than 1 year of education. Finally, need for diabetes care was significantly more likely to be met (measures 4-7) in the oldest age and highest educational groups. INTERPRETATION Diabetes has already reached high levels of prevalence in several countries in sub-Saharan Africa. Large proportions of need for diabetes diagnosis and care in the region remain unmet, but the patterns of unmet need vary widely across the countries in our sample. Novel health policies and programmes are urgently needed to increase awareness of diabetes and to expand coverage of preventive counselling, diagnosis, and linkage to diabetes care. Because the probability of met need for diabetes diagnosis and care consistently increases with age and educational attainment, policy makers should pay particular attention to improved access to diabetes services for young adults and people with low educational attainment. FUNDING None.
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Affiliation(s)
- Jennifer Manne-Goehler
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Rifat Atun
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Andrew Stokes
- Boston University Center for Global Health and Development, Boston, MA, USA
| | - Alexander Goehler
- Department of Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Dismand Houinato
- Faculty of Health Science, University of Abomey-Calavi, Cotonou, Benin
| | - Corine Houehanou
- Faculty of Health Science, University of Abomey-Calavi, Cotonou, Benin
| | | | - Benjamin Longo Mbenza
- Department of Family Medicine, Faculty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Eugène Sobngwi
- Hopital Central de Yaounde Faculte de Medecine et des Sciences Biomedicales et Centre de Biotechnologie, Yaoundé, Cameroon
| | - Naby Balde
- Department of Endocrinology and Diabetes, Donka University Hospital, Conakry, Guinea; NCD Department, Ministry of Health, Conakry, Guinea
| | | | - Gladwell Gathecha
- Division of Non-Communicable Diseases, Kenya Ministry of Health, Nairobi, Kenya
| | | | | | | | - Nuno Lunet
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine of the University of Porto and EpiUnit, Institute of Public Health of the University of Porto, Portugal
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne, Switzerland; Ministry of Health, Victoria, Seychelles
| | | | | | - Mary Mayige
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Gibson Kagaruki
- National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | | | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | - Gerald Mutungi
- Section on Non-Communicable Disease, Uganda Ministry of Health, Kampala, Uganda
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Naomi S Levitt
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Joshua A Salomon
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - John S Yudkin
- Division of Medicine, University College London, London, UK
| | - Sebastian Vollmer
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Economics, University of Göttingen, Göttingen, Germany
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Africa Health Research Institute, Somkhele, South Africa; Insitute of Public Health, Faculty of Medicine, Heidelberg University, Heidelberg, Germany
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25
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Healthcare Professional Shortage and Task-Shifting to Prevent Cardiovascular Disease: Implications for Low- and Middle-Income Countries. Curr Cardiol Rep 2016; 17:115. [PMID: 26482758 DOI: 10.1007/s11886-015-0672-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiovascular diseases (CVD) account for 18 million of annual global deaths with more than three quarters of these deaths occurring in low- and middle-income countries (LMIC). In LMIC, the distribution of risk factors is heterogeneous, with urban areas being the worst affected. Despite the availability of effective CVD interventions in developed countries, many poor countries still struggle to provide care due to lack of resources. In addition, many LMIC suffer from staff shortages which pose additional burden to the healthcare system. Regardless of these challenges, there are potentially effective strategies such as task-shifting which have been used for chronic conditions such as HIV to address the human resource crisis. We propose that through task-shifting, certain tasks related to prevention be shifted to non-physician health workers as well as non-nurse health workers such as community health workers. Such steps will allow better coverage of segments of the underserved population. We recognise that for task-shifting to be effective, issues such as clearly defined roles, evaluation, on-going training, and supervision must be addressed.
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26
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Stringhini S, Forrester TE, Plange-Rhule J, Lambert EV, Viswanathan B, Riesen W, Korte W, Levitt N, Tong L, Dugas LR, Shoham D, Durazo-Arvizu RA, Luke A, Bovet P. The social patterning of risk factors for noncommunicable diseases in five countries: evidence from the modeling the epidemiologic transition study (METS). BMC Public Health 2016; 16:956. [PMID: 27612934 PMCID: PMC5017030 DOI: 10.1186/s12889-016-3589-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 08/25/2016] [Indexed: 12/04/2022] Open
Abstract
Background Associations between socioeconomic status (SES) and risk factors for noncommunicable diseases (NCD-RFs) may differ in populations at different stages of the epidemiological transition. We assessed the social patterning of NCD-RFs in a study including populations with different levels of socioeconomic development. Methods Data on SES, smoking, physical activity, body mass index, blood pressure, cholesterol and glucose were available from the Modeling the Epidemiologic Transition Study (METS), with about 500 participants aged 25–45 in each of five sites (Ghana, South Africa, Jamaica, Seychelles, United States). Results The prevalence of NCD-RFs differed between these populations from five countries (e.g., lower prevalence of smoking, obesity and hypertension in rural Ghana) and by sex (e.g., higher prevalence of smoking and physical activity in men and of obesity in women in most populations). Smoking and physical activity were associated with low SES in most populations. The associations of SES with obesity, hypertension, cholesterol and elevated blood glucose differed by population, sex, and SES indicator. For example, the prevalence of elevated blood glucose tended to be associated with low education, but not with wealth, in Seychelles and USA. The association of SES with obesity and cholesterol was direct in some populations but inverse in others. Conclusions In conclusion, the distribution of NCD-RFs was socially patterned in these populations at different stages of the epidemiological transition, but associations between SES and NCD-RFs differed substantially according to risk factor, population, sex, and SES indicator. These findings emphasize the need to assess and integrate the social patterning of NCD-RFs in NCD prevention and control programs in LMICs.
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Affiliation(s)
- Silvia Stringhini
- University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.
| | - Terrence E Forrester
- Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica
| | | | - Estelle V Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Walter Riesen
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Wolfgang Korte
- Center for Laboratory Medicine, Canton Hospital, St. Gallen, Switzerland
| | - Naomi Levitt
- Chronic Disease Initiative in Africa, Department of Medicine, University of CapeTown, Cape Town, South Africa
| | - Liping Tong
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Lara R Dugas
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - David Shoham
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | - Amy Luke
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Pascal Bovet
- University Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Biopôle 2, Route de la Corniche 10, 1010, Lausanne, Switzerland.,Ministry of Health, Victoria, Republic of Seychelles
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27
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Su R, Cai L, Cui W, He J, You D, Golden A. Multilevel Analysis of Socioeconomic Determinants on Diabetes Prevalence, Awareness, Treatment and Self-Management in Ethnic Minorities of Yunnan Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13080751. [PMID: 27463725 PMCID: PMC4997437 DOI: 10.3390/ijerph13080751] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Revised: 07/14/2016] [Accepted: 07/19/2016] [Indexed: 01/19/2023]
Abstract
Objectives: The objective of this manuscript is to investigate socioeconomic differences in prevalence, awareness, treatment and self-management of diabetes among ethnic minority groups in Yunnan Province, China. Methods: We conducted a cross-sectional survey in a sample of 5532 Na Xi, Li Su, Dai and Jing Po ethnic minorities. Multilevel modeling was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for diabetes prevalence, as well as the other outcomes. Results: Higher individual educational level was associated with a higher rate of awareness, treatment, adherence to medicines and monitoring of blood glucose (OR = 1.87, 4.89, 4.83, 6.45; 95% CI: 1.26–2.77, 1.87–12.7, 1.95–11.9, 2.23–18.6, respectively). Diabetic respondents with better household assets tended to receive more treatment (OR = 2.81, 95% CI: 1.11–7.12) and to monitor their blood glucose (OR = 3.29, 95% CI: 1.48–7.30). Diabetic patients with better access to medical services were more likely to treat (OR = 7.09, 95% CI: 2.46–20.4) and adhere to medication (OR = 4.14, 95% CI: 1.46–11.7). Income at the contextual level was significantly correlated with diabetes prevalence, treatment and blood glucose monitoring (OR = 1.84, 3.04, 4.34; 95% CI: 1.20–2.83, 1.20–7.73, 1.45–13.0, respectively). Conclusions: Future diabetes prevention and intervention programs should take both individual and township-level socioeconomic factors into account in the study regions.
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Affiliation(s)
- Rong Su
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
- Department of Gerontology, The Affiliated Ganmei Hospital of Kunming Medical University, 504 Qing Nian Road, Kunming 650011, China.
| | - Le Cai
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
| | - Wenlong Cui
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
| | - Jianhui He
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
| | - Dingyun You
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
| | - Allison Golden
- School of Public Health, Kunming Medical University, 1168 Yu Hua Street, Chun Rong Road, Cheng Gong New City, Kunming 650500, China.
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28
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Mayén AL, Bovet P, Marti-Soler H, Viswanathan B, Gedeon J, Paccaud F, Marques-Vidal P, Stringhini S. Socioeconomic Differences in Dietary Patterns in an East African Country: Evidence from the Republic of Seychelles. PLoS One 2016; 11:e0155617. [PMID: 27214139 PMCID: PMC4877066 DOI: 10.1371/journal.pone.0155617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 05/02/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND In high income countries, low socioeconomic status (SES) is related to unhealthier dietary patterns, while evidence on the social patterning of diet in low and middle income countries is scarce. OBJECTIVE In this study, we assess dietary patterns in the general population of a middle income country in the African region, the Republic of Seychelles, and examine their distribution according to educational level and income. METHODS Data was drawn from two independent national surveys conducted in the Seychelles among adults aged 25-64 years in 2004 (n = 1236) and 2013 (n = 1240). Dietary patterns were assessed by principal component analysis (PCA). Educational level and income were used as SES indicators. Data from both surveys were combined as no interaction was found between SES and year. RESULTS Three dietary patterns were identified: "snacks and drinks", "fruit and vegetables" and "fish and rice". No significant associations were found between SES and the "snacks and drinks" pattern. Low vs. high SES individuals had lower adherence to the "fruit and vegetables" pattern [prevalence ratio (95% CI) 0.71 (0.60-0.83)] but a higher adherence to the traditional "fish and rice" pattern [1.58 (1.32-1.88)]. Income modified the association between education and the "fish and rice" pattern (p = 0.02), whereby low income individuals had a higher adherence to this pattern in both educational groups. CONCLUSION Low SES individuals have a lower consumption of fruit and vegetables, but a higher consumption of traditional foods like fish and rice. The Seychelles may be at a degenerative diseases stage of the nutrition transition.
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Affiliation(s)
- Ana-Lucia Mayén
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
| | - Helena Marti-Soler
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | | | - Jude Gedeon
- Ministry of Health, Victoria, Republic of Seychelles
| | - Fred Paccaud
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Silvia Stringhini
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland
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29
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Yepes M, Maurer J, Stringhini S, Viswanathan B, Gedeon J, Bovet P. Ideal Body Size as a Mediator for the Gender-Specific Association Between Socioeconomic Status and Body Mass Index. HEALTH EDUCATION & BEHAVIOR 2016; 43:56S-63S. [DOI: 10.1177/1090198116630527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. While obesity continues to rise globally, the associations between body size, gender, and socioeconomic status (SES) seem to vary in different populations, and little is known on the contribution of perceived ideal body size in the social disparity of obesity in African countries. Purpose. We examined the gender and socioeconomic patterns of body mass index (BMI) and perceived ideal body size in the Seychelles, a middle-income small island state in the African region. We also assessed the potential role of perceived ideal body size as a mediator for the gender-specific association between SES and BMI. Method. A population-based survey of 1,240 adults aged 25 to 64 years conducted in December 2013. Participants’ BMI was calculated based on measured weight and height; ideal body size was assessed using a nine-silhouette instrument. Three SES indicators were considered: income, education, and occupation. Results. BMI and perceived ideal body size were both higher among men of higher versus lower SES ( p < .001) but lower among women of higher versus lower SES ( p < .001), irrespective of the SES indicator used. Multivariate analysis showed a strong and direct association between perceived ideal body size and BMI in both men and women ( p < .001) and was consistent with a potential mediating role of perceived ideal body size in the gender-specific associations between SES and BMI. Conclusion. Our study emphasizes the importance of gender and socioeconomic differences in BMI and ideal body size and suggests that public health interventions that promote perception of healthy weight could help mitigate SES-related disparities in BMI.
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Affiliation(s)
- Maryam Yepes
- Lausanne University Hospital, Lausanne, Switzerland
- University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Jude Gedeon
- NCD Section, Ministry of Health, Victoria, Republic of Seychelles
| | - Pascal Bovet
- Lausanne University Hospital, Lausanne, Switzerland
- NCD Section, Ministry of Health, Victoria, Republic of Seychelles
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30
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Atiase Y, Farni K, Plange-Rhule J, Luke A, Bovet P, Forrester TG, Lambert V, Levitt NS, Kliethermes S, Cao G, Durazo-Arvizu RA, Cooper RS, Dugas LR. A comparison of indices of glucose metabolism in five black populations: data from modeling the epidemiologic transition study (METS). BMC Public Health 2015; 15:895. [PMID: 26374293 PMCID: PMC4572672 DOI: 10.1186/s12889-015-2233-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 09/04/2015] [Indexed: 12/25/2022] Open
Abstract
Background Globally, Africans and African Americans experience a disproportionate burden of type 2 diabetes, compared to other race and ethnic groups. The aim of the study was to examine the association of plasma glucose with indices of glucose metabolism in young adults of African origin from 5 different countries. Methods We identified participants from the Modeling the Epidemiologic Transition Study, an international study of weight change and cardiovascular disease (CVD) risk in five populations of African origin: USA (US), Jamaica, Ghana, South Africa, and Seychelles. For the current study, we included 667 participants (34.8 ± 6.3 years), with measures of plasma glucose, insulin, leptin, and adiponectin, as well as moderate and vigorous physical activity (MVPA, minutes/day [min/day]), daily sedentary time (min/day), anthropometrics, and body composition. Results Among the 282 men, body mass index (BMI) ranged from 22.1 to 29.6 kg/m2 in men and from 25.8 to 34.8 kg/m2 in 385 women. MVPA ranged from 26.2 to 47.1 min/day in men, and from 14.3 to 27.3 min/day in women and correlated with adiposity (BMI, waist size, and % body fat) only among US males after controlling for age. Plasma glucose ranged from 4.6 ± 0.8 mmol/L in the South African men to 5.8 mmol/L US men, while the overall prevalence for diabetes was very low, except in the US men and women (6.7 and 12 %, respectively). Using multivariate linear regression, glucose was associated with BMI, age, sex, smoking hypertension, daily sedentary time but not daily MVPA. Conclusion Obesity, metabolic risk, and other potential determinants vary significantly between populations at differing stages of the epidemiologic transition, requiring tailored public health policies to address local population characteristics.
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Affiliation(s)
| | - Kathryn Farni
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | | | - Amy Luke
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Pascal Bovet
- Institute of Social & Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland. .,Switzerland & Ministry of Health, Victoria, Republic of Seychelles.
| | - Terrence G Forrester
- Solutions for Developing Countries (SODECO), University of the West Indies, Mona, Kingston, Jamaica.
| | - Vicki Lambert
- Research Unit for Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa.
| | - Naomi S Levitt
- Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Stephanie Kliethermes
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Guichan Cao
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Ramon A Durazo-Arvizu
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Richard S Cooper
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.
| | - Lara R Dugas
- Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA. .,Public Health Sciences, 2160 S. 1st Ave, Maywood, IL, 60153, USA.
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Xu G, Liu J, Liu S, Zhou H, Orekoya O, Liu J, Li Y, Tang J, Zhou C, Huang J. The Expanding Burden of Elevated Blood Pressure in China: Evidence From Jiangxi Province, 2007-2010. Medicine (Baltimore) 2015; 94:e1623. [PMID: 26426647 PMCID: PMC4616863 DOI: 10.1097/md.0000000000001623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 08/24/2015] [Accepted: 08/26/2015] [Indexed: 01/19/2023] Open
Abstract
Elevated blood pressure (BP) as a risk factor accounts for the biggest burden of disease worldwide and in China. This study aimed to estimate attributed mortality and life expectancy (LE) to elevated BP in Jiangxi province between 2007 and 2010. BP and mortality data (2007 and 2010 inclusive) were obtained from the National Chronic Diseases and Risk Factors Surveillance Survey and Disease Surveillance Points system, respectively. Population-attributable fraction used in comparative risk assessment of the Global Burden of Disease study 2010 were followed to quantify the attributed mortality to elevated BP, subsequently life table methods were applied to estimate its effects on LE. Uncertainty analysis was conducted to get 95% uncertainty intervals (95% uncertainty interval [UI]) for each outcome. There are 35,482 (95% UI: 31,389-39,928) and 47,842 (42,323-53,837) deaths in Jiangxi province were caused by elevated BP in 2007 and 2010, respectively. 2.24 (1.87-2.65) years of LE would be gained if all the attributed deaths were eliminated in 2007, and increased to 3.04 (2.52-3.48) in 2010. If the mean value of elevated BP in 2010 was decreased by 5 and 10 mm Hg, 5324 (4710-5991) and 11,422 (10,104-12,853) deaths would be avoided, with 0.41 (0.37-0.48) and 0.85 (0.71-1.09) years of LE gained, respectively. The deaths attributable to elevated BP in Jiangxi province has increased by 35% from 2007 to 2010, with 0.8 years of LE loss, suggesting the necessity to take actions to control BP in Chinese population.
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Affiliation(s)
- Gang Xu
- From the Department of Preventive Medicine, School of Basic Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China (GX, JH); Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA (JL, OO); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China (SL, YL); Department of Statistics, University of South Carolina, Columbia, South Carolina, USA (HZ); Division of Chronic Disease Control and Prevention, Jiangxi Province Center for Disease Control and Prevention, Nanchang, Jiangxi, China (JL); Chinese Preventive Medicine Association, Beijing, China (JT); and Department of Nosocomial Infectious Prevention and Control, Beijing Friendship Hospital, Capital Medical University, Beijing, China (CZ)
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Yeates K, Lohfeld L, Sleeth J, Morales F, Rajkotia Y, Ogedegbe O. A Global Perspective on Cardiovascular Disease in Vulnerable Populations. Can J Cardiol 2015; 31:1081-93. [PMID: 26321432 DOI: 10.1016/j.cjca.2015.06.035] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/29/2015] [Accepted: 06/29/2015] [Indexed: 12/24/2022] Open
Abstract
Cardiovascular disease (CVD) is a major contributor to the growing public health epidemic in chronic diseases. Much of the disease and disability burden from CVDs are in people younger than the age of 70 years in low- and middle-income countries, formerly "the developing world." The risk of CVD is heavily influenced by environmental conditions and lifestyle variables. In this article we review the scope of the CVD problem in low- and middle-income countries, including economic factors, risk factors, at-risk groups, and explanatory frameworks that hypothesize the multifactorial drivers. Finally, we discuss current and potential interventions to reduce the burden of CVD in vulnerable populations including research needed to evaluate and implement promising solutions for those most at risk.
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Affiliation(s)
- Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - Lynne Lohfeld
- McMaster University, Department of Clinical Epidemiology and Biostatistics, Hamilton, Ontario, Canada
| | - Jessica Sleeth
- Office of Global Health, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Fernando Morales
- ICAP at Columbia University, Mailman School of Public Health, New York, New York
| | | | - Olugbenga Ogedegbe
- Division of Health an Behavior, Center for Healthful Behavior Change, College of Global Public Health, Center for Healthful Behavior Change, New York University, Langone Medical Center, New York, New York
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Yusuf S, Rangarajan S, Teo K, Islam S, Li W, Liu L, Bo J, Lou Q, Lu F, Liu T, Yu L, Zhang S, Mony P, Swaminathan S, Mohan V, Gupta R, Kumar R, Vijayakumar K, Lear S, Anand S, Wielgosz A, Diaz R, Avezum A, Lopez-Jaramillo P, Lanas F, Yusoff K, Ismail N, Iqbal R, Rahman O, Rosengren A, Yusufali A, Kelishadi R, Kruger A, Puoane T, Szuba A, Chifamba J, Oguz A, McQueen M, McKee M, Dagenais G. Cardiovascular risk and events in 17 low-, middle-, and high-income countries. N Engl J Med 2014; 371:818-27. [PMID: 25162888 DOI: 10.1056/nejmoa1311890] [Citation(s) in RCA: 592] [Impact Index Per Article: 59.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND More than 80% of deaths from cardiovascular disease are estimated to occur in low-income and middle-income countries, but the reasons are unknown. METHODS We enrolled 156,424 persons from 628 urban and rural communities in 17 countries (3 high-income, 10 middle-income, and 4 low-income countries) and assessed their cardiovascular risk using the INTERHEART Risk Score, a validated score for quantifying risk-factor burden without the use of laboratory testing (with higher scores indicating greater risk-factor burden). Participants were followed for incident cardiovascular disease and death for a mean of 4.1 years. RESULTS The mean INTERHEART Risk Score was highest in high-income countries, intermediate in middle-income countries, and lowest in low-income countries (P<0.001). However, the rates of major cardiovascular events (death from cardiovascular causes, myocardial infarction, stroke, or heart failure) were lower in high-income countries than in middle- and low-income countries (3.99 events per 1000 person-years vs. 5.38 and 6.43 events per 1000 person-years, respectively; P<0.001). Case fatality rates were also lowest in high-income countries (6.5%, 15.9%, and 17.3% in high-, middle-, and low-income countries, respectively; P=0.01). Urban communities had a higher risk-factor burden than rural communities but lower rates of cardiovascular events (4.83 vs. 6.25 events per 1000 person-years, P<0.001) and case fatality rates (13.52% vs. 17.25%, P<0.001). The use of preventive medications and revascularization procedures was significantly more common in high-income countries than in middle- or low-income countries (P<0.001). CONCLUSIONS Although the risk-factor burden was lowest in low-income countries, the rates of major cardiovascular disease and death were substantially higher in low-income countries than in high-income countries. The high burden of risk factors in high-income countries may have been mitigated by better control of risk factors and more frequent use of proven pharmacologic therapies and revascularization. (Funded by the Population Health Research Institute and others.).
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Affiliation(s)
- Salim Yusuf
- From the Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON (S.Y., S.R., K.T., S.I., S.A., M. McQueen), Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC (S.L.), the Department of Medicine, University of Ottawa, Ottawa, ON (A.W.), and Laval University Heart and Lungs Institute, Quebec City, QC (G.D.) - all in Canada; the National Center for Cardiovascular Diseases, Cardiovascular Institute and Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing (W.L., L.L., J.B.), Jiangsu Province Institute of Geriatrics, Jiangsu Province, Nanjing City (Q.L.), Shandong Province Academy of Medical Science, Shandong Province, Jinan City (F. Lu), Xi'an Electronic Technology University Hospital, Shanxi Province, Xi'an City (T.L.), Shenyang City 242 Hospital, Liaoning Province, Shenyang City, Huanggu District (L.Y.), Bayannaoer Center for Disease Control and Prevention, Inner Mongolia, Bayannaoer City, Linhe District, Jiefangxi (S.Z.) - all in China; the Division of Epidemiology and Population Health, St. John's Research Institute, Bangalore (P.M., S.S.), Madras Diabetes Research Foundation, Chennai (V.M.), Fortis Escorts Hospitals, JLN Marg, Jaipur (R.G.), Postgraduate Institute of Medical Education and Research School of Public Health, Chandigarh (R. Kumar), and Health Action by People, Trivandrum, Kerala (K.V.) - all in India; Estudios Clinicos Latinoamerica ECLA, Rosario, Santa Fe, Argentina (R.D.); Dante Pazzanese Institute of Cardiology, São Paulo (A.A.); Fundacion Oftalmologica de Santander (FOSCAL), Medical School, Universidad de Santander, Floridablanca-Santander, Colombia (P.L.-J.); Universidad de La Frontera, Temuco, Chile (F. Lanas); Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, and UCSI University Kuala Lumpur, Kuala Lumpur (K.Y.), and the Department of Community Health, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur (N.I.) - all in Malay
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Stringhini S, Rousson V, Viswanathan B, Gedeon J, Paccaud F, Bovet P. Association of socioeconomic status with overall and cause specific mortality in the Republic of Seychelles: results from a cohort study in the African region. PLoS One 2014; 9:e102858. [PMID: 25057938 PMCID: PMC4109956 DOI: 10.1371/journal.pone.0102858] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 06/24/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Low socioeconomic status (SES) is consistently associated with higher mortality in high income countries. Only few studies have assessed this association in low and middle income countries, mainly because of sparse reliable mortality data. This study explores SES differences in overall and cause-specific mortality in the Seychelles, a rapidly developing small island state in the African region. METHODS All deaths have been medically certified over more than two decades. SES and other lifestyle-related risk factors were assessed in a total of 3246 participants from three independent population-based surveys conducted in 1989, 1994 and 2004. Vital status was ascertained using linkage with vital statistics. Occupational position was the indicator of SES used in this study and was assessed with the same questions in the three surveys. RESULTS During a mean follow-up of 15.0 years (range 0-23 years), 523 participants died (overall mortality rate 10.8 per 1000 person-years). The main causes of death were cardiovascular disease (CVD) (219 deaths) and cancer (142 deaths). Participants in the low SES group had a higher mortality risk for overall (HR = 1.80; 95% CI: 1.24-2.62), CVD (HR = 1.95; 1.04-3.65) and non-cancer/non-CVD (HR = 2.14; 1.10-4.16) mortality compared to participants in the high SES group. Cancer mortality also tended to be patterned by SES (HR = 1.44; 0.76-2.75). Major lifestyle-related risk factors (smoking, heavy drinking, obesity, diabetes, hypertension, hypercholesterolemia) explained a small proportion of the associations between low SES and all-cause, CVD, and non-cancer/non-CVD mortality. CONCLUSIONS In this population-based study assessing social inequalities in mortality in a country of the African region, low SES (as measured by occupational position) was strongly associated with overall, CVD and non-cancer/non-CVD mortality. Our findings support the view that the burden of non-communicable diseases may disproportionally affect people with low SES in low and middle income countries.
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Affiliation(s)
- Silvia Stringhini
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Valentin Rousson
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Jude Gedeon
- Ministry of Health, Victoria, Republic of Seychelles
| | - Fred Paccaud
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Pascal Bovet
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Ministry of Health, Victoria, Republic of Seychelles
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Wang A, Stronks K, Arah OA. Global educational disparities in the associations between body mass index and diabetes mellitus in 49 low-income and middle-income countries. J Epidemiol Community Health 2014; 68:705-11. [PMID: 24683177 DOI: 10.1136/jech-2013-203200] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite the well-established link between body mass index (BMI) and diabetes mellitus (DM), it remains unclear whether this association is more pronounced at certain levels of education. This study assessed the modifying effect of educational attainment on the associations between BMI and DM-as well as the joint associations of BMI and education with DM-in low-income countries (LICs) and middle-income countries (MICs). METHODS The authors used cross-sectional data from 160 381 participants among 49 LICs and MICs in the World Health Survey. Overweight and obesity levels were defined using WHO's classification. Educational attainment was classified in four categories: 'no formal education', 'some/completed primary school', 'secondary/high school completed' and 'college and beyond'. We used random-intercept multilevel logistic regressions to investigate the modifying influence of educational attainment on the associations of different BMI levels-as well as their joint associations-with DM. RESULTS We found positive associations between excessive BMI and DM at each education level in both LICs and MICs. We found that the joint associations of BMI and education with DM were larger than the product of their separate single associations among females in LICs. With joint increases in BMI and education, males and females in LICs had similar increased odds of DM, but males had higher such odds than females in MICs. CONCLUSIONS BMI and education are associated with the DM, but the associations seem to differ in complex ways between LICs and MICs and by gender.
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Affiliation(s)
- Aolin Wang
- Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Karien Stronks
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Onyebuchi A Arah
- Department of Epidemiology, The Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands UCLA Center for Health Policy Research, Los Angeles, California, USA
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Wang JY, Wang CY, Juang SY, Huang KY, Chou P, Chen CW, Lee CC. Low socioeconomic status increases short-term mortality of acute myocardial infarction despite universal health coverage. Int J Cardiol 2014; 172:82-7. [PMID: 24444479 DOI: 10.1016/j.ijcard.2013.12.082] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/16/2013] [Accepted: 12/20/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND This nationwide population-based study investigated the relationship between individual and neighborhood socioeconomic status (SES) and mortality rates for acute myocardial infarction (AMI) in Taiwan. METHODS A population-based follow-up study included 23,568 patients diagnosed with AMI from 2004 to 2008. Each patient was monitored for 2 years, or until their death, whichever came first. The individual income-related insurance payment amount was used as a proxy measure of patient's individual SES. Neighborhood SES was defined by household income, and neighborhoods were grouped as advantaged or disadvantaged. The Cox proportional hazards model was used to compare the mortality rates between the different SES groups after adjusting for possible confounding risk factors. RESULTS After adjusting for potential confounding factors, AMI patients with low individual SES had an increased risk of death than those with high individual SES who resided in advantaged neighborhoods. In contrast, the cumulative readmission rate from major adverse cardiovascular events did not differ significantly between the different individual and neighborhood SES groups. AMI patients with low individual SES had a lower rate of diagnostic angiography and subsequent percutaneous coronary intervention (P<0.001). The presence of congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, pneumonia, septicemia, and shock revealed an incremental increase with worse SES (P<0.001). CONCLUSIONS The findings indicate that AMI patients with low individual SES have the greatest risk of short-term mortality despite being under a universal health-care system. Public health strategies and welfare policies must continue to focus on this vulnerable group.
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Affiliation(s)
- Jen-Yu Wang
- Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Shiun-Yang Juang
- Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Kuang-Yung Huang
- School of Medicine, Tzu Chi University, Hualian, Taiwan; Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Pesus Chou
- Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Wei Chen
- School of Medicine, Tzu Chi University, Hualian, Taiwan; Division of Cardiology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
| | - Ching-Chih Lee
- School of Medicine, Tzu Chi University, Hualian, Taiwan; Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Department of Education, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Center for Clinical Epidemiology and Biostatistics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
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Cooper RS, Bovet P. Measures of health and disease in Africa: are current methods giving us useful information about trends in cardiovascular diseases? Prog Cardiovasc Dis 2013; 56:270-7. [PMID: 24267434 DOI: 10.1016/j.pcad.2013.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An enormous burst of interest in the public health burden from chronic disease in Africa has emerged as a consequence of efforts to estimate global population health. Detailed estimates are now published for Africa as a whole and each country on the continent. These data have formed the basis for warnings about sharp increases in cardiovascular disease (CVD) in the coming decades. In this essay we briefly examine the trajectory of social development on the continent and its consequences for the epidemiology of CVD and potential control strategies. Since full vital registration has only been implemented in segments of South Africa and the island nations of Seychelles and Mauritius - formally part of WHO-AFRO - mortality data are extremely limited. Numerous sample surveys have been conducted but they often lack standardization or objective measures of health status. Trend data are even less informative. However, using the best quality data available, age-standardized trends in CVD are downward, and in the case of stroke, sharply so. While acknowledging that the extremely limited available data cannot be used as the basis for inference to the continent, we raise the concern that general estimates based on imputation to fill in the missing mortality tables may be even more misleading. No immediate remedies to this problem can be identified, however bilateral collaborative efforts to strength local educational institutions and governmental agencies rank as the highest priority for near term development.
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Affiliation(s)
- Richard S Cooper
- Department of Public Health Sciences, Loyola University Stritch School of Medicine, Maywood, IL.
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