Prevalence and predictors of drinking, binge drinking, and related health and social problems in Puerto Rico

Prevalence of very high cardiovascular disease risk in patients with type 2 diabetes mellitus: A population-based cross-sectional screening study

AIM

The 2019 ESC/EASD guidelines categorize cardiovascular disease risk (CVD) in patients with diabetes mellitus (DM). Assessing CVD risk is necessary to identify individuals at very high risk of CVD, enabling tailored and precise intervention for this high-risk population. This study aims to evaluate the severity of a very high risk for CVD stratification among patients with type 2 DM (T2DM) across different regions in China.

METHODS

We conducted a cross-sectional screening study from 1 January 2020 to 30 December 2022. Disease duration, body mass index (BMI), targeted organ damage, such as atherosclerotic heart disease, proteinuria, impaired renal function, left ventricular hypertrophy, retinopathy and known CVD risk factors, were collected from diabetic patients by professionally trained physicians. The risk of CV in patients with DM was categorized into two groups: very high risk and others, according to the 2019 ESC/EASD guidelines.

RESULTS

In total, 1 870 720 participants from 1669 hospitals in 30 provinces of China, excluding Tibet, Taiwan, Hong Kong and Macao, were enrolled from 2020 to 2022, among whom 67.50% of patients with T2DM were at very high risk for CVD. The proportions of very high-risk T2DM were higher in Northeast China (75.82%), Central China (73.65%) and Southwest China (72.66%), while the lowest prevalence of very high-risk T2DM was found in Southern China (60.15%). The multivariate binary logistic regression analyses suggested that the category of very high risk for CVD is associated with age [odds ratio (OR) = 1.04; 95% confidence interval (CI): 1.04-1.04; p < .0001], BMI (OR = 1.07; 95% CI: 1.07-1.07; p < .0001), duration of DM (OR = 1.05; 95% CI: 1.05-1.05; p < .0001), hypertension (OR = 3.75; 95% CI: 3.72-3.78; p < .0001), dyslipidaemia (OR = 5.22; 95% CI: 5.18-5.27; p < .0001) and smoking (OR = 2.92; 95% CI: 2.89-2.95; p < .0001).

CONCLUSIONS

This study represented the largest observational study of CVD risk assessment in patients with T2DM in China. The CVD risk situation of patients with diabetes in China is critical, and comprehensive control and management of CVD risk factors, such as hypertension, BMI and dyslipidaemia, in patients with DM need to be strengthened in patients with T2DM in China.

Adverse Childhood Experiences and Risk Patterns of Alcohol and Cannabis Co-Use: A Longitudinal Study of Puerto Rican Youth

PURPOSE

Adverse childhood experiences (ACEs) are common in Puerto Rican youths. Few large longitudinal studies of Latine youth examined what predicts co-use of alcohol and cannabis in late adolescence and young adulthood. We investigated the prospective association between ACEs with alcohol/cannabis co-use in Puerto Rican youth.

METHODS

Participants from a longitudinal study of Puerto Rican youth (n = 2,004) were included. Using multinomial logistic regressions to test associations between prospectively reported ACEs (11 types, reported by parents and/or children, categorized as 0-1, 2-3, and 4+ ACEs) with young adult alcohol/cannabis use patterns in the past month (i.e., no lifetime use, low-risk [no binge drinking and cannabis use < 10], binge-drinking only, regular cannabis use only, and alcohol/cannabis co-use). Models were adjusted for sociodemographic variables.

RESULTS

In this sample, 27.8% reported 4+ ACEs, 28.6% endorsed binge drinking, 4.9% regular cannabis use, and 5.5% alcohol/cannabis co-use. Compared to individuals with no lifetime use, those reporting 4+ (vs. 0-1) ACEs had greater odds of low-risk use (adjusted odds ratio [aOR] 1.60, 95% confidence interval [CI] = 1.04-2.45), regular cannabis use (aOR 3.13 95% CI = 1.44-6.77), and alcohol/cannabis co-use (aOR 3.57, 95% CI = 1.89-6.75). In relation to low-risk use, reporting 4+ ACEs (vs. 0-1) was associated with 1.96 odds (95% CI = 1.01-3.78) of regular cannabis use and 2.24 odds (95% CI = 1.29-3.89) of alcohol/cannabis co-use.

DISCUSSION

Exposure to 4+ ACEs was associated with the occurrence of adolescent/young adulthood regular cannabis use and alcohol/cannabis co-use. Importantly, ACEs exposure differentiated young adults who were co-using compared to those engaged in low-risk use. Preventing ACE or interventions for Puerto Rican youth experiencing 4+ ACEs may mitigate negative consequences associated with alcohol/cannabis co-use.

Trends in prevalence and clustering of modifiable cardiovascular disease risk factors across socioeconomic spectra in rural southwest China: a cross-sectional study

OBJECTIVES

This study aimed to determine the changing prevalence of clustering of cardiovascular disease (CVD) risk factors across socioeconomic spectra in rural southwest China.

DESIGN

Data were collected from two waves of cross-sectional health interviews and examinations among individuals aged ≥35 years in rural China. Anthropometric measurements, blood pressure and fasting blood sugar levels were recorded for each participant.

SETTING

This study was conducted in rural Yunnan Province of China.

PARTICIPANTS

8187 individuals in 2011 and 7572 in 2021 consented to participate in this study.

RESULTS

From 2011 to 2021, prevalence increased of hypertension (26.1% vs 41.6%), diabetes mellitus (5.9% vs 9.8%), obesity (5.9% vs 12.0%) and central obesity (50.0% vs 58.3%) (p<0.01), while prevalence decreased of current smoking (35.2% vs 29.6%), secondhand smoke exposure (42.6% vs 27.4%) and current drinking (26.6% vs 29.6%) (p<0.01). This decade also saw an increase in the prevalence of participants with clustering of ≥2 (61.8% vs 63.0%) and ≥3 CVD risk factors (28.4% vs 32.2%) (p<0.05). These increasing rates were also observed among subgroups categorised by sex, ethnicity, education level, income level and those ≥45 years of age (p<0.05). In both 2011 and 2021, male participants and participants with a lower education level had higher prevalence of clustering of ≥2 and ≥3 CVD risk factors than their counterparts (p<0.01). Ethnic minority participants and participants with higher annual income had higher prevalence of clustering of CVD risk factors in 2011 but presented opposite associations in 2021 (p<0.01).

CONCLUSION

The prevalence of clustering of CVD risk factors increased substantially across all socioeconomic spectra in rural southwest China from 2011 to 2021. Future efforts to implement comprehensive lifestyle interventions to promote the prevention and control of CVD should in particular focus on men, those of Han ethnicity and those with low socioeconomic status.

Ethnic disparities in prevalence and clustering of cardiovascular disease risk factors in rural Southwest China

Background

This study examines how prevalence and clustering of cardiovascular disease (CVD) risk factors differ by ethnicity and socioeconomic status (SES) among rural southwest Chinese adults.

Methods

A cross-sectional survey of 7027 adults aged ≥35 years of Han and four ethnic minority group descent (Na Xi, Li Shu, Dai, and Jing Po) was used to derive prevalence of tobacco smoking and exposure to secondhand smoke (SHS) as well as alcohol consumption and physical activity data. Anthropometric measurements were also taken, including height, weight, and waist and hip circumference, as well as blood pressure (BP) and fasting blood glucose (FBG) measurements.

Results

Current smoking and drinking status were the top two CVD risk factors in the study population. Dai ethnic minority participants had the highest prevalence of hypertension, obesity, and central obesity, whereas Jing Po ethnic minority participants had the highest prevalence of current smoking status, SHS exposure, and current drinking status (P < 0.01). Han participants had the highest prevalence of diabetes and physical inactivity (P < 0.01). 11.1% of all participants did not have any of the studied CVD risk factors, while 68.6% of Han, 60.2% of Na Xi, 50.7% of Li Shu, 82.2% of Dai, and 73.0% of Jing Po participants had clustering of two or more CVD risk factors. Prevalence of CVD risk factor clusters increased with age (P < 0.01). Males and individuals with lower education levels and lower annual household income were more likely to have CVD risk factors than their counterparts (P < 0.01).

Conclusion

Clustering of CVD risk factors is common in rural southwest China. Ethnicity and individual SES significantly impact prevalence of CVD risk factors and their clustering.

Drinking and Driving in Puerto Rico

BACKGROUND

Epidemiological information is lacking for driving under the influence of alcohol (DUI) in Puerto Rico.

OBJECTIVES

To examine the prevalence and correlates of DUI in Puerto Rico.

METHODS

Data are from a household sample of 1510 individuals, aged 18-64 years in San Juan, Puerto Rico. The response rate was 83%.

RESULTS

The rate of 12 month self-reported DUI was 20% among men and 8% among women (p < 0.001). Twelve month DUI arrests were reported by 0.1% of men and 0.2% of women (p: ns) while lifetime arrests were reported by 6% of men and 0.7% of women (p < 0.001). Adjusted analyses showed that the number of hours of daily driving (OR = 1.08, 95% CI = 1.01-1.17; p < 0.05), male gender (OR = 1.66, 95% CI = 1.07-2.58; p < 0.01), having more liberal drinking norms (OR = 4.81; 95% CI = 2.61-8.84; p < 0.01) and more positive attitudes towards drinking (OR = 4.58; 95% CI = 1.28-16.31; p < 0.01), consuming a higher number of weekly drinks (OR = 1.05; 95% CI: 1.03-1.07; p < 0.001), and binge drinking (OR = 2.60; 95% CI = 1.62-4.16; p < 0.001) were factors of risk for self-reporting DUI. A lifetime arrest was associated with being separated or divorced (OR = 2.7; 95% CI = 1.04-7.36; p < 0.05), male gender (OR = 5.25; 95% CI = 1.93-14.26; p < 0.001), more liberal drinking norms (OR = 6.97; 95% CI = 2.37-20.48; p < 0.001), and illicit drug use (OR = 2.82; 95% CI = 1.25-6.35; p < 0.001).

CONCLUSIONS

The prevalence of self-reported DUI in San Juan, Puerto Rico was high, but the proportion of people arrested for DUI in a span of 12 months or during their lifetime was low. Stricter enforcement of DUI laws may be necessary to minimize DUI in urban Puerto Rico.

Illegal drug use and its correlates in San Juan, Puerto Rico

BACKGROUND

Data on the prevalence and correlates of illegal drug use in Puerto Rico are now almost 20 years old.

OBJECTIVES

This study sought to estimate the 12-month prevalence of illegal and non-prescribed medical drug use in San Juan, Puerto Rico and identify sociodemographic correlates of use.

METHODS

Data are from a random household sample of 1510 individuals, 18-64 years of age in San Juan, Puerto Rico.

RESULTS

The 12-month prevalence of any illegal or non-prescribed drug use was 16.5%. Prevalence among men (20.7%) was higher than among women (12.9%; chi² = 16.308; df = 1; p < .01). Prevalence for specific drugs ranged from 11.2% for marijuana to 0.2% for methadone.

RESULTS

of the multiple logistic regression analysis showed that male gender (OR = 1.67, 95CI = 1.21-2.3; p < .01), age 18-29 (OR = 2.39; 95CI = 1.35-4.23; p < .01), age 30-39 (OR = 1.93; 95CI = 1.01-3.69; p < .05), low (OR = 2.03; 95CI = 1.36-3.02; p < .001) and medium (OR = 1.50; 95CL = 1.01-2.23; p < .05) family cohesion/pride, and no religious preference (OR = 1.99; 95CI = 1.23-3.22; p < .01) increased the odds of drug use. Annual family income of $40,000-$60,000 (OR = 0.45; 95CI = 0.21-0.93; p < .05) and $60,001 and more (OR = 0.35; 95CI = 0.13-0.94; p > .05) were negatively associated with drug use compared to annual income up to $10,000.

CONCLUSIONS

As in many other places in the U.S., drug use in San Juan, Puerto Rico is high, affecting about 1 in 6 adults in the population. The highest prevalence is for marijuana use, which cannot be medically prescribed and of which recreational use is illegal on the island.

DSM-5 Alcohol Use Disorder Severity in Puerto Rico: Prevalence, Criteria Profile, and Correlates

BACKGROUND

Our aim was to examine lifetime criteria profiles and correlates of severity (mild, moderate, severe) of DSM-5 alcohol use disorders (AUD) in Puerto Rico.

METHODS

Data are from a household random sample of individuals 18 to 64 years of age in San Juan, Puerto Rico. The survey response rate was 83%. DSM-5 AUD was identified with the Spanish version of the World Health Organization's Composite International Diagnostic Interview. The analyses also identify correlates of each severity level using an ordered logistic regression model.

RESULTS

The prevalence of lifetime DSM-5 AUD among men and women was 38 and 16%, respectively. Mild lifetime DSM-5 AUD was the most prevalent severity level among both men (18%) and women (9%). The most common criteria, independent of gender and severity level, were drinking larger quantities and for longer than planned (men range: 80 to 97%; women range: 78 to 91%) and hazardous use (men range: 56 to 91%; women range: 42 to 74%). Results from ordered logistic regression showed that the adjusted odds ratio for weekly drinking frequency, greater volume of alcohol consumed per drinking occasion, positive attitudes about drinking, drinking norms, and male gender invariantly increased risks across all DSM-5 AUD severity levels (mild, moderate, severe). Greater negative attitudes about drinking, low family cohesion, and Protestant religion were related to greater risks at higher AUD severity levels.

CONCLUSIONS

AUD prevalence is high in San Juan, Puerto Rico. Prevalence rates for some criteria are equally high across severity levels and poorly differentiate between mild, moderate, or severe DSM-5 AUD. The sociodemographic and alcohol-related risks vary across DSM-5 severity levels.

Children exposed to alcohol-related problems and DSM-5 alcohol use disorder in San Juan, Puerto Rico

This article estimates the proportion of children (17 and younger) exposed to an adult with an alcohol problem or alcohol use disorder (AUD) in San Juan, Puerto Rico. Data are from a household random sample of 1,510 individuals 18-64 years of age. A total of 20.9% of children in sample households were exposed to an adult with an alcohol problem, and 5.7% were exposed to an adult with DSM-5 AUD. These considerable proportions suggest that alcohol treatment and family support programs should include help for adults in the family, and special support for exposed children in the household.

The prevalence of and factors associated with high-risk alcohol consumption in Korean adults: The 2009-2011 Korea National Health and Nutrition Examination Survey

Background

The consequences of alcohol consumption on health outcomes are largely determined by two separate, but related, dimensions of drinking: the total volume of alcohol consumed and the pattern of drinking. Most epidemiological studies focus on the amount of alcohol consumed and do not consider the pattern of drinking.

Objectives

This study evaluated the prevalence of and factors associated with high-risk and heavy alcohol drinking in Korean adults.

Methods

This study analyzed 15,215 of the 28,009 participants in the 2009–2011 Korea National Health and Nutrition Examination Survey (KNHANES). High-risk alcohol drinking was defined as Alcohol Use Disorders Identification Test (AUDIT) scores ≥16, which provides a framework for intervention to identify hazardous and harmful drinking patterns as the cause of alcohol-use disorders, according to World Health Organization guidelines.

Results

The prevalence of high-risk drinking was 15.1%, with the highest prevalence of 17.2% in middle-aged adults (45–64 years). In men, the prevalence of high-risk alcohol drinking was 23.7%, with the highest prevalence found in middle-aged adults. In women, the prevalence of high-risk alcohol drinking was 4.2%, with the highest prevalence found in younger adults. Men had higher weighted mean AUDIT scores than women (10.0 vs. 4.0, P<0.001), and age was negatively associated with the AUDIT score (P<0.001). Elementary school graduates had higher mean AUDIT scores than senior high school (P = 0.003) or college (P<0.001) graduates. Regarding occupation, clerical support workers (P = 0.002) and service and sales workers (P<0.001) had higher mean AUDIT scores than managers and professionals. Logistic regression analyses of high-risk alcohol drinking using sex, age, education level, number of family members, household income, and occupation as covariates was performed. Women had a lower risk of high-risk alcohol drinking (odds ratio (OR) 0.14, 95% CI: 0.13–0.16, P<0.001) than men. Regarding age, compared to control subjects aged 19–29 years, adults aged 60–69 and older than 70 years had 0.67- (95% CI: 0.51–0.89, P = 0.005) and 0.29-fold (95% CI: 0.20–0.70, P<0.001) lower risks, respectively, of high-risk alcohol drinking, whereas adults aged 30–59 had an increased risk of high-risk alcohol drinking. Using elementary school graduates as controls, senior high school (OR: 0.70, 95% CI: 0.55–0.87, P = 0.002) and college (OR: 0.54, 95% CI: 0.42–0. 70, P<0.001) graduates had lower risks of high-risk alcohol drinking. Regarding occupation, compared to managers and professionals as controls, service and sales workers had a greater risk of high-risk alcohol drinking (OR: 1.36, 95% CI: 1.07–1.73, P = 0.011). The number of family members and household income did not influence high-risk alcohol drinking.

Conclusions

In a representative sample of Korean adults, the prevalence of high-risk alcohol drinking was 15.1%, with the highest prevalence of 28.3% found in middle-aged men (45–64 years). This study suggests that younger age, male sex, low education level, and service and sales workers are at risk for a high-risk drinking pattern.