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Wang L, Zhang H, Yao H, Gong C, Zhong J, Liu D, Liang Z. Social determinants of health and hypertension in women compared with men in the United States: An analysis of the NHANES study. Clin Cardiol 2023; 46:958-966. [PMID: 37430468 PMCID: PMC10436798 DOI: 10.1002/clc.24079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/14/2023] [Accepted: 06/20/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Social determinants of health (SDH) reflecting social deprivation have been developed for population health management. There is a paucity of data on the prevalence of SDH and its associations with prevalent hypertension in women compared with men. METHODS A total of 49 791 participants aged over 20 years from the 1999-2018 National Health and Nutrition Examination Surveys, were included. Information on the SDH, including race/ethnicity, education level, family income, housing, marriage status, employment, were collected. We calculated the prevalence ratio (PR) for each adverse SDH with prevalent hypertension and uncontrolled hypertension by using Cox regression with equal times of follow-up assigned to all individuals with adjustment for age, diabetes, taking lipid-lowering medication, and health behaviors. The population-attributable fractions (PAF) of the SDH were also assessed. RESULTS A lower proportion of low education attainment was observed in women than men (women: 16.8% vs. men: 17.9%, p = .003), but women had higher proportions of low family income (15.3% vs. 12.5%, p < .001), unmarried state (47.3% vs. 40.9%, p < .001), and unemployment (22.7% vs. 10.7%, p < .001). All the SDH was significantly associated with hypertension in women. There were significant dose-response associations between the numbers of adverse SDH with hypertension. The total PAF of SDH for prevalent hypertension was greater in women (22.2%) than in men (13.9%). CONCLUSIONS The widely influential SDH is associated with prevalent hypertension and uncontrolled hypertension. To improve hypertension management, health resources should prioritize socioeconomically disadvantaged groups considering gender differences.
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Affiliation(s)
- Li Wang
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Hao Zhang
- Department of Clinical MedicineNorth China University of Science and TechnologyTangshanChina
| | - Hong Yao
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Chunlin Gong
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Jiaoyue Zhong
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Dongxue Liu
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Zhaoguang Liang
- Department of CardiologyThe First Affiliated Hospital of Harbin Medical UniversityHarbinChina
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Alizadeh G, Gholipour K, Azami-Aghdash S, Dehnavieh R, JafarAbadi MA, Azmin M, Khodayari-Zarnaq R. Social, Economic, Technological, and Environmental Factors Affecting Cardiovascular Diseases: A Systematic Review and Thematic Analysis. Int J Prev Med 2022; 13:78. [PMID: 35706860 PMCID: PMC9188896 DOI: 10.4103/ijpvm.ijpvm_105_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/27/2020] [Indexed: 11/04/2022] Open
Abstract
Background Today, cardiovascular disease (CVD) is the leading cause of mortality in both sexes. There are several risk factors for heart diseases; some controllable, others not. However, socioeconomic, technological, and environmental factors can impact CVD as well as exclusive risk factors. Accurate identification and assessment of these factors are often difficult. In the present systematic review, we aimed to explore factors affecting CVD. Methods Multiple databases (MEDLINE, Scopus, ISI Web of Science, and Cochrane) and gray literature were searched. The included studies described at least one determinant of CVD. The framework method was applied to analyze the qualitative data. Results A total of 64 studies from 26 countries were included. The contextual determinants of CVD were categorized into 45 determinants, 15 factors, and 4 main social, economic, technological, and environmental categories. The 15 potentially reversible factors were identified as sociodemographic, violence, smoking, occupation, positive childhood experience, social inequalities, psychological distress, eating habits, neighborhood, family income, rapid technology, environmental pollution, living environments, noise, and disaster. Conclusions Devolution and more efficient health policies are required to achieve further sustained reduction in CVD mortality, increase life expectancy, and reduce its associated risk factors. Policymakers should fully address the value of social, economic, technological, and environmental factors. In fact, a prevention agenda should be developed and updated collaboratively in terms of the determinant factors.
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Affiliation(s)
- Gisoo Alizadeh
- Department of Health policy and Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Tabriz Health Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Dehnavieh
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Asghari JafarAbadi
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrdad Azmin
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Rahim Khodayari-Zarnaq
- Department of Health policy and Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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Eggink E, Hafdi M, Hoevenaar-Blom MP, Richard E, Moll van Charante EP. Attitudes and views on healthy lifestyle interventions for the prevention of dementia and cardiovascular disease among older people with low socioeconomic status: a qualitative study in the Netherlands. BMJ Open 2022; 12:e055984. [PMID: 35228289 PMCID: PMC8886413 DOI: 10.1136/bmjopen-2021-055984] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Individuals with a low socioeconomic status (SES) have an increased risk of cardiovascular disease (CVD) and dementia, partly due to the high prevalence of unhealthy behaviours in this population. Interventions targeting lifestyle-related risk factors can potentially delay or prevent CVD and dementia onset. In this study, we explore the attitudes, experiences and views of low SES older adults on healthy lifestyles for the prevention of CVD and dementia. We also aim to study the potential role for coach-supported mobile health (mHealth) use, facilitating the development of the Prevention of Dementia using Mobile Phone Applications intervention. DESIGN We performed semi-structured interviews and used thematic analysis to analyse the data. SETTING Recruitment through multiple general practices in the Netherlands. PARTICIPANTS Dutch non-demented adults aged ≥55, at increased risk of dementia, who possess a smartphone. Participants were purposively sampled on age, sex and history of CVD and diabetes. RESULTS Between May 2018 and June 2019, we performed 19 interviews. Five main themes were: (1) participants perceived little influence on their future health, (2) the sacrifices of healthy lifestyles outweighed the potential benefits, (3) physical complaints or disease could prompt behaviour change, (4) participants perceived they had limited self-efficacy to change their behaviour and (5) the social network had an important role in behaviour change. Needs regarding mHealth support were an easy-to-use smartphone application with trustworthy health information, which is provided in a non-obligatory way. CONCLUSIONS Low SES older adults may benefit from lifestyle interventions that aim to improve self-efficacy levels by (remote) human support. Appropriateness and attractiveness of such interventions may increase when taking into account the participant's own autonomy, and when emphasising the direct gains of lifestyle changes for daily life. Moreover, involving the social network may be a valuable approach when developing lifestyle interventions for low SES older adults. TRIAL REGISTRATION NUMBER PRODEMOS trial, ISRCTN15986016; Pre-results.
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Affiliation(s)
- Esmé Eggink
- Department of General Practice, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Melanie Hafdi
- Department of Neurology, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Marieke P Hoevenaar-Blom
- Department of Public and Occupational Health, Amsterdam UMC locatie AMC, Amsterdam, The Netherlands
| | - Edo Richard
- Department of Public and Occupational Health, Amsterdam UMC locatie AMC, Amsterdam, The Netherlands
- Department of Neurology, Radboud University Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Department of Public and Occupational Health, Amsterdam UMC locatie AMC, Amsterdam, The Netherlands
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Chen L, Tan Y, Yu C, Guo Y, Pei P, Yang L, Chen Y, Du H, Wang X, Chen J, Chen Z, Lv J, Li L. Educational disparities in ischaemic heart disease among 0.5 million Chinese adults: a cohort study. J Epidemiol Community Health 2021; 75:1033-1043. [PMID: 33782052 PMCID: PMC8515104 DOI: 10.1136/jech-2020-216314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/25/2021] [Accepted: 03/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The relationship between educational attainment and ischaemic heart disease (IHD) is limited in evidence in middle-income countries like China. Exploring lifestyle-related mediators, which might be not universal between socioeconomic status and health outcomes in diverse regions, can contribute to interventions targeted at the Chinese to narrow the educational gap in IHD. METHODS Based on the China Kadoorie Biobank of 489 594 participants aged 30-79 years who did not have heart disease or stroke at baseline, this study examined the association of educational attainment with IHD. Total IHD cases were further divided into acute myocardial infarction (AMI) cases and non-AMI cases. The Cox proportional hazard model was performed to estimate the HRs and 95% CIs for mortality and incidence of IHD. Logistic regression was used to estimate the ORs and 95% CIs for case fatality. RESULTS During the median follow-up period of 11.1 years, this study documented 45 946 (6668) incident IHD (AMI) cases and 5948 (3689) deaths altogether. Lower educational attainment was associated with increased risk of incident AMI as well as death and fatality of total IHD including its subtypes (ptrend <0.001). Although the risk of incident non-AMI was greater for participants with higher levels of education in the whole population (ptrend <0.001), an inverse association of education with its incidence was found in participants from <50 years age group and rural areas. Smoking and dietary habits were the two most potent mediating factors in the associations of education with mortality and AMI incidence; whereas, physical activity was the major mediating factor for non-AMI incidence in the whole population. DISCUSSION Interventions targeting unhealthy lifestyles are ideal ways to narrow the educational gap in IHD while solving 'upstream' causes of health behaviours might be the most fundamental ones.
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Affiliation(s)
- Lu Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Yunlong Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
| | - Yu Guo
- Chinese Academy of Medical Sciences, Beijing, China
| | - Pei Pei
- Chinese Academy of Medical Sciences, Beijing, China
| | - Ling Yang
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yiping Chen
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Huaidong Du
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Xiaohuan Wang
- Hainan Center for Disease Control and Prevention, Haikou, China
| | - Junshi Chen
- China National Center for Food Safety Risk Assessment, Beijing, China
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jun Lv
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Liming Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, China
- Center for Public Health and Epidemic Preparedness & Response, Peking University, Beijing, China
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VERCELLI MARINA, LILLINI ROBERTO. Application of Socio-Economic and Health Deprivation Indices to study the relationships between socio-economic status and disease onset and outcome in a metropolitan area subjected to aging, demographic fall and socio-economic crisis. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E718-E727. [PMID: 34909500 PMCID: PMC8639118 DOI: 10.15167/2421-4248/jpmh2021.62.3.1890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 05/27/2021] [Indexed: 12/27/2022]
Abstract
Aims Genoa is a city affected by a deep economic, demographic and social involution. The association between disease onset and outcome and socioeconomic status (SES) was assessed in the mortality by cause in two periods, using indices referred to the distribution of deprivation in the population defined in a ten-years span (2001 to 2011). Material and Methods Two Socio-Economic and Health Deprivation Indices (SEHDIs), computed at census tract level (2001 and 2011 Censuses), were applied to analyse the SMRs by cause, age (0-64 and 65+ years) and gender of the five normalised groups of deprivation individuated in the two population distribution. The associations between SES and onset of disease was described in the mortality 2008-11 using the index referred to 2001 population. The second index, referred to 2011 population, described the associations between SES and disease outcomes in the mortality 2009-13. Two ANOVAs evaluated the statistical significance (p < 0.05) of differences in death distribution among groups. Results The population at medium-high deprivation increased in Genoa between 2001 and 2011. The mortality by age and gender showed different trends. Not significant trends (NS) in both periods regarded only the younger (respiratory diseases in both sexes, prostate cancer, diabetes in women). Linearly positives (L↑) trends in both periods were observed only in men (all cancers and lung cancers, overall mortality and cardiovascular diseases in younger, diabetes in older). Not linear trends (NL) in both periods interested both sexes for flu and pneumonia, women for lung cancer, old women for overall mortality and respiratory diseases, old men for colorectal cancers. Instead, L↑ trends in the final phases of disease interest all cancers in the elderly (NS trend at the disease onset), all cancers and breast cancer in young women, diabetes and colorectal cancers in young men (NL trends at the disease onset). On the contrary, L↑ trends at the disease onset and NL trends in the final phases regarded cardiovascular diseases in elderly, overall mortality, respiratory diseases and prostate cancer in old men, diabetes and colorectal cancers in old women. Finally, NL trends at the disease onset regarded colorectal cancers in young women (NS trend in the final phases) and breast cancer in the older (linearly negative trend, L↓, in the final phases). Discussion Deprivation trends confirmed the literature about populations shifting towards poverty. Aging-linked social risks were revealed, reflecting the weakening of social-health care, which worsened in elderly if alone. Serious problems in younger singles or in the single-parent families arose. Cardiovascular diseases, all cancers and colorectal cancers trends confirmed the advantage of less deprived when diseases are preventable and curable. Prostate and breast cancers trends reflected the rising incidence and increasing problems in care. The need of corrective interventions in social and health policies was emerging, aimed to support in a targeted way a population in an alarming condition of socio-economic deterioration.
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Affiliation(s)
- MARINA VERCELLI
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - ROBERTO LILLINI
- Analytical Epidemiology & Health Impact Unit, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy
- Correspondence: Roberto Lillini. Analytical Epidemiology & Health Impact, Fondazione IRCCS “Istituto Nazionale Tumori”, Milan, Italy - Tel: +390223903564 - E-mail:
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Bahloul A, Ellouze T, Hammami R, Charfeddine S, Triki S, Abid L, Kammoun S. [Impact of socioeconomic factors on blood pressure control: Observational study about 2887 hypertensive patients]. Ann Cardiol Angeiol (Paris) 2021; 70:259-265. [PMID: 34144787 DOI: 10.1016/j.ancard.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 05/21/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Despite therapeutic progress, less than half of hypertensive patients are controlled. The objective of this study was to examine the links between blood pressure control and socioeconomic factors. METHODS We used data collected in the cardiology department of Sfax University Hospital as part of the Tunisian national hypertension registry. We studied the associations between the socio-economic variables (educational level, profession, medical insurance) and optimal blood pressure control (SBP<140mmHg and DBP<90mmHg) using logistic regression models. RESULTS The average age of our population was 65 and the sex ratio was 0.95. We found, as expected, the clinical and behavioral factors associated with a good blood pressure control, namely: female sex, low-sodium diet, therapeutic compliance, and regular physical activity. However, obesity and an increased number of antihypertensive drugs have been associated with poor blood pressure control. The study of the effect of socio-economic variables on BP control finds a significant gradient against the most disadvantaged social categories for our three social variables in the univariate analysis. The inclusion of clinical and behavioral factors in the multivariate analysis attenuated these associations but did not fully explain them. CONCLUSION Our study shows that there are social inequalities in the control of blood pressure. Social justice and improving living conditions are probably the real solutions to the problem of these social inequalities in health.
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Affiliation(s)
- A Bahloul
- Service de cardiologie, centre hospitalo-universitaire Hèdi-Chaker, Sfax, Tunisie.
| | - T Ellouze
- Service de cardiologie, centre hospitalo-universitaire Hèdi-Chaker, Sfax, Tunisie
| | - R Hammami
- Service de cardiologie, centre hospitalo-universitaire Hèdi-Chaker, Sfax, Tunisie
| | - S Charfeddine
- Service de cardiologie, centre hospitalo-universitaire Hèdi-Chaker, Sfax, Tunisie
| | - S Triki
- Service de cardiologie, centre hospitalo-universitaire Hèdi-Chaker, Sfax, Tunisie
| | - L Abid
- Service de cardiologie, centre hospitalo-universitaire Hèdi-Chaker, Sfax, Tunisie
| | - S Kammoun
- Service de cardiologie, centre hospitalo-universitaire Hèdi-Chaker, Sfax, Tunisie
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Nguyen T, Barefield A, Nguyen GT. Social Determinants of Health Associated with the Use of Screenings for Hypertension, Hypercholesterolemia, and Hyperglycemia among American Adults. Med Sci (Basel) 2021; 9:medsci9010019. [PMID: 33806794 PMCID: PMC8005927 DOI: 10.3390/medsci9010019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/02/2021] [Accepted: 03/18/2021] [Indexed: 11/16/2022] Open
Abstract
National and international health guidelines have recommended measurements of blood pressure, blood cholesterol, and blood glucose as the first step in detecting hypertension, hypercholesterolemia, and hyperglycemia, respectively. These chronic conditions are modifiable risk factors for chronic diseases such as obesity, diabetes, and cardiovascular disease. Social determinants of health (SDoHs) have contributed to persistent chronic condition disparities in the United States. This study identified SDoHs associated with the use of screening services for hypertension, hypercholesterolemia, and hyperglycemia by analyzing data from the 2019 United States National Health Interview Survey. Examined SDoHs consisted of demographic characteristics, socioeconomic status, and health care utilization. Age, gender, education, annual income, health coverage, and usual care source were positively associated with the odds of receiving secondary preventive services. There was a marginal significance among race/ethnicity and employment status in association with the odds of receiving secondary preventive services. This study's findings inform health educators and providers, public health professionals, and policymakers to fund, plan, and coordinate services and interventions accordingly to improve the population's quality of life and lengthen lifespan by promptly diagnosing and treating these diseases.
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Affiliation(s)
- Tran Nguyen
- College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA;
- Correspondence: ; Tel.: +1-706-721-2940
| | - Amanda Barefield
- College of Allied Health Sciences, Augusta University, Augusta, GA 30912, USA;
| | - Gia-Thien Nguyen
- Medical College of Georgia, Augusta University, Augusta, GA 30912, USA;
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Baumgartner S, Bruckert E, Gallo A, Plat J. The position of functional foods and supplements with a serum LDL-C lowering effect in the spectrum ranging from universal to care-related CVD risk management. Atherosclerosis 2020; 311:116-123. [PMID: 32861515 DOI: 10.1016/j.atherosclerosis.2020.07.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/02/2020] [Accepted: 07/17/2020] [Indexed: 12/19/2022]
Abstract
A wealth of data demonstrates a causal link between serum low-density lipoprotein cholesterol (LDL-C) concentrations and cardiovascular disease (CVD). Any decrease in serum LDL-C concentrations is associated with a decreased CVD risk, and this benefit is similar to a comparable LDL-C reduction after drug treatment and dietary intervention. Moreover, life-long reductions in serum LDL-C levels have a large impact on CVD risk and a long-term dietary enrichment with functional foods or supplements with a proven LDL lowering efficacy is therefore a feasible and efficient approach to decrease future CVD risk. Functional foods with an LDL-C lowering effect can improve health and/or a reduce the risk of disease. However, it has not been mentioned specifically whether this concerns mainly universal prevention or whether this can also be applied to the hierarchy towards care related prevention. Therefore, we here describe the effects of a list of interesting functional food ingredients with proven benefit in LDL-C lowering. In addition, we pay particular attention to the emerging evidence that the addition of these functional ingredients and supplements is advisable as universal and selective prevention in the general population. Moreover, functional ingredients and supplements are also helpful in care related prevention, i.e. in patients with elevated LDL-C concentrations who are statin-intolerant or are not able to achieve their LDL-C target levels. Furthermore, we will highlight practical aspects regarding the use of functional foods with an LDL-C lowering effect, such as the increasing importance of shared decision making of medical doctors and dieticians with patients to ensure proper empowerment and better adherence to dietary approaches. In addition, we will address costs issues related to the use of these functional foods, which might be a barrier in some populations.
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Affiliation(s)
- Sabine Baumgartner
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, 6200 MD, Maastricht, the Netherlands.
| | - Eric Bruckert
- Endocrinology Metabolism and Cardiovascular Prevention, E3M Institute and Cardiometabolic IHU (ICAN), Sorbonne University, Pitié Salpêtrière Hospital, Paris, France
| | - Antonio Gallo
- Endocrinology Metabolism and Cardiovascular Prevention, E3M Institute and Cardiometabolic IHU (ICAN), Sorbonne University, Pitié Salpêtrière Hospital, Paris, France
| | - Jogchum Plat
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, 6200 MD, Maastricht, the Netherlands
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Abstract
Smoking cessation is the key cancer and cardiovascular disease (CVD) prevention action for smokers; however, smokers can still benefit from earlier diagnosis. This study aims to investigate behaviours towards cancer and CVD prevention by smoking habits in Italy. The study relies on data from a large Italian population-based survey carried out in 2013 on a sample of 119 073 individuals. We studied the relationship between smoking habits and the participation in cancer (cervical, breast and colorectal) screening programmes, or CVD prevention (performing cholesterol, blood pressure and glycaemia exams) using a multilevel logistic regression model. Only 11.4, 40.1 and 8.0% of the subsamples attended cervical, breast and colorectal cancer screening, respectively, whereas CVD prevention registered higher attendance: 83.3, 66.4 and 58.1%, respectively, for cholesterol, blood pressure and glycaemia. Smokers were less likely to undergo Pap smear compared with nonsmokers [odds ratio (OR): 0.70; 95% confidence interval (CI): 0.57-0.87], whereas former smokers showed a higher attendance for breast and colorectal cancer screening (OR: 1.25; 95% CI: 1.14-1.37 for breast, OR: 1.21; 95% CI: 1.07-1.38 for colorectal cancer). Former smokers were also more likely to perform CVD prevention. Moreover, CVD prevention was inversely related to smoking (OR: 0.84; 95% CI: 0.74-0.96 for cholesterol; OR: 0.86; 95% CI: 0.79-0.93 for blood pressure; OR: 0.61; 95% CI: 0.54-0.69 for glycaemia). Particular attention should be paid to involve smokers in prevention checks. Research aimed at understanding smokers' pessimistic attitudes, which may determine smokers' prevention avoidance, and at improving smokers' engagement with prevention is needed and may help increase the reach of supported smoking-cessation programmes.
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Biswas S, Andrianopoulos N, Duffy SJ, Lefkovits J, Brennan A, Walton A, Chan W, Noaman S, Shaw JA, Ajani A, Clark DJ, Freeman M, Hiew C, Oqueli E, Reid CM, Stub D. Impact of Socioeconomic Status on Clinical Outcomes in Patients With ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Qual Outcomes 2019; 12:e004979. [DOI: 10.1161/circoutcomes.118.004979] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sinjini Biswas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
| | - Stephen J. Duffy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (J.L., A.A.)
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
| | - Antony Walton
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
| | - William Chan
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia (W.C., D.S.)
| | - Samer Noaman
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
| | - James A. Shaw
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
| | - Andrew Ajani
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia (J.L., A.A.)
| | - David J. Clark
- Department of Cardiology, Austin Health, Melbourne, Australia (D.J.C.)
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia (M.F.)
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Australia (C.H.)
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Australia (E.O.)
| | - Christopher M. Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- School of Public Health, Curtin University, Perth, Australia (C.M.R.)
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia (S.B., N.A., S.J.D., J.L., A.B., A.A., C.M.R., D.S.)
- Department of Cardiovascular Medicine, The Alfred Hospital, Melbourne, Australia (S.B., S.J.D., A.W., W.C., S.N., J.A.S., D.S.)
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia (W.C., D.S.)
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Alicandro G, Frova L, Sebastiani G, Boffetta P, La Vecchia C. Differences in education and premature mortality: a record linkage study of over 35 million Italians. Eur J Public Health 2017; 28:231-237. [DOI: 10.1093/eurpub/ckx125] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
- Gianfranco Alicandro
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Italian National Institute of Statistics (ISTAT), Rome, Italy
| | - Luisa Frova
- Italian National Institute of Statistics (ISTAT), Rome, Italy
| | | | - Paolo Boffetta
- The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Kim MJ, Lee H, Kim EH, Cho MH, Shin DW, Yun JM, Shin JH. Disparity in Health Screening and Health Utilization according to Economic Status. Korean J Fam Med 2017; 38:220-225. [PMID: 28775812 PMCID: PMC5541170 DOI: 10.4082/kjfm.2017.38.4.220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) has become the most common cause of mortality and morbidity worldwide. Health screening is associated with higher outpatient visits for detection and treatment of CVD-related diseases (diabetes mellitus, hypertension, and dyslipidemia). We examined the association between health screening, health utilization, and economic status. METHODS A sampled cohort database from the National Health Insurance Corporation was used. We included 306,206 participants, aged over 40 years, without CVD (myocardial infarction, stroke, and cerebral hemorrhage), CVD-related disease, cancer, and chronic renal disease. The follow-up period was from January 1, 2003 through December 31, 2005. RESULTS Totally, 104,584 participants received at least one health screening in 2003-2004. The odds ratio of the health screening attendance rate for the five economic status categories was 1.27 (95% confidence interval [CI], 1.24 to 1.31), 1.05 (95% CI, 1.02 to 1.08), 1, 1.16 (95% CI, 1.13 to 1.19) and 1.50 (95% CI, 1.46 to 1.53), respectively. For economic status 1, 3, and 5, respectively, the diagnostic rate after health screening was as follows: diabetes mellitus: 5.94%, 5.36%, and 3.77%; hypertension: 32.75%, 30.16%, and 25.23%; and dyslipidemia: 13.43%, 12.69%, and 12.20%. The outpatient visit rate for attendees diagnosed with CVD-related disease was as follows for economic status 1, 3, and 5, respectively: diabetes mellitus: 37.69%, 37.30%, and 43.70%; hypertension: 34.44%, 30.09%, and 32.31%; and dyslipidemia: 18.83%, 20.35%, and 23.48%. CONCLUSION Thus, higher or lower economic status groups had a higher health screening attendance rate than the middle economic status group. The lower economic status group showed lower outpatient visits after screening, although it had a higher rate of CVD diagnosis.
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Affiliation(s)
- Min Jung Kim
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
| | - Hyejin Lee
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
| | - Eun Ha Kim
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
| | - Mi Hee Cho
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
| | - Jae Moon Yun
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
| | - Jung-Hyun Shin
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Korea
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13
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Turner LR, Cicuttini F, Pearce C, Mazza D. Cardiovascular disease screening in general practice: General practitioner recording of common risk factors. Prev Med 2017; 99:282-285. [PMID: 28322884 DOI: 10.1016/j.ypmed.2017.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 03/03/2017] [Accepted: 03/11/2017] [Indexed: 02/05/2023]
Abstract
The assessment and screening of individual risk factors for cardiovascular disease (CVD) is a critical component of CVD prevention strategies in general practice (GP). This study sought to examine current CVD risk factor recording as recommended by Australian guidelines for the management of absolute cardiovascular disease risk. A retrospective analysis of routine GP data from 149,306 GP patients aged 45years and above in eastern Melbourne was conducted. Data were collected from GP clinics located throughout inner east Melbourne from July 2011 to September 2014 through the Melbourne East Monash General Practice Database. Recording of primary risk factors necessary for CVD screening as recommended by the national guidelines was assessed, and logistic regression with generalised estimating equations was used to estimate associations between patient characteristics and risk factor recording. 137,976 (92.4%) patients were found to have had at least one risk factor recorded, 62,214 (41.7%) had the Framingham risk factors recorded (lipids, blood pressure, smoking status), while only 1957 (1.3%) had all risk factors recorded. Females (Odds Ratio [OR]: 0.72, 95% Confidence Interval [CI]: 0.65, 0.81), and those identified with diabetes (OR: 12.26, 95% CI: 9.58, 15.68) were less and more likely to have documented risk factors, respectively. Given the role of GPs in the prevention and management of CVD, it is important to improve the identification of high risk patients through screening and recording of CVD risk factors. Strategies are therefore needed to encourage ongoing CVD risk factor recording to support preventive care by GPs.
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Affiliation(s)
- Lyle R Turner
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Victoria 3168, Australia.
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Victoria 3004, Australia; Rheumatology Unit, Alfred Hospital, 55 Commercial Road, Victoria 3004, Australia.
| | - Christopher Pearce
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Victoria 3168, Australia; Melbourne East General Practice Network (trading as Outcome Health), 1/5 Lakeside Drive, Victoria 3151, Australia.
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Building 1, 270 Ferntree Gully Road, Victoria 3168, Australia.
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14
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The 2013 cholesterol guideline controversy: Would better evidence prevent pharmaceuticalization? Health Policy 2016; 120:797-808. [PMID: 27256859 DOI: 10.1016/j.healthpol.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 05/10/2016] [Accepted: 05/12/2016] [Indexed: 01/08/2023]
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15
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Han X, Robin Yabroff K, Guy GP, Zheng Z, Jemal A. Has recommended preventive service use increased after elimination of cost-sharing as part of the Affordable Care Act in the United States? Prev Med 2015; 78. [PMID: 26209914 PMCID: PMC4589867 DOI: 10.1016/j.ypmed.2015.07.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND An early provision of the Affordable Care Act (ACA) eliminated cost-sharing for a range of recommended preventive services. This provision took effect in September 2010, but little is known about its effect on preventive service use. METHODS We evaluated changes in the use of recommended preventive services from 2009 (before the implementation of ACA cost-sharing provision) to 2011/2012 (after the implementation) in the Medical Expenditure Panel Survey, a nationally representative household interview survey in the US. Specifically, we examined: blood pressure check, cholesterol check, flu vaccination, and cervical, breast, and colorectal cancer screening, controlling for demographic characteristics and stratifying by insurance type. RESULTS There were 64,280 (21,310 before and 42,970 after the implementation of ACA cost-sharing provision) adults included in the analyses. Receipt of recent blood pressure check, cholesterol check and flu vaccination increased significantly from 2009 to 2011/2012, primarily in the privately insured population aged 18-64years, with adjusted prevalence ratios (95% confidence intervals) 1.03 (1.01-1.05) for blood pressure check, 1.13 (1.09-1.18) for cholesterol check and 1.04 (1.00-1.08) for flu vaccination (all p-values<0.05). However, few changes were observed for cancer screening. We observed little change in the uninsured population. CONCLUSIONS These early observations suggest positive benefits from the ACA policy of eliminating cost-sharing for some preventive services. Future research is warranted to monitor and evaluate longer term effects of the ACA on access to care and health outcomes.
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Affiliation(s)
- Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States.
| | - K Robin Yabroff
- Health Services and Economics Branch, National Cancer Institute, Rockville, MD, United States
| | - Gery P Guy
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Zhiyuan Zheng
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, United States
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16
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Okwuosa IS, Lewsey SC, Adesiyun T, Blumenthal RS, Yancy CW. Worldwide disparities in cardiovascular disease: Challenges and solutions. Int J Cardiol 2015; 202:433-40. [PMID: 26433167 DOI: 10.1016/j.ijcard.2015.08.172] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 08/21/2015] [Indexed: 12/20/2022]
Abstract
The 20th century saw cardiovascular disease ascend as the leading cause of death in the world. In response to the new challenge that heart disease imposed, the cardiovascular community responded with ground breaking innovations in the form of evidence based medications that have improved survival, imaging modalities that allow for precise diagnosis and guide treatment; revascularization strategies that have not only reduced morbidity, but also improved survival following an acute myocardial infarction. However the benefits have not been distributed equitably and as a result disparities have arisen in cardiovascular care. There is tremendous data from the United States demonstrating the many phenotypical forms of disparities. This paper takes a global view of disparities and highlights that disparate care is not limited to the United States and it is another challenge that the medical community should rise and face head on.
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Affiliation(s)
- Ike S Okwuosa
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States.
| | - Sabra C Lewsey
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Tolulope Adesiyun
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Roger S Blumenthal
- Department of Medicine, Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, United States
| | - Clyde W Yancy
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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17
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Bukman AJ, Teuscher D, Feskens EJM, van Baak MA, Meershoek A, Renes RJ. Perceptions on healthy eating, physical activity and lifestyle advice: opportunities for adapting lifestyle interventions to individuals with low socioeconomic status. BMC Public Health 2014; 14:1036. [PMID: 25280579 PMCID: PMC4210550 DOI: 10.1186/1471-2458-14-1036] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 09/29/2014] [Indexed: 11/10/2022] Open
Abstract
Background Individuals with low socioeconomic status (SES) are generally less well reached through lifestyle interventions than individuals with higher SES. The aim of this study was to identify opportunities for adapting lifestyle interventions in such a way that they are more appealing for individuals with low SES. To this end, the study provides insight into perspectives of groups with different socioeconomic positions regarding their current eating and physical activity behaviour; triggers for lifestyle change; and ways to support lifestyle change. Methods Data were gathered in semi-structured focus group interviews among low SES (four groups) and high SES (five groups) adults. The group size varied between four and nine participants. The main themes discussed were perceptions and experiences of healthy eating, physical activity and lifestyle advice. Interviews were transcribed verbatim and a thematic approach was used to analyse the data. Results In general, three key topics were identified, namely: current lifestyle is logical for participants given their personal situation; lifestyle change is prompted by feedback from their body; and support for lifestyle change should include individually tailored advice and could profit from involving others. The perceptions of the low SES participants were generally comparable to the perceptions shared by the high SES participants. Some perceptions were, however, especially shared in the low SES groups. Low SES participants indicated that their current eating behaviour was sometimes affected by cost concerns. They seemed to be especially motivated to change their lifestyle when they experienced health complaints, but were rather hesitant to change their lifestyle for preventive purposes. Regarding support for lifestyle change, low SES participants preferred to receive advice in a group rather than on their own. For physical activities, groups should preferably consist of persons of the same age, gender or physical condition. Conclusions To motivate individuals with low SES to change their lifestyle, it may be useful to (visually) raise their awareness of their current weight or health status. Lifestyle interventions targeting individuals with low SES should take possible cost concerns into account and should harness the supportive effect of (peer) groups. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1036) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea J Bukman
- Division of Human Nutrition, Wageningen University, P,O Box 8129, 6700 EV Wageningen, The Netherlands.
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18
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Preventive care use among the Belgian elderly population: does socio-economic status matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 11:355-72. [PMID: 24368427 PMCID: PMC3924448 DOI: 10.3390/ijerph110100355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/13/2013] [Accepted: 12/14/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the association between influenza and pneumococcus vaccination and blood cholesterol and blood sugar measurement by Belgian elderly respondents (≥ 65 years) and socio-demographic characteristics, risk factors, health status and socio-economic status (SES). METHODS A cross-sectional study based on 4,544 non-institutionalized elderly participants of the Belgian Health Interview Surveys 2004 and 2008. Multivariate logistic regression models were constructed to examine the independent effect of socio-demographic characteristics, risk factors, health status and SES on the four preventive services. RESULTS After adjustment for age, sex, region, survey year, living situation, risk factors (body mass index, smoking status, physical activity) and health status (self-assessed health and longstanding illness) lower educated elderly were significantly less likely to report a blood cholesterol and blood sugar measurement. For instance, elderly participants with no degree or only primary education were less likely to have had a cholesterol and blood sugar measurement compared with those with higher education. Pneumococcus vaccination was not related to educational level, but lower income groups were more likely to have had a pneumococcus immunization. Influenza vaccination was not significantly related to SES. CONCLUSION The results highlight the need to promote cholesterol and blood sugar measurement for lower SE groups, and pneumococcus immunization for the entire elderly population. Influenza immunization seems to be equally spread among different SE groups.
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Vetrano DL, Martone AM, Mastropaolo S, Tosato M, Colloca G, Marzetti E, Onder G, Bernabei R, Landi F. Prevalence of the seven cardiovascular health metrics in a Mediterranean country: results from a cross-sectional study. Eur J Public Health 2013; 23:858-62. [DOI: 10.1093/eurpub/ckt130] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Rasiah R, Yusoff K, Mohammadreza A, Manikam R, Tumin M, Chandrasekaran SK, Khademi S, Bakar NA. Cardiovascular disease risk factors and socioeconomic variables in a nation undergoing epidemiologic transition. BMC Public Health 2013; 13:886. [PMID: 24066906 PMCID: PMC3849479 DOI: 10.1186/1471-2458-13-886] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 09/16/2013] [Indexed: 11/17/2022] Open
Abstract
Background Cardiovascular disease (CVD) related deaths is not only the prime cause of mortality in the world, it has also continued to increase in the low and middle income countries. Hence, this study examines the relationship between CVD risk factors and socioeconomic variables in Malaysia, which is a rapidly growing middle income nation undergoing epidemiologic transition. Methods Using data from 11,959 adults aged 30 years and above, and living in urban and rural areas between 2007 and 2010, this study attempts to examine the prevalence of CVD risk factors, and the association between these factors, and socioeconomic and demographic variables in Malaysia. The socioeconomic and demographic, and anthropometric data was obtained with blood pressure and fasting venous blood for glucose and lipids through a community-based survey. Results The association between CVD risk factors, and education and income was mixed. There was a negative association between smoking and hypertension, and education and income. The association between diabetes, hypercholesterolemia and being overweight with education and income was not clear. More men than women smoked in all education and income groups. The remaining consistent results show that the relationship between smoking, and education and income was obvious and inverse among Malays, others, rural women, Western Peninsular Malaysia (WPM) and Eastern Peninsular Malaysia (EPM). Urban men showed higher prevalence of being overweight than rural men in all education and income categories. Except for those with no education more rural men smoked than urban men. Also, Malay men in all education and income categories showed the highest prevalence of smoking among the ethnic groups. Conclusions The association between CVD risk factors and socioeconomic variables should be considered when formulating programmes to reduce morbidity and mortality rates in low and middle income countries. While general awareness programmes should be targeted at all, specific ones should be focused on vulnerable groups, such as, men and rural inhabitants for smoking, Malays for hypertension and hypercholesterolemia, and Indians and Malays, and respondents from EPM for diabetes.
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Affiliation(s)
- Rajah Rasiah
- Faculty of Economics and Administration, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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Ose D, Rochon J, Campbell SM, Wensing M, Freund T, Lieshout JV, Längst G, Szecsenyi J, Ludt S. Health-related quality of life and risk factor control: the importance of educational level in prevention of cardiovascular diseases. Eur J Public Health 2013; 24:679-84. [DOI: 10.1093/eurpub/ckt139] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Prevention and Control Program for Cardiovascular Diseases in Turkish Population: PRE-CONTROL Study Group. Glob Heart 2013; 8:115-9. [PMID: 25690376 DOI: 10.1016/j.gheart.2012.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death throughout the world. Despite its high prevalence, the atherosclerotic process can be slowed and its consequences markedly reduced by preventive measures. The lack of risk factor awareness is a major barrier. OBJECTIVES We aimed to assess total CV risk, determine the knowledge and awareness regarding CVD, and evaluate the effectiveness of education program in urban population of Turkey. METHODS A 24-item questionnaire was used to detect CV risk factors and the awareness of participants about CVD. The feedback data for the education program were collected by either questionnaires or individual interviews with participants. For comparison of total CVD risk in men and women in different age groups, a sample t test was used. The level of statistical significance was set at p < 0.05. RESULTS The prevalence of hyperlipidemia was established to be 41.3%. Nearly one-quarter of the women and one-third of the men were smokers (p < 0.001). One-quarter of the responders had a history of hypertension (men: 21.5%, women: 18.6%), and one-tenth were diabetic. The high CV risk rate was more pronounced among men (p < 0.01) and those with low socioeconomic level (p < 0.01). Awareness regarding CV risk factors following the educational program increased from 6.6% to 12.7% for high blood pressure, from 3.9% to 9.2% for diabetes mellitus, and from 10.2% to 15.1% for elevated cholesterol levels. All the increases were statistically significant. The educational program significantly increased the awareness of CVD and risk factors. CONCLUSIONS The prevalence of CV risk factors was higher in low socioeconomic level groups. The knowledge and awareness of the risk factors for CVD before the education program was very low in our study group. The awareness of CVD and risk factors significantly increased following our education programs.
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Damiani G, Federico B, Basso D, Ronconi A, Bianchi CBNA, Anzellotti GM, Nasi G, Sassi F, Ricciardi W. Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study. BMC Public Health 2012; 12:99. [PMID: 22305108 PMCID: PMC3314546 DOI: 10.1186/1471-2458-12-99] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 02/03/2012] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Breast and cervical cancer screening are widely recognized as effective preventive procedures in reducing cancer mortality. The aim of this study was to evaluate the impact of socioeconomic disparities in the uptake of female screening in Italy, with a specific focus on different types of screening programs. METHODS A cross-sectional study was conducted using data from the 2004-2005 national health interview survey. A sample of 15, 486 women aged 50-69 years for mammography and one of 35, 349 women aged 25-64 years for Pap smear were analysed. Logistic regression models were used to estimate the association between socioeconomic factors and female screening utilization. RESULTS Education and occupation were positively associated with attendance to both screening. Women with higher levels of education were more likely to have a mammogram than those with a lower level (OR = 1.28; 95% CI = 1.10-1.49). Women of intermediate and high occupational classes were more likely to use breast cancer screening (OR = 1.77; 95% CI = 1.55-2.03, OR = 1.63; 95% CI = 1.40-1.91) compared to unemployed women. Women in the highest occupational class had a higher likelihood of cervical cancer screening compared to those in the lowest class (OR = 1.81; 95% CI = 1.63-2.01). Among women who attended screening, those with lower levels of education and lower occupational classes were more likely than more advantaged women to attend organized screening programs rather than being screened on the basis of their own initiative. CONCLUSIONS Inequalities in the uptake of female screening widely exist in Italy. Organized screening programs may have an important role in increasing screening attendance and tackling inequalities.
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Affiliation(s)
- Gianfranco Damiani
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Bruno Federico
- Department of Health and Sport Sciences, Università di Cassino, Via S. Angelo snc, 03043 Cassino (FR), Italy
| | - Danila Basso
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Alessandra Ronconi
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | | | - Gian Marco Anzellotti
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Gabriella Nasi
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Franco Sassi
- Health Division, Directorate for Employment, Labour and Social Affairs, OECD-Organization for economic Cooperation and Development, 2 rue André Pascal, 75775 Paris, Cedex 16, France
| | - Walter Ricciardi
- Department of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
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